By Leslee Jaquette
Nationwide, the incidence of diabetes is increasing. According to Bev Bromfield, program manager for the American Diabetes Association (ADA) serving Southwest Washington, one in five individuals over the age of 65 has diabetes. In 2009 it was estimated that 5.6 million Americans take insulin and that 4.5 million of those individuals have type 2 diabetes (see sidebar with definitions).
Using data from the 2007 National Diabetes Fact Sheet, 54-year-old Anita Manley, coordinator for the Diabetes Program at Southwest Washington Medical Center (SWMC) in Vancouver, reports that a total of 23.6 million children and adults in the United States or nearly 8 percent of the population have diabetes. Another 57 million people are pre-diabetic.
“Although diabetes is an equal-opportunity disease, it can happen to all sizes and shapes, the good part is that an array of new medications and treatments are available to support the prevention measures already in place,” says Manley, who oversees Southwest’s monthly Diabetes 101 educational class. “The good news is that diabetes can be well managed, diabetics can control blood sugar and good management significantly reduces health risks.”
After 18 years with the ADA, Bromfield notes that one of the most dramatic changes in diabetic treatment occurred in 2005 when synthetic insulin was introduced. Prior to that, cow and pig insulin had been used since the 1920s. In contrast to animal insulin, synthetic insulin has proven to be more rapidly absorbed, freer of allergic and autoimmune reactions and less expensive.
An ADA medical treatment timeline shows that since 1990 at least 10 new diabetic medications have been introduced, with incretions providing some of the most exciting outcomes. Incretions are oral agents that stimulate or increase glucose by stimulating insulin secretions.
Manley notes that incretions such as Beytta, introduced about four years ago, are often used for type 2 diabetes and require injections twice a day. Victoza, introduced last April, works similarly to Beytta, but is injected only once a day. Manley projects the industry will see more of these kinds of drugs because they support weight loss by encouraging a decrease in appetite. This is significant given that 40 to 60 percent of diabetics are struggling with obesity and that most medications encourage weight gain.
She cautions that Beytta, for example, works well for many diabetics but so far it is very expensive due to the fact that generics have not been developed yet. “Incretions are helpful, they offer a new tool; but they are not for everyone,” notes Manley. “The obvious drawback is that they still require injection.”
New diabetic treatments and technology
Both Bromfield and Manley point to Continuous Glucose Monitors (CGM) as one of the most significant recent diabetic treatments. A CGM device uses a sensor to measure glucose levels in the fluid just under the skin (which is very similar to glucose levels in the blood). The sensor transmits the results to a handheld receiver or insulin pump every few minutes, so the wearer knows their glucose levels throughout the day.
Currently, there are a number of different CGMs on the market and they all differ a bit. Some devices show glucose levels every minute, others every five minutes, some show trends on a graph and others even sport alarms when levels get out of whack. “By reporting minute-by-minute levels, CGMs help diabetics avoid high and low levels and make appropriate adjustments,” explains Bromfield.
Another recent development that has gone mainstream is the insulin pump. “This equipment is becoming increasingly common for type 1 diabetes because it mimics what the pancreas normally does. While pumps are able to give a continuous baseline dose, the next generation pumps will be better able to monitor and administer extra doses of insulin to correct for food intake and exercise.”
Bromfield is also excited about other devices that stand to revolutionize the industry. One of those is a glucose sensing contact lens. Phototonic crystal, contact lens sensors can sense glucose levels through the eyes. Using a handheld device to scan the eye, the physician can use the device as a diagnostic tool and the diabetic can use it to determine levels.
Another bright star on the horizon of diabetes care is the artificial pancreas. This constant monitoring device senses glucose levels and automatically provides the correct dose. Not yet on the market, researchers are scrambling to streamline all parts of the system so it is easy to use.
In the future, connectivity will affect diabetes management. In the article “Aspects of Insulin Treatment” by Zachary T. Bloomgarden, MD in the January 2010 issue of Diabetes are (care.diabetesjournals.org), the author notes that in addition to transmission of CGM and control of insulin by small devices, Sleep Sentry devices with remote display and alarms are being developed that will connect to smartphones as data integrators. For example, a service under development at Diasend.com promises to use cell phone technology and allow uploading of information from various monitors to be shared by patients and clinicians.
Diabetes prevention standards
Although all manner of new medications and treatments are poised to revolutionize diabetes management, the goal is still prevention, states Manley. Noting that, “Everyone has been touched by diabetes in their family or circle of friends,” Manley describes steps individuals can and should take to assume responsibility for their health.
First of all, everyone age 45 and older should be screened for diabetes. Manley suggests people take a Fasting Plasma Glucose Test (FPG) or the newer hemoglobin AIC test, which is used to access long-term blood sugar control. The difference is that the fasting test can vary from day-to-day, depending on a number of variables; whereas, the hemoglobin test looks at average blood sugar levels over a three month period.
The crux of diabetic care, however, is prevention. In the monthly, one-hour-long class, Diabetes 101: How to Prevent Diabetes, SWMC staff focuses on the things people can change: diet, exercise and monitoring. For starters, students are encouraged to start small and build up to 30-minutes of activity five-days per week. Secondly, they are invited to choose a diet bulging with fruits and vegetables and low in fats and devoid of empty calories from sugar drinks such as soda, coffee and alcoholic beverages.
At the class, staff gives away a copy of the “Quick & Healthy Cookbook.” They also explain the “plate method of eating,” which divides the plate into sections: one-half for vegetables, one-fourth for protein and one-fourth for starch (e.g., pasta, potatoes, and rice). Condiments such as mayonnaise, butter and ranch dressing are not a food group.
American Diabetes Association: 503-736-2770; www.diabetes.org
Southwest Washington Medical Center: Diabetes 101: How to Prevent Diabetes 360-514-2190; www.swmedicalcenter.org.
By Leslee Jaquette