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xMenace
07-23-2008, 12:38 PM
Diabetes Experts Recommend One-Two Punch for Treating Patients with Pre-Diabetes - MarketWatch (http://www.marketwatch.com/news/story/diabetes-experts-recommend-one-two-punch/story.aspx?guid=%7B7C3F6906-586B-4B7D-93C6-00574F86B8E9%7D&dist=hppr)

Diabetes Experts Recommend One-Two Punch for Treating Patients with Pre-Diabetes


Last update: 12:11 p.m. EDT July 23, 2008

WASHINGTON, Jul 23, 2008 (BUSINESS WIRE) -- For the first time, a consensus of diabetes and metabolic disorder experts have recommended a comprehensive treatment regimen for patients with pre-diabetes. The recommendations call for specific guidelines on both lifestyle, and pharmaceutical intervention where appropriate. The recommendations are made in a Consensus Statement released this morning by the American Association of Clinical Endocrinologists (AACE).

Pre-diabetes is a condition defined by elevated fasting glucose levels or impaired glucose tolerance. According to the Centers for Disease Control (CDC), more than 56 million Americans currently have the condition, which leaves patients at risk, not only for developing type 2 diabetes, but also for cardiovascular complications. This is an extension of the effort to recognize and treat type 2 diabetes earlier and more aggressively.

However, at this time, there are no pharmacologic therapies that have been approved by the FDA for prevention of the conversion of pre-diabetes to diabetes. That's why the expert panel has recommended a two-pronged approach to treating pre-diabetes. The first is intensive lifestyle management to prevent the progression to type 2 diabetes.

"As individuals and as a society, we need to address those forces which are creating the epidemic of obesity, diabetes, and pre-diabetes," said Yehuda Handlesman, MD, FACP, FACE, Treasurer of AACE and Medical Director of the Metabolic Institute of America. "We understand the difficulties in implementing solutions, but as an association of endocrinologists we are committed to supporting community and national efforts in every way we can."

The recommendation calls for patients to adhere to the guidelines set forth in the Diabetes Prevention Program, established by the United States government.

"Although lifestyle can clearly modify the progression of patients towards overt diabetes, it may not be sufficient," said Alan J. Garber, MD, PhD, FACE, Professor of Medicine, Baylor College of Medicine, Houston, and Chairman of the Consensus Conference. "Medications may well be required, particularly in high risk groups."

The second approach is to prevent the development of cardiovascular complications, and to help those patients where lifestyle modifications have been insufficient to modify cardiovascular risk factors. This requires cardiovascular risk reduction medications for abnormal blood pressure and cholesterol independent of glucose control medications.

"The data show that there is a spectrum of severity, with the most severely affected approaching the risks of people with diagnosed type 2 diabetes," said Daniel Einhorn, MD, FACP, FACE, Vice President of AACE and Medical Director of the Scripps Whittier Institute for Diabetes in La Jolla, CA. "In these highest risk individuals, who represent a minority, pharmacologic strategies may be appropriate if intensive lifestyle therapies fail. Regardless, all individuals at risk for diabetes should be aware of the level of their risk factors and be prepared to take action."

While the number of people with pre-diabetes in the United States exceeds 56 million, most patients with the condition have not been diagnosed. People are considered high risk if they have near diabetic levels of blood glucose, hypertension, or abnormal lipid profiles. These patients should consider working with their doctor to monitor their status.

The preliminary publication of the Consensus Statement is available at media.aace.com. The final document will be published later this year in Endocrine Practice, the Journal of the American Association of Clinical Endocrinologists.
View the AACE pre-diabetes consensus conference executive summary here:

About AACE

AACE is a professional medical organization with more than 6,000 members in the United States and 84 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine diseases, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

For more information, contact Bryan Campbell of the American Association of Clinical Endocrinologists at 904-353-7878, or bcampbell@aace.com.

SOURCE: American Association of Clinical Endocrinologists
American Association of Clinical Endocrinologists
Bryan Campbell, 904-353-7878 ext. 122
bcampbell@aace.com

Copyright Business Wire 2008

Ronin
07-23-2008, 07:43 PM
He presumes a lot!

While the picture presented between the lines of this article point to a Pre-D who is overweight, hypertensive, high cholesterol, couch-potato, poor diet, et cetera may include a lot of people, it is not comprehensive and I'm living proof of that.

I'm not overweight (6' and 155 pounds), my cholesterol levels are darned good with my total at around 170 and my HDL around 80, my blood pressure is low-normal as is my resting pulse (in the 50's) and I exercise a lot (90 minutes/day five to six days per week). Yet, I'm still a Pre-D.

Perhaps it's my low C-Peptide which indicates that my pancreas isn't producing as much insulin as it might.

Also, diet and exercise do maintain my HbA1c levels in the mid to low 5's.

Chances are that I might go the way of LADA or Type-1.5 but not likely Type-2. Yet, the article presumes to say that all Pre-D's will automatically become Type-2 and that meds are the only answer. While the article doesn't identify a specific medication my guess is that the emphasis will be on drugs that increase insulin sensitivity and that is great if you make lots of insulin, but not so great if you don't.

General rules, I don't accept general rules that are so presumptive. Yeah, this article got me started.

cyberus
07-23-2008, 07:55 PM
Following the links at the bottom of the DPP webpage I see that the same old "low fat high carb" program is the base of the study.

Just another attempt to prove an old theory thats being chipped away monthly.