While diabetes is becoming more common, people are learning how to better manage the disease.
The result has been lower risk of heart attack, high blood sugar, strokes and leg amputations because of the disease.
Dr. Amber Taylor, director of the Diabetes Center at Mercy Medical Center in Baltimore, talks about new treatments for diabetes.
What are the most common complications from diabetes?
The most common complications are eye problems (retinopathy or blindness), chronic kidney disease (kidney failure), nerve damage (pain in the feet or wounds that can lead to amputations), heart disease and strokes. The higher the blood sugar, the higher the risk of many of these problems. High blood sugars can affect many organs in the body. We often group these changes, or "complications," into effects on the small vessels or large vessels. Microvascular, or small vessel disease, can affect the eyes, kidneys and nerves. Macrovascular, or large vessel disease, affects the heart, brain and vascular supply. Microvascular changes tend to be very sensitive to blood sugar control.
Thankfully, new research continues to surge forward with new therapies for diabetes and new strategies to live better with the disease. The reduction in complications from diabetes can be attributed to overall better comprehensive care for patients with diabetes, including lipid-lowering therapy (statins) for all patients with diabetes, blood pressure-lowering drugs, and attention to diabetes effects on the kidney.
Type 2 diabetes, the most common type resulting because the body doesn't use insulin properly, tends to be a progressive disease, meaning that more and more medications are needed to control the disease over time. New drugs are an important part of the arsenal for diabetes care as the insulin-making cells begin to fail and more drugs are needed. We have many very good therapies for Type 2 diabetes these days. We've come a long way since insulin was discovered less than 100 years ago!
While research continues for a cure for Type 1 diabetes, where the pancreas produces little or no insulin, new devices make living with the disease a little bit easier and safer. These drugs and devices can be life-saving, but new therapies are often costly — contributing to the overall rise in the cost of diabetes care.
Are the best treatments drug- or lifestyle-related?
Lifestyle, both diet and exercise, is important for anyone with diabetes, Type 1 or 2. Despite the improvements in drugs and insulins, we still can't compensate for a diet full of excess starches and sugar-laden beverages.
In the early stages of diabetes, lifestyle change can actually reverse Type 2 diabetes. Changes such as weight loss of 5 to 10 percent body weight, exercising more than 150 minutes per week, eating more fruits and vegetables, getting more fiber, and drinking less alcohol seem to make a big difference in preventing progression or eliminating diabetes. However, later in the disease, these lifestyle factors are important, but drug and insulin therapy may also be required.
Who is not benefiting from new treatments?
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There are still a lot of people that have uncontrolled diabetes or don't even know they have diabetes. In diabetes, I believe that understanding the disease process is extremely important. The more a patient knows, the better they can understand what they need to do and how a treatment can help. Patients who are seeing a doctor should ask to be screened for diabetes, especially if there is a family history. Unfortunately, what you don't know CAN hurt you.
The rate of diabetes continues to escalate, despite lower rates of complications. Unfortunately, the diagnosis of diabetes tends to lag behind development of obesity. This makes sense physiologically, as insulin resistance is driving many of the changes in the metabolic syndrome, such as high cholesterol, high blood sugars, and high blood pressure.
It is not difficult to see why we continue to gain weight every year — all we have to do is look around. Our bodies have not kept up with our society and lifestyle change. It used to be a treat to have a dessert or a soda. Less than 100 years ago, a teenager might ride their bicycle to the soda shop once a week; now we see kids drinking 20-ounce bottles of soda for breakfast (and they aren't riding their bikes).
Unfortunately, the obesity trend has also continued to rise, so we expect diabetes rates will continue to follow until the obesity epidemic can be slowed. Maintaining or getting to a healthy body weight is very important; both dietary changes and exercise are important for weight loss.