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Providing Long-Term Support for Lifestyle Changes: A Key to Success in Diabetes Prevention. Diabetes Spectrum. 20(4): 205-209. Fall 2007.
This article is one from a series on the importance of diabetes self-management education (DSME) in the everyday care of people with diabetes and in prevention of the complications of the disease. The authors remind readers that there is increasing evidence to demonstrate that type 2 diabetes can be delayed or prevented in people with elevated risk by modest changes in lifestyle. The authors explore how partnering with the YMCA organization can result in a community-based intervention approach to implement diabetes prevention programs. YMCA staff trained to deliver a structured lifestyle intervention to prevent diabetes can achieve short-term weight-loss results comparable to those achieved during the Diabetes Prevention Program clinical trial. The authors comment on the importance of maintaining intervention programs to maintain the benefits they [s2]can achieve. 42 references.
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Diabetes Overview. Bethesda, MD: National Diabetes Information Clearinghouse. 2006. 16 p.
This fact sheet provides an overview of information about diabetes, defined as a disorder of metabolism. The fact sheet describes the three main types of diabetes: type 1 diabetes, an autoimmune disease in which the pancreas produces little or no insulin; type 2 diabetes, in which the body does not produce enough insulin or uses insulin inefficiently; and gestational diabetes, which is associated with pregnancy and an increased risk of type 2 diabetes subsequently. The fact sheet then discusses diagnostic considerations, the condition of pre-diabetes, the complications that may be associated with diabetes, epidemiology of type 1 and type 2 diabetes, and patient care for people with diabetes. The fact sheet also describes current research efforts in the diabetes arena, including the Environmental Determinants of Diabetes in the Young Consortium (TEDDY), Type 1 Diabetes TrialNet, the Immune Tolerance Network, islet transplantation studies, the Diabetes Prevention Program (DPP), studies on type 2 diabetes in children and teens, and studies focusing on preventing and treating cardiovascular disease in people with type 2 diabetes. The contact information for four resource organizations is listed. A final section provides the contact information and a brief description of the goals and activities of the National Diabetes Information Clearinghouse. 2 figures.
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Lifestyle for Prevention: Choices, Changes, Challenges. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 22-42.
This chapter on lifestyle for the prevention of diabetes is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The authors note that the prevention and delay of diabetes and the chronic complications associated with diabetes have become urgently important in both public health and patient care. Education plays a large role in preventing and delaying the onset of type 2 diabetes, as well as in preventing and controlling its devastating complications. Topics covered include risk factors and their interactions, the effectiveness of lifestyle intervention in diabetes prevention, related landmark studies including the Diabetes Prevention Program (DPP), self-care behaviors, translating prevention research for diverse populations and settings, a clinical approach for high-risk individuals, the Medicare Medical Nutrition Therapy Act of 2005, and the role of a community approach to diabetes prevention. The chapter includes a list of key points, a summary of teaching strategies, suggested Internet resources, a glossary of key terms, and a list of references. 1 figure. 4 tables. 44 references.
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Clinical Outcomes and Cost-Effectiveness of Strategies for Managing People at High Risk for Diabetes. Annals of Internal Medicine. 143(4): 251-264, W53-W68. August 2005.
Lifestyle modification can forestall diabetes in high-risk people, but the long-term cost-effectiveness is uncertain. This article reports on a study undertaken to estimate the effects of the lifestyle modification program used in the Diabetes Prevention Program (DPP) on health and economic outcomes. The authors performed a cost-effectiveness analysis using the Archimedes model. Results showed that, compared with no prevention program, the DPP lifestyle program would reduce a high-risk person's 30-year chances of getting diabetes from about 72 percent to 61 percent, the chances of a serious complication from about 38 percent to 30 percent, and the chances of dying of a complication of diabetes from about 13.5 percent to 11.2 percent. The drug metformin would deliver about one-third of the long-term health benefits achievable by immediate lifestyle modification. Compared with not implementing any prevention program, the expected 30-year cost per quality-adjusted life-year (QALY) of the DPP lifestyle intervention from the health plan's perspective would be about $143,00. From a societal perspective, the cost per QALY of the lifestyle intervention (compared with doing nothing) would be about $62,600. Either using metformin of delaying the lifestyle intervention until after a person develops diabetes would be more cost-effective, costing about $35,400 or $24,500 per QALY gained, respectively, compared with no program. Compared with delaying the lifestyle program until after diabetes is diagnosed, the marginal cost-effectiveness of beginning the DPP lifestyle program immediately would be about $201,800. Compared with no program, lifestyle modification for high-risk people can be made cost-saving over 30 years if the annual cost of the intervention can be reduced to about $100. The authors conclude that lifestyle modification is likely to have important effects on the morbidity and mortality of diabetes and should be recommended to all high-risk people. However, the program used in the DPP study may be too expensive for health plans or a national program to implement. The authors call for less expensive methods to achieve the degree of weight loss seen in the DPP. A lengthy appendix is included that contains additional information about the Archimedes model pertinent to the analysis of the prevention and management of diabetes in high-risk people. 10 figures. 10 tables. 48 references.
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Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance. Annals of Internal Medicine. 142(5): 323-332. March 2005.
The Diabetes Prevention Program (DPP) demonstrated that interventions can delay or prevent the development of type 2 diabetes. This article reports on a study undertaken to estimate the lifetime cost-utility of the DPP interventions. The authors use a Markov simulation model to estimate progression of disease, costs, and quality of life. The interventions considered include intensive lifestyle, metformin, and placebo. The results showed that, compared with the placebo intervention, the lifestyle and metformin interventions were estimated to delay the development of type 2 diabetes by 11 years and 3 years, respectively, and to reduce the absolute incidence of diabetes by 20 percent and 8 percent, respectively. The cumulative incidence of complications were reduced and survival was improved by 0.5 years and 0.2 years. Compared with the placebo intervention, the cost per quality adjust life-years (QALY) was approximately $1100 for the lifestyle intervention and $31,300 for the metformin intervention. From a societal perspective, the interventions cost approximately $8,800 and $29,900 per QALY, respectively. From both perspectives, the lifestyle intervention outperformed the metformin intervention. The authors caution that simulation results depend on the accuracy of the underlying assumptions, including participant adherence.
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Depression Symptoms and Antidepressant Medicine Use in Diabetes Prevention Program Participants. Diabetes Care. 28(4): 830-837. April 2005.
This article reports on a study that assessed depression markers (symptoms and antidepressant medicine use) in Diabetes Prevention Program (DPP) participants and determined whether changes in depression markers during the course of the study were associated with treatment arm, weight change, physical activity level, or participant demographic characteristics. The DPP participants (n = 3,187) were in one of three treatment arms: intensive lifestyle, metformin, and placebo. On study entry, 10.3 percent of participants had Beck Depression Inventory (BDI) scores greater than 11, which was used as the threshold for mild depression; 5.7 percent took antidepressant medicines, and 0.9 percent had both depression markers (BDI score over 11 and antidepressant medications). During the DPP, the proportion of participants with elevated BDI scores declined, while the proportion taking antidepressant medicines increased, leaving the proportion with either marker unchanged. These time trends were not significantly associated with the DPP treatment arm. Men were less likely to have elevated depression scores and were less likely to use antidepressant medicine at baseline. Those with more education were less likely to have elevated symptoms scores but more likely to be taking antidepressant medicine. Non-Hispanic white participants were less likely than African Americans to have BDI scores greater than 11, but white participants were most likely to be taking antidepressant medicine than any other racial/ethnic group. The authors conclude that the finding that those taking antidepressant medicine often do not have elevated depression symptoms indicates the value of assessing both markers when estimating overall depression rates. 2 figures. 2 tables. 44 references.
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Fishes, Whales, and Fishing Tips: Hooking an Active Lifestyle. Diabetes Spectrum. 18(2): 114-118. Spring 2005.
Given that a physically active lifestyle is important to health and quality of life, health care professionals are faced with the challenge of guiding individuals as they attempt to increase their level of physical activity. This article shares the suggestions of several lifestyle interventionists (many of whom were part of the Diabetes Prevention Program) gleaned from their experiences with participants and patients whom they have encountered through the years. The authors first review the benefits of an active lifestyle for people with diabetes, then discuss the problem of many people who continue to choose a sedentary lifestyle. Other topics covered include public health recommendations, the Diabetes Prevention Program (DPP) and its findings, the importance of maintaining any exercise or activity program, the fun of exercising with friends, creative ways to incorporate exercise and activity into everyday life, and how to handle and overcome barriers to exercise. 13 references.
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I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians. Bethesda, MD: National Diabetes Information Clearinghouse, 2005. 16 p.
Although people with diabetes can prevent or delay complications by keeping blood glucose levels close to normal, preventing or delaying the development of type 2 diabetes in the first place is even better. This booklet, written in nontechnical language, answers common questions about type 2 diabetes and its prevention and management. The booklet begins with a letter from a Native American physician and a note that describes the results of the Diabetes Prevention Program, which demonstrated successful strategies for preventing diabetes in people at high risk for the condition. Topics include the different types of diabetes, the signs and symptoms of type 2 diabetes, the condition pre-diabetes, risk factors for type 2 diabetes, how to know if one should be tested for diabetes, and how to lower the risks for diabetes. Another section describes research that focused on a population of Pima Indian volunteers. Two forms are included for readers to keep track of their daily food and drink intake and their daily physical activities. A final section summarizes the activities of the National Diabetes Information Clearinghouse. 3 figures. 5 tables.
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Sailing on a Wave of New Research: Part 2. Diabetes Forecast. 58(11): 45-48. November 2005.
This article, the second in a two-part series, summarizes recent research findings that were reported at the American Diabetes Association's 65th Scientific Sessions, held in San Diego (2005). This article covers undiagnosed kidney disease in people with type 2 diabetes, diet soda and weight gain in both type 1 and type 2 diabetes, poor diabetes control and depression in children and adolescents with type 1 diabetes, the use of exercise to prevent gestational diabetes, and eye disease (retinopathy) that may develop before clinical diabetes develops. Some of the information reported is from the Diabetes Prevention Program (DPP), a study that showed that weight loss, exercise, or treatment with the diabetes drug metformin can cut the risk of developing diabetes in people with pre-diabetes.
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Strategies to Identify Adults at High Risk for Type 2 Diabetes: The Diabetes Prevention Program. Diabetes Care. 28(1): 138-144. January 2005.
The Diabetes Prevention Program (DPP) was a large, multicenter, randomized clinical trial testing interventions to prevent or delay type 2 diabetes. A major challenge of the program was to identify eligible high-risk adults, defined by DPP as having both impaired glucose tolerance (IGT) (2-hour glucose 140-199 milligrams per deciliter) and elevated fasting plasma glucose (EFG, defined as 95-125 mg/dl). This article reports on these strategies used to identify adults at high risk for type 2 diabetes. The study analyzed how screening yields would be affected by the presence of established risk factors such as age, sex, ethnicity, BMI, and family history of diabetes, and how much yields would be enhanced by preselecting individuals with elevated capillary blood glucose. Of 158,177 adults originally contacted, 79,190 were potentially eligible. The authors report on the 30,383 participants who completed an oral glucose tolerance test (OGTT). Based on the OGTT, 27 percent had impaired glucose tolerance with EFG, meeting the DPP eligibility criteria for being at high risk of diabetes, and 13 percent had previously-undiagnosed diabetes (based on OGTT). The authors conclude that the DPP screening approach successfully identified adults with or at high risk for type 2 diabetes across various ethnic groups and provided guidance to more efficient use of OGTTs. They note that fasting capillary glucose is a useful adjunct in screening programs combined with data on age and adiposity. 3 figures. 2 tables. 21 references.
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Effects of Glycemic Control on Diabetes Complications and on the Prevention of Diabetes. Clinical Diabetes. 22(4): 162-165. Fall 2004.
This article reviews randomized, controlled clinical trials (RCT's) completed during the past several years or currently underway that have addressed glycemic control. Landmark RCTs have demonstrated that meticulous glycemic (blood glucose) control reduces the risk of microvascular (small blood vessel) and neurological (nerve) complications of diabetes. Studies in pre-diabetes have shown that early intervention slows progression to diabetes. Ongoing studies are examining the effects of glycemic interventions on macrovascular complications of diabetes, the impact of early treatment on the course of diabetes, and whether there are differences depending on the type of the intervention used, including aggressive control of blood pressure and normalization of lipids (fats). Some of the studies discussed include the Diabetes Control and Complications Trial (DCCT), the U.K. Prospective Diabetes Study (UKPDS), the Stockholm Diabetes Intervention Study (SDIS), the Veterans Affairs Diabetes Trial (VADT), the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the U.S. Diabetes Prevention Program (DPP), the Heart Outcomes Prevention Evaluation (HOPE) trial, the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, the Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) study, the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial, Actos Now for Prevention of Diabetes (ACT-NOW), the Outcome Reduction with an Initial Glargine Intervention (ORIGIN), A Diabetes Outcome Progression Trial (ADOPT), and the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) study. 2 tables. 32 references.
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Translating the Diabetes Prevention Program. IN: From Clinical Trials to Community: The Science of Translating Diabetes and Obesity Research. Bethesda, MD: National Diabetes Information Clearinghouse. pp. 49-52.
This document was prepared to assist investigators in either academic or community-based organizations who are engaged in translational activities or translational research. The document reports the proceedings of a conference sponsored by the Diabetes Mellitus Interagency Coordinating Committee (DMICC) in January 2004 in Bethesda, MD, on the subject of diabetes translation, a focus that underpins bringing the results of laboratory discoveries and clinical research to the patient and to medical practice. This document reviews the findings of the Diabetes Prevention Program (DPP) research and shows how it can be translated to the clinical setting. The DPP demonstrated that type 2 diabetes can be delayed or possibly prevented by lifestyle modification and use of medication. The interventions, however, were not designed in a way that is directly deliverable on a public health scale. The author notes that translation on a public health scale will require increased community awareness of risk factors for diabetes and strategies for reducing them; defining real-world strategies to identify individuals at risk who are likely to benefit most from lifestyle modification; and developing intervention strategies to enhance dissemination and sustainability in nonresearch environments, particularly community venues where it can be accessed by broader segments of the population. 9 references.
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Costs Associated with the Primary Prevention of Type 2 Diabetes Mellitus in the Diabetes Prevention Program. Diabetes Care. 26(1): 36-47. January 2003.
This article reports on a study that describes the costs of the Diabetes Prevention Program (DPP) interventions that are designed to prevent or delay type 2 diabetes. The authors describe the direct medical costs, direct nonmedical costs, and indirect costs of the placebo, metformin, and intensive lifestyle interventions over the 3 year study period of the DPP. Resource use and cost are summarized from the perspective of a large health system and society. Research costs are excluded. The data showed metformin and lifestyle interventions are associated with modest incremental costs compared with the placebo intervention. The evaluation of costs relative to health benefits will determine the value of these interventions to health systems and society. 7 tables. 24 references.
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Diabetes and Your Weight: What's the Connection?. Alexandria, VA: American Diabetes Association. 2003. 3 p.
This brochure helps people recently diagnosed with diabetes to understand the connections between type 2 diabetes and obesity. The recently completed Diabetes Prevention Program (DPP) proved that type 2 diabetes can be prevented or delayed by keeping weight in control and by increasing physical activity. The brochure describes the use of the Body Mass Index (BMI) to ascertain risk factors, the use of counting calories to help with weight loss attempts, other strategies for losing weight and keeping it off, and the importance of regular physical activity, not just for weight loss but also for general cardiovascular health and stress reduction. Readers are advised to work closely with their health care providers and to contact the American Diabetes Association (www.diabetes.org) for more information. 1 table.
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Diabetes Prevention Program. Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2003. 4 p.
This fact sheet describes the Diabetes Prevention Program (DPP), a major clinical trial that studied whether either diet and exercise or the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes in people with impaired glucose tolerance (IGT). The DPP found that over the 3 years of the study, diet and exercise sharply reduced the chances that a person with IGT would develop diabetes. Metformin also reduced risk, although less dramatically. This fact sheet reviews the DPP study design and goals, type 2 diabetes and pre-diabetes, and the DPP results. One additional section briefly reports on future research projects in this area. The fact sheet concludes with a brief description of the goals and activities of the National Diabetes Information Clearinghouse (NDIC).
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Effects of Withdrawal From Metformin on the Development of Diabetes in the Diabetes Prevention Program. Diabetes Care. 26(4): 977-980. April 2003.
In the Diabetes Prevention Program (DPP), metformin significantly reduced the risk of diabetes in individuals with impaired glucose tolerance (IGT). This article reports on a study in which diabetes status was assessed by oral glucose tolerance tests (OGTTs) performed while participants were still taking metformin or placebo. To determine whether the observed benefit was a transient pharmacological effect or more sustained, the authors performed a repeat OGTT after a short 'washout' period during which medications (metformin or placebo) were withheld. There were 1,274 participants who underwent the washout study and 529 who did not because they had already developed diabetes. Before the washout, the odds of diabetes in the metformin group was lower than that in the placebo group. After the washout, diabetes was somewhat more frequently diagnosed in the metformin participants. Combining diabetes conversions during the DPP and during the washout, diabetes was diagnosed significantly less frequently in the metformin than the placebo group. The primary analysis of the DPP demonstrated that metformin decreased the risk of diabetes by 31 percent. The washout study shows that 26 percent of this effect can be accounted for by a pharmacological effect of metformin that did not persist when the drug was stopped. After the washout, the incidence of diabetes was still reduced by 25 percent. 2 figures. 2 tables. 8 references.
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ABCs of Diabetes Research. Clinical Diabetes. 20(1): 5-8. 2002.
This article describes the major studies in the field of diabetes, which are most commonly known by their acronyms. Among these are DPT-1 (Diabetes Prevention Trial in Type 1 Diabetes), ENDIT (European Nicotinamide Diabetes Intervention Trial), DPP (Diabetes Prevention Program), XENDOS (Xenical in the Prevention of Diabetes in Obese Subjects), STOP NIDDM (Study to Prevent Non-Insulin Dependent Diabetes Mellitus), HOPE (Heart Outcomes Protection Evaluation), and DREAM (Diabetes Reduction Assessment With Ramipril and Rosiglitazone Medications). The authors highlight these studies dealing with prevention, cardiovascular disease in diabetes, genetic linkages, and treatment. The authors also provide descriptions of study design, outcomes when available, and funding sources. The authors include information about how patients can participate in upcoming studies. 1 figure. 8 references.
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Behavioral Science Research in the Prevention of Diabetes: Status and Opportunities. Diabetes Care. 25(3): 599-606. March 2002.
Recent studies show that diabetes can be prevented. Growing knowledge of the biological bases of the disease opens further prevention opportunities. This article focuses on behavioral science research that may advance these opportunities. The authors introduce an ecological model that guides attention to how prevention research may be pursued at the individual, group, or community levels. Three key areas are reviewed: risk communication, screening, and preventive interventions. Research on diabetes risk communication is limited but suggest that many people are relatively unaware of risks and may have misconceptions about the disease. The authors note that amid policy debates and research regarding the potential benefits and costs of screening, identification of diabetes may itself be risky in terms of psychological and social consequences. The Diabetes Prevention Program and other studies make clear that diabetes can be prevented, both by the combination of weight loss and physical activity and by medications. Research needs to address promoting these methods to individuals as well as to groups and even whole communities. The authors conclude that fundamental as well as applied research should address how risks of diabetes are understood and may be communicated; how to enhance benefits and minimize psychological and other risks of screening; how to promote healthy eating and weight loss, physical activity, and appropriate use of medications to prevent diabetes; and how to reduce socioeconomic and cultural disparities in all these areas. 88 references.
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Diabetes Prevention Program (DPP): Description of Lifestyle Intervention. Diabetes Care. 25(12): 2165-2171. December 2002.
This article provides a detailed description of the highly successful lifestyle intervention administered to 1,079 participants, which included 45 percent racial and ethnic minorities and resulted in a 58 percent reduction in the incidence rate of diabetes. The two major goals of the Diabetes Prevention Program (DPP) lifestyle intervention were a minimum of 7 percent weight loss and weight maintenance, and a minimum of 150 minutes of physical activity similar in intensity to brisk walking. Both goals were hypothesized to be feasible, safe, and effective based on previous clinical trials in other countries. The methods used to achieve these lifestyle goals include the following key features: individual case managers or lifestyle coaches; frequent contact with participants; a structured, state of the art, 16 session, core curriculum that taught behavioral self management strategies for weight loss and physical activity; supervised physical activity sessions; more flexible maintenance intervention, combining group and individual approaches, motivational campaigns, and restarts; individualization through a toolbox of adherence strategies; tailoring of materials and strategies to address ethnic diversity; and an extensive network of training, feedback, and clinical support. 2 tables. 23 references.
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Integral Role of the Dietitian: Implications of the Diabetes Prevention Program. (commentary). Journal of the American Dietetic Association. 102(8): 1065-1068. August 2002.
Obesity and type 2 diabetes have become increasingly prevalent worldwide. This commentary article on the integral role of the dietitian in diabetes prevention discusses the Diabetes Prevention Program (DPP). The DPP compared three treatment groups: intensive lifestyle modification, standard care plus metformin, and standard care plus placebo, in a diverse group of individuals (n = 3,234) with impaired glucose tolerance (IGT). The researchers were evaluating the safety and effectiveness of interventions in delaying or preventing diabetes in diverse populations of high-risk individuals in the United States. The authors of this commentary consider the role of dietitians as DPP lifestyle coaches, as DPP case managers, and in the DPP central management. The authors conclude that now is the time for dietitians to make concerted efforts to help translate the DPP findings into their various practice settings and reduce the forthcoming health care burden of the emerging epidemic of type 2 diabetes. 1 figure. 14 references.
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Projected Impact of Implementing the Results of the Diabetes Prevention Program in the U.S. Population. Diabetes Care. 25(11): 1940-1945. November 2002.
This article reports on a study undertaken to determine the feasibility of using either fasting plasma glucose of HbA1c (glycosylated hemoglobin, a measure of blood glucose levels over time) to identify individuals in the United States population who meet the Diabetes Prevention Program (DPP) criteria for intervention. The study analyzed a representative sample of U.S. adults aged 40 to 74 years with no medical history of diabetes for whom data on height, weight, fasting plasma glucose, HbA1c, and 2 hour plasma glucose during an oral glucose tolerance test (OGTT) were obtained. Using body mass index (BMI) less than 24 as an initial criterion eliminated 27.2 percent of U.S. adults from further testing. Of the remaining group, 41.4 percent did not have to be considered for an OGTT because their fasting glucose level was below or above 96 to 125 milligrams per deciliter. Overall, 10.6 percent of adults aged 40 to 74 years without medical history of diabetes met the DPP eligibility criteria for intervention. Among individuals with a BMI greater than 24 and fasting glucose level 96 to 125 milligrams per deciliter, applying a fasting plasma glucose cutoff of greater than 105 milligrams per deciliter excluded 62.5 percent of this group. The authors conclude that using data on BMI and setting cutoff values for fasting glucose and HbA1c would greatly reduce the number of individuals who would need to undergo an OGTT while achieving adequate sensitivity, specificity, and positive predictive value (PPV). 2 figures. 3 tables. 19 references.
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Uncomplicated Guide to Diabetes Complications. 2nd ed. Alexandria, VA: American Diabetes Association. 2002. 294 p.
Diabetes mellitus can result in many complications, but many of them can be prevented. This book explains to patients how early testing, new medical treatments, and improvements in diabetes control can prevent or slow the development of complications. Each complication is discussed, including symptoms, medical treatments, and self care approaches, in nontechnical language. Twenty chapters cover acute complications (diabetic ketoacidosis or DKA, and hyperosmolar hyperglycemic state or HHS), hypoglycemia (low blood glucose levels), foot problems, eye disease (diabetic retinopathy), heart disease, cholesterol and other blood fats, stroke, hypertension (high blood pressure), nephropathy (kidney disease), peripheral vascular disease, peripheral neuropathy (nerve disease), autonomic neuropathies, gastrointestinal complications, infection and diabetes, diabetes and skin, psychosocial complications, men's sexual health, women's sexual health, oral health, and prevention strategies. This edition includes information on the discoveries and recommendations from the recently completed Diabetes Prevention Program, which linked improved diet and exercise with a slow-down in the development of diabetes and of its complications. One appendix lists medical tests, including recommended scheduling for those tests. A brief description of the activities and resources of the American Diabetes Association is included. A subject index concludes the book.
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Alphabet Soup of Diabetes Research Studies. Diabetes Spectrum. 14(1): 44-48. February 2001.
This article describes some of the major studies on diabetes that are most frequently known by their acronyms. Studies that are completed, currently underway, and anticipated to begin soon are included. Completed studies include the Diabetes Control and Complications Trials (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), the Heart Outcomes Prevention Evaluation (HOPE) study, the Bypass Angioplasty Revascularization Investigation (BARI), the Diabetes List of Goals (DiaLOG), and the Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Current trials include the Diabetes Prevention Program (DPP) and Atorvastatin as Secondary Prevention of Coronary Heart Disease (ASPEN) trial. Newer trials that are anticipated to have an impact on the diabetes community at large include the Diabetes Prevention Trial-IDDM (DPT-1), the Hyperglycemia and Adverse Pregnancy Outcomes Study (HAPO), the Genetics of Non-Insulin Dependent Diabetes (GENNID) study, and A Diabetes Outcome Progression Trial (ADOPT). Three large National Institutes of Health trials that are not yet open for patient recruitment that will attempt to address issues related to cardiovascular disease in people with diabetes are the Study of Health Outcomes and Weight Loss (SHOW), the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, and the Bypass Angioplasty Revascularization Investigation II (BARI-II) trial. For each study discussed, the article provides a description of the study design, outcomes when available, and funding sources. The article also provides references regarding where to find information about participating in upcoming studies. 11 references. (AA-M).
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Type 2 Prevention: The Results are In. Diabetes Forecast. 54(12): 50-52. December 2001.
This article brings readers up to date on research that has been investigating the prevention of type 2 diabetes. The author reports some of the results from the Diabetes Prevention Program (DPP), a study of 3,234 people at risk for type 2 diabetes. The sponsor, the National Institutes of Health (NIH), called the study to a halt a year early, because the findings were so clear: exercise, eating right, and, for those who are overweight, losing about 15 pounds, can slash the risk of developing type 2 diabetes by as much as 71 percent in some people at high risk for the disease. All participants in the DPP were considered at high risk because of their impaired glucose tolerance (IGT), a condition in which blood sugars (glucose) are higher than normal but not high enough for a diagnosis of diabetes. In addition, all the participants were overweight. The DPP included three different prevention strategies or treatment arms, including lifestyle (nutrition and exercise), metformin (Glucophage), and troglitazone (Rezulin). The second and third groups received some information on diet and exercise, but much less than that provided to the first group. The author reports the specific results found in each group. The article includes a seven question quiz for readers and family members to take to estimate their own risk for developing diabetes; one height and weight chart helps readers determine their body mass index (BMI) and unhealthy levels of body weight. 1 table.
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Vascular Abnormalities in the Prediabetic State. In: Johnstone, M.T. and Veves, A. Diabetes and Cardiovascular Disease. Totowa, NJ: The Humana Press, Inc. 2001. p. 65-80.
With over ten million diagnosed patients and another five million undiagnosed, diabetes mellitus and its complications is a major public health problem that will assume epidemic proportions as the population grows older. This chapter on vascular abnormalities in the prediabetic state is from a textbook that offers physicians practical knowledge about cardiovascular disease and diabetes. This chapter is in Part I, which focuses on pathophysiology, including the mechanisms and risk factors for diabetic cardiovascular disease. The authors note that the risk for macrovascular (large blood vessel) disease (including coronary heart disease or CHD) in diabetes seems to depend to a considerable degree on other associated abnormalities such as hypertension (high blood pressure), dyslipidemia (altered levels of fats in the blood), altered fibrinolysis, and obesity, all components of the insulin resistance syndrome. Since the insulin resistance syndrome is usually present before the development of diabetes, a significant contribution to the risk for cardiovascular disease in people with diabetes is established before the appearance of hyperglycemia. The authors discuss the entity of prediabetes, cardiovascular risk and the prediabetic state, endothelial function (the cells lining body cavities and the cardiovascular system), vascular reactivity in type 2 diabetes and in the prediabetic state, endothelial activation, mechanisms involved in vascular abnormalities in the prediabetic state, and diabetes prevention. The authors briefly describe the Diabetes Prevention Program (DPP), a national research project aiming to prevent or slow the development of type 2 diabetes in individuals with impaired glucose tolerance (IGT). 2 figures. 3 tables. 109 references.
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Diabetes Prevention Program: Baseline Characteristics of the Randomized Cohort. Diabetes Care. 23(11): 1619-1629. November 2000.
This article describes the baseline demographic and biomedical characteristics of participants of the Diabetes Prevention Program (DPP) and presents the major outcome variables that were measured at entry. The DPP is a 27 center randomized clinical trial designed to evaluate the safety and efficacy of interventions that may delay or prevention development of diabetes in people at increased risk for type 2 diabetes. Eligibility requirements were age 25 years or older, body mass index (BMI) 24 kilograms per meter squared or greater (BMI 22 kilograms per meter squared or greater for Asian Americans), and impaired glucose tolerance plus a fasting plasma glucose of 5.3 to 6.9 mmol per liter (6.9 mmol or less for Native Americans). Randomization of participants into the DPP over 2.7 years ended in June 1999. Baseline data for the intensive lifestyle medication, standard care plus metformin, and standard care plus placebo groups are presented for the 3,234 participants who were randomized. Of all participants, 55 percent were Caucasian, 20 percent were African American, 16 percent were Hispanic, 5 percent were Native American, and 4 percent were Asian American. Their average age at entry was 51 plus or minus 10.7 years, and 67.7 percent were women. Moreover, 16 percent were less than 40 years of age, and 20 percent were 60 years or older. Of the women, 48 percent were postmenopausal. Men and women had similar frequencies of history of hypercholesterolemia or hypertension. On the basis of fasting lipid determinations, 54 percent of men and 40 percent of women fit National Cholesterol Education Program criteria for abnormal lipid profiles. More men than women were current or former cigarette smokers or had a history of coronary heart disease. Furthermore, 66 percent of men and 71 percent of women had a first degree relative with diabetes. Overall, BMI averaged 34.0 plus or minus 6.7 kilograms per meter squared at baseline, with 57 percent of men and 73 percent of women having a BMI equal to or greater than 30 kilograms per meter squared. Average fasting plasma glucose and glycosylated hemoglobin in men were comparable with values in women. The article concludes that the DPP has successfully randomized a large cohort of participants with a wide distribution of age, obesity, and ethnic and racial backgrounds who are at high risk for developing type 2 diabetes. 1 appendix. 7 tables. 48 references. (AA-M).
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Reducing the Burden of Diabetes and CVD. Patient Care. 34(9): 28-30, 35-36, 39, 40, 42, 45-48. May 15, 2000.
This article addresses the issue of reducing the occurrence of diabetes and cardiovascular disease (CVD) among racial and ethnic minorities. Diabetes disproportionately affects racial and ethnic minorities in the United States. In addition, minorities experience higher rates of complications from diabetes. Various government agencies, including the Centers for Disease Control and Prevention (CDC), have instituted several intervention programs for minorities. One CDC sponsored program, Project Diabetes Intervention Reaching and Educating Communities Together, is the largest community based diabetes prevention program in the United States. The CDC has also established a training program entitled Diabetes Today. Another program of interest is the Bureau of Primary Health Care's Diabetes Collaborative Breakthrough Series. Minority patients face many barriers to ongoing, comprehensive care for CVD and diabetes. These barriers can be classified as primary, secondary, and tertiary. Primary access refers to having immediate access to medical resources and having insurance coverage to pay for the care. Secondary access involves issues of logistics such as transportation and the mechanics of maneuvering through the health care system. Tertiary access refers to factors influencing physician decision making, the relationship between the patient and physician, and the social and cultural barriers to effective interpersonal processes of care. Clinicians caring for minority patients must be willing to view patients in the context of their ethnic and racial background. 9 figures. 11 references.
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