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Feature:
Diabetes Complications

Tailoring Diabetes Treatment to the Patient

Judith Fradkin, MD

Judith Fradkin, M.D., is director of the Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Photo: Bill Branson, NIH

Judith Fradkin, M.D., is director of the Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). She recently answered questions about current diabetes guidelines and research.

New guidelines have recently been reported for the treatment of type 2 diabetes. How was the NIH involved?

These are guidelines from the American Diabetes Association (ADA), not from the NIH. But they are based in part on NIH research. The National Diabetes Education Program (NDEP)—a joint program of the NIH and Centers for Disease Control and Prevention (CDC)—uses ADA and other organizations' guidelines in its materials.

How has NIH research led to changes in the guidelines that tailor them to individual patients?

The guidelines focus on tailoring goals to the individual, based on potential risks and benefits of blood sugar control as measured by the A1C test. That is a lab test that measures average blood glucose level over the last two to three months. These new guidelines call for better control of diabetes in people who are newly diagnosed, do not have many other health problems, and can expect to live a long time. Other people should have less strict A1C goals. Those include people with severe low blood sugar, other serious health problems—such as heart disease—or longstanding or hard to control diabetes.

These guidelines are consistent with findings in the NIH-funded Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. This study found that lowering blood glucose to a goal of near normal, or non-diabetic levels, increased the risk of death; the study participants had longstanding type 2 diabetes and either had heart disease or were at high risk for it.

Two other studies, the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Complications (EDIC)—studied patients treated intensively early in the course of type 1 diabetes. These studies showed that tight blood glucose control lowers the risk of diabetes complications, and that the benefits continued years after the trial ended.

These trials tell us that treatment should be tailored for the individual patient. For some people with diabetes, intensive glucose control might not be best. For other people, it may be the right thing to do. We've learned that a one-size approach does not fit all in treating diabetes. It is important to remember that it's not just glucose control that is important. Controlling blood pressure and taking cholesterol-lowering statin drugs have a huge effect in preventing heart disease in people with diabetes.

Due to the rise of obesity in the U.S., many people have prediabetes—a condition that puts them at high risk for type 2 diabetes. What can those people do to help stay away from developing type 2 diabetes?

that are higher than normal, but not high enough to be called diabetes. People can sometimes reverse prediabetes with weight loss that comes from healthy eating and physical activity. Even a small weight loss can prevent or delay progression to type 2 diabetes. We learned in the Diabetes Prevention Program (DPP) study that losing just 5-7 percent of your body weight (about 15 pounds for many people) can help prevent or delay the chances of getting type 2 diabetes. That's true even if you don't get down to your ideal body weight. A diet low in fat and calories and regular physical activity, such as walking 30 minutes for five days a week, can reduce the risk type 2 diabetes by more than half.

It is important to note that these proven benefits of weight loss are for delay or prevention of type 2 diabetes in people who have been diagnosed with prediabetes or have risk factors for developing type 2 diabetes. Obesity does not cause type 1 diabetes, nor does weight loss prevent it.

To Find Out More

The National Diabetes Education Program—a joint program of NIH and the CDC—is also a great resource for education on diabetes: www.YourDiabetesInfo.org. NDEP's resources include many publications—in many languages—on both nutrition and physical activity.

Are there research studies for type 2 diabetes that show promise in preventing and/or treating the disease more effectively in the future?

The NIDDK funds many studies examining better ways to prevent and treat type 2 diabetes, including:

  • Look AHEAD (Action for Health in Diabetes)—This study looks at people who already have type 2 diabetes. It has shown that a lifestyle intervention that helps participants lose weight reduces the need for medications to control diabetes, and improves mobility and quality of life.
  • Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study, the first large-scale study to compare treatments for young people with type 2 diabetes.
  • The Restoring Insulin Secretion (RISE) study is looking at ways to preserve beta cell function in people early in the course of type 2 diabetes.
  • The ACCORD, DPP/DPPOS, and DCCT/EDIC studies continue to follow participants so we can learn more about the long-term outcomes of people with and at risk of diabetes.

Has diabetes become a worldwide problem now, as more and more countries deal with changes in diet and growing obesity?

Rates of type 2 diabetes have grown around the world, particularly in the Middle East and Asia. In 2010, the CDC estimated nearly 26 million Americans have diabetes; in India, the number is at least twice that, and in China even greater.

Read More "Diabetes Complications" Articles

Learning a Healthier Way to Live / Preventing and Managing Diabetes Complications / Personal Stories / Tailoring Diabetes Treatment to the Patient

Fall 2012 Issue: Volume 7 Number 3 Page 14