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Almost everyone knows someone
who has diabetes. An estimated
20.8 million people in the
United States—7.0 percent of the
population—have diabetes, a
serious, lifelong condition. Of
those, 14.6 million have been
diagnosed, and 6.2 million have
not yet been diagnosed. In 2005,
about 1.5 million people aged 20
or older were diagnosed with
diabetes. For additional
statistics, see the National
Diabetes Statistics fact
sheet online at
www.diabetes.niddk.nih.gov/dm/pubs/statistics
or call the National Diabetes
Information Clearinghouse at
1–800–860–8747 to request a
copy.
d
What is diabetes?
Diabetes is a disorder of
metabolism—the way our bodies
use digested food for growth and
energy. Most of the food we eat
is broken down into glucose, the
form of sugar in the blood.
Glucose is the main source of
fuel for the body.
After digestion, glucose
passes into the bloodstream,
where it is used by cells for
growth and energy. For glucose
to get into cells, insulin must
be present. Insulin is a hormone
produced by the pancreas, a
large gland behind the stomach.
When we eat, the pancreas
automatically produces the right
amount of insulin to move
glucose from blood into our
cells. In people with diabetes,
however, the pancreas either
produces little or no insulin,
or the cells do not respond
appropriately to the insulin
that is produced. Glucose builds
up in the blood, overflows into
the urine, and passes out of the
body in the urine. Thus, the
body loses its main source of
fuel even though the blood
contains large amounts of
glucose.
What are the types of
diabetes?
The three main types of
diabetes are
- type 1 diabetes
- type 2 diabetes
- gestational diabetes
Type 1 Diabetes
Type 1 diabetes is an
autoimmune disease. An
autoimmune disease results when
the body’s system for fighting
infection (the immune system)
turns against a part of the
body. In diabetes, the immune
system attacks and destroys the
insulin-producing beta cells in
the pancreas. The pancreas then
produces little or no insulin. A
person who has type 1 diabetes
must take insulin daily to live.
At present, scientists do not
know exactly what causes the
body’s immune system to attack
the beta cells, but they believe
that autoimmune, genetic, and
environmental factors, possibly
viruses, are involved. Type 1
diabetes accounts for about 5 to
10 percent of diagnosed diabetes
in the United States. It
develops most often in children
and young adults but can appear
at any age.
Symptoms of type 1 diabetes
usually develop over a short
period, although beta cell
destruction can begin years
earlier. Symptoms may include
increased thirst and urination,
constant hunger, weight loss,
blurred vision, and extreme
fatigue. If not diagnosed and
treated with insulin, a person
with type 1 diabetes can lapse
into a life-threatening diabetic
coma, also known as diabetic
ketoacidosis.
Type 2 Diabetes
The most common form of
diabetes is type 2 diabetes.
About 90 to 95 percent of people
with diabetes have type 2. This
form of diabetes is most often
associated with older age,
obesity, family history of
diabetes, previous history of
gestational diabetes, physical
inactivity, and certain
ethnicities. About 80 percent of
people with type 2 diabetes are
overweight.
Type 2 diabetes is
increasingly being diagnosed in
children and adolescents.
However, nationally
representative data on
prevalence of type 2 diabetes in
youth are not available.
When type 2 diabetes is
diagnosed, the pancreas is
usually producing enough
insulin, but for unknown reasons
the body cannot use the insulin
effectively, a condition called
insulin resistance. After
several years, insulin
production decreases. The result
is the same as for type 1
diabetes—glucose builds up in
the blood and the body cannot
make efficient use of its main
source of fuel.
The symptoms of type 2
diabetes develop gradually.
Their onset is not as sudden as
in type 1 diabetes. Symptoms may
include fatigue, frequent
urination, increased thirst and
hunger, weight loss, blurred
vision, and slow healing of
wounds or sores. Some people
have no symptoms.
Gestational Diabetes
Some women develop
gestational diabetes late in
pregnancy. Although this form of
diabetes usually disappears
after the birth of the baby,
women who have had gestational
diabetes have a 20 to 50 percent
chance of developing type 2
diabetes within 5 to 10 years.
Maintaining a reasonable body
weight and being physically
active may help prevent
development of type 2 diabetes.
About 3 to 8 percent of
pregnant women in the United
States develop gestational
diabetes. As with type 2
diabetes, gestational diabetes
occurs more often in some ethnic
groups and among women with a
family history of diabetes.
Gestational diabetes is caused
by the hormones of pregnancy or
a shortage of insulin. Women
with gestational diabetes may
not experience any symptoms.
How is diabetes diagnosed?
The fasting blood glucose
test is the preferred test for
diagnosing diabetes in children
and nonpregnant adults. It is
most reliable when done in the
morning. However, a diagnosis of
diabetes can be made based on
any of the following test
results, confirmed by retesting
on a different day:
- A blood glucose level of
126 milligrams per deciliter
(mg/dL) or more after an
8-hour fast. This test is
called the fasting blood
glucose test.
- A blood glucose level of
200 mg/dL or more 2 hours
after drinking a beverage
containing 75 grams of
glucose dissolved in water.
This test is called the oral
glucose tolerance test (OGTT).
- A random (taken at any
time of day) blood glucose
level of 200 mg/dL or more,
along with the presence of
diabetes symptoms.
Gestational diabetes is
diagnosed based on blood glucose
levels measured during the OGTT.
Glucose levels are normally
lower during pregnancy, so the
cutoff levels for diagnosis of
diabetes in pregnancy are lower.
Blood glucose levels are
measured before a woman drinks a
beverage containing glucose.
Then levels are checked 1, 2,
and 3 hours afterward. If a
woman has two blood glucose
levels meeting or exceeding any
of the following numbers, she
has gestational diabetes: a
fasting blood glucose level of
95 mg/dL, a 1-hour level of 180
mg/dL, a 2-hour level of 155 mg/dL,
or a 3-hour level of 140 mg/dL.
What is pre-diabetes?
People with pre-diabetes have
blood glucose levels that are
higher than normal but not high
enough for a diagnosis of
diabetes. This condition raises
the risk of developing type 2
diabetes, heart disease, and
stroke.
Pre-diabetes is also called
impaired fasting glucose (IFG)
or impaired glucose tolerance (IGT),
depending on the test used to
diagnose it. Some people have
both IFG and IGT.
- IFG is a condition in
which the blood glucose
level is high (100 to 125
mg/dL) after an overnight
fast, but is not high enough
to be classified as
diabetes. (The former
definition of IFG was 110
mg/dL to 125 mg/dL.)
- IGT is a condition in
which the blood glucose
level is high (140 to 199
mg/dL) after a 2-hour oral
glucose tolerance test, but
is not high enough to be
classified as diabetes.
Pre-diabetes is becoming more
common in the United States,
according to new estimates
provided by the U.S. Department
of Health and Human Services.
About 40 percent of U.S. adults
ages 40 to 74—or 41 million
people—had pre-diabetes in 2000.
New data suggest that at least
54 million U.S. adults had
pre-diabetes in 2002. Many
people with pre-diabetes go on
to develop type 2 diabetes
within 10 years.
The good news is that if you
have pre-diabetes, you can do a
lot to prevent or delay
diabetes. Studies have clearly
shown that you can lower your
risk of developing diabetes by
losing 5 to 7 percent of your
body weight through diet and
increased physical activity. A
major study of more than 3,000
people with IGT, a form of
pre-diabetes, found that diet
and exercise resulting in a 5 to
7 percent weight loss—about 10
to 14 pounds in a person who
weighs 200 pounds—lowered the
incidence of type 2 diabetes by
nearly 60 percent. Study
participants lost weight by
cutting fat and calories in
their diet and by exercising
(most chose walking) at least 30
minutes a day, 5 days a week.
What are the scope and
impact of diabetes?
Diabetes is widely recognized
as one of the leading causes of
death and disability in the
United States. In 2002, it was
the sixth leading cause of
death. However, diabetes is
likely to be underreported as
the underlying cause of death on
death certificates. About 65
percent of deaths among those
with diabetes are attributed to
heart disease and stroke.
Diabetes is associated with
long-term complications that
affect almost every part of the
body. The disease often leads to
blindness, heart and blood
vessel disease, stroke, kidney
failure, amputations, and nerve
damage. Uncontrolled diabetes
can complicate pregnancy, and
birth defects are more common in
babies born to women with
diabetes.
In 2002, diabetes cost the
United States $132 billion.
Indirect costs, including
disability payments, time lost
from work, and premature death,
totaled $40 billion; direct
medical costs for diabetes care,
including hospitalizations,
medical care, and treatment
supplies, totaled $92 billion.
Who gets diabetes?
Diabetes is not contagious.
People cannot “catch” it from
each other. However, certain
factors can increase the risk of
developing diabetes.
Type 1 diabetes occurs
equally among males and females
but is more common in whites
than in non-whites. Data from
the World Health Organization’s
Multinational Project for
Childhood Diabetes indicate that
type 1 diabetes is rare in most
African, American Indian, and
Asian populations. However, some
northern European countries,
including Finland and Sweden,
have high rates of type 1
diabetes. The reasons for these
differences are unknown. Type 1
diabetes develops most often in
children but can occur at any
age.
Type 2 diabetes is more
common in older people,
especially in people who are
overweight, and occurs more
often in African Americans,
American Indians, some Asian
Americans, Native Hawaiians and
other Pacific Islander
Americans, and
Hispanics/Latinos. On average,
non-Hispanic African Americans
are 1.8 times as likely to have
diabetes as non-Hispanic whites
of the same age. Mexican
Americans are 1.7 times as
likely to have diabetes as
non-Hispanic whites of similar
age. (Data are not available for
estimation of diabetes rates in
other Hispanic/Latino groups.)
American Indians have one of the
highest rates of diabetes in the
world. On average, American
Indians and Alaska Natives are
2.2 times as likely to have
diabetes as non-Hispanic whites
of similar age. Although
prevalence data for diabetes
among Asian Americans and
Pacific Islanders are limited,
some groups, such as Native
Hawaiians, Asians, and other
Pacific Islanders residing in
Hawaii (aged 20 or older) are
more than twice as likely to
have diabetes as white residents
of Hawaii of similar age.
Diabetes prevalence in the
United States is likely to
increase for several reasons.
First, a large segment of the
population is aging. Also,
Hispanics/Latinos and other
minority groups at increased
risk make up the fastest-growing
segment of the U.S. population.
Finally, Americans are
increasingly overweight and
sedentary. According to recent
estimates from the Centers for
Disease Control and Prevention
(CDC), diabetes will affect one
in three people born in 2000 in
the United States. The CDC also
projects the prevalence of
diagnosed diabetes in the United
States will increase 165 percent
by 2050.
d
How is diabetes managed?
Before the discovery of
insulin in 1921, everyone with
type 1 diabetes died within a
few years after diagnosis.
Although insulin is not
considered a cure, its discovery
was the first major breakthrough
in diabetes treatment.
Today, healthy eating,
physical activity, and taking
insulin are the basic therapies
for type 1 diabetes. The amount
of insulin must be balanced with
food intake and daily
activities. Blood glucose levels
must be closely monitored
through frequent blood glucose
checking. People with diabetes
also monitor blood glucose
levels several times a year with
a laboratory test called the
A1C. Results of the A1C test
reflect average blood glucose
over a 2- to 3-month period.
Healthy eating, physical
activity, and blood glucose
testing are the basic management
tools for type 2 diabetes. In
addition, many people with type
2 diabetes require oral
medication, insulin, or both to
control their blood glucose
levels.
Adults with diabetes are at
high risk for cardiovascular
disease (CVD). In fact, at least
65 percent of those with
diabetes die from heart disease
or stroke. Managing diabetes is
more than keeping blood glucose
levels under control—it is also
important to manage blood
pressure and cholesterol levels
through healthy eating, physical
activity, and use of medications
(if needed). By doing so, those
with diabetes can lower their
risk. Aspirin therapy, if
recommended by the health care
team, and smoking cessation can
also help lower risk.
People with diabetes must
take responsibility for their
day-to-day care. Much of the
daily care involves keeping
blood glucose levels from going
too low or too high. When blood
glucose levels drop too low—a
condition known as
hypoglycemia—a person can become
nervous, shaky, and confused.
Judgment can be impaired, and if
blood glucose falls too low,
fainting can occur.
A person can also become ill
if blood glucose levels rise too
high, a condition known as
hyperglycemia.
People with diabetes should
see a health care provider who
will help them learn to manage
their diabetes and who will
monitor their diabetes control.
Most people with diabetes get
care from primary care
physicians—internists, family
practice doctors, or
pediatricians. Often, having a
team of providers can improve
diabetes care. A team can
include
- a primary care provider
such as an internist, a
family practice doctor, or a
pediatrician
- an endocrinologist (a
specialist in diabetes care)
- a dietitian, a nurse,
and other health care
providers who are certified
diabetes educators—experts
in providing information
about managing diabetes
- a podiatrist (for foot
care)
- an ophthalmologist or an
optometrist (for eye care)
and other health care
providers, such as cardiologists
and other specialists. In
addition, the team for a
pregnant woman with type 1, type
2, or gestational diabetes
should include an obstetrician
who specializes in caring for
women with diabetes. The team
can also include a pediatrician
or a neonatologist with
experience taking care of babies
born to women with diabetes.
The goal of diabetes
management is to keep levels of
blood glucose, blood pressure,
and cholesterol as close to the
normal range as safely possible.
A major study, the Diabetes
Control and Complications Trial
(DCCT), sponsored by the
National Institute of Diabetes
and Digestive and Kidney
Diseases (NIDDK), showed that
keeping blood glucose levels
close to normal reduces the risk
of developing major
complications of type 1
diabetes.
This 10-year study, completed
in 1993, included 1,441 people
with type 1 diabetes. The study
compared the effect of two
treatment approaches—intensive
management and standard
management—on the development
and progression of eye, kidney,
nerve, and cardiovascular
complications of diabetes.
Intensive treatment aimed to
keep A1C levels as close to
normal (6 percent) as possible.
Researchers found that study
participants who maintained
lower levels of blood glucose
through intensive management had
significantly lower rates of
these complications. More
recently, a follow-up study of
DCCT participants showed that
the ability of intensive control
to lower the complications of
diabetes has persisted more than
10 years after the trial ended.
The United Kingdom
Prospective Diabetes Study, a
European study completed in
1998, showed that intensive
control of blood glucose and
blood pressure reduced the risk
of blindness, kidney disease,
stroke, and heart attack in
people with type 2 diabetes.
Hope through Research
NIDDK conducts research in
its own laboratories and
supports a great deal of basic
and clinical research in medical
centers and hospitals throughout
the United States. It also
gathers and analyzes statistics
about diabetes. Other Institutes
at the National Institutes of
Health (NIH) conduct and support
research on diabetes-related eye
diseases, heart and vascular
complications, autoimmunity,
pregnancy, and dental problems.
Other Government agencies
that sponsor diabetes programs
are the CDC, the Indian Health
Service, the Health Resources
and Services Administration, the
Department of Veterans Affairs,
and the Department of Defense.
Many organizations outside
the Government support diabetes
research and education
activities. These organizations
include the American Diabetes
Association (ADA), the Juvenile
Diabetes Research Foundation
International (JDRF), and the
American Association of Diabetes
Educators.
In recent years, advances in
diabetes research have led to
better ways of managing diabetes
and treating its complications.
Major advances include
- development of
quick-acting, long-acting,
and inhaled insulins
- better ways to monitor
blood glucose and for people
with diabetes to check their
own blood glucose levels
- development of external
insulin pumps that deliver
insulin, replacing daily
injections
- laser treatment for
diabetic eye disease,
reducing the risk of
blindness
- successful kidney and
pancreas transplantation in
people whose kidneys fail
because of diabetes
- better ways of managing
diabetes in pregnant women,
improving their chances of a
successful outcome
- new drugs to treat type
1 and type 2 diabetes and
better ways to manage this
form of diabetes through
weight control
- evidence that intensive
management of blood glucose
reduces and may prevent
development of diabetes
complications
- demonstration that two
types of antihypertensive
drugs, ACE (angiotensin-converting
enzyme) inhibitors and ARBs
(angiotensin receptor
blockers), are more
effective than other
antihypertensive drugs in
reducing a decline in kidney
function in people with
diabetes
- advances in
transplantation of islets
(clusters of cells that
produce insulin and other
hormones) for type 1
diabetes
- evidence that people at
high risk for type 2
diabetes can lower their
chances of developing the
disease through diet, weight
loss, and physical activity
What will the future bring?
Researchers continue to look
for the cause or causes of
diabetes and ways to manage,
prevent, or cure the disorder.
Scientists are searching for
genes that may be involved in
type 1 or type 2 diabetes. Some
genetic markers for type 1
diabetes have been identified,
and it is now possible to screen
relatives of people with type 1
diabetes to determine whether
they are at risk.
Type 1 Diabetes
A number of Federally-funded
research studies and clinical
trials are under way. Studies
focus on the prevention and
causes of type 1 diabetes as
well as experimental treatments
such as islet transplantation.
The Environmental
Determinants of Diabetes in the
Young Consortium
The main mission of The
Environmental Determinants of
Diabetes in the Young (TEDDY)
consortium, an international
group of clinical centers, is to
identify infectious agents,
dietary factors, or other
environmental factors (including
psychosocial events) that
trigger type 1 diabetes in those
who are genetically susceptible.
In addition, the consortium aims
to
- create a central
repository of data and
biological samples for use
by researchers
- develop novel approaches
to finding the causes of
type 1 diabetes
- find ways to understand
how the disease starts and
progresses
- discover new methods to
prevent, delay, and reverse
type 1 diabetes
TEDDY is funded by the NIDDK,
the National Institute of
Allergy and Infectious Diseases
(NIAID), the Eunice Kennedy
Shriver National Institute
of Child Health and Human
Development (NICHD), the
National Institute of
Environmental Health Sciences,
the CDC, the JDRF, and the ADA.
For more information, see
www.niddk.nih.gov/patient/TEDDY/TEDDY.htm.
Type 1 Diabetes
TrialNet
Type 1 Diabetes TrialNet is a
network of experts and
facilities dedicated to
developing new approaches to the
understanding, prevention, and
treatment of type 1 diabetes.
Clinical centers are located in
the United States, Canada,
Europe, and Australia.
TrialNet studies are focusing
on
- understanding the
natural history of type 1
diabetes (to determine its
causes and how the disease
progresses)
- preventing type 1
diabetes in those at risk
- developing ways to
preserve the function of the
insulin-producing cells in
the pancreas in people
recently diagnosed with type
1 diabetes
For more information, see
www.DiabetesTrialNet.org or
call 1–800–HALT–DM1
(1–800–425–8361).
In many ways, the TrialNet
studies build on the advances
and insights gained from earlier
research in type 1 diabetes. For
example, researchers learned a
great deal about how to predict
type 1 diabetes in at-risk
people from the Diabetes
Prevention Trial—Type 1 (DPT–1).
This study showed that people at
risk of developing type 1
diabetes can be identified. The
DPT-1 researchers discovered
ways to identify two populations
at risk of developing type 1
diabetes within 5 years: those
at high risk (with at least a 50
percent chance) and those with
an intermediate risk (having a
25 to 50 percent risk). Then
researchers explored possible
ways of preventing type 1
diabetes in both groups.
TrialNet will identify people at
risk who may be eligible for
clinical trials. In addition,
TrialNet will conduct trials to
save beta cell function in those
with new onset type 1 diabetes.
TrialNet is funded by the
NIDDK, NICHD, and NIAID. JDRF
and ADA also support this
effort.
The Immune Tolerance
Network
TrialNet works closely with the
Immune Tolerance Network,
another international,
collaborative consortium. Its
goal is to find safe and
effective ways to induce
long-term immune
tolerance—prevention of an
unwanted immune response by the
body. For example, type 1
diabetes might be prevented if
scientists could learn how to
prevent the immune system from
mistakenly attacking the
insulin-producing cells in the
pancreas. Effective immune
tolerance could possibly
- prevent the body’s
rejection of organ or tissue
transplants
- prevent or treat
autoimmune diseases
- prevent or treat
allergies and asthma
Islet Transplantation
Researchers are working on a way
for people with type 1 diabetes
to live without daily insulin
injections. In an experimental
procedure called islet
transplantation, islets are
taken from a donor pancreas and
transferred into a person with
type 1 diabetes. Once implanted,
the beta cells in these islets
begin to make and release
insulin.
Scientists have made many
advances in islet
transplantation in recent years.
Since reporting their findings
in the June 2000 issue of the
New England Journal of
Medicine, researchers at
the University of Alberta in
Edmonton, Alberta, Canada, have
continued to use a procedure
called the Edmonton protocol to
transplant pancreatic islets
into people with type 1
diabetes. Before use of the
Edmonton protocol, during the
1990s, less than 10 percent of
islet cell transplant recipients
were able to control blood
glucose levels for more than 1
year without insulin injections.
The Collaborative Islet
Transplant Registry (CITR),
funded by NIDDK, was created in
2001. CITR’s mission is to
expedite progress and promote
safety in islet transplantation
by collecting, analyzing, and
communicating data on islet
transplantation. The CITR will
study islet transplantation
alone as well as islet
transplantation following kidney
transplant.
The September 2005 CITR
annual report noted that with
use of the Edmonton protocol,
after 1 year, 58 percent of
those who had transplants no
longer needed to inject insulin.
Of those who were still
insulin-dependent 1 year after
transplantation (33 percent of
those followed by the registry),
requirements for insulin were
decreased. The average reduction
in insulin requirements was 69
percent. In summary, a total of
91 percent of those with
transplants showed improvement
following transplantation. The
success of the Edmonton protocol
has been confirmed at other
study sites, including the NIDDK.
The goal of islet
transplantation is to infuse
enough islets to control the
blood glucose level without
insulin injections. For an
average-sized person (154
pounds), a typical transplant
requires about 1 million islets,
extracted from two donor
pancreases. Because good control
of blood glucose can slow or
prevent the progression of
complications associated with
diabetes, such as nerve or eye
damage, a successful transplant
may reduce the risk of these
complications. However,
transplanted islets lose their
ability to function over time.
Also, a transplant recipient
needs to take immunosuppressive
drugs to stop the immune system
from rejecting the transplanted
islets.
These drugs have significant
side effects, and their
long-term effects are still
unknown. Immediate side effects
of immunosuppressive drugs may
include mouth sores and
gastrointestinal problems, such
as stomach upset or diarrhea.
Patients may also have increased
blood cholesterol levels,
decreased white blood cell
counts, decreased kidney
function, and increased
susceptibility to bacterial and
viral infections. Taking
immunosuppressive drugs
increases the risk of tumors and
cancer as well. Researchers are
trying to find safer or less
toxic immunosuppressants or new
approaches that will allow
successful transplantation
without the use of
immunosuppressive drugs.
The results of the Edmonton
protocol are very encouraging,
but more research is needed to
develop safer and more effective
immunosuppression and to enhance
islet survival after
transplantation.
Another obstacle to
widespread use of islet
transplantation is the severe
shortage of islets. Only about
6,000 pancreases a year become
available for transplantation or
for harvesting of islets.
However, researchers are
pursuing alternative sources,
such as creating islets from
other types of cells. New
technologies could then be
employed to grow islets in the
laboratory.
Type 2 Diabetes
Diabetes Prevention
Program
In 1996, NIDDK launched its
Diabetes Prevention Program (DPP).
The goal of this research effort
was to learn how to prevent or
delay type 2 diabetes in people
with impaired glucose tolerance
(IGT), a strong risk factor for
type 2 diabetes.
The findings of the DPP,
released in August 2001, showed
that people at high risk for
type 2 diabetes could sharply
lower their chances of
developing the disorder through
diet and exercise. In addition,
treatment with the oral diabetes
drug metformin also reduced
diabetes risk, though less
dramatically. Metformin lowers
the amount of glucose released
by the liver and also fights
insulin resistance, a condition
in which the body doesn't use
insulin properly.
Participants randomly
assigned to intensive lifestyle
intervention reduced their risk
of getting type 2 diabetes by
almost 60 percent. On average,
this group maintained their
physical activity at 30 minutes
per day, usually with walking or
other moderate intensity
exercise, and lost 5 to 7
percent of their body weight.
Participants randomized to
treatment with metformin reduced
their risk of getting type 2
diabetes by 31 percent.
Of the 3,234 participants
enrolled in the DPP, 45 percent
were from minority groups that
suffer disproportionately from
type 2 diabetes: African
Americans, Hispanics/Latinos,
Asian Americans and Pacific
Islanders, and American Indians.
The trial also recruited other
groups known to be at higher
risk for type 2 diabetes,
including individuals aged 60
and older, women with a history
of gestational diabetes, and
people with a first-degree
relative with type 2 diabetes.
Participants are being followed
to check for long-term effects
of the interventions, including
the effects on risk of CVD.
Type 2 Diabetes in
Children and Teens
Two studies focusing on type 2
diabetes in children and teens
are under way. The TODAY
(Treatment Options for type 2
Diabetes in Adolescents and
Youth) study, a 13-site study
sponsored by NIDDK, will compare
treatments for type 2 diabetes
in children and teens.
Participants will undergo one of
three treatments:
- taking one diabetes
medication (metformin)
- taking two diabetes
medications (metformin and
rosiglitazone, another
medication that fights
insulin resistance)
- taking metformin and
participating in an
intensive lifestyle change
program designed to promote
weight loss by cutting
calories and increasing
physical activity
The main goal of the study is
to determine how well each type
of treatment controls blood
glucose levels. The study also
will evaluate how long each type
of treatment is effective.
The STOPP-T2D (Studies to
Treat or Prevent Pediatric Type
2 Diabetes) study, sponsored by
NIDDK with support from the ADA,
is exploring methods to lower
risk factors for type 2 diabetes
and CVD in middle-school
children (grades 6 through 8) at
eight sites. A 3-year program
will focus on the benefits of
improving nutrition, promoting
physical activity, and making
changes in behavior.
Preventing and
Treating CVD in People with Type
2 Diabetes
CVD is the main killer of people
with type 2 diabetes. For this
reason, the NIH is studying the
best strategies to prevent and
treat CVD in people with
diabetes in three major studies.
These studies are all joint
efforts of the NIDDK and the
National Heart, Lung, and Blood
Institute.
The Look AHEAD (Action for
Health in Diabetes) trial is the
largest clinical trial to date
to examine the long-term health
effects of voluntary weight
loss. This multi-center,
randomized clinical trial is
studying the effects of a
lifestyle intervention designed
to achieve and maintain weight
loss over the long term through
decreased caloric intake and
increased exercise. Look AHEAD
will focus on the disorder most
associated with being overweight
or obese, type 2 diabetes, and
on the outcome that causes the
greatest morbidity and mortality
in people with type 2 diabetes,
CVD.
The Action to Control
Cardiovascular Risk in Diabetes
(ACCORD) trial, a multi-center,
randomized trial, is studying
three approaches to preventing
major cardiovascular events in
individuals with type 2
diabetes. ACCORD is designed to
compare current practice
guidelines with more intensive
glycemic control in 10,000
individuals with type 2
diabetes, including those at
especially high risk for CVD
events because of age, evidence
of subclinical atherosclerosis,
or existing clinical CVD. More
intensive control of blood
pressure than is called for in
current guidelines and a
medication to reduce
triglyceride levels and raise
HDL (good) cholesterol levels
will also be studied in
subgroups of these 10,000
volunteers. Each treatment
strategy will be accompanied by
standard advice regarding
lifestyle choices, including
diet, physical activity, and
smoking cessation, appropriate
for individuals with diabetes.
The primary outcome to be
measured is the first occurrence
of a major CVD event,
specifically heart attack,
stroke, or cardiovascular death.
In addition, the study will
investigate the impact of the
treatment strategies on other
cardiovascular outcomes; total
mortality; limb amputation; eye,
kidney, or nerve disease;
health-related quality of life;
and cost-effectiveness.
The Bypass Angioplasty
Revascularization Investigation
2 Diabetes (BARI 2D) trial, a
5-year, multi-center clinical
trial, is comparing medical
versus early surgical management
of patients with type 2 diabetes
who also have coronary artery
disease and stable angina or
ischemia. At the same time, BARI
2D will study the effect of two
different strategies to control
blood glucose—providing insulin
versus increasing the
sensitivity of the body to
insulin—on the risk of
cardiovascular mortality and
morbidity.
A complete listing of
clinical trials can be found at
www.ClinicalTrials.gov.
Points to Remember
What is diabetes?
- a disorder of
metabolism—the way the body
uses or converts food for
energy and growth
What are the main types of
diabetes?
- type 1 diabetes
- type 2 diabetes
- gestational diabetes
What are the impacts of
diabetes?
- It affects 20.8 million
people—7.0 percent of the
U.S. population.
- It is a leading cause of
death and disability.
- It costs $132 billion
per year.
Who gets diabetes?
- people of any age
- people with a family
history of diabetes
- others at high risk for
type 2 diabetes: older
people, overweight and
sedentary people, African
Americans, Alaska Natives,
American Indians, Asian
Americans, Native Hawaiians,
some Pacific Islander
Americans, and
Hispanics/Latinos
For More Information
To learn more about type 1,
type 2, and gestational
diabetes, as well as diabetes
research, statistics, and
education, contact:
National Diabetes
Education Program
1 Diabetes Way
Bethesda, MD 20892–3560
Phone: 1–800–438–5383
Internet:
www.ndep.nih.gov
To find a clinical trial,
check NIH’s database at
www.ClinicalTrials.gov
online.
To participate in studies
about type 1 diabetes, contact:
Type 1 Diabetes
TrialNet
Phone: 1–800–425–8361
Internet:
www.DiabetesTrialNet.org
The following organizations
also distribute materials and
support programs for people with
diabetes and their families and
friends:
American Diabetes
Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–342–2383
Internet:
www.diabetes.org
Juvenile Diabetes
Research Foundation
International
120 Wall Street, 19th Floor
New York, NY 10005
Phone: 1–800–533–2873
Internet:
www.jdrf.org
|
(National
Diabetes Education Program)
(National
Institute of Diabetes and Digestive and
Kidney Diseases)
