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Medical Edge Newspaper Column from Mayo Clinic

DIABETES INNOVATIONS IMPROVE PATIENTS’ PROSPECTS

DEAR MAYO CLINIC: What are some of the newest findings in the area of diabetes? — Avery, Tex.

ANSWER: There are many exciting advancements in the management of diabetes. One new finding is especially influential: if you are a diabetic who takes good care of yourself — both at home and through regular visits to your doctor — you’ll have much less to worry about. Although we have known for some time that aggressive control of blood glucose helps to prevent microvascular complications such as kidney, eye and nerve damage, recent studies have shown that patients with type 1 diabetes who aggressively control their disease have fewer heart disease complications.

In diabetes, the pancreas produces insufficient amounts of the hormone insulin, which is needed to help cells absorb glucose, the body’s main source of energy. People with type 2 diabetes produce some insulin, though not enough. Those with type 1 diabetes produce no insulin at all. Thus, while many type 2 patients can be treated either by decreasing their body’s need for insulin through diet and exercise or by taking certain medications in pill form (and, sometimes, injections of insulin itself), type 1 patients must administer insulin permanently. It must be taken by injection, because digestive enzymes would otherwise break it down.

A new drug called exenatide (brand-name Byetta) is a natural hormone — glucagon-like peptide-1 (GLP-1) — that enhances insulin production in the pancreas. It has been available since the summer of 2005 for type 2 diabetes patients who take pills to stimulate their bodies’ own insulin release or to improve insulin action. Byetta has also shown itself to be effective at helping patients control their weight, thereby ameliorating a major diabetes risk factor.

A new drug for type 1 diabetes patients (and type 2 diabetes patients who take insulin) was released recently. Called pramlintide (Symlin), it is a protein that, in healthy people, is secreted by the pancreas along with insulin. This protein is missing in type 1 diabetes patients as well, but when taken along with insulin injections, Symlin controls blood-sugar levels after eating. It too has a modest weight-control benefit.

Inhaled insulin, which has been approved by the FDA, is expected to be on the market soon. Inhaled insulin is short-acting and should be used at mealtimes to eliminate spikes in blood-glucose levels. It complements the effects of injected long-acting (“basal”) insulin — or, alternatively, pills — which are needed to hold the blood-sugar level steady when the patient is (BEGIN ITAL)not(END ITAL) eating.

Yet another recent innovation is the Minimed continuous glucose sensor used in conjunction with their insulin pump. About the size of a pager, this monitoring device can be worn by the patient for an instant readout of blood-glucose level. It is not necessarily meant for constant use but to determine how the body reacts to situations — such as eating certain meals or doing specific types of exercise — and to aid in the appropriate adjustment of insulin doses.

Finally, researchers have discovered that gastric-bypass surgery, which has been a virtual godsend for many obese individuals, improves diabetes beyond what would be expected from the weight loss alone. The surgery changes some of the gut hormones — in particular, it enhances secretion of GLP-1 — which leads to enhanced production of insulin by the pancreas. Although this is a serious operation, I often counsel obese diabetes patients to at least consider it.

Let me emphasize that along with exploiting new drugs and other advances, it is critical for diabetes patients to continue with the tried-and-true process of seeing their doctors regularly for evaluation of diabetes control and related problems — for example, tests that measure cholesterol, blood pressure, albumin in the urine (to detect any early kidney damage) and blood-glucose trends over recent months. Such care is a big part of the approach to diabetes care that has resulted in such notable reductions in diabetes complications.
— Lori R. Roust, M.D., Endocrinology, Mayo Clinic, Scottsdale, Ariz.

Additional Resources:
Diabetes

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.