Stemming the Diabetes Tide

from the American Diabetes Association’s annual advanced post-graduate course, New York

It’s pretty routine for a medical-meeting speaker–especially when starting the leisurely and lengthy type of lecture they gave at this meeting–to begin  by placing the disease in question in some sort of introductory context. The demographics of type 2 diabetes, mentioned several times during 2 days of talks here, are staggering and sobering, even if they’re no longer really newsworthy.

As one speaker said today, the prevalence of type 2 diabetes in the United States is estimated to have tripled between 1990 and 2006, and by last year about 24 million Americans had the disease. Given the massive morbidity linked with diabetes, those numbers and trends are downright scary.

The speaker, Dr. Mary H. Parks, director of the Division of Metabolism and Endocrinology Products in the Center for Drug Evaluation and Research of the U.S. Food and Drug Administration,  went on in her presentation to discuss the pros and cons for using drug therapy to treat people identified as having “pre-diabetes” to slow or prevent their progression to full-fledged type 2 diabetes. Dr. Parks’ conclusion was that while lifestyle modifications (better diet, more exercise) were very effective and fine to prescribe, drug therapies, while effective in certain cases, had not yet been proven to have benefits that outweigh their risks.

After her talk, the session’s chairman couldn’t help taking an impromtu poll of the 400 or so people in the audience. How many, he asked, have prescribed metformin, the most widely used oral, anti-diabetes drug in the U.S., to prevent people with “pre-diabetes” from progressing. Roughly 20% of the audience raised their hands, a percent that was especially impressive because many in the audience were health-care professionals who aren’t licensed to prescribe drugs.  When the chair then asked who in the audience would never consider prescribing metformin this way a single hand rose up.

The FDA may not yet be convinced that drugs have a role in battling this epidemic at the “pre-diabetes” level, but many in the medical community seem to have have reached a different conclusion.

–Mitchel Zoler

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Filed under Endocrinology, Diabetes, and Metabolism

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