A new approach to treating type 2?

The ADA’s recommended first-line treatment for type 2 diabetes – lifestyle changes and metformin – doesn’t include drugs that could preserve all-important insulin-producing cells of the pancreas, and should be changed, Dr. Ralph DeFronzo of the University of Texas Health Sciences Center told scientists today at the ADA’s Scientific Sessions here in San Francisco.

Dr. DeFronzo is the recipient of this year's Banting Medal, ADA's highest award for scientific achievement. In his award lecture, he said that at the time of diagnosis, most type 2 patients have already lost 80% of their pancreatic beta cells, and would benefit from newer classes of drugs that have been shown to reduce beta cell loss, the thiazolidenediones (TZDs) such as Actos or Avandia, and drugs that affect gut hormones, such as exenatide (Byetta).

By delaying the start of these newer (and more expensive) therapies, there is the risk of further loss of beta cell function, Dr. DeFronzo said.

The damage of diabetes begins well before blood glucose levels rise to the point where diabetes is diagnosed, he said. Studies show about 10% of people with IGT, impaired glucose tolerance, already have diabetic eye damage, even though they have "pre-diabetes", not diabetes.

“I have serious concerns about the phrase ‘pre-diabetes,’’’ he said. “Prevention of beta cell damage must begin early.’’

He said studies to be presented later in the meeting will show that TZDs can slow or prevent progression from impaired glucose tolerance to full-blown type 2 diabetes
Research in recent years has shed light on many body systems that play a role in diabetes, from the gut to the brain, he said. “It’s clear type 2 diabetes will require multiple drugs in combination to correct multiple pathophysiological defects.’’

Treatment should start early and should not be based only on targeting A1C, which measures glucose levels over two or three months, he said. There is an “additive effect’’ of combining drugs such as metformin with an insulin-sensitizing TZD, he said, but most doctors put newly diagnosed patients on a program of diet and exercise, metformin, and perhaps a sulfonylurea. “This should be a major concern for all of us here,’’ he said. Instead, he recommends a combination of “lifestyle modification plus triple therapy from the beginning,’’ including a TZD plus metformin and exenatide, along with an A1C target of under 6%, considerably lower than the current ADA recommendation of 7%.

His novel approach might raise some eyebrows, Dr. DeFronzo acknowledges, but he said all new ideas face the same kind of skepticism: “When it’s new, of course, it isn’t so. And when it’s proven, of course, it isn’t new’’

Comments

[Kerry]

Hello Anita,

You are doing an excellent job at highlighting the hot topics at this year's ADA meeting. Thank you!
Incretin-based therapies are definitely a hot area and as Dr. DeFronzo pointed out in the Banting lecture these drugs have potential to not only lower blood glucose but also diminish beta-cell decline. I found that the education forum Caring For Diabetes did a nice job summarizing much of the new data on incretin-based therapies presented this year at ADA and thought some of your readers would find the summary helpful. The interim conference report can be found at
http://caringfordiabetes.com

Kerry

[Allie]

Two years ago, I tested low functioning for my Thyroid Gland and and I take Levothroid medication. Last year my glucose fasting test was 82.(normal range, and I am not diabetic) however recently I have ALL the symptoms for diabetes and I will have another glucose fasting test. Can the test results change in one year from non diabetic to diabetic? Can my low functioning Thyroid Gland contribute to Diabetes?
Are there other tests in conjunction to the Glucose fasting test to test for Diabetes that may be more acccurate?

Thank You,

Allie

[diabetic signs]

more better early agresive treatment on type 2 diabetes, secretion also recistency insulin.

[diabetic symptoms]

the main cause type 2 is .....low uptake blood glucose into our cell......metformin good choice

[annette]

I'm so glad you're doing this blog. My husband has had to have another toe amputated because of diabetes...it is a terrible illness. I hope some new information comes out of this convention.

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