Is it right to delay supportive medication – insulin sensitizers like metformin / galega – while overweight progresses inexorably to obesity, type 2 diabetes or even vascular death before diabetes can present?
· that diabetes now affects about 8% and prediabetes 20% of Americans;
· Diabetes and its complications costs America almost $200 billion a year;
· Prediabetes increases the risk of diabetes 5 fold; and heart disease by 50%;
· Diabetes complications begin early in the progression from normal to frank diabetes.
· Conversion of impaired fasting glucose to diabetes doubles CVD,
· Persons with pre-diabetes should reduce and maintain weight 5-10% lower- This lowers
hypertension, glucose, fats and thus all risks;
· Better lifestyle is difficult to maintain.
· Monitoring of patients with pre-diabetes should include testing for . FPG, HBA1C, lipids and
microalbuminuria at least twice a year.
· metformin delayed onset of diabetes by 3.4 years and reduced incidence of diabetes by 8% after
· identify people with prediabetes and treat them by recommending changes to lifestyle- diet and
exercise- and prescribing drugs if necessary. Otherwise the human and financial cost would
be huge, they warned.”
DIABETES RISKS: In the King’s College London 2008 study in 48 000 diabetics , mortality was down from 4.3% in 1996 to 2.6%pa by 2005, ascribed to a combination of statins, antihypertensives and metformin. Their 2005 study showed that even 5 years before diagnosis of diabetes, the future diabetics consulted and were treated far more than controls.
Similarly, in the Munster 2000 prospective study, men who went on to develop diabetes differed significantly from those who would not by body mass index, fasting serum levels of glucose and HDL, and family history of diabetes mellitus.
The 2005 Scottish analysis of diabetic studies over 60 yrs worldwide showed that diabetes increased mortality about 40%, but less in those over 70yrs. The 2006 Univ Surrey GP practice analysis of 44 000 diabetics (compared with 220 000 controls) showed that diabetes almost doubled mortality. Bandolier reviews Martin et al Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: Diabetalogia 2006 in Germany- Mortality rate was 0.57%pa over 6.5yrs ie by 68.5yrs, in 3,000 diabetes patients from 192 randomly selected practices at time of diagnosis (1995-1999) over 45 years of age, average BMI 30 kg/m 2, a fasting blood glucose of 9.3 mmol/L, and HbA 1c of 7.7%; after diagnosis of type 2 diabetes, over half of patients had no specific therapy.
In the 20year UKPDS in some 5000 UK diabetes patients starting at a mean age of 53ys (25-65yrs), all mortality on lifestyle-diet management only was 28% after 15years ie almost 2%pa by age 68yrs; metformin reduced this by a third.
DIABETES & STROKE: The 1984 Copenhagen Stroke study found that 20% of strokes were associated with diabetes, such patients were 3 years younger than non-diabetics, half had hypertension, more (24%) died- diabetes almost doubled risk of dying- and most involved thrombosis rather than bleeding.
the 2001 Newcastle UK Diabetes study showed that diabetes increased all mortality almost 4fold compared to non-diabetics.
And it is common cause that diabetes is the commonest cause of devastating neuropathy, amputation and endstage kidney failure, and overweight let alone diabetes is the commonest associate of hypertension and lipidemia.
A 1984 study showed that almost 5% of diabetics had visual impairment.
DIABETES: & CANCER: A 1994 Italian study shows that, even correcting for obesity, diabetes increases the risk of cancer 2 to 3 fold in liver, pancreas and endometrium Diabetes is associated with 24% increased risk of breast cancer in the 2007 Karolinska worldwide meta analysis, but not in white women in the US southwest 2008 study . Only obesity, not diabetes, increased the risk of hghgrade prostate cancer in the USA 2006 study A history of overweight with hypertension was associated with 77% increased risk of breast cancer in a 2006 study . In nondiabetics with breast cancer, raised fasting insulin doubled the risk of breast cancer in a 2002 study .
DIABETES & DEMENTIA: The 1996 Rotterdam Study showed that 22% of dementia patients had diabetes, with diabetes increasing dementia risk by 30%, and insulin use trebling the risk of dementia. Recent 2006 studies suggest that diabetes may increase risk of dementia up to 4fold.
PREDIABETES: In the 3 to 4yrs Diabetes Prevention Programs in China, USA and India, moderate dose metformin (ie not metformin adjusted to tolerance) reduced new diabetes by 30 to 70%. The intensive diet and exercise group in the USA DPP did much better- but they were not patients in real life, they were rare volunteers prepared to commit as they did for years to strict diet and at least 3.5hours of sweaty exercise a week.
In the Texas 1995 autopsy study in accident victims as young as 25years, (as in GIs killed in the Vietnam war) disease markers (raised HBA1C, adiposity) were strongly associated with vascular disease.
Thus, given the increasing pandemic of overweight- related diseases from teens upwards, the above studies make it criminal neglect not to monitor body mass index and waist girth, and enforce permanent optimal lifestyle, diet and metformin prevention from youth. This onus, as with strong support against smoking and alcoholism, rests as much on every parent and individual as it does on teachers, educational institutions, employers, health insurers and health workers.
But of course the onus is especially binding on registered professionals- teachers and health workers -and the of-necessity regulated health insurance/ medical aid providers.
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