PREVENTION OF TYPE 2 DIABETES

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PREVENTION OFTYPE 2 DIABETES

• Francine Ratner Kaufman, M.D.
• Professor of Pediatrics
• The Keck School of Medicine of USC
• Head, Center of Diabetes, Endocrinology and
  Metabolism
• Childrens Hospital Los Angeles
• President, American Diabetes Association

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Burden of Diabetes in USA

• 17 Million Americans Have Diabetes
• 16 Million Americans Have Prediabetes
• 210,000 Diabetes-Related Deaths/year
• Leading Cause of Blindness, Kidney Failure,
  Amputation
• 65 Cardiovascular Disease-Related Death
• Cost 132 Billion/2002

Mokdad, et al, JAMA 2001 286,1195
3
Diabetes Prevalence Among Minority Populations in
the U.S.
Percentage of each population with diabetes
Non-Hispanic Whites
Latinos
African Americans
Native Americans Alaska Natives
7.8 (11.4 million)
10.2 (2 million)
13 (2.8 million)
15.1 (105,000)
?
Asian Americans and Pacific Islanders are 2-5
times more likely to have diabetes than
Non-Hispanic Whites.
Centers for Disease Control and Prevention (CDC)
1999 www.cdc.gov/diabetes

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Natural History of Type 2 Diabetes
Onset ofdiabetes
Geneticsusceptibility Environmentalfactors Nutr
ition Obesity Physical inactivity
Complications
Disability
IGT
Ongoing hyperglycemia
Insulin resistance
Death
Hyperinsulinemia HDL-C TriglyceridesAtheroscl
erosisHypertension
BlindnessRenal failureCHDAmputation
RetinopathyNephropathyNeuropathy
AtherosclerosisHyperglycemiaHypertension
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The Diabetes Prevention Program A Randomized
Clinical Trial to Prevent Type 2 Diabetes in
Persons at High Risk The DPP Research Group
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Study Interventions
Eligible participants Randomized Standard
lifestyle recommendations
Intensive DRUG
Placebo Lifestyle Metformin (n 1079)
(n 1073) (n 1082)
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Weight Change
Placebo
Metformin
Lifestyle
The DPP Research Group, NEJM 346393-403, 2002
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Type 2 Diabetes Prevention
Percent developing diabetes

Risk reduction 31 by metformin 58 by lifestyle
All participants
All participants
Lifestyle (n1079, pPlac )
Metformin (n1073, p40
Placebo (n1082)
30
Placebo
Metformin
Cumulative incidence ()
20
Lifestyle
10
0
0

1

2

3

4
Years from randomization
The DPP Research Group, NEJM 346393-403, 2002
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Prevention of Type 2 with Lifestyle Intervention
Tuomilehto, et al , Turku ADA 2000

• Intervention 523 IGT, mean age 55, BMI 31
• Diet, exercise, frequent visits vs advice yearly

Incidence of diabetes reduced 58 (p.0003)
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DIABETES INCIDENCE IN PREVENTION STUDIES
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• Translation of the
• DPP Results

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ADA/NIDDK Screening Recommendations For
Prediabetes in AdultsDiabetes Care, 252002

• Case Finding
• Test
• 45 years, BMI 25 kg/m2
• 9 lbs,
  dyslipidemia, hypertension, non-Caucasian
• At 3 yr intervals, if negative

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ADA/NIDDK Recommendations In AdultsDiabetes
Care, 252002

• How to Test
• In context of health care visit
• FPG, 2-h OGTT
• Intervention
• Prediabetes counsel for weight loss and PA,
  Follow-up counseling
• Monitor for DM q 1-2 years, CVD risk factors
• Avoid drug therapy

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What Children Should be Tested ADA/AAP
RecommendationsDiabetes Care 232000

• Age 10 years or onset of puberty
• BMI 85th
• First or Second Degree Relative
• Race/Ethnic Group
• Signs of Insulin Resistance
• Acanthosis nigricans
• Hypertension
• PCOS
• Dyslipidemia

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Small Steps Big Rewards
Diabetes Prevention Program For People at High
Risk

• Weight Loss
• Diet
• Exercise
• Lower Risk for Diabetes

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Studies to Treat Or Prevent Pediatric Type 2
Diabetes(STOPP-T2D)
Funded by National Institute of Diabetes and
Digestive and Kidney Diseases National Institutes
of Health
TODAY
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Weight Loss Reduces Medical Costs

• Costs of diabetes 132 billion (2002)
• Direct Costs 5.7 National Health Expenditure
• 7 10 Weight Loss
• 58 Reduction in Diabetes
• Treatment Cost Reduction
• 123 for the insulin-treated patient/month
• 61 for the hyperlipidemic patient/month

(Wolf AM, Colditz GA. Obes Res. 1998) (Greenway
FL, et al. Obes Res. 1999)
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GLOBAL PROJECTIONS FOR THE DIABETES EPIDEMIC
2000-2010
26.5 32.9 24
14.2 17.5 23
84.5 132.3 57
9.4 14.1 50
1.0 1.3 33
15.6 22.5 44
World 2000 151 million 2010 221
million Increase 46