by Daniel Einhorn, MD
Unlike Type 1 diabetes, which is an autoimmune disease, type 2 is greatly affected by obesity and lack of exercise. Accounting for over 90 percent of people with diabetes, type 2 usually occurs in adults, but is on the rise among teens and children as obesity becomes more common in these groups.
Underlying type 2 diabetes is insulin resistance, a disorder that includes multiple risk factors for cardiovascular disease, which by far is the most common complication of type 2 diabetes.
People with insulin resistance maintain normal blood sugars initially because they make large amounts of insulin to overcome the resistance. One in five goes on to diabetes when they can no longer sustain the high insulin production.
Some people with type 2 diabetes can control it through diet and exercise. Research has found that dramatic weight loss is not always necessary to control the disease; in fact, losing just 5 to 7 percent of body weight can make a significant difference, because it helps the body use insulin more efficiently.
For those who need medication, combinations of old and new agents have been very successful if begun early in the course of type 2 diabetes.
At Scripps, we have been studying Byetta, a promising new treatment that is an analogue of a hormone naturally produced in our bodies. Byetta not only helps to control blood sugars, it also reduces hunger.
People have lost a substantial amount of weight using the drug, and some have even been able to taper their other diabetes medications. I expect Byetta to become widely prescribed for type 2 diabetes patients who need to lose weight (and most do).
Another treatment that shows great potential involves a new application of an established technology: the gastric pacemaker. Similar to those used for the heart, gastric pacemakers pace the stomach.
If we apply the appropriate current and pulsation to a specific area of the stomach, it can cause a decrease in appetite. The resulting weight loss, even in small amounts, leads to improved blood sugar levels.
At Scripps, we’ve been conducting this research in conjunction with Medtronic, a leading manufacturer of diabetes treatment devices.
We were the first in the country to implant a gastric pacemaker for the treatment of diabetes, and we anticipate that this treatment will be available to the public within the next one to two years.
For those who need insulin, the FDA recently approved a form of inhaled insulin called Exubera. Designed for people who are reluctant to inject insulin, Exubera is considered an effective source of fast acting insulin, taken at meals to control the rise in sugar with food.
The FDA also recently approved a new insulin sensitizer, muraglitazar, which not only improves the action of insulin in the body, but also improves lipids.
Another drug blocks the cannabenoid receptors thought to give people who smoke marijuana the “munchies.” Named rimonanbant (Accomplia), this drug may have potential to help with weight loss as well with type 2 diabetes.
More than 80 percent of death and disability from type 2 diabetes is a result of accelerated cardiovascular disease.
I recently returned from an international diabetes conference, where we analyzed the results of a clinical study to prevent cardiovascular disease using the diabetes drug ACTOS. An insulin sensitizer, ACTOS has been used for years to control blood sugar.
It was also hoped that it might be able to prevent heart disease through its actions on lipids and inflammation. The four-year landmark study, called PROactive, involved more than 5,000 patients in 19 European countries.
The results showed that, among people with severe heart disease, ACTOS decreased the rate of heart attack, stroke and death by over 16% percent, over and above all the other therapies these patients received.
I expect that this work and others will stimulate the development new, more effective therapies for type 2 diabetes.
This Scripps Health and Wellness information was provided by Daniel Einhorn, MD, editor of Endocrinology and Metabolism Clinics of North America for Type 2 Diabetes.