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Old 06-10-2012, 16:43   #1
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2012 ADA Diabetes Dispatch - Sunday

Especially the next to the last paragraph where some doctor says that "on a long-term basis lifestyle changes won't work". Ohhhhh.....I wonder who's being paid by a pharmaceutical company????

They should be attacking the food companies for putting HFCS in everything that led to the huge increase in type 2, but instead they're finding ways to say that inexpensive drugs like Metformin and lifestyle changes won't work. I wish I could wring some necks!

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Old 06-10-2012, 18:02   #2
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Of course they'll argue that metformin is less effective . . . nobody can make any money on it. This is just more talking heads acting like they know something about managing this.

Did you happen to browse around the home page of professional.diabetes.org? Here's what they have to offer about diagnosis:
Quote:
Some patients cannot be clearly classified as having type 1 or type 2 diabetes. Clinical presentation and disease progression vary considerably in both types of diabetes. Occasionally, patients who otherwise have type 2 diabetes may present with ketoacidosis. Similarly, patients with type 1 may have a late onset and slow (but relentless) progression of disease despite having features of autoimmune disease. Such difficulties in diagnosis may occur in children, adolescents, and adults. The true diagnosis may become more obvious over time.
Hello? Can they spell LADA? Can they use the GAD & c-peptide tests?




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Old 06-10-2012, 19:27   #3
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Diana, your link does not appear to work...I was curious to read it.




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Old 06-10-2012, 20:36   #4
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It seems to be a type of file more like a .pdf which takes more time to load. See if this one opens any easier:

Experts to debate adequacy of drugs and lifestyle therapy in managing prediabetes | ADA 2012




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Old 06-10-2012, 21:02   #5
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All I get on my iMac is a blank page no matter how long I leave it open, so thanks so much for the second link.




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Old 06-10-2012, 22:17   #6
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All I get on my iMac is a blank page no matter how long I leave it open, so thanks so much for the second link.
It's [email protected]#$%^& Flash, so if you don't have an up-do-date plugin for your browser, it's not going to work. Apple is no longer automatically installing Flash readers because of some nasty exploits.

 
Old 06-10-2012, 22:59   #7
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Yeah - I'm having a go-round with Adobe myself this week . . . just this afternoon I dumped all of it & will only reinstall what seems truly essential.




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Old 06-11-2012, 00:34   #8
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Sorry for those unable to open that file...this should work!

This afternoon’s symposium on The Role of Pharmacology in Managing Prediabetes will feature a debate of the pros and cons of prescribing lifestyle changes and metformin for individuals with prediabetes and at risk of developing type 2 diabetes.

The two-hour symposium, which will begin at 4:30 p.m. in Room 201, will feature two experts with different views on the adequacy of lifestyle changes and metformin.

“I will describe how effective lifestyle changes and metformin are in preventing diabetes using data from the Diabetes Prevention Program (DPP), the Finnish Diabetes Prevention Study (DPS), and other research,” said Richard F. Hamman, MD, DrPH, Professor of Epidemiology at the Colorado School of Public Health at the University of Colorado, Aurora.

“In both the DPP and the DPS, lifestyle changes were shown to reduce the incidence of diabetes by 58 percent three years after randomization. At long-term, 10-year follow up, the DPP shows that lifestyle changes remain effective and decrease diabetes incidence by 34 percent,” said Dr. Hamman, who is the National Vice Chair of the Diabetes Prevention Program.

“Metformin is somewhat less effective than lifestyle changes, but is still very effective long-term and reduced diabetes incidence by 31 percent in the DPP,” he continued. “It was also responsible for long-term, stable weight loss of about 2 to 3 kilograms.”

Preventing diabetes is the most effective way of preventing the complications of diabetes, Dr. Hamman said, so using effective and cost-effective prevention tools and techniques is essential.

“In the Diabetes Prevention Program we had great lifestyle coaches, but there are more cost-effective ways to help patients make lifestyle changes,” he said. “However, it’s not just something you can do with a pamphlet and a couple of words about it in office practice. It takes real involvement of trained individuals to do a lifestyle program.”

But not everyone is convinced that lifestyle changes and metformin are adequate. Ralph A. DeFronzo, MD, Professor of Medicine and Chief of the Diabetes Division at the University of Texas Health Science Center at San Antonio, believes that lifestyle changes are not effective long-term for most patients and metformin is not potent enough.

“In order to prevent the development of type 2 diabetes, we need to start early at the prediabetic stage and intervene with drugs that reverse specific pathophysiologic disturbances,” Dr. DeFronzo said.

“Although metformin does have an effect on the liver, it is not a very potent insulin sensitizer in muscle and it has no effect on preserving beta cell function,” he explained. “On a long-term basis, this drug is not going to work. On a short-term basis, it will have efficacy. Just as metformin fails to control glucose in type 2 diabetes, it will fail in the prediabetic stage.”

Dr. DeFronzo recommends using other drugs, including the GLP-1 analogs and the thiazolidinedione (TZD) agent pioglitazone, to improve beta cell function and insulin sensitivity.

“From the pathophysiologic standpoint, the drugs that work best are the TZDs and the GLP-1 analogs,” he said. “We already have five big studies showing that the TZDs work not only in the long-term, but they are also associated with dramatic reductions in diabetes. TZDs are two or three times more effective than metformin, and we know from several studies that they have powerful effects to improve insulin sensitivity and to stabilize beta cell function.”

Dr. DeFronzo acknowledges that metformin is relatively cheap to purchase, which raises the issue of cost versus benefit.

“Metformin is eventually going to fail in the long-term, whereas the more expensive drugs are very likely to continue to work on a long-term basis, although that needs to be proven by studies that follow at-risk individuals for three to five years or longer,” he said. “If patients’ blood sugar levels don’t go up and they don’t develop diabetes, they are not going to develop the complications of diabetes.”

Regarding lifestyle changes, Dr. DeFronzo said, “I think it’s very clear that on a long-term basis, lifestyle changes just don’t work. Most people regain the weight they lost once they are out of a lifestyle program.”

A third speaker, Ronald T. Ackermann, MD, MPH, Associate Professor in Medicine–General Internal Medicine and Geriatrics at Northwestern University’s Feinberg School of Medicine, Chicago, will tackle the question, “Who Will Pay for Prevention?”

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Old 06-11-2012, 01:21   #9
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If I'm reading correctly, the missing piece is this: How can clinicians help diabetics learn self-management?

Any "lifestyle program" that does not provide for (or, heck, consist solely of) providing patients with the tools to create their own healthy diabetic lifestyles will definitely fail over time, if not immediately. (See The "Well, Duh!" Principle.)

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Old 06-11-2012, 01:30   #10
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If I'm reading correctly, the missing piece is this: How can clinicians help diabetics learn self-management?

Any "lifestyle program" that does not provide for (or, heck, consist solely of) providing patients with the tools to create their own healthy diabetic lifestyles will definitely fail over time, if not immediately. (See The "Well, Duh!" Principle.)
And it's extremely condescending to assume that everyone will fall off the wagon and just shove strong medications down their necks from the word go. I'm prepared to take medications if that is the only solution, but I do expect to be given the chance to try other methods first. And that's where the prediabetes discussions should be between doctor and patient. Even if it only works for 40% for six-10 years, it's got to be better for the patients and the healthcare system. And if those 40% find it works and tell their friends...

 
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