How to avoid diabetes

One of the nasty consequences of aging (in North America at least) is the development of adult-onset diabetes (type 2 diabetes).  Linked to weight gain, this form of diabetes is so prevalent that it is commonly described as an epidemic.  The US Centers for Disease Control and Prevention estimate that over 21 million Americans alone suffer from this form of diabetes at present.

The first line of treatment for at risk patients is often the orally-administered drug metformin – an effective drug with a good side-effect profile.  It’s hoped that metformin will help these patients avoid the descent into full diabetes or delay it as long as possible.  Clinical evidence for metformin’s efficacy is good but what happens when patients are dosed over many years?  Is the treatment effect maintained?  Are there even better ways to control the development of adult onset diabetes?

A recent study published in The Lancet compared three possible treatments for patients at high risk for developing type 2 diabetes over a 10 year period:

• Lifestyle modification (diet and exercise)
• Metformin
• Placebo

The results showed that metformin is indeed an effective drug in preventing the progression to type 2 diabetes over the long term.  Placebo was, predictably, a poor choice.  The somewhat surprising outcome was that lifestyle modification was the most effective of the three regimens providing sustained improvements over the 10 year window:

• Placebo = 11.0 news cases of diabetes/100 person years
• Metformin = 7.8 new cases of diabetes/100 person years (31% reduction)
• Lifestyle change = 4.8 new cases of diabetes/100 person years (58% reduction)

This publication showed that diet and exercise, if properly adhered to, can arrest the development of type 2 diabetes.  It would be reasonable to suggest that diet and exercise should be the gold standard treatment for high risk patients from now on with metformin used as a second line for those who cannot (or will not) adhere to the lifestyle changes required.

For patients with morbid obesity and adult onset diabetes, the use of a lap band (surgically-implanted band which restricts the stomach size) has also produced dramatic improvements including reversal of pre-existing diabetes.

Diabetes is just one of the many diseases of aging. And we know that there’s a huge demographic change headed our way. Wondering how we’ll cope with the economic burden of a rapidly aging society?  Find out more at the MaRS Business of Aging conference.