Prevent Diabetes with Lifestyle: Study

An important study was published in November 14th's edition of the Lancet medical journal, which proves that diabetes can be prevented with lifestyle changes, and that this benefit can persist over the long term.

This study is called the Diabetes Prevention Program Outcome Study (DPPOS), and is a follow up to the landmark Diabetes Prevention Program initial study (DPP) that was published in 2002 in the New England Journal of Medicine.

The DPP was a study of over 3,000 prediabetics who were randomized to received either intensive lifestyle counseling, a diabetes medication called metformin, or placebo treatment, to see how effective these strategies were in preventing progression to full blown diabetes. The DPP trial was stopped prematurely, because the evidence for the superiority of the lifestyle intervention was already clear. After an average of 2.8 years, the lifestyle group had a 58% lower rate of development of diabetes than the placebo group, which was even better than the metformin treated group, who had a 31% lower rate of development of diabetes than placebo. Weight loss was also superior in the lifestyle group at 5.6kg, compared to 2.1kg in the metformin group, and 0.1kg in the placebo group.

In the DPPOS follow up study, all patients were offered lifestyle therapy, similar to the initial lifestyle group of the DPP, but in a less intense format. Placebo was stopped, and the metformin group continued their metformin.

During the 10 year follow up in the DPPOS, the original lifestyle group regained most of their weight, which may be related to the less intense nature of the DPPOS lifestyle program. Both the metformin and the original placebo groups lost a bit of weight (with the onset of the lifestyle program), but gained it back. As such, there was no significant difference in weight between the 3 groups at the end of the DPPOS.

However, despite there being no difference in weight, there continued to be a lower overall rate of onset of diabetes in the original lifestyle and metformin groups: they still had a 34% and 18% lower incidence of diabetes than the original placebo group, respectively. In other words, the original intensive lifestyle undertaken in the first 2.8 years of this study delayed diabetes onset by 4 years, and metformin delayed diabetes onset by 2 years.

Furthermore, although the diabetes incidence was highest in the placebo group overall, the rate of onset of diabetes in both the placebo and metformin groups fell to equal the rate of onset in the original lifestyle group, due to the institution of lifestyle therapy at the start of DPPOS. This points again towards the benefits of lifestyle in prevention of diabetes.

The bottom lines:

• Effectively changing your lifestyle in favor of healthy eating and increasing exercise is beneficial to prevent diabetes.

• The more intensive the support and counseling in making these changes, the more effective that program is to prevent diabetes.

• Even if an intensive support program is not feasible for the very long term, the benefits of diabetes prevention during the time of the intense program are still maintained over the long term!

Dr. Sue © 2009 www.drsue.ca drsuetalks@gmail.com

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The SLEEP AHEAD Study: Weight Loss Improves Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a huge problem. Did you know that 25% of adults are at risk of having OSA? Amongst obese type 2 diabetics, a whopping 86% suffer this disorder. Even worse - many don't know that they have it.



In obstructive sleep apnea, breathing is abnormal during sleep because of narrowing or closure of the throat; this results in air movement being periodically diminished or stopped. It is a serious condition that can affect a person's ability to safely perform normal daily activities and can affect long term health.

It is a well known fact that obesity increases the risk of developing obstructive sleep apnea, and as such, it would make sense that weight loss would improve OSA; however, this had not been definitively proven - until this week.

In the Archives of Internal Medicine, Gary Foster and colleagues published results from their SLEEP AHEAD study. They enrolled 264 overweight or obese patients with type 2 diabetes, and randomized them to receive either a portion controlled diet plus a moderate exercise program, versus three group diabetes education sessions without a specific weight loss plan, for a 1-year period. People in the diet group lost 24 lbs, compared with just over 1 lb in controls. Overall, there was a marked improvement in OSA in the diet group, while OSA worsened in the control group, despite not gaining weight. In addition, more than three times as many participants in the diet group had total remission of their OSA compared to the control group.

Take home messages here are:

1. If you have a risk factor for OSA, or symptoms of OSA, speak with your family doctor about it, as OSA is often underdiagnosed. Risk factors include overweight, male gender, increasing age, and use of sedative medications. Symptoms can include restless sleep, morning headaches, awakening with a choking sensation, awakening feeling unrested, and having difficulty concentrating.

2. We now have clear evidence that in overweight individuals, weight loss improves OSA. Though this study was conducted in diabetics, it is likely that this weight loss benefit would extend to non diabetics as well.

3. A big weight loss and significant improvement in OSA was seen using simple measures: portion control and moderate exercise! Portion control in this study was in the form of liquid meal replacements, snack bars, and portion controlled meals (such as Healthy Choice and Lean Cuisine), which are great options; a portion control plate is a good choice as well!

Dr. Sue © 2009 http://www.drsue.ca/ drsuetalks@gmail.com

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Does Insulin Glargine Cause Cancer?

Both Health Canada and the FDA are undertaking a safety review of insulin glargine (trade name is Lantus ©), in response to four studies that were published in this month's Diabetologia journal. Three of these four European observational studies suggested that there may be higher rates of cancer amongst patients who use Lantus insulin.

Lantus is one of two long acting synthetic insulins (the other is insulin detemir, trade name Levemir ©). Levemir © was not studied in the above mentioned studies, because it is a newer insulin that was not available at that time. These insulins have been altered from long acting human insulin (known as N or NPH insulin), resulting in different actions of these insulins, with benefits including a longer duration of action and lower risk of low blood sugars (hypoglycemia) compared to human insulin.

Some studies have suggested an increased risk of cancer in all patients with diabetes (on any kind of treatment), though the common denominator here may be obesity (obesity is a well known risk factor for several types of cancers). People with type 2 diabetes (particularly in the earlier years) and people who are overweight or obese often have high insulin levels, also known as insulin resistance. Insulin is an important growth factor, for example for cells that line the colon; in fact, insulin has been shown to stimulate colonic tumor cells. So, insulin in general, whether produced internally, or given as a treatment of diabetes, may be associated with an increased risk of cancer.

So how does Lantus © play into all of this? Lantus © is known to interact with insulin growth factor receptors to a higher degree than other insulins, which could theoretically be associated with increased cancer risk. However, it has to be taken into consideration that these recent studies were observational only, and therefore not high quality data (in other words, not something we can hang our hat on).

The bottom line is, that we do not know at this time whether Lantus © increases cancer risk. Health Canada and the FDA are doing the right thing by looking into this issue. In the meantime, it is important not to take extreme reaction to information that is highly debatable. If you are taking Lantus ©, it is important that you do not simply stop taking it, as not treating your diabetes can lead to dangerously high blood sugars. If you are concerned, please speak to your doctor about the issue, and make a decision about your diabetes treatment that is best for you.

Dr. Sue © 2009 http://www.drsue.ca/ drsuetalks@gmail.com

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What's YOUR risk of getting Type 2 Diabetes?

Alongside the obesity epidemic in our society and across the globe, type 2 diabetes has also become - pun intended - a large and growing problem. Nearly 2 million Canadians have diabetes, and even more alarming, as much as 3% of the adult population are walking our streets with diabetes, but don't know that they have it.

One of those people could be you.


Also worrisome is the fact that by the time most people with type 2 diabetes are diagnosed, they have had it for 5-7 years, but did not know it. This is because in many cases, type 2 diabetes can be more or less without symptoms for a number of years, so if an individual does not see their doctor for regular checkups, the diabetes is not detected. Unfortunately, even though there can be little in the way of symptoms, the diabetes is still very active behind the scenes, causing damage to the heart, kidneys, eyes, and nervous system.

The British Medical Journal has recently published a tool called the QDScore, that you can use to calculate your approximate risk of developing Type 2 Diabetes over the next 10 years. This diabetes risk calculator is based on British data from over 2.5 million people, and is valid for use for people between the ages of 25-79. Although it is based on British data, it should still give a very reasonable estimate for Canadians.

To use the calculator, you need to know your weight in kg, and your height in cm.

Weight in kg = Weight in lbs/2.2

Height in cm = height in inches x 2.54(there are 12 inches to a foot, so someone who is 5 feet 4 inches = 64 inches = 163 cm)

So, you've calculated your risk. Now what? See your doctor to talk about it. Your MD will likely elect to test you for diabetes with blood tests, and if negative, you can build a strategy of diabetes prevention together. Should you happen to be one of those 3% with previously undiagnosed diabetes - then you and your doctor can tackle the issue head on, and get started on a treatment plan without delay.

While this risk calculator is a useful tool, it does not replace a visit to your doctor. It is important to see your doctor for regular check ups - but it doesn't hurt to come prepared with this extra information. Knowledge is Power!

Dr. Suehttp://www.drsue.ca/ © 2009 drsuetalks@gmail.com

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What IS Diabetes?

Diabetes mellitus, usually referred to simply as diabetes, is a condition characterized by abnormally high blood glucose (sugar) levels. Blood glucose is normally controlled by a complex interaction of several hormones, the most important of which is insulin, which is produced in the pancreas and works to assist the movement of glucose out of the bloodstream and into our cells.

There are two types of diabetes. Type 1 diabetes (T1DM) is a condition where the pancreas stops producing insulin. This happens because of a glitch in the immune system, where the immune system mistakes the insulin producing cells of the pancreas (called beta cells) as foreign, and attacks them, causing failure and eventually absent insulin prodution. T1DM has onset most commonly in children or young adults.

Type 2 diabetes (T2DM) is caused by a problem that we call 'insulin resistance'. This means that the body's cells need higher levels of insulin to assist movement of glucose into the cells. This puts the pancreas into a state of overdrive, in that it has to work extra hard to make enough insulin to push glucose into the cells and thereby maintain normal blood glucose levels. When the pancreas simply cannot make enough insulin to overcome the insulin resistance, blood sugars start to climb and T2DM results. One of the most important risk factors for T2DM is obesity, because the more a person weighs, the higher their insulin resistance. The onset of Type 2 diabetes has traditionally been seen amongst older individuals, but with the prevalence of obesity on the rise, we are seeing T2DM in younger adults, and even in children.

Dr. Sue © 2009 drsuetalks@gmail.com

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