Less sugar and more of the sweet life: the Diabetes Prevention Program

Black Issues in Higher Education, Dec 11, 1997 by Eric St. John

Washington -- The Diabetes Prevention Program (DPP) is a researh study being conducted at twenty-five medical centers around the country. Sponsored by the National Institutes of Health's (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the program hopes to prove that type 2 diabetes can be prevented by altering one's lifestyle and/or medication.

"This is the first program of its type where we are actively seeking to find a way to prevent a disease and not just treat it," said David Nathan, M.D., study chairman of the DPP and director of the Diabetes Center at Massachusetts General Hospital in Boston.

Although the six-year study began last year, research sites are still recruiting participants. In fact, participants will be recruited for two more years.

Medlantic Clinical Research Center is collaborating on the project with Howard University, the only historically Black college or university involved in the study. Wayman Cheatham, M.D., from Howard University School of Medicine's Department of Endocrinology, codirects the Washington, D.C., study with Robert Ratner, M.D, head of Medlantic.

Nationally, 4,000 volunteers will be screened for the program and they must be suffering from a condition known as impaired glucose tolerance (IGT). People with IGT have blood sugars which are higher than normal but not high enough to be considered diabetes. A major risk factor for type 2 diabetics, approximately 21 million Americans have IGT. However, according to NIDDK, most them do not know they have the condition.

The program is designed for people with IGT who have fasting glucose levels between 95 and 125. Fasting glucose levels are blood-sugar measurements taken after a person has not eaten for twelve hours. Fasting glucose levels above 125 are considered diabetic; levels between 110 and 125 are considered Impaired Fasting Glucose; levels between 70 and 110 are considered normal; and levels below 70 are considered too low, or hypoglycemic.

According to Gretchen Youssef, program coordinator of the DPP study being conducted by Howard and Medlantic, it was decided that for the sake of the study, the impaired fasting glucose level should be lowered to 95. That is because someone with IGT may have a fasting glucose level of under 110 and a two-hour glucose level - taken two hours after a meal - of more than 150, which is within the range for two-hours IGT (from 141 to 190).

Of the 4,000 volunteers wanted for the program, it is planned that half of them will be women and half of them will be minorities. One quarter of the study group I will be sixty-five or older.

Its Importance

The significance of the research has wide-ranging health implications. Diabetics have trouble processing sugars within their bodies because insulin, the substance that breaks down sugar molecules in the blood, is either being produced in insufficient quantities or being ignored by the body. When sugars are not sufficiently broken down, the blood thickens and flows at a slower rate through the circulatory system. The thicker blood and slower rate of circulation affect the ability of the circulatory system to deliver oxygen to individual cells.

There are two main types of diabetes Type 1 diabetics are insulin-dependent and usually become afflicted with the disease during childhood or adolescence. They comprise between 5 percent and 10 percent of all those with diabetes. Type 2 diabetics do not necessarily require insulin and usually become afflicted after the age of forty.

After several years, diabetics begin developing other problems -- heart disease, stroke, high blood pressure, blindness, nerve damage, and kidney failure. Circulation problems related to diabetes can also result in the amputation of toes, feet, and legs. Furthermore, males can experience impotency as a result of the disease.

Finding a cure for type 2 diabetes can alleviate many of those complications. And if it can be shown that the disease can be prevented, insurance companies may be more willing to cover the cost of medication, maintenance, and education programs for diabetics.

"That's why I'm really excited about the trial," David Schade, M.D., professor of internal medicine at the University of New Mexico (UNM), told the Albuquerque journal last summer. "In five years, if I'm right, we'll see everybody preventing diabetes because it's cost effective."

Diabetes maintenance for type 2 individuals not using insulin involves self-testing for blood-sugar levels, diets low in sugar and fat, exercise, and - although not always - medication.

According to NIDDK, the number of Americans with type 2 diabetes has increased to 16 million -- 8 million diagnosed and another 8 million estimated to have the disease. Officials with the Center for Disease Control and Prevention (CDC) in Atlanta said, on October 31, that the number of persons diagnosed with diabetes has increased sixfold in forty years. In 1958, 1.6 million Americans had diabetes; in 1997 that number rose to 10 million. The CDC numbers include both type 1 and type 2 diabetics.