Diabetes treatment, research & cure

Ebony, March, 2005 by Kevin Chappell

IT'S the fifth deadliest disease in the United States, and it has no cure. In fact, diabetes has become so insidious--striking more people than ever, and at an earlier age than ever--that medical and nutrition experts say it has reached pandemic levels.

Look at the numbers. Nearly 3 million--or 1 out every 10--African-Americans aged 20 and older have diabetes. Perhaps the hardest hit group is African-American women. One in 4 Black women over 55 years of age have the disease. Blacks are nearly twice as likely to have diabetes than the general population, and are twice as likely to develop some of the most life-threatening consequences of the disease.

Then there's the cost. One of the most expensive diseases to treat, diabetes-related medical costs totaled $132 billion in 2002. But more than that, it was estimated that when disability, work loss and premature mortality are added in, diabetes cost America another $40 billion. In the end, 1 out of every 10 health care dollars is spent on diabetes.

But there is hope. Cutting-edge research and earlier recognition of symptoms, combined with new combinations of medications and a team approach to tackling the disease, are helping people with diabetes live longer, and healthier lives.

RISING RATE AMONG ADOLESCENCE

Living longer and healthier is increasingly important because diabetes is striking at a much earlier age. Hard hit are today's youth, who are vulnerable because they, on average gain more weight and less physically active than past generations. With calories coming from and processed foods, less physical activity cause of computer games and TV, youngsters not only eat more, but also burn fewer calories.

It all adds up to an increased possibility of developing diabetes at an earlier age. While genes have always played a role in type 2 diabetes, doctors say the combination of increased weight and decreased exercise promotes diabetes, particularly in African-American youths, that might otherwise have been kept in check.

One of the most recognizable signs of a child with diabetes is thick, darkened skin around the neck or on other body parts that are frequently bent or rubbed. It's a condition called acanthosis nigricans. Scientists once believed acanthosis nigricans was associated with conditions such as polycystic ovarian syndrome, but recently they found that it is a marker for high levels of insulin.

Health experts say you should also watch for signs of diabetes itself (for example, increased desire for liquids, increased urine output, unusual tiredness, or a quick but unexplained drop in weight). While there are no guarantees, an active lifestyle and healthful weight seems to be the most important factors in warding off diabetes in youths.

THE SEARCH FOR A CURE

While insulin was discovered in 1921, it's only now that scientists are really beginning to understand how it truly works. Research today focuses on understanding ways to prevent diabetes and to more effectively treat complications.

Scientists are using genetics to understand type 2 diabetes and obesity, particularly fat cells, to develop new therapeutic and prevention strategies. There is also interest in the research community in the growth of pancreatic beta cells and their potential clinical use for treatment of type 1 diabetes.

With diabetes medication, studies are being conducted to determine why some people respond to certain diabetes drugs while others do not. There are also trials being conducted on new noninvasive blood glucose monitors.

Meanwhile, molecular studies of fat cells and how insulin works, as well as studies of growth hormone replacement in adults, offer some promise. In addition, new video technology is allowing clinicians to watch blood flow in the eye during examination, allowing earlier diagnosis of even small changes.

A nationwide study is also underway to determine if type 1 diabetes can be prevented or delayed in high-risk individuals by the use of small amounts of insulin injected daily, and in moderate-risk people by the use of insulin crystals taken orally.

Research studies have found that lifestyle changes, such as diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week), can prevent, reverse or delay the onset of type 2 diabetes in high-risk adults. In fact, in the American Diabetes Association's Diabetes Prevention Program, which studied people at high risk for diabetes, the development of the disease was reduced 58 percent over a 3-year period.

Some of the most important scientific initiatives in the diagnosis and treatment of diabetes have been the result of research at the Joslin Diabetes Center, which works closely with the American Diabetes Association to coordinate research and develop treatments.

Dr. Alan R. Shuldiner heads the Division of Endocrinology, Diabetes and Nutrition at the Joslin Diabetes Center at the University of Maryland School of Medicine. Utilizing candidate gene and positional cloning approaches, Dr. Shuldiner, in a 5,000-square-foot, state-of-the art laboratory, searches for genes susceptible to diabetes and obesity, as well as gene variants that may predict responsivity to medications used to treat diabetes. Breakthroughs in these areas will provide unique avenues for therapy and prevention.