Diabetes care in the years ahead

        Diabetes remains a major national health problem, affecting 20.8 million citizens and contributing to about 224,100 deaths each year, according to the American Diabetes Association. In fact, diabetes is a major risk factor for cardiovascular disease (CVD), heart attack and stroke; nearly 65 percent of diabetes patients eventually die of CVD.
        The good news is that breakthroughs in genetics, surgery and medicine have led to greatly improved treatment for this often deadly but sometimes preventable disease. And more advances are on the horizon.

Two main types
        Diabetes develops due to chronic shortages of insulin, a hormone from the pancreas that transfers glucose (blood sugar) from the liver into cells to make energy.
        Some people with diabetes are type 1: Their bodies have mysteriously “shut off” their pancreas’s ability to make insulin. People with type 1 diabetes must take daily insulin injections to keep blood sugar levels stable. Still, they account for no more than 5 percent of patients.
        The overwhelming majority—about 95 percent—have type 2, in which the pancreas either can’t make enough insulin (requiring insulin shots) or the patient becomes “insulin resistant” and doesn’t process insulin correctly.
        You can’t prevent type 1 diabetes because it’s genetically programmed. But evidence suggests you can use preventive measures to avoid or delay the onset of type 2 diabetes. Consider, for instance, that 80 percent of people with type 2 diabetes are overweight. Doctors now know that obesity and elevated LDL (“bad”) cholesterol, which interferes with insulin, are major risks for developing the disease. Other major risks are lack of exercise, poor diet and smoking.

The heart disease link
        The American Heart Association now recognizes diabetes as a major risk factor for heart disease. Some doctors go further, stating that type 2 diabetes is a form of heart disease. That’s why heart-healthy lifestyle changes that fight cardiovascular disease are now the first line of preventive defense against diabetes, too.
        This strategy got a boost when a major study found that eating more fruits and veggies, doing 150 minutes of exercise a week and losing 10 to 15 pounds of excess weight cut patients’ risk of developing type 2 diabetes by 50 percent.

On the horizon
        People with type 2 diabetes already have powerful new drugs that help “push” insulin into cells, speed up the pancreas’s output of insulin or slow down the liver’s release of glucose. Combined with weight control, exercise, a healthy diet and special care, these drugs often free type 2 patients from needing insulin shots. Look for more progress ahead as scientists perfect exciting new diabetes treatments including:
        • No-needle insulin. Insulin can’t be taken orally ... yet. Scientists are working on insulin pills as well as nasal sprays, patches, eye drops and slow-release gels, making needle-free insulin only a matter of time.
        • Long-lasting insulin. New types of injectable insulin can last 24 hours.
        • Smart pumps. Worn on the belt, such a device takes over the job of glucose monitoring and automatically pumps the correct amount of insulin under the skin around-the-clock.
        • Smoother transplants. Though pancreas transplants are performed, they often are unsuccessful due to rejection. New post surgical drugs can prevent rejection.
        • Bioengineering. Scientists hope to develop stem cells or modified T-cells that will coax the pancreas into making sufficient insulin.

Without warning—sometimes
        Diabetes, especially type 2, is a slow-to-develop disease that sometimes has no symptoms until it’s been in the body for years. But two symptoms—constant thirst and frequent urination—are often its first signs as excess glucose in the bloodstream draws water from your tissues. Others that also merit a trip to your physician:
        • flu like symptoms such as muscle aches, weakness or fatigue
        • sudden unexplained weight gain or loss
        • vision problems
        • frequent infections, especially of the bladder or vagina
        • slow-healing sores
        • inflamed, painful gums
        • nerve damage—tingling in the extremities, burning leg pain