Monday, June 11, 2012


Diabetes Mellitus is a dreaded disease because it comes insidiously, and once established have long long term consequences which are very troublesome. The complications can make a patient quite sick and unwell, losing valuable job hours and also be a severe drain on a family's resources, until the end finally comes. I always tell my patients that this is a disease best prevented, and avoided.
Again, in T2 DM, we do not yet know the cause, and we try our best to identify risk factors, like obesity, family history and lifestyle factors including diet and exercise.
A just published study gives us more information.
There is a on-going program in USA called the Diabetes Prevention Program DPP ). Dr Perreautt and colleagues, using data from 1990 patients in this program, have published their findings on the Diabetes Prevention Program Outcome study ( DPPOS ), in the online edition of Lancet, June 9th.
In their study, they looked into the outcome of 3 groups of patients from the DPP cohort. All these patients selected had the criteria of pre-diabetes ( meaning fasting blood glucose of >5.7 mMols/L, but below the 8mMols/L limit for diabetes ).. They divided the 1990 patients into the treatment group ( treatment with Metformin ), the lifestyle modification group ( on diet and exercise ), and the placebo group ( which will be almost like group 2 ). They found that 6 years later, the patients who were able to normalise their fasting sugars, even if only temporary ) is less than 50% likely to develop diabetes.
The message is, if you are pre-diabetic and wish to prevent diabetes, please get you fasting blood sugar to normal ( <5.7 mMols/L ) level, even if only for a short duration. That will make you less likely to get diabetes. Of course, it is better if you can normalise if all the time.
It appears that those who after 6 years follow-up, do not get diabetes, although they are prediabetic, are the "milder" ones, and normalising their sugar, even if only for a short duration, allows us to know that this patient is less likely to get diabetes.
I see two sides to this conclusion. Yes, it is reassuring to know that if I am pre-diabetic and can get my blood sugar to normalise, I am relieved that I am less likely to get diabetes. But the other side of the coin is that, what happens if I abuse myself and go back to my "diabetogenic" lifestyle? Will I then become diabetic? This study uses Metformin ( an insulin sensitiser), which may mean that the metabolic syndrome is the reason for the pre-diabetes.
Well, interesting study to confirm what we largely know. If you have a metabolic syndrome physique, please check your fasting blood sugar. Should you be pre-diabetic, please get the sugar down, be it by drugs ( metformin ) or lifestyle. If not, you have a more than 50% chance of developing diabetes in 6 years. I think that sums it up.

No comments: