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APPROACHES TO PREVENTING DIABETES

By Sean Henahan, Access Excellence


SAN FRANCISCO- June 10, 1996- New treatment strategies suggest it may be possible to prevent Type II, or non-insulin dependent diabetes (NIDDM), according to several reports at the annual scientific meeting of the American Diabetes Association.

Type II diabetes accounts for more than 90% of all cases of the disease. It is most often seen in older, sedentary overweight individuals. Unlike Type I diabetics, people with Type II do continue to produce insulin, the hormone that regulates sugar metabolism, but are unable to use it effectively. This condition known as insulin resistance, has become the focus of several therapeutic strategies.

CHROMIUM CURE?

A USDA sponsored clinical study conducted in China suggests it may be possible to treat the disease with the micronutrient chromium.

Adult NIDDM patients receiving chromium picolinate (a bioavailable form of the element) saw their blood sugar levels drop to within the normal range after two or three months of daily therapy. No such improvement was seen in patients receiving a placebo. Glycated hemoglobin, considered the most sensitive measure of diabetes control dropped significantly in patients taking the supplement.

"By adding chromium picolinate to the diets of these Chinese patients, who were not well-controlled on medication alone, we were able to help them achieve a more normal lab profile," said Richard Anderson, Ph.D., the leading chromium researcher at the US. Department of Agriculture's Human Nutrition Research Center, Beltsville, Md. "We now need to see if these results can be replicated in patients with diabetes in this country."

"These are improvements to the level of good control. It's as good as what we currently have available--oral hypoglycemic agents, diet and exercise. If further research confirms these numbers, chromium supplements could be an add-on therapy to current treatments to further lower blood glucose, noted Lois Jovanovic-Peterson, a physician specializing in diabetes and a senior scientist at the Sansum Medical Research Foundation in Santa Barbara, Calif.

The people taking chromium also showed significant drops in cholesterol and plasma insulin. People with type II, or maturity-onset, diabetes produce more insulin than normal in the early stages of the disease, Anderson explained, because the hormone is less efficient at clearing glucose from the blood. Chromium apparently makes the hormone more efficient.

NEW PREVENTION STUDY

Researchers from the NIH and the American Diabetes Association announced the launch of the largest diabetes prevention study ever conducted, the "Diabetes Prevention Program." The study is based on the observation that individuals with a condition called impaired glucose tolerance (IGT) are at high risk to develop Type II diabetes. The six year study is now enrolling 4,000 volunteers with IGT at 25 centers throughout the US. These volunteers will be randomly assigned to receive either a drug treatment that reduces IGT and insulin resistance (metformin or troglitazone), or to a lifestyle modification program aimed at losing weight and getting more exercise. A control group will receive placebos. Researchers will determine whether these interventions can prevent or delay the onset of diabetes.

The two drugs used in the study represent something old and something new. One drug, metformin has been used to treat diabetes for some 30 years. Smaller clinical studies suggest it may reduce hepatic glucose release and enhance insulin sensitivity. The other drug, troglitazone is still considered investigational. It appears to enhance insulin sensitivity quite specifically.

"Approximately 21 million Americans have higher than normal blood sugar levels or IGT. Most of these people don't know they have IGT and that they may be at risk for developing Type II diabetes sometime during their lives," said Phillip Gorden, M.D., director of the National Institute of Diabetes and Digestive and Kidney Diseases, at an ADA press conference.

The study will attempt to enroll those most at risk for developing Type II diabetes. This includes anyone with a family history of diabetes and IGT, as well as African Americans, Hispanic Americans, Native Americans and Asian and Pacific Island Americans.

Those interested in participating in the Diabetes Prevention Program can call: 1-888-DPP-JOIN (1-888-377-5646).

INSULIN RESISTANCE PROTEIN

On the genetic research front, investigators have identified a protein called PC-1 that appears to be linked to insulin resistance.

UC San Francisco researchers obtained abdominal muscle tissue from type II diabetic patients and non-diabetic patients who underwent elective surgery. The researchers found that independent of diabetes, excess body fat was associated with higher cellular levels of PC-1 and insulin resistance.

The protein reduces glucose uptake by blocking the function of an enzyme that activates signaling inside the cell by the insulin receptor.

The new results suggest a causative role for PC-1 in insulin resistance says Ira Goldfine, MD, professor of medicine and physiology and director of the Division of Diabetes and Endocrine Research at UCSF/Mount Zion Medical Center,. In addition, the number of insulin receptors on the muscle cells also was significantly associated with insulin resistance in the new study, he noted.

Goldfine said it may be possible to develop drugs that target PC-1 to successfully treat type II diabetes in a significant percentage of cases:

"The aging of the population and the prevalence of obesity and sedentary lifestyles is leading to a rise in the incidence of type II diabetes, much of which goes undiagnosed. Our work suggests the protein PC-1 has a role in the failure of many obese individuals to respond normally to insulin. Since this insulin resistance is a profound risk factor for the development of diabetes, and now also appears to be implicated in processes that independently lead to heart disease as well, we want to know more about how PC-1 works."


Related information on the Internet

USDA

American Diabetes Association

Chromium Information Bureau

National Institute of Diabetes and Digestive and Kidney Disease


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