What Did We Learn About Diabetes in 2011?

Gregory A. Nichols, PhD

Disclosures

November 23, 2011

In This Article

Game-Changing Research in Diabetes

Although a "cure" for diabetes remains elusive, researchers made significant strides in expanding our knowledge of diabetes this past year. The following review covers studies that have changed or will change the management of diabetes as well as efforts to prevent the disease and, eventually, find a cure.

Preventing Diabetes to Prevent Cardiovascular Disease

The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in persons without known CVD at baseline.

Yeboah and colleagues[1] used data from the MESA baseline exam and follow-up exams to clarify the associations of impaired fasting glucose (IFG) with type 2 diabetes and CVD. During 7.5 years of follow-up, type 2 diabetes was associated with increased CV incidence after adjustment for demographics and traditional risk factors compared with subjects not having type 2 diabetes. IFG was not associated with incident CV events in the full multivariate model compared with normal fasting glucose. IFG was strongly associated with development of type 2 diabetes.

Why Is This a Game Changer?

Diabetes is a known risk factor for CVD and is considered a CVD "risk equivalent".[2] But whether CVD risk is increased in the presence of hyperglycemia below the threshold for diabetes diagnosis has remained unclear. Two meta-analyses found a likely association between IFG and CVD risk, but those studies were performed because individual studies did not garner clear results.[3,4]

The current study by Yeboah and colleagues suggests that the association between IFG and CVD risk is likely due to the coexistence of traditional CVD risk factors in persons with IFG. Thus, the threshold of fasting glucose that is independently associated with CVD risk may be above the threshold for a diabetes diagnosis.

In that context, prevention of diabetes takes on new meaning. Patients with diabetes generate considerable costs relative to patients without diabetes, largely because of the complications associated with the disease.[5] CVD remains the leading cause of morbidity and mortality among patients with diabetes, and the costs associated with CVD are enormous.[6] This study suggests that preventing diabetes would result in significant cost savings, not to mention the improvement in quality of life that results from reduction in morbidity and mortality.

What Does This Mean for the Practitioner?

We've known for several years now that prevention or delay of diabetes is possible through lifestyle changes or use of metformin.[7] However, there is evidence that identification of high-risk patients is still poor, and subsequent prevention efforts are lacking.[8] Both patients and clinicians may be inclined to deal with diabetes when it arrives, rather than preventing its arrival, perhaps because the benefits of prevention have not been elucidated.

Here, we have evidence that prevention does indeed matter. If avoiding diabetes is not sufficient motivation for patients to take the necessary preventive steps, perhaps avoiding CVD may provide further impetus. If so, clinicians may be able to use these results to encourage patients to engage in helpful lifestyle modifications.

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