Obesity is making diabetes a heftier problem

Drug Store News,  Oct 10, 2005  by Michael Johnsen

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NEW YORK -- There currently are more than 20 million people with diabetes in the United States today, according to Dr. Robert Rizza, professor of medicine at the Mayo Clinic College of Medicine and president of the American Diabetes Association. And there are another 50 million who have what is called pre-diabetes, meaning they have all the risk factors but still have some time possibly to prevent full-onset diabetes.

But the number of people with diabetes represents only one-fifth of the disease state's potential. With a clear link established between being overweight and being at risk for developing diabetes, there are about 100 million people in the United States who are overweight, but who do not yet have diabetes.

"[Obesity] is the overwhelming precursor of the form of diabetes known as type 2 diabetes," Rizza said. "There's a ticking time bomb there because even the people with pre-diabetes, their systems are already beginning to fail." People carrying excess weight today are marching right behind those contending with pre-diabetes and eventually diabetes.

"Even people who have type 1 diabetes, a disturbing fact is that many of those people are now overweight or obese," he said, noting that diabetics are not immune to the same societal influences that have made 127 million men and women in this country overweight. In fact, obesity in type 1 diabetes patients may create the need for more insulin, as opposed to the insulin demands for type 1 patients who are more trim.

A report published in the New England Journal of Medicine earlier this year suggested that the current obesity epidemic actually could shorten the average life span of an entire generation: today's children. Already, 16 percent of children are overweight, and another 15 percent are at risk. In addition to type 2 diabetes, chronic obesity places young adults at risk for high blood pressure, high cholesterol and a greater chance for developing cardiovascular disease.

According to the NEJM report, obesity today reduces life expectancy by four months to nine months.

"As we learn more about why people who have diabetes have developed diabetes ... there will be more and more targeted therapies that will try to fix those abnormalities," Rizza said.

And that already is happening. Drug manufacturers are looking to develop diabetes medicines that do more than just help maintain blood glucose levels. Bristol-Myers Squibb and Merck have teamed up on a drug therapy called Pargluva that lowers triglycerides, in addition to controlling blood sugar. And while Sanofi-Aventis currently is not seeking a diabetes indication for its yet-to-be-approved weight-loss / smoking cessation drug Acomplia, the drug has demonstrated it can help lower blood glucose levels. Acomplia is believed to act in two places: the brain, where it reduces hunger, and in adipose tissue (fat), where it increases levels of adiponectin, a protein that, when deficient, is associated with increased insulin resistance and a higher risk of developing type 2 diabetes.

In addition to developing drug therapies, suppliers also are helping to develop a comprehensive approach to treating diabetes and its underlying conditions, like obesity. Becton Dickinson's BD Diabetes Care unit recently presented the results of its DC Diabetes Makeover at the American Association of Diabetes Educators' national convention in Washington.

Although only three diabetics participated, the program demonstrated that a holistic, team-oriented approach goes a long way in reducing complications.

The BD Diabetes Dream Team--a group of the nation s leading clinical, diabetes education, nutrition, fitness and lifestyle organization experts--provided participants in the DC Makeover with individual evaluations and a tailored program to improve their diabetes care. The personalized care plans included a clinical evaluation, updated medication regimens, education on diabetes self-management practices, an individualized fitness plan, nutrition guidance, lifestyle management skills and ongoing support.

The bigger they are ...
the more likely they are
to develop type 2 diabetes

                                       % likely to get type 2
                          % of
BMI *                 population **        Men     Women

25.0 to 29.9
  (overweight)            19.5%            4.9       7.1
30.0 to 34.9
  (obese)                 17.2             10.1      7.2
40.0 and greater
  (severely obese)         3.0             10.7     19.9

* Body mass index ** Based on most recent U.S. Census data

Source: American Obesity Association

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