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Diabetes The diabetes way of life

With over 17 million American afflicted and over 30 million projected by 2050, diabeteshas become an alarming problem in this country. In the past it affected primarily olderpeople but because of our sedentary life styles and poor eating habits youngergenerations are now suffering. This case study will focus on the disease, those who areaffected by it, how to cope with it and promising new research and developments.

Young type 2 diabetics face severeproblems

Damage often precedes diabetesdetection

Blood-vessel inflammation maysignal diabetes, stroke

Diabetes: A lesson in living

Case Study Expert: Francine Ratner Kaufman, M.D.President, American Diabetes Association

The diabetes way of lifeAmericans with disease learn to eat well, exerciseBy Anita Manning

Ted DeLeon’s family is plagued bydiabetes on all sides. His parents, auntsand uncles and seven of nine siblingshave it.

Yet, when it came to him, he didn’trecognize it.

“I was thirsty all the time. I gained 30pounds over summer, was going to therest room a lot at night,” he says. When,by chance, he saw an article aboutdiabetes symptoms, “I said, shoot, that’sme.” He went to a doctor who tested thelevel of sugar in his blood. Normal is 70 to149. DeLeon’s reading was 360.

“I was almost on the verge of a diabeticcoma.”

DeLeon’s story is one that is becomingall too common in the USA. An estimated17 million Americans have diabetes — anincrease of nearly 1.5 million in twoyears. Of these, nearly 6 million areundiagnosed, yet the disease is silently atwork in them, damaging blood vessels,nerves, eyes, heart, kidneys, legs and feet.

The American way of life — too muchfood, too little exercise — has contributedto an epidemic of diabetes that is strikingpeople of all ages. Even adolescents are

being diagnosed with type 2 diabetes, aform of the disease usually seen only inmidlife.

Once diagnosed, diabetes becomes away of life for the patient and his family.While diabetics may live long and activelives, the disease is chronic and incurable,and may lead to symptoms that cancause disability and death.

Type 2 diabetes is caused by the body’sinability to use efficiently the hormoneinsulin, which helps convert sugar intoenergy. Up to 95% of people with diabeteshave type 2. Type 1, or juvenile diabetes,occurs when insulin-producing cells inthe pancreas are destroyed. Type 1, whichstrikes one in every 400 to 500 childrenand adolescents, requires daily insulininjections.

Type 2 diabetes is mushrooming in theUSA. Most affected are minoritycommunities, where a combination oflifestyle and genetics combines toincrease risk.

DeLeon, 54, who is Mexican-American,and his wife, Debbie, 48, who is NativeAmerican, are well aware of that and arespreading the word in their communitiesin Lansing, Mich., through an ethnicalliance that focuses on access to medical care.

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HS2002-01

www.usatodaycollege.com

Cover story

Researchers weigh in on soaringdiabetes rates

Companies seek alternatives toinjected insulin

In trial, drug curtails diabetes

Cell infusion is a ‘miracle’ fordiabetic

Cooking up a balance

—By Anita Manning

“Being indigenous,” DeLeon says, “we’re way ahead of the restof the population in terms of prevalence.”

Debbie says she doesn’t have diabetes, “yet,” but it’s “rampantin my family. It has been devastating. Many have not made it totheir 50s.”

Diabetes is so common among American Indians, affectingmore than 25% of the population in some tribes, that casinos andpublic buildings on reservations are equipped with hazardouswaste disposal boxes mounted in rest rooms for safe disposal ofinsulin syringes and lancets used in testing blood.

While genes may set you up for diabetes, Ted DeLeon says, it“kicks in when you gain a lot of weight and you don’t exercise.Where our family’s ancestors came from in Mexico, they don’thave it. Why? They eat beans and tortillas. Meat is a treat. There’sno McDonald’s. They work a lot (physically), and we don’t.”

By watching his diet and walking — or being walked by — his90-pound dog, T’tonka, every day, DeLeon has successfully kepthis blood sugars under control. But for many people, managingdiabetes is a complex balancing act that involves monitoringblood sugar levels two or more times a day, gaining anunderstanding of how foods interact with metabolism and howexercise affects blood sugar levels.

Many diabetics take medications and some require insulininjections.

“Diabetes, perhaps more than any other chronic disease, mustbe managed in large part by the patient,” says biologist andmedical writer Gretchen Becker of Halifax, Vt., in the introductionto her book, The First Year: Type 2 Diabetes (Marlowe & Co.

$14.95). “This is because everything you doaffects your blood sugar levels.”

The weight connection

For Sandra Henson, 50, of Beaumont,Texas, diabetes meant major changes in hereating habits. “In southeast Texas, we eat alot of rice, and I had to change to brown rice,change portion size, always watching to noteat too much at one time,” she says. Now,“I’ve lost weight, yes, but I’ve still got a longway to go.”

She’s not worrying about her figure out ofvanity. Being overweight reduces insulinsensitivity in people with diabetes, and itincreases the risk of developing the diseasein the first place. Because exercise has beenfound in several clinical studies to improvecontrol of blood sugar, Henson, who rarelyworked out before she was diagnosed, hasbecome faithful about going to the gym.

But it’s not always easy. “I travel a lot, andsometimes I work late. When I get home I’mtired, and I don’t want to exercise. You have

to discipline yourself and, hopefully, get other people to motivateyou.” Like many new diabetics, she attended diabetes educationclasses to learn such survival skills as what to do if her bloodsugar level plummets, how to cook without added fat, thedifference between complex and simple carbohydrates and muchmore.

Family members play an important supporting role in diabetesmanagement, experts say, and that may require sacrifices of theirown. No more ice cream in the freezer. Fewer rich dinners infabulous restaurants. Less drinking. Constant attention to diet andexercise. And, in some cases, it means tending to the needs of apatient whose feet have been amputated or whose vision is lost.

The demands of the disease on patient and family can lead todepression, marital discord and other stresses that John Zrebiec,associate director of mental health services at the Joslin DiabetesCenter in Boston, calls “diabetes burnout.”

The emotional impact of diabetes and its effect on the familymay require professional help, he says, identifying three specificpoints that send patients to a counselor: “We tend to see peoplewhen they’re newly diagnosed, when something about theirdiabetes care is going off track — there’s frustration, depression,anxiety, it’s not going smoothly — and third, is when there is theonset of long-term complications of diabetes. The most commondiagnosis we see is depression.”

People with diabetes are four times more likely to be depressedthan non-diabetics, Zrebiec says. “I don’t know of research onhow it affects the rest of the family, but I wouldn’t be surprised ifthey have more depression, too.”

While there may be a physical explanation for the increased

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Ted and Debbie DeLeon walk their dog, T’Tonka, Saturday, March 16, 2002, in Bancroft Park in Lansing, Mich.Ted was diagnosed with diabetes nine years ago and exercises every day with a brisk walk with the dog in alarge park adjacent to their home.

By Al Goldis, USA TODAY

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rate of depression, he says, it’s clear the psychological cause is “afeeling of helplessness,” he says. “There are many times in tryingto live with diabetes that you feel out of control and helpless.There are times you can do 110% of what you’re asked to do andstill have blood sugars that make no sense.”

Knowing your body

Still, many people manage to balance the demands of thedisease to enjoy full, happy and healthy lives.

One of these is Gabriel Caro, a Boston Web site developer. At 6-foot-1, a fit 174 pounds and only 29 years old, he doesn’t fit thestereotype of an overweight, middle-aged diabetic. Caro wastraining for a marathon when he was diagnosed two years agowith type 2 diabetes.

While he has to remain ever vigilant, he says, a combination ofmedication and a lot of exercise keep his diabetes under control,allowing him flexibility to commit the odd dietary indiscretionwithout serious repercussions. “I will never let something likehaving diabetes get in the way of me enjoying my life,” he says.

“There are times when I know I should not be having a glass ofwine or piece of cake, but I will have it.”

He refuses to feel guilty. “Diabetes comes with this mystiquearound it. People are incredibly afraid of making a mistake or noteating well, or they just punish themselves for not exercising,” hesays, but “it’s OK and natural and human to enjoy life and food.Ultimately, the most effective technique of controlling your diseaseis approaching it from different levels, physically, spiritually andemotionally. It’s a matter of quality of life. Yes, you have to watchwhat you eat, and you have to exercise, but you should view thosethings as positive.”

Living with diabetes means a lot of reading, he says. “You haveto understand your metabolism and how your body works, thenyou have to read about food and the properties of food, how to eatin proportions, the correct amounts of food, how to space yourmeals,” he says, but there is a benefit that others who don’t havediabetes may not experience. “You also have to study yourself alot,” he says. “I think that among other things, it really tunes youin and makes you aware of your body.”

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By Anita Manning

Will Cross wants the world to know thatdiabetes doesn’t have to mean disability. Toprove that, Cross, who was diagnosed 25years ago at age 9 with type 1 diabetes, isgetting ready to trek across the Antarctic tothe South Pole. The expedition will set outin November, with a goal of reaching thepole by New Year’s Day.

Last year, Cross went to the North Pole.He also has climbed several mountains,including Alaska’s Mount McKinley, thetallest peak in North America, and takenpart in expeditions to the Sahara, Patagoniaand India’s Thar Desert.

On his latest mission, the “Ultimate Walkto Cure Diabetes,” his aim is to raise moneyfor the Juvenile Diabetes ResearchFoundation’s efforts to find a cure and toshow others, especially children, that thereis no reason diabetes should keep them onthe sidelines.

“I hope to inspire younger kids and theirfamilies who are wondering whether theirkid can participate in school activities andsports,” Cross says. “I played sports allthrough school, but people are veryhesitant to include the diabetic, because what if your blood sugarsuddenly goes low? What if you need medication? I was alwaysstriving for independence. If you don’t, you don’t get toparticipate.”

Type 1 diabetes, which affects 5% to 10% of the 17 milliondiabetics in the USA, results from destruction of insulin-producingcells in the body. It usually is diagnosed by early adulthood andrequires daily insulin and careful monitoring of levels of bloodglucose, or sugar.

Cross, who wears an insulin pump that delivers a constantsupply of the hormone to his body, says he has never let hisillness stand in the way of his explorations. Now 34 and the fatherof four, his life is a series of adventures, from his day job asprincipal of the Alternative School in Pittsburgh, where he workswith students with behavior problems, to his expeditions inhostile climates.

Diabetes is a disease that requires patients to “be fit and eat

well if you’re going to live long,” he says. “It becomes a lesson in how to manage what you eat, to test your blood, exercise for atleast an hour, four or five days a week.” How well that isaccomplished, especially early on, is critical, he says. “Researchshows the better you manage during your first year of diagnosis,the better off you are, long range.”

On his treks, he works with the University of Pittsburgh onstudies of diabetic metabolism and how a diabetic might react toa 7,000-calorie-a-day diet and 12 hours of exercise pulling a 200-pound sled. “That’s exercise and eating in the extreme, but it’srelevant to the newly diagnosed diabetic, because it gives a brutalunderstanding of how the body will manage under thoseconditions,” he says.

“If you can manage under this environment, you certainly canin high school or at work.”

For details on the Ultimate Walk to Cure Diabetes, checkwww.curewalk.com

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Diabetes: A lesson in livingDiabetes can’t chill an adventurous Will

Role model: Will Cross’ trek to the North Pole last year and his preparations for the South Pole in November aretwofold: to raise money for the Juvenile Diabetes Research Foundation to find a cure and to let youth know theycan have fulfilling lives.

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By Anita Manning

SAN FRANCISCO — Diabetes researchers studying themechanisms that lead to chronic illnesses are zeroing in oninflammation as a major factor in both diabetes and heart disease.

Scientists have recently noted that substances which signalinflammation, called inflammation markers, can be found in theblood of patients who have diabetes, as well as of those who haveatherosclerosis, or hardening of the arteries, in which chronicinflammation of blood-vessel walls creates lesions that rupture,form clots and lead to stroke.

Now, data presented here at the American Diabetes Associationsuggest that inflammation is part of the disease process in bothconditions, and that these inflammation markers can be useful inpredicting who will develop diabetes and which diabetics maysuffer from heart disease.

Treating inflammation may be a way to prevent both diseases,says endocrinologist Paresh Dandona of the State University ofNew York-Buffalo. Dandona reported on research that shows adrug called rosiglitizone, one commonly taken by adults withdiabetes to boost insulin sensitivity, appears to have anti-inflammatory properties.

That means treating diabetes with these drugs may produce twobenefits: increasing insulin response and decreasing the risk ofatherosclerosis. Rosiglitizone, and probably other drugs in thesame class, Dandona says, “can not only treat high glucose (sugar)levels in diabetes, they may actually prevent the major cause ofdeath in diabetes.”

Other highlights from the diabetes meeting:

• The GlucoWatch Biographer, a wristwatch-like device that testsblood sugar levels through the skin, appears to work in children aswell as in adults, research suggests. A study in 40 children ages 7to 17 who have type 1, or juvenile, diabetes found that automaticglucose monitoring significantly improved control of blood sugar.The device is licensed only for adults, but the developer, Cygnus, isseeking Food and Drug Administration approval for its use bychildren.

• An international survey of 2,702 people with diabetes findsthat 60% say they’re not worried about such long-termcomplications as blindness or limb amputation, although studiesshow that if untreated, 74% of people with diabetes will develop acomplication that could lead to blindness, kidney failure or lower-limb amputation. The study by the International DiabetesFoundation and Lions Clubs International Foundation also found afatalism that researchers found especially disturbing. “Over 40%think nothing they do will change the course of their disease,” saysJames Gavin, senior scientific officer at the Howard HughesMedical Institute. “That’s wrong. We can prevent or delay all thesecomplications. The fact that they don’t know that shows we haveenormous work to do.”

The study points to the need for better education, says Croatianendocrinologist Zeljko Metelko, vice president of the InternationalDiabetes Federation-Europe. “Enormous amounts of money arespent on research, and enormous amounts are spent ontreatment,” he says, “but the transfer of knowledge to physiciansand patients is lacking.”

Blood-vessel inflammationmay signal diabetes, stroke

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By Anita Manning

SAN FRANCISCO — The first long-term study of childrendiagnosed with type 2, or “adult-onset” diabetes, shows that asyoung adults, many suffer from severe complications, includingkidney disease, miscarriages and death.

The study, though small, is ringing alarm bells for researchershere at a meeting of the American Diabetes Association, givingweight to predictions that a growing incidence of type 2 diabetesin children could have catastrophic health consequences in years tocome.

Type 2 diabetes is the most common form of the disease,affecting at least 90% of the more than 17 million Americans withdiabetes. It is associated with obesity, lack of exercise and genetics,and, until about 20 years ago, almost never occurred in teens orchildren.

Unlike type 1, or juvenile, diabetes, type 2 is most often detectedin middle age or older, but it is increasingly being found in children,especially among ethnic minorities, and has become a “dramaticand very alarming fact of our lives,” says Eugene Barrett of theUniversity of Virginia, vice president of the diabetes association.

Because it is new in children and many doctors don’t look for it,many cases may be overlooked, experts say. In communitieswhere there is a large Hispanic, Native American or blackpopulation, as many as 50% of newly diagnosed children have type2, Barrett says.

Heather Dean, professor of pediatrics at the University ofManitoba in Winnipeg, Canada, who presented her study onSaturday, found a high rate of diabetic complications in a group of51 Native Americans, now ages 18 to 33, who had been diagnosed

with type 2 diabetes before the age of 17. She reported:

• Three are on dialysis because of kidney failure.

• One became blind at 26.

• One had a toe amputated.

• Of 56 pregnancies, only 35 resulted in live births.

• Two died of heart attacks during dialysis. Another five died ofcauses unrelated to diabetes.

Because her study was small and involved a genetically distinctgroup, Dean says, the findings can’t be applied to all children withtype 2 diabetes. And, she says, the outlook may improve, thanks toadvances in the treatment of diabetes in the past 15 years.

“We’ve become much more aggressive in our treatmentstrategies,” she says. “My sense is the future is more optimistic, butthis is the first group, and this helps us to realize this is a veryaggressive disease with very serious long-term complications.”

The reasons for the increase in children are not entirely known,but many experts believe inactivity, overeating and genetics arecoming together to create a public health time bomb set to go offover the next two decades.

“Obesity is pulling the trigger,” says pediatrician Silva Arslanianof the University of Pittsburgh School of Medicine. “Rates ofobesity in children are escalating like a rocket. Two of five childrenare overweight, and some races are even more prone to beoverweight.”

Young type 2 diabetics facesevere problems

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By Anita Manning

SAN FRANCISCO — Drug companies are making progress inefforts to bring needle-free insulin to people with diabetes, butthey’re still years from the finish line.

Several studies reported here Sunday at a meeting of theAmerican Diabetes Association show that research in alternativesto insulin injections is advancing rapidly, says Christopher Saudekof Johns Hopkins School of Medicine, president of the association.But he cautions that “each is at a different stage in development,and people are well advised to take advantage of what is availabletoday” to manage diabetes.

Of the estimated 17 million Americans with diabetes, about 3.7million need daily insulin shots to keep levels of blood sugar on aneven keel and to prevent such long-term complications as heartdisease, blindness, kidney disease and amputations.

Among developments:

* Insulin pills. Nobex Corp. and Emisphere Technologies aretaking slightly different approaches in developing insulin pills thatcan be absorbed through the digestive system without being

degraded. “We’re able to control blood glucose, probably for thefirst time, with an oral insulin preparation that is ingested,” saysresearcher Stephen Clement of Georgetown University, whopresented results of studies on the Nobex drug. The product isearly in development, he says, but is “very feasible.”

* Insulin patch. A two-step system that uses a battery-powered sticky patch to open skin pores, then deliver insulinthrough a second patch, is being made by Altea DevelopmentCorp. In a small study, it provided a steady supply of insulin over12 hours.

* Insulin mouth spray. Generex Biotechnology Corp.’sRapidMist allows insulin to be absorbed through cells lining themouth. Generex researcher Pankaj Modi says the insulin spray wasas effective in tests as fast-acting injected insulin.

* Inhaled insulin. Five companies are racing to develop a fast-acting form of insulin that can be inhaled into the lungs in liquid orpowder form, but questions remain about its safety for long-termuse.

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Companiesseekalternatives to injectedinsulin

This is an AERx insulin delivery system, an alternative method of insulin administration.

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By Anita Manning

Last year, in the middle of a teenage whirl of high school,friends and sports, Emma Lowenstein’s life changed. The ChevyChase, Md., teenager, now 15, was diagnosed with type 1, orjuvenile, diabetes.

Her mother says she never saw it coming. Emma hadsymptoms, she says, including weight loss and constant thirst,but diabetes “was so off my radar screen.” No one in the familyhad the disease. The Juvenile Diabetes Research Foundation saysthat’s common in about 90% of cases.

“I knew one kid my daughter’s age with diabetes, but I knewnothing about it,” says Emma’s mother, Shelley Lowenstein. “Wewere so ignorant.”

Not anymore. The diagnosis has meant changes, not only forEmma — who has learned to test her blood several times a day,inject insulin and balance diet and exercise — but also for herfamily.

“We didn’t know if Emma could ever eat cookies again,” hermother says. She and Emma pored over nutrition labels in thegrocery store, combed through cookbooks and went onlinelooking for information. “We were always a family that loved tocook,” she says. “My husband clips recipes. We eat out all thetime.”

Now the family’s dining choices are influenced by Emma’s needto eat a balanced diet on a daily schedule. As a diabetic, “you learnto live by the clock, which we’ve never done,” Lowenstein says.“That means you have to get up at a certain time, eat at a certaintime, have a mid-morning snack at a certain time . . . “

People with diabetes need to eat frequently, generally threemeals and at least a couple of snacks, to keep blood sugars on aneven keel. That means keeping portion sizes small and eating avariety of foods in moderation, says Carol Guber, whose book,Type 2 Diabetes Life Plan (Broadway Books, $25) is beingpublished this week.

While most dieters obsess over fats and calories, diabetics needto limit carbohydrates, which greatly affect blood sugar. Guber says most adults can consume 45-75 grams of carbohydrates permeal, depending on age, weight and activity level. (There arearound 15 grams of carbohydrates in a slice of bread or half abanana, and about 41 per cup of pasta. A 2-ounce package ofstrawberry Twizzlers has 54 grams.)

Carbohydrates are nutrients that are released into the

bloodstream in the form of glucose, a simple sugar that fuels cells.Insulin is a hormone that allows cells to use this sugar fuel, but injuvenile diabetes the body’s insulin-producing mechanism isdestroyed. Patients have to take insulin shots every day.

In type 2 diabetes, insulin is produced, but it’s not usedefficiently by the body, resulting in high blood sugars. Type 2diabetes often can be managed with drugs and diet. In eitherform of the disease, diet plays a crucial role in balancing bloodsugars.

Food and family eating habits have as much to do with cultureand social interaction as with nutrition, Guber says. When shewas diagnosed with diabetes nearly five years ago at age 50, shesays, “I thought it was going to separate me from everyone.”

Food was “part of the community I lived in,” says Guber, whotaught nutrition and food preparation at New York University formany years. She feared the need to watch every morsel wouldseparate her from her peers.

It hasn’t, she says. In fact, she says she’s able to incorporate newdining habits seamlessly into everyday life — whether eating athome or in restaurants — by corralling her cravings, losing weight

Cooking up a balanceNew approaches helpdiabetics make tasty food

Big adjustments: Shelly Lowenstein and daughter Emma, 15, adapt their favoriterecipes to suit Emma’s diabetic needs. She often needs a bedtime snack to get herthrough the night, when sugar levels tend to drop.

By Steve Barrett for USA TODAY

and developing eating patterns that would be good for allAmericans.

“Everybody should be eating as if they have diabetes,” Gubersays. “It’s a healthy way of eating.”

When Emma Lowenstein was diagnosed with diabetes, hermother set out to find recipes that would be good for Emma andthat the whole family would enjoy. That soon proved frustrating,she says, because newspapers, magazines, cooking shows andeven cookbooks often fail to provide complete nutritionalinformation.

Lowenstein set out to change that, launching an advocacy groupcalled Per Serving (www.per-serving.org) to try to persuadenewspaper food editors, through a letter-writing campaign, toinclude per-serving food facts for all recipes. The effort has wonthe support of the American Association of Diabetes Educators,the American Cancer Society, American Heart Association andother groups.

“I’m a very practical person, and I want to do anything I can tomake her day-to-day life easier,” Lowenstein says.

“When reputable newspapers run headlines all the time aboutdiabetes, obesity, heart disease and cancer and don’t give us thisinformation on their food pages, they’re only giving us half thestory.”

So far, she says, the reaction from editors has been mixed. Manybig-city papers, including The Washington Post, The PhiladelphiaInquirer, Chicago Tribune and San Francisco Chronicle do printcomplete nutrition information with recipes, but “there is still a lotof resistance,” she says. One editor wrote to say her paperprovides information on calories and fat in recipes; anything moreis important only to “people with special needs, and she can’t

cater to them,” Lowenstein says. “She said those people should getspecial cookbooks.”

There are plenty of “special cookbooks” for diabetics, includingdozens published by the American Diabetes Association (ADA),(www.diabetes.org). “People with diabetes are starving forinformation,” says Chris Smith, author of Cooking with the DiabeticChef ($19.95), one of the ADA’s publications.

A Culinary Institute of America-trained chef and a type 1diabetic, Smith has developed cooking methods that hedemonstrates across the country for audiences made up ofdiabetics, heart patients and others interested in healthy eating. Ata recent event at the East Texas Medical Center in Tyler, whereabout 70 audience members were expected, a crowd of 800showed up, most of them non-diabetic, he says.

Smith will attend the upcoming ADA annual meeting, startingFriday in San Francisco. While most of the hundreds ofpresentations will focus on the latest medical advances in diabetes,Smith will hold cooking seminars on such topics as summersalads, vegetarian cuisine and grilling.

There’s nothing magic about a diabetes-friendly diet, he says.

“What I teach is actually cooking lessons, from pan searing toroasting to wok cooking to poaching,” he says. “People arecompromised nutritionally. I’m fighting a tidal wave. I want toteach people to eat healthy.”

By exercising portion control and making simple changes incooking methods — roasting instead of deep-fat frying, forinstance, or using marinades and spices to flavor foods instead ofheavy sauces — people with diabetes or other health problems caneat just about anything, he says.

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Diabetes

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By Anita Manning

A two-week treatment with an experimental immune-suppressing drug halted progression of diabetes in newlydiagnosed patients for at least a year, scientists report today.

In a study in today’s New England Journal ofMedicine, researchers at Columbia University saythey followed the course of illness in 24 patients,ages 7 to 27, who recently were diagnosed withtype 1 diabetes, a form of the disease that occurswhen the insulin-producing cells in the pancreasare destroyed by the body’s own immunesystem.

They found that the drug halted destruction ofinsulin-producing cells in nine of the 12 treatedpatients, while 10 of the 12 untreated patientshad significant decline in insulin production.

The experimental drug is safer than other immune-suppressants because it targets only specific cells, eliminatingdangerous side effects on other organs or tissues, says itsdeveloper, Jeffrey Bluestone of the University of California-SanFrancisco. Its beneficial effects continue beyond treatment, hesays.

“It seems to re-educate the immune system, for a while atleast,” he says.

A two-year trial involving 80 patients is scheduled to beginwithin a few weeks, Bluestone says.

If results are confirmed in larger studies, the drug could be a“major contribution” to diabetes prevention, says Jay Skyler of theUniversity of Miami.

Skyler, director of a large diabetes prevention study, reports in asecond journal article that in a study of 339people at high risk of developing type 1 diabetes,insulin injections did not prevent the disease.

The data, initially reported last year at a meetingof the American Diabetes Association, failed toconfirm smaller studies that indicated insulininjections might preserve the ability of pancreascells to produce insulin by giving the cells periodsof inactivity and making them less likely to betargeted for destruction by the immune system.

“We’d hoped we’d find something that wouldhave been a help to the people at risk for

diabetes,” Skyler says. Because so much is known about insulinand its safety, he says, “if we had hit with this, we would havebeen thrilled.”

The study shows the value of clinical trials, Skyler says. “Smallstudies might give us hints of what might be right,” but theirresults need to be confirmed in larger studies.

The second part of the Diabetes Prevention Trial, a study todetermine the effect on diabetes prevention of oral insulin, whichworks through a different mechanism than injected insulin, shouldbe completed next year, Skyler says.

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In trial, drug curtails diabetes

Type 1 diabetes:

About 5% to 10% ofthe nation’s estimated17 million diabetics have type 1, or juvenile,diabetes, caused by thebody’s inability toproduce insulin.

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By Anita Manning

WASHINGTON — More than 17 million Americans havediabetes, and if rates continue to soar, there could be 30 millionsuffering from the chronic, sometimes fatal, disease by 2050.

Diabetes is “a side effect of prosperity” that is growingalarmingly around the world, says Christopher Saudek, director ofthe diabetes center at Johns Hopkins University.

“Any nation that increases its body weight is going to increaseits diabetes.”

In the USA, he says, diabetes rates have risen 6% a year for thepast decade.

Saudek, president of the American Diabetes Association, spokeTuesday at a briefing by the Journal of the American MedicalAssociation on its theme issue on diabetes, published today.

Among reports:

• Differences in the long-term diabetes complications amongethnic groups may have more to do with genetic susceptibilitythan access to good medical care, say researchers at KaiserPermanente in Oakland.

An analysis of data on 62,432 diabetic patients enrolled in theKaiser Permanente HMO in Northern California found that whiteshave higher rates of heart attack than blacks, Asians and Latinos,while minorities experience more kidney failure than whites.Rates of congestive heart failure and stroke were similar for blacksand whites but were lower for Asians and Latinos.

The incidence of limb amputations was similar among blacks,whites and Latinos, but in Asians, the rate was a startling 60%lower than that of whites.

The disparities suggest the complications have “geneticunderpinnings,” Kaiser researcher Joe Selby says.

• Children with diabetes are more likely to suffer dangeroushighs and lows in blood sugar levels if they are underinsured,have had erratic blood sugar level swings in the past threemonths or have psychiatric problems that could cause them toskip insulin injections.

A study by researchers at the University of Colorado-Denverlooked at 1,243 diabetics under age 20 and their incidence ofsevere high blood sugar, called ketoacidosis, and very low bloodsugar levels, or hypoglycemia. Either condition can cause comaand death.

The researchers found that 80% of the episodes occurred in 20%of the children, suggesting that children at greatest risk can beidentified and targeted for extra help. Researchers estimate thecost of treating ketoacidosis and hypoglycemia in diabetic childrenin the USA at more than $100 million per year during the late1990s.

• One or two drinks of alcohol a day improve insulin sensitivityin older women, who are at increased risk of diabetes aftermenopause. In a study of 63 postmenopausal, non-diabeticwomen, researchers at the Human Nutrition Research Center, partof the U.S. Department of Agriculture in Beltsville, Md., found thatthose who had one or two drinks before bed — they were givengrain alcohol mixed with orange juice — each night for eightweeks had better insulin sensitivity and lower levels oftriglycerides, a type of fat, than non-drinkers. Earlier studies havefound that moderate drinking reduces heart disease risk,researchers say. The new data show a similar effect on diabetesrisk.

• Women who are born small may be at higher risk ofdeveloping gestational diabetes, a transient form of the disease,during their first pregnancy, says a report from the University ofColorado and the University of Virginia. Gestational diabetes oftendisappears after pregnancy, but it is a risk factor for laterdevelopment of diabetes in the mother. The finding suggests thatsusceptibility to diabetes may be “preprogrammed in uteruo,”researchers say.

AS SEEN IN USA TODAY LIFE SECTION - WEDNESDAY - May 15 2002 - 5D

Researchers weigh in onsoaring diabetes rates

By Anita Manning

For 50 years, Sigrun Schwendinger of Potomac, Md., coped withdiabetes. She gave herself multiple insulin injections every day,tested her blood-sugar levels frequently and paid constantattention to her diet and exercise.

That changed in February 2001, when Schwendinger got thesecond of two infusions of insulin-producing pancreatic cells in anexperimental procedure at the National Institutes of Health.

The process, developed by Canadian scientists and reportedtwo years ago, is being duplicated in medical centers around the world.

Before the procedure, Schwendinger had been unable tostabilize her blood-sugar level, no matter what she did. Now, it’salways on target. She no longer needs insulin shots because herbody is producing the hormone. She eats what she wants, whenshe wants, and even has a glass of wine now and then.

She has some side effects from the immune-suppressing drugsshe takes daily to keep her body from rejecting the transplantedcells, such as edema, high blood pressure and a low white-blood-cell count. She says the trade-off is worth it.

“I’m one of the first pioneers,” says Schwendinger, diagnosedwhen she was 7. The procedure has “a long way to go and quite abit of research has to be done, but I think it’s fantastic. All thoseyears, that was my one prayer: ‘Please, God, take this disease awayfrom me.’ “

Schwendinger and other pioneers who have undergone islet-cell transplantation are in Washington, D.C., today to kick off theannual meeting of the Juvenile Diabetes Research Foundation andlobby Congress for funding to help find a cure for diabetes.

Juvenile diabetes, also called type 1, affects about 1 millionAmericans. Usually diagnosed by early adulthood, it results fromthe loss of insulin-producing islet cells in the pancreas. Becausetheir bodies produce little or no insulin, type 1 diabetics requiredaily injections to stay alive.

Robert Goldstein, chief scientific officer of the Juvenile DiabetesResearch Foundation, says fewer than 80 people have undergonethe process, in which doctors remove islet cells from cadavers andinfuse them through a thin tube into recipients.

Usually two pancreases are needed to harvest enough islet cells,and a lack of the donated organs is one reason more islet-celltransplantations have not occurred.

For people whose diabetes has caused complications, such asvision or hearing loss, or who can’t control wide swings in blood-sugar levels, “to be able to change the course of their disease isakin to a miracle,” Goldstein says.

But because transplant patients have to take drugs every day,the procedure isn’t for everyone

“This is not the ultimate answer,” Goldstein says..

Reprinted with permission. All rights reserved. Page 12

AS SEEN IN USA TODAY LIFE SECTION - THURSDAY - May 16, 2002 - 8D

Cell infusion is a ‘miracle’ for diabetic

Sigrun Schwendinger is a diabetic but is off insulin injections afterundergoing an experimental procedure. She works in the admis-sions office of the Landon School in Bethesda.

By H. Darr Belser, USA TODAY

By Anita Manning

The complications of diabetes come on slowly and stealthily, sayexperts from the American Association of ClinicalEndocrinologists, who on Tuesday staffed the first USA TODAYonline chat on the illness.

“It may take as long as 10 or 15 years for complications todevelop,” says AACE president Rhoda Cobin of Mount Sinai Schoolof Medicine in New York, in response to a reader’s question.“Often people who have type 2 diabetes (the form usuallydiagnosed in midlife) have actually had it for many years before itis detected, so as many as 50% already have complications at thetime of detection. Neuropathy (nerve damage), eye, kidney andheart disease may all occur.”

The diabetes hotline drew questions from 708 readers aroundthe world. Cobin — and endocrinologists Paul Jellinger of theUniversity of Miami School of Medicine, and Om Ganda ofHarvard Medical School and the Joslin Diabetes Center in Boston,fielded questions on diagnosis, medications, diet andcomplications of diabetes, which affects 17 million Americans. Asampling:

QQ:: DDooeess hheeaavvyy ddrriinnkkiinngg ooff lliiqquuoorr aaffffeecctt tthhee bblloooodd ssuuggaarr?? IIss oonneettyyppee bbeetttteerr tthhaann ootthheerrss?? —— LLaakkee WWoorrtthh,, FFllaa..

A: Too much alcohol poisons the liver and predisposes the bodyto hypoglycemia (low blood sugar). But it also contains calories, soit can make the sugar go up and put on weight. Alcohol is alcohol,but some drinks, like sweet wines, beer, etc., have more caloriesand sugar in them. — Cobin

QQ:: MMyy ddaauugghhtteerr wwhhoo iiss 2200,, hhaass hhaadd aadduulltt--oonnsseett ddiiaabbeetteess ssiinncceetthhee aaggee ooff 1166.. SShhee iiss aatt pprreesseenntt oonn iinnssuulliinn.. HHooww lloonngg aa lliiffee ccaann IIeexxppeecctt ffoorr hheerr?? WWiillll sshhee bbee aabbllee ttoo mmaarrrryy aanndd hhaavvee cchhiillddrreennnnoorrmmaallllyy?? —— DDuubbaaii,, UUnniitteedd AArraabb EEmmiirraatteess

A: It depends on how well controlled her sugar is. If it is undergood control and she has no complications, she should be able tolive a long life. Pregnancy likewise, but (it) requires very frequenttesting to tightly control the blood sugar to make sure the babyhas no problems. Please consult a specialist who is familiar withpregnancy in a diabetic before conception, if possible. — Cobin

QQ:: IIff yyoouu hhaavvee aa ssttrroonngg ffaammiillyy hhiissttoorryy ffoorr ddiiaabbeetteess,, iiss iittrreeccoommmmeennddeedd ttoo ssttaarrtt oonn mmeeddiiccaattiioonnss bbeeffoorree yyoouu hhaavvee ((iitt))?? ——OOrrllaannddoo

A: Research is looking at that question, but the final word is notyet in. No recommendation for medication is at this timeappropriate, but that recommendation may be with us in the nearfuture. Stick with diet, exercise and weight loss (if obese) for now.— Jellinger

QQ:: WWhhaatt iiss tthhee ssttaattuuss ooff aa ccuurree iinn tthhee nneexxtt ffiivvee yyeeaarrss?? ——BBllaaiirrssvviillllee,, GGaa..

A: The cure is not yet in sight, unfortunately. A number ofstudies are in progress. Islet-cell transplant looks more promisingthan before. Efforts are also underway in the development of avaccine. — Ganda

Reprinted with permission. All rights reserved. Page 13

AS SEEN IN USA TODAY LIFE SECTION - WEDNESDAY - April 17, 2002 - 8D

Damage often precedesdiabetes detection

Reprinted with permission. All rights reserved. Page 14

Behind the Story: A Reporter’s NotebookAs the prevalence of diabetes increases

around the world, the need for broaderunderstanding of this disease and itsimpact on nearly every facet of society hasgrown.

Diabetes affects the individual, thefamily, employers, insurance companies,the food industry, schools andgovernment. Studies show changes inlifestyle may be as effective as medicationin some cases, and promising newresearch is being done with islet celltransplantation and stem cells.

In order to bring together the diverse parts of this story, I rely onthose who have diabetes to describe how it affects their own lives, supplementing that with information from scientists and

physicians. I call on diabetes experts for practical lifestyle advice forpatients and families, and national health leaders for statistical andpolicy information.

Underlying all this coverage is a belief that the more our readersunderstand about diabetes, the better prepared they will be to conduct their own lives and to influence public health policy.

Anita Manning is a medical reporter at USA TODAY. She beganworking for Gannett in 1979 at the News Journal in Wilmington,Del., and has been with USA TODAY since 1983. She specializes incoverage of infectious diseases, vaccines, food safety and diabetes.

Anita was awarded the C. Everett Koop Medal for HealthPromotion and Awareness in 2001 by the American DiabetesAssociation. She received a degree in English, with a minor injournalism, from the University of Rhode Island in 1968, and nowlives and works in Wilmington, Del.

Anita Manning

1. Why is the prevalence of type 2 diabetes increasing inthe U.S.?

2. What are the most effective prevention strategies fortype 2 diabetes?

3. How do particular types of inflammatory signalsincrease risk for diabetes cardiovascular disease?

4. For many people with diabetes, self-administeringinsulin is a daily, painful chore. What are the newinsulin delivery technologies on the horizon?

5. Is there hope of developing a cure for type 1 diabetes?

About Francine Ratner Kaufman, M.D.

Additional resources

For discussionFuture

implications:

President, American Diabetes Association

Dr. Kaufman is currently a Professor of Pediatrics at the Keck School of Medicine at the University ofSouthern California; Director, Comprehensive Childhood Diabetes Center; and Head of the Division ofEndocrinology, Diabetes & Metabolism, at Childrens Hospital of Los Angeles.

Dr. Kaufman earned her undergraduate degree from Northwestern University and her medical degreefrom Chicago Medical School, where she was Valedictorian of her medical school class and won the MedicalSchool Pediatric Award.

Dr. Kaufman has received continual funding from the National Institutes of Health (NIH) since 1980, andhas focused her work on many aspects of diabetes, including type 1 and type 2 diabetes prevention, theendocrinology of HIV infection, and galactosemia, a rare inborn metabolic error.

Dr. Kaufman has been actively involved with the American Diabetes Association since 1978. TheAssociation gave her the award for Outstanding Contribution to Children and Youth with Diabetes in 1996.

http://www.usatodaycollege.com Page 15

1. There are now scientifi-cally proven strategies toprevent or delay type 2diabetes. How can healthcare providers better rec-ognize those at risk forthe disease and incorpo-rate these proven strate-gies into clinical care?

2. What impact could newglucose monitoringdevices, such as continu-ous monitors, have on thefuture of diabetes care?

Organizations:American Diabetes Association

(www.diabetes.org)Juvenile Diabetes Research Foundation

(www.jdf.org)American Association of Diabetes Educators

(www.aadenet.org)American Association of Clinical

Endocrinologists (www.aace.com)International Diabetes Foundation (www.idf.org)

Books:The First Year: Type 2 Diabetes

(Gretchen Becker, Marlowe & Co)Type 2 Diabetes Life Plan

(Carol Guber , Broadway Books)Cooking with the Diabetic Chef

(Chris Smith)

Referenced Web Site:Per Serving (www.per-serving.org)