Nov. 24--Diabetes research, treatment and prevention surge forward every year.
Charles Ponte, professor of Clinical Pharmacy and Family Medicine at WVU, talked
to The Dominion Post about advances in medications -- but made an important
point about all the efforts by researchers, providers and educators.
"The adage that it takes a village -- it does," he said. "The most important
person is not the provider, it's not necessarily the service that's provided.
It's the patient. If we collectively can't get you to buy into your own
self-care," none of the educational programs or other outreach matters.
"You might as well take it all and flush it down the toilet. If I can't get you
to buy into your self-care, everything I do is for naught."
One of the biggest obstacles to self-care is depression, said Guy Hornsby,
associated chairman of WVU's Department of Exercise Physiology. Having diabetes
doubles a person's chances of becoming depressed, and 1 in 4 patients with
diabetes is depressed.
It can become a vicious cycle, Hornsby said.
"If the person is depressed and they're sad and they can't function properly,
they can't take care of their disease," he said. Diabetes requires daily
management of diet, exercise and medication. The patient must make regular
doctor visits. It can be overwhelming, and feed the depression.
Hornsby and the WVU Human Performance Lab are part of a team working in three
states to study and treat diabetes patients with depression. WVU is into its
third year of a five-year study. "We are trying to look at what is the best way
to care for people who have depression and diabetes, and that's a lot of
people," he said.
Their project is called Program ACTIVE (Appalachians Coming Together to Increase
Vital Exercise). Eligible volunteers are placed in one of four groups: Exercise
therapy, cognitive behavior therapy (talk therapy), exercise plus talk, and
It's proven that exercise and talk therapy can help depression, he said, and the
idea of the study is to see if the combination gives better results for the
depression and management of the diabetes.
Hornsby said it's well known that depression increases a person's chances of
heart trouble. A depressed person who suffers a heart attack has a reduced
chance of survival. Heart disease is the biggest killer of people with diabetes.
Potential participants are screened to see if they have symptoms of major
depressive disorder, Hornsby said, if they're healthy enough for the moderate
exercise program, if they've had Type 2 diabetes for at least a year and haven't
had a heart attack in the past two years.
The program runs for 12 weeks, with follow ups at six months and one year. All
treatment is free during the 12-week period, and participants in the exercise
portions receive a gym membership.
Hornsby said the project began with a pilot at Ohio University. Two-thirds of
the initial 50 subjects became free of symptoms of a major depressive disorder.
A site in Indianapolis just launched a program.
WVU is seeking more volunteers, and needs 26 more people to fill its study
Once the study is complete, he said, and the results are in, researchers hope
other treatment centers will join the bandwagon.
Along with the benefits to patients, he said, insurers may find the financial
motivation to cover exercise therapy -- something most don't do now. The program
could wean patients off expensive medications and reduce complications, saving
the insurers and patients money.
"Diabetes is the most expensive disease in the c o u n t r y, " Hornsby said.
One of every five health care dollars goes toward diabetes treatment. "Yo u
would save everyone a lot of money. I think it would be cost effective."
Hornsby is a medal-winning weightlifter who also has Type 1 diabetes and has
earned a bronze medal from the Joslin Diabetes Center, in Boston, for
successfully managing the disease for more than 50 years. When he was diagnosed,
in the mid-1960s, he said, his projected life expectancy was 25 years.
The Joslin Medalist Program, Joslin said, began in 1948, with a 25-year victory
medal. As science advanced and people began living longer, it upgraded to a
50-year medal: 2,905 people have received one. In 1996, it awarded its first
75-year gold medal and has given out more than 720 since.
Ponte said 1995 was a pivotal year for treating diabetes through medicines.
Before that, there was only insulin and some oral medications, such as
Diabinese, that lowered glucose levels by stimulating pancreatic cells (called
beta cells) to secrete insulin. The pancreas doesn't produce any more insulin,
it just releases it into the body.
From 1995 on, he said, medications flourished -- each a different class
addressing different conditions or "defects" contributing to the disease. "We
have a lot of new medications to treat Type 2."
Glucophage, for instance, addresses a problem where defective beta cells don't
secrete insulin when they're supposed to when glucose increases following a
meal. In Type 2 diabetes, the liver makes excess glucose and glucophage tells
the liver to stop glucose production.
Another class of drugs has been less successful than desired. Alpha-glucosidase
inhibitors inhibit an enzyme in gastrointestinal tract that breaks down complex
carbohydrates. This slows the digestion of the carbs and reduces post-meal
glucose elevation, improving glucose control.
Unfortunately, it has unpleasant side effects, such as increased gas, cramps,
nausea and diarrhea, so it hasn't been as well received as once hoped, Ponte
Another class of drugs addresses insulin resistance. Insulin is a hormone for
metabolizing carbs, fats and proteins. But insulin-resistant cells resist the
hormone's operation, requiring higher levels to operate and overtaxing the
pancreas over time.
Actos -- pioglitazone -- is an oral drug that goes inside the cell and programs
the nucleus to make proteins; one protein goes to a cell's surface and brings
glucose inside, to help overcome resistance.
Another drug mimics the activity of a hormone called GLP-1, which offers
beneficial effects for sugar control, curbs the appetite (Type 2 is often
associated with obesity), shuts off a hormone that causes the liver to produce
glucose, and can repopulate or preserve beta cells. The down side of this drug
is delivery -- injection, anywhere from twice a day to once a week.
A new oral GLP-1 drug inhibits the enzyme that breaks it down, so it can do its
A final group, Ponte said, targets the kidneys, which reabsorb glucose. The drug
inhibits that absorption so excess glucose can be expelled from the body.
Often, Ponte said, a patient requires a combination of treatments, what he calls
a "therapeutic soup."
But for the care providers, he said, all these drugs provide a toolbox of
choices. "It's challenging from the standpoint of patients, providers, to keep
it all straight." Also in play are the patient's willingness to accept
treatment, other conditions and drug interactions, and insurance coverage.
But overall, the advances are positive, he said. "It's been a blessing."
Doctor, pharmacist and patient need to work together to manage the disease,
Ponte said. "It affects everything from head to toe; there's nothing in a person
with diabetes that's spared when it comes to a potential adverse effect or a
But he values what he does, he said. "Some of the best and most rewarding
activities that I've had as a practitioner have been trying to help people that
have diabetes. You can make a huge difference to these people. Sometimes you
can't, but "you always try, and do the best you can."
The state Bureau of Public Health is working with the U.S. Centers for Disease
Control and Prevention (CDC) to offer the CDC's National Diabetes Prevention
Program across the state, said Jessica Wright, director of the bureau's Division
of Health Promotion and Chronic Disease.
The program targets people with pre-diabetes -- in which a person has a blood
sugar level higher than normal, but not high enough for a diagnosis of diabetes.
The CDC estimates that 1 out of every 3 U.S. adults had pre-diabetes in 2010 --
79 million people -- and most d o n't know they have it.
The prevention program emphasizes lifestyle changes. Wright said it's a 16-week
group training program, with follow-ups, where participants learn strategies for
coping, eating healthy and incorporating physical activity.
The CDC said research shows that modest weight loss and regular physical
activity can help prevent or delay Type 2 diabetes by up to 58 percent in people
with pre-diabetes. Modest weight loss means 5 percent to 7 percent of body
weight, which is 10 to 14 pounds for a 200-pound person. Getting at least 150
minutes each week of physical activity, such as brisk walking, is important.
Monongalia General Hospital and WVU Extension Service offer CDC-recognized
(c)2013 The Dominion Post (Morgantown, W.Va.)
Visit The Dominion Post (Morgantown, W.Va.) at www.dominionpost.com
Distributed by MCT Information Services