The traditional medical approach to diabetes is simply to manage it after it has been diagnosed. Because there isn't a cure, the emphasis is on keeping blood sugars as close to normal as possible -- usually with exercise and weight loss coupled with medication -- and dealing with complications as they arise. But while this sort of treatment can allow people with diabetes to have full and relatively normal lives, it doesn't get at the root causes of the illness.
Thomas Buchanan, MD, professor of medicine at the University of Southern California, believes this is precisely why the thrust of diabetes treatment needs to be changed.
In every issue of WebMD the Magazine, we ask our experts to answer readers' questions about a wide range of topics. In our January-February 2011 issue, we asked WebMD's diabetes expert, Michael Dansinger, MD, to answer a question about the link between prediabetes and diabetes.
Q: At my last checkup, my doctor told me I have prediabetes. Does that mean I'll ultimately develop diabetes?
A: Almost everyone who develops type 2 diabetes develops prediabetes first. But not everyone who has prediabetes...
"Typically, in diabetes treatment, the whole focus is on blood sugar," says Buchanan, who is also director of the clinical research center at the Keck School of Medicine. "But people aren't thinking enough about the actual disease that's causing the problem."
To address this issue, Buchanan led the Troglitazone in Prevention of Diabetes (TRIPOD) study, which treated women at risk of developing type 2 diabetes with a class of drugs called glitazones or thiazolidinediones, or more commonly, TZDs. The results were dramatic: The drugs were apparently effective in preventing the onset of the disease.
Given that an epidemic of type 2 diabetes may be on the horizon -- due primarily to the increasing levels of obesity in the U.S. and around the world -- preventing diabetes is an urgent public health priority. TZDs could be part of the solution.
TZDs and the TRIPOD Study
Unlike some drugs used to treat diabetes, the main strength of TZDs as treatment doesn't lie in their ability to directly boost insulin production or lower glucose levels. Instead, TZDs work on a different level by affecting the beta cells in the pancreas.
For the body to use blood glucose as energy, beta cells secrete the hormone insulin. As insulin circulates throughout the body, it attaches itself to individual cells; once the insulin is attached, the cell becomes receptive to glucose and absorbs it, providing itself with energy. In many people developing type 2 diabetes, the body becomes less sensitive to insulin -- a condition called insulin resistance -- making the absorption of glucose from the bloodstream more difficult.
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