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Preventing Type 2 Diabetes

Can drugs prevent the onset of type 2 diabetes? One class of drugs shows promise, but it has its drawbacks.

A New Direction?

Based in part on the results of the TRIPOD study, Buchanan believes the emphasis of diabetes treatment needs to be shifted.

"Basically, right now, we treat people whose glucose levels are already high enough to cause long-term complications and we try to get their levels lowered," he says. "But by the time someone has gotten to the point of diabetes, they've probably lost about 80% of their beta-cell function. Someone with just Impaired glucose tolerance [an aspect of pre-diabetes] has already lost about 50% of their beta-cell function."

Buchanan wants diabetics and doctors to understand better the difference between the manifestations of disease -- heightened glucose levels -- and the loss of beta-cell function that may be causing them.

"The current paradigm of diabetes treatment is focused on the sprint -- what your glucose levels are -- instead of the marathon, which is how the disease is progressing," he says.

However, other experts caution that the results of the TRIPOD study and the effectiveness and safety of TZDs need to be confirmed.

"TZDs are an incredibly important addition to our set of tools," says Fran Kaufman, president of the American Diabetes Association and division head of endocrinology at the Children's Hospital Los Angeles. But she cautions that more studies need to be done. "Whether other studies will show a similarly robust effect of TZDs [as the TRIPOD study did] is something we just don't know."

The Risks and The Costs

There are potential dangers to TZDs. This was most evident in 2000, when the Food and Drug Administration asked the manufacturer of Rezulin to withdraw it after reports of severe and sometimes fatal liver poisoning. The two other TZDs that are currently available, Actos and Avandia, have not shown the same risks and other TZDs are currently in various stages of development. However, the FDA still recommends that liver function of people using TZDs be tested regularly.

The problems with Rezulin illustrate the risks of using any newly developed drug. "Like any drug that's only been used for a short time, we just don't know what the long-term risks might be of TZDs," Buchanan says.

As noted, TZDs have also been connected with weight gain. While the extra fat may be subcutaneous, and thus not as dangerous as visceral fat, the long-term effects of the weight increase aren't known; some patients gain so much weight that treatment needs to be stopped. Studies have also shown an increase in the risk of edema -- the build-up of fluid in tissue -- from TZD use.

There have been reports of other potential problems, and one survey of patients using TZDs found that the risk of congestive heart failure actually increased, in contrast to studies demonstrating the cardio-protective characteristics of the drugs.

Finally, the financial costs of TZDs may hamper their usefulness; they are significantly more expensive than other drugs used to treat diabetes. While Kaufman hopes that prices will drop as more TZDs are released, Buchanan is concerned that this may not happen until the patents on particular TZDs expire.

Is This Normal? Get the Facts Fast!

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If the level is below 70 and you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.

People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.

Congratulations on taking steps to manage your health.

However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.

Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.

Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.

One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.

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