The Centers for Disease Control and Prevention (CDC) maintains statistics on many diseases, including diabetes. According to their 2014 report, the most recent available, 29.1 million people, 9.3% of the US population has diabetes. Of these, 21 million have been diagnosed while 8.1 million are still undiagnosed. The rate increases with age and is slightly more common in men than in women.
Diabetes can cause many serious problems, including heart disease and stroke, blindness, and kidney failure. It is also a cause of lower limb amputation. The CDC reports that people with diabetes have elevated rates of high blood pressure and cholesterol. The risk of cardiovascular death, heart attack and stroke were at least 50% higher among diabetics than among the general population. The CDC reports “Diabetes was the seventh leading cause of death in the United States in 2010 based on the 69,071 death certificates in which diabetes was listed as the underlying cause of death. In 2010, diabetes was mentioned as a cause of death in a total of 234,051 certificates.” Even this may be under reporting because for the period 2003 — 2006 the all-cause death rate among people with diabetes was 1.5 times that of the non-diabetic population.
The CDC states: “Diabetes can be treated and managed by healthful eating, regular physical activity, and medications to lower blood glucose levels. Another critical part of diabetes management is reducing cardiovascular disease risk factors, such as high blood pressure, high lipid levels, and tobacco use. Patient education and self-care practices also are important aspects of disease management that help people with diabetes stay healthy.” This may be questionable. The presumption has been that if blood sugar can be kept close to, or especially at normal levels, the patient will be free of the adverse effects of the disease. But, Canada’s Therapeutics Letter, published by the Therapeutics Initiative of the University of British Columbia, in its May-June 2016 issue, questioned the basis for approval of non-insulin glucose-lowering drugs. These are drugs that promise to lower your blood sugar, including sitagliptin (Januvia), liraglutide (Victoza), canagliflozin (Invokana) and others. These drugs were approved for sale in Canada based on evidence that they lower blood sugar and HbA1c. HbA1c is a measurement of past blood glucose levels, and has been called the gold standard for measuring diabetes risk. When glucose sticks to the hemoglobin in red blood cells it forms ‘glycosylated hemoglobin’ also called hemoglobin A1C or HbA1C. High levels of HbA1c indicate higher levels of glucose in the blood. Blood glucose and A1c levels are surrogate markers. It’s assumed that if your blood sugar is low, your risks of heart attack, stroke, blindness, or other adverse effects associated with diabetes are lowered. The physicians responsible for the Therapeutics Letter question this assumption.
The Therapeutics Initiative returned to this topic in its November-December 2016 issue of Therapeutics Letter. This essay was titled, “Is the current ‘glucocentric’ approach to management of type 2 diabetes misguided?” In this issue they cite a number of studies which agree that intense focus on blood sugar levels may be difficult for patients and impose serious risks of drug adverse effects. They cite a 2017 essay that appeared in Journal of the American Medical Association: “Trials that use outcomes based solely on glycemic parameters are no longer acceptable for clinical decision-making. Clinicians and patients need evidence about outcomes associated with different drug classes and likely with different agents within a class. Investments in pragmatic studies of existing agents are needed to understand the impact on outcomes of all treatment options.”
For years, physicians and patients have relied on blood sugar measurements to estimate the safety and effectiveness of treatment of diabetes type 2, but now there’s increasing evidence that these are the wrong measures and it becomes urgent to conduct studies to discover a truly effective treatment for diabetes 2, particularly as the condition becomes increasingly common. We need treatments that improve lives and prevent complications, not just numbers, but that calls for a major research initiative.
That need runs full tilt into the Trump budget which cuts $5.8 billion, or 18%, from the National Institutes of Health, which funds much of the basic research needed to treat cancer, diabetes and other diseases. The CDC seems to retain its overall budget, but $500 million is carved out for block grants to the states. Block grants are a favorite of Republicans, but they make it more difficult to deal with a nationwide problem such as the growth of diabetes and heart disease. These cuts are in contrast to Trump’s $54 billion increase in the military budget.
There is one hope for saving the NIH funding. The failure of Trumpcare may weaken the hold of the current president on Congress. More than 80% of the NIH budget goes to more than 300,000 researchers at more than 2,500 universities, medical schools and other research institutions. These researchers in turn buy equipment and supplies, while the universities they work for apply some of their share of the grant money to building maintenance which helps cut the need for funding from other sources. Medical research was never intended to be a jobs program but it has that effect. Which is more likely to make America great: a cure for diabetes, or cancer, or heart disease – or more bombs? It’s a matter of life or death.
Sam Uretsky is a writer and pharmacist living in New York. Email email@example.com.
From The Progressive Populist, May 1, 2017
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