What’s new for diabetes management and prevention

From new ways of predicting who will and won’t develop diabetes, to new diabetes meds, to new evidence regarding which anti-vascular endothelial growth factor (VEGF) might be better for your specific patient, the last year has given us better tools for helping our patients with diabetes.

A number of interesting developments have arisen in the last year concerning risk assessment, treatment, and management of both diabetes and diabetes-related eye disease. The stage has been set by the increasing prevalence of diabetes, with 29.1 million Americans having diabetes, and another 86 million having pre-diabetes.¹ More recently, analysis published recently in JAMA shows that about 12 percent of U.S. adults have diabetes, with more than half of the adult population having either diabetes or pre-diabetes, including an astounding 83 percent of U.S. adults over the age of 65 years.² Worldwide, diabetes rates continue to climb, particularly in Asia. In fact, if we total the number of people living with diabetes in China (100 million), India (50 million), and the U.S., this amalgam would represent the third most populous country in the world.³

Clearly, we need to do a better job of identifying those at highest risk for development of both diabetes and especially sight-threatening eye disease. The other thing we need is a whole lot of prevention.

More diabetes: Improve and protect your next patient with diabetes

Risk factors for type 2 diabetes

Some interesting and novel risk factors for type 2 diabetes (T2DM) have arisen within the last year, including alterations in the gut microbiome that fosters insulin resistance, at least some of which is attributable to both excess consumption of refined carbohydrates and non-nutritive sweeteners like aspartame and sucralose.^3,4 Elevated liver enzymes ALT and AST also have been shown to be highly predictive of T2DM, particularly in women, and these are commonly associated with non-alcoholic fatty liver disease (NAFLD).⁵

Both of these findings bolster evidence that avoidance of added dietary sugars (the World Health Organization now recommends less than 40 grams per day, with an ideal target less than 25 grams per day)⁶ will lower diabetes risk at a population level. Lifestyle intervention continues to trump metformin for preventing T2DM over 15 years in high-risk subjects from the Diabetes Prevention Program (DPP), with 27 percent and 18 percent reduced incidence comparing 100 minutes/week walking to metformin vs. no intervention.⁷ Interestingly, a composite index of microvascular complications did not differ significantly between the treatment groups, though women assigned to the “lifestyle” group were about 22 percent less likely to experience any microvascular complication, including retinopathy.

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