If everyone who had the most common form of diabetes were given a daily “polypill” that combined low-dose aspirin with commonly used drugs to lower cholesterol, blood pressure and blood sugar, it would prevent 7.2 million deaths and disabilities that result from the disease, the president of the American Diabetes Association says.
Such a basic standard of treatment would cost about $100 a year, Robert Rizza said Saturday at a briefing, and would reduce heart attack risk by half, kidney failure by 21% and blindness and eye surgery by 33%.
The predictions were produced by Archimedes, a mathematical model that simulates the biological processes in diabetes and models the effects of various interventions, such as changes in treatment. The system has accurately predicted the outcome of numerous medical clinical trials, Rizza says, and the ADA used it to predict what would happen in the next 30 years under three scenarios:
- A cure for diabetes would reduce the number of serious complications by 1.4 million a year and save more than $700 billion.
- If everyone with diabetes got the best treatment available, it would save more than $325 billion in medical care and result in 18 million fewer deaths and serious complications.
- If at least 80% of people with diabetes got optimal care, it would reduce the risk of diabetes complications by 60% and would save $150 billion.
With changes in the system to focus on prevention, “you can save millions of lives with no net increase of the current dollars we’re using,” Rizza says.
Nearly 21 million Americans have diabetes and 41 million have pre-diabetes, a condition in which blood sugar is elevated but not to the point of diabetes. Up to 95% of diabetics have a form of the disease caused by the body’s inability to use insulin properly.
Other studies presented over the weekend at the ADA meeting:
- Antidepressants appear to increase progression to diabetes in people who already are at risk for the disease, a study suggests. Researchers at Johns Hopkins University School of Medicine analyzed data from more than 3,000 people at high risk of diabetes who took part in the Diabetes Prevention Program. Those who took antidepressants regularly were two to three times more likely to develop diabetes during the study. There was no increased risk in those who were not taking antidepressants, says study co-leader Richard Rubin, and, mysteriously, those who took the glucose-lowering drug metformin along with antidepressants had no increased risk.
- “We don’t have a clue what’s going on,” Rubin says. He says this is the first large study to report such findings, and “we have to look more closely because of the potential public health implications.”
- Doctors are slow to boost treatment for high blood sugar or high blood pressure, even when they see the numbers rising, four studies report. Researchers cited examples of what they called “clinical inertia,” suggesting doctors may not be aware of ADA’s target goals or are not following them.
“This set of abstracts really highlights the irrefutable evidence that physicians are just not aggressive enough,” ADA scientific director Richard Kahn says.
Diabetes management is key to reducing long-term complications, an issue that is increasingly important as rates of diabetes rise, scientists say. The Centers for Disease Control and Prevention estimates that one of every three children born in the USA in 2000 will develop diabetes. Today, 9.6% of adults have the disease, and for those ages 60 or older, it’s 20.9%.
“If you knew there was a biological weapon coming that could hurt your children, what would you do?” Rizza asks. “That biological weapon is diabetes. It’s going to kill something like 40 million people, and it is here in our country.”
