Improving Diabetes Control in High-Risk Populations

Diabetes experts are now calling for earlier and more aggressive management of type 2 diabetes. Why are new treatment strategies needed? Type 2 diabetes has become the epidemic of the new millennium. There are now an estimated 150 million persons with diabetes worldwide. By 2010, there may be more than 240 million if we do not reverse the trend. In the United States, the problem is at a crisis level. CDC researchers recently reported a 33% increase in the prevalence of diabetes in the United States in just 8 years.

We now know that type 2 diabetes is a disease involving dual defects—insulin deficiency and insulin resistance—and so dual treatments are necessary to manage it effectively. In addition to diet and exercise, most patients will eventually need a combination of oral agents or oral agents and insulin to control their diabetes effectively and prevent long-term complications.

Introduction of new short-acting (eg, insulin aspart) and long-acting (eg, insulin glargine) insulin analogs and new insulin delivery systems (eg, inhaled insulin) should make it possible to achieve more physiologic insulin patterns. This would help maintain near-normal blood glucose levels and reduce the incidence of diabetes-related complications.

We also have to do something about obesity, which is a major factor in type 2 diabetes. Obesity in women of childbearing age is a particular concern, because obese women are at increased risk for developing gestational diabetes. Their babies tend to be overweight as children and as adults and are at increased risk for developing type 2 diabetes. This is because maternal hyperglycemia leads to overnutrition of the fetus and thereby promotes fetal hyperinsulinemia, excess adipose tissue, and insulin resistance.