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Diabetes Update: How Diabetes Works

Number 20; August 30, 2001

By David Mendosa

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contributions are:

    on August 24, 2001
  • How Diabetes Works
    My new "About the Internet" column for the American Diabetes Association's Web site reviews the article called "How Diabetes Works" at Marshall Brain's HowStuffWorks wonderful Web site. I interviewed Marshall, and, yes, Brain really is his last name. And he is really smart. Be sure to visit "How Diabetes Works" for the graphics, if nothing else. The column is at

Updates Include:

  • This week I added a section on diet and food programs to my Web page, On-line Diabetes Resources, Part 13: Software. Previously the page included descriptions and links only to blood glucose tracking programs. Right now the diet and food section includes only two programs, and I would love to get nominations for more.

Special Notice:

Two announcements about diabetes made the news this month. But they were so important they probably didn't make as much news as they deserved. So I am summarizing them here.

  1. The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) worked out the first ACE Consensus Conference on Guidelines for Glycemic Control. Their tough new diabetes guidelines differ in some important respects from those of the American Diabetes Association. The question on the table now is whether the ADA will follow suit.

    The most important change is that the guidelines lower the target on the glycosylated hemoglobin A (HbA1c) test to 6.5%. The ADA's current position statement on "Standards of Medical Care for Patients With Diabetes Mellitus" sets a level of less than 7.0% as the "goal." But not until the level rises above 8.0% is "additional action suggested."

    The conference also wants to simplify the name of the test. Just call it the A1C test, they say.

    The conference also recommended that diabetes screeing should begin for high-risk groups at age 30. Previously the recommendation was to start at age 45.

    Finally, the guidelines set targets for plasma glucose: fasting and preprandial (before eatingl) levels should be less than110 mg/dl and 2-hour postprandial (after eating) levels should be less than 140 mg/dl.

    For more information please see

  2. The National Institute of Diabetes and Digestive and Kidney Diseases announced this month that it had terminated the Diabetes Prevention Program one year early, because the results were already clear. The DPP was a major clinical trial comparing diet and exercise to treatment with metformin in 3,234 people with impaired glucose tolerance, a condition that often precedes diabetes.

    The study had originally four groups or "arms." One was based on intensive lifestyle changes with the aim of reducing weight by 7 percent through a low-fat diet and exercising for 150 minutes a week. The second was treatment with 850 mg twice a day of the drug metformin (Glucophage). They compared the success of these groups against the third group, which took placebo pills. The fourth arm, treatment with the drug troglitazone (Rezulin) combined with standard diet and exercise recommendations, was terminated in June 1998, because of its liver toxicity. Rosiglitazone (Avandia) and (pioglitazone) Actos, two leading drugs for the reduction of insulin resistance, were not available when the study started and were therefore not included. The diet and exercise group reduced their risk of getting type 2 diabetes by 58 percent. The group treated with metformin reduced their risk of getting type 2 diabetes by 31 percent.

    Unfortunately, the study left us with no way to tease apart of effects of weight reduction from those of exercise. Certainly, both together went a long way toward reducing the risk of getting type 2 diabetes. But was weight reduction more important than exercise? No one knows.

    For more information please see


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