1. Kennedy, Maureen Shawn MA, RN, news director

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Despite San Diego's "June gloom" weather and a small earthquake, some good news emerged for the more than 13,000 attendees of the 65th Scientific Sessions of the American Diabetes Association (ADA) in June. Physicians, nurses, psychologists, dietitians, podiatrists, health educators, and consumer advocates gained a greater understanding in managing diabetes and reducing its complications.


"Past, Present, and Future" was the title of the address given by ADA president Alan D. Cherrington, PhD. He cited statistics from 1985, 1990, and those most recently available regarding the trends in prevalence (see Figure 1, at right) and costs. While he acknowledged treatment advances such as pancreas and islet cell transplantation and new medications, he also noted that "the economic and personal burden of diabetes will be overwhelming" if current trends continue. He noted that only 45% of people with diabetes receive care according to established guidelines and called for investing in research, adopting a chronic care treatment model (which places greater emphasis on involving patients in planning treatment), focusing on early treatment and prevention, and working to decrease the prevalence of obesity. Noting that Medicare does not reimburse for prevention efforts, he called on the Bush administration "to invest in this war-the war on diabetes." He ended his address announcing the formation of a new organization, Shaping America: The Association for Weight Management and Obesity Prevention, noting that the increasing prevalence of obesity, a trend that began in 1990, coincides with the increasing incidence of diabetes.

Figure 1 - Click to enlarge in new windowCherrington AD.

More bad news came from a report showing that diabetic retinopathy occurs earlier than previously thought. Richard Hamman, MD, DrPH, vice chair of the ADA's Diabetes Prevention Program, reported that nearly 8% of patients with prediabetes (fasting blood glucose of 100 to 125 mg/dL) had clinically detectable retinopathy.


Good news came from a follow-up report on patients with type 1 diabetes who took part in the Diabetes Control and Complications Trial between 1983 and 1989. That study showed that patients on an intensive glucose management regimen and who maintained tight blood glucose control (a hemoglobin A1c level of 7% or less; 6% is normal) dramatically reduced renal, eye, and nerve damage compared with those on conventional therapy. The effects of the intensive therapy still show a "dramatic effect on reducing eye, renal, and nerve damage by as much as 76%," according to a presentation by David Nathan, MD, who cochaired the study group. The intensive therapy group also showed a 42% reduction in cardiovascular disease during the 20 years of follow-up. He urged that intensive therapy be started early in patients with type 1 diabetes.