Investigative Report Warns on Alarming Impact of the Long-Term Complications of Type 2 Diabetes

  Experts Call for Action to Address the Escalating Burden of the Disease

A new report suggests that current approaches to the management of Type 2 diabetes are not doing enough to reduce the burden of long-term complications of the disease - a burden which now concerns over 90% of GPs and nurses. ^1,2  The report calls for increased understanding of the underlying causes of the condition, and changes to current management focus based on available clinical and attitudinal evidence, to positively affect the course of the impending epidemic.

Professor Anthony Barnett, Consultant Diabetologist and DEFINe Dossier contributor said: “The most recent Diabetes UK report highlighted that the burden of Type 2 diabetes and its complications pose a major healthcare challenge which, if unchecked, is destined to bankrupt healthcare systems. The DEFINe Dossier illustrates the need for an urgent change in our approach to the management of Type 2 diabetes, to address the long-term complications.

“By applying the evidence base we now have and improving the organisation of care for our patients, we will reduce the future impact of the condition, which is ultimately in all our interests. This must include not just focusing on the immediate symptoms, but targeting a major underlying cause of the condition – insulin resistance – through providing lifestyle advice and using appropriate pharmacotherapy,”  Professor Barnett concluded.

Further research outlined in the DEFINe Dossier demonstrates an overwhelming understanding of the role of insulin resistance and the importance of reducing the long-term complications of Type 2 diabetes. 99% of GPs think it is important to address insulin resistance, ¹ and 90% agree that only an early and aggressive approach to the management of Type 2 diabetes is likely to significantly impact the development of complications. ⁹  Unsurprisingly, 86% rank the prevention of complications as their number one priority when treating their patients. ¹

However, despite this encouraging level of awareness, 83% of diabetologists feel that the number of Type 2 diabetes patients they see who are referred with diabetes-related complications could be reduced if all management options were adequately explored. ¹⁰ In addition, only 14% of GPs feel they are highly successful in adopting an early and aggressive treatment approach, ⁹ and only 20% feel NICE is keeping pace with current available treatments . ¹

Together with earlier diagnosis, improved lifestyle intervention and better prevention and education measures, the adoption of an insulin-resistance-based approach to the management of existing Type 2 diabetes patients could support reductions in associated complications and contribute to relieving the future burden of the disease. Echoing this, 94% of diabetologists agree that targeting insulin resistance early in the disease progression would help improve patient outcomes. ¹⁰

Dr David Levy, Consultant Diabetologist and DEFINe Dossier contributor stated: “This therapeutic area is one of the greatest threats to our health service, but if we tackle the problems underlying Type 2 diabetes then there is hope that the burden of complications will level off or even decline. There is a need for healthcare professionals and patients alike to look ahead, rather than just focusing on short-term achievements such as reducing blood sugar levels.”

This approach accords with recommendations by the Association of British Clinical Diabetologists (ABCD), which recently issued a statement drawing attention to the time limited nature of current NICE guidance, and recommended the use of treatments that directly target insulin resistance (insulin sensitisers) and improve cardiovascular risk factors such as blood pressure as especially appropriate in obese patients. ¹¹ Currently, it is estimated that 80% of Type 2 diabetes patients are overweight or obese. ¹²

Dr Minesh Patel, a Sussex-based GP with an interest in diabetes and a DEFINe Dossier contributor said: "Type 2 diabetes is a complex and interesting disease. Furthermore, it is now more treatable than at any time before. Health care professionals are gaining an understanding of what is at the heart of the disease, namely insulin resistance. It is at the top of the list of conditions where we can now effectively reduce the risk of longer-term complications, and it should not be considered to have an inevitable end. We have the information and for the first time we have treatments that get to the heart of the disease. The time for action is now"

Notes

About Type 2 diabetes

Type 2 diabetes is an inability to process glucose properly due to a combination of genetic and environmental factors, particularly obesity. This leads to insulin resistance and ultimately a failure to produce enough insulin for the body’s needs.

Insulin resistance occurs when the body is unable to respond properly to the insulin it makes and so has difficulty in regulating blood glucose levels.

References

1.        Survey of 200 GPs in the United Kingdom . Conducted by TNS Health care; 22-24 July, 2004

3.        Robertson, KE et al. What the UKPDS Really Says About Cardiovascular Disease and Glycemic Control. Clinical Diabetes :17(3); 109. 1999

4.        Kirpichnikov D, Sowers JR. Diabetes mellitus and diabetes-associated vascular disease.  Trends Endocrinol Metab . 2001 Jul;12(5):225-30. Review.

5.        Bonora E, Formentini G, Calcaterra F. HOMA-estimated insulin resistance is an independent predictor of cardiovascular disease in type 2 diabetic subjects. Diabetes Care 2002;25(7) 1135-1141

6.        Jones TA et al. Addition of rosiglitazone to metformin is most effective in obese, insulin resistant patients with type 2 diabetes. Diabetes, Obesity and metabolism 2003; 5:163-170

7.        Haffner SM, D'Agostino R Jr, Mykkanen L et al .  Insulin sensitivity in subjects with type 2 diabetes. Relationship to cardiovascular risk factors: the Insulin Resistance Atherosclerosis Study.  Diabetes Care . 1999 Apr;22(4):562-8 

8.        Warram JH, Martin BC, Krolewski
AS , Soeldner JS, Kahn CR. Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic patients. Ann Intern Med. 1990 Dec 15; 113 (12):909-15

9.        Internet Omnibus Survey of 217 GPs in the United Kingdom . Conducted by TNS
Health care; 7-11 October, 2004

10.    Survey of 52 Diabetologists in the United Kingdom .  Conducted by TNS
Health care; 16-28 September, 2004

(10/11/04)