As reported by the Danbury News-Times, September 8, 2005.

Common Drugs May Prevent Diabetes Onset

By Robert Miller

In the midst of an epidemic, any tool to fight disease is welcome.
Which is why a study by researchers at the University of Connecticut that found two common drugs may actually prevent diabetes is welcome.

"It's an intriguing study,'' said Dr. Robert Bernstein, an endocrinologist at New Milford Hospital.

"It's something else we may be able to use,'' said Dr. Robert Savino, chief of endocrinology at Danbury Hospital. "It opens the door to further study.''

A team of doctors at the UConn Health Center in Farmington and Hartford Hospital used what is called a meta-analysis — combining research from 11 different studies involving more than 66,000 patients — to show that two drugs used commonly to treat heart disease could reduce the risk of developing Type 2 diabetes by 22 percent. Their findings were published in the September issue of the journal Diabetes Care.

The two drugs — ACE inhibitors and angiotensin receptor blockers, or ARBs — are used to control high blood pressure.

Previous studies have shown that once people are diagnosed with Type 2 diabetes — by far the most common type of the disease — these drugs help slow its progression.

Craig Coleman, a pharmacy professor at UConn and senior author of the study, said the team decided to see if there was any proof the two drugs might prevent diabetes, rather than just treating it once it is diagnosed.

By combining the studies and re-analyzing their data, Coleman said the team found the drugs did substantially reduce the onset of the disease.

The importance of the finding lies in the rise of Type 2 diabetes in the United States and the entire world.

Type 1 diabetes — once called juvenile diabetes — is the rare form of the disease. It's an autoimmune disease that occurs when the body's own immune system attacks the pancreas and disables its insulin-producing cells. About 5 percent to 10 percent of the 18.2 million Americans with diabetes have this form of the disease, which almost always manifests itself in childhood.

The more common form of the disease — Type 2 diabetes — is a metabolic disease in which the body slowly becomes resistant to the insulin the pancreas produces, creating an insulin deficiency. That in turn forces the pancreas to go into overdrive to produce more insulin, which eventually results in full-blown diabetes.

Diabetes is the sixth-leading cause of mortality in the United States, killing more than 73,000 Americans a year. It's also a major cause of heart disease, kidney disease, blindness and limb amputation. Often these diseases — and not diabetes — get listed as the cause of death on mortality records.

It's also expensive. Diabetes costs the United States about $92 billion a year in health care costs and $40 billion in lost productivity, according to the American Diabetes Association.

While a family history and genetic predisposition to Type 2 diabetes are important factors in causing the disease, so are environmental and social factors like obesity and lack of exercise.

In recent years, doctors have begun diagnosing Type 2 diabetes — once thought to be a disease of middle age — in obese teenagers and people in their 20s. It's now estimated that by 2030 there will be 30 million diabetics in the United States, with diabetes rates doubling in other countries.

Doctors are also seeing a rise in a pre-diabetic condition called metabolic syndrome. People with this syndrome are overweight, have high blood pressure, high triglycerides, low HDL cholesterol — the "good cholesterol'' — and early stages of insulin resistance.

Because of the rise of metabolic syndrome, UConn's Coleman said the study may be of great importance. If doctors know that patients have this syndrome, they might put them on a regimen of ACE inhibitors or ARBs and keep them from ever developing diabetes.

"We know these drugs have benefits,'' he said. "This may be one more.''

And Coleman said because there are generic versions of ACE inhibitors on the market, they are not more expensive than more traditional blood pressure medications like diuretics, which do nothing to help diabetics.

But Savino of Danbury Hospital said the current treatment guidelines of the American Diabetes Association stress weight loss and exercise to reduce the risk of diabetes in people with pre-diabetic conditions, rather than medications — something the UConn researchers also stressed.

"If I had a patient who was pre-diabetic, with no high blood pressure, would I prescribe these drugs? I would not,'' Savino said. "But if they had high blood pressure? Yes, I might.''

Bernstein of New Milford Hospital also said the major flaw in the UConn report is that none of the 11 studies included in the meta-analysis had as a goal to see if these drugs reduced the risk of diabetes. While they collected data on the condition, they were primarily studying the effect of the drugs on conditions like heart disease.

A more convincing study, Bernstein said, would be a test that contrasted the two drugs versus a placebo and looked directly at their ability to reduce the risk of diabetes.

Savino said such a study — called the DREAM study — is underway. This research, headed by a team in Canada, is looking at 4,000 patients in Canada, the United States and Europe over 5 years to see if ACE inhibitors and ARBs reduce the risk of diabetes. The results of this study should be released in the next two years.

"When that's published, we'll know more,'' Savino said. "Right now this (the UConn study) is something to consider.''