March 15, 2013
NIH Podcast Episode #0186
Balintfy: Welcome to episode 186 of the new NIH Research Radio. The new NIH Research Radio is your source for weekly news and information about the ongoing medical research at the National Institutes of Health – NIH . . . Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode our news summary at the end of the program includes items on how the improved health from quitting smoking far outweighs weight gain concerns, and discoveries on how brain cells wipe out unimportant information to help future learning.
But first, our feature story...
Big improvement in diabetes control over past decades
Balintfy: Currently, about 26 million Americans have diabetes. Diabetes is a group of diseases where a person’s blood glucose or blood sugar, is too high. Another 79 million Americans have prediabetes, a condition that places them at increased risk for developing type 2 diabetes and heart disease. Over time, having too much glucose in your blood can cause serious problems. But now a study is showing that people with diabetes are doing better at controlling their disease. Dr. Catherine Cowie, is the study’s senior author and director of the Diabetes Epidemiology Program at the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases. I’m talking with her and the paper’s first author, Dr. Sarah Stark Casagrande, she’s a diabetes epidemiologist whose work is supported by the NIH. First Dr. Cowie, the measures for successfully controlling diabetes are often called the ABCs of diabetes. Can you explain what those are?
Cowie: So the ABCs stand for hemoglobin A1C, blood pressure, and cholesterol. The A for hemoglobin A1C is a measure of average blood sugars over the last three months and then we know blood pressure and cholesterol.
Balintfy: Now, the study which appears in Diabetes Care shows there are improvements in those three key markers, right?
Cowie: There are big improvements since 1988 to 2012, which was the last year of our study. More people are meeting the goals in these three key markers of diabetes control. It went from 2% in 1988 and is 19% now in 2010. An additional bit of information is that more than 50% of people with diabetes meet each goal individually as we found in 2010. That’s the good news.
Balintfy: What’s the bad news?
Cowie: The bad news is that 19% of people are meeting all three goals, which means there’s still plenty of room for improvement. In addition, while 50% have met each goal individually that means that roughly 50% also have to meet each of these goals still.
Balintfy: Dr. Cowie, why is it important for people to manage their diabetes?
Cowie: It’s important because when these measures fall outside the healthy ranges, people are more likely to be burdened by the complications of diabetes. These include heart disease, stroke, kidney disease, blindness, amputation. Diabetes is the number one cause of blindness, of kidney disease, and of not traumatic amputations.
Balintfy: Why aren’t more than 19 percent of people with diabetes meeting those three goals?
Cowie: Right. Well there may be several reasons why they’re not. First, the American Diabetes Association goals may be biologically unattainable. For some patients who have severe diabetes, they may have complications of diabetes, they may be on more medications, they may be older. There are certain type 1 diabetes is different than type 2 diabetes as far as its control. So this is one reason why. Second, patients may not have the skills or the resources necessary for adhering to really a rather demanding regimen for managing their diabetes. Third, goals are increasingly being tailored on the basis of individual factors and therefore some patients may not be expected to achieve all three goals.
There’s also a gap in access to care for some groups and I thought that maybe Sarah could talk about some of the groups that are not attaining these goals as much as what we would like.
Balintfy: So let me turn to you, Dr. Sarah Stark Casagrande, can you explain the differences among groups when it comes to meeting diabetes control goals?
Casagrande: Yes. So we found that younger persons and some minorities were less likely to meet the ABC goals. Specifically people between age 20 and 49 were less likely to meet the A1C goals compared to older persons and about 44% of Mexican-Americans met the A1C goals versus 53% of non-Hispanic blacks and whites.
Balintfy: Any ideas why those groups measured so differently?
Casagrande: Well we did not assess why some people were less likely to meet these goals, but we can speculate some reasons for these results. Younger people generally see healthcare practitioners less often for diabetes management perhaps because they have fewer resources or they may think that meeting the goals is not important because of their overall better health. For the racial, ethnic disparities that we found, lower income and education, lack of health insurance, and access to care may make it harder for some of these people to achieve the goals.
Balintfy: What do you think should be done for young people or minorities to improve their diabetes management?
Casagrande: Well research effort should consider focusing on some social factors such as income, geographic location and language, which may lead to poor control. Other factors that should be addressed include as I mentioned before access to care, health insurance coverage and education and also translation efforts on the importance of control early in the disease course, which we know can improve outcomes down the line.
Balintfy: Let’s go back to the good news that 19 percent of people with diabetes managing their three key measures is better than the 2 percent it was back in 1988. Dr. Cowie, where did this improvement come from?
Cowie: So some of the improvement maybe from improvement in medications and monitoring devices. There is improvement in research, increasing research that has come out showing the importance of managing diabetes and also there is better communication of all of this information to people with diabetes and also the health practitioners that are helping them. There are examples of some studies the Diabetes Control and Complications Trial, the Epidemiology of Interventions and Complications Study that shows that improvement in blood sugar as early as possible in the course of disease significantly reduces the risk of diabetes complications and heart disease. There has also been other trials that have come out looking at the benefit of reaching blood pressure goals, the benefit of reaching cholesterol goals showing an improvement in heart disease over time. Then of course there is the National Diabetes Education Program that is developing materials, practical materials and information on what the ABCs are and they are successful, have been successful in getting this information out to individuals with diabetes and their physicians.
Balintfy: Your study looked at a lot of data. Were you able to see whether medications like statins worked better than lifestyle changes to improve diabetes control?
Cowie: That was one thing that we could not assess in these national data. We can speculate that the improvement is related to these improved and new therapeutic agents. So the percentage of people that are using antihypertensive medication has significantly increased over this time period so has the use of cholesterol medications. Their statin use has increased dramatically over this time period and also there is the use of certain diabetes medications such as metformin that is very well tolerated in people with diabetes. In addition, there is more information and healthy behaviors related to obesity and what you can do to try to prevent it which then obesity is related to diabetes. People may be more likely maybe improving their lifestyle behaviors over this time period.
Balintfy: A question for both of you: were there any results that you found particularly surprising?
Casagrande: Well we are very encouraged to see that almost all subgroups saw improvements in meeting the goals over this time period. We are also struck again by the fact that younger people were less likely to have A1C and cholesterol control compared to their older counterparts. This finding was very important because we know that good diabetes control early in the course of the disease has long lasting effects on complications in the future.
Cowie: I think I mean we have seen this interesting finding that A1C levels are actually somewhat worse in young individuals as compared to older individuals, but it hasn’t been the focus of the research whereas in this it has been highlighted. You know, it could be what Sarah mentioned that young people may not be focused on their health because they’re healthy and again they may not have the resources.
It is possible that there could be some interesting things that are complicating this message. There may be a greater proportion of people who have type 1 diabetes, which is a more difficult diabetes to control. It could be that the older individuals have lived long enough to be older and so they’re healthier. So it’s a little bit of a complicated message but I don’t think it changes the message. There should still be a focus on improving diabetes control as early as possible in the disease course to try to ward off complications.
Balintfy: Thanks to Drs. Catherine Cowie and Sarah Stark Casagrande. For more on this study, visit www.niddk.nih.gov. And for more information on diabetes control, visit the National Diabetes Education Program website http://ndep.nih.gov.
And coming up the improved health from quitting smoking far outweighs weight gain concerns, and discoveries on how brain cells wipe out unimportant information to help future learning. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Balintfy: Now for some recent news headlines from NIH, here’s Craig Fritz.
Fritz: The improvement in cardiovascular health that results from quitting smoking far outweighs limited risks from the modest amount of weight gained after quitting, according to a study funded by NIH. Researchers found that former smokers had about half as much risk of developing cardiovascular disease as current smokers, and this risk level did not change when post-quitting weight gain was accounted for in the analysis.
Scientists at NIH have found that when the mind is at rest, electrical signals used by brain cells to communicate appear to travel in reverse. This process seems to wipe out unimportant information but also prepares the cells for future sensory learning. The research performed in rats has implications not only for studies seeking to help people learn more efficiently, but also for attempts to understand and treat things such as post-traumatic stress disorder―where the mind has difficulty moving beyond a disturbing experience.
For this NIH news update, I’m Craig Fritz.
Balintfy: You can get more information on these news items at www.nih.gov/news.
And that’s it for this episode of the new NIH Research Radio. Please join us again next Friday, March 22 when our next edition will be available. Coming up in that episode insight into Lynch syndrome, from the researcher who discovered it, and a patient:
It’s been an uphill battle because there isn’t a lot of knowledge about Lynch syndrome especially when primary care physicians –you know, finding a primary care physician who actually knew what kind of screening I needed was difficult. I was lucky I finally found one here and I think I’m getting up to date screening and testing and I think my family knows the risks.
Balintfy: If you have any questions or comments about this program, or have a story suggestion for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next week, I'm your host, Joe Balintfy. Thanks for listening.
Announcer: NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.
About This Podcast
Spokesperson: Dr. Catherine Cowie; Dr. Sarah Stark Casagrande
Topic: diabetes, type 2 diabetes, diabetes control, diabetes ABCs, ABC, hemoglobin, A1C, blood pressure, cholesterol, blood sugar, blood glucose, high blood glucose, heart disease, disease