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Diabetes Newsletter
October 8, 2012
In this Issue
• Diabetes Screening May Not Lower Overall Death Rates
• New Survey Examines States' Investments in Dealing With Diabetes
• Diabetes Patients Should Have More Voice in Treatment: Experts

Diabetes Screening May Not Lower Overall Death Rates

10-year British study found no survival benefit for population at large

WEDNESDAY, Oct. 3 (HealthDay News) -- Screening for type 2 diabetes does not appear to reduce the risk of death in the general population, according to a new study.

Researchers looked at the number of deaths over 10 years among more than 20,000 people, aged 40 to 69, in England. All of them were at high risk for diabetes.

The patients were divided into three groups. One group underwent a round of diabetes screening that was followed up by routine care for those diagnosed with diabetes; another group had a round of screening followed by intensive management for those diagnosed with diabetes; and a third group did not undergo diabetes screening.

Over an average follow-up of nearly 10 years, the overall death rates in the groups that had diabetes screening were no lower than in the group that had no screening. There also was no significant difference between the groups in the number of deaths specifically from diabetes, cardiovascular illness, cancer or other causes.

The study appears Oct. 3 in the journal The Lancet.

"It seems that the benefits of screening might be smaller than expected and restricted to individuals with detectable disease," study author Dr. Simon Griffin, of the epidemiology unit at Addenbrooke's Hospital in Cambridge, said in a journal news release. "However, benefits to the population could be increased by including the detection and management of cardiovascular risk factors alongside the assessment of diabetes risk, performing repeated rounds of screening and improving strategies to maximize the uptake of screening."

A U.S. expert said the new findings didn't surprise him.

"Diabetes screening and diagnosis can be done with relative ease, which further escalates popular support for wide-scale screening," Michael Engelgau, of the U.S. Centers for Disease Control and Prevention, wrote in an accompanying editorial. "However, these compelling arguments overlook the screening costs, potential harm and lack of clear evidence that screening improves health outcomes compared with current routine clinical diagnosis."

"This study increases the doubt about the value of wide-scale screening for undiagnosed diabetes alone, and deserves credit for tackling the screening quandary head-on," Engelgau concluded. "Nevertheless, for any one study to address the diverse factors that affect screening policies -- ranging from the magnitude of population burden of disease to the capacity and effectiveness of prevention approaches -- is a tall order. Screening recommendations are therefore likely to be country specific and context specific for the foreseeable future."

More information

The American Diabetes Association outlines what you can do to prevent diabetes  External Links Disclaimer Logo.

New Survey Examines States' Investments in Dealing With Diabetes

Report showed dip in federal grants to prevent, treat condition

FRIDAY, Oct. 5 (HealthDay News) -- States are investing millions to prevent or control diabetes, according to a new survey from the National Conference of State Legislatures.

In all, 14 states have set aside more than $7.7 million for diabetes treatment, prevention and education for 2012, the survey revealed. In addition, nine states have approved $11.5 million that could be spent on diabetes programs, as well as $77 million to prevent and treat chronic diseases, including diabetes.

Federal grants to all 50 states for diabetes prevention and management fell 13 percent in 2011, however. The U.S. Centers for Disease Control and Prevention gave states about $23.8 million in grant money that year, $3.6 million less than in 2010.

States are using the money to delay or prevent the development of diabetes as well as reduce its complications. By doing so, states can reduce the health care costs attributable to diabetes and eliminate diabetes-related health disparities, according to a conference news release.

States are also investing in programs to encourage people to stop smoking, eat a healthy diet, get regular exercise and lose weight in an attempt to prevent or manage diabetes.

"With states looking at ways to control Medicaid costs, lawmakers recognize that programs to help prevent diabetes can be one of the tools," Richard Cauchi, a health program director at the NCSL's Denver office, said in the news release.

Diabetes affects more than 25 million Americans, the release noted.

More information

Visit the National Conference of State Legislatures to view the States Address the Cost of Diabetes  External Links Disclaimer Logo report.

Diabetes Patients Should Have More Voice in Treatment: Experts

New guidelines say individual, doctor and evidence must all contribute to decisions

TUESDAY, Oct. 2 (HealthDay News) -- New guidelines meant to provide type 2 diabetes patients with truly individualized care have been issued by the American Diabetes Association and the European Association for the Study of Diabetes.

The new position statement recommends more patient involvement in the treatment and management of their condition and gives guidance on the rational approach to the choice of therapy. Choices -- including precise goals for blood sugar control -- should combine the best available scientific evidence with the doctor's and patient's own preferences.

"Given the uncertainties in terms of type and sequence of therapies, this approach is particularly appropriate in type 2 diabetes," Andrew Boulton, a professor at the University of Manchester, in England, and EASD president, said in a news release from the organization.

Among the other main points in the new guidelines:

  • Diet, exercise and education remain the foundation of any type 2 diabetes treatment program.
  • Unless there are good reasons for not using it, metformin (brand names include Fortamet, Glucophage, Glumetza and Riomet) is the best first-line drug.
  • After metformin, there is limited data to guide treatment. Combination therapy with an additional one or two oral or injectable drugs is reasonable, aiming to minimize side effects where possible.
  • Eventually, many patients will require insulin therapy alone or in combination with other drugs to maintain glucose control.
  • Comprehensive cardiovascular risk reduction must be a major focus of therapy.

The guidelines were scheduled for release Tuesday at the annual meeting of the EASD, in Berlin, and appear in the journal Diabetologia.

In the guidelines, patient-centered care is defined as "an approach to providing care that is respective and responsive to individual patient preferences, needs and values, ensuring that the patients' own values guide all clinical decisions."

Ultimately, patients make the final decision about their lifestyle choices and, to some degree, the drug treatments they receive. Their diabetes care and management has to fit in with their lives.

More information

The American Diabetes Association has more about diabetes treatment and care  External Links Disclaimer Logo.

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