17 May 2012 Turning diabetes treatment upside down
Type 2 diabetes is fast becoming a world-wide pandemic. One in 10 Americans have type 2 diabetes. Treatment tends to move from lifestyle changes and then onto a series of what’s called “stacking meds” – combinations of drugs that inevitably become ineffective and eventually lead to insulin injections to lower blood sugar. This is the story of one American doctor who is looking at diabetes treatment from a different angle… The data is mind-numbing: two-thirds of all Americans are overweight or obese, putting them at increased risk for diabetes. Many already have the disease and don’t know it. It’s an epidemic: according to the Centers for Disease Control and Prevention, in 2010, one in 10 Americans had type 2 diabetes. And roughly one in every 10 health-care dollars is spent on diabetes every year.
Today, if you’re diagnosed with type 2 diabetes — the most common form — your treatment would likely go like this: Your doctor would tell you to change your lifestyle, exercise more, lose weight, eat more fruits and vegetables. You’d be given a device to check your blood-glucose levels, and you’d be told to come back in a couple of months.
After an average of two years of checking your glucose levels, you’d be put on metformin, the most common medicine for type 2 diabetics. Then the disheartening process of “stacking meds” would start. In addition to metformin, which lowers blood sugar by reducing the amount of sugar produced by the liver and helps the body better use its own insulin, you’d be put on sulfonylureas, drugs that stimulate the pancreas to release additional insulin.
As this combination became ineffective, you would be put on any of nine other classes of drugs, an average of one additional med every two years. At the end of 10 years, you’d finally be shown how to inject insulin several times a day to lower your blood sugar. If you’re like most patients, this is when you’d feel like a failure. And you’d have spent 10 years thinking you were the victim of a disease.
But Jay Shubrook (above), an associate professor of family medicine and director of clinical research at Ohio University Heritage College of Osteopathic Medicine, is developing another story….
The multipronged approach he’s taking in his research on diabetes is revolutionary. He refuses to treat his patients as passive victims. He asks them to fight — to take certain risks, and face deep fears. And he is turning the practice of stacking meds upside down…..
All the while, Shubrook was well aware that patients were frustrated with the stacking of meds and how long lifestyle changes can take to have an effect. “We were always a step behind,” he says. “We were chasing the disease. The burden on patients was significant.”
Diabetes doctors sometimes see patients with such high levels of glucose, or hyperglycemia, that the treatment has to be aggressive, which means insulin is the only option.
“We had these people who were really hyperglycemic, so we knew meds would not work quickly enough,” says Shubrook. “We put them on insulin first. We knew it wouldn’t harm them.”
Shubrook wondered whether using insulin first would also work in patients who weren’t severely hyperglycemic. “That made a lot of people nervous,” he says.
“I was told, ‘You can’t do that, because [blood-glucose levels] will drop too low,’ ” making the patient hypoglycemic, the opposite of hyperglycemic.
Other doctors and researchers saw it as a shockingly aggressive approach. Shubrook almost didn’t get funding for his Insulin First study, because funders thought he’d never find participants who were willing to try first what had long been a last resort. But Shubrook understood his patients in this corner of Appalachia; he knew they were ready to try something, anything, different.
In 2006, Shubrook began a series of trials with a group of patients who’d been newly diagnosed with type 2. Instead of 10 years to build up to insulin, they were taught to give themselves four shots a day almost immediately.
The results were undeniable. In six to eight weeks, the patients’ blood-sugar levels started to normalise. Shubrook and his team then, with close monitoring, started to withdraw the insulin. In three to four months, the patients no longer needed the injections to regulate their blood sugar. And many were able to stay off all medicines for up to three or more years. Shubrook asked people to work at maintaining a balanced diet and as much exercise as they could do, but, “We did not ask them to do any more than we ask of all our patients,” he explains…..