Prevention of diabetes

                   Prevention of diabetes

Primary and secondary prevention in diabetes mellitus

The diabetes mellitus, commonly referred to as diabetes known, includes various forms of glucose metabolism disorder associated with a chronically elevated glucose levels. In the type 1 diabetes and type 2 diabetes are distinguished.

Type 1 diabetes children and young people receive the diagnosis especially, before they reach the twentieth year of life. Here, one can speak of a triggered by viral infections or genetically related autoimmune disease. Because the body's Immunssystem destroys the insulin-producing beta cells (islet cells) in the pancreas. Therefore, the body can no longer produce the needed amount of insulin. Lack of insulin, which is responsible for the healthy people that glucose is absorbed by the body's cells, increases the value of sugar in the blood. This form of diabetes affects approximately 5 to 10% of all diabetics in Germany.Far more often, the type 2 diabetes occurs. 90% of diabetics suffer from this form of diabetes, which affects commonly more older people. This form of diabetes, the body's cells are more resistant to the body's own insulin. Also in this case, you can transport the glucose from the blood no longer sufficient in the body's cells. As a cause, an unhealthy lifestyle is stated here. In particular very overweight and lack of exercise can lead to a type 2 diabetes.

If the number of new cases of type 2 diabetes is far higher than in the type 1 diabetes, yet is a significant increase in those affected to both diseases. It is above all especially alarming that now not only people who have significantly exceeded the age of 40 are affected by type 2 diabetes, but that also more and more children and young people due to poor nutrition and lack of exercise have this form of diabetes.

Here, it is clear that an urgent preventive measures must be taken, which can reduce the number of new cases and at an early stage to prevent an outbreak of the disease. In the prevention of diabetes research distinguishes between the primary and secondary prevention, which will attack at different times in the course of the disease.

Far more often, the type 2 diabetes occurs. 90% of diabetics suffer from this form of diabetes, which affects commonly more older people. This form of diabetes, the body's cells are more resistant to the body's own insulin. Also in this case, you can transport the glucose from the blood no longer sufficient in the body's cells. As a cause, an unhealthy lifestyle is stated here. In particular very overweight and lack of exercise can lead to a type 2 diabetes.

If the number of new cases of type 2 diabetes is far higher than in the type 1 diabetes, yet is a significant increase in those affected to both diseases. It is above all especially alarming that now not only people who have significantly exceeded the age of 40 are affected by type 2 diabetes, but that also more and more children and young people due to poor nutrition and lack of exercise have this form of diabetes.

 Here, it is clear that an urgent preventive measures must be taken, which can reduce the number of new cases and at an early stage to prevent an outbreak of the disease. In the prevention of diabetes research distinguishes between the primary and secondary prevention, which will attack at different times in the course of the disease.

Primary prevention of type 1 diabetes

The goal of primary prevention is to intervene in the immune system before body's own antibodies, can emerge and attack the beta cells of the pancreas. It is intended, therefore, already long time before the occurrence of the disease eliminate the cause of a possible disease. World's researchers are looking currently for ways the immune systems of genetically highly vulnerable children (children, their parents or siblings already had type 1 diabetes) keep from, to turn against the body. The measures concern only young children because it has been established that the beta cell antibodies are already detectable within the first two years of life in the blood, if children develop type 1 diabetes before entering puberty.(Trial to reduce IDDM in the genetically at risk), for example, in the Finnish double-blind and placebo-controlled study of TRIGR has been tested whether the omission of cow milk protein reduces the likelihood during the first 6-8 months of life a child, that a child suffering from diabetes. In the animal model, already positive effects set by avoiding of the protein. After two years, it showed that the 207 children were classified on the basis of a study of umbilical cord blood as endangered children with regard to the type 1 diabetes, the presence of antibodies that turn against the beta-cells has halved. These results should be reviewed in an international study.

Also a researcher of the University of Munich are developing an approach in which the change of diet focuses on is. They are based on the DAISY study (diabetes Autoimmunity study in the young) who has shown that children with first degree-relatives living with type 1 diabetes, are potentially more vulnerable to develop diabetes if they have been fed before the fourth month with cereals. In the so-called BABY diet intervention study, Anette-G study Prof. Dr.. Ziegler and her colleagues, to what extent a gluten-free diet the occurrence of antibodies associated with diabetes (gluten it is a protein that is part of many grains) may delay or prevent. Parents risk children monitor the nutrition of their children and submit all three months of blood, Chair and urine samples at the Institute for diabetes research. First results are due by 2008.

In addition, supplements are currently for the researchers such as fish oil and vitamin D to prevent type 1 diabetes in young children in conversation. The breastfeeding duration is being discussed again and again. As through longer breastfeeding get substances more autoimmune slackening the children and only delay with possible risk materials such as cow's milk protein and gluten in contact.

It shows that action is still urgently required in the area of primary prevention of type 1 diabetes. The results so far are still not sufficiently secured to derive applicable preventive measures.

Secondary prevention for type 1 diabetes

Secondary prevention involves diabetes research, to prevent the onset of type 1 diabetes. This means that the secondary prevention to people is, which in the blood already against beta-cells, destructive antibodies are detected, where the disease has however still not clinically manifests. The goal here is to stop the antibodies in their destructive power. Intervention measures as well as prophylactic procedures have been tested for this.

An approach in the secondary prevention of type 1 diabetes provided for the administration of NIACINAMIDE (NICOTINAMIDE acid). Researchers hoped a protection of islet cells in the pancreas of the use of this substance so that it can continue to produce insulin. Unfortunately, significant results could be listed here in the German DENIS study or in the Euro Canadian intervention study ENDIT. In the double-blind and placebo-controlled ENDIT study participants treated with NICOTINAMIDE between five and 40 years developed, which were selected after your first degree-relationship with a type 1 diabetic, percentage terms equally often after five years a type 1 diabetes as the placebo control group.

Unfortunately no successes in preventing secondary diabetes were recorded in the US DPT-1 study. This insulin prophylaxis study, insulin tablets administered genetically preloaded people who had already developed beta cells antibodies and showed a 50% owned risk over the next five years to developing type 1 diabetes. In the double blind procedure, a control group received a placebo drug. Within the trial period of five years, both groups equally developed a type 1 diabetes.

In Finland is currently the only study for secondary prevention (DIPP), which examines not only patients, but all newborns on islet cells antibodies using a genetic screening test. Babies with high risk of developing a type 1 diabetes, are tested for antibodies to all three to six months time and again. If they have finally developed antibodies in the blood, they are recorded in a double-blind, placebo-controlled study in which they are treated daily with a nasal spray, contains the insulin. Results of this study are to date still not available.

The featured studies show that unfortunately still not successful in the field of secondary prevention with type 1 diabetes were recorded.

Primary prevention of type 2 diabetes

A primary prevention to prevent already (before the disease manifests itself) in the pre antidiabetic phase that the body's cells against the body's own insulin become resistant. The aim is thus to counteract an occurrence of type 2 diabetes. In contrast to the type 1 diabetes, the person at risk for type 2 diabetes potentially can contribute much to keep of his body healthy and take preventive measures. Because a balanced, properly dosed, low-fat diet and an exercise plan personally matched to people can help in this case, to prevent an of type 2 diabetes.

With numbers, a Finnish and an American study prove this approach. Prof. Toumilehto and his Finnish colleagues have shown in their DPS study that is the 522 obese participants, which already a glucose tolerance error was found, after three years the risk of a new diabetes by 58% reduced, if they took part in the food and the movement therapy. The success was significantly higher than in the control group, which is less elaborately was supervised.

Very positive, a 5% weight loss has spilled over. The American Diabetes Prevention Program (DPP) confirmed this result of a 58% reduction in risk. However, a third group has been tested in this study along with the treated group and the control group. Metformin (antidiabetic) was given to this group. This group was not as significant successes such as the food and movement therapy group, however, a 31% reduction in the risk that the diabetes has progressed, there was also here.

Another study tested the effect of drugs for type 2 diabetes. So, for example, the STOP-NIDDM study has investigated to what extent acarbose may prevent the occurrence of diabetes. Acarbose delayed the sugar increase after eating. About 1,500 people received either acarbose or a Placebopräperat over a study period of more than three years. Here, acarbose could reduce the risk of a manifestation of diabetes by 36%. Also the glucose tolerance error normalized to some participants in addition. This showed that this effect of acarbose was 30% higher than that of placebo.

It is noteworthy that a healthier lifestyle can reduce the risk of developing type 2 diabetes more clearly than prescribed active ingredients such as metformin and acarbose. This makes it clear that especially in heavily overweight children and adolescents at an early stage on a change of diet and a movement therapy are required, in order to prevent type 2 diabetes in young people.

 Secondary prevention of type 2 diabetes

The secondary prevention of type 2 diabetes will attempt to avoid the consequential damages of an already manifested diabetes. Type 2 diabetics have to often fight in the further course of the disease with vascular disease (micro- and Makroangiopathie) or a nervous (neuropathy). Therefore, in particular an as accurate as possible setting of the blood glucose values of importance is in the field of secondary prevention.

So has the UKPDS study (United Kingdom prospective diabetes study) demonstrated that damages of a diabetes can be reduced significantly if the patients be treated significantly reduce blood sugar. This study included 5102 patients who were diagnosed with recently type 2 diabetes. Reduced the HbA1c value by 1%, the risk to suffer from, micro vascular damages could be reduced by 35%. Also fell with diabetes related mortality by 25%.

To prevent a vascular disease, is also the regulation of blood lipid of great importance, as well as the cessation of smoking. Can be cast with alpha-lipoic acid against a nervous. To prevent the diabetic foot, it requires specific foot and nail care. Bestensfalls is on orthopaedic footwear to use cotton socks and powders.

Since 2004 the national action Forum is diabetes mellitus (NAFDM), funded by the Federal Ministry of health, committed, diabetes research, prevention, early detection, and patient care to be improved and promoted. The action forum wants to prevent an extension of type 2 diabetes and prevent that the forecasts and projections that predict for 2010 exceeding the 10 million mark in type 2 diabetes patients, enter.

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A lot has been achieved much, there is still to do. Under this motto, the diabetes prevention situation in Germany could be together. Urgently further studies for primary and secondary prevention of both type 1 diabetes and type 2 diabetes are needed to curb the spread of the diabetes disease effectively. The German health report Diabetes 2007 requires that the goal must be to develop a national diabetes prevention programme in the near future. This requires further information in society, politics and economy. Here must attention particularly to the dangers of unhealthy lifestyles, to raise awareness particularly children and young people of the issue of type 2 diabetes.