Scientists from all over the world will meet up in Seattle October 22-23 to attend the Warren G. Magnuson Congress for a Global Diabetes Alliance. The initiative is intended to help fight the rapid rise of type 2 diabetes worldwide. International Diabetes Federation past president Pierre Lefebvre, who will be a speaker at the conference, says the need for such an alliance to fight the T2 global epidemic "could not be more urgent."

More than one hundred diabetes experts hailing from over twenty countries will attend the congress. There's one main goal: the discussion of how to help under-served populations, such as indigenous peoples. However, the more general problems - prevention, treatment and the possibility of a cure - will also be on the table. It is also hoped that the alliance can help change public perception of type 2 diabetes as a disease associated with affluence, when in fact it is spreading faster in poor, developing countries where people frequently lack access to medical care.

Organizers say this is the first global alliance on diabetes. Speaking of organizers: who's behind this anyway? Well, it's being convened by the Pacific Northwest Research Institute (PNRI). Incoming president of the American Diabetes Association, Dr. Paul Robertson, is president and scientific director of the PNRI. Warren G. Magnuson, for whom the conference is named, was a US senator and supporter of the sciences who died from diabetes complications in 1989.

The ADA and PNRI's Dr. Robertson is optimistic the organization can effect change: "The response from top experts from around the world to develop a global, multidisciplinary, collaborative endeavor focused on clinical research on diabetes has been overwhelming."

Indignation, frustration. It's all growing stronger amongst diabetics over the fact that most people don't understand this basic fact: type 1 and type 2 diabetes are two very different conditions. When, oh when (or ever?), will we get more appropriate names.

"Type 1" and "type 2" are so meaningless to most non-diabetics and probably to a lot of type 2 diabetics as well. "Juvenile" or "childhood onset" are, these days, likewise, quite meaningless when so many kids are getting T2DM due to atrocious lifestyle/eating habits.

A recent editorial caught my eye. I want to share, because I think it's a good example of how the media helps add to this ignorance when journalists fail to make a distinction between T1 and T2. "In our view: Targeting Diabetes," was published August 16 in The Columbian of Vancouver, WA. "Diabetes is everywhere...Diabetes lasts a lifetime," it reads, "and there is no cure, even though steps involving diet and exercise can lower many risks." Not true! It goes on to say, "With generous gifts and more education, fewer of us will get the disease." Again, not true! You and I know that statement does not apply to T1s. But I'll wager an overwhelming majority of non-diabetic and T2 diabetic readers would not bat an eye at such a comment.

Diabetic and want to help educate people? Long-term, we need new names! Short-term, public education will help. Here's a start: hit the link above to this Columbian editorial and post a comment!

In my previous post, I looked at a RAND Corporation study of undiagnosed diabetes - something that continues to be a big problem. Now I want to zero in on one aspect of that study that really caught my eye. According to the sole author, James P. Smith, talk of a type 2 diabetes epidemic is over-exaggerated.

Hang on a minute. Aren't we always hearing about the so-called epidemic proportions of diabetes' spread in the US and globally? And aren't cities like New York taking steps to track the spread of diabetes, keeping tabs on its growth just as you'd do with a contagious epidemic outbreak of, say, tuberculosis? Well, yes. But Smith isn't buying it.

During the twenty-five-year period included in the study, Smith says diagnosis of men with diabetes more than doubled. However, it's a tricky thing to take diagnosis rates and translate them into prevalence rates. That is, more people being diagnosed with a disease may simply mean we're getting better at diagnosing the problem. We may think we're seeing astronomical growth rates in diabetes when in fact it's probably a combination of increased diabetes and more efficient diagnosis.

Which is not to say Smith is denying that the spread of type 2 diabetes is a serious issue: "Diabetes is one of the major health challenges faced across the United States," he says, "but these finding suggest that the prevalence of the disease is not growing as rapidly as often claimed."

James P. Smith is RAND's corporate chair of labor market and demographic studies. RAND is a nonprofit research organization.

Details are emerging from today's advisory committee meeting on Glaxo's Avandia. First up was a presentation by Dr. Robert Ratner of Washington's MedStar Research Institute outlining the unprecedented spread of type 2 diabetes. Ratner emphasized the inadequacy of current drug therapies for diabetes and the strain on the health system caused by the disease. The possible implication: Avandia does more good than harm right now, so let's keep it as an option.

Next, in written preview comments, an official from the US Food and Drug Administration stated his belief that the diabetes drug should be taken off the market. The official, Dr. David Graham, says the heart risks posed by Avandia mean it's just not worth the risk to patients. Especially, he said, not when there are safer alternatives like Actos (by Takeda), which also stabilizes blood sugar levels.

It's a significant step that someone from the FDA publicly made this statement. But will anything come of it? Maybe not. The decision about whether or not Avandia stays on the market is not up to Dr. Graham, who The New York Times reports has a history of coming down harder on drug risks than many colleagues. (Give the guy a medal!) Thing is: there appear to be plenty of other officials within the FDA who don't agree with Graham's interpretation.

The Democratic presidential candidates all know this: whoever gets the nomination has an excellent shot at making it to the White House. First, though, is the long, hard, down and dirty campaign slog in which each candidate has to do the impossible - try and be all things to all people.

One thing we can except is that they all devote a little time to addressing diabetes. Specifically, finding a cure for type 1 diabetes and strategies for containing the unprecedented spread of type 2 diabetes. The type 2 "epidemic" (as it is sometimes called) is all the more serious because of the strain it is adding to the US healthcare system, a system already failing to meet the needs of many Americans.

During Monday night's CNN/YouTube debate, the candidates were asked about their plans for the healthcare system. Click here to read what they had to say about health issues. Two of the candidates, Senator Chris Dodd (CT) and Governor Bill Richardson (NM), both mentioned diabetes and their desire to cope with the problem, but they didn't get a chance to go into detail in the context of a televised debate. Such is the world we live in, folks! Visit CNN to read a transcript of the debate.

Meanwhile, Hillary Clinton has joined with other New York lawmakers to push for Congressional funding to fight the spread of type 2 in that state. The requested sum? $120 million. Click here to check out Allie's take on that issue.

This headline on the website Diabetes Health got my attention: "The Federal Government Hugely Out-of-Pocket for Diabetes Care." Here are the key numbers: In 2005, the federal government spent almost eighty billion dollars on diabetes care, writes Linda von Wartburg, reporting on a study commissioned by drug giant Novo Nordisk as part of its "Changing Diabetes" campaign. In fact, one in every eight healthcare dollars - or twelve percent of the budget - was spent on diabetes. Need some more perspective? Well, according to the Novo study, this amounts to more than the entire budget of the Department of Education. Phew.

Yes, diabetes care is costing a lot of money. But the ballooning cost of diabetes treatment is only part of the problem. Of equal concern is the amount spent on care versus the amount allocated for prevention and education. Paltry, is the word you might use. Of the 79.7 billion spent, only 3.9 billion went to prevention or education. Considering Type 2 diabetes cases are ballooning in the US - some say it constitutes an epidemic - the feds might want to consider tweaking the budget a bit, don't you agree? That's what the study's authors are recommending. They say more money is desperately needed for prevention and public education. Click here to read more on Novo's Federal Spending Report.

Eureka! I have just stumbled across the best explanation of Type 2 diabetes that I have ever read. The author is fitness enthusiast Mark Sisson and the entire text can be accessed at his website, Mark's Daily Apple. This is where Mark posts his blogs on health and fitness-related topics, and it also links into his online store, which sells nutritional supplements.

Mark does a great job of explaining what he calls the "Completely Unnecessary Disease Epidemic" - how Type 2 diabetes works and why the US Food and Drug Administration could be doing much more to help people avoid or minimize the disease's impact. We are overloading ourselves with carbohydrates and those carbs are poisoning us. Why? Because they are converted into sugars that our bodies just can't handle. In a detailed, yet easy-to-read and light-hearted way, Mark explains exactly how this occurs and his advice is simple: ignore the government's stodgy old food pyramid and cut those carbs. (Yes, I know, they've updated the food pyramid, but not enough to really address the problem, as far as I'm concerned.)

Mark, in fact, personally favors the "Stone Age" diet that did good things in a recent study involving overweight Type 2 diabetics. Click here to read more about that. He has even designed his own "Carb Pyramid," which you can view by clicking here. Mark happily describes his own food routine, and this is where he and I part ways because he says "I'm not really a pasta or pizza guy" and "I'm not much of a snacker." Must be nice...

After you've read his blog, Mark says, "Print this explanation out, stick it on your fridge, email it to your aunt. And put down the pasta." Oh, Mark, now you're just breaking my heart!

I do not like vaccinations. I wonder if they are connected to the autism and diabetes epidemics, even attention-deficit disorders. I do vaccinate my children, just begrudgingly. Yet if there ever was a vaccination against type 1 diabetes, I would be first in line.

Researchers in France and Germany have demonstrated you can treat a type 1 diabetic mouse with a vaccination. Type 1 diabetes is an autoimmune disease in which the immune system's T cells cannot distinguish between "non-self" and "self", attacking cells of the pancreas that produce insulin.

Previously, Drs. Falk and Rotzschke of the Max Delbruck Center for Molecular Medicine (MDC), blocked the misdirected immune system by vaccinating mice with modified structures of the same organ targeted by the defective T cell immune response. Antigens are structures which activate a body's immune system, and the mice were protected from type 1 diabetes through the body's own antigens linked together in a repetive chain of identical copies. But the researchers did not understand how this protective string of antigens worked.

Last time I checked -drugs weren't cool, but according to a recent study, within the last 3 years, the number of teens using type 2 diabetes drugs has soared.

Medco, the largest US drug benefits manager, found the number of children taking medicine for type 2 diabetes more than doubled between 2001 and 2005. An analysis of prescription data found a 146% increase over four years in young people aged 10-19 taking type 2 diabetes drugs, and 115 % increase in all children in the survey. Children on diabetes medicines also faced other serious problems. About 17% of the boys and 13% of the girls were on drugs for high blood pressure; 5% of both were taking cholesterol-reducing drugs; and nearly 20% were taking narcotic pain relievers, drugs for respiratory conditions and antidepressants. Medco reviewed over 500,000 children each year. Of those aged 10-19, about 1.47 per 1,000 were taking type 2 diabetes drugs with a clear rising trend.

I'm so glad I'm not a teenager any more. These days it's not about abstaining from drugs. It's about the type of drugs you use. Just because your doctor is the one prescribing it doesn't mean you have to succumb to the peer pressure of drug use. I found an appropriate Chinese proverb for this blog: it is easy to get a thousand prescriptions but hard to get one single remedy. Put that in your pipe and smoke it.

The discovery of insulin, in 1922, was a breakthrough in the treatment of diabetes and it produced a remarkable increase in the life expectancy of diabetic patients. Animal-derived insulins have been used to treat people with diabetes since insulin was first discovered and continuously subjected to various purification technologies. In 1973, Novo produced a purer type of insulin, called monocomponent insulin. This set a new standard in purity. In 1982, Human Monocomponent was the world's first insulin preparation identical to human insulin. It was actually pig insulin, modified by enzymes, to appear identical to human insulin.

When Novo tried to introduce monocomponent insulin into the USA, Lilly fought back with 'human' Humulin insulin. Before Humulin insulin became available, insulin had been produced from animal sources, pigs and cows. It is believed by some that the animal insulin provided the diabetic with better awareness of hypos, and it is certainly true that the long-acting animal insulin such as Ultralente are longer-acting than their 'human' equivalents. The fact that both pig and cow differ from human insulin by certain amino acids (1 in pig and 3 in cow) has lead the majority of physicians to recommend 'human' insulin. 'Animal' insulin became increasingly hard to find, particularly in the USA (see This Little Piggy Left the Market).

In the late 1990s Eli Lilly developed Lispro, brand name Humalog. This was approved for prescription use in the UK and the US by 1996. This insulin has a shorter activity curve than Regular. This means it can be injected closer to the meal time, even after it. Studies have shown that it does not improve control as measured by long-term indicators (Hba1c), but that it does decrease the number of hypos. Glargine, brand name Lantus, was approved for use in the US in 2004. It has become widely touted as better than other long-acting insulins because it has a plateau effect on glucose control that lasts for approximately 24 hours. Some people find it acts a little shorter (and some doctors don't believe that's possible!) So there you have it - the short and sweet version of the history of insulin. I strongly suggest anyone who wishes to fill the spaces between the discovery in 1922 and present day to pickup The Discovery of Insulin (Michael Bliss). I welcome all comments to fill-in the pivotal details I've failed to include.

Fair and balanced, just like Fox News -- I want to let everyone know that the "Matt P" I spoke to, at the ADA responded to my blog about the aforementioned conversation. His response is #17 and it is sincere and genuine -- certifiable in my book. Again, let me reiterate that the nature of my call to the ADA was to ask for their assistance in getting a big pharmaceutical company to sponsor C-peptide FDA trials here in the US. Thanks again to Matt. He really is doing all he can, but there seems to be a suspicious roadblock holding up the research here in the US. Any guesses? Without further adieu, here's Matt:

I hope people will take time to read my reply to yesterday's post about ADA and c-peptide. I work for ADA, and I was the "Matt P" who talked to Allie a week or two ago.

I certainly wouldn't\'t discourage you from calling our 800-DIABETES number, but I think you should consider why we have an 800 number and what the staff of our Call Center are trained to do. Their primary goal is to help people with basic questions about taking care of diabetes. They have very little information about what research is going on in diabetes, because that information does not yet have any relevance for the vast majority of people who need the help of our Call Center. Callers are primarily concerned about nutrition, help with paying for medications, and information about complications. The staff does try to take care of callers who want to give guidance to ADA on things like research and legislative priorities, but their primary focus is on providing immediate, direct advice about diabetes management to people who can't get it any other way.

Again, please read my other reply. Guys, diabetes is awful, everyone who works at ADA thinks so and of course so do all of you. We would all sincerely like to see effective treatments come into our hands immediately, but I'm afraid that there is almost nothing ADA can do to change the basic nature of the research process or the drug approval process. Despite recent promising research results regarding c-peptide, there's no way the FDA would approve it as a therapy for diabetes complications until more research is done to precisely define what it does and how well and how safely it does it.

Could industry do more? Probably, although we don't know exactly what they\'re doing now---please see my other post. We live in free society where people and companies don't always have to tell you what they're doing. If you want my pledge to talk to people at Lilly and Novo about the potential promise of c-peptide, you have it.

By all means, call them yourself. I'm afraid our Call Center staff, who do an incredible job with handling a huge number of calls from a lot of desperate people, aren't going to be able to do much to address an issue that is still at the research stage.

Sincerely,

Matt

Thousands of pre-school age children are being diagnosed with Type 1 diabetes as new figures show a dramatic rise over the past 20 years.

Between 1985 and 2004, the study conducted by Bristol University, has seen an increase in cases of type 1 diabetes in children under the age of 5 five times the previous average. Type 1 diabetes is an auto-immune disease in which the body fails to produce insulin or makes only a little. One of the theories leading to the rise in type 1 diabetes is due to infants being exposed to exorbitantly clean households. The researchers found that incidence in all children under 15 had doubled. But the incidence of type 1 diabetes in children under the age of five went from .2 cases per 1,000 to 1 case per thousand.

The hypothesis offered by Prof Bingley leads to a very good argument. He said, "the increase is too steep to be put down to genetic factors, so it must be due to changes in our environment. This could mean that we are being exposed to something new or that we have reduced exposure to something that was previously controlling our immune responses". Much like the denouement in a game of CLUE: perhaps it was Mr. Clean, with the mop, in the kitchen!

Any headline that features die is bound to grab your attention. The headline appeared in an article published by The Scotsman. What the title lacks in sensitivity it makes up for in reader feedback. Both, statistically eye-popping and universally alarming, I give you extracts from the article and a few passionate responses from readers. How does it make you feel?

Research from Edinburgh University reveals the number of people diagnosed with type-2 diabetes will soar by 60% within the next ten years. This is mainly due to the obesity crisis, with current estimates showing a quarter of the population is likely to be classed as obese by 2018. Doctors say they are treating an increasing number of teenagers for type-2 diabetes, which traditionally only develops in older people. Being overweight is a strong factor in becoming a type-2 diabetic, which can lead to complications of diabetes like blindness, amputations, cardiovascular disease and kidney failure. Diabetes and complications therein are estimated to costs the NHS nearly a tenth of its yearly budget. With future expectations of diagnosis -- the strain on the NHS will get worse. Andy Kerr, the health minister, admitted diabetes would prove to be a time bomb if the Executive's healthy eating initiatives failed. But he ruled out screening children for diabetes or rationing healthcare for people diagnosed with type-2 because of their unhealthy lifestyles.

And now for the comments:

Commenter #3 says I daresay the Scottish obesity/diabetes problems predates devolution.
Commenter #9 says, The statistical analysis regarding type 2 diabetes is flawed; the medical profession have been guilty in prescribing drugs and reissuing prescriptions for drugs that are only safe for short periods. One such drug has had its usage limited by the authorities within the past 3 years in Scotland and has only been reclassified in England and Wales in the past 6 months. This drug is now listed as causing type 2 diabetes, how many more are there out there? Hence the statistical analysis is being used to cover a grave error that is to be covered up.
Commenter #20 says, Perhaps we should take a closer look at why our kids are obese. They are marooned in the house for most their lives and when they actually do go out mum or dad are suckered into driving them everywhere. Tackle the fear which causes this situation and you are half way to solving the obesity problem of our youngsters.

All things considered, what if this headline was featured in the New York Times or more revealing - the 5 o'clock news? How would you react to it?

In 2005, insulin cost state Medicaid programs $500 million. The diabetes epidemic is causing the government to question one of the big-ticket items on the shopping list - insulin. Insulin was developed over 20 years ago and many of these original forms are now off patent. This is a screaming opportunity for generic drug makers to prosper and government programs to save.

Two of the largest insulin makers, Novo Nordisk and Eli Lily, say they are opposed to any F.D.A. action that would approve generic insulin without clinical studies. Why the concern? The combined sales in the United States for Humulin and Novolin is about $1 billion. No wonder.

A drug maker needs to prove the generic version contains the same active ingredients, purity and quality, and provides equivalent delivery over time as the brand-name version. However the makers of generic drugs agree that the approval process for generic biologics, like insulin, would be more complex than the current shortened process for other generic drugs. Anybody have a guess as to what the hold up is for this much needed and overdue generic insulin explosion?

Doctors are now finding patients who suffer from both type 1 and type 2 diabetes -- a phenomenon known as double diabetes. This development is predominantly due to the obesity epidemic.

Type 1 diabetes is caused by the body's inability to produce insulin, the hormone that ushers blood sugar to cells for energy. Type 2 diabetes results from insulin resistance -- the body's inability to properly use the hormone. Almost 30% of Americans diagnosed with diabetes have type 2 diabetes, due to excess weight and lack of exercise. Generally, double-diabetes sufferers will often look as though they have the more common type 2 version because they're overweight. But subsequent blood tests reveal they also have type 1 disease.

Double diabetes might be caused, in part, by type 1 diabetics who are taking insulin but haven't made the other lifestyle changes necessary to control the disease. Sadly, one of the consequences of insulin use can be weight gain. The national trend toward unhealthy weight gain has spurred both the diabetes epidemic and this newer, more complex form of the disease, mirroring the obesity epidemic. This is an enigma that leaves gaping holes in the rationale of conventional medicine. So there it is-- insulin causes weight gain. Weight gain increases the chances of developing type 2 diabetes. There you have it: a diabetes double-whammy. No fair.