Alzheimer's Patients Could Benefit From Diabetes Drug

Main Category: Alzheimer's / Dementia
Also Included In: Diabetes
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Metformin, a drug used in type 2-diabetes might have the potential to also act against Alzheimer's disease. This has been shown in a study from scientists of the German Center for Neurodegenerative Diseases (DZNE), the University of Dundee and the Max-Planck-Institute for Molecular Genetics. The researchers have found out that the diabetes drug metformin counteracts alterations of the cell structure protein Tau in mice nerve cells. These alterations are a main cause of the Alzheimer's disease. Moreover, they uncovered the molecular mechanism of metformin in this process. "If we can confirm that metformin shows also an effect in humans, it is certainly a good candidate for an effective therapy on Alzheimer's diseases," says Sybille Krauß from DZNE. Their results have been published in the scientific journal PNAS.

Alzheimer's disease is a form of dementia that affects almost exclusively elderly people. Today, about 700,000 people are suffering from Alzheimer's disease in Germany. Neurons in their brains die, leading to cognitive impairment. At the molecular level, the disease is characterized amongst others by the formation of Tau protein deposits in nerve cells. Tau is a molecule that usually binds to the supportive cytoskeleton and performs a function in the transport system of the cell. In Alzheimer's disease, Tau is tipped too strongly with phosphate groups. This phosphorylation causes removal of Tau from the cytoskeleton and aggregation.

To counteract this problem, researchers aimed at regulating the protein PP2A. This protein is normally responsible for removing phosphate groups from Tau protein. In Alzheimer's disease, PP2A is not active enough - leading to an increased phosphorylation and deposition of Tau. The scientists around Sybille Krauß and Susann Schweiger (University of Dundee) therefore looked for a drug that increases the activity of PP2A. "So far there is no drug on the market that targets the formation of tau aggregates," says Krauß.

In cell culture experiments with mouse nerve cells, the researchers showed that metformin directly protects PP2A against degradation by preventing the binding to special degradation proteins. This mechanism of metformin has been unknown so far. In addition, an increase in PP2A activity leads to a reduction in Tau phosphorylation. In a next step, the scientists added metformin to drinking water of healthy mice. This also led to a reduction of Tau-phoshorylation in brain cells. In further experiments, the researchers now intend to investigate, whether metformin prevents the deposition of tau proteins also in mouse models of Alzheimer's disease and improves cognitive performance of the animals. The effect in humans will then be tested in clinical studies. There is no risk of unexpected side effects, due to the fact that the drug is already used against diabetes.

Original paper:
Kickstein E, Krauss S, Thornhill P, Rutschow D, Zeller R, Sharkey J, Williamson R, Fuchs M, Kohler A, Glossmann H, Schneider R, Sutherland C, Schweiger S: The Biguanide metformin acts on tau phosphorylation via mTOR/PP2A signalling. PNAS published ahead of print November 22, 2010, doi:10.1073/pnas.0912793107.

Source:
Dr. Katrin Weigmann
Helmholtz Association of German Research Centres

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The United States Of Diabetes: New Report Shows Half The Country Could Have Diabetes Or Prediabetes At A Cost Of $3.35 Trillion By 2020

Main Category: Diabetes
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More than 50 percent of Americans could have diabetes or prediabetes by 2020 at a cost of $3.35 trillion over the next decade if current trends continue, according to new analysis by UnitedHealth Group's (NYSE: UNH) Center for Health Reform & Modernization, but there are also practical solutions for slowing the trend.

New estimates show diabetes and prediabetes will account for an estimated 10 percent of total health care spending by the end of the decade at an annual cost of almost $500 billion - up from an estimated $194 billion this year.

The report, "The United States of Diabetes: Challenges and Opportunities in the Decade Ahead," produced for this month's National Diabetes Awareness month, offers practical solutions that could improve health and life expectancy, while also saving up to $250 billion over the next 10 years, if programs to prevent and control diabetes are adopted broadly and scaled nationally. This figure includes $144 billion in potential savings to the federal government in Medicare, Medicaid and other public programs.

Key solution steps include lifestyle interventions to combat obesity and prevent prediabetes from becoming diabetes and medication control programs and lifestyle intervention strategies to help improve diabetes control.

"Our new research shows there is a diabetes time bomb ticking in America, but fortunately there are practical steps that can be taken now to defuse it," said Simon Stevens, executive vice president, UnitedHealth Group, and chairman of the UnitedHealth Center for Health Reform & Modernization. "What is now needed is concerted, national, multi-stakeholder action. Making a major impact on the prediabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models. Done right, the human and economic benefits for the nation could be substantial."

The annual health care costs in 2009 for a person with diagnosed diabetes averaged approximately $11,700 compared to an average of $4,400 for the remainder of the population, according to new data drawn from 10 million UnitedHealthcare members. The average cost climbs to $20,700 for a person with complications related to diabetes. The report also provides estimates on the prevalence and costs of diabetes, based on health insurance status and payer, and evaluates the impact on worker productivity and costs to employers.

Diabetes currently affects about 27 million Americans and is one of the fastest-growing diseases in the nation. Another 67 million Americans are estimated to have prediabetes. There are often no symptoms, and many people do not even know they have the disease. In fact, more than 60 million Americans do not know that they have prediabetes. Experts predict that one out of three children born in the year 2000 will develop diabetes in their lifetimes, putting them at grave risk for heart and kidney disease, nerve damage, blindness and limb amputation.

Estimates in the report were calculated using the same model as the widely-cited 2007 study on the national cost burden of diabetes commissioned by the American Diabetes Association (ADA).

Diabetes and Obesity

The report also focuses on obesity and its relationship to diabetes. Being overweight or obese is one of the primary risk factors for diabetes, and with more than two-thirds of American adults and 17 percent of children overweight or obese, the risk is clearly rising. In fact, over half of adults in the U.S. who are overweight or obese have either prediabetes or diabetes, and studies have shown that gaining just 11-16 pounds doubles the risk of type 2 diabetes and gaining 17-24 pounds nearly triples the risk.

"Because diabetes follows a progressive course, often starting with obesity and then moving to prediabetes, there are multiple opportunities to intervene early and prevent this devastating disease before it's too late," said Deneen Vojta, M.D., senior vice president of the UnitedHealth Center for Health Reform & Modernization, who helped develop UnitedHealth Group's Diabetes Prevention and Control Alliance.

Solutions

The United States of Diabetes: Challenges and Opportunities in the Decade Ahead focuses on four categories of potential cost savings over the next 10 years:

- Lifestyle Intervention to Combat Obesity: There is an opportunity to reduce the number of people who would develop prediabetes or diabetes by nearly 10 million Americans, through public health initiatives and the wider use of wellness programs to combat obesity.

- Early Intervention to Prevent Prediabetes from Becoming Diabetes: Evidence from randomized controlled trials and UnitedHealth Group's own experience demonstrates that the use of community-based intervention programs - such as the UnitedHealth Group Diabetes Prevention Program (DPP) in partnership with the Y - could reduce the number of people with prediabetes who convert to diabetes by an additional 3 million. The DPP is based on the original U.S. Diabetes Prevention Program, funded by the National Institutes of Health (NIH) and the CDC, which demonstrated that with lifestyle changes and modest weight reduction, individuals with prediabetes can prevent or delay the onset of the disease by 58 percent.

- Diabetes Control through Medication and Care Compliance Programs: Better management of diabetes through improved medication and care compliance programs can help control the disease and reduce complications, such as UnitedHealth Group's Diabetes Control Program (in partnership with community pharmacists).

- Lifestyle Intervention Strategies for Diabetes Control: The wider use of public-private partnerships to develop the infrastructure to scale nationally the promising learnings of the Look AHEAD Trial.

The report's analysis draws on evidence-based, practical solutions derived from research, pilot programs and UnitedHealth Group's own experience serving more than 75 million individuals worldwide.

Source:
UnitedHealth Center for Health Reform & Modernization
UnitedHealth Group

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Number of Americans With Diabetes Could Triple by 2050

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Recent CDC data suggest that obesity rates may have recently leveled off. But the new diabetes estimates should hold up even if obesity rates remain static, according to the CDC.

Number of Americans With Diabetes Could Triple by 2050Jen Blackstock
Oct 29, 2010

The Centers for Disease Control and Prevention released a startling new projection last week regarding diabetes:? As many as one in three U.S. adults could have diabetes by 2050. The announcement on Friday represents a dramatic threefold increase in the number of Americans expected to have diabetes within the next 40 years if current trends continue.

Current estimates place the number of people with diabetes at around 24 million, which is one in 10 Americans, but the number could grow to one in five or even one in three by mid-century, according to officials.

"This is alarming," said Ann Albright, director of the CDC's Division of Diabetes Translation.

The CDC has been working on such projections for some time now, with various estimates being released based on current trends. The last revision put the number at 39 million by 2050. This new estimate takes it to the range of 76 to 100 million, a dramatic increase.

Edward W. Gregg, chief of the CDC branch that handles diabetes epidemiology and statistics, explained that three main factors contributed to the increased numbers. First, the new estimate includes people who have diabetes but remain undiagnosed-a group that wasn't figured into earlier estimates. Second, the researchers included new population growth estimates for the elderly and minorities, who have higher rates of type 2 diabetes. Third, diabetics are living longer, thanks to improvements in medical care. A longer life span means that more people are living with diabetes at any one time. As Dr. Sue Kirkman stated in response to the CDC's latest news, "Not all of the increase in prevalence is a bad thing." Dr. Kirkman is the American Diabetes Association's senior vice president of medical affairs and community information.

Another factor is obesity rates among Americans. Type 2 diabetes is most common in people who are overweight and obese, in people 60 and older, and in African-Americans and other minority groups. The growth in U.S. diabetes cases has been closely tied to escalating obesity rates, another trend that the CDC has been monitoring closely. Recent CDC data suggest that obesity rates may have recently leveled off. But the new diabetes estimates should hold up even if obesity rates remain static, according to the CDC.

The reality is that diabetes will continue to grow if people do not do more to prevent it, especially as the population ages and obesity continues to grow. While the new numbers are startling, they will hopefully be a wake-up call.

* * *

Sources:

http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2010/10/22/national/a072312D18.DTL&tsp=1

http://www.cdc.gov/diabetes/pubs/factsheet07.htm

Categories: Government & Policy, Health, Health Care, Pre-Diabetes, Type 1 Issues

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