Study indicates pill could delay diabetes in pre-diabetics

Friday, June 14th 2002, 12:00 am

By: News On 6

LONDON (AP) _ A pill that blocks the digestion of starch could prevent or delay the development of the most common form of diabetes in those with slightly high blood sugar, a new study indicates.

Experts estimate more than 200 million people worldwide _ including nearly 16 million Americans _ are pre-diabetic and half will develop diabetes within 10 years. They predict a worldwide explosion by 2025 and say the disease is likely to become the biggest epidemic in history.

Although exercise and healthier eating can delay or prevent diabetes for most people, some experts believe that because many people won't heed advice about healthier lifestyles, drugs will be necessary.

A study published this week in The Lancet medical journal found that pre-diabetics who took starch-blocker pills cut by 25 percent their chances of progressing to diabetes, which is a leading cause of blindness, kidney failure, amputations and heart disease. It is the fourth-leading cause of death in the industrialized world.

Type 1 diabetes, which is not affected by this medication, usually occurs at birth or in early childhood and represents 10 percent of diabetes cases. But 90 percent of cases are Type 2 diabetes, which usually is acquired later in life. Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that converts sugar, starches and other food into energy.

The drug tested in the study, acarbose, prevents the breakdown of sugar, so it is expelled from the body undigested and does not reach the bloodstream.

Acarbose, made by Bayer and sold as Precose in the United States and as Glucobay in Europe, has been approved for the treatment of diabetes for nearly 10 years. However, it is not widely used because of unwelcome side-effects _ diarrhea and flatulence.

The study, funded by Bayer, involved 1,400 people from nine countries who had pre-diabetes, known scientifically as impaired glucose tolerance.

Half were given acarbose pills and half were given fake pills.

After more than three years, 32 percent of the patients who were taking acarbose had progressed to diabetes, compared with 42 percent of those taking the dummy tablets.

The results mean the people taking acarbose were 25 percent less likely than the others to develop diabetes.

Some experts were encouraged by the findings, while others believe the drug is not a practical solution.

``It clearly does not make huge sense for people to swallow food and then take tablets to stop them digesting it,'' said Dr. Edwin Gale, a professor of diabetic medicine at the University of Bristol in England who was not connected with the study. ``The best thing you can do is take exercise once or twice a week for 20 minutes. That will halve your risk.''

One problem is identifying pre-diabetics, which is done by blood tests.

Another obstacle is that once identified, pre-diabetics _ who usually feel fine _ have to be convinced their health is in danger.

``The problem is that people are just not psychologically prepared to accept it,'' Gale said.

However, Dr. Paul Zimmet, director of the International Diabetes Institute in Australia, believes drugs have an important role to play in coping with diabetes.

People involved in the diet and exercise studies had regular help from dietitians and exercise specialists and were monitored closely _ support that would be too expensive for all pre-diabetics.

``In the real world, lifestyle change is very hard to achieve,'' said Zimmet, who was not connected to the study. ``Can people ... with a sedentary lifestyle change their lifestyles even if it can save their lives?''

Also, a better diet and exercise regime does not work in as many as 50 percent of pre-diabetics, Zimmet said.

He said acarbose is a reasonable option if it is taken properly and with the correct diet.