Diabetes and prediabetes will account for an estimated 10% of total health care spending by the end of the decade at an annual cost of almost US$500 billion (RM1.5 trillion) – up from an estimated US$194 billion (RM582 billion) this year, according to a report by insurer UnitedHealth Group Inc. In October, the US Centres for Disease Control and Prevention projected that up to a third of US adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise.

“Cost analyses have shown that use of a health plan sponsored health club benefit by the general older population and by older adults with diabetes was associated with slower increases in total healthcare costs over two years,” Dr Marco Pahor of the University of Florida wrote in an editorial in the Journal of the American Medical Association. In the study, Daniel Umpierre of the Hospital de Clinicas de Porto Alegre in Brazil and colleagues analysed data from 47 clinical trials and more than 8,000 patients, looking for the best way for diabetics to control their blood sugar.

They found that diabetics who participated in a supervised programme for more than 150 minutes a week did a better job of lowering blood sugar than just being advised to exercise. Diabetics who did supervised exercise training cut a measure of blood sugar known as hemoglobin A1c by 0.67% compared with control group participants.

Pahor said clinical trials are needed to prove that supervised exercise programmes help diabetics the most but he said it may be time to consider paying for these programmes as a way to prevent larger health costs linked with the complications of diabetes. Complications related to diabetes can include heart and kidney disease, nerve damage, blindness and circulatory problems that can lead to wounds that will not heal and limb amputations. – Reuters

But they admitted there have been many setbacks in crafting such a shield, and some advocated a return to fundamentals, and said it is time to draw lessons from failure. “Vaccine science is still more of an art than a science,” said Tachi Yamada, executive director of the Bill and Melinda Gates Foundation’s Global Health Programme, a major donor to the vaccine effort.

Yamada pointed to fundamental gaps in knowledge about how the stealthy human immunodeficiency virus (HIV) subverts the immune system. Meanwhile, Yamada said funding, collaboration and cooperation urgently had to be stepped up to avoid wasted or duplicated efforts. He said the arena must be opened up to smart, revolutionary ideas, and a new generation of vaccine researchers must be groomed. “We need big investments for the future not only in the basic science of HIV prevention, but also in clinical trials for an HIV vaccine,” Yamada said.

“We have to be unafraid to fail. The road to success begins with setbacks.” Alan Bernstein, director of the Global HIV Vaccine Initiative, said the hunt was “at a critical crossroads” and any success could only be viewed as “long term.” More than 25 million lives have been claimed by AIDS and 33 million people are estimated to have HIV. A safe, effective primer of the body’s defences – the frontline antibody troops and the heavy artillery of the immune cells – remains far out of reach, however.

Out of the 50 candidates that have been evaluated among humans, only two vaccines have made it through all three phases of trials, and both were rejected as quite ineffective. In the past year, one major vaccine trial was halted after early results showed that it appeared to place volunteers at greater risk of HIV infection. Another vaccine in planning phases, involving tests among 8,500 subjects, was scrapped after a similar formula, tested in 2007, was found to be largely ineffective.

Researchers also urged governments and health communities to ramp up male circumcision to prevent HIV infection, particularly in vulnerable countries in eastern and southern Africa. Three studies were cut short in 2006 after they showed strong evidence that male circumcision could prevent HIV infection, but very little effort has been made to push for more men to go under the knife, they said.
“This is a call to action… to call for male circumcision. It’s been two years and still there is not enough money, focus to scale up effort and more needs to be done,” said Dvora Joseph, head of the HIV department at Population Services International, a US-based non-profit organisation.

About 56,300 people were infected with the virus that causes AIDS in 2006, a figure 40% higher than the previous estimate of 40,000 new infections a year, the Centres for Disease Control and Prevention
(CDC) said. “This new picture reveals that the HIV epidemic is – and has been – worse than previously known and underscores the challenges in confronting this disease,” Kevin Fenton, director of the CDC’s National Centre for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

The CDC said new technology allowed it to establish a more precise estimate of the epidemic. “These data, which are based on new laboratory technology developed by CDC, provide the clearest picture to date of the US HIV epidemic, and unfortunately we are far from winning the battle against this
preventable disease,” said CDC Director Julie Gerberding. “We as a nation have to come together to focus our efforts on expanding the prevention programmes we know are effective,” she said. The study found that the annual number of new infections was never as low as 40,000.

While new infections increased in the last 1990s, they have been roughly stable since then. “While the level of HIV incidence is alarming, stability in recent years suggests that prevention efforts are having
an impact,” said Richard Wolitski, acting director of the CDC’s Division of HIV/AIDS Prevention.
The study also found that gay and bisexual men as well as African American men and women are the groups most affected by HIV. The new estimate found that 53% of new infections occurred in gay and bisexual men, while heterosexuals accounted for 31% of them and intravenous drug users for 12%.

African Americans, who make up 13% of the US population, accounted for 45% of the new infections in 2006. The infection rate among blacks was seven times higher than among whites – 83.7 out of 100,000 people compared to 11.5 out of 100,000. The study found some encouraging signs of progress
as new infections have dropped among both intravenous drug users and heterosexuals. – AFP

It also improved blood pressure, raised high-density lipoprotein (HDL) by 16%, and lowered triglycerides by 15% and high-sensitivity C-reactive protein by some 45%. This double-blind study was conducted by world renowned heart specialist Dr Steven Nissen, of Cleveland Clinic, Ohio, in the US.

It was carried out from August 2003 till March 2006, across 97 hospitals in North and South America. The study covered 543 diabetic patients who also have heart disease.

Datuk Dr Khoo Kah Lin, the director of the National Heart Foundation (Yayasan Jantung Malaysia), said that Type 2 diabetics constantly faced life-threatening conditions such as stroke, coronary heart disease and kidney failure due to complications arising from diabetes.

He said the outcome of the study has given diabetics new hope in managing their cardio-vascular risk factors. The study, titled Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation (Periscope), compared insulin-sensitiser pioglitazone with insulin secretagogue, glimepiride, over an 18-month period.

The result of the Periscope study indicated that, while glimepiride therapy showed a 0.73% rise in plaque (a deposit of fatty material on the inner lining of an arterial wall, which can lead to clogged arteries), pioglitazone, instead, had a 0.16% drop in plaque volume.

Khoo said: “This is the first time an oral medication has shown such an ability to reduce the clogging of
coronary arteries. “It clearly shows that with daily intake of pioglitazone, Type 2 diabetics have a lower chance of developing heart disease.

This obviously a very significant result that offers diabetics a new lease in life. “We must always be aware that Type 2 diabetes does not have a known cure but with the inclusion of pioglitazone in a diabetic heart patient, it can help prolong life.”

He added that the Periscope results showed pioglitazone did not have any ill cardio-vascular side effect that other drugs of its class had. More importantly, it had benefited Type 2 diabetics beyond controlling their blood sugar levels by reducing mortality and diseases arising from diabetic complications and preserving quality of life.