Diabetes Research: Why It Needs To Be More Of A Budget Priority

   I have long since given up looking for logic from the Bush administration. However, the recently proposed cuts in funding for diabetes research certainly fly in the face of very disturbing statistics about the prevalence and impact of this disease.    According to a recent news article in Diabetes Today, the proposed budget numbers would slash $11 million from funding for the National Institute of Diabetes and Digestive and Kidney Disease, a research division of the National Institutes of Health (NIH), and $20 million from funding for chronic disease prevention at the Centers for Disease Control (CDC).    Granted, it is high time President Bush corralled the runway budget deficit. The previous run up the tab on future generations approach always seemed fiscally irresponsible. However, the research cuts for diabetes research are not the way to go and may have serious ramifications beyond any monetary savings.    Consider emerging research from a study that was recently published in Diabetes Care. In a study of over 1,700 eighth-grade students, researchers found that half of the students were overweight or on the verge of becoming overweight. The authors of the study also found that 41 percent of those studied had elevated blood sugar levels and 36 percent had high insulin levels. All of these are significant risk factors for type 2 diabetes.    Approximately 7 percent of the U.S. population (or 20.8 million people) has diabetes, according to estimates from the CDC. The statistics are particularly disturbing in New York City, according to a recent article, “Facing The Diabetes Epidemic — Mandatory Reporting of Glycosylated Hemoglobin Values In New York City,” by Robert Steinbrook, MD, in The New England Journal Of Medicine.    The article notes that an estimated 530,000 people in New York City have been diagnosed with diabetes. Citing statistics from a 2002 survey by the city’s health department, Dr. Steinbrook notes that 89 percent of diabetic adults in New York City do not know their glycosylated hemoglobin values.    According to the article, the city’s health department is planning to create and fund a registry of glycosylated hemoglobin value results. While some may raise privacy issues with such an endeavor, clearly the benefits of identifying and reaching out to high-risk patients and their physicians, and facilitating more regular checkups is well worth the effort.    In addition to this noble preventive effort, emerging studies continue to bear fruit in the realm of diabetes research. A recently published study in Diabetes Care assessed follow-up results for over 1,200 patients six and half years out from the Diabetes Control and Complications Trial. The researchers found that patients who initially received intensive diabetes therapy (at least three insulin injections a day) had a 10 percent lower prevalence of diabetic neuropathy than patients who initially received conventional diabetes therapy (no more than two insulin injections a day).    Clearly, preventive initiatives and long-term studies need the requisite funding in order to facilitate significant progress in combating this disease and ultimately saving lives.    With this backdrop in mind, we present our Sixth Annual Diabetes Theme Issue. Our cover story, “Closing Difficult Wounds” (see page 44), and “Key Insights On Split Thickness Skin Grafts” (see page 64) examine current approaches to facilitate improved healing of wounds among patients with diabetes. Rounding out the issue are features on diabetic peripheral neuropathy (see page 58), nutritional supplements (see page 72) and difficult nails in patients with diabetes (see page 91).    Hopefully, this theme issue will provide pertinent insights you can use to help treat these patients in your practice.