Health: Why So Many Of Us Are Getting Diabetes

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Coincidence? Probably not, which is why physicians have lumped all these symptoms together in one condition that they now call metabolic syndrome. They believe that anyone with metabolic syndrome is at much greater risk of developing not just heart disease but diabetes as well. They're not sure whether there is a primary trigger for metabolic syndrome--say, obesity or insulin resistance--or if several biological pathways are involved. Whatever the case, says Dr. Scott Grundy, a leading expert on cholesterol who chaired the American Heart Association's first clinical conference on metabolic syndrome in September, "right now there's no single drug that can treat the whole metabolic syndrome." Individual symptoms like high blood pressure still have to be treated separately. But your best bet for an overall solution is to eat better, lose weight and get more exercise.

AN INFLAMMATORY QUESTION

As central as insulin resistance has become to understanding Type 2 diabetes, scientists are starting to wonder whether another factor, the inflammatory response, may also play a key role. Inflammation is a complex biological process the immune system uses to limit the damage caused by various injuries. (Ever notice how a turned ankle swells or a sunburn feels warm to the touch? That's inflammation in action.) But when inflammation becomes chronic, it no longer limits damage. In fact, it starts to do harm to the body.

Over the past five years, researchers have shown that inflammation is at least as important as high cholesterol levels in causing heart disease. (High levels in the blood of certain molecules, such as C-reactive protein (CRP), indicate a runaway inflammatory process and are better predictors of heart attacks than cholesterol.) Could the same be true for diabetes? "In 2001, when we published our first paper on inflammation and diabetes, everybody thought we were just wrong," recalls Dr. Paul Ridker, a cardiologist at Brigham & Women's Hospital in Boston. "Now there are half a dozen studies confirming that if you measure markers of inflammation, and CRP in particular, you can do a good job of predicting who's going to get diabetes."

If these results are confirmed and inflammation turns out to be as important as insulin resistance in triggering diabetes, then it should become much easier to identify incipient problems in metabolism before they get out of control. Why? Because inflammation is much easier to measure than insulin resistance; all that is required is a single blood test. (Abnormal glucose levels only suggest the possibility of insulin resistance; they don't prove it. Insulin resistance is difficult to measure directly.) It might also mean that anti-inflammatory agents like aspirin may be particularly effective in diabetics.

AN OUNCE OF PREVENTION