Diabetes Is Nectar to the Big Pharm Beehive

      Free cups of cola, sugared coffee and tea, cakes and cookies at a diabetes conference? That's the equivalent of a convention of dentists handing out candy at the door, or cardiologists smoking during breaks between lectures.

      The massive pharmaceutical company exhibition attached to the 36th annual meeting of the European Association for the Study of Diabetes (EASD) last month - with nearly 9,000 participants from 80 countries, the largest medical gathering in Israel's history - presented a skewed message. Having spent millions of shekels to show doctors and scientists their drugs, blood glucometers, insulin pumps, and other paraphernalia used for monitoring and dosing patients, these giant companies clearly want to treat the disease - not prevent it.

      Diabetes is among the world's most expensive chronic disorders to treat; it's categorized in two main groups: insulin-dependent diabetes mellitus (type I, or IDDM), and non-insulin-dependent diabetes mellitus (type II, or NIDDM). The first kind develops during childhood, adolescence, or even before birth. It's an autoimmune disease that runs in families, in which the body's immune system mistakenly regards the beta cells of the pancreas as an enemy and destroys them. This halts the body's production of insulin, which is a vital hormone needed to metabolize sugar. Without insulin, type-I diabetics would be doomed to death, but the development of insulin for injection saved their lives and offers them a near-normal life.

      In type II diabetes, which is far more common, the pancreas is still able to produce the hormone, but the body is less able to make use of the insulin. This causes high levels of sugar in the blood, which over a course of years can cause severe harm to various bodily systems. It's part of a whole syndrome that frequently includes overweight, hyperlipidemia (high blood fats), heart disease, and hypertension.

      If a patient's blood sugar and insulin levels are not kept in balance, complications such as blindness, kidney failure, stroke, heart attacks, blood vessel deterioration, foot sores, and gangrene in the limbs can result. It affects 4 to 5 percent of the entire population in Western societies and 6 to 7% of those aged 40 to 65. More than 90% of the 150 million diabetics around the world have the type II form, and the total figure is expected to rise to 300 million in 25 years.

      ALTHOUGH TODAY scientists know much more about the genetics of type I and type II diabetes, there are as yet no clinical applications for knowing about an individual's risk. Diabetes is not like cystic fibrosis, which involves a single mutated gene. Diabetes is the result of a combination of many genes found normally in many people, as well as the environment, and it's very complex to sort it out.

      Yet US scientists recently identified a variant of a gene that increases the risk for type II diabetes, and their discovery may ultimately lead to new ways to treat the condition. Dr. Joel Hirschhorn and his team at the Whitehead Institute in Cambridge, Massachusetts wrote in a recent issue of Nature Genetics about the PPAR-gamma variant gene that appears in 85% of the population. It gave carriers a 25% increased risk for NIDDM. The gene affects the development of fat cells, controlling what cells become fat tissue. It also plays a still-mysterious role after development, something scientists discovered because a relatively new class of diabetes drugs works directly on PPAR receptors.

      But until gene testing and gene therapy become practical and widely available, prevention of type II diabetes is the name of the game. That's why the lack of exhibits and stands to promote prevention, by advising people how to change their lifestyle, was so disappointing.

      The pharmaceutical companies were busy luring conference participants to their stands with free pens and medical quiz lotteries, in addition to the sugary refreshment come-ons. Insiders in pharmaceutical and biotech companies even suggest that "there's no money" in curing juvenile-onset diabetes.

      But there are numerous non-profit patient organizations around the world; some non-commercial group should have had a presence at the exhibition and stressed the importance of maintaining a proper body weight, exercising, eating a high-fiber and low-carbohydrate diet, eschewing junk food, and not smoking.

      ON THE OTHER hand, inside the Jerusalem International Convention Center's plenum and in the hundreds of individual lecture sessions, the need to prevent type II diabetes and keep blood sugar under control by changing lifestyles was an important topic, along with reports on the latest research about treatment. But doctors at the conference admit they've been largely unsuccessful in motivating diabetics to prevent or control their type II diabetes by changing their lifestyle, as too little research has been devoted to the complex psychological issue of behavior modification.

      More than 1,700 papers had been submitted; a third were accepted. "There are numerous doctors and scientists who are diabetics themselves, and that alone has given a boost to diabetes research," explained EASD president Jorn Nerup, a Danish diabetes expert, whose organization last held a conference in Jerusalem 18 years ago, with only 600 participants. The massive numbers of aging "baby boomers" in the US and other Western countries are also boosting diabetes research, as this generation wants to enjoy maximum functioning during its middle and old age.

      Although Type II diabetes used to be considered a middle-aged disease, it's being diagnosed in younger people more than ever, said Nerup, who made a breakthrough discovery in the early 1970s, when he found that in insulin-dependent diabetes the body's immune system attacked the pancreas. "We had never seen NIDDM in teenagers until recently. Today's younger generation are couch potatoes; they sit in front of their computer and the TV set and don't get exercise, and they eat a lot of sugar and junk food."

      Blacks and other racial groups who survived conditions of famine for thousands of years and suddenly join the middle-class Western lifestyle are also in bad shape. Their risk of type II diabetes is considerably higher than in whites. "Evolution protected them because they were hunters and gatherers in ancient times, and their bodies were good at storing energy. That's beneficial in famine conditions, but not at a time of plenty," explained Nerup. "They can't easily metabolize the extra sugar."

      A joint Australian-Israeli study on the Negev rodent called the sandrat (a relative of the gerbil) has found it's an excellent animal model for type II diabetes. The animals are perfectly healthy, subsisting on meager desert rations. In the lab, they were fed on cactus and remained perfectly healthy. But when another group of sandrats were fed Western-style junk food in the lab, the

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