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THE CSTE WASHINGTON REPORT
Marcia S. Mabee, MPH, PhD
Editor
11479 Waterview
Reston, Virginia 20190
mmabee@ix.netcom.com
703-709-3001
AUGUST 15, 2001 Volume 5, Number 16
EDITOR’S NOTE: Diet and exercise alone can significantly reducce the
incidence of type 2 diabetes, according to a broad new study released this
month. The findings came from the Diabetes Prevention Program (DPP), a
major clinical trial comparing diet and exercise to treatment with
metformin in 3,234 people with impaired glucose tolerance, a condition
that often precedes diabetes. Participants randomly assigned to intensive
lifestyle intervention reduced their risk of getting type 2 diabetes by 58
percent. On average, this group maintained their physical activity at 30
minutes per day, usually with walking or other moderate intensity
exercise, and lost 5-7 percent of their body weight. Participants
randomized to treatment with metformin reduced their risk of getting type
2 diabetes by 31 percent. The study, summarized in this Washington Report,
confirms the power of improving lifestyles of at-risk populations.
The CSTE Washington Report will take an August break
and will resume publication in September.
The CSTE Washington Report is provided as a information resource for
members of the Council of State and Territorial Epidemiologists on federal
legislation and regulation affecting public health and epidemiology in the
U.S. Regulations cited can be accessed via http:
www.gpo.gov
APPROPRIATIONS UPDATE – In recent meetings with Congressional staff,
public health groups have learned that the Congressional Budget Office (CBO)’s
projection of the federal budget surplus, expected shortly, is likely to
come in at $130-$140 billion. This is $20-$30 billion below what OMB
Director Daniels has been verbally projecting, and means Congress may have
to dip into the Medicare Trust Fund to fund programs at the President’s
requested level in FY 2002. This makes restoring cuts to programs, such as
the chronic disease program within CDC, and the 60 percent proposed cut
for Health Professions at HRSA, even more difficult, as well as efforts to
increase funding for a number of programs such as the new public health
infrastructure program. Prevention Block Grant, and environmental
surveillance. Staff also project a very late mark up in the Senate for the
Labor-HHS-Education Appropriations bill due to delays caused by the
change-over in party leadership. The corresponding House Subcommittee is
expecting to mark up in September, but Senate staff say their mark-up may
be in October or later.
Diet and Exercise Dramatically Delay Type 2 Diabetes -- At least 10
million Americans at high risk for type 2 diabetes can sharply lower their
chances of getting the disease with diet and exercise, according to the
findings of a major clinical trial announced by HHS Secretary Tommy G.
Thompson August 8 at the National Institutes of Health (NIH).
"In view of the rapidly rising rates of obesity and diabetes in America,
this good news couldn't come at a better time," said Secretary Thompson.
"So many of our health problems can be avoided through diet, exercise and
making sure we take care of ourselves. By promoting healthy lifestyles, we
can improve the quality of life for all Americans, and reduce health care
costs dramatically."
The same study found that treatment with the oral diabetes drug metformin
(GlucophageĆ) also reduces diabetes risk, though less dramatically, in
people at high risk for type 2 diabetes.
Participants randomly assigned to intensive lifestyle intervention reduced
their risk of getting type 2 diabetes by 58 percent. On average, this
group maintained their physical activity at 30 minutes per day, usually
with walking or other moderate intensity exercise, and lost 5-7 percent of
their body weight. Participants randomized to treatment with metformin
reduced their risk of getting type 2 diabetes by 31 percent.
The findings
came from the Diabetes Prevention Program (DPP), a major clinical trial
comparing diet and exercise to treatment with metformin in 3,234 people
with impaired glucose tolerance, a condition that often precedes diabetes.
On the advice of the DPP's external data monitoring board, the trial ended
a year early because the data had clearly answered the main research
questions.
Smaller studies in China and Finland have shown that diet and exercise can
delay type 2 diabetes in at-risk people, but the DPP, conducted at 27
centers nationwide, is the first major trial to show that diet and
exercise can effectively delay diabetes in a diverse American population
of overweight people with impaired glucose tolerance (IGT). IGT is a
condition in which blood glucose levels are higher than normal but not yet
diabetic.
Of the 3,234
participants enrolled in the DPP, 45 percent are from minority groups that
suffer disproportionately from type 2 diabetes: African Americans,
Hispanic Americans, Asian Americans and Pacific Islanders, and American
Indians. The trial also recruited other groups known to be at higher risk
for type 2 diabetes, including individuals age 60 and older, women with a
history of gestational diabetes, and people with a first-degree relative
with type 2 diabetes.
"Lifestyle
intervention worked as well in men and women and in all the ethnic groups.
It also worked well in people age 60 and older, who have a nearly 20
percent prevalence of diabetes, reducing the development of diabetes by 71
percent. Metformin was also effective in men and women and in all the
ethnic groups, but was relatively ineffective in the older volunteers and
in those who were less overweight," said DPP study chair Dr. David Nathan
of Massachusetts General Hospital, Boston.
NIAID Awards Grant to Rapidly Sequence the Malaria Mosquito Genome -- The
National Institute of Allergy and Infectious Diseases (NIAID) August 8
announced a $9 million award to help reveal the genetic secrets of
malaria, a complex disease responsible for up to 3 million deaths
worldwide each year. Through the grant to Celera Genomics Group, NIAID has
expanded its efforts to determine the genetic blueprint of Anopheles
gambiae, a mosquito species that transmits the malaria parasite to people.
As part of an international consortium of A. gambiae researchers and
genome sequencing centers, Celera scientists will help sequence the
mosquito genome and make the information freely available to the
scientific community. Celera anticipates completing the project next
spring.
Malaria is caused by parasites of the genus Plasmodium. The disease
strikes 300 to 500 million people annually, 90 percent of whom live in
sub-Saharan Africa. More than 40 percent of the world's population lives
in areas where malaria naturally occurs.
Malaria
parasites undergo a complex life cycle; to thrive and spread they must
spend parts of their lives in both humans and mosquitoes. To learn more
about how the parasite, mosquitoes and humans interact, researchers will
study the Anopheles genome along with the recently deciphered human genome
and the soon-to-be-completed DNA sequence of the deadliest malaria
parasite, Plasmodium falciparum. The three genome sequences will provide
scientists with a unique opportunity to study the natural history of
malaria. For the first time, researchers will have the complete genetic
information on an infectious organism, its natural host, and the insect
that transmits the disease from person to person.
"This
initiative will give us the pieces to an incredibly complex puzzle," says
NIAID Director Anthony S. Fauci, M.D. "By analyzing and comparing the
genomes of all three organisms, researchers will have a wealth of new
information for understanding malaria and how it is spread, and for use in
developing new tools to help reduce its devastating impact."
Additional information on NIAID's malaria research and genomic sequencing
activities is available at "http://www.niaid.nih.gov/dmid/genomes"
Scientists
Find Drastic Underestimations of Malaria Morbidity, Mortality, and
Economic Burden -- Challenging long-standing beliefs about the
international burden of malaria, scientists have presented new information
about the severity of malaria morbidity, mortality, and its economic toll
in a supplement to The American Journal of Tropical Medicine and Hygiene.
Titled "The Intolerable Burden of Malaria: A New Look at the Numbers," the
supplement was published by the Multilateral Initiative on Malaria (MIM)
with support from MIM partners, including NIH, The Centers for Disease
Control and Prevention, GlaxoSmithKline, the Rockefeller Foundation, The
United Kingdom Medical Research Council, The United Nations Foundation,
the United States Agency for International Development (USAID), The
Wellcome Trust, and the World Health Organization.
"With new data
and a fresh look, this landmark supplement highlights the many burdens
caused by malaria. To address the pervasive and intractable problems that
malaria represents, it is essential that malaria's full burden on
societies and families be measured both epidemiologically and
economically," said Gerald T. Keusch, M.D., Director of the Fogarty
International Center (FIC) and MIM, and NIH Associate Director for
International Research. He added, "The enormous burden of malaria and the
disparity in global malaria research efforts is the rationale for the MIM
and the reason why U.S., European, and African scientists have joined
together in the MIM to promote malaria research in Africa to develop new
and improved control interventions."
For more than
50 years, the mantra of "one million annual deaths due to malaria" has
been cited by scientists and journalists. Until recently, this estimate
had generally gone unexamined in regard to its accuracy, clinical
components, and economic implications. The supplement reports that, at a
minimum, between 700,000 and 2.7 million people die annually from malaria,
over 75% of them African children. New data presented in the supplement
show that over 85% of these malaria-induced childhood deaths are due to
anemia, low birth weight, and hypoglycemia. The supplement also reports
that between 400 and 900 million acute febrile episodes occur annually in
African children under the age of 5 living in malaria-endemic regions, and
that this number will double by 2020 if effective control interventions
are not implemented. This is notable because high fevers and febrile
convulsions in infants and children can retard brain development, often
resulting in impairments in high-order cognitive function such as
planning, decision-making, self-awareness, and social sensitivity. Of all
the manifestations of malaria, those impacting cognition and behavior are
the subtlest, least defined, and have the most profound implications for
children, families, and societies.
Detailed
information about MIM, its partners, and activities is available on the
MIM website at http://mim.nih.gov” To request a copy of "The Intolerable
Burden of Malaria: A New Look at the Numbers," e-mail MIM Secretariat
Coordinator AndrČa Egan, Ph.D. "mailto:mim@nih.gov”.
Component of Fly Saliva Makes Promising Leishmaniasis Vaccine--
Researchers seeking to make a vaccine against a serious parasitic
infection have discovered a dose of fly saliva might be just what the
doctor ordered. Leishmaniasis, a disabling and sometimes deadly tropical
illness, is caused by a parasite transmitted to people through the bite of
a sand fly. In a report released August 6, scientists from the National
Institute of Allergy and Infectious Diseases (NIAID) describe how a
vaccine they developed against a component of sand fly saliva prevents
leishmaniasis in mice.
Leishmaniasis, a major health problem in many tropical and desert
climates, has resisted efforts to develop an effective vaccine. "Today's
report describes a novel vaccine," says NIAID Director Anthony S. Fauci,
M.D. "Rather than targeting the parasite, as is typical, our researchers
produced a vaccine to the saliva of the insect that transmits the
parasite. This approach could potentially be used to develop vaccines for
other insect- or tick-borne diseases."
Leishmaniasis refers to a group of related diseases. Different species of
the single-celled parasite Leishmania can cause flesh-eating nose, throat
and mouth infections (mucosal leishmaniasis); painful skin lesions (cutaneous
leishmaniasis); or fatal infestations of the internal organs (visceral
leishmaniasis). An estimated 12 million people currently are affected by
one or more of these diseases, most of whom live in South or Central
America, Africa and the Middle East.
Donna Knutson
Executive Director
Council of State and Territorial Epidemiologists
770-458-3811
770-458-8516
dknutson@cste.org
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