An innovative clinical study is underway to determine if an intensive approach with combination medication to improve insulin sensitivity, in addition to lifestyle changes, can help battle the alarming rise of Diabetes in Ontario and Canada.
The CANOE Study (Canadian Normoglycemia Outcomes Evaluation) is being set up in two provincial centres – in Toronto and London – and will study 200 people with a pre-diabetes condition known as Impaired Glucose Tolerance.
The study is the first of its kind to investigate the effectiveness of lifestyle changes in addition to a combination medication – Avandamet which consists of Avandia and Metformin – designed to improve insulin sensitivity on the prevention of diabetes in people with pre-diabetes, said Dr. Bernard Zinman, Director of the Leadership Sinai Centre for Diabetes at Mount Sinai Hospital, who is heading the study with Dr Stewart Harris from The University of Western Ontario.
According to the Canadian Diabetes Association, more than two million Canadians have diabetes – a number expected to rise significantly in the future.
“This is going to cripple the health care system,” said Dr. Zinman. “In about 10 or 15 years we’re going to have a huge problem.”
People who are at risk may be overweight, have a family history of diabetes, have high blood pressure or had gestational diabetes, and participants will be tracked for three to five years.
Dr. Zinman says that in Canada, the epidemic is also escalating as a result of a graying population, a sedentary population and immigration from regions of the world where susceptibility to diabetes is higher, Diabetes-related complications, including blindness, amputation and kidney replacement therapy, in turn, result in a major impact on the health care system.
CANOE is designed to determine whether lifestyle intervention with a medication can have a dramatic effect on preventing diabetes compared to lifestyle alone. Zinman explains that previous studies have looked at lifestyle changes or various medications, and what has been found is that lifestyle is very effective in reducing the rate of diabetes. However, it only seems to delay its onset by approximately three years.
“[CANOE is a] unique study, which combines a lifestyle intervention with an intensive approach to improve insulin sensitivity. By improving insulin sensitivity you reduce stress on the pancreas, dramatically reducing the risk of diabetes,” said Dr. Zinman. “We think we will see as much as a 75 per cent reduction in the development of diabetes.”
In addition, the study will implement lifestyle changes that can be maintained once participants have completed the study, and access to a study website is an exciting and innovative new step in diabetes research, said Dr. Zinman. People in Toronto or London who have risk factors for Diabetes [Obesity, family history of diabetes, elevated blood pressure or gestational diabetes] would be eligible to be screened with a glucose tolerance test to determine their eligibility to participate in CANOE.