1. A new view on Diabetes from Aging Research Karl Otto Greulich Leibniz Inst of Age Research /Fritz Lipmann Institute Beutenbergstr 11 D 07745 Jena Germany y : Lifelong treatment of diabetes2 results only in moderate extension of life expectancy A survival table based on UKPDS data Clarke et al Eur Heart J (2009) 30, 834–839 can be approximated, for 65 year old persons with total / HDL cholesterol of 6 Years = P - (H + R - 10) / 3 - B / 40 Where “Years” is the residual life span, % HBA1c is the value of glycosylated hemoglobin above 6 % and mmHg is the blood pressure above 120. Particularly, a therapeutic decrease of HBA1c by 1% does increase the life expectancy only by 1 / 3 year. Lifelong treatment of diabetes2 results only in moderate extension of life expectancy A survival table based on UKPDS data Clarke et al Eur Heart J (2009) 30, 834–839 can be approximated, for 65 year old persons with total / HDL cholesterol of 6 Years = P - (H + R - 10) / 3 - B / 40 Where “Years” is the residual life span, % HBA1c is the value of glycosylated hemoglobin above 6 % and mmHg is the blood pressure above 120. Particularly, a therapeutic decrease of HBA1c by 1% does increase the life expectancy only by 1 / 3 year. ANIMAL EXPERIMENTS Numerous findings of ageing research indicate that the role of diabetes as a disease may have to be seen in a more differentiated way than this is the case in conventional medicine. Diabetes like lesions can i n c r e a s e lifespan by up to 50 %. HUMAN DIABETES: When one does not restrict the studies to the typical diabetes - caused diseases (cardio- vascular disease, kidney problems or retinopathies), but simply focuses on overall life expectancy, the result is surprising: The highest life expectancy among diabetics is seen at HBA1c values of 7 – 9, corresponding to blood glucose levels around 200 mg/dl, a level at which practical medicine states already an urgent need of therapy. A recent US study (ACCORD) has been prematurely terminated due to a 22 % higher death rate among patients treated for glucose levels towards 100 mg/dl, which by practical medicine is presently seen as ideal target value. Highest life expectancy at high blood glucose levels (HBA1c 7- 9) or, using HBA1c = 2,6+0,03 MBG) = 150 - 220 mg/dl Currie et al 2010 THE LANCET 375 481 - 489 Highest life expectancy at high blood glucose levels (HBA1c 7- 9) or, using HBA1c = 2,6+0,03 MBG) = 150 - 220 mg/dl Currie et al 2010 THE LANCET 375 481 - 489 The diabetes puzzle: diabetes is a serious disease, but …. Animal experiments in ageing research indicate that diabetes-like conditions (inactivation of the Insulin / IGF1 signalling pathway in cells and disruption of insulin producing ß cells) i n c r e a s e life span (source: BIOSpektrum Feb. 2009,136) Resveratrol (red wine) which affects Insulin /IGF pathway, shortens the life span of young fishes but extends lifespan of old fishes (Cellerino / Englert Lab, Leibniz Institute of Age Res, Jena) Centennarians have more diabetes than their earlier-deceased relatives Treating diabetes only moderately decreases risk of heart and vessel disease, kidney and eye disease, but r e d u c e s life expectancy by 22 % (ACCORD study, which was terminated due to death cases) The known diabetes related diseases (heart and vessel disease, kidney and eye disease) are primarly caused by diabetes 1 (youth diabetes DCCT study ) not so much by diabetes 2 (diabetes of the elderly UKPDS study ) Markus Lind, PhD thesis Univ Göteborg 2009 Lifelong treatment increases life expectancy only by a few months (3,5 months per 1 % HBA1c). Eur Heart J (2009) 30, 834–839 Is„normal“ blood sugar level only healthy up to a certain age, but later a higher value is better? The diabetes puzzle: diabetes is a serious disease, but …. Animal experiments in ageing research indicate that diabetes-like conditions (inactivation of the Insulin / IGF1 signalling pathway in cells and disruption of insulin producing ß cells) i n c r e a s e life span (source: BIOSpektrum Feb. 2009,136) Resveratrol (red wine) which affects Insulin /IGF pathway, shortens the life span of young fishes but extends lifespan of old fishes (Cellerino / Englert Lab, Leibniz Institute of Age Res, Jena) Centennarians have more diabetes than their earlier-deceased relatives Treating diabetes only moderately decreases risk of heart and vessel disease, kidney and eye disease, but r e d u c e s life expectancy by 22 % (ACCORD study, which was terminated due to death cases) The known diabetes related diseases (heart and vessel disease, kidney and eye disease) are primarly caused by diabetes 1 (youth diabetes DCCT study ) not so much by diabetes 2 (diabetes of the elderly UKPDS study ) Markus Lind, PhD thesis Univ Göteborg 2009 Lifelong treatment increases life expectancy only by a few months (3,5 months per 1 % HBA1c). Eur Heart J (2009) 30, 834–839 Is„normal“ blood sugar level only healthy up to a certain age, but later a higher value is better?