Let’s get started with our headlines this month. We have many of them so relax and read on. Remember that you need to be the best experts on your care and to do that you need to be an expert on diabetes. We will then present abstracts about the progressive loss of B-cell function in first-degree relatives of type 2 diabetic individuals and classification of distinct insulin infusion patterns of children and adolescents with type 2 diabetes on continuous subcutaneous insulin infusion therapy. Our first headline highlights what we talk about here on www.diabetic-lifestyle.com on a regular basis. Dr. Lana L. Watkins and her associates at Duke University studied 907 patients with coronary artery disease to look at the interplay of diabetes and severe depression on this disease. A total of 325 of the patients had type 2 diabetes. During the more than 4 years the patients were followed, 135 patients died. The researchers found that moderate to severe depression and diabetes were both associated with increased death, independent of age, gender, body weight, and heart function. Among diabetics with coronary heart disease, having severe symptoms of depression further increased the risk by roughly 25 percent. The researchers added that mild depression did not affect survival rates.
The March issue of Diabetes Care shares an article by Dr. Danit R. Shahar and his colleagues from Ben-Gurion University of the Negev which suggests that a diet rich in low-fat dairy calcium boots weight loss in overweight type 2 diabetics. The weight-loss promoting effect of this diet came out of a study of 259 overweight diabetic patients who were assigned to a mixed glycemic diet, a low-glycemic index diet, or a modified Mediterranean diet. The researchers found that a restricted calorie diet with a higher level of low-fat dairy products enhanced the weight loss process over 6 months. People on this regime had 2.4-fold increased odds of weight loss of greater than 8 percent.
The Feb. issue of the journal Stroke had an article written by Dr. Tien Y. Wong et al from the University of Melbourne, Australia. They found that damage to the retina that sometimes comes with diabetes is associated with an increased risk of having a stroke. “Diabetes can exert its effect on multiple organs in the body, and damage in the blood vessels seen in the eye—retinopathy—is a marker of probably unseen damage occurring elsewhere." “Blood vessel damage in the eye is linked to blood vessel damage in the brain, heralding the onset of a strike." At the start of the study 197 of the 1617 participants had moderate retinopathy and 44 had severe retinopathy. During an average follow-up of almost 8 years, 75 strokes occurred in the group as a whole. After making allowances for various stroke risk factors—such as blood pressure, insulin treatment and cholesterol levels—having diabetic retinopathy more than doubled the likelihood of having a stroke. The researchers conclude that a more comprehensive assessment of stroke risk needs to be done in patients with diabetic retinopathy.
Eli Lilly has announced that they will introduce a unique insulin pen that has the potential to reduce the number of finger pricks for diabetics. The Memoir pen, called the “Lexus" of insulin pens, which uses Humalog has a computer chip to remember the last 16 insulin doses delivered. We’ll see if this pen catches on in the US as others have in Europe and Asia.
Here’s bad news for those of us on Medicare. Eight of 10 American age 65 or older are living with heart disease, diabetes, or some other from of chronic disease according to aw new report by the U.S. Centers for Disease and Prevention (CDC). The State of Aging and Health in America 2007 as released during the first week of March. Fifty percent of older Americans suffer are burdened by 2 chronic diseases. All of this means that we as a society have to afford physicians time to share ways of living a more healthy lifestyle with patients and communities need facilities appropriate for this age group. Health is not a check list; rather it is intervention.
Want to have more ammunition to get funding for diabetes care? Look at this! Rates of diabetes in Canada’s most populous province—Ontario—has already zoomed past what was predicted for 2030, which suggests that the global epidemic will be far worse than feared. “In view of this linear growth in prevalence, more than 10 percent of the adult population of Ontario will be diagnosed with type 2 diabetes before 2010"."WHO has predicted a 39 percent rise in the worldwide prevalence of diabetes between 2000 and 2030, but (the study) indicates that this figure might be a gross underestimation".
Finally, we leave you with an article from March’s journal, Circulation. After reading this, we can all feel comfortable asking for more CAD screening tests. Dr. Claes Held et al from the Karolinska Institute in Stockholm, Sweden followed 31,500 subjects in an international study for an average of 2.4 years. They found that a increase of 1 millimole per liter (mmol/L) in blood glucose level increased the risk of hospitalization for congestive heart failure of cardiovascular death by nine percent for all patients, by 5 percent for those with diabetes, and by 3 percent for those without diabetes. ““Even in the normal range, results indicate that elevated blood glucose is associated with the risk of heart failure." “The researchers stated that “You can look at blood glucose much like blood pressure or cholesterol. Even if you have normal blood pressure, there is a gradual increase in risk wherever you start the scale. If the blood sugar is ‘high normal’ there is a higher risk than those with ‘low normal’ fasting blood glucose levels" Held stated.
Our first abstract is titled Progressive Loss of B-cell Function Leads to Worsening Glucose Tolerance in First-Degree Relatives with Type 2 Diabetes. The article, written by Miriam Cnop, M.D., PhD et all is found in Diabetes Care 30:677-682,2007. The relative roles of insulin resistance and B-cell dysfunction in the pathogenesis of impaired glucose tolerance (IGT) and type 2 diabetes are debated. First-degree relatives of individuals with type 2 diabetes are at increased risk of developing hyperglycemia. To examine this, the researchers evaluated the evolution of insulin sensitivity, B-cell function, glucose effectiveness, and glucose tolerance over 7 years in 33 nondiabetic, first-degree relatives of type 2 diabetic individuals using frequently samples tolbutamide-modified intravenous and oral glucose tolerance tests. The subjects gained weight, and their waist circumference increased. Insulin sensitivity, the acute insulin response to glucose, and glucose effectiveness did not change significantly. However, when they accounted for the modulating effect of insulin release, B-cell function determined as the disposition index decreased 22%. This decrease was associated with declines in intravenous and oral glucose tolerance. Of the subjects with normal glucose tolerance at the first assessment, they compared those who progressed to IGT and those who did not. The disposition index was 50% lower in the nonprogressors at the follow-up. The researchers concluded that the decline in glucose tolerance over time in first-degree relatives of type 2 diabetic individuals is strongly related to the loss of B-cell function. This, early intervention to slow the decline in B-cell function should be considered in high-risk individuals.
Our second abstract was also found in Diabetes 30:568-573, 2007 and is titled Classification of Distinct Baseline Insulin Infusion Patterns in Children and Adolescents with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Therapy by Paul-Martin Holterhus, M.D et al. The researchers hypothesized systematic differences in the patterns of programmed basal insulin infusion rates in children and adolescents with type 1 diabetes on continuous insulin infusion (CSII). They aimed at classification of basal infusion rate regimes and comparing patient’s underlying clinical characteristics. The German/Austrian diabetes data acquisition system for prospective surveillance database for quality control and scientific surveys in diabetic diabetology served as the primary data base. Latest (Sept., 2004) basal insulin basal rates on all 1,248 patients with type 1 diabetes on CSII (0.38-18 years) were analyzed. Basal insulin infusion rates per hour were expressed relative to mean basal insulin rates per 24 hour. Unsupervised clustering was used to classify basal infusion rate patterns. Clinical characteristics of patients falling into distinct basal insulin infusion rate clusters were compared by Kruskal-Wallis test. Changes in basal insulin infusion rates in 64 patients were followed from initial settings before CSII to latest programming in an independent dataset 2. The results reported were that seven different basal insulin rate patterns occurred in data base 1. A dawn-dusk pattern was used in 708 patients with a peak basal insulin infusion rate as 5AM/ Additional patterns showed only one basal insulin infusion rate oscillation per 24 hours with a backshift of peak basal insulin infusion rates in younger children. All but two patients in dataset 2 were initially set on dawn-dusk patterns but showed comparable diversification of basal insulin infusion rates during follow-up with backshift of peak basal insulin infusion rates in younger children. The researchers concluded that pediatric diabetologists shape distinct basal insulin infusion rate profiles during treatment of CSII patients, mainly reflecting differences in age. Their data strongly suggest that age-dependent endocrine changes during childhood (e.g., puberty) affect circadian distribution of insulin needs in CSII, which should be kept in mind when considering basal insulin infusion rate strategies in children and adolescents.
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