Every month we bring you the latest headlines about diabetes and its complications as well as medical journal abstracts. We’re pleased that you read these news items each month and that you are know the benefits of understanding this disease. After we present the headlines, you’ll read abstracts about chronic kidney disease and the importance of seeing a nephrologist fro the best results and a change in the number of young diabetes being hospitalized. Let’s begin.
Diabetes’ rates continue to grow in the United States. Federal projections estimate that by 2050 some 48 million Americans will have type 2 diabetes. “Studies have suggested that for the first time in history, the generation of people born in 2000 is probably going to have shorter life expectancy than their parents," said Dr. Sue Kirkman, vice president of clinical affairs of the ADA. In 2008 more people will die from diabetes world wide then HIV/AIDS and Malaria combined. If you are not proactive in the fight to cure diabetes we hope that this information will get you to join the Juvenile Diabetes Research Foundation and/or the American Diabetes Association and contact your representatives to get more funding for research, education, and treatment.
Nature Neuroscience, online Feb. 17, 2008 shares an animal study that indicated that the cognitive impairment that can occur in people with diabetes appears to be the result of high levels of the stress hormone cortisol. Dr. Mark P. Mattison from Princeton University and colleagues found that diabetes impairs memory and several neurological processes in the brain. Moreover, corticosterone, which is similar to cortisol in humans, played a key role in these adverse effects. They concluded that “it will be important to determine whether drugs that block the production or actions of cortisol will prevent cognitive deficits in patients with diabetes."
Those of us who have diabetes are forced to deal with the short and long term complications of diabetes and make plans for our care if we are left alone as we age. We also know that exercise such as strength training is very important for people with diabetes. The Feb., 2008 Diabetes Care journal reiterates the need to understand this problem. British researchers found that among 800 adults ages 65 and older those with diabetes were more likely to have problems with walking and performing daily tasks like bathing, climbing stairs and dressing. Furthermore, 4% of those with diabetes were “highly dependent" on someone else to care for them. 45% per cent used some form of mobility aid like a cane or walker which compared to 31% of those without diabetes. Researchers noted that nerve damage and impaired blood flow to the legs likely play a role in the higher rate of walking problems, but study diabetics also tended to have co-existing health conditions, such as high blood pressure and a history of stroke and heart attack which could also be physically limiting. As others we have reported about, the researchers highly suggest that exercise could improve blood glucose levels and mobility too.
For years we have thought that there are three major types of diabetes, but have you ever heard of MODY? Diabetes is undergoing a genetics revolution that suggests there are many subtypes of the disease. The discoveries already trigger important changes in treatment for a fraction of patients with some rare diabetes types caused by single genes gone awry—if they have a doctor aware of the findings. To help figure out why different people have different reactions to diabetes U.S. health officials are bringing 20 drug companies together with international gene specialists to jump-start the hunt for new therapies.
The February 2008 issue of the Journal of Clinical Psychiatry has an article that states that the Metabolic Syndrome may be a “predisposing factor for the development of depression". Dr. Hannu Koponen of the University in Kuopio, Finland and his colleagues followed a large group of middle-ages men and women living in central Finland for 7 years. Components of metabolic syndrome include high cholesterol and triglyceride levels, low levels of “good" HDL cholesterol, high blood sugar, high blood pressure, and excess belly fat. According to the researchers, non-depressed subjects at the start of the study who were found to have the metabolic syndrome were twice as likely as those without the metabolic syndrome to have symptoms of depression at the follow-up years later. The increasing incidence of metabolic syndrome suggests that the incidence of depression may rise accordingly, the researchers concluded.
For those of you who have not followed the news about inhaled insulin, Eli Lilly has announced it will terminate development of their inhaled insulin treatment for diabetes which it was conducting in partnership with Alkermes Inc. after deciding that the product’s commercial potential was not strong. Lilly’s decision marks the third setback in recent months for inhaled insulin formulations, once deemed potential blockbuster products because of their greater convenience than standard injectable insulin. “While Lilly may elect not commercialize Air Insulin, Alkermes believes that the phase 3 safety and efficacy trials should be completed," Alkermes said in a statement. After Lilly’s announcement the company said it was evaluating the impact of termination, which will become effective in 90 days. Lilly’s action comes five months after Pfizer Inc. abandoned Exubera, the first approved inhaled form of insulin, and returned the rights of the product to longtime partner Nektar Therapeutics. A second setback for inhaled insulin came in January, when Novo Nordisk said it was halting development of its AERx product meant to deliver inhaled droplets. The Danish drug maker said AERx did not have adequate ales potential, given the limited commercial success seen with Exubera.
It’s time now to review our medical abstracts. If you have been reading this web site you know that the majority of patients with end-stage kidney disease have diabetes. To impress upon all of us the importance to see specialists when diagnosed with a serious disease we bring you the following abstract. It is titled Survival Benefit of Nephrologic Care in Patients with Diabetes Mellitus and Chronic Kidney Disease in the Archives of Internal Medicine, 2008:169(1):55-62 by Chin-Lin Tseng, DrPH et al. The association of Nephrologic care and survival in patients with diabetes and chronic kidney disease is unknown. These researchers using data from 1997 to 200 conducted a retrospective cohort study of Veterans Health Administration clinic users having diabetes and stage 3 or 4 chronic kidney disease. The baseline period was 12 months, and medium follow-up was 19.3 months. The outcome measure was dialysis-free death. Of the 39,031 patients, 70.0%, 22.0%. And 7.6% had early stage 3, late stage 3, and stage 4 chronic kidney disease respectively, and 3.1%, 9, 5%, and 29.2 respectively visited a nephrologists. Dialysis-free mortality rates were 9.6, 14.1, and 19.4 respectively, per 100 person-years. More calendar quarters with visits to a nephrologist were associated with lower mortality: adjusted hazard ratios were 0.80, 0.68, and 0.45 respectively when the groups having 2, 3,and 4 visits were compared with those who had no visits. One visit only was not associated with a difference in mortality when compared with no visits. The researchers concluded that the consistency of outpatient Nephrologic care was independently associated in a graded fashion with low risk of deaths in patients with diabetes and moderately severe to severe chronic kidney disease. However, only a minority of patients had any visits to a nephrologist.
The newspapers are full of articles about the epidemic of obesity in our youth. Diabetes Care 30:3035-3059,2007 has an article about this subject titled Trends in Hospitalizations for Diabetes Among Children and Young Adults , United States, 1993-2004, by Joyce M. Lee, M.D, MPH et al. The purpose of this study was to examine national trends in hospitalizations associated with diabetes for U.S. children and young adults. The study included hospital discharges for individuals age 0-29 with a diagnosis of diabetes in the Nationwide Inpatient Sample (1993-2004). Outcomes were weighted, nationally representative estimates of the frequency of population-adjusted hospital discharges and hospital charges. Among individuals 0-29 years, population –adjusted hospitalizations associated with diabetes over the 12-year period increased by 38%. Age-specific increases in annual hospitalizations for diabetes occurred primarily among individuals 20 -24 years and 25-29 years. Trends in hospitalization among younger individuals showed no significant patterns. Hospitalization rates were constantly higher for females than for males, with a greater rate of increase for females than for males. Inflation-adjusted total charges for diabetic hospitalization increased 130% from $1.05 billion in 1993 to 2.42 billion in 2004. The researchers concluded that the number of young adults hospitalized with diabetes in the U.S. had increased significantly over the last decade. Sex-specific differences in hospitalization rates and trends in obesity among U.S. children may amplify future trends in diabetes hospitalizations and corresponding rapid growth in association with health care expenditures.
BSP
