Diabetes reports that Dr. Karl L. Skorecki and his colleagues at the Israel Institute of Technology in Haifa, Israel, have grown embryonic stem cells in adherent and suspension culture conditions and found that the cells differentiated onto insulin-producing beta-islet like cells. Dr. Christopher Saudek, president of the American Diabetes Association calls the findings, "exciting. Up until his point, people have talked about the possibility that human stem cells could produce insulin. But here it is being demonstrated," he continued.
We wish to thank President Bush for allowing stem cell research to continue on those clusters already in existence and for committing $250 million in US Government funds for this very important research. The US Senate still has not spoken and now is the time for you to contact your Senators. Not only could this critical research be the first step to find a possible cure for diabetes, but also Parkinson's disease and spinal cord injuries. Make your voice count. Go to www.senate.gov. Once there, click on "contacting the Senate." You will then find an alphabetical list of the senators and their e-mail address. Scroll down to the names of your senators and send your e-mails today.
The wheels of research continue to turn and this month we are once again bringing you some of the latest news about diabetes. It is our pleasure to share this information with you each month with the hope that you will continue to be the best informed diabetics in the world. After all, this is not a disease that we can forget about for long. We all have those days when questions arise about issues we are not sure of and then there are those days that we seem to sail through with little or no difficulty. Those latter days are the ones when I do my best research. Less is scary and more is interesting. I hope this is one of those days for you and that reading this site will help you have many more of those days when you feel well, your blood glucose levels are normal, work nor family has their "crisis du jour," and you have time to learn something new.
This month, we start with information that was reported at the American Diabetes Association's 61st annual meeting, held in Philadelphia. We look at papers on children and insulin pumps, heart disease in young diabetics, and finally sildenafil and intercourse success in men with type 1 diabetes. Then we'll go on to look at journal articles about the use of an automated device for alternate site blood glucose monitoring and we end with an article on comorbidity and glycemic control in type 2 diabetes. It's a full plate, so read on.
Our first topic from the ADA conference concerns two reports on the safety of insulin pumps for children. The first research was done by JoAnn H. Ahern at Yale University. According to the report, which followed 102 children, all younger that 12, the pump was more effective at stabilizing blood glucose levels than injections and did not cause any significant adverse reactions. The school ages children were on the pump for nearly 20 months and the preschoolers for an average of 17 months. The risk of hypoglycemia was 0.2 events per year per patient. Infections at the site where the pump was implanted were minor and were easily treated. The author recommends the insulin pump for children who check their blood glucose levels at least four times a day, as well as for those who have hypoglycemia at night or who are fussy eaters.
The results of the second study, however, suggest that children's risk of ketoacidosis may increase on an insulin pump. In addition, it points to an increase of hypoglycemia, extreme thirst and a number of other complications if the pump is set incorrectly. This study took place at Children's Hospital in Philadelphia and was reported by Dr. Nicole Celona-Jacobs and colleagues. They reviewed data on 34 children with an average age of 14 years who received multiple daily insulin injections and insulin pump therapy, each for 1 year. While on the insulin pump the children experienced significantly more incidents of ketoacidosis, and the average body mass index increased. These researchers concluded that patients who are not proficient at self-monitoring their diabetes, regardless of their age, are not candidates for the pump. Do we agree? I would say so. I shared this with you in the articles about my pump. I have had to learn how to take care of both me and the pump, and I can not imagine even an adult doing well with a pump who minds taking frequent blood glucose levels or who minds being connected to a pump that must be reset every 2 or 3 days. As I've said before, with all that said, just try and take my pump away. Please read our articles on the pump if you are considering one for yourself or loved one.
Our second report from the ADA conference is about heart disease in type 1 diabetes and when it begins. Dr. Jody S. Krantz, from the University of Southern California and Children's Hospital in LA, studied 57 children with diabetes, ages 12 to 21, and a group of adolescents without diabetes. Type 1 diabetes was associated with substantial plaque buildup inside the arteries regardless of body weight, family history, smoking and length of time with diabetes. According to the author, the results underscore the need to evaluate lipid levels in young type 1 diabetics. "The increased lipid levels in adolescents and young adults, and the possible association with atherosclerosis suggests abnormal lipid levels may warrant intervention." concluded Dr. Krantz.
Our third study is about sildenafil citrate, which was found to increase the percentage of successful attempts at intercourse in men with type 1 diabetes. We have reported several studies done with type 2 diabetic men and this medication, but this is our first report on type 1 men. Dr. Liam Murphy from the University of Manitoba in Winnipeg, Canada, and colleagues randomized 188 men with erectile dysfunction and concomitant diabetes to 12 weeks treatment with either sildenafil, 25 to 100 mg, or placebo. Efficacy of the treatment was assessed using questions from the International Index of Erectile Function (IIEF), which asks patients about their ability to achieve and maintain erections. After 12 weeks the responses to the questions used from the IIEF were significantly higher in the group given sildenafil. There were nearly twice as many successful intercourse attempts in patients taking sildenafil compared to those taking the placebo. Most adverse events associated with taking sildenafil use were transient and mild to moderate in severity. Headache, flushing and dyspepsia were reported most often. Want to read more? Just look for the minutes of the 61st meeting of the ADA or ask your physician for reports from this meeting.
Now on to other information. Diabetes Care 24:1217-1220.2001 looks at Use of an automated device for alternative site blood glucose monitoring by S. Edwin Fineberg, M.D. et al. The group evaluated the accuracy, comfort, and ease of use of a new automated device for blood glucose monitoring using the arm as an alternative sampling site. The studies used an automated hand-held device that applies a small vacuum, lances the skin, transfers blood onto an electrochemical test strip, and measures glucose. Patients with type 1 and type 2 diabetes who had no previous training using this device were recruited form 5 clinics in Indiana, Minnesota, New Mexico, Massachusetts and Texas. Testing was performed by the patients using the device and by trained healthcare professionals. Blood glucose was measured by 354 patients: from the arm using the device, from the finger using a laboratory reference instrument, and from the finger using a device via the secondary test port. Each patient completed a questionnaire rating the level of pain and ease of use of the device. Results indicated that blood glucose levels in samples obtained from the arm with the automated device agreed well with finger-stick plasma glucose results using a reference instrument. In the survey, 60% of the patients stated that it was "painless"; another 31% of the patients stated that it was "much less painful" and 6% considered using the device "less painful" than finger-stick testing. In a survey containing 15 questions for rating the ease of use with a scale of 1 to 6, the overall mean rating was 5.5. The authors concluded that the automated device is easy to use and provides accurate glucose results; 97% of the participants found it less painful than finger-stick testing.
The Archives of Internal Medicine. 2001;161:1295-1300 has an article titled Comorbidity and glycemic control in patients with type 2 diabetes by Imad M. El-Kebbi, MD et al, in which, knowing that good glycemic control is difficult to achieve in persons with type 2 diabetes, the impact of comorbidity on glycemic control was studied at presentation and subsequent follow-up visits in patients with type 2 diabetes. They studied 654 consecutive patients who presented to a diabetes clinic in 1997. Comorbidity was rated using the Chronic Disease Score (CDS) index, which is a validated, weighted score that takes into account the patient's age, sex, and classes of medications. Univariate and mulivariate linear regressions were used to determine the contribution of age, body mass index, diabetes duration, type of therapy, and CDS to initial hemoglobin A1c level. A similar analysis was performed for the 169 patients with a follow-up HbA1c level 6 months after presentation. The patients were 90% African American, and 66% female, with average age of 53 years. Average diabetes duration was 5 years, body mass index was 33, HbA1c level was 8.8 %, and CDS was 1121 (range 232-7953). At presentation, patients with higher CDSs tended to be older and to have a lower HbA1c level, but multivariate linear regression showed that receiving pharmacological therapy, younger age, and having a lower C-peptide level were the only significant contributors to HbA1c level. In the 169 follow-up patients, presenting characteristics were not significantly different from those of the full cohort: average initial HbA1c level was 8.8%: CDS was 2073. Their HbA1c level at 6 months averaged 7.5% and the CDS had no significant impact on their follow-up HbA1c level. The authors concluded that comorbidity does not appear to limit achievement of good glycemic control in patients with type 2 diabetes. No excuses, you readers out there: You can do it. The study says so.
BSP
