We begin, as usual with some headlines that will whet your appetite for more reading and research. The Net has many medical web sites. You can select your favorite Medical facility and most likely you will be able to find articles on it. You can also go to the JDF or ADA and read the latest news. By the way, did you know that you can join advocacy groups on the Net for those of us with diabetes? Go to the ADA and you will see what bills are about to pass and what losses those of us with diabetes will suffer. Then you can e-mail your senator or representative very easily with a prewritten message. You'll note that this month we have more headlines than usual. Some months we find many articles to share with you. So please read on.
Here come those headlines. Diabetes Care 2003;26:1869-1873 has an article about serum testosterone being associated with atherosclerosis among men with type 2 diabetes. The research was done in Japan by Dr. Michiaki Fukui et al. They found that serum testosterone correlated with the severity of atherosclerosis regardless of whether the patients had overt cardiovascular disease or not. Future large prospective trials to assess the possible benefits of testosterone replacement may be next.
An experimental vaccine may be able to stop the progression of type 1 diabetes according to mid-stage clinical trial results at UCLA. Dr. Daniel Kauffman presented the encouraging data at ADA meetings this month. The study showed that it is possible to inhibit the autoimmune attack on cells that make insulin. Further studies are planned. You can bet that we will keep you up to date on this one.
JAMA 2003;290:81-85 has an article of interest for all of us with diabetes. Put this information away if you or someone you know uses these medications. Dr. Harlan M. Krumholz et al from Yale found that despite warnings on package inserts, metformin and thiazolidinediones are often given to people with diabetes hospitalized with heart failure. Worse, the findings indicate that inappropriate use of these drugs is increasing. The authors concluded that "Future guidelines should provide more explicit guidance in defining the safe treatment" of these patients.
Here's another headline to take to your physician. Bristol-Myers Squibb Company announced recently that the FDA has approved their marketing their statin (Pravachol) in combination with low-dose aspirin under the brand name Pravigard PAC. It was approved for the prevention of various cardiovascular events, including heart attacks, in at-risk patients, as long as the drug maker markets several separate doses.
Here's a headline that caught our eye because of the magnitude of the people it affects. It also pinpoints the need to continue to educate ourselves about our medical care. This article was published in the New England Journal of Medicine 2003;348(26):2635-2645 and was written by RAND Health Associate Director Elizabeth McGlynn. The bottom line is that despite a growing body of evidence in support of clinically recommended treatment approaches, adult Americans receive them in only half of their medical encounters. In the random sample of adults living in 12 metropolitan areas, only 54.9% received recommended standard care such as routine mammography or screening for flu shots for people over 65 years of age. People with chronic diseases did not fare much better. Only 56.1% received the recommended medication for uncontrolled mild hypertension or diet and exercise counseling to control diabetes.
There are 200,000 people who use an insulin pump in the US. Those of us who want to use a pump or replace our current pump will soon be able to purchase a new pump made by MiniMed, which promises to calculate how much insulin is needed after a meal and then pump that insulin. Users will still have to prick fingers to know blood glucose levels, and program in how many carbohydrates they plan to eat, but this pump will then calculate the proper dose of insulin and deliver it. The new system is called Paradigm and is slightly more expensive than their other pumps. It will be shipped as of July 21.
In past months we have shared the importance of dental care for people with diabetes. The ADA: 2003-07-07. Dr. William C. Knowler's article concludes "diabetic people with periodontal disease had increased death rates due to cardiovascular disease and renal failure which are two major complications of type 2 diabetes". After adjusting for factors such as age, sex, duration of diabetes, obesity and cholesterol levels, the researchers found that diabetics with severe gum disease were twice as likely as those without it to die of these two complications.
Finally, we received notice of research on a new medication, which is in phase 3 clinical trials for type 2 diabetes from Eli Lilly and Amylin Pharmaceuticals. Exenatide is a first-in-class compound being investigated for its potential to address the unmet medical needs of people with type 2 diabetes. We will continue to follow the trials and let you know when it is to go before the FDA.
At the ADA 63rd scientific meetings, Elizabeth Boland from Yale Pediatrics Diabetes Team presented the group's finding titled Insulin Pump Therapy Lowers HbA1c More Than Insulin Glargine in Diabetic Children. In an ongoing randomized, prospective study, they are comparing the use of pump therapy with insulin aspart versus multiple injections (4 per day) consisting of insulin glargine (once-daily) and insulin aspart taken at meal times and snacks in 30 patients with type 1 diabetes ages 8 to 19 years of age. Preliminary findings showed that pump therapy was more effective in controlling blood sugar as measured by HbA1c than the multiple injection regime. At 4 months, pump users significantly lowered their HbA1c to 7.2% from 8.1% at baseline. There was no significant drop in the MDI group. Pump users as compared to glargine users significantly lowered their total daily dose of insulin. There were no cases of diabetic ketoacidosis and 4 episodes of severe hypoglycemia in the MDI group and 2 in the pump group. After 4 months, all 12 children on the pump group chose to continue with that therapy, and 12 of the 14 children in the MDI group opted to switch to the pump. The researchers suggest that young children be offered pump therapy to help them achieve better metabolic control.
The Archives of Internal Medicine 2003;163:1397-1398,1440-1447 had an article titled Walking increases longevity in diabetes, even when comorbidities are present, Dr Edward W. Gregg et al from the Centers for Disease Control and Prevention. This is an article that proves what we have been trying to share with you since we started this site and that is that exercise is just plain important to your health. This is an important study because it does not just look at younger people with diabetes as earlier studies did. It examined data from 2896 people all of whom were interviewed in 1990 and 1991. Mortality was assessed during the next 8 years. People considered disabled were not included in the analysis. Ages ranged from 18 to 95 years with an average time since diagnosis of 11.0 years. Nearly one-third reported a history of heart disease, and almost half had limitation in daily function. Compared with the subjects who reported no walking, those who walked at least 2 hours per week had a 39% lower all-cause mortality rate and a 34% reduced cardiovascular disease mortality risk after controlling for age, gender, ethnicity, body mass index, smoking and comorbid conditions. "Thus among diabetic adults, one death per year may be preventable for every 61 people who could be persuaded to walk at least 2 hours/week". Risk reduction was greatest among those who reported moderate increases in heart rate or breathing while walking.
The Journal Of Diabetes Complications 2003;17:141-144 has an article titles Erythromycin improves esophageal and gastric motility in diabetes by Dr. Chia-Hung Koa et al of China Medical College Hospital in Taiwan. The researchers examined the effects of a 2-week course of oral erythromycin on esophageal transit and gastric emptying in 45 patients with type 2 diabetes. They also assessed the effect of corrected blood sugar control in these patients. All patients enrolled in the study were taking hypoglycemic agents to control blood sugar. The radio nuclide esophageal transit test and gastric emptying study were performed to evaluate esophageal and gastric mobility at baseline and after 2 weeks of treatment with 250 mg erythromycin given 3 times a day, 30 minutes before meals. Fasting blood sugar was also monitored. Mean transit time shortened from 9.32 to 6.28 s after the 2-week treatment with erythromycin. The half time of gastric emptying shortened from 210.2 to 128.3 min after the 2-week treatment with erythromycin. After the 2-week treatment period, a significant decrease in fasting blood sugar (198.2 mg/dl to 121.5 mg/dl) was observed. No adverse events or changes in laboratory results were reported.
The New England Journal of Medicine, 2003;348:2599-2608, has an article by Dr. Dimitrios Trichopoulos et al from the University of Athens titled More evidence Mediterranean diet cuts death. A "Mediterranean" type diet, rich in vegetables, legumes, fruits and olive oil, indeed appears to lower risk of death according to this article. The researchers followed more than 22,000 adults in Greece for almost 4 years. Previous reports have shown that people living in Mediterranean regions tend to live longer than North Americans and people from Northern Europe and this latest research adds further evidence that dietary factors are responsible for survival differences. The researchers surveyed the population about their eating habits, noting how closely each person followed the traditional Mediterranean diet. The researchers then followed the participants for 44 months, noting who died and of what causes. During the study period, the researchers recorded 275 deaths. They noted that the more closely a person followed the Mediterranean diet at the outset of the study, the less likely he was to die of any cause. In addition, people who followed the Mediterranean diet more closely than others were also 33% less likely to die from cardiovascular disease and 24% less likely to die from cancer. Interestingly, after breaking down the individual components of the Mediterranean diet, the authors discovered that no single component appeared to reduce the risk of death.
BSP
