We are ready to share Headlines and Abstracts about diabetes and amputations, and diabetes, high cholesterol, and hypertension in chronic kidney disease in the US. You’ll note that once again we share information to take to your physician so that you both are up to date with diabetes care. Just when you thought you knew all of the long and short term complications of diabetes here comes another one. A new study published in the June 17th Annals of Internal Medicine which reveals that hearing loss is about two times as common in adults with diabetes compared to those without the disease. The researchers assessed data from hearing tests administered from 1999 to 2004 to participants in the National Health and Nutrition Examination Survey. The researchers found hearing loss across all frequency sounds. The study also found that those with pre-diabetes had a 30 percent higher rate of hearing loss compared to those with normal fasting blood sugar.
For the first time the American Academy of Pediatrics recommends that some children as young as 8 years old be given cholesterol-fighting drugs to ward off future heart disease. The academy also recommends low-fat milk for 1-year-olds and wider cholesterol testing. Drug treatment would be targeted for kids at least 8 years old who have high LDL, the bad cholesterol along with risky conditions including obesity and high blood pressure. It is suggested that cholesterol be tested sometime after age 2 years but no later than 10 years at routine check-ups. By the way, if you have a family history of heart disease, make sure that information is in your child’s medical records, and just in case your pediatrician is as busy as ours was, check to make sure the proper tests are done and that your child spends time in active play each day. Those electronic games are fun, but hop scotch, jump rope, catch, are all fun and cheap to play.
I spend some very rewarding time with people who want to change the way they eat and lose weight. For years I have suggested a food diary for patients who are able to keep one. Dr. Victor J. Stevens from Kaiser Permanente Center for Health Research in Portland, OR has published an article in the August issue of the American Journal of Preventive Medicine based 1,700 men and women who were either overweight or obese. The average weight was 212 pounds. The participants attended 20 weekly group meetings and were encouraged to eat about 500 fewer calories a day, to engage in moderate intensity physical activity 30 minutes or more a day, and to follow the low-fat, low-sodium DASH dietary plan, which emphasizes fruits, vegetables and low-fat foods. Participants were asked to record daily food intake and their exercise minutes. After 20 weeks, the total average weight loss was about 13 pounds. "The more food records they kept, the more they post. Those who kept no food records lost about 9 pounds, and those who kept six or more per week lost about 18 pounds. That’s a whopping difference." Dr. Stevens credits the food diary as a way to be accountable for your own behaviors and a learning tool to see were extra calories came from. The good news is that most participants who used the diary said it got easier to keep over time. We all know that habits are easy; changing behavior is hard, so give it a try. Do this with friends and make sure you weigh in at each meeting so that you all keep honest.
We frequently receive e-mails about diabetes and sexual complications. The European Society of Human Reproduction and Embryology presented 2 reports in July in Barcelona, Spain. While semen samples from diabetics look normal under a microscope, a closer examination revealed DNA damage, Dr. Con Mallidis of Queen’s University in Belfast. "Sperm RNA was significantly altered, and many of the changes they observed are in RNA transcripts involved in DNA damage. Sperm DNA quality is known to be tied to decreased embryo quality, low embryo implantation rates, higher miscarriage rates and some serious childhood diseases, including cancers. The researchers found advanced glycation end products (AGEs) in the male reproductive tract. These accumulate during normal aging and are dependent on lifestyle, diet, smoking, etc. and in many diabetic complications are centrally implicated in DNA damage, The researchers believe that they play a similar role in the male reproductive system.
Obesity, which often plays a factor in diabetes, and being too thin, was also found to cause problems with sperm. In a separate study, scientists found that men with a higher body mass (BMI, a ratio of weight to height) had less seminal fluid and more abnormal semen volume. The researchers did not look at DNA damage in the sperm. "Adopting a health y lifestyle, a balanced diet, and regular exercise will, in the vast majority of cases, lead to normal BMI" said A.Ghiyath Shayeb from the University of Aberdeen, "We are pleased to be able to add improved semen quality to the long list of benefits that we know are the result of an optimal body weight."
Finally Japanese scientists are reporting a discovery that could affect the use of transplants of insulin-making cells for the treatment of diabetes. The researchers note in ACS’ Bioconjugate Chemistry journal. Currently a large number of transplanted islet cells are eliminated by the body in an inflammatory reaction initiated by blood clotting on the cell’s surface. In an effort to counter the issue, the scientists covered islet cells with a special polymer film filled with either heparin or urokinasae. In lab studies, the coatings stopped the clotting long enough to ward off the destruction that usually happen right after transplantation. The coatings did not impact the ability of the cells to manufacture insulin, according to the study.
Our last headline shouts at us that diabetes makes a person about three, that’s 3, times as likely to develop tuberculosis and It may be to blame for more than 10% of TB cases in India and China. If you think this won’t touch us in the US, please know that TB and diabetes rates are very high in Native American populations here. We bring this note to you because many people are cavalier about diabetes thinking that there is medication for the disease so you’ll be fine if you take those pills. As we all know diabetes affects just about every system in our bodies and we are on constant patrol of what is happening to us. We know from our heads to feet, we need to have physicians who are willing to work as a care-giving team for us and we are responsible for knowing and reporting any symptoms of any of these long term complications to our team.
Here come the abstracts. Pull up that second cup of coffee and get ready to learn some more. I found this article published by the BBC news ( 7/7/08) It is a quick rewriting of the abstract. Diabetes UK has reported that about 100 people a week in the UK have a limb amputated as a result of diabetes. (Do the math; there are 2.3 million diabetics in the UK along with another 500,000 with undiagnosed type 2 diabetes) Both the ADA here in the US and Diabetes UK have modified their reporting on diabetes to the press stressing the "life shattering" impact of the illness. The press release states that diabetics are more likely to develop foot problems, including ulcers which can get infected and can even lead to gangrene. More than 1 in 10 foot ulcers results in amputation.
Diabetes Care 10:1337-1342, 2008 has a timely article titled Trends in Diabetes, High Cholesterol, and Hypertension in Chronic Kidney Disease in Chronic Kidney Disease Among U.S. Adults:1988-1994 to 1999-2004 by Caroline S. Fox, MD,MPH and Paul Muntner, PHD. The incidence of chronic kidney disease (CKD) increased in U.S. adults from 1988-1994 to 1999-2004. The researchers explored the trends in risk factors over time. They compared the prevalence ratio of risk factors across survey periods. These risk factors included the prevalence of cigarette smoking, obesity, hypertension, high cholesterol, and diabetes among U.S. adults with stage 3 CKD (estimated glomerular filtration rate <60 ml/min per 1.73m²) and albuminuria (urinary albumin-to-creatinine ratio =30mg/g). They were determined separately for 1988-1994 and 1999-2004 using data from serial National Health and Nutrition Examination Surveys. The prevalence ratios (PRs) for stage 3 CKD and albuminuria by the presence of these risk factors were compared across the survey. The results indicate that PR for CKD declined between 1998-1994 and 1999-2004 for obesity, hypertension, and high cholesterol. However, for diagnosed diabetes, the PR remained unchanged. Similar results were observed for undiagnosed diabetes. The association of cigarette smoking was similar in each time period. Besides obesity, for which the association remained stable over time, similar patterns were observed for the PR of albuminuria. The researchers concluded that in terms of CKD, improvements in hypertension and high cholesterol management have been offset by both diagnosed and undiagnosed diabetes. Further increases in CKD may occur if diabetes continues to increase.
BSP
