December has arrived and we are all busy making plans for holidays, guests, and the decoration of our homes. Do we have time to read research at this time of the year? The answer has to be a resounding "yes," because holidays do not give us a reprieve from controlling and understanding our diabetes and how it affects us. We get many questions about alcohol and diabetes and this month we have two articles to share with you about this important subject. We then look at hypoglycemia and type 1 diabetes and the incidence of celiac disease in US children with diabetes. We also found an article on estrogen and stroke prevention, or nonprevention as you'll find out, and finally, because we think exercise is very important, we look at an article on the effects of exercise on blood glucose levels and BMI in type 2 diabetes.
First let's look at those headlines we start with each month. The November issue of Diabetes Care shares that the number of Americans diagnosed with diabetes is projected to increase 165% over the next 50 years. Once again, the authors suggest that people can slow this trend by changing their diet and exercise regimes. Adults over 75 years of age, who are a growing segment of the population, will make up the greatest number of these patients. What's worse is that researchers note that the report may underestimate future rates of diabetes because many cases go undiagnosed. Next we report that the ADA has joined the US Dept. of Health and Human Services (HHS) as well as the NIDDK and the National Diabetes Education Program to treat diabetes comprehensively. They recommend A1c less than 7% to be checked twice a year, blood pressure, below 130/80 to be checked during medical exams, and cholesterol (LDL) below 100 to be checked once a year. Finally, of note is the announcement that Japan's first use of human embryonic stem cells in research was cleared Nov.4 by Kyoto University's ethics committee in a move to advance research in regenerative medicine. Stay tuned. We'll continue to monitor where, when and how from around the world.
Now on to our journal abstracts. We start with those two articles on alcohol consumption and diabetes. The American Journal of Epidemiology 2001;154:748-757 has an article by Dr. Frederick L. Brancati from Johns Hopkins titled Heavy drinking increases diabetes risk in men. The researchers looked at 12,261 middle-aged men and women enrolled in the Atherosclerosis Risk in Communities (ARIC) study. What they found was that men who consumed a substantial amount of alcohol (more than 21 drinks a week) were 50% more likely to develop type 2 diabetes as compared to counterparts who drank "one or fewer" drinks per week. In contrast, even high levels of alcohol consumption in women has no effect on diabetes risk. Dr. Brancati concluded that "Our results, along with those of previous studies, suggest that strategies for the prevention of type 2 diabetes [in women] need not target moderate alcohol consumption. In contrast, men who drink more than 14 drinks of spirits per week should be advised of the increased risk of diabetes associated with heavy alcohol consumption".
Our second article is from Diabetes Care 24:1888-1893,2001 titled The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes by Benjamin C. Turner, MRCP et al. The researchers knew that alcohol is associated with acute hypoglycemia in people with type 1 diabetes and that delayed hypoglycemia after drinking at night has also been described, however its cause is unknown. The researchers performed a controlled study to investigate this phenomenon. The research was based on six men with type 1 diabetes who were hospitalized from before dinner one day to noon the next. They continued to take insulin injections and a basal insulin infusion. They drank either white wine or mineral water. Blood glucose, alcohol, insulin, cortisol, growth hormone, and glucagon levels were measured. What the researchers found was that in the morning, fasting and postprandial blood glucose levels were significantly lower after the consumption of wine, and from 10:00 A.M., five subjects required treatment for hypoglycemia. None of the subjects had hypoglycemia after drinking water. The researchers found that after consuming wine, growth hormone secretion was significantly reduced between midnight and 4:00 A.M. There were no differences in insulin or other hormone levels. The researchers conclude that the risk of hypoglycemia and appropriate intervention should be explained to type 1 persons with diabetes who plan to drink moderately in the evening.
Here's another article about hypoglycemia. This one from Diabetes Care 24:1878-1881,2001 written by Catherine Allen, Ph.D. et al is titled Risk factors for frequent and severe hypoglycemia in type 1 diabetes. The researchers wanted to determine the risk of hypoglycemia and the associated demographic and clinical risk factors. They measured demographic and diabetes self-management factors in 415 subjects for 4-6.5 years in a population-based incident cohort. Blood samples were collected up to three times yearly to test glycosylated hemoglobin levels. Reports of frequent (2-4 times/week) and severe (lost consciousness) hypoglycemia as well as diabetes self-management data were collected by questionnaires. The results indicate that frequent hypoglycemia was common (33 or 35% of participants reported this on the 4 and 6.5 year questionnaires, respectively), whereas severe hypoglycemia occurred much less often. Better glycemic control and more frequent self-monitoring of blood glucose levels were independently related to frequent hypoglycemia. The association of frequent hypoglycemia with intensive insulin therapy increased with age. Better glycemic control and older age were related to severe hypoglycemic reactions. No sociodemographic factors other than age increased the risk of hypoglycemia. The researchers concluded that frequent hypoglycemia was common in a population representing the full range of glycemic control. Intensive insulin management and blood glucose monitoring independently predicted frequent but not severe hypoglycemia. This information should be useful for updating patients so that minor changes in diabetes management might decrease the daily burden of having diabetes while maintaining intensive insulin therapy.
Our next journal article comes from the October issue of the Journal of Pediatric Gastroenterology and Nutrition written by Dr.Steven L.Werlin et al from the Medical College of Wisconsin. Nearly 5% of children with type 1 diabetes living in the US have celiac disease according to this research. The team tested for the IgA endomysial antibody in 218 patients with type 1 diabetes and in 117 matched control subjects. Patients with positive results were offered a small bowel biopsy. Symptom status was assessed through parent questionnaire. Seventeen diabetics tested positive for the IgA endomysial antibody, while no positive results were found among the control subjects. More than half of the patients with biopsy-proven celiac disease were asymptomatic. "There is a known association between asymptomatic celiac disease and juvenile diabetes" said Dr. Werlin. "Findings from European studies have indicated that management of diabetes is easier if the celiac disease is also treated. Treatment during the asymptomatic stage prevents many of the complications associated with celiac disease." Dr. Werlin suggests that children with type 1 diabetes be tested for the antibody so that children can be treated for celiac disease if it is present.
Finally we share one more article about estrogen replacement. This one comes from The New England Journal of Medicine 2001;345:1243-1249. This study by Catherine M. Viscoli, M.D. and Walter N. Kernan, M.D. at Yale University School of Medicine looks at the association of estrogen replacement therapy and the prevention of recurrent stroke. Despite some past evidence that hormone replacement might lower stroke risk in older women, this research shows that it will not protect women form recurrent strokes and may instead carry some risks. In a study of 664 postmenopausal women who had recently suffered strokes, researchers found that estrogen replacement therapy (ERT) did not reduce their rate of further strokes. What's more, when they did suffer strokes, women on ERT were slightly more likely than non-users to die or have neurological damage. The women in this study had all had strokes within the past 3 months. The authors suggest that women with "remote strokes' who are already on hormones might do well to discuss their alternatives with their physician. Currently, the only well-established benefits of hormone replacement are in reducing menopause symptoms such as hot flashes, and in preserving bone mass. In this current study, Viscoli and her team followed women who had either an ischemic stroke or a "mini-stroke" known as transient ischemic attack. Some of the women took daily ERT, while the rest took an inactive placebo. After an average of nearly three years, the researchers found no difference in the risk of nonfatal stroke between the two groups. Only a small number of women suffered fatal strokes, but there were 12 deaths in the ERT group, compared with 4 in the placebo group. Women on ERT were also slightly more likely to show neurological impairment after suffering a stroke. The researchers conclude that the results "add to the evolving body of evidence from clinical trials that do not show a benefit of estrogen for women with established vascular disease.
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