The JDRF-funded researchers in Boston have developed a drug therapy that shows promise in blocking rejection of transplanted tissue without undermining the immune system's long-term effectiveness. This system developed at Beth Israel Deaconess Medical Center uses three drugs which hopefully establish transplant tolerance. Find more information on the JDRF web site. Also from the JDRF comes news that a novel way of tracking type 1 diabetes has been developed in mice. It is hoped that this method will help researchers clarify what goes wrong to trigger the disease and allow them to monitor the effectiveness of therapies more closely.
In What's Hot this month we address alcohol and diabetes. The Archives of Internal Medicine 2003;163:1329-1336 has an article titled Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger women, by S.Goya Wannamethee, PhD et al. This is a prospective study of 109,690 women aged 25 to 42 years of age with no history of coronary heart disease, stroke, cancer, or diabetes. They were followed for ten years after an initial questionnaire was answered. There were 935 incident cases of type 2 diabetes noted. The researchers found that light to moderate alcoholic beverage consumption may be associated with a lower incidence of type 2 diabetes in this population. It did not appear to hold for women who were heavy drinkers.
Clinical Psychiatry News 2003: Vol 31.No 10 1-5 has an article that caught our eye about a new theory of insulin resistance. This theory links insulin resistance to depression and the development of Alzheimer's. If it proves reliable, physicians could someday identify patients at risk for dementia and prevent it by treating for insulin dysregulation. This theory was proposed by Dr. Natalie Rasgon at the meeting of the International Psychogeriatric Association in Chicago. She theorizes that persistent, untreated insulin resistance among patients with depression leads to neuro-degeneration-apoptosis, B-amyloid plaques, and neurofibrillary tangles associated with Alzheimer's. "For too long physicians have seen depression only as mental illness. The striking comorbidity of diabetes, among other major somatic illnesses, with depression should be a sharp reminder that untreated physical illness can have significant consequences later on."
JAMA.2003;290:1884-1890 has an article by K.M. Venkat Narayan, M.D. et al which looks as the lifetime risk of diabetes mellitus in the US. The statistics are not good. The researchers estimated the age, sex and race/ethnicity-specific lifetime risk of diabetes in a cohort born in 2000. The estimated risk for males is 32.8% and 38.5% for females. The highest risk is among Hispanics. They estimated that an individual diagnosed at age 40, men will lose 11.6 life-years and 18.6 quality-adjusted years, while women will lose 14.3 life-years and 22.0 quality-adjusted life-years.
We get many questions about Glucosamine-Chondroitin supplementation and its effect on type 2 diabetes. The Archives of Internal Medicine 2003;163:1587-1590 has an article by Daren A. Scroggie, M.D. et al which examined the Hemoglobin A1c before and after a 90 day regime of supplementation therapy. No patients reported any adverse effects from the therapy and no patient had any changes in their diabetes management.
Every month we write an article about the importance of exercise for all of us. This month we announce that Vinnie Santana, a tri-athlete with type 1 diabetes, came in 9th place in the 20-24 age group at the Pan American Triathlon Championships. WE'RE warming up now for a run.
Finally we present some quick headlines to whet your appetite for reading journals and newspapers. The news that diabetics have a harder time quitting smoking than others came out of meetings of the American College of Chest Physicians in Long Island.
A continuous glucagon-like peptide infusion is helpful for diabetics. Is announced in an article appearing in the Oct. issue of Diabetes Care.
Also in Diabetes Care is an article, Revised diabetes guidelines lower threshold for impaired fasting glucose. It has been lowered from 110mg/dL to 100 mg/dL so that the diagnosis of prediabetes will increase by approximately 20%.
Two announcements from Cleveland Clinic about heart health. The first concerns a new blood test of a specific protein to be given in ER's that can predict if a person will have a heart attack. The second is about a new drug that can raise HDL that can roto-rooter arteries. Keep your eye on the paper and read more. To find more information go to the Cleveland Clinic Heart Center web site to read about heart disease and interventions.
The Archives of Internal Medicine 2003;163:2277-2282 has our first article, titled Inhaled insulin provides improved glycemic control in patients with type 2 diabetes mellitus inadequately controlled with oral agents, by Stuart R. Weiss, M.D. et al. The authors knowing the benefits of good glycemic control wanted to determine whether glycemic control can be improved in patients with type 2 diabetes who add preprandial inhaled insulin to their regime. Sixty-eight patients with inadequately controlled type 2 diabetes were randomly divided into two groups; the first added inhaled insulin, 1-mg to 3-mg doses, to the oral agents prescribed, and the second group continued oral medication only, for 12 weeks trial. At week 12, there was a significantly greater reduction in glycosylated hemoglobin for the inhaled insulin plus oral meds group as compared to those who took only oral medications. 34% of those receiving both therapies achieved glycosylated hemoglobin levels less that 7%. Both fasting and postprandial levels were significantly improved. There was one reported case of severe hypoglycemia in the group that took both medications and a greater weight gain. Pulmonary function was unchanged. The researchers concluded that the addition of preprandial inhaled insulin to existing oral agents improves control without a need for injections in patients with type 2 diabetes who have failed to achieve satisfactory control with oral medications alone.
Archives of Internal Medicine 2003;163:93-99 has an article titled C-reactive protein as a predictor for incident diabetes mellitus among middle-aged men, by Barbara Thorand, PhD. et al. Previous studies have suggested that low grade systemic inflammation is involved in the pathogenesis of type 2 diabetes, so this group investigated the association between C-reactive protein (CRP), the classic acute-phase protein, and incident type 2 diabetes among middle aged men. A total of 299,952 initially nondiabetic men aged 45 to 74 who participated, took one of the MONICA Augsburg surveys from 1984 to 1995, and then were followed up on the average of 7.2 years. High-sensitive CRP was measured by assay. A total of 101 cases of incident diabetes occurred during the follow-up period. Men in the highest quartile CRP had a 2.7 times higher risk of developing diabetes than those in the lowest quartile. After further adjustment for body mass index, smoking and systolic blood pressure, the observed association was significantly reduced and became nonsignificant. The researchers concluded that low-grade systemic inflammation is associated with an increased risk of type 2 diabetes in middle-aged men. Inflammation could be one mechanism by which known risk factors for diabetes such as obesity, smoking, and hypertension, promote the development of diabetes.
Diabetes Care 26:2999-3005, 2003 has an article titled Complications in young adults with early-onset type 2 diabetes, by Teresa A Hillier, MD, MS and Kathryn L. Pedula, MS. The researchers examined 7,844 newly diagnosed diabetics adults in a health care maintenance organization from 1996 to 1998 to see if adults diagnosed with type 2 diabetes from age 18 to 44 years develop clinical complications more aggressively after diagnosis that adults diagnosed at 45 years or older. Adults with early-onset type 2 diabetes were 80% more likely to begin insulin therapy than those with usual-onset type 2 diabetes, despite a similar time requiring insulin. Although the combined risk of macrovascular complications did not differ overall, microalbuminuria was more likely in early-onset diabetics than usual-onset type 2 diabetes. The hazard of any macrovascular complication in early-onset type 2 diabetic patients compared with control subjects was twice as high in usual-onset type 2 diabetic patients compared with control subjects. Myocardial infarction (MI) was the most common macrovascular complication, and the hazard of developing an MI in early-onset type 2 diabetic patients was a 14-fold higher than in control subjects. In contrast, adults with usual-onset type 2 diabetes had less than four times the risk of developing an MI compared to control subjects. The researchers concluded that early-onset type 2 diabetes appears to be a more aggressive disease from a cardiovascular standpoint. Although the absolute rate of cardiovascular disease is higher in older adults, young adults with early-onset type 2 diabetes have a much higher risk of cardiovascular disease relative to age-matched control subjects.
Do you have a child with type 1 diabetes and wonder about how they perceive their life? This article will make you smile. General quality of life in youth with type 1 diabetes, by Lori M.B. Life, MD, MPH et al appears in Diabetes Care 26:3067-3073, 2003. The researchers evaluated self-report and parent proxy report of children/teen general quality of life in youth with type 1 diabetes as compared to those of a general pediatric population. It sought to identify relationships between diabetes management, diabetes-related family behavior, and diabetes-specific family conflict, with quality of life in the type 1 diabetes population of youth. The study participants included 100 children, 8-17 years of age with type 1 diabetes for 0.5-6 years. Each child and parent completes the Pediatric Quality of Life Inventory (PedsQL), completed the Diabetes Family Conflict Scale, and provided data on parent involvement in diabetes management. An independent measure of adherence to treatment assessed by the patient's clinician and a measure of glycemic control (HbA1c) were also collected.
PedsQL responses from youth with type 1 diabetes were stable over 1 year and similar to norms from a healthy standardization sample for all three scales of the PedsQL total physical and psychosocial quality of life. After controlling for age, duration of diabetes, sex, HbA1c, and family involvement, child report of diabetes-specific family conflict was the only significant predictor of child report of quality of life. The authors concluded that youth with type 1 diabetes report remarkably similar quality of life to a nondiabetic youth population. Greater endorsement of diabetes-specific family conflict predicted diminished quality of life for a child. As treatment programs focus on intensifying glycemic control in youth with type 1 diabetes, interventions should include efforts to reduce diabetes-specific family conflict in order to preserve the child's overall quality of life.
BSP
