As always we will start this month with headline news and then go on to our abstracts. This month they cover reduced screening mammography among women with diabetes, and the incidence of End-stage renal disease in patients with type 1 diabetes.
Circulation, 10/4/2005 has an article with information you may want to put away for reference someday. Dr. Manel Sabate from San Carlos University in Madrid, examined the differences between sirolimus-coated or standard stents in patients with diabetes. His group found that for people with diabetes undergoing angioplasty to clear clogged heart arteries, stents that release sirolimus to prevent re-clogging are better than bare-metal stents. At the 9 month follow-up point the sirolimus stent patients had a much reduced narrowing of the affected artery and the rate of major cardiac adverse events was also significantly lower. Just a fact to put aside.
The Journal of Gerontology, Sept. 2005 has another headline making article. In a study of 139 nursing home residents, researchers from Columbia University in New York found that men and women with diabetes were four times more likely than those without the disease to suffer a fall–a major cause of disability and death among the elderly. Dr. Mathew S. Maurer, the lead researcher was not surprised by the results of the study. That is because the number of diabetes-related complications would be expected to contribute to falls. For example, they postulated that diabetic retinopathy can impair vision and cause nerve damage that causes sudden blood pressure drops upon standing can trigger dizziness and falls. But, this was not found to be a cause of falls. What they considered next was diabetic neuropathy which affects sensation in the feet and may throw someone off balance, but for now they concluded that diabetes should be considered a major risk factor for falls among the elderly, but not just because of neuropathy. Knowing this it was hoped that staff in nursing homes would identify those at risk and provide special care to reduce the odds of suffering a fall.
The Oct, 2005 journal, Diabetes Care has an article connecting infection with the hepatitis C virus and the risk of developing type 2 diabetes. The article written by Dr. Alessandro Antonelli et all from the University of Pisa noted that at least one large study had cast doubt on this theory. They studied 564 patients with hepatitis C, 82 with hepatitis B and a comparison group of 302 who were uninfected. The tam found that 12.6% of the hepatitis C infected patients had diabetes which was significantly higher than the 4.9% of hepatitis B patients or the 7% of the controls. They suggest that hepatitis C-related liver disease is associated with diabetes at a stage when liver function is still largely preserved. They also noted that the hepatitis C patients with diabetes were significantly leaner and their LDL cholesterol concentration was lower. The team called for a study to test whether antiviral therapy for hepatitis C may prevent the appearance of type 2 diabetes.
On Oct. 28, 2005 the Food and Drug Administration delayed the final decisions on the first inhalable insulin for three months while it reviews chemistry data. The agency’s decision on whether the drug could be marketed to the public had been expected this last week of October. The previous month the FDA advisory committee twice voted 70-2 to recommend that the agency approve the drug and inhaler device for sale in the US. Advisers who voted to recommend inhaled insulin said its potential benefits outweighed certain problems, most notably whether the effects of the drug on people with lung disorders had been fully studied. Other advisors worried that doctors and patients with diabetes may not be properly trained in the use and maintenance of the inhaler device. Drug company representatives suggested that the inhaler was not any more complicated than syringes that diabetics now use. Also this week, developers of another drug to help diabetics control blood sugar as well as cholesterol said they were unsure whether they will continue to pursue the trials as the FDA sought additional safety data about it.
Abbott Diabetes Care has warned users of its meters that they can unintentionally be switched from one unit of measurement to another resulting in an inaccurate blood glucose interpretation by the user. The affected glucose meters made by Abbott sold in the US are : FreeStyle, FreeStyle Tracker, Precision Ztra, MediSense, Sor-Tract, Precision Sof-Tract, MediSense, Optium, and private label brands PeliOn Ultima, RiteAid, and Kroger blood glucose meters. Precision Sof-Tact meters, which were inadvertently omitted from Abbott’s press release, also are subject to this action. You can contact Abbott Diabetes Care at 1-800-553-4105 open 24 hours a day or www.AbbottDiabetesCare.com
The December journal Diabetes Care has an interesting article about a three year study which found that type 2 diabetes and depression can be a fatal mix. The researchers at the University of Washington found that depression is common in people with type 2 diabetes and is strongly linked to mortality. However, they concluded that more work is necessary to untangle the cause-and-effect relationships among depression, diabetes complications, and mortality.
Finally research presented in October at an obesity conference in Vancouver suggests that the simple act of regularly weighing in helps people from regaining lost pounds. “That’s the biggest problem we have. We have lots of ways to help people lose weight. What’s the real challenge is getting people to keep their lost weight off over the long term," said Susan Yanovski, director of the obesity and eating disorders program at the National Institute of Diabetes and Digestive and Kidney Diseases. She was not a part in this study, This study was led by Rena Wing, a psychologist and director of the weight control center at Brown University Medical School. It involved 291 people, mostly women, who in the previous two years had lost 10 percent of their body weight, an average of 44 pounds. They weighted 171 on average when the weight maintenance study began." You’re more likely to catch small changes in body weight “if checking weight daily, Wing said. “It’s much easier to get back on track if you’ve gained a pound or two."
The Archives of Internal Medicine, 2005;165:2090-2095 had an article titled Reduced Screening Mammography among Women with Diabetes by Lorraine L. Lipscombe, MD et al. Despite regular health care, preventive health issues may be neglected in patients with chronic disease like diabetes. Case-control studies in the United States have shown lower mammography rate in women with diabetes; however, it is not known whether the presence of diabetes mellitus affects mammography use in a Canadian setting, where there is universal access to health care. Using health data bases in Ontario from April 1, 1999 to March 31, 2002, the retrospective cohort study observed women aged 50 to 67 years, who were free of breast cancer, until their first mammogram in a 2-year period. Mammogram rates were compared were compared between women who had diabetes for a minimum of 2 years and women without diabetes. The results indicated that compared with women without diabetes, diabetic patients were older, had more physician visits, were more often from a lower-income neighborhood, and in those 65 years or older, were less likely to be taking estrogen. The odds ratio of having a mammogram during the 2-year period was 0.68 for women with diabetes and adjustment for age and other covariates did not modify this effect. The researchers concluded that women with diabetes were significantly less likely to have a mammogram during a 2-year period than were women without diabetes, despite more health care visits. These results suggest that, because of the complexity involved in diabetes care, routine preventive care such as such as cancer screening is often neglected. These findings highlight the need for better organization of primary care for patients with chronic diseases.
Incidence of End-stage Renal Disease in Patients with Type 1 Diabetes by Patrik Finne, MD, PHD et al in JAMA, 2005;294:1782-1787 may be another journal article of interest. End-stage renal disease (ESRD) is one of the most severe complications of type 1 diabetes. Yet, data on patients’ risk of developing ESRD are sparse. The study was done to estimate the long-term risk of developing ESRD and to assess how age at diagnosis of diabetes, time period of diagnosis, and sex affect the risk. A cohort of all patients younger than 30 years diagnosed as having type 1 diabetes in Finland in 1965-1999 (n= 20,005) was identified from the Finnish Diabetes Register. The cohort was followed up from diagnosis of diabetes until development of ESRD (dialysis or kidney transplantation as identified from the Finnish Registry for Kidney Diseases), death, or end of follow-up on December 31, 2001. The main outcome measure was cumulative incidence of ESRD, accounting for death as a competing risk. The results found the cohort was followed up for maximally 37 years, with a median of 16.7 years. During 346, 851 person-years, 632 patients developed ESRD. The cumulative incidence of ESRD was 2.2% at 20 years and 7.8% at 30 years after diagnosis. The risk of developing ESRD was lowest in patients whose diagnosis occurred at younger than 5 years. The risk of ESRD was lower for patients diagnosed as having type 1 diabetes in later years. The risk did not differ significantly between sexes. They concluded that with respect to ESRD, the prognosis of type 1 diabetes has improved during the past 4 decades. Children diagnosed as having diabetes before age 5 have the most favorable prognosis. Overall, incidence of ESRD appears to be lower than previously estimated.
BSP
