This month our abstracts will deal with celiac disease and type 1 diabetes in children, correctible visual impairment among people with diabetes in the U.S., and finally periodontal disease and diabetes. Let’s get going with some hopeful headlines for those of us with diabetes and some cautionary thoughts. We have being talking for some time about the genetic loads for developing type 2 diabetes. A UK teams found that people with two copies of the mutant TCF7L2 gene were twice as likely to develop type 2 diabetes compared with those with no copies. The researchers said that their research suggests a particular genetic make-up can put people as much at risk of the disease as being clinically obese. The research was published in the journal of Molecular Medicine by Professor Steve Humphries from the University College London Center for Cardiovascular Genetics. The researchers discovered those carrying one copy of a variant of the gene were 50% more likely to develop type 2 diabetes, while those men who carried two copies of the variant were 100% more likely to get the disease compared with those who had no copies.
We share many articles about cardiovascular disease and diabetes because of the increased risk factor for this disease when we develop diabetes. The American Heart Association journal Circulation posted an article about heart transplant and diabetes. The researchers’ found that diabetics who don’t have other health problems survive heart transplantation as well as nondiabetics which suggests diabetes should not keep patients from a transplant waiting list. Currently there are no national rules that prevent diabetics from getting heart transplants. This is controlled by the individual transplant centers. One word of reality here— the study found that with complicating conditions the survival rate fell significantly.
The Journal of Urology 2006; 176:1081-1085 has an article about erectile dysfunction being a marker for both young and older men for diabetes. We know that ED exists with diabetes but this research looked at whether men with ED were any more likely to have diabetes. The research was done Dr. Peter Sun et al from Lilly Research Laboratories. The investigators compared the rates of diabetes in 285,436 ED patients and in 1,584,230 men without ED who were identified in a managed care claims database. Diabetes was seen in 20.0% of men with ED compared with 7.5% of men without ED. On multivariate analysis, the presence of ED raised the risk of diabetes by 60%. In further analysis it was shown that this association was largely driven by findings in younger men, in particular those 26-35 years of age. ED nearly tripled the odds of having diabetes. The strength of the association waned with age so that by the time a man passed 66 years of age, the predictive value of ED for diabetes was gone. Based on these findings, the investigators concluded, “We support the use of ED as an observable early marker of diabetes mellitus strongly for men 45 years old or younger, as a likely marker for men 46-65 years old, but not for men 66 years old or older."
Good news spreads quickly. Read this and you’ll not mind that special diet, medication, and/or injections for a while knowing that researchers are really working on a cure! This one made my pump sigh with relief that maybe one day it can retire, but then this is just preliminary so keep up all of that good work keeping your self healthy. U.S. scientists say human embryonic stem cells can be converted into cells that produce all five hormones made by the pancreas, including insulin. Research conducted by Edward Baetge and colleagues at Novocell Inc. in San Diego suggests the possibility of turning human embryonic stem cells into pancreatic cells that can be used for diabetes therapy. Beatge and colleagues show the efficient generation of insulin-producing cells from human embryonic stem cells from human embryonic stem cells depends on guiding the cells through stages similar to those in pancreatic development. The researchers said the cells they created contained high levels of insulin and were also capable of secreting insulin—but only minimally in response to sugar, which is a crucial function of adult beta cells. The scientists speculate that with additional research the cells have the potential to be matures into insulin-producing cells that could be suitable for transplantation into patients.
The American Heart Journal, Sept. 2006 has an article that is of specific interest to those with type 2 diabetes. Individuals with type 2 diabetes who require insulin or oral anti-diabetic drugs have an increased early and long-term risk of dying or having a heart attack after bypass surgery, Swedish researchers reported. Dr. Torbjorn Ivert of Karolinska University Hospital in Stockholm and colleagues determined the risk death or heart attack 10 years after bypass surgery in 6,727 patients who had the operation between 1980 and1995. Compared to nondiabetic patients, insulin-treated type 2 diabetics had a fourfold increased risk of dying early while those treated with oral anti-diabetic medication had a twofold increased risk of early death. The risk in diet-treated diabetic patients did not differ significantly from non-diabetics. Moreover, survival at 10 years free of heart attack was 40% for patients with insulin-treated type 2 diabetes and 48% for those on oral medications, compared with 59% for diabetic patients managed with diet restriction only and 66% in patients without diabetes. Compared to patients without diabetes, the relative risk of death or having a heart attack at 10 years was 80 percent higher in type 2 diabetic patients treated with insulin and 40% higher in type 2 diabetics treated with oral medication. “Our findings," the team concluded, “support intense metabolic monitoring and attempt to reduce cardiovascular risk factors" in patients with diabetes, particularly those requiring insulin after coronary bypass surgery.
Next, we reiterate once again the importance of exercise in treating diabetes. The November Diabetes Care journal shared research by Drs. Neil J. Snowing and Will G. Hopkins of New Zealand which concluded that combining resistance training such as weight lifting with aerobic workouts appears to be the most beneficial for long term control of blood glucose levels than either form of exercise alone. Of note is the fact that the researchers found that exercise had a stronger effect on people with more severe disease which they call a reassuring finding for those prescribing exercise to patients. The actual cardiovascular risk reduction with exercise for diabetic patients is small, they note, but added to diet and medication combined can produce an even larger “risk reduction".
Our final headline has to do with the FDA approval of a new medication. This is a new class of medication known as DPP-4 inhibitors that enhances the body’s own ability to lower blood sugar. The FDA approved Januvia for use in addition to diet and exercise to improve blood sugar levels in patients with type 2 diabetes alone or in combination with two other commonly prescribed oral agents, metformin or a PPAR agonist, when either of these two medications alone doesn’t provide adequate blood glucose control. Januvia prolongs the activity of proteins that increase the release of insulin after blood sugar rises, for example, after a meal. Januvia does this blocking an enzyme (DPP-IV) which breaks down these proteins, leading to better blood sugar control.
Let’s get right into the abstracts for this month. Our first abstract has to do with Celiac disease and type 2 diabetes titled Celiac Disease and the Risk of Subsequent Type 1 diabetes by Jonas Ludvigsson, MD, PHD et al from Sweden as read in Diabetes Care 29:2483-2488, 2006. Earlier studies have suggested that children with type 1 diabetes are more likely to have a subsequent diagnosis of celiac disease. However, research has not yet made this connection. The researchers identified 9,243 children with a diagnosis of celiac disease in the Swedish national inpatient register between 1964 and 1004. They then identified five reference individuals matched at time of diagnosis for age, calendar year, sex, and country (n=45,680). Only individuals with >1 year follow-up after study entry (diagnosis of celiac disease) were included. The researchers found that celiac disease was associated with a statistically increased risk of subsequent type 1 diabetes before age 20 years. This risk increase was seen regardless of whether celiac disease was first diagnosed between 0 and 2, or 3 and 20 years of age. Individuals with prior celiac disease were also at increased risk of ketoacidosis or diabetic coma before the age of 20 years. The researchers concluded that children with celiac disease are at increased risk of subsequent type 1 diabetes. This risk increase is low considering that 95% of individuals with celiac disease are HLA-DQ2 positive.
The CDC has issued a paper titled Correctable Visual Impairment Among Persons with Diabetes—United States, 1999-2004, (MMWR Nov.3, 2006/55(43); 1169-1172). People with diabetes are more likely to be visually impaired than people with the disease. This study looks at the proportion of diabetics whose vision could be corrected with accurately prescribed glasses or contact lenses. To estimate that proportion, CDC analyzed 1999-2004 data from the National Health and Nutrition Examination Survey (NHANES). For the 1999-2000, 2001-2002, and 2003-2004 surveys, participants also were asked questions regarding vision function, and the physical examination included a vision examination in which visual acuity was measured before and after an objective autorefraction test (optical correction measured by an autorefractor).IN this study, visual acuity before correction was defined as visual acuity with whatever form of current correction (e.g. glasses or contact lenses) and the participant might have worn at the time of examination. Visual acuity after correction was defined as potential visual acuity as assessed by an objective autorefraction test. Only those participants whose visual acuity before correction was worse then 20/30 were administered the autorefraction test. For analysis, 1.237 adults aged =20 years with self-reported diabetes were divided into three groups according to their visual acuity in the better-seeing (before and after optical correction): 1) normal: visual acuity of 20/40; 2) mild impairment: visual acuity better than 20/200 and worse than 20/40; and 3)severe impairment: visual acuity of 20/200 or worse. The prevalence of CVI (correctable visual impairment), was defined as the proportion of adults with mild or severe impairment before correction who were found to the potential for normal visual acuity after correction. The researchers found that overall; the prevalence of CVI among U.S. citizens =20 years with diabetes was 7.2%, which indicated that the proper prescription for glasses or contact lenses would have restored normal visual acuity to 65.5% of visually impaired adults with diabetes. The results indicated that 9.7% of U.S. adu7lts with diabetes had mild visual impairment, and 1.4% had severe visual impairment before correction; 2.9%% had mild impairment and 1.0% had severe impairment after correction. Thus, optical correction would have restored normal visual acuity to approximately 73.4% of adults with mild impairment and 9.1% of adults with severe impairment. Although the crude prevalence of CVI among adults aged =65 years with diabetes was similar to that among those aged 20-64 years, 89.2% of visual impairment cases among the younger age group were correctable, compared to 46.4% of cases among the older group. The age-adjusted prevalence of CVI was similar among men and women. Although not statistically significant, the age-adjusted prevalence of CVI was higher among non-Hispanic blacks and Mexican Americans than among non-Hispanic whites.
Diabetes Research and Clinical Practice, Vol. 74, Issue 1, 41-47, Oct.,2006 has an article that caught our eye because we knew of the risk for increased periodontal disease in people with diabetes. It is titled Effects of High Glucose on Cellular Activity of Periodontal Ligament Cells in Vitro by Hyun Sook Kim et al. Periodontal ligament cells (PDL) are the most important cells in the healing of wounds and the regeneration of periodontal tissues. The response of PDL cells regarding cellular activity to high glucose concentration levels could be the key in understanding the events associated with the dental care of brittle diabetics. The researchers studied the effect of high glucose concentration levels on cellular activity of PDL cells from five non-diabetic patients in vitro. PDL cells were cultured for 14 days in a normal glucose medium or in a high glucose medium and a 3-2.5-diphenyl tetazolium bromide (MTT) assay for cellular viability was also performed. In order to evaluate the differentiation of PDL cells to osteroblast-like cells, mineralized nodule formation was induced with supplemented media. High glucose significantly inhibited the proliferation of PDL cells and reduced the optic density of the MTT assay. Concerning the mineralized nodule formation, the percentage of the calcified area to the total culture dish of PDL cells in high glucose level was lower than in the normal glucose medium. In conclusion, high glucose inhibits the proliferation and differentiation of PDL cells. The data provide an explanation for the delayed periodontal regeneration and healing in diabetic patients.
BSP
