As always, we start out with headlines and then go on to our abstracts. We will bring you information about strategies to identify adults at high risk for type 2 diabetes, periodontal disease and mortality in type 2 diabetes, and aspirin use among adults with diabetes.
Our headlines are interesting this month and start with new rules to regulate vague terms on food labels. The FDA is expected to issue new guidelines about how labels may tout calories, fats, and carbohydrate content of food products clarifying vague terms such as “net carbs". They will create regulatory definitions of the terms low, reduced and free for the use with carbohydrates on packages much as they have done with fats and sugar. One example of a change in process due to this process is the change in “net carbs" which will be removed from Atkins diet products. It will be replaced with “net Atkins count".
Dec.13, 2004 brought news that Duke University Medical Center researchers have found that not just abdominal fat measurements can be used to measure a risk factor for heart disease, but that waist circumference can also be a reliable risk indicator. We have shared how to calculate BMI in the past, but now you can put your calculator away and just use a tape measure. The reason this works, according to Gina Giannetto, MD, is that “…where you store your body fat is actually more important than how much fat you have." “People who carry more weight in their abdomen tend to have higher amounts of visceral fat, or abdominal fat, and that’s a much higher risk for diseases such as heart disease, high cholesterol and diabetes." Your tape measure can tell you if you are at risk for serious health problems. “A waist size in women greater than 35 inches and a waist size in men greater than 40 inches is also a risk factor, because we are concerned where the body fat is and where the weight is. It’s definitely more dangerous to carry extra weight in the middle of your body than in the bottom half." The author says this is a tool and easy to do just as BMI is a tool.
On Nov. 17, 2004 the JDF shared that the results of a poll they sponsored showed that in starp contrast to generally held perceptions, stem cell research is widely supported by those who voted to re-elect the President. In a national survey of 800 self-identified Bush voters conducted Nov. 12-14, 2004, 52% said that they strongly support or somewhat support medical research using stem cells obtained from human embryos that are frozen in fertility clinics five days after the an egg has been fertilized and have been donated by the parents. These would be discarded if they are not donated. By contrast 42% are either strongly opposed or somewhat opposed. Only 2% of voters polled identified embryonic stem cell research as the most important factor in determining their vote.
The American Journal of Obstetrics and Gynecology 2004;190:790-6 has an interesting article about Diet-controlled gestational diabetes mellitus does not influence the success rates fro vaginal birth after cesarean delivery by D. Marchiano et al. We receive man e-mails from those of you with gestational diabetes. Here is good news. The researchers identified 13,079 women who attempted vaginal birth among 25,079 pregnant women with a previous cesarean delivery who were delivered between 1995 to 1999 at 16 community and university hospitals. They found that women with diet-controlled gestational diabetes mellitus who were carrying singleton fetuses who had no more than 1 previous low flap cesarean delivery should be counseled that their disease does not decrease their chances for a successful vaginal birth after cesarean delivery. Among diet-controlled diabetes women, the overall success rate for vaginal birth after cesarean delivery remains acceptable, and attempted vaginal birth after cesarean delivery should not be discouraged solely on the basis of gestational diabetes mellitus.
Reuters on Dec 31, 2004 had an article about women with type 1 diabetes and the fact that their pregnancy can go well. The research by Dr. Dorte M. Jensen of Odense University Hospital reported that only one third of women said that they monitored their blood sugar levels every day. Daily monitoring and good overall control pf blood glucose levels are associated with a lower likelihood of infant mortality and birth defects. This article in Diabetes Care compared rates of pregnancy complication in the general population for 1,218 consecutive pregnancies in 990 women with type 1 diabetes. Among the women with diabetes, compared with the general population, the percentage of babies that died soon after birth was higher as was the rate of stillbirths and birth defects. Among the 93 women who had serious adverse outcomes-22% monitored their blood glucose levels daily at conception compared to 35% of the women who had uncomplicated pregnancies. Blood sugar control before and after pregnancy was not as good among the adverse outcome group, and they were less likely to have received pre-conception guidance than women without seriously affected babies.
Here I add just a few words from my experience. I have gone through pregnancies with women who have type 1 diabetes. They do control blood glucose levels and did do so before they became pregnant. I have been there to see their healthy new born. The sad thing about this study is that it took place in Denmark where health care is free and still women did not appear to take control of their diabetes. The Danes have a way to go to meet the goals of the St. Vincent declaration which in 1989 stated that in 5 years rates of complication in diabetic pregnancies should be similar to those seen with non-diabetes pregnancy. It is obvious that this goal has not been met.
Strategies to identify adults at high risk for type 2 diabetes, The Diabetes Prevention Program in Diabetes Care 28:138-144, 2005 is written by the George Washington University Biostatistics Center. The Diabetes Prevention Program (DPP) was a large, multicenter, randomized clinical trial testing interventions to prevent or delay type 2 diabetes. A major challenge was to identify eligible high-risk adults, defined by DPP as having both impaired glucose tolerance (IGT) (2-h glucose 140-199 mg/dl) and elevated fasting plasma glucose (EFG) (95-125mg/dl).They analyzed how screening yields would be affected by the presence of established risk factors such as age, sex, BMI, and family history of diabetes, and how much yields would be enhanced by preselecting individuals with elevated capillary blood glucose levels. Of 158,177 contacted adults, 79,190 were potentially eligible. They focused on the 30,383 who completed an oral glucose tolerance test (OGTT). Based on OGTT, 27% had IGT with EFG, meeting DPP eligibility criteria for being at high risk of diabetes, and 13% had previously undiagnosed diabetes based on OGTT. Older age and higher BMI increased yield of high-risk individuals and those with newly diagnosed diabetes in most ethnic groups 9whites, African Americans, Hispanics, and American Indians). In Asian Americans, age but not BMI predicted high risk and diabetes. Independent of age and BMI, the primary fasting capillary glucose predicted screening yield in all ethnic groups, with an inverted –U pattern defining DPP eligibility alone and a steep curvilinear pattern defining either IGT-EFG or newly discovered diabetes. Fasting capillary glucose did not attenuate the affects of other participant characteristics in predicting IGT-EFG of the combination of IGT-IFG and newly discovered diabetes. They concluded that the DPT screening approach identified adults with or at high risk for type 2 diabetes across various ethnic groups and provided guidance to more efficient use of OGTTs. Fasting capillary glucose is a useful adjunct in screening programs combined with data on age and adiposity.
Years ago I asked my health insurance to pay for peridontal work because I have type 1 diabetes. The answer was a resounding “no" because there was no evidence that there was relationship between the two. I fought it with scientific research to no avail Here is the latest research on the subject which will be forwarded to my new insurance company. Hope it helps you too. Diabetes Care 28:27-32, 2005 has an article titled Periodontal disease and mortality in type 2 diabetes by Aramesh Saremi, MD et al. In a prospective longitudinal study of 628 subjects aged 35 years or older, the researchers examined the effect of periodontal disease on overall and cardiovascular disease mortality in Pima Indians with type 2 diabetes. Periodontal abnormality was classified as no or mild, moderate, and severe, based on panoramic radiographs and clinical dental examinations.
During the mean follow-up of 11 years, 204 subjects died. The age-and sex adjusted death rates for all natural causes expressed as the number of deaths per 1,000 person-years of follow-up 3.7 for no or mild periodontal disease, 19.6 for moderate periodontal disease, and 28.4 for severe periodontal disease. Periodontal disease predicated deaths from ischemic heart disease (IHD) and diabetic nephropathy. Death rates from other causes were not associated with periodontal disease. After adjustment for age, sex, duration of diabetes, HbA1c, microalbuminuria, BMI, serum cholesterol concentration, hypertension, electrocardiographic abnormalities, and current smoking in a proportional hazards model, subjects with severe periodontal had a 3.2 times risk of cardiorenal mortality (IHD and diabetic nephropathy combined) compared with the reference group(no or mild periodontal disease and moderate periodontal disease combined). The researchers concluded that periodontal disease is a strong predictor of mortality from IHD and diabetic nephropathy in Pima Indians with type 2 diabetes. The effect of periodontal disease is in addition to the effects of traditional risk factors for these diseases.
The Archives of Internal Medicine 2004;164:2492-2499 has an article titled Aspirin use among adult with diabetes, recent trends and emerging sex disparities by Stephen D. Persell. MD, MPH; David W. Baker, MD, MPH. The researchers assessed recent self-reported regular aspirin use among adults 35 years or older with diabetes. They used statewide telephone surveys conducted in 7 states in 1997 and 20 states in 1999 and 2001 including 875, 3205, and 4272 subjects in 1997, 1999 and 2001, respectively. Aspirin use increased from 37.5% in 1997 to 48.7% in 2001. In 2001, 74.2% of diabetic adults with cardiovascular disease but only 37.9% of those without cardiovascular disease, used aspirin regularly including less than 40% with diagnosed hypertension or hypercholesterolemia or who smoked. After adjusting for cardiac factors and socioeconomic characteristics, among those with cardiovascular disease, aspirin use was less common in age 35 to 49 years and 50 to 64 years and in men aged 35 to 49 years compared to men 65 years and older. For those with diagnosed cardiovascular disease, aspirin diagnosed with cardiovascular disease, aspirin use was lower among women and adults younger than 50 years. The disparity in aspirin use between men and women appeared between 1997 and 2001. The researchers concluded that aspirin use among adults with diabetes with diabetes has increased. However, many high-risk individuals, especially women and those younger than 50 years do not use this effective and inexpensive therapy.
BSP
