We begin as always with our Headlines and then look at our Abstracts which this month which examine Vitamin D deficiency and risk for cardiovascular disease, and Sirolimus Stent recommended for those with diabetes and heart disease. Let’s start off with good news. January’s Diabetes Care tells us that the percentage of U.S. adults with diabetes who have their blood glucose levels under control, as measured by glycosylated hemoglobin (A1c) levels of less than 7 percent increased from 1999 and 2004. The investigators from the Centers for Disease Control and Prevention found that the proportion of diabetics with average A1c values of less than 7 percent increased from 37.0 percent between 1999 and 2000 to 56.8 percent between 2003 and 2004. Where are the cheerleaders when we really need them?
The BBC posted an article based on research at Oxford University of more than 90,000 people-19,000 with diabetes-and found that many more would benefit from statins than previously realized. They found that standard daily treatment with statins would prevent about one third of heart attacks and strokes in people with diabetes. These benefits were seen regardless of age, sex and whether patients were already showing signs of cardiovascular disease. After five years, 42 fewer people with diabetes had major problems, such as heart attacks or strokes, for every 1.000 treated with statins. The only exceptions for treatment should be those with exceptionally low risk, such as children or those who cannot take the drugs for other reasons, such as pregnant women. Study leader Professor Colin Baigent stated that “People with diabetes are a clearly defined group of people at an increased risk of cardiovascular disease." “What we’re saying is statins are clearly effective in every type of person with diabetes. However, the chief executive of Diabetes UK recommended statins for people with diabetes over the age of 40 or younger than 40 with another risk factor.
New research shows that using a special thermometer to measure the temperature of their soles can give patients early warning to avoid one of diabetes’ most intractable complications. Foot ulcers each year strike 600,000 U.S. diabetics with many not recognizing the problem because of numbed feet. Foot ulcers are slow-healing and vulnerable to infection and are responsible for most of the roughly 80,000 amputations of toes, feet and lower legs that diabetics undergo each year. This is not a standard thermometer, but a $150 infrared one with a tip that digitally measures skin temperature. Maker Xilas Medical, with an NIH grant, is working to make the thermometer resemble a bathroom scale. Step up and it would automatically flash any trouble spots to the patient and a computer would alert the doctor. That’s still a few years from market, but for now the San Antonio based Xilas sells a hand held TempTouch by prescription.
Diabetes Care, Dec. 2007 has an article which has been cited in various media which concludes that moderate drinking might improve fasting glucose in people with diabetes. The study done in Israel examined 109 adults with type 2 diabetes who had not consumed more than one alcoholic drink in the past week and who were randomly assigned to drink one standard glass of wine (150mg) or the same amount of nonalcoholic beer daily with dinner for 3 months. All participants received dietary counseling and were instructed to consume a specific amount of calories. Ninety-one people completed the trial. Fasting blood glucose levels decreased in the alcohol group (from 149 to 118 mg/dL) but not in the nonalcoholic-beer group. These decreases were greatest among patients with higher glycosylated hemoglobin (HbA1c) levels at study entry. Postprandial glucose levels did not significantly differ between the groups. Comments about the article state that the results should not make diabetic patients begin drinking alcohol. Clinical trials are needed to evaluate the safety and efficacy of moderate drinking for reaching the improved outcomes suggested by observational studies.
Thirteen young diabetics in Brazil have ditched their insulin shots and other medications thanks to a risky but promising treatment with their own stem cells- apparently the first time such a feat has been accomplished. Though too early to call it a cure, the procedure has enabled the young people who have type 2 diabetes to live insulin-free, so far for as long as three years. The treatment involves stem cell transplants from the patient’s own blood. "It’s the first time in the history of Type 1 diabetes where people have gone without treatment whatsoever…no medications at all, with normal blood sugars,"said study co-author Dr. Richard Burt of Northwestern University medical school in Chicago. While the procedure can be potentially life-threatening, none of the 15 patients in the study died or suffered lasting side effects, but it did not work for twp of them. Larger, more rigorous studies are needed to determine if stem cell transplants could become standard treatment for people with Type 1 diabetes. Ethicists have questioned whether this research should have been done on children rather than adults. It is known that transplanting stem cells may raise the risk for infertility and late-onset cancers. However, the Brazilian ethics committees approved the research. Burt and other diabetes experts called the results an important step forward. Dr. Gordon Weir, our old friend from Joslin in Boston, stated “These are very exciting results. They look impressive." Still Weir cautioned that more studies are needed to make sure that the treatment works and is safe. “It’s really too early to suggest to people that this is a cure." The patients involved were newly diagnosed Type 1 diabetics ages 14 to 31. The procedure involves stimulating the body to produce new stem cells and harvesting them from a blood sample. Next comes several days of high-dose chemotherapy which virtually shuts down the immune system and prevents the reintroduced cells from being fought off by white blood cells. Hospitalization for about three weeks is necessary as well as potent drugs to ward off infection. Then the harvested stem cells are injected back into the body where they can build a healthier immune system. Timing is key said Burt. “If you wait too long you’re exceeding the body’s ability to repair itself."
It’s time to look at our journal abstracts. We all know that our risk of heart disease is two to four times higher than those without diabetes so these tow articles are important to all of us. The first article Vitamin D Deficiency and the Risk of Cardiovascular Disease by Thomas J. Wang, MD et al is found in the Jan. 7th issue of Circulation. To find out if you have low Vitamin D levels you can take a blood test which where we live is sent to a special lab and takes at least a week or two a week for results. After reading this you too may be motivated to speak to your cardiologist, endocrinology, or internist about a screening and maybe taking vitamin D. currently here in the middle of the country large bottles of Vitamin D are available at our wholesale clubs. Vitamin D receptors have a broad distribution that includes vascular smooth muscle, endothelium, and caradiomyocytes. A growing body of evidence suggests that Vitamin D deficiency may adversely affect the cardiovascular system, but the data from longitudinal studies are lacking. The researchers studies 1739 Framingham Offspring Study participants (mean age 59 years; 55% women; all white) without prior cardiovascular disease. Vitamin D status was assessed by measuring 25-dihydroxyvitmin D (25-OH D) levels. Prespecified thresholds were used to characterize varying degrees of 25-OH D deficiency (<15 ng/mL, <10 ng/mL). Multivariable Cox regression models were adjusted for conventional risk factors. Overall, 28% of individuals had levels <15ng/mL, and 9% had levels <10ng/mL. During a mean follow-up of 5.4 years, 120 individuals developed a first cardiovascular event. Individuals with 25-OH D <15ng/mL had a multivariable adjusted hazard ratio of 1.62 for incident cardiovascular events compared with those with 25-OH D =15ng/mL. This effect was evident in participants with hypertension but not in those without hypertension. There was a graded increase in cardiovascular risk across categories of 25-OH D, with multivariable-adjusted hazard ratios of 1.53 for levels 10 to <15ng/mL and 1.80 for levels <10ng/mL. Further adjustment for C-reactive protein, physical activity, or vitamin use did not affect he findings. The authors concluded that Vitamin D deficiency is associated with incident cardiovascular disease. Further clinical and experimental studies may be warranted to determine whether correction of Vitamin D deficiency could contribute to the prevention of cardiovascular disease.
Diabetes Care 31:15-19, 2008 has an article titled Sirolimus Stent Best for Diabetic Disease, A prospective, randomized, multicenter study but Dr. Fabrizio Tomai et al. A stent is a tiny hollow tube that is placed in the coronary arteries to maintain blood flow after the blood vessel has been dilated with angioplasty. In the past, stents were simply made of metal and did not release drugs. In recent years, there has been evidence that the so called “drug-eluding" stents are superior to the bare metal ones. The researchers from the European Hospital in Rome, concluded that the optimal drug-eluding stent for diabetic patients has been unclear and so Dr. Tomai and his colleagues enrolled 60 patients with two or more blockages in different segments of the coronary arteries. Overall, 60 blockages were successfully treated with paclitaxal stents and 60 with sirolimus stents. At 9-month follow-up, X-ray analysis revealed that the arteries treated with sirolimus stents showed less narrowing than those treated with paclitxel stents. In short, significant narrowing was over twice as likely to occur with paclitaxal stents then the sirolimus ones. As a treatment for heart disease in diabetes, stents that release sirolimus, and immune-suppressing drug, are more effective than those that release paclitaxal, a cancer-fighting drug, for keeping coronary arteries open after angioplasty. However they added that further research is needed to determine if the better X-ray results achieved with sirolimus stents actually translate into long-term clinical benefits.
BSP
