Lets get started with our headlines and then we’ll go on to our abstracts which are about depression and diabetes, insulin Detemir compared with NPH, insulin sensitively in the children of type 1 and type 2 diabetes women, and finally biomarkers of endothelial dysfunction and risk of type 2 diabetes.
We have many headlines, so let’s jump right in. JAMA, April 28,2004 has an article which talks about a team of international scientists that has discovered that a mutation in a single gene is a common cause of diabetes in newborns. The BBC reported that only a small number of babies are born with neonatal diabetes each year and they were routinely given regular injections of insulin. These researchers found that these children had a mutation in the potassium channel gene and that they can respond well to a sulphonylurea medication. They researchers hypothesize that over one third of patients diagnosed with diabetes before the age of six months have this deficit.
The April, 2004 Archives of Ophthalmology has an interesting article about the prevalence of diabetic retinal disease in the US which they say is approximately 8 percent of diabetics. However, this article found that retinopathy threatens the vision of nearly 30 percent of adults with type 1 diabetes before 30 years of age. Dr. Kempen of Johns Hopkins found the prevalence of retinopathy among people with diabetes was 40.3 percent, and the prevalence of vision-threatening disease was 8.2 per cent. By comparisons, the corresponding figures in the general population were 3.4 percent and 0.75 percent. The results of the study show that retinopathy often presents itself during the working-age years, and thus results in a large economic cost, however, it is often preventable with intensive control of blood glucose level and blood pressure as well as regular patient monitoring of patients who are at high risk for diabetic retinopathy.
The April 26, 2004 issue of The Archives of Internal Medicine has an article on Physical Activity, Body Mass Index and the Risk of type 2 diabetes with normal or impaired glucose regulation by Guan Hu, PhD et al. The authors prospectively followed 2017 Finnish men and 2352 Finnish women between 45 and 64 years of age with newly diagnosed diabetes at baseline. The researchers concluded that increasing physical activity can reduce the risk of type 2 diabetes. The protective effect of physical activity was observed in subjects with excessive BMI and elevated glucose levels. Physical activity was associated with prevention in subjects with both normal and impaired blood glucose levels.
A new study in Nature says that researchers have been able to show regeneration in beta cells in mice. This has the potential for helping people with type 1 diabetes. Douglas Melton who is co-author is a Howard Hughes Medical Institute researcher at Harvard.
Now we will share our abstracts and hope that you will learn information that will help you understand and control your diabetes. Thank you for your continued readership and support. Diabetes Care27:1006-1070,2004 has an article titled Diabetes, depression and quality of life, by Robert D. Goldney, M.D. et al from the University of Adelaide, South Australia. The aim of the study was to assess the prevalence of diabetes and depression and their association with quality of life using a representative population sample. This was done using 3,010 personal interviews conducted by trained health interviews. The results indicate that the prevalence of depression in the diabetic population was 24% compared with 17% in the nondiabetic population. Those with diabetes and depression experienced an impact with a large effect size on every dimension of the Short Form Health-Related Quality-of-Life Questionnaire as compared with those who suffered from diabetes and who were not depressed. A supplementary analysis comparing both depressed diabetic and depressed nondiabetic groups showed there were statistically significant differences in the quality-of-life effects between the two depressed populations in the physical and mental components of the questionnaire used. The researchers concluded that depression for those with diabetes is an important comorbidity that requires careful management because of its severe impact on quality of life.
Insulin Detemir offers improved glycemic control compared to NPH insulin in people with type 1 diabetes by Philip Home, DM, DPHIL et al is an article in Diabetes Care 27:1081-1087, 2004. Insulin detemir is a soluble long-acting basal insulin analog designed to overcome the limitation of conventional basal formulations. Accordingly, insulin detemir has been compared with NPH insulin with respect to glycemic control with respect to glycemic control (HbA1c pre-breakfast glucose levels and variability, and hypoglycemia) and timing of administration.
People with type 1 diabetes were randomized in an open-label, parallel trial of 16 weeks treatment duration using either insulin detemir or NPH. Insulin detemir was administered twice daily using two different regimes, either before breakfast and at bedtime or at a 12-hour interval. NPH was administered before breakfast or at bedtime. Mealtime insulin was given as rapid-acting insulin analog insulin aspart. The researchers concluded that overall glycemic control with insulin detemir was improved compared with NPH insulin. With both insulin detemir groups, clinical fasting plasma glucose was lower than with NPH insulin. The risk of minor hypoglycemia was lower in both insulin detemir compared to NPH insulin in the last 12 weeks of treatment, this being mainly attributable to a 53% reduction in nocturnal hypoglycemia in the insulin detemir morning and bed group. Although HbA1c for each insulin detemir was not different from the NPH group, HbA1c, for the pooled insulin detemir groups was significantly lower than for the NPH group. The NPH group gained weight during the study, but there was no change in weight in either of the insulin detemir groups. The researchers concluded that this data provide a basis for tailoring the timing of administration of insulin detemir to the individual person’s need.
Insulin sensitivity in the offspring of women with type 1 and type 2 diabetes is our next abstract by Wendy A. Hunter, MBCHB et al in Diabetes Care 27:1148-1152, 2004. The researchers examined if insulin sensitivity is altered in prepubertal offspring exposed to a diabetic intrauterine environment. Fifteen control children, 17 offspring of type 1 diabetic women and 10 off spring of type 2 diabetic women, aged 5 to 10 years of age, underwent frequent sampled intravenous glucose tolerance test. Weight and height were measured, and body composition was calculated using bioelectrical impedance. Bergman’s minimal model was applied to the glucose and insulin measurements to obtain values for insulin sensitivity, acute insulin response, and glucose effectiveness. The researchers concluded that intrauterine exposure to hyperglycemia by itself was not associated with alterations in glucose regulation in prepubertal offspring. Children of mothers with type 2 diabetes, however, were overweight, and had a tendency for reduced insulin sensitivity. The combined effect of genetic and postnatal environmental factors, rather than prenatal exposure to hyperglycemia, may place this group at risk for developing impaired glucose tolerance in later life.
JAMA, 2004;291:1978-1986 has an article titled Biomarkers of endothelial dysfunction and risk of type 2 diabetes mellitus by James B. Meigs, M.D., MPH et al. Endothelial dysfunction occurs in diagnosed type 2 diabetes mellitus but may also precede the development of diabetes. The researchers wanted to determine whether elevated plasma levels of biomarkers reflecting endothelial dysfunction and vascular cell adhesion molecule predict the development of type 2 diabetes in initially nondiabetic women. They used a prospective, nested case-control study within the Nurses’ Health Study an ongoing US study initiated in 1076. Of 121,700 women initially enrolled, 32,826 provided blood samples in 1989-1990; of those none had a diagnosis of diabetes, cardiovascular disease or cancer at baseline, 737 developed diabetes incident diabetes by 2000. Controls were selected according to matched age, fasting status, and race. The study concluded that endothelial dysfunction predicts type 2 diabetes in the elevated E-section and ICAM-1 levels found. Theses were independent of other risk factors including obesity and subclinical inflammation.
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