We start out each month with the headlines we read each month. Then we go on to print medical journal abstracts. This month you’ll find out more about Mortality trends in men and women with diabetes, 1971-2000 and the eating habits and insulin misuse in teenagers and young adults with type 1 diabetes. Pull up your coffee or tea, get those glasses on and read on.
I note that both the Israelis and we have published initial reports of glucose testing done with light rays. Penn State University Medical Center reported on the GlucoLight and OrSense reported on the NBM-100. Keep your eyes open for these. If the research trials move on to larger numbers of people who knows when sticking our fingers will go the way of the dodo? Hopefully in time for my finger tips to begin to heal and soften before I am so old that it no longer matters.
You may know that I currently use an insulin pump as well as a continuous glucose sensor and receiver to better control my brittle type 1 diabetes. Today is June 5, and the FDA has approved a 7 day glucose sensor made by the DexCom, the company which makes my sensor. You know who will be calling the company to order the longer acting sensors when I have used all of my three day sensors. That’s the good news. Of course those of us who use these sensors know that we still have to do finger pricks when we need to decide to intervene to control high or low blood glucose levels, but the every five minute blood glucose levels gives us important trends so we don’t wind up in major trouble. Good work DexCom.
In case you have not been listening to the news or reading the paper GlaxSmithKline, PLC the maker of Avandia has come under attack because the medication has been linked to a greater risk of heart attack and possibly death. The government issued a safety alert in mid-May. The FDA urged diabetics taking the medication to talk to their doctors, but stopped short of forcing a sharper warning label. More than 6 million people worldwide have taken the medication since it came on the market eight years ago. Pooled results of dozens of tests revealed a 43 percent higher risk of heart attack according to a review published in the New England Journal of Medicine. All medication we take has pros and cons and we and our doctors need to weight the benefits and risks so do make sure you know all of your risk factors for heart disease so you can talk intelligently with your physician.
If you have purchased our new book, the Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook, you know the importance of including omega-3 fatty acids in your diet. As s diabetic, you know you have a four-fold risk of heart disease so keeping that beating muscle healthy is prime. Fatty fish such as trout, salmon and mackerel are high in omega-3 as are nuts like walnuts, flaxseed and canola oil. The research examined the diet and its relation to high blood pressure in 4,680 people in Japan, Great Britain and the U.S. The people who ate diets rich in omega-3 fatty acids had slightly lower blood pressure on average. “With blood pressure, every millimeter counts. The effect of each nutrient is apparently small but independent so that it can add up to a substantial impact on blood pressure", according to Dr. Ueshima of Japan. If that’s not a good enough reason to eat more foods with omega-3 then you should also know that diets high in this nutrient are also linked to better brain development and lower overall risk of cancer. Bon appetite!
A related story was found on NPR, May 24th. It highlights the long known fact that research continues to show that beating back the risk of type 2 diabetes can be done as effectively with diet and exercise as with medication. Nothing new here. Look at the New England Journal of Medicine in Feb., 2002 with follow-up articles continuing. It’s time to help our teenagers and young adults in our lives to understand the importance of losing weight if they are over weight, exercising, and eating a healthy diet. The health cost to each person who has diabetes can be overwhelming to them and their families not to mention our health care system. The answers are self evident so lets all get on the bandwagon and try to educate those around us.
Want even more proof? The June Diabetes Care journal brings interesting information from Oslo, Norway where researchers examined the interaction of blood glucose control in type 1 diabetic children and hours spent in front of the television. The results indicate that those type 1 diabetic children who spent time glued to the TV had a tougher time controlling their blood glucose levels. In our country the American Academy of Pediatrics suggests that children should watch no more than two hours of TV daily. The authors concluded that spending less time in front of the TV can improve glucose levels and health. Others examined the data and suggested that children who consistently have high blood glucose levels may feel too sick to do much besides watch TV. Both groups feel that it’s clear there is a relationship between the two factors, now it has to be found. What is obvious is that for the three months of the study, there was a continuous increase in blood glucose levels for every hour of TV watched, rising to the highest level for those who watched at least four hours a day. If nothing else, this is a cheap way to lower blood glucose levels. After all, it costs very few calories to get up and turn off a TV.
Our last headline will bring hope to all of us who have to use exogenous insulin to stay alive. May 25 brought the news from the US and Great Britain that a first step had been taken in making stem cells taken from umbilical cords of newborns and engineering them to produce insulin. The researchers hope that this will someday be used to treat diabetes. The study which was directed by Dr. Randall Urban of the University of Texas Medical Branch at Galveston was published in the journal Cell Proliferation with researchers form the University of Newcastle in Great Britain. The authors hope that this research will eventually produce an alternative to using controversial stem cells where the battle in the U.S. goes on.
The Annals of Internal Medicine, Aug 7, 2007, Vol. 147, Issue 3 has a good news research article titled Mortality Trends in Men and Women with Diabetes, 1971-2000 if you are a man with diabetes,written by Edward W. Gregg, PhD et al. It once again stresses the fact that many women are not given the treatment necessary to protect their cardiovascular system. After reading this, I was happy that my physicians are as compulsive as they are when referring me on to specialists. Without quadruple bypass surgery on my 48th birthday this site would not be her, nor probably would I. Speak up please. Remember that all diabetics are by definition cardiovascular patients. The researchers assessed mortality rates among diabetic adults or excess mortality associated with diabetes in the United States. The objective was to examine whether all-cause and cardiovascular disease mortality rates have declined among the U.S. population with and without self-reported diabetes. Population-based health surveys (National Health and Nutrition Examination Surveys l, ll, and lll) with mortality follow-up assessment were used as a basis for the research. The participants were ages 35 to 74 years of age with and without diabetes. Diabetes was determined by self-repot for each survey (1971-1975, 1976-1980, and 1988-1994), and mortality rates were determined through 1986, 1992, and 2000 for the surveys, respectively. Among diabetic men, the all-cause mortality rate decreased by 18.2 annual deaths per 1000 persons between 1971 to 1986 and 1986 to 2000, accompanying decreases in the nondiabetic population. Cardiovascular disease mortality trends paralleled those of all-cause mortality, with 26.4 annual deaths per 1000 persons in 1971 to 1986 and 12.8 annual deaths per 1000 in persons in 1988 to 2000. Among women with diabetes, however neither all-cause nor cardiovascular disease mortality declined between 1971 to 1986 and 1988 to 2000. and the all-cause mortality rate difference between diabetic and nondiabetic women more than doubled (from a difference of 8.3 to 18.2 annual deaths per 1000 personas). The reduction in mortality rates among diabetic men eliminated the sex difference in rates among diabetic adults that was observes in earlier surveys. The researchers concluded that progress in reducing mortality rates among persons with diabetes has been limited to men. Diabetes continues to greatly increase the risk of mortality, particularly among women.
For a long time we have shared articles about psychiatric disorders which may accompany diabetes including depression and eating disorders. Diabetes Care, Vol. 22, Issue 12 has an article titled Eating Habits, Body Weight, and Insulin Misuse. A Longitudinal Study of Teenagers and Young Adults with Type 1 Diabetes by KS Bryden at al. Parents, now is the time to talk to your children with diabetes about this issue. The repercussions of misuse can be disastrous. The objective of this study was to examine disordered eating, insulin misuse, weight change, and their relationships with glycemic control and diabetic complications in adolescents with type 1 diabetes followed up over 8 years. Of 76 adolescents (43 male, 33 female) with diabetes aged 11-18 years of age at the first assessment, 65 were interviewed as young adults (ages 20-28 years of age). Eating habits were assessed using a standardized Eating Disorder Examination. Height and weight were determined and BMI calculated. Three consecutive urine specimens were collected for measurement of albumin/creatinine ratio and other significant diabetic complications were recorded. Glycemic control was assessed by glycated hemoglobin. The results indicated that weight and BMI increased from adolescence to young adulthood. Females were overweight as adolescents and both sexes were overweight as young adults. Concern over weight and shape increased significantly for both sexes from adolescence to young adulthood. This increase in concern was reflected in increased levels of dietary restraint. Features of disordered eating were apparent in females at both assessments, but no patients met the criteria for anorexia nervosa or bulimia nervosa at either assessment. A total of 10 (30%) females, but none of the males admitted underusing insulin to control weight. Five (45%) females with microvascular complications had intentionally misused insulin to prevent weight gain. The researchers concluded that an increase in BMI from adolescence was associated with higher levels of concern over shape and weight and more intense dietary restraint, especially among females. Overt eating disorders were more prevalent in these patients than in the general population, but milder forms of disordered eating were common and have implications for diabetes management. Insulin omission for weight control was frequent among females and may contribute to poor glycemic control and to the risk of complications.
BSP
