June has arrived as has our new medical journals and abstracts, which we bring to you monthly so that you can keep up with the field. Each month we read these journals and scour the news to keep all of us up to date. So, if you have areas of interest that you want us to report on, just let us know. In the meantime, read on. Knowledge is the best weapon against diabetes and its complications. It is the road to living a full and gratifying life.
This month we will bring you articles on the following: dairy consumption, diabetes and obesity, insulin resistance in young adults, diabetes raising the risk of vascular dementia in the aged, sexual dysfunction in women with type 1 diabetes, and finally renal outcome in type 2 diabetic patients with and without nephropathies.
Before we look at these articles, let's look at our monthly headlines. Our first headline shares information about a new medication that increases "good" cholesterol. The drug, a CETP inhibitor, works by blocking the action of the cholesterol ester transfer protein, which is known to lower HDL (the "good" cholesterol). Of course more studies need to be done, but keep reading about this medication.
Our second headline is important to those of you who take troglitazone, as it's been associated with hepatic failure. Diabetes Care 25:815-821, 2002 has an article by Harold E. Lebovitz, MD et al which found no evidence of hepatotoxic effects in the 5,508 person-year study. This is in keeping with hepatic data from clinical trials of another member of the class of medication, pioglitazone, and is in contrast to the clear evidence of hepatotoxic effects observed during the troglitazone clinical trial program. It is felt that poorly controlled patients with type 2 diabetes may have moderate elevations of serum ALT that will decrease with improved glycemic control during treatment with antihyperglycemic agents.
If you read our What's Hot article this month you will know it is about neuropathy. Diabetes Care 25:859-864, 2002, shares information about the risk factors for development of incipient and overt diabetic neuropathy in type 1 diabetic patients. Rossing et al examined 537 patients for 10 years. They found the following significant predictors of the progression from normoalbuminuria to microalbuminuria which include baseline log urinary albumin excretion rate 2.63, HbA1c 1.13%, presence of any retinopathy, and smoking. Sex, duration of diabetes, arterial blood pressure, serum creatinine, height, and social class were not risk factors.
Our third headline concerns hormone replacement. The New York Times reports that a panel of international experts has cast doubt on the longstanding claims that hormone replacement in postmenopausal women can prevent or treat a variety of ills, including heart disease, Alzheimer's disease, major depression, urinary incontinence and broken bones due to osteoporosis. They suggest that medications for individuals should be based on their needs and each medication should address that medical problem.
Our final headline is from the American Journal of Gastroenterology 2002; 97:604-611. Dr Talley examined 463 patients and found that poor glycemic control was independently associated with dysmotility-like dyspepsia and ulcer-like dyspepsia. Diabetic complications such as nephropathy, retinopathy, or peripheral neuropathy were significantly associated with GI symptoms. As the number of complications increased the rates of abdominal pain, dyspepsia, GERD, constipation, and fecal incontinence increase significantly. The author suggests that these symptoms can be alleviated by tight control of blood glucose levels.
JAMA, ,2002; 287:2081-2089 has an article by Mark A. Pereira, PhD et al about Dairy consumption, obesity, and the insulin resistance in young adults. If you have relatives who are risk for developing type 2 diabetes and who are over weight, here is an article for you. The authors knowing that components of the insulin resistance syndrome (IRS), including obesity, glucose intolerance, hypertension, and dyslipidemia are major risk factors for type 2 diabetes and heart disease, examined the association between dairy intake and the incidence of IRS, adjusting for confounding lifestyle and dietary factors. They measured a ten-year cumulative incidence of IRS and its association with daily consumption, measured by daily history interview. The results showed that dairy consumption was inversely associated with the incidence of all IRS components among participants who were overweight at baseline but not among leaner individuals. Each daily occasion of dairy consumption was associated with 21% lower odds of IRS. These associations were similar for blacks and whites, and for men and women. Other dietary factors, including macronutrients and micronutrients, did not explain the association between daily intake and IRS. The authors concluded that dietary patterns characterized by increased daily consumption have a strong inverse association with IRS among overweight adults and may reduce risk of type 2 diabetes and cardiovascular disease.
CNS News, Vol.4;4:1&44 has an article on Diabetes raises risk of vascular dementia in aged by Linda B. Hassing, PhD et al from Sweden. The researchers followed a population-based sample of 702 twins aged 80 years and older for 10 years. Of the 187 who developed dementia, 31 had been diagnosed with diabetes mellitus before the onset of dementia. The results were presented at the 2002 International Congress on Vascular Dementia. According to Dr. Hessing and her group, very elderly individuals with type 2 diabetes have 2.5 times greater risk of developing vascular dementia than the elderly without prior diabetes. The researchers found no connection between diabetes and Alzheimer's disease in this population. The findings were independent of the fact that the participants studied were twins. The data were also adjusted for differences in age, gender, education, smoking habits and circulatory disease. Dr. Hassing cautioned that these results cannot be generalized to other populations, for example to all hospitalized patients. According to researchers, the study findings have important implications for the diagnosis of dementia. It is important for neurologists to know if their patients have diabetes, they have a higher risk of developing vascular or a mixed type of dementia than they are of displaying a pure Alzheimer's dementia. The former differs from the latter in that there is a stepwise as opposed to a gradual cognitive decline. They also suggest that physicians ask diabetic patients about previous small vascular events in order to help distinguish between vascular dementia and Alzheimer's dementia. The researchers conclude that diabetes is a treatable risk factor for dementia, which all physicians need to be aware of.
We receive frequent questions about sexual dysfunction and diabetes. When we find such an article, whether about men or women, we report them to you. Diabetes Care 25;672-677,2002 has such as article by Paul Enzlin, MA et al from Belgium. The title is Sexual dysfunction in women with type 1 diabetes. The researchers wanted to examine the prevalence of sexual problems in women with type 1 diabetes, compare this prevalence rate with that of an age-matched control group, study the influence of diabetes-related somatic factors on female sexuality and look at the influence of psychological variable functioning of both groups. A total of 120 women with diabetes visiting an outpatient clinic completed questionnaires evaluating adjustment to diabetes, marital satisfaction, depression, and sexual functioning. Medical records were used to obtain HbA1c, medication, BMI, and early-onset microvascular complications. An age-matched control group of 180 healthy women attending an outpatient GI clinic for preventive routine assessment also completed the non-diabetes-related questionnaires.
The results of the research indicate that more women with diabetes than control subjects reported sexual dysfunction, but a significant difference was found only for decreased lubrication. No association was found between sexual dysfunction and age, BMI, duration of diabetes, HbA1c, use of medication, menopausal status, or complications. Women with complications, however, reported significantly more sexual dysfunctions, and the presence of complications altered treatment satisfaction. Both diabetic and control women with sexual dysfunction mentioned lower overall quality of marital relation and more depressive symptoms than their respective counterparts without sexual problems. Depression was a significant predictor for sexual dysfunction in both women with diabetes and the control group. The researchers concluded that sexual problems are frequent in women with diabetes and that this affects their overall quality of life. It deserves more attention in clinical practice and research.
Diabetes Care 25:900-905, 2002 has an article by Teresa Yuk Hwa Wong, MRC titled Rena; outcome in type 2 diabetic patients with and without coexisting nondiabetic nephropathies. The researchers wanted to determine the risk factors for adverse renal outcome in type 2 diabetic patients who underwent renal biopsy and were followed-up longitudinally. They examined 68 consecutive patients with type 2 diabetes during 1985-1999 who underwent renal biopsy fro porteinuria, renal involvement at the absence of retinopathy, renal involvement with duration diabetes < 5 years, or unexplained hematuria of glomerular origin. Their clinical features and underlying renal lesions were correlated with renal outcome after longitudinal follow-up. Three groups of patients were defined based on their renal pathology: Group1 consisted of 24 patients with diabetic glomerulosclerosis (DGS) alone, group 2 consisted of 13 patients with nondiabetic nephropathy (NDN) superimposed on DGS, and group 3 consisted of 31 patients with NDN alone without evidence of DGS.
The results of the research were that after a mean follow-up of 123 months from the diagnosis of type 2 diabetes, univariate analysis showed that risk factors for reaching end-stage renal disease included proteinuria > 2g/day or =2g/day, SCr > 120 umol/l, presence of retinopathy at the time of biopsy, and biopsy showing DGS (groups 1 and 2). On multivariate analysis, retinopathy was the only independent variable correlated with end-stage renal disease. This study showed the association of hematuria or proteinuria with the absence of retinopathy constitutes the strongest indication for a nondiabetic lesion. The authors concluded that patients with type 2 diabetes undergoing renal biopsy constitute a heterogeneous group by their clinical presentations and underlying pathology, but longitudinal studies on the renal outcome of these patients remain limited. This study showed that renal biopsy is indicated in selective diabetic patients because of potentially treatable nephropathy and a better prognosis than DGS.
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