Let’s start with our headlines and then we’ll go on to abstracts about early and late postprandial exercise in type 1 diabetics, the association of elevated serum ferritin and gestational diabetes, finally a comparison of the diets of diabetic and nondiabetic adolescents.
Although the first headline, which comes from the University of Pittsburg is certainly not positive, we thought those of you with type 1 diabetes would need to know about it to make sure you are getting the very best cardiovascular care. This article, in Diabetes 2006 55:1463-1469 by Georgia Pambianco et al, reports that heart and eye disease have not improved in the last 25 to 30 years for type 1 diabetics. The researchers analyzed long-term complications such as mortality, renal failure, and coronary artery disease in 906 type 1 diabetic people between 1950 and 1980 that were in the Pittsburg Epidemiology of Diabetes Complications study. They found that those diagnosed later in life lived longer. This means that those diagnosed in the 1950’s had a five time higher rate of early death at 25 years post-diagnosis than those diagnosed in the 1070’s. Some morbidity rates were reduced; kidney-failure rates declined significantly for those diagnosed more recently. There were, however, no differences across cohorts for rates of cardiovascular disease events and cardiac intervention procedures.
We receive many questions about diabetes and depression. There is an article in the Archives of General Psychiatry 2006:63:521-529, Antidepressants Extend Time to Relapse in Diabetics by Patrick J. Lustman, MD et al from Washington University School of Medicine in St. Louis. The researchers looked at the effect of maintenance treatment with the antidepressant sertraline (Zoloft) after a first episode of depression has been resolved. Depression is highly prevalent in those with diabetes and recurrence after successful treatment is common. Depression is also linked to increase morbidity and mortality among diabetics. Pervious studies looked at no more than 16 weeks of treatment. There were 2 phases of this study. In the first phase, 351 patients with moderately severe and recurrent major depression, medication up to 200mg/day was given for 16 weeks. Recovery occurred in 156 or 44% of patients. In the second phase of 152 diabetics from the first group who were successfully treated for depression. Seventy-nine were treated with Zoloft and 73 to placebo. The researchers report that Zoloft was significantly more successful than placebo in prolonging the depression-free interval, 57 days as compared to 226 days. During the second phase changes in HbA1c did not differ, however, they were lower than baseline during depression-free periods.
The Journal of Periodontology 206;77:591-598 has an article titled Periodontal Therapy Aids Glycemic Control in Diabetics which once again stresses the importance of seeing your dentist for routine care. Diabetics are prone to gum disease so getting referred to a specialist who cares for inflammation of the gums around the teeth is common. It is known that diabetics have a higher risk periodontal disease than do non-diabetics. Dr. Antonio Bascones et al studied 10 patients with type 2 diabetes and compared them to 10 people without diabetes. All had a diagnosis of moderate generalized chronic periodontitus. The patients underwent conventional periodontal root scaling and root planning and after a few months all showed significant improvement in gum bleeding, amount of plaque on teeth, and the degree of looseness of teeth. Furthermore, the team found the group with diabetes had a significant improvement in glucose control, as indicated by a drop from 7.2 to 5.7 in glycosylate hemoglobin levels (HbA1c). The investigators call for further studies but suggest that “there is s two-way relationship between diabetes mellitus and periodontitus, with the former producing a greater severity of periodontal disease and later compromising blood glucose control."
Our abstracts start with an article we found in Diabetes Research and Clinical Practice, Vol. 72, Issue 2, 128-134 (May 2006) titled Is Early and Late Post-meal Exercise So Different in Type 1 Diabetic Lispro Users by M.-C Dube et al. To compare blood glucose (BG) responses during a 60 minute moderate intensity exercise session performed in early or late postprandial periods. Nine generally well-controlled type 1 diabetic performed, at least one week apart, two exercise sessions, 60 (early exercise) and 180 minute (late exercise) after a standardized breakfast. All subjects were using Humulin N (N) and Humalog (Lispro, LI) insulin. During exercise, the overall decrease in BG was 4.8± 0.6 mmol/l and 3.6±0.8 mmol/l in early and late exercise, respectively. To prevent hypoglycemia, a dextrose infusion was initiated when BG reached 5mmol/l. The quantity of dextrose infused was 6.2±3.0g and 10.5±3.2g in early and late exercise respectively (NS). The time free of dextrose infusion during exercise was 41.2±7.8 minutes in early and 31.7±7.5 minutes in early and late exercise, respectively (NS). In N-LI users, overall drop in BG during exercise tends to be greater in the early postprandial period. However, early and late exercise present similar quantity of dextrose infused and time free of dextrose infusion. Consequently, the similar risk of exercise-induced hypoglycemia suggests similar precautions in either exercise times.
The National Diabetes Education Program (NDEP) latest diabetes prevention program is spreading the word about the risk for type 2 diabetes faced by women with a history of gestational diabetes and their off spring. It’s Never Too Early to Prevent Diabetes is the latest addition to NDEP’s campaign, Small Sreps, Big Rewards, Prevent type 2 Diabetes, the nation’s first comprehensive multicultural type 2 diabetes prevention campaign. The Diabetes Prevention Program, an NIDDK-funded clinical trial, found that people at increased risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight through increased physical activity and a low fat, low calorie eating plan. To stress the importance of gestational diabetes we noted an article in Diabetes Care titled Association of Elevated Serum Ferritin Levels and the Risk of Gestational Diabetes in Pregnant Women by Xinhua Chen, MD et al. The investigators examined the influence of a moderately elevated serum Ferritin level at entry to care on the risk of gestational diabetes mellitus (GDM) and a possible mechanism (increased iron stores verse inflammation). The research looked at a prospective observational study with 1,456 healthy pregnant women in Camden , New Jersey, serum Ferritin, and anthropometric measurements were determined. Serum C-reactive protein (CRP) concentration was measured in a nested case-control study of 172 subjects. The results indicated that women who developed GDM had a higher concentration of serum Ferritin than women who did not develop GDM. Elevated serum Ferritin level (highest quintile) was significantly and positively correlated with prepregnant BMI and skinfold measurements. Women in the highest quintile of serum had a twofold increased risk of developing GDM adjusted for several known risk factors. Similar results were obtained with a nested case-control study, in which women in the highest tertile of serum Ferritin or CRP had a greater than twofold increased of GDM. However, these effects were modified and became nonstatistically significant after additional adjustment for prepregnant BMI. They concluded that elevated serum Ferritin concentrations early in gestation are associated with an in creased risk of GDM. The association, at least in part, is mediated by the maternal fat mass and obesity. These data suggest a possible link between elevated serum Ferritin and low-grade inflammation.
Diabetes Care 29:982-987,2006 has an interesting article titled Diet of Adolescents with and without Diabetes by Vicki S. Helgeson, PHD et al. The investigators compared the dietary intake of adolescents with type 1 diabetes with that of adolescents without diabetes matched on age, sex, and year in school and to compare the diets of both groups with recommendations. Participants were 132 adolescents with type 1 diabetes, recruited from the Children’s Hospital of Pittsburgh, and 131 adolescents without diabetes ranging in age from 10.70 to 14.21 years. Dietary intake was assessed with three 24-hour recall interviews with each participant and one parent. Percentage of calories from protein, carbohydrates, and total fat; amount of each type of fat; amount of each type of fat; and amount of cholesterol, fiber, and sugar were calculated as averages across 3 days. The results indicated that adolescents with diabetes took in less energy than recommended. The percentage of calories from carbohydrates and protein were within recommendation for adolescents for adolescents with and without diabetes, but adolescents with diabetes exceeded the recommended fat intake. The diet of adolescents with diabetes consisted of a greater percentage of fat and protein and a smaller percentage of carbohydrates relative to adolescents without diabetes. Adolescents without diabetes consumed more sugar, while adolescents with diabetes took in more of all components of fat than adolescents without diabetes. Male subjects had an especially high intake of saturated fat. They concluded that adolescents with type 1 diabetes consume fewer calories from carbohydrates but more calories from fat than adolescents without diabetes and exceed the recommended levels of fat intake. These findings are of concern given the risk that type 1 diabetes poses for cardiovascular disease.
BSP
