As we do each month, we will begin with our headlines and then go on to share medical abstracts this month about resistance training and its affect on glucose tolerance in older persons, and understatement of cardiovascular risk factors among people with diabetes in the United States. Get your iced tea and pull up to the computer and let’s learn.
Drug store chains are banding together to bring emergency prescription drug information to people stranded by disasters. A group representing some of the nation’s biggest drug retailers—including CVS, Eckert, Rite Aid, Walgreens, and Wal-Mart said that they have developed Rx History, a service that can allow licensed prescribers and pharmacists to securely access a patient’s prescription history. The move comes as a response to displaced hurricane victims and is part of a larger movement to make health information more portable. Emergency medical teams that rushed to help people after hurricanes Katrina and Rita devastated the Gulf Coast found that one of the biggest problems was that people left behind their medications and could not remember what drugs they had been prescribed. Many drug store chains already have their own systems to serve customers who are traveling, but this system would share information across rival chains. The system is now available in the event of a national emergency, but the plan is that some day it will be available as part of routine care, said Rob Cronin, a spokesman for SureScripts, operator of the Pharmacy Health Information Bureau which operates the system owned by the pharmacy industry. The system is designed to reduce the risk of medication errors by making drug records available to licensed caregivers where they are treating patients. Pharmacists and doctors without the specific softwear can access the system through the website www.ICERx.org. through Informed Decisions Group and the American Medical Association.
Scientists have found new gene variations that raise the risk of type 2 diabetes. In one of the largest studies yet of human genetic variability, scientists tested the DNA of more than 32,000 people to pin down the spots that harbor genetic risk factors for this complicated killer. This type of research—called “genome-wide association study—promises to usher in a new era of genetics. The work, by three international research teams that shared their findings, was published online by the journal Science. Also the journal Nature Genetics reported separately finding the same new genes seem to increase the diabetes risk.
Elderly people who are depressed are more likely to become diabetic than those who are not according to a study that suggests depression may play a role in causing type 2 diabetes, the most common form of the disease. Writing in the Archives if Internal Medicine April 23,2007 journal, Mercedes Carnethon, lead author of the article of the Northwestern University Feinberg School of Medicine, found that the findings suggest may play a role in causing diabetes. The study statistically accounted for lifestyle risk factors for diabetes like being overweight and sedentary and still found that depression increased the risk for diabetes. The researchers tracked 4,681 men and women in North Carolina, California, Maryland, and Pennsylvania age 65 and older with the average age of 73 who did not have diabetes when the study began in 1989. For 10 years, they were screened annually for 10 symptoms of depression. The findings point to the importance of doctors screening older adults for depression and, if present, for diabetes, the researchers concluded.
Those of us who have hypoglycemic events because we have tight control of our diabetes and try to keep our A1c levels as normal as possible have wondered about the affects these have on out mental functioning. Dr. Alan Jacobson, director of the behavioral and mental health research program, et al from Joslin Diabetes Center examined patients from the DCCT study; they randomly divided patients into two groups, one “intensive management" program and one “standard" care program. Those in the intensive group were urged to get their A1c scores as close to normal as possible —that is under 6 percent. At the end of the study this group—18 years latter—lowered their scores to 7 percent while the standard treatment group lowered theirs to 9 percent. During that time there were a total 1,355 episodes of coma or seizure due to hypoglycemia. Three of the more than 1,100 people in the trial also died due to hypoglycemia. Not surprisingly, there were more incidences of low blood sugar in those in the intensive management portion of the trial. However, the good news from this study is that occasional hypoglycemic events didn’t appear to have any effect on long-term cognition. Dr. Jacobson stated, “Of course, it goes without saying that hypoglycemia can be a serious problem. But if you’ve had a more serious hypoglycemic event, at least it appears that you don’t have to worry that 10 years later you may have trouble doing your job or thinking."
Headlines can bring good news as the one about hypoglycemia or something that you may want to talk over with your physician if you are at those years when having a child is a focus of your marriage. The BBC 5/2/07 published an article about research reported in Human Reproduction by Dr, Allan Pacey from Sheffield University. Tests showed DNA in sperm from diabetic men had more signs of damage than men without the condition. Defective sperm DNA is one cause of male infertility, pregnancy failure and miscarriage, but the implications for sperm affected by diabetes is unknown. The study of 56 sperm samples is the first to compare the quality of DNA is sperm from men with and without diabetes. Around 52% of the DNA in the sperm was fragmented in the diabetic men compared with 32% in the men without the disease. The study also found a higher rate of deletions of DNA in the mitochondria-tiny, energy-generating compartments found within cells. Semen volume was significantly less in diabetic men, but there were no significant differences in sperm concentration, structure of the sperm or their ability to move. Although the men in the study had type 1 diabetes the researchers have found the same DNA damage in sperm from men with type 2 diabetes.
Now on to our abstracts. Each month we write an article titled Burning Calories because exercise is an important aspect of controlling diabetes and keeping our bodies strong and healthy. The American Journal of Clinical Nutrition, Vol.85. No.4, 1005-1013, April 2007 has an excellent article that shows that it’s never too late. This research done by Dr. Wayne W. Campbell et al from Perdue University assessed the influence of dietary protein independently intake on Resistance training (RT) induced changes in systemic glucose tolerance and contents of skeletal muscle insulin signaling proteins in healthy older persons. Thirty-six men and women in their early 60s experienced significant improvements in glucose tolerance after a 12-week resistance-training regime. People lose their ability to metabolize sugar effectively as they age, even if they’re otherwise healthy. Weight gain that frequently accompanies aging worsens glucose tolerance and compounds diabetic risk. One in five American older than 60 years has type 2 diabetes. The researchers had the study participants work out on resistance machines thee times a week during the study. Half of the participants consumed 0.9 grams of protein for each kilogram of body weight per day (low-protein group, LP) and the other half consumed 1.2 grams of protein per kilogram (high protein group, HP). The current recommended amount of protein is 0.8 grams per kilogram of weight. The results showed that after RT, body weight was unchanged; whole-body protein and water masses increased, and fat mass decreased with no significantly different responses observed between LP and HP groups. The RT-induced improvement in oral glucose improvement in oral glucose tolerance was not significantly different between the groups. The insulin and C-peptide AUCs decreased in the LP group but did not change significantly in the HP group. Skeletal muscle insulin receptor, insulin receptor substrate-1, and Akt contents were unchanged, and the amount of a typical protein kinase, a protein involved with insulin signaling, increased 56% with RT, independent of protein intake. The researchers concluded that the results support the hypothesis that older people who consume adequate or moderately high amounts of dietary protein can use RT to improve body composition, oral glucose tolerance, and skeletal muscle protein kinase ?/? without a change in body weight.
Diabetes Research and Clinical Practice, Vol. 77, Issue 1, 126-133, July 2007 has an article those of us with diabetes will want to read titled Undertreatment of cardiovascular risk factors among persons with diabetes in the United States by Shaista Malik et al. This is one to take to your health care provider and ask how you are doing. We all know that diabetics are at very high risk for cardiovascular diseases. The researchers’ objective was to examine the extent of control of cardiovascular risk factors and distance from the goal for those with uncontrolled levels in a recent sample of U.S. adults with diabetes. In the cross-sectional National Health and Nutrition Examination Survey 2001-2002, 532 (projected to 15.2 million) or 7% of adults aged = 18 years had diabetes. Use of antihypertensive, antidiabetic and antidyslipidemic medication was examined. The researchers determined the proportion of subjects not at goal for blood pressure (BP), lipids and glycosylated hemoglobin (A1c) and examined the distance from goal for those not under control. Overall, 50.2% of the patients with diabetes were not at goal for A1c, 64% for low density lipoprotein-cholesterol (LDL-C), 52.3% for high density lipoprotein-cholesterol (HDL-C), 48.6% for triglycerides and 53.0% BP. Only 5.3% of men and 12.7% of women with diabetes were simultaneously at goal for A1c, LDL-C, and BP. Even among those on treatment, most were not at goal for those parameters. Women were more likely to have LDL-C and HDL-C not at goal than men. Non-Hispanics Blacks were more often not at goal for BP and LDL-C. Mean distances from targets were 36mg/dl for LDL-C, 18mmHg for systolic BP, 6mmHg for diastolic BP and 2.0% for A1c. The researchers concluded that many U.S. adults with diabetes have sub-optimal control of cardio-vascular risk factors and remain far from target goals.
BSP
