Our first headline comes from the journal Ophthalmology which found that women with type 2 diabetes have about a 70 per cent increased risk of developing the most common form of glaucoma—primary open-angle glaucoma—compared to women without diabetes. Lead researcher Dr. Louis Pasquale of the Massachusetts Eye and Ear Infirmary looked at 76,000 women enrolled in the 20-year long Nurses’ Health Study. Glaucoma occurs when there’s a gradual increase in the normal fluid inside the eyes. This causes damage to the optic nerve resulting in vision loss and blindness. Early detection and treatment can help prevent serious vision loss. Currently about 2 million Americans have this variety of the disease, and the ADA was so impressed with this research that they concluded that the risk of glaucoma is increased in people with diabetes.
The BBC News has printed research from the Lancet which concludes that a short course of intensive insulin may delay disease progression in people newly diagnosed with type 2 diabetes. All 380 patients in the study were later managed with a standard diet and exercise regime. A second study also published in Lancet found that taking part in diet and exercise programs for six years can prevent or delay diabetes for up to 14 years. Now you know why we work so hard to spread the message of nutrition and exercise on this web site.
The Journal Watch Pediatrics and Adolescent Medicine, April 23 , 2008, has a interesting article once again touting vitamin D. U.K. investigators conducted a systematic review and meta-analysis ( based on 1429 cases and 5026 healthy controls) in which they compared the risk for type 1 diabetes among people who did or did not receive supplemental vitamin D during infancy. In the meta-analysis, infants who received vitamin D supplementation were significantly less likely than those who did not receive it to have developed diabetes by 15 to 30 years. Limitations include the retrospective nature of the studies, recall bias, failure to document vitamin D levels before or after supplementation, and heterogeneity of types of supplements evaluated. Nontheless, dietary vitamin D supplementation can be recommended for many reasons, including bone health and now, diabetes. The researchers conclude that a prospective study is required to clarify the magnitude and mechanism of vitamin D’s influence on the underlying genetic propensity for type 1 diabetes.
The May, Diabetes Care has an interesting article about the influence of drug adherence and the race gap for African Americans and why they fare more poorly than whites in managing diabetes. The research done at Harvard Medical School reviewed the medical records of 1806 adult patients in their health system with type 2 diabetes. In general, the study found that black patients had a higher average blood sugar level than white patients did one year after starting drug therapy. They were also somewhat less likely to comply with the medication regime, which was gauged by how often patients refilled their prescriptions. The authors led by Dr. Alyce S. Adams said this did not fully explain the racial gap. They hypothesize that African-Americans tend to have more severe diabetes by the time they are diagnosed and treated, so they may need more intensive treatment off the bat, including higher medication doses. They also concluded that whatever the reasons for racial disparities it is unlikely that improving black patients’ medication adherence will be enough to close the gap.
The ADA, April 30, 2008 shared that new research suggests ties between gum disease (periodontitis) and diabetes. Because diabetes can affect circulation, it can restrict blood flow to the gums. That along with suppressed immunity in patients with diabetes can create the perfect setup for periodontitus. Recent research has suggested has suggested that treating periodontal disease can improve blood-sugar control. Consumer Reports states that some major insurance companies already offer patients with diabetes extended coverage for periodontal treatments. Do look into your policy. This is an important part of keeping healthy with diabetes.
Keeping on the dental and diabetes topic, the journal Pediatrics, May 2008, has an article that stated that children with diabetes may develop their permanent teeth earlier than normal, which could potentially increase their risk for dental problems. The researchers found that 10 to 14 year-olds with diabetes tended to have their final permanent teeth come in earlier than their peers did. The problem with such accelerated tooth “eruptions" is that they could raise the odds of misaligned or “crowded" teeth—which, in addition to cosmetic effects, can make it harder to clean the teeth and keep gums healthy. The research headed by Dr, Shantanu Lai of Columbia Medical Center. For now the researchers concluded that the research underscores the importance of regular dental checkups for children with diabetes. According to Lai’s team, the reasons for the speedier tooth eruption may have to do with gum inflammation, which tended to be greater in children with diabetes. Gum inflammation may diminish the mass of bones supporting the teeth, shortening the distance that developing teeth need to progress to break through the gums.
The New England Journal of Medicine, vol.358:1001-2002, May 8, 2008 has an interesting article titled Hyperglycemia and Adverse Pregnancy Outcomes, The HAPO study cooperative research group. It remains controversial whether maternal hyperglycemia less severe than that in diabetes is associated with increased risks of adverse pregnancy outcomes. A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter or less and the 2-hour plasma glucose level was 200 mg per deciliter. Primary outcomes were birth rates above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilrubinemia, and preeclampsia. For the 23,316 participants with blinded data, the calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD, an increase in the 1-hour plasma glucose level of 1 SD, and an increase in the 2-hour plasma glucose level of 1 SD were calculated. For birth weight above the 90th percentile, the odds ratios were 1.38, 1.46, and 1.38 respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55, 1.46,amd 1.37; for primary cesarean delivery, 1.11,1.10, and 1.08; and for neonatal hypoglycemia, 1.0, 1.13, and 1.10. There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker.
The authors concluded that the results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.
Pediatrics, Vol.121, No.5, May 2008: 1133-1138 has an article of interest to all of us who use insulin pumps or whose children use them, titled Adolescent Use of Insulin and Patient-Controlled Analgesia Pump Technology: A 10-Year Food and Drug Administration Retrospective Study of Adverse Events by Judith U. Cope, MD, MPH et al. From Jan.1, 2005, through Dec. 31, 2005, the Food and Drug Administration received 5 adolescent death reports associated with the use of insulin pumps, raising concerns about the use of this device in this age group. To understand better the types of infusion pump-related problems in adolescents, the researchers performed comprehensive evaluation of insulin and patients-controlled analgesic pup-related adverse events reported for adolescents that were received by the Food and Drug Administration from 1996 to 1005.
A search for medical device adverse event reports from Jan.1, 1996 through Dec.31, 2005, involving insulin pumps or patient-controlled analgesic pumps used by patients who were 12 to 21 years was conducted in the Food and Drug Administration’s Manufacturer and User Facility Experience Database. Reports were reviewed for demographic characteristics, type of adverse event, and patient morbidity, and potential contributory factors were classified from narratives in the reports.
A total of 1674 reports were identified: 1594 for insulin pumps and 53 for patient-controlled analgesic pumps. In reports of insulin pump events, there were 13 reported deaths, 2 reports that indicated possible suicide attempts, and several reports indicating severe hypoglycemic of hyperglycemic events that seemed to be device-related. A total of 102 insulin-pump reports highlighted factors that may have contributed to the adverse event, including problems associated with compliance, education, sports-related activities, and dropping or damaging the pump. Eighty-two percent of the cases involving the insulin pump resulted in hospitalization. Half of the reports involving patient-controlled analgesic pumps indicated that the patient received an excess of medication; tampering and noncompliance were evident in some case.
The researchers concluded that adolescents are a special population who deserved careful consideration of risk and benefit for use of device technology. Studies need to further identify safety problems in this age group.
BSP
