We begin with headlines and then as each month, we bring you an interesting articles and abstracts. We share an update on fixed-dose medication for those of you with type 2 diabetes, research on stroke and newly diagnosed type 2 diabetics, and finally sexual function and endocrine profile in type 1 diabetic women. Get your coffee or tea hot again and here we go.
Let’s start with our headlines. Whole grains and foods low in the glycemic index may help those of us with diabetes as well as those in the general population. Here are two headlines that will attest to this. Diabetes Care, Feb., 2006 reports that women with type 2 diabetes who incorporate more whole grains, bran, and cereal fiber into their diets may reduce their risk of heart disease. What’s more, low-glycemic index foods may also help curb early signs of heart trouble. The study written by Dr. Lu Qi at Harvard School of Public Health found that women who ate the higher fiber diet tended to have lower levels of two markers of blood vessel inflammation that are linked to heart disease—CRP and TNF-R2. The researcher recommends that women with diabetes “consume whole grain bread and cereals and less refines grains. In addition, a meal with low glycemic components such as bean, cruciferous vegetables, low-fat unsweetened yogurt, grapefruit, apples, tomatoes will also help."
The American Journal of Clinical Nutrition has an article which found that diets rich in whole grains can lower the risk of diabetes and heart disease. The study examined the diet records and blood samples of nearly 1,000 healthy middle-aged adults and measured levels of insulin and hemoglobin A as an index of diabetes risk, as well as homocysteine and cholesterol concentration to gauge coronary heart disease. The authors concluded that while there appears to be a lowered risk of diabetes and heart disease among individuals who consume higher levels of whole grains, the reasons for how this works is unclear. However, whole grains are rich in fiber, minerals, vitamins, and antioxidants. “These compounds all may have important biological functions which as a whole are an important contribution to reductions in diabetes and ischemic heart disease". The authors speculated also that slower digestion is likely a key factor as well.
One more abstract about heart disease will hopefully help all of us to rededicate ourselves to a heart healthy life style. Circulation, Feb.7, 2006 has an article written by Dr. David C. Goff from Wake Forest University School of Medicine. This article concludes that people who are at highest risk for cardiovascular disease generally have the lowest level of control of high cholesterol levels. They conclude that since cardiovascular disease is a public health problem in the US and there is a known benefit of using lipid-lowering therapy for primary prevention, “…efforts to improve the treatment and control of (high cholesterol) and to eliminate disparities…should be considered among our highest national healthcare quality improvement priorities."
Diabetes Care, February 2006 has an article that will again have all of us using intensive therapy in treating our diabetes. This study involved 1,257 subjects who were enrolled in the Diabetes Control and Complications Trial who were randomly assigned to receive intensive or conventional diabetes therapy. The intensive approach involved at least three injections of insulin per day, while the conventional approach involved no more than two. After following the subjects for an average of 6.5 years, all the subjects were encouraged to use the intensive therapy. The patients were then evaluated annually for neuropathy and other complications. Patients who received intensive therapy were 64 percent and 45 percent less likely to have symptoms and signs, respectively, of neuropathy compared to those who received conventional therapy. The benefit persisted fro at least 8 years after the end of trials. The researchers concluded the relationship between blood sugar control and neuropathy suggests that interventions have durable effect on neuropathy similar to what has previously been noted in diabetic eye disease and kidney.
Now is the time to read our abstracts. The Medical Letter on Drugs and Therapy is published by The Medical Letter, Inc. Volume 48, January 30, 2006 highlighted Pioglitazone/Metformin combination for type 2 diabetes. This information is important so we are bringing it you for your edification. For some patients, taking one medication to fight hyperglycemia does not do the job. The FDA has approved a fixed-dose combination of two popular medications called Actoplus met—Takeda. It is made up of metformin (Glucophage) and thiazolidinedione pioglitazone (Actos). It is suggested for patients already being treated with both of these medications or as a second-line therapy for those not adequately controlled with either medication alone. Rosigilitazone, another thiazolidinedione, is also available in a fixed-dose combination with metformin. The two medications work differently. Thiazolidinediones such as pioglitazone improve sensitivity to insulin in muscles, adipose tissue, and the liver. Metformin acts primarily by reducing hepatic glucose production, but also improves peripheral glucose uptake and utilization. Studies have shown that the fixed-dose combination is equivalent to the same doses of the individual drugs taken at the same time. The clinical efficacy and safety of Actoplus met have been established only I studies of pioglitazone and metformin taken concurrently. Adverse side effects of metformin include gastrointestinal difficulties including metallic taste, nausea, abdominal pain, and diarrhea as well as modest weight loss. Pioglitazone patients often gain weight, but the fixed-dose combination lowers that median weight gain from 2.6 kg for pioglitazone alone to 1.8 kg with the combined fixed-dose medication. The article reports on Adverse Effects including Lactic Acidosis, Heat Failure, Hepatotoxicity, Pregnancy, Drug Interactions, Dosage and Administration and concludes that the fixed-dose combination of these two medication in Actoplus met could be more convenient and less expensive than taking the drugs separately, but the limited number of tablet strengths could reduce flexibility in dosing. Whether the new fixed-dose combination offers any advantage over rosiglitazone/metformin remains to be established.
An increasing incidence of type 2 diabetes could bring a rise in death and disability caused by stroke according to a Canadian study of more than 12,000 newly diagnosed type 2 diabetics. These findings were presented to the American Stroke Association annual stroke conference by Dr. Thomas Jeerakathil, an assistant professor of neurology and medicine at the University of Alberta. His group found that people newly diagnosed with type 2 diabetes have a double risk of stroke, and those under 55 years of age are at greatest risk to be admitted to a hospital for stroke. Of the study population more than 9% were admitted to the hospital for stroke in the first five years after diagnosis. This finding “argues for very aggressive cardiovascular risk factor control". The researchers suggest advising diabetics to pay attention to cholesterol and blood pressure, to stop smoking, exercise, and eat a diet high in whole grains and vegetables. Concern was noted that when people are diagnosed they think they have years until complications kick in. “In fact there is real risk of stroke even in the first few years after being diagnosed."
Diabetes Care 29:312-316, 2006 has an interesting article titled Sexual function and endocrine profile in fertile women with type 1 diabetes by Andrea Salonia, MD et al. The researchers assessed sexual function and endocrine profile among fertile type 1 diabetic women during the follicular and luteal phrases of the menstrual cycle, to compare these results with those obtained among healthy luteal women who served as control subjects, and to explore the correlations between sexual function and endocrine milieu among patients and control subjects during the follicular and luteal phases of the menstrual cycle. Fifty fertile women with type 1 diabetes and 47 healthy control subjects completes a semi-structured medical interview and filled in self-administered validated instruments to evaluate sexual function, depression, and sexual distress. The results indicate that type 1 diabetic women had decreased sexual function and increased sexual distress compared with control subjects during the luteal, but not the follicular, phase of the menstrual cycle. During the follicular phase, patients had lower estrogenic tone, lower “weak" androgen production, and lower free-triiodothyronine and free-thyroxine levels compared with control subjects. During the luteal phase, total testosterone levels were the higher in patients than control subjects, while 17ß-estradiol and progesterone levels were lower in patients than in control subjects. They concluded that among type 1 diabetic women, sexual function and sexual distress vary according to the phase of the menstrual cycle. The finding has implications on the clinical assessment of sexual function in type 1 diabetic women.
BSP
