Let’s start with our headlines and then go on to abstracts on the subjects of Metabolic Syndrome Predicts Heart Risk: Study and Sitagliptin for type 2 diabetes. The risk of depression is well known for people with diabetes. For that reason we bring you the following: Depression and loneliness may be tied to physical ills such as heart disease and dementia according to thee sets of researchers writing in the Archives of General Psychiatry. Dr. Jesse Stewart, formally of the University Of Pittsburg School Of Medicine, found a correlation between depression and hardening of the arteries in his three-year study of 324 men and women who averaged 60 years old. The arteries of those who were depressed had narrowed twice as much as those who were least depressed. Hardening of the arteries leads to an overreaction of the immune system and resulting inflammation is known to release chemicals that can influence behavior. Another study found that persistent feeling of loneliness among the elderly doubled their risk of developing Alzheimer’s-like symptoms compared to those who felt connected to others. The third study looked at people in Great Britain with severe mental illness and found this population less than 50 years of age was more than 3 times more likely to die of coronary heart disease and stroke.
Each month we try to remind you to read articles on exercise that we have here on diabetic-lifestyle.com knowing the important link between diabetes health and exercise is. The sad facts are that most people with type 2 diabetes or those at risk for the disease do not head this advice to become more active. In fact, Dr. Elaine Moreno, an assistant professor at the University of Colorado, Denver who has a PhD in public health and epidemiology surveyed more than 22,000 patients and founds that although nearly quarters of diabetes reported that doctors had advised them to exercise, fewer than 40 percent get exercise. The study found that the more danger the patients are in, the less likely they are to be active. Dr. Larry Deeb, president of medicine and science at the ADA said that by the time patients have type 2 diabetes or are at risk of getting it, the deck may be stacked against them. Without exercise, this population is at increased risk of nerve damage and high blood pressure, however, they may already have problems with mobility as a result of obesity or foot or circulatory disorders that make exercise difficult. “He responded to the research by saying, “There’s a difference between being unable and being unwilling." The question, then becomes, what to do with this information. How do we as a society stem the incidence of obesity and lack of exercise which will continue to raise the number of type 2 diabetics in this country?
As a type 1 diabetic, I read with interest that cells passed from mother to child during pregnancy can grow into functioning pancreatic cells that produce insulin. The findings were published in the Jan.22, 2007 journal Proceedings of the National Academy of Science. The research done at the Fred Hutchinson Cancer Research Center in Seattle found that children and young adults with type 1 diabetes had higher levels of maternal DNA in their blood than siblings or unrelated people without diabetes. This suggests an attempt to repair damaged tissue. The researchers found no evidence that the mother’s cells were attacking the child’s insulin cells or that the maternal cells were being attacked by the child’s immune system. “We think the maternal cells may be helping to regenerate damaged tissues in the (child’s) pancreas." Dr. J. Lee Nelson, member of the research division at Hutchinson, said in a prepared statement.
Modern blood pressure treatments are less likely to be associated with new cases of diabetes than older medicines, researchers at Rush University Medical Center, Chicago, reported in Jan., 2007. The propensity of some blood-pressure-lowering drugs to reduce glucose tolerance and trigger diabetes has been known for some time but a meta-analysis of past clinical trials found the danger was less with angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme inhibitors (ACR). William Elliott and colleagues reported in the Lancet medical journal that the link with incidents of diabetes was lowest for ARBs and Ace inhibitors, followed by calcium-channel blockers and placebos, than beta-blockers and diuretics.
Finally, the FDA has approved orlistat capsules as an over-the-counter weight loss aid for overweight adults. “We know that overweight has many adverse consequences, including an increase in the risk of heart disease and type 2 diabetes", said Dr. Douglas Throckmorton, Deputy Director for FDA’s Center for Drug Evaluation and Research. This medication is not for people who have problems absorbing food or nor people who are not overweight. Make sure you talk to your physician about side effects and precautions.
We talk about heart disease and diabetes frequently on this site just because those of us with diabetes have a four-fold risk of developing this class of disease. Metabolic syndrome can be a precursor of the diagnosis of type 2 diabetes. This article is available in the Jan. 30 issue of the Journal of the American College of Cardiology and addresses Metabolic Syndrome Predicts Heart Risk: Study by Dr. Apoor S. Gami, an assistant professor of medicine at the Mayo Clinic College of Medicine. Metabolic syndrome is a cluster of cardiac factors and is known to be a strong indicator of increased risk of heart disease. This syndrome includes factors such as lower0abdomen obesity, high blood pressure, blood fat disorders such as high LDL cholesterol, and insulin resistance or elevated sugar levels. Generally, someone with three or more of these factors is said to have metabolic syndrome. The question that the research looked at is what is the risk associated with metabolic syndrome. They did a meta-analysis from a host of prior studies to come up with a solid conclusion. The analysis of 37 studies included more than 170,000 people. Gami and his colleagues not only analyzed published studies, but also sought more detailed information from the researchers who did the studies. The meta-analysis found that the risk of heart attack or death was 78 percent higher for people with metabolic syndrome than those who did not have the constellation of risk factors. “The main take-away from this study is that people identified with metabolic syndrome, regardless of the criteria used to describe metabolic syndrome, are at increased risk of cardiac events or death,: Gami said. “There is anywhere from a 50 percent to 200 percent increase in risk, which seems to be stronger in women." Although there is some controversy about the definition of this syndrome and its components, Gami responded by sharing that the presence of the metabolic syndrome provides better evidence of risk than taking individual components of the syndrome one by one. Gami countered. “Three studies addressed this, and the risk was increased by 50 percent above those of the individual risk factors that were present," he said. What we hope you take away from this article is the fact that you have control of your health. It means that you and your health care team need to join together to get your blood pressure down if it is elevated, and your weight more normal. That stomach fat has to be worked off by exercise and blood glucose levels need to normal. To that end we all need to know our HA1c levels, LDL score, blood pressure, and weight.
We get the Medical Letter each month and are happy to share articles that can help our readers understand how to manage diabetes. The Jan. 1, 2007 issue has an article about Sitagliptin (Januvia) for Type 2 Diabetes. Sitagliptin phosphate (Januvia-Merck) is the first dipeptidyl-peptidase-4 (DPP-4) inhibitor to be marketed for the treatment of type 2 diabetes. It has been approved by the FDA for oral use as monotherapy or in combination with metformin (Glucophage, and others), pioglitazone (Actos) or rosigilitazone (Avandia). In several studies, Sitagliptin-treated patients showed improvement in some indices of hormone secretion and beta-cell function, including HOMA-B and fasting proinsulin-to-insulin ratio. Whether beta cells can actually be preserved or regenerated in humans remains to be established. In clinical trials, the incidence of adverse effects with Sitagliptin 100mg daily was similar to that of placebo. The incidence of gastrointestinal effects or hypoglycemia was no higher with Sitagliptin than with placebo. Treatment with Sitagliptin once daily had no effect on weight. The article concluded Sitagliptin (Januvia), the first of a new class of type 2 drugs, appears to be effective as monotherapy and in combination with other antibiotic drugs and is well tolerated, even in patients with decreased renal function. To date it has not caused weight gain or hypoglycemia, but any drug that causes increased insulin production will probably cause hypoglycemia in some patients. The effectiveness of Sitagliptin compared to older drugs and its long-term safety and efficacy remain to be established. Metformin and sulfonylureas appear to be more effective in lowering HbAi1c levels in the short term, and they cost much less.
BSP
