As we do each month, we will begin this month with headlines which highlight the breaking news you need to know. Then we bring you journal abstracts. This month we share articles about the long term effects of vitamin E on cardiovascular events and cancer, depression symptoms and antidepressant medicine use in Diabetes Prevention Program participants, and finally coronary artery disease in type 1 diabetic transplant candidates.
Diabetes Care, April 2005, brings us our first headline. We have a multitude of articles on exercise on the site. You may ask why, but if you read on, the answer will become evident. Researchers in Finland followed over 3000 men and women with type 2 diabetes for almost 19 years. They found that participants who reported moderate or high levels of physical activity were less likely to die of cardiovascular disease or from any other cause than less active adults. “The benefits of physical activity in subjects with and without obesity, with and without hypertension, with normal cholesterol, and with hypercholesterteremia, in subjects who report never smoking or current smoking," study author Dr. Gang Hu reports in the article. The researchers conclude that “There is no doubt that physical activity should be considered an integral part of treatment among patients with type 2 diabetes".
Again, look at the EXERCISE articles for more information about how to get started, how to remain motivated, and what exercises are out there.
Here’s an interesting headline which appears in April’s Diabetes. In the article Dr. Nicola Abate describes a gene mutation which makes people especially vulnerable to type 2 diabetes. If a person has this gene variation then-without waiting for the development of insulin resistance- he or she should be encouraged to follow lifestyle changes to prevent the onset of diabetes. According to Abate’s team, the gene encodes a protein that blocks the action of insulin. The ENPP1 variant identified in this study boosts the action of this protein, blocking insulin action even more than normal.
The Archives of Internal Medicine 2005;165:436-441 has an article about Performance of screening questionnaires and risk scores for undiagnosed diabetes. The sad thing about this article is that with the epidemic of obesity and diabetes as well as heart disease in the world the results indicated that current proposed questionnaires yielded low validity when applied to a new population likely due to differences in their characteristics. Performance of diabetes risk questionnaire scores must be assessed to the target population where they will be applied. What this means is that the published screening questionnaires and risk scores for undiagnosed diabetes do not work well in all populations.
This next article which also appeared in the Archives of Internal Medicine, 2004;164:167-705 has special interest to many of us trying to control LDL and who have negative side effects from statins. The title is New perspectives on the use of niacin in the treatment of lipid disorders. This article published by the Virginia Commonwealth University, James McKenney, PharmD, reiterates the benefits of the use of niacin and more importantly the benefits of extended release niacin which is associated with fewer flushing and gastrointestinal symptoms without increasing hepatotoxic risk. According to the article niacin-induced changes in serum lipid levels produce significant improvements in both coronary heart disease and clinical outcomes. It significantly reduces LDL, triglycerides, and lipoprotein (a) levels, while increasing HDL cholesterol levels.
Here’s a headline to make you push away from the table and start that exercise program yesterday. In Britain, which has the fastest growing rate of obesity in the developed world, one in five people has a serious weight problem. Douglas Smallwood, the executive chief of Diabetes UK reported that people who are obese are up to 80 times more likely to develop diabetes. Obesity is not the only risk factor for diabetes, but Diabetes UK reports that people who have a body mass index (BMI) of more than 30 are 10 times more likely to develop other illnesses also.
Finally, Diabetes Care, March 2005, has a report that Long-acting insulin is unaffected by exercise by Dr. David R. Owens. In people with type 1 diabetes exercise does not appear to increase the rate of absorption of insulin glargine (Lantus). The study suggests that insulin glargine can be safely and effectively administrated without a dose change during exercise. However, the researchers note that the study does not rule out the possibility of exercise-induced low blood sugar, also called hypoglycemia, and insulin glargine reduction may be warranted depending on individual patient reactions. The researchers cautioned against over interpreting the results, noting that real-world exercise activity may have different effects on glargine absorption.
The news this month is replete with new information about that wonder vitamin E which many of us thought would keep us healthy after we read articles and saw news coverage about it on the TV. JAMA 2005;293:1338-1347 has an article titled Effects of long-term vitamin E supplementation on cardiovascular events and cancer, a randomized controlled trial by the HOPE and HOPE-TOO Trial Investigators. Experimental and epidemiological data suggest that vitamin E supplementation may prevent cancer and cardiovascular events. Clinical trials have generally failed to confirm benefits, possibly due to their relatively short duration. The researchers evaluated whether long-term supplementation with vitamin E decreases the risk of cancer, cancer death, and major cardiovascular events. A randomized, double blind, placebo-controlled international trial (the initial Heart Outcomes Prevention Evaluation (HOPE) trail conducted between December 21, 1993, and April 15, 1999) of patients at least 55 years with vascular disease or diabetes mellitus was extended (HOPE-The Ongoing Outcomes (HOPE-TOO) between April 16,1999, and May 26, 2003. Of the initial 267 HOPE centers that had enrolled 9541 patients, 174 centers participated in the HOPE-TOO trial. The intervention was a daily dose of natural source vitamin E (400 IU) or matching placebo. Among all HOPE patients there were no significant differences in the primary analysis. In patients with vascular disease or diabetes mellitus, long-term vitamin E supplementation does not prevent cancer or major cardiovascular events and may increase risk for heart failure.
Diabetes Care 28: 830-837, 2005 has an article of importance to many of you who write in and ask about diabetes and depression. Depression symptoms and antidepressant medicine use in diabetes prevention program participants, written by The diabetes prevention program research group is that article. The objective of this research is to assess depression markers in Diabetes Prevention Program (DPP) participants and to determine whether changes in depression markers during the course of the study were associated with treatment arm, weight change, physical activity level or participant demographic characteristics. DPP participants (3,187) in three arms (intensive lifestyle, metformin, and placebo) completed the Beck Depression Inventory (BDI) and reported on the use of antidepressant medications at randomization and subsequently at each annual visit (average duration in study 3.2 years). On study entry, 10.3% of participants had BDI scores <= 11, which was used as a threshold for mild depression, 5.9% took antidepressant medications, and 0.9% had both depression markers.
During DPP, the proportion of participants with elevated DBI scores declined (from 10.3% at baseline to 8.4% at year 3), while the proportion with either marker was unchanged. These time trends were not significantly associated with DPP treatment arm. Depression markers throughout the study were associated with some participant demographic factors, adjusted for other factors. Men were less likely to have elevated depression scores and less likely to use antidepressant medication as baseline and throughout the study. Those with more education were less likely to have elevated symptom scores but more likely to be taking antidepressant medication. Non-Hispanic white participants were than African American to have BDI scores <= 11, but white participants were more likely to be taking antidepressant medicine than any other racial/ethnic group. The researchers concluded that participation in DDP was not associated with changes in levels of depression. Countervailing trends in the proportion of DDP participants with elevated depression symptoms and the proportion taking antidepressant medicine resulted in no significant change in the proportion with either marker. The finding that those taking antidepressant medicine often do not have elevated depression symptoms indicates the value of assessing both markers when estimating overall depression rates.
Our last article caught our eye as anyone with type 1 diabetes is interested in those who undergo islet transplantation .Diabetes Care 28:866-872,2005 has an article titled Coronary artery disease is common in nonuremic asymptomatic type 1 diabetic transplant candidates by Peter A. Senior, MBBS, PHD et al. Coronary artery disease (CAD) is common in uremic diabetic patients, but its prevalence in nonuremic type 1 patients is unknown. The prevalence of CAD was determined by coronary angiography and the performance of noninvasive investigation evaluated in a total of 60 consecutive candidates for islet transplantation with preserved renal function. The research reported that most subjects had no history or symptoms of CAD;23 (43%) of these asymptomatic subjects had stenoses >50%. CAD was associated with age, duration of diabetes, hypertension, and smoking. Although specific electrocardiographic stress test (EST) and myocardial perfusion imaging (MPI) were not sensitive as predictors of CAD on angiography but helped identify two of the three subjects requiring revascularization. EST and MPI did not enhance logistic regression models. A clinical algorithm to identify low-risk subjects who may not requite angiography was highly sensitive but was applicable only to a minority. They concluded that nonuremic type 1 diabetic patients with hypoglycemic unawareness and/or metabolic liability referred for islet transplantation are at high risk asymptomatic CAD despite negative noninvasive investigations. Aggressive management of cardiovascular risk factors and further investigation into optimal cardiac risk stratification in type 1 diabetes are warranted.
BSP
