We begin with our headlines. After those we will bring you articles of interest which we hope will keep you on target. These are on the worsening of movement problems and diabetes, ketoacidosis in both type 1 and type 2 diabetes, the relationship between physical activity vs. BMI in women with type 2 diabetes, and the affects of acute hyperglycemia on mood and cognitive performance in type 2 diabetes.
We first share two articles from the latest Diabetes Care magazine. The first is titled Atrophy of foot muscles by Henning Anderson, MD, PhD et al, 2382-2385. The researchers knowing that diabetic neuropathy in a length-dependent process that leads to decreased muscle strength and atrophy of leg muscles in some patients looked at the total volume of the intrinsic foot muscle in the non-dominant foot in long-term diabetic patients. They found that total volume of the foot muscles is halved in patients with diabetic neuropathy. The atrophy is closely related to the severity of neuropathy and reflects motor dysfunction.
Our second headline, also in the same journal, p. 2325-2319 by Patrick J.O’Connor, MD, MPH et al is titled Is patient readiness to change a predictor of improved glycemic control? This is a randomized survey data with HbA1c of consenting adults with diabetes. Change in the HbA1c from baseline to a 1-year follow-up was computed. What do you guess? Well the researchers found that diabetes readiness to change independently predicts change HbA1c for patients with high functional health status, but not for those with low status. The researchers hope that customized use of readiness to change will be used to treat those with diabetes.
The Archives of General Psychiatry, 2004;61:1042-1049 addresses depression and diabetes in the Pathway Study by Wayne J. Katon, MD et al. Pathway is a collaborative Care model. There is a known association between depression and diabetes. This can lead to poor self-management for some people. The researchers looked at whether enhancing the quality of care for depression improves both depression and diabetes outcomes in patients with both. The Pathway collaborative care model which includes a Pathway case manager with enhanced education, support, and/or medication for depression made significant differences at 6 months and 12 month follow-ups in terms of depression. The not so good news is that this did not translate to improved glycemic control. Keep your eyes here. Hopefully, this is just a first step in figuring out the relationship between these two diagnoses.
Finally, just as you are thinking of sneaking a piece of a cousin’s sinful dessert, we bring you information from the Archives of Internal Medicine 2004;164:1737-1748 by Hoong Sern Lim, MRCP et al from an article titled Diabetes mellitus, the retin-angiotensin-aldosterone system, and the heart. With type 2 diabetes at epidemic proportions secondary mainly to obesity, the impact of cardiovascular disease makes this a dominant public health problem. The complex interaction that results in diabetic heart disease is created by overlapping mechanisms. There is a propensity to develop premature, diffuse atherosclerotic coronary disease, which is associated with adverse short- and long-term morbidity and mortality. There are structural and functional abnormalities of the microvasculature, autonomic dysfunction, and intrinsic failure of myocardial contraction. These changes are amplified by arterial hypertension and kidney disease. In this review the writers talk about how in the last 5 years blocking the retin-angiotension-aldosterone system has emerged as a critical therapeutic intervention.
Neurology, 2004;63:996-1001 has a very interesting article titles Diabetes mellitus and progression of rigidity and gait disturbance in older persons by Z. Arvanitakis, MD et al from the Rush University Medical Center in Chicago. Parkinsonian-like signs, including rigidity, gait disturbance, and bradykinesia are common in old age and are associated with morbidity and mortality. Few risk factors for these signs have been identified. The authors looked at if diabetes, which becomes more common as people age, is associated with physical and neurologic disability and may be associated with these Parkinsonian symptoms. The researchers examined 822 older Catholic clergymen and women who were without clinically diagnosed Parkinson disease or dementia at baseline. They were followed for up to 9 years with uniform annual evaluations. Diabetes was present in 128 (15.6%) of the participants. In random effects models controlling for age, sex, and education, diabetes was associated with worsening rigidity and gait, over an average of 5.6 years, but not with bradykinesia or tremor. The presence of stroke did not substantially affect the association of diabetes with rigidity but reduced the association of diabetes with gait to a trend. The researchers concluded that diabetes may be a previously unrecognized risk factor for progression of Parkinsonian-like signs in older people.
The Archives of Internal Medicine, 2004;164:1925-1931 has an article of interest to all of us with diabetes titled Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus by Christopher A. Newton, MD and Phillip Raskin, MD. The researchers wrote an overview and analysis of different clinical and biochemical characteristics of diabetic ketoacidosis (DKA) that might be predicted between patients with type 1 and type 2 diabetes. They reviewed 176 admissions of patients with moderate-to-severe DKA. Patients were classified as either type 1 or type 2 diabetics based on history, medical treatment, and/or autoantibody status. Groups were compared for differences in symptoms, precipitants, vital statistics, biochemical profiles at presentation, and response to therapy. Of 138 patients admitted for moderate-to-severe DKA, 30 had type 2 diabetes. A greater proportion of the type 2 diabetes group was Latino American or African American. Thirty-five admissions were for newly diagnosed diabetes. A total of 85% of all admissions involved discontinuation of medication use in the type 2 group. Infections were present in 21% of the type 1 and 48.4% of the type 2 diabetes admissions. A total of 21% of patients with type 1 diabetes and 70 % with type 2 diabetes had a body mass index greater then 27. Although, the type 1 diabetes group was more acidotic, type 2 diabetes patients required longer treatment periods to achieve ketone-free urine. Complications from therapy were uncommon. The researchers concluded that a significant proportion of DKA occurs in patients with type 2 diabetes. The time-tested therapy for DKA of intravenous insulin with concomitant glucose as the plasma level decreases, sufficient fluid and electrolyte replacement, and attention to associated problems remains the standard of care irrespective of the type of diabetes.
JAMA. 2004;292:1188-1194 has an article titled Relationship of physical activity vs. body mass index with type 2 diabetes in women by Amy R. Weinstein, MD, MPH et al from Boston. Physical inactivity and BMI are established independent risk factors in the development of type 2 diabetes; however, their comparative importance and joint relationship with diabetes is unclear. These researchers examined the relative contributions and joint association of BMI and inactivity. This is a prospective cohort study of 37,878 women free of cardiovascular disease, cancer, and diabetes with a mean follow-up of 6.9 years. Weight, height, and recreational activities were reported at study entry. Normal weight was defined as a BMI less than 25; overweight25 to less than 30; and obese, 30 or higher. Active was defined as expending more than 1000kcal on recreational activities per week. The results indicated that during the follow-up 1361 cases of incident diabetes occurred. Individually, BMI and physical inactivity were significant predictors of diabetes. In a combined analysis, overweight and obese participants, whether active or inactive, had significantly elevated risks of developing diabetes, compared to normal-weight active people. Their conclusion from all of the data indicated that although BMI and physical inactivity are independent predictors of incident diabetes the magnitude of the association with BMI was greater than with physical activity in combined analysis findings. Theses findings underscore the critical importance of adiposity as a determinant of diabetes.
Just to make sure you try to keep blood glucose levels normal during the holidays we share an article from Diabetes Care 27;2355-2340,2004 titled Acute hyperglycemia alters mood state impairs cognitive performance in people with type 2 diabetes by Andrew J. Sommerfield, MRCP et al from the UK. The researchers looked at the effects of acute hyperglycemia on cognitive function and mood in type 2 diabetes. Twenty subjects with type 2 diabetes, medium age 61.5 years, known duration of diabetes 5.9 years, and HbA1c 7.5% were studied. Treatment ranged from antidiabetic medications to insulin. A hyperinsulinemic glucose clamp was used to maintain arterialized blood glucose at either 4.5 (euglycemia) or 16.5 mmol/l (hyperglycemia) on two occasions in a randomized and counterbalanced fashion. Tests of information processing, immediate and delayed memory, working memory, and attention were administered, along with a mood questionnaire, during each experimental condition. The results indicate that during acute hyperglycemia cognitive function was impaired and mood state deteriorated in a group of people with type 2 diabetes. Speed of information processing, working memory, and some aspects of attention were impaired during acute hyperglycemia. Subjects were significantly more dysphoric during hypoglycemia, with reduced energetic arousal and increased sadness and anxiety. This is an important finding because intermittent or chronic hyperglycemia is common in people with type 2 diabetes and may interfere with daily activities through adverse effects on cognitive function and mood.
BSP
