Before we begin, we were honored to be asked to review Conquering Diabetes, A Cutting-Edge Program for Prevention and Treatment by Anne Peters, MD, Hudson Street Press. Dr. Peters treats people from various socioeconomic strata in the Los Angeles area and has written a medical text on the subject. If you have just been diagnosed this is an excellent primer on how to care for yourself. It uses common sense to explain ways of controlling weight and blood glucose levels. We like this book because it discusses everything that we would have wanted someone to talk about with when we were first diagnosed. It talks about both type 1 and type 2 diabetes as well as Gestational diabetes. You will have a good idea about the importance of exercise, carbohydrate counting, which medications work to protect your cardio-vascular system if they are needed, long and short term complications and diet and nutrition after reading this book. She even talks about how to select a physician, a topic that is very important to anyone with the disease. Diabetes is a complicated disease and caring for yourself takes a great deal of information. Let’s hope that Dr. Peters continues to re-edit this book to bring her readers the best and most up to date information. This is not a book that talks down to the reader. You feel that an intelligent physician is spending time with you explaining in the ins and outs of diabetes and how to modify your lifestyle to live the fullest and most rewarding life possible. Even better than that it gives you the information needed to talk to your physician to make sure your medical care is the best possible.
As in other months we begin with headlines and then go on to the abstracts which will deal with Mortality in childhood-onset diabetes, Metabolic control of diabetes is associated with an improved response of diabetic retinopathy to panretinal photocoagulation, and Risk factors for declining ankle-brachial index in men and women 45 years and older.
Nature 2005;437:569-573 has an article by Dr. Christopher J. Hupfeld which postulates the chronically high insulin levels block beta-adrenergic receptors from activating protein kinase A, an enzyme that stimulates lipolysis in adipocytes. This may help to explain why obesity and diabetes often occur together. In type 2 diabetes this prolonged high insulin level can drown out the normal catecholamine signal that triggers energy release thus excessive energy storage occurs in the adipocyte.
Diabetes Research and Clinical Practice brings us information about diabetes complications and socioeconomic conditions in Vol 70, Issue 2, 143-150, 2005 by Michael G. Walsh et al. The researchers used the World Health Organization DiaMond complications study which is a multinational, cross-sectional study of complications of type 1 diabetes and examined 892 subjects from 14 countries. All subjects had been diagnosed before 15 years of life. Both diabetes complications and economic and health are factors vary widely across the DiaComp centers. Health system performance, as measured by disability adjusted life expectancy, gross national investment per capita and purchasing power all showed strong consistent correlations with complications, and significant independent associations with complication prevalence after controlling for HbA1c and hypertension. In conclusion, health system performance, social distribution of wealth and purchasing power may play important roles in explaining the geographic variation of diabetes complications.
The ADA 64th Annual Scientific Sessions heard the results of phase ll trials on a once-daily oral agent that preserves the action of glucagons-like peptide 1(GLP) by inhibiting the enzyme that degrades it and appears to improve glycemic control in patients with type 2 diabetes who are inadequately controlled with metformin. The positive effects on glycemia were durable for up to one year, according to Bo Ahrén, MD from the University of Lund in Sweden. The drug, LAF237, is the first in a new class of agents known as dipeptidyl peptidase IV (DPP-4), which rapidly degrades GLP-1. GLP-1 is secreted from the intestine in response to food. It stimulates beta-cell secretion, suppresses glucagons secretion, and contributes to satiety, making it an attractive target for drug therapy to treat type 2 diabetes. In addition, GLP-1 appears to preserve beta-cell function, suggesting that it could be used in conjunction with islet cell transplantation. The researchers found that subjects in the group using the LAF237 had a mean A1c that was 1.1% lower than those receiving placebo. In contrast to exenatide, however, patients receiving LAF237 did not lose a significant amount of weight compared to those receiving placebo. In both groups, there was a slight decrease of 0.2 kg.
The ADA has reported that people that smoke are nearly three times more likely to develop diabetes as those who have never smoked in the Oct. 2005 issue of Diabetes Care., 28:2501-2507, 2005. Dr. Capri Foy, the lead investigator at Wake Forest University School of Medicine’s Department of Public Health Sciences found that 25% of current smokers develop diabetes after 5 years, compared to just 14% of people who have never smoked. There are several possible mechanisms by which smoking may increase the risk of diabetes. It is known that higher abdominal fat is associated with increased risk of diabetes and some studies have shown that smokers have more abdominal fat. Also studied have found that increased blood glucose levels, increased insulin levels, and increased blood pressure all associated with increased risk of diabetes. Also, cigarettes contain many poisonous substances along with nicotine such as cadmium which has been associated with diabetes.
The September issue of Diabetes Care shares the fact that some people with type 2 diabetes avoid insulin shots at the expense of their health. This Canadian study done by Dr. A Brett Hauber et al, 28:2243-2245,2005. Researchers surveyed nearly 1000 Canadians with type 2 diabetes many of whom that avoiding insulin shots was just as important to them as improving their blood sugar control. It was diabetics who were not yet on insulin, in particular, who felt this way, a concerning finding, since these individuals my mean that they put off needed insulin therapy. The results of the survey indicated that diabetics felt that limited insulin injects to once a day was as important as raising their blood sugar control from “suboptimal" to “optimal". On the other hand, those survey respondents already on insulin placed much more value on getting their disease under control than trimming back their daily shots. The researchers concluded that much more education may be necessary to encourage type 2 diabetics to start insulin therapy when it’s warranted.
Diabetes Care 28:2384-2387, 2005 has an article of interest titled Mortality in childhood-onset type 1 diabetes, a population-based study by Gisela Dahlquist, MD, PHD and Benst Källen, MD, PHD, in Sweden. The rational for this study is to describe the age-and sex-specific mortality in a cohort of young type 1 patients and to analyze the causes of death with special focus on suicide, accidents, and unexplained deaths. A population-based incident childhood diabetes register, covering onset cases since July1, 1977, was linked to the Swedish Cause of Death Register up to December 2000. The official Swedish population register was used to calculate age-and sex- standardized mortality rate (SMRs), excluding neonatal deaths. To analyze excess risks for specific diagnosis, case subjects were compared with five nondiabetic control subjects, matched by age, sex, and year of death. Death certificates were compared for all case subjects. For case subjects with unclear diagnosis, hospital records and/of forensic autopsy reports were obtained. The results indicated mean age-and sex- SMR was 2.15 and tended to be higher among females. Mean age at death was 15,2 years and mean duration of 8.2 years. Twenty-thee deaths were clearly related to diabetes; 20 died of diabetic ketoacidosis. Only two case subjects died with late diabetes complications (acute coronary infarction). Thirty-thee case subjects died with a diagnosis not directly to diabetes; 7 committed suicide, and 14 died from accidents. Obvious suicide tended to be increased but not statically significant. Seventeen diabetic case subjects were found deceased in bed without any cause of death found at forensic autopsy. Only two of the control subjects died of similar unexplained deaths. The researchers concluded that in a well-developed health care system, there is still excess mortality in young type 1 diabetics. They confirmed a very large proportion of unexplained deaths in bed, which should be further studied. There was no clear excess death rate caused by suicide or traffic accidents among the young diabetics.
Metabolic control of diabetes is associated with an improved response of diabetic retinopathy to panretinal photocoagulation by Maria G. Kotoula, MD et all is published in Diabetes Care 28:2454-2457, 2005. The objective of the study was to examine the influence of glycemic control and the presence of microalbuminuria on the initial response to panretinal photocoagulation (PRP) in patients with a high-risk proliferative diabetic retinopathy (PDR). This is a prospective cohort study with two-by-two factorial design. The researchers used full-scattered PRP to treat 115 eyes of type 2 diabetic patients who have high-risk PDR. HbA1c and albumin levels in 34-hour urine were constantly monitored during the pre-enrollment, treatment, and post-treatment periods. At the follow-up visit 12 weeks after the last PRP session, the fundus was examined for characteristics of regression from high-risk PDR and the response to PRP was determined to be successful or unsuccessful. The eye were categorized into four groups based on average A1c Levels and the presence of absence of microalbuminuria. The data was analyzed using logistic regression model. Their statistical analysis determined the probability of achieving a satisfactory response to PRP in association with A1C levels and the presence or absence of microalbuminuria. The researchers found that of the 115 eyes examined, 65 (56.5%) had a successful initial response to PRP and 50 (43.5%) did not. The probability of a satisfactory response to PRP was related to A1C levels but not to microalbuminuria and its interaction with hemoglobin glycosylation. They concluded that low levels of hemoglobin glycosylation (A1C<8%) during the pre-treatment, treatment, and post-treatment periods are associated with a regression of proliferative diabetic retinopathy.
The Archives of Internal Medicine 2005;165:1896-1902 has an article titled Risk factors for declining ankle-brachial index in men and women 65 years or older, The Cardiovascular Health Study, by Margaret Kennedy, MD. MSc, er al. An ankle-brachial index (ABI) of less than 0.9 is a noninvasive measure of lower extremity arterial disease and a predictor of cardiovascular events. Little information is available on longitudinal change in ABI or on risk factors for declining ABI in a community-based population. To assess the risk factors for ABI decline, they studied 5888 participants in the Cardiovascular Health Study cohort (men and women 65 years or older). They measured ABI in 1992-1993 and again in 19998-1999. At baseline, they excluded individuals with an ABI greater than 1.4, or confirmed systematic lower extremity arterial disease. The group with ABI decline included 218 participants with decline greater than 0.15 and 0.9 or less. The Comparison group comprised the remaining 2071 participants with follow-up ABI. The results indicated the percentage of participants with ABI decline was 9.5% over 6 years of follow-up. The mean ±SD decline was 0.33 ±0.12 in cases of ABI decline and 0.02±0.13 in noncases. Independent predictors of ABI decline, reported as odds ratios, were are age 1.96for 75 to 84 years and 3.79 for those older than 85 years compared with the younger than 75 years; current cigaretteuse,1.74; hypertension, 1.64; diabetes,1.77; higher low-density lipoprotein cholesterol levl.1.60 and lipid-lowering drug use 1.74. They concluded that worsening arterial disease assessed as ABI decline, occurred in 9.5% of this elderly cohort over 6 years and was associated with modifiable vascular disease risk factors.
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