This month we were asked to review a new product which may be of value to you or to someone you know who has a medical condition. The product is called “iD". This looks like and really is a USB flash drive. For those of you who don’t know what this is it is a way to back up information you have on your computer on a very small plastic and metal item as compared to a disc which would difficult to carry around. This product was developed with local EMS authorities. I was sent one of the flash drives and when I inserted into my USB portal an easy questionnaire was there to fill out with all of my medical information as well as medical records if I wished to include any. Now just in case this is a technique that our medium sized city emergency services could not use, I called to find out if the lap tops that rescue workers carry have the portals available; the answer was an emphatic “yes". The “iD" comes as a key chain or with the ring to be placed on your key chain. It could also be placed on a necklace or bracelet, although it is not inconspicuous or small being about 2 ¾ inches long and ½ inch wide. We all know that Medic Alert is available and the emergency personnel can contact your physician easily through their program via phone and American Medical ID sells personalized Medical IDs which is a one time cost. Having said all of this, coming into the computer age may well be something you want to consider. Want more information? Contact Chris Owens as 801-944-6393 or email cowens@identificationdevices.net . We rarely endorse any products but this may well be the device of today.
Let’s get on with our headlines and then journal abstracts about diabetes and morality following acute coronary syndromes and autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes.
The Journal of the American Medical Association, Sept. 26, 2007 has an article of interest written by Dr. Jill M. Norris from the University of Colorado at Denver and Health Science Center which shows that omega-3’s may lower type 1 diabetes risk in children with a family history of type 1 diabetes or who have a genetic pattern linked to the condition. Dr. Norris cautions that because this is the first study in the area the results are preliminary and should be interpreted with caution. The study followed 1770 children at high risk for diabetes up to an average age of 6 years. Islet autoimmunity risk was assessed in blood samples by looking at autoantibodies to insulin and other molecules. Fifty-eight children developed islet autoimmunity. Higher total intake of omega-3 acids was associated with 55% less risk of islet autoimmunity. Higher fish oil intake reduced the risk by 19 percent. Dr, Norris and her team are continuing to follow the children in the study; they want to further explore the mechanism of their finding by measuring the markers of inflammation in these children.
Limb salvage teams in emergency rooms like the Cabrini Medical Center in NYC, and Georgetown University Hospital are working hard to prevent amputation in diabetic patients. A word to the wise means that we, as diabetics, make sure our physicians test our unhealed wounds in legs and feet, but also test blood pressure in the extremities (PAD). Proper cleaning of wounds and a complete medical plan can help prevent you being one of the 80,000-plus amputations of toes, feet and lower legs that American diabetics undergo each year. Ask your medical team which emergency room in your area is prepared to treat you as a diabetic and please ask the proper questions, and remove your shoes and socks each time you see your endocrinologist or primary care physician. Make sure your limbs and feet are examined. The difference between treating a foot ulcer and infected one can be $10,000.00 or more depending on where you live. The amputation will change your life forever.
A report released the first week of October concluded that chronic illnesses like diabetes and heart disease are costing the U.S. a staggering $1.3 trillion per year. Just think of what the government could do with that money to counter poverty, illiteracy and better yet, cure us all of these two diseases and maybe two or three others. The analysis shows that the lost productivity in the form of missed work days and poor work performance actually cost the economy more money than simply treating these diseases. The study which was done by the Center for Health Care Economics at the Milken Institute stated that “The trajectory our nation is on is one that is unsustainable".
Finally the October issue of Cell Metabolism shares that Chinese researchers have outlined the molecular chain of activity of resveratrol a chemical found in the skin of red grapes and in red wine. The study focused on how resveratrol improved the sensitivity of mice to insulin an important fact for those with type 2 diabetes where human cells lose their sensitivity to insulin. Do not however think that drinking red wine will make you anything but high so please talk over you wine use with your physician. Those extra, often uncounted, calories can be difficult to lose. Alcohol can also make us hungrier and for get those extra calories too. Try controlling your medication with uncounted calories; it’s hard. Keep tuned and we’ll continue to look for articles on the chemical reactions in the study. I’m sure the mice enjoyed the wine, but let’s wait and see if the same thing happens in humans. Then, we’ll lift a great glass of cabernet.
Time to share abstracts has arrived. The first found in JAMA, 2007;198:765-775 is titled Diabetes and Mortality Following Acute Coronary Syndromes by Sean M. Donahoe, M.D. et al. Because of the high incidence of heart disease and diabetes this article is of special interest to those of us with diabetes either type 1 or type 2. The worldwide epidemic of diabetes is increasing the burden of burden of cardiovascular disease, the leading cause of death among people with diabetes. The independent effect of diabetes on mortality following acute coronary syndromes (ACS) is uncertain.
The objective of this study is to evaluate the influence of diabetes on mortality following ACS using a large database spanning the full spectrum of ASC. A subgroup analysis of patients with diabetes enrolled in randomized clinical trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997 to 1006 were pooled including 62,036 patients and 15,459 with unstable/non-STEMI, of whom 10,613 had diabetes. A multivariable model was constructed to adjust for baseline characteristics, aspects of ACS presentation, and treatments for the ACS event.
Mortality at 30 days was significantly higher among patients with diabetes than without diabetes presenting with UA/NSTEMI and STEMI. After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with higher 30-day mortality after UA/NSTEMI or STEMI. Diabetes at presentation with ASC was associated with significantly higher mortality 1 year after US/NSTEMI or STEMI. BY 1 year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI.
The researchers concluded that despite modern therapies for ACS, diabetes confers a significant adverse prognosis which highlights the importance of aggressive strategies to manage this high-risk population with unstable ischemic heart disease.
JAMA 2007;297:1568-1576 has a article of interest to those of us with type 1 diabetes titled Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus by Julio C. Voltaraelli, M.D., PhD et al. Those of us with type 1 diabetes read many such articles hoping that others newly diagnosed will not live with the daily routines we must live with and suffer form both long and short term complications irregardless of our control. As we all know type 1 diabetes results from a cell-mediated autoimmune attack against pancreatic beta cells. Previous animal and clinical studies suggest that moderate immunosuppression in newly diagnosed type 1 DM can prevent further loss of insulin production and can reduce insulin needs. The objective of the study was to determine the safety and metabolic effects of high-dose immunosuppression followed by autologous nonmyeloablative hematopoietic stem cell transplantation (AHST) in newly diagnosed type 1 DM. A prospective phase ½ study of 15 patients with type 1 DM diagnosed the previous 6 weeks by clinical findings and hyperglycemia and confirmed with positive antibodies against glutamic acid decarboxylase. Enrollment was Nov. 2003-July 2006 with observation until Feb. 2007 at the Bone Marrow Transplantation Unit of the School of medicine of Ribeirão Preto, Brazil. Patients with previous diabetic ketoacidosis failed to benefit from AHST. Hematopoietic stem cell cells were mobilized with cyclophosphamide and granulocyte colony-stimulating factor and then from peripheral blood by leukapheresis and cryopreserved. The cells were injected intravenously after conditioning with cyclophosphamide and rabbit antitihymocyte globulin. Morbidity and mortality from transplantation and temporal changes in exogenous insulin requirements were the main outcome measures. Secondary end points: serum levels of hemoglobin A1c, C-peptide levels during the mixed-meal tolerance test, and anti-glutamic acid decarboxylase antibody titers measured before and at different times followed AHST. During a 7-to 36-month follow-up, 14 patients became insulin-free, (1 for 35 months, 4 for at least 21 months, 7 for at least 6 months; and 2 late response were insulin-free for 1 and 5 months respectively). Among those, 1 patient resumed insulin use 1 year after AHST. At 6 months after AHST, mean total area under C-peptide response curve was significantly greater than the pretreatment values and 12 and 24 months it did not change. Anti-glutamic acid decarboxylase antibody levels decreased after 6 months and stabilized at 12 and 24 months. Serum levels of hemoglobin A1c were maintained at less than 7% in 13 of the 14 patients. The acute severe effect was culture-negative bilateral pneumonia in 1 patient and late endocrine dysfunction in 2 others. There was no mortality. The researchers concluded that high-dose immunosuppression and ASHT were performed with acceptable toxicity in a small number of patients with newly diagnosed type 1 DM. With AHST, beta cell function was increased in all but 1 patient and included prolonged independence in the majority of the patients.
BSP
