The abstracts we will highlight will address Cardiovascular risk factors predict the development of type 2 diabetes, Corneal changes after small-incision cataract surgery in patients with diabetes mellitus, Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes, and Hemoglobin A1c level and future cardiovascular events among women.
Our headlines abound this month so let’s just jump in and learn. The Archives of Internal Medicine 2004; 164:934-942 shares the following information about Women and heart disease by Elizabeth Barrett-Connor, MD et al. The authors suggest that aside from high blood glucose levels type 2 diabetic women also have a risk factor for hypertension, dyslipidemia, and smoking. They state that that presentation and diagnosis of CVD may differ between men and women, regardless of the presence of diabetes. They suggest that treatment should be at least as aggressive for women-and especially for women with diabetes- as it is for men.
In a Press Release dated Sept.5, 2004 Novo Nordisk announced the clinical benefits of their new insulin Levemir and illustrated how this new basal insulin analog can help realize maximum potential of insulin therapy. The data was presented at the European Association of the Study of Diabetes meeting. The clinical trials compared Levemir with NPH and found that it was more predictable, caused less hypoglycemia, did not cause undesirable weight gain, and supported better glycemic control.
The Health Behavior News Service dated Aug. 30, 2004 talks about the fact that psychologically distressed people with diabetes are more likely to smoke and avoid exercise and to have high blood pressure and high cholesterol-all risk factors for heart disease. This is based on a survey of more than 4,000 patients nationwide. The study by Tara W. Strine, M.P.H is published in The American Journal of Health Behavior.
Another article on the same subject appears in Diabetes Care 27:2154-2160, 2004 is titled Relationship of Depression and diabetes self-care, medication adherence, and preventive care by Elizabeth Lin, MD, MPH et al. In this study of 4,463 patients most of which where type 2 diabetics, the researchers found. The researchers found that major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria and retinopathy was similar among depressed and non-depressed patients.
Then there is The prospective study of red meat consumption and type 2 diabetes in middle-aged and elderly women by Yiqing Song, MD et al. Over 8.8 years the researchers evaluated 37,309 participants in the Women’s Health Study. During 326,876 person years of follow-up, they documented 1,558 incident cases of type 2 diabetes. After adjusting for age, BMI, total energy intake, exercise, alcohol intake, a positive history of diabetes and smoking, they found positive associations between intakes of red meat and processed meat and the risk of type 2 diabetes. Comparing women in the highest quintile with those in the lowest quintile, the multivariate-adjusted relative risks of type 2 diabetes were 1.28 for red meat and 1.23 for processed meat intake. Furthermore, the significantly increased diabetes risk appeared to be most pronounced for frequent consumption of total processed meat and the two major subtypes, which were bacon and hot dogs. These remained significant after adjustment for intakes of dietary fiber, magnesium, glycemic load, and total fat. Intakes of total cholesterol, animal protein, and heme iron were also significantly associated with a higher risk of type 2 diabetes.
Diabetes Care 27:2234-2240, 2004 has an article of interest titled, Cardiovascular disease risk factors predict the development of type 2 diabetes, The Insulin Resistance Atherosclerosis Study, by Ralph B. D’Agostino, Jr, PHD et al. The objective of this study was to determine whether the presence of CVD risk factors (RF) predict the eventual development of diabetes after controlling for the RFs, such as directly measured resistance and obesity. The study examined 872 participants with normal or impaired glucose tolerances (IGT) who were enrolled at baseline in the insulin Resistance Atherosclerosis Study (IRAS). Of those, 143 (16%) developed type 2 diabetes in 5 years. Using these participants a series of regression models were fit to address the question. The results showed significant RFs for developing type 2 diabetes included high plasminogen activator inhibiyor-1, hypertension, high triglycerides, low levels of HDL cholesterol, and IGT. The 5-year cumulative incidence of type 2 diabetes by the number of RFs (0-5) was as follows: no RFs 11 of 230+5%, 31 of 278+ 11%, two RFs, 36 of 202 +18%; three RFs 41 of 110+ 37%: 4 RFs, 41 of 110+37%; RF, 19of 42= 45%; and 5 RFs, 50f 10=50%. The odds ratio (OR) for conversion to type 2 diabetes for each additional RF was 2.1 after adjusting for insulin resistance, determined by the frequently sampled intravenous glucose tolerance tests and waist circumference, each additional CVD FR increased the risk of type 2 diabetes significantly. The researchers concluded that individuals with multiple CVD FRs are at increased risk of type 2 diabetes, which is partially mediated by insulin resistance or central adiposity. This information should be useful for identifying high-risk patients for developing diabetes through RF assessments.
The Archives of Ophthalmology 2004:122:966-969 has an article titled Corneal changes after small-incision cataract surgery on patients with diabetes mellitus by Soichi Morikubo, MD et al from the Division of Ophthalmology, School of Medicine, Fukui University, Japan. The objective was to evaluate functional impairment in the corneal endothelium of eyes in diabetic patients after small-incision cataract surgery. The researchers evaluated 93 eyes in patients with diabetes and 93 eyes in patients without diabetes who underwent cataract surgery. Using a topography system, the corneal thickness in the central area was measured before surgery and 1 day, 1 week, and 1 month after surgery. Corneal endothelial cells counted using a noncontact specular microscope. Results indicate no significant differences in any preoperative measures were observed between the diabetic and nondiabetic groups. The increase in corneal thickness 1 month after surgery was significantly higher in the diabetic group the in the nondiabetic group. The corneal endothelial cell losses 1 day and 1 week after surgery were significantly higher in the diabetic group than in the nondiabetic group. The researchers concluded that compared with nondiabetic eyes of patients with diabetes mellitus showed more damage in corneal endothelial cells due to cataract surgery and a delay in the postoperative recovery of corneal edema.
With all of the hype of low-carbohydrate diets we were interested in the article in Diabetes 53:2375-2382, 2004 titles Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes by Mary C. Cannon and Frank Q. Nuttall. The researchers knowing that there has been interest in the effect of various types and amount of dietary carbohydrates and proteins on blood glucose levels designed a high-protein/low carbohydrate, weight-maintaining, nonketogenic diet. Its effect on glucose control in people with untreated type 2 diabetes was determined. They refer to this as a low-biologically-available-glucose (LoBAG) diet. Eight men were studied using a randomized 5-week crossover design with a 5-week washout period. The carbohydrate: protein: fat ration of the control diet was 55:15:30. The test diet ratio was 20:30:50. Plasma and B-hydroxybutyrate were similar on both diets. The mean 24-h integrated serum glucose at the end of the control and LoBAG diets was 198 and 126 mg/dl, respectively. The percentage of Glycohemoglobin was 9.8 and 7.5, respectively. It was still decreasing at the end of the BoBAG diet. Thus, the final calculated Glycohemoglobin was estimated to be ~6.3-5,4%. Serum insulin was decreased, plasma glucagon was increased. Serum cholesterol was unchanged, Thus LoBAG diet ingested for 6 weeks dramatically reduced circulated glucose concentration in people with untreated type 2 diabetes. Potentially, this could be a patient-empowering way to ameliorate hyperglycemia without pharmacological intervention. The long-term effects of such a diet remain to be determined.
The Archives of Internal Medicine 2004;2004164:757-761 was an article titled HemoglobinA1c level and future cardiovascular events among women by Gavin J. Blake, MD, MPH, MSc, et al. Available data suggest that hemoglobin A1c also known as glycosylated hemoglobin, levels may be related to cardiovascular risk on the general population without diabetes mellitus. This research group sought to test the hypothesis prospectively in a cohort of women with and without overt cardiovascular disease. They conducted a nest case-control study of the Women’s Health Study cohort. They identified 464 case patients with incident myocardial infarction, stroke, or coronary revascularization and 928 unmatched control subjects who remain free of cardiovascular events at case diagnosis. The mean follow-up was 7years. Of the overall study, 136 has a history of diabetes mellitus or a baseline A1c level > 6.4 % and were excluded from the primary analyses. The researchers after examining the data reported that A1c level is associated with future cardiovascular risk among women without diabetes mellitus, but this relationship is largely attributable to a strong correlation with other cardiovascular factors. In contrast, diabetes mellitus is a strong independent determinate of cardiovascular risk.
BSP
