Let’s begin, as usual, with headlines our quick and easy way to read news about diabetes. From there we’ll bring you journal articles about the association of duration and severity of diabetes with cognitive impairment and a microsphere-based vaccine which prevents and reverses new-onset autoimmune diabetes in mice. Our first headline comes from JAMA, 2008;300(2):182-188 written by Joachim H. Ix, M.D et al which states that rising levels of a blood protein called fetuin-A may indicate an elevated risk of developing type 2 diabetes. These researchers from San Diego found that older people with the highest levels of fetuin-A were more likely to develop diabetes than those with lower levels. The researchers concluded that "…if fetuin-A can really differentiate diabetes risk, it gives us an opportunity for public health interventions".
We have been reporting on the vast numbers of diabetics around the world and since we know patients may have started to develop long term complications before they are diagnosed, a test to identify undetected diabetes would be of great public help. Dr. Christopher Saudek, director of the Johns Hopkins Comprehensive Diabetes Center spoke for the consensus statement authors released by a group of experts. Those of us with diabetes know all about the HbA1c test and know our numbers all too well. We know it gives us a measure of glucose control by giving us a percentage of how mush glucose red blood cells have been exposed to for the previous 120 days. Most people who are at risk and are tested may be given a test that measures the blood glucose level at the moment the test is taken. That means that the patient has to fast for 10 hours and the results will be affected by diet and exercise for several days before they provide the blood sample. Some people also “tune up" before going to the doctor which can throw off the results. The consensus statement concluded that the HbA1c should be used as the front-line method for identifying patients with diabetes, especially patients at high risk for the disease. The test does not require fasting and isn’t affected by short-term changes in diet and exercise. You can find the results of this statement in the July issue of The Journal of Clinical Endocrinology and Metabolism. You should know that the meeting was financially supported by Metrika Inc. a manufacturer of diabetes equipment.
All of us who have type 1 diabetes have heard about the imminent development of an artificial pancreas. Twenty five years ago when I was diagnosed my doctor told me that diabetes would be cured in a matter of five years. Those five years continue to loom in front of all of us who use insulin pumps and continuous glucose monitors but who must still program our insulin intake and take blood glucose levels frequently. July 28 brings us news that researchers continue work on an artificial pancreas which they say is just a few years away. They believe that they can link our insulin pumps to continuous glucose monitors to make a continuous seamless package. “I think we are on the brink of a first generation artificial pancreas, reports Dr. Roam Hovorka of Britain’s University of Cambridge who is testing some experimental devices with components by Abbott Laboratories and Medtronic, the number 1 maker of insulin pumps and continuous monitors. A continuous glucose sensor is implanted under the skin, and transmits blood sugar readings to a monitor. A computer calculates the right dose of insulin, which is delivered by the insulin pump—something many patients already wear. His team is ready to send some patients home with the device, but has to work out the logistics of keeping a nurse full-time in each volunteer’s home, just in case. The U.S. Food and Drug Administration regulators are working closely with the researchers to ensure they design studies in way that can lead to quick review, said Dr. Aaron Kowalski of the Juvenile Diabetes Research Foundation which funds many of the artificial pancreas study teams.
Once again we read news about how our health affects that of our children. The July Diabetes Care journal has an article by Dr. Dana Dabelea at the University of Colorado and co-investigators who reported that babies exposed to their mom’s diabetes and obesity in the womb are at increased risk of developing type 2 diabetes in adolescence. The adjusted odds for type 2 diabetes was roughly 7-fold higher with exposure to maternal diabetes and more than 3-fold higher with exposure to maternal overweight/obesity. Moreover, “the odds for type 2 diabetes was 2.5-fold higher when the diabetes was diagnosed before verses after pregnancy" “ This finding suggests that even in the selected group of offspring at high genetic risk, exposure to diabetes in utero is associated with a further increase in type 2 diabetes." The association between offspring diabetes and maternal obesity was attenuated after accounting for childhood BMI, indicating the researchers say, that maternal obesity increases the probability of childhood obesity, which in turn heightens the risk of diabetes.
Finally it was reported in the American Journal of Obstetrics and Gynecology that the Centers of the Disease Control and Prevention authored a study written by Dr. Adolfo Correa which implicates both type 1 and typ2 diabetes with birth defects. Women who have diabetes before becoming pregnant are three times as likely as other women to have a bay with at least one birth defect. A variety of defects are associated with women who have type 1 and type 2 diabetes. These include defects of the heart, brain, spine, kidneys and gastrointestinal tract, penile and ear abnormalities and cleft palate. “This study documents the fact that diabetes is associated with a wider range of defects than we had been aware of in the past", stated Dr. Correa. “Preconception care is not reaching all women with diabetes the way it ought to. “ Correa said doctors who know a woman who is pregnant or planning to become pregnant may consider steps including weight control, diet, exercise and medications.
Our first abstract come from the Archives of Neurology 2008; 65(8):1056-1073, titled Association of Duration and Severity of Diabetes Mellitus with Mild Cognitive Impairment by Rosebud O. Roberts, MBCHB, MS et al. The researchers from the Mayo Clinic found that developing diabetes before age 65 and greater severity of diabetes may be important in the development of mild cognitive impairment among individuals in their 70’s and 80’s. The term “mild cognitive impairment" describes a transitional stage between normal aging and dementia. Poor control of blood sugar over time may lead to loss of brain cells, and diabetes increases the risk of cardiovascular disease and stroke, which may also increase the risk of cognitive impairment. Dr. Rosebud O. Roberts and her colleagues studies 1,969 people who were between 70 and 89 years old and free of dementia in 2004. A total of 356 of them were diabetic. According to the team, rates of diabetes were similar among the 329 individuals with mild cognitive impairment (20.1 %) and the 1,640 individuals without mild cognitive impairment (17.7%). However, mild cognitive impairment was associated with developing diabetes before the age of 65, having diabetes for 10 years or longer, being treated with insulin and having diabetes complication, Severe diabetes is more likely to be associated with chronic high blood sugar, which in turn, increases the likelihood of disease in the small blood vessels of the brain and may contribute to brain cell damage and cognitive impairment, the investigators suggest. That people with diabetic retinopathy were twice as likely to have mild cognitive
Impairment supports the theory that diabetes-related damages to blood vessels in the brain may contribute to the development of cognitive problems, they say.
Diabetes has an article titled A Microscopere-Based Vaccine Prevents and Reverses New-Onset Autoimmune Diabetes 57:1544-1555, 2008 by Brett Phillips et al. This study was aimed at ascertaining the efficacy of antisense oligonucleotide microspheres to prevent type 1 diabetes and reverse new-onset disease. The microspheres were delivered into NOD mice. Glycemia was monitored to determine disease prevention and reversal. “Certainly, (this Vaccine) will not reverse disease in a person who has had diabetes for more than 5 years" Dr. Nick Giannoukakis from the University Of Pittsburgh School Of Medicine cautioned. The researchers reported that a single injection of the vaccine significantly delayed the onset of diabetes in the mice and 8 consecutive injections prevented the onset of diabetes altogether. Similar studies in mice with established hyperglycemia showed that injection of the vaccine twice weekly for no more that 25 days could reverse new-onset hyperglycemia and maintain normal blood glucose levels after vaccine discontinuation. The protein bits contained in the vaccine were previously shown to effectively enable human immune system cells called dendritic cells to suppress diabetes. The vaccine will be tested for safety in volunteers with type 1 diabetes pending the completion of preliminary studies now in progress. Once safety is confirmed, the vaccine’s ability to reverse newly diagnosed diabetes and to abrogate the evolution of silent type 1 diabetes into full-blown diabetes will be tested.
BSP
