Let’s start with our headlines first and then go on to the journal abstracts of the month. This month we will bring you research on PTSD in the parents of children with diabetes, Coffee consumption and the risk of type 2 diabetes, and Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults. First, it was reported this month in the journal Nature Genetics that a gene that may regulate the body’s response to insulin has been linked to both obesity and type 2 diabetes has been found in both Britain and France. The discovery helps to explain how being overweight is associated with type 2 diabetes. The researchers report “If we can identify those at risk at an earlier age, it may be possible to take preventive measures earlier on, and reduce the burden of ill health caused by obesity in later life." suggested the authors, Philippe Froguel.
Cholesterol-lowering statin drugs do not help severely ill diabetics, and may even raise their risk of a deadly stroke. In the study of patients on Lipitor it was found that patients were twice as likely to die of stroke. It was the first major test of statins in diabetics who need dialysis machines to remove waste from their bloodstream because their kidneys cannot do the job. The results are surprising because previous research showed Lipitor helped less severely ill diabetes. The study was funded by Lipitor’s maker, Pfizer Inc. and involved 1,255 Europeans with type 2 diabetes and the results were published in the New England Journal of Medicine.
The President of the ADA, Robert A. Rizza of the Mayo Clinic and Foundation issued the following statement in response in support of the “Stem Cell Enhancement Act of 2005: by Majority Leader Frist. “The American Diabetes Association applauds this morning’s support of the Stem Cell Research Enhancement Act. By easing existing restrictions and supporting research that uses embryonic stem cells-while also implementing strong ethical guidelines-this legislation provides hope to the more than 18million Americans living with diabetes. In May, the U.S. House of Representatives passed the legislation with clear, bipartisan support, and public opinion polls show a strong majority of Americans support it, as well. The Senate should follow the bipartisan lead of the House of Representatives and immediately pass a clean version of this legislation and send it to the President. Majority Frist’s support of this legislation is vital to the passage in the Senate, and the Association calls on him to give the legislation an up or down vote when the Senate returns from its August recess. The Senate has an opportunity to help advance the search for better treatments and a cure for diabetes. With Dr. Frist’s support, it is an opportunity that will not be wasted."
If you have been reading our What’s Hot articles, you know we have reported that children with diabetes have certain rights in school under the Americans with Disabilities Act. Under a new law passed in Texas, children there with diabetes will have more flexibility to manage their disease. Schools will be required to train additional employees in caring for those with diabetes and provide detailed plans on their care while in school. Texas is among 11 states, including California and Virginia, to outline specific protections for students with diabetes, both type 1 and 2, which is reaching epidemic levels in children. “This law will make it clear that this is so important to the children and it could be life threatening" said Rep. Elvira Reyna, R-Mesquite, author House Bill 984. Prior to the law, some schools didn’t allow diabetic students to attend certain extracurricular activities or to check their blood glucose levels in class. Some students couldn’t carry monitors or medications to class. And in severe cases, parents had to take their children off campus several times a day to administer insulin, advocated said. “Children with diabetes should be able to manage their diabetes on school property. In a lot of schools, that was not happening, “said Veronica De La Garza, a regional advocacy for the ADA. You can find more information about how the city of Houston is changing in the Houston Chronicle and on the ADA web site. We are pleased that children with diabetes will be kept out of hospital.
An injection which tricks the body into thinking it is full is being tested by scientists and could be developed into tablet form. It contains the digestive hormone, oxyntomodulin, normally released by the body, when you’ve eaten enough. A study in the journal Diabetes showed that three injections a day cut 14 volunteers’ daily calorie intake by up to 250. Experts hope to develop a daily injection and a pill to make it easier and cheaper to use, Professor Steve Bloom, head of investigative medicine at Imperial College London, so we’ll keep our eyes and ears peeled to headlines and journal articles.
Our first journal article comes from Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 44, No.7,682-688,2005, and is titles Prospective study of posttraumatic stress disorder in parents of newly diagnosed type 1 diabetes by Markus A Landolt, PhD, et al. Having seen this problem in the parents of newly diagnosed children, I was interested in the conclusions of these researchers. Hopefully, you will find that others have a difficult time when their child develops diabetes. The researchers wanted to determine the prevalence, course, and predictors of posttraumatic stress disorder (PTSD) in mothers and fathers of children with newly diagnosed type 1 diabetes. Most studies show moderate to high initial psychological maladjustment in the first weeks after diagnosis. Parental symptoms include depression, anxiety, grief reactions, and overall distress. This maladjustment seems to diminish during the first year. However one study found a slight increase in maternal symptoms with illness duration. Moreover, parental psychological adjustment appears to be an important predictor of child metabolic control. The researchers assessed 49 mothers of 52 children (response rate 65%) with newly diagnosed diabetes (age 6.5-15 years) at 6 weeks, 6 months, and 12 months after the children were diagnosed with the Posttraumatic Diagnostic Scale. The prevalence of PTSD in mothers was 22.4% at 6 weeks, 16.3% at 6 months, and 20.4% at 12 months. In fathers, PTSD was found in 14.6%, 10.4%, and 8.3% respectively. Mothers endorsed more symptoms of PTSD at all assessments. Multivariate analysis controlling for demographics, metabolic control, and treat appraisals reveled that in mothers, the number of preceding life events and PTSD symptoms at 6 months predicted PTSD at 12 months. In fathers, PTSD severity at 6 months was the only significant predictor for PTSD at 12 months. The findings support the applicability of a posttraumatic stress model for investigating the psychological impact of childhood diabetes on parents. Although the sample size was small, the researchers find they support the need for careful evaluation of PTSD in the parents of newly diagnosed diabetic children. Early diagnoses would allow for timely intervention thus enhancing the quality of life for family members. In addition, the study findings highlight the specific situation of mothers so that clinical interventions should consider their situations and help minimize their distress, especially during the first months after diagnosis.
Systematic reviews and meta-analysis of short-acting insulin analogs in patients with diabetes mellitus, by Johannes Plank, M.D. et al in Achieves of Internal Medicine 2005;165:1337-1334 hopefully will help you make important decisions about your care. This article compares the effect of treatment with short-acting insulin analogues (SAI) vs. regular insulin on glycemic control, hypoglycemic episodes, quality of life, and diabetes-specific complications. Electronic searchers (Cochrane Library, MEDLINE, and EMBASE) and additional searching (pharmaceutical companies, experts, approval agencies. Abstracts of diabetology meetings) were performed. Two reviewers independently screened randomized controlled trials to determine inclusion. Forty-two randomized control trials that assessed the effect of SAI analogues vs. regular insulin in 7933 patients with type 1 diabetes mellitus, type 2 diabetes mellitus, and gestational diabetes mellitus were identified. The weighted mean difference between hemoglobin A1c values were using SAI analogues and regular insulin was -0.12% for adult patients with type 1 diabetes and -0.02 for patients with type 2 diabetes. The standard mean for overall hypoglycemia (episodes per patient per month) was
-0.50 comparing SAI analogues with regular insulin in adult patients with type 1 and type 2 diabetes respectively. No differences between treatments were observed in children with type 1 diabetes, pregnant women with type 1 diabetes, and women with gestational diabetes. Concerning quality of life, improvement was observed only in open-label studies in patients with type 1 diabetes. No differences were seen in a double-blinded study of patients with type 1 diabetes or in studies of patients with type 2 diabetes. The researchers’ analysis suggests only a minor benefit to hemoglobin A1c values in adult patients with type 1 diabetes but no benefit in the remaining population with type 2 or gestational diabetes from SAI analogue treatment.
JAMA has an interesting article titled Coffee consumption and the risk of type 2 diabetes, A systematic review, by Rob M. van Dam, PhD and Frank B. Hu, MD, PhD. We have reported here about studies that imply higher coffee consumption may reduce the risk of type 2 diabetes. The authors searched MEDLINE through January 2005 and examined the reference lists of retrieved articles. Because this review focuses on studies of habitual coffee consumption and risk of type 2 diabetes, we excluded studies of type 1 diabetes, animal studies, and studies of short-term exposure to coffee or caffeine, leaving 15 epidemiological studies. Information on study design, participant characteristics, measurement of coffee consumption and outcomes, adjustment for potential confounders, and estimates of associations was abstracted independently by 2 investigators. They identified 9 cohort studied of coffee consumption and risk for type 2 diabetes including 193,473 participants and 8394 incident cases of type 2 diabetes, and calculated summary relative risks (RRs) using a random-effects model. The RR of type 2 diabetes was .65 for the highest and .72 for the second highest category of coffee consumption compared with the lowest consumption category. These associations did not differ substantially by sex, obesity, or region (United States and Europe). In cross-sectional studies conducted in northern Europe, southern Europe, and Japan, higher coffee consumption was consistently associated with newly detected hyperglycemia, particularly postprandial hyperglycemia. The researchers concluded that systemic review supports the hypothesis that habitual coffee consumption is associated with a substantially lower risk of type 2 diabetes. They suggest longer-term intervention studies on consumption and glucose metabolism are warranted to examine the mechanisms underlying the relationship between coffee consumption and type 2 diabetes.
Finally, we bring you an article titled Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose I older white and black adults, The Health, Aging, and Body Composition Study by Elsa S. Strotmeyer, PhD et al in the Archives of Internal Medicine 2005;165:1612-1617. The researchers wanted to determine if type 2 diabetes or impaired fasting glucose was associated with higher fracture rates in older adults and to evaluate how diabetic individuals with fractures differed from those without fractures. The Health, Aging, and Body Composition Study participants were functioning, community-dwelling men and women aged 70 to 79 years (N=2979, 42% black), of whom 19% had diabetes and 6% impaired fasting glucose at baseline. Incident Nontraumatic clinical fractures were verified by radiology reports for a mean ±SD of 4.5±1.1 years. Cox proportional hazards regression models determined how diabetes and impaired fasting glucose affected subsequent risk of fracture. Diabetes was associated with elevated fracture risk after adjustment for a hip bone mineral density (BMD) and fracture risk factors. Impaired fasting glucose was not significantly associated with fractures. Diabetic participants with fractures had lower hip BMD and lean mass and were more likely to have reduced peripheral sensation, transient ischemic attack/stroke, a lower physical performance battery score, and falls compared diabetic participants without fractures. The researchers concluded that older white and black adults with diabetes are at higher fracture risk compared with nondiabetic adults with a similar BMD since a higher risk of Nontraumatic fractures was found after adjustment for hip BMD. They suggest that fracture prevention needs to be target specific for risk factors found in adults with diabetes.
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