Once again, the journals are full of articles of interest to those with diabetes. First and foremost this month we will review the prospects for research in diabetes mellitus as outlined by the Feb. 7, 2001 Journal of the American Medical Association. Next, we will update you on inhaled insulin, this time for persons with type 2 diabetes. Our next article is on the importance of type 1 diabetics relatives being screened for autoimmune thyroid disease, and we end with an article on a typical antipsychotic agents and diabetes. So, put on your specs and read on. Once again, let us know what your interests in research are and we'll keep our eyes open and our pen on the ready. Thanks for your continued interest. We are very pleased and gratified to know that you read these abstracts and we enjoy getting your feedback.
First let's look at some quick information you may need to know about that we noted in journal articles. If you want N.I.H. to get more funds for research and the President to fund stem cell research which has the promise to cure diabetes and Parkinson's as well as other diseases, contact the White House. Leading scientists have welcomed Health and Human Services Secretary Tommy Thompson to the campus of N.I.H. and applauded the largest new budget proposal for medical research. Contact both the President and Secretary to keep this on target. Preventive Medicine 2001; 32:33-39 has an article titled Virus-infected cells improve glucose control in diabetic rates by Dr. Simon Barry. Look for more on this in the future. Preventive Medicine and Dr. Ford from the Centers for Disease and Prevention have come out with studies that reiterate fruit and vegetable consumption are inversely associated with diabetes incidence. We've been preaching this as have others. Keep reading.
Jerold M. Olefsky, MD wrote the article on Prospects for research in diabetes mellitus, February 7,2001-Vol285, No 5, pages 628-632. Diabetes is the 6th leading cause of death in the United States, and morbidities resulting from diabetes-related complications such as retinopathy, kidney disease, and limb amputation place a huge burden in the national health care system. This researcher sees the identification of genetic components of type 1 and type 2 diabetes as one of three most important areas of research because the elucidation of the diabetes gene will influence all efforts toward a mechanistic understanding of the disease, its complications, and its treatment, cure, and prevention. Also, the link between obesity and type 2 diabetes mandates a redoubling of the effort to understand the genetic and behavioral contributions to obesity.
Last month we spoke of the worldwide epidemic of diabetes. Here in the US, it is projected that 800,000 new cases of diabetes per year will be diagnosed and that it will affect 23 million Americans within 10 years. We will not go into the costs of diabetes for our society because we have done this many times, rather, we will list the research opportunities and forecast for diabetes.
First let's examine key research opportunities in type 1 diabetes:
- Development of new readily applicable methods of achieving tight glucose control without hypoglycemia. The results of improving this area of diabetes treatment would be the prevention of diabetic complications.
- Identification of predisposing diabetes genes would lead to predictive diagnostic tests and preventive strategies.
- Understanding the causes and molecular mechanisms responsible for autoimmune destruction of insulin-producing B cells would lead to the prevention of diabetes.
- Development and testing of methods for replacing B-cell function in patients, including Islet transplantation, could lead to a functional cure of diabetes.
- Development of a sufficient source of insulin-producing cells for cell-based therapy would lead to a functional cure of diabetes and major advances for cell-based therapies in other diseases.
Here are the key research opportunities and forecast for type 2 diabetes:
- Identification of the genes conferring disease susceptibility in common forms of type 2 diabetes and obesity would lead to a predictive diagnostic test and development of specific mechanism-based drugs and/or gene therapy based drugs and/or gene therapy.
- Elucidation of the molecular mechanisms responsible for insulin resistance and defective insulin secretion would lead to the development of improved anti-diabetic drugs.
- Definition of the pathways of appetite regulation and energy expenditure would lead to new methods of prevention and treatment of obesity.
- Identification of the mechanisms whereby environmental factors convert predisposition to type 2 diabetes into overt clinical disease would lead to new methods for testing and development of antidiabetic therapies.
- Application of noninvasive and other cutting edge technologies to unravel derangements would lead to complete understanding of the metabolic pathophysiology of obesity and diabetes.
The author ends his article with the following: "The surest way to treat diabetic complications is to prevent them by glycemic control in patients with established diabetes or preferably by the prevention of diabetes. While moving toward these goals over the next 25 years, it is critical to improve treatment and prevention of microvascular and macrovascular complications of diabetes because these complications account for the excessive morbidity and mortality associated with the disease. All of these predictors are fully achievable if adequate resources (financial and human) are applied to the field of diabetes. With appropriate effort, future generations could be freed from the scourge of diabetes".
For the past few months, we have shared information about trials of inhaled insulin for the treatment of type 1 diabetes. The Annals of Internal Medicine, Feb 6th volume has an article by Dr. William T. Cefalu for the University of Vermont College of Medicine who with his colleagues assessed the safety and efficacy of inhaled insulin therapy by evaluating the pulmonary function and glycemic control of 26 type 2 diabetic patients who received 3 months of preprandial inhaled insulin therapy plus bedtime ultralente injections. Patients performed home glucose monitoring and had weekly adjustments of their insulin dose to achieve a target preprandial glucose level of 5.55 to 8.88 nnol/L (100 to 160 mg/dL).
Glycemic control was significantly better after 3 months of therapy than at baseline. While no severe hypoglycemic events occurred, patients did have an average of .83 mild to moderate events per month. No significant weight gain or change in pulmonary function was noted. The authors call for larger studies to provide the long-term efficacy and safety necessary if inhaled insulin is to become a viable clinical option.
Diabetes Care 2001;24:27-32 has an article titled Type 1 diabetics; relatives should be screened for autoimmune thyroid disease by Jaeger, C, M.D. et al from Geissen, Germany. The researchers analyzed serum from 197 patents with recent-onset type 1 diabetes, 882 of their first-degree relatives and 150 healthy controls for antibodies associated with type 1 diabetes, autoimmune thyroid disease, celiac disease, pernicious anemia and Addison's disease. Dr. Jaeger's team found that there was no difference among the groups for antibodies to pernicious anemia and Addison's disease. There was, however, a significantly higher prevelence of celiac antibodies in the diabetic group than in the other groups. Of note was the fact that thyroid antibodies were significantly more frequent both in diabetic patients and in the relatives than in the controls. Furthermore, in the diabetic group, 27.4% had antibodies for two or more of the three disorders of interest (type 1 diabetes, autoimmune thyroiditis and celiac disease), compared with 3.1% in the group of first-degree relatives and 0 of 150 in the control group. Dr. Jaeger and his colleagues concluded that all recent-onset diabetic patients be routinely screened for autoimmune thyroid disease and for celiac disease. He also suggests that first-degree relatives be tested for thyroid autoimmunity and pre-type 1 diabetes.
Primary Psychiatry, May 2000, Vol 7, No 5 has an article titled Atyipical antipsychotic agents and diabetes mellitus by Goldstein, L.E. M.D., PhD and Henderson, D.C., M.D. We often get questions about psychiatric illness and diabetes so here's an article we hope you won't have to use, but if you do, the information is excellent. Atypical antipsychotic agents (AAAs) offer a significant advantage over conventional antipsychotic drugs in clinical efficacy and side-effect profiles. Recently, a series of case reports have documented treatment-emergent diabetes mellitus (DM) and diabetes ketoacidosis( DKA) associated with AAA therapy. It is unclear whether the new-onset DM described in these cases is related to treatment with AAAs of other factors. This article reviews and evaluates the current literature suggesting a possible association between these drugs and the development of new-onset DM or exacerbation of preexisting diabetic conditions. The relationship of weight gain during treatment with AAAs is also examined. Other postulated mechanisms that may relate AAAs to glucose metabolic abnormalities are also reviewed. These include insulin resistance and insulin transporters as well serotonin 5-HT1A receptors. The recommendations are for identifying, monitoring and counseling those patients who may be at increased risk for abnormal glucose metabolism when treated with these drugs. Rigorously controlled studies to examine the possible association between AAAs and DM are needed to aid patients and clinicians in making informed decisions and to guide clinical practice.
BSP
