This month we begin with our head lines and then go on to bring you abstracts on the contribution of abdominal visceral obesity and insulin resistance to the cardiovascular profile of postmenopausal women, and an article on adherence to statin therapy and LDL cholesterol attainment by patients with diabetes and dyslipidemia…….Let’s begin.
HEADLINES: Diabetes Care, 28:668-674, 2005, has an article on Diabetes, glucose, insulin, and heart variability, the Atherosclerosis Risk in Communities (ARIC) study by Emily B. Schroeder, PHD et al. The objective here was to describe the progression of autonomic impairment among individuals with diabetes and pre-diabetic metabolic impairments. The results were based on 9-year change in heart rate variability (HRV) in a population based cohort of 6,245 people aged 45-64 at baseline and cross-sectional associations among 9,940 individuals. The results indicate that diabetic subjects have a more rapid temporal decrease in HRV conditional on baseline HRV than nondiabetic subjects.
A pilot study done by Joslin Diabetes Center in Boston was reported Oct.25. The study was a joint venture with a student at Harvard Medical School and a professor at MIT and was published in Diabetes Technology and Therapeutics. It found that children 8-18 with type 1 diabetes were more apt to monitor their blood glucose level when they engaged in a game called DiaBetNetTM-an application that integrated blood glucose, insulin dosing, and carbohydrate intake data and challenges use to predict their next blood glucose levels. At Joslin the head researcher was Lori LAffel, MD, head of Joslin’s Pediatric and Adolescent section.
Researchers from the University Of Pittsburg School Of Medicine have demonstrated for the first time that gene therapy can reverse diabetic neuropathy. These studies have so far only involved research in mice; however the results are significant because they provide the earliest evidence that such an approach might some day help people with diabetes. Details of the research were presented Oct.26, 2005 at the 34th Annual Meeting of the Society for Neuroscience which was held in San Diego Oct.23-27. The presenter, James R. Gross, PhD reported that 5 weeks after a one-time inoculation, diabetic animals receiving gene therapy had complete reversal of established peripheral neuropathy and restoration of lost nerve endings to their feet.
A herb used in traditional Indian medicine to treat diabetes seems to lower blood sugar and insulin levels in a manner similar to prescription drugs according to the Journal of the American Dietetic Association and Steve Hertzer the co-author and assistant professor of nutrition at Ohio State University. Salacia oblonga, which is native to regions of India and Sri Lanka, binds to intestinal enzymes that break down carbohydrates in the body. These enzymes, called alpha-glucosidases, turn carbohydrates into glucose, the sugar that circulates throughout the body. If the enzyme binds to the herbal extract rather than the carbohydrate, than less glucose gets into the blood stream, resulting in lowered glucose and insulin levels. Research continues on how much of the enzyme is most efficacious and when it should be taken relative to eating a meal. The enzyme is difficult to purchase in the US report the researchers.
The Archives of Internal Medicine, 2005;165:430-435 has an article titled Sex difference in the effect of diabetes duration on coronary heart disease mortality by Sunder Natarajan, MD, MSc et al. It is not known whether the coronary heart disease mortality risk associated with recent or long-standing diabetes varies with age. These researchers found out that in men, RDM(recent diabetes) and LDM(long-standing diabetes) were associated with as high a risk for CHD death as MI. In women although RDM had a CHD mortality risk similar to MI, LDM had an even greater risk. Because women showed LDM places them at very high risk for CHD mortality, current guidelines may need to be further refined to match intensity to treatment to risk in these women.
Contribution of abdominal visceral obesity and insulin resistance to the cardiovascular risk profile of postmenopausal women by Marie-Eve-Piché, et al in Diabetes 54:770-777,2005 is of great importance to those who read these articles. The aim of this study was to determine the respective contribution of abdominal visceral adipose tissue (AT) accumulation and insulin resistance (IR) to the determination of a comprehensive cardiovascular metabolic risk profile in 108 postmenopausal women not receiving hormone therapy. Insulin sensitivity (M/I) was determined by a hyperinsulinemic-euglycemic clamp, and visceral AT area was measured by computed tomography. Median values of visceral AT and insulin sensitivity were used to form four subgroups: 1) low visceral IR, 2) low visceral AT-high IR, 3) high visceral AT-low IR, and 4) high visceral AT-high IR. Women with isolated IR were characterized by significantly higher fasting and 2-h glycemia and higher fibrinogen, triglyceride, and VLDL-apolipoproprotein (apo) B concentrations than women with low visceral AT and low IR. The plasma lipid-lipoprotein profile and inflammatory markers were not significantly different between woman with high visceral AT and low IR. Women with high visceral AT and high IR had higher fasting and 2-h glycemia, triglyceride, and VLDL-apoB levels; lower apoAI and HDL2 cholesterol levels; as well as higher C-reactive protein and interleukin-6 concentrations than women with low visceral AT and low IR. In addition, 15 of the 35 women in the high visceral AT and high IR group were newly diagnosed with type 2 diabetes, whereas no women were diagnosed with type 2 diabetes in the group of women with low visceral AT and low IR. These results show that although the presence of high IR in its isolated form is associated with some metabolic alterations, it is the combination of both high visceral AT and high IR that is the most detrimental for the metabolic health of postmenopausal women.
Adherence to statin therapy and LDL cholesterol goal attainment by patients with diabetes and dyslipidemia, Diabetes Care 28:595-599, 2005 by Elizabeth S. Parris, RD, CDE, is our next abstract. The purpose of this study was to assess the relationship between adherence to statin therapy and LDL cholesterol goal achievement in patients with diabetes and dyslipidemia. The records of patients being medically treated for dyslipidemia in a managed care diabetes program from January 2001 to December 2002 were used to assess LDL cholesterol goal assessment and to compute a 9-month medication possession ratio(MPR). A total of 653 records were analyzed. The average MPR was significantly higher for men than women. Overall, 44% of the patients achieved an LDL cholesterol level <100 mg/dl. A significant correlation emerged between MPR and plasma LDL cholesterol, and MPR was significantly higher in patients who achieved the cholesterol target than in those who did not.
Although statins are highly effective for decreasing LDL cholesterol levels in patients with dyslipidemia, including those with diabetes, failure to reach LDL cholesterol targets remains common. Adherence to statin therapy, as reflected by MPR, is closely related to LDL cholesterol goal attainment in patients with diabetes and dyslipidemia. The probability of goal achievement appears to increase substantially when MPR is > 0.80. Pharmacy records can be used to identify patients who are poorly compliant with statin therapy and at high risk for failure to attain cholesterol goals. Because outcomes are directly related to patients’ medication-taking behavior, when clinical goals are not being reached, adherence should be the first item assessed by the clinictian.
BSP
