As we do each month, we begin our article with some headlines and then we will share our abstracts of the month. Our abstracts deal with changes in brain structure in long standing type 1 diabetes who have significant numbers of hyper and hypoglycemic events and another about depression treatment and types 1 and 2 diabetes. So pull up your chair to the computer and dig into information which we hope will make you the expert you need to be about diabetes.
We read the Wall Street Journal each morning. You can do what you want with that information about investing, but every so often we come away with excellent medical information and so we begin this month’s headlines with an article that may bring future new type 1 diabetes great hope to prevent or at least limit the devastating side effects of diabetes for these young people. The article was printed in the March 7, 2006 Personal Journal section of the Wall Street Journal under the title New Treatments Show Promise for Some Diabetics and was written by Betsy McKay. In it, Ms McKay shares information about the promise of using newer medications normally given to organ-transplant patients which are less harmful than earlier medications, for long term use. Researchers are hopeful that using these medications early in the process of type 1 diabetes before the pancreas no longer stops making insulin may prevent the disease in those who are at risk for developing the disease. There are 3 studies which are currently or soon will enroll new-onset type 1 diabetes patients.
- AbATE study which will enroll children and adults ages 8-30 diagnosed within the last 6 weeks. To get information go to: www.newonsetdiabetes.org
- MMF/DZB study will enroll children and adults from ages 12-35 diagnosed with type 1 diabetes within the past three months. Information can be found at www.diabetestrialnet.org
- Rituximab(AntiCD-20) study which will enroll children and adults ages 12-45 diagnosed with type 1 diabetes within the past three months. Information will be posted soon at www.diabetestrialnet.org
Many people rebel about taking insulin for type 2 diabetes fearing weight gain. This next article will make you and your loved one feel better about taking insulin or medication to control diabetes. Diabetes Care 29:493-497,2006 has an article titled Stability of Body Weight in Type 2 Diabetes by Zoobia W. Chaudhry, MD et al from Minneapolis, Minnesota. The researchers wanted to know if weight gain was higher in type 2 diabetics treated with medications as compared with the general population knowing that there is an epidemic of obesity in the Western countries. They looked at data on 205 men who had attended a diabetes clinic more =5 years. Their weight and glycohemoglobin at the last visit were compared with initial visit data. The subjects were also categorized according to the type of treatment they received. The group on a whole had a mean body weight of 0.23±0.2 kg/year. Treatment modality did have an effect on the amount of weight gained. Those on insulin with or without oral agents gained weight at the rate of 0.44±0.1 kg/year. In persons treated with metformin or metformin and a sulfonylurea, there was a mean loss in weight of -0.24±0.09 kg/year and with sulfonylureas alone weight increased by 0.42±0.02 kg/year. The researchers concluded that men treated with insulin alone or insulin combined with oral agents gained weight at a rate comparable with that reported for the general population, i.e. weight gain was not extraordinary. Metformin treatment resulted in modest loss of weight.
I had a phone call this week from one of my husband’s relatives who was concerned about her daughter who was pregnant and had developed gestational diabetes. When I read this article I decided to share it for all of you who e-mail us questions about this problem. Gestational Diabetes Identifies Women at Risk for Permanent Type 1 and Type 2 Diabetes in Fertile Age in Diabetes Care 29:607-612, 2006 by Ilkka Y. Järvelä. MD et al from Finland. The researchers evaluated the predictive value of gestational diabetes (GDM), diabetes-associated autoantibodies, and other factors for the development of clinical diabetes later in life. In this case-control study, the presence of autoantibodies was studied in 435 women with GDM and in healthy matched control subjects. The need for exogenous insulin during GDM was recorded. In the GDM group, the mean follow-up was 5.7 years and in the control group was 6.1 years. The researchers found that pregnancy seems to identify women who are at risk for developing diabetes later in life. About 10% of Finnish women with GDM will develop diabetes over the next 6 years; nearly half of them will develop type 1 diabetes and the other half type 2 diabetes. Age =30 years, the need for insulin treatment during pregnancy, and positvity for islet cell antibodies and autoantibodies to GAD confer a high risk of subsequent progression to type 1 diabetes in women with GDM.
Now for our abstracts. Diabetes 2006;55:326-333 has an article titled Severe Glycemic Excursions Appear to Alter Brain Structure by Dr. Alan M Jacobson of the Joslin Diabetes Center in Boston. As a type 1 diabetic, and someone who has started a clinic for the working poor with diabetes, it’s results appeared important enough to share with all of you. If you are a type 1 diabetic who has difficulty controlling your blood glucose levels, you may want to share these findings with your physician and work together to keep your diabetes under tighter control. The physicians at Joslin used voxel-based morphometry (VBM) analysis of MRI images of the brain to compare patients with diabetes with age-matched healthy controls. VBM creates three dimensional images of magnetic resonance imaging data which can be used to evaluate structural changes in the brain. The subjects were between the ages of 25 to 40 years of age and had had type 1 diabetes for 15 to 25 years. The researchers found lower grey matter density in regions important for memory, language processing, and attention in those who had chronically higher blood glucose levels as measured by HbA1c. There was a positive association between the occurrence of severe hypoglycemia and reduced grey matter density in the left posterior lobe. VBM showed less dense grey matter in the left and right superior temporal gyri, left angular gyrus, left middle temporal and frontal gyri, and left thalamus among diabetic subjects compared to controls. The authors also tested the subjects in general intelligence, executive function, memory, and psychomotor speed to see how they were associated with the grey matter changes. In 18 of the 20 tests, there was no significant difference between the diabetic and control groups. However, diabetic subjects scored slightly lower on vocabulary, paired associations, inhibition in the color-word task, and card sorting. Dr. Jacobson and his group concluded that if early changes in grey matter “could be detected at an early stage through use of VBM methods or other means, it might be possible to implement treatment regimes that minimize risks to patients in terms of hypo-and hyperglycemia and its effects on the CNS." The same researchers are using other MS technologies to evaluate the relationship between diabetes and white matter and neurochemical changes in the brain because of the increased risk of depression in diabetes and changes in brain structure.
Speaking of depression, we found an interesting article titled Depression Treatment and Satisfaction in a Multicultural Sample of Type 1 and type 2 Diabetic Patients, Diabetes Care 29:549-553,2006, by Mary de Grout, PHD, et al. The researchers assessed the rates of depression symptoms, depression treatment, and satisfaction in a multicultural sample of people with both types 1 and 2 diabetes. The sample of 221 people was predominantly female (60.3%), had type 2 diabetes (75%) and was middle class with a mean age of 54±12 years. A total of 53% were white. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CESD). Using conservative thresholds, 25.3% of participants reported significant depression. Rates of depression did not differ by ethnic group or diabetes type. The majority (76%) of depressed participants reported treatment (52% antidepressants, 63% mental health providers, 19% alternative healers, and 15% herbal remedies). African Americans were less likely to report depression treatment, to receive antidepressant medication, or receive treatment from a mental health professional compared with whites. Participants with high depressive systems reported general satisfaction with depression treatment experiences. The researchers concluded that high rated of depressive symptoms were observed across ethnic groups, yet significant differences in use of depression treatment existed within these groups. Those who did seek treatment reported satisfaction with a variety of treatment modalities. They suggest that increased depression screening may be beneficial for ethnically diverse patients with both types 1 and 2 diabetes.
BSP
