As always we start with headlines and then go on to our abstracts which this month will deal with the effect of glucose variability on the risk of microvascular complications in type 1 diabetes and then the prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Finally we look at research which examines coffee consumption and the risk of developing type 2 diabetes.
This first head line was published by Diabetes UK and is taken from the journal Diabetologia. It was of interest to me because I became a type 1 diabetic after failing to recover from a severe viral infection. Lead author, Dr. Richard McNally of Newcastle University’s School of Clinical Medical Sciences (Child Health) and his colleagues’ analyzed information from a register of over 4,000 people aged 0 to 29 years when diagnosed with type 1 diabetes over a 25-year period. They analyzed the times and places where children and young adults were diagnosed. A pattern emerged where “clusters" of cases were found at different locations and time intervals for 10-19-year-olds. There were six to seven percent more cases of Type 1 diabetes found in this age group in the clusters then would have been expected. This pattern, which experts call “space-time clustering", is typical of conditions triggered by infections. It has been previously suggested that infections are linked to the development of type 1 diabetes in children who are genetically susceptible to certain environmental triggers. Dr. McNally suggests “this research brings us closer to understanding more about type 1 diabetes. However, it’s just one piece of the puzzle and mush more research is needed before we can identify which infections may be to blame and thus inform advice on preventative measures."
Each month we present articles on long and short time complications as well exercise. We do this to help you our readers to control diabetes and these complications. To put the state of treatment under the microscope in the US, we present this summery of a speech to the ADA. On June 11, Dr. Robert A Rizza the ADA’s president of medicine and science told delegations at the annual meeting of the ADA the following: “Unless something is done to prevent it (the oncoming epidemic of diabetes), diabetes will soon result in 35 million heart attacks, 13 million strokes, 6 million episodes of renal failure, 8 million instances of blindness or eye surgery, 2 million amputations and 62 million deaths, for a total of 121 million serious diabetes-related adverse events in the next 30 years". A cure for diabetes is the ultimate goal and would save the US approximately $6.6 trillion in the next 30 years on treating the disease, but that achievement, according to Dr. Rizza, is not on the horizon. Although he sees scientists as being “tantalizingly close" to major breakthroughs, until that time patients need optimal medical care including lifestyle changes. He suggested that all patients need an A1C of less than 7%, blood pressure readings of less than 130/80 mmHg, LDL readings of less than 100 mg/dl and an HDL of equal to or greater than 40 or 50 mg/dl for men and women respectively. Triglycerides should be less than 150 mg/dl, and body mass index should be less than 25 (the threshold for overweight). The ADA also suggests that diabetes take a baby aspirin each day to prevent stroke, and that no diabetic should smoke. “If our health care system were designed to implement this type of optimal care, it would have a dramatic impact on reducing heart attacks, stroked, kidney failure, eye disease, amputation, and premature death", Rizza said. Now, after reading these statistics please make sure you know your numbers. Make sure your physician is helping you to live the healthiest life by treating any discrepancies. Please take care.
The Journal of Clinical Endocrinology and Metabolism, Vol. 91, No.6 2087-2092 has an interesting article about a problem that is of concern to many of us with type 1 diabetes titled Nocturnal Hypoglycemia in Type 1 diabetes: An Assessment of Preventative Bedtime Treatments by Dr. Philip E. Cryer and others at Washington University School of Medicine. The authors examined this night time problem knowing that keeping tight control may lead to low blood glucose levels during the night and this can lead to confusion or even seizures. To investigate possible bedtime solutions, Cryer and colleagues studied 21 patients with type 1 diabetes over five nights. They found that a conventional bedtime snack (with or without acarbose which is the alpha-glucosidase inhibitor) or an uncooked cornstarch bar did not consistently prevent nocturnal hypoglycemia. The beta 2-adrenergic agonist terbutaline prevents nocturnal hypoglycemia but causes hyperglycemia the following morning. The efficacy of a lower dose of terbutaline remains to be determined. If this a continuing problem for you or someone you know, please see your physician. A few days u sing a continuous glucose monitor will help you decide if you have this problem if you are not aware of it. For those of us with type 1 diabetes who work hard to prevent complications by keeping tight control the looming aspect of night time hypoglycemia can be difficult. We’ll keep reading journals and bring the latest to you.
Our first abstract is titled The Effect of Glucose Variability on the Risk of Microvascular Complications in Type 1 Diabetes by Eric S. Kilpatrick, MD, FRCPATH et al and appears in Diabetes Care 29:1486-1490, 2006. It is not known whether glycemic instability may confer a risk of Microvascular complications that is an addition to that predicted by the mean blood glucose (MBG) value alone. This study has analyzed data from the Diabetes Control and Complications Trial (DCCT) to assess the effect of glucose variability on the risk of retinopathy and nephropathy in patients with type 1 diabetes. Pre- and postprandial seven-point glucose profiles were collected quarterly during the DCCT in 1,441 individuals. The mean area under the control glucose and SD of glucose variability with 24 hours and between visits were compared with the risk of retinopathy and nephropathy, and was adjusted for age, sex, disease duration, treatment group, prevention cohort, and phase of treatment. Multivariate Cox regression showed that within-day and between-day variability in blood glucose around a patients’ mean value has no influence on the development or progression of either retinopathy or nephropathy. Neither preprandial nor postprandial glucose concentrations preferentially contribute to the probability of retinopathy. The authors concluded that this study has shown that blood glucose variability does not appear to be an additional factor in the development of microvascular complications. Also pre- and postprandial glucose values are equally predictive of the small-vessel complications of type 1 diabetes.
Diabetes Care 29: 1518-1522, 2006 has an excellent article on neuropathy titled The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes by Mark Davies, MSC at al. The objective of this study was to determine the prevalence of painful diabetic neuropathy (PDPN) in a population-based sample and to estimate its severity and impact. To do this the research method was a cross-sectional descriptive study consisting of two phases: phase 1, a postal survey to patients with type 2 diabetes (an initial screening questionnaire including one question about pain); phase 2, neurological history and examination using the Toronto Clinical Scoring System, Subjects with PDPN of mixed (PDPN and nonneuropathic) pain completed the Neuropathic Pain Scale and Neuroqol ( a quality of life instrument) to assess severity and nature of the pain and impact on quality of life. Those without PDPN completed the Neuroqol only. The results indicated that in phase 1, there was a 92.7% response with patients reporting pain. In phase 2, 269 (82.5%) subjects attended and 51 (19.0%) were found to have PDPN: 99 (36.8%) nonneuropathic pain, 20 (7.4%) mixed pain, and 99 (36.8%) no pain (PDPN prevalence 26.4%). Of those with PCPN, 80% stated that their pain was moderate or severe. Those affected had poorer quality of life than those with no pain compared with those with nonneuropathic pain. Both pain and neuropathy score were independently associated with quality of life, and subjects with PDPN had significantly higher neuropathy scores. The researchers concluded that their study showed a prevalence of PDPN of 26.4%. Having PDPN has a significant negative effect on quality of life, and increasing neuropathy is associated with an increasing risk of developing PDPN.
The Archives of Internal Medicine 2006;166:1311-1316 has an interesting article for those of us who love the taste of coffee. Coffee Consumption and the Risk of Type 2 Diabetes is written by Mark Pereira, PhD et al. The researchers examined the role of caffeine in reducing the risk of type 2 diabetes. Other research has already examined the effects of the minerals, phytochemicals, and antioxidants in coffee and their abilities to cut the risk of type 2 diabetes. This is a prospective study analysis of the Iowa Women’s Health Study (1986-1997) which included 28,812 postmenopausal women free of diabetes and cardiovascular disease in the general community. The main outcome measure was the incident of type 2 diabetes as determined by mailed questionnaire. Coffee intake was categorized as 0, less than 1, 1 to 3, 4to 5, and 6 or more cups per day. During the 11 years of follow-up, there were 1418 incident cases of diabetes. Relative risks (RR) were adjusted for a variety of demographic, adiposity, and lifestyle measures. Compared to women who reported 0 cups of coffee per day, women who consumed 6 or more cups per day had a 22% lower risk of diabetes. The association appeared to be largely explained by decaffeinated coffee rather than regular coffee. Intake of magnesium and phytate did not explain these associations. Intakes of caffeine from all sources were not associated with risk of diabetes. The researchers concluded that coffee intake, especially decaffeinated, was inversely associated with risk of type 2 diabetes in this cohort of postmenopausal women.
BSP
