Diabetes Research
| August means that we begin to look forward to sending children back to school and we must make medical appointments for them. Rules about what our children and grandchildren must be inoculated against should be known and kept up to date. If you have a child with diabetes you should be aware of his or her Individualized educational plan; it’s his or her right. If you live in most of the country you know that August is also the month of extreme heat. If you have diabetes you know you must take care to not become dehydrated and guard your skin from drying out. If you are outside make sure to carry water and come inside if you have any of the symptoms of heat exhaustion. Better yet do not go out when the temperatures are high and the sun is at its hottest. Go to the market early in the day or when the sum sets. Ask your physician about special creams to keep your skin healthy and keep preparations for fungal infections in your drawer in case you have an outbreak. Do not give up on exercise. Today in American 2/3 of our population are overweight and 26% are obese. Please do not give up on your exercise and take along your nondiabetic friends. Exercise in doors in air-conditioning with friends to make sure all are safe and that you have fun. If you swim go early and use sun screen. What ever you do continue to exercise and read about diabetes so you know what all the diabetes terms like A1c levels are. Know what that score translates to and ask you physician what your standard deviation is so you know how much how often you have highs and lows. It’s those highs and lows that impact on your ability to function well. Let’s begin our monthly self education here with the headlines and then we’ll present the medical abstracts. This month they are about the effects of physician education and improvement in insulin prescribing, and hypoglycemia unawareness and reduced adherence to therapeutic decisions in type 1 diabetics. |
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We get many e-mails about new treatments and “cures” for diabetes and so we are sharing an article from New Zealand where a biotech company announced that they
will implant cells from newborn pigs into eight human volunteers as an experimental treatment for type 1 diabetes. (Please read on to get both the positive and negatives about this
treatment.) The cells produce pig insulin, which is similar to human insulin and has the same effect on lowering blood sugar, and Living Technologies hopes the cells may be able to delay
the effects of type 1 diabetes, though Bob Elliott, medical director of the company acknowledges that even in the best case scenario, the treatment would not eliminate all of the symptoms.
There is some worry that that implanting porcine cells carries a risk for introducing new virus to humans. Others fear that it is too soon to begin treatment in humans because no animal
trials were conducted. Elliott stated that “There is no evidence of risk of retrovirus infections. Nobody has developed as retrovirus.” The piglets used, recovered from 150
years of isolation on islands south of New Zealand, and carry no known agent that could infect humans and are held in a closed sterile environment. Elliott has run two previous trials one
in New Zealand with six patients (1995-1996) and one in Russia with 10 patients which began in 2007. The cells implanted into one of the volunteers in the New Zealand study continued to
produce insulin 12 years after being implanted. The others either rejected the pigs’ cells or the implanted cells stopped producing insulin after a year. We’ll continue to
follow this story for you.
Have you ever wondered why you can take your blood glucose levels in different hands or with different meters and get significantly different readings? We certainly have and an article in the Wall Street Journal found out exactly what we have found. I can remember taking my blood glucose level before going into my endocrinologist’s office and 2 minutes latter a nurse took it again with a different meter. I might as well have just not wasted a chem strip, the two readings were really off. According to the article a study by government researchers found that when comparing tests from five different popular monitors, results varied by as much as 32%. In a high school science project done in Arlington, Va., a student had her diabetic father use seven different monitors. “What I found was that almost all of the meters were off from one another by 60 to 75 points”, said Morgan DiSanto-Ranney a student at Bishop O’Connell High School. Her mother happens to work as an investigator for Senator Grassley, (R-Iowa) with whom she shared the results of the research and he wrote a letter to the F.D.A. asking officials to review the problem. The medical world is hoping this will not sour patients on using monitors because as we all know we know we need to know the tendencies of our blood glucose levels. On a personal level, I have spoken about my continuous blood glucose monitor. It may be off at times, but it still keeps me aware of the direction I am heading and I can take my blood glucose level to make sure I don’t wind up either hurting myself or someone else if I’m driving or wind up on the floor unconscious. Every year the F.D.A. receives reports of several deaths and thousands of injuries related to glucose monitors but this reports only a fraction of the actual toll. Statistics indicate that type 1 diabetics can slip into unconsciousness about once a year and that 40 % suffer seizures or coma in their lifetimes because of low blood glucose levels. Now that the government knows the facts the major diabetes organizations will continue to advocate for more accurate glucose monitors because we all know that insulin can be dangerous if not used correctly. When we see headlines about major breakthroughs we always caution you that these are just the beginning of our understanding diabetes, This month we bring you one of these “good news” research that occurred in mouse studies that brings information about mouse embryos. Researchers have found that an early embryonic gene plays an important role in directing cells to become part of the pancreas or part of the biliary system. It is thought that this finding could help in efforts to find a cure for type 1 diabetes.” James Wells a researcher in the developmental division at Cincinnati Children’s Hospital Medical Center and his group found that the Sox 17 gene acts like a toggle or binary switch that sets off a cascade of genetic events. In normal embryonic development when you have an undecided cell, if Sox17 goes one way, the cell becomes part of the biliary system; if is goes the other way, the cell becomes part of the pancreas. The discovery could prove important in guiding embryonic stem cells to become pancreatic beta cells which scientists believe could be used to treat or cure. When type 1 diabetes insulin-producing beta cells in the pancreas are attacked by the immune system type 1 diabetes follows. We’ll keep you posted. You can find more information in the July 21 issue of Developmental Cell. The Annals of Family Medicine July/August issue brings news that diabetes itself doesn’t up risk of depression. Although we all know that people with diabetes have a higher risk of being diagnosed with depression, a large new study has found that much of that increase can be accounted for by patients’ more frequent contact with the medical system. Dr. Patrick J. O’Connor of HealthPartners Research Foundation in Bloomington, Minnesota stated that our data suggest a higher likelihood of those with diabetes is no more affected that others with a chronic disease. They examined information from patients records from a large medical group that treated 225,000 patients between 1997 and 2003.They compared 2,932 people who received a diagnosis of diabetes during that time and 14,144 diagnosed with diabetes before 1997. They were place in two groups. The first was matched by age and sex and the second was matched by age, sex and number of primary care visits. For every group the likelihood of being newly diagnosed with depression fell as the number of times they visited the doctor increased. Among patients who already diabetes, those who had fewer physician visits during the study period were 46% more likely to be newly diagnosed with depression during the course of the study. For diabetic patients who had more than 10 physician visits during the study period, the risk of a new depression diagnosis was similar to that of non-diabetic individuals who visited the physician equally often. The reason why people who see their physician less often seems related to a diagnosis of depression is not clear. It might be that the primary care physicians are good at diagnosising depression after only a few visits but other explanations are possible. Abstracts are next and our first comes from Diabetes research and Clinical Practice, Vol. 85, Issue 2, P. 159-165 by Javier Ena et al titled Long-term improvements in insulin prescribing habits and glycemic control in medical inpatients associated with the introduction of a standard educational approach. The researchers carried out an educational strategy to increase physician adherence to 8 recommendations for inpatient evaluation and management of diabetes endorsed by the ADA. They evaluated physician attitude, barriers and facilitators to incorporate the proposed recommendations into clinical practice. The analyzed the impact of the educational strategy on process-of-care and outcome variable in 138 patients with type 2 diabetes discharged from the internal medicine department before the intervention, a 3 month and 9-month after the intervention. After the educational intervention there was a high motivation of physicians to adhere to the proposed recommendations. The intervention caused a significant reduction of insulin administered by sliding scale, and the median pre-discharge glycemic values, in the three periods, respectively. The basal-bolus-correction insulin dosage increased in post-intervention periods. Hypoglycemia episodes were similar among the three periods. The intervention required improvements to promote hemoglobin A1c ordering on admission and diabetes intensification therapy at discharge when needed. The researchers concluded that their educational strategy improved physician adoption of practice guidelines. Diabetes Care 32.7.1196 has an interesting abstract titles Hypoglycemia unawareness is associated with reduced adherence to therapeutic decisions in patients with type 1 diabetes written by Charlotte B. Smith, MB, et al. Hypoglycemia unawareness increases severe hypoglycemia risk. Hypoglycemia avoidance restores awareness, but it is difficult to sustain. The researchers compared adherence to treatment changes by awareness status. Case notes of 90 type 1 diabetic patients were analyzed retrospectively, identifying awareness status and insulin requirements, identifying awareness status and insulin regimes over four visits. The proportions of patients adhering to advice and percent advice taken were calculated. A total of 31 patients with hypoglycemia awareness and 19 with hypoglycemia unawareness were identifies, with insulin regimes available to 23 and 13 respectively. Patients with hypoglycemia unawareness were older and had longer diabetes duration. More patients with hypoglycemia unawareness reported severe hypoglycemia and fewer were adherent having lower adherence scores. The researchers concluded that reduces adherence to changes in insulin regime in hypoglycemia unawareness is compatible with habituation to hypoglycemic stress. Therapies aimed at reversing repetitive harmful behaviors may be useful to restore hypoglycemia awareness and protection from severe hypoglycemia. BSP |
