Headlines first. You'll find something for every one here including new medications and use of medications.
Our first headline actually made the headlines. It is about the fact that Americans are growing fatter and fatter. John Foreyt of Baylor College of Medicine sees this problem as an epidemic and fears that in the near future (2230) just about all of us will be obese. The greatest problem that will result from this is diabetes. The cost of obesity in 2001 was $123 billion. Today it is estimated that 61% of diabetes is due to obesity and the fear is that as the country gets fatter that this will break the health care bank. Now is the time to take a stance in your family. None of us wants our children to live with a potentially life-threatening disease.
Our second headline has to do to with the facts that certain polymorphisms and the apolipoprotein E (APOE) gene may be important in forecasting diabetic nerve damage. Dr. Richard S. Bedlack of Duke University suggests screening diabetics and prescribing the proper treatments for aggressive management. Dr. Bedlack explains that neuropathy symptoms tend to worsen over time and people with symptoms in the "high risk'" type of APOE tended to have more symptoms of neuropathy than those who are not at risk. The size of the effect "that we found is equivalent to having 15 extra years or 15 extra years of diabetes duration". They continue to research the effects of other forms of APOE and how they relate to neuropathy as well as other genetic factors.
We report here that the FDA has given a supplementary approval allowing Bristol-Myers Squibb Co to use Glucovance (glyburide and metformin HCl ) along with thiazolidinediones (TZD's) with Avandia (rosiglitazone), and Actos (pioglitazone). Please read last months What's Hot about medications to help make sense of this.
GlaxoSmithKline also received US approval for Avandamet, a tablet combination of Avandia and metformin. Once again look at that What's Hot article.
Another new medication from Merck & Co and Schering-Plough Corp. has been approved called Zetia. This is a new type of cholesterol-lowering medication. In a cited study. The medication was added to ongoing statin treatment lowering cholesterol 25% compared to 4% in those who received a placebo.
Just when we all have our LDL and HDL scores memorized we see articles on the importance of the size and number of lipoproteins in the blood. Tests at the Univ. of Pittsburgh found that measuring these factors was a good predictor of heart attack risk in women, probably better than the traditional blood cholesterol analysis. Researchers at Duke University found that small particles are the best predictors of heart disease risk and that exercise has a positive effect on changing the number and size of these particles, which carry cholesterol through the bloodstream. Now we know you'll head to the Exercise articles. Remember, we have 5 years worth of those.
One last headline that caught our eye and that is from the New England Journal of Medicine 2002;347:1309-1317 by Dr. Eric J. Topol of the Cleveland Clinic Foundation. In this article the current taboo of avoiding aspirin until at least 24 hours after bypass surgery is re-examined. "The benefits include survival, less bleeding, and reduction of virtually every complication of cardiac surgery". Researchers studied 5,065 coronary bypass patients. The results of the study "show that platelet activation and clotting after surgery is important, and that antiplatelet drugs such as aspirin have profound effects..."
Now we will report on several abstracts and papers that hopefully will be of interest to many of you and which you can take with you when you visit your physicians.
At various times we read articles warning about supplements, This one asks the question "to soy or not to soy?" Our first abstract which appeared in Diabetes Care 2002;25:1709-1714 by Dr. Vijay Jayagopal and colleagues from the Hull Royal Infirmary in the UK reports facts that you may want to take to your nutritionist. The researchers conducted a cross-over trial in which 32 post menopausal women with type 2 diabetes during which the subjects either received a dietary supplement with phytoestrogens or a placebo for 12 weeks. Compared with placebo use, phytoestrogen use was associated with significantly greater reductions in fasting insulin levels, insulin resistance, HbA1c levels, total cholesterol levels, LDL cholesterol, cholesterol/HDL ratio, and free thyroxine levels. The researchers conclude "these data show that short-term dietary ...supplementation reduces insulin resistance and improve glycemic control...while reducing their cardiovascular risk..." It remains unclear whether the soy protein or isoflavone component was primarily responsible for the beneficial effects or if both act synergistically. We will look forward to reading more research in the future, but soy nuts sound good right about now.
Just when you thought you had made peace with HRT, whether you are still taking hormones or not, there comes an article in Diabetes Care2002; 25(10):1675-1680 by Carlos J. Crespo Dr PH et al of the Department of Social and Preventive Medicine, School of Medicine and Biomedical Sciences, University of Buffalo, State University of New York. It is entitled Hormone replacement therapy and its relationship to lipid and glucose metabolism in diabetic and nondiabetic postmenopausal women. Among postmenopausal women, those with diabetes develop more cardiovascular diseases than those without diabetes. The researchers examined the relationship of HRT with indicators of lipid and glucose metabolism using a national sample of diabetic and nondiabetic women. They used data from the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994. A total of 2,786 postmenopausal women aged 40-74 years participated in an oral glucose tolerance test, had blood drawn for lipid assessment, and responded to HRT questions. The results showed that postmenopausal women with diabetes had increased dislipidemia compared to nondiabetic women.
Among diabetic women, current HRT users had significant different lipid and glucose control levels compared to newer users of HRT for the following variables: total cholesterol (225 vs. 241mg/dl), non-HDL (169 vs.188 mg/dl), apoA (171 vs.147 mg/dl), fibrinogen (306 vs.342 mg/dl), glucose (112 vs. 154 mg/dl), insulin (16.81 vs. 22 uU/ml), and GHb (6.03 vs.7.13 mg/dl). The researchers concluded that diabetic and nondiabetic postmenopausal women currently taking HRT had better lipoprotein profiles than newer or previous users of HRT. Diabetic women currently taking HRT had better glycemic control than newer or previous users of HRT.
At the recent annual research conference of the ADA investigators presented a paper of great interest to all of us. The researchers from Rio Grande del Sul, Brazil; the State University of New York in Buffalo; and the University of Alberta in Canada presented their results. Investigators have concluded in recent years that heart disease may be linked to inflammation. Now there is evidence that type 2 diabetes, which is strongly linked to heart disease, may be related to inflammation also. The research is based on the fact that when you get an infection your body produces cells that help fight off disease. When this happens a variety of protein types and other substances collect in the blood stream. Inflammation can be measured by looking at these substances and are "markers" of inflammation. Higher levels of several of these markers have been found in people with heart disease and their presence seems to predict development of heart disease in people who don't have it yet. Two studies presented at the June15th meeting point out that commonly prescribed drugs appear to reduce inflammation and improve diabetes control The link between diabetes and inflammation may not be a coincidence, the researchers suggest. One study presented in Buffalo found that rosiglitazone (Avandia) reduced levels of several blood markers of inflammation. A similar effect was noted in another study at the same medical school using Rezulin, a thiazolidinedione.
Researchers in Canada examined the medication records of 11,000 type 2 diabetic patients who took medication to lower blood glucose levels. Researchers found it took longer for patients' diabetes to get worse if they took statins. Previous studies have shown that people who take statins have a 33% lower risk of developing diabetes. Researchers said more research is needed to see if statins should be used even when not needed for high cholesterol in those at risk for inflammatory based type 2 diabetes.
Our last article related to many e-mails we receive about surgery for obesity in diabetic persons. This article appeared in the Archives of Surgery 2002;137:1109-1117 titled Effects of obesity surgery on non-insulin-dependent diabetes mellitus by Scott E. Greenway, M.D. et al. Losing weight is frustrating for anyone, but for diabetic people it is important for control of long term complications. In the past many patients have had disappointing results from weight loss programs, medications and behavior modification programs. Bariatric surgery is postulated to be a most effective method of diabetes management and cure in the morbidly obese population. Surgical procedures to cause malabsorption provide a more dramatic effect on diabetes owing to the imparted bypass of hormonally active foregut. Data was gleamed from 40 years of pertinent journal articles and textbooks. The results of the research indicate that bariatric surgery has proven a much more successful method of weight loss and diabetes control in the obese population than conservative methods. These surgical procedures have proven safe with a reported mortality rate of 0% to 1.5 %. There are two bariatric operations noted.
The first category is restrictive and includes vertical banded gastroplasty and adjustable silicone gastric banding. These operations improve diabetes by decreasing food intake and body weight with a slowing of gastric emptying. The second category not only contains restrictive components but also elements of malabsorption. This category includes the Roux-en-Y gastric bypass and biliary-pancreatic diversion, which bypass the foregut. Although both categories of surgery offer improved weight loss compared to conservative methods, the Roux-en-Y gastric bypass and biliary-pancreatic diversion offer superior weight loss and resolution of diabetes. The more dramatic effect seen in the surgical procedures to cause malabsorption is likely secondary to the bypass of the foregut resulting in increased weight loss and elevation of the enteroglucagon level.
BSP
