Winter has settled in and the cold north winds keep us home more and more. Now is the time to reread the latest research on diabetes and find out what , where and how research is being done to control, understand, and cure diabetes. What ever your interests, please let us know and we'll try to find out an answer. If you need information on a specific topic, we will try to research it; if you are troubled or excited about some aspect of our disease, let us know. In the mean time, please read this month's research and catch up on other months so that we all are the most educated readers on the net. This month we look at the variation of blood glucose levels during the day and diagnosis of diabetes, retinopathy progression after surgery, appropriate insulin regimes in type 2 diabetes, and finally research on a gene linked to autoimmune syndrome and its effect on type 1 diabetes.
We start with news that the FDA has approved a new diabetes drug to help patients control blood glucose levels after meals. Starlix, an amino acid derivative, is marketed by Novaris Pharmaceuticals Corp. and is the company's first drug for type 2 diabetes. In clinical studies, the medication showed an ability to stimulate insulin production quickly in the pancreas, addressing a basic defect in type 2 diabetes. By this action, the manufacturer states that Starlix lowers overall blood glucose levels and blunts the effect of mealtime glucose spikes. This is a common problem among people with type 2 diabetes and has the possibility to prevent serious complications of diabetes.
Second, we share a report from the American Institute for Cancer Research which published information about diet and hypertension. The journal Hypertension has a study that showed that after 6 months, 22 percent of the participants who got regular exercise and lost weight were able to reduce their blood pressure to normal without medication. Another study used the DASH diet, which focuses on increasing antioxidant consumption with 8 to 10 servings of fruits and vegetables a day and 4 to 5 servings of nuts per week. In a large group of people with mildly elevated blood pressure, this diet significantly lowered blood pressure without weight loss or decreased salt. When 2 to 3 servings of low-fat or fat-free dairy products a day were substituted in the diet, subjects almost doubled the amount they lowered their blood pressure. What else impacts blood pressure? Less alcohol consumption, using olive oil instead of other fats and watching the amount of sodium you eat, all appear to impact hypertension. This type of diet not only helps control hypertension, but according to the American Institute for Cancer Research, it may prevent 30 to 40 percent of cancers.
Nature 2001;409:92-97 has an article about SHIP2, a gene which may become a target for the treatment of type 2 Diabetes. This morning, Jan.9, 2001 the news is full of the relationship between diabetes and high blood pressure and mental processing. This new study shows deterioration deep in the brain at younger ages than was thought before and points to the need for early intervention and control of both diseases. We have been sharing information about this slowing in older patients, but here it is in younger participants. Keep reading here and we'll bring you more information.
The Journal of the American Medical Association, 12/27/00, Vol. 284, N0. 24: 3157-3159 has an article titles Diurnal Variation in Fasting Plasma Glucose, Implications for Diagnosis of Diabetes in Patients Examined in the Afternoon, by Troisi, R ScD et al. Current diagnostic criteria are based on plasma glucose levels in blood samples obtained in the morning after an overnight fast, with a value of 7.0 mmol/L (126mg/dL) or more indicating diabetes. However, many patients are seen by their physicians in the afternoon. Because blood glucose levels are higher in the morning, it is unclear whether these diagnostic criteria can be applied to patients who are tested in the afternoon. To examine this, the researchers documented diurnal variation in fasting blood glucose levels in adults who were not thought to have diabetes, and to examine the applicability to afternoon-examined patents of the current diagnostic criteria for diabetes. The researchers examined data from the US population based Third National Health and Nutrition Survey (1988-1994) on participants aged 20 years or older who had no previous diagnosis of diabetes and who were randomly assigned to morning (n=6483) or afternoon (6399) examinations and who had fasted prior to blood sampling. The morning and afternoon groups did not differ in age, body mass index, waist-to-hip-ratio, physical activity index, glycosylated hemoglobin level, and other factors. The results indicated that if current diagnostic criteria are applied to patients seen in the afternoon, approximately half of all cases of undiagnosed diabetes in these patients will be missed.
Researchers in the US and Canada report that they've used gene therapy to convert cells in the upper intestine of diabetic mice into pancreas-like insulin factories that help restore the animals' blood sugar balance. This is a long way from being researched in humans but it is a promising new approach to cure diabetes. Look at the ADA web site for more information and whenever you see information, let us know. We'll keep in top of this situation and keep you advised.
The Archives of Ophthalmology, Vol.118 No. 7, July 2000 has an article titled Retinopathy Progression and Visual Outcomes After Phacoemulsification in Patients with Diabetes Mellitus by Mittra, R. MD et al. The objectives of the study were to determine the progression of diabetic retinopathy after phacoemulsification surgery, and whether surgeon experience and/or surgery duration adversely affect visual outcome. This is a retrospective review of 150 eyes of 119 diabetic patients who underwent this surgery during a 5-year period. Data collected included patient age, sex, type and duration of diabetes, diabetic control, associated systemic health factored, preoperative visual acuity and retinopathy grade, duration of surgery, intraoperative complications, and postoperative course. The effect of these factors on visual outcome and rate of retinopathy progression was studied by means of univariate and stepwise multivariate logistic regression analysis. Resident and private cases were compares. The results indicated that visual acuity improved by 2 or more lines in 117 eyes (78%); 93 eyes (62%) had a final visual acuity of at least 20/40. Retinopathy progression was seen in 37 eyes (25%) with 6 to 10 months follow-up. Preoperative nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, and limited surgical experience were statistically associated with retinopathy progression and poor visual outcome. The conclusions were that visual results and rate of retinopathy progression after phacoemulsification surgery did not differ significantly from those reported that used other techniques. Nonproliferative and proliferative diabetic retinopathy and surgical inexperience resulted in an increased rate of retinopathy progression.
Diabetes Care 23(11):1612-1618, 2000has an article titled Appropriate Insulin Regimes for Type 2 Diabetes: A Multicenter Randomized Crossover Study, by Taylor, R. MD et al. The objective of this study was to directly compare the rate of hypoglycemia and blood glucose control achieved on once-daily ultralente insulin with twice -daily NPH insulin administration in patients with type 2 diabetes. Patients treatment satisfaction and quality of life were examined before and during each treatment. A crossover study was performed involving 5 center and 79 patients with type 2 diabetes (fasting blood glucose >8mmol/l) with a 2-month run-in followed by two 6-month periods of either NPH or ultralente insulin administration. Patients were managed by a specialists nurse using a dosage adjustment protocol. The results indicates that HbA1c was lower with NPH insulin therapy during each of the 6 -month periods. The difference accounted for by higher evening glucose levels with ultralente. Despite worse control, the total number of hypoglycemic episodes was greater with ultralente insulin (220vs.171), and hypoglycemic episodes requiring third-party assistance occurred almost entirely with ultralente (14 vs.1). Treatment satisfaction rose with change to NPH, but fell upon changing to ultralente insulin. These changes were highly significant. Diabetes quality of life improved on both regimes. In conclusion, the data demonstrated the lower hypoglycemia rate, better glucose control, and greater treatment satisfaction accompanying therapy for type 2 diabetes with twice daily NPH compared with twice daily ultralente insulin.
Finally we look at an article in the Journal of Clinical Investigation 2000;106:75-86 titles Gene Linked to Autoimmune Syndrome Has Implication for Type 2 Diabetes, by Chatila, T. MD et al. It looked at mutations in the gene JM2 which appears to cause X-linked autoimmunity-allergic dysregulation syndrome (XLAAD), a disorder presenting early in life characterized by early-onset type 2 diabetes mellitus and severe atopy, such as food allergy, eczema, and cosinophilic inflammation. The researchers performed a genetic analysis for two kindreds with XLAAD. Among the families studies, the authors identified 5 males that were affected with the disorder. Analysis of T-helper cell type 2 function in these patients revealed dysregulated responses consistent with XLAAD. Using a positional-candidate approach, the investigators detected mutations in the JM2 gene of both kindreds. The gene, which encodes a fork head domain-containing protein, is located on the chromosome Xp11.23. One defect, a point mutation at a splice junction site, creates a truncated protein which lacks the forkhead homology domain. The other mutation, as in-frame, 3bp deletion, would likely impair the function of a leucine zipper dimerization domain. The XLAAD susceptibility locus identified in the current study overlaps with genetic interval previously defined in other XLAAD families. The clinical observations in XLAAD patients of the beneficial effects of T-cell immunosuppressents point to a pivotal role for JM2 in maintaining T-cell tolerance in regulating T-helper cell differentiation. The findings in this study may have implications for sporadic type 1 diabetes mellitus which appears that mutations and/or polymorphisms in JM2 may be more broadly contribute to the pathogenesis of sporadic type 1 diabetes mellitus.
