Welcome to the ongoing world of research and education that we bring you each month here at www.diabetic-lifestyle.com. We take great pride in sharing our finds with you and hope that you use the information to better understand how to live the most healthy, full life possible. Diabetes is a 24/7 disease, but with knowledge our lives can become more controllable and comfortable. If you have specific interests, just let us know and we'll keep our eyes peeled for research in that area. We like to hear from you so feel free to e-mail. Get a cup of java and read on. We know that the time you spend reading will help you make the decisions necessary to keep your diabetes under the best control possible.
As always, we will start out with some headlines and then go on to abstracts about irregular menstrual cycles may be a marker for the risk of type 2 diabetes, a practical approach to achieving healthy blood pressure goals in people with diabetes, the connection of smoking and people with type 2 diabetes, glucose monitoring and children with type 1 diabetes, Captopril for use in diabetic hypertensives, and finally LDL oxidation in diabetics.
Here are our headlines. Novo Nordisk has been cleared by the US Food and Drug Administration to market its InnoLet prefilled insulin-delivery device. The product is to be launched in March and is a new delivery system for type 2 diabetics. It has large, easy to read numerals and is easy to grip. According to the company, it allows "accurate, fine-tuned dosing; a reversible dose mechanism allows patients to correct a misdialed dose". It will be sold with two formulations of its Novolin premixed insulin. They have also received approval from the US FDA allowing the use of its rapid-acting insulin analog NovoLog (insulin aspart[ rDNA origin] )@? No close parentheses. Is 'aspart' correct? Does the r belong before 'DNA'? with external insulin pumps.
Here is a headline to take to heart. The journal Circulation had an article that stated that high levels of leptin, a hormone naturally produced in fat cells, can be a strong predictor of heart disease, as reported by a Scottish study. This connection was found to be independent of other risk factors such as smoking, high cholesterol and high blood pressure.
Pfizer reported that a Texas jury has awarded at least $43 million in damages for patient's liver injuries allegedly arising from its recalled Rezulin diabetes treatment in a case that could trigger similar decisions against this the world's largest drug maker.
We get questions about alcohol consumption and diabetes. The ADA recommends that people with diabetes follow the same guidelines as the general public and limit daily consumption to no more than 2 alcoholic beverages for men and 1 for women. One = 12 oz beer, or 5 oz wine, or 1.5 oz distilled spirits. The problem for diabetes is hypoglycemia. The 2001 ADA position statement states that "if alcohol is used in moderation with food, blood glucose levels are not affected when diabetes is well controlled", but adds that alcohol consumption should be avoided in pregnancy and in those who have a history of abuse as well in those with pancreatitis, neuropathy, or dyslipidemia.
Finally, the ADA issued new dietary guidelines in late December saying that people with diabetes can eat sweets occasionally as long as they keep their blood sugar levels under control. Occasional sweet treats are permissible under the guidelines, as long as the total intake of starches and sugars is kept in balance with insulin or other medications and exercise and does not exceed caloric needs. The report emphasizes what we have for the years that we have written books and articles for those of us with diabetes. That is that there is no one diet for everyone with diabetes. Rather, diets need to be individualized to accommodate preferences and medical factors.
JAMA 2001;286:2421-2426 has an article titled Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus by Caren G. Solomon, MD et al. The researchers knowing that oligomenorrhea has been associated cross-sectionally with insulin resistance and glucose intolerance, wanted to examine whether it was also a marker for increased future risk of type 2 diabetes. They used the Nurses' Health Study II, a prospective observational cohort study. A total of 101,073 women who had no prior history of diabetes and who reported their usual menstrual cycle pattern at age 18 to 22 years on the baseline (1989) questionnaire made up the participants. Incident reports of diabetes, with follow-up through 1997, compared among women categorized by menstrual cycle length (5 categories). The results indicate that during the 564,333 person-years of follow-up, there were 507 cases of type 2 diabetes. Women with long or highly irregular menstrual cycles had a significantly increased risk for developing type 2 diabetes that is not completely explained by obesity.
The Archives of Internal Medicine 2001;161:2661-2667 has an article titled A practical approach to achieving recommended blood pressure goals in diabetic patients by George L. Bakris, MD. Approximately 11 million Americans have both hypertension and diabetes mellitus. This double diagnosis places such people at high risk for renal damage, especially end-stage renal disease. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends a blood pressure goal of less than 130/85 mmHg to reduce or slow the onset of renal disease and cardiovascular events in patients with hypertension and diabetes. Recent data, however, now suggests that an even lower diastolic blood pressure goal i.e., <80 mmHg) may be necessary. Studies have shown that use of angiotensin-converting enzyme inhibitors can prevent the progression of microalbuminuria to overt proteinuria, reduce proteinuria in patients with overt diabetic nephropathy, slow the deterioration of the glomerular filtration rate, delay progression to end-stage renal disease, and lower blood pressure. Thus all diabetic patients with blood pressure greater than 130/80 mmHg should begin angiotensin-converting enzyme inhibitor treatment and be titrated to moderate or high doses until blood pressure goal is achieved. However using just one medication may not suffice. Studies have shown that use of multiple antihypertensive agents is necessary and successful in helping patients to reach targeted goals.
Diabetes Care 24:2043-2048,2001 has a timely article titled Smoking and mortality among women with type 2 diabetes by Wael K. Al-Delaimy, MD, PH.D. et al. The researchers assessed the relationship between smoking and mortality among women with type 2 diabetes in the Nurses' Health Study cohort. The study included 7,401 women with type 2 diabetes diagnosed at baseline or during the follow-up from 1996 to 1996. Total and cause-specific mortality of these diabetic were the outcomes of interest for this study. The researches documented 724 deaths during the 20 years of follow-up among women with type 2 diabetes. In multivariate analysis, adjusting for age, history of high blood pressure and high cholesterol, and other cardiovascular risk factors, compared to newer smokers, the RR's of mortality were 1.31 for past smokers, 1.43 for current smokers of 1-14 cigarettes/day, 1.64 for current smokers of 15-34 cigarettes/day, and 2.19 for currents of equal to or greater than 35 cigarettes/day. Women with type 2 diabetes who had stopped smoking for greater than or equal to 10 years had a mortality RR of 1.2 compared to diabetic women who were nonsmokers. The researchers concluded that cigarette smoking is associated in a dose-response manner with an increased mortality in women with type 2 diabetes. Furthermore, quitting smoking appears to decrease this rate of mortality. The results give new credence to throwing away that pack of cigarettes you have hidden some place in the house.
Diabetes Care 2001 2001;24:1858-1862 has an article about Routine glucose monitoring may be inadequate for children with type 1 diabetes by Dr. William V. Tamborlane et al from Yale University. The results of their study of continuous glucose monitoring in children with type 1 diabetes highlight current limitation of conventional self-monitoring of blood glucose. Diabetic children are often asked to monitor blood glucose levels before meals and at bedtime. If results are in the target range along with results of HbA1c measures, it was thought that overall control was adequate. However, marked glycemic deviations may be missed by only looking at "brief glimpses" provided by self-blood glucose monitoring. The researchers taught 56 children between 2 and 18 years to use the MiniMed Continuous Glucose Monitoring System (CGMS) for 3 days. At the end of 3 days, glucose values were downloaded and analyzed. The CGMS data showed that most children experienced "profound postprandial hyperglycemia" as well as "frequent and prolonged asymptomatic hypoglycemia" despite satisfactory HbA1c levels and preprandial glucose levels. The researchers found that continuous home glucose monitoring devices may be the "most important advance" in the management of diabetes in children in the past two decades. The wealth of data provided by glucose sensors will help clinicians and patients optimize basal and bolus insulin replacement. They emphasize, however, that further studies are needed on repeated use of the MiniMed CGMS devise. This system is currently intended for one-time or occasional testing and not for ongoing use, according to a FDA statement.
Still trying to understand diabetes and hypertension, our final abstract is titled Captopril superior to diuretics and beta-blockers in diabetic hypertension by Dr. Leo Niskanen et al form the University of Kuopio and reported in Diabetes Care 2001;24:2091-2096. The Finnish researchers performed a subanalysis of data from the Captopril Prevention Trial (CAPPP). In that trial, 10,985 patients with distolic blood pressure of 100 mmHg or more were randomized to captopril or diuretics and/or beta-blockers, and of these 572 had diabetes. Analysis of the diabetic patients showed that the primary end point of fatal or nonfatal myocardial infarction, stroke, and other cardiovascular deaths was significantly lower among those receiving caotopril than on those on diuretics and/or beta-blockers. There were fewer deaths from all causes among those taking captopril compared to those taking diuretics/beta-blockers. However, there was no difference between treatment groups in stroke. Patients with impaired metabolic control appeared to derive the most benefit form the captopril regime according to the researchers. The researchers concluded that this ACE inhibitor is the obvious first-choice drug for hypertensive patients with diabetes, especially when there is metabolic decompensation. However, because elevated blood pressure should be aggressively treated in diabetic patients, a multiple drug regime is commonly required to achieve optimal goals. This is the second research abstract that highlights this finding. Do use these facts when talking to your physician about your health if you suffer from hypertension. Taking medication sure beats developing the medical problems that accompany hypertension and diabetes.
BSP
