Our first headline is from Hypertension 2003;42:1137-1143. Dr Alice Stanton et al from Dublin found that a new non-peptide orally active renin inhibitor, aliskiren appears safe and effective in treating hypertension. They found that dose-related reduction in daytime systolic blood pressure was found in the aliskiren group of subjects.
Great Britain issued an alert on the Avantis' Optipen Pro insulin pen, stating that more than 1,000 people have complained of difficulties using the pen injection system. The system, which injects Lantus, has been available since 2002 in Britain. An Avantis spokeswoman said that over 3 million pens have distributed worldwide and she is not aware of any problems in other countries. The difficulties in the UK reflected the need for better training to use a sophisticated device.
Diabetes Care 2004;27:129-133 has an article about Depressive symptoms tied to subsequent risk of type 2 diabetes in women by Dr. Cassandra Arroyo et al of Morehouse School of Medicine in Atlanta, GA. They analyzed data from 72,172 female nurses aged 45 to 72 years of age without diagnosis of diabetes at baseline. Women with depressive symptoms included in this analysis had a multivariate RR (relative risk) of developing type 2 diabetes of 1.29. "These findings require further corroboration but suggest that depressive symptoms may identify a group at increased risk of subsequent type 2 diabetes."
Pediatrics 2004;113:82-86 has an article by Dr. Terence J. Wilkin et al from the UK. They conducted the Early Bird Study investigation, whether girls were intrinsically more insulin resistant than boys, in this community-based study that included 307 healthy children from school entry at age 5. According to the results, insulin resistance, based on fasting glucose and insulin concentration, was 35% greater in the girls than in the boys, even after adjustment for a number of risk factors. Neither physical activity nor weight-adjusted resting energy expenditure correlated with insulin resistance in boys or girls, though the boys were more physically active and had higher resting energy expenditure. The researchers concluded that "girls are intrinsically more insulin resistant than boys, exposing them in childhood to a greater risk of metabolic disturbances such as diabetes."
A new type of treatment for type 2 diabetes may help people with this condition to control their blood sugar levels better than traditional therapies. Research shows that an experimental drug, called exenatide, can improve blood sugar levels in people who haven't reached optimal levels through diet and other diabetes treatments. Exenatide is a diabetes treatment that has been shown to increase the number of insulin-producing cells in the pancreas in animal studies. By boosting the number and function of these cells, researchers say, this synthetic biological drug helps bring blood sugar levels under control without using insulin injections. The results of this study are found in the August issue of Diabetes Care.
Many type 1 diabetics can engage in heavy exercise without fear that the activity will influence the result of kidney function. When monitoring people with diabetes, doctors periodically check their urine for the presence of a protein called albumin, a sign that their kidneys are not functioning properly. The lead author Dr. James T. Lane in Diabetes Care: 2003-12-31.Lane, of the University of Nebraska Medical Center and his associates found that people with type 1 diabetes with normal blood pressure and no traces of albumin in their urine under normal conditions, did not excrete abnormal amounts of albumin after heavy exercise. The researchers caution that these findings apply strictly to people with type 1 diabetes.
Caffeinated coffee intake inversely associated with type 2 diabetes is an article in Annals of Internal Medicine 2004;140:1-8 written by Dr. Frank B Hu from Harvard. These new findings stem from data on more than 42,000 men and 84,000 women in the Health Professional's Follow-up Study and Nurses' Health Study, who reported caffeinated beverage consumption every 2 to 4 years over a period 12 to 18 years. In analyses adjusted for age, body mass index, cigarette smoking and other dietary and lifestyle factors, a statistically inverse relationship emerged between drinking coffee or other caffeinated beverages and the incidence of type 2 diabetes in both men and women. The multivariate relative risks for diabetes were 0.93, 0.71 and 0.46 respectively, in men who reported drinking 1 to 3, 4 to 5 or 6 or more cups of caffeinated coffee per day. The corresponding relative risks in women were 0.99, 0.70, and 0.71, respectively. No such association was found for decaffeinated coffee consumption. Commenting on the results, Dr, Hu noted that "last year a Dutch study found that heavy coffee drinkers had a substantially reduced risk of type 2 diabetes. That study set off a major controversy among researchers, because it is known that caffeine adversely affects glucose metabolism, in short-term studies," he said. "[Ours] is a much larger study with longer follow-up [and] is more rigorous in measuring coffee intake. Also, unlike the Dutch study, we looked at both regular coffee and decaffeinated," he added. Dr. Hu emphasized that while caffeine is a main ingredient of coffee, coffee has many other substances and compounds such as magnesium and antioxidants that many be beneficial for glucose metabolism and diabetes risk. "More studies are needed to examine the effects of these compounds in coffee," he said.
Islet transplantation may be justified for only most severe type 1 diabetes is an article in Diabetes Care 2003;26:3288-3295 written by Dr. David M. Harlan et al at the US Institutes of Health. The research team suggests that pancreatic islet transplantation may be appropriate only for those patients with severe "end-stage" type 1 diabetes resistant to an optimal treatment regime. The researchers report their experience with allogeneic transplantation in six patients, ages 39 to 63 years, with severe type 1 diabetes accompanied by hypoglycemia unawareness. Two patients received one cadaveric donor islet allograft each and four received two each. Three subjects remained insulin independent for more than a year and a half, but the authors note that glycemic control appeared to deteriorate over time. Three patients discontinued immunosuppressive therapy, but the authors were surprised to find that C-peptide production continued for more than 6 months in two of these, suggesting recovery of some endogenous pancreatic islet function. However, there were two life-threatening procedure-related complications: partial portal vein thrombosis and intra-abdominal hemorrhage. Immunosuppression led to two cases of severe neutropenia, three cases of reduced kidney function, and one case of interstitial pneumonitis.
Because of the risks, Dr. Harlan's group suggests that islet transplantation be reserved for patients with "severe metabolic instability despite compliance with an optimized diabetes regime including best current dietary, blood glucose monitoring, and insulin delivery systems."
Mutant CCr5 alters the course of type 1 diabetes is an article in the Journal of Diabetes and its Complications 2003;17:387-392 by Dr. Ingred Kalev at al. The CC-chemokine receptor CCR5-del32 mutation, already well-known as a protective factor against HIV infection, is also a modifying pathogenic factor in type 1 diabetes, a team of investigators from Tartu University in Estonia found. A significant correlation between CCR5 receptor gene polymorphism and the onset and clinical course of type 1 diabetes did emerge. "In type 1 diabetes, the disease started 5.4 years earlier in the case of wild-type CCR5 genotype compared to CCR5-del32 heterozygotes. We speculate the CCR5 gene may be a modifying gene for the course of human type 1 diabetes," Dr. Kalev said.
However, the gene is "not directly associated with the aetiology of either type 2 or type 2 diabetes," according to the study. In type 2 diabetes, the receptor gene polymorphism did not affect the age of onset and the clinical course of diabetes. However, in the case of CCR5 wild-type genotype, the frequency of concomitant diseases such as mental disorders, diseases of the musculoskeletal and respiratory system, neoplasm, endocrine and metabolic disease, per patient was increased compared to CCR5-del32 heterozygotes.
This suggests a link between CCR5 polymorphism in type 2 diabetes and immunologic homeostasis. "We propose that ...CCR5 polymorphism in type 2 diabetes is related to the life quality of patients," Dr. Kalev said. The researchers called for further studies of patients to confirm the disease-modifying effects of the CCR5 gene in diabetes.
Dietary magnesium may help prevent development of type 2 diabetes in Diabetes Care 2003;27:134-140 by Ruy Lopez-Ridaura, M.D et al from Harvard Medical School is of interest to many people who ask about supplements and diabetes. Magnesium-containing foods can prevent developing of type 2 diabetes in both men and women, according to the results of this large cohort trial. A second cohort study in the same issue of Diabetes Care showed a similar benefit, especially in overweight women. "Our findings suggest a significant inverse association between magnesium intake and diabetes risk," stated the lead researcher Dr. Lopez-Ridaura. "This study supports the dietary recommendations to increase consumption of major food sources such as nuts, whole grains, and green leafy vegetables."
The study population consisted of 85,060 women and 42,872 men with no history of diabetes, cardiovascular disease, or cancer at baseline. Using a validated food frequency questionnaire every two to four years, the investigators determined dietary magnesium intake. During the follow-up of 18 years in women and 12 years in men, there were 4,085 incident cases of type 2 diabetes in women and 1,333 cases in men. Comparing the highest and lowest quintile of total magnesium intake, the relative risk (RR) of type 2 diabetes, after adjustment for age, body mass (BMI), physical activity, family history of diabetes, alcohol consumption, and history of hypertension and hypercholesterolemia at baseline, was 0.66-0.60 in women and 0.67 in men. Further adjustment for other dietary variables did not affect the inverse association between magnesium intake and reduced diabetes risk, nor did subgroup analysis according to BMI, physical activity, or family history of diabetes.
Study limitations included inability to screen for blood glucose, resulting in failure to diagnose some cases of diabetes, and possible residual confounding. The researchers concluded that, "Higher magnesium intake is likely more beneficial among individuals with some degree of magnesium deficiency. The effect of magnesium supplementation in general or in high-risk populations requires further research, ideally in a randomized clinical trial."
BSP
