We begin with our headlines as we do every month and then go on to the Abstracts which this month bring information about Disparities in Diabetes Care and the Metabolic Syndrome.
Cell. December,2005 has an article which shares that a team at the University of California at San Diego, lead by Dr.Jamey D.Marth, has identified a gene that produces an enzyme that enables cells in the pancreas to recognize and secrete insulin, and that a high fat diet suppresses this enzyme. The group describes the gene that encodes GnT-4a, a glucose transporter enzyme. Without GnT-4a, beta cells in the pancreas fail to produce insulin when exposed to fat and glucose. If further research confirms the findings, one possible clinical application would be the development of therapeutic agents to boost the GnT-4a levels, research Dr. Marth is currently working on. Agents that inhibit GnT-4a may also be useful in preventing a number of diseases linked to too much insulin production, like cancer and cardiovascular disease.
Diabetologia, December, 2005 has an article that will be of interest to everyone. Dr. Barry I. Freedman and colleagues from Wake Forest University School of Medicine reported that compared to whites with type 2 diabetes, blacks with type 2 diabetes suffer more heart attacks, strokes, and end-stage renal disease, but African Americans appear to have significantly lower rates of clinical coronary artery disease. The team investigated whether there were ethnic differences in the amount of calcified plaque seen in the coronary carotid arteries of more than 1100 patients with type 2 diabetes enrolled in a heart study. Calcified plaque in the arteries was markedly lower in African-Americans that in whites, even though black subjects had a worse risk profile and significantly thicker walls of the carotid artery The researchers state, “These findings, observed despite poorer glycemic control, generally adverse cardiovascular disease risk factor profiles…in African Americans support the hypothesis that calcified atherosclerotic plaque does not have the same pathobiologic significance between ethnicities and genders".
Diabetes Care, December 2005, has an article about infrared energy and its ability to ease or not ease diabetic nerve damage by Judy K. Clifft, a physical therapist at the University of Tennessee Health Science Center. Devices that deliver monochromatic infrared energy (MIRE) are approved by the Food and Drug Administration for certain uses, but it seems they are no better than placebo treatments in reducing foot numbness experienced by people who have nerve damage related to diabetes, according to her research. The FDA approved MIRE devices in the mid-1990s to increase circulation and reduce pain and has been used in patients with wounds and soft-tissue.
Having a sibling with a history of cardiovascular disease carries a same or greater risk as having a parent with a history of the disease, according to a new report from the long-standing Framingham Heart Study conducted by the National Heart, Lung, and Blood Institute (NHLBI). Personal risk of having a cardiovascular event such as heart attack, stroke, or peripheral artery disease may be raised as much as 45 percent in middle-aged people whose brother or sister has had such an event. The study appeared in the December 28, 2005 edition of the Journal of the American Medical Association and is written by Director Elizabeth G. Nabel, MD.
The number of people with diabetes in Maine has doubled since 1994, and state officials are worried that inactivity and overeating are pushing up rates even more. Figures from the Centers for Disease Control and Prevention show that 3.4 percent of adult Mariners had been diagnosed with diabetes as of 1994. Within the last decade that figure has grown to 7.6 percent of adults across the state. Maine is not alone in the battle with diabetes, which is the 6th leading cause of death in the US. In the last decade, 23 states have doubled their diabetes rates. Puerto Rico has the highest rate, at 10.8 percent, and Colorado has the lowest, at 4.8 percent.
JDRF-funded researchers at Harvard Medical School may have found a direct pathway through which a virus or dietary factor could disrupt normal immune function and trigger type 1 diabetes. The study suggests that the immune system goes awry when it overreacts to foreign matter entering the pancreatic lymph nodes, and marshals its immune T cells to increase their ranks and destroy everything, including the body’s own insulin cells. “This finding could be an important step toward identifying what identifies type 1 diabetes", said JDRF Executive Vice President for research Richard Insel, M.D.
Now, we bring you the abstracts of the month. Out first appears in the Archives of Internal Medicine, 2005;165:2631-2638 and is titled Disparities in Diabetes Care by Susan M. Frayne, MD, MPH et al. Emerging evidence indicates that patients with mental health conditions (MHCs) may receive less intensive medical care. The researchers used diabetes as a useful condition to test for MHC-related disparities in care. They examined whether quality measures for diabetes care are worse for patients with or without MHCs. This is a national, cross-sectional study including 313,586 noninstitutionalized Veterans Health Administration patients with diabetes whose VA facility transmitted laboratory data to a central database; 76,799 (26%) had MHCs (based on diagnostic codes for depressed mood, anxiety, psychosis, manic symptoms, substance use disorders, personality disorders, and other categories). National data from Veterans Health Administration records, Medicare claims, and a national survey were linked to characterize 1999 diabetes care. The results indicated that failure to meet diabetes performance measures were more common in patients with MHCs: unadjusted odds ratio (95% confidence level) was 1.24 for no hemoglobin A1c testing, 1.25 for no low-density lipoprotein cholesterol testing, 1.05 for no eye examination, 1.32 for poor glycemic control, and 1.17 for poor lipemic control. Disparities persisted after case adjustment and were pronounced with specific MHCs (psychotic, manic, substance use, and personality disorders). The percentage not meeting diabetes care standards increased with increasing numbers of MHCs. The researchers concluded that patients with mental illness merit special attention in national quality improvement efforts.
Diabetes Care 29:123-130,2006 has an article titled Metabolic Syndrome, Risk factor distribution and 18-year mortality in the Multiple Risk Factor Intervention Trial by Lynn E. Eberly, PhD et al. The reason for this research was to examine the long-term association of metabolic syndrome with mortality among those with high risk for cardiovascular disease (CVD). A total of 10,950 Multiple Risk Factor Intervention Trial (MRFIT) survivors were followed for mortality an additional 18.4 years from 1980-1999.Proportional hazards models examined multivariate-adjusted risks associated with Adult Treatment III—defined metabolic syndrome conditions, with BMI substituted for waist circumference. At MRFIT annual visit 6, 4,588 (41.9%) men, mean age 53.0±5.9 years had metabolic syndrome and 6,362 did not. Comparing men with metabolic syndrome to men without, adjusted hazard ratios (HRs) were 1.21. 1.49. and 1.51 for 18-year total, and coronary heart disease mortality respectively. Among men with metabolic syndrome, elevated glucose, and low HDL cholesterol were most predictive of CVD mortality, followed by elevated BMI, elevated blood pressure, and elevated triglycerides. Among metabolic syndrome men with no nonfatal CVD event, smokers with elevated LDL cholesterol showed higher CVD mortality compared to nonsmokers with elevated LDL cholesterol; this additional risk was even greater for metabolic syndrome with nonfatal CVD event. The researchers concluded that metabolic syndrome is associated with an increased risk of mortality. Among those with metabolic syndrome, risk is further increased by having more metabolic conditions, by cigarette smoking, and by elevated LDL cholesterol. They also suggested that primary prevention of each metabolic syndrome condition should be emphasized, and presence of each condition should be treated in accordance with current guidelines.
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