Diabetes Research
| February can be a cruel month of cold inclement weather and so we need to find ways to exercise and keep healthy foods in our homes for those days when staying under the covers sounds really good. To keep motivated to exercise join a group of friends who will call you to make sure you are out if bed and getting dressed. If possible purchase an at home exercise video for those days that going out is not possible or get some friends who can walk hall ways or shopping malls. Look into local gyms to see if you can pay for only winter months and join with your friends. To keep a healthy pantry, look at any of our books where we have lists for your freezer, refrigerator, and pantry. Keep an ear to the weather and if you may be stored in make sure you have stocked up on food and all of your medications as well as batteries for the radio so you can keep up incase the electricity goes off. Make sure you have a person who will check up on you and that you have a list of people to check on. That way, everyone will be cared for. Have a happy February. Try something new for Presidents’ Weekend and look at our Entertaining articles for some really wonderful suggestions for Valentine’s Day. |
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Headlines begin our news highlights each month and then we bring you abstracts. This month you can read about pitfalls in the measurement of nocturnal blood pressure dip
in adolescents with type 1 diabetes, and diabetic patients’ medication underuse, illness outcomes, and beliefs about antihyperglycemic and antihypertensive treatments. Let’s
begin! Just when you thought you had read everything about the long term complications of diabetes we read this month about research done by Dr. Roger Dixon of the University of Alberta in
Edmonton. He and his colleagues found small but significant differences between people with diabetes and their healthy peers on some tests of brain function and speed. This test on 465 men
and women between 55 and 81 years of age, 41 of whom had type 2 diabetes found that the diabetics did just as well on tests of memory, fluency, reaction time, and perceptual speed, they
fared worse on some tests of executive functioning. Specifically, they weren’t as quick on a task that required them to complete a sentence with a single word or to provide a word
that didn’t complete the sentence properly. They also took longer on a test that required them to read a string of letters and state if the letters spelled an English word, and
another test requiring them to read a sentence and say whether or not they were plausible or nonsensical. The question now is why this occurs and how diabetes affects blood vessels or how
insulin and blood sugar regulation and variability could play a role. The longer I do this research the more often I read the same hypothesis for the reasons for complications so please
know your A1c numbers, blood pressure number and all other blood work so you can talk to your doctor about to better control your health.
Quite often we hear from people who are newly diagnosed with diabetes and they ask for an easy way of knowing their blood glucose levels without drawing any blood. Over the years we have reported on new inventions but none that we know of are used widely so we were interested in reading about researchers in Oregon and India who have identified proteins in saliva that appear more frequently in people with diabetes. Using these proteins, they are working to develop a test to monitor and perhaps diagnose the condition. Although some doctors caution about thinking this will be available any time in the near future, the Indian researchers led by Paturi V. Roa from the departments of Endocrinology and Metabolism and Medicine at Nizam’s Institute of Medical Science University in Hyderabad, India, and colleagues analyzed saliva samples from people with and without type 2 diabetes. They found 65 proteins that occur twice as frequently in the people with diabetes than in those without diabetes. Using these proteins, Roa’s team hopes to develop a noninvasive test for diabetes screening, detection and monitoring. There are many people in the limelight who have diabetes and so we were not surprised to read that Denver Broncos star Jay Cutler who was diagnosed with type 1 diabetes last spring will serve as the U.S. ambassador for a unique diabetes charity program. Look for Cutler to kick off his involvements in an E.Lilly program during the Super Bowl in Tampa. Inspired by Diabetes is a unique philanthropic initiative that uses art to provide diabetes summer camp scholarships for kids in the United States. Globally, the program contributes to a program that provides care for children with diabetes in developing countries. The campaign encourages all people touched by diabetes, particularly children and their families, to share their stories through visual and written creative expressions such as art, essays, poems or photography. For each entry into the contest from the United States, Lilly will donate money to the American Diabetes Association in Cutler’s honor for scholarships for children from lower-income families to attend ADA diabetes camps. You can find out more about the contest, etc. just go to www.inspiredbydiabetes.com. Another question we get frequently is about medical trials around the country. Joslin Diabetes Center scientists are taking groundbreaking research on the role of inflammation in type 2 diabetes to a new level with the launch of a national clinical trial to investigate whether Salsalate, an anti-inflammatory drug used for years to manage arthritis pain, can reduce blood glucose levels in people with type 2 diabetes. If successful, the trial could lead one day to an inexpensive way to treat this most common form of diabetes, which has been increasing at epidemic rates in recent years. About 500 adults with poorly controlled blood glucose levels are being sought to participate for one year in a clinical research study, referred to as Targeting inflammation with Salsalate in Type 2 Diabetes (TINSAL-T2D). The study is being funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. This study will be conducted at Joslin in Boston and at about 20 other medical institutions across the nation. For the TINSAL-T2D study, the researchers are seeking adults 18 to 75 whose glucose levels are not in good control and who do not take insulin. Participants must be using no medication or be taking only one or two oral medication, among other criteria. Most participants can expect their involvement to last about a year. Those volunteering to participate in the TINSAL-T2D study will undergo a variety of tests to determine if they are eligible. Participants selected for the study may receive either the study drug or a placebo. For more information about the study, please contact ALLISON b. Goldfine, M.D. and for a complete listing of trial sites and visit http://www.tinsalt2d.org. Diabetes Care 32:165-168.2009 has an article titled Pitfalls in Measurement of the Nocturnal Blood Pressure Dip in Adolescents with Type 1 Diabetes by Angela Delaney, M.D. et al. The objective of this study was to screen adolescents with type 1 diabetes using ambulatory blood pressure monitoring (ABPM) to 1) test the hypothesis that using a preset sleep time results in an over diagnosis of abnormal nocturnal dipping in systolic blood pressure and 2) assess the reproducibility of an abnormal nocturnal systolic blood pressure dip. For aim 1, ABPM from 53 type 1 adolescents was reviewed. Nocturnal dips in systolic pressure calculated by actual sleep time were compared with those from a preset sleep time. For aim 2, blood pressure monitoring from 98 patients using actual reported sleep time was reviewed. Reproducibility of the nocturnal dip in systolic blood pressure was assessed in a subset of “nondippers". The indicated that for aim 1, the actual mean ±SE decline in nocturnal systolic blood pressure was 11.6± 4.7%, whereas the mean decline in nocturnal systolic blood pressure calculated using the preset sleep time was 8.8±4.9%. For aim 2, 64% of patients had a normal nocturnal decline in systolic blood pressure whereas 36% had an abnormal dip. Repeat ABPM performed in 22 of the 36 nondippers revealed that only 36% had abnormal systolic dipping on the repeat ABPM. The researchers concluded that the use of actual reported sleep time is required to accurately determine the nocturnal dip in systolic blood pressure. Repeating ABPM in nondippers is essential to confirm this abnormality. Many of us have noted differences in the how patients perceive the benefits of medications. My first experiences were at a clinic we founded for the working poor where more patients than I wish to recall had been convinced that they could become addicted to insulin much as a drug user might become addicted to an illegal drug. It took great care and insight to convince them of their misperceptions and for them to begin to use their medications to control the diabetes that was ravaging their organs. This research from the University of Michigan lends some light on the issue. Diabetes Care 32:19-24.2009 has an interesting article titled Diabetic Patients’ Medication Underuse, Illness Outcomes and Beliefs about Antihyperglycemic and Antihypertensive Treatments by James E. Aikens, PHD and John D. Piette, PHD. The objective of the study was to determine how patients’ beliefs about antihyperglycemic and antihypertensive medications relate to medication underuse and health status. In diabetic patients from an economically distressed region, they assessed perceived necessity and harmfulness for antihyperglycemic (n=803) and antihypertensive (n=573) medications, past year’s medication underuse, A1C, systolic blood pressure (SBP), and diastolic blood pressure (DBP). The results indicate that after correction for multiple analyses, multivariate models indicated that perceived need for antihyperglycemic medication was associated was associated with being younger, being prescribed insulin, and being prescribed multiple medications. Concern about antihyperglycemic medication was associated with being younger, African American, dissatisfied with information received about medication, and of low health literacy. For antihypertensive, perceived necessity was associated with having numerous medical comorbidities and being dissatisfied with medication information; concern was associated with being younger, dissatisfied with information received about medication; and low health literacy. Up to one-half of patients underused at least one of the types of medications; many of these patients attributed this underuse to cost. For both types of medications, concern was significantly associated with both cost-related and non-cost-related underuse, and antihypertensive concern was associated with SBP and DBP. The researchers concluded that even after adjustment for economic factors, patients who are younger, African American, or low health literacy are especially concerned about medication harmfulness, which is in turn associated with medical underuse and higher blood pressure. To enhance adherence and outcomes, interventions should address patients’ underlying concerns about potential adverse treatment effects and focus on cultural factors and health literacy. BSP |
