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The December 17, 1997 Journal of the American Medical Association reported an article on Risk of End-Stage Renal Disease in Diabetes Mellitus. Diabetes has long been associated with renal disease, but the magnitude of this risk factor was unknown. This study led by researchers at Johns Hopkins finds that diabetic men are 13 times more likely to develop End-Stage Renal Disease (ESRD) than non-diabetic men. ESRD occurs when both kidneys fail to function and dialysis or kidney transplants are needed for survival. Results of this study also show that diabetic men are 4 times more likely as non-diabetics to develop ESRD attributed to non-diabetic disorders such as high blood pressure or kidney infection.
Researchers studies the records of 332,544 men ages 35 to 75 who participated in the Multiple Risk Factor Trial (MRFIT), a national multicenter trial conducted in the 1970s that aimed to reduce death rates from coronary artery disease by helping men to control blood pressure, lower cholesterol, and quit smoking.
ESRD risk was calculated by comparing these records with men enrolled in the national Health Care Financing Administration. ESRD treatment registry from 1973 to 1990. Over the 16-year followup there were 136 cases of ESRD in the 5,147 diabetic men and 678 cases in the 327,397 non-diabetic men.
The authors of the study conclude that the data demonstrates improvements in the prevention and control of diabetes, even for those with mild cases could substantially lower the health care burden caused by chronic renal failure.
New Oral Medication for Type 2 Diabetes
On December 23, 1997, it was announced that the United States Foods and Drug Administration approved Nova Nordisk A/S's Prandin (trademark) (repaglinide), a new agent for the treatment of type 2 diabetes. Prandin is the first improved produce in a new chemical class (meglitinide class) or orally-administered drugs, and was developed to manage meal-related (prandial) glucose levels. It is different from other oral agents in its structure and clearance. Its quick onset and short duration of action concentrates its effect on meal-time glucose levels which is important in the treatment of type 2 diabetes.
If a meal is skipped, the medication is also, and if an extra meal is added, and extra tablet is added. It works by stimulating insulin secretion from the beta calls of the pancreas, and is minimally excreted by the kidneys, which may be an advantage for patients with decreased kidney function.
Ask your physician if this new drug is appropriate for your diabetes control.
Two Genes that Might Contribute to Diabetes
Investigators in diabetes research at the Brigham and Women's and the Massachusetts General Hospital in Boston reported in the August 11, Human Gene Therapy journal that they have identified two genes that may contribute to the disease, and functionally demonstrated the ability of normal copies of these genes to correct diabetic cells in the majority of patients. The study which has been in progress for more than 20 years to identify and correct a cellular defect of human diabetes is a collaboration of two Harvard researchers, Drs. Wang and Faustman, who work with type 1 diabetes.
"This work shows that it is possible to use a patient's own cells and correct them and reinfuse them. This has tremendous implications for patients who have recurrent disease after pancreas transplantation and for patients who are at great risk for diabetes," Dr. Faustman reported.
"Human treatments are years off, however. The pace of research applications is directly related to available funding," Dr. Faustman reported. He was concerned that research for diabetes is less well-funded than breast cancer even though there are 16 million Americans with diabetes (with new diagnostic guidelines determined since this report, this number is expected to have increased significantly). With funding, clinical trials could be started, but as of now, there are not the funds available for all promising research.
New Clinical Trial
FYI -- The Diabetes Research Institute's Cell Transplantation Center at the University of Miami School of Medicine has initiated a new clinical trial involving the transplantation of human islet cells and high dose donor bone marrow infusions from the same donor source. Recent studies at the center showed that high dose bone marrow infusions greatly enhance graft acceptance in organ transplant patients. For the first time islets will be transplanted into patients who do not require an organ transplant and therefore, long-term immunosuppression.
Previously, islet transplantation was only performed in patients requiring continuous immunosuppressive drugs to prevent rejection of transplanted organs such as kidney or liver. In this trail all patients will have their innumosuppression drugs discontinued after one year. The study will be initially conducted on a limited group of patients with labile (brittle) insulin-dependent diabetes, as well as those who are unable to sense hypoglycemia and who meet the age and duration of diabetes requirements and other approved criteria. Contact the DRI at gkleiman@mednet.miami.edu.
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