It's a new year and once again we make a pledge to bring you results of the latest research on diabetes. Now it's your turn to make the promise to yourself that you will keep up with what is happening in this field and learn every thing you can about diabetes so that your life will be as full of health and happiness as possible. Once again we will begin with a few headlines for you to peruse and then we will look at research concerning alcohol and type 2 diabetes plus the relationship of blood glucose levels throughout the day and HbA1c in type 2 diabetes, depression and diabetes, the relationship between a vision questionnaire and visual acuity, Ramipril and the development of diabetes, and finally hypoglycemia and type 2 diabetes.
The lead headline is that there has been progress toward a type 1 vaccine. This injection of attenuated spleen lymphocytes has been shown to mitigate or prevent impairment in glucose tolerance and insulin secretion in an animal model in Buenos Aires. The study by Dr. Juan Basabe gives strong support to the possibility of developing a T-cell vaccine aimed at blocking the autoimmune attack that is believed to cause IDDM. Keep tuned and we will continue to look for articles on this subject.
Our second headline will come as no surprise to anyone who reads the paper or who watches the news, but it is important to reiterate. Vol.286, N0.4, July 2001 of JAMA has an article on the acute effects of passive smoking on the coronary circulation of healthy young adults by Otsuka, R, MD et al. The researchers measured the effects of passive smoking using coronary flow velocity reserve (CFVR). The results showed that passive smoking substantially reduced CFVR in healthy nonsmokers. The results provide direct evidence that passive smoking may cause endothelial dysfunction of the coronary circulation in nonsmokers.
An article in the Archives of Internal Medicine, Vol.161 No.19, Oct.22,01 concerns continuous subcutaneous insulin infusion (CSII) by Lenhard, M.J., MD and Reeves, G.D., MD. The article is a comprehensive review of insulin pump therapy and concludes that CSII provides better glycemic control than multiple injections and is especially indicated during pregnancy or for preconception care and for diabetes presenting in childhood or adolescence.
Our last quick review is again something we might all know, but it is good to see it in print. Diabetes Care 2001;24:1923-1928 has an article about how metabolic control is associated with the quality of life in diabetic adolescents. This is an Irish study, which showed that there is an association between lower HbA1c and a lower impact of disease, fewer worries, greater satisfaction and better health perception. Of note was that there was no correlation between adolescent and parent, or between adolescent and professional scores on the questionnaire given.
We receive e-mails each month about alcohol and diabetes. Here is one more research article. The article appears in the Journal of the American College of Cardiology 2001:38:1836-1842 and is written by Dr. Mihaela Tanascscu from Harvard School of Public Health in which the team looked at 2419 diabetic men who participated in the Health Professionals Follow-Study. The study is consistent with previous reports in other populations that show coronary heart disease risk reduction due to light or moderate alcohol intake. " Light -to-moderate drinking with meals may be an attractive and beneficial lifestyle component for the patients with diabetes. It remains for the clinician to decide whether to include alcohol recommendations as part of the treatment plan for type 2 diabetes. For most, the benefits would likely outweigh the risk", the researchers conclude.
Diabetes Care 24:21023-2029,2001 has an article titled Plasma glucose levels throughout the day and HbA1c interrelationships in type 2 diabetes by Bonora, Enzo, MD, Ph.D. et al. The research evaluated the extent of plasma glucose excursions with meals, the relations between plasma glucose levels at different times of the day, and the relations between the latter and HbA1c in non-insulin-treated type 2 diabetic subjects. The results of this study bear reading. They suggest that the majority of non-insulin treated type 2 diabetes patients have exaggerated plasma/blood glucose excursions with meals, and many of them have higher than recommended glucose concentrations 2 hours after meals. They also found that plasma/blood glucose levels throughout the day are not as strongly interrelated as one might believe, and that HbA1c is more related to preprandial than postprandial plasma/blood glucose levels. These findings are important to all with type 2 diabetes when discussing their care with treatment teams, and most especially when deciding when to take blood glucose levels.
The Archives of Internal Medicine 2000;160:3278-3285 has an article by Paul S. Ciechanowski MD et al to help those of you who ask about depression and diabetes. They found that depressive symptom severity is associated with poorer diet and medication regime adherence, functional impairment, and higher health costs in primary diabetic patients. These results were gleaned from 367 patients with both type 1 and 2 diabetes from two health maintenance organization primary care clinics. Patients in the medium-and-high severity tertiles were significantly distinct from those in the low-severity tertile in days of adherence, in following dietary recommendation, in nonadherence to oral hypoglycemic regimes, poorer in physical and mental functioning, had a greater risk of being seen in an emergency room setting, primary care facility or being an inpatient. All of this suggests that treating depression is an important part of controlling type 1 and type 2 diabetes as well as health care costs for this population.
The Archives of Ophthalmology 2001;119:733-740 has an interesting article titled The NEI-VFQ-25 in people with long-term type 1 diabetes mellitus, the Wisconsin epidemiological study of diabetic retinopathy by Ronald Klein, MD, MPH et al. This examines the association of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) overall and specific scale scores with visual acuity, diabetic retinopathy, and other characteristics, in a cohort of persons with type 1 diabetes. Statistical analysis revealed that the total NEI-VFQ-25 score was lower in older people, had a longer duration of diabetes, higher glycosylated hemoglobin, were in renal failure, and had a history of cardiovascular disease, hypertension, or amputation of a lower limb, had poorer visual acuity, more severe diabetic retinopathy, macular edema, glaucoma, cataract, abnormalities in tactile sensation or temperature sensitivity, smoked more total pack-years, led a more sedentary lifestyle, and had poor peak expiratory flow. Lower total NEI-VFQ-25 scores were independently associated with poorer visual acuity, more severe retinopathy, older age, history of loss of tactile sensation, and more pack-years of cigarettes smoked. The conclusions of this cross-sectional study indicate that this 25 item questionnaire seems to be strongly associated with vision, independent of severity of retinopathy and other complications associated with type 1 diabetes. It may be a useful measure of health-related quality of life as it relates to vision in epidemiological studies and clinical trials in diabetics.
JAMA 2001;286:1882-1885 has an article titled Ramipril and the development of diabetes by Salim Yusuf, DPhil, FRCPC et al. The researchers wanted to examine which preventive efforts of lifestyle modification are not helping stop the growing clinical and public health problem of type 2 diabetes. They examined the effectiveness of ramipril, an angiotensin-converting enzyme inhibitor, in preventing diabetes in high risk persons. At the end of the study, the researchers reported that ramipril is associated with lower rates of new diagnosis of diabetes in high-risk individuals. Because these results have important clinical and public health implications, this requires prospective confirmation. Keep reading these abstracts and we'll look for that future research.
The Archives of Internal Medicine 2001;161:1653-1659 has an article titled Hypoglycemia in patients with type 2 diabetes mellitus by Chritopher D. Miller, MD et al. The researchers wanted to examine this topic about which there is little information. They wanted to determine the prevalence and predisposing factors for hypoglycemia in people with type 2 diabetes. To do this they used retrospective and cross-sectional analysis of 1055 patients in an outpatient specialty diabetes clinic. Prevalence of hypoglycemia was 12% for patients treated with diet alone, 16% for those using oral agents alone, and 30% for those using any insulin. Severe hypoglycemia occurred in only 5 patients, all using insulin. Insulin therapy, lower HbA1c level at follow-up, younger age, and report of hypoglycemia at baseline visit were independently associated with increase of hypoglycemia. The researchers concluded that mild hypoglycemia is common in people with type 2 diabetes undergoing aggressive management, but severe hypoglycemia is rare. Concerns about hypoglycemia should not deter efforts to achieve tight glycemic control in most people with type 2 diabetes.
BSP
