Diabetes Research
| January can be a dark cold month where we live so we change the way we exercise into going to the gym each morning with friends and going to the market and pharmacy on clear days to stock up on food and medications so that we are always prepared. If you haven’t read the Welcome Page, we suggest there that this is a good month to make physician and dental appointments. We all know it may take time to actually get one so sit back and relax while you’re on hold. Before you go, make sure you have your questions on paper and that you know your last HA1c, blood test results, and reports from other physicians who have sent you reports that may or may not have been sent to all of the professionals you see. If you read these research articles you know what’s new in treatment issues so you know what you need to talk about. Remember, it’s your health and future you’re talking about. Your dentist and doctor will go home at the end of the day to return the next day to see another group of patients. |
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As always we begin with headlines and then we go on to our abstracts which this month are about binge eating and weight loss outcomes in overweight type 2 diabetics,
changes in the incidence of diabetes-related eye disease among elderly people in the US, 1994-2005, and finally, low-dose aspirin for primary prevention of atherosclerotic events in type 2
diabetes.
Let’s begin with our headlines. Diabetes Care, 32:2325-2331, 2008 has an interesting article that we type 1 diabetics may find interesting about impaired hyperglycemia-induced delay in gastric emptying in patients with type 1 diabetes deficient for islet amyloid polypeptide by Hans J. Woerle, M.D. et al. The researchers found that gastric emptying was greater in type 1 diabetic patients and 50% retention times were comparable in healthy subjects and type 1 diabetic subjects. Hyperglycemia markedly delayed gastric emptying in healthy subjects but did not alter it in type 1 diabetic subjects. Plasma islet amyloid polypeptide (IAPP) increased approximately fourfold in healthy subjects, whereas it was undetectable in type 1 diabetic subjects. IAPP replacement, using the analog pramlintide, in type 1 diabetic subjects slowed gastric emptying to a comparable extent, as did hyperglycemia in healthy subjects, and greatly reduced postprandial hyperglycemia. Meal-derived appearance in plasma was reduces, and splanchnic glucose sequestration increased. They concluded that in type 1 diabetes the ability to delay gastric emptying in response to hyperglycemia is impaired. This contributes to exaggerated rates of meal-derives glucose appearance and ultimately postprandial glucose excursions. Many people have nocturnal hypoglycemia so an article in the same Diabetes Care journal by Benjamin A Cooperberg, M.D. et al examined Terbutaline and the prevention of nocturnal hypoglycemia in type 1 diabetes. The researchers altered the dosage of Terbutaline from 5.0 mg to 2.5 mg to see if would control nocturnal hypoglycemia without causing morning hyperglycemia which occurs with the higher dosage. This was a randomized double-blind crossover pilot study in 15 patients with type 1 diabetes. The researchers concluded that Terbutaline may be shown to be effective and safe in the prevention of nocturnal hypoglycemia in type 1 diabetes. They suggested a suitably powered randomized controlled study. Diabetes Care 31:2251-2257,2008 has an article about weight-loss practices and weight-related issues among youth with type 1 or type 2 diabetes by jean M. Lawrence, SCD, MPH, MSSA et al. A total of 1,742 female and 1,615 male youth aged 10-21 years with type 1 and type 2 diabetes completed a SEARCH for Diabetes in Youth study visit during which height. Weight, and A1c were measured. A survey assessed weight-related issues and weight-loss practices. They found that although more common in youth with type 2 diabetes, youth with type 1 diabetes also reported weight-loss concerns and had elevated BMI. Among youth who had never tried to lose weight, healthy weight-loss practices were the most common, whereas unhealthy practices using diet aids, vomiting or laxative use and skipping insulin doses were less common. In sex-specific multivariable models including age, race/ethnicity, diabetes type, BMI category, and glycemic control, obese females, overweight/obese males were more likely to report or ever practicing unhealthy weight-loss practice than normal-weight youth. These practices were associated with poor glycemic for female but not male subjects. All unhealthy weight-loss practices except fasting were more common in female than male subjects. Dieting, fasting, and using diet aids were more common in youth with type 2 diabetes than those with type 1 diabetes. The researchers concluded that health care professionals caring for youth with diabetes to pay attention to identifying youth, especially females, with unhealthy weight-loss practices. It’s Abstract time. These research articles will open your eyes and hopefully provide fodder for talks with your physicians. The Archives of General Psychiatry, Vol. 65, No. 12, Dec., 2008 has another articles about eating and diabetes titled Binge eating and Weight Loss Outcomes in Overweight and Obese Individuals with Type 2 Diabetes by Amy A. Gorin, PhD et al. The researchers examined the affects between weight loss and binge eating (BE) in type 2 diabetes. The Look AHEAD (Action for Health in Diabetes) trial is a randomized controlled trial examining the long-term effect of intentional weight loss on cardiovascular disease in overweight and obese adults with type 2 diabetes. A total of 5145 overweight and obese individuals aged 47 to 76 years with type 2 diabetes participated in this study. Participants were randomly assigned to an intensive intervention or to enhanced usual care ( a diabetes support and education control condition). At base line and 1 year, participants had their weight measures and completed a fitness test and self repot measures of BE and dietary intake. Analyses controlled for baseline differences between binge eating and non-binge eaters. Most individuals (85.4%) did not report BE at baseline or 1 year, 7.5 % reported BE only at baseline, and 3.7% reported BE at both times, and 3.4% reported BE only at 1 year, with no differences between intensive lifestyle intervention and diabetes support and education conditions. Across intensive lifestyle intervention and diabetes support and education, (greater weight loss, 5.3) and those who reported no BE at either time (weight loss. 4.8), than in those who continued BE (weight loss 3.1) and those who began BE at 1 year. Poet hoc analyses suggested that differences were due to changes in caloric intake. They concluded that overweight and obese individuals with type 2 diabetes who stop BE appear to be just as successful at weight loss as non-binge eaters after 1 year of treatment. We are all aware of retinal disease in diabetes, but there appears to be more to the problem The Archives of Ophthalmology, 2008;126(10):142`-1427 presents an article titled Diabetes Mellitus and Visual Impairment, National Health and Nutrition Examination Survey, 1999-2004 by Xinzhi Zhang, M.D. PhD et al. Using National Health and Nutrition Examination Surveys conducted during 1999-2004, the researchers estimated the prevalence of presenting correctable, and uncorrectable visual impairment (VI) among Americans 20 years or older with and without diabetes. Data were weighted to make estimates representative of the US civilian noninstitutionalized population. They used multivariate logistic regression to calculate odds ratios and corresponding 95% confidence intervals. The results indicate that approximately 11.0% of US adults with diabetes had some form of VI. Among those without diabetes, 5.9% had some form of VI. People with diabetes were more likely to have uncorrectable VI than those without diabetes, even after controlling for selected factors. The findings also suggest a strong association between VI and older age, member of racial/ethnic minorities, lower income, and lack of health insurance, all independent of diabetes status. The researchers concluded that vision loss is more common in people with diabetes than in people without diabetes. Diverse public health strategies are needed to reduce the burden of both correctable and uncorrectable VI. Our last abstract comes from JAMA, 2008;300(18):2134-2141 and is titled Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Patients with Type 2 Diabetes by Hisao Ogawa, MD, PhD et al. This research looks at the efficacy of low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes. It was a multicenter, randomized, open-label, blinded, end-point trial conducted from Dec. 2002 through April, 2008 at 163 institutions throughout Japan, which enrolled 2539 patients with type 2 diabetes without a history of atherosclerotic disease and had a median follow-up of 4.37 years. Primary end points were atherosclerotic events, including fatal or nonfatal ischemic heart disease, fatal or nonfatal stroke, and peripheral arterial disease. Secondary end points included each primary end point and combinations of primary end points as well as death from any cause. A total of 154 atherosclerotic events occurred:68 in the aspirin group and 86 in the nonaspirin group. The combined end point of fatal coronary events and fatal cerebrovascular events occurred in 1 patient in the aspirin group and 10 patients in the nonaspirin group. A total of 34 patients in the aspirin group and 38 patients in the nonaspirin died from any cause. The composite of hemorrhagic stroke and significant gastrointestinal bleeding was not significantly different between the aspirin and nonaspirin groups. The researchers concluded that in this study of patients with type 2 diabetes, low dose aspirin as a primary prevention did not reduce the risk of cardiovascular events. BSP |
