Before we begin, once again the ADA has announced the Donnelly Youth Tennis Awards. To find out more, go to the American Diabetes Association site or call your local chapter. These are eleven one-time awards of $2000.00 each given annually to be used for education, tennis development, and/or medical care.
Let's dive into the headlines first. Yale University reports that elderly people may develop insulin resistance -- one of the major risk factors for diabetes -- because "power plants" in their muscle cells decline or fail with age. This was reported in May 16, 2003 issue of Science and was written by Gerald Shulman and his colleagues. The researchers think that pinpointing the cause of type 2 diabetes in the elderly would solve a major health problem. "Approximately one in four individuals over the age of 60 has type 2 diabetes, which is a remarkable statistic. And, if you add impaired glucose tolerance, you're talking about forty percent of the population". "The finding is important because studies in our lab and others have shown that the amount of lipid inside the muscle cell is a very good predictor of insulin resistance", said Shulman.
At the meeting of the American Society of Transplantation and the American Society of Transplant Surgeons, Dr. James Shapiro reported that islet-alone transplants with the Edmonton protocol is safe. Preliminary findings were presented at the meetings. The primary endpoint of the trial is insulin independence. Secondary endpoints include metabolic parameters, such as stable HbA1c, glucose tolerance and stimulation tests. To date 52% of the patients who received any transplants are insulin-independent, while 82.3% of those in whom transplants have been completed are insulin-independent; some patients have required up to three transplants. "There was considerable variation in success of islet transplantation between different sites," Dr Shapiro reported. It ranged from 90% at the Edmonton site to 23% success rate at some other sites. "This reflects a learning curve", he noted.
A new German study offers evidence that leisure-time exercise helps ward off heart disease . . .but heavy physical strain at work might promote it. The article in the Archives of Internal Medicine 2003;163:1200-1205 by Dr. Wolfgang Koenig et al found that the risk of heart decreased with leisure exercise as compared to no exercise. In contrast, as physical strain increased so did the risk for heart disease. The researchers found that those who exercised during leisure time had lower levels of inflammatory markers such as C-reactive protein that are believed to contribute to hardening of the arteries. The finding provides more support to the notion that exercise helps the heart by reducing inflammation.
The American Society of Hypertension meeting in May reported on a study of hypertension and diabetes in patients. The data indicate that hypertension, often combined with diabetes, appeared to contribute to 39.5% increase in stroke hospitalizations in South Carolina from 1991 to 2000. Dr. Lackland, who gave the report, reported that the number of hospitalizations for stroke is more of a sensitive indicator of the changing incidence of stroke over time than mortality because the technology for keeping stroke patients alive keeps improving. "Blood pressure control is much more cost-effective, if you want to look at it that way, than paying for hospitalization", he added.
Now we can go on to the abstracts we promised. Out first is from Clinical Diabetes 21:51-52,2003 and is written by Jennifer B. Marks, MD, FACP, FACE, Editor. This is an easy report to bring to you. Dr. Marks suggests that even busy physicians need to help their patients with diabetes or at risk for developing diabetes to change their lifestyles, not just take a pill. She also suggests that those who are at high risk for developing diabetes might be given the same results of the Diabetes Prevention Program for type 2 diabetes which was published last year. This study proved that in an ethnically diverse population with impaired glucose tolerance, the onset of diabetes can be significantly delayed or prevented across a spectrum of ages by lifestyle changes including a routine of moderate physical activity and modest weight loss. The problem is that the threat of developing diabetes does not often motivate people to change. It is also known that the drug metformin also reduced the incidence of diabetes in at-risk people, but less effectively than did lifestyle changes.
The Journal of the American Society of Nephrology 2003; 14:1568-1577 had an article titled Diabetes partly to blame for rise in kidney failure by Dr. Paul Muntneret al from Tulane University in New Orleans. The researchers, knowing that the incidence of Americans with end-stage renal disease has advanced substantially and steadily, looked at data collected in 1978 and 1991 in a national survey to estimate end-state kidney disease cases resulting from diabetes, and improved heart attack and stroke survival. Compared to 1978, in 1991 there were roughly 4.3 million more people with diabetes, 1.2 million more with a history of heart attack or stroke and 36,881 more people requiring treatment for end-state disease. According the team, nearly 28 percent of the additional cases of treated end-stage kidney disease in 1991 resulted from diabetes, and about 5% resulted from increased heart attack and stroke survival. The prevalence of diabetes increased by 59% between 1978 and 1991, according to the report. Overall, 50% of cases of end-stage kidney disease that required treatment in 1991 involved diabetes. The author reported that he is not surprised that the rapid increase in diabetes has had an impact on kidney failure, but he was surprised about the "minimal impact" that better heart attack and stroke survival has had. He concluded that "Our study reminds us that people with diabetes and those who've had heart attacks and strokes are at very high risk for kidney failure and we should work hard to prevent diabetes because diabetes is causing trends in other diseases."
Diabetes Care 2003;26:1356-1361 had an article titles Fat intake not linked to hyperlipidemia in diabetic children by Dr. Esko J. Wiltshire et al from North Adelaide, Australia. Lipid abnormalities that can be found in children with type 1 diabetes are related to glycemic control, but not to fat intake, according to this report. Since the 1970s, dietary recommendations for diabetics have shifted from higher- to lower-fat diets. Despite this change, there are limited data on how dietary factors influence the lipid profiles of children with type 1 diabetes. The researchers measured lipid levels in 79 children and adolescents with type 1 diabetes, and matched control subjects. In addition, all subjects completed dietary questionnaires. Twenty-eight diabetic children had LDL cholesterol levels greater than or equal to 3.35 mmol/L the level at which the National Cholesterol Education Program recommends dietary intervention. Compared with controls, diabetics had higher intake and lower intake of refined sugar, the investigators noted. In terms of energy intake, the diabetics' higher percentage came from complex carbohydrates, while the lower percentage came from saturated fat compared with controls.
The researchers found that levels of total cholesterol, LDL cholesterol, HDL cholesterol, apaB, and apo A1 were independently associated with HbA1c levels in diabetics. Triglyceride levels correlated with percentage intake from complex carbohydrates. In contrast, dietary intake was not related to these lipid levels. The findings indicate that hyperlipidemia is a common problem among children and adolescents with type 1 diabetes. Moreover, the results suggest that treatment of this lipid abnormality should focus primarily on improving glycemic control.
Circulation 2003,10:1161/01 has an article titled Low paraoxonase activity predicts coronary events in the caerphilly prospective study, by Bharti Mackness, PhD et al from Great Britain. The hypothesis that paraoxonase (PONI) has a role in preventing atherosclerosis is based on experimental, transgenic, and case-control studies but this had not been studied prospectively. The Caerphilly Prospective Study is a cohort study of men aged 49 to 65 years observed for coronary heart disease (CHD) events (fatal and nonfatal myocardial infarction) over a mean period of 15 years. Serum PONI activity toward paraoxon was measured in1353 participants. PONI activity was 20% lower in the 163 men who had a coronary event. Men in the highest quintile of PONI activity had a decreased risk compared with those in the lowest quintile. The researchers concluded that low serum PONI activity toward paraoxon is an independent risk factor for coronary events in men at high risk because of preexisting disease or other CHD risk factors.
Our final article comes from Diabetes Care 26:1869-1873,2003 and is titled Association between serum testosterone concentration and carotid atherosclerosis in men with type 2 diabetes by Michiaki Fukui, MD et al from Osaka, Japan and Kyoto, Japan. There is evidence to suggest that low concentrations of testosterone are associated with an increased risk of cardiovascular disease in men. The aim of this study was to evaluate the relationship between serum testosterone concentration and carotid atherosclerosis as well as major cardiovascular risk factors in men with type 2 diabetes. Serum free and total testosterone concentrations were measured in 253 consecutive men with type 2 diabetes. The relationships between serum testosterone concentration and carotid atherosclerosis, determined ultrasonographically, evaluated intima-media thickness (IMT) and plaque score (PS) in a subgroup of 154 diabetic patients. Major cardiovascular risk factors, including age, blood pressure, and lipid concentrations, were evaluated as well. Inverse correlations were found between free testosterone (F-tes) concentration and IMT and between F-tes concentration and PS. The IMT and PS were significantly greater in patients with lower concentrations of F-tes than in patients with higher concentrations. An inverse correlation was found between serum F-tes concentration and age. A positive correlation was found between serum F-tes and total cholesterol concentrations. The researchers concluded that serum F-tes concentration is inversely associated with carotid atherosclerosis as determined by ultrasonographically evaluated IMT and PS in men with type 2 diabetes.
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