As we do each month we start with headlines and then go on to our abstracts that this month are about the comparison of complications in adolescents with type 1 and type 2 diabetes, the prevalence of diabetes and impaired fasting glucose levels in US adolescents, and finally an article about the use of Viagra to improve the sex life in diabetic women.
Dr. Catherine C. Cowie et al of the National Institute of Diabetes and Kidney Diseases in Bethesda, Maryland, reported in Diabetes Care 29:1263-1268,2006, that more than one out of every three people in the United States has diabetes or impaired fasting glucose, a condition that increases the risk of developing diabetes. The findings are based on an analysis of four years of data from the National Examination Survey (NHANES). The study included information on 4,761 adults, age 20 years or older, who were classified according to their glycemic status. Cowie and her team compared data from 1999-2002 with data from 1988-1994. More than 35 percent of the study participants, representing 73.3 million people had diabetes or impaired fasting glucose in 2002. A total of 9.3 percent had diabetes in 1988-2002 and the prevalence of undiagnosed remained stable at 2.8 percent during this period. However, the prevalence of diagnosed diabetes rose from 5.1 percent in 1988-1994 to 6.5 percent in 1999-2002. They also estimate that about one third of diabetics are undiagnosed. “We were surprised by the fact that diagnosed diabetes is increasing" We need to do a better job of diagnosing those one in three who don’t know they have it (diabetes) and finding those with impaired fasting glucose."
The American Diabetes Association logged an article concerning stem cell research that may be of interest. The United States is lagging behind Britain and other leading nations in stem cell research, a visiting U.S. Congressional delegation to London stated on Thursday, June 8, 2006. Scientists believe that stem cells, master cells in the body that can develop into any cell type, could be used to treat diseases ranging from diabetes to Parkinson’s disease. Their use is controversial because the most promising stem cells for treating human diseases are derived from human embryos. Colorado Democrat Rep. Diana DeGette shared that restricted federal funding has forced some American scientists to relocate to countries that have more lenient policies. “In addition, leadership in this area of research has shifted to the United Kingdom, which sees this scientific area as a cornerstone of the biotech industry", she said in a statement. DeGette and Delaware Republican Rep. Michael Castle, who is also part of the delegation, introduced a bill to expand federal funding of stem cell research on human embryos that would otherwise be discarded. It was approved by the House of Representatives last year and has been introduced into the Senate. The President has threatened to veto it. Opponents of the research object to the use of federal funds to finance this research. Sir Richard Gardner, of Britain’s national academy of science the Royal Society, who met with the delegation, said the expanding federal funding in the United States would benefit patients and researchers in Britain and other countries.
The May 2006 American Journal of Clinical Nutrition has an article that highlights the fact that nutrition changes can improve the kidney function of type 2 diabetics. The article written by Dr. Jorge L. Gross councils that withdrawal of red meat from the diet “may represent an additional therapeutic tool in the management of this complication of diabetes. He suggests that to cut the rate of albumin in urine, patients should replace read meat with chicken. Previously, Gross and colleagues from Universidade Federal do Rio Grande do Sul in Porto Alegre, Brazil reported that this simple change reduced urinary albumin excretion rate by 46 percent and also improved cholesterol levels in a group of type 2 diabetic patients with microalbuminuria. In their latest study, the researchers had 17 type 2 diabetic patients with micoalbuminuria follow their usual diet; a chicken diet (red meat replaced with chicken); or a low protein vegetarian diet that included milk and milk products. Each participant followed each diet, in a random order, for four weeks, taking a four-week break in between the diets. The urinary albumin excretion rate was significantly lower after the chicken and the low-protein diet compared with the usual diet, the team reported. The diet-induced reduction in urinary albumin in patients who already had advanced diabetic kidney disease was “one of the most important findings," Gross noted. The chicken and low-protein diets also improved cholesterol and increased blood levels of polyunsaturated fatty acid, one of the “good" fats. This shows that eliminating red meat from the diet may lower the increased risk of death from cardiovascular disease that often occurs in these patients, added Gross. Levels of blood sugar and blood pressure were largely unaffected by the diets. While the patients’ weight was not altered by the usual diet or the chicken diet, it was lower after the low-protein diet.
Amylin Pharmaceuticals is set to present data for its promising diabetes drug at the annual meeting of the American Diabetes Association. The company and partner Eli Lilly will present results of a two-year-follow-up of 283 patients taking top-selling diabetes treatment Byetta. In addition, Amylin, Lilly and Alkermes will present full results from a Phase II trial of exenatide LAR, the successor of Byetta. “We expect exenatide LAR, currently in pivotal trials, to be the first long-acting GLP-1 (Glucagon-like peptide) to market in 2009" wrote analyst Thomas Wei. “We expect LAR to maintain a leading market position".
Diabetes Care 29:1300-1306,2006 presents a very interesting article titles Prevalence of Diabetes Complications in Adolescents with Type 2 Compared with Type 1 Diabetes by Maike C. Eppens et al. The authors compared the prevalence of diabetes complications and their risk factors in youth with type 1 vs type 2 diabetes. To this end they performed a comparative clinic-based study of 1,433 patients with type 1 diabetes and 68 patients with type 2 diabetes aged <18 years from New South Wales, Australia. Retinopathy was assessed by seven-field stereoescopic retinal photography; albumin excretion from three consecutive, times, overnight urine collections; peripheral neuropathy by thermal and vibration threshold; and autonomic neuropathy by pupillometry. HbA1c and lipids were measured in all patients and C-peptide in patients with type 2 diabetes. The results indicated that in patients with type 1 verses type 2 diabetes, median age was 15.7 years (13.9-17.0) and 15.3 years (13.6-16.4), respectively, whereas median diabetes duration was 6.8 years and 1.3 years respectively. Retinopathy was significantly more common in patients with type 1 diabetes, while micoalbuminuria and hypertension were significantly less common (6 and 16% in type 1 diabetes vs. 28 and 36% in type 2 diabetes). Rates of peripheral and autonomic neuropathy were similar (27 and 61% in type 1 diabetes vs. 21 and 57% in type 2 diabetes). In multivariate analysis, micoalbuminuria was significantly associated with older age and systolic hypertension in type 1 diabetes, while only higher A1C was significant in patients with type 2 diabetes. The researchers concluded that youth with type 2 diabetes have significantly higher rates of micoalbuminuria and hypertension than their peers with type 1 diabetes, despite shorter diabetes duration and lower A1c. The researchers also concluded that the results of this study support recommendations for early complications screening and aggressive targeting of glycemic control in patients with type 2 diabetes.
The Archives of Pediatric and Adolescent Medicine, 2006;160:523-528, presented an article titled Prevalence of Diabetes and Impaired Fasting Glucose Levels Among US Adolescents, National Health and Nutrition Examination Survey, 1999-2002, by Glen E. Duncan, PhD, RCEPSM. The author wished to determine the current prevalence of self-reported diabetes and impaired fasting glucose levels in US adolescents. A sample of 4370 adolescents (aged 12-19 years) with self-reported diabetes and subsample of 1496 adolescents without self-reported diabetes who had fasted for at least 8 hours. Subjects who reported having diabetes and using insulin were further categorized as having type 1 diabetes, those reporting having diabetes and not using insulin as having type 2 diabetes, and those with a fasting plasma glucose level greater than or equal to 5.6 mmol/L (100 mg/dl) as having impaired fasting glucose levels. The main outcome measures were prevalence of self-reported diabetes, type 1 and type 2 diabetes and impaired fasting glucose levels among the adolescents. In the full sample, 0.5% of adolescents reported having diabetes. Of those reporting diabetes, roughly 71% were categorized as having type 1 diabetes and 29% as having type 2 diabetes. In the subsample, roughly 11% had impaired fasting glucose levels. Using population-based sample weights, these proportions were equivalent to 39,005 US adolescents with type 2 diabetes and 2,769,736 with impaired fasting glucose levels. The study concluded that the prevalence of type 2 diabetes and impaired fasting glucose levels is substantial in US adolescents. These estimates have important implications for public health because of the high rate of conversion from impaired fasting glucose level to type 2 diabetes in adults and the increased risk of cardiovascular disease in individuals with type 2 diabetes.
Fertility and Sterility has an article by Dr. Salvatore Caruso et al titles Viagra May Improve Sex Life of Diabetic Women, May 2006. Young women with diabetes with sexual dysfunction may find Viagra (sildenafil) improves arousal, orgasm and sexual enjoyment and decreases pain during intercourse. Diabetic women may experience sexual dysfunction due to vaginal dryness, discomfort, and other factors. To test the theory, the researchers recruited 32 women with type 1 diabetes who in the past had experienced normal sexual desire, but currently experienced sexual dysfunction-3.5 years on average. The subjects were randomly assigned to Viagra or inactive “placebo" and then the opposite treatment for 8 weeks at a time. The women were instructed to take medication 1 hour before sexual intercourse. Viagra use was associated with significantly improved arousal, orgasm, and enjoyment. Only desire and frequency did not change significantly. A special ultrasound test was used to measure blood flow in the clitoris. Viagra, but not placebo, was associated with improved blood flow.
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