Diabetes Research
| Where we live, June brings warm weather and more sunshine so we begin to think about exercising indoors on hot muggy mornings. It also brought the following information about a contest backed by American Diabetes Wholesale which has announced a contest to see Charlie Kimball a 24 year old Indy Lights race car driver who has type 1 diabetes. The winner will go to the Firestone Indy Lights race and all you have to do is to write an essay on how diabetes has impacted your life. Go to www.glucostories.com to find out all about this contest and how its rules. This racer is an interesting young man who was diagnosed at age 22 and who races with a continuous glucose monitor where he can see it and orange juice hooked up so he can raise his blood glucose levels while keeping his race and his car on the road to victory. Back to suggestions for indoor exercising. For me, a health club connected to our hospital of choice is ideal as my internist and endocrinologist are there and if I become hypoglycemic I know that people will know who to contact if I cannot control the event well. I also know that I do not want to become dehydrated by running out side. I’m not a teenager any longer and like the creature comforts of water, towels, a women’s locker room with hair dryers and all of my needs right there. The best thing about this health club is that no matter when I walk in early in the morning, I have friends there to make the minutes go by quickly and I can hear about all of the hospital and local news so it’s a win-win situation all around. If you want to exercise outside, please read our exercise articles about exercising in the heat and follow your physician’s directions on carrying liquids, carbs, and please make sure you do not have hypoglycemia unawareness so that this condition which can be dangerous does not sneak up on you. For myself, I would not be outside running alone even in cool weather and I would make sure my partners know what hypoglycemia looks like for me. Having said all of this, please keep exercising. We all know how important it is for our cardiovascular system, to protect out bones, and to make sure our blood pressure remains in control. Most of all exercise makes all of us feel jus plain good. |
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The abstracts this month will deal with the adjustment of adolescents with type 1 diabetes, increased risk of pancreatitis and biliary disease in people with type 2
diabetes, and focal subcortical biophysical abnormalities in people with type 2 diabetes and depression. First we begin with our headlines get that second cup of coffee and find out more
about diabetes. The May issue of Diabetes Care,32:780-785,2009, had an interesting article written by Dr, Paul Enzlin and colleagues from Leuven University in Belgium which found that over
one third of women with type 1 diabetes have some form of sexual difficulty. The study involved 652 women. After 10 years the women completed a sexual function questionnaire and underwent a
physical examination, an evaluation of mood, and laboratory testing. Thirty-five percent of the women were classified as having as having sexual dysfunction including loss of libido by 57
%, problems with orgasm by 51 %, reduced lubrication by 47%, reduced arousal by38% and pain by 21 %. On initial analysis, sexual dysfunction to older age, not being married, being
postmenopausal, having circulatory problems, and depression and only depression and marital status were significantly related to sexual dysfunction. Enzlin’s team concludes
“women with type 1 diabetes should also be queried about the presence of depressive symptoms, sexual function, and sexual satisfaction.”
About 6.3 million Americans have diabetes without knowing it and complications from their undiagnosed disease account for an estimated $18 billion in U.S. healthcare costs each year, U.S. researchers said this month. Prior studies have shown that diabetes cost the U.S. economy about $174 billion in 2007 in medical expenses and lost productivity. Many people often begin having complications from diabetes years before they get a diagnosis, and costs are often overlooked, according the study by Yido Zhang of the healthcare research the Lewin Group and published in the journal Population Health management. Zhang and colleagues studied the healthcare use patterns of nearly 30,000 people for the 2 year period leading up to a diagnosis of diabetes and compared them to medical claims of people never diagnosed with diabetes. They estimated that undiagnosed diabetes in 2007 cost an additional $2,864 per person, or a total of $18 billion per year. Complications often present in people with newly diagnosed diabetes include retinal damage, nerve pain and heart disease. The researchers suggest earlier detection and treatment programs to reduce costs. People with type 2 diabetes may soon get a different treatment approach and drug that controls diabetes via the brain, an idea sparked by the metabolism of migrating birds. The FDA approved Cycloset, maker VeroScience Inc. announced this month. It’s a new version of an old drug called bromocriptine used in higher doses to treat Parkinson’s. Unlike its older parent, Cycloset is formulated to require a low, quick-acting dose taken just in the morning, no other time of day. This timing provides a bump of activity in a brain chemical that seems to reset a body clock that in turn helps control metabolism in Type 2 diabetes. Cycloset is the first drug to win FDA approval under the new guidelines that require better evidence that diabetes treatments are heart-safe. This medication regulates the regulator, dopamine. VeroScience is currently in negotiations with larger drug companies to find a distributor. More medication news. Biotechnology company Amylin Pharmaceuticals has asked the FDA to approve its highly anticipated once-weekly injectable exenatide LAR. The drug is an extended version of its twice-daily drug Byetta, a version of the protein found in Gila monster salvia, and is being viewed by the Wall Street Journal as a way for Amylin to reinvigorate sales. Byetta sales fell 32 per cent in 2008 because of safety concerns. The company’s partners on Byetta and exenatide LAR include Indianapolis-based Eli Lilly & Co and Cambridge, Mass-based Alkermes. It’s time to get to our abstracts. The first in Diabetes Care 32:744-779, 2009 is titled Explaining the Adjustment of Adolescents with Type 1 Diabetes by Jamil A. Malik, MSC and Hans M. Koot, PHD from the Netherlands. The researchers examined adjustment by testing the direct, mediating, and moderating effects of diabetes-specific and psychosocial factors of this process using an adapted version of the Disability-Stress-Coping model of Wallender and Varni. A total of 437 adolescents (54.5% girls; age 11-19) with type 1 diabetes (mean ±SD diabetes duration 6.13±3.78 years) were recruited from 25 hospitals in the Netherlands. Questionnaires were completed by the adolescents and family members. Metabolic control was measured by measuring A1c in all participants in one laboratory. The results indicated that diabetic stress mediated between A1c and adjustment, after controlling for protective factors, and explained an additional 16% variance in quality of life and 15% variance in general well-being, whereas a 19% additional variance in psychopathology was explained by both diabetes-related and general stress. No moderating effects were identifies after controlling for the main effects of all risk and protective factors. The researchers concluded that both diabetes-related and general stresses are critical predictors of the adjustment of adolescents with type 1 diabetes. Protective factors such as self-worth and social support may medicate the stress may mediate the effects of generic stress and thus should be encouraged. Diabetes-related stress has the potential to displace the effects of protective factors and thus play a critical role in the development of maladjustment in diabetic adolescents. Diabetes Care 32:834-838,2009 has an article titled Increased Risk of Acute Pancreatitis and Biliary Disease Observed in Patients with Type 2 Diabetes By Rebecca A. Noel, DRPH,MSPH et al. The researchers conducted a retrospective cohort study using a large geographically diverse U.S. health care claims data base. Eligible patients (= 18 years) were enrolled for at least 12 continuous months (1999-2005), with no incident events of pancreatitis or biliary disease during that 1 year’s baseline period. ICD-9 codes and prescription data were used to identify patients with type 2 diabetes; ICD-9 codes were also used to identify cases of pancreatitis and biliary disease. Overall, 337,067 patients with type 2 diabetes were matched on age and sex with 337,067 patients without diabetes. Incidence rates of disease and 95% CI were calculated per 100,000 person-years of exposure. The results indicated that type the type 2 cohort had a 2.83-fold greater risk of pancreatitis and a 1.91-fold greater risk of biliary disease compared to the nondiabetic cohort. Relative to patients of corresponding age without diabetes, younger type 2 patients had the highest risk of pancreatitis. The researchers concluded that their data suggest that patients with type 2 diabetes may have an increased risk of acute pancreatitis and biliary disease. The Archives of General Psychiatry 2009;66(3):324-330, had an article of interest titled Focal Subcortical Abnormalities in Patients Diagnosed with Type 2 Diabetes and Depression By Anand Kumer, M.D. et al. Although major depressive disorder has been consistently identified in people with type 2 diabetes, however the neurobiological substrates underlying depression in this population are largely unknown. The research examined the biophysical integrity of proteins in critical white and grey matter regions in patients with type 2 diabetes and major depression to understand the pathophysiology of depression in diabetes. The employed a cross-sectional magnetization transfer study using magnetic resonance imaging. Regions of the brain examined included the anterior cingulate, corpus callosum; frontal and occipital while matter, and the caudate and lenticular nuclei. They studied 16 patients diagnosed with type 2 diabetes and major depression, 22 patients diagnosed without diabetes (diabetic controls), and 30 controls without diabetes of major depression (healthy controls). The results showed that magnetization transfer ratios were significantly lower bilaterally in the head of the caudate nucleus in the group with diabetes and depression compared with the 2 other groups. Diabetic controls had values between the depressed diabetic and healthy control groups. There were no significant differences in magnetization transfer ratios between the groups in the outer regions examined. The researchers concluded that the data indicate that there is an important subcortical biophysical component to depression in patients with type 2 diabetes. This funding has broad implications for the neural circuity underlying mood disorders. BSP |
