It's March again and the winds whip through the city. We all look forward to spring and a new start. Why not a new start for your understanding of diabetes? To that end, lets look at what the people in the know are saying about the latest research about this disease that we live with every hour of every day. Again, if there is a subject you're interested in, just let us know. When we scan the journals we try to come up with a variety that hits all those areas you have asked about and some we are interested in. Any other area of interest will be addressed if you just ask. Glasses on, and note pad out. It's time to learn more about your future.
As always, we start with some headlines that we have seen this month. Then we'll go into more depth about research articles we found to be of interest. Our articles this month touch on the effect of caffeine on insulin sensitivity, blood glucose testing at alternate sites, anorexia and diabetes, erectile dysfunction and diabetes, blood glucose levels related to beliefs, and finally see if there is a difference in oral agents and blood glucose levels. Now, the headlines. First, if you live in Florida you live in the first state to offer every new born a chance to be screened for type 1 diabetes. If a baby is at high risk, they will have the chance to be monitored for life. Second, for all of us with type 1 diabetes, the researchers at Harvard Medical School found that in mice, the insulin-producing islet cells can regenerate themselves. The researchers discovered a way to train immune islet cells in blood not to attack islet cells, and simultaneously kill immune system cells in the pancreas where islet cells are destroyed. The researchers then tried to introduce healthy islet cells into the pancreas. In these mice, diabetes was cured. The cure is years away, but the treatments are out there. Keep watching. Number three. We have counseled many families with young children who have diabetes, and an article in new Feb. Diabetes Care states what we have found and that there is a moderate relationship between behavior problems and general parenting stress around food, nutrition and meal times. Finally, number four, also from Feb. Diabetes Care, we find out about a new subcutaneous glucose monitor, the Glucoday. The researchers found the monitor was well tolerated and the readings correlated well with venous glucose measurements.
Now to our abstracts. We have received a lot of mail about caffeine and diabetes. In fact, we wrote one of our 'what's hot' articles about this subject. Diabetes Care 25:364-369, 2002 has an article titled Caffeine can decrease insulin sensitivity, by Gerben B. Keijzers, MD et all from the Netherlands. Caffeine is a central stimulant that increases the release of catecholamines. The researchers hypothesized that caffeine reduces insulin sensitivity either due to catecholamines and/or as a result of blocking adenosine-mediated stimulation of peripheral glucose uptake. They examined 12 healthy women in a randomized, double blind, crossover design where caffeine was administered intravenously. The found caffeine decreased insulin sensitivity by 15%. It was felt that this occurred because of elevated epinephrine levels because dipyidamole did not affect glucose uptake, and that peripheral adenosine receptor antagonism did not appear to contribute to this effect.
Diabetes Care 25;337-341,2002 has an article titled Whole-blood glucose testing at alternate sites by J.Paul Lock, MD et al from the University of Massachusetts. The researchers measured the hematocrit (Hct) and glucose concentration in capillaries drawn from the fingertip and forearm of a group of 50 nonfasting subjects with diabetes. The results were very interesting to those of us who keep looking for new place to test our blood glucose levels. In this cross-sectional study, blood glucose levels changed to various degrees during the experiment, but no significant glucose difference was observed between the capillary beds of the forearms and the fingertip, regardless of whether glucose was assayed with the HemoCue or the Sof-Tact Blood Glucose System. On the other hand Hb concentration and Hct were found to be significantly higher in the capillary blood of the forearm.
We have written about eating disorders and type 1 diabetes both in journal abstracts and What's Hot. Here in Diabetes Care 25;309-312, 2002 is an article titled Mortality in concurrent type 1 diabetes and anorexia nervosa, by Soren Neilsen, MD et al from Denmark. This is the first look at mortality in this group of patients. The researchers looked at a 10 year follow-up of diabetic women and those with anorexia nervosa. They found that 8 of the 23 concurrent cases had died which was significantly higher than for type 1 diabetics. They concluded that although concurrent type 1 diabetes and anorexia is rare, it is very serious in females. They suggest vigorous and well-directed treatment efforts in this subpopulation with collaboration between diabetologists and eating disorder specialists. They also strongly suggest that research be done on the implications of other eating disorders and subclinical disorders in diabetic populations.
We wrote an article on erectile and sexual dysfunction in our What's Hot section a bit ago, and our email was overwhelming. Diabetes Care 25;284-291,2002 has an article by Giorgia De Berardis, MSC (CHEM) et al titled Erectile dysfunction and quality of life in type 2 diabetes. The article is a joint venture of the Istituto di Ricerche Farmacologiche Mario Negri, Italy and Tufts University School of Medicine in Boston. The study involved 1,460 patients enrolled by 114 diabetes outpatient clinics and 112 general practitioners. Patients filled out a questionnaire about their ability to achieve and maintain an erection . Other areas of their life were also assessed using surveys and scales. Overall, 34% of the patients reported frequent erectile problems, 24% reported occasional problems, and 42% reported no problems. After adjusting for patient characteristics, erectile dysfunction was associated with higher levels of diabetes-specific health distress and worse psychological adaptation to diabetes, which were, in turn, related to worse metabolic control. Erectile problems were also associated with a dramatic increase in the prevalence of severe depressive symptoms, lower scores in the mental components of testing, and a less satisfactory sexual life. Sadly, a total of 63% of the patients reported that their physicians had never investigated their sexual problems.
Our next article, Blood sugar control partially a function of beliefs, comes from the Jan. issue of Psychosomatic Medicine and is written by Catherine H. Johnson-Brooks, Ph.D. et al from the Denver Veterans Affairs Medical Center. There have been research articles in the past that look at the relationship between psychosocial factors and diabetic control or between self-care and diabetic control, however, this is the first to demonstrate the relationship between the belief in one's capabilities of adhering to a diet and exercise regime (self-efficacy) and blood glucose control. It also lends credence to the commonly accepted hypothesis that the belief in one's ability to adhere to a diabetes regime improves self-care, which in turn is associated with better metabolic control. They followed 88 young adults at a Denver treatment center for one year. Results were measured by questionnaires. HbA1c measured Blood glucose levels. The results were, as expected, that young adults with high self-efficacy tend to have the best blood glucose control and best adherence to self care regime, both in the long and short term. They state that "beliefs are a strong predictor of behavior" and therefore, clinical outcomes. This is believed to be important for health care providers and can be used for both young adults and adults with type 1 diabetes.
Our final article which comes from JAMA, 2002;287:360-372 titled Oral antihyperglycemic therapy for type 2 diabetes by Silvio E. Inzucchi. MD. This is a review from the literature regarding the efficacy of oral antidiabetic agents, both as monotherapy and in combination. A MEDLINE search was performed to identify all English-language reports involving recently available oral agents for type 2 diabetes. Sixty-three were included in the analysis with the stipulation that the study period was at least 3 months, each group contained at least 10 subjects, and hemoglobin A1c was reported. Five distinct oral drug classes are now available for the treatment of type 2 diabetes. Compared with placebo treatment, most of the agents lower HA1c levels approximately 1% to 2%. Equivalent efficacy is usually demonstrated when different agents are compared with one another in the same population. When they are used in combination, there are additional glycemic benefits. Long-term vascular risk reduction has been demonstrated only with sulfonylureas and metformin. The author concluded that with few exceptions, the available oral antidiabetic agents are equally effective in lowering blood glucose concentrations. Their mechanisms of action are different, however, and as a result they appear to have distinct metabolic effects. These are reflected in their adverse effect profiles and their effect on cardiovascular risk, and may influence drug choice.
BSP
