First, we bring Headlines about Diabetes Health and then we will share in more depth some health abstracts on preventing foot ulcers in diabetic patients, comparison of basal insulin added to oral agents verses twice-daily premixed insulin as initial therapy for type 2 diabetes, and poor pregnancy outcome in women with type 2 diabetes.
Our first headline concerns a large new British study which goes against what many of us type 1 diabetics have been told and that is that controlling out blood glucose levels would control neuropathy and heart risk. Now diabetic experts day that statins and other heart disease treatments should be studied to see if they can stave off or slow the progression of nerve damage in diabetics. The Brits found an apparent connection between nerve damage and risk factors for heart disease.
Swedish researchers have found that psychological stress may increase insulin resistance putting pressure on insulin-producing beta-cells. This article is in February’s Diabetes Care. In type 1 diabetes the body’s immune system destroys the beta cells. Add stress to that scenario, and the beta cells may be even more vulnerable. Both physical and emotional stress can spike blood sugar. The article stresses that improvement of stress management skills makes it easier to ride out life’s ups and downs whether you have diabetes or not.
On Feb. 07, 1005 the American Diabetes Association stated that it is very disappointed in President Bush’s budget cuts to agencies responsible for the diabetes epidemic facing this country. There are currently 18.2 million Americans living with diabetes and more than 40 million with prediabetes. The Association is particularly concerned that the Centers for Disease Control and Prevention (CDC) is slated for a 6.22% funding cut and areas within the CDC responsible for responding to the diabetes epidemic are slated for a 6.5% funding cut. Each year, diabetes costs more than 213,000 lives and over 132 billion in direct and indirect costs. The ADA believes that the only way to decrease those staggering numbers is to increase the federal investment in prevention and control programs and toward research for a cure.
On Jan. 19, at Kyoto University Hospital, Dr. Koichi Tanaka and Dr James Shapiro (of the Edmonton Protocol) removed part of a 56-year-old woman’s pancreas. Dr. Shinichi Masumoto them isolated the living islets in the Kyoto Centre for Cell and Molecular Therapy. Under DR. Shapiro’s supervision, the team then transplanted the insulin-producing cells into the woman’s 27-year-old diabetic daughter. The transplanted islets began producing insulin within minutes. Normally the transplanted cells of the Edmonton Protocol are islet cells from a brain dead organ donor. Theses islets are often severely injured from cold storage, transport time and the pancreas is severely by toxins which circulate in the blood stream after brain death. Although the recipients use the same organ rejection drugs, Dr. Shapiro expect that these islets from near- perfect organs will work better, although he adds that “It is too early to tell."
Boston’s NewsCenter 5's Ronda Mann reported on Feb 11th that the FDA cleared a treatment called anodyne therapy which helps people with neuropathy of the feet to walk again. She reported on one patient who after eight-forty minute sessions, he started to regain sensation. The therapy involves a painless infrared light wrapped around the problem area. It emits a photo energy the manufacturer claims can increase circulation by 400 percent.
The World Health Organization said on Sunday, Feb 13th that it is initiating a study on the economic impact of diabetes for a world-wide implementation model for controlling the disease. The program-Diabetes Action Now- is collaboration with the International Diabetes Federation (IDF) and will discuss how to address the overwhelming burden of non-communicable disease, especially in the developing world. WHO will also update its 1994 report on diabetes as part of a new drive against the diabetes “epidemic" that was no longer a lifestyle disease? By 2030, there will be 366 million diabetes patients world-wide. The most increase will occur in developing countries in the working age group, among the 36-64 year ages.
Many of you are type 2 diabetics and are on diets to lose weight according to your e-mails. Here are some ways to control hunger while dieting according to Yahoo. Minimizing the intake of trigger foods is a first trick; especially avoid foods with hidden fat or calories. Follow a diet plan that uses a meal replacement approach and portion-controlled meals to reduce caloric intake; aerobic and heavy resistance exercise, relapse prevention; social support; and stress reduction. Regular physical activity (see our articles on Exercise) is essential for long- term weight control, stress reduction and overall health.
Now for our new abstracts. The first comes from JAMA 2005;293:217-228 titled Preventing foot ulcers in patients with diabetes by Nalini Singh, MD et al. Among patients diagnosed with diabetes the prevalence of foot ulcers is 4% to 10%, the annual population-based incidence is 1.0% to 4.1%, and the lifetime incidence may be as high as 25%. These ulcers frequently become infected, cause great morbidity, engender considerable costs, and are the first step to lower extremity amputation. The researchers reviewed the evidence on the efficacy of methods advocated for preventing diabetic foot ulcers in the primary care setting. The EBSCO, MEDLINE, and National Guideline Clearinghouse databases were searched for articles published between Jan. 1980 and April2004 using database-specific keywords. Prevention of diabetic foot ulcers begins with screening for loss of protective sensation which is accomplished in the primary care setting with a brief history and the Semmes-Weinstein monofilament. Specialist clinic may quantify neuropathy and biothesiometry, measure plantar-foot pressure, and assess lower extremity vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings form the history and physical examination and enable clinicians to stratify patients based on risk and to determine the type of intervention. Educating patients about proper foot care and periodic foot examinations are effective interventions to prevent ulceration. Other possibly effective clinical interventions include optimizing glycemic control, smoking cessation, intensive podiatric care, debridement of calluses, and certain types of prophylactic foot surgery. The value of various types of prescription footwear for ulcer prevention is not clear. They concluded that substantial evidence supports screening all patients with diabetes to identify those at risk for foot ulceration. These patients might benefit from certain prophylactic interventions including patients’ education, prescription footwear, intensive podiatric care, and evaluation for surgical interventions.
Diabetes Care 28:254-259, 2005 has an article titled Comparison of basal insulin added to oral agents verses twice-daily premixed insulin as initial insulin therapy for type 2 diabetes, by Hans U. Janka, MD et al. The objective of this study was to compare the efficacy and safety of adding once-daily basal insulin verses switching to twice-daily premixed insulin in type 2 diabetic patients insufficiently controlled by oral medication. In a 24-week, multinational, multicenter, open, parallel group clinical trial, 371 insulin-naïve patients with poor glycemic control on OAD (sulfonylurea plus metformin) were randomized to once-daily morning insulin glargine plus glimepiride and metformin or to 30% regular/70% human NPH insulin twice daily without OADs. Insulin dosage was titrated to target FBG = 100 mg/dl using a weekly forced algorithm. The results indicated that mean HbA1c decrease from baseline was significantly more pronounced and more patients reached HbA1c =7.0% without confirmed nocturnal hypoglycemia with glargine plus OAD than with 70/30. Similarly, FBG decrease was greater with glargine plus OAD and more patients reached target FBG =100 mg/dl with glargine plus OAD than 70/30. Glargine plus OAD patients had fewer confirmed hypoglycemic episodes than 70/30 patients. The researchers concluded that initiating insulin treatment by adding basal insulin glargine once daily to glimepiride plus metformin treatment was safer and more effective than beginning twice-daily injection of 70/30 and discontinuing OADs in with type 2 diabetic patients inadequately controlled with OADs.
Diabetes Care has an article titled Poor pregnancy outcome in women with type 2 diabetes by Tine D. Clausen, MD et al. The researchers wanted to examine the perinatal outcome and frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001. They studied medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes during this time frame. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996-200, the background population, and pregnant women with type 2 diabetes during 1980-1992 from the same department. The perinatal mortality in pregnancies complicated by type 2 diabetes was increased four-and ninefold, respectively, and the rate of major congenital malformations was more than doubled, although not statistically compared, compared with type 1 diabetic pregnancies and background population. The glycemic control was similar or better in women with type 2 diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA1c at admission and type 2 diabetes were independently associated with serious adverse fetal outcome (perinatal mortality and/or congenital malformations). The perinatal mortality and the rate of major congenital malformations in type 2 diabetic pregnancies have increased in the last decade. The researchers concluded that perinatal outcome of pregnancies in women with type 2 diabetes during 1996-2001 is poor. It is worse that the outcome of pregnancies in women with type 1 diabetes and the background population in the same period, as well as in women with type 2 diabetes studied during 1982-1990.
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