This month we will bring you information that is confusing to say the least, about treatment of elderly people with type 2 diabetes. This is must reading and information to talk over with your physician no matter your age. You’ll note that this is not the only contradiction in research that we report. That’s why we caution readers to understand that when a “miracle" appears in the newspaper, to make sure that the research can be replicated at an institution known for excellence. But first we start with out headlines so let’s get going. I have always known that our dogs could tell when I was on my way to hypoglycemia. They would stay by me if I was unable to get help or even go to a family member and bring them back to me. To tell the truth one of our standard poodles was the quickest diagnostician of some illness I ever knew, so this was no surprise. Now we read that Irish researchers are hoping to prove that a dog’s keen sense of smell gives it the ability to watch over the blood levels of diabetics. Researchers at Queen’s University in Belfast, Northern Ireland are taking the “helpful companion" idea one step further by gathering scientific evidence that could verify dogs can reliably detect dangerous blood sugar level drops in diabetics. The article found in HealthDay News on Feb 3, 2008 is written by Maryann Mott says that two organizations in the US already train dogs to detect low glucose levels. But what these animals detect is what lead researcher professor Deborah Wells will be examining. In California alone the all-volunteer Guide Dogs for the Blind has placed 30 trained canines in the homes of Northern California residents with type 1 diabetes. Dogs for Diabetics use Labrador retrievers who do not graduate from the guide dog school and train them to detect scents samples of low blood glucose levels. Currently demand for these dogs is high with more than 100 people on the waiting list.
Reuters on Jan.27, 2008 posted an article written by Will Dunham which stated that researchers at Duke University Medical Center have concluded that “Caffeine appears to disrupt glucose metabolism in a way that could be harmful to people with type 2 diabetes" James Lane who led the study who led the study and his group used a tiny glucose monitor embedded under the abdominal skin to monitor the glucose levels continuously in 10 people, average age 63 years of age. The article was published in Diabetes Care 31: 221-222, 2008. “What we are really showing here is that when people with type 2 diabetes who are regular coffee drinkers, it produced an elevation in their glucose throughout the day above what it is if they don’t have caffeine". This new finding seems to counter previous research which showed that people who drank coffee had a reduced risk of type 2 diabetes with this risk lowering as the amount of coffee increased. We will follow the caffeine-diabetes research. If you read something please let us know.
The journal Circulation Research, Jan.2008;102:95-102 has an article about diabetes causing blood vessels to function poorly by creating competition for L-arginine as reported by researchers at the Medical College of Georgia. L-arginine, an amino acid, is broken down by the enzyme arginase to urea to help the body eliminate toxins resulting from proteins we eat, reported the study author Dr. Maritza Romero et al. What this means is that too little L-arginine is available to help nitric oxide synthase make nitric oxide, which is a vasodilator that helps blood vessels relax. The researchers discovered that the amino acid L-citrulline along with statins prevent elevation of arginase activity. The researchers now want to develop medications to combat excessive arginase activity in diabetes. They also suggest clinical trials of L-citrulline as a supplemental therapy for people with diabetes with vascular problems.
The ADA reports on Feb. 5,2008 about an article in the journal Diabetologia that researchers, led by Dana Spence, have linked production of the C-peptide protein to controlling cardiovascular problems in people with type 1 diabetes. Formerly, the protein was believed to simply to be an insulin byproduct. They found that C-peptide assists red blood cells with glucose absorption. The red blood cells then use glucose to produce the ATP energy molecule, which leads to nitric oxide production. The presence of nitric oxide causes blood vessel expansion and prevents platelets from clotting, resulting in improved circulation. Spence and colleagues discovered that the protein does not need insulin to produce effects, but activation must be stimulated by a metal. Patients with type 2 diabetes would be resistant to C-peptide effects, Spence believes, just as their bodies are resistant to the effects of insulin. Though the research appears promising the ADA president for medicine and science John Buse says that it is still premature to determine whether C-peptide “would be an effective and safe treatment for diabetes."
British scientists have reported in the Jan 26, 2008 Lancet, 287-288 that environmental pollution may be linked to type 2 diabetes. University of Cambridge scientists led by Dr. Oliver Jones, said there may be a link between persistent organic Pollutants or POPs and insulin resistance. The research demonstrates that individuals with high levels of POPs in their blood were at higher risk of type 2 diabetes. “Of course correlation does not immediately imply causation. But if there is indeed a link, the health implications could be tremendous." The report said that current research into type 2 diabetes focuses on genetics and obesity, with almost no consideration for the possible influence of environmental factors. POPs such as DDT continue to find their way into the food chain even though many of these toxins were banned many years ago. The compounds can persist in the body for very long periods of time following exposure, the report stated.
Our final headline comes from Diabetes Care 31:289-294.2008 and is titled Salsalate Improves Glycemia and Inflammatory Pparameters in Obese Young Adults by Allison B. Goldfine, MD al. This medication is approved for the treatment of arthritis but according to the researchers, it may have a role in reducing the risk of diabetes and heart trouble developing in young obese individuals a Joslin Diabetes study reports. Compared with an inactive placebo, this anti-inflammatory drug reduced glucose levels by an average of 13 percent in 20 non-diabetic adults no older than 30 years of age and a body mass index (BMI) of at least 30. As well as reducing fasting glucose levels, Salsalate decreased the glycemic response after an oral glucose tolerance test, improved insulin sensitivity and curbed markers of inflammation. Currently clinical trials with Salsalate are ongoing. “If it is efficacious to treat or prevent diabetes and/or cardiovascular disease, the health economic implications are exciting," Goldfine noted, “as the product is inexpensive to manufacture and generic, which is important as the number of persons with these health issues is large."
Now let’s look at those confusing results about diabetes treatment in 2 studies. One week after U.S. researchers announced that pushing down blood sugar levels as close as possible to normal might be dangerous for high-risk diabetes patients, a preliminary analysis of a similar international study has found no such risk. Last week, researchers at the National Institutes of Health surprised experts when they announced their analysis of an ongoing study involving more than 10,000 patients in the United States and Canada. They found 54 more deaths in the group that had intensive therapy to lower their blood-sugar levels than the group that received standard treatment. The announcement about the U.S- based ACCORD results which prompted a panel monitoring a similar study known as ADVANCE to conduct a preliminary analysis of its own data which involve more than 11.000 patients in Europe, Asia and Canada, said study director Anushka Patal of the George Institute Health in Australia. “Because of the ACCORD results, we felt we needed to ask our data safety and monitoring board to look at the data," Patel said. Like the ACCORD trial, the ADVANCE study involved patients at high risk for heart problems. The patients were 66 years on average. The ADVANCE analysis found no similar increase in deaths among the patients receiving the most intense therapy for an average of 5 years. She said. “There is no sign of the increased mortality that was evident in the ACCORD study."
Federal health officials said there are a variety of possible explanations for the differing findings, and they planned to meet with their counterparts at the international study to try to explain the results. “Hopefully when we sit down and look at the data, we’ll come up with some mutual conclusions," said Denise Simons-Morton at the National, Heart, Lung and Blood Institute. More than 21 million Americans have type 2 diabetes which has become increasingly common because of the obesity epidemic. The disease, as we know, causes blood-sugar levels to rise abnormally high, making patients prone to a host of complications, including blindness, nerve damage, kidney failure, heart attacks, and strokes. Patients typically try to lower their blood sugar through diet and exercise of by taking medication such as insulin of oral medications.
“This unfortunately just makes things more confusing", says Richard Kahn of the American Diabetes Association. “I think patients will be confused. I think doctors will be confused. So I think the message is: Don’t do anything until we get this sorted out."
Please keep your eyes and ears at the ready for news about this issue and continue to keep the lines of communication open with your health care team so you can make intelligent decisions about your what you need to keep healthy. We certainly will be reading and researching this issue for you.
BSP
