I've been collecting medical articles and newspaper articles for another month so get your glasses cleaned, and read on. First, let us stop and thank you for your continued positive response to these articles each month. We love to hear from you, and try to answer all of your questions to the best of our abilities. So don't just resign yourself to diabetes, learn all you can about it and please ask questions of the experts. Your health care team should have a great deal of it for you. We supplement as we can.
We received a lovely e-mail this past month from a daughter of an elderly diabetic who wanted to know if there were noninvasive glucose monitors and we answered with a list that we know are being developed. We did report on this subject last year and were interested ourselves in any progress. Lo and behold, the next day we read about the approval of the GlucoWatch, so we lead off with that information for you. Next we bring you information about retinopathy and type 1 diabetes. After that we'll look at the relationship of fruit and vegetable consumption to diabetes, and then for those of us who are waiting for islet cell transplantation to cure type 1 diabetes, we take a look at recent research in this field. We end with a synopsis of a paper given at the American College of Cardiology which links insulin use and coronary artery disease, and an article on diabetes pills being tested on children and the elderly.
Let's begin with the FDA's OK of Cygus Inc's GlucoWatch which checks glucose levels every 20 minutes by sending tiny electric currents through the skin. The FDA reports that the watch won't completely replace finger pricks because it is not perfect, but it will supplement finger pricks with more frequent readings, thus helping to control diabetes and its long and short term complications. So far the Glucowatch is just for adults as the developer has not studied it yet in children. Cygnus has not released a date for its availability or a price, but it does state that physicians will need to be trained how to use the device so they can train patients. At this time, it is suggested that people who use the GlucoWatch do not take extra insulin before checking blood glucose levels with a finger prick as these readings can differ about 30% of the time. The GlucoWatch can be programmed to sound an alarm if blood glucose levels are falling, allowing time to recheck levels with a finger pick device. The GlucoWatch does not work if the patient's arm becomes too sweaty and it is less effective at detecting very low glucose than very high. Still for those who work hard to control diabetes, this may well be a welcome addition to our armaments in controlling diabetes complications.
Those of us with diabetes are told to see a ophthalmologist each year to check for retinopathy. Diabetes Care 2001;24:522-526 has an article linking early onset retinopathy and the onset of type 1 diabetes by Dr. John I Malone et al from the Diabetes Center at the University of South Florida. The ADA recommends a first eye exam after 3-5 years of diagnosis, however, Dr. Malone's group disagree. They evaluated 1613 patients with type 1 diabetes of less than 5 years duration who were screened and followed for the DCCT. Their results show that 54.2% of the subjects had photographic or fluorescent angiographic evidence of diabetic retinopathy at baseline, and 67.1% had retinopathy before 5 years duration of diabetes.
Dr., Malone found that microvascular pathology begins early in the natural history of type 1 diabetes. Therefore, dilated eye exams should be performed as early as the first year after diagnosis. The data also suggests that type 1 diabetes with early retinal lesions have a tendency for more rapid progression of complications. Early recognition could identify this group who need more attention. Dr. Malone and his group want us to consider yearly eye exams from the first year after diagnosis, and not to wait for the 3-5 years suggested.
Preventive Medicine 2001;32:33-39 has an article on fruit and vegetable consumption inversely associated with diabetes incidence by Dr. Earl S. Ford at al. The researchers from the Centers for Disease Control and Prevention came to the conclusion that fruit and vegetable consumption was especially valuable in women. In total, 1018 subjects from a sample of 9665 participants developed diabetes. The percentage of subjects consuming five or more fruits and vegetables per day was lower among those who developed diabetes than among those who did not. The researchers noted 19.6% of diabetic men and 18.9% of diabetic women consumed five or more servings a day, compared with 25.6% of nondiabetic men and 40.2% of nondiabetic women. The difference was statistically significant only for women.. After adjustment for a number of actors, including age, race and systolic blood pressure, "the hazard ratio for participants consuming five or more servings of fruits and vegetables per day compared with those consuming none was 0.73 for all participants, 0.54 for women, and 1.09 for men." The researchers suggest more education of the public and those at risk to stem the incidence of diabetes.
Diabetes 2001;50:515-520 has an article on Viral vector shows promise in transduction of islet cells to prolong graft survival by Dr. Mark Atkinson from the University of Florida et al who assesses the gene transduction abilities of the rAAV type 2 and type 5 vectors with the promise that these recombinant adeno-associated virus vectors may protect pancreatic islet cells from autoimmune destruction seen with type 1 diabetes after transplantation.
The researchers found that the type 2 vector was capable of transducing human and murine pancreatic islet cells with immunoregulatory cytokine genes ex vivio, but a very high multiplicity of infection was required. The type 5 vector, however, was able to achieve these effects as a much lower multiplicity of infection. "The unique properties of rAAV versus other gene therapy delivery approaches provide an ideal treatment modality for delivery of transgenes for long-term expression in islets before transplantation and one that could markedly enhance the efficacy of this clinical procedure." the researchers concluded. They note the "the introduction of cytoprotective molecules into islets using rAAV vectors will not be limited to cytokines. A series of recent studies has indicated pivotal roles for both antioxidants...and agents capable of interrupting apoptotic pathways...in prolonging graft survival after transplantation."
Frangis Lavavani and his colleagues at Latter Day Saints Hospital in Salt Lake City looked at insulin therapy and its association with a very high risk of death for diabetics with cardiovascular disease. They analyzed mortality data in 1428 patients with diabetes and documented coronary artery disease in patients who had been admitted to the hospital for angiography. Nearly all the patients had at least 70% stenosis in at least one coronary artery. The researchers did not differentiate between type 1 and type 2 diabetes. After a 2.5 year follow-up, Lavasini reported patients on insulin had a mortality rate of 28%, those on sulfonylures a mortality rate of 16%, those on a glitazone a mortality rate of 14% and those on metformin a mortality rate of 8%. Researchers disagreed with early aggressive insulin treatment for treating diabetes. they suggest starting with metformin and adding glitazone if necessary.
Amid an explosion of US cases of type 2 diabetes, pharmaceutical companies are testing drugs on two groups once excluded from experiments for safety reasons: children and the elderly. This news comes thanks to the Associated Press. Bristol-Myers Squibb, Novartis and Pfizer are among the major companies testing new drugs or going back and testing approved ones on youngsters or seniors. This is important because of the vulnerability of these two groups. Before December, the only approved treatment for children with diabetes was insulin. Now there is one oral medication, Glucophage by Bristol-Meyers Squibb, which is approved. Squibb recently announced it is designing studies in children for its Glucovance, just approved last summer. Novartis is recruiting 270 people 70 to 90 for testing with its drug Starlix. It also plans studies on children. Pfizer, the world's largest pharmaceutical company, also has tested its diabetes drugs on seniors. That company makes Glucotrol and Diabinese.
We at diabetic-lifestyle remind you to never change your medication without talking to your physician. One research paper does not the truth make. We all are looking for the answer to our diabetes. These abstracts are presented to inform you of what is being pursued. Keep reading and we'll bring you the results of the next research on these subjects and the next after that, until we know for sure the best and most efficacious ways of controlling diabetes. One day we hope to bring you the news of the cure. Keep reading, keep e-mailing your representatives in Washington, or your state capital for more funding, and keep volunteering your time and efforts to make that day come sooner.
BSP
