Let's begin with our headlines. Here we bring you a few lines about important facts that have come to our attention this past month. Get another cup of coffee or tea and if the message fits, take it to your physician and ask questions about your health.
The Archives of Internal Medicine, 2003;163:33-40 shared information about the need for more stringent interventions, management, and more stringent goals needed for people with diabetes for the control of hyperglycemia, hypertension, dyslipidemia and obesity. This comes as an important review of research for all of us with diabetes and needs to be a matter of discussion with our cardiologists or generalists to protect our health.
We now know with some certainty the results of the Diabetes Prevention Program, which is a multicentered clinical trial. It studied the effectiveness of intensive lifestyle interventions and the antidiabetic drug metformin in preventing type 2 diabetes in more than 3,000 high-risk adults with impaired glucose tolerance. The study demonstrated that diet and exercise significantly cut the risk of type 2 diabetes in high-risk adults. Now you know why we call our web site www.diabetic-lifetsyle.com and why each month we have a new article on exercise, cooking tips, recipes and entertaining as well as What's Hot.
More news from the Diabetes Prevention Trial-Type 1 is that low-dose insulin injections do not prevent or delay type 1 diabetes. The research screened nearly 90,000 relatives of type 1 diabetes for islet cell antibodies and who underwent further genetic and metabolic tests. The results are interesting as it was not long ago when we read about prophylactic insulin shots. On a positive side, Phase III data indicates that inhaled insulin can improve glycemic control as compared with insulin injections in type 2 diabetes. This was done by Dr. Patricia Hollander at Baylor University Medical Center. The results showed that HbA1c levels declined similarly in two groups, one group using inhaled insulin before meals plus a bedtime dose of long-acting insulin and the other receiving a conventional regime of injections.
Here's a headline that is near and dear to me, as I have type 1 diabetes. Diabetes Care 26:1106-1109,2003 has an article titled The Impact of Severe Hypoglycemia and Impaired Awareness of Hypoglycemia on Relatives of Patients with Type 1 Diabetes by Hanne V. Jorgensen, RN et al. The researchers compared patients' and relatives' assessments of rates and severe hypoglycemia and state of awareness and to explore the influence on involvement and concern of relatives. The results of this study were not surprising to those of us who have lived with type 1 for some time. Cohabitants of patients with type 1 recall significantly more episodes of severe hypoglycemia than did the patients. The rate of severe hypoglycemia and the state of hypoglycemic awareness are the principal determinants of degree of cohabitants' involvement in their partner's disease.
Diabetes Care 26:1181-1185,2003 has an article titled Thyroid dysfunction in patients with type 1 diabetes by Guillermo E. Umpierrez, M.D. et al in which the researchers concluded from their longitudinal study there is an association between autoimmune thyroid dysfunction and type 1 diabetes. The research indicated that all subjects with type 1 diabetes should undergo annual screening by serum TSH measurement to detect asymptomatic thyroid dysfunction, particularly those with positive TPO (thyroid peroxidase) antibidues.
Finally, we bring you a headline about sugar and diabetes. We do this because we get many e-mails from you about the subject and there appears to be confusion about carbohydrates and diabetes. To that end, please read our What's Hot article this month. It may help. Diabetes Care has an article titled A prospective Study of Sugar Intake and Risk of Type 2 Diabetes in Women by Sok-Ja Janket, DMD, MPH et al. The study investigates whether intake of total intake or type of sugar is associated with the risk of developing type 2 diabetes. The results imply that intake of sugars does not appear to play a deleterious role in primary prevention of type 2 diabetes. These prospective data support the recent American Diabetes Association's guideline that a moderate amount of sugar can be incorporated in a healthy diet.
It's time to look at some abstracts from journals that we found interesting this month. Again, if you have special interests, just ask and we'll try to keep an eye peeled.
Our first article comes from Diabetes Care 26:105201057,2003 and is titled Poor Prognosis of Young Adults with Type 1 Diabetes, by Kathryn S. Bryden, RN et al from Great Britain. The researchers looked at the role of early behavioral and psychological factors on later outcomes in young adults with childhood-or adolescent-onset type 1 diabetes. They conducted a longitudinal cohort study of young outpatients in a diabetes clinic from Oxford, U.K.A total of 113 people (51 males) aged 17-25 completed assessments and 87 (77%) were reinterviewed as older adults (aged 28-37 years). Longitudinal assessments were made of glycemic control (HbA1c) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up. The results indicated no significant improvement between baseline and follow-up in mean HbA1c levels. The proportion of people with serious complications (preproliferative or laser-treated retinopathy, proteinuria, or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3% to 37% during the 11 years period. Women were more likely than men to have multiple complications. Psychiatric disorders increased from 16% to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores and recurrent admissions with diabetic ketoacidosis. The researchers concluded that clinical and psychiatric outcomes in this cohort were poor. They also found that psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.
The American Journal of Clinical Nutrition, Vol.77,No.3,612-621, March 2003 has an article titled Long-term effect of varying the source or amount of dietary carbohydrate on postprandial plasma glucose, insulin, triaclglycerol, and free fatty acid concentrations in subjects with impaired glucose tolerance, by Thomas MS Wolever and Christine Mehling. The researchers looked at two ways to reduce the glycemic load which is thought to be beneficial in managing insulin resistance. They examined the results of reducing carbohydrate intake and by reducing the glycemic index (GI) of food eaten on postprandial plasma glucose, insulin triaclglycerol, and free fatty acid concentrations in people with impaired glucose tolerance (IGT). Thirty-four subjects with IGT were randomly assigned to high-carbohydrate, high GI; high-carbohydrate, low-GI; and low-carbohydrate, high monounsaturated fatty acid (MUFA) diets for 4 months. Plasma glucose, insulin, and free fatty acids were measured from 0800 to 1600 at baseline in response to high-GI meals (60% carbohydrate, GI=61, GL=63) and after 4 months in response to meals representative of the study diet. The researchers found that in these subjects with IGT, reducing the GI of the diet for 4 months reduced postprandial plasma glucose by the same amount as did reducing the carbohydrate intake. The two dietary maneuvers had different effects on postprandial plasma insulin, triaclglycerols, and free fatty acids.
The Archives of Disease in Childhood 2003;88:240-245 had an article titled Prevention of severe hypoglycemia in type 1 diabetes: a randomized controlled population by S. Nordfeldt et al from Sweden. The researchers investigated the use of targeted self study in type 1 diabetes patient education regarding dissemination, perceived patient benefit, and prevention of severe hypoglycemia. This was a randomized study of 322 people with type 1 diabetes (ages2.6-18.9 years) during which 261 completed the endpoint questionnaire. The intervention group received videotapes and a brochure designed to review skills for self control and treatment, aimed at preventing severe hypoglycemia. Two control groups received a videotape and brochure with general diabetes information, or traditional treatment, only. Yearly incidence of severe hypoglycemia decreased from 425 TO 275 in the intervention group, but not the controls. HbA1c remained unclear. Levels of use ranged from 1 to 20 times; 40-49% had shown the materials to friends, relatives, school staff, sports coaches, etc. Higher benefit and learning levels resulted from the intervention material, especially in patients with severe hypoglycemia. The conclusions were that mass distributed pedagogical devices such as high quality video programs and brochures might contribute to the prevention of severe hypoglycemia. Such self study materials can reach high dissemination levels and constitute a cost effective complement to regular visits to a diabetes team and to other types of education.
Diabetes Care 26;1153-1157,2003 has an article titled The continuous glucose monitoring system is useful for detecting unrecognized hypoglycemias in patients with type 1 and type 2 diabetes but not better than frequent capillary glucose measurement for improving metabolic control, by Ana Chico, MD, PHD et al. These Spanish researchers evaluated the continuous glucose monitoring system (CGMS;MiniMed, Sylmar, CA) for its usefulness in investigating the incidence of unrecognized hypoglycemias in type 1 and type 2 diabetes and its implications for metabolic control. A total of 70 diabetic subjects (40 type 1 and 30 type 2 subjects) were monitored using CGMS. The numbers of unrecognized hypoglycemias were registered. Furthermore, the 40 type 1 diabetic patients whose treatment was modified in accordance with information obtained from the CGMS were compared with a control with 35 different type 1 diabetic patients using intensive capillary glucose measurements. HbA1c levels were measured before the monitoring period and 3 months later. The results indicated that CGMS detected unrecognized hypoglycemias in 62.5% of the type 1 diabetic patients and in 46.6% of the type 2 diabetic patients. They found that 73.7% of all events occurred at night. HbA1c concentrations decreased significantly in both the group of type 1 diabetic subjects monitored with the CGMS and the control group. The greatest reduction was observed in the subgroup of patients who started continuous subcutaneous insulin infusion therapy, both in the CGMS-monitored and control groups. They concluded that the CGMS is useful for detecting unrecognized hypoglycemias in type 1 and type 2 diabetic subjects, however, it is not better than standard capillary glucose measurements for improving metabolic control of type 1 diabetic subjects, regardless of the therapeutic regime.
BSP
