Our abstracts will deal with Early Glycemic Control and Microvascular Complications, Childhood Vaccination and Type 1 diabetes, Diabetes and the Risk of Pancreatic Cancer, and Adult Stem Cell Research and its Promise for a Diabetes Cure.
We start with our monthly headlines. Ontario, Canada, diabetics live 12 to 13 years less than people without the disease reports a study in Feb. Diabetes Care journal. Professor Douglas Manuel et al at the University of Toronto examined the 1996-97 data from a population health survey linked to a diabetes registry. Life expectancy for male diabetics in Ontario is 64.7 years (77.5 in the general population) and 70.7 for female diabetics (82.9 in the general population). Eradicating diabetes would increase life expectancy by 2.8 years for men and 2.6 years for women in the province. The researchers also looked at the effects diabetes has on both quality of life and longevity in a measure called health-adjusted life expectancy.
Arlington, Texas, has begun screening students in the 3rd, 5th, and 8th grades for a diabetes marker, a rough spot, acanthosis nigricans, which can easily be mistaken for dirt. Presence of the marker signals elevated insulin levels. If found, parents are advised by mail. The test comes as a response to the rising rates of type 2 diabetes in children. If you want more information, you can contact your public health department and, if you live in Texas, contact the Health Office at the University of Texas.
The American Chemical Society's meeting in California brought news about researchers now being able to stop autoimmune damage happening in rats. An inflammatory body chemical called macrophage migration inhibitory factor (MIF) is associated with autoimmune diseases and with septic shock. Dr. Yousef Al-Abed and his team from the Jewish Research Institute in Manhasset, New York developed a compound-ISO-1-that binds MIF, thus blocking the inflammatory process. When administered to mice before they were treated chemically to induce diabetes, ISO-1 completely prevented the onset of high blood glucose levels. In mice bred genetically to develop diabetes, 90% of the animals were protected.
The March, 2004 issue of Diabetes Care has an article written by Dr. Edward W. Gregg et al at the U.S. Centers for Disease Control and Prevention (CDC). They found that among 1,401 diabetics they studied, those who said they had tried to lose weight in the past year were less likely to die over the next nine years. The reason may have to do with the overall healthier lifestyles that weight watchers tend to adopt. People who try to lose weight may tend to exercise more or eat more nutritious foods. The research leaves us all with the same question that has been posed before, should weight loss or a healthy style of life be stressed. The authors suggest that diabetic patients should aim for gradual weight loss using "healthy lifestyle changes in moderation" including exercise, cutting calories and eating more fruits, vegetables, and whole grains.
S.N. Davis of the Vanderbilt University Medical Center, Division of Diabetes, Endocrinology, and Metabolism has an interesting article in Diabetes/Metabolism Research and Review Vol20. Issue 2, 124-130. The researchers know that exercise is an important part of controlling health for people with diabetes, however insulin regulation is complex and often difficult, often resulting in hypoglycemia in patients with type 1 diabetes. Until recently, the mechanisms responsible for exercise related hypoglycemia have been attributed to relative increases of insulin levels or incomplete glycogen repletion after physical activity. Owing to the qualitative similarity of neuroendocrine, autonomic nervous system (ANS), and metabolic response to hypoglycemia and exercise, they hypothesize that neuroendocrine and ANS counterregularory dysfunction may also play an important role in the pathogenesis of exercise-related hypoglycemia in type 1 diabetics. Vicious cycles can be created in type 1, where an episode of hypoglycemia or exercise can feed forward to down regulate neuroendocrine and ANS responses to a subsequent episode of either stress.
Finally a clinical study comparing three treatments of type 2 diabetes in children and teens has begun in 12 medical centers and their affiliated sites around the country. The program called TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) is the first clinical trial, and is sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The TODAY study's main goal is to determine how well and for how long each treatment approach controls blood glucose levels.
Now let's start looking at those abstracts. Diabetes Care has an article in 27:955-962, 2004 by Maria Svensson, MD, PhD et al from Sweden titled Early glycemic control, age of onset, and development of microvascular complications in childhood-onset type 1 diabetes. The aim of this study was to study the impact of glycemic control (HbA1c) early in disease and age at onset on the occurrence of incipient diabetic nephropathy (MA) and background retinopathy (RP) in childhood-onset type 1 diabetes. All children, diagnosed at 0-14 years in a geographically defined area in northern Sweden between 1981 and 1992 were identified by the Swedish Childhood Diabetes Registry. From 1981, a nationwide childhood diabetes care program was implemented recommending intensified insulin treatment, HbA1c and urinary albumin excretion were analyzed, and fundusphotography was performed regularly. Retrospective data on all 94 patients were retrieved from medical records and laboratory reports.
During the follow up period with a mean duration of 12 years plus or minus 4 years, 17 patients (18%) developed MA, 45 patients (45%) RP, and 52% had either or both complications. A Cox proportional regression, modeling duration to occurrence of MA or RP, showed that glycemic control (reflected by mean HbA1c) during the follow-up was significantly associated with both MA and RP when adjusted for sex, birth weight, age of onset, and tobacco use as potentional confounders. The age of onset of diabetes before the age of 5 years, compared with the age-groups 5-11 and > 11 years, showed a longer time to occurrence of RP, but no clear tendency was seen for MA, perhaps due to lower statistical power. They concluded that despite modern insulin treatment, greater than 50% of patients with childhood-onset type 1 diabetes developed detectable complications after 12 years of diabetes. Inadequate glycemic control, also during the first five years of diabetes, seems to accelerate time to occurrence, whereas a young age at onset of diabetes seems to prolong the time to development of microvascular complications.
The New England Journal of Medicine 350:1398-1404, 2004 has an article titled Childhood vaccination and type 1 diabetes by Anders Hviid, M.Sc et al. Anyone who reads about diabetes has read articles on the link between childhood vaccinations and the development of type 1 diabetes. These researchers evaluated a cohort compromising all children born in Denmark Jan.1990 through Dec. 2000 for whom detailed information on vaccinations and type 1 diabetes was available. Using Poisson regression models, they estimated rate ratios according to vaccination status, including the trend associated with the number of doses, among all children and in a subgroup of children who had siblings with type 1 diabetes. Given recent claims of clustering of cases of diabetes two to four years after vaccination, they also estimated rate ratios during the period after vaccination. The results indicated that type 1 diabetes was diagnosed in 681 children during 4,720,517 person-years follow-up. The rate ratio for type 1 diabetes among children who received at least one dose of vaccine, as compared with unvaccinated children was 0.91 for Haemophilus influenza type b vaccine, 1.02 for diphtheria, tetanus, and inactivated poliovirus vaccine; 0.96 for diphtheria, tetanus, acellilar pertussis, and inactivated poliovirus vaccine; 1.06 for whole cell pertussis vaccine; 1.14 for measles, mumps, and rubella vaccine. The development of type 1 diabetes in genetically predisposed children was not significantly associated with vaccination. Furthermore, there was no evidence of any clustering of cases two to four years after vaccination with any vaccine.
The New England Journal of Medicine 331:81-84,2004 has an article titled Diabetes and the risk of pancreatic cancer by Lucio Guillo et al. from Bologna, Italy. Diabetes and pancreatic cancer are known to be associated. But the cause of the association and whether diabetes is a risk factor for pancreatic cancer remain controversial. The researchers enrolled 720 patients with pancreatic cancer and 720 control patients from 14 Italian centers in the study. All were interviewed personally and in detail about their clinical history. The diagnosis of diabetes was based on criteria recommended by the American Diabetes Association. One hundred sixty-four patients with pancreatic cancer and 60 controls had diabetes. In the majority of the patients with pancreatic cancer, diabetes was diagnosed either concomitantly with the cancer or within two years before the diagnosis of cancer. The association between the two conditions was significant. However, when only patients with diabetes of three of more years' duration were considered, the association was no longer significant. All the patients with pancreatic cancer whose diabetes had been diagnosed before the cancer had non-insulin dependent diabetes; all but one of the control patients with diabetes had the non-insulin form of the disease. The researchers concluded that diabetes in patients with pancreatic cancer is frequently of recent onset and is presumably caused by the tumor. Diabetes is not a risk factor for pancreatic cancer.
Finally we found an article on Adult stem cell research may hold promise for diabetes by Maia Gallager of LifeNews.com. March 26,2004. She reports that researchers at the University of Florida have reported that they've cultured adult bone marrow stem cells to become insulin-producing cells. The resulting cells managed to bring blood glucose levels back to normal in diabetic laboratory animals. Previous research has shown that pancreatic stem cells and liver stem cells can also produce insulin, however experts say that marrow cells are easier to harvest. The good news here is that the researchers found that stem cells stabilized the glucose levels of lab animals for more than three months. The not so good news is that scientists are not certain if humans would react the same way. Keep looking here and we'll report on any and all articles and research that we read about.
BSP
