Diabetes Research
| Late fall brings Thanksgiving, Christmas, Chanukah, business parties, family gatherings and more. The only good thing about the downturn in the economy is that perhaps there will be less alcohol and less food at these gatherings, especially the business parties. Please never drink without eating food first. If you do not know what the hostess is serving make a phone call and find out. If you will be served only cheese and crackers, make sure to have a bite before to arrive. Remember the fat content on the foods presented. If you are a type 2 diabetic and need to watch your waist line ask if you can bring some fresh fruit or vegetables with a healthy dip. We certainly have recipes fro dips in our books and on the web site. If you are invited to a family dinner also call and make sure that there are foods that you can eat. Marshmallow topped sweet potatoes may not be in your meal plan, but certainly fresh vegetables without a high calorie sauce is welcome. Watch out for gravy and desserts that are fat laden. If your hostess does not have healthy recipes in her arsenal and you know her well ask if you can e-mail a recipe or two or bring something to the party so that you do not become ill. To tell the truth, a little humor often opens doors at these times. My favorite has to do with my type 1 diabetes and the fact that my insulin pump doesn’t have enough insulin in it to cover the menu which of course sounds wonderful. On the day someone cures me, I’ll be there with plastic containers to take home leftovers, but in the mean time I am trying to stay healthy to see my grandchildren grow up. A little education for people who know little about diabetes goes a long way to people being very welcoming and kind. I’ve never had a hostess who didn’t want to be part of the solution not part of the problem. Have any problems? Just e-mail and we’ll try to help. |
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Let’s begin with our headlines. After that we’ll go on to the abstracts which this month will be about continuing glucose monitoring vs. intensive treatment in
type 1 diabetes and a 10 year follow-up of the UKPDS which is a wake up call for intensive treatment as soon as a patient is diagnosed. Swedish researchers have developed a vaccine that may
change the way the immune system responds in people who are newly diagnosed with type 1 diabetes. Dr. Jonny Ludvigsson, a professor of pediatrics and head physician at Linkoping University
Hospital made the announcement. That’s the good news; however the results of the study didn’t change the clinical course of the disease. Insulin requirements of the children
involved were similar whether the children were treated with the vaccine or a placebo. At the end of the study in children who were more recently diagnosed, there was evidence that the
treated group retained more activity in their pancreas. That’s important because the more insulin-producing function you retain “the short-term risks are less, as are the risk
of long-term complications". New trials have begun on children who’ve had diabetes for much shorter periods of time. Additionally they’ll be working on a clinical trial to see
if the vaccination could be used to prevent type 1 diabetes from occurring in children who have a high risk of the disease.
Dr. Rean Quyyam from Johns Hopkins Hospital told Reuters Health that people with type 2 diabetes can use premixed insulin analogues which provide tighter glucose control than long-acting insulin and non-insulin agents. The article published in Annals of Internal Medicine found that premixed insulin analogues were comparable to premixed human insulin in lowering A1c levels, as an indicator of relatively long-term glucose control. The occurrence of hypoglycemic events was similar with the 2 types of insulin. The researchers stated that longer follow-up are needed to determine whether the effects observed early in treatment are sustainable long-term. We have suggested that women with type 1 diabetes have bone density tests on a regular basis. The results of a study published in Diabetes Care states that young women with type 1 diabetes have lower bone mineral densities (PMD) than young women without the disease. Dr. Lucy D. Mastrandrea and colleagues from the University of Buffalo previously reported that young women with type 1 with diabetes have a lower BMD than their counterparts. Now the researchers have performed a 2-year follow-up study of these women to determine if BMD differences persist over time. Included in the study were 63 women with type 1 diabetes and 85 “control" subjects. After adjusting the findings for age, BMI and oral contraceptive use, BMD continued to be lower in the diabetes patients than the controls after 2 years. The researchers concluded that bone density testing may be important in young women with type 1 diabetes. These patients should be counseled about lifestyle modification that may improve their bone health, such as getting enough calcium, vitamin D and exercise. Regular moderate exercise helps people with diabetes to reduce fat in their livers, in turn preventing liver failure and heart disease. Kerry Stewart a Johns Hopkins exercise physiologist presented his findings to the American Association of Cardiovascular and Pulmonary Rehabilitation in Indianapolis. People with type 2 diabetes often have elevated liver fat levels and are at high risk for a condition called nonalcoholic fatty liver disease. Diabetics who did a six-month program of cardiovascular exercise and weight lifting three times a week cut the fat in their livers by about 40 % in the study. The condition also known as hepatic steatosis can also lead to cirrhosis of the liver, liver failure, and a higher risk for diabetes-related heart problems. The researchers stated that they were able to demonstrate pretty definitively another benefit of exercise. Those in the exercise group also improved their overall fitness, shedding weight, gaining strength, and losing abdominal fat. Abstracts are next so let’s get reheat our coffee or tea and get ready to learn more about diabetes. If you are a frequent reader of the site you know that I am a continuous glucose monitor user and the new technology has done wonders for this brittle diabetic. The New England Journal of Medicine Oct 2 issue (10.1056/NEJMoa0805017) has a article titled Continuous Glucose Monitoring and Intensive Treatment of Type 1 Diabetes, The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The value of continuous glucose monitoring in the management of type 1 diabetes has not been determined. This is a multicenter trial that randomly assigned 322 adults and children who were already receiving intensive therapy for type 1 diabetes to a group with continuous glucose monitoring or to a group a group performing home monitoring with a blood glucose meter. All the patients were stratified into three groups according to age and a glycated hemoglobin level of 7.0 to 10.o %. The primary outcome was the change in the glycated hemoglobin level at 26 weeks. The results indicated the changes in glycated hemoglobin levels in the two study groups varied markedly according to age group, with a significant difference among patients 25 years of older that favored the continuous monitoring group. The between-group was not significant among those who were 15 to 24 years of age. Secondary glycated hemoglobin outcomes were better in the continuous-monitoring group than in the control group among the oldest and youngest patients but not among those who were 15 to 24 years of age. The use of continuous glucose monitoring averaged 6.0 or more days per week for 84% of the patients 25 years of age or older, 30% of those 15 to 24 years of age, and 50% of those 8 to 14 years of age. The rate of severe hypoglycemia was low and did not differ between the two study groups; however the trial was not powered to detect the difference. The study group concluded that continuous glucose monitoring can be associated with improved glycemic control in adults with type 1 diabetes. Further work is needed to identify barriers to effectiveness of continuous monitoring in children and adolescents. Not to overlook our type 2 comrades, The New England Journal of Medicine (10.1055/NEJMMao0806470) has a very interesting article titled 10-Year Follow-up of Intensive Control of Type 2 Diabetes by Rury R. Holman, F,R,C,P. et al. During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes who received intensive therapy had a lower risk of cardiovascular complications than did those receiving conventional dietary therapy. A post-trial monitoring was done to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes. Of 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin, or in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend clinics, and all patients in years 6 to 10 were assessed through questionnaires. They examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomized categories. Between-group differences in glycated hemoglobin levels were lost after the first year in the sulfonylurea-insulin group, relative reduction in the risk persisted at 10 years for any diabetes-related end point, and risk reductions for myocardial infarction emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%), myocardial infarction (33%), and death from any cause (27%). The researchers concluded that despite an early loss of glycemic differences, a continuous reduction I microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during the 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. BSP |
