October has arrived and we have more time to sit and read, ponder, and review. Once again we make promises to ourselves about caring for our diabetes and once again we look for answers about diabetes. Once again journals and the newspapers are full of articles about diabetes and the interesting research about it. Please read on to find out more about what researchers are up to, and their directions of research. If there is an area that interests you, just ask and we'll look for it. What ever you do, please read on. Education is one of the best ways to keep you and your loved ones safe. We know it can be hard, but we know you do want to know. To that end, we will be looking at the safeness of statins, the use of Lamotrigine in reducing diabetic neuropathy pain, alcohol use and diabetic compliance, hyperglycemia in acute stroke, and finally, the aspirin-enzyme-diabetes link.
First, as always we bring you some headlines and re- thinks about past abstracts. First, Archives of Internal Medicine, 2001;161;1849-1856 has an article that once again tells us that depression is common in hospitalized patients with CHF ( congestive heart failure) and is independently associated with poor prognosis. The title is, Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure, by Jiang, Wei, MD et al. We can see once again the importance of treating depression as a chronic disease. The August national meeting of the American Chemical Society in Chicago announced that an oral insulin delivery system appears to have strong potential. The new delivery system prevents metabolism of insulin until it reaches the small intestine. Aaron C. Foss of Purdue University, reported that the oral insulin delivery system "worked beautifully" in the laboratory experiments. He cautioned that further experiments with larger animals will have to be done, followed by clinical studies, but still we will continue to hope and support diabetes research. We noted a headline that stated NIH reveals location of stem cells; debate to continue. August 27, Reuters Health reported that NIH announced the names of 10 organizations whose embryonic stem cells are eligible for federally funded research. These facilities are in the US, Australia, Sweden, India, Israel, and Germany. This announcement helped to settle the debate over whether the promised lines exist and where they are located, but it is unlikely to quell the concerns that you and we may have about the limitations placed on research by the administration, and whether academic researchers will be able to access these privately owned lines. If you are interested, please keep writing e-mails and letters to the White House and Congress.
Now let's look at those journal and news articles we promised. Many of us, including me, take statins. I take it to lower my LDL, although my cholesterol is quite low. The headlines about statins, coming after those about hormone replacement, made many of us call our doctors once again. The American College of Cardiology (ACC) and the American Heart Association (AHA) are reassuring patients that these drugs are safe and very effective. More than a decade of medical research has shown that statins prolong lives and prevent heart disease by effectively lowering serum cholesterol levels. "While statins, like all drugs, have side effects, the benefits of using statins to manage patients' cholesterol far outweigh the risks of serious side effects from their use," said ACC President Douglas P. Zipes, MD. Recent media reports about the Aug. 8 voluntary withdrawal of Baycol have prompted some people to stop taking any statin. "Patients are understandably concerned" said Dr. Zipes. "We want to reassure patients that statins have been proven to be safe and very effective drugs and we urge patients who are taking a statin and who have had no side effects to continue taking the drugs and to consult their physicians." There are five other statins other than Baycol. Dr. Faxon, president of the AHA states that "Overall, multiple large studies have found statins significantly reduce the risk of death in patients with heart disease by as much as 30 percent." "Patients on any statin who have experienced side effects such as muscle aches or dark urine should stop taking the drug and immediately consult their physician," continued Dr., Faxon. If caught early, side effects can be quickly and effectively treated. Tests can be done including those for liver function, and medicines for muscle inflammation are available. These side effects are rare, but both physicians suggest you talk to your personal physician, and said that statins are meant to be an adjunct to lifestyle changes such as diet and exercise.
We get e-mails asking about treatments for neuropathy pain. Neurology 2001; 57:505-509 had an article written by Dr. E Eisenberg titled Lamotrigine reduces diabetic neuropathy pain. The research randomly assigned 27 patients to treatment with lamotrigine and 26 to treatment with placebo. The results showed that 32.5 % of those treated regarded the drug as highly efficacious, and 41.5% reported the drug was moderately efficacious. The medication was rated as "highly tolerable" by 81% of the group. A longer treatment period was thought to be needed for further research as improvements were not reflected in scores for the McGill Pain Questionnaire or the Beck Depression Inventory.
We also get questions about alcohol use for those of you with diabetes. Archives of Family Medicine, Vol. 9 No 10, Nov/Dec 2000 has an article titled Alcohol consumption and compliance among inner-city minority patients with type 2 diabetes mellitus by Karlon H. Johnson, MD et al. The objective was to examine the relation between alcohol consumption and self-reported compliance with prescribed therapies for type 2 diabetes among underserved minority patients. The design was a cross-sectional sampling of consecutive patients with diabetes and was performed following routine visits to their primary care physicians. Interviewers measured compliance using the Summary of Diabetes Self-Care Questionnaire, and alcohol consumption using the timeline followback method and the Alcohol Use Disorders Identification Test. The setting was seven inner-city medical clinics that provide primary care services to low-income residents of South Central Los Angeles, California. Participants were a total of 392 ethnic minority patients (61.5% Hispanic, 29% African American) with type 2 diabetes mellitus. . The main outcome measures were self-report: compliance with prescribed diet, exercise, home glucose monitoring, medications; and outpatient follow-up. Conclusions of the researchers were that alcohol consumption may be associated with poorer compliance. They provided recommendations for some self-care behavior for this population.
The Archives of Neurology 2001; 58: 1209-1212 has an article titled, The role of hyperglycemia in acute stroke by Nadya Kagansky, MD et al, in which the authors reviewed animal and human studies on the relationship between hyperglycemia and brain ischemia that elucidate some of the mechanisms of the deleterious effects of hyperglycemia. The article discusses present and future recommendations for glucose control. The method was to search computerized data sources and published indexes and articles from 1976 through 2000 for human studies that evaluated the association between stroke and hyperglycemia, and animal studies which focused on experimental models of hyperglycemic animals with focal and global brain ischemia. The results show that human studies indicate that admission hyperglycemia in patients with or without diabetes is associated with a worse clinical outcome than in patients without hyperglycemia. The association is more consistent in the nonlacunar type of stroke. Animal studies support these findings by showing both in global and local postischemic models that hyperglycemia exaggerates the following damaging processes: intracellular acidosis, accumulation of extracellular glutamate, brain edema formation, blood-brain barrier disruption, and a tendency for hemorrhage transformation. Insulin treatment of hyperglycemic animals was found to have beneficial effect in focal and global brain ischemia, which may be mediated by the glucose-reduction effect or by a direct neuroprotection. The authors concluded that most studies show the deleterious effect of early hyperglycemia, especially in patients with nonlacunar focal or global ischemia. Clinical trials of intensive insulin treatment are needed. Meanwhile, simple measures to avoid excessive hyperglycemia are recommended.
The AP had an article on Aug.30, 2001 on the Aspirin-enzyme-diabetes link. Since 1876, doctors have found that patients with diabetes improved when given aspirin. There has been little interest in this fact until researchers at Harvard and University Of California reported in Science that in studies using diabetic mice they found that high doses of aspirin block the action of an enzyme called ikB kinase Beta or ikkBeta. This blocking makes the body more sensitive to insulin, with the result that blood glucose levels drop. "The study helps us to understand what causes insulin insensitivity due to obesity and a high fat diet," said Dr. Steven E. Shoelson, a researcher at Joslin Diabetes Center and the Harvard Medical School. Don't go out and start to take aspirin, because the amount you'd have to take is dangerous. The amount you'd be taking could cause intestinal bleeding, dizziness and nausea. What Shoelson and his co-workers are now looking for is a chemical molecule that blocks ikkBeta without the side effects of aspirin. "We now have a defined protein target and we are trying to find drugs against it." Dr. Shoelson says that the research in mice is promising, but it will take years of research before it can be tried in humans.
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