After the headlines we will be looking at articles about the following: risk factors which affect vascular complications, improved screening for retinopathy, demyelinating neuropathy, sex differences in CHD, and the key ingredient in the Mediterranean diet. We're jammed packed, so here goes.
Headlines are made up of short reviews of articles you may find informative. There is so much out there it is difficult to keep up.
For months, the government has been pushing the use of adult stem cells. Stanford University reported on Sept. 6, that these stem cells were unable to transform into other types of cells. Amy Wager's article in Science talks about the studies. Other researchers, however, say the jury is still out on this issue. We'll keep our eyes peeled.
The journal Psychophysiology in its Sept. issue has an article that correlated a woman's physical fitness and her ability to mitigate risk and on her risk of developing high blood pressure. Get on your cross trainers and read our exercise articles.
The International Journal of Cardiology (20002;84:41-45) has an article that reports that mild diabetes does not increase the risk of restenosis or influence the late morbidity after coronary stenting. These findings suggest that "the presence of diabetes itself might not be associated with an increase of the risk of restenosis."
Eating the recommended 3 servings of whole grains was reported to reduce long-term risk of type 2 diabetes in men. This was found in the American Journal of Clinical Nutrition and followed 42,898 participants form 1986-1998.
At a meeting of the American Chemical Society meeting, Dr Yizhong Yu from Animas Corp. in Frazer, PA discussed the company's efforts to develop a tiny titanium-coated device which would communicate continuous readings via telemetry to a monitor worn on the wrist. Sensors would scan through blood vessel walls to gauge the blood's absorption of near-infrared light. The device, about the size of a pacemaker, would convert the readings to blood glucose levels. The device is designed to last for 5 years. Human studies will begin in a year.
Texas A&M and Penn State are working on a "smart Tattoo" which would be implanted and using a very small fluorescent light get a reading of blood glucose levels.
Finally, there was an Associated Press release about the effect of blood pressure that doesn't drop at night being an ominous indication that type 1 diabetics may develop kidney disease. Dr. Daniel Clark of Northwestern University reported his findings. The findings support the ides that higher than normal blood pressure over any period of time is significant and 24-hour checks can give vital information.
Our first journal abstract is from the Journal of Diabetes Complications 2002;16:271-276 by Dr. Wladyslaw Grzeszczak et al from Zabrze, Poland on different risk factors differently affecting vascular complications of diabetes. Those of you with type 2 diabetes will want to read this one and make sure you keep your blood work in the normal range. This longitudinal study indicated that elevated blood pressure and increased glucose levels are risk factors for the microvascular complications of type 2 diabetes. In contrast, blood pressure, but not blood glucose levels, appears to influence the risk of macrovascular complications. The team analyzed the medical records of all patients with newly diagnosed type 2 diabetes who presented to a diabetes clinic between 1980 and 1994. A total of 2175 patients were identified. The researchers found that the risk of developing nephropathy and proliferative retinopathy increased as fasting plasma glucose and mean blood pressure increased. Also, blood pressure, but not glucose level, was directly related to the risk of stroke and cardiovascular disease. High cholesterol levels were found to increase the risk of coronary artery disease and proliferative retinopathy.
Diabetes Care 2002;25(8) 1384-1389 has an article that may important for those of you who do not live close to large cities and specialized hospitals. Telemedicine may improve screening for diabetic retinopathy by Francisci Gomez-Ulla, MD et al from the University of Santiago de Compostela and Complejo Hospitalario in Spain. They found that hospital diabetes specialists, ophthalmologists and primary car physicians could share the digital retinal images of their patients which can improve the care of these patients. The investigators used a nonmydriatric camera at two peripheral units to obtain non-stereoscopic digital retinal images from 70 diabetic patients. One ophthalmologist at a reference center diagnosed and graded these images after receiving them via the Internet. Two other ophthalmologists, one at each peripheral unit, examined the patients directly. The authors found that this system "is a suitable method for detecting and grading diabetic retinopathy in a non-selected diabetic population. However, it has some limitations for diagnosis of macular edema with no hard exudates and for the diagnosis of vascular lesions in hemorrhagic forms of diabetic retinopathy".
Demyelinating neuropathy in Diabetes Mellitus form Archives of Neurology Vol.59, No 5, May 2002 by Khema R. Sharma, MD et al looks at the current reports that suggest that patients with diabetes mellitus have a predisposition to develop chronic inflammatory demyelinating polyneuropathy (CIDP). The authors wanted to examine records of diabetic patients in their electro-physiology lab over a 51- month period to evaluate the relationship between diabetes and CIDP. They prospectively determined during a 14- month period (second stage) the frequency of diabetes in patients seen in their electro-physiology laboratory with other neuromuscular diseases, and the frequency of idiopathic CIDP. The researchers report that during the first part of their research, 120 patients with diabetes met the electro-physiologic criteria for CIDP. The most frequent clinical features noted were those of a predominantly large-fiber sensorimotor neuropathy, with recent motor deterioration and a moderately increased cerebrospinal fluid protein concentration. The diabetic CIDP occurred equally in type 1 and type 2 patients. Among the 938 patients without diabetes, 17 (1.8%) had idiopathic CIDP. The odds of occurrence of those with diabetes and CIDP were 11 times higher among diabetic than nondiabetic patients. The researchers concluded that demyelinating neuropathy meeting the electro-physiologic criteria for CIDP occurred in both type 1 and 2 diabetes and its occurrence was significantly higher than in the nondiabetic population.
The Archives of Internal Medicine 2002; 162:1737-1745 has an article of interest: Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus by Alka M. Kanaya, MD et al . The authors adjusted their results for classic CHD risk factors for age, hypertension, total cholesterol and smoking to see if women have a higher risk factor for developing CHD than men. The news here is good for those of us who are women as these authors found that after examining 16 studies and adjusting for these risk factors, that the excess relative risk of CHD mortality in women vs men with diabetes was absent, but men had more CHD deaths attributable to diabetes than women.
The European Journal of Clinical Nutrition 2002;56:715-722 has an article that is of interest for all of us responsible for preparing food and for those of us who eat those meals. M. A. Martinez-Gonzalez of the University of Navarre in Pamplona, Spain looked at designating the key ingredient of the Mediterranean diet perhaps being fiber. We have shared with you already the government raising the amount of fiber for a healthy diet. These researchers found that people who ate the most fiber are more likely than those who eat the least fiber to suffer a non-fatal heart attack. Furthermore, the study authors note, this link between high fiber and low risk of heart disease is independent of other dietary factors that can influence cardiovascular health. Scientists were first alerted to the possible significance of a diet rich in vegetables, wine, olive oil, beans and fish-when they began to notice lower rates of heart disease in Mediterranean populations. In these areas, geographic and agricultural factors have diets relatively high in fiber and fatty acids, and low in artery-clogging saturated fat. In response, the researchers conducted nutritional surveys of 171 residents who had suffered their first, non-fatal attack and compared their diet with those patients who had not had a heart attack. The investigators found people who ate fiber were 86% less likely to have a heart attack than people who ate less fiber. Eating fruit also appeared to cut the risk of heart attack, but the researches found no relationship between heart attacks and vegetable and legume intake. In addition to adding fiber, fruit may improve health by taking the place of less healthy foods. The pattern of eating fruit as dessert after the main meal may explain the consumption observed in Spain and may have some interesting benefits such as replacing foods rich in saturated fats such as ice cream, cakes and cookies.
BSP
