Two major health organizations in Europe and the US are calling for closer examination of the Metabolic Syndrome which has been thought to predict the risk of developing heart disease. They question whether it has been appropriately defined and whether it is a syndrome at all. The ADA is concerned that diagnosing someone with metabolic syndrome may sound like a unique disease but may be only a well-known risk factor for cardiovascular disease. Part of the problem is that different organizations have different definitions for the syndrome. Consequently, studies showing a correlation between combinations of factors and the risk of developing heart disease are highly inconsistent. Consequently, studies showing a correlation between a combination of these factors and the risk of developing heart disease are highly inconsistent. In patients with diabetes or known vascular disease inordinate attention to the Metabolic Syndrome can impede appropriate care. It is suggested that physicians continue to evaluate patients for the presence of other cardiovascular risk factors when one is discovered and aggressively treat these risk factors, while avoid diagnosing Metabolic Syndrome.
We have brought you information on type 1 diabetes and eating disorders before and answered many e-mails about the subject. According to research published in the Journal of Endocrinological Investigation, 2005;28(5):417-419, and research at the University of Florence the prevalence of anorexia nervosa in type 1 diabetic subjects was not significantly different than that of controls, while that of bulimia nervosa and of the two conditions combined was significantly higher in diabetic patients. “Type 1 diabetes is associated with a higher prevalence of bulimia nervosa in females," concluded Edoardo Mannucci et al.
The September, 2005 American Journal of Public Health has an article by Dr. Terry J. Rosenberg from the Medical Health and Research Association of New York City in which it was concluded that obesity and diabetes are independent risk factors for a number of adverse pregnancy outcomes, such as caesarean delivery and having an infant with low birth weight. The magnitude of the effect varied with racial and ethnic groups. The results indicate with all women in the study with gestational or chronic diabetes had an increased risk of cesarean delivery. This risk ranged from 23% for whites with gestational diabetes and almost threefold increased risk for Hispanics with chronic diabetes. Similarly, diabetes was tied to elevated risks for preterm births in all age groups. In this case, the increased risk ranged from 20% for whites with gestational diabetes to more than threefold for Hispanics with chronic diabetes. For all groups, pregnancy weight higher than 149 pounds was tied to increased risk of preeclampsia, also known as toxicemia of pregnancy. This condition is marked by high blood pressure, fluid retention and protein in the urine. If untreated, this condition may progress to eclampsia, a life-threatening complication. Increased body weight was also raised the risk of cesarean delivery, but was associated with a reduced risk of low birth weight. It was concluded that health care to control weight in type 2 diabetics over their lifetime be instituted.
Diabetes Care, August, 2005 has an interesting article about treatment of ketoacidosis or DKA in children with diabetes by DR. Durval Damiani of Sao Paulo University School in Brazil. In the past the treatment of choice might include hospitalization and continuous intravenous administration of insulin. The team treated 60 children with DKA who were randomly assigned to treatment with continuous regular insulin or lispro given every 2 hours, which was reduced to every 4 hours once blood sugar levels began to fall. All children were given IV fluid replacement. Blood glucose levels fell below danger levels within 6 hours after therapy began in both groups. However, acidosis and ketosis resolved somewhat more quickly in the continuous insulin than in the lispro group. This was likely due to a “less than optimum" administration schedule in the lispro group. The researchers suggest smaller doses given at shorter time intervals which may be more effective. Nonetheless, the lispro approach promises simplicity and cost savings, conclude the researchers. “Protocols of DKA treatment with subcutaneous rapid-acting analogs represent a technical simplification and may lower the mean cost for hospitalization as the patients would not need either insulin pumps or a second intravenous line."
Diabetes Care, August, 2005 has an article by Dr. David S. Ludwid et al from Children’s Hospital in Boston who examined data from the diabetes prevention trial which shows that low-dose treatment of insulin has no apparent effect on body weight or physical development in adolescents and children who are at increased risk of developing type 1 diabetes. “Some experts argue that insulin acts in the brain to decrease hunger and food intake. Others propose that insulin acts in the periphery to promote fat deposition." The team focused on 55 young subjects who underwent insulin therapy and 45 who were just closely monitored. At the start of the study, the participants ranged in age form age 4 to 19 years. Over the course of 2 years, there were no differences between the groups in physical development. In particular, there were no differences in average weight, body mass index or height between children on low-dose insulin and those who were untreated. Dr. Ludwig concluded that …"there were no differences in average body weight loss, possibly because central and peripheral actions are closely counter-balance," and that further research is needed “to determine whether insulin, or agents that block insulin action, could play a role in body weight management."
Finally, a high blood level of a hormone called adiponectin has been found to be associated with improved sugar control in women with diabetes as reported in the August, 2005 Journal of Clinical Endocrinology. Dr. Christos S. Mantzoros from Harvard Medical School and his colleagues assessed the association between adiponectin levels and sugar control, cholesterol and inflammation in 925 diabetic women enrolled in the Nurses’ Health Study. They found that adiponectin levels increased as HDL cholesterol levels and physical activity levels rose. By contrast, adiponectin levels dropped as body weight, LDL and various inflammatory proteins increased. Overall, the results suggest that adiponectin has direct beneficial effects in preventing atherosclerosis, the authors report.
We receive many e-mails asking about diabetes and alcohol consumption so when we saw this article we knew you’d be interested in reading it. Diabetes Care 28:2230-2235, 2005 has an article titled Alcohol intake among women and its relationship to diabetes incidence and all-cause mortality, The 32-year follow-up of a population study of women in Gothenburg, Sweden by Lief Lapidus, MD et al. The purpose of the study was to explore the predictive value of women’s alcohol habits in relationship to incidence diabetes and all-cause mortality with special attention paid to potential confounding factors such as age, heredity, socioeconomic group, physical inactivity, smoking, blood pressure, serum lipids, and in particular, obesity. The longitudinal study examined a representative sample of 1,462 women aged 38-60 in Göteborg, Sweden in 1968-1969 monitoring for diabetes and mortality for 32 years. The results indicate that alcohol intake, expressed as intake of wine, hard liquor, to total grams of alcohol, was significantly negatively associated to 32-year diabetes incidence independent of age. However, the apparently protective effect of alcohol variable was attenuated when BMI was included as a covariant. The inverse relationship between wine intake and diabetes did not remain after adjustment for physical activity or socioeconomic group. Beer and wine intake was significantly negatively associated to mortality. Increase of alcohol intake between examination in1968-1969 and 1980-1981 was significantly inversely related to the mortality between 1980-to1981 and 2000-2001 and independent of all covariates. No relationship was observed between an increase in alcohol intake and diabetes incidence. However, after adjustment for age, family history, and basal alcohol consumption altogether, a significant inverse relationship was observed between increase of alcohol and diabetes incidence. The authors concluded that the initially significant inverse associations observed between alcohol and diabetes as well as mortality was dependent on a number of confounding factors, of which BMI seems to be the most important.
Diabetes 54:2787-2794, 2005 has an article titled Rosiglitazone improves myocardial glucose uptake in patients with type 2 diabetes and coronary artery disease by Riikka Lautamäki et al. This study written by researchers from Finland, the UK and Italy found that Rosiglitazone therapy improves insulin sensitivity and glucose in patients with uncomplicated type 2 diabetes. In coronary artery disease (CAD), glucose is an important source of energy and preserved myocardial glucose uptake is essential for the viability of jeopardized myocardium. The aim was to test whether Rosiglitazone changes myocardial metabolism in type 2 diabetic patients with CAD. They studied 54 patients (38 men and 16 women) with type 2 diabetes with CAD. Myocardial glucose uptake was measured with fluro-2-deoxy-D-glusoe positron emission tomography in ischemic and nonischemic regions during euglycemic-hyperinsulinemic clamp before and after a 16-week intervention period with Rosiglitazone (n=27) or placebo (n=27). Rosiglitazone significantly improved myocardial control and whole body insulin sensitivity. Rosiglitazone increased myocardial glucose from 20.6±11.8 too 25.5±15.5µmol·100g ¯1 in ischemic regions and from 21.7± 12±.1 to 28.0±12.7 µmol ·100g¯1· baseline in nonischemic regions. The increase in myocardial glucose uptake was partially explained by the suppression of free fatty acid levels during clamp. Rosiglitazone therapy significantly increased insulin sensitivity and improved myocardial glucose uptake in type 2 diabetic patients with CAD. These results suggest that Rosiglitazone therapy may facilitate myocardial glucose storage and utilization in these patients.
Nontraumatic facture risk with diabetes mellitus and impaired fasting glucose in older white and black adults, the Health, Aging, and Body Composition Study by Elsa S. Stotmeyer, PhD et al. The Archives of Internal Medicine 2005; 165:1612-1617. The medical background of this study is that researchers know that diabetes and related complications may increase clinical fracture risk in older adults. Their objectives were to determine if type 2 diabetes or impaired fasting glucose were was associated with higher fracture rates in older adults and to evaluate how diabetic individuals with fractures differed from those without fractures. The Health, Aging, and Body Composition Study participants were well-functioning men were aged 70 to 79 years (N=2979; 42% black), of whom 19% had DM and 6% had impaired fasting glucose levels at baseline. Incident nontraumatic clinical fractures were verified by radiology reports for a mean of 4.5±1.1 years, Cox proportional hazards regression models determined how DM and impaired fasting glucose affected subsequent risk of fracture. The results of the study indicated that diabetes was associated with elevated fracture risk after adjusted for a hip bone mineral density (BMD) and fracture risk factors. Impaired fasting glucose was not associated with fractures. Diabetic participants had lower hip BMD and lean mass and were more likely to have reduces peripheral sensation, transient ischemic attack/stroke, and lower physical performance battery score, and falls compared with diabetic participants without fractures. The researchers concluded these results indicate that older white and black adults with diabetes are at higher fracture risk compared with nondiabetic adults with similar BMD. A higher risk of Nontraumatic fractures was found after adjustment for hip BMD. Fracture prevention needs to target specific risk factors found in older adults with diabetes.
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