This month after our headlines, we will be sharing excerpts from an article titled Looking Past Blood Sugar to Survive with Diabetes written by Gina Kolata for the New York Times on August 20, 2007. It is an excellent statement of the problems of diabetes care especially in type 2 diabetes. The statistics alone will make you sit up and take notice so let’s begin our headlines and see what made news about diabetes in our newspapers and journals.
The diabetes drugs Avandia and Actos will be labeled with severe warnings about a risk of heart failure in some patients. The warning states that the medications may cause or worsen heart failure and that [patients should be closely monitored. This is different than the June warnings that stated they drugs may raise the risk of heart attacks. The evidence wasn’t conclusive enough to merit taking Avandia from the market. They did recommend Avandia’s label be updated to include information on that risk.
Once you read about the Times article, you’ll understand why we start with this one. The Archives of Pediatrics and Adolescent Medicine, 2007;161:159-165 has an article titled Serum Lipids and Glucose Control by Diana B. Petitti. MD et al. which made many news services. The researchers examined 1973 children and adolescents in the SEARCH for Diabetes Youth Study who were 10 to less than 20 years of age. They looked at HA1c, Fasting total cholesterol (TC), LDL, HDL, and triglycerides in both type 1 and 2 types of diabetes. What they found is eye-opening because we all know that diabetes and heart disease are linked in a significant way. There was a significant trend of higher levels of TC,LDL, non-HDL but not HDL, with higher HA1c in both forms of diabetes. They concluded that glycemic control and lipid levels are independently associated with both type 1 and type 2 diabetes. For this reason alone, you may want to ask for a fasting lipid profile for your children. To add to this there is an article in the August journal of Pediatrics written by Dr. Morrison et al which concludes that obese children with syndrome X are at higher risk for developing heart disease as adults.
Mexico has warned that as the rate of diabetes rockets upward that it is threatening to cripple the country’s already strained healthcare system. Like many modern day societies Mexicans are spurning exercise and healthy eating in favor of heavy foods and sugary drinks. Health Secretary Jose Cordova warned expensive treatment for diabetes, Mexico’s number 1 cause of death in recent years, would bankrupt the health care system in the next decade if illness levels were not controlled. Currently 6.5 million Mexicans are diabetic, bit this number is expected to rise to 11 million by 2025.
The July Plant Biotechnology Journal, July 2007 reports that US researchers have successfully expressed the precursor protein of insulin in lettuce and tobacco plants. Moreover, feeding these genetically modified plants to mice that have a tendency to become diabetic protected the animals against inflammation of the pancreas. Something good may yet come out of tobacco plants!
Tiny capsules made from seaweed and iron may help diabetics whose bodies reject insulin producing cell transplants as reported by FOX news based on an article published in Nature Medicine. The researchers from Johns Hopkins in a an effort to learn what happens to transplanted cells encapsulated them in a matrix made of alginate-derived from seaweed-and an iron-containing material so they could track the cells magnetically. “It’s very exciting, because now you will be able to see what’s going on with all these cells. We hope it will help us understand the disease process and what’s going on." Dr. Aravind Arepailly, as assistant professor of radiology and surgery at Hopkins stated. In the first instance, the small capsules were implanted in diabetic mice. The porous capsules had openings large enough to let insulin out for the body to use, but not big enough for immune cells to get in and attack the transplants. The researchers then moved up to implanting swine where capsules were placed in the liver rather than the pancreas because the liver has more blood vessels that can carry the insulin to the rest of the body. Three weeks after implantation, the capsules were still in place and were releasing insulin in useable levels. Currently the researchers are beginning a longer-term trial in pigs and working with a private company to begin the process of seeking FDA approval. Co-author Jeff Bulte, professor of radiology and chemical and biomolecular engineering, said the hope is that the capsules will reduce the need for anti-rejection drugs in people receiving transplants.
Now, it is our pleasure to share some of the more interesting thoughts from the August 20, 2007 article in the New York Times titles Looking Past Blood Sugar to Survive with Diabetes by Gina Kolata. By the way, if you have the time try to get the entire article to read. You won’t be sorry because it will give you a great deal of information in one article that we here at www.diabetic-lifestyle.com have been trying to warn our readers about for a very long time. Ms. Kolata writes the facts with ease and great impact. The article starts out with a vignette about a type 2 diabetic who thought he was taking great care of himself by becoming “fixated on his blood sugar. His doctor warned him to control it or the consequences could be dire—he could end up blind or lose a leg. His kidneys could fail." To do this, the patient tried dieting, then counting carbohydrates, then he took pills to lower his blood glucose levels and took his blood glucose levels several times a day. But, with all of his interventions, his blood glucose levels remained high and in focusing entirely on blood sugar levels he neglected something even more important, —controlling his cholesterol levels. The truth is that making that hearts are strong especially for diabetics is extremely important because our risk factor for dying of complications of heart disease is very high as compared to the general population. Nearly 73,000 Americans die from diabetes annually, more than any other disease except heart disease, cancer, stroke and pulmonary disease. Yet according to the federal Centers for Disease Control and Prevention, just 7 percent of diabetic patients receive all of the treatments they need, that is protecting their cardiovascular system. According to Dr. Michael Brownlee, director of the JDRF International Center for Diabetic Complications Research at the Albert Einstein College of Medicine in New York part of the problem lies in the fact that most people with diabetes are treated by primary care physicians who have just a few hours of instruction on diabetes when in medical school. Then doctors have just about 10 minutes with patients, far too little time according to this good doctor to treat such complex disease. Also Dr. Brownlee also faults the advertising of diabetes drugs which only control blood sugar levels which turns out to be very expensive and has not proven to save lives. Because he did not know better, the patient question, suffered a major heart attack last year. He had not known how important it was for him to control his blood pressure and cholesterol. “Yet, said Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital, “when you think about it, it’s not diabetes that kills you, it’s the diabetes causing cardiovascular disease that kills you." Hundreds of millions of dollars have been spent on the benefits of lowering cholesterol and blood pressure for diabetics and yet the fast majority of those with the disease do not know of the relationship between the 2 diseases. The current guidelines for LDL for diabetics is that it should be below 100 milligrams per deciliter and if possible between 70 and 80. This is below the levels suggested for otherwise healthy individuals. Many people think that type 2 diabetes is a result of obesity. Obesity does increase the risk of developing diabetes but the disease includes more than that. In fact, only 5-10 percent of obese people have diabetes and many with diabetes are not obese. Even when an obese patients loses weight and they stabilize at a lower level, the diabetes may remain. The main culprit is genetics. “The statistics are grim: A quarter to a third of all heart attack patients have diabetes, even though diabetic patients constitute just 9.3 percent of the population. Another 25 percent of heart attack patients are verging on diabetes with abnormally high blood sugar levels."
It is not just type 2 diabetics that suffer this association to heart disease. Type 1 diabetics also have a high risk factor for heart disease. There appears to be something about diabetes that leads to high levels of LDL, the bad cholesterol which is quite dangerous. Diabetes also leads to high levels of triglycerides which are fats in the blood which also increase the risk of cardiovascular disease and in diabetics is linked to high blood pressure.
Part of the problem with research on the subject has not yet shown that shown a one-to-one association between controlled blood glucose levels and protection against cardiovascular disease. Even research with type 1 diabetics who were given a rigorous blood glucose regime and seemed to exert a delayed effect on heart disease, it was noted that the people in the study has not been able to sustain this level of control after the study was over, In fact, staying on a rigorous regime that promotes strict blood glucose control often results in burn out. The accompanying guilt for not taking care, taking numerous blood sugar readings per day, weighing food, etc does little to protect type 2 diabetics as the insulin they do make lessens and their ability to use it does too. The conclusion of the article are simple: PROTECT YOUR HEART. Talk to your primary physician about how to control your blood pressure, cholesterol and lipids. Make sure your physician knows the levels that are suggested for people with diabetes. Ask for a referral to an endocrinologist to make sure that you have a complete workup for all long term complications and learn how to protect yourself for you and your family. Thanks for reading this short review of the article. It is certainly a cardiovascular protective intervention.
BSP
