[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1. %%Social Support Helps Cognitively Impaired Diabetics Control Glucose
Levels (Reuters Health) Nov 24 - In adult diabetics with cognitive
impairment,

higher levels of social support for DM care may ameliorate the poor glycemic
control often seen in these patients.

[1097 adults at least 50 yr old with DM] The 35-point HRS cognitive scale
(HRS-cog) was used to measure cognitive function. The results showed that
HbA1c

levels were significantly higher in subjects with the HRS-cog scores in the
lowest quartile compared to those with scores in the highest. This
association

was modified by a high level of social support for DMcare. Among subjects in
the lowest cognitive quartile, those with high levels of support had
significantly

lower odds of having higher HbA1c than those with low levels of support."A
comprehensive geriatric assessment aimed at identifying the presence of
cognitive

impairment, depressed mood, and level of social support may be important in
identifying older adults with DM  who are at risk for poor glycemic control

and need additional support for their DM care.J Am Geriatr Soc 2009;57:

 

2.%% MW - Diabetes, LV Mass Predict Progression From Prehypertension to
Hypertension (Reuters Health) Nov 23 - Systolic blood pressure, left
ventricular

(LV) mass, and diabetes status independently predict the likelihood that
prehypertensive patients with cardiac risk factors will develop overt
hypertension.

The team

advises that "prehypertensive DM patients and/or those with increased LV
mass...be referred to more extensive clinical evaluation...and possibly
treated

to prevent (hypertension)," and that overweight prehypertensive patients
should be directed to weight-loss programs.[625 subjects] All had untreated
prehyper-

tension but none had cardiovascular disease; 22% had diabetes.

Hypertension 2009;54

 

3.%% MNTD Diabetes Experts Underline Benefits Of SMBG For All Types Of
Treatment Plans 11/28/09 A panel of leading European DM  experts has
published a

"Consensus Statement A European perspective" on the benefits of
self-monitoring  of blood glucose values(SMBG)..in order to achieve proper
glucose control

and values which are close to normal, without increasing the risk of
hypoglycaemia. It emphasizes that optimal frequency and patterns of SMBG
always depend

on a variety of factors the type of DM, chosen therapy options, individually
set targets of HbA1c as well as pre- and postprandial blood glucose values.

"What is important to us is a homogeneous, structured and detailed approach
to SMBG, which takes into account individual requirements"... Experts
differentiate

between six patients' groups. Newly diagnosed T2, for example, should test
their blood glucose values 3-5 times a week to learn about the effects of
lifestyle

and medications on their metabolism. patients undergoing an intensified
insulin treatment as well as "high risk" patients should check their values
several

times a day, especially

postprandial or at nighttimes. For those experiencing severe hypoglycaemia
even an increased frequency of nocturnal testing is recommended. , the
consensus

paper states that individual glycaemic targets should always be agreed upon
between patient and the healthcare professional.

 

4.%% MNTD Molecule Discovered That Makes Obese People Develop Diabetes
11/25/09 Many people who are overweight or obese develop insulin resistance
and

T2 at some stage in their lives. A research team has now discovered that
obese people have large amounts of the molecule CXCL5, produced by certain
cells

in fatty tissue.  "Chronic inflammation of the adipose tissue, which is
characteristic of obese people, is a crucial stage in the development of
insulin

resistence and T2. The results of this new study show that serum levels of a
chemokine molecule called CXCL5, produced by certain adipose tissue cells,

appear at much high levels in the tissues of obese people than in those of
individuals with normal weight. This has helped the  team to come to a
biomedically

relevant conclusion:

"The CXCL5 molecule helps cause insulin resistance and T2".

The most important part of this study,is the discovery that an experimental
treatment aimed at inhibiting the action of CXCL5 can help to protect obese

mice from developing T2. "If these studies

can be confirmed in humans, this treatment would represent a fundamental
improvement in the quality of life of obese individuals", the researcher
concludes.

 

5.%% JH Should You Take Avandia for Diabetic Retinopathy?  12/3/09

If you have DM retinopathy, what can you do to slow its progression? Of
course, tight blood glucose control lessens the risk that retinopathy will
get

worse. And treating other conditions, such as high BP and abnormal
cholesterol levels, may also slow progression. What about Avandia? A reader
asks: I’ve

heard that Avandia can slow the progression of diabetic retinopathy. Should
everyone with this condition be taking it?

Johns Hopkins answers:  Not necessarily. Rosiglitazone (Avandia) is
currently prescribed to control high blood sugar in people with T2.
Recently, a study

in the Archives of Ophth  reported that it may also inhibit the growth of
new blood vessels in the eye, delaying the onset of a more advanced stage of

DM retinopathy known as proliferative

diabetic retinopathy (PDR). Researchers reviewed the medical records of 282
people with DM followed 3 yr av.. This included 124 people treated with
Avandia

and 158 who were not. A total of 38 were at significant risk of progression
to PDR.Among the high-risk group, those who took Avandia had a 60% lower
risk

of PDR than those who didn’t take it. Also, fewer people in the Avandia
group had a loss of 3 or more lines on a standard vision chart. The news
isn’t

all good, however. The FDA now requires Avandia to carry a label warning
that it has been shown to increase the risks of heart attack and heart
failure.

The bottom line:  It’s premature to recommend taking Avandia to prevent the
progression of DM retinopathy. There are many other effective oral
medications

for T2. For now, if your condition is under control while using another
medication, there’s no reason to switch -- even if you have diabetic
retinopathy.

 

6.%% Nat Reviews Endo 5, (December 2009) Type 1 diabetes mellitus and
multiple sclerosis: common etiological features Abstract - T1DM and MS have
been

largely seen as different, organ- specific diseases, which are managed by
different medical specialties. Here we highlight the latest epidemiological
and

genetic findings, which have identified many features common to both
disorders. Experts consider it increasingly likely that the environment
contributes

substantially to this overlap. However, although genetic elements that are
distinct to each disease probably determine the ultimate form of
autoimmunity

that is manifested, strikingly broad parallels are seen between

the components of genetic risk of T1 and multiple sclerosis.

Similarities and differences between these two diseases draw attention to
shared disease pathways but insights into each disorder are providing mutual

illumination of their pathogenesis.

 

7.%%Nature Reviews Endo 5, December 2009   Diabetes: Maternal weight and
type 1 diabetes mellitus in children Abstract

Rasmussen, T. et al. Maternal BMI before pregnancy, maternal weight gain
during pregnancy, and risk of persistent positivity for multiple
diabetes-associated

autoantibodies in children with the high-risk HLA genotype: the MIDIA study.
Diabetes Care 32, 1904–1906 (2009).

To read this article in full you may need to log in, make a payment or gain
access through a site license..

 

8.%% Nature Immunology 10, (2009)  Deaf1 isoforms control the expression of
genes encoding peripheral tissue antigensin the pancreatic lymph nodes
during

T1DM   Abstract - T1 may result from a breakdown in peripheral tolerance
that is partially controlled by the expression of peripheral tissue antigens
(PTAs)

in lymph nodes.

Here we show that the transcriptional regulator Deaf1 controls the
expression of genes encoding PTAs in the pancreatic lymph nodes (PLNs).
[using] nonobese

diabetic (NOD) mice. We identified an equivalent variant Deaf1 isoform in
the PLNs of patients with T1.. Lower PTA expression resulting from the
alternative

splicing of

DEAF1  may contribute to the pathogenesis of type 1 diabetes.

 

9.%% 

www.medscape.com

 Heartwire   EASD  Experts Debate Bariatric Surgery as a Cure for Diabetes
Dec 1, 2009  — Could gastric bypass or banding operations--known as
bariatric

surgery--for the treatment of obesity also be a potential cure for diabetes?

Diabetologists, surgeons, and other doctors debated the idea during a
special session at(EASD) Use of this type of surgery has conventionally been
reserved

for those whose body-mass

index (BMI) is 35 kg/m2   or greater. Trials in these morbidly obese
patients confirm the benefits in terms of weight loss and provide evidence
that cardiovascular

risk factors are improved as a result, and the surgery can result in
remission of DM in many cases. Now, given these encouraging results, there
appears

to be a downward drift in the criteria for which this procedure is being
considered, with many advocating it as a reasonable option for diabetics
with

a lower BMI (<35) who have failed other attempts at therapy. But this
approach is severely hampered by a lack of prospective clinical-trials

data on bariatric surgery in this group of patients, a situation that does
not seem likely to be rectified anytime soon.

Surgeon Dr F Rubino NY told heartwire that he does not believe BMI should be
the primary determining factor for bariatric surgery in diabetics. BMI, or

level of obesity, "is a crude measure on its own. It doesn't reflect the
risk from DM. And cardiovascular disease in diabetes is predicted by other
factors,

so if you just use BMI you don't capture the patients who might benefit
most." Endocrinologist Dr N Finer UK is an advocate of bariatric surgery for
certain

diabetes patients.. "Bariatric surgery clearly is established as a highly
effective intervention forreducing CV risk and in terms of hard end
points--ie,

reducing mortality, not just from CV disease but from cancer. And clearly,
you can remit 75% or more of patients who have DM and you can prevent
progression

to diabetes." But there is a major obstacle to making this procedure
available to diabetics who are not morbidly obese--a lack of appropriate
trials, he

says. We do not have long-term studies, on diabetics who are overweight or
obese below a BMI of 35. Diabetologist Dr John Buse NC urged caution at the

EASD meeting, "We do need to remember that surgical approaches to medical
problems have been fraught with their fits and starts. Lobotomy was widely
viewed

as a reasonable therapy for behavioral disorders, and now it's considered an
abomination." , he added: "The general feeling is that, for people who are

morbidly obese, [this surgery] is potentially lifesaving. I do think the
heavier the patient, the greater

the potential benefit, in part because diabetes is not the only target.
[Gastric bypass] is a mutilating procedure; effectively, they take out your
stomach.

Mother Nature put your stomach there for a reason.

I'm just a little bit afraid that in the year 2025 people will say, 'What
were they thinking? How did they ever think it was reasonable to cut out
someone's

stomach as a treatment, a sort of panacea, for a

bad lifestyle?' "..Rubino also told EASD attendees that surgery "is not as
dangerous as you think." The mortality rate from bariatric surgery (around
0.3%)

is comparable to that for hip replacements and also for laparoscopic removal
of the gall bladder. Surgery Effect Is About More Than Weight Loss Rubino

says the benefits of bariatric surgery are of a hormonal nature, in addition
to the weight loss, because the bowel is an endocrine organ. Finer concurs:

"There's absolutely no doubt" that this is about more than weight loss, he
told heartwire

. "In these patients, their diabetes remits before they lose weight. This
sounds very dramatic, but it is actually true. Patients will wake up from
surgery

and they will say, 'I've never had this feeling before. I don't want to eat,
I'm not hungry. There is no doubt there is a very, very early effect on
eating

behavior, on food intake, and this has been shown now with MRI studies and
PET scans that you completely alter the way the brain responds to food or
signals

about food."

 

10.%% MW Monitoring Postprandial Glucose  11/30/2009 Question

When (at what A1C level) should I start asking my patients to monitor their
postprandial glucose? It is hard enough to get them to check their blood
glucose

once or twice a day, and I do not want to overwhelm them with multiple
checks until it is really significant.

Response from Roy Daniel Pollom, MD    Monitoring postprandial glucose (PPG)
becomes increasingly important as your patient’s A1C declines with treatment

and gets closer to goal. A very important study showed that the
contributions of fasting plasma glucose (FPG) and PPG to A1C differ with the
degree of

glycemic control. In patients with high A1C levels (>8.5%), FPG makes the
greatest contribution to A1C, but at lower levels (<8.5%), PPG is the major
determinant

of A1C.

 Monitoring PPG is also important because it has been shown to be a
significant and independent risk factor for macrovascular events in patients
with diabetes. 

Being able to target the testing may not add extra tests to the total number
done per week or month. If patients know that they lose control after every

meal, the information will help them to modify their carbohydrate intake.
This change will help to lower postmeal hyperglycemia and the A1C level.

 

11.%% MW Practical Guidance on Intensification of Insulin Therapy With BIAsp
30: A Consensus Statement 11/30/2009; Int J Clin Pract. 2009;63(11):Summary


Basal insulin and premix insulin are commonly prescribed first-line insulin
therapies for patients failing to maintain glycaemic control on oral
therapy.

When control on these insulins starts to drift, premix analogues, such as
biphasic insulin aspart 30/70 (BIAsp 30), are a simple and effective tool
for

intensification as they can be injected up to three-times daily (TID).
Simple treatment algorithms have been developed for (i) patients on basal
insulin

(human or analogue) once daily or twice daily (BID) who need intensification
to BIAsp 30 BID, and (ii) patients on BIAsp 30 once daily or BID who can be

intensified to BIAsp 30 BID or TID. As well as these algorithms, specific
guidance has been provided on dose transfer (from basal insulin to BIAsp
30),

dose split (when intensifying from once daily to BID), and combination oral
therapies. In addition, a guide to dose titration is included.

 

12.%% Fertility Issues in Women with Diabetes 11/30/2009; Women's Health.
2009;5(6): Abstract  - Diabetes mellitus Type 1 and Type 2 should be
considered

in the differential diagnosis of menstrual abnormalities and infertility.
The reproductive period of diabetic women may be reduced due to delayed
menarche

and premature menopause. During the reproductive years, DM has been
associated with menstrual abnormalities, such as oligomenorrhea and
secondary amenorrhea.

It was found that better glycemic control and prevention

of diabetic complications improves these irregularities and increases
fertility rates close to those that are seen in the general population.
Women with

persistent menstrual abnormalities despite adequate treatment need to be
approached by broader evaluation, which will include the examination of the
hypothalamic–pituitary–ovarian

axis and the hormonal status, presence of autoimmune thyroid disease and
antiovarian autoantibodies, and hyperandrogenism.

 

13.%% MW A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney
Disease. 11/30/2009; N Engl J Med 2009 Oct 30

Changes Clinical Practice:  Darbepoietin should not be given to patients
with chronic kidney disease (CKD). Erythropoiesis- stimulating agents (ESAs)
should

not be administrated to patients

with chronic kidney disease (CKD) and DM when their hemoglobin (Hb) level is
above 11.3g/dl. In this trial, darbepoetin did not provide substantial
beneficial

effects on cardiovascular or renal outcomes in patients in whom a median Hb
level of 12.5g/dl was achieved by darbepoetin treatment. Stroke risk was
increased

2-fold in ESA- treated patients compared with patients in the placebo group
in whom a median Hb level of 10.5g/dl was achieved.

 

14.%% MW -  Incident Dysglycemia and Progression to T1 among Participants in
the Diabetes Prevention Trial– Type 1 12/03/2009; Diabetes Care. 2009;32(9):


Objective - —We studied the incidence of dysglycemia [abnormal blood
glucose] and its prediction of the development of T1DM in islet cell
autoantibody

(ICA)-positive individuals. In addition, we assessed whether dysglycemia was
sustained. [515 subjects; with normal glucose tolerance..] 60%had at least

one episode of dysglycemia over a maximum follow-up of 7 years. Dysglycemia
at the 6-month visit was highly predictive of the development of type 1
diabetes,

both in those aged <13 and those aged =13 years. Conclusions —ICA-positive
individuals with normal glucose tolerance had a high incidence of
dysglycemia.

Fluctuations

in and out of the dysglycemic state are not uncommon before the onset of
type 1 diabetes.

 

15.%% MW - T2DM Linked to Increased Perinatal Mortality (Reuters Health) Nov
27 - Perinatal mortality is higher in women with T2 than in women with T1

report researchers. The team performed a systematic review and meta-analysis
on 33 studies of maternal and fetal outcomes.Compared with women with T1,

those with T2 were older,heavier and had higher rates of chronic
hypertension and lower rates of prepregnancy care, the authors report. On
the other hand,

women with T2 had lower rates of diabetic complications and lower HbA1c at
enrollment and throughout pregnancy. The risk of perinatal mortality was 50%

higher in women with T2 than in women with T1, but there were no significant
differences in the risks of major congenital malformation, stillbirth, and

neonatal mortality. "Despite a milder glycemic disturbance, women with T2
had no better perinatal outcomes than those with type 1, indicating that T2
in

pregnancy is a serious condition." J Clin Endocrinol Metab 2009;94

 

16.%% Medscape Medical News  - New Diabetes Screening Score May Be Better
Than Existing Tools 11/30/09 — A new, easy-to-use, DM es screening score
seems

better than existing methods. The goal of this study was to develop a new
diabetes screening score and compare

it with available screening instruments. The new screening tool was
developed in US adults 20 years or older by use of the National Health and
Nutrition

Examination Survey (NHANES) and validated in a combined cohort of 2
community studies. the investigators designed a risk-scoring algorithm for
undiagnosed

diabetes, defined as a fasting plasma glucose level of at least 7.0 mmol/L
(126 mg/dL) in patients without known diabetes. Identification of
participant

characteristics that were independently associated with undiagnosed DM was
accomplished with logistic regression. Factors associated with undiagnosed
diabetes

were age, sex, family history of DM. 

history of hypertension, obesity, and physical activity."This easy-to-
implement diabetes screening score seems to demonstrate improvements over
existing

methods," the study authors write. "Studies are needed to evaluate it in
diverse populations in real-world settings."

 

17.%% MNTD Sugary Cola Drinks Linked For 1st Time To Higher Risk Of
Gestational Diabetes (GDM) 1 Dec 2009  Researchers have found for the first
time that

drinking more than 5 servings of sugar- sweetened cola a week prior to
pregnancy appears to significantly elevate the risk of developing diabetes
during

pregnancy. [13,475 women ] After adjustment for known risk factors for GDM
including age, family history of DM, parity, physical activity, smoking
status,

sugar-sweetened beverage intake, alcohol intake, prepregnancy BMI, and
Western dietary pattern, intake of sugar-sweetened cola was positively
associated

with the risk of GDM. No significant association was found for other
sugar-sweetened beverages or diet beverages. "Compared with women who
consumed less

than 1 serving per month, those who consumed more than 5 servings per week
of sugar-sweetened cola had a 22% greater GDM risk,"   (GDM), defined as
glucose

intolerance beginning during pregnancy, is one of the most common pregnancy
complications. Women with GDM are

at increased risk for complications and illness during pregnancy and
delivery, as well as post-pregnancy T2. Children of mothers with GDM are at
increased

risk for obesity, glucose intolerance, and early onset diabetes. . available
evidence suggests that the main defect in the development of GDM is
relatively

diminished insulin secretion

coupled with pregnancy-induced insulin resistance.

 

18.%% MW Patients With Type 2 Diabetes and Major Depression at Greater Risk
for Significant Cardiovascular [CV] Complications

12/8/09 — Adults with T2 who have major depression face a greater

risk for life-altering microvascular and macrovascular complications
regardless of their self-care habits or the degree to which their disease is
controlled."A

meta-analysis of 27 studies found a significant association between
depression and a wide variety of DM complications (neuropathy, retinopathy,
nephropathy,macrovascular

complications, and sexual dysfunction). Researchers collected a longitudinal
cohort of 4623 adults with T2.Five years later, the team,  collected data

on 3922 of the original patients (85.1%) regarding the development of
advanced complications of diabetes, both microvascular (eg, blindness,
end-stage

renal disease, amputations,

and renal failure deaths) and macrovascular (eg, myocardial infarction,
stroke, cardiovascular procedures, and deaths). They found  that
participants who

reported major depression had a 36% increased risk of developing advanced
microvascular complications and a 25% greater risk of developing significant

macrovascular issues compared with those with mild or no depression."After
adjustment for prior complications, demographic, clinical and diabetes
self-care

variables, major depression was associated with significantly higher risks
of adverse microvascular outcomes and adverse macrovascular outcomes ," the

authors write.  Researchers posit that both biologic and behavioral factors
may affect the association between depression and DM complications.
Depression

and ongoing stress can trigger the hypothalamic-pituitary-adrenal axis,
arouse the sympathetic nervous system, elevate inflammatory and platelet
aggregation,

and negatively affect the patient's glycemic control and self-care, which
can also increase the risk for complications.

 

19.%% Eye (2009) 23,  Pain relief during panretinal photocoagulation for
diabetic retinopathy: a national survey

Panretinal photocoagulation (PRP) for proliferative retinopathy is known to
be painful for some people. The vast majority of responses to a questionaire

(96%) were from doctors. .most patients require up to 5 sessions of PRP. 88%
said that the procedure is painful. Once present, pain can affect the number

and strength of burns delivered and indirectly increases the number of
sessions required to complete the therapy. Conclusions PRP is painful;
however,

most units do not deliver pain relief pre-emptively. There may be a case to
support the routine use of sub-tenons anaesthesia until the full effects of

new laser techniques become known.

 

20.%% MW Diabetic Cohort Analysis Confirms Sulfonylurea Risks, Adds to
Glitazone Debate 12/11/2009; — The sulfonylureas as a drug class were
associated

with an excess all-cause mortality risk, and treatment with some of them was
followed by more heart failure, compared with treatment with metformin, in

a retrospective analysis encompassing >90,000 UK diabetics."Our findings
suggest a relatively unfavorable risk profile of sulfonylureas compared with
metformin.

This is consistent with the recommendations of the ADA

 and International Diabetes Federation , which favor metformin as the
initial treatment for T2DM," write the authors. Looking also at the
thiazolidinediones

(TZDs), they found that survival was significantly better on pioglitazone
(Actos) compared with metformin...

 

21.%% MW Expert Review of Ophthalmology  Pathophysiology and Management of
Diabetic Retinopathy 12/1/2009;Abstract - Diabetic retinopathy [DR] remains

a major cause of worldwide preventable blindness. In this review, we
evaluate the recent advances in understanding the molecular mechanisms of
DR, highlight

the current management and new therapeutic approaches, and discuss the range
of potential future therapeutic strategies in order to combat the disease.

The microvasculature of the retina responds to hyperglycemia through a
number of biochemical changes, including the activation of PKC, increased
advanced

glycation end-products formation, polyol pathway and oxidative stress, and
activation of the renin-angiotensin system. There is an accumulating body of

evidence that inflammation and neurodegeneration play a prominent role in

the pathogenesis of diabetic retinopathy. Strict metabolic control, tight BP
control, laser photocoagulation and vitrectomy remain the standard care for

DR. Emerging therapies include intravitreal triamcinolone or anti-VEGF
agents, ruboxistaurin, renin-angiotensin system blockers, fenofibrate, islet
cell

transplantation, PPAR-? agonists and intravitreal hyaluronidase. However,
more randomized, controlled clinical trials are required to clarify their
role

alone or in combination. Introduction (DR) is the most common microvascular
complication of diabetes and remains one of the leading causes of blindness

worldwide among adults aged 20-74 years. The two most important visual
complications of DR are diabetic macular edema

(DME) and proliferative DR (PDR). The prevalence of DR increases with the
duration of DM .. nearly all people with T1 and more than 60% of those with
T2,

have some retinopathy after 20 years. The retina consists of a number of
cells, and normal vision depends on intact cell-cell communication among
them.

Diabetes damages all the major retinal cells of the retina, vascular cells
(endothelial cells and pericytes),  neurons (photoreceptors, bipolar,
horizontal,

amacrine and ganglions),  glia (Müller cells and astrocytes), microglia and
pigment epithelial cells.  Before damage, these cells are activated, which

changes the production pattern of a number of mediators, such as growth
factors, vasoactive agents, coagulation factors and adhesion molecules,
resulting

in increased blood flow, increased capillary permeability, proliferation of
the extracellular matrix and thickening of basal membranes, altered cell
turnover

(apoptosis, proliferation, hypertrophy), procoagulant and proaggregant

patterns and, finally, in angiogenesis and tissue remodeling. The mechanisms
of diabetes-induced damage to retinal cells correlate with excessive
circulating

levels of glucose, lipids, hormones, amino acids and inflammatory molecules.
The increased systemic, vitreal

and retinal levels of these factors in diabetic patients induce several
unrelated and inter-related biochemical pathways and molecules implicated in
pathophysiology

of the disease, which are briefly discussed in the following
sections...[actually 69 pages]

 

22.%% Medscape Medical News   High Coffee/Decaf/Tea Intake Linked to Lower
Diabetes Risk 12/14/09  High intakes of coffee, decaffeinated coffee, and
tea

are associated with a reduced risk for T2DM “We report herein the findings
of meta-analyses for the association between coffee, decaffeinated coffee,
and

tea consumption with risk of diabetes." [18 studies, 457,922
participants,]After adjustment for potential confounders,.. every additional
cup of coffee

consumed in 1 day was associated with a 7% decrease in the excess risk for
diabetes (relative risk, 0.93)  the study authors write. "Similar
significant

and inverse associations were observed with decaffeinated coffee and tea and
risk of incident diabetes." ..the identification of the active components

of these beverages would

open up new therapeutic pathways for the primary prevention of DM.

Arch Intern Med. 2009;169

 

23.%% MW - Diagonal Ear Lobe Crease (ELC)in Diabetic South Indian
Population: Is It Associated with Diabetic Retinopathy? [DR]12/08/09; BMC
Ophthalmol

© 2009  ..there is a link between ELC and macrovascular disease (CHD), and
between, microvascular disease and macrovascular disease..Conclusion ELC is

present in nearly 60% of urban south Indian population with diabetes, aged
above 40 years. The presence of ELC is somewhat related to sight-threatening

DR. However, the present study does not support the use of ELC as a
screening tool for both any DR and sight-threatening retinopathy.

 

24.%% MW  Rheumatic Manifestations of Endocrine Diseases [diabetic section]
12/7/09; Curr Opin Rheumatol. 2010;22(1):

 Musculoskeletal complaints accompanying or as a result of endocrine
disorders are common and have been well described. This review re-examines
these associations

in light of newer information on biology and genetics..  Diabetes Mellitus -
Patients with DM have several rheumatic syndromes, many of which are
associated

with the severity of the disease. These include diabetic neuropathy and its
associated arthropathy. The pathogenesis is neurovascular  instead of the
generally

thought neurotraumatic (resulting from decreased sensitivity of nerve
endings) or reduced flow secondary to arterial sclerosis of small vessels.
Patients

with diabetes have increase blood flow (secondary to neuropathy involving
the sympathetic nervous system) to subchondral bone, resulting in increased
osteoclastic

activity and bone resorption. This occurs even in the absence of peripheral
vascular disease, resulting in bone fatigue and disorganization. It appears

radiographically as progression from localized osteopenia to osteolysis of
subchondral bone, fragmentation of bone and cartilage (part of which may be

come embedded in synovial tissue) and sclerosis.  Joints involved in order
of frequency include ankle, metatarsophalangeal and tarsometatarsal.

 The pathogenic mechanism which may be active in DM causing tissue damage is
unknown; however, advanced glycation end products bind to RAGE receptors
(increased

in diabetes and thought to be responsible for inflammation and increased
atherosclerosis) on chondrocytes up-regulating matrix metalloproteinase
which

are involved in inflammation.  There are relationships between gout,
hyperuricaemia and the metabolic syndrome. The metabolic syndrome increases
the risk

for atherosclerotic cardiovascular disease (CVD) and T2. A recent study
looked at the relationship between gout and the development of T2
[11,351males]

the  risk for T2 among men with gout at baseline compared to men without
gout was 1.34  These findings from men with a high cardiovascular risk
suggests

that men with gout are at a higher future risk of developing type 2 diabetes
independent of the other known risk factors. The evidence for co-occurrence

of two autoimmune diseases RA and T1DM  has been reported. RA [rheumatoid
arthritis]has been linked with the premature development of cardiovascular
disease

which is related to the inflammatory burden and predisposes to the
development of atherosclerosis in these patients. Systemic inflammation has
also been

implicated in predisposition to developing T2 as well as insulin resistance.
One established genetic risk factor, the 620W allele of the protein tyrosine

phosphate N22gene (PTPN22), is shared by both RA and T1..Diffuse idiopathic
skeletal hyperostosis (hyperostosis or DISH) originally described as
confined

to the axial skeleton involves calcification of tendon and ligament
attachments in both spinal and extraspinal locations as well as hyperostosis
at bony

prominences. Forty to fifty percent of patients with this condition also
have diabetes mellitus. Elderly patients with DM have an increased
prevalence

of DISH over age-matched controls; however, the severity of the diabetes is
not related to the extent of DISH present. Periarthritis and adhesive
capsulitis

(frozen shoulder) presenting with shoulder pain (often awaking the patient
at night) progressing sometimes to progressive limitation of motion over
months

is associated with several medical conditions including diabetes mellitus.
Carpal Tunnel Syndrome (CTS)- Idiopathic in over 50% of cases  is associated

with diabetes (present in 25% of cases), RA, hypothyroidism, CPPD,
acromegaly, and multiple myeloma. Hand involvement in diabetes mellitus is
common (seen

in over 30% of patients) presenting in several different forms..Occurring
more often with increased duration of disease it is often predictive of
renal,

retinal and other complications of diabetes mellitus. Osteoporosis: Diabetes
mellitus is thought to impact on quality of bone. Studies

have demonstrated decreased bone density and increased bone marrow fat as
well as reduced new bone formation...

 

European Association for the Study of Diabetes (EASD) 45th Annual Meeting

- Abbreviations:  DM - diabetes Mellitus;T1DM - type 1 diabetes mellitus
T2DM - type 2; DME - diabetic macular edema; FPG - fasting plasma glucose BP
-

blood pressure; CV - cardio-vascular; MI -myocardial infarction or heart
attack ;HTN - hypertension or high BP; OCT - optical coherence tomography;
VA

- visual acuity  -ADA - Amer Diabetes Ass; CDC:  US Centers for Disease
Control and Prevention; FDA Federal Drug Administration; JH - Johns Hopkins
; MW

Medscape Web MD; NIH - National Institutes of Health;  MNTD- Medical News
Today  

Definitions - Dorlands 31st Ed and Google.  Disclaimer, I am a BSN RN but
not a diabetic or diabetic educator. Reports are excerpted unless otherwise
noted.

This project is done as a courtesy to the blind/visually impaired and
diabetic communities. Dawn Wilcox BSN RN Coordinator The Health Library at
Vista

Center contact above e-mail or 

thl at vistacenter.org     

       

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