[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1. %% Heartwire   Lifestyle-Based Diabetes Prevention Seen to Endure for at
Least a Decade  Oct 30, 2009 A number of studies have shown that behavioral

and lifestyle interventions can provide lasting protection against new T2 in
those at increased risk - but for how long?  The original DM Prevention
Program

Research Group [3234 non-DM patients with elevated fasting glucose and
impaired glucose tolerance.] saw rate of new DM fall by 58% with intensive
lifestyle

intervention and by 31% with metformin only; mean of 2.8 yr. In the
follow-up study; 5.7yr - the new onset DM rates fell sharply in the
metformin and former

placebo groups from what they had been in the first trial. We now know that
an intensive lifestyle intervention is effective over 10years, and remains

the best bet for prevention of diabetes. "I consider this lifestyle
intervention an important step in the right direction, but it's clearly not
sufficient.

Because still, after 10 years, half the people developed DM..."

 

2.%% MW Diabetes Slows Cognitive Decline in Patients With Alzheimer's
Disease (AD)10/29/09  - Rather than accelerating cognitive decline, (DM)
appears

to slow this decline in patients with  (AD). The lead author said ", it is
hoped that earlier and prompt treatment of DM before dementia is diagnosed
may

prevent the cerebrovascular lesions and may delay the onset of cognitive
decline.   [ 608 patients] Within the DM group, the rate of cognitive
decline

was similar between those using or not using insulin. Neuropathologic
differences may explain the slower cognitive decline . Patients with DM may
be more

likely to have a mixed brain pathology (AD with cerebrovascular disease),
and such patients tend to have a slower cognitive decline than patients with

AD, she noted. DM patients with AD may take more cardiovascular medications
such as statins or anti-hypertension drugs which might also contribute to a

slower progression of cognitive decline. As well, insulin-sensitizing drugs
may have beneficial cognitive effects.

 

3.%% Statins Might Slightly Boost Diabetes Risk (Reuters Health) Oct 23
"Contrary to our expectation we did not find any benefit of statins on DM
risk.

In fact, there is a suggestion that statins may be associated with increased
risk " [ meta-analysis; 57,000 patients; mean follow-up 3.9yr] the team
observe

there were a number of possible confounding factors.- such as  the
diagnostic criteria for DM varied across trials.  An accompanying editorial
states "Because

cardiovascular disease accounts for almost two-thirds of deaths in people
with DM the protective effect of statins on this major complication may
suffice

to support their use despite a potential risk of new-onset diabetes."
Diabetes Care 2009:32;

 

4.%%  Cancer Risk Increased in Diabetics With Low LDL Cholesterol and
Albuminuria  (Reuters Health) Oct 27 - Patients with T2DM  who have low LDL
cholesterol

and albuminuria face an increased risk of developing cancer. The good news
is that statin use in such patients may eliminate the elevated risk. [3793
statin-naive

diabetics and 1483 controls] Patients who used statins were more likely to
use other drugs and develop cardiovascular complications but less likely to

have cancer and die, compared with patients who did not receive statin
treatment,  The presence of both LDL cholesterol (110 mg/dl) and albuminuria
was

associated with a 3.1-fold increased risk of cancer.. patients with both
risk factors who were treated with statins during follow-up did not have an
increased

cancer risk. "These observations are not causal but suggest complex
interplays between lipid and growth promoting pathways which may be
dependent on renal

function,"Diabetes Care 2009;32:

 

5.%% Ophth vol116,issue 11 Nov 2009   Blindness in a 25-Year Follow-up of a
Population-Based Cohort of Danish Type 1 Diabetic Patients ..Blindness was

predicted by HbA1 and maculopathy at baseline. Age and duration at baseline,
gender, proteinuria, smoking, systolic and diastolic BP, and visual acuity

at baseline were not associated with the development of blindness. Mortality
was higher in patients who had become blind (61.0% vs. 42.1%).  Conclusions

-

Blindness is still a common complication in T1. Glycemic regulation and the
presence of maculopathy are important risk factors for the development of
blindness.

 

6.%% Ophth vol116,issue 11 Nov 2009   Results of the Ranibizumab for Edema
of the macula in Diabetes Study  Objectives - To compare ranibizumab
[lucentis]

with focal/grid laser or a combination of both in diabetic macular edema
(DME). [126 patients ] Conclusions - During a span of 6 months, ranibizumab
injections

by the current protocol had a significantly better visual outcome than
focal/grid laser treatment in patients with DME.

 

7.%% Ophth vol116,issue11 Nov 2009  Five-year Results of a Randomized Trial
with Open-label Extension of Triamcinolone Acetonide (IVTA)for Refractory
DME

[69 eyes]  Intravitreal injection of  triamcinolone acetonide with
adjunctive laser therapy  Results -Improvement of 5 letters after 5 years
was found

in 14 of 33 eyes. Conclusions - The majority of eyes that initially improved
with IVTA maintained their gain after 5 years. No new safety concerns were

identified. IVTA treatment may be considered in carefully selected cases of
impaired vision caused by advanced DME unresponsive to other interventions.

 

8.%% MW   FDA Approves Exenatide for First-Line Use; Warns of Renal Failure
Risk Nov 3,09  The FDA has issued a warning about the incretin-mimetic
exenatide

(Byetta), the same day it approved an expanded indication for the drug,
allowing its first-line use along with diet and exercise to improve glycemic
control

in patients with T2DM. The warning includes 78 postmarketing reports of
kidney dysfunction (including acute renal failure and insufficiency),
received

between 4/05-10/08, in 6.6 million users. "Some cases occurred in patients
with pre-existing kidney disease or in patients with one or more risk
factors

for developing kidney problems,"  FDA emphasizes that exenatide should not
be used in patients with severe renal impairment or end-stage renal disease,

and it advises caution during initiation of therapy or dose increases in
patients with moderate renal dysfunction. Patients receiving exenatide
should

be carefully monitored for signs and symptoms of altered renal function,
including increased serum creatinine, changes in urination, unexplained
swelling

in the extremities, BP increases, lethargy, changes in appetite or
digestion, or the emergence of a dull ache in the mid- to lower back...
Adverse events

related to the use of exenatide should be communicated to the FDA's MedWatch
reporting program at 1-800-FDA-1088,

 

9.%% WebMD Health News  Yellow Pea Flour May Help Diabetes

Oct 30,09 -A new study suggests that yellow pea flour may be an inexpensive
substitute for wheat flour to create healthier, low glycemic index versions

of typically high glycemic index foods, such as cookies, breads, and pasta.
The glycemic index (GI) of a food refers to the spike in blood
sugar(glucose)produced

after eating it. High GI foods produce a more rapid spike in blood sugar
levels, which can be dangerous for people with T2 who need to keep their
blood

sugar levels under control. Researchers say pulses, including yellow peas,
are now being studied as potential ingredients in foods because they are
high

in fiber, protein, and antioxidants and are low in fat.  This team created
banana bread, biscotti, and pasta using whole yellow pea flour.  They then
compared

the glucose responses of 19 healthy subjects. The team concludes that the
results support the use of whole yellow pea flour as an alternative
ingredient

in producing "tasty, low GI foods that help prevent and manage T2.."

 

10.%%  High Heart Rate Predisposes to Obesity and Diabetes original pub
12/11/08   Researchers following a group of healthy subjects for 20 years
report

that those who had high heart rates at baseline were twice as likely to
become obese and had a 5 fold higher risk of developing DM [620 subjects]a
heart

rate of 80 beats per minute or higher in 1979 was a significant predictor of
obesity, insulin  resistance, and DM 2 decades later. The findings speak to

a role for the sympathetic nervous system with at least three hypothetical
mechanisms predisposing high-heart-rate patients to DM: stimulation of
beta-adrenergic

receptors, (can cause acute insulin resistance); chronic beta-adrenergic
stimulation,(increases the number of insulin-resistant fast-twitch muscles;
or

vasoconstriction and decreased skeletal muscle blood flow, leading to
impaired glucose uptake in skeletal muscle...

 

11.%% Understanding the Role of Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in
T2DM 10/21/09; Summary - Traditional treatment for T2 does not address the

issue of progressive decline in beta-cell function. While metformin and
thiazolidinediones  act primarily by improving hepatic insulin resistance,
DPP-4

inhibitors primarily increase glucose stimulated insulin secretion and
suppress postprandial [after meal] glucagon concentration. Combination of a
DPP-4

inhibitor with a thiazolidinedione or with metformin in patients whose
condition is inadequately controlled with either of them will improve
glycemic control

without the potential adverse effect of hypoglycemia.

 

12.%% MW Newer Laser Treatment for Diabetic Macular Edema [DME] Causes Less
Scarring (Reuters Health) Oct 27 - A sub-threshold micropulse diode laser
(MPDL)

is as effective as a conventional green laser (CGL) for the photocoagulation
of DME, according to the results of a new controlled trial .The MPDL-treated

group showed a trend toward better vision 12 months later though this did
not reach statistical significance. Fewer patients had laser scars after
MPDL. 

Macular edema is the most frequent cause of blindness in patients who have
DM 20 years or longer. In patients with clinically significant DME, laser
photocoagulation

can reduce the incidence of visual loss by about half for at least 3years
[53 patients] (84 eyes) The clinical significance of the reduction in
visible

scarring caused by MPDL compared to CGL "is yet to be determined," the team
cautioned. In theory, less scarring should result in better vision, though

a longer follow-up would likely be needed to demonstrate that. Br J
Ophthalmol 2009;93:

 

13.%% Can a Mediterranean (MED)Diet Delay the Need for Drug Therapy in T2DM?
10/27/2009 [ randomized controlled trial [RCT]; 108 subjects with newly
diagnosed

T2 were assigned to a MED diet;107 assigned to a low-fat diet.] The MED diet
- rich in vegetables and whole grains, low in red meat, 50% of calories from

complex carbs, 30% of calories from fat (mainly olive oil).  The low-fat
diet -rich in whole grains; 30% of cal from fat;10% of cal from saturated
fat.

1800 calories per day for men/1500 for women;follow-up 4yr. Both groups lost
weight. Other measures of glycemic control ( HbA1c, plasma glucose, serum

insulin, insulin sensitivity, and adiponectin) all favored  MED
participants. HDL High-density lipoprotein cholesterol increased and
triglycerides decreased

significantly more in the MED group. Current guidelines recommend the
initiation of metformin immediately upon diagnosis of T2 along with
lifestyle changes

designed to induce weight loss. However, oral antihyperglycemics fail over
time, creating the need for ever-intensifying drug regimens. These results
demonstrate

that a MED-style diet can delay the need for antihyperglycemic agents for at
least 3 years for most newly diagnosed patients.  

 

14.%%Less Fiber Prompts More Diabetes in Older Men  (Reuters Health) Oct 22
-"This study confirms that diets higher in fiber intake -- more or less
regardless

of the source of fiber -- may be protective against development of T2 ," the
team says. [3428 non DM men age 60-79 years;follow-up 7yr]. men with the
lowest

daily fiber intake (20 g or less) were at increased risk of DM. Total fiber
intake was also significantly and inversely associated with inflammatory
markers

associated with hepatic fat deposition. ".. part of fiber's protection
against DM may stem from beneficial effects to keep liver fat and
inflammation levels

down." Diabetes Care 2009;32:

 

15.%% IDF  Two-Year Update of LEAD-3 Trial Confirms Durability of
Liraglutide's Effects 10/23/09  Liraglutide [Victoza] is a human
glucagon-like peptide-1

analogue that "has insulin stimulatory effects in the presence of glucose,
has glucagon- suppressive effects in the absence of hypoglycemia, retards
gastric

emptying, and diminishes appetite," the presenter said "It sounds like an
ideal combination for overweight people with T2 " [321 patients] Compared to

glimepiride,

treatment with liraglutide resulted in significantly greater reductions in
Hb A1c. [it] was also associated with a greater proportion of patients
achieving

HbA1c levels of less than 7% or of 6.5% or more without hypoglycemia or
weight gain. . the key issue with incretin- based therapies, such as
liraglutide,

will be whether they truly protect beta cells. "The other question is the
[risk for] complications. There's a hint of pancreatitis or thyroid
problems,

which [might] be significant. It's too early to say. . these things usually
come out in post- marketing, with large, large numbers of people in the real

world." research  sponsored by Novo Nordisk 

 

16.%% IDF Immunomodulator Otelixizumab Appears to Preserve Beta Cell
Function in T1DM 10/27/09  Otelixizumab, an investigational immunomodulator,
has shown

promise in phase 2 trials as a means of safely preserving beta cell
functioning in T1.  [it] is a chimeric/ humanized aglycosylated anti-CD3
monoclonal

antibody directed against the T-cell antigen CD3e, and has been developed as
a treatment for autoimmune disorders such as T1."It's given as an
intravenous

infusion over 30 minutes," A pediatric endocrinologist, points out that
otelixizumab is 1 of several drugs currently being studied for the
preservation

of islet cells.."Preserving islet cell function is a critical step prior to
curing T1,"

 

17.%% MNTD Vegetables Can Protect Unborn Child Against Diabetes

28 Oct 2009  [6,000 5 year-olds ] Children at risk of developing T1 have
antibodies in their blood which attack their insulin-producing cells.  3% of
those

in this study  had either elevated levels of these antibodies or fully
developed T1 at age 5. These risk markers were up to twice as common in
children

whose mothers rarely ate vegetables during pregnancy. The risk was lowest
among children whose mothers stated that they ate vegetables every day. "We
cannot

say with certainty on the basis of this study that it's the vegetables
themselves that have this protective effect, but other factors related to
vegetable

intake, such as the mother's education, do not seem to explain the link,"
The term "Vegetables "in this study included all vegetables except for root
vegetables.

 

18.%%MNTD Protein Critical For Insulin Secretion May Be Contributor To
Diabetes  28 Oct 2009 A cellular protein from a family involved in several
human

diseases is crucial for the proper production and release of insulin
suggesting that the protein might play a role in DM. Mice lacking the ClC-3
channel

have only one-fifth the circulating insulin of normal mice. The authors
argue that the finding may explain a portion of what goes wrong in T2 and
help

doctors find rare patients whose DM has a previously- undetected genetic
origin..A mutation in the function of ClC-3 in humans could very well be the
cause

of a select few cases of juvenile diabetes..

 

19.%% Prehypertension Linked to an Increased Risk of Diabetes

(Reuters Health) Nov 02 - Much of the risk is explained by disorders related
to insulin resistance.. prehypertension  -- systolic blood pressure (SBP)

between 120 -139 mm Hg and/or diastolic blood pressure (DBP)80-89  Hg -- is
known to be linked with increased cardiovascular risk and insulin
resistance.

[2767 subjects] The odds of incident DM were 2.21-fold greater among those
with  prehypertension after adjusting for age, sex, and ethnicity. Pre -
hypertension

was also associated with increased DM risk in subjects between the ages of
25- 49 years but not in those between 50 -65 .Diabetes Care 2009;32:

 

20. %%Nature Medicine 15, (2009)  High blood sugar can lead to diabetic
retinopathy [DR] and subsequent blindness. Glucose is now found to quench a
growth

factor that keeps pericytes [cell that surrounds small blood vessels] alive.
Without these key support cells, the retinal vasculature degenerates. 40%

of DM patients over 40 years of age are diagnosed with retinopathy.[linked
study same issue] Activation of PKC-delta and SHP-1 by hyperglycemia causes

vascular cell apoptosis [programed cell death] and DR. Cellular apoptosis
induced by hyperglycemia is crucial for the initiation of diabetic
pathologies.

In the retina, pericyte apoptosis and the formation of acellular capillaries
is linked to the loss of platelet-derived growth factor )-mediated survival

actions..  hyperglycemia persistently activates PKC-delta to increase the
expression of (SHP-1), a protein tyrosine phosphatase. We observed increased

PKC-delta  activity and an increase in the number of acellular capillaries
in diabetic mouse retinas, renal cortex, and brain pericytes. . These were
not

reversible with insulin treatment. These findings elucidate a new signaling
pathway by which hyperglycemia can induce DM vascular complications. 

 

21.%% AAO-PAAO  Myopia Is Protective Against Diabetic Retinopathy, 11/5/09
Myopia that results from longer axial length and greater depth of the front

eye chamber might be particularly protective against diabetic retinopathy
[DR] and result in reduced risk for the eye disease. [675 subjects with
DR].t

participants whose eyes were more myopic, were less likely to have diabetic
retinopathy; the association was particularly significant for
sight-threatening

DR. even those with mild myopia had a significantly decreased risk for
diabetic retinopathy. The team said "As the eye is stretched and the retina
becomes

thinner, the amount of blood flow is reduced.  Myopic eyes are anatomically
and structurally different and it is possible that the difference in
choroidal

or retinal blood flow contributes to the reduced risk of retinal and
choroidal vascular diseases,"..

 

22.%% MW No Benefits of Aspirin for Primary Prevention in Diabetics,
Meta-Analysis Suggests 11/11/09- Another meta-analysis concludes that "a
clear benefit

of aspirin in the primary prevention of major  cardiovascular [CV] events in
people with DM remains unproved."

It seems that not only in individuals with DM, but also in all other
high-risk groups, the efficacy of aspirin for primary prevention is lower
than expected..

that means we need to select very carefully the patients who are more likely
to benefit.Diabetes is associated with hyperglycemia, hyperinsulinemia,
insulin

resistance, oxidative stress, and advanced glycation end products, and all
these factors can be responsible for activation of platelets [via] different

pathways that are not blocked by aspirin."

 

23.%% MNTD To Heal Diabetic Foot Ulcers, A New Drug Harnesses Stem Cells
Inside Us All 11/10/09  Mesenchymal stem cells (MSCs), as distinct from the
embryonic

type, may be the key to healing DM foot ulcers. These stem cells can
differentiate into various cell types., MSCs help drive its rapid initial
growth;

by the time we reach our teens, however, MSCs are mostly found in bone
marrow. When wounded or burned, our skin craves MSCs, which it harbored when
first

growing.. surgically moving these cells from bone marrow onto hard-to-heal
wounds accelerates healing. In contrast to surgically removing MSCs from
bone

marrow-a painful, time consuming and expensive process-a new topical drug,
the novel angiotensin analog DSC127, appears to activate [these] cells. "It

appears that DSC127 directs MSCs to the injury site, mobilizing them to help
repair wounded or burned skin, accelerate healing and reduce scars.. ," said

the CEO of Derma Sciences Inc. currently in phase II human trial

 

24.%%J H Health Alerts;  New Approach to Slow Diabetic Kidney Disease
11/12/09    30 - 40% of people with T1DM and 20% of those with T2DM
eventually develop

diabetic nephropathy (kidney disease)  though by no means do all of them go
on to kidney failure. The damage occurs in tiny blood vessels throughout the

kidneys, which act as filters to remove waste products from the bloodstream.
High BP (hypertension) [HTN] worsens kidney disease, so controlling [it] is

an essential part of managing DM nephropathy. For many people, existing
antihypertensive drugs fail to slow kidney damage, but the new drug
aliskiren (Tekturna)

may offer much-needed additional protection.[599 subjects] All took the
antih-HTN drug losartan (Cozaar) in addition to drugs to lower BP.
Participants

taking Tekturna had reduced proteinuria (loss of protein in the urine)-- a
sign of failing kidneys.  In addition, almost 25% of the drug takers had a
50%

reduction in protein loss in urine, compared with 13% of the placebo group.
Many common anti-HTN drugs work by interfering with angiotensin, a chemical

that raises BP by constricting blood vessels. Tekturna also blocks renin,
the enzyme that produces angiotensin. Study appeared in New Eng Jour of
Medicine

(vol358)

 

25.%%MW Sole Use of Monofilament Testing Not Recommended to Diagnose
Peripheral Neuropathy 11/11/09 "Several tests are used to detect peripheral
neuropathy.., 

"Electrodiagnostic tests can be complex, expensive, and time consuming,..
Monofilament testing is an inexpensive, easy-to-use, and portable test for
assessing

the loss of protective sensation. "Despite the frequent use of monofilament
testing, little can be said about the test accuracy for detecting neuropathy

in feet without visible ulcers," the study authors write. "Optimal test
application and defining a threshold should have priority in evaluating
monofilament

testing, as this test is advocated in many clinical guidelines. Accordingly,
we do not recommend the sole use of monofilament testing to diagnose
peripheral

neuropathy."

"The diagnosis of peripheral neuropathy can be made only after a careful
clinical examination with more than 1 test, as recommended by the ADA" 

 

AAO-PAAO American Academy of Ophthalmology Joint Annual Meeting With the
Pan-American Association of Ophthalmology 

International Diabetes Federation (IDF) 20th World Diabetes Congress

 

- Abbreviations:  DM - diabetes Mellitus;T1DM - T1 type 1 diabetes mellitus
T2DM - T2 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; RCT - randomized controlled
trial;

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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