[acb-diabetics] MANY ARTICLES

[Patricia LaFrance-Wolf]

1. %% M Serum Potassium [K] May Independently Predict Incident T2DM 10/29/10
Serum [K]level is an independent predictor of incident T2."Serum [K] levels
affect insulin secretion by pancreatic ß-cells, & hypokalemia [low K] assoc
with diuretic use has been associated with  [abnormal sugar level] writes
the team. [12,209 pts] Serum K level was inversely associated with the risk
for incident DM, based on multivariate analyses. "Further study is needed to
determine if modification of serum K could reduce the subsequent risk of
DM."

 

2.%%Heartwire  Sugary Drinks and Sodas Linked to Increased DM, Metabolic
Syndrome 10/29/10 A Harvard team reports that drinking  just 1 or 2
sugar-sweetened beverages per day is associated with a 26% greater risk of
developing T2 & a 20% increased risk of  developing metabolic syndrome. "The
team combined data from 11 studies  then analyzed the results based on
whether pts reported drinking no sugar-sweetened drinks or more than 1or 2
per day;12oz serving. . " for those who drink 2-3 sodas per day, their risk
of developing T2 would be increased by 30 to 40%, which is not very
different from the increased risk associated with cigarette smoking." He
also emphasized that some but not all of the effects of sugary- drink
consumption on DM or metabolic syndrome seem to be mediated through the
increased calories and excess pounds.

 

3.%%  FDA Requests More Data for Once-Weekly Exenatide 10/29/10  FDA has
issued a complete response letter regarding a once-weekly extended- release
formulation of exenatide injection (Bydureon) a GLP-1 receptor agonist used
to improve glycemic control in pts with T2. FDA requested a thorough QT
study to evaluate the effects of elevated exenatide plasma levels, such as
those caused by renal impairment, on heart rate. They also asked for safety
and efficacy data from a head-to-head study comparing once-weekly exenatide
with the currently approved twice-daily product (Byetta)

 

4.%%M 10/22/10 Pts with DM are 3 times more likely to have bacteria in their
urine than nondiabetics, But there are no recommendations to screen or treat
them unless symptoms develop. The only exception, the team notes, is during
pregnancy, when treatment of asymptomatic bacteriuria  lowers the risk of
pyelonephritis and preterm delivery.

 

5.%% M 10/20/10 Insulin Resistance [IR] Increases Stroke Risk in Nondiabetic
Adults[1509;mean age 68] pts free of stroke & DM, those in the top [fourth]
of IR, had a nearly 3-fold greater risk for ischemic stroke during follow-up
than adults without IR. "These findings, if confirmed, may open new
treatment opportunities with direct effect on reducing the atherosclerotic
process," the team said. IR is a key pathophysiologic contributor to the
increased risk for CVD.

 

6.%% M  Multivitamin Use Not Linked to DM Risk in Older Adults 11/2/10
[14,130 DM pts] However, the use of vit C or calcium supplements was
associated with a significantly lower risk for DM. Diabetes risk was not
linked to use of vit E or other individual vitamin and mineral supplements.
NIH study

 

7.%% New Treatments for Diabetic Retinopathy: AAO 2010  David
Brown.(Methodist Hospital Houston.) We are going to discuss some of the
developments in DM retinopathy [DR]. In the 1990s, both AMD and DR were
treated with ablative therapy [distruction by laser ]. In 2005, we had a
major paradigm shift in AMD & converted to pharmaco therapy [drugs] we
realized that anti-VEGF [vascular endothelial growth factor] injections
given continuously improve visual acuity rapidly & sustain visual acuity
gains in AMD. This same shift is happening in DR, but at a much slower pace.
In 2007, [a research group] showed that  [avastin] injections into the eye
improved the anatomy for about 3 weeks.. those injections given every 6 wks
seemed to improve visual acuity at 12 wks.. where are we today?  RISE & RIDE
studies, are testing head-to-head intravitreal injections of [lucentis]
monthly vs our previous ablative laser therapy. These data will be out in
2011. ..Will there still be a role for laser? Probably. VEGF production is
continuous in DM and if pharmacotherapy is the only thing we have, this
means sustained injections for the rest of the pt’s life. So, I think there
is going to be a role for combination therapy, [above study] is going to
look at some of these.. implants of a steroid derivative are injected every
18-24 months.. may compete with nti-VEGF monthly therapy. Stay tuned. It's
going to  be exciting.

 

8. %% ADA  Stress Raises Risk of Diabetes 1/11/10   Middle-aged men who are
under extreme stress have higher prevalence of DM than women [South Korea]
diabetes was twice as prevalent in males in their 30s- 50s than female
peers.  Some experts suggest that middle- aged men experience stress at work
or the pressure of responsibility to care for their family, with few
opportunities to relax.  "Stress may not be the direct cause of DM. But
psychological symptoms affect the brain function controlling hormone
production, leading to bad eating habits," said the spokesman .

 

9.%%M From Pre-diabetes to T2DM in Obese Youth: 10/22/10; [ 24pts] Concl -
Obese adolescents who show signs of glucose dysregulation, including
abnormal fasting glucose, glucose intolerance or both, are more likely to
have impaired insulin secretion rather than reduced insulin
sensitivity..they are at high risk for progression to T2.

 

10.%% M Fetal Exposure to Maternal T1 Associated with Renal Dysfunction as
Adults  10/28/10  In animal studies, hyperglycemia during fetal development
reduces nephron [main kidney cell] numbers. We tested whether this
observation translates into renal dysfunction in humans by studying renal
functional reserve in adult offspring exposed in utero to maternal T1 [19 pt
T1 mothers vs 18 pt T1 fathers]  Reduced functional reserve may reflect a
reduced number of nephrons undergoing hyperfiltration. If so, offspring of
T1 mothers may be predisposed to glomerular and vascular diseases.

 

11.%% NIH Researchers Identify Genetic Elements Influencing the Risk of T2.
11/2/10  A team at the Nat Human Genome Research Instit.  has captured the
most comprehensive snapshot to date of DNA regions that regulate genes in
human pancreatic islet cells, a subset of which produces insulin.  Genetic
information is written in the chemical language of DNA, a long molecule of
nucleic acid wound around specialized proteins called histones. Together,
they constitute chromatin, the DNA-protein complex that forms chromosomes
during cell division. The team detected about 18,000 promoters, which are
like molecular on-off switches and more than one switch can control a gene.
Several hundred of these were previously unknown and found to be highly
active in the islet cells.

 

12.%% JH Walking for Tighter Glucose Control   Research shows that starting
a walking program can help people with T2 achieve tighter glucose control.
.. sedentary DM participants who began walking 30 min a day lowered their
hemoglobin A1c levels by 0.4% after 2 yrs. They also had major improvements
in cholesterol, triglycerides (a type of fat in the blood), protective
high-density lipoprotein (HDL) cholesterol, & BP.  Most people with DM can
follow the Am. Heart Assoc recommendation to get at least 30 min of moderate
physical activity on most, days of the week or at least 20 min of vigorous
aerobic activity 3 days a week. "Moderate" activity is defined as equivalent
to walking at a pace of 3- 4 miles per hour... simple rules of thumb ..:
Walk as though you're running late to catch a bus or plane, but not so fast
that you can't talk and keep up a conversation. If you don't break a sweat
during a workout, chances are you aren't walking fast enough. Start
counting.. walking at a pace equal to roughly 100 steps per min produces a
moderate degree of physical exertion. (Or use a pedometer.)

 

13.%% MTD  Glucosamine Causes The Death Of Pancreatic Cells 10/29/10  High
doses or prolonged use of glucosamine causes the death of pancreatic cells
and could increase the risk of developing DM.  "In our experiments, we used
doses 5-10 times higher than the recommended 1,500 mg/day," said the team
leader. They showed that glucosamine triggers a mechanism intended to lower
very high blood sugar levels. However, this reaction negatively affects
SIRT1, a protein critical to cell survival...

 

14.%% MTD Haptoglobin [Hpg]As An Early Serum Biomarker Of Virus- Induced
T1DM In Rats 10/28/10  T1, is a disease of complex etiology characterized by
the autoimmune destruction of pancreatic beta cells. In addition to genetic
susceptibility, environmental factors play important roles in triggering
[it]. viral infections [includes] mumps, rubella, & enteroviruses  have been
associated with human T1. In rats treated with [virus that cause DM] the
team found increased levels of serum Hpg very early in the course of DM
induction. "mutations in human Hpg gene are associated with increased risk
of DM complications such as retinopathy & CVD. However,In our rat studies,
Hpg was identified very early following virus infection, well prior to the
development of DM or its complications..this  may represent a biomarker for
the pathogenesis of autoimmune DM ." Reliably identifying children in the
earliest phases of (pre-diabetes) would provide clinicians with a window of
opportunity when [drug] therapy could be most effective in slowing or
halting the disease."

 

15.%% M Vitamin-D Analog - Paricalcitol Could Lower Renal Risk in Diabetic
Nephropathy 11/5/10   The addition of paricalcitol to therapy in pts with DM
nephropathy reduces albuminuria.. results suggest that paricalcitol could be
an important adjunctive treatment and a novel way to lower residual renal
risk in DM, lead author says. [281 pts] already receiving conventional
renin- angiotensin-system blockade with either an ACE inhibitor or an
angiotensin-receptor blocker.  study  funded by Abbott.

 

16.%% M Postprandial Glucose as a Key for Better Glycemic Control 10/27/10
I'm Dr. Julio Rosenstock. Dallas DM and Endocrine Center, The goal of
today's activity is to discuss the evidence linking postprandial glucose
(PPG) to A1c [glycated hemoglobin] & diabetes- related complications, and
the role of current and future glucagon -like peptide (GLP)-1 agonists in
managing PPG. I'm pleased to be joined by 2 international DM experts. Dr. S.
Del Prato,  Pisa Italy, and Dr. V. Fonseca, Tulane there is no consensus on
how to define PPG.  Internat DM Fed (IDF) & Amer Asso of Clinical
Endocrinologists (AACE), say 2-hour PPG concentration should be < 7.8
mmol/L. .ADA suggestion says PPG should be lower than 10 mmol/L..With a
normal individual, there is very little fluctuation of glucose even after
eating a large meal, so to suggest that there is very tight control in PPG -
that a treatment is effective, [it] should reduce, as closely as possible,
the PPG concentration.. what kind of tools do we have? .  whenever we start
treating an individual with DM  we have to pay as much attention to control
fasting glucose as well as the PPG. The sum of the two most likely will
result in a better A1c level. Dr. R:. many variables play a role in
regulating the level of glucose after ingestion of a meal, such as the size
and composition of the meal. In T2 the interplay between the 2 main hormones
regulating glucose homeostasis is completely disrupted..However.. if you
push too much on the insulin secretion, you may be able to reduce the PPG,
but you may be ending up with hypoglycemia.. the gut hormones secreted by
the endocrine cells play a key role in regulating many of these things. Not
only do they stimulate insulin secretion  but they also suppress glucagon
and may control gastric emptying. Thus, GLP-1 may play a very important role
.. instead of just giving insulin, we should try to match the insulin
secretion physiologically with the meal and the rise in glucose...

Dr. F - The first of the agonists of GLP-1 receptors was exenatide, given
twice daily. we also have liraglutide-once daily. .exenatide once weekly has
an effect on the A1c level because they lower fasting glucose and, to some
extent, PPG, whereas exenatide twice daily works mainly on the PPG and not
so much on the fasting glucose. Several GLP-1 agonists are in development..
Metformin has been proven to be very effective...if somebody wants to use
only oral agents, they can take metformn plus a DPP-4 [dipeptidyl
peptidase-4] inhibitor. If somebody wants to take metformin and wants to see
more weight loss, then combining it plus a GLP-1 receptor agonist would make
sense. Dr. F. That's very good in the early stages, but at later stages, you
may have to use insulin as well, in combination with other agents. We use it
a lot with metformin, [or]with thiazolidinediones, and in some cases we use
it in combination with the incretin-based therapies. . we are facing a very
interesting time for new opportunities for treating T2-we have new tools,
but we have to learn how to make the best out of those tools, and I think
that PPG, which has been an unmet need for so long, is now demonstrating
better results if it is controlled. independent educational grant from
sanofi-aventis.

 

17.%% M FDA Approves Saxagliptin/Metformin Combo Pill for T2DM 10/8/10 (FDA)
has approved the first and only once-daily combination tablet featuring
saxagliptin and extended-release metformin HCl (Kombiglyze XR) for T2.
"Kombiglyze XR combines two effective DM medications in a simple once-a-day
dose for adults who need A1c reductions." said spokesman.  By incorporating
the complimentary mechanisms of a dipeptidyl peptidase 4 inhibitor
(saxagliptin) and a biguanide (metformin), the combo. therapy addresses all
3 key defects in T2 It increases insulin secretion in a glucose- dependent
manner, suppresses hepatic gluconeogenesis, and improves insulin
sensitivity. Because of the metformin-related risk for lactic acidosis,
patients should be warned against excessive alcohol intake.  Rx with
saxagliptin/metformin is not recommended in hepatic [liver] impairment &
contraindicated in renal impairment.

 

18.%% M Drugs for Diabetes: Part 1 Metformin  Br J Cardiol. Nov. 2010;17(5):
Metformin is one of the oldest oral treatments to reduce hyperglycaemia in
people with DM. Gastrointestinal side effects are common & metformin should
be used with caution in pts with renal impairment because of the slight risk
of lactic acidosis. The fact that metformin significantly reduces CV events
plus reduces weight has meant that metformin is the drug of first choice in
guidelines for the treatment of T2. There are no longer concerns about using
metformin in patients with chronic heart failure, other than in patients
with associated renal failure, or during episodes of acute left ventricular
failure..

 

19.%% M Vitamin B6, B9 and B12 in Diabetic Nephropathy—Beware 11/1/10; Nat
Rev Endocrinol. 2010;6(9):  a recent study provided evidence of adverse
effects of high-dose vit B6, B9 & B12 supplementation in advanced stage DM
nephropathy.[kidney disease] . high doses with this particular vitamin
combination should  be avoided in advanced stage DM nephropathy, ..research
on the biochemical basis for the adverse effects needs to be initiated..

 

20.%% M  Retinal, Gingival Bleeding Linked by Abnormal Glucose Metabolism
(Reuters Health) Oct 28 - Gingival [gums] and retinal hemorrhaging are
predictive of each other and most often reflect an underlying disorder in
glucose metabolism, [pts over 40 who bled in both the gums and the inner
lining of the eye] this  it was most commonly associated with chronically
elevated blood sugar levels,"  lead author said. The team examined data on
hemorrhaging at the retina & the dental gingiva and related these findings
to changes in glycosylated hemoglobin [HbA1C]. People with bleeding at 1 in
5 gingival sites had a 57% higher likelihood of retinal hemorrhaging.
Chronic hyperglycemia explained more than 50% of the association between
gingival and retinal hemorrhaging. These findings, "are consistent with the
hypothesis that retinopathies indicate hidden systemic microvascular
injuries that are largely driven by abnormal glucose metabolism." "Bleeding
gums should make people think about more than just a toothbrush.

 

21.%% Heartwire  Lorcaserin "Encouraging" in Obese Diabetics, But
Valvulopathy Signal Also Seen 11-9-10 [this] trial of investigational
obesity drug lorcaserin  in pts with DM  was part of the additional info
requested by FDA when it rejected the drug last month. .there was also a
higher rate of new valvulopathy with lorcaserin than with placebo, which the
company played down. . Heart-valve damage associated with exposure to
[appetite reducing ]drugs, such as fenfluramine, resulted in the withdrawal
of those products from the market in the 1990s. At week 52,  2.9% of pts on
lorcaserin and 0.5%on placebo had new valvulopathy. 

 

22.%%  Lighthouse  Preventing Diabetes & Vision Loss  Currently, about 24
million Amer adults have diabetes. That figure could rise dramatically in
the next 40 years due to an aging population, increases in minority groups,
and people with DM  living longer. "People don't realize that DM is the
number one cause of preventable blindness in working people," said A
Zaldivar, LH Internat. . Even though DM retinopathy is the leading cause of
blindness in American adults, about half have never had a retinal
examination, leaving them either unaware of this serious complication or
failing to take steps to prevent it. So what can you do to either prevent or
treat DM  eye disease? If you have diabetes, it is recommended you receive a
dilated eye exam at least once a year. You should also follow the "ABCs" of
preventing diabetes complications .. includes monitoring your average blood
glucose level [H 1AC] controlling your BP & cholesterol, and refraining from
smoking.  If uncontrolled, DM  can lead to many complications. It's
imperative that you take care of your vision, since it can impede how you
take care of yourself.

 

%% News - President Obama Signs 21st Century Communications and Video
Accessibility Act  On Oct 8, 2010, President Barack Obama signed into law
the Twenty-First Century Communications and Video Accessibility Act of 2010.
The legislation requires smart phones, the internet and TV programming to
include audible & visual notifications so they are accessible to anyone with
a vision or hearing loss.

 

23.%%ADA  Dietary Intervention in Infancy and Later Signs of Beta- Cell
Autoimmunity 11/11/10  Early exposure to complex dietary proteins has been
found to potentially increase the risk of beta-cell autoimmunity and T1DM in
genetically susceptible children. [Finland] [230 infants, all with
HLA-conferred susceptibility to T1+at least one family member with T1]
received either a casein hydrolysate formula or a conventional,
cow's-milk-based formula (control group) birth-8m ;fup 10yr.  The team
wrote, "Our data suggest that weaning to a highly hydrolyzed formula,
compared with a cow's-milk-based formula, was associated with a decreased
risk for at least one DM--associated autoantibody.  Dietary intervention in
infancy could have a long- lasting effect on markers of beta-cell
autoimmunity, they  suggest.

 

24.%%ADA  Your Dentist May Be First to Notice Signs of DM  1-11-10   Regular
dental visits may help people receive an early warning if they are at high
risk for DM.. "We've known for a long time that people with diabetes are
more susceptible to gum disease," team leader.  "And today evidence is
emerging that periodontal disease is associated with increased risk for DM
complications and may be associated with the development of T2.  More than
120 diseases can cause specific symptoms in and around the mouth and jaw, so
dental professionals can notice symptoms of serious health problems while
performing checkups.  Preventive checkups can help identify and intervene
early in dental-related diseases, potentially reducing associated pain and
financial costs.

 

25.%% ADA   Abuse in Childhood and Adolescence as a Predictor of T2DM in
Adult Women 11/11/10   A new study sought to determine whether child abuse
previously associated with obesity, increases risk of T2. [68,000 women]
Mild physical abuse was not associated with DM risk in adulthood, but
moderate and severe physical abuse was associated with 26 to 54% higher
risks of DM.  Conclusion -moderate-to-severe physical & sexual abuse
-childhood and adolesc. have dose-response associations with risk of T2
among adult wome.

 

26.%% M Supervised Exercise Program Improves HbA1c Levels in DM Patients
11/11/10 This program, a twice-weekly, 75 min facility-based regimen that
included aerobics, resistance training, and counseling was significantly
better at improving HbA 1c  levels and CV risk than a treatment regimen that
only counseled physical activity. [606 pts]  those in the program had  lower
HbA 1c  levels--a significant 0.30% difference between the 2 groups at 12
months--as well as improved markers of CV risk, such as LDL- and
HDL-cholesterol levels.

 

27.%% M 11/5/10 Insulin Analogs: The Role of Continuous Subcutaneous Insulin
Infusion (CSII ) Pumps.. I don’t  know a lot of patients, whether T1 or T2
that sit there and say, okay, I’m going to eat in 30 min, I’ll take my
injection. The majority will take the injection with the meal or sometime
after. It helps if you use an analog-lispro, aspart, glulisine - because
there’s a more rapid action - a rapid rise & a quicker drop- reducing the
risk of hypoglycemia vs using regular human insulin. .Conclusion, insulin
analog therapy is a safe and effective way to go. It is not a convenience
item. Most of my prescriptions for insulin will be analog insulin, either
multi-dose insulin, anywhere from 2 to 4 or 5 injections a day based on the
pt’s need vs using an analog insulin pump. Obviously, the cost of the pump
is more than that of injectable insulin. But the most important point I can
make is, if you’re going to put somebody on an insulin pump, make sure they
know how to carb count, at least have some working knowledge.  Do it first
with injectable insulin. Then make sure they never forget it, particularly
if they’re traveling and their pump is not functioning properly. Dr.
Roberts, Lebovitz & Peters. ..

 

28.%% M Aspirin for Primary Prevention in Diabetes11/10/10;  this metabolic
disorder is the 7th leading cause of death, with mortality occurring at a
rate nearly twice that of people without the disease.  Mortality is
attributed to macrovascular complications such as peripheral vascular
disease,  (CVD), & stroke. Conclusion - Low-dose aspirin is no longer
advocated as primary prevention for all pts  40 & older with DM. Low-dose
aspirin is now recommended for pts with an increased CV risk, including men
over 50 and women over 60 years with at least one additional major risk
factor.

 

29.%% M Genetic Basis for End-Stage Renal Disease (ESRD)in T2 11/4/10  ..
differing races vary significantly in their level for risk for kidney
disease. [1338 pts T2 Chinese] the team focused on protein kinase C-beta a
molecule involved in cell signaling implicated in the vascular complications
of DM. Adjusting for usual  factors that predict development of ESRD
(includes: duration of DM, BP, A1c, glomer.. filtration rate), 2 alleles
were  strongly associated with an increased risk for ESRD.. it is reasonable
to look to PKC-beta in the pathogenesis of DM kidney disease & for an
inhibitor of PKC-beta to play a potential therapeutic role.

 

30.%% JH The Eye-Heart Connection  20 + years ago, the Framingham Heart &
Eye Study uncovered an association between DM retinopathy [DR] and CV
diseases, including coronary heart disease and stroke. . A team recently
reported a strong association between DR & the amount of calcium in the
coronary arteries.  Calcium levels are a reliable marker for
atherosclerosis, which can lead to stroke, heart attack, and, yes, eye
problems. Atherosclerosis is the hardening and narrowing of arteries from
plaque, a buildup on blood vessel walls of cholesterol but also of calcium
and other substances. [204 pts with T2; CT scan] those with proliferative DR
(the dangerous growth of new blood vessels on the back of the vitreous
humor) were 6 times more likely to have coronary artery calcium (CAC) levels
over 400 -- a score that places them at risk for heart disease -- than
people who didn't have the condition.  team also found that when they
accounted for other risk factors for heart disease, [includes] age,
smoking, high BP, the assoc between DR and calcium levels persisted.  these
findings suggest that increased CAC levels are an independent risk factor
for DR and that both may be caused by the same underlying pathology. 

 

31.%% Am J Ophth vol 150;6 Dec 2010   Retinal Thickness in the Offspring of
Diabetic Pregnancies  Purpose - To compare macular and  retinal nerve fiber
layer thickness in children from diabetic compared with nondiabetic
pregnancy. [2367 age 11-14] Conclusion - Diabetes during pregnancy is
associated with changes in retinal [structure] in the offspring. Thinning of
the pericentral [around the macula]  macular parameters was evident . These
findings suggest the possibility that maternal DM impacts on the development
of the retina.

 

32.%%  Stem Cell-Based Therapeutic Applications in Retinal Degenerative
Diseases  Springer Science + Business Media, 9/22/10  Abstract - Retinal
degenerative diseases that target photoreceptors or the adjacent retinal
pigment epithelium (RPE) affect millions of people worldwide. Retinal
degeneration (RD) is found in many different forms of retinal diseases
including (RP), (AMD), diabetic retinopathy, cataracts, and glaucoma.
Gene-replacement Rx has been shown to improve visual function in inherited
retinal disease. However, this treatment was less effective with advanced
disease. Stem cell-based therapy is being pursued as a potential alternative
approach in the treatment of retinal degenerative diseases. In this review,
we will focus on stem cell- based therapies in the pipeline and summarize
progress in treatment of retinal degenerative disease. ..

 

33.%% DM Drug Benfluorex Linked to Thousands of Hospitalizations, Hundreds
of Deaths for Valvular Disease 11/19/10 Benfluorex (Médiator, Servier), also
used off-label for the treatment of obesity in the few countries where it is
approved, likely caused 500 deaths & ..3500 hospitalizations for valvular
heart disease in France since 1979,  French nat health-insurance
organization CNAM.. Heartwire 

 

34.%% M Some Alcohol Use Reduces Diabetes, Mortality After Kidney Transplant
11/22/10 [600 kidney transplant recipients;fup 7yr] pts who had moderate
alcohol intake were 44% less likely to die than those who consumed more or
less alcohol, and they were as much as 67% less likely to develop DM.

 

35.%% Diastolic BP Less Than 70 mm Hg in DM Linked to Increased CV Risk
11/22/10 Diastolic (BP) less than 70 in pts with T2 linked to increased CV
risk, even when systolic BP is in recommended  ranges, [1791 pts]"Increased
risk of CVD events with SBP=140 mmHg emphasizes the urgency for treatment of
systolic hypertension," the study authors write. The results emphasize that
DBP<70 mmHg in these patients was associated with elevated CVD risk and may
best be avoided."

 

36.%% N Rev Endo vol6;12 Nov 2010   retinal safety profile of insulin
glargine and human neutral protamine Hagedorn (NPH) insulin in pts with T2
[5 yr; pt with either no or non-proliferative retinopathy]   Conclusions
This study shows no evidence of a greater risk of the development or
progression of DR with insulin glargine vs NPH insulin treatment in patients
with T2

 

37.%% NREndo 6;12 Nov 2010 Epigenetic phenomena linked to DM  complications
Environmental factors, such as diet and exposure to hyperglycemia,
contribute to the etiology of DM and its associated micro & macrovascular
complications which are the main cause of the [sickness and death] burden of
DM. Studies suggest that early exposure to hyperglycemia predisposes
individuals to development of DM complications, a phenomenon referred to as
metabolic memory. Interestingly, transient exposure to hyperglycemia results
in long-lasting changes in gene expression..[definition= Epigenetics  refers
to modifications in gene expression  that are controlled by heritable but
potentially reversible changes in DNA..]

 

38.%%"Compelling Evidence" Supports Bidirectional Depression- DM
Relationship 11/23/10 The relationship between depression and diabetes
appears to be bidirectional, suggesting DM increases the risk for depression
& vice versa, [Nurses Health Study] showed women with depression were 17%
more likely to develop DM;  those who were taking antidepressants had a 25%
higher risk compared with their counterparts without depression. .women with
DM were 29% more likely to develop depression.  Women who took insulin had a
53% higher risk than women without DM. All associations were independent of
sociodemographic, diet, and lifestyle factors.

 

39.%% JH Two Common Diabetes Diet Myths Exposed - Diabetes Myth 1: "Eating
too much sugar causes diabetes." This is probably the most common myth
regarding DM and diet, and it's easy to see why some people fall for this
fallacy. Because DM causes blood glucose, or sugar, to rise too high, many
people make the assumption that eating too many sugary foods must then cause
DM. . eating too much sugar has nothing to do with causing T1 – it is
entirely due to destruction of the insulin-producing cells in the pancreas
by the immune system. T2 is caused by a combination of insulin resistance &
inadequate insulin production. While eating too many sugary foods may be a
contributing factor, that's only because consuming too much of any food type
-- whether chocolate bars or cheeseburgers -- can make you gain weight. And
research clearly shows that obesity increases the risk of insulin resistance
and T2.

Diabetes Myth 2: "Fructose is a 'safe' sweetener because it doesn't elevate
glucose levels." Like many diet myths, this one contains a kernel of truth.
Fructose is a simple sugar naturally found in many foods like fruits,
vegetables, and honey. Fructose is also sold as a sweetener in health food
stores and on the Internet; it is low on the glycemic index, meaning that it
does not cause as great a rise in blood glucose as table sugar (sucrose) or
glucose. For that reason, some doctors used to advise pts with DM to choose
foods sweetened with fructose .But  the benefits of swapping table sugar for
fructose are controversial, because some studies show that a diet high in
fructose can raise levels of artery-clogging fats called triglycerides. For
this reason, the ADA advises against using fructose as a sweetener but says
that there's no need to avoid the naturally occurring fructose in fruits,
vegetables, and honey.

 

40.%% M Dialysis 6 Times a Wk Associated With Lower CV  Mortality 11/22/10
[[378pt;3-yr trial]  results do not suggest that all hemo- dialysis patients
can benefit from a regimen of treatment 6 days/wk  but they do provide
evidence of increased CV vitality for those who do. Measurements were
significantly better with daily dialysis."   left ventricle mass [of heart]
decreased by 13.8% in pts who underwent dialysis 6 x/wk instead of the
normal 3. The team cites a number of serious health complications associated
with hemodialysis that need to be addressed; including those related to
heart disease, anemia,  bone disease, poor nutrition, inflammation, and
impaired cognitive & physical function. "You have to factor in the burden of
additional sessions, the travel, and the cost,"   editorial U of Missouri,
"This randomized, controlled trial, which took a decade to complete, did
show that frequent dialysis was better with respect to control of
hypertension and control of hyperphosphatemia."Whether the more frequent
vascular-access and clotting issues would be increasingly problematic over
time is not known, Whether patients would do even better at home is also
unclear." Renal Week 2010: Am Society of Nephrology 43rd Annual Meeting.

 

41.%% Diabetes Mellitus and Increased Risk of Cancer: Focus on Metformin and
the Insulin  Analogs 11/18/10  Conclusion - T2 does seem to be linked to a
variety of cancers including breast, hepatic, colorectal, and pancreatic
cancer. The proposed mechanism of action includes hyperinsulinemia and the
effects that insulin has to promote survival and progression of early
malignant cells.. The data regarding cancer risk and antidiabetic drugs are
contradictory and at this time inconclusive. There does seem to be a
decreased risk of cancer in patients treated with metformin. Use of insulin
analogs [ie glargine (Lantus)] overall does not seem to increase cancer risk
any more than the use of human insulin. Until long-term, randomized,
prospective studies are available to elucidate a correlation with cancer and
insulin, it is important to continue treating DM with insulin analogs in
order to avert the long- term complications of the disease.

 Pharmacotherapy. 2010;30(11)

 

   Abbreviations: fup-follow up; pt - patients;  DM - diabetes Mellitus;
T1DM - type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema;
GDM -gestational diabetes; PDR - proliferative diabetic retinopathy; alleles
-one of 2 or more alternate forms of a gene;  FPG - fasting plasma glucose;
BP - blood pressure; CVD - cardio-vascular disease; MI -myocardial
infarction/ heart attack ;HTN - hypertension or high BP; OCT - optical
coherence tomography; BCVA - best corrected  visual acuity ;ADA - Am Diab
Ass & ADA Professional; JH- Johns Hopkins Alerts ; M- Medscape Web MD; NIH -
Nat Instit Health;  MTD- Medical News Today;  Definitions via online Medical
dictionaries.  Disclaimer, I am a BSN RN but not a diabetic or diabetic
educator. Reports are excerpted unless otherwise noted. [translations,
explanations by thl] 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; an affiliate of the Stanford
Hospital Health Library.   contact above e-mail or thl at vistacenter.org     

            

 

 

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20101207/ff6f85c9/attachment-0001.htm>