[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1.%%  MW Serum Selenium Concentrations and Diabetes in U.S.
Adults:1/26/2010; Environmental Health Perspectives. 2009;117(9) Background:
Increasing evidence

suggests that high selenium levels are associated with diabetes and other
cardiometabolic risk factors.

[917 adults].. Conclusions:  In U.S. adults, high serum selenium
concentrations were associated with higher prevalence of diabetes and higher
fasting plasma

glucose and glycosylated hemoglobin levels. Given high selenium intake in
the U.S. population, further research is needed to determine the role of
excess

selenium levels in the development or the progression of diabetes.

 

2.%% Medscape Cardiology- Blood Pressure Targets, Global Risk Factors, and
Diabetes -- the Latest Data Are not Encouraging

1/25/2010  Hypertension is the number 1 risk factor for premature death
worldwide, according to a new report from the World Health Organization
(WHO).

Furthermore, cardiovascular and cerebrovascular diseases are the 2 leading
causes of death.

The importance of controlling blood pressure is underscored by several new
studies. US researchers have found that although

patients are controlling their blood glucose levels, they are significantly
less likely to be treating or controlling their BP or cholesterol - clinical

trial evidence suggests that this is backwards as a healthcare approach. ..

 

3.%%Medscape Diabetes & Endocrinology  Preventing Diabetes With Lifestyle
Interventions and Medication  1/28/2010  10-Year Follow-up of Diabetes
Incidence

and Weight Loss in the Diabetes Prevention

Program Outcomes Study (DPP)Lancet. 2009;374   Study Summary

(DPP), a randomized clinical trial, demonstrated that intensive lifestyle
intervention or metformin prevented or delayed development

of T2DM in high-risk adults compared with placebo. The current article is
the first report  (DPPOS), a long-term follow-up of the DPP designed to
determine

whether the delay in DM can be sustained.

The delay in median time to DM diagnosis was estimated from DPP

results to be 11 years for the lifestyle group and 3 years for the metformin
group. However, the current study estimated the delay to be about 4 years

by lifestyle intervention and 2 years by metformin. Viewpoint- The main
finding of this study -- that the prevention or delay of DM with lifestyle
intervention

or metformin can persist for at least 10 years -- is indeed good news. It is
also important to note that the metformin group experienced a lower
incidence

rate during the DPPOS than the DPP. This finding suggests that adding modest
lifestyle change to metformin may enhance the drug’s effect.

Not all the news was good, however. What remains to be seen is whether
lifestyle or metformin intervention reduces the debilitating (and costly)
microvascular

and macrovascular complications associated with diabetes. ..

 

4.%% Meeting American Diabetes Association Targets May Prevent Nephropathy
(Reuters Health) Jan 29 - Patients with T1DMwho achieve physiologictargets

(ADA) have a lower incidence

of microalbuminuria -  a powerful risk factor for diabetic nephropathy, the
leading cause of end-stage renal disease worldwide."Our findings suggest
that

(multifactorial) intervention can be used at the very

early stages of diabetic renal disease and that such early intensive
multiple interventions can reduce the risk of diabetic nephropathy," the
researchers

write. [1290 patients] All patients participated in a strict intervention
program -- including nutritional plans, physical activity and
cholesterol-lowering

medication -- designed to meet

ADA target levels for BP, glucose, cholesterol and triglycerides.

The ADA targets were as follows: - Hemoglobin A1c < 7%

- Systolic BP < 130 mmHg - Diastolic BP < 80 mmHg

- Low density lipoprotein cholesterol < 100 mg/dL - Triglycerides < 150
mg/dL - High density lipoprotein cholesterol > 40 mg/dL in men and > 50
mg/dL in

women. In addition, the ADA recommends exercise at least 5 days per week,
for a total of at least 150 minutes.

Arch Intern Med 2010;170

 

5.%%Heartwire - New UK Data Support ACCORD Findings, Emphasize Need for
Individualization of Blood Glucose Control 2/3/10 — A new retrospective
cohort

study in T2 patients found that the lowest and highest glycated hemoglobin
A1c (HbA1c) levels were associated with increased all-cause mortality and
cardiac

events.  the lowest death and lowest event rates were seen at an HbA1c level
of 7.5%, says the team.: "The primary message is that overintensification

of blood glucose control, certainly in some patients, may be detrimental in
terms of outcome and may be associated with an adverse risk of mortality.
That

said, poor blood glucose control in the analysis--which

is based on real-life data--is also associated with adverse outcomes, so the
take-home message is that we should individualize therapy. 

 

6.%%MW 2/2/10 (Reuters Health) - Omega-3 fatty acid supplements have a
beneficial vascular effect in T2DM  improving both large and small vessel
function.

[34 patients - 2 gm of purified EPA/DHA or olive oil placebo daily for 6
weeks.] "Our study shows that highly purified omega 3 fatty acids" can
prevent

"postprandial vascular dysfunction at the level of macrocirculation and
improve postprandial vascular

function of the microcirculation, An anti-atherosclerotic effect is
suggested, but has to be proven by large interventional studies."

Am J Clin Nutr 2010.

 

7.%% JHA  Looking Out for Number One: Diabetes & Cardiovascular Coronary
heart disease and stroke -- the two predominant types of cardiovascular
disease

[CVD ] -- claim the lives of almost two thirds of people with DM-- 2-4 times
higher than the rate in the general population. In fact, as many as 80% of

people with T2 develop macrovascular disease, defined as narrowing and/or
blockages in large arteries which can lead to angina (chest pain), heart
attacks,

strokes, aortic aneurysms, and peripheral arterial disease (poor blood flow
to the legs and feet). In addition, nearly half of people with DM over age

65 develop heart failure, a life-threatening condition that occurs when the
heart muscle weakens and can no longer pump enough blood to meet the body's

needs.  Why is CVD so common in people with diabetes? To begin with, people
with DM typically have other major risk factors for heart and blood vessel

trouble, such as obesity and hypertension. In addition, they also often have
elevated triglycerides that can cause larger amounts of an aggressive form

of low-density lipoprotein (LDL, or "bad") cholesterol -- that is, small,
dense particles that are more likely to form plaques that clog arteries and
cut

off blood flow to the heart.

What's more, excessive insulin levels characteristic of DM not only raise
triglycerides but also lower beneficial high-density lipoprotein (HDL)
cholesterol,

further promoting plaque formation. Another possible factor may be that high
blood glucose levels can injure the inner artery wall..eventually leading

to plaque deposits that reduce blood flow and can cause a heart attack or
stroke. And finally, DM also increases the risk of blood clot formation.
Taking

steps to control your BP, cholesterol, and other risk factors is the first
line for maintaining a healthy heart and blood vessels. The evidence is
overwhelming

that lowering blood pressure and cholesterol as well as quitting smoking can
reduce the incidence of CVD in diabetics. If you have dm, you should keep

your BP below 130/80 mm Hg --

that's lower than the 140/90 mm Hg or less recommended for the general
population.. the best drugs to accomplish this are an ACE inhibitor or
angiotensin

II receptor blocker and a diuretic. Keeping your BP from rising will also
help ward off other DM complications, such as vision loss and kidney
failure.  

Your doctor will want to see your LDL cholesterol at least below 100 mg/dL
and possibly below 70 mg/dL. You should also try to maintain triglyceride
levels

below 150 mg/dL and to boost HDL cholesterol. Statin drugs are the most
effective medications for controlling total and LDL cholesterol. Anyone with
diabetes

over age 40 should consider taking a daily aspirin which prevents clumping
of  platelets in the blood from forming clots that can block blood flow to
the

heart or the brain. Protecting yourself against cardiovascular disease also
requires keeping your blood glucose levels in balance. The ADA recommends
maintaining

HbA1c levels of less than 7%, which is equivalent to an average blood
glucose level of about 170 mg/dL or less.

 

8.%% Nature Medicine 15, 2009  A crucial role for adipose tissue p53 in the
regulation of insulin resistance   Here we show that p53 expression in
adipose

[fat] tissue is crucially involved in the development of insulin resistance,
which underlies age-related cardiovascular and metabolic disorders. We found

that excessive calorie intake led to the accumulation of oxidative stress in
the adipose tissue of mice with T2–like disease and promoted senescence-like

changes,  [includes] expression of p53 and increased production of
proinflammatory cytokines. Inhibition of p53 activity in adipose tissue
markedly ameliorated

these changes, and improved insulin resistance in mice with T2–like disease.
Adipose tissue from individuals with diabetes also showed senescence-like

features.

 

9.%% Nature Med 15(2009) Genetic deficiency and pharmacological
stabilization of mast cells reduce diet-induced obesity and diabetes in mice
Although

mast cell functions have classically been related to allergic responses
...This study presents evidence that mast cells also contribute to
diet-induced

obesity and DM. For example, white adipose tissue (WAT) from obese humans
and mice contain more mast cells than WAT from their lean counterparts. in
the

context of mice on a Western diet, genetically induced deficiency of mast
cells, or their pharmacological stabilization, reduces body weight gain and
levels

of inflammatory cytokines, chemokines and proteases in serum and WAT, in
concert with improved glucose homeostasis and energy expenditure.

 

10.%% ADA  Blindness Study Might Find Cure 2/2/10   Scientists have
completed research that may lead to a new type of treatment for diabetic
retinopathy,

by finding how cell death occurs in a high- glucose environment.  The enzyme
(GAPDH) moves from its cytosolic environment to the cell's nucleus to create

energy, when cell death occurs.  However, the team discovered the siah-1
protein, which can be manipulated to keep the cell from dying, reducing the
effects

of retinopathy.  They  are continuing their study of this process, hoping
that further discoveries on cell death will lead to better treatments for
diabetic

retinopathy.   published in  Journal of Biological Chemistry.

 

11.%% ADA Whole Grain Intake Prevents Diabetes, Heart Diseases, and Excess
Weight Gain 2/1/10  Although nat guidelines recommend 3 daily servings of
whole

grains to prevent T2DM, , coronary heart disease, and excess weight gain,
survey data shows  few adolescents and young adults follow them. [2478
subjects]

The team found that young people consume less than one serving of whole
gains per day 

[ eating 1  slice of dark bread; kasha, couscous, or bulgur; one small bag
of popcorn; one bowl of hot breakfast cereal;one bag of cold breakfast
cereal-

per day]. Home availability of whole grains was the only socio-environmental
factor involved in increased consumption.  

 

12.%%MNTD  Preventing Pancreatic Islet Loss After Transplantation

2 Feb10  Although transplantation of pancreatic islets is an attractive way
to treat T1DM, early islet loss soon after transplantation has limited its

clinical use. By studying islet transplantation in a mouse model of
diabetes, a team of researchers, has identified a potential new set of
targets to improve

the efficiency of pancreatic islet transplantation. . that the protein HMGB1
plays a crucial role in the initial events of early loss .. Of potential
clinical

significance, treatment with an antibody targeting HMGB1 prevented early
pancreatic islet loss and inhibited IFN-gamma production.. These data
provide

several potential drug targets for improving the efficiency of

pancreatic islet transplantation in humans.

 

13.%% MNTD Increased Risk Of Kidney Failure, Blindness, Heart Attack And
Stroke In Depressed Diabetes Patients 29 Jan 10

Depression raises risks of advanced and severe complications from DM
including kidney failure or blindness, the result of small vessel

damage, as well as major vessel problems leading to heart attack or stroke.
[3723 T2 subjects; followed over 5 yr] major depression was associated with

a 36% higher risk of developing advanced micro- vascular complications
[end-stage kidney disease or blindness] and a 25% risk of developing
advanced macrovascular

complications, such as stroke or myocardial infarction (heart attack from a
blood clot), compared with DM patients without depression. As in earlier
reports,

the DM patients with major depression tended to be slightly younger,
heavier, have more co-existing medical conditions, and were more likely to
be treated

with insulin than were diabetes patients without depression. They also had
higher levels of a substance in the blood formed when the sugar glucose
attaches

to hemoglobin, an oxygen-carrying protein.. People with depression are prone
to DM and vice versa. Impairment from DM, such as blindness interferes with

a person's daily life and can be overwhelming. Further research is needed,
the authors added, to clarify the underlying biological mechanism for the
association

between depression and complications of DM, and to test interventions.

 

14.%% MNTD Beta Cells Need Key Protein To Divide And Conquer Diabetes  27
Jan 2010 [Mice study] Researchers have identified a

cell-cycle protein - cyclin D2 --that is essential for beta-cell replication
to respond successfully to insulin resistance. The finding may point toward

eventual therapies for preventing T2. Cyclin D2 is a member of a small
family of proteins that aid in the cell cycle, by which cells divide into
two."Beta-cell

replication occurs naturally in diet-induced obesity and in pregnancy, so
this process gives us a target for therapy," they will look for its analog
in

humans.

 

15.%% MW In Diabetics, Revascularization More Likely After PCI Vs CABG
(Reuters Health) Feb 03 - For patients with diabetes and complex multivessel
coronary

artery disease, the risk of repeat vascularization within one year is
elevated 3-fold after percutaneous coronary intervention (PCI) compared with
surgery.Otherwise,

rates of serious outcomes at 12 months in diabetic patients were similar

after coronary artery bypass grafting (CABG) and PCI with the Taxus Express
paclitaxel-eluting stents. The SYNTAX study was the first to compare CABG
and

PCI with Taxus for complex left main and/or 3-vessel disease in both
diabetic and nondiabetic patients.[1800 patients] The researchers note that
aggressive

progression of diffuse disease in diabetics is likely to have a greater
impact in the stented cohort versus the CABG group, in which distal grafts
minimize

disease progression in upstream proximal vessels. They caution, however,
that due to the complexity of participants' coronary artery

disease, these results should not be generalized to all patients with DM.
Also, these results are early, with follow-up planned for 5 years.

 

16.%% MW ADA Offers 3 new Diabetes Treatment Recommendations

NOTE: Commentator, Dr. Anne L. Peters, states that the following is more of
a suggestion for change as opposed to a recommendation.

The following recommendations for treatment can be found in the ADA  2010
guidelines for  Treatment of Diabetes.

 Gestational Diabetes: 1. Lower blood glucose values have shown to have a
better outcome for the pregnancy.   2. A better job needs to be done to
identify

patients with Hyperglycemia.  3. The (International Association for Diabetes
Pregnancy Study Group stated the following recommendation:  a) Targets to

be lower (glucose values)  b) All women who are pregnant should have a 75
gram Oral Glucose

Tolerance Test between 24 -28 weeks of pregnancy. (previous recommendation
was  testing at 2 months)

   Use of Aspirin in Diabetic patients 1. Recent data cast doubt on benefits
of the use of aspirin in younger patients at less risk and not used as part

of primary prevention.  2. Recommendation is as follows with the use of
aspirin:  a)  Look at 10 year risk of cardiovascular [CV] disease b) If risk
higher

than 10% : use of aspirin @ 75 - 162 mgs

per day is recommended    c)  Most men 50 or older and women 60 or older
with one CV risk factor (eg. hypertension, dislipodemia, family history of
CV

disease) should be on an aspirin regimen as a primary prevention of a
cardiovascular event.    d)  Men less than 50 and women less than 60 may not
benefit

from this regimen. The patients full CV risk profile should be looked at.
e)  Those patients who have had a CV event should use aspirin as secondary
prevention.

  Hospitalized Diabetic Patient Recommendations 1. Patients who have
sustained  hyperglycemia above a blood glucose level of 180 mg per dL while
critically

ill,  to be given insulin. 2. In most cases, this will be insulin given
through an IV insulin infusion if patient is in the ICU or CCU.  3. IV
insulin

infusion as been proved to be safe and effective.  4. Target range of blood
glucose level between 140 - 180

 5. Critically ill patients NOT in ICU should be treated basically normal
with real emphasis given to  preventing hyperglycemia  6. Final note on
hospitalized

patients:  a) Frankly, we don't have a lot of data on the "at risk" and
benefits of control in the subset of hospital patients.  b) Targets remain
standard.

Keeping the fasting blood glucose level below 140,  postprandial 180 and
avoiding blood glucose levels below 100.  Medscape Diabetes & Endocrinology
1/22/2010

 

17.%% MW  How Often to Measure Blood Glucose? 2/01/2010

Question  How frequently and at what times should BG be monitored?

The Amer Asso of Diabetes Educators recommends that all patients should be
encouraged to self-monitor blood glucose (BG), regardless of whether they
are

being treated with insulin or oral agents. The ADA

recommends that patients with T2DM who are taking multiple insulin
injections should monitor BG at least 3 times per day, but they also note
that the optimum

frequency for self-monitoring is not clear

for patients taking oral drugs or less frequent insulin injections. 

Others have suggested that patients taking insulin should  self- monitor BG
at least 4 times a day, before meals and bedtime; and that patients with T2

should check their BG at least 4 times per week (twice fasting and twice
after meals).

 

18. %% Closed-Loop "Artificial Pancreas" May Be Helpful in T1DM 2/4/10 — A
closed-loop "artificial pancreas" system may improve blood glucose control
in

children and adolescents with T1, according to the results of a phase 2,
randomized crossover trial. [19] patients Patients' standard pump settings
were

used during control nights, whereas during closed-loop nights, a control
algorithm calculated the rate of insulin infusion based on glucose
measurements

every 15min  and a nurse adjusted the insulin pump. Closed-loop delivery was
associated with increased time in the target range. "Closed-loop systems
could

reduce risk of nocturnal hypoglycaemia in children and adolescents with T1.
Advancements in glucose- sensing technologies could further improve
performance

of closed-loop systems. Fully automated closed-loop delivery will need
wireless data transmission to replace manual control of the pump by nurses,"
the

team adds.. the absence of any sensor or pump failure during the trials
allows realistic extrapolation towards a home environment,"  "Starting with
overnight

control before addressing control at meal times and during various
activities is the most rational way forward. Lancet. Published online
February 5, 2010.

 

19.%% Faculty of 1000 Medicine - Impact of Untreated Obstructive Sleep Apnea
on Glucose Control in Type 2 Diabetes. 2/01/2010; Patients with T2DM should

undergo screening for obstructive sleep apnea (OSA) and polysomnography if
evidence of OSA is found. At least 80%, if properly screened and studied,
will

have OSA, which is a treatable condition. Treating OSA might improve
glycemic control.

This study evaluated the potential impact of untreated OSA on hemoglobin A1c
(HbA1c) in T2 [60 patients]  Increasing severity of OSA was associated with

worse glucose control..elevations in HbA1c appeared clinically important, in
that patients with severe OSA had adjusted HbA1c values of nearly 9.5% as

compared with patients without OSA (HbA1c < 6%).studies will be needed to
investigate whether CPAP therapy improves glycemic control.

 

20.%% MW Intensive Glucose-lowering Therapy—Weighing Up the Evidence
1/29/2010; Nat Rev Endocrinol. 2010;6(1):9  In conclusion, the study by
Lingvay and

colleagues is a small trial of relatively short duration that shows insulin
therapy to be a safe and effective treatment for newly diagnosed T2 and
comparable

to triple oral therapy. Follow-up of current outcome studies should answer
some

of the important questions on intensive therapies and glycemic control that
remain. How early should we treat? Which agents should we use? Which
patients

should be targeted? Is ß-cell function preserved by early intensive
treatment? Until these issues have

been elucidated, insulin should remain an alternative option rather than the
preferred first-line treatment in the management of newly diagnosed T2DM.

 

21.%% MNTD  Amer Asso Of Clinical Endocrinologists Approves New Diagnosis
For Diabetes 3 Feb 2010  The (AACE) has approved the use

of A1c as an additional diagnostic criterion for T2DM. An A1c of 6.5 or

greater is now considered an alternate criterion for the diagnosis of T2.
A1c is a test that is used to determine the average level of blood glucose
over

a prior 3e month period. It is currently used to measure glucose control in
patients already diagnosed with diabetes. The test requires a single blood

draw, and the results can be available the same day.  The most common
criteria currently used to diagnose diabetes are a fasting glucose of 126 or
greater

or a 2 hour value on a glucose tolerance test (GTT) greater than 200. Both
tests require patients to fast for a minimum of eight hours prior to being
tested.

 

 

22.%% MW-  Mediterranean Diet Reduces Cerebrovascular Disease 2/9/10—
Magnetic resonance images (MRIs) have confirmed that the Mediterranean diet
[Mdiet]decreases

cerebrovascular disease. Investigators suggest this reduced risk may also
lessen cognitive decline later in life. "The impact of the Mdiet on
cognition

may be partially mediated by brain infarction," said the lead
investigator.[700 subjects; 5yr data; divided into 3 groups — low, moderate,
and high adherence

to the M diet  Compared with participants in the low adherence group, those
in the moderate group had a 21% reduced risk of having an infarct.
Participants

in the highest adherence group had the lowest rate, a 36% reduction vs those
with low adherence to the diet. Editorial comment -  "Imaging studies in a

population-based study is a great strength, The results reinforce the notion
that a healthy lifestyle protects the brain and the heart."  Paper to be
presented

in April 2010 at the Amer Acad Neurology meeting.

 

23.%%  Childhood Obesity and Glucose Intolerance Linked With Premature Death
2/10/10 – Obesity, glucose intolerance, and hypertension in childhood are

strongly linked with premature death from endogenous causes in young
adulthood and middle age, according to the results of a new epidemiological
study

in a cohort of Amer Indian children "obesity is probably the primary
metabolic derangement that causes hyperglycemia and high BP,” the lead
investigator

said. The purpose of this study was to study the effect of childhood risk
factors for cardiovascular disease on adult mortality. [4857 children
non-diabetic]

The take-home message from this is that having a threshold for high glucose
and saying that we're only going to intervene when it is above that
threshold

might not be good enough." 

 

- Abbreviations:  DM - diabetes Mellitus;T1DM - type 1 diabetes mellitus
T2DM - type 2; DME - diabetic macular edema; GDM gestational diabetes; FPG -
fasting

plasma glucose BP - blood pressure; CVD - cardio-vascular disease; MI
-myocardial infarction or heart attack ;HTN - hypertension or high BP; OCT -
optical

coherence tomography; VA - visual acuity  -ADA - Amer Diabetes Ass & ADA
Professional Resource Online; FDA Federal Drug Adm. JHA - Johns Hopkins
Alerts

; MW Medscape Web MD; NIH - National Institutes of Health;  MNTD- 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. 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     

            

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