[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1.%%  nature.com Nature Reviews Endocrinology 6, 2 (January 2010) |

A Mediterranean diet [Med-diet] is best for T2DM. In comparison with a
low-fat diet, a Med-style, low-carbohydrate diet delays the need for
antihyperglycemic

drug therapy in overweight patients with T2. The randomized trial also shows
that the Med- diet provides additional benefits in terms of glycemic control

and coronary risk.  The team  randomly allocated 215 overweight individuals
with newly diagnosed

T2 who had never received antihyperglycemia drugs to one of two diets for 4
years: a low-fat diet or  low-carbohydrate, Med- diet which is characterized

by high consumption of foods such as whole grains, vegetables and olive oil.
Need for antihyperglycemic drug therapy differed significantly between the

2 groups. At the end of the trial, 70% of the low-fat diet group required
this therapy whereas only 44% of the patients in the Med- diet group did.
Both

groups increased their physical activity level and decreased caloric intake
to the same extent; therefore, the team suggests that the benefit of the
Med-diet

might stem from early, increased weight loss and the consumption of
monounsaturated fatty acids (which are believed to increase insulin
sensitivity) in

this group.

 

2.%% Nat Reviews Endo 6, 3 (January 2010)  Novel T2DM risk locus near IRS1
is associated with insulin resistance and hyperinsulinemia  A genome-wide
association

study has identified a new genetic variant associated with (T2DM) located
next to the insulin receptor substrate 1(IRS1) gene. [a genome scan of
16,273

single nucleotide polymorphisms (SNPs) in 4977 subjects]  IRS1, is
associated with insulin resistance as well as an increase in pancreatic
insulin secretion.

“These characteristics distinguish it from the other T2 risk loci identified
to date that have been associated with decreased pancreatic ß-cell
function,”

says the team.“ it would be interesting to do long-term outcome studies to
investigate if IRS1  variant carriers have a higher risk of cardiovascular
events,”

 

 

3.%% Nat Rev Endo 6, 8 (January 2010) |Long-term effects of oral
antidiabetic agents on C-reactive protein levels.  A study that compared
efficacy and

safety of oral antidiabetic agents in patients

with newly diagnosed T2 has shown that rosiglitazone reduces

levels of C-reactive protein—a systemic marker of inflammation and risk
factor for cardiovascular disease—faster and more prominently than
glibenclamide

or metformin over a period of 4 years. [904 drug- naive T2 patients] Levels
of C-reactive protein were comparable between all3 groups at baseline and
correlated

with BMI, waist circumference and insulin resistance. Over the treatment
period, concentrations of C-reactive protein decreased most in the
rosiglitazone

group and least in the group treated with glibenclamide. In the long term,
patients who received rosiglitazone gained significantly more weight, but
showed

greater improvement of insulin resistance, independent of changes in
C-reactive protein levels from baseline to 1 year, compared with the other
two treatment

groups.

 

4.%% Nat Rev Endo 6, (January 2010)| Residual microvascular risk in DM:
unmet needs and future directions  Abstract- The burden of microvascular
disease

in patients with T2 continues to escalate worldwide. Current standards of
care reduce but do not eliminate the

risk of diabetic retinopathy, nephropathy or neuropathy in these patients.
Correction of atherogenic dyslipidemia, which is characterized by elevated
triglyceride

levels and low levels of HDL cholesterol, might provide additional benefit.
Whereas promising

data have been published with respect to fibrate therapy for maculopathy,
fenofibrate for diabetic retinopathy, and statin or fibrate therapy for
diabetic

nephropathy, further studies are warranted to define optimal management
strategies for reducing the residual microvascular risk. Such strategies are
especially

relevant in cases

of diabetic peripheral neuropathy, where even optimal care fails to affect
disease progression.

 

5.%% Nat Rev Endo 6, (January 2010) | Hereditary hemochromatosis and
diabetes mellitus: implications for clinical practice

Abstract - Hereditary hemochromatosis (HH) is a genetic condition that can
lead to unregulated absorption of iron from the gut with resultant iron
overload.

Untreated, iron overload can lead to considerable morbidity including liver
cirrhosis, arthritis and diabetes mellitus, and increased mortality. The
pathophysiology

of diabetes mellitus in HH is thought to be due primarily to defects in the
early insulin response to glucose. An  mouse model of HH has demonstrated
defects

in ß-cell function and ß-cell apoptosis that may be mediated by increased
oxidative stress. Fortunately, these defects seem to be reversible if
phlebotomy

treatment is initiated before the development of cirrhosis or DM in
patients. Further research into the long-term effects of treatment on
prevention of

DM in HH is needed.

 

6.%% Nat Rev Endo 6, (January 2010) | Management of osteomyelitis of the
foot in diabetes mellitus  Abstract - Although osteomyelitis occurs in
approximately

10-20% of patients with DM-related foot ulcers, no widely accepted guideline
is available for its treatment. In particular, little consensus exists on

the place of surgery. A number of experts claim that early surgical excision
of all infected or necrotic bone is essential. Others suggest that surgery

should not be performed routinely, but instead only in patients who do not
respond to antibiotic treatment or in case of particular clinical
indications.

Unfortunately, no studies have directly compared the 2 approaches. Over 500
cases of conservative (that is, nonsurgical) management with resolution
rates

of 60-80% have been described previously. Most patients in these series,
however, received prolonged courses of

broad-spectrum antibiotics, which increase the risk of diarrhea caused by
Clostridium difficile  or the emergence of multidrug- resistant organisms.
By

contrast, relatively few series of primarily surgical management have been
published, with widely differing outcomes, and some of them also reported
high

recurrence rates. Further research is required to establish the relative
importance of each approach, but the available data clearly indicate that a
combined

assessment and treatment by surgeons and physicians together

is essential for many patients.

 

7.%%www.medscape.com Acrylamide Exposure Tied to Reduced Insulin Levels
(Reuters Health) Dec 15 - Exposure to acrylamide -- present in industrial
by-products,

cigarette smoke, and a variety of fried or baked foods - can reduce serum
levels of insulin, researchers report - As for the mechanism involved, the
authors

speculate that acrylamide may have a toxic effect on islet cells. [1356
participants]  "although the health impact due to this association and the
exact

mechanism are unknown, this finding reminds us to pay more attention to low
dose acrylamide exposure in daily life."

Diabetes Care 2009;32:

 

8.%% NYTimes 12/22/09 Fighting Diabetes With Lots of Espresso

Coffee and tea drinkers are less likely to develop T2DM  than nondrinkers,
with those drinking 3-4cups a day at a 25 % lower risk for the disease than

those who drink less than two cups, a large analysis  has found. It does not
matter whether the drinks are caffeinated or not. The analysis does not
prove

that drinking tea or coffee lowers the risk of the so-called adult-onset
diabetes , but it is not the first study to report such a link. And it goes
further

than other

studies, finding that for caffeinated coffee, risk dropped by 5 to 10% 

with each additional cup consumed, which the researchers say suggests a
causal relationship. Those drinking more than 6cups of coffee a day were at
40

% lower risk for T2 than nondrinkers. Some studies have indicated that
chemical components of tea and coffee may have beneficial effects on glucose
metabolism

and insulin sensitivity, but the evidence is mixed. “Caffeine can’t be the
answer, because you see the same sort of overall response from diabetes with

decaf as with caffeinated coffee,” said the paper’s senior author.

 

9.%% Heartwire  Quality of HDL Differs in Diabetics But Improves With Niacin
Therapy 12/22/09 — A small study published this week hints that the HDL
cholesterol

in individuals with diabetes has impaired endothelial protective functions
compared with the HDL from healthy subjects, although treatment with
extended-release

niacin  can improve these endothelial protective effects. The team writes
that because recent HDL-raising intervention studies have yielded mixed
results,

"circulating HDL-cholesterol levels alone likely do not represent an
adequate measure of therapeutic efficacy, .."We have to understand that we
can't look

only at the HDL levels in the plasma, but we need to look at the quality,"
he said. "The quality of the HDL is not the same in different patients. This

is very important for targeting HDL as a treatment. Second, niacin therapy
is a promising way not only to raise HDL but also to improve the quality..

 

10.%% MW Intravitreal Triamcinolone May Slow Diabetic Retinopathy
Progression 12/22/09  Intravitreal use of the corticosteroid triamcinolone
may slow the

progression of diabetic retinopathy, but adverse effects including cataract
formation and glaucoma may prevent use of this treatment merely to reduce
progression

of proliferative diabetic retinopathy (PDR). [840 eyes of participants

with diabetic macular edema [DME].At 2 years, the cumulative probability of
progression of retinopathy was 31% in the laser group, 29% in the 1-mg
group,

and 21% in the 4-mg group . "Given the exploratory nature of this analysis
and because intravitreal triamcinolone adverse effects include cataract
formation

and glaucoma, use of this treatment merely to reduce the rates of
progression of proliferative diabetic retinopathy or worsening of the level
of diabetic

retinopathy does not seem warranted at this time." Arch Ophthalmol.
2009;127:

 

11.%%Liraglutide Once Daily Provides Superior Glycemic Control to Exenatide
Twice Daily..12/17/09  independent reviewers commented that "The LEAD-6
trial

shows that liraglutide provides greater improvements in glycemic control and
is better tolerated than exenatide; therefore, this novel GLP-1 analogue
might

be a good option for the treatment of T2DM." [464 T2 patients] Liraglutide
led to greater reduction in HbA1c than exenatide Moreover, more patients
taking

liraglutide reached the ADA-recommended target HbA

1C  level of < 7% (54% vs 43%, respectively). Mean weight loss was similar
for the 2 groups. Hypoglycemia was rare with both treatments.

 

12.%% Poor Glucose Homeostasis in Childhood May Predict Adult Prediabetes
12/29/09  "T2DM is preceded by a pre-diabetic state linked to a relative
insulin

resistance associated with mild increases in blood glucose levels, despite
hyperinsulinemia," writes the team.

"A number of studies have indicated that hyperinsulinemia/insulin resistance
is associated with cardiometabolic risk factors including obesity,
dyslipidemia,

and hypertension, a constellation of disorders characteristic of the
metabolic syndrome. Previous findings have shown  that the elevations in
insulin and

glucose levels persist (track) over time in children and adults alike."
[1058 normoglycemic, 37 prediabetic, and 25 T2 adults; follow up 17yr]At
least

half of participants who were in the top quintile [fifth] of glucose
homeostasis variables in childhood were above the 60th percentile for these
variables

in adulthood. The best predictors of adulthood glucose homeostasis variables
were the change in body mass index (BMI) z-score from childhood to
adulthood,

followed by the corresponding childhood levels of glucose, insulin, and
HOMA-IR.

 

13.%% JH Health Alerts Preventing Hypo- or Hyperglycemia During Exercise
12/24/09 Everyone knows that regular physical activity is essential for good
health,

and research continues to prove that's especially true if you have diabetes.
An analysis of more than 100 studies involving nearly 10,500 participants

found that individuals with DM who were physically active had lower HbA1c
levels (the hemoglobin A1c test used to assess blood glucose control of the
previous

2-3months) than those who did not exercise. If you have DM and take insulin
or oral medication, you need to protect against

hypoglycemia (low glucose levels) while exercising. A less common problem is
hyperglycemia (high blood glucose) that may occur immediately after exercise

Here's how to avoid the lows:

Check your blood glucose level beforehand. If your glucose is between 100 &
130mg/dL and you have T2, it is safe to begin exercising. If glucose is
lower

than 100 mg/dL, have a carbohydrate snack such as a piece of fruit or
3graham crackers before starting. Do not exercise if your blood glucose
levels are

300 mg/dL or higher.

Always have a source of fast-acting carbohydrate (such as glucose tablets or
hard candies) with you when exercising. If you experience any symptoms of

hypoglycemia (such as faintness, palpitations, or weakness), test your blood
glucose levels immediately and have a snack if necessary. Since blood
glucose

levels can drop hours after exercise, test your levels immediately after
exercise and again a few hours later. As for hyperglycemia, people who take
insulin

-- especially those with T1DM -- are often surprised to find that their
glucose level actually rises after exercise. Almost always, this happens
when the

exercise is very vigorous. It is considered to be due to an "adrenaline
rush" that occurs with extreme exercise. It, too, can be followed some hours
later

by a blood glucose drop (hypoglycemia).

 

14.%% Heartwire Treatment to Low Glucose Targets Cuts CV Risk in Less-Sick
Diabetics: Cohort Study 12/17/09  — Addressing issues raised recently, to
much

controversy and debate, a prospective observational study in T2 diabetics
suggests that aggressive control

of glycated hemoglobin (HbA1c) levels--that is, to no higher than 6.5% or
7%--significantly improves cardiovascular risk over 5 years, but only in
patients

who aren't too old or sick at the outset . In the analysis of several
thousand patients from diabetes clinics and community practices, those who
started

out with a lot of comorbidity didn't show a decline in CV risk from
attaining such HbA 1c  levels; nor, on the other hand, was their CV risk any
worse.

Several randomized trials over the past decade,, have shaken traditional
diabetes management by suggesting no CV benefit or perhaps even heightened
CV

risk from treating to such low HbA1c targets.. But post hoc analyses of the
those studies and various meta-analyses have pointed to a more complex
picture,

in which such treatment may cut CV risk if it's started before diabetes is
well established and comorbidities are few, but perhaps not in longtime
diabetics

with manifest heart disease. These poor people, they're on six or seven
medications, many of them taking 25 or 30 pills a day. They're trying to eat
right

and get some exercise, with their arthritis or other conditions. . . . What
we're saying with this study is, Ease up a little

bit, they'll get just as much out of having an HbA 1c between 7 and 8.

"The trouble with post hoc analyses is that they're considered exploratory,"
observed the lead author of the current cohort study, in

which patients were prospectively stratified by comorbidity scores that
accounted for any coexisting vascular, lung, genitourinary, and
gastrointestinal

diseases; and arthritis, vision loss, and other conditions; each weighted
according to their clinical and functional impact. "Our study is much
stronger

and more quantitative..[3074 patients with T2]

 

15.%%Am J Ophth Volume 149,Issue 1 January 2010   The Vitreous Gel: More
than Meets the Eye  Results - A new understanding of the vitreous gel is
emerging,

placing it central to many disease processes affecting the eye, including
diabetic retinopathy, retinal vein occlusion, AMD, nuclear sclerotic
cataract,

and primary open-angle glaucoma. The vitreous gel recently has been found to
have the important function of oxygen regulation and distribution within the

eye. As the gel undergoes age-related liquefaction or surgical removal this
function is impaired. The resultant elevated intraocular oxygen tension
likely

proves beneficial for vascular endothelial growth factor–mediated retinal
diseases. However, it may lead to oxidative stress within the eye and may
contribute

to disease states such as nuclear cataract and primary open-angle glaucoma.

 

16.%% Am J Ophth Vol 149, issue 1 January 2010 Subthreshold Micropulse Diode
Laser Photocoagulation for Diabetic Macular Edema in Japanese Patients
Conclusions 

In patients with moderate diabetic ME, subthreshold micropulse diode laser
photocoagulation controls ME and maintains visual acuity with minimal
retinal

damage. 

 

17.%% MW  Insulin-based versus Triple Oral Therapy for Newly Diagnosed T2DM:
Which is Better?  12/23/2009; Diabetes Care. 2009;32(10) Abstract —Early use

of insulin after diagnosis of T2 is met with resistance because of
associated weight gain, hypoglycemia, and fear of decreased compliance and
quality of

life (QoL). [29 patients randomly assigned into each group,3-year study] At
study completion, A1C was 6.1 insulin group) versus 6.0 (oral group). Weight

increased similarly in both groups. Conclusions

—When compared with a clinically equivalent treatment regimen, insulin-based
therapy is effective and did not cause greater weight gain or hypoglycemia

nor decrease compliance, treatment satisfaction, or QoL. Insulin is safe,
well-accepted, and effective for

ongoing treatment of patients with newly diagnosed T2

 

18.%% MW Viewpoints Regaining Normal Glucose Function in Patients With
Prediabetes  12/22/09   Diabetes Care.  2009;32:

Study Summary The Diabetes Prevention Program (DPP) was a randomized
clinical trial involving 3234 volunteers at high risk for diabetes. .The
study discussed

here evaluated a subgroup of participants who also had impaired fasting
glucose (IFG), Viewpoint

No one would argue that preventing progression to diabetes is a worthwhile
pursuit. However, even in subdiabetic states of IFG and IGT, the
microvascular

and macrovascular complications generally associated with diabetes are more
common than in patients with NGR [normal glucose regulation]."true diabetes

prevention likely resides in the restoration of NGR rather than in the
maintenance of a high-risk state, such as pre-diabetes." Therefore, it is
encouraging

to note that nearly one quarter of the study participants achieved NGR
within the 3-year study window. Over half of those patients did so in the
first

year, so for the most part, those who succeed in having NGR restored will do
so relatively quickly. One important finding was that if NGR is to be
regained,

it will likely occur through healthy eating and exercise and that this
effect is probably independent of weight loss. However, it is important to
remember

that the DPP was a clinical trial of healthy

volunteers who received a structured intervention. Whether these findings
can translate to clinical practice needs further study.

 

19.%%  Reuters Health Information  Fake Sugar May Alter Glucagon- Like
Peptide 1 Release in Response to Real Sugar 12/18/09

- Combining artificial sweeteners with the real thing boosts the stomach's
secretion of the "fullness" hormone, glucagon-like peptide-1 (GLP-1), new
research

shows. It's unknown whether this means anything for people's health, but "in
light of the large number of individuals using artificial sweeteners on a

daily basis, it appears

essential to carefully investigate the associated effects on metabolism and
weight," conclude the researchers. Because artificial sweeteners are
virtually

carbohydrate-free, they have been thought

not to have any effect on how the body handles glucose, But there's some
evidence that artificial sweeteners may trigger secretion of GLP-1 by the
digestive

tract, and thereby curb appetite and calorie intake. [22 healthy
normal-weight young people] people secreted significantly more GLP-1 when
they drank diet

soda before the glucose challenge compared to when they drank carbonated
water.

..our data demonstrate that artificial sweeteners synergize with glucose to
enhance GLP-1 release in healthy volunteers," What this all means to the
average

diet soda drinker is not known, but the fact that the effect occurred with
less than a single can of diet soda suggests it "may be relevant in daily
life,"Future

research is needed to understand the significance of enhanced GLP-1
secretion for health, they conclude, and studies should be conducted in
people with

T2.. Diabetes Care 2009;32:

 

20.%% Reuters Health  Preprandial Insulin Aspart Started Pre- Conception May
Cut Hypoglycemia in Pregnancy Dec 21 - Pregnant women with T1DM  had fewer

severe hypoglycemic episodes when they started a preprandial insulin analog
regimen before conception rather than afterward. [322 subjects] During the

first half of pregnancy, women who were randomized to preprandial Aspart
before conception were 70% less likely to experience severe hypoglycemia
than

those randomized in early pregnancy. As for the optimal type of insulin for
preprandial therapy, there was a trend toward lower rates of severe
hypoglycemia

with insulin aspart at all points studied.

 

21.%% Ophthalmology Vol 117, issue 1 January 2010  The 25-Year Incidence of
Visual Impairment (VI) in Type 1 Diabetes Mellitus: The Wisconsin
Epidemiologic

Study of Diabetic Retinopathy

Nine hundred fifty-five insulin-taking persons living in an 11-county area
in southern Wisconsin with T1DM diagnosed before age 30 years  follow-up
(4-,

10-, 14-, and 25-year) examinations. Conclusions These data show that the
25-year cumulative incidence of VI is related to modifiable risk factors
and,

therefore, that VI may be reduced by better glycemic and blood pressure
control and avoidance of smoking.

 

22.%% Ophth vol117,issue 1 January 2010  Micronutrients and Diabetic
Retinopathy: A Systematic Review

Background - We have evaluated the evidence for the association between
intake and blood levels of micronutrients and diabetic retinopathy.
Treatment for

diabetic retinopathy requires significant clinical input and specialist
ophthalmologic care. Micronutrients, including vitamin C, vitamin E, and
magnesium,

may interfere with pathologic mechanisms of diabetic retinopathy and
potentially alter its risk. Methods We conducted a search of epidemiologic
literature

in PubMed and Embase from 1988 to May 2008, using keywords for exposures,
including magnesium, ascorbic acid, a-tocopherol and antioxidants, and
outcomes,

including diabetic retinopathy. Of the 766 studies identified, we reviewed
15 studies, comprising 4094 individuals.  Conclusions  - The evidence
suggests

that dietary intake or plasma levels of vitamins C and E and magnesium do
not seem to be associated with diabetic retinopathy. Because of differences
in

study designs and measurement of micronutrients, incomplete ascertainment of
retinopathy, and residual confounding, these findings require confirmation.

 

23.%% Low Blood Sugar May Impair Diabetics' Driving (Reuters Health) Dec 24
- Bouts of low blood sugar can lead to unsafe driving

among people with diabetes, new research shows. In 452 adult drivers with
T1DM, 52% reported at least one driving mishap when

their blood sugar was low. Just as one would pull over to deal with a flat
tire, the lead author commented. diabetics with low blood sugar "need to
immediately

stop driving, eat fast-acting sugar, and wait for blood sugar to rise,"
before driving on. Driving with low blood sugar did not appear to cause a
large

number of collisions.. 22% of the drivers reported some sort of collision
during the year, but just 2.4% were said to be related to bouts of low blood

sugar. Nonetheless, about 35% of the time drivers said they had checked
their blood sugar

30 minutes prior to having some sort of driving mishap. In 78% of these
times, blood sugar readings were less than 90 mg/dL. In 48% of these times,
readings

were less than 70 mg/dL. Moreover, in addition to the half who reported at
least one low-blood-sugar-related

driving mishap, such as zoning out or becoming disoriented, being stopped by
police, or having someone else take over driving, 32% reported 2 or more and

5% reported 6 or more such mishaps. The team suggest that healthcare
providers encourage those reporting

such events to strive for blood sugar levels greater than 90 mg/dL before
beginning to drive. Diabetes Care 2009.

 

24.%% MNTD Rapid-Acting Insulin Analogues: Trials Provide No Proof Of
Additional Benefit For Children And Adolescents With Type 1 Diabetes  21 Dec
2009 

Long-term research is lacking - potential harm remains unclear - valid
studies are urgently needed for growing and developing children and
adolescents

Due to a lack of suitable studies, it remains unclear whether children and
adolescents with T1DM benefit more or less from long-term treatment with
rapid-acting

insulin analogues than with short-acting human insulin. Certainly, there is
no proof of additional benefit from the available results from clinical
trials

of maximum one year duration. This applies both in the comparison with human
insulin and in the comparison between analogues only. This is the conclusion

of the final report of the Institute for Quality and Efficiency in Health
Care (IQWiG) published on 16 November 2009. The Institute believes that
studies

of longer duration are urgently needed because insulin performs a variety of
functions particularly during stages of human growth and development and it

is not clear what effect insulin analogues have. .

 

25.%% NYT 1/5/10  The Claim: Diabetes Can Lead to ‘Frozen Shoulder’

Shoulder problems are not what come to mind when most people think of
diabetes. Butstudies have found a link  between both types of diabetes  and
this

mysterious shoulder condition, which occurs in three stages: weeks of
inexplicable shoulder pain, followed by months of “frozen” stiffness and
restricted

motion, and then finally

a “thawing” stage in which motion gradually returns. The condition, also
known as adhesive capsulitis afflicts 2 to 5 %t of the general population,
but

at least 20 % of all people with T1 & T2 with the risk increasing with age.
No one knows precisely what causes it. But scientists think it may have
something

to do with excess glucose building up in the shoulder and essentially gluing
collagen fibers together, restricting movement. Diabetics seem to develop

more aggressive cases but doctors say there are measures to counter it.
Controlling blood sugar is one important step. Using heating pads and taking
anti-inflammatories

like aspirin and ibuprofen can ease the initial pain. And home stretching
exercises and physical therapy

 can help restore movement and sometimes prevent the return of symptoms.
Cortisone injections are another option, but some experts suspect they may
increase

glucose levels. When nothing else works, doctors recommend an outpatient
arthroscopic shoulder procedure,

which removes scar  tissue and frees ligaments. Studies show it has a high
success rate. The bottom line - Diabetes significantly raises the risk of
frozen

shoulder.

 

26..%% Is Prehypertension a Risk Factor for the Development of Type 2
Diabetes?12/29/09; Diabetes Care. 2009;32(10) [2767 subjects;7.8yr
follow-up] After

adjusting for age, sex, and ethnicity, the odds of incident DM were 2.21
greater for individuals with prehypertension than for individuals with
normal

BP. Subjects with prehypertension had more DM risk than those with normal BP
regardless of sex, ethnic origin, and categories of obesity and glucose
tolerance.

Conclusions - Our study confirms previous reports on the relation of
prehypertension to obesity and insulin resistance  and demonstrates that
individuals

with prehypertension have higher rates of conversion

to diabetes than those with normal blood pressure. Much of the diabetes risk
associated with prehypertension is explained by disorders related to the
insulin

resistance syndrome.

 

27.%%Medscape Medical News   ADA Revises Diabetes Guidelines

12/29/09 — The American Diabetes Association (ADA) revised clinical practice
recommendations for DM diagnosis promote hemoglobin A1c (A1c) as a faster,

easier diagnostic test that could help reduce the number of undiagnosed
patients and better identify patients with prediabetes. "We believe that use
of

the A1c, because it doesn't require fasting, will encourage more people to
get tested for T2  and help further reduce the number of people who are
undiagnosed

but living with this chronic and potentially life-threatening disease," the
ADA president-elect of medicine & science, said. The A1c test, which
measures

average blood glucose levels for a period of up to 3months  was previously
used only to evaluate diabetic control with time. An A1c level of
approximately

5% indicates the absence of diabetes, and according to the revised
evidence-based guidelines, an A1c score of 5.7% to 6.4% indicates
prediabetes, and an

A1c level of 6.5% or higher indicates the presence of diabetes. For optimal
diabetic control, the recommended ADA target for most people with DM is an

A1c level no greater than 7%. It is hoped that achieving this target would
help prevent serious DM-related complications including nephropathy,
neuropathy,

retinopathy, and gum disease.   Unlike fasting plasma glucose testing and
the oral glucose tolerance test, A1c testing does not require overnight
fasting.

..

 

- 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;  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     

       

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20100105/8855353f/attachment-0001.htm>