[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1. %% NYTimes 6/28/10  The Claim: Diabetes Makes You Sensitive to Heat THE
FACTS   Summer can be uncomfortable for anyone. But for people with DM, the

heat and humidity can be particularly hazardous. One of the complications
of T1 and T2 is an impaired ability to adjust to rises in temperature, which

can cause dangerous increases in body temperature. The underlying problem,
nerve damage , occurs in 60-70% of Americans with DM; it can affect nearly
every

organ in the body, including sweat glands. When nerve damage keeps the
sweat glands from working properly, the body fails to cool down as the
mercury rises.

One small study compared diabetic patients and a group of healthy control
subjects. As temperatures rose, the control subjects’ perspiration rates
increased

proportionately; their core temperatures stayed constant. “For subjects
with DM, sweat seemed to plateau irrespective of an alarming rise in core
temperature,”

research shows that DM patients have higher rates of adverse events - like
hospitalizations, dehydration  and death - in the heat. Yet a survey found
many

were unaware of the greater risk and the need for special precautions. THE
BOTTOM LINE People with diabetes are particularly vulnerable to hot weather.

 

2.%% ADA 70;REACH for Metformin to Reduce Deaths in Patients With Diabetes
& Atherothrombosis 7/1/10 In patients with DM and  atherothrombosis, the use

of metformin was associated with a 24% reduction in all-cause mortality
after 2yr Fup.[20,000 DM pts in REACH registry]  who had cerebrovascular
disease,

coronary disease,  claudication . plus at least 3 otherothrombotic risk
factors, including current smoking, hypercholesterolemia, DM nephropathy,
hypertension,.

and the presence of at least 1 carotid plaque.

 

3.%% Nature news avandia 6/28/10 Evidence mounts against diabetes drug
Studies continue to find heart-attack risk. Avandia, used to treat T2DM,
has attracted

controversy. Patients who take Avandia are more likely to have a stroke or
heart failure, or die, than those who take a rival drug, a survey of more
than

200,000 insurance records has revealed.. The finding, is the latest salvo
in a continuing battle over Avandia (rosiglitazone). The possible health
risks

of Avandia were brought to light in 2007, when a meta-analysis by Steven
Nissen, a cardiologist at the Cleveland Clinic suggested that the drug
could cause

heart attacks . This is a particular concern given that diabetics already
have a high risk of CV disease...The US Senate launched an investigation and

concluded  that GSK was aware of the adverse effects of Avandia well before
the risks were made public.  In a new paper Nissen and statistician Kathy
Wolski,

repeat their 2007 meta- analysis, incorporating new clinical-trial data
..They again found that Avandia boosts heart-attack risk -  by up to 39%.
Meanwhile,

in JAMA, David Graham, a drug-safety researcher at FDA et al; analysed the
insurance records of 227,571 pts treated with either Avandia or Actos
(pioglitazone)

a similar drug and found that patients taking Avandia were 18% more likely
to suffer from a stroke, heart failure, heart attack or death than those on

Actos.  "The study by Graham et al . is very convincing," says C.de Vries,
an epidemiologist at the U. of Bath, UK. "I can't fault it, and I suspect it

might be the nail in the coffin for rosiglitazone."

 

4.%% ADA 70;  New Class of Drug for T2DM Acts Independent of Insulin
6/28/10 - Dapagliflozin, improves glycemic control by reducing renal
glucose reabsorption,

[phase 3 study.] Given with metformin, dapagliflozin represents a new
therapeutic option for the treatment of T2 patients who have inadequate
glycemic

control with metformin alone. Dapagliflozin,a selective sodium-glucose
cotransporter-2 inhibitor, prevents reabsorption of glucose in the kidneys
and promotes

the excretion of glucose in the urine. It thereby reduces high levels of
blood glucose without affecting insulin- dependent systems."Because [of
this]

mechanism, it should be suitable for use at any time during the duration of
the disease process, and should be compatible with ..any of the other
therapies

that we have available at the moment." [534 T2 adults randomly assigned to
1of 3 doses of dapagliflozin or placebo orally once daily, in addition to
their

prestudy metformin dose. Results - mean HbA1c decreased by -0.30% in the
placebo group compared with 0.84% in the dapagliflozin 10 mg group.
Hypoglycemia

was reported at similar frequency in both groups. However, symptoms of
genital infections were more common in the dapagliflozin groups - in 8-13%
of individuals

compared with in 5% of those in the placebo group. "This is likely to
reflect the extra glucose that is eliminated in the urine,".. Mean weight
loss was

0.9 kg [1.98 lb] per person in the placebo group compared with 2.9 kg in
the dapagliflozin 10 mg group. study -supported by Bristol-Myers Squibb and
AstraZeneca.

 

 

5.%% MW Mixing Insulin Aspart and Detemir in a Single Syringe Lets Children
Avoid Extra Shots  (Reuters Health) Jun 21 - In children with T1DM, mixing

insulin aspart and detemir in the same syringe has the same effect on blood
sugar levels as giving the injections separately, investigators report. Not

surprisingly, pain from injections is a big obstacle to managing DM in
children. Detemir should ideally be taken twice a day and aspart must be
taken with

at least all 3 major meals, resulting in 5 injections given separately.
"With the results from our trial, we will be able to reduce insulin
injections

by 2/day and that equals a reduction of 60 injections/month without
compromising glucose levels,"said senior author. [14 children with T1]Each
child wore

a continuous glucose monitoring device, and the team analyzed

data for the last 72 hours of each study period.] There was no
statistically significant difference in glucose amplitude or frequency of
mild hypoglycemia.Diabetes

Care 2010.

 

6.%% MW Islet Transplantation a Decade Later and Strategies for Filling a
Half-full Glass 6/23/10 Diabetes. 2010;59(6):  Alloislet transplantation for

the treatment of T1DM enjoyed highly favorable status in the first half of
the last decade but declined in favor during the second half. I will briefly

review the literature published in this area from 2000 - 2010 for the
purposes of extracting lessons we have learned, considering whether the
procedure

should be deemed a partial success or a partial failure, and offering
strategies to improve alloislet transplantation outcomes in the future. In
the end,

I hope to strike a positive note about where this procedure is going, and
how it will be applied to establish insulin independence in patients with
T1...

Bridge to the Future     A valid argument against islet transplantation as
a treatment for T1 is the undeniable arithmetic that not nearly enough
pancreas

donors exist to treat patients with T1, let alone all people with T1 &T2.
Does this mean we have been wasting our time and resources by studying islet

transplantation? I don't believe so. There will always be DM patients who
need ß-cell replacement by transplantation of islets or the pancreas. One
group

of patients comprises those with rapid development of secondary
complications despite optimal medical care. Another group is made up of
patients with the

neurological disorder of autonomic insufficiency, which is accompanied by a
50% death rate within 5 years of diagnosis. They are clearly candidates
because

successful pancreas transplantation converts this death rate from 50 to
10%. One must also consider what the future may bring. Our experiences with
islet

transplantation have taught us lessons that will be important for the use
of ß-cell surrogates, be they stem cell derivatives or modified cell
lines. We

have learned about culturing cells, isolating islets and ß-cells,
identifying safe and physiological sites for transplantation, avoiding
immunosuppressive

drugs that are toxic to ß-cells, meeting environmental needs for
physiological a-cell function, and selecting appropriate patients for ß-
cell replacement.

This is important information to use as we continue to meet the challenge
of creating better means of controlling hyperglycemia and avoiding its
complications.

We just need to continue on with new scientific work until the
transplantation glass is successfully filled.  R. Paul Robertson
..University of Washington,

 

rpr at pnri.org

 

7.%% MW Combination Therapy for Patients with T2DM: Repaglinide in
Combination with Metformin [combo R+M]  6/23/10 Abstract - In patients with
T2, adequate

glycemic control is a critical factor in reducing long-term micro- and
macro-vascular complications. Traditionally, the approach is to initiate
monotherapy

first, followed by combination therapy that targets 2 main defects in T2.
Repaglinide [prandin], a rapidly acting insulin secretagog, stimulates
insulin

secretion via closure of ATP-dependent potassium channels on the cell
membrane of ß-cells. Repaglinide is ideally used at mealtime to reduce
postprandial

[after meal] glucose levels, thus lowering the 24-h blood glucose profile
and improving HbA1c levels. Metformin is an insulin sensitizer that
effectively

acts against insulin resistance, one of the predominant metabolic defects
in T2. Combo R+M is indicated as an adjunct to diet and exercise to improve
glycemic

control in adults with T2. When monotherapy with oral antidiabetic agents
fails, Combo R+M has been demonstrated to be safe and effective in the
treatment

of T2DM. Funding to support manuscript provided by Novo Nordisk

 

9.%% MW Does Diabetes Mellitus in the Recipient Jeopardize Graft Survival
in Kidney Transplant Patients? 6/21/10 Am J Transplant. 2010;10: Summary -
analysis

of adult, deceased-donor, solitary kidney transplants 1994 - 2005 [25,523
pairs (51,046 total kidney transplants) ;75% white] Multivariable analysis
confirmed

the association between DM recipients and DGF:[DM graft failure].. The
cause of DGF .. It is hypothesized that ischemia-reperfusion injury during
transplantation

procedure causes a cascade of molecular events that eventually leads to
apoptosis, inflammation, and endothelial injury, resulting in organ
dysfunction

and nephron [kidney cell] loss.further investigation of intensive glucose
control in both the diabetic kidney donor and the recipient during the
perioperativeperiod

may be warranted to determine the effect of glucose control on initial
graft function.

 

10.%% Hip Fractures Linked to Thiazolidinedione [TZ] Use Higher Than
Expected in Men 6/29/10 ADA 70  TZs increase fracture risk, not just in
women,but

in men, particularly middle-aged men. Moreover, these fractures are not
limited to distal sites like the feet and hands, but also occur in the hip.
The

team looked at fracture requiring hospitalization in T2.[212,977 people]
They  found that exposure to either rosiglitazone or pioglitazone was
associated

with a 1.7-fold increase in the overall fracture rate in women, and a 1.3-
fold increase

in men.  Male TZ users had a 2-fold risk for hip fracture. "I would point
out that the risk in men is actually not in older men, it's more in middle-
aged

men between 55 - 65 yrs,"

 

11.%% MNTD 12 New Genes Linked To Type 2 Diabetes 6/28/10

This brings the total number of genes known to be associated with the
condition to 38. An international consortium of scientists compared the DNA
of over

8,000 people with T2s with almost 40,000 people without the condition at
almost 2.5 million locations across the genome."This is strong research and
adds

to our knowledge of the genes that increase the risk of developing T2. As
we continue to add more pieces to the jigsaw, our greater understanding of
the

genetics behind T2 could lead to new avenues of research into

prevention and improving treatments..

 

12.%%  ADA 70;  Women With T1DM Receive No Heart Benefit From Omega-3
6/28/10 Consuming higher amounts of omega-3 fatty acids does not appear to
lower

heart disease risk for women with T1. Omega-3 fatty acids, primarily found
in fish, promote heart health by preventing buildup of cholesterol in the
arteries.

Little is known about the effect of consuming omega-3 in people with T1DM,
who are at much greater risk for heart disease. The incidence of heart
disease

was lowest in men who consumed the highest quantities of omega-3 - more
than 0.2 grams per day. Women who consumed similar amounts  did not have
lower

rates of heart disease. "Although omega-3 is typically associated with
decreased risk for CV disease, this may not be the case for women with T1,"
said

the lead author. “.. we shouldn't assume men and women with T1 are the
same."

 

13.%% MNTD Too Much HDL May Be Harmful To Women With T1DM 6/28/10 Elevated
blood levels of high-density lipoprotein (HDL) or "good" cholesterol,
typically

thought to protect against heart disease, may do the opposite in women with
T1 [658 men &women HDL cholesterol is known as "good" cholesterol because it

helps prevent arteries from becoming clogged. High levels of HDL over 60mg
per  deciliter (mg/dL), generally protect against heart disease, while low
levels

(less than 40 for men and less than 50 for women) increase risk. the
incidence of heart disease increased in both men & women with DM who had
lower levels

of HDL - below 47.5 mg/dL. For men, as levels of HDL increased, their
incidence of heart disease decreased. The same was found for women, except
in those

with very high levels of HDL (over 80 mg/dL) whose incidence of heart
disease increased substantially. "We need to examine this relationship
further, but

our study suggests that too much of a good thing may not always offer
protection and may even be harmful for women with T1.

 

14.%% MNTD Explaining Complications Associated With Diabetes

6/25/10 New research uncovers a molecular mechanism that links diabetes
with an increased risk of CV problems and sudden cardiac death. It  finds
that

high blood sugar prevents vital communication between the brain and the
autonomic nervous system, which controls many involuntary activities in the
body.

"Diseases, such as DM, that disturb the function of the autonomic nervous
system cause a wide range of abnormalities that include poor control of BP,
cardiac

arrhythmias, and digestive problems," explains senior study author.  The
team examined the transmission of electrical signals from the brain to
autonomic

neurons in a mouse model of DM. The brain communicates with autonomic
neurons at synapses, a small gap between 2 nerve cells where electrical
signals from

one nerve cell are sent to the next by chemical neurotransmitters. "In
healthy people, synaptic transmission in the autonomic nervous system is
strong

and stable; however, if synapses on these neurons malfunction due to some
disease process, the link between the nervous system and the periphery
becomes

disrupted," The team discovered that high blood sugar causes such a
disruption in synaptic transmission which is apparent as early as 1 week
after the

onset of DM becoming more severe over time."

 

15.%% MNTD Poor Control Of Diabetes May Be Linked To Low  Vitamin D 6/22/10
Vit D deficiency is highly prevalent in patients with T2 and may be
associated

with poor blood sugar control [124pts   with T2; divided into [quarter
groups] based on vit D level.  the team found an inverse relationship
between the

patients' blood levels of vit D and their hemoglobin A1c value, a measure
of blood sugar control over the past several months. Lower vit D levels were

discovered in patients with higher average blood sugars. Compared with
whites, blacks had a higher average A1c and lower average vit D level..
screening

& vit D supplementation as part of routine primary care may improve health
outcomes of this highly prevalent condition," 

 

16.%% MNTD 6/28/10  Resveratrol - found in red wine, grapes, blueberries,
peanuts and other plants - stops out-of-control blood vessel growth in the
eye.

The discovery has implications for preserving vision in eye diseases such
as diabetic retinopathy and AMD.  Working with mouse retinas, the team found

that resveratrol can inhibit angiogenesis - when the mice were given
resveratrol, the abnormal blood vessels began to disappear.  Examining the
blood-

vessel cells they found a pathway - known as a eukaryotic elongation factor-
2 kinase (eEF2) regulated pathway, that was responsible for the compound's

protective effects. "We have identified a novel pathway that could become a
new target for therapies, and we believe the pathway may be involved both in

age-related eye disease and in other diseases where angiogenesis plays a
destructive role." said the lead author. In mice, resveratrol was effective
both

at preventing new blood vessels and at eliminating abnormal blood vessels
that already had begun to develop...If resveratrol therapy is tried in
people

with eye disease, it would need to be given in pill form because of the
high doses required,

 

17.%% JH Microalbuminuria: What It Means 7/1/10  Both elevated blood
glucose and high BP damage blood vessels in the kidneys, just as they harm
blood vessels

throughout the body-- a vicious cycle may develop. As your kidneys weaken,
BP often rises, and that in itself damages the kidneys further. Diabetic
nephropathy

or kidney disease develops slowly over the course of years. Long before any
physical manifestations are present, kidney disease leaves a clue that
allows

doctors to detect it early: microalbuminuria, or small quantities of the
protein albumin in the urine.  When elevated blood glucose and BP damage
blood

vessels in the kidneys' filters, protein starts to leak into the urine. At
first, the leaks are tiny, so only small amounts of proteins like albumin
slip

through. At a later stage, the amount of protein in the urine
(proteinuria), increases. You should be screened each year for
microalbuminuria if you have

T2 or have had T1 for at least 5 years. Screening can be done any time of
day with just one sample of urine. What about blood tests? The fact is that
no

abnormalities show up in the blood until kidney disease has progressed
beyond micro albuminuria. ..

 

18.%% NIH News 6/29 /10 #1. Aiming for Near-normal Blood Sugar Did Not
Delay Combined Risk of Diabetic Damage for People with  Long- standing
Diabetes,

In people with longstanding T2DM who are at high risk for heart  attack and
stroke, lowering blood sugar to near-normal levels did not delay the
combined

risk of DM damage to kidneys,eyes, or nerves, but did delay several other
signs of diabetic damage. The intensive glucose treatment was compared with
standard

glucose control.  Over time, DM damages the small blood vessels of the
eyes, nerves, kidneys and other organs, leading to pain and disability.
Heart disease

due to damaged large blood vessels is a major cause of death in persons
with T2. The longer a person has DM, the greater the chances of serious
complications,

including vision loss - blindness, foot ulcers - amputations, kidney
disease -kidney failure, and heart disease - stroke."In these ACCORD
participants

with established T2 and additional risk factors for CV disease, intensive
lowering of blood glucose reduced some markers of eye, nerve and kidney
disease

compared with standard glucose control, but the groups did not differ in
the rate of progression to kidney failure, nerve disease, and major vision
loss,"

said lead author. [10,000 adults withT2] "Although increasing treatment to
try to achieve near-normal blood sugar provides some benefit, clinicians and

patients should note that this treatment strategy also potentially
increases the risk of adverse effects in patients with additional risk
factors for heart

disease, such as those studied in ACCORD."

#2.  ACCORD Eye Study Finds Intensive Blood Sugar Control or Combination
Lipid Therapy Decrease Diabetic Eye Disease Progression: In high-risk
adults with

T2, researchers have found that 2 therapies may slow the progression of
diabetic retinopathy [DR], an eye disease that is the leading cause of
vision loss

in working-age Americans. Intensive blood sugar control [BSC] reduced the
progression of DR compared with standard BSC, and combination lipid therapy
with

a fibrate & statin also reduced disease progression compared with statin
therapy alone. However, intensive BP provided no additional benefit
compared with

standard BP control.  ACCORD Eye Study [subset of 2,856 subjects]. the team
analyzed the effects of the treatment strategies on blood vessels in the eye

by identifying DR progression over 4 yrs. Diabetic retinopathy is a disease
in which blood vessels in the eye's light-sensitive retinal tissue are
damaged

by DM. Blood vessels can begin to leak, causing swelling in the retina, and
abnormal new blood vessels can develop, both causing vision loss. Compared

with standard BSC, intensive control decreased the progression of DR by
10.4 to 7.3 %. Those in the intensive control group had a median blood
sugar level

of 6.4 % hemoglobin A1c-a level close to values in people without DM. The
standard BSC group maintained a median level of 7.5%."Previous clinical
trials

have shown the beneficial effects of intensive BSC on slowing the
progression of DR with T1 or newly diagnosed T2," said NEI director Paul A.
Sieving "The

ACCORD Eye Study expands these findings to a larger population of adults
who had T2 for an average of 10 years, and demonstrates that the eye
benefits

from the reduction of glucose below previously established levels." more
info about this trial (NCT00542178) at 

www.clinicaltrials.gov>

 

19.%% ADA 70; Gestational Diabetes (GDM) and Obesity Lead to Macrosomia
6/29/10 (GDM) and obesity alone and together increase the risk for
excessively

large birth weight infants. [23,000 women] Those who did not have GDM but
who were obese had a 13.6% increase in risk for macrosomia (a child weighing

[8lb 13oz] or more at birth) than nonobese women. The combination of
obesity and GDM was associated with a 20.2% increase in risk for
macrosomia...

 

20.%% ADA 70: Dual SGLT Inhibitor Causes Rapid Drop in Glucose Values
6/29/10  An investigational oral antidiabetic agent - a dual sodium-glucose
transporter

(SGLT)-2/SGLT-1 inhibitor- showed significant improvement in (HbA1c),
fasting plasma glucose (FPG), and oral glucose tolerance testing (OGTT)
levels over

4 weeks in patients with T2.In a phase 2a trial of LX4211 in 36 patients,
mean HbA1c levels declined from baseline by 1.5% among patients treated with

a 150 mg dose of the drug compared with a 0.49% drop for patients treated
with placebo. Despite the increased urinary glucose secretion in patients in

the LX4211 groups, there were no treatment- related urinary tract or
genital infections, the authors reported.

 

21.%% Long-Term Cardiac Risk: Higher With Diabetes, or a First MI?

Jun 25 - If you compare diabetics without heart disease, and primary heart
attack patients without DM, which group will have the higher

10-year rate of major coronary events? The one with the primary heart
attacks, new research shows. In a study in a Mediterranean group, pts with
T2  had

a significantly lower long-term incidence of unstable angina and fatal or
nonfatal myocardial infarction (MI) compared to nondiabetics who'd had a
primary

MI. [2260 T2 diabetics; 2150 MI pts] 

 

22.%% ADA 70: Standard CV Risk Factors Don't Explain the Doubling of
Vascular Disease Risk in Diabetes 7/1/10- Diabetes is a risk factor not
only for ischemic

vascular diseases such as MI and ischemic stroke, it also seems to pose a
significant risk across the spectrum of different forms of vascular disease,

including hemorrhagic stroke, suggests a meta-analysis encompassing almost
700,000 patients  Moreover, it showed that the elevated risks were largely
independent

of conventional CV risk factors, suggesting that DM must be raising
vascular risk through less familiar mechanisms. . "very little of the
excess CV risk

associated with DM is explained by obesity, BP, lipids, inflammatory
markers, or renal function." the presenter said "That means there are yet-
to-be discovered

pathways that better explain why people with diabetes are at increased CV
risk,

 

23.%%  Ophth 117,7 July 2010  Sustained Ocular Delivery of Fluocinolone
Acetonide (FA)by an Intravitreal Insert   Purpose -  compare Iluvien
intravitreal

inserts that release 0.2 or 0.5 μg/day of e (FA) in patients with diabetic
macular edema (DME) Prospective, randomized, interventional, [37pts]
Conclusions

-[these]inserts provide excellent sustained intraocular release of FA for
=1 year. Although the number of patients in this trial was small, the data
suggest

that the inserts provide reduction of edema and improvement in BCVA [best
corrected visual acuity] in patients with DME with mild effects on IOP over
the

span of 1 year.

 

24.%% Oph 117,7 July 2010 Retinal Vascular Fractals and Micro-vascular and
Macrovascular Complications in T1DM Fractal analysis is a method to quantify

the geometric pattern and complexity of the retinal vessels. This study
examined the association of retinal fractal dimension(Df) and micro and
macrovascular

complications in a population-based cohort with T1 [208 pts] Conclusions
This study adds to the evidence that Df  may have some role as a global
measure

of retinal vasculature and its association with systemic disease. 

 

25.%% MW Obesity and Cardiometabolic Risk Factors: The Loaded Gun 6/28/0  -
One of the most profound statements I ever heard was during my diabetes
fellowship."Think

of genetics as the loaded gun and the environment as pulling the trigger."
.. if you put a person who has a genetic predisposition for DMs in an
environment

that promotes weight gain, the patient will most likely become diabetic.
Conversely, if you put that same person .. where it is difficult to gain
weight,

then the DM may never manifest. ..To explain the relationship between
obesity and diabetes, one must first understand how humans gain weight. One
of the

easier ways to think of obesity and the accumulation of fat cells is to
view fat gain as central or peripheral. Peripheral fat gain refers to
subcutaneous

fat that is easily measurable by grabbing the fat just under the skin.
Peripheral fat is relatively benign in metabolic terms; much of its
deleterious

effects are structural..[such as] increased load on the weight-bearing
joints..  Central or visceral fat, is deep in the abdomen and the chest and
is found

around or sometimes in the organs. An example- the presence of omental fat
around the small intestines and visceral organs, as in "fatty liver"
disease.

Central fat is also associated with insulin resistance and metabolic
syndrome.    In the 1960s, a biochemist reported on the competition between
fat and

glucose for entry into the human cell- how a cell has its choice of energy
to run the cell's functions. If times are lean - not much food is available,

very little insulin is needed to transport glucose into cells. If food is
abundant, however, the cell can function on fatty acids or glucose. The more

fatty acids are floating around in the blood stream, the more insulin is
needed to get these fatty acids and glucose into cells. Thus, as the body
makes

more visceral fat, there is an abundance of fatty acids in the blood, and
competition with glucose for entry into the cell, in turn, increases the
amount

of insulin needed. This is called insulin resistance because more insulin
is needed to transport the same amount of glucose into a cell. .. as fatty
acid

levels rise with weight gain, more insulin is needed to drive in fatty
acids &  glucose into cells. .. the body can produce only so much insulin;
eventually

the pancreas cannot keep up with these larger demands to produce insulin.
This is the first step toward diabetes -- the blood glucose will start to
increase

because of a combination of insulin resistance and inability to make enough
insulin.

As this state of central weight gain and insulin resistance sets in, other
cardiometabolic [CM] factors begin to emerge. Lipid changes known as
dyslipidemia

begin to occur, and one will see a drop in high- density lipoprotein (HDL)
cholesterol levels and an increase in triglyceride levels. At this point BP

can begin to rise. This move of CM risk factors in the wrong direction is
commonly known as metabolic syndrome .With normal dieting one loses weight
that

is a combination of visceral and peripheral fat. [which] will improve blood
glucose, HDL and triglyceride levels. . a weight loss as little as 5%-10%
will

improve DM measures and even reverse borderline blood glucose levels to
within the normal range..  it is not surprising that more T2 is seen in men
and

Asians of both sexes. .since  [this group] gains their weight centrally -
not peripherally. "Asian"[here = ]eastern Asians (eg, Chinese, Japanese) and

western Asians ( Indians from India)...

 

26.%% ADA 70;Vitamins C and E a Bust at Preventing Preeclampsia in Diabetic
Women 7/2/10 - Vitamins C and E get an F+ when it comes to preventing
preeclampsia

in women with T1DM  Neither vit C nor E supplements were better than
placebo at preventing preeclampsia in DMc women. Vitamin supplementation
also failed

to reduce the

frequency of gestational hypertension or  low birth weight..however, we did
not observe any adverse maternal or neonatal outcomes, and in.. subgroup
analyses,

the risk for preeclampsia was significantly

reduced in women with low antioxidant status at baseline randomized to
vitamin treatment, compared with [those] assigned to placebo," 

 

27.%% ADA 70:Diabetic Instructors Help Neighbors Lose Weight, Improve
Glucose Profiles 7/2/10 A community-based health intervention styled after
the Diabetes

Prevention Program (DPP) helped adults at risk for DM lose significant
amounts of weight and pull their belts in by a notch or 2, [301 subjects
with Prediabetes]"Our

reduction in glucose of 4 mg/dL is comparable to the DPP and to the Finnish
DM Prevention Study. Those differences were associated with about a 50%
reduction

in the incidence of DM, so we believe this is a clinically meaningful
reduction in glucose."I think we need as many outlets for DM education and
prevention

as we can find," the presenter said.The program is delivered through local
diabetes care centers by registered dietitians and community health workers,

who are diabetes patients identified as good candidates for training and
group leadership.

 

28.%% Switching to Once-daily Liraglutide from Twice-daily Exenatide
Further Improves Glycemic Control in Patients with T2DM using Oral Agents
6/29/10;

Diabetes Care. 2010;33(6) Conclusions  Conversion from exenatide to
liraglutide is well tolerated and provides additional

glycemic control and cardiometabolic benefits...[389 pts]

 

29.%% Cinnamon and Prickly Pear Cactus -- Should They Be Part of a T2DM
Diet? 6/30/10 Case Presentation Mr. Lopez is an English- speaking Latino
patient 

The patient is unhappy about the suggestion to add a second antidiabetic
medication because he does not wish to be medication dependent. He has been
advised

by his family to use nopal (prickly pear cactus) and to add cinnamon and
fenugreek to his food. A review of 108 trials of herbs and dietary
supplements

used for glycemic control in 4565 patients with DM or impaired glucose
tolerance found that the supplements seemed to be generally safe but needed
further

study. Another review of herbals used in Mexico examined therapies
preferred by 573 patients with T2. nopal was used most often. The exact
mode of action

is not known, although nopal has high fiber and may have an insulin-
sensitizing effect... The broiled stems are traditionally used for their
hypoglycemic

effect, which is seen 3-4 hours after ingestion and can persist for up to
6hr.  When 85 g of nopal was added to typical Mexican breakfasts, it reduced

glucose levels for several hours and favorably altered the glycemic index
of  test breakfasts [36pts with T2 who were receiving glibenclamide,
metformin,

or both]. This team proposed that nopal be used to supplement dietary
approaches to DM care in a culturally effective way for Mexicans. The
theoretical

concern with use of nopal is interaction with antidiabetic medication, with
consequent hypoglycemia. Patients who use nopal regularly should be advised

to monitor blood glucose closely. .. Gymnema extract,.. overall, evidence
is insufficient for its efficacy in DM treatment. Gymnema should be used
with

caution in DM patients.  Cinnamon., Animal and in vitro studies have
indicated that cinnamon may mimic the effects of insulin, act as an insulin
sensitizer,

and improve cellular glucose uptake and glycogen synthesis.  Clinical
studies are small and have produced contradictory results. In the most
recent randomized

controlled trial, of 109 patients with T2, cinnamon capsules at a dose of 1
g daily for 90 days lowered A1c by 0.83% The team recommended cinnamon as an

adjunct to DM care for patients with an A1c greater than 7.0%.The dose of
cinnamon for T2 is typically 1- 6 g daily; 1 teaspoon contains 4.75 g. This
dose

is considered to be safe for up to 4 months. Of note, cinnamon contains
coumarin; ingestion of large amounts is therefore not recommended. Liver
toxicity

in animal models has also been reported..fenugreek. In one study, 10
patients with T1 The fenugreek diet significantly reduced fasting blood
glucose and

improved glucose tolerance test results.; there is a theoretical risk for
interaction with warfarin, which entails risk for bleeding.  Of the CAM
therapies

that Mr. Lopez has asked about, nopal and cinnamon seem to hold the most
promise for glucose control in persons with A1c levels greater than 7.0%,
and

both would be easy to introduce into his meals.

 

ADA 70 - ADA 70th Scientific Sessions

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;   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; JHA - Johns Hopkins Alerts ; MW Medscape Web MD; NIH - Nat
Institutes of Health;  MNTD- Medical News Today  NREndo;Nature Reviews
Endocrinology   

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     

www.vistacenter.org

            

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