[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1.%% MNTD New Evidence That Drinking Coffee May Reduce The Risk Of Diabetes
6/11/10.. past studies have suggested that regular coffee drinking may
reduce

the risk of T2. However, little of that evidence comes from studies on lab
animals used to do research that cannot be done in humans. The scientists
fed

either water or coffee to a group of lab mice commonly used to study
diabetes. Coffee consumption prevented the development of high-blood sugar
and also

improved insulin sensitivity in the mice, thereby reducing the risk of DM.
Coffee also caused a cascade of other beneficial changes in the fatty liver

and inflammatory adipocytokines related to a reduced DM risk. Additional lab
studies showed that caffeine may be "one of the most effective anti-diabetic

compounds in coffee," the scientists say.

 

2.%% MW  Links Between Diabetes and Cancer -- ADA/ACS Consensus Report
6/16/10  — A consensus statement issued jointly by the(ADA) and the American
Cancer

Society (ACS) notes that there are some links between diabetes and cancer,
but points out that there are also many unanswered questions. "Probably the

most important point to re-emphasize is that modifiable risk factors
(overweight, obesity, lack of exercise, poor diet, and smoking) contribute
to both

DM and cancer risk, probably in part through similar mechanisms, such as
insulin resistance and increased inflammation," the spokes person said. The
report

notes that DM primarily T2, is associated with an  increased risk for some
cancers, including liver, pancreas,  colorectal, breast,  but it is also
associated

with a decreased risk for prostate cancer. "It remains unclear whether the
association is direct ( due to hypo-glycemia), whether DM is a marker of
underlying

biological factors that alter cancer risk ( insulin resistance and
hyperinsulinemia), or whether the association between cancer and diabetes is
indirect

and due to common risk factors such as obesity,"

 

3.%% MW  Obesity and Diabetes on the Rise, CDC Survey Finds 6/16/10— Obesity
and diagnosed cases of DM among adults continue to rise and are at their
highest

levels since the government began compiling these data in 1997, according to
the Centers for Disease

Control and Prevention's National Center for Health Statistics.

[88,129 persons,] survey found that 28% of US adults aged 20 years and older
were obese (defined as a body mass index of 30 kg/m2 +) 9% of adults were

diagnosed with the disease in 2009 compared with 8.2% the previous year.
Adults aged 65 years and older (19.5%) were more than 6 times as likely as
adults

aged 18 to 44 years (2.9%) to have DM. For adults aged 65 yr +, the
prevalence was higher for men than for women.  The age- & sex-adjusted
prevalence of

diagnosed diabetes was 12.1% for Hispanic persons, 7.4% for non-Hispanic
white persons, and 13.0% for non-Hispanic black persons.

 

4.%%At 1 Year, Drug-Eluting Stents Reduce Revascularization in Diabetics:
Study (Reuters Health) Jun 14 - Balloon angioplasty, drug-eluting stents,
and

bare metal stents appear to be equally effective at reducing death or
myocardial infarction (MI) over a year's time in diabetic patients,
according to

a new study. But drug-eluting stents were the most effective at reducing
need for repeat revascularization,  Previous research has shown that DM
patients

have higher risks for late thrombosis of coronary stents. With a growing
number of diabetics undergoing percutaneous coronary interventions (PCI),
[data

on 1846 diabetic patients] The authors note that patients who received
stents were more likely to receive recommended medications at discharge
(e.g., aspirin,

angiotensin- converting enzyme inhibitors [ACE], beta blockers, lipid
lowering agents and antiplatelet agents).The rates of repeat PCI or bypass
surgery

in 1 year were 30% for balloon angioplasty, 20% for bare metal stents and
13% for drug-eluting stents. The authors note that their study is limited by

lack of information, [includes] extent of glucose control, or DM duration.
Diabetes Care 2010.

 

5.%% Vista Center [to professional staff]6/10/10 Subject:  Those elusive
strips. . .There has been some concern about the  availability of strips for
the

Prodigy Voice and Prodigy Autocode glucose meters  through Kaiser. I have
contacted the regional Kaiser  pharmacy.  Kaiser has never routinely stocked

the strips but they will special order them if requested by a patient. If
you [staff ]have difficulty acquiring  strips for a Kaiser patient, you may
seek

out the assistance of the diabetes  educators at the specific Kaiser
facility in which you are having problems.  Paul Raskin, M.A. Supervisor of
Instructional

Services Vista Center for the  Blind and Visually Impaired

 

6.%% Heartwire HbA1C Variation by Race Weakens Its Exclusive DM s Diagnostic
Power 6/18/10 — African Americans have higher levels of glycated hemoglobin

(HbA1c) than whites given the same blood glucose concentrations, and the
difference is greater as glucose levels go up--Those findings were
independent

of age, sex,  body- mass index, BP, and education. [1581 non-Hispanic black
& white adult non-DM subjects] Blacks in the study had 0.20 of a percentage

point higher HbA1c concentration than whites; The spread was narrower among
those who were normoglycemic and wider among those with [diagnosed ]
diabetes.

 

7.%% 6/10/10 — Restrictive lung function impairment is associated with
incident T2DM and fatal coronary heart disease (CHD). [4434 men; no history
of CVD

or DM; 20yr Fup] "Restrictive rather than obstructive impairment of lung
function is associated with

incident T2 (and fatal CHD)." the study authors write. "The assoc. between
reduced lung function and fatal CHD and T2 in particular was to some extent

associated with inflammatory pathways," [This] association] may provide
another possible explanation for the increased risk of fatal CHD in
individuals

with T2DM."

 

8.%%MW Newly Diagnosed Diabetes May Increase Risk for Liver Disease 6/21/10
Adults with newly diagnosed diabetes are at increased risk for advanced
liver

disease, known as diabetic hepatopathy. [438,069 adults ]Among persons with
newly diagnosed DM, the incidence rate of serious liver disease was 8.19 per

10,000 person-years vs 4.17 per 10,000 person-years among those without
diabetes,... "Whether this reflects nonalcoholic fatty liver disease or
direct

glycemic injury of the liver remains to be determined. Although diabetic
hepatopathy is potentially less common, it may be appropriate for addition
to

the list of target-organ conditions related to DM, such as glomerulopathy,
retinopathy and neuropathy," the study authors conclude. "Annual screening
for

liver disease might be accomplished by means of a simple biochemical analyte
such as alanine aminotransferase. However, before screening can be
considered,

the efficacy of primary and secondary preventive measures, such as weight
loss and glycemic and lipid control, must be validated.

 

9.%%New ACCORD Insights: Steady Glycemic Control Most Important

6/14/10 Diabetes Care. 2010;33:Study Summary  The Action to Control
Cardiovascular Risk in DM (ACCORD) trial enrolled 10,251 subjects with T2 &
either

a previous CV event or other evidence of high CV risk. Patients were
randomly assigned to either an intensive glycemic strategy with the aim of
achieving

hemoglobin A1c levels below 6.0% or a standard strategy with the aim of
keeping A1c between 7.0% and 7.9%. The intensive treatment strategy was
stopped

early when it was determined that mortality was higher in that group. The
current post hoc analysis was conducted to shed light on this unexpected
finding.

The team tested patients' A1c levels over 3.4 years Fup.. a higher average
A1c level was a stronger predictor of mortality than either the final A1c or

the decreases in A1c in the first year. Higher average A1C level was
associated with higher risk for death: Each percentage- point increase in
mean A1c

was associated with an approximate 20% increase in all-cause mortality. The
original finding that mortality risk was higher with the intensive strategy

than with the standard strategy appeared to hold only when average A1c level
was above 7%.

Viewpoint -.. Patients with DM need ongoing therapy adjustments to maintain
glycemic control,  yet those adjustments often do not occur in a timely
manner.

As a result, patients may experience long periods of inadequately controlled
A1c. It may be that good glycemic control over the duration of diabetes as

opposed to tight control interspersed with spikes in A1c is the key to risk
reduction. ..Slow and steady might well win the race.

 

10.%%  Dipeptidyl Peptidase-4 Inhibitors for the Treatment of T2DM
6/17/2010; Pharmacotherapy. 2010;30(5)  Abstract - T2 has been characterized
by insulin

resistance and ß-cell dysfunction, leading to hyperglycemia and eventual
micro- % macrovascular complications. [ie blindness & heart attack]
Dipeptidyl

peptidase-4 (DPP-4) inhibitors are a relatively new class of drugs available
for the management of T2. In order to provide a comprehensive evaluation and

comparison of the pharmacology, efficacy, and safety of the DPP-4
inhibitors— sitagliptin, vildagliptin, saxagliptin, &  alogliptin  we
conducted a MEDLINE

search (1966–July 2009)..the DPP-4 inhibitors have become widely accepted
because of their low risk of hypoglycemia, favorable adverse-effect profile,

and once-daily dosing. They are weight neutral (do not cause weight gain or
loss) and appear to increase ß-cell survival. Based on information from
preclinical,

clinical, and post marketing data, there does not appear to be a compelling
advantage of one DPP-4 inhibitor over another in terms of efficacy, safety,

or ease of clinical use. Although theoretical advantages exist for agents
with a higher specificity for DPP-4 inhibition versus inhibition of other

isoenzymes associated with toxicity, comparative studies and/or increased
clinical experience with this class of drug will determine the clinical
advantages,

if any, of one agent over another...

 

11.%%  Oxalate Kidney Stones More Common in Diabetics  (Reuters Health) Jun
10 - Along with their well-known risk for uric acid [stones]  diabetics seem

to be at higher risk for calcium oxalate stones.[46 stone- forming DM pts
416 without DM] The diabetics had significantly greater daily urine volume
than

the nondiabetics. They also excreted less potassium, phosphate and
creatinine and had significantly lower daily urine pH. In addition, the
diabetics excreted

around 15% more urinary oxalate daily than nondiabetics.  In the 34 DM
patients with stones of known composition, 82.3% were 100% calcium and the
remaining

17.7% were purely or mostly uric acid. The findings "may influence dietary
counseling, medical management and stone prevention" in diabetics, the
authors 

conclude.J Urol 2010;183:

 

12.%% MNTD Study Shows Direct Link Between Circadian Clock In Pancreas And
Diabetes 6/21/10 The pancreas has its own molecular clock.  If the clock is

faulty, the result is diabetes. .. insulin-secreting islet cells .. called
beta-cells, have their own dedicated clock. The clock governs the rhythmic
behavior

of proteins and genes involved in insulin secretion, with oscillations over
a 24-hour cycle. "The biological programs in animals for harvesting energy

-- much like the photosynthesis of plants -- are under control of the clock.
Our findings will help us figure out the causes of glucose abnormalities,

but we still have a lot to learn." the authors said. There is an association
in the changes of the cycling of the clock within the pancreas itself and

disease. The next question is, can we modulate this?" the team determined
that a circadian clock is expressed autonomously in the pancreas. The visual

proof is shown in a short video they produced of the beating clock in live
insulin-producing cells of the pancreas. The cells emitted light once every

24 hours over a sustained period of time. "It's important to remember that
body clocks are ancient mechanisms that regulate fundamental biological
systems

important to health, such as insulin secretion, the time we go to bed, the
time we get up and the time we get hungry," The body's primary circadian
clock

resides deep in the brain, but local biological clocks also are found in
tissues throughout the body, including the , lungs, liver, heart and
skeletal

muscles. The clocks operate on a 24-hour, circadian (Latin for "about a
day") cycle that governs functions such as sleeping and waking, rest and
activity,

fluid balance, body temperature, cardiac output, oxygen consumption,
metabolism and endocrine gland secretion.

 

13.%% Heartwire Later Diabetes Risk Rises With Midlife Weight Gain, Measures
of Central Adiposity 6/25/10  Weight gain as well as familiar, easily
obtained

measures of central adiposity in middle-aged and elderly adults can point to
increased risk of developing DM in later years. [4000 people;12 yrs]"For
each

measure, there was a graded increase in the risk of DM, with increasing
quintiles [group of fifths]of adiposity," write the authors, the risk
increase

remained significant

but was attenuated for the oldest participants, those >75 years.

 JAMA 2010; 303:

 

14.%% MNTD Artificial Pancreas Can Prevent The Development Of Hypoglycemia
6/19/10 .. using an artificial pancreas system overnight can significantly
reduce

the risk of nocturnal hypoglycemia in children and adolescents with T1DM
Moreover, the first clinical trial of an artificial pancreas system
delivering

both insulin and glucagon has shown that this system can prevent development
of hypoglycemia. Dr R. Hovorka, a leading artificial pancreas researcher
reviews

system components and challenges to the introduction of this technology into
clinical practice, including the need for superfast-acting insulin analogs,

dual hormone approaches to accelerate insulin absorption, and optimization
of the clinical

infrastructure to support the use of closed-loop systems. A related
editorial details how technological developments supporting DM self

-management have so far failed to lead to major improvements in glycemic
control or to consistently reduced rates of severe hypoglycemia. .that one
reason

may be the requirement for patients to estimate both basal and prandial
insulin doses, which can be demanding for many patients and may lead to
ineffective

diabetes self-management [and] how the introduction of closed-loop

systems might address this issue.

 

15.%% MNTD Potential For Diabetics To Create Their Own Insulin

6/15/10 Researchers have used a unique collection of pancreas specimens
taken from patients who died soon after diagnosis of T1DM to show that they
respond

to the ongoing process of destruction by inducing their islet cells to
proliferate. The findings are important because, until now, it has been
generally

believed that,

in humans, beta cells divide only very infrequently after the first year or
so of life and that they do not readily proliferate once T1 is diagnosed.
this 

study presents evidence that there is a 10-fold increase in islet cell
replication in patients recently diagnosed with T1. The factors that trigger
the

replication process in [these pts] are still unclear, although the study
shows a correlation with the infiltration of immune cells (which suggests
that

an immune mediator is likely to be involved).  The results of the research
offer the hope that, in future, it might be  possible to encourage a newly
diagnosed

T1 patient's own beta cells to reproduce as a means of replacing those being
destroyed by the disease. .such a therapy could mean that some patients with

T1 would be able to produce their own insulin for a longer period.

 

16.%% MW Cognitive Decline Increased in Middle-Aged Patients With T2DM
6/24/10  — Middle-aged patients with T2 have roughly a 3 times

greater decline in certain cognitive functions during a 5-year period than
people without DM. [2613 people] After adjustment for age, sex, and
educational

level, patients with DM at baseline had statistically significantly greater
declines in memory function, cognitive flexibility, and global cognitive
function

than people without DM. In a model that adjusted for additional factors
[includes] .. cholesterol levels, systolic BP, history of MI, depression,
physical

activity, alcohol consumption, smoking, and waist circumference, declines in
memory, flexibility and global cognitive function were greater in patients

with DM vs people without diabetes. However, this was statistically
significant only for flexibility in those 60 years and older and for global
cognitive

function. The results suggest that hyperglycemia affects various cognitive
functions at different stages of the disease process. They write, "For
instance,

memory seems to be affected continuously while speed of cognitive processes
seems to be affected during the first years of hyperglycaemia only. These
results,

they added, "suggest that early treatment of hyperglycaemia could prevent
some of the decline in speed of cognitive processes, but probably less so

in the case of memory."

 

17.%% Routine Screening of Celiac Disease Recommended for Type 1 Diabetics
6/24/10)  Pediatric endocrinologists should regularly

screen their T1DM patients for celiac disease, investigators advised here at
ENDO 2010: Importantly, the presence of symptoms should not be a
prerequisite

for screening, they said. .Awareness needs to be

raised .. to the fact that celiac disease patients don't have many obvious
symptoms." [532 pts] Results showed that 25 T1 patients (5.1%) were
seropositive

for celiac disease on their initial testing. Of these, 11 patients (44%) had
biopsy-proven celiac disease. Of the 94.9%) who were seronegative for celiac

disease on their initial screening,(5.4%) had a repeat positive screen... No
T1 patient with biopsy-proven celiac disease reported gastrointestinal (GI)

symptoms before a  definitive diagnosis had been established. How often
should patients be screened? "Some patients develop celiac disease as long
as 10

years after their DM diagnosis, so ongoing screening is essential.. we
recommend screening once a year. Patients in whom a diagnosis of celiac
disease

is confirmed should be placed on a gluten-free diet and referred to a
gastroenterologist." "Prior research has shown that because of shared
genetic predisposing

traits, the prevalence of celiac disease is higher in T1 ranging from 1% to
16%, compared with 0.3% to 1% in the general population," Dr. Speiser
pointed

out. Undiagnosed celiac disease might cause significant morbidity..
Short-term complications include growth disturbances, weight loss, and
difficulty achieving

glycemic control in T1. Long- term complications can include small bowel
malignancy. 

J L. Rosenzweig, MD,"Certainly, the study suggests that there is some
benefit from screening diabetic children for celiac disease," he said. But
should

we routinely screen all pediatric diabetics for celiac disease? I am not yet
convinced, and I think that more studies in this area will be helpful."

 

18.%% MW Antihypertensives Helpful in Diabetics With and Without Kidney
Disease  (Reuters Health) 6/23/10 - Combination ACE inhibitor- diuretic
therapy

with perindopril and indapamide improved outcomes in T2DM pts with chronic
kidney disease (CKD). "The absolute effects of treatment in these people are

much larger than in people with normal kidney function," an author reported.
[10,640 pts with T2] Compared with placebo, after a mean follow-up of 4.3

years, active treatment reduced mean systolic and diastolic BP..Risk
reductions for cardiovascular and all-cause death followed similar patterns.
.The

relative benefits of this regimen for T2 "are consistent across all stages
of CKD at baseline, But, they add, the fact that absolute benefits are
higher

in CKD patients highlights the importance of keeping their BP under control.

 

19.%% MW Once-Weekly Exenatide Lowers HbA1c More Than Daily Oral
Antidiabetics or Insulin Glargine 6/27/10 — Once-weekly exenatide [byetta]
was better

at lowering glycosylated hemoglobin (HbA1c) levels in patients with T2DM in
2 randomized trials  that pitted the drug against sitagliptin [januvia],
pioglitazone

[actos] and insulin glargine. Patients receiving exenatide had a -1.5% drop
in HbA1c compared with -1.3%  for patients receiving once-daily insulin
glargine,

said the presenter. patients receiving exenatide also lost significantly
more weight than patients receiving the comparator drugs, and there were no
cases

of major hypoglycemia with any of the study drugs.[160 pts on exenatide,166
sitagliptin;165 pioglitazone]

The difference in HbA1c reduction between exenatide and sitagliptin was
-0.6% in favor of exenatide

 

20.%% ADA 70  Exercise Alone Reduces Diabetes Risk in Obese Boys

6/26/10 Obese boys who engaged in regular aerobic or resistance

exercise - without dietary changes — had significant improvements over 3
months in their total body fat, visceral adipose tissue concentrations, and
insulin

sensitivity than their more sluggish counterparts. The results suggest that
a moderate increase in activity (180 minutes per week) can help prevent T2.

 

21.%% MW 6/15/10 From BMC Nephrology  Large Kidneys Predict Poor Renal
Outcome in Subjects With Diabetes and Chronic Kidney

Disease [75 pts with DM & CKD ]Conclusions.  Large kidneys still predict
progression in advanced CKD complicating diabetes. In

these patients, ultrasound imaging not only excludes obstructive renal
disease, but also provides information on the progression of the renal
disease.

 

ADA 70 American Diabetes Association 70th Scientific Sessions.

ENDO 2010: The Endocrine Society 92nd Annual Meeting.

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     

            

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