[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1.%% Heartwire Almost Half of US Adults Have Diabetes, Hypertension, or
Hypercholesterolemia 4/29/10  - 45%  of all adults in the US have one
chronic condition

associated with an increased risk of cardiovascular disease. Of these, 3% of
adults had all 3 conditions and 13% had 2. 3%  had high BP & DM...The data

also showed that approximately 8% of adults have undiagnosed hypertension,
3% have undiagnosed diabetes, and another 8% have undiagnosed
hypercholesterolemia.

 

2.%% MW Statins Are Protective Against Candida Infection in Hospitalized
Diabetics 4/29/10 - Exposure to statin therapy might be protective against
Candida 

colonization or infection in high-risk patients with T2DM ..[1019
patients;statin exposure =filling 1 or more s.. prescriptions during 6
months prior to

or during hospitalization.]  After adjustment for cofounders, the use of
statins was associated with a 40% reduction in the development of Candida
colonization

...the effect of statins does not appear to be dose-dependent or associated
with a particular statin type. Commentary - K. Shakir, "It's a fascinating

study because Candida  infection is very common in diabetics, and is costly
to treat. Statins are widely prescribed, especially in T2 diabetics who are

at high risk for myocardial infarction. So in addition to lowering
cholesterol, this study suggests this could be an added benefit."

 

3.%% Heartwire  Raise a Red Flag--Prehypertension and Prediabetes Together
Boost CVD Risk 5/3/10  New data  illustrate how individuals with these
conditions

are at increased cardiovascular risk and should, at the very least, be
receiving counseling about lifestyle changes. "We would like to propose that
prehypertension

(BP >120/80 mm Hg) and prediabetes (blood glucose >100 mg/dL) occurring
together should be a red flag for urgent further evaluation, A poster
detailing

a noninvasive screening program for early CV disease in those with
prediabetes--consisting of interventions such as retinal digital
photography--showed

that they were more likely to have early changes in vascular structure than
people with normal glycemia. And patients with prehypertension appear to
have

altered metabolic

and inflammatory markers that are more usually associated with hypertension,
according to another study.  The researchers found that 1 in 3 apparently

disease-free adults had prehypertension and one in four had preDM, with 10%
of those surveyed having both... compared with normal individuals, those
with

both conditions were fatter- ( higher body mass index & waist
circumference); and had higher C-reactive protein (CRP) levels; higher
insulin resistance;

higher pulse pressure; and altered fasting lipids,..Rasmussen Disease Score:
In this study 369 subjects with preDM were compared with 1277 people with

normal glycemia. 10 noninvasive tests for the early detection of CVD were
performed: [including ]small and large artery elasticity, sitting at rest
and

upright exercise BP; optic fundus digital photography; and ECG. Each test
was scored 0 if it was normal, 1 if borderline, and 2 if abnormal; the 10
tests

provided a total score of 0 to 20, which the team called the Rasmussen
Disease Score. In the group with prediabetes,[ this] Score was significantly
higher

than in the normoglycemic group, even after adjustment for age, sex, and
BMI. This was not the case for the classic approach, using the Framingham
Risk

Score.

 

4.%% MW Moderate Alcohol Intake Independently Reduces Diabetes Risk 5/3/10
- [35,625 adult subjects; age 20-70;10yr fol-up]

The association between moderate alcohol intake and T2 tended to be

stronger in women vs men, However, men made up only one fourth of the
cohort. ..The findings, they conclude, support the presence of an inverse
link between

moderate alcohol intake and incident T2 and extend this association to
adults already at low-risk on the basis of multiple low-risk lifestyle
habits. 

The Nat Institute on Alcohol Abuse and Alcoholism defines a standard drink
in the US as 11 - 14 g of alcohol. This corresponds to approximately 1.5
ounces

of 80-proof distilled spirits one 5-ounce glass of wine, or one 12-ounce
beer.

 

5.%% MW Liraglutide (victoza) Superior to Sitagliptin (januvia) When Added
to Metformin for Glycemic Control 4/23/10  The addition of a glucagonlike
peptide-1

(GLP-1)agonist in patients with inadequate glycemic control when treated
with metformin alone resulted in significantly larger reductions in HbA1c
levels

when compared with the addition of a dipeptidyl peptidase-4 (DPP-4)
inhibitor..and

resulted in greater reductions in body weight. [T2] The team writes the
"superiority of liraglutide vs sitagliptin for blood glucose control and
weight

reduction was probably due to increased circulating

concentrations of the GLP-1 agonist, leading to different pharmacological
effects, as shown with exenatide (Byetta) [225 patients]  The new treatment
is

indicated in conjunction with diet and exercise to improve blood sugar
control in patients with T2 . The team  said that sitagliptin is a "good
drug,"

.. but the efficacy is limited. Liraglutide, on the other hand, increases
pharmacological levels of GLP-1 activity and in major studies has been shown

to be superior to oral agents, including exenatide and sulfonylureas. It
also suppresses glucagon secretion, delays gastric emptying, and decreases
food

intake, which results in weight loss. Both sitagliptin and liraglutide have
low rates of hypoglycemia, . liraglutide tends to cause nausea, although it

is usually mild and short-lived in most patients...further studies are
needed to address the long-term efficacy of the liraglutide vs sitagliptin.
Ongoing

clinical trials, such as the 12 000-patient

LEADERS  study with liraglutide, are examining hard clinical end points,
including cardiovascular end points.  study was sponsored by Novo Nordisk.

 

6.%% AACE  Efficacy of Liraglutide Is Maintained, Despite Antibody
Development 4/26/10  - Liraglutide remains effective in the treatment of T2
even if

patients develop antibodies to it, according to a pooled

analysis of 4 phase III trials.  The glucagon-like peptide-1 (GLP-1)
receptor agonist liraglutide (Victoza) was approved by FDA this past January
for once-daily

injection to help T2 diabetics lower their blood glucose (along with diet,
exercise, and selected other hypoglycemic agents). We know that peptide
drugs

have the potential to induce antibodies, "These antibodies can bind to the
effective peptide and decrease efficacy. [102 of 1185 subjects (8.6%) had
anti-liraglutide

antibodies,] But the antibodies did not alter liraglutide's efficacy in
reducing HbA1c..

 

7.%% C-Sections for Type 1 Diabetics May Be Overused (Reuters Health) Apr 28
- More accurate diagnosis of macrosomia [large body] could lead to fewer
unnecessary

cesarean sections in women with T1DM.  Researchers  found that nearly
two-thirds of women with T1who delivered by planned C-section due to
suspected macrosomia

gave birth to infants weighing less than 4,000 g [8.8lb] C-section rates are
known to be very high among women with T1.The researchers conclude: "In the

absence of macrosomia and when glycemic control

is good, a conservative management with fetal surveillance waiting for a
favorable cervical status should be investigated in a randomized controlled
study

to potentially decrease the rate of failed inductions in this high-risk
population." Obstet Gynecol 2010;115:

 

8.%% MW Insulin Glargine Inhibits Endogenous Glucose Production

(Reuters Health) Apr 26 - Insulin glargine lowers blood sugar levels by

inhibiting endogenous glucose production, without much effect on glucose
disposal. [ 20 obese T2patients]"A single subcutaneous injection of glargine
can

have a duration of action of at least 24 hours," the authors conclude.
Diabetes Care 2010.

 

9.%% MW Sleep Restriction Reduces Insulin Sensitivity in Type 1 Diabetes
(Reuters Health) Apr 23 -"This study proves that sleep is one of the
physiological

factors that influence glucose regulation in T1.A single night of short
sleep can decrease insulin sensitivity," team leader said. "As a
consequence, more

insulin might be necessary to have the same effects on blood glucose
levels." [7 patients] The researchers studied the patients for two periods:
once during

and after a normal night's sleep and once during and after only 4 hours of
sleep. All of the patients used insulin pumps.  the rate of glucose infusion

was decreased 21% with sleep restriction, "reflecting decreased peripheral
insulin sensitivity."

 

10.%% Recurrent Moderate Hypoglycemia Ameliorates Brain Damage and Cognitive
Dysfunction Induced by Severe Hypoglycemia 4/23/10

Diabetes. 2010;59(4):   [9 wk old rats]The functional significance

of severe hypoglycemia-induced brain damage was evaluated by motor and
cognitive testing. Results . Rats subjected to recurrent moderate
hypoglycemia had

62-74% less brain cell death and were protected from most of these cognitive
disturbances. Conclusions

changes brought about by recurrent moderate hypoglycemia can be viewed,
paradoxically, as providing a beneficial adaptive response

in that there is mitigation against severe hypoglycemia-induced brain damage
and cognitive dysfunction.

 

11.%%  Plasma Selenium and Risk of Dysglycemia in an Elderly French
Population: Results 4/23/10 Nutr Metab. 2010;7:21 [1162 subjects; 9-yr F-up]
Conclusions: 

This prospective study suggests a sex-specific protective effect of higher
selenium status at baseline on later occurrence of dysglycemia.[abnormal
glucose

metabolism]

 

12.%% Current Pharmacotherapeutic Concepts for the Treatment of
Cardiovascular Disease in Diabetics 4/26/10 ) With the growing worldwide
obesity epidemic,

T2DM and hypertension [HTN]leading to premature CV events, are increasingly
prevalent.. we consider 6 classes of drugs currently prescribed for the
treatment

of HTN hypertension as they impact endothelial cell function and advocate
for the development of novel drugs that can repair the endothelium and
enhance

nitric oxide availability thus preventing future CV events.  The endothelium
[lining of blood vessels] is the initial physical barrier between the
vascular

contents and the rest of the body, thus it is often first affected by
hyperglycemic episodes.  Endothelial cell dysfunction may precede the
diagnosis of

T2 by several years. Hyperglycemia may cause endothelial cell damage by
amplifying free radical production, increasing oxidative stress, inhibiting
nitric

oxide production, causing vasoconstriction and creating a pro-inflammatory
state. The primary goals of pharma.. intervention in the management of CV
disease

in DM patients:  maintain endothelial cell function and treat hyperglycemia,
intensively manage dyslipidemia and HTN to a target BP  <130/80mmHg. 

Currently 6 classes of drugs are recommended for achieving the four
treatment targets ; HMG-CoA reductase inhibitors ('the statins'), the
fibrates, the

renin-angiotensin-aldosterone system (RAAS) inhibitors, the beta-blockers,
the calcium channel blockers and the diuretics. The pharmacotherapies
considered

in this review cannot be successful unless a commitment is made on the part
of the patient to lifestyle modifications such as increased physical
activity,

weight loss and smoking cessation. Such changes are crucial to the
management of CV complications in diabetics but are rarely achieved, even
though regular

exercise of 30min twice a week, reduces CV  risk by 30% in patients with HTN
and exercise is known to reverse endothelial dysfunction  Furthermore,
diabetics

who smoke are at increased risk for peripheral artery disease.

 

13.%% ADA Prof. Resources Online  Lower birthweight and higher weight gain
during early adulthood increase the risk of gestational diabetes [GDM]
5/7/10

[21,647 women.] Lower birthweight (with a 20% higher risk) and greater
adolescent BMI and adult overall body and abdominal adiposity (2.36 higher
risk)

significantly and independently correlated with an increased risk of
incident GDM. Conclusion-weight loss prior to pregnancy is the best strategy
to prevent

gestational diabetes.

 

14.%% ADA  Vitamin D supplementation does not improve cardiovascular risk
factors 5/5/10 [438 obese subjects] After 1 year of treatment, mean serum
levels

substantially increased in groups receiving vit D sup., but measures of
glucose metabolism and serum lipids remained unchanged. However, systolic BP
slightly

but significantly increased in patients treated with vit D compared to
placebo.

 

15.%%   LifeScan is recalling certain lots of SureStep glucose test strips
because they may provide falsely low results when glucose levels are above
400

mg/dL. If these results are used to adjust insulin doses, too little insulin
could be administered. This could result in severe hyperglycemia, coma and

death. Patients who have SureStep OneTouch test strips from one of the
recalled lots, should call LifeScan at 1-800-574-6139 to get replacements.
It is

important to continue monitoring your blood glucose while waiting for the
new strips to arrive. To do this, use a meter that does not take the
OneTouch

strips if it is available. If not, patients can continue to use the recalled
strips, but be sure to contact your healthcare professional if you get
results

above 400 mg/dL, because your actual blood glucose level might be
significantly higher than that.  FDA MedWatch Safety Alert. OneTouch
SureStep Test Strips

(LifeScan): Recall. Feb 26, 2010. FDA Patient Safety News - 

www.fda.gov/psn

 

16.%% MNTD Before Symptoms Arise, New Tool Helps Scientists 'See' Molecular
Signals Of Eye Disease 5/1/10 - new research  details a noninvasive
ground-breaking

tool that detects signs of disease at early molecular stages before symptoms
can be seen using traditional methods. . this tool promises to detect some

eye diseases so early that they may be reversed before any permanent damage
can occur. ..  may also give physicians a more precise way of evaluating the

effectiveness of therapies.  Mass Eye and Ear Infirmary, Harvard Medical
School - team combined fluorescent microspheres with molecules found on the
surface

of immune cells. These molecules are up-regulated early in inflammation. The
scientists combined this compound once more with custom-designed imaging
probes.

Then they used probes targeting endothelial markers in the eyes of test
animals.  Results showed a strikingly superior sensitivity of the
double-conjugated

probes that allowed detection of molecules that may be expressed at very low
levels, which occurs in many diseases. The imaging probes also detected
activated

immune cells, leading to unprecedented quantitative knowledge about immune
response to disease. FASEB J. 2010 24:

 

17.%% Heartwire  Unsuccessful Intensive Therapy the Culprit in ACCORD
4/30/10  An observational post hoc analysis of the

Action to Control Cardiovascular Risk in Diabetes  (ACCORD) Glycemia  trial
goes some way toward demystifying the findings of this study. ACCORD
Glycemia

was conducted in 10 000 high-risk patients with T2 randomly assigned to
either intensive glycemic control (HbA1c <6%) or standard glycemic control
(HbA1c

7%-7.9%). To everyone's surprise, it was stopped early, in Feby 2008,
because of higher mortality in the intensive-glycemic-control group. First
author

of the new paper, Dr M. C Riddle  says: "There was a mismatch between the
better level of glucose control achieved in the intensive arm, the
epidemiologic

evidence that in general lower is better, and the fact that some people in
the intensive arm had bad outcomes--it seemed counterintuitive." He said the

newly published findings show that, rather than hypoglycemia per se being
the culprit, as was originally thought, "This seems to be a problem that was

specific to the subgroup of people who tried the intensive strategy but
could not get their HbA1c levels down below 7, those who had persistently
high

HbA 1c levels." So it wasn't really intensive therapy that was associated
with the increased mortality, it was unsuccessful intensive therapy, he
said...Those

who easily achieved target A1c levels had the lowest risk of death, while
those who struggled to achieve low A1c levels had the highest risk of
death,..

an editorial agrees that the study likely exonerates hypoglycemia as the
cause of the excess number of deaths in the intensive-treatment arm. But
there

remain other unexplained findings from the study.. One Size Doesn't Fit All 

Riddle says the findings so far, can be taken together to indicate that this
population, consisting of people who have had DM for 10 years with  medical

complications, "is difficult to help in a short-term kind of way. You don't
reverse what's already happened, and that's an important message we can use,

practically speaking.., we need to have different targets for different
groups of people and perhaps different treatment strategies to reach those
different

targets as well.

Diabetes Care 33;1149-1150.

 

18.%% MW FDA Approves Orphan Drug Status for Type 1 Diabetes Stem Cell
Therapy 5/7/10   The US Food and Drug Administration (FDA) has approved
orphan drug

designation for a stem cell therapy (

Prochymal; Osiris Therapeutics, Inc) in patients with newly diagnosed T1DM.
The product is an intravenous formulation of adult mesenchymal stem cells

(MSCs) that are isolated from the bone marrow of healthy young adult donors,
thereby avoiding the controversy associated with embryonic and fetal cell

sources. Cell culture allows the large-scale production of thousands of
doses from a single donation.  According to the company, MSCs are designed
to provide

therapeutic benefit by controlling inflammation, promoting tissue
regeneration, and preventing scar formation. Preclinical studies indicate
that MSCs may

delay the progression of T1 by preserving beta cell function. Treatment
safety and efficacy are currently being evaluated in a 62-patient,
double-blind,placebo-

controlled phase 2 study conducted at 20 medical centers across the USs. To
be eligible, patients must be aged 12 to 35 years and have been diagnosed 2

to 20 weeks before study entry.

 

19.%%JAMA.  2010 Apr 28;303(16):Effect of B-vitamin therapy on progression
of diabetic nephropathy: a randomized controlled trial.

CONTEXT: Hyperhomocysteinemia [elevated homocysteine] is frequently observed
in patients with DM nephropathy. B-vitamin therapy (folic acid, vitn B(6)

& vit B(12)) has been shown to lower the plasma concentration of
homocysteine. OBJECTIVE: To determine whether B-vitamin therapy can slow
progression of

DM nephropathy and prevent vascular complications. [238 subjects with T1or
T2  and 

DM nephropathy. INTERVENTION: Single tablet of B vitamins containing folic
acid (2.5 mg/d), vit B(6) (25 mg/d), and vitamin B(12) (1 mg/d), or matching

placebo. CONCLUSION: Among patients with diabetic nephropathy, high doses of
B vitamins compared with placebo resulted in a greater decrease in
glomerular

filtration rate  and an increase in vascular events [includes] stroke, and
myocardial infarction. Jour Am Med Ass.

 

20.%% Poor Glycemic Control Associated With Aspirin Resistance in Diabetics
(Reuters Health) May 04 - Diabetics have significantly higher rates of
aspirin

[ASA]resistance than healthy controls, with aspirin resistance correlated
with glycemic control. The findings also show that diabetics might be better

off taking 300mg doses of ASA, rather than low-dose therapy -- because use
of low-dose ASA was a significant risk factor for aspirin resistance. The
team

measured aspirin resistance as platelet aggregation [AUC] in 108 diabetics &
67 controls.  The diabetics had a significantly larger mean platelet
aggregation

response . Patients were considered aspirin resistant if the AUC was above
300. Overall, 43.5% of the diabetics and 26.9% of controls were ASA
n-resistant.

Among DM  patients , unregulated hemoglobin A1c (i.e.,> 7%) was a
significant risk factor for aspirin resistance as were obesity,
atherosclerotic heart

disease history, and use of low-dose aspirin (100 mg vs 300 mg). "Our study
supports the hypothesis that better glycemic control is associated with
decreased

ASA resistance."  "It is also not known to what extent aspirin resistance
causes treatment failures in the prevention of stroke and cardiovascular
events

in DM patients."  J Clin Endocrinol Metab 2010.

 

21.%% MW Benfotiamine Not Beneficial in Diabetic Nephropathy

(Reuters Health) Apr 29 - Benfotiamine [thiamine - vit B1]does not reduce
urinary albumin excretion or renal tubule damage in patients with diabetic
nephropathy.[

82 T2 with high urinary albumin levels despite optimal treatment with
angiotensin converting enzyme [ACE] inhibitors or angiotensin receptor
blockers.The

benfotiamine group had a significant improvement in thiamine status  but no
decrease in urinary albumin excretion or 24-hour KIM-1 excretion. .

 

22.%% Therapeutic Effect of Bevacizumab [avastin] Injected into the Silicone
Oil in Eyes with Neovascular Glaucoma after Vitrectomy for Advanced Diabetic

Retinopathy 5/3/10; Eye. 2010;24(4) C 2010 Nature Pub Group  Purpose -  To
evaluate the effect of intra-silicone injection of bevacizumab for the
treatment

of neovascular glaucoma (NVG) after vitrectomy for advanced [PDR] [5
patients with NVG] The iris neovascularization (INV) and NVG had developed
1.5-4 months

after vitrectomy and silicone oil tamponade. The main outcome measures were
regression of INV, IOP and visual acuity.  Conclusion  Intra- silicone
injection

of bevacizumab is effective in the treatment of patients with INV and NVG
after vitrectomy for advanced PDR   

Vascular endothelial growth factor (VEGF) plays a central role in several
ocular pathologies characterized by neovascularization and increased
vascular

permeability.  Neovascular glaucoma (NVG) is a devastating complication
associated with ischaemic retinopathies such as diabetic retinopathy.
Standard

treatment includes retinal photocoagulation and cyclodestructive or drainage
procedures.

Silicone oil is an important adjunct in the management of complex
vitreoretinal surgical procedures. It has been extensively used as a
tamponade in cases

in which conventional vitreoretinal surgery is likely to result in a poor
success rate.  In the presence of silicone oil tamponade, the delivery and
concentration

of drugs injected into the posterior segment of the eye become
unpredictable...In all cases, the INV completely disappeared clinically
within 7 days, starting

almost 72 h after injection. Visual acuity improved in all eyes. In all
cases, the IOP decreased within 72 h and returned to levels <20 mm Hg with
timolol

and dorzolamide within 7 days. No inflammation or other complications were
observed. INV recurrence associated with

IOP elevation was detected in one patient 10 weeks after injection, which
regressed after intra-silicone reinjection of bevacizumab.

We therefore conclude that this injection may be the treatment of choice for
these patients, and we recommend it as soon as possible after the appearance

of active INV and NVG, as delayed treatment may result in peripheral
anterior synechiae formation complicating the clinical picture. The rapid
diffusion

of bevacizumab out of silicone oil, as evidenced by dramatic clinical
response in our patients, also has other important implications. Many
vitreoretinal

surgeons inject bevacizumab intravitreally at the end of vitrectomy for PDR
without

tamponade.  Our results indicate that it can also be injected at the end of
surgery for severe cases where silicone tamponade is used, and it may help

to induce regression of the remaining new vessels as well as serve as an
anti-inflammatory agent We injected 2.5 mg bevacizumab into the silicone oil
instead

of the more commonly

used dose of 1.25 mg. The 2.5-mg dose has been used by several investigators
for the treatment of choroidal neovascularization and diabetic macular
oedema,

and has been found to have the same or higher efficacy as compared with the
1.25-mg dose, without significant side effects.  The small size of this
study

is partly because of the fact that the occurrence of NVG in post-diabetic
vitrectomy eyes with silicone oil is a rarely observed complication.

 

23.%%Efficacy and Safety of Lacosamide [vimpat - anti seizure] in Painful
Diabetic Neuropathy 5/3/10; Diabetes Care. 2010;33(4): [357 DM patients with

at least moderate neuropathic pain were randomized to placebo or lacosamide
400 or 600 mg/day over 6-wktitration and 12-wk maintenance periods.
Conclusions

-  Lacosamide reduced neuropathic pain and was well tolerated but the
primary efficacy criterion was not met, possibly due to an increased placebo
response

over the last 4 weeks. High placebo responses are not unusual in neuropathic
pain studies.

 

24.%% MW Preconception Care of Women With Diabetes: A Review of Current
Guideline Recommendations 5/4/10  BMC Women's Health. 2010;10:5  Background:
The

prevalence of (T2DM) continues to rise worldwide. .resulting in more
pregnancies complicated by T2, and placing both mother and foetus at higher
risk.

Management of these risks is best achieved through comprehensive
preconception care and glycaemic control, prior to and during pregnancy.
Conclusions: 

International guidelines for the care of women with DM who are contemplating
pregnancy are consistent . there is now a need to focus on implementation

through an examination of the barriers and enablers and the applicability of
the recommendations in the local setting...Diabetes in pregnancy is
associated

with higher rates of miscarriage, pre-eclampsia, preterm labor and higher
rates of fetal malformation;  neural tube defect, urinary tract disorder,
macrosomia,

birth injury, and perinatal mortality.  These risks can be minimised by
optimal glycaemic control, prior to and throughout pregnancy,  and is best
achieved

through comprehensive preconception care where other issues such as genetic
risks, health status, reproductive history, exposure to environment toxins,

immunisation and lifestyle risk factors can also be addressed ..

 

25.%% MNTD Agents That Keep Insulin Working Longer Developed By Mayo-Led
Research Team 5/10/10 More than half a century after researchers identified
a

promising way to treat diabetes based on blocking the breakdown of insulin
in the body, a research team have done just that. The tiny molecules they
developed

work by inhibiting a powerful molecular machine known as insulin-degrading
enzyme (IDE) from chewing up the insulin hormone. That keeps insulin in the

body longer to help remove glucose (simple food sugar) from the blood. IDE
is a protease, an enzyme that chops proteins or peptides into smaller
pieces.

.. This team initially tried to find IDE inhibitors using robots to test
hundreds of thousands of compounds. [but]  it was technology invented in
1950

[that worked]  Then chemists generated a compound that contained the
preferred peptide sequence, (IDE inhibitor 1). "Ii1" is about a million
times more

potent than any previous IDE inhibitors, but additional work will be needed
to turn it into a drug suitable for therapeutic use, The structure of IDE is

unlike other proteases, .. It is shaped like a hinged clamshell that opens
and shuts, like the well-known video game protagonist, Pac-Man. The team
found 

that the Ii1 peptide acts like a magnetic latch that holds the clamshell
shut. If IDE is inhibited, insulin remains in the body longer. Normally,
about

half of the insulin produced by the pancreas is immediately destroyed by the
liver; no one knows why this occurs but it may be a way to regulate how much

insulin enters the bloodstream.. IDE inhibitors would slow the rate of this
initial destruction. However, they would also help prevent degradation of
insulin

at the "destination" cells that are responsible for removing sugar from the
bloodstream. Source:  May issue of PLoS ONE

 

26.%% MNTD Insulin Resistance Can Result From Only One Sleepless Night
5/6/10 A study found that healthy people who had just one night of short
sleep can

show signs of insulin resistance, a condition that often precedes T2.  The
team leader reports that over the last 10 years the average night's sleep in

western societies has shortened, coinciding with a rise in cases of insulin
resistance and T2. These findings suggest this may be more than a
coincidence...

a short night of sleep has more profound effects on metabolic regulation
than previously appreciated," [9subjects] the results suggest that day to
day

insulin sensitivity is not fixed in healthy people, but depends on how much
sleep they have had the previous night. . further investigations should be

done to find out whether improving sleep duration could help stabilize
glucose levels in patients with diabetes.

 

27.%% MNTD Rye And Barley Products Facilitate Blood Glucose And Appetite
Regulation 5/6/10 Evidence from observational studies indicates that diets
rich

in whole grain reduce risk of obesity and other diseases related to
metabolic syndrome (T2 & cardio- vascular disease. Barley products rich in
indigestible

carbohydrates , facilitated glycaemic regulation through a mechanism
involving fermentation by gut micro-organisms. . release of specific gut
hormones

(GLP-1), with benefits on a variety of factors  associated with reduced risk
of the metabolic syndrome, Addition of wh grain barley products in test
meals

significantly improved insulin sensitivity in T2 as compared with wh grain
or white wheat. Rye products also induced lowered insulin response .Sources:

J Nutr 138;Nutr J 25;8: 

 

28.%%MNTD  Arteries And Insulin Resistance 5/5/10 In people with insulin
resistance or full-blown DM, an inability to keep blood sugar levels under
control

isn't the only problem. A new report shows that our arteries suffer the
effects of insulin resistance, too,  for entirely different reasons. "We
think

about insulin resistance in liver, muscle, and fat, but insulin also works
on vascular cells," said C R-Madsen - Joslin Diabetes Center. insulin in our

arteries sends a signal that helps prevent the buildup of fatty plaques that
can cause arteries to harden. The team  found that mice prone to
atherosclerosis

fare much worse when the linings of their arteries can't respond to insulin.
The animals' insulin-resistant arteries develop plaques that are twice the

size of those on normal arteries. [these] blood vessels don't open up as
well, and levels of a protein known as VCAM-1 rise."It sits on the
endothelium

and binds white blood cells." Those cells can enter the artery wall, where
they start taking up cholesterol, and an early plaque is born. "The results

provide definitive evidence that loss of insulin signaling in the
endothelium, in the absence of competing systemic risk factors, accelerates
atherosclerosis,"

.. The results suggest drugs specifically designed to treat insulin
resistance in the vasculature might prevent CV complications in people with
insulin

resistance or T2 "Atherosclerosis is the main reason for shorter life spans
in diabetes patients,"

 

29.%% Eye (2010) 24, The conjunctival bacterial pattern of diabetics
undergoing cataract surgery Purpose - to reduce the risk of postoperative
endophthalmitis

(PE). [5922 patients;22.37% diabetics]

Conclusions - Diabetics have a conjunctival flora pattern whose increased
bacteria are a predominant cause of many DMc infections. An abnormally high
blood

creatinine level is an indicator of increased conjunctival colonisation in
diabetics and non-diabetics.

 

30. %% Whole Grain, Bran Intake Linked to Lower Mortality in Diabetic Women
5/11/10   As part of the Nurses' Health Study, 7822 US women with T2DM
completed

regularly administered questionnaires evaluating dietary intakes. During
follow-up (up to 26 years), there were 852 all-cause deaths & 295
cardiovascular

deaths. Compared with the lowest fifths of intakes of whole grain, cereal
fiber, bran, and germ, the highest fifths were associated with 16% - 31%
lower

all- cause mortality rate, after adjustment for age.  "These findings
suggest a potential benefit of whole grain, and particularly bran, in
reducing death

and CV  risk in DM patients," the team leader said.

 

31.%% MW Byetta Improves Cardiac Risk Biomarkers Independent of Body
Composition (Reuters Health) May 11 - T2 patients treated with Byetta
(exenatide)

for one year had significantly reduced body weight and total fat mass and
greatly improved profiles of circulating biomarkers for cardiovascular
disease.

. the biomarker improvements were largely independent of changes in body
composition, suggesting the involvement of other mechanisms. "Until now, all
possible

beneficial effects of exenatide on CVr disease risk were attributed to body
weight change," said lead author."This finding needs to be confirmed by
other

clinical trials and more fundamental

adipocyte [fat cells] molecular studies," he said. [69 patients]

The study was sponsored by Amylin Pharmaceuticals Inc. and Eli Lilly and
Co., which manufacture and market Byetta. Diabetes Care 2010.

 

AACE - Amer Ass of Clinical Endocrinologists (AACE) 19th Annual Meeting

- Abbreviations:  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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