[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1. %% Nature Reviews Nephrology   The RAAS in the Pathogenesis and Treatment
of Diabetic Nephropathy 5/4/10 Abstract - Angiotensin II and other
components

of the renin-angiotensin-aldosterone system (RAAS) have a central role in
the pathogenesis and progression of diabetic renal disease. A study in
patients

with T1DM and overt nephropathy found that RAAS inhibition with angiotensin-
converting- enzyme (ACE) inhibitors was associated with a reduced risk of

progression to end-stage renal disease and mortality compared with
non-RAAS-inhibiting drugs. BP control was similar between groups and
proteinuria reduction

was responsible for a large part of the renoprotective and cardioprotective
effect. ACE inhibitors can also prevent microalbuminuria in patients with
T2DM

who are hypertensive and normoalbuminuric; ACE inhibitors are also cardio-
protective even in the early stages of DM renal disease. Angiotensin-
II-receptor

blockers (ARBs) are renoprotective (but not cardio protective) in patients
with T2 and overt nephropathy or micro-albuminuria. Studies have evaluated
the

renoprotective effect of other RAAS inhibitors, such as aldosterone
antagonists and renin inhibitors, An important task for the future will be
identifying

which combination of agents achieves the best renoprotection (and
cardio-protection) at the lowest cost. Such findings will have major
implications, particularly

in settings where money and facilities are

limited and in settings where renal replacement therapy is not available and
the prevention of kidney failure is life saving...

 

2.%% PPARs in the Spotlight: Insights from Amer College of Cardiology
4/22/10  Slide 1.  Dr R Henry, Prof Medicine at UCSD and Chief of
Endocrinology.

I am joined by Dr D McGuire, U of Texas Southwestern; Dr J Plutzky, Harvard
Med School; and Dr S Nicholls,  Cleveland Clinic. PPAR basics, there are 3

distinct PPARs, or peroxisome proliferator- activated receptors: a, ß/d, and
?. These are nuclear transcription factors that regulate a variety of genes

that are involved in lipid homeostasis, carbohydrate metabolism, and energy
expenditure. PPARa and PPAR? agonists are used therapeutically. -, the
fibrates

are PPARa agonists and are used in the treatment of hyperlipidemia. The
TZDs, or thiazolidinediones  are used in the treatment of T2. TZDs Role in
Insulin

Resistance and T2DM: Emerging Data ..We have been using these drugs now for
fewer than 15 years , and we've seen a lot of observations of intermediate

biomarker effects on CV risk and disease. .we are still trying to understand
what the relevant difference is within the class of drugs - between
pioglitazone

and rosiglitazone. [actos and avandia] .But you know, these drugs are
different, and they have different effects.. rosiglitazone has a product
label "caution"

with regard to the uncertainty with myocardial infarction, and in contrast,
pioglitazone, with 1 large randomized trial and a meta-analysis .. suggests

a   benefit with pioglitazone for atherosclerosis. So, we have 2 drugs in
the same class, lots of markers going in similar directions, but when we put

them in patients, they behave quite differently. So, my perspective from a
CV perspective: in absence of heart failure for atherosclerotic risk disease

mitigation that you should choose the pioglitazone over the rosiglitazone.
pioglitazone  has a more favorable effect on lipids, and numerically less of

a risk for heart failure. So, those are all tilting the balance in favor of
pioglitazone. . I think one of the aspects of this story is that there is
really

no substitute for a prospective, large, randomized clinical trial, Slide 15
gene differential in gene expression,.. one of the groups of genes that
appears

to be quite different in its profile is the metalloproteases .one of the
things that we had noticed early on in the lab was the fact that
PPARa-agonists

could repress adhesion molecules, specifically vascular cell adhesion
molecule-1 (VCAM-1),.And, Jorge, you brought up the point of the changes in
LDL particles

.. Yes, this is the subanalysis of a few centers participating in BARI 2D
who measured lipoprotein particles with NMR and showed, as we have seen
before

with the fibric acids and the TZDs, that there is a shift from small, dense
to large, buoyant LDL, so the mean particle size increases. ..You know, it's

kind of a double-edged Jekyll and Hyde here, in that we are increasing LDL,
which is something we cardiologists don't like to do, but we're also
changing

the characteristics of the profile to what we would perceive to be, though
it is unproven, a less atherogenic distribution..We now have new compounds
coming

into clinic and into phase III, and they appear to have very profound ,
beneficial effects on lipids, ..how will they affect the lipid patterns
compared

to let's say pioglitazone? ..the a/? agonists, appear to be the most
promising with regard to their effect on the lipid profile. So, if you're
looking

beyond glucose control, which all of these drugs are being developed
primarily to do, the ancillary effects, the a/? probably

holds the most promise for CV disease, probably with a similar effect on
hemoglobin A1C and microvascular disease across the classes.

..The wrong message for the DM patient to get is that their diabetes really
isn't coronary disease risk equivalent, because untreated it is. By
untreated,

I do not mean glucose treatment; I mean aspirin for people who are higher
than average risk among DM  patients, and across this swath of diabetic
patients,

aggressive attention to BP and lipid management. So, I think what we are
doing is working. It's the constant tension between the clinician and the
clinical

trialists.. in the last few months we have launched a study called
ALECARDIO, a CV  outcomes study to evaluate the potential of aleglitazar to
reduce CV

risk in patients with a recent acute coronary syndrome event and T2. 6000
patients, 2 to 6 weeks following an acute coronary syndrome, treated with
placebo

or 150 mcg of aleglitazar, for a minimum of 2.5 years. We will ultimately
see what the cardiovascular benefit there is. What's kind of impressive
about

that study is that there's been a lot of confusion about DM drugs and drug
development in the last few years, largely driven by this uncertainty about

rosiglitazone and whether there is harm and how we develop and approve a
diabetes drug, and there's been a lot of discussion at the FDA. Do you show
that

a drug has a metabolic benefit, and then at least try to rule out, that it
doesn't do harm.. What's nice about this study is that it is actually going

1 step further and actually is legitimately testing whether there's an
efficacy. It's powered to see if there is actually a significant reduction
in CV

events .. But also, I think it is important to realize, up until 1995, we
only had 3 therapeutic options:insulin, sulfonylureas, and a-glucosidase
inhibitors.

Then, in 1995, we got metformin, and then there is another span of time
before we get any other drug. So, there was a clinical urgency to bring
drugs to

market, not really waiting until we have these huge outcomes trials that
take years and years to do, and just get something available for our
patients.

That pressure is gone now.  We have over 30 formulations and over 10 classes
of drugs available for treatment of hyperglycemia and T2. And so, I think

it's in that backdrop that the FDA has flipped this switch that says, "With
these signals, we're not exactly sure what we're doing, and we've got a lot

of drugs to use while we investigate both against the placebo and one
against the other comparative effectiveness... we have to remember, we're
not just

treating macrovascular disease here, we also are mitigating microvascular
disease risk. That looks to be a continuum across hemoglobin A1C control. If

we have drugs that favorably affect Hemoglobin A1C and we simply assume that
we're going to favorably affect the microvascular disease risk, then we'll

take that... For the PPARs, and the dual agonists—the 1 thing that persists
for the diabetologist is that insulin resistance is exquisitely severe in
the

vast majority of patients. There was really no other therapy that can
address insulin resistance and appears to do a pretty impressive job of CV
risk factors..

I think addressing the insulin resistance as well as the risk factors, and
hopefully translating this to improve or reduce CV, is going to be crucial
in

the next decade or so. I think the study is well poised to do that. 

 

3.%% NYTimes 5/17/10 Patterns: Testing Link Between Diabetes and Family
History  Diet and lifestyle contribute to diabetes , but so does family
history.

So Australian researchers undertook an unusual experiment: they recruited
healthy volunteers from families with and without a history of T2DM  and
overfed

them. [41 subjects;1,250

calories a day beyond what they needed.] After 4 weeks, all of the
participants had put on weight and showed some signs of insulin resistance,
a condition

that is a precursor to diabetes. But those with

a family history of diabetes gained 7.5 pounds, significantly more than
those without a genetic susceptibility (4.8 pounds). Those with a family
history

of diabetes also showed more insulin resistance. . “T 2 diabetes is both an
environmental and a genetic disease,” said the

senior author, “So people who know they have a history of this should be
extra diligent about eating right and exercising more.”

 

4.%% MW Effect of Prior Intensive Therapy in T1DM on 10-year Progression of
Retinopathy in the DCCT/EDIC: Comparison of Adults and Adolescents 5/7/10;

Diabetes. 2010;59(5)   Objective - The aim of this study was to examine
differences between adolescents and adults in persistence of the benefits of
intensive

therapy 10 years after completion of the Diabetes Control and Complications
Trial (DCCT). [1,055 adults/156 adolescents.]  Results During 10 years of
follow-up,

HbA1c (A1C) was similar between original intensive (INT) and conventional
(CON) groups and between former adolescents and adults. At EDIC year 10,
adults

in the former INT group continued to show slower progression of diabetic
retinopathy than those in the CON group whereas in adolescents this
beneficial

effect had disappeared . Conclusions  Prior glycemic control during DCCT is
vital for the persistence of the beneficial effects of INT therapy 10 years

later. Lowering A1C to as close to normal as safely possible without severe
hypoglycemia and starting as early as possible should be attempted for all

subjects with T1. These results underscore the importance of maintaining A1C
at target values for as long as possible because the benefits of former INT

treatment wane over time if A1C levels rise.

 

5.%% MW Simultaneous Kidney-Pancreas Transplant Outcomes Similar for Type 1
and Type 2 Diabetics 5/12/10   T2 diabetics with brittle diabetes and
end-stage

renal disease have similar survival rates to T1 diabetics after receiving
simultaneous kidney and pancreas transplants (SKP), according to a study
presentedat

the American Transplant Congress 2010. [6650 SKP recipients; (11%) had T2; 4
years follow up ] ..The research is important because although T2 comprised

only about 10% of SKD recipients, there were a lot more T2 than T1 with
end-stage renal disease, according to Dr. Sampaio.  "If you have a patient
with

T2 who has end-stage renal disease and a kidney transplant is indicated, you
can offer a simultaneous kidney– pancreas transplant. But you have to look

at the associated conditions .. If [he/she]is very old or obese, the patient
has more risk. It doesn't matter much if [patient has] T1 or T2  you have

to look at associated conditions to help you decide.,"

 

6.%% Medscape Diabetes & Endocrinology Are ACCORD's Lessons on Hypertension
Applicable for All Patients With Diabetes? 5/11/10

 Summary -Action to Control  Cardiovascular Risk in Diabetes (ACCORD)
enrolled 10,251 high-risk patients with T2DM. All subjects  

were randomly assigned to either intensive or standard glycemic control . In
addition, 4733 participants were randomly assigned to either intensive or

standard (BP) control. (ACCORD BP trial)  targeted systolic BP of less than
120 mm Hg, or standard therapy systolic BP of less than 140 mm Hg. All
participants

were considered at high risk for CV disease.. After 1 year, the mean BP in
the intensive-therapy group was 119/64 compared with 134/71 mm Hg in the
standard

group This difference was achieved through the use of significantly more
medications. No risk reduction in stroke was observed for intensive therapy.
[previous

studies] have demonstrated a clear benefit to tight BP control ..Thus, the
lack of benefit reported in the current study is even more surprising than
the

negative results of the ACCORD glycemic control findings., the median
duration of DM was 10 years in  ACCORD. It is therefore possible that
although tightening

control at this relatively late stage had no effect, earlier aggressive
treatment may still be beneficial. The ACCORD data contained hints that it
takes

many years of tight control to achieve a benefit. For the average DM patient
the current recommendation to maintain a BP of 130/70 mm Hg appears to be

about right. The newly diagnosed, relatively young patient, however, could
still receive (unproven) benefit from tighter BP control.

 

7.%% Processed Meat, Not Red Meat Per Se, Linked to CHD, Diabetes

5/18/10— The first study [Harvard School of Public Health]  to
systematically separate out the effects of red unprocessed meat from
processed-meat products

has shown that eating the former is not associated with an increased risk of
coronary heart disease or DM. But eating 50 g of processed meat per day--the

equivalent of one typical hot dog in the US, or two slices of deli meat--was
associated with a 42% higher risk of CHD and a 19% increased risk of
diabetes.

"We found red meats and processed meats had similar amounts of saturated fat
and cholesterol, but processed meats had about 4 times the amount of sodium

and 50% more preservatives, such as nitrates, than the unprocessed red meat.
. people "shouldn't use these findings as license to eat as much unprocessed

red meat as they like," because although there was no increased risk for
heart disease and diabetes, "it is important to stress that there was no
reduced

risk either." Also, she noted, processed and unprocessed meats have been
associated with a higher risk of some cancers, especially colorectal,
"People

should definitely give more emphasis to increasing consumption of foods that
have been shown to be protective, such as fruits, vegetables, whole grains,

fish, and nuts." The team reviewed and combined all prior published studies
around the world that examined the relationship between eating meat and the

risk of heart disease, DM, and stroke. [20 relevant studies; 1 million
adults world wide]. . they contacted the authors of each study and requested
that

they separate out unprocessed from processed meats. After multivariate
adjustment, red-meat intake of 100 g per day- -defined as unprocessed beef,
pork,

or lamb--was not associated with CHD (4 studies) or diabetes mellitus (5
studies). In contrast, consumption of processed meat--any meat preserved by
smoking,

curing, or salting, such as sausages, bacon, and salami--was associated with
increased risk of CHD .."We know that dietary sodium increases BP, and in

animal experiments, nitrate preservatives have been shown to promote
atherosclerosis and reduce glucose tolerance.

 

8.%% MNTD Computers Can Help Detect Diabetes-Related Eye Problems 5/14/10
People with diabetes have an increased risk of blindness, yet nearly half of

the approximately 23 million Americans with DM do not get an annual eye exam
to detect possible problems.

But it appears that cost-effective computerized systems to detect early eye
problems related to diabetes can help meet the screening need, University of

Iowa analysis shows. The  team compared the ability of two sets of computer
programs to detect possible eye problems in 16,670 people with diabetes.
Each

of the two programs ) performed equally well, achieving the maximum accuracy
theoretically expected. The systems require a trained technician to use a

digital camera to take pictures of the retina, located inside the eye. The
images are then transferred electronically to computers, which can
automatically

detect the small hemorrhages (internal bleeding) and signs of fluid that are
hallmarks of diabetes damage." Our analysis shows that the computerized
programs

appear to be as accurate and thorough as a highly trained expert in
determining if these initial signs of an eye problem are developing in
someone with

diabetes. Once the initial problems are found, an eye specialist can treat
the patient," To explain the system's efficiency,  among a group of 100
patients

with diabetes, 10 people would likely have DM-related eye problems. An
ophthalmologist (eye doctor) would have to check the eyes of all 100
patients to

find out who had problems. The computer programs,  given photos of the eyes
of the same 100 patients, flag on average 20 people as possibly having
DMs-related

eye problems. Thus, an ophthalmologist would need to see only the 20 people
prescreened by the computer program instead of the original 100  allowing
ophthalmologists

to spend time on patients who actually need care and provide better care to
those patients.

 

9.%% MNTD Why Can Surgical Treatment Improve T2DM? 5/13/10 Diabetes mellitus
is a chronic metabolic disease resulted from, either decreased production

of insulin or increased resistance to it from peripheral tissues or both
factors combined together. While medical treatment remains the mainstay of
treatment,

some surgical procedures, such as Roux-en-Y gastric bypass, (RYGB) have
demonstrated potential to be a treatment option for DMs. Increased insulin
activity

is observed among the patients who underwent (RYGB)and it is possibly
associated with increased post-surgical expression of PDX-1(Pancreatic
duodenal homeobox-1)

and regeneration of pancreatic ß-cells. PDX-1 is an important transcription
factor expressed during the embryonic development of the pancreas and
ß-cells

are the insulin secreting  cells found in pancreatic islets. .The findings
provided concrete evidence to explain that the increased expression of the
PDX-1

and regeneration ß-cells are the associated mechanisms of RYGB surgery to
treat T2.

 

10.%%MNTD In Type 2 Diabetes, Treatment Of Gum Disease May Lower Blood Sugar
Levels 5/12/10  The research team analysed randomised controlled trials of

people with T1DM and T2DM who had also been diagnosed with periodontal
disease. The team looked

at 690 papers and included 7studies in the review. Their findings suggest
that the treatment of periodontal disease can reduce blood

sugar levels in T2, although there was not enough available evidence

to support the same benefit for those with T1. Current belief is that, when
bacteria infect the mouth and cause inflammation, the

resulting chemical changes reduce the effectiveness of insulin produced in
the body, thus making it more difficult for diabetics to control their blood

sugar.  The lead author said: "It would be wise to advise patients of the
relationship between treating periodontal disease and the possibility of
lowering

their blood sugar levels. Additionally, an oral health assessment should be
recommended as part of their routine diabetes management."

 

11.%% MNTD How Depression May Affect Diabetes 5/11/10

In this study of patients with T2DM, baseline depression predicted problems
with medication adherence, problems with health-related

behaviors, and unsatisfactory glycemic control at follow-up.[866 pt; Fup 12
months] Patients with depression at t0 revealed increased rates of
medication

nonadherence and problems with diabetes- related health behavior.

 

12.%% 2-Hr Plasma Glucose in "High Normal" Range Tied to Cardiac Death Risk
(Reuters Health) May 13 - Patients whose fasting plasma glucose (FPG) and
2-hour

plasma glucose levels are both within the normoglycemia range are not
necessarily off the hook. If their 2-hour glucose levels are higher than
baseline,

they're at increased risk for insulin resistance and CV death, a new study
shows. A few studies have shown that when 2-hour plasma glucose does not
return

to FPG levels, patients are at significantly higher risk for T2DM and a
worse CV risk-factor profile compared to patients whose plasma glucose
levels do

return to baseline, the lead author said. "We have further

shown that these people's CV disease mortality was also high,"

[12,566men;10,874 women;Fup 9 yr]

 

13.%% NIH News  21 May 2010 : Computers Analyze Environmental Factors in
Diabetes Like many complex diseases, diabetes results from the interplay of
genetic

and environmental factors. To examine genetic risk factors, scientists pore
over the human genome sequence. Environmental factors have been trickier to

pin down because there is no way to evaluate them comprehensively. Now,
researchers at Stanford University present what they call an
environment-wide association

study (EWAS) or a systematic examination of the contributions of hundreds of
factors in the development of T2DM.  This "enviromics" approach, which
mirrors

genome-wide association studies, harnesses high-speed computers and publicly
accessible databases. The authors examined 226 separate environmental
factors

like nutrition and exposure to bacteria, viruses, allergens and toxins. They
found that certain factors, notably a pesticide derivative and the
environmental

contaminant PCB, were strongly associated with the development of diabetes.
Other factors, including the nutrient beta-carotene, served a protective
role.

The authors acknowledge that many challenges remain, including the fact
that, unlike the genome, "the environment is boundless." 

 

14.%% MW Long-Term Metformin Treatment Linked to Vitamin B12 Deficiency
5/24/10   In type 2 diabetes, long-term metformin treatment is linked to
vitamin

B12  deficiency, according to the results of a , randomized,
placebo-controlled trial."Metformin is considered a cornerstone in the
treatment of DM and

is the most frequently prescribed first line therapy for individuals with
T2," writes the team leader  "In addition, it is one of a few
antihyperglycaemic

agents associated with improvements in cardiovascular morbidity and
mortality, which is a major cause of death in patients with T2 .Metformin
does, however,

induce vitamin B-12 malabsorption, which may increase the risk of developing
vitamin B-12 deficiency — a clinically important and treatable condition."

[390 T2 patients being treated with insulin received 850 mg of metformin or
placebo 3x/day;Fup 4.3yr]  The metformin group vs the placebo group had a
mean

decrease in vitamin B12  concentration of -19% and a mean increase in
homocysteine concentration of 5%  At the end of the study, the absolute risk
for

vitamin B12  deficiency was 7.2 percentage points higher with metformin vs
placebo "Long term treatment with metformin increases the risk of vit B-12
deficiency,

which results in raised homocysteine concentrations. Vit B-12 deficiency is
preventable; therefore, our findings suggest that regular measurement of vit

B-12 concentrations during long term metformin treatment should be strongly
considered."

 

15.%%.Associations of Hyperglycemia and Insulin Usage with the Risk of
Cancer in Type 2 Diabetes  5/14/10; Diabetes. 2010;59(5 [4623 pts with T2
free of

cancer, and naive to insulin at enrollment.]  Conclusions —In Chinese
patients with T2, hyperglycemia predicts cancer, whereas insulin usage was
associated

with a reduced cancer risk. Insulin has mitogenic effects and is a
stimulator and regulator of growth and proliferation of a variety of somatic
cells. 

It is suggested that insulin resistance and hyperinsulinemia may be
important risk factors for cancer.

 

16.%%Rise in Obesity Only Partly Explains Rise in Type 2 Diabetes in UK Men
(Reuters Health) May 13 - Not all of the increase in T2among

British men is because they've been getting heavier over time. [6460 British
men ]After adjusting for age, the risk of DM more than doubled between
1984-1992

and 1999-2007 Only an estimated 25.9% of the increased risk could be
explained by a population averaged age- adjusted increase in body mass index
(BMI)

from the start of the first period to the start of the second...

 

17.%% MNTD Ethnic Disparities Found In HbA1c Test - Diabetes UK

23 May 2010  A new study in New Orleans has found that black

children have statistically significantly higher HbA1c scores than white
children. If the higher HbA1c ( A1c) levels found in black children are a
factor

of ethnicity, not actual elevated levels of blood glucose, they could have a
potentially dangerous effect when treating DM based upon glycated
haemoglobin

or HbA1c. The researchers  acknowledge such ethnic disparity has already
been shown in previous studies in adults. [276 children av age 12.5; T1;Fup
6yr]

"The (ADA) has already considered the use of HbA1c for diagnosis and have
published a cut-off for screening for DM with an HbA1cof 6.5%. Diabetes UK's

current position on this is that we are concerned whether this is the
correct cut-off level without having the opportunity to review the evidence
on which

the ADA has based this decision," said the Dirr of Care, "The new WHO
recommendations will need to be discussed and examined carefully... we do
not expect

to see different diagnostic levels for different groups. However, as with
current diagnostic criteria, clinicians will need to use their clinical
judgement

to use varying screening criteria for different groups. For example, people
of South Asian descent should be tested at an earlier age and lower BMI than

people of a Caucasian background. As with all diagnoses, any diagnosis
should be based on the most suitable tests for that population.

 

18.%% NR Endo 6, 297 (June 2010)  Previous intensive insulin treatment has
long-lasting beneficial effects on peripheral

neuropathy. The researchers evaluated the long-term effect of intensive
versus conventional insulin treatment on neuropathy in patients with T1DM
who were

former participants of the Diabetes Control and Complications Trial. The
prevalence of neuropathy increased in both treatment groups, 13–14 years
after

the end of the trial. The incidence of neuropathy, however, remained lower
among former recipients of intensive treatment (22%) than among those who
had

received conventional treatment (28%). 

--

Species differences in the sequence of the islet amyloid polypeptide (

IAPP) gene could underlie the lack of amyloid formation and improved
survival of transplanted porcine islets. One of the limitations of islet
transplantation

has been poor long-term survival of grafts. Potter et al

. transplanted human islets into diabetic mice and detected amyloid
deposition after 4 weeks, which was associated with graft failure. By
contrast, transplanted

neonatal or adult porcine islets that had maintained normoglycemia for up to
195 days showed no amyloid formation. Transplantation of porcine islets
could,

therefore, have therapeutic potential for patients with DM

 

19.%%NR Endo 6, 298 (June 2010) Therapy: Diabetic ketoacidosis [DK],
long-acting insulin analogs and pediatric type 1 DM .  Use of the
long-acting insulin

analogs glargine and detemir does not reduce the risk of DK in children and
adolescents with T1, compared with the use of neutral protamine Hagedorn
(NPH)

insulin.  In a prospective, observational study, researchers evaluated the
incidence of DK requiring hospitalization in 10,682 pts age 20 years with T1

for 2 years. After adjustment for DM duration, HbA1c, sex, insulin dose, age
at DM onset and migration background, risk of diabetic ketoacidosis was
higher

for patients in the group using long-acting insulin analogs than in the
group using NPH insulin. “Contrary to our hypothesis, the use of insulin
glargine

or insulin detemir did not protect children and adolescents from
ketoacidosis,” summarizes the team leader  “..the choice of insulin should
be based on

other, individual considerations of the treating physician.”

 

20.%% NREndo 6, 299 (June 2010) Nocturnal hypoglycemia is frequent in
patients with T1DM. Episodes of nocturnal hypoglycemia are frequent and can
be prolonged

in patients with T1“Hypoglycemia while sleeping is an extremely important
management problem in T1 ”

explains lead researcher,“as it can lead to seizures or coma and in rare
cases even death.” [36,467 nights of data ;176 pts age 8–72] Hypoglycemia
occurred

during 8.5% of the study nights—equivalent to approximately 2 episodes per
month per patient. The median duration of hypoglycemia was 53 min, with 11%

of events lasting =3 h. The researchers found that high hypoglycemia risk
was associated with low baseline HbA1c levels. Once nocturnal hypoglycemia
has

been identified in a patient, overnight insulin delivery and the type of
bedtime snack eaten could be modified to minimize the occurrence of these
events.

Ultimately, this study “reinforces the need for an artificial pancreas in
which the insulin delivery from the pump is adjusted based on the glucose
readings

from the continuous glucose monitoring device,” 

 

21.%% May 2010 NIH Study Finds That Overweight Girls Who Lose Weight Reduce
Adult Diabetes Risk    Overweight girls who lose weight before they reach
adulthood

greatly reduced their risk for developing T2DM [10,000 women] An initial
survey collected information about the women's health, history and lifestyle
habits.

One question asked them to pick which of a series of diagrams best matched
their body shape at ages 5, 10 & 20..Women who indicated that their size at

age 5 matched or exceeded the size 6 figure were more than twice as likely
to develop DM as those who recalled matching the size 2 figure. .women who
recalled

being overweight at age 10 but not overweight as adults were no more likely
to become diabetic than their peers who had been normal-weight children.
"These

findings suggest that ensuring that overweight kids reverse their weight
gain is critical to limiting their future risk of diabetes as adults,"said
study

author. They found  that women who gained weight after age 18 also increased
their diabetes risk.  Those who gained more than 25 pounds increased their

DM risk more than 20 times. 

 

22.%%MW FDA Clears New Blood Glucose Test Strips 5/28/10

FreeStyle Lite ; Abbott Diabetes Care) strips help patients better manage
their DM by minimizing the potential for interference by other sugars. The
glucose-specific

test strips use the (GDH-FAD) enzyme, thereby avoiding falsely elevated
readings that can result from  (GDH-PQQ)–based methods that can be affected
by

common nonglucose sugars, such as maltose or galactose. Compatible with all
FreeStyle Lite monitoring systems, the new test strips also feature a
proprietary

tapered design  intended to ensure quicker blood application and decrease
error messages and wastage. They  are expected to be widely available in the

US by the end of August 2010.

 

 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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