[acb-diabetics] articles

[Patricia LaFrance-Wolf]

1.%% MP Some T1Diabetics Seem Shielded Against Complications 3/29/11
[351pts;T1 for 50yr; av A1C 7.7 %] .. 43% remained free of serious eye
disease, & 87% never developed kidney disease.."We have identified a group
of people who can clearly live well with DM for a long time," said author(
Joslin).. most of them eluded complications because they manage their
disease pretty well, but even in this group some developed complications,
while others appeared to have some sort of protection against them. One
potential reason is suggested by substances called advanced glycation end
products (AGEs), which were 7.2 times more common in those with
complications. AGEs develop in the body after long- term exposure to high
blood sugar levels... The author of accompanying editorial noted that a
receptor for AGE called sRAGE is lacking in people with complications.

2.%% MP Diabetes tied to higher Parkinson's disease [PD] risk 3/30/11
(Reuters Health) - In a study of 289,000 older adults, those with DM have a
slightly increased risk of developing PD. When the team accounted for other
factors - like age, weight & smoking – DM itself was linked to a 41%
increase in the risk of future Parkinson's. That, however, does not prove
that DM is a cause of PD- the reasons for the connection remain unknown,
said the team leader ...People with DM should continue to do the things
already recommended for their overall health -- eating a well-balanced diet
& getting regular exercise.

3.%% MTD 3/30/11 EndoBarrier Triggers Beneficial Hormone Effects Leading To
Rapid Glycemic Control, Weight Loss & Reduced Heart Disease Risk. GI
Dynamics announced new results from 3 studies that demonstrate the positive
effects of EndoBarrier [EB] Gastroin-testinal Liner on T2, wt loss & other
metabolic factors. These data support the use of EB as a primary therapy for
T2 & obesity in pts with BMI 30 + who have been unable to control their DM
or lose weight through lifestyle changes & medications...1 study revealed EB
offered rapid and long- lasting improvement in DM & beneficial hormonal
effects similar to surgical interventions such as Roux-en-Y gastric bypass.
[17pt;24wks] L M. Kaplan (Harvard) commented, "The EB appears to affect the
metabolic functions involved in T2 through mechanisms similar to those that
make bariatric surgery such an effective therapy for DM & obesity." EB is
approved for up to12m use & is available in Europe & S. America. It is an
advanced investigate tional device in the US. EB is placed in the GI tract
endoscopically (via the mouth) to create a barrier between food & the wall
of the intestine. Physicians believe that preventing food from coming into
contact with the intestinal wall may alter the activation of hormonal
signals that originate in the intestine, thus mimicking the effects of a
Roux-en-Y gastric bypass procedure without surgery. 

4.%% MTD Potential New Non-Insulin Treatment For T1 3/24/11 .. Fibroblast
growth factor 19 (FGF19) another hormone, has insulin-like characteristics
beyond its role in bile acid synthesis. Unlike insulin, FGF19 does not cause
excess glucose to turn to fat, suggesting that its activation could lead to
new treatments for DM or obesity. Bile acids, produced by the liver, break
down fats in the body. Utilizing ng FGF19 as an alternative to insulin Rx
remains a daunting challenge .In some studies in rodents caused the liver to
grow & develop cancer.

5.%% M Alerts 3/30/11 A class I recall of the ACCU-CHEK FlexLink Plus
infusion set, made by Roche has been issued because a kinked or bent cannula
could result in under or no delivery of insulin, (FDA) announced."This can
lead to elevated blood glucose levels (hypergly- cemia) [which] can lead to
many serious health complications, including death,".. recall applies only
to ACCU-CHEK FlexLink Plus infusion sets manufactured & distributed from
11/1/10 to 2/20/11. Symptoms of hyperglycemia include nausea/vomiting,
blurred vision, excessive thirst / hunger, frequent urination,
fatigue/sleepiness, headache, fruity acetone breath, & abdominal pain. "If
untreated hyperglycemia could lead to DM ketoacidosis, serious illnesses &
in severe cases death," company said. Customer Care 800-688-4578,

6.%% Oph 118,4 Apr 2011 Ranibizumab Monotherapy or Combined with Laser vs
Laser Monotherapy for Diabetic Macular Edema (DME) [345pts;T1 &T2;12m]
randomized Conclusions:[lucentis alone] & combined with laser provided
superior visual acuity gain over standard laser in pts with visual
impairment due to DME.

7.%% Oph 118,4 Apr/11 Long-term Benefit of Sustained-Delivery Fluocinolone
Acetonide (FA) [a steroid] Vitreous Inserts for DME [565pts;2yr] randomized
subjects received study drug or sham injection. - ..FA inserts significantly
improved best corrected visual acuity. This is the first pharmacologic Rx
that can be administered by an outpt injection to provide substantial
benefit in pts with DME. .

8.%% Elderly Diabetics at More Risk of Anterior Ischemic Optic Neuropathy
(NAION) (Reuters Health) Apr 14 - coauthor said "The annual incidence of
NAION among those 68 and older is much higher than previously reported.. We
found an incidence of 82 per 100,000. The higher incidence may also relate
to misdiagnosis of other
optic neuropathies reported by US providers."

9.%% Oph 118,4 Apr/11 Severity of Diabetic Retinopathy (DR) & Health Related
Quality of Life: To assess the impact of DR & its severity on health-related
quality of life (HRQOL) in a population-based sample of Latinos with T2.
Conclusions - Greater severity of DR was associated with lower general &
vision- -specific HRQOL. Persons with bilateral moderate [nonproliferative
DR] had the most substantial decrease in quality of life compared with those
with less severe DR. prevention of incident DR & its progression from
unilateral to bilateral ..should be considered an important goal in
management of individuals with DM.

10.%% UPI 4/2/11 Diabetes makes you older before your time Adults ages 51-70
with DM developed age-related ailments such as cognitive impairment, falls,
dizziness, vision impairment & pain at a faster rate than those without
diabetes. For adults age 51-60 with DM the odds of developing new geriatric
conditions were nearly double those who didn't have DM, but by the time
people reach 80, the disparities begin to disappear.."Because DM affects
multiple organ systems, it has the potential to contribute significantly to
the development of a number of issues that we associate with aging." study
leader said

11.%% M More Data on Diabetes Risk With Statins 3/31/11 A new analysis of 3
major trials with atorvastatin (Lipitor) suggests that the risk of new-onset
DM with statins appears to be dose dependent and related to the strength of
cholesterol lowering achieved with the statin --ie, the more powerful the
statin, the higher the risk of DM. But the authors, as well as other
experts, stress that the benefits of statin treatment still clearly outweigh
the risks in patients with coronary or cerebrovascular disease.

12.%% M 4/28/11 CBT for Depressed Diabetes Patients Improves Overall Health
Cognitive behavioral therapy (CBT) targeting depression in patients with DM
is associated with improvements in overall health but not in glycemic
control, according to the
results of a randomized trial "Depression is a common, treatable issue for
many people who have diabetes," said lead author “This study shows that
telephone-delivered counseling can improve patients' access to effective
depression care, improve their CV health and get them moving again." [291
pts] randomly assigned to receive usual care or a manualized telephone CBT
program delivered weekly by nurses for 12 weeks, followed by 9 monthly
booster sessions.
Limitations of this study include duration of follow-up limited to 12
months, limited generalizability because only 16% of participants were
racial/ethnic minorities, In addition, 31% of patients contacted refused
participation. NIH

13.%% Nature Med Apr/2011 Metabolite profiles & risk of developing DM
Emerging technologies allow profiling of metabolic status from a blood
specimen (metabolomics). [2,422 normoglycemic subjects;12yr] Amino acids &
other metabolites were profiled by liquid chromato-graphy–tandem mass
spectrometry . A combination of 3 amino acids predicted future diabetes
(with a more than fivefold higher risk for individuals in top [quarter]).
These findings underscore the potential key role of amino acid metabolism
early in pathogenesis of DM & suggest that amino acid profiles could aid in
DM risk assessment.

14.%% MAP 4/2011 Long-term effects [5yr] of intensive glucose lowering on
cardiovascular outcomes. We randomly assigned pts with T2 & CVD or
additional CV risk factors to receive intensive therapy (targeting a
glycated hemoglobin level below 6.0%)or standard Rx (7-7.9%). Conclusions:
As compared with standard Rx, the use of intensive therapy [as above]
reduced 5-yr nonfatal MI but increased 5-year mortality. Such a strategy
cannot be recom mended for high- risk pts with advanced T2. Nat Heart, Lg &
Blood Institute

15.%% MAP 4/11 Functional variants of the HMGA1 gene & T2DM. High- mobility
group A1 (HMGA1) protein is a key regulator of insulin receptor gene
expression..Case-control study [3278 pts;] The most frequent functional
HMGA1 variant.. was present in 7- 8% of pts with T2. Conclusions: Compared
with healthy controls, the presence of functional HMGA1 gene variants in
individuals of white European ancestry was associated with T2.

16.%%MAP 4/11 Racial differences in glycemic markers: Although differences
between black & white pts in hemoglobin A(1c)(HbA (1c)) values are well
established, recent studies suggest this might not reflect differences in
glycemia. [376 control;343DM] Conclusion: Differences between black & white
persons in glycated albumin .. & fructosamine levels parallel differences
between these groups in HbA(1c) values. Racial differences in hemoglobin
glycation and erythrocyte [red blood cell] turnover cannot explain racial
disparities in these serum markers. The possibility that black persons have
systematically higher levels of nonfasting glycemia warrants further study.

17.%% HD Certain Diabetes Drugs Better for Heart Health, 4/7/11 In a study
that included more than 100,000 subjects taking metformin or another group
of oral DM medications called insulin secretagogues , (IS] researchers found
that metformin & the IS drugs gliclazide & repaglinide had the lowest risk
of CVD & death. an accompanying editorial said the findings are likely an
indication that metformin, gliclazide & repaglinide are protective. They
cautioned that people shouldn't stop taking any type of DM drug on their
own. If you're concerned, "have a discussion with your care provider."

18.%% Nurs. Times Poor sleep for diabetes patients linked to eye disease
4/10/11 T2 patients with sleep problems are at higher risk of eye disease,
foot problems & amputation [231;148 with obstructive sleep apnoea (OSA)].
They found 48% with severe retinopathy in the OSA group & 20% in the non OSA
group. authors said: “Our results suggest that OSA is not an innocent
bystander in patients with T2 & might contribute to morbidities associated
with this condition.”

19.%% MTA 4/25/11 Early Warning That A Child Will Develop DM May Be Possible
By Monitoring Protein Levels Scientists are looking at blood levels of
interleukin-1 receptor antagonist (IL-1ra) in children being closely
followed because their genes put them at risk for T1. They also are looking
at DM mice missing IL-1ra to see how its deficiency affects immune function
& destruction of insulin-producing islet beta cells. "We want to know if we
can use IL-1ra levels to identify children who will soon develop DM, then
use IL-1 inhibitors to prevent it," said team leader. [see #30]

20.%% delete 
21.%% M 1 4/6/11 Intensive glycemic therapy reduces the risk of erectile
dysfunction (ED) in young men with T1 no matter where he falls on the
spectrum of glucose control, "there is a benefit to tight control, namely a
lower risk of ED," said lead author [600 pts; 6.5yr] 23% reported ED. In
those with some microvascular manifestations, tightly controlled pts had
12.8% rate vs 30.8% of ED in those managed with non-intensive therapy.
Higher (Hb)A1c was significantly assoc. with ED risk in both cohorts. Other
risk factors were age, peripheral neuropathy and lower urinary tract
symptoms. 

22.%% MP Spot Warning Signs of Low Blood Sugar 4/8/11 -- Hypoglycemia [hypo]
is the medical term for low blood glucose, common among people with DM. It
can occur even when you're trying hard to manage your blood sugar levels.
ADA says while you can't always prevent hypo, you can take steps to treat it
if you know the warning signs: • Sweating or turning pale. • Feeling dizzy
or shaking.
• Developing a headache.• Feeling hungry.• Showing moodiness, or rapid
behavior changes. • Moving awkwardly or clumsily. • Having a seizure.•
Acting confused, or having problems paying attention.
• Having a tingly feeling around the mouth.

23.%% HD Nasal Insulin Induces Immune Tolerance of Injected Insulin
4/13/11 [52 pts;12m] were randomly allocated to receive nasal insulin or a
nasal placebo "Our finding that the antibody response to subcutaneous
insulin was suppressed by prior treatment with nasal insulin is the first
evidence for immune tolerance induction to an autoantigen demonstrated by
rechallenge in humans," they write.

24.%% MTD Link Found Between High-Fat Diet & T2 4/12/11 People who acquire
T2 are typically obese & are resistant to insulin, the hormone that removes
sugar from the blood and stores it as energy. A new study finds that
saturated fatty acids but not the unsaturated type can activate immune cells
to produce an inflammatory protein, called interleukin-1beta.
"Interleukin-1beta then acts on tissues and organs such as the liver, muscle
& fat (adipose) to turn off their response to insulin, making them insulin
resistant to develop T2. supported in part by NIH 

25.%% MTD Latest Findings On The Effects Of Caffeine In Diabetes
4/8/11 A growing body of research suggests that caffeine disrupts glucose
metabolism and may contribute to the development & poor control of T2
..contradicting earlier studies suggesting a protective effect of caffeine.
.numerous studies that have shown caffeine's potential for increasing
insulin resistance (impaired glucose tolerance) in adults that do not have
DM, an effect that could make susceptible individuals more likely to develop
the disease. In adults with T2, studies have shown that the increase in
blood glucose levels that occurs after they eat carbohydrates is exaggerated
if they also consume a caffeinated beverage such as coffee. The new review
of the topic gives the clearest account to date of what we know,..

26.%% MP Latest Artificial Pancreas Trials Reduce Risk of Low Blood Sugar
4/14/11-- An artificial pancreas combines insulin pumps & continuous glucose
monitors with a computer algorithm that tells these devices what to do when
blood sugar levels are rising or falling. The closed loop insulin delivery
system, computes insulin doses & administers them according to glucose
levels detected by a sensor. The hope is that an artificial pancreas will
closely mimic the way the human pancreas normally releases insulin in
response to food or stress. .in a 24-hour period, the average person with T1
spends about 10 hours with blood sugar levels too high, & about an hour a
day with blood sugar levels too low, an accompanying editorial noted that
the artificial pancreas is still "in its infancy," but some experts were
cheered by the findings. "This study [24 pts] is more good news, and we're
seeing an evolution of more and more sophistication in this closed loop
study," said Kowalski.

27.%% M 3/15/11 Only Long-Term Diabetes Is a 'CHD Risk Equivalent'
In a study of more than 4000 middle-aged men, a diagnosis of DM in pts 60 &
older, with a mean diabetes duration of 5 yrs, had a CHD risk half that of
patients who were diagnosed with DM before age 60 & who had DM for more than
16 years. In the early- onset diabetes pts, the risk of death &vascular
events was equivalent to patients with a prior MI. The results suggest "that
a longer duration of diabetes may be necessary to raise risks toward a CHD
risk equivalent." writes study author.

28.%% MP 4/17/11 Do Immune System Ills Help Drive Type 2 ?
Findings from mouse, human research suggest new insights.."The main point of
this study is trying to shift the emphasis in thinking of T2 as a purely
metabolic disease, & instead emphasize the role of the immune system said
study co-author. The team has identified immune system antibodies in people
who are obese & insulin- resistant that aren't present in people who are
obese without insulin resistance. Nearly 26 mil Americans have DM 90-95%
have T2 where the body doesn't use insulin efficiently, so the pancreas must
make increasing amounts & eventually, it stops making enough insulin to meet
the increased demand. T1 occurs when the immune system mistakenly destroys
the insulin-producing beta cells in the pancreas. This type of DM is
considered an auto-immune disease, & isn't linked to how much a person
weighs. .. excess weight has been linked to inflammation.. As visceral fat
(abdominal fat) expands, it eventually runs out of room. At that point, the
fat cells may become stressed, inflamed, & eventually die. When that
happens, immune system cells -macrophages- come to sweep up the mess. Other
immune system cells-T-cells & B-cells, also respond to the stressed or dying
cells. But, these cells are the ones that create specific antibodies to
remember a threat to the body such as a certain flu virus. In this case,
however, instead of creating antibodies against a foreign substance, immune
system cells create antibodies against fat cells; attacking them, making
them insulin resistant & hindering their ability to process fatty acids. In
addition to T2, this onslaught against the fat cells is associated with
fatty liver disease, high cholesterol & high BP, according to the team. [32
obese humans] the mice & human volunteers were all male, so it's not clear
if these findings are applicable to women.

29.%% Nat Reviews Endocrinology 7, 248 (May 2011) Pathogenesis of diabetes
mellitus: does glutamate have a role? Glial glutamate transporter 1 (GLT1)
is expressed in pancreatic ß cells and acts as a critical regulator of
extracellular glutamate levels, which in turn promotes ß-cell survival,...To
read this article in full..

30.%% ADA 4/26/11 New study describes molecular process that causes T1 A
team has identified a gr of previously unknown immune system cells that may
play a major role in development of T1. These findings could lead to the
creation of new drugs to suppress these cells & help people avoid the
condition. The team showed that a previously unknown subset of CD4+ T cells
produce proteins called chemokine receptor 9 (CCR9) & interleukin 21
(IL-21). Both of these proteins have been shown to play active roles in the
ability of another immune cell known as CD8+ to cause inflammation in
tissues of the gastrointestinal tract. When pancreatic tissue becomes
inflamed, insulin-producing islet cells are killed, resulting in T1.[see
#19]

31.%% M 4/14/11 Diet Drug Orlistat Linked to Kidney, Pancreas Injuries A
review of patients taking orlistat (Xenical/Alli,) show a 2% increase in
acute kidney injuries within one year of starting the drug . in May 2010,
the FDA issued a warning about the risks of severe liver injury with
orlistat use.. Thursday, GlaxoSmithKline, which sells over -the-counter
orlistat (Alli) in the US, announced that it is one of the products to be
dropped in 2011

32.%% M Patients With DM Lack Knowledge About Hypoglycemia
4/14/11 A national survey [2530 adults with T2] in the US reveals that many
pts remain uneducated about the risks for hypo 42% had experienced low blood
sugar symptoms while working, 26% while exercising, & 19% while driving. 27%
did not know that the leading causes of hypo..included skipping meals. 35%
did not know that some DM meds may enhance the risk for hypo. some did not
know that the most common symptoms are dizziness & shakiness & 39%
incorrectly thought that thirst was the primary symptom. "The survey shows
that it's important to inform pts about the causes, symptoms, & how to
address hypoglycemia," one presenter said. Amer College of Endo. recently
launched Blood Sugar Basics, an educational program with a Web site that
includes fact pages on how pts with DM can best manage their blood sugar
levels.

33.%% MAP 4/20/11 Effects of obesity & T2 on cardiac structure and function
in adolescents & young adults. Results: Adolescents with obesity &
obesity-related T2 were found to have abnormal cardiac geometry compared
with lean controls..our findings suggest that adolescents with obesity-
related T2 may be at increased risk of progressing to early heart failure
compared with their obese & lean counterparts.

34.%% MAP 4/20/11 HbA(1c) levels in schoolchildren with T1 are seasonally
variable & dependent on weather conditions. [589pt] The lowest HbA(1c)
levels were observed in late summer & highest in winter months- differences
exceeding 0.44%. Conclusions: Seasonal changes of HbA(1c) levels in
schoolchildren with T1 are a significant phenomenon & should be considered
in pt ed & DM management

35.%% MAP 4/20/11Low serum potassium levels and risk of type 2 
[4409 Japanese men;5yr] Conclusions: Mild to moderately low serum potassium
levels, within the normal range & could be predictive of T2.

36.%% MAP 4/20/11 effect of high-protein, low-carbohydrate diets in the
treatment of T2: [99pt;12 m] randomised to..high protein or high carbo diet.
HbA(1c) decreased in both groups over time as did weight
serum triacylglycerol, total cholesterol, and increases in HDL. results
suggest that there is no superior long-term metabolic benefit of a
high-protein diet over a high-carbo in the management of T2.

37.%% M 4/18/11 Metformin vs. Other Sulfonylureas: CV Risk Most
sulfonylureas used by a cohort of adults with T2 raised clinical risk
compared with metformin , regardless of MI history..[107,000 pts] 

38.%% MP Many kids with T1 have other immune diseases 4/21/11
[491pts] Researchers measured blood levels of "autoantibodies" that serve as
markers of certain conditions. Autoantibodies are immune system proteins
directed against the body's own cells. T1 is known as an autoimmune disease,
where the immune system launches a misguided attack on the body's own
tissue. In the case of DM, the assault kills off cells in the pancreas that
make the blood-sugar regulating hormone insulin. ADA recommends that
children with T1 be tested for thyroid disease & celiac disease at the time
of their DM diagnosis. The study leader says parents should pay attention to
their children's growth & physical development, & keep track of problems
they are having with episodes of low blood sugar, abdominal pain,
constipation or diarrhea. It's estimated that 15 -30% of people with T1 have
autoimmune thyroid disease, 4-9 % have celiac disease, and less than 1% have
Addison's.

39.%% JH 4/21/11 Importance of Vitamin D in Diabetes Management
..until recently, vitD hasn't been considered an important factor in
controlling diabetes. A growing amount of research links a deficiency of
vitD to an increased risk of developing T2 or its complications. Vitamin D's
main role in the body is to help with calcium absorption, which, in turn,
promotes bone strength & maintains healthy bones & teeth. VitD also
strengthens the immune system. Researchers are discovering that vitD also
plays a role in regulating blood glucose levels. In people who have DM, vitD
has been shown to increase insulin production by regulating blood levels of
calcium & improving pancreatic beta-cell function. Low vitamin D levels are
also known to nearly double the risk of CVD in people with DM and to
increase the risk of heart attack and stroke... more research needs to be
done to prove that attaining adequate levels through sun exposure, food
intake or supplements will lower risk. Still, it's important to meet your
daily vit D requirements. It's also a good idea to ask your doctor about a
blood test to measure your vitamin D levels.

40.%% M Bromocriptine: A Sympatholytic, D2-dopamine Agonist for the
Treatment of T2 Diabetes 4/19/11 .. bromocriptine taken within 2 h of
awakening is believed to augment low dopamine levels..resulting in increased
suppression of liver glucose production. Addition of bromocriptine to poorly
controlled T2 pts treated with diet alone, metformin, sulfonylureas, or
thiazolidinediones produces a 0.5–0.7 decrease in HbA1c, fasting & postmeal
plasma free fatty acid & triglycerides. [52pt] double- blind,
placebo-controlled study.


41.%% M 4/19/11 Nocturnal Hypoglycemia Common in Pediatric T1 
As many as two-thirds of children and adolescents with T1 have nocturnal
hypoglycemia,(NH) a pilot study suggests. [25pt] Those with NH were
significantly older (mean, 12.8 years) than those without NH (mean, 9.4
years; ..

42.%% MAP Relationship Between Sleep-Disordered Breathing and Iris and/or
Angle Neovascularization in Proliferative Diabetic Retinopathy (PDR) Am J
Oph 2011 [151pt] Conclusions In pts with PDR, nocturnal intermittent
hypoxia/reoxygenation resulting from sleep-disordered breathing may be a
risk factor for iris &/or angle neovascularization. [growth of abnormal new
vessels]

43.%% MP 4/28/11- Weight loss surgery appears to change the body's
metabolism in a way that dieting alone cannot, helping to explain why T2
often disappears after the surgery even before much weight is lost. 
The team found that unlike dieting, gastric bypass [Roux-en-Y] changes a
person's metabolism by significantly reducing levels of circulating amino
acids -- compounds linked with obesity, DM & insulin resistance. They are
now looking to discover ways to develop drugs that could replicate this
effect.

Abbreviations: fup-follow up; pt - patients; DM - diabetes Mellitus; T1DM -
type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema;DR -
diabetic retinopathy; FPG - fasting plasma glucose; BP - blood pressure; GI-
gastrointestinal tract;NV- neovascularization; CVD - cardiovascular disease;
MI -myocardial infarction/ heart attack ; OCT - optical coherence
tomography; BCVA - best corrected visual acuity ;ADA - Am Diab Ass & ADA
Prof; HD -HealthDay; M- Medscape Web MD; MAP- Medline Abstract &Plus; MTD-
Med News Today;NEI - Nat Eye Institute; Definitions via online Medical
dictionaries. Disclaimer, I am a BSN RN but not a diabetic or diabetic
educator. Reports are excerpted unless otherwise noted. [translations,
explanations by thl] This project is done as a courtesy to the
blind/visually impaired and diabetic communities. Dawn Wilcox RN BSN
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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