[acb-diabetics] Many articles

[Patricia LaFrance-Wolf]

1.%% M 11/30/11 In Diabetes With Chronic Kidney Disease (CKD), Moderate
Glycemic Control May Be Ideal - In patients with DM & 
CKD, HbA1c targets that fall between 7% - 9% may be associated with
decreased risk for adverse outcomes, whereas levels either above or below
this range may increase this risk,according to a new study. [21,155 pts;3.8
yrs] for stage 3 & 4 of CKD, HbA1c levels above 9% were associated with
significantly higher all-cause mortality than HbA1c levels below 7%.

2.%% ADA 12/1 Liquid cinnamon extract helps control BS levels A
Meta-analysis of pts with T2 &/or pre-DM concluded cinnamon extract &/or
cinn. helps lower BS levels. "Consuming cinnamon..does produce a modest but
statistically significant lowering in fasting blood glucose," said author
UC. published in the J of Medicinal Foods

3.%% M11/29 T2DM Risk Variants & Colorectal Cancer Risk [8060pts] 9 single
nucleotide repeats (SNPs) associated with T2 were tested in a case-control
study. Summary- results suggest that established T2 risk variants contribute
to the risk of colorectal cancer. This finding builds upon previous studies
showing an association between DM & colorectal cancer, & provides new info
on the complexity of the pathways shared between these 2 diseases.

4.%%M12/11 FDA Plan for Developing Artificial Pancreas[AP] Pleases Critics
Spurred on by DM advocacy grps & politicians to pick up its regulatory
speed,FDA issued preliminary recommendations to help, not hinder,
researchers & manufacturers in their pursuit of the AP. AP consists of an
insulin pump & a continuous glucose monitor (CGM) connected to a sensor
placed under the skin of a pt with T1. The system automatically doses the
right amount of insulin based on the pt's glucose levels. An ultimate form
of the system called "treat-to- target" would set a desired level for BS &
try to maintain it at all times, as opposed to merely staving off highs &
lows.. Such a fully automated device would allow people with T1, to lead
active lives without having to constantly check their glucose levels. Right
now, US researchers are testing the AP in inpatient clinical trials. At
issue is how quickly the research can reach the stage of outpatient trials,
which are already underway in other countries. Groups such as the
JDRF(formerly the Juvenile Diabetes Research Foundation) & ADA contend that
an overly cautious FDA has prevented life-saving technology from reaching
pts in a timely manner. More info on the draft guidance on FDA Web site

5.%% ADA 12/2 Video shows diabetes cell processes A team at La Jolla
Institute created videos showing immune system T-cells attacking
insulin-producing beta cells in the pancreas of mice.. "In the past,
scientists would remove a pancreas & make sections of it. That gave you a
snapshot of cellular destruction. But the videos let you see it happening.."
www.upi.com/Science_News/ 2011/12/02/Video-
shows-diabetes-cell-processes/UPI-70301322850997/?spt=hs&or=sn

6.%% M 11/25 Moderate Drinking Tied to Lower DM Risk [80,000pts;26 yrs] the
team found that those who ate a diet high in refined carbs had a 30% lower
risk of developing DM than women with similar eating habits who didn't drink
alcohol. Previous research linked mod. drinking with lower DM risk, but this
study looked at women with high-glycemic diets. "If you eat a high carb diet
without drinking alcohol, your risk of developing DM is increased by 30%,"
said author [moderate- typically 0.8 oz of alcohol a day, about two drinks
per wk.] Dr. Hu isn't encouraging people to start drinking alcohol as a
means of DM prevention, but he does think the study reveals an interesting
interaction between alcohol & carbs. Am J Clin Nutr 2011.

7.%% M 12/9 Double-blind, Randomized, Multicentre,..Investigation of the
Effect Of Pioglitazone [actos] Metformin, & Combination of Both on CV Risk
in Pts With T2 Receiving Stable Basal Insulin Therapy Hanefeld et al;
Cardiovasc Diabetol.2011;10(65) [121 pts] Conclusions - In pts with long
term T2 & suboptimal stable insulin Rx the addition of [actos] but not
metformin reduced the level of inflammatory biomarkers & increased insulin
sensitivity & adiponectin The combo of pioglitazone with metformin resulted
in better HbA1C & lipid control without added effect on inflammation,
fibrinolysis, & renal function. No serious side effects were observed but
pioglitazone Rx was assoc with more edema & weight gain as expected.
Controlled clinical trials measuring CV endpoints are needed to compare risk
benefit of individual add-on treatment with oral antidiabetic drugs to basal
insulin, a question which is of high clinical relevance.

8.%%MNT12/8 Women On Rotating Night-Shifts At Increased Risk Of Type 2
Diabetes, Weight Gain In women, there is a strong association between
rotating night shift work and the risk of T2 . Long hours of shift work, is
also associated with greater weight gain. These findings by Frank Hu of
Harvard School of Public Health This public health finding is representative
since a large proportion of the working population is involved in some kind
of permanent night shift work. Using statistical models, it was found that
the risks of women developing T2, increased with the numbers of years
working rotating shifts. The associations were slightly weaker after other
factors were taken into consideration. The findings show that preventative
strategies, in rotating night shift workers, should be considered. Since we
exist in an increasingly '24/7' society, and the option to eradicate shift
working is not realistic, it has been determined that rotating shift work
among T2 diabetes shift workers through promotion of healthy life styles,
weight control, early identification with treatment of pre-diabetic and
diabetic employees is needed.

9.%% M 12/5 New Criteria for Gestational Diabetes (GDM) Increase Diagnoses
The use of more stringent criteria for diagnosing GDM is associated with a
137% increase in prevalence. The new criteria, proposed by the Internat
Assoc of DM & Pregnancy Study Groups have been endorsed by ADA but not by
the Am College of Ob & Gyne-cologists. The new criteria call for the
diagnosis of GDM after a single abnormal fasting plasma glucose result of
92-126 mg/dL at the first prenatal visit or, if the initial test is normal,
an abnormal oral glucose tolerance test at 24 -28 wks of gestation... [660
pts] using the new criteria, were compared with a historic cohort that had
been evaluated using the old criteria. The dramatic increase in GDM
diagnosis seen with the proposed criteria have been the subject of much
discussion...

10.%% M 12/5 Depression Doubles Dementia Risk in Diabetic Patients
A large study [19,000 pts] showed those who also had depression had a 2-fold
higher risk of developing dementia over 5yrs compared with their
counterparts who did not have depression. In addition, younger pts with
depression also had a significantly higher risk for dementia vs those who
were older, whereas those who took insulin had a significantly lower risk
compared with those were not on insulin. ".., future studies are needed to
further evaluate whether effective depression interventions reduce the risk
of dementia and identify the mechanisms that may explain our observation,"
say investigators..

11.%% ADA 12/7 Fructose No Substitute for Glucose in Diabetes
Although it negates the dumping of glucose directly into the blood-stream,
fructose may not be an ideal sweetener for DM. Its links with
hypertension,[fat tissue] & increased uric acid levels could potentially
outweigh its immediate BS benefits, especially among DM pts who already have
or are at risk for such [problems] Fructose, the main sugar found in fruits,
is a monosaccharide, like glucose. But unlike glucose, which requires
insulin to move it into the body's muscle tissue where it's processed into
energy, fructose is metabolized by the liver. There, it's changed into
glycogen, a starch, & lipids, author said-Boston U. Some studies show that
fructose intake is linked with higher levels of triglycerides, potentially
contributing to weight gain. It's also been tied to increased levels of uric
acid- which situation has been linked with atherosclerosis, (hardening of
the arteries) a known complication of DM itself. The same problems could be
assoc. with high-fructose corn syrup, a polysaccharide that's chemically
similar to plain table sugar (sucrose.) It is half fructose & half glucose
Thus, diabetics get the initial dumping of blood glucose, plus the liver hit
of fructose. ADA doesn't recommend fructose as a substitute sweetener for
glucose. It does recommend fruit intake as part of a healthy diet -- the
amount of fructose in fruits is hardly enough to contribute significantly to
obesity.

12.%% JH 12/8 Diabetes & the Glycemic Index [GI] The GI is the amount that a
particular carbohydrate raises the blood glucose levels [BS] level as
compared with a slice of white bread, a reference point with a GI of 100.
Foods with a GI higher than 100, (instant rice), cause a faster & greater
surge in BS. Kidney beans score low at 38 - glucose jumps much less after
eating them. Because foods with a low GI (whole grains & most fruits & vegs)
do not produce as rapid an increase in BS levels when eaten,proponents of
these diets claim that they are more healthful than foods with a high index.
The GI can encourage better carb choices, such as eating more fiber & fewer
high-sugar foods, but it may also lead to worse choices, such as avoiding
carbs altogether & eating fattier foods. There are certain limitations to
the GI- For instance, it considers the effect only of the carb & not the
other foods you are putting in your stomach at the same time.. In our
opinion, Choosing healthy carbs is certainly beneficial, but this does not
have to be done with a careful glycemic index calculation.

13.%% 12/8 ADA Adding dapagliflozin to sulfonylurea improved HbA1c in T2
Study results demonstrate that when added to sulfonylurea therapy,
dapagliflozin reduced HbA1c at 24 weeks vs. placebo plus sulfonylurea in pts
with T2. The reduction was maintained at 48wks..[452pts;48wks]
EndocrineToday

14.%% MP 12/6 Diabetes, Obesity After 60 May Drive Up Breast Cancer Risk--
[2700pts developed breast CA out of 20,500 total pts; 10yr] Obesity after
age 60 boosted breast cancer risk by 55%. Up to 4yr after a DM diagnosis,
women of any age had a 37% higher risk of developing breast CA. There was
also a link between abnormally low levels of blood lipids or fats, & a 25%
higher risk. Glargine (Lantus) was linked with a nearly doubled risk of
breast cancer. However, metformin (Glucophage) was linked with a slightly
lower risk.

15.%% Eye 25 Dec 2011 Regression of early diabetic macular oedema (DMO) is
associated with prevention of dark adaptation [34pts] with mild
non-proliferative diabetic retinopathy [DR] & early, untreated
non-sight-threatening DMO slept for 6months wearing masks that illuminated
the eyelid of one closed eye. Conclusions Sleeping in dim light that can
keep rods light adapted may reverse the changes of DMO. Editorial same
source: Arden et al have tested the hypothesis that keeping an eye with mild
DR light adapted during sleep will substantially reduce rod oxygen
consumption, & thus will have remedial effects on the disease by making the
retina less hypoxic. In the dark, rods maintain the phototransduction dark
current, & the result is that oxygen consumption by rods in the dark is
greater than any other cell in the retina. In studies by Okawa et al, bright
light decreased retinal O2 consumption in the mouse by 40-60%..mostly due to
a drop in ATP consumption by the rods. To read in full...

16.%% MP12/8 DM Type 2:Insulin treatment T2 occurs when the pancreas (an
organ in the abdomen) produces insufficient amounts of the hormone insulin
&/or the body's tissues become resistant to normal or even high levels of
insulin. This causes high blood glucose (sugar) [BS] levels, which can lead
to a number of complications. Treatment includes lifestyle adjustments,
self-care measures, & medications, which can minimize the risk of DM-related
& CV compli-cations (heart attacks/strokes). Keeping BS levels in control is
one way to decrease the risk of complications. Heart disease a
macro-vascular disease is the most common complication of T2. Macro- means
large, & vascular means vessels. Also at increased risk of developing micro
vascular(small vessel) disease are the eyes, nerves, & kidneys, which can
result in blindness, foot ulcers/amputation, kidney diseases & impotence in
men. Micro & macrovascular comp-lications usually occur after many years of
DM & are related to elevated levels of BS over time. However, these
conditions may be present when T2 is first diagnosed due to a delay in
getting the diagnosis. Blood sugar control can be measured with a blood test
called A1C that measures the average BS during the past 2-3 months. The goal
A1C for most people with T2 is less than 7%. However, goal A1C levels in Pts
with T2 should be tailored to the individual- the A1C goal should be set
some what higher (8 %) for frail older pts & those with a limited life
expectancy.
T2 Treatment Options: Most people who are newly diagnosed with T2 are
treated with a combination of diet, EX, & an oral medication ( pills) Some
oral medications (eg, metformin) improve the body's response to insulin.
Other meds cause the body to produce more insulin. A second medication may
be added within the first 2-3 months if BS control is not adequate. Insulin
may be recommended early if the A1C remains elevated despite lifestyle
changes & DM pills. T2 typically progresses over time, causing the body to
produce less insulin & resist the action of insulin that is produced. In
addition, it can be difficult for some people to follow the recommended
diet, EX or Rx plan. Some people will need to add insulin or another
injectable med. because their BS levels are not controlled... Nat Institute
DM & Digestive & Kidney Diseases (www.niddk.nih.gov/) ADA 800-342-2383
(www.diabetes.org) topic updated: Sept 20, 2011

17.%%MP 12/22 Hepatitis B Vaccine Recommended for Adults With DM --
Hepatitis B vaccination is recommended for all unvaccinated adults with T1 &
T2 aged 19 to 59, say new guidelines from the U.S. Advisory Com on
Immunization Practices (ACIP). The vaccination should be done as soon as
possible after adults in this age group are diagnosed with DM. Those who are
older than 59 can receive hepatitis B vaccination at the discretion of their
doctor. Between 700,000 & 1.4 mil people in the US are infected with
hepatitis B virus (HBV) More than 15 % of adults with chronic HBV infection
develop cirrhosis & liver cancer, authors noted. Diabetics are at increased
risk for HBV infection, which can occur through exposure to small, even
invisible, amounts of blood from an infected person who earlier used a
shared medical or glucose-monitoring device, the article states. HBV can
survive outside the body and is easily transmitted.

18.%%ADA 12/12 UK research into a rare genetic disorder (pancreatic
agenesis) may speed up progress towards stem cell treatments for T1. In
pancreatic agenesis, the body is unable to produce a pancreas, which plays
an essential role regulating BS levels."What is it that programmes cells to
become pancreatic beta cells? Our study suggests that a gene GATA6 plays a
very important role in this process & we hope this will help the crucial
work to try & make beta cells for pts with T1." team leader said. T1, or
insulin dependent DM is an auto-immune disease in which the body's own
defences attack & destroy pancreatic beta cells. Pub - Nature Genetics. 

19.%% Am J Oph 153 Jan 2012 Panretinal Photocoagulation for Proliferative
Diabetic Retinopathy (PDR): Pattern Scan Laser Versus Argon Laser Purpose -
To evaluate the efficacy of the pattern scan laser(PASCAL)in treating newly
diagnosed high-risk PDR [82eyes;6m] Conclusions - When using traditional
laser settings, PASCAL is less effective than that performed with
traditional argon laser in obtaining lasting regression of retinal
neovascularization in previously untreated high-risk PDR. Physicians may
need to change Rx regime when using PASCAL pattern laser therapy for
high-risk PDR.

20.%% Am J Oph 153 Jan 2012 Retinal Arteriolar Tortuosity [twisting] is
Associated With Retinopathy & Early Kidney Dysfunction in T1 [1159
pts;12yrs] Conclusions-Greater retinal arteriolar twisting was independently
assoc with retinopathy & early nephropathy in T1. These findings may offer
the potential of measurement of retinal vessel tortuosity for diabetic
complication risk assessment.


21.%%ADA12/9 Glycemic Control Linked to Brain Structure &Function An
accelerated decline in brain function is an important risk that needs to be
examined further in relation to glycemic control in older people with
long-standing DM. At a mean age of 62, pts in MIND study (Memory in DM) were
"already experiencing an annual decline of total brain volume in a range
reported for pts 15 yrs older..."said Dir of neuroepidemiology -NIH "MIND
pts are at an age when disease processes in the brain begin to accelerate,
eventually leading to double the risk of dementia in pts with T2 compared to
people without this disorder," she said at IDF. [2977pts;40m] 1 group had
intensive BS control; the 2nd-standard Rx -HbA1c 7-7.9%. Total brain volume
was assessed with MRI in a subset of 503 pts.. total brain volume in
cognitively stable non-DM people in their mid-70s declines by about 0.4% per
year, vs 0.8% in those who eventually convert to mild cognitive impairment
or dementia. Expert - USC said "It is likely that the cause for the
impairment in cognitive function in DM is multifact- orial & includes
dyslipidemia,hypertension, & inflammation"

22.%% M 12/13 # 1 of the Top 10 Articles for Endocrinologists in 2011 FDA
Approves New Drug for T2 The FDA (5/2- approved linagliptin (Tradjenta) for
improving blood glucose control in adults with T2, as a stand-alone or in
combo with other therapies. Tradjenta Linagliptin, (tablet) boosts the level
of hormones that stimulate the release of insulin after a meal by blocking
an enzyme - dipeptidyl peptidase-4. 8 double-blind, placebo-controlled
clinical trials showed that the drug is safe & effective in pts with T2. It
has been studied as a stand-alone Rx & in combo with other T2 Rx, such as
metformin, glimepiride & (Actos). However, the combination of linagliptin &
insulin has not been studied. Clinicians should not prescribe linagliptin
for pts with T1 or those who have DM ketoacidosis. The drug's most common
adverse effects are upper resp tract infection, stuffy or runny nose, sore
throat, muscle pain, & headache.

23.%% MP 12/14 Relationship between early-onset T2 and retinopathy severity,
premature development & risk factors Res Clin Pract. 2011; 94(2): cross
sectional approach [2,516 pts;10yr fup] Conclusions: Early-onset T2 subjects
are at risk of developing premature retinopathy caused by hypertension &
prolonged suboptimal DM control. 

24.%% MP Glucagon-like peptide analogues for T2. Cochrane System
Rev.2011;(10): Glucagon-like peptide analogues are a new class of drugs used
in the Rx of Type 2 that mimic the endogenous hormone glucagon-like peptide1
(GLP-1) which is an incretin, a gastrointestinal [GI] hormone that is
released into circulation in response to a meal. [it] regulates glucose
levels by stimulating insulin secretion.. by suppressing glucagon secretion,
delayed gastric emptying & increasing satiety. [random.control;6899pts;fup
26 wks] all GLP-1 agonists reduced HbA1c levels by about 1%. Exenatide &
liraglutide reduced it by 0.20% & 0.24% respectively more than insulin
glargine. Both [of these]led to greater wt loss than most active
comparators. Hypoglycaemia occurred more frequently in pts who were also on
sulphonylurea. GLP-1 agonists caused GI adverse effects, mainly nausea.
Conclusions:GLP-1 agonists are effective in improving glycaemic control.

25.%% ADA 12/15 Needle-free, test being introduced to help Diabetics reduce
their risk for serious complications. Young or old, any ethnic background,
diabetes can hit anyone at anytime. A new tool is being tested to help
identify the disease in record time. Right now, 7 million diabetics are
undiagnosed in the US.. Pediatric endocrinologist Dr. S. Chalews says the
new tool uses light instead of an invasive skin biopsy to measure abnormal
proteins in the skin associated with DM complications...Two pts with the
same BS may have very different levels of glycated proteins. This new system
is being tested as a way to quickly screen large numbers of diabetics
without the need for drawing blood. The new device is restricted to
investigational use in the U.S. But it could get FDA approval by 2013. In
other related news, USC neuroscientists have found the missing link on how
the brain regulates BS. They identified the exact enzymes that lead to the
release of glucose-controlling hormones. Understanding how the body
naturally corrects for high or low blood sugar could change the way DM is
treated. Eyewitness News LA (KABC) --

26.%% MP Changes in ..autoantibodies (GADA & IA-2A) during progression to
T1..Conclusions: IA-2A titers increase during the years before the diagnosis
of T1D, even among those positive for IA-2A. In contrast GADA titers tend to
decline during those years.

27.%% MP Insulin sensitizers may reduce lean mass loss in older men with DM.
DiabCare.2011;34(11):Lee CG et al;[3,752pts;age 65; 3.5yr fup] Insulin
sensitizer meds (metformin &/or thiazolidinediones) Conclusions - Skeletal
muscle loss was accelerated in men with impaired fasting glucose & DM except
when they were treated with insulin sensitizers. These findings suggest that
these drugs may reduce muscle loss.

28.%% M12/5 Preserving Vision in Patients With DM J. B. Saaddine- medical
epidemiologist CDC Video.. People with DM often develop eye problems,
including diabetic retinopathy [DR], cataracts, & glaucoma. In addition,
diabetics also have sharp increases & drops in blood glucose that can change
the shape of the lens inside the eye & cause blurred vision.. DR causes
gradual damage to small blood vessels in the retina. It leads to vision loss
in 2 ways: proliferative DR, where new blood vessels grow along the retina &
the surface of the vitreous gel that fills the inside of the eye; & macular
edema, when fluid leaks into the center of the macula making it swell. Early
diagnosis & timely treatment can prevent 50%-90% of severe vision loss
related to DM. Vision loss from DR can be prevented in several ways. The
first step is maintaining good control of blood glucose, BP & lipids. Early
detection through screening is also important, since DR has no early warning
signs. Pts with diabetes should have a dilated eye exam given by an eye care
provider at least once a year, or more often if they have the advanced stage
of diabetic retinopathy. Depending on the condition, laser therapy or other
surgery may be options. Focal laser therapy, which is used to treat macular
edema, slows leakage & reduces the amount of fluid in the retina. Scattered
laser therapy shrinks abnormal blood vessels, but may cause a loss of some
peripheral vision. If bleeding is severe, patients might need vitrectomy.
Additional treatment options include medications such as ranibizumab or
bevacizumab. These medications are injected in the eye several times a year,
for life. Risk factors for diabetic retinopathy include high HA1c levels,
long duration of DM, & no recent eye exam.

29.%% ADA 12/15 Intense Exercise Lowers Blood Sugar T2 diabetics use glucose
more efficiently many hours after each activity Serena Gordon Health Day A
new study by M. Gibala, PhD -McMaster U. & J. Zonszein,M.D. Dir. Clinical DM
Center, Montefiore MedCenter, has found that 30 minutes of high-intensity
exercise a week resulting in a total exercise time of 75 min a week can
lower blood sugar [BS] levels for 24 hrs after exercise [EX]. This helps
prevent post- meal BS spikes in people with T2 . Muscles use glucose as a
fuel & EX helps the body use insulin more efficiently. Recommendations from
ADA suggest diabetics should try to get at least 150 min of moderate to
vigorous EX/week. [8 pts;av age 63;BMI 32] a level considered obese.For
2wks, they completed 6 sessions of high-intensity training. For one minute,
the EX was intense, followed by a minute of rest. The intense exercise was
done to get the heart rate to 90% of their maximal heart rate. It was found
that BS levels dropped from 137 mg per deciliter(mg/dL) to 119 mg/dL. BS
levels after meals were reduced long after training sessions were complete.
Biopsies from the thigh muscles showed increased skeletal mitochondrial
capacity, which showed improved metabolic health. Glucose-transports
proteins in the blood after EX, & these transporters move glucose into the
muscles. This study showed short bouts of EX can help the body better use
glucose, but that more exercise is better. C 2011 HealthDay 

30.%% ADA 12/19 Diabetic Pancreases Sending Mixed Signals For the first time
in humans, researchers have shown that insulin signaling is changed in the
pancreas of people with T2. These faulty signals affect both the quantity &
quality of beta cells (the cells in the pancreas that produce insulin). In
most organs throughout the body, except the central nervous system, a dead
cell is replaced by a new cell that does the same job. Drs. Folli & Kulkarni
study findings show that the beta cells try to reproduce themselves but fail
because of the changed insulin signals. The inability of beta cells to
replicate them- selves leads to a huge problem with insulin secretion in
later stages of T2. The team also found that beta cell receptors (molecules
that receive signals from hormones) are extremely important for maintaining
a healthy number of beta cells. pub in PLoS ONE.

31.%% IDF 12/16 Diabetes Reversed With Investigational Weight Loss Drug -
Slightly more than a year of treatment with an investigational obesity drug
(Qnexa) that the FDA rejected for approval last year, reversed T2 in 15% of
subjects, The drug is a controlled-release combo of phentermine, an appetite
suppressant, & topiramate, an anticonvulsant. [146pts;1yr] pts were
randomized to receive placebo, a half or a full dose daily of the drug.
Results pts on the low-dose had a wt loss of 6.6%;those on the high dose
a12.1% loss;placebo group 2.8%. "Fasting BS & HA1c showed statistically
significant changes from baseline at the full dose," presenter said although
she did not elaborate. Resolution of DM - absence of clinical & lab signs of
DM was seen in 1.7% of pts on placebo, 8.3% on half dose & 15.4% of those on
the full dose. The most common adverse events included constipation,
paresthesia, insomnia, dry mouth, headache, & dysgeusia [distortion of
taste]. In the FDA's response letter rejecting the company's New Drug App,
teratogenicity [abnormal fetal develop ment] was mentioned as a major
concern, as was elevated heart rate. Metabolic acidosis, sleep disorders, &
depression. Cognitive disorders, including attention, memory, & language
have been mentioned. The question is: Will they be able to show enough
safety so the FDA will be comfortable enough to approve it? The hope is that
they will," said expert at USC..

32.%% ADA12/20 Driving Isn't An Issue for Most People With Diabetes
The biggest concern about drivers with DM stems from the risk of low blood
sugar (hypoglycemia), which can cause confusion & disorient-ation. While an
episode of hypo. can affect driving ability, the ADA says such incidences
are rare. An analysis of 15 previous studies found that, people with DM have
between a 12-19 % increased risk of a motor vehicle accident compared to the
general driving population. But, society tolerates riskier driving
situations all the time. People with attention-deficit hyperactivity
disorder(ADHD) have about four times the car accident risk of the general
public, while those with sleep apnea are about 2.4 times more likely to
crash. ..The ADA recommends that people who take insulin test their BS
before driving and retest at regular intervals if they're driving for longer
than 1 hour. "Pts with T1 are really normal these days. There's no reason to
restrict their driving ability," said Dr. J.Zonszein, Montefiore Med Center
"Pts are very smart today, & have more technology to help them manage their
diabetes & avoid hypoglycemia." The ADA also recommends having a fast-acting
source of carbs (fruit juice, hard candy or dextrose tablets) to quickly
raise BS available in the car & to keep an extra snack, such as cheese
crackers, handy, too. Other factors related to DM that could affect driving
include diabetic eye & nerve disease (peripheral neuropathy). Retinopathy
can affect vision & neuropathy can impair the ability to feel the gas and
brake pedals. ADA recommends that people with DM who may pose a risk while
driving be evaluated by a doctor familiar with diabetes. The bottom line for
people with diabetes, is to "know what your sugar is before you start to
drive, and don't drive if you're below 70 mg/dL."

33.%% MND 12/23 Can Nerve Growth Factor Gene Therapy Prevent Diabetic Heart
Disease? DM can reduce blood supply to the heart tissue & damage cardiac
cells, resulting in heart failure. Research U Bristol, has studied if nerve
growth factor (NGF) gene therapy can prevent DM heart failure & small
vascular disease in mice. The critical finding from our research is that DM
reduces cardiac level of NGF. .. engineering the DM heart with AAVs
(adeno-associated viral vectors) to make it produce NGF can prevent heart
failure. said team leader.
Before this gene therapy approach can be trialled in pts additional
pre-clinical studies need to be done to verify not only the efficiency &
safety of AAVs-mediated NGF in T1, but also to find the most efficient AAV
serotype, optimal dose and delivery route to be used.

IDF International Diabetes Federation World Diabetes Congress 2011. 

%% Abbreviations-acronyms fup-follow up; pt - patient or participant ; DM -
diabetes Mellitus; T1- type 1 DM;T2 - type 2; DME - diabetic macular
edema;DR - diabetic retinopathy; BS - blood sugar/ glucose; HbA1C- glycated
hemoglobin A1C; BP - blood pressure; NV- neovas cularization; CVD -
cardiovascular disease; CHD -coronary heart disease; MI -myocardial
infarction/heart attack;OCT-optical coherence tomography; BCVA - best
corrected visual acuity ;ADA - Am Diab Ass ; M- Medscape Web MD; MP- Medline
Abstract, Medline Plus; MNT- Med News Today;NEI - Nat Eye
Institute;SciA-Scientific American Definitions via online Medical
dictionaries. Disclaimer, I am a BSN RN but not a diabetic or diabetic
educator. Assistant Editor: Cam Acker, 50yr Diabetes survivor. Reports are
excerpted unless otherwise noted. [translations, explanations by thl] This
project is done as a courtesy to the blind/visually impaired & 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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