[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1.%% ADA 4/3  Risk of Parkinson Disease Onset in Patients With Diabetes   A
9-year population-based cohort study[603,416 DM pts; 472,188 control]   The
incidence of PD was 3.59 & 2.15 per 10,000 person-years for the diabetic &
control group, respectively, an hazard ratio (HR) of 1.61 Conclusions: DM is
associated with an increased risk of PD onset in a Chinese
population-relation is stronger in women and younger patients.

 

2.%% ADA 3/12  A fat gene identified that protects against T2- The
gene(ChREBP) converts glucose/sugar into fatty acids & boosts sensitivity to
insulin, the hormone that regulates BS. In most obese people, sugar is
blocked from entering fat cells, then blood sugar levels rise leading to
insulin resistance & T2. Obesity is assoc with metabolic dysfunction that
puts pts at higher risk for DM, stroke & heart disease, but a large
percentage of obese people are  metabolic-ally healthy. The new study
disassociated obesity from its adverse effects. The team tweaked a "glucose
transporter" gene in obese mice that serves as a gateway for sugar. Usually,
its activity in fat cells drops with obesity. When the glucose transporter
levels was increased in obese mice, it allowed more sugar into their fat
cells which protected them from DM. Conversely, normal weight mice missing
that gene developed DM symptoms.  Sugar in fat cells triggered a response
from the ChREBP gene that regulated insulin sensitivity throughout the body.
online edition of the journal Nature.  

 

3.%% DiabCare.2012;35(2) Efficacy/safety of exenatide once weekly (EQW) vs
metformin, pioglitazone, & sitagliptin used as monotherapy in drug-naive pts
with T2 Random-double-blind study;26wks. Goal- test the safety & efficacy of
EQW compared with metformin (MET), piogli-tazone (PIO), & sitagliptin
(SITA)pts with T2. Conclusions: EQW & MET provided similar improvements in
glycemic control plus the benefit of weight reduction and no increased risk
of hypoglycemia. 

 

4.%%M 3/29 Use Insulin Earlier, Not Later, in T2DM - Expert Interview
-J.Marquess, PharmD  Insulin administration [IT]has traditionally been one
of the last steps in the Rx of T2 but that's changing, says Dr.M.  Medscape:
Would you describe early initiation & intensification of IT. Dr.M It means
utilizing the guidelines from the ADA & using insulin sooner rather than
later. All too often, doctors...advise pts to take oral agent #1, then #2,
then oral agent #3, & then say, "Wow, I guess it's time to start insulin."
M: Why is this topic important?  Dr.M We have got a failing grade on the
number of pts that have their DM in control. In a lot of patients, the
hemoglobin A1c is above 7%-complications happen at a more prevalent rate [at
that level]..we have some fantastic insulins now that we didn't have just a
few years ago. We can now match pts' physiologic problems with the insulins.
M: What are some common misperceptions abt IT? ..pts think the needle is
really, long  or that they will be perceived as having bad control of their
DM...I always say, "Let's talk about insulin pens." One big challenges is
that this is not a 10 second talk.This disease is very complex- you have to
talk to them about ..watching what they eat, BG monitoring, physical
activity - how important that is & how to treat hypoglycemia with 15  grams
of carbohydrate..& you have to continually ask the patient how they're
doing. AmPharmAssoc Annual Meeting 3/12/2012.

 

5.%% MPD 4/9 Anti-VEGF Shot Sharpens Sight in diabetic macular edema. [DME]
Laser has been the mainstay of Rx for DME for the past 3 decades. While the
technique reduces the risk of visual loss, it may not be quite as good at
improving visual acuity. That's why clinicians have been using VEGF
inhibitors off-label for this condition. The 2 most commonly used are
ranibizumab (Lucentis) which is approved for age-related macular
degeneration & avastin-long approved for various cancer indications. Both
drugs are made by Genentech, but ranibizumab injections can run $1,950 each
while bevacizumab costs only $50 per shot. [80pts with DME that persisted
despite previous laser] bevacizumab [avastin] injections compared with
further laser . Those who had the injections, had a mean gain of 8.6 letters
vs mean  loss of 0.5 letters in the laser surg grp. Pts had a median of 13
avastin injections vs 4 laser Rx. They added that it's possible that a 4-wk
injection cycle may provide even better visual acuity gains. There were 27
ocular adverse events with avastin vs 7 in the laser group. There were no
cases of endophthalmitis & no unusual complications related to the
injection. UK. Arch Ophthalmol  2012; 

 

6.%% M 4/2 Once-Daily Lixisenatide Effective for T2  Monotherapy [1 drug]
with the investigational GLP-1 receptor antagonist lixisenatide
significantly reduces postprandial [after meal] glucose & HbA1c in T2  V
Fonseca & team point out that while other GLP-1 receptor agonists are on the
market, exenatide (Byetta, Bydureon) & liraglutide (Victoza) -- lixisenatide
is highly selective for the GLP-1 receptor, & stimulation of insulin
secretion with lixisenatide depends "strictly" on glucose
levels.[361pts;12wk; random-double-blind] pts assigned to once-daily
subcutaneous [under skin] lix injections that increased in dosage in 1or2
steps or to similar placebo regimens. The proportion of pts achieving an
HbA1c <7% in the 2 lixisenatide groups was 52.2 & 46.5%, respectively, vs
26.8% in placebo grps. Rates of hypoglycemia were 1.7% in lix groups & 1.6%
in the placebo arms. Nausea was 23% with lix vs 4.1% with placebo). Authors
conclude, "The results support a role for once-daily lixisenatide
monotherapy ..in pts not controlled on lifestyle interventions ..DiabCare
2012.

 

7.%% ADA 4/3 Diabetes associated with more TB symptoms, adverse effects DM
increases the risk for developing TB threefold. [5,146pts with TB;most men.
On multivariate analysis, the following were assoc with DM: age +39 & being
an injection drug user Those with diabetes had more treatment adverse
effects & TB symptoms compared with those without DM. “Doctors & health
providers must be aware & increase the level of suspicion & screening when
seeing a pt with either DM or TB,” Moreno A. 22nd EuroCongClinMicrobiology &
Infectious Diseases; 4/3/2012;

 

8.%% M 4/3 Sulfonylureas in Diabetes  Sulfonylureas, which stimulate beta
cells to produce more insulin are known to keep many pts with T2 off
injected insulin.. Recent guidelines by AmerCollege Physicians (ACP) state
that metformin should be used as a first-line agent to treat DM when diet &
EX are insufficient There was an assoc risk for severe hypoglycemia with SUs
which exceeds the risk with metformin The combo of metformin plus SUs is
assoc with 6x more risk for hypo  The ACP statements suggest that, for
agents other than metformin, SUs should be considered 3rd or 4th line agents
for T2. Some DM agents, seem to preserve beta-cell function, but the action
of SUs  "burns out" beta cells. .A significant benefit with the use of
sulfony-lureas is that they are very inexpensive - the only generic anti-DM
drug available. Guidelines that recommend SUs as initial or second- line Rx
tend to be much simpler & easier to follow., Some clinicians may prefer "the
devil they know" rather than newer drugs that seem to carry uncertainties.
More to come, later... M.L. Mintz, MD     CA

 

9.%% MNT 4/9 Enzyme In Saliva Helps Regulate Blood Glucose [BG] BG levels
after starch ingestion are influenced by differences in salivary amylase
[SA]an enzyme that breaks down dietary starches. Higher SA activity is
related to lower blood glucose. Findings show a significant metabolic role
for salivary amylase in starch digestion. Other implications relate to
calculating the glycemic index of starch- rich foods & ultimately the risk
of developing DM. 2 pts may have very different glycemic responses to the
same starchy food, depending on their SA levels. Those with high SA are
better adapted to eat starches, because they rapidly digest the starch while
maintaining balanced BG levels. Those with low SA levels need to take their
amylase levels into account when paying attention to the glycemic index of
foods they are eating. Starch from wheat, corn, potatoes, & other grains
makes up to 60% of calories in the US.  Amylase enzymes secreted in saliva
help break down starches into simpler sugars that can be absorbed into the
bloodstream thus influencing BG levels. [48 healthy adult] divided into high
amylase(HA) & low (LA). Each pt drank a corn starch solution. Afterwards,
pts in the HA grp had lower BG levels vs those in the LA grp. This appears
to be related to an early release of insulin by the HA pts. Pts with higher
levels of salivary amylase are able to maintain more stable BG levels when
eating starch. This might lessen their risk for insulin resistance &
non-insulin dependent DM.  Future study focus will involve identifying the
neuro-endocrine mechanisms that connect starch breakdown in the mouth with
insulin release.

 

10.%%  M 4/12 DM Linked to Phthalates   Phthalates, [P] which are found in
common plastics, cosmetics, pharmaceuticals & medical devices, have been
associated with the development of DM among seniors in Sweden. 3 P
metabolites were associated with a 25-30% increase in the risk for DM. [1016
pt;70yrs +] 4 of 10 metabolites were detectable in blood serum of at least
96% of pts with DM. 4 P metabo-lites are commonly used in personal care
fragrances (includes- monoethyl P(MEP). monoisobutyl P(MiBP).  MEP & MiBP
were significantly related to DM prevalence. The metabolites are related to
either poor insulin secretion or insulin resistance P metabolites are known
to affect glucose stability in humans. Further studies are needed that show
similar associations. However, for seniors at normal levels of exposure to
chemicals.. this study showed that several phthalate metabolites are related
to DM prevalence, as well as to markers of insulin secretion & resistance.
pub 4/2012  DiabCare.

 

11.%% M 4/10 Infant & Toddler T1DM Complications After 20 Years' Duration
S. Salardi, MD; et al:Diabetes Care2012;35(4):  To compare the effect of the
prepubertal duration of DM on the occurrence of complications in 2 groups of
patients after the same number of years of the disease. [105 pts aged
16–40.3 years; 53 prepubertal at diagnosis (aged 0–3);52 were pubertal
Results: prevalence of diabetic retinopathy (DR) was higher in pubertal than
in prepubertal pts

Conclusions:  If diabetes is diagnosed in infants or toddlers and the
prepubertal duration of DM is very long, the patients seem to be protected
against DR. This protection disappears if lifetime metabolic control is bad.
Instead, when onset is at puberty, the DR risk is higher & less dependent on
metabolic control & may be influenced by age- related factors, such as BP.

 

12.%%MA 4/6 Postprandial Administration of Intranasal Insulin Intensifies
Satiety & Reduces Intake of Palatable Snacks in Women Diab 2012;61(4):
Abstract - The role of brain insulin signaling in the control of food intake
in humans has not been thoroughly defined. We hypothesized that the hormone
contributes to the postprandial [PP] regulation of appetite for palatable
food..Two groups of subjects were intranasally given 160 IU insulin or
placebo after lunch. 2hr later  con-sumption of cookies of varying
palatability was measured. In control study,the effects of intranasal
insulin administered to fasting female subjects were assessed. Compared with
placebo, insulin adm in the PP but not in the fasting state decreased
appetite as well as intake & rated palatability of chocolate chip cookies.
In both experiments, intranasal insulin induced a slight decrease in plasma
glucose but did not affect serum insulin concentrations. Data indicate that
brain insulin acts as a relevant satiety signal during the PP period, in
particular reducing the intake of highly palatable food, & impacts
peripheral glucose homeostasis. PP intranasal insulin adm might be useful in
curtailing overcon-sumption of snacks..

 

13.%% M 4/12 Higher HbA1c Levels Predict Better Outcomes in Advanced Heart
Failure [HF] With Diabetes — Patients with advanced HF who were also
diabetic had better 2yr survival if their baseline glycated hemoglobin
(HbA1c) levels were >[greater than] 7.3% in a new study. The retrospective
cohort study pub3/27/12 online in the AmerJ Cardiology. "We're finding that
in HF plus DM, higher HbA1C levels are associated not with worse outcomes,
but with better outcomes," lead investigator Dr T. Horwich(UCLA)said. This
suggests that for pts with both diseases, ".. aiming for a midrange of 7.2
to 8.2% may be very reasonable ..in someone with advanced HF who may be
having difficulties with hypoglycemia or other adverse effects of DM meds,
less stringent glycemic control (HbA1C <8%) may be acceptable,” On the other
hand, "if patients are tolerating the meds without difficulties, current
glycemic guidelines should continue to be followed as we await further info
from prospective clinical trials."

 

14.%% PostgradMed J2012;88 Diabetes-induced Osteoarthritis   Data support
the hypothesis that DM could be an independent risk factor for OA. If
confirmed, this new paradigm will have a dramatic impact on prevention of OA
initiation & progression..Diabetes was first considered as a
non-inflammatory disease. However, we now know hyperglycaemia can trigger a
low-grade systemic inflamm. which would explain the increased risk of CV
events seen in pts with DM. Low-grade systemic inflammation is associated
with cartilage loss. ..an independent hyperglycaemia-induced systemic inflam
may also have an impact on the progression of OA. ..Finally, the
neurotoxicity of hyperglycaemia leads to a neuromuscular deficiency, which
will also worsen OA by destabilising the joint.

 

15.%% MPD Diabetes Diagnosis and Management 2011 Web cast for health care
providers- The Endocrine Society

http://www.softconference.com/endocrine/generic.asp?ID=8067

 

16.%% MA 4/11 Bevacizumab Beats Laser Therapy in Macular Edema Trial  A
2-year randomized controlled trial suggests that bevacizumab (Avastin) is
more effective than macular laser therapy in pts with DME. R Rajendram,
Moorfields & team report "Many people are using bevacizumab, even though
this is the only study out there that shows any benefits," said Dr. Frank
Wayne State U "I think it's an important study, though it's not yet
definitive because there were only 80pts &   you would usually like to have
hundreds."  Macular laser therapy had been the mainstay of treatment for
clinically significant DME since the 1980s. The procedure reduces the risk
for moderate visual loss, but visual acuity improves in less than 3% of pts.
Preliminary evidence has emerged that intravitreal injections of
antivascular endothelial growth factor (anti-VEGF) drugs are more
effective..patients randomly assigned to receive either bevacizumab or
laser. Those receiving avastin had an injection at baseline, 6 & 12 wks,
were reviewed at 18 wks & every 6 wks to wk 102 for the need of more
injections. If the central macular thickness was greater than 270 ?m at 18
wks the team continued injections until the pts had stable macular
thickness. Overall, the patients receiving bevacizumab fared better than the
pts receiving laser. The mean ETDRS best-corrected visual acuity at 24 m in
the Bev group was 64.4 letters(Snellen equiv 20/50) vs In the laser group
54.8 letters(Snell 20/80). The pts on Bev gained a mean of 8.6 letters,
while laser grp lost a mean of 0.5. The pts on bevacizumab had 27 adverse
events, 22 related to the injections. A few pts in both groups experienced
transient vision loss. 3 patients in the laser grp  had serious ocular
adverse events. There were no cases of endophthalmitis, intraocular
inflammation, or retinal detachment in the bevacizumab group. "This
investigator-initiated single-center study provides evidence for the
longer-term use of bevacizumab," authors write. UK Arch Oph online 4/9/12

 

17.%%Eye(2012)26,New approaches for  treatment of DME -lucentis
Abstract The current standard therapy for DME-focal/grid laser... We
reviewed 1-& 2-year clinical trial findings for ranibizumab [lucentis] used
as treatment for DME... For DME with centre involvement & assoc vision loss
due, monthly ranibizumab with Rx interruption & re-initiation based on VA
stability is recommended. Laser therapy based on ETDRS guidelines is
recommended for other forms of clinically significant DME without centre
involvement or when no vision loss has occurred.. Since these
recommendations are based on randomised controlled trials of 1–2 years
duration, guidance may need updating as long-term ranibizumab data become
available and as additional therapeutic agents are assessed in clinical
trials.

 

18.%%Eye 2012)26, Distribution, reabsorption, and complications of
preretinal blood under silicone oil after vitrectomy for severe prolifer
ative diabetic retinopathy [DR] 44 pts;3-yr period. Intravitreal [avastin]
was used preop for cases with active proliferation, & in all cases at the
end of surgery. Conclusion - Most rebleeding occurred within the first
post-op wk, with gradual reabsorption within 4 wks; widespread.. bleeding
might result in severe reproliferation & detachment. A major complication of
preretinal bleeding was formation of fibrosis. Re-operation achieved a mild
VA improvement.

 

 

19.%% ADA 4/18 CV Autonomic Neuropathy Risk for CVD Despite Albumin Status
Cardiovascular autonomic neuropathy (CAN)

appears to affect the risk of CV disease even in T1 pts with normal albumin
excretion rates [NAR].  CAN is present in about a quarter of pts with T1,
The Danish team measured [includes] coronary artery plaque burden, coronary
artery calcium, & pulse pressure over 24-hrs  in 56 NAR T1 pts 26 of whom
had CAN. Compared with pts without CAN, those with CAN had higher coronary
artery calcium scores. " CAN in normoalbuminuric T1 is associated with
distinct signs of subclinical CV disease," pub online 4/12/12 Diabetes.

 

20.%% NatRevEndo Molecular connection between the nuclear & mitochondrial
aging processes that occur in pts with T2DM. The human body has a
chronological age & biological age. Biological age is represented by the DNA
sequence at the end of each chromosome, like the plastic tips on shoelaces
(telomeres). The telomeres get shorter each time a cell divides. Short
telomeres reflect accelerated aging. Many recently discovered genes that can
be manipulated to slow the aging process are involved in the control of
metabolism. Metabolic syndrome, is a precursor of metabolic disorders like
T2 & CV disease, which have been shown to be a sign of premature aging. DM
is a state of accelerated aging. While telomere shortening is associated
with T2, there is a lack of studies that explore the relationship among
telomere length, oxidative stress, mitochondrial DNA content, & the levels
of adiponectin (a protein produced by fat cells which play a role in the
development of obesity). Researchers reason that the susceptibility to
develop T2 & cardio-vascular diseases could be explained by studying these
emerging biomarkers. Unlike chronological aging, accelerated aging can be
reversed. With maintenance of appropriate mitochondrial function & telomere
length by pharmacological means or lifestyle modification there will be
potential for T2DM & associated vascular disorders.  DiabResearch Found
India 4/17/12. Full report Courtesy of and edited by C Acker  

 

21.%% NatRevEndo May 2012 Functional ß cells detected in long- standing T1DM
- a new hope for intervention? J Osório  - C-peptide, a hallmark of ß-cell
function, can be detected in the serum of pts with T1 >30 yrs after disease
onset, report researchers from Harvard Med School.   C-peptide [C-P] is a
chain of proteins that is spun off when the beta cell makes insulin. A
precursor molecule, pro-insulin is split into insulin & C-P. For every
molecule of insulin produced, your beta cells also produce a molecule of
C-peptide. C-P is removed from the bloodstream by your kidneys while insulin
is removed by the liver. A C-peptide test tells you whether or not you are
making C-P. If there is no C-peptide in a blood sample, your beta cells are
not making any insulin. A very low C-peptide results in the diagnosis of
severe T1DM. When doing C-peptide tests it is important to know whether the
C-P test is taken fasting/not fasting & what the blood glucose level was
when the sample was taken. A high fasting BS with a high C-peptide shows T2
caused by insulin resistance. In contrast, a normal C-P  value taken at the
same time as a high fasting glucose suggests T2 where failing beta cells
rather than insulin resistance is the primary reason for raising blood
sugar. Unfortunately, there is no standard way a lab measures C-peptide  If
you sent the same sample to a different lab, you could get a very different
result. 

Here's what your C-peptide can tell you: 1. If your C-P is significantly
below the normal fasting range your beta cells are likely to be dead or
dying. A very low C-peptide value is a good way of diagnosing T1DM
(autoimmune) rather than T2DM. Some insurers require a C-peptide test result
below .5 nanograms/ml before they will cover the costs of an insulin pump.
2. If your fasting C-P level is high, it is very likely that you will be
able to control your BS by cutting way down on the amount of carbohydrate
you eat. It also means that you should first try strategies that lower
insulin resistance before trying drugs that stimulate more insulin. Exercise
may also be very helpful, as many  find, to reduce insulin resistance.
Research suggests  C-peptide rather than being only an inert by-product of
insulin synthesis, is rather important for preventing DM complications. If
it turns out that C-P is able to prevent complications, those who have
secretory defects that respond to beta cell stimulation may have to
reconsider whether or not to stimulate their beta cells with drugs like
sulfony-lureas or whether to supplement with injected insulin that does not
contain C-peptide.    Provided & edited courtesy of  C Acker.

 

22.%% NREndo May 2012 Bone, sweet bone—osteoporotic fractures in diabetes
mellitus C. Hamann, et al; DM adversely affects the skeleton & is assoc with
an increased risk of osteoporosis & fragility fractures. The mechanisms
underlying low bone strength are not fully understood but could include
impaired accrual of peak bone mass & DM complications, such as nephropathy.
T1 affects the skeleton more severely than T2, probably due to lack of the
bone anabolic actions of insulin & other pancreatic hormones. Bone mass can
remain high in T2 but it does not protect against fracture, as bone quality
is impaired The class of oral anti-DM meds-glitazones [Actos, Avandia] can
promote bone loss & osteoporotic fx in post-menopausal women & should be
avoided if O is diagnosed. A physically active, healthy lifestyle &
prevention of DM complications, along with calcium & VitD, is the mainstay
of therapy for O in pts with T1 or T2. Assessment of BMD [bone mineral
density] & other risk can help design tailored Rx plans. All osteoporosis
drugs seem to be effective in pts with DM.

 

23.%%MNT 4/11 A Step Closer To A Better Treatment For Autoimmune Diabetes
Insulin is needed for the regulation of BS levels. In T1,cells that produce
insulin are destroyed by the immune system. C Mathieu & team have attempted
to circumvent this response by taking advantage of the fact that the immune
system accepts foreign gut bacteria. They engineered gut bacteria which make
a form of insulin.. these special bacteria increased the frequency of cured
mice when compared to traditional methods, with seemingly no undesirable
effects. Traditional methods suppress the immune system, which brings
[risks] such as increased infections. This study provides a promising step
towards the ability to reverse T1 & other autoimmune disorders, without
incurring adverse side effects. J Clinical Invest

 

24.%% MP 4/19 Value of Metformin, Insulin Combo for T2 Questioned   Danish
researchers who reviewed data from 23 clinical trials [2,200 pts 18+] found
that taking metformin plus insulin leads to better BS control, less weight
gain & less need for insulin. However, they also noted that the clinical
trials provided little info about long-term pt out- comes, such as deaths
from CV disease. ..more clinical trials are needed to determine the
long-term benefits & risks of the combo The team also believe  the combo
combination of metformin & insulin raises the odds for severe low BS
(hypoglycemia)  One US expert took issue with the findings. "It certainly
seems like a controversial statement since all our Rx is based on metformin
with additional meds [insulin or other] added when BS is no longer
controlled .." Sources: MA Banerji, online April 19 in the BMJ

 

25.%% MPD 4/20 FDA Warns of Aliskiren Combos  FDA warns against combining
the BP med aliskiren (Tekturna) with ACE inhibitors & angiotensin receptor
blockers (ARBS) in pts with DM, renal impair-ment  The warning, is based on
the terminated ALTITUDE study which found increased risk of adverse events
in high-risk pts taking the direct renin inhibitor as an add-on to other
anti-hypertensive meds. DM pts who mix the drugs are at risk of renal
impairment, hypotension & hyperkalemia [high potassium]

 

26.%% ADA Sticky Molecules Linked to Brain Abnormalities in T2 People with
T2 are at greater risk of cognitive dysfunction, dementia, & Alzheimer’s
disease than those without DM. Previous research has found that certain
regions in the brains of those with DM seem shrunken compared to those
without the disease. Some scientists suspect that inflammation, which is
increased in people with DM, may be involved. [147pts;av age 65] MRI plus
blood tests to detect markers of inflamm. Tests of mental health, brain
function, & walking speed. Compared to those without DM, pts with DM were
slower walkers, were more likely to be depressed & their brains were more
likely to have problems with blood flow & atrophy. In the whole the brain
abnormalities correlated with levels of a set of molecules associated with
inflammation “adhesion molecules.” Levels of these molecules in the body are
also related to walking speed & brain function. The associations were
stronger in pts with DM. This study cannot prove that inflamm caused the
observed changes in brain structure & function, only that there is an
association. brain function may be related to inflamm--in particular,
adhesion molecules which could provide new targets for brain-saving
medications... Vera Novak et al;  Diabetes Care 34: 2011

 

27.%% MA T2 associated with faster degeneration of bioprosthetic

valve [1113 pts;1113 controls] early (30 days) mortality rate was 7.8%  vs
2.9% in pts with or without T2 respectively. 7 yr freedom from valve
deterioration in T2 pts 73.2% vs 95.4% in controls    (hazard ratio 2.39) in
T2 Circulation 2012; 25(4)

 

28.%% ADA 4/19 ADA & European Assoc for the Study of DM(EASD) Issue Joint
Position Statement on Hyperglycemia Treatment  ..new guidelines for managing
elevated BG levels in people with T2 have been developed jointly. The
guidelines call for providing all patients with DM education, in an
individual or group setting, which focuses on dietary intervention & the
importance of increased physical activity as well as weight management, when
appropriate. They encourage developing individualized Rx plans built around
a pt’s specific symptoms, co-morbidities,[other illness] age,wt
racial/ethnic/gender differences & lifestyles...DM is a complex disease that
manifests differently in different people &the best way for one person to
manage it may not work for someone else. For more info in English /Spanish:
call ADA 1-800-DIABETES (1-800-342-2383) visit www.diabetes.org 

 

29.%% ADA 4/24 Medication, clinic appointment noncompliance ups mortality in
insulin-treated T2DM  [15,984pts] data showed clinic non-attenders were more
likely to be smokers, younger, have higher gly-cated hemoglobin, &
significantly greater morbidity. Medication non-compliers were more likely
to have higher H1C ,were more likely to be women, smokers, & have greater
morbidity. Several authors disclosed financial ties to medical device &
pharm companies,

 

30.%% M 4/16 Sleeve Gastrectomy Proves Effective in DM Remission
Laparoscopic sleeve gastrectomy (LSG) has proved highly effective in
alleviating T2 & its complications compared with traditional medical
treatment Prospective cohort study of 60 morbidly obese pts with T2; 30 had
gastrectomy; 30-conventional med Rx.  LSG is a minimally invasive procedure
-surgeon removes a major portion of the stomach & leaves a small
banana-shaped pouch. Of the 30 pts in the surgical grp, 24 (80%) had their
DM resolved by 18 m after surgery & reduced their mean body mass index (BMI)
from 41.3 to 28.3kg/m2 Mean BMI in traditional Rx grp increased from 39 to
39.8 & all pts remained diabetic.  Conventional Rx included drug therapy,
regular physical activity, & 1200-calorie diet. Fleonetti et al; Arch Surg.
April 16, 2012.

 

31.%% M 4/17  Detecting Early Microvascular Disease in T1 - Wavelet
Transform Analysis..Diabetic retinopathy [DR] is assoc with markedly
increased risk of CV events. Analysis of retrobulbar [behind eye] blood
velocity waveforms should help characterise micro-vessels since waveform
morphology [structure] is partly determined by wave reflection. Ultrasound
exams of common carotid, ophthalmic & central retinal arteries done. [39
pts;mean age 33;Europids]. Wave-forms characterised into 11 bands. mean
amplitude was higher for pts with DM in several bands. Once microvascular
disease is  detect-able in the eye, the risk of macrovascular CVD  outside
the eye is increased many times.. Pt had good DM control, no history of CVD
& no significant disease complications. Brit J DiabVascDisease2012;12 

 

32.%%ADA 4/23 Metabolites Linked to Insulin Resistance [IR] 20 meta
bolites, including amino acids, intermediates in glucose synthesis, ketone
bodies, & fatty acids, are assoc with IR  Researchers, Finland performed
metabolic profiling with magnetic resonance spectroscopy in 7,098 pts (mean
age 31) Associations for [several] amino acids were sex- & obesity-dependent
"Metabolic signatures extending beyond obesity & lipid abnormalities
reflected the degree of IR in young, normoglycemic adults.,"pub online
4/17/12 Diab.

 

33.%% Genetics Home Ref 4/12 Wolfram syndrome is a condition that affects
many of the body's systems. It’s hallmark features are high BS levels
resulting from a shortage of the hormone insulin (diabetes mellitus)&
progressive vision loss due to degeneration of opticnerves (optic atrophy).
People with Wolfram syn often also have pituitary gland dysfunction &
hearing loss. DM typically the first symptom is usually diagnosed around age
6...

 

%% Abbreviations-acronyms fup-follow up; pt - patient/participant ;  DM -
diabetes Mellitus; T1- type 1 DM;T2 - type 2; DME - diabetic macular
edema;DR - DM retinopathy; BS/BG- blood sugar/glucose; HbA1C, glycated
hemoglobin A1C; BP - blood pressure; CVD - cardio-vascular disease; IR-
insulin resistance; MI -myocardial infarction/ heart attack; OCT-optical
coherence tomography; BCVA - best corrected visual acuity; RCT -Randomised
controlled trial; ADA - Am Diab Ass;M- Medscape Web MD; MA- Medline
Abstract, MP- Medline Plus; MNT- Med News Today;MPD - Med Page 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 DM 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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