Guest guest Posted August 2, 2007 Report Share Posted August 2, 2007 A definite keeper. I believe I will read this one at least five times from beginning to end. I will probably even take notes on it. articles 1. Welcome to Medscape Nephrology and to this Spotlight entitled, " Managing Anemia in Patients With Type 2 Diabetes and Chronic Kidney Disease. " I am Dr. Ajay Singh, Clinical Director at Brigham & Women's Hospital and Associate Professor of Medicine at Harvard Medical School in Boston, MA, and I will be your moderator. Slide 4. Prevalence of Diabetes and CKD Willa A. Hsueh, MD: I think all of our audience knows that diabetes is the most common cause of end stage renal disease in the US and there are about 30% to 40% of patients with type 1 DM who will go on to have chronic kidney disease and about 10% to 15%, maybe even as high as 20%, of patients with type 2 who will go on to have chronic kidney disease. Aggressive Prevention of CKD Slide 5. Aggressive Prevention of CKD I think we're all realizing, thanks to our nephrology colleagues, that as patients develop albuminuria, not only is that an important sign of kidney disease, but I think it's a sign that there may be terrible problems with the endothelium that could then lead to problems, of course, with coronary heart disease and stroke, so that should raise a red flag for all of us. In addition, I think we also know that glycemic control is very important for the microvascular complications, not just the kidney but the eye and some of the neurologic complications. So with that said, I think as endocrinologists we're really focusing on tight control early, tighter and tighter control. In fact, the recent ADA Guidelines suggest that we get our control to nearly normal in all of our patients with hemoglobins around 5.5% or less. So there's an aggressive effort, I think, to try to prevent chronic kidney disease. Unfortunately, I think some patients will not respond to some of those or comply with some of those aggressive efforts, and we will still have problems with the kidney. Slide 6. Recognizing the Complications of CKD .. the question is how do we recognize some of the complications early, that would include not just the, as we said, the coronary heart disease complications but also the anemia, the changes in type 2 hyperparathyroidism or secondary hyperparathyroidism, and issues about early interventions for the anemia, and early interventions with vitamin D therapy? Dr. Singh: One of the really important issues, of course, is the burden of cardiovascular disease in this population. Dr. Hsueh: Absolutely. Dr. Singh: It seems like a number of observational studies have indicated that at a very early stage in the syndrome of diabetic nephropathy, patients develop vascular disease and cardiovascular disease. Is it your sense that the diabetologists are now increasingly recognizing this and are becoming more aggresive in managing cardiovascular disease in this population? Dr. Hsueh: Oh absolutely, you cannot go to an endocrine meeting without hearing about the marked increased incidence of cardiovascular disease in patients with diabetes, and I think we've known for a long time that albuminuria is a key signal that heralds that, and I think you all know well that as there is a progressive decrease in glomerular filtration rate, there's a progressive increase in cardiovascular disease. %%Slide 8. Clinical Practice Guidelines for CKD and Diabetes Mark E. Molitch, MD: several things came out of reviewing the literature for those guidelines, certainly the glycemic control that Willa had talked about remains important, and even in the patient as they have advancing kidney disease, we still need to get good glycemic control to try to reduce and ameliorate some of the other long-term complications of diabetes. But as far as the cardiovascular disease goes and the lipid management, these are patients at such high risk that we recommend an LDL goal of less than 70 for those patients, obviously blood pressure treatment to get blood pressures less than 130/80 for virtually all patients with diabetes, and perhaps even more stringent goals for the patient who's getting progressive nephropathy. I think one of the things that brought home to me as we were reviewing all this, is the knowledge that's relatively new, at how early secondary hyperparathyroidism and anemia start to be found. %% Slide 9. Development of Anemia in Patients With Diabetes Dr. Singh: one of the things that I have come across in the literature is the idea that anemia tends to develop at an earlier stage in diabetics than it seems to in nondiabetics, so for any given level of GFR. What are your thoughts on that, Willa ? Dr. Hsueh: Well we're recognizing more patients, for example, with stage 3 chronic kidney disease, and we are seeing evidence that if patients have diabetes, the anemia for any level of chronic kidney disease seems to be worse than the nondiabetic patient, and of course there is this anemia of chronic disease to begin with that our patients with diabetes have, and then when the kidney disease sets in, there are problems with synthesis, as you know, of erythropoietin, and so that complicates the issue, . Dr. Singh: Mark, do you refer patients once they develop anemia or do you manage the anemia yourself in your own practice? Dr. Molitch: Well I think in our practice and probably in most endocrine practices, by the time we find the patient whose hemoglobin is getting less than 11 and we start thinking about erythropoietin [EPO], we have generally been referring that patient to the nephrologist.Slide 10. TREAT Study Design this is a randomized prospective study looking at the effects of erythropoietin supplementation, trying to get the hemoglobin levels up. Slide 12. Diabetologists and Nephrologists Working Together Dr. Singh: In my own nephrology practice, I tend not to spend a lot of time thinking about different types of insulin, so I would imagine that Willa, you also don't think about all the newer erythropoietins that are coming out since you have such a strong nephrology division at UCLA. Dr. Hsueh: Well, like Mark, with erythropoietin, we're actually when we feel patients need that, we actually call our nephrology colleagues and, as you said, they have a very strong background. What I'm amazed at is that our nephrology colleagues, once the GFR is somewhere around 30 or less, they take over full management, so they actually have to know about insulins and know about other issues. %%Slide 15. Managing Patients With Diabetes and CKD Dr. Singh: So what are your top 2 or 3 things that nowadays in 2007 you think about in managing patients with diabetes who have chronic kidney disease? Do you, as Mark is alluding to, manage their lipids more aggressively, their hypoparathyroidism, or do you feel that these areas still represent controversial issues? Dr. Hsueh: Well, as I said, we would see these patients more in stage 2, stage 3, and maybe the beginning of stage 4, and I manage their cardiovascular risk, hypertension especially, very aggressively because I know that whatever changes in blood pressure happen have great impact on the kidney. The lipids I'm concerned with, but I'm aware of the studies you said, and then the question is the role of vitamin D because there's very intriguing information that not only is it good for the calcium-phosphorus changes but also it may have anti-inflammatory effects; and there are a number of studies at UCLA, then of course the whole issue of anemia, and in patients with heart disease, of course you want to provide oxygen but you don't want to provide so many red cells that you get thrombosis formation. Dr. Singh: So, Mark, do you think that diabetologists and nephrologists can work together in managing these important conditions or is there hope for us to work together? Dr. Molitch: Well absolutely I think it's almost a natural combination, but I think one of the things we have to do is keep working together, and so it's not a hand off, it's a continued comanagement of the patients even once they get on dialysis. I think the diabetologists can lend a hand in trying to help manage their diabetes even at that point. ..Dr. Singh: So management of anemia and diabetes and kidney disease are interrelated and now one can manage them in a diabetes center in a collaborative fashion or one can refer these patients but it seems like one of the key issues is to certainly manage them, to recognize it early and manage them. Slide 16. Management of Dialysis Patients With Diabetes One quick question I have before we summarize is what about the dialysis patient - do you tend to have them come back to your diabetes center or diabetes practice and continue to follow them or is it your observation that most of these patients get managed wholly by the nephrologist when they reach end-stage renal disease? Dr. Hsueh: Well I'm happy because there are more oral agents now on board that we can use in dialysis patients, for example, in addition to insulin, . We now have sitagliptin or Januvia,.. you have to adjust the dose, but it's a DPP-4 inhibitor that works on the incretin pathway. We have the TZDs [thiazolidinediones] which can be used all the way through to end-stage kidney disease. And, of course, we have acarbose, which mainly works on the gut and just slows, doesn't inhibit, just slows carbohydrate absorption. So you actually have 3 oral agents that you can mix and match in patients with chronic kidney disease and then you have insulin, so I think we've broadened the horizons for patients with CKD. %% Slide 17. Summary and Closing Comments Dr. Singh: So it sounds like nephrologists need to learn more about how to manage diabetes with different types of insulins and oral agents and diabetologists need to learn to manage perhaps a little bit more about the comorbidities of kidney disease such as hypoparathyroidism and lipid abnormalities but also anemia. And whether you refer these patients or you manage them in the diabetes center, the key is to try to manage them together. Dr. Hsueh: Well, we're waiting for you to do the studies to tell us what level of hemoglobin should we intervene, when should we intervene with vitamin D; of course, both of those studies are ongoing. Dr. Singh: Right. Well, that was, I think, a very productive discussion, and I'd like to thank Dr. Hsueh and Dr. Molitch for participating. I think we achieved our objectives of discussing the interrelatedness of anemia, diabetes, and chronic kidney disease. I also believe that we really brought out the notion that diabetologists and nephrologists need to work together in both early recognition and then subsequent management of these patients. Supported by an independent educational grant from Roche 2.%% Notice: The LightHouse for the Blind and Visually Impaired will be hosting several informational survey interviews on talking glucose meters and adaptive insulin syringe devices. These interview sessions will be conducted in conjunction with a doctorial student from UC Berkeley. The focus of the interviews is to collect data concerning talking glucose meters and adaptive insulin syringe devices. The interview will take between 60 to 90 minutes in San Francisco and there will be a $40 honorarium for those who participate. The participants must be diabetic and have used or currently use a talking glucose meter. If you know of individuals who may qualify please contact Beth Berenson at The LightHouse, Phone: or via email at: 3.%% Medscape - Metabolic Syndrome Linked to Chronic Kidney Disease (Reuters Health) Jul 24 - A study of a Chinese population aged 40 years and older found an association between metabolic syndrome and chronic kidney disease. (CKD) Metabolic syndrome " is a common disorder in developed countries, " note the researchers. " With its dramatic economic development and the consequent changes in lifestyle and diet, China too has seen the metabolic syndrome become an important health care problem. " [2310 people; cross-sectional study; mean age 60.7 years,] The overall prevalence of metabolic syndrome was 34.1%, and the overall prevalence of CKD was 10.7%. The prevalence of CKD was higher among subjects with metabolic syndrome than those without metabolic syndrome (15.4% versus 8.3%, respectively. " Further studies are needed to determine if treatment of metabolic syndrome could substantially ease the burden of CKD in China, " the team concludes. Mayo Clin Proc 2007;82 4.%% In Diabetes Today 23-JUL-2007 - Hepatitis C Strongly Linked to Type 2 Diabetes (Reuters Health) - People infected with hepatitis C virus have an increased risk of developing type 2, or " adult-onset " diabetes, a population-based study confirms. This risk is particularly high in younger people who are overweight, researchers have found. Therefore, screening for and preventing diabetes in persons with HCV infection could be started earlier than the suggested age of 45 or older, which is the recommendation for the general population, especially for patients with are heavier or who have other diabetes risk factors for diabetes, the team writes. [4,958 people age 40 or older without diabetes, 3,486 tested negative and 812 positive for HCV; 116 subjects were infected with both HCV and HCV; 544 tested positive for hepatitis B; 7 year follow up] After adjusting the data to account for established diabetes risk factors, the incidence of DM was 70 percent higher in persons with HCV infection than in those without it. " This finding is consistent with past studies showing that HCV infection is highly associated with diabetes. " the younger group with HCV infection was at greater risk for the disease, they note. HCV infection plus being overweight or obese magnified the risk of diabetes by about three times compared with uninfected persons of normal weight. American Journal of Epidemiology, July 15, 2007. 5.%% TimesSelect F.D.A. Review Criticizes Diabetes Drug and Maker July 26, 2007 Patients who take Avandia, a popular but controversial diabetes medicine made by GlaxoKline, [GSK] are far more likely to suffer and die from heart problems than those who take Actos, a similar pill made by Takeda, according to federal drug reviewers. Avandia is particularly dangerous to patients who also take insulin. By contrast, Actos can be taken safely with insulin, according to the review. The findings likely spell the end of Avandia's status as one of the nation's most popular drugs for treating diabetics who are not dependent on insulin. Last year, more than a million patients in the US took Avandia, and a similar number took Actos. Avandia's 2006 global sales were nearly $3.4 billion. The report and charges that GSK sought to intimidate a doctor who publicly warned about Avandia's risks in 1999 could lead to a cascade of lawsuits against the company. Indeed, F.D.A. reviewers were sharply critical of the quality of the studies GSK has undertaken to test the safety of Avandia, dismissing the present and future results of an ongoing 4,000-patient trial as unreliable and invalid. The report by medical and safety reviewers within the FDA also provides ammunition to critics on Capitol Hill and elsewhere who claim that top F.D.A. officials have been far too slow to acknowledge Avandia's risks. GlaxoKline suggested a year ago that the agency add a note to the drug's label about Avandia's growing heart risks, the report states. These conclusions come in a 436-page compendium of reviews released in advance of an advisory committee hearing to be held on Monday to discuss Avandia's effects on the heart. The F.D.A. intends to ask the committee of independent experts whether Avandia should continue to be sold. It is far from clear, F.D.A. safety reviewers concluded in the report, whether taking Avandia, also known as rosiglitazone, is worth the risk. " A critical question to be resolved in determining appropriate regulatory action is whether the anticipated therapeutic benefit of rosiglitazone outweighs the demonstrated cardiovascular risk, " one F.D.A. reviewer concluded. 6.%% Medscape - Corneal Sensitivity Is Linked to Diabetic Neuropathy (Reuters Health) Jul 26 - Results of a new study suggest that corneal sensitivity is reduced in diabetic patients, and is related to the severity of neuropathy. " In diabetic patients, corneal sensitivity is reduced, due to a loss of corneal nerve fibers, which leads to corneal keratopathy and a susceptibility to injury, with recurrent erosions and ulcers, " researchers write . Corneal sensation, they add, can be evaluated using the Cochet-Bonnet aesthesiometer (C-BA) or the noncontact corneal aesthesiometer (NCCA). They examined corneal sensitivity in 147 diabetic patients and 18 controls using these approaches and also assessed neuropathy deficit score. Neuropathy was classified as being absent, mild, moderate or severe. No significant differences in age, type of diabetes, and A1C were observed among the groups. The duration of diabetes increased with neuropathic severity. Corneal sensitivity was significantly reduced in patients with diabetes compared with controls. It was not reduced in diabetic patients without neuropathy. However, a significant reduction was observed in those with any degree of neuropathy. A significant correlation was observed between neuropathy established by C-BA and NCCA. The findings, the investigators conclude " have important clinical implications regarding the development of corneal abnormalities in diabetic patients and also raise the possibility that corneal sensation could be used to screen for diabetic neuropathy. " Diabetes Care 2007;30 7.%% Medical News Today - Improving Heart Health In Kids With Diabetes Type 1: The More They Exercise, The Lower The Risk Of Early Death 28 Jul 2007 It's never too early to focus on how to maintain good cardiovascular health, especially for people with type 1. A study published in the August issue of Diabetes Care underscores the need for regular physical activity among youth, finding that the more active the child, the better the child's cardiovascular risk profile. Heart disease is the number one killer of people with diabetes. Among type 1 patients as young as 20-39 years, the risk of dying from cardio- and cerebrovascular events is five times higher than it is for people who don't have diabetes. Previous studies have shown that the development of atherosclerotic lesions begins in childhood and that 69 percent of pediatric patients with type 1 diabetes exhibit one or more cardiovascular risk factors. A new study by researchers in Germany and Austria, which looked at the physical activity levels and cardiovascular health of more than 23,000 young people between the ages of 3 and 18, found that those who were most physically active were the least likely to be at risk for heart disease. As physical activity levels rose, risk factors such as high lipid profiles, diastolic blood pressure, and blood glucose levels fell. Regular physical activity was defined as exercising for at least 30 minutes at a time, not including school sports. The study found that those who were active at least once or twice per week were also less likely to have high blood pressure than those who didn't exercise at all. And, it showed that the frequency of regular physical activity " was one of the most important influencing factors for HbA1c. " The A1c test measures average blood glucose levels over a period of 2-3 months and helps a person with diabetes determine how well they are keeping blood glucose levels under control overall. 8.%% Medscape Medical News - The Choice of a Metabolic Syndrome Generation: Soft Drink Consumption Associated With Increased Metabolic Risk [for another version of this see DRList 7-24-07] July 25, 2007 - Drinking more than one soft drink daily is associated with a higher risk of developing adverse metabolic traits, as well as developing the metabolic syndrome, a new study has shown. Interestingly, it doesn't matter if the soda consumed is the diet variety, those with zero calories, as investigators showed these also increased the burden of metabolic risk in middle-aged adults. " That was one of the more striking aspects of this study, " lead investigator Dr R. Vasan (Boston University School of Medicine, MA) told heartwire. . " It actually doesn't matter if the soft drink is regular or diet. There was an association of increased risk of developing the metabolic syndrome with both types of drinks. " Vasan said that the consumption of soft drinks has doubled to tripled between 1977 and 2001. During this same time period, soft-drink sizes have also increased to staggering proportions. With evidence that soft-drink consumption is linked with weight gain and obesity as well as an increased risk of diabetes, the investigators questioned whether soft-drink consumption in adults, in amounts that are seemingly innocuous, like one per day, posed any metabolic hazard. The team related the incidence of metabolic syndrome and its components to soft-drink consumption in more than 6000 individuals participating in the Framingham Heart Study. In a cross-sectional analysis of the data, investigators report that those consuming more than one soft drink daily had a 48% higher prevalence of metabolic syndrome than those who drank less than one soft drink per day. In a longitudinal analysis of more than 6000 subjects free from metabolic syndrome at baseline, drinking more than one soft drink daily was associated with a 44% greater risk of developing metabolic syndrome and with developing 4 out of 5 components of metabolic syndrome. In a smaller sample of participants who had data available regarding the type of soft drink consumed, researchers observed that that those who consumed one or more drinks of diet or regular soda per day had a 50% to 60% increased risk of developing new-onset metabolic syndrome. Despite the fact that diet soda has zero calories, the findings are not entirely surprising, said Vasan, as diet soft drinks have been previously linked with poor health outcomes in children, such as weight gain and high blood pressure. In terms of theories explaining the association between soft-drink consumption and the metabolic syndrome risk, Vasan said there are no definitive answers yet. .it might be a lifestyle/dietary background thing driving this. " In addition, Vasan said diet soda might also induce a conditioning response in which the soft drinks promote a dietary preference for sweeter foods. Also, because diet soda is liquid, this has the effect of individuals eating more at the next meal, mainly because liquids are not as satiating. And finally, the brown caramel in soda has been linked with tissue damage and inflammation, which might contribute to the increased risk. All of these theories, however, are debated in literature. " Clearly, these findings are sufficiently intriguing that scientists now have to help us understand better why we see this association, " said Vasan. " We are not inferring causality from this analysis. It is just an association, so we need to turn to the scientists who are better positioned to help us understand the association more. " Circulation. Published online July 23, 2007. 9.%% -FDA Advisory Panels Acknowledge Signal of Risk With Rosiglitazone, but Stop Short of Recommending Its Withdrawal Wood Heartwire 2007. C 2007 Medscape July 31, 2007 - Rosiglitazone (Avandia, GlaxoKline [GSK]) is associated with a clear signal of cardiac ischemic risk in type 2 diabetics, the available data suggest, but this signal is not enough to justify yanking the drug from the market. This was the near-unanimous conclusion of the FDA's joint Endocrinologic and Metabolic Drugs/Drug Safety and Risk Management advisory committees at Monday's hearing. A long day of confusing, often conflicting data was capped by the seemingly inconsistent conclusions of the committee members who agreed 20:3 with the statement that available studies supported a signal of harm, but voted 22:1 to keep rosiglitazone on the market. Dr Pickering who was one of the three members who did not agree that there was a clear increased risk of ischemic events, pointed to the apparent contradiction: " I'm puzzled as to how people can vote yes for both questions, " he mused. But the vast majority of voting members on the panel seemed to agree with the sentiment raised repeatedly by presenters, panelists, and open public-hearing speakers, that it was important for physicians to have rosiglitazone in their arsenal of treatments for type 2. Indeed, some of the day's discussion revolved around an emerging hypothesis that the other thiazolidinedione (TZD) on the market, pioglitazone [Actos], might not carry the same safety concerns as rosiglitazone. Those data, however, comes predominantly from an as-yet unpublished analysis conducted by pioglitazone manufacturer Takeda, and has not yet been reviewed by the FDA, nor was it provided in full to panel members. A review of that data, was on track to be completed in time for the panel's review of the cardiovascular ischemic/thrombotic risks of TZDs, which had originally been scheduled for later in the year. The hearing, however, was bumped up after the publication of a controversial meta-analysis in the New England Journal of Medicine (NEJM) [1]--pointing to a significant 43% increase in myocardial infarction with rosiglitazone. During today's session, panel members heard from the sponsor and the FDA, both of whom had conducted their own meta-analyses of the randomized controlled trial data and turned up findings that were surprisingly consistent with the NEJM analysis--a 40% increased risk of serious ischemic events by the FDA's reckoning and a 31% increase in myocardial ischemic events in GSK's meta-analysis. All of the yes-votes reiterated the same concerns: that the evidence linking rosiglitazone with increased risk of cardiovascular death or MI was weak or inconsistent, particularly in trials that had active control arms rather than placebo comparators; that ischemic risk appeared higher in older patients, patients with heart failure, patients with preexisting coronary disease, and patients taking insulin--and that this should be reflected in the labeling. In fact, several panelists pointed out that current labeling lists rosiglitazone as being indicated for diabetics taking insulin; they felt this should be removed and a black box should be added warning against its use in this group. Others emphasized that the inconclusiveness of the existing studies and the fact that trials are still ongoing should also be mentioned in the packaging. But time and again, the experts on the panel bemoaned the fact that, not for the first time, the FDA had not had the foresight to mandate appropriate trials, leaving the committees to try to draw conclusions from meta-analyses and observational studies. Even the ongoing RECORD, ACCORD, and BARI-2D trials, by the FDA's own review, are underpowered or not designed to answer key questions about whether ischemic events will be higher than with other diabetes drugs, and if they are, which patient subsets will be affected. The mere fact that most of the studies included in the meta-analyses were only six months in duration underscores the paucity of solid information. The sole no-vote on the key question of whether rosiglitazone should remain on the market came from Dr Arthur Levin (Center for Medical Consumers, New York, NY). " It seems to me that given the evidence of a strong safety signal, given the fact that around this table and at the FDA there are doubts about the ability of ongoing clinical trials to definitively answer the question about the CV safety of the drug, and given the enormity of the potential public health risk of allowing this drug to continue to be marketed and used by millions of people for the rest of their lives, I logically can't find any way to justify leaving this drug on the market. " Levin's opinions have the support of at least two FDA insiders, Dr Gerald Dal Pan and Dr Graham , both in the FDA's Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research. Graham presented a risk/benefit assessment of rosiglitazone, pointing out that although his views were his own, his findings had been reviewed and were supported by others in his department, such that he was not just speaking as " Graham the FDA Whistle-Blower. " Graham showed projections to back up his claim that ongoing studies " will not change our state of knowledge... Graham's concerns about the quality of the existing rosiglitazone data, and the flawed studies in progress, struck a chord with panel members, who called for stricter standards for pre-approval and post-marketing studies. " I would have to say, the FDA has to take some responsibility for the dilemma in which we find ourselves, for approving less than optimally designed trials in the past, " Dr Arthur Moss observed. " I do think there is a problem that needs to be rectified in the future. " Vindication for Nissen Commenting on the day's deliberations to heartwire, Dr Nissen (Cleveland Clinic, OH), seemed satisfied that the FDA and sponsors' meta-analyses had confirmed his own findings. . " One concern I have is that black-box warnings do not always result in huge changes in prescribing practices, so time will tell, " he told heartwire 1. Nissen SE and Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007; 356:2457-2471. 10.%% Simultaneous Pancreas Kidney Transplantation From Old Donors Medscape Transplantation. 2007; C2007 Medscape 07/24/2007 Patient and Graft Survival Implications of Simultaneous Pancreas Kidney Transplantation From Old Donors Am J Transplant. 2007;7 Summary - The authors performed a retrospective analysis of the United Network for Organ Sharing database and identified adult patients with type 1 DM who were placed on the waiting list for simultaneous pancreas-kidney (SPK) transplantation. 8850 patients (54%) received an SPK transplant, of which 9% were from donors 45 years of age or older. Survival analyses were performed . .SPK transplantation from both young and old donors independently predicted lower mortality compared with staying on the waiting list. An additional expected wait of 1.5 years for a young donor equalized long-term survival expectations between young and old SPK donors. On the basis of these findings, the authors concluded that SPK transplantation offers a substantial survival benefit independent of donor age and should be considered for patients with decreased access to organs from young donors. Viewpoint - The critical shortage of donor organs challenges the transplant community to maximize and optimize the use of organs from all consenting deceased donors. .the profile of acceptable older donors for SPK transplantation may include female sex, low body mass index, and noncerebrovascular etiology of brain death. The patient population most likely to benefit from SPK transplantation from old donors includes either patients with limited access to timely transplantation (eg, blood type O or B, highly sensitized) or those who cannot afford to wait for an extended period of time (unstable diabetes, prolonged duration of dialysis, older age [> 50 years], known peripheral vascular or cardiovascular disease). 11.%% Medscape Medical News - Low GI Diets Better for Weight Loss, Lipid Profiles, Finds Cochrane Review July 24, 2007 - A new Cochrane review of six randomized controlled trials comparing low glycemic index (GI) or glycemic load (GL) diets with other diets has found that overweight or obese people lost more weight and had more improvement in lipid profiles with the low GI eating plans. Those on the low GI diets lost an average of 2.2 pounds (1 kg) more than those given comparison diets, which included higher GI or GL diets and conventional weight loss diets. They also had significantly better decreases in total and low-density lipoprotein (LDL) cholesterol, the researchers note. And in the two trials that evaluated only obese participants, weight loss was even more apparent - the low GI dieters lost about 9.2 pounds, compared with about 2.2 pounds shed by those on the other diets. However, the scientists caution that enduring data are still needed. " Longer trials with increased length of follow-up will determine whether the improvements reported can be maintained and incorporated into lifestyle long-term, " they say. Two experts not connected with the review expressed mixed opinions. One said this was a great review, while the other pointed out that the difference in weight loss between the low and high GI diets was rather small. The team included six trials in their review, including a total of 202 adults. The diets lasted from 5 weeks to 6 months, and none of the studies reported any adverseveffects associated with consuming a low GI diet.vAs well as losing more weight, those on the low GI diets also had significantly greatervloss of total fat mass and decrease in body mass index (BMI) than those on the comparison diets. " Considering the brevity of the interventions, the results are notable, " they add. Improvements in blood lipids were also significant. Cochrane Database Syst Rev. Published online July 18, 2007. Abbreviations: ADA - American Diabetes Association; DM - diabetes Mellitus; FDA Federal Drug Administration; NIH - National Institutes of Health; VA - Veterans Administration. Definitions - Dorlands 31st Ed and Google 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 Coordinator The Health Library at Vista Center contact above e-mail or thl@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2007 Report Share Posted December 12, 2007 I love the description of the new Accu-Chek. Now if they would just make it talk it would be perfect. Becky _____ From: blind-diabetics [mailto:blind-diabetics ] On Behalf Of LaFrance-Wolf Sent: Wednesday, December 12, 2007 12:20 PM To: Blind-DiabeticsYahoogroups (DOT) Com; Acb-DiabeticsAcb (DOT) Org; Doc Mahaber Dr. (Doc Mahaber Dr.); 'rayann Myers' Subject: articles 1. December 2007 FDA Patient Safety News Homepage Possibility of Pancreatitis in Patients Taking Byetta FDA is alerting healthcare professionals that Byetta (exenatide) may be associated with acute pancreatitis in some patients. Byetta is administered subcutaneously to treat T2DM. FDA has reviewed 30 reports of acute pancreatitis in patients taking Byetta. 21 were hospitalized, 5 of them with serious complications. 22 of the patients improved after discontinuing the drug. Practitioners should be alert to the signs and symptoms of pancreatitis in patients taking Byetta. If pancreatitis is suspected, discontinue the drug. If the diagnosis is confirmed, do not restart Byetta unless an alternative cause for the pancreatitis is identified. Patients taking Byetta should be cautioned to promptly seek medical care if they experience symptoms of pancreatitis, such as persistent and severe abdominal pain, possibly accompanied by vomiting. The manufacturer of Byetta, Amylin Pharmaceuticals, has agreed to include information about pancreatitis in the Precautions section of the drug's labeling. 2.%% MW - High Glycemic Index Foods May Increase Risk for T2DM in Chinese Women Dec 4, 2007 — High intake of foods with a high glycemic index (GI), especially rice, may increase the risk for T2 in middle-aged women of Chinese descent, according to the results of a new study. " Much uncertainty exists about the role of dietary glycemic index and glycemic load [GL] in the development of T2DM, especially in populations that traditionally subsist on a diet high in carbohydrates, " researchers write. " we prospectively examined the relationships between dietary carbohydrates, GI, GL, and carbohydrate- rich foods with the risk of T2 in” [this population] [64,227 women free of DM or other chronic disease at baseline; follow up 4.6 years]... " High intake of foods with a high glycemic index and glycemic load, especially rice, the main carbohydrate-contributing food in this population, may increase the risk of T2 in Chinese women, " Arch Intern Med. 2007;167. 3.%% MW - Cereal Fiber Intake Reduces Risk for T2DM in US Black Women Dec 4, 2007 — Increasing high-fiber cereal in the diet may reduce the risk for T2 in US black women, according to the results of a new study. . Our aim was to examine the association of GI [glycemic index], GL [glycemic load], and cereal fiber intake with the risk of type 2 diabetes in a cohort of US black women. " [cohort study of 59,000 the investigators estimated incidence rate ratios (IRRs) for quintiles of dietary factors, after adjustment for lifestyle and dietary factors. GI was positively associated with the risk for T2. " Increasing cereal fiber in the diet may be an effective means of reducing the risk T2 a disease that has reached epidemic proportions in black women, " the study authors write. " There was an almost 2-fold increase in risk for those in the highest quintile of GI and a 59% decrease for those in the highest quintile of cereal fiber intake relative to the lowest in women with a BMI lower than 25. " Arch Intern Med. 2007;167 4.%% Ophthalmology Volume 114,Issue 12,(December 2007) Intravitreal Triamcinolone plus Sequential Grid Laser versus Triamcinolone or Laser Alone for Treating Diabetic Macular Edema : Six-Month Outcomes Conclusions - Contrary to the results of a recent study, combined treatment of intravitreal TA plus grid laser did not yield better CFT reduction or BCVA improvement at 6 months than intravitreal TA alone. Grid laser alone was significantly worse than the 2 other treatment modalities. Published by Elsevier 5.%%MW - Vitamin E Cardioprotective in Older Diabetics With Certain Genotype (Reuters Health) Dec 03 - Vitamin E supplementation reduces the incidence of myocardial infarction (MI) among older patients with T2DM who produce a less active form of the antioxidant protein haptoglobin (Hp). Mega-doses of vitamin E can be lethal when used indiscriminately. However, researchers maintain that " high-dose antioxidant therapy may only provide benefit to individuals who suffer from particularly high levels of oxidative stress. " The Hp-2 protein is an inferior antioxidant compared with the Hp-1 protein, the team explains. In longitudinal studies of DM patients, 2- to 5-fold increases in cardiovascular events were documented in Hp 2-2 carriers compared with those with Hp 1-1 and Hp 1-2 genotypes. In the current prospective trial, the group randomized 1434 individuals 55 years of age or older (mean 69 years) with T2 and the Hp 2-2 genotype to vitamin E 400 U/day or placebo. The primary outcome was a composite of MI, stroke and cardiovascular death. At 18 months, the primary outcome was significantly reduced (2.2%) in the vitamin E group compared with the placebo group (4.7%), which lead to early trial termination. " The event rate in Hp 2-2 individuals randomized to vitamin E was remarkably similar to that of Hp 1-1 and Hp 2-1 individuals " identified in the same target population. The team stress that the results are relevant only to Hp 2-2 DM individuals over the age of 55 and can not be generalized to the entire population. Furthermore, vitamin E should not be used to replace other proven therapies to prevent cardiovascular disease. The researchers hope to motivate the " establishment of a platform for a substantially larger trial without the limitations of the current study, and which could therefore constitute the basis for conclusive treatment guidelines. " Arterioscler Thromb Vasc Biol 2008;28. 6.% Diabetes Increases Colorectal Cancer Risk for Women Study Finds Diabetic Women Have 50 Percent Higher Risk of Colon, Rectum Cancer ABC News Medical Unit Dec. 7, 2007 — Women with DM already have to manage a complex diagnosis and treatment protocol. Now they may have another disconcerting diagnosis: colorectal cancer. According to a new study women with DM are 1.5 times more likely to develop colorectal cancer -- in which cancerous tumors develop in the tissues of the colon or rectum -- than women who don't have the metabolic disorder. The research was announced at the American Association for Cancer Research's Sixth Annual International Conference on Frontiers in Cancer Prevention Research. " We are just beginning to understand the role of insulin in the increased risk of many cancers, " said the lead author. " Our primary finding in this study was that a diagnosis of DM meant a 50 % stronger chance of developing colorectal cancer. " The team tracked the records of more than 45,000 women in the Breast Cancer Demonstration Project to identify how many women later developed colorectal cancer.After adjusting for a number of variables, he said the results remained statistically significant, and he believes insulin has something to do with it. " Elevated rates of insulin itself may promote the risk, " he said. Dr. D Beck,department of colon and rectal surgery at the Ochsner Clinic Foundation in New Orleans, agrees that insulin may play a role in cancer development. " Insulin is important in cells' ability to use glucose, one of the cells' major energy source, " he said. " Elevated glucose levels might support cell growth initially or may contribute to new blood vessel growth, which would allow cells to grow faster. This might be a factor in other cancer development. " To test the hypothesis that higher insulin levels -- common in people developing DM or people who have poorly managed glucose -- triggered cancerous polyps, the team then examined other data from women who were later diagnosed with diabetes. They were surprised to find that women in this " prediabetic " stage did not actually have as high an increased risk. The exact way reason that increased insulin hastens the development of cancer cells remains largely unknown. Flood suspects it may have something to do with the length of time and the degree of elevated insulin in the body. The best way women with diabetes can help their bodies not to develop colorectal cancer is through " management of glucose, " Beck reminds patients " Healthy lifestyles and diet are important, however colorectal cancer screening with colonoscopy is critical to the prevention of colorectal cancer, " he said. " If diabetic women are at increased risk, it is even more important to screen them and we may consider decreasing the time for follow-up exams. " 7.%% Medical News Today - Half The Steps To Test - With The New And Only, All-In-One Blood Glucose Monitoring System 05 Dec 2007 Roche Diagnostics is launching a new and unique, ergonomically designed blood glucose monitoring system - that looks like a mobile phone - combining all the necessary measurement tools in one instrument. The only one of its kind, the new Accu-Chek Compact Plus is a three-in-one solution comprising of a detachable lancing device, a test strip drum with 17 test strips and a meter with a bright self-illuminating display. Now users can measure their blood glucose levels in half the steps as the new Compact Plus has a drum with 17 built-in test strips which eliminates strip handling (I). One push of the button and the strip appears, ready to use, making the process simple, fast and hygenic. .Accu-Chek Compact Plus automatically self-codes to ensure accuracy of testing. The quick five second test reading is complemented with an easy to read, glow-in-the dark display. A further advantage is that the user needs only one hand to operate the measurement functions as the device has a detachable finger pricker..11-depth settings allow for virtually pain-free blood sampling from 0.8mm to 2.3mm. Accu-Chek Compact Plus is available through pharmacies rrp £12.99, or direct from Roche from December 2007, replacing the current model as stocks on shelf sell out. For more information, visit http://www.accu- <http://www.accu-chek.com.> chek.com. 8.%%MW-Missing the Point: Substituting Exenatide for Nonoptimized Insulin Going From Bad to Worse! Diabetes Care. 2007;30(11) ©2007 ADA Inc. 12/03/2007 The recent ADA/European Association for the Study of Diabetes consensus treatment algorithm for T2DM has advanced basal insulin treatment as a much earlier therapeutic option following a structured target-driven strategy. However, the misconception by both providers and patients that insulin should be regarded as the therapy of last resort still prevails and is perhaps the main barrier to insulin treatment, even at the price of many years of poor glycemic control. Insulin is the most effective DM agent, only limited by hypoglycemia; however, when used inappropriately in nonphysiological and nonoptimized regimens, many patients treated with insulin remain poorly controlled..The concept of adding a new therapy to insulin was the initial strategy employed with troglitazone to get fast regulatory approval in 1997. [its] makers then unleashed an aggressive marketing campaign, including direct-to- consumer advertising reinforcing the misconception against insulin and possibly further delaying initiation of insulin therapy in many patients. Although subsequent trials with glitazones in combination with insulin showed only modest improvements in glycemic control, this strategy also led to misguided attempts to substitute newer agents for insulin treatment with the false concept of " rescuing " patients from insulin therapy. In this issue of Diabetes Care, et al. report on a small study exploring the safety of substituting exenatide for insulin therapy in an attempt to take patients off insulin. The scientific value is rather unclear, but the marketing appeal is quite obvious. .. we wonder whether the patients were really " successful " in stopping insulin and switching to exenatide if baseline A1C went up from 8.1 to 8.4%. . .This was clearly a negative trial, with a flawed study design and a conclusion that perhaps should have been stronger against substituting exenatide for insulin. ..we hope that we will not see educational messages or marketing headlines that may mislead patients and providers, such as " More than 50% of T2 patients on insulin therapy can be successfully switched to exenatide! " Negative studies are rarely published because of author and reviewer biases. Nevertheless, we feel that the journal was correct in accepting this study for publication so that the readers can learn what not to do with exenatide and insulin therapy.. We encourage investigators to explore innovative approaches to improve glycemic control in patients treated with insulin using combinations of drugs that impact the endocrine system along with insulin, rather than as a substitute for insulin. Such combinations might help alleviate some of the problems of insulin therapy, such as weight gain and hypoglycemia. The aim of the trials should be to define the best treatment strategy for patients rather than to attempt to show that newer therapies can replace insulin—in our opinion, an exercise in futility. Until such studies are done, we encourage practitioners to follow guidelines and recommendations based on randomized controlled clinical trials that will help achieve glycemic goals without putting patients at unnecessary risk. Clearly, as of today, substitution of insulin with newer therapies is inappropriate. 9.%% MW - A Patient With Type B Insulin Resistance Syndrome, Responsive to Immune Therapy Nat Clin Pract Endocrinol Metab. 2007;3(12) ©2007 Nature Pub. Group 12/03/2007 Summary Background: A 55-year-old woman with vitiligo, hypothyroidism, interstitial lung disease and diabetes mellitus developed severe insulin resistance during a hospital admission for respiratory failure. Before hospitalization, her HbA 1c level was 8.1% on ~100 U/day of insulin. Her interstitial lung disease had been treated with glucocorticoids, but after their withdrawal her insulin requirements had increased dramatically. She remained hyperglycemic despite intravenous insulin at doses as high as 30,000 U/day. Diagnosis: Type B insulin resistance syndrome. The initial goal when treating patients with type B insulin resistance is to manage their hyperglycemia, and this generally requires large amounts of insulin. The clinical course of patients with type B insulin resistance is variable. Many patients will have a spontaneous remission of the autoantibody syndrome but the time to remission is unpredictable. Type B insulin resistance is a rare disease that responds in an unpredictable manner to immunosuppressive therapies; therefore, there are no treatment guidelines for [their] use for patients with the disease. This case report underscores the importance of considering immune-mediated insulin resistance along with other, more common, contributors to decreased insulin sensitivity in hospitalized patients with marked insulin needs. 10.%% MW - Eating Disturbance Common and Persistent in Girls With Type 1 Diabetes (Reuters Health) Dec 06 - There is a high prevalence of disturbed eating behavior and eating disorders among girls with T1DM, according to Canadian researchers. They found that eating disturbances in this population are likely to persist over time. At baseline of this 5 year study, higher rates of disturbed eating behavior were observed in girls with T1 between the ages of 9 and 13 years than in non-diabetic control patients (8% versus 1%). Overall, 126 girls participated at baseline, declining to 98 at 5 years. The mean age was 11.8 years at baseline;16.5 years at 5 years. Of the 98 girls who participated at 5 years, 48 (49.0%) reported current disturbed eating behavior. Specifically, 43 of the 98 girls reported active dietary restraint, 6 reported binge-eating episodes, 3 reported self-induced vomiting, 3 reported insulin omission, and 25 reported intense, excessive exercise for weight control. A total of 13 girls met the criteria for eating disorders. The authors note that A1C was not higher in subjects with disturbed eating behavior (8.7% versus 8.4%). However, a trend for higher A1C was observed among those with an eating disorder (9.1% versus 8.5%; ). Subjects with disturbed eating behavior had higher BMI (26.1 versus 23.5). " Eating disturbances early in the study, in the pre-teen years, were very likely to persist over time; 92% of girls with eating disturbances detected early in the study continued to report eating disturbances later in their teen years, " Dr. Colton said in an interview with Reuters Health. " This study contributes to the growing understanding of the close relationship between physical health and mental health in individuals with diabetes, " she continued. " In particular, eating disturbances are very common and persistent in girls and women with T1, and can arise in even pre-teen girls, " These results suggest that screening for eating disturbances in individuals with T1 should start in the pre-teen years. " Individuals with diabetes who are struggling with eating disturbances should receive early support and treatment to prevent the development of full-syndrome eating disorders and the medical risks associated with the. It is often hard for individuals to tell someone that they have an eating disorder, and so sensitivity to body image issues, body dissatisfaction and eating disturbances, both at home and in the clinic setting, is crucial to helping these individuals seek appropriate help and support in optimizing their health and reaching their full potential, " she concluded. Diabetes Care 2007;30:. 11.%% MW - Insulin Detemir May Be Safer Than NPH Insulin in Elderly Type 2 Diabetics (Reuters Health) Dec 06 - In patients older than 65 with T2 requiring insulin, insulin detemir may be a better choice than neutral protamine Hagedorn (NPH) insulin, based on an analysis of pooled data from randomized studies. " The findings of the study show that there was less hypoglycemia with insulin detemir than with other basal insulins, " the lead investigator Dr. A. Garber told Reuters Health. The team examined data from 3 open-label studies. [416 subjects aged 65 years or more and 880 younger subjects. They were treated for 22 to 26 weeks with basal detemir or NPH, along with mealtime insulin or oral agents. The level of glycemic control achieved was similar with both insulins and in both age groups. However, those in the insulin detemir groups gained significantly less body weight (about 1 kg) [2.2lb] than did patients on NPH insulin. Moreover, with insulin detemir, there was a significant risk reduction of 41% for all hypoglycemic episodes in the older group. The risk reduction in the younger group was 25%. " This suggests, " he said " that insulin detemir may be a safer therapeutic choice in patients, such as the elderly, for whom hypoglycemia may produce serious complications. " J Am Geriatr Soc 2007;55. 12.%% MW - Diabetic Retinopathy Screening Improved With Automated Grading of Digital Images (Reuters Health) Dec 05 - An automated system that tags digital retinal images as positive or negative for disease would greatly facilitate widespread screening for diabetic retinopathy, researchers report. The investigators developed software that could grade digital images of the retina and fundus as having " disease " or " no disease. " They then tested the sensitivity and specificity of the system compared with the clinical reference standard on 14,406 images from 6,722 patients.. " In our study of 6,722 patients, there was no statistical difference in the ability of automated 'no disease/disease' grading to detect patients with referable retinopathy/maculopathy compared to standard practice, " " The advantage of automated 'disease/no disease' grading for diabetic retinopathy rests not just on its equivalent efficacy to standard practice, but on its ability to reduce the manual grading workload of photographic diabetic retinopathy screening programs by 60%, " they pointed out. The Aberdeen researcher said that the prevalence of diabetic retinopathy is at least 4% in the UK, where efforts are being made to establish a national screening program. Br J Ophthalmol 2007;91. 13.%% MW - Glycemic Profiles During Pregnancy Differ Between Type 1 and Type 2 Diabetes (Reuters Health) Dec 05 - The first study to use continuous glucose monitoring to examine changes in glycemic excursions throughout pregnancy shows that levels of glycemic control differ significantly between women with T1DM and those with T2DM In one respect, however, the two groups did not differ. " It is particularly alarming that during the critical stage of early pregnancy, women with DM on average spend only 50% of 12 h/day with blood glucose levels in the euglycemic [=normal not hypo or hyperglycemic] range, " the researchers report. [data from continuous glucose monitoring during 7 days in each trimester of pregnancy in 40 women with pregestational T1 and 17 women with T2. The researchers found that time spent within the euglycemic range (blood glucose 70-140 mg/dL) increased as gestation advanced, and that women with T2 spent about a third more time euglycemic than women with T1. Time spent hyperglycemic (> 140 mg/dL) decreased as gestation advanced, and women with T2 spent only two-thirds as much time hyperglycemic as women with T1. T2DM was also associated with shorter durations of extreme hyperglycemia (> 200 mg/dL). Although the proportion of time spent hypoglycemic (< 70 mg/dL) did not change significantly over gestation, women with T1DM spent more time hypoglycemic than did those with T2. " Strikingly, the data highlight just how difficult it is to reach current targets for euglycemia, particularly for women with T1. They add, " These data are important for all clinicians seeking to limit hypoglycemia and optimize maternal glycemic control in daily practice, as well as researchers seeking to improve therapeutic interventions aimed at achieving normoglycemia during pregnancy. " Diabetes Care 2007;30. 14.%% MW - Vitamin E Cardioprotective in Older Diabetics With Certain Genotype (Reuters Health) Dec 03 - Vitamin E supplementation reduces the incidence of myocardial infarction (MI) among older patients with T2DM who produce a less active form of the antioxidant protein haptoglobin (Hp). Mega-doses of vitamin E can be lethal when used indiscriminately. However, the researchers maintain that " high-dose antioxidant therapy may only provide benefit to individuals who suffer from particularly high levels of oxidative stress. " The Hp-2 protein is an inferior antioxidant compared with the Hp-1 protein, the team explains. In longitudinal studies of diabetic patients, 2- to 5-fold increases in cardiovascular events were documented in Hp 2-2 carriers compared with those with Hp 1-1 and Hp 1-2 genotypes. In the current prospective trial, the group randomized 1434 individuals 55 years of age or older (mean 69 years) with T2DM and the Hp 2-2 genotype to vitamin E 400 U/day or placebo. The primary outcome was a composite of MI, stroke and cardiovascular death. At 18 months, the primary outcome was significantly reduced (2.2%) in the vitamin E group compared with the placebo group (4.7%), which lead to early trial termination. The team stresses that the results are relevant only to Hp 2-2 DM individuals over the age of 55 and can not be generalized to the entire population. Furthermore, vitamin E should not be used to replace other proven therapies to prevent cardiovascular disease. They hope to motivate the " establishment of a platform for a larger trial without the limitations of the current study, and which could therefore constitute the basis for conclusive treatment guidelines. " Arterioscler Thromb Vasc Biol 2008;28. 15.%% MW -Vinegar at Bedtime Moderates Waking Glucose Level in Type 2 Diabetics (Reuters Health) Dec 04 - Results of a study suggest that a dose of vinegar taken at bedtime may favorably impact waking glucose concentrations in patients with T2DM. " Given the importance of maintaining acceptable blood glucose concentrations, there is much interest in identifying foods and diet patterns that will help individuals with diabetes manage their condition, " write the Previous data showed that vinegar ingestion at mealtime reduces postprandial glycemia. In the current study, the researchers examined the effect of vinegar taken at bedtime in 4 men and 7women (aged 40 to 72 years) with T2 who were not taking insulin. The patients measured fasting glucose at 7 a.m. for 3 consecutive days prior to the start of the study. They then followed a standardized meal plan for 2 days, consuming either 2 tablespoons of apple cider vinegar or water at bedtime with 1 oz cheese. After a 3- to 5-day washout period, they crossed over to the alternate bedtime treatment. The participants had a typical fasting glucose of 7.6 mmol/L before the start of the study. Fasting glucose fell by (2%) with placebo and by (4%) with vinegar treatment. The investigators report that the vinegar treatment was especially effective for subjects with a typical fasting glucose greater than 7.2 mmol/L (n = 6). Fasting glucose in these participants was reduced 6% compared with a reduction of 0.7% in those with a typical fasting glucose less than 7.2 mmol/L. " Vinegar is widely available, it is affordable, and it is appealing as a remedy, but much more work is required to determine whether vinegar is a useful adjunct therapy for individuals with DM, " they conclude. Diabetes Care 2007;30: Abbreviations: ADA - American Diabetes Association; BP - blood pressure; DM - diabetes Mellitus;HTN - hypertension; MW Medscape Web MD; FDA Federal Drug Administration; NIH - National Institutes of Health; VA - Veterans Administration. Definitions - Dorlands 31st Ed and Google. 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 Coordinator The Health Library at Vista Center contact above e-mail or thlvistacenter (DOT) <mailto:thl%40vistacenter.org> org __________ NOD32 2718 (20071212) Information __________ This message was checked by NOD32 antivirus system. http://www.eset. <http://www.eset.com> com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 12, 2007 Report Share Posted December 12, 2007 My thought exactly Becky! articles 1. December 2007 FDA Patient Safety News Homepage Possibility of Pancreatitis in Patients Taking Byetta FDA is alerting healthcare professionals that Byetta (exenatide) may be associated with acute pancreatitis in some patients. Byetta is administered subcutaneously to treat T2DM. FDA has reviewed 30 reports of acute pancreatitis in patients taking Byetta. 21 were hospitalized, 5 of them with serious complications. 22 of the patients improved after discontinuing the drug. Practitioners should be alert to the signs and symptoms of pancreatitis in patients taking Byetta. If pancreatitis is suspected, discontinue the drug. If the diagnosis is confirmed, do not restart Byetta unless an alternative cause for the pancreatitis is identified. Patients taking Byetta should be cautioned to promptly seek medical care if they experience symptoms of pancreatitis, such as persistent and severe abdominal pain, possibly accompanied by vomiting. The manufacturer of Byetta, Amylin Pharmaceuticals, has agreed to include information about pancreatitis in the Precautions section of the drug's labeling. 2.%% MW - High Glycemic Index Foods May Increase Risk for T2DM in Chinese Women Dec 4, 2007 — High intake of foods with a high glycemic index (GI), especially rice, may increase the risk for T2 in middle-aged women of Chinese descent, according to the results of a new study. " Much uncertainty exists about the role of dietary glycemic index and glycemic load [GL] in the development of T2DM, especially in populations that traditionally subsist on a diet high in carbohydrates, " researchers write. " we prospectively examined the relationships between dietary carbohydrates, GI, GL, and carbohydrate- rich foods with the risk of T2 in” [this population] [64,227 women free of DM or other chronic disease at baseline; follow up 4.6 years]... " High intake of foods with a high glycemic index and glycemic load, especially rice, the main carbohydrate-contributing food in this population, may increase the risk of T2 in Chinese women, " Arch Intern Med. 2007;167. 3.%% MW - Cereal Fiber Intake Reduces Risk for T2DM in US Black Women Dec 4, 2007 — Increasing high-fiber cereal in the diet may reduce the risk for T2 in US black women, according to the results of a new study. . Our aim was to examine the association of GI [glycemic index], GL [glycemic load], and cereal fiber intake with the risk of type 2 diabetes in a cohort of US black women. " [cohort study of 59,000 the investigators estimated incidence rate ratios (IRRs) for quintiles of dietary factors, after adjustment for lifestyle and dietary factors. GI was positively associated with the risk for T2. " Increasing cereal fiber in the diet may be an effective means of reducing the risk T2 a disease that has reached epidemic proportions in black women, " the study authors write. " There was an almost 2-fold increase in risk for those in the highest quintile of GI and a 59% decrease for those in the highest quintile of cereal fiber intake relative to the lowest in women with a BMI lower than 25. " Arch Intern Med. 2007;167 4.%% Ophthalmology Volume 114,Issue 12,(December 2007) Intravitreal Triamcinolone plus Sequential Grid Laser versus Triamcinolone or Laser Alone for Treating Diabetic Macular Edema : Six-Month Outcomes Conclusions - Contrary to the results of a recent study, combined treatment of intravitreal TA plus grid laser did not yield better CFT reduction or BCVA improvement at 6 months than intravitreal TA alone. Grid laser alone was significantly worse than the 2 other treatment modalities. Published by Elsevier 5.%%MW - Vitamin E Cardioprotective in Older Diabetics With Certain Genotype (Reuters Health) Dec 03 - Vitamin E supplementation reduces the incidence of myocardial infarction (MI) among older patients with T2DM who produce a less active form of the antioxidant protein haptoglobin (Hp). Mega-doses of vitamin E can be lethal when used indiscriminately. However, researchers maintain that " high-dose antioxidant therapy may only provide benefit to individuals who suffer from particularly high levels of oxidative stress. " The Hp-2 protein is an inferior antioxidant compared with the Hp-1 protein, the team explains. In longitudinal studies of DM patients, 2- to 5-fold increases in cardiovascular events were documented in Hp 2-2 carriers compared with those with Hp 1-1 and Hp 1-2 genotypes. In the current prospective trial, the group randomized 1434 individuals 55 years of age or older (mean 69 years) with T2 and the Hp 2-2 genotype to vitamin E 400 U/day or placebo. The primary outcome was a composite of MI, stroke and cardiovascular death. At 18 months, the primary outcome was significantly reduced (2.2%) in the vitamin E group compared with the placebo group (4.7%), which lead to early trial termination. " The event rate in Hp 2-2 individuals randomized to vitamin E was remarkably similar to that of Hp 1-1 and Hp 2-1 individuals " identified in the same target population. The team stress that the results are relevant only to Hp 2-2 DM individuals over the age of 55 and can not be generalized to the entire population. Furthermore, vitamin E should not be used to replace other proven therapies to prevent cardiovascular disease. The researchers hope to motivate the " establishment of a platform for a substantially larger trial without the limitations of the current study, and which could therefore constitute the basis for conclusive treatment guidelines. " Arterioscler Thromb Vasc Biol 2008;28. 6.% Diabetes Increases Colorectal Cancer Risk for Women Study Finds Diabetic Women Have 50 Percent Higher Risk of Colon, Rectum Cancer ABC News Medical Unit Dec. 7, 2007 — Women with DM already have to manage a complex diagnosis and treatment protocol. Now they may have another disconcerting diagnosis: colorectal cancer. According to a new study women with DM are 1.5 times more likely to develop colorectal cancer -- in which cancerous tumors develop in the tissues of the colon or rectum -- than women who don't have the metabolic disorder. The research was announced at the American Association for Cancer Research's Sixth Annual International Conference on Frontiers in Cancer Prevention Research. " We are just beginning to understand the role of insulin in the increased risk of many cancers, " said the lead author. " Our primary finding in this study was that a diagnosis of DM meant a 50 % stronger chance of developing colorectal cancer. " The team tracked the records of more than 45,000 women in the Breast Cancer Demonstration Project to identify how many women later developed colorectal cancer.After adjusting for a number of variables, he said the results remained statistically significant, and he believes insulin has something to do with it. " Elevated rates of insulin itself may promote the risk, " he said. Dr. D Beck,department of colon and rectal surgery at the Ochsner Clinic Foundation in New Orleans, agrees that insulin may play a role in cancer development. " Insulin is important in cells' ability to use glucose, one of the cells' major energy source, " he said. " Elevated glucose levels might support cell growth initially or may contribute to new blood vessel growth, which would allow cells to grow faster. This might be a factor in other cancer development. " To test the hypothesis that higher insulin levels -- common in people developing DM or people who have poorly managed glucose -- triggered cancerous polyps, the team then examined other data from women who were later diagnosed with diabetes. They were surprised to find that women in this " prediabetic " stage did not actually have as high an increased risk. The exact way reason that increased insulin hastens the development of cancer cells remains largely unknown. Flood suspects it may have something to do with the length of time and the degree of elevated insulin in the body. The best way women with diabetes can help their bodies not to develop colorectal cancer is through " management of glucose, " Beck reminds patients " Healthy lifestyles and diet are important, however colorectal cancer screening with colonoscopy is critical to the prevention of colorectal cancer, " he said. " If diabetic women are at increased risk, it is even more important to screen them and we may consider decreasing the time for follow-up exams. " 7.%% Medical News Today - Half The Steps To Test - With The New And Only, All-In-One Blood Glucose Monitoring System 05 Dec 2007 Roche Diagnostics is launching a new and unique, ergonomically designed blood glucose monitoring system - that looks like a mobile phone - combining all the necessary measurement tools in one instrument. The only one of its kind, the new Accu-Chek Compact Plus is a three-in-one solution comprising of a detachable lancing device, a test strip drum with 17 test strips and a meter with a bright self-illuminating display. Now users can measure their blood glucose levels in half the steps as the new Compact Plus has a drum with 17 built-in test strips which eliminates strip handling (I). One push of the button and the strip appears, ready to use, making the process simple, fast and hygenic. .Accu-Chek Compact Plus automatically self-codes to ensure accuracy of testing. The quick five second test reading is complemented with an easy to read, glow-in-the dark display. A further advantage is that the user needs only one hand to operate the measurement functions as the device has a detachable finger pricker..11-depth settings allow for virtually pain-free blood sampling from 0.8mm to 2.3mm. Accu-Chek Compact Plus is available through pharmacies rrp £12.99, or direct from Roche from December 2007, replacing the current model as stocks on shelf sell out. For more information, visit http://www.accu- <http://www.accu- <http://www.accu-chek.com.> chek.com.> chek.com. 8.%%MW-Missing the Point: Substituting Exenatide for Nonoptimized Insulin Going From Bad to Worse! Diabetes Care. 2007;30(11) ©2007 ADA Inc. 12/03/2007 The recent ADA/European Association for the Study of Diabetes consensus treatment algorithm for T2DM has advanced basal insulin treatment as a much earlier therapeutic option following a structured target-driven strategy. However, the misconception by both providers and patients that insulin should be regarded as the therapy of last resort still prevails and is perhaps the main barrier to insulin treatment, even at the price of many years of poor glycemic control. Insulin is the most effective DM agent, only limited by hypoglycemia; however, when used inappropriately in nonphysiological and nonoptimized regimens, many patients treated with insulin remain poorly controlled..The concept of adding a new therapy to insulin was the initial strategy employed with troglitazone to get fast regulatory approval in 1997. [its] makers then unleashed an aggressive marketing campaign, including direct-to- consumer advertising reinforcing the misconception against insulin and possibly further delaying initiation of insulin therapy in many patients. Although subsequent trials with glitazones in combination with insulin showed only modest improvements in glycemic control, this strategy also led to misguided attempts to substitute newer agents for insulin treatment with the false concept of " rescuing " patients from insulin therapy. In this issue of Diabetes Care, et al. report on a small study exploring the safety of substituting exenatide for insulin therapy in an attempt to take patients off insulin. The scientific value is rather unclear, but the marketing appeal is quite obvious. .. we wonder whether the patients were really " successful " in stopping insulin and switching to exenatide if baseline A1C went up from 8.1 to 8.4%. . .This was clearly a negative trial, with a flawed study design and a conclusion that perhaps should have been stronger against substituting exenatide for insulin. ..we hope that we will not see educational messages or marketing headlines that may mislead patients and providers, such as " More than 50% of T2 patients on insulin therapy can be successfully switched to exenatide! " Negative studies are rarely published because of author and reviewer biases. Nevertheless, we feel that the journal was correct in accepting this study for publication so that the readers can learn what not to do with exenatide and insulin therapy.. We encourage investigators to explore innovative approaches to improve glycemic control in patients treated with insulin using combinations of drugs that impact the endocrine system along with insulin, rather than as a substitute for insulin. Such combinations might help alleviate some of the problems of insulin therapy, such as weight gain and hypoglycemia. The aim of the trials should be to define the best treatment strategy for patients rather than to attempt to show that newer therapies can replace insulin—in our opinion, an exercise in futility. Until such studies are done, we encourage practitioners to follow guidelines and recommendations based on randomized controlled clinical trials that will help achieve glycemic goals without putting patients at unnecessary risk. Clearly, as of today, substitution of insulin with newer therapies is inappropriate. 9.%% MW - A Patient With Type B Insulin Resistance Syndrome, Responsive to Immune Therapy Nat Clin Pract Endocrinol Metab. 2007;3(12) ©2007 Nature Pub. Group 12/03/2007 Summary Background: A 55-year-old woman with vitiligo, hypothyroidism, interstitial lung disease and diabetes mellitus developed severe insulin resistance during a hospital admission for respiratory failure. Before hospitalization, her HbA 1c level was 8.1% on ~100 U/day of insulin. Her interstitial lung disease had been treated with glucocorticoids, but after their withdrawal her insulin requirements had increased dramatically. She remained hyperglycemic despite intravenous insulin at doses as high as 30,000 U/day. Diagnosis: Type B insulin resistance syndrome. The initial goal when treating patients with type B insulin resistance is to manage their hyperglycemia, and this generally requires large amounts of insulin. The clinical course of patients with type B insulin resistance is variable. Many patients will have a spontaneous remission of the autoantibody syndrome but the time to remission is unpredictable. Type B insulin resistance is a rare disease that responds in an unpredictable manner to immunosuppressive therapies; therefore, there are no treatment guidelines for [their] use for patients with the disease. This case report underscores the importance of considering immune-mediated insulin resistance along with other, more common, contributors to decreased insulin sensitivity in hospitalized patients with marked insulin needs. 10.%% MW - Eating Disturbance Common and Persistent in Girls With Type 1 Diabetes (Reuters Health) Dec 06 - There is a high prevalence of disturbed eating behavior and eating disorders among girls with T1DM, according to Canadian researchers. They found that eating disturbances in this population are likely to persist over time. At baseline of this 5 year study, higher rates of disturbed eating behavior were observed in girls with T1 between the ages of 9 and 13 years than in non-diabetic control patients (8% versus 1%). Overall, 126 girls participated at baseline, declining to 98 at 5 years. The mean age was 11.8 years at baseline;16.5 years at 5 years. Of the 98 girls who participated at 5 years, 48 (49.0%) reported current disturbed eating behavior. Specifically, 43 of the 98 girls reported active dietary restraint, 6 reported binge-eating episodes, 3 reported self-induced vomiting, 3 reported insulin omission, and 25 reported intense, excessive exercise for weight control. A total of 13 girls met the criteria for eating disorders. The authors note that A1C was not higher in subjects with disturbed eating behavior (8.7% versus 8.4%). However, a trend for higher A1C was observed among those with an eating disorder (9.1% versus 8.5%; ). Subjects with disturbed eating behavior had higher BMI (26.1 versus 23.5). " Eating disturbances early in the study, in the pre-teen years, were very likely to persist over time; 92% of girls with eating disturbances detected early in the study continued to report eating disturbances later in their teen years, " Dr. Colton said in an interview with Reuters Health. " This study contributes to the growing understanding of the close relationship between physical health and mental health in individuals with diabetes, " she continued. " In particular, eating disturbances are very common and persistent in girls and women with T1, and can arise in even pre-teen girls, " These results suggest that screening for eating disturbances in individuals with T1 should start in the pre-teen years. " Individuals with diabetes who are struggling with eating disturbances should receive early support and treatment to prevent the development of full-syndrome eating disorders and the medical risks associated with the. It is often hard for individuals to tell someone that they have an eating disorder, and so sensitivity to body image issues, body dissatisfaction and eating disturbances, both at home and in the clinic setting, is crucial to helping these individuals seek appropriate help and support in optimizing their health and reaching their full potential, " she concluded. Diabetes Care 2007;30:. 11.%% MW - Insulin Detemir May Be Safer Than NPH Insulin in Elderly Type 2 Diabetics (Reuters Health) Dec 06 - In patients older than 65 with T2 requiring insulin, insulin detemir may be a better choice than neutral protamine Hagedorn (NPH) insulin, based on an analysis of pooled data from randomized studies. " The findings of the study show that there was less hypoglycemia with insulin detemir than with other basal insulins, " the lead investigator Dr. A. Garber told Reuters Health. The team examined data from 3 open-label studies. [416 subjects aged 65 years or more and 880 younger subjects. They were treated for 22 to 26 weeks with basal detemir or NPH, along with mealtime insulin or oral agents. The level of glycemic control achieved was similar with both insulins and in both age groups. However, those in the insulin detemir groups gained significantly less body weight (about 1 kg) [2.2lb] than did patients on NPH insulin. Moreover, with insulin detemir, there was a significant risk reduction of 41% for all hypoglycemic episodes in the older group. The risk reduction in the younger group was 25%. " This suggests, " he said " that insulin detemir may be a safer therapeutic choice in patients, such as the elderly, for whom hypoglycemia may produce serious complications. " J Am Geriatr Soc 2007;55. 12.%% MW - Diabetic Retinopathy Screening Improved With Automated Grading of Digital Images (Reuters Health) Dec 05 - An automated system that tags digital retinal images as positive or negative for disease would greatly facilitate widespread screening for diabetic retinopathy, researchers report. The investigators developed software that could grade digital images of the retina and fundus as having " disease " or " no disease. " They then tested the sensitivity and specificity of the system compared with the clinical reference standard on 14,406 images from 6,722 patients.. " In our study of 6,722 patients, there was no statistical difference in the ability of automated 'no disease/disease' grading to detect patients with referable retinopathy/maculopathy compared to standard practice, " " The advantage of automated 'disease/no disease' grading for diabetic retinopathy rests not just on its equivalent efficacy to standard practice, but on its ability to reduce the manual grading workload of photographic diabetic retinopathy screening programs by 60%, " they pointed out. The Aberdeen researcher said that the prevalence of diabetic retinopathy is at least 4% in the UK, where efforts are being made to establish a national screening program. Br J Ophthalmol 2007;91. 13.%% MW - Glycemic Profiles During Pregnancy Differ Between Type 1 and Type 2 Diabetes (Reuters Health) Dec 05 - The first study to use continuous glucose monitoring to examine changes in glycemic excursions throughout pregnancy shows that levels of glycemic control differ significantly between women with T1DM and those with T2DM In one respect, however, the two groups did not differ. " It is particularly alarming that during the critical stage of early pregnancy, women with DM on average spend only 50% of 12 h/day with blood glucose levels in the euglycemic [=normal not hypo or hyperglycemic] range, " the researchers report. [data from continuous glucose monitoring during 7 days in each trimester of pregnancy in 40 women with pregestational T1 and 17 women with T2. The researchers found that time spent within the euglycemic range (blood glucose 70-140 mg/dL) increased as gestation advanced, and that women with T2 spent about a third more time euglycemic than women with T1. Time spent hyperglycemic (> 140 mg/dL) decreased as gestation advanced, and women with T2 spent only two-thirds as much time hyperglycemic as women with T1. T2DM was also associated with shorter durations of extreme hyperglycemia (> 200 mg/dL). Although the proportion of time spent hypoglycemic (< 70 mg/dL) did not change significantly over gestation, women with T1DM spent more time hypoglycemic than did those with T2. " Strikingly, the data highlight just how difficult it is to reach current targets for euglycemia, particularly for women with T1. They add, " These data are important for all clinicians seeking to limit hypoglycemia and optimize maternal glycemic control in daily practice, as well as researchers seeking to improve therapeutic interventions aimed at achieving normoglycemia during pregnancy. " Diabetes Care 2007;30. 14.%% MW - Vitamin E Cardioprotective in Older Diabetics With Certain Genotype (Reuters Health) Dec 03 - Vitamin E supplementation reduces the incidence of myocardial infarction (MI) among older patients with T2DM who produce a less active form of the antioxidant protein haptoglobin (Hp). Mega-doses of vitamin E can be lethal when used indiscriminately. However, the researchers maintain that " high-dose antioxidant therapy may only provide benefit to individuals who suffer from particularly high levels of oxidative stress. " The Hp-2 protein is an inferior antioxidant compared with the Hp-1 protein, the team explains. In longitudinal studies of diabetic patients, 2- to 5-fold increases in cardiovascular events were documented in Hp 2-2 carriers compared with those with Hp 1-1 and Hp 1-2 genotypes. In the current prospective trial, the group randomized 1434 individuals 55 years of age or older (mean 69 years) with T2DM and the Hp 2-2 genotype to vitamin E 400 U/day or placebo. The primary outcome was a composite of MI, stroke and cardiovascular death. At 18 months, the primary outcome was significantly reduced (2.2%) in the vitamin E group compared with the placebo group (4.7%), which lead to early trial termination. The team stresses that the results are relevant only to Hp 2-2 DM individuals over the age of 55 and can not be generalized to the entire population. Furthermore, vitamin E should not be used to replace other proven therapies to prevent cardiovascular disease. They hope to motivate the " establishment of a platform for a larger trial without the limitations of the current study, and which could therefore constitute the basis for conclusive treatment guidelines. " Arterioscler Thromb Vasc Biol 2008;28. 15.%% MW -Vinegar at Bedtime Moderates Waking Glucose Level in Type 2 Diabetics (Reuters Health) Dec 04 - Results of a study suggest that a dose of vinegar taken at bedtime may favorably impact waking glucose concentrations in patients with T2DM. " Given the importance of maintaining acceptable blood glucose concentrations, there is much interest in identifying foods and diet patterns that will help individuals with diabetes manage their condition, " write the Previous data showed that vinegar ingestion at mealtime reduces postprandial glycemia. In the current study, the researchers examined the effect of vinegar taken at bedtime in 4 men and 7women (aged 40 to 72 years) with T2 who were not taking insulin. The patients measured fasting glucose at 7 a.m. for 3 consecutive days prior to the start of the study. They then followed a standardized meal plan for 2 days, consuming either 2 tablespoons of apple cider vinegar or water at bedtime with 1 oz cheese. After a 3- to 5-day washout period, they crossed over to the alternate bedtime treatment. The participants had a typical fasting glucose of 7.6 mmol/L before the start of the study. Fasting glucose fell by (2%) with placebo and by (4%) with vinegar treatment. The investigators report that the vinegar treatment was especially effective for subjects with a typical fasting glucose greater than 7.2 mmol/L (n = 6). Fasting glucose in these participants was reduced 6% compared with a reduction of 0.7% in those with a typical fasting glucose less than 7.2 mmol/L. " Vinegar is widely available, it is affordable, and it is appealing as a remedy, but much more work is required to determine whether vinegar is a useful adjunct therapy for individuals with DM, " they conclude. Diabetes Care 2007;30: Abbreviations: ADA - American Diabetes Association; BP - blood pressure; DM - diabetes Mellitus;HTN - hypertension; MW Medscape Web MD; FDA Federal Drug Administration; NIH - National Institutes of Health; VA - Veterans Administration. Definitions - Dorlands 31st Ed and Google. 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 Coordinator The Health Library at Vista Center contact above e-mail or thlvistacenter (DOT) <mailto:thl%40vistacenter.org> org __________ NOD32 2718 (20071212) Information __________ This message was checked by NOD32 antivirus system. http://www.eset. <http://www.eset. <http://www.eset.com> com> com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2008 Report Share Posted January 14, 2008 Hi Dave, I would say you're right if you get a nurse who dddoes not seem to know, butI have a nurse friend who specializes as a diabetic clinical practice nurse and is also a a certified diabetes educater. I do not hesitate to run the odd thing past her and vice versa. We learn from each other on occasion. Maybe you will run into a nurse like this one day so don't close your options. Ruth From: blind-diabetics [mailto:blind-diabetics ] On Behalf Of dave Bond Sent: Sunday, January 13, 2008 8:08 PM To: blind-diabetics Subject: Re: articles I'd scream " law suit " or go into a rage before I'll ever let lame brain nurses treat my diabetes. Never, never, never let someone who doesn't know your diabetes treat it. If you can't treat it, heaven knows no one else can! Sorry to any nurses on the list, but in the case of diabetes, if the patient knows anything about their diabetes, that's probably twice as much as most nurses know. Dave Re: articles From what I understand type 2s on medication can have lows, but they tend to not be as severe as in those with type 1. Even type 2s on insulin seem to have less of a problem with sudden, severe lows from what I have read, for some reason. I could be wrong on this so I'd be interested to hear what those with type 2 on the list have to say. You would know you are experiencing lows if you have symptoms of hypoglycemia (shakiness, sweatiness, dizziness, hunger, headache, concentration and coordination difficulties, in severe cases loss of consciousness and seizures) and if your blood sugar tested low at this time. I always test when I feel low because sometimes I'm actually high, so never just assume you are low and treat unless it is an emergency. Jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2008 Report Share Posted January 14, 2008 That may not be ture if the nurse is a CDE. Re: articles I'd scream " law suit " or go into a rage before I'll ever let lame brain nurses treat my diabetes. Never, never, never let someone who doesn't know your diabetes treat it. If you can't treat it, heaven knows no one else can! Sorry to any nurses on the list, but in the case of diabetes, if the patient knows anything about their diabetes, that's probably twice as much as most nurses know. Dave Re: articles From what I understand type 2s on medication can have lows, but they tend to not be as severe as in those with type 1. Even type 2s on insulin seem to have less of a problem with sudden, severe lows from what I have read, for some reason. I could be wrong on this so I'd be interested to hear what those with type 2 on the list have to say. You would know you are experiencing lows if you have symptoms of hypoglycemia (shakiness, sweatiness, dizziness, hunger, headache, concentration and coordination difficulties, in severe cases loss of consciousness and seizures) and if your blood sugar tested low at this time. I always test when I feel low because sometimes I'm actually high, so never just assume you are low and treat unless it is an emergency. Jen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 8, 2008 Report Share Posted February 8, 2008 1. MW - Medtronic Gets FDA Nod for Blood Sugar Monitoring Device Reuters Health Information 2008. C 2008 Reuters Ltd. (Reuters) Jan 29 - Medtronic Inc said U.S. health regulators approved its blood sugar monitoring device, the CGMS iPro Recorder. The U.S. medical device maker said patients wear the device for three days, after which physicians can review the data and use the results to uncover glucose patterns. 2. %% MW - Outpatient Nephrologic Care Linked to Improved Survival in Diabetic Kidney Disease Reuters Health Information 2008. C 2008 Reuters Ltd. Jan 30 - Outpatient nephrologic care is independently associated with a reduced risk of death in patients with DM and chronic kidney disease, researchers report. " The current study extends previous findings in that early consistent care by a nephrologist may be associated with lower risk of death in persons with diabetes and chronic kidney diseases not yet on dialysis, " lead investigator told Reuters Health. the team conducted a retrospective study of data collected over 3 years on more than 39,000 such patients with stage 3 or 4 kidney disease. Compared to patients who had not seen a nephrologist, patients who had made visits in 2 quarters during a baseline period of 12 months had a 20% lower risk of death during a median follow-up of 19.3 months. For patients who had made visits in all 4 quarters, the corresponding reduction was 55%. " Greater consistency of care is associated with greater decreases in mortality, but only a minority of patients received nephrologic care,..a new care model may be needed to respond to the treatment demands of a rapidly increasing number of patients with chronic kidney diseases by a limited number of practicing nephrologists. " Arch Intern Med 2008;168 3.%% Thu, 31 Jan 2008 : FDA MedWatch- NuCel Labs Eye Drops and Eye/Ear Wash- Nationwide Recall Because Of The Presence Of Bacteria And Particulate Matter ...NuCel Labs and FDA informed consumers and healthcare professionals of a voluntary nationwide recall of all Eye Drops and Eye/War Wash Products. The products were recalled after testing indicated the presence of bacteria and particulate matter, deeming these products non-sterile. Non-sterile eye drops pose an unacceptable risk of causing eye infections, which in rare cases could lead to blindness. No illnesses or injuries have been reported to date. There are no lot numbers or expiration dates on the products. Consumers who have the product should discontinue use of the product and return it to NuCel Lab. See the manufacturer's press release for return shipping information. www.fda.gov/medwatch/safety/2008/safety08.htm#NuCel 4.%%PubMed Am J Clin Nutr. 2008 Jan;87(1) Dietary glycemic index and glycemic load and the risk of type 2 diabetes in older adults. Sahyoun NR et al; BACKGROUND: It is unclear whether immediate dietary effects on blood glucose influence the risk of developing T2DM. DESIGN: The Health, Aging, and Body Composition Study is a prospective cohort study of 3075 adults who were 70-79 y old at baseline (n = 1898 for this analysis). The intakes of specific nutrients and food groups and the risk of T2over a 4-y period were examined according to dietary GI and GL. RESULTS: Persons in the higher quintiles [fifths]of dietary GI or GL did not have a significantly greater incidence of type 2 diabetes. CONCLUSIONS: These findings do not support a relation between dietary GI or GL and the risk of T2 in older adults. Because dietary GI and GL show strong nutritional correlates, the overall dietary pattern should be considered. PMID: 18175745 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2008 Report Share Posted February 14, 2008 YES! I am so glad they've finally done some research on C-peptide and linking it to complications! This debate of whether C-peptide plays a role in why people with diabetes get complications. has been going on for years. Maybe now they'll eventually start including the stuff in synthetic insulin. Jen Quote Link to comment Share on other sites More sharing options...
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