Guest guest Posted January 14, 2008 Report Share Posted January 14, 2008 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 14, 2008 Report Share Posted February 14, 2008 1. ADA MSU Research May Aid Type 1 Diabetes Feb - 5 - 2008 Michigan State University researchers have linked production of the C-peptide protein to controlling cardiovascular problems in people with type 1 diabetes. Formerly, the protein was believed to simply be an insulin byproduct. However, chemistry professor Dana Spence notes in the journal Diabetologia that C-peptide assists red blood cells with glucose absorption. The red blood cells then use glucose to produces the ATP energy molecule, which leads to nitric oxide production. The presence of nitric oxide causes blood vessel expansion and prevents platelets from clotting, resulting in improved circulation. His team discovered that the protein does not need insulin to produce effects, but its activation must be stimulated by a metal. Patients with T2DM would be resistant to C-peptide effects, he believes, just as their bodies are resistant to the effects of insulin. Though the research appears promising, ADA president for medicine and science Buse says that is still premature to determine whether C-peptide " would be an effective and safe treatment for DM " News summaries © Lansing State Journal (MI) (02/03/08) 2.%% ADA - Predictors of Cognitive Impairment and Dementia in Older People With Diabetes Feb - 5 - 2008 Diabetes is linked to a higher risk of dementia, but there are many possible mechanisms. Researchers recently assessed the relative contribution of diabetes associated variables as predictors of dementia in older adults with DM. 302 people;age 70 and up underwent a comprehensive assessment of diabetes, complications, and cardiovascular risk factors. 9.3 percent had dementia, and 19.9 percent had cognitive impairment without dementia. The leading predictors of dementia were found to be older age, DM duration, peripheral arterial disease, and exercise (which was protective). For probable Alzheimer's disease, diabetes duration was an independent predictor in addition to age and diastolic BP. The researchers concluded that peripheral arterial disease is a strong independent risk factor for dementia in DM, but additional factors not studied may also be factors. News summaries Diabetologia (02/01/08) Vol. 51, No. 2, 3.%% ADA Diabetes Makes It Hard for Blood Vessels to Relax 2/5/08 DM can cause blood vessels to function poorly by creating competition for L-arginine, report researchers. L-arginine, an amino acid, is broken down by the enzyme arginase to urea to help the body eliminate toxins resulting from proteins we eat, says lead author. This means that too little L-arginine is available to help nitric oxide synthase make nitric oxide, which is a vasodilator that helps blood vessels relax. The team discovered that the amino acid L-citrulline along with statins prevent elevation of arginase activity. The researchers now want to develop pharmaceutical agents to combat excessive arginase activity in DM. They also suggest clinical trials of L-citrulline as a supplemental therapy for people with DM with vascular problems.News summaries © Science Daily (02/01/08) 4.%% ADA Breast Size and Risk of Type 2 Diabetes Mellitus 2/5/08 Researchers conducted a secondary analysis of the Nurses' Health Study II to determine any connection between a woman's bra size and the onset of T2DM in middle age. [116,609 women,]-this team focused on 92,106 women, eliminating those who did not answer questions about breast size or had DM during pregnancy when the study began. The analysis used questionnaires from 1993 that asked women to state whether their bra cup size at age 20 was an A cup or smaller, a B cup, a C cup, or a D cup or larger. During the course of the study, 1,844 women were diagnosed with T2. Adjusting only for age--the women developed DM at an average age of 44.9 years--the risks of diabetes rose two-fold for women with a Bcup, four-fold for those with a C cup, and five-fold for those with a D cup. However, the risk was less than double when adjusted for other factors, such as age at first menstruation, body mass index, number of children, physical activity level, and diet. News summaries ©Journal of the Canadian Medical Association (01/29/08) Vol. 178, No. 3 5.%% ADA Linolenic acid may reduce incidence of peripheral neuropathy in DM Feb- 4-2008 A study conducted at the CDC and the National Center for Health Statistics analyzed data from 1,062 diabetic men and women aged = 40 years enrolled in the National Health and Nutrition Examination Survey (NHANES) to evaluate the correlation between polyunsaturated fatty acids (PUFAs) intake and peripheral neuropathy. Multivariate logistic regression models revealed that the mean dietary intake of linolenic acid was higher among patients without peripheral neuropathy as compared to those with peripheral neuropathy (1.45 vs. 1.25). Further studies are required to determine the biological mechanism underlying this positive association between linolenic acid intake and decreased risk of DM peripheral neuropathy ( Diabetes Care 2008, 31(1)). 6.%% ADA Type 2 diabetes is a major health problem among patients with schizophrenia and other psychotic disorders 1/31/08 Data from 8,028 people aged 30 years and older were used to compare the rates of T2 in individuals with schizophrenia or other nonaffective psychotic disorders and in people using antipsychotic medication. After adjustment for age and sex, T2 was diagnosed in 22.0% of patients with schizophrenia, 13.4% of patients with other psychotic disorders, and 6.1% of patients without other psychotic disorders. The use of all types of antipsychotic drugs correlated with increased odds of having T2. These findings indicate that type 2 diabetes is a major health problem that is underdiagnosed and undertreated among subjects with schizophrenia and other nonaffective psychotic disorders Eur Arch Psychiatry Clin Neurosci 2007, Nov 7 7.%% Early Multifactorial Intervention Key in Diabetes - Heartwire 2008. © 2008 Medscape Feb 7, 2008 – A new Danish study Steno-2 has shown that in high-risk T2DM patients, early intensive intervention with multiple drug combinations and behavior modification leads to reduced rates of death and cardiovascular disorders. " The most impressive finding is the 20% absolute risk reduction in all-cause mortality after13.3 years of follow-up. Similarly, the absolute risk reduction for cardiovascular death was 13.0%. We show these risk reductions in high-risk T2 patients--defined by the presence of microalbuminuria. The principal investigator said. The results of Steno-2 at first glance appear to be in direct contrast to those of a National Heart, Lung, and Blood Institute (NHLBI) study, ACCORD, in which the blood-glucose-lowering arm has just been prematurely halted, as reported due to a higher mortality in patients in the intensive glucose-lowering arm compared with patients in the standard arm. But Pedersen is keen to point out that the study populations of the 2 trials should not be confused Patients in Steno-2 were younger, had DM on average 6years, and were deemed high risk by the presence of microalbuminuria rather than having heart disease or two known risk factors for heart disease, as in ACCORD (just 25% of Steno-2 patients had known cardiovascular disease on entry). Also, because of treatment resistance, only 18% of patients in Steno-2 achieved the target HbA1c level of below 6.5%, he notes. " The impact on mortality and micro- and macroangiopathy in Steno-2 is likely related to the early and additive effects of treating dyslipidemia, hypertension, hyperglycemia, and platelet aggregation in a relatively intensive and structured way. " He explained that around a third of all T2DM patients have microalbuminuria, " which is a marker of global vascular damage. Not just a marker for developing nephropathy; it's a risk marker for premature cardiovascular disease. So it's not a trivial population. " [160 patients; mean age 55] randomly assigned to receive either intensive therapy--with tight glucose regulation and the use of renin- angiotensin blockers, aspirin, and lipid-lowering agents- or conventional multifactor therapy; the mean treatment period 7.8 yr - The current paper looks at a mean follow-up period of 5.5 years after the initial treatment period had ended; during this time, all patients in the conventional- therapy arm were offered intensive treatment. Despite this, patients who were originally in the intensive arm did better, indicating the benefit of early intervention as compared with late intervention, say the researchers. " In comparison with the results of trials involving treatment of single risk factors in patients with T2, the achieved risk reductions in our trial were considerable. " " We are dealing with the additive effects of multiple drugs on a background of healthy-behavior coaching, " he said. " This study justifies widespread use of multiple medications to achieve treatment targets in T2 patients at high risk. " In terms of glucose lowering- at the end of the 7.8 years of randomization in Steno-2, the mean A1c was 7.9% in the intensive arm vs 9.0% in the conventional- treatment arm. At the end of the observational follow-up at 13.3 years, these figures were 7.7% and 8.1%, respectively. In the glycemic-control part of ACCORD, the median A1c level achieved in the intensive-treatment group was 6.4%, vs 7.5% in the standard group. The trial was stopped early because of an excess of three deaths per 1000 participants per year in the intensive group vs the standard group, over an average of four years of treatment. The Steno-2 researchers point out the " shocking " 50% mortality rate during the entire follow-up period in the patients originally offered conventional treatment, emphasizing a very poor prognosis for these patients, " comparable to many forms of cancer, " unless treated early and intensively. The first important step is to identify T2 patients with microalbuminuria, which can be done with a simple urine albumin measurement. Pedersen said " The results we obtained were because we began treatment at a very early stage, as soon as we identified microalbuminuria, and that's key. We need to develop the tools to assist patients to adhere to multiple drugs, and that's not easy. Also, we need to figure out how to translate these kinds of 'greenhouse experiments' in a clinical trial to GPs and the primary-care community, where the majority of patients are treated. New Engl J Med 2008; 358. 8.%% MW - The Day After: Experts Puzzled Over Increased Death Rate in ACCORD Heartwire 2008. Feb 7, 2008 – Experts within and outside of the ACCORD trial are equally flummoxed by the finding that the group receiving intensive glucose lowering showed a higher mortality rate than those receiving standard care. The announcement that the glucose-lowering part of the trial was being stopped because of this mortality difference was made yesterday by the National Heart, Lung, and Blood Institute (NHLBI), the organization coordinating the study. [see DRList 2-7-08 for details] Chair of the ACCORD steering committee, Dr Friedewald (Columbia University, New York), commented to heartwire : " The simple and honest answer is that we have done extensive analyses and not identified a cause for the increased mortality. We will now do even more extensive analyses with all of our investigators, who are now unblinded to the results, and prepare a paper with the data and our best impressions of the possible causes. " In an interview with heartwire, Dr Buse, ACCORD steering committee member, suggested three basic possibilities that would explain the higher mortality rate in the intensively treated group: it could have been a spurious observation, and it might have disappeared with further follow-up; it could have been due to adverse effects of a particular drug or drug combination that has not yet been teased out; or it could be that the observation is true, that lowering blood-sugar levels too much in older diabetics with heart disease is a bad thing. He added that it would be difficult to detect an adverse effect of one or two drugs, given the large array of therapies used in the study. Buse's personal belief is that the increased mortality may not have been due to the level of A1C but more to do with the intensity of the intervention. " The patients enrolled in this study were quite vulnerable in that they were relatively old (av age 62) and had heart disease or at least two or more other risk factors for heart disease. Maybe we just flogged them too hard to get their sugar levels down. The intensive group had extremely rigorous treatment, with some patients taking 4 shots of insulin and 3 pills and checking their blood-sugar levels 4 times a day. Perhaps this was just too many drugs at too high a dosage, and the effort required just stressed them out too much. I think our conclusion is therefore that we should not be zealots about lowering blood sugar at all costs. We must understand that there are risks and benefits and one size probably does not fit all patients, " he said. But he pointed out that both groups in ACCORD did very well compared with similar patients in real life, who have a mortality rate 2-3 times that seen in either group in this study. " Taking that into account, the difference in mortality between the two arms seems like a pretty small signal, but the [data safety and monitoring board] DSMB were in a very difficult position. They could have decided to carry on for longer but then would have faced criticism if the mortality difference had increased. ...but I do feel we need more data, and I'm glad there are other studies under way that may shed more light on this issue, " more information should become available fairly soon, as there are at least three more trials under way looking at intensive vs standard lowering of blood-sugar levels in diabetics (ORIGIN, ADVANCE, and the VA Diabetes trial), 2 of which are thought to be reporting later this year. No Need for Panic - " My key message is that the ACCORD result is not a reason to panic. The kind of patients enrolled in this study are a minority in terms of DM patients, and the treatment given was exceptionally intensive, so the average diabetic patient need not worry about these results, " he reiterated. .. Observers from outside the trial also had little to offer in the way of possible explanations, all saying they needed to see more data from the study in the form of a published paper. But all were surprised by the result. Dr Steve Nissen (Cleveland Clinic) commented : This effect could have been due to some of the drugs being used to lower glucose levels, which may have other effects that cause harm. We know that rosiglitazone [avandia] increases MI risk, so others may do this too ..We don't even know what percentage of people in each group were on rosiglitazone. Dr R Holman ( UK): ..said that the main question was whether the low sugar levels or the multiple treatments were the cause of the excess deaths and that in this regard it would be important to establish whether the patients who died had the lowest blood-sugar levels. " The intensive arm was aiming for an A1c level of 6, and they got to an average of 6.4, so some patients would have gone quite a way below 6. It would be interesting to know if more deaths occurred in these patients who went very low. If so, then it could be the low A 1c. But they haven't released that information yet. " he also suggested that the observation that patients in the intensive arm of ACCORD were less likely to have an MI, but if they did have an MI it was more likely to be fatal, might provide some clues, adding that " if you have an MI, the chances of surviving depend on your background metabolic status. " ..For me, the message to patients remains that near-normal glucose levels are still better than high levels. " 9.%% MW - VEGF and Nerve Fiber Loss Linked in Diabetic Neuropathy (Reuters Health) Feb 06 - Neurological evaluation of diabetics indicates that there is relationship between diminished vascular endothelial growth factor (VEGF) expression and neuropathy, UK researchers. " This is the first human study to support experimental studies in showing that a reduction in VEGF expression is associated with increasing nerve damage in diabetic patients, " the senior investigator told Reuters Health. [53 DM and 12 controls] Skin biopsies from the dorsum of the foot showed that intra- epidermal nerve fiber density decreased progressively as DM neuropathy increased. Dermal blood flow in response to acetylcholine was significantly reduced in mild to moderate diabetics and the intensity of VEGF-A staining was significantly reduced in diabetics compared to controls. There was a positive correlation between VEGF-A expression and intra-epidermal nerve fiber density. The reduction in VEGF expression, he said, " thus provides a mechanism for nerve damage and hence a therapeutic target for the treatment of human diabetic neuropathy with VEGF. " Diabetes Care 2008;31: 10.%% AFB ACCESSWORLD ® Vol 9:1 Jan 2008 Issue An Update on the Blood Glucose Monitor Market The latest demographic research shows that 3.2 million Americans with DM are blind or have low vision.. In the March 2007 issue we introduced the Prodigy and the Advocate, two small, inexpensive blood glucose monitors ...This article examines the SensoCard Plus and the new Prodigy Voice, both of which feature much more accessibility and usability..Blood glucose meters have revolutionized diabetes care by allowing individuals with DM to control their condition more actively. If you are not able to operate the meter and read the results, the meter is not usable, and you have a much lower chance of keeping the ravages of diabetes at bay. The SensoCard Plus - is distributed by BBI Healthcare in the UK and is manufactured by a Hungarian company called Electronica 77. It is priced in Europe at £49.99. BBI hopes to have FDA approval soon. The SensoCard is a thin, credit card-sized monitor with built-in speech output that supports all its functions. It weighs 2.5 ounces and measures 3.5 by 2.2 by 0.3 inches. with a small speaker protruding an additional 0.25 inches from the back of the bottom panel. It has a 1.3-inch-square black- and- white LCD (liquid crystal display) screen and 3 control buttons. There is a small slot in the front panel for inserting a test strip and another slot for a code card strip that calibrates the meter with each new container of test strips. There is an infrared data port for transferring data to a PC, but there is no headphone jack. The Prodigy Voice - Priced at $79.99, is distributed by Diagnostic Devices and is manufactured in Taiwan by Taidoc Technology. It came on the U.S. market on Nov 19, 2007, and its speech output supports every function of the meter, far surpassing the accessibility of the original Prodigy. The Prodigy Voice weighs 2.7 ounces and measures 2.0 by 3.5 by 0.8 inches. The front panel has a monochrome black-on-gray display, with 3control buttons. On the right side panel are two triangular buttons used to adjust the various settings and to scroll through the various readings in memory. The Eject button allows you to eject a used test strip easily and safely without touching it. The ear phone jack, near the bottom of the right side panel, allows you to use a headphone for privacy or to connect a speaker to amplify the speech. The data port, allows you to download the meter's test results to a computer using Prodigy's download software. How Did We Evaluate the Monitors? we first examined the tasks involved in performing the basic function of obtaining a blood glucose measurement and evaluated how easily a person who is blind or has low vision could perform each task. . could it be performed by touch alone or if vision would be required. We then did the same with other tasks related to several other features and functions of the monitors. We also looked at how easily a person with low vision could read the display information and perform the other tasks. In addition, we evaluated the accessibility of the print and electronic manuals. Results - The process of obtaining a blood glucose measurement is fully accessible on both the Prodigy Voice and the SensoCard, with speech output supporting the process the entire way and speaking your test results. Both feature high-quality recorded human speech, rather than synthesized speech, and both speak test results in only 5 seconds. Both also alert you if your reading is out of the normal healthy range. Both have control buttons that are easy to identify tactilely, and both require a small sample of blood. Both use strips with capillary action, which pulls your blood sample into the strip, eliminating the need to place a large hanging drop of blood onto the strip. Both meters use strips with a tactile notch for orientation purposes. Both meters can provide results in both milligrams per deciliter (mg/dL) and millimoles per liter (mmol/L), and changing from one type of measurement result to the other is accessible on both meters. Both meters play a shutdown tune and turn themselves off automatically if they are not used for a short time. The memory function of both meters is fully accessible and is supported entirely by speech output. The SensoCard can store up to 500 readings and provides 7-,14-, and 28-day averages. The Prodigy Voice can store up to 450 readings with 7-,14-,21-,30-,60-, and 90-day averages. It is easy with each meter to scroll through the averages and the individual readings, voicing the glucose level, date, and time of each reading. Coding the Test Strips - Most blood glucose monitors require that you set a code number to calibrate them to the test strips every time you open a new container of strips, and doing so is usually inaccessible for people who are blind or have low vision. However, the Prodigy Voice has an auto code feature that automatically codes the meter when a strip is inserted. The SensoCard still requires coding for each new bottle of test strips, but it uses a code card, eliminating the need to code the meter manually. The settings functions of both meters are fully accessible, with speech supporting the entire process. Download Software - Both meters have free software available, so you can download your results to a PC. The Prodigy Voice requires a cable accessory to connect the monitor to a PC-- The SensoCard requires its " Light Link " adapter, which creates an infrared link to the meter. The software creates charts and graphs for monitoring your test history and prepares reports that you can send to your health care provider., so he or she can track your blood sugar levels over time. We used both Window-Eyes and JAWS to test the accessibility of the SensoCard software, but the Prodigy Voice software was not yet available at the time of our testing. Both the Prodigy Voice and the SensoCard speak to warn you that the batteries are low and that it is time to change them. You can change the batteries independently on both meters, but it is a bit easier to do so with the Prodigy, which uses two AAA batteries, which are easier to orient tactilely than are the two small round, silver watch-style batteries that the SensoCard uses. Documentation - Each meter comes with a print manual in standard 12-point font, which is too small for most people with low vision to read. Each also has an electronic version of the manual available in PDF format. Although both are untagged PDF documents, only the SensoCard manual works well when you use a screen reader. Low Vision Accessibility - Both monitors have a monochrome display screen with black text and icons against a gray background. These low-contrast displays are similar to the old calculator display screens and would not be preferred by most people with low vision. The results of the blood glucose measurement are in a 60-point font, and the time and date are in a 26-point font. However, the text indicating the type of measurement, such as milligrams per deciliter, is in a 6-8-point font. The SensoCard consistently uses large fonts, with font sizes ranging from 18 points to 60 points, which can be easily read by most people with low vision. The Prodigy Auto Code and Advocate Redi-Code are two other blood glucose meters that came on the U.S. market in 2007. They are virtually the same as the Prodigy and Advocate evaluated in the March 2007 issue. The main difference is that they both have added the convenience of an automatic coding system, eliminating the need to calibrate the monitor to each new bottle of test strips. nothing else has been done with these 2 monitors to increase overall accessibility. The Prodigy and Advocate Duo, which also came on the market in 2007, are basically the original Prodigy and Advocate meters combined with talking BP monitors.. they are wrist-type BP monitors, The Bottom Line - The Prodigy Voice and the SensoCard are both highly accessible and are much-needed additions to the blood glucose meter market. They are smaller; cheaper; faster; and, in general, much better than anything we have had in the past as far as accessible blood glucose monitors. Although we are impressed with both meters, each has an advantage over the other here and there. We consider the Prodigy Voice to be a slightly more accessible and usable meter. The most obvious advantage of the Prodigy Voice is that it is available in the US now, while the SensoCard is still awaiting FDA approval. The Prodigy Voice's earphone jack is a major advantage over the SensoCard, allowing you to use a headset for privacy or for connecting a speaker for amplification of the speech output. You can also adjust the volume on the Prodigy Voice, but not on the SensoCard. The Prodigy Voice's Auto Code feature is another advantage of the Prodigy Voice. When you use the Prodigy Voice, you know if you have inserted a test strip improperly, which is not the case when you use the SensoCard. The Prodigy Voice's accessible download software is another advantage for those who are interested in tracking their measurement data on their PCs or e-mailing their data to their health care providers. Finally, the Eject button is a nice convenience found only on the Prodigy. We want to stress, however, that we like both these new meters, and the SensoCard has some advantages of its own. The major advantage of the SensoCard is its accessible and well-written electronic manual, which many people may consider the most important factor. The SensoCard is also slightly smaller and more portable and uses large fonts more consistently on its display screen. Finally, it allows you to mark abnormal readings, so they are not included in your weekly and monthly averages. Both BBI and Diagnostic Devices should be applauded for their efforts in making accessible blood glucose meters and for seeking input from many people who are blind or have low vision who will use the meters. We are happy that these small companies have brought accessibility to the market of blood glucose meters, but we would also like to see the large pharmaceutical companies that have dominated this market for the past several decades do something to serve people who are blind or have low vision. We also would like to see some movement toward accessibility with the other devices that people with diabetes use, such as insulin pumps, insulin pens, and home blood pressure monitors. Certainly, the 3.2 million Americans with diabetes who have some degree of vision loss are a large enough market to attract some interest from the manufacturers. What do you say, Roche? and ? Abbott Labs? Readers who are interested in the accessibility of blood glucose monitors should be aware that the Accu-Chek Voicemate talking blood glucose monitor was discontinued by its manufacturer Roche Diagnostics. Although the price of the Voicemate was high and it was heavy and bulky; it was at one time the most fully accessible monitor on the market. It is disturbing to see it disappear from the market without a replacement being introduced.. 11. %% Medical News Today - Diabetes Worsens With Impaired Fat-Burning Gene 08 Feb 2008 Researchers have discovered new cellular mechanisms that lead to insulin resistance in people with DM. T2DM is a chronic disease resulting from a reduction in insulin production from the pancreas or an inability of other tissues in the body to respond adequately to the produced insulin, so called insulin resistance. This leads to increased blood sugar, which in turn leads to a worsening of the insulin resistance, increasing the risk of developing many serious diabetes-associated complications. An international research team, have identified previously unknown molecular mechanisms by which elevated blood sugar leads to impaired insulin sensitivity in people with DM. The team identified a 'fat-burning' gene, the products of which are required to maintain the cells insulin sensitivity. They also discovered that this gene is reduced in muscle tissue from people with high blood sugar and T2. In the absence of the enzyme that is made by this gene, muscles have reduced insulin sensitivity, impaired fat burning ability, which leads to an increased risk of developing obesity. " The expression of this gene is reduced when blood sugar rises, but activity can be restored if blood sugar is controlled by pharmacological treatment or exercise " , they say. " Our results underscore the importance of tight regulation of blood sugar for people with diabetes. " Publication: Down-Regulation of Diacylglycerol Kinase Delta Contributes to Hyperglycemia-Induced Insulin Resistance Cell, 8 February 2008, 12.%% MW - Gastric Banding and Diabetes Remission 2/06/2008 Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes: A Randomized Controlled Trial JAMA. 2008;299 Summary - This is the first randomized trial to compare surgically induced weight loss with conventional therapy for the treatment of obesity in T2DM. Patients between ages 20- 60, with a body mass index (BMI) of 30-40 kg/m2 diagnosed with clearly documented T2 within the previous 2 years and had no evidence of renal impairment or retinopathy, were eligible. 30 patients each were assigned to receive either laparoscopic adjustable gastric banding (LAGB) or conventional therapy (CT), which included individually structured lifestyle modification programs that incorporated reduction of fat intake and specific physical activity advice. Participants visited a physician, nurse, dietitian, and/or diabetes educator at least once every 6 weeks for 2 years. The primary endpoint was the proportion of each group achieving remission of DM defined as fasting plasma glucose < 126 mg/dL and glycated hemoglobin (A1c) < 6.2% without the use of antihyperglycemic agents. Secondary outcome measures included percentage of change in A1c, weight, BP, waist circumference, total cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL). After 2 years of follow-up, 22 of 30 (73%) LAGB patients achieved DM remission compared with 4 of 30 (13%) CT patients. Furthermore, in addition to A1c and fasting glucose, the LAGB group experienced significantly greater reductions in weight, insulin resistance, waist circumference, and triglycerides, and greater increases in HDL. At randomization, 29 of 30 patients in each group had metabolic syndrome but 21 or those in the LAGB group compared with 4 in the CT group no longer met the metabolic syndrome criteria after 2 years. 13.%% MW -Negative Pressure Wound Therapy Br J Diabetes Vasc Dis. 2007;7(5): 2/06/2008 NPWT also known as TNP has emerged as a non-pharmacological treatment for acute and chronic wounds, including pressure ulcers and diabetic wounds. Inadequate treatment for foot ulcers results in avoidable complications and unnecessarily extended healing times. The lifetime risk of a person with DM developing a foot ulcer is as high as 25% - and [they] are the cause in the US of 16% of all hospital admissions and 23% of total hospital days. NPWT therapy is based on the idea of turning an open wound into a controlled, closed wound while removing excess fluid from the wound bed, thus enhancing circulation and disposal of cellular waste from the lymphatic system. The system consists of a nonadherent, porous wound dressing (such as foam), a draining tube placed in the dressing , a transparent film to seal the wound and drainage tube that is connected to a vacuum source for negative pressure-computerised therapy unit applies the pressure while drawing exudate away from the wound, into a sealed canister. The system is usually applied to an open wound for periods of 48 hours Conclusion - All people with DM are at risk of developing foot ulcers, and despite measures to prevent complications a number of diabetic wounds become chronic and non-healing (potentially leading to amputation). The system has been shown to have a number of important advantages: it appears to be safe and it results in faster wound healing than conventional methods - thus proving cost effective, despite much greater material costs. Based on current available clinical and anecdotal evidence, diabetic foot ulcer wounds most suitable for NPWT are those that are complex with poor healing responses and higher rates of complications. 14.%%MW - Tolerability of Prolonged-Release Metformin (Glucophage) in Individuals Intolerant to Standard Metformin -- Results From Four UK Centres Br J Diabetes Vasc Dis. 2007;7(5). ©2007 Sherborne Gibbs Ltd. 02/04/2008 Abstract - Advances in drug formulation have improved the tolerability of many commonly used agents. Metformin is recommended as initial drug therapy for T2DM and has proven long-term efficacy and safety. However, gastrointestinal (GI) side-effects of standard, immediate-release (IR) metformin often reduce medication adherence and limit dose titration. A prolonged- release metformin formulation may improve tolerability over its IR counterpart. [ 95 patients intolerant to standard IR metformin assessed 3-6 months following a switch from IR to prolonged-release metformin (Glucophage® SR). Between 62% and 100% of patients from the centres tolerated the prolonged-release formulation. Glycaemia following the switch was improved or unchanged. Prolonged-release metformin represents a useful option for patients intolerant of standard IR metformin due to GI side-effects. This improved tolerance of prolonged-release metformin may improve medication adherence and thereby enhance treatment outcomes. 15.%% MW -Effect of enoxaparin versus unfractionated heparin in diabetic patients with ST-elevation myocardial infarction in the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment Am Heart J. 2007;154(6) ©2007 Mosby, Inc. 02/04/2008 Abstract Background: Patients with diabetes mellitus (DM) are at higher risk for complications after ST-elevation myocardial infarction (STEMI) than patients without DM. Potent antithrombotic therapies may offer particular benefit for these high-risk patients and must be balanced against the potential for increased bleeding. [analysis of efficacy and safety in patients with DM among 20479 patients with STEMI treated with fibrinolysis and randomized to a strategy of enoxaparin (up to 8 days) or unfractionated heparin (UFH) (48 hours) in ExTRACT-TIMI 25. Results: Patients with DM (n = 3060) were older and more likely to be women and to present with heart failure than those without DM. After adjustment for the TIMI Risk Score, sex, and renal function, patients with DM were at 30% higher risk for death or myocardial infarction (MI) by 30 days (OR 1.29,. Among patients with DM, the enoxaparin strategy reduced mortality (9.5% vs 11.8%, ), death/MI (13.6% vs 17.1%, The enoxaparin strategy was associated with a trend toward higher major bleeding (2.6% vs 1.6%). Taking efficacy and safety into account, the enoxaparin strategy offered superior net clinical benefit with UFH in patients with DM. AFB - Amer Foundation for the Blind Abbreviations: T1DM - type 1 diabetes mellitus T2DM - type 2; 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 thl@... Quote Link to comment Share on other sites More sharing options...
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