Guest guest Posted March 14, 2008 Report Share Posted March 14, 2008 Articles 1. MW -Clinical Implications of a Molecular Genetic Classification of Monogenic Beta-cell Diabetes Nat Clin Pract Endocrinol Metab ():, 2008. © 2008 Nature Pub.. Group Introduction - Since 1992, numerous genetic subtypes of diabetes have been described in which gene mutations result in DM primarily through ß-cell dysfunction. This knowledge means that patients who were previously categorized clinically as having maturity-onset diabetes of the young (MODY), permanent neonatal diabetes mellitus (PNDM) or transient neonatal diabetes mellitus (TNDM) can now usually be classified by genetic subgroup. Conclusions - With the advances in defining the monogenic etiology of diabetes, which accounts for approximately 1-2% of all diabetes cases, we have learned that these genetic subtypes of DM require different treatments. Patients with Kir6.2 or SUR1 PNDM require high-dose sulfonylurea therapy, most cases of transcription factor diabetes require low-dose sulfonylurea therapy, and glucokinase diabetes requires no hypoglycemic treatment. These therapies are different to those used to treat T1 & T2,so it is important that we identify individuals with a probable monogenic cause for their diabetes.. Diagnostic molecular genetic testing is now available [and] can improve management of these monogenic forms of diabetes, which are often underdiagnosed. 2.%% ANI London, Feb 27: Researchers have shown that autoimmune diseases, like T1DM, may not stem from defects in the immune system alone, but also could be triggered by certain embryo defects. Giving an alternative explanation as to what triggers DM, D. Faustman at Harvard Medical School and her colleagues found differences in the structure of several organs, including the pancreas, in mice predisposed to develop T1, even before any autoimmune attack takes place. The team suggested that this abnormal organ development before birth could predispose certain individuals to autoimmune disease. They observed before that mice and humans with T1are at a greater risk of developing hearing loss and Sjogren’s syndrome, an autoimmune disease affecting the salivary glands. The team examined the organs of nonobese diabetic (NOD) mice that developed autoimmune symptoms of pancreatic and salivary gland destruction. They found that these organs, while geographically far from each other, shared developmental abnormalities, and that their cell lineages all develop through the Hox11 transcription factor. They speculate that these organs are somehow predisposed to targeting by autoimmune diseases through their common lineage. Hox11 is expressed in normal mice but without organ defects. " It challenges the orthodoxy that autoimmunity is solely caused by a defective immune system, " New Scientist magazine quoted Faustman, as saying. Findings published in Immunology & Cell Biology. 3.%% New Test Enables Diabetics to Detect Peripheral Neuropathy (Reuters Health) Feb 28 - The indicator plaster neuropad (IPN) is a new test that can be used by diabetic patients to identify peripheral neuropathy, " The IPN can be performed by the patient at home in 10 minutes, and the result can be offered to the doctor in the next visit, " Dr. N. Tentolouris from Athens University Medical School told Reuters Health. " The test offers the opportunity to the patients to participate actively in the prevention of the devastating complications related to the diabetic foot problems. " The team evaluated the interrater reliability between 156 patients and their healthcare providers for IPN in the diagnosis of peripheral neuropathy and the feasibility of using this test. The IPN was previously shown to have a high sensitivity for the diagnosis of peripheral neuropathy and excellent reproducibility, the authors explain. The IPN turns a pink color when nerve conduction is normal and a blue color when peripheral neuropathy is present. Patients and health care providers agreed in 90.3% of the cases, deciding that the IPN results were normal or abnormal. Patients consistently rated the IPN test instructions as easy to understand, easy to use, and easy to evaluate. About one fifth of the patients said they needed help performing the test. " The results of the tests agree with those obtained by more complex tests used for the diagnosis of the diabetic neuropathy, including nerve conduction velocity studies, considered to be the 'gold-standard' method for the diagnosis, " " Currently there is no etiologic treatment for the diabetic peripheral neuropathy, and prevention of this complication with good metabolic control is the only available option, " Dr. Tentolouris explained. " Therefore, patients with abnormal IPN test, that is patients with peripheral neuropathy, will be educated for the care of their feet, they will be instructed to use proper footwear, and they will have their feet examined by the healthcare professionals more often. " " According to ADA recommendations, DM patients without complications -- including peripheral neuropathy -- should be tested for the presence of complications yearly, " His group recommends that patients with diabetes use the IPN once per year for the detection of peripheral neuropathy.Diabetes Care 2008;31 4.%% MW -Insulin Resistance Predicts Stroke, Vascular Risk in Nondiabetics Feb 28, 2008 — A new analysis suggests that insulin resistance is associated with an increased risk for a first ischemic stroke and combined vascular events in nondiabetics. Researchers report that insulin resistance, defined in this study as a homeostatic model assessment of insulin sensitivity (HOMA) index of greater than 3, was associated with a more-than-doubled risk for ischemic stroke and a 50% increase in vascular events, including myocardial infarction (MI), stroke, or vascular death, independent of waist circumference, body mass index (BMI), or other components of the metabolic syndrome. These findings " again raise the issue that it's not just diabetes but may be prediabetes or insulin resistance that we need to detect and possibly treat to reduce the risk of stroke and vascular disease, " the senior author told Medscape Neurology & Neurosurgery. The study was presented here at the American Stroke Association International Stroke Conference 2008. " [1735 nondiabetic subjects who were free of stroke at baseline;mean age 68 years, 63% of subjects were women,; multiethnic cohort: 61% Hispanic, 19% black, and 19% white. 5.%% BBC NEWS 3-March-08 Frog skin diabetes treatment hope Skin secretions from a South American " shrinking " frog could be used to treat type 2 diabetes, researchers say. A compound isolated from the frog, which grows to 27cm as a tadpole before shrinking to 4cm in adulthood, stimulates insulin release. A synthetic version of the compound - pseudin-2 - could be used to produce new drugs, delegates at the Diabetes UK annual conference heard. Scientists have tested a synthetic version of pseudin-2, a compound which protects the paradoxical frog from infection. They found it stimulated the secretion of insulin in pancreatic cells in the laboratory. And importantly, there were no toxic effects on the cells. The synthetic version was better at stimulating insulin than the natural compound, opening the way for it potential development as a drug for treating diabetes. the study leader said there had been a lot of research into bioactive molecules from amphibian skin secretions. One recently developed diabetes drug - exenatide - was developed from a hormone in the saliva of the Gila monster - a lizard found in south-western US. " We found that it stimulated the secretion of insulin and that the synthetic version is more potent that pseudin-2 itself. " More research is needed, but there is a growing body of work around natural anti-diabetic drug discovery that, as you can see, is already yielding fascinating results. " 6.%% MedlinePlus Health Information: Marker for Diabetes Might Miss Early Vision Complication Feb. 29 (HealthDay News) -- Fasting blood sugar levels are typically used to diagnose diabetes, however, a common complication of the disease that can lead to blindness begins at blood sugar levels below what is considered diabetic, researchers report. Retinopathy is a vascular condition where the small blood vessels in the eye become damaged; other complications of DM include heart, kidney and circulatory problems. " Retinopathy, which is one of the complications traditionally associated with DM, occurs at fasting glucose levels below the threshold that is used to define diabetes, " said the lead researcher. Wong's team analyzed three studies that looked at retinopathy among 11,405 people. The report was published in the March 1 issue of The Lancet. They found that the overall prevalence of retinopathy ranged from 9.6 % to 15.8% percent in the general population. In addition, they didn't find evidence of a particular blood glucose level that would indicate the presence of retinopathy. In fact, 60 % of retinopathy cases were missed by the current threshold for diabetes diagnosis, which is 7.0 mmol/L. The finding suggests that eye damage happens much earlier and at lower blood sugar levels than what is currently used to pinpoint the presence of DM, he said. " This suggests that diagnostic threshold may have to be revised, so that we can pick up more people who are at risk of eye and other complications, " he noted. In addition to retinopathy, signs of cardiovascular disease also appear to develop at glucose levels below those defined as DM. One expert agrees that fasting blood sugar levels may not be the best way of diagnosing DM and those at risk for [it]. " It is becoming more common that studies are showing that a fasting blood sugar value is not necessarily the best way to judge diabetes or diabetes control, " said Dr. S Weiss, an endocrinologist at NYUy Medical Center. He noted that right now there is no other marker for DM. However, many new studies point to the use of blood sugar levels after eating as being better markers for risk, he said. " Fasting blood sugar is not all that helpful, " " The problem is that a lot of our thinking is based on fasting. That's an issue we need to focus in on, " 7.%% MW - Insulin Restriction in Women With Type 1 Diabetes May Increase Mortality Feb 29, 2008 — Insulin restriction in women with T1DM was associated with increased morbidity and mortality, according to the results of a new study. " Improvements in diabetes treatment are associated with declining rates in DM complications and mortality; however, patients with T1DM continue to have higher mortality rates when compared with patients without diabetes, " write researchers from the Joslin Diabetes Center in Boston. " To date, few reports have examined the connection between insulin restriction and mortality. The objective of this 11-year follow-up study was to determine whether insulin restriction in women with T1 predicted higher rates of diabetic complications and an increased risk for mortality more than 10 years later. [234 women ;mean age 45; mean duration of DM 28 years; mean body mass index (BMI) was 25 kg/m 2, and mean hemoglobin A1c (HbA1c) level was 7.9%. At baseline, 71 (30%) women reported insulin restriction. During follow-up, 26 women had died. After controlling for baseline age, BMI, and HbA1c levels, insulin restriction was associated with a 3-fold increased risk for mortality; Compared with women who did not restrict insulin, those who did had died at a younger age (mean, 45 vs 58 years; and had higher reported rates of nephropathy and foot problems at follow-up. Compared with survivors, women who died during follow-up had reported more frequent insulin restriction and more symptoms of eating disorders at baseline. " Mortality associated with insulin restriction appeared to occur in the context of eating disorder symptoms, rather than other psychological distress. " " We propose a screening question appropriate for routine diabetes care to improve detection of this problem, " the study authors conclude. " Further research is needed to validate this screening method in clinical practice and to determine the best treatment strategies for women struggling with this problem. 8.%% MW - Risk Factors for Falls Identified in Older Adults With Diabetes March 3, 2008 — In older adults with diabetes, decreased peroneal compound muscle action potential, higher levels of cystatin-C, and poor contrast sensitivity each increased the risk for falls, according to the results of a new study " Older adults with T2DM are more likely to fall, but little is known about risk factors for falls in this population, " write Ann V. Schwartz, PhD, UCSF and team from the Health, Aging, and Body Composition Study. " We determined whether diabetes-related complications or treatments are associated with risk of falls in older diabetic adults. " [446 participants with DM; Mean age 73.6; average duration follow-up 4.9 years.] The proportion of patients who reported falling was 24% in the first year and 22%-30% in subsequent years. The factors associated with the risk for falls were decreased peroneal nerve response amplitude; higher cystatin- C, which is a marker of reduced renal function; poorer contrast sensitivity; and low hemoglobin A1c (HbA1c) levels in insulin users . Although adjustment for physical performance explained some of these associations, it did not explain them all. " In older diabetic adults, reducing DM-related complications may prevent falls, " the study authors write. " Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C =6% increased risk of falls. " Limitations of the study include self-reported falls causing the potential for misclassification; enrollment limited to well-functioning participants; and participants not queried about hypoglycemia. " Diabetes-related complications (reduced peripheral nerve function, renal function, and vision) contribute to risk of falls in older adults with diabetes, " the study authors conclude. Diabetes Care. 2008;31 9.%% MW -Ask the Experts about Insulin Therapy in Type 2 Diabetes Adding a Third Oral Agent 2/26/2008 Question - Are there situations in which you would consider adding a third oral agent rather than initiating insulin? Response from L. Pearson, MS, RN, CDE Director, Diabetes Care, Fairview Health Services, Minneapolis,MN The prevalence of diabetes continues to rise with no end in sight. Fortunately, the arsenal of medications used to treat DM also continues to grow. This poses a particular challenge for the treatment of people with T2DM because the question of which agents to use when can be confusing, to say the least. Both the ADA in conjunction with the European Ass. for the Study of Diabetes, and the American Association of Clinical Endocrinologists have created algorithms to help guide the clinician in decisions about the initiation and advancement of therapy. ..Given that DM is a progressive disease, the likelihood that one agent will be adequate to keep blood glucose under control over time is slim. In the UK Prospective Diabetes Study it was found that in 75% of patients, monotherapy was not adequate to control blood glucose long term. Adding a second oral agent seems to be fairly well accepted as well as recommended. However, there are several things to consider when making the decision to add a third oral agent vs initiating insulin. The most important consideration is the patient. For a relatively young, overweight person who has had DM for less than 5 years and has a glycated hemoglobin (A1C)level of less than 8%, adding an insulin sensitizer or even a secretagogue may be beneficial. A dipeptidyl peptidase (DPP)-IV inhibitor may also be a good alternative in this scenario. Any one of these agents could drop the A1C by up to an additional 1% and hold off the need for insulin for a period of time. Along with the third oral agent, it is important to continue the conversation about diet and exercise, emphasizing the impact that lifestyle changes have on A1C as well as overall health. Another noninsulin agent, albeit an injectable, is exenatide. Given the profile of the patient described above, the added benefit of potential weight loss makes this option particularly appealing. Amazingly, the possibility of weight loss does seem to outweigh the fear of needles. However, DM is a progressive disease. With .. eventual insulin deficiency, agents -- such as the secretagogues -- become less effective, and DPP-IV inhibitors and exenatide seem to be more effective earlier in the disease process.. if the A1C is 9% or 10% they may all have little added benefit, only serving to delay the inevitable addition of insulin. With all of that said, cost needs to be considered as well. Many of the newer agents are at a higher co-payment, so people may be caught by surprise when taking nongeneric drugs. Potential cost must be part of the conversation when considering 3 oral diabetes agents along with the other medications taken by most people with T2. Another consideration is adherence. It is important to find a regimen that is going to set the patient up for the greatest chance of success. Talk to the patient about a typical day, and ask about current experiences with medications. Asking a question, such as " Most people miss a dose now and then; does that ever happen to you? " will help open the discussion in a nonjudgmental way. If there is a problem with adherence, adding a third agent won't solve that problem. Talk about the challenges faced by the patient. Cost may be one challenge; lifestyle and just sheer forgetfulness may be issues as well. It will be most important to find a regimen that the patient is willing to follow. During these discussions, the patient may be the one to ask whether it is time for insulin. In a collaborative discussion, the patient can take an active part in the decision about which agent is best, and this level of engagement will increase the likelihood of adherence. Asking the patient to do self-monitoring of blood glucose will help both the provider and the patient determine when blood glucose goals are not being reached and when it is time to make another change in therapy. For the best outcomes, it is important to make the diagnosis early, begin treatment as soon as possible, and advance therapy every 2-3 months until targets are achieved. 10.%% Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Arch Intern Med. 2008; 168(2) Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with T2DM during usual care visits. METHODS: randomized controlled trial of a 12-month intervention;310 patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater. In the intervention group, self-management goals for nutrition and physical activity were set using a tailored computer program. Goals were then reviewed at each clinic visit by physicians. The control group received only printed health education materials. RESULTS: In the intervention group, recommended levels of physical activity increased from 26% at baseline to 53% at 12 months (P< .001) compared with controls and 32% of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9% of controls. CONCLUSION: A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss. 11.%%Hyperglycemia and ACS: Much More Work Needed From Heartwire Feb 26, 2008 — The American Heart Association (AHA) is calling for a coordinated national effort to address the effects of hyperglycemia in patients with acute coronary syndromes (ACS), noting that there are huge gaps in knowledge in this field and great inconsistencies in the extent to which hyperglycemia is recognized and/or treated in ACS . Lead author Dr P. Deedwania UCSF told heartwire: " 2 million people each year in the US suffer from ACS, but we are focusing only on recanalization of the coronary artery. We are ignoring other prognostic indicators. There is plenty of evidence that hyperglycemia is a frequent problem in patients with ACS arriving at the hospital - as many as 25% to 50% are affected - but elevated blood sugar is frequently ignored despite being strongly associated with increased mortality. ..we are informing the medical community that many gaps exist within our knowledge and that there is limited guidance regarding the evaluation and management of hyperglycemia in the ACS setting. He explained that despite " millions of dollars " having being spent on trials looking at the effects of hyperglycemia in ACS...we have not achieved what we were supposed to have. " The questions that require answers include, first, a careful assessment of the true prevalence of hyperglycemia " " Next, we need to find the most suitable method to initially measure and subsequently monitor blood glucose in the acute setting of ACS. And then we need to define the target value for blood glucose. .. Finally, but possibly most important of all, is the need for ACS patients with hyperglycemia to be properly evaluated for diabetes, he says. " Even more central than whether acute treatment is going to have a significant impact or not is the message that these people should be investigated further for new-onset diabetes and for other things. We recommend that they should all undergo fasting-glucose- tolerance testing and fasting-glucose testing before discharge from the hospital, and they should be carefully followed up afterward. " Source Deedwania P, Hyperglycemia and acute coronary syndrome. A scientific statement from the AHA Diabetes Committee of the Nutrition, Physical Activity and Metabolism Council.Circulation . 2008 12.%% MW - Predictive Factors of Outcome After Gastric Banding: A Nationwide Survey on the Role of Center Activity and Patients' Behavior Ann Surg 246(6) © 2007 Lippincott & Wilkins Conclusions: This nationwide survey shows that the best profile for a success after gastric banding is a patient < 40 years, with an initial BMI < 50 kg/m 2, willing to change his eating habits and to recover or increase his physical activity after surgery and who has been operated by a team usually performing > 2 bariatric procedures per week. This study emphasizes that obesity surgery requires a significant experience of the surgical team and a multidisciplinary approach to improve behavioral changes.[> greater than;< lesser than 13.%% The Dipeptidyl Peptidase-4 Inhibitor Vildagliptin Improves ß-Cell Function and Insulin Sensitivity in Subjects With Impaired Fasting Glucose Diabetes Care. 2008;31(1)©2008 ADA Conclusions - We have demonstrated that in subjects with impaired fasting glucose (IFG), 6 weeks of treatment with the DPP-4 inhibitor vildagliptin increased insulin and C-peptide responses to intravenous glucose and also increased insulin sensitivity, indicating that ß-cell function was greatly improved. .. Based on the findings of the current study, it is therefore likely that therapeutic approaches with agents that improve ß-cell function, such as DPP-4 inhibitors, could offer another option to slow or prevent the progression to diabetes. The definitive answer to this will require a long-term clinical trial. 14.%% MW - Initial Combination Therapy With Sitagliptin, a Dipeptidyl Peptidase-4 Inhibitor, and Metformin for Patients With T2DMExpert Rev Endocrinol Metab. 2008;3(1) 2/22/2008 Abstract The two incretin hormones, glucagon-like peptide (GLP)-1 and glucose-dependent insulinotropic polypeptide potentiate nutrient-dependent insulin secretion following meal ingestion. Metabolic control can be improved markedly by administration of exogenous GLP-1, but the native peptide is almost immediately degraded by the enzyme dipeptidyl peptidase (DPP)-4 and, therefore, has little clinical value. Oral formulations that inhibit DPP-4, thereby prolonging the duration of endogenous incretin action, have, therefore, been developed. Sitagliptin, a once-daily, orally active, competitive and fully reversible inhibitor of DPP-4, was, as first in its class, introduced to the market as Januvia™. Recently, the US FDA approved initial combination therapy with sitagliptin and metformin (Janumet™) in order to help more patients with T2 get closer to accepted glycemic control targets. This article reviews initial treatment with Janumet as an alternative to monotherapy. 15.%% MW - Atrial Fibrillation Risk Increased in Metabolic Syndrome Feb 22, 2008 - Individuals who met standard criteria for the metabolic syndrome had at least a 60% increased age- and sex-adjusted risk of new-onset atrial fibrillation (AF) over 4 and a half years in a prospective community-based study. The study also found that the AF risk rose with the number of metabolic-syndrome components a person displayed and that most of the syndrome's components were individually predictive of AF. " The syndrome has a strong association with stroke, MI [myocardial infarction], and cardiovascular and all-cause mortality, " observe the authors. and the increased incidence of stroke and higher mortality in subjects with the metabolic syndrome can be partially explained by its association with AF. " [28,000 persons in Japan] The cohort excluded persons with a history of AF or atrial flutter and those taking " antihyperlipidemic drugs. " All of the component risk factors, save raised triglycerides, were significantly predictive of AF. . " Although the pathogenesis of the metabolic syndrome is not well understood, it is likely that the condition represents a complex interplay between metabolic, genetic, and even environmental factors, " according to the group. As " inflammation and oxidative stress have been proposed as common etiologic factors linking these processes and have likewise been implicated in the pathogenesis of AF, " the increased AF risk in the metabolic syndrome " may be related in part to activation of signaling pathways important in inflammation and oxidative stress. " Those signaling pathways, they propose, might make an attractive therapeutic target for lowering the risk of both atherosclerotic disease and AF. .The authors concluded that patients with the metabolic syndrome are at an increased risk for AF even in the absence of hypertension and diabetes, and clinicians should assess these patients for AF. 16.%% MW -Hepatic Missing Link Said to Unite Insulin, Lipoproteins, and Coronary Disease Heartwire 2008. © 2008 Medscape 2/27/08 - Hepatic insulin resistance appears to mediate the glucose, triglyceride, and HDL-cholesterol abnormalities that contribute to the constellation of heart-disease risk factors called the metabolic syndrome and so may represent a pathophysiologic tie that binds hyperinsulinemia and dyslipidemia as promoters of coronary disease, conclude researchers in the February 2008 issue of Cell Metabolism The molecular causes of such insulin resistance might make an effective treatment target for patients with the metabolic syndrome, according to Dr S Biddinger (Joslin Diabetes Center, Boston, MA) and associates. But a leading critic of metabolic syndrome's emerging status as a clinical entity disagrees with what the new findings mean. " The study itself is beautiful, " Dr Kahn , chief scientific and medical officer of (ADA), told heartwire. " But it's irrelevant to the metabolic syndrome. " Almost every study in humans that has explored root causes of the metabolic syndrome, he said, " showed that there were at least 2-4 factors, two to four underlying causes, not just insulin resistance. " Yet Biddinger et al say their series of experiments with liver insulin-receptor knockout (LIRKO) mice suggest, among other things, that hepatic insulin resistance alters the lipoprotein profile to make it more atherogenic, such as by lowering HDL cholesterol and raising total cholesterol and apolipoprotein-B (apoB) levels, at the same time that higher insulin concentrations promote hypertriglyceridemia. Their research further suggests that the pro-atherogenic derangements caused by insulin resistance can be exacerbated by a poor diet and obesity, which further contribute to the development of atherosclerosis, according to the group. The LIRKO mice rapidly developed vascular disease when given a " Western " high-fat, high-cholesterol diet. " Together these produce the full complement of lipid abnormalities associated with the metabolic syndrome in humans, " write the authors. At least in the study's experimental model, " insulin resistance is enough to drive these lipid abnormalities in the metabolic syndrome, and when coupled with diet, it's enough to drive the atherosclerosis, too, " coauthor and senior investigator Dr C Kahn (Joslin Diabetes Center) told heartwire. The group says their research is clinically important " because it suggests that the metabolic syndrome is not merely a collection of abnormalities that should be considered and treated independently, as some experts have advocated. Rather, it appears that the metabolic syndrome is truly a syndrome, in which disturbances in glucose and cholesterol metabolism both stem from a defect in insulin signaling. " Said coauthor Kahn when interviewed, " One thing I hope will be an outcome of this is that the organizations that have said there is no metabolic syndrome, like the ADA, will at least now admit that a lot of it is tied to a single problem and that there is good reason to try to treat it as a commonly linked problem. " 17.%% MW - Sulfonylurea Safe and Effective for Diabetics With SUR1 Mutations Reuters Health Information 2008. © 2008 Reuters Ltd. Feb 21 - Oral sulfonylurea therapy is a safe and effective treatment for patients with diabetes due to sulfonylurea receptor 1 (SUR1) mutations and may be able to replace insulin injections, UK researchers report. Neonatal diabetes can result from mutations in the Kir6.2 and SUR1 subunits of the pancreatic ATP-sensitive potassium channel. Prior research has shown that sulfonylurea can successfully replace insulin in patients with Kir6.2 mutation- related diabetes, but it was unclear if the same held true for patients with SUR1 mutation-related disease. Researchers in the Neonatal Diabetes International Collaborative Group attempted to switch 27 patients with SUR1 mutations from insulin to oral sulfonylurea therapy. By 2 months after the switch, 23 patients (85%) had completely traded insulin injections for oral sulfonylurea therapy without significant adverse effects or increased hypoglycemia. Moreover, this change was associated with a significant drop in median HbA1c from 7.2% to 5.5%. Compared to a group of Kir6.2 patients described in a prior study, the SUR1 patients required lower doses of insulin prior to the change in therapy and lower doses of sulfonylureas afterward. " Long-term follow-up is needed in a large cohort of patients to see whether trends in improved glycemic control and decreased sulfonylurea dose continue, " the authors conclude. Diabetes Care 2008;31 18.%% MW - Insulin Resistance Independently Associated With Chronic Hepatitis C (Reuters Health) Feb 27 - The results of a new study suggest that insulin resistance is a specific feature of chronic hepatitis C virus (HCV) infection, independent of disease severity or thebpresence of metabolic factors.bInsulin resistance is also significantly more common in patients chronically infected with hepatitis C genotypes 1 and 4, and in patients with high viral loads, French investigators report. They also found insulin resistance to be an independent predictorbof significant fibrosis. " HCV infection is now recognized as a systemic disease involving lipid metabolism, oxidative stress, and mitochondrial function, " the lead author writes. [500 consecutive patients with chronic HCV .Insulin resistance was present in (32.4%).Insulin resistance was more frequent in chronic HCV patients (35%) than a group of matched chronic hepatitis B patients (5.0%). " Insulin resistance should be assessed in the routine management of patients with chronic hepatitis C, " Gastroenterology 2008;134 Abbreviations: DM - diabetes Mellitus;T1DM - type 1 diabetes mellitus T2DM - type 2; ADA - Amer Diabetes Asso; AFB - Amer Foundation for the Blind BP - blood pressure;HTN - hypertension; MW Medscape Web MD; FDA Federal Drug Administration; NIH - National Institutes of Health; VA - Veterans Administration. MNTD- Medical News Today 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@... LaFrance-Wolf 5120 Myrtus Avenue Temple City, CA 91780 Quote Link to comment Share on other sites More sharing options...
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