Guest guest Posted March 19, 2008 Report Share Posted March 19, 2008 Hi Can you write to me off list? robertantunez@... articles 1. BBC 13 March 2008 Vitamin D 'cuts risk of diabetes' Exposure to sunlight allows the body to manufacture vitamin D Giving young children vitamin D supplements may reduce their risk of developing type 1 diabetes later in life, research suggests. Children who took supplements were around 30% less likely to develop the condition than those who did not. T1 results from the immune system destruction of pancreatic cells which produce the hormone insulin. The study appears in Archivesof Disease in Childhood. T1 is most common among people of European descent, with around 2million Europeans and North Americans affected. It is becoming increasingly common, and it is estimated that the number of new cases will rise by 40% between 2000 and 2010. The team pooled data from 5 studies examining the effect of vitamin D supplementation. Not only did the use of supplements appear to reduce the risk, the effect was dose dependent - the higher and more regular the dose, the lower the likelihood of developing the disease. Previous research has found that people newly diagnosed with T1have lower concentrations of vitamin D than those without the condition [and ] that T1 is more common in countries where exposure to sunlight - which enables the body to manufacture vitamin D - is lower. For instance, a child in Finland was 400 times more likely to develop the disease than a child in Venezuela. Separate research has linked low levels of vitamin D and sunlight to other autoimmune disorders, including multiple sclerosis and rheumatoid arthritis. Further evidence of vitamin D's role comes from the fact that pancreatic beta cells and immune cells carry receptors or docking bays for the active forms of the vitamin. It is thought that vitamin D helps to keep the immune system healthy, and may protect cells from damage caused by chemicals which control inflammation. Dr V King, of Diabetes UK, said: " Much more research, in particular controlled trials which compares the results when one group of people are given vitamin D supplements and one group is not, are needed before we can confirm a concrete association between vitamin D and T1. " Governnment [uK] experts recommend vitamin D supplementation for at least the first two years of a child's life. 2.%% 13 Mar 2008 2, 17, 4629 s Hopkins Health Alerts:Diabetes - Stopping Insulin Resistance Before It Leads to Diabetes In this Health Alert, s Hopkins endocrinologists discuss intriguing research that affects all who have T2DM. Researchers have identified a fat cell protein that may predict insulin resistance and help doctors to prescribe treatments to prevent or slow the development of T2DM. In a healthy person the pancreas makes enough insulin to keep the supply and use of glucose in balance. In DM, the glucose balancing system is disrupted, either because too little insulin is produced or because the body's cells do not respond to insulin normally -- a condition called insulin resistance. The result is an unhealthy rise in blood glucose levels. If DM is left untreated, the two principal dangers are the immediate results of high blood glucose levels (which include excessive urination, dehydration, intense thirst, and fatigue) and long-term complications that can affect your eyes, nerves, kidneys, and large blood vessels. A screening test to identify people with insulin resistance could allow doctors to prescribe treatments or lifestyle measures to stop or slow the development of T2. Researchers have taken a step toward such a screening test, according to a new study reported in The New England Journal of Medicine (Volume 354, page 2552 ). The team identified increased blood levels of a protein produced and secreted by fat cells in people who become insulin resistant. The protein's name: retinol-binding protein 4 (RBP4). Scientists already know that people with insulin resistance have increased levels of RBP4. The new study found that levels of RBP4 rose in parallel with the severity of insulin resistance in people who were obese or had prediabetes or T2 and in healthy people with a family history of the disease. Researchers are trying to determine whether lowering RBP4 with medication makes cells more sensitive to insulin. However, the study also found that about two thirds of the participants were able to decrease their RBP4 levels and reduce insulin resistance with a tried-and-true lifestyle measure: exercise. 3.%% Eye (2008) 22, Can we predict which patients are at risk of having an ungradeable digital image for screening for diabetic retinopathy? Conclusion - Inability to visualise the fovea is the commonest cause of an ungradeable image from digital retinal photography. Age and posterior subcapsular cataract were best predictors of ungradeable status of nonmydriatic fundus photographs.C 2008 The Royal College of Ophthalmologists 4.%% MW -Diabetes Linked to Risk of Endometrial Cancer (Reuters Health) Mar 12 - T2DM is associated with endometrial cancer, regardless of the presence of most other risk factors, according to new findings. " A positive association has been observed in nearly all studies of T2DM in relation to the incidence of endometrial cancer, " Researchers write. " Given the adverse effect of obesity on the incidence of both DM and endometrial cancer, investigators have adjusted for obesity in a number of these studies, " they note. . .This team examined whether the risk of endometrial cancer among T2 women differs with respect to other endometrial cancer risk factors, [1303 cases;1779 controls.] An association was observed between T2 and endometrial cancer (odds ratio = 1.7). The association was stronger among women with a DM diagnosis within 5 years (OR = 2.6) than those with a more distant diagnosis. " Among women with no history of hypertension, those with DM had virtually no elevation in risk compared with those without DM, whereas among women with hypertension, the corresponding odds ratio was 2.1. " The risk of endometrial cancer associated with DM appeared not to vary greatly with respect to menopausal hormone use, cigarette smoking, age, race, education, or parity. " They conclude that T2DM is associated with endometrial cancer irrespective of the presence of other risk factors, " except possibly hypertension and extreme obesity. " Am J Epidemiol 2008;167 5.%% MW - Metabolic Syndrome Linked to Silent Ischemic Brain Lesions March 14, 2008 - Metabolic syndrome (MetS) is associated with the prevalence of silent brain lesions independent of other risk factors for ischemic stroke, according to the results of new a study. " Metabolic syndrome (MetS) is a recognized risk factor for stroke, but it is unclear whether MetS is also related to subclinical ischemic lesions, " write the researchers " We examined the association of MetS with the prevalence of silent brain infarction, periventricular hyperintensity, and subcortical white matter lesions in healthy adults. " [(MRI) brain scans of 1151 healthy Japanese subjects] MetS was significantly associated with silent brain infarction, periventricular hyperintensity (PVH), and subcortical white matter lesions (SWML) after adjustment for age and other clinical factors. Among the components of MetS, high blood pressure was associated with all 3 types of lesions, whereas dyslipidemia was associated with SWML and elevated fasting blood glucose levels were associated with PVH. There were positive trends between the number of MetS components and the prevalence of silent lesions. The positive trend between MetS components and silent lesions could be used as a diagnostic tool to predict and prevent future stroke. " Stroke. Published online March 6, 2008. 6.%% MW - More Support for Statins in Diabetics January 11, 2008 - A new meta-analysis, combining data on more than 18000 diabetic patients across 14 trials, helps support the current wisdom that all diabetic patients at " sufficiently high risk " for vascular events can benefit from statins The study is the latest analysis from the Cholesterol Treatment Trialists (CTT) Collaborators and indicates that statins reduce deaths from vascular causes in diabetics, without increasing the risk from non-vascular causes, to a degree similar to that seen in nondiabetics. According to one of the CTT collaborators, the findings should help quell debate spurred by the recent 4D and ASPEN trials, which found no clear benefit of statins in diabetics. In the current meta-analysis, the effects of statins were not only similar in people with and without DM, they were also similar in diabetics with and without vascular disease, an important finding since many of the diabetics in the study did not have vascular disease at baseline. " It also did not matter whether they were young or old, men or women, obese or not obese, had mild kidney disease or not, " " Most important of all, it didn't matter what their starting cholesterol was, so even people with below-average LDL [low-density lipoprotein] cholesterol: if they were diabetic and at increased risk, they benefited from the statin. " 7.%% MW - Insulin Glargine Mix Improves Glucose Control in Diabetic Children (Reuters Health) Mar 18 - Insulin glargine mixed with rapid-acting insulin analogs is more effective than standard treatment with neutral protamine Hagedorn and rapid-acting insulin analogs in children with newly diagnosed T1DM researchers report. " we tested the hypothesis that insulin glargine mixed with rapid-acting insulin analogs is superior to the standard therapy of neutral protamine Hagedorn twice a day with rapid-acting insulin analogs. " . . in an earlier study they established that both could be combined in the same syringe, reducing daily injections from four to two. In the current study, the team studied 42 children with new-onset T1. . the team found that A1C in the combination group had fallen from 6.8% at baseline to 6.7%. " The fact that we were able to mix glargine with rapid-acting insulin analogs in the same syringe, " she concluded, " decreased the number of injections, which will further help adherence to the regimen. " Pediatrics 2008;121 8.%% MW - Type 2 Dabetes in People of South Asian Origin: Potential Strategies for Prevention 3/11/2008 Abstract - South Asians have a one in three lifetime risk for the development of diabetes, developing the condition 10 years earlier than Europids. The high social and economic burden of DM in South Asians is augmented by greater rates of attrition from renal and cardiovascular disease. Conclusions - Prevention (or at least delay) in the development of DM is feasible with rigorous lifestyle intervention or drug therapy in people at high risk of DM. Trials that have shown particular benefit include a significant lifestyle component - exercise levels of 30 minutes per day, plus at least two-monthly dietary advice or education sessions for the first year. If the early data from the IDPP study is borne out, serious consideration of the early use of metformin in high-risk South Asians should be undertaken. Early treatment of hypercholesterolaemia with statins and hypertension with ACE-inhibitors may also contribute to the prevention of DM in South Asian people. The greatest challenge lies in the development of culturally appropriate interventions using a whole community approach. It is important that interventions to prevent diabetes in South Asians start early, and involve families and communities. 9.%% MW - Metabolic Syndrome a Possible Risk Factor for Depression (Reuters Health) Mar 11 - Metabolic syndrome may be a " predisposing factor for the development of depression, " Finnish researchers report. [the team followed a large group of middle-aged 7 years. At baseline they assessed depressive symptoms using the Beck Depression Inventory. They also assessed the presence of metabolic syndrome in the subjects, using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Non-depressed subjects at baseline with metabolic syndrome were twice as likely as subjects without metabolic syndrome to have symptoms of depression at follow-up 7 years later, with an odds ratio of 2.2 for both sexes. Effective prevention and treatment of the metabolic syndrome may, in turn, reduce the incidence of depression. " In the future, new long-term studies are needed to elucidate the long-term course and prognosis, proper treatment and specific symptom picture of depression related to metabolic syndrome, " they J Clin Psychiatry 2008;69. 10.%% MW - Gender Impacts Anorexigenic, Memory Effects of Intranasal Insulin Reuters Health Information 2008. C 2008 Reuters Ltd. Mar 07 - Insulin administered intranasally acutely decreases food intake in men but not in women; on the other hand, it acutely improves memory function in women but not in men, investigators observed in a small study. " Our findings indicate that gender is a critical factor in brain insulin signaling that affects both food intake and cognitive functions, " study investigator Dr. C.Benedict said. The findings further suggest that intranasal insulin " may be helpful in the treatment of cognitive and metabolic disorders like Alzheimer's disease and obesity that are assumed to derive at least in part from malfunctions of central nervous insulin signaling, " Central nervous insulin is critically involved in the regulation of body weight and memory formation, the investigators point out .The team assessed the effects of a single intranasal dose (160 IU) of regular human insulin or vehicle on food intake and memory processing in 32 healthy, normal-weight men and women. " Because intranasal insulin reaches the brain but bypasses the circulation, it's possible to assess insulin effects on the central nervous system without affecting blood glucose levels, " " Importantly, gender differences will have to be considered in the possible future development of intranasal insulin therapeutics. " J Clin Endocrin Metab 2008. 11.%% MW -Breast Cancer Risk May Be Reduced After Gestational Diabetes Mar 07 - Women who develop gestational diabetes [GDM] appear to have a lower risk of breast cancer later in life, according to a new report. [1526 white women;798 Hispanic women with breast cancer; matched with a similar number of controls.] DM overall and T2 were not associated with breast cancer, they report, but there was a statistically significant inverse association between gestational diabetes and breast cancer (odds ratio 0.70). The effect was stronger when gestational diabetes was diagnosed before age 35 years " Should the inverse association between GDM and breast cancer be observed in future studies, " they conclude, " potential biologic explanations should be further investigated. " Am J Epidemiol 2008;167 12.%% Medical News Today - Least Likely To Monitor Their Blood Glucose Are Minority, Low-Income Diabetics 17 Mar 2008 Black and Hispanic adults with insulin-treated DM are less likely than whites to monitor their blood glucose, according to a new study presented at the American Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention. The disparities were greatest for low-income Hispanics, said the lead author of the study. " Minority and financially vulnerable adults with insulin-treated diabetes appear to have lower reported rates of self-monitoring of blood glucose (SMBG) - a vital disease management component. " Efforts to improve diabetes control, including the collection and use of SMBG data in Hispanic and black populations with diabetes (particularly those on insulin), are warranted given that Hispanics and blacks have a higher frequency of diabetes-related complications compared to whites. We need to better understand income's role in racial and ethnic disparities in SMBG to offer effective programs and policies to improve SMBG by minorities. " [16,630 adults 19 years + with insulin-treated DM] Source: Astle American Heart Association 13.%% Medical News Today - Mechanisms Suggest New Way To Treat Heart Disease Among Diabetics 14 Mar 2008 Researchers have discovered how diabetes, by driving inflammation and slowing blood flow, dramatically accelerates atherosclerosis, according to research to be published in the March 14 edition of the journal Circulation Research. Experts once believed that atherosclerosis, or hardening of the arteries, developed when too much cholesterol clogged arteries with fatty deposits called plaques. When blood vessels became completely blocked, heart attacks and strokes occurred. Today most agree that the reaction of the body's immune system to fatty build-up, more than the build-up itself, creates heart attack risk. Immune cells traveling with the blood mistake fatty deposits for intruders, akin to bacteria, home in on them, and attack. This causes inflammation that makes plaques more likely to swell, rupture and cut off blood flow. Making matters worse, nearly 21 million Americans have diabetes, a disease where patients' cells cannot efficiently take in dietary sugar, causing it to build up in the blood. In part because DM increases atherosclerosis-related inflammation, DM patients are twice as likely to have a heart attack or stroke. Past work has shown that high blood sugar has two effects on cells lining blood vessels as part of atheroslerosis. First, it increases the production of free radicals, highly reactive molecules that tear about sensitive cell components like DNA, causing premature cell death (apoptosis). This process also reduces the availability of nitric oxide (NO), which would otherwise enable blood vessels to relax and blood flow to increase. In contrast to diabetes, exercise and good diet bring about faster blood flow through blood vessels. The force created by fast, steady blood flow as it drags along blood vessel walls has been shown by recent studies to protect arteries from atherosclerosis. Physical force has emerged recently as a key player in bodily function, capable of kicking off biochemical processes (e.g. weightlifting thickens bone). " Inflammation is blood vessels is one of the main drivers of atherosclerosis, and DM makes it much worse, " said a study author. " Our study argues that a pathway surrounding a key signaling enzyme both protects the heart in normal cases, and is sabotaged by the chemicals produced in diabetes. We believe we have found a new therapeutic target for the treatment of DM-related damage to blood vessels. " How Diabetes Does It- In people without DM, fast blood flow triggers an enzyme called extracellular signal-regulated kinase 5 (ERK-5). ERK5 in turn signals endothelial nitric oxide synthase (eNOS) to produce more nitric oxide and dilate blood vessels. It also activates Kruppel-like factor 2 (KLF2) and peroxisome proliferator-activated receptor-g (PPARg), both of which block the ability of pro-inflammatory immune cells to home in on and adhere to diseased portions of blood vessels. The current results provides the first mechanistic description of how diabetes takes away the ability of fast blood flow force to protect blood vessels, arguing that it does so by interfering with ERK5 and its signaling partners. The team showed that molecules called advanced glycation end products (AGEs), produced in greater levels by patients with diabetes, interfere with ERK5 cardioprotection. Glycation reactions cause the release of oxidizing side products like hydrogen peroxide (H202) that drive free radical production, inflammation and cell damage in many diseases. Researchers found that AGEs and H202 sabotage ERK5 by encouraging the attachment to it of a small ubiquitin-related modifier (SUMO), a protein tag used by cells to fine-tune their control over proteins. In normal function, a cell may extend a protein's lifespan, or send it from one part of the cell to another, by attaching a SUMO tag. In the current study, researchers found that AGEs and H202 induced ERK5-SUMOylation as part of disease. In addition, the team found that ERK5-SUMOylation was increased in the aortas of diabetic mice. This work is supported by grants from the America Heart Association and the National Institutes of Health. " Our experiments found that taking away the " SUMO tag " from ERK protects blood vessels against diabetes, We believe that the SUMOylation of ERK turns off 'good' genes that are important in countering atherosclerosis. In the next phase, we will be looking for drug candidates that can turn on ERK5 as diabetes attempts to shut it down. " Source: Greg University of Rochester Medical Center Press release. 14.%% Medical News Today - FDA Approves Abbott's FreeStyle Navigator® Continuous Glucose Monitoring System 14 Mar 2008 Click to Print The (FDA) has approved the FreeStyle Navigator® Continuous Glucose Monitoring System in the United States for people with diabetes. Designed to discretely and continuously measure glucose levels through a sensor in the back of the upper arm or abdomen, [this] system provides minute-by-minute information about which way and how quickly blood sugar levels are changing. This information can lead to proactive adjustments that can result in tighter glucose ranges. Before adjusting therapy for DM management based on the results and alarms from the FreeStyle Navigator system, traditional blood glucose tests must be performed. " Understanding glucose trends, with the goal of minimizing fluctuations, is an important part of improving the management of diabetes, " said endocrinologist and Director of the International Diabetes Center " We are always looking for new tools like these to enable people with diabetes to continuously monitor their glucose levels, putting them on the offense, not defense, so they can take action before a high or low glucose level occurs. " For people with DM, less time spent with low (hypoglycemia) or high (hyperglycemia) blood sugar has been correlated with less risk for a number of serious short- and long-term diabetes-related complications. By measuring glucose levels continuously, the FreeStyle Navigator system is designed to provide more and better information than traditional fingerstick glucose measurements, which can lead to improved diabetes management. The system monitors glucose levels by measuring and transmitting glucose information once per minute to the pager-sized receiver, which can be clipped to a belt or carried in a pocket or purse. It also provides audible or vibrating alarms before glucose levels become too high or too low, displays five directional trend arrows to help people understand if glucose is rising or falling, and stores historical data and glucose trend information for up to 60 days. Additionally, the sensor and transmitter are designed to accommodate showering, swimming and a range of normal physical activities. The accuracy, safety and efficacy of the FreeStyle Navigator system have been demonstrated in two separate l clinical trials, including a five-day, in-clinic study and a study of people with T1 and T2 at home. Five-Day In-Clinic Study:[58 subjects 18-64years old] Home Use Study: [123 people with T1 & T2 used it in their homes for 40 days, wearing the sensor on the back of their upper arm or abdomen. A e Error Grid (CEG) analysis demonstrated that 96.8 percent of the values were in the most accurate zones The FreeStyle Navigator system is composed of three parts: a sensor, a transmitter and a receiver. The sensor, worn for up to five days and then replaced, is placed just under the skin and is attached to a plastic sensor mount with adhesive to adhere to the skin, like a patch. The transmitter snaps into the sensor mount and sends glucose information wirelessly to the pager- sized receiver. The system discreetly measures glucose levels once per minute; provides high/low glucose alarms based on customizable, physician- and patient-determined levels; and delivers early-warning alarms that indicate if glucose levels are likely to be too high or too low 10, 20 or 30 minutes in advance. The system also stores up to 60 days worth of glucose information that can be analyzed by the user or a health care professional. Indicated for people ages 18 and older, the FreeStyle Navigator system is designed to continually record interstitial fluid glucose levels for the purpose of improving DM management. Navigator system are not intended to replace traditional blood glucose monitoring. 15.%% MW -Metabolic Syndrome may Increase Operative Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery Future Lipidol. 2008;3(1):27-29. C2008 Future Medicine Ltd. Abstract : Metabolic syndrome increases operative mortality in patients undergoing coronary artery bypass grafting surgery. . Metabolic syndrome (MS) is associated with increased risk of coronary heart disease, stroke and cardiovascular mortality. However, little data exist on the relationship between MS and operative mortality following coronary revascularization. This retrospective study found that MS in patients undergoing coronary artery bypass graft (CABG) surgery is a significant independent predictor of an increased risk of post-operative mortality. Thus, MS may be an important and novel patient risk factor for CABG surgery. 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@... __________ NOD32 2954 (20080318) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com LaFrance-Wolf 5120 Myrtus Avenue Temple City, CA 91780 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 29, 2008 Report Share Posted May 29, 2008 1. Nature Clinical Practice Endocrinology & Metabolism (2008) 4 Artificial pancreas is feasible for pediatric patients with type 1 diabetes The most promising treatment for pediatric patients with T1 is an artificial pancreas, which links continuous blood-glucose monitoring to computerized control of a subcutaneous insulin pump. Such systems are feasible in adults, but inherent delays in subcutaneous insulin delivery along with peripheral insulin resistance in puberty could increase the risks of postprandial glucose-level excursion and subsequent hypoglycemia. Weinzimer and colleagues hypothesized that these risks could be reduced by manual administration of a preprandial 'priming' insulin bolus. Full text is available 1. Personal subscription 2. 7 day single article pass for US$18 © 2008 Nature Publishing Group 2.%% Nature Clinical Practice Endocrinology & Metabolism (2008) 4 Diabetes is associated with poor outcomes after bypass surgery Critical limb ischemia can be treated with vascular bypass surgery, but if ischemia does not resolve, lower-limb amputation might become necessary. In developed countries, the majority of such amputations are performed in patients with diabetes. Whether the outcomes of bypass surgery are less favorable in patients with diabetes than in patients without diabetes is, however, unclear. Malmstedt and colleagues performed a nationwide, population-based cohort study to compare postoperative amputation-free survival in patients with and without diabetes. Full text [see #1] 3.%% Nature Clinical Practice Endocrinology & Metabolism (2008) 4 Diabetic nephropathy—an evaluation of potential risk factors in young patients with type 1 diabetes mellitus Raile et al. have performed a prospective epidemiological study of risk factors for diabetic nephropathy in a large cohort of patients with T1DM. In almost 28,000 patients with childhood onset of T1 disease duration, HbA1c level, lipid abnormalities, and BP were identified as risk factors for microalbuminuria. In addition, male sex was a risk factor for macroalbuminuria. Full text [see #1] 4.%% Nature Clinical Practice Endocrinology & Metabolism (2008) 4 Treatment of impaired glucose tolerance in childhood Impaired glucose tolerance is a prediabetic condition that is a major risk factor for subsequent development of T2DM. As T2 has become common among obese adolescents, options for the management of children with impaired glucose tolerance are discussed in this Viewpoint. Full text [see #1] 5.%% Nature Clinical Practice Endocrinology & Metabolism (2008) 4 Prevention of type 1 diabetes: the time has come Type 1 diabetes mellitus is a chronic process of many years, during which insulin production slowly decreases. This key feature makes the disease a potential candidate for treatment but also for prevention against symptoms becoming clinically overt. This Review discusses issues of diagnosis and risk stratification, and the development of prevention strategies. Full text [see #1] 6.%% MW - Risk for Metabolic Syndrome Linked to Sleep Duration May 21, 2008 — Risk for metabolic syndrome was associated with sleep duration, according to the results of a cross-sectional community-based cohort study. " Short and long sleep duration have been linked to various risk factors for cardiovascular disease, " write M. Hall, PhD, and team " In the present study, we evaluated the relationship between sleep duration and presence of the metabolic syndrome, which is a cluster of physiologically interrelated risk factors for cardiometabolic disease. " [1214 participants aged 30- 54 were divided into 4 groups on the basis of their reported sleep duration.] Adjusted odds for metabolic syndrome were increased 45% in both short and long sleepers vs those sleeping 7-8 hours per night. " Additional studies are needed to evaluate temporal relationships among these measures, the behavioral and physiologic mechanisms that link the two, and their impact on subsequent cardiometabolic disease. " Sleep. 2008;31 7.%% Erectile Dysfunction in Diabetics Predictive of Coronary Artery Disease Journal of the American College of Cardiology, May 21, 2008, as reported by WebMD Erectile dysfunction (ED) is a " powerful " predictor of coronary heart disease/cardiovascular disease events, including death, in T2DM. In the first of 2 separate studies, Italian investigators showed that among 291 type 2 diabetic men with angiographically proven asymptomatic coronary artery disease, the presence of ED was associated with a doubling of risk for a major cardiac adverse event over 4 years. In the second study, researchers in Hong Kong looked at 2306 men with T2 and found that ED was an independent predictor for coronary heart events (hazard ratio, 1.58; after adjustment for other covariates. 8.%% MW - Oxidized LDL Associated With Metabolic Syndrome Heartwire May 21, 2008 — A higher concentration of oxidized low-density lipoprotein (LDL)-cholesterol was associated with increased incidence of metabolic syndrome overall, as well as its components of abdominal obesity, hyperglycemia, and hypertriglyceridemia in a new population-based study. The senior author commented to: " This is another piece of evidence suggesting that oxidized LDL is harmful and is a signal of future heart disease risk even in people who are currently young and healthy. " The authors explain that studies in cellular and animal models have suggested that oxidized LDL, which accounts for only a minor fraction of LDL (0.001%-5%), contributes to processes that lead to the incidence of the metabolic syndrome, but this association has not been tested in humans. [CARDIA study -5115 participants ages 18-30; followed 20 years. After adjustment for many different variables, oxidized LDL showed a graded relation to incident metabolic syndrome, with those in the highest quintile of oxidized LDL having a 3.5-times increased risk of metabolic syndrome compared with those in the lowest. They conclude: " As yet, it is not possible to conclude whether oxidized LDL is a marker related to mechanistic underlying factors on the pathway to the development of metabolic syndrome or whether it is by itself a functional intermediary in this pathway. However, the strong association of oxidized LDL with the incidence of metabolic syndrome is consistent with a causal role. " JAMA 2008;299. 9.%% Adverse Childhood Experiences Linked to Obesity, Type 2 Diabetes in Mid-adulthood 5/21/08 - Certain adverse childhood experiences increased the risk for obesity and T2DM in midadulthood, according to the results of a prospective longitudinal study. " Child abuse has been associated with poorer physical health in adulthood. " We have examined how different stressful emotional or neglectful childhood adversities are related to adiposity and glucose control in midadulthood. At 45 years of age, 9310 members of the 1958 British birth cohort took part in a biomedical interview. Several adversities in childhood were associated with increased risk for obesity by 20- 50%. These included physical, verbal, or witnessed abuse; humiliation; neglect; strict upbringing; physical punishment; conflict or tension; and low parental aspirations or interest in education. Adversities with the strongest associations with adiposity, such as physical abuse, tended to be associated with HbA1c levels of 6 or more. In most cases, however, associations were explained by adjusting for adiposity or other adulthood mediators. " Some childhood adversities increase the risk of obesity in adulthood and thereby increase the risk for T2. ..Research is needed to understand the interrelatedness of adversities, the social context of their occurrence, and trajectories from adversity to adult disease. " 10.%% MNTD - High Triglycerides Common In People Who Are Obese And/Or Diabetic, At Risk For Heart Disease 5/26/08 Diabetes researchers have identified a potential target for the development of new therapies to treat hypertriglyceridemia, a lipid disorder commonly seen in people who are obese and diabetic. The scientists studied the role of a protein known as Forkhead Box O1 (FoxO1) that mediates the metabolism of glucose and cholesterol. In the lab, they were able to curb the secretion of triglycerides in animals that were obese and diabetic by inhibiting the production of FoxO1 in the liver. " Our latest findings suggest that we may eventually be able to develop drug therapies that inhibit FoxO1, which would thereby inhibit the production of proteins that lead to elevated triglyceride levels in people who are obese and/or who suffer from T2DM , " said the senior author. " Hypertriglyceridemia is a known risk factor for developing heart disease, the leading cause of death in the US. " Their research suggests that FoxO1 is vital to the regulation of a protein known as microsomal triglyceride transfer protein (MTP) which facilitates the production of very low-density lipoproteins (VLDL), which are produced in extreme excess in people with hyper -triglyceridemia. They found FoxO1 mediates insulin action on the production of MTP in the liver. The team is now studying its function in other tissues and organs to determine what an impact such therapies might have on children and adults who are obese and/or have T2. adapted by Medical News Today from original press release. 11.%% MNTD - Benefits In Using Early Intensive Insulin Therapy To Control Glucose 23 May 2008 In a Diabetes Special Issue of The Lancet, researchers have shown that patients with newly diagnosed T2DM who receive early intensive insulin therapy may be able to improve the function of their insulin-producing ß-cells. The therapy regimen has also been associated with the recovering and restoration of blood glucose control. The researchers conducted a randomized controlled trial in China. [382 patients;age 25 to 70 with T2] After regular blood glucose control (normoglycemia) was restored for a period of two weeks, patients stopped receiving treatment and were then followed up on just diet and exercise. The findings of this team support the early intensive insulin therapy. More patients achieved target blood glucose control and achieved it more quickly in both of the insulin groups compared to the group on oral drugs. In addition, patients in the insulin groups significantly improved the function of ß-cells (pancreaticcells that produce insulin). " Although the relevant biological mechanisms and target tissues contributing to preferential improvement in ß-cell function remain unclear, these data suggest that use of intensive insulin therapy early in the course of T2 warrants further clinical investigation. " The Lancet (2008). 371[9626] 12.%% MNTD -Anti Inflammatory Medication May Treat Type 2 Diabetes 22 May 2008 Researchers at the Joslin Diabetes Center who reported earlier this year that an inexpensive, non-steroidal anti-inflammatory drug called salsalate might prevent T2DM are now reporting that the drug may also be beneficial in the treatment of the disease. The paper, reports on 3 studies that demonstrate that salsalate, which has been used for decades to treat arthritis, may benefit patients with T2 by lowering blood sugar and reducing inflammation. Together, these studies have led to 3 large, clinical trials that seek to confirm the benefit of targeting inflammation using salsalate to lower glucose in patients with T2 or who are at risk for DM or to reduce atherosclerosis in patients with coronary artery disease. . It had originally been noted nearly 150 years ago that salicylates could lower blood glucose levels, but this had either been forgotten or ignored. Lab studies found that the inflammatory pathway regulated by NF-kB is activated in animals with obesity and DM. They went on to demonstrate that this pathway could be inhibited using salicylates, thus showing that the effects of obesity are mediated through inflammation. This was not an accepted concept at the time, and is still debated in field. The team opted to study salsalate, which is a salicylate similar to aspirin but that does not cause stomach upset or bleeding. " Our findings are potentially very exciting because we show that a medication that treats inflammation may also treat diabetes and related medical conditions. " If we can show in the larger clinical trials now underway that it is safe and effective, it means salsalate may be a new way to treat diabetes. " Clinical and Translational Science (CTS),5:08 13.%% MNTD - Doctors Not Always Sure When To Treat BP In People With Diabetes 20 May 2008 For people with diabetes, high blood pressure poses a special threat, multiplying their risk of heart attacks, strokes and kidney problems. But a new study finds that even when people with DM show up in their doctor's office with a high BP reading, there's only a 50-50 chance that each of them will get some sort of attention for it. That might mean a change to their medications, or a plan to follow up a few weeks later to see if the reading is still high. What happens the other 50 percent of the time? Something that others have termed " clinical inertia " takes over, say the researchers who conducted the study. The fear is that this lack of response to high BP readings at clinic visits could mean that patients' pressures will keep getting worse. The study finds little evidence supporting the idea that providers are just " ignoring " blood pressure problems. What really seems to have an impact on treatment decisions is plain old uncertainty about whether the BP is really elevated, or providers being occupied with other medical issues. Providers might need to spend the visit addressing more pressing problems, some of which, like pain, may be contributing to elevated blood pressures. Or, they might take another reading and conclude there's no need for action. Or, patients may report that their pressure readings at home have been fine. More systematic guidelines for monitoring BP in people with DM and better guidance for when to change treatment when pressures get too high, are needed, say the researchers. " While there are many guidelines about treating hypertension, there is an amazing lack of clarity and guidance about how many blood pressures should be taken at a clinic visit, whether those BPs should be averaged or whether just the lowest should be used, and how to incorporate home blood pressure readings in decisions to intensify medications. As long as this confusion exists, we may not make progress in treating hypertension. " The national goal for people with DM is less than 130/80 mm Hg. (For people without diabetes or kidney problems, the goal is less than 140/90, which is considered the cutoff for Stage I hypertension.) " Providers clearly 'trust' their own reading more than they do the reading taken at the clinic intake point, " " But there is no evidence that supports that approach. In fact, the literature suggests that provider measurements are less reliable and subject to large biases relative to independent measures by nurses using electronic blood pressure cuffs. " While at-home monitoring can be important, Kerr says, the fact of the matter is that there is no standard for how often to monitor and how to record home pressure readings over time. Further, patients might preferentially report only the " normal " blood pressures and ignore the out-of-range values. Patients should talk to their doctors about how often to monitor and record their BP and look at averages over time. ls of Internal Medicine 2008, Vol. 148, 10. 14.%% Rapid Rise in Type 1 Diabetes Seen in Finnish Children (Reuters Health) May 22 - Finland is known to have the highest incidence of T1DM in the world and now new research indicates that cases among children are increasing faster than ever. Patients with T2 and those with DM from other causes were excluded from the analysis. The average rate of T1 during the 26-year period was 42.9 cases per 100,000 per year. In 2005, the rate per 100,000 per year was 64.2, a marked jump from the 31.4 noted in 1980. The largest increase in cases, 4.7% annually, was noted in children under 5 years. " A changing environment, infant and maternal diets in particular, would seem to be the most likely explanation for this alarming acceleration, " was the comment in an accompanying editorial. They point out, however, that " identification of the probable agents is the ultimate challenge because they might be ubiquitous, and the hardest cause of a disease to identify is that which universally present. " Lancet 2008;371. 15.%% MW -Modestly Elevated Glucose in Pregnancy Raises Future Diabetes Risk (Reuters Health) May 23 - Women without gestational diabetes,[GDM] but who have modestly elevated glucose levels during pregnancy, face an increased risk of subsequently developing diabetes. Gestational diabetes is known to increase the risk of developing T2, the authors explain, but whether less marked elevations of blood glucose during pregnancy increase the risk of future diabetes remains unclear. To investigate, the team investigated whether pregnant women who fell into oral glucose challenge test (OGCT) quartiles [quarters] 2 through 4 have a higher risk of DM compared with women in quartile 1, and whether pregnant women with one abnormal oral glucose tolerance test (OGTT) value have a greater risk compared with women with normal values. Pregnant women with OGCT values in the 2nd to 4th quartile were 68% to 365% more likely to develop diabetes than were pregnant women with OGCT values in the 1st quartile, they report. Similarly, the investigators say, pregnant women with one abnormal OGTT value were just over twice as likely as similar women with normal OGTT values to develop DM. " The risk of diabetes in women with mildly elevated OGCT or OGTT results likely occurs because they have an intermediate form of glucose intolerance, " the authors explain. " Whether women who fall within this intermediate range of glucose tolerance during pregnancy may benefit from increased diabetes surveillance and life-style interventions proven to reduce the risk of developing DM is unknown, " they conclude. Diabetes Care 2008;31 16.%% Guidelines Issued About Lack of Evidence for Screening for Gestational Diabetes May 23, 2008 — The US Preventive Services Task Force (USPSTF) has issued a recommendation statement and systematic review about lack of evidence to recommend screening for gestational diabetes mellitus (GDM) . . " Current evidence is insufficient to assess the balance of benefits and harms of screening for GDM, either before or after 24 weeks' gestation, " the statement concludes. " Until there is better evidence, clinicians should discuss screening for GDM with their patients and make case-by-case decisions. The discussion should include information about the uncertain benefits and harms as well as the frequency and uncertain meaning of a positive screening test result. " Ann Intern Med.2008;148 17.%% Receptor for Advanced Glycation End Products (RAGEs) and Experimental Diabetic Neuropathy Diabetes. 2008;57(4) 5/21/2008 - Several peripheral nervous system (PNS) abnormalities complicate DM.. The most common form of somatic nerve disease in diabetic subjects is a diabetic symmetric sensorimotor polyneuropathy. Chronic hyperglycemia has a robust association with the development of complications in long-term DM, as identified during clinical intervention trials in both T1 & 2 . The increased nonenzymatic glycation of proteins, leading to irreversible formation and deposition of reactive advanced glycation end products (AGEs), may similarly lead to critical abnormalities within the diabetic PNS. .the receptor for AGEs (RAGE) has been demonstrated on hematopoietic cells and endothelial cells, as well as spinal motor neurons and cortical neurons. RAGE has been postulated to contribute to the development of diabetic complications. In conclusion, our data identify an important role for RAGE in a long-term model of experimental DM. Not only is heightened RAGE expression prominent and progressive at multiple levels (and in multiple cells) of the PNS, but its expression strictly parallels structural and electrophysiological alterations. .Whereas overexpression of RAGE, and the consequent aberrant signaling of neurons and glial cells, is not the only mechanism of neurological damage in diabetes, our data suggest that it has an important contribution to neuropathy in this animal model of diabetes. 18.%% MW - Metabolic Consequences of Insulin-Related Weight Gain 5/22/2008 Question- Does the weight gain associated with insulin therapy have metabolic consequences, such as insulin resistance? Response from Y. Chao, MD Most of the pharmacologic interventions, including insulin, that improve glycemic control in patients with T2DM are associated with weight gain. Indeed, more intensive therapies to achieve lower glycated hemoglobin (A1C) levels often lead to more weight gain. Because most patients with T2 are overweight, additional weight gain may not be desirable. For example, it may aggravate pre-existing hypertension, exacerbate sleep apnea, and worsen osteoarthritis. The metabolic consequences include higher low-density lipoprotein (LDL) cholesterol and lower high-density lipoprotein (HDL) cholesterol. Weight gain may also increase insulin resistance, which is present in about 90% of patients with T2. Inflammatory markers, such as C-reactive protein, may also increase. Although large trials have shown that improved A1C -- even in the presence of weight gain -- leads to fewer DM complications, any attempt to minimize weight gain associated with insulin therapy should further extend the benefits of better glycemic control in patients with T2. However, further studies will be needed to test this hypothesis. Medscape Diabetes and Endocrinology 2008 19.%% MW - Optimizing Antidiabetic Treatment Options for Patients with Type 2 Diabetes Mellitus and Cardiovascular Comorbidities Pharmacotherapy. 2008;28(2): 5/20/2008 Conclusion - Patients with T2 have an inherent, elevated risk for cardiovascular disease that likely begins well in advance of a diagnosis of chronic hyperglycemia. As with treatment of dyslipidemia, hypertension, and hypercoagulability, when indicated, glycemic control is a critical element in a multifactorial approach to management of cardiovascular risk in patients with DM. Owing to the varied mechanisms of many commonly prescribed antidiabetic therapies, these agents have the potential either to mitigate or increase the risk for cardiovascular events in patients with DM. In some cases, the risk imposed by the nonglycemic effects of an agent can preclude its use, making selection of an alternative agent more appropriate. This is particularly true for patients with established cardiovascular disease. Insulin is a well-studied therapy that has no apparent potential to increase cardiovascular risk and can be an important component of a safe and effective regimen for glycemic control. Health care providers must carefully consider the potential cardiovascular risks or benefits of the numerous available anti-diabetic agents to determine the most appropriate treatment strategies for their patients. 20.%% Clinical Reviews Diabetes Care -- Insulin Delivery in a Changing World Medscape J Med. 2008;10(5): 5/20/2008 Conclusions - The long-term benefits to patients with T2DM of maintaining optimal glycemic control within recommended limits has now been firmly established in key landmark studies. ..development of the new insulin analogs, combined with innovative insulin devices and SMBG systems, makes this goal more achievable than ever before. The involvement and cooperation of patients is crucial to attaining these goals, and the benefits of patient education, together with the use of chronic disease management tools such as log books, cannot be underestimated. The contribution of insulin analogs to glycemic control is further enhanced by the range of delivery devices in which they are available. The most widely used of these, prefilled pens and cartridge pens, help ensure compliance by allowing patients to administer their insulin discreetly, simply, and accurately. Exciting developments in SMBG technology, including an integrated pump/CBMG system, have also increased the potential for optimal glycemic control. Insulin therapy has evolved, and by informing and reassuring patients about currently available treatment options, healthcare professionals can break down many of the barriers to achieving optimal glycemic control. [AACE 2008] American Association of Clinical Endocrinologists 17th Annual Meeting and Clinical Congress Abbreviations: DM - diabetes Mellitus;T1DM - type 1 diabetes mellitus T2DM - type 2; BP - blood pressure; MI [myocardial infarction or heart attack] ;HTN - hypertension; ADA - Amer Diabetes Asso; AFB - Amer Foundation for the Blind ; FDA Federal Drug Administration; JH - s Hopkins ; MW Medscape Web MD; 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@... __________ NOD32 3134 (20080527) Information __________ This message was checked by NOD32 antivirus system. http://www.eset.com Quote Link to comment Share on other sites More sharing options...
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