Guest guest Posted August 21, 2008 Report Share Posted August 21, 2008 1. MW -Weight Loss May Improve Glycemic Control and Blood Pressure in T2DM Aug 12, 2008 - Patients newly diagnosed with T2DM who lost weight after the initial diagnosis have improved glycemic control and blood pressure despite weight regain, according to the results of a retrospective cohort study. " Weight loss in T2 is very important, " write the researchers. [2574 patients 21-75 years of age newly diagnosed with T2 were grouped into 4 categories. The higher stable weight group, lower stable weight group, and weight gain group were more likely than the weight loss group to have above-goal HbA1c levels, after adjustment for age, sex, baseline control, and related medication use. " A weight-loss pattern after new diagnosis of T2 predicted improved glycemic and BP control despite weight regain, " they write. " The initial period post- diagnosis may be a critical time to apply weight loss treatments to improve risk factor control. " 2.%% MNTD - 80 Million Americans Can Benefit From New Diabetes Resource - Free Educational Website Created By UCSF Diabetes Teaching Center Goes Live 11 Aug 2008 A complete online diabetes self-management education program, has been launched by the University of California, San Francisco Diabetes Teaching Center. This website mirrors the highly successful (ADA) accredited teaching program curriculum created by UCSF clinicians and presented to thousands of patients over the past 30 years. Because the rate of DM is increasing so rapidly, the need for diabetes education and medical care far exceeds the number of dedicated DM care providers. According to the latest statistics in the U.S. there are over 23 million individuals with DM and 57 million with pre-diabetes, yet it has been estimated that only 4,000 trained diabetes physicians provide specialized care. Very few individuals with DM can expect to see a diabetes specialist - but everyone with internet access can now be educated about diabetes. Not only does the website offer a complete, separate curriculum for T1 & T2 patients, it provides a sub- curriculum for T2 patients based on treatment (oral medication management vs. insulin management) and information for health care providers. For the newly diagnosed, this website can help individuals understand diabetes, and facilitate the necessary lifestyle changes to manage their care. For those already living with diabetes, this program provides training in the latest advances in self-care and problem-solving skills. Diabetes Education Online (DEO) is unique from other diabetes education websites in that it focuses on the equation, " understanding = improved management. " Through the years, UCSF clinicians have recognized that it is just as important to explain why to do something, as well as what to do. [lots of info; accessible site; some pdf documents] 3.%% MNTD - Do You Know What You Are Eating? ADA Introduces MyFoodAdvisor 11 Aug 2008 Even when you try to eat healthy there are oftentimes hidden ingredients lurking. Did you know that low-fat often means high in sugar or sodium? Today the (ADA) launched an online nutrition tool --MyFoodAdvisorT -- that unlocks the mystery of what is in many of the foods you eat at .[note I discovered flash player required] MyFoodAdvisor provides food information to people with DM, heart disease, kidney disease and those looking to lose weight. This interactive tool compares foods by 22 different nutrients, suggests healthy alternatives, and analyzes what you currently eat. Portion sizes are standardized, based on the ADA and American Dietetic Association exchange lists so all carbohydrate-containing foods are shown in servings of about 15 grams of carbohydrate. the new MyFoodAdvisor features, include: Explore Foods -- Seek healthier alternatives to foods that are overall lower in sodium or saturated fat, or higher in fiber, ranking options that may provide alternatives for a meal. -- Browse by food category (starches and grains, vegetables) or by a specific foods (pork tenderloin). -- Compare foods by 22 nutrients including potassium, and phosphorus. " Sometimes the low-fat version of our favorite foods contains more sugar or sodium than the regular version or the sugar-free contains more trans and saturated fat, " Recipes -- Save recipes to personal recipe box (with log in). -- Search for recipes by amount of calories, carbohydrate, sodium, and saturated fat. Create a dish -- Tracks all 22 nutrients consumed each day shows contribution of each new food to the overall dish. ADA 1-800-DIABETES ( 1-) 4.%% MNTD -Broccoli Could Reverse Diabetes Heart Damage, Study 6 Aug 2008 UK researchers said that eating broccoli could reverse the damage done to heart blood vessels by DM because the vegetable contains a compound called sulforaphane which was tested and found to increase enzymes that protect heart blood vessels and reduced the molecules that damage them. People with DM have a 5 times greater risk of developing heart disease and stroke, primarily because of damage to heart blood vessels from having about 3 times the normal level of circulating oxidative molecules called Reactive Oxygen Species (ROS) caused by having high blood glucose (hyperglycaemia). [it] is known that eating lots of vegetables, and brassicas like broccoli in particular, is significantly linked to lower risk of heart disease and stroke. The team wondered if this had anything to do with the presence of sulforaphane which is known to activate a protein called nrf2 that switches on genes that increase antioxidants and a number of protective and metabolic enzymes. They cultured human microvascular HMEC-1 endothelial cells in low and high glucose concentrations and assessed the effect of adding sulforaphane on biochemical dysfunction, and other metabolic processes. There was a significant reduction in ROS molecules. Sulforaphane reversed the increase in ROS caused by hyperglycemia by 73%. Sulforaphane doubled the activation of nrf2, leading to increased production of antioxidant and detoxifying enzymes in human microvascular cells. They concluded that: " Activation of nrf2 may prevent biochemical dysfunction and related functional responses of endothelial cells induced by hyperglycemia in which increased expression of transketolase has a pivotal role. " (Transkelotase, is a key enzyme that changes potentially damaging glucose byproducts into harmless compounds for safe elimination.) They added the study " Suggests that compounds such as sulforaphane from broccoli may help counter processes linked to the development of vascular disease in diabetes. " However, the director of research at Diabetes UK, cautioned that findings based on research done on cells in the lab is a long way from trials in real human subjects. But he sain it was good to see that: the team have identified a potentially important substancevthat may protect and repair blood vessels from the damaging effects of diabetes. " Diabetes published online on August 4, 2008, as db06-1003 5.%% MNTD - Eye Abnormality Associated With Increased Heart Disease 12 Aug 2008 Abnormalities of the retina, the light sensitive tissue at the back of the eye, are associated with an increased risk of death from heart disease, [published ahead of print in the Heart.]The researchers assessed the presence and severity of retinal disease (retinopathy) among almost 3000 adults, using retinal photos. 200 of these participants had been diagnosed with DM. 29% of those with DM had retinopathy, One in 10 of those without DM also had it. The researchers then tracked the number of people dying from coronary heart disease over a period of 12 years (353.) People with DM and moderate retinopathy were more than 6 times as likely to die of coronary heart disease as those without retinopathy, after adjusting for other influential factors. And those without DM were 50% more likely to die of coronary heart disease if they had retinopathy, equivalent to the same level of risk conferred by a diagnosis of diabetes alone. This finding is important they say. retinal disease can be detected by proper eye examination. Retinopathy may signal generalized microvascular disease and inflammation, leading to the artery hardening characteristic of ischaemic heart disease, they suggest. 6.%% ADA A1C or Average Glucose: Take your pick The results of the A1C-Derived Average Glucose study (ADAG), published in Diabetes Care this month, have affirmed the existence of a linear relationship between A1C and average blood glucose levels. Prior studies using limited numbers of meter glucose readings primarily in T1DM Caucasian populations had been used in the past to estimate average glucose. The international ADAG study clarified very close linkage using about 2700 glucose readings per subject per A1C measurement, and verified that the relationship holds in people with T1 & T2 of all ages, both genders, and across ethnic/racial groups. The " new numbers " are somewhat different than those in the old tables of A1C vs. average glucose. In light of the study results, health care providers can confidently report A1C results to patients using the same units (mg/dl or mmol/l) that patients see routinely in blood glucose measurements. 7.%% ADA CRLA does not reduce oxidative damage in type 1 diabetes Aug - 14 - 2008 The antioxidant efficacy of an oral controlled-release formulation of alpha-lipoic acid (CRLA) in T1DM was evaluated in a double-blind trial. 40 pubertal and postpubertal adolescents with T1 were randomized to receive CRLA or placebo. After 3 months of treatment, researchers found no significant effects of CRLA on markers of oxidative damage, total antioxidant status, hemoglobin A1C, and microalbuminuria, therefore suggesting that CRLA is not effective for preventing diabetic complications. Nevertheless, the authors recommend additional investigations Pediatric Diabetes, 2008: 9(3): 69). 8.%% ADA Diabetes Mellitus and Birth Defects 8/12/08 Researchers with the National Birth Defects Prevention Study investigated the associations between DM and 39 birth defects. [4,895 control subjects and 13,030 cases. According to the findings, pregestational DM was significantly associated with noncardiac defects and cardiac defects. Meanwhile, gestational diabetes was linked to fewer noncardiac defects and cardiac defects. These associations were weaker than those for pregestational DM and primarily seen in babies born to women with prepregnancy body mass index that was greater than or equal to 25 kg/m2. The researchers note that " the importance of identifying and implementing effective detection, control, and prevention strategies for impaired glucose tolerance among women of childbearing age cannot be overstated. " News summaries C Amer Jour of Obstetrics and Gynecology -- AJOG News (07/01/2008) 9.%% ADA Twenty Disease-Specific Stem Cell Lines Created 8/12/08 Harvard Stem Cell Institute (HSCI) researchers have developed a new collection of 20 disease-specific stem cell lines using a new induced pluripotent stem cell (iPS) technique. The iPS cells were taken from patients ranging in age from one month to 57 years and who were diagnosed with a number of conditions. The cell lines include the genes or genetic information for 10 different conditions, including T1DM, Parkinson's Disease, and Down Syndrome. According to the team, embryonic stem cell lines can only be used to gain generic information, while the iPS lines can be used to examine the root causes of these diseases, outside of a patient. The iPS cells will be kept in a new HSCI " core " facility at Massachusetts General Hospital that will also be used as a technical laboratory. C published online in the journal Cell. Science Daily (08/07/08) 10.%% ADA Common Spices May Help Diabetes 8/12/08 Researchers conducted lab studies which indicate that common herbs and spices could help block the inflammation believed to propel diabetes. The research, published in the Journal of Medicinal Food, involved 24 herbs and spices, many of which contained anti-inflammatory antioxidants called polyphenols. Ground cloves and cinnamon contained the most polyphenols of the spices tested, while oregano, marjoram, and sage had the highest polyphenol levels of the dried herbs. " We showed that herbs and spices are powerful sources of antioxidants and anti-inflammatory agents, " they said. " About a teaspoon of cinnamon, for example, is plenty to get these beneficial effects. " News summaries C CBS News (08/06/08) 11.%% ADA Neuropathy in Diabetes 8/12/08 Up to 10 % of neuropathy cases in people with diabetes are not caused by the DM itself. Using a misdiagnosed case as an example, researchers assert that it is important to consider possible causes of peripheral neuropathy in people with DM. In the case cited, the patient was initially diagnosed with diabetes-related neuropathy and had two toes amputated, but a diagnosis of vasculitic neuropathy was ultimately made. Journal of the American Podiatric Medical Association (08/01/08) Vol. 98, No. 4, 12.%% MW - ACE Inhibition May Prevent Left Ventricular Hypertrophy in Type 2 Diabetes (Reuters Health) Aug 07 - Angiotensin converting- enzyme (ACE) inhibition reduces the occurrence of left ventricular hypertrophy (LVH) in hypertensive patients with T2 " All subjects with T2 and hypertension (virtually all type 2 diabetics, since they almost invariably have systolic/diastolic more than 130/80 mmHg) should be started on ACE inhibitors and treatment should target systolic/ diastolic less than 130/80, " the lead researcher told Reuters Health. The team compared the effect of ACE inhibition versus non-ACE- inhibitor therapy on incident ECG-LVH in 816 hypertensive T2patients. After a median 36 months of follow-up, significantly fewer patients receiving ACE inhibitors (5.5%) developed LVH, compared with patients receiving non-ACE-inhibitor therapy (8.2%), the authors report. Follow-up BP (systolic and diastolic) were significantly lower in the ACE inhibitor group than in the comparison group as were A1C levels. Diabetes Care 2008;31: 13.%% MW - Diabetes Linked to Accelerated Atherosclerotic Plaque Progression Reuters Health Information 2008. C 2008 Reuters Ltd. Aug 08 - Patients with coronary artery disease and DM exhibit more extensive atherosclerosis and inadequate compensatory remodeling of the arterial wall, compared to patients without diabetes. " Patients with DM have a markedly increased incidence of adverse cardiovascular events and less favorable outcomes from myocardial infarction or after coronary interventions, " write researchers [systematic analysis of data on 2237 patients with coronary artery disease who underwent serial evaluation by intravascular ultrasound] Results controlling for differences in risk factors demonstrated that patients with DM had a greater percent atheroma [fatty deposit in artery walls] volume (PAV) and total atheroma volume(TAV) Glycated hemoglobin was more closely related to PAV and TAV than was fasting glucose, Diabetic subjects had smaller lumen [inner open space of vessel] volume than non-diabetic subjects. However, there was no difference between the groups in external elastic membrane volume. Patients with DM had more rapid progression of PAV and TAV. .The findings " support the need to develop new antiatherosclerotic strategies in diabetic patients, " they conclude. J Am Coll Cardiol 2008;52: 14.%% MedWatch - The FDA Safety Information and Adverse Event Reporting Program 8/18/08 FDA MedWatch - Byetta (exenatide) - Since issuing Information for Healthcare Professionals in October 2007, FDA has received reports of 6 cases of hemorrhagic or necrotizing pancreatitis in patients taking Byetta. Byetta [exenatide] is a medicine given by subcutaneous injection to help treat adults with T2DM. Of the 6 cases of hemorrhagic or necrotizing pancreatitis, all patients required hospitalization, 2 patients died and 4 patients were recovering at time of reporting. Byetta was discontinued in all 6 cases. Byetta and other potentially suspect drugs should be promptly discontinued if pancreatitis is suspected. There are no signs or symptoms that distinguish acute hemorrhagic or necrotizing pancreatitis associated with Byetta from the less severe form of pancreatitis. If pancreatitis is confirmed, initiate appropriate treatment and carefully monitor the patient until recovery. Byetta should not be restarted. Consider antidiabetic therapies other than Byetta in patients with a history of pancreatitis. Read the complete MedWatch 2008 Safety Summary, including a link to the ' " Information for Healthcare Professionals " page, at: www.fda.gov/medwatch/safety/2007/safety07.htm#Byetta 15.%% MW - Vitamin K Supplementation May Reduce Progression of Insulin Resistance in Older Men 8/15/08 - Vit K supplementation for 36 months at doses that could be achieved through dietary intake may reduce progression of insulin resistance in older men, according to a new study. " Vitamin K has a potentially beneficial role on insulin resistance, but evidence is limited in humans, " write researchers " We tested the hypothesis that vitamin K sup. for 36 months will improve insulin resistance in older men and women. " [36-month, randomized, double-blind, controlled clinical trial; 355 nondiabetic adults 60 -80 years] Compared with men in the control group, men in the supplement group had statistically significantly lower HOMA-IR [measure of insulin resistance] at 36 months after adjustment for baseline HOMA-IR, (BMI), and body weight change. Women in the 2 intervention groups did not differ significantly in HOMA-IR or in other outcome measures. Diabetes Care. Published online August 12, 2008. 16.%% MW - Adults Born Preterm Have Higher Blood Pressure, Lower Insulin Sensitivity (Reuters Health) Aug 15 - Preterm-born individuals are at increased risk for the development of insulin resistance and increased BP. [29 young adult subjects born preterm appropriate for gestational age, 28 born preterm small for gestational age, and 30 born at term with a normal birth weight (controls).] The authors report that insulin sensitivity was lower in individuals born preterm appropriate for gestational age and those born preterm small for gestational age than in control subjects. Compared to control subjects, those born preterm appropriate for gestational age and those born preterm small for gestational age also had higher systolic blood pressure and diastolic blood pressure. " Growth during the first year of life was not associated with increased risk, " they report " In contrast, increased height gain during 1 and 5 years of age and increased weight gain between 2 and 21 years of age were strongly associated with lower insulin sensitivity, " " Increased height gain between 1 -21 years of age and increased weight gain between 2 -21 years of age were strongly associated with higher BP. " " Preterm born individuals can be considered as a high-risk group for the development of metabolic complications and hypertension, which are both considered as cardiovascular risk factors. " Because the study shows that spontaneous catch-up growth is a risk factor, it implies that " efforts aimed at the optimization of growth during infancy, childhood and adolescence are metabolically disadvantageous, especially when this is done by improving the nutrient intake, because weight gain is associated with decreased insulin sensitivity, " The lead author noted that the cohorts of preterm-born subjects are still relatively young and have not yet developed the metabolic syndrome, but it is important that these individuals be followed as they get older. " For example, we also found differences in postprandial lipid metabolism " It is conceivable that these derangements develop to dyslipidemia when these individuals become older, " Pediatrics 2008;122:. 17.%% MW -Sulfonylureas and Metformin May Increase Risk for Cardiovascular Hospitalization 8/18/08 - The combination of sulfonylureas and metformin significantly increases the relative risk (RR) for cardiovascular hospitalization or mortality but not the risk for cardiovascular death or all-cause mortality alone, according to the results of a meta-analysis " Observational studies assessing the association of [this] combination therapy on all-cause and/or cardiovascular mortality in T2DM have shown conflicting results, " researchers write. " We therefore evaluated the effects of combination therapy of sulfonylureas and metformin on the risk of all-cause mortality and cardiovascular disease (CVD) among people with T2. " [299 identified reports,9 included in the meta-analysis because they met criteria of combination therapy of [these drugs] and report of the risk for cardiovascular disease and/or mortality. " The combination therapy of metformin and sulfonylurea significantly increased the RR of the composite end point of cardiovascular hospitalization or mortality (fatal and nonfatal events) irrespective of the reference group (diet therapy, metformin monotherapy, or sulfonylurea monotherapy); however, there were no significant effects of this combination therapy on either CVD mortality or all-cause mortality alone, " they write. " Overall, our results provide a mix of reassurance and concern to prescribers of DM medications who use combination therapies to achieve good glycemic control, " Diabetes Care. 2008;31: 18.%% MW-Changes in Gut Hormones After Bariatric Surgery Clin Endocrinol. 2008;69(2): 8/14/2008 Conclusion - The ongoing studies based on gut hormone profiles following bariatric surgeries are shedding more light on the complex role of these hormones in eating behaviour and weight loss. Changes in appetite are evident within days following gastric bypass surgery. And a recent study has further demonstrated that postprandial PYY and GLP-1 profiles start rising as early as 2 days following the operation. . in patients with poor weight loss after gastric bypass procedures, the postprandial PYY and GLP-1 responses are attenuated compared to patients with good postoperative weight loss. Future studies are needed to fully understand the complex neuroendocrine regulation of appetite and energy homeostasis. Nevertheless from evidence so far it is likely that gut hormones play a role in the decreased hunger and increased satiety experienced by those who undergo bariatric surgery. This alteration in appetite regulation following bariatric surgery may explain both the significant and sustained weight loss. 19.%% Surgical Management of the Diabetic Foot Wounds. 2008;20(3): 8/14/2008 Wounds of the foot are the most common reason for hospitalization in patients with DM it is estimated that 15- 20% of patients with diabetes will develop an ulcer on their foot at some point.. The foot is highly specialized to cope with a large degree of repetitive stress. Fatty tissue on the plantar surface and a thickened dermis and epidermis cushion and absorb repeated forces of compression, torsion, and shear during locomotion and standing. However, the pathophysiology of DM can significantly alter the wound healing process, leading to an increased risk for foot ulceration. Conclusion - The combination of angiopathy, neuropathy, and immunopathy substantially increase the risk that patients with DM will develop lesions of the foot and that they will be unaware of the problem until it reaches an advanced stage. Many patients with DM avoid seeking treatment and fear surgery, as it is associated with amputation. In reality, preventive surgery carried out at an early stage can be used to reduce focal points of pressure and to correct deformities that may increase the risk for ulceration and the need for more extensive surgery at a later date. A simple surgical procedure may also be the quickest and most effective treatment option if ulceration does occur. However, patients with DM are highly unlikely to request corrective surgery and it is the duty of all clinicians involved in their care to be aware of the possible benefits of early surgical intervention. 20.%% MW - Dietary Behaviors Predict Glycemic Control in Youth With T1DM Diabetes Care. 2008;31(7): 8/12/2008 Objective. To investigate the association between dietary adherence and glycemic control among youth with T1. [119 youth aged 9-14 years] Conclusions. Greater dietary adherence was associated with lower A1C among youth with type 1 diabetes. Introduction Data for youth with T1demonstrate a gap between attained glycemic control and age-specific goals. With intensive insulin therapy, dietary behaviors become central to optimizing glycemic control. Studies have shown that greater dietary adherence improves glycemic control among adults with T1. Conclusions .. In our sample of youth aged 9-14 years, the A1C of youth in the lowest tertile [third]of parent-reported dietary adherence was 0.6-0.9% higher than the A1C of youth in the upper two tertiles. This suggests that lower A1C values may be achieved in youth with type 1 diabetes whose families attain a threshold of dietary adherence. . Alternatively, youth using pumps may be more attentive to dietary and BGM behaviors because they need to administer insulin throughout the day. . 21.%% MW -Human Adenovirus Type 36 Enhances Glucose Uptake in Diabetic and Nondiabetic Human Skeletal Muscle Cells Independent of Insulin Signaling Diabetes. 2008;57(7):8/12/2008 Objective: Human adenovirus type 36 (Ad-36) increases adiposity but improves insulin sensitivity in experimentally infected animals. We determined the ability of Ad-36 to increase glucose uptake by human primary skeletal muscle (HSKM) cells. Conclusions: Ad-36 infection increases glucose uptake in HSKM cells via Ras-activated PI 3-kinase pathway in an insulin-independent manner. These findings may provide impetus to exploit the role of Ad-36 proteins as novel therapeutic targets for improving glucose handling. 22.% MW - Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women Diabetes Care. 2008;31(7): ADA 8/08/2008 purpose of this study was to examine the association between fruit, vegetable, and fruit juice intake and development of T2DM. [ 71,346 female nurses aged 38-63 years who were free of cardiovascular disease, cancer, and DM followed for 18 years] During follow-up, 4,529 cases of diabetes were documented, and the cumulative incidence of diabetes was 7.4%. An increase of three servings/day in total fruit and vegetable consumption was not associated with development of DM hazard ratio 0.99 whereas the same increase in whole fruit consumption was associated with a lower hazard of diabetes (0.82 An increase of 1 serving/day in green leafy vegetable consumption was associated with a modestly lower hazard of diabetes (0.91) , whereas the same change in fruit juice intake was associated with an increased hazard of diabetes (1.18 )Conclusions: Consumption of green leafy vegetables and fruit was associated with a lower hazard of diabetes, whereas consumption of fruit juices may be associated with an increased hazard among women. 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@... Quote Link to comment Share on other sites More sharing options...
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