multiple articles

[Guest guest]

1. Depression Hinders Glucose Control in Type 2 Diabetes 11/13/08

Depression in individuals with T2DM is associated with higher blood glucose

levels

with time, new research suggests. The study of[11,525 veterans with T2 shows

that hemoglobin A 1c (HbA1c) values are, on average, 0.13% higher in those

with depression during a 4-year period. " Our study shows depression is a

major and important comorbidity in people with T2. The team added that this

difference

is " quite significant " and is enough to push individuals with DM over the

optimal threshold for glucose control and increase their risk for poor

outcomes.

Comorbid [a condition in addition to primary diagnosis] depression occurs in

approximately 30% of adults with DM and is associated with poor metabolic

control, higher complication rates, increased healthcare use, poorer

quality of life, and increased disability and mortality rates. . " . this

study found

a significant association between depression and glycemic control over time

even in a sample with relatively well-controlled DM. This suggests that in

populations with higher baseline HbA1c, the magnitude of association may be

much higher. " Gen Hosp Psychiatry. 2008;30:

2.%% AHA 2008: Rosiglitazone [Avandia] Doesn't Affect Atherosclerosis

Progression in Diabetics With CV [cardio-vascular] Disease Heartwire Nov

14, 2008

- Atherosclerosis progression as gauged by intravascular ultrasound (IVUS)

was unaffected by a year and a half of treatment with Avandia, compared with

more conventional treatment with the sulfonylurea (Glucotrol) in [ less than

700] T2 diabetics with CV disease, investigators report. . there were no

suggestions

of any of a host of potential clinical hazards and adverse effects that have

been attributed to rosiglitazone over the past 18 months..[such as] risk of

CV death, new MI, heart failure, peripheral edema, or bone fracture. " I do

think it's reassuring as far as the effect of the drug on the coronary

arteries, "

the principal investigator said.

3.%% MW - Hyperglycemia Offsets Benefits of Ischemic Preconditioning

Reuters Health Information 2008. Nov 13 - Acute hyperglycemia attenuates the

cardioprotective

effects of the ischemic preconditioning seen in patients who experience

angina shortly

before the onset of myocardial infarction (MI), researchers report. [205

patients with a first acute MI; 33% had a blood glucose level of 198 mg/dL

and

were deemed hyperglycemic.] The 55 patients who were not hyperglycemic and

reported experiencing pre-infarction angina (PIA) had a lower incidence of

systolic

flow reversal and a higher coronary flow reserve, than did their

counterparts without PIA. However, among the hyperglycemic patients, there

was no significant

differences in these parameters between patients who did and did not

experience PIA. The team concludes that the " protective effect of PIA on

microvascular

function was reduced in patients with acute hyperglycemia, resulting in

unfavourable functional recovery. " Heart 2008;94:

4.%% MW - Gestational Diabetes (GDM)and Excessive Pregnancy Weight Gain a

Harmful Combination Nov 14, 2008 - Women diagnosed with (GDM) who gain more

than the Institute of Medicine-(IOM) recommended amount of weight during

pregnancy are at increased risk for undesirable perinatal outcomes,

including

macrosomia [overly large baby], preterm delivery and cesarean delivery.

They are also more likely to require medical therapy to control their DM.

[31,074

women with singleton pregnancies and GDM] 31.7% had weight gain above the

IOM guidelines. [these ] women had a higher frequency of primary cesarean

delivery

(25.4%) compared with women who gained within (19.8%) or below (16.6%) the

guidelines. We speculate that women with GDM may not require the same amount

of weight gain as women without GDM, " Obstet Gynecol. 2008;112:.

5.%% Insulin-Treated T2DM Is Associated With a Decreased Survival in Heart

Failure Patients After Cardiac Resynchronization Therapy (CRT) Pacing Clin

Electrophysiol.

2008;31(11): 11/07/2008 Conclusions: Insulin-treated diabetes is associated

with a worse functional recovery and a higher mortality in patients with

advanced

heart failure after CRT. While cardiac death accounts for the majority of

deaths in nondiabetic patients, a relevant proportion of the mortality in DM

patients seem to result from noncardiac causes.

6.%% MNTD Survey Reports Young Adults With Type 1 Diabetes Need More Social

And Psychological Support 15 Nov 2008 Data from a new global survey finds

that many teens and young adults with T1DM are optimistic about their

future, but report a lack of support from school staff. The poll highlights

the importance

of family and peer-to-peer support. " The DAWN Youth WebTalk Survey

demonstrates the serious issues faced by young people living with T1 and

their desire

for peer-to-peer support and improved care and education during the school

day, " said the spokesperson.-61%of young adults with DM said it was

important

to talk with other people their age who had diabetes, and 81% of parents

felt it was important

for their children to do so -- 41% of young adults had not been involved

with any DM-related youth activities-- Most parents and young adults thought

that

schools should have teachers who are better informed about DM, or who know

how to deal with an emergency diabetes situation -- 9 out of 10 young adults

with DM said that when they were in elementary and high school, they could

not rely on a school nurse to assist them with their DM during school hours

The Survey was an internationally coordinated series of online surveys of

the views of young adults with DM [18-to 25 years,] parents/caregivers, and

health

care providers [9,200 respondents]

7.%% MNTD 11/15/08 New Study Finds Changes In Position Of Conventional

Insulin Pumps Can Cause Fluctuations In Insulin Delivery Rates . . Such

changes

may occur during routine daily activities such as getting dressed, sleeping

or showering. This siphon effect has been reported previously in hospital IV

pumps, but this is the first time it has been investigated in continuous

subcutaneous insulin infusion pumps. " Insulin pump therapy allows for

precise

control of insulin delivery for patients with T1DM. However, in this study,

we saw that a conventional pump's insulin delivery rate can fluctuate

significantly

due to changes in the pump's height relative to its infusion set and the end

of the tubing. This can increase blood glucose variability, which is a risk

factor for the progression of complications of DM, " said the lead

investigator. The team tested conventional insulin pumps from Medtronic

Diabetes (MiniMed

512 & 515, which uses 110 cm tubing) and s Medical (Deltec Cozmo 1700,

which uses 80 cm tubing), and also compared them to the tubing-free pump

from

Insulet Corporation (OmniPod). They found that raising or lowering a

conventional insulin pump, to the full extent of its tubing, can

significantly affect

the accuracy of insulin delivery, especially at low basal infusion rates.

" This is particularly important for children, for whom low basal rates are

often

used, " The most pronounced differences were seen during basal delivery in

the Cozmo and MiniMed pumps. For the 1U/hr rate, differences ranged from

74.5%

of the expected delivery when the pumps were below the pipettes and pumping

upward to 123.3% when the pumps were above the pipettes and pumping

downward.

In contrast, the OmniPod, which has no external tubing, was the least

affected by pumping orientation and direction. For the 1U/hr rate, its

differences

only ranged from 98.3% when its delivery cannula was in a level pumping

position to 101.3% when the cannula was in an upward pumping position. The

study

was supported by a grant from Insulet Corporation of Bedford, MA.

8.%% Chronic Sulfonylurea Use Causes Reversible Loss of Insulin Secretory

Capacity (Reuters Health) Nov 10 - In an animal model, beta-cells lose the

capacity

to secrete insulin after prolonged sulfonylurea use, but this failure is

reversed with discontinuation of the drug. " We would like physicians to

recognize

that the responsivity of islets to sulfonylurea drugs may not be static, and

moreover that sulfonylurea failure might not simply reflect beta-cell

death, "

the team says. " Further clinical studies, such as testing sulfonylurea

'holidays' or short-acting sulfonylureas might be warranted. " PLoS Med

2008;5:

9.%% Pregabalin in the Treatment of Neuropathic Pain Associated with

Diabetic Peripheral Neuropathy Future Neurol. 2008;3(6):. 11/11/08

Neuropathic

pain associated with diabetic peripheral neuropathy (DPN) is a common

debilitating complication of DM with unmet therapeutic needs. Pregabalin is

a recently

introduced a 2-d subunit ligand that has shown good efficacy with a

tolerable side- effect profile. 1438 patients have been studied receiving

either placebo

or [the drug]. [it] has achieved analgesia as early as 1 day after

initiating therapy. As its mechanism of action is different from other

anticonvulsants

and antidepressants, interactions with other drugs are unlikely

...Conclusion Pregabalin can be considered effective and safe for the

treatment of PDN.

Gabapentin and antidepressants are similarly effective and safe and should

still be considered first-choice treatments owing to economic advantages.

Future Perspective NMDA-receptor Antagonists.- Memantine...a Phase III

trial in PDN demonstrated a nonsignificant difference to placebo and the

development

for this indication has been stopped. . Neurodex,. underwent a Phase III

trial for PDN and demonstrated significantly better pain relief than placebo

and

an improvement in several secondary outcomes. Another noncompetitive

ion-channel blocker CNS-5161 is currently in early trials for neuropathic

pain with

promising results.

10.%% s Hopkins Health Alerts: Diabetes 9 Steps to Help You Control

Blood Glucose Levels During an Illness - If you have DM you know that

getting

sick (even a cold or flu) can trigger a rise in blood glucose levels..

Illness not only affects your eating, sleeping, and exercise, it may cause

the

liver to make and release glucose into the bloodstream. This increase in

glucose provides extra energy to combat the stress of an illness, but in

people

with DM it can cause blood glucose to rise too high, whether or not you are

eating. At the same time, an illness decreases the sensitivity of cells to

insulin and makes it more difficult for these cells to remove glucose from

the bloodstream. To minimize fluctuations in blood glucose levels, follow

these

sick-day precautions.

1. Inform your health care professional when you become sick. This

precaution is particularly important if you are unable to eat regular foods,

have

diarrhea or vomiting for more than 6 hours, or have had a fever for a

couple of days.

2. Follow the treatment plan for the sickness. For example, take any

necessary medications, such as antibiotics for an infection,

according to schedule.

3. Test blood glucose levels more often than usual. If you have T1 test

blood glucose and urine ketone levels every 4 hours, even during the night.

If

you have T2 testing blood glucose levels 4 times during the day is

probably enough; if blood glucose levels exceed 250 mg/dL test urine for

ketones.

Call your health care professional if blood glucose levels are consistently

above 250 mg/dL and are accompanied by ketones in the urine.

4. Take your diabetes medication as usual, unless, of course, your health

professional advises otherwise. Being sick causes blood glucose levels to

rise,

even if you are not eating.

5. If you use insulin, keep a bottle of rapid- or very rapid-acting insulin

handy. You should take this precaution even if you do not take these types

of insulin regularly.

6. Watch for any symptoms of dehydration, ketoacidosis, or hyperosmolar

nonketotic state (extremely high blood glucose levels in people with T2).

The

symptoms of dehydration include dry mouth, cracked lips, and dry or flushed

skin. Ketoacidosis symptoms include nausea, vomiting, and lack of appetite,

while hyperosmolar nonketotic state is characterized by increased hunger,

nausea, or stomach pain.

7. Prevent dehydration by drinking plenty of liquids. You should consume

at least one large (8 oz.) glass of clear fluid each hour while awake.

8. Try to consume a normal amount of carbohydrates. Eating many small

portions throughout the day may help. Eat easy-to-digest foods

such as gelatin, crackers, soup, and applesauce.

9. Rest as much as possible. If necessary, get someone -- such as a

family member or friend -- to help care for you.

11.%% MW- Genetic Screening May Only Modestly Improve Detection of Type 2

Diabetes Nov 19, 2008 -Genetic screening based on 18 risk alleles only

modestly

improves detection of T2DM, but traditional risk factors are as effective to

identify the disease. " Multiple genetic loci have been convincingly

associated

with the risk of T2, " write researchers " In clinical practice, a few common

risk factors that can be easily measured are powerful harbingers of T2.

[2377

participants underwent genotyping of single-nucleotide polymorphisms (SNPs)

at 18 loci associated with DM]. The team created a genotype score from the

number of risk alleles. Analysis indicated the extent to which the genotype

score could predict the risk for DM - when used alone and in combination

with

clinical risk factors. [28 years follow-up] ... the genotype score yielded

appropriate risk reclassification of 4% of the participants. " [this]

genotype

score predicted new cases of diabetes in the community but provided only a

slightly better prediction of risk than knowledge of common risk factors

alone, "

the authors write. " A possible explanation for this finding is that some

alleles might increase the risk through these intermediate traits or that

phenotypic

risk factors are overwhelmingly stronger determinants of the near-term risk

of DM than are known genetic influences. "

12.%% Nature Clinical Practice Endocrinology & Metabolism (2008) 4, Type 1

diabetes: TNF agonists selectively kill autoreactive T cells

in vitro .. [first paragraph] Targeted destruction of autoreactive T cells

is an optimum treatment goal for T1DM.. In animal models of T1,

administration

of tumor necrosis factor (TNF)selectively kills autoreactive T cells and

prevents or suppresses the disease. To assess the human therapeutic

potential

of this approach in vitro, Ban et a tested whether TNForTNF agonists

selectively killed autoreactive T cells isolated from blood samples of

patients with

T1. Full text available with 1. Personal subscription 2. Single article

pass US$18

13.%% Nature Clinical Practice Endocrinology & Metabolism (2008) 4,

Metformin therapy for gestational diabetes mellitus (GDM): are we there yet?

Metformin

is an effective alternative to insulin for nonpregnant women with T2;

however, it has not yet been studied in the setting of GDM. Concerns have

been raised

about the effect of metformin on fetal development, particularly because it

crosses the placenta. In this commentary, I discuss the findings of a trial

by Rowan et al ., in which women with GDM were randomly allocated to receive

metformin (plus insulin when necessary) or insulin alone. .Although the

results

of this study are encouraging, further data are needed on the long-term

safety of metformin before it can be considered as first-line therapy for

women

with GDM. [Full text # 12]

14.%% Nature Clinical Practice Endocrinology & Metabolism (2008) 4, Insulin

therapy versus cell-based therapy for T1DM: what lies ahead? Current

approaches

to treat T1 can be divided into 3 categories: insulin therapy, cell-based

therapy or modification of the autoimmune process associated with T1.

Comparing

the benefits, risk and challenges of insulin therapy and cell-based

therapy,this Viewpoint discusses the prospects for these two therapeutic

approaches.

[full text see #12]

15.%%MedWatch - Animas Corporation and FDA informed consumers and healthcare

professionals of a nationwide recall of battery caps used with the OneTouch

Ping System, Animas 2020 Insulin Pump, Animas IR1200 Insulin Pump, and

Animas IR1250 Insulin Pump. The battery caps used with the above infusion

pumps

were manufactured from June 1, 2008 through July 31, 2008, and were

distributed from June 16, 2008 through August 1, 2008. There may be an

intermittent

loss of contact between the battery cap and the battery compartment in the

pump which may result in the device resetting. This can cause the device to

stop administering insulin, which could result in an excess level of glucose

in the blood (hyperglycemia). Additionally, this failure may lead to user

confusion in the amount of insulin administered, contributing to errors in

future doses, which may result in lower than normal level of glucose in the

blood (hypoglycemia). Healthcare professionals are advised to ensure that

their patients replace the battery cap on their insulin pump.

16.%% MW -Parathyroid Hormone Linked to Falls in Diabetic Adults Nov 21,

2008 - As levels of parathyroid hormone rise, so does the risk of falls in

older,

well-functioning women and men with DM. Some studies have suggested that

high levels of parathyroid promote protein catabolism and muscle weakness.

In

terms of falls, some reports have indicated that high levels of the hormone

increase the risk, while others have not found this. Using data from 472

adults

age 70-79 with DM, this team examined the impact of parathyroid hormone

levels on the risk of falls. Roughly 30% of the subjects reported a fall,

and the

average level of parathyroid hormone was significantly higher in those who

fell than in those who did not. . On final analysis, accounting for physical

performance, kidney function, medication and supplement use, and chronic

conditions, the odds ratio was 1.26. This suggests that " physical

performance

did not mediate the association between parathyroid hormone and falls.

Further investigation,aimed at understanding the underlying mechanism for

the association

between serum parathyroid hormone on muscle strength, physical performance,

and falls is needed. " J Am Geriatr Soc. 2008;56: Reuters Health Information

2008. .

17.%% MW - Long-Term A1c Stability Reduces Risk of Diabetic Retinopathy,

Nephropathy (Reuters Health) Nov 21 - Results from the long-term Diabetes

Control

and Complications Trial (DCCT) " suggest that long term stability of glucose

control is a factor in reducing the risk of the small vessel complications

of T1DM, " one of the principal investigators tells Reuters Health. [1,441 T1

diabetics;9 years follow -up] They found that increasing variability in

A1c adds to the mean value in predicting patients' risk for new or worsening

ocular and renal complications. For retinopathy, the hazard ratio was 2.26

for every 1% increase in A1c standard deviation. For nephropathy,

the hazard ratio was 1.80 for every 1% increase in A1c standard deviation.

He notes that the long-term stability and not just the average glucose

control

is predictive of risk of complications, and that " the relationship (is) a

feature in conventionally treated patients in particular. " [compared to]

intensively

treated diabetics. " [this] is probably another reason to aim for stable good

glycemic control rather than only good glycemic control. Glucose management

is only part of the story; It is as important to ensure that BP and lipids

are tightly controlled in order to reduce the micro- and macrovascular

complications

... " Diabetes Care 2008;31:

18.%% Cognitive Processing Speed Impaired in Diabetics (Reuters Health) Nov

20 - New research shows that among the cognitive abilities that are affected

by T2DM, processing speed appears to be the most severely impaired,

particularly in patients with undiagnosed disease. Findings from several

studies have

linked T2 with cognitive dysfunction, however, it was unclear which

cognitive domains were most affected and how undiagnosed DM and abnormal

fasting glucose

levels influenced cognitive performance. [1917 nondemented men and women; av

age 76; 955 were normoglycemic 744 had impaired fasting glucose, 163 were

diagnosed diabetes, and 55 had undiagnosed DM. Compared with normoglycemic

subjects, patients with diagnosed DM had significantly slower processing

speed.

Memory performance and executive function were comparable in the two groups,

except for those who had DM for 15 years or longer, for whom significantly

poorer executive function was also observed. For those with undiagnosed DM,

both processing speed and memory performance were significantly worse

relative

to their normoglycemic peers. For those with impaired fasting glucose,

cognitiveperformance in all 3 areas was on par with that seen in

normoglycemic subjects.

" Given the increasing prevalence of T2 in older adults and the complexity of

disease management in these high-risk individuals, future treatment

protocols

should be developed with the cognitive status of patients with T2 in mind, "

the team concludes.

Am J Epidemiol 2008;168:

19.%% MNTD -Mouse Model Produces Pure Insulin-Producing Cells

23 Nov 2008 Singapore researchers have developed an unlimited number of pure

insulin-producing cells from mouse embryonic stem cells (ESCs). These pure

insulin-producing cells, which according to electron microscopy studies,

have the same sub-cellular structures as the insulin-producing cells

naturally

found in the pancreas, were highly effective in treating DM in the mouse

model. The transplants of pure insulin-producing cells reduced the blood

glucose

levels

of diabetic mice with high blood glucose levels. None of the diabetic mice

involved in the transplant experiments developed teratoma,

which are a type of tumour often associated with ESCs and which could

complicate their use in human therapeutic treatment. . the pure

insulin-producing

cells managed to retain their insulin-production and glucose-sensing

capacity over time. [this] achievement provides proof of principle that

this strategy

could be applied to human ESCs to obtain similar pure insulin-producing

cells. These research findings were published in the July and August 2008

online

versions of the journal Stem Cell Research. .

20.%% MNTD - Immune System Tricked In Diabetic Mice 21 Nov 2008

The body's immune system hates strangers. When its security patrol spots a

foreign cell, it annihilates it. This is the problem when people with T1DM

undergo human islet cell transplantation. The islet cells from a donor

pancreas produce robust amounts of insulin for the recipient -- often

permitting

independence from insulin therapy. But, the immune system tries to kill the

new hard-working islets. A person who has the transplant procedure must take

powerful immunosuppressive drugs to prevent their bodies from rejecting the

cells. The drugs, however, are toxic to the new islet cells and put patients

at risk for infections and cancer. Now researchers have found a way to

trick the immune system of mice into believing those transplanted islets are

its

own cells. This new technique eliminated the need for the immunosuppressive

drugs in mice with chemically -induced DM after they had islet

transplantation.

As many as 3 million people in the U.S. may have T1. There are about 50 to

70 islet transplants annually in North America .. and greater than 70 %

maintained

transplants long-term. In the [mouse] study, researchers took a type of

white blood cell from the islet donor's spleen and treated them with a

chemical

that masked the cells' identity. They then injected these chemically treated

cells into DM mice before and after they underwent islet cell

transplantation.

As a result, the immune system of the mice didn't try to reject the cells,

because it didn't perceive them as foreign and dangerous. When the same test

was done without pre-treated cells, the immune system rejected the

transplanted islets within 15 days. In an upcoming study, the team will work

with mice

that have autoimmune disease that destroys their islet cells, as occurs in

T1. " Hopefully this next study will show we can take combined therapies for

underlying autoimmune disease and transplanted islets. If successful, the

next step would be testing the technique on human subjects.

21.%% MNTD-Type 1 Diabetes Prevented, Reversed By Two Cancer Drugs, 18 Nov

2008 Two common cancer drugs have been shown to both prevent and reverse

T1DM

in a mouse model. The drugs - imatinib (Gleevec) and sunitinib (Sutent) -

were found to put T1 into remission in 80% of the test mice and work

permanently

in 80 % of those that go into remission. The findings may offer a new weapon

against this autoimmune disease, formerly called juvenile-onset diabetes,

for which few drugs have been developed to address the underlying causes.. "

this benefit, with a drug already proven to be safe and effective in cancer

patients, is very promising, " said the director of the Diabetes Center at

UCSF " The fact that the treated mice maintained normal blood glucose levels

for

some time after the drug treatment was stopped suggests that imatinib and

sunitinib may be 'reprogramming' their immune systems in a permanent way. "

Both

drugs treat cancer by inhibiting a small subset of the more than 500

tyrosine kinases, which are enzymes that modify cells' signaling proteins

through

a simple biochemical change. Kinases are agents of cell growth and

proliferation, and are also involved in many diseases such as inflammation

and cancer.

In the immune system, tyrosine kinases are thought to be key to nearly every

aspect of immunity. " This study opens up a new area of research in the field

of T1, and importantly, opens up exciting opportunities for developing new

therapies to treat this disease and other autoimmune diseases. "

22.%% MW -Continuous Glucose Monitors Detect Nocturnal Hypoglycemia Before

Seizures (Reuters Health) Nov 24 - When used as sensors for nocturnal

hypoglycemia

alarms, continuous glucose monitors have sufficient time to awaken a patient

to prevent a seizure. " Concerns over nocturnal hypoglycemia are a major

reason

for people with T1DM welcoming the possibility of using real-time

continuous glucose monitoring (CGM) with real-time hypoglycemic alarms, " Dr.

B Buckingham

of Stanford and team write. However, subcutaneous CGM has a 5-18minute

delay when compared with glucose levels measured directly from the blood.

Greater

delays occur when blood glucose levels are rapidly changing. This might mean

that a seizure could occur before an alarm sounds, In the current study, the

team examined the duration of sensor- detected nocturnal hypoglycemia

preceding a hypoglycemic seizure by asking investigators from around the

world to

submit cases. Four were included who had sensor hypoglycemia levels less

than 60 mg/dL. Nocturnal hypoglycemia was documented on the CGM record for

2.25

to 4 hours before the seizure occurred. . in one instance the alarm was

inaudible under the subject's bedding. " Glucose sensors should have

sufficiently

robust alarm systems, particularly at night, to insure either the patient or

a surrogate is awoken to intervene ..we suggest augmenting the alarm with

a bedside device that would turn on a light and transmit the alarm to

another location in the house, such as a parent's bedroom. " Diabetes Care

2008; 31:

23.%% MW -Blood Viscosity, Hematocrit Linked to Diabetes Risk

Nov 24 - Elevated blood viscosity and hematocrit are associated

with an increased risk of insulin resistance and T2DM. Blood viscosity is

inversely related to flow, the authors explain, and might thereby contribute

to flow-related insulin resistance. The team analyzed data from the

Atherosclerosis Risk in Communities (ARIC)

Study. Elevated whole blood viscosity was associated with [includes] waist

circumference, systolic BP, fasting glucose, insulin, white blood cells, and

triglyceride levels and with lower high density lipoprotein cholesterol

levels. During 9 years of follow-up, whole blood viscosity was positively

associated

with diabetes, with a nearly 2-fold gradient in DM risk between the lowest

and highest

quartile of estimated whole blood viscosity. . the highest quartile [quarter

of the group] of whole blood viscosity was associated with a 68% increased

incidence of T2. Blood viscosity predicted the development of DM in both men

and women, in whites and African Americans, and in smokers and

nonsmokers. " The

main implication of our study is that elevated blood viscosity might be an

independent risk factor for T2, " Am J Epidemiol 2008;168:

24.%% Middle-Aged Diabetic Women More Likely to Die After MI Than Diabetic

Men (Reuters Health) Nov 25 - Women younger than 65 with diabetes tend to

have

worse cardiovascular risk profiles than diabetic men of the same age,

leading to higher mortality rates following an MI, analysis of data

indicate. " The

female advantage with fewer cardiovascular events than in men at younger

ages is attenuated once a woman has the diagnosis of DM .the risk is

increased

about twofold in men and up to four times in women. " [25,555 patients;21% of

women and 16% of men had diabetes.] Compared with the male patients, female

patients had higher rates of hypertension and heart failure and were more

likely to smoke. Fewer women than men had undergone revascularization prior

to

their first MI, and women were less likely to be treated with intravenous

beta-blockers and to be prescribed ACE inhibitors at discharge. By contrast,

there were no significant gender-related differences in mortality in older

people, or among subjects without DM. " The present observation makes further

study of the impact of improved risk factor management in this particular

group of relatively young, easily identifiable, high-risk

patients important, " the authors conclude, " together with attempts to

initiate treatment and cardiac investigations before their first myocardial

infarction

or the onset of heart failure. " Heart 2008;94:

25.%% Diabetes Care 31:, 2008 ADA Inflammation and Progressive Nephropathy

in Type 1 Diabetes in the Diabetes Control and Complications Trial

Objective-Progressive

nephropathy represents a substantial source of morbidity and mortality in

T1DM. Increasing albuminuria is a strong predictor of progressive renal

dysfunction

and heightened cardiovascular risk. Early albuminuria probably reflects

vascular endothelial dysfunction, which may be mediated in part by chronic

inflammation.

We measured baseline levels of 4 inflammatory biomarkers (high-sensitivity

C-reactive protein, soluble intercellular adhesion molecule-1 [sICAM-1],

soluble

vascular cell adhesion molecule-1, and soluble tumor necrosis

factor-{alpha} receptor-1) in stored blood samples from the 1,441

participants of the (DCCT).

Higher baseline sICAM-1 levels predicted an increased risk of progressive

nephropathy in T1 and may represent an early risk marker that reflects the

important

role of vascular endothelial dysfunction in this long-term complication.

26.%% Possible Link Between Diabetes and Pelvic Girdle Syndrome

Nov- 25 - 2008 Diabetes may be linked to an increased risk of pelvic girdle

syndrome.[1,816 women ages 18- 40 who had given birth] 5% of the women had

serious pelvic girdle syndrome--pain in both iliosacral ligaments and

symphysis pubis during their last pregnancy. Of these women, 3% reported

having

DM, compared to0.5 % of the women who did not have [this] syndrome. Women

with DM had a 7-fold higher risk of severe pelvic girdle syndrome. The

causes

of this syndrome are largely unknown, but mechanical, traumatic, or hormonal

factors may play a role. The hormone relaxin softens the pelvic joint.

Relaxin

belongs to the family of insulin-like growth factors and is often present in

high levels among pregnant women with T1. Science Daily (11/14/08)

AAO/SOE 2008 - 2008 Joint Meeting of the American Academy of Ophthalmology

and the European Society of Ophthalmology.

AHA 2008 - American Heart Association 2008 Scientific Sessions

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@...