MANY ARTICLES

December 7, 2010

1. %% M Serum Potassium [K] May Independently Predict Incident T2DM 10/29/10

Serum [K]level is an independent predictor of incident T2. " Serum [K] levels

affect insulin secretion by pancreatic ß-cells, & hypokalemia [low K] assoc

with diuretic use has been associated with [abnormal sugar level] writes

the team. [12,209 pts] Serum K level was inversely associated with the risk

for incident DM, based on multivariate analyses. " Further study is needed to

determine if modification of serum K could reduce the subsequent risk of

DM. "

2.%%Heartwire Sugary Drinks and Sodas Linked to Increased DM, Metabolic

Syndrome 10/29/10 A Harvard team reports that drinking just 1 or 2

sugar-sweetened beverages per day is associated with a 26% greater risk of

developing T2 & a 20% increased risk of developing metabolic syndrome. " The

team combined data from 11 studies then analyzed the results based on

whether pts reported drinking no sugar-sweetened drinks or more than 1or 2

per day;12oz serving. . " for those who drink 2-3 sodas per day, their risk

of developing T2 would be increased by 30 to 40%, which is not very

different from the increased risk associated with cigarette smoking. " He

also emphasized that some but not all of the effects of sugary- drink

consumption on DM or metabolic syndrome seem to be mediated through the

increased calories and excess pounds.

3.%% FDA Requests More Data for Once-Weekly Exenatide 10/29/10 FDA has

issued a complete response letter regarding a once-weekly extended- release

formulation of exenatide injection (Bydureon) a GLP-1 receptor agonist used

to improve glycemic control in pts with T2. FDA requested a thorough QT

study to evaluate the effects of elevated exenatide plasma levels, such as

those caused by renal impairment, on heart rate. They also asked for safety

and efficacy data from a head-to-head study comparing once-weekly exenatide

with the currently approved twice-daily product (Byetta)

4.%%M 10/22/10 Pts with DM are 3 times more likely to have bacteria in their

urine than nondiabetics, But there are no recommendations to screen or treat

them unless symptoms develop. The only exception, the team notes, is during

pregnancy, when treatment of asymptomatic bacteriuria lowers the risk of

pyelonephritis and preterm delivery.

5.%% M 10/20/10 Insulin Resistance [iR] Increases Stroke Risk in Nondiabetic

Adults[1509;mean age 68] pts free of stroke & DM, those in the top [fourth]

of IR, had a nearly 3-fold greater risk for ischemic stroke during follow-up

than adults without IR. " These findings, if confirmed, may open new

treatment opportunities with direct effect on reducing the atherosclerotic

process, " the team said. IR is a key pathophysiologic contributor to the

increased risk for CVD.

6.%% M Multivitamin Use Not Linked to DM Risk in Older Adults 11/2/10

[14,130 DM pts] However, the use of vit C or calcium supplements was

associated with a significantly lower risk for DM. Diabetes risk was not

linked to use of vit E or other individual vitamin and mineral supplements.

NIH study

7.%% New Treatments for Diabetic Retinopathy: AAO 2010

Brown.(Methodist Hospital Houston.) We are going to discuss some of the

developments in DM retinopathy [DR]. In the 1990s, both AMD and DR were

treated with ablative therapy [distruction by laser ]. In 2005, we had a

major paradigm shift in AMD & converted to pharmaco therapy [drugs] we

realized that anti-VEGF [vascular endothelial growth factor] injections

given continuously improve visual acuity rapidly & sustain visual acuity

gains in AMD. This same shift is happening in DR, but at a much slower pace.

In 2007, [a research group] showed that [avastin] injections into the eye

improved the anatomy for about 3 weeks.. those injections given every 6 wks

seemed to improve visual acuity at 12 wks.. where are we today? RISE & RIDE

studies, are testing head-to-head intravitreal injections of [lucentis]

monthly vs our previous ablative laser therapy. These data will be out in

2011. ..Will there still be a role for laser? Probably. VEGF production is

continuous in DM and if pharmacotherapy is the only thing we have, this

means sustained injections for the rest of the pt’s life. So, I think there

is going to be a role for combination therapy, [above study] is going to

look at some of these.. implants of a steroid derivative are injected every

18-24 months.. may compete with nti-VEGF monthly therapy. Stay tuned. It's

going to be exciting.

8. %% ADA Stress Raises Risk of Diabetes 1/11/10 Middle-aged men who are

under extreme stress have higher prevalence of DM than women [south Korea]

diabetes was twice as prevalent in males in their 30s- 50s than female

peers. Some experts suggest that middle- aged men experience stress at work

or the pressure of responsibility to care for their family, with few

opportunities to relax. " Stress may not be the direct cause of DM. But

psychological symptoms affect the brain function controlling hormone

production, leading to bad eating habits, " said the spokesman .

9.%%M From Pre-diabetes to T2DM in Obese Youth: 10/22/10; [ 24pts] Concl -

Obese adolescents who show signs of glucose dysregulation, including

abnormal fasting glucose, glucose intolerance or both, are more likely to

have impaired insulin secretion rather than reduced insulin

sensitivity..they are at high risk for progression to T2.

10.%% M Fetal Exposure to Maternal T1 Associated with Renal Dysfunction as

Adults 10/28/10 In animal studies, hyperglycemia during fetal development

reduces nephron [main kidney cell] numbers. We tested whether this

observation translates into renal dysfunction in humans by studying renal

functional reserve in adult offspring exposed in utero to maternal T1 [19 pt

T1 mothers vs 18 pt T1 fathers] Reduced functional reserve may reflect a

reduced number of nephrons undergoing hyperfiltration. If so, offspring of

T1 mothers may be predisposed to glomerular and vascular diseases.

11.%% NIH Researchers Identify Genetic Elements Influencing the Risk of T2.

11/2/10 A team at the Nat Human Genome Research Instit. has captured the

most comprehensive snapshot to date of DNA regions that regulate genes in

human pancreatic islet cells, a subset of which produces insulin. Genetic

information is written in the chemical language of DNA, a long molecule of

nucleic acid wound around specialized proteins called histones. Together,

they constitute chromatin, the DNA-protein complex that forms chromosomes

during cell division. The team detected about 18,000 promoters, which are

like molecular on-off switches and more than one switch can control a gene.

Several hundred of these were previously unknown and found to be highly

active in the islet cells.

12.%% JH Walking for Tighter Glucose Control Research shows that starting

a walking program can help people with T2 achieve tighter glucose control.

... sedentary DM participants who began walking 30 min a day lowered their

hemoglobin A1c levels by 0.4% after 2 yrs. They also had major improvements

in cholesterol, triglycerides (a type of fat in the blood), protective

high-density lipoprotein (HDL) cholesterol, & BP. Most people with DM can

follow the Am. Heart Assoc recommendation to get at least 30 min of moderate

physical activity on most, days of the week or at least 20 min of vigorous

aerobic activity 3 days a week. " Moderate " activity is defined as equivalent

to walking at a pace of 3- 4 miles per hour... simple rules of thumb ..:

Walk as though you're running late to catch a bus or plane, but not so fast

that you can't talk and keep up a conversation. If you don't break a sweat

during a workout, chances are you aren't walking fast enough. Start

counting.. walking at a pace equal to roughly 100 steps per min produces a

moderate degree of physical exertion. (Or use a pedometer.)

13.%% MTD Glucosamine Causes The Death Of Pancreatic Cells 10/29/10 High

doses or prolonged use of glucosamine causes the death of pancreatic cells

and could increase the risk of developing DM. " In our experiments, we used

doses 5-10 times higher than the recommended 1,500 mg/day, " said the team

leader. They showed that glucosamine triggers a mechanism intended to lower

very high blood sugar levels. However, this reaction negatively affects

SIRT1, a protein critical to cell survival...

14.%% MTD Haptoglobin [Hpg]As An Early Serum Biomarker Of Virus- Induced

T1DM In Rats 10/28/10 T1, is a disease of complex etiology characterized by

the autoimmune destruction of pancreatic beta cells. In addition to genetic

susceptibility, environmental factors play important roles in triggering

[it]. viral infections [includes] mumps, rubella, & enteroviruses have been

associated with human T1. In rats treated with [virus that cause DM] the

team found increased levels of serum Hpg very early in the course of DM

induction. " mutations in human Hpg gene are associated with increased risk

of DM complications such as retinopathy & CVD. However,In our rat studies,

Hpg was identified very early following virus infection, well prior to the

development of DM or its complications..this may represent a biomarker for

the pathogenesis of autoimmune DM . " Reliably identifying children in the

earliest phases of (pre-diabetes) would provide clinicians with a window of

opportunity when [drug] therapy could be most effective in slowing or

halting the disease. "

15.%% M Vitamin-D Analog - Paricalcitol Could Lower Renal Risk in Diabetic

Nephropathy 11/5/10 The addition of paricalcitol to therapy in pts with DM

nephropathy reduces albuminuria.. results suggest that paricalcitol could be

an important adjunctive treatment and a novel way to lower residual renal

risk in DM, lead author says. [281 pts] already receiving conventional

renin- angiotensin-system blockade with either an ACE inhibitor or an

angiotensin-receptor blocker. study funded by Abbott.

16.%% M Postprandial Glucose as a Key for Better Glycemic Control 10/27/10

I'm Dr. Julio Rosenstock. Dallas DM and Endocrine Center, The goal of

today's activity is to discuss the evidence linking postprandial glucose

(PPG) to A1c [glycated hemoglobin] & diabetes- related complications, and

the role of current and future glucagon -like peptide (GLP)-1 agonists in

managing PPG. I'm pleased to be joined by 2 international DM experts. Dr. S.

Del Prato, Pisa Italy, and Dr. V. Fonseca, Tulane there is no consensus on

how to define PPG. Internat DM Fed (IDF) & Amer Asso of Clinical

Endocrinologists (AACE), say 2-hour PPG concentration should be < 7.8

mmol/L. .ADA suggestion says PPG should be lower than 10 mmol/L..With a

normal individual, there is very little fluctuation of glucose even after

eating a large meal, so to suggest that there is very tight control in PPG -

that a treatment is effective, [it] should reduce, as closely as possible,

the PPG concentration.. what kind of tools do we have? . whenever we start

treating an individual with DM we have to pay as much attention to control

fasting glucose as well as the PPG. The sum of the two most likely will

result in a better A1c level. Dr. R:. many variables play a role in

regulating the level of glucose after ingestion of a meal, such as the size

and composition of the meal. In T2 the interplay between the 2 main hormones

regulating glucose homeostasis is completely disrupted..However.. if you

push too much on the insulin secretion, you may be able to reduce the PPG,

but you may be ending up with hypoglycemia.. the gut hormones secreted by

the endocrine cells play a key role in regulating many of these things. Not

only do they stimulate insulin secretion but they also suppress glucagon

and may control gastric emptying. Thus, GLP-1 may play a very important role

... instead of just giving insulin, we should try to match the insulin

secretion physiologically with the meal and the rise in glucose...

Dr. F - The first of the agonists of GLP-1 receptors was exenatide, given

twice daily. we also have liraglutide-once daily. .exenatide once weekly has

an effect on the A1c level because they lower fasting glucose and, to some

extent, PPG, whereas exenatide twice daily works mainly on the PPG and not

so much on the fasting glucose. Several GLP-1 agonists are in development..

Metformin has been proven to be very effective...if somebody wants to use

only oral agents, they can take metformn plus a DPP-4 [dipeptidyl

peptidase-4] inhibitor. If somebody wants to take metformin and wants to see

more weight loss, then combining it plus a GLP-1 receptor agonist would make

sense. Dr. F. That's very good in the early stages, but at later stages, you

may have to use insulin as well, in combination with other agents. We use it

a lot with metformin, [or]with thiazolidinediones, and in some cases we use

it in combination with the incretin-based therapies. . we are facing a very

interesting time for new opportunities for treating T2-we have new tools,

but we have to learn how to make the best out of those tools, and I think

that PPG, which has been an unmet need for so long, is now demonstrating

better results if it is controlled. independent educational grant from

sanofi-aventis.

17.%% M FDA Approves Saxagliptin/Metformin Combo Pill for T2DM 10/8/10 (FDA)

has approved the first and only once-daily combination tablet featuring

saxagliptin and extended-release metformin HCl (Kombiglyze XR) for T2.

" Kombiglyze XR combines two effective DM medications in a simple once-a-day

dose for adults who need A1c reductions. " said spokesman. By incorporating

the complimentary mechanisms of a dipeptidyl peptidase 4 inhibitor

(saxagliptin) and a biguanide (metformin), the combo. therapy addresses all

3 key defects in T2 It increases insulin secretion in a glucose- dependent

manner, suppresses hepatic gluconeogenesis, and improves insulin

sensitivity. Because of the metformin-related risk for lactic acidosis,

patients should be warned against excessive alcohol intake. Rx with

saxagliptin/metformin is not recommended in hepatic [liver] impairment &

contraindicated in renal impairment.

18.%% M Drugs for Diabetes: Part 1 Metformin Br J Cardiol. Nov. 2010;17(5):

Metformin is one of the oldest oral treatments to reduce hyperglycaemia in

people with DM. Gastrointestinal side effects are common & metformin should

be used with caution in pts with renal impairment because of the slight risk

of lactic acidosis. The fact that metformin significantly reduces CV events

plus reduces weight has meant that metformin is the drug of first choice in

guidelines for the treatment of T2. There are no longer concerns about using

metformin in patients with chronic heart failure, other than in patients

with associated renal failure, or during episodes of acute left ventricular

failure..

19.%% M Vitamin B6, B9 and B12 in Diabetic Nephropathy—Beware 11/1/10; Nat

Rev Endocrinol. 2010;6(9): a recent study provided evidence of adverse

effects of high-dose vit B6, B9 & B12 supplementation in advanced stage DM

nephropathy.[kidney disease] . high doses with this particular vitamin

combination should be avoided in advanced stage DM nephropathy, ..research

on the biochemical basis for the adverse effects needs to be initiated..

20.%% M Retinal, Gingival Bleeding Linked by Abnormal Glucose Metabolism

(Reuters Health) Oct 28 - Gingival [gums] and retinal hemorrhaging are

predictive of each other and most often reflect an underlying disorder in

glucose metabolism, [pts over 40 who bled in both the gums and the inner

lining of the eye] this it was most commonly associated with chronically

elevated blood sugar levels, " lead author said. The team examined data on

hemorrhaging at the retina & the dental gingiva and related these findings

to changes in glycosylated hemoglobin [HbA1C]. People with bleeding at 1 in

5 gingival sites had a 57% higher likelihood of retinal hemorrhaging.

Chronic hyperglycemia explained more than 50% of the association between

gingival and retinal hemorrhaging. These findings, " are consistent with the

hypothesis that retinopathies indicate hidden systemic microvascular

injuries that are largely driven by abnormal glucose metabolism. " " Bleeding

gums should make people think about more than just a toothbrush.

21.%% Heartwire Lorcaserin " Encouraging " in Obese Diabetics, But

Valvulopathy Signal Also Seen 11-9-10 [this] trial of investigational

obesity drug lorcaserin in pts with DM was part of the additional info

requested by FDA when it rejected the drug last month. .there was also a

higher rate of new valvulopathy with lorcaserin than with placebo, which the

company played down. . Heart-valve damage associated with exposure to

[appetite reducing ]drugs, such as fenfluramine, resulted in the withdrawal

of those products from the market in the 1990s. At week 52, 2.9% of pts on

lorcaserin and 0.5%on placebo had new valvulopathy.

22.%% Lighthouse Preventing Diabetes & Vision Loss Currently, about 24

million Amer adults have diabetes. That figure could rise dramatically in

the next 40 years due to an aging population, increases in minority groups,

and people with DM living longer. " People don't realize that DM is the

number one cause of preventable blindness in working people, " said A

Zaldivar, LH Internat. . Even though DM retinopathy is the leading cause of

blindness in American adults, about half have never had a retinal

examination, leaving them either unaware of this serious complication or

failing to take steps to prevent it. So what can you do to either prevent or

treat DM eye disease? If you have diabetes, it is recommended you receive a

dilated eye exam at least once a year. You should also follow the " ABCs " of

preventing diabetes complications .. includes monitoring your average blood

glucose level [H 1AC] controlling your BP & cholesterol, and refraining from

smoking. If uncontrolled, DM can lead to many complications. It's

imperative that you take care of your vision, since it can impede how you

take care of yourself.

%% News - President Obama Signs 21st Century Communications and Video

Accessibility Act On Oct 8, 2010, President Barack Obama signed into law

the Twenty-First Century Communications and Video Accessibility Act of 2010.

The legislation requires smart phones, the internet and TV programming to

include audible & visual notifications so they are accessible to anyone with

a vision or hearing loss.

23.%%ADA Dietary Intervention in Infancy and Later Signs of Beta- Cell

Autoimmunity 11/11/10 Early exposure to complex dietary proteins has been

found to potentially increase the risk of beta-cell autoimmunity and T1DM in

genetically susceptible children. [Finland] [230 infants, all with

HLA-conferred susceptibility to T1+at least one family member with T1]

received either a casein hydrolysate formula or a conventional,

cow's-milk-based formula (control group) birth-8m ;fup 10yr. The team

wrote, " Our data suggest that weaning to a highly hydrolyzed formula,

compared with a cow's-milk-based formula, was associated with a decreased

risk for at least one DM--associated autoantibody. Dietary intervention in

infancy could have a long- lasting effect on markers of beta-cell

autoimmunity, they suggest.

24.%%ADA Your Dentist May Be First to Notice Signs of DM 1-11-10 Regular

dental visits may help people receive an early warning if they are at high

risk for DM.. " We've known for a long time that people with diabetes are

more susceptible to gum disease, " team leader. " And today evidence is

emerging that periodontal disease is associated with increased risk for DM

complications and may be associated with the development of T2. More than

120 diseases can cause specific symptoms in and around the mouth and jaw, so

dental professionals can notice symptoms of serious health problems while

performing checkups. Preventive checkups can help identify and intervene

early in dental-related diseases, potentially reducing associated pain and

financial costs.

25.%% ADA Abuse in Childhood and Adolescence as a Predictor of T2DM in

Adult Women 11/11/10 A new study sought to determine whether child abuse

previously associated with obesity, increases risk of T2. [68,000 women]

Mild physical abuse was not associated with DM risk in adulthood, but

moderate and severe physical abuse was associated with 26 to 54% higher

risks of DM. Conclusion -moderate-to-severe physical & sexual abuse

-childhood and adolesc. have dose-response associations with risk of T2

among adult wome.

26.%% M Supervised Exercise Program Improves HbA1c Levels in DM Patients

11/11/10 This program, a twice-weekly, 75 min facility-based regimen that

included aerobics, resistance training, and counseling was significantly

better at improving HbA 1c levels and CV risk than a treatment regimen that

only counseled physical activity. [606 pts] those in the program had lower

HbA 1c levels--a significant 0.30% difference between the 2 groups at 12

months--as well as improved markers of CV risk, such as LDL- and

HDL-cholesterol levels.

27.%% M 11/5/10 Insulin Analogs: The Role of Continuous Subcutaneous Insulin

Infusion (CSII ) Pumps.. I don’t know a lot of patients, whether T1 or T2

that sit there and say, okay, I’m going to eat in 30 min, I’ll take my

injection. The majority will take the injection with the meal or sometime

after. It helps if you use an analog-lispro, aspart, glulisine - because

there’s a more rapid action - a rapid rise & a quicker drop- reducing the

risk of hypoglycemia vs using regular human insulin. .Conclusion, insulin

analog therapy is a safe and effective way to go. It is not a convenience

item. Most of my prescriptions for insulin will be analog insulin, either

multi-dose insulin, anywhere from 2 to 4 or 5 injections a day based on the

pt’s need vs using an analog insulin pump. Obviously, the cost of the pump

is more than that of injectable insulin. But the most important point I can

make is, if you’re going to put somebody on an insulin pump, make sure they

know how to carb count, at least have some working knowledge. Do it first

with injectable insulin. Then make sure they never forget it, particularly

if they’re traveling and their pump is not functioning properly. Dr.

, Lebovitz & s. ..

28.%% M Aspirin for Primary Prevention in Diabetes11/10/10; this metabolic

disorder is the 7th leading cause of death, with mortality occurring at a

rate nearly twice that of people without the disease. Mortality is

attributed to macrovascular complications such as peripheral vascular

disease, (CVD), & stroke. Conclusion - Low-dose aspirin is no longer

advocated as primary prevention for all pts 40 & older with DM. Low-dose

aspirin is now recommended for pts with an increased CV risk, including men

over 50 and women over 60 years with at least one additional major risk

factor.

29.%% M Genetic Basis for End-Stage Renal Disease (ESRD)in T2 11/4/10 ..

differing races vary significantly in their level for risk for kidney

disease. [1338 pts T2 Chinese] the team focused on protein kinase C-beta a

molecule involved in cell signaling implicated in the vascular complications

of DM. Adjusting for usual factors that predict development of ESRD

(includes: duration of DM, BP, A1c, glomer.. filtration rate), 2 alleles

were strongly associated with an increased risk for ESRD.. it is reasonable

to look to PKC-beta in the pathogenesis of DM kidney disease & for an

inhibitor of PKC-beta to play a potential therapeutic role.

30.%% JH The Eye-Heart Connection 20 + years ago, the Framingham Heart &

Eye Study uncovered an association between DM retinopathy [DR] and CV

diseases, including coronary heart disease and stroke. . A team recently

reported a strong association between DR & the amount of calcium in the

coronary arteries. Calcium levels are a reliable marker for

atherosclerosis, which can lead to stroke, heart attack, and, yes, eye

problems. Atherosclerosis is the hardening and narrowing of arteries from

plaque, a buildup on blood vessel walls of cholesterol but also of calcium

and other substances. [204 pts with T2; CT scan] those with proliferative DR

(the dangerous growth of new blood vessels on the back of the vitreous

humor) were 6 times more likely to have coronary artery calcium (CAC) levels

over 400 -- a score that places them at risk for heart disease -- than

people who didn't have the condition. team also found that when they

accounted for other risk factors for heart disease, [includes] age,

smoking, high BP, the assoc between DR and calcium levels persisted. these

findings suggest that increased CAC levels are an independent risk factor

for DR and that both may be caused by the same underlying pathology.

31.%% Am J Ophth vol 150;6 Dec 2010 Retinal Thickness in the Offspring of

Diabetic Pregnancies Purpose - To compare macular and retinal nerve fiber

layer thickness in children from diabetic compared with nondiabetic

pregnancy. [2367 age 11-14] Conclusion - Diabetes during pregnancy is

associated with changes in retinal [structure] in the offspring. Thinning of

the pericentral [around the macula] macular parameters was evident . These

findings suggest the possibility that maternal DM impacts on the development

of the retina.

32.%% Stem Cell-Based Therapeutic Applications in Retinal Degenerative

Diseases Springer Science + Business Media, 9/22/10 Abstract - Retinal

degenerative diseases that target photoreceptors or the adjacent retinal

pigment epithelium (RPE) affect millions of people worldwide. Retinal

degeneration (RD) is found in many different forms of retinal diseases

including (RP), (AMD), diabetic retinopathy, cataracts, and glaucoma.

Gene-replacement Rx has been shown to improve visual function in inherited

retinal disease. However, this treatment was less effective with advanced

disease. Stem cell-based therapy is being pursued as a potential alternative

approach in the treatment of retinal degenerative diseases. In this review,

we will focus on stem cell- based therapies in the pipeline and summarize

progress in treatment of retinal degenerative disease. ..

33.%% DM Drug Benfluorex Linked to Thousands of Hospitalizations, Hundreds

of Deaths for Valvular Disease 11/19/10 Benfluorex (Médiator, Servier), also

used off-label for the treatment of obesity in the few countries where it is

approved, likely caused 500 deaths & ..3500 hospitalizations for valvular

heart disease in France since 1979, French nat health-insurance

organization CNAM.. Heartwire

34.%% M Some Alcohol Use Reduces Diabetes, Mortality After Kidney Transplant

11/22/10 [600 kidney transplant recipients;fup 7yr] pts who had moderate

alcohol intake were 44% less likely to die than those who consumed more or

less alcohol, and they were as much as 67% less likely to develop DM.

35.%% Diastolic BP Less Than 70 mm Hg in DM Linked to Increased CV Risk

11/22/10 Diastolic (BP) less than 70 in pts with T2 linked to increased CV

risk, even when systolic BP is in recommended ranges, [1791 pts] " Increased

risk of CVD events with SBP=140 mmHg emphasizes the urgency for treatment of

systolic hypertension, " the study authors write. The results emphasize that

DBP<70 mmHg in these patients was associated with elevated CVD risk and may

best be avoided. "

36.%% N Rev Endo vol6;12 Nov 2010 retinal safety profile of insulin

glargine and human neutral protamine Hagedorn (NPH) insulin in pts with T2

[5 yr; pt with either no or non-proliferative retinopathy] Conclusions

This study shows no evidence of a greater risk of the development or

progression of DR with insulin glargine vs NPH insulin treatment in patients

with T2

37.%% NREndo 6;12 Nov 2010 Epigenetic phenomena linked to DM complications

Environmental factors, such as diet and exposure to hyperglycemia,

contribute to the etiology of DM and its associated micro & macrovascular

complications which are the main cause of the [sickness and death] burden of

DM. Studies suggest that early exposure to hyperglycemia predisposes

individuals to development of DM complications, a phenomenon referred to as

metabolic memory. Interestingly, transient exposure to hyperglycemia results

in long-lasting changes in gene expression..[definition= Epigenetics refers

to modifications in gene expression that are controlled by heritable but

potentially reversible changes in DNA..]

38.%% " Compelling Evidence " Supports Bidirectional Depression- DM

Relationship 11/23/10 The relationship between depression and diabetes

appears to be bidirectional, suggesting DM increases the risk for depression

& vice versa, [Nurses Health Study] showed women with depression were 17%

more likely to develop DM; those who were taking antidepressants had a 25%

higher risk compared with their counterparts without depression. .women with

DM were 29% more likely to develop depression. Women who took insulin had a

53% higher risk than women without DM. All associations were independent of

sociodemographic, diet, and lifestyle factors.

39.%% JH Two Common Diabetes Diet Myths Exposed - Diabetes Myth 1: " Eating

too much sugar causes diabetes. " This is probably the most common myth

regarding DM and diet, and it's easy to see why some people fall for this

fallacy. Because DM causes blood glucose, or sugar, to rise too high, many

people make the assumption that eating too many sugary foods must then cause

DM. . eating too much sugar has nothing to do with causing T1 – it is

entirely due to destruction of the insulin-producing cells in the pancreas

by the immune system. T2 is caused by a combination of insulin resistance &

inadequate insulin production. While eating too many sugary foods may be a

contributing factor, that's only because consuming too much of any food type

-- whether chocolate bars or cheeseburgers -- can make you gain weight. And

research clearly shows that obesity increases the risk of insulin resistance

and T2.

Diabetes Myth 2: " Fructose is a 'safe' sweetener because it doesn't elevate

glucose levels. " Like many diet myths, this one contains a kernel of truth.

Fructose is a simple sugar naturally found in many foods like fruits,

vegetables, and honey. Fructose is also sold as a sweetener in health food

stores and on the Internet; it is low on the glycemic index, meaning that it

does not cause as great a rise in blood glucose as table sugar (sucrose) or

glucose. For that reason, some doctors used to advise pts with DM to choose

foods sweetened with fructose .But the benefits of swapping table sugar for

fructose are controversial, because some studies show that a diet high in

fructose can raise levels of artery-clogging fats called triglycerides. For

this reason, the ADA advises against using fructose as a sweetener but says

that there's no need to avoid the naturally occurring fructose in fruits,

vegetables, and honey.

40.%% M Dialysis 6 Times a Wk Associated With Lower CV Mortality 11/22/10

[[378pt;3-yr trial] results do not suggest that all hemo- dialysis patients

can benefit from a regimen of treatment 6 days/wk but they do provide

evidence of increased CV vitality for those who do. Measurements were

significantly better with daily dialysis. " left ventricle mass [of heart]

decreased by 13.8% in pts who underwent dialysis 6 x/wk instead of the

normal 3. The team cites a number of serious health complications associated

with hemodialysis that need to be addressed; including those related to

heart disease, anemia, bone disease, poor nutrition, inflammation, and

impaired cognitive & physical function. " You have to factor in the burden of

additional sessions, the travel, and the cost, " editorial U of Missouri,

" This randomized, controlled trial, which took a decade to complete, did

show that frequent dialysis was better with respect to control of

hypertension and control of hyperphosphatemia. " Whether the more frequent

vascular-access and clotting issues would be increasingly problematic over

time is not known, Whether patients would do even better at home is also

unclear. " Renal Week 2010: Am Society of Nephrology 43rd Annual Meeting.

41.%% Diabetes Mellitus and Increased Risk of Cancer: Focus on Metformin and

the Insulin Analogs 11/18/10 Conclusion - T2 does seem to be linked to a

variety of cancers including breast, hepatic, colorectal, and pancreatic

cancer. The proposed mechanism of action includes hyperinsulinemia and the

effects that insulin has to promote survival and progression of early

malignant cells.. The data regarding cancer risk and antidiabetic drugs are

contradictory and at this time inconclusive. There does seem to be a

decreased risk of cancer in patients treated with metformin. Use of insulin

analogs [ie glargine (Lantus)] overall does not seem to increase cancer risk

any more than the use of human insulin. Until long-term, randomized,

prospective studies are available to elucidate a correlation with cancer and

insulin, it is important to continue treating DM with insulin analogs in

order to avert the long- term complications of the disease.

Pharmacotherapy. 2010;30(11)

Abbreviations: fup-follow up; pt - patients; DM - diabetes Mellitus;

T1DM - type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema;

GDM -gestational diabetes; PDR - proliferative diabetic retinopathy; alleles

-one of 2 or more alternate forms of a gene; FPG - fasting plasma glucose;

BP - blood pressure; CVD - cardio-vascular disease; MI -myocardial

infarction/ heart attack ;HTN - hypertension or high BP; OCT - optical

coherence tomography; BCVA - best corrected visual acuity ;ADA - Am Diab

Ass & ADA Professional; JH- s Hopkins Alerts ; M- Medscape Web MD; NIH -

Nat Instit Health; MTD- Medical News Today; Definitions via online Medical

dictionaries. Disclaimer, I am a BSN RN but not a diabetic or diabetic

educator. Reports are excerpted unless otherwise noted. [translations,

explanations by thl] This project is done as a courtesy to the

blind/visually impaired and diabetic communities. Dawn Wilcox BSN RN

Coordinator The Health Library at Vista Center; an affiliate of the Stanford

Hospital Health Library. contact above e-mail or thl@...

April 30, 2011

Hi List,

I found article 14 below particularly interesting. It refers to yet another

randomized study which finds that diabetic patients attempting to lower A1C to

below 6% have a higher death rate than those trying to achieve A1C between 7%

and 7.9%. I've seen other studies over the last few years which seem to link a

lower A1c to a higher death rate. The best known is probably that study that

was halted a few years ago when too many patients trying to get A1C below 6.5

died during the study.

I don't understand why trying to get that A1C below 6% or 6.5% increases my risk

of death. Can anyone point to a scientific study or article that explains what

is going on here? Also, is there any indication whether these studies, which

are based on type 2 diabetics, also apply to us type 1 diabetics?

Thanks,

Mark

many articles

1.%% MP Some T1Diabetics Seem Shielded Against Complications 3/29/11

[351pts;T1 for 50yr; av A1C 7.7 %] .. 43% remained free of serious eye

disease, & 87% never developed kidney disease.. " We have identified a group

of people who can clearly live well with DM for a long time, " said author(

Joslin).. most of them eluded complications because they manage their

disease pretty well, but even in this group some developed complications,

while others appeared to have some sort of protection against them. One

potential reason is suggested by substances called advanced glycation end

products (AGEs), which were 7.2 times more common in those with

complications. AGEs develop in the body after long- term exposure to high

blood sugar levels... The author of accompanying editorial noted that a

receptor for AGE called sRAGE is lacking in people with complications.

2.%% MP Diabetes tied to higher Parkinson's disease [PD] risk 3/30/11

(Reuters Health) - In a study of 289,000 older adults, those with DM have a

slightly increased risk of developing PD. When the team accounted for other

factors - like age, weight & smoking - DM itself was linked to a 41%

increase in the risk of future Parkinson's. That, however, does not prove

that DM is a cause of PD- the reasons for the connection remain unknown,

said the team leader ...People with DM should continue to do the things

already recommended for their overall health -- eating a well-balanced diet

& getting regular exercise.

3.%% MTD 3/30/11 EndoBarrier Triggers Beneficial Hormone Effects Leading To

Rapid Glycemic Control, Weight Loss & Reduced Heart Disease Risk. GI

Dynamics announced new results from 3 studies that demonstrate the positive

effects of EndoBarrier [EB] Gastroin-testinal Liner on T2, wt loss & other

metabolic factors. These data support the use of EB as a primary therapy for

T2 & obesity in pts with BMI 30 + who have been unable to control their DM

or lose weight through lifestyle changes & medications...1 study revealed EB

offered rapid and long- lasting improvement in DM & beneficial hormonal

effects similar to surgical interventions such as Roux-en-Y gastric bypass.

[17pt;24wks] L M. Kaplan (Harvard) commented, " The EB appears to affect the

metabolic functions involved in T2 through mechanisms similar to those that

make bariatric surgery such an effective therapy for DM & obesity. " EB is

approved for up to12m use & is available in Europe & S. America. It is an

advanced investiga tional device in the US. EB is placed in the GI tract

endoscopically (via the mouth) to create a barrier between food & the wall

of the intestine. Physicians believe that preventing food from coming into

contact with the intestinal wall may alter the activation of hormonal

signals that originate in the intestine, thus mimicking the effects of a

Roux-en-Y gastric bypass procedure without surgery.

4.%% MTD Potential New Non-Insulin Treatment For T1 3/24/11 .. Fibroblast

growth factor 19 (FGF19) another hormone, has insulin-like characteristics

beyond its role in bile acid synthesis. Unlike insulin, FGF19 does not cause

excess glucose to turn to fat, suggesting that its activation could lead to

new treatments for DM or obesity. Bile acids, produced by the liver, break

down fats in the body. Utilizing ng FGF19 as an alternative to insulin Rx

remains a daunting challenge .In some studies in rodents caused the liver to

grow & develop cancer.

5.%% M Alerts 3/30/11 A class I recall of the ACCU-CHEK FlexLink Plus

infusion set, made by Roche has been issued because a kinked or bent cannula

could result in under or no delivery of insulin, (FDA) announced. " This can

lead to elevated blood glucose levels (hypergly- cemia) [which] can lead to

many serious health complications, including death, " .. recall applies only

to ACCU-CHEK FlexLink Plus infusion sets manufactured & distributed from

11/1/10 to 2/20/11. Symptoms of hyperglycemia include nausea/vomiting,

blurred vision, excessive thirst / hunger, frequent urination,

fatigue/sleepiness, headache, fruity acetone breath, & abdominal pain. " If

untreated hyperglycemia could lead to DM ketoacidosis, serious illnesses &

in severe cases death, " company said. Customer Care ,

6.%% Oph 118,4 Apr 2011 Ranibizumab Monotherapy or Combined with Laser vs

Laser Monotherapy for Diabetic Macular Edema (DME) [345pts;T1 & T2;12m]

randomized Conclusions:[lucentis alone] & combined with laser provided

superior visual acuity gain over standard laser in pts with visual

impairment due to DME.

7.%% Oph 118,4 Apr/11 Long-term Benefit of Sustained-Delivery Fluocinolone

Acetonide (FA) [a steroid] Vitreous Inserts for DME [565pts;2yr] randomized

subjects received study drug or sham injection. - ..FA inserts significantly

improved best corrected visual acuity. This is the first pharmacologic Rx

that can be administered by an outpt injection to provide substantial

benefit in pts with DME. .

8.%% Elderly Diabetics at More Risk of Anterior Ischemic Optic Neuropathy

(NAION) (Reuters Health) Apr 14 - coauthor said " The annual incidence of

NAION among those 68 and older is much higher than previously reported.. We

found an incidence of 82 per 100,000. The higher incidence may also relate

to misdiagnosis of other

optic neuropathies reported by US providers. "

9.%% Oph 118,4 Apr/11 Severity of Diabetic Retinopathy (DR) & Health Related

Quality of Life: To assess the impact of DR & its severity on health-related

quality of life (HRQOL) in a population-based sample of Latinos with T2.

Conclusions - Greater severity of DR was associated with lower general &

vision- -specific HRQOL. Persons with bilateral moderate [nonproliferative

DR] had the most substantial decrease in quality of life compared with those

with less severe DR. prevention of incident DR & its progression from

unilateral to bilateral ..should be considered an important goal in

management of individuals with DM.

10.%% UPI 4/2/11 Diabetes makes you older before your time Adults ages 51-70

with DM developed age-related ailments such as cognitive impairment, falls,

dizziness, vision impairment & pain at a faster rate than those without

diabetes. For adults age 51-60 with DM the odds of developing new geriatric

conditions were nearly double those who didn't have DM, but by the time

people reach 80, the disparities begin to disappear.. " Because DM affects

multiple organ systems, it has the potential to contribute significantly to

the development of a number of issues that we associate with aging. " study

leader said

11.%% M More Data on Diabetes Risk With Statins 3/31/11 A new analysis of 3

major trials with atorvastatin (Lipitor) suggests that the risk of new-onset

DM with statins appears to be dose dependent and related to the strength of

cholesterol lowering achieved with the statin --ie, the more powerful the

statin, the higher the risk of DM. But the authors, as well as other

experts, stress that the benefits of statin treatment still clearly outweigh

the risks in patients with coronary or cerebrovascular disease.

12.%% M 4/28/11 CBT for Depressed Diabetes Patients Improves Overall Health

Cognitive behavioral therapy (CBT) targeting depression in patients with DM

is associated with improvements in overall health but not in glycemic

control, according to the

results of a randomized trial " Depression is a common, treatable issue for

many people who have diabetes, " said lead author " This study shows that

telephone-delivered counseling can improve patients' access to effective

depression care, improve their CV health and get them moving again. " [291

pts] randomly assigned to receive usual care or a manualized telephone CBT

program delivered weekly by nurses for 12 weeks, followed by 9 monthly

booster sessions.

Limitations of this study include duration of follow-up limited to 12

months, limited generalizability because only 16% of participants were

racial/ethnic minorities, In addition, 31% of patients contacted refused

participation. NIH

13.%% Nature Med Apr/2011 Metabolite profiles & risk of developing DM

Emerging technologies allow profiling of metabolic status from a blood

specimen (metabolomics). [2,422 normoglycemic subjects;12yr] Amino acids &

other metabolites were profiled by liquid chromato-graphy-tandem mass

spectrometry . A combination of 3 amino acids predicted future diabetes

(with a more than fivefold higher risk for individuals in top [quarter]).

These findings underscore the potential key role of amino acid metabolism

early in pathogenesis of DM & suggest that amino acid profiles could aid in

DM risk assessment.

14.%% MAP 4/2011 Long-term effects [5yr] of intensive glucose lowering on

cardiovascular outcomes. We randomly assigned pts with T2 & CVD or

additional CV risk factors to receive intensive therapy (targeting a

glycated hemoglobin level below 6.0%)or standard Rx (7-7.9%). Conclusions:

As compared with standard Rx, the use of intensive therapy [as above]

reduced 5-yr nonfatal MI but increased 5-year mortality. Such a strategy

cannot be recom mended for high- risk pts with advanced T2. Nat Heart, Lg &

Blood Institute

15.%% MAP 4/11 Functional variants of the HMGA1 gene & T2DM. High- mobility

group A1 (HMGA1) protein is a key regulator of insulin receptor gene

expression..Case-control study [3278 pts;] The most frequent functional

HMGA1 variant.. was present in 7- 8% of pts with T2. Conclusions: Compared

with healthy controls, the presence of functional HMGA1 gene variants in

individuals of white European ancestry was associated with T2.

16.%%MAP 4/11 Racial differences in glycemic markers: Although differences

between black & white pts in hemoglobin A(1c)(HbA (1c)) values are well

established, recent studies suggest this might not reflect differences in

glycemia. [376 control;343DM] Conclusion: Differences between black & white

persons in glycated albumin .. & fructosamine levels parallel differences

between these groups in HbA(1c) values. Racial differences in hemoglobin

glycation and erythrocyte [red blood cell] turnover cannot explain racial

disparities in these serum markers. The possibility that black persons have

systematically higher levels of nonfasting glycemia warrants further study.

17.%% HD Certain Diabetes Drugs Better for Heart Health, 4/7/11 In a study

that included more than 100,000 subjects taking metformin or another group

of oral DM medications called insulin secretagogues , (IS] researchers found

that metformin & the IS drugs gliclazide & repaglinide had the lowest risk

of CVD & death. an accompanying editorial said the findings are likely an

indication that metformin, gliclazide & repaglinide are protective. They

cautioned that people shouldn't stop taking any type of DM drug on their

own. If you're concerned, " have a discussion with your care provider. "

18.%% Nurs. Times Poor sleep for diabetes patients linked to eye disease

4/10/11 T2 patients with sleep problems are at higher risk of eye disease,

foot problems & amputation [231;148 with obstructive sleep apnoea (OSA)].

They found 48% with severe retinopathy in the OSA group & 20% in the non OSA

group. authors said: " Our results suggest that OSA is not an innocent

bystander in patients with T2 & might contribute to morbidities associated

with this condition. "

19.%% MTA 4/25/11 Early Warning That A Child Will Develop DM May Be Possible

By Monitoring Protein Levels Scientists are looking at blood levels of

interleukin-1 receptor antagonist (IL-1ra) in children being closely

followed because their genes put them at risk for T1. They also are looking

at DM mice missing IL-1ra to see how its deficiency affects immune function

& destruction of insulin-producing islet beta cells. " We want to know if we

can use IL-1ra levels to identify children who will soon develop DM, then

use IL-1 inhibitors to prevent it, " said team leader. [see #30]

20.%% delete

21.%% M 1 4/6/11 Intensive glycemic therapy reduces the risk of erectile

dysfunction (ED) in young men with T1 no matter where he falls on the

spectrum of glucose control, " there is a benefit to tight control, namely a

lower risk of ED, " said lead author [600 pts; 6.5yr] 23% reported ED. In

those with some microvascular manifestations, tightly controlled pts had

12.8% rate vs 30.8% of ED in those managed with non-intensive therapy.

Higher (Hb)A1c was significantly assoc. with ED risk in both cohorts. Other

risk factors were age, peripheral neuropathy and lower urinary tract

symptoms.

22.%% MP Spot Warning Signs of Low Blood Sugar 4/8/11 -- Hypoglycemia [hypo]

is the medical term for low blood glucose, common among people with DM. It

can occur even when you're trying hard to manage your blood sugar levels.

ADA says while you can't always prevent hypo, you can take steps to treat it

if you know the warning signs: . Sweating or turning pale. . Feeling dizzy

or shaking.

. Developing a headache.. Feeling hungry.. Showing moodiness, or rapid

behavior changes. . Moving awkwardly or clumsily. . Having a seizure..

Acting confused, or having problems paying attention.

. Having a tingly feeling around the mouth.

23.%% HD Nasal Insulin Induces Immune Tolerance of Injected Insulin

4/13/11 [52 pts;12m] were randomly allocated to receive nasal insulin or a

nasal placebo " Our finding that the antibody response to subcutaneous

insulin was suppressed by prior treatment with nasal insulin is the first

evidence for immune tolerance induction to an autoantigen demonstrated by

rechallenge in humans, " they write.

24.%% MTD Link Found Between High-Fat Diet & T2 4/12/11 People who acquire

T2 are typically obese & are resistant to insulin, the hormone that removes

sugar from the blood and stores it as energy. A new study finds that

saturated fatty acids but not the unsaturated type can activate immune cells

to produce an inflammatory protein, called interleukin-1beta.

" Interleukin-1beta then acts on tissues and organs such as the liver, muscle

& fat (adipose) to turn off their response to insulin, making them insulin

resistant to develop T2. supported in part by NIH

25.%% MTD Latest Findings On The Effects Of Caffeine In Diabetes

4/8/11 A growing body of research suggests that caffeine disrupts glucose

metabolism and may contribute to the development & poor control of T2

..contradicting earlier studies suggesting a protective effect of caffeine.

.numerous studies that have shown caffeine's potential for increasing

insulin resistance (impaired glucose tolerance) in adults that do not have

DM, an effect that could make susceptible individuals more likely to develop

the disease. In adults with T2, studies have shown that the increase in

blood glucose levels that occurs after they eat carbohydrates is exaggerated

if they also consume a caffeinated beverage such as coffee. The new review

of the topic gives the clearest account to date of what we know,..

26.%% MP Latest Artificial Pancreas Trials Reduce Risk of Low Blood Sugar

4/14/11-- An artificial pancreas combines insulin pumps & continuous glucose

monitors with a computer algorithm that tells these devices what to do when

blood sugar levels are rising or falling. The closed loop insulin delivery

system, computes insulin doses & administers them according to glucose

levels detected by a sensor. The hope is that an artificial pancreas will

closely mimic the way the human pancreas normally releases insulin in

response to food or stress. .in a 24-hour period, the average person with T1

spends about 10 hours with blood sugar levels too high, & about an hour a

day with blood sugar levels too low, an accompanying editorial noted that

the artificial pancreas is still " in its infancy, " but some experts were

cheered by the findings. " This study [24 pts] is more good news, and we're

seeing an evolution of more and more sophistication in this closed loop

study, " said Kowalski.

27.%% M 3/15/11 Only Long-Term Diabetes Is a 'CHD Risk Equivalent'

In a study of more than 4000 middle-aged men, a diagnosis of DM in pts 60 &

older, with a mean diabetes duration of 5 yrs, had a CHD risk half that of

patients who were diagnosed with DM before age 60 & who had DM for more than

16 years. In the early- onset diabetes pts, the risk of death & vascular

events was equivalent to patients with a prior MI. The results suggest " that

a longer duration of diabetes may be necessary to raise risks toward a CHD

risk equivalent. " writes study author.

28.%% MP 4/17/11 Do Immune System Ills Help Drive Type 2 ?

Findings from mouse, human research suggest new insights.. " The main point of

this study is trying to shift the emphasis in thinking of T2 as a purely

metabolic disease, & instead emphasize the role of the immune system said

study co-author. The team has identified immune system antibodies in people

who are obese & insulin- resistant that aren't present in people who are

obese without insulin resistance. Nearly 26 mil Americans have DM 90-95%

have T2 where the body doesn't use insulin efficiently, so the pancreas must

make increasing amounts & eventually, it stops making enough insulin to meet

the increased demand. T1 occurs when the immune system mistakenly destroys

the insulin-producing beta cells in the pancreas. This type of DM is

considered an auto-immune disease, & isn't linked to how much a person

weighs. .. excess weight has been linked to inflammation.. As visceral fat

(abdominal fat) expands, it eventually runs out of room. At that point, the

fat cells may become stressed, inflamed, & eventually die. When that

happens, immune system cells -macrophages- come to sweep up the mess. Other

immune system cells-T-cells & B-cells, also respond to the stressed or dying

cells. But, these cells are the ones that create specific antibodies to

remember a threat to the body such as a certain flu virus. In this case,

however, instead of creating antibodies against a foreign substance, immune

system cells create antibodies against fat cells; attacking them, making

them insulin resistant & hindering their ability to process fatty acids. In

addition to T2, this onslaught against the fat cells is associated with

fatty liver disease, high cholesterol & high BP, according to the team. [32

obese humans] the mice & human volunteers were all male, so it's not clear

if these findings are applicable to women.

29.%% Nat Reviews Endocrinology 7, 248 (May 2011) Pathogenesis of diabetes

mellitus: does glutamate have a role? Glial glutamate transporter 1 (GLT1)

is expressed in pancreatic ß cells and acts as a critical regulator of

extracellular glutamate levels, which in turn promotes ß-cell survival,...To

read this article in full..

30.%% ADA 4/26/11 New study describes molecular process that causes T1 A

team has identified a gr of previously unknown immune system cells that may

play a major role in development of T1. These findings could lead to the

creation of new drugs to suppress these cells & help people avoid the

condition. The team showed that a previously unknown subset of CD4+ T cells

produce proteins called chemokine receptor 9 (CCR9) & interleukin 21

(IL-21). Both of these proteins have been shown to play active roles in the

ability of another immune cell known as CD8+ to cause inflammation in

tissues of the gastrointestinal tract. When pancreatic tissue becomes

inflamed, insulin-producing islet cells are killed, resulting in T1.[see

#19]

31.%% M 4/14/11 Diet Drug Orlistat Linked to Kidney, Pancreas Injuries A

review of patients taking orlistat (Xenical/Alli,) show a 2% increase in

acute kidney injuries within one year of starting the drug . in May 2010,

the FDA issued a warning about the risks of severe liver injury with

orlistat use.. Thursday, GlaxoKline, which sells over -the-counter

orlistat (Alli) in the US, announced that it is one of the products to be

dropped in 2011

32.%% M Patients With DM Lack Knowledge About Hypoglycemia

4/14/11 A national survey [2530 adults with T2] in the US reveals that many

pts remain uneducated about the risks for hypo 42% had experienced low blood

sugar symptoms while working, 26% while exercising, & 19% while driving. 27%

did not know that the leading causes of hypo..included skipping meals. 35%

did not know that some DM meds may enhance the risk for hypo. some did not

know that the most common symptoms are dizziness & shakiness & 39%

incorrectly thought that thirst was the primary symptom. " The survey shows

that it's important to inform pts about the causes, symptoms, & how to

address hypoglycemia, " one presenter said. Amer College of Endo. recently

launched Blood Sugar Basics, an educational program with a Web site that

includes fact pages on how pts with DM can best manage their blood sugar

levels.

33.%% MAP 4/20/11 Effects of obesity & T2 on cardiac structure and function

in adolescents & young adults. Results: Adolescents with obesity &

obesity-related T2 were found to have abnormal cardiac geometry compared

with lean controls..our findings suggest that adolescents with obesity-

related T2 may be at increased risk of progressing to early heart failure

compared with their obese & lean counterparts.

34.%% MAP 4/20/11 HbA(1c) levels in schoolchildren with T1 are seasonally

variable & dependent on weather conditions. [589pt] The lowest HbA(1c)

levels were observed in late summer & highest in winter months- differences

exceeding 0.44%. Conclusions: Seasonal changes of HbA(1c) levels in

schoolchildren with T1 are a significant phenomenon & should be considered

in pt ed & DM management

35.%% MAP 4/20/11Low serum potassium levels and risk of type 2

[4409 Japanese men;5yr] Conclusions: Mild to moderately low serum potassium

levels, within the normal range & could be predictive of T2.

36.%% MAP 4/20/11 effect of high-protein, low-carbohydrate diets in the

treatment of T2: [99pt;12 m] randomised to..high protein or high carbo diet.

HbA(1c) decreased in both groups over time as did weight

serum triacylglycerol, total cholesterol, and increases in HDL. results

suggest that there is no superior long-term metabolic benefit of a

high-protein diet over a high-carbo in the management of T2.

37.%% M 4/18/11 Metformin vs. Other Sulfonylureas: CV Risk Most

sulfonylureas used by a cohort of adults with T2 raised clinical risk

compared with metformin , regardless of MI history..[107,000 pts]

38.%% MP Many kids with T1 have other immune diseases 4/21/11

[491pts] Researchers measured blood levels of " autoantibodies " that serve as

markers of certain conditions. Autoantibodies are immune system proteins

directed against the body's own cells. T1 is known as an autoimmune disease,

where the immune system launches a misguided attack on the body's own

tissue. In the case of DM, the assault kills off cells in the pancreas that

make the blood-sugar regulating hormone insulin. ADA recommends that

children with T1 be tested for thyroid disease & celiac disease at the time

of their DM diagnosis. The study leader says parents should pay attention to

their children's growth & physical development, & keep track of problems

they are having with episodes of low blood sugar, abdominal pain,

constipation or diarrhea. It's estimated that 15 -30% of people with T1 have

autoimmune thyroid disease, 4-9 % have celiac disease, and less than 1% have

's.

39.%% JH 4/21/11 Importance of Vitamin D in Diabetes Management

..until recently, vitD hasn't been considered an important factor in

controlling diabetes. A growing amount of research links a deficiency of

vitD to an increased risk of developing T2 or its complications. Vitamin D's

main role in the body is to help with calcium absorption, which, in turn,

promotes bone strength & maintains healthy bones & teeth. VitD also

strengthens the immune system. Researchers are discovering that vitD also

plays a role in regulating blood glucose levels. In people who have DM, vitD

has been shown to increase insulin production by regulating blood levels of

calcium & improving pancreatic beta-cell function. Low vitamin D levels are

also known to nearly double the risk of CVD in people with DM and to

increase the risk of heart attack and stroke... more research needs to be

done to prove that attaining adequate levels through sun exposure, food

intake or supplements will lower risk. Still, it's important to meet your

daily vit D requirements. It's also a good idea to ask your doctor about a

blood test to measure your vitamin D levels.

40.%% M Bromocriptine: A Sympatholytic, D2-dopamine Agonist for the

Treatment of T2 Diabetes 4/19/11 .. bromocriptine taken within 2 h of

awakening is believed to augment low dopamine levels..resulting in increased

suppression of liver glucose production. Addition of bromocriptine to poorly

controlled T2 pts treated with diet alone, metformin, sulfonylureas, or

thiazolidinediones produces a 0.5-0.7 decrease in HbA1c, fasting & postmeal

plasma free fatty acid & triglycerides. [52pt] double- blind,

placebo-controlled study.

41.%% M 4/19/11 Nocturnal Hypoglycemia Common in Pediatric T1

As many as two-thirds of children and adolescents with T1 have nocturnal

hypoglycemia,(NH) a pilot study suggests. [25pt] Those with NH were

significantly older (mean, 12.8 years) than those without NH (mean, 9.4

years; ..

42.%% MAP Relationship Between Sleep-Disordered Breathing and Iris and/or

Angle Neovascularization in Proliferative Diabetic Retinopathy (PDR) Am J

Oph 2011 [151pt] Conclusions In pts with PDR, nocturnal intermittent

hypoxia/reoxygenation resulting from sleep-disordered breathing may be a

risk factor for iris & /or angle neovascularization. [growth of abnormal new

vessels]

43.%% MP 4/28/11- Weight loss surgery appears to change the body's

metabolism in a way that dieting alone cannot, helping to explain why T2

often disappears after the surgery even before much weight is lost.

The team found that unlike dieting, gastric bypass [Roux-en-Y] changes a

person's metabolism by significantly reducing levels of circulating amino

acids -- compounds linked with obesity, DM & insulin resistance. They are

now looking to discover ways to develop drugs that could replicate this

effect.

Abbreviations: fup-follow up; pt - patients; DM - diabetes Mellitus; T1DM -

type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema;DR -

diabetic retinopathy; FPG - fasting plasma glucose; BP - blood pressure; GI-

gastrointestinal tract;NV- neovascularization; CVD - cardiovascular disease;

MI -myocardial infarction/ heart attack ; OCT - optical coherence

tomography; BCVA - best corrected visual acuity ;ADA - Am Diab Ass & ADA

Prof; HD -HealthDay; M- Medscape Web MD; MAP- Medline Abstract & Plus; MTD-

Med News Today;NEI - Nat Eye Institute; Definitions via online Medical

dictionaries. Disclaimer, I am a BSN RN but not a diabetic or diabetic

educator. Reports are excerpted unless otherwise noted. [translations,

explanations by thl] This project is done as a courtesy to the

blind/visually impaired and diabetic communities. Dawn Wilcox RN BSN

Coordinator The Health Library at Vista Center; an affiliate of the Stanford

Hospital Health Library. contact above e-mail or thl@...

May 1, 2011

Mark,

That study, called the Accord Study, has been pretty well proven to be a bad

study. Most of the people who died in that study had many complications when

they entered the study.

Many, many other studies have proven that keeping your A1C near normal

prevents those complications , thereby prolonging your life.

_____

From: blind-diabetics

[mailto:blind-diabetics ] On Behalf Of Mark M

Sent: Saturday, April 30, 2011 5:30 AM

To: blind-diabetics

Subject: Re: many articles

Hi List,

I found article 14 below particularly interesting. It refers to yet another

randomized study which finds that diabetic patients attempting to lower A1C

to below 6% have a higher death rate than those trying to achieve A1C

between 7% and 7.9%. I've seen other studies over the last few years which

seem to link a lower A1c to a higher death rate. The best known is probably

that study that was halted a few years ago when too many patients trying to

get A1C below 6.5 died during the study.

I don't understand why trying to get that A1C below 6% or 6.5% increases my

risk of death. Can anyone point to a scientific study or article that

explains what is going on here? Also, is there any indication whether these

studies, which are based on type 2 diabetics, also apply to us type 1

diabetics?