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1.%% M Long-term Effect of Metformin on Blood Glucose Control in Non-obese

Patients with T2DM 12/29/10; Nutr Metab. 2010;7 [213 pts] Results: The

course of HbA1c was similar between the non-obese and the obese groups,

while the dose of metformin required to control blood glucose was

significantly lower in the non-obese group than in the obese group.

Conclusions: The present study demonstrated the long-term beneficial effect

of metformin in non-obese DM pts. [395pts on metformin]

2.%% M Remission of T2 after Gastric Bypass and Banding: Mechanisms and 2

Year Outcomes Summary : Glycemic control in T2 is improved after bariatric

surgery. [1,340 pts] Remission of DM was defined as patients not requiring

hypoglycemic medication, fasting glucose below 7 mmol/L, 2 hour glucose

after oral glucose tolerance test below 11.1 mmol/L, and HbA1c <6%.

3.%% JH Diabetes Diet Myths DM Myth 1: " Artificial sweeteners are bad for

you. " In general, artificial sweeteners can satisfy a sweet tooth without

raising your blood glucose or causing weight gain. But many people fear that

.. aciculae potassium (Sunset), aspartame (Nutrasweet, Equal),

saccharin(Sweet'N Low), or sucralose (Splenda) are unsafe based on claims of

worrisome ill effects. there were concerns about some artificial sweeteners

-- namely saccharin because it caused bladder cancer in lab rats and

aspartame owing to a possible link to adverse neurological effects in

people. However, research has shown no health dangers when these sweeteners

-- all approved by FDA -- are consumed in moderate amounts. Myth 2:

" High-protein diets are best for people with T2 One study found that

adopting a high-protein diet comprising 30% of total calories for 5wks

lowered hemoglobin A1c levels by 0.8%. Other research has found that eating

more protein helps promote weight loss and control blood glucose following

meals. . most of the studies were small and short term. That means we don't

know whether these findings will be repeated in larger groups or whether

it's possible to sustain a high- protein diet and maintain the benefits on

blood glucose over the long term. Thus, most people with diabetes should

consume the same portion of dietary protein as you would find in a typical

American diet, 15 -20% of total calories. For individuals with kidney

disease, avoiding a high-protein diet is particularly important to reduce

stress on the kidneys.

4.%% Nat Med 17, 2011 .. The protein hormone adiponectin promotes insulin

sensitivity, decreases inflammation and promotes cell survival. No unifying

mechanism has yet explained how adiponectin can exert such a variety of

beneficial systemic effects. Here, we show that [it] potently stimulates

ceramidase activity and formation of sphingosine lipid [ regulates cell

growth] [this] activity is impaired in cells lacking adiponectin receptor

isoforms, leading to enhanced susceptibility to cell death. .. our

observations suggest a unifying mechanism of action for the beneficial

systemic effects exerted by adiponectin, with sphingolipid metabolism as its

core signaling component...W.Holland et al;

5.%% M Deadly Combination of Depression and Diabetes Doubles Mortality Risk

1/7/11 Women who have DM and depression have a significantly higher risk

for all-cause mortality and cardiovascular disease (CVD). [cohort study;

78,000 women + 54 yr] When considering only deaths from CVD, women with

diabetes had a 67% increased mortality risk, women with depression had a 37%

increased risk, and women with both had more than 2.7 times the increased

risk. " Our findings suggest that these 2 conditions of depression and DM,

which often go hand in hand, create a vicious cycle or what I call 'a double

whammy' in terms of health outcomes, " a team member said. Symptoms of

depression affect between 20 -25% of pts with DM which is " nearly twice as

many " as individuals without diabetes. " It is generally suggested that

depression is associated with poor glycemic control, an increased risk of

diabetes complications, poor adherence to DM management by patients, &

isolation from the social network, " Depression was determined by

self-report, antidepressant use, or a score of 52 or less on the 5-item

Mental Health Index Exclusion criteria included a history of gestational,

type 1, or secondary diabetes. The study was funded by grants from the NIH

and Nat Alliance for Research on Schizophrenia and Depression.

6.%% Diabetes/Cardiovascular Risk with Prostate Cancer Drugs

FDA Patient Safety News: Jan 2011 The labeling for Gonadotropin- Releasing

Hormone (GnRH) agonists is being updated to describe an increased risk of

diabetes and certain CV diseases in patients being treated for prostate

cancer. GnRH agonists are sold under a variety of brand names, including

Lupron, Zoladex, Trelstar, and Eligard. FDA is requiring that the

manufacturers add this safety information to product labels based on the

Agency's review of several published studies. Most of these reported small,

but statistically significant increased risks of DM and/or CV events in

patients receiving these drugs. .Pts being treated with these drugs should

have their blood glucose and/or glycosylated hemoglobin monitored

periodically. Healthcare professionals should also monitor pts for signs and

symptoms of cardiovascular disease and manage them accordingly.

7.%% M Using ACCORD to Target HbA1c: Think Ages and Stages

Expert Interview With F. Ismail-Beigi, MD, PhD, Case Western Reserve U.

Principle Investigator (ACCORD) trial. ACCORD, sponsored by Nat Heart, Lung

& Blood Institute was set up to test efficacy of 3 medical treatment

strategies (blood glucose lowering, BP lowering, & lipid altering) in

reducing cardiovascular events in middle-aged & older people with T2 plus

(CVD) or additional CV risk factors.[ 5128 pts randomized to intensive

glycemia Rx group & 5123 to standard Rx. Intensive Rx was stopped in Feb

2008 because of 27% per year increase in mortality seen in that group. ..In

Lancet the authors noted that the microvascular benefits of intensive

therapy should be weighed against the observed risks: increase in total and

CVD-related mortality, increased weight gain, & increased risk for severe

hypoglycemia. They advised caution in pursuing a strategy of intensive

glycemic control for prevention of microvascular complications in DM pts

similar to those in the ACCORD trial. " An HbA1c target of = 6.0% with

present strategies seems imprudent, " [summary by Dr.Is-Beigi ] . I think

that an A1C of < 7% or < 6.5% may make a lot of sense in a younger

individual who is going to live 40 years, hopefully. If you and they do not

manage their disease, they might be on dialysis & may become blind and have

amputations over the decades if not properly controlled. But in someone who

is 69 yrs old and has other diseases, DM is a problem, but it is not their

preeminent problem. That is what I mean by individualization.. The global

message is that in relatively advanced disease and older age, you have to

have different goals. 1 goal for everyone does not work anymore.. Should

the guidelines be changed? that is what healthcare providers want to know.

It is interpretation of all this information that is needed..we need to have

discussion and hopefully reach a consensus.

8.%% MTD Lucentis (Ranibizumab) Launched For Vision Loss Due To Diabetic

Macular Oedema, 1/11/11 Novartis Pharmaceuticals UK Ltd announced that

Lucentis® has launched in the UK for the treatment of visual impairment due

to diabetes, specifically diabetic macular oedema (DMO).[DME as spelled in

US] This offers fresh hope for people with this serious and common

complication of DM. Until now, laser treatment has been the current standard

treatment but has not been shown to improve vision. Ranibizumab not only

offers stabilisation of vision loss but can also lead to significant

improvements in vision. Approval for this new indication for ranibizumab was

based on data from two pivotal randomised Phase III trials, which

demonstrated ranibizumab provided rapid, superior and sustained vision gains

compared to the current standard of treatment. [ RESTORE Phase III study

(354 eyes), show that ranibizumab is significantly more effective at

treating visual impairment due to DMO, compared to laser treatment. The

safety profile of ranibizumab in RESTORE is consistent with that previously

observed in large controlled clinical trials for (wet AMD), with no new

safety risks observed. DMO affects 5-10% of people with diabetes, and in

many it will cause visual impairment. If DMO is left untreated, there is a

25-30% risk of developing clinically significant macular oedema, leading to

vision loss.. (DMO) is a consequence of diabetic retinopathy, the most

common diabetic eye complication, and is characterised by changes in the

blood vessels of the retina, the light-sensitive layer at the back of the

eye. Leakage from these abnormal blood vessels occurs in the central portion

of the retina, called the macula. Because this part of the eye is

responsible for sharp central vision, DMO can lead to significant visual

impairment.

9.%%PubMed Cur Opin Oph 2010 Jan;21(1):Cataract surgery and diabetes.

Recent studies have focused on interventions to minimize progression of

retinal disease in DM patients undergoing cataract Surgery. [CS] Recent

Findings: Perioperative intravitreal [avastin], sub-Tenon's triamcinolone, &

panretinal photocoagulation (PRP) after CS (instead of before) have been

examined as ways to improve CS results in DM patients. The [avastin] &

triamcinolone results are promising, but the inclusion criteria are

variable, the sample sizes are small, & follow-up is short. Postsurgery PRP

shows improved CS results in diabetics with more severe retinopathy up to 1

year after surgery. Summary: Recent studies do not support the generalized

conclusion that phacoemulsification surgery causes progression of

retinopathy and macular edema in all DM patients. In certain populations of

DM patients undergoing CS, peri-op triamcinolone and bevacizumab may blunt

the progression of diabetic macular edema and DM retinopathy. The optimal

timing of PRP in relation to cataract surgery in patients with more severe

retinopathy warrants further evaluation.

10.%% ADA Prof. Insulin resistance may increase the risk of cardiovascular

disease in T1. 1/14/11 The CACTI (Coronary Artery Calcification in T1DM)

study assessed the role of insulin action on peripheral glucose utilization

and nonesterified fatty acid (NEFA) suppression in predicting coronary

artery calcification (CAC) in T1... results suggest that insulin resistance

may contribute towards increasing the risk of CVD both in T1 & in subjects

without diabetes.

11.%% ADA Prof: Enterovirus 'Linked to DM' 1/13/11 Enterovirus infection

may increase the risk of developing T1 from islet auto-immunity, a study

suggests. [2365 children who were genetically predisposed to DM] According

to the findings, detection of enteroviral RNA in serum, but not rectal

swabs, was associated with a 7 fold increased risk for progressing from

islet autoimmunity to T1. The team noted " enterovirus infection may be

just one of many factors that can accelerate progression to DM, e.g.,

through non-specific activation of autoreactive T-cells. "

12.%% ADA Prof: New data on the role of plasma SHBG levels in inverse

association between coffee consumption and risk of T2 1/13/11 A

case-control study assessed the role played by sex hormones & sex

hormone-binding globulin (SHBG) plasma levels

in the inverse correlation observed between coffee consumption and risk of

T2 in postmenopausal women. [359 subjects;359 controls; 10yr fup]. A

positive correlation was found between caffeinated coffee intake and SHBG

plasma levels, but not with sex hormones levels. No association was observed

between SHBG or sex hormones & tea or decaffeinated coffee. The authors

concluded that SHBG may account for the inverse association between coffee

consumption and risk of T2 in postmenopausal women .

13.%% Am J Ophth 151;2 Feb 2011 Association of Pathomorphology,[structure]

Photoreceptor [rods and cones] Status, & Retinal Thickness With Visual

Acuity in Diabetic Retinopathy [125 eyes with DR] Conclusions: The

[structure] and [rod and cone] status at the fovea [center of macula] and

retinal edema [around the macula] are correlated with the VA in diab

retinopathy. content on this site intended for health professionals.

14.%% M Protection Against or Triggering of T1 - Different roles for viral

infections 1/10/11; Key Issues - T1 is the unfortunate consequence of a

genetic predisposition & 1 or more environmental triggers, such as viral

infection. Although a firm assoc between T1 & viral infections could not be

established in humans, there is a huge body of evidence that heavily

supports the existence of this association. Studies in rodent models of T1

clearly show the opposing abilities of viruses to both trigger DM onset but

also prevent disease under certain circumstances. Epidemiological studies in

humans link the presence of enteroviruses, especially coxsackie viruses, to

the occurrence of T1 suggesting that a protective vaccine could positively

influence disease incidence. The rise in T1 in developed countries may be a

direct consequence of the hygienic living conditions resulting in a reduced

exposure to various microbial agents, including viruses. .. In

particular..to potentially protective viruses. .Efforts to better understand

what environmental influences protect from or promote disease .. may pave

new paths towards preventive interventions for those at risk.

15.%% JH 1/21/11 The 3 Stages of Diabetic Retinopathy [DR] Around

21 mil Americans have DM, a condition characterized by abnormally high

levels of glucose (sugar) in the blood. There are two forms - In people with

T1 mild abnormalities in the retina begin to appear an average of 7 yrs

after the diabetes begins, but damage that threatens vision usually does not

develop until much later. In people with T2 retinopathy may be present at

the time of diagnosis or relatively soon afterward. This is because the

onset of T2 is gradual, and changes in the retina may have already taken

place before the DM is even diagnosed. Here are the three progressive stages

of DR]: Microaneurysms -- In the early - nonproliferative, stages of DR

blood vessels in the retina develop weak spots that bulge outward

(micro-aneurysms) and may leak fluid and blood into surrounding retinal

tissue. These initial abnormalities usually cause no visual symptoms, and in

many people the disease progresses no further. However, microaneurysms can

lead to macular edema .

Macular Edema -- Swelling around the macula caused by the leakage &

accumulation of fluid can occur in people with DM. The swelling alters the

position of the retina and causes blurred vision. Loss of vision is more

pronounced when the center of the macula is affected. Proliferative

Retinopathy -- This is the most dangerous form of DR, characterized by

neovascularization -- the growth of new blood vessels onto the back surface

of the vitreous humor. Acute loss of vision can occur when new blood vessels

rupture and bleed into the vitreous humor or when these blood vessels lead

to traction on the retina, causing it to detach from the back of the eye

(retinal detachment). Experts don't yet know exactly how high blood

glucose levels cause DR. One possibility involves a protein known as

vascular endothelial growth factor (VEGF), which promotes the growth of new

blood vessels in the eye and is secreted into the eye in response to damage

caused by DM. Studies also suggest that elevated levels of cholesterol &

triglycerides as well as high BP can increase the risk of diabetic

retinopathy. These conditions are more common in people with DM than in the

general population. Vision Jan 21,2011

16.%% MTD Why Do Some Diabetics Escape Complications? 1/22/11

Much research has been carried out on why diabetics develop complications.

Now researchers want to know why some DM patients do not develop

complications. " The majority of diabetics will over time develop severe or

fatal complications, but 10-15% never do. They are the ones we are

interested in in the PROLONG study " , explains the co-leader. Stiff sugary

arteries: Despite decades of intensive research on DM complications, the

fundamental mechanisms are not fully known. Neither is it possible to

prevent or treat the damage to the blood vessels that affects the majority

of diabetics. The risk of dying from CV disease is 2-3 times higher for

diabetics than for non- diabetics. The small blood vessels are also damaged.

After only 10 yr with DM, 70 % of patients will have some form of kidney

damage - As many suffer from eye complications some will develop severe

visual impairment and 2 % will become blind. " The blood vessels and other

organs of the body become sugar coated and stiff. It is reminiscent of

premature biological ageing " [12,000 people;had DM 30+ yrs; of these, 1,600

have had it for 50+ years. " About half of these DM veterans do not have

major complications. Two thirds of those who have had DM for more than 50

years have escaped complications. Clearly they are different - we want to

find out what it is that protects them. " The PROLONG study is starting now

with a pilot study of patients with DM duration of more than 30 years..

Copying nature's protective mechanisms: subjects will answer questions

about their lifestyle & about diseases they, or their closest relatives, may

have. blood samples, including genetic tests, will be analysed, and close

relatives of the participants will also be invited to take part in the

study. " If we can identify factors protecting these veterans from

devastating complications, then it might be possible to develop drugs that

can do the same thing " ..

17.%% M The Pathway from Diabetes and Obesity to Cancer, on the Route to

Targeted Therapy 1/16/11 Conclusions: Insulin, insulinlike growth factor 1,

and insulinlike growth factor 2 signaling through the insulin receptor and

the insulinlike growth factor 1 receptor can induce tumorigenesis

[development of tumors], accounting to some extent for the link between DM,

obesity, & cancer. Knowledge of these pathways has enhanced our

understanding of tumor development and allowed for the discovery of novel

cancer treatments.

18.%% M Not All Insulin Analog Regimens the Same for Type 2 Diabetes:

Meta-Analysis 1/17/11 (Reuters Health) - Some insulin analog regimens will

help up to two-thirds of T2 diabetics maintain hemoglobin A1C below 7% --

but others will only help fewer..analysis of 16 randomized controlled trials

found that basal insulin analogs get fewer patients to reach their A1C

targets than prandial or biphasic insulin analogs; on the other hand, basal

insulin is associated with less hypoglycemia and weight gain than biphasic

insulin. But what's best for a given individual? " Of course, this question

is paramount, but the answer is, it depends, " lead author wrote.

19.%% Nat Rev Endo 7, 62 (Feb 2011) Immunosuppression restores ß-cell

function in T1DM? Abstract - Mild immunosuppressive monotherapy could be

used to treat patients with long-term T1for which the only currently

available cure is a more aggressive immunosuppression in combination with

allogenic islet transplantation. The team evaluated the possibility that the

immuno-suppressive drug rapamycin might reinstate ß-cell function in 22pts s

with long-term T1 on rapamycin monotherapy . To read this article in full

...need to log in, make a payment ..

20.%% N Rev Endo 7, 108-114 (Feb 2011) Cognitive function, dementia and T2

in the elderly Abstract - Increasing numbers of people are developing T2,

but interventions to prevent & treat the classic micro and macrovascular

complications have improved, so that people are living longer with the

condition. This means that new complications of T2, which are not targeted

by current management strategies,could start to emerge. Cognitive impairment

& dementia could come into this category. T2 is associated with a

1.5–2.5-fold increased risk of dementia. The etiology of dementia &

cognitive impairment in T2 is probably multifactorial. Chronic hyperglycemia

is implicated, perhaps by promoting the development of cerebral

microvascular disease...

Other possible moderators of cognitive function include inflammatory

mediators, rheological factors [flow of matter such as blood] and

dysregulation of the hypothalamic–pituitary–adrenal axis. Cognitive function

should now be included as a standard end point in randomized trials of

therapeutic interventions in patients with T2.

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; CHD - coronary heart

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 Institute 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 RN BSN Coordinator The Health Library at Vista Center; an affiliate

of the Stanford Hospital Health Library. contact above e-mail or

thl@...