multiple articles

[Guest guest]

1. %% Reuters 11/23/10 Half of Americans Facing Diabetes by 2020: at a cost

to the U.S. health care system of $3.35 trillion if current trends go on

unabated. The average annual health care costs in 2009 for a person with

known DM were about $11,700 compared with $4,400 for non-diabetics,

according to new data [10 million United Healthcare members.] " Because DM

follows a progressive course, often starting with obesity and then moving to

predicaments, there are multiple opportunities to intervene early on and

prevent this devastating disease before it's too late, "

2.%% M What is the Best Management Strategy for Patients With Severe Insulin

Resistance? 11/24/10; The management of patients with severe insulin

resistance (SIR) is extremely challenging, with affected individuals at high

risk for T2, metabolic dyslipidemia, atherosclerosis & polycystic ovarian

syndrome. Although individual insulin sensitivity & risk for T2 may have a

major genetic component, obesity is a critical cofactor in producing

clinical disease in most pts..

3.%% Initial Combination Therapy With Alogliptin and Pioglitazone in

Drug-naïve Patients with T2DM 11/21/10; Diabetes Care. Because the

pathogenesis of T2 involves defects in both insulin secretion and insulin

action, simplified, well-tolerated, & effective combo. therapies are being

considered as potential standard initial treatment .. 2 drug classes with

complementary modes of action are thiazolidinediones (TZDs), nsulin

sensitizers that increase peripheral glucose uptake, & dipeptidyl peptidase

(DPP)-4 inhibitors, which augment pancreatic insulin secretion and reduce

hepatic glucose output. Conclusions Initial combination therapy with DPP-4

inhibitor alogliptin plus the TZD pioglitazone[actos] daily for 26 wks

significantly improved glycemic control compared with therapy with either

component alone.

4.%% Erectile Dysfunction in Diabetic Men and Risk of CVD, CHD, and Strokes

11/26/10 Diabetic men with erectile dysfunction (ED) might be preoccupied

about what's not happening beneath the sheets--but a new study suggests they

should be more worried about their risks of CV disease. The team points out

that the penis is an " extensively vascularized organ ..erections are, to a

large degree, vascular events. " they conclude that rather than having a

direct, independent effect on CVD, it is more likely that ED is a marker of

cardiovascular disease risk.

5.%% Combined Aerobic and Strength Training Improves Glucose Control in

Diabetes 11/3/10 In patients with T2DM, aerobic exercise combined with

resistance training improves glycosylated hemoglobin (HbA1c) levels vs

levels in a nonexercising control group; however, neither form of exercise

alone achieves this benefit.[randomized;262 pts;T2] conclusion - cumulative

benefit across all outcomes was greater in the combo training group compared

with either aerobic or resistance training alone., " JAMA. 2010;304:

6.%%Ophth vol117;12 Dec 2010 Relationship between [OCT] Retinal Parameters

and Visual Acuity in Diabetic Macular Edema(DME) (67 eyes) Thickness,

volume, and intensity were calculated for neuro-sensory retina and

subretinal fluid. In addition, photoreceptor outer segment (POS) thickness

was quantified. Conclusions Subanalysis and quantification of OCT features

in eyes with DME seem to be of value. In particular, POS thickness seems to

be an important predictor of function and visual acuity in pts with DME.

7.%% MTD Scientists Discover New Mechanism For Controlling Blood Sugar Level

11/30/10 " We found that in order to maintain the correct levels of sugar, a

protein present on the cells that release insulin in the pancreas has to be

active. This protein - M3-muscarinic receptor, is not only active but also

needs to undergo a specific change which. triggers insulin release and the

control of blood sugar levels. " Prof Tobin added: " Without the change in the

M3-muscarinic receptor protein sugar levels go up in the same way that we

see in DM.

8.%% MTD Excess Fructose May Play Role In DM, Obesity And Other Health

Conditions 11/30/10 Dietary fructose is present primarily in added dietary

sugars, honey, & fruit. Americans often ingest fructose from sucrose, a

disaccharide containing 50% fructose and 50% glucose and high fructose corn

syrup (HFCS). With the introduction of HFCS in the 1970s, an increased

intake of fructose has occurred & obesity rates have risen simultaneously. .

authors conclude " Science shows us there is a potentially negative impact of

excessive amounts of sugar and high fructose corn syrup on CV and kidney

health.

9.%% MTD T1 Mortality Rates Dropping 11/29/10 Mortality rates for people

with T1are decreasing, but overall remain 7 times higher than those of the

general population -- likely as a result of long-term complications. women

with T1 were 13 times more likely to die than women without T1; a much

higher proportion of Afr-Americans (50.6 %) died than Caucasians (24%).

" It's unclear why, for both women and Af- Americans, T1 has such a major

effect compared to the general population, " said author " It looks like the

main improvement in those most recently diagnosed is related to dramatically

reducing mortality in the first 5 years after diagnosis, probably a result

of better management and awareness of DM control, blood glucose self-

monitoring, A1C testing and use of new BP medications such as

angiotensin-converting enzyme inhibitors, [ACE] which also help protect

against DM kidney disease.

10.%% M (CDC): Expert Commentary Diabetes and Influenza: A Dangerous Mix

11/29/10 Influenza is a serious threat to people with all types of DM.

Diabetics are 3 times more likely to die from flu complications, and 6 times

more likely to be hospitalized. Death rates from pneumonia and influenza

among African Americans with DM are double the death rates among whites with

diabetes. Last year during the H1N1 pandemic, 1of every 4 people

hospitalized with the flu had DM. Getting the influenza vaccine offers the

best protection. This is true for everyone for whom the vaccine is not

contraindicated, but it's especially important for people with diabetes.

Studies have shown that the vaccine can prevent 3out of 4 flu- related

hospitalizations and deaths among adults with DM. Yet less than half of

those with DM get vaccinated. People with DM should get the flu shot, not

the nasal spray vaccination. Also, people with T1 & T2 should get the

pneumococcal vaccine if they have not already had one in the last 5 years,

because pneumonia is a complication of influenza. Make sure patients with

DM know they have special sick day rules - they should: Monitor their blood

glucose closely, because levels can fluctuate substantially in a short time;

Take their usual dose of pills or insulin as close to the usual time as

possible; Advise patients to follow up with your office if their blood

glucose is not staying in a healthy range; If they can't eat their usual

diet, they should eat enough soft foods or drink liquids to take the place

of their regular meals; Every hour, drink at least a half-cup of

calorie-free liquids, like water, diet soda or tea; If a person is unable to

keep liquids down, he or she should call your office or go to the emergency

room; Check temperature every 4 hours, if the temp is over 101 degrees, call

your office; To avoid getting sick with the flu, remind patients to take

everyday healthy actions, such as washing their hands often with soap and

water, and covering their mouth or nose with a tissue when coughing or

sneezing; and They should try to avoid contact with sick people. more info

on DM and the flu at www.cdc.gov/diabetes/flu

11.%% MTD Combining Exenatide With Insulin May Be 'Best Result Ever' For

Diabetes Patients 12/8/10 T2 is a devastating disease, a leading

contributor to blindness, amputations, kidney failure, heart attack, stroke

and cancer. But the most powerful DM drug, Lantus a formulation of insulin,

is associated with weight gain and low blood sugar reactions. Exenatide

(Byetta) whose active ingredient was first discovered in the saliva of the

Gila monster, a large lizard from the Arizona desert. " has the advantages

of not leading to low blood sugar and in fact promotes wt loss, " lead author

said. [30wk;261 pts on Lantus,] They were randomly assigned to receive

twice-daily injections of Byetta or placebo in addition to the DM meds that

they were taking. 60% of the Byetta group achieved near normal blood sugar

levels, compared to 35% in placebo grp. Byetta recipients also lost an

average of 4 lb while placebo recipients gained an average of 2. There were

no differences in the rates of hypoglycemia between the two groups. funded

/sponsored by an alliance of Eli Lilly & Amylin

12.%% M T2DM Tied to Obesity, but Predisposition to Obesity Poorly

Understood 12/8/10 Attempts to find more effective therapeutic and

preventive approaches to T2 and obesity have been frustrated by inadequate

understanding of the pathology. However, genetic variants associated with

risk may provide insight into how these diseases develop.. according to a

review article.. 2- 3% of severe obesity was explained by variants of

MC4R..the newest research approaches involve investigation of links between

genetic variants and diseases. These found the assoc between T2 & TCF7L2

variants, with the encoded protein affecting the function of pancreatic

islets. . In most cases, the allele conferring susceptibility increases DM

risk 15 to 20%. . variants of about 40 genes have been associated with T2

risk. The story is similar for genetic variants affecting the risk for

obesity. genomewide association studies have found about 30 genetic loci

whose variants influence obesity risk . NEGR1, SH2B1, & BDNF are also

associated with obesity and also involved in neural function, which supports

the role of the hypothalamus in obesity risk. Finally, the article

highlighted the importance of genetic testing in selecting a therapy for

monogenic DM. However, the contribution of genetics is less clear in

managing more common forms of obesity and T2 At present, the greatest

influence of genetic information on therapy may be through drug discovery.

New Engl J Med. 2010;363.

13.%% M New Guidelines for Exercise in T2DM 12/10/10 New guidelines issued

jointly by the ADA & Amer College of Sports Med stress the crucial role that

physical activity plays in the management of T2 and replace the 2000

paper. " High-quality studies establishing the importance of exercise and

fitness in DM lacking until recently, " the panel writes, " but it is now well

established that participation in regular physical activity improves blood

glucose control and can prevent or delay T2, along with positively affecting

lipids, BP, CV events, mortality, and quality of life. " For people who

already have T2, the new guidelines recommend at least 150 minutes per week

of moderate to vigorous aerobic exercise spread out at least 3 days during

the week, with no more than 2 consecutive days between bouts of aerobic

activity. They call for a regimen of moderate-to- vigorous activity and make

no recommendation for a lesser amount of vigorous activity. " they state that

for most people with T2 brisk walking is a moderate-intensity exercise. They

also recommend that resistance training should be done at least twice a week

(ideally 3 times a wk) on non-consecutive days. The panel also recommends

that people just beginning to do weight training be supervised by a

qualified exercise trainer " to ensure optimal benefits to blood glucose

control, BP, lipids, cardiovascular risk and to minimize injury risk. "

14.%% MTD New Study Reveals Low Sex Drive In Women With DM 12/8/10 Almost

half of women in the US with T1or T 2 report that it has a negative impact

on their sex lives. [800 subjects] " Even women who have lived with diabetes

for years seem to lack basic information about the disease, " said author. .

58 % of those questioned did not know that the menstrual cycle can trigger

changes in blood sugar. Along with diminished libido, 25% the women reported

loss of spontaneity, and 22 % said they were less likely to reach orgasm.

Nearly 3of 4 had trouble managing their weight, and nearly half had trouble

choosing the right foods. Half reported that controlling their blood sugar

was a major challenge, and 1 out of 3 admitted that they found it hard to

take care of themselves before looking after others.

15.%% MTD Report Ties Diabetes To Shortened Life Expectancy 12/2/10 Despite

medical advances enabling those with DM to live longer today than in the

past, a 50-year-old with the disease still can expect to live 8.5 years

fewer years, on average, than a 50-year-old without the disease. The report

also found that, compared to older adults without DM, those with the disease

are less likely to be employed and more likely to have other health

problems, such as heart disease, depression, and disabilities that interfere

with normal life activities. [data from 20,000 aduts over 50]

16.%% MTD Diabetic Brains Suffer From Lack Of Cholesterol 12/2/10 Our brains

are packed with cholesterol, almost all of which has to be produced within

the brain itself, where it is critical for normal brain functions. a new

study reveals how that critical cholesterol synthesis in the brain is

derailed in mice with DM. The findings offer a new explanation for the

neurologic and cerebral complications that come with DM, including cognitive

dysfunction, depression, and an increased risk of Alzheimer's. " People with

diabetes can have a lot of problems with brain function, especially if it is

uncontrolled. The assumption had been that this was related to the effects

of poor glucose control. Our findings suggest a completely new concept. " The

discovery came out of a exploration of changes in gene activity in the

brain's hypothalamus in insulin-deficient DM mice. The team found changes

in genes involved in appetite & feeding. But they also turned up many genes

involved in cholesterol synthesis. the insulin- deficient mice showed a

reduction in a gene (SREBP-2) which is a master controller of cholesterol

metabolism. That change lowered the amount of cholesterol in cell membranes

in the brain that are important for the communications from one neuron to

the next. These changes were traced to the direct effects of insulin on

brain cells. Cholesterol synthesis was completely restored when the animals

were injected with insulin. The findings also point to a general need in

science to learn much more about cholesterol metabolism in the brain and

what might affect it, for better or worse. For instance, the results raise

the prospect that cholesterol-lowering statins - some of which can cross the

blood-brain barrier - might have unintended consequences for the brain and

its function. Earlier studies designed to look for a potential effect of

statins on cognitive function in patients have so far yielded conflicting

results.

17.%% Google News Sperm stem cells hope for diabetics UK Men with

insulin-dependent T1 may one day have their condition treated using cells

from their testicles. Scientists have succeeded in transforming sperm stem

cells into the pancreatic cells that generate insulin. Tests on DM mice

showed the beta islet cells could produce enough of the vital hormone to

start reversing their disease. Researchers hope in future it may be

possible to treat men with T1 with islet cells grown from their own

spermatogonial stem cells (SSCs) Because the therapeutic cells would

originate from their own bodies they would not be rejected by the immune

system. Egg stem cells may have the same potential to change into islet

cells, which could benefit female patients, the scientists believe. A US

team took the SSCs from the testes of dead human donors. One gram of tissue

was used to grow about a million stem cells with the biological

characteristics of beta islet cells. These were then transplanted into the

backs of immune-deficient diabetic mice, where they secreted insulin. While

the effects lasted only a week, more recent work by the team has shown that

the insulin yield can be greatly increased. ..

18.%% Treating Patients With GLP-1 Receptor Agonists: Focus on Fasting and

Postprandial Glucose --Let's summarize - The currently emerging

GLP-1receptor agonists have proven efficacy in T2 in dropping H A1c,

reducing bodyweight, in decreasing fasting plasma glucose, and have a very

large impact on postprandial glucose levels. .. the overweight population

that is typical of T2 would certainly benefit from the application of GLP-1

agonists because they make wt loss occur as glucose levels normalize.. One

of the hurdles in using these agents is that these are injectable meds. .

pills are easier for people to [take] but on the other hand, the needles

that are used to inject GLP-1 receptor agonists and the insulin compounds

are now so short and so small that we see very few complaints about the

needle going through the skin. You can expect to see formulation changes

with the GLP-1 agonists occurring in upcoming months.. exenatide twice-daily

therapy, will probably move into a once- weekly agent. However, this is not

currently FDA approved. The second agent to the class was liraglutide once

daily,.it has a better effect on fasting glucose concentrations. .

19.%%Higher-Protein/Low-Glycemic-Index Diet Best for Maintaining Weight Loss

12/2/10 A new study looking at ways of maintaining wt loss in subjects

who've successfully shed pounds through a restricted-calorie diet has found

that a higher-protein, lower glycemic- index diet was significantly better

than other diets either lower in protein, or with a higher glycemic index,

or both . Whether that ability to maintain a healthy weight--or the means

used to attain it--have implications for the heart remains to be seen, the

lead author added.

Five Diets Compared [26wk; 773 subjects who had lost about 8% of their

initial weight at study onset] they were randomized to a control diet, a

low-protein/low-glycemic-index diet, a low-protein/high- glycemic- index

diet, a high-protein/low-glycemic-index diet, or a high-protein/

high-glycemic-index diet.. only subjects randomized to the

low-protein/high-glycemic-index diet regained significant weight, whereas

those in the high-protein/low-glycemic- index group actually lost a small

amount of weight and this group was least likely to drop out of the study.

20.%% M Cinnamon for Diabetes: It Helps...A Little 12/3/10 Summary - this

relatively small clinical trial used a randomized placebo- controlled,

double-blind design to test the effects of daily intake of 2 g of cinnamon

on A1C, BP, and lipid profiles. [58pts with T2]..The sale of dietary

supplements is a multibillion dollar industry that is mainly comprised of

products that have not undergone rigorous scientific testing to validate

their effectiveness claims. Pts with DM are 1.6 times more likely to use

dietary supplements or other forms of complementary and alternative

medicine, and a number of products are believed to reduce hyper-glycemia.

One such product is cinnamon. Although a previous study found that cinn

reduced fasting glucose, a meta-analysis of 5 trials did not find a

reduction in A1C with cinn intake. The apparent A1C & BP benefits reported

in the current study were relatively small, the trial was of short duration,

and the study population was atypical. it remains to be seen whether these

results can be achieved in a more representative sample and sustained over a

longer period.

21.%% M Inhaled Corticosteroid Use May Increase Risk for Diabetes Mellitus

12/15/10 " High doses of inhaled corticosteroids commonly used in pts with

[chronic obstructive pulmonary disease (COPD)] are associated with an

increase in the risk of requiring treatment for DM and of having to

intensify therapy to include insulin, " author said. " .. patients instituting

therapy with high doses of inhaled corticosteroids should be assessed for

possible hyperglycemia and Rx with high doses of inhaled corticosteroids

[should be] limited to situations where the benefit is clear. " [ 388,584

pts] Those with current use of inhaled corticosteroids had a 34% increase in

the rate of DM.

22.%% N Rev Endo 7;2 Jan 2011 Treatment with losartan increases risk of

adverse renal outcomes In patients with T2 and nephropathy, treatment with

the angiotensin-receptor blocker losartan increases levels of serum

potassium, which is associated with a raised risk of adverse renal outcomes.

...

23.%% MTD Researchers Uncover Potential Inroad To Diabetes Treatment [good

description of how research is done] 12/13/10 A myriad of inputs that report

on a body's health bombard pancreatic beta cells continuously, and these

cells must consider all signals and " decide " when and how much insulin to

release to maintain balance in blood sugar, for example. A team at s

Hopkins have teased out how these cells interpret incoming signals and find

that 3 proteins relay signals similar to an electrical circuit. " We have

discovered a tunable circuit that may control the behavior of the cell. "

they report. . typically PKA (protein kinase A) acts as a switch and turns

on & does what it needs to do until it's done and turns off. The team

recorded video of live cells using biosensors they made that are protein

tags that glow one color when turned off and another color when turned on.

They found that PKA turns on and off in regular intervals - about 3 cycles

every 10 min. " We knew that calcium [CA] levels in these cells oscillate &

this controls the release of insulin, " Using a dye that changes color when

CA levels are high, they found- every time PKA turned on, CA peaked a short

while later, and PKA would turn off almost immediately, overlapping with a

decrease in calcium. The team then turned to colleagues in biomedical

engineering to build a mathematical model of this circuit to better study

and predict how these oscillating signals are used in a cell. The team

hopes that this finding can lead to repairing deficient cells in treating

diabetes. " funded by the National Institutes of Health.

24.%% MTD Almonds May Help Reduce Risk Of T2DM And Heart Disease 12/20/10 A

study examining ..disease prevention benefits of almond consumption finds

that eating an almond- enriched diet may help improve insulin sensitivity

and decrease LDL- cholesterol levels in those with prediabetes. [65

subjects;16wks] the randomized group that ate an almond-enriched diet showed

significantly improved LDL-cholesterol levels and measures of insulin

sensitivity, risk factors for heart disease & T2. A caveat - although both

groups were instructed to eat the same amount of calories from

carbohydrates, there was less self-reported carbohydrate intake among those

in the almond group. Lead author says " ..It would be beneficial to conduct

tightly controlled metabolic feeding studies and postprandial studies that

feature controlled amounts of carbohydrate to confirm the findings of this

study, which was performed in a free-living population. " ..Nutrients in

almonds, such as fiber and unsaturated fat, have been shown to help reduce

LDL-cholesterol, increase insulin sensitivity and increase beta-cell

function, all of which can help to prevent development of T2 and reduce the

risk of CVD. Almonds offer 3.5 grams of fiber, 13 grams of unsaturated fat

and only 1 gram of saturated fat per one-ounce serving.

25.%% M T2 Independently Predicts Asthma Risk (Reuters Health) Dec 10,10

- Patients with T2 have nearly twice the risk of asthma vs

non-diabetics..The link remained after adjusting for BMI and chronic

bronchitis. " More and more evidence is emerging that asthma - possibly mostly

adult asthma -has a strong metabolic component with ith inflammation of fat

tissue, " lead author said. " If asthma results in part from metabolic

disturbance, prevention could be possible through healthy activities

relating to exercise and diet. " [35,000 twins] Asthma was more common in DM

than in non-diabetics, both in men (13.5% vs.7.5%) & women (16.6% vs.

9.6%).The team reports that genetic factors accounted for 62% of the

variance in susceptibility to asthma. Shared environmental factors, on the

other hand, did not play a role. .it's still unknown whether DM treatment

has an effect on asthma.

26.%% NYTimes 12/20/10 What We’re Not Looking After: Our Eyes

Joe Lovett , 65 was scared, really scared. Being able to see was critical to

his work as a documentary filmmaker and, he thought, to his ability to live

independently. But longstanding glaucoma threatened to rob him of this most

important sense — the sense that more than 80% of Americans worry most about

losing, according to a recent survey. Partly to assuage his fears, partly to

learn how to cope if he becomes blind, and partly to alert Americans to the

importance of regular eye care, he decided to do what he does best. He

produced a documentary “Going Blind,” with the telling subtitle “Coming Out

of the Dark About Vision Loss.” In addition to Mr. L, the film features six

people whose vision was destroyed or severely impaired by disease or injury:

, an artist who lost her sight to diabetic retinopathy at age

32, but now teaches art to blind and disabled children. ..a schoolboy whose

vision is limited by albinism.., and who uses comedy to help him cope with

bullies.a, an architect in his 80s who has continued working despite vision

lost to age-related macular degeneration. Ray Korman, blinded at age 40 by

RPwhose life was turned around by a guide dog & who now promotes this aid to

others. , a fiercely independent woman legally blind

because of glaucoma and a traumatic injury, who continues to work as a

program support assistant for the VA. a soldier blinded at age 22 by a

roadside bomb in Iraq, who now lives independently and offers encouragement

to others injured at war. Sadly, the nationwide survey (1004 subjects;

2010; Interactive) showed that only a small minority of those most at

risk get the yearly eye exams that could detect a vision problem & prevent,

delay or even reverse its progression. Fully 86% of those who already have

an eye disease do not get routine exams. survey was commissioned by

Lighthouse International whose president emphasized that our rapidly aging

population predicts a rising prevalence of sight-robbing diseases like AMD &

DMc retinopathy that will leave “some 61 million Americans at high risk of

serious vision loss.” Low vision and blindness are costly problems .. In

addition to the occupational and social consequences of vision loss, there

are serious medical costs, not the least of them from injuries due to falls.

Poor vision accounts for 18 % of broken hips..So, why, don’t more of us get

regular eye exams? For one thing, they are not covered by Medicare & many

health insurers. Even the new health care law has yet to include basic eye

exams and rehab services for vision loss. Lighthouse is one of 5 regional

low- vision centers participating in a Medicare demo project in which

trained therapists teach patients how to use optical devices, make changes

in their homes to facilitate independence and how to maintain mobility

outside the home. . an interim analysis showed, the costs of providing these

services are well below what had been anticipated. I can think of no good

reason for excluding this coverage in the nation’s health care overhaul, any

more than there are good excuses for Medicare’s failure to pay for hearing

aids . But even those who have insurance or can pay out of pocket are often

reluctant to go for regular eye exams. Fear and depression are common

impediments for those at risk of vision loss, said Dr.Rosenthal, low- vision

specialist at Lighthouse. Pts worry that they could become totally blind

and unable to work, read or drive car, he said. Yet many people fail to

realize that early detection can result in vision-reserving therapy. Those

at risk include people with diabetes, high BP, high cholesterol or

CVdisease, as well as anyone who has been a smoker or has a family history

of an eye disorder like macular degeneration, diabetic retinopathy or

glaucoma. Smoking raises the risk of macular degeneration 2-6 times.

Furthermore, he said, the eyes are truly a window to the body, and a proper

eye exam can often alert physicians to a serious underlying disease like

diabetes, multiple sclerosis or even a brain tumor. Annual checkups are

best done from age 20 on, and certainly by age 40.. Waiting until you have

symptoms is hardly ideal. For example, glaucoma in its early stages is a

silent thief of sight. It could take 10 years to cause a noticeable problem,

by which time the changes are irreversible. For those who already have

serious vision loss, the range of visual aids now available is

extraordinary.. There are large-picture closed-circuit televisions, devices

like the Kindle that can read books aloud, computers and readers that scan

documents and read them out loud, Braille and large-print music, as well as

the more familiar long canes and guide dogs. On Oct. 13, President Obama

signed legislation requiring that every new technological advance be made

accessible to people who are blind, visually impaired or deaf. Producing

“Going Blind” helped to reassure Mr. L that he will be able to cope,

whatever the future holds. Meanwhile, the regular checkups and treatments he

has received have slowed progression of his glaucoma, allowing him to

continue his prof work and ride his bicycle..

27.%% M Utilizing the Second-meal Effect in T2: Practical Use of a

Soya-yogurt Snack 12/10/10; Objective - evaluate the effect of a

pre-breakfast high-protein snack upon post-breakfast hyperglycemia. [10 pt]

...eating high-protein prebreakfast snack results in almost 40% reduction of

postprandial glucose increment. The 2nd-meal effect can be applied to

improve postbreakfast hyperglycemia in those with T2.

28.%% Formula Type and Development of T1 12/10/10 Dietary Intervention in

Infancy % Later Signs of Beta-Cell Autoimmunity Summary - 5 autoantibodies

are associated with insulin-dependent (type 1) (IDDM), including antibodies

to: islet cells, insulin, glutamic acid decarboxylase, insulinoma-associated

2 molecule, and zinc transporter. this study asked whether altering early

food protein exposures could reduce the risk of developing some of these

auto-antibodies, theoretically reducing the risk for progression to IDDM.

l. [475 newborns with first-degree relative with IDDM]..study does provide

some compelling evidence that the immune response can potentially be altered

with early dietary intervention...

29.%% MedWatch - The FDA Safety Info & Adverse Event Reporting Program

Abbott Glucose Test Strips: Recall FDA & Abbott Diabetes Care notified

healthcare professionals and patients of a recall of 359 different lots of

glucose test strips marketed under the following brand names: Precision

Xceed Pro, Precision Xtra, Medisense Optium, Optium, OptiumEZ & ReliOn

Ultima. The problem relates to a defect that inhibits sufficient absorption

of blood into the test strip. Strips exposed to warm weather or prolonged

storage may be more likely to provide a false result. Test strips with lot

numbers that have been recalled may give falsely low blood glucose results,

which can lead pts to try to raise their blood glucose when it is

unnecessary, or to fail to treat elevated blood glucose due to a falsely low

reading. Both scenarios pose risks to health.. test strips were manufactured

between Jan & May 2010, are sold retail and online settings directly to

consumers, but are also used in health care facilities. FDA is releasing

recommendations ..how to determine whether a particular lot is affected,

howto order a free replacement set of strips, & what steps to take in the

meantime. Pts with DM should be aware of this problem and take steps to

prevent it from affecting their health. check for tests trips from the

recalled lots by visiting Abbott’s website to look up their product lot

number: www.precisionoptiuminfo.com

30.%% M Got Milk? Trans Fatty Acid in Dairy Foods Linked to Reduced DM Risk

12/21/10 Circulating levels of trans-palmitoleic acid, a fatty acid derived

from dairy food sources, are inversely associated with the risk of new-onset

diabetes mellitus and metabolic risk factors. The findings, open the

possibility that yogurt, milk, and cheese might one day be recommended in

attempts to lower the risk of developing atherogenic dyslipidemia, insulin

resistance, and DM. " In several recent observational studies, people who eat

more dairy foods tended to have lower risks of insulin resistance and

diabetes, " lead investigator said (Harvard). " However, the mechanism for

such potential protection is unknown. Trans-palmitoleic acid is a fatty acid

relatively unique to dairy foods. We don't make it in our bodies, so

consuming it is the only way for it to enter the bloodstream. [3736 adults]

Trans-palmitoleic acid represented less 1% of the total fatty acids measured

but was strongly correlated with biomarkers of dairy fat consumption. .. &

also associated with less insulin resistance and a lower risk of new-onset

DM..there was nearly a threefold difference in risk when individuals with

the highest levels of trans-palmitoleic acid were compared with those who

had lower levels.

31.%% Search for DM " Cure " Focuses on Beta-Cell Regeneration

Rabinovitch, MD 12/17/10 The Sanford Project began in June 2008 with the

goal of finding a cure for T1 through beta-cell regeneration. Beta-cell

regeneration is a relatively new and very promising area of diabetes

research. Scientists hope that the body's ability to generate new beta cells

can be exploited to reduce or even eliminate insulin dependency in T1. Dr.

Rab..is Asso Director of the Sanford Project. Dr. R: Our goal has been to

find a treatment that will work in T1 to achieve normoglycemia & hopefully

reduce the need for insulin. We have spent at least 5 years in the lab

determining which 2 medications we'd like to test in people with T1. We've

discovered in our basic research, using nonobese DM (NOD) mice with T1 that

we could restore them to normoglycemia with a combination of 2 drugs:

sitagliptin (Januvia®) and a proton-pump inhibitor (PPI). Sitagliptin, a

dipeptidyl peptidase-4 inhibitor, raises endogenous glucagon-like peptide-1

levels (GLP-1), & PPI, lansoprazole, raises endogenous gastrin. The

combination of GLP-1 and gastrin produced by these 2 drugs protected

existing beta cells in the mice, regenerated new beta cells from the

pancreatic exocrine duct cells, and at the same time stopped the autoimmune

reaction against the new beta cells. Both of these meds. are currently used

for other indications. ..Medsc: What prevents the immune system from

attacking the newly formed beta cells, the way it does in T1, to stop them

from producing insulin? Dr.R. We were surprised to find that we didn't have

to use any drugs to suppress the immune system to prevent it from reacting

against the new beta cells... GLP-1, induced by sitagliptin, & gastrin,

induced by the PPI, acted together against the immune system. So we are we

are generating new insulin- producing cells and we are preventing the

autoimmune reaction without using conventional immunosuppressive agents.

These are very exciting developments. I am confident that we will see some

new possibilities from this trial. I am not saying that these 2 agents will

get T1 off of their insulin entirely, but I am confident that they'll need

less insulin, have better glucose control, and avoid harmful swings in blood

glucose. Dr. R: We are planning to study sitagliptin and lansoprazole in

combo.therapy for new-onset T1- If it works in recent-onset we will expand

the study to those with longer-existing T1 -we will enroll 54 patients,

randomly assigned in a 2:1 ratio to active agents or placebo. Meds: How does

this research fit into the search for a cure for T1.. Dr. Ra: Most of the

emphasis in T1DM research has been on addressing the autoimmune response. we

are focusing more on regenerating beta cells.. counting on these agents to

not only regenerate but also stop the autoimmune attack. The advantage of

that, if it works, is avoiding serious immuno suppression. Medsc Is there a

chance that this therapy could work for T2 ..Dr. R: Yes. Sitagliptin is

already used in T2...We envision that regeneration of the beta cells might

work for T2 pts who otherwise would need insulin. When it comes to

restoring the ability of the pancreatic beta cells to make insulin in pts

with T1 there are a few different approaches. One method of replacing beta

cells, at present, is achieved by transplantation ..The material used as

human donor tissue to replace the insulin-producing beta cells is very

limited because it is obtained from deceased pancreas donors. It takes a lot

of work in the lab to prepare those donor cells for transplantation, and it

takes perhaps 3 or so different donors to provide enough insulin-producing

cells for 1 recipient. Moreover, the recipient must take immunosuppressives

to prevent immune system rejection of the transplanted islets. For these

reasons, we typically reserve that treatment for adult patients who have had

T1 for many years..Over the past 6 weeks since our clinical trial began, we

have enrolled 9 young patientswho were recently diagnosed with T1. At this

rate, we should have completed enrollment of all 54 subjects by spring 2011,

with final results 1 year later.

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

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

thl@...