Guest guest Posted May 29, 2011 Report Share Posted May 29, 2011 1. %% M 5/2/11 FDA Approves New Drug for T2 -linagliptin (Tradjenta) either as a stand-alone or in combo. with other therapies. Tradjenta which comes in tablet form, boosts the level of hormones that stimulate the release of insulin after a meal by blocking an enzyme called dipeptidyl peptidase-4. Eight double-blind, placebo- controlled clinical trials showed the drug is safe and effective in pts with T2. However, the combination of linagliptin & insulin has not been studied. Clinicians should not prescribe linagliptin for pts with T1 or those who have DM ketoacidosis. The drug's most common adverse effects are upper respiratory tract infection, stuffy or runny nose, sore throat, muscle pain, headache. 2.%% M 4/28/11 New Diabetes Guidelines Address Gap in Compre-hensive Care In an effort to address the dangerous conditions that often accompany DM as well as the symptoms of the disease itself, The (AACE) has released new clinical practice guidelines for T1 & T2 emphasizing individualized, comprehensive healthcare for pts with DM. statistics show that DM patients suffer complications such as heart attack.. 3-7 times more often than those without diabetes, Unfortunately, many patients with DM do not have the most common complications of the disease - high lipids & high BP, in addition to high blood sugar under control. The new guidelines also address but also underrecognized problems affecting pts with DM , such as depression & sleep apnea.. The guidelines recommend a blood glucose target of an HbA1c level of 6.5% if it can be achieved safely- a level more stringent than that recommended by the ADA which recommends 6.9% or below. 3.%% [deleted] 4.%% Is Glucose Self-Monitoring Beneficial in Noninsulin Therapy? 4/22/11 Structured Self-Monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-Treated T2 [12-m; 483pt] 5.%% MP Structured Exercise Programs Help Lower Blood Sugar, 5/3/11- A structured EX program helped people with T2 lower their blood sugar level more effectively than just receiving advice about getting more physical activity. [47 randomized clinical trials; 8500pts] " If these pts can perform training for more than 150 min per wk, this would be more beneficial concerning their glucose control. However, if they cannot reach this level, lower exercise amounts are also beneficial. " The studies used hemoglobin A1C (HbA1C) to assess a particular Rx’s effectiveness. HbA1C, sometimes just A1C, is a measure of long-term blood sugar control. It provides an average of blood sugar levels over a 2-3 month period. ADA recommends that people with DM strive to lower their HbA1C levels to less than 7%. 6.%% 4/28/11 Joslin Diabetes Medication Misconceptions T1 & T2 One of the most pervasive myths about DM --both forms--is that it can be treated by simply refining your diet or exercising more. While this is certainly an option for some people with T2, it is absolutely untrue for people with type 1. T1 is an auto-immune disease that occurs when the body’s disease fighting system, the immune system, destroys all your body's insulin- producing cells. Insulin is a vital agent that your body needs to convert food into energy. If your body is not producing insulin, you must take it by injection or a pump to live. Insulin currently cannot be taken by mouth because the digestive juices will break down the insulin before it has a chance to get into your bloodstream to do its job. If you have T2, you may or may not need insulin injections. insulin injections are not for people with DM who have been " bad " instead, taking insulin is a reflection of insulin production by the pancreas. People just diagnosed with T2 generally are still producing some insulin- but their cells may also be resistant to the effects of insulin, so they need more than a person without DM. Sometimes oral DM drugs are needed to help your body produce more insulin or use it more efficiently. People who have had T2 for many years may ultimately discover that despite their best efforts, the oral drugs, along with diet & EX, no longer keep their blood glucose in a healthy range. This is not unusual - your insulin-producing cells may just be depleted from having to produce extra insulin to overcome insulin resistance for an extended period of time. At this time, insulin injections may be required to continue to keep your blood glucose in the healthy range to avoid long-term diabetes complications. 7.%% M 5/4/11 Stress Predicts Development of Impaired Glucose Metabolism Perceived stress and stressful life events predict the development of impaired glucose metabolism (IGM) over 5 years in previously normoglycemic [normal level of blood glucose] people The study showed that perceived stress increased the risk for incident IGM by between 1.0-1.06. " The effect size sounds quite small but for every point increase there is a 4% increased risk of developing IGM, so stress is quite a strong risk factor for IGM, " presenter said.. " ..we think stress management should be incorporated into health behavioral interventions for the most effective prevention and management of DM 8.%% M Comprehensive Review of the Effects of Diabetes on Ocular Health repub 5/4/11 DM afflicts 23.6 million people in the USA, & an additional .. 57mil exhibit prediabetic symptoms. Conclusion - It is clear that pts with uncontrolled DM are at risk of developing a wide range of ocular pathology. While treatment of sight-threatening retinal disease is paramount in these pts, visual morbidity can also result from DM-induced infection as well as damage to optic nerve, cornea, uveal tract, orbital tissues & lids, cranial nerves that innervate the [eye] muscles, & lens. Recent advancements in the Rx of some of these complications, such as the use of VEGF inhibitors & intravitreal steroid injections, have improved the visual outcome in pts. However, other advances in eyecare such as LASIK have presented DM pts with new challenges. The most important approach to the prevention of ocular complications in DM patients remains the maintenance of tight glycemic control. [References of over - 300 deleted] 9.%% Vista Center 5/2/11 New T1 clinical trials at UCSF Diabetes Centre From: S. E. Gitelman, M.D. The purpose of my letter is to inform you about 2 new exciting clinical research studies currently underway at UCSF for pts with recent onset T1. --Treatment of T1with Polyclonal Tregs Phase I study, the researchers will take T Regulatory cells (Tregs) from the pt’s blood, multiply them in the lab, & infuse them back into the pt to determine which dose of multiplied Tregs is the safest in humans & if they can prevent further beta cell destruction. --Reversing T1 After it is Established with Thymoglobulin (ATG) & Neulasta (GCSF) a randomized, placebo- controlled Phase I/II study designed to determine the safety of using a combo therapy (ATG + GCSF), & test its ability to retain/ enhance beta cell function in pts with established T1.Basic criteria: • Recent onset T1 [age 16 - 44 yrs] recruitment coordinator Kathleen Fraser or kfraser@... for more info 10.%% Oph 118 May 2011 Is Diabetic Retinopathy Related to Subclinical Cardiovascular Disease? Persons with DM retinopathy (DR) have an increased risk of clinical CV events.[927 pts] measures assessed included high coronary artery calcium score; ankle-brachial index.. Conclusions In persons with DM without a history of clinical CVD, the presence of advanced-stage DR is assoc with subclinical coronary artery disease. These findings emphasize the need to be careful about the use of anti–vascular endothelial growth factor [VEGF] for the treatment of DR. 11.%% Oph 118 May 2011 Incidence of Nonarteritic Anterior Ischemic Optic Neuropathy: Increased Risk Among Diabetic Patients [25515pts] randomly selected Conclusions -DM significantly increased the risk of NAION. incidence of NAION among pts aged 67 + may be higher than previously reported. 12.%% ADA 4/28/11 Insulin Pumps - Insulin pumps replace the need for periodic injections by delivering rapid-acting insulin continuously throughout the day using a catheter. They offer many advantages that can simplify DM management. Switching to a pump requires some adjustment, so discuss the options with your health care team before making a decision. By using an insulin pump, you can match your insulin to your lifestyle rather than adjusting your lifestyle to your body's response to insulin injections. People of all ages with T1 use insulin pumps, & people with T2 have started to use them as well. 13.%% MTD 5/3/11 Insomnia Linked To High Insulin Resistance In DM Lead author said " People who have a hard time controlling their blood glucose [bG] levels have a greater risk of complications, reduced quality of life, & reduced life expectancy. " [40pt;6 nights] poor sleepers had 23% higher BG in the morning, & 48% higher blood insulin levels. poor sleepers with DM had 82% higher insulin resistance than normal sleepers with DM. The next step is to see if treating poor sleep can improve long-term outcomes and quality of life for diabetics. 14.%% MTD 4/30/11 Researchers study Way To Make Insulin Cells ... A UCLA team shows that chemical tags called " methyl groups " bind to DNA, where they act like a volume knob, turning up or down the activity of certain genes. This is crucial to understanding how cells can be converted into insulin- secreting beta cells. . the basis for this conversion depends not on genetic sequences but on modifications to the DNA that dictates how the it is wrapped within the cell, " 15.%% Nat Med 5/2011 B cells promote insulin resistance through modulation of T cells & production of pathogenic IgG antibodies . Chronic inflammation characterized by T cell & macrophage [large white blood cell which takes in foreign material] infiltration of visceral adipose [abdominal fat] tissue (VAT) is a hallmark of obesity- assoc. IR & glucose intolerance. B cells accumulate in VAT in obese mice, but those mice lacking Bcells are protected from disease despite weight gain. .Rx with a B cell– depleting antibody decreases disease.. Moreover, insulin resistance in obese humans is assoc with a unique profile of IgG auto- antibodies. These results establish the importance of B cells & adaptive immunity in IR & suggest new therapeutic modalities for managing the disease. 16.%% Nat Endo 7, (June 2011) Endocrine disruptors in the etiology of T2DM Abstract - The etiology of T2 involves the induction of IR along with the disruption of pancreatic ß-cell function & the loss of ß-cell mass. In addition to a genetic predisposi tion, lifestyle factors seem to have an important role. Epidemiological studies indicate that the increased presence of endocrine disrupting chemicals (EDCs) in the environment may also play an important part in the incidence of metabolic diseases. Widespread EDCs, such as dioxins, pesticides & bisphenol A, cause insulin resistance and alter ß-cell function in animal models. These EDCs are present in human blood & can accumulate in and be released from adipocytes [fatcells]. After binding to cellular receptors & other targets, EDCs either imitate or block hormonal responses. Many of them act as estrogens in insulin-sensitive tissues & in ß cells.. exposure in mice produces IR & other metabolic alterations; during pregnancy, EDCs alter glucose metabolism in female mice. .. evidence already exists to consider exposure to EDCs as a risk factor in the etiology of T2.. 17.%% MAP 5/24/11 Long-term benefit of sustained-delivery fluocinolone acetonide (FA) [steriod] vitreous inserts for diabetic macular edema. [716pt ] Conclusions: Both FA inserts significantly improved best corrected visual acuity in pts with DME over 2 years, This is the first pharmacologic treatment that can be administered by an outpatient injection to provide substantial benefit in patients with DME for at least 2 years. 18. %% ADA -- Aerobic exercise alone or combined with resistance training significantly improves cardiovascular (CV) risk factors including H A1c, systolic blood pressure (SBP), triglycerides, & waist circumference in pts with T2. meta-analysis -34 studies pub 1970-09. Aerobic EX alone or in combo with resistance training, significantly improved H A1c levels & SBP. Triglyceride levels & waist circum also improved significantly, but these were measured in fewer studies.. Resistance training alone, or in combo with other forms of EX, was not associated with a significant impact on CV markers.” 19.%% ADA 5/10/11 Creatine supplementation improves glucose tolerance .. [25subjects;12wk; randomized, double-blind, placebo- controlled] Creatine, a natural amine in the human body, is partly synthesized by kidneys, pancreas, & liver as well as ingested from food- meat & fish..In summary, we reported a novel therapeutic role of creatine supplementation on metabolic control in T2 pts. .creatine supplementation might modulate glucose uptake in these pts mainly via an increase in GLUT-4... 20.%% ADA 5/11 Insulin resistance precedes mitochondrial dysfunction in T2DM It has long been known that people with T2 often suffer from dysfunctions in their mitochondria [M], organelles contained within cells that produce energy. However, it was not known whether these M irregularities were the cause of IR & DM, or whether a single preexisting difference accounted for both IR & impaired M function. The team examined people born with genetic defects in their insulin receptors- a dysfunction mimicking symptoms of T2. tests showed that insulin signaling dysfunction & insulin resistance are the root cause of M dysfunctions. Showing that IR is the cause of mitochondrial dysfunction rather than the other way around, could provide direction to researchers who are looking to solve the health consequences that can result from either condition. Aside from health complications assoc. with T2, M dysfunction can lead to muscle weakness, hearing loss, & loss of vision. 21.%% MAP 5/24/11 Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with Type?2 diabetes. [note some authors are now using ? Like this & also re beta-cells] [74pt;24-wk] randomized, to veg. or “conventional DM diet” Both diets were calorie restricted. All meals were provided. The second 12wk of the diet were combined with aerobic EX. Conclusions A calorie- restricted vegetarian diet had greater capacity to improve insulin sensitivity than conventional DM diet over 24 weeks. The greater loss of visceral fat & improvements in plasma concentrations of adipokines & oxidative stress markers with this diet may be responsible for the reduction of IR. The addition of EX training further augmented the improved outcomes. 22. MAP 5/24/11 Losing weight may not be required to lower a person's risk for DM, Rather, ..small dietary changes can make a big difference in risk, even without weight loss & particularly among blacks. [69 pts] lower-fat group consumed a diet comprised of 27 % fat & 55 % carbs. The low-carb group's diet was 39% fat & 43 % carbs. " At 8wks, the group on the lower-fat diet had significantly higher insulin secretion, better glucose tolerance and tended to have higher insulin sensitivity, " The findings were stronger among black participants. the results suggest that attention to diet quality, not quantity, can make a difference in risk for T2 23.%% MP 5/15/11 Scientists find " master switch " gene for obesity ...a gene linked to DM & cholesterol is a " master switch " that controls other genes found in fat in the body.. .. & since fat plays an important role in susceptibility to metabolic diseases like obesity, heart disease & DM, this regulating gene could be target for drugs to treat such illnesses.. Scientists have already identified a gene - KLF14 -as being linked to T2 & cholesterol levels, but until now they did know what role it played. [20,000 genes from fat under the skin of 800 pt] They found a link between the KLF14 gene & levels of many other genes found in fat tissue. genes controlled by KLF14 are linked to a range of metabolic traits, including body mass index, obesity, cholesterol, insulin & glucose levels. " KLF14 seems to act as a master switch controlling processes that connect changes in the behavior of subcutaneous fat to disturbances in muscle & liver that contribute to DM and other conditions, " 24.%% MP 5/13/11 More signs DM drug linked to bladder cancer - A review of official reports of drug reactions is revealing more signs that people taking Actos are at higher risk of developing bladder cancer. Between 2004 & 2009, there were 138 instances of bladder cancer in pts taking at least one of more than 15 different anti-DM drugs. However, more than a fifth of those bladder cancers were in pts on Actos (pioglitazone)a " disproportionate risk " in comparison with other anti-diabetics, ..these findings do not show Actos increases the risk of bladder cancer, the author cautioned - just that researchers should look into it further. Actos is in the same class of drugs as Avandia, which has not been associated with bladder cancer but has been linked to heart risks. FDA has said patients should not stop taking Actos unless told to do so by their doctor. 25.%% Diabetes.co.uk 5/24/11 Computed tomography (CT) scan, could help predict early death in patients suffering from T2. The study also revealed that diabetics were at an increased risk of developing heart & vascular disease. [1500pt;13yr]The team used a high coronary artery calcium (CAC) score to assess the risk of coronary heart disease being present in the blood vessels of the heart. For people with DM, there is a typically a wide range of calcified plaque that has built up in the heart & arteries. ..a significant risk of dying earlier was found in those with highest levels of calcified plaque in their blood vessels. . 26.%% M Can DM Meds Treat Depression? 5/15/11 The insulin- releasing properties of suphonylureas [sU] may include antidepres- sant effects. In study, DM pts prescribed a SU alone had the lowest likelihood for concurrent co-prescription with an antidepressant The presenter,in 2007 proposed a new hypothesis for the pathophysiology of depressive disorder, - that it might be a " diabetes of the brain " - an attenuated cerebral glucose metabolism in astroglia [type of brain cell]. [3.4mil persons’s data] " .SUs, " the only group of oral antidiabetic drugs directly stimulating insulin release (probably also in the brain as the drug has access to cerebral tissues), are associated with a significantly lower concurrent anti-depressant use...this data support the idea that there is a compensatory increased activity of brain insulin in depression. " ..it is important to realize that the glucose absorption of astroglia is influenced by insulin, whereas in neurons insulin does not have this effect. " 27.%% 5/17/11Breakthrough on insulin sensitivity and cholesterol .. removal of cholesterol by an enzyme (CEH) can reduce inflammation & slow development of T2. The team used a mouse model to assess the part CEH plays in regulating the removal of cholesterol from cells & making it available to high-density lipo protein (HDL), sometimes known as " good cholesterol " . ...when the CEH transgene is expressed, the mice showed improved insulin sensitivity, despite equal weight gain. Diabetes.co.uk 28.%% MAP 5/17/11 Influence of diabetes on endothelial cell response during sepsis. [infection] observational cohort study [207pts] Conclusions: During septic shock, pts with DM had higher levels of circulating biomarkers of endothelial cell adhesion & VEGF signalling (sFLT-1). Future studies should address whether enhanced activation of the endothelium [inner cell layer of blood vessels] places pts with DM at increased risk for the development of sepsis and worsening morbidity and mortality. 29.%% Another Anti-VEGF Drug Showing Promise for Diabetic Macular Edema (DME) (Reuters Health) 5/16/11 -.. intravitreal injections of a fusion protein called VEGF Trap-Eye proved superior to focal/grid laser treatment. The anti-VEGF drugs ranibizumab (Lucentis) and bevacizumab (Avastin), have recently been shown to be effective in reducing swelling in the retina and improving vision in these pts. But the team- Wilmer Eye Institute, s Hopkins - says VEGF Trap-Eye has some theoretical advantages over [lucentis & avastin] including a longer half-life in the eye, a higher binding affinity to VEGF-A, & the capacity for binding placental growth factors 1 & 2. [52-wk; 221 pts;randomly assigned to 1 of 5 groups] VEGF Trap-Eye led to significantly better mean visual acuity outcomes compared with laser therapy..results suggest it may be possible to prolong the retreatment interval from 4 wks to 8 wks. Local adverse events were ..consistent with those seen with other intravitreal anti-VEGF agents, " study sponsored by Regeneron Pharmaceuticals, 30.%% M Immunology and Immunogenetics, Joslin DM Center 5/11 T1 affects 1 in 300 people & the incidence of the disease is rising worldwide. T1 is caused by chronic autoimmune destruction of the insulin-producing cells. Exact etiology & primary auto- antigen are not yet known. The autoimmune, chronic, & progressive nature of DM raises the possibility of intervention, preferably by slowing down or stopping the destruction of the ?-cells. Since the 1980s, several attempts have been made to maintain ?-cell function using immuno-suppressive agents, immune modulation such as plasmapheresis, cytokine therapy, or antibody treatment. These agents were not DM s specific; the occasionally observed beneficial effect did not compensate for the often very severe side effects. According to the latest assumption, the administration of diabetes- specific auto- antigens can elicit tolerance, which can prevent the destruction of the ?-cells, hopefully without serious side effects...In T1 pts, not only these special cells, but the entire CD4 + T-cell population is down- regulated affecting [includes] cell cycle, key immune functions, & electron transport. There are 3 stages at which the process leading to T1 can be intercepted. In the first stage auto- immunity has not yet started - primary prevention The second stage is when the subject has already developed auto- antibodies signaling the presence of ongoing autoimmunity. The goal here is to prevent the onset of the clinical disease. These studies target those individuals at risk of developing DM, such as relatives of T1 pts carrying genetic markers, ..or showing an abnormal handling of glucose (but not yet diabetic). The third stage is when clinical T1 is already present but there is still a residual ?-cell function to preserve. If the autoimmune process is inhibited, there is a chance of regeneration of the ?cells. ..Glucocorticoids have been widely used as immunosuppressive treatments. Unfortunately several serious adverse effects can follow chronic Rx, including weight gain, dyslipidemia, & even steroid- induced DM. Cyclosporine & tacrolimus have an temporary immuno-suppressive effect & have toxic effects on kidney, liver, & nervous system Attempts to use plasmapheresis to maintain ?-cell function in T1 pts did not have any beneficial effects.. The anti- CD20 (rituximab) used in Rx of B-cell lymphomas, decreases the amount of CD20+ B cells & thus can also reduce auto-antibody production. The team recently completed a double- blind, placebo- controlled phase I clinical trial with insulin B chain. The vaccinated pts developed a vigorous insulin- specific humoral & T-cell response. Summary - There are many successful Rxs & prevention methods using NOD mice, but those failed to yield the same results in humans, The pathogenesis of T1 is different in humans & NOD mice. Using dogs or monkeys, is not feasible for ethical & financial reasons. Among the prevention & intervention studies, the most promising are those based on re-establishment of immune tolerance to DM-specific self-antigens. .increasing data indicate that the primary auto-antigen in humans is insulin or proinsulin. It is conceivable that combination therapies may need to be used to tackle autoimmunity; 31.%% M 5/12/11 How Does Type 1 DM Develop? The Notion of Homicide or ?-Cell Suicide Revisited Despite decades of acknow ledging that a loss of insulin-producing pancreatic ?-cells is central to the disorder now referred to as T1, the specific roles for genetic susceptibility, environmental factors, the immune system, and ?-cells themselves in the pathogenic processes underlying the disorder remain unclear...Many reasons exist with respect to why we are in this knowledge void, including the exceedingly complex nature of T1, the likelihood that this disorder may represent a disease with more than one etiology, as well as the complex interplay of genetics, the immune system, & environment. One limitation in solving important pathogenic questions in T1 has likely been suboptimal cross-talk among geneticists, epidemiologists, endocrinologists, & others. [long very technical discussion of research] .. the onset of T1 may not be solely a consequence of irreversible ?-cell death. Loss of insulin production more likely results from a combo of ?-cell destruction alongside partially reversible loss of ?-cell function caused by inflammatory cytokines. .. back to the question, is the death of a ?-cell in the pathogenesis of DM homicide or suicide? given what we have learned about the immune response & the ?-cell, our belief is that T1 appears to be a case of (immune) self-assisted homicide. 32.%% ADA Enzyme may increase IR and T2 risk Higher levels of an enzyme known as PKC-delta may lead to greater insulin resistance & a higher risk of developing T2, IR is one of the first steps in the development of T2. It occurs when tissue no longer responds to the hormone, which is responsible for removing glucose from the blood & converting it to energy. The findings showed that mice susceptible to IR had a gene that caused levels of the PKC-delta enzyme to rise. When these mice were fed a high-fat diet, enzyme levels increased at about the same rate as insulin resistance. However, when the team eliminated the gene from the mice, they were much less likely to develop IR. 33.%% ADA 5/20/11 Men with T2DM are more likely to suffer cardio-vascular complications than women [1123 subjects] while just 1.7% of women suffered a heart attack during the study period, 3.8% of the men did. Author concluded that regular MPI screening [myocardial perfussion imaging] is not recommended for women with T2 due to their relatively low rate of heart attack. However, the procedure may help men who are at the highest risk of suffering a MI. 34.%% Vitamin D Levels, Microvascular Complications, & Mortality in T1DM [227 pts] Conclusions—In patients with T1, severe vitD deficiency independently predicts all-cause mortality but not development of microvascular complications in the eye & kidney. Whether vitD substitution in T1 patients can improve the prognosis remains to be investigated. 35. %% MP 5/25/11 Combo of Paxil, Pravachol May Raise Blood Sugar Taken in combination, 2 commonly prescribed drugs, the antidepres sant Paxil & the cholesterol-lowering medication Pravachol, appear to significantly raise blood sugar levels..the increase is most apparent -- & concerning -- among diabetics. It's possible that the blood sugar spike triggered a diagnosis of T2 in some pts, Altman (Stanford) said. Neither drug alone raises blood sugar, & he said they can't yet explain the effect of the combination. Also, combos of other antidepressants & cholesterol-lowering drugs do not boost glucose levels. " It is not what we would call a 'class' effect, " Paxil(paroxetine) is in a class of drugs called selective serotonin reuptake inhibitors (SSRIs), & Pravachol (pravastatin) is a statin. The team used data from the FDA Adverse Event Reporting System, plus data from Stanford, Harvard & Vanderbilt to identify associations that would not be apparent to doctors treating individual pts. They found 135 non-DM pts on both drugs whose blood sugar increased 19 mg per deciliter after starting Rx & 104 diabetics whose blood sugar increased an average of 48 mg/dl while taking both drugs. People with blood sugar levels of 126 mg/dl or higher on 2 tests are considered diabetic. The team believes that of 33 million people currently taking Paxil or Pravachol, 500,000 - 1million take them together... Goldberg [u of Miami] thinks it's too early to change clinical practice based on this study alone. " This needs to be confirmed in a clinical trial, " he said. 36.%% M 5/26/11 Diabetic men are significantly more likely to require invasive second- and third-line therapies to manage erectile dysfunction (ED) than nondiabetic men, including surgical intervention. Data from a large medical-claims database found that DM men were more than 50% more likely than nondiabetic men to progress to secondary therapies, such as penile suppositories or injectables, within 5 years of an ED diagnosis. " Our results suggest that ED among diabetics may be less responsive to primary treatment with oral agents, more rapidly progressive than ED not associated with diabetes, or both, " Am Urological Assoc. 2011 37.%% 5/27/11 'ultra-bad' cholesterol present in elderly & people with T2. Scientists have discovered a new form of ‘ultra-bad’ cholesterol that increases the risk of heart disease. The ultra-bad form, called MGmin-LDL, has sugary molecules that are smaller and denser than those of normal LDL. The altered shape readily sticks to artery walls, providing a starting point for the build-up of dangerous fatty plaques. As the deposits grow, they narrow arteries and reduce blood flow. Eventually they can rupture, triggering a blood clot that causes a heart attack or stroke. ..U.S. Halts 'Good Cholesterol' Study a drug that boosts people’s good cholesterol did not go on to prevent heart attacks or strokes, leading officials to abruptly halt a major study yesterday. The disappointing findings involve super-strength niacin, a type of B vitamin that many doctors already prescribe as potential heart protection. The failed study marks the latest setback in the quest to harness good cholesterol to fight the bad kind. Mailonline UK AACE -American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress. Abbreviations: fup-follow up; pt - patients; DM - diabetes Mellitus; T1DM - type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema;DR - diabetic retinopathy; IR-insulin resistance;EX-exercise; FPG - fasting plasma glucose; BP - blood pressure; Rx-treatment ;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; M- Med scape 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@... Quote Link to comment Share on other sites More sharing options...
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