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

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

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

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

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

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

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

potential reason is suggested by substances called advanced glycation end

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

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

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

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

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

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

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

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

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

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

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

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

& getting regular exercise.

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

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

Dynamics announced new results from 3 studies that demonstrate the positive

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

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

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

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

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

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

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

metabolic functions involved in T2 through mechanisms similar to those that

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

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

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

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

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

contact with the intestinal wall may alter the activation of hormonal

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

Roux-en-Y gastric bypass procedure without surgery.

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

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

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

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

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

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

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

grow & develop cancer.

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

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

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

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

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

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

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

blurred vision, excessive thirst / hunger, frequent urination,

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

untreated hyperglycemia could lead to DM ketoacidosis, serious illnesses &

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

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

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

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

superior visual acuity gain over standard laser in pts with visual

impairment due to DME.

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

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

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

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

that can be administered by an outpt injection to provide substantial

benefit in pts with DME. .

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

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

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

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

to misdiagnosis of other

optic neuropathies reported by US providers. "

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

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

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

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

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

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

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

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

management of individuals with DM.

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

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

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

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

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

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

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

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

leader said

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

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

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

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

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

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

the risks in patients with coronary or cerebrovascular disease.

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

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

is associated with improvements in overall health but not in glycemic

control, according to the

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

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

telephone-delivered counseling can improve patients' access to effective

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

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

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

booster sessions.

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

months, limited generalizability because only 16% of participants were

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

participation. NIH

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

Emerging technologies allow profiling of metabolic status from a blood

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

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

spectrometry . A combination of 3 amino acids predicted future diabetes

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

These findings underscore the potential key role of amino acid metabolism

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

DM risk assessment.

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

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

additional CV risk factors to receive intensive therapy (targeting a

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

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

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

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

Blood Institute

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

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

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

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

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

individuals of white European ancestry was associated with T2.

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

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

established, recent studies suggest this might not reflect differences in

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

persons in glycated albumin .. & fructosamine levels parallel differences

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

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

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

systematically higher levels of nonfasting glycemia warrants further study.

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

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

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

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

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

indication that metformin, gliclazide & repaglinide are protective. They

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

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

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

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

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

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

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

bystander in patients with T2 & might contribute to morbidities associated

with this condition.”

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

By Monitoring Protein Levels Scientists are looking at blood levels of

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

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

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

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

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

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

20.%% delete

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

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

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

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

those with some microvascular manifestations, tightly controlled pts had

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

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

risk factors were age, peripheral neuropathy and lower urinary tract

symptoms.

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

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

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

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

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

or shaking.

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

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

Acting confused, or having problems paying attention.

• Having a tingly feeling around the mouth.

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

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

nasal placebo " Our finding that the antibody response to subcutaneous

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

evidence for immune tolerance induction to an autoantigen demonstrated by

rechallenge in humans, " they write.

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

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

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

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

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

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

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

resistant to develop T2. supported in part by NIH

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

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

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

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

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

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

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

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

blood glucose levels that occurs after they eat carbohydrates is exaggerated

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

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

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

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

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

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

system, computes insulin doses & administers them according to glucose

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

closely mimic the way the human pancreas normally releases insulin in

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

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

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

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

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

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

study, " said Kowalski.

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

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

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

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

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

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

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

risk equivalent. " writes study author.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

if these findings are applicable to women.

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

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

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

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

read this article in full..

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

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

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

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

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

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

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

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

tissues of the gastrointestinal tract. When pancreatic tissue becomes

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

#19]

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

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

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

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

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

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

dropped in 2011

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

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

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

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

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

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

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

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

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

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

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

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

levels.

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

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

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

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

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

compared with their obese & lean counterparts.

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

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

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

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

schoolchildren with T1 are a significant phenomenon & should be considered

in pt ed & DM management

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

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

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

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

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

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

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

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

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

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

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

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

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

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

markers of certain conditions. Autoantibodies are immune system proteins

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

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

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

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

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

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

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

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

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

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

's.

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

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

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

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

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

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

strengthens the immune system. Researchers are discovering that vitD also

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

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

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

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

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

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

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

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

blood test to measure your vitamin D levels.

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

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

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

suppression of liver glucose production. Addition of bromocriptine to poorly

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

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

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

placebo-controlled study.

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

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

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

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

years; ..

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

Angle Neovascularization in Proliferative Diabetic Retinopathy (PDR) Am J

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

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

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

vessels]

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

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

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

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

person's metabolism by significantly reducing levels of circulating amino

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

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

effect.

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

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

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

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

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

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

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

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

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

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

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

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

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

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