Many articles

[Guest guest]

mark, living with type one diabetes, i can say i would rather die early than

have complications. being blind is bad enough but being legless is worse and i

want quality of life. karen

many articles

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

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

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

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

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

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

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

potential reason is suggested by substances called advanced glycation end

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

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

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

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

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

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

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

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

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

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

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

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

& getting regular exercise.

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

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

Dynamics announced new results from 3 studies that demonstrate the positive

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

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

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

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

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

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

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

metabolic functions involved in T2 through mechanisms similar to those that

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

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

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

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

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

contact with the intestinal wall may alter the activation of hormonal

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

Roux-en-Y gastric bypass procedure without surgery.

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

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

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

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

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

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

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

grow & develop cancer.

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

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

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

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

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

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

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

blurred vision, excessive thirst / hunger, frequent urination,

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

untreated hyperglycemia could lead to DM ketoacidosis, serious illnesses &

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

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

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

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

superior visual acuity gain over standard laser in pts with visual

impairment due to DME.

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

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

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

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

that can be administered by an outpt injection to provide substantial

benefit in pts with DME. .

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

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

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

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

to misdiagnosis of other

optic neuropathies reported by US providers. "

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

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

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

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

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

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

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

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

management of individuals with DM.

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

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

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

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

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

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

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

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

leader said

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

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

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

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

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

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

the risks in patients with coronary or cerebrovascular disease.

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

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

is associated with improvements in overall health but not in glycemic

control, according to the

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

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

telephone-delivered counseling can improve patients' access to effective

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

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

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

booster sessions.

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

months, limited generalizability because only 16% of participants were

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

participation. NIH

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

Emerging technologies allow profiling of metabolic status from a blood

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

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

spectrometry . A combination of 3 amino acids predicted future diabetes

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

These findings underscore the potential key role of amino acid metabolism

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

DM risk assessment.

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

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

additional CV risk factors to receive intensive therapy (targeting a

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

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

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

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

Blood Institute

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

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

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

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

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

individuals of white European ancestry was associated with T2.

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

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

established, recent studies suggest this might not reflect differences in

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

persons in glycated albumin .. & fructosamine levels parallel differences

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

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

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

systematically higher levels of nonfasting glycemia warrants further study.

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

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

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

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

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

indication that metformin, gliclazide & repaglinide are protective. They

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

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

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

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

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

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

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

bystander in patients with T2 & might contribute to morbidities associated

with this condition. "

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

By Monitoring Protein Levels Scientists are looking at blood levels of

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

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

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

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

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

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

20.%% delete

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

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

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

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

those with some microvascular manifestations, tightly controlled pts had

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

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

risk factors were age, peripheral neuropathy and lower urinary tract

symptoms.

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

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

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

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

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

or shaking.

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

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

Acting confused, or having problems paying attention.

. Having a tingly feeling around the mouth.

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

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

nasal placebo " Our finding that the antibody response to subcutaneous

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

evidence for immune tolerance induction to an autoantigen demonstrated by

rechallenge in humans, " they write.

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

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

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

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

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

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

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

resistant to develop T2. supported in part by NIH

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

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

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

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

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

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

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

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

blood glucose levels that occurs after they eat carbohydrates is exaggerated

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

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

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

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

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

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

system, computes insulin doses & administers them according to glucose

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

closely mimic the way the human pancreas normally releases insulin in

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

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

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

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

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

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

study, " said Kowalski.

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

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

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

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

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

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

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

risk equivalent. " writes study author.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

if these findings are applicable to women.

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

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

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

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

read this article in full..

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

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

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

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

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

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

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

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

tissues of the gastrointestinal tract. When pancreatic tissue becomes

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

#19]

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

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

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

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

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

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

dropped in 2011

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

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

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

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

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

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

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

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

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

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

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

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

levels.

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

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

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

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

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

compared with their obese & lean counterparts.

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

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

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

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

schoolchildren with T1 are a significant phenomenon & should be considered

in pt ed & DM management

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

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

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

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

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

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

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

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

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

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

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

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

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

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

markers of certain conditions. Autoantibodies are immune system proteins

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

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

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

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

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

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

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

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

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

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

's.

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

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

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

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

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

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

strengthens the immune system. Researchers are discovering that vitD also

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

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

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

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

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

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

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

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

blood test to measure your vitamin D levels.

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

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

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

suppression of liver glucose production. Addition of bromocriptine to poorly

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

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

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

placebo-controlled study.

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

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

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

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

years; ..

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

Angle Neovascularization in Proliferative Diabetic Retinopathy (PDR) Am J

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

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

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

vessels]

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

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

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

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

person's metabolism by significantly reducing levels of circulating amino

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

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

effect.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Guest guest]

1.%% M 11/30/11 In Diabetes With Chronic Kidney Disease (CKD), Moderate

Glycemic Control May Be Ideal - In patients with DM &

CKD, HbA1c targets that fall between 7% - 9% may be associated with

decreased risk for adverse outcomes, whereas levels either above or below

this range may increase this risk,according to a new study. [21,155 pts;3.8

yrs] for stage 3 & 4 of CKD, HbA1c levels above 9% were associated with

significantly higher all-cause mortality than HbA1c levels below 7%.

2.%% ADA 12/1 Liquid cinnamon extract helps control BS levels A

Meta-analysis of pts with T2 & /or pre-DM concluded cinnamon extract & /or

cinn. helps lower BS levels. " Consuming cinnamon..does produce a modest but

statistically significant lowering in fasting blood glucose, " said author

UC. published in the J of Medicinal Foods

3.%% M11/29 T2DM Risk Variants & Colorectal Cancer Risk [8060pts] 9 single

nucleotide repeats (SNPs) associated with T2 were tested in a case-control

study. Summary- results suggest that established T2 risk variants contribute

to the risk of colorectal cancer. This finding builds upon previous studies

showing an association between DM & colorectal cancer, & provides new info

on the complexity of the pathways shared between these 2 diseases.

4.%%M12/11 FDA Plan for Developing Artificial Pancreas[AP] Pleases Critics

Spurred on by DM advocacy grps & politicians to pick up its regulatory

speed,FDA issued preliminary recommendations to help, not hinder,

researchers & manufacturers in their pursuit of the AP. AP consists of an

insulin pump & a continuous glucose monitor (CGM) connected to a sensor

placed under the skin of a pt with T1. The system automatically doses the

right amount of insulin based on the pt's glucose levels. An ultimate form

of the system called " treat-to- target " would set a desired level for BS &

try to maintain it at all times, as opposed to merely staving off highs &

lows.. Such a fully automated device would allow people with T1, to lead

active lives without having to constantly check their glucose levels. Right

now, US researchers are testing the AP in inpatient clinical trials. At

issue is how quickly the research can reach the stage of outpatient trials,

which are already underway in other countries. Groups such as the

JDRF(formerly the Juvenile Diabetes Research Foundation) & ADA contend that

an overly cautious FDA has prevented life-saving technology from reaching

pts in a timely manner. More info on the draft guidance on FDA Web site

5.%% ADA 12/2 Video shows diabetes cell processes A team at La Jolla

Institute created videos showing immune system T-cells attacking

insulin-producing beta cells in the pancreas of mice.. " In the past,

scientists would remove a pancreas & make sections of it. That gave you a

snapshot of cellular destruction. But the videos let you see it happening.. "

www.upi.com/Science_News/ 2011/12/02/Video-

shows-diabetes-cell-processes/UPI-70301322850997/?spt=hs & or=sn

6.%% M 11/25 Moderate Drinking Tied to Lower DM Risk [80,000pts;26 yrs] the

team found that those who ate a diet high in refined carbs had a 30% lower

risk of developing DM than women with similar eating habits who didn't drink

alcohol. Previous research linked mod. drinking with lower DM risk, but this

study looked at women with high-glycemic diets. " If you eat a high carb diet

without drinking alcohol, your risk of developing DM is increased by 30%, "

said author [moderate- typically 0.8 oz of alcohol a day, about two drinks

per wk.] Dr. Hu isn't encouraging people to start drinking alcohol as a

means of DM prevention, but he does think the study reveals an interesting

interaction between alcohol & carbs. Am J Clin Nutr 2011.

7.%% M 12/9 Double-blind, Randomized, Multicentre,..Investigation of the

Effect Of Pioglitazone [actos] Metformin, & Combination of Both on CV Risk

in Pts With T2 Receiving Stable Basal Insulin Therapy Hanefeld et al;

Cardiovasc Diabetol.2011;10(65) [121 pts] Conclusions - In pts with long

term T2 & suboptimal stable insulin Rx the addition of [actos] but not

metformin reduced the level of inflammatory biomarkers & increased insulin

sensitivity & adiponectin The combo of pioglitazone with metformin resulted

in better HbA1C & lipid control without added effect on inflammation,

fibrinolysis, & renal function. No serious side effects were observed but

pioglitazone Rx was assoc with more edema & weight gain as expected.

Controlled clinical trials measuring CV endpoints are needed to compare risk

benefit of individual add-on treatment with oral antidiabetic drugs to basal

insulin, a question which is of high clinical relevance.

8.%%MNT12/8 Women On Rotating Night-Shifts At Increased Risk Of Type 2

Diabetes, Weight Gain In women, there is a strong association between

rotating night shift work and the risk of T2 . Long hours of shift work, is

also associated with greater weight gain. These findings by Hu of

Harvard School of Public Health This public health finding is representative

since a large proportion of the working population is involved in some kind

of permanent night shift work. Using statistical models, it was found that

the risks of women developing T2, increased with the numbers of years

working rotating shifts. The associations were slightly weaker after other

factors were taken into consideration. The findings show that preventative

strategies, in rotating night shift workers, should be considered. Since we

exist in an increasingly '24/7' society, and the option to eradicate shift

working is not realistic, it has been determined that rotating shift work

among T2 diabetes shift workers through promotion of healthy life styles,

weight control, early identification with treatment of pre-diabetic and

diabetic employees is needed.

9.%% M 12/5 New Criteria for Gestational Diabetes (GDM) Increase Diagnoses

The use of more stringent criteria for diagnosing GDM is associated with a

137% increase in prevalence. The new criteria, proposed by the Internat

Assoc of DM & Pregnancy Study Groups have been endorsed by ADA but not by

the Am College of Ob & Gyne-cologists. The new criteria call for the

diagnosis of GDM after a single abnormal fasting plasma glucose result of

92-126 mg/dL at the first prenatal visit or, if the initial test is normal,

an abnormal oral glucose tolerance test at 24 -28 wks of gestation... [660

pts] using the new criteria, were compared with a historic cohort that had

been evaluated using the old criteria. The dramatic increase in GDM

diagnosis seen with the proposed criteria have been the subject of much

discussion...

10.%% M 12/5 Depression Doubles Dementia Risk in Diabetic Patients

A large study [19,000 pts] showed those who also had depression had a 2-fold

higher risk of developing dementia over 5yrs compared with their

counterparts who did not have depression. In addition, younger pts with

depression also had a significantly higher risk for dementia vs those who

were older, whereas those who took insulin had a significantly lower risk

compared with those were not on insulin. " .., future studies are needed to

further evaluate whether effective depression interventions reduce the risk

of dementia and identify the mechanisms that may explain our observation, "

say investigators..

11.%% ADA 12/7 Fructose No Substitute for Glucose in Diabetes

Although it negates the dumping of glucose directly into the blood-stream,

fructose may not be an ideal sweetener for DM. Its links with

hypertension,[fat tissue] & increased uric acid levels could potentially

outweigh its immediate BS benefits, especially among DM pts who already have

or are at risk for such [problems] Fructose, the main sugar found in fruits,

is a monosaccharide, like glucose. But unlike glucose, which requires

insulin to move it into the body's muscle tissue where it's processed into

energy, fructose is metabolized by the liver. There, it's changed into

glycogen, a starch, & lipids, author said-Boston U. Some studies show that

fructose intake is linked with higher levels of triglycerides, potentially

contributing to weight gain. It's also been tied to increased levels of uric

acid- which situation has been linked with atherosclerosis, (hardening of

the arteries) a known complication of DM itself. The same problems could be

assoc. with high-fructose corn syrup, a polysaccharide that's chemically

similar to plain table sugar (sucrose.) It is half fructose & half glucose

Thus, diabetics get the initial dumping of blood glucose, plus the liver hit

of fructose. ADA doesn't recommend fructose as a substitute sweetener for

glucose. It does recommend fruit intake as part of a healthy diet -- the

amount of fructose in fruits is hardly enough to contribute significantly to

obesity.

12.%% JH 12/8 Diabetes & the Glycemic Index [GI] The GI is the amount that a

particular carbohydrate raises the blood glucose levels [bS] level as

compared with a slice of white bread, a reference point with a GI of 100.

Foods with a GI higher than 100, (instant rice), cause a faster & greater

surge in BS. Kidney beans score low at 38 - glucose jumps much less after

eating them. Because foods with a low GI (whole grains & most fruits & vegs)

do not produce as rapid an increase in BS levels when eaten,proponents of

these diets claim that they are more healthful than foods with a high index.

The GI can encourage better carb choices, such as eating more fiber & fewer

high-sugar foods, but it may also lead to worse choices, such as avoiding

carbs altogether & eating fattier foods. There are certain limitations to

the GI- For instance, it considers the effect only of the carb & not the

other foods you are putting in your stomach at the same time.. In our

opinion, Choosing healthy carbs is certainly beneficial, but this does not

have to be done with a careful glycemic index calculation.

13.%% 12/8 ADA Adding dapagliflozin to sulfonylurea improved HbA1c in T2

Study results demonstrate that when added to sulfonylurea therapy,

dapagliflozin reduced HbA1c at 24 weeks vs. placebo plus sulfonylurea in pts

with T2. The reduction was maintained at 48wks..[452pts;48wks]

EndocrineToday

14.%% MP 12/6 Diabetes, Obesity After 60 May Drive Up Breast Cancer Risk--

[2700pts developed breast CA out of 20,500 total pts; 10yr] Obesity after

age 60 boosted breast cancer risk by 55%. Up to 4yr after a DM diagnosis,

women of any age had a 37% higher risk of developing breast CA. There was

also a link between abnormally low levels of blood lipids or fats, & a 25%

higher risk. Glargine (Lantus) was linked with a nearly doubled risk of

breast cancer. However, metformin (Glucophage) was linked with a slightly

lower risk.

15.%% Eye 25 Dec 2011 Regression of early diabetic macular oedema (DMO) is

associated with prevention of dark adaptation [34pts] with mild

non-proliferative diabetic retinopathy [DR] & early, untreated

non-sight-threatening DMO slept for 6months wearing masks that illuminated

the eyelid of one closed eye. Conclusions Sleeping in dim light that can

keep rods light adapted may reverse the changes of DMO. Editorial same

source: Arden et al have tested the hypothesis that keeping an eye with mild

DR light adapted during sleep will substantially reduce rod oxygen

consumption, & thus will have remedial effects on the disease by making the

retina less hypoxic. In the dark, rods maintain the phototransduction dark

current, & the result is that oxygen consumption by rods in the dark is

greater than any other cell in the retina. In studies by Okawa et al, bright

light decreased retinal O2 consumption in the mouse by 40-60%..mostly due to

a drop in ATP consumption by the rods. To read in full...

16.%% MP12/8 DM Type 2:Insulin treatment T2 occurs when the pancreas (an

organ in the abdomen) produces insufficient amounts of the hormone insulin

& /or the body's tissues become resistant to normal or even high levels of

insulin. This causes high blood glucose (sugar) [bS] levels, which can lead

to a number of complications. Treatment includes lifestyle adjustments,

self-care measures, & medications, which can minimize the risk of DM-related

& CV compli-cations (heart attacks/strokes). Keeping BS levels in control is

one way to decrease the risk of complications. Heart disease a

macro-vascular disease is the most common complication of T2. Macro- means

large, & vascular means vessels. Also at increased risk of developing micro

vascular(small vessel) disease are the eyes, nerves, & kidneys, which can

result in blindness, foot ulcers/amputation, kidney diseases & impotence in

men. Micro & macrovascular comp-lications usually occur after many years of

DM & are related to elevated levels of BS over time. However, these

conditions may be present when T2 is first diagnosed due to a delay in

getting the diagnosis. Blood sugar control can be measured with a blood test

called A1C that measures the average BS during the past 2-3 months. The goal

A1C for most people with T2 is less than 7%. However, goal A1C levels in Pts

with T2 should be tailored to the individual- the A1C goal should be set

some what higher (8 %) for frail older pts & those with a limited life

expectancy.

T2 Treatment Options: Most people who are newly diagnosed with T2 are

treated with a combination of diet, EX, & an oral medication ( pills) Some

oral medications (eg, metformin) improve the body's response to insulin.

Other meds cause the body to produce more insulin. A second medication may

be added within the first 2-3 months if BS control is not adequate. Insulin

may be recommended early if the A1C remains elevated despite lifestyle

changes & DM pills. T2 typically progresses over time, causing the body to

produce less insulin & resist the action of insulin that is produced. In

addition, it can be difficult for some people to follow the recommended

diet, EX or Rx plan. Some people will need to add insulin or another

injectable med. because their BS levels are not controlled... Nat Institute

DM & Digestive & Kidney Diseases (www.niddk.nih.gov/) ADA

(www.diabetes.org) topic updated: Sept 20, 2011

17.%%MP 12/22 Hepatitis B Vaccine Recommended for Adults With DM --

Hepatitis B vaccination is recommended for all unvaccinated adults with T1 &

T2 aged 19 to 59, say new guidelines from the U.S. Advisory Com on

Immunization Practices (ACIP). The vaccination should be done as soon as

possible after adults in this age group are diagnosed with DM. Those who are

older than 59 can receive hepatitis B vaccination at the discretion of their

doctor. Between 700,000 & 1.4 mil people in the US are infected with

hepatitis B virus (HBV) More than 15 % of adults with chronic HBV infection

develop cirrhosis & liver cancer, authors noted. Diabetics are at increased

risk for HBV infection, which can occur through exposure to small, even

invisible, amounts of blood from an infected person who earlier used a

shared medical or glucose-monitoring device, the article states. HBV can

survive outside the body and is easily transmitted.

18.%%ADA 12/12 UK research into a rare genetic disorder (pancreatic

agenesis) may speed up progress towards stem cell treatments for T1. In

pancreatic agenesis, the body is unable to produce a pancreas, which plays

an essential role regulating BS levels. " What is it that programmes cells to

become pancreatic beta cells? Our study suggests that a gene GATA6 plays a

very important role in this process & we hope this will help the crucial

work to try & make beta cells for pts with T1. " team leader said. T1, or

insulin dependent DM is an auto-immune disease in which the body's own

defences attack & destroy pancreatic beta cells. Pub - Nature Genetics.

19.%% Am J Oph 153 Jan 2012 Panretinal Photocoagulation for Proliferative

Diabetic Retinopathy (PDR): Pattern Scan Laser Versus Argon Laser Purpose -

To evaluate the efficacy of the pattern scan laser(PASCAL)in treating newly

diagnosed high-risk PDR [82eyes;6m] Conclusions - When using traditional

laser settings, PASCAL is less effective than that performed with

traditional argon laser in obtaining lasting regression of retinal

neovascularization in previously untreated high-risk PDR. Physicians may

need to change Rx regime when using PASCAL pattern laser therapy for

high-risk PDR.

20.%% Am J Oph 153 Jan 2012 Retinal Arteriolar Tortuosity [twisting] is

Associated With Retinopathy & Early Kidney Dysfunction in T1 [1159

pts;12yrs] Conclusions-Greater retinal arteriolar twisting was independently

assoc with retinopathy & early nephropathy in T1. These findings may offer

the potential of measurement of retinal vessel tortuosity for diabetic

complication risk assessment.

21.%%ADA12/9 Glycemic Control Linked to Brain Structure & Function An

accelerated decline in brain function is an important risk that needs to be

examined further in relation to glycemic control in older people with

long-standing DM. At a mean age of 62, pts in MIND study (Memory in DM) were

" already experiencing an annual decline of total brain volume in a range

reported for pts 15 yrs older... " said Dir of neuroepidemiology -NIH " MIND

pts are at an age when disease processes in the brain begin to accelerate,

eventually leading to double the risk of dementia in pts with T2 compared to

people without this disorder, " she said at IDF. [2977pts;40m] 1 group had

intensive BS control; the 2nd-standard Rx -HbA1c 7-7.9%. Total brain volume

was assessed with MRI in a subset of 503 pts.. total brain volume in

cognitively stable non-DM people in their mid-70s declines by about 0.4% per

year, vs 0.8% in those who eventually convert to mild cognitive impairment

or dementia. Expert - USC said " It is likely that the cause for the

impairment in cognitive function in DM is multifact- orial & includes

dyslipidemia,hypertension, & inflammation "

22.%% M 12/13 # 1 of the Top 10 Articles for Endocrinologists in 2011 FDA

Approves New Drug for T2 The FDA (5/2- approved linagliptin (Tradjenta) for

improving blood glucose control in adults with T2, as a stand-alone or in

combo with other therapies. Tradjenta Linagliptin, (tablet) boosts the level

of hormones that stimulate the release of insulin after a meal by blocking

an enzyme - dipeptidyl peptidase-4. 8 double-blind, placebo-controlled

clinical trials showed that the drug is safe & effective in pts with T2. It

has been studied as a stand-alone Rx & in combo with other T2 Rx, such as

metformin, glimepiride & (Actos). 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 resp tract infection, stuffy or runny nose, sore

throat, muscle pain, & headache.

23.%% MP 12/14 Relationship between early-onset T2 and retinopathy severity,

premature development & risk factors Res Clin Pract. 2011; 94(2): cross

sectional approach [2,516 pts;10yr fup] Conclusions: Early-onset T2 subjects

are at risk of developing premature retinopathy caused by hypertension &

prolonged suboptimal DM control.

24.%% MP Glucagon-like peptide analogues for T2. Cochrane System

Rev.2011;(10): Glucagon-like peptide analogues are a new class of drugs used

in the Rx of Type 2 that mimic the endogenous hormone glucagon-like peptide1

(GLP-1) which is an incretin, a gastrointestinal [GI] hormone that is

released into circulation in response to a meal. [it] regulates glucose

levels by stimulating insulin secretion.. by suppressing glucagon secretion,

delayed gastric emptying & increasing satiety. [random.control;6899pts;fup

26 wks] all GLP-1 agonists reduced HbA1c levels by about 1%. Exenatide &

liraglutide reduced it by 0.20% & 0.24% respectively more than insulin

glargine. Both [of these]led to greater wt loss than most active

comparators. Hypoglycaemia occurred more frequently in pts who were also on

sulphonylurea. GLP-1 agonists caused GI adverse effects, mainly nausea.

Conclusions:GLP-1 agonists are effective in improving glycaemic control.

25.%% ADA 12/15 Needle-free, test being introduced to help Diabetics reduce

their risk for serious complications. Young or old, any ethnic background,

diabetes can hit anyone at anytime. A new tool is being tested to help

identify the disease in record time. Right now, 7 million diabetics are

undiagnosed in the US.. Pediatric endocrinologist Dr. S. Chalews says the

new tool uses light instead of an invasive skin biopsy to measure abnormal

proteins in the skin associated with DM complications...Two pts with the

same BS may have very different levels of glycated proteins. This new system

is being tested as a way to quickly screen large numbers of diabetics

without the need for drawing blood. The new device is restricted to

investigational use in the U.S. But it could get FDA approval by 2013. In

other related news, USC neuroscientists have found the missing link on how

the brain regulates BS. They identified the exact enzymes that lead to the

release of glucose-controlling hormones. Understanding how the body

naturally corrects for high or low blood sugar could change the way DM is

treated. Eyewitness News LA (KABC) --

26.%% MP Changes in ..autoantibodies (GADA & IA-2A) during progression to

T1..Conclusions: IA-2A titers increase during the years before the diagnosis

of T1D, even among those positive for IA-2A. In contrast GADA titers tend to

decline during those years.

27.%% MP Insulin sensitizers may reduce lean mass loss in older men with DM.

DiabCare.2011;34(11):Lee CG et al;[3,752pts;age 65; 3.5yr fup] Insulin

sensitizer meds (metformin & /or thiazolidinediones) Conclusions - Skeletal

muscle loss was accelerated in men with impaired fasting glucose & DM except

when they were treated with insulin sensitizers. These findings suggest that

these drugs may reduce muscle loss.

28.%% M12/5 Preserving Vision in Patients With DM J. B. Saaddine- medical

epidemiologist CDC Video.. People with DM often develop eye problems,

including diabetic retinopathy [DR], cataracts, & glaucoma. In addition,

diabetics also have sharp increases & drops in blood glucose that can change

the shape of the lens inside the eye & cause blurred vision.. DR causes

gradual damage to small blood vessels in the retina. It leads to vision loss

in 2 ways: proliferative DR, where new blood vessels grow along the retina &

the surface of the vitreous gel that fills the inside of the eye; & macular

edema, when fluid leaks into the center of the macula making it swell. Early

diagnosis & timely treatment can prevent 50%-90% of severe vision loss

related to DM. Vision loss from DR can be prevented in several ways. The

first step is maintaining good control of blood glucose, BP & lipids. Early

detection through screening is also important, since DR has no early warning

signs. Pts with diabetes should have a dilated eye exam given by an eye care

provider at least once a year, or more often if they have the advanced stage

of diabetic retinopathy. Depending on the condition, laser therapy or other

surgery may be options. Focal laser therapy, which is used to treat macular

edema, slows leakage & reduces the amount of fluid in the retina. Scattered

laser therapy shrinks abnormal blood vessels, but may cause a loss of some

peripheral vision. If bleeding is severe, patients might need vitrectomy.

Additional treatment options include medications such as ranibizumab or

bevacizumab. These medications are injected in the eye several times a year,

for life. Risk factors for diabetic retinopathy include high HA1c levels,

long duration of DM, & no recent eye exam.

29.%% ADA 12/15 Intense Exercise Lowers Blood Sugar T2 diabetics use glucose

more efficiently many hours after each activity Serena Gordon Health Day A

new study by M. Gibala, PhD -McMaster U. & J. Zonszein,M.D. Dir. Clinical DM

Center, Montefiore MedCenter, has found that 30 minutes of high-intensity

exercise a week resulting in a total exercise time of 75 min a week can

lower blood sugar [bS] levels for 24 hrs after exercise [EX]. This helps

prevent post- meal BS spikes in people with T2 . Muscles use glucose as a

fuel & EX helps the body use insulin more efficiently. Recommendations from

ADA suggest diabetics should try to get at least 150 min of moderate to

vigorous EX/week. [8 pts;av age 63;BMI 32] a level considered obese.For

2wks, they completed 6 sessions of high-intensity training. For one minute,

the EX was intense, followed by a minute of rest. The intense exercise was

done to get the heart rate to 90% of their maximal heart rate. It was found

that BS levels dropped from 137 mg per deciliter(mg/dL) to 119 mg/dL. BS

levels after meals were reduced long after training sessions were complete.

Biopsies from the thigh muscles showed increased skeletal mitochondrial

capacity, which showed improved metabolic health. Glucose-transports

proteins in the blood after EX, & these transporters move glucose into the

muscles. This study showed short bouts of EX can help the body better use

glucose, but that more exercise is better. C 2011 HealthDay

30.%% ADA 12/19 Diabetic Pancreases Sending Mixed Signals For the first time

in humans, researchers have shown that insulin signaling is changed in the

pancreas of people with T2. These faulty signals affect both the quantity &

quality of beta cells (the cells in the pancreas that produce insulin). In

most organs throughout the body, except the central nervous system, a dead

cell is replaced by a new cell that does the same job. Drs. Folli & Kulkarni

study findings show that the beta cells try to reproduce themselves but fail

because of the changed insulin signals. The inability of beta cells to

replicate them- selves leads to a huge problem with insulin secretion in

later stages of T2. The team also found that beta cell receptors (molecules

that receive signals from hormones) are extremely important for maintaining

a healthy number of beta cells. pub in PLoS ONE.

31.%% IDF 12/16 Diabetes Reversed With Investigational Weight Loss Drug -

Slightly more than a year of treatment with an investigational obesity drug

(Qnexa) that the FDA rejected for approval last year, reversed T2 in 15% of

subjects, The drug is a controlled-release combo of phentermine, an appetite

suppressant, & topiramate, an anticonvulsant. [146pts;1yr] pts were

randomized to receive placebo, a half or a full dose daily of the drug.

Results pts on the low-dose had a wt loss of 6.6%;those on the high dose

a12.1% loss;placebo group 2.8%. " Fasting BS & HA1c showed statistically

significant changes from baseline at the full dose, " presenter said although

she did not elaborate. Resolution of DM - absence of clinical & lab signs of

DM was seen in 1.7% of pts on placebo, 8.3% on half dose & 15.4% of those on

the full dose. The most common adverse events included constipation,

paresthesia, insomnia, dry mouth, headache, & dysgeusia [distortion of

taste]. In the FDA's response letter rejecting the company's New Drug App,

teratogenicity [abnormal fetal develop ment] was mentioned as a major

concern, as was elevated heart rate. Metabolic acidosis, sleep disorders, &

depression. Cognitive disorders, including attention, memory, & language

have been mentioned. The question is: Will they be able to show enough

safety so the FDA will be comfortable enough to approve it? The hope is that

they will, " said expert at USC..

32.%% ADA12/20 Driving Isn't An Issue for Most People With Diabetes

The biggest concern about drivers with DM stems from the risk of low blood

sugar (hypoglycemia), which can cause confusion & disorient-ation. While an

episode of hypo. can affect driving ability, the ADA says such incidences

are rare. An analysis of 15 previous studies found that, people with DM have

between a 12-19 % increased risk of a motor vehicle accident compared to the

general driving population. But, society tolerates riskier driving

situations all the time. People with attention-deficit hyperactivity

disorder(ADHD) have about four times the car accident risk of the general

public, while those with sleep apnea are about 2.4 times more likely to

crash. ..The ADA recommends that people who take insulin test their BS

before driving and retest at regular intervals if they're driving for longer

than 1 hour. " Pts with T1 are really normal these days. There's no reason to

restrict their driving ability, " said Dr. J.Zonszein, Montefiore Med Center

" Pts are very smart today, & have more technology to help them manage their

diabetes & avoid hypoglycemia. " The ADA also recommends having a fast-acting

source of carbs (fruit juice, hard candy or dextrose tablets) to quickly

raise BS available in the car & to keep an extra snack, such as cheese

crackers, handy, too. Other factors related to DM that could affect driving

include diabetic eye & nerve disease (peripheral neuropathy). Retinopathy

can affect vision & neuropathy can impair the ability to feel the gas and

brake pedals. ADA recommends that people with DM who may pose a risk while

driving be evaluated by a doctor familiar with diabetes. The bottom line for

people with diabetes, is to " know what your sugar is before you start to

drive, and don't drive if you're below 70 mg/dL. "

33.%% MND 12/23 Can Nerve Growth Factor Gene Therapy Prevent Diabetic Heart

Disease? DM can reduce blood supply to the heart tissue & damage cardiac

cells, resulting in heart failure. Research U Bristol, has studied if nerve

growth factor (NGF) gene therapy can prevent DM heart failure & small

vascular disease in mice. The critical finding from our research is that DM

reduces cardiac level of NGF. .. engineering the DM heart with AAVs

(adeno-associated viral vectors) to make it produce NGF can prevent heart

failure. said team leader.

Before this gene therapy approach can be trialled in pts additional

pre-clinical studies need to be done to verify not only the efficiency &

safety of AAVs-mediated NGF in T1, but also to find the most efficient AAV

serotype, optimal dose and delivery route to be used.

IDF International Diabetes Federation World Diabetes Congress 2011.

%% Abbreviations-acronyms fup-follow up; pt - patient or participant ; DM -

diabetes Mellitus; T1- type 1 DM;T2 - type 2; DME - diabetic macular

edema;DR - diabetic retinopathy; BS - blood sugar/ glucose; HbA1C- glycated

hemoglobin A1C; BP - blood pressure; NV- neovas cularization; CVD -

cardiovascular disease; CHD -coronary heart disease; MI -myocardial

infarction/heart attack;OCT-optical coherence tomography; BCVA - best

corrected visual acuity ;ADA - Am Diab Ass ; M- Medscape Web MD; MP- Medline

Abstract, Medline Plus; MNT- Med News Today;NEI - Nat Eye

Institute;SciA-Scientific American Definitions via online Medical

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

educator. Assistant Editor: Cam Acker, 50yr Diabetes survivor. Reports are

excerpted unless otherwise noted. [translations, explanations by thl] This

project is done as a courtesy to the blind/visually impaired & 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@...