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1.%% ADA 4/3 Risk of Parkinson Disease Onset in Patients With Diabetes A

9-year population-based cohort study[603,416 DM pts; 472,188 control] The

incidence of PD was 3.59 & 2.15 per 10,000 person-years for the diabetic &

control group, respectively, an hazard ratio (HR) of 1.61 Conclusions: DM is

associated with an increased risk of PD onset in a Chinese

population-relation is stronger in women and younger patients.

2.%% ADA 3/12 A fat gene identified that protects against T2- The

gene(ChREBP) converts glucose/sugar into fatty acids & boosts sensitivity to

insulin, the hormone that regulates BS. In most obese people, sugar is

blocked from entering fat cells, then blood sugar levels rise leading to

insulin resistance & T2. Obesity is assoc with metabolic dysfunction that

puts pts at higher risk for DM, stroke & heart disease, but a large

percentage of obese people are metabolic-ally healthy. The new study

disassociated obesity from its adverse effects. The team tweaked a " glucose

transporter " gene in obese mice that serves as a gateway for sugar. Usually,

its activity in fat cells drops with obesity. When the glucose transporter

levels was increased in obese mice, it allowed more sugar into their fat

cells which protected them from DM. Conversely, normal weight mice missing

that gene developed DM symptoms. Sugar in fat cells triggered a response

from the ChREBP gene that regulated insulin sensitivity throughout the body.

online edition of the journal Nature.

3.%% DiabCare.2012;35(2) Efficacy/safety of exenatide once weekly (EQW) vs

metformin, pioglitazone, & sitagliptin used as monotherapy in drug-naive pts

with T2 Random-double-blind study;26wks. Goal- test the safety & efficacy of

EQW compared with metformin (MET), piogli-tazone (PIO), & sitagliptin

(SITA)pts with T2. Conclusions: EQW & MET provided similar improvements in

glycemic control plus the benefit of weight reduction and no increased risk

of hypoglycemia.

4.%%M 3/29 Use Insulin Earlier, Not Later, in T2DM - Expert Interview

-J.Marquess, PharmD Insulin administration [iT]has traditionally been one

of the last steps in the Rx of T2 but that's changing, says Dr.M. Medscape:

Would you describe early initiation & intensification of IT. Dr.M It means

utilizing the guidelines from the ADA & using insulin sooner rather than

later. All too often, doctors...advise pts to take oral agent #1, then #2,

then oral agent #3, & then say, " Wow, I guess it's time to start insulin. "

M: Why is this topic important? Dr.M We have got a failing grade on the

number of pts that have their DM in control. In a lot of patients, the

hemoglobin A1c is above 7%-complications happen at a more prevalent rate [at

that level]..we have some fantastic insulins now that we didn't have just a

few years ago. We can now match pts' physiologic problems with the insulins.

M: What are some common misperceptions abt IT? ..pts think the needle is

really, long or that they will be perceived as having bad control of their

DM...I always say, " Let's talk about insulin pens. " One big challenges is

that this is not a 10 second talk.This disease is very complex- you have to

talk to them about ..watching what they eat, BG monitoring, physical

activity - how important that is & how to treat hypoglycemia with 15 grams

of carbohydrate.. & you have to continually ask the patient how they're

doing. AmPharmAssoc Annual Meeting 3/12/2012.

5.%% MPD 4/9 Anti-VEGF Shot Sharpens Sight in diabetic macular edema. [DME]

Laser has been the mainstay of Rx for DME for the past 3 decades. While the

technique reduces the risk of visual loss, it may not be quite as good at

improving visual acuity. That's why clinicians have been using VEGF

inhibitors off-label for this condition. The 2 most commonly used are

ranibizumab (Lucentis) which is approved for age-related macular

degeneration & avastin-long approved for various cancer indications. Both

drugs are made by Genentech, but ranibizumab injections can run $1,950 each

while bevacizumab costs only $50 per shot. [80pts with DME that persisted

despite previous laser] bevacizumab [avastin] injections compared with

further laser . Those who had the injections, had a mean gain of 8.6 letters

vs mean loss of 0.5 letters in the laser surg grp. Pts had a median of 13

avastin injections vs 4 laser Rx. They added that it's possible that a 4-wk

injection cycle may provide even better visual acuity gains. There were 27

ocular adverse events with avastin vs 7 in the laser group. There were no

cases of endophthalmitis & no unusual complications related to the

injection. UK. Arch Ophthalmol 2012;

6.%% M 4/2 Once-Daily Lixisenatide Effective for T2 Monotherapy [1 drug]

with the investigational GLP-1 receptor antagonist lixisenatide

significantly reduces postprandial [after meal] glucose & HbA1c in T2 V

Fonseca & team point out that while other GLP-1 receptor agonists are on the

market, exenatide (Byetta, Bydureon) & liraglutide (Victoza) -- lixisenatide

is highly selective for the GLP-1 receptor, & stimulation of insulin

secretion with lixisenatide depends " strictly " on glucose

levels.[361pts;12wk; random-double-blind] pts assigned to once-daily

subcutaneous [under skin] lix injections that increased in dosage in 1or2

steps or to similar placebo regimens. The proportion of pts achieving an

HbA1c <7% in the 2 lixisenatide groups was 52.2 & 46.5%, respectively, vs

26.8% in placebo grps. Rates of hypoglycemia were 1.7% in lix groups & 1.6%

in the placebo arms. Nausea was 23% with lix vs 4.1% with placebo). Authors

conclude, " The results support a role for once-daily lixisenatide

monotherapy ..in pts not controlled on lifestyle interventions ..DiabCare

2012.

7.%% ADA 4/3 Diabetes associated with more TB symptoms, adverse effects DM

increases the risk for developing TB threefold. [5,146pts with TB;most men.

On multivariate analysis, the following were assoc with DM: age +39 & being

an injection drug user Those with diabetes had more treatment adverse

effects & TB symptoms compared with those without DM. “Doctors & health

providers must be aware & increase the level of suspicion & screening when

seeing a pt with either DM or TB,” Moreno A. 22nd EuroCongClinMicrobiology &

Infectious Diseases; 4/3/2012;

8.%% M 4/3 Sulfonylureas in Diabetes Sulfonylureas, which stimulate beta

cells to produce more insulin are known to keep many pts with T2 off

injected insulin.. Recent guidelines by AmerCollege Physicians (ACP) state

that metformin should be used as a first-line agent to treat DM when diet &

EX are insufficient There was an assoc risk for severe hypoglycemia with SUs

which exceeds the risk with metformin The combo of metformin plus SUs is

assoc with 6x more risk for hypo The ACP statements suggest that, for

agents other than metformin, SUs should be considered 3rd or 4th line agents

for T2. Some DM agents, seem to preserve beta-cell function, but the action

of SUs " burns out " beta cells. .A significant benefit with the use of

sulfony-lureas is that they are very inexpensive - the only generic anti-DM

drug available. Guidelines that recommend SUs as initial or second- line Rx

tend to be much simpler & easier to follow., Some clinicians may prefer " the

devil they know " rather than newer drugs that seem to carry uncertainties.

More to come, later... M.L. Mintz, MD CA

9.%% MNT 4/9 Enzyme In Saliva Helps Regulate Blood Glucose [bG] BG levels

after starch ingestion are influenced by differences in salivary amylase

[sA]an enzyme that breaks down dietary starches. Higher SA activity is

related to lower blood glucose. Findings show a significant metabolic role

for salivary amylase in starch digestion. Other implications relate to

calculating the glycemic index of starch- rich foods & ultimately the risk

of developing DM. 2 pts may have very different glycemic responses to the

same starchy food, depending on their SA levels. Those with high SA are

better adapted to eat starches, because they rapidly digest the starch while

maintaining balanced BG levels. Those with low SA levels need to take their

amylase levels into account when paying attention to the glycemic index of

foods they are eating. Starch from wheat, corn, potatoes, & other grains

makes up to 60% of calories in the US. Amylase enzymes secreted in saliva

help break down starches into simpler sugars that can be absorbed into the

bloodstream thus influencing BG levels. [48 healthy adult] divided into high

amylase(HA) & low (LA). Each pt drank a corn starch solution. Afterwards,

pts in the HA grp had lower BG levels vs those in the LA grp. This appears

to be related to an early release of insulin by the HA pts. Pts with higher

levels of salivary amylase are able to maintain more stable BG levels when

eating starch. This might lessen their risk for insulin resistance &

non-insulin dependent DM. Future study focus will involve identifying the

neuro-endocrine mechanisms that connect starch breakdown in the mouth with

insulin release.

10.%% M 4/12 DM Linked to Phthalates Phthalates, [P] which are found in

common plastics, cosmetics, pharmaceuticals & medical devices, have been

associated with the development of DM among seniors in Sweden. 3 P

metabolites were associated with a 25-30% increase in the risk for DM. [1016

pt;70yrs +] 4 of 10 metabolites were detectable in blood serum of at least

96% of pts with DM. 4 P metabo-lites are commonly used in personal care

fragrances (includes- monoethyl P(MEP). monoisobutyl P(MiBP). MEP & MiBP

were significantly related to DM prevalence. The metabolites are related to

either poor insulin secretion or insulin resistance P metabolites are known

to affect glucose stability in humans. Further studies are needed that show

similar associations. However, for seniors at normal levels of exposure to

chemicals.. this study showed that several phthalate metabolites are related

to DM prevalence, as well as to markers of insulin secretion & resistance.

pub 4/2012 DiabCare.

11.%% M 4/10 Infant & Toddler T1DM Complications After 20 Years' Duration

S. Salardi, MD; et al:Diabetes Care2012;35(4): To compare the effect of the

prepubertal duration of DM on the occurrence of complications in 2 groups of

patients after the same number of years of the disease. [105 pts aged

16–40.3 years; 53 prepubertal at diagnosis (aged 0–3);52 were pubertal

Results: prevalence of diabetic retinopathy (DR) was higher in pubertal than

in prepubertal pts

Conclusions: If diabetes is diagnosed in infants or toddlers and the

prepubertal duration of DM is very long, the patients seem to be protected

against DR. This protection disappears if lifetime metabolic control is bad.

Instead, when onset is at puberty, the DR risk is higher & less dependent on

metabolic control & may be influenced by age- related factors, such as BP.

12.%%MA 4/6 Postprandial Administration of Intranasal Insulin Intensifies

Satiety & Reduces Intake of Palatable Snacks in Women Diab 2012;61(4):

Abstract - The role of brain insulin signaling in the control of food intake

in humans has not been thoroughly defined. We hypothesized that the hormone

contributes to the postprandial [PP] regulation of appetite for palatable

food..Two groups of subjects were intranasally given 160 IU insulin or

placebo after lunch. 2hr later con-sumption of cookies of varying

palatability was measured. In control study,the effects of intranasal

insulin administered to fasting female subjects were assessed. Compared with

placebo, insulin adm in the PP but not in the fasting state decreased

appetite as well as intake & rated palatability of chocolate chip cookies.

In both experiments, intranasal insulin induced a slight decrease in plasma

glucose but did not affect serum insulin concentrations. Data indicate that

brain insulin acts as a relevant satiety signal during the PP period, in

particular reducing the intake of highly palatable food, & impacts

peripheral glucose homeostasis. PP intranasal insulin adm might be useful in

curtailing overcon-sumption of snacks..

13.%% M 4/12 Higher HbA1c Levels Predict Better Outcomes in Advanced Heart

Failure [HF] With Diabetes — Patients with advanced HF who were also

diabetic had better 2yr survival if their baseline glycated hemoglobin

(HbA1c) levels were >[greater than] 7.3% in a new study. The retrospective

cohort study pub3/27/12 online in the AmerJ Cardiology. " We're finding that

in HF plus DM, higher HbA1C levels are associated not with worse outcomes,

but with better outcomes, " lead investigator Dr T. Horwich(UCLA)said. This

suggests that for pts with both diseases, " .. aiming for a midrange of 7.2

to 8.2% may be very reasonable ..in someone with advanced HF who may be

having difficulties with hypoglycemia or other adverse effects of DM meds,

less stringent glycemic control (HbA1C <8%) may be acceptable,” On the other

hand, " if patients are tolerating the meds without difficulties, current

glycemic guidelines should continue to be followed as we await further info

from prospective clinical trials. "

14.%% PostgradMed J2012;88 Diabetes-induced Osteoarthritis Data support

the hypothesis that DM could be an independent risk factor for OA. If

confirmed, this new paradigm will have a dramatic impact on prevention of OA

initiation & progression..Diabetes was first considered as a

non-inflammatory disease. However, we now know hyperglycaemia can trigger a

low-grade systemic inflamm. which would explain the increased risk of CV

events seen in pts with DM. Low-grade systemic inflammation is associated

with cartilage loss. ..an independent hyperglycaemia-induced systemic inflam

may also have an impact on the progression of OA. ..Finally, the

neurotoxicity of hyperglycaemia leads to a neuromuscular deficiency, which

will also worsen OA by destabilising the joint.

15.%% MPD Diabetes Diagnosis and Management 2011 Web cast for health care

providers- The Endocrine Society

http://www.softconference.com/endocrine/generic.asp?ID=8067

16.%% MA 4/11 Bevacizumab Beats Laser Therapy in Macular Edema Trial A

2-year randomized controlled trial suggests that bevacizumab (Avastin) is

more effective than macular laser therapy in pts with DME. R Rajendram,

Moorfields & team report " Many people are using bevacizumab, even though

this is the only study out there that shows any benefits, " said Dr.

Wayne State U " I think it's an important study, though it's not yet

definitive because there were only 80pts & you would usually like to have

hundreds. " Macular laser therapy had been the mainstay of treatment for

clinically significant DME since the 1980s. The procedure reduces the risk

for moderate visual loss, but visual acuity improves in less than 3% of pts.

Preliminary evidence has emerged that intravitreal injections of

antivascular endothelial growth factor (anti-VEGF) drugs are more

effective..patients randomly assigned to receive either bevacizumab or

laser. Those receiving avastin had an injection at baseline, 6 & 12 wks,

were reviewed at 18 wks & every 6 wks to wk 102 for the need of more

injections. If the central macular thickness was greater than 270 ?m at 18

wks the team continued injections until the pts had stable macular

thickness. Overall, the patients receiving bevacizumab fared better than the

pts receiving laser. The mean ETDRS best-corrected visual acuity at 24 m in

the Bev group was 64.4 letters(Snellen equiv 20/50) vs In the laser group

54.8 letters(Snell 20/80). The pts on Bev gained a mean of 8.6 letters,

while laser grp lost a mean of 0.5. The pts on bevacizumab had 27 adverse

events, 22 related to the injections. A few pts in both groups experienced

transient vision loss. 3 patients in the laser grp had serious ocular

adverse events. There were no cases of endophthalmitis, intraocular

inflammation, or retinal detachment in the bevacizumab group. " This

investigator-initiated single-center study provides evidence for the

longer-term use of bevacizumab, " authors write. UK Arch Oph online 4/9/12

17.%%Eye(2012)26,New approaches for treatment of DME -lucentis

Abstract The current standard therapy for DME-focal/grid laser... We

reviewed 1- & 2-year clinical trial findings for ranibizumab [lucentis] used

as treatment for DME... For DME with centre involvement & assoc vision loss

due, monthly ranibizumab with Rx interruption & re-initiation based on VA

stability is recommended. Laser therapy based on ETDRS guidelines is

recommended for other forms of clinically significant DME without centre

involvement or when no vision loss has occurred.. Since these

recommendations are based on randomised controlled trials of 1–2 years

duration, guidance may need updating as long-term ranibizumab data become

available and as additional therapeutic agents are assessed in clinical

trials.

18.%%Eye 2012)26, Distribution, reabsorption, and complications of

preretinal blood under silicone oil after vitrectomy for severe prolifer

ative diabetic retinopathy [DR] 44 pts;3-yr period. Intravitreal [avastin]

was used preop for cases with active proliferation, & in all cases at the

end of surgery. Conclusion - Most rebleeding occurred within the first

post-op wk, with gradual reabsorption within 4 wks; widespread.. bleeding

might result in severe reproliferation & detachment. A major complication of

preretinal bleeding was formation of fibrosis. Re-operation achieved a mild

VA improvement.

19.%% ADA 4/18 CV Autonomic Neuropathy Risk for CVD Despite Albumin Status

Cardiovascular autonomic neuropathy (CAN)

appears to affect the risk of CV disease even in T1 pts with normal albumin

excretion rates [NAR]. CAN is present in about a quarter of pts with T1,

The Danish team measured [includes] coronary artery plaque burden, coronary

artery calcium, & pulse pressure over 24-hrs in 56 NAR T1 pts 26 of whom

had CAN. Compared with pts without CAN, those with CAN had higher coronary

artery calcium scores. " CAN in normoalbuminuric T1 is associated with

distinct signs of subclinical CV disease, " pub online 4/12/12 Diabetes.

20.%% NatRevEndo Molecular connection between the nuclear & mitochondrial

aging processes that occur in pts with T2DM. The human body has a

chronological age & biological age. Biological age is represented by the DNA

sequence at the end of each chromosome, like the plastic tips on shoelaces

(telomeres). The telomeres get shorter each time a cell divides. Short

telomeres reflect accelerated aging. Many recently discovered genes that can

be manipulated to slow the aging process are involved in the control of

metabolism. Metabolic syndrome, is a precursor of metabolic disorders like

T2 & CV disease, which have been shown to be a sign of premature aging. DM

is a state of accelerated aging. While telomere shortening is associated

with T2, there is a lack of studies that explore the relationship among

telomere length, oxidative stress, mitochondrial DNA content, & the levels

of adiponectin (a protein produced by fat cells which play a role in the

development of obesity). Researchers reason that the susceptibility to

develop T2 & cardio-vascular diseases could be explained by studying these

emerging biomarkers. Unlike chronological aging, accelerated aging can be

reversed. With maintenance of appropriate mitochondrial function & telomere

length by pharmacological means or lifestyle modification there will be

potential for T2DM & associated vascular disorders. DiabResearch Found

India 4/17/12. Full report Courtesy of and edited by C Acker

21.%% NatRevEndo May 2012 Functional ß cells detected in long- standing T1DM

- a new hope for intervention? J Osório - C-peptide, a hallmark of ß-cell

function, can be detected in the serum of pts with T1 >30 yrs after disease

onset, report researchers from Harvard Med School. C-peptide [C-P] is a

chain of proteins that is spun off when the beta cell makes insulin. A

precursor molecule, pro-insulin is split into insulin & C-P. For every

molecule of insulin produced, your beta cells also produce a molecule of

C-peptide. C-P is removed from the bloodstream by your kidneys while insulin

is removed by the liver. A C-peptide test tells you whether or not you are

making C-P. If there is no C-peptide in a blood sample, your beta cells are

not making any insulin. A very low C-peptide results in the diagnosis of

severe T1DM. When doing C-peptide tests it is important to know whether the

C-P test is taken fasting/not fasting & what the blood glucose level was

when the sample was taken. A high fasting BS with a high C-peptide shows T2

caused by insulin resistance. In contrast, a normal C-P value taken at the

same time as a high fasting glucose suggests T2 where failing beta cells

rather than insulin resistance is the primary reason for raising blood

sugar. Unfortunately, there is no standard way a lab measures C-peptide If

you sent the same sample to a different lab, you could get a very different

result.

Here's what your C-peptide can tell you: 1. If your C-P is significantly

below the normal fasting range your beta cells are likely to be dead or

dying. A very low C-peptide value is a good way of diagnosing T1DM

(autoimmune) rather than T2DM. Some insurers require a C-peptide test result

below .5 nanograms/ml before they will cover the costs of an insulin pump.

2. If your fasting C-P level is high, it is very likely that you will be

able to control your BS by cutting way down on the amount of carbohydrate

you eat. It also means that you should first try strategies that lower

insulin resistance before trying drugs that stimulate more insulin. Exercise

may also be very helpful, as many find, to reduce insulin resistance.

Research suggests C-peptide rather than being only an inert by-product of

insulin synthesis, is rather important for preventing DM complications. If

it turns out that C-P is able to prevent complications, those who have

secretory defects that respond to beta cell stimulation may have to

reconsider whether or not to stimulate their beta cells with drugs like

sulfony-lureas or whether to supplement with injected insulin that does not

contain C-peptide. Provided & edited courtesy of C Acker.

22.%% NREndo May 2012 Bone, sweet bone—osteoporotic fractures in diabetes

mellitus C. Hamann, et al; DM adversely affects the skeleton & is assoc with

an increased risk of osteoporosis & fragility fractures. The mechanisms

underlying low bone strength are not fully understood but could include

impaired accrual of peak bone mass & DM complications, such as nephropathy.

T1 affects the skeleton more severely than T2, probably due to lack of the

bone anabolic actions of insulin & other pancreatic hormones. Bone mass can

remain high in T2 but it does not protect against fracture, as bone quality

is impaired The class of oral anti-DM meds-glitazones [Actos, Avandia] can

promote bone loss & osteoporotic fx in post-menopausal women & should be

avoided if O is diagnosed. A physically active, healthy lifestyle &

prevention of DM complications, along with calcium & VitD, is the mainstay

of therapy for O in pts with T1 or T2. Assessment of BMD [bone mineral

density] & other risk can help design tailored Rx plans. All osteoporosis

drugs seem to be effective in pts with DM.

23.%%MNT 4/11 A Step Closer To A Better Treatment For Autoimmune Diabetes

Insulin is needed for the regulation of BS levels. In T1,cells that produce

insulin are destroyed by the immune system. C Mathieu & team have attempted

to circumvent this response by taking advantage of the fact that the immune

system accepts foreign gut bacteria. They engineered gut bacteria which make

a form of insulin.. these special bacteria increased the frequency of cured

mice when compared to traditional methods, with seemingly no undesirable

effects. Traditional methods suppress the immune system, which brings

[risks] such as increased infections. This study provides a promising step

towards the ability to reverse T1 & other autoimmune disorders, without

incurring adverse side effects. J Clinical Invest

24.%% MP 4/19 Value of Metformin, Insulin Combo for T2 Questioned Danish

researchers who reviewed data from 23 clinical trials [2,200 pts 18+] found

that taking metformin plus insulin leads to better BS control, less weight

gain & less need for insulin. However, they also noted that the clinical

trials provided little info about long-term pt out- comes, such as deaths

from CV disease. ..more clinical trials are needed to determine the

long-term benefits & risks of the combo The team also believe the combo

combination of metformin & insulin raises the odds for severe low BS

(hypoglycemia) One US expert took issue with the findings. " It certainly

seems like a controversial statement since all our Rx is based on metformin

with additional meds [insulin or other] added when BS is no longer

controlled .. " Sources: MA Banerji, online April 19 in the BMJ

25.%% MPD 4/20 FDA Warns of Aliskiren Combos FDA warns against combining

the BP med aliskiren (Tekturna) with ACE inhibitors & angiotensin receptor

blockers (ARBS) in pts with DM, renal impair-ment The warning, is based on

the terminated ALTITUDE study which found increased risk of adverse events

in high-risk pts taking the direct renin inhibitor as an add-on to other

anti-hypertensive meds. DM pts who mix the drugs are at risk of renal

impairment, hypotension & hyperkalemia [high potassium]

26.%% ADA Sticky Molecules Linked to Brain Abnormalities in T2 People with

T2 are at greater risk of cognitive dysfunction, dementia, & Alzheimer’s

disease than those without DM. Previous research has found that certain

regions in the brains of those with DM seem shrunken compared to those

without the disease. Some scientists suspect that inflammation, which is

increased in people with DM, may be involved. [147pts;av age 65] MRI plus

blood tests to detect markers of inflamm. Tests of mental health, brain

function, & walking speed. Compared to those without DM, pts with DM were

slower walkers, were more likely to be depressed & their brains were more

likely to have problems with blood flow & atrophy. In the whole the brain

abnormalities correlated with levels of a set of molecules associated with

inflammation “adhesion molecules.” Levels of these molecules in the body are

also related to walking speed & brain function. The associations were

stronger in pts with DM. This study cannot prove that inflamm caused the

observed changes in brain structure & function, only that there is an

association. brain function may be related to inflamm--in particular,

adhesion molecules which could provide new targets for brain-saving

medications... Vera Novak et al; Diabetes Care 34: 2011

27.%% MA T2 associated with faster degeneration of bioprosthetic

valve [1113 pts;1113 controls] early (30 days) mortality rate was 7.8% vs

2.9% in pts with or without T2 respectively. 7 yr freedom from valve

deterioration in T2 pts 73.2% vs 95.4% in controls (hazard ratio 2.39) in

T2 Circulation 2012; 25(4)

28.%% ADA 4/19 ADA & European Assoc for the Study of DM(EASD) Issue Joint

Position Statement on Hyperglycemia Treatment ..new guidelines for managing

elevated BG levels in people with T2 have been developed jointly. The

guidelines call for providing all patients with DM education, in an

individual or group setting, which focuses on dietary intervention & the

importance of increased physical activity as well as weight management, when

appropriate. They encourage developing individualized Rx plans built around

a pt’s specific symptoms, co-morbidities,[other illness] age,wt

racial/ethnic/gender differences & lifestyles...DM is a complex disease that

manifests differently in different people & the best way for one person to

manage it may not work for someone else. For more info in English /Spanish:

call ADA 1-800-DIABETES (1-) visit www.diabetes.org

29.%% ADA 4/24 Medication, clinic appointment noncompliance ups mortality in

insulin-treated T2DM [15,984pts] data showed clinic non-attenders were more

likely to be smokers, younger, have higher gly-cated hemoglobin, &

significantly greater morbidity. Medication non-compliers were more likely

to have higher H1C ,were more likely to be women, smokers, & have greater

morbidity. Several authors disclosed financial ties to medical device &

pharm companies,

30.%% M 4/16 Sleeve Gastrectomy Proves Effective in DM Remission

Laparoscopic sleeve gastrectomy (LSG) has proved highly effective in

alleviating T2 & its complications compared with traditional medical

treatment Prospective cohort study of 60 morbidly obese pts with T2; 30 had

gastrectomy; 30-conventional med Rx. LSG is a minimally invasive procedure

-surgeon removes a major portion of the stomach & leaves a small

banana-shaped pouch. Of the 30 pts in the surgical grp, 24 (80%) had their

DM resolved by 18 m after surgery & reduced their mean body mass index (BMI)

from 41.3 to 28.3kg/m2 Mean BMI in traditional Rx grp increased from 39 to

39.8 & all pts remained diabetic. Conventional Rx included drug therapy,

regular physical activity, & 1200-calorie diet. Fleonetti et al; Arch Surg.

April 16, 2012.

31.%% M 4/17 Detecting Early Microvascular Disease in T1 - Wavelet

Transform Analysis..Diabetic retinopathy [DR] is assoc with markedly

increased risk of CV events. Analysis of retrobulbar [behind eye] blood

velocity waveforms should help characterise micro-vessels since waveform

morphology [structure] is partly determined by wave reflection. Ultrasound

exams of common carotid, ophthalmic & central retinal arteries done. [39

pts;mean age 33;Europids]. Wave-forms characterised into 11 bands. mean

amplitude was higher for pts with DM in several bands. Once microvascular

disease is detect-able in the eye, the risk of macrovascular CVD outside

the eye is increased many times.. Pt had good DM control, no history of CVD

& no significant disease complications. Brit J DiabVascDisease2012;12

32.%%ADA 4/23 Metabolites Linked to Insulin Resistance [iR] 20 meta

bolites, including amino acids, intermediates in glucose synthesis, ketone

bodies, & fatty acids, are assoc with IR Researchers, Finland performed

metabolic profiling with magnetic resonance spectroscopy in 7,098 pts (mean

age 31) Associations for [several] amino acids were sex- & obesity-dependent

" Metabolic signatures extending beyond obesity & lipid abnormalities

reflected the degree of IR in young, normoglycemic adults., " pub online

4/17/12 Diab.

33.%% Genetics Home Ref 4/12 Wolfram syndrome is a condition that affects

many of the body's systems. It’s hallmark features are high BS levels

resulting from a shortage of the hormone insulin (diabetes mellitus) &

progressive vision loss due to degeneration of opticnerves (optic atrophy).

People with Wolfram syn often also have pituitary gland dysfunction &

hearing loss. DM typically the first symptom is usually diagnosed around age

6...

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

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

edema;DR - DM retinopathy; BS/BG- blood sugar/glucose; HbA1C, glycated

hemoglobin A1C; BP - blood pressure; CVD - cardio-vascular disease; IR-

insulin resistance; MI -myocardial infarction/ heart attack; OCT-optical

coherence tomography; BCVA - best corrected visual acuity; RCT -Randomised

controlled trial; ADA - Am Diab Ass;M- Medscape Web MD; MA- Medline

Abstract, MP- Medline Plus; MNT- Med News Today;MPD - Med Page 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 DM 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@...