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1.%%AACE 5/24 Expert Cites Need to Standardize Diabetic Medical Tattoos As

more DM pts swap medical alert jewelry for permanent ink, there is a growing

need to standardize, S Aldasouqi said. " First responders are not universally

educated about this.. consensus on a standard appearance & location for

medical tattoos is important. ..

2.%% AACE 5/25 Latent Autoimmune Diabetes (LADA) in Adults Often

Misdiagnosed as T2[100pts] The 2 strongest factors associated with LADA were

shorter duration of disease & a negative family history of DM. " We need to be

rigorous about defining whether some one has auto-immune DM or not,

regardless of age. the only way to know is to test, " G-Campoy U Minn.

3.%% M 5/31 Myopia Protects Against Diabetic Vision Loss [630 eyes; T1 & T2]

longitudinal study The team found that eyes with longer axial length (AL)

were less likely to have mild, moderate, or severe diabetic retinopathy.

They also saw a decreased risk for mild & mod but not severe, diabetic

macular edema. Dr. Gardner added. " Axial length is one of the few protective

associations we have in general, but in terms of actual practice, I'm not

sure how one actually applies it...The big question remaining is just why AL

is protective.

4.%% ADA 2012 6/11 Exenatide Beats Glimepiride in T2 — Although metformin is

first-line Rx for pts with T2, glycemic control fails with met alone in

many. Sulfonylureas are inexpensive, but cause hypo & wt gain, " G

Schernthaner said. Exenatide is a glucagon-like peptide-1 (GLP-1) agonist.

randomized controlled trial [1000pts] An HbA1c of less than 7% was achieved

in 44% of the ex group & in 31% in the glimepiride grp. In the ex grp, mean

weight loss was 3.32 kg; in the glimep group, mean wt gain was 1.15 kg Hypo

events were less frequent in the ex group. With GLP-1 agonists, you have

better durability, weight loss, & much less hypo .Dr S reports being a

consultant [numerous drug com]. Lancet. Pub online June 9, 2012.

5.%% AACE 5/29 Eating Disorder Problems in Some Diabetics

Diabulimia is a little known but dangerous practice in which T1pts, mostly

women, withhold insulin in order to lose weight. The term diabulimia is

relatively new but the disorder is not. Several years ago, JR Garber Harvard

had a group of diabetics who had complications, such as gastropathy &

autonomic neuropathy, much too early for the course of their disease. They

had T1 for less than 10yrs while these complications were typically seen in

those who had DM for 10-20yrs. [234women;T1] 30% reported restricting

insulin to lose wt. At 11yr follow-up, those who restricted insulin had

increased rates of DM complications & shortened lifespan. Factors that were

assoc with insulin restriction included greater eating disorder

symptoms,overall psychological symp, & fear of hypo at baseline. The more

control the group had over BG, the less progressive their wt gain. Possible

signs of diabulimia include:pt’s need for perfectionism with meal plans

gradually taking over body image as they entered adolescence. Med advisors

encourage an active lifestyle as a guard against diabulimia. Exercise is the

$10 billion drug that no one prescribes. Ca

6.%% ADA 5/29 Lower Limb Muscle Limitations Hamper Walking in Diabetes-

[835pts]S Volpato & team found that pts with DM had significantly lower

muscle density, knee/ankle strength, & muscle power after adjustment for age

& gender.

7.%% MP 6/12 Avandia & Actos- Thiazolidinediones class (TZD) - may raise

risk of macular edema [ME]. There has been a tie to increased risk of heart

attack in the case of Avandia & bladder cancer with Actos. In a new study

[100,000pts]1.3% of those on TZD developed ME by 1yr vs 0.2% of those not

taking TZDs–a 2-3 fold increase risk aggressive management of risk factors

for ME should be used in pts who take TZD. Routine screening for visual

acuity should be done during routine DM review. Macular edema is swelling of

the part of the eye( macula) which is responsible for sharp vision when

looking straight ahead. Swelling occurs when fluid leaks into the center of

the macula, blurring vision. About 20% of people with DM have this problem.

There are alternative drugs that lower BS, such as insulin & metformin.The

major limitation of this study is inability to separate out whether the

effect on ME is due to the drug or the underlying disease. Pts with DM

should seek prompt referral to an eye doctor if they have visual symptoms

while taking Avandia or Actos. Sources:S Singh, JH, Arch InternalMed ca

8.%%M 5/31 Hypertriglyceridaemia [HT] in T2DM Pts with DM are at markedly

higher risk of CVD, partly because of increased incidence of HT, a key

component of DM dyslipidaemia [disorder of fat metabolism also assoc with

pancreatitis Several drugs lower triglyceride levels, although pts may need

more than one.

9.%% M 6/22 Cognitive Aging Linked to Poor Glucose Control T2

The findings suggest that " older adults with diabetes or at risk should be

monitored closely for cognitive complaints or symptoms, " Dr. Yaffe UCSF

said. " special attention needs to be paid to that group, as cognitive

impairment could affect the ability to take care of DM as well. "

[3069pts;av74.2;10yrs]Mod Mini-Mental State & Digit Symbol Substitution Test.

Pts with DM had lower baseline scores than those without DM. it remains

unclear what the mechanisms are that link DM to cognitive aging, but authors

suggest that hyperglycemia may " contribute” ..via formation of advanced

glycation end products, inflamm & microvascular disease. " F Grodstein,

Harvard ..pointed out that hyperinsulinemia has been implicated in the

accumulation of amyloid beta in the brain, & amyloid beta plaques are the

hallmark pathology of Alzheimer's disease. Arch Neurol. Pub 6/18/12

10.%% ADA 6/20 Experiences of People with Long-Term T1DM to Benefit Others

Researchers at Joslin Diabetes Center have completed a study of 158 people

who have lived with T1 for 50 years. After many decades of follow-up, they

have concluded that a high proportion of this group of ptss developed little

to no DM eye disease over time. The study focused on patients known as

" 50-year Medalists, " working to improve the lives of people with T1DM by

reducing/eliminating the impact of its complications. Their results were

presented at the 72nd (ADA) Scientific Sessions in Philadelphia this past

weekend. Diabetic retinopathy (DR) refers to a number of vision

abnormalities that are all related to damage to the blood vessels in the eye

caused by high BG levels. It is the most common & one of the most serious

complications of DM affecting nearly 90% of people who have had T1DM for at

least 20 years. Although some treatment options exist, DR remains the

leading cause of vision loss among working age adults in the U.S. &

worldwide. The fact that approximately 40% of Medalists are relatively

unaffected by such a complication led the researchers to evaluate whether

these Medalists developed DR & then experienced regression or never

developed significant DR at all. The Joslin study characterized DR as an

important starting point for preventing/treating this complication of T1.

They stated that these Medalists have been relatively unaffected, which

implies that there may be biological or genetic protective factors that

could be utilized to benefit other people with T1DM. The progression of DR

seems to slow after about 4 years in comparison to those who do develop

advanced DR. After about two decades, the process of DR worsening

essentially seems to halt. This program proves to be as an incentive for

those who had lived with T1DM for 25 years, rewarding them for commitment to

good self-management techniques. In order to be selected as a 50-year

Medalist, like the patients involved in this study, a person must have lived

with documented insulin-dependent DM for at least 50 years. Juvenile

Diabetes Research Foundation Internat. MedNews Today 6/13/12 ca

11.%% MP 6/1/12 Opting for plain water might prevent DM- Women who choose

plain water, instead of sweet drinks have a lowered risk of developing -

[82,902 women;12yr] Sugar-sweetened drinks & fruit juice were tied to a

higher risk of DM, at a rate of about 10% higher for each cup drunk each

day. The team estimated that if women replaced 1cup of soda or juice with

one of plain water, their DM risk would fall by 7- 8%. The bottom line is

that plain water is one of the best calorie-free choices for drinks. Source-

AmerJClinical Nutrition, online May 2, 2012.Reuters Health ca

12.%% ADA 6/1 Depression Found to Increase Risk of Death in DM -- Sullivan,

& team collected responses to the Patient Health Question-naire (PHQ)-9

measure of depression symptoms [2,053pts with T2]For pts with PHQ-rated

probable major depression, all-cause mortality was significantly

increased-HR 2.24. " Depression increases risk of all-cause mortality & may

increase the risk of macrovascular events among adults with T2 at high risk

for CV events, " authors say.

13.%% ADA 6/5 New genetic factor associated with lean T2 diabetics [5000

lean pts T2;13,000 obese T2;75000 controls. The team found differences in

genetic enrichment between lean & obese cases, which support the hypothesis

that lean diabetics have a greater genetic pre disposition to the disease.

This is in contrast to obese pts with T2, where factors other than T2 genes

are more likely to be responsible. Genetic variants near the gene LAMA1,

were linked to T2 risk for the first time-an effect that appeared only in

the lean pts. " Whenever a new disease gene is found, there is always the

potential for it to be used as a drug target ..but more work is needed. lead

author said. " ..T2 may not be one disease, but may represent a number of

subgroups...PLoS Genetics.(ANI)

14.%%M 6/6 T2DM Risk Linked to Abdominal Fat Waist circumference, [WC] a

simple measure of fat distribution predicts who is most at risk of

developing T2, especially for women, .. large, case-cohort study by C

Langenberg & team [2 grps-12,403+ 6,154pts;10yrs] After adjusting for body

mass index (BMI), physical activity, smoking, & ed, the team found that

among women, each 1 standard deviation [sD] increase in WC leads to a 125%

rise in the risk for T2 vs a 37% rise in men. Obese women with a WC of

[34.6in] or larger were 31.8 times more likely to develop T2 than women with

a normal weight & a WC less than 31.4 " WC " is independently & strongly assoc

with T2, & should be more widely measured, " The team also caution since pts

were of European descent, not to infer WC contribution to DM risk in other

ethnic grps with different body composition & T2 incidence. PloS 6/5/12

15.%% M 6/8 Changes in Treatment Adherence & Glycemic Control During the

Transition to Adolescence in T1DM [225 age 9-11; 2yrs] treatment adherence

as measured by blood glucose monitoring frequency(BGMF) during transition

-HbA1c went from 8.2 to 8.6% & BGMF decreased from 4.9 to 4.5 checks/ day.

The magnitude of the effect of declining Rx adherence on BG control in young

adolescents may be even greater than those observed among older adolescents.

BGMF offers a powerful tool for targeted management of glycemic control for

T1.one less ck of BG per day period predicted an increase in HbA1c of 1.26%

J R. Rausch, et al; Diabetes Care. 2012;35(6):

16.%%NREndo July 2012 Management of DM: is the pump mightier than the pen? -

Continuous subcutaneous insulin infusion (CSII, or insulin pump therapy)

reduces HbA1c levels & hypoglycaemia in pts with T1 compared with multiple

daily insulin injections (MDI). Since the greatest reduction in HbA 1c

levels with CSII occurs in pts with the worst glycaemic control, the most

appropriate use of CSII in adults with T1 is in those who have continued,

elevated HbA1c or disabling hypo episodes with MDI.. The disadvantages of

CSII include higher costs than MDI & the risk of ketosis in the event of

pump failure. Pumps are not generally recommended for pts with T2 but may

improve control in some subgroups. A new generation of smaller insulin

infusion pumps with an integrated cannula, (patch pumps) could improve

uptake of CSII in general.

17.%% Nat 485 5/17 Immune system studies in T1 In T1 the immune system goes

haywire & depletes insulin-producing cells. JF Bach, immunologist U of

Paris.. Argues that T1 should be considered a “medical emergency” & that the

goal should be to reverse [it] as soon as possible...Much attention has

focused on T cells, thought to be behind the targeted killing of beta cells.

2 anti-CD3 antibody drugs, teplizumab & otelixizumab have been tested in

humans. In contrast to the mouse models, the effect in humans is temporary;

The same story of high hopes dashed in phase III trials unfolded for

glutamic acid decarboxylase(GAD), also involved in the immune attack.

Injections of GAD failed to either stem the loss of beta-cell function or

improve DM control.. This research cul-de-sac has prompted scientists to

look at innate, immune responses such as inflammation- proinflammatory

interleukin-1 (IL-1) can kill insulin- producing beta cells. The impact of

immunotherapy could extend beyond Rx.. become the basis for DM prevention,

since immune related destruction of beta cells is thought to begin several

years before DM becomes clinically apparent... “.. we need more basic

research“ ..beta cells in T1 might not be the victim of an immune attack,

but rather have defective responses to injury or stress..

18.%% ADA 6/15 Vitamin B12 Deficiency With Metformin Linked to Neuropathy in

T2 Peripheral neuropathy [PN] is typically diagnosed as diabetic neuropathy,

but this can also be a symptom of vitamin B12 deficiency. [84pts] B12

17.8%pts met hreshold for vit B12 deficiency & 26% for borderline def.

VitB12 levels were negatively assoc with age & duration of Met use. Lower

serum levels of vitB12 were associated with more severe PN. " I think we must

be careful about older patients & pts who take metformin for a long time..

we treat deficiencies with B12 supplements, " said Dr. Klen.

19.%% ADA 6/13 : Glycemic Control Reduces CV Risk A Swedish observational

study found an assoc between lowering HbA1c to 7% & a significant 45%

decreased risk of cardiovascular death over median follow-up period of more

than 5 yrs. [18,035pts;8-10yr fup] absolute risk of a death from a CV cause

was 9.9 events per1,000 person-years in pts with decreasing HbA1c &

17.8/1,000 in those with stable or increasing HbA1c. The team adjusted for

[includes] age, DM duration, sex, BP & BP Rx, lipid status/Rx & BMI, as well

as changes in those risk factors & treatments. The team found that better

glycemic control was significantly associated with risk reductions in fatal

& nonfatal coronary heart events of 39% .. Pts were receiving routine care

for T2 which shows that targeting HbA1c to 7% can help mitigate the higher

risk of CV events generally seen in DM. Eg-Olofsson K, et al " HbA1c

reduction & risk of CV diseases in T2DM:.. ADA 2012; Abstract 415 P.

20.%% M 6/12 Selenium Linked to Lower DM Risk The risk of T2 is as much as

24% lower among both men & women on a diet rich in selenium , a known

antioxidant [7,000pts;+10yr] The study rein-forces the need for a healthy

diet, while discouraging the use of sup- plements to get more S. The

Institute of Medicine, advisory panel to the US gov, recommends most adults

get 55 mcg of S per day. 3 oz of canned tuna, in water, contains about 68

mcg. & 1egg provides15mcg Selenium toxicity is rare, but health officials

suggest an upper limit of 400 mcg/day for adults as high levels can lead to

selenosis, with symptoms including stomach problems & mild nerve damage.

Brazil nuts sometimes contain more than 500 mcg of S per ounce. Pts with

higher levels of selenium are known to eat more whole grains & less

saturated fat, coffee & alcohol.Diabetes Care 2012.Reuters Health ca

21.%%6/12 M Enhanced Glucose Control May Prevent DM Neuropathy

A systematic review has added to the evidence suggesting that aggressive

control of BS in T1 & T2 may reduce the risk for diabetic neuropathy. future

research will need to identify optimal target levels to prevent serious

complications, DM Neuro affects 10% of pts with DM at diagnosis & 40-50%

after10yrs. A meta-analysis of 2 studies [1228 pts] found a significant

-1.84% reduced risk of developing clinical neuropathy in those pts with

enhanced glucose control (H A1c levels < 6.0%)vs standard control

(7.0-7.9%). A similar analysis [6669 pts] had an annualized risk difference

of -0.58% with intensive vs standard BS control. However, the incidence of

hypo events & serious adverse events, such as brain injury, was

significantly higher with intensive glucose control in both types of

diabetes. " Enhanced glucose control significantly prevents the development

of clinical neuropathy ..in T1 " Dr. Callaghan & team write. They add that in

T2, enhanced glucose control was assoc with a reduced incidence of

neuropathy, but the trend was not statistically significant. study not

commercially supported Cochrane Database Syst Rev. 2012;6.

22.%% AmJ Oph 154,1 July 2012 Fenofibrate – A Potential Systemic Treatment

for Diabetic Retinopathy [DR]? Review focused on 2 major randomized

controlled trials:[11,388pts T2] 5701 were treated with fenofibrate (±

statin) for up to 5 yrs. Fenofibrate reduced first laser treatment by 31% &

progression of DR..Conclusions There are now robust & consistent clinical

data to recommend fenofibrate as an adjunctive treatment for early diabetic

retinopathy in patients with T2.

23.%% AmJ Oph 152 July 2012 Enhanced Circulating Soluble LR11 in Pts with DM

Retinopathy [DR] Cross-sectional study [54pts] - Serum sLR11 concentration

may reflect progression of DR in pts with T2. sLR11, released from immature

vascular cells & indicating the development of atherosclerosis is expected

to be a new biomarker for DR in T2

24.%% M 6/26 Through the Fog: Recent Clinical Trials to Preserve ?-Cell

Function in T1DM For almost 50 years, T1 has been described as an autoimmune

disease characterized by the T-cell–mediated destruction of ?-cells, which

begins long before clinical diagnosis. Clinical trials ..aimed at modulating

the immune system before or after onset of clinical disease have failed to

prevent or cure T1... the pathway to achieve this goal remains elusive. To

see our way through the fog, we must increase our understanding of the

heterogeneous natural history of T1, focus efforts on preventing clinical

onset of disease, do proof-of-concept pilot studies prior to embarking on

large clinical trials, & more fully explore the relationship of residual

insulin secretion & clinical outcomes. Diabetes. 2012;61(6)

25.%%NatRevEndo July 2012 Modified LDLs linked to progression of retinopathy

in T1DM Abstract - High circulating levels of immuno-complexes containing

oxidized LDLs or advanced glycation end product (AGE)-LDLs are associated

with an increased risk of progres-sion of retinopathy in pts with T1. To

read this article...

26.%%NRvEndo July 2012 Cardiovascular autonomic neuropathies [AN] as

complications of DM - Diabetic AN are a heterogeneous & progressive disease

entity which commonly complicate both T1 & T2 ..hyperglycaemia, insulin

deficiency, metabolic derangements & potentially autoimmune mechanisms are

thought to play an important role. A subgroup of AN, cardiovascular

autonomic neuropathy (CAN), is one of the most common DM-assoc complications

& is clinically important because of its correlation with increased

mortality. The natural history of CAN is unclear, but is thought to progress

from a subclinical stage [includes]..heart rate variability to a clinically

stage with diverse & disabling symptoms. Early diagnosis of CAN, using

spectral analysis of heart rate variability or scintigraphic imaging, might

enable identification of pts at highest risk for the development of clinical

CAN enabling intensive therapeutic approaches.

27.%% ENDO 6/24 Sulfonylureas Up Mortality Risk in Diabetes DM patients

treated with 3 commonly prescribed sulfonylurea drugs had a 50% higher

mortality risk than those treated with metformin. The relative risk ranged

from 59% with glyburide to 68% with glimepiride. " Metformin, when not

contra-indicated, should be the first-line agent prescribed to control BS

levels in pts with T2. K Pantalone, said. Several studies have suggested

that some sulfonylureas might be safer than others; all 3 drugs are

available in inexpensive generic forms. Metformin offers an alternative to

sulfonylureas as first-line oral therapy for DM & also is available as a

generic. The team used an electronic health record (EHR) system to conduct a

retrospective study [23,915 DM pts;2.2yrs] pts treated with a sulfonylurea

had a mortality hazard ratio of 1.50 vs metformin, including: Glipizide --

HR 1.64, Glyburide-1.59 Glimepiride -1.68 " Our results suggest that if a

sulfonylurea is required to control BS levels, glimepiride may be the

preferred sulfonylurea in those with known CAD, " he said study supported by

AstraZeneca. Pantalone had no conflicts of interest.

28.%% M 6/22 Predictors of Mortality Over 8 Years in T2DM Patients [8334pts]

Results; the predictors of all-cause mortality included older age, male sex,

white race, lower income, smoking, insulin Rx, nephro pathy, higher LDL

cholesterol, angina/MI/coronary/bypass congestive heart failure, aspirin, &

diuretic use. Risk of death can be predicted in pts with T2 using simple

demographic, socio economic & biological risk factors with fair reliability.

DiabCare. 2012;35(6): © 2012 American Diabetes Association, Inc.

29.%% ADA 2012 Anti-Inflammatory Drug, Salsalate, Used for Decades, Now

Found to Lower Blood Glucose Levels in T2 Researchers have found that a drug

related to aspirin, first used by ancient Egyptians & Greeks for pain caused

by inflammation, also has glucose-lowering properties & may be a potential

Rx for people with T2 Salsalate, a pain med used for decades for rheumatoid

arthritis, lacks many of the side effects of aspirin & is available as an

generic, inexpensive drug. “We now have to determine whether the degree to

which this drug lowers BS is large enough to warrant using it as an addition

to the current DM drugs” [286pts;1yr] salsalate reduced A1C levels (a

measure of average BG levels over time) by 0.24%. The salsalate grp achieved

them while requiring lower doses of other DM meds than the control grp. NIH

study

30.%% MA Peripheral retinal ischaemia associated with diabetic macular

oedema. [DME] Purpose: To determine the relationship between retinal

ischaemia [insufficient blood suppy] & the presence of DME in patients with

diabetic retinopathy (DR) using ultra-widefield fluorescein angiography

(UWFA) imaging. [122eyes] There was a significant direct correlation between

DME & peripheral retinal ischaemia In addition, patients with retinal

ischaemia had 3.75 times increased odds of having DME compared with those

without retinal ischaemia BrJOph 2012;96(5): PreMedline Identifier:22423055

ENDO 2012. Houston

ADA 2012; ADA 72nd Scientific Sessions

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

diabetes Mellitus; T1- type 1 DM;T1A -autoimmune T1; T2 - type 2; DME -

diabetic macular edema;DR - DM retinopathy; BS/BG- blood sugar/glucose;

HA1C, glycated hemoglobin A1C; BP -blood pressure; CVD - cardio-vascular

disease; IR- insulin resistance; OCT-optical coherence tomography; BCVA -

best corrected visual acuity; RCT -Randomized controlled trial; ADA - Am

Diab Ass;J- Joslin DiabCenter; 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 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@...