Long-Term Follow-Up Of Type 1 Diabetes Finds Heart Disease Rates Have Not Changed Over Past 30 Years

Study suggests better lipid and blood pressure control is needed

April 28, 2006, (University of Pittsburgh) — In one of the most comprehensive, long-term studies to date of the complications associated with type 1 diabetes, researchers at the University of Pittsburgh Graduate School of Public Health (GSPH) discovered that while cases of premature death and a few other complications have declined, rates of other serious diabetes-related disorders such as heart and eye disease have not improved over the past 25 to 30 years.

In the study, published in the May 1 issue of the journal Diabetes, the investigators analyzed long-term complications such as mortality, renal failure and coronary artery disease in 906 type 1 diabetics participating in the Pittsburgh Epidemiology of Diabetes Complications Study, or EDC. The EDC is an ongoing investigation to document long-term complications of type 1 diabetes among juveniles and adolescents who were patients at Children’s Hospital of Pittsburgh between 1950 and 1980.

To conduct their analysis, the University of Pittsburgh researchers and their collaborators divided EDC participants into five groups according to the year their diabetes was first diagnosed: 1950–1959, 1960–1964, 1965–1969, 1970–1974 and 1975–1980. The investigators then analyzed lifespan and illness data among the participants for three separate time intervals: 20, 25 and 30 years post-diagnosis.

Their analysis of mortality data showed that for each group, those diagnosed in later years lived longer. Indeed, individuals diagnosed in the 1950s had a five-fold higher rate of early death at 25 years post-diagnosis than those diagnosed in the 1970s. Some morbidity rates also were reduced. For example, kidney-failure rates declined significantly for those diagnosed more recently. At 20 years post-diagnosis, 4 percent of those diagnosed after 1964 developed renal failure compared to 16 percent among those diagnosed in the 1950s. At 30 years post-diagnosis, renal-failure rates had declined from 31 percent in the 1950s to 18 percent in the 1960s.

On the other hand, there were no differences across cohorts for rates of cardiovascular disease events and cardiac intervention procedures. Even when the researchers took into account the fact that revascularization procedures, such as balloon angioplasty and stenting, have become more common than they were in the 1950s and 1960s, their analysis found no differences in cardiovascular disease among the study population at either 20 or 30 years duration. Finally, there were no differences between the groups in rates of kidney dysfunction or proliferative retinopathy, a major cause of blindness in type 1 diabetics, at 20 and 25 years post-diagnosis.

“ Doctors have long considered type 1 diabetes a small blood vessel problem, so they have traditionally not focused on the potential large blood vessel complications, such as cardiovascular disease. However, our study suggests that doctors and their patients need to pay more attention to factors that affect the larger blood vessels, such as lipids and blood pressure,” explained Georgia Pambianco, M.S., M.P.H., lead study author, who has been a member of the EDC research staff from its inception.

Indeed, although focusing primarily on blood-glucose control has significantly decreased early death in type 1 diabetics, the data from this study suggests these individuals remain significantly burdened with other serious chronic diseases. “We were, in fact, both surprised and disappointed that there were no improvements in cardiovascular and retinopathy disease rates, particularly because other complications improved so dramatically,” said Trevor Orchard, M.D., professor of epidemiology, medicine and pediatrics at GSPH and principal investigator of the EDC. “Our data show that focusing solely on blood-glucose control is only postponing, not preventing, some of the more significant complications of this disease.”

Dr. Orchard, who also is medical director of the Nutrition Lipid Program at the University of Pittsburgh, said although there have been only a few studies in children on the safety of statins—the lipid lowering drugs—those studies found statins to be relatively safe. “This is certainly a group that could potentially benefit from more aggressive lipid control. In fact, much more focused attention needs to be paid to all cardiovascular risk factors, particularly lipids and blood pressure, and at an earlier age than we have been doing previously. This childhood-onset group is at a higher risk for cardiovascular disease even at early middle age. Waiting until they are adults to treat their lipids is too late.”

Ms. Pambianco added that “many of the guidelines currently used for managing type 1 diabetes are derived from what we know about people with type 2 diabetes. We need to recognize that they are two different conditions with different processes involved. Therefore, some of the complications we see in type 2 diabetes do not occur in type 1 and vice versa.”

More than 700,000 Americans have type 1 diabetes, an autoimmune disorder in which the body errantly attacks the insulin-producing cells of the pancreas. Type 1 diabetes, which is usually diagnosed in children and young adults, is the leading cause of new cases of blindness among adults aged 20 to 74 years and also is the leading cause of kidney failure in the U.S. Two out of three people with diabetes die from heart disease and stroke, and about 60 percent to 70 percent have mild-to-severe forms of nervous-system damage. Ten times as many people in the U.S. have type 2 diabetes—or adult-onset diabetes—which is most often the result of cells in the body becoming resistant to the effects of insulin. It is most often easier to manage than type 1 diabetes.

This research was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. In addition to Ms. Pambianco and Dr. Orchard, others involved in the study include Tina Costacou, Ph.D. GSPH; Demitrius Ellis, M.D., and Dorothy J. Becker, M.B.B.Ch., both at Children’s Hospital of Pittsburgh; and Ronald Klein, M.D., M.P.H., University of Wisconsin Medical School.

Posted by dlife at 09:26 AM | Comments (0)

Gene Chip Technology Unlocks Window on Diabetes

April 27, 2006 (Newswise) — Groundbreaking research using new Gene Chip technology has discovered a gene that appears to be linked to diabetes. The research was presented Thursday at the 15th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists.

The research was presented by C. Ronald Kahn, M.D., President and Director of the Joslin Diabetes Center and Professor of Medicine at Harvard Medical School. Dr. Kahn’s research is part of the Diabetes Genome Anatomy Project (DGAP), and shows that a newly discovered gene called ARNT (Aryl hydrocarbon Receptor Nuclear Translocator) may be closely linked to diabetes. In laboratory studies, mice without the ARNT gene were compared to normal mice. The mice without the ARNT gene developed hyperglycemia and diabetic symptoms.

Dr. Kahn says that this research is “opening up new diagnostic avenues for diabetes”.

“This breathtaking basic science should permit us a better understanding of the development of diabetes, and hopefully allow new therapeutic tools to manage diabetes more effectively,” said Victor L. Roberts, MD, Clinical Professor of Medicine at the University of Florida and member of the National Board of Directors of AACE.

The link between ARNT and its activity is being closely studied for its role in developing type 2 diabetes in humans. The gene chip technology is critical for the continued advances in this research. Gene chip technology uses a half inch chip in a handheld device that probes and displays RNA matches. RNA is critical for gene expression in health and disease. This area of investigation is known as genomics.

The Diabetes Genome Anatomy Project (DGAP) represents a unique, multidimensional initiative whose goal is to unravel the interface between insulin action, insulin resistance and the genetics of type 2 diabetes.

Diabetes is just one of the many endocrine disorders that is being addressed during the 15th Annual AACE Clinical Congress. New research involving vitamin D, thyroid cancer, androgen use, and performance enhancing drugs will be presented. In addition, hundreds of medical abstracts ranging from osteoporosis to reproductive endocrinology will be presented at exclusive poster sessions for registered media.

Posted by dlife at 09:52 AM | Comments (0)

Addition of Spironolactone Reduces Albuminuria in Type 2 Diabetes Patients on ACE Inhibitors

April 25, 2006 (Newswise) — Preliminary findings suggest that patients with type 2 diabetes mellitus (DM2) currently being treated with angiotensin converting enzyme (ACE) inhibitors benefit from a low dose of spironolactone as an effective and safe method of decreasing albuminuria, a first sign of diabetic kidney disease. These new findings will be presented at the American Association of Clinical Endocrinologists (AACE) Fifteenth Annual Meeting and Clinical Congress which will be held April 26 – 30, at the Hyatt Regency Chicago.

According to the National Kidney Foundation, kidney disease is one of the most serious complications of diabetes. Albuminuria in patients with DM2 confers a high risk of significant morbidity and mortality, including end-stage renal disease. While inhibition of aldosterone, a hormone released by the adrenal glands, has been previously demonstrated to decrease mortality in patients with heart failure, the data presented in this study support its emerging role in treating nephropathy of DM2.

This original research is being presented by Michael Benjamin Davidson, DO; Alan Wong, MD; Mariam Stevens, MD; Amir Hamrahian, MD, FACE and Elias S Siraj, MD, FACE. This study took place at the Cleveland Clinic in Ohio and was selected by the AACE to be featured as an oral presentation on Saturday, April 29, 2006. The AACE Fifteenth Annual Meeting and Clinical Congress will be held April 26 – 30, at the Hyatt Regency Chicago.

AACE is a professional medical organization with more than 5,300 members in the United States and 85 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine disease, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

For further information about AACE and the Annual Meeting, visit the AACE web site at http://www.aace.com.

Posted by dlife at 09:54 AM | Comments (0)

History of Gestational Diabetes Raises Lifelong Diabetes Risk in Mother and Child

Lifestyle Changes Can Prevent Or Delay Later Diabetes

April 25, 2006 (NIH News) - "It's Never Too Early to Prevent Diabetes", the latest diabetes prevention campaign message by the National Diabetes Education Program (NDEP), is spreading the word about the risk for type 2 diabetes faced by women with a history of gestational diabetes mellitus (GDM) and their offspring. On April 25th the NDEP joined Deputy Surgeon General, RADM Kenneth P. Moritsugu and Griffin P. Rodgers, M.D., acting director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one of the National Institutes of Health (NIH), in Washington to announce this latest message in an ongoing national public awareness effort. The NDEP is jointly sponsored by the NIH and the Centers for Disease Control and Prevention, agencies of the U.S. Department of Health and Human Services.

"It's Never Too Early to Prevent Diabetes" is the latest addition to NDEP's campaign, "Small Steps. Big Rewards. Prevent type 2 Diabetes", the nation's first comprehensive multicultural type 2 diabetes prevention campaign. The campaign offers materials that can help women with a history of GDM take steps to prevent or delay type 2 diabetes and help their children lower their risk for the disease. Available campaign materials include a tip sheet in English and Spanish for women who have had GDM, a tip sheet in English and Spanish for children at risk for type 2 diabetes, and a booklet for adults to help women and their families make healthy food choices and be more physically active to prevent or delay type 2 diabetes. These materials are available on the NDEP website at www.ndep.nih.gov.

"Mothers who've had GDM need to know that they and their children have an increased lifelong risk for developing type 2 diabetes," explained Moritsugu. "The risk doesn't go away. By making modest lifestyle changes to lose a small amount of weight, usually by making healthy food choices and being more physically active, women can help prevent or delay the disease. Children can lower their risk for type 2 diabetes by not becoming overweight or obese."

GDM is a form of glucose intolerance that occurs during pregnancy. GDM affects about 7 percent of all U.S. pregnancies annually, resulting in approximately 200,000 cases a year. After pregnancy, 5 to 10 percent of women who had GDM continue to have type 2 diabetes. Women with a history of GDM have a 20 to 50 percent chance of developing diabetes in the future, and their children are at increased risk for obesity and diabetes during childhood and adolescence compared to other children.

The Diabetes Prevention Program (DPP), an NIDDK-funded clinical trial, found that people at increased risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight through increased physical activity and a low fat, low calorie eating plan. The DPP included several hundred women with a history of GDM, and the powerful reduction in risk of diabetes demonstrated in the study -- up to 58 percent -- was found in all subgroups including this group of women.

"Diabetes prevention is proven, possible, and powerful," said Dr. Rodgers. "Small steps like eating fresh fruits and vegetables and whole grains, taking the stairs instead of the elevator, and playing with your kids in the park can yield a lifetime of healthy rewards for the entire family."

Recent reports have shown high or increasing rates for GDM in various parts of the country, including:

-- Washington, D.C, where in 2003 the GDM prevalence rate in Hispanic women was 12 percent -- close to the highest rate of 14 percent seen in some American Indian women.

-- New York City, where the GDM prevalence rate increased 46 percent from 1990 to 2002 -- with the highest increase found among Asian women.

-- Colorado, where the GDM prevalence rate increased 95 percent from
1994 to 2002 -- with the highest among Hispanic women.

-- Northern California, where the number of new cases each year increased 35 percent from 1991 to 2000.

These regional GDM prevalence rates raise concern that the increase may reflect the ongoing pattern of increasing obesity and contribute to the upsurge in cases of diabetes in the U.S.

The NDEP has materials for health care professionals and people at risk for diabetes -- including older adults, American Indians and Alaska Natives, Hispanics/Latinos, African Americans, and Asian Americans and Pacific Islanders. For more information about the NDEP or to obtain a copy of the new "It's Never Too Early to Prevent Diabetes" and "Nunca es muy temprano para prevenir la diabetes" tip sheets and other "Small Steps. Big Rewards." diabetes prevention materials, visit www.ndep.nih.gov or call 1-800-438-5383.

The U. S. Department of Health and Human Services' National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.

The National Institutes of Health (NIH) -- "The Nation's Medical Research Agency" -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.ndep.nih.gov.

Posted by dlife at 09:50 AM | Comments (0)

Half of Older Diabetics Lack Drugs to Protect Kidneys and Heart

April 18, 2006 (Newswise) - Only 43 percent of older people with diabetes receive medicines that could protect their heart and kidneys, despite the fact that virtually all of them could benefit from those drugs, a new study finds. And even among those with the most to gain from the medicines, the rate of use barely reaches 53 percent.

The classes of prescription medications, called ACE inhibitors and ARBs for short, have been recommended by national diabetes-treatment guidelines for years, because of the strong evidence that they can prevent heart attacks, strokes, kidney failure and other problems that disproportionately threaten older people who have diabetes. The inexpensive drugs are especially recommended for diabetics who already show signs of heart or kidney damage, or who have high blood pressure.

But the first national study of their actual use in diabetics over age 55 reveals a large gap between what should be and what is.

The study, published in the April issue of the Journal of General Internal Medicine, was conducted by U-M Medical School researcher Allison Rosen, M.D., Sc.D., using data from the federal National Health and Nutrition Examination Survey (NHANES).

“These are drugs that we know save lives and save money, and still we’re only using them in less than half of the people who could benefit,” says Rosen, an assistant professor of internal medicine at U-M who also holds positions at the U-M School of Public Health and the VA Ann Arbor Healthcare System. “It’s especially striking that their rate of use isn’t much higher in people most likely to gain – that is, those with multiple clinical indications and risk factors.”

Rosen notes that the study did not reveal the reasons that use of the drugs was so low. But she says that lack of awareness among physicians, the cost to patients and lack of effective measures to track and encourage use of the drugs may all contribute.

Last year, Rosen and her colleagues published a study showing that the Medicare system could actually save money while saving thousands of lives by giving free ACE inhibitors and ARBs to its diabetic participants in an effort to encourage more use of the drugs.

Such a program ultimately would save lives and reduce spending by preventing cardiovascular and kidney-related health complications — and the costly hospitalizations, dialysis sessions, operations and other treatments they would require.

Even if a free-medications program only increased ACE inhibitor and ARB use to 50 percent of patients, the Medicare system would still save money in the long run, the 2005 study found.

The newly published study is based on data from a nationally representative sample of adults over age 55 with diabetes, all of whom underwent a thorough health exam, medication review and interview under the NHANES program.

Rosen assessed the percentage that were using any drug in the ACE or ARB class, and tallied up each person’s total number of indications and risk factors that would increase the benefit that they would receive from the drugs.

Three clinical indications were examined: Cardiovascular disease of any sort including heart failure, history of heart attack or stroke, or clogged coronary arteries; high blood pressure, whether controlled by medication or not; and the presence of protein in the patient’s urine, a condition called albuminuria that indicates impaired kidney function.

National guidelines say that any diabetic who has even one of those clinical indications should be taking an ACE inhibitor or ARB, except for a very small number may not be able to take them. Studies also suggest that the drugs are beneficial to diabetics who smoke or have high cholesterol, but who have not yet experienced cardiovascular problems, high blood pressure or kidney problems.

In all, 92 percent of the participants in the new study met at least one of the three clinical guideline indications, and 100 percent either had one of the clinical indications or an additional risk factor for cardiovascular disease. Just over 34 percent had cardiovascular disease, almost 47 percent had albuminuria, and nearly 83 percent had high blood pressure. Nearly 73 percent had high cholesterol and 24 percent smoked.

“In other words, every one of the people in this nationally representative survey probably should have been taking an ACE inhibitor or an ARB, and most weren’t,” says Rosen. “The more risk factors and indications someone had, the more likely they were to be on one of these drugs, but still, even in people with four or more indications to be treated with these life saving drugs, only 53 percent were on them.”

Rosen says she hopes the study results will encourage physicians, insurers, hospitals and others to find new ways to encourage ACE inhibitor and ARB use among people with diabetes. She notes that the current “quality benchmarks” that are used to rate health care providers and health plans do not typically include measurements of ACE and ARB use. They do, however, often include a measure of how often diabetics’ receive urine tests — but they do not measure what happens after the results of those tests come back, especially if albuminuria is found.

“The way we’re measuring quality in this area is not working,” Rosen says. “We need to create incentives and benchmarks that will encourage responsible prescribing of ACE inhibitors and ARBs, while also creating conditions that will lower patients’ barriers to using these medications.”

In the meantime, she adds, people with diabetes should talk to their physicians about whether they should be taking one or more of the drugs in the ACE inhibitor or ARB classes of drugs. Such drugs are available as generic and brand-name medicines, and can cost less than $300 a year.

The study was funded by an Agency on Healthcare Research and Quality fellowship that Rosen held while she was at the Harvard University School of Public Health. To read about the ACE/ARB Medicare simulation study, published in the Annals of Internal Medicine in July 2005, see http://www.med.umich.edu/opm/newspage/2005/freemeds.htm. Reference: Journal of General Internal Medicine, Vol. 21 Issue 4.

Posted by dlife at 09:58 AM | Comments (0)

The Heart Truth Road Show Travels to Three Cities

Tour Features Free Screenings and Counseling, Health Information, and Designer Red Dresses on Display

April 18, 2006 (NIH News) - The Heart Truth Road Show, a heart health exhibit, will travel to local communities this spring to provide free health screenings, announced the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, U.S. Department of Health and Human Services (HHS). In collaboration with the American College of Cardiology (ACC) and the HHS Office on Women’s Health (OWH), the tour will stop in Pittsburgh, Memphis, and Washington, DC.

Only 13 percent of women consider heart disease to be their own greatest health risk. Yet an astonishing 80 percent of midlife women have one or more risk factors for heart disease such as high blood pressure or high blood cholesterol.

“We know that there is a disconnect among women as it relates to heart disease and their own personal risk,” said NHLBI Director Elizabeth G. Nabel, M.D. “Therefore, it is critical for NHLBI and our partners to be in communities that are at high risk of heart disease to help women better understand their own personal risk and empower them to take action for heart health.”

The Heart Truth Road Show travels first to Pittsburgh’s Century III Mall in West Mifflin, PA on April 21-23, and then stops at Southland Mall in Memphis, TN on April 28-30. The tour concludes in Washington, DC at Union Station on May 12-14, which is Mother’s Day weekend and the kickoff of National Women’s Health Week. Visit www.hearttruth.gov for additional information, including screening schedules.

Heart health screenings are an important step in assessing risk for heart disease. The Heart Truth Road Show will provide free screenings for diabetes, high blood cholesterol, high blood pressure, and body mass index. Also at each stop, ACC members, cardiovascular health care professionals, will be on hand to provide counseling. “Many women don’t realize that their risk for heart disease significantly increases based on the number of risk factors they have,” noted Dr. Nabel. “In fact, having just one risk factor can increase a woman’s chance of developing heart disease twofold. Having two risk factors increases the chance fourfold, and having three or more risk factors increases a woman’s chance of developing heart disease more than tenfold.”

The heart health exhibit will also highlight NHLBI’s Red Dress, the national symbol for women and heart disease awareness first introduced by The Heart Truth’s ambassador Mrs. Laura Bush. Accompanying the free screening and educational materials will be a display of six designer red dresses from The Heart Truth’s Red Dress Collection Fashion Shows, which are held each February in New York at Olympus Fashion Week. Designs to be exhibited at each mall include those worn by the following celebrities: Calvin Klein worn by model Christie Brinkley; Carmen Marc Valvo worn by singer Lee Ann Womack; Tracy Reese worn by the Mamas and the Papas singer Michelle Phillips; Betsey Johnson worn by singer Nelly Furtado; Luca Luca worn by tennis star Venus Williams; and Esteban Cortazar worn by “American Idol” judge Paula Abdul.

NHLBI continues to lead the nation in a landmark heart health awareness movement that is getting results and raising awareness across the country. A 2005 survey shows that 55 percent of American women know that heart disease is the leading killer of women, up from 34 percent in 2000.

The Institute created the Red Dress to deliver an urgent wake-up call to American women, and it has become the much-needed rallying symbol to unite partners — the fashion world, the women’s health community, major corporations, and voluntary and community groups — toward a common goal of greater awareness and better heart health for all women.

The Heart Truth is a national awareness campaign for women about heart disease. Its partners include: The Office on Women's Health, Department of Health and Human Services; the American Heart Association; WomenHeart: the National Coalition for Women with Heart Disease, and other organizations committed to the health and well-being of women. Visit www.hearttruth.gov for more information.

The American College of Cardiology, a 33,000- member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at: www.nhlbi.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

Posted by dlife at 09:56 AM | Comments (0)

Markers of PCOS Inherited, Persist and Raise Risk for Heart Disease, Diabetes

April 17, 2006 (EurekAlert) - Menstrual irregularity and unhealthy metabolic traits associated with polycystic ovary syndrome (PCOS) are inherited and persist with age, putting women with PCOS at a high risk for cardiovascular disease and type 2 diabetes.

That finding is reported in a new study published April 17 in the early online edition of the Proceedings of the National Academy of Sciences (www.pnas.org).

"There have been few studies looking at the long-term consequences of PCOS. Results of our study strongly suggest that metabolic problems will continue as women with PCOS age," said senior author Andrea E. Dunaif, M.D., Charles F. Kettering Professor of Endocrinology at Northwestern University Feinberg School of Medicine.

Dunaif is also professor of medicine and chief of endocrinology, metabolism and molecular medicine at Feinberg and president of The Endocrine Society.

PCOS is a common problem affecting about 7 percent young adult women. Women with this disorder have irregular menstrual cycles and elevated levels of male hormones, or androgens, which may result in excessive facial hair growth and acne.

PCOS is frequently also associated with insulin resistance, and the syndrome is a leading cause of type 2 diabetes in adolescent and young adult women. Another negative health feature of PCOS is abnormal lipid levels, but the reasons are controversial. Insulin resistance, type 2 diabetes, increased low-density lipoprotein (LDL) levels and metabolic syndrome all increase risk for heart disease.

Studies of women with PCOS, by definition, have been limited to women in their reproductive years; therefore, little is known about their health as they age. The long-term health consequences of PCOS are of considerable importance because many of these women have risk factors that confer substantially increased risk for developing cardiovascular disease and other problems.

It is well documented that PCOS runs in families. Though limited, past studies of mothers of women with PCOS have shown increased androgen levels, insulin resistance, and glucose intolerance, suggesting that these traits are inherited.

Dunaif and colleagues Susan Sam, M.D., of Feinberg, and Richard S. Legro, M.D., of Pennsylvania State University College of Medicine, Hershey, tested their hypothesis that abnormal lipid levels are inherited in families of women with PCOS, and assessed the impact of age on reproductive and metabolic characteristics.

The researchers studied 215 non-Hispanic white mothers of women with PCOS and a control group of 62 women of comparable age, weight and ethnicity, drawn from the National Health and Nutrition Examination Survey III (NHANES III).

The study group was limited to non-Hispanic white women because of the potential confounding effects of ethnicity on insulin sensitivity and lipid levels. All participants were asked to complete a questionnaire on their reproductive history, exercise habits, tobacco use, and alcohol intake.

In investigating lipid levels, the researchers found that mothers of women with PCOS had elevated total and LDL cholesterol, but triglycerides and high-density lipoprotein (HDL) cholesterol levels did not differ between the groups. The mothers had markers of insulin resistance. They also had an increased prevalence of the metabolic syndrome, compared with nationwide prevalence in normal women of similar age.

The strongest predictor of LDL levels in mothers was their daughters' LDL levels. The researchers had previously found that elevated LDL levels are the predominant lipid abnormality in women with PCOS, a finding that was mirrored in the mothers' group.

Over 30 percent of mothers reported a history of irregular menstrual periods. There were no differences in age or body mass index between these mothers and those with a history of regular menses. Mothers with menstrual problems also had higher levels of androgens, glucose and LDL compared with mothers with a history of regular menses, suggesting that these mothers may have had PCOS.

Total testosterone and unbound testosterone levels were higher in mothers with a history of irregular menses than in controls. Prevalence of elevated androgen levels was likely underestimated in this study because of a general decline in ovarian function with age, which leads to lower circulating androgen levels.

"Menstrual history is an accurate marker for PCOS in both epidemiologic and genetic studies," Legro said.

Almost 50 percent of mothers had metabolic syndrome compared with 32 percent of the control group. There was a significant increase in the prevalence of metabolic syndrome in obese mothers compared with the general population represented by the women in NHANES III.

Moreover, the researchers believe that the prevalence of metabolic syndrome in mothers is underestimated because mothers receiving medications for hypertension, diabetes or elevated lipid levels were excluded. Overall, these findings suggest that mothers of women with PCOS should be screened for cardiovascular disease risk factors.

Posted by dlife at 10:08 AM | Comments (0)

Two New Studies Published on Anodyne Photo-Therapy Demonstrate Significant Pain Reduction in Patients Suffering from Chronic Conditions

TAMPA, Fla., April 17, 2006 (Business Wire) - Anodyne(R) Therapy, LLC announced today that two studies involving over 2500 patients have been published on its patented photo-energy treatment device.

A 2239 patient study was published in the March/April issue of Diabetes and Its Complications and showed a 67% reduction in pain in patients with chronic foot and leg pain when Anodyne Therapy was used as part of a comprehensive plan of care. The second study published in the March/April issue of Physical and Occupational Therapy in Geriatrics involved 272 patients at 7 facilities and also demonstrated significant pain reduction and improvement in functional outcomes when Anodyne Therapy was used to increase circulation and reduce pain as part of a comprehensive physical therapy program.

"We are very pleased to have a growing pool of data including 11 peer-reviewed studies showing the efficacy of Anodyne Infrared Photo Therapy on over 4000 patients," said Craig Turtzo, CEO. "This treatment gives clinicians a non-invasive and drug-free tool for increasing circulation and reducing pain, which can have a significant impact on patients' quality of life."

Anodyne Therapy treatments are currently available nationwide at more than 4500 outpatient therapy facilities, hospitals, nursing homes, physician offices and home health agencies as part of a comprehensive program to improve functional outcomes for patients suffering from painful, circulatory conditions caused by a number of chronic conditions. Products are also available for convenient home use. For more information, visit http://www.anodynetherapy.com.

Posted by dlife at 10:04 AM | Comments (0)

Blood Sugar Control Before Surgery Associated With Fewer Infections Afterward

April 17, 2006 (EurekAlert) - Patients with diabetes who have good control of blood glucose levels before having surgery may be less likely to have infections after their procedures, according to a study in the April issue of Archives of Surgery, one of the JAMA/Archives journals.

Postoperative infections, including pneumonia, wound infection, urinary tract infection and sepsis (systemic blood infection), can lead to poor outcomes and high health care costs, according to background information in the article. The risk of infection is higher in patients with diabetes. Controlling blood sugar has been shown to reduce many of the complications associated with diabetes, including kidney, nerve and eye diseases. However, previous studies have not examined whether controlling blood sugar before surgery can affect outcomes afterward.

Annika S. Dronge, M.D., Yale University School of Medicine, West Haven, Conn., and colleagues examined the relationship between glycemic (blood sugar) control and postoperative infections in 490 diabetic patients. All of the participants underwent major noncardiac surgery in the Veterans Affairs Connecticut Healthcare System between Jan. 1, 2000, and Sept. 30, 2003, and had their hemoglobin (Hb A1c) levels measured within 180 days prior to surgery. Hb A1c reflects the patient's control of blood glucose levels over the previous two to three months. Good glycemic control was defined as meeting the American Diabetes Association target, an Hb A1c level of less than 7 percent.

The patients had an average age of 71 years and 197 (40 percent) had good glycemic control. Those who did not have good glycemic control had higher rates of infectious complications after surgery, as did those who were older, had higher scores on physical status tests, had wounds that were classified as "nonclean" or had operations that took longer.

There could be two reasons for the association between glycemic control and infections, the authors write. One is that patients with better preoperative glycemic control are likely to have lower blood sugar levels after surgery as well, which has been shown in other studies to reduce risk of infection. "The other possibility for decreased postoperative infection with long-term glucose control is the overall improvement in general health and metabolic milieu of the well-controlled diabetic patient," the authors write.

"In conclusion, this study confirmed an association between tight preoperative glucose control, as indicated by Hb A1c levels less than 7 percent, and a decreased risk of postoperative infections across a spectrum of surgical cases," they conclude. "If the association is confirmed in other studies, strategies to improve glycemic control prior to elective surgery can be employed to decrease infections and improve overall outcomes for diabetic surgical patients."

Posted by dlife at 10:02 AM | Comments (0)

Medtronic Receives FDA Approval for World's First Insulin Pump with Real-Time Continuous Glucose Monitoring

MiniMed Paradigm® REAL-Time System Allows Patients to Make Immediate Diabetes Management Decisions; Marks Major Step Toward an Artificial Pancreas

MINNEAPOLIS, April 13, 2006 — Medtronic, Inc. (NYSE: MDT) today announced FDA approval of the MiniMed Paradigm® REAL-Time Insulin Pump and Continuous Glucose Monitoring System, a progressive new therapy available for patients who use insulin to treat diabetes. For the first time in the history of diabetes management, an insulin pump integrates with REAL-Time continuous glucose monitoring (CGM). This new technology will help patients take immediate corrective or preventive action to maintain healthy glucose levels and delay or prevent diabetes-related complications, including coma, blindness, kidney failure, amputation, impotence, and heart disease.

The MiniMed Paradigm REAL-Time System is made up of two components, a REAL-Time Continuous Glucose Monitoring (CGM) System, and a MiniMed Paradigm insulin pump. The REAL-Time CGM System relays glucose readings every five minutes from a glucose sensor to the insulin pump, which displays to 288 readings a day – nearly 100 times more information than three daily fingersticks. REAL-Time glucose information displayed on the insulin pump allows patients to take immediate action to improve their glucose control after taking a confirmatory fingerstick. The REAL-Time CGM System component is indicated for any patient 18 years of age or older, and insulin pump therapy for all patients requiring insulin.

“The approval of the MiniMed Paradigm REAL-Time System opens the door to the next generation of diabetes management,” said Robert Guezuraga, president, Medtronic Diabetes. “As this is the first integrated insulin pump and continuous glucose monitoring system ever approved, we feel this new therapy will revolutionize the way patients manage their diabetes and will improve their lives.”

Integrating an insulin pump with REAL-Time CGM is a major step toward the development of a “closed-loop” insulin delivery system that may one day mimic some functions of the human pancreas. Medtronic is testing future systems that would employ advanced scientific algorithms to proactively recommend insulin dosages to patients. Through this process, Medtronic anticipates developing an external, closed-loop system designed to simplify and improve patient diabetes management.

The MiniMed Paradigm REAL-Time System’s continuous glucose sensor is a tiny electrode that is inserted under the skin using the Sen-Serter®, a small device that patients or their caregivers can use at home to make sensor insertion easier. The sensor measures glucose in the interstitial fluid found between the body’s cells, and is typically discarded and replaced after three days of use. Glucose measurements obtained by the sensor are relayed every five minutes from a transmitter to the insulin pump, which displays the glucose value, three-hour and 24-hour trend graphs, as well as arrows to indicate how quickly glucose is moving up or down. In addition, an alarm alerts patients when glucose levels become too high or too low.

The MiniMed Paradigm REAL-Time System includes a “smart” MiniMed Paradigm insulin pump, which has a powerful built-in Bolus Wizard® calculator to manage the complex diabetes math for patients. Smart insulin pumps recommend insulin dosages after considering the amount of insulin still “active” in the body, helping patients avoid dangerous hypoglycemic episodes caused when too much insulin is delivered.

Current standards for assessing glucose control include A1C tests and fingerstick measurements, yet both have limitations. An A1C test, which measures glucose control over a three-month period, is important for long-term management, but it is only an average and does not reveal day-to-day glucose fluctuations that can damage the body. In turn, fingerstick measurements only reveal a glucose value at a single moment in time. As a result, patients are unable to detect approximately 60 percent of low glucose (hypoglycemia) events, and have difficulty assessing glucose fluctuations while they sleep. In contrast, REAL-Time CGM allows patients to view glucose trends throughout the day and night, and understand how fast, and in what direction, their glucose levels are heading. By discovering how diet, exercise, medication and lifestyle affect their glucose levels, patients can make more informed self-management decisions and achieve a greater sense of confidence when managing their disease.

About Insulin Pump Therapy
An insulin pump is a small pager-size device that delivers insulin around the clock, much like a healthy pancreas. It is the most advanced method for precise and adjustable insulin delivery. Unlike injection therapy, insulin pump users can program their insulin pump to deliver insulin at varying rates to meet their changing insulin needs throughout the day and night. In addition, insulin can be delivered on demand at the touch of a few buttons. Many patients experience improved quality of life with insulin pump therapy, ridding themselves of multiple injections, strict meal schedules and rigid sleep patterns that are associated with injection therapy.

Diabetes Statistics
According to the American Diabetes Association, almost 21 million Americans (seven percent of the population) have the disease. Diabetes affects children and adults, costing the United States more than $132 billion in direct and indirect costs.

About Medtronic Diabetes
Medtronic Diabetes (www.minimed.com) is the world leader in insulin pump therapy and continuous glucose monitoring. The company’s products include external insulin pumps, continuous glucose monitoring systems and related disposable products.

About Medtronic
Medtronic, Inc. (www.medtronic.com), headquartered in Minneapolis, is the global leader in medical technology, alleviating pain, restoring health and extending life for millions of people around the world.

Posted by dlife at 10:12 AM | Comments (0)

Diabetes and Cancer: Alpha Connection

A study in Nature has defined the function of p110 alpha PI3K, which is in one of the most frequently activated pathways in cancer. Using a new approach to generating mouse models investigators from the Ludwig Institute for Cancer Research and the UCL Centre for Diabetes & Endocrinology have uncovered important information for planned clinical trials.

April 12, 2006 (Newswise) — A study published by Nature today has defined the function of p110 alpha, the flag-ship molecule of the eight member PI3K family, which is one of the most frequently activated pathways in cancer. The function of p110 alpha in the body has eluded researchers for over a decade but a new approach to generating mouse models, has allowed investigators from the Ludwig Institute for Cancer Research’s (LICR) UCL Branch and the UCL Centre for Diabetes & Endocrinology to solve the mystery and yield important information for planned clinical trials with PI3K inhibitors.

The study showed that p110 alpha controls the action of insulin and other key hormonal signals that play roles in growth, diabetes and obesity. p110 alpha is frequently mutated or overexpressed in cancer, and the results of the present work imply that cancer cells hijack a key signalling pathway to fuel their energy needs and drive their proliferation and survival. The current work has far-reaching implications, given that several million of people are affected by metabolic disorders, and every year, several hundreds of thousand new cancer cases with mutations in p110 alpha are diagnosed.

Importantly, says LICR’s Dr. Bart Vanhaesebroeck, the senior author of the study, the findings have immediate implications for the testing of p110 alpha-specific inhibitors for human therapies. “Accurate information on the specific role of p110 alpha is needed urgently by the pharmaceutical industry, which is preparing to initiate clinical trials based on PI3K inhibition, not only in cancer but also in inflammation, allergy and auto-immunity. These mice mimic the effect of systemic administration with a p110 alpha-specific drug,”

According to Dr. Vanhaesebroeck, traditional mouse models investigating the function of PI3K proteins have been engineered to completely remove the p110 alpha gene. However the LICR and University College London team and collaborators from the Universities of Edinburgh and Fribourg introduced a single mutation into the p110 alpha gene that inactivates, but does not remove, the protein. The scientists discovered that the mice were smaller, but ate more and had increased levels of body fat. Additionally, the mice had raised insulin levels and were glucose-intolerant. However, the mice did not go on to develop full diabetes. “The finding that these mice, despite having dampened insulin signalling, showed no signs of developing diabetes, is welcome news, as this suggest that drugs that block p110 alpha function in cancer cells may not have the severe metabolic disturbances first expected.”

For Dr. Dominic Withers from the UCL Centre for Diabetes & Endocrinology, a senior co-author on the study, this work adds another important part to solving the puzzle of how insulin works. “In order to be able to treat diabetes and other metabolic disorders, such as obesity, we first have to understand the normal regulation of this complex system, so that therapies are targeted at the key players in this pathway.”

This study was conducted by investigators from the: University College London Branch of the Ludwig Institute for Cancer Research (UK); Centre for Diabetes & Endocrinology, Rayne Institute, University College London (UK); The Institute for Stem Cell Research, University of Edinburgh (UK); Department of Medicine, University of Fribourg (Switzerland). This study was funded in part by a grant from Diabetes UK.

Posted by dlife at 10:16 AM | Comments (0)

MicroIslet Announces Encouraging Data From Islet Transplantation Studies in Primates

SAN DIEGO, April 12, 2006 (PRNewswire-FirstCall) - MicroIslet, Inc. (Amex: MII), a biotechnology company engaged in the research, development and commercialization of patented technologies in transplantation therapy for people with insulin-dependent diabetes, today announced encouraging data from preclinical primate studies.

The data shows that minimally-invasive transplantation of encapsulated porcine islets into diabetic primates resulted in significant and prolonged (greater than 30 days) improvement of blood sugar, with reduced insulin use, in the primate subjects.

These results were accomplished using MicroIslet's proprietary encapsulation formulation, which is designed to more effectively assure immunoisolation of the encapsulated islets while preserving their access to nutrients, oxygen, and transport of low molecular weight proteins. In other words, the insulin-producing islets were sufficiently isolated from the subjects' immune systems to prevent their destruction as foreign tissues during the recorded survival period. At the same time, the encapsulated islets were able to receive necessary nutrients and oxygen from the bloodstream and release blood-glucose-modulating insulin into the bloodstream through the outer layers of the islet capsules.

In the primate studies, the encapsulated porcine islets were transplanted by means of intraperitoneal injection rather than by more invasive surgical procedures. This procedure significantly reduces the trauma and infection risks inherent in major surgery, and minimizes post-transplant recovery time.

For the therapeutic approach being developed, MicroIslet anticipates that some patients with diabetes may require periodic transplantations of additional islet cells after an initial procedure. The second procedure would replace previously transplanted insulin-producing islets whose immunoisolation has been compromised by the patient's natural immune rejection reaction or by cell attrition over time. The Company previously conducted re-transplantation experiments in small animals and found that the subsequent transplants were at least as effective and well tolerated as the first transplant. Parallel tests in primates are planned for later stages of the primate studies currently underway.

"The crucial elements of our proprietary approach to treating diabetes through transplantation are coming together," commented Dr. James R. Gavin III, M.D., Ph.D., Interim President and Chief Executive Officer of MicroIslet. "Although the data is preliminary and there remain challenges, we are encouraged by the data received to date. As I discussed in my recent communication to shareholders, MicroIslet enjoys exclusive access to the Mayo Foundation's designated pathogen free pig facility for the treatment of diabetes, and we know of no other facility in the United States that is presently able to supply such pigs. MicroIslet's islet replacement program thus combines an existing supply of suitable cells with a promising approach for addressing immune response, both of which are essential elements for a sustainable program of successful transplantation of islet cells from foreign sources."

Posted by dlife at 10:14 AM | Comments (0)

Liver Signal Critical for Insulin's Brain Action

April 4, 2006 (EurekAlert) - New research in the April 5, 2006 Cell Metabolism identifies a key player in the body's ability to respond to insulin action in the brain by ratcheting down the export of blood sugar from the liver. The findings point to a potential new drug target for the treatment of type 2 diabetes, according to the researchers.

The group found evidence in mice that the gene STAT3 in liver mediates the effects of brain insulin. The STAT3 response depends upon interleukin-6, a chemical involved in the body's reaction to stresses, they reported.

Earlier evidence by the researchers showed that the gene STAT3 controls glucose balance by limiting the activity of genes that manufacture glucose in the liver. However, the mechanism by which nutritional and hormonal status controls hepatic STAT3 had remained unknown, said study author Masato Kasuga of Kobe University Graduate School of Medicine in Japan.

Insulin secreted by the pancreas after a meal normally allows body tissues, such as muscle and fat, to take up the blood sugar glucose. "In liver, which is responsible for minute-by-minute regulation of blood glucose levels and can export glucose as well as store it, insulin not only promotes the storage of glucose but also inhibits the production of sugar for export," explained Martin Myers, Jr., in a preview. The brain participates in the regulation of glucose production and insulin response by sensing and responding to nutrient levels and hormonal signals of energy intake and storage.

In those with diabetes due to a lack of normal insulin or insulin resistance, blood sugar rises, a condition that can lead to tissue damage. An increase in glucose issued from the liver is largely responsible, Kasuga said.

Now, the researchers have found in mice that an increase in blood insulin levels, achieved by administering glucose or insulin, leads to the activation of STAT3 in liver. The response depends upon the hormone's effects in the brain and an increase in interleukin-6. Animals lacking STAT3 only in the liver and those deficient for interleukin-6 lost the ability to respond normally to brain insulin by lowering the production of glucose, they reported.

The current findings provide a "first glimpse" into the mechanisms that operate within the liver to decrease glucose output in response to insulin action in the brain, Myers said.

"Given that disregulation of glucose production in the liver is an important pathophysiological feature of type 2 diabetes, the mechanism uncovered in this study may serve as a therapeutic target for this increasingly prevalent condition," the research team wrote.

Posted by dlife at 10:30 AM | Comments (0)

Big Hips, Big Belly? It's in Your Genes

Obesity, Body Fat Distribution More in Your Genes Than Previously Known, Joslin Diabetes Center-led Study Shows

BOSTON, April 10, 2006 (Joslin Diabetes Center) - Do you have big hips or a "beer" belly? Are you "apple-shaped" or "pear-shaped"? It makes a difference, since we know that abdominal obesity is linked to diabetes and many other metabolic conditions, i.e., the metabolic syndrome. What's new is that, according to a new study led by researchers at Joslin Diabetes Center in Boston, both obesity and body shape seem to be controlled by important genes that are part of the mechanisms regulating normal development.

"By looking at your genes, we can tell how fat you are and how your body fat will be distributed," said lead researcher C. Ronald Kahn, M.D., President of Joslin and the Mary K. Iacocca Professor of Medicine at Harvard Medical School. In lower animals, he added, it's long been known that genes play an important role in the body's development. "Genes tell the body where the head goes and where the tail goes, what goes on the front and what goes on the back. In insects, genes determine if the wings go on the front or back and whether they will be large or small. So it's not surprising that in humans, genes may determine how many fat cells we have and where they are located," he said.

Together with Joslin post-doctoral fellow Stephane Gesta, Ph.D., and colleagues at the University of Leipzig in Germany, the researchers for the first time used gene chips as a tool to understand what genes might control the development of fat inside the abdomen versus fat under the skin. The resulting study will be published online today, April 10, in the journal Proceedings of the National Academy of Sciences.

When it comes to obesity, the location of body fat can significantly impact one's risk for developing serious chronic diseases. Obesity, which is reaching worldwide epidemic proportions, is a major risk factor for type 2 diabetes, cardiovascular disease, cancer and other metabolic disorders. Doctors have long recognized that people who are "apple-shaped" -- with their fat concentrated in the abdomen -- are much higher risk for diabetes and metabolic syndrome than those whose fat is mainly subcutaneous, i.e., distributed beneath the skin primarily in the buttocks and thighs.

While recent studies at Joslin and elsewhere have shed light on the role of appetite and energy expenditure (physical activity) in obesity, little has been known about the role of genes in fat distribution or the association of genes in metabolic disorders like type 2 diabetes.

To investigate this question the researchers examined the genetic makeup of fat samples from around internal organs and under the skin of both mice and almost 200 human subjects ranging from normal to very obese, and including people with mostly abdominal obesity and people with subcutaneous and intra-abdominal obesity. Theorizing that fat distribution patterns -- and perhaps obesity itself -- may originate in the genes involved in control of development, the researchers found that as many as 12 developmental genes may play a role in different fat depots and that at least three of these seemed to be especially important in obesity.

The researchers compared levels of activity for these three genes --Tbx15, Gpc4, and HoxA5 -- in intra-abdominal and subcutaneous fat taken from individuals of normal weight versus overweight or obese individuals. "The differences we found in gene expression were so distinct," said Dr. Gesta, "that we could identify the body mass index (level of obesity) and the waist/hip ratio (whether the fat is in the abdomen or under the skin) in the overweight population by the expression level of these genes. This finding suggests that the expression of these genes could be related to the pathogenesis of obesity."

These results also suggest that different fat cell precursors are responsible for where the body stores fat. "While we don?t know yet whether this genetic activity is a cause or an effect of obesity," said Dr. Gesta, "these data do suggest that different forms of obesity could be a developmental problem that begins very early in life."

Can people outsmart their fat genes to alter the outcome? "Now that's the big question," said Dr. Kahn. "While we now can predict the fat pattern, we have no magic bullet to alter the outcome. But with these new findings, we have identified potential targets for perhaps one day changing body shape. We don't have drugs to alter the pattern now, but perhaps in the future we will."

Other Joslin researchers participating in the study were Yuji Yamamoto, Andrew W. Norris, M.D., Ph. D., Jeremie Boucher, Ph.D., and Choy Lewis. Researchers from the Department of Internal Medicine of the University of Leipzig were Matthias Blüher, M.D., Janin Berndt, and
Susan Kralisch.

Funding for the study was provided by the National Institutes of Health, the American Diabetes Association, the Diabetes Genome Anatomy Project (DGAP), and the Deutsche Forschungsgeminschaft.

About Joslin Diabetes Center
Joslin Diabetes Center, dedicated to conquering diabetes in all of its forms, is the global leader in diabetes research, care and education. Founded in 1898, Joslin is an independent nonprofit institution affiliated with Harvard Medical School. Joslin research is a team of more than 300 people at the forefront of discovery aimed at preventing and curing diabetes. Joslin Clinic, affiliated with Beth Israel Deaconess Medical Center in Boston, the nationwide network of Joslin Affiliated Programs, and the hundreds of Joslin educational programs offered each year for clinicians, researchers and patients, enable Joslin to develop, implement and share innovations that immeasurably improve the lives of people with diabetes. As a nonprofit, Joslin benefits from the generosity of donors in advancing its mission. For more information on Joslin, call 1-800-JOSLIN-1 or visit www.joslin.org.

Posted by dlife at 10:21 AM | Comments (0)

Shock Wave Therapy for Kidney Stones Linked to Increased Risk of Diabetes

April 10, 2006 (Newswise) — Mayo Clinic researchers are sounding an alert about side effects of shock wave lithotripsy: in a research study, they found this common treatment for kidney stones to significantly increase the risk for diabetes and hypertension later in life. Risk for diabetes was related to the intensity of the treatment and quantity of the shock waves administered; hypertension was related to treatment of stones in both kidneys.

Shock wave lithotripsy uses shock waves to break up an impassable kidney stone into smaller, sandlike pieces which can be passed spontaneously, usually within a month. The patient and the lithotriptor that emits the shock waves are placed in a water bath. Water allows easier conduction of the shock waves through the patient’s tissue and precise focus on the kidney stone.

“This is a completely new finding,” says Amy Krambeck, M.D., Mayo Clinic urology resident and lead study investigator. “This opens the eyes of the world of urology to the fact that hypertension and diabetes are potential side effects. We can’t say with 100 percent certainty that the shock wave treatment for the kidney stones caused diabetes and hypertension, but the association was very strong. The risk of developing diabetes after shock wave lithotripsy is almost four times the risk of people with kidney stones treated with medicine, and the risk of developing hypertension is one and one-half times, which is a significant risk increase.”

The study, which is the first examination of the effects of shock wave lithotripsy over the long term, involved reviewing charts of 630 patients treated with shock wave lithotripsy in 1985 at Mayo Clinic. The researchers sent those still alive a questionnaire; almost 60 percent responded. The researchers matched the patients treated with lithotripsy to patients similar in age, gender and initial time of seeing a urologist for kidney stones who received a different treatment, medicine. Nineteen years post-treatment, those treated with lithotripsy had 3.75 times the risk of having diabetes as those given the other kidney stone treatment. The degree of increased risk rose with greater number and intensity of shocks administered. Those treated with lithotripsy also had 1.47 times the risk of having hypertension -- high blood pressure -- than those who received the other kidney stone treatment; risk was highest for those who had both kidneys treated.

The researchers hypothesize that the increase in risk for diabetes associated with shock wave therapy for kidney stones relates to damage inflicted to the pancreas, a previously known risk of lithotripsy, which may affect the islet cells in the pancreas that make insulin. They believe the increased risk for hypertension may relate to scarring, which the treatment may cause to the kidneys and could alter the secretion of hormones centered in the kidneys like renin, which influence blood pressure.

Drs. Krambeck and Joseph Segura, M.D., Mayo Clinic urologist and study investigator, say that they continue to use shock wave treatment, among other alternative treatments for kidney stones.

“Despite the risks, shock wave therapy still can save the day for patients, and it would be a mistake to put it on the shelf,” says Dr. Segura.

The researchers indicate that they now counsel patients about the potential risk for diabetes and hypertension prior to shock wave treatment.

Dr. Segura stresses the need for kidney stone patients and their physicians to weigh the pros and cons of shock wave treatment according to individual situations. “It’s a trade-off about whether the risks are worth taking,” he says. “We’re assuming doing nothing is not the right thing to do for patients. You have to look at it in terms of treatment alternatives -- percutaneous stone removal [removing a kidney stone through a small incision in the patient’s back using an instrument called a nephroscope] or ureteroscopy [snaring a stone with a small instrument passed into the ureter through the bladder and then breaking up the stone with ultrasound or laser energy] -- each of which has its own set of risks.”

The Mayo Clinic researchers examined the long-term effects of lithotripsy for patients treated with a 1985 lithotriptor, one of the early models, in this study. Drs. Krambeck and Segura say additional research studies, including research on newer machines and different models, are needed on shock wave therapy and risk for diabetes and hypertension later in life.

Prior to age 70, approximately 10 percent of men and 5 percent of women will experience a kidney stone, according to the National Institutes of Health. About 1 million people in the United States have had shock wave lithotripsy, says Dr. Segura.

Posted by dlife at 10:18 AM | Comments (0)

New Research Shows Second-Hand Smoke Raises Diabetes Risk

April 6, 2006 (Newswise) - Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study BMJ Online First.

A study published on bmj.com this week shows for the first time that breathing other people’s smoke raises the risk of developing glucose intolerance, the precursor to diabetes.

The US research also shows that overall, white Americans are more susceptible to this effect than African-Americans.

Researchers examined 4572 men and women in four US cities, dividing them into four categories of smoking status: ranging from those who smoked, to those who had neither smoked nor breathed in other people’s smoke. The study focussed only on those who were white or African-American.

The authors then tracked how many participants developed glucose intolerance - where the body can no longer produce enough insulin to regulate blood sugar - over 15 years of follow-up.

The study found that smokers had the highest risk, with 22% of them getting the disease over the study period. Non-smokers who had no exposure to second-hand smoke had the lowest risk, with less than 12% developing the condition.

But 17% of those who had never smoked themselves but were subject to second-hand smoke also developed glucose intolerance - higher than the 14% risk rate in the group who had previously smoked and given up.

Those breathing second-hand smoke are exposed to many toxins, say the authors. And the chemical reactions which produce second-hand smoke mean that some of those toxins may be at even higher concentrations than the levels breathed in directly by smokers. If one of these toxins particularly affects the pancreas - the organ which produces insulin - this may explain the findings, they suggest.

Until now, it had not been known that those breathing second-hand smoke faced an increased risk of diabetes, say the researchers. More studies are now needed, they conclude.

Posted by dlife at 10:24 AM | Comments (0)

Type 2 Diabetics’ Acidity Heightens Risk for Kidney Stones

April 5, 2006, Newswise — People with type 2 diabetes have highly acidic urine, a metabolic feature that explains their greater risk for developing uric-acid kidney stones, researchers at UT Southwestern Medical Center have found. The study – the first to compare the urinary biochemical characteristics of type 2 diabetics with those of normal volunteers – is available online and will be published in the May issue of the Journal of the American Society of Nephrology.

Individuals with type 2 diabetes (non-insulin dependent diabetes mellitus) are at increased risk for developing kidney stones in general, and have a particular risk for uric-acid stones. The mechanisms for this greater risk were previously not entirely understood. This new study demonstrates that the propensity for type 2 diabetics to develop uric-acid stones is elevated because their urine is highly acidic.

“Our next step is to find out what causes type 2 diabetics to have an abnormally acidic urine, and what other urinary factors protect some diabetics who do not form uric-acid stones,” said Dr. Mary Ann Cameron, the paper’s lead author and a postdoctoral trainee in internal medicine.

Obesity and a diet rich in animal protein are associated with abnormally acidic urine. In earlier studies, UT Southwestern researchers also concluded that uric-acid stones are associated with insulin resistance and type 2 diabetes.

But when researchers in this latest study accounted for these components, type 2 diabetics continued to have more acidic urine levels when compared to nondiabetics. These findings suggest that other factors associated with type 2 diabetes or insulin resistance account for the overly acidic urine in this population.

“Diet intake and obesity, those two factors alone, don’t explain the whole picture,” said Dr. Naim Maalouf, an author and assistant professor of internal medicine. “So, other unrecognized factors may play a role.”

Dr. Khashayar Sakhaee, senior author of the study and chief of mineral metabolism, said: “Our group at UT Southwestern was the first to determine that the more overweight a person is the more likely he or she is to form uric-acid kidney stones.”

More than 18 million people in the United States live with diabetes, a chronic disease that affects the body’s ability to produce or respond to insulin and that can lead to life-threatening illness, including heart disease and stroke.

Kidney stones are solid deposits that form in the kidneys from substances excreted in urine. When waste materials in urine do not dissolve completely, microscopic particles begin to form and, over time, grow into stones. These solid deposits can remain in the kidney or they can break loose and travel down the urinary tract. Small stones can pass out of the body naturally, but larger stones can get stuck in a ureter, the bladder or the urethra, possibly blocking the flow of urine and often causing intense pain.

Uric acid stones are more difficult to diagnose than other types of stones because they don’t show up on regular abdominal X-rays, often delaying the diagnosis and leading to the continued growth of the stone.

Other UT Southwestern researchers contributing to the study were Dr. Orson Moe, director of the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, and Beverley Adams Huet, assistant professor of clinical sciences and internal medicine.

Posted by dlife at 10:28 AM | Comments (0)

Fat Cells Around Coronary Arteries May Play a Role in Heart Disease

April 4, 2006 (EurekAlert) - The fat cells that surround coronary arteries may play a central and previously unrecognized role in development of cardiovascular disease, according to a study by University of Iowa researchers.

Dr. Lynn Stoll presented the research team's findings on April 4 at Experimental Biology 2006 in San Francisco. Her presentation was part of the scientific program of the American Society of Investigative Pathology.

Once thought of as mere storage depots for excess energy, fat cells ("adipocytes") are now known to be highly active metabolically, releasing potent pro-inflammatory proteins and hormones that regulate inflammation, blood pressure, insulin activity, and other biological processes. Where fat cells are located has a major influence on their impact, as seen in the fact that visceral fat surrounding the internal organs ("apple" body shape) is far more highly correlated with development of diabetes and cardiovascular disease than subcutaneous fat in the thighs and buttocks (pear" body shape).

One area of adipose tissue that has received little attention is the perivascular adipose tissue that envelops most large blood vessels in humans. The function of these fat cells is largely unknown, but the fact that the coronary arteries are embedded in fat tissue led the Iowa researchers to believe that these fat cells have a direct role in the pathogenesis of the atherosclerosis to which these arteries are so highly susceptible.

The research team, led by Dr. Stoll and senior investigator Dr. Neal Weintraub, isolated and cultured adipocytes from the fat tissue surrounding human coronary arteries and, for comparison, cells from other fat tissue including subcutaneous fat. Their experiments showed three important differences in how the fat cells from around the coronary arteries (the epicardial adipocytes) function compared to fat from other areas of the body:

The epicardial adipocytes release greater amounts of harmful, inflammation-producing cytokines in response to certain stimuli.
Epicardial adipocytes (but not adipocytes from subcutaneous or renal fat) strongly induce coronary artery endothelial cells to form elongated, branching structures indicative of blood vessel formation (angiogenesis).
When exposed to hypoxia, epicardial adipocytes produce larger amounts of vascular endothelial growth factor (VEGF), a peptide that stimulates angiogenesis.
Since epicardial fat tissue receives its blood supply directly from the adjacent coronary artery through the vasa vasorum, a network of tiny blood vessels near the outer surface of the heart, the Iowa team's results suggest that coronary artery blockages may lead to oxygen deprivation (ischemia) in the surrounding adipose tissue, which could contribute locally to vascular inflammation. At the same time, epicardial adipocytes could act as a sensor for local ischemia, serving as a powerful stimulator of angiogenesis and resulting in proliferation of the vasa vasorum, which has been suggested to contribute to coronary artery disease by causing intraplaque hemorrhage and accumulation of cholesterol from red blood cell membranes.

The fat cells surrounding coronary arteries may ultimately prove to be an important link between obesity, type 2 diabetes, and coronary artery disease, all of which are increasing at epidemic rates in the U.S. and throughout the world, says Dr. Stoll. A better understanding of how epicardial adipocytes sense and respond to inflammation and ischemia could lead to new, rationally designed therapies for heart disease.

Posted by dlife at 10:32 AM | Comments (0)

National Study Reveals Doubling in Type 2 Diabetes Prescriptions Among Children

Dramatic Four-Year-Increase a Leading Indicator of Future Health Care Cost Growth

ST. LOUIS, April 4, 2006 (PRNewswire-FirstCall) - Express Scripts today announced results of a study of prescription claims for millions of U.S. children ages 5 to 19 revealing a four-year doubling in those taking medication typically used to treat or prevent Type 2 diabetes. This rapid increase, a rise from about 0.3 to 0.6 per thousand from 2002 to 2005, represents enormous implications for national long-term health care needs and expenditures.

The Express Scripts study, "2002-2005 Trends in the Prevalence of Use of Antidiabetic Agents in Children: 5 to 19 Years," analyzed the prevalence of antidiabetic prescription use among children enrolled with Express Scripts, Inc., through commercial health plans. The study reviewed the prescription records of at least 3.7 million U.S. children each year.

Because Type 2 diabetes, in which the body is unable to use insulin efficiently, is treated with different medications than for type 1 diabetes, the study was able to specifically identify those taking medication to treat or prevent type 2 diabetes. Type 2 diabetes is more common among individuals who are overweight or obese, which medical researchers believe to be the primary factor behind increases in type 2 diabetes among children.

"This study is the first of its kind nationally to reveal the long-suspected national increase in the prevalence of children with or at risk for diabetes," said Emily Cox, PhD, Express Scripts senior director of research and the study's lead author. "By using prescription claims data to better understand the scope and significance of this problem, we believe the health care community finally has the validation it needs to directly address the issue," added Steve Miller, MD, Express Scripts vice president of research and a study author.

"It's surprising to see such a significant change within such a short time-period," said Joyce Lee, MD, of the University of Michigan Pediatric Endocrinology Department, and one of the nation's foremost researchers on childhood diabetes. "This is the first national study of its kind available that uses prescription claims to document and highlight the increase in risk and prevalence of type 2 diabetes."

According to Cox, Express Scripts undertook this study as part of its mission to help organizations better manage the cost of prescriptions and understand the underlying causes of rising healthcare expenses.

"With the quality and volume of data we have available, Express Scripts is one of the few organizations in the nation capable of undertaking a study of this magnitude and importance. We're publicly sharing these results because of the important long-term health and financial implications these findings have for children, their families and those that pay for health care in this country," said Cox.

Type 2 Diabetes on the Rise ... Creating Immediate and Long-Term Health Concerns

While the use of medications typically prescribed for type 2 diabetes doubled, the rise was most significant among pre-adolescents, with prevalence of type 2 diabetes treatment growing 106% among 10- to 14-year-olds. Use of type 2 diabetes treatments was most prevalent among 15- to 19-year-old teenagers, growing from 0.6 to 1.2 per thousand.

The study also identified a 30.5% increase in type 1 diabetes prescription use, and a 41.0% increase in total prevalence of diabetes medication use for either type 1 or type 2 diabetes. (See Table 2 below.)

"As recently as 2004, standard pediatric textbooks talked about pediatric diabetes in the 'per hundred thousand children' level," said Ed Weisbart, MD, Express Scripts chief medical officer and a family physician. "Now we're talking about it at the per-thousand children level. We've moved two orders of magnitude within just a few years. In fact, type 2 diabetes has long been regarded as 'adult-onset diabetes' due to its representation among middle-aged and older adults, but this study indicates that children with or at risk of type 2 diabetes are becoming far more common."

Battle with Obesity Crucial to Stem Tide

While this study did not investigate the causes behind the increasing prevalence of type 2 diabetes medication use among 5- to 19-year-olds, childhood obesity is believed to be the primary factor. According to the 1999-2002 National Health and Nutrition Examination Survey (NHANES), 16% of children 6 to 19 years of age were considered overweight, an increase from the estimated 11% reported in the 1988-1994 NHANES survey. Research also indicates that overweight and obese children are approximately twice as likely as normal-weight children to develop Type 2 diabetes.

According to a March 2006 report by the International Journal of Pediatric Obesity, nearly half of all children in North and South America will be overweight by 2010, as opposed to about one-third today. Researchers indicate that this trend is fueled by more sedentary lifestyles among children and the increased availability and intake of junk food, among multiple factors.

"The increase in type 2 diabetes carries enormous health care risks," Weisbart said. "Diabetes is known to shorten life expectancy by about a decade, on average. Diabetics are two to four times more likely to develop heart disease and stroke, 10 times more likely to require amputations, and are far more likely to suffer nervous system damage, blindness, kidney disease and complications with pregnancy."

According to Weisbart, parents can identify the likelihood of type 2 diabetes in their children by regularly measuring their children's height and weight. "Because of the strong and direct correlation between childhood obesity and the likelihood of developing Type 2 diabetes, parents can identify this by simply measuring their child's height and weight to determine the child's body mass index (BMI)," he said. "And according to a recent Journal of Pediatrics article, parents should also be measuring the waist size of their children to help predict type 2 diabetes risk."

The National Institutes of Health has a BMI calculator available at http://nhlbisupport.com/bmi/ .

According to the American Diabetes Association, the total economic cost of diabetes was estimated to be $132 billion in 2002, with direct medical expenditures of $91.8 billion. "Very clearly, the increase in diabetes prevalence among children signals the beginning of multiple health-care issues for many, many children as they grow into adulthood, and vast economic costs to our society," Weisbart said.

About the Trends in the Prevalence of Use of Antidiabetic Agents in Children Study

Study authors determined the prevalence of antidiabetic prescription use in children from 2002 to 2005 using a database containing ambulatory administrative pharmacy claims and eligibility information for children enrolled with Express Scripts, Inc., through commercial health plans. The health-plan sponsors selected for the study sample in each year were private- and public-sector employer groups, managed-care organizations, third-party administrators and unions. type 1 treatment patients were identified as those taking mono-therapy insulin or insulin with newer adjunctive medications (e.g. amylin analog). Type 2 treatment patients were identified as those taking an oral antidiabetic agent alone or in combination with either insulin or the new adjunctive therapy.

Posted by dlife at 10:26 AM | Comments (0)

Pine Nut Oil Ups Appetite Suppressors 60% for 4 Hours

Pine nut oil’s greatest effect came after 30 minutes, with overweight subjects reporting a 29% reduction in desire to eat and a 36% drop in prospective food intake. Separately, conjugated linoleic acid cut area-specific fat mass in three months: Women lost from legs and trunk, men mostly from trunk.

April 3, 2006, Newswise — In the face of the growing obesity health challenge, “appetite suppressants are increasingly interesting because they work on the very simple premise of ‘What you don’t eat now, you won’t need to lose later,’” Alexandra Einerhand, director, nutrition and toxicology-Europe at Lipid Nutrition notes.

Einerhand says that in a study, polyunsaturated fatty acids (PUFAs) derived from “Korean pine nuts, which have been part of our diet since before ancient Greek and Roman times, stimulated two well-known appetite suppressing peptide hormones at the same time that overweight women reported significantly less desire to eat only 30 minutes after ingestion,” compared with an olive oil placebo.

In a paper being presented in an American Physiological Society session at Experimental Biology 2006, Einerhand reports that “in this randomized, double-blind cross-over trial, the greatest effect was observed after just 30 minutes, with the 18 women reporting a 29% reduction in “desire to eat” and a 36% drop in “prospective food intake” scores. Their subjective feelings of appetite were evaluated by visual analog scales, a validated scoring system.

The experiment found a parallel and significant increase in cholecystokinin (CCK) of 60% and glucagon-like peptide 1 (GLP1) of 25% that remained as long as four hours after ingestion. CCK and GLP1 are appetite suppressors, which “send signals of satiation to the brain diminishing the desire to eat and food intake usually significantly,” she adds.

The experiment utilized 3 grams of a product called PinnoThin™, comprised of over 88% Korean pine nut PUFAs, and which is marketed by Lipid Nutrition, a division of Loders Croklaan, of the Netherlands.

*Paper presentation: “Korean pine nut fatty acids affect appetite sensations, plasma CCK and GLP1 in overweight subjects,” 12:30 p.m.-3 p.m. Monday April 3, Physiology Obesity and Satiety 494.2/board #C781. On view 7:30 a.m. - 4 p.m. Research was by Alexandra Einerhand, Jos Heimerikx, Marianne O’Shea and Luisa Gambelli of Lipid Nutrition, a division of Loders Croklaan, Wormerveer, the Netherlands; Wilrike Pasman, Carina Rubingh, Robin van den Berg and Henk Hendriks of TNO Quality of Life, in Zeist.

CLA differentially reduces fat mass in men and women in just 3 months

Two other presentations by Einerhand at Experimental Biology report on a six-month human trial with another Lipid Nutrition product called Clarinol™, or conjugated linoleic acid.

“The location and gender differences in fat mass loss are very new and unexpected,” Einerhand says: “Lost fat mass was from the legs and abdomen of women and from the abdomen of men. Neither men or women lost any fat from the arms,” she adds.

“After only three months, there was a significant fat mass loss,” Einerhand notes, and the losses continued for the next three months. After six months, there was an average fat mass loss of 2 kilos corresponding to about 6% fat loss. At the same time, “overall body weight loss was ‘only’ 1.5 kilos because there was a gain in muscle mass,” she reports.

Waist measurements shrunk 2.2 centimeters and hips 0.5 cm over six months. Waist-hip ratio decreased a significant 0.024. BMI fell an on average 0.6, from the starting point of BMI 28-32 for the 118 overweight and obese subjects. In the trial, subjects received either 3.4 grams per day of CLA (Clarinol™), or olive oil placebo.

Health implications, plus ‘body molding’ effects

“Overall, this location-specific loss of fat mass is both interesting and important,” Einerhand notes. “While the fat mass loss in the legs and abdomen represents a kind of ‘body shaping’ effect, the loss of abdominal fat mass is potentially a very important healthy effect because abdominal fat is correlated with an increased risk of cardiovascular disease and diabetes,” she adds. As part of the study, safety factors were monitored, and CLA was found to have no effect on insulin resistance.

*Paper presentations: “Conjugated linoleic acid induces regional-specific decreases in fat mass in a 6-month clinical trial,” 12:30 p.m.- 3 p.m. Sunday April 2, Clinical Nutrition, 138.10/board #B289. Research was by Jean-Michel Gaullier, Ola Gudmundsen and Christian Syvertsen of SCR A/S, Norway; Johan Halse of Diabetic and Overweight Medical Center, Norway; Hans Olav Hoivik of Hedmark Medical Center, Norway; and Alexandra Einerhand and Marianne O’Shea of Lipid Nutrition, a division of Loders Croklaan.

“Six months supplementation with conjugated linoleic acid (CLA) does not induce insulin resistance in overweight and obese” 12:30- p.m. – 3 p.m. Wednesday, April 5, Human and Clinical Nutrition, board #LB406. Research was by Alexandra Einerhand, Marianne O'Shea, Lipid Nutrition, a division of Loders Croklaan, the Netherlands; Christian Syvertsen, Jean-Michel Gaullier, Minna Nurminiemi, Knut Kristiansen, Ola Gudmundsen of Scandianavian Clinical Research AS, Norway; Johan Halse, Diabetes and Overweight Specialist Medical Center, Norway; and Hans Olav Hoivik, Hedmark Medical Center, Norway.

Funding: Research was underwritten by the Lipid Nutrition, a division of Loders Croklaan.

The American Physiological Society was founded in 1887 to foster basic and applied bioscience. The Bethesda, Maryland-based society has more than 10,000 members and publishes 14 peer-reviewed journals containing almost 4,000 articles annually.

APS provides a wide range of research, educational and career support and programming to further the contributions of physiology to understanding the mechanisms of diseased and healthy states. In May 2004, APS received the Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring (PAESMEM).

A searchable online program for EB is at http://www.faseb.org/meetings/eb2006/call/default.htm

Experimental Biology is an annual scientific meeting convened by the Federation of American Societies of Experimental Biology, including the American Physiological Society (APS) and other biomedical societies. The meeting features “nominated” lectures, symposia, research presentations, awards, a job placement center, and an exhibit of scientific equipment, supplies, and publications. This year’s participating Societies are APS, American Association of Anatomists, American Society for Biochemistry and Molecular Biology, American Society for Investigative Pathology, American Society for Nutritional Sciences, and the American Society for Pharmacology and Experimental Therapeutics.

Posted by dlife at 10:39 AM | Comments (0)

Poor Blood Sugar Control Linked to Depression in Youth With Diabetes

Kaiser Permanente Researcher Leads Study on Possible Indicators Behind Higher Rates of Depression

OAKLAND, CA., April , 3, 2006 (PRNewswire) - Poor blood sugar control and frequent emergency room visits are just two of the telltale signs that children and adolescents with diabetes may be suffering from symptoms of depression, finds a new study by researchers at Kaiser Permanente Southern California and five other study sites. These results are from the first large population-based study to look at diabetes in youth in the United States.

The study, which found that girls were more likely to have symptoms of depression than boys, estimated the prevalence of depression among 2,672 youth with diabetes, aged 10 to 21, as well as possible factors associated with higher rates of depression. The results appear in the April 3 issue of Pediatrics.

Fourteen percent of study participants had symptoms of mild depression, while nearly 9 percent had symptoms of moderate to severe depression. Depressive symptoms increased in both boys and girls in tandem with increases in Hemoglobin A1c, which is measured to determine long-term blood sugar control. Boys with moderate or severe depressive symptoms had 80 percent more emergency room visits, whereas girls had 60 percent more ER visits than did youth with no symptoms of depression.

"This study found several clear signs that a child or adolescent with diabetes may be experiencing symptoms of depression and may benefit from additional mental health screening from physicians and other health care professionals," says Jean Lawrence, ScD, MPH, the study's lead author and an epidemiologist with the Department of Research & Evaluation in Kaiser Permanente's Southern California region. Additionally, she notes, "health care providers should also consider mental health evaluations and interventions for youth who have a history of depression and who are not currently in treatment, since depression is associated with poor blood sugar control."

In addition to poor blood sugar control and more trips to the ER, researchers discovered that girls who had diabetes, along with additional health problems, were more likely to show signs of depression, compared with girls with diabetes alone. At the same time, boys with type 2 diabetes were more likely to have moderately to severely depressed mood than boys with type 1 diabetes.

"This is the first study to document the frequency of depression symptoms among youth with diabetes, in a large population-based sample," says Michael Engelgau, MD, acting director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC). "The findings of an association of depression and poor glycemic control, and of a higher frequency of depression among girls have great relevance for improving diabetes control and the quality of life for these young people and their families."

Eighty-five percent of the study's participants had type 1 diabetes, while 14 percent had type 2 diabetes. Lawrence points out that study participants were not screened for clinical depression, but rather, the study aimed to identify those at risk for depression. Lawrence also reports that youth with diabetes were no more likely to show signs of depression than youth without diabetes from similar age and racial/ethnic groups who had undergone screening using the same methodology in previous studies.

The study is funded by the Centers for Disease Control and Prevention and the National Institutes of Health, and is part of SEARCH for Diabetes in Youth, a six-center, population-based study focusing on physician-diagnosed diabetes in children and youth in the United States. SEARCH, a 10-year study that began in 2000, is aimed at identifying diabetes cases among more than 5 million American children each year. SEARCH has study centers in California, Colorado, Hawaii, Ohio, South Carolina and Washington. "The SEARCH program and studies like this one are indicative of the gains we can make in the medical community as a whole, when we partner in research, prevention, and control efforts," added Engelgau.

Kaiser Permanente has research offices in California, Oregon, Hawaii, Georgia, Colorado, Maryland, and Ohio. Results of research conducted by Kaiser Permanente physicians and investigators have been published in the Journal of the American Medical Association, the New England Journal of Medicine, the American Journal of Obstetrics & Gynecology, the American Journal of Public Health, Pediatrics, The Permanente Journal, and other clinical journals. Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a nonprofit, group practice prepayment program with headquarters in Oakland, Calif. Kaiser Permanente serves the health care needs of 8.4 million members in 9 states and the District of Columbia. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 145,000 technical, administrative and clerical employees and caregivers, and more than 12,000 physicians representing all specialties.

Posted by dlife at 10:37 AM | Comments (0)

Retisert(TM) Slows Progression of Diabetic Retinopathy in Diabetic Macular Edema Trials

April 3rd - Global bio-nanotech company pSivida Limited (NASDAQ:PSDV)(ASX:PSD)(Xetra:PSI) today announced additional two year trial results of Bausch & Lomb's two randomized trials to evaluate the safety and efficacy of the Retisert(TM) implant in releasing fluocinolone acetonide in the management of Diabetic Macular Edema (DME). Bausch & Lomb, exclusive licensee of Retisert(TM) from pSivida conducted the studies in hospitals in the United States involving 277 patients. The trial results were presented at the prestigious 6th International Symposium on Ocular Pharmacology and Therapeutics in Berlin that commenced on 30 March 2006 http://www.kenes.com/isopt/index.asp.

The two year trial results demonstrated that 30% of eyes receiving standard of care (repeat laser treatment) had a worsening of their Diabetic Retinopathy compared with only 10% of eyes receiving a Retisert(TM) implant. This was statistically significant. Retisert(TM) also reduced retinal thickening involving the fovea (the center most part of the macula responsible for sharp, central vision) and led to a statistically significant three line improvement in vision.

Diabetic Retinopathy (DR) is the leading cause of vision loss of people in the United States under the age of 65 with an estimated 1,000,000 treatable cases. DR occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. DR usually affects both eyes. Currently the only FDA approved treatment is laser therapy in which holes are burned into the macula with a laser. This treatment is often ineffective or generally provides only temporary benefit. DME is a common complication of DR. There are no approved drug therapies for the treatment of either DME or DR.

"We believe the finding that sustained release fluocinolone acetonide can slow or reduce the progression of Diabetic Retinopathy is important and may have significant implications for Retisert(TM) and Medidur(TM)," said Mr Gavin Rezos, CEO of pSivida Limited.

pSivida receives royalties on Retisert(TM) sales. Retisert(TM) is presently priced at US$18,250 and is approved as a 30 month treatment for chronic non-infectious posterior segment uveitis, a sight threatening condition that affects an estimated 175,000 people in the United States and an estimated 800,000 people worldwide. Covered in the United States by Medicare and Medicaid, Retisert(TM) is co-marketed in the United States by Bausch & Lomb and Novartis.

Three year results of the Retisert(TM) in DME trial will be presented at ARVO conference in May 2006 www.arvo.org.

Posted by dlife at 10:34 AM | Comments (0)