A Link Between TV and Glucose Levels

May 29, 2007 (ADA) A research study performed in Norway has found that the more television a child or adolescent watched, the higher the child’s average blood glucose level measured. In the United States, children and adolescents spend more time watching television than any other activity except sleep, and they may even spend more time watching TV than going to school. With the increasing childhood obesity rates in the United States, such activites as television viewing are of particular concern.

ALEXANDRIA, Va., May 25 — The more hours of TV kids with type 1 diabetes watch, the less they are able to maintain good blood glucose control, according to a study published in the June issue of Diabetes Care.

The study by researchers in Norway found that the more television a child or adolescent watched, the higher the child’s average blood glucose level measured. For example, young people who watched less than one hour of television per day scored an average level of 8.2 percent on the HbA1c, a test that measures how well blood glucose is controlled over several months. Those who watched up to 2 hours daily scored 8.4 percent; up to 3 hours daily scored 8.7 percent; up to 4 hours daily scored 8.8 percent; and those who watched more than 4 hours of TV per day scored 9.5 percent on the A1C test. The ADA recommends keeping A1C levels at 7 percent or below.

The study noted that “children and adolescents in the United States spend more time watching television than any other activity except sleep,” and that they may even spend more time watching TV than going to school. With childhood obesity reaching epidemic proportions in the United States, sedentary activities such as television viewing are of particular concern. The American Academy of Pediatrics recommends children spend no more than two hours per day watching television, but 55 percent of the subjects in this study exceeded that level.

“It takes very little energy to sit in front of the tube,” said lead researcher Dr. Hanna D. Margeirsdottir, from the Department of Pediatrics at the Ullevaal University Hospital in Oslo. “The time spent watching TV could otherwise be spent on activities that require a lot more exertion and burn more calories. What’s more, TV viewing tends to be associated with snacking and may lead to poor eating habits. Obviously with childhood obesity levels being what they are these days, parents should be encouraging their children and teens to watch far less television and get out and move around a lot more.”

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Mayo Study: A Simple Tool Can Enhance How Patients with Diabetes Take Their Medications

May 29, 2007 (EurekAlert) - Though diabetes contributes to nearly a quarter million deaths in the United States annually, patients with chronic ailments don't always take their medication as prescribed. A Mayo Clinic research team has designed a simple tool to improve compliance with life-saving medications. The tool is clearly effective and preferred by 84 percent of patients, according to a study published in the May 28 issue of the Archives of Internal Medicine.

Victor Montori, M.D., an endocrinologist at Mayo Clinic and lead investigator of the study, recommends using this tool as a decision aid to spark conversation between doctors and patients about medication. It consists of an easy-to-follow guide with answers to four questions tailored to individual patients: (1) What is your risk of having a heart attack in 10 years" (2) What are the benefits of taking statins as compared to not taking statins" (3) What side effects can you expect from statins" (4) What do you want to do now"

"Conversations with patients about prescription medications tend to be brief and incomplete, but we found that when a decision aid was introduced, it was the start of a conversation in which the patient -- now better equipped with information -- felt empowered to participate in deciding whether a statin would be appropriate for them," Dr. Montori says.

How They Did It

The study was done in concert with Mayo's SPARC Innovation Program. SPARC (See, Plan, Act, Refine and Communicate) is a laboratory that identifies innovative and effective ways to improve health care. Dr. Montori is director of research and education at SPARC.

This preliminary study focused on compliance with statins among diabetes patients. (Statins are used to lower cholesterol and thus, lower the risk of developing heart disease, which is often a complicating factor with diabetes.) Dr. Montori videotaped 98 sessions between doctors and patients. Only half the patients expressed satisfaction with the way they get information now, compared to 84 percent of patients who were satisfied with the decision aid.

Patient-doctor visits took on an entirely new dimension after the decision aid was introduced: body postures changed as patient and physician leaned in to focus on the material and both listened intently during the ensuing conversation.

"The first thing that is apparent in the videotape: the nature of the conversation changes when the decision aid is introduced. Without the decision aid, their body language was not in synch; but with this tool, their postures changed while they both focused on the decision aid. The quality of the communication, both verbal and nonverbal, improved as did the relationship," Dr. Montori says.

The decision aid plainly and simply displays for a patient his or her risk of heart attack in the next 10 years with and without a statin. Is the risk worth it" "That much people understand," he says. "If my risk of having a heart attack is very small, a pill that reduces that risk may not be worth it for me, but if my risk is really high, a pill that reduces that risk sounds compelling." Once a patient has a sense of the potential benefits, they can look at the potential downsides (side effects and costs) and make an informed choice with their clinician.

Among the decision-aid users, the number of patients still taking a statin after three months increased threefold. The decision aid had a greater impact on patients with a high risk of heart attack as compared to low risk patients. The high-risk group was more likely to start using statins than low-risk patients
Conversation is Critical

So why don't these conversations take place in the absence of a decision aid"

"That's a good question as we put forward that having an open and candid conversation with your physician is a primary reason for the visit. But clinicians are not necessarily trained to help patients make decisions using quantitative information. Secondly, we don't have tools available to routinely do this in a meticulous way. Thirdly, there is no perceived need for this despite scores of patients who start medication but don't follow through or even fill the prescription," Dr. Montori says.

"Time is the universal barrier in any effort to improve the health care experience. Society needs to have this discussion: How should we dedicate the time in the visit" If we have programs to improve the quality of care, should those programs include tools like this to ensure that patients make better decisions with their clinician and take their medications as prescribed or would that visit be better spent in other ways"" Dr. Montori asks.

Dr. Montori and his research team continue to study the effectiveness of this and other decision aids for diabetes patients. In addition, they are currently developing decision aids for patients with other chronic conditions. Mayo researchers plan to collaborate with researchers at Mount Sinai Hospital in New York City, which serves a disproportionately high number of Hispanics with diabetes, to conduct

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Adult Stem Cells from Human Cord Umbilical Cord Blood Successfully Engineered to Make Insulin

May 25, 2007 (EurekAlert) -- In a fundamental discovery that someday may help cure type 1 diabetes by allowing people to grow their own insulin-producing cells for a damaged or defective pancreas, medical researchers here have reported that they have engineered adult stem cells derived from human umbilical cord blood to produce insulin.

The researchers announced their laboratory finding, which caps nearly four years of research, in the June 2007 issue of the medical journal Cell Proliferation, posted online this week. Their paper calls it "the first demonstration that human umbilical cord blood-derived stem cells can be engineered" to synthesize insulin.

"This discovery tells us that we have the potential to produce insulin from adult stem cells to help people with diabetes," said Dr. Randall J. Urban, senior author of the paper, professor and chair of internal medicine at the University of Texas Medical Branch at Galveston and director of UTMB’s Nelda C. and Lutcher H. J. Stark Diabetes Center. Stressing that the reported discovery is extremely basic research, Urban cautioned: "It doesn’t prove that we’re going to be able to do this in people — it’s just the first step up the rung of the ladder."

The lead author of the paper, UTMB professor of internal medicine/endocrinology Larry Denner, said that by working with adult stem cells rather than embryonic stem cells, doctors practicing so-called regenerative medicine eventually might be able to extract stem cells from an individual’s blood, then grow them in the laboratory to large numbers and tweak them so that they are directed to create a needed organ. In this way, he said, physicians might avoid the usual pitfall involved in transplanting cells or organs from other people — organ rejection, which requires organ recipients to take immune-suppressing drugs for the rest of their lives.

Huge numbers of stem cells are thought to be required to create new organs. Researchers might remove thousands of donor cells from an individual and grow them in the laboratory into billions of cells, Denner explained. Then, for a person with type 1 diabetes, researchers might engineer these cells to become islets of Langerhans, the cellular masses that produce the hormone insulin, which allows the body to utilize sugar, synthesize proteins and store neutral fats, or lipids. "But we’re a long way from that," Denner warned.

Denner said this research, which reflects a fruitful collaboration with co-authors Drs. Colin McGuckin and Nico Forraz at the University of Newcastle Upon Tyne in the United Kingdom, used human umbilical cord blood because it is an especially rich source of fresh adult stem cells and is easily available from donors undergoing Caesarian section deliveries in UTMB hospitals. "However," he added, "embryonic stem cell research was absolutely necessary to teach us how to do this."

Embryonic stem cells have been engineered to produce cardiac, neural, blood, lung and liver progenitor cells that perform many of the functions needed to help replace cells and tissues injured by many diseases, the paper notes. Among the insights into cell and tissue engineering gained from work with embryonic stem cells, it adds, are those "relevant to the engineering of functional equivalents of pancreatic, islet-like, glucose-responsive, insulin-producing cells to treat diabetes."

The researchers said they tested adult stem cells in the laboratory to ensure that they were predisposed to divide. Then they used a previously successful method in which complex signals produced by the embryonic mouse pancreas were used to direct adult stem cells to begin developing, or "differentiating," into islet-like cells.

As they grew these adult stem cells in the laboratory, the researchers conducted other tests in which the cells to be engineered showed evidence of a characteristic, or marker, known as SSEA-4 that was previously thought to exist only in embryonic cells. They also found that, just as embryonic cells have been shown to do, these adult stem cells produced both C-peptide, a part of the insulin precursor protein, and insulin itself. Confirming the presence of the C-peptide was especially crucial, the researchers suggested, because although insulin is often found in the growth media with which the cells are nurtured and is often taken up by such cells, the presence of the C-peptide proves that at least some of the insulin was produced, or synthesized, by the engineered cells.

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Statement from the American College of Cardiology, American Diabetes Association and American Heart Association Related to NEJM article, 'Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes'

May 25, 2007 (ADA) -- The following is a Statement from the American College of Cardiology, American Diabetes Association and American Heart Association Related to NEJM article, 'Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes':

Today the New England Journal of Medicine published an article entitled, "Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes." The conclusions of this analysis of previous studies of rosiglitazone (brand name, Avandia) suggest that this oral agent used to treat type 2 diabetes may be associated with increased risk of heart attack and death from cardiovascular causes.
According to ACC, ADA and AHA, this study deserves serious thought and follow-up. As estimated here, the overall level of the risk associated with rosiglitazone appears to be small, but nonetheless one that must be considered carefully.

In the meantime, patients using this drug should talk to their health care provider to determine the most appropriate course of action. Patients should not stop taking any prescribed medications without first discussing the issue with their health care provider. Further research will be needed in this area to provide conclusive evidence.

It is very important to prevent diabetes when possible and to effectively treat it when it is present. The treatment of diabetes should be a team approach, with health care providers and patients working together to ensure patient education and empowerment.

The most life-threatening consequences of diabetes are heart disease and stroke, which strike people with diabetes more than twice as often as they do others. If you have diabetes, it is very important to control your blood glucose, blood pressure and cholesterol levels.

Information from the FDA for rosiglitazone can be found at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01636.html.

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Rosiglitazone -- Seeking a Balanced Approach to Avoid Panic Among Patients

May 24, 2007 (EurekAlert) - A calmer and more considered approach to the safety of rosiglitazone (Avandia) – the GlaxoSmithKline treatment for type 2 diabetes - is needed to avoid unnecessary panic among patients, says an Editorial published early Online today and in an upcoming edition of The Lancet.

The Editorial discusses the sudden anxiety caused by the publication in the New England Journal of Medicine (NEJM) of a systematic review of trials using rosiglitazone. The NEJM analysis suggests that the risk of a heart attack increases by 43% for patients taking rosiglitazone compared to control groups, and the risk of death by heart attack by 64%.

The tone of the NEJM paper is one of urgency, yet GSK has responded by stating it "strongly disagrees" with its conclusions. Who is right"

Of studies to date, the two most reliable to inform decision making are DREAM (published in The Lancet) and ADOPT (published in the NEJM). DREAM, which involved over 5,000 patients, recorded small increases in cardiovascular events compared to controls, which were not statistically significant. ADOPT involved more than 4,000 patients, with the only significant relevant finding an excess of congestive heart failure episodes for rosiglitazone-treated patients compared with glyburide (22 vs 9 events).

When taken together, the Editorial concludes these results could certainly be a matter of concern; but it says that patients, physicians and the US Food and Drug Administration can reasonably await the results of RECORD – a phase III trial specifically designed to analyse cardiovascular events connected to use of rosiglitazone.

The Editorial says: "Until the results of RECORD are in, it would be premature to overinterpret a meta-analysis that the authors and NEJM editorialists all acknowledge contains important weaknesses."
It concludes: "To avoid unnecessary panic among patients, a calmer and more considered approach to the safety of rosiglitazone is needed."

Posted by dlifenews at 10:36 AM | Comments (1)

When It Comes to Preventing Amputation in Diabetics, Site, Not Size, Matters

May 24, 2007 (EurekAlert) - Researchers at Scholl College's Center for Lower Extremity Ambulatory Research (CLEAR) at Rosalind Franklin University of Medicine and Science, Leiden University in the Netherlands, and Texas A&M University have presented important new information that could help physicians and their patients predict dangerous recurrent wounds that precede amputations in persons with diabetes. The study, conducted over a several-year period, identified two simple items that helped predict recurrence.

"The study was surprising and promising in that, out of a whole lot of data, some simple truths emerged," noted David G. Armstrong, DPM, PhD, Professor of Surgery at Scholl College and a principal investigator on the study. "The location of the ulcer (under the big toe) and the presence of poor blood flow were the key factors that dramatically increased the risk for recurrent wounds in these patients, thereby increasing their risk for gangrene and amputation. These findings could go a long way to help us predict and prevent the unnecessarily high rate of complications in persons with diabetes, worldwide."

Posted by dlifenews at 10:33 AM | Comments (0)

FDA Issues Safety Alert on Avandia

May 23, 2007 (FDA) - The U.S. Food and Drug Administration (FDA) is aware of a potential safety issue related to Avandia (rosiglitazone), a drug approved to treat type 2 diabetes. Safety data from controlled clinical trials have shown that there is a potentially significant increase in the risk of heart attack and heart-related deaths in patients taking Avandia. However, other published and unpublished data from long-term clinical trials of Avandia, including an interim analysis of data from the RECORD trial (a large, ongoing, randomized open label trial) and unpublished reanalyses of data from DREAM (a previously conducted placebo-controlled, randomized trial) provide contradictory evidence about the risks in patients treated with Avandia.

Patients who are taking Avandia, especially those who are known to have underlying heart disease or who are at high risk of heart attack should talk to their doctor about this new information as they evaluate the available treatment options for their type 2 diabetes.

FDA's analyses of all available data are ongoing. FDA has not confirmed the clinical significance of the reported increased risk in the context of other studies. Pending questions include whether the other approved treatment from the same class of drugs, pioglitazone, has less, the same or greater risks. Furthermore, there is inherent risk associated with switching patients with diabetes from one treatment to another even in the absence of specific risks associated with particular treatments. For these reasons, FDA is not asking GlaxoSmithKline, the drug's sponsor, to take any specific action at this time. FDA is providing this emerging information to prescribers so that they, and their patients, can make individualized treatment decisions.

"FDA remains committed to assuring that doctors and patients have the latest information available to make treatment and medication use decisions. In this case, FDA is carefully weighing several complex sources of data, some of which show conflicting results, related to the risk of heart attack and heart-related deaths in patients treated with Avandia," said Steven Galson, M.D., M.P.H., director of FDA's Center for Drug Evaluation and Research. "We will complete our analyses and make the results available as soon as possible. FDA will take the issue of cardiovascular risk associated with Avandia and other drugs in this class to an Advisory Committee as soon as one can be convened."

Avandia was approved in 1999 for treatment of type 2 diabetes, a serious and life threatening disease that affects about 18 to 20 million Americans. Diabetes is a leading cause of coronary heart disease, blindness, kidney failure and limb amputation. Since the drug was approved, FDA has been monitoring several heart-related adverse events (e.g., fluid retention, edema and congestive heart failure) based on signals seen in previous controlled clinical trials of Avandia alone and in combination with other drugs, and from postmarketing reports. FDA has updated the product's labeling on several occasions to reflect these new data, most recently in 2006. The most recent labeling change for Avandia also included a new warning about a potential increase in heart attacks and heart-related chest pain in some individuals using Avandia. This new warning was based on the result of a controlled clinical trial in patients with existing congestive heart failure.

Recently, the manufacturer of Avandia provided FDA with a pooled analysis (meta analysis) of 42 randomized, controlled clinical trials in which Avandia was compared to either placebo or other anti-diabetic therapies in patients with type 2 diabetes. The pooled analysis suggested that patients receiving short-term (most studies were 6-months duration) treatment with Avandia may have a 30-40 percent greater risk of heart attack and other heart-related adverse events than patients treated with placebo or other anti-diabetic therapy. These data, if confirmed, would be of significant concern since patients with diabetes are already at an increased risk of heart disease.

Avandia is manufactured by GlaxoSmithKline, which is based in Research Triangle Park, N.C.

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Sleep Apnea Increases Risk of Diabetes and Hypertension in Pregnant Women

May 23, 2007 (EurekAlert) —Sleep apnea is associated with a greatly increased incidence of pregnancy-induced diabetes and high blood pressure, according to a study presented at the American Thoracic Society 2007 International Conference, on Wednesday, May 22.

The study found that when the women’s weight was taken into account, sleep apnea was associated with a doubling of the incidence of gestational diabetes and a fourfold increase in the risk of pregnancy-induced hypertension.

In obstructive sleep apnea, the upper airway narrows, or collapses, during sleep. Periods of apnea end with a brief partial arousal that may disrupt sleep hundreds of times a night. Obesity is a major risk factor for sleep apnea.

The most effective treatment for sleep apnea is an apparatus called nasal CPAP, for contin¬u¬ous posi¬tive airway pres¬sure, which delivers air through a mask while the patient sleeps, keeping the airway open.

The researchers analyzed data from all pregnancies associated with sleep apnea, gestational diabetes (women who developed diabetes during pregnancy) and pregnancy-induced high blood pressure nationwide in 2003. Out of almost 4 million deliveries, 452 had sleep apnea. Of the 167,227 women who had gestational diabetes, 67 had sleep apnea. Of the 200,902 pregnancies with pregnancy-induced high blood pressure, 166 had sleep apnea.

“The repetitive decrease in oxygen that occurs during the night in someone with sleep apnea heightens the body’s ‘fight or flight’ state, which can raise blood pressure,” explains researcher Hatim Youssef, D.O. of UMDNJ-Robert Wood Johnson Medical School. “The body also secretes more hormones such as cortisol and epinephrine, and the body responds by producing more glucose coupled with a decreased sensitivity to insulin, which can lead to diabetes.”

Pregnancy can worsen sleep apnea, especially during the third trimester when a woman’s weight is greatest, Dr. Youssef explains. “When a mother’s oxygen level drops at night, it may also affect the oxygen level of the fetus, and we don’t know what the long-term effects are. That’s why it’s important for a pregnant woman with sleep apnea to be treated with CPAP during her pregnancy.”

It is not yet known whether CPAP treatment can reduce the risk of diabetes and hypertension during pregnancy, he says. “In the non-pregnant population, research has shown that treating sleep apnea will reduce the risk of diabetes and hypertension. In the future, we want to follow pregnant women whose sleep apnea is well-controlled to see if treatment prevents them from developing these conditions, or makes it less severe.”

He recommended that pregnant women who are obese, hypertensive or diabetic be closely evaluated for the presence of sleep apnea.

If sleep apnea is present, treatment in the form of nasal CPAP should be used and her blood pressure and blood sugar should be closely monitored, Dr. Youssef says.

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Sleep Apnea May Increase Risk of Diabetes

May 22, 2007 (EurekAlert) — Researchers at the Yale University School of Medicine have found that patients with obstructive sleep apnea are at increased risk for developing of type II diabetes, independent of other risk factors. The findings are being presented at the American Thoracic Society 2007 International Conference, on Monday, May 21.

The study looked at 593 patients at the VA Connecticut Health Care System referred for evaluation of sleep-disordered breathing. Each patient spent a night in a sleep laboratory to undergo a sleep study, called polysomnography.

The researchers followed the subjects for up to six years and found that patients diagnosed with sleep apnea had more than two-and-half times the risk of developing diabetes compared with those without the nighttime breathing disorder. The patients were then divided into groups based on the severity of their sleep apnea, and the more severe a patient’s sleep apnea, the greater the risk of developing diabetes.

In obstructive sleep apnea, the upper airway narrows, or collapses, during sleep. Periods of apnea end with a brief partial arousal that may disrupt sleep up to hundreds of times a night. Obesity is a major risk factor for sleep apnea. Emerging evidence also exists that sleep apnea is associated with hypertension, stroke and heart disease.

The most effective treatment for sleep apnea is a treatment called contin¬u¬ous posi¬tive airway pres¬sure (CPAP), which delivers air through a mask while the patient sleeps, keeping the airway open. It is successful in treating sleep apnea and improving daytime drowsiness, resulting in an improved quality of life and even reduction in risk for traffic accidents. It has yet to be determined whether treatment for sleep apnea with CPAP can actually improve conditions such as diabetes.

“Our next step will be to determine whether the treatment of sleep apnea can improve an individual’s diabetic parameters and consequently the negative health effects of diabetes.” says researcher Nader Botros, M.D., of Yale University.

Dr. Botros said that although it is not known exactly what the link is between sleep apnea and diabetes, it is thought that sleep apnea activates the body’s fight-or-flight response. This triggers a cascade of events, including the production of high levels of the hormone cortisol that ultimately leads to insulin resistance and glucose intolerance, pre-diabetic conditions that, if left untreated, can lead to the development of diabetes. Low oxygen levels also appear to play an important role.

“The impact of diabetes on public health is great,” Dr. Botros says. “Diet and exercise, along with a medication regimen, are the mainstays of treatment, but unfortunately diabetes remains a major public health challenge. New approaches are needed to better understand the risk factors for diabetes in order to develop additional preventive strategies. Understanding the link between sleep-disordered breathing and diabetes may represent one such approach.”

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GlaxoSmithKline Strongly Defends its Record on Avandia

May 22, 2007 (Medwire) - The following is GlaxoSmithKline’s (NYSE: GSK) response to a press release issued by the US Senate Committee on Finance about Avandia® (rosiglitazone maleate):

The suggestion that GlaxoSmithKline has placed patients at risk and attempted to silence independent investigation of data is absolutely false. Any fair examination of the company’s record will show that GSK has been fully transparent in its efforts to thoroughly study the safety and effectiveness of Avandia, and to widely communicate that information to governments, scientists, physicians, and the public in the best interests of both patients and scientific debate.

The statistical analysis on which the Committee bases its concern is, by the author’s own admission, limited, while the editorial accompanying the paper states: “the possibility that the findings were due to chance cannot be excluded.”

In contrast, GSK has initiated the most comprehensive and rigorous program of scientific analysis for any oral anti-diabetic medicine on the market today, with experience in over 52,000 patients. The company has initiated:

* Extensive clinical trials, including long-term clinical trials in diabetic patients;
* A prospective, long-term, clinical trial specifically designed to address cardiovascular safety in diabetic patients;
* A proactive, integrated clinical trial analysis of the company’s own collected data; and
* Rigorous monitoring of spontaneously reported adverse events.

These data show that Avandia has a cardiovascular safety profile comparable to other oral anti-diabetic medicines. In addition, independent investigators performed a comprehensive analysis of patients in a US managed care database of more than 33,000 people with diabetes, and showed there was no difference in cardiovascular events among patients taking Avandia-containing regimens versus other oral anti-diabetic medicines.

Over time, the company has actively shared new data on Avandia with the FDA and with regulators worldwide as quickly as scientifically possible. GSK has a strong commitment to providing timely access to its data, which is why the company was one of the first to develop a Clinical Trials Register, on which Avandia data has been posted, and where it is available to any scientific investigator interested in doing their own analysis.

GSK stands firmly behind the safety of Avandia when used appropriately, and will strongly defend its commitment to patient safety and to full transparency of its scientific information. We welcome the opportunity to meet with the Committee and its staff to correct misunderstandings and to clarify the record.

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Cleveland Clinic Study Shows Commonly Used Diabetes Drug Increases Risk of Heart Attack and Cardiovascular Death

May 21, 2007 (PRNewswire) -- A drug commonly used to treat patients with type 2 diabetes mellitus, raises patients' risk of heart attack and cardiovascular death, according to an analysis completed by the Chairman of Cardiovascular Medicine at Cleveland Clinic.

In an analysis of 42 trials, Steven Nissen, M.D., found that use of the drug rosiglitazone (Avandia(TM)) raises patients' risk of heart attack and cardiovascular death by 43% and 64%, respectively, in comparison to the use of a placebo or other anti-diabetic therapies. The findings represent a particular public health
concern because more than 65% of the deaths amongst diabetic patients are attributed to heart disease.

Dr. Nissen's manuscript was posted on-line by the New England Journal of Medicine at 5 pm today and will subsequently appear in the print version of the journal. His co-author is Cleveland Clinic statistician Kathy Wolski.

"The results of this analysis raise serious concerns about the cardiovascular safety of rosiglitazone," Dr. Nissen said. "While our study was limited by lack of access to original source data, which would have enabled time-to-event analysis, patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes."

Rosiglitazone was approved for use by the Food and Drug Administration in 1999, based on the drug's ability to lower blood glucose and reduce glycohemoglobin levels. Since then, approximately 60 million prescriptions have been issued and several million patients currently take the drug.

Rosiglitazone is one of the primary therapies used to lower blood sugar in patients with type 2 diabetes. "However, the objective of lowering blood sugar is the reduction of the complications of diabetes," Dr. Nissen explains. "The effect of anti-diabetic therapy on cardiovascular outcomes is of critical importance because cardiovascular disease represents the overwhelming source of diabetic mortality. Unfortunately, rosiglitazone appears to increase, rather than decrease, the most serious complication of diabetes, heart disease."

In the 42 studies comprising the analysis, 15,560 patients were randomized to regimens including rosiglitazone and 12,283 were assigned to comparator groups that did not. Patients were relatively young, averaging less than 57 years of age for both treatment groups and there was a moderate male predominance (53-61%).

Posted by dlifenews at 09:54 AM | Comments (1)

Quality Improvement Effort Pays Off in Diabetes Care

May 18, 2007 (EurekAlert) - Spending money to improve diabetes care at federally qualified community health centers is a sound investment, according to one of the first studies to examine the clinical and economic impact of quality improvement on diabetes care.

In the June 2007 issue of Health Services Research, a University of Chicago-based research team reports that a relatively inexpensive national effort to improve the process of care at selected clinics was able to make enough difference in its first four years that, if sustained, it could reduce patients' lifetime risk of blindness, end-stage kidney disease and coronary artery disease—all common complications of diabetes.

At a cost of less than $500 per patient each year, this modest quality improvement effort is projected to reduce the incidence of major complications, such as end-stage renal disease, which can cost $44,000 per patient each year.

"In this setting, we found that the economic value of improving the delivery of existing diabetes care was roughly equal to the benefits of developing a new treatment, such as a novel diagnostic technology or a better drug," said study author Elbert Huang, MD, assistant professor of medicine at the University of Chicago. "A small investment in upgrading the delivery of health care brought about a substantial improvement in health that justified the costs of the program."

"Unfortunately," he added, "the people who make such financial investments are not the people who directly benefit from them."

Federally qualified community health centers (FQHCs) routinely lose money on health care improvement programs. The added costs are borne by the health centers and by state and federal government programs; the benefits accrue to society. "Cost-effective medicine," Huang said, "depends entirely on an ongoing societal commitment to providing chronic care for vulnerable patients."

The researchers studied how diabetes care changed at 17 Midwestern FQHCs that participated in the Health Disparities Collaboratives—a national, federally funded quality-improvement initiative launched in 1998.

The program was designed to make certain that patients at these FQHCs, which provide primary care services in underserved urban and rural communities, received the current standard of care. This includes regular testing for glycosylated hemoglobin (a measure of blood sugar control), assessment of fats and cholesterol in the blood, eye exams and blood pressure checks, with appropriate follow-up. It also involves preventive treatments such as the use of ACE inhibitors, which can treat high blood pressure and heart failure, and aspirin, which can prevent heart attacks and strokes.

After reviewing four years of charts for 80 patients from each of the 17 centers, the researchers reported that "multiple components of care improved from 1998 to 2002." Annual glycosylated hemoglobin testing increased from 71 percent to 92 percent of patients. Blood lipid testing rose from 15 percent to 44 percent. Eye exams went from 25 percent to 44 percent. Prescriptions for ACE inhibitors rose from 33 percent of patients to 55 percent, and aspirin prescriptions rose from 22 percent to 45 percent.

These improvements added very little expense. The diabetes quality-improvement program cost about $700 per patient the first year, $600 the second year, $500 the third year and leveled off at $378 per year beginning in year four.

The researchers then estimated how much the patients' risk for the major complications from diabetes would be decreased if these improvements were maintained. Better care, they concluded, should reduce the lifetime incidence of blindness from 17 percent of patients down to 15 percent, of kidney failure from 18 down to 15 percent and of coronary artery disease from 28 to 24 percent.

Next they tried to place a dollar value on the benefits of the program—a longer life with fewer complications. In medical cost-effectiveness analysis, a commonly accepted standard is to say that a new device, medication or program that generates one year of extra life for a healthy person at less than $100,000 is a good value. Another commonly used standard is $50,000 per one year of extra life in perfect health.

The diabetes quality-improvement initiative passed all these standards. Even at twice the price and with the benefits deeply discounted, the value added by the program exceeded commonly accepted standards.

"Since diabetes is so common and is increasing rapidly, whatever enhances diabetes care is worth looking at," Huang said.

A study released last month at the American Association of Clinical Endocrinologists' annual meeting in Seattle found that poorly managed type 2 diabetes costs the U.S. health system an extra $22.9 billion a year in direct medical costs. Diabetic complications cost almost $10,000 per patient each year, concluded the author of that study, Willard Manning, PhD, a University of Chicago health economist.

Multiple quality-improvement programs have been found to produce improvements similar to those generated by the Health Disparities Collaboratives' diabetes program, Huang said, but "the economic value of these programs is generally unknown." The lessons learned from this evaluation, he added, "can provide important insights for policy makers."

Posted by dlifenews at 10:03 AM | Comments (0)

RAND Study Finds Women with Heart Disease and Diabetes Less Likely to Receive Proper Care

May 15, 2007 (EurekAlert) - Women with heart disease and diabetes are less likely to receive several types of routine outpatient medical care than men who have similar health problems, according to a RAND Corporation study issued today.

While previous research has shown that women less frequently receive expensive medical care such as angioplasty for heart disease, few studies have evaluated gender disparities in managed care settings.

All the patients in the RAND Health study had either private insurance or were enrolled in Medicare managed care plans, had been diagnosed with heart disease and/or diabetes, and had visited health providers to receive care. The study is published in the May/June edition of the journal Women’s Health Issues.

"We found that the routine medical care received by women for their heart disease and diabetes was not as good as the care received by men," said Chloe Bird, the study’s lead author and a sociologist at RAND, a nonprofit research organization. "These are low-cost treatments that can forestall serious health problems in the future -- and women with diabetes and heart disease are not receiving them as often as men with similar problems."

Researchers studied more than 50,000 men and women enrolled in both commercial and Medicare managed care plans in 1999. The study examined 11 different screening tests, treatments or measurements of health status shown to be important to all people diagnosed with heart disease or diabetes.

Among people enrolled in commercial health plans, women were significantly less likely than men to receive the care evaluated in six of the 11 measures, while women enrolled in the Medicare plans were less likely to receive the care evaluated in four of the 11 measures.

The largest disparity found by researchers was that women were less likely to lower their cholesterol to recommended levels after suffering a heart attack or other acute cardiac event, or if they had diabetes.

For example, women with diabetes were 19 percent less likely than men to have their cholesterol within recommended ranges if they were enrolled in Medicare and 16 percent less likely than men to have cholesterol with recommended ranges if enrolled in commercial health plans.

Other types of care women received less often than men included being prescribed ACE inhibitor drugs for chronic heart failure and receiving prescriptions for beta blocker drugs following a heart attack.

Women with diabetes in both Medicare and commercial health plans were more likely to have received eye exams than their male peers.

The disparities were found among women even though they generally see a doctor or other health care provider more often than men. The disparities also remained after researchers accounted for socioeconomic factors that may influence care.

"These were all insured people. They all had access to medical care and they were all diagnosed with these diseases," Bird said. "The disparities cannot be explained by a lack of patient reporting or not recognizing the symptoms of a disease."

Bird said that more research needs to be done to understand why there are gender differences in outpatient care.

"As we become a nation with an older population, the type of routine preventive care we studied will become even more important," Bird said. "Understanding these gender differences may allow us to improve care."

The RAND study is one of four published in the latest edition of Women’s Health Issues reporting on studies that found gender disparities among patients treated in managed care settings.

"Taken together, these studies make a compelling case for routine assessment and reporting of selected quality indicators by gender," said Dr. Allen Fremont, the lead author of an accompanying editorial and co-author of the RAND study. Fremont is a natural scientist and sociologist at RAND.

Posted by dlifenews at 10:57 AM | Comments (0)

Grain Fiber and Magnesium Intake Associated with Lower Risk for Diabetes

May 15, 2007 (EurekAlert) - Higher dietary intake of fiber from grains and cereals and of magnesium may each be associated with a lower risk of type 2 diabetes, according to a report and meta-analysis in the May 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Projections indicate that the number of people diagnosed with diabetes worldwide may increase from 171 million in 2000 to 370 million by 2030, according to background information in the article. The associated illness, death and health care costs emphasize the need for effective prevention, the authors write. Fiber may help reduce the risk of diabetes by increasing the amount of nutrients absorbed by the body and reducing blood sugar spikes after eating, among other mechanisms. Current American Diabetes Association guidelines include goals for total fiber intake, but research suggests that some types of fiber may be more beneficial than others. Findings regarding magnesium and diabetes risk remain unclear.

Matthias B. Schulze, Dr.P.H., and colleagues at the German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, conducted a study of 9,702 men and 15,365 women age 35 to 65 years. Participants completed a food questionnaire when they enrolled in the study between 1994 and 1998, then were followed up through 2005—an average of seven years—to see if they developed diabetes. In addition, the researchers performed a meta-analysis of previously published work related to intake of fiber or magnesium and risk of diabetes.

During the follow-up period, 844 individuals in the study developed type 2 diabetes. Those who consumed more fiber through cereal, bread and other grain products (cereal fiber) were less likely to develop diabetes than those who ate less fiber. When the participants were split into five groups based on cereal fiber intake, those who ate the most (an average of 17 grams per day) had a 27 percent lower risk of developing diabetes than those in the group that ate the least (an average of 7 grams per day). Eating more fiber overall or from fruits and vegetables was not associated with diabetes risk, nor was magnesium intake.

In the meta-analysis, the researchers identified nine studies of fiber and eight studies of magnesium intake. Based on the results of all the studies, in which participants were classified into either four or five groups according to their intake of fiber or magnesium, those who consumed the most cereal fiber had a 33 percent lower risk of developing diabetes than those who took in the least, while those who consumed the most magnesium had a 23 percent lower risk than those who consumed the least. There was no association between fruit or vegetable fiber and diabetes risk.

"In conclusion, the evidence from our study and previous studies, summarized by means of meta-analysis, strongly supports that higher cereal fiber and magnesium intake may decrease diabetes risk," the authors conclude. "Whole-grain foods are therefore important in diabetes prevention."

Posted by dlifenews at 10:55 AM | Comments (0)

Glucosamine-like Supplement Inhibits Multiple Sclerosis, Type 1 Diabetes

EurekAlertMay 14, 2007 (EurekAlert) — A glucosamine-like dietary supplement has been found to suppress the damaging autoimmune response seen in multiple sclerosis and type-1 diabetes mellitus, according to University of California, Irvine health sciences researchers.

In studies on mice, Dr. Michael Demetriou and colleagues with the UC Irvine Center for Immunology found that N-acetylglucosamine (GlcNAc), which is similar but more effective than the widely available glucosamine, inhibited the growth and function of abnormal T-cells that incorrectly direct the immune system to attack specific tissues in the body, such as brain myelin in MS and insulin-producing cells of the pancreas in diabetes. Study results appear on the online version of the Journal of Biological Chemistry.

“This finding shows the potential of using a dietary supplement to help treat autoimmune diseases,” said Demetriou, an assistant professor of neurology, and microbiology and molecular genetics. “Most importantly, we understand how this sugar-based supplement inhibits the cells that attack the body, making metabolic therapy a rational approach to prevent or treat these debilitating diseases.”

The UC Irvine study defines how metabolic therapy with the sugar GlcNAc and other related nutrients modifies the growth and autoimmune activitiy of T-cells. Virtually all proteins on the surface of cells, including T-cells, are modified with complex sugars of variable lengths and composition. Recent studies have shown that changes in these sugars are often associated with T-cell hyperactivity and autoimmune disease.

In mouse models of both MS and type 1 diabetes, Demetriou and colleages found that GlcNAc prevented this hyperactivity and autoimmune response by increasing sugar modifications to the T-cell proteins. This therapy normalized T-cell function and prevented development of paralysis in MS and high blood glucose levels in type 1 diabetes.

This study comes on the heels of others showing the potential of GlcNAc in humans. One previous clinical study reported that 8 of 12 children with treatment-resistant autoimmune inflammatory bowel disease improved significantly following two years of treatment with GlcNAc. No significant adverse side effects were noted.

“Together, these findings identify metabolic therapy using dietary supplements such as GlcNAc as potential treatments for autoimmune diseases.” Demetriou said. “Excitement for this treatment strategy stems from the novel mechanism for affecting T-cell function and autoimmunity and the availability and simplicity of its use. However, additional studies in humans will be required to assess the full potential of this therapeutic approach.”

Autoimmune diseases such as MS and type 1 diabetes mellitus result from poorly understood interactions between inherited genetic risk and environmental exposure. MS results in neurological dysfunction, while uncontrolled blood glucose in type 1 diabetes can lead to damage of multiple organs.

Posted by dlifenews at 10:50 AM | Comments (0)

Diabetes and Heart Failure Is Double Trouble for Older Women

May 11, 2007 (Newswise) — New research from UAB (University of Alabama at Birmingham) shows that the effect of diabetes on the severity of illness and risk of death for patients with heart failure is much worse in women than men. The effect is even more pronounced in older patients, according to findings published online in Heart on May 8.

The UAB research team, led by Ali Ahmed, M.D., MPH, associate professor in the division of gerontology, geriatrics and palliative care and director of UAB’s Geriatric Heart Failure Clinic and Geriatric Heart Failure Research, found that diabetes was associated with a significant increase in the risk of death and hospitalization in patients with heart failure. Women over age 65 had worse outcomes than men or younger women.

“Our results suggest that heart failure patients should be thoroughly evaluated for the presence of diabetes and if it is present, should be intensively managed based on published guidelines,” said Ahmed. “Further studies should test current interventions and develop new ones to reduce the adverse effects of diabetes in heart failure patients in general, and among older adults in particular.”

Ahmed and his colleagues examined 2,056 heart failure patients with diabetes compared to the same number of non-diabetic heart failure patients who had similar characteristics at baseline. They used a technique called propensity score matching to design their study while remaining blinded to study outcomes as in a randomized clinical trail. Patients were followed on average for 38 months and analysis performed in two stages; one to see if the effect of diabetes differed in male or female heart failure patients and a second to examine if the age of the patient contributed to the effect of diabetes.

Patients in this study were participants in the Digitalis Investigational Group (DIG) trial, a multi-center trial funded by the National Heart Lung and Blood Institute, one of the National Institutes of Health. The DIG trial examined 7788 patients at 302 sites in the U.S. and Canada.

Posted by dlifenews at 10:06 AM | Comments (1)

"Virus Sponge" Could Improve Flu Treatments, Diabetes Care, Vaccine Development

May 11, 2007 (Newswise) — Influenza virus H5N1, which caused the recent outbreak of avian flu, may have a new enemy.

Researchers at the University of Maryland's A. James Clark School of Engineering have created a "virus sponge" that could filter a patient's blood in a process similar to kidney dialysis, removing the virus from the patient's body. The concept could also be used to make vaccine production more efficient and in a pill to reduce glucose levels in diabetics, among other applications.

The virus sponge is based on a technology called molecular imprinting. In molecular imprinting, researchers stamp a molecule's shape into a substance (in this case, a hydrogel—a sponge-like material). When the specific molecule filters through the hydrogel, it fits in the imprint hole and is trapped.
The research group of Peter Kofinas, a professor in the Clark School's Fischell Department of Bioengineering, is the first to apply molecular imprinting to the capture of viruses, and to show that this approach is possible using an inexpensive hydrogel.

Kofinas' team has so far used this technique on plant viruses and Human Parvovirus B19, which causes "fifth disease" in babies, and has now begun work on the H5N1 influenza virus.

"This new technology could be integrated into hospitals and healthcare centers at minimal cost," according to Kofinas. Modifying existing dialysis machines to include the virus sponge technology would be relatively simple, he said.

"This virus removal device can be used the same way as a kidney dialysis machine," Kofinas continued. "If you have a viral infection, you can go to the hospital and have your blood cleaned of that virus."

While a new vaccine must be developed each year for the strain of influenza that is expected to be the most potent, a hydrogel can be imprinted as a universal filter for all flu strains. However, to achieve better performance, a hydrogel filter can also be produced to catch a particular strain of the virus.
The molecular imprinting process has many applications beyond trapping viruses.

"Applying the technology to a drug or food additive could contribute to the dietary freedom of those who suffer from type II diabetes," Kofinas said.

A pill containing the hydrogels could be developed to remove excess sugars when taken with food, thus helping diabetics regulate their diet, Kofinas explained. The hydrogels would work within the small intestine to remove glucose prior to absorption into the blood stream.

Drug manufacturers could use the hydrogel filters in vaccine production. Pharmaceutical companies use viruses to create the vaccines that fight them. Hydrogels could be used to strip the virus out of the finished medication—a process that is currently very time-consuming and expensive.

Another potential application is to use the material as a filter in masks for those needing protection in case of biological warfare or other harmful biological agent exposure.

Kofinas has filed a patent on this technology. Currently, he is collaborating with researchers at the National Institutes of Health on how to use the hydrogels to clean human viruses out of blood. Advances in this area could help ensure a safer blood supply by allowing for the low-cost removal of viruses like hepatitis and HIV from donor blood.

Kofinas is also associate chair and director of graduate studies in the Fischell Department of Bioengineering. His graduate students, Linden Bolisay, Brendan Casey, Angela Fu and Daniel Janiak, continue to contribute to this research.

Posted by dlifenews at 10:03 AM | Comments (0)

Caring for the Sick Now a Public Health Priority for Developing Countries

May 11, 2007 (EurkeAlert) - Of the 57 million people dying worldwide each year, 6 million deaths are caused by cancer and 3 million from HIV/AIDS, with the majority of both occurring in developing countries. These figures indicate the large number of people experiencing incapacitation and pain through shortness of breath, constipation, diarrhoea, nausea as well as distress, depression and anxiety.

New research published in the Journal of Public Health Policy, prepared by research staff at The George Institute for International Health, the School of Public Health at the University of Sydney and the Department of Palliative Medicine at Calvary Hospital, highlights that a potential 100 million people in these poorer nations could benefit from palliative care services, including family members and close companions.

Lead author of the paper Dr Ruth Webster, a Research Fellow at The George Institute, says that "The scale of this epidemic of death and dying requires acknowledgement and priority as a public health issue, with more than just an emphasis on prevention of these diseases and their cure. Around 100 countries around the world have palliative care services, however only 6% are located in Asia and Africa, where the highest demand for the services is".

"Palliative care is not on the health agenda of governments as a public health problem, which is extremely detrimental to the populations that most need these services. WHO has recommended that all countries have a policy to implement these types of services, but despite this, one only African country, has made this a priority, Uganda. South Africa has recently included palliative care in their new health policies." added Dr Webster.

The review found three specific barriers to implementing palliative care in developing countries - government commitment, opioid availability and education. While pain management is only part of the picture, the availability of opioids and morphine is extremely difficult for developing countries. Webster says that policy makers and health professionals need to understand that lifting unnecessary regulations is vital for the large number of ill people needing care.

The authors recommend training and education as a key part to developing palliative care programs. "Experience shows that training programs for health professionals is an essential and rewarding step to build capacity in developing countries. Educating family members and utilising volunteer caregivers, in conjunction with publicly raising the profile of palliative care services, is essential so that people know what options are available and what is the best option for a particular illness."

Dr Webster adds "Palliative care needs to be appropriate to each particular country’s culture, resources and existing health problems. Local healers for example can play a key role in symptom relief. We acknowledge care of this kind is difficult to establish in poorer countries, but urgent steps must be taken to deliver these services."

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

Employee Health Program Improves Blood Pressure, Diabetes Control

May 10, 2007 (EurekAlert) – (American Heart Association meeting report) Employees who participated in a worksite health program improved blood pressure control by 9 percent and diabetes control by 15 percent, researchers reported at the American Heart Association's 8th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

During three years (2004–06) of follow-up on 2,100 workers, researchers also found that absenteeism declined significantly at JEA, a municipal utility in Jacksonville, Fla. The number of employees who missed work due to hypertension dropped from 25.8 percent to 15.6 percent, while those who missed work because of diabetes dropped by 66.2 percent (from 50 percent to 16.9 percent).

Workplace accidents also dropped by nearly 70 percent from 83 incidents in 2003 to 25 incidents in 2006. In all, 20 of the 83 incidents in 2003 resulted in lost time away from work, compared to only seven incidents in 2006.

The rising cost of medical care and the utility's predominantly male workforce (median age, 47) contributed to the need for a program that focused on preventing heart and blood vessel disease, said Sharon A. Clark, D.H.Sc., lead author of the study and JEA's health promotion specialist.

"With an aging workforce, we were concerned with making a change to the modifiable risk factors for cardiovascular disease for our employees," Clark said.

While safety has long been a priority at the utility, about a dozen employees started the worksite health program in 1989. The workers had been walking along the bridges in Jacksonville's downtown river area during their lunch hours and decided they wanted a more formal exercise facility, Clark said.

"They approached the company to create a fitness center," she said. "Being a public utility, JEA has to be mindful of where its resources are spent."

The company agreed to provide the space, custodial help and security services, and the employees took out a loan for the equipment. The employees also chose the exercise classes and took over most of the day-to-day administration of what has expanded into seven fitness centers at various company facilities.
"Over the years, the company began to notice benefits to helping workers stay fit," Clark said. "The program has grown to where it is now part of the company's strategic plan."

For the study, JEA teamed up with its healthcare provider, Blue Cross/Blue Shield of Florida and with Pfizer Global Pharmaceuticals in Jacksonville.

With their help, the company expanded its safety and health program into a comprehensive wellness system that includes live and written health education information, health screenings, coaching and an incentive program to encourage participation.

Researchers, collecting mounds of data during the three years of follow-up, attempted to quantify the effects of lifestyle-changing activities aimed at reducing cardiovascular disease risks such as smoking, excess weight, high blood pressure and diabetes.

The backbone of the program is the Health Risk Assessment (HRA), a screening tool that includes measures of employees' health through blood pressure, blood sugar and cholesterol testing. It also includes a 60-question survey that asks about current health status, family history, daily nutrition, physical activity, the use of alcohol and tobacco, safe habits (such as seat belt usage), stress and depression, use of available medical screening tests and gender-related health questions.

The survey ends by asking questions that measure how willing an employee is to make lifestyle changes related to health and safety, and providing coaching to accomplish that change.

"Just knowing about something doesn't make you change," Clark said. "So the last part of the HRA is one-on-one coaching."

Employees are asked what they want to change first, such as weight, blood pressure or diabetes control. The coaching, set up through the health insurance company, is structured so that patients can call the same coach repeatedly to build a dialogue.

The researchers also used a Wellness Inventory Survey (WIS) to gather data and provided incentives such as time off or the chance to win prizes for participating in the survey and other aspects of the health and safety program.

The survey includes questions about absenteeism (time away from work due to illness) and presenteeism (unproductive time spent at work due to health or personal situations that make it hard to concentrate). During the study, the percentage of employees with normal blood pressure increased from 28 percent to 37 percent and the percentage with normal blood glucose (sugar) increased from 43 percent to 58 percent. The percentage of non-smokers increased from 86 percent to 89 percent.

Employees also reported feeling better about themselves, with a significant increase in the percentage describing their health status as "excellent or very good," jumping 22 percent from 41.7 percent to nearly 51 percent.

"We are planning to continue to work with modifiable risk factors because we think it benefits both the employees and the employer," Clark said.

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

The Stem Cells That Weren't There

Surprising findings points to shift in quest for novel diabetes treatments

May 8, 2007 (EurekAlert) - Diabetes researchers, investigating how the body supplies itself with insulin, discovered to their surprise that adult stem cells, which they expected to play a crucial role in the process, were nowhere to be found. Many researchers had proposed that adult stem cells develop into insulin-producing cells, called beta cells, in the pancreas.

Instead, the beta cells themselves divide, although slowly, to replenish their own population.

"Ultimately, if diabetes researchers learn how to control insulin production, we can better treat patients who now can't produce insulin--children and adults with type 1 diabetes," said study leader Jake A.

Kushner, M.D., a pediatric endocrinologist at The Children's Hospital of Philadelphia. "This research tells us that we need to better understand what regulates the growth of beta cells, rather than searching for adult stem cells that give rise to beta cells."

Dr. Kushner's team reported their findings, based on animal studies, in the May issue of Developmental Cell.

The discovery does not have immediate implications for diabetes treatment. Rather, it advances basic knowledge of insulin biology that could form a foundation for eventual therapies.

Currently, patients with type 1 diabetes depend on life-saving insulin injections or medication. Looking to future techniques, medical researchers hope to fulfill a promise of regenerative medicine: restoring the body's ability to produce its own insulin. One solution is to transplant tissues called the islets of langerhans, small masses within the pancreas containing the beta cells that normally secrete insulin. Islet transplants have already been performed experimentally, but typically fail after a few years in a patient's body.

Moreover, islets are taken from cadavers, and supplies are very limited, so researchers are seeking ways to grow islets in the laboratory. Another potential implication of the research is for beta cell regeneration, a controversial area of diabetes research. Patents with longstanding type 1 diabetes have small amounts of islets that escape destruction by the immune system. With sufficient biological knowledge and the appropriate techniques, it might even be possible to someday stimulate these residual beta cells inside patients to proliferate and produce healthy amounts of insulin.

"We expected to find adult stem cells that differentiate into beta cells," said Kushner. "Such adult stem cells are important in renewing skin, intestines and other tissues." (Adult stem cells are different from the embryonic stem cells found in human embryos that are a current focus of social and political controversies.)

"However," he added, "we found no evidence for adult stem cells that give rise to beta cells or other pancreatic tissue. We found that all beta cells can replicate, and are, in a sense, their own stem cells."
Kushner's group found that beta cells renew themselves and grow slowly. Unexpectedly, the researchers found the beta cells undergo a prolonged waiting period before dividing. This delay, which they call a replication refractory period, had never been observed in mammalian development.

The researchers made use of a novel cell labeling technique that allows them to view the fates of individual cells throughout multiple rounds of cell divisions. "Although the cell labeling technique had been described previously by other groups, our group was the first to use it over long periods of time," said Kushner.
By providing rats with a timed sequence of colored dyes in their drinking water, the researchers were able to see discrete beta cells in the rat pancreas, shining in single colors that indicated a sequence of cell divisions. In contrast, the rapidly dividing cells in the rats' intestine showed blended colors, indicating that they had divided multiple times from specialized cells—possibly from adult stem cells.

"We expect that other developmental biologists can use this cell labeling technique to track the fate of cells in many other tissues, such as brain and muscle," said Kushner, adding that the technique may also be useful in following cells in cancer research.

If these findings open up a new avenue of investigation into how insulin-producing cells develop, diabetes researchers may be a step closer to manipulating the process to benefit patients. "This research also has implications for type 2 diabetes, in which the body fails to produce and respond to insulin," added Kushner. The incidence of type 2 diabetes has been rising dramatically, especially among children and adolescents.

Posted by dlifenews at 11:14 AM | Comments (0)

Massachusetts Residents May Participate in a Research Study To See if the Aspirin Family of Drugs Can Improve Type 2 Diabetes Management

May 7, 2007 (Joslin) -- Are you one of the estimated 360,000 people with type 2 diabetes in the Commonwealth of Massachusetts? If so, you may be eligible to participate in a clinical trial at Joslin Diabetes Center investigating whether salsalate, an anti-inflammatory drug used for years to manage arthritis pain, can reduce blood glucose levels in people with type 2 diabetes.

Massachusetts follows the national trend of diabetes. Approximately 6 out of 100 people in the Commonwealth have been diagnosed with diabetes, and 20 out of every 100 deaths are diabetes-related. Clinical trials are a critical way to explore better treatment and management programs that can reduce the complications caused by diabetes, such as heart attacks and strokes. This study will examine if salsalate, which is chemically similar to aspirin but has fewer side effects, can significantly reduce high levels of blood glucose and lead to an inexpensive yet effective treatment path for people with type 2 diabetes. Salsalate has been used for more than 40 years to treat pain associated with arthritis.

Participants in this study will make seven to eight visits to Joslin Diabetes Center over the course of 21 weeks. Each visit will be an hour or less, including an exam and lab work. Participants will be provided at no charge with a glucose monitor and trial medication (either the study drug or a placebo, a pill with no active medication). Parking is free for each visit, and participants will receive monetary compensation for each study visit completed. During the study, participants will continue to see their personal physician for all of their healthcare needs.

The ideal candidates will be adults diagnosed with type 2 diabetes who are between the ages of 18 and 75, who are not on insulin and whose glucose levels are not in good control. Other criteria will be reviewed during the screening process for the study.

If you are interested in participating in this study, referred to as Targeting Inflammation with Salsalate in Type 2 Diabetes (TINSAL-T2D), please contact Elizabeth Tatro at 617-735-1940. For more information on Joslin, call 1-800-JOSLIN-1 or visit http://www.joslin.org/

For more information about the study, please contact Allison B. Goldfine, M.D., via phone at 617-732-2643 or via e-mail at Allison.Goldfine@joslin.harvard.edu or visit the clinical research part of Joslin's Web site: http://www.joslinresearch.org/PINET/ClinicalDetail.asp?clinicalSectionID=3

Posted by dlifenews at 02:29 PM | Comments (0)

UW Study Tests Topical Honey as a Treatment for Diabetic Ulcers

May 7, 2007 (EurekAlert) - The sore on Catrina Hurlburt's leg simply wouldn't heal.

Complications from a 2002 car accident left Hurlburt, a borderline diabetic, with recurring cellulitis and staph infections. One of those infections developed into a troublesome open sore that, despite the use of oral antibiotics, continued to fester for nearly eight months.

Then Hurlburt's physician, Jennifer Eddy of UW Health's Eau Claire Family Medicine Clinic, suggested she try using topical honey.

Within a matter of months, the sore had healed completely.

"I remember thinking, holy mackerel-what a difference," says Hurlburt, who can't use topical antibiotics because of allergies. "It's a lot better than having to put oral antibiotics into your system."

With funding provided by the Wisconsin Partnership Fund for Health and the American Academy of Family Physicians Foundation, Eddy is currently conducting the first randomized, double-blind controlled trial of honey for diabetic ulcers. Eddy first successfully used honey therapy a few years ago with a patient who was facing amputation after all medical options had been exhausted.

Experts believe that treating wounds with honey has tremendous potential for the approximately 200 million people in the world with diabetes, 15 percent of whom will develop an ulcer, usually because of impaired sensation in their feet.

Currently, every 30 seconds someone somewhere in the world undergoes amputation for a diabetic foot ulcer. In 2001, treating diabetic ulcers and amputations in U.S. patients cost $10.9 billion.

"Patients like Catrina Hurlburt are a great example of the potential health care savings," explains Eddy, who is also assistant professor of family medicine at University of Wisconsin School of Medicine and Public Health. "Unsuccessful conventional care for ulcers can cost thousands of dollars. Therapy with honey may only cost a few hundred."

Diabetics typically have poor circulation and decreased ability to fight infection. Diabetic ulcers treated with long courses of systemic antibiotics can become colonized with drug-resistant organisms--so-called "superbugs" such as Methicillin-resistant Staphylococcus aureus (MRSA). Since honey fights bacteria in numerous ways, it is essentially immune to resistance. Honey's acidic pH, low water content (which effectively dehydrates bacteria), and the hydrogen peroxide secreted by its naturally-occurring enzymes make it ideal for combating organisms that have developed resistance to standard antibiotics.

"This is a tremendously important issue for public health," explains Eddy, adding that the Centers for Disease Control and the World Health Organization have identified bacterial resistance as one of the most important medical problems of our day.

Patients in the clinical trial will receive ulcer care and treatment by an expert podiatrist. Half will be randomly assigned to receive honey, while the other half will receive a wound-care gel that has been compounded with inert components to give it the flavor and color of honey. The ulcers will be measured to see how quickly they heal, to evaluate whether honey or the standard wound gel is better for healing.

If honey proves the more effective method, Eddy cautions patients against using it at home without a physician's involvement. "Unfortunately, diabetic ulcers are very complicated, and honey would only be part of the solution," she says. Successful care also requires off-loading-avoiding walking and putting weight on the sore-and the sterile removal of dead skin and bacteria from the wound.

"If we can prove that honey promotes healing in diabetic ulcers, we can offer new hope for many patients," says Eddy. "Not to mention the cost benefit, and the issue of bacterial resistance. The possibilities are tremendous."

Posted by dlifenews at 11:10 AM | Comments (0)

Eating Pistachios May Reduce the Impact of Carbohydrates on Blood Sugar Levels

May 3, 2007 (Newswise) — “Heart disease remains the leading cause of death among both men and women and another 20 million people are living with diabetes each year – so these findings are very exciting and relevant,” said Dr. Cyril Kendall, lead researcher of the study and a professor in the University of Toronto's Department of Nutritional Sciences. “We know that controlling blood glucose levels is important for preventing and controlling diabetes and recent data indicate that it is also important in preventing heart disease. Controlling postmeal fluctuations in glucose appears to be particularly important. Pistachios have been shown to decrease risk factors for heart disease, however little has been known about the specific effects of pistachios on blood glucose until now. Our preliminary findings demonstrate that suppressing the glycemic (blood sugar) response of high carbohydrate foods may be part of the mechanism by which pistachios contribute to cardiovascular health and to the prevention and control of diabetes. More research is definitely warranted.”

“Glycemic Response of Pistachios – A Dose Response Study and Effect of Pistachios Consumed with Different Common Carbohydrate Foods on Postprandial Glycemia was presented today to more than 10,000 scientists at the Experimental Biology Conference in Washington, DC. The study is the first of its kind to examine the effects of pistachios and glucose levels in combination with carbohydrates. The research was led by University of Toronto’s Dr. Cyril Kendall and Dr. David Jenkins - researchers well known for their studies of the glycemic index which measures how rapidly sugars from foods are absorbed into the blood stream. Certain carbohydrates elevate blood sugar levels more quickly than other foods – like pistachios – that contain higher levels of protein, fiber and monounsaturated fat. In general, foods that do not quickly raise blood sugar are often considered healthier than their more processed counterparts.

Drs. Jenkins and Kendall and their research colleagues studied 10 healthy individuals who participated in a number of acute dietary studies over the course of two months. After an overnight fast, participants were given a one-, two- or three-ounce serving of pistachios alone or served with a slice of white bread and blood sugar levels were measured over a two-hour period. The findings suggest that consumption of pistachios with a carbohydrate-rich meal significantly lowered the d blood glucose response. As consumption of pistachios increased, the blood sugar lowering response was enhanced. In addition, when pistachios were consumed alone, the rise in blood glucose was minimal.

The researchers also monitored the effect of pistachios consumed with different common carbohydrate foods on postprandial glycemia, or blood sugar levels after eating. The addition of pistachios to a number of other commonly consumed carbohydrate-rich foods – such as mashed potatoes, pasta and rice – also resulted in significant reductions in the blood sugar response, compared to when these foods were eaten alone.

In July 2003, the U.S. Food and Drug Administration (FDA) approved a much-awaited qualified health claim for nuts and heart disease prevention. The claim states, "Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, such as pistachios, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease." According to the California Pistachio Commission, the University of Toronto’s research findings are important for individuals who are living a heart-healthy lifestyle and those that monitor their blood sugar levels.

“Most people with diabetes have other risk factors – such as high blood pressure and cholesterol that increase one's risk for heart disease and stroke. When combined with diabetes, these risk factors can add up to serious health problems,” explains Constance Geiger, PhD, RD, and consultant to the California Pistachio Commission. “Recent research has suggested that pistachios are a heart-healthy, high-protein snack. Now people have yet another reason to grab a handful – they may blunt the blood sugar response of meals and may be beneficial for assisting with long-term blood glucose control.”

Posted by dlifenews at 02:21 PM | Comments (2)

Keeping the Immune System From Starting a 'Food Fight'

May 3, 2007 (EurekAlert) - After every meal, the body must prevent the immune system from launching an all-out fight against food. Now, researchers report the identity of a nutrient "floodgate" that serves to protect against such an inflammatory immune response. Their findings appear in the May 4, 2007 issue of the journal Cell, a publication of Cell Press.

The researchers found that animals lacking a protein enriched in fat cells, called STAMP2, develop acute inflammation in deep pockets of visceral fat. The animals also showed symptoms of metabolic syndrome—including insulin resistance and fatty liver disease—even while eating a regular diet.

In those who regularly consume an overload of nutrients, the flood control protein may become overwhelmed and give out, leading to the chronic, low-grade inflammation characteristic of obesity and other metabolic diseases, the researchers suggest. Treatments designed to reinforce that barrier may therefore provide the "next frontier" of therapies to combat the rising tide of chronic metabolic disease, they said.

"Humans were not meant to deal with little to no exercise and a constant bombardment of nutrients," said Gökhan Hotamisligil of the Harvard School of Public Health of his team’s findings. "If we could find ways to strengthen STAMP2 or prevent its suppression, the body might retain control," effectively unlinking chronic overeating and obesity from other symptoms of metabolic disease. He cautioned, however, that the realization of such a treatment strategy remains uncertain and would require years of continued investigation.

Cells and organisms must strike an appropriate balance between nutrient sufficiency and surplus, the researchers explained. While adequate amounts of nutrients must be obtained to ensure health and survival, chronic overeating can lead to obesity and an array of associated metabolic disorders, including insulin resistance, fatty liver disease, type 2 diabetes, and cardiovascular disease. This cluster of chronic diseases now constitutes the largest global health threat, Hotamisligil said.

Their current findings pinpoint STAMP2 as a critical factor to prevent overt inflammatory responses during everyday nutrient fluctuations or conditions of nutrient excess. In fat cells, a lack of STAMP2 led to aberrant inflammatory responses to both nutrients and acute inflammatory stimuli, they reported.

Similarly, they showed that the visceral fat surrounding the internal organs of STAMP2-deficient mice became inflamed, and the animals developed spontaneous metabolic disease on a regular diet, manifesting insulin resistance, glucose intolerance, high blood sugar and lipid levels, and fatty liver disease. They also showed that the loss of STAMP2 exacerbated the metabolic symptoms of mice with a genetic predisposition to obesity due to other factors.

When food enters the system, STAMP2 normally keeps the immunity response "button" from getting pushed, Hotamisligil said.

"We suggest that, over time, the accumulation of small cellular stresses due to daily changes and fluctuations in nutrients in STAMP2-deficient mice may lead to the activation of inflammatory pathways and inhibition of insulin action, resulting in systemic metabolic deterioration over the long term," he continued.

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Posted by dlifenews at 12:57 PM | Comments (0)

First Research to Show That Diabetes Damages DNA in Men's Sperm and May Affect Fertility

May 3, 2007 (EurekAlert) - Scientists have found that sperm from diabetic men have greater levels of DNA damage than sperm from men who do not have the disease. They warn that such DNA damage might affect a man’s fertility.

In the first study [1] to compare the quality of DNA in sperm from diabetic and non-diabetic men, the researchers from Belfast, Northern Ireland showed that the DNA in the nuclei of the sperm cells had greater levels of fragmentation in diabetic men (52%, versus 32% in non-diabetic men), and that there were more deletions of DNA in the tiny, energy-generating structures in the cells called mitochondria (4 versus 3).

Dr Ishola Agbaje, who undertook the research published online today (Thursday 3 May) in the journal Human Reproduction, said: "As far as we know, this is the first report of the quality of DNA in the nucleus and mitochondria of sperm in diabetes. Our study identifies important evidence of increased DNA fragmentation of nuclear DNA and mitochondrial DNA deletions in sperm from diabetic men. These findings cause concern, as they may have implications for fertility."

The incidence of type 1 and type 2 diabetes is increasing rapidly worldwide. While diet and obesity are known to be key factors in the increase of type 2 (or late onset) diabetes, type 1 diabetes which is usually diagnosed in childhood or adolescence, is increasing by three per cent a year in European children, although the reason for this is not entirely clear. Genetic factors that make people more susceptible, or environmental factors such as viruses that may trigger the onset of type 1 diabetes, could play a role.

Dr Agbaje, a research fellow in the Reproductive Medicine Research Group at Queen’s University, Belfast, said: "If the increasing trend in the incidence of type I diabetes continues, this will result in a 50% increase over the next ten years. As a consequence, diabetes will affect many more men prior to and during their reproductive years. Infertility is already a major health problem in both the developed and developing world, with up to one in six couples requiring specialist investigation or treatment in order to conceive. Moreover, the last 50 years have seen an apparent decline in semen quality. Sperm disorders are thought to cause or contribute to infertility in 40-50% of infertile couples. The increasing incidence of systemic diseases such as diabetes may further exacerbate this decline in male fertility. However, it is not clear to what extent clinics consider information about the diabetic status of their patients when investigating fertility problems." [2]

Dr Agbaje and his colleagues examined sperm from 27 diabetic men, with an average age of 34, and 29 non-diabetic men with an average age of 33. They found that although semen volume was significantly less in diabetic men (2.6 versus 3.3 ml), there were no significant differences in sperm concentration, total sperm output, form and structure of the sperm or their ability to move. When they measured DNA damage they found that the percentage of fragmented nuclear DNA was significantly higher in sperm from the diabetic men and that the number of deletions in mitochondrial DNA was also higher – the number of deletions ranged from three to six (average four) in the diabetic men and from one to four (average three) in the non-diabetic men.

Professor Sheena Lewis, scientific director of the Reproductive Medicine Research Group, said: "Our study shows increased levels of sperm DNA damage in diabetic men. From a clinical perspective this is important, particularly given the overwhelming evidence that sperm DNA damage impairs male fertility and reproductive health. Other studies have already shown that, while the female egg has a limited ability to repair damaged sperm DNA, fragmentation beyond this threshold may result in increased rates of embryonic failure and pregnancy loss. In the context of spontaneous conception, sperm DNA quality has been found to be poorer in couples with a history of miscarriages."

However, Prof Lewis said that it was not possible to say from this current study whether the DNA damage caused by diabetes would have the same effect on men’s fertility and the health of future children as DNA damage caused by other factors such as smoking.

"This is just one, relatively small study that highlights a possible concern. Further studies need to be carried out in order to understand the precise nature of the diabetes-related damage, the causal mechanisms and the clinical significance. Given the global rise in the prevalence of diabetes, it is also vital to examine the reproductive outcomes of pregnancies fathered by diabetic men, and the prevalence of diabetes amongst men attending for infertility treatment," she concluded.

Posted by dlifenews at 09:11 AM | Comments (0)

National Joslin-Led Study Shows Tight Blood Glucose Control in People with Type 1 Diabetes Does Not Impact Cognitive Ability

JoslinMay 2, 2007 (Joslin) - A study led by researchers at Joslin Diabetes Center provides good news for patients with type 1 diabetes who want to maintain tight blood glucose control and thus significantly reduce their risk of developing the devastating complications of the disease--heart disease, kidney failure, eye disease and blindness, and nerve damage. The study, which is part of the Epidemiology of Diabetes Interventions and Complications study (EDIC) funded by the National Institutes of Health (NIH), will be published in the May 3, 2007, issue of the New England Journal of Medicine.

The EDIC is a follow-up study of the Diabetes Control and Complications Trial (DCCT), a large NIH-funded study that compared intensive management of blood glucose to conventional control in people with type 1 diabetes. The study's findings established the effectiveness of tight blood glucose control in dramatically slowing the onset and progression of diabetes complications. However, intensive control increased episodes of severe hypoglycemia--abnormally low blood glucose levels that can cause confusion, irrational behavior, convulsions and unconsciousness--that is associated with tight control. After following participants for 12 more years, the researchers have shown that multiple episodes of severe hypoglycemia do not lead to long-term loss of cognitive ability. They cautioned, however, that further study is needed to determine whether hypoglycemic episodes in young children have any lasting cognitive effects, since the youngest DCCT participants were 13 years old at the beginning of the study.

"The EDIC study provides further support for the safety of intensive diabetes therapy and the benefits of maintaining good glycemic control," says the study's principal investigator, Alan M. Jacobson, M.D., head of Joslin's Behavioral and Mental Health Research Section and Professor of Psychiatry at Harvard Medical School. Preliminary findings from the EDIC study were presented at the June 2006 Scientific Sessions of the American Diabetes Association. "While acute episodes of hypoglycemia can impair thinking and can even be life-threatening, type 1 diabetes patients do not have to worry that such episodes will impair their long-term abilities to perceive, reason and remember."

"Hypoglycemia is a serious, frightening experience," said Catherine Cowie, Ph.D., who oversees EDIC for the NIH. "However, given the importance of intensive blood glucose control in preventing the complications of diabetes, it is tremendously heartening to know that such episodes have no long-term cognitive effects in the age groups studied in the DCCT/EDIC."

The DCCT findings confirmed Dr. Elliott P. Joslin's theory on the benefits of tight diabetes control in reducing diabetes complications. The DCCT investigators examined 1,441 subjects, ages 13 to 39, with type 1 diabetes. About half of the group received intensive therapy with either an insulin pump or three or more daily insulin injections. The remaining subjects received conventional therapy of one to two insulin injections daily. During the study, the patients' A1C readings, which reflect average blood glucose levels over several months, differed between the two groups by about 2 percentage points (7.1 percent for the intensive therapy group vs. 9.0 percent for the conventional). At the study's conclusion in 1993, researchers reported that the group receiving intensive therapy experienced 76 percent less eye disease, 50 percent less kidney disease, and 60 percent less nerve disease. As a result of their findings, intensive therapy was recommended for all subjects taking part in the trial.

But the DCCT also showed that tight control comes at a cost: patients who received intensive therapy were three times as likely to experience hypoglycemic episodes severe enough to require the assistance of another person than patients who were on conventional therapy. This finding raised the fear that, although tight control may lower the risk of developing serious diabetes complications, it might also lead to a long-term loss of cognitive ability.

At the start of the DCCT, in order to evaluate the potential impact of diabetes treatment and recurrent hypoglycemic episodes on cognitive ability, all patients were given a comprehensive battery of cognitive tests. These tools analyzed abilities in eight domains: problem solving, learning, immediate memory, delayed recall, spatial information, attention, psychomotor efficiency and motor speed. When these tests were repeated during the DCCT on an average of 6.5 years after its start, no adverse effects were observed that were associated with either treatment type or with the number of severe hypoglycemic episodes experienced.

Although these findings were encouraging, the researchers recognized the need for longer-term follow-up to determine if the increase in hypoglycemic episodes would affect cognitive ability over time. Furthermore, a longer-term study would allow them to examine whether the added effect of increasing age and duration of the disease might also contribute to a decline in cognitive ability.

To answer these questions, Dr. Jacobson and his colleagues at 28 other medical centers around the country examined 1,144 participants from the original DCCT trial: 588 patients who had received intensive therapy, and 556 patients who received conventional therapy. Tracking for hypoglycemic comas or seizures over the 12-year period following the DCCT, 889 patients reported no such events; 246 reported from one to five events; and nine patients reported more than five.

"While it is most gratifying to find little evidence of a direct effect of moderately severe hypoglycemia on intelligence, diabetic patients still need to avoid hypoglycemia because very low blood sugar levels can trigger a temporary reduction in their ability to pay attention and react quickly, which may, in turn, lead to serious injuries," said Christopher Ryan, Ph.D., Professor of Psychiatry, Psychology, and Health & Community Systems at the University of Pittsburgh School of Medicine.

The researchers evaluated all of the patients using the same neuropsychological tests administered during the DCCT trial. Adjusting for age, sex, years of education, length of follow-up, and the number of cognitive tests taken, the researchers found no change in any of the eight areas examined. Higher A1C readings among patients--which indicate less, not tighter, control--were associated with a modest decline in motor speed and psychomotor efficiency, but no other cognitive domain was affected.

"The DCCT/EDIC is a study of the complications of type 1 diabetes that is entering its 23rd year and will continue through 2016. The study has been heralded for the high rate of ascertainment and the quality of the data," said Patricia A. Cleary, M.S., who is the director of the data coordinating center for DCCT/EDIC at the Biostatistics Center of The George Washington University.

Others collaborating with Dr. Jacobson in this study included: Amanda Burwood, Katie Weinger, Ed.D., R.N., and Gail Musen, Ph.D., of Joslin; Barbara Waberski, M.S., of George Washington University's Biostatistics Center; Meg Bayless, R.N., of the University of Iowa; William Dahms, M.D., of Case Western Reserve University; Nancy Silvers, R.N., of the University of Pittsburgh Medical Center; and Judy Harth, R.N., of the University of Western Ontario. The study was supported by grants from the National Institute of Diabetes and Digestive Kidney Diseases and the General Clinical Research Centers Program of the National Center for Research Resources.

Posted by dlifenews at 09:09 AM | Comments (0)

TXNIP -- Regulator of Glucose Homeostasis and Potential Diabetes Drug Target