Obese Women with PCOS Can Lose Weight with a Doctor’s Help

June 10, 2009

June 10, 2009 (Newswise) - Simple weight-loss advice from a physician and regular follow-up helped obese women with polycystic ovary syndrome lose a substantial amount of weight, a new study found. The results were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

Polycystic ovary syndrome, or PCOS, is a common hormone imbalance in young women that raises the risk of infertility, obesity, type 2 diabetes and heart disease. Past research shows that modest weight loss—at least 5 percent of body weight—can significantly improve PCOS symptoms and reduce the risk of diabetes and heart disease.

However, medical management of obesity tends to be neglected, said study co-author Jean-Patrice Baillargeon, MD, MSc, an endocrinologist with the University of Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada.

“Research shows that primary care physicians are usually reluctant to manage their patients’ obesity because they feel poorly equipped to do so and their success is limited,” Baillargeon said. “But our study demonstrates that it is possible, with a doctor’s weight-loss advice and follow-up, for obese women with PCOS to achieve clinically significant and sustained weight loss.”

Baillargeon stressed that this study did not involve multidisciplinary care from a team of different health care specialists, which many doctors view as the most effective approach to weight loss but which is costly. Instead, as is usually the case in real life, study patients saw only a doctor. The physician gave them general advice on losing weight and on diet and exercise.

The investigators reviewed the medical records of 117 obese women with PCOS who had an initial doctor’s visit and follow-up care for at least 2 months at the medical center’s reproductive endocrinology clinic between May 2002 and September 2008. These women had an average weight of 231 pounds (104 kilograms) and an average body mass index, or BMI, of 38.7, which is close to morbidly obese. Follow-up visits, usually every 6 months, consisted of PCOS management as well as a weigh-in and discussion of weight loss, which Baillargeon said helped maintain patients’ motivation.

Of the 74 women who had 6 to 12 months of follow-up, 32 patients (43.2 percent) lost 5 percent or more of their body weight, which is considered clinically significant, the authors reported. Among 35 women with 3 years of follow-up or longer, 16 (nearly 46 percent) lost that much weight, and seven (20 percent) lost at least 10 percent of their body weight.

If needed, women received the diabetes drug metformin, which is often used to treat problems related to PCOS. Although past studies of whether metformin affects weight loss have shown mixed results, women in this study who took metformin lost more weight than those who did not.

“Medical management of these women is an opportunity to improve their future metabolic health,” Baillargeon said. “Any physician who sees obese women with PCOS should at least discuss the importance of weight loss and lifestyle modifications.”

Posted by dlife at 05:42 PM | Comments (0)

Bariatric Surgery Increases Risk of Fractures

June 10, 2009 (Newswise) - After weight loss surgery, people have nearly twice the expected risk of breaking a bone and an even higher risk of a foot or hand fracture, a new study has found. The results were presented at The Endocrine Society’s 91st Annual Meeting in Washington, D.C.

“This finding is unexpected,” said study co-author Jackie Clowes, MD, PhD, assistant professor of medicine at Mayo Clinic, Rochester, Minn. “The established opinion is that obesity protects against osteoporosis and, therefore, fractures.”

Past research shows that bariatric surgery results in an increased bone turnover, the rate of bone breakdown and bone formation. However, it is not clear whether this change is clinically relevant. Clowes and her group suspected that the accelerated bone turnover after weight loss surgery would increase fracture risk.

The researchers therefore reviewed the medical records of patients who had bariatric surgery to treat medically complicated obesity, performed at Mayo Clinic between 1985 and 2004, and looked at data, including postoperative fractures. So far, the authors have analyzed data for 97 of the 292 patients whose records are available.

Of the 97 patients, 86 are women, and their average age was 44 years. Ninety percent of the patients had the most common type of weight loss surgery—gastric bypass—and the other patients had either vertical banded gastroplasty (also called gastric band surgery) or biliopancreatic diversion. The average length of follow-up was 7 years.

After bariatric surgery, 21 patients suffered one or more fractures, for a total of 31 fractures.

Compared with the fracture rate expected in an age- and sex-matched population in southeastern Minnesota, the patients who underwent bariatric surgery were 1.8 times likelier to have a first fracture at any site of the body. Fractures were especially common at the hand and foot, with the risk of hand fracture being more than three times greater than average, and foot fracture risk nearly four times greater.

“It is currently unclear why fractures are more common after bariatric surgery, especially at the hand and foot,” Clowes said. “Although aggressive calcium and vitamin D supplementation after surgery may well help, it may still be insufficient to prevent the increased risk of fracture.”

She added that further studies are needed to identify the potential mechanisms and risk factors for increased fracture risk after bariatric surgery. Subject to future funding, the authors plan to continue analyzing the data for the remaining patients. This study received funding from Mayo Clinic’s Department of Medicine.

Posted by dlife at 05:34 PM | Comments (0)

Obesity Does Not Worsen Asthma, But May Reduce Response to Medications

June 03, 2009

June 3, 2009 (EurekAlert) - Being overweight or obese does not make asthma worse in patients with mild and moderate forms of the disease, according to a study by National Jewish Health researchers, although it may reduce the response to medications.

"With both asthma and obesity on the rise in recent years, there has been much interest in the possible link between these two conditions," said lead author E. Rand Sutherland, Associate Professor of Medicine at National Jewish Health. "By studying a well characterized group of patients with asthma, we were able to determine that increased weight is not associated with more severe asthma. Although benefits can be obtained with weight loss in other diseases, these findings suggest that an improvement in asthma may not necessarily result from weight loss."

"The findings also suggest that patients and physicians should be aware that obese asthma patients may not respond well to corticosteroids, the most successful controller medication for asthma, which can affect dosing decisions and choices of possible alternatives to steroids."

Previous studies have suggested that obesity predisposes people to developing asthma, to suffer more severe asthma symptoms, and to respond less to medications. However, the exact mechanism for these links has been unclear, and the studies have generally relied upon patients' reports of their diagnosis and symptoms rather than using more precise tools to characterize patients.

Dr. Sutherland and his colleagues decided to examine the issue in a well characterized group of 1,256 patients who had participated in NIH-sponsored studies. They divided them into patients with a body mass index of less than 25 (lean) and greater than or equal to 25 (overweight and obese). They found that lean asthma patients had slightly greater forced expiratory volume in one second , or FEV1 (3.05 liters vs 2.91 liters), and slightly greater ratio of FEV1 to forced vital capacity (83.5% vs. 82.4%), both common measures of lung function. They also found slightly greater use of rescue inhalers among overweight patients (1.2 puffs per day vs. 1.1 puffs per day) and slightly higher scores asthma-relate quality of life questionnaires (5.77 vs. 5.59).

"These differences were small and are unlikely to be of any real clinical significance," said Dr. Sutherland.

Response to medications, however, did show an effect of increased weight. Among a subgroup of 183 people, lean patients taking inhaled corticosteroids alone showed a 55% greater reduction in exhaled nitric oxide, a measure of inflammation. Lean patients taking a combination inhaled steroid and long-acting beta agonist increased their FEV1 by 80 more milliliters. There were no differences, however, between these patients in the number of asthma exacerbations.

"The data suggest overweight and obese people respond less well to controller medications for asthma than do their lean counterparts," said Dr. Sutherland. "These data come from already-completed studies designed to answer other questions, however, and ongoing studies are being conducted to more definitively determine the effect of increased weight on treatment response in asthma."

Posted by dlifenews at 11:56 AM | Comments (0)

Ginkgo Reduces Neuropathic Pain in Animal Studies

June 3, 2009 (Newswise) - An extract of ginkgo biloba shows scientific evidence of effectiveness against one common and hard-to-treat type of pain, according to animal data reported in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

Dr. Yee Suk Kim and colleagues of The Catholic University of Seoul, South Korea, performed experiments in rats to evaluate the effectiveness of ginkgo against neuropathic pain, a common pain problem associated with herpes zoster, limb injury, or diabetes. Affected patients may feel severe pain in response to harmless stimuli like heat, cold, or touch.

Objective Evidence of Pain Reduction with Ginkgo
In the experiments, rats with neuropathic pain were treated with different doses of a standardized ginkgo biloba extract or with an inactive solution. Objective tests were performed to see how ginkgo affected neuropathic pain responses to cold and pressure.

For both cold and pressure stimuli, pain responses were significantly reduced in ginkgo-treated rats. This was so on before-and-after treatment comparisons and on comparison of ginkgo-treated versus placebo-treated animals. The higher the dose of ginkgo extract, the greater the pain-relieving effect. Pain was reduced for at least two hours after ginkgo treatment.

The study provides no evidence as to how ginkgo works to reduce pain. Several mechanisms are possible, including antioxidant activity, an anti-inflammatory effect, or protection against nerve injury—perhaps in combination.

Many herbs and "alternative" drugs are commonly used without prescriptions for a wide range of purposes, despite a lack of scientific evidence for health claims. Ginkgo, one of the most popular herbal products, is widely used as a memory enhancer, among other purposes.

The new study provides the first scientific evidence that ginkgo has a real effect in reducing neuropathic pain. New treatments are needed for neuropathic pain, which does not always respond well to available treatments.

"It's still too early to stock up on ginkgo biloba if you have chronic pain," comments Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia. Many treatments that are effective in animals do not prove to be effective in humans, or prove to have unacceptable toxic effects when given to patients, Dr. Shafer reminds. "However," he adds, "it is at least reassuring to know that scientists are investigating the properties of this ancient oriental herbal medication in an effort to determine what chemical constituents account for the many beneficial effects traditionally ascribed to it."

Posted by dlife at 10:40 AM | Comments (0)

Ginkgo Reduces Neuropathic Pain in Animal Studies

June 3, 2009 (Newswise) - An extract of ginkgo biloba shows scientific evidence of effectiveness against one common and hard-to-treat type of pain, according to animal data reported in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

Dr. Yee Suk Kim and colleagues of The Catholic University of Seoul, South Korea, performed experiments in rats to evaluate the effectiveness of ginkgo against neuropathic pain, a common pain problem associated with herpes zoster, limb injury, or diabetes. Affected patients may feel severe pain in response to harmless stimuli like heat, cold, or touch.

Objective Evidence of Pain Reduction with Ginkgo
In the experiments, rats with neuropathic pain were treated with different doses of a standardized ginkgo biloba extract or with an inactive solution. Objective tests were performed to see how ginkgo affected neuropathic pain responses to cold and pressure.

For both cold and pressure stimuli, pain responses were significantly reduced in ginkgo-treated rats. This was so on before-and-after treatment comparisons and on comparison of ginkgo-treated versus placebo-treated animals. The higher the dose of ginkgo extract, the greater the pain-relieving effect. Pain was reduced for at least two hours after ginkgo treatment.

The study provides no evidence as to how ginkgo works to reduce pain. Several mechanisms are possible, including antioxidant activity, an anti-inflammatory effect, or protection against nerve injury—perhaps in combination.

Many herbs and "alternative" drugs are commonly used without prescriptions for a wide range of purposes, despite a lack of scientific evidence for health claims. Ginkgo, one of the most popular herbal products, is widely used as a memory enhancer, among other purposes.

The new study provides the first scientific evidence that ginkgo has a real effect in reducing neuropathic pain. New treatments are needed for neuropathic pain, which does not always respond well to available treatments.

"It's still too early to stock up on ginkgo biloba if you have chronic pain," comments Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia. Many treatments that are effective in animals do not prove to be effective in humans, or prove to have unacceptable toxic effects when given to patients, Dr. Shafer reminds. "However," he adds, "it is at least reassuring to know that scientists are investigating the properties of this ancient oriental herbal medication in an effort to determine what chemical constituents account for the many beneficial effects traditionally ascribed to it."

Posted by dlife at 09:45 AM | Comments (0)

Carbon Monoxide Reverses Diabetic Gastric Problem in Mice

June 01, 2009

June 1, 2009 (EurekAlert) - Mayo Clinic researchers have shown that very low doses of inhaled carbon monoxide in diabetic mice reverses the condition known as gastroparesis or delayed stomach emptying, a common and painful complication for many diabetic patients. The findings will be presented on June 1 at Digestive Disease Week in Chicago.

"This is a significant finding, as it shows that loss of the enzyme that makes carbon monoxide is the actor in this process and that it provides us with a clear approach toward a possible new therapy for this condition," says Gianrico Farrugia, M.D., Mayo Clinic gastroenterologist and lead investigator on the study.

Gastroparesis occurs when the stomach retains undigested food for long periods. When that food eventually passes into the small intestine, insulin is released. Because the passage of food out of the stomach becomes unpredictable, maintaining a proper blood glucose level -- critical for controlling diabetes -- also becomes difficult. Gastroparesis can cause pain, nausea, vomiting, stomach spasms and weight loss due to inability to ingest enough nutrients. In some patients with diabetes, the abnormally high blood glucose levels cause chemical changes in nerves and in pacemaker cells, which regulate digestive processes in the gut, and damage blood vessels that carry oxygen and nutrients to cells.

Previous studies by the Mayo team showed that gastroparesis is associated with the loss of up-regulation of heme oxygenase-1 (HO1) and an increase in oxidative stress. It also causes a loss of Kit, a marker for the pacemakers cells called interstitial cells of Cajal, which regulate muscle contraction in the digestive tract. When the team induced HO1 production, signs of oxidative stress dropped and gastroparesis was restored along with Kit.

The metabolite that normalized gastric functioning was not known. Suspecting carbon monoxide, the Mayo investigators studied ten mice with diabetes that had exhibited delayed gastric emptying. Five mice were given carbon monoxide by inhalation (100 parts per million) for six hours daily. Within three weeks gastroparesis reversed, oxidative stress decreased and Kit expression increased, all without increasing HO1 expression.

Posted by dlife at 04:50 PM | Comments (0)

Triglycerides Implicated in Diabetes Nerve Loss

May 18, 2009

May 18, 2009 (EurekAlert) - A common blood test for triglycerides – a well-known cardiovascular disease risk factor – may also for the first time allow doctors to predict which patients with diabetes are more likely to develop the serious, common complication of neuropathy.

In a study now online in the journal Diabetes, University of Michigan and Wayne State University researchers analyzed data from 427 diabetes patients with neuropathy, a condition in which nerves are damaged or lost with resulting numbness, tingling and pain, often in the hands, arms, legs and feet. The data revealed that if a patient had elevated triglycerides, he or she was significantly more likely to experience worsening neuropathy over a period of one year. Other factors, such as higher levels of other fats in the blood or of blood glucose, did not turn out to be significant. The study will appear in print in the journal's July issue.

"In our study, elevated serum triglycerides were the most accurate at predicting nerve fiber loss, compared to all other measures," says Kelli A. Sullivan, Ph.D., co-first author of the study and an assistant research professor in neurology at the U-M Medical School.

"These results set the stage for clinicians to be able to address lowering lipid counts with their diabetes patients with neuropathy as vigilantly as they pursue glucose control," says Eva L. Feldman, M.D., Ph.D., senior author of the study and the Russell N. DeJong Professor of Neurology at the U-M Medical School.

With a readily available predictor for nerve damage – triglycerides are measured as part of routine blood testing – doctors and patients can take pro-active steps when interventions can do some good, says Feldman.

"Aggressive treatment can be very beneficial to patients in terms of their neuropathy," says Feldman, who is also director of the A. Alfred Taubman Medical Research Institute and director of the Juvenile Diabetes Research Foundation Center at U-M for the study of complications in diabetes.

People can reduce blood triglyceride levels with the same measures that reduce cholesterol levels: by avoiding harmful fats in the diet and exercising regularly.

Context

Diabetic neuropathy affects around 60 percent of the 23 million people in the United States who have diabetes. It is a complication in both type 1 and type 2 diabetes.

Until now, doctors have lacked an effective way to predict which diabetes patients are at greatest risk of neuropathy. Most often, the condition becomes evident when irreversible nerve damage has already occurred. Neuropathy is the leading cause of diabetes-related hospital admissions and amputations that are not secondary to trauma.

Triglycerides are a type of lipid, or fat, that the body makes from calories it doesn't need immediately. Triglycerides are stored in fat cells until they are needed to provide energy. When higher-than-normal amounts circulate in the blood, a person is at higher risk of cardiovascular disease.

Research implications

The new finding adds to an emerging picture of the close connections between cardiovascular disease and diabetes. Elevated triglycerides are one of the most common features of the lipid disorders found in patients with type 2 diabetes, by far the most common form of diabetes, says Rodica Pop-Busui, M.D., Ph.D., one of the study's authors and an assistant professor in the metabolism, endocrinology and diabetes division of the Department of Internal Medicine at the U-M Medical School.

"Cardiovascular disease is the main cause of excess mortality among patients with diabetes. Research also has shown that the presence of neuropathy is an important predictor of these deaths," says Pop-Busui.

"Our findings in this study reinforce the tight links between cardiovascular disease and peripheral neuropathy in patients with diabetes. We demonstrated that the same lipid particles that contribute to the progression of atherosclerosis are also very important players in peripheral nerve fiber loss."

In addition, the study confirms a growing belief among some diabetes researchers that elevated blood levels of certain lipids, rather than solely elevated blood sugar, are key in the progression of diabetic neuropathy. The study pinpoints triglycerides as the critical indicator.

Research details

The researchers examined data from a previous clinical trial of a drug that showed promise for relieving neuropathy. They looked at data from 427 participants who had mild to moderate diabetic neuropathy at the beginning of the one-year trial. Among other factors, the trial measured myelinated fiber density in a peripheral nerve in the leg in participants over the course of the year. A decline in this density is a prime indicator that neuropathy is worsening.

The new findings from U-M are an example of how medical science often looks for one thing and doesn't find it—the drug trial found that a promising agent turned out to be ineffective for treating neuropathy—but the data can yield unexpected, useful knowledge about something else.

Realizing the trial data held potential clues, the U-M team selected trial participants who had similar characteristics regarding nerve function at the beginning of the study but significantly lower myelinated fiber densities at the end. They used microarray technology not available 15 years ago, when the data was collected.

"We then compared all of the other data concerning lipids and blood glucose. We found that out of all the data collected on these patients, elevated triglycerides were the factor that differed the most, when we compared the patients who lost nerve fibers with those who didn't," says Sullivan.

Elevated triglycerides correlated with the nerve fiber loss independent of disease duration, age, diabetes control or other variables.

Posted by dlifenews at 09:57 AM | Comments (0)

Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer

April 30, 2009

April 30, 2009 (EurekAlert) - A drug widely used to treat Type 2 diabetes may have unintended effects on the pancreas that could lead to a form of low-grade pancreatitis in some patients and a greater risk of pancreatic cancer in long-term users, UCLA researchers have found.

In a study published in the online edition of the journal Diabetes, researchers from the Larry L. Hillblom Islet Research Center at UCLA found that sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. Januvia is marketed by Merck & Co. Inc. Sitagliptin is a member of a new class of drugs that enhance the actions of the gut hormone known as glucagon-like peptide 1 (GLP-1), which has been shown to be effective in lowering blood sugar in people with Type 2 diabetes. The study is available at http://diabetes.diabetesjournals.org/cgi/content/abstract/db09-0058v1.

"Type 2 diabetes is a lifelong disease — people often take the same drugs for many years, so any adverse effect that could over time increase the risk for pancreatic cancer would be a concern," said Dr. Peter Butler, director of the Hillblom Center and the study's lead investigator. "A concern here is that the unwanted effects of this drug on the pancreas would likely not be detected in humans unless the pancreas was removed and examined."

An observed connection between Byetta, a drug used to treat Type 2 diabetes that is related to Januvia in its intended actions, and pancreatitis has already been reported, prompting a Food and Drug Administration warning. Amylin Corp., which markets Byetta, has suggested that since there is no known mechanism linking the cases of pancreatitis with Byetta, the association might be chance. The UCLA study suggests that there may indeed be a link between drugs that enhance the actions of GLP-1 and pancreatitis — by increasing the rate of formation of cells that line the pancreatic ducts.

In the study, researchers used human IAPP transgenic (HIP) rats to test both sitagliptin and metformin; metformin, a member of an older, different class of diabetes drugs in use since the 1950s, has recently been found to have anti-tumor properties. The researchers sought to determine how the drugs, both singly and in combination, affected islet disease progression in the pancreas — particularly how they affected beta cells in the pancreas's Islets of Langerhans. Beta cells are responsible for releasing insulin in people with normal metabolism, but they don't produce insulin in sufficient amounts in diabetes patients. HIP rats approximate both the islets and metabolism of people with Type 2 diabetes. The drugs were tested in 40 rats for 12 weeks.

The researchers found that the two drugs in combination had a synergistic effect that helped preserve beta cells, improved their function and enhanced insulin sensitivity in the test rats. With the sitagliptin alone, however, the rats had abnormally high rates of cell production in their pancreatic ducts; a few developed an abnormality known as ductal metaplasia, and one developed pancreatitis.

But the metformin, trade name Glucophage, seems to counteract sitagliptin's adverse effect.

"The apparent protection against the unwanted actions of sitagliptin in the exocrine pancreas are intriguing and may offer a potential way of using the GLP-1 class of drugs safely," Butler said. "The protective effect may have been either by the actions of metformin to decrease blood glucose values or its recently appreciated properties as a tumor suppressive agent."

Butler noted that the present study was undertaken in rats and that it is possible the adverse effects observed would not occur in humans.

"Given these findings, it is probably sensible to use the GLP-1 class of drugs only with metformin until other data is forthcoming," he said.

Posted by dlifenews at 12:23 PM | Comments (3)

Diabetes, Obesity and Hypertension Increase Mortality in Hepatitis C Patients

April 22, 2009

April 22, 2009 (EurekAlert) - The specific impact of metabolic syndrome on mortality in hepatitis C patients has been revealed by new research to be presented on Sunday April 26 at EASL 2009, the Annual Meeting of the European Association for the Study of the Liver in Copenhagen, Denmark.

According to the results of the research, type 2 diabetes (DM), obesity and hypertension (HTN) are associated with overall and liver related mortality in hepatitis C (HCV) infected patients. In HCV-infected patients, the top three predictors of liver related mortality were having higher body mass index (BMI), presence of insulin resistance (IR) and elevated serum cholesterol. Overall mortality in HCV patients was most linked to metabolic syndrome, higher BMI and hypertension.

Metabolic syndrome is a combination of medical problems that increase risks of cardiovascular disease and diabetes. It affects one in five people, and prevalence increases with age. Recent data have suggested that metabolic syndrome is associated with adverse outcomes in HCV patients. This study set out to assess which aspects of metabolic syndrome are of most risk to such HCV patients and to quantify their specific impact on mortality.

Professor Zobair Younossi MD, MPH from the Center for Liver Diseases at Inova Fairfax Hospital and the Executive Director of Betty and Guy Beatty's Center for Integrated Research, Virginia, USA, who led the study, said: "Exploring the risk factors associated with adverse outcomes in HCV patients helps us to better understand the complex nature of this highly prevalent disease. This study shows a clear association between key components of metabolic syndrome and mortality in HCV patients and demonstrates the importance of lifestyle improvements and coaching in the management of HCV patients, to potentially minimise the onset and impact of metabolic syndrome and its associated mortality risks."

Researchers in this study utilised the Third National Health and Nutrition Examination Survey (NHANES III) and Linked Mortality Files. HCV was defined as positive HCV RNA by PCR assay. Subjects without other causes of chronic liver disease such as presumed NAFLD with elevated serum aminotransferases (ALT> 40 U/L, AST> 37 U/L in men, and ALT> 31 U/L, AST>31 U/L in women), excessive alcohol use (>10 grams/day in women and > 20 grams/day in men), elevated transferrin saturation (>50%) and positive hepatitis Bs antigen were designated controls without liver disease. HCV patients were compared to HCV-negative individuals and controls without liver disease using Rao-Scott chi-square statistics. Adjusted hazard ratios (AHR, 95% CI) for overall mortality and cause-specific mortality were calculated for HCV patients using persons without HCV. The Cox proportional hazard model was used for calculation of AHR for independent risk factors, and for the presence of HCV as a potential risk factor for overall mortality and cause-specific mortalities. MS was defined according to ATP-III and insulin resistance (IR) was defined as HOMA>3.0.

The cohort included 15,866 individuals with complete data. Among those, 264 patients were HCV-positive, and 13,004 were considered controls. HCV patients had more IR (37.4±3.2% vs. 22.8±0.9%, p< 0.0001) and higher rate of DM (9.2±2.3% vs. 5.5±0.3%, p=0.0885) than controls. In comparison to the HCV-negative patients, HCV patients had higher overall mortality (AHR=2.80, 2.79-2.81), higher liver-related mortality (AHR=17.96, 17.80-18.12), higher DM-related mortality (AHR=18.55, 18.36-18.74) and higher mortality from solid organ malignancy (AHR=1.601, 1.587-1.616). In HCV patients, increased overall mortality was associated with components of MS [DM (AHR=2.139, 2.11-2.16), higher BMI (AHR=1.054, 1.53-1.055) and HTN (AHR=1.408, 1.394-1.422)]. In HCV patients, increased liver-related mortality was associated with higher BMI (AHR=1.275, 1.274-1.277) and HTN (AHR=3.751, 3.653-3.851).

Dr Younossi added "This is the largest population-based study to provide the strongest evidence confirming an association between components of MS, especially type 2 diabetes and obesity, with adverse mortality outcomes for HCV infected patients. These data should help us not only develop better targeted treatment strategies for HCV patients but also encourage public health policies to address the increasing epidemic of obesity and type 2 diabetes that may affect a large number of population, including those infected with HCV".

Posted by dlifenews at 09:55 AM | Comments (0)

Psoriasis Associated with Diabetes and High Blood Pressure in Women

April 20, 2009

April 20, 2009 (EurekAlert) - Women with psoriasis appear to have an increased risk for developing diabetes and hypertension (high blood pressure), according to a report in the April issue of Archives of Dermatology, one of the JAMA/Archives journals.

Psoriasis, a chronic inflammatory skin disease, affects between 1 percent and 3 percent of the population, according to background information in the article. Recent studies indicate that psoriasis is associated with an increased risk of other illnesses and death. "Systemic inflammation in psoriasis and an increased prevalence of unhealthy lifestyle factors have been independently associated with obesity, insulin resistance and an unfavorable cardiovascular risk profile," the authors write.

Abrar A. Qureshi, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues studied 78,061 women involved in the Nurses' Health Study II, a group of female nurses age 27 to 44 years in 1991. Participants—all of whom were free of diabetes and hypertension at the beginning of the study—responded to a survey which included a question about lifetime history of psoriasis in 2005 and were assessed for the development of diabetes or hypertension during the 14-year follow-up.

Of the women, 1,813 (2.3 percent) reported a diagnosis of psoriasis. A total of 1,560 (2 percent) developed diabetes and 15,724 (20 percent) developed hypertension. Women with psoriasis were 63 percent more likely to develop diabetes and 17 percent more likely to develop hypertension than women without psoriasis. These associations remained strong even after the researchers considered age, body mass index and smoking status.

Inflammation could be a biologically plausible explanation for the association between psoriasis and hypertension as well as that between psoriasis and diabetes, the authors note. Inflammation is a risk factor for high blood pressure and may also contribute to insulin resistance, a pre-diabetic stage where the body does not respond to the glucose-regulating hormone insulin. Alternatively, systemic steroid therapy or other treatments for psoriasis may promote development of diabetes or hypertension.

"These data illustrate the importance of considering psoriasis a systemic disorder rather than simply a skin disease," the authors conclude. "Further research is needed to better understand the mechanisms underlying these associations and to find out whether psoriasis therapy can reduce the risk for diabetes and hypertension."

Posted by dlifenews at 10:20 AM | Comments (0)

Severe Hypoglycemia Linked with Higher Risk of Dementia for Older Adults with Diabetes

April 14, 2009

April 14, 2009 (EurekAlert) - Having hypoglycemic (low blood sugar level) episodes that are severe enough to require hospitalization are associated with a greater risk of dementia for older adults with type 2 diabetes, according to a study in the April 15 issue of JAMA, a theme issue on diabetes.

Rachel A. Whitmer, Ph.D., of Kaiser Permanente, Oakland, Calif., presented the findings of the study at a JAMA media briefing at the National Press Club in Washington, D.C.

Hypoglycemic episodes may include dizziness, disorientation, fainting or seizures. While most hypoglycemia is mild and self-managed, more severe hypoglycemia can require hospitalization. Although some studies have reported an association between history of hypoglycemia and impaired cognitive functioning in children and young adults with type 1 diabetes, no studies have evaluated whether or to what extent hypoglycemic episodes are a risk factor for the development of dementia in populations of older patients, who are more likely to have type 2 diabetes than type 1. "With the increasing prevalence of type 2 diabetes worldwide, and potentially of hypoglycemia and dementia among patients with diabetes, the relationship between these conditions should be evaluated," the authors write.

Dr. Whitmer and colleagues conducted a study to determine whether prior episodes of hypoglycemia that required hospitalization or emergency department (ED) visits are associated with an increased risk of dementia. The study, that included 22 years (1980-2002) of follow-up for hypoglycemic episodes and more than 4 years (starting in 2003) of follow-up for diagnosis of dementia, included 16,667 patients with type 2 diabetes (average age, 65 years).

The researchers found that a total of 1,822 patients (11 percent) had a diagnosis of dementia and 1,465 patients (8.8 percent) had at least 1 episode of hypoglycemia; 250 patients had both dementia and at least 1 episode of hypoglycemia (16.95 percent). Age-adjusted incidence rates of dementia by frequency of hypoglycemic episodes were significantly elevated for patients with at least 1 episode compared with patients with no episodes. "Specifically, we observed a 2.39 percent increase in absolute risk of dementia per year of follow-up for patients with history of hypoglycemia, compared with patients without a history. Although this 1-year absolute risk difference is modest, the cumulative effects would be sizeable," the authors write.

Compared with patients with no hypoglycemia, patients with single or multiple episodes had a graded increase in risk of dementia. Patients with 1 hypoglycemic episode had a 26 percent increased risk; 2 episodes, an 80 percent increased risk; and 3 or more hypoglycemic episodes were associated with nearly double the risk for dementia.

"Our results suggest that hypoglycemic episodes severe enough to require hospitalization or an ED visit are associated with increased risk of dementia, particularly for patients who have a history of multiple episodes," the researchers write.

"A large body of evidence suggests that individuals with diabetes are at an increased risk of dementia, yet exact mechanisms are not known; our study suggests a potentially modifiable mechanism. Pharmacologically induced severe hypoglycemia may be associated with neurological consequences in an older population already susceptible to dementia. More scientific studies examining hypoglycemia and cognitive performance and brain-imaging sequelae in populations of older patients with type 2 diabetes are needed."

Posted by dlifenews at 10:13 AM | Comments (0)

A Healthy Color

April 10, 2009

April 10, 2009 (EurekAlert) - About 80 percent of adults suffer from some form of periodontal, or gum disease, which can result in not just tooth loss, but has also been linked to heart disease, diabetes, blood infection, low birth-weight babies, cancer and most recently, obesity.

Screening for the disease is often costly, time-consuming and sometimes painful for the patient. But researchers at Temple University have found that a simple color-changing oral strip can help detect gum disease in a patient more quickly and easily than traditional screening methods.

Lead researcher Ahmed Khocht, DDS, associate professor of periodontology at Temple's Maurice H. Kornberg School of Dentistry, and his team looked at the strip's effectiveness in detecting periodontal disease among 73 patients divided into three groups: healthy, those with gingivitis (bleeding of the gums) and those with periodontitis (bleeding of the gums and a receding gum line). Color reaction was scored based on a color chart, and those scores were compared with scores from traditional clinical evaluation methods such as plaque index, gingival index, attachment levels and bleeding on probing.

Researchers found strong correlations between the numbers from these tests and the numbers from the oral strip, suggesting the strips would be a comparable screening method.

"The strip changes from white to yellow depending on levels of microbial sulfur compounds found in the saliva," said Khocht. "A higher concentration of these compounds means a more serious case of gum disease, and shows up a darker shade of yellow."

Because periodontal disease can affect a person's overall health, Khocht says it's important to have a screening method like the oral strips that are quick and easy for clinicians to use.

"The faster we can find out the disease is present, the sooner we can begin treatment," he said. "And because the strips can change color, they can also act as a benchmark to help doctors find the right treatment for their patient and monitor their progress."

Posted by dlifenews at 09:20 AM | Comments (0)

Blocking Protein May Help Ease Painful Nerve Condition

March 15, 2009

March 15, 2009 (EurekAlert) - Scientists have identified the first gene that pulls the plug on ailing nerve cell branches from within the nerve cell, possibly helping to trigger the painful condition known as neuropathy.

The condition is a side effect of some forms of chemotherapy and can also afflict patients with cancer, diabetes, kidney failure, viral infections, neurodegenerative disorders and other ailments.

Researchers at Washington University School of Medicine in St. Louis showed that blocking the dual leucine zipper kinase (DLK) gene inhibits degeneration of ailing nerve cell branches, possibly preventing neuropathy.

"Neuropathy can become so extraordinarily painful that some patients stop taking their chemotherapy, regardless of the consequences in their fight against cancer," says co-senior author Aaron DiAntonio, M.D., Ph.D., associate professor of developmental biology. "So we're very excited about the possibilities this gene may offer for reducing that pain."

The findings are published online on March 15 in Nature Neuroscience.

Scientists have known since 1850 that nerve cells have ways to prune branches (also known as axons) that are injured. Although axon pruning is also a normal part of early human development, inappropriate loss of axons in the adult nervous system causes painful sensations that have been compared to burning, freezing or electric shock and have come to be known as neuropathy.

DiAntonio's lab previously revealed that the fruit fly's version of DLK helps establish synapses, junctures where two nerve cells communicate. But they found the gene doesn't do the same thing in mice.

Curious about DLK's role in mammals, Bradley Miller, an M.D./Ph.D. student in DiAntonio's lab, consulted with co-senior author Jeffrey Milbrandt, M.D., Ph.D., the David Clayson Professor of Neurology. Milbrandt studies the role of various proteins in neurodegeneration. With support from the University's Hope Center for Neurological Disorders, they showed that the long axons of the sciatic nerve in mice with a mutated DLK gene resisted degeneration after it was surgically cut.

In follow-up tests, Miller and Craig Press, an M.D./Ph.D. student in Milbrandt's lab, took nerve cells in culture and treated their axons with the chemotherapy drug vincristine. Normal axons degenerated rapidly after exposure to the drug, but axons where DLK's activity had been blocked were protected from degeneration.

"The pain of neuropathy is often a key factor that limits the dose in cancer chemotherapy," DiAntonio notes. "We know when patients are going to start their treatment, so one day it might be possible to start patients on a DLK-blocking drug before their chemotherapy and spare them considerable pain."

DLK appears to act like a contractor that calls in wrecking crews, DiAntonio notes. It helps make the decision to eradicate an axon, but the actual demolition is left to other processes called up by DLK.

"We want to more fully understand the chain of molecular reactions that carry out DLK's decision, because that might reveal a better opportunity to block the effect with a drug," says DiAntonio.

DiAntonio and Milbrandt also plan to test if blocking DLK stops neurodegeneration in other forms of injury and stress, including the harm inflicted on the optic nerve by glaucoma and central nervous system phenomena like stroke and Parkinson's disease.

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

Plasminogen Activator Inhibitor Type-1 -- A Potential Link Between Heart Failure And Diabetes

February 24, 2009

February 24, 2009 (EurekAlert) - Researchers at the University of Vermont Cardiovascular Research Institute, Colchester, Vermont have found that increased expression in the heart of plasminogen activator inhibitor type-1 (PAI-1) is profibrotic. The results, which appear in the March 2009 issue of Experimental Biology and Medicine, implicate PAI-1 overexpression, known to accompany insulin resistance and type 2 diabetes, as a factor contributing to the high incidence of heart failure after myocardial infarction in people with diabetes. The research team, Dr. A.K.M. Tarikuz Zaman, a research associate, Mr. Christopher J. French, medical and graduate student, Dr. David J. Schneider, Professor of Medicine and Director of the Cardiology and Vascular Biology Units, and Dr. Burton E. Sobel, Professor of Medicine and Director of the Cardiovascular Research Institute, performed studies in 10 week old mice subjected to coronary occlusion. Controls and PAI-1 overexpressing mice congenic on a C57BL6 background had comparable PAI-1 content in left ventricular myocardium despite a marked elevation of PAI-1 in plasma in the latter. 6 weeks after coronary occlusion the PAI-1 overexpressing mice exhibited a 2-fold increase in left ventricular (LV) PAI-1 content. Histochemical analysis demonstrated 33% more LV fibrosis as well. The increased fibrosis associated with increased PAI-1 was accompanied by functional derangements including diminished LV wall thickness in both diastole and systole, increased end systolic LV dimensions, depressed fractional shortening, a greater impairment of LV segmental function, and greater transmitral E-wave amplitude.

In summary, overexpression of PAI-1 in the heart altered the response of the left ventricle to myocardial infarction. It led to increased expression of PAI-1 late after coronary occlusion accompanied by increased fibrosis and functional derangements indicative of both systolic and diastolic dysfunction. Dr. Sobel said that "in concert with our previously reported findings demonstrating increased expression of PAI-1 in the heart in transgenic mice rendered insulin resistant, these results suggest that the markedly increased incidence and severity of heart failure following myocardial infarction in patients with insulin resistance and type 2 diabetes may reflect in part adverse consequences of increased PAI-1 expression in the heart predisposing to fibrosis and impairment performance of the left ventricle."

Dr. Steven R. Goodman, Editor-in-Chief of Experimental Biology and Medicine said "these elegant studies by Dr. Sobel and colleagues provide substantial insight into the mechanisms by which type 2 diabetes, with the resulting increase in PAI-1 in the heart, can lead to increased incidence and severity of heart failure following myocardial infarction. This is a major step forward in our understanding of the linkage between diabetes and cardiovascular disease".

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

Vitamin B and Folic Acid May Reduce Risk Of Age-Related Vision Loss

February 19, 2009

February 19, 2009 (EurekAlert) - Taking a combination of vitamins B6 and B12 and folic acid appears to decrease the risk of age-related macular degeneration in women, according to a report in the February 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Age-related macular degeneration (AMD) is a leading cause of vision loss in older Americans, according to background information in the article. Treatment options exist for those with severe cases of the disease, but the only known prevention method is to avoid smoking. Recent studies have drawn a connection between AMD and blood levels of homocysteine, an amino acid. High levels of homocysteine are associated with dysfunction of the blood vessel lining, whereas treatment with vitamin B6, vitamin B12 and folic acid appears to reduce homocysteine levels and may reverse this blood vessel dysfunction.

William G. Christen, Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a randomized, double-blind clinical trial involving 5,442 women age 40 and older who already had heart disease or at least three risk factors. Of these, 5,205 did not have AMD at the beginning of the study. In April 1998, these women were randomly assigned to take a placebo or a combination of folic acid (2.5 milligrams per day), pyridoxine hydrochloride (vitamin B6, 50 milligrams per day) and cyanocobalamin (vitamin B12, 1 milligram per day). Participants continued the therapy through July 2005 and were tracked for the development of AMD through November 2005.

Over an average of 7.3 years of treatment and follow-up, 137 new cases of AMD were documented, including 70 cases that were visually significant (resulting in a visual acuity of 20/30 or worse). Of these, 55 AMD cases, 26 visually significant, occurred in the 2,607 women in the active treatment group, whereas 82 of the 2,598 women in the placebo group developed AMD, 44 cases of which were visually significant. Women taking the supplements had a 34 percent lower risk of any AMD and a 41 percent lower risk of visually significant AMD. “The beneficial effect of treatment began to emerge at approximately two years of follow-up and persisted throughout the trial,” the authors write.

“The trial findings reported herein are the strongest evidence to date in support of a possible beneficial effect of folic acid and B vitamin supplements in AMD prevention,” the authors write. Because they apply to the early stages of disease development, they appear to represent the first identified way—other than not smoking—to reduce the risk of AMD in individuals at an average risk. “From a public health perspective, this is particularly important because persons with early AMD are at increased risk of developing advanced AMD, the leading cause of severe, irreversible vision loss in older Americans.”

Beyond lowering homocysteine levels, potential mechanisms for the effectiveness of B vitamins and folic acid in preventing AMD include antioxidant effects and improved function of blood vessels in the eye, they note.

Posted by dlifenews at 10:46 AM | Comments (0)

ORNL, UT Project Could Save Vision Of Millions

February 17, 2009

February 17, 2009 (EurekAlert) - In the blink of an eye, people at risk of becoming blind can now be screened for eye diseases such as diabetic retinopathy and age-related macular degeneration.

Using a technology originally developed at the Department of Energy's Oak Ridge National Laboratory to understand semiconductor defects, three locations in Memphis have been equipped with digital cameras that take pictures of the retina. Those images are relayed to a center where they are analyzed and the patient knows in minutes whether he or she needs additional medical attention.

"Once we've taken pictures of the eyes, we transmit that information to our database, where it is compared to thousands of images of known retinal disease states," said Ken Tobin, who led the ORNL team that developed the technology. "From there, the computer system is able to determine whether the patient passes the screening or it provides a follow-up plan that includes seeing an ophthalmologist."

Already, this technology is making a difference as two patients at the Church Health Center in Memphis have been identified as needing laser treatment for moderate and severe diabetic retinopathy and macular edema, both conditions that can lead to blindness.

While some cameras have been installed, others will be installed at several rural and urban health care centers serving the Mississippi Delta. Another camera is planned for a federally funded health center in Chattanooga. Eventually, the goal is to have hundreds of cameras throughout the United States and beyond. If disease can be detected early, treatments can preserve vision and significantly reduce the occurrence of debilitating blindness.

This project takes advantage of ORNL's proprietary content-based image retrieval technology, which quickly sorts through large databases and finds visually similar images. For more than a decade manufacturers of semiconductors have used this technology to rapidly scan hundreds of thousands of tiny semiconductors to learn quickly about problems in the manufacturing process.

"Our approach allows us to adapt a proven technology to describe key regions of the retina, and this information can then be used to index images in a content-based image retrieval library," Tobin said. "What separates this from other methods is that we have automated the process of diagnosing retinal disease by capturing the expert knowledge of an ophthalmologist in a patient archive."

Leading the medical portion of the project is Edward Chaum, an ophthalmologist and Plough Foundation professor of retinal diseases at the University of Tennessee Health Science Center (http://www.eye.utmem.edu) Hamilton Eye Institute in Memphis. Chaum, the lead researcher on the National Eye Institute grant that has funded much of this research, is especially excited about the number of people, particularly the indigent and medically underserved communities, that this technology will help.

"Right now, with 21 million diabetics in the United States, we need to be screening 400,000 patients for diabetic eye disease every week," Chaum said. "Less than half of these diabetics receive the recommended annual eye exam, which is absolutely essential to minimize serious eye complications and potential blindness."

By 2050 the number of diabetics in the United States is expected to double, so the task of screening patients becomes even more daunting. Looking beyond the United States and more near term, the World Health Organization estimates that by 2025 more than 1 million patients will need to be screened worldwide for diabetes every day.

"To reach this goal, we are going to have to change the health care delivery paradigm," Chaum said, "and that will mean distributing these cameras to clinics and offices of primary care physicians."

Over the next few months, a more fully automated image analysis network managing images nationwide -- and eventually worldwide -- will be rolled out, according to Chaum, who envisions this being a global effort using automated technology and the connectivity of the World Wide Web.

Other researchers involved in this project are Tom Karnowski and Luca Giancardo of ORNL's Measurement Science and Systems Engineering Division, Stacy Li of the University of Tennessee Health Science Center in Memphis and Karen Fox of the Delta Health Alliance.

Posted by dlifenews at 10:29 AM | Comments (0)

Bone Marrow Cells Can Heal Nerves In Diabetes Model

February 04, 2009

February 4, 2009 (EurekAlert) - Transplanting cells that replenish blood vessels can also restore nerve function in an animal model of diabetic neuropathy, Emory researchers have found.

The results are described online this week in the journal Circulation.

The majority of people with diabetes have some form of neuropathy--damage to the peripheral nerves that can cause a loss of sensation in hands, arms, feet or legs. The damage, caused by high blood sugar, occurs gradually and in advanced cases can lead to amputation. Scientists have connected the damage to problems with peripheral nerves' blood supply.

Cultured cells from the bone marrow can promote the regrowth of both blood vessels and the protective lining of nerves in the limbs of diabetic animals, a team led by Young-sup Yoon, MD, PhD, associate professor of medicine (cardiology) at Emory University School of Medicine, found.

Bone marrow is thought to contain endothelial progenitor cells (EPCs), which can divide into endothelial cells, forming a "patch" for damaged blood vessels.

Yoon's team cultured bone marrow cells in a way designed to enrich them for EPCs and injected them next to the sciatic nerves of diabetic mice. The sciatic nerve is a large nerve that runs from the back to the rear leg. The mice were made diabetic by giving them streptozocin, a drug that poisons insulin-producing cells in the pancreas.

The team found that over several weeks, nerve signal speed and sensitivity to temperature were restored to normal in diabetic mice injected with the bone marrow cells.

A fraction of the bone marrow cells appear to become endothelial cells although many of them retain characteristics that make them look like white blood cells. However, they secrete molecules that stimulate the growth of both endothelial cells and Schwann cells, which protect and insulate peripheral nerves, the authors found.

Bone marrow-derived EPCs have also been used in studies of heart muscle repair after heart attack. However, most previous studies indicate that they disappear from the heart muscle after a few weeks.

"We were surprised to find that in this specific environment, they engraft and survive longer than in other tissues," Yoon says. "These cells appear to home to peripheral nerves."

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

Diabetes And Heart Disease: Risk Intertwined

February 4, 2009 (Newswise) - What’s the most common long-term complication of diabetes? Problems with the heart and blood vessels, according to the February issue of Mayo Clinic Women’s HealthSource.

Cardiovascular diseases, including heart attack and stroke, account for 65 percent of all diabetes-related deaths. People with diabetes are two to four times more likely to have a heart attack than is someone without the disease. For a middle-aged person with type 2 diabetes, the risk of a future heart attack is the same as that of someone who’s already had a heart attack. Also attention getting: when people with diabetes have heart attacks, they are more serious and more likely to result in death than in adults without diabetes.

People with diabetes are at higher risk of cardiovascular disease because too much blood sugar (glucose) can lead to damage inside blood vessel walls. This damage makes it easier for fatty deposits (plaques) to form in arteries and cause narrowing or blockages that can lead to heart attacks or strokes.

Having diabetes doesn’t mean heart disease is inevitable. Optimal control over the ABCs of diabetes, as suggested by the American Diabetes Association, can reduce heart disease risk. The ABCs are:

A1C: The best way to measure blood glucose levels over time is the glycoslyated hemoglobin A1C test. This blood test, given by a physician, reflects average blood sugar control over three months. The ADA recommends maintaining the A1C level at less than 7 percent. New research has indicated that intensive measures required to get below 7 percent might not offer cardiovascular benefits. A physician can determine the best goal for the A1C level. The test is recommended at least twice a year.

Blood pressure: High blood pressure is a common partner to diabetes. For people with diabetes, an ideal reading is below 130/80 millimeters of mercury (mm Hg).

Cholesterol levels: The optimal target is less than 100 milligrams per deciliter (mg/dL) for low-density lipoprotein (LDL) cholesterol. For high-density lipoprotein (HDL) cholesterol, the recommended level is more than 50 mg/dL for women and more than 40 mg/dL for men.

A physician can help with a treatment plan to meet these guidelines. A healthy diet, regular physical activity, weight loss, smoking cessation and limited alcohol consumption all are beneficial. Medications also may be needed. For example, research has shown that most adults with high blood pressure and diabetes require multiple drug therapies to reach blood pressure goals.

The bottom line: Risks and complications from diabetes and heart disease are intertwined. People with diabetes who manage heart disease risks can help avoid life-threatening complications.

Posted by dlifenews at 10:21 AM | Comments (1)

Small Device Helps Sleep Apnea Sufferers In A Big Way

February 02, 2009

February 2, 2009 (Newswise) - Imagine choking and gasping for air every time you fall asleep. Between 18 million and 20 million people in the United States suffer from these frightening symptoms because of a common disorder called sleep apnea. Because of a lack of awareness among both health professionals and the public, up to 90 percent of sufferers aren’t diagnosed or treated, and that could prove deadly.

When left untreated, sleep apnea may lead to more serious health problems. According to national health statistics, nearly 38,000 cardiovascular deaths annually are in some way related to sleep apnea.

Dental researchers offer new treatment alternative

Although treatment is available, many don’t comply with standard therapies. Researchers in the Dental School at The University of Texas Health Science Center at San Antonio are offering another treatment option that is more appealing, more affordable and easier to use than standard therapies.

The Thornton Adjustable Positioner is a device that helps pull the lower jaw forward, creating an open airway in the throat.

Paul McLornan, B.D.S., assistant professor in the Department of Prosthodontics, is the lead investigator of an 18-month study involving sleep apnea patients at the South Texas Veterans Health Care System, Audie Murphy Division. Researchers used an oral appliance called the Thornton Adjustable Positioner (TAP) to treat those suffering from moderate to severe sleep apnea.

Patients did not use standard treatment

“What we found was that many of our patients with moderate to severe sleep apnea were not adhering to standard treatment with a Continuous Positive Airway Pressure (CPAP) machine,” Dr. McLornan said. Although the CPAP is considered to be the gold standard in treating sleep apnea and is very effective, Dr. McLornan said compliance by patients is well below 50 percent.

“Some patients say the machine (which uses a face mask connected to tubes and blows air down a patient’s throat during sleep to keep the airway open), is cumbersome or noisy,” Dr. McLornan said. “Some said it was uncomfortable or that it bothered their spouses, or that they were just too embarrassed to use the machine.”

Dr. McLornan’s study proved that the TAP device, which is much smaller and fits in a patient’s mouth, is now an option for patients with severe sleep apnea.

New device moves lower jaw forward, opening the airway

Patients were fitted with the TAP appliance and given a tiny key that fits in the front of the device. The patient was instructed to wear the appliance every night and to insert and turn the key several millimeters before bedtime. By turning the key, the patient pulls his lower jaw forward, thus creating an open airway in the throat.

Patients in his study improved significantly when using the TAP. “We saw patients who began the study with severe sleep apnea end the study with very mild or no sleep apnea. They reported sleeping better, feeling more rested in the morning and altogether healthier.”

Dr. McLornan said this research is vital to both the medical and dental communities.

Many health issues associated with sleep apnea

“Sleep apnea is a growing and serious problem for people of all ages and all ethnic groups,” Dr. McLornan said. “If left untreated, it becomes progressively worse. People suffering from sleep apnea are at increased risk for high blood pressure, heart attacks, strokes, obesity and diabetes. It takes both dentists and medical professionals working together to control this potentially deadly disorder. The TAP gives patients another viable treatment alternative.” It is also less invasive and costly than CPAP or surgery.

Consult doctor with concerns about sleep apnea

Dr. McLornan said patients who think they may suffer from sleep apnea should consult their family physician and undergo a standard sleep study in a lab. Costs are normally covered by medical insurance.

The American Academy of Sleep Medicine, the professional society that sets the standards for and promotes excellence in sleep medicine, now recommends that oral appliances can be the first line of treatment for people with mild to moderate sleep apnea. Dr. McLornan’s study demonstrates it can be used for patients with severe problems as well.

Posted by dlifenews at 10:14 AM | Comments (1)

Twin Study: Diabetes Significantly Increases Risk For Alzheimer's Disease And Other Dementia

January 27, 2009

January 27, 2009 (EurekAlert) - Diabetics have a significantly greater risk of dementia, both Alzheimer's disease — the most common form of dementia — and other dementia, reveals important new data from an ongoing study of twins. The risk of dementia is especially strong if the onset of diabetes occurs in middle age, according to the study.

"Our results . . . highlighted the need to maintain a healthy lifestyle during adulthood in order to reduce the risk of dementia late in life," explained Dr. Margaret Gatz, who directs the Study of Dementia in Swedish Twins.

In a study published in the January 2009 issue of Diabetes, Gatz and researchers from Sweden show that getting diabetes before the age of 65 corresponds to a 125 percent increased risk for Alzheimer's disease. Nearly 21 million people in the United States have diabetes, according to the American Diabetes Association, which publishes the journal.

This risk of Alzheimer's disease or other dementia was significant for mid-life diabetics — as opposed to those who develop diabetes after 65 — even when controlling for family factors. In other studies, genetic factors and childhood poverty have been shown to independently contribute to the risk of both diabetes and dementia.

"Twins provide naturally matched pairs, in which confounding factors such as genetics and childhood environment may be removed when comparisons are made between twins," explained Gatz, professor of psychology, gerontology and preventive medicine at the University of Southern California and foreign adjunct professor of medical epidemiology and biostatistics at the Karolinska Institute in Sweden.

Indeed, the chances of a diabetic developing Alzheimer's disease may be even greater in real life than in the study, the researchers write. They identify several factors that might have led them to underestimate the risk of dementia and Alzheimer's among those who develop diabetes before the age of 65.

Diabetes usually appears at a younger age than dementia does, the researchers note. Diabetes is also associated with a higher mortality rate, which may reduce the size of the sample of older adults. In addition, approximately 30 percent of older adults with diabetes have not been diagnosed.

The results of the study implicate adult choices such as exercise, diet and smoking, as well as glycemic control in patients with diabetes, in affecting risk for Alzheimer's disease and diabetes, according to the researchers.

The sample for the study was 13,693 Swedish twins aged 65 or older in 1998, the year tracking for dementia began. Information about diabetes came from prior surveys of twins and linkage to hospital discharge registry data beginning in the 1960s.

Posted by dlifenews at 10:39 AM | Comments (2)

New Survey Results Show Huge Burden of Diabetes

January 26, 2009

January 26, 2009 (NIH) - In the United States, nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed, according to epidemiologists from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), whose study includes newly available data from an Oral Glucose Tolerance Test (OGTT). Diabetes is especially common in the elderly: nearly one-third of those age 65 and older have the disease. An additional 30 percent of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range. The researchers report these findings in the February 2009 issue of Diabetes Care, which posted a pre-print version of the article online at http://diabetes.org/diabetescare.

The study compared the results of two national surveys that included a fasting blood glucose (FBG) test and 2-hour glucose reading from an OGTT. The OGTT gives more information about blood glucose abnormalities than the FBG test, which measures blood glucose after an overnight fast. The FBG test is easier and less costly than the OGTT, but the 2-hour test is more sensitive in identifying diabetes and pre-diabetes, especially in older people. Two-hour glucose readings that are high but not yet diabetic indicate a greater risk of cardiovascular disease and of developing diabetes than a high, but not yet diabetic, fasting glucose level.

“We’re facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with pre-diabetes,” said lead author Catherine Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the NIH. “For years, diabetes prevalence estimates have been based mainly on data that included a fasting glucose test but not an OGTT. The 2005-2006 National Health and Nutrition Examination Survey, or NHANES, is the first national survey in 15 years to include the OGTT. The addition of the OGTT gives us greater confidence that we’re seeing the true burden of diabetes and pre-diabetes in a representative sample of the U.S. population.”

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. It is the most common cause of blindness, kidney failure, and amputations in adults and a leading cause of heart disease and stroke. Type 2 diabetes accounts for up to 95 percent of all diabetes cases and virtually all cases of undiagnosed diabetes. Pre-diabetes, which causes no symptoms, substantially raises the risk of a heart attack or stroke and of developing type 2 diabetes.

In its analysis, the team also found that:

* The rate of diagnosed diabetes increased between the surveys, but the prevalence of undiagnosed diabetes and pre-diabetes remained relatively stable.
* Minority groups continue to bear a disproportionate burden. The prevalence of diabetes, both diagnosed and undiagnosed, in non-Hispanic blacks and Mexican- Americans is about 70 to 80 percent higher than that of non-Hispanic whites.
* Diabetes prevalence was virtually the same in men and women, as was the proportion of undiagnosed cases.
* Pre-diabetes is more common in men than in women (36 percent compared to 23 percent).
* Diabetes is rare in youth ages 12 to 19 years, but about 16 percent have pre-diabetes.

“These findings have grave implications for our health care system, which is already struggling to provide care for millions of diabetes patients, many of whom belong to vulnerable groups, such as the elderly or minorities,” said Griffin P. Rodgers, M.D., director of the NIDDK. “Of paramount importance is the need to curb the obesity epidemic, which is the main factor driving the rise in type 2 diabetes.”

The study is based on 2005-2006 data from the NHANES conducted by the CDC’s National Center for Health Statistics. The survey involved 7,267 people, who represented a national sample of persons age 12 years and older. Participants were interviewed in their homes and received a physical exam. A subsample had a blood sugar reading taken after an overnight fast as well as the OGTT, sometimes called a 2-hour glucose challenge. The OGTT measures blood glucose 2 hours after a person drinks a premeasured sugary beverage. The findings were then compared to those of the last NHANES survey that included the OGTT, which was conducted from 1988 to 1994.

“These findings of yet another increase in diabetes prevalence are a reminder that a full-scale public health response is in order. Re-directing the trends in diabetes will require changing the nutritional and physical activity habits of people at risk, and also creative and substantial efforts by health systems and communities," said Ed Gregg, Ph.D., epidemiology and statistics branch chief in CDC’s Division of Diabetes Translation.

“It’s important to know if you have diabetes or pre-diabetes, because there’s so much you can do to preserve your health,” said Joanne Gallivan, M.S., R.D., director of the National Diabetes Education Program (NDEP) for the NIH. “You should talk to your health care professional about your risk. If your blood glucose is high but not high enough to be diagnosed as diabetes, losing a modest amount of weight and increasing physical activity will greatly lower your risk of getting type 2 diabetes. If you already have diabetes, controlling your blood glucose, blood pressure, and cholesterol will prevent or delay the complications of diabetes.”

People over age 45 should be tested for pre-diabetes or diabetes. Those younger than 45 who are overweight and have another risk factor should ask their health care provider about testing. People are at greater risk of developing pre-diabetes and type 2 diabetes if they:

* are age 45 or older
* have a family history of diabetes
* are overweight
* are inactive (exercise less than three times a week)
* are members of a high-risk ethnic population (e.g., African American, Hispanic/Latino American, American Indian and Alaska Native, Asian American, Pacific Islander)
* have high blood pressure: 140/90 mm/Hg or higher
* have an HDL cholesterol less than 35 mg/dL or a triglyceride level 250 mg/dL or higher
* have had diabetes that developed during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds
* have polycystic ovary syndrome, a metabolic disorder that affects the female reproductive system
* have acanthosis nigricans (dark, thickened skin around neck or armpits)
* have a history of disease of the blood vessels to the heart, brain, or legs
* have had higher-than-normal blood glucose levels on previous testing.

The National Diabetes Education Program, jointly sponsored by the NIH, CDC, and 200 partner organizations, provides diabetes education to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of diabetes. In its “Small Steps. Big Rewards. Prevent Type 2 Diabetes” campaign, the NDEP (www.ndep.nih.gov/) informs people at risk for type 2 diabetes that they have the power to turn the tide against this disease. The “Control Your Diabetes for Life” campaign encourages people with diabetes to control their blood glucose as well as their blood pressure and cholesterol to prevent or delay complications, which affect the heart, eyes, nerves, kidneys, and blood vessels.

CDC, through its Division of Diabetes Translation www.cdc.gov/diabetes, funds 59 diabetes prevention and control programs across all states, and U.S.-Affiliated territories and island jurisdictions, and 11 tribes and tribal organizations.

For Immediate Release
Monday, January 26, 2009

E-mail this page
Subscribe Contact:
Joan Chamberlain, NIH
301-496-3583

CDC Media Relations
404-639-3286

New Survey Results Show Huge Burden of Diabetes
Study Includes Sensitive Test of Blood Glucose Abnormalities

In the United States, nearly 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed, according to epidemiologists from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), whose study includes newly available data from an Oral Glucose Tolerance Test (OGTT). Diabetes is especially common in the elderly: nearly one-third of those age 65 and older have the disease. An additional 30 percent of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range. The researchers report these findings in the February 2009 issue of Diabetes Care, which posted a pre-print version of the article online at http://diabetes.org/diabetescare.

The study compared the results of two national surveys that included a fasting blood glucose (FBG) test and 2-hour glucose reading from an OGTT. The OGTT gives more information about blood glucose abnormalities than the FBG test, which measures blood glucose after an overnight fast. The FBG test is easier and less costly than the OGTT, but the 2-hour test is more sensitive in identifying diabetes and pre-diabetes, especially in older people. Two-hour glucose readings that are high but not yet diabetic indicate a greater risk of cardiovascular disease and of developing diabetes than a high, but not yet diabetic, fasting glucose level.

“We’re facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with pre-diabetes,” said lead author Catherine Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the NIH. “For years, diabetes prevalence estimates have been based mainly on data that included a fasting glucose test but not an OGTT. The 2005-2006 National Health and Nutrition Examination Survey, or NHANES, is the first national survey in 15 years to include the OGTT. The addition of the OGTT gives us greater confidence that we’re seeing the true burden of diabetes and pre-diabetes in a representative sample of the U.S. population.”

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. It is the most common cause of blindness, kidney failure, and amputations in adults and a leading cause of heart disease and stroke. Type 2 diabetes accounts for up to 95 percent of all diabetes cases and virtually all cases of undiagnosed diabetes. Pre-diabetes, which causes no symptoms, substantially raises the risk of a heart attack or stroke and of developing type 2 diabetes.

In its analysis, the team also found that:

* The rate of diagnosed diabetes increased between the surveys, but the prevalence of undiagnosed diabetes and pre-diabetes remained relatively stable.
* Minority groups continue to bear a disproportionate burden. The prevalence of diabetes, both diagnosed and undiagnosed, in non-Hispanic blacks and Mexican- Americans is about 70 to 80 percent higher than that of non-Hispanic whites.
* Diabetes prevalence was virtually the same in men and women, as was the proportion of undiagnosed cases.
* Pre-diabetes is more common in men than in women (36 percent compared to 23 percent).
* Diabetes is rare in youth ages 12 to 19 years, but about 16 percent have pre-diabetes.

“These findings have grave implications for our health care system, which is already struggling to provide care for millions of diabetes patients, many of whom belong to vulnerable groups, such as the elderly or minorities,” said Griffin P. Rodgers, M.D., director of the NIDDK. “Of paramount importance is the need to curb the obesity epidemic, which is the main factor driving the rise in type 2 diabetes.”

The study is based on 2005-2006 data from the NHANES conducted by the CDC’s National Center for Health Statistics. The survey involved 7,267 people, who represented a national sample of persons age 12 years and older. Participants were interviewed in their homes and received a physical exam. A subsample had a blood sugar reading taken after an overnight fast as well as the OGTT, sometimes called a 2-hour glucose challenge. The OGTT measures blood glucose 2 hours after a person drinks a premeasured sugary beverage. The findings were then compared to those of the last NHANES survey that included the OGTT, which was conducted from 1988 to 1994.

“These findings of yet another increase in diabetes prevalence are a reminder that a full-scale public health response is in order. Re-directing the trends in diabetes will require changing the nutritional and physical activity habits of people at risk, and also creative and substantial efforts by health systems and communities," said Ed Gregg, Ph.D., epidemiology and statistics branch chief in CDC’s Division of Diabetes Translation.

“It’s important to know if you have diabetes or pre-diabetes, because there’s so much you can do to preserve your health,” said Joanne Gallivan, M.S., R.D., director of the National Diabetes Education Program (NDEP) for the NIH. “You should talk to your health care professional about your risk. If your blood glucose is high but not high enough to be diagnosed as diabetes, losing a modest amount of weight and increasing physical activity will greatly lower your risk of getting type 2 diabetes. If you already have diabetes, controlling your blood glucose, blood pressure, and cholesterol will prevent or delay the complications of diabetes.”

People over age 45 should be tested for pre-diabetes or diabetes. Those younger than 45 who are overweight and have another risk factor should ask their health care provider about testing. People are at greater risk of developing pre-diabetes and type 2 diabetes if they:

* are age 45 or older
* have a family history of diabetes
* are overweight
* are inactive (exercise less than three times a week)
* are members of a high-risk ethnic population (e.g., African American, Hispanic/Latino American, American Indian and Alaska Native, Asian American, Pacific Islander)
* have high blood pressure: 140/90 mm/Hg or higher
* have an HDL cholesterol less than 35 mg/dL or a triglyceride level 250 mg/dL or higher
* have had diabetes that developed during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds
* have polycystic ovary syndrome, a metabolic disorder that affects the female reproductive system
* have acanthosis nigricans (dark, thickened skin around neck or armpits)
* have a history of disease of the blood vessels to the heart, brain, or legs
* have had higher-than-normal blood glucose levels on previous testing.

The National Diabetes Education Program, jointly sponsored by the NIH, CDC, and 200 partner organizations, provides diabetes education to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of diabetes. In its “Small Steps. Big Rewards. Prevent Type 2 Diabetes” campaign, the NDEP (www.ndep.nih.gov/) informs people at risk for type 2 diabetes that they have the power to turn the tide against this disease. The “Control Your Diabetes for Life” campaign encourages people with diabetes to control their blood glucose as well as their blood pressure and cholesterol to prevent or delay complications, which affect the heart, eyes, nerves, kidneys, and blood vessels.

CDC, through its Division of Diabetes Translation www.cdc.gov/diabetes, funds 59 diabetes prevention and control programs across all states, and U.S.-Affiliated territories and island jurisdictions, and 11 tribes and tribal organizations.

NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit www.niddk.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Posted by dlife at 11:15 AM | Comments (0)

Athletes Not Spared From Health Risks Of Metabolic Syndrome

January 13, 2009

January 13, 2008 (EurekAlert) - College-age football players who gain weight to add power to their blocks and tackles might also be setting themselves up for diabetes and heart disease later in life, a new study suggests.

Nearly half of a sample of collegiate offensive and defensive linemen who underwent a battery of tests for the study had metabolic syndrome. This means the players had at least three of five risk factors that indicate a person has higher chances of developing heart disease and diabetes than those without the risk factors.

Based on the results, standard health screening for these risk factors might be a good idea for all collegiate football players, said Jackie Buell, director of sports nutrition at Ohio State University and lead author of the study.

"The current health of the athlete is of obvious concern, but these results suggest more attention needs to be paid to preventing future health problems at the same time," Buell said.

Metabolic syndrome is characterized by a cluster of clinical symptoms that include excess fat in the abdominal area (as measured by waist circumference), borderline or high blood pressure, cholesterol problems that foster plaque buildup in arteries, insulin resistance or glucose intolerance indicating the body can't properly use insulin or blood sugar, and the presence of a protein in the blood that means inflammation is present.

If a male athlete's waist measurements and blood pressure exceed set points – a 40-inch waist and a blood pressure reading higher than 130 over 85 – he ideally should undergo a blood test to see if high cholesterol, glucose and triglyceride levels, too, indicate that he might benefit from nutrition counseling and other health guidance to prevent chronic disease down the road, Buell said.

"With screening, we could know what their propensities are and teach them how to reduce or eliminate these risk factors before they get out of college," said Buell, who is a registered dietitian.

The research is published in the current issue of the Journal of Athletic Training.

The American Heart Association estimates that more than 50 million Americans have metabolic syndrome.

Buell noted that the presence of these combined risk factors does not automatically mean the football players are destined for disease. But it does suggest a heightened risk that could be reduced with lifestyle modifications.

In the study, researchers tested a total of 70 football linemen from Division I, II and III college programs as defined by the National Collegiate Athletic Association.

Of those, 34 athletes had at least three risk factors indicating they had metabolic syndrome based on measures of waist circumference, glucose levels, high-density lipoprotein (HDL, or good cholesterol), blood pressure and triglycerides.

Of those 34, one athlete had all five risk factors, and eight had four risk factors.

Large waists and low HDL were characteristics shared by all but two of the 34 athletes qualifying for metabolic syndrome. Elevated blood pressure was reported in all but five of those 34 players.

Among the trends the researchers saw were generally low levels of HDL cholesterol, which affected the athletes' cholesterol ratio, a measurement that offers more health information than a total cholesterol reading. The ratio refers to how the total cholesterol measurement relates to HDL cholesterol, and is obtained by dividing the HDL cholesterol level into the total cholesterol. The heart association's goal is to keep the ratio below 5:1; the optimum ratio is 3.5:1. Thirty-two of the athletes studied had ratios higher than 5:1.

"We assume this doesn't happen in a young person," Buell said. "The point of this research is, if you don't do a study like this, you don't know. I think we all assume they don't have these health risks because they're athletes.

"What worries me is what happens when they stop participating in sports that are a positive influence physiologically – then what happens to them?"

Most research suggests that reducing abdominal fat is the best way to prevent disease in the long run. Buell and colleagues suggested that because weight loss during competitive years might not be considered desirable to the lineman, it might be best to help athletes after their sports careers have ended.

The researchers said the Therapeutic Lifestyle Changes Guidelines proposed by the National Cholesterol Education Program could function as a guide for athletes with numerous risk factors. The guidelines recommend that saturated fats constitute no more than 7 percent of total calories, fats should constitute 25 percent to 35 percent of daily calories, and cholesterol consumption should not total more than 200 milligrams per day.

Though the researchers did not test the aerobic capacity of the athletes, they said prehypertension and low levels of HDL cholesterol suggest these football players could benefit from increased aerobic training.

"We understand these athletes want to be big, but they can't assume all their weight gain is lean mass just because they're lifting weights and taking protein supplements," Buell said. "The bottom line is we're seeing more and more abdominal obesity. And these findings show that athletes aren't necessarily off the hook when it comes to health risks."

Posted by dlife at 03:38 PM | Comments (0)

Diabetics With Previous Foot Ulcers May Be Able To Participate In Walking Program

January 13, 2009 (EurekAlert) - More than 20 million Americans are living with diabetes, and that number is expected to increase by more than 5 million by 2010. One complication related to diabetes, Diabetic Peripheral Neuropathy, (DM+PN), can cause individuals to develop foot ulcers and, in extreme cases, amputation might be necessary. Previously, doctors and scientists have recommended that individuals with this complication stay off their feet. Now, a University of Missouri researcher has concluded that individuals with DM+PN might be able to engage in a graduated walking program under close supervision of a medical professional and thus prevent other life threatening illnesses.

Diabetic Peripheral Neuropathy is a nerve disorder that mostly affects the legs and feet by causing ulcerations, pain, tingling or even total loss of feeling. Ulcers might occur due to loss of muscle, which would expose the bones to greater pressure under the foot, or to loss of feeling in the foot.

"Physical activity is recommended for people with diabetes because it is proven to reduce the risk of mortality and development of cardiovascular disease," said Joseph LeMaster, an associate professor of family and community medicine at the University of Missouri. "Individuals with type 2 diabetes can increase their risk of cardiovascular disease by 34 percent and their risk of mortality by 39 percent if they do not participate regularly in some type of moderately intense exercise. People who have diabetes are already less active than most of the population and those with diabetic peripheral neuropathy tend to be even less active."

In the MU study, LeMaster examined the effects of lower-extremity exercise and walking intervention programs on foot ulcer occurrence in people with diabetic peripheral neuropathy. Participants with DM+PN were assigned to one of two groups: an intervention group, which was frequently monitored and assisted through leg strengthening exercises, a graduated walking program and motivational telephone calls every two weeks, and a control group. Both groups received diabetic and regular foot care education and eight sessions with a physical therapist.

During the first six months, LeMaster noted an increase in the total number of minor foot lesions and ulcers. However, at the end of the year, the number of lesions and ulcers in the intervention group had started to decrease compared to the control group, indicating a reduced risk.

"Because weight-bearing activity did not lead to a significant increase in foot ulcers, our study suggests that weight-bearing exercise might be appropriate for people with DM+PN if the patient currently has no foot ulcers, wears proper footwear, and is in a walking program that is well-supervised and safely monitored by a medical professional," LeMaster said.

Posted by dlife at 03:36 PM | Comments (0)

Researchers Find Roughly Half Of Healthy, Younger Adults Could Be At Risk For Heart Disease

January 12, 2009

January 12, 2008 (Southwestern Medical Center) - Even younger adults who have few short-term risk factors for heart disease may have a higher risk of developing heart disease over their lifetimes, according to new findings by a UT Southwestern Medical Center researcher.

The findings, based on clinical studies and appearing in the Jan. 26 issue of the journal Circulation: Journal of the American Heart Association, suggest that traditional methods of identifying heart disease risk might not adequately identify patients who actually have a higher lifetime risk.

“We found that about half of individuals who are 50 years of age or younger and at low short-term risk for heart disease may not remain at low risk throughout their lives,” said Dr. Jarett Berry, assistant professor of internal medicine at UT Southwestern and lead author of the study.

Using current 10-year risk assessment data, more than 90 percent of patients 50 years of age and younger are considered at low risk for heart disease. But when researchers added a lifetime risk model to the 10-year risk model, they found that about half of those with a low 10-year risk but high lifetime risk had a greater progression of heart disease, as measured by buildup of coronary artery calcium and thickening of the carotid artery.

The short-term (10-year) risk factors in the study were represented by the Framingham Risk Score, a tool typically used by physicians to assess risk for heart disease in patients. Risk factors listed on the assessment include cholesterol levels, blood pressure, smoking, age and gender.

“There is a discrepancy between short-term and long-term risk,” Dr. Berry said. “People deemed low-risk, using the 10-year assessment, may not remain low-risk throughout their lives.”

About 4,000 adults younger than 50 were divided according to their short-term risk for heart disease. For those with low short-term risk and without diabetes, the researchers also estimated the lifetime risk using factors such as blood cholesterol levels, smoking and blood pressure.

“When we compared the people with low short-term but high lifetime predicted risk with those individuals who had low short-term and low lifetime predicted risk, we found that the former group had a greater prevalence and progression of atherosclerosis,” Dr. Berry said. “Thus, long-term risk estimates in younger patients may provide new information regarding risk prediction that is not usually available using only a 10-year risk model.”

Dr. Berry added that because such an estimate has a profound association with subclinical atherosclerosis at this young age, it further supports the notion that long-term risk estimation could be a useful addition to current clinical practice. In particular, a long-term risk estimate could be used in combination with a short-term risk estimate to counsel patients more effectively, especially younger adults with risk factors for heart disease.

Data from the study came from the Coronary Artery Risk Development in Young Adults (CARDIA) study and the Multi-Ethnic Study of Atherosclerosis (MESA) study, both sponsored by the National Heart, Lung and Blood Institute.

Researchers from Northwestern University, University of Minnesota, University of Alabama at Birmingham, Wake Forest University School of Medicine, Tufts University School of Medicine, Columbia University College of Physicians and Surgeons and Kaiser Permanente Northern California also contributed to this study.

Visit http://www.utsouthwestern.org/heartlungvascular to learn more about
UT Southwestern’s clinical services in heart disease.

Posted by dlife at 05:29 PM | Comments (0)

Ophthalmology Highlights January 2009: Inflammatory Factors and Diabetic Macular Edema

January 05, 2009

January 5, 2009 (EurekAlert) - With a new study from the Centers for Disease Control and Prevention predicting that diabetic retinopathy will triple from 5.5 million in 2005 to 16 million in 2050, improved treatments are urgently needed for this leading cause of blindness in working-age people. The CDC study is the latest indicator of a world-wide diabetes epidemic that is motivating ophthalmic research around the globe. Hideharu Funatsu, MD, and colleagues at the Tokyo Women's Medical University, Japan, focused on diabetic macular edema (DME) a serious complication of retinopathy. Their findings on inflammatory factors associated with DME are presented in this month's Ophthalmology, the journal of the American Academy of Ophthalmology.

Retinopathy typically develops gradually over many years in people who have diabetes. It impacts the retina, the area at the back of the eye that focuses images for transmission to the brain. Advanced complications include the growth of abnormal blood vessels on the retina and optic nerve, and DME, swelling of the macula at the center of the retina as fluid leaks from permeable blood vessels. Precisely how DME develops is unclear, but the condition is similar to chronic inflammation that can occur in other areas of the body. When inflammation occurs, the body's immune system releases chemical messengers into the blood or affected tissues in an attempt to rid the body of a perceived infection, irritant, or injury. Some of the chemicals cause leakage of fluid into the tissues, resulting in swelling.

Dr. Funatsu's group measured levels of four inflammatory factors and one anti-inflammatory factor in the vitreous gel, which fills the eye between the lens and the retina, in 53 patients with DME, 15 patients with nondiabetic ocular disease, and 8 diabetic patients without retinopathy. Vascular endothelial growth factor (VEGF), intercellular adhesion molecule (ICAM)-1, interleukin (IL)-6, monocyte chemotactic protein (MCP)-1 and the anti-inflammatory pigment epithelium-derived factor (PEDF) were selected because earlier research had linked them to the development or exacerbation of DME.

All four inflammatory factors were significantly higher and PEDF significantly lower in the vitreous of in patients with DME compared with the two other patient groups. VEGF and ICAM-1 had a stronger influence on the severity of DME than the other factors. VEGF is a strong vascular permeability factor that is overproduced in response to reduced oxygen levels in the retinas of people with retinopathy, and Dr. Funatsu's research suggests that VEFG is the key to the inflammatory response in DME. Building on earlier, similar findings, the study also indicates that PEDF may block the expression and actions of the key inflammatory factors.

Although this study suggests that intravitreal injection of steroids such as triamcinolone acetonide may be useful in treating DME, further clinical trials are required to confirm this finding.

"Triamcinolone acetonide down-regulates VEGF and ICAM-1, inhibits inflammatory cells, stabilizes cell membranes, and increases PEDF levels. It appears to control more of the cytokine messengers that contribute to abnormal blood vessel permeability," said Dr. Funatsu. He adds that further focus on VEGF and ICAM-1 may further illuminate the mechanisms of blood vessel breakdown in DME and lead to new treatments.

Posted by dlifenews at 02:42 PM | Comments (0)

Two Common Diabetes Drugs Double The Risk Of Fractures In Women

December 10, 2008

December 10, 2008 (EurekAlert) - Two common diabetes drugs — rosiglitazone and pioglitazone — are linked to higher fracture rates in women, according to a meta-analysis in CMAJ by a team of researchers from the University of East Anglia in the United Kingdom and Wake Forest University in the United States http://www.cmaj.ca/press/080486.pdf.

The drugs, called thiazolidinediones, help improve glycemic control and decrease insulin resistance in patients with diabetes.

The researchers looked at 10 randomized controlled trials of at least one year's duration involving 13 715 diabetes patients taking thiazolidinediones and those not taking the therapy. They found significantly reduced bone density in the lumbar spine and at the hip in women on the drugs.

It appears that long-term thiazolidinedione use doubles the risk of fractures among women with type 2 diabetes, without a significant increase in fracture risk in men. The researchers estimate that a fracture would occur in 1 out of 21 women at high risk of fracture who are taking thiazolidinedione for one year and among low risk women, there would be 1 fracture in every 55 if these drugs are taken for more than a year.

With more than 4 million users of thiazolidinediones in the United States alone in 2006, "the public health impact may be considerable," write Dr. Yoon Loke and coauthors. "If one assumes that half of those users were women and that the baseline risk of fractures is similar to that found in the ADOPT study, an estimated 30 000 excess fractures may have occurred if these women had been prescribed thiazolidinediones rather than metformin for more than a year."

The researchers call for further investigation into the underlying causes of this apparent sex-specific effect.

In a related commentary http://www.cmaj.ca/press/081713.pdf, Dr. Lorraine Lipscombe of the Institute for Clinical Evaluative Sciences and the University of Toronto writes that "clinical drug trials are often underpowered to detect unanticipated and rare adverse effects, and a standardized postmarketing surveillance process is needed." She cautions that the net benefit of these drugs is unclear, and there are other effective drugs that can control glycemia with fewer adverse events.

Posted by dlife at 09:34 AM | Comments (3)

Occurrence Of Major Eye Disease Projected To Increase Among Patients With Diabetes

December 08, 2008

December 8, 2008 (EurekAlert) - Based on projected increases in the prevalence of diabetes, the number of people with diabetes-related retinal disease, with glaucoma and with cataracts is estimated to increase significantly by 2050, according to a report in the December issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Diabetic retinopathy (damage to the small blood vessels in the retina) is the leading cause of blindness among American working-age adults with approximately $500 million spent on direct medical costs for diabetic retinopathy in 2004, according to background information in the article. "People with diabetes mellitus also have a higher prevalence of other eye diseases, such as cataracts and glaucoma, than the general population," the authors write. "Vision loss related to eye disease among people with diabetes is an important disability that threatens independence and can lead to depression, reduced mobility and reduced quality of life."

Jinan B. Saaddine, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues used published data from the 2004 National Health Interview Survey and the U.S. Census Bureau to estimate the number, age, sex and race/ethnicity of Americans with diabetes that will have the following eye conditions in the year 2050: diabetic retinopathy, vision threatening diabetic retinopathy, glaucoma and cataracts.

U.S. Census projections suggest that the total U.S. population will reach 402 million in 2050. It is expected that there will be 213 million non-Hispanic whites, 53 million blacks, 98 million Hispanics and 38 million people of other races. Based on these data and the projected increase in diabetes prevalence, the authors estimate that from 2005 to 2050 diabetic retinopathy cases will increase from 5.5 million to 16 million; vision threatening diabetic retinopathy cases will increase from 1.2 million to 3.4 million; increases in diabetic retinopathy and vision threatening diabetic retinopathy among Americans age 65 or older will be more prominent (rising from 2.5 million to 9.9 million for diabetic retinopathy and from 0.5 million to 1.9 million for vision threatening diabetic retinopathy); cataract cases among whites and blacks age 40 or older with diabetes will likely rise 235 percent; cataract cases among people with diabetes age 75 or older will increase 637 percent for black women and 677 percent for black men; and glaucoma cases among Hispanics age 65 or older with diabetes will increase 12-fold.

"In summary, our projections have shown higher numbers than previously estimated for diabetic retinopathy, vision threatening diabetic retinopathy, cataracts and glaucoma among Americans with diabetes," they conclude. "Efforts to prevent diabetes and to optimally manage diabetes and its complications are needed."

Posted by dlife at 09:55 AM | Comments (0)

Vitamin B1 Could Reverse Early-Stage Kidney Disease In Diabetes Patients

December 8, 2008 (EurekAlert) - Researchers at the University of Warwick have discovered high doses of thiamine – vitamin B1 – can reverse the onset of early diabetic kidney disease.

Kidney disease, or diabetic nephropathy, develops progressively in patients with type 2 diabetes. Early development of kidney disease is assessed by a high excretion rate of the protein albumin from the body in the urine, known as microalbuminuria.

The research is led by Dr Naila Rabbani and Professor Paul J Thornalley at Warwick Medical School, University of Warwick, in collaboration with researchers at the University of Punjab and Sheik Zaid Hospital, Lahore, Pakistan.

The team has discovered taking high oral doses of thiamine can dramatically decrease the excretion of albumin and reverse early stage kidney disease in type 2 diabetes patients.

In a paper published online in the journal Diabetologia, the team show 300 mg of thiamine taken orally each day for three months reduced the rate of albumin excretion in type 2 diabetes patients. The albumin excretion rate was decreased by 41% from the value at the start of the study. The results also showed 35% of patients with microalbuminuria saw a return to normal urinary albumin excretion after being treated with thiamine.

Forty patients with type 2 diabetes aged between 35 and 65 years old took part in the trial. They were randomly assigned a placebo or 3 x 100mg tablets of thiamine a day for three months.

The Warwick research group has already conclusively proven that type 2 diabetes patients have a thiamine deficiency. In an earlier study led by Professor Paul Thornalley at Warwick Medical School, the research team showed that thiamine deficiency could be key to a range of vascular problems for diabetes patients.

Dr Rabbani said: "This study once again highlights the importance of Vitamin B1 and we need to increase awareness. Professor Thornalley and I are planning a foundation at the University of Warwick to further education and research in thiamine deficiency."

Posted by dlife at 09:32 AM | Comments (0)

Gene Variation For Persons With Diabetes Associated With Increased Risk Of Coronary Artery Diseas

November 25, 2008

November 25, 2008 (EurekAlert) - Patients with type 2 diabetes who have poor glycemic control and a certain genetic variation have an increased risk of coronary artery disease, according to a study in the November 26 issue of JAMA.

Among the known risk factors for cardiovascular disease, diabetes mellitus ranks as one of the most potent. It increases the lifetime risk of a major cardiac event by 2 to 4 times, relative to individuals without diabetes, according to background information in the article. A substantial proportion of cardiovascular risk is under the control of genetic factors.

Genetic variation on chromosome 9p21 has been associated with increased risk of coronary artery disease (CAD) in the general population. Alessandro Doria, M.D., Ph.D., M.P.H., of the Joslin Diabetes Center, Harvard Medical School, Boston, and colleagues examined the association of this genetic variant with coronary artery disease in individuals with type 2 diabetes and whether the association is affected by poor glycemic control. The researchers conducted two studies, with one including 734 type 2 diabetes patients (322 with angiographically diagnosed CAD and 412 with no evidence of CAD), who were recruited between 2001 and 2006; the other study included 475 type 2 diabetes patients whose survival status was monitored from their recruitment between 1993 and 1996 until December 31, 2004.

Participants for both studies were tested for a representative single-nucleotide polymorphism (gene variation) of chromosome 9p21 (rs2383206) and characterized for their long-term glycemic control by averaging measurements of hemoglobin A1c (HbA1c) taken in the years before study entry.

The researchers found that relative to the CAD risk for patients with neither a 9p21 risk gene variant nor poor glycemic control, the odds for CAD among participants having two risk gene variants but not poor glycemic control was increased 2-fold, whereas the odds for CAD among study participants with the same genotype but poor glycemic control was increased 4-fold. The interaction was stronger when a measure of long-term glycemic control (7-year average rather than most recent HbA1c) was used for participants having two risk gene variants and a history of poor glycemia and for participants with the same genotype but not long-term poor glycemia.

A similar interaction between the 9p21 variant and poor glycemic control was observed with respect to the rate of death after 10 years.

"In conclusion, 9p21 [variant] and poor glycemic control interact in determining the odds of CAD in type 2 diabetes. This finding may have implications for our understanding of atherogenesis [the process of plaque forming in arteries] in diabetes and for the design of more effective prevention strategies. More broadly, it illustrates the complex etiology of multifactorial disorders and highlights the importance of accounting for gene-environment and gene-gene interactions in the quest for genetic factors contributing to these conditions," the authors write.

Posted by dlife at 04:25 PM | Comments (1)

Study Shows Direct Link Between Leptin And Obesity-Related Cardiovascular Disease

November 10, 2008

November 10, 2008 (EurekAlert) - Obese people who don't have high cholesterol or diabetes might think they're healthy – despite the extra pounds. But new Ohio University research suggests that obesity raises levels of the hormone leptin, which can be as big a threat to the cardiovascular system as cholesterol.

Tadeusz Malinski and colleagues have published the first study to directly observe how high levels of leptin can create a cascade of harmful biochemical changes in the body. Leptin, a peptide hormone produced by fat cells, helps regulate body weight by acting on the hypothalamus to suppress appetite and burn stored fat.

But an excess of fat in the body can produce too much of the hormone, which, in turn, can lower levels of bioavailable nitric oxide. Nitric oxide, produced by the endothelial cells, supports healthy cardiovascular function by relaxing blood vessels and maintaining good blood flow, explained Malinski, who has developed special nanosensors that can detect levels of the substance.

In addition, Malinski found that the high levels of leptin stimulate greater production of superoxide. It reacts with nitric oxide to create peroxynitrite, a very toxic molecule that can impact DNA replication and damage endothelial cells in the vascular system.

"The nanosensors provide a more direct method of determining what processes are occurring in the body. Previously, researchers didn't have a clear idea of how this works," said Malinski, the Marvin and Ann Dilley White Distinguished Professor of Biomedical Sciences at Ohio University.

The study, which examined the process in single human cells and also obese mice models, was published in a recent issue of the American Journal of Physiology – Heart and Circulatory Physiology.

Though obesity is closely associated with heart failure, scientists haven't fully understood the relationship, Malinski noted. The new study suggests that increased levels of leptin alone can cause long-term cardiovascular damage similar to hypertension, arthrosclerosis, diabetes and other disorders.

"Now that we know the exact molecules responsible for the damage, we can design a method to mollify the effect of obesity on the cardiovascular system," Malinski said.

Posted by dlife at 10:20 AM | Comments (2)

Eye Conditions Linked with Obstructive Sleep Apnea

November 10, 2008 (Newswise) - If a good night’s sleep helps the brain and body perform better, it’s a good guess that sleep problems can cause more than just fatigue. Numerous studies have shown a connection between sleep disorders and medical conditions such as cardiovascular disease, cerebrovascular disease, and metabolic disorders, including the risk of obesity and diabetes mellitus. In the November issue of Mayo Clinic Proceedings, Mayo Clinic researchers outline several interesting associations between sleep disorders and eye disease.

Obstructive sleep apnea and eye disorders

More than 12 million people in the United States have obstructive sleep apnea -- a potentially serious sleep disorder in which breathing repeatedly stops and starts during sleep. Sleep apnea has several types. The most common is obstructive sleep apnea (OSA), which occurs when throat muscles relax and block the airway.

Multiple studies have identified OSA as an independent risk factor for the development of several medical conditions, including high blood pressure, which are related to impairments or alterations in a person’s vascular (circulatory) system. With their own complex and sensitive vascular system, the eyes can sometimes signal and be affected by systemic vascular problems.

“Given the vascular consequences of OSA, it is not surprising that ophthalmologic manifestations exist,” explains the article’s lead author, E. Andrew Waller, M.D., a Mayo Clinic pulmonologist and sleep specialist.

The researchers conducted a literature search focused on sleep disorders and eye disease. In the article, they discuss a variety of ophthalmologic conditions associated with obstructive sleep apnea. Highlighted below are a few findings.

* Floppy eyelid syndrome: This disorder causes eyelids to evert (turn inside-out) spontaneously during sleep, resulting in excessive watering, stickiness, discomfort and blurred vision. While not a serious medical problem, this syndrome can signal that a person also has OSA, which can lead to more significant health problems.
* Glaucoma: This condition is the second most common cause of blindness and the most common cause of irreversible blindness. OSA is linked to two forms of this disease -- primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). The severity of glaucoma appears to correlate with the number and duration of apnea episodes in patients with OSA.
* Nonarteritic anterior ischemic optic neuropathy (NAION): Research shows an increased incidence of OSA in people diagnosed with NAION. This condition is characterized by the sudden painless onset of vision loss in one eye, often noticed upon awakening. Up to 6,000 patients annually in the United States are diagnosed with this condition, which can cause irreversible vision loss.
* Papilledema: People with OSA may have a higher incidence of papilledema, swelling of the optic nerve in both eyes. Papilledema typically occurs due to increased pressure within the skull and can lead to progressively worsening vision and, in some cases, blindness.

According to Dr. Waller, knowing the links between these eye conditions and OSA may hasten early diagnosis and appropriate treatment.

“Our understanding of the mechanisms that link these disorders is minimal,” says Dr. Waller. “However, the recognition of these associations is important for primary care physicians, ophthalmologists, and sleep physicians. For patients with OSA, a routine eye examination to evaluate for early signs of glaucoma, particularly in the setting of visual loss or change, should be recommended. Patients with ophthalmologic diseases known to be associated with sleep apnea should be screened clinically for sleep apnea and referred to a sleep center if signs or symptoms are present.”

The authors from Mayo Clinic are Rick Bendel, M.D., ophthalmologist and Joseph Kaplan, M.D., pulmonologist and sleep specialist.

A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at http://www.mayoclinicproceedings.com.

Posted by dlife at 10:09 AM | Comments (1)

Even Mild Sleep Apnea Increases Cardiovascular Risk

October 24, 2008

October 24, 2008 (Newswise) - People with even minimally symptomatic obstructive sleep apnea (OSA) may be at increased risk for cardiovascular disease because of impaired endothelial function and increased arterial stiffness, according to a study from the Oxford Centre for Respiratory Medicine in the UK.

“It was previously known that people with OSA severe enough to affect their daytime alertness and manifest in other ways are at increased risk of cardiovascular disease, but this finding suggests that many more people—some of whom may be completely unaware that they even have OSA—are at risk than previously thought,” said lead author of the study, Malcolm Kohler, M.D.

The study will be published in the first issue for November of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

“Only one out of approximately five subjects with [clinically defined OSA] complains of excessive daytime sleepiness in population studies,” wrote Geraldo Lorenzi-Filho, M.D., Ph.D. in an editorial in the same issue of the Journal. “[I]t is now recognized that OSA triggers a cascade of biological reactions, including increased sympathetic activity, systemic inflammation, oxidative stress, and metabolic alterations that are potentially harmful to the cardiovascular system.”

To determine the exact nature of some of these effects, Dr. Kohler and colleagues performed a controlled, cross-sectional study to assess differences in endothelial function (often a harbinger for cardiovascular problems to come), arterial stiffness and blood pressure in patients with minimally symptomatic OSA. They compared 64 patients who had proven OSA to matched control subjects without OSA.

Their findings suggested that minimally symptomatic OSA is a cardiovascular risk factor to a degree not previously known.

“In our study, the augmentation index, a measure of central arterial stiffness that independently predicts cardiovascular events in high-risk populations, was significantly higher in patients with minimally symptomatic OSA compared to matched controls,” said Dr. Kohler. “We also found impaired endothelial function as indicated by decreased vascular reactivity of their arteries compared to control subjects without OSA.”

The difference in arterial stiffness between OSA patients and control subjects, Dr. Kohler said was “comparable in size to the effect seen after four weeks’ continuous positive airway pressure (CPAP) therapy in patients with moderate to severe symptomatic OSA.”

This suggests that asymptomatic or minimally symptomatic patients with OSA may enjoy a cardiovascular benefit from CPAP therapy.

Dr.Kohler and colleagues from the Oxford Centre for Respiratory Medicine are currently investigating the effects of 6 month CPAP therapy on arterial stiffness and endothelial function as part of an international randomized controlled trial (Multicentre Obstructive Sleep Apnoea Interventional Cardiovascular Trial; MOSAIC) which will show the impact of CPAP therapy on cardiovascular risk in patients with minimally symptomatic OSA.

Posted by dlife at 10:51 AM | Comments (1)

Experts Discover New Information about Diabetes’ Link to Tuberculosis

October 24, 2008 (Newswise) - New evidence discovered by researchers at The University of Texas School of Public Health Brownsville Regional Campus shows that patients with Type 2 diabetes may be at increased risk of contracting tuberculosis because of a compromised immune system, resulting in life-threatening lung infections that are more difficult to treat.

Blanca I. Restrepo, Ph.D., assistant professor of epidemiology; and Susan P. Fisher-Hoch, M.D., professor of epidemiology; and Joseph B. McCormick, M.D., regional dean, previously reported that Type 2 diabetes was the leading risk factor for tuberculosis (TB) in the United States/Mexico border area. Several other studies in Asia and elsewhere have confirmed this observation.

The UT School of Public Health team has now led three new studies that revealed key findings:
*Type 2 diabetes, especially Type 2 diabetes involving chronic high blood sugar, is associated with altered immune response to TB, and this was particularly marked in patients with chronically high blood sugar.
*Patients with diabetes and TB take longer to respond to anti-TB treatment.
*Patients with active tuberculosis and Type 2 diabetes are more likely to have multi-drug resistant TB.

The World Health Organization estimates that 180 million people in the world have diabetes, and that number is expected to double by 2030. Also, according to the WHO, each person with active, untreated TB infects on average 10 to 15 people per year. "You do the math and it adds up to a major public health threat," McCormick said. "If you have Type 2 diabetes in an area with high rates of TB, your chances of getting TB goes up. In countries where a third of the population is infected with TB, this becomes a real issue."

In a recently published study in Clinical Infectious Diseases, researchers reported that the immune systems of patients with Type 2 diabetes and tuberculosis respond differently compared with patients with TB alone. "This immune impairment may be what makes patients with diabetes so susceptible to TB," said Fisher-Hoch, whose career as a scientist was recently honored with a Hall of Fame Award from Women In Technology International.

Restrepo and her colleagues found that innate and type 1 cytokine responses were significantly higher in patients with tuberculosis who had diabetes than in the control group of patients with TB and no diabetes. The effect was consistently and significantly more marked in diabetic patients with chronic hyperglycemia, or uncontrolled high blood sugar. Diabetes results in the body's ineffective use of insulin. If left uncontrolled, the chronic high sugar in the bloodstream can affect the critical immune system and damage the body's systems, especially the nerves, the retina of the eyes and blood vessels.

“These findings are the opposite of what we were expecting,” Restrepo said. “These innate and type 1 cytokines are typically associated with TB protection, but in patients with diabetes, it appears the cytokines are not effective. Diabetics may have more advanced TB with more bacteria, and hence, more stimulation for secretion of type 1 cytokines.”

The researchers wrote, "More detailed knowledge of the underlying mechanisms should focus on the effect of chronic hyperglycemia on the immune response to help in understanding the enhanced susceptibility of diabetic patients with tuberculosis."

In a second study, which was published in an October issue of the American Journal of Tropical Medicine and Hygiene, the researchers demonstrated that diabetic patients with TB were more likely to take longer to clear the TB bacterium during the first phase of treatment than TB patients who are not diabetic. Using data from 469 TB patients in south Texas, those with diabetes had a five-day delay in mycobacterial clearance within the first 60 days of treatment.

"Despite the goal of global eradication by the year 2050, in 2004, there were an estimated 8.9 million new cases of TB worldwide," the researchers wrote. "Our data showed that adult onset diabetes mellitus (also known as Type 2 diabetes) seems to interfere with sterilization of pulmonary TB by drug therapy. By 2030, it is estimated that 336 million of the world's population will have diabetes mellitus, many in TB-endemic countries. Diabetes on this scale may impact TB control. Prospective studies are needed to define more clearly the consequences for transmission among diabetes patients and the prevention and therapeutic measures that might be taken to lessen the effect."

A third study demonstrated that patients with diabetes were more at risk of developing multi-drug resistant tuberculosis. In an Epub abstract online in Scandinavian Journal of Infectious Diseases, researchers reported that almost 6 percent of patients living along the Texas-Mexico border had TB that was resistant to rifampin and isoniazid, common medications for tuberculosis. Of those with multi-drug resistant tuberculosis, 30 percent also had Type 2 diabetes. "It is possible that impaired immunity in Type 2 diabetes increases susceptibility to infection with resistant strains," the abstract states.

McCormick, the senior author of all three papers, said these research findings shed new light on a long-known correlation between diabetes and tuberculosis. "It opens a door to doing something about it," said McCormick, the university's James H. Steele Professor. "We can educate physicians and offer more TB screenings. We have an opportunity to make sure patients are diagnosed correctly and that there is no delay in diagnosis."

Fisher-Hoch said the research could help diagnosis TB patients who previously would not be considered at risk for contracting the airborne, contagious disease. "The classic TB patient in this country is a younger male in an urban setting who may have alcohol and drug abuse problems and be HIV-infected," she said. "Our research shows older female patients who have never been in jail and have no history of alcohol and drug abuse or HIV infection are at risk of contracting TB if they have diabetes."

"I think we are illuminating a very important association between TB and diabetes that had pretty well been overlooked," Fisher-Hoch added. "The public health aspect is that we are trying to make sure we can prevent and treat these patients, and when they are TB-infected, treat them better."

Fisher-Hoch recommends that medical professionals screen patients for TB if they have diabetes and a chronic cough. She also recommends that patients with Type 2 diabetes take precautions. "If they are visiting an area where there is a lot TB, they need to be careful," she said. "TB spreads in crowded places with poor ventilation."

The research was supported in part by the Center for Clinical and Translational Sciences at The University of Texas Health Science Center at Houston, which includes the UT School of Public Health and its five regional campuses. Important logistics support was provided by the Hidalgo County Health Department. In addition to epidemiologists at the UT School of Public Health at the main campus in Houston and Brownsville Regional Campus, researchers included those from the Texas Department of State and Health Services Region 11, Michigan State University, The University of Texas at Austin and Secretaria de Salud de Tamaulipas.

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

High Blood Pressure Takes Big Toll On Small Filtering Units Of The Kidney

September 19, 2008

September 19, 2008 (EurekAlert) - Take a kidney out of the body and it still knows how to filter toxins from the blood.

But all bets are off in the face of high blood pressure.

"How does the kidney know how to do it and why does it break in hypertension?" says Dr. Edward W. Inscho, physiologist in the Medical College of Georgia Schools of Medicine and Graduate Studies.

The kidneys filter about 200 quarts of plasma daily, eliminating about two quarts of waste product and extra water as urine, according to the National Institute of Diabetes and Digestive and Kidney Diseases. But the complete physiology remains a mystery.

He challenged colleagues to fill in important blanks in how this process works normally and how to make it work better in disease during the Sept. 19 Lewis K. Dahl Memorial Lecture at the 62nd High Blood Pressure Research Conference and Workshop in Atlanta.

One thing is clear: Hypertension takes a serious toll on the kidneys and damaged kidneys worsen hypertension. Dr. Inscho believes the kidneys' million hard-working filters, or glomeruli, are direct victims of high pressure. His research focuses on the minute arteries, or arterioles, that feed blood into each of them. These afferent arterioles are responsible for keeping blood pressure at a comfortable 60 mmHg inside glomeruli. At a healthy blood pressure of 120/80 mmHg, blood enters the artery at a mean pressure of 100 mmHg, but higher pressures mean the arterioles must work even harder to reach the 60 mmHg target. They seem up to the task at least initially, contracting to make it harder for blood to pass and reducing pressure in the process. "We want to know how it does that," Dr. Inscho says as he watches the near instantaneous contraction.

He thinks he may at least know the messenger. The first reaction to high pressure actually is for the small vessel to stretch. That stretch prompts smooth muscle cells on the vessel wall to release ATP, a common molecule known as an energy source but also gaining acceptance as an extracellular messenger, he theorizes. "It's an action-reaction kind of event."

When he puts ATP on the vessel it rapidly constricts; when he blocks the ATP receptor it won't. Unfortunately ATP works best in the face of normal pressures: constricting pressure about 25 percent as opposed to 2-3 percent when it's high. Still there are plenty of questions. Whether ATP is really released by the initial stretching is a critical one, he says. Whether ATP really comes from smooth muscle cells is another.

University of Southern California researcher Dr. Janos Peti-Peterdi thinks high pressures tugging the tethers connecting smooth muscle cells to others in the blood vessel wall may really be what releases ATP, a theory Dr. Inscho presented during the Sept. 19 meeting. It may be that hypertension changes the attachment of those tethers so they don't respond and the blood vessel can't either.

"We are trying to figure out how all this fits together," says Dr. Inscho. Figuring out the critical steps of this "amazingly elegant, amazingly precise and very complicated" process will lead to better understanding of what gets corrupted by diseases such as hypertension and diabetes and maybe how to stop kidney destruction.

As scientists are finding with many diseases, Dr. Inscho says inflammation likely plays a big role. "We know we can make these animals hypertensive, treat them with anti-inflammatories and prevent this whole process from occurring," he says of glomeruli destruction. "I think that's pretty exciting, but we don't know exactly how we are doing that." Blood pressure is not affected, just the negative impact on the kidneys. Inflammation, he notes, is likely well-intended but ultimately ends up thickening blood vessel walls and hampering flexibility.

Posted by dlife at 10:49 AM | Comments (0)

Cognitive Problems Associated With Diabetes Duration And Severity

August 11, 2008

August 11, 2008 (EurekAlert) - Individuals with mild cognitive impairment appear more likely to have earlier onset, longer duration and greater severity of diabetes, according to a report in the August issue of Archives of Neurology, one of the JAMA/Archives journals.

Mild cognitive impairment is a transitional stage between normal aging and dementia, according to background information in the article. Previous studies have found an association between mild cognitive impairment and diabetes. Poor blood glucose control over time may lead to neuron loss, and diabetes is associated with cardiovascular disease risk and stroke, which also may increase the risk of cognitive impairment.

Rosebud O. Roberts, M.B.Ch.B., M.S., and colleagues at Mayo Clinic, Rochester, Minn., studied individuals from Olmsted County, Minnesota, who were age 70 to 89 on Oct. 1, 2004. Participants received a neurological examination, neuropsychological evaluation and tests of blood glucose levels, and completed an interview with questions about diabetes history, treatment and complications. A medical records linkage system was used to confirm diabetes history.

Rates of diabetes were similar among 329 individuals with mild cognitive impairment (20.1 percent) and 1,640 participants without mild cognitive impairment (17.7 percent). However, mild cognitive impairment was associated with developing diabetes before age 65, having diabetes for 10 years or longer, being treated with insulin and having diabetes complications.

"Severe diabetes mellitus is more likely to be associated with chronic hyperglycemia [high blood glucose], which, in turn, increases the likelihood of cerebral microvascular disease and may contribute to neuronal damage, brain atrophy and cognitive impairment," the authors write. That individuals with the eye disease diabetic retinopathy were twice as likely to have mild cognitive impairment supports the theory that diabetes-related damage to blood vessels in the brain may contribute to the development of cognitive problems.

"Our findings suggest that diabetes mellitus duration and severity, as measured by type of treatment and the presence of diabetes mellitus complications, may be important in the pathogenesis of cognitive impairment in subjects with diabetes mellitus," they conclude. "In contrast, late onset of diabetes mellitus, short duration of diabetes mellitus or well-controlled diabetes mellitus may have a lesser effect."

Posted by dlife at 08:55 AM | Comments (0)

Study Shows That People With Sleep Apnea Have A High Risk Of Death

August 01, 2008

August 1, 2008 (EurekAlert) - A study in the August 1 issue of the journal Sleep shows that people with severe sleep apnea have a much higher mortality risk than people without sleep apnea, and this risk increases when sleep apnea is untreated.

Results show that people who have severe sleep apnea, which involves frequent breathing pauses during sleep, have three times the risk of dying due to any cause compared with people who do not have sleep apnea. This risk is represented by an adjusted hazard ratio of 3.2 after controlling for age, sex and body mass index. When 126 participants who reported regular use of continuous positive airway pressure (CPAP) therapy were removed from the statistical analysis, the hazard ratio for all-cause mortality related to severe sleep apnea rose to 4.3.

"We found that both men and women with sleep apnea in the general population - not patients - mostly undiagnosed and untreated, had poorer survival compared with persons without sleep apnea, given equal BMI, age and sex," said principal investigator and lead author Terry Young, PhD, professor of epidemiology at the University of Wisconsin-Madison.

According to Young, most previous studies of sleep apnea and mortality have involved patients referred for a clinical sleep diagnostic evaluation; the mortality risk for sleep apnea in the general population has not been previously reported.

The study was an 18-year follow-up of 1,522 participants in the ongoing Wisconsin Sleep Cohort Study, which was established in 1988 and involved a random sample of men and women from the community who were between the ages of 30 and 60 when the study began. After spending one night at the University of Wisconsin General Clinical Research Center for assessment by polysomnography, participants were categorized by apnea-hypopnea index (AHI), which is the average number of breathing pauses (apneas) and reductions (hypopneas) per hour of sleep. Sixty-three individuals (about four percent) had severe sleep apnea at baseline with an AHI of 30 or more and a range of 30 to 97 apneas and hypopneas per hour. About 76 percent of the study group (1,157 individuals) had no sleep apnea with an AHI of less than five.

For the follow-up study, state and national death records were reviewed up to March 1, 2008, to identify participants who had died and to note the causes of death listed on the death certificates. Eighty deaths were recorded, including 37 deaths attributed to cancer and 25 deaths attributed to cardiovascular disease and stroke.

About 19 percent of participants with severe sleep apnea died (12 deaths), compared with about four percent of participants with no sleep apnea (46 deaths). Although participants with mild sleep apnea (AHI of five to 14) or moderate sleep apnea (AHI of 15 to 29) had a mortality risk that was 50 percent greater than those with no sleep apnea, the results did not achieve statistical significance.

Hazard ratios for all-cause mortality remained high after further adjustments for other factors such as smoking, alcohol use, sleep duration and total cholesterol. Severe sleep apnea was associated with increased mortality whether or not participants experienced daytime sleepiness.

About 42 percent of deaths in people with severe sleep apnea (5 of 12 deaths) were attributed to cardiovascular disease or stroke, compared with 26 percent of deaths in people with no sleep apnea (12 of 46 deaths). When the 126 participants who reported regular CPAP use were removed from the analysis, the hazard ratio for cardiovascular mortality soared from 2.9 to 5.2 for people with severe sleep apnea. The results suggest that regular CPAP use may protect sleep apnea patients against cardiovascular death.

"I was surprised by how much the risks increased when we excluded people who reported treatment with CPAP," Young said. "Our findings suggest - but cannot prove - that people diagnosed with sleep apnea should be treated, and if CPAP is the prescribed treatment, regular use may prevent premature death."

Statistical adjustments show that high blood pressure, cardiovascular disease, stroke and diabetes may play a role in the association between sleep apnea and mortality, but the specific mechanisms by which sleep apnea contributes to mortality remain unclear.

The study was supported by grants from the National Institutes of Health.

According to the American Academy of Sleep Medicine, obstructive sleep apnea (OSA) involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.

The most common treatment for OSA is CPAP therapy, which provides a steady stream of air through a mask that is worn during sleep. This airflow keeps the airway open to prevent pauses in breathing and restore normal oxygen levels.

Posted by dlife at 03:57 PM | Comments (2)

Diabetes Increases Risk Of Tuberculosis, Studies Show

July 15, 2008

July 15, 2008 (Science Daily) - People with diabetes mellitus are at increased risk of developing active tuberculosis (TB), according to an analysis published in PLoS Medicine.

Searching for research over the past four decades containing data on the relationship between diabetes and TB, Christie Jeon and Megan Murray of the Harvard School of Public Health identified 13 studies involving more than 1.7 million participants, including 17,698 cases of TB.

Combining the data from cohort studies in particular, the researchers calculated that diabetes increases the risk of active TB by about a factor of three.

A three-fold increased risk suggests that diabetes may already be responsible for more than 10% of TB cases in India and China. If these findings are replicated in other countries, global TB control might benefit from special attention to people with diabetes when identifying and treating latent TB.

Increased efforts to diagnose and treat diabetes might also decrease the global burden of TB, which kills about 1.6 million people each year.

Posted by dlife at 03:03 PM | Comments (3)

New Study: Hearing Impairment Is Common Among Adults With Diabetes

June 17, 2008

June 17, 2008 (EurekAlert) - Hearing impairment is common in adults with diabetes, and diabetes seems to be an independent risk factor for the condition according to a study published today on the Web site of Annals of Internal Medicine.

"We found that hearing loss was much more common in people with diabetes than people without the disease," says Kathleen E. Bainbridge, PhD, the study's lead researcher. "The hearing loss we detected did not seem to be caused by other factors such as exposure to loud noises, certain medicines, and smoking."

Using the National Health and Nutrition Examination Survey, collected by the National Center for Health Statistics from 1999 to 2004, the researchers analyzed data from 5,140 adults aged 20 to 69 who completed an audiometric examination and a diabetes questionnaire.

Hearing impairment was more prevalent among adults with diabetes. Age-adjusted prevalence of low- or mid-frequency hearing impairment of mild or greater severity assessed in the worse ear was 21.3 percent among 399 adults with diabetes compared to 9.4 percent among 4,741 adults without diabetes. These differences in hearing between people with and without diabetes were present in both sexes; all groups of race or ethnicity, education, and income; and all age groups but the oldest.

Similarly, age-adjusted prevalence of high-frequency hearing impairment of mild or greater severity assessed in the worse ear was 54.1 percent among adults with diabetes compared to 32 percent among adults without diabetes.

Diabetes, which can damage small blood vessels and nerves in the body, affects an estimated 9.6 percent of the U.S. adult population.

"It is possible that high blood sugar levels damage the small blood vessels and nerves of the inner ear, resulting in hearing impairment," says Bainbridge. "People with diabetes might benefit from having their hearing checked."

Hearing impairment was assessed from the pure tone average of thresholds over low or mid-frequencies (500; 1,000; and 2,000 Hz) and high frequencies (3,000; 4,000; 6,000; and 8,000 Hz) and was defined as mild or greater severity (pure tone average greater than 25 decibels hearing level and moderate or greater severity (pure tone average greater than 40 decibels hearing level). Hearing loss is reported by more than 17 percent of the U.S. adult population.

The editors of Annals of Internal Medicine caution that diabetes was self-reported and was verified in only a small fraction of participants, and the researchers did not distinguish between type 1 and type 2 diabetes. Noise exposure was based on participant recall.

In an accompanying editorial, Keiko Hirose, MD, of Washington University, writes, "We have few current therapeutic options for progressive hearing loss from any cause, and the study of hearing loss in diabetic patients could lead to important progress in new techniques of studying and treating microvascular disease of the inner ear."

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

Diabetes Medication Associated With Slower Progression Of Retina Disease

June 09, 2008

June 9, 2008 (EurekAlert) - Patients with diabetes who take the medication rosiglitazone may be less likely to develop the eye disease proliferative diabetic retinopathy or to experience reductions in visual acuity (sharpness), according to a report in the June issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Proliferative diabetic retinopathy occurs when existing blood vessels in the retina are blocked or damaged and new, tiny blood vessels form, according to background information in the article. It one of is the most common causes of severe vision loss among working-age Americans, and few effective therapies exist to delay its progression.

Lucy Q. Shen, M.D., of the Jules Stein Eye Institute, University of California–Los Angeles, and colleagues reviewed the medical records of 124 patients who were treated with rosiglitazone and who were receiving medical and ophthalmic care at the Joslin Diabetes Center in Boston between May 2002 and May 2003. They compared these patients to 158 patients who also had diabetes but were not taking rosiglitazone or a similar medication.

At the beginning of the study, 14 eyes of those in the rosiglitazone group (6.4 percent) and 24 eyes of those in the control group (9.3 percent) had severe non-proliferative diabetic retinopathy, an earlier stage of the disease in which new blood vessels have not yet developed. Among those, 7.7 percent of those in the rosiglitazone group and 29.2 percent of those in the control group progressed to proliferative diabetic retinopathy after one year. After three years, 19.2 percent in the rosiglitazone group and 47.4 percent in the control group had progressed from non-proliferative to proliferative diabetic retinopathy—a 59.5 percent relative risk reduction in the rosiglitazone group.

In addition, fewer eyes in the rosiglitazone group than in the control group experienced a loss in visual acuity of three or more lines on the vision chart (.5 percent vs. 14.5 percent) during an average of 2.8 years of follow-up.

Rosiglitazone may delay the progression of retinopathy and preserve vision by reducing the formation of new blood vessels, a process known as angiogenesis, the authors note. "However, because this study does not rigorously prove that rosiglitazone either reduces the incidence of proliferative diabetic retinopathy or prevents loss of visual acuity, and because there may be adverse effects from therapy, rosiglitazone treatment of patients with diabetes specifically to reduce these ophthalmic complications is not advocated at this time," they write. Known adverse effects include fluid build-up, abnormal liver function test and the worsening of congestive heart failure.

"Determination of the full efficacy and clinical role of rosiglitazone in the treatment of proliferative diabetic retinopathy and other angiogenic conditions awaits confirmation of risks and benefits and possibly large-scale definitive studies," the authors conclude.

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

Large, Long-Term Veterans Affairs Diabetes Trial (VADT) Reveals Important Cardiovascular Safety News on AVANDIA(R)

June 08, 2008

June 8, 2008 (PRNewswire) - Findings from the Veterans Affairs Diabetes Trial (VADT), a large, long-term and independent cardiovascular (CV) outcomes study in high-risk diabetes patients were released today at the 68th Scientific Sessions of the American Diabetes Association (ADA). According to news announced by the ADA, AVANDIA(R) (rosiglitazone maleate) was used in a majority of patients in the study and was not associated with increased deaths. These safety data are consistent with results from other long-term studies with AVANDIA. The primary result of VADT did not show that intensive blood sugar control (HbA1c levels below 7%) had a statistically significant effect on reducing major CV events associated with diabetes. However, it was found that there was a favorable trend in reducing all CV events, except CV death, among the patients in the intensive arm.

"Given the size and duration of this trial, the data on AVANDIA offer important safety information to physicians treating patients with type 2 diabetes," said Farhad Zangeneh, MD, FACP, FACE, assistant clinical professor of medicine at the George Washington University in Washington, DC and medical director of the Endocrine, Diabetes & Osteoporosis Clinic in Sterling, VA.

Dr. Zangeneh added, "While the VADT did not meet its primary endpoint, it is critical that these results do not detract from what we already know about the benefits of long-term blood sugar control on other serious and potentially life-threatening complications of diabetes, such as kidney failure, blindness and amputation."

In VADT, the patient population was considered at higher risk for CV disease since more than 40% had prior CV events. Further, trial participants had other risk factors, including hypertension (80%), lipid abnormalities (50%) and the majority were obese. Due to this high-risk patient population, the investigators predicted that there would be 650-700 CV events among the patients. However, there were significantly fewer CV events in the trial - 263 in the standard group and 231 in the intensive group.

Use of AVANDIA in VADT

AVANDIA was used along with other treatment options in the intensive arm to achieve tight glycemic goals. AVANDIA was the most commonly prescribed drug in the first year of the study - 85% and 78% in the intensive and standard arms, respectively. By the third year, use of AVANDIA decreased to 72% in the intensive arm and to 62% in the standard arm. The investigators noted that some of the reasons for this decrease relate to the known side effects of weight gain and edema associated with AVANDIA. There were no increased deaths in the study that were associated with AVANDIA.

VADT Study Design

VADT is a prospective, two-arm, randomized clinical trial designed to evaluate whether intensification of glucose control can reduce major CV events in patients with type 2 diabetes. A total of 1,791 mostly male veterans aged 41 and older with type 2 diabetes who were no longer responding to a maximum dose of at least one oral antidiabetic agent and/or daily insulin injections were enrolled over two years and followed up for a period of five to seven years, with clinician visits scheduled every 1.5 months; and were randomized to receive either intensive glycemic therapy (HbA1c less than 7%) or standard glycemic therapy (HbA1c = 8-9%).

Diabetes and the Role of Improved Blood Sugar Control

More than 19 million Americans have type 2 diabetes - a chronic, progressive and serious disease that occurs either when the body does not produce enough insulin or when the body does not respond properly to its natural insulin.

Improving blood sugar control in people with type 2 diabetes can help reduce the risk of diabetes-related complications, which include heart disease, stroke, eye damage, kidney failure and foot problems that lead to amputations. An epidemiological analysis from the United Kingdom Prospective Diabetes Study (UKPDS) showed that every one percent drop in HbA1c is associated with a significant reduction in risk of death related to diabetes by 21 percent, heart attack by 14 percent and diabetes-related microvascular complications by 37 percent.

Posted by dlife at 02:37 PM | Comments (0)

IDF Urges Health Care Providers to Address the Relationship Between Type 2 Diabetes and Sleep Apnea

June 07, 2008

June 7, 2008 (EurekAlert) – The International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention warned today that recent research demonstrates that type 2 diabetes and obstructive sleep apnea (OSA) are closely related, and that both disorders have significant implications on public health and on individuals. These were the conclusions of a meeting of diabetes and sleep experts who examined the impacts of untreated OSA, the most common form of sleep disordered breathing. The resulting IDF statement was released in a presentation at the American Diabetes Association (ADA) 68th Annual Scientific Sessions and in an article published in Diabetes Research and Clinical Practice1.

“While type 2 diabetes is recognized as a serious global epidemic, the severe health consequences of untreated sleep apnea, especially in people with diabetes, are not. Health policy makers and the general public must be made aware of the link between type 2 diabetes and sleep apnea so that we can begin to address the significant economic burden and debilitating health consequences to both individuals and the community,” said Professor Paul Zimmet, Foundation Director of the International Diabetes Institute in Melbourne, Australia and co-chair of the IDF Task Force on Epidemiology and Prevention. “Today’s statement is an urgent call to action to the medical community. It is imperative that we better understand the relationship between diabetes and sleep apnea through research and establish appropriate standards of care for managing diabetes and co-morbidities such as sleep apnea.”

Recent studies show that OSA is common in people with diabetes: estimates suggest that up to 40% of people with OSA have diabetes2,3. However further research is needed in this area in order to strengthen the evidence base between diabetes and OSA.

Additionally, both conditions have tremendous economic implications. While the annual costs of diabetes alone amount to USD170 billion in the United States4, and to at least ID (International Dollars) 16 billion, 15 billion and 6 billions in Japan, China and India respectively5, he estimated annual medical costs of OSA are much harder to define.

Professor Sir George Alberti, co-chair of the IDF Task Force and former President of IDF said that although the mechanisms linking OSA with diabetes are not yet fully understood, the consequences of both conditions cannot be ignored. It has been shown that the prevalence of CVD increases progressively with the increasing severity of OSA and that people with diabetes and/or OSA face serious cardiovascular problems and earlier death. Undiagnosed OSA may interfere with lifestyle treatment for diabetes. IDF therefore strongly recommends that healthcare professionals working in both type 2 diabetes and sleep disorders are educated about the links between the two conditions and encouraged to adopt clinical practices to ensure that a person presenting with one condition is considered for the other.

The IDF Task Force on Epidemiology and Prevention statement includes recommendations for screening, treatment and further research. While people with OSA should be routinely screened for metabolic disease and type 2 diabetes as screening tests are inexpensive and easy to conduct, people with diabetes should be screened for OSA particularly when they present classical symptoms such as witnessed apneas, heavy snoring or daytime sleepiness and poor workplace performance.

Recommendations for treatment of OSA include weight reduction in overweight and obese people, reduction in alcohol intake and CPAP treatment. Although further research is needed, the treatment of OSA may improve glycaemic control and will certainly benefit people as it improves their quality of life, blood pressure control and risk of cardiovascular disease.

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

Periodontitis Associated With Development of Type 2 Diabetes and Its Complications

June 06, 2008

June 6, 2008 (Marketwire) - Critical links between periodontal (gum) disease and the development of type 2 diabetes, as well as the development and progression of its complications, were reported here today in the first ever symposium presented by dentists to diabetes experts at the American Diabetes Association's Annual Scientific Sessions at its 68th such event.

"One of the many complications of diabetes is a greater risk for periodontal disease," said Maria E. Ryan, DDS, PhD, Professor of Oral Biology and Pathology, and Director of Clinical Research, School of Dental Medicine, Stony Brook University, New York, in a recent interview. "If you have this oral infection and inflammation, as with any infection, it's much more difficult to control blood glucose levels." Intensive periodontitis treatment significantly reduces levels of A1C, a measure of glucose control over the prior two to three months.

These links between oral and systemic health may start even before clinical diabetes begins. "We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C, a measure of poor glycemic control of diabetes," she said.

The importance of these findings were emphasized by her colleague, George W. Taylor, DrPH, DMD, Associate Professor of Dentistry, Schools of Dentistry and Public Health, University of Michigan. "Several recent studies have shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control and puts them at much greater risk of end-stage kidney disease and death," he reported.

"Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications," said Dr. Taylor.

Nearly 21 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputation. It is the fifth leading cause of death by disease in the U.S. Type 2 occurs mainly in adults who are overweight and ages 40 and older.

Periodontal (gum) disease is an infection and chronic inflammatory disease of the tissues surrounding and supporting the teeth. It is a major cause of tooth loss in adults. In periodontitis, unremoved plaque hardens into calculus (tartar), gums gradually begin to pull away from the teeth, and pockets form between the teeth and gums. However, people often do not know they have periodontal disease because it is usually painless.

Periodontitis Associated with Insulin Resistance and Diabetes Severity

"In an analysis of the National Health and Nutrition Examination Survey of the U.S. population data from 1988-94, we recently found that people with periodontal disease were twice as likely to have insulin resistance than those without such disease," said Dr. Taylor. This result was found after controlling for other characteristics that would be associated with insulin resistance, such as obesity, lipids, exercise, and other markers of inflammation, such as CRP, and whether or not they had diabetes.

In an unpublished study at the General Clinical Research Center at Stony Brook University, a group of individuals who were by one measure -- RD values (a measure of glucose uptake and insulin sensitivity) -- insulin resistant, and likely had pre-diabetes, also had their oral health assessed. Their degree of insulin resistance directly correlated with the severity of their periodontal disease.

"The inflammation from the oral cavity may be contributing to the insulin resistance in this patient population," said Dr. Ryan.

Also measured in this group were levels of cytokines, such as IL-1 beta, which are pro-inflammatory mediators involved in the long-term diabetes complications. "Genetic testing revealed that 50% of the insulin resistant patients had an IL-1 polymorphism -- in contrast to 20% in the overall population, meaning that they are genetically susceptible to an excessive inflammatory response, and this 50% was the group that had high levels of insulin resistance and more severe periodontal disease," she said.

The presence of the IL-1 polymorphism fits with one theory of how periodontitis worsens glycemic control in type 2 diabetes.

"We think periodontitis may adversely affect glycemic control because the pro-inflammatory chemicals produced by the infection -- such as IL-1-beta, IL-6, and TNF-alpha -- could transfer from the gum tissue into the bloodstream and stimulate cells to become resistant to insulin," said Dr. Taylor. "Then insulin resistance prevents cells in the body from removing glucose from the bloodstream for energy production."

Periodontitis Associated with Diabetes Complications

Dr. Taylor reported on studies at the University of Michigan and elsewhere demonstrating the association between periodontitis and the complications of type 2 diabetes.

"A recent set of observational studies of the Pima Indians in the Southwest, a population with a very high rate of type 2 diabetes, investigated whether those with periodontitis are more likely to develop poorer glycemic control," said Dr. Taylor. "We found that those with periodontitis were more than four times as likely to develop worsened glycemic control after two years of follow-up."

Studies of Pima Indians published by others have shown a higher risk of diabetes complications in those with periodontal disease. For example, one showed that residents of the Gila River Indian Community with severe periodontal disease were at more than three times the risk of death due to diabetic nephropathy or ischemic heart disease than those with no, mild, or moderate periodontal disease over 11 years.

Periodontal Treatment Can Improve Diabetes Control

"Just as periodontal disease makes diabetes worse, the reverse also appears to be true, with improvements in periodontal disease benefiting diabetes control," said Dr. Taylor. "We conducted an NIH-funded, randomized clinical trial in 46 people with type 2 diabetes and, 15 months after routine periodontal treatment, found a statistically significant reduction of 0.67% in A1C levels," said Dr. Taylor.

"We recently published a randomized, placebo-controlled, 30-patient study done at the General Clinical Research Center at Stony Brook University showing that a sub-antimicrobial dose of doxycycline, during and after root planing, as part of a 9-month course of treatment, significantly reduced A1C by 1% and also reduced proteinuria, a marker of diabetic kidney disease, and CRP, a marker of inflammation," said Dr. Ryan. "It also significantly reduced pocket depths associated with periodontitis and enabled gains in clinical attachment, while reducing signs of inflammation, such as bleeding upon probing or brushing." Two confirmatory 3-month studies of this program developed at Stony Brook have been conducted, at Columbia University and Buffalo University with 150 patients, and presented at International Association for Dental Research meetings.

"When glycemia has been difficult to control, the physician might consider asking patients when they last saw their dentist, whether periodontitis has been diagnosed and, if so, whether treatment has been completed," said Dr. Ryan. "A consultation with the dentist may be appropriate, to discuss whether periodontal treatment has been successful or whether a more intensive approach with oral or sub-antimicrobial antibiotics is in order because, just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there's infection and inflammation of the gums."

Posted by dlife at 02:34 PM | Comments (0)

Diabetes Doubles Liver Cancer Risk for Patients With Advanced Hepatitis C

May 29, 2008

May 29, 2008 (EurekAlert) - Patients who have chronic hepatitis C with advanced fibrosis have twice the risk of developing liver cancer if they also have diabetes. These findings are published in the June issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). The article is also available online at Wiley Interscience (www.interscience.wiley.com).

Recent studies have suggested that diabetes increases one’s risk for hepatocellular carcinoma (HCC), also known as liver cancer, possibly because diabetes often occurs as part of the metabolic syndrome, which increases the risk of non-alcoholic steatohepatitis (NASH), which can lead to liver cancer. Chronic hepatitis C also increases the risk of liver cancer, so patients who have both diabetes and hepatitis C have two pathways through which HCC might develop.

Researchers led by Bart Veldt and Harry Janssen of the Erasmus MC University Medical Center in the Netherlands, aimed to quantify the liver cancer risk of patients who have both diabetes mellitus and advanced hepatitis C. They used data from five large hepatology units in Europe and Canada and included 541 consecutive patients between 1990 and 2003 who had chronic hepatitis C and advanced liver fibrosis or cirrhosis as shown by liver biopsy. For each patient, they gathered demographic, clinical, biochemical and virological data, along with fibrosis assessment and details of hepatitis C treatment.

Eighty-five of the 541 patients included in the study had diabetes. Patients with more severe fibrosis were more likely to be diabetic. “The prevalence of diabetes mellitus was 10.5 percent for patients with Ishak fibrosis score 4, 12.5 percent for Ishak-score 5 and 19.1 percent for Ishak-score 6,” the authors report.

During the median follow-up time of four years, 11 patients (13 percent) with diabetes vs. 27 patients (5.9 percent) without diabetes developed hepatocellular carcinoma. The 5-year occurrence was 11.4 percent and 5.0 percent, respectively. Male gender and older age were significantly associated with elevated HCC risk. “In addition, there was a strong trend towards a higher incidence of HCC among patients with diabetes mellitus,” the authors report. Multivariate Cox regression analysis of patients with Ishak 6 cirrhosis showed that diabetes was independently associated with the development of HCC.

Interestingly, among patients with diabetes, there was a trend towards higher risk of HCC as fasting glucose levels increased. The authors hypothesize that resulting hyperinsulinemia might help explain the increased risk of HCC among diabetic patients.

Whatever the mechanism, the risk is clear. “For patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC,” the authors conclude.

Posted by dlife at 10:48 AM | Comments (0)

Study Shows Pine Bark Naturally Reduces Cardiovascular Risk Factors in Diabetics

May 28, 2008

May 28, 2008 (EurekAlert) - A new study published in the May 2008 (volume 8, issue 25) edition of the journal of Nutrition Research shows Pycnogenol (pic-noj-en-all), an antioxidant plant extract from the bark of the French maritime pine tree, reduces blood sugar in type II diabetes patients, allows people to lower their antihypertensive medication and improves cardiovascular disease (CVD) risk factors. The study, conducted at the University of Arizona, Tucson, indicates Pycnogenol may serve as a potent adjunct to prescription medications for the 20 million people in the Unites States living with diabetes.

“Most people with type II diabetes have cholesterol problems and half of those people experience hypertension. It has been documented that Pycnogenol mediates a number of beneficial effects on the cardiovascular system for diabetics and healthy individuals,” said Dr. Ronald Watson, a lead researcher of the study. “Previous studies have shown Pycnogenol supplementation to be associated with reducing platelet aggregation, lowering LDL and increasing HDL cholesterol and modifying hypertension, among others. But what really makes the study results compelling is Pycnogenol simultaneously lowered blood glucose, LDL cholesterol and blood pressure in patients. Furthermore, this is the first study suggesting that Pycnogenol might also be beneficial in protecting kidney function in diabetics.”

The 12-week, randomized, double-blind, placebo-controlled trial consisted of 48 men and women, 40 to 75 years of age, with noninsulin-dependent type II diabetes, taking anti-diabetic medication with metformin, sulfonylurea and glitazones. Furthermore, they took antihypertensive medications with ACE inhibitors such as Lisinopril. Despite their medication their fasting blood sugar was above healthy values (142 mg/dL) and their average systolic blood pressure was 139 mmHg subjects were randomly assigned to receive either Pycnogenol (25 mg, 5 times daily) or matched placebo. Participants were instructed to continue taking their prescription medications.

Blood pressure and heart rate were recorded at baseline and at biweekly follow-up visits physicians tried to lower the patient’s individual anti-hypertensive medication with aim to keep it below 130 mmHg. At monthly follow-up visits, all unused prescription medications were collected and counted. Change from baseline at weeks four, eight and 12 were calculated after eight hours of fasting for assessing plasma glucose, LDL cholesterol and endothelin-1. Urinary protein concentration was measured from spot urine samples on a monthly basis.

In the Pycnogenol treated groups, results revealed Pycnogenol achieved blood pressure control in 58.3 percent of patients at the end of the 12 weeks with 50 percent reduction in prescription medications. Plasma endothelin-1, a very potent hormone-like arterial constrictor which is typically elevated in diabetes patients, decreased by 17.8 percent. The constriction of arteries is believed to be the cause of hypertension and the decreased endothelin-1 with Pycnogenol is suggested to be the cause for the healthier blood pressure. The mean average blood glucose decreased from high 142.3 mg/dL to a healthy value 118.6, a decrease by 16.7% after 12 weeks. Low-density lipoprotein cholesterol improved significantly, declining by 11.9%.

“It is amazing to see that adding Pycnogenol to the regimen of prescription medication brought blood glucose to healthy levels, allowed half the patients to reach healthy blood pressure and enabled 58% to even lower their anti-hypertensive medication,” said Watson. “An absolutely new finding is that Pycnogenol appears to improve kidney function in diabetic people, this deserves more attention in future investigations. Pycnogenol should be standard adjunct to pharmaceutical treatment of diabetic patients to help control an array of cardiovascular problems.”

In the past four years alone, numerous studies have been published on Pycnogenol’s health benefits for people living with diabetes. In a study published in the March 2004 Diabetes Care, Pycnogenol was shown to lower blood sugar levels and not affect insulin levels. The October 2006 journal of Angiology revealed Pycnogenol reduces diabetic microangiopathy and in 2006, published research in the July journal of Clinical and Applied Thrombosis/Hemostasis revealed Pycnogenol heals leg ulcers in patients who suffer from diabetic leg ulcerations. Additionally, Pycnogenol has been shown to reduce fasting and postprandial serum glucose levels and glycosylated hemoglobin in patients with type II diabetes. And, earlier studies with more than 1,000 diabetes patients, showed that Pycnogenol has the ability to seal leaky capillaries in the eye. This capability stops the progression of vision loss in patients suffering from diabetic retinopathy, a diabetes-induced eye disease that ultimately leads to blindness.

Posted by dlife at 11:25 AM | Comments (51)

Promising Early Evidence Of The Superior Benefits Of Drug Therapy For Diabetic Eye Disease

April 29, 2008

April 29, 2009 (EurekAlert) - A JDRF collaboration between Johns Hopkins researchers and Genentech has shown that a drug for the treatment of diabetic eye disease has performed better in clinical trials than the current standard treatment using laser surgery.

These findings, representing the six-month end-point evaluation of the READ-2 clinical trial coordinated by The Johns Hopkins University, were presented Monday at the 2008 Annual Meeting of The Association for Research in Vision and Ophthalmology, in Fort Lauderdale, Florida.

According to Barbara Araneo, Ph.D., director of the complications program at JDRF, “These are very encouraging results, showing that drugs we have been testing in human clinical trials can be effective in slowing or stopping the effects of eye disease brought on by diabetes.”

The multi-center READ-2 Study (Ranibizumab for Edema of the mAcula in Diabetes), which began in December 2006, was designed to test the long-term safety and effectiveness of injections of the drug ranibizumab in patients with diabetic macular edema, a condition characterized by swelling of the central portion of the retina, or macula, at the back of the eye. In addition, the trial sought to determine the comparative efficacy of ranibizumab versus conventional treatment – laser photocoagulation therapy – or both together.

Macular edema, one of the most common causes of blindness, occurs when fluid and protein deposits collect on or under the macula, causing it to thicken and swell.

Participating in the clinical trial were 126 diabetic patients (average age 62) with documented Diabetic Macular Edema prior to enrollment; the majority had 20/80 vision in the eye that was treated. Patients were randomly assigned to receive one of three interventions: ranibizumab, laser photocoagulation, or a combination of the two treatments. At each visit over the course of the six-month treatment period, patients were evaluated for vision, retinal thickening, and general eye health. Although the study ended at six months, patients will be monitored for two years.

Patients treated with ranibizumab experienced significantly greater improvements in visual acuity, or clarity of vision, compared with patients receiving either of the other interventions. On average, the vision of ranibizumab-treated patients improved to 20/63 at month six, compared with essentially unchanged acuity scores of about 20/80 in both the laser and the combination treatment groups.

In addition, patients treated with ranibizumab had a 56 percent reduction in excess retinal thickness, whereas only an 11 percent reduction was seen in those receiving laser treatments.

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

Cholesterol, Blood Pressure Control May Reverse Atherosclerosis in Adults With Diabetes

April 08, 2008

April 8, 2008 (EurekAlert) - Aggressively lowering cholesterol and blood pressure levels below current targets in adults with type 2 diabetes may help to prevent – and possibly reverse – hardening of the arteries, according to new research supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Hardening of the arteries, also known as atherosclerosis, is the number one cause of heart disease and can lead to heart attack, stroke, and death.

The three-year study of 499 participants is the first to compare two treatment targets for LDL (“bad”) cholesterol and systolic blood pressure levels, key risk factors for heart disease, in people with diabetes. Results are published in the April 9 issue of the Journal of the American Medical Association.

“This study provides good news for adults with type 2 diabetes,” said Elizabeth G. Nabel, M.D., NHLBI director. “These patients are two to four times more likely than people without diabetes to die from heart disease. For the first time, we have evidence that aggressively lowering LDL cholesterol and blood pressure can actually reverse damage to the arteries in middle-aged adults with diabetes.”

In the Stop Atherosclerosis in Native Diabetics Study (SANDS), approximately one-half of the participants (247) were asked to lower to standard levels their LDL cholesterol (to 100 milligrams per deciliter) and blood pressure (systolic blood pressure of 130 mmHg or lower), while the other half (252) aimed for more aggressive lowering of LDL cholesterol to 70 mg/dL or lower and of systolic blood pressure to 115 mmHg or lower. All participants were American Indians 40 years or older (average age of 56) who had diabetes, high blood cholesterol, and high blood pressure but no history of heart attack or other evidence of heart disease. The study was conducted at four clinical centers in southwestern Oklahoma; Phoenix, Ariz.; northeastern Arizona; and South Dakota. All participants continued to receive their medical care, including diabetes management, dietary and exercise counseling, and smoking cessation, from their health care providers with the Indian Health Service. Like the NIH, the Indian Health Service is part of the U.S. Department of Health and Human Services.

“American Indians have a high rate of diabetes and cardiovascular disease related to diabetes, but there are few clinical trials that address these issues in this population,” said Barbara V. Howard, Ph.D., of MedStar Research Institute in Hyattsville, Md., lead author of the paper. “These study results provide needed evidence to help develop community-based programs to treat and prevent the epidemic of cardiovascular disease among American Indians. At the same time, we are increasing our understanding of the effects of intensively lowering cholesterol and blood pressure in adults with type 2 diabetes, which might also apply to other populations.”

During the three-year study, participants were examined by study clinicians one month after enrollment, then every three months, to assess their blood cholesterol and blood pressure levels and general well being. Food and Drug Administration-approved blood pressure and cholesterol medications were added and adjusted as needed to help participants achieve their treatment goals. The same medications were available to participants in the standard and the aggressive treatment groups. Participants were also encouraged to follow lifestyle approaches to help meet their blood pressure and cholesterol treatment targets, such as following a heart-healthy eating plan, being physically active, maintaining a healthy weight, and not smoking.

To assess the impact of the treatments on the participants’ cardiovascular health, researchers used ultrasound to measure the thickness of the carotid (neck) artery -- an indication of hardening of the arteries, a leading effect of high blood pressure and cholesterol and an early sign of cardiovascular disease. In addition, ultrasound was also used to measure the size and function of the left ventricle, the heart's main pumping chamber. Enlarged hearts are known to be predictors of increased risk of heart attack and stroke. These measurements were taken at enrollment, at 18 months, and at 36 months, when the study ended.

On average, participants in both groups reached and maintained their target goals for blood cholesterol and blood pressure levels. The numbers of heart attacks and other cardiovascular events were similar between the two groups and lower than expected.

In addition, carotid artery thickness measurements of participants in the aggressive treatment group were significantly lower than those in the standard treatment group. Researchers report that, compared to baseline, carotid artery thickness increased slightly in the standard group and regressed in the aggressive treatment group, indicating a partial reversal of atherosclerosis. Furthermore, although heart size decreased from baseline in both groups, the beneficial change was significantly greater among participants in the aggressive treatment group.

“Many patients with diabetes do not reach their blood pressure and cholesterol goal levels and thus remain at high risk for heart attacks and stroke,” noted Howard. “In our study, participants successfully managed their blood cholesterol and blood pressure to reach their goal levels. Our message to doctors, nurses, and patients is that you can reach your goal levels, and we should work together to help you do that.”

As with any therapy, the benefits and risks must be considered for each patient. In SANDS, participants in the aggressive treatment group on average needed more medications and higher doses than the standard treatment group, and they were slightly more likely to have side effects from blood pressure-lowering medications than those in the standard group. Such adverse effects generally resolved, however, after the medication was changed or the dose reduced. There were no differences in side effects related to cholesterol-lowering drugs between the standard and the aggressive treatment groups.

“These encouraging findings from SANDS suggest that more aggressive blood pressure and cholesterol targets than those currently recommended in patients with diabetes may reduce their future cardiovascular risk,” said Jerome L. Fleg, M.D., NHLBI project officer of the study and a coauthor of the paper. “Longer term followup of this population as well as additional studies in other populations are needed to confirm the benefit and cost-effectiveness of these lower targets.”

Posted by dlife at 02:54 PM | Comments (0)

Reduced Lung Capacity Accelerates with Diabetes

March 26, 2008

March 26, 2008 (Newswise) — People who have diabetes encounter a faster loss of lung capacity than those who do not have diabetes, a finding that may have implications for the potential use of inhaled insulin, according to a study appearing in the April issue of Diabetes Care.

The April issue also contains a consensus statement from the American Diabetes Association and American College of Cardiology Foundation emphasizing the need for more aggressive goals in controlling lipids to reduce cardiometabolic risk. In particular, the paper focuses for the first time on the need to test for and treat high levels of a protein called apolipoprotein B (ApoB), a more direct measure of the number of LDL particles that lead to plaques that cause heart disease (atherosclerosis). This is based on evidence that levels of ApoB are a better indicator of heart disease risk than total cholesterol or LDL (“bad cholesterol”).

Reduced Lung Capacity in People with Diabetes

The lung research, part of a larger investigation known as the Atherosclerosis Risk in Communities (ARIC) study, confirmed previous suggestions that the lung is a target organ for diabetic injury and that lung abnormalities accelerate once diabetes takes hold. Previous research by the same authors established that decreased lung capacity precedes and may predict a diagnosis of diabetes. The new study is accompanied by an editorial that concludes that diminished lung function may contribute to diabetes morbidity and mortality.

Specifically, the study found that people with type 2 diabetes experienced a more rapid decline in forced vital capacity, the measure of how well the lungs fill with air, than people who did not have diabetes. Though all people experience a decline in forced vital capacity as they age, people with diabetes appear to undergo a more rapid loss that appears before the diabetes diagnosis and accelerates after the disease sets in.

This could be because high blood sugar levels stiffen the lung tissue, or because the fat tissue in the chest and abdomen may confine the lungs more in people with diabetes, explained the researchers. They concluded the study with advice to clinicians to “pay heightened attention to pulmonary function in their patients with type 2 diabetes.”

“Think of the lung as a crime victim who unwittingly abets the perpetrator to hasten the demise of the host,” wrote Dr. Connie Hsia, of the University of Texas Southwestern Medical Center’s Department of Internal Medicine, in an editorial accompanying the study. She suggested that the loss of pulmonary function could add

to diabetic morbidity and mortality, and raised concerns about the potential use of inhaled insulin, since it may “trigger or exacerbate pulmonary dysfunction.”

Recently, makers of inhaled insulin have pulled their products from the market because of poor sales or halted product investigations, though several companies continue to explore this type of insulin delivery.

“Manufacturers of inhaled insulin should find these data useful as they study potential long-term effects of their product on lung function,” said Dr. Fred Brancati, one of the lead researchers on the study. “The results suggest that doctors and patients should keep an eye on the literature about diabetes and the lung down the road, since there’s a stronger connection than we previously thought.”

Consensus Statement Urges Greater Lipid Control

The ADA-American College of Cardiology (ACC) paper highlights a new consensus suggesting that, in people who exhibit cardiometabolic risk factors (such as insulin resistance, hypertension, overweight/obesity, or a family history of premature heart disease), a certain protein called apolipoprotein B (apo B) may better predict the risk of heart disease than LDL cholesterol levels, long used as one measurement of good heart health. A panel of diabetes and heart experts agreed that LDL (“bad”) cholesterol was still an important risk factor, but that after LDL cholesterol levels were brought under control, ApoB (a measure of the number of LDL particles in the blood that cause hardening of the arteries) should also be tested and treated to target levels in people at high risk.

The statement emphasizes the need to examine all factors for heart disease, to continue to focus on lifestyle interventions to reduce the risk for type 2 diabetes and heart disease, and to more aggressively control all lipids. The paper also urged health care providers to look at a person’s lifetime risk for heart disease, rather than just at short-term risks.

Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation’s fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations. For more information about diabetes, visit the American Diabetes Association Web site http://www.diabetes.org or call 1-800-DIABETES (1-800-342-2383).

Posted by dlife at 09:28 AM | Comments (2)

Study Shows Cholesterol-lowering Power of Dietitian Visits

March 04, 2008

March 4, 2008 (Newswise) — Worried about your cholesterol? You may want to schedule a few appointments with a registered dietitian, to get some sound advice about how to shape up your eating habits, according to a new national study led by University of Michigan Health System researchers.

Not only are you likely to lower your cholesterol levels, you may be able to avoid having to take cholesterol medication, or having to increase your dose if you’re already taking one. And you’ll probably lose weight in the process, which also helps your heart.

The new results, published in the February issue of the Journal of the American Dietetic Association, are based on data from 377 patients with high cholesterol who were counseled by 52 registered dietitians at 24 sites in 11 states.

In the group of 175 patients who started the study with triglycerides less than 400 milligrams per deciliter of blood (mg/dL), and who had their cholesterol measured before they changed or added medication, 44.6 percent either reduced their levels of “bad” cholesterol by at least 15 percent, or reached their cholesterol goal.

The results reflect progress in approximately eight months, after three or more appointments with a dietitian. But the results add further evidence that medical nutrition therapy, as it is called, can make a big difference in a patient’s life.

All of the R.D.s in the study based their advice to their patients on the latest research-based evidence about eating habits and cholesterol levels available at the time of the study: the American Dietetic Association’s 1998 Medical Nutrition Therapy Hyperlipidemia Protocol.

Since that time, the ADA has updated the clinical guideline based on new research, which means that patients who see an R.D. today may have even more success.

The study was funded by the ADA and its Clinical Nutrition Management Dietetic Practice Group, and based on a framework developed for a pilot project carried out in Michigan by the Michigan Dietetic Association and led by U-M cardiovascular dietitians.

“Everyone knows that nutrition is important for cholesterol management, and that a registered dietitian is the professional most thoroughly trained to help patients choose foods wisely,” says lead author Kathy Rhodes, Ph.D., R.D., manager of Nutrition Services with the U-M Cardiovascular Medicine program at Domino’s Farms and the U-M Cardiovascular Center. “But this is the first national study to show what happens when high-risk patients work with R.D.s to follow nutrition guidelines grounded in the best evidence.”

Key nutrition issues in the 1998 guidelines used in the study include reducing saturated and trans fat and increasing “healthy” fats such as olive oil; increasing soluble and insoluble fiber; eating fish twice a week; increasing fruits and vegetables; regular exercise and healthy weight management. Information about food-label reading and dining out was also included.

Called the Lipid Management Nutrition Outcomes Project or LMNOP, the national study was launched by Rhodes and her U-M colleagues Melvyn Rubenfire, M.D., and Martha Weintraub, MPH, R.D., after the successful completion of the Michigan-wide pilot project. Rubenfire, Weintraub and Christina Biesemeier, M.S., R.D., FADA, of Vanderbilt University are co-authors of the new study.

The study gives us an important “real world” picture of what happens when R.D.s try to implement evidence-based nutrition guidelines in daily practice, Rhodes notes.

Some commercial health insurance plans are beginning to cover appointments with registered dietitians, but many still do not. Only dietitian visits for diabetes or kidney disease are covered by Medicare. It is important for people to check their specific health insurance plan to see whether nutrition is covered, Rhodes says. But even if individuals need to pay for the appointments out of their own pocket, they may find that an R.D.’s advice will pay off in the long run, she says.

To get uniform data, the researchers brought lead R.D.s from each state to U-M for training on the cholesterol and nutrition guidelines, and on the data collection practices used in the study. R.D.s at Veterans Affairs hospitals got their training by phone conferencing. R.D.s then returned to their own practices, trained their colleagues and implemented the ADA guidelines.

The study included only patients between the ages of 25 and 70 years who had high cholesterol levels, or triglyceride levels over 200 mg/dL, and who met other inclusion criteria including no recent changes in their cholesterol medication status. Neither the R.D.s nor their patients were paid to participate in the study.

The “real world” aspect of this study included the disappointing finding that many patients dropped out of nutrition counseling after one or two visits, when three or four sessions with an R.D. is recommended to make and sustain truly effective changes in eating habits. Lack of insurance coverage was a major factor in this dropout rate.

Patients whose doctors changed their cholesterol medication status, either by starting them on a drug for the first time, or increasing their dose before assessing the effect of diet change, were not included in the analysis. But for the 219 patients who didn’t have any change in their medication status, the impact of the R.D. counseling became apparent in the first year after the initial visit.

“Although some patients may already be eating a relatively healthy diet, medical nutrition therapy can increase patient’s knowledge of ‘cardioprotective foods’ and assist them in individualizing the guidelines to fit their preferences and lifestyle,” says Weintraub. A significant number of patients reduced the fat in their diets to less than 30 percent of calories, as recommended for a heart health. Many participants also lost weight and/or increased the number of days each week on which they exercised for 30 minutes or more.

“Often, we see heart patients who are on multiple cholesterol medications but have never seen a dietitian. And even when a patient with high cholesterol does get to see an R.D., their care team may not allow enough time to see how effective diet is before they add additional treatment,” says Rhodes. “We hope that this demonstration of how well cholesterol can be lowered without medication or increases in medication will be very useful for patients and physicians, and perhaps insurers too.”

To learn more about how eating habits can influence cholesterol levels, or to find an R.D., visit the ADA’s web site at http://www.eatright.org. For more on U-M Cardiovascular Medicine and its nutrition services, visit http://www.med.umich.edu/cvc/prevention. Reference: JADA, Vol. 108, No. 2, Feb. 2008.

Posted by dlife at 11:14 AM | Comments (2)

Intensive insulin Therapy Protects Kidneys in Critically Ill Patients

January 30, 2008

Reductions in kidney injury and mortality risk question thinking on 'stress diabetes'

January 30, 2008 (EurekAlert) — For critically ill patients, intensive insulin therapy (IIT) to keep blood sugar (glucose) at normal levels reduces the risk of acute kidney injury, reports a study in the March Journal of the American Society of Nephrology.

The new research builds on previous randomized trials, including more than 2,700 patients, which reached the "startling" conclusion that IIT reduces the risk of death in critically ill patients, according to lead author Dr. Miet Schetz of University of Leuven, Belgium. In those studies, one group of patients received IIT, with insulin given continuously to maintain normal glucose levels. The other group received conventional insulin therapy, in which blood glucose levels are allowed to rise above normal.

Dr. Schetz and colleagues re-analyzed the trial data, focusing on differences in the rates of acute kidney injury (AKI) between the two treatment groups. Acute kidney injury is a common and serious complication among patients admitted to the intensive care unit (ICU). It occurs in five to 30 percent of patients, with death rates exceeding 40 percent.

The re-analysis showed that AKI developed in 4.5 percent of patients assigned to IIT, compared to 7.6 percent of those receiving conventional insulin therapy. The reduction in AKI was greatest when glucose levels remained within the normal range.

Intensive insulin therapy was more effective in protecting against AKI in patients admitted to the ICU after surgery (surgical ICU), compared to critically ill patients who did not undergo surgery (medical ICU). "This difference can be explained by the fact that IIT is a preventive strategy that cannot heal damage that is already present," explains Dr. Schetz. “The medical ICU patients were much sicker to begin with and may have already had kidney damage.”

For many years, the medical community has considered high blood sugar levels in critically ill patients—called "stress diabetes"—as a beneficial reaction of the body to ensure adequate energy supply to the organs during severe illness. The new research grew out of studies led by Dr. Greet Van den Berghe, exploring the hormonal changes induced by critical illness. Subsequent trials found that strict glucose control with IIT reduced the risk of death in both surgical and medical ICU patients. Rates of organ failure were also lower with IIT compared to conventional insulin therapy. (Dr. Van den Berghe is a co-author of the new study.)

The new analysis builds on these results by confirming that IIT reduces the risk of AKI in critically ill patients, especially after surgery. “This finding is especially important, because intensive insulin therapy is the first medical treatment that has been clearly shown to protect the kidney of critically ill patients," Dr. Schetz adds.

More research is needed to clarify how IIT acts to protect the kidneys—whether by preventing direct kidney damage caused by high blood sugar, or through indirect effects. Regardless of the mechanism, Dr. Schetz concludes, "Since AKI is associated with increased morbidity and mortality, the goal should be to prevent its development."

Posted by dlife at 04:43 PM | Comments (0)

Chronic Kidney Disease in the US Appears to be Increasing

November 07, 2007

November 7, 2007 (EurekAlert) - The estimated prevalence of chronic kidney disease among adults in the U.S. has increased to 13 percent, in part because of the increase in diabetes and hypertension, according to a study in the November 7 issue ofJAMA.

Chronic kidney disease (CKD) is now recognized as a common condition that elevates the risk of cardiovascular disease as well as kidney failure and other complications. The number of patients with kidney failure treated by dialysis and transplantation (the end-stage of CKD) has increased dramatically in the United States, as has the incidence of end-stage renal disease, according to background information in the article. “Estimation of the prevalence of earlier stages of CKD in the U.S. population and ascertainment of trends over time is central to disease management and prevention planning, particularly given the increase in the prevalence of obesity, diabetes, and hypertension, the leading risk factors for CKD,” the authors write. Whether there have been changes in the prevalence of earlier stages of CKD is uncertain.

Josef Coresh, M.D., Ph.D., of Johns Hopkins University, Baltimore, and colleagues compared the prevalence, stages and severity of CKD in National Health and Nutrition Examination Surveys (NHANES 1988-1994 [n = 15,488] and NHANES 1999-2004 [n = 13,233]), a nationally representative sample of adults age 20 years or older. Chronic kidney disease prevalence was determined based on persistent albuminuria (the presence of excessive protein in the urine) and decreased estimated glomerular filtration rate (GFR; a measurement of fluid filtered by the kidney).

The researchers found that the prevalence of both albuminuria and decreased GFR increased from 1988-1994 to 1999-2004. The prevalence of CKD stages 1 to 4 increased from 10.0 percent in 1988-1994 to 13.1 percent in 1999-2004. A higher prevalence of diagnosed diabetes and hypertension and higher body mass index explained the entire increase in prevalence of albuminuria but only part of the increase in the prevalence of decreased GFR. Change in average serum creatinine (a product of protein metabolism) accounted for some of the increased prevalence of CKD.

“In conclusion, survey data suggest that the prevalence of CKD in the United States is high and has increased between 1988-1994 and 1999-2004, from 10 percent to 13 percent, while awareness of kidney disease among the general public remains very low. The increasing prevalence of diagnosed diabetes and hypertension has contributed to this increase, which may propagate to higher rates of complications and kidney failure requiring dialysis or transplantation. Earlier stages accounted for most of the individuals with CKD. Because individuals with early stages of CKD have a higher risk of cardiovascular disease morbidity and mortality than their risk of progression to kidney failure, cardiovascular risk factor management in this group is critical. The high prevalence of CKD overall, and particularly among older individuals and persons with hypertension and diabetes, suggests that CKD needs to be a central part of future public health planning,” the authors write.

Posted by dlifenews at 04:12 PM | Comments (0)

Rare Diabetes Foot Complication Becoming More Common

October 25, 2007

October 25, 2007 (Newswise) — At first, Kim Schraeder didn’t worry about the swelling in her left foot.

After all, it was pulling double-duty while her other foot recovered from surgery.

“I have a high threshold for pain,” she says. “It hurt to walk on it, but I didn’t think it was serious.”

Just a year earlier, doctors diagnosed the 48-year-old mother of four with diabetes. The recent surgery on her right foot corrected a bunion to prevent reoccurring diabetic ulcers. As Schraeder’s bunion
recovery moved forward, her left foot moved outwards. Her ankle bent inwards. The foot grew so swollen none of her shoes fit. The skin was warm and red. Schraeder started to worry.

During a follow-up visit with her foot and ankle surgeon, she spoke up. Her doctor took one look and said, “We have a problem.”

Schraeder was diagnosed with a rare diabetic complication called Charcot foot. It is estimated to affect less than one percent of people with diabetes. Now doctors with the American College of Foot and Ankle Surgeons (ACFAS) say Charcot foot’s prevalence appears to be growing as more Americans get diabetes.
Some worry that few patients – or their diabetes care providers – seem to know about this complication or its warning signs.

Charcot foot is a sudden softening of the foot’s bones caused by severe neuropathy, or nerve damage, a common diabetic foot complication. It can trigger an avalanche of problems, including joint loss, fractures, collapse of the arch, massive deformity, ulcers, amputation, and even death. As the disorder progresses, the bottom of the foot can become convex, bulging like the hull of a ship. Since most people with Charcot cannot feel pain in their lower extremities, they continue walking on the foot, causing further injury.

Charcot cannot be reversed, but its destructive effects can be stopped if the complication is detected early.

The symptoms of Charcot foot appear suddenly. They include warm and red skin, swelling and pain. A person with diabetes who has a red, hot, swollen foot or ankle requires emergency medical care because these can also be symptoms of deep vein thrombosis or an infection.

Doctors say Charcot’s ambiguous symptoms can lead to misdiagnosis. Since patients don’t feel pain, doctors may presume the swelling is due to infection and prescribe antibiotics. Meanwhile the patient continues walking on a foot that is collapsing.

“More people with diabetes, their families and their care providers need to know about Charcot foot,” says J. T. Marcoux. DPM, FACFAS, one of only a handful of Massachusetts foot and ankle surgeons who performs Charcot foot reconstructions. “When I diagnose a patient with this complication, I telephone their primary care doctor and educate them about it as well.”

Schraeder says no one told her about Charcot. “It was not even in my vocabulary,” she says. “If someone had educated me, I think I would have been more aware that I had a major problem.”

But educating patients and their care providers is only half the battle. Keith Jacobson, DPM, FACFAS is the Houston foot and ankle surgeon who diagnosed and reconstructed Schraeder’s Charcot foot. He and Marcoux say there’s little they can do when patients are apathetic or in “diabetic denial.”

“I’ve had patients who are literally blind, on dialysis and neuropathic who refuse to admit they have diabetes,” says Jacobson. “I have seen horrific deformities with this condition.”

Marcoux tells of a middle-aged woman he diagnosed with Charcot. Typically the first order of business is to immobilize the foot by putting the patient in a boot or cast, and to keep the patient off the foot by using crutches or a wheelchair. Marcoux says his patient was “in massive denial” about her Charcot diagnosis.

“I tried to get her off the foot, but she wouldn’t do it” he says, “Six months later she came in with a bone infection and a gaping hole in her foot.”

Foot and ankle surgeons expect to see more patients like that as diabetes rates soar.

Today, Schraeder is back to walking on both feet. Three months after her Charcot diagnosis, she underwent reconstructive surgery. Her recovery included spending three months in a “halo” external fixator where a series of pins and screws are placed into the bones and connected to clamps and rods outside the skin. She then wore a custom shoe boot for nearly a year.

The experience taught her four children to appreciate their mother a lot more, since all the cooking, cleaning, and laundry fell on their shoulders.

“They’re all like hawks now,” she says. “If I’m sitting here with bare feet, they’ll look to make sure they’re not red, hot and swollen.”

Posted by dlifenews at 11:08 AM | Comments (2)

For Some Diabetics, Burden of Care Rivals Complications of Disease

September 28, 2007

September 28, 2007 (University of Chicago) - Many patients with diabetes say that the inconvenience and discomfort of constant therapeutic vigilance, particularly multiple daily insulin injections, has as much impact on their quality of life as the burden of intermediate complications, researchers from the University of Chicago report in the October 2007, issue of Diabetes Care.

A typical diabetes patient takes many medications each day, including two or three different pills to control blood sugar levels, one or two to lower cholesterol, two or more to reduce blood pressure, a daily aspirin to prevent blood clots, plus diet and exercise. As the disease progresses, the drugs increase, often including insulin shots.

"The people who care for patients with a chronic disease like diabetes think about that disease and about preventing long-term complications," said study author Elbert Huang, MD, assistant professor of medicine at the University of Chicago. "The people who have a chronic disease think about their immediate lives, which includes the day-to-day costs and inconvenience of a multi-drug regimen. The consequences are often poor compliance, which means long-term complications, which will then require more medications."

Despite growing reliance on such complex multi-drug regimens, large proportions of patients with type-2 diabetes continue to have poorly controlled glucose (20%), blood pressure (33%) and cholesterol (40%).

"This tells us that we need to find better, more convenient ways to treat chronic illness," Huang said. "It is hard to convince some patients to invest their time and effort now in rigorous adherence to a complex regimen with no immediate reward, just the promise of better health years from now," Huang said.

"This certainly rings true to me," agreed diabetes specialist Louis Philipson, MD, PhD, professor of medicine at the University of Chicago, who was not part of the research team. "Some patients, if you judge by their behavior, would rather be well on the road to future blindness, kidney failure or amputations then work hard now at their diabetes."

Huang and colleagues conducted hour-long face-to-face interviews with a multiethnic sample of 701 adult, type-2 diabetes patients attending Chicago area clinics between May 2004 and May 2006. They asked patients to rank the benefits of various treatments and the daily quality-of-life burdens of diabetes-associated complications.

Patients were asked to express their preferences in a series of trade-offs. The surveyors asked, for example: would you rather have six years of life in perfect health, or ten years with an amputation?

As expected, patients were most distressed by end-stage complications, especially kidney failure, a major stroke or blindness. They were slightly less concerned about amputations or diabetic retina damage, and still less about angina, diabetic nerve or kidney damage.

Patients also disliked intensive treatments, especially intensive glucose control, with multiple daily insulin injections, and what the authors called comprehensive diabetes care, which was intensive glucose control plus other medications.

On average, patients ranked the burden of comprehensive diabetes care and intensive glucose control as equal to the burden of angina, diabetic nerve damage or kidney damage.

Patients varied widely in how they ranked treatments and complications. Those who had experience with a specific medication or complication saw them as having less of an impact on quality of life than those without such direct experience.

But many patients found both complications and treatment onerous. Between 12 and 50 percent were willing to give up 8 of 10 years of life in perfect health to avoid life with complications. More surprising, between 10 and 18 percent of patients were willing to give up 8 of 10 years of healthy life to avoid life with treatments.

The existing burden of treatment may even increase when results from the ongoing ACCORD trial are announced in 2010, said Huang. "This trial may produce evidence for even greater use of medications to try to prevent complications," he said

"Our study results show that taking multiple medications on a routine basis represents a significant burden for many patients," the authors conclude. "Quality of life related to treatments will be likely to improve if we can simplify or modify current treatments through treatment innovations."

Until specialists find ways to do that, Philipson added, "physicians need to be able to spend more time with patients." This includes finding ways to bill appropriately for phone- and web-based interactions. "We also need more ancillary services like psychiatric social workers and diabetes educators to meet with patients," he added. "That could save the health care system a ton of money, even without developing new drugs or treatments. But we have to do that as well."

The Centers for Disease Control and Prevention, the National Institute of Aging, the National Institute of Diabetes and Digestive and Kidney Disease, and the Chicago Center of Excellence in Health Promotion Economics funded the research. Additional authors were Sydney Brown, Bernard Ewigman, Edward Foley and David Meltzer of the University of Chicago.

Posted by dlifenews at 02:23 PM | Comments (0)

New Research Shows Inadequate Blood Sugar Testing Leaves Millions of People with Type 2 Diabetes at Risk of Life-Threatening Complications

September 18, 2007

September 18, 2007 (Press Release) - A global survey of healthcare professionals (HCPs) and patients presented today at the European Association for the Study of Diabetes (EASD) in Amsterdam, the Netherlands, demonstrates suboptimal use of HbA1c testing in clinical practice in a wide range of countries, leaving millions of people in poor control of their type 2 diabetes and at risk of long-term complications.

The survey, which was conducted by a Global Task Force (GTF) on Glycaemic Control, a panel of 15 global experts in diabetes and endocrinology, in association with Novo Nordisk, questioned nearly 1,400 HCPs and over 1,000 patients in eight countries (UK, Poland, Turkey, Canada, Russia, Sweden, India and China). It aimed to evaluate their awareness, attitudes and behaviours towards the management of type 2 diabetes, and to identify key barriers to good glycaemic control. The survey specifically investigated awareness and use of the HbA1c test, which is the only method of measuring long-term blood sugar levels (also referred to as glycosylated haemoglobin), and results demonstrate a clear gap between guideline recommendations on glucose monitoring and clinical reality.

“Achieving good glycaemic control is vital for people with type 2 diabetes, but this new survey shows that patient awareness and understanding of HbA1c testing is limited, and its value in the wider management of the condition is underestimated by HCPs,” commented Dr Kerstin Berntorp, member of the GTF on Glycaemic Control, Department of Endocrinology, Malmö University Hospital, Sweden. “Each 1% reduction in HbA1c decreases the risk of damage to the retina, kidneys and nerve function by 37%, and the risk of diabetes-related death by 20%. These figures demonstrate the importance of controlling blood glucose levels and they should not be overlooked.”

Despite the fact that the HbA1c test is recognised as part of a series of tests needed for optimal treatment of type 2 diabetes, and current guidelines from the International Diabetes Federation (IDF) recommend that testing takes place every two to six months if clinicians are to effectively relate individual blood glucose control to risk of complication development,1,2 the survey shows that it is used far too infrequently.

Furthermore, communication about the importance of the test is inadequate, and patient awareness and understanding of HbA1c is low. These factors are likely to contribute greatly to the suboptimal glycaemic control observed in many countries3–7, including those that participated in the survey. In addition, short and infrequent consultations often due to stretched healthcare systems, as well as treatment adherence issues with regard to complex regimens and negative preconceptions about insulin among patients, were identified as key barriers to improving glycaemic control.

“This new data is very important for the future management of type 2 diabetes,” said Professor Eric Kilpatrick, chairman of the GTF on Glycaemic Control, Hull Royal Infirmary, UK. “Not only is the problem of poor glycaemic control very real in most countries, and becoming a major medical and economic challenge worldwide, it is linked to issues that we can change. Many patients with diabetes are not achieving the HbA1c level of 6.5%, the target level recommended by the IDF if the risk of developing complications is to be minimised. The GTF is working to identify practical solutions that will motivate and enable physicians and their patients to test HbA1c more regularly. We believe that education is key, and are currently developing management recommendations, and will be working to implement these with full guidance for clinical practice in 2008.”

Further information:
Katrine Sperling
+45 3079 6718
krsp@novonordisk.com

Posted by dlifenews at 03:35 PM | Comments (0)

Metabolic Syndrome Heightens Risk for Development of Uric-Acid Kidney Stones

September 13, 2007

September 13, 2007 (Newswise) — Researchers at UT Southwestern Medical Center have found that patients suffering from the metabolic syndrome – a cluster of conditions that increases the risk for heart disease, stroke and diabetes – also have a propensity to develop highly acidic urine, which increases the risk of developing kidney stones.

The first study, to demonstrate this relationship independent of age and renal function, appears in the September issue of the Clinical Journal of the American Society of Nephrology.

The metabolic syndrome is characterized by a group of risk factors that include obesity, high blood pressure, diabetes and high cholesterol. The American Heart Association estimates that more than 50 million Americans suffer from the syndrome.

“Our findings suggest that the presence of an increasing number of metabolic syndrome features augments the propensity for uric-acid stone formation,” said Dr. Naim Maalouf, assistant professor of internal medicine and the study’s lead author.

In previous studies, UT Southwestern researchers have found that people who were overweight or suffered from diabetes had highly acidic urine, which often leads to the development of uric-acid kidney stones.

The current findings indicate that people with the other components leading to the metabolic syndrome also have highly acidic urine.

“The association of highly acidic urine with elevated levels of systolic blood pressure, serum glucose, triglycerides and lower levels of high-density lipoprotein cholesterol – all features of the metabolic syndrome – has not been previously reported,” Dr. Maalouf said.

In the study, researchers recorded the height, weight and blood pressure of 148 participants who had never developed kidney stones. They also gathered blood and urine samples and tested the blood for features of the metabolic syndrome.

They found that participants with the metabolic syndrome had highly acidic urine, compared to participants without the syndrome, and the correlation was independent of factors already known to influence urine acidity such as age, gender and body weight.

“This is the first time it has been shown that acidic urine, a major cause of uric-acid stone disease, is a part of the metabolic syndrome,” said Dr. Khashayar Sakhaee, chief of mineral metabolism at UT Southwestern and senior author of the study. “We also found that the relationship is not driven by body mass alone.”

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

Other UT Southwestern researchers contributing to the study were Dr. Orson Moe, director of the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, and Beverley Adams-Huet, assistant professor of clinical sciences.
The research was supported by the National Institutes of Health and the National Kidney Foundation.

Posted by dlifenews at 03:31 PM | Comments (0)

School-Based Overweight Prevention Program May Cut Risk of Eating Disorders Among Girls

September 03, 2007

September 3, 2007 (EurekAlert) - -- Eating disorders among adolescent girls and boys can have substantial negative impact on their health and lead to dangerous weight-control behaviors, such as self-induced vomiting or abusing laxatives or diet pills to control weight. The middle school age is a high risk time, especially for girls starting to engage in these dangerous weight-control behaviors that affect millions of Americans. Researchers at the Harvard School of Public Health (HSPH) set out to determine if an obesity prevention program called 5-2-1-Go! could reduce the risk of eating disorder symptoms and harmful weight-control behaviors in adolescents. The study showed that almost 4% of middle-school girls receiving only their regular health education began vomiting or abusing laxatives or diet pills, but just 1% of the girls in the 5-2-1-Go! program did so. The results showed no effect of the program on middle-school boys. The study appears in the September 2007 issue of Archives of Pediatrics & Adolescent Medicine.

“We are very encouraged by the results,” said S. Bryn Austin, assistant professor at HSPH and a researcher at Children’s Hospital in Boston. “We are hopeful that carefully designed health promotion programs like this one may help us prevent both eating disorders and overweight at the same time. The protective effect that we found was strong and held up under two rigorously designed studies,” she said. The 5-2-1-Go! program (eat 5 servings of fruits and vegetables daily, limit screen time to no more than 2 hours a day, and get at least 1 hour of physical activity daily) includes the Planet Health curriculum, which was developed by HSPH researchers. It emphasizes eating a balanced diet, staying physically active and reducing the amount of time spent watching television. A previous study of the Planet Health curriculum had shown a protective effect on disordered weight-control behaviors in girls. The researchers wanted to see if that beneficial effect could be repeated in a larger study among a different group of schools.

The randomized, controlled study took place in 13 middle schools in Massachusetts between 2002 and 2004 and involved 1,451 sixth- and seventh-graders (749 girls, 702 boys). Six schools utilized the 5-2-1-Go! curriculum and seven utilized just their regular health education. The results showed a two-thirds reduction in risk of adopting disordered weight control behaviors among girls in the 5-2-1-Go! program.

The results suggest that it may be possible for school-based programs to help prevent obesity and eating disorder symptoms in adolescent girls. “Unhealthy weight loss behaviors and overweight are taking an enormous toll on the health of young people today,” said senior author Karen E. Peterson, director of the Program in Public Health Nutrition at HSPH and an associate professor at the School. “These problems may be linked in a number of ways, and the solutions are likely to be too. Approaches that foster healthy weights by changing lifestyles of youth in schools seem to be very promising.”

The authors note that further studies are needed to tackle the question of how other obesity prevention programs are affecting eating disorder symptoms in young people. “We found that our obesity prevention program was safe, that is, it did not worsen eating disorder symptoms and even protected against the development of eating disorder symptoms among girls,” said Austin. “The team of scientists and educators that created the program was also very careful not to single out or stigmatize overweight kids. Those involved with other obesity prevention programs in schools and communities around the country should look at the effects of those programs on eating disorder symptoms and weight-related bullying to make sure they’re safe for the children.”

Posted by dlifenews at 02:19 PM | Comments (0)

Gender, Coupled with Diabetes, Affects Vascular Disease Development

August 16, 2007

August 16, 2007 (EurekAlert) - Diabetes is associated with the development of vascular (blood vessel) disease. As we age, vascular disease becomes more common. It has been thought that females may be more susceptible to the earlier development of vascular disease, as vascular changes are observed in females long before any significant development occurs in males. Now, a team of Georgetown University researchers has determined that the vascular activities in diabetic animals vary according to sex. This discovery may eventually have implications for the way males and females are treated medically in the future.

The Study

The study, entitled "Sex Differences in Response to Vasoactive Substances in Early Uncontrolled Diabetes," was conducted by Adam Mitchell, Adam Myers and Susan Mulroney, all of the Department of Physiology and Biophysics, Georgetown University, Washington, DC. Mr. Mitchell presented the status of the team¡¦s findings at the conference, Sex and Gender in Cardiovascular-Renal Physiology and Pathophysiology. The meeting, sponsored by the American Physiological Society (APS; www.The-APS.org), was held August 9-12, 2007 in Austin, TX.

The Study

The researchers examined the notion that very early changes in artery activity exists in diabetic animals and differ by sex. To test their hypothesis they divided adult male and female rats into three groups. The first group (control) received no treatment. The second group received streptozotocin (STZ) to induce diabetes. The third group received STZ plus growth hormone (GH), which is thought to exacerbate disease progression in diabetes.

After eight weeks, the vascular reactivity to phenylephrine, which increases blood pressure, and acetylcholine, which reduces blood pressure, was measured in the vessels from the animals. Vascular response to these substances was also observed during exposure to L-NAME (which blocks production of nitric oxide, a potent artery relaxer) and neuropeptide Y (which augments the restriction of blood vessels).

The investigators found that:

• in the early stage of the disease, both male and female diabetics experienced significant decreases in the reactivity (i.e., how responsive the vessel is to a drug) of their blood vessels when exposed to acetylcholine. This occurred independent of the GH injections.

• while female diabetic rats had an increased response to phenylephrine, there was no such change among their male counterparts.

• female controls had a larger change in phenyleprine reactivity in the presence of L-NAME than did diabetic females, indicating that the diabetic females had a reduced level of nitric oxide, which dilates the artery and increases blood flow.

• diabetic males had the opposite reaction of diabetic females when exposed to phenylephrine and L-NAME. The diabetic males also produced more nitric oxide than did their controls.

• all diabetic rats exposed to growth hormone showed an increase in nitric oxide, regardless of gender.

Conclusions

The findings support the researchers¡¦ hypothesis of the existence of sex-related changes in vascular activity in diabetic animals. While the production of NO is significantly altered in the diabetic rats, the results show that gender and the presence of GH greatly contribute to this vascular dysfunction. According to Mitchell, "These findings show the importance of sex differences to understanding development of vascular problems early in diabetes and has implications on potential sex-specific therapeutic intervention."

Posted by dlifenews at 08:41 AM | Comments (0)

Diabetes Appears to Increase Risk of Death for Patients With Acute Coronary Syndromes

August 14, 2007

August 14, 2007 (JAMA) – Individuals with diabetes and acute coronary syndromes (ACS) such as a heart attack or unstable angina have an increased risk of death at 30 days and one year after ACS, compared with ACS patients without diabetes, according to a study in the August 15 issue of JAMA.

“The presence of elevated blood glucose levels, diabetes mellitus, or both contributes to more than 3 million cardiovascular deaths worldwide each year. With the increase in obesity, insulin resistance, and the metabolic syndrome, the worldwide prevalence of diabetes is expected to double by the year 2030,” the authors write. They add that more than 1.5 million adults in the U.S. were newly diagnosed with diabetes in 2005, and nearly 65 percent of individuals with diabetes die from cardiovascular disease in the U.S., establishing it as the leading cause of death among this growing segment of the population. The effect of diabetes on the risk of death following ACS is uncertain.

Sean M. Donahoe, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues evaluated the independent effect of diabetes on risk of death following ACS at 30 days and 1 year using a large clinical trial database that included ACS. The study consisted of an analysis of patients with diabetes enrolled in randomized controlled trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997 to 2006 were pooled, including 62,036 patients (46,577 with ST-segment elevation myocardial infarction [STEMI; a certain pattern on an electrocardiogram following a heart attack] and 15,459 with unstable angina/non–STEMI [UA/NSTEMI]), of whom 10,613 (17.1 percent) had diabetes.

The researchers found that the rate of death was significantly higher among patients with diabetes than among patients without diabetes at 30 days following either UA/NSTEMI (2.1 percent vs. 1.1 percent) or STEMI (8.5 percent vs. 5.4 percent). After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with a nearly 80 percent increased risk of death at 30-days after UA/NSTEMI, and 40 percent increased risk of death at 30-days after STEMI.

At 1 year, diabetes remained a significant independent factor associated with all-cause death for patients presenting with UA/NSTEMI (65 percent increased risk of death) or STEMI (22 percent increased risk of death). By 1 year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI (7.2 percent vs. 8.1 percent).

“Despite modern therapies for ACS, diabetes conferred a significant independent excess mortality risk at 30 days and 1 year following ACS. Current strategies are insufficient to ameliorate the adverse impact of diabetes. Given the increasing burden of cardiovascular disease attributable to diabetes worldwide, our study highlights the need for a major research effort to identify aggressive new strategies to manage unstable ischemic heart disease among this high-risk population,” the authors conclude.
(JAMA. 2007;298(7):765-775. Available pre-embargo to the media at www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Posted by dlifenews at 09:40 AM | Comments (0)

Diabetics Experience More Complications Following Trauma

July 17, 2007

July 17, 2007 (EurekAlert) - Individuals with diabetes appear to spend more days in the intensive care unit, use more ventilator support and have more complications during hospitalization for trauma than non-diabetics, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.

Approximately 17 million Americans have diabetes, with one-third remaining undiagnosed, according to background information in the article. These patients develop complications more frequently and do worse after an acute illness than individuals without diabetes. Studies show that diabetics do worse after being hospitalized for stroke, heart attack and heart surgery, but little is known about their outcomes after trauma.

Rehan Ahmad, D.O., and colleagues at the Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Penn., used a statewide database to identify 12,489 patients with diabetes who were hospitalized at 27 trauma centers between 1984 and 2002. They then selected an additional 12,489 patients who were the same age and sex and had the same severity of injury but did not have diabetes for comparison.

There was no difference between the two groups in death rates or length of hospital stay. However, compared with patients who did not have diabetes, patients with diabetes:

• were more likely to experience any complication (23 percent vs. 14 percent)
• were more likely to require care in the intensive care unit (ICU) (38.4 percent vs. 35.9 percent)
• stayed in the ICU longer on average (7.6 days vs. 6.1 days)
• required longer duration of ventilator support (10.8 days vs. 8.4 days)
• developed more infections (11.3 percent vs. 6.3 percent)

“Patients with diabetes mellitus were less likely to be discharged to home and were more likely to require skilled nursing care after discharge compared with patients who did not have diabetes mellitus,” the authors write. “This may have accounted for the similarity in overall hospital length of stay between the diabetes mellitus and non–diabetes mellitus groups. In addition, improved diabetes mellitus treatment modalities and advances in critical care and trauma resuscitation likely contributed to comparable mortality rates between the two groups, despite the greater morbidity associated with having diabetes mellitus.”

Previous studies have demonstrated that diabetes reduces the effectiveness of some components of the immune system, the authors continue. “Results from this study confirm that patients with diabetes mellitus are at higher risk for developing an infectious complication, despite matching for sex, age and the severity of injury,” they conclude. “They also require a higher level of care, which adds to the cost of hospitalization. Future studies are needed to evaluate the effect of improved glycemic control on hospitalized patients with diabetes mellitus involved in trauma.”

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

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

May 24, 2007

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)

Sleep Apnea May Increase Risk of Diabetes

May 22, 2007

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.”

Posted by dlifenews at 11:50 AM | Comments (0)

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

May 15, 2007

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)

Diabetes and Heart Failure Is Double Trouble for Older Women

May 11, 2007

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)

Diabetes, Depression Together Increase Risk for Heart Patients

March 10, 2007

March 9, 2007 (EurekAlert) -- Having both depression and type 2 diabetes increases the risk of death for heart patients. Each factor had been known to increase the risk of heart disease deaths by itself, but together they’re even more deadly.

In an analysis of more than 900 patients with established coronary artery disease, Duke University Medical Center psychologists found that those with both type 2 diabetes and symptoms of depression were more likely to die than heart patients without those conditions.

The study showed that among type 2 diabetes patients, having high depression scores increased the risk of dying by 20 to 30 percent compared to patients with similar depression scores but no type 2 diabetes.

"We found a trend showing that the probability of death increases as the level of depression increases in diabetic patients with coronary artery disease," said Duke researcher Anastasia Georgiades, Ph.D. She presented the results of the Duke analysis on Friday, March 9, 2007, at the annual meeting of the American Psychosomatic Society, in Budapest, Hungary. "Our data appear to show an important interaction between type 2 diabetes and depression, meaning that physicians should closely monitor their heart patients who have both of these disorders.

"There is some sort of synergistic effect between type 2 diabetes and depression that we don’t fully understand," Georgiades said. "In our analysis, we controlled for factors that could influence mortality, such as heart disease severity and age. For whatever reasons, these patients were still at higher risk of dying, and future research will aim to investigate the mechanisms for this association."

The research was supported by the National Heart, Lung, Blood Institute.

The researchers followed 933 heart patients for more than four years and correlated the 135 deaths that occurred during that period with the presence of type 2 diabetes and depression alone and together.

Georgiades said there are some possible explanations for the link between depression and diabetes.

"Patients with type 2 diabetes typically have an extensive self-care regimen involving special diet, medications, exercise and numerous appointments with their doctor," she said. "It may be that such patients who are depressed might not be as motivated to carry out all these activities, thereby putting them at higher risk."

Depression has also been linked to other cardiovascular risk factors such as insulin resistance, hypertension, obesity, increased cigarette smoking, alcohol abuse and physical inactivity.

Posted by dlife at 02:50 PM | Comments (1)

Even 'High Normal' Glucose Levels May Increase the Risk of Hospitalization for Heart Failure

March 06, 2007

March 6, 2007 (EurekAlert) - Fasting glucose levels may independently predict the risk of being hospitalized with congestive heart failure in heart attack survivors and others who are at high risk of developing the disorder, researchers reported in Circulation: Journal of the American Heart Association.

Drawing on data from 31,546 high-risk patients participating in two international trials, researchers found that even small increases in fasting glucose raised the risk of congestive heart failure in both diabetes patients and those whose blood sugar fell within the normal range.

"This illustrates that blood glucose by itself is a continuous risk factor for developing heart failure because all of these patients were free of heart failure when they enrolled in the trials," said Claes Held, M.D., Ph.D., lead author of the study.

"However, these are only associations," said Held, an associate professor of cardiology at the Karolinska Institutet in Stockholm, Sweden. "They do not prove that elevated blood glucose causes heart failure. To demonstrate a causal relationship, you would have to do a study that showed lowering blood glucose levels would reduce the incidence of heart failure."

About 5.2 million Americans evenly divided between males and females suffer from heart failure, according to the American Heart Association. Each year about 550,000 new cases are diagnosed and about 57,700 people die from it. Heart failure is a debilitating condition in which the heart fails to pump an adequate supply of blood throughout the body. Established heart failure risks include uncontrolled high blood pressure, diabetes and heart attack.

To examine the relationship between blood glucose levels and congestive heart failure, Held and colleagues performed an interim analysis on the blinded data from the ONgoing Telmisartan Alone and in combination with the Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (TRANSCEND) trials. Both were randomized, controlled, parallel clinical studies testing drug regimens aimed at reducing fatal and nonfatal cardiovascular events. ONTARGET had 25,620 patients enrolled and TRANSCEND had 5,926, and both included patients with and without diabetes. Researchers obtained fasting blood glucose levels for patients when they entered the trials and periodically thereafter.

"We know that diabetes is a strong risk factor for cardiovascular disease including heart failure, but these studies included patients with and without diabetes," Held said. "This was a great opportunity to evaluate a broad population of high-risk individuals and study the association between blood glucose and cardiovascular disease, regardless of the diabetic state."

Patients in the two trials were average age 67 at entry, and 69 percent were men. Thirty-seven percent had been previously diagnosed with diabetes and 3.2 percent were diagnosed with the disease at the time of entry.

Patients were assigned to five groups based on their entry fasting blood glucose levels, measured in millimoles per liter of blood, or mmol/L. The lowest group had an average fasting blood glucose of 4.6 mmol/L and the highest had an average reading of 8.5 mmol/L.

The mmol/L is the international standard unit for measuring blood glucose. In the United States, blood glucose levels are usually reported in milligrams per deciliter, mg/dL. Multiplying the number of mmol/L by 18 converts the number to mg/dl.

Researchers analyzed data from patients with an average follow-up of 2.4 years. During this time there were:

• 1,067 cardiovascular deaths
• 926 heart attacks
• 823 strokes
• 668 hospitalizations for congestive heart failure

When the researchers examined fasting blood glucose levels alone as a risk factor by adjusting for other known risk factors, they found that, for all patients, an increase of 1 mmol/L above a patient's entry glucose level increased the risk of hospitalization for congestive heart failure by 5 percent.

Similarly, a 1 mmol/L rise increased the risk of congestive heart failure hospitalization or cardiovascular death by 9 percent for all patients, by 3 percent for patients without diabetes and by 5 percent for patients with diabetes.

"Even in the normal range, our results indicate that elevated blood glucose is associated with the risk of heart failure," Held said. "You can look at blood glucose much like blood pressure or cholesterol. Even if you have normal blood glucose, there is a gradual increase in risk wherever you start on the scale. If the blood sugar is "high normal" there is a higher risk than those with "low normal fasting blood glucose levels."

He and colleagues suggested several potential mechanisms for rising glucose levels which increase the risk of developing congestive heart failure.

"Individuals with disturbances in their glucose regulation usually have more coronary artery disease, which is a well known underlying risk factor for heart failure," Held said. "That is a strong explanation for our findings but the others are more speculative and hypothetical."

Posted by dlife at 01:40 PM | Comments (2)

Joslin Researchers Discover a Surprising Culprit in the Search for Causes of Diabetic Birth Defects

March 05, 2007

Protein Makes It Possible for High Blood Glucose to Enter Embryonic Cells

March 5, 2007 (EurekAlert) - Over the past several years, Joslin Investigator Mary R. Loeken, Ph.D., and her colleagues at Joslin Diabetes Center have unlocked several mysteries behind what puts women with diabetes more at risk of having a child with birth defects. Even though those risks have decreased significantly over the years, thanks in part to advancements at Joslin, women with diabetes still are two to five times more likely than the general population to have a baby with birth defects, especially of the heart and spinal cord, organs that form within the first few weeks of pregnancy.

In past work, Dr. Loeken and her research team were able to establish through their studies in mice that the mother's high blood glucose levels are the cause of these defects. This is one of the reasons why women with diabetes who are planning a pregnancy are encouraged to have their blood glucose levels under good control prior to conception. The Joslin researchers also have shown that the damage occurs because the extra glucose in the mother's blood inhibits the expression of embryonic genes that control essential developmental processes.

Now, in this latest study done in mice, Dr. Loeken and her colleagues have discovered that the protein called glucose transporter 2 (Glut2) makes it possible for the high concentrations of glucose to get into the embryonic cells efficiently when the mother's blood glucose concentrations are high. Also involved in the study was Rulin Li, Ph.D., a former postdoctoral fellow at Joslin. The study, supported by the National Institutes of Health, will appear in the March print edition of Diabetologia and was published online by the journal on Jan. 18.

"Glut2 is a gene that we wouldn't have expected to be switched on in early embryonic development," said Dr. Loeken, Investigator in the Section on Developmental and Stem Cell Biology and Associate Professor of Medicine at Harvard Medical School. "Yet our research in mice shows that the expression of this gene in the early embryo enables the cells to absorb glucose about two to three times faster when the mother's glucose levels are elevated, while other glucose transporters would be saturated at normal glucose concentrations. This makes the embryo very susceptible to the malformations that high glucose levels cause, such as neural tube defects."

Researchers so far have identified 14 different glucose transporters, a class of proteins that sit on the membranes of cells and enable the cells to absorb glucose. Each type plays a different role in glucose uptake and is found in different cell types. "We knew that the embryo expresses a variety of glucose transporters that bring necessary glucose into the developing cells," said Dr. Loeken, "but what caught my eye was that one of them was Glut2." This protein, Dr. Loeken explained, is what is known as a high-Km glucose transporter, that is, it works efficiently only when glucose levels are high. Low-Km glucose transporters, on the other hand, become saturated at these higher levels and no longer work efficiently to get glucose into the cells.

Low Km transporters can be thought of like a narrow doorway into a room that will only allow one person to pass at a time, whereas a high Km transporter is like a wide-open door that will allow several people to pass at a time, explained Dr. Loeken. When very few people need to get through the doors at a time, the narrow doors will work just as well as the wide-open doors, but if a crowd needs to get through the doors, the narrow doors will be saturated, the wide open doors will allow the people to go through at a high rate, and the concentration of people in the room will be very high.

"After birth, the Glut2 transporter is expressed on insulin-producing beta cells of the pancreas and in the liver, the tissues that receive blood carrying high concentrations of glucose absorbed from the intestine after a meal," said Dr. Loeken. "It makes sense that Glut2 would be expressed in the pancreas where the high glucose level signals the beta cells to release insulin, and in the liver, where it signals the liver to store the glucose. In a normal pregnancy, the glucose in the mother's blood that circulates to the uterus would never be as high as the blood that flows by the pancreas and the liver, and the embryo would not be exposed to high concentrations of glucose. Therefore, Glut2 won't work any better than the other glucose transporters to absorb glucose. But glucose concentrations can be very high during a diabetic pregnancy, and if this highly efficient glucose transport is functioning, the embryo cells act like a glucose sponge, absorbing glucose at a much higher rate than normal."

Using mice that lacked Glut2 genes, which were developed by one of the study's co-authors, Bernard Thorens, Ph.D., of the Center for Integrated Genomics at the University of Lausanne in Switzerland, Joslin researchers found that only embryos carrying normal Glut2 genes developed malformations when the mothers were diabetic, whereas embryos that lacked Glut2 genes were protected from malformations during diabetic pregnancy. "This shows that the high-transport Glut2 transporter was responsible for getting higher concentrations of glucose in the cell and causing the malformations." The embryos were examined on the 10th day of gestation. The time span in the mice, Dr. Loeken explained, is comparable to about the fourth or fifth weeks of a human pregnancy, which is about the time a woman may discover that she is pregnant.

The Joslin researchers were also surprised to find that there were fewer embryos recovered on day 10 of gestation if they lacked the Glut2 genes, whether or not the mothers were diabetic, suggesting that there is a survival advantage in having the Glut2 transporter. "Recent research by our collaborator, Dr. Thorens, has shown that Glut2 is also a transporter for glucosamine, an amino sugar that serves important functions in the synthesis of proteins," said Dr. Loeken. "Since glucosamine is synthesized in the liver, which the early embryo still lacks, it must get it from its mother's circulation. Although we don't know for sure, Glut2 could be needed by the embryo for glucosamine transport."

Putting these findings together, Dr. Loeken said, "The early embryo must express Glut2 for some reason, because fewer embryos survived early development if they lacked this transporter. Perhaps it is because it is needed to transport glucosamine. However, because this transporter, which works so well after birth to allow the pancreas to produce insulin and the liver to store glucose, also makes the early embryo take up glucose very efficiently when glucose concentrations are high, as can occur during diabetic pregnancy, this explains why the embryo is so sensitive to the mother's hyperglycemia.

"While it is too early yet to give any clinical recommendations to patients based on these new findings, the research does suggest that once the glucose reaches the concentration where the Glut2 transporter functions efficiently, that is probably sufficient to cause malformations," said Dr. Loeken. "The best we can do now to prevent malformations in diabetic pregnancy is to help a woman establish good blood glucose control before she becomes pregnant, so that she will be better able make sure her glucose levels are as close to normal during pregnancy," she added.

Posted by dlife at 01:51 PM | Comments (0)

Joslin Study Finds Increased Use of Insulin Pumps, New Insulin Types Give Teens More Tools to Better Manage Diabetes

February 27, 2007

Feb. 27, 2007 (Joslin) - It is widely recognized that the teenage years are often a challenging time for youth with diabetes to maintain good blood glucose control. Hormonal changes, peer pressure, food temptations, and resistance to following good health practices are among the factors that make it difficult for many youngsters. Unfortunately, poor diabetes control places youth at increased risk of developing complications from diabetes later in life.

The landmark Diabetes Control and Complications Trial, which ended in 1993, confirmed the long-held belief of Joslin's founder, Elliott P. Joslin, M.D., that good blood glucose control is necessary to help stave off diabetes-related complications, such as heart disease, blindness and nerve damage. Among the 1,441 people evaluated in the DCCT, about 200 were adolescents. It was not surprising that this small group generally had higher blood glucose levels than the adults.

Now a new study led by Lori Laffel, M.D., M.P.H., and her colleagues in Joslin Diabetes Center's Pediatric, Adolescent and Young Adult Section reveals some good news for youngsters with type 1 diabetes. The study found that adolescents are doing a better job controlling their blood glucose levels than they were previously, thanks in part to tools like insulin pumps and insulin analogs that have become available in recent years. The study appears in the March edition of the Journal of Pediatrics.

"The good news is that we have shown that teens are able to better control diabetes than they were in the DCCT study," said Dr. Laffel, Chief of Joslin Pediatrics, Investigator in the Genetics and Epidemiology Section and Associate Professor of Pediatrics at Harvard Medical School.

The researchers studied more than 400 youth with type 1 diabetes who were ages 8 to 16 years and divided into two groups. The first group of 299 youngsters began being studied in 1997; the second group of 152 began being followed by the researchers in 2002. Each group was followed for a two-year period. As five years separated the two study groups, the researchers were able to track the improvements in control from the first group to the second group.

"We found about 40 percent of the first group were checking their blood glucose at least four times per day, and in the second group, it was 72 percent," Dr. Laffel said. In regard to insulin delivery systems, no patients in the first group were on insulin pumps when they entered the study, compared to 23 percent of the youth in the second group.

The researchers also found fewer hospitalizations, emergency room visits and severe low blood glucose episodes (hypoglycemia) with the second group. Furthermore, they did not see evidence of increased weight gain with the second group, which can be associated with increased intensity of insulin usage.
The improved control paid off for the second group with lower A1C values, which reflect a patient's average blood glucose over several months. The average A1C at the start of the study was 8.7 percent for the first group, compared to 8.4 percent for the second group. Furthermore, only 30 percent of patients in the first group met a target A1C of 8 percent or below, while close to half of the patients in the second group met this goal. "Of course there's still room for improvement. We want to see 100 percent of patients achieving tight control," said Dr. Laffel. "Nonetheless, there was considerable improvement between the two groups," she added.

"While it took the general medical community some time to adopt intensive therapy and to provide patients and families with the skills necessary to carry out tight diabetes control, we at Joslin were quick to translate the DCCT findings to clinical care," Dr. Laffel said. "In Joslin's pediatrics program, about 80 percent of patients were put on insulin analogs early on," she said.

"It's not acceptable that only half the people in the second group reached the A1C target goal. Further technologic advances are still needed. For example, we are excited to be starting two new studies at Joslin evaluating the use of continuous glucose monitoring devices. We hope that this technology will be able to further help our patients achieve

Posted by dlife at 04:09 PM | Comments (3)

18 Million Men in the United States Affected by Erectile Dysfunction

February 05, 2007

February 5, 2007 (Newswise) — More than 18 million men in the United States over age 20 are affected by erectile dysfunction, according to a study by researchers from the Johns Hopkins Bloomberg School of Public Health. The prevalence of erectile dysfunction was strongly linked with age, cardiovascular disease, diabetes and a lack of physical activity. The findings also indicate that lifestyle changes, such as increased physical activity and measures to prevent cardiovascular disease and diabetes, may also prevent decreased erectile function. The study is published in the February 1, 2007, issue of the American Journal of Medicine.

“Physicians should be aggressive in screening and managing middle-aged and older patients for erectile dysfunction, especially among patients with diabetes or hypertension,” said Elizabeth Selvin, PhD, MPH, lead author of the study and a faculty member in the Bloomberg School of Public Health’s Department of Epidemiology. “The associations of erectile dysfunction with diabetes and cardiovascular risk factors may serve as powerful motivators for men who need to make changes in their diet and lifestyle.”

For the study, the research team analyzed data from 2,126 men who participated in the National Health and Nutrition Examination Survey (NHANES). Men who reported being “sometimes able” or “never able” to get and keep an erection were categorized as having erectile dysfunction, while men who reported being “always or almost always able” or “usually able” were not.

The overall prevalence of erectile dysfunction among men in the United States was 18 percent. Men aged 70 and older were much more likely to report having erectile dysfunction compared to only 5 percent in men between the ages of 20 and 40. Nearly half of all men in the study with diabetes also had erectile dysfunction. And, almost 90 percent of all men with erectile dysfunction had at least one risk factor for cardiovascular disease, including diabetes, hypertension, having poor cholesterol levels or being a current smoker. Men with erectile dysfunction were also less likely to have engaged in vigorous physical activity within the month prior to participation in the study.

“Prevalence and Risk Factors for Erectile Dysfunction in the U.S.” was written by Elizabeth Selvin, PhD, MPH, Arthur L. Burnett, MD, and Elizabeth A. Platz, ScD, MPH. Selvin and Platz are with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. Platz and Burnett are with the James Buchanan Brady Urological Institute at Johns Hopkins Hospital.

The researchers were supported by grants from the National Institutes of Health’s National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK.)

Posted by dlife at 09:48 AM | Comments (0)

Vision Loss Can Be Prevented in People with Diabetes

January 08, 2007

January 8, 2007 (Newswise) — The millions of Americans afflicted with Type 1 and 2 Diabetes face many potential complications, including: heart and kidney disease; nerve damage and stroke; foot and skin problems; and gastrointestinal disorders and hypoglycemia.

Another major complication, affecting up to 24,000 new people per year, is permanent blindness due to diabetic retinopathy, a degenerative disease of the retina (the sensitive area at the back of the eye). Overall, diabetic retinopathy affects 5.3 million Americans 18 and older.

But there’s hope. The American Academy of Ophthalmology wants Americans to know that even though diabetes is the leading cause of new cases of blindness, vision loss can be prevented if the disease is diagnosed and treated in time.

“Only 50 to 60 percent of those with diabetes get the recommended yearly eye examinations,” said Jose S. Pulido, MD, Academy clinical correspondent and professor of ophthalmology at the Mayo Clinic in Rochester, Minn. “Studies show effective treatments, including an annual dilated eye exam, can reduce severe vision loss by up to 94 percent.”

According to the American Diabetes Association, there are 20.8 million people in the United States, or 7 percent of the population, who have diabetes. While an estimated 14.6 million have been diagnosed, 6.2 million people (or nearly one-third) are unaware that they have the disease.

“This is a tragedy waiting to happen because people who are unaware they have the disease are at a substantially greater risk for vision loss and other complications,” said Dr. Pulido. “The first step in preventing complications is finding out if you have the disease. It’s important for all healthy adults over the age of 45 to have a blood sugar test once every three years.”

Dr. Pulido said that the longer a person has diabetes, the greater the risk for developing diabetic retinopathy.
“Diabetic retinopathy does not only affect people who have had diabetes for many years, it can also appear within the first year or two after the onset of the disease,” he said. “For some people, diabetic retinopathy is one of the first signs of the disease.”

Anatomy of Diabetic Retinopathy
High blood sugar levels weaken blood vessels in the eye's retina, causing them to leak blood or fluid. This causes the retina to swell and can lead to vision loss.

Blood sugar fluctuations can also promote growth of new, fragile blood vessels on the retina, which can easily break and leak blood into the vitreous (the clear, jelly-like substance that fills the center of the eye). This can blur vision and lead to permanent blindness.

In its earliest stages diabetic retinopathy may not affect vision, but over time it can cause vision loss and even blindness in both eyes.

What are the Signs of Diabetic Retinopathy?

“Fluctuations in blood sugar levels can temporarily affect vision, so it's sometimes difficult to know if a serious eye problem is developing," said Dr. Pulido. "That's one of the reasons strict control of your blood sugar is so important. If you notice a vision change in one eye, a change that lasts more than a day or two, or changes not associated with fluctuations in blood sugar, contact your Eye M.D. immediately."

Other ways to reduce the risk of eye disease:

• Keep your blood glucose level as close to normal as possible through diet, exercise and, if needed, medication
• Keep your blood pressure under control
• Keep your cholesterol levels low
• Don’t smoke
• Make sure your hemoglobin A1c levels (a measure of good blood sugar control) are measured at least every four months and are less than 7.1.

Diabetic Retinopathy: A New Hope

Although incurable, diabetic retinopathy can be treated to retard its onset and progression. There’s hope for the development of new pharmacological treatments that would not require invasive laser surgery. These treatments might even restore the vision that the disease destroys.

These potential treatments signal a move away from laser photocoagulation to drugs injected into the eye, as well as oral treatments.

Many of these drugs block the pathways that contribute to the vascular disruptions that characterize diabetic retinopathy. Specifically, they aim to inhibit the growth of new blood vessels or the activity of proteins in the nerve cells of the retina.

These treatments hold promise of intervention at earlier, non-sight-threatening stages, but they will require renewed emphasis on early detection. The newest and best treatments will be most effective only when the underlying disease—diabetes—is under control.

Posted by dlife at 10:52 AM | Comments (1)

Joslin Diabetes Center Launches Veraxa Health to Meet Large Unmet Patient Need for Timely Detection of Diabetic Eye Disease

November 17, 2006

Joslin Vision NetworkTM (JVN), a proven retinal imaging service, targets millions of patients with diabetes at risk for vision loss

November 15, 2006 (Joslin) -- Joslin Diabetes Center, global leader in diabetes research, care and education, announced today the launch of Veraxa Health, Inc. as an independent company. The first for-profit spin-off in the center's 100-plus year history, Veraxa will market the Joslin Vision NetworkTM (JVN), a proven retinal imaging device and clinical service developed by Joslin to address a significant patient need: detection and management of diabetic retinopathy and other ocular disorders. JVN is delivered via customized Joslin software and nonmydriatic cameras supplied by Topcon Medical Systems of Paramus, N.J., which also provided bridge funding to help accelerate Veraxa Health's growth in the market.

Filling a Gap in Care
Diabetes is the leading cause of new-onset blindness in working-age adults across industrialized httpcountries, yet millions of patients do not receive the regular, recommended eye care they require. Lack of ready access to eye care specialists, the need for pupil dilation and the frequent lack of symptoms when retinopathy is initially present are among the factors contributing to poor rates of annual eye examination for people with diabetes. With JVN, Joslin researchers developed an imaging system and service that allow patients to receive regular retinal evaluations within a primary care practice, endocrinology office or other clinical setting without the need for pupil dilation. By improving access to eye care, JVN increases the rate of ongoing disease surveillance and facilitates appropriate and timely referral of patients to eye care specialists when needed.

Preserving vision and improving the long-term quality of life for people with diabetes is core to Joslin's mission. "As a research institution, Joslin developed this technology for remote evaluation of patients. As a clinical center, we use JVN to educate and counsel patients on appropriate care to prevent vision loss. Now, with Veraxa Health, a greater segment of the population can benefit from JVN technology," said C. Ronald Kahn, M.D., President of Joslin Diabetes Center and the Mary K. Iacocca Professor of Medicine at Harvard Medical School.


The Essence of JVN
JVN images, along with other key patient data, including blood pressure and A1C scores (the average blood glucose measurement during the two to three months before the date the A1C test was taken), obtained in the primary care physician's practice or endocrinologist's office, are transmitted securely via the Internet to the JVN Reading and Evaluation Center at Joslin Diabetes Center in Boston. There the images are evaluated by an expert team of ophthalmologists, optometrists and clinical staff. Utilizing the latest imaging technology, Joslin's expert team interprets images, identifies specific levels of diabetic retinopathy and provides appropriate clinical guidance for each patient. The Joslin team also identifies ocular pathologies other than diabetic retinopathy if observed.

JVN was founded by world-renowned Joslin ophthalmologist Lloyd M. Aiello, M.D., and internationally recognized leader in telehealth and teleophthalmology Sven-Erik Bursell, Ph.D., as a means to utilize technology and expertise to reach patient populations at risk of losing vision. Based on more than a decade of research, development, clinical use and validation, JVN has been shown to provide clinical retinal evaluation of diabetic retinopathy comparable to 35 mm stereo slides (the industry's "gold standard" for diabetic retinopathy exam), and comparable to a dilated retinal examination by a retinal specialist. JVN is currently deployed in more than 70 sites in 20 states nationwide, including locations within the Veterans Health Administration and Indian Health Service.

"Veraxa Health will focus on marketing JVN to primary care and endocrinology practices nationwide, in order to reach large patient populations and facilitate referrals to eye care providers when needed," said Rick Morello, Chief Executive Officer and President, Veraxa Health. "With the strength of Joslin research, development and validation of JVN, Veraxa offers physicians a powerful clinical solution that helps patients take charge of their eye health."

Diabetic Eye Disease
While more than 90 percent of people with diabetes annually visit their primary care physician or endocrinologist, as few as 40 percent receive an annual eye exam with documented treatment guidance. In diabetic retinopathy, there may be no symptoms or pain, even with advanced disease. According to the World Health Organization (WHO), approximately 200 million people worldwide have diabetes and all are at risk of developing diabetic retinopathy during their lifetimes. Early detection and consistent management enable prompt referral to an eye care specialist for appropriate intervention when needed.

According to Joslin ophthalmologist Lloyd Paul Aiello, M.D., Ph.D., director of Joslin Diabetes Center's Beetham Eye Institute and the JVN Reading and Evaluation Center, "The accuracy of JVN as a diagnostic tool for diabetic retinopathy has been rigorously described and validated in scientific peer review journals such as Ophthalmology, American Journal of Ophthalmology and Diabetes Care. In addition, the American Diabetes Association's (ADA) recommendations state that patients with diabetes have a dilated eye exam or a validated digital retinal image exam annually. JVN is a new tool to help realize the best care for these patients."

Posted by dlife at 12:07 PM | Comments (2)

Panic Attacks Can Increase Complications in Diabetes Patients

November 17, 2006 (Newswise) — People with diabetes who have repeated panic attacks are less likely to have properly managed the disease and suffer more severe health complications and poorer quality of life, a new study finds.

Lead author Evette Ludman, Ph.D., a researcher with Group Health Cooperative in Seattle, said her group’s previous work showed depression was associated with more poorly controlled glucose, more diabetes symptom, and lower functioning. “But because panic and depression so often go hand in hand, we weren’t certain that patients who have panic, independent of depression, would also have with these indicators.”

For the new study, which appears in the November issue of General Hospital Psychiatry, a survey was mailed to 4,385 patients with diabetes. Of those participants, 193 (4.4 percent) reported having panic episodes that caused a definite change in behavior. Among the 193 patients, 54.5 percent also had symptoms of depression.

Respondents were asked about recent panic or fear “spells” and if these feelings forced them to change their behavior. Participants were also given questionnaires that measured their diabetes symptoms as well as their level of functioning and disability.

Of those with panic disorder, the average HbA1c levels — a measure of long-term glucose control — were 8.1 percent compared with 7.7 percent for those without panic episodes. (Usual treatment goal is to keep levels below 7 percent.) Also, those with panic episodes reported having an average of 4.2 diabetes symptoms compared with 2.4 symptoms in those without panic.

Panic disorder is characterized by recurrent panic attacks, followed by persistent worry about having another attack.

The authors say that panic symptoms might be a consequence of diabetes itself. Panic episodes may contribute to poor outcomes by interfering with self-care and patients’ ability to follow their treatment regimens.

The authors and diabetes experts agree that if physicians treating patients with diabetes can better recognize and treat the symptoms of panic episodes and depression, they can improve the patients’ quality of life.

“I think most careful clinicians have noted that there are patients who do not cope well with their diabetes and have a variety of neuropsychosocial issues including panic disorder, depression, anxiety and personality disorders,” said John Buse, M.D., division chief of the Diabetes Center at University of North Carolina at Chapel Hill. “The key really is to very carefully assess patients who are not doing well in their management of diabetes or other chronic illness.”

Posted by dlife at 11:44 AM | Comments (2)

Repair Not Destruction: A New Approach to Treating Retinopathy

November 16, 2006

November 16, 2006 (EurekAlert) - Many diseases of the eye (such as retinopathy of prematurity (ROP) and diabetic retinopathy) that result in loss of vision are the result of the growth of abnormal blood vessels that leak and bleed. Current treatments are designed to prevent the growth of these abnormal blood vessels. However, the authors of a study using a mouse model of retinopathy suggest that an alternative treatment strategy might be to repair these blood vessels so that they do not leak and bleed, causing loss of vision.

In the study, which appears online on November 16 in advance of publication in the December print issue of the Journal of Clinical Investigation, Martin Friedlander and colleagues from The Scripps Research Institute, La Jolla, show that the abnormal blood vessels that grow in the retina of mice exposed to a stimulus that induces retinopathy can be converted to normal blood vessels if the mice are transplanted with adult bone marrow–derived myeloid progenitor cells. Blood vessel repair occurred when the transplanted cells migrated to the eye and became cells known as microglial cells, it also required that the transplanted cells express a protein known as HIF-1-alpha.This study has clinical relevance because it suggests that transplantation of autologous bone marrow–derived progenitor cells might be a viable therapy for the treatment of human diseases that resemble this mouse model of retinopathy, such as ROP.

Posted by dlife at 09:53 AM | Comments (0)

Diabetes Medication May Help Slow Progression of Artery Wall Thickening

November 13, 2006

November 13, 2006 (Newswise) — A medication given to diabetics to improve their body’s sensitivity to insulin also appears to slow the thickening of their artery walls, according to a study posted online today by JAMA. The study is being released early to coincide with its presentation at the American Heart Association Scientific Session. It will be published in the December 6 print issue of JAMA.

Individuals with diabetes, who cannot produce sufficient amounts of insulin or respond to the insulin needed to turn glucose into energy, have a higher risk for myocardial infarction (heart attack), according to background information in the article. Controlling blood pressure and low-density lipoprotein (LDL, or “bad”) cholesterol has been shown to reduce some of this excess risk. “However, even with optimal control of these potent cardiovascular risk factors, incremental risk for cardiovascular events remains high compared with individuals without diabetes,” the authors write. “New approaches are, therefore, needed to further reduce cardiovascular risk in patients with diabetes.”

Theodore Mazzone, M.D., of the University of Illinois at Chicago College of Medicine, and colleagues studied the effects of a potential new approach, using a drug known as pioglitazone, in 462 adults with type 2 diabetes in the Chicago metropolitan area between 2003 and 2006. Study participants had an average age of 60 and included 289 men and 173 women; they were randomly assigned to receive a daily dose of either pioglitazone (15 to 45 milligrams) or of glimepiride (1 to 4 milligrams), another diabetes medication that works through different mechanisms. At the beginning of the study and again 24, 48 and 72 weeks later, ultrasound was used to measure the thickness of the middle layers of the carotid arteries (which are located in the neck and carry blood to the brain). The measurements are called carotid artery intima-media thickness, or CIMT. Using this measurement, other studies have suggested that thicker artery walls, and changes in artery wall thickness over time, are associated with a higher risk for heart events. Glycosolated hemoglobin (HbA1c) levels, a measure of blood glucose control over an extended period, were also monitored throughout the study, as were blood pressure, blood cholesterol levels and adverse events.

A total of 158 (68 percent) of the pioglitazone group and 165 (72 percent) of the glimepiride group completed the 72-week trial; 175 (76 percent) of those in the pioglitazone group and 186 (81 percent) in the glimepiride group had at least one ultrasound of the carotid artery and were included in the artery wall thickness analysis. At baseline, the average CIMT was comparable in the pioglitazone group than among and the glimepiride group (.771 millimeters vs. .779 millimeters). At the 72-week follow-up period, the CIMT of patients in the glimepiride group increased by an average of .012 millimeters from the beginning of the study, while the average CIMT in the pioglitazone group decreased by .001 millimeters. “A pre-specified subgroup analysis based on age, sex, systolic blood pressure, duration of type 2 diabetes mellitus, body mass index, HbA1c value and statin use showed a uniform beneficial effect of pioglitazone treatment,” the authors write.

Over the course of the study, blood pressure changes were not significantly different between the two groups. HbA1c levels were also similar until week 48, when those in the pioglitazone group became significantly lower than those in the glimepiride group. High-density lipoprotein (HDL or “good”) cholesterol levels increased in those taking pioglitazone by week 24 and remained higher through 72 weeks compared with those taking glimepiride. These measures represent potential mechanisms by which pioglitazone reduced artery thickness, the authors write. “It also remains possible that thiazolidinediones [the class of drug that includes pioglitazone] can have a directly beneficial effect on the vessel wall,” they continue.

Posted by dlife at 11:38 AM | Comments (0)

ACE Inhibitors Reduce Kidney Disease Risk in Diabetics with High Blood Pressure

November 02, 2006

November 2, 2006 (Newswise) — In diabetic patients with hypertension, ACE inhibitors reduce the risk of developing diabetes-related kidney disease, independent of their effect in lowering blood pressure, reports a study in the December Journal of the American Society of Nephrology.

"Our results clearly show that an ACE inhibitor should always be used in patients with high blood pressure and diabetes, even when they have no evidence of renal or cardiovascular disease," comments the study’s lead author, Dr. Piero Ruggenenti of Mario Negri Institute for Pharmacological Research in Bergamo, Italy.

The BErgamo NEphrologic DIabetes Complications Trial (BENEDICT) study included 1,204 patients with type 2 diabetes and high blood pressure. At the beginning of the study, none of the patients had any signs of kidney disease. They were randomly assigned to treatment with an ACE inhibitor, another type of blood pressure drug called a calcium channel blocker, a combination of an ACE inhibitor with a calcium channel blocker, or an inactive placebo. Rates of microalbuminuria—small amounts of the protein albumin in urine, the first sign of diabetic kidney disease—were compared between groups.

After an average of 31⁄2 years, patients who had good blood pressure control—regardless of which treatment they received—had lower rates of microalbuminuria. Patients taking the combination treatment had the greatest reduction in blood pressure and were less likely to require additional drugs to keep their blood pressure under control.

Taking an ACE inhibitor, alone or as part of the combination treatment, provided further protection against diabetic kidney disease. This was also the case for patients whose blood pressure remained high—as long as they were taking an ACE inhibitor, their microalbuminuria risk was similar to that of patients whose blood pressure was well-controlled. Dr. Ruggenenti points out, "Treatment with an ACE inhibitor was particularly important when the blood pressure was poorly controlled—as may happen in most diabetic patients with hypertension, despite the use of two, three, or even more drugs."

About 30 percent of people with diabetes will go on to develop kidney failure, while even more may be at risk of premature death from cardiovascular disease. Eighty to ninety percent of patients with type 2 diabetes also have hypertension, a major risk factor for diabetic kidney disease. "Optimizing blood pressure control appears extremely important to reduce or prevent the risk of kidney failure or death for these patients," says Dr. Ruggenenti.

All doctors who treat diabetes need to know about the protective benefits of ACE inhibitor treatment—especially primary care doctors who care for the vast majority of diabetic patients without kidney disease. "Early and effective treatment of hypertension is of paramount importance in people with diabetes, and ACE inhibitors should be the treatment of choice," Dr. Ruggenenti concludes. "However, in most patients, an ACE inhibitor alone is not enough to achieve good control of arterial blood pressure—less than 130/80 mm Hg. In these patients, the doctor should also use other antihypertensive drugs, including a diuretic, in most cases, to achieve this target. Although using an ACE inhibitor is important, so is achieving the target blood pressure whenever possible." For patients who can't take ACE inhibitors, another class of drugs—the angiotensin II receptor antagonists—may be a valid alternative.

Posted by dlife at 01:58 PM | Comments (6)

New Tool Can Help Predict Diabetes Complications

October 25, 2006

Other Studies This Month: Coffee Helps Prevent Diabetes; When You Get Diabetes (Middle v. Old Age) Matters

October 25, 2006 (ADA) – A noninvasive tool that measures the skin’s autofluorescence could help doctors determine whether people with diabetes are beginning to develop serious complications, according to a study published in the November issue of Diabetes Care.

Researchers in the Netherlands found that illuminating a patient’s lower arm with a fluorescent tube accurately reflects vascular damage caused by the accumulation of advanced glycosylation end products (AGEs). AGEs are produced in the body when glucose links with protein. They play a role in damaging blood vessels, which can lead to complications, such as nerve damage.

Previous studies have shown that AGEs have fluorescent properties. This study confirmed that those properties could be measured by illuminating the skin, and that high levels of autofluorescence were associated with more severe diabetes complications, such as neuropathy, retinopathy and cardiovascular problems.

“With this tool, doctors could easily check people with diabetes in an outpatient clinic setting to see whether they may already be developing dangerous complications,” said lead researcher Dr. Helen Lutgers, of the University Medical Center in Groningen, the Netherlands. “The sooner complications are detected, the better the chance of preventing progression of damage.”

The technology used in this study is currently commercially available in Europe. Until FDA approval is obtained, its availability in the USA is restricted to experimental use only.

Posted by dlife at 10:47 AM | Comments (1)