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 (1)

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 appropria