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Archive - 12 - 2012

Diabetics with Cancer Dangerously Ignore Blood Sugar

Posted by dlife on Sun, Dec 02, 12, 12:02 PM 0 Comment

November 30, 2012 (Northwestern Medicine) When people with Type 2 diabetes are diagnosed with cancer a disease for which they are at higher risk they ignore their diabetes care to focus on cancer treatment, according to new Northwestern Medicine research. But uncontrolled high blood sugar is more likely to kill them and impairs their immune systems ability to fight cancer.However, people with Type 2 diabetes who received diabetes education after a cancer diagnosis were more likely to take care of their blood sugar. As a result, they had fewer visits to the emergency room, fewer hospital admissions, lower health care costs, and they tested their blood sugar levels more often than people who didnt have the education. They also had more hemoglobin a-1c level tests at their doctors offices. The latter is a critical marker of how well someone has managed their diabetes and blood sugar over the last three months.People with diabetes hear cancer and they think that it is a death sentence, so who cares about diabetes at this point? said June McKoy, MD, director of geriatric oncology at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. But if theyre not careful, its the diabetes that will take them out of this world, not the cancer. Thats why this education is so critical when cancer comes on board. Patients must take care of both illnesses.McKoy, also an associate professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital, is the senior author of the study recently published in the journal Population Health Management. Lauren Irizarry, a fourth-year medical student at Feinberg, is the lead author.Uncontrolled high blood sugar can result in kidney damage and failure as well as blindness and amputation of the feet as blood vessels are damaged by excess sugar. In addition, Type 2 diabetes dampens the immune system and hampers the bodys ability to fight cancer.If you are not taking good care of your diabetes, your cancer suffers, too, added McKoy.People with diabetes have a higher incidence of liver cancer, pancreatic cancer, colon cancer, breast cancer, bladder cancer, and endometrial cancer.For the study, researchers examined five years of health records for 166,000 commercial insurance patients and 56,000 Medicare Advantage patients. They found 65.2 percent of cancer patients who received diabetes education had their hemoglobin a-1c tested at least twice, and 88 percent had it tested at least once over three years. The numbers were significantly lower for patients who did not receive diabetes education; 48 percent of that group had hemoglobin a-1c tested twice and 78 percent had it tested once over a period of three years. Ideally, hemoglobin a-1c should be tested every four months.The group who received diabetes education had 416 emergency room visits over three years compared to 463 who did not receive the education. In addition, the educated group had 658 hospital admissions and the uneducated had 883 admissions.The diabetes education sessions were twice a week for four to six weeks.If you dont have the power of education, you are flailing in the wind, McKoy said. You have to get this information and physicians really need to be information brokers for our patients. Having diabetes and then getting cancer can be overwhelming.The research was funded by the Medical Student Summer Research Program (MSSRP) at the Feinberg School and the grant K01 CA134554-01 from the National Cancer Institute of the National Institutes of Health.

Enzyme Explains Angina in Diabetics

Posted by dlife on Sun, Dec 02, 12, 11:52 AM 0 Comment

November 27, 2012 (Karolinska Institutet) In a new study published in the scientific journal Circulation, scientists at Karolinska Institutet and Karolinska University Hospital show that an enzyme called arginase might have a key part to play in the development of cardiovascular disease in patients who already have type II diabetes. According to the team, arginase prevents the formation of protective nitrogen oxide in the blood vessels, and treatments that inhibit this enzyme reduce the risk of angina in diabetics."The fact that we could demonstrate the presence of arginase in several types of cell in the vessel wall gives us an entirely new explanatory model for the development of complications in these patients," says lead investigator Professor John Pernow.Complications in diabetes patients result from constrictions of the blood vessels caused by plaque deposits on the vessel walls (atherosclerosis). The ensuing reduction in blood flow and oxygen supply can lead to angina, myocardial infarction or stroke, and possible amputation. Atherosclerosis is more common in people who smoke and who have high levels of blood lipids, although the risk is most pronounced in patients with diabetes. The reason for this correlation between diabetes and cardiovascular disease has largely eluded scientists and there is still no specific treatment for these complications.In this present study, the researchers analysed the function of the arginase enzyme (or protein) in the blood vessels of patients with both type II diabetes and angina and found that it prevents the formation of protective molecule nitric oxide in the vessel wall. After introducing a substance already known to inhibit the enzyme, they observed a significant improvement in blood vessel function in these patients.A comparative analysis showed that the arginase inhibitor did not have the same positive effect on patients with angina but without type II diabetes, and had no effect at all on healthy controls."Nitric oxide has a very important function to perform in the vessel walls," says Professor Pernow. "Apart from dilating them, it prevents the formation of plaque. For some reason, however, the mechanism is impaired in people with diabetes."A total of 48 patients were included in the study and the team is now planning a larger follow-up study to confirm their results and develop treatments using arginase inhibitors. The study was financed by the Swedish Research Council, the Swedish Heart-Lung Foundation, the NovoNordisk Foundation, the European Foundation for the Study of Diabetes, and the Gustav V and Queen Victoria Foundation.

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