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Archive - 05 - 2009

Obesity and Diabetes Double Risk of HF -- Patients with Both Conditions 'Very Difficult' to Treat

Posted by dlife on Sat, May 30, 09, 09:23 AM 0 Comment

May 30, 2009 (EurekAlert) - The twin epidemics of obesity and type 2 diabetes will continue to fuel an explosion in heart failure, already the world's most prevalent chronic cardiovascular disease, according to John McMurray, professor of cardiology at the Western Infirmary, Glasgow, and President of the Heart Failure Association. He reported that around one-third of patients with heart failure have evidence of diabetes, and for them the outlook is very serious. For doctors, he added, effective treatment is "very difficult." besity, like diabetes, is increasing in prevalence. The latest report from Euroaspire, Europe's largest survey of cardiovascular risk factors in coronary patients, found that the prevalence of obesity had increased from 25 per cent in 1997 to 38 per cent in just ten years and this in people who had already had at least one heart attack.Now, a session at Heart Failure 2009 emphasises that obesity is not just associated with an increased risk of heart attack, but also and especially - with an increased risk of heart failure.1,2 "Obesity is at least as great a risk factor for heart failure as it is for heart attack or stroke," says Professor McMurray. "Obesity more than doubles the risk."The pathways by which obesity plays such a role in heart failure are not yet fully understood, but have been shown to have an indirect effect via hypertension, or heart attack, or diabetes and a direct effect on the heart muscle itself. "We know that the underlying changes in the structure and function of the heart may be different in obese and non-obese patients with heart failure," says Professor McMurray. An even more "intriguing" suggestion, he added, is that adipose cells might act as an endocrine tissue, secreting substances which may have a harmful effect on heart tissue and blood vessels.The relationship between diabetes and heart failure is also a subject of investigation, with the risk of heart failure doubled in diabetics. Heart failure patients with diabetes also have worse symptoms, a higher risk of hospitalisation and a greater risk of death than those without diabetes suggesting that the underlying pathophysiology of heart failure may be different in diabetics and non-diabetics. Professor McMurray also notes an "intersection" of the two conditions by which those with diabetes have a higher risk of heart failure, and those with heart failure have a higher risk of diabetes. "But whichever is the causative factor," he adds, "it's very bad news for those with both conditions."

Continuous Glucose Monitoring Technology -- Special Issue of Diabetes Technology and Therapeutics

Posted by dlife on Fri, May 29, 09, 01:49 PM 0 Comment

May 29, 2009 (EurekAlert) - Continuous Glucose Monitoring (CGM) devices represent a critical step toward achieving automated glucose measurement, offering people with diabetes a promising new tool for maintaining optimal glucose control. A comprehensive review of this rapidly changing field, featuring the most recent research findings and critical analysis, is the focus of a special supplement of Diabetes Technology & Therapeutics, a peer-reviewed journal published by Mary Ann Liebert, Inc. (www.liebertpub.com). The supplement is available free online at www.liebertonline.com/dia"CGM is still in its infancy, yet this technology is already becoming the standard of care," writes Satish K. Garg, MD, Editor-in-Chief of Diabetes Technology & Therapeutics, and Professor of Medicine and Pediatrics from the University of Colorado Denver, in an editorial introducing the supplement. Over the past decade, "The annual healthcare costs related to diabetes care in the United States have increased significantly by 32%...to $174 billion," despite improvements in glucose control, Garg notes. Better methods are needed to prevent the long- and short-term complications associated with diabetes.This in-depth supplement provides a detailed presentation of the need for better glucose monitoring techniques, describes state-of-the-art CGM technology, and looks to the future and the ultimate goal of integrating CGM with an artificial pancreas to simulate normal blood glucose control systems in the body. Several articles focus on the challenges that CGM must still overcome, whether technical, practical, or economic. In the editorial, "Do We Really Need Continuous Glucose Monitoring?" Anne Peters, MD, from the University of Southern California Keck School of Medicine (Los Angeles), points out some of the drawbacks of current CGM technology: for example, the devices are "finicky and require care and calibration leading patients to use them infrequently"; "few physicians know how to interpret the data"; and "CGM devices have not been shown to reduce rates of severe hypoglycemia."Associate Editor Jay S. Skyler, MD, from the University of Miami Miller School of Medicine (Florida), reviews the history of CGM in an editorial entitled, "Continuous Glucose Monitoring: An Overview of Its Development." Eric Orzeck, MD, from Endocrinology Associates (Houston, TX), describes the need for better documentation, coding, and appeal procedures for use of CGM to improve insurance coverage, in the article, "Maximizing Reimbursement through Correct Coding Initiatives."In the commentary entitled, "Continuous Glucose Monitoring: Understanding Our Current Culture," Irl Hirsch, MD, from the University of Washington School of Medicine (Seattle), concludes that CGM, "is only a tool to help patients make better decisions about insulin and food. Until we have a closed-loop system or islet cell transplant, human behavior will continue to dictate the success of a patient with his or her diabetes control."

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