Diabetes Articles

DIABETES ARTICLES - To Prevent Amputations, Doctors Call for Aggressive Care

2006-12-09T02:35:00.000-08:00

DIABETES ARTICLES

To Prevent Amputations, Doctors Call for Aggressive Care

After leaving her job at NASA’s Goddard Space Flight Center in Maryland, Elaine Fry mapped out her life as an active retiree: daily outdoor excursions, meetings with friends, cross-country trips.
But as her legs inexplicably began retaining more and more fluid, swelling like ripening melons, just leaving her bedroom became a struggle. Last year, an ulcer appeared on her bloated right calf, with an infection that festered for months and turned the surrounding tissue black. Her doctor confirmed her worst fears: an above-the-knee amputation was the only option.

Following the surgery, Ms. Fry, now 63, sold her house and went to live with her daughter, her son-in-law and their four children in a basement apartment of their Columbia, Md., home that she describes as “not wheelchair friendly.”

“Before, if I wanted to go to the bookstore or grocery store, I could,” she said. “But now, my daughter can’t just drop everything and do whatever I want to do. Losing my independence has been really hard.”

Ms. Fry’s story is a surprisingly common one, though amputation is often stereotypically viewed as a side effect of war, not a consequence of disease. About 1.8 million Americans have had amputations; every year, more than 100,000 non-accident-related, lower-limb amputations are performed in the United States.

The high numbers have prompted the medical community to debate whether most foot and leg amputations can be prevented — and, if so, how.

Dr. Karel Bakker, a foot specialist who is a chairman of the International Diabetes Federation, believes that more effective foot care and patient education strategies would render up to 85 percent of these procedures unnecessary. Lower-limb ulcers are the most reliable harbingers of future amputation: according to a study published earlier this year in the journal Diabetes Care, nearly 9 in 10 nontraumatic foot and leg amputations come after the development of these infected sores, which can spread and quickly destroy surrounding tissue.

Some of these amputations, like Ms. Fry’s, can be traced to ulcers resulting from edema or other conditions that affect blood flow to the lower extremities. Others — as many as 60 percent, according to some estimates — are due to a common complication of diabetes: lower-limb numbness resulting from nerve damage from the disease.

Dr. Michael S. Pinzur, an orthopedic surgeon at Loyola University in Chicago, has had diabetes patients who have lost so much sensation in their feet that they have been oblivious to large objects, like cigarette lighters or toy trucks, that have gotten lodged in their shoes.

“Normally, if you’ve got something as small as an ingrown toenail, you feel it,” Dr. Pinzur said. “These people can’t feel it.”

Because there is no pain to alert them to potential danger, these patients often continue walking on increasingly sore, infected legs until they resemble hunks of raw meat.

With proper education, observation and follow-up care, Dr. Bakker argues, most patients at high risk of amputation could be healed before reaching the point of no return. He envisions an across-the-board protocol of aggressive wound care that would function a little like early-stage cancer treatment, vanquishing relatively minor sores and irritations before they have a chance to become something more serious.

“Some people do go to clinics for their ulcers and have them treated, but there often isn’t any follow-up,” he says. “There’s no good recall system. If you have an ulcer, you should really be seen every three months.”

At present, he points out, only 14 percent of general practitioners perform foot exams during yearly patient visits. He hopes this percentage will increase greatly as doctors become more aware of the benefits of preventive foot care, which includes checking the feet for redness, cuts and sores.

The World Health Organization has also lobbied for better preventive foot care to eliminate the need for amputations.

“Any amputation, especially for conditions like diabetes, is a human tragedy and a gross failure of public health efforts,” said Dr. Robert Beaglehole, W.H.O.’s director of chronic diseases and health promotion. “We are failing desperately to prevent the most preventable conditions.”

Dr. Pinzur, however, thinks it is unrealistic to expect the levels of patient compliance needed to achieve the results that Dr. Bakker and Dr. Beaglehole envision. Many diabetics, he notes, have difficulty learning to administer proper wound care, and many other patients do not follow doctors’ orders or show up for scheduled visits. “ “One-on-one patient education is really the only solution,” he said.
But Dr. Vivian Ho, an economist at Rice University, said that raising awareness about amputation danger signs among patients and doctors only addresses part of the problem. Her 2005 analysis of Medicare claims data showed that adding one vascular surgeon for every 33,000 Medicare beneficiaries in a region yielded a 1.6 percent decrease in amputations.
These results suggest that in many poor or rural regions of the United States, there simply are not enough specialists available to perform foot- and leg-saving procedures.

“Whether or not you have an amputation is a function of who you get sent to,” Dr. Ho said. “If there are only six vascular specialists in the entire state, many patients won’t get told to see a vascular surgeon at all.”

While general practitioners are trained to perform amputations, they are not usually qualified to perform complex limb-saving operations like bypasses or balloon angioplasties.

Economically and socially marginalized groups, Dr. Ho adds, get the shortest shrift in the amputation lottery. Among diabetics in North America, Hispanics and African-Americans are 1.5 to 2.5 times more likely than whites to undergo lower limb amputations. “There’s no advocacy group for this condition the way there is for something like breast cancer,” she said. “It’s a disease of the lower class.”

Dr. Ho argues that Medicare reimbursement rates in underserved regions should be raised to create an economic incentive for specialists to move to those areas.

“There’s correlation between the supply of specialists and how attractive an area is in terms of culture and economy — all the factors you’d find in the Places Rated Almanac,” she said. “But doctors will respond to higher rates. Anywhere dollar signs come into play, you’ll see an effect.”

Some physicians, though, think Dr. Ho’s focus on the drought of specialists is misguided. “The obvious answer is, ‘Let’s get everyone to see a vascular surgeon,’ but that won’t solve anything,” Dr. Pinzur said. “Vascular surgeons only start seeing patients at the point when they already have nonhealing ulcers, and at that point a lot of the damage has been done.”

Even in areas where specialists are plentiful, said Dr. Herbert Dardik, chief of vascular surgery at Englewood Hospital and Medical Center in New Jersey, doctors may be performing amputations that are not absolutely necessary.

“Doctors have to decide whether to spend three or four hours doing a complicated salvage procedure, or 35 minutes for a short, quick amputation,” he said.

Still, doctors caution against viewing amputation as something to be avoided at all costs. “Some people say: ‘If you take my leg off, my life is over. I’m going to die’ ” Dr. Pinzur said. “But it’s not a black-or-white issue. You always have to ask, ‘Will a salvage outperform an amputation in this case?’ ”

One of Dr. Pinzur’s patients, vehemently opposed to amputation, had been in and out of the hospital for years as a recurring infection smoldered in his foot.

“Finally he said, ‘Enough is enough,’ ” Dr. Pinzur said, “and two weeks after his amputation, he was walking around with a prosthesis and asking, ‘Why did I wait so long?’ ”

For Elaine Fry, the recovery process has been slower — just healing her surgical wound took several months.

A year after surgery, she has been attending physical therapy to get used to a recently fitted prosthesis and has been learning to drive with a left-leg accelerator pedal.

“I’m looking forward to doing all the things I used to do,” she said.

by Elizabeth Svoboda at The New York Times, published on Nov 7 2006

DIABETES ARTICLES - Rookie Is No Novice at Dealing With Diabetes

2006-11-23T19:19:00.000-08:00

DIABETES ARTICLES

Rookie Is No Novice at Dealing With Diabetes

After a dismal shooting night, the Charlotte Bobcats rookie Adam Morrison sat in front of his locker, head bowed as he tried to explain a 1-of-8 performance. At his feet was a duffel bag of energy bars and apple juice, reminders of what he has overcome to get this far.

“It’s something I’ve got to work through,” Morrison said of his shooting problems. “I’ve worked through it before and gone through adversity.”

It was not that long ago that Morrison sat in a hospital room, a 14-year-old listening as a doctor told him he was a Type 1 diabetic — a diagnosis he figured would end his N.B.A. dreams. But as the doctor started to rattle off the diabetic athletes who played professionally — the hockey Hall of Famer Bobby Clarke, the nine-time baseball All-Star Ron Santo and the longtime N.B.A. player Chris Dudley — a new goal came into focus.

“Right after that, the nurse came in to give him the second insulin shot and he told her, ‘You better show me how to do this, because I’m going to be doing it for the rest of my life,’ ” recalled his father, John.

Today, the 22-year-old Morrison is the only known diabetic in the N.B.A.. Dudley, the league’s last active player with the disease, hopes that does not become an issue as Morrison struggles to improve a shooting percentage that has not moved above 40 percent and to get quicker as a defender, where he has often been a step slow.

But after going 10 of 43 during a five-game stretch, Morrison rebounded this week to score 21 and 27 points in back-to-back games.

“If he struggles in the midseason, people may talk about his diabetes,” Dudley said. “But every rookie goes through that. Every rookie hits the wall at some point. I hope people don’t blame the guy if he struggles.”

About 21 million Americans have diabetes, which affects the body’s ability to make or properly use insulin. Type 2 diabetes is the most common and involves the destruction of insulin-producing cells, in part because of obesity or poor diet. Morrison has the less-common Type 1. His body cannot make insulin, which it needs to convert sugar from food into energy.

If left untreated, diabetics can experience heart and kidney problems, blindness and even death. They are told to closely monitor their diet and get plenty of rest. Morrison set a daily routine and settled on having the same meal before every game: a steak and baked potato exactly two hours before tip-off.

It worked. Morrison went on to have a stellar high school career in Spokane, Wash., before starring at Gonzaga, where he was the top scorer in college basketball last season at 28.1 points a game. He did it while constantly testing his blood-sugar level, up to four or five times during the day and nearly every timeout during a game.

The Bobcats trainer Joe Sharpe got Morrison’s system down during the preseason and keeps the bench stocked with apple juice and energy bars. There is also insulin on hand should Morrison’s blood sugar get too high.

“I try to make it as quick as possible,” Sharpe said. “I have his kit ready to go. He sits down, pricks his finger and gets his reading. I then give him what he needs.”

Morrison took great care to make sure he would be ready to play at the pro level and deal with the disease. Earlier this year he met with Dudley, who spent 16 seasons in the N.B.A. before retiring in 2003.

“I told him you’re not going to be perfect, but you have to be careful,” Dudley said. “Talking to teams about Adam before the draft, I told them if Adam was the kind of player that you had to worry about being overweight during the summer and all those things, I’d be a lot more worried about him. I’m not worried about that with Adam. He’s the type of guy who knows his body and is going to take care of his body.”

When Dudley first entered the league in 1987, it took 45 seconds to test his blood sugar. The technology has improved. Morrison recently signed an endorsement deal with LifeScan, which makes a device that gives a reading in 5 seconds.

When Morrison’s blood sugar is too high or low, he feels sluggish on the court. But he feels he will be able to adjust to the grind of an 82-game N.B.A. schedule.

“Obviously, you have to take care of your body,” Morrison said. “It’s definitely different than college.”

After signing a rookie contract that pays more than $3 million a season, Morrison has taken advantage of his new wealth. He has hired a full-time chef, had meetings with a nutritionist, and his sister and 5-year-old niece moved to Charlotte, N.C., to help with his off-the-court responsibilities.

That maturity was one of the reasons the Bobcats did not shy away from selecting Morrison with the No. 3 pick in the draft. Dudley, who runs a foundation that helps children deal with diabetes, believes the high-profile Morrison will raise awareness for the disease.

“We all want a cure and we’re trying to get a cure, but in the meantime these kids have to deal with diabetes, and we try to get the message out that they can succeed,” Dudley said.

Morrison said he realizes the influence he can have, and spent time this summer on a promotional tour for the company that makes his blood sugar meter. Could the day come when, instead of being asked to autograph a shirt or a ball, a child with diabetes hands Morrison his blood-sugar meter to sign?

“That would be pretty wild, but you know, I think it would be cool if it could happen,” Morrison said. “I’ll try to give back and be a role model to kids and even adults.”

by The Assosiated Press at The New York Times, published on Nov 19, 2006

DIABETES ARTICLES - When Advice on Diabetes Is Sound, but Ignored

2006-11-16T23:19:00.000-08:00

DIABETES ARTICLES

When Advice on Diabetes Is Sound, but Ignored

Ask any diabetes specialist whether people can protect themselves from Type 2 diabetes through diet and exercise and the answer will be a resounding yes. It has been shown three times, in studies in three countries, one of them the United States.

Weight loss and exercise can do more than just stave off diabetes, diabetes specialists will tell you. They can result in lower blood pressure, lower levels of cholesterol, less sleep apnea, more vigor and, in general, a better life.

But if you ask how likely it is that people at high risk of diabetes will follow the advice to diet and exercise, or about using a drug instead, you will get a different sort of answer.

It is a classic conundrum in medicine: if doctors know that patients can help themselves without taking drugs, but they also know that patients are not likely to follow this advice, what should they do?

Should diabetes specialists even bother to advise patients to try helping themselves through diet and exercise first, before prescribing drugs?

A large federal study, completed several years ago, seemed to make a compelling case that they should. A third of its 3,234 participants were assigned to a low-fat, low-calorie diet and told to exercise for 150 minutes a week. The others were given a placebo or were given metformin, a diabetes drug available as an inexpensive generic.

After an average of three years, just 14.1 percent of those in the diet and exercise group had developed diabetes. In contrast, 28.9 percent of participants taking the placebo had diabetes, and 21.7 percent of those taking metformin.

But the diet and exercise program was nothing like what an ordinary person might expect. The participants got extensive individual counseling and group support, at a cost of $1,356 a person the first year and $672 in each subsequent year. Even so, they shed only about 12 pounds after four years, or 4 percent of their initial weight. Most were continuing with their exercise program, though. If a large health plan decided to offer the same program for its members at risk for diabetes, the plan’s price for every member would rise by 1 percent, said Dr. David Eddy, the medical director of Archimedes Inc., a health care consulting company. Over 30 years, 61 percent of the people at risk would develop diabetes, as compared with 72 percent if no such program were instituted.

Last month, another study showed that a newer diabetes drug, rosiglitazone, might be more effective than either metformin or diet and exercise. Over three years, it reduced the risk of developing diabetes by 60 percent in people with elevated blood sugar levels.

Both drugs are relatively safe. Patients may lose about five pounds if they take metformin; other than that its major side effect is gastrointestinal disturbances, like a sense of fullness or soft bowel movements. Patients may gain about five pounds with rosiglitazone, about half of which is from fluid retention. That increases the risk of heart failure in people with heart disease.

But with the drugs’ effectiveness in preventing diabetes, maybe, some specialists say, doctors will soon view blood sugar as they do blood pressure or cholesterol. As soon as they spot an abnormally high level, they will whip out their prescription pads.

Already, health authorities have ventured along that path. International treatment guidelines once said that the first step for patients with full spectrum Type 2 diabetes was to exercise and lose weight. Only after patients had tried that and utterly failed were doctors to prescribe drugs.

As of August, however, the guidelines have changed.

“We recommend starting patients on metformin immediately,” said Dr. David M. Nathan, who directs the diabetes center at Massachusetts General Hospital and is a member of the group that formulated the new guidelines. “Don’t start with lifestyle alone, even for newly diagnosed people. Most end up failing the lifestyle recommendations.”

He added: “What classically happened was that the patients would take three months and try to diet. It wouldn’t work. Then they joined a health club. It didn’t work. Then they take another three months and try some more. By the time they were on effective therapy, they had had diabetes for years and years.”

In developing the new guidelines, the group reasoned that the consequences of untreated diabetes — which can include heart attacks, strokes, kidney failure, blindness and amputations — are too dire to allow high blood sugar levels to persist.

But that does not necessarily mean that drugs should be the first choice for people with so-called prediabetes, who have elevated blood sugar levels but have not yet developed the disease.

Or so says Rena Wing, a professor of psychiatry and human behavior at Brown University Medical School. Dr. Wing helped develop the diet and exercise program for the federal study of prediabetes.

Drugs, she said, should be a last resort for people with prediabetes. The answer to the problem of poor compliance with diet and exercise programs is to develop better ways of encouraging people to follow them, she said.

“If you have a problem that can be solved with a lifestyle change, you have to work on how to do that, how to bring it to people,” Dr. Wing said. “We have to change the system.”

For example, she said, there could be lists of effective programs for weight loss and exercise so doctors would stop telling patients to simply “lose weight” and say instead, “Join this program.”

Yet, if people know that a drug can solve their problem, how much incentive is there to change their diet and exercise patterns?

“The behaviorists say that if you have a medication available, you can hang up the idea that the patients will try lifestyle,” Dr. Nathan said.

Still, he said, “as a realist, it seems to me that the truth is that whatever your thoughts are on the importance of self-control and willpower and profligacy, and that we shouldn’t be such pigs, that we should exercise more, the truth is that we are what we are.”

Dr. Nathan added, “We have recognized that although lifestyle can be miraculously effective, it often isn’t, because people won’t change.”

by Gina Kolata at The New York Times, published on Oct 17 2006

DIABETES ARTICLES - Merck Wins U.S. Approval for a New Diabetes Drug

2006-11-09T02:02:00.000-08:00

DIABETES ARTICLES

Merck Wins U.S. Approval for a New Diabetes Drug

Federal drug regulators yesterday approved a new diabetes medicine from Merck that is expected to become a blockbuster treatment used by millions of people worldwide.
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Merck

Januvia, the new medicine, is a once-daily pill that has fewer severe side effects than existing diabetes medications and does not cause weight gain, according to clinical trials. The Food and Drug Administration said Januvia could be prescribed either on its own or in addition to other medicines.

It is aimed at Type 2 diabetes, the most common form, which affects nearly 21 million Americans — 7 percent of the population — and more than 200 million people globally.

Merck said Januvia would cost just under $5 a day, or about $145 a month, comparable to existing treatments. Merck shares rose slightly after the approval was announced yesterday morning, which had been expected.

Many doctors say they believe Januvia — and Galvus, a similar drug from Novartis that is expected to be approved later this year — will be valuable for many patients with diabetes, most of whom have dangerously high levels of blood sugar despite existing treatments.

“I can’t wait to put people on the drug,” Dr. James Underberg, a clinical assistant professor at New York University medical school who participated in a clinical trial of Januvia. Januvia is the third major new diabetes drug approved since the summer of 2005, and potentially the most important, analysts and doctors say. The drug works in a different way than existing treatments, and its pill form makes it more convenient than Byetta, a treatment approved last year that has some of the same benefits as Januvia but must be taken by injection.

Analysts predict that Januvia, either as a stand-alone treatment or in combination with an existing diabetes drug called metformin, will have worldwide sales of nearly $2 billion by 2010. Merck hopes to win approval for that combined drug early next year.

Optimism about Januvia has helped push Merck shares up 38 percent this year, compared with an 11 percent gain for the average large drug stock. Merck shares closed yesterday at $43.96, up 20 cents — at their highest level since the company withdrew its arthritis drug Vioxx in September 2004 after a study linked Vioxx to heart attacks and strokes.

Executives at Merck declined to comment on their plans for advertising Januvia to consumers. Unlike several other major drug makers, Merck has not committed to waiting at least six months before advertising new drugs so that doctors have a chance to learn about new therapies before patients begin asking for them.

But physicians like Dr. Underberg are already enthusiastic. “It doesn’t cause weight gain, it doesn’t cause episodes of hypoglycemia, and the side effects otherwise are pretty moderate,” he said.

Hypoglycemia is a potentially dangerous condition in which blood sugar levels drop too fast. In severe instances, it can cause fainting or even coma. Several older diabetes drugs can cause hypoglycemia by pushing the pancreas to produce large amounts insulin quickly.

In contrast, Januvia and Galvus are the first in a newer class of drugs called DPP-IV inhibitors, which work by enhancing levels of a natural protein called GLP-1. The protein stimulates the pancreas to produce insulin and discourages the liver from making glucose. But the DPP-IV inhibitors work only when blood sugar levels are already elevated, such as after a meal, sharply lowering the risk for hypoglycemia.

“The approval of Januvia marks an important advance in the fight against diabetes,” Dr. Steven Galson, director of the F.D.A.’s center for drug evaluation and research, said in a statement. “We now have another new option that treats the disease in an entirely new way.”

Diabetes is a disease in which blood sugar rises uncontrollably from a lack of, or resistance to, insulin, a hormone normally produced in the pancreas. In Type 1 diabetes, the pancreas is unable to produce insulin.

Type 2 diabetes is linked to obesity and inactivity. Typically, the disease progresses over several years as the pancreas gradually loses the ability to produce insulin, and drug treatments lose their effectiveness. Eventually, many patients wind up injecting themselves with insulin to control their blood sugar. Severe, late-stage diabetes sharply raises the risks of many medical problems, including heart attacks, strokes, kidney disease and blindness.

Jay Galeota, general manager of Merck’s global diabetes division, said Merck planned to ship Januvia to pharmacies and offer samples to doctors’ offices quickly. The company expects to market Januvia to both doctors and patients almost immediately, he said.

“We’re confident that we’re going to communicate the science of Januvia in a very wide way,” he said. “We’re expecting very rapid uptake right away.”

While there are several major classes of diabetes medicines already on the market, many have side effects that discourage patients from taking them, including weight gain and nausea. As a result, the market is ripe for new treatments, doctors and analysts say.

In clinical trials that examined Januvia in 2,719 patients, the most common side effects were sore throat, diarrhea and colds, the F.D.A. said.

Richard Evans, an analyst at Sanford C. Bernstein & Company, said he expected Januvia and Galvus to rapidly replace an older class of drugs called sulfonylureas. The newer drugs are similarly effective but much less likely to cause weight gain and hypoglycemia, he said.

“Everybody knows that sulfonylureas are kind of a losing game,” he said. While Galvus and Januvia are very similar, Januvia may have an edge because it clearly works as a once-a-day pill, while Galvus was initially formulated to be taken twice daily, Mr. Evans said. Novartis, the manufacturer of Galvus, now claims that its drug is effective when taken once daily, but doctors may be skeptical of that claim, he said.

Tony Butler, an industry analyst at Lehman Brothers, said he expected that Januvia would have sales of $271 million next year, rising to $1.1 billion by 2010. Mr. Butler said sales of the Januvia-metformin combination pill would be $500 million more in 2010.

by Alex Berenson at The New York Times, Published: October 18, 2006

DIABETES ARTICLES - Firm Reports Stem Cell Use for Making of Insulin

2006-11-02T22:36:00.000-08:00

DIABETES ARTICLES

Firm Reports Stem Cell Use for Making of Insulin

Scientists at a small California biotechnology company reported yesterday that they had developed a process to turn human embryonic stem cells into pancreatic cells that can produce insulin and other hormones.

The work by the company, Novocell, based in San Diego, is a step toward using embryonic stem cells to replace the insulin-producing cells that are destroyed by the body’s immune system in people with Type 1, or juvenile, diabetes. Years of research remain, however, before a therapy developed from this approach can be put to use.

Embryonic stem cells can potentially be turned into any type of tissue in the body, and scientists are trying to figure out how to form various types.

Other researchers have previously reported turning various types of human or animal stem cells into cells that produce insulin. But the new work, published online yesterday by the journal Nature Biotechnology, represents a significant advance, some experts said.

“It provides some very strong evidence that it will be possible to make insulin-producing pancreatic beta cells from human E.S. cells in a culture dish,” Dr. Mark A. Magnuson, a professor at Vanderbilt University, wrote in an e-mail message. He said the scientists at Novocell had achieved an efficiency of cell conversion and insulin production in “orders of magnitude higher than anything previously accomplished.”

Dr. Magnuson, however, also said that in laboratory experiments the cells had not varied their insulin production much in response to the level of glucose, a key requirement for a beta cell. So more work is needed.

Emmanuel Baetge, the chief scientific officer at Novocell and the senior author of the paper, said the cells were “not fully mature” but rather seemed similar to the beta cells in a human fetus. Those cells also do not respond to glucose, a capability gained after the baby is born.

He said the insulin-producing cells had been derived by taking the embryonic stem cells and adding and subtracting various growth factors in a series of stages that mimicked the process that cells in an embryo go through to become a pancreatic cell. The process takes 16 to 20 days, he said.

Dr. Baetge said that the company hoped to begin testing its cells in animals in 2008 and that if all went well to begin clinical trials in human patients in 2009. Such timeline projections by companies often prove overly optimistic.

Doctors are already experimenting with transplanting cells from the pancreases of deceased organ donors into people with Type 1 diabetes. In some cases, the transplants relieve the recipients of the need to give themselves daily injections of insulin. But the effect wears off for most patients by two years.

Donated pancreases are scarce, so scientists hope to use stem cells to create insulin-producing cells. People with Type 1 diabetes and their families were among the biggest backers of the effort to create a $3 billion program of stem cell research in California. The program’s chairman, the real estate developer Robert N. Klein, has a son with diabetes.

by Andrew Pollack at New York Times

DIABETES ARTICLES - The Beep of the Sensor, the Thrill of Control

2006-09-17T18:23:00.000-07:00

DIABETES ARTICLES.

The Beep of the Sensor, the Thrill of Control

On Cape Cod for a two-week vacation last August, I went to sleep one night and almost never woke up. An insulin-dependent diabetic, I had developed such a severe low-blood-sugar level that my 9-year-old daughter, Annie, found me unresponsive and soaked in sweat in the morning.With my wife in New Jersey for a couple of days to attend a meeting, Annie managed to dribble some grape soda into my mouth, followed by a few spoonfuls of Marshmallow Fluff. Fifteen minutes later, my blood sugar rising, I came to my senses enough to think, “Not again!”

No, I’m not one of those out-of-control diabetics who refuse to follow their doctors’ advice. I knew a guy like that once. When I told him I tested my blood sugar seven or eight times a day, he told me, “I’d rather die than do that.” And then he did die, a couple of years later, from severe low blood sugar.

I’m at the other extreme, always testing, then taking a little insulin to bring down a high or having a snack to avoid a low. The crazy thing, though, is that by carefully following my doctor’s advice to keep my blood-sugar levels as close to normal as possible (which, studies have shown, greatly reduces the risk of long-term complications), I always live on the edge, a cupcake away from a coma.

Every day or two, I get a brief, mild low that leaves me feeling muddle-headed and cranky for half an hour. Not the end of the world, but a definite annoyance. And in the 30 years since developing diabetes during my freshman year of college, I’ve had seven or eight awful lows like the one last August.

So imagine my enthusiasm when I learned last fall that the Food and Drug Administration had finally approved the first implantable sensor to continuously measure glucose, beeping or vibrating a warning whenever levels head too high or too low. On Monday, June 12, I took the train down to Washington to be hooked up while the annual meeting of the American Diabetes Association was in town.

The device, made by Medtronic MiniMed, is called the Paradigm Real-Time, a combination insulin pump and continuous glucose sensor. The sensor doesn’t control the pump but allows a diabetic to make quicker, presumably better decisions. I’d already been on a stand-alone MiniMed pump for a few years, but I found it only an incremental improvement over taking insulin by injection.

Like the pump, the sensor requires injecting a tiny catheter (less than an inch long) into the midsection of the body, and changing it every three days to avoid infection. The sensor has a coated tip that measures the electrical conductivity of the interstitial fluid, the juice floating between fat cells right under the skin. As luck would have it, the conductivity is directly proportional to how much glucose is floating around in the juice.

Even with the help of an expert trainer from MiniMed, I found that injecting the catheter took much more dexterity than injecting one for a pump. It has to be placed above the hip or the buttocks, which makes reaching it awkward, and then the wire leading from the sensor has to be connected to a transmitter that wirelessly sends the information to the pump.

When everything was in, I had two catheters and the transmitter all taped to my body, plus the pump hanging on my belt. Kind of weird, but kind of cool, in a sci-fi way, and I remained thrilled at the prospect of seeing my first glucose reading.

Then the waiting began. The sensor needs three hours to settle in before it can begin transmitting data. By late afternoon, when it was supposed to start, I got an error message instead. When I tried to recalibrate it a half-hour later, it still wasn’t working right, so I had to remove it and inject a second one. It was after 9 p.m. before the second one finally began working.

At first, I was transfixed by the numbers as they were updated every five minutes. That night, however, the sensor kept beeping me awake, nearly every hour, warning that my glucose level was too high.

I kept following the recommendations of the embedded calculator, taking only very small amounts of insulin to bring my sugar level down. But by morning, I was still high, so I followed my own usual guesstimate and took much more.

Two hours later, while attending a session at the diabetes association meetings, in which four experts talked about the new sensors, I heard mine beep again, this time warning me that my glucose level was plummeting. I quickly drank a juice box, and within minutes my numbers started leveling off. I had avoided my first low. All the hassles of the past 24 hours were forgiven. This bionic diabetic was in rapture.

Over the next six weeks of testing, I came down to earth as I realized that while the sensor enabled me to drastically cut my usual number of lows, it did not eliminate them.

The main problem was that the sensor was simply not as accurate as a blood-glucose tester. MiniMed’s studies show the sensor’s accuracy can be off by as much as 18 percent. Another sensor, just approved by the F.D.A. and made by DexCom, is said by some researchers to be a bit more accurate, as is a third device, from Abbot, which has not yet been approved. But none are as accurate as a standard blood-sugar test.

I also had three sensor catheters slip out and require early replacement, which would be especially annoying to anyone paying the $35 that each sensor costs; I wasn’t, because MiniMed had supplied everything free for testing, but everybody else will, since the sensors are not yet covered by insurance. With each catheter intended to last just three days, the bill comes to $350 a month.

But the bottom line is that over the entire six weeks I had only a few lows that left me feeling woozy, the kind I used to put up with two or three times a week.

On July 24, my test period over, I felt like Mr. Magoo without his glasses. I made it through our annual Cape Cod vacation without incident, but Annie kept a wary eye on me. I think I owe it to her to start shelling out that $350 per month, at least until the insurance companies figure out what a lifesaver this transformative new technology can be.

by Dan Hurley at The New York Times

DIABETES ARTICLES - Genetic Test for Diabetes May Gauge Risk, but Is the Risk Worth Knowing?

2006-08-19T04:05:00.000-07:00

DIABETES ARTICLES.

Genetic Test for Diabetes May Gauge Risk, but Is the Risk Worth Knowing?

Like her mother and grandmother, my mother had Type 2 diabetes. For her, its most awful complication was artery disease, which caused innumerable mini-strokes, pinched off the circulation to her legs and ultimately ended her life.

My sisters and I hope to avoid her fate, or at least postpone it. Since obesity often brings on the disease in people with a family history like ours, we try to watch our weight.

Lately, I've been intrigued by the discovery of a gene variant that can predispose people to this type of diabetes, which usually develops in adults. Having the variant doesn't guarantee that you will get the disease, and lacking it doesn't guarantee that you won't. But it tells something about risk.

People who have one copy of the gene, inherited from one parent, have 1.4 times the risk of someone who lacks it, and those with two copies -- one from each parent -- have about twice the risk. People with the variants tend to make insufficient insulin, the hormone that lowers blood sugar.

The gene accounts for about 21 percent of all diabetes cases; more than a third of Americans carry one copy. Seven to 10 percent carry two.

Am I one of them? Do I want to find out? There is no way to do that yet, but Decode Genetics, the Icelandic company whose researchers found the gene variant, is planning to market a test, possibly by 2007 or 2008. It will probably cost hundreds of dollars, and be available only through doctors.

At first glance, testing doesn't seem to offer much to people like me. We already figure the deck is stacked against us. Even if the test came out negative, I would still suspect I was at risk, but from some other gene that hasn't been discovered yet.

Then again, if I tested positive, the threat would seem more real. Maybe I would eat less, exercise more, check my blood sugar more often, keep better track of risk factors for heart disease like cholesterol and blood pressure. I would also have to decide whether to inflict the information on my sons.

I'm not sure I want that straight-up shot of reality. Even with my family history, I figure there's a chance I got lucky and didn't inherit whatever my mother had. A test could erode that bit of optimism.

Dr. David Altshuler, a diabetes expert at Harvard who has studied the gene variants, said he thought offering a routine genetic test now would be premature.

He said the test would not help people who already know they are at risk because of their family histories or because they have impaired glucose tolerance, a condition that often leads to diabetes. They should already be trying to exercise and lose weight, or taking a medication to treat the glucose problem, he said.

''There may be people who would say, 'If I knew my risk was 50 percent instead of 30 percent, I would like to know that to make me try harder,' '' Dr. Altshuler said. ''You could argue that either of those is really high, and you should be trying hard already.''

He also cautioned that people who do get tested must keep in mind that a positive result does not seal their fate: their risk is higher, but not absolute. Similarly, those who test negative are not in the clear. If they have other risk factors they still have to be careful, because other genes are almost certainly involved in diabetes as well.

Dr. Richard Kahn, chief scientific and medical officer for the American Diabetes Association, had similar concerns and said the research was important, but, ''translating it into some practical action is a long ways away.''

Dr. Altshuler said another reason for his wariness is that ''there is another gold rush in this, in diagnostics.''

He praised Decode as first-rate in terms of science and ethics, but he said he worried about other companies looking to cash in on legitimate research by marketing questionable genetic tests directly to consumers.

''A lot of companies will push the idea of doing genetic testing -- 'You can have this done, we'll give you advice,' '' he said. ''I'm deeply concerned. Companies are pushing things that aren't valid, saying send us your DNA and we'll give you advice about lifestyle or diet based on your genetic profile. Very little is known, let alone anything with implications.'' But, he noted wryly, despite all his reservations he has not been able to talk his own mother out of wanting the genetic test for Type 2 diabetes.

The Federal Trade Commission is also concerned. Last month, its Web site carried a warning that there were no valid studies to support many genetic tests being marketed to consumers to gauge their disease risks or suggest they need dietary supplements or special diets.

Dr. Kari Stefansson, Decode's chief executive, said genetic tests that measure the probability of developing a disease ''are a new sort of information that our society is growing rapidly more accustomed to, but it is still not absolutely clear how we are going to use it.''

The first use of a Type 2 diabetes test, he said, would probably be in people with impaired glucose tolerance. Those who came out positive could be treated aggressively, perhaps with drugs. Those who tested negative could be offered a more conservative approach.

For people with a family history and normal glucose tolerance, Dr. Stefansson said, the best use of the test would be to test both the relative with diabetes and the concerned family member. If both tested positive, then the family member was at high risk and could try to do something about it.

What about people like me, whose diabetic relatives are long gone? I could be tested, he said, and if I had the risky variant it might be a warning sign. But if I didn't have it, I still wouldn't be out of the woods.

So what do I want to do? Right now, I'm leaning toward having the test if it becomes available. I'm not sure what I'd do with the results or whether they would mean anything for my future. But I'd like the information, and the right to decide for myself whether to act on it.

By DENISE GRADY at The New York Times

DIABETES ARTICLES - Concern Grows Over Increase In Diabetes Around World

2006-08-09T18:24:00.000-07:00

DIABETES ARTICLES.

Concern Grows Over Increase In Diabetes Around World

The number of people around the world suffering from diabetes has skyrocketed in the last two decades, from 30 million to 230 million, claiming millions of lives and severely taxing the ability of health care systems to deal with the epidemic, according to data released Saturday by the International Diabetes Federation.

While the growing problem of diabetes in the United States has been well documented, the federation's data show that 7 of the 10 countries with the highest number of diabetics are in the developing world.

China has the largest number over age 20, around 39 million people, or about 2.7 percent of the adult population, the federation says. The group says India has the second-largest number of cases, with an estimated 30 million people, or about 6 percent of the adult population.

Other countries have higher rates of diabetes than either China or India, but the federation says rising diabetes rates in the large, rapidly industrializing nations are especially worrisome because of the size of their populations. In some countries in the Caribbean and the Middle East, the percentage of diabetic people ranged from 12 to 20 percent.

In some of the world's poorest nations, the disease is a quick death sentence. While Americans can live for many years with the disease, a person in Mozambique who requires injections of insulin can expect to live just a year; in Mali, such people survive about 30 months.

There are many factors driving the growth in diabetes worldwide, but most experts agree that changes in lifestyle and diet are the chief culprits, in addition to genetic predisposition. As developing countries industrialize, people tend to do work involving less physical activity and eat food that is cheap but high in calories. The combination causes weight gain, which leads to greater risk of developing Type 2 diabetes, the most common form of the disease.

The other form, Type 1, is responsible for only 5 percent to 10 percent of cases, and is believed to stem almost entirely from genetic factors.

''Diabetes is one of the biggest health catastrophes the world has ever seen,'' said Dr. Martin Silink, the president-elect of the International Diabetes Federation.

To help stem the tide of the disease, the federation is seeking a United Nations resolution to recognize the seriousness of the problem. If that effort is successful, it would be the first of its kind for a noncommunicable disease.

by Marc Santora at New York Times.

DIABETES ARTICLES - Diabetes Prevention in a Cuppa Joe?

2006-08-03T20:12:00.000-07:00

DIABETES ARTICLES

Diabetes Prevention in a Cuppa Joe?

Drinking coffee is linked to a reduced risk for diabetes, a new study reports, and caffeine apparently has little to do with the effect.

The researchers, led by Mark A. Pereira, associate professor of epidemiology at the University of Minnesota, studied the dietary habits of more than 28,000 postmenopausal women. They found that those who drank six or more cups of regular or decaffeinated coffee a day had a 33 percent reduced risk of Type 2 diabetes, compared with those who drank none. Those with intermediate levels of coffee intake tended to have intermediate diabetes risk. Over the period of the study, from 1986 to 1997, 1,418 women developed the illness.

Coffee drinking was also associated with eating less fruit and more high-fat dairy products, higher alcohol and cigarette consumption, high blood pressure and a lower level of vigorous exercise, some of which are known risk factors for diabetes. When adjusted for these lifestyle factors, the link with a reduced risk for diabetes was weaker but still present, and the association was stronger for decaffeinated than caffeinated coffee.

"The thing about coffee that sets it apart from many other dietary factors that may protect against diabetes is that people consume a lot of it," Dr. Pereira said. "We can see the effect because we're able to study massive doses of it."

The authors acknowledge that their study, which appeared yesterday in The Archives of Internal Medicine, depends on self-reports rather than objective experimental design.

The scientists were unable to determine what ingredient in coffee might be protective against diabetes, but they pointed out that coffee was known to be a rich source of minerals and antioxidants that may delay or prevent the onset of the illness.

Diabetes Articles - Link Between Diabetes and Alzheimer’s Deepens

2006-07-31T18:02:00.000-07:00

Diabetes Articles.

Link Between Diabetes and Alzheimer’s Deepens

Several new studies suggest that diabetes increases the risk of Alzheimer’s disease, adding to a store of evidence that links the disorders. The studies involve only Type 2 diabetes, the most common kind, which is usually related to obesity.

The connection raises an ominous prospect: that increases in diabetes, a major concern in the United States and worldwide, may worsen the rising toll from Alzheimer’s. The findings also add dementia to the cloud of threats that already hang over people with diabetes, including heart disease, strokes, kidney failure, blindness and amputations.

But some of the studies also hint that measures to prevent or control diabetes may lower the dementia risk, and that certain diabetes drugs should be tested to find whether they can help Alzheimer’s patients, even those without diabetes. Current treatments for Alzheimer’s can provide only a modest improvement in symptoms and cannot stop the progression of the disease.

The new findings were presented yesterday by the Alzheimer’s Association at a six-day conference in Madrid attended by 5,000 researchers from around the world.

Alzheimer’s affects 1 in 10 people over age 65, and nearly half of people over 85. About 4.5 million Americans have it, and taking care of them costs $100 billion a year, according to the association. The number of patients is expected to grow, possibly reaching 11.3 million to 16 million by 2050, the association said.

But those projections do not include a possible increase from diabetes.

“Alzheimer’s is going to swamp the health care system,” said Dr. John C. Morris, a neurology professor at Washington University in St. Louis and an adviser to the Alzheimer’s Association.

Not everyone with diabetes gets Alzheimer’s, and not all Alzheimer’s patients are diabetic. But in the past decade, several large studies have found that compared with healthy people of the same age and sex, those with Type 2 diabetes are twice as likely to develop Alzheimer’s. The reason is not known, but researchers initially suspected that cardiovascular problems caused by diabetes might contribute to dementia by blocking blood flow to the brain or causing strokes.

More recently, though, scientists have begun to think that the diseases are connected in other ways as well. In both, destructive deposits of amyloid, a type of protein, build up: in the brain in Alzheimer’s, in the pancreas in Type 2 diabetes.

People with Type 2 often have a condition called insulin resistance, in which their cells cannot properly use insulin, the hormone needed to help glucose leave the blood and enter cells that need it. To compensate, the pancreas makes extra insulin, which can reach high levels in the blood. Too much insulin may lead to inflammation, which can contribute to damage in the brain.

In addition, abnormalities in glucose metabolism and insulin levels in the brain itself may be harmful. Some research has found that too much insulin in the brain can contribute to amyloid buildup. Researchers have even suggested that Alzheimer’s disease may actually be “Type 3 diabetes,” a form of the disease affecting the nervous system.

About 20 million people in the United States have Type 2 diabetes. The number has doubled in the past two decades. An additional 41 million are “prediabetic,” with blood sugar rising toward the diabetic level. Diabetes rates are expected to increase because rates of obesity are rising, and epidemiologists predict that one in three American children born in 2000 will eventually develop Type 2 diabetes.

Worldwide, diabetes is also on the rise, increasing to 230 million cases from 30 million in the past 20 years.

One of the new studies found that even people who had borderline diabetes were 70 percent more likely than those with normal blood sugar to develop Alzheimer’s. The study, by researchers from the Karolinska Institute in Sweden and the Stockholm Gerontology Research Center, included 1,173 people 75 and older.

The incidence of dementia was highest in borderline diabetics who also had high blood pressure. But the higher risk occurred only in those who did not carry the gene apo E4, which is associated with some cases of Alzheimer’s.

The director of the study, Dr. Weili Xu, said that since increased exercise and changes in diet can reverse borderline diabetes, they may also help ward off dementia.

Another study found that in people with diabetes, the higher their blood sugar, the greater the risk of dementia. Higher levels of blood sugar mean the diabetes is severe or is being poorly treated, or both.

The study, led by Rachel A. Whitmer of the Division of Research at Kaiser Permanente in Oakland, Calif., was based on the records of 22,852 patients with Type 2 diabetes who were followed for eight years.

Initially, none had dementia. The researchers looked at glycosylated hemoglobin, a blood test that reflects blood sugar levels for the previous two months. Normal is 7 or lower. Here, the risk of dementia rose when the level reached 10. Those with readings from 10 to 11.9 had 13 percent more risk than people with levels below 10. From 12 to 14.9, the risk was 24 percent higher. Over 15, it jumped to 83 percent higher.

In an interview, Dr. Whitmer said one implication of the study was that tight control of blood sugar was important in elderly patients, even though some doctors tended to relax the rules for them.

“Tight control is important for the whole life span,” Dr. Whitmer said. “The older you are, the more likely you are to get dementia.”

She added: “With the whole diabetes epidemic we’re seeing much more Type 2, so are we going to see even more Alzheimer’s than we thought we would see? If we continue in this direction, it’s a little bit frightening.”

Another study suggested that a certain class of diabetes drug, commonly called a glitazone, might lower the risk of Alzheimer’s in people with diabetes. Pilot studies in small groups of patients have hinted that the drugs may be of some help, and the National Institute on Aging is sponsoring research in this area.

In the study, researchers used the records of 142,328 patients in the Veterans Affairs system who did not have dementia but were just starting to take a glitazone or insulin. They tracked the patients for six years. Compared with those using insulin, among the patients who took pioglitazone (Actos) or rosiglitazone (Avandia), there were nearly 20 percent fewer cases of Alzheimer’s. The glitazones had a similar advantage over another diabetes drug, metformin.

Glitazones lower blood sugar by helping the body to use insulin more efficiently, so that less insulin is needed. The drugs may also lower inflammation.

Though the results sound like good news for patients, the director of the study, Donald R. Miller, an epidemiologist at Boston University and at the Department of Veterans Affairs, cautioned that the findings were not conclusive and that they did not mean that people should start taking the drugs to ward off Alzheimer’s.

“This is preliminary, the first study of its kind,” Dr. Miller said, emphasizing that more studies were needed to verify his results.

GlaxoSmithKline, the maker of rosiglitazone, sponsored the study but did not control the way it was done or interpreted, Dr. Miller said.

Another study, a small one with only 25 patients, tested pioglitazone for 18 months in nondiabetic people with Alzheimer’s to see if it was safe and showed signs of slowing the disease.

The drug did seem safe, causing only some foot and ankle swelling. But compared with people taking placebos, patients taking the drug showed no statistically significant differences in memory, thinking, daily function or abnormal behavior.

But there were hints that some measures worsened less in the patients on the drug, and the researchers, led by Dr. David S. Geldmacher of the University of Virginia, said it deserved further study in Alzheimer’s. The study was sponsored by the drug’s maker, Takeda.

by Denise Grady at The New York Times.

DIABETES ARTICLES - Study of Children With Diabetes Suggests Obesity Is Affecting Life Expectancy

2006-07-26T04:47:00.000-07:00

DIABETES ARTICLES.

Study of Children With Diabetes Suggests Obesity Is Affecting Life Expectancy

Children who get obesity-related diabetes face a much higher risk of kidney failure and death by middle age than people who develop diabetes as adults, a study suggests. The research, in The Journal of the American Medical Association, lends support to warnings obesity-related ills are on the verge of shortening the average life span in the United States. The study involved Pima Indians in Arizona. Of the 1,865 participants with Type 2 diabetes, 96 developed it in childhood. During at least 15 years of follow-up, 15 of them, or 16 percent, developed end-stage kidney failure or died from diabetic kidney disease by age 55. That compared with 133, or 8 percent, of those who developed diabetes after age 20.

Diabetes Articles. Carbohydrate Diet for Diabetics

2006-07-03T22:48:00.000-07:00

Diabetes Articles.

Carbohydrate Diet for Diabetics

Since the early 1960's, studies have hinted that the traditional advice to diabetics to eat lots of protein and very few carbohydrates may not be the wisest approach. Such a diet is likely to be rich in cholesterol-raising fats, which would further increase the diabetic's already high risk of developing atherosclerotic heart disease.

Now, several recent studies have clearly shown that the traditional high-protein, low-carbohydrate diet is much less effective in controlling diabetes than a diet rich in fibercontaining complex carbohydrates. In the latest such study, published in the Jan. 3 issue of The Lancet, a leading British medical journal, researchers found that a diet containing large amounts of beans, whole-grain bread, vegetables and fruits ''improves all aspects of diabetic control,'' including how high the blood sugar rises immediately after eating.

The research team, from Oxford University, concluded on the basis of their studies that ''continued use of a low carbohydrate diet no longer appears justified.'' Similar conclusions have been reached by Dr. James W. Anderson of the University of Kentucky, who has been able to reduce and sometimes eliminate the need for insulin in diabetics who follow his high-fiber, high-carbohydrate diet.

In the British experimental diet, most of the protein was derived from legumes, such as kidney beans and butter beans, which are rich in dietary fiber as well as complex carbohydrates (starches). The researchers said the high-bean diet, when introduced slowly, produced little abdominal discomfort, but they predicted that most people would eventually find the menu monotonous. The researchers are now examining modified versions that may be equally effective and more acceptable as lifelong diets. A Voyage to Uranus

The National Aeronautics and Space Administration has approved a plan to continue Voyager 2 on a trajectory that would take it to Uranus in 1986 after flying past Saturn this August.

Under the plan, the spacecraft should fly within 66,000 miles of Uranus Jan. 24, 1986, making measurements and taking pictures as it races by and heads for a possible encounter later with Neptune. Uranus, the seventh planet out from the Sun, is twice as far from the Sun as Saturn.

The decision to aim Voyager 2 for Uranus was reached by NASA officials after it was determined that Voyager 1 had achieved all its scientific objectives in flying by Saturn and its moons last November. By continuing on a Uranus-bound trajectory, Voyager 2 will not be able to make a close reconnaissance of Saturn's largest moon, Titan, but will still return thousands of high-resolution pictures of Saturn and several of its other moons. Mussels Have Problems Too

To all appearances, mussels enjoy a serene lifestyle and have no cares in their marine world. But scientists have discovered that life can be hard for the placid grayish-brown creatures that are usually found clustered on tide-pool rocks or on wooden pier pilings. In fact, life can be so tough that mussels, as well as other fish, are showing signs of stress, a byproduct of modern industrialization.

Dr. Florence Harrison, a marine biologist at the University of California's Lawrence Livermore National Laboratory, together with four co-workers has found that chemicals and heavy metals that flow to the sea from the nation's industrial centers are the culprits. They cause biological stress symptoms ranging from a shortened life span to stunted growth, decreased reproduction and increased susceptibility to disease.

The pollutants the biologists are studying include hydrocarbons from oil spills, discharges from coal and oil-burning plants and such metals as copper in effluents from sewage and power plants. The research was conducted in a marine laboratory by raising common bay mussels and segmented worms that live in the ocean floor and exposing them to pollutants found in the environment.

The project is part of a United States Environmental Protection Agency project called ''Musselwatch'' that studies mussel populations around the world, enabling scientists to keep an eye on the health of shoreline areas by monitoring the health of the animals and their exposure to pollutants. The studies are funded by the E.P.A. and the Federal Department of Energy.

from New York Times

DIABETES ARTICLES. Surgeons elated by heart partient

2006-06-29T18:29:00.000-07:00

DIABETES ARTICLES.

Surgeons elated by heart partient

Surgeons who implanted the first self-contained artificial heart on Monday said today that so far the patient's recovery had vastly exceeded their expectations.

The surgeons strongly cautioned that the procedure was an experiment in which a complication could occur at any time because of the patient's severe illness and the complexity of the AbioCor artificial heart that they implanted. But they expressed optimism that their patient, identified only as a man in his 50's, would be able to return to daily activities.

One complication that the surgeons described as ''very minor'' has already occurred; late Monday night, the patient underwent a second operation lasting two hours to stop bleeding caused by one or two loose stitches among the hundreds placed in his chest during the original implant operation. Officials at Jewish Hospital, where the implant was performed, did not mention the problem in Tuesday's announcement of the procedure.

At a news conference today, the surgeons described the patient as a diabetic man in his mid-to-late 50's who was terminally ill with heart failure and who was in dire condition before the implant operation. Another medical center outside the Louisville area had rejected the man as a candidate for a heart transplant because he had significant kidney failure and abnormally high pressure in blood vessels in his lungs, the surgeons said.

But surgeons who implanted his artificial heart say he may eventually be eligible for a heart transplant.

The man had had an 80 percent chance of dying within 30 days because earlier heart attacks had left such extensive scarring that the heart's two pumping chambers were failing badly, they said.

Before the operation, the man's lungs had been drowning from pulmonary edema, a buildup of fluid that occurs in heart failure, said the surgeons, Dr. Laman A. Gray and Dr. Robert D. Dowling, from the University of Louisville. By this morning, the artificial heart, which has been beating about 120 times a minute, had virtually cleared the fluid from his lungs. They said they were surprised that the problem had resolved so quickly.

The man is conscious but sedated, has responded appropriately to commands and recognizes relatives who have been constantly at his side, the doctors said. They said they expected him to resume speaking after doctors removed a breathing tube connected to a mechanical respirator; later they said the tube had been removed.

Dr. Gray said one reason for his optimism was that tests that measure blood levels of creatinine, a substance that reflects kidney function, had shown no deterioration.

The doctors said they hoped to have the man sit in a chair in the next few days. But they said they were reluctant to make predictions about when he might walk and conduct other normal activities because the man's muscles had become so weak in recent weeks as his heart failure worsened and he was forced to use a wheelchair.

''When he came into the hospital, he could only walk a few feet at a time and could not walk down the corridor because he was so weak,'' Dr. Gray said. ''He did not have enough energy to eat'' and digest protein.

Dr. Dowling said his team did not know how long it would take for the man to gain enough strength to resume normal activities if he continued to progress without complications.

The man sought the heart less than two weeks ago, the doctors said.

When he was admitted to Jewish Hospital, the surgeons said, they had to insert a device known as an intra-aortic balloon pump to help his heart pump. They said the man's heart could barely pump enough blood to keep him alive. He was not a good candidate for a ventricular assist device, another type of implanted device that can keep some people with heart failure alive, because of increased blood pressure in his lungs. They said he needed three drugs, which they did not name, to maintain an adequate blood pressure. A standard creatinine blood test was about 3, showing moderately severe kidney failure.

by Laurce K. Altman at New York Times

Diabetes device to monitor blood sugar

2006-06-22T19:26:00.000-07:00

DIABETES ARTICLES - Diabetes device to monitor blood sugar

A new device that monitors blood sugar constantly and lets the patient administer insulin right away if needed might greatly simplify life for people with diabetes.

The Medtronic Inc. device combines an insulin pump and a continuous blood-monitoring system. An alarm sounds if blood sugar goes out of safe ranges.

Patients are clamoring to test and use the device, researchers for the company told participants here at the meeting of the American Diabetes Association.

The device, called the Minimed Paradigm Real Time Insulin Pump and Continuous Glucose Monitoring System, is approved for people older than 18 with insulin-dependent diabetes. People with type 1 diabetes, also known as juvenile diabetes, depend on insulin, as do some type 2 diabetics.

"It's a pretty exciting advance," said Dr. John Buse, vice president of the American Diabetes Association. "I am not sure that it's the best pump ever and the best monitoring device ever. It's not an artificial pancreas...but it's getting pretty close," Buse added in an interview.

Linda Frederickson, a nurse and diabetes educator who tested the device for Medtronic, said she was surprised at how much the device told her.

"I write books and used to write books about food and carbohydrate and I think I am pretty smart...but I found out more about foods using this sensor. You can tell what your favorite food...is going to do to you and when it will do it," she told a briefing for investors and analysts.

Dr. Bruce Buckingham, a Stanford University pediatric endocrinologist who tested this and other monitors, said parents were surprised to watch the monitor's effects on their children with type 1 diabetes.

"It really changed their habits and how they eat and how they deliver their insulin," Buckingham told the briefing.

BETTER CONTROL

Buckingham's study showed that, on average, the children in his study showed a 20 percent decrease in A1c, a commonly used measure of blood sugar.

"It was very easy to recruit for this study. Patients were just wanting to come in," Buckingham said.

"If you have a child with diabetes, 75 percent of seizures occur at night so they have a continuous monitor that alarms them when they are low. For the kids, it allows them to have the alarm and makes them feel more comfortable in trying to bring their blood sugar down."

Nearly 21 million Americans have diabetes and 3 million of them have type 1 diabetes.

Patients usually have to constantly prick their fingers during the day, test their blood sugar level, and then inject insulin or eat something to adjust their blood sugar level.

It requires constant vigilance and discipline. Patients do not show immediate symptoms if they fail to control blood sugar, but over time they may develop serious complications that can result in limb amputation, kidney failure and death.

Frederickson, a lifelong type 1 diabetic who said she had good control of her blood sugar already, said the device improved her levels even more. "I am just thrilled with it," she said. "My A1c has improved. My glucose control was already fairly good but it had gone down half a point," she said.

The company said it is seeking U.S. Food and Drug Administration approval for use of the device in children but doctors are free to prescribe any approved device or drug as they see fit.

DIABETES ARTICLES

2006-06-09T00:49:00.000-07:00

DIABETES ARTICLES.

Americans need more help managing diabetes

U.S. patients and doctors alike show a surprising level of ignorance about diabetes and are not doing nearly enough to manage the condition, diabetes experts said on Wednesday.
A survey found that while patients believe they understand diabetes, they are not doing what they need to do to control it, and their doctors are unable to help much.

A team approach that would add nurses, diabetes educators and pharmacists to the mix might work better, they suggested.

"Diabetes prevalence has almost doubled since 1980 in America," Dr. Sethu Reddy of the Cleveland Clinic in Ohio and the American Association of Clinical Endocrinologists told a news conference.

Nearly 21 million people in the United States have diabetes, according to the U.S. Centers for Disease Control and Prevention, with type 2 diabetes accounting for up to 95 percent of the cases. The CDC says another 41 million have pre-diabetes.

Type 2 diabetes develops as a result of diet, exercise and genetic components. Type 1, or juvenile diabetes, is an autoimmune disease in which the insulin-producing cells in the pancreas are destroyed by the body.

Type 2 diabetes can be prevented or managed with careful diet, regular exercise and in some cases with drugs.

Reddy and colleagues held a meeting they called the Diabetes Roundtable and agreed that for various reasons type 2 diabetes is not managed properly.

"We all agreed that the future of good diabetes care will not rely on a single doctor," he said. "Realistically, one doctor can't do everything for a patient."

Insurers, Medicare and other payers will often cover visits to a nurse or a diabetes educator, who can work more closely and personally with a patient, but patients need to know to ask for this care, and primary care doctors need to know to refer patients, Reddy said.

NOT CONNECTING THE DOTS

The endocrinologists' group and the American Association of Diabetes Educators commissioned a Harris poll of 780 patients and more than 400 primary care physicians.

The findings suggest a "disconnect" between what patients know and what they actually do, said Donna Rice of the educators' association.

For instance, 69 percent of the patients said they felt knowledgeable about managing their condition. But 81 percent of the doctors said they were frustrated with the number of their type 2 diabetes patients who did not follow their treatment regimens.

Half of the patients surveyed showed little or no understanding of their A1C level -- a measure of a protein that can indicate how well their blood sugar has been controlled for the past three months.

And 59 percent of patients admitted their diabetes was somewhat or not at all well-controlled.

"It's like knowledge doesn't equate to behavior change," said Rice, a registered nurse and wellness program manager at Botsford General Hospital in Novi, Michigan.

The doctors also showed they do not fully understand diabetes, according to the survey.

The majority of the primary care physicians surveyed -- 78 percent -- said insulin resistance is the most important contributor to progression of type 2 diabetes.

Yet the experts said the insulin-producing beta cells are progressively damaged in type 2 diabetes and that this process may be a more important factor than insulin resistance.

"This suggests that primary care physicians do not consistently focus on how beta cells in the pancreas work," Reddy said.

Diabetes is the sixth leading cause of death in the United States and patients have a high risk of heart disease, kidney disease, blindness and nerve damage.

Worldwide more than 194 million people have diabetes.

Recognizing Early Symptoms Diabetes

2006-06-04T23:27:00.000-07:00

Diabetes Articles - Recognizing Early Symptoms Diabetes

Stay alert in recognizing early symptoms of diabetes. Certain symptoms put you on notice and you'll want to decrease the chance of developing into complications. You'll do yourself a lot of good with early treatment if necessary to maintain optimum health. If you don't have the early symptoms of diabetes looked your risking more than you need too.

Some of the early signs of the diabetic issue are frequent urination, blurry vision, irritability, extreme hunger, excessive thirst, unusual weight loss and increased fatigue. Sometime these show up together so be attentive and sensitive to your how you feel. Unfortunately over 20 + million people now have various forms of the disease. That's almost 25% or 1 out of 4 of our population. Of those one-third don't even know it.

If you are of member of Pacific Islanders, African American, Latino, Native American you'll be a little more cautious since diabetes is more common among these groups. Weight, age, hereditary issues, and lack of exercise are factors. Symptoms are similar in juveniles. Keeping alert about your child certainly is important along with the many other issues that already occupy your mind for their well being.

Type 1 generally is found in child and young adults with heart disease, blindness and kidney damage are of the biggest concerns. Type 2 is the most common where the body doesn't produce enough insulin so the body is able to use up the sugar intake. With the depletion of the food chain, fast foods with highly processed ingredients the problem will continue to grow. All ages are effected and it's scary to find out a person has it.

Although serious, people can certainly live long and happy lives. So spending some time today taking care of yourself is really a great investment. Firm up with some liquid quality vitamins and minerals to keep the immune system strong as possible for as long as possible. Get adequate rest, exercise at least some and try to cut down on the processed foods and turn to fruits and vegetables as well. By having some understanding of early symptoms diabetes you'll just that much better equipped to deal with the issues.

by Rolf Rasmusson at http://ezinearticles.com

Diabetes Articles - Digital organizers may help diabetics with diet

2006-05-31T03:47:00.000-07:00

Diabetes Articles.

Digital organizers may help diabetics with diet.

New research suggests that handheld digital organizers could help people with diabetes follow a "low-GI" diet -- a potentially effective but complicated eating plan for controlling blood sugar.

The small pilot study found that type 2 diabetics showed better blood sugar control after they were given a personal digital assistant (PDA) equipped to help them follow a low-GI diet.

GI, or glycemic index, refers to the effects a particular food has on blood sugar levels. Foods classified as high-GI, such as white bread and potatoes, tend to trigger a sharp, rapid rise in blood sugar, and some research suggests that limiting high-GI foods could help people manage or even prevent type 2 diabetes.

However, the true usefulness of the low-GI diet is not yet clear, and one of the criticisms of the eating plan is that it's just too complex.

That's where the PDA could come in, said the lead author of the new study, Dr. Yunsheng Ma of the University of Massachusetts Medical School in Worcester.

The 15 adults in the study received nutritional counseling on low-GI eating and then used PDAs with specialized software to help them keep track of their overall GI for the day. They could look up the GI score for a food before they ate it, and the software kept a log of their meals and GI scores for the previous 30 days.

The focus was on controlling overall GI for the day, rather than "forbidding" white bread or French fries, Ma explained.

After six months, the researchers found, patients' HbA1C -- a measure of long-term blood sugar control -- had dipped by 0.5 percent, on average. Calorie intake, body weight and blood pressure also tended to decline, Ma's team reports in the European Journal of Clinical Nutrition.

While he called the findings "encouraging," Ma said that further studies are needed to prove that the digitally-assisted diet is responsible for the positive changes, and to show that there are long-term benefits for diabetes control.

SOURCE: European Journal of Clinical Nutrition

Diabetes Articles.The Charcot Foot Condition - A Little Known Diabetes Complication

2006-05-30T01:15:00.000-07:00

Diabetes Articles.
The Charcot Foot Condition - A Little Known Diabetes Complication

Charcot Foot disease is a little known complication that can affect anyone who has diabetes. This condition also occurs in non-diabetic patients too, but diabetics can be more prone to this disease due to a diabetic complication known as neuropathy (nerve damage) Nerve damage can stop someone from feeling pain, so the foot can get injured without the person being aware that something is wrong.

The Charcot Foot condition is a very serious condition. Joints and bones can literally be crushed without being known to the sufferer. Imagine breaking your foot and not knowing that it’s broken due to no pain being felt. As time wears on, those broken bones (and sometimes joints) can suffer irreparable damage, with the person walking on the foot normally instead of the foot being in a cast and trying to heal.

Once this damage happens the foot can become misshapen, become dislocated, warm to the touch, and the arch of the foot can literally collapse. The Charcot condition is often called a “silent” disease since a sufferer might not know there is a problem until massive damage has occurred.

Treatment for this condition, traditionally has been to apply a cast so the fractures and dislocations can heal. The foot would be immobilized for a long period of time (often a year or more). Surgery, although done in some cases is ruled out for many patients due to an increased risk of the foot not healing properly.

Some patients must wear a special brace on their foot/leg in order to be able to walk with the Charcot condition present. It’s extremely important for the foot to stay as stable as possible in order to avoid future additional damage such as ulcers, infection and amputation.

A Charcot Foot (also called a Charcot Fracture) can bring devastating changes to a person’s life. Day-to-day activities can be limited and the person might find themselves immobilized for long periods of time, sometimes having to use a wheelchair to get around. Often people can go back to work after treatment with limitations and/or corrective shoes/braces.

by Belver Ladson at http://www.articlecity.com

2006-05-23T17:57:00.000-07:00

Diabetes Articles. Pre-Diabetes: "Check Engine" Warning Light

Your car has an early detection system and so does your body. Take 3 minutes to read this article and learn how you
can save yourself a life time of aches, pains, and costly medical bills.

Have you ever had the "Check Engine" warning light come on in your car? Most newer cars have a system that monitors the performance of your car. If something is not working
properly, the "Check Engine" light usually comes on.

The good news is that this "pre-warning" system can help you avoid costly damage, which may be occurring with your vehicle, by detecting small problems before they become big
problems. However, the only way to be certain is to have your car inspected by an expert mechanic when the "Check
Engine" light comes on.

Did you know that your body has a "pre-warning" system?

With many diseases, your body will start producing symptoms such as aches, pains, fatigue, frequent thirst, and so on. These symptoms are your body's "Check Engine" light, warning
you about problems.

However, with diabetes, pre-warning signs don't always show up so easily. The medical community is calling it:
"Pre-Diabetes".

Today, roughly 41 million Americans have pre-diabetes which left undetected and untreated, progresses into full-blown diabetes.

The challenge with pre-diabetes is the fact that the condition doesn't like to reveal itself with noticeable symptoms. Because there are few, if any symptoms, most people will not bother having screening tests performed. With pre-diabetes, noticeable symptoms like frequent thirst and urination may not occur until the disease has progressed
and is already causing considerable damage to your body. Most Type 2 diabetics don't have symptoms because the onset of diabetes is so slow.

Don't wait for your "Check Engine" light to come on. Have your blood tested. Call your doctor today and make the appointment.

The goal with identifying pre-diabetes is to prevent the onset of diabetes from ever happening.

Your physician can determine if you have pre-diabetes with two common tests. The fasting plasma glucose test (FPG) and the oral glucose tolerance test (OGTT). Both require an overnight fast.

The good news is that you can greatly improve your odds and likely prevent diabetes with early detection and proper care.

Don't wait 'til it hurts. Ask your doctor about diabetes and have your blood sugar checked several times a year.

by David Anderson at articlesfactory.com

Coping with Diabetes

2006-05-16T00:58:00.000-07:00

Diabetes Articles. Coping with Diabetes

Every day, in the United States, more than 2000 new cases of diabetes are diagnosed. Type II diabetes, the most prevalent form of diabetes worldwide, often shows few or even no symptoms!

After eating, food is broken down into what is known as glucose, a sugar carried by the blood to cells throughout the body. Using a hormone known as insulin, made in the pancreas, cells process glucose into energy.

Because cells in the muscles, liver, and fat do not use insulin properly in the body of a person with type II diabetes, they have problems converting food into energy. Eventually, the pancreas cannot make enough insulin for the body's needs. The amount of glucose in the body increases, and the cells are starved of energy.

This starvation of the cells, paired with the high blood glucose level can damage nerves and blood vessels. This leads to complications such as kidney disease, nerve problems, blindness, and heart ailments.

There are a lot of factors that can help to attribute to diabetes cases - lifestyle, environment, heredity - and those who are at risk should be screened regularly to prevent diabetes. Those that are already diagnosed with diabetes should aim to keep their glucose level under control.

But how do you know if you have type II diabetes? After all, it has few symptoms, often no symptoms in some patients. However, if you notice an increased thirst or hunger, a change in weight, or blurred vision, getting tested for type II diabetes is necessary, as only your doctor will be able to help you find the treatment steps necessary to being able to manage your life with diabetes.

Simple changes such as eating right, managing your weight, and keeping your blood sugar level under control may be enough. However, you doctor may prescribe diabetes-regulating medications to assist you in controlling your type II diabetes.

Diabetes is a serious ailment with extreme consequences if it isn't treated properly. But if you follow your doctor's advice and maintain both your lifestyle and blood sugar levels, you can help to prevent the more serious consequences from occurring.

This article is for information purposes only and is not meant to treat, diagnose or prevent any ailment or disease. See your physician for proper diagnosis and treatment.

by Amanda Baker at articlecity.com

Bodybuilding with Diabetes

2006-05-09T18:13:00.000-07:00

Diabetes Articles. Bodybuilding with Diabetes

The symptoms of diabetes may begin slowly and hard to identify at first. They may include fatigue, frequent urination, excessive thirst, and a feeling of becoming sick. When there is extra glucose in the blood, one way the body gets rid of it is through frequent urination. This loss of fluids can cause excessive thirst. Diabetes can also cause other symptoms such as blurred vision, slow healing of skin, sudden weight loss, genital itching, and gum and urinary tract infections.
People who suffer from diabetes must take extra precautions when wanting to exercise. These people should not exercise outside on very hot or humid days due to the increased risk of heat stroke or exhaustion. If you are exercising in warm weather , dress in loose-fitted clothing or special fabrics that promote heat loss. To prevent dehydration, drink a cup of cold water before and after exercise. If your exercise session lasts longer that thirty minutes or if you sweat alot, drink water during your workout. Make sure that you know the warning signs of heart problems such as jaw, arm, and chest pain, dizziness, nausea, irregular pulse, and unusual shortness of breath during exercise. Exercise, along with good nutrition, helps decrease body fat, which helps normalize glucose metabolism. Exercise also helps lower coronary risk factors such as high cholesterol and high blood pressure. Type 1 diabetes is a lifelong disease which occurs when the pancreas does not produce enough insulin to regulate blood sugar levels. Without adequate insulin, glucose builds up in the bloodstream leading to increased hunger. In addition, the high levels of glucose in the blood causes the patient to urinate more, which also causes excessive thirst. Within five to ten years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed and no more insulin can be produced. Type 1 diabetes can happen at any age, but it usually begins with people under the age of twenty-five. The exact cause of type 1 diabetes is unknown and only accounts for around 5 percent of the new cases formed each year. Previously known as noninsulin-dependent diabetes mellitus, type 2 diabetes is the most common form of diabetes. 90-95 percent of people who have diabetes have type 2. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not use the insulin it makes. Type 2 diabetes typically occurs after the age of forty years. A resistance to insulin develops, often accompanied by excess weight and leaving the pancreas unable to produce enought insulin to compensate. Hypoglycemia is the clinical syndrome that results from low blood sugar. The symptoms of hypoglycemia can vary from person to person which can become severe enough to need treatment. Classically, hypoglycemia is diagnosed by a low blood sugar with symptoms that resolve when the blood sugar returns to a normal range. While patients who do not have any metabolic problems can complain of symptoms suggestive of low blood sugar. Hypoglycemia usually occurs in patients being treated for type 1 or type 2 diabetes. Patients with pre-diabetes can also have low blood sugars on occasion if their high circulating insulin levels are further challenged by a prolonged period of fasting. Living with diabetes is not fun, but by taking preventative care of yourself, you can do the things you want to do in life. Exercise and proper nutrition are very important to steps in recovery and you never know, maybe you didn't have diabetes after all, you just needed a lesson in nutrition.

by Zach Bashore at articlesfactory.com

Diabetes Articles - Natural Ways To Treat Diabetes

2006-04-27T22:45:00.000-07:00

Diabetes Articles - Natural Ways To Treat Diabetes

Diabetes is a disease caused when the body does not properly produce insulin. Seven percent of the population in the United States has diabetes. There are two types of the disease. Type one diabetes is where the body does not produce insulin and type two is where the body resists insulin. The majority of people diagnosed with this disease have type two. Symptoms of diabetes include extreme thirst, hazy vision, excessive hunger, weight fluctuation, fatigue and frequent urination. Diabetes is often controlled with insulin and prescription drugs, but diet and exercise play a large part in the ability to control the disease. There are also herbs that can help reduce the effects of diabetes.

Ensure a healthy diet by concentrating on foods such as vegetables, grains, fiber and legumes. These foods will help regulate sugar in the blood stream. Avoid junk food and foods that contain sugar such as cakes, cookies and other sweets. Alcohol, tobacco and caffeine should also be avoided to maintain a nourishing diet.

Exercise helps promote good health and combats against the negative effects of diabetes. It is important to exercise regularly and keep an appropriate weight. People who are inactive or overweight have a higher risk factor for diabetes and are prone to suffer from more side effects caused by the disease. It is especially important to exercise to build muscle. Starting a weight program will increase muscle mass which will increase sensitivity to insulin.

There are many herbal remedies recognized for their therapeutic properties of treating diabetes. They are commonly found in pharmacies and grocery stores and can be a great natural remedy. Prickly pear cactus has shown positive results in the treatment of this disease and was recently recognized by the International Diabetes Center as a viable natural remedy. Bitter Melon has been used for years in Asia, Africa and South America for treatment. Garlic will reduce sugar levels and is a healthy way to add flavor to food while benefiting from its curative traits. Other common herbs are ginseng, psyllium, fenugreek, bilberry, dandelion and burdock.

Vitamin supplements are frequently used to help treat diabetes with the most commonly recommended ones being vitamins B6, C and E. Also, zinc, selenium, alpha lipoic acid, chromium and vanadium are commonly used. Rather than take individual supplements, some patients opt for a multivitamin to add to their diet.

Diabetes is a disease that affects a large portion of the population. The risks associated with it are serious but can be controlled with lifestyle change. Ensuring a well balanced diet and good exercise routine will help in preventing side effects. Also, proper use of herbs, vitamins and natural remedies will help prevent the necessity for more traditional means of medication.

By Gray Rollins at articlecity.com

Diabetic And Sugar

2006-04-21T03:38:00.000-07:00

Diabetic And Sugar

There are several myths about sugar. Most of these myths are untrue and do not make you fat, become Diabetic or make your teeth bad.

There are many myths about sugar. But panels of experts have found that sugar does not cause Diabetes, Obesity, Hyperactivity or other vitamin deficiencies.
Myth - Sugar Makes You Put On WeightIt's not eating sugar that makes you fat but eating too much food does. Food is broken down into Calories and Calories = 1 Unit of Energy. With a teaspoon of Sugar having only 15 Calories, so 15 Calories is 15 Calories. It doesn't matter what food the Calories come from.

Your Weight Loss Programme will only succeed if you take in fewer Calories than you use.

After a 5-year study in 2002 The National Academy of Sciences concluded "There is no clear and consistent association between increased intakes of added sugars and BMI. BMI = (Body Mass Index) is an indicator of body weight and Obesity.

Myth - Sugar Can Give You DiabetesDiabetes is not caused by having too much sugar. Just like eating Carbohydrates eg Potatoes, Bread, Cakes and Pastries, may if eaten in excess, make you put on weight but it is not what causes Diabetes.

There are two types of Diabetes:

1. Diabetes Type 1 2. Diabetes Type 2Type 1 is usually Insulin dependent. The people have to inject Insulin into themselves every day. This is because the Pancreas does not produce enough Insulin. Insulin is a Hormone. And this Hormone is needed for converting the sugar into energy.

Type 2 is usually found in people of 50+. It is also called 'Age Onset Diabetes. In this kind of Diabetes, the body produces Insulin but something goes wrong and the body can't use it properly.

The American Diabetic Association advises Diabetics that they may take sugar as long as it is counted as part of their daily Carbohydrate Allowance.

Myth -Sugar Has A High Glycemic Index (GI)The body must convert Sugars and Starches we get from our food, into Blood Glucose (Blood Sugar) to enable the body to function properly.

Glycemic Index is a description of how fast the body breaks down Starches and Sugars to make them into Blood Glucose.

Blood Glucose levels are dependent on how much Protein or Fat is eaten with the Carbohydrate.

Myth - Sugar Stops Other Nutrients Being AbsorbedIn recent years, sugar has been accused of stopping Vitamins and Minerals from doing their job.

In the US, several diet surveys have shown that the consumption of sugar actually has little influence on Vitamin and Mineral intakes.

The body in order to function properly needs a varied diet of Nutritious food. Sugar should be part of the daily intake.

Myth - Sugar Makes Kids HyperactiveSugar does not make a child Hyperactive. Hyperactivity is caused by something in the brain not functioning properly. So a 'normal' child cannot become Hyperactive if they have sugar in their daily diet.

Children are naturally enthusiastic, prone to showing excitement and they like to be on the go all the time. It can be more of a worry, if a child sits around doing nothing all day. Usually means they are sickening for something.

Myth - Sugar Makes Bad TeethIn the mouth Bacteria breaks down all Carbohydrates (both Sugar and Starches). This is a normal process that produces Acids and it is this Acid that attacks the enamel on the teeth, causing the Acid to take Mineral from the enamel. And this is what causes cavities. Eating sticky snacks that linger on the teeth prolongs acid production. Some of the culprits are Dried Fruit, Cereals and Potato Chips.

Dentists advise cutting out in between meal snacks and limiting sweet and sticky foods to mealtimes.

The answer is to clean the teeth with a good toothpaste. Preferably after every meal. And visit the dentist regularly.

Myth - You Can Become Addicted To SugarOh dear! If we all belonged to the SA (Sugar Anonymous) we would be kept so busy supporting our friends we'd have no time to do anything else.

Seriously, addiction is a Compulsive Behaviour with medically identifiable emotional, mental or physiological symptoms.

People like sweet tasty foods, but liking them is not the same as being addicted.

So if you have a sweet tooth, don't worry enjoy your food. Just be sure you are getting a good varied diet of Protein, Fats and Carbohydrates.

by

The Importance of Blood Glucose Testing

2006-04-10T18:32:00.000-07:00

Why test my blood sugar?

A blood glucose meter is essential to controlling your diabetes, and many different models are now available. Here is what you should know before you buy.

In 1993, a landmark study from the National Institutes of Health, underscores the value of tight blood glucose control in people with diabetes: The study divided patients into "intensive therapy" and "standard therapy" groups and compared how many of them developed the complications of diabetes. The "standard therapy" group took one or two insulin injections a day and rarely if ever tested their blood glucose levels. The "intensive therapy" group, on the other hand, took three or more injections of insulin a day or used an insulin pump, monitored their blood sugar levels at least four times a day, and worked closely with their health-care team to keep their blood glucose levels close to normal.

Amazingly, patients in the "intensive control" group had a 76% less chance of developing diabetic retinal disease, 42% less chance of developing diabetic kidney disease, and 60% less chance of developing diabetic nerve disease than those in the "standard therapy" group. And the better they controlled their blood glucose levels, the lower their risk of developing complications all across the board.

Because of these findings, health care professionals are more enthusiastic than ever about blood glucose monitoring. Blood glucose testing is crucial to intensive diabetes control, providing invaluable feedback that guides patients and doctors in fine-tuning food intake, insulin dose, and activity level.

Selecting the meter that is right for you is now an option. Meters now come in all shapes and sizes. In order for you to find the meter that best matches your needs you may want to narrow down your choices. For instance, if you have arthritis, then you may prefer a meter that is larger with strips that are easy to handle and to apply a blood sample. Or you may be a busy person with little time and desire a meter that is quick, small, and discreet. Children may prefer meters that look like "space age gadgets" or are "fun" to operate.

Items to Consider

Cost: The cost of different blood glucose meters and test strips varies considerably, and these costs may vary throughout the country. Take into consideration the special rebates, trade-ins, or other discounts offered by the manufacturer.

Ease of Use: Meters vary in terms of how much blood is required on the test strip and how many steps are involved.

Size of Display Area: Make sure you can read the meter’s display.

Test Time: Most meters provide fast results, usually less than 60 seconds. But if you want a fast meter compare the speeds of different meters.

Memory: A meter stores anywhere from your last test result up to 1,000 tests in its memory. Some also include the date and time. If you would like to be able to look back at past test results a meter with good memory may be good for you. But if you chart your test in a book this may be less important.

Hematocrit Range: If you have a condition that can affect your hematocrit levels, such as pregnancy, polycythemia, anemia, or kidney disease, make sure you get a meter that is accurate at your level.

source: Anita Austin, RPh, CDE at diabetis digest

How to prevent type 2 diabetes

2006-04-05T07:39:00.000-07:00

Diabetes Prevention - How to prevent type 2 diabetes.
Recent studies by Harvard researchers have concluded that moderate
exercise and a healthy diet can prevent most cases of type 2
diabetes - the most common form of diabetes. The study
overwhelmingly indicated that by making the appropriate
lifestyle changes, diabetes can be prevented over 90% of the
time. The study also concluded that lifestyle changes
significantly reduced the risk of getting the disease by 58%
among people who already showed signs of developing diabetes.
A healthy diet and regular exercise program not only will improve
your appearance, but it also can improve your health and
decrease your risk of developing certain diseases.

Diabetes is a disease where your underlying genetic background is
critical. If you have these genes and are at risk of developing
diabetes, your lifestyle decisions very well may determine
whether these genes become active or remain dormant.

Type 2 diabetes accounts for over 90% of all diabetes cases. It
occurs when your body can not properly utilize insulin in
getting nutrients to your cells. This results in high levels of
sugar in your blood. The number of cases of diabetes has been
growing rapidly. Studies indicate that over 16 million
Americans have some form of diabetes! Type 2 diabetes used to be
considered a disease of the old, but not anymore. It is becoming
much more prevalent in younger people and has recently been
showing an alarming increase among young people.

What is most interesting is that Harvard researchers determined
that 91% of cases among the people they studied could have been
prevented by watching their weight, eating a healthy diet,
moderate exercise, and not drinking and smoking. Being
overweight is the number one reason people contract diabetes -61%
of all cases are attributed to obesity and weight problems.

Some other interesting facts: Overweight women cut their risk by
24% simply by walking regularly. There is a direct correlation
between the amount of exercise and instances of diabetes. The
more exercise, the less instances. Those who did 7 or more
hours a week of exercise had a 29% lower risk than those who did
not exercise or exercised less than 30 minutes per week. Eating
a diet that is high in fiber, low in fat and low in partially
hydrogenated oils (french fries, commercial baked goods) also
significantly decreases your risk. If you already do not do so,
become a label reader!

Pepper may not just be for seasoning. Capsaicin is a protein
compound found in pepper and peppers significantly lowers blood
sugar levels and increases insulin levels. Researchers have not
concluded if the pepper compound acts by increasing the release
of insulin, or by slowing it's breakdown. Large doses of aspirin
also lower your blood sugar and is an effective treatment of
diabetes, but researchers warn that that the large doses required
have detrimental side effects (intestinal bleeding, dizziness,
nausea) that outweigh the benefits.

There are many diseases and illnesses you have no control over,
but type 2 diabetes is highly preventable by watching your
weight, exercising, eating a healthy diet, and not smoking or
drinking.

Diabetes and Carbohydrate

2006-04-02T23:13:00.000-07:00

Diabetes and Carbohydrate

To eat or not to eat carbohydrates. that is the question.
There are good carbs and there are bad carbs.
How can we tell the difference and how do we know
what to eat?

The old way of classifying carbohydrates:

Complex Carbohydrates provide fiber, vitamins,
minerals and energy. Some foods that contain complex
carbohydrates are whole grain bread, legumes like peas
and beans, pasta, rice, and starchy vegetables.

Simple Carbohydrates are broken down quickly to
provide energy. Simple carbohydrates are found
naturally in milk, fruits and vegetables. Simple carbs
are also found in processed foods like syrup, soda,
and refined sugar found in many processed baked goods.

In this way of classifying carbs, it is recommended that
we limit our intake of simple carbs and get most of our
carbohydrates from complex carbs.

The new way of classifying carbohydrates:

The Glycemic Index (GI) measures how quickly blood
sugar rises after ingesting a food with carbohydrates.
Eating a diet full of foods that have been rated with a
high GI may contribute to an increased risk of diabetes
and heart disease.

Highly processed or highly refined carbohydrates have
been found to have a high GI - foods like white bread,
white rice, white pasta, french fries and refined
breakfast cereals.

Whole foods will have a lower GI - legumes, whole
fruit, and whole grains like wheat, oats, barley, and
brown rice.

However, there are exceptions to this rule. Many other
factors influence the GI of a food. Fiber content,
fat content, ripeness, and type of starch also affect the
GI. Thus some foods like potatoes and bananas have
a high GI.

Diets that advise you to eat a low amount of
carbohydrates have gone part of the way to increase
awareness of the differences of carbs. The Glycemic
Index has also helped us to determine that all carbs are
not created equal. Some kinds of carbohydrates help
promote health, but others actually increase the risk for
diseases like diabetes and coronary heart disease.

What should we eat?

The general rule is that highly processed carbs are not as
good for us as natural carbs. How can we get away from
highly refined foods - it's everywhere you look!

Here are some techniques for buying food:

1. Educate yourself. learn to read the backs of packages
of food and know the difference between a processed food
and a natural food. (However, if it's packaged in a box,
bag, or can - chances are it's processed.)
2. Go to the store with a list.
3. Do not go to the store hungry.
4. Do not go to fast food restaurants. instead try out
diners or restaurants that boast home cooked meals.
5. Get your fruits and vegetables from farmers markets or
farm stands whenever possible. Not only will you save
money, you will also be getting better quality produce.

by Renee Kennedy at articlesfactory.com

Diabetes Test - Cinnamon Helps Diabetics

2006-03-31T06:51:00.000-08:00

Diabetes Test - Cinnamon Helps Diabetics.
Diabetics should have the following tests done once a year:

Full vision test (Sugar Deposits in the eyes can cause blindness)
Check up of the feet (Sugar Deposits can settle in the feet and cause gangrene)
Complete check up of kidney function
Blood pressure
Check for Cholesterol in Blood
Diabetics come under 2 groups.

1. Type 1 are Insulin Dependent Diabetics

2. Type 2 are Age Onset Diabetics, these patients control their Diabetes with diet and don't have to rely on insulin injections.

How Taking Cinnamon Can HelpIn a recent survey in the USA, 60 Type 2 Diabetics were divided into four groups.

Group 1 was given one gram of cinnamon per day
Group 2 received three grams
And Group 3 six grams
Group 4 were given placebos.

Those who had been given cinnamon reduced their blood sugar by 18 –29%, their triglycerides by 23 –30% and their LDL cholesterol by 7-27% plus their total cholesterol by 12-26%.

The group that had been given placebos showed no change in their blood sugar.

So adding cinnamon to your daily diet will not only enhance the flavour of your food but could prove very helpful to your health.

Other Health Benefits of CinnamonCinnamon has been used for its medicinal properties for hundreds of years.

It has been found that cinnamon has anti-inflammatory properties, reduces cholesterol and is also one of nature's best blood sugar balancers.

In 2003 the journal Diabetes Research and Clinical Practice published an animal study. This study was carried out on rats. They were given 300 mg of cinnamon per kilogram of body weight, daily for 3 weeks. The results showed they were able to absorb 17% more blood sugar per minute than rats not given the cinnamon.

Again using rats in another study they were fed a high fructose diet. Usually this would induce significant metabolic changes. But they were also fed some cinnamon. The result of this test was their glucose metabolism was improved so much there was no noticeable difference from the rats that didn't receive the high fructose.

These studies seem to prove that cinnamon can lower your risk of developing diabetes.

For those who are already Diabetic, it can be an effective and affordable tool to help manage your condition.

Further Information About Diabetes.

You can contact Diabetes UK on Tel: 020 7424 1000 or E-Mail: info@diabetes.org.uk Website: http://www.diabetes.org.uk

by Eva Moffat at articlesfactory.com

Top 10 Do's For Women With type II Diabetes

2006-03-28T17:26:00.000-08:00

Diabetes type II - Top 10 Do's For Women With type II Diabetes

It has been observed that women who are diagnosed with Type 2 diabetes are overweight. The exact cause of this type of diabetes is unclear, but it does appear to be associated with weight gain. In fact, a sedentary lifestyle, along with poor dietary habits, popular in the culture today, is among the explanations for the dramatic increase in the numbers of women suffering with Type 2 diabetes.

The connection between diet and diabetes is that, if you eat a high-fat, high calorie diet, which a lot of us do today, you put yourself at risk for weight gain, and if you are more than 120% of your desirable body weight, in simple terms, more than 20 pounds over what you should weigh, you become more insulin resistant, you use your own insulin at less capacity than you should, and you will have higher blood sugars, which will lead to diabetes. Diabetes is on the rise, and women with diabetes have an elevated risk of heart disease and stroke.

The good news is that there are steps they can take to reduce their risk of diabetes complications. From the National Diabetes Education Program (NDEP), here are Top 10 do's to help women with diabetes live longer, healthier lives.

Do review your treatment plan with your doctor or health care provider at least once a year. Make changes if your plan is not working well.

Do work with a dietitian. Create a meal plan that gives you healthy choices and is just right for you. A dietician will guide you on how to exercise portion control & make healthy food choices.

Do have a snack when you're hungry. Choose something healthy (something that's low in carbohydrates) that fits into your overall meal plan. All the starchy foods like rice and potatoes and breads and cereals get broken down into sugar in the body. If you eat them in excess, your blood sugar is going to go up, so you need to use some portion control. The real key, is portion control.

Do ask your health care provider for an A1C test. A1C, short for hemoglobin A1C, is the best test to know if your blood glucose (sugar) is under control. Aim for a fasting blood sugar between 70 and 120. Before a meal, we want it less than 122, and after a meal, about an hour after a meal, we want it to be less than 180. These are actually the blood sugars that you should be aiming for, and that is actually what we call good control.

Do control the ABCs of diabetes: A1C for blood glucose, B for blood pressure and C for cholesterol. That's the key to reducing your risk of heart disease and stroke.

Take care of your feet. Wear comfortable shoes that have a smooth lining, fit well and protect your them. Do have your feet, eyes and kidneys checked at least once a year. Regular check-ups help to find problems early, when they can be treated and managed well. Also, do see your dentist twice a year. Make sure he or she knows you have diabetes.

Do your housework and get more than a clean house. Turn up the music, get some exercise and burn away those calories. Exercise is a really important tool, because it can help lower your blood sugars. Your muscles use sugar, glucose, as the source of energy, so it can actually lower your blood sugars. Begin after you have undergone a stress test before starting on a fitness routine. Just walking like maybe half a mile in the beginning, would be enough, then you can slowly build up from that.

Do walk whenever you have the chance. Get off the bus or subway a few stops early or park at the far end of the lot. Walking is a great place to start . You don't need any fancy equipment, you don't need to have a special outfit or anything, what you really need is a good pair of walking shoes, and to go out and start.

Do avoid smoking. Smoking doubles the damage to the body by contributing to poor blood glucose control by interfering with the timing and effects of insulin. It also raises your blood glucose level, which contributes to poor diabetes control. If not checked in time ,it can cause hardening of the arteries. This particularly affects the body's larger arteries to the legs and brain, making amputation and strokes more likely. Although it is true that most people gain some weight when they quit smoking, for the vast majority of smokers the gain amounts to less than 10 pounds. The health benefits of quitting far outweigh the risks of a few extra pounds . Beyond fear of weight gain, the most common obstacle to quitting is the addictiveness of nicotine. Ask your doctor or nurse about ways to help you quit smoking. Log on to:
http://www.diabetes.org/main/community/forecast/page46.jsp to know more on Diabetes & Smoking.

Do talk with family and friends about managing your diabetes. Be an inspiration with your healthy lifestyle.

The mainstay in treatment of Type 2 diabetes is actually diet and exercise. Regardless what type of medicines you're going to be on, diet and exercise are always going to be important. Your medicines are not going to work if you mess up at your diet.

For more information on diabetes care, call the National Diabetes Education Program at 1-800-438-5383 or visit the NDEP Web site at www.ndep.nih.gov .

by Namita Nayyar at articlesfactory.com

Diabetes Diet And Exercise

2006-03-23T23:43:00.000-08:00

Controlling Type II Diabetes Through Diet And Exercise

If you have been diagnosed with adult onset type II Diabetes, you may be able to control your condition through diet and exercise. Many people have genetic predispositions for adult onset diabetes, but the disease is usually brought on by poor diet and a sedentary lifestyle. It can be hard to reverse the damage caused by years of unhealthy living, but by changing the way you eat and exercise, you can help control your disease and can lead a fairly normal life without the need for insulin-regulating medicine.

Before embarking on a workout plan or adhering to a new diet, you should first consult your doctor. He or she will probably make dietary suggestions and will usually refer you to a dietician who can help you plan your meals. The dietician will tell you what you can and cannot eat, and what you can eat in moderation. You will have to cut out all of the sugar from your diet. This means drinking diet sodas, if you must drink sodas at all, and eating sugar free candy on those special occasions.

It is important to eat a variety of fruits and vegetables to take the place of all of those empty calories and to keep you feeling full and energetic. You should make sure to take in enough protein to help your muscles get your through your new workout schedule, and be sure to drink plenty of water to keep yourself hydrated. You will want to eat several small meals throughout the day rather than just eating two or three times with a lot of time in between. By eating more small meals, you will keep your blood sugar at a more steady level, rather than having the ups and downs associated with large meals followed by gaps in eating.

Once your diet is under control. The next step is to begin an exercise program. You don't have to aim for running a marathon or even a mile. Walking is the most prescribed form of exercise for diabetes patients. Whether you walk in the mall, around the neighborhood or on a treadmill, the most important thing is to get moving and to keep moving for an extended period of time every single day. Though you may not feel motivated at first, you will soon start to look and feel better and better. Seeing these changes will hopefully provide you with enough motivation to stick to your workout plan.

If find walking boring, try to find a partner who will keep you motivated. There are also many diabetes support groups that have walking clubs that meet daily. You can join a club and meet other diabetes sufferers who will help keep you on the right track. They can provide inspiration and encouragement by sharing success stories and by keeping you aware of the complications that can arise if the disease is left untreated. Once you get into fairly good shape, you might try playing a sport that you enjoy, like golf or tennis. You could also join a gym and participate in some yoga or aerobics classes to add some variety to your workout plan.

Keep in mind that the best way to avoid diabetes complications is to change your lifestyle. Many of the common problems of people diabetes can be avoided by staying away from sugar and other harmful foods. By exercising and staying healthy, you can avoid vision loss and circulation problems associated with the disease without having to use expensive and debilitating drugs to keep your blood sugar at a healthy level. Remember that your body is your most important asset, and keeping it working properly should be your highest priority.

by Sintilia Miecevole at articlecity.com

The Right Diabetes Diet

2006-03-23T23:32:00.000-08:00

How Important Is The Right Diabetes Diet?

There is nothing more important than the right diabetes diet. Diabetes is a serious disease that you need to learn as much as you can about if your or someone that you care about has been diagnosed with it. Eating right and staying healthy is the only way to battle diabetes and knowing what you can and cannot eat is essential. If you have the proper diet you may be able to have some control over your diabetes.

Having diabetes is a balancing act and it is one that you can manage if you take the time to learn how. As long as you are eating the right amount of healthy foods and you are avoiding all of the sugar that you are not allowed to eat you will be well on your way to staying healthy in spite of diabetes.

Keeping an eye on your sugar intake is key to good diabetes diet management. This will mean learning all of the best sugar replacements and sugar free foods. This used to be a lot harder than it is now. These days there are all kinds of great sugar replacements, many are even perfect for baking, and the sugar free products are becoming ever so popular. Even people without diabetes are choosing them over the sugar filled alternatives. Sugar free products taste delicious, which makes the easy to eat and enjoy while still maintaining a good blood sugar level.

You will also need to watch how much food that you eat. Eating too much or too little can have a negative impact on your diet and health. Talk to your doctor about how much food you should be eating each and every day and what times are optimal. Your diabetes diet will have to be set just right if you want to stay in perfect control and health. As long as you eat right every day you will stay feeling good and healthy for years to come.

by Dana Goldberg at articlecity.com

Cats with feline diabetes can still lead a happ life

2006-03-21T19:07:00.000-08:00

Feline diabetes.
"Your cat has feline diabetes." If this is your vet's message after examining your beloved friend, it will come as a shock. Yes, your cat has a serious disease. But you can treat it!

I got the message myself early 2003. My (then) 10-year-old neutered cat Duvelke had been urinating and drinking more than usual for a few weeks. First it was thought to be connected with a previous medication. But after urine and blood tests the veterinarian was certain. "Your cat has feline diabetes."

Now what is diabetes?

Blood contains sugar (glucose). The blood sugar level is controlled by the hormone insulin, which is produced by the pancreas. If this organ produces not enough insulin, we speak of diabetes.

Symptoms of feline diabetes differ. Duvelke started to pass more urine than usual, and had an increased thirst as a result of this. Other possible symptoms are weight loss, decreased appetite, lethargy and a poor coat condition.

Cats with untreated diabetes will become inactive, vomit regularly, stop urinating and fall into a coma. But if you treat feline diabetes correctly, your cat might still be able to lead a long and happy life. It does take effort and dedication, though.

Your cat will need to get food at set times, and preferably should stay indoors.

And – this is essential - you will have to give your cat insulin shots. Once a day, often two times daily. Your vet will determine the quantity and tell you how to do it. It is not scary!

But keep an eye on your friend. Your cat should have had food before getting the insulin shot! If not, a hypoglycemic shock (a ‘hypo') may occur. This is also possible if your cat gets too much insulin. And this is really dangerous. If you are not there to help, your cat might die from a hypo.

Duvelke has had a few hypos since 2003. He survived. How? By putting glucose in his mouth, on the inside of his cheeks. Honey on his tongue also worked well.

Duvelke's quantity of insulin has been reduced considerably the past year. And he's doing really fine. If you didn't know about his disease, you would assume he is a perfectly healthy cat.

So, with a proper treatment, diabetic cats can still lead a happy life!

source: Marc de Jong at articlesfactory.com

Hurricane Katrina Causes Diabetes

2006-03-16T22:20:00.000-08:00

"Hurricane Katrina Causes Diabetes" may soon be a real headline. This article will explain what you need to know before you or someone you know are unpleasantly surprised.

Though the debate still continues as to the exact cause, Type 1 diabetes (having to use insulin) is thought to be the result of an inappropriate autoimmune response in the body.

What apparently happens is that the body attacks the Beta cells of the pancreas believing them to be invaders. These insulin-producing cells are therefore destroyed to a significant degree and "Hey Presto! Instant Diabetes".

Type 2 diabetes (not needing insulin) is caused by insulin resistance which is generally the result of obesity though now there is a blurring of boundaries between Type 1 and 2.

Now, with the above in mind, the question is, how the heck could a hurricane cause diabetes? Well, regarding Type 1 diabetes a theory that may prove correct or incorrect is that an autoimmune response may be precipitated by on going stress of such intensity that the inflammation caused by chronically high levels of cortisol leads to an immune system malfunction.

However, regarding Type 2 diabetes I think there is a very clear and direct connection. For the sake of brevity I will not cover all pertinent details because the purpose of this article is to convey an idea that may be worth considering.

So, "Hurricane Katrina Causes Diabetes" may be a reality when you look at two groups of persons. First, are those directly affected. Many people, when stressed sufficiently, will eat more than they need. I am willing to bet that over the next 5 years, if the direct victims are tracked, many of them will become obese and get diabetes; even those without a genetic predisposition.

The second group are those who, though not directly involved with the disaster, are vicariously involved to the point where they begin to gain significant amounts of weight due to poorly managed stress.

Both groups may also, to some degree, be affected by a type of hyper-vigilance that creates an on going 'fight or flight' response that can lead to insulin resistance. Untreated insulin resistance not only can lead to diabetes but, to its corollary, hyperinsulinemia which is also very dangerous.

So, what is an answer? For both groups, effective stress management tools are a must. I believe that being taught self-hypnosis is the best, most cost-effective answer. If insurance companies want to save a lot of money over the next decade then it is definitely in their best interests to somehow get their insured clients strongly involved in stress reduction classes.

Stress reduction may also mitigate some of the potential harmful, autoimmune responses that Katrina may induce in those who are susceptible.

source: C. Devin Hastings at articlesfactory.com

Potato lovers may have higher diabetes risk

2006-03-15T21:45:00.000-08:00

Potato lovers may have higher diabetes risk.
Holding that side of fries might help thwart type 2 diabetes, new research suggests.
In a long-term study of nearly 85,000 U.S. women, researchers at Harvard University found that those with the highest potato intake had a modestly elevated risk of developing type 2 diabetes.

The link was strongest among obese women, who are already at increased risk of the disease, suggesting that heavy potato consumption may pose a particular problem for them, the researchers point out.

The findings are published in the American Journal of Clinical Nutrition.

Though potatoes have healthful attributes, they also have a high glycemic index (GI) -- meaning they cause a rapid, strong rise in blood sugar. Over time, these surges may damage the pancreatic cells that produce the hormone insulin, which is needed to metabolize blood sugar.

Overweight or sedentary adults may be particularly vulnerable to the effects of high-GI foods because they often have underlying insulin resistance -- a precursor to diabetes in which body cells lose their sensitivity to insulin.

So it would make sense for these individuals to lay off the french fries, Thomas L. Halton, the lead author of the new study, told Reuters Health.

He and his colleagues found that women with the highest potato intake were 14 percent more likely than those with the lowest intake to develop diabetes over 20 years. And women who ate the most french fries, specifically, had a 21 percent greater risk of diabetes than those who ate the fewest.

Overall diet and other lifestyle habits did not explain the link, and potatoes seemed to be more problematic when a woman ate them instead of whole grains.

Whole grains -- as well as many high-fiber vegetables, fruits and legumes -- have a lower GI than potatoes and white-flour products. So eating those foods in place of potatoes, Halton's team concludes, could potentially cut diabetes risk.

source: healtcentersonline

Whole grains good for the diabetic heart

2006-03-14T16:51:00.000-08:00

Whole grains good for the diabetic heart.
Women with type 2 diabetes who incorporate more whole grains, bran, and cereal fiber into their diets may reduce their risk of heart disease, according to a new study.
What's more, low-glycemic index foods, that is, readily digested carbohydrates that cause a rapid rise in blood sugar levels, may also help to curb early signs of heart trouble.

"To adapt a diet high in whole grains and low in glycemic load will help diabetic patients to reduce the risk of cardiovascular disease," study author Dr. Lu Qi, of the Harvard School of Public Health in Boston, Massachusetts, told Reuters Health.

The findings are based on an analysis of data from 902 women with diabetes who were involved in the Nurses' Health Study.

Qi and colleagues found that women who reported eating more whole grains, bran, and cereal fiber tended to have lower levels of two markers of blood vessel inflammation that have been linked to heart disease -- CRP and TNF-R2.

In fact, cereal fiber, which is largely composed of whole grains like bran, "may confer stronger effects than fibers from other food sources such as fruit and vegetable," they note in the journal Diabetes Care.

Based on the current findings, Qi recommends that women with diabetes "consume more whole grain bread and cereals and less refined grains. In addition, a meal with more low-glycemic components, such as beans, cruciferous vegetables, low-fat unsweetened plain yogurt, grapefruit, apples and tomatoes will also help."

source: healthcentersonline

Sexual function variable in diabetic women

2006-03-13T16:58:00.000-08:00

Sexual function variable in diabetic women. Research suggests that women with type 1 or insulin-dependent diabetes have decreased sexual function and increased sexual distress during the second half of the menstrual cycle after ovulation and before menstruation (also known as the luteal phase of the menstrual cycle).
A group of Italian researchers lead by Dr. Andrea Salonia, of University Vita-Salute San Raffaele, Milano, evaluated the sexual function and endocrine profile in 50 fertile women with type 1 diabetes, noting the follicular (roughly the first two weeks of the menstrual cycle) and luteal phases of the menstrual cycle, and compared the findings with those of 47 controls.

Compared with the controls, women with diabetes had decreased sexual function and increased sexual distress during the luteal, but not the follicular phase of the menstrual cycle.

During the luteal phase, patients had higher total testosterone levels and lower estrogen and progesterone levels compared with the controls.

"Decreased sexual function occurs independently of mood deflections and does not seem to be influenced by glycemic (sugar) control," Salonia and colleagues write.

The variability of sexual function with different phases of the menstrual cycle may have implications on the clinical assessment in diabetics, they conclude.

source: healthcentersonline

Diabetic complications rooted in faulty cell repair

2006-03-11T23:35:00.000-08:00

Scientists say they may have discovered why diabetes patients are prone to diseased blood vessels and a host of complications, a finding that could lead to treatments.
Diabetes is a condition in which the body either stops making or cannot properly use the hormone insulin. Insulin is needed to process glucose (blood sugar), the body's primary fuel.

Researchers at the University of Florida explored why people with diabetes have increased risk of disorders of the blood vessels and vascular complications such as heart conditions and stroke. They suggest that the problem is at least partly due to failure of cells created in bone marrow to repair damage to the lining of blood vessels (endothelium), leading to complications such as atherosclerosis ("hardening of the arteries") and the eye disease diabetic retinopathy.

The scientists studied vascular repair cells in blood samples taken from volunteers with diabetes and chronic kidney disease. These cells could not move normally. However, they became more flexible and mobile when the researchers added nitric oxide, a gas that occurs naturally in the body. Many diabetic individuals have low levels of nitric oxide, which promotes the functioning and repair of blood vessels.

"The benefit of this is that when cells have improved movement they are able to repair the endothelium better and perhaps prevent atherosclerosis," researcher Dr. Mark S. Segal reported.

"The importance of this is related to other work that has shown that many drugs being used on the market today actually affect nitric oxide levels within these cells. So someday there may be two ways to help people whose cells may not function as well as they should. One is through certain medications - there may be a way we could actually give medications that would affect the nitric oxide levels within these cells and enhance their migratory ability. The other is through certain instances where we might actually collect these cells, treat them with nitric oxide outside the body and give them back to patients, to help improve the cells' migration ability," Segal concluded.

Source : Healthcentersonline

Common chemical linked to insulin resistance

2006-03-09T17:10:00.000-08:00

Common chemical linked to insulin resistance
Scientists report a possible connection between a common chemical and insulin resistance, a condition that often precedes type 2 diabetes.
Insulin resistance is an inability of the cells to properly use insulin, a hormone needed to process glucose (blood sugar) for energy. Insulin resistance causes high blood glucose (hyperglycemia), which can lead to type 2 diabetes. In people with type 1 diabetes, insulin resistance can lead to double diabetes.

Spanish scientists studying adult mice found that injections of the synthetic chemical bisphenol-A (BPA) or a female estradiol hormone reduced glucose and increased insulin in the bloodstream. After four days, mice treated with BPA or estradiol had chronic hyperinsulinemia (high levels of insulin in the blood) and altered test results for insulin and glucose tolerance.

BPA is found in many consumer plastics including food containers, dental sealants, electronics, sports equipment and cars. The plastics industry says BPA is safe and useful. The researchers describe it as a widespread contaminant.

The scientists assert that the study shows a link between environmental estrogens and insulin resistance, and that heavy exposure to estrogens increases the risk of type 2 diabetes, high blood pressure and dyslipidemia (unhealthy levels of blood fats such as cholesterol).

The study was published in the January issue of Environmental Health Perspectives, a publication of the U.S. government's National Institute of Environmental Health Sciences.

Source: HealthCentersOnline

Smoking not good with new inhaled insulin

2006-03-08T16:48:00.000-08:00

09 Mar 2006
Based on Reuter Health, smoking leads to major changes in the absorption of the newly approved inhaled insulin, Exubera, German and US researchers warn.
"These findings, which are consistent with other studies conducted to assess the effect of inhaled insulin in smokers, show that smoking greatly increases the rate and extent of absorption of Exubera," Dr. Reinhard H. A. Becker told Reuters Health.

Becker, of Aventis Pharma Deutschland, Frankfurt, and colleagues examined the absorption profile of Exubera in 20 healthy non-diabetic active chronic smokers, who then quit smoking and finally resumed smoking. In addition, the team compared the absorption of inhaled insulin in smokers with that in 10 healthy non-smokers.

Maximum levels of insulin in the blood were significantly higher in smokers than in nonsmokers, the researchers report in the medical journal Diabetes Care. The time it took to reach peak levels was also shorter in smokers than in non-smokers.

Following smoking cessation, insulin absorption declined within 1 week and approached non-smoker levels. This was completely reversed with smoking resumption.

Thus, "Exubera should not be used in people with diabetes who choose to continue smoking," warned Becker, because rapid changes in insulin levels can lead to excessively low blood sugar levels.

"In line with the recommendations from the FDA and EU Commission," he concluded, "people should have stopped smoking at least 6 months prior to starting Exubera and if smoking is resumed during Exubera therapy, treatment should be discontinued immediately."

Diabetes Overview

2006-02-24T02:04:00.000-08:00

Contents:

What is diabetes?
What are the types of diabetes?
What are the tests for diagnosing diabetes?
What are the other forms of impaired glucose metabolism, also called pre-diabetes?
What are the scope and impact of diabetes?
Who gets diabetes?
How is diabetes managed?
Hope Through Research
What will the future bring?

What is diabetes?
Diabetes is a disorder of metabolism-the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body.

After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

When we eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

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What are the types of diabetes?
The three main types of diabetes are

a. type 1 diabetes
b. type 2 diabetes
c. gestational diabetes

a. Type 1 Diabetes

Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live.

At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It develops most often in children and young adults, but can appear at any age.

Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.

b. Type 2 Diabetes
The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. This form of diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 80 percent of people with type 2 diabetes are overweight.

Type 2 diabetes is increasingly being diagnosed in children and adolescents. However, nationally representative data on prevalence of type 2 diabetes in youth are not available.

When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes-glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.

The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some people have no symptoms.

c. Gestational Diabetes
Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years.

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What are the tests for diagnosing diabetes?
The fasting plasma glucose test is the preferred test for diagnosing type 1 or type 2 diabetes. It is most reliable when done in the morning. However, a diagnosis of diabetes can be made after positive results on any one of three tests, with confirmation from a second positive test on a different day:

A random (taken any time of day) plasma glucose value of 200 mg/dL or more, along with the presence of diabetes symptoms.
A plasma glucose value of 126 mg/dL or more after a person has fasted for 8 hours.
An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in a blood sample taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor's office, measures plasma glucose at timed intervals over a 3-hour period.

Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT. Glucose levels are normally lower during pregnancy, so the threshold values for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting plasma glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

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What are the other forms of impaired glucose metabolism (also called pre-diabetes)?
People with pre-diabetes, a state between "normal" and "diabetes," are at risk for developing diabetes, heart attacks, and strokes. However, studies suggest that weight loss and increased physical activity can prevent or delay diabetes. There are two forms of pre-diabetes.

Impaired Fasting Glucose
A person has impaired fasting glucose (IFG) when fasting plasma glucose is 100 to 125 mg/dL. This level is higher than normal but less than the level indicating a diagnosis of diabetes.

Impaired Glucose Tolerance
Impaired glucose tolerance (IGT) means that blood glucose during the oral glucose tolerance test is higher than normal but not high enough for a diagnosis of diabetes. IGT is diagnosed when the glucose level is 140 to 199 mg/dL 2 hours after a person drinks a liquid containing 75 grams of glucose.

About 35 million people ages 40 to 74 have impaired fasting glucose and 16 million have impaired glucose tolerance. Because some people have both conditions, the total number of U.S. adults ages 40 to 74 with pre-diabetes comes to about 41 million. These recent estimates were calculated using data from the 1988–1994 National Health and Nutrition Examination Survey and projected to the 2000 U.S. population.

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What are the scope and impact of diabetes?
Diabetes is widely recognized as one of the leading causes of death and disability in the United States. In 2000, it was the sixth leading cause of death. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke.

Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

In 2002, diabetes cost the United States $132 billion. Indirect costs, including disability payments, time lost from work, and premature death, totaled $40 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $92 billion.

[back to Top]
Who gets diabetes?
Diabetes is not contagious. People cannot "catch" it from each other. However, certain factors can increase the risk of developing diabetes.

Type 1 diabetes occurs equally among males and females, but is more common in whites than in nonwhites. Data from the World Health Organization's Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown.

Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, some Asian Americans, Native Hawaiians and other Pacific Islander Americans, and Hispanic Americans. On average, non-Hispanic African Americans are 1.6 times as likely to have diabetes as non-Hispanic whites of the same age. Hispanic Americans are 1.5 times as likely to have diabetes as non-Hispanic whites of similar age. American Indians have one of the highest rates of diabetes in the world. On average, American Indians and Alaska Natives are 2.2 times as likely to have diabetes as non-Hispanic whites of similar age. Although prevalence data for diabetes among Asian Americans and Pacific Islanders are limited, some groups, such as Native Hawaiians and Japanese and Filipino residents of Hawaii aged 20 or older, are about twice as likely to have diabetes as white residents of Hawaii of similar age.

The prevalence of diabetes in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanic Americans and other minority groups make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates, the prevalence of diabetes in the United States is predicted to reach 8.9 percent of the population by 2025.

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How is diabetes managed?
Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.

Today, healthy eating, physical activity, and taking insulin via injection or an insulin pump are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low-a condition known as hypoglycemia-a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.

People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. An endocrinologist is a doctor who often specializes in diabetes care. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, and dietitians and diabetes educators to learn the skills needed for day-to-day diabetes management.

The goal of diabetes management is to keep blood glucose levels as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes.

This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches-intensive management and standard management-on the development and progression of eye, kidney, and nerve complications of diabetes. Intensive treatment aimed to keep hemoglobin A1C as close to normal (6 percent) as possible. Hemoglobin A1C reflects average blood glucose over a 2- to 3-month period. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a followup study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted 8 years after the trial ended.

The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.

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Hope Through Research
NIDDK conducts research in its own laboratories and supports a great deal of basic and clinical research in medical centers and hospitals throughout the United States. It also gathers and analyzes statistics about diabetes. Other Institutes at the National Institutes of Health (NIH) conduct and support research on diabetes-related eye diseases, heart and vascular complications, pregnancy, and dental problems.

Other Government agencies that sponsor diabetes programs are the Centers for Disease Control and Prevention, the Indian Health Service, the Health Resources and Services Administration, the Department of Veterans Affairs, and the Department of Defense.

Many organizations outside the Government support diabetes research and education activities. These organizations include the American Diabetes Association, the Juvenile Diabetes Research Foundation International, and the American Association of Diabetes Educators.

In recent years, advances in diabetes research have led to better ways of managing diabetes and treating its complications. Major advances include

development of quick-acting and long-acting insulins
better ways to monitor blood glucose and for people with diabetes to check their own blood glucose levels, including advances in noninvasive blood glucose monitoring
development of external insulin pumps that deliver insulin, replacing daily injections
laser treatment for diabetic eye disease, reducing the risk of blindness
successful kidney and pancreas transplantation in people whose kidneys fail because of diabetes
better ways of managing diabetes in pregnant women, improving their chances of a successful outcome
new drugs to treat type 2 diabetes and better ways to manage this form of diabetes through weight control
evidence that intensive management of blood glucose reduces and may prevent development of diabetes complications
demonstration that two types of antihypertensive drugs, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers), are more effective than other antihypertensive drugs in reducing a decline in kidney function in people with diabetes
promising results with islet transplantation for type 1 diabetes reported by the University of Alberta in Canada
evidence that people at high risk for type 2 diabetes can lower their chances of developing the disease through diet, weight loss, and physical activity

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What will the future bring?
Prevention of Diabetes
Researchers continue to look for the cause or causes of diabetes and ways to prevent and cure the disease. Scientists are searching for genes that may be involved in type 1 or type 2 diabetes. Some genetic markers for type 1 diabetes have been identified, and it is now possible to screen relatives of people with type 1 diabetes to determine whether they are at risk.

Type 1 Diabetes
The Diabetes Prevention Trial-Type 1 (DPT-1) identified relatives at risk for developing type 1 diabetes and investigated two ways to delay or prevent type 1 diabetes. Results showed that neither low-dose insulin injections nor an oral form of insulin were successful in delaying or preventing type 1 diabetes in people at risk.

The DPT-1 was funded by the NIDDK, the National Institute of Allergy and Infectious Diseases, the National Institute of Child Health and Human Development, and the National Center for Research Resources within the National Institutes of Health, as well as the American Diabetes Association and the Juvenile Diabetes Research Foundation International.

Researchers are working on a way for people with type 1 diabetes to live without daily insulin injections. In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and transferred into a person with type 1 diabetes. Once implanted, the beta cells in these islets begin to make and release insulin.

Scientists have made many advances in islet transplantation in recent years. Since reporting their findings in the June 2000 issue of the New England Journal of Medicine, researchers at the University of Alberta in Edmonton, Alberta, Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes. A multicenter clinical trial of the Edmonton protocol for islet transplantation is currently under way, and results will be announced in several years. According to the International Islet Transplant Registry, as of June 2003 about 50 percent of the patients have remained free of the need for insulin injections up to 1 year after receiving a transplant. A clinical trial of the Edmonton protocol is also being conducted by the Immune Tolerance Network, funded by the National Institutes of Health and the Juvenile Diabetes Research Foundation International.

The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. For an average-sized person (70 kg), a typical transplant requires about 1 million islets, extracted from two donor pancreases. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce the risk of these complications. But a transplant recipient will need to take immunosuppressive drugs to stop the immune system from rejecting the transplanted islets.

Researchers are trying to find new approaches that will allow successful transplantation without the use of immunosuppressive drugs. These drugs have significant side effects and their long-term effects are still unknown. Immediate side effects of immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea. Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections. Taking immunosuppressive drugs increases the risk of tumors and cancer as well.

Researchers do not fully know what long-term effects islet transplantation may have. Although the early results of the Edmonton protocol are very encouraging, more research is needed to answer questions about how long the islets will survive and how often the transplantation procedure will be successful.

A major obstacle to widespread use of islet transplantation will be the shortage of islet cells. The supply available from deceased donors will be enough for only a small percentage of those with type 1 diabetes. However, researchers are pursuing alternative sources, such as creating islet cells from other types of cells. New technologies could then be employed to grow islet cells in the laboratory.

Type 2 Diabetes
In 1996, NIDDK launched its Diabetes Prevention Program (DPP). The goal of this research effort was to learn how to prevent or delay type 2 diabetes in people with impaired glucose tolerance (IGT), a strong risk factor for type 2 diabetes.

The findings of the DPP, which were released in August 2001, showed that people at high risk for type 2 diabetes could sharply lower their chances of developing the disease through diet and exercise. In addition, treatment with the oral diabetes drug metformin also reduced diabetes risk, though less dramatically.

Participants randomly assigned to intensive lifestyle intervention reduced their risk of getting type 2 diabetes by 58 percent. On average, this group maintained their physical activity at 30 minutes per day, usually with walking or other moderate intensity exercise, and lost 5 to 7 percent of their body weight. Participants randomized to treatment with metformin reduced their risk of getting type 2 diabetes by 31 percent.

Of the 3,234 participants enrolled in the DPP, 45 percent were from minority groups that suffer disproportionately from type 2 diabetes: African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians. The trial also recruited other groups known to be at higher risk for type 2 diabetes, including individuals aged 60 and older, women with a history of gestational diabetes, and people with a first-degree relative with type 2 diabetes.

Prevention and Treatment of Cardiovascular Disease
The National Institutes of Health (NIH) is studying the best strategies to prevent and treat cardiovascular disease (CVD) in people with diabetes in three trials: Look AHEAD, ACCORD, and BARI 2D. These studies are all joint efforts of the NIDDK and the National Heart, Lung, and Blood Institute.

The Look AHEAD: Action for Health in Diabetes study will be the largest clinical trial to date to examine the long-term health effects of voluntary weight loss. This multi-center, randomized clinical trial will study the consequences of a lifestyle intervention designed to achieve and maintain weight loss over the long term through decreased caloric intake and increased exercise. Look AHEAD will focus on the disease most associated with overweight and obesity, type 2 diabetes, and on the outcome that causes the greatest morbidity and mortality in people with type 2 diabetes, cardiovascular disease.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, a randomized multi-center trial, is being undertaken by the NIH to study three key approaches to preventing major cardiovascular events in individuals with type 2 diabetes. The primary outcome to be measured is the first occurrence of a major cardiovascular disease event, specifically heart attack, stroke, or cardiovascular death. In addition, the study will investigate the impact of the treatment strategies on other cardiovascular outcomes; total mortality; limb amputation; eye, kidney, or nerve disease; health-related quality of life; and cost-effectiveness.

The Bypass Angioplasty Revascularization Investigation in Type 2 Diabetics (BARI 2D) trial, a 5-year, multi-center clinical trial, will compare medical versus early surgical management of patients with type 2 diabetes who also have coronary artery disease and stable angina or ischemia. At the same time, BARI 2D will study the effect of two different strategies to control blood glucose-providing insulin versus increasing the sensitivity of the body to insulin-on the risk of cardiovascular mortality and morbidity.

A complete listing of clinical research studies can be found at http://ClinicalTrials.gov.

Several new drugs have been developed to treat type 2 diabetes. By using the oral diabetes medications now available, many people can control blood glucose levels without insulin injections. Studies are under way to determine how best to use these drugs to manage type 2 diabetes.

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2006-02-24T01:57:00.000-08:00

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