Diabetes Dialectics

Type 2 Diabetics Experience Hyperglycemia Throughout The Day?

noreply@blogger.com (Roger Alexander) — Sat, 14 May 2011 11:50:00 +0000

POSTPRANDIAL (after meals) hyperglycemia is one of the earliest abnormalities of glucose homeostasis associated with type 2 diabetes and is markedly exaggerated in diabetic patients with fasting hyperglycemia. And research conducted with human patients, mice, and pancreas beta cell cultures all point to a single threshold at which elevated blood sugars cause permanent damage to your body: 140 mg/dl (7.8 mmol/l) after meals.

Better control of postprandial blood glucose levels contributes more to improvement in HbA1c levels than fasting glycemic control. And since HbA1c is the gold standard for determining glycemic control among people with both type 1 and type 2 diabetes, all diabetics struggle to control the blood sugar round-the-clock.

However, a new research study from The Netherlands suggests that diabetics face a Sisyphean task ‒ postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients, including even those patients with HbA1c well below 7.0%.

Although postprandial hyperglycemia is recognized as an important target in type 2 diabetes treatment, information on the prevalence of postprandial hyperglycemia throughout the day is limited. The researchers therefore assessed the prevalence of hyperglycemia throughout the day in type 2 diabetes patients and healthy controls under standardized dietary, but otherwise free-living conditions.

The researchers recruited 60 male type 2 diabetes patients (HbA1c 7.5 ± 0.1%) and 24 age- and BMI-matched normal glucose tolerant controls to participate in a comparative study of daily glycemic control. During a 3-day experimental period, blood glucose concentrations throughout the day were assessed by continuous glucose monitoring (CGM).

The researchers discovered that type 2 diabetes patients experienced hyperglycemia (glucose concentrations > 180 mg/dl [10 mmol/l]) 38 ± 4% of the day. Even diabetes patients with an HbA1c level below 7.0% (53 mmol/mol) experienced hyperglycemia for as much as 24 ± 5% throughout the day. Hyperglycemia was negligible in the control group (3 ± 1%).

After evaluating the data, the researchers concluded that hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients, including even those patients with HbA1c well below 7.0%. More importantly, “standard medical care with prescription of oral blood glucose lowering medication does not provide ample protection against postprandial hyperglycemia,” the authors wrote.

The aim of every diabetic is to keep postprandial blood sugar levels in line with the recommendations of the American Association of Clinical Endocrinologists, an organization of specialists who treat diabetes, that blood sugar should not be allowed to rise above 140 mg/dl two hours after a meal. The International Diabetes Federation (IDF) has also adopted the 140 mg/dl post-meal blood sugar target.

Since, as Dutch study shows, a majority of patients with diabetes fail to achieve their glycemic goals, it means elevated postprandial glucose (PPG) concentrations contribute to suboptimal glycemic control.

What is the contribution of PPG to the long-term complications of diabetes? Many studies have demonstrated a positive association between diabetic complications and hyperglycemia. “Complications" is a euphemism for some very ugly outcomes that include blindness, amputation, kidney failure and death. Considering the interrelationships among glycemic measures, this is not surprising.

A team of Italian researchers led by A Gastardelli started examining beta cell response to glucose in people with normal blood sugars discovered that a small amount of beta cell dysfunction began to be detectable in people whose blood sugar rose only slightly over 100 mg/dl on a 2-hour glucose tolerance test. The beta cells are the cells in the pancreas that produce the insulin your body uses to control your blood sugar.

Analyzing their data further, they found that with every small increase in the 2-hour glucose tolerance test result, there was a corresponding increase in how much beta cell failure was detectable. The higher a person's blood sugar rose within "normal" range, the more beta cells were failing.

In another study, University of Utah neurologists found that patients who were not known to be diabetic, but who registered 140/mg or higher on the 2-hour sample taken during a glucose tolerance test were much more likely to have a diabetic form of neuropathy than those who had lower blood sugars. Even more telling, the researchers found that the length of time a patient had experienced this nerve pain correlated with how high their blood sugar had risen over 140 mg/dl on the 2-hour glucose tolerance test reading.

It is important to note that this study also showed that only the glucose tolerance test results corresponded to the incidence of neuropathy in these patients, not their fasting blood sugar levels or their results on the HbA1c test. This is significant because most American doctors do not offer their patients glucose tolerance tests, only the fasting glucose and HbA1c tests that fail to diagnose these obviously damaging post-meal blood sugars.

Given facts such as these, what does a diabetic do? Jenny Ruhlsuggests that if your blood sugar has been very high for a while, you can bring down the levels by proceeding in stages, setting your blood sugar targets progressively lower, a step at a time. But don't stay at higher than normal levels for any longer than is absolutely necessary. Once your body does adapt, you will probably feel much better and much more energetic than before.

Ruhl recommends patience while your body becomes accustomed to new, healthy, blood sugar levels, cautioning not to respond to feeling as if you were having a hypo by eating carbs to push up your blood sugar as long as your blood sugar tests at 80 mg/dl (4.4 mmol/l) or above. Give your body a chance to adapt and eventually you will feel completely normal when you have a normal blood sugar and may feel surprisingly toxic when your blood sugar reaches the dangerously high levels that you used to feel normal at, she says.

The 140 mg/dl (7.8 mmol/L) blood sugar target is a good start, but many of us find we feel better and get even more normal health if we shoot for truly normal blood sugars and keep our blood sugar under 120 mg/dl (6.7 mmol/L) at all times. If you can do it, go for it. Now that we know that heart attack risk rises significantly at HbA1c in the mid 5% range, getting to true normal is that much more important, Ruhl concludes.

After Cracking Metformin Code, Scientist Makes Breakthrough Discovery That Points The Way To New Class Of Diabetes Drugs

noreply@blogger.com (Roger Alexander) — Fri, 13 May 2011 17:53:00 +0000

HDAC inhibitors may provide a novel way to cut excessive blood glucose levels at the source

RESEARCHERS have uncovered a novel mechanism that turns up glucose production in the liver when blood sugar levels drop, pointing towards a new class of drugs for the treatment of metabolic disease, the Salk Institute for Biological Studies announced in a press statement today.

In a uniquely collaborative study, the scientists have found evidence ‒ published in the May 13, 2011 issue of the journal Cell‒ that a group of enzymes, or proteins, currently under investigation for the treatment of cancer could potentially also work as a treatment for type 2 diabetes. This is significant because it not only portends a new treatment for diabetes, but it also could mean that a new treatment has already gotten through the costly and lengthy early stages of drug development.

The Salk discovery revolves around enzymes called histone deacetylases, or HDACs, which help the liver produce sugars when blood glucose runs low after prolonged periods of fasting, particularly at night. After a meal, insulin “instructs” muscle cells to store this glucose and turns off sugar production in the liver. In patients with type 2 diabetes, however, the body effectively doesn’t “listen” to insulin, and the liver keeps producing sugar.

Dr, Reuben J. Shaw

"These exciting results show that drugs that inhibit the activity of class II HDACs may be worthwhile to be pursued as potential diabetes drugs," said lead author Reuben Shaw, an assistant professor in Salk’s Molecular and Cell Biology Laboratory.

Up to this point, all experiments had been performed in cultured cells but the researchers were really interested in whether class II HDACs controlled blood glucose in mouse models of diabetes. Strikingly, suppression of all three HDACs simultaneously restored blood glucose levels to almost normal in four different models of type 2 diabetes.

"The key will be to specifically block HDACs involved in glucose control," said Shaw, "but the fact gluconeogenesis takes place in the liver makes this task easier as most drugs sooner or later travel to the liver once they hit the bloodstream."

"Our results predict then that some of those drugs, probably not the same ones that work on cancer but some of the ones that are sitting on the shelf that maybe weren’t effective for cancer but in fact hit these enzymes, that they could be potential therapeutics for diabetes," said Shaw. "That means that the time from this initial discovery until the time that this can be tested in the clinic is much shorter."

Ronald Evans, a professor in Salk’s Gene Expression Laboratory, said that while this discovery is novel, scientists have long noticed a link between cancer and diabetes, particularly because the risks of both diseases are increased in obese patients. This discovery -- that suppressing HDACs can treat diabetes as well as cancer -- is a way of turning this theory into a potential treatment.

"We know that along with increased weight and obesity there is an increased risk of cancer. We also know that cancer cells undergo a profound metabolic change and so the cancer metabolism has become a very big area (of study)," Evans said.

"So for those of us who study metabolism and study cancer, the link between these two seemingly separate areas, actually at the level of the genome, happen to work with several common pathways," he continued, "because they’re both dealing with either consuming energy, which is what happens with cancer, or storing energy, which is what happens with obesity."

Currently, metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet), an oral biguanide anti-diabetic drug, is the most widely prescribed agent for treatment of type 2 diabetes. The drug mainly works by lowering glucose production by the liver, and thus lowering fasting blood glucose. Although metformin – approved in the United States in 1994, and in Europe prior to that – has been used for many years, its mechanism of action is not well understood.

"Metformin is originally derived from a plant found in Western Europe called 'French lilac' or 'Goat's Rue' because goats didn't like to eat it. They steered clear of the plant because it contains a compound that acts to naturally lower blood glucose in animals that eat it ‒ to prevent them from eating it again," Shaw explained.

Does Periodic Fasting Lower The Risk?

A few years ago, Shaw discovered how metformin helps insulin to control glucose levels: It binds to a "metabolic master switch" known as AMPK that blocks glucose production in the liver. Trying to identify novel targets of AMPK that might be relevant to diabetes, Maria Mihaylova, a graduate student in the Shaw laboratory, focused her efforts on a family of HDACs known as class II HDACs. They function as negative regulators of gene activity by stabilizing the tightly coiled structure of DNA in chromosomes, making it inaccessible to proteins that transcribe DNA.

Working closely with Ronald M. Evans and his team, Mihaylova found that inhibiting class II HDACs shut down genes encoding enzymes needed to synthesize glucose in liver. "We identified class II HDACs as direct targets of AMPK in a bioinformatics-based screen, but we didn't know which genes they might regulate in liver since they weren't even known to be found there," said Mihaylova.

In collaboration with her colleagues in Marc Montminy's lab, a professor in the Clayton Foundation Laboratories for Peptide Biology, and like Shaw and Evans a member of the Center for Nutritional Genomics at the Salk Institute, Mihaylova discovered that HDACs themselves associated with the DNA regulatory elements controlling the expression of the glucose synthesizing enzymes, but they only flocked there after she had treated cells with the fasting hormone glucagon.

"In response to the glucagon, chemical modifications on class II HDACs are removed and they can translocate into the nucleus," she explains. There, they bind to FOXO, a key metabolic regulator, which had been shown previously to be shut down by insulin.

"It came as a big surprise that FOXO is activated by glucagon," explains Shaw. Further experiments confirmed that the genetic suppression of class II HDACs in liver cells led to an increase in acetylated FOXO, which now can neither bind DNA nor activate the genes encoding glucose-synthesizing enzymes.

A parallel study, led by Montminy and published in the same issue of Cell as Shaw's paper, shows that in fruit flies, FOXO not only controls the expression of a fat-digesting enzyme but is activated by a glucagon-like hormone in a manner similar to human FOXO.

"The central circuitry of how animals regulate metabolism in response to fasting and feeding is conserved from fly all the way to man emphasizing the importance of class II HDACs in coordinating how different hormones direct the creation and use of glucose," says Shaw, who is a co-author on Montminy's paper.

Shaw next plans to test whether these glucose loving HDACs may also play roles in certain forms of cancer as well.

Source: Salk Institute for Biological Studies

UK Trials to Determine if Metformin Given to Overweight Expectant Mothers Can Stop Them From Having Fat Babies Begin

noreply@blogger.com (Roger Alexander) — Thu, 12 May 2011 15:15:00 +0000

HUNDREDS of overweight mothers-to-be are being given metformin up to three times a day during their pregnancy to stop them from having obese babies as part of a controversial trial in the UK. The trial involves 400 obese but non-diabetic volunteers at hospitals in Liverpool, Edinburgh and Coventry.

Half will take metformin from around 12 weeks into their pregnancy and half will take a placebo. Their health and their babies’ health will be monitored and the results are expected in four years. It is hoped the treatment will prevent the birth of overweight babies and bring down the need to carry out caesarean sections as well as preeclampsia.

The latest figures show that almost half of women of childbearing age in Britain are overweight or obese and more than 15 percent of pregnant women are obese. This raises their odds of dying in pregnancy, of their baby being stillborn and of a host of pregnancy complications, some of which can be fatal.

Indeed, one of the most alarming facts to emerge after the trails were announced is that each year the Liverpool Women’s Hospital, for example, cares for more than 500 pregnant women who have a body mass index of more than 40 – which translates as severely obese.

Doctors believe many overweight adults can trace their problems back to the womb, when the fetus absorbs too many sugars and fats because of the high levels of insulin in their mother’s blood. But rather than trying to help the expectant mother lose weight, the drug would help keep the weight of the unborn baby down by reducing the levels of blood sugar passed to babies in the womb

Metformin, long cleared for the treatment of diabetes in pregnancy, has been safely used by diabetics for decades and the UK researchers think early intervention administering it to obese expectant mothers could save youngsters from a lifetime of weight problems and ill-health.

The doctors behind the trial say obesity among pregnant women is reaching epidemic proportions and they need to protect the health of tomorrow’s children. However, many healthy women are likely to be uneasy about mass medication in pregnancy for a problem that can be treated through changes to diet and exercise.

Ian Campbell, medical director of charity Weight Concern, said: “In an ideal world we would be in a position to assist women to be of a near-normal bodyweight prior to conception. But that is not realistic in the current environment. The reality is that many women go through pregnancy carrying too much body fat and it is important we do something about it because it causes serious problems.”

Defending the exercise which has raised the hackles of several groups, Andrew Weeks, who is leading the trial, said: "It is about trying to improve outcomes in pregnancy for women who are overweight. The problem is babies tend to be larger and many of the downsides of being overweight during pregnancy relate to the birth."

Documents for the trial state: “Rates of obesity in adults and children are rising exponentially in the UK, as in other developed nations, and there are major causes for concern. The problem of maternal obesity, leading to programming of future life obesity risk in offspring, and manifest by excess birth weight, is reaching epidemic proportions. We believe that metformin will likely be an effective therapy in interrupting this cycle.”

Professor Norman, of Edinburgh University, said metformin was judged as a safe drug but the trial is needed to ensure the benefits outweighed any risks. She added that if the trial does show metformin to be of benefit, it is unlikely to work in all women and is most likely to be prescribed alongside advice on diet and exercise.

Nonetheless, women rightfully feel "uneasy" about the trial, said Alison Wetton, CEO of Britain's fastest growing weight loss organization, All About Weight. "No mother-to-be likes to take medication, and the fact that the widely-used diabetes pill, metformin, is being trialed to prevent obese babies being born to overweight mothers is disturbing to me, and I am sure most other women as well," she said.

Will Williams, scientific advisor for All About Weight, said that although there were "reasonable grounds" for the trial, it was "a shame that it is needed at all.” He said women wanting to conceive could instead lose weight by following a healthy weight loss plan, including diet and exercise, and "thus achieve all the things that the metformin trial is hoping to do, without the risks or costs of adding a drug with uncertain long term effects."

“This would be far preferable to popping a pill that may help pregnancy outcomes but is unlikely to break the cycle of an unhealthy lifestyle leading to overweight children and the continuing rise of obesity and diabetes in the general population," he stressed.

Fat Fathers Pass on Diabetes

Looking Beyond HbA1c: Research To Find New Diabetes Biomarkers Gains Traction

noreply@blogger.com (Roger Alexander) — Wed, 11 May 2011 11:07:00 +0000

The discovery of several new biomarkers in the blood may further our understanding of exactly who’s at risk for diabetes
BETA cells within the pancreas produce and release insulin. Loss of the function of these cells compromises the body’s ability to control blood sugar and underlies the development of diabetes. So, one of the next frontiers of diabetes therapeutics is to change the progression rate of beta cell failure.

Recognizing this as a research priority, the Foundation of the National Institutes of Health (FNIH) Biomarkers Consortium announced Tuesday the launch of a multi-year clinical study to improve tools for measuring the function of insulin-producing beta cells in people with type 2 diabetes mellitus. Researchers hope the initiative will lead to improved techniques for tracking progression of the disease and pave the way for more effective treatments.

The project ‒ “Diabetes Drug Development: Identification and Validation of Markers that Predict Long-Term Beta Cell Function and Mass” ‒ is being managed by the Metabolic Disorders Steering Committee (MDSC) of the FNIH Biomarkers Consortium.

It is a three-year, $5.1 million clinical study to standardize tests for measuring beta cell function in the clinical setting that aims to improve methods for the early prediction of the long-term response to an intervention and for identification of patients at risk for rapid beta cell function deterioration, thereby enabling future clinical studies that examine diabetes progression.

A biomarker is a biochemical feature or facet that can be used to measure the progress of disease or the effects of treatment. So the validation of biomarkers to measure the progression of diabetes will greatly facilitate the development of better medicines to treat and potentially prevent this disease and its often disabling complications.

Experts believe biomarkers will become one of the major driving forces of pharmaceutical research and drug development in the coming years.

Currently, diabetes researchers are working without the benefit of agreed-upon standards for gauging beta cell function and this initiative will give researchers practical tools that can be used to measure beta cell function over time and stimulate research to maintain and improve that function.

The project was developed through a rigorous consensus-building process by a team of experts from across the entire scientific community. The pharmaceutical industry, academic, and government representatives contributed their clinical trials expertise and scientific support to the design and execution of the studies.

Utilizing a collaborative approach, the FNIH Biomarkers Consortium has brought together diabetes experts from the National Institutes of Health (NIH), Food and Drug Administration (FDA), leading academic institutions, the pharmaceutical industry, and non-profit sector to develop the project.

Biomarkers play an integral part in conducting clinical trials and treating patients. In most instances, they help medical practitioners, researchers, and regulatory officials make well-informed, scientifically sound decisions.

However, in clinical studies, there is often uncertainty in how much weight to place on biomarker results versus clinical outcomes. This uncertainty emanates from opposing goals of the drug approval process. On one hand, the process must ensure that all therapeutics tested are safe and that the benefits outweigh the risks. On the other hand, the process should allow therapies to be accessible to patients as quickly as reasonably possible.

Judicious use of biomarkers in the drug development process can bring these goals into alignment. More efficient discovery and use of biomarkers in the development of anti-diabetes drugs will depend on advancing current understanding of the pathogenesis of diabetes and especially its macrovascular (pertaining to the larger blood vessels) complications.

The idea of using biomarkers to predict diabetes is not entirely new. Glycated hemoglobin (HbA1C) values are now routinely being monitored to screen for at-risk patients. A study published in PLoS One last year shows that several new biomarkers in the blood may further our understanding of exactly who’s at risk for diabetes, and increase our knowledge of the etiology of the disease.

Veikko Salomaa and colleagues from the Department of Chronic Disease Prevention at the National Institute for Health and Welfare in Helsinki, Finland, tested nearly 13,000 people and found almost 600 cases of diabetes during routine follow-up exams.

According to the study, low levels of adiponectin, and high levels of apoB, C-reactive protein (CRP), and insulin, increase the chance that a woman will develop diabetes. When these factors were measured, proper diabetes prediction increased by 14% compared to when doctors only use classic risk factors, such as BMI and blood glucose levels, to predict disease.

The biomarkers that best predicted diabetes in men were low adiponectin, and high levels of CRP, interleukin-1 receptor antagonist (IL-1RA), and ferritin. Accounting for these biomarkers led to a 25% increase in correct diabetes detection in the cohort. Adiponectin is a hormone found in the body that modulates a number of metabolic processes, including glucose regulation and fatty acid catabolism.

The use of adiponectin, a hormone derived from fat cells, which is abundant in plasma and easy to measure through commercially available kits, was also confirmed as a robust biomarker predictive of glycemic efficacy in Type 2 diabetes and healthy subjects, after treatment with peroxisome proliferator-activated receptor-agonists (PPAR), but not after treatment with non-PPAR drugs such as metformin by the first project to be completed by the Biomarkers Consortium.

The project conducted a statistical analysis of pooled and blinded pre-existing data from Phase II clinical trials contributed by four pharmaceutical companies and analyzed under the direction of a diverse team of scientists from industry, the National Institutes of Health (NIH), U.S. Food & Drug Administration (FDA), and academic research institutions.

Source: FNIH Biomarker Consortium

mHealth: How Cell Phones Can Deliver Better Diabetes Care

noreply@blogger.com (Roger Alexander) — Sun, 08 May 2011 11:30:00 +0000

AT long last, technology is coming to the rescue of diabetics, trying to make diabetes management easier. In fact, just in the past few years, there finally has been marvelous progress in diabetes care. This isn’t just with insulin pumps and home blood glucose monitoring systems. The technologies available now and those at the cusp of development are really encouraging and exciting.

It is heartening to see the advantages of the wireless world finally being brought to use beyond socializing. For diabetics, they’re being used as a means of communicating critical information about our health and the status of the conditions that can be mortally devastating and an expensive burden.

For example, after a year-long study researchers have demonstrated how a mHealth ‒ mobile-phone-based remote patient monitoring ‒ system helped patients in Canada with type 2 diabetes and uncontrolled hypertension get their blood pressure (BP) under control. The study findings were presented at a press briefing in Tampa, Florida at the American Telemedicine Association’s (ATA) 16th Annual International Meeting last week and discussed later in this report.

Telehealth: The New Frontier
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth.

Telemedicine is not a separate medical specialty. Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services.

Of course, nothing replaces weight loss and proper diet. But communications technology can be used as a means to inform, monitor and support patients and health care providers and medical companies are quickly learning how to leverage emerging communication and electronic technologies to make diabetes management more efficient, reducing hospitalizations and ultimately decreasing the cost of the disease to individuals and on society.

Mobile Health: The New Hot Topic
Dale C. Alverson, MD, ATA president and medical director of the Center for Telehealth at the University of New Mexico Health Sciences Center in Albuquerque, said "mobile health, or mHealth, is the hot topic in telemedicine technology. These are applications for remote monitoring of patients with chronic disease, such as diabetes and chronic congestive heart failure, through a mobile phone-based system."

This technology is "becoming ubiquitous," he added, "and in our program, we are seeing the providers and the patients adopting this technology in ways we may never have dreamed of. It adds that mobility and that sense of connection between patient and provider."

Killer Apps That Are Revolutionizing Diabetes Care

This was ably demonstrated by Joseph Cafazzo, PhD, PEng, senior director of eHealth Innovation at the University Health Network, in Toronto, Ontario, Canada, and his colleagues who developed and tested an mHealth intervention to automate capture of BP readings through a mobile-phone-based system that provides "actionable messages to patients and critical alerts to physicians."

Their study involved 110 men and women with type 2 diabetes and uncontrolled systolic hypertension. Study subjects had a mean age of 62 years and a mean weight of 90.2 kg (198.4 lbs).

Over the course of 1 year, half of the subjects monitored their BP at home with a standard home BP monitoring system (the control group). The other half used a Bluetooth-enabled BP monitor that transmitted readings through a mobile-phone-based remote patient monitoring system to their family physician (the intervention group). These patients were also given automated reminders after 3 days of not taking their measurements.

The ChroniCare system

At baseline, patients' mean daytime BP was 142.7/77.1 mm Hg. After 1 year, Dr. Cafazzo reported, the intervention group had a 9.1 mm Hg dip in systolic BP (P < .0001) and a 4.6 mm Hg dip in diastolic BP (P < .0001). In contrast, there was virtually no change in the control group. According to the investigators, "50% of patients in the telemonitoring group had their BP under good control (130/80 mm Hg)," compared with only 29% in the control group (P < .05).

Self-awareness: Gateway to Better Self-care
"The family doctors caring for these patients really had nothing to do with the improvements. This was really a self-care tool and the patients were performing better self-care because they were more self-aware, more accountable," Dr. Cafazzo said.

By contrast, study patients who merely checked their BP at home, without reporting it to their physician through the remote system, had no marked change in BP during the study. "The act of just giving a patient a [BP] home monitor had no effect; it had to have the telemonitoring component," Dr Cafazzo pointed out.

"We believe that patients become far more self-aware and more accountable to their care provider knowing that the data are going back to their care provider and that the care provider will be acting on it," he explained.

During the briefing, Dr. Cafazzo also shared similarly promising findings from a recently completed study in which a mobile-phone-based system significantly improved uncontrolled BP in a group of chronic heart failure patients.

For the heart failure patient, he explained, "we have a decision support engine that looks at the data and only sends relevant data to the clinician when the algorithm determines that the patient is deteriorating at home." This is a "first of its kind," he added, in terms of using a mobile-phone-based system to monitor multiple parameters.

Next Target: Adolescents With Diabetes
Dr. Cafazzo also presented preliminary findings from the first clinical trial of an iPhone application called "Bant," which has a fully integrated glucometer and targets adolescents 12 to 16 years of age with type 1 diabetes. The study currently has 28 adolescents enrolled.

"This is a very difficult population," he said. "They are transitioning from being totally dependent on their parent's care to asserting their independence, and unfortunately their HbA1c often starts to increase. We knew this population would be amenable to the iPhone, but that their attention span would be very short."

To entice these young people, the researchers incorporated a social networking application. "There is essentially a microblogging chat room where these kids can exchange their experiences; so far, kids are using it and usually they talk about music, the iPhone, anything but their diabetes," Dr. Cafazzo reported.

There is also a redeemable point system that rewards participants with iTunes for taking and reporting their blood sugar levels regularly. "The rewards mechanism appears to be working very well," Dr. Cafazzo said.

Not surprisingly, it is because of studies like these that the health care market is seeing a large influx of companies who are putting technology to use in a growing field of healthcare communications and health-record management. At a basic level, this means using technology to manage health records and share information with a patient’s physician or other approved health care providers and caregivers ‒ including family members. At an advanced level, the possibilities are endless.

Sources: American Telemedicine Association, Medscape News, PubMed

Related articles:
Sustaining better diabetes care in remote indigenous Australian communities

A feasibility study of remote monitoring of CAPD patient’s blood pressure and blood glucose measurements via the internet

Mobile phone-based remote patient monitoring system for management of hypertension in diabetic patients

“Normal” Blood Sugar Levels May Still Mean You Have Prediabetes

noreply@blogger.com (Roger Alexander) — Sat, 07 May 2011 18:33:00 +0000

FPG between 91 and 99 mg/dl is a strong independent predictor of type 2 diabetes, claims new study

Type 2 diabetes is a lifestyle disease in which the body no longer responds appropriately to the hormone insulin, which helps ferry sugar from the blood into our cells after a meal. When fasting blood sugar levels reach 126 mg/dl or more, doctors will diagnose diabetes.

Prediabetes means that your blood sugar level is higher than normal, but it's not yet increased enough to be classified as type 2 diabetes. Still, without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less. (Scroll to end for Prediabetes FAQs)

Traditionally, blood sugar levels below 100 mg/dl have been considered “safe”, whereas levels between 100 and 126 signal a “higher risk” of diabetes (prediabetes). But according to the new study by Dr. Paolo Brambilla and colleagues at the University Milano Bicocca in Italy, the currently accepted "normal" blood sugar range might be too wide.

“FPG (Fasting Plasma Glucose) between 91 and 99 mg/dl is a strong independent predictor of type 2 diabetes and should be used to identify people to be further investigated and aided with preventive measures,” the researchers say. The conclusion significantly expands the "prediabetes" label.

To back their claim, the researchers report that in the course of their study they discovered people at the high end of what's considered the "normal" blood sugar range are twice as likely to get the disease as are those in the low end. The findings are in line with an earlier study from Oregon, and the Italian researchers say they can help identify the people who need extra medical attention.

The researchers looked at data for nearly 14,000 men and women who'd had blood drawn several times at their clinic. The patients were between 40 and 69 years old and all of them had normal blood sugar levels at first. Over the next seven to eight years, on average, about two percent of the women and nearly three percent of the men developed diabetes.

Less than one percent of those who started out with fasting blood sugar levels between 51 and 82 mg/dl wound up with the disease, while more than three percent did so if they had values between 91 and 99. After controlling for other factors that might influence the likelihood of getting diabetes, that corresponded to a two-fold difference in risk of developing the disease.

Research has shown that if you have prediabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting. If your blood sugar tests over 100 mg/dl fasting more than once, your fasting blood sugar is likely to go over the 125 mg/dl level used to diagnose full diabetes within 3 years.

More importantly, if your blood sugar is at 100 mg/dl fasting, it is very likely that your post-meal blood sugar is heading towards the diabetic range, which is over 200 mg/dl which is why your fasting blood sugar is deteriorating. High post-meal blood sugars kill beta cells. If you can bring down those post-meal highs, you may be able to prevent the beta cell death that is destroying your fasting control!

While opinion is divided on the question whether doctors should treat these people any different, as the researchers suggest, everyone agrees that people should strive to manage their weight and be physically active irrespective of what their blood sugar level is.

The bald reality is that, according to the American Diabetes Association, in the US alone there are three times as many prediabetics as people with diabetes (79:27 million). And It is estimated that there will be 418 million people worldwide with prediabetes by 2025.

How to Tell if You Have Prediabetes
The American Diabetes Association says while diabetes and prediabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others and warns that Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. This means they are also at increased risk for developing prediabetes.

There are three different tests your doctor can use to determine whether you have prediabetes:

• The A1C test

• The fasting plasma glucose test (FPG)

• The oral glucose tolerance test (OGTT).

The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have prediabetes or diabetes.

If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT). Both are also known as prediabetes.

The American Diabetes Association Risk Test for Diabetes can help you determine if you are at increased risk for diabetes or prediabetes. A high score may indicate that you have prediabetes or at risk for prediabetes. Take the test and find out for sure.

ADA Prediabetes FAQs

What is prediabetes and how is it different from diabetes?
Prediabetes is the state that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. About 11 percent of people with prediabetes in the Diabetes Prevention Program standard or control group developed type 2 diabetes each year during the average 3 years of follow-up. Other studies show that many people with prediabetes develop type 2 diabetes in 10 years.

What are the symptoms of prediabetes?
The reason why so many people suffer from prediabetes and are completely unaware of it is because it is quite possible for no symptoms to manifest themselves. Both diabetes and prediabetes develop at a gradual rate.

How do I know if I have prediabetes?
Doctors can use either the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT) to detect prediabetes. Both require a person to fast overnight. In the FPG test, a person's blood glucose is measured first thing in the morning before eating. In the OGTT, a person's blood glucose is checked after fasting and again 2 hours after drinking a glucose-rich drink.

How do I stop prediabetes developing into Type 2 diabetes?

The good news may be that, if you have become aware of the disease early, your condition can still be cured. The two principle factors for consideration are the changing of diet and the addition of appropriate physical exercise to your lifestyle. By making these changes, it may be possible to return blood sugar levels to normal. Prediabetes is a serious medical condition that can be treated.

The recently completed Diabetes Prevention Program study conclusively showed that people with prediabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range. But for a comprehensive and individual plan you should see your doctor.

Is prediabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?
Yes. Doctors sometimes refer to this state of elevated blood glucose levels as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG), depending on which test was used to detect it.

Why do we need to give it a new name? Has the condition changed?
The condition has not changed, but what we know about it has. We are giving IGT/IFG a new name for several reasons. prediabetes is a clearer way of explaining what it means to have higher than normal blood glucose levels. It means you are likely to develop diabetes and may already be experiencing the adverse health effects of this serious condition. People with prediabetes are at higher risk of cardiovascular disease. People with prediabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. People with diabetes have a 2- to 4-fold increased risk of cardiovascular disease. We now know that people with prediabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes.

How does the FPG test define diabetes and prediabetes?
Normal fasting blood glucose is below 100 mg/dl. A person with prediabetes has a fasting blood glucose level between 100 and 125 mg/dl. If the blood glucose level rises to 126 mg/dl or above, a person has diabetes.

How does the OGTT define diabetes and prediabetes?
In the OGTT, a person's blood glucose is measured after a fast and 2 hours after drinking a glucose-rich beverage. Normal blood glucose is below 140 mg/dl 2 hours after the drink. In prediabetes, the 2-hour blood glucose is 140 to 199 mg/dl. If the 2-hour blood glucose rises to 200 mg/dl or above, a person has diabetes.

Which test is better?
According to the expert panel, either test is appropriate to identify prediabetes.

Why do I need to know if I have prediabetes?
If you have prediabetes, you can and should do something about it. Studies have shown that people with prediabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle that include modest weight loss and regular exercise. The expert panel recommends that people with prediabetes reduce their weight by 5-10 percent and participate in some type of modest physical activity for 30 minutes daily. For some people with prediabetes, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.

What is the treatment for prediabetes?
Treatment consists of losing a modest amount of weight (5-10 percent of total body weight) through diet and moderate exercise, such as walking, 30 minutes a day, 5 days a week. Don't worry if you can't get to your ideal body weight. A loss of just 10 to 15 pounds can make a huge difference. If you have prediabetes, you are at a 50 percent increased risk for heart disease or stroke, so your doctor may wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.

Who should get tested for prediabetes?
If you are overweight and age 45 or older, you should be checked for prediabetes during your next routine medical office visit. If your weight is normal and you're over age 45, you should ask your doctor during a routine office visit if testing is appropriate. For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or prediabetes. These include high blood pressure, low HDL cholesterol and high triglycerides, a family history of diabetes, a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds, or belonging to an ethnic or minority group at high risk for diabetes.

How often should I be tested?
If your blood glucose levels are in the normal range, it is reasonable to be checked every 3 years. If you have prediabetes, you should be checked for type 2 diabetes every 1-2 years after your diagnosis.

Could I have prediabetes and not know it?
Absolutely. People with prediabetes don't often have symptoms. In fact, millions of people have diabetes and don't know it because symptoms develop so gradually, people often don't recognize them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, a frequent desire to urinate, blurred vision, or a feeling of being tired most of the time for no apparent reason.

Sources: American Diabetes Association, Diabetes Care, Diabetes UK

Group Visits To Doctor Can Help Diabetics Get High-Value, High-Quality Health Care At Reduced Cost

noreply@blogger.com (Roger Alexander) — Fri, 06 May 2011 13:53:00 +0000

THE American Association of Clinical Endocrinology (AACE) at its 20th Annual Meeting and Clinical Congress in San Diego last month issued new clinical practice guidelines for developing comprehensive care plans for patients with type 1 and type 2 diabetes. The guidelines emphasize a personalized approach to controlling diabetes and achieving blood glucose targets with care plans that take into account patients’ risk factors for complications, comorbid conditions, and psychological, social, and economic status.

While it is recognized that every individual patient’s needs are unique, there are times when simple group visits also work wonders for diabetics manage their condition. It's a small but slowly growing trend that promises to get more attention with the tight supply of primary care physicians, who find it hard to squeeze in time to teach their patients how to deal with a complex chronic illness like diabetes.

Group visit programs are rapidly proliferating in group practice and managed care organizations throughout the United States in an effort to leverage existing resources and to provide high-value, high-quality health care in this era of increasing purchaser and patient demands for enhanced services at reduced cost.

Group visits typically include group education, shared problem-solving, focused private or semi-private medical evaluations that allow individualized medication adjustment, and ordering of preventive services and referrals. Sessions may last from 60 minutes to several hours and typically include 3 to 20 patients. The draw for patients lies in the potential for group visits to provide better access and to improve counseling, between-patient learning, and self-efficacy.

What's in it for the doctor? Dr. Ray Dorsey, a neurologist, studied the pros and cons of group appointments and found he learned more about how his Parkinson's patients were faring by watching them interact with others than when he had them one-on-one. Indeed, group visits gave him the opportunity to observe his patients for a longer period of time and appreciate problems he may not readily have appreciated during a routine office visit.

"I can see if you're getting worse over the course of the visit, your ability to eat, to walk, to converse and to think," says Dorsey, who led a pilot study of group checkups for Parkinson's patients at the University of Rochester Medical Center, adding, "This is a new way of delivering health care. People are thirsting for better ways." Dorsey reported his findings last week in the journal Neurology.

"Many heads are better than one. They think of questions you wouldn't normally think of by yourself," says Jim Euken, a retired judge and Parkinson's patient from Belmont, NY. He began exercising on a bicycle after one of Dorsey's group visits discussed research showing some patients can still cycle when they can barely walk, for unknown reasons. “I still think I learned more and I think the process was better doing it in a group format," he confirmed.

Research has shown patients often enjoy interacting in a group environment that can provide encouragement and tips that they may not receive in a short clinical visit. On the other hand, physicians may benefit from the change of pace and a chance to creatively and more thoroughly address the issues presented by chronic conditions common in primary care.

Peer pressure among patients helps, family physician Dr. George Whiddon of Quincy, Florida, told Associated Press. He has about 40 diabetic patients divided into groups for shared checkups at Tallahassee Memorial Family Medicine Quincy, and he wants to add more.

One woman with uncontrolled diabetes for years confessed to fellow patients that she'd ignored Whiddon's eat-better-take-your-meds advice for too long. "Now I only have one toe left. I should have listened," Whiddon recalled her saying. "That had more impact than anything I said all day."

The use of group visits is an innovative approach now receiving attention for its potential to improve the care of established patients with chronic conditions, such as diabetes, while using available resources more efficiently. The terminology of group visits includes “group visits,” “shared medical appointments,” “cluster visits,” and “problem-solving DIGMA (drop-in group medical appointments).”

Of course, group appointments don't replace the patient's annual in-depth physical. But many people with chronic illnesses, especially if they're not well-controlled, are supposed to have additional follow-up visits about every three months — an opportunity for shared checkups that stress patient education.

But how well do these group visits work? Evidence is mixed. An Italian study published last year found that diabetics who took part in them lowered their blood sugar, blood pressure and cholesterol more than similar patients who got regular individual office visits.

A separate study at two Veterans Affairs Medical Centers, in North Carolina and Virginia, tracked people with poorly controlled diabetes and blood pressure and also concluded shared appointments can improve care for some people. Those in group visits significantly improved their blood pressure and needed less emergency care, but there was no difference in diabetes improvement between patients who had shared checkups or regular ones.

Shared check-ups aim to help patients who are battling certain chronic diseases, and they're far from the typical 15-minute office visit. They're stretched over 90 minutes or even two hours, offering more time to quiz the doctor about concerns, learn about managing the disease — and get tips from fellow patients.

What needs to be stressed, though, is that group and individual visits work well together and complement each other: the strengths of one model are often the weaknesses of the other, and vice versa.

Edward B. Noffsinger, a pioneer in the field of group medical visits, sounds a note of caution. “While a carefully thought-out group visit program can maximize benefits to patients, physicians, purchasers, insurers, and health care organizations alike, it is very important that any potential for abuse also be thoroughly examined and scrupulously prevented if these benefits are to be fully realized,” he says.

He points out that in today's challenging, competitive health care environment, group visits can be abused in two basic ways: 1) by putting fewer resources into group visits than adequately supported, properly run programs require, or 2) by attempting to extract more from group visits than is commensurate with good care.

“If we wait until some abuse of group visits actually occurs and receives negative publicity, we could incur a public relations black eye, which could seriously undermine the credibility of all such programs in the future ‒ a predictable, preventable, and completely unnecessary injury to the image of group visit programs,” he says.

Moreover, should third-party insurers, upon recognizing the multiple economic and patient care benefits which group visits can offer, over-incentivize them relative to individual visits, abuse could result which would reduce the voluntary nature of group visits for physicians and patients alike.

“Despite all of these concerns surrounding potential abuses, group visits will undoubtedly continue to grow in importance and be ever more frequently used during the coming years. Without question, group visits have an important role to play in the future of health care,” Noffsinger concludes.

Sources: Associated Press, Neurology, American Academy of Family Physicians, NIH

Related Posts:

Individualized Care Plans Necessary for Treating Diabetes, Says AACE

NIH Unveils 10-Year New Strategic Plan to Combat Diabetes

Caring Doctors Improve Patients’ A1c, LDL Scores

Analysis Shows Value of Structured Exercise Programs in Diabetes Care

noreply@blogger.com (Roger Alexander) — Thu, 05 May 2011 18:32:00 +0000

Insurance Benefits for Exercise Programs Can Cut Health Costs

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FOR the person with type 2 diabetes, or the high-risk individual who is trying to prevent the development of diabetes, there is an enormous body of research literature documenting the benefits of exercise. Indeed, research shows that just six weeks of exercise is enough to change both brain chemistry and body chemistry for the better; diets alone don’t have the same effect. But some questions still remain ‒ how much exercise is needed, and what kind?

A host of studies have linked exercise programs with improved health measures related to blood pressure, lipid levels — including cholesterol and triglycerides — cardiovascular events, cognition, physical performance, premature death and quality of life. Analyses of interventions to promote physical exercise in adults have found that compared with no intervention, exercise programs are cost-effective and have the potential to improve survival rates and health-related quality of life.

A recent systematic review and meta-analysis ‒ undertaken by scientists led by Daniel Umpierre of the Hospital de Clinica de Porto Alegre in Brazil ‒ compares the association between physical activity advice and structured exercise programs, respectively, and markers of diabetes. It reveals that implementing structured exercise training — including aerobic, resistance or both — is associated with a greater reduction in HbA1c levels for patients with diabetes compared to patients in control groups. Results of the study are published in the May 4 issue of the Journal of the American Medical Association (JAMA).

A structured exercise is a task, activity, or question posed by a leader that pushes everyone to reflect, focus, offer ideas and insights, and become engaged in learning. Structured exercises offer group leaders a variety of options for encouraging group participation and discussion, practicing skills, and involving adults who have a range of learning styles and capabilities.

After analyzing the results of 47 randomized clinical trials, the researchers also found that exercising for longer periods of time was better at bringing blood sugar levels down than exercising more intensively. Longer weekly exercise duration was also associated with a greater decrease in these levels, according to results of the analysis of previous studies.

The meta-analysis shows that greatest reductions in HbA1c occurred in patients exercising for more than 150 minutes in total per week. Exercise intensity did not appear to matter. Exercising a minimum of 150 minutes a week (usually broken down to 30 minutes of exercise five days a week) is recommended by such institutions as the American College of Sports Medicine.

"People with type 2 diabetes should engage in regular exercise training, preferentially supervised exercise training," says Beatriz Schaan, the study's senior author. "If these patients can perform training for more than 150 minutes per week, this would be more beneficial concerning their glucose control. However, if they cannot reach this amount of weekly exercise, lower exercise amounts are also beneficial."

The Importance of Exercise in Diabetes Management

A recent joint statement from the American Diabetes Association (ADA) and the American College of Sports Medicine (ACSM) has already underscored the importance of physical exercise to prevent and manage insulin resistance, type 2 diabetes mellitus, gestational diabetes mellitus, and the complications of diabetes.

“Current guidelines recommend that patients with type 2 diabetes should perform at least 150 minutes per week of moderate-intensity aerobic exercise and should perform resistance exercise three times per week,” the authors of the Brazil study wrote. “Regular exercise improves glucose control in diabetes, but the association of different exercise training interventions on glucose control is unclear.”

Indeed, although some clinical trial evidence suggests that aerobic exercise and resistance training can each improve glucose control in patients with type 2 diabetes mellitus, not all clinical trials are consistent with regard to this finding.

However, differences in results of clinical trials about the ability of aerobic exercise and resistance training to improve glucose control are primarily due to differences in trial design, including modality, intensity, exercise program duration, adherence to the programs, sample size, and patient populations.

In the Brazilian study, the authors analyzed 47 randomized controlled trials (RCTs) into the effect of exercise on HbA1c, with a total of 8538 patients. In 23 of these RCTs, patients took part in structured exercise training, and in the other 24 they were simply given advice on physical activity.

Across all studies analyzed, engaging in structured exercise was associated with decreased HbA1c levels compared with controls, whether this was structured resistance training (fall in HbA1c of 0.57%), structured aerobic exercise (fall of 0.75%), or a combination of both (0.51% fall).

A longer total time spent in structured exercise was associated with better glycemic control. If total weekly time in structured exercise exceeded 150 minutes, the average drop in HbA1c was 0.89%, against 0.36% for a time of 150 minutes or less.

Physical activity advice was only associated with a decline in HbA1c if it was combined with dietary advice.

The authors said: “This systematic review and meta-analysis of RCTs demonstrates important findings regarding the prescription of structured exercise training. First, aerobic, resistance, and combined training are each associated with HbA1c decreases, and the magnitude of this reduction is similar across the three exercise modalities.

“Second … structured exercise of more than 150 minutes per week is associated with greater declines in HbA1c than structured exercise of 150 minutes or less per week in patients with type 2 diabetes. This finding is important because the current guideline-recommended exercise duration is at least 150 minutes per week.

They added: “Although high-intensity exercise has been previously shown to have an association with HbA1c reduction, our findings did not demonstrate that more intensive exercise was associated with greater declines in HbA1c.”

In an accompanying editorial, Marco Pahor, director of the University of Florida Institute on Aging, argues that “the meta-analysis … and cumulative evidence from a large number of randomized controlled trials conducted over the past few decades in the area of physical activity and exercise provide solid evidence for public policy makers to consider structured exercise and physical activity programs as worthy of insurance reimbursement to promote health, especially in high-risk populations.”

Insurance Benefits for Exercise Programs Can Cut Health Costs
With respect to type 2 diabetes, Medicare reimburses for approved self-management education and medical nutrition therapy programs. But no specific reimbursement is given for any physical activity or exercise program, despite evidence that such programs can help improve health and cut costs.

Questions remain as to what format reimbursable exercise and physical activity programs should take, what population group should be targeted, and at what stage of life or health status would a lifestyle intervention be most cost-effective to implement.

Some insurance providers already include a fitness benefit for members, such as monthly membership at certain fitness centers or access to personal trainers or exercise classes at reduced cost. Indeed, use of such health plan-sponsored club benefits by older adults has been linked to slower increases in total health care costs.

In one study, older adults who visited a health club two or more times a week over two years incurred $1,252 less in health-care costs in the second year than those who visited a health club less than once a week. Programs among people with lower incomes can also pay off, because people in that group are otherwise more likely to forego health-promoting physical activity because of economic constraints or safety concerns.

“People are willing to invest in improved health, but if you have a fixed amount of resources then you want to choose where you get the most health for the dollar,” said Erik Groessl, an assistant professor of family and preventive medicine at the University of California, San Diego, and director of the UCSD Health Services Research Center. Groessl was not involved in the current analysis.

Group training or walking programs, for example, can be cost-effective, sustainable forms of physical activity that don’t require expensive health care professionals or equipment. But more costly interventions that yield dramatic results might also be worth the expense.

“There is a lot of evidence that physical activity works, and I think it’s time to start putting it into practice more widely,” Groessl said.

Sources: JAMA, University of Florida News, Medpage Today

Poor Sleep Quality In People With Diabetes Leads To Poor Blood Sugar Control

noreply@blogger.com (Roger Alexander) — Wed, 04 May 2011 18:19:00 +0000

• Do you have difficulty falling or staying asleep?

• Are you excessively sleepy during the day or fall asleep when you don't want to?

• Do you snore or have you been told that you snore loudly?

• Do you gasp for air or have you been told that you stop breathing during sleep?

• Do you experience uncomfortable sensations in the legs in the evening that are relieved by movement?

• Are you a restless sleeper or have you been told that you kick during sleep?

SLEEP disturbances are common and can be detrimental to the health, mood, and quality of life of people with diabetes. Sleep-disordered breathing, pain, restless legs syndrome, primary insomnia, and lifestyle factors all contribute to a high rate of sleep complaints in this population.

Because the etiology of poor sleep quality is often multifactorial and may shift over time, a careful evaluation for insomnia, sleep-disordered breathing, and restless legs syndrome should be an integral part of the routine care of patients with diabetes, say experts.

Generally, people with diabetes have poorer sleep than non-diabetics. Also, poor sleep has been proposed as a risk factor for developing the disease. Sleep disorders, such as obstructive sleep apnea, are more prevalent in people with type 2 diabetes. Therefore, it is not surprising that up to 71% of this population complain of poor sleep quality and high rates of hypnotic use.

Diabetes is worse when combined with insomnia symptoms. In fact, insomnia makes most medical diseases much worse in ways that are only just being found out and can chemically disrupt the body’s insulin balance enough to even be a root cause for certain types of diabetes, say experts.

Insomnia-Insulin Resistance Link

In the largest study of its kind to establish a link between sleep and diabetes ‒ published in the June issue of Diabetes Care ‒ researchers have found that people with diabetes who sleep poorly have higher insulin resistance, and a harder time controlling the disease.

"Poor sleep quality in people with diabetes was associated with worse control of their blood glucose levels," says Kristen Knutson, PhD, assistant professor of medicine at the University of Chicago Medical Center and lead author of the study.

"People who have a hard time controlling their blood glucose levels have a greater risk of complications. They have a reduced quality of life. And, they have a reduced life expectancy," she explains in apress statement.

Multiple factors contribute to insomnia complaints in patients with diabetes, say Phyllis C Zee, and Erik Naylor in their expert columnin Medscape. In type 1 diabetes, rapid changes in glucose levels during sleep have been postulated to cause awakenings. For individuals with type 2 diabetes, sleep disturbances may be related to obesity or obesity-associated sleep disorders, such as sleep apnea.

Sleep-disordered breathing correlates highly with obesity in the diabetic population. A strong association also exists between obesity, impaired glucose tolerance, insulin resistance, and sleep-disordered breathing.

Furthermore, the severity of sleep-disordered breathing, as measured by the apnea-hypopnea index, correlates with the severity of glucose intolerance, insulin resistance, and diabetes. Although obstructive sleep apnea is the most common type of sleep-disordered breathing, central-type apneas and periodic breathing have been reported in patients with autonomic diabetic neuropathy.

The Chemistry of the Sleep-Wake Cycle

Since diabetics are sensitive to blood glucose levels and chemical balances in the body, it’s illustrative to explore just how detrimental disruptions in the sleep cycle can be. Studies have shown that diabetes worsens when adult sufferers sleep less than 6 hours per night or more than 9.

The loss of normal sleep hours or addition of sleep hours seems to undo the body’s chemistry and completely throw off-balance the blood glucose levels. Doctors don’t know for sure the exact chemistry behind this phenomenon outside of the observation. This underscores the importance of the sleep cycle chemistry.

In Knutson’s study, for example, among the diabetics, poor sleepers had 23% higher blood glucose levels in the morning, and 48% higher blood insulin levels. Using these numbers to estimate a person's insulin resistance, the researchers found that poor sleepers with diabetes had 82% higher insulin resistance than normal sleepers with diabetes.

Other studies have shown that chronic insomnia in healthy people can also instigate diabetes. Loss of sleep interrupts insulin balance—leads to insulin resistance—which in turn can lead to more severe medical problems and Type 2 diabetes.

Diabetes Management

Much of the challenge for diabetics is proper and long-term management of their diabetes. When the sleep-wake cycle is also mismanaged, so too is the diabetes. Like many other medical diseases and conditions, diabetes is sensitive to sleep disturbances. But insomnia, as a set of symptoms, is usually secondary to something else.

Insomnia is characterized in a number of ways: you could have problems going to sleep (sleep onset insomnia), problems waking up and going back to sleep (middle of the night insomnia), or waking up in the early dawn unable to return to sleep that night (terminal or late insomnia). Doctors can often associate particular patterns of insomnia such as these to particular medical problems.

Insomnia is rarely treated as a primary affliction. In most medical sectors it’s important to identify and diagnose insomnia for its implication in other problems, including depression, a common secondary illness to diabetes. As patients get older, the risk for depression escalates. Loss of a loved one, stress, anxiety and a range of other social disturbances can set in motion the symptoms for chronic insomnia. Loss of sleep makes for haywire blood sugar.

The Way Forward

Knutson says the next step for researchers is to see if treating poor sleep can improve long-term outcomes and quality of life for diabetics. "For someone who already has diabetes, adding a sleep treatment intervention, whether it's treating sleep apnea or treating insomnia, may be an additional help for them to control their disease," she points out.

In fact, restoring a healthy amount of sleep may be as powerful an intervention as the drugs currently used to treat type 2 diabetes. "This suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti-diabetes drugs," says Eve Van Cauter, PhD, professor of medicine and co-author of the study.

"For someone who already has diabetes, adding a sleep treatment intervention, whether it's treating sleep apnea or treating insomnia, may be an additional help for them to control their disease," feels Knutson.

Further investigation into which leads to the other – the chronic poor sleep or chronic insulin resistance – could improve the quality of life for people with type 2 diabetes. "Anything that we can do to help people improve their ability to control their glucose will help their lives in the long run," Knutson concludes.

Type 2 Diabetics Also At Increased Risk Of Hypothyroidism

noreply@blogger.com (Roger Alexander) — Mon, 02 May 2011 17:21:00 +0000

THYROID is an important endocrine gland of human body and plays vital role in the normal functioning of the body. It has important effects on glucose metabolism along with lipids and proteins and conversely can be affected by abnormal glucose metabolism.

Recently new research has found a strong link between type 2 diabetes and an increased risk of hypothyroidism, the most common type of thyroid disorder. It is the situation where the thyroid fails to make enough thyroid hormone to regulate the body's metabolism. The findings were presented at the American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress in San Diego last month.

Symptoms of underactive thyroid gland functioning, no matter what the cause, include fatigue, dry, coarse skin and hair, inability to tolerate cold weather, weight gain, hoarse voice, and heavy or irregular menstrual periods. The symptoms develop so slowly that sometimes people just think they are growing old prematurely.

Thyroid disorders (hypothyroidism or hyperthyroidism) and diabetes mellitus are quite common endocrinopathies (diseases of endocrine glands) seen in general population. Thyroid disorder in the general population is estimated to be 6.6%, while the prevalence in diabetic population has been estimated at 10.8%. The prevalence of sub-clinical (early stage) hypothyroidism is 5.4% and clinical hypothyroidism is 4.1%, while the prevalence of sub clinical hyperthyroidism is 5.8% and the clinical hyperthyroidism is 5.1%, the researchers noted.

The cross-sectional study comparing 1,848 adult patients with type 2 diabetes with 3,313 individuals without diabetes, showed the prevalence of hypothyroidism on the study group to be 5.7% compared with 1.8% in the control group (P ≤.0001).

Citing the Whickham survey, the researchers said thyroid function affected 6.6% of adults. A higher prevalence of abnormal TSH concentration in Type 2 diabetic patients (31%) was reported by Celani et al, they pointed out. In their study, sub-clinical hypothyroidism was detected in 11.66% of evaluated diabetic patients and hypothyroidism was evident in 35% of diabetic patients, which is a quite high ratio as compared to other reported data. “This may be because of only concentrating diabetes mellitus and its complications rather than thinking other diagnosis partly or misreporting by patients,” they noted.

“Although there is a recognized association between thyroid disease and diabetes, this association has been perceived mostly for type 1 diabetes. However, in type 2 diabetes, there is no consensus as to whether screening for hypothyroidism is necessary. We were surprised that the results showed an association that was this high,” said lead author Hector Eloy Tamez-Perez, MD, Autonomous University of Nuevo Leon, Monterrey, Mexico.

The study included patients who were enrolled in a private outpatient clinic in 2009, had a diagnosis of type 2 diabetes, and were treated with levothyroxine (Levothroid, Levoxyl, Synthroid, Tirosint, Unithroid), although patients with thyroid neoplasia (the process of abnormal and uncontrolled growth of cells. The product of neoplasia is a neoplasm, i.e. a tumor), panhypopituitarism (a deficiency involving all the hormonal functions of the pituitary gland), or have surgical complications of a multinodular goiter or a thyroid nodule were excluded.

It was found that around 10 per cent to 31 per cent of patients with type 2 diabetes had thyroid dysfunction, and that those with subclinical (early stage) hypothyroidism were the most common thyroid condition.

“So it is important to evaluate diabetic population regarding hypothyroidism whether clinical or sub-clinical, as one condition can worsen the other if left untreated by causing worsening control of diabetes mellitus, worsening dyslipidemias and causing diverse complications. Therefore, it is imperative to screen diabetic population regarding hypothyroidism. Moreover further studies on large scale should be planned to evaluate the magnitude of the disorder,” they concluded.

Popular Health Central columnist Dr Bill Quick, a physician living with diabetes, writes:

Treatment for hypothyroidism is straight-forward: give the patient thyroid hormone replacement. How much thyroid hormone to give is about the only question: give too little, and the symptoms continue; give too much and the patient can become hyperthyroid. Physicians adjust the dose of thyroid hormone replacement by rechecking the TSH (thyroid stimulating hormone) level rather than judging by symptom levels: when the TSH is in the normal range, it can be assumed that the amount of thyroid hormone replacement therapy is appropriate.

Testing for hypothyroidism is easy to do, thyroid disease is common in the age group that has T2DM, treatment for hypothyroidism is easy and rewarding in relieving symptoms and decreasing the risk of future disease.

Lab tests for hypothyroidism are done using a standard blood sample, and include measurement of the TSH levels, thyroid hormone levels (called T3 and T4), and sometimes thyroid antibodies. In a patient with the symptoms, an elevated TSH level with simultaneous low levels of T3 and T4 are conclusive evidence that the thyroid gland is underactive. Indeed, a high level of TSH with normal levels of T3 and T4 are considered very suggestive evidence of impending hypothyroidism and worthy of treatment.

By the way, note the paradox: the TSH level is high in most underactive thyroid disorders. This is easy to understand when it is understood that TSH is made elsewhere, in the pituitary gland, and if the thyroid is failing to make its thyroid hormone, then the pituitary gland attempts to stimulate the thyroid to make more thyroid hormone, hence the TSH level goes up. For people without symptoms of hypothyroidism, measurement of the TSH level can be used as a screening test to look for early thyroid gland problems; sometime, it's also recommended that thyroid antibodies be part of the screening process.

The American Diabetes Association suggests for patients with T1DM that "TSH concentrations should be measured after metabolic control has been established. If normal, they should be re-checked every 1-2 years, or if the patient develops symptoms of thyroid dysfunction..." But there's no ADA recommendation for people with T2DM. The authors of the (Monterrey study) abstract (cited above) advised testing "similar to what occurs in type 1 diabetes."

If you have diabetes, whether T1DM or T2DM, it seems reasonable that you should have your TSH level checked every year or two.

Diabetics Who Adhere to Their Medication Have a 31% Associated Lower Risk of Hospitalization

noreply@blogger.com (Roger Alexander) — Fri, 29 Apr 2011 10:14:00 +0000

Lifestyle-related diseases stemming from tobacco, alcohol and obesity, have taken over infectious diseases such as HIV and malaria to become the greatest killer of people worldwide, says a new World Health Organization report. Indeed, chronic illnesses like cancer, heart disease and diabetes have reached global epidemic proportions and now cause more deaths than all other diseases combined.

Evidence shows that a comprehensive focus on prevention and improved treatment leads to dramatic declines in mortality rates. Currently, the report points out, the main focus of health care for non-communicable diseases (NCDs) in many low- and middle-income countries is hospital-centered acute care. This is a very expensive approach that will not contribute to a signiﬁcant reduction of the NCD burden. It also denies people the health beneﬁts of taking care of their conditions at an early stage.

To contain the diabetes worldwide epidemic, WHO says at least three interventions for prevention and management of diabetes are shown to reduce costs while improving health. Blood pressure and glycemic control, and foot care are feasible and cost-effective interventions for people with diabetes, including in low- and middle-income countries.

WHO’s recommendations have been validated by a new study in the U.S. which shows that individuals with diabetes who adhere to their medication have lower risk of hospitalization by one-third when compared to patients who do not adhere to their medication.

The results of the study by Prime Therapeutics (Prime), a thought leader in pharmacy benefit management, are being presented the last week in April at the Academy of Managed Care Pharmacy's 23rd Annual Meeting and Showcase in Minneapolis earlier this week.

Nearly 300 million people worldwide have (mostly type 2) diabetes. In the U.S. alone, more than 23 million Americans have been diagnosed with diabetes mellitus (DM) and each year another 1.6 million people are diagnosed with the condition.

Poor medication adherence has been associated with worse medical outcomes and increased medical costs for patients with diabetes in a single employer or the elderly.

Until now, there has been little data quantifying the potential value of improved outcomes and costs possible with better medication adherence in a large commercially insured population. In this study, one of the largest of its kind, more than 15,000 commercially insured individuals with a diabetes diagnosis medical claim were followed for one year.

"Our research found adherent individuals had $1,010 lower medical costs during the year," said Patrick Gleason, PharmD, director of Clinical Outcomes Assessment at Prime, in a press release. "Besides the medical cost savings, patients that adhere to their medications are likely to have improved health and increased quality of life. Yet in this study, we found one-quarter of patients do not stick to their diabetes medication, so the medical community must find ways to increase adherence for those most at-risk."

Researchers from Prime and one of its Blue Cross and Blue Shield clients reviewed pharmacy and medical claims from a commercial medical plan with 1.3 million members. The study identified individuals continuously enrolled between 2007 and 2009.

Researchers then focused on members who had either two separate office visits for diabetes or a diabetes-related hospitalization in 2008 and with a DM medication supply or a diagnosis of diabetes with microvascular disease. All medical and pharmacy claim costs were added up to determine the total cost of care.

A total of 15,043 members were followed for one year. Of that group, 73.9 percent (11,108 members) were adherent to their medication and 26.1 percent (3,935 members) were non-adherent. While those individuals adherent to DM medication had higher pharmacy costs which led to an increase in the overall total cost of care ($572), those adhering to medications were found to have a 31 percent lower risk of hospitalization and significantly lower overall medical costs ($1,010) than the non-adherent group.

Earlier studies, too, have shown that non-adherence with medication regimens results in increased use of medical resources, such as physician visits, laboratory tests, unnecessary additional treatments, emergency department visits, and hospital or nursing home admissions. Non-adherence may also result in treatment failure.

In the context of disease, medication non-adherence can be termed an "epidemic." More than 10% of older adult hospital admissions may be due to non-adherence with medication regimens. In one study, one-third of older persons admitted to the hospital had a history of non-adherence. Nearly one-fourth of nursing home admissions may be due to older persons' inability to self-administer medications.

Problems with medication adherence were cited as a contributing factor in more than 20% of cases of preventable adverse drug events among older persons in the ambulatory setting. It is estimated that non-adherence costs the US health care system $100 billion per year. In addition, approximately 125,000 deaths occur annually in the U.S. due to non-adherence with cardiovascular medications.

Of all age groups, older persons with chronic diseases and conditions benefit the most from taking medications, and risk the most from failing to take them properly. Among older adults the consequences of medication non-adherence may be more serious, less easily detected, and less easily resolved than in younger age groups.

Improving adherence with medication regimens can make a difference. A recently published study found that for a number of chronic medical conditions - diabetes, hypertension, hypercholesterolemia, and congestive heart failure - higher rates of medication adherence were associated with lower rates of hospitalization (see diagram), and a reduction in total medical costs.

How To Manage Diabetes On A Budget Without Cutting Corners

noreply@blogger.com (Roger Alexander) — Tue, 26 Apr 2011 05:01:00 +0000

IF you have diabetes, there is no getting around the fact that taking care of yourself can be expensive. The cost of medical care, diabetes medications and supplies, and healthy foods add up. And these expenses can be difficult to manage even in the best of times.

Even in less developed economies like India and other countries in Asia and Latin America where the spread of diabetes has assumed epidemic proportions, while seeing your doctor and a pharmacist every month might seem expensive.

Popular blogger Scott Strumello has calculated that in 2007, medical bills contributed to 62.1% of all bankruptcies in the U.S. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by about 50%.

Contrary to popular assumptions, chronic illnesses dominate the top 2 categories, and diabetes ranks second, following only nonstroke neurologic problems (i.e., multiple sclerosis).
According to a study published online in The American Journal of Medicine indicated that the health problems that left patients with the highest out-of-pocket medical expenses weren't dominated by catastrophic illnesses. The article reports that among common diagnoses, the health problems that left patients with the highest out-of-pocket expenses were ranked as follows:
#1) Neurologic (e.g., multiple sclerosis): $34,167
#2) Diabetes: $26,971
#3) Injuries: 25,096
#4) Stroke: $23,380
#5) Mental illnesses: $23,178
#6) Heart disease: $21,955

Also, it is important to keep in mind that among the other categories, diabetes is a leading contributor to the stroke and heart disease categories. These are some pretty astonishing figures!

Another interesting observation: hospital bills are, not surprisingly, the largest single out-of-pocket expense for 48.0% of patients who file for bankruptcy, but the second-largest category isn't doctor's bills, its for prescription drugs for 18.6%. Doctors' bills isn't far behind, accounting for 15.1%, and premiums accounting for 4.1%. The remainder cited expenses such as medical equipment and nursing homes.

As a person with type 1 diabetes myself, I must admit that while this disease is anything but cheap, even I was a bit surprised by some of these findings, especially considering that in February 2009, the American Diabetes Association and others were citing studies which showed many Americans with diabetes were skipping certain medical treatments, drugs etc. due to the cost.

In the context of rising costs for managing a chronic disease such as diabetes, a small study from Ohio shows that in the long run regular visits to the doctor saves patients and their families money in the long run when

Columbus-area pharmacist Allen Nichol looked at two groups of diabetic patients on Medicaid at one physician's office – 40 who kept monthly appointments and took their medications as prescribed and 120 who did not. He worked with Dr. Charles May, a primary-care doctor at Grandview Family Practice, and gathered the data in 2008.

During the monthly appointments, they evaluated patients' blood pressure, cholesterol and blood-sugar levels. If the numbers were good, the patient would continue with the same medications; if not, Nichol would suggest a medication change. "We'd have a plan, like a coach of a football team planning the first quarter," Nichol said.

The study found that patients not being managed were hospitalized more than those who regularly saw their doctor and pharmacist. This resulted in a net savings of $5,582 per patient for the year, Nichol said.

Health leaders acknowledge the benefits of having pharmacists work with patients, whether at a doctor's office or a pharmacy. For example, all Medicare prescription-drug plans are required to pay for meetings between beneficiaries and pharmacists. Private health insurers have found that when patients meet with pharmacists, costly emergency-room visits and hospital admissions can be reduced.

Here are a few tips from NFB to help you ensure that you do not miss out on manage your condition during hard times when many patients find it difficult pay their medical bills.

General Financial Management
Having a budget and sticking to it is important for everyone, even more so during hard times. You should evaluate your personal or family budget at least once a year, or more often if your income or expenses are changing. Involve the entire family in discussing the budget and brainstorming for ways to save money.

Here are a few questions to consider:

• What is your monthly income?

• What are your monthly expenses for essentials (home, utilities, phone, food, transportation, medicine)?

• When are your bills due? Avoid late fees by paying bills on time.

• Do you have expenses that come once or twice a year (such as taxes and insurance)?

• Where does the money go from your wallet? Keep a diary of your spending.

• Identify non-essential expenses (entertainment, shopping as “stress management,” eating out).

Paying cash helps you stay within your limits. Use a credit card only in emergencies. If you have several cards, cancel most of them, and keep one and two. Pay off your credit card bill each month, so you aren’t paying high interest for carrying charges. If you have credit card debt, call your creditors to discuss options to deal with it, and try to negotiate a lower interest rate. If you feel you cannot do this, or if your debt load is overwhelming, seek consumer credit counseling from your bank or card issuer.

Healthy Eating on a Budget
Many people have the misconception healthy meals are always more expensive. Actually, healthy eating can save money through using smaller portion sizes and fewer high-calorie, high-priced foods.

Here is a list of tips to help you keep your food prices down:

• Plan a menu each week based on sales in grocery stores near you.

• Check what you already have to keep from buying what you do not need.

• Take a shopping list with you, and buy only what is on that list.

• Avoid going to the store if you are hungry, to make it easier to stick to your list.

• Store brand or generics are often just as good as name brand, and usually less expensive.

• Cook enough to have leftovers. Take the leftovers to work instead of buying lunch, or freeze the leftovers for a busy time.

• Add vegetables to casseroles, stews, or soups. This is a good way to increase your vegetables and stretch a meal.

If you manage your personal finances well, you’ll never find it difficult to skimp on managing expenses related to your medical condition.

A Cure for Diabetes By Implanting Insulin-Producing Islets in Abdomen

noreply@blogger.com (Roger Alexander) — Sun, 24 Apr 2011 06:22:00 +0000

Trials on Primates Have Shown Promising Results

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DOCTORS from Hackensack University Medical Center (HUMC) in New Jersey hope to find a cure for diabetes as they embark on a partnership with one of the world's leading researchers for the disease.

The hospital will be the first to try a procedure on humans with diabetes that is currently being tested on monkeys in Florida — a collaborative effort with Dr. Camillo Ricordi, a pioneer in the field and the scientific director and chief academy officer of the University of Miami Diabetes Research Institute.

"Dr. Ricordi wants to find a cure for diabetes, and he doesn't care how many people are involved in the process or share in the credit," said Dr. Michael Shapiro, Hackensack’s chief of organ transplantation and leader of the diabetes partnership. "This collaboration will do great things for diabetes research."

“Forty percent of transplant patients have diabetes. And we know the DRI is committed to linking everyone worldwide to find a cure,” he said.

Diabetes occurs when the body cannot produce or properly use insulin, a hormone that helps the body metabolize glucose into energy and control blood sugar levels.

With Type 1 diabetes, earlier called juvenile diabetes and the most serious form of the disease, the body's immune system destroys the cells from the pancreas that make insulin, called islets. People with Type 2 diabetes make insulin, but their body doesn't utilize it correctly and production of it typically declines as they age. More than 25 million Americans have diabetes, and about 3 million of those suffer with Type 1.

Typical treatment for diabetic patients includes insulin pumps, injections and oral medications. Transplanting islets from deceased donors is sometimes effective, but it frequently triggers other complications because the islets need to be implanted in the liver. The number of organ donors also falls way short of the number of diabetics who would benefit from a transplant.

NewTechnique

Dr. Ricordi's technique includes loading islets — the cells that make insulin and are destroyed by Type 1 diabetes — on a disc and implanting them in the abdomen. In the past, islets have been transplanted in the liver with little success.

Dr Camillo Ricordi

"The challenge is we're dealing with an autoimmune disease so we have to replace or get cells to regenerate that were destroyed," Ricordi told dozens of HUMC executives, physicians and health care workers last week. "And the key is to do this without a lifelong regimen of autoimmune rejection drugs."

But successfully transplanting the islets will only be part one of the cure. Researchers need to figure out how to create islets in the lab so there will be enough to treat all diabetic patients who need them. Still, the partnership has hospital executives determined and diabetic patients hopeful. "I'm absolutely sure we'll find a cure," said Robert Garrett, president and chief executive of HUMC.

Because of promising results with the monkeys, Shapiro hopes to have four patients undergo the procedure in early 2012. The ideal patients will be those who aren't responding to other treatments.

Past Success

Physicians attending the announcement highlighted Ricordi's expertise and advances in treatment of the disease.

His creation, the Ricordi Chamber, is so well-known in the field that it was mentioned in a recent episode of the medical drama "Grey's Anatomy." Critical for a transplant, it is able to efficiently separate islets from the pancreas.

Stephanie Stone, who was diagnosed with diabetes at 10 and is now 18, attended the announcement with her Franklin Lakes family. "I'm optimistic for the future," Stephanie said. "If this isn't a cure, it sounds like it's a better treatment before a cure is found."

Earlier in January, the Molly and Lindsey Diabetes Research Foundation at Hackensack University Medical Center (HUMC) and the Diabetes Research Institute (DRI) at the University of Miami Miller School of Medicine had announced the formation of the Hackensack-Miami DRI Federation Project.

The project is aimed to provide a unique opportunity for funding agencies, financial institutions, and corporate entities to collaborate with the scientists and their project teams in order to provide the core competencies and infrastructure needed to move projects forward in the safest, fastest, and most efficient way possible.

“This collaboration represents an exceptional opportunity to overcome current limitations of research progress within traditional academic institutions,” said Robert C. Garrett,

“Hackensack University Medical Center is going to take the lead in diabetes research in the tri-state area,” said Dr. Shapiro. “Forty percent of transplant patients have diabetes. And we know the DRI is committed to linking everyone worldwide to find a cure.”

One of the group’s first objectives is to expand collaborative alliances with other leading research centers and to foster dynamic multidisciplinary research teams.

“There are few other collaborative projects that fully integrate basic, pre-clinical and clinical scientists to increase the rate of progress at which therapeutic solutions for type 1 diabetes can be safely and effectively brought from the bench to the bedside and eventually to a cure,” said Dr. Ricordi.

The impossible becomes possible when you bring the right people and the right resources together – especially when there is a common goal. The Molly and Lindsey Diabetes Research Foundation is the brainchild of two families who know what it means to have a child living with diabetes.

Nick Miniccuci and his wife, Susan, made a pledge more than two decades ago when they were told their nine-year-old daughter Molly had diabetes. “I vowed to do everything in my power to find a cure” explains Mr. Miniccuci, one of the philanthropists behind the alliance. “That was a promise I intend to keep.”

“When Lindsey was diagnosed at the age of 11, we searched the world for a place that focused on curing the disease – not simply on learning to live with it – and found theDRI,” said Bonnie Inserra, co-founder of the Foundation. “There’s nobody like them worldwide. TheDRI team doesn’t keep research to themselves; they are experts who believe in worldwide collaborative science. I want to see diabetes cured.”

In recognition of the endless efforts of Susan and Nick Minicucci and Bonnie and Larry Inserra, the HUMC Foundation’s Executive Vice President and Chief Operating Officer Robert L. Torre, presented a $500,000 check to the Miami-Hackensack project during a dinner held in January at the Stony Hill Inn Hackensack. More than 50 people came together to celebrate a turning point in the history of diabetes thanks to the Minicucci and Inserra families. “We want to celebrate this new partnership – together we will find a cure,” Torre said.

About HUMC

HUMC is a nationally recognized healthcare organization offering patients the most comprehensive services, state-of-the-art technologies, and facilities. A leader in providing the highest quality patient-centered care, the medical center has been recognized for performance excellence encompassing the entire spectrum of hospital quality and service initiatives. These honors include being named one of America’s 50 Best Hospitals by HealthGrades® for four years in a row.

HUMC is the only hospital in New Jersey, New York, and New England to receive this honor. The medical center has also been ranked by U.S. News and World Report's "America's Best Hospitals 2010-11" in Geriatrics and Heart and Heart Surgery. NJBIZ, New Jersey’s premiere business news publication, honored HUMC as the 2010 Hospital of the Year, recognized for its excellence, innovation, and efforts which are making a significant impact on the quality of healthcare in New Jersey.

Hospital Newspaper, the leading provider of local hospitals and healthcare community news and information for hospital executives, also named HUMC Hospital of the Year in its December 2010 edition. Additionally, HUMC was named to The Leapfrog Group’s annual class of top hospitals and health systems and is one of only two hospitals in New Jersey to receive this national designation. HUMC is the hometown hospital of the New York Giants and Nets Basketball.

About the DRI

The Diabetes Research Institute, a Center of Excellence at the University of Miami Miller School of Medicine, is a recognized world leader in cure-focused research. Since its inception in the early 1970s, the DRI has made significant contributions to the field of diabetes research, pioneering many of the techniques used in islet transplantation.

The DRI is now building upon these achievements by bridging cell-based therapies with emerging technologies to restore insulin production. For the millions of families already affected by diabetes, the Diabetes Research Institute is the best hope for a cure. Visit DiabetesResearch.org or call 800-321-3437 for more information.

Benchmark Cambridge Trial In Quest For Ambulatory Artificial Pancreas

noreply@blogger.com (Roger Alexander) — Fri, 22 Apr 2011 07:29:00 +0000

I had reported earlier that once perfected and approved by regulators, safe and robust ambulatory artificial pancreas ‒ or to use the scientific term ‘closed loop insulin delivery system’ ‒ has the potential to greatly improve the health and lives of people with type 1 diabetes. The idea itself is not new but the old generation closed loop insulin delivery systems were cumbersome and unsuitable for long term or outpatient use.

Artificial pancreas concept

The newer systems link a continuous glucose monitor and a subcutaneous insulin infusion pump via a control algorithm, which retrieves continuous glucose monitoring data in real time (for example, every five minutes) and uses a mathematical formula to compute insulin delivery rates that are then transmitted to the insulin pump.

However, artificial pancreas that can be worn by diabetics on their person as they go about their daily lives is still in development, with the first in-clinic studies now being reported. Preliminary results have been promising ‒ the most notable improvement is in overnight control of type 1 diabetes, with improvements in safety and a reduction in nocturnal hypoglycemia being reported.

These improvements result from the fine adjustment of insulin delivery provided by closed loop control overnight being superior to a generally fixed basal rate and less likely to cause hypoglycemia. The first application of closed loop control is therefore likely to be in glucose regulation overnight, a step that has the potential to improve dramatically the safety of insulin delivery during crucial, generally unsupervised, periods.

Now a University of Cambridge research tem led by Roman Hovorka has demonstrated the safety and efficacy of overnight closed loop insulin delivery with conventional insulin pump therapy in adults with type 1 diabetes.

Artificial Pancreas Best Hope For Diabetics In Near Term

The trial group consisted of 24 adults (10 men and 14 women) aged 18-65, who had used insulin pump therapy for at least three months and the research team used two protocols ‒ a medium sized meal (60 g carbohydrate) and a large size meal (100 g carbohydrate + alcohol) ‒ to see whether artificial pancreas were effective in overcoming nocturnal hypoglycemia.

As in previous studies carried out by Boris Kovatchev and others in the U.S. and France, the Cambridge closed loop system significantly increased the time that plasma glucose was in the target range (70-144 mg/dl), reduced incidence of hypoglycemia, and better overnight control.

But what makes the Cambridge study important is that the randomized crossover trial design is virtually unique in the field of closed loop control. Because this design is the gold standard for clinical research, the results set a benchmark for future studies.

The only other randomized controlled trial of closed loop control was recently presented by the University of Virginia research team led by Kovatchev at the 4th International Conference on Advanced Technologies and Treatments for Diabetes. This study recruited 24 adults and adolescents with type 1 diabetes in the United States and in France and achieved results similar to those reported by Hovorka and colleagues ‒ more time within the target range of 70-180 mg/dl and a threefold reduction in hypoglycemia.

Dr Roman Hovorka

Moreover, the control algorithm used by Hovorka and colleagues belongs to an advanced class of closed loop control technologies known as “model predictive control”. Algorithm designs for artificial pancreas have generally used either “proportional-integral-derivative control” or “model predictive control”.

Proportional-integral-derivative control algorithms are reactive, responding to changes in glucose levels with adjustment in insulin delivery. Model predictive control algorithms are built over a model of the human metabolic system and are therefore proactive, delivering insulin in anticipation of changes in glucose concentrations.

This compensates partially for the time delays inherent in subcutaneous glucose control (the time delay in insulin action, which can amount to 60 minutes or more). For this reason, model predictive control has become the approach of choice more recently.

The algorithm developed by Hovorka and colleagues has certain distinct features, such as real time adaptation of the underlying model to changing patient parameters implemented as a selection from several predefined models. However, this potential advantage remains to be evaluated.

Most importantly, this is one of the first studies to test realistic meal scenarios and challenge the participants with a large dinner that included alcohol. As such, the study is a clear advance in the quest for an artificial pancreas that can be used by a diabetic while performing normal daily activity.

However, as the authors admit, one limitation is the exclusivelymanual control of the artificial pancreas used relied on study personnel to transmit data manually from the continuous glucose monitor (CGM) to the computer running the closed loop control, and to transmit insulin injection recommendations from the computer to the insulin pump because of technological and regulatory barriers

In fully automated systems ‒ which is what researchers and medical device makers are hoping to make a reality for diabetics ‒ these processes are handled by data transmission and pump control devices, respectively. However, Cambridge method limited the investigation to testing only the control algorithm, not the artificial pancreas as a whole. The testing of other key components, such as sensor-pump communication and error mitigation, would require much more effort and thorough system validation.

Studies using fully automated systems have already been reported by the Artificial Pancreas Project and offer hope for the future of ambulatory systems i.e. devices that be worn by diabetics on their person in their daily lives.

Lastly, despite the sophistication of the control algorithm and the significant reduction in nocturnal hypoglycemia, four episodes of severe hypoglycemia (<70 mg/dl) occurred, three of which the authors thought were attributable to the preceding prandial insulin dose and could not be prevented by the artificial pancreas suspending insulin delivery.

This finding reinforces the recently proposed idea that a dedicated hypoglycemia safety system ‒ a separate algorithm responsible solely for the assessment and mitigation of the risk of hypoglycemia ‒ may need to accompany closed loop control. Such safety systems already exist, and have proved useful.

Based on ‘Boris Kovatchev: Closed Loop Control For Type 1 Diabetes (BMJ 2011; 342:d1911)

Related Post: Killer Apps That Are Revolutionizing Diabetes Care

Diabetes Management: Telephonic CBT Counseling for Diabetics with Depression Can Improve Treatment Outcomes

noreply@blogger.com (Roger Alexander) — Thu, 21 Apr 2011 08:13:00 +0000

A NEW investigative study by researchers at VA Ann Arbor Healthcare System and University of Michigan Health System shows that telephonic intervention can improve patients’ access to effective depression care, improve their cardiovascular health and get them moving again, reports Endocrine Web.

As is well known, depression is a common, treatable issue for many people who have diabetes but most busy clinics cannot provide the level of intensive care these patients need. In many cases this proves to be a major hurdle for diabetics in maintaining the strict medication regimen or exercise schedule.

Patients with diabetes and depression often have self-management needs that require between-visit support. The study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes.

3G Wireless Technology Delivers Diabetes Health Care In Innovative Project

The research team worked over a year to improve diabetes patients’ health by first addressing their depression. The program began with behavioral therapy sessions over the telephone with a specially trained nurse and later phased in a walking program. This was done because delivering therapy by telephone makes it feasible to reach large numbers of patients who may not attend traditional in-person appointments.

For the investigation, researchers divided a group of 291 participants with type 2 diabetes and significant depressive symptoms into two groups. One group received standard care, while the other segment was put through a year-long intervention program, which consisted of 12 weeks of cognitive behavioral therapy and nine months of supplemental phone checkups.

The findings ‒ published online ahead of print in Medical Care ‒ showed the intervention was successful in lowering patients’ blood pressure, increasing their physical activity by about four miles of walking per week and easing their depressive symptoms. At the end of the year, 58 percent of patients who received the intervention had depression symptoms that were in remission, compared to only 39 percent of the patients who did not receive counseling.

Even Telephonic Intervention Improves Diabetes Control

The cognitive behavior therapy helped the study participants address negative thought processes and behaviors that made it difficult for them to manage their diabetes and make healthy lifestyle choices.

The physical activity component of the program used pedometers to help patients set walking goals and monitor their progress. Earlier studies have shown that along with physical benefits, exercise also helps boost one’s mood.

Indeed, patients with depression and additional chronic medical conditions do better, as the study demonstrates, if their depression is addressed first, if it is addressed systematically, and if exercise is also encouraged.

Most patients entered the study with relatively good blood glucose control. So while the intervention did not lead to a drop in A1C ‒ a common measurement of blood glucose levels ‒ patients did see more than a 4-point improvement in their systolic blood pressure, walked about half a mile more per day and reported an improvement in their general quality of life.

“This study shows that telephone-delivered counseling can improve patients’ access to effective depression care, improve their cardiovascular health and get them moving again,” said lead author John Piette.

In view of this study, “health systems should consider routinely offering structured telephone psychotherapy to their patients with diabetes and depression,” concluded senior study author Marcia Valenstein.

(The research was funded by grants from the National Institutes of Health, Michigan Diabetes Research and Training Center and the Michigan Institute for Clinical and Health Research.)

TeloVac Vaccine Trial Holds Hope For Diabetics With Pancreatic Cancer

noreply@blogger.com (Roger Alexander) — Wed, 20 Apr 2011 07:08:00 +0000

More than 1,000 patients with advanced pancreatic cancer have joined the final stage trial at 53 hospitals in Britain

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LIVING with diabetes means being diligent about listening to your body for any signs or symptoms that something isn’t quite right. Most people with diabetes know to watch out for issues with their circulation, kidneys, and even gums; but how many realize they should be on the alert for cancer, specifically pancreatic cancer?

Pancreatic cancer is the eighth major form of cancer-related death worldwide, causing 227 000 deaths annually. And Type 2 diabetes is widely considered to be associated with pancreatic cancer. But whether this represents a causal or consequential association is unclear.

Researchers have found that about 80 percent of people who have pancreatic cancer also have glucose intolerance (blood sugar levels that are high, but not yet at diabetic levels) or diabetes.

Another study found that people diagnosed with diabetes after age 50 are eight times more likely to develop pancreatic cancer compared with the general population.

Indeed, pancreatic cancer has the worst survival rate of all common cancers ‒ just three in 100 patients survive the disease for five years or more.

New-Onset Diabetes May Help Guide Pancreatic Cancer Screening

It is for this reason that the Phase-3 (final stage) trial in the UK on the GV1001 vaccine (TeloVac) to treat pancreatic cancer is being followed with great interest around the world. The vaccine is being developed by GemVax AS, a subsidiary of Pharmexa A/S.

Vaccines are usually associated with preventing infections, but this is part of a new approach to try to stimulate the immune system to fight cancer. The trial involves regular doses of the GV1001 vaccine (TeloVac) together with chemotherapy and compares this with chemotherapy alone.

One of the best documented therapeutic cancer vaccines currently in development, GV1001 is a 16-amino acid peptide vaccine that comprises T cell epitopes from human telomerase, an enzyme which is over-produced by cancer cells.

The vaccine ensures robust activation of both CD4+ (memory) as well as CD8+ (cytotoxic) T-cells. The aim is to stimulate the immune system to recognize the telomerase which sits on the surface of the cancer cells and to target the tumor.

Professor John Neoptolemos from Royal Liverpool University Hospital, who is helping to co-ordinate the trial, said: "The problem is tumors are clever and are able to turn the immune cells into traitors which help to guard the tumor. The vaccine takes away the masking effect of the tumor."

Cancer Research UK's chief clinician Professor Peter Johnson said: "One of big problems with cancer treatment is you are almost always left with a few malignant cells and it is from those few cells that the cancer can regrow. If you can program the immune system to recognize those cells and get rid of them altogether or keep them in check then you can effectively stop the cancer from growing back lifelong."

Controlling Diabetes May Reduce Cancer Risk and Death

Doctors usually treat advanced pancreatic cancer with gemcitabine(Gemzar) and capecitabine (Xeloda) chemotherapy. But there is evidence suggesting that using a type of treatment called immunotherapy as well as chemotherapy may give better results. Immunotherapy is a type of biological therapy.

The TeloVac trial is to see whether giving the GV1001 vaccine as well as chemotherapy will improve treatment for pancreatic cancer.

Immune system cells search for and kill abnormal cells. But they don’t always recognize cancer cells as being abnormal. The GV1001 vaccine works by teaching immune cells to recognize certain proteins (antigens) made by pancreatic cancer cells. The immune cells can then find the pancreatic cancer cells and kill them.

Doctors want to find out how well the GV1001 vaccine works when it is used with chemotherapy as well. The aims of this trial are to see:

• If adding GV1001 to gemcitabine with capecitabine chemotherapy helps pancreatic cancer treatment to be more successful

• What the side effects are when GV1001 is added to gemcitabine with capecitabine chemotherapy treatment

• How well GV1001 helps the body’s immune system to attack pancreatic cancer cells

The Phase-3 TeloVac trial should produce results in just over a year which will show whether the vaccine has a positive effect. Cancer Research UK is keen to stress that the vaccine is not a cure, but if it works, might prolong life.

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Pancreatic Cancer Risk and Diabetes: What Can You Do?
If you have diabetes, there are ways to reduce your risk of pancreatic cancer and increase your chances of catching it earlier if it does occur:

• Be aware of pancreatic cancer risk factors. Some risk factors for pancreatic cancer cannot be changed, such as being over age 60, being African-American, being male, and having a family history of pancreatic, colon, or ovarian cancer. Other pancreatic cancer risk factors, however, can be reduced or eliminated, including being overweight and smoking.

• Ask for tests. Going with the hypothesis that pancreatic cancer may cause diabetes, it would be reasonable for people newly diagnosed with diabetes to ask their doctor if there are any tests they should have to rule out pancreatic cancer. Because the non-specific early symptoms of pancreatic cancer — pain, jaundice, and weight loss — can be hard to detect or easily confused with other diseases, pancreatic cancer diagnosis may be difficult and often is not made until the cancer has spread.

• Eat a healthy diet. Once it is determined that pancreatic cancer is not behind the diabetes diagnosis, it is important for people with diabetes to keep their blood sugar levels under control by eating well-balanced meals in the right portion size.

• Stay active. Exercise is another important aspect to work into your daily schedule, especially if you are overweight. Losing the extra pounds can be doubly beneficial by helping keep the diabetes under control and reducing the overall risk for developing pancreatic cancer.

Finally, simply be aware of your body and how you feel. If you experience abdominal pain, sudden weight loss, or any other significant changes, be sure to call your doctor.

Source: CancerHelp UK

Bad Diet for Expectant Mother Can Mean a Fat Baby and Later a Diabetic Adult

noreply@blogger.com (Roger Alexander) — Tue, 19 Apr 2011 16:14:00 +0000

AN expectant mother’s diet can create an obesity time bomb for her unborn child by altering the baby's DNA in the womb, increasing its risk of obesity, heart disease and diabetes in later life, a groundbreaking study has revealed.

The process ‒ called epigenetic change ‒ can lead to her child tending to lay down more fat. Importantly, the study shows that this effect acts independently of how fat or thin the mother is and of child's weight at birth. The study found there was an element in a woman's diet, particularly during the first third of a pregnancy that was of crucial importance.

The epigenetic changes ‒ which alter the function of our DNA without changing the actual DNA sequence inherited from the mother and father ‒ can also influence how a person responds to lifestyle factors such as diet or exercise for many years to come. The changes were noticed in the RXRA gene that makes a receptor for vitamin A, which is involved in the way cells process fat.

The study ‒ to be published on April 26 in the journal Diabetes ‒ shows that the epigenetic effect work independently of how fat or thin the mother is - meaning thin mothers who eat badly are just as likely to cause obesity in their children as fat ones.

The scientists drew their conclusions after measuring epigenetic changes in nearly 300 children at birth (samples first taken after birth using umbilical cord tissue DNA), and relating these to obesity rates at six or nine years of age.

What was surprising was the size of the effect: children vary in how fat they are, but measurement of the epigenetic change at birth allowed the researchers to predict 25 per cent of this variation, basically by mapping data to the topology they had and achieving results which would be the placebo effect in a medical study.

Keith Godfrey, Professor of Epidemiology and Human Development at the University of Southampton, who led the international study, said: "It is both a fascinating and potentially important piece of research. All women who become pregnant get advice about diet, but it is not always high up the agenda of health professionals. The research suggests women should follow the advice as it may have a long term influence on the baby's health after it is born."

Speaking in Auckland, Peter Gluckman, from Auckland University's Liggins Institute, who led the New Zealand team, said the rate of epigenetic change was possibly linked to a low carbohydrate diet in the first three months of pregnancy, but it was too early to draw a definitive conclusion and further studies were needed. He said one theory was that an embryo fed a diet containing few carbohydrates ‒ which provide the body with energy ‒ assumed it would be born into a carbohydrate-poor environment and altered its metabolism to store more fat, which could be used as fuel when food was scarce.

"This study provides the most compelling evidence yet that just focusing on interventions in adult life will not reverse the epidemic of chronic diseases, not only in developed societies but in low socio-economic populations too," he said.

Fat Fathers Pass on Diabetes

Gluckman added that it is not just women who should be mindful, as it is likely obese fathers change the DNA in the sperm, ultimately influencing how the baby develops its control of blood sugar and fat deposition after that baby grows up.

"There is good evidence in animals, and there is some supportive evidence in humans that fathers who are obese have impact on the gene switches of their babies as well. We should not imagine that father has no role in determining the outcome of the baby's health."

It has long been known a mother's diet can affect her unborn child, but the research reveals how much of an influence it can have on a child's health. While it is not clear exactly which foods have the greatest influence on the DNA of unborn babies, a link was found with mothers on low carb diets.

Humans originally ate food as it came in nature ‒ legumes, pulses, things like lentils and chick peas, and fruits. Root vegetables and potatoes are a lovely source of carbohydrate as well. It is therefore important mothers are educated about the effects of diets.

Low-carb diets are in fashion and women have used them to control their weight, but where that information has gone awry is people have become confused and cut-out really important sources of carbs like legumes and fruit.

The study will continue for a at least two more years as scientists look into which foods are the most harmful for unborn babies, but in the meantime their advice for expectant mothers is to eat a balanced diet.

Diabetes+Diet Sodas: Confusing Cause and Effect

noreply@blogger.com (Roger Alexander) — Tue, 19 Apr 2011 06:20:00 +0000

SCIENTISTS like to remind us not to confuse cause and effect. But they're not immune from making that mistake themselves. Last week, for example, the mass media reported a Harvard Universitystudy that has exonerated diet sodas and other artificially-sweetened beverages from previous studies linking their consumption to diabetes.

“This is such a great example of confusing cause and effect. It’s akin to saying ‘playing basketball makes you tall’ because height and basketball are correlated. Of course, the real answer is that taller people play basketball,” says Dr. Josh Bloom of the American Council on Science and Health.

(Courtesy: Chris Coombs)

The new study ‒ published in The American Journal of Clinical Nutrition ‒ indicates that the link is a result of other factors common to both diet soda drinkers and people with diabetes, including that they are more likely to be overweight. In other words, people who are already diabetic or overweight are drinking more diet soda for those very reasons.

The Harvard University researchers, who followed a large group of men for 20 years, found that drinking regular soda and other sugary drinks often meant a person was more likely to get diabetes, but that was not true of artificially-sweetened soft drinks, or coffee or tea. They found that men who drank the most sugar-sweetened beverages ‒ about one serving a day on average ‒ were 16 percent more likely to be diagnosed with diabetes than men who never drank those beverages. The link was mostly due to soda and other carbonated beverages, and drinking non-carbonated sugar-sweetened fruit drinks such as lemonade was not linked with a higher risk of diabetes.

When nothing else was accounted for, men who drank a lot of diet soda and other diet drinks were also more likely to get diabetes. But once researchers took into account men's weight, blood pressure, and cholesterol, those drinks were not related to diabetes risk.

Replacing sugary drinks with diet versions seems to be a safe and healthy alternative, the authors say. "There are multiple alternatives to regular soda," says Dr. Frank Hu, one of the study's authors, adding, “Diet soda is perhaps not the best alternative, but moderate consumption is not going to have appreciable harmful effects."

When asked to comment on the study, Dr. Rebecca Brown, an endocrinologist at the National Institutes of Health, who has studied artificial sweeteners but was not involved in the Harvard research, told Reuters Health: “People who are at risk for diabetes or obesity…those may be the people who are more likely to choose artificial sweeteners because they may be more likely to be dieting.”

Hu and his colleagues analyzed data from more than 40,000 men who were followed between 1986 and 2006. During that time, participants regularly filled out questionnaires on their medical status and dietary habits, including how many servings of regular and diet sodas and other drinks they consumed every week. About 7 percent of men reported that they were diagnosed with diabetes at some point during the study.

The study also found that drinking coffee on a daily basis ‒ both regular and decaffeinated ‒ was linked to a lower risk of diabetes. Researchers aren't sure why that is, but it could be due to antioxidants or vitamins and minerals in coffee, Hu said.

Brown said that while there are still some health concerns about artificial sweeteners, none have been proven. "I certainly think that we have better evidence that drinking sugar-sweetened beverages increases health risks," Brown said, adding, "Certainly, reducing sugar-sweetened beverage consumption by any means (including substitution with diet drinks) is probably a good thing."

Breaking News: Type-2 Diabetes May Be An Autoimmune Disease

noreply@blogger.com (Roger Alexander) — Mon, 18 Apr 2011 10:46:00 +0000

Type-2 diabetes is characterized by the gradual development of insulin resistance, which affects the ability of the body to properly metabolize glucose. It's associated with being overweight, but it can also have a genetic component. But despite the fact that millions of people have type-2 diabetes, the root cause of the insulin resistance is not known

Today, Stanford researchers reported that type-2 diabetes islooking more and more like an autoimmune disease, rather than a strictly metabolic disorder.

"The main point of this study is trying to shift the emphasis in thinking of type 2 diabetes as a purely metabolic disease, and instead emphasize the role of the immune system in type 2," says the study’s co-first author Daniel Winer, MD.

Commenting on the findings, Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association, said, “This doesn't change our current approach to type 2 diabetes therapy, but it's important to understand that type 2 has multiple contributors to its onset. For some people, it may be an immune component, and if it is, we should be able to develop some better therapies."

"People with type 2 diabetes are often blamed for bringing the disease on, but it's a combination of genetic and physiological factors exposed to a certain environment. And, this study points out what may be another important biologic factor," he added.

Be that as it may, these findings ‒ published online April 17 in the journal Nature Medicine ‒ will change the way people think about obesity, and will likely impact medicine for years to come as physicians begin to switch their focus to immune-modulating treatments for type-2 diabetes.

Although the causes of type 2 haven't been clear, it's known that the disease runs in families, suggesting a genetic component. Also, while type 2 is strongly linked to increased weight, not everyone who is overweight gets type 2 diabetes. And, that's what got the researchers searching for another factor.

In 2009, Daniel Winer (along with his twin brother Shawn) showed that T- cells of the immune system were involved in people developing insulin resistance. They have now discovered that another immune cell, called a B-cell, also plays an important role.

Winer explained that excess weight has been linked to inflammation, which can cause the immune system to react. As visceral fat (abdominal fat) expands, it eventually runs out of room. At that point, the fat cells may become stressed and inflamed, and eventually the cells die. When that happens, immune system cells known as macrophages come to sweep up the mess.

Other immune system cells, known as T-cells and B-cells, also respond to the stressed or dying cells. But, these cells are the ones that create specific antibodies to remember a threat to the body. For example, these are the cells responsible for creating immunity when you're exposed to a certain flu virus.

In this case, however, instead of creating antibodies against a foreign substance, immune system cells ‒especially the B cells ‒ create antibodies against fat cells. Those antibodies then start attacking the fat cells, making them insulin resistant and hindering their ability to process fatty acids. In addition to type 2 diabetes, this onslaught against the fat cells is associated with fatty liver disease, high cholesterol and high blood pressure, according to the researchers.

The researchers found that mice genetically engineered to lack B cells were protected from developing insulin resistance even when they grew obese on the high-fat diet (60 percent fat). However, injecting these mice with B cells or purified antibodies from obese, insulin-resistant mice significantly impaired their ability to metabolize glucose and caused their fasting insulin levels to increase.

Interestingly, treating the mice with a compound called anti-CD20, which targets mature B cells for destruction, kept the animals from developing insulin resistance. The human version of anti-CD20, called rituximab, is already FDA-approved to treat some blood cancers and autoimmune disorders.

The researchers also tested blood samples from 32 obese humans. Half had insulin resistance. Those who were insulin-resistant had a distinct set of antibodies compared to the antibodies found in those without insulin resistance. This, according to Winer, suggests the possibility of developing a vaccine for type 2 diabetes based on what appear to be protective antibodies in those who are obese but not insulin-resistant.

Pointing out the mice and the human volunteers were all male, Winer said it's not clear if these findings are applicable to women. He also noted that anti-CD20 is not benign ‒ it dampens the immune system and can cause significant side effects, it’s not certain if it would ever be used for type 2 diabetes because other treatments are available.

Sources: Stanford News, HealthDay, Nature Medicine

"Metreleptin Treatment Leads to Long-Term Improvements in Diabetes and Lipid Control in Patients with Lipodystrophy"

noreply@blogger.com (Roger Alexander) — Mon, 18 Apr 2011 06:07:00 +0000

RESULTS from a new analysis of an ongoing, long-term research study of the investigational drug metreleptin, an analog of the human hormone leptin, demonstrated robust reductions in HbA1c levels and triglycerides that were sustained for several years of treatment in patients with lipodystrophy.

Lipodystrophy

“Lipodystrophy is a rare, debilitating chronic disease with a large, unmet clinical need. No therapies are indicated specifically for the treatment of the metabolic abnormalities associated with lipodystrophy,” Christian Weyer, MD, senior vice president, research and development, Amylin Pharmaceuticals, said at a late-breaking oral session on April 17 at the 20th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists (AACE) in San Diego.

In the study, which has been ongoing for more than 10 years, researchers at the NIH are examining the effects of metreleptin on several metabolic abnormalities, such as diabetes and hypertriglyceridemia, in patients with rare inherited or acquired forms of lipodystrophy.

[Amylin recently submitted the clinical and nonclinical sections of a rolling Biologics License Application (BLA) for metreleptin to treat diabetes and/or hypertriglyceridemia (high levels of triglycerides in the bloodstream) in patients with rare inherited or acquired forms of lipodystrophy. If approved, metreleptin would be the first therapy indicated specifically for the treatment of diabetes and high triglycerides in patients with lipodystrophy, and the first approved therapeutic use of leptin.]

Weyer presented results of an analysis of 55 patients with lipodystrophy who were assigned to metreleptin. According to the researchers, this is the largest cohort to date. At baseline, 75% of patients had uncontrolled diabetes (HbA1c ≥7%) and 75% had hypertriglyceridemia (≥200 mg/dl).

“When metreleptin was introduced as a subcutaneous injection once or twice a day, both HbA1c and triglycerides fell very rapidly and profoundly in the first 4 months of therapy,” Weyer said. When patients were followed to 3 years, the changes were maintained. In the patients with diabetes, mean HbA1c decreased from 9.4% at baseline to lower than 7% at year 3. In the patients with hypertriglyceridemia, mean triglyceride concentrations decreased from 500 mg/dl to under 200 mg/dl at year 3.

Weyer said adverse events were consistent with known comorbid conditions of lipodystrophy, including pancreatitis, proteinuria and autoimmune/chronic hepatitis, or expected pharmacological effects of metreleptin, such as weight loss or insulin-induced hypoglycemia in the setting of improved insulin sensitivity in patients taking high doses of insulin.

Other studies conducted worldwide have demonstrated metreleptin’s positive effects on insulin sensitivity, high triglycerides, hyperglycemia and liver fat in patients with lipodystrophy who are not responsive to conventional lipid and glucose-lowering agents, the researchers said. Amylin is working with the FDA to get approval of metreleptin. If approved, it would be the first therapy indicated specifically for the treatment of diabetes and hypertriglyceridemia in patients with lipodystrophy.

Commenting on Weyer’s remarks, AACE President Elect Yehuda Handelsman, MD, said:

This whole thing about leptin is fascinating, and I think there is so much more to learn about it. (News about) leptin is everywhere: it is related to bone, it turns out, it is related to smell, taste and hunger. We found out from Dr. Unger (here at the meeting) that it suppresses glucagon terrifically.

Dr. Weyer represents an organization that has a drug called exenatide (Byetta), a glucagon-like peptide 1 that we also think in some way suppresses glucagon. It will be interesting to know if there is any relationship between the leptin suppression and glucagon suppression. We can see now that leptin, in the rarest disease, may be more applicable to a larger group of people that may have partial lipodystrophy, and we don’t as yet know how to recognize it.

Diabetes: “Welchol Added to Existing Diabetes Therapy Achieves Better Glucose Control”

noreply@blogger.com (Roger Alexander) — Sun, 17 Apr 2011 18:06:00 +0000

WHEN used in combination with certain antidiabetes medications, colesevelam effectively lowers HbA1c levels in adults with type 2 diabetes, reports Endocrine Today. Colesevelam was approved by the FDA in 2008 for use in combination with metformin (Glucophage), sulfonylureas (Amaryl, DiaBeta, Glucontrol)) and insulin to improve glycemic control in adults with type 2 diabetes.

Harold Bays, MD

Although originally developed as an agent to lower LDL, data from three clinical trials demonstrated that colesevelam (Welchol, Daiichi Sankyo) improved glucose levels in adults with type 2 diabetes, Harold Bays, MD, medical director and president of the Louisville Metabolic and Atherosclerosis Research Center in Kentucky, said during a session of the American Association of Clinical Endocrinologists 20th Annual Meeting in San Diego this week.

Compared with placebo, when added to metformin, insulin and sulfonylureas, colesevelam led to 0.5%, 0.6% and 0.8% reductions in HbA1c levels, respectively, he said. “We did one set of clinical trials with metformin-based therapy, insulin and sulfonylureas…What’s really interesting when we look at the data is that, while these are somewhat different agents, reductions in HbA1c were remarkably similar,” Bays told the audience.

To further evaluate the efficacy of colesevelam, researchers conducted a pooled post-hoc analysis of the three pivotal studies of the drug in patients with type 2 diabetes. In total, the number of patients in the treatment group increased to 355. Results indicated that when added to metformin-based therapy, colesevelam significantly reduced cholesterol levels, improved glycemic parameters and exhibited a good safety profile.

“We found almost exactly what could be anticipated from the original trials,” Bays said. “Data showed reductions in HbA1c, fasting glucose levels, LDL, non-HDL and a nonsignificant increase in HDL and moderate increases in triglycerides.”

Colesevelam was also generally well-tolerated, Bays said. A moderate increase in constipation was the most notable side effect, with 10% to 13% of patients experiencing constipation vs. 2% to 3% in the placebo group. Other common adverse events included nausea, dyspepsia and nasopharyngitis (common cold). In studies involving pediatric populations with heterozygous familial hypercholesterolemia, adverse reactions included nasopharyngitis, headache, fatigue, increases in creatine phosphokinase, rhinitis and vomiting.

Prescribing information for colesevelam recommends against use in patients with a history of bowel obstruction, triglyceride levels greater than 500 mL or with a history of hypertriglyceridemia-induced pancreatitis. Bay emphasized that strict adherence to these indications is important for preventing adverse events and use of clinical judgment.

“We cannot look to these clinical trials for blanket safety information for all patients,” Bays said. “The results are only applicable to those patients who were administered the drug in keeping with the study populations.”

Calorie Labeling and Mandated Food Choices: Can Such Strategies Work?

noreply@blogger.com (Roger Alexander) — Sun, 17 Apr 2011 17:08:00 +0000

EARLIER this month Boston's mayor Thomas M. Menino issued an executive order to phase out sugary drinks from all city property earlier this month.

Subsequently, the Boston Public Health Commission has applied the familiar red, yellow and green labels to sugary drinks in its "Stop-Rethink Your Drink-Go On Green" campaign against sugary drinks.

"Red" beverages include non-diet sodas, sweetened ice teas, sports drinks, etc. Diet sodas and diet iced teas, 100 percent fruit juices and low calorie sports drinks qualify as "yellow" beverages, while "green" drinks mean bottled water, low fat milk or unsweetened soy milk.

Boston's not alone in trying to combat obesity through mandated choices. Cities like San Francisco, San Antonio, Seattle, Los Angeles County and New York City have also set standards to limit or prohibit the sale or distribution of unhealthy food ‒ including sugary drinks.

Soda and other sugar-sweetened beverages account for up to 10 percent of total calories consumed in the U.S. diet, and are known to be major contributors to obesity. And a Huff Post report claims there's some proof this type of food policing works.

However, while mandated choice may make an impact on consumption behavior, posting calorie counts to change purchasing behavior may not work, and may actually backfire in some consumers, according to a recent report from researchers at Maastricht University and New Mexico State University and published in the American Journal of Clinical Nutrition.

The report looked at imposing junk-food taxes and posting calorie counts as strategies for combating obesity.

Researchers talked to 178 university students and asked them three times to choose from a list of hypothetical lunch items, of which the high-fat choices had varying prices. Some participants were also provided with calorie information; others were not. In addition, those interviewed were categorized as either restrained or unrestrained eaters. Restrained eaters were those that regularly limited their caloric intake.

Participants were given either $10 or $20 and asked not to exceed those amounts in their lunch purchases during the three times they were asked to do so. The first time, the prices on the menu were based on the prices of the school cafeteria.

The second time, prices for high-calorie products were raised to 125% of the base price, and the third time, prices were raised to 150% of the base price. This study did not include actual calorie consumption – only potential calorie purchases.

While researchers thought they would find an inverse relationship between price and caloric intake, they learned that this association was rather complex and dependant on other factors – i.e. if caloric information was provided and if the consumer was a restrained or unrestrained eater.

When faced with a junk-food tax, unrestrained eaters decreased their caloric intake, regardless of if caloric information was provided or not. On the other hand, pricier foods only dissuaded restrained eaters when caloric intake was not provided.

“Our results suggest that if one wants to help people in general to prevent caloric overconsumption then imposing a high tax on high energy dense food items is much more efficacious than providing calorie-information,” says Dr. Janneke Giesen, Faculty of Psychology and Neuroscience at Maastricht University and a study co-author.

As expected, the food tax did reduce the amount of calories people bought, but this effect was limited to consumers that did not receive calorie information.

Interestingly, the food tax effect existed regardless of the amount of money a participant had to spend, even though those with $20 to spend purchased more calories than those with $10 to spend. Still, the results also suggest that people will not substitute the purchase of expensive high-calorie foods for cheaper low-calorie foods based on price alone.

In the case of the restrained eater, they may continue to buy a product as long as they can afford it. A restrained eater provided with caloric information will make the necessary adjustments in their caloric intake and adjust the energy content of their lunch, regardless of taxes inflicted.

Dr. Collin R. Payne, Assistant Professor of Marketing at New Mexico State University and a study co-author, says that this study speaks to the problem of a "one-size-fits-all" policy strategy.

That is, in this study, it took a tax of over 25% to change potential calorie purchases significantly, but that tax increase didn't change potential calorie purchasing for those who are most sensitive to calorie consumption and who received calorie information.

In other words, for those who would most benefit from a food tax and calorie information, it didn't help.

Payne continues, “The benefit of caloric posting may be simply that the company posting calories may be seen as more transparent and less likely to trick consumers into purchasing their food. The drawback, as seen in this study, is it is difficult to predict how multiple policy measures interact, sometimes leading to less health food consumption, and sometimes leading to more.”

Giesen says that it’s possible that a large junk food tax could work in combating obesity. It is not clear, though, whether a smaller tax, which is perhaps politically more viable, would help in decreasing obesity rates too – or if it could potentially backfire.

More research is needed to determine the relationship of lower taxes on food purchasing choices. The relationship between caloric information and taxing should be further examined as well, he said.

“As noted by Dr. Loewenstein in the editorial, ‘Confronting reality: Pitfalls of Calorie Posting,’ in the same issue of the American Journal of Clinical Nutrition as our paper, it could be possible that for some people calorie posting may actually increase caloric intake, as in the case of low-income individuals who try to get the most calories for their money,” says Giesen. “Of course this needs to be tested first before we can conclude if this is really the case.”

Payne adds that, for their part, retailers could pair with academic researchers to understand – for their target market – what combination of tools would lead to the best possible health outcome for their shoppers.

Shoppers could then be provided with informational surveys that provide them with what is known about labeling and taxing foods, and would allow them to better accomplish their goals in the supermarket.

“The benefit of a junk-food tax is decreasing less nutritious food consumption and raising public funds to help defer health costs related to obesity and obesity related diseases associated with their over-consumption,” says Payne.

“However, junk-food taxes – at a minimum level – may only stimulate demand, and – at a maximum level – reduce consumption at the expense of the food industry and result in concerns about consumer freedom of choice.”

In this context, it remains to be seen whether Boston’s "Stop-Rethink Your Drink-Go On Green" campaign will actually succeed in arresting the city’s obesity epidemic. After all, Mayor Menino’s mandate covers only city properties and not the entire metropolitan area.

How Fatty Foods Lead to Diabetes

noreply@blogger.com (Roger Alexander) — Sun, 17 Apr 2011 09:57:00 +0000

Findings provide further evidence of importance of choosing foods low in unhealthy saturated fats

FINALLY, new research from the University of North Carolina at Chapel Hill School of Medicine adds clarity to the connection between high saturated fat diet and type 2 diabetes.

Several decades ago scientists noticed that people with type 2 diabetes have overly active immune responses, leaving their bodies rife with inflammatory chemicals. In addition, people who acquire the disease are typically obese and are resistant to insulin, the hormone that removes sugar from the blood and stores it as energy.

But for years no one has known exactly how the connection between high levels of body fat (obesity), inflammation and insulin resistance, three factors that are known to increase type 2 diabetes risk.

The Chapel Hill study has found that saturated fatty acids ‒ but not the unsaturated type ‒ can activate immune cells to produce an inflammatory protein, called interleukin-1beta.

Using mouse cell lines (in vitro) and genetically engineered (defective inflammasome pathway) and wild-type mice (in vivo), the researchers found that intake of the saturated fatty acid palmitate, activates the NLRP3-ASC inflammasome-triggering production of IL-1beta, as well as the additional inflammatory factors caspase-1 and IL-18.

The activation of the inflammasome then impairs insulin signaling in several target tissues, such as muscle and adipose fat, thus reducing glucose tolerance and insulin sensitivity. IL-1beta also affects insulin sensitivity through tumor necrosis factor-α-independent and dependent pathways. When fed with a high-fat diet, mice with a defective inflammasome pathway had better maintenance of glucose homeostasis and higher insulin sensitivity.

The Chapel Hill researchers found that induction of the inflammasome by saturated palmitate is distinguished by its use of the AMP-activated protein kinase and unc-51-like kinase-1 autophagy-signaling pathways, and the presence of mitochondrialreactive oxygen species.

"The cellular path that mediates fatty acid metabolism is also the one that causes interleukin-1beta production. Interleukin-1beta then acts on tissues and organs such as the liver, muscle and fat (adipose) to turn off their response to insulin, making them insulin resistant. As a result, activation of this pathway by fatty acid can lead to insulin resistance and type 2 diabetes symptoms,” explains senior study co-author Jenny Y. Ting, PhD, William Kenan Rand Professor in the Department of Microbiology and Immunology

In layman terms, a diet rich in saturated fat, in addition to causing weight gain, activates certain cells of the immune system, instructing them to produce a protein called interleukin-1beta. This molecule is known to cause inflammation throughout the body.

This molecular complex inside cells, called the inflammasome, plays an important role in immunity by triggering inflammation in response to a wide variety of harmful agents ranging from bacteria to asbestos. This inflammation, in turn, affects the tissue of muscles, the liver and other organs, impairing their ability to react to insulin. This characteristic is one of the hallmarks of type 2 diabetes

Ting and colleagues have found that palmitate, a fatty acid common in a high fat diet, triggers activation of the inflammasome. Palmitate-triggered inflammation is also responsible for interfering with the insulin sensitivity of liver cells ― a major feature of type 2 diabetes.

In addition to explaining a poorly understood set of processes that were known to increase type 2 diabetes risk, the findings also provide further evidence of the importance of choosing foods low in unhealthy saturated fats. The researchers found that unsaturated fats, like omega-3s, did not activate this process.

Individualized Care Plans Important for Treating Diabetes, Says AACE

noreply@blogger.com (Roger Alexander) — Sat, 16 Apr 2011 06:28:00 +0000

The American Association of Clinical Endocrinology (AACE) on April 14 released new clinical practice guidelines for developing comprehensive care plans for patients with type 1 and type 2 diabetes mellitus, developed by a panel of 23 of the leading diabetes experts in the U.S.

Debunking one-size-fits-all care plans, the guidelines emphasize the importance of achieving a treatment plan that avoids hypoglycemia, now considered to be a continual and pressing concern for many patients with diabetes. The implications of the new guidelines for practicing physicians, as well as new data on low blood sugar in patients with diabetes, are being discussed at the AACE 20th Annual Meeting and Clinical Congress, now in session in San Diego.

Caring Doctors Improve Patients' A1c, LDL Scores

The new AACE guidelines are also published in supplement 2 of the March/April issue of the association's official medical journal, Endocrine Practice.

The guidelines emphasize a personalized approach to controlling diabetes and achieving blood glucose targets with care plans that take into account patients' risk factors for complications, comorbid conditions, and psychological, social, and economic status. Although the guidelines recommend a blood glucose target of an HbA1c level of 6.5%, if it can be achieved safely, a treatment plan should take into account a patient's risk for the development of severe hypoglycemia.

CGM is the New Standard

The new guidelines also provide information on the appropriate use of new technologies such as insulin pumps and continuous glucose monitoring, as well as managing conditions that may not be immediately obvious to treating physicians, such as sleep and breathing disturbances and depression.

Millions Risk Early Death Because of Poor Diagnosis and Ineffective Treatment

In a statement, Yehuda Handelsman, MD, AACE president-elect and co-chair of the AACE Diabetes Guidelines Writing Committee, said that it was crucial for physicians to address not just hyperglycemia in patients with diabetes but also associated cardiovascular risk factors. "These state-of-the-art guidelines provide the most up-to-date evidence-based answers to real-life (clinical) questions," Dr. Handelsman said.

Tight Cholesterol, BP Control Does Little Good for Diabetics

In the guidelines, AACE recommends comprehensive diabetes lifestyle management education at the time of diagnosis, as well as throughout the course of diabetes. The importance of medical nutrition therapy, physical activity, avoidance of tobacco products, and adequate quantity and quality of sleep should be discussed with patients who have prediabetes, as well as type 1 and type 2 diabetes, according to the new guidelines.

Related Posts:
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Even Telephonic Intervention Improves Diabetes Control

Hypoglycemia: Many Diabetics Do Not Know Most Common Symptoms Like Dizziness and Shakiness Linked to Low Blood Sugar

noreply@blogger.com (Roger Alexander) — Fri, 15 Apr 2011 17:45:00 +0000

NEW survey data released today at the American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress reveal that more than half (55%) of people with type 2 diabetes across the country report they have experienced hypoglycemia, or low blood sugar. But, surprisingly, many patients remain uneducated about the risks for hypoglycemia.

The survey also highlighted why hypoglycemia may be more of a health hazard than previously reported, as patients said they often experience low blood sugar during daily activities such as working and driving. Indeed, hypoglycemia has clear risks, as well as being an expensive burden for the healthcare system.

This survey of 2,530 adults diagnosed with type 2 diabetes assessed patients’ personal experience with and knowledge about low blood sugar, and was conducted online in November and December 2010 by Harris Interactive. (See details below)

Hypoglycemia occurs when the level of glucose in the blood is too low for the body’s needs. Symptoms that may be caused by low blood sugar include nervousness or anxiety, shakiness, sweating, tiredness, confusion, hunger, fast heartbeat and dizziness. Low blood sugar usually is caused by eating less or later than usual, changes in physical activity, or a diabetes medicine that is not matched to your needs.

Many diabetics experienced hypoglycemia during typical daily activities such as working (42%), exercising (26%) and driving (19%), according to the survey designed by the American College of Endocrinology (ACE). Recognizing symptoms like nervousness, sweating or shakiness before engaging in common activities is important to help reduce the risk of serious consequences, such as fainting or loss of consciousness.

(These eye-popping results can be extrapolated to other countries as well. I mean, if this is happening in America where the level of diabetes awareness is high thanks to a widespread education program, one can only speculate about the scenario in less developed countries like India and China.)

Hypoglycemia: Don'y Rely on the Doctor's Prognosis - Tell Him What Needs to be Done to Save Your Life

The fact that patients with diabetes experience hypoglycemia while working and driving is especially problematic, as these activities require focus and concentration, and experiencing hypoglycemia during driving can be life-threatening, said Etie Moghissi, MD, vice president and president-elect of AACE, and an associate clinical professor of medicine at the University of California in Los Angeles, at a press conference.

Although the study clearly showed that at least half (52%) of the patients surveyed were concerned about experiencing a future episode of hypoglycemia, some did not know that the most common symptoms are dizziness (22%) and shakiness (17%), and 39% incorrectly thought that thirst was the primary symptom of hypoglycemia. "Many patients are unable to name the leading causes of hypoglycemia, which is also a great cause for concern," Moghissi confirmed.

Low blood sugar can be caused by skipping meals or irregular mealtimes, sudden increase in or excessive exercise, or certain diabetes medications. In this survey, a number of patients with type 2 diabetes were unable to identify the leading causes, including skipping meals, such as breakfast (27%), and certain diabetes medications (35%). Forty-six percent of patients with type 2 diabetes also remained unaware that excessive exercise may bring on hypoglycemia, particularly when combined with some medications for type 2 diabetes.

These results suggest there is a need for better education and understanding of the common causes, signs and symptoms of low blood sugar. Learning to recognize the symptoms of low blood sugar and quickly treating them is important – symptoms may be mild at first but may worsen quickly if not treated. According to the survey, 6 percent of patients with type 2 diabetes have had to go to the emergency room at some point as a result of low blood sugar.

To help bridge this knowledge gap, ACE recently launched the Blood Sugar Basics program, which aims to help people living with diabetes, their families and loved ones learn about the importance of understanding and managing low and high blood sugar. While the program is focused on type 2 diabetes, the most common type of diabetes, it also may be useful for people with other types of diabetes.

Although hypoglycemia has long been known to be a risk associated with diabetes and its treatment, it often falls under the radar of busy physicians, particularly those in primary care, who may be treating patients for other conditions, Moghissi noted. "The survey shows that it's important to inform patients about the causes, symptoms, and how to address hypoglycemia," Moghissi stressed.

“Low blood sugar can be an alarming experience for people with type 2 diabetes, and failure to recognize and treat symptoms in a timely manner can cause serious complications,” says Moghissi, adding, “Low blood sugar can be avoided, so it’s important for patients to know what can cause blood sugar levels to drop and talk with their doctor about how they can reduce the frequency of future episodes.”

The need for emergency care is just one of the potential consequences resulting from untreated low blood sugar. The survey also indicated that about one in five (21%) patients who have experienced it have needed assistance from others. It is important that patients and their friends, family and caregivers recognize and understand the symptoms of low blood sugar and what to do if it occurs.

Survey Design
This survey was conducted online by Harris Interactive between November 17 and December 14, 2010, among 2,530 adults diagnosed with type 2 diabetes mellitus in the United States. This included 1,308 nationally sampled respondents, as well as oversamples in the following metropolitan statistical areas (MSAs): Cleveland (n=261), Dallas (n=208), Detroit (n=222), Houston (n=211), St. Louis (n=200), San Diego (n=120). Results were weighted as needed for age, sex, race/ethnicity, education, region and household income. Propensity score weighting also was used to adjust for respondents’ propensity to be online. A full methodology is available upon request. The survey was developed by the American College of Endocrinology (ACE) and supported by Merck.

About Blood Sugar Basics
Blood Sugar Basics is an educational program aimed to help people living with diabetes, their families and loved ones learn about the importance of blood sugar control as part of a successful diabetes treatment plan. The program was developed by the American College of Endocrinology (ACE) and supported by Merck.