Guest guest Posted December 6, 2007 Report Share Posted December 6, 2007 1. MW Novo Reports Significant Weight Loss With Liraglutide (Reuters) Nov 20 -Novo Nordisk reports its liraglutide led to significant weight loss in obese people in a phase II clinical trial. The drug given once daily over 20 weeks at the highest dose led to a weight loss of just above 7 kg, compared to just below 3 kg in the placebo group and just above 4 kg in a group treated with Xenical, or orlistat. The patients enrolled did not have diabetes, but 30 percent showed signs of pre-diabetes. " (The results) give us reason to believe that liraglutide has the potential to become a new and important treatment option in the fight against serious obesity, " The company's chief science officer said. Liraglutide is a modification of a naturally occurring hormone, which Novo is developing primarily as a treatment for T2DM, where it has shown improved glucose control and lower body weight in phase III studies. Novo plans to file for an approval review for liraglutide in the US and Europe in 2008. 2.%%MW - Higher Vitamin D Levels May Lower Type 2 Diabetes Risk Reuters Health Information 2007. C 2007 Reuters Ltd. Nov 19 - During a 17-year follow-up of a Finnish cohort of approximately 4,000 men and women, researchers demonstrated that individuals with a higher serum vitamin D level had a 40% lower risk of developing T2DM than those with lower values. The mean serum 25-hydroxyvitamin D (25OHD) concentration collected at baseline was 43.6 nmol/L. During follow-up, there were 187 incident cases of T2..a statistically significant inverse association was observed between serum 25OHD level and incidence of T2. " The relative risk between the highest and lowest serum 25OHD quartile was 0.60, " " Our study is the first to demonstrate this association in a human population and therefore it has to be replicated before any firm conclusions can be made, " Dr. Knekt noted. " Vitamin D comes from the diet (mainly from fish), sun exposure and supplements. Previous human studies have suggested that high intake of fish fat is related to a reduced risk of coronary heart disease. Our DM finding is thus in line with the suggestion of beneficial health effects of fish, " Diabetes Care 2007;30. 3.%%M - Exercise Training Improves Glycemic Control in Insulin- Treated Type 2 Diabetes (Reuters Health) Nov 19 - Combined endurance training and resistance-type training is beneficial and well-tolerated in patients with long-standing T2DM requiring insulin therapy. " Regular exercise represents an effective strategy to prevent and/or treat T2 write the researchers. " However, the clinical benefits of exercise intervention in a vastly expanding group of long-standing insulin-treated T2DM patients with comorbidities are less evident. " [11 male diabetics; mean age 59;5-month low-impact exercise intervention program that combined endurance and resistance-type exercise. The mean duration of DM was 12 years, and the participants had been on insulin treatment for a mean of 7 years. All the patients were sedentary and had a high cardiovascular risk profile. The attendance rate for the supervised sessions was 83%. The exercise training was associated with a decline in truncal fat mass and an increase in lean leg muscle mass. There was an improvement in glycemic control, and a significant decline in both fasting blood glucose concentration and A1C (from 7.6% to 7.2%). The team found no change in exogenous insulin requirements throughout the training program. " Although selection bias and sample size should be acknowledged when generalizing the outcome of this study, we conclude that low-impact endurance and resistance-type exercise training should be prescribed in [this] vastly expanding population.Diabetes Care 2007;30. 4.%%Any Degree of Albuminuria Signals Increased Cardiovascular Risk Heartwire 2007. C 2007 Medscape Nov 20, 2007 - Albuminuria, even in low levels within the " normal " range, is an independent predictor of cardiovascular and all-cause mortality, a new analysis of the PEACE trial shows. The team leader Dr S told heartwire: " We found that virtually any degree of albuminuria, even albumin below the level we call microalbuminuria, placed a patient at significantly higher risk of cardiovascular events. A number of other studies have been suggestive of this- ..but ours was a particularly low-risk population, so we've extended the findings to this low-risk group with stable CHD. We should stop thinking about cut-off values for microalbuminuria. If albumin is detectable in the urine, the patient is at increased risk. " He explained that as such low levels of albumin cannot be detected with a dipstick test, they used a spot assay that measures the urinary albumin-to-creatinine ratio(ACR), which gives a more accurate measure of albumin status, .. " This is still a very easy, noninvasive, and cheap test. [it] gives us a new window to the health of the vasculature that we should take advantage of, " Noting that a previous analysis of the PEACE population had shown that a reduced glomerular filtration rate (GFR) was also associated with increased cardiovascular risk, he said: " We have now shown that both measures of kidney function are markers of increased risk. If either one is compromised, then risk is increased, and if both are affected, then risk is very much increased. These two studies are telling us that cardiologists need to pay more attention to kidney function in our patients and to understand that these are not patients who will ever come to dialysis or even necessarily see a nephrologist, but they do have mild kidney disease that puts them at increased risk for a cardiovascular event. " The main PEACE trial evaluated the effects of trandolapril vs placebo in 8290 patients with stable coronary artery disease and normal left ventricular ejection fraction. In the current analysis, the urinary ACR was assessed in 2977 patients at baseline and in 1339 patients at follow-up (mean 34 months). Circulation 2007; 5.%% http://www.diabetes.org/ People with Diabetes May Not Notice Hypoglycemia 11/27/2007 In the Diabetes Care journal, researchers note that individuals with DM might continue to drive in spite of hypoglycemia. The study evaluated 65 individuals with T1 or T2DM, finding that almost half of adults with T1 experienced difficulty with noticing a drop in their blood sugar levels. Over 40% of individuals also stated they felt well enough to drive despite hypoglycemia, a condition that impairs the ability to think and react quickly. News summaries C 2007 Information, Inc. Reuters 6.%% http://www.diabetes.org/ Genetic Tests May Cut Insulin Need 11/27/2007 At the Primary Care Genetics Society conference, Professor Mark explained the importance of genetic testing for DM patients. He said that patients with maturity onset diabetes of the young (MODY) could improve their condition by differentiating between the different kinds of MODY and adjusting patient therapies accordingly or by instating early sulphonylurea treatment. Individuals with MODY3 generally experience insulin-dependent DM and have greater small vessel complications, but remain hypersensitive to sulphonylureas. He added that MODY could be attributed to only 1 to 3 percent of T2DM patients, while MODY2 accounts for up to 95 percent of patients. He also cited the potential for mitochondrial diabetes for patients with a strong family history and sensorineural deafness. News summaries C2007 Information, Inc.GP Magazine (11/23/07) 7.%% http://www.diabetes.org/ Glycemic Index, Glycemic Load, and Cereal Fiber Intake and Risk of T2DM in U.S. Black Women 11/27/2007 An analysis of African-American women was conducted with respect tocarbohydrate quality and risk of T2. [data from the Black Women's Health Study, a prospective cohort study of 59,000 African-American women in the US.] Factors considered include glycemic load, glycemic index, and cereal fiber with respect to T2. There were nearly 2,000 cases of DM in the 8years of follow-up. The findings demonstrate that glycemic index was correlated to an increased risk of DM, while cereal fiber intake was inversely associated with risk of diabetes. The researchers suggest that increasing cereal fiber intake could help reduce the risk associated with T2DM. News summaries C2007 Information, Inc. Archives of Internal Medicine (11/26/07) Vol. 167 8.%% NIHPRESS Digest (#2007-172) 28 Nov 2007 People with Diabetes and Sickle Cell Trait Should Have Reliable A1c Test A new information campaign of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the NIH, highlights the importance of using accurate methods to test hemoglobin A1c in people with DM who have sickle cell trait or other inherited forms of variant hemoglobin. The specific needs for testing blood glucose control in these patients are explained in two booklets, " Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: [for Physicians] " and " For People of African, Mediterranean, or Southeast Asian Heritage: Important Information about Diabetes Blood Tests " at www.diabetes.niddk.nih.gov " In the US, more than 3,000 labs rely on 20 different methods to measure A1C in people with DM , " says the head of NGSP. " However, 6of these methods yield unreliable results in patients with sickle cell trait. Health care professionals caring for people with DM should know that specific A1C tests should be used in this group of patients. " Many individuals are unaware they have a hemoglobin variant such as sickle cell trait because the condition usually causes no symptoms. In DM patients of African, Southeast Asian or Mediterranean descent, several situations may suggest the presence of a hemoglobin variant: an A1C result does not correlate with results of self blood glucose monitoring-- an A1C result is different than expected or radically differs from a previous test result after a change in lab A1C methods-- an A1C result is more than 15 %. Hemoglobin is the oxygen-transporting protein in red blood cells. Mutations in the genes that code for the protein, which occur more frequently in people of African, Mediterranean, and southeast Asian descent, cause variations in the structure or amount of hemoglobin. The most common variant is sickle cell trait in which a person inherits a gene for hemoglobin S and a gene for hemoglobin A, the usual form of hemoglobin. Having sickle cell trait or another hemoglobin variant does not increase a person's risk for developing DM. The A1C test is not used in diabetes patients with sickle cell anemia due to the shortened life span of red blood cells. 9.%% Am Journal Ophthamology Volume 144,Issue 6 (Dec 2007) Triple Therapy of Vitrectomy, Intravitreal Triamcinolone, and Macular Laser Photocoagulation for Intractable Diabetic Macular Edema Purpose - To evaluate the effect of a sequentially combined triple therapy on intractable diabetic macular edema (DME). [24 eyes from 24 subjects with intractable DME of nontractional origin,] were subjected to vitrectomy. Intravitreal triamcinolone acetonide injection and macular laser photocoagulation were conducted sequentially at one and 14 days after vitrectomy. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded before surgery and at three, six, and 12 months after triple therapy. Results. . The major adverse events after triple therapy were development of nuclear sclerotic cataracts and elevation of intraocular pressure. Conclusions The triple therapy may facilitate early recovery of vision and may improve the long-term outcomes in some patients with DME refractory to conventional monotherapy. 10.%% Treatment for Depression Reduces Mortality by Half in Older Diabetics Medscape Medical News 2007. Nov 29, 2007 - Older depressed patients with DM who receive additional intervention for their depression are half as likely to die within 5 years as similar patients who not provided this intervention, according to a new study " These results indicate that a depression care management intervention can significantly reduce all-cause mortality among depressed patients with diabetes, " the authors conclude. " There's a policy statement here, " the lead author told Medscape Psychiatry. " We need more resources in primary care settings to treat depression. " The team used data from the randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) This latest study sample included 599 depressed patients,of whom(66.1%) met Diagnostic and Statistical Manual of Mental Disorders,4th ed (DSM-IV) criteria for major depression. the sample size for analysis was 584 patients; mean age 70.3. Of these participants,(21.2%) reported a history of DM. The intervention group had access to trained depression care managers, who collaborated with physicians by offering guidelines-based treatment recommendations, monitoring clinical status of patients, and providing appropriate follow-up. " These managers met with the patients in person or talked with them over the phone when clinically necessary or at scheduled intervals, in some cases as often as once a week. Basically, they found out how the patient was feeling and whether their symptoms had improved. " They also assessed whether the patient was having any trouble taking medications. The fact that a person trained in depression management was available to address any problems or concerns that arose likely made a difference to the outcome for those in the intervention group. In the usual-care group, physicians were informed of a patient's depression diagnosis but did not receive specific treatment recommendations. Depressed patients with DM in the intervention group were about half as likely to die during that 5-year follow-up as were depressed patients with DM receiving usual care. The study suggests more attention should be paid to treating depression in patients with DM. The 2 are intimately related; depression is a risk factor for diabetes, and depression is increased by a factor of 2 in patients with DM, they write. Depression also contributes to poor adherence to medication and dietary regimens. Diabetes Care. 2007;3 11.%% MW- Diabetes, Low HDL, High Homocysteine Levels Predict Poorer Stroke Recovery 11/29/07 - Vascular risk factors associated with metabolic stress, including DM, low levels of high-density lipoprotein (HDL) cholesterol, and elevated levels of homocysteine predict slower stroke recovery, new research suggests. The study found that individuals with DM, low levels of HDL cholesterol, and high levels of homocysteine who have had a mild to moderate ischemic stroke were twice as likely as their counterparts without these conditions to have poorer cognitive function and greater disability after a stroke. The team also found that recovery was most difficult in individuals older than age 57 with high total plasma levels of homocysteine..Although the mechanism by which these factors impede recovery is not clear, the team speculated that oxidative stress may impair endothelial function in the central nervous system or directly affect neuronal function by a complex interaction of several metabolic and inflammatory pathways. [data on 3680 men and women older than age 35 years who have had a mild to moderate ischemic stroke within 90 days of trial enrollment and a fasting level of homocysteine greater than the 25th percentile for patients with stroke.] The team looked at several factors that might have an impact on recovery including medication use, race, and age, among others. " Not surprisingly, the older people were, the more difficult it was for them to recover from stroke. However, what was a bit of a surprise was that individuals of nonwhite race had a slower return of their cognitive function. " They added that only African- American race was associated with slower recovery of physical function. 3 factors most strongly associated with poorer cognitive function and greater disability after a stroke were diabetes, low levels of HDL cholesterol, and high levels of homocysteine. " DM had a very strong influence on cognitive function. This is likely due to its damaging impact on the brain's capillaries and microvessels and that this small-vessel damage is slowing recovery, " Neurology. 2007;69 12.%%MW -Insulin-Sensitizing Metformin Treatment Not Linked to Higher Rate of Fractures 11/29/2007 - Insulin-sensitizing treatment with metformin is not associated with a higher incidence of bone fractures, but current treatment with insulin increases the risk for fractures, according to the results of a nested case-control study. However, in the long-term, insulin treatment did not affect bone frailty. " Hypoglycaemic treatments could modulate the risk for fractures in many ways, " write the researchers. [cohort of 1945 outpatients with DM;follow-up 4.1 years;83 cases of bone fractures and 249 controls matched for age, sex, duration of DM, body mass index, levels of hemoglobinA1c, comorbidity, smoking, and alcohol abuse.] The investigators determined exposure to hypoglycemic drugs during the 10 years preceding the event or the matching index date. " Bone fractures deserve to be considered among treatment outcomes for the choice of hypoglycemic medication, particularly in older patients with T2DM the authors conclude. Diabetes Care. online 13.%% MW Nov 30, 2007 - The ADA and the European Association for the Study of Diabetes have issued a consensus statement on the management of hyperglycemia in T2DM . This consensus algorithm for the initiation and update regarding the thiazolidinediones was published in the November 27 Online First issue of Diabetologia. " New information suggests additional hazards associated with the use of either thiazolidinedione, and rosiglitazone in particular may result in an increased frequency of myocardial infarctions, " write D M. , MD, " We therefore recommend greater caution in using the thiazolidinediones, especially in patients at risk of, or with, CHF [congestive heart failure]. " [about] 1 year ago, [the 2 associations] commissioned development of an evidence-based, consensus algorithm for the management of T2 which was designed to help clinicians choose the most appropriate treatment regimens from the expanding armamentarium of available drugs. The authors note that newly approved medications and new data from clinical trials and other studies should be considered, thereby warranting an update of the algorithm. The present update mainly focuses on recent understanding of the advantages and disadvantages of the thiazolidinediones. The guidelines also now include the dipeptidylpeptidase-4 inhibitor sitagliptin as a management option.. Advantages of sitagliptin are that it is weight neutral, but disadvantages are that there is scant clinical experience with the drug, and it is expensive. The revised guidelines continue to support the major features of the original algorithm, including the need for tight glycemic control within, or as close to, the nondiabetic range without compromising safety; beginning lifestyle interventions and treatment with metformin at the time of diagnosis; rapidly adding medications and changing to new regimens when target glycemia is not reached; and adding insulin treatment for patients not achieving target HbA 1c levels. .Although the underlying data are not thought to be conclusive, clinicians are still warned to use extra caution when considering use of rosiglitazone. However, another recent meta- analysis (RECORD), reviewing virtually the same data, showed that neither rosiglitazone nor pioglitazone was associated with a significantly increased risk for cardiovascular death. " At this time, we do not view as definitive the clinical trial data regarding increased or decreased risk of myocardial infarctions with rosiglitazone or pioglitazone, respectively, " the guidelines authors conclude. " Nor do we think that the increased risk of CHF or fractures with either of the available thiazolidinediones is of a magnitude to warrant their removal as one of the possible second-step medications in our algorithm, given that they cause hypoglycaemia less frequently than other second-step drugs. On the other hand, we do believe that the weight of the new information outlined above should prompt clinicians to consider more carefully whether to use this class of drugs vs insulin or sulfonylureas as the second step in the algorithm. " Diabetologia. Published online November 27, 2007. 14.%% MW- Familial Factors Influence Diabetic Microvascular Complications (Reuters Health) Nov 30 - Familial factors influence the risk of microvascular complications of T1, independent from the familial risk of DM itself. " To the extent that glucose control is important, it may be even more critical in those patients potentially at higher risk for complications, those being T1-affected siblings of T1 patients with complications, and also women, who appear to be at higher risk for complications, " researchers told Reuters Health. The team sought to identify familial risk factors for DM microvascular complications and to examine how these risk factors influence retinopathy, nephropathy, and neuropathy onset. [total 8114 subjects : 4935 probands with T1DM, 921 siblings, 695 parents.] The presence T2 (but not T1) in a parent was significantly associated with the development of all 3 microvascular complications, they report. DM patients whose siblings had T1DMcomplications faced substantially higher risks of developing microvascular complications themselves, with odds ratios of 9.9 for retinopathy in patients whose siblings had retinopathy, 6.18 for nephropathy in patients whose siblings had nephropathy, and 2.2 for neuropathy in patients whose siblings had neuropathy. Retinopathy and neuropathy were more common in female T1patients than in male T1patients; and the risk of second complications was higher in female patients than in male patients. The risk of complications increased with increasing duration of T1DM and diagnosis at a very young age (under 5 years) or past puberty (over 14 years) was associated with a lower likelihood of developing complications. " These new findings tell us that the explanation for what causes complications must involve shared pathogenic mechanisms in the family (mechanisms that may be independent of the susceptibility to type 1 diabetes), " the authors conclude. " Today, the emphasis is on whole-genome association studies and SNS, " they pointed out. " One of the consequences of this emphasis is that family data, such as we used in our work, has been denigrated, and data collection in genetic studies focuses on subjects with the disease and their comparison with controls. Thus, the familial aspects of genetic studies are being lost, which will ultimately be detrimental to our overall understanding of how genes cause disease. " J Clin Endocrin Metab 2007. 15.%%28 November 2007 Nature news.2007.305 Red wine mimic can fight diabetes - Chemical cousin of red-wine extract restores insulin sensitivity in mice. Drugs that mimics the health-protection effects of a chemical compound in red wine could form the basis of the next generation of treatment for diabetes. An extract of red wine, resveratrol, is known to temper the damage done by fatty diets, helping to extend healthy life and battle fat-related disease. To read this story in full you will need to login or make a payment .. 16.%% Prevalence of Self-Reported Cardiovascular Disease Among Persons Aged >35 Years With Diabetes -- US, 1997-2005 MMWR. 2007;56(43) C2007 Centers for Disease Control and Prevention (CDC) Introduction - Adults with DM are at greater risk for dying from heart disease than adults without diabetes. Heart disease and stroke account for approximately 65% of deaths among persons with DM. During 1997--2005, the age-adjusted prevalence of diagnosed diabetes in the US increased 43%, from 3.7% in 1997 to 5.3% in 2005. To assess trends in prevalence of heart disease, stroke, and other cardiovascular diseases (CVDs) among persons with DM, CDC analyzed data from the National Health Interview Survey (NHIS). - an annual, in-person household survey of the civilian, noninstitutionalized U.S. population. [it] provides information on the health of the U.S. population, including prevalence and incidence of disease, extent of disability, and use of health-care services. Data were analyzed by age, sex, race (black or white), and ethnicity (Hispanic or non-Hispanic). the results indicated that although the number of persons aged =35 years with diagnosed diabetes who reported having CVD increased 36% the age-adjusted prevalence decreased 11%; The decrease in CVD prevalence indicates that the increase in the number of persons with diagnosed diabetes exceeded the increase in the number of persons with diagnosed DM who reported having a CVD. Continued interventions are needed to reduce modifiable CVD risk factors among persons with DM, better control diabetes, and decrease CVD prevalence further. 17.%% Self-Monitoring of Blood Glucose Among Adults With Diabetes -- United States, 1997-2006 MMWR. 2007;56(43). Blood-glucose control is critical for managing diabetes and preventing DM-related complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. In addition to recommending that patients with DM have a glycated hemoglobin (HbA1c) measurement at least two times a year, ADA recommends self-monitoring of blood glucose (SMBG) as an integral part of DM management for patients who are treated with insulin and as a useful component for achieving glycemic goals for patients who use oral medications or medical nutrition therapy. The CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1997-2006 - the findings of that analysis, indicated that the proportion of adults with DM who check their blood glucose at least once a day increased at the national level, In 2006, the daily SMBG rate was 63.4% among all adults with DM and 86.7% among those treated with insulin. Collaborations to ensure adequate health insurance coverage, diabetes education and counseling to encourage more intensive medical care and self-management practices, and continued surveillance measures to track changes in SMBG rates are needed to improve and monitor SMBG trends. Unlike previous studies, multivariate analysis indicated no significant associations between SMBG and age, race/ethnicity, or having at least two HbA1c measurements per year. However, consistent with findings from other studies, lower rates of SMBG were correlated with being male, having less than a high school education, having no health insurance coverage, taking no medication or oral medication only, making two or fewer doctor visits annually, and not having taken a diabetes-education course. The negative associations between SBMG and lower education or lack of health insurance coverage suggest that socioeconomic barriers might impede the practice of SMBG. The cost of blood glucose--monitoring supplies might be a barrier for patients with limited economic resources. The findings in this report are subject to limitations. [including] First BRFSS data are self-reported and subject to recall bias. Second, [it] excludes persons without landline telephones. Adults with only wireless telephones tend to be younger, to have lower incomes, to be Hispanic, and to have no health insurance coverage. As a result, the SMBG rates might be overestimated and might not be generalizable to certain segments of the U.S. population. 18.%% MW - The Impact of Family History of Diabetes on Risk Factors for Gestational Diabetes Clin Endocrinol. 2007;67(5) C2007 Blackwell Pub. 11/26/2007 Summary Objective: Familial history of T2DM (FHD) represents a pathophysiologically unique risk factor for gestational diabetes (GDM), insofar as it encompasses both inherited and lifestyle elements. We thus hypothesized that the risk factors for gestational hyperglycaemia in women with FHD may differ from those in women without FHD. [90 women with FHD;83 women without FHD Conclusion: Established risk factors for GDM are relevant in women with FHD but may not be the principal determinants of gestational hyperglycaemia in women without FHD. Moreover, FHD may be more relevant to risk of GDM in nulliparous women than in parous subjects. These findings highlight the complex relationship between FHD and gestational hyperglycaemia, and may hold implications for selective screening for GDM. 19.%%MW Long-Term Predictors of Insulin Resistance: Role of Lifestyle and Metabolic Factors in Middle-Aged Men Diabetes Care. 2007;30(11) C2007 ADA 11/26/2007 Introduction Insulin resistance, i.e., low insulin sensitivity, precedes T2DM and is an emerging risk factor for cardiovascular disease. Approximately 25% of the U.S. population has clinically significant insulin resistance. It is therefore important to identify predictors of insulin sensitivity to help optimize prevention. In summary, this large study investigating long-term predictors of insulin sensitivity per se demonstrated that multiple factors contribute independently from each other.. Lifestyle factors including a high proportion of saturated fat in the diet, low physical activity, and socioeconomic status all contribute to the variation in insulin sensitivity, but adiposity is the most important single factor, even in individuals with " normal " BMI. 20.%% MW-Ask the Experts about Triglycerides in Cardiovascular Disease Triglycerides and Insulin Resistance Henry Ginsberg, MD 11/27/2007 Question - What is the relationship between elevated triglycerides and insulin resistance? Response from Henry Ginsberg, MD College of Physicians and Surgeons, Columbia University,.. Overproduction of very-low-density lipoproteins (VLDL), with increased secretion of both triglyceride (TG) and apolipoprotein B100 (apoB100), is central to the etiology of increased plasma VLDL TG levels in patients with insulin resistance. Recent studies in cell culture, rodents, and humans have provided significant insights regarding the mechanisms whereby insulin resistance can drive increased VLDL secretion. ..Insulin resistance is associated with increases in the 3 main sources of TG for VLDL assembly: fatty acid flux from adipose tissue to the liver; hepatic uptake of VLDL, intermediate density lipoproteins, and chylomicron remnants; and de novo hepatic lipogenesis. It is known that plasma albumin-bound fatty acids are a source of VLDL TG. Postprandial hyperlipidemia is common in insulin-resistant individuals, and this finding is almost certainly associated with hepatic uptake of remnants that contain more TG than do remnants in normal people. Uptake of these TG-containing lipoproteins will stimulate VLDL assembly and secretion. Finally, de novo hepatic fatty acid synthesis (lipogenesis) in the liver is clearly an important source of VLDL TG in rodents. Data in humans are less abundant, but several recent papers have shown that lipogenesis contributes significantly to VLDL TG and is increased in individuals with obesity and insulin resistance... Finally, the level of plasma TG will be determined by both secretion of TG into blood and the efficiency of TG clearance, which may be reduced in people with insulin resistance. 21.%% MW -The Problem With ADAGE (A1c-Derived Average Glucose Equivalent) Medscape General Medicine. 2007;9(4):43. 11/27/2007 ADAGE is the acronym given to an international study performed to confirm the relationship between average glucose and A1c levels. The goal of the study is to report glycohemoglobin results to patients as A1c-derived averages rather than strictly A1c values. This strategy has the advantage of reporting chronic glycemia in the same units as patients' self-monitoring, and presumably adds clarity for diabetic patients looking to manage their disease .. Problems, though, underlie this procedure. To a diligent diabetic who measures and records blood sugar at regular intervals on a daily basis, a blood sugar average is simply the sum of N successive glucose values divided by N. The classical relationship between glucose and A1c, however, is a weighted average ie, the sum of N successive glucose values, each multiplied by a known weight factor then added together, the weighted sum then divided by N. There's also a constant, whose units are the inverse of glucose units, introduced to nondimensionalize the determined A1c value. Both the patient average and the A1c average are generated from the same set of reference values save that the A1c average has the cumulative effect of the weighting (and the constant). As clearly stated the intent of ADAGE is to measure the A1c of a given patient and from that measurement deduce an estimate of the patient's average glucose. Given, though, that average glucose is unaffected by " scrambling " (randomly rearranging) the glucose values while the value of A1c is not, the same average glucose can produce different A1c values..The bottom line is that, in the weighted-average format, the (time) order of occurrence of glucose values affects the A1c value while in the patient-average format it doesn't. This nonuniqueness questions the viability of the ADAGE result. : Readers are encouraged to respond to the author at trevinochires@... or to Blumenthal, MD, Deputy Editor of MedGenMed , for the editor's eyes only or for possible publication as an actual Letter in MedGenMed via email: pblumen@... 22.%% MW - Increased Serious Heart Failure Incidence With Pioglitazone [actos] (Reuters Health) Nov 26 - Pioglitazone use is associated with an increased incidence of serious heart failure, but still provides clinical benefits, with no evidence that it increases subsequent mortality and morbidity, " PROactive demonstrated the macrovascular ischemic safety profile of pioglitazone in patients with T2DM who are at high risk for cardiovascular events, " lead researcher Dr. Erdmann said.v " As a cardiologist, I have no reservations in its use in this condition when correctlyvand appropriately prescribed.... When considering the appropriate therapeutic strategy for patients, the potential benefits and risks should be fully considered based on the evidence for both efficacy and safety, " Diabetes Care 2007;30: 23.%% MW -Osteoprotegerin: New Marker for Silent Myocardial Ischemia Risk in Diabetics (Reuters Health) Nov 27 - Osteoprotegerin appears to be an independent marker of silent myocardial ischemia in asymptomatic DM patients, French researchers report. " Additional markers, " the lead investigator told Reuters Health, " are truly necessary for optimal management of cardiovascular risk in diabetic patients. " To investigate the utility of osteoprotegerin, a substance involved in atherosclerosis, and other possible markers of cardiovascular risk, the team studied 465 diabetic patients and identified 92 with silent myocardial ischemia. Levels of other proteins including C-reactive protein and fibrinogen had no significant value as markers, but patients with osteoprotegerin levels above the 75th percentile were at significantly increased relative risk (3.19) of silent myocardial ischemia compared to those with lower levels. This remained true after adjusting for other known silent myocardial ischemia risk factors including age, body mass index and BP. The association remained significant in patients of both sexes with T1or 2 with or without nephropathy. However, it was not significant in patients with peripheral artery disease. Thus, " osteoprotegerin appears as a promising marker that may help identify patients for whom non-invasive and invasive investigations are justified. " Diabetes Care 2007;30: Abbreviations: ADA - American Diabetes Association; BP - blood pressure; DM - diabetes Mellitus;HTN - hypertension; MW Medscape Web MD; FDA Federal Drug Administration; NIH - National Institutes of Health; CDC -Centers for Disease Control and Prevention;VA - Veterans Administration. Definitions - Dorlands 31st Ed and Google. Disclaimer, I am a BSN RN but not a diabetic or diabetic educator. Reports are excerpted unless otherwise noted. This project is done as a courtesy to the blind/visually impaired and diabetic communities. Dawn Wilcox Coordinator The Health Library at Vista Center contact above e-mail or thl@... Quote Link to comment Share on other sites More sharing options...
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