many articles

[Guest guest]

1. %% NYTimes 6/28/10 The Claim: Diabetes Makes You Sensitive to Heat THE

FACTS Summer can be uncomfortable for anyone. But for people with DM, the

heat and humidity can be particularly hazardous. One of the complications

of T1 and T2 is an impaired ability to adjust to rises in temperature, which

can cause dangerous increases in body temperature. The underlying problem,

nerve damage , occurs in 60-70% of Americans with DM; it can affect nearly

every

organ in the body, including sweat glands. When nerve damage keeps the

sweat glands from working properly, the body fails to cool down as the

mercury rises.

One small study compared diabetic patients and a group of healthy control

subjects. As temperatures rose, the control subjects¡¯ perspiration rates

increased

proportionately; their core temperatures stayed constant. ¡°For subjects

with DM, sweat seemed to plateau irrespective of an alarming rise in core

temperature,¡±

research shows that DM patients have higher rates of adverse events - like

hospitalizations, dehydration and death - in the heat. Yet a survey found

many

were unaware of the greater risk and the need for special precautions. THE

BOTTOM LINE People with diabetes are particularly vulnerable to hot weather.

2.%% ADA 70;REACH for Metformin to Reduce Deaths in Patients With Diabetes

& Atherothrombosis 7/1/10 In patients with DM and atherothrombosis, the use

of metformin was associated with a 24% reduction in all-cause mortality

after 2yr Fup.[20,000 DM pts in REACH registry] who had cerebrovascular

disease,

coronary disease, claudication . plus at least 3 otherothrombotic risk

factors, including current smoking, hypercholesterolemia, DM nephropathy,

hypertension,.

and the presence of at least 1 carotid plaque.

3.%% Nature news avandia 6/28/10 Evidence mounts against diabetes drug

Studies continue to find heart-attack risk. Avandia, used to treat T2DM,

has attracted

controversy. Patients who take Avandia are more likely to have a stroke or

heart failure, or die, than those who take a rival drug, a survey of more

than

200,000 insurance records has revealed.. The finding, is the latest salvo

in a continuing battle over Avandia (rosiglitazone). The possible health

risks

of Avandia were brought to light in 2007, when a meta-analysis by

Nissen, a cardiologist at the Cleveland Clinic suggested that the drug

could cause

heart attacks . This is a particular concern given that diabetics already

have a high risk of CV disease...The US Senate launched an investigation and

concluded that GSK was aware of the adverse effects of Avandia well before

the risks were made public. In a new paper Nissen and statistician Kathy

Wolski,

repeat their 2007 meta- analysis, incorporating new clinical-trial data

...They again found that Avandia boosts heart-attack risk - by up to 39%.

Meanwhile,

in JAMA, Graham, a drug-safety researcher at FDA et al; analysed the

insurance records of 227,571 pts treated with either Avandia or Actos

(pioglitazone)

a similar drug and found that patients taking Avandia were 18% more likely

to suffer from a stroke, heart failure, heart attack or death than those on

Actos. " The study by Graham et al . is very convincing, " says C.de Vries,

an epidemiologist at the U. of Bath, UK. " I can't fault it, and I suspect it

might be the nail in the coffin for rosiglitazone. "

4.%% ADA 70; New Class of Drug for T2DM Acts Independent of Insulin

6/28/10 - Dapagliflozin, improves glycemic control by reducing renal

glucose reabsorption,

[phase 3 study.] Given with metformin, dapagliflozin represents a new

therapeutic option for the treatment of T2 patients who have inadequate

glycemic

control with metformin alone. Dapagliflozin,a selective sodium-glucose

cotransporter-2 inhibitor, prevents reabsorption of glucose in the kidneys

and promotes

the excretion of glucose in the urine. It thereby reduces high levels of

blood glucose without affecting insulin- dependent systems. " Because [of

this]

mechanism, it should be suitable for use at any time during the duration of

the disease process, and should be compatible with ..any of the other

therapies

that we have available at the moment. " [534 T2 adults randomly assigned to

1of 3 doses of dapagliflozin or placebo orally once daily, in addition to

their

prestudy metformin dose. Results - mean HbA1c decreased by -0.30% in the

placebo group compared with 0.84% in the dapagliflozin 10 mg group.

Hypoglycemia

was reported at similar frequency in both groups. However, symptoms of

genital infections were more common in the dapagliflozin groups - in 8-13%

of individuals

compared with in 5% of those in the placebo group. " This is likely to

reflect the extra glucose that is eliminated in the urine, " .. Mean weight

loss was

0.9 kg [1.98 lb] per person in the placebo group compared with 2.9 kg in

the dapagliflozin 10 mg group. study -supported by Bristol-Myers Squibb and

AstraZeneca.

5.%% MW Mixing Insulin Aspart and Detemir in a Single Syringe Lets Children

Avoid Extra Shots (Reuters Health) Jun 21 - In children with T1DM, mixing

insulin aspart and detemir in the same syringe has the same effect on blood

sugar levels as giving the injections separately, investigators report. Not

surprisingly, pain from injections is a big obstacle to managing DM in

children. Detemir should ideally be taken twice a day and aspart must be

taken with

at least all 3 major meals, resulting in 5 injections given separately.

" With the results from our trial, we will be able to reduce insulin

injections

by 2/day and that equals a reduction of 60 injections/month without

compromising glucose levels, " said senior author. [14 children with T1]Each

child wore

a continuous glucose monitoring device, and the team analyzed

data for the last 72 hours of each study period.] There was no

statistically significant difference in glucose amplitude or frequency of

mild hypoglycemia.Diabetes

Care 2010.

6.%% MW Islet Transplantation a Decade Later and Strategies for Filling a

Half-full Glass 6/23/10 Diabetes. 2010;59(6): Alloislet transplantation for

the treatment of T1DM enjoyed highly favorable status in the first half of

the last decade but declined in favor during the second half. I will briefly

review the literature published in this area from 2000 - 2010 for the

purposes of extracting lessons we have learned, considering whether the

procedure

should be deemed a partial success or a partial failure, and offering

strategies to improve alloislet transplantation outcomes in the future. In

the end,

I hope to strike a positive note about where this procedure is going, and

how it will be applied to establish insulin independence in patients with

T1...

Bridge to the Future A valid argument against islet transplantation as

a treatment for T1 is the undeniable arithmetic that not nearly enough

pancreas

donors exist to treat patients with T1, let alone all people with T1 & T2.

Does this mean we have been wasting our time and resources by studying islet

transplantation? I don't believe so. There will always be DM patients who

need ©¬-cell replacement by transplantation of islets or the pancreas. One

group

of patients comprises those with rapid development of secondary

complications despite optimal medical care. Another group is made up of

patients with the

neurological disorder of autonomic insufficiency, which is accompanied by a

50% death rate within 5 years of diagnosis. They are clearly candidates

because

successful pancreas transplantation converts this death rate from 50 to

10%. One must also consider what the future may bring. Our experiences with

islet

transplantation have taught us lessons that will be important for the use

of ©¬-cell surrogates, be they stem cell derivatives or modified cell

lines. We

have learned about culturing cells, isolating islets and ©¬-cells,

identifying safe and physiological sites for transplantation, avoiding

immunosuppressive

drugs that are toxic to ©¬-cells, meeting environmental needs for

physiological a-cell function, and selecting appropriate patients for ©¬-

cell replacement.

This is important information to use as we continue to meet the challenge

of creating better means of controlling hyperglycemia and avoiding its

complications.

We just need to continue on with new scientific work until the

transplantation glass is successfully filled. R. on

...University of Washington,

rpr@...

7.%% MW Combination Therapy for Patients with T2DM: Repaglinide in

Combination with Metformin [combo R+M] 6/23/10 Abstract - In patients with

T2, adequate

glycemic control is a critical factor in reducing long-term micro- and

macro-vascular complications. Traditionally, the approach is to initiate

monotherapy

first, followed by combination therapy that targets 2 main defects in T2.

Repaglinide [prandin], a rapidly acting insulin secretagog, stimulates

insulin

secretion via closure of ATP-dependent potassium channels on the cell

membrane of ©¬-cells. Repaglinide is ideally used at mealtime to reduce

postprandial

[after meal] glucose levels, thus lowering the 24-h blood glucose profile

and improving HbA1c levels. Metformin is an insulin sensitizer that

effectively

acts against insulin resistance, one of the predominant metabolic defects

in T2. Combo R+M is indicated as an adjunct to diet and exercise to improve

glycemic

control in adults with T2. When monotherapy with oral antidiabetic agents

fails, Combo R+M has been demonstrated to be safe and effective in the

treatment

of T2DM. Funding to support manuscript provided by Novo Nordisk

9.%% MW Does Diabetes Mellitus in the Recipient Jeopardize Graft Survival

in Kidney Transplant Patients? 6/21/10 Am J Transplant. 2010;10: Summary -

analysis

of adult, deceased-donor, solitary kidney transplants 1994 - 2005 [25,523

pairs (51,046 total kidney transplants) ;75% white] Multivariable analysis

confirmed

the association between DM recipients and DGF:[DM graft failure].. The

cause of DGF .. It is hypothesized that ischemia-reperfusion injury during

transplantation

procedure causes a cascade of molecular events that eventually leads to

apoptosis, inflammation, and endothelial injury, resulting in organ

dysfunction

and nephron [kidney cell] loss.further investigation of intensive glucose

control in both the diabetic kidney donor and the recipient during the

perioperativeperiod

may be warranted to determine the effect of glucose control on initial

graft function.

10.%% Hip Fractures Linked to Thiazolidinedione [TZ] Use Higher Than

Expected in Men 6/29/10 ADA 70 TZs increase fracture risk, not just in

women,but

in men, particularly middle-aged men. Moreover, these fractures are not

limited to distal sites like the feet and hands, but also occur in the hip.

The

team looked at fracture requiring hospitalization in T2.[212,977 people]

They found that exposure to either rosiglitazone or pioglitazone was

associated

with a 1.7-fold increase in the overall fracture rate in women, and a 1.3-

fold increase

in men. Male TZ users had a 2-fold risk for hip fracture. " I would point

out that the risk in men is actually not in older men, it's more in middle-

aged

men between 55 - 65 yrs, "

11.%% MNTD 12 New Genes Linked To Type 2 Diabetes 6/28/10

This brings the total number of genes known to be associated with the

condition to 38. An international consortium of scientists compared the DNA

of over

8,000 people with T2s with almost 40,000 people without the condition at

almost 2.5 million locations across the genome. " This is strong research and

adds

to our knowledge of the genes that increase the risk of developing T2. As

we continue to add more pieces to the jigsaw, our greater understanding of

the

genetics behind T2 could lead to new avenues of research into

prevention and improving treatments..

12.%% ADA 70; Women With T1DM Receive No Heart Benefit From Omega-3

6/28/10 Consuming higher amounts of omega-3 fatty acids does not appear to

lower

heart disease risk for women with T1. Omega-3 fatty acids, primarily found

in fish, promote heart health by preventing buildup of cholesterol in the

arteries.

Little is known about the effect of consuming omega-3 in people with T1DM,

who are at much greater risk for heart disease. The incidence of heart

disease

was lowest in men who consumed the highest quantities of omega-3 - more

than 0.2 grams per day. Women who consumed similar amounts did not have

lower

rates of heart disease. " Although omega-3 is typically associated with

decreased risk for CV disease, this may not be the case for women with T1, "

said

the lead author. ¡°.. we shouldn't assume men and women with T1 are the

same. "

13.%% MNTD Too Much HDL May Be Harmful To Women With T1DM 6/28/10 Elevated

blood levels of high-density lipoprotein (HDL) or " good " cholesterol,

typically

thought to protect against heart disease, may do the opposite in women with

T1 [658 men & women HDL cholesterol is known as " good " cholesterol because it

helps prevent arteries from becoming clogged. High levels of HDL over 60mg

per deciliter (mg/dL), generally protect against heart disease, while low

levels

(less than 40 for men and less than 50 for women) increase risk. the

incidence of heart disease increased in both men & women with DM who had

lower levels

of HDL - below 47.5 mg/dL. For men, as levels of HDL increased, their

incidence of heart disease decreased. The same was found for women, except

in those

with very high levels of HDL (over 80 mg/dL) whose incidence of heart

disease increased substantially. " We need to examine this relationship

further, but

our study suggests that too much of a good thing may not always offer

protection and may even be harmful for women with T1.

14.%% MNTD Explaining Complications Associated With Diabetes

6/25/10 New research uncovers a molecular mechanism that links diabetes

with an increased risk of CV problems and sudden cardiac death. It finds

that

high blood sugar prevents vital communication between the brain and the

autonomic nervous system, which controls many involuntary activities in the

body.

" Diseases, such as DM, that disturb the function of the autonomic nervous

system cause a wide range of abnormalities that include poor control of BP,

cardiac

arrhythmias, and digestive problems, " explains senior study author. The

team examined the transmission of electrical signals from the brain to

autonomic

neurons in a mouse model of DM. The brain communicates with autonomic

neurons at synapses, a small gap between 2 nerve cells where electrical

signals from

one nerve cell are sent to the next by chemical neurotransmitters. " In

healthy people, synaptic transmission in the autonomic nervous system is

strong

and stable; however, if synapses on these neurons malfunction due to some

disease process, the link between the nervous system and the periphery

becomes

disrupted, " The team discovered that high blood sugar causes such a

disruption in synaptic transmission which is apparent as early as 1 week

after the

onset of DM becoming more severe over time. "

15.%% MNTD Poor Control Of Diabetes May Be Linked To Low Vitamin D 6/22/10

Vit D deficiency is highly prevalent in patients with T2 and may be

associated

with poor blood sugar control [124pts with T2; divided into [quarter

groups] based on vit D level. the team found an inverse relationship

between the

patients' blood levels of vit D and their hemoglobin A1c value, a measure

of blood sugar control over the past several months. Lower vit D levels were

discovered in patients with higher average blood sugars. Compared with

whites, blacks had a higher average A1c and lower average vit D level..

screening

& vit D supplementation as part of routine primary care may improve health

outcomes of this highly prevalent condition, "

16.%% MNTD 6/28/10 Resveratrol - found in red wine, grapes, blueberries,

peanuts and other plants - stops out-of-control blood vessel growth in the

eye.

The discovery has implications for preserving vision in eye diseases such

as diabetic retinopathy and AMD. Working with mouse retinas, the team found

that resveratrol can inhibit angiogenesis - when the mice were given

resveratrol, the abnormal blood vessels began to disappear. Examining the

blood-

vessel cells they found a pathway - known as a eukaryotic elongation factor-

2 kinase (eEF2) regulated pathway, that was responsible for the compound's

protective effects. " We have identified a novel pathway that could become a

new target for therapies, and we believe the pathway may be involved both in

age-related eye disease and in other diseases where angiogenesis plays a

destructive role. " said the lead author. In mice, resveratrol was effective

both

at preventing new blood vessels and at eliminating abnormal blood vessels

that already had begun to develop...If resveratrol therapy is tried in

people

with eye disease, it would need to be given in pill form because of the

high doses required,

17.%% JH Microalbuminuria: What It Means 7/1/10 Both elevated blood

glucose and high BP damage blood vessels in the kidneys, just as they harm

blood vessels

throughout the body-- a vicious cycle may develop. As your kidneys weaken,

BP often rises, and that in itself damages the kidneys further. Diabetic

nephropathy

or kidney disease develops slowly over the course of years. Long before any

physical manifestations are present, kidney disease leaves a clue that

allows

doctors to detect it early: microalbuminuria, or small quantities of the

protein albumin in the urine. When elevated blood glucose and BP damage

blood

vessels in the kidneys' filters, protein starts to leak into the urine. At

first, the leaks are tiny, so only small amounts of proteins like albumin

slip

through. At a later stage, the amount of protein in the urine

(proteinuria), increases. You should be screened each year for

microalbuminuria if you have

T2 or have had T1 for at least 5 years. Screening can be done any time of

day with just one sample of urine. What about blood tests? The fact is that

no

abnormalities show up in the blood until kidney disease has progressed

beyond micro albuminuria. ..

18.%% NIH News 6/29 /10 #1. Aiming for Near-normal Blood Sugar Did Not

Delay Combined Risk of Diabetic Damage for People with Long- standing

Diabetes,

In people with longstanding T2DM who are at high risk for heart attack and

stroke, lowering blood sugar to near-normal levels did not delay the

combined

risk of DM damage to kidneys,eyes, or nerves, but did delay several other

signs of diabetic damage. The intensive glucose treatment was compared with

standard

glucose control. Over time, DM damages the small blood vessels of the

eyes, nerves, kidneys and other organs, leading to pain and disability.

Heart disease

due to damaged large blood vessels is a major cause of death in persons

with T2. The longer a person has DM, the greater the chances of serious

complications,

including vision loss - blindness, foot ulcers - amputations, kidney

disease -kidney failure, and heart disease - stroke. " In these ACCORD

participants

with established T2 and additional risk factors for CV disease, intensive

lowering of blood glucose reduced some markers of eye, nerve and kidney

disease

compared with standard glucose control, but the groups did not differ in

the rate of progression to kidney failure, nerve disease, and major vision

loss, "

said lead author. [10,000 adults withT2] " Although increasing treatment to

try to achieve near-normal blood sugar provides some benefit, clinicians and

patients should note that this treatment strategy also potentially

increases the risk of adverse effects in patients with additional risk

factors for heart

disease, such as those studied in ACCORD. "

#2. ACCORD Eye Study Finds Intensive Blood Sugar Control or Combination

Lipid Therapy Decrease Diabetic Eye Disease Progression: In high-risk

adults with

T2, researchers have found that 2 therapies may slow the progression of

diabetic retinopathy [DR], an eye disease that is the leading cause of

vision loss

in working-age Americans. Intensive blood sugar control [bSC] reduced the

progression of DR compared with standard BSC, and combination lipid therapy

with

a fibrate & statin also reduced disease progression compared with statin

therapy alone. However, intensive BP provided no additional benefit

compared with

standard BP control. ACCORD Eye Study [subset of 2,856 subjects]. the team

analyzed the effects of the treatment strategies on blood vessels in the eye

by identifying DR progression over 4 yrs. Diabetic retinopathy is a disease

in which blood vessels in the eye's light-sensitive retinal tissue are

damaged

by DM. Blood vessels can begin to leak, causing swelling in the retina, and

abnormal new blood vessels can develop, both causing vision loss. Compared

with standard BSC, intensive control decreased the progression of DR by

10.4 to 7.3 %. Those in the intensive control group had a median blood

sugar level

of 6.4 % hemoglobin A1c-a level close to values in people without DM. The

standard BSC group maintained a median level of 7.5%. " Previous clinical

trials

have shown the beneficial effects of intensive BSC on slowing the

progression of DR with T1 or newly diagnosed T2, " said NEI director A.

Sieving " The

ACCORD Eye Study expands these findings to a larger population of adults

who had T2 for an average of 10 years, and demonstrates that the eye

benefits

from the reduction of glucose below previously established levels. " more

info about this trial (NCT00542178) at

www.clinicaltrials.gov>

19.%% ADA 70; Gestational Diabetes (GDM) and Obesity Lead to Macrosomia

6/29/10 (GDM) and obesity alone and together increase the risk for

excessively

large birth weight infants. [23,000 women] Those who did not have GDM but

who were obese had a 13.6% increase in risk for macrosomia (a child weighing

[8lb 13oz] or more at birth) than nonobese women. The combination of

obesity and GDM was associated with a 20.2% increase in risk for

macrosomia...

20.%% ADA 70: Dual SGLT Inhibitor Causes Rapid Drop in Glucose Values

6/29/10 An investigational oral antidiabetic agent - a dual sodium-glucose

transporter

(SGLT)-2/SGLT-1 inhibitor- showed significant improvement in (HbA1c),

fasting plasma glucose (FPG), and oral glucose tolerance testing (OGTT)

levels over

4 weeks in patients with T2.In a phase 2a trial of LX4211 in 36 patients,

mean HbA1c levels declined from baseline by 1.5% among patients treated with

a 150 mg dose of the drug compared with a 0.49% drop for patients treated

with placebo. Despite the increased urinary glucose secretion in patients in

the LX4211 groups, there were no treatment- related urinary tract or

genital infections, the authors reported.

21.%% Long-Term Cardiac Risk: Higher With Diabetes, or a First MI?

Jun 25 - If you compare diabetics without heart disease, and primary heart

attack patients without DM, which group will have the higher

10-year rate of major coronary events? The one with the primary heart

attacks, new research shows. In a study in a Mediterranean group, pts with

T2 had

a significantly lower long-term incidence of unstable angina and fatal or

nonfatal myocardial infarction (MI) compared to nondiabetics who'd had a

primary

MI. [2260 T2 diabetics; 2150 MI pts]

22.%% ADA 70: Standard CV Risk Factors Don't Explain the Doubling of

Vascular Disease Risk in Diabetes 7/1/10- Diabetes is a risk factor not

only for ischemic

vascular diseases such as MI and ischemic stroke, it also seems to pose a

significant risk across the spectrum of different forms of vascular disease,

including hemorrhagic stroke, suggests a meta-analysis encompassing almost

700,000 patients Moreover, it showed that the elevated risks were largely

independent

of conventional CV risk factors, suggesting that DM must be raising

vascular risk through less familiar mechanisms. . " very little of the

excess CV risk

associated with DM is explained by obesity, BP, lipids, inflammatory

markers, or renal function. " the presenter said " That means there are yet-

to-be discovered

pathways that better explain why people with diabetes are at increased CV

risk,

23.%% Ophth 117,7 July 2010 Sustained Ocular Delivery of Fluocinolone

Acetonide (FA)by an Intravitreal Insert Purpose - compare Iluvien

intravitreal

inserts that release 0.2 or 0.5 ¥ìg/day of e (FA) in patients with diabetic

macular edema (DME) Prospective, randomized, interventional, [37pts]

Conclusions

-[these]inserts provide excellent sustained intraocular release of FA for

=1 year. Although the number of patients in this trial was small, the data

suggest

that the inserts provide reduction of edema and improvement in BCVA [best

corrected visual acuity] in patients with DME with mild effects on IOP over

the

span of 1 year.

24.%% Oph 117,7 July 2010 Retinal Vascular Fractals and Micro-vascular and

Macrovascular Complications in T1DM Fractal analysis is a method to quantify

the geometric pattern and complexity of the retinal vessels. This study

examined the association of retinal fractal dimension(Df) and micro and

macrovascular

complications in a population-based cohort with T1 [208 pts] Conclusions

This study adds to the evidence that Df may have some role as a global

measure

of retinal vasculature and its association with systemic disease.

25.%% MW Obesity and Cardiometabolic Risk Factors: The Loaded Gun 6/28/0 -

One of the most profound statements I ever heard was during my diabetes

fellowship. " Think

of genetics as the loaded gun and the environment as pulling the trigger. "

... if you put a person who has a genetic predisposition for DMs in an

environment

that promotes weight gain, the patient will most likely become diabetic.

Conversely, if you put that same person .. where it is difficult to gain

weight,

then the DM may never manifest. ..To explain the relationship between

obesity and diabetes, one must first understand how humans gain weight. One

of the

easier ways to think of obesity and the accumulation of fat cells is to

view fat gain as central or peripheral. Peripheral fat gain refers to

subcutaneous

fat that is easily measurable by grabbing the fat just under the skin.

Peripheral fat is relatively benign in metabolic terms; much of its

deleterious

effects are structural..[such as] increased load on the weight-bearing

joints.. Central or visceral fat, is deep in the abdomen and the chest and

is found

around or sometimes in the organs. An example- the presence of omental fat

around the small intestines and visceral organs, as in " fatty liver "

disease.

Central fat is also associated with insulin resistance and metabolic

syndrome. In the 1960s, a biochemist reported on the competition between

fat and

glucose for entry into the human cell- how a cell has its choice of energy

to run the cell's functions. If times are lean - not much food is available,

very little insulin is needed to transport glucose into cells. If food is

abundant, however, the cell can function on fatty acids or glucose. The more

fatty acids are floating around in the blood stream, the more insulin is

needed to get these fatty acids and glucose into cells. Thus, as the body

makes

more visceral fat, there is an abundance of fatty acids in the blood, and

competition with glucose for entry into the cell, in turn, increases the

amount

of insulin needed. This is called insulin resistance because more insulin

is needed to transport the same amount of glucose into a cell. .. as fatty

acid

levels rise with weight gain, more insulin is needed to drive in fatty

acids & glucose into cells. .. the body can produce only so much insulin;

eventually

the pancreas cannot keep up with these larger demands to produce insulin.

This is the first step toward diabetes -- the blood glucose will start to

increase

because of a combination of insulin resistance and inability to make enough

insulin.

As this state of central weight gain and insulin resistance sets in, other

cardiometabolic [CM] factors begin to emerge. Lipid changes known as

dyslipidemia

begin to occur, and one will see a drop in high- density lipoprotein (HDL)

cholesterol levels and an increase in triglyceride levels. At this point BP

can begin to rise. This move of CM risk factors in the wrong direction is

commonly known as metabolic syndrome .With normal dieting one loses weight

that

is a combination of visceral and peripheral fat. [which] will improve blood

glucose, HDL and triglyceride levels. . a weight loss as little as 5%-10%

will

improve DM measures and even reverse borderline blood glucose levels to

within the normal range.. it is not surprising that more T2 is seen in men

and

Asians of both sexes. .since [this group] gains their weight centrally -

not peripherally. " Asian " [here = ]eastern Asians (eg, Chinese, Japanese) and

western Asians ( Indians from India)...

26.%% ADA 70;Vitamins C and E a Bust at Preventing Preeclampsia in Diabetic

Women 7/2/10 - Vitamins C and E get an F+ when it comes to preventing

preeclampsia

in women with T1DM Neither vit C nor E supplements were better than

placebo at preventing preeclampsia in DMc women. Vitamin supplementation

also failed

to reduce the

frequency of gestational hypertension or low birth weight..however, we did

not observe any adverse maternal or neonatal outcomes, and in.. subgroup

analyses,

the risk for preeclampsia was significantly

reduced in women with low antioxidant status at baseline randomized to

vitamin treatment, compared with [those] assigned to placebo, "

27.%% ADA 70:Diabetic Instructors Help Neighbors Lose Weight, Improve

Glucose Profiles 7/2/10 A community-based health intervention styled after

the Diabetes

Prevention Program (DPP) helped adults at risk for DM lose significant

amounts of weight and pull their belts in by a notch or 2, [301 subjects

with Prediabetes] " Our

reduction in glucose of 4 mg/dL is comparable to the DPP and to the Finnish

DM Prevention Study. Those differences were associated with about a 50%

reduction

in the incidence of DM, so we believe this is a clinically meaningful

reduction in glucose. " I think we need as many outlets for DM education and

prevention

as we can find, " the presenter said.The program is delivered through local

diabetes care centers by registered dietitians and community health workers,

who are diabetes patients identified as good candidates for training and

group leadership.

28.%% Switching to Once-daily Liraglutide from Twice-daily Exenatide

Further Improves Glycemic Control in Patients with T2DM using Oral Agents

6/29/10;

Diabetes Care. 2010;33(6) Conclusions Conversion from exenatide to

liraglutide is well tolerated and provides additional

glycemic control and cardiometabolic benefits...[389 pts]

29.%% Cinnamon and Prickly Pear Cactus -- Should They Be Part of a T2DM

Diet? 6/30/10 Case Presentation Mr. is an English- speaking Latino

patient

The patient is unhappy about the suggestion to add a second antidiabetic

medication because he does not wish to be medication dependent. He has been

advised

by his family to use nopal (prickly pear cactus) and to add cinnamon and

fenugreek to his food. A review of 108 trials of herbs and dietary

supplements

used for glycemic control in 4565 patients with DM or impaired glucose

tolerance found that the supplements seemed to be generally safe but needed

further

study. Another review of herbals used in Mexico examined therapies

preferred by 573 patients with T2. nopal was used most often. The exact

mode of action

is not known, although nopal has high fiber and may have an insulin-

sensitizing effect... The broiled stems are traditionally used for their

hypoglycemic

effect, which is seen 3-4 hours after ingestion and can persist for up to

6hr. When 85 g of nopal was added to typical Mexican breakfasts, it reduced

glucose levels for several hours and favorably altered the glycemic index

of test breakfasts [36pts with T2 who were receiving glibenclamide,

metformin,

or both]. This team proposed that nopal be used to supplement dietary

approaches to DM care in a culturally effective way for Mexicans. The

theoretical

concern with use of nopal is interaction with antidiabetic medication, with

consequent hypoglycemia. Patients who use nopal regularly should be advised

to monitor blood glucose closely. .. Gymnema extract,.. overall, evidence

is insufficient for its efficacy in DM treatment. Gymnema should be used

with

caution in DM patients. Cinnamon., Animal and in vitro studies have

indicated that cinnamon may mimic the effects of insulin, act as an insulin

sensitizer,

and improve cellular glucose uptake and glycogen synthesis. Clinical

studies are small and have produced contradictory results. In the most

recent randomized

controlled trial, of 109 patients with T2, cinnamon capsules at a dose of 1

g daily for 90 days lowered A1c by 0.83% The team recommended cinnamon as an

adjunct to DM care for patients with an A1c greater than 7.0%.The dose of

cinnamon for T2 is typically 1- 6 g daily; 1 teaspoon contains 4.75 g. This

dose

is considered to be safe for up to 4 months. Of note, cinnamon contains

coumarin; ingestion of large amounts is therefore not recommended. Liver

toxicity

in animal models has also been reported..fenugreek. In one study, 10

patients with T1 The fenugreek diet significantly reduced fasting blood

glucose and

improved glucose tolerance test results.; there is a theoretical risk for

interaction with warfarin, which entails risk for bleeding. Of the CAM

therapies

that Mr. has asked about, nopal and cinnamon seem to hold the most

promise for glucose control in persons with A1c levels greater than 7.0%,

and

both would be easy to introduce into his meals.

ADA 70 - ADA 70th Scientific Sessions

Abbreviations:Fup-follow up; pt - patients; DM - diabetes Mellitus; T1DM -

type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema; GDM

gestational

diabetes;PDR - proliferative diabetic retinopathy; FPG - fasting plasma

glucose; BP - blood pressure; CVD - cardio-vascular disease; MI -myocardial

infarction

or heart attack ;HTN - hypertension or high BP; OCT - optical coherence

tomography; VA - visual acuity -ADA - Amer Diabetes Ass & ADA Professional

Resource

Online; JHA - s Hopkins Alerts ; MW Medscape Web MD; NIH - Nat

Institutes of Health; MNTD- Medical News Today NREndo;Nature Reviews

Endocrinology

Definitions via online Medical dictionaries. 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 BSN RN Coordinator The Health Library

at

Vista Center; an affiliate of the Stanford Hospital Health Library.

contact above e-mail or

thl@...

www.vistacenter.org