Sunday, July 30, 2006

How common is it?

From

mydr.com.au

An alarming number of Australians and Europeans have diabetes, with many new cases expected to be diagnosed in the coming years, according to Australian and European research.

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab), presented to Federal Health Minister Michael Wooldridge in April this year, revealed that diabetes and its associated complications are set to become Australia’s most costly and significant public health issue within a decade.

AusDiab showed that one in 4 Australians now has diabetes or are at high risk of developing it in the next 5–10 years, while the number of Australians with diabetes has increased by more than 300 per cent in the past 20 years, from 250,000 to one million.

Co-Chief Investigator of AusDiab, Professor Paul Zimmet, warned public health officials to take heed of the figures.

‘This is now an epidemic rivalling infectious diseases such as smallpox, typhoid and cholera. The scenario is identical for obesity, a major cause of diabetes,’ Professor Zimmet said.

Meanwhile, similarly alarming European results were announced at the International Diabetes Federation’s Summit in Switzerland in May.

It was revealed that Type 2 diabetes (previously referred to as non insulin-dependent diabetes) currently affects one in 20 European adults (about 22.5 million in all), with a further 6 million expected to be affected by 2025.

An even more worrying fact is that half of these people are undiagnosed and a further one in 7 adults (65 million) has a condition that places them at very high risk of developing diabetes and its associated complications.

Despite advancements in its treatment, Type 2 diabetes remains a major risk factor for blindness, amputations, kidney failure and cardiovascular disease (heart disease and stroke). Eight out of every 10 people with Type 2 diabetes will die from cardiovascular disease.

International Diabetes Federation President Professor Sir George Alberti urged governments to take action to fight the growing worldwide epidemic of diabetes.

‘Prevention and early detection of Type 2 diabetes must now be the priorities. It is time to consider screening high-risk individuals for diabetes,’ Professor Alberti said.

The major risk factors for diabetes are a family history of the disease, obesity, being aged over 50 and being from certain ethnic backgrounds, such as Pacific Island or Asian Indian.

Exercise for type 2 diabetes mellitus.

Exercise for type 2 diabetes mellitus.

Thomas D, Elliott E, Naughton G.

BACKGROUND: Exercise is generally recommended for people with type 2 diabetes mellitus. However, some studies evaluate an exercise intervention including diet or behaviour modification or both, and the effects of diet and exercise are not differentiated. Some exercise studies involve low participant numbers, lacking power to show significant differences which may appear in larger trials.

OBJECTIVES: To assess the effects of exercise in type 2 diabetes mellitus. SEARCH STRATEGY: Trials were identified through the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and manual searches of bibliographies. Date of last search was March 3, 2005. SELECTION CRITERIA: All randomised controlled trials comparing any type of well-documented aerobic, fitness or progressive resistance training exercise with no exercise in people with type 2 diabetes mellitus.

DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed trial quality and extracted data. Study authors were contacted for additional information. Any information on adverse effects was collected from the trials.

MAIN RESULTS: Fourteen randomised controlled trials comparing exercise against no exercise in type 2 diabetes were identified involving 377 participants. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6% (-0.6 % HbA(1c), 95% confidence interval (CI) -0.9 to -0.3; P < 0.05). This result is both statistically and clinically significant. There was no significant difference between groups in whole body mass, probably due to an increase in fat free mass (muscle) with exercise, as reported in one trial (6.3 kg, 95% CI 0.0 to 12.6). There was a reduction in visceral adipose tissue with exercise (-45.5 cm(2), 95% CI -63.8 to -27.3), and subcutaneous adipose tissue also decreased. No study reported adverse effects in the exercise group or diabetic complications. The exercise intervention significantly increased insulin response (131 AUC, 95% CI 20 to 242) (one trial), and decreased plasma triglycerides (-0.25 mmol/L, 95% CI -0.48 to -0.02). No significant difference was found between groups in quality of life (one trial), plasma cholesterol or blood pressure.

AUTHORS' CONCLUSIONS: The meta-analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss.

A new Canadian study indicates that diabetics have the same risk of cardiovascular disease as someone who is 15 years older. The Eye on Health Team spoke with a local heart surgeon who is not surprised by the findings.

Researchers found, on average, a 40-year-old diabetic has the same risk for heart disease as a non-diabetic at age 55.

Las Vegas cardiovascular surgeon, Matthew Cooper, says evidence of diabetes shows up in pre-operative angiograms. "Because diabetics tend to have very diffuse and very severe disease. And we often say that their arteries looked pruned. That is, they're very small like the small branches of a tree branch," Dr. Cooper said.

The narrowing effect which diabetes has on blood vessels can sometimes cause an enlarged heart. If the diabetic patient winds up needing a procedure such as a bypass, their outcome and recovery is less certain.

"Dr. Cooper continued, "Diabetes is a significant risk factor in patients we operate on. And when there's poor left-ventricle function, the left ventricle being the main pumping chamber of the heart, that really is the main determinant of long-term survival."

Dr. Cooper says that even close monitoring of blood glucose levels is not a guaranteed protection against heart disease. Proper diabetes management, including exercise, improves your odds.

"Individuals who tightly control their sugars, in general usually take better care of themselves overall. The better shape you're in, the better you're able to handle any additional insult, whether that be progression of your heart disease or anything else that comes along," he explained.

Dr. Cooper says diabetics who smoke are taking an even bigger risk. That combo can be lethal on the heart.

Wednesday, July 26, 2006

Health experts say lifestyle changes can battle potential killer A NATIONAL EPEDEMIC Health experts say lifestyle changes can battle potential killer
Diabetes can be avoided, controlled
By LISA ROBERTS The Orlando Sentinel
“As a community, diabetes is one of those diseases that screams ‘treat me early’ so we can avoid complications, because complications are so very expensive.”

Mark Williams CEO of Community Health Centers Inc.

If you don’t know someone with diabetes, there’s a good chance you soon will.

A recent study found the occurrence of Type 2 diabetes has doubled over the last 30 years. Another estimated that a third of U.S. adults — more than 73 million — have diabetes or may be developing it.

Simply put, it’s an epidemic, and it’s driven by sedentary lifestyle and obesity, the upswing of which closely parallels the growth of the disease, says Dr. Kimberley Bourne, an Orlando, Fla., endocrinologist who treats diabetics.

But here’s some good news: Most cases of Type 2 — once called “adult onset”—are preventable. You can head off the disease with lifestyle changes, says Dr. Robert Rizza, president of the American Diabetes Association. “In fact, if you stay lean and fit, you reduce your changes of getting the disease by 95 percent. It’s almost totally preventable.”

The prescription? Diet and exercise.

Diabetes is a disease in which the body doesn’t produce, doesn’t properly use, or ignores insulin. The hormone regulates the metabolism of blood glucose — sugar — which fuels our cells.

When diabetes takes hold, glucose can build up in the body and coat blood vessels and nerves. Left untreated, the disease can cause an array of devastating maladies, including blindness, cardiovascular disease and kidney failure. When glucose interrupts nerve impulses and blood flow to extremities, diabetics sometimes are unaware of things such as cuts, scrapes and blisters, which may become infected. In severe cases, an amputation might be necessary.

Though the exact cause of diabetes hasn’t been determined, research has repeatedly pointed a finger at obesity — usually a result of an inactive lifestyle and a poor diet — as perhaps the greatest risk of all. As weight increases, the pancreas pumps out more and more insulin to handle increased blood sugars. “If the pancreas could make endless amounts, you might be OK,” Bourne says. “But it says, ‘I can’t do it anymore.”’

By the time signs of diabetes show up — numbness in extremities, extreme hunger, frequent urination, excessive thirst, increased fatigue and blurry vision among them — the damage already has begun.

But the ability to fend off diabetes is within almost everyone’s grasp.

Exercise and a proper diet not only can help to decrease weight, they can take a bite out of high blood sugar. Says Bourne: “We used to think it (diabetes) was a slippery slope of progression,” but research has found that the prescription can reduce blood sugars in diabetics and help those diagnosed as “pre-diabetic” to return to normal levels.

Prevention and early treatment of diabetes are paramount goals, says Mark Williams, CEO of Community Health Centers Inc., which operates a network of central Florida clinics and offers diabetes screening.

“As a community, diabetes is one of those diseases that screams ‘treat me early’ so we can avoid complications, because complications are so very expensive.”

At the Florida Hospital Diabetes Center in Orlando, diabetics are proving that eating well and working out can help control the disease. Gym members test their blood before and after their workouts, and the difference they see in their blood sugar after exercising motivates them to keep on the move, says Paul Frickman, the center’s exercise coordinator.

It’s not unusual to see blood sugar tumble from, say, 140 to the normal range, which is between 70 and 100. The benefit of a workout lasts from 24 to 72 hours. Another bonus: “When you exercise, sugar goes into your body without the assistance of insulin,” he says, so a diabetic’s reliance on drugs may lessen.

Talar Glover, a clinical nurse specialist at the center, says today’s supersized meal portions and fat- and sugar-laden foods, as well as a variety of social conditions, are helping to fuel the disease.

Though many believe diabetes is about eating excess sugar, “it is not about sugars — it’s about carbohydrates. They turn into sugar,” she says.

That’s why diets should be based on a balance of meat, fruits, vegetables, dairy products and whole grains.

But today’s go-go society is largely stuck in the fast-food drive-through lane. Balanced meals at home are rarer, she says, and children, who generations ago walked or rode bikes to school and played with neighborhood friends, are now shuttled to school and sitting in front of TVs and computers.

Many of the center’s participants are models of how the disease can be contained. Joe Herring, 73, of Altamonte Springs, Fla., estimates he has lost about 40 pounds since he learned in 1993 that he had diabetes. He watches his diet and gets to the center’s gym twice a week. When he’s not there, he walks or works out at home.

Herring’s last blood work-up showed “everything well in line,” he says. “You’ve got to take control of it, or it’ll take control of you.”

Tuesday, July 25, 2006

Pfizer markets first insulin inhaler for diabetes sufferers

Bloomberg News

Published: July 24, 2006



After more than two decades of daily needle injections to treat his diabetes, Ken Wagner said he was eager to try Exubera, the first inhaled insulin that Pfizer was to start promoting to doctors on Monday.
For seven years Wagner, 41, has had a needle-like plastic tube inserted into his skin carrying life-sustaining insulin into his bloodstream as needed from a pager-sized portable pump. Before that, Wagner gave himself injections four times a day.
"We are all just waiting to be totally relieved of this problem," said Wagner, a bank compliance officer who lives in New York City and has had diabetes since he was 15. Though Exubera studies show it can damage the lungs of a small portion of users, Wagner said, "I'll take the potential negatives of an inhaled device over the insulin pump."
Pfizer, based in New York, was planning to deploy 2,300 salespeople in the United States to promote to doctors the water bottle- shaped inhaler that can reduce the need for insulin shots in some patients and eliminate it in others. The product will be available for patients in September, seven months after being approved by U.S. regulators.
Pfizer spent more than 10 years perfecting the product and tested it in 3,500 patients over seven years, said Michael Berelowitz, Pfizer vice president for worldwide medical research, who helped develop the product. Exubera may generate $1.9 billion in annual revenue by 2010, the company said at an analysts' meeting in February.
The inhaled insulin has been anticipated by many patients, Christopher Saudek, a professor at Johns Hopkins University School of Medicine in Baltimore and past president of the American Diabetes Association, said in a telephone interview last week.
"There is a lot of excitement about trying it out," Saudek said. "The main attraction is that it frees you from some needle sticks. It's the beginning of an era where we will be able to deliver insulin by the inhaled route, through the lungs."
On Friday, Pfizer shares closed at $23.83, up 12 cents in New York Stock Exchange composite trading.
In the 13 million Americans diagnosed with diabetes, the pancreas either does not produce enough of the hormone insulin or the body does not properly use it.
The new product will have hurdles in gaining wide use, Saudek said. Doctors and other health providers will have to teach their patients how to use it, especially as proper dosing will take practice, he said.
Exubera also carries the risk of causing lung damage. Doctors must test patients to avoid giving it to those susceptible to the side effect. Pfizer told the U.S. Food and Drug Administration in September that coughs and decreased lung capacity were more frequent in patients using Exubera.
The drug's label describing its use to doctors says the product should not be used by smokers because smoking interferes with the lung's ability to absorb the insulin.
A British government panel recommended in April that the National Health Service, which treats most residents, not pay for Exubera. The group, which rules if new drugs are worth their cost, said the product did not provide a significant benefit over the traditional treatment.

Article on lack of education for Diabetics taken from, http://today.reuters.co.uk/news

LONDON (Reuters) - Nearly two-thirds of diabetics in Britain do not take their medication as prescribed because they don't fully understand the disease, according to a report on Tuesday.

One in five of the two million people with diabetes are suffering from preventable complications as a result, it said.

The report is a joint venture between Diabetes UK, the Association of the British Pharmaceutical Industry (ABPI) and independent body Ask About Medicines.

It said the problem was due in part to people not fully understanding the disease, with more than a third saying they did not realise they would have the condition for life.


Many struggled to understand medical terms and were too embarrassed to ask questions.

"Short-termism is a great enemy of good diabetes care," said Director of Care and Policy at Diabetes UK, Simon O'Neill.

"Many people struggle to realise the importance of taking their medicines, especially if the consequences are not immediately apparent, despite the fact that damage caused by not taking their medicines is irreparable."

The report will be presented to the Department of Health on Tuesday. It urges those in the health profession to provide more information to patients as well as encouraging them to ask more questions.

Tuesday, July 18, 2006

Article from CentreDaily.com

Do overweight people with diabetes have themselves to blame?

Yes. Just like almost every other disease, obesity and type 2 diabetes are caused in part by what we do. Behaviors such as smoking, exposure to stress and what we eat contribute to whether we suffer heart disease, infections and many forms of cancer. In fact, even getting less than eight hours of sleep each night affects health.

So, yes, overweight people with diabetes have themselves to blame, in part. But is there any point to assigning that blame? Is anyone helped by that blame?

Do we typically blame the smoker dying of lung cancer, or do we as neighbors and friends try to help the patient and his or her family?

Do we usually blame the rock-climber who was injured -- after all, she chose that dangerous activity -- or do we as neighbors and friends help her take care of her young children until she is better?

In most situations, we have sympathy and empathy in regard to those suffering from illnesses and injuries. We can see ourselves in that person's shoes. We can see that blame is pointless; it helps no one.

And so it should be with obesity and type 2 diabetes. But often, that is not the case. In fact, overweight people are often blamed, ostracized and shunned. It happens on playgrounds, in schools and in hiring for jobs.

Enough. In more than 20 years, I have treated people with diabetes. I have seen thousands of overweight patients, and none of them could keep weight off with ease.

Why is that? Why can't people just eat less and exercise more?

Because being overweight and having diabetes are not just caused by what we choose, but also by our genes, the behaviors of our mothers before we were born, our jobs and the society that we live in.

While there is a lot more to it, whether I have that second helping is in part a function of how hungry I feel and how much willpower I have. And guess what -- both are affected by my genes and my upbringing.

We each understand this much better with smoking. How addicting cigarettes are and how strong willpower is to quit vary from person to person, based on genes and upbringing.

So again, do overweight people with diabetes have themselves to blame? Yes.

So let's all try as hard as we can to live healthier. We do have the personal responsibility to exercise our willpower as best as we can. But also, let's stop blaming those among us who have health problems related to obesity.

Instead, let's support each other in trying to make healthier choices in all that we do.

Dr. Jan Ulbrecht is one of the diabetes physicians at Centre Medical and Surgical Associates and is credentialed at Mount Nittany Medical Center. He is also one of the four co-directors of the Penn State Diabetes Center.

UK get tough on Diabetes

Diabetes UK is delighted to announce its single biggest ever research initiative. This involves making £3 million available to improve the lives of people with diabetes.

There is a real need for more research to improve the care and treatment of people with diabetes and this is reflected in our recently published Research Strategy.

"We are extremely excited to be embarking on this huge research initiative, which will go some way towards achieving our mission to improve the lives of people with diabetes," said Dr Angela Wilson, Director of Research at Diabetes UK.

"While we wait for and are working towards finding a cure, we must find better ways to help people live with the condition on a daily basis."

"I am confident that this major new research iniative will move us a step in closer to helping people with diabetes live longer, and live healthier for longer with improved quality of life."

Research projects will be assessed on the quality of the science, potential to make a difference to the lives of people with diabetes and value for money.

There is no funding limit for individual projects and projects can last for up to five years.

Sunday, July 16, 2006

Insulin Resistance in teenagers

The following is a study that was conducted in the Keck School of Medicine in Los Angeles. It supports the use of resistance training in teenagers to increase insulin sensitivity.

PURPOSE:: Insulin resistance is thought to be a core defect in the pathophysiology of obesity-related comorbidities in children, such as type 2 diabetes. Exercise training is known to improve insulin resistance and reduce the risk of type 2 diabetes in adults. However, very little is known regarding the effects of exercise on insulin resistance in youth. Therefore, we examined the effects of a 16-wk resistance training exercise intervention on insulin sensitivity in youth at high risk for developing type 2 diabetes.

METHODS:: Twenty-two overweight Latino adolescent males were randomly assigned to either a twice-per-week resistance training group (RT = 11) or a nonexercising control group (C = 11) for 16 wk. Strength was assessed by one-repetition maximum, body composition was quantified by dual-energy x-ray absorptiometry, and insulin sensitivity was determined by the frequently sampled intravenous glucose tolerance test with minimal modeling.

RESULTS:: Significant increases in upper- and lower-body strength were observed in the RT compared with the C group. The RT group significantly increased insulin sensitivity compared with the C group (P < 0.05), and this increase remained significant after adjustment for changes in total fat mass and total lean tissue mass (P < 0.05). Compared with baseline values, insulin sensitivity increased 45.1 +/- 7.3% in the RT group versus -0.9 +/- 12.9% in controls (P < 0.01).

CONCLUSION:: A twice-per-week 16-wk resistance training program can significantly increase insulin sensitivity in overweight Latino adolescent males independent of changes in body composition.

Saturday, July 15, 2006

Nearly one-third of US adults have prediabetes. The study focuses on those individuals with prediabetes who have the highest risk of developing diabetes. 'We found that bearing a share of the costs of efforts to help Americans with prediabetes alter their lifestyles would save private insurance companies and Medicare more than they would eventually pay to treat persons who will develop diabetes without preventive treatment,' said Tom Hoerger, RTI International senior health economics researcher.
The study, co-authored by Hoerger and RTI researcher Katherine Hicks and published in the June issue of the journal Diabetes Care, found that providing lifestyle interventions that encourage weight loss and exercise for 50-year-old persons with prediabetes could reduce the onset of new cases of diabetes in this group by 37 percentage points at age 65.
The research showed that if private health insurers and Medicare each contribute a share of the costs and persons with prediabetes make modest copayments, private insurers and Medicare would cover the costs of diabetes prevention programs and the health implications of diabetes would decline.