“State of Diabetes in America” A new report from the American Association of Clinical Endocrinologists, which is a respected medical society, has recently been presented and claims that 2/3 of diabetic Americans are not at goal. Goal, as defined by this society is a HbA1c of 6.5% or less. More disturbing, however, was the fact that 84% of those interviewed, thought that they were doing a good job of managing their diabetes. 61%, did not know what a HbA1c test was! Consequently, this society is planning to launch a public awareness campaign in order to educate the diabetic population about good control in general, and HbA1c, in particular. Further information concerning this is available online at www.stateofdiabetes.com. I want to make sure that everyone who is a patient of the Litvin Centers for Diabetes knows what the HbA1c test is and what their HbA1c number is. In case you are not sure, please ask during your next visit, you may also read about it on our web site, click here.     Diabetes Personal Health Decisions(PHD) The American Diabetes Association has launched a new web-based tool for diabetics who are interested in calculating their risks for complications from diabetes. The site provides the ability to enter most of the relevant information, and then calculates and gives a graphic representation of the risk. More importantly, the program can make predictions based on alterations of the risks. A patient may enter a lower body weight, or enter him/herself as a non-smoker if they are smokers, in order to see what benefits these changes will provide. This tool, of course, does not replace the good judgment of the physician, but it does provide some guidance. The site address is: www.diabetes.org/diabetesPHD.
Fat Distribution Matters Whether your fat tissue is mainly in the abdominal area versus in the thighs, apparently makes a big difference. A recent investigation looked at 3,035 obese volunteers who underwent CAT scans in order to determine the distribution of their fat tissue. 39% of the group had the Metabolic Syndrome (a condition preceding diabetes). Results of the study showed that the Metabolic Syndrome was associated with visceral (stomach area) fat two to three times more often than with other fat distribution patterns. In contrast, subcutaneous (under skin) fat in the thighs was inversely associated with the Metabolic Syndrome. Diabetes specialists have always thought that the pear-shape body type is less diabetes-prone than the apple shape, and this study seems to support that notion.
Polycystic Ovary Syndrome(PCOS) and Diabetes PCOS is a very common cause of infertility in women. It is a condition characterized by obesity, excess male hormones, irregular periods with infertility, and sometimes diabetes. A recent study showed that the prevalence of the Metabolic Syndrome is twice as high in women with PCOS than in the general population. Among women with PCOS at the age group of 20-29, the Metabolic Syndrome was eightfold that of similar women in the general population Women with PCOS are everywhere, and they need to be screened for diabetes! This should be done by all health-care professionals.
Byetta Although mentioned in previous newsletters, this new drug deserves further clarification. As you may know, it has recently been approved by the FDA, and is currently available in the pharmacies. It is administered in a pen similar to the insulin pens, and is taken twice daily as a subcutaneous injection. Derived from the saliva of the Gila monster, it mimics certain hormones in the gastrointestinal tract (GIT) who's job it is to stimulate insulin. These hormones are activated by food (particularly carbs), and immediately travel from the intestines to reach the beta cells of the pancreas. Insulin is quickly turned on in a physiological manner, only to be turned off when glucose levels normalize. In addition to stimulating insulin, Byetta suppresses Glucagon – thus controlling glucose release from the liver – and modifies appetite – thus enhancing weight loss. Byetta is indicated for diabetics type 2 who have not reached good control of oral agents. Since such patients currently are prescribed insulin, Byetta may serve as an interim drug prior to insulin. The obvious drawback is, of course, the need for injections. Only time will tell how successful this medication will turn out to be.
Symlin Yet another new drug for diabetics has recently been approved by the FDA. Symlin, which is a synthetic analog of human Amylin, has been trying for many years to enter the armamentarium of the diabetes specialist. Amylin is made in the beta cells of the pancreas, and is secreted along with insulin. Its role is mainly to slow gastric emptying, to increase satiety, thus reduce food intake, to reduce glucagon secretion, thus reducing after-meal glucose excursions, and consequently to stabilize blood glucose. Like insulin, it is injected. Unfortunately, it cannot be mixed with insulin, and therefore will require an extra pre-meal injection along with insulin. This will likely encounter much patient resistance. I can think of a few patients who might benefit from this drug, and very few who might agree to take it in addition to insulin.
New To The Site: Featured Products - HTTP://DIABETES-DOCTOR.COM We recently added a new area to our web site called "Featured Products." This area features novel devices that have recently been introduced into the diabetes marketplace, and have been selected for presentation because it is deemed by the staff to have definite potential to help the average diabetic patient.  Obviously, not all devices are for every patient, but we hope that enough patients will find our selection informative and helpful.  Since diabetes is unfortunately on the rise, we anticipate that in the future, there will be no lack of new devices for us to report on, and would like to encourage you to send us information about possible devices which would be suitable for presentation in this section.   With your help, we hope to disseminate this important information to all subscribers. Also, let us know how you like our site, our newsletters and Dr. Litvin's Blogs by commenting in our Guest Book. It's located in the header of our web site. Let us know if there is anything else you would like to see us do! We welcome your feedback and would love to hear what you think. Enjoy!

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