This is a huge and important study in 2,287 patients in the US and Canada between 1999 and 2004 comparing the different effects of percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) on patients with stable coronary artery disease (CAD). PCI is performed in the US more than 1 million times a year. It typically involves either doing an angioplasty, or inserting a stent into the coronary artery. These procedures are intended to create a widening of the coronary artery and thus allow for better blood flow and consequently prevention of a heart attack. OMT would only subject the patient to medical therapy without invasive procedures. When comparing outcome of these randomly assigned groups, results failed to show any significant benefit for the PCI group in all aspects related to coronary illness. The authors of the study stressed, however, the PCI has a role in acute myocardial infarction, where the impact of opening an occlusion may be of critical benefit.

A study coming out of Brazil showed promising results in 15 patients who received high dose immunosupression followed by an infusion of stem cells harvested from themselves. This is a method used in other autoimmune conditions such as Lupus Erythematosus, where the immune system is attacking vital organs. It involves initially acquiring these cells that typically reside in the patient's marrow, and subsequently transfusing them back. In the interim, the immune system is being suppressed. Somehow this modifies the immune system and damage to the islet cells is reduced, rendering patients with more manageable blood glucose. Of the 15 patients, 13 were free of injected insulin for more than one year after the procedure. This is encouraging news. Stay tuned.

Stomach stapling or banding for purpose of weight control in obese individuals has increased dramatically in the US. Approximately 120,000 procedures were performed in 2004 vs. only 12,000 in 1994, with a yearly increase of 50%. In addition to normalizing weight, these procedures also reverse type 2 diabetes, in most cases. The exact procedure used is typically Roux-en-Y gastric bypass, which reverses diabetes in 84% of cases. However, patients develop multiple side effects such as malabsorption, nutritional deficiencies, osteoporosis, reactive hypoglycemia, and even hyperparathyroidism. Researchers recently discovered that when the same procedure is performed but without the stomach restriction, diabetes is reversed even without the weight loss. Apparently, just doing the duodenal- jejunal bypass is all it takes. Obviously, some intestinal or gastric (stomach) hormones are involved, and this may represent a future therapeutic option for some non-obese diabetics in the future.

A new study at NYU (New York University) showed that 53 morbidly (BMI>40) obese adolescents lost an average of half their weight in one year after undergoing a minimally invasive procedure placing an inflatable silicon ring around their stomach. The device - a laparoscopically adjustable gastric band - was approved by the FDA in 2001 for adults only. It is now being considered for approval in teens.

Inflammation or infection of the gums translates into kidney and even heart complications in diabetics. The connection is unclear, but researchers are suspecting bacteria residing in the gums. Symptoms of gum disease are: Bleeding during or after brushing, red, swollen or tender gums, bad breath or bad taste, receding gums, formation of deep pockets between teeth and gums, loose or shifting teeth, or changes in the way dentures fit together when biting. If you have any of these symptoms, please see your dentist!

If you are a type 2 diabetic, owning a dog may improve your chances of staying fit and with better control. Interestingly, it is not just the exercise that contributes, but also the companionship. Since poor control of diabetes and depression has been found to be very much related, owning a dog would certainly go a long way towards ameliorating that. Please consider seriously!

Providing information to both health-care providers and patients has been launched about a month ago, and can be accessed at: http://www.acponline.org.

A New Zealand man, who received a dose of encapsulated pig-derived islets (composed mainly of beta cells) about 10 years ago, is still showing signs that the islets are functional! A clinical trial using pig islets is set to start in the USSR soon, the results of which will likely have a far-reaching impact.

You may have heard the recent news about Avandia causing an increased risk of coronary events when compared to other diabetic medications. The FDA has not made any recommendations yet, but it is likely that such a recommendation will be made shortly. Since Avandia has been shown to have other concerning side effects, I have shunned away from it over the past years. If you happen to be on Avandia, please contact this office and speak to me.

Medi-Fridge: This is a portable refrigerating system for Insulin or other injectable medications. It weighs less than 2 pounds, and includes power cords. Inquire at 512- 255-2271 or at www.medi-fridge.com.

EurosRX: These are diabetic socks for anyone with circulation problems or swelling of ankles.