| Litvin Centers for Diabetes Newsletter |
Volume 30
June, 2008 |
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In This Issue. This issue is reviewing several current items that recently appeared in the diabetic literature and that may interest you, both as they may relate to you personally and in a general academic sense. In addition, we are introducing a press release about our new retinal-photography service which will screen patients for diabetic retinopathy in the office, on a regular basis. We would also like to mention that as of next month, an acupuncture specialist will be working from our Fort Lee office. Please take advantage of these services.
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Recent Diabetes News
New guidelines from the American Diabetes Association (ADA)
The ADA has approved treating "prediabetics" with Metformin. The ADA specifies that these patients must have both an impaired fasting glucose (IFG), and impaired glucose tolerance (IGT), and also at least one other risk factor. IFG is defined as a fasting glucose between 100 and 125 mg/dL, and an IGT is defined as the 2 hour glucose after a glucose load between 140 and 199. Testing must be done on separate days, and the risk factors are one of the following: younger than 60 years of age, body mass index of at least 35, family history of diabetes in 1st degree relatives, elevated triglycerides, reduced HDL cholesterol, or HbA1c greater than 6.0%. The ADA claims that up to 70% of individuals with prediabetes will eventually develop diabetes, which obviously leads to the dreaded complications. In order to delay or prevent this progression, the ADA recommends "life-style" interventions and the use of Metformin at 850 mg twice a day. The position of the American Association for Clinical Endocrinologists (AACE) is that intervention should start earlier - when individuals with high risk for insulin resistance are identified. These are important developments, and should be welcomed by all.
Type 1 Diabetes and Beta-Cell Loss
Type 1 diabetes is an autoimmune condition in which the body's immune system is attacking the beta cells. This process takes time, and typically we see the patient when enough beta cells are impaired to cause hyperglycemia (high sugar). Multiple clinical trials are underway asking many questions regarding prevention, delay, and treatment. Trials looking at prevention seek patients who are at risk of developing diabetes - these may be kids with a certain genetic mutation, or a relative who has the disease. Trials looking at delaying the disease look for patients who already have the antibodies (produced by the immune system), but are not yet hyperglycemic. For patients who already have the condition, trials are seeking to modify the action of the immune system, so as damage to the individual is limited or even stopped. Much encouragement is sustained from experiments in mice, where diabetes can be cured! People are a "whole different ball game". More time and more understanding of the complexities of the immune system are needed, but progress is certainly being made.
Diabetes, Depression, and Coronary Artery Disease (CAD)
In a study coming from Budapest, Hungary, the authors claim that having the combination of depression and diabetes puts patients at higher risk of CAD than patients with similar depression but without diabetes. The synergy between diabetes and depression may be a simple one. We all know how involved and disciplined a diabetic must be in order to achieve his or her goals. Being depressed is hardly conducive with achieving these goals. However, the relationship may be more complex than we think. There may be some "central" mechanisms which are important but yet unknown. Regardless, depression in the context of diabetes should be taken very seriously, and treated. |
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Cuisine Corner
Burgul, Tuna, Tomato and Avocado Salad
1/3 cup bulgur wheat, 1 cup halved grape tomatoes, 1 can (6 ounces) tuna packed in water, drained and flaked, ¼ cup finely chopped red onion, 1 large stalk celery, trimmed and thinly sliced, ¼ cup finely chopped avocado, 1 tablespoon minced fresh Italian parsley, 1 to 2 tablespoons lemon juice, 4 teaspoons chicken broth, 1 teaspoon olive oil, and 1/8 teaspoon black pepper.
1. Bring 2/3 cup water to a boil in small saucepan. Stir in bulgur. Cover. Reduce heat to low. Simmer 8 minutes or until bulgur swells and has absorbed most of the water. Remove from heat. Set aside, covered, 10 minutes.
2. Meanwhile, combine tomatoes, tuna, onion and celery in large bowl. Stir in cooked bulgur. Add avocado and parsley. Stir together lemon juice, chicken broth, oil and pepper in small bowl. Pour over salad. Toss gently to mix. Chill 2 hours before serving. Makes 3 (1-cup) servings.
Dietary exchanges: 1 starch, 1 meat. Calories:166 (21% from fat). Total fat 4g, saturated fat 1g, protein 17g, carbs 17g, cholesterol 17mg, dietary fiber 4g, and Sodium 221mg.
Recipe taken from Diabetic Cooking, May/June 2008.
Nutrition
Heart Failure risk and Cereal Consumption
Whole-grain cereal for breakfast is apparently associated with reduced risk of heart failure - in men. Don't ask why or how, just select a tasty whole-grain cereal, and do it!
Vitamin D and Type 1 Diabetes
Researchers in the United Kingdom have found that infants treated with Vitamin D supplementation, compared with those not supplemented, were less likely to develop type 1 diabetes later in life. This is interesting, but it seems like everywhere you turn these days, you see Vitamin D.
Salt and Soft Drink Intake in Children
In a study of 851 boys and 837 girls aged 4 to 18 years, researchers in the UK found that decreasing salt intake by 3 g/day corresponded with an average 81 g/day decrease in soft drink consumption. This translates to 250 kcalories per week, and could account for some of the obesity seen in this age group. As we all know, all snack (junk) food is loaded with salt. |
Medication & Lifestyle Info
TZD and fractures in women
Both Thiazolidinedione drugs currently on the market - Avandia and Actos - have been reported as being associated with higher rate of fractures in distal parts of all four extremities. This is unfortunate, since both drugs have a beneficial role in diabetes care. The mechanism for this is not clear, but it probably has to do with the TZD's action on young bone-marrow cells which instead of developing into mature bone-building cells (osteoblasts), turn into fat cells (adipocytes). TZD's have three other known side effects: 1) weight gain, 2) fluid retention, and 3) anemia. We typically overlook these side effects which appear in only some of the patients, anticipating to reap the benefits, which are typically of greater magnitude. But with this new development, the balance may be tipping against this group of drugs. Only time will tell.
Vardenafil (Levitra) effective in older men with erectile dysfunction (ED)
In a Canadian study following 12,063 patients with ED for longer than 3 years, whose mean age was 70 years, a total of 91% reported an overall improvement in ED, and 97.5% reported being satisfied with the overall tolerability (side effects). I keep on quoting my 82 year old patient who came to see me one day complaining that the 100 mg Viagra tablet that he takes is no longer working. Several days after telling him that he should try 125mg, he called me back and left a message with my secretary that "all is well now."
Inhaled Insulin and Lung Cancer
A recent clinical trial has revealed that six out of 4,740 patients treated with inhaled insulin (Exubera), developed lung cancer, compared with only one of 4,292 patients not treated with that preparation. Apparently, all cases had a previous history of cigarette smoking. Pfizer, who was marketing the drug, has since stopped doing so. Insulin is a well known growth-promoting factor, and as such, may have stimulated pre-existing cancers towards further growth.
Oral-Lyn Insulin
Oral-lyn insulin is a pre-meal insulin that is used via an inhaler into the mouth/pharynx area, similar to the inhalers that are available to patients with asthma. It is currently available in Ecuador, and has been approved recently to be marketed in India. The FDA has not approved it in this country, and with the cancer-related data, I doubt that it will.
Teenage Obesity in the USA
Morbid obesity is defined as a body mass index (BMI) greater than 40 kg/meter squared. Looking at adolescents aged 12-19; approximately 3.8% of them are at that BMI. Some of them are at 50 BMI or greater! This translates to 2.7 million children, and represents a huge burden for the health-care system in the near future.
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