The International Diabetes Federation (IDF) has come out with a “Diabetes Atlas,” which has determined that there are now 246 million diabetics in the world. Predictions are that within 20 years that number will increase to 380 million. The president of the IDF has proclaimed that “diabetes is fast becoming the epidemic of the 21st Century,” affecting 5.9% of the population, with 80% in the developing countries. The highest rates are found in the Middle East with a 9.2% rate. Both India and China have about 40 million diabetics. The IDF has managed to influence the UN to pass a resolution which designates a World Diabetes Day on November 14, starting in 2007. On that day all UN member states are to execute predetermined national policies for the prevention, treatment and cure for diabetes. Finally, we see some international responsibility for this entity!

Medtronic Inc. has been in the insulin pump business for several decades, and in 1989 started human intraperitoneal (inside the abdomen) insulin pump transplantations – in Europe. Currently, pumps are offered in France in 14 sites for poorly controlled type 1s. Between 1995 and 2005, 181 patients with type 1 received the pump. Most patients were on an external insulin pump, but were experiencing multiple hypoglycemic episodes. Most showed some improvement in their HbA1c, but some had to have the pump removed for various malfunctions. Interestingly, the insulin used in these pumps is U400 – which is 4 times more concentrated than the one you use. In the US, Medtronic is focusing on the MiniMed Paradigm Real-time system which utilizes the combination insulin pump and glucose sensor. In the not too distant future, we shall certainly see implantable insulin pumps with an integrated glucose sensor and an algorhythm which will render the system totally independent from input from the patients.

Amputations of lower extremities caused by complicated diabetes are more common in counties along the Texas-Mexican border than in counties that are not along the border. Specifically, 8.3 per 10,000 people in border counties were amputated versus only 4.5 per 10,000 people in non-border counties. The overall rate of diabetes was 53.6 per 10,000 in border counties compared with 39.9 per 10,000 in non-border counties. From this data, I would presume to conclude that border counties probably have a higher population of Mexicans who are more prone to develop diabetes once exposed to the typical “All American Diet.”

In a recent study, once-daily extended release Metformin was found to be just as effective as twice- daily, and associated with less side effects. 2000mg extended release seemed to reach the maximum glycemic response. It’s worth a try!

A new study from the Dana-Farber Cancer Institute has determined that weight misperception was most common among African-American men and women, and also among Hispanic men (but not women), compared to their white counterparts. Apparently there is less social pressure in the African-American community for people to lose weight. The highest misperception was among overweight African- American women – 40.9%, compared with 20.6% in overweight white women. Wow! This is really important and remediable. This means that with proper education some of these trends might be reversed. Whoever is in a leadership position should now accept this challenge and step up to the plate!

Walmart has started to offer generic drugs at $4 for a 30-day supply. Among the diabetic drugs are: 1) Glipizide 5mg and 10mg. 2) Glyburide 2.5mg and 5mg. 3) Glyburide MCR 3mg and 6mg. 4) Glimepiride 1mg. 5) Metformin 1,000mg, 850mg, 500mg, and 500mg ER. This must be like a breath of fresh air to many of you. Please take advantage. For further inquiries go to: www.walmart.com/pharmacy.

Talking Glucometers: These are audible meters which are affordable and can even be combined with an easy-to-use audible blood pressure monitor. They are manufactured by diagnostic Devices, Inc., and are available at various durable medical equipment providers. The meter is called Prodigy. More info at www.diabeteshealth.com/tv.

ReliOn Fruit Punch Glucose Gel: A new solution for hypoglycemia. It is a gel that contains no fat, caffeine, sodium, or cholesterol. Each package comes with three tubes of 15g of gel. It is available at Wal-Mart, 888-922-0400 or at www.walmart.com.

Pen Plus Wallet: This product from Medicool allows people with diabetes to travel with medication that needs refrigeration. In addition, it has a pocket for organizing supplies. It is water resistant and is available in black or blue. 800-433-2469 or at www.medicool.com.