| Litvin Centers for Diabetes Newsletter |
Volume 29
March, 2008 |
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Dear Patients and Friends,
In this issue we are beginning to see a transformation of the newsletter. Previously I tried to focus strictly on medical topics and ideas. With this issue, my focus is shifting to include topics which may have some non-conventional roots. Gradually, I would like to achieve a balance between these two sometimes conflicting fields of knowledge. I believe that no one field has a monopoly on knowledge, and that true understanding may be achieved when several areas of expertise are consulted and combined. In order to reach a wider audience, and because of the importance of these topics, please be prepared to read anything related to diabetes. In fact, I would like to encourage you to write to us with any new idea that may come across you desk. Together, we may come up with a unique newsletter which may end up having a wide range appeal.
Sincerely,
YL |
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Recent Diabetes News
The ACCORD Study - How Strict Should We Be?
A recent study caused much anxiety among patients and physicians alike, when it claimed that strict blood glucose control caused more mortality than less strict control. Physicians have been preaching for years the exact opposite, so what is going on?? Well, in this study - The Action to Control Cardiovascular Risk in Diabetes (ACCORD) - one group of type 2 diabetics was treated for an A1c target of less than 6%, whereas the other group to a target of 7%-7.9%. The more strictly-controlled group had 20% higher mortality rate than the group with the more lax A1c, prompting the study director to terminate the more strict arm of the study. There is no satisfying explanation for these results, but the bottom line is, again, that moderation must be a key ingredient.
This also made the headlines recently. Here, a Merck drug - Vytorin - made the spotlight. In a study following two groups of patients with familial hypercholesterolemia (a genetically-caused elevated cholesterol levels), researchers found that it made little difference whether patients were either on Vytorin, or on Zocor alone, when it came to the thickness of the lining of the carotid arteries. Vytorin is a combination drug made up of Zetia and Zocor. Vytorin is much more expensive than the now generic Zocor. Consequently, doctors hurried to discontinue Vytorin and switch to Zocor. Here too, caution and prudence are necessary. This study was conducted in a highly selective group, and the "end point" of carotid thickness is a very finicky thing. I have learned to take a deep breath before making changes, and I suggest that you do too.
Novocell Reports Successful Use of Stem Cells to Generate Insulin
A recent breakthrough from a biotech company (Novocell) is making headlines. This company was able to convert stem cells to become beta cells which were subsequently transplanted in mice and were functional - producing insulin and preventing the occurence of type 1 diabetes. This is not human work yet, but that's coming hopefully in the near future.
The Centers for Disease Control and Prevention (CDC) has launched its Spanish language web site - CDC en Espanol. The site provides up-to-date information on disease prevention topics of special interest to the Hispanic communities, including diabetes. The site receives more than 6 million visitors a year and its address is: www.cdc.gov/spanish. |
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The Cost of Diabetes
Newly released data from the American Diabetes Association shows that at least 24 million Americans have diabetes, for which the national cost in 2007 was about $174 billion!! Furthermore, this may even be a conservative figure. Since 2002, when the previous analysis was determined, the cost has risen by 32%. The number of Americans with diabetes that are being diagnosed on a yearly basis is one million! The reasons are manifold, and the challenges ahead are great.
Diabetes and Increased Risk in Women of Colorectal Cancer
In a study conducted across the US and involving about 45,000 women, there was about a 50% increased risk of colorectal cancer in women with type 2 diabetes. The postulated reasons have to do with the fact that these women are typically more overweight, and therefore more insulin resistant. They would tend to have higher endogenous insulin levels, which are thought to stimulate cancers.
33% of Nursing Home Residents are Diabetics!
Previous studies conducted in nursing homes showed a prevalence of 11%-27%, whereas current studies establish a resounding 33% of residents with type 2 diabetes. These individuals were at mean age of 83 years, and had multiple other medical conditions. This segment of the population is likely to increase in the coming years by 56%, which means 7.5 million older Americans with diabetes by 2020.
Types 1 and 2 Diabetes Have Similar Impact on Mortality
In patients diagnosed after age 30, both types of diabetes have a similar impact on cardiovascular mortality. 834 patients in Finland were followed for 18 years and found to have a mortality rate of 23 per 1000 person-years and of 35 per 1000 person-years in either type 1 or type 2, respectively, whereas in non-diabetics the mortality rate was only 4.6 per 1000 person-years. Both types of diabetics should adopt a preventative mode when dealing with potential cardiovascular complications.
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Cuisine Corner
Moroccan Carrot Salad (we need to cite where this recipe was taken from)
Serves 4; Prep time: 15 min; Total time: 15 min.
Prepare this salad and store in the refrigerator, without the cilantro and pistachios, up to two days ahead.
¼ cup shelled pistachios
Coarse salt and ground pepper
1-1/2 pounds carrots, peeled, halved lengthwise, and cut into 2-inch pieces 9 halve pieces again if thick)
¼ cup raisins
3 tablespoons lemon juice (from one lemon)
2 garlic cloves, mashed to a paste
½ teaspoon ground cumin
½ teaspoon paprika
¼ teaspoon ground cinnamon
1/8 teaspoon ground cayenne pepper
2 tablespoons extra-virgin olive oil
¼ cup fresh cilantro leaves
1. Preheat oven to 350 degrees. Spread pistachios on a rimmed baking sheet, toast in the oven until fragrant, 8 to 10 min. Let cool, coarsely chop.
2. In a large saucepan of boiling salted water, cook carrots until crisp-tender, 5 to 7 min, adding raisins during last min of cooking. Drain in a colander, rinse under cold water until cool.
3. In a medium bowl, whisk together lemon juice, garlic, cumin, paprika, cinnamon, and cayenne; season with salt and pepper. Whisking constantly, slowly add olive oil. Add carrots, pistachios, and cilantro to dressing; toss to combine.
Per serving: 214 calories; 4 g protein; 11 g fat; 29 g carbs; 6 g fiber.
Nutrition
The Healthy Aging Diet
Two cultures which have shown longevity are the European countries that border the Mediterranean Sea and the Okinawas of Japan.. Typical menus in both include generous amounts of fruits, vegetables, and legumes, limited dairy and red meat, and healthy fats. Okinawans have an average life expectancy of 81(the highest), but you don't have to live in Japan in order to benefit from their life style. Focus of the following in your diet: 1) Consume a large portion of plants - fruits and vegetables - daily. 2) Choose the right fats. Avoid animal fat and Trans fats (found in margarine and in many processed foods). Increase consumption of omega 3 fatty acids found in: fish, flaxseed, and walnuts. 3) Hold the sugar. All products with a high glycemic index should be avoided. 4) Eat fresh. 5) Eat consciously. |
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Medication & Lifestyle Info
Welchol, Newly Approved for Diabetics
This cholesterol-lowering agent (Colesevelam), has been recently approved by the FDA for use in diabetic patients for lowering blood glucose levels. Relative to placebo (nothing-pill), when added to the regimen of patients already on Metformin, caused a further reduction of 0.47% in HbA1c. LDL Cholesterol (the bad cholesterol), went down at the same time, as well. The problem with this pill is that one has to take 6 per day, and one has to tolerate potential stomach-intestinal side effects.
Daily Cialis
The FDA has approved a daily 2.5 or 5 mg Cialis use for erectile dysfunction. Same benefit/side effects profile can be expected. Eli Lilly (the manufacturer) will of course be the main beneficiary.
Type 1 Diabetes Vaccine
Diamyd Medical recently announced that its diabetes vaccine has shown the ability to preserve beta cell (cells that make insulin) function in people with type 1 diabetes. The study has been conducted over a span of 30 months, in a group of type 1 diabetics aged 10 to 18 years. The study used a placebo group, and looked at the response of C-Peptide after a meal. C-Peptide is typically co-secreted with insulin, and would therefore be a good indicator of beta-cell function. The study was conducted in Sweden, and suggests that in the future patients with type 1 will have some protection from the typical deterioration of their beta cells.
Diet Soda and the Metabolic Syndrome (MS)
The MS is a condition which typically precedes the development of type 2 diabetes. In a study which gathered dietary information on 9,514 individuals over a period of 9 years, researchers found that the single food item with the strongest association to development of the MS was diet soda. Those who consumed an average of one serving a day had a 34% higher risk of developing the MS than those who drank none. Dairy intake, on the other hand, had a beneficial impact, or a reduction in risk of 13%. Both meat consumption and fried foods were associated with a 25% greater risk. No clear explanation for this phenomenon is available at this time, but the evidence should not be ignored. | |