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.

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.

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.

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 if a relative 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 experiment 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.

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."

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!

In Vitro Fertilization (IVF) is a laborious and expansive process for achieving fertility in infertile couples. A study from Detroit has reported results looking at both white and black obese women and their success rate. Overall, obesity lowered success rate from 51% to 35%, irrespective of race. However, overweight black women had a pregnancy rate of 19% compared with 67% in black women who were normal weight. Sad but probably true, why, we don't know.

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 of 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.

Eli Lilly Introduces A New Digital Insulin Pen Called The Memoir: The pen allows patients to record and review their last 16 insulin doses. The pen contains a cartridge of humalog, and a display screen which includes information about the time, date, and dose administered.

Animas Introduces A New Insulin Pump:Animas Corporation recently announced the release of its Animas 2020 insulin pump which features a new screen, according to the company - is the smallest pump on the market, is water-proof, and has a 500-food database and tools to help users achieve greater insulin dosing accuracy.

Diabetes Emergency Cards: SelectWisely, Sparta, NJ, has introduced Diabetes Emergency Cards for travelers with health problems such as diabetes. The cards are the size of a credit card, and are available in more than 25 languages. More info at: www.selectwisely.com