A significant relationship was found between levels of air toxicants and existence of diabetes. States with high levels of toxic emissions had more people with diabetes.
This type of study cannot be used to state that exposure to high levels of air pollutants increases the risk for diabetes. Although, its compelling association should be used to fuel research that can provide a cause-and-effect relationship.
Morris et al analyzed food intake from 815 residents of Chicago, 65 years of age or older, at least 50% of whom were black. Consumption of vitamins E and C, and beta carotene from either food or supplements was studied. After a mean follow-up of 3.9 years, only vitamin E from food was found to reduce the risk for Alzheimer disease.
Engelhart et al analyzed food intake from 5395 residents of Rotterdam, the Netherlands, 55 years of age or older. Consumption of foods containing beta carotene, flavonoids, and vitamins E and C was studied. After a mean follow-up of 6 years, high intakes of vitamins C and E were found to reduce the risk for Alzheimer disease.
Both studies reported benefit from foods containing antioxidants, but not from antioxidant supplements. Antioxidants are thought to protect brain tissue from harmful effects of oxidation. Fresh fruits and vegetables are rich sources of vitamin C, flavonoids, and beta carotene. Vitamin E is found in nuts and nut oils, whole grains, and green leafy vegetables.
Three studies appearing in this week's New England Journal of Medicine investigate the use of a class of drug commonly used to reduce blood pressure, known as an angiotensin II-receptor blocker: ARB. All studies were conducted on people with type 2 diabetes suffering some level of kidney disease, and were randomized, double-blind, and placebo-controlled. Patients receiving the drug showed fewer signs of kidney disease (such as protein in the urine or high serum creatinine) than those receiving placebo.
Both the newer ARBs and the older ACE inhibitors (angiotensin converting enzyme: ACE) reduce the action of angiotensin II, either by blocking it or reducing the amount available in the bloodstream. Angiotensin II is a hormone that constricts blood vessels, leading to increases in blood pressure. Drugs that inhibit the action of angiotensin can decrease elevated blood pressure. The kidney protection seen in these three studies however could not be explained by the drugs' blood pressure lowering effect.
The ARB drugs used in the studies were irbesartan, brand name Avapro, by Bristol-Myers Squibb (150-300 mg); and losartan, brand name Cozaar, by Merck (50-100 mg).
If you are taking Baycol, call your healthcare provider to determine an alternate medication. Prescription alternatives in the US include Lipitor (Pfizer), Mevacor (Merck), Pravachol (Bristol-Myers Squibb), Zocor (Merck), and Lescol (AstraZeneca).
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In the July 18th issue, researchers reviewed data from more than 27,000 women across the US taking part in the ongoing Women's Health Study and found that otherwise healthy participants who had higher levels of 2 inflammatory proteins (C-reactive protein CRP, interleukin 6 IL-6) in their blood had a higher risk of developing diabetes during a 4-year observation period than those with lower levels.
In the July 4th issue, researchers documented an association between the lipid-lowering drug pravastatin and the inflammation response. Levels of the protein CRP were reduced approximately 14% in 2884 men and woman who received the drug, during either a double-blind trial on individuals with no history of cardiovascular disease or an open-label trial on individuals with known cardiovascular disease.
Earlier this year, researchers reporting in Circulation, a journal of the American Heart Association, found a 30% reduced risk for type 2 diabetes in participants receiving pravastatin. As expected, lipid levels were lowered by the treatment, but it was proposed that an anti-inflammatory effect of the drug may have contributed to the reduced risk.
Inflammatory proteins such as C-reactive protein (CRP) are typically released in response to injury and infection. Chronic conditions such as recurring bronchitis and periodontal disease will elevate CRP levels. The concentration of CRP is also positively associated with smoking, stress, obesity, and blood pressure. The female hormone estrogen is known to increase it.
| Treatment Goals |
|---|
| Weight loss of 5% or more. (5% of 200 lbs. is 10 lbs.) |
| Total daily fat intake no more than 30% of calories. |
| Total daily saturated fat intake no more than 10% of calories. |
| Total daily fiber intake at least 15 grams per 1000 calories. |
| Moderate exercise at least 30 minutes per day. |
All participants had some level of impaired glucose tolerance (IGT: Blood glucose 140-200 mg/dl 2 hours after glucose ingestion but less than 140 mg/dl when fasting) before the study. About 35% of people with IGT will develop diabetes. This study shows that diabetes may be prevented even in a high-risk population.
The effectiveness of insulin delivered through inhalers received attention from a study published in the journal Lancet this February. Researchers from 10 health centers across the US studied 73 men and women with insulin-deficient, type 1 diabetes. Participants replaced 3 before-meal injections with inhaled insulin, although continued with a bedtime long-acting ultralente (Humulin-U, Eli Lilly) insulin injection. After 12 weeks, those who used inhaled insulin had similar measures of glycosolated hemoglobin (HbA1c), fasting and before-meal blood glucose, and instances of low blood glucose (hypoglycemia), than did those in a control group who continued with their regular regimen of 2 to 3 insulin injections a day. The inhaled insulin was well tolerated and had no effect on tests of lung function, however only non-smokers and those without asthma or other respiratory diseases were selected for the study.
The GlucoWatch will be available only by prescription to adults 18 and older. The new technology is not intended to replace conventional finger prick tests yet, but continued study and refinement may allow it one day to completely eliminate more invasive techniques.
Earlier animal studies used higher doses of recombinant human Nerve Growth Factor (rhNGF), from 1 to 10 mg/kg. This study used 0.1 ug/kg, a dose that may be inadequate to show benefit but that was better tolerated by participants in phase 1 studies.
Approximately 60% of diabetic patients will develop some form of neuropathy during the course of their disease. Loss of function in nerves feeding the arms, hands, legs or feet can cause decreased sensitivity and a feeling of muscle weakness, or increased pain, burning, and tingling. Nerve growth factor plays a role in development and maintenance of these peripheral nerves.
Older formulations of oral diabetes medications were thought to cross the placenta and cause abnormalities in the fetus. The glyburide used in this study was not detected in any of the participants' umbilical cords or fetuses. Infants born to women taking glyburide weighed the same and had the same blood glucose values as those born to women taking insulin.
Glyburide is in the class of diabetes medications known as sulfonylureas that work by stimulating release of insulin from the pancreas.
Glucophage and Glucophage XR help to lower blood glucose by decreasing glucose output by the liver, decreasing absorption of glucose from food, and improving insulin sensitivity.
Ten of the 13 trials used a standardized garlic powder (Kwai), with doses ranging from 600 to 900 mg/day for 8 to 24 weeks. Commercial preparations of garlic are standardized to 1.3% alliin, the main ingredient. However, it is not clear that alliin is responsible for the lipid-lowering properties of garlic. Also, the modest cholesterol reductions appearing in this analysis do not address garlic's other possible benefits including blood pressure reduction, blood clot reduction, blood flow increases, and specific changes in HDL and LDL cholesterol.
Over 5000 women in the Nurses' Health Study who reported having diabetes were followed for 14 years. Less than 1/2 drink daily reduced these women's risk of CHD by 25%; greater than 1/2 drink daily reduced their risk by 50%. (One drink is typically one 12-oz. beer, one 4-oz wine, or one mixed drink.)
Over 87,000 men in the Physicians' Health Study were followed for 5.5 years. Those who consumed at least 1 drink daily reduced their risk of death by CHD greater than 50%.
Alcohol may deliver its positive effects by increasing HDL (high-density lipoprotein, a beneficial blood cholesterol), and by decreasing clotting of blood. Alcohol consumed in large amounts may exacerbate nerve and eye complications of diabetes. There is also the risk of hypoglycemia (low blood sugar) when alcohol is consumed without food or along with certain diabetic medications.
An overview of the report is available from the US Air Force at: http://www.brooks.af.mil/AFRL/HED/hedb/afhs/afhs.shtml
Last year (March 1999) an FDA panel reviewed cases of liver failure associated with Rezulin but recommended its continued use. In June 1999, the FDA placed stricter controls on Rezulin's use, requiring monthly liver function tests and mandating that it be prescribed only as a last resort, and always in conjunction with other diabetes medications. Today the manufacturer decided to remove Rezulin from the market, citing intense media coverage of Rezulin's risks as a factor in eroding public confidence in their product.
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Visit the NIDDK's website for more information.
The FDA has stopped importation of the following herbal products:
For more information refer to the California Department of Health Services - News Release
Health Care Financing Administration Press Release
American Diabetes Association News Update
- Have been diagnosed with type 1 diabetes before age 31.
- Have a clinical diagnosis of kidney disease (such as proteinuria, dialysis, or kidney transplant)
- Have at least one other sibling with type 1 diabetes who has no kidney problems.
Distance is no object. People from all over the world may take part. Participation consists of a one-time meeting where a blood sample will be collected. Participants will receive compensation for their time. For more information, call the Joslin Center toll free at 877-264-2739 or email Kellie Anderson at kidneygene@Joslin.harvard.edu
Center for Epidemiological Studies
Depression Scale
10-Item Version
| Question | Answer |
|---|---|
| 1. I felt depressed | Yes |
| 2. I felt that everything I did was an effort | Yes |
| 3. My sleep was restless | Yes |
| 4. I was happy | No |
| 5. I felt lonely | Yes |
| 6. People were unfriendly | Yes |
| 7. I enjoyed life | No |
| 8. I felt sad | Yes |
| 9. I felt that people disliked me | Yes |
| 10. I could not get going | Yes |
The study considered a score of 4 or more as indicative of depression. The article that accompanies this screening test is available on the Journal's website: www.ama-assn.org/internal
In a national, government-sponsored symposium convened last year (1997) by the NIH to investigate the mechanisms and new treatment options for type 2 diabetes, it was reported that "obesity should be regarded as a major vehicle for ultimately controlling the growing prevalence of type 2 diabetes", and that "the prevention or reduction of obesity would eliminate or alleviate up to 70 percent of instances of type 2 diabetes." Also, weight gain that accompanies intensive therapy has resulted in an increasing prevalence of overweight type 1 diabetic patients.
In June of this year (1998), the first federal guidelines on the identification, evaluation, and treatment of overweight and obesity in adults were published. The guidelines are based on the most extensive review of scientific evidence on overweight and obesity conducted to date.
Highlights of this initiative include:
Visit http://www.shodor.org/aida to try the simulator.
The benefits of enlisting tight glucose control in an elderly population, a population that presents with more underlying conditions and a shorter life expectancy, must be weighed against the increased risks for developing hypoglycemia.
It is known that obesity, sodium intake, and alcohol consumption influence blood pressure. This study confirms the effects of dietary patterns on hypertension.