New research has discovered a substance in tangerines not only prevents obesity, but also offers protection against Type 2 diabetes, and even atherosclerosis....
Murray Huff, a vascular biology scientist at the Schulich School of Medicine & Dentistry, studied the effects of a flavonoid in tangerines called Nobiletin. In a model of metabolic syndrome developed by the Huff laboratory at the Robarts Research Institute, mice were fed a "western" diet high in fats and simple sugars. One group became obese and showed all the signs associated with metabolic syndrome: elevated cholesterol and triglycerides, high blood levels of insulin and glucose, and a fatty liver. These metabolic abnormalities greatly increase the risk of cardiovascular disease and Type 2 diabetes.
The second group of mice, fed the exact same diet but with Nobiletin added, experienced no elevation in their levels of cholesterol, triglycerides, insulin or glucose, and gained weight normally. Mice became much more sensitive to the effects of insulin. Nobiletin was shown to prevent the buildup of fat in the liver by stimulating the expression of genes involved in burning excess fat, and inhibiting the genes responsible for manufacturing fat.
"The Nobiletin-treated mice were basically protected from obesity," says Huff, the Director of the Vascular Biology Research Group at Robarts. "And in longer-term studies, Nobiletin also protected these animals from atherosclerosis, the buildup of plaque in arteries, which can lead to a heart attack or stroke. This study really paves the way for future studies to see if this is a suitable treatment for metabolic syndrome and related conditions in people."
Huff's research has focused on the pharmacological properties of naturally-occurring bioactive molecules. Two years ago, his research drew international attention when he discovered a flavonoid in grapefruit called Naringenin offered similar protection against obesity and other signs of metabolic syndrome. Huff says, "What's really interesting to us is that Nobiletin is ten times more potent in its protective effects compared to Naringenin, and this time, we've also shown that Nobiletin has the ability to protect against atherosclerosis."
Diabetes, April 2011
Wednesday, June 29, 2011
Tuesday, June 28, 2011
5 Reasons Men Shouldn't Blow Off Going to the Doctor
“Half of Men Don’t Go to the Doctor.” The story was based on a survey that found 45 percent of men between ages 18 and 50 don’t have a primary care physician, and 40 percent of men in their 40s have never even had their cholesterol tested.
Other research over the past few years backs this up. In fact, an American Academy of Family Physicians survey found that more than half of men—55 percent—hadn’t seen their M.D. in the previous year. What gives?
Simple. "Men are babies," says T.E. Holt, M.D., Ph.D., a Men’s Health contributing editor and practicing physician with the University of North Carolina School of Medicine. “Men notoriously avoid doctors, especially men between the ages of 20 and 40. These are the same years in which men are twice as likely as women to die.”
What are men afraid of? What their physicians will find, of course. But this is far scarier: Avoiding your annual checkup could be a fatal mistake. Here are 5 killer reasons to schedule your doctor's appointment today.
Schedule a Doctor's Appointment Because . . . Your heart may be hiding something
Nearly 800,000 Americans will have a first heart attack this year, according to the American Heart Association. For more than a third of them, the first symptom will be death. But half of all victims could have seen the attack coming, especially with the help of their doctors.
The first two symptoms are usually shortness of breath during light activity, or slight chest pain when exercising, says Michael Blaha, M.D., M.P.H., a cardiologist at Johns Hopkins Hospital. This is why most doctors ask about your fitness regimen, whether you've been feeling any discomfort (like “muscle strain” or “heartburn”) lately, and if you're able to do as much as you used to. The fact is, most men don't recognize the symptoms of heart disease.
"It only clicks afterward," Dr. Blaha says. “It’s common, after a heart attack, for the person to say they’ve been short of breath or more fatigued than usual."
Sometimes, these symptoms last for years before the person has a heart attack. “There’s often plenty of time to correct the problem," says Dr. Blaha, "through medication or exercise.” You just need to be man enough to start the conversation with your doctor. Are you?
Schedule a Doctor's Appointment Because . . . Your blood sugar may be running rampant
Although not an infectious disease, diabetes seems to be spreading like one. Since 1980, its prevalence in the United States has risen by 47 percent, a trend that's expected to accelerate more in the next decade. Nearly half of American men today either have the condition or are on the verge of developing it, according to a new report from the National Institutes of Health. More than a third of them don’t even know it.
Everyone in America should be tested for diabetes. (It’s a simple pin-prick test. No excuses.) Why? There’s just too much at stake, says David Kendall, M.D., American Diabetes Association chief scientific and medical officer. Consider:
• Having diabetes doubles your chances of dying at any age compared with a person who's diabetes-free.
• Diabetes is the primary cause of cardiovascular disease in the United States, slashing a man's life span by an average of 13 years. According to a recent study in the Archives of Internal Medicine, if you're diagnosed with diabetes before age 60, your risk of heart attack increases 2.5 times.
• The farther along the disease progresses before diagnosis, the greater your likelihood of eye problems (often resulting in blindness), kidney problems (often resulting in dialysis), and trouble healing (often resulting in amputation).
• Undiagnosed diabetes also puts you at higher risk of certain types of cancer.
Here’s the good news: When caught early enough, the progression of diabetes can be slowed or even stopped through simple lifestyle changes, such as diet and exercise, says Keith Berkowitz, M.D., founder and medical director of the Center for Balanced Health in New York City. (In fact, one maverick doctor has reversed the progression of diabetes in some patients—check out The Cure for Diabetes.)
Diabetes screening should start no later than age 45, says Dr. Kendall. For those at higher risk—because they have high blood pressure, cholesterol problems, or a family history—screening should begin immediately.
Schedule a Doctor's Appointment Because . . . The second-deadliest cancer is almost entirely preventable
More than 150,000 Americans are diagnosed with colon cancer every year, and 53,000 die annually from the disease. But more than 60 percent of all cases could easily be caught earlier, according to the Centers for Disease Control and Prevention.
Why is this important? Colon cancer is 90 percent curable when caught early. The disease starts when a few abnormal cells in the colon develop into polyps. Then, 10 to 15 years later, those polyps turn malignant and often spread to other parts of the body. But, through regular screening, doctors can find and remove the polyps while they’re still harmless.
“You can’t wait for symptoms,” says David Johnson M.D., chief of gastroenterology at Eastern Virginia Medical School. “Changing bowel habits, bleeding, and abdominal pain come only in the late stages of this cancer. They’re potentially very ominous.”
Bonus Tip: For the latest men's health news, along with tips that can improve your life instantly, check out our new Health Headlines blog!
Schedule a Doctor's Appointment Because . . . Your abs may be covering an aneurysm
More than 30,000 Americans die of aneurysms each year—it’s the 14th most common cause of death in this country. When you hear the word, you probably think of a rupture of an artery in the brain. But abdominal aortic aneurysms are far more common than you think, especially in older men. In fact, according to a study published in the Annals of Vascular Medicine, 5 percent of men ages 65 and older will eventually have one.
Your chances of surviving an aortic aneurysm are small: just 6 to 21 percent, depending on the location. “Only 1 of 20 patients has any pain like a rumbling of a volcano before the actual tearing occurs,” says John Elefteriades, M.D., chief of cardiac surgery at Yale Medical School. “That’s why it’s important to do everything we can to detect these aneurysms.
“Aneurysms in the belly can be felt on physical exam," he goes on. "But aneurysms in the chest can’t be felt because of the ribcage.” This is why your doctor will listen for a heart murmur, an early symptom of an aneurysm in the making.
If you have a family history of the disease, it's important to tell your doctor. Chances are, he or she will order a chest screening. Don't be afraid—you just have to lay there!
Schedule a Doctor's Appointment Because . . . That may not be a mole
Skin cancer attacks a disproportionate number of men. In fact, of the more than 3.5 million new skin cancer cases in America each year, more than two-thirds occur in men.
The deadliest form of the disease is melanoma, a cancer of the skin's pigment-producing cells that kills almost 8,000 people each year. One in 39 men (versus 1 in 58 women) will eventually develop melanoma, but don't fret. "Early detection can be difficult with other organs in the body, but not so with the skin," says Adnan Nasir, M.D., a clinical professor of dermatology at the University of North Carolina.
“When melanoma first develops, it’s only on the surface of the skin, making it easy to remove and cure,” says Daniel Kaplan, M.D., Ph.D., assistant professor of dermatology at University of Minnesota. “The longer it goes untreated, however, the more it spreads. That makes the chances of survival much slimmer.”
In most cases, you have up to a year to find a melanoma before it will hurt you, which is why dermatologists recommend annual exams. They also advise monthly self-exams. Ask your girlfriend or wife to help, and then return the favor.
This, men, actually is scary: Despite recent medical advances, the 5-year survival rate for stage IV melanoma is only 15 percent. And if you’ve had just five—that's right, only five—moderate sunburns in your lifetime, your risk of developing the malignant melanoma is double.
Still afraid to call your doctor now? I thought not.
Other research over the past few years backs this up. In fact, an American Academy of Family Physicians survey found that more than half of men—55 percent—hadn’t seen their M.D. in the previous year. What gives?
Simple. "Men are babies," says T.E. Holt, M.D., Ph.D., a Men’s Health contributing editor and practicing physician with the University of North Carolina School of Medicine. “Men notoriously avoid doctors, especially men between the ages of 20 and 40. These are the same years in which men are twice as likely as women to die.”
What are men afraid of? What their physicians will find, of course. But this is far scarier: Avoiding your annual checkup could be a fatal mistake. Here are 5 killer reasons to schedule your doctor's appointment today.
Schedule a Doctor's Appointment Because . . . Your heart may be hiding something
Nearly 800,000 Americans will have a first heart attack this year, according to the American Heart Association. For more than a third of them, the first symptom will be death. But half of all victims could have seen the attack coming, especially with the help of their doctors.
The first two symptoms are usually shortness of breath during light activity, or slight chest pain when exercising, says Michael Blaha, M.D., M.P.H., a cardiologist at Johns Hopkins Hospital. This is why most doctors ask about your fitness regimen, whether you've been feeling any discomfort (like “muscle strain” or “heartburn”) lately, and if you're able to do as much as you used to. The fact is, most men don't recognize the symptoms of heart disease.
"It only clicks afterward," Dr. Blaha says. “It’s common, after a heart attack, for the person to say they’ve been short of breath or more fatigued than usual."
Sometimes, these symptoms last for years before the person has a heart attack. “There’s often plenty of time to correct the problem," says Dr. Blaha, "through medication or exercise.” You just need to be man enough to start the conversation with your doctor. Are you?
Schedule a Doctor's Appointment Because . . . Your blood sugar may be running rampant
Although not an infectious disease, diabetes seems to be spreading like one. Since 1980, its prevalence in the United States has risen by 47 percent, a trend that's expected to accelerate more in the next decade. Nearly half of American men today either have the condition or are on the verge of developing it, according to a new report from the National Institutes of Health. More than a third of them don’t even know it.
Everyone in America should be tested for diabetes. (It’s a simple pin-prick test. No excuses.) Why? There’s just too much at stake, says David Kendall, M.D., American Diabetes Association chief scientific and medical officer. Consider:
• Having diabetes doubles your chances of dying at any age compared with a person who's diabetes-free.
• Diabetes is the primary cause of cardiovascular disease in the United States, slashing a man's life span by an average of 13 years. According to a recent study in the Archives of Internal Medicine, if you're diagnosed with diabetes before age 60, your risk of heart attack increases 2.5 times.
• The farther along the disease progresses before diagnosis, the greater your likelihood of eye problems (often resulting in blindness), kidney problems (often resulting in dialysis), and trouble healing (often resulting in amputation).
• Undiagnosed diabetes also puts you at higher risk of certain types of cancer.
Here’s the good news: When caught early enough, the progression of diabetes can be slowed or even stopped through simple lifestyle changes, such as diet and exercise, says Keith Berkowitz, M.D., founder and medical director of the Center for Balanced Health in New York City. (In fact, one maverick doctor has reversed the progression of diabetes in some patients—check out The Cure for Diabetes.)
Diabetes screening should start no later than age 45, says Dr. Kendall. For those at higher risk—because they have high blood pressure, cholesterol problems, or a family history—screening should begin immediately.
Schedule a Doctor's Appointment Because . . . The second-deadliest cancer is almost entirely preventable
More than 150,000 Americans are diagnosed with colon cancer every year, and 53,000 die annually from the disease. But more than 60 percent of all cases could easily be caught earlier, according to the Centers for Disease Control and Prevention.
Why is this important? Colon cancer is 90 percent curable when caught early. The disease starts when a few abnormal cells in the colon develop into polyps. Then, 10 to 15 years later, those polyps turn malignant and often spread to other parts of the body. But, through regular screening, doctors can find and remove the polyps while they’re still harmless.
“You can’t wait for symptoms,” says David Johnson M.D., chief of gastroenterology at Eastern Virginia Medical School. “Changing bowel habits, bleeding, and abdominal pain come only in the late stages of this cancer. They’re potentially very ominous.”
Bonus Tip: For the latest men's health news, along with tips that can improve your life instantly, check out our new Health Headlines blog!
Schedule a Doctor's Appointment Because . . . Your abs may be covering an aneurysm
More than 30,000 Americans die of aneurysms each year—it’s the 14th most common cause of death in this country. When you hear the word, you probably think of a rupture of an artery in the brain. But abdominal aortic aneurysms are far more common than you think, especially in older men. In fact, according to a study published in the Annals of Vascular Medicine, 5 percent of men ages 65 and older will eventually have one.
Your chances of surviving an aortic aneurysm are small: just 6 to 21 percent, depending on the location. “Only 1 of 20 patients has any pain like a rumbling of a volcano before the actual tearing occurs,” says John Elefteriades, M.D., chief of cardiac surgery at Yale Medical School. “That’s why it’s important to do everything we can to detect these aneurysms.
“Aneurysms in the belly can be felt on physical exam," he goes on. "But aneurysms in the chest can’t be felt because of the ribcage.” This is why your doctor will listen for a heart murmur, an early symptom of an aneurysm in the making.
If you have a family history of the disease, it's important to tell your doctor. Chances are, he or she will order a chest screening. Don't be afraid—you just have to lay there!
Schedule a Doctor's Appointment Because . . . That may not be a mole
Skin cancer attacks a disproportionate number of men. In fact, of the more than 3.5 million new skin cancer cases in America each year, more than two-thirds occur in men.
The deadliest form of the disease is melanoma, a cancer of the skin's pigment-producing cells that kills almost 8,000 people each year. One in 39 men (versus 1 in 58 women) will eventually develop melanoma, but don't fret. "Early detection can be difficult with other organs in the body, but not so with the skin," says Adnan Nasir, M.D., a clinical professor of dermatology at the University of North Carolina.
“When melanoma first develops, it’s only on the surface of the skin, making it easy to remove and cure,” says Daniel Kaplan, M.D., Ph.D., assistant professor of dermatology at University of Minnesota. “The longer it goes untreated, however, the more it spreads. That makes the chances of survival much slimmer.”
In most cases, you have up to a year to find a melanoma before it will hurt you, which is why dermatologists recommend annual exams. They also advise monthly self-exams. Ask your girlfriend or wife to help, and then return the favor.
This, men, actually is scary: Despite recent medical advances, the 5-year survival rate for stage IV melanoma is only 15 percent. And if you’ve had just five—that's right, only five—moderate sunburns in your lifetime, your risk of developing the malignant melanoma is double.
Still afraid to call your doctor now? I thought not.
Monday, June 27, 2011
Diet Soda Not Linked to Raised Diabetes Risk
Harvard University researchers suggest in a new study that diet sodas and other drinks with sugar-substitutes, once blamed for increasing the odds of developing diabetes, are not guilty....
Researchers followed a group of men for 20 years and found that those who drank sugary beverages were more likely to get diabetes, but the same was not true for those who drank diet soft drinks and other artificially-sweetened beverages.
The authors said replacing sugary drinks with diet replacements seems to be a safe and healthy life choice.
Dr. Frank Hu, a co-author of the study stated that, "There are multiple alternatives to regular soda." "Diet soda is perhaps not the best alternative, but moderate consumption is not going to have appreciable harmful effects."
Studies in the past have suggested that people who drink diet beverages on a regular basis might be more likely to get diabetes than those who refrained from artificially-sweetened drinks altogether.
Hu and his colleagues analyzed data from more than 40,000 men followed from 1986 to 2006. During the course of the study, participants regularly filled out questionnaires on their medical status and dietary habits, including their intake of regular and diet beverages on a weekly basis.
About 7 percent of the men reported that they were diagnosed with diabetes at some point during the 20-year study. The researchers discovered that men who drank the most sugary drinks -- about one serving per day on average -- were 16 percent more likely to be diagnosed with diabetes than men who never drank sweetened beverages. The link, however, was mainly due to carbonated beverages. Drinking other non-carbonated sweetened fruit drinks such as lemonade was not linked to a higher risk of diabetes.
The study found that when they did not take any other factors into consideration, men who drank a lot of diet soda and other diet drinks were more likely to get diabetes. But once the researchers added in factors such as weight, blood pressure, and cholesterol, those drinks were not related to risk of diabetes.
The researchers believe that, in older studies, a link was made between diet drinks and risk of diabetes because it was most likely that a large part of participants in those studies were overweight, had high blood pressure and/or cholesterol already.
Dr. Rebecca Brown, an endocrinologist at the National Institutes of Health mentioned that, the new study finding confirms the idea "that it's really these differences between people who choose to, versus don't choose to, drink artificially-sweetened beverages," that is related to diabetes.
"People who are at risk for diabetes or obesity ... those may be the people who are more likely to choose artificial sweeteners because they may be more likely to be dieting," said Brown, who has studied artificial sweeteners but was not involved in the current research.
The study also found that drinking regular or decaffeinated coffee on a regular basis was linked to a lower risk of diabetes. Researchers are unclear why that is, but believe it could be due to antioxidants, vitamins or minerals found in coffee, said Hu.
Although, there still exists some health concern about artificial sweeteners, none have been proven, said Brown. "I certainly think that we have better evidence that drinking sugar-sweetened beverages increases health risks."
American Journal of Clinical Nutrition, April 2011
Researchers followed a group of men for 20 years and found that those who drank sugary beverages were more likely to get diabetes, but the same was not true for those who drank diet soft drinks and other artificially-sweetened beverages.
The authors said replacing sugary drinks with diet replacements seems to be a safe and healthy life choice.
Dr. Frank Hu, a co-author of the study stated that, "There are multiple alternatives to regular soda." "Diet soda is perhaps not the best alternative, but moderate consumption is not going to have appreciable harmful effects."
Studies in the past have suggested that people who drink diet beverages on a regular basis might be more likely to get diabetes than those who refrained from artificially-sweetened drinks altogether.
Hu and his colleagues analyzed data from more than 40,000 men followed from 1986 to 2006. During the course of the study, participants regularly filled out questionnaires on their medical status and dietary habits, including their intake of regular and diet beverages on a weekly basis.
About 7 percent of the men reported that they were diagnosed with diabetes at some point during the 20-year study. The researchers discovered that men who drank the most sugary drinks -- about one serving per day on average -- were 16 percent more likely to be diagnosed with diabetes than men who never drank sweetened beverages. The link, however, was mainly due to carbonated beverages. Drinking other non-carbonated sweetened fruit drinks such as lemonade was not linked to a higher risk of diabetes.
The study found that when they did not take any other factors into consideration, men who drank a lot of diet soda and other diet drinks were more likely to get diabetes. But once the researchers added in factors such as weight, blood pressure, and cholesterol, those drinks were not related to risk of diabetes.
The researchers believe that, in older studies, a link was made between diet drinks and risk of diabetes because it was most likely that a large part of participants in those studies were overweight, had high blood pressure and/or cholesterol already.
Dr. Rebecca Brown, an endocrinologist at the National Institutes of Health mentioned that, the new study finding confirms the idea "that it's really these differences between people who choose to, versus don't choose to, drink artificially-sweetened beverages," that is related to diabetes.
"People who are at risk for diabetes or obesity ... those may be the people who are more likely to choose artificial sweeteners because they may be more likely to be dieting," said Brown, who has studied artificial sweeteners but was not involved in the current research.
The study also found that drinking regular or decaffeinated coffee on a regular basis was linked to a lower risk of diabetes. Researchers are unclear why that is, but believe it could be due to antioxidants, vitamins or minerals found in coffee, said Hu.
Although, there still exists some health concern about artificial sweeteners, none have been proven, said Brown. "I certainly think that we have better evidence that drinking sugar-sweetened beverages increases health risks."
American Journal of Clinical Nutrition, April 2011
Friday, June 24, 2011
Hemoglobin A1c as a Diagnostic Tool for Diabetes Screening and New-Onset Diabetes Prediction
A 6-year community-based prospective study
OBJECTIVE Various cutoff levels of hemoglobin A1c (A1C) have been suggested to screen for diabetes, although more consensus about the best level, especially for different ethnicities, is required. We evaluated the usefulness of A1C levels when screening for undiagnosed diabetes and as a predictor of 6-year incident diabetes in a prospective, population-based cohort study.
RESEARCH DESIGN AND METHODS A total 10,038 participants were recruited from the Ansung-Ansan cohort study. All subjects underwent a 75-g oral glucose tolerance test at baseline and at each biennial follow-up. Excluding subjects with a previous history of diabetes (n = 572), the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of the A1C cutoff. The Cox proportional hazards model was used to predict diabetes at 6 years.
RESULTS At baseline, 635 participants (6.8%) had previously undiagnosed diabetes. An A1C cutoff of 5.9% produced the highest sum of sensitivity (68%) and specificity (91%). At 6 years, 895 (10.2%) subjects had developed incident diabetes. An A1C cutoff of 5.6% had the highest sum of sensitivity (59%) and specificity (77%) for the identification of subsequent 6-year incident diabetes. After multivariate adjustment, men with baseline A1C ≥5.6% had a 2.4-fold increased risk and women had a 3.1-fold increased risk of new-onset diabetes.
CONCLUSIONS A1C is an effective and convenient method for diabetes screening. An A1C cutoff of 5.9% may identify subjects with undiagnosed diabetes. Individuals with A1C ≥5.6% have an increased risk for future diabetes.
Footnotes
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc10-0644/-/DC1.
Received April 6, 2010.
Accepted January 23, 2011.
© 2011 by the American Diabetes Association.
OBJECTIVE Various cutoff levels of hemoglobin A1c (A1C) have been suggested to screen for diabetes, although more consensus about the best level, especially for different ethnicities, is required. We evaluated the usefulness of A1C levels when screening for undiagnosed diabetes and as a predictor of 6-year incident diabetes in a prospective, population-based cohort study.
RESEARCH DESIGN AND METHODS A total 10,038 participants were recruited from the Ansung-Ansan cohort study. All subjects underwent a 75-g oral glucose tolerance test at baseline and at each biennial follow-up. Excluding subjects with a previous history of diabetes (n = 572), the receiver operating characteristic curve was used to evaluate the diagnostic accuracy of the A1C cutoff. The Cox proportional hazards model was used to predict diabetes at 6 years.
RESULTS At baseline, 635 participants (6.8%) had previously undiagnosed diabetes. An A1C cutoff of 5.9% produced the highest sum of sensitivity (68%) and specificity (91%). At 6 years, 895 (10.2%) subjects had developed incident diabetes. An A1C cutoff of 5.6% had the highest sum of sensitivity (59%) and specificity (77%) for the identification of subsequent 6-year incident diabetes. After multivariate adjustment, men with baseline A1C ≥5.6% had a 2.4-fold increased risk and women had a 3.1-fold increased risk of new-onset diabetes.
CONCLUSIONS A1C is an effective and convenient method for diabetes screening. An A1C cutoff of 5.9% may identify subjects with undiagnosed diabetes. Individuals with A1C ≥5.6% have an increased risk for future diabetes.
Footnotes
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc10-0644/-/DC1.
Received April 6, 2010.
Accepted January 23, 2011.
© 2011 by the American Diabetes Association.
Thursday, June 23, 2011
Testosterone Deficiencies Can Increase Death in Men with Diabetes
Allowing low testosterone levels to go untreated may sharply increase the risk of early death among men with Type 2 diabetes....
This study is important because low testosterone is a common complication of Type 2 diabetes and treating this problem could save the lives of countless men.
A testosterone test may provide men with Type 2 diabetes a glimpse of their risk of dying young. New research has connected untreated deficiencies of the hormone to a higher risk of death among this group.
The University of Sheffield researchers who conducted the study said that their findings are important because testosterone deficiencies are a known complication of diabetes. Many men with the condition suffer from hormonal problems. The findings indicate that more of these men should be receiving treatment.
For the study, the researchers examined the hormone levels of 587 men with Type 2 diabetes. The participants were classified as having healthy testosterone levels, receiving treatment for deficiencies or having untreated low levels. The men were then followed for six years.
During the course of the study, men who went untreated for testosterone deficiency were more than twice as likely to die, compared to those who had normal levels of the hormone. Participants who were on testosterone replacement therapy were the least likely to die.
The results showed that 20 percent of the participants with untreated testosterone deficiencies died during the study, while only 9 percent of those with normal levels died during the testing period. Just 8.6 percent of men who were being treated for hormone deficiencies passed away during the study.
The researchers said that their findings may help advance the understanding of complications that can arise in diabetics from hormone deficiencies.
Professor Hugh Jones, who led the investigation, said that the findings are important, but they are likely the tip of the iceberg when it comes to complications associated with low testosterone in men with Type 2 diabetes. There have been few investigations into how hormone deficiencies affect men with the condition.
"It is well known that men with Type 2 diabetes often have low testosterone levels, so it is important that we investigate the health implications of this," he said. "We now need to carry out a larger clinical trial to confirm these preliminary findings. If confirmed, then many deaths could be prevented every year."
The findings were presented at the annual meeting of the Society for Endocrinology, April 2011
This study is important because low testosterone is a common complication of Type 2 diabetes and treating this problem could save the lives of countless men.
A testosterone test may provide men with Type 2 diabetes a glimpse of their risk of dying young. New research has connected untreated deficiencies of the hormone to a higher risk of death among this group.
The University of Sheffield researchers who conducted the study said that their findings are important because testosterone deficiencies are a known complication of diabetes. Many men with the condition suffer from hormonal problems. The findings indicate that more of these men should be receiving treatment.
For the study, the researchers examined the hormone levels of 587 men with Type 2 diabetes. The participants were classified as having healthy testosterone levels, receiving treatment for deficiencies or having untreated low levels. The men were then followed for six years.
During the course of the study, men who went untreated for testosterone deficiency were more than twice as likely to die, compared to those who had normal levels of the hormone. Participants who were on testosterone replacement therapy were the least likely to die.
The results showed that 20 percent of the participants with untreated testosterone deficiencies died during the study, while only 9 percent of those with normal levels died during the testing period. Just 8.6 percent of men who were being treated for hormone deficiencies passed away during the study.
The researchers said that their findings may help advance the understanding of complications that can arise in diabetics from hormone deficiencies.
Professor Hugh Jones, who led the investigation, said that the findings are important, but they are likely the tip of the iceberg when it comes to complications associated with low testosterone in men with Type 2 diabetes. There have been few investigations into how hormone deficiencies affect men with the condition.
"It is well known that men with Type 2 diabetes often have low testosterone levels, so it is important that we investigate the health implications of this," he said. "We now need to carry out a larger clinical trial to confirm these preliminary findings. If confirmed, then many deaths could be prevented every year."
The findings were presented at the annual meeting of the Society for Endocrinology, April 2011
Wednesday, June 22, 2011
Short-term study shows better results with PRP vs. cortisone for plantar fasciitis
COPENHAGEN — According to a presentation here, an injection of platelet-rich plasma resulted in better foot and ankle scores than cortisone in patients with severe chronic plantar fasciitis.
“I decided to apply the use of platelets and platelet-rich plasma (PRP) technology in this type of refractory case,” Raymond R. Monto, MD, said at the 12th EFORT Congress 2011. “How does it work? We are probably seeing modulation at least of angiogenesis of collagen turnover and some tissue healing.”
In his level 2 study, Monto block randomized 40 patients with chronic plantar fasciitis to receive either a 40 mg cortisone injection or a PRP injection at the site of injury. The injections were guided by ultrasound.
The mean American Orthopaedic Foot & Ankle Society (AOFAS) scores of in the cortisone group increased from 52 points pre-injection to 81 points at 3-months post-treatment. However, Monto found that the score dropped to 74 points after 6 months. The pre-injection AOFAS score of the PRP group increased from 37 points to 95 points at 3 months.
“I think the interesting finding here is that they maintained those high levels of results,” Monto said, adding that no patients were lost to follow-up or experienced complications.
“In this well-documented subset, PRP is significantly more effective than cortisone both in short- and long-term management for severe chronic plantar fasciitis,” he said.
Reference:
Monto RR. Platelet rich plasma is more effective than cortisone injection for chronic plantar fasciitis. Paper #652. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.
“I decided to apply the use of platelets and platelet-rich plasma (PRP) technology in this type of refractory case,” Raymond R. Monto, MD, said at the 12th EFORT Congress 2011. “How does it work? We are probably seeing modulation at least of angiogenesis of collagen turnover and some tissue healing.”
In his level 2 study, Monto block randomized 40 patients with chronic plantar fasciitis to receive either a 40 mg cortisone injection or a PRP injection at the site of injury. The injections were guided by ultrasound.
The mean American Orthopaedic Foot & Ankle Society (AOFAS) scores of in the cortisone group increased from 52 points pre-injection to 81 points at 3-months post-treatment. However, Monto found that the score dropped to 74 points after 6 months. The pre-injection AOFAS score of the PRP group increased from 37 points to 95 points at 3 months.
“I think the interesting finding here is that they maintained those high levels of results,” Monto said, adding that no patients were lost to follow-up or experienced complications.
“In this well-documented subset, PRP is significantly more effective than cortisone both in short- and long-term management for severe chronic plantar fasciitis,” he said.
Reference:
Monto RR. Platelet rich plasma is more effective than cortisone injection for chronic plantar fasciitis. Paper #652. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.
Monday, June 20, 2011
New Guidelines on Best Treatments for Diabetic Nerve Pain
The American Academy of Neurology has issued a new guideline on the most effective treatments for diabetic nerve pain....
This guideline was developed in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation.
Diabetic nerve pain, or neuropathy, is caused by nerve damage. "When neuropathy strikes, it is painful and can disrupt sleep; because of this it can also lead to mood changes and lower quality of life," said lead guideline author Vera Bril, MD, FRCP, with the University of Toronto and a member of the American Academy of Neurology. "It is estimated that diabetic nerve pain affects 16 percent of the more than 25 million people living with diabetes in the United States and is often unreported and more often untreated, with an estimated two out of five cases not receiving care."
According to the guideline, strong evidence shows the seizure drug pregabalin is effective in treating diabetic nerve pain and can improve quality of life; however, doctors should determine if it is appropriate for their patients on a case-by-case basis.
In addition, the guideline found that several other treatments are probably effective and should be considered, including the seizure drugs gabapentin and valproate, antidepressants such as venlafaxine, duloxetine and amitriptyline and painkillers such as opioids and capsaicin. Transcutaneous electric nerve stimulation (TENS), a widely used pain therapy involving a portable device, was also found to be probably effective for treating diabetic nerve pain.
"We were pleased to see that so many of these pain treatments had high-quality studies that support their use," said Bril. "Still, it is important that more research be done to show how well these treatments can be tolerated over time since diabetic nerve pain is a chronic condition that affects a person's quality of life and ability to function."
The recommendations of this guideline will serve as the foundation for a new set of tools the AAN is creating for doctors to measure the quality of care they provide people with nerve pain. The measures will be released in 2012.
The following is a snapshot of the strong evidence (Level A) and moderate evidence (Level B) recommendations that were in the guidelines released by the AAN:
The guideline is published in the April 11, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology, and was presented April 11, 2011, at the American Academy of Neurology's Annual Meeting in Honolulu.
Bril, J. England, G. M. Franklin, M. Backonja, J. Cohen, D. Del Toro, E. Feldman, D. J. Iverson, B. Perkins, J. W. Russell, D. Zochodne. Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology, 2011; DOI: 10.1212/WNL.0b013e3182166ebe
This guideline was developed in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation.
Diabetic nerve pain, or neuropathy, is caused by nerve damage. "When neuropathy strikes, it is painful and can disrupt sleep; because of this it can also lead to mood changes and lower quality of life," said lead guideline author Vera Bril, MD, FRCP, with the University of Toronto and a member of the American Academy of Neurology. "It is estimated that diabetic nerve pain affects 16 percent of the more than 25 million people living with diabetes in the United States and is often unreported and more often untreated, with an estimated two out of five cases not receiving care."
According to the guideline, strong evidence shows the seizure drug pregabalin is effective in treating diabetic nerve pain and can improve quality of life; however, doctors should determine if it is appropriate for their patients on a case-by-case basis.
In addition, the guideline found that several other treatments are probably effective and should be considered, including the seizure drugs gabapentin and valproate, antidepressants such as venlafaxine, duloxetine and amitriptyline and painkillers such as opioids and capsaicin. Transcutaneous electric nerve stimulation (TENS), a widely used pain therapy involving a portable device, was also found to be probably effective for treating diabetic nerve pain.
"We were pleased to see that so many of these pain treatments had high-quality studies that support their use," said Bril. "Still, it is important that more research be done to show how well these treatments can be tolerated over time since diabetic nerve pain is a chronic condition that affects a person's quality of life and ability to function."
The recommendations of this guideline will serve as the foundation for a new set of tools the AAN is creating for doctors to measure the quality of care they provide people with nerve pain. The measures will be released in 2012.
The following is a snapshot of the strong evidence (Level A) and moderate evidence (Level B) recommendations that were in the guidelines released by the AAN:
The guideline is published in the April 11, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology, and was presented April 11, 2011, at the American Academy of Neurology's Annual Meeting in Honolulu.
Bril, J. England, G. M. Franklin, M. Backonja, J. Cohen, D. Del Toro, E. Feldman, D. J. Iverson, B. Perkins, J. W. Russell, D. Zochodne. Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology, 2011; DOI: 10.1212/WNL.0b013e3182166ebe
Sunday, June 19, 2011
Stress Predicts Development of Impaired Glucose Metabolism
Perceived stress and stressful life events predict the development of impaired glucose metabolism (IGM) over 5 years in previously normoglycemic individuals, according to results from the Australian Diabetes, Obesity, and Lifestyle study AusDiab)....
The study by Emily Williams, PhD, Monash University, Melbourne, Australia, showed that perceived stress increased the risk for incident IGM over 5 years by between 1.04 and 1.06, depending on the model used. Using the same models, high levels of stressful life events also increased the risk for incident IGM by between 1.24 and 1.35 in the same longitudinal cohort.
Dr. Williams reported that, "The effect size sounds quite small but for every point increase [in these models], there is a 4% increased risk of developing IGM, so stress is quite a strong risk factor for IGM." "And we think stress management should be incorporated into multiple health behavioral interventions for the most effective prevention and management of diabetes."
AusDiab included 11,247 adults older than 25 years who were randomly selected from 42 areas of Australia. At baseline, a 2-hour, 75-g oral glucose tolerance test was given along with the Perceived Stress Questionnaire and a life events score to measure psychosocial adversity.
At 5 years, more than 6,500 of the original participants returned for follow-up during which another 2-hour oral glucose test was taken and the questionnaires re-administered.
"We used the outcome of a polled analysis of fasting glucose, impaired glucose tolerance, and diabetes to have a larger category of impaired glucose metabolism to try and tap into a wider range of abnormal glucose metabolism, and by measuring perceived stress as well as the experience of stress, we tried to measure both objective and subjective markers of stress. Only subjects who were normoglycemic at baseline were included in the analyses," said Dr. Williams.
At 5-year follow-up, 474 subjects had progressed to IGM. Adjusting for age, sex, and education, logistic regression analyses showed that perceived stress increased the odds of IGM by 1.06. Controlling for the same variables, those reporting high levels of stressful life events were 34% more likely to have developed IGM at 5 years compared with those reporting low levels of stressful life events.
When health behaviors were added to the model, results showed that perceived stress increased the odds of IGM by 1.05. The same model also showed that those reporting high levels of stressful life events had a 35% higher risk of developing IGM compared with those reporting low levels of stressful life events. Adding obesity to the mix attenuated the effect of perceived stress as a risk factor for IGM but not by much, at an odds ratio of 1.04.
Similarly, obesity slightly attenuated the risk for stressful life events contributing to IGM at an odds ratio of 1.26. Lastly, when all variables plus traditional cardiovascular disease (CVD) risk factors were added to the analysis, perceived stress still had the same effect on IGM risk at an odds ratio of 1.04. Again, compared with those who reported low levels of stressful life events, those reporting high levels of stressful life events had a 24% greater chance of developing IGM at 5 years when analyzed in the final model.
Table 1. Perceived Stress as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1: Age, sex, education
1.06
Model 1 plus health behaviors (model 2)
1.05
Model 2 plus obesity (model 3)
1.04
Model 3 plus cardiovascular disease risk factors (model 4)
1.04
Table 2. Stressful Life Events as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1 low life stress vs high life stress
1.34
Model 2 low life stress vs high life stress
1.35
Model 3 low life stress vs high life stress
1.26
Model 4 low life stress vs high life stress
1.24
Investigators also evaluated how stress affected glycemic control over time among subjects who already had diabetes at baseline. Interestingly, said Dr. Williams, there no relationships between stress and glycemic control was observed in men, but among women with diabetes at baseline, both perceived stress and stressful life events were shown to predict elevated glycosylated hemoglobin at follow-up, after adjustment for other risk factors (P = .024).
Dr. Williams stated that, "All of the evidence in CVD suggests that stress is a key independent risk factor for the development of heart disease, but it hasn't been done in diabetes, and yet they are on the same chronic disease trajectory. "So there is no reason to think stress isn't involved in the development of diabetes too and even more so because diabetes requires so much daily management it's bound to affect a person's experience."
The study by Emily Williams, PhD, Monash University, Melbourne, Australia, showed that perceived stress increased the risk for incident IGM over 5 years by between 1.04 and 1.06, depending on the model used. Using the same models, high levels of stressful life events also increased the risk for incident IGM by between 1.24 and 1.35 in the same longitudinal cohort.
Dr. Williams reported that, "The effect size sounds quite small but for every point increase [in these models], there is a 4% increased risk of developing IGM, so stress is quite a strong risk factor for IGM." "And we think stress management should be incorporated into multiple health behavioral interventions for the most effective prevention and management of diabetes."
AusDiab included 11,247 adults older than 25 years who were randomly selected from 42 areas of Australia. At baseline, a 2-hour, 75-g oral glucose tolerance test was given along with the Perceived Stress Questionnaire and a life events score to measure psychosocial adversity.
At 5 years, more than 6,500 of the original participants returned for follow-up during which another 2-hour oral glucose test was taken and the questionnaires re-administered.
"We used the outcome of a polled analysis of fasting glucose, impaired glucose tolerance, and diabetes to have a larger category of impaired glucose metabolism to try and tap into a wider range of abnormal glucose metabolism, and by measuring perceived stress as well as the experience of stress, we tried to measure both objective and subjective markers of stress. Only subjects who were normoglycemic at baseline were included in the analyses," said Dr. Williams.
At 5-year follow-up, 474 subjects had progressed to IGM. Adjusting for age, sex, and education, logistic regression analyses showed that perceived stress increased the odds of IGM by 1.06. Controlling for the same variables, those reporting high levels of stressful life events were 34% more likely to have developed IGM at 5 years compared with those reporting low levels of stressful life events.
When health behaviors were added to the model, results showed that perceived stress increased the odds of IGM by 1.05. The same model also showed that those reporting high levels of stressful life events had a 35% higher risk of developing IGM compared with those reporting low levels of stressful life events. Adding obesity to the mix attenuated the effect of perceived stress as a risk factor for IGM but not by much, at an odds ratio of 1.04.
Similarly, obesity slightly attenuated the risk for stressful life events contributing to IGM at an odds ratio of 1.26. Lastly, when all variables plus traditional cardiovascular disease (CVD) risk factors were added to the analysis, perceived stress still had the same effect on IGM risk at an odds ratio of 1.04. Again, compared with those who reported low levels of stressful life events, those reporting high levels of stressful life events had a 24% greater chance of developing IGM at 5 years when analyzed in the final model.
Table 1. Perceived Stress as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1: Age, sex, education
1.06
Model 1 plus health behaviors (model 2)
1.05
Model 2 plus obesity (model 3)
1.04
Model 3 plus cardiovascular disease risk factors (model 4)
1.04
Table 2. Stressful Life Events as a Risk Factor for Impaired Glucose Metabolism
Controlling for
Odds Ratio
Model 1 low life stress vs high life stress
1.34
Model 2 low life stress vs high life stress
1.35
Model 3 low life stress vs high life stress
1.26
Model 4 low life stress vs high life stress
1.24
Investigators also evaluated how stress affected glycemic control over time among subjects who already had diabetes at baseline. Interestingly, said Dr. Williams, there no relationships between stress and glycemic control was observed in men, but among women with diabetes at baseline, both perceived stress and stressful life events were shown to predict elevated glycosylated hemoglobin at follow-up, after adjustment for other risk factors (P = .024).
Dr. Williams stated that, "All of the evidence in CVD suggests that stress is a key independent risk factor for the development of heart disease, but it hasn't been done in diabetes, and yet they are on the same chronic disease trajectory. "So there is no reason to think stress isn't involved in the development of diabetes too and even more so because diabetes requires so much daily management it's bound to affect a person's experience."
Saturday, June 18, 2011
Study Find that People Who Stay Up Late Eat More, Eat Worse
Staying up late at night can lead to an additional two pounds a month weight gain....
The study showed that people who go to bed late eat more food, have worse diets and are more likely to have a higher body mass index.
Many studies over the last 10 years have pointed to the need for people to sleep when they're supposed to (at night) and to sleep for the needed amount of time -- about eight hours for adults. Keeping a healthy sleep schedule allows the body's circadian rhythms to stay in sync and keeps a range of metabolic and physiological systems running smoothly.
The new study adds to the sleep-weight connection. Northwestern University scientists examined 52 adults on their sleep and dietary patterns. More than half of the participants were normal sleepers -- meaning that the midpoint of sleep occurred at or before 5:30 a.m. Late sleepers (44% of the sample) got less sleep and went to sleep later.
Late sleepers consumed more calories at dinner and after 8 p.m., ate more fast food, drank more high-calorie soft drinks and had lower fruit and vegetable consumption. Overall, late sleepers consumed 248 more calories per day than normal sleepers. The late sleepers tended to eat less in the morning, then steeply increased their caloric intake in the afternoon and evening. It's not clear, however, whether the late sleepers ate more unhealthy foods at night because they preferred them or because they had limited choices of food at later hours.
Dr. Phyllis Zee said, in a news release, that, "The study reinforces that age-old wisdom that when you eat is important." "When sleep and eating are not aligned with the body's internal clock, it can lead to changes in appetite and metabolism."
The study showed that people who go to bed late eat more food, have worse diets and are more likely to have a higher body mass index.
Many studies over the last 10 years have pointed to the need for people to sleep when they're supposed to (at night) and to sleep for the needed amount of time -- about eight hours for adults. Keeping a healthy sleep schedule allows the body's circadian rhythms to stay in sync and keeps a range of metabolic and physiological systems running smoothly.
The new study adds to the sleep-weight connection. Northwestern University scientists examined 52 adults on their sleep and dietary patterns. More than half of the participants were normal sleepers -- meaning that the midpoint of sleep occurred at or before 5:30 a.m. Late sleepers (44% of the sample) got less sleep and went to sleep later.
Late sleepers consumed more calories at dinner and after 8 p.m., ate more fast food, drank more high-calorie soft drinks and had lower fruit and vegetable consumption. Overall, late sleepers consumed 248 more calories per day than normal sleepers. The late sleepers tended to eat less in the morning, then steeply increased their caloric intake in the afternoon and evening. It's not clear, however, whether the late sleepers ate more unhealthy foods at night because they preferred them or because they had limited choices of food at later hours.
Dr. Phyllis Zee said, in a news release, that, "The study reinforces that age-old wisdom that when you eat is important." "When sleep and eating are not aligned with the body's internal clock, it can lead to changes in appetite and metabolism."
Thursday, June 16, 2011
A1c Predicts Diabetic Wound Healing
Worse glycemic control correlated with slower wound healing in patients with diabetes. Every 1% increase in HbA1c was associated with -0.028 cm2decrement in the daily change in wound area....
Every 1% increase in hemoglobin A1c was associated with almost a 0.03 cm2reduction in daily rate of wound resolution. Diabetic patients with peripheral neuropathy or peripheral arterial disease (PAD) were especially susceptible to the impact of glycemic control on wound healing.
In a multivariate analysis, hemoglobin A1c, used as a surrogate for glycemic control, was the only independent predictor of change in wound area, according to a report.
Anna L. Christman, BA, of Johns Hopkins University in Baltimore, stated that, "Our results suggest that better glycemic control could help wound healing in diabetic patients, but that would have to be confirmed in a prospective clinical study."
"It would seem logical that glycemic control would affect wound healing, but to our knowledge, this is the first time the association has been clearly demonstrated," she added.
"Previous studies had evaluated the effect of glucose levels on the risk of amputation, and the results were inconsistent. Ours is the first study to use digital imaging of wounds to examine the association."
Diabetes continues to be a major contributor to lower-leg amputations, ranking second only to trauma as a cause. The necessity of amputation in diabetic patients arises from disease-related neuropathy and vasculopathy.
Identification of modifiable factors that influence wound healing could help reduce the need for amputation, Christman and colleagues noted in a poster presentation. To that end, they performed a retrospective cohort study to identify clinical variables associated with wound healing.
Investigators hypothesized that elevated A1c levels would be the strongest predictor of poor wound healing among common laboratory and clinical measures.
The study involved 183 diabetic patients with an average of 310 wounds and a total wound area that averaged 7.2 cm2. Clinical evaluation of the patients included blood pressure, pulse, temperature, and assessment of peripheral neuropathy status. Laboratory values of interest included HbA1c, total cholesterol, LDL, HDL, triglycerides, and white blood-cell count, as well as body mass index (BMI), smoking status, and presence of PAD.
The primary outcome was the change in the size of the wound area as determined by calibrated tracings of digital images. The impact of clinical variables on wound healing was assessed by multiple linear regression and investigators stratified the results by peripheral neuropathy status and PAD status.
The patients had a mean age of 61, with men and whites each accounting for 55% of the study population. The BMI averaged 35. The mean HbA1c was 8.0%, including 71 patients with values more than 7%, 42 patients with levels of 7.0 to 8.0%, and 70 with HbA1c values >8%.
A majority of the study group (60%) had peripheral neuropathy and 29% had PAD. The patients had an average of 2.3 wounds with a total wound area of 7.2 cm2.
In the overall analysis, HbA1c remained the only significant predictor of the change in wound area per day. Every 1% increase in HbA1c was associated with -0.028 cm2 decrement in the daily change in wound area (P=0.03).
The association remained significant in the stratified analyses. Among patients with peripheral neuropathy, each 1.0% increase in HbA1c was associated with a 0.022 cm2 decrease in the daily wound-healing rate (P=0.043).
Patients with PAD had a decrease in healing rate of 0.030 cm2 for every 1% increase in HbA1c (P=0.046).
Practice Pearls
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that a retrospective cohort study found diabetics with higher HbA1c had a significantly slower rate of wound healing than those with lower HbA1c.
Note that wound healing rates were calculated from calibrated tracings of digital wound images
Christman AL, et al "Hemoglobin A1ac predicts healing rate in diabetic wounds" SID 2011; Abstract 204
Every 1% increase in hemoglobin A1c was associated with almost a 0.03 cm2reduction in daily rate of wound resolution. Diabetic patients with peripheral neuropathy or peripheral arterial disease (PAD) were especially susceptible to the impact of glycemic control on wound healing.
In a multivariate analysis, hemoglobin A1c, used as a surrogate for glycemic control, was the only independent predictor of change in wound area, according to a report.
Anna L. Christman, BA, of Johns Hopkins University in Baltimore, stated that, "Our results suggest that better glycemic control could help wound healing in diabetic patients, but that would have to be confirmed in a prospective clinical study."
"It would seem logical that glycemic control would affect wound healing, but to our knowledge, this is the first time the association has been clearly demonstrated," she added.
"Previous studies had evaluated the effect of glucose levels on the risk of amputation, and the results were inconsistent. Ours is the first study to use digital imaging of wounds to examine the association."
Diabetes continues to be a major contributor to lower-leg amputations, ranking second only to trauma as a cause. The necessity of amputation in diabetic patients arises from disease-related neuropathy and vasculopathy.
Identification of modifiable factors that influence wound healing could help reduce the need for amputation, Christman and colleagues noted in a poster presentation. To that end, they performed a retrospective cohort study to identify clinical variables associated with wound healing.
Investigators hypothesized that elevated A1c levels would be the strongest predictor of poor wound healing among common laboratory and clinical measures.
The study involved 183 diabetic patients with an average of 310 wounds and a total wound area that averaged 7.2 cm2. Clinical evaluation of the patients included blood pressure, pulse, temperature, and assessment of peripheral neuropathy status. Laboratory values of interest included HbA1c, total cholesterol, LDL, HDL, triglycerides, and white blood-cell count, as well as body mass index (BMI), smoking status, and presence of PAD.
The primary outcome was the change in the size of the wound area as determined by calibrated tracings of digital images. The impact of clinical variables on wound healing was assessed by multiple linear regression and investigators stratified the results by peripheral neuropathy status and PAD status.
The patients had a mean age of 61, with men and whites each accounting for 55% of the study population. The BMI averaged 35. The mean HbA1c was 8.0%, including 71 patients with values more than 7%, 42 patients with levels of 7.0 to 8.0%, and 70 with HbA1c values >8%.
A majority of the study group (60%) had peripheral neuropathy and 29% had PAD. The patients had an average of 2.3 wounds with a total wound area of 7.2 cm2.
In the overall analysis, HbA1c remained the only significant predictor of the change in wound area per day. Every 1% increase in HbA1c was associated with -0.028 cm2 decrement in the daily change in wound area (P=0.03).
The association remained significant in the stratified analyses. Among patients with peripheral neuropathy, each 1.0% increase in HbA1c was associated with a 0.022 cm2 decrease in the daily wound-healing rate (P=0.043).
Patients with PAD had a decrease in healing rate of 0.030 cm2 for every 1% increase in HbA1c (P=0.046).
Practice Pearls
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Explain that a retrospective cohort study found diabetics with higher HbA1c had a significantly slower rate of wound healing than those with lower HbA1c.
Note that wound healing rates were calculated from calibrated tracings of digital wound images
Christman AL, et al "Hemoglobin A1ac predicts healing rate in diabetic wounds" SID 2011; Abstract 204
Wednesday, June 15, 2011
Diet Soft Drinks Not Linked to Type 2 Diabetes
New research demonstrates that the consumption of diet soft drinks is not associated with an increased risk of type 2 diabetes....
The study adds weight to the significant research using low-calorie sweeteners that has shown intake of these ingredients does not affect the development of type 2 diabetes. The authors concluded, "This supports our hypothesis that participants use artificially sweetened beverages as dieting aids or because of poor health. A lack of adjustment for these [health and lifestyle] factors may therefore have contributed to illusory associations [between diet soda consumption and type 2 diabetes] in other studies." They further noted, "The association between artificially sweetened beverages and type 2 diabetes was largely explained by health status, pre-enrollment weight change, dieting, and body mass index."
The researchers followed 40,389 adult men enrolled in the Health Professionals Follow-Up study from 1986 until 2006, to examine the associations between the normal consumption of sugar-sweetened beverages and diet soft drinks and the development of type 2 diabetes.
The data from 2,680 reported cases of type 2 diabetes developed over the 20-year study seemed to indicate that both types of beverages were associated with an increased incidence of type 2 diabetes. However, after adjusting for the health and lifestyle factors, including family history of type 2 diabetes, smoking, physical activity, high triglycerides, high blood pressure, diuretic use, body mass index (BMI), and total calorie intake, the Harvard University researchers found no significant association between diet soft drinks and incidence of type 2 diabetes.
Major health organizations including the American Diabetes Association and the American Dietetic Association support the use of low-calorie sweeteners for people with diabetes to control calorie intake. The American Dietetic Association states in its position paper on the use of nutritive and nonnutritive sweeteners, "Nonnutritive sweeteners are appropriate in medical nutrition therapy for people with diabetes and may help control energy intake." The statement further notes, "Nonnutritive sweeteners do not affect glycemic response and can be safely used by those with diabetes." "When used as part of an overall healthy diet, low-calorie sweeteners, diet soft drinks and other light products can be beneficial tools in helping people control caloric intake and weight," adds Beth Hubrich, a registered dietitian with the Calorie Control Council, an international trade association.
American Journal of Clinical Nutrition, May 2011
The study adds weight to the significant research using low-calorie sweeteners that has shown intake of these ingredients does not affect the development of type 2 diabetes. The authors concluded, "This supports our hypothesis that participants use artificially sweetened beverages as dieting aids or because of poor health. A lack of adjustment for these [health and lifestyle] factors may therefore have contributed to illusory associations [between diet soda consumption and type 2 diabetes] in other studies." They further noted, "The association between artificially sweetened beverages and type 2 diabetes was largely explained by health status, pre-enrollment weight change, dieting, and body mass index."
The researchers followed 40,389 adult men enrolled in the Health Professionals Follow-Up study from 1986 until 2006, to examine the associations between the normal consumption of sugar-sweetened beverages and diet soft drinks and the development of type 2 diabetes.
The data from 2,680 reported cases of type 2 diabetes developed over the 20-year study seemed to indicate that both types of beverages were associated with an increased incidence of type 2 diabetes. However, after adjusting for the health and lifestyle factors, including family history of type 2 diabetes, smoking, physical activity, high triglycerides, high blood pressure, diuretic use, body mass index (BMI), and total calorie intake, the Harvard University researchers found no significant association between diet soft drinks and incidence of type 2 diabetes.
Major health organizations including the American Diabetes Association and the American Dietetic Association support the use of low-calorie sweeteners for people with diabetes to control calorie intake. The American Dietetic Association states in its position paper on the use of nutritive and nonnutritive sweeteners, "Nonnutritive sweeteners are appropriate in medical nutrition therapy for people with diabetes and may help control energy intake." The statement further notes, "Nonnutritive sweeteners do not affect glycemic response and can be safely used by those with diabetes." "When used as part of an overall healthy diet, low-calorie sweeteners, diet soft drinks and other light products can be beneficial tools in helping people control caloric intake and weight," adds Beth Hubrich, a registered dietitian with the Calorie Control Council, an international trade association.
American Journal of Clinical Nutrition, May 2011
Deadly Fungus Strikes Joplin Tornado Survivors, Volunteers
William Browning William Browning – Thu Jun 9, 2:16 pm ET
Contribute content like this. Start here.
The Greene County (Mo.) Health Department has issued a memo to health care workers who are treating injured victims of May's deadly Joplin tornado, warning them that a powerful fungus has infected patients' wounds.
The Springfield News-Leader reports as many as nine cases have been reported in tornado victims across the area in various hospitals. Once the aggressive fungus -- called zygomycosis -- enters the body, it causes the death of infected cells. Three or four patients, who otherwise would have survived their wounds, have died from it.
If the fungus stays in a limb, like an arm or leg, some treatments have necessitated amputation to save the patient. Others with wounds near the head weren't so lucky -- as soon as brain tissue started dying, it was too late to save the patient.
The National Institutes of Health says this rapid form of infection most often occurs in patients with suppressed immune systems. One study in 2009 noted a diabetes patient who died of the fungal infection at age 48. Despite being treated early, the man's health rapidly declined as the fungus spread through his lungs.
Infections spread through the blood and affects blood circulation. It is unknown how many people may be suffering from infections, but the problem doesn't stop with those injured by the tornado.
KYTV in Springfield reports those helping with cleanup efforts may become scratched by nails or splinters and any fungus residue on those objects may infect someone.
Anyone with diabetes should be extremely careful. The National Institutes of Health lists severe symptoms of the infection: fever, headache, sinus pain, and swelling. Complications that can arise from these fungal infections include nerve damage, blindness, blood clots to the brain and lungs, or even death in extreme cases.
Cases of the deadly fungal infection have shown up in massive disasters before such as the 2004 tsunami off the coast of Indonesia. Health officials in Greene County stated in their memo that this particular infection is "invasive" and that aggressive treatment may be needed "within 24 hours" of reoccurring symptoms.
Any patients suspected of having this infection have been told to seek the guidance of a trauma surgeon or the infectious disease doctor on call.
William Browning, a lifelong Missouri resident, writes about local and state issues for the Yahoo! Contributor Network. Born in St. Louis, Browning earned his bachelor's degree in English from the University of Missouri. He currently resides in Branson.
Contribute content like this. Start here.
The Greene County (Mo.) Health Department has issued a memo to health care workers who are treating injured victims of May's deadly Joplin tornado, warning them that a powerful fungus has infected patients' wounds.
The Springfield News-Leader reports as many as nine cases have been reported in tornado victims across the area in various hospitals. Once the aggressive fungus -- called zygomycosis -- enters the body, it causes the death of infected cells. Three or four patients, who otherwise would have survived their wounds, have died from it.
If the fungus stays in a limb, like an arm or leg, some treatments have necessitated amputation to save the patient. Others with wounds near the head weren't so lucky -- as soon as brain tissue started dying, it was too late to save the patient.
The National Institutes of Health says this rapid form of infection most often occurs in patients with suppressed immune systems. One study in 2009 noted a diabetes patient who died of the fungal infection at age 48. Despite being treated early, the man's health rapidly declined as the fungus spread through his lungs.
Infections spread through the blood and affects blood circulation. It is unknown how many people may be suffering from infections, but the problem doesn't stop with those injured by the tornado.
KYTV in Springfield reports those helping with cleanup efforts may become scratched by nails or splinters and any fungus residue on those objects may infect someone.
Anyone with diabetes should be extremely careful. The National Institutes of Health lists severe symptoms of the infection: fever, headache, sinus pain, and swelling. Complications that can arise from these fungal infections include nerve damage, blindness, blood clots to the brain and lungs, or even death in extreme cases.
Cases of the deadly fungal infection have shown up in massive disasters before such as the 2004 tsunami off the coast of Indonesia. Health officials in Greene County stated in their memo that this particular infection is "invasive" and that aggressive treatment may be needed "within 24 hours" of reoccurring symptoms.
Any patients suspected of having this infection have been told to seek the guidance of a trauma surgeon or the infectious disease doctor on call.
William Browning, a lifelong Missouri resident, writes about local and state issues for the Yahoo! Contributor Network. Born in St. Louis, Browning earned his bachelor's degree in English from the University of Missouri. He currently resides in Branson.
Monday, June 13, 2011
Weight Gain between First and Second Pregnancies Increases Woman's Gestational Diabetes Risk
Compared with women whose weight remained stable, body mass index gains between the first and second pregnancy were associated with an increased risk of gestational diabetes mellitus in the second pregnancy....
But losing weight between the first and second pregnancies appeared to reduce GDM risk in a second pregnancy, particularly for women who were overweight or obese to begin.
GDM is associated with an increased risk of adverse perinatal outcomes as well as subsequent diabetes in women and their offspring, researchers say.
The study examined a diverse cohort of 22,351 women over a 10-year period. Women who gained 2.0-2.9 BMI units (approximately 12 to 17 pounds) between the first and second pregnancy were over two times more likely to develop GDM in the second pregnancy, compared with those whose weight remained stable (plus or minus 6 pounds between pregnancies). Women who gained 3.0 or more BMI units (approximately 18 or more pounds) between the first and second pregnancy were over three times more likely to develop GDM during the second pregnancy, compared with those whose weight remained stable.
Conversely, women who lost more than 6 pounds between the first and second pregnancy reduced their risk of developing GDM in the second pregnancy by approximately 50 percent compared with women whose weight remained stable. The association between losing weight and reduced GDM risk was strongest in women who were overweight or obese in their first pregnancy, explained the researchers.
Previous research has shown that excessive postpartum weight retention and lifestyle changes have been associated with a woman being overweight years after pregnancy, which increases the risk of developing non-insulin-dependent diabetes, said study lead investigator Samantha Ehrlich, MPH. Weight gain before pregnancy and gestational weight gain similarly have been shown to increase the risk of GDM. Additional research has shown that a pregnancy complicated by GDM is associated with a high risk of recurrent GDM in a subsequent pregnancy, explained Ehrlich, who is a PhD candidate in epidemiology at the University of California at Berkeley.
This study is the first to examine whether weight loss before a second pregnancy reduces the risk of recurrent GDM.
Women who lose BMI units between pregnancies appear to have a decreased risk of GDM in their second pregnancy, but there was significant variation by maternal overweight or obese status in the first pregnancy. Weight loss was associated with lower risk of GDM, primarily among women who were overweight or obese in their first pregnancy, Ehrlich said.
She explained that being overweight or obese prior to pregnancy is a well-established risk factor for GDM. Women of normal weight who go on to develop GDM are likely to be more genetically susceptible to the disease. Thus, lifestyle changes resulting in weight loss may not be as effective in reducing GDM risk among normal weight women, she added.
"The results also suggest that the effects of body mass gains may be greater among women of normal weight in their first pregnancy, whereas the effects of losses in body mass appear greater among overweight or obese women," Ehrlich said. "Taken together, the results support the avoidance of gestational weight retention and postpartum weight gain to decrease the risk of GDM in a second pregnancy, as well as the promotion of postpartum weight loss in overweight or obese women, particularly those with a history of GDM."
In the study, BMI change was calculated for each woman. The average height of women in the study was 5 feet 4 inches and one BMI unit corresponded to approximately 6 pounds for women of that height.
A study in the American Journal of Epidemiology found that cardio-metabolic risk factors such as high blood sugar and insulin, and low high-density lipoprotein cholesterol that are present before pregnancy, predict whether a woman will develop diabetes during a future pregnancy.
A study in The American Journal of Obstetrics and Gynecology found there is an increased risk of recurring gestational diabetes in pregnant women who developed gestational diabetes during their first and second pregnancies.
A study in Diabetes Care of 10,000 mother-child pairs showed that treating gestational diabetes during pregnancy can break the link between gestational diabetes and childhood obesity. That study showed, for the first time, that by treating women with gestational diabetes, the child's risk of becoming obese years later is significantly reduced.
A study in Obstetrics & Gynecology of 1,145 pregnant women found that women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in their pregnancy.
A study in Ethnicity & Disease of 16,000 women in Hawaii found that more than 10 percent of women of Chinese and Korean heritage may be at risk for developing gestational diabetes.
Obstetrics & Gynecology May 2011
But losing weight between the first and second pregnancies appeared to reduce GDM risk in a second pregnancy, particularly for women who were overweight or obese to begin.
GDM is associated with an increased risk of adverse perinatal outcomes as well as subsequent diabetes in women and their offspring, researchers say.
The study examined a diverse cohort of 22,351 women over a 10-year period. Women who gained 2.0-2.9 BMI units (approximately 12 to 17 pounds) between the first and second pregnancy were over two times more likely to develop GDM in the second pregnancy, compared with those whose weight remained stable (plus or minus 6 pounds between pregnancies). Women who gained 3.0 or more BMI units (approximately 18 or more pounds) between the first and second pregnancy were over three times more likely to develop GDM during the second pregnancy, compared with those whose weight remained stable.
Conversely, women who lost more than 6 pounds between the first and second pregnancy reduced their risk of developing GDM in the second pregnancy by approximately 50 percent compared with women whose weight remained stable. The association between losing weight and reduced GDM risk was strongest in women who were overweight or obese in their first pregnancy, explained the researchers.
Previous research has shown that excessive postpartum weight retention and lifestyle changes have been associated with a woman being overweight years after pregnancy, which increases the risk of developing non-insulin-dependent diabetes, said study lead investigator Samantha Ehrlich, MPH. Weight gain before pregnancy and gestational weight gain similarly have been shown to increase the risk of GDM. Additional research has shown that a pregnancy complicated by GDM is associated with a high risk of recurrent GDM in a subsequent pregnancy, explained Ehrlich, who is a PhD candidate in epidemiology at the University of California at Berkeley.
This study is the first to examine whether weight loss before a second pregnancy reduces the risk of recurrent GDM.
Women who lose BMI units between pregnancies appear to have a decreased risk of GDM in their second pregnancy, but there was significant variation by maternal overweight or obese status in the first pregnancy. Weight loss was associated with lower risk of GDM, primarily among women who were overweight or obese in their first pregnancy, Ehrlich said.
She explained that being overweight or obese prior to pregnancy is a well-established risk factor for GDM. Women of normal weight who go on to develop GDM are likely to be more genetically susceptible to the disease. Thus, lifestyle changes resulting in weight loss may not be as effective in reducing GDM risk among normal weight women, she added.
"The results also suggest that the effects of body mass gains may be greater among women of normal weight in their first pregnancy, whereas the effects of losses in body mass appear greater among overweight or obese women," Ehrlich said. "Taken together, the results support the avoidance of gestational weight retention and postpartum weight gain to decrease the risk of GDM in a second pregnancy, as well as the promotion of postpartum weight loss in overweight or obese women, particularly those with a history of GDM."
In the study, BMI change was calculated for each woman. The average height of women in the study was 5 feet 4 inches and one BMI unit corresponded to approximately 6 pounds for women of that height.
A study in the American Journal of Epidemiology found that cardio-metabolic risk factors such as high blood sugar and insulin, and low high-density lipoprotein cholesterol that are present before pregnancy, predict whether a woman will develop diabetes during a future pregnancy.
A study in The American Journal of Obstetrics and Gynecology found there is an increased risk of recurring gestational diabetes in pregnant women who developed gestational diabetes during their first and second pregnancies.
A study in Diabetes Care of 10,000 mother-child pairs showed that treating gestational diabetes during pregnancy can break the link between gestational diabetes and childhood obesity. That study showed, for the first time, that by treating women with gestational diabetes, the child's risk of becoming obese years later is significantly reduced.
A study in Obstetrics & Gynecology of 1,145 pregnant women found that women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in their pregnancy.
A study in Ethnicity & Disease of 16,000 women in Hawaii found that more than 10 percent of women of Chinese and Korean heritage may be at risk for developing gestational diabetes.
Obstetrics & Gynecology May 2011
Sunday, June 12, 2011
Broccoli Sprouts Have Benefits for Diabetes Patients
Broccoli sprouts may boost antioxidant defenses in people with diabetes....
According to findings, a daily dose of five or 10 grams of the broccoli sprout powder was associated with an increase in the total antioxidant capacity of the blood, and reductions in malondialdehyde (MDA), a reactive carbonyl compound and a well-established marker of oxidative stress. The study adds to the growing body of science supporting the potential health benefits of broccoli and broccoli sprouts, most often touted for their potential anti-cancer activity.
The tissue of cruciferous vegetables, like broccoli, cauliflower, cabbage and Brussels sprouts, contain high levels of the active plant chemicals glucosinolates. These are metabolized by the body into isothiocyanates, which are known to be antioxidants and powerful anti-carcinogens. The main isothiocyanate from broccoli is sulphoraphane.
The new study employed a broccoli sprout powder that provided a dose of sulphoraphane isothiocyanates of 22.5 micromoles per gram, and looked at the potential antioxidant activity of broccoli sprout powder to counter oxidative stress in diabetics.
Oxygen-breathing organisms naturally produce reactive oxygen species (ROS), which play an important role in a range of functions, including cell signaling. However, over production of these ROS from smoking, pollution, sunlight, high intensity exercise, or simply ageing, may overwhelm the body's antioxidant defenses and lead to oxidative stress.
Oxidative stress has been linked to an increased risk of various diseases including cancer, Alzheimer's, and cardiovascular disease.
Researchers also note that oxidative stress is a key driver in the onset of insulin resistance, which ultimately leads to diabetes. Diabetes itself is associated with increased levels of oxidative stress, and this can promote the development of diabetes-related complications
Researchers from the National Nutrition and Food Technology Research Institute at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, recruited 81 diabetics to participate in their double-blind, placebo-controlled, randomized clinical trial.
Participants were randomly assigned to receive either five or 10 grams per day of the broccoli sprout powder, or placebo, for four weeks.
Results showed that both broccoli groups experienced significant decreases in MDA, a well-established marker of oxidative stress, as well as reductions in levels of oxidized LDL cholesterol, another oxidative stress marker.
The doses used in this study provided 225 micromoles and 112 micromoles sulforaphane isothiocyanates daily per 10 g and 5 g broccoli sprout doses, respectively.
European Journal of Clinical Nutrition; "Broccoli sprouts reduce oxidative stress in type 2 diabetes: a randomized double-blind clinical trial" Z Bahadoran, P Mirmira, et al
According to findings, a daily dose of five or 10 grams of the broccoli sprout powder was associated with an increase in the total antioxidant capacity of the blood, and reductions in malondialdehyde (MDA), a reactive carbonyl compound and a well-established marker of oxidative stress. The study adds to the growing body of science supporting the potential health benefits of broccoli and broccoli sprouts, most often touted for their potential anti-cancer activity.
The tissue of cruciferous vegetables, like broccoli, cauliflower, cabbage and Brussels sprouts, contain high levels of the active plant chemicals glucosinolates. These are metabolized by the body into isothiocyanates, which are known to be antioxidants and powerful anti-carcinogens. The main isothiocyanate from broccoli is sulphoraphane.
The new study employed a broccoli sprout powder that provided a dose of sulphoraphane isothiocyanates of 22.5 micromoles per gram, and looked at the potential antioxidant activity of broccoli sprout powder to counter oxidative stress in diabetics.
Oxygen-breathing organisms naturally produce reactive oxygen species (ROS), which play an important role in a range of functions, including cell signaling. However, over production of these ROS from smoking, pollution, sunlight, high intensity exercise, or simply ageing, may overwhelm the body's antioxidant defenses and lead to oxidative stress.
Oxidative stress has been linked to an increased risk of various diseases including cancer, Alzheimer's, and cardiovascular disease.
Researchers also note that oxidative stress is a key driver in the onset of insulin resistance, which ultimately leads to diabetes. Diabetes itself is associated with increased levels of oxidative stress, and this can promote the development of diabetes-related complications
Researchers from the National Nutrition and Food Technology Research Institute at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, recruited 81 diabetics to participate in their double-blind, placebo-controlled, randomized clinical trial.
Participants were randomly assigned to receive either five or 10 grams per day of the broccoli sprout powder, or placebo, for four weeks.
Results showed that both broccoli groups experienced significant decreases in MDA, a well-established marker of oxidative stress, as well as reductions in levels of oxidized LDL cholesterol, another oxidative stress marker.
The doses used in this study provided 225 micromoles and 112 micromoles sulforaphane isothiocyanates daily per 10 g and 5 g broccoli sprout doses, respectively.
European Journal of Clinical Nutrition; "Broccoli sprouts reduce oxidative stress in type 2 diabetes: a randomized double-blind clinical trial" Z Bahadoran, P Mirmira, et al
Saturday, June 11, 2011
Lowering Fat Intake Might Stave off Diabetes Even without Weight Loss
Small differences in diet -- even without weight loss -- can significantly affect risk for diabetes....
In this study, 69 healthy, overweight people who did not have diabetes -- but were at risk for it -- were placed on diets with modest reductions in either fat or carbohydrate for eight weeks.
Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at University of Alabama at Birmingham and lead author of the study noted that, "At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity." "These improvements indicate a decreased risk for diabetes."
Gower says the unique aspect of this study is that the results were independent of weight loss.
The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.
"People find it hard to lose weight," said Gower. "What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes."
The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.
Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate. The lower carb group's diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.
"The diets used in this study were actually fairly moderate," said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. "Individuals at risk for diabetes easily could adopt the lower fat diet we employed. Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease."
A typical dinner meal on the lower fat diet would include sesame chicken with rice, snow peas and carrots, frozen broccoli, fat-free cheese, oranges and a dinner roll.
Gower says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.
Published online May 18, 2011, by the American Journal of Clinical Nutrition
In this study, 69 healthy, overweight people who did not have diabetes -- but were at risk for it -- were placed on diets with modest reductions in either fat or carbohydrate for eight weeks.
Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at University of Alabama at Birmingham and lead author of the study noted that, "At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity." "These improvements indicate a decreased risk for diabetes."
Gower says the unique aspect of this study is that the results were independent of weight loss.
The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.
"People find it hard to lose weight," said Gower. "What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes."
The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.
Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate. The lower carb group's diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.
"The diets used in this study were actually fairly moderate," said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. "Individuals at risk for diabetes easily could adopt the lower fat diet we employed. Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease."
A typical dinner meal on the lower fat diet would include sesame chicken with rice, snow peas and carrots, frozen broccoli, fat-free cheese, oranges and a dinner roll.
Gower says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.
Published online May 18, 2011, by the American Journal of Clinical Nutrition
Thursday, June 9, 2011
Patients with Type 2 Diabetes Lack Knowledge about Hypoglycemia
A national online survey of more than 2,530 adults living with Type 2 diabetes in the US reveals that many patients remain uneducated about the risks for hypoglycemia....
The survey also highlighted why hypoglycemia may be more of a health hazard than previously reported, as patients said they often experience low blood sugar during daily activities such as working and driving.
In the survey, 55% of respondents said they had experienced at least one episode of hypoglycemia. Of 702 patients with diabetes who reported hypoglycemia, 42% had experienced low blood sugar symptoms while working, 26% while exercising, and 19% while driving.
The fact that patients with diabetes experience hypoglycemia while working and driving is especially problematic, as these activities require focus and concentration, and experiencing hypoglycemia during driving can be life-threatening.
Many patients were unable to name the leading causes of hypoglycemia, which is a great cause for concern. Twenty-seven percent of those surveyed did not know that the leading causes of hypoglycemia included skipping meals, and 35% did not know that some diabetic medications may enhance the risk for hypoglycemia. Forty-six percent of patients with Type 2 diabetes also remained unaware that excessive exercise may bring on hypoglycemia, particularly when combined with certain medications for Type 2 diabetes.
Although the study clearly showed that at least half (52%) of the patients surveyed were concerned about experiencing a future episode of hypoglycemia, some did not know that the most common symptoms are dizziness (22%) and shakiness (17%), and 39% incorrectly thought that thirst was the primary symptom of hypoglycemia.
Although hypoglycemia has long been known to be a risk associated with diabetes and its treatment, it often falls under the radar of busy physicians, particularly those in primary care, who may be treating patients for other conditions stated, stated Etie Moghissi, MD, vice president and president-elect of AACE, and an associate clinical professor of medicine at the University of California–Los Angeles. Yet hypoglycemia has clear risks, as well as being an expensive burden for the healthcare system. Indeed, the survey showed that 6% of patients who responded to the online survey had to be treated for hypoglycemia in the emergency room.
Dr. Moghissi noted that, "The survey shows that it's important to inform patients about the causes, symptoms, and how to address hypoglycemia." To achieve that goal, the American College of Endocrinology recently launched a program called Blood Sugar Basics, an educational program with an interactive website that includes fact pages on how patients with diabetes can best manage their blood sugar levels.
The results of the survey were announced at the American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress. April 15, 2011.
The survey also highlighted why hypoglycemia may be more of a health hazard than previously reported, as patients said they often experience low blood sugar during daily activities such as working and driving.
In the survey, 55% of respondents said they had experienced at least one episode of hypoglycemia. Of 702 patients with diabetes who reported hypoglycemia, 42% had experienced low blood sugar symptoms while working, 26% while exercising, and 19% while driving.
The fact that patients with diabetes experience hypoglycemia while working and driving is especially problematic, as these activities require focus and concentration, and experiencing hypoglycemia during driving can be life-threatening.
Many patients were unable to name the leading causes of hypoglycemia, which is a great cause for concern. Twenty-seven percent of those surveyed did not know that the leading causes of hypoglycemia included skipping meals, and 35% did not know that some diabetic medications may enhance the risk for hypoglycemia. Forty-six percent of patients with Type 2 diabetes also remained unaware that excessive exercise may bring on hypoglycemia, particularly when combined with certain medications for Type 2 diabetes.
Although the study clearly showed that at least half (52%) of the patients surveyed were concerned about experiencing a future episode of hypoglycemia, some did not know that the most common symptoms are dizziness (22%) and shakiness (17%), and 39% incorrectly thought that thirst was the primary symptom of hypoglycemia.
Although hypoglycemia has long been known to be a risk associated with diabetes and its treatment, it often falls under the radar of busy physicians, particularly those in primary care, who may be treating patients for other conditions stated, stated Etie Moghissi, MD, vice president and president-elect of AACE, and an associate clinical professor of medicine at the University of California–Los Angeles. Yet hypoglycemia has clear risks, as well as being an expensive burden for the healthcare system. Indeed, the survey showed that 6% of patients who responded to the online survey had to be treated for hypoglycemia in the emergency room.
Dr. Moghissi noted that, "The survey shows that it's important to inform patients about the causes, symptoms, and how to address hypoglycemia." To achieve that goal, the American College of Endocrinology recently launched a program called Blood Sugar Basics, an educational program with an interactive website that includes fact pages on how patients with diabetes can best manage their blood sugar levels.
The results of the survey were announced at the American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress. April 15, 2011.
Wednesday, June 8, 2011
A1c of 5.8 Percent in Children a Better Diagnostic Target to Diagnose Diabetes
Utility of A1c of 6.5% for diagnosing pre-diabetes and diabetes in obese, questioned....
Hemoglobin A1c has emerged as a recommended diagnostic tool foridentifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1c with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.
Researchers studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1c measurement. These tests were repeated after a follow-up time of 2 years in 218 subjects.
At baseline, subjects were stratfied according to A1c categories: 77% with normal glucose tolerance (A1c ,5.7%), 21% at risk for diabetes (A1c 5.7–6.4%), and 1% with diabetes (A1c .6.5%). In the at-risk-for-diabetes category, 47% were classfied with pre-diabetes or diabetes, and in the diabetes category, 62% were classified with Type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1c was 0.81 (95% CI 0.70-0.92).
The threshold for identifying Type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1c and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.
In a large clinic based multiethnic cohort of obese children and adolescents, regardless of age and sex, an A1c of 6.5% had relatively low sensitivity and specificity for classifying Type 2diabetes. There was poor agreement between A1c and OGTT criteria in classifying subjects with glucose values suggestive of Type 2 diabetes. The optimal threshold of A1c was 5.8% for identifying Type 2 diabetes, with a specificity of 87.64% and sensitivity of 67.7%, and 5.5% for identifying IGT. The diagnostic utility of A1c was examined according to ADA criteria with OGTT as the reference. Researchers observed that the use of an A1c of 6.5% would largely underestimate the prevalence of pre-diabetes and Type 2 diabetes. They said that theseresults suggest that, although A1c could be used as a clinical tool to identify Type 2 diabetes,along with fasting and 2-h glucose, the use of A1c by itself to pinpoint prediabetes and Type 2 diabetes is not recommended.
Researchers also said that their data are in agreement with those who reported using the National Health and Nutrition Examination Survey of 14,611 individuals aged <20 years,clearly showing that an A1c of 6.5% has a lower capacity to detect prediabetes and undiagnosed Type 2 diabetes than the OGTT.
Studies in adults have clearly shown the utility of A1c in predicting Type 2 diabetes (12–14) and cardiovascular disease even in nondiabetic adults. Nevertheless, concerns in the use of A1c for diagnosing Type 2 diabetes have been recently raised in view of the poor relationship with fasting glucose, the overall lower diagnostic performance in some groups such as pregnant women and the elderly, and the risk of over diagnosing patients with anemia and those predisposed to rapid glycosylation. In addition, as previously stated, it should be noted that, despite the numerous advantages, the use of A1c as a diagnostic tool would largely affect national surveillance of prediabetes and Type 2 diabetes.
Different cutoff points have been reported when the ROC curve was used to identify the cutoff point for diagnosing Type 2 diabetes or prediabetes. A review on A1c as a screening tool for diabetes showed that three cutoff points (5.9, 6.1, and 6.3%) of A1c were advised as cutoff points for detecting diabetes in at least two different studies, and most studies identified a cutoff point of >6.1% as optimum for the detection of Type 2 diabetes. In addition, researchersconcluded that at equivalent cutoff points, sensitivity was generally lower in detecting IGT for both A1c and fasting plasma glucose in both community- and hospital-based studies. Thus, the cutoff point identified in this study of 5.8% is somewhat lower than oftentimes reported,which might indicate that the population is of especially high risk. Although only a small percentage of subjects had a repeated A1c and OGTT after a follow-up of 2 years, we believethat the data are important, indicating that the best predictors of future diabetes or prediabetes are A1c and the 2-h glucose from the OGTT. Thus, both the cross-sectional and longitudinal data would argue in favor of the utility of performing both tests in obese youth forpredicting future development of diabetes.
A few limitations are worth noting. There is no lean control group, a clinic based cohort was studied, and the follow-up group is small. Strengths include the large group of obese youngsters without known diabetes and the existence of data derived on the same day for both the OGTT and A1c.
The American Diabetes Association suggested that an A1c of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1c by itself represents a poor diagnostic tool forprediabetes and Type 2 diabetes in obese children and adolescents.
Further investigation on the role of A1c in the diagnosis of prediabetes and diabetes in children and adolescents is needed. Prospective studies are especially important to examine the utility of A1c in pediatric populations in the prediction of diabetes-related comorbidities later in life.
Published online before print April 22, 2011, doi: 10.2337/dc10-1984 Diabetes Care April 22, 2011
Hemoglobin A1c has emerged as a recommended diagnostic tool foridentifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1c with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.
Researchers studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1c measurement. These tests were repeated after a follow-up time of 2 years in 218 subjects.
At baseline, subjects were stratfied according to A1c categories: 77% with normal glucose tolerance (A1c ,5.7%), 21% at risk for diabetes (A1c 5.7–6.4%), and 1% with diabetes (A1c .6.5%). In the at-risk-for-diabetes category, 47% were classfied with pre-diabetes or diabetes, and in the diabetes category, 62% were classified with Type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1c was 0.81 (95% CI 0.70-0.92).
The threshold for identifying Type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1c and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.
In a large clinic based multiethnic cohort of obese children and adolescents, regardless of age and sex, an A1c of 6.5% had relatively low sensitivity and specificity for classifying Type 2diabetes. There was poor agreement between A1c and OGTT criteria in classifying subjects with glucose values suggestive of Type 2 diabetes. The optimal threshold of A1c was 5.8% for identifying Type 2 diabetes, with a specificity of 87.64% and sensitivity of 67.7%, and 5.5% for identifying IGT. The diagnostic utility of A1c was examined according to ADA criteria with OGTT as the reference. Researchers observed that the use of an A1c of 6.5% would largely underestimate the prevalence of pre-diabetes and Type 2 diabetes. They said that theseresults suggest that, although A1c could be used as a clinical tool to identify Type 2 diabetes,along with fasting and 2-h glucose, the use of A1c by itself to pinpoint prediabetes and Type 2 diabetes is not recommended.
Researchers also said that their data are in agreement with those who reported using the National Health and Nutrition Examination Survey of 14,611 individuals aged <20 years,clearly showing that an A1c of 6.5% has a lower capacity to detect prediabetes and undiagnosed Type 2 diabetes than the OGTT.
Studies in adults have clearly shown the utility of A1c in predicting Type 2 diabetes (12–14) and cardiovascular disease even in nondiabetic adults. Nevertheless, concerns in the use of A1c for diagnosing Type 2 diabetes have been recently raised in view of the poor relationship with fasting glucose, the overall lower diagnostic performance in some groups such as pregnant women and the elderly, and the risk of over diagnosing patients with anemia and those predisposed to rapid glycosylation. In addition, as previously stated, it should be noted that, despite the numerous advantages, the use of A1c as a diagnostic tool would largely affect national surveillance of prediabetes and Type 2 diabetes.
Different cutoff points have been reported when the ROC curve was used to identify the cutoff point for diagnosing Type 2 diabetes or prediabetes. A review on A1c as a screening tool for diabetes showed that three cutoff points (5.9, 6.1, and 6.3%) of A1c were advised as cutoff points for detecting diabetes in at least two different studies, and most studies identified a cutoff point of >6.1% as optimum for the detection of Type 2 diabetes. In addition, researchersconcluded that at equivalent cutoff points, sensitivity was generally lower in detecting IGT for both A1c and fasting plasma glucose in both community- and hospital-based studies. Thus, the cutoff point identified in this study of 5.8% is somewhat lower than oftentimes reported,which might indicate that the population is of especially high risk. Although only a small percentage of subjects had a repeated A1c and OGTT after a follow-up of 2 years, we believethat the data are important, indicating that the best predictors of future diabetes or prediabetes are A1c and the 2-h glucose from the OGTT. Thus, both the cross-sectional and longitudinal data would argue in favor of the utility of performing both tests in obese youth forpredicting future development of diabetes.
A few limitations are worth noting. There is no lean control group, a clinic based cohort was studied, and the follow-up group is small. Strengths include the large group of obese youngsters without known diabetes and the existence of data derived on the same day for both the OGTT and A1c.
The American Diabetes Association suggested that an A1c of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1c by itself represents a poor diagnostic tool forprediabetes and Type 2 diabetes in obese children and adolescents.
Further investigation on the role of A1c in the diagnosis of prediabetes and diabetes in children and adolescents is needed. Prospective studies are especially important to examine the utility of A1c in pediatric populations in the prediction of diabetes-related comorbidities later in life.
Published online before print April 22, 2011, doi: 10.2337/dc10-1984 Diabetes Care April 22, 2011
Monday, June 6, 2011
How to Stop Food Cravings
Over time, restricting some foods may tamp down those cravings....
The study centered on 270 men and women who were randomly assigned to a low-carbohydrate diet or a low-fat diet for two years. Those on the low-carb diet were told to limit carbohydrates and eat foods high in fat and protein. Those on the low-fat diet cut back on calories and fat and limited protein to about 15% of calories from protein, 30% from fat and 55% from carbohydrate.
Foods such as jelly that are high in sugar were discouraged on the low-carb diet, and high-carb foods such as bagels were banned on the low-carb diet.
Researchers surveyed participants about how often they craved sweets, high-fat foods, carbohydrates and starches and fast-food fats. Participants also were asked about their preferences for certain foods -- this was used to measure how much they liked the foods that were restricted from their diets.
The researchers found that those in the low-carbohydrate group had much larger drops in cravings for carbs and starches compared to the low-fat group. The low-carb group showed substantially bigger declines in preferences for high-carb and high-sugar foods compared to the low-fat group. The low-carb group also was less bothered by hunger than those in the low-fat group.
The low-fat group, meanwhile, saw bigger decreases in cravings for high-fat foods than did the low-carb group. The low-fat group also had larger reductions in preferences for low-carb/high-protein foods compared to the low-carb group.
The findings "demonstrate that promoting the restriction of specific types of foods while dieting causes decreased cravings and preferences for the foods that are targeted for restriction," the authors wrote.
That's counterintuitive to what most people think they'll experience when they diet and, the authors noted, could put those dieters' concerns to rest.
Obesity, April 2011.
The study centered on 270 men and women who were randomly assigned to a low-carbohydrate diet or a low-fat diet for two years. Those on the low-carb diet were told to limit carbohydrates and eat foods high in fat and protein. Those on the low-fat diet cut back on calories and fat and limited protein to about 15% of calories from protein, 30% from fat and 55% from carbohydrate.
Foods such as jelly that are high in sugar were discouraged on the low-carb diet, and high-carb foods such as bagels were banned on the low-carb diet.
Researchers surveyed participants about how often they craved sweets, high-fat foods, carbohydrates and starches and fast-food fats. Participants also were asked about their preferences for certain foods -- this was used to measure how much they liked the foods that were restricted from their diets.
The researchers found that those in the low-carbohydrate group had much larger drops in cravings for carbs and starches compared to the low-fat group. The low-carb group showed substantially bigger declines in preferences for high-carb and high-sugar foods compared to the low-fat group. The low-carb group also was less bothered by hunger than those in the low-fat group.
The low-fat group, meanwhile, saw bigger decreases in cravings for high-fat foods than did the low-carb group. The low-fat group also had larger reductions in preferences for low-carb/high-protein foods compared to the low-carb group.
The findings "demonstrate that promoting the restriction of specific types of foods while dieting causes decreased cravings and preferences for the foods that are targeted for restriction," the authors wrote.
That's counterintuitive to what most people think they'll experience when they diet and, the authors noted, could put those dieters' concerns to rest.
Obesity, April 2011.
Sunday, June 5, 2011
Antifibrotic May Slow Diabetic Nephropathy
Diabetic nephropathy may not just slow but may actually improve with the novel antifibrotic agent pirfenidone (Esbriet)....
Kidney function continued to drop in diabetic kidney disease patients without treatment, but rose significantly with a low dose of pirfenidone over one year.
Mean estimated glomerular filtration rate (eGFR) rose by an average 3.3 ml/min per 1.73 m2 with 1,200-mg pirfenidone, but fell by 2.2 ml/min per 1.73 m2 with placebo in the study (P=0.026). This kind of improvement hasn't been seen with the current standard of care with renin-angiotensin system (RAS) blockers, the researchers noted, calling the results promising.
"Even when maximized, [RAS blockers] may decrease rate of progression, but they do not arrest or reverse diabetic nephropathy," wrote Dr. Sharma, of the University of California San Diego and VA Medical Center in La Jolla.
When diabetes patients develop even low levels of kidney disease, their risk of cardiovascular and other complications requiring hospitalization goes up, Sharma explained.
Pirfenidone is under development for treatment of idiopathic pulmonary fibrosis. An FDA advisory panel gave the thumbs up to the drug early last year, but the agency ultimately turned it down, citing the need for further efficacy data.
But since fibrosis and inflammation play a role in progression of diabetic kidney damage as well, Sharma's group did an exploratory study in 77 patients with Type 1 or Type 2 diabetes and established nephropathy marked by elevated albuminuria and eGFR of 20 to 75 ml/min per 1.73 m2.
The double-blind, placebo-controlled, dose-ranging protocol randomized patients to placebo or pirfenidone at either 1,200 or 2,400 mg per day on top of their stable regimen; study participants had both their diabetes and their blood pressure under good control.
During the study, no patient in the low-dose pirfenidone group was put on dialysis by their primary provider, whereas four placebo-group patients initiated dialysis, as did one in the 2,400-mg pirfenidone group.
However, a larger study is needed to validate any difference in rates of progression to dialysis, Sharma warned. The paper also noted that a larger study was needed to replicate these results.
Change in urine albumin-to-creatinine ratio did not differ significantly among groups. Nor did the researchers find any biomarkers that could predict benefit from pirfenidone.
Sharma said his group is actively looking for such biomarkers and noted that their exploratory study is just one step on the way to a larger-scale trial to validate the benefits for diabetic nephropathy.
Practice Pearls:
Explain that an exploratory study found that 54 weeks of 1200 mg of the new antifibrotic drug, pirfenidone, improved the mean estimated glomerular filtration rate (eGFR) in patients with existing diabetic nephropathy due to Type 1 or Type 2 diabetes.
Note that the eGFR after one year was not significantly different between those receiving 2400 mg of the drug and placebo and the study had a high drop-out rate.
Journal of the American Society of Nephrology, April 2011.
Kidney function continued to drop in diabetic kidney disease patients without treatment, but rose significantly with a low dose of pirfenidone over one year.
Mean estimated glomerular filtration rate (eGFR) rose by an average 3.3 ml/min per 1.73 m2 with 1,200-mg pirfenidone, but fell by 2.2 ml/min per 1.73 m2 with placebo in the study (P=0.026). This kind of improvement hasn't been seen with the current standard of care with renin-angiotensin system (RAS) blockers, the researchers noted, calling the results promising.
"Even when maximized, [RAS blockers] may decrease rate of progression, but they do not arrest or reverse diabetic nephropathy," wrote Dr. Sharma, of the University of California San Diego and VA Medical Center in La Jolla.
When diabetes patients develop even low levels of kidney disease, their risk of cardiovascular and other complications requiring hospitalization goes up, Sharma explained.
Pirfenidone is under development for treatment of idiopathic pulmonary fibrosis. An FDA advisory panel gave the thumbs up to the drug early last year, but the agency ultimately turned it down, citing the need for further efficacy data.
But since fibrosis and inflammation play a role in progression of diabetic kidney damage as well, Sharma's group did an exploratory study in 77 patients with Type 1 or Type 2 diabetes and established nephropathy marked by elevated albuminuria and eGFR of 20 to 75 ml/min per 1.73 m2.
The double-blind, placebo-controlled, dose-ranging protocol randomized patients to placebo or pirfenidone at either 1,200 or 2,400 mg per day on top of their stable regimen; study participants had both their diabetes and their blood pressure under good control.
During the study, no patient in the low-dose pirfenidone group was put on dialysis by their primary provider, whereas four placebo-group patients initiated dialysis, as did one in the 2,400-mg pirfenidone group.
However, a larger study is needed to validate any difference in rates of progression to dialysis, Sharma warned. The paper also noted that a larger study was needed to replicate these results.
Change in urine albumin-to-creatinine ratio did not differ significantly among groups. Nor did the researchers find any biomarkers that could predict benefit from pirfenidone.
Sharma said his group is actively looking for such biomarkers and noted that their exploratory study is just one step on the way to a larger-scale trial to validate the benefits for diabetic nephropathy.
Practice Pearls:
Explain that an exploratory study found that 54 weeks of 1200 mg of the new antifibrotic drug, pirfenidone, improved the mean estimated glomerular filtration rate (eGFR) in patients with existing diabetic nephropathy due to Type 1 or Type 2 diabetes.
Note that the eGFR after one year was not significantly different between those receiving 2400 mg of the drug and placebo and the study had a high drop-out rate.
Journal of the American Society of Nephrology, April 2011.
Friday, June 3, 2011
Pregnancy Foot Problems
Pregnancy and the Feet
Pregnancy is seen by most as a time of anticipation and joy, but it can take a toll on a woman’s body. Even the feet can be affected. Researchers report more than half of all pregnant women have foot complaints.
According to Adriana Karpati, D.P.M., Podiatrist in Grapevine, TX one of the most commonly encountered foot problems in pregnancy is plantar fasciitis (heel pain). As the woman nears the last trimester, production of a hormone, called relaxin, causes the ligaments to loosen in preparation for movement of the baby through the birth canal. This process also loosens the ligaments in the foot. The extra weight during pregnancy compounds the problem, and may cause the arch to flatten and the foot to roll inward while walking. This puts stress on the fascia, or connective tissue that runs from the front of the foot to the heel. The fascia becomes inflamed, leading to heel pain. The pain is worse when first getting out of bed in the morning or after sitting for long periods of time.
Foot swelling is also very common in pregnancy. It occurs due to extra blood volume to support the fetus and pooling of fluid in the lower body. Swelling can be worse after standing for extended periods or during warmer weather. The increase in foot size also makes wearing some shoes more uncomfortable.
Many pregnant women complain of foot cramps (the cramps can also occur in the legs). These become more common during the second and third trimester. The cramps can be caused by an increase in blood volume, relaxation of the blood vessels (which slows circulation) and compression of the veins in the pelvis from the added weight (affecting circulation in the feet). Foot cramps are common at night, but can also occur during the day.
Karpati says pregnant women may also develop ingrown toenails. This is usually caused when the swollen feet are stuffed inside shoes that are too tight. She says pregnant women are used to getting bigger maternity clothes to match their growing girth. However, many patients don’t think about changing their shoe size. The foot can get flatter and wider, growing in length by an extra half inch.
Treating and Preventing Pregnancy-related Foot Problems
Karpati says it’s important for a pregnant woman to take care of her feet as well as the rest of her body. Many foot problems can be relieved or prevented by wearing properly sized shoes. Since the feet tend to swell and enlarge, a new pair of comfortable shoes may be needed. Make sure to get shoes that have a good arch support. Orthotics can also help support the arch. If shoes in general are uncomfortable, try wearing slippers around the house. Avoid going barefoot, which doesn’t give any support to the feet and can increase risk of foot injury.
To reduce swelling, take frequent breaks from standing. Sit down and prop up the feet for at least 30 minutes a day. Don’t cross the legs (this impedes the ability of blood to flow back up to the heart) and avoid wearing pants with constricting ankle cuffs or tight ankle jewelry. It’s also important to watch salt intake, which can contribute to fluid retention and swelling, get regular exercise and eat a healthy diet.
For both heel pain and leg/foot cramps, Karpati recommends stretching. A splint may be worn at night to keep the ankle and foot at a right angle and reduce risk of cramps while sleeping.
Women with ingrown toenails may get some relief by soaking the foot in warm water for the nail to soften. For very small ingrown nails, it may be possible to cut the nail at an angle and peel off the excess nail on the side. For larger or deeper ingrown nails, or if the nail is very red, sore or has any drainage, see a podiatrist for treatment.
Karpati says many pregnancy-related foot problems resolve after the baby is born and the woman gets back to a normal weight and routine. However, sometimes the feet may still be larger, requiring a larger shoe size than that worn needed before pregnancy.
For information on foot problems:
American College of Foot and Ankle Surgeons
American Orthopaedic Foot and Ankle Society
American Podiatric Medical Association
Copyright 2011 by WSOCTV.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Pregnancy is seen by most as a time of anticipation and joy, but it can take a toll on a woman’s body. Even the feet can be affected. Researchers report more than half of all pregnant women have foot complaints.
According to Adriana Karpati, D.P.M., Podiatrist in Grapevine, TX one of the most commonly encountered foot problems in pregnancy is plantar fasciitis (heel pain). As the woman nears the last trimester, production of a hormone, called relaxin, causes the ligaments to loosen in preparation for movement of the baby through the birth canal. This process also loosens the ligaments in the foot. The extra weight during pregnancy compounds the problem, and may cause the arch to flatten and the foot to roll inward while walking. This puts stress on the fascia, or connective tissue that runs from the front of the foot to the heel. The fascia becomes inflamed, leading to heel pain. The pain is worse when first getting out of bed in the morning or after sitting for long periods of time.
Foot swelling is also very common in pregnancy. It occurs due to extra blood volume to support the fetus and pooling of fluid in the lower body. Swelling can be worse after standing for extended periods or during warmer weather. The increase in foot size also makes wearing some shoes more uncomfortable.
Many pregnant women complain of foot cramps (the cramps can also occur in the legs). These become more common during the second and third trimester. The cramps can be caused by an increase in blood volume, relaxation of the blood vessels (which slows circulation) and compression of the veins in the pelvis from the added weight (affecting circulation in the feet). Foot cramps are common at night, but can also occur during the day.
Karpati says pregnant women may also develop ingrown toenails. This is usually caused when the swollen feet are stuffed inside shoes that are too tight. She says pregnant women are used to getting bigger maternity clothes to match their growing girth. However, many patients don’t think about changing their shoe size. The foot can get flatter and wider, growing in length by an extra half inch.
Treating and Preventing Pregnancy-related Foot Problems
Karpati says it’s important for a pregnant woman to take care of her feet as well as the rest of her body. Many foot problems can be relieved or prevented by wearing properly sized shoes. Since the feet tend to swell and enlarge, a new pair of comfortable shoes may be needed. Make sure to get shoes that have a good arch support. Orthotics can also help support the arch. If shoes in general are uncomfortable, try wearing slippers around the house. Avoid going barefoot, which doesn’t give any support to the feet and can increase risk of foot injury.
To reduce swelling, take frequent breaks from standing. Sit down and prop up the feet for at least 30 minutes a day. Don’t cross the legs (this impedes the ability of blood to flow back up to the heart) and avoid wearing pants with constricting ankle cuffs or tight ankle jewelry. It’s also important to watch salt intake, which can contribute to fluid retention and swelling, get regular exercise and eat a healthy diet.
For both heel pain and leg/foot cramps, Karpati recommends stretching. A splint may be worn at night to keep the ankle and foot at a right angle and reduce risk of cramps while sleeping.
Women with ingrown toenails may get some relief by soaking the foot in warm water for the nail to soften. For very small ingrown nails, it may be possible to cut the nail at an angle and peel off the excess nail on the side. For larger or deeper ingrown nails, or if the nail is very red, sore or has any drainage, see a podiatrist for treatment.
Karpati says many pregnancy-related foot problems resolve after the baby is born and the woman gets back to a normal weight and routine. However, sometimes the feet may still be larger, requiring a larger shoe size than that worn needed before pregnancy.
For information on foot problems:
American College of Foot and Ankle Surgeons
American Orthopaedic Foot and Ankle Society
American Podiatric Medical Association
Copyright 2011 by WSOCTV.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Thursday, June 2, 2011
Limiting Carbs, Not Calories, Reduces Liver Fat Faster
Curbing carbohydrates is more effective than cutting calories for individuals who want to quickly reduce the amount of fat in their liver....
Lead author Dr. Jeffrey Browning, assistant professor of internal medicine at UT Southwestern, stated that, "What this study tells us is that if your doctor says that you need to reduce the amount of fat in your liver, you can do something within a month."
The results could have implications for treating numerous diseases including diabetes, insulin resistance and nonalcoholic fatty liver disease, or NAFLD. The disease, characterized by high levels of triglycerides in the liver, affects as many as one-third of American adults. It can lead to liver inflammation, cirrhosis and liver cancer.
For the study, researchers assigned 18 participants with NAFLD to eat either a low-carbohydrate or a low-calorie diet for 14 days.
The participants assigned to the low-carb diet limited their carbohydrate intake to less than 20 grams a day, the equivalent of a small banana or a half-cup of egg noodles for the first seven days. For the final seven days, they switched to frozen meals prepared by UT Southwestern's Clinical and Translational Research Center (CTRC) kitchen that matched their individual food preferences, carbohydrate intake and energy needs.
Those assigned to the low-calorie diet continued their regular diet and kept a food diary for the four days preceding the study. The CTRC kitchen then used these individual records to prepare all meals during the 14-day study. Researchers limited the total number of calories to roughly 1,200 a day for the female participants and 1,500 a day for the males.
After two weeks, researchers used advanced imaging techniques to analyze the amount of liver fat in each individual. They found that the study participants on the low-carb diet lost more liver fat.
Although the study was not designed to determine which diet was more effective for losing weight, both the low-calorie dieters and the low-carbohydrate dieters lost an average of 10 pounds.
Dr. Browning cautioned that the findings do not explain why participants on the low-carb diet saw a greater reduction in liver fat, and that they should not be extrapolated beyond the two-week period of study. "This is not a long-term study, and I don't think that low-carb diets are fundamentally better than low-fat ones," he said. "Our approach is likely to be only of short-term benefit because at some point the benefits of weight loss alone trounce any benefits derived from manipulating dietary macronutrients such as calories and carbohydrates.
"Weight loss, regardless of the mechanism, is currently the most effective way to reduce liver fat."
American Journal of Clinical Nutrition April, 2011
Lead author Dr. Jeffrey Browning, assistant professor of internal medicine at UT Southwestern, stated that, "What this study tells us is that if your doctor says that you need to reduce the amount of fat in your liver, you can do something within a month."
The results could have implications for treating numerous diseases including diabetes, insulin resistance and nonalcoholic fatty liver disease, or NAFLD. The disease, characterized by high levels of triglycerides in the liver, affects as many as one-third of American adults. It can lead to liver inflammation, cirrhosis and liver cancer.
For the study, researchers assigned 18 participants with NAFLD to eat either a low-carbohydrate or a low-calorie diet for 14 days.
The participants assigned to the low-carb diet limited their carbohydrate intake to less than 20 grams a day, the equivalent of a small banana or a half-cup of egg noodles for the first seven days. For the final seven days, they switched to frozen meals prepared by UT Southwestern's Clinical and Translational Research Center (CTRC) kitchen that matched their individual food preferences, carbohydrate intake and energy needs.
Those assigned to the low-calorie diet continued their regular diet and kept a food diary for the four days preceding the study. The CTRC kitchen then used these individual records to prepare all meals during the 14-day study. Researchers limited the total number of calories to roughly 1,200 a day for the female participants and 1,500 a day for the males.
After two weeks, researchers used advanced imaging techniques to analyze the amount of liver fat in each individual. They found that the study participants on the low-carb diet lost more liver fat.
Although the study was not designed to determine which diet was more effective for losing weight, both the low-calorie dieters and the low-carbohydrate dieters lost an average of 10 pounds.
Dr. Browning cautioned that the findings do not explain why participants on the low-carb diet saw a greater reduction in liver fat, and that they should not be extrapolated beyond the two-week period of study. "This is not a long-term study, and I don't think that low-carb diets are fundamentally better than low-fat ones," he said. "Our approach is likely to be only of short-term benefit because at some point the benefits of weight loss alone trounce any benefits derived from manipulating dietary macronutrients such as calories and carbohydrates.
"Weight loss, regardless of the mechanism, is currently the most effective way to reduce liver fat."
American Journal of Clinical Nutrition April, 2011
Wednesday, June 1, 2011
Preventing Type 2 Diabetes with Early Pharmacological Intervention
According to Ralph DeFronzo, it is never too early to prevent diabetes....
In the U.S., 26 million individuals have type 2 diabetes, and twice as many have impaired glucose tolerance (IGT). Approximately 40-50% of individuals with IGT will progress to type 2 diabetes over their lifetime. Therefore, treatment of high-risk individuals with IGT to prevent type 2 diabetes has important medical, economic, social, and human implications.
Weight loss, although effective in reducing the conversion of IGT to type 2 diabetes, is difficult to achieve and maintain. Moreover, 40-50% of IGT subjects progress to type 2 diabetes despite successful weight reduction. In contrast, pharmacological treatment of IGT with oral antidiabetic agents that improve insulin sensitivity and preserve β-cell function -- the characteristic pathophysiological abnormalities present in IGT and type 2 diabetes -- uniformly have been shown to prevent progression of IGT to type 2 diabetes.
The most consistent results have been observed with the thiazolidinediones (Troglitazone in the Prevention of Diabetes [TRIPOD], Pioglitazone in the Prevention of Diabetes [PIPOD], Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM], and Actos Now for the Prevention of Diabetes [ACT NOW]), with a 50-70% reduction in IGT conversion to diabetes. Metformin in the U.S. Diabetes Prevention Program (DPP) reduced the development of type 2 diabetes by 31% and has been recommended by the American Diabetes Association (ADA) for treating high-risk individuals with IGT. The glucagon-like peptide-1 analogs, which augment insulin secretion, preserve β-cell function, and promote weight loss, also would be expected to be efficacious in preventing the progression of IGT to type 2 diabetes. Because individuals in the upper tertile of IGT are maximally/near-maximally insulin resistant, have lost 70-80% of their β-cell function, and have an ∼ 10% incidence of diabetic retinopathy, pharmacological intervention, in combination with diet plus exercise, should be instituted.
Type 2 diabetes can be prevented with early pharmacological intervention; DeFronzo RA, Abdul-Ghani M; Diabetes Care 34 Suppl 2 S202-9 (May 2011)
In the U.S., 26 million individuals have type 2 diabetes, and twice as many have impaired glucose tolerance (IGT). Approximately 40-50% of individuals with IGT will progress to type 2 diabetes over their lifetime. Therefore, treatment of high-risk individuals with IGT to prevent type 2 diabetes has important medical, economic, social, and human implications.
Weight loss, although effective in reducing the conversion of IGT to type 2 diabetes, is difficult to achieve and maintain. Moreover, 40-50% of IGT subjects progress to type 2 diabetes despite successful weight reduction. In contrast, pharmacological treatment of IGT with oral antidiabetic agents that improve insulin sensitivity and preserve β-cell function -- the characteristic pathophysiological abnormalities present in IGT and type 2 diabetes -- uniformly have been shown to prevent progression of IGT to type 2 diabetes.
The most consistent results have been observed with the thiazolidinediones (Troglitazone in the Prevention of Diabetes [TRIPOD], Pioglitazone in the Prevention of Diabetes [PIPOD], Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication [DREAM], and Actos Now for the Prevention of Diabetes [ACT NOW]), with a 50-70% reduction in IGT conversion to diabetes. Metformin in the U.S. Diabetes Prevention Program (DPP) reduced the development of type 2 diabetes by 31% and has been recommended by the American Diabetes Association (ADA) for treating high-risk individuals with IGT. The glucagon-like peptide-1 analogs, which augment insulin secretion, preserve β-cell function, and promote weight loss, also would be expected to be efficacious in preventing the progression of IGT to type 2 diabetes. Because individuals in the upper tertile of IGT are maximally/near-maximally insulin resistant, have lost 70-80% of their β-cell function, and have an ∼ 10% incidence of diabetic retinopathy, pharmacological intervention, in combination with diet plus exercise, should be instituted.
Type 2 diabetes can be prevented with early pharmacological intervention; DeFronzo RA, Abdul-Ghani M; Diabetes Care 34 Suppl 2 S202-9 (May 2011)
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