Having diabetes for a decade or more dramatically increases the risk for ischemic stroke 3% each year and triples at 10 years....
Senior investigator Mitchell Elkind, MD, from Columbia University Medical Center in New York, stated that, "We were not surprised to see an increased risk, but we were taken aback by how high the risk was."
Using data from the Northern Manhattan Study, investigators looked at 3298 multi-ethnic participants. They found that 22% had diabetes at baseline and another 10% went on to develop the disease over the course of the study. There were 244 ischemic strokes.
The authors explained, "Our study provides evidence that the risk of ischemic stroke increased continuously with duration of diabetes mellitus." "This was after controlling for other factors such as age, smoking history, physical activity, history of heart disease, blood pressure, and cholesterol."
"The increase is not as much during the second half of the first decade," they noted, "but it increases steeply as the disease enters its second decade."
Duration of Diabetes and Ischemic Stroke Risk
Diabetes (Years) Hazard Ratio 95% Confidence Interval
0 to 5 1.7 1.1 - 2.7
5 to 10 1.8 1.1 - 3.0
>10 3.2 2.4 - 4.5
Among the nearly 26 million Americans with diabetes, more than half are younger than age 65 years, according to the American Diabetes Association. Dr. Elkind said, "We used to think of type 2 diabetes as a disease people get when they are older, after a lifetime of poor dietary habits, but the age at diagnosis is getting younger and younger because of the obesity problem among young people."
The researchers pointed out that diabetes was determined by self-report in this study. "It's possible we missed some cases," Dr. Elkind added during an interview. An estimated one third of diabetes cases may be undiagnosed. It has also been found that true onset of diabetes may be 4 to 7 years earlier than clinical diagnosis.
As the population ages and the elderly live longer, more and more people will live with longer duration of disease, the authors note. "It is important to better understand the dynamics between diabetes, time, and stroke, and to emphasize the importance of interventions to prevent early diabetes. Minimizing the number of years a patient has diabetes would help combat the increase in stroke risk with each year of the disease."
Some of the reasons for increased stroke risk may include an association between longer diabetes duration and thicker plaque in neck arteries and the higher prevalence of hypertension, accelerated vascular complications, and clotting abnormalities.
Saturday, June 30, 2012
Friday, June 29, 2012
9 Footwear Do's and Don'ts
Our poor feet. They withstand lots of abuse, quickly carrying us to last-minute outings, pounding the pavement on mind-clearing runs, and being squeezed into impractical (but fashionable) shoes. But we need to take care of them to avoid foot pain, injury, and other ailments. So do your tootsies a favor and follow these healthy tips.
Don't wear high heels for too long. We've all been there: out on the town in an amazing pair of pumps ... with achy feet and knees. A 2010 study found that over time, wearing heels higher than 2 inches can put you at risk for joint degeneration and knee osteoarthritis, and a new study finds that high heels are a leading cause of ingrown toenails, which can lead to infection and permanent nail damage. But we're not telling you to stop wearing heels--that's unrealistic. "I wouldn't recommend walking miles in heels, but a comfortable heel can be worn to work all day if it has the right features and/or orthotic," says Michele Summers, a California-based podiatrist and shoe designer. (You can pick up arch-support inserts at drug stores.) Try saving your sky-high heels for short-lived occasions like dinners, says John Brummer, a New York City-based podiatrist.
Don't wear flip-flops everywhere. They're easy, and as temperatures heat up, you're likely to slip them on often. Cool it, say experts. "Flip-flops give your foot basically no support, and the constant rubbing of the thong between the toes can cause a friction blister," says Summers. Not to mention they make stubbed toes, cuts, and sprained ankles more likely, according to the American Podiatric Medical Association (APMA). Limit flip-flops to settings like the beach or the pool. And when you do wear them, invest in a supportive leather pair, or a pair that carries the APMA seal of acceptance, the association advises. (If you have diabetes, you should never wear flip-flops, since the disease can dull your sense of pain, allowing minor wounds to become major problems--infected, for example--without your knowledge.)
Do exercise in shoes designed for your sport. It's "extremely important" to find gym shoes designed for your sport of choice because they'll accommodate the actions needed for the specific activity, says Brummer. If you're a runner, consider going a step further with a professional fitting, since your gait and range of motion affect the shoe you need, advises the American Academy of Podiatric Sports Medicine. For example, overpronators--runners whose feet rotate too far inward--are steered toward shoes that offer more support.
Don't wear the same shoes every day. It's tempting to always throw on your trusty flats. But alternating shoes can help keep your feet limber, says Summers. Plus it's good to air out shoes every other day to avoid bad smells. (Your significant other will thank you.)
Don't wear hand-me-downs. Reconsider those thrift-store sandals. "Each foot imprints a different wear pattern into the shoe," says Summers, so a used pair may not be the best fit.
Do discard worn-out shoes. Speaking of old shoes, it might be time to pitch yours. (Sniff.) If the sole is worn down more on one side than the other or is separating, let the pair go, says Summers. And replace athletic shoes that are beyond their shelf life; running shoes can last about 300 to 500 miles before causing problems, depending on the athlete, Brummer says.
Do change out of sweaty footwear. Fungal infections aren't just a consequence of barefoot showering at the gym. (By the way, don't do that.) You could get athlete's foot if you hang out in damp hosiery. Change your shoes and socks regularly, wash your feet daily, and dry your feet thoroughly to help prevent infection, advises the APMA.
Do have your feet measured. It's not your imagination: Your shoes may no longer fit. "Our shoe size can change from anything such as weight gain, hormonal activity, circulation disorders, or simple aging," says Brummer. "It is best to try on shoes at the end of the day when your feet are most swollen." You should have your feet measured at least once a year, especially if you're an older adult, adds Summers. (If you have diabetes, you should also see a podiatrist at least twice a year, Brummer says.)
Don't buy shoes that hurt. Sorry to break it to you, but you're probably not going to break in those painful shoes. "A shoe should feel comfortable when you try it on in the store," says Summers. "If it feels too tight in the store, it will be too tight at home and may even feel worse after being worn for a little while." That said, shoes can be stretched and modified for certain foot deformities such as bunions and hammertoes, says Brummer. Use good judgment--and walk away if you have any doubts. Your (happy) feet will thank you later.
Don't wear high heels for too long. We've all been there: out on the town in an amazing pair of pumps ... with achy feet and knees. A 2010 study found that over time, wearing heels higher than 2 inches can put you at risk for joint degeneration and knee osteoarthritis, and a new study finds that high heels are a leading cause of ingrown toenails, which can lead to infection and permanent nail damage. But we're not telling you to stop wearing heels--that's unrealistic. "I wouldn't recommend walking miles in heels, but a comfortable heel can be worn to work all day if it has the right features and/or orthotic," says Michele Summers, a California-based podiatrist and shoe designer. (You can pick up arch-support inserts at drug stores.) Try saving your sky-high heels for short-lived occasions like dinners, says John Brummer, a New York City-based podiatrist.
Don't wear flip-flops everywhere. They're easy, and as temperatures heat up, you're likely to slip them on often. Cool it, say experts. "Flip-flops give your foot basically no support, and the constant rubbing of the thong between the toes can cause a friction blister," says Summers. Not to mention they make stubbed toes, cuts, and sprained ankles more likely, according to the American Podiatric Medical Association (APMA). Limit flip-flops to settings like the beach or the pool. And when you do wear them, invest in a supportive leather pair, or a pair that carries the APMA seal of acceptance, the association advises. (If you have diabetes, you should never wear flip-flops, since the disease can dull your sense of pain, allowing minor wounds to become major problems--infected, for example--without your knowledge.)
Do exercise in shoes designed for your sport. It's "extremely important" to find gym shoes designed for your sport of choice because they'll accommodate the actions needed for the specific activity, says Brummer. If you're a runner, consider going a step further with a professional fitting, since your gait and range of motion affect the shoe you need, advises the American Academy of Podiatric Sports Medicine. For example, overpronators--runners whose feet rotate too far inward--are steered toward shoes that offer more support.
Don't wear the same shoes every day. It's tempting to always throw on your trusty flats. But alternating shoes can help keep your feet limber, says Summers. Plus it's good to air out shoes every other day to avoid bad smells. (Your significant other will thank you.)
Don't wear hand-me-downs. Reconsider those thrift-store sandals. "Each foot imprints a different wear pattern into the shoe," says Summers, so a used pair may not be the best fit.
Do discard worn-out shoes. Speaking of old shoes, it might be time to pitch yours. (Sniff.) If the sole is worn down more on one side than the other or is separating, let the pair go, says Summers. And replace athletic shoes that are beyond their shelf life; running shoes can last about 300 to 500 miles before causing problems, depending on the athlete, Brummer says.
Do change out of sweaty footwear. Fungal infections aren't just a consequence of barefoot showering at the gym. (By the way, don't do that.) You could get athlete's foot if you hang out in damp hosiery. Change your shoes and socks regularly, wash your feet daily, and dry your feet thoroughly to help prevent infection, advises the APMA.
Do have your feet measured. It's not your imagination: Your shoes may no longer fit. "Our shoe size can change from anything such as weight gain, hormonal activity, circulation disorders, or simple aging," says Brummer. "It is best to try on shoes at the end of the day when your feet are most swollen." You should have your feet measured at least once a year, especially if you're an older adult, adds Summers. (If you have diabetes, you should also see a podiatrist at least twice a year, Brummer says.)
Don't buy shoes that hurt. Sorry to break it to you, but you're probably not going to break in those painful shoes. "A shoe should feel comfortable when you try it on in the store," says Summers. "If it feels too tight in the store, it will be too tight at home and may even feel worse after being worn for a little while." That said, shoes can be stretched and modified for certain foot deformities such as bunions and hammertoes, says Brummer. Use good judgment--and walk away if you have any doubts. Your (happy) feet will thank you later.
Thursday, June 28, 2012
Most diabetes amputations 'preventable'
An estimated 80% of lower limb amputations in people with diabetes are preventable, a charity has revealed.
In Northern Ireland, there were 199 diabetes-related amputations last year.
A campaign has been launched aimed at putting a stop to preventable amputations.
'Putting Feet First' by Diabetes UK Northern Ireland wants to reduce diabetes-related amputations by 50% within five years.
Diabetes is a serious condition where the amount of glucose in your blood is too high.
People with Type 1 diabetes do not produce any insulin which is needed in order to control the levels of glucose in the blood. Those with Type 2 diabetes produce an insufficient amount of insulin - or can be insulin resistant.
If blood glucose levels are not maintained at normal levels, it can lead to long-term complications such as heart disease, stroke and amputation.
There are currently 73,500 people diagnosed with diabetes in the region.
Iain Foster, the charity's National Director, said: "A single preventable amputation is one too many so the fact that hundreds of people in Northern Ireland have endured unnecessary foot amputations is nothing short of shameful."
Amputations have a devastating effect on quality of life and so every amputation that results from poor healthcare is a tragedy.
Iain Foster
He explained that diabetic foot problems arise from reduced circulation and damaged nerve endings.
He said a big part of bringing this to an end is giving people with diabetes information about how to look after their feet.
The charity wants everyone with diabetes to get a thorough annual foot check and for a specialist diabetes foot care teams for foot ulcers to deal with referrals within 24 hours.
"Many people with diabetes aren't even aware that amputation is a potential complication. We also need to make sure that people with diabetes understand what healthcare they should be getting."
Mr Foster said there are opportunities within the current healthcare system for problems to be detected early - and treatment obtained - before complications set in.
The campaign will include working with healthcare professionals in GP practices and areas, such as A&E departments, to increase awareness of the signs of early complications and the need for a quick referral to specialist staff.
He added: "Quality of care makes a big difference to amputation rates. Foot ulcers can deteriorate in a matter of hours so failing to refer someone quickly enough can literally be the difference between losing a foot and keeping it."
"It is a scandal that needs to be brought to an end."
In Northern Ireland, there were 199 diabetes-related amputations last year.
A campaign has been launched aimed at putting a stop to preventable amputations.
'Putting Feet First' by Diabetes UK Northern Ireland wants to reduce diabetes-related amputations by 50% within five years.
Diabetes is a serious condition where the amount of glucose in your blood is too high.
People with Type 1 diabetes do not produce any insulin which is needed in order to control the levels of glucose in the blood. Those with Type 2 diabetes produce an insufficient amount of insulin - or can be insulin resistant.
If blood glucose levels are not maintained at normal levels, it can lead to long-term complications such as heart disease, stroke and amputation.
There are currently 73,500 people diagnosed with diabetes in the region.
Iain Foster, the charity's National Director, said: "A single preventable amputation is one too many so the fact that hundreds of people in Northern Ireland have endured unnecessary foot amputations is nothing short of shameful."
Amputations have a devastating effect on quality of life and so every amputation that results from poor healthcare is a tragedy.
Iain Foster
He explained that diabetic foot problems arise from reduced circulation and damaged nerve endings.
He said a big part of bringing this to an end is giving people with diabetes information about how to look after their feet.
The charity wants everyone with diabetes to get a thorough annual foot check and for a specialist diabetes foot care teams for foot ulcers to deal with referrals within 24 hours.
"Many people with diabetes aren't even aware that amputation is a potential complication. We also need to make sure that people with diabetes understand what healthcare they should be getting."
Mr Foster said there are opportunities within the current healthcare system for problems to be detected early - and treatment obtained - before complications set in.
The campaign will include working with healthcare professionals in GP practices and areas, such as A&E departments, to increase awareness of the signs of early complications and the need for a quick referral to specialist staff.
He added: "Quality of care makes a big difference to amputation rates. Foot ulcers can deteriorate in a matter of hours so failing to refer someone quickly enough can literally be the difference between losing a foot and keeping it."
"It is a scandal that needs to be brought to an end."
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