An ancillary study to the ARIC (Atherosclerosis Risk in Communities) study supports the most recent (2010) ADA risk categories of hemoglobin (Hb) A1c in identifying future risk of developing diabetes and macrovascular and microvascular disease. The data were presented by Elizabeth Selvin, PhD.
The ADA now recommends the use of HbA1c for the diagnosis of diabetes and identification of persons at increased risk for diabetes. The ADA defines an HbA1c of 5.7% to less than 6.5% as “high risk” for the future development of diabetes.
In this analysis, 11,092 participants from ARIC, a large community-based epidemiologic study, without cardiovascular disease or diabetes at baseline had HbA1c measured from stored whole blood samples obtained between 1990 and 1992. Participants were followed for 15 years.
“In individuals with an A1c of 5.7% to less than 6.5%, which is the group identified as high risk for the development of diabetes and other complications, we see a very high risk of the subsequent development of diabetes. We can also see that individuals in that range are at risk for kidney disease, CHD [coronary heart disease], and stroke,” said Selvin, assistant professor of epidemiology and medicine at Johns Hopkins in Baltimore.
Compared with the reference population with an HbA1c level of 5% to less than 5.7%, those in the high-risk category of 5.7% to less than 6.5% had more than triple the risk of diagnosed diabetes, a 60% increase in the risk of CHD, a 56% increase in the risk of stroke, a 62% increased risk of end-stage renal disease, and a 42% increase in all-cause mortality, all adjusted for age, sex, race, and other potential confounders.
These risks were even greater in the cohort with HbA1c levels of 6.5% or greater at baseline.
“The vast majority of individuals with HbA1c greater than 6.5% will subsequently be diagnosed with diabetes during follow-up, and they’re at very high risk of kidney disease and have almost 4 times the risk of developing end-stage renal disease compared to those people in the normal range, and a 2-fold increased risk of developing CHD or stroke or dying during follow-up,” she said.
More than 20% of the group with HbA1c values of 5.7% to less than 6.5% and almost 80% of those with values of 6.5% or greater developed diabetes within 10 years.
Thursday, July 1, 2010
Tuesday, June 29, 2010
New Study Demonstrates Dramatic Impact of Podiatric Care
Patients with diabetes who receive medical and surgical care provided by a podiatrist are less likely to suffer hospitalization or amputation than patients who do not receive care from a podiatrist, according to a new study from Thomson Reuters. Thomson Reuters is an internationally respected research firm with expertise in the health-care market.
The study, sponsored by APMA, examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation. James Wrobel, DPM, presented the results at the American Diabetes Association Scientific Sessions this weekend in Orlando, Florida.
"The dramatic results of the study demonstrate the important role of today's podiatrist," said APMA President Kathleen Stone, DPM. "As a profession, we make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, we will see even greater reductions in cost and improvements in patients' quality of life. The next step is to confirm these findings with prospective pilot programs that identify high-risk patients and provide preventive foot care services by podiatrists."
The study, sponsored by APMA, examined records for more than 32,000 patients with diabetes under 65 and matched health and risk factors for those who had podiatry visits to those who did not. Care by a podiatric physician, defined as at least one pre-ulcer visit, was associated with lower risk of hospitalization and amputation. James Wrobel, DPM, presented the results at the American Diabetes Association Scientific Sessions this weekend in Orlando, Florida.
"The dramatic results of the study demonstrate the important role of today's podiatrist," said APMA President Kathleen Stone, DPM. "As a profession, we make a significant impact on patient outcomes and health-care costs. As more diabetic patients receive high-quality medical care by podiatrists prior to developing ulcers, we will see even greater reductions in cost and improvements in patients' quality of life. The next step is to confirm these findings with prospective pilot programs that identify high-risk patients and provide preventive foot care services by podiatrists."
Wednesday, June 16, 2010
Join CKPA for 2nd Annual Rip’s B.A.D. Ride
Alefs Harley-Davidson
July 31st, 2010
The American Diabetes Association’s Bikers Against Diabetes (B.A.D.) Ride is an event for EVERYONE! It is a family festival with good entertainment, good friends, prizes, auctions, raffles, games all for a great cause!
Bikers will make a minimum donation of $30 and receive a patch to commemorate the ride. T-shirts, bandanas, and more prizes will be available for riders, depending on levels of money they raise. Riders will enjoy a ride around the beautiful plains of Kansas and have the option of participating in a poker run. B.A.D. Ride is sure to be a great time for the whole family! Help us on the road to a CURE!
The ADA- We make a difference everyday for the 23.6 million adults and children affected by diabetes in the United States
July 31st, 2010
The American Diabetes Association’s Bikers Against Diabetes (B.A.D.) Ride is an event for EVERYONE! It is a family festival with good entertainment, good friends, prizes, auctions, raffles, games all for a great cause!
Bikers will make a minimum donation of $30 and receive a patch to commemorate the ride. T-shirts, bandanas, and more prizes will be available for riders, depending on levels of money they raise. Riders will enjoy a ride around the beautiful plains of Kansas and have the option of participating in a poker run. B.A.D. Ride is sure to be a great time for the whole family! Help us on the road to a CURE!
The ADA- We make a difference everyday for the 23.6 million adults and children affected by diabetes in the United States
Are Your Feet Vacation Ready?
Although rest and relaxation are the goals for most vacations, they usually involve a lot of walking and a lot of walking usually involves sore feet.
Walking is great exercise and one of the most reliable forms of transportation. But if your feet aren't in the best shape or you don't have the right shoes, too much walking can cause foot problems.
Good foot care is essential if you plan to subject your feet to long periods of walking. Some simple foot care tips include:
1. Wear thick, moisture control socks (wool or synthetic fabrics instead of cotton) and change them often!
2. Dry feet thoroughly after bathing, making sure to dry between toes. Use powder before putting on shoes and even antiperspirant on your feet if you sweat profusely.
3. Nails should be cut regularly and straight across the toe. Check for ingrown toenails and avoid cutting them too short.
4. Moisturize your feet regularly, but never between your toes. Also watch out for athlete's foot fungus infections.
5. Massage any aching muscles after exercise and apply ice to any sore joints for at least 15 minutes.
6. Bunions, hammertoes or any other serious foot problems should be evaluated by a podiatrist prior to your planned vacation. Custom orthotics can help balance your feet so your vacation can be more enjoyable and pain free!
The right shoe is also important to healthy walking. The ideal walking shoe should be stable from side to side, and well-cushioned, and it should enable you to walk smoothly. Many running shoes will fit the bill. There are also shoes made especially for walking. Walking shoes tend to be slightly less cushioned, bulkier, and heavier than running shoes. Whether a walking or running shoe, the shoes need to feel stable and comfortable.
Never wear new shoes for the first time on vacation. Always "break them in" for at least a week to make sure the fit is proper and there are no seams rubbing! Blisters can put a damper on a vacation!
Also, two pairs of shoes can be very helpful in making your vacation more comfortable. After a vigorous day walking, your shoes need almost 24 hours to dry out so they do not smell and harbor fungus, the cause of athlete’s foot.
Warm up exercises to help alleviate any muscle stiffness or pulled muscles are advised before walking. Loosening up the heel cords (Achilles tendon and calf) and thigh muscles before a walk is especially effective.
If you're not accustomed to long walks, start slowly and rest if your feet start hurting.
Walking is great exercise and one of the most reliable forms of transportation. But if your feet aren't in the best shape or you don't have the right shoes, too much walking can cause foot problems.
Good foot care is essential if you plan to subject your feet to long periods of walking. Some simple foot care tips include:
1. Wear thick, moisture control socks (wool or synthetic fabrics instead of cotton) and change them often!
2. Dry feet thoroughly after bathing, making sure to dry between toes. Use powder before putting on shoes and even antiperspirant on your feet if you sweat profusely.
3. Nails should be cut regularly and straight across the toe. Check for ingrown toenails and avoid cutting them too short.
4. Moisturize your feet regularly, but never between your toes. Also watch out for athlete's foot fungus infections.
5. Massage any aching muscles after exercise and apply ice to any sore joints for at least 15 minutes.
6. Bunions, hammertoes or any other serious foot problems should be evaluated by a podiatrist prior to your planned vacation. Custom orthotics can help balance your feet so your vacation can be more enjoyable and pain free!
The right shoe is also important to healthy walking. The ideal walking shoe should be stable from side to side, and well-cushioned, and it should enable you to walk smoothly. Many running shoes will fit the bill. There are also shoes made especially for walking. Walking shoes tend to be slightly less cushioned, bulkier, and heavier than running shoes. Whether a walking or running shoe, the shoes need to feel stable and comfortable.
Never wear new shoes for the first time on vacation. Always "break them in" for at least a week to make sure the fit is proper and there are no seams rubbing! Blisters can put a damper on a vacation!
Also, two pairs of shoes can be very helpful in making your vacation more comfortable. After a vigorous day walking, your shoes need almost 24 hours to dry out so they do not smell and harbor fungus, the cause of athlete’s foot.
Warm up exercises to help alleviate any muscle stiffness or pulled muscles are advised before walking. Loosening up the heel cords (Achilles tendon and calf) and thigh muscles before a walk is especially effective.
If you're not accustomed to long walks, start slowly and rest if your feet start hurting.
Oldest leather shoe steps out after 5,500 years
WASHINGTON (AP) — About 5,500 years ago someone in the mountains of Armenia put his best foot forward in what is now the oldest leather shoe ever found.
It'll never be confused with a penny loafer or a track shoe, but the well-preserved footwear was made of a single piece of leather, laced up the front and back, researchers reported Wednesday in PLoS One, a journal of the Public Library of Science.
Worn and shaped by the wearer's right foot, the shoe was found in a cave along with other evidence of human occupation. The shoe had been stuffed with grass, which dated to the same time as the leather of the shoe — between 5,637 and 5,387 years ago.
"This is great luck," enthused archaeologist Ron Pinhasi of University College Cork in Cork, Ireland, who led the research team.
"We normally only find broken pots, but we have very little information about the day-to-day activity" of these ancient people. "What did they eat? What did they do? What did they wear? This is a chance to see this ... it gives us a real glimpse into society," he said in a telephone interview.
Previously the oldest leather shoe discovered in Europe or Asia was on the famous Otzi, the "Iceman" found frozen in the Alps a few years ago and now preserved in Italy. Otzi has been dated to 5,375 and 5,128 years ago, a few hundred years more recent than the Armenian shoe.
Otzi's shoes were made of deer and bear leather held together by a leather strap. The Armenian shoe appears to be made of cowhide, Pinhasi said.
Older sandals have been found in a cave in Missouri, but those were made of fiber rather than leather.
The shoe found in what is now Armenia was found in a pit, along with a broken pot and some wild goat horns.
But Pinhasi doesn't think it was thrown away. There was discarded material that had been tossed outside the cave, while this pit was inside in the living area. And while the shoe had been worn, it wasn't worn out.
It's not clear if the grass that filled the shoe was intended as a lining or insulation, or to maintain the shape of the shoe when it was stored, according to the researchers.
The Armenian shoe was small by current standards — European size 37 or U.S. women's size 7 — but might have fit a man of that era, according to Pinhasi.
He described the shoe as a single piece of leather cut to fit the foot. The back of the shoe was closed by a lace passing through four sets of eyelets. In the front, 15 pairs of eyelets were used to lace from toe to top.
There was no reinforcement in the sole, just the one layer of soft leather. "I don't know how long it would last in rocky terrain," Pinhasi said.
He noted that the shoe is similar to a type of footwear common in the Aran Islands, west of Ireland, up until the 1950s. The Irish version, known as "pampooties" reportedly didn't last long, he said.
"In fact, enormous similarities exist between the manufacturing technique and style of this (Armenian) shoe and those found across Europe at later periods, suggesting that this type of shoe was worn for thousands of years across a large and environmentally diverse region," Pinhasi said.
While the Armenian shoe was soft when unearthed, the leather has begun to harden now that it is exposed to air, Pinhasi said.
Oh, and unlike a lot of very old shoes, it didn't smell.
Pinhasi said the shoe is currently at the Institute of Archaeology in Yerevan, but he hopes it will be sent to laboratories in either Switzerland or Germany where it can be treated for preservation and then returned to Armenia for display in a museum.
Pinhasi, meanwhile, is heading back to Armenia this week, hoping the other shoe will drop.
The research was funded by the National Geographic Society, the Chitjian Foundation, the Gfoeller Foundation, the Steinmetz Family Foundation, the Boochever Foundation and the Cotsen Institute of Archaeology at UCLA.
It'll never be confused with a penny loafer or a track shoe, but the well-preserved footwear was made of a single piece of leather, laced up the front and back, researchers reported Wednesday in PLoS One, a journal of the Public Library of Science.
Worn and shaped by the wearer's right foot, the shoe was found in a cave along with other evidence of human occupation. The shoe had been stuffed with grass, which dated to the same time as the leather of the shoe — between 5,637 and 5,387 years ago.
"This is great luck," enthused archaeologist Ron Pinhasi of University College Cork in Cork, Ireland, who led the research team.
"We normally only find broken pots, but we have very little information about the day-to-day activity" of these ancient people. "What did they eat? What did they do? What did they wear? This is a chance to see this ... it gives us a real glimpse into society," he said in a telephone interview.
Previously the oldest leather shoe discovered in Europe or Asia was on the famous Otzi, the "Iceman" found frozen in the Alps a few years ago and now preserved in Italy. Otzi has been dated to 5,375 and 5,128 years ago, a few hundred years more recent than the Armenian shoe.
Otzi's shoes were made of deer and bear leather held together by a leather strap. The Armenian shoe appears to be made of cowhide, Pinhasi said.
Older sandals have been found in a cave in Missouri, but those were made of fiber rather than leather.
The shoe found in what is now Armenia was found in a pit, along with a broken pot and some wild goat horns.
But Pinhasi doesn't think it was thrown away. There was discarded material that had been tossed outside the cave, while this pit was inside in the living area. And while the shoe had been worn, it wasn't worn out.
It's not clear if the grass that filled the shoe was intended as a lining or insulation, or to maintain the shape of the shoe when it was stored, according to the researchers.
The Armenian shoe was small by current standards — European size 37 or U.S. women's size 7 — but might have fit a man of that era, according to Pinhasi.
He described the shoe as a single piece of leather cut to fit the foot. The back of the shoe was closed by a lace passing through four sets of eyelets. In the front, 15 pairs of eyelets were used to lace from toe to top.
There was no reinforcement in the sole, just the one layer of soft leather. "I don't know how long it would last in rocky terrain," Pinhasi said.
He noted that the shoe is similar to a type of footwear common in the Aran Islands, west of Ireland, up until the 1950s. The Irish version, known as "pampooties" reportedly didn't last long, he said.
"In fact, enormous similarities exist between the manufacturing technique and style of this (Armenian) shoe and those found across Europe at later periods, suggesting that this type of shoe was worn for thousands of years across a large and environmentally diverse region," Pinhasi said.
While the Armenian shoe was soft when unearthed, the leather has begun to harden now that it is exposed to air, Pinhasi said.
Oh, and unlike a lot of very old shoes, it didn't smell.
Pinhasi said the shoe is currently at the Institute of Archaeology in Yerevan, but he hopes it will be sent to laboratories in either Switzerland or Germany where it can be treated for preservation and then returned to Armenia for display in a museum.
Pinhasi, meanwhile, is heading back to Armenia this week, hoping the other shoe will drop.
The research was funded by the National Geographic Society, the Chitjian Foundation, the Gfoeller Foundation, the Steinmetz Family Foundation, the Boochever Foundation and the Cotsen Institute of Archaeology at UCLA.
Mental decline from diabetes can start in middle age
(Reuters Health) - Diabetes can lead to a decline in memory, thinking speed, and mental flexibility in middle age, but controlling the blood sugar disorder might prevent some of these effects, new research from the Netherlands suggests.
Health
While the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.
Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.
At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.
The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.
Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.
But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.
Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.
Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.
The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.
The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.
The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.
They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."
SOURCE: link.reuters.com/xyd69k Diabetes Care, online June 2, 2010
Health
While the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.
"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.
Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.
At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.
The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.
Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.
But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.
Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.
Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.
The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.
The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.
The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.
They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."
SOURCE: link.reuters.com/xyd69k Diabetes Care, online June 2, 2010
Wednesday, May 5, 2010
Medicare Diabetic Shoe Program
Diabetes is reaching epidemic proportions in the United States. Over the past decade, there has been an increase of 33% with the diabetic population currently topping 16 million people. There are many complications associated with diabetes including kidney, heart, vision, circulatory and foot problems. The good news is that many of these potential problems can be minimized as a result of life style changes, medications and other preventive care.
Amputations, and/or partial amputations, of the feet and legs are growing at an alarming rate. In fact, it is one of the leading causes of non-traumatic amputation in the US alone. Just recently American Podiatric Medical Association, Medicare officials and the American Diabetes Association established a team to explore ways to reduce the number of amputations in the diabetic population. The number of these lower extremity amputations grew by 28% in the past several years. However, it has been determined that a majority of these amputations could have been prevented by routine foot care.
As Medicare providers our doctors not only treat everything from routine foot care to surgery we also prescribe and dispense Medicare approved diabetic shoes and inserts. This valuable prevention program allows diabetic patients to receive one pair of diabetic shoes and 3 pairs of diabetic inserts every calendar year. As an approved program participant Medicare will cover 80% of the allowable amount and many supplemental insurance plans take care of the remaining 20%, leaving you with little or no additional cost. Many diabetic patients qualify for this benefit.
Amputations, and/or partial amputations, of the feet and legs are growing at an alarming rate. In fact, it is one of the leading causes of non-traumatic amputation in the US alone. Just recently American Podiatric Medical Association, Medicare officials and the American Diabetes Association established a team to explore ways to reduce the number of amputations in the diabetic population. The number of these lower extremity amputations grew by 28% in the past several years. However, it has been determined that a majority of these amputations could have been prevented by routine foot care.
As Medicare providers our doctors not only treat everything from routine foot care to surgery we also prescribe and dispense Medicare approved diabetic shoes and inserts. This valuable prevention program allows diabetic patients to receive one pair of diabetic shoes and 3 pairs of diabetic inserts every calendar year. As an approved program participant Medicare will cover 80% of the allowable amount and many supplemental insurance plans take care of the remaining 20%, leaving you with little or no additional cost. Many diabetic patients qualify for this benefit.
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