Author: Staff Writers

Dental Diabetes Detection: Does it make sense to offer diabetic screenings in a dental office? New research tends to suggest that under specific circumstances it does.

According to ScienceDaily.com, “An overwhelming majority of people who have periodontal (gum) disease are also at high risk for diabetes and should be screened for diabetes, a New York University nursing-dental research team has found. The researchers also determined that half of those at risk had seen a dentist in the previous year, concluded that dentists should consider offering diabetes screenings in their offices, and described practical approaches to conducting diabetes screenings in dental offices.”

Data was examined from 2,923 adult dental patients over a two-year period. These patients “had not been diagnosed with diabetes.”

Dr. Shiela Strauss is an Associate Professor of Nursing and Co-Director of the Statistics and Data Management Core for NYU’s Colleges of Dentistry and Nursing. Strauss led the study conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

According to ScienceDaily.com, “Using guidelines established by the American Diabetes Association, Dr. Strauss determined that 93 percent of subjects who had periodontal disease, compared to 63 percent of those without the disease, were considered to be at high risk for diabetes and should be screened for diabetes. The guidelines recommend diabetes screening for people at least 45 years of age with a body mass index (a comparative measure of weight and height) of 25 or more, as well as for those under 45 years of age with a BMI of 25 or more who also have at least one additional diabetes risk factor. In Dr. Strauss’s study, two of those additional risk factors — high blood pressure and a first-degree relative (a parent or sibling) with diabetes — were reported in a significantly greater number of subjects with periodontal disease than in subjects without the disease. Dr. Strauss’s findings, published today in the online edition of the Journal of Public Health Dentistry, add to a growing body of evidence linking periodontal infections to an increased risk for diabetes.”

The reason Strauss suggests using the dental office to conduct diabetic screenings is that many patients will visit the dentist when they will not routinely visit their family doctor, “Three in five reported a dental visit in the past two years; half in the past year; and a third in the past six months,” she said. These statistics seem to suggest a helpful health link between early diagnosis of diabetes and dental visits.

Strauss commented, “The issue of undiagnosed diabetes is especially critical because early treatment and secondary prevention efforts may help to prevent or delay the long-term complications of diabetes that are responsible for reduced quality of life and increased levels of mortality among these patients. Thus, there is a critical need to increase opportunities for diabetes screening and early diabetes detection.”

While it has been suggested dentists might use a standard glucose meter to test blood sugar samples in patients there are others who believe a gum tissue blood sample could be viewed as standard procedure among patients who don’t generally expect a finger prick in a dental office.

We have yet to see if dental offices will become a first line defense for diabetes detection, but the idea does appear to have merit. If a routine dental visit can help identify what is believed to be a large number of undiagnosed cases there may be room for improved quality of life by starting intervention therapies earlier.

A Partnership to Save Beta Cells: What would it be like for those who may be prone to the development of Type 1 diabetes to encounter a solution that stops beta cells from being destroyed? A newly announced partnership hopes to answer that question.

According to PRNewswire.com, “The Juvenile Diabetes Research Foundation, a leader in setting the agenda for diabetes research worldwide, said that it will begin working with The Johnson & Johnson Corporate Office of Science and Technology, and its affiliates, to speed the development of drug targets and pathways to promote the survival and function of insulin-producing cells in people who have diabetes. The program will look to fund research at academic centers around the world that could eventually lead to novel drug targets and industry collaborations for the treatment of type 1 diabetes.”

It may not be possible to completely stop the development of type 1 diabetes, but the long-term consequences could be diminished if insulin-producing cells can be spared from damage following an initial attack, “The joint program will solicit grant proposals from academia and medical research foundations for one- or two-year research projects. The research will focus on agents and compounds that safely promote survival and function of beta cells – the cells within the pancreas that produce insulin, and that are lost in the immune attack that causes type 1 diabetes. Preserving or maintaining beta cell mass and activity in people with type 1 diabetes can reduce insulin requirements, make controlling the disease easier and more effective, and lower the risk of both short- and long-term complications of the disease,” according to the PRNewswire report.

The release further quotes Alan J. Lewis, Ph.D., President and Chief Executive Officer of the Juvenile Diabetes Research Foundation, “This program will clearly help accelerate the translation of basic research into therapies useful in the treatment of diabetes. By creating this novel incubator program to support early stage research with a company known for first-class research and significant experience in the commercialization of products, we believe we can increase the number of viable drug targets identified and fundamentally change the pace of diabetes research.”

In type 1 diabetes the problem always originals with damaged cells that effectively destroy the ability of the pancreas to produce needed insulin. If therapies can be developed that result in salvaging remaining cells this would be a huge plus to type 1 diabetics. It could also be argued that if this partnership is successful it may be possible to develop therapies that not only preserve remaining cells, but also prevent damage before it starts.

Martin Fitchet, M.D., Therapeutic Area Head, Cardiovascular and Metabolism for Johnson & Johnson Pharmaceutical Research and Development, L.L.C was also quoted in the PRNewswire release, “Beta cell survival is a critical research focus to advance the understanding of the natural history of diabetes, and importantly, where to intervene to slow or arrest the progression of this disease. Establishing this alliance with The Juvenile Diabetes Research Foundation is a part of our commitment to access external innovation to drive discovery and development of new therapies for the patients who most need them.”

The partnership is designed to fast track ideas and initiatives that can accelerate the dynamics of diabetes research in a critical area that attempt to get at the root of the most prevalent problem in type 1 diabetes and provide substantial assistance in an arena that has previously been closed to medical intervention.

A New Way to Test for Prediabetes: Screening for new diabetes cases has always been a challenge because testing isn’t mandatory and current testing is very specific in how it is administered. However, a test not currently used for diagnosing diabetes may be added as a less restrictive way to check for the presence of the disease.

The American Diabetes Association (ADA) recently recommended using the A1C test as a way to identify those who are diabetic and prediabetic.

According to WebMD, “Patients do not need to fast before the test is given, and it is far less likely to identify clinically irrelevant fluctuations in blood sugar because it measures average blood glucose levels over several months.”

This is important because no special preparation for the test is required and can be administered during any routine visit to the doctor if the physician feels it is warranted.

John Buse, MD, PhD, ADA president for medicine and science told WebMD, “We now know that early diagnosis and treatment can have a huge impact on outcomes by preventing the complications commonly seen when diabetes is not well controlled. Our hope is that people with early or prediabetes who might otherwise not be tested would have the A1C test.”

While the A1C test has been available for more than three decades it has taken some time for the test to be considered a reliable test for diabetes detection.

WebMD suggests diabetic testing for the following…

• Any adult who is overweight or obese (BMI of 25 or greater) with one or more additional risk factor for diabetes including: having a family history of the disease, belonging to a high-risk ethnic group (African-American, Latino, Native American, Asian-American), having high blood pressure or a history of gestational diabetes.
• Anyone who is age 45 or older, regardless of risk factors. (Source: WebMD)

When A1C levels are above 6.5 an individual is diagnosed as diabetic. Anything reading between 5.7 and 6.4 is considered pre-diabetic. A healthy patient should have an A1C level of around 5.

While the A1C test is not to be used as a replacement for current tests Buse believes the addition of this test could help identify millions of prediabetics who have not had any traditional tests. Buse told WebMD, “I’m thinking of an overweight guy who is 40 years old who doesn’t see the doctor unless he strains his back or is sick.”

If an individual who is overweight could reduced their overall weight by 5-10% most risk factors for diabetes are reduced by as much as 60% according to the report.

This goal is achieved through lifestyle alterations and adding physical exercise to your daily routine. The ADA would like to see insurance companies help by paying for programs for those diagnosed as prediabetic. No word on if that will happen, but the pressure is on for a greater awareness and diagnoses of prediabetes – and then removing the obstacles that stand in the way of good health.

The potential of a test that identifies those most at risk for developing diabetes is important because early detection can allow choices to be made that could prevent the disease from further development.

If you overweight and are 45 years of age or older this might be a great test to help you get on track with long-term health objectives.

Couch Potatoes Run the Risk of Death: Shocking research from Australia indicates that people who spend too much time in front of the TV often find themselves at pronounced risk of death or critical health care issues.

According to WiredPRNews.com, “A recent study suggests that too much time in front the television can be bad for the health of individuals; regardless of whether they are overweight or at a healthy weight. As reported by Reuters, Australian researchers found that hours spent sitting in front of a television daily can increase risks of death from heart complications and other health conditions.”

This sedentary lifestyle can result in obesity, which can it turn develop into diabetes. Study leader David Dunstan, of the Baker Heart and Diabetes Institute, is quoted in the report as remarking, “A lot of the normal activities of daily living that involved standing up and moving the muscles in the body have been converted to sitting… For many people, on a daily basis, they simply shift from one chair to another – from the chair in the car to the chair in the office to the chair in front of the television,” according to WiredPRNews.com.

The average television viewing time in America is 5 hours a day. This exceeds the amount researchers felt was acceptable. In fact the study shows that watching more than 4 hours of television each day can result in an 80% greater chance of death by cardiovascular disease and a 46% greater chance of death through other means.

What Causes Death in Watching TV?

You may be surprised to know that weight isn’t always a contributing factor in those who watch TV and struggle with disease. The real culprit seems to be in the act of sitting still for long periods of time. It appears that even those who spend up to an hour each day in exercise can face similar problems if they spend significant amounts of time in activities in which they remain still.

These activities could be reading a book, checking out the web, in a car commuting from one place to another or at a desk in an office.

Our bodies are designed to be used. When we sit without any movement we can cause our bodies to experience problems they weren’t made to handle.

So, is TV Watching Out?

Not necessarily. You might try a stationary bike while watching TV or fold clothes or perform other household chores that still allow you to watch your favorite show. Some individuals might experience better health by not using the remote to change the television or perhaps to use commercial breaks to walk around the house until the show comes back on.

The real key here is to pay attention to how much time you spend sitting still. In school academic activity is broken up by physical movement. The same should be true in the life of a family. Limit the amount of time a child spends playing video games. Transfer some of the time you might spend in watching TV to an evening walk or time on a treadmill.

If you work in an office take the time to walk a report to a colleague or to find time to locate office supplies you need rather than using the intercom to ask for it to be brought to your office. Find ways to get and stay mobile. Your long-term health is more important than what’s new on television tonight.

A Compelling Reason to Never Start Smoking: What if I were to tell you that people who stop smoking are 70% more likely to develop diabetes? I suppose that depends on whether you’ve only considered smoking and this convinces you not to – or if you are a smoker and have considered stopping.

It’s a new year and many individuals are doing their best to kick a habit that does damage to the lungs and often shortens life expectancy, but new information has many struggling with how to make wise decisions.

A new study followed 10,000 people who did not have diabetes when the study began. What researchers discovered was that a significant portion of those who quit smoking for health reasons were also prone to the development of diabetes.

The common thread in these findings was that of weight gain. Patients who quit smoking often substituted their craving for nicotine with a craving for something else. This was usually fulfilled in eating comfort foods. Essentially the weight gain from these coping mechanisms resulted in conditions in which diabetes could develop.

There is good news in this story. According to Guardian.co.uk the diabetes risk spiked in the first three year. “It then slowly reduced, over about 10 years, down to the level of risk of someone who never smoked,” the report indicated.

What if weight gain was not a problem? Well according to that same report, “The risk of diabetes from stopping smoking was almost cancelled out when they took account of the amount of weight people gained. So a smoker who didn’t gain weight after stopping might have little or no increased risk of diabetes.”

This works to confirm the long-standing research that indicates excess weight is often a profound contributor to diabetes.

According to Guardian.co.uk, “The study was done by researchers at universities in the US (Johns Hopkins University School of Medicine) and in Brazil. It was published in a journal called the Annals of Internal Medicine. The study was funded by grants from the National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases in the US.”

To be clear this report is in no way suggesting that people who smoke should continue smoking. The health risks make stopping not only reasonable, but also responsible. The overriding consensus seems to be that those who stop smoking should also be very aware of potential weight gain and work with their health care provider to maintain the weight while they break the chains of cigarette addiction.

Perhaps critical to this story is the idea that the best defense is a proactive offense. As diabetic rates continue to rise to unprecedented levels it may make more sense that ever to encourage young people to refrain from smoking in the first place. If a young person can really grasp the notion that the smoke damages the lungs and increases risk for heart attack and stroke they might think about not smoking. If they also understand that by trying to quit smoking once they start the end result could be diabetes they may rightfully conclude that it is a waste of time to pick up the habit.

Like almost everything in life it all comes down to choices. Some you can make early and can affect you for a lifetime. Others are made later and may provide more challenging circumstances to deal with.

Diabetic Gene Therapy Proves Promising in Mice: Research can be a protracted effort with baby steps resulting in new findings that simply ask new questions. One recent discovery indicates the potential to control diabetes independent of weight. As with most research this is preliminary with more research needed.

According to ScienceDaily.com, “Researchers have found that even a very little bit of the fat hormone leptin goes a long way when it comes to correcting diabetes. The hormone controls the activity of a gene known as IGFBP2 in the liver, which has antidiabetic effects in animals and could have similar therapeutic effect in humans, according to a report published by Cell Press in the January issue of Cell Metabolism.”

Jeffrey Friedman of Rockefeller University is quoted by the online resource as saying, “It was surprising to me how potent leptin was in treating diabetes. It had a highly significant impact at plasma levels that were undetectable.”

Leptin provides an interesting yet helpful side effect, “Leptin also causes marked weight loss, which by itself can improve diabetes. To get around that issue in the new study, Friedman and his colleagues first identified the lowest dose of leptin that could correct insulin resistance and diabetes without leading animals to eat less or lose weight,” according to ScienceDaily.com.

In essence researchers were already aware of the fact that this hormone causes weight loss, but by significantly reducing the dose in research subjects (animals) they further found that even the small doses had a profoundly positive effect on diabetes. The report further declared, “Earlier studies had shown that leptin treatment effectively corrects high blood sugar and insulin levels in leptin-deficient mice and humans. Leptin’s usefulness as a therapy has also been shown in some clinical settings, in people with rare metabolic disorders. But it wasn’t clear exactly how the hormone produced in fat tissue acts to improve diabetes.”

In a practical application researcher were led to the IGFBP2 gene. The ScienceDaily.com report states, “Treatments designed to increase IGFBP2 expression in obese and diabetic mice reversed their diabetes. Further study showed that animals treated with the protein responded to insulin three times better than untreated ones.

“They also found that leptin-deficient patients do indeed have lower blood levels of IGFBP2 at baseline and that those levels can be raised with low-dose leptin treatment.”

As mentioned earlier this discovery may sound amazing on the surface, but in order for it to eventually lead to a medical therapy further clinical research will be needed to answer the new questions raised from this initial research.

To immediately begin marketing this as a cure-all for diabetes may be irresponsible because while all indicators point to effective control, the research has yet to extend to humans and side effects have not been noted in long-term use. In fact, “Friedman said that future experiments in mice lacking IGFBP2 altogether are needed to confirm that the protein is required for leptin’s antidiabetic influence. Now that they know that very high levels of IGFBP2 can act to improve diabetes, they’ll also need to explore the effects of normal physiologic levels,” said ScienceDaily.com.

In other words there will still be rodent research before it ever gets to human clinical trials. The most important ‘next’ finding will simply be to replicate the findings of this initial, and compelling research and answer as many new questions as possible in the process.

Back on the World Stage 10 Years After Diabetes Diagnosis: He is thought of as one of the most elite cross country skiers in America and, “Kris Freeman is back in the hunt for an Olympic medal in Vancouver after being named… to the U.S. ski team following a disappointing finish at the 2006 Games in Torino, Italy,” according to PRNewsWire. Freeman lives with Type 1 diabetes.

It is anticipated that Freeman will participate in as many as five events in the 2010 Olympics including “the 15 km freestyle, the individual sprint, the 30 km pursuit, the team sprint, and the 50 km mass start classic,” said PRNewsWire.

Freeman was diagnosed ten years ago as a teenager and health care providers told him he would never be able to compete in the Olympics. This isn’t the first Olympics in which Freeman has been able to participate. According to the press release, “A key marker on Freeman’s comeback trail is how he is now treated for type 1 diabetes.  To compete in the 2010 Games, Freeman will wear a small device, called an insulin pump, which provides an adjustable supply of insulin to help manage his diabetes even while racing.”

Freeman was quick to point out, “I’m motivated to win for my country and myself, but to also prove to detractors that it’s possible to compete against the world’s best cross-country skiers, even with type 1 diabetes.”

It is this ‘can do’ attitude that has allowed Freeman to not only achieve much, but also to excel in his chosen sport. It should be noted that only one other American Olympian has ever medalled in cross-country skiing. To add a greater sense of drama to the prospect PRNewsWire reported that Freeman “underwent surgery in both legs last spring to alleviate debilitating pain caused by a rare muscle disorder called compartment syndrome.”

While Freeman is looking for a win he is also concerned about the health of other young people who also must wage a daily battle with Type 1 diabetes. When he’s not skiing Freeman “travels for sponsor Eli Lilly and Company to children’s diabetes camps across the U.S. to speak to campers about their disease. To date, he has met with more than 3,000 youngsters nationwide.”

Freeman talks about that experience, “I have a blast meeting the campers, but more importantly, I want them to see that a person with diabetes can do almost anything he or she puts his mind to, including competing in the Olympics.”

Press release information states, “In competition, Freeman is a 13-time U.S. National cross-country champion and recently had his best finish at the 2009 World Championships and the best U.S. finish in any cross-country event in more than two decades. He came in fourth in November’s World Cup 15 km classic in Kuusamo, Finland.

“At the 2002 Olympics in Salt Lake City, Freeman placed 22nd in the 15 km classic and 14th in the 30 km pursuit. He also logged the sixth fastest time overall in the 4 x 10 km team relay, helping the U.S. team secure fifth place — the best Olympic finish for the U.S. cross-country team in history. In 2003, Freeman finished sixth and fifth in two consecutive World Cups, and finished 22nd in the 15 km classic at the 2006 Winter Games in Torino, Italy.”

While managing his disease can take time and patience Freeman continues to prove that diabetes does not have to prevent you from achieving your dreams.

Seeking Quality Insulin Delivery For Type 1 Diabetics: As research continues into the possibility of an artificial pancreas there is new evidence to suggest that the current method of insulin delivery for Type 1 diabetics may have some flaws.

According to Marketwatch, “Researchers at Sansum Diabetes Research Institute and University of California, Santa Barbara have concluded that changing the height of a conventional insulin pump in relation to its tubing and infusion set can significantly impact expected insulin delivery rates. Such changes can occur during routine daily activities like dressing, sleeping or showering. The study, ‘Siphon Effects of Continuous Subcutaneous Insulin Infusion Pump Delivery Performance,’ evaluated the siphon or hydrostatic pressure action effects on continuous subcutaneous insulin infusion and was published in the January issue of Journal of Diabetes Science and Technology.”

The core findings of this report suggests that some of the most common insulin pumps will supply less insulin when the unit is lower than the tubing site and more insulin when the unit is above the tubing.

Marketwatch continues by quoting lead investigator Howard Zisser, MD, Director of Clinical Research and Diabetes Technology at the Sansum Diabetes Research Institute in Santa Barbara, CA, “In this study we found a pronounced siphon effect in conventional insulin pumps, which caused significant fluctuations in the accuracy of insulin delivery rates when the pump position was moved higher or lower relative to its tubing and infusion site. Insulin pump therapy allows for precise control of insulin delivery for patients with type 1 diabetes. The unintended fluctuation in insulin delivery, which may arise from pump movement during normal daily use, can increase blood glucose variability, a risk factor for the progression of complications of diabetes. The effect of hydrostatic pressure was most significant at low basal rates and therefore these findings may be particularly important for pediatric diabetes patients, who often use insulin pumps at low basal rates.”

The primary reason for the research was to identify which pump could supply the best delivery of insulin according to the actual need. While no pump was perfect the research did indicate, “The OmniPod, which has no external tubing, was the least affected by pumping orientation and direction. With the OmniPod System, the 1U/hr rate differences only ranged from 98.3% when its delivery cannula was in a level pumping position to 101.3% when the cannula was in an upward pumping position. For the 1.5U/hr rate, its differences only ranged from 96.0% in a level pumping position to 102.5% in an upward pumping position.”

The research was funded by a grant from the Insulet Corporation and was conducted by the Sansum Diabetes Research Institute, “A non-profit research center devoted to the prevention, treatment and cure of diabetes through research and education. In particular, it is known for its work on methods to detect and chart the progress of diabetes, its success in developing protocols to increase the incidence of healthy babies born to women with diabetes, and its expertise in new diabetes technology.”

The goal of this type of research is to work to hold manufacturers accountable to produce pumps with the highest degree of accuracy. By pinpointing the best it may encourage other manufacturers to work to provide pumps with a greater level of accuracy as well. It is presumed that when the artificial pancreas is available the delivery of insulin will be more accurate because no outer tubing will be required.

Diabetes and Black History Month: February is Black History month and one Congressional leader is urging African Americans to get their eyes checked – especially if they also have diabetes.

According to a press release from the American Academy of Ophthalmology (AAO), “The incidence of diabetes continues to increase, particularly among African Americans. 3.7 million African Americans aged 20 years or older have diabetes. Studies show that African Americans with diabetes are more likely to develop diabetic complications and experience greater disability from the complications than white Americans with diabetes. The only way to prevent this is through strict glucose control and by having an annual dilated eye exam.”

Congressman and House Majority Whip James E. Clyburn (SC-6) is quoted in the release as saying “Diabetes is an epidemic in the African American community. People with diabetes are 25 times more likely to go blind and African Americans with diabetes are at an even higher risk — almost 50 percent more likely to develop diabetic retinopathy. If you have diabetes, it’s critically important for you to receive an annual diabetic eye exam, because it will help detect and prevent eye disease.”

Retinopathy is a common optical issue among those who have diabetes. This can be even truer among African Americans. The release states, “For every white American who gets diabetes, 1.6 African Americans get diabetes and one in four black women, 55 years of age or older, has diabetes. Diabetes is associated with an increased risk for a number of serious and sometimes life-threatening complications, including blindness, heart disease, kidney disease, and stroke. Managing your diabetes can help reduce your risk.”

On a related Note the National Health Service (NHS) in the UK is celebrating a nurse practitioner of African Caribbean descent. Because diabetes is so prevalent among people of Asian and African descent it was easy for Grace Vanterpool to pursue a career as a “nurse consultant in diabetes”.

A video provided by the NHS shows Vanterpool visiting patients and discussing ways to improve their condition. Vanterpool is also the only African Caribbean nurse consultant in diabetes in the U.K.

The NHS report states, “Grace works closely with patients, GPs and practice nurses, as well as training students and clinicians to provide high-quality care. She also works to ensure that all local services for people with diabetes provide the same standards of care.”

Grace and her team work with around 5,000 patients in treating and educating. Grace remembers some of her early work, “We had a double decker bus that went around town, testing people for diabetes and giving out information. During evenings and weekends we’d go wherever people gathered, such as train stations or the university. We also went to local factories, mosques and churches. We discovered that a lot of people had diabetes but didn’t know it.”

The report suggests that there are some 75,000 people in the U.K. that had undiagnosed diabetes. Grace continues, “Raising awareness among black and minority ethnic (BME) communities under an award-winning project called Action Diabetes. As a result, in 2006, she won Community Nurse of the Year and overall Nurse of the Year at the Nursing Standard awards.”

Grace concluded her NHS interview by saying, “The important message is not to ignore diabetes, as it’s a progressive condition. It’s the biggest cause of blindness in the UK working population, but this and other complications are preventable if diabetes is managed well and monitored.”

That includes regular eye exams.