Category: Diabetes 101

Glucose Test May Predict Risk of CVD In Diabetes Patients: The most important way to manage ones diabetes is to manage the hemoglobin A1C level within the body.  There are many reasons as to why this level is particular is important but one major reason is that by managing it, it can help reduce the risk of cardiovascular disease, also known as CVD.

Through research, diabetes had been noted as a risk factor for cardiovascular disease. However, with patients already suffering from diabetes, the risk is much higher.

Nina P. Paynter, Ph.D., from Brigham and Women’s Hospital, Boston, and colleagues, used data from participants of the Women’s Health Study and the Physician’s Health Study II states, “Simulated cost-benefit analyses have suggested that this variability in CVD risk could provide an opportunity for tailored preventive therapy in diabetic patients.”

Researchers wanted to investigate the importance of HbA 1c levels through a test that reflects the average blood glucose level throughout a period of two months/ three months. Through this test, researchers could see how the HbA 1c affected diabetes and how it was being managed.

Through the test, 24,674 women where used, 685 having diabetes and 11,280 men were used, 563 having diabetes. Through questionnaires, researchers obtained health history and received blood samples to check cholesterol, C-reactive protein and HbA 1c levels. Researchers followed up for a middle point of 10.2 years for women and a midpoint of 11.8 years for men to look for new cases of cardiovascular disease. Their findings consisted of 125 cardiovascular cases in the 685 female surveyors with diabetes and 170 in the 563 male surveyors with diabetes.

The researchers stated, “We found that in these large population-based cohorts of both men and women, presence of diabetes alone did not confer a 10-year risk of CVD higher than 20 percent, and measurement of HbA 1c level in diabetic subjects improved risk prediction compared with classification as cardiovascular risk equivalent. They propose that the difference in risk between the sexes may be partly attributed to the increase in CVD risk with age and the delayed risk in women. Our findings suggest that the improvement in CVD risk prediction, and possibly calibration, obtained with adding HbA 1c levels is highest in lower-risk populations.”

New Drug Raises HGL Cholesterol And Helps Control Type 2: According to new research, a medication that was designed to help improve the levels of “good” cholesterol could also help to control blood sugar in people who have diabetes and are taking a cholesterol-lowering drug.

This finding came from researchers who were analyzing data from a clinical trial for a drug called torcetrapib. Torcetrapib is a cholesterol ester transfer protein inhibitor, a drug that increases high-density lipoproteins also known as HDL levels.

This study was completed on 6,661 people who have type 2 diabetes who showed improvement in their blood sugar levels while taking torcetrapib and a stain medication that helped to reduce low-density lipoproteins, also known as LDL levels.

Philip Barter, M.B.B.S., Ph.D., a professor of medicine and director of the Heart Research Institute at the University of Sydney in Australia says, “The possibility that CETP inhibitor drugs may not only reduce the risk of heart attack and stroke, but may also improve the control of blood sugar in people with diabetes, is an exciting prospect that may translate into real health benefits for people with diabetes.”

According to the World Health Organization about 220 million people across the globe have diabetes and about 95 percent have type 2 diabetes, which adds an increase to heart disease, stroke and other heart problems.

Barter states, “While the experimental drug was not as effective in taming diabetes as drugs that are commonly used for that purpose, it did reduce the adverse impact on blood sugar commonly seen with statin use, inhibition of CETP has the potential to prevent a worsening of diabetic control that often occurs in people taking statin drugs.”

The clinical trial was called ILLUMINATE (Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events) and was completed on 15,000 people from age 45 to 75. Every person that the trial was completed on had either a history of heart attack, stroke, chest pain, peripheral vascular disease or cardiac revascularization (angioplasty or bypass) and all were on medication to control their diabetes.

Swamp Gas May Be Used in New Diabetes Treatments: Hydrogen sulfide, more commonly known as “swamp gas” – is responsible for various disagreeable odors, from the smell of rotting plants and sewer systems to certain industrial fumes. Yet a new study supported by the National Institutes of Health, the Juvenile Diabetes Foundation, and Shriners Hospital for Children and conducted by the University of Texas Medical Branch at Galveston suggests that this foul-smelling compound plays an important role in shielding blood vessels from the effects of diabetes.

The University of Texas Medical Branch states in a new paper published in the Proceedings of the National Academy of Science that experiments with diabetic rats and human endothelial cells – the cells that make up the inside layer of our blood vessels – have shown that hydrogen sulfide levels play an important role in the possibility of diabetic complications in the blood vessels. It has been shown in recent years that hydrogen sulfide occurs naturally in the human body, playing a role in the circulatory system.

The UTMB research group, headed by Dr. Csaba Szabo, began their experiments by exposing human endothelial cells to sugar at a level similar to what the cells of a diabetic person would experience. The results were predictable: “Upon exposure to such high sugar levels, the cells started to produce increasing amounts of highly reactive toxic free radicals, and as a consequence, they began to die,” Dr. Szabo stated. However, the presence of hydrogen sulfide affected the health of the endothelial cells: “Low hydrogen sulfide levels accelerated this process, while constant replacement of hydrogen sulfide protected the cells against the toxic effects of high sugar,” according to Dr. Szabo. Exposing the cells to this “swamp gas” was shown to have a protective effect against the complications of diabetes.

In treating diabetic rats, the research team showed that these rats had lower levels of hydrogen sulfide present in their circulatory systems than normal. They also improved the rats’ conditions by exposing them to hydrogen sulfide treatment for a month, improving the health of their blood vessels.

Dr. Szabo stressed the importance of the health of the endothelial cells in preventing diabetic complications. “The loss of endothelial cell function in diabetes is a first step that leads to many complications, such as eye disease, heart disease, kidney disease, foot disease and others.” He went on to state that this swamp gas research may be utilized in new diabetes treatments: “The observation that hydrogen sulfide can control an early checkpoint in all of these processes may open the door for new therapies.”

Body Muscle Mass Helps Fight Insulin Resistance: Body muscle mass helps prevent insulin resistance even in overweight individuals. Insulin resistance, in many cases, leads to a diagnosis of type 2 diabetes.  There is a possibility of stopping the progression from a diagnosis of insulin resistance to full-blown type 2 diabetes with building additional body muscle mass.  Insulin resistance is a condition where blood glucose levels are higher than the normal range and is a cause for concern in one’s overall health.

A recent study, the results of which are soon to be published in The Endocrine Society’s Journal of Clinical Endocrinology and Metabolism, was recently done at the University of California, Los Angeles.  The senior author of the study results, Preethi Srikanthan, M.D., stated, “Our findings represent a departure from the usual focus of clinicians, and their patients, on just losing weight to improve metabolic health.”  Srikanthan further added, “Instead, this research suggests a role for maintaining fitness and building muscle.  This is a welcome message for many overweight patients who experience difficulty in achieving weight loss, as any effort to get moving and keep fit should be seen as laudable and contributing to metabolic change.”

In studies in the past, it was discovered that low muscle mass is a risk factor for insulin resistance.  Until this time, however, no study had examined whether increasing the body muscle mass to average and then above average levels, separately from the overall body weight, would lead to improved blood sugar levels.

This study took into account the body muscle mass in relationship to insulin resistance and blood sugar metabolism disorders.  It was a nationally representative group sample of 13,644 people.  Those in the study were all older than 20 years of age, none were expecting a child and they all weighed more than a set figure.  This study reflected that the more muscle mass an individual had in relationship to body size the less likely the individual was to insulin sensitivity and, therefore, a lower risk of pre-diabetes.

Usually, research has indicated that individuals with a waist circumference within certain inches is a good indicator for pre-diabetes – the larger the waist measurement, the more likely an individual is to develop pre-diabetes or even diabetes.  Body mass index has been taken into account as well.

Dr. Srikanthan added, “Our research shows that beyond monitoring changes in waist circumference or BMI, we should also be monitoring muscle mass.”

More research would be needed to determine how much help can be garnered from intervention in a person’s life in regards to their exercise routine, to include lightweight weights and more cardio exercise.

Simply lifting soup cans in a repetitive manner (arm curls or over the head) while standing in the kitchen can benefit anyone.  As well, doing small push-ups from the kitchen counter can strengthen the arms.  Doing ten lunges when dusting can strengthen the leg muscles.  Small changes can be incorporated into an individual’s daily life that would help tone and build muscle mass.  In the process, an individual could be helping to prevent the diagnosis of pre-diabetes or even full-blow diabetes.

Cell Phones Helping Manage Diabetes: According to a new study from the University Of Maryland School Of Medicine, an interactive computer software program could be very effective in helping patients with type 2 diabetes, manage their diabetes using their mobile phone.

Patients who used the mobile health software were studied, it was seen that those using the mobile health software gained a reduction in the amount of hemoglobin A1C in their blood. The amount lowered was 1.9 percent over a period of one year. Through these findings, researchers are looking at other health management alternatives as well.

Charlene C. Quinn, Ph.D., R.N., an assistant professor of epidemiology and public health at the University Of Maryland School Of Medicine and the principal investigator states, “These results are very encouraging. The 1.9 percent decrease in A1C that we saw in this research is significant. Previous randomized clinical trials have suggested that just a 1 percent decrease in A1C will prevent complications of diabetes, including heart disease, stroke, blindness and kidney failure.”

Since the world is mostly dependent on internet use in today’s more technical savvy world, the study shows that more people are managing their diabetes better through the internet located on their mobile phones or other mobile communications devices. Not only can patients manage their diabetes, they can send their results directly to their doctor as well.

Dr. Quinn gives more details about the mobile software program, “Mobile health has the potential to help patients better self-manage any chronic disease, not just diabetes. This is one of the first large, reported, randomized clinical studies examining the mobile health industry, which is rapidly growing. The U.S. Food & Drug Administration just last month released draft guidance on how it intends to regulate the field. Our results can help define the science behind this new strategy for disease management.”

While this software is perfect for type 2 diabetic patients, it is not recommended for type 1 diabetic patients. People who have been diagnosed with type 2 diabetes either cannot produce enough insulin to process sugar into energy or their cells do not recognize the insulin at all. The important measure to manage diabetes is to control the amount of hemoglobin A1C is a person’s blood.  A1C is a molecule that is found in a person’s red blood cells that binds itself with sugar. If a person’s blood sugar level is high, their A1C level will be high as well. The recommended amount for a person’s A1C level is 7 percent. People with diabetes stand at about 9 percent or more which can increase any diabetic complications.

Dr. Quinn says, “We tell patients that they can meet these goals if they eat a healthy diet, exercise daily and take their medication as directed, but we don’t really give them the tools to do that.”

However, the new mobile software program is just the tool that type 2 diabetics need to manage their diabetes.

New Research – Stem Cell Memory and Insulin Levels: According to new research, stem cells from early embryos can be persuaded into becoming a various selection of particular cells that can both recover and restore different areas in the body. Researchers have often thought about the use of this process for diabetes but have admitted some medical and ethical downsides.

However, researchers at the Tel Aviv University are taking advantage of this process and are started to use the memory of stem cells to generate from adult cells to bring some new found hope to patients suffering from juvenile and type 1 diabetes. This process could open up a whole new line in new treatments for diabetic patients.

Prof. Shimon Efrat of TAU’s Department of Human Molecular Genetics and Biochemistry at the Sackler Faculty of Medicine states, “these “induced pluripotent stem cells” derived from adult cells, represent an embryonic-like state. To some degree, the cells retain a “memory” of what they once were when created from pancreatic beta cells, the cells responsible for the production of insulin, these pluripotent cells prove more efficient than their embryonic counterparts in creating insulin-producing cells. Prof. Efrat says that this discovery promises to advance the development of cell replacement therapy for diabetics, possibly leading to an effective alternative to organ transplants.”

Embryonic stem cells are chosen over adult dells because they grow easier in the lab and can form any type of cell in the body.

Professor Efrat states, “But turning them into pancreatic beta cells is not an easy task. When generated from human beta cells, pluripotent stem cells maintain a ‘memory’ of their origins, in the proteins bound to their genes. As though receiving a prompt from their past life, the cells already have some understanding of their purpose, making them more efficient in generating beta cells.

While today many diabetic patients can choose an option for an organ transplant to replace damaged pancreatic beta cells, there is a shortage among organ donors.

Professor Efrat states, “The ratio of donors to potential recipients is about one to 1,000. A better option is sorely needed, and stem cells present a viable hope for the future.”

No Higher Risk for Type 2 Diabetes In Natural Menopause versus Ovarian Removal Menopause: Whether menopause comes naturally as a female ages or is brought on at an earlier age due to a hysterectomy that involves ovary removal, there is no increase in the diagnosis of type 2 diabetes, and the risk for type 2 diabetes does not increase.

This is the finding of a recent menopausal study that specifically targeted women who had natural menopause and also included women who had had their ovaries removed.  In all other studies, the natural menopausal women and the ovarian-removed menopausal women were combined together in a group rather than being separated.   This study is unique in that it separated the natural versus ovarian removal menopause for analysis and study.

This conclusion came as a result of a study carried out by the University of Michigan Health System.  The lead author of the study, Catherine Kim., M.D., M.P.H., an Associate Professor of Internal Medicine and Obstetrics and Gynecology, stated, “In our study, menopause had no additional effect or risk for diabetes.”  Dr. Kim added, “Menopause is one of many small steps in aging and it doesn’t mean women’s health will be worse after going through this transition.”

It was previously thought that postmenopausal women were at higher risks for type 2 diabetes because of a relatively high level of testosterone, the male hormone, which is considered a risk factor for type 2 diabetes.  This study concluded that was not the case.

This study also gave new information on the effect of diet and exercise and hormone replacement therapy on the overall health of menopausal women.

The participants of the study were enrolled in the Diabetes Prevention Program, which was a clinical trial of adults with glucose intolerance.  Glucose intolerance is the body’s struggle to convert glucose, or blood sugar, into energy.  Glucose intolerance at times leads to type 2 diabetes.  There are many factors that contribute to the diagnosis of type 2 diabetes, and these include age, weight, physical activity and family history.

When someone is diagnosed with glucose intolerance, the Diabetes Prevention Program study showed that lifestyle intervention and the addition of Metformin, a drug commonly used in the treatment of type 2 diabetes, as a preventive measure can delay or stop the progression to a diagnosis of type 2 diabetes in women who have gone through menopause.  Lifestyle changes would consist of losing 7 percent of a person’s body weight and exercising at least 150 minutes per week.  The study found that more research is needed on the role that hormone replacement therapy plays in the risk for type 2 diabetes.

The results of this study will appear in the magazine Menopause.  Funding for the research was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute on Aging, the Centers for Disease Control and Prevention, and the American Diabetes Association.

V-Go Disposable Insulin Device for Type 2 Diabetes: In most instances type 2 diabetes can be controlled through diet and exercise, plus oral medication when needed. There are times, though, when these three critical ingredients aren’t enough to control the patient’s blood sugar levels. When that occurs, the patient is advised to add injectible insulin in their regimen to control their diabetes. The V-Go has been available since March 2011 in the United States, as it was given approval by the Food and Drug Administration in December 2010.

The V-Go has been described as a disposable insulin source, and there are two different medications that have been approved for use with the device – Humalog and NovoLog.

The device is described as small, 2-1/4” by 1-1/3” inch by 0.5”, and would weigh approximately 1 ounce when filled with insulin. The patient would apply a new V-Go to the skin daily for one 24-hour period. The V-Go would be inserted into the skin; the device would be worn next to the body underneath one’s clothing, so it would not be visible to the naked eye. The device is not electronic and has no moving parts. It will deliver 30 to 40 units of insulin over a 24-hour period. The device is designed for the continuous subcutaneous (under the skin) release of insulin. The V-Go provides a pre-set basal rate of insulin, plus an added dosing at mealtime, which would alleviate the need for multiple daily insulin injections. “The device was engineered to simplify basal-bolus insulin therapy for the millions of people suffering from type 2 diabetes.”

The device was recently approved for use in the United Kingdom for those suffering from type 2 diabetes. It received the CE Mark approval for sale in the European Economic Area.

Actos for type 2 diabetes to go Generic in 2012: Actos, a medication commonly used in the treatment of type 2 diabetes, will cost less in 2012 when its generic form will become available as Pioglitazone. The maker/seller of Actos is Merck, and Merck’s patent on Actos will expire in August 2012 which opens the door for a generic form of the medication. 2012 is the scheduled date, but this date can deviate due to arrival dates, litigation or regulatory issues. For now, though, the hope is that Actos will become available in generic form in August 2012.

With the high cost of any medication that is not available in generic form, the purses of American consumers have been hit hard over the past years with newer and better medications to treat their illnesses. Drug companies spend many years researching and developing a drug for human consumption with as few side effects as possible. These years of research and development are a costly endeavor. The only way for the companies to recoup their expenses in developing the medications is through the patents that they have over the medication for a specified number of years. Once the patent has expired, the generic form of the medication becomes available through a variety of pharmaceutical companies. These generic forms of medication cost a great deal less.

Other medications with their patents ending within the next 14 months are as follows:

October 2011 – Zyprexa (schizophrenia/bipolar)
November 2011 – Lipitor (high cholesterol)
March 2012 – Lexapro (depression)
March 2012 – Seroquel (schizophrenia/bipolar)
March 2012 – Avapro/Avalide (high blood pressure)
April 2012 – Provigil (narcolepsy)
May 2012 – Plavix (clot prevention)
July 2012 – Tricor (high triglycerides)
August 2012 – Singulair (asthma/allergies)
August 2012 – Actos (diabetes)
September 2012 – Diovan (high blood pressure)
September 2012 – Geodon (bipolar disorder)
November 2012 – Lidoderm (pain patch)
December 2012 – Atacand (heart failure)
March 2013 – Lovaza (high triglycerides)
August 2013 – Tremodar (brain tumors)

As the cost of medication has risen, many people have cut back on their expenses by not taking their prescribed medications or reducing their dosage. This leaves the patient vulnerable to a medical emergency from which they may not survive. With the reduction in cost of any medication the patient may be taking, the easier the financial hardship on the patient and the more likely the patient is to take their medication at the prescribed dosage.

Generic medications are the chemical equivalent of the original brand-name medication and work just as well for nearly all patients, and the cost of using a generic medication versus an original brand-name medication can be drastic. As an example, Protonix, a medication used for severe heartburn, went off patent recently. Protonix now costs on average $16.00 a month for a generic form of the medication whereas the original brand-name medication is around $170.00 per month. A huge difference.

With each original brand-name medication that goes off patent, that means bigger and better savings for the consumer.

Diabetes Cure: Adult Stem Cells or Embryonic Stem Cells: A cure for type 1 diabetes has long been thought to eventually come from the replacement of the beta cells within the pancreas that produce insulin, a hormone that is necessary for life. These beta cells are contained with the Islets of Langerhans in the pancreas, and their job is to make and release insulin and control the level of glucose in the blood. There has been much controversy surrounding the use of embryonic stem cells (cells that are derived from an early-stage embryo) from a moral and ethical point. In some instances, the mere mention of stem cells taken from an embryo can cause an uproar in regards to abortions.

Embryonic stem cells are easy to grow in the lab, but these embryonic stem cells are difficult to turn into pancreatic beta cells that produce the needed insulin.

Embryonic stem cells are pluripotent cells and can generate all cell types in the body, whereas adult stem cells are multipotent cells and can only produce a limited number of cell types.

Professor Shimon Efrat of the Tel Aviv University, Department of Human Molecular Genetics and Biochemistry at the Sackler Faculty of Medicine, has done a study with the adult pluripotent stem cells. These adult-derived stem cells could pave the way for new treatment in diabetes, states Professor Efrat. Professor Efrat added that, “these induced pluripotent stem cells represent an embryonic-life state. To some degree, he found, the cells retain a ‘memory’ of what they once were – when created from pancreatic beta cells, the cells responsible for the production of insulin, these pluripotent cells prove more efficient than their embryonic counterparts in creating insulin-producing cells.” Professor Efrat stated, “This discovery promises to advance the development of cell replacement therapy for diabetics, possibly leading to an effective alternative to organ transplants.” He further stated that, “When generated from human beta cells, pluripotent stem cells, these memory cells act as though they are receiving a prompt from their past life; the cells already have some understanding of their purpose, making them more efficient in generating beta cells.”

There are 3 million Americans with type 1 diabetes. For a cure to type 1 diabetes (a condition difficult to control on a day-to-day basis and that many times results in subsequent severe complications) some people have opted from an organ transplant to replace those insulin-producing cells. Like with any organ transplant, it is a difficult road to maneuver – a long wait list and a shortage of organ donors. This process can take many years. Professor Efrat noted, “The ratio of donors to potential recipients is about one to 1,000. A better option is sorely needed, and stem cells present a viable hope for the future.”

Professor Efrat did his study with a Ph.D. student, Holgen Russ, and in collaboration with Professor Nissim Benvenisty and Ori Bar-Nur from the Hebrew University, and the results were recently published in the journal Cell Stem Cell. “This discovery that was made by Professor Efrat and his fellow researchers was licensed to a start-up company that promotes the research and development of technology of innovative treatments for diabetes.”