Researchers have developed basic and enhanced risk-scoring systems that both effectively identify older adults at risk for Type 2 diabetes, with the enhanced system showing better accuracy at predicting extreme risk.

The incidence of diabetes continues to increase worldwide, but there is now good evidence to show that dietary and exercise interventions can significantly reduce the risk for developing the condition among those at high risk, say Henry Kahn (gov/” rel=”nofollow”>Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and team.

Lifestyle programs can be expensive and difficult to maintain, however, and are therefore difficult to justify for people who are at low risk for diabetes.

Kahn and colleagues tested a basic and an enhanced risk-scoring system on 12,729 participants of the Atherosclerosis Risk in Communities (ARIC) study, aged 45??”64 years at baseline, who were followed up for 10 years for incident Type 2 diabetes.

The basic risk-score system allowed researchers to calculate an accumulated risk score based on waist circumference, maternal/paternal diabetes, hypertension, short stature, Black race, older age (55 years or older), high body mass index, rapid pulse, and smoking history.

The enhanced risk-score system based the score on the above factors plus results taken from blood tests of biomarkers such as blood glucose, lipids, and uric acid.

During the follow-up period, 19% of participants developed Type 2 diabetes.

Writing in the Annals of Internal Medicine, Kahn and co-workers report that results from area under the receiver operator curve analysis show that the basic system had a sensitivity of 69% and a specificity of 64%. The enhanced system had a sensitivity of 74% and a specificity of 71%.

When the cohort was divided into ascending quintiles of basic risk score the 10-year incidences of Type 2 diabetes across the score groups were 5.3%, 8.7%, 15.5%, 24.5%, and 33.0%, respectively. The corresponding values from the lowest to the highest quintile of the enhanced risk score were 3.5%, 6.4%, 11.5%, 19.3%, and 46.1%.

The authors caution: “These scoring systems need to be validated in different populations and their utility evaluated before widespread application.”

They conclude that the basic score was effective at identifying individuals at high risk for Type 2 diabetes, but say the additional data from fasting blood tests used to calculate the enhanced score better identified those at extreme risk.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Levels of plasma apolipoprotein (apo)B, but not low-density lipoprotein (LDL) cholesterol, are associated with coronary artery calcification (CAC) scores in Type 2 diabetics, report researchers.

“Evidence favors apoB over LDL cholesterol as a predictor of cardiovascular events but data is lacking on CAC, especially in Type 2 diabetes, where LDL cholesterol may underestimate atherosclerotic burden,” say Muredach Reilly (University of Pennsylvania School of Medicine, Philadelphia, USA) and colleagues.

To investigate, they carried out a cross-sectional analysis of 611 Caucasian individuals with Type 2 diabetes from the Penn Diabetes Heart Study (PDHS) and 803 Caucasian individuals without diabetes, but with a family history of premature coronary heart disease (CHD), from the Study of Inherited Risk of Coronary Atherosclerosis (SIRCA).

None of the participants had clinical evidence of CHD, defined as myocardial infarction, coronary revascularization, angiographic disease, or a positive stress test. Electron beam tomography was used to calculate CAC scores, which are a marker of preclinical atherosclerosis.

The authors found that in individuals with Type 2 diabetes apoB, but not LDL cholesterol, was associated with CAC score. More specifically, for every standard deviation increase in apoB there was a 36% increase in the CAC score, compared with a nonsignificant 9% increase in CAC score for every standard deviation increase in LDL cholesterol.

In the non-diabetic sample from SIRCA, however, both apoB and LDL cholesterol were associated with CAC score. In this case, there was a 65% and 56% increase in CAC score for every standard deviation increase in apoB and LDL cholesterol, respectively.

When the data from PDHS and SIRCA participants were combined, apoB was found to be a better overall predictor of CAC score than LDL cholesterol, total cholesterol, the ratio of total-to-high-density lipoprotein (HDL) cholesterol, and triglyceride-to-HDL cholesterol ratio. It was also a marginally better predictor than non-HDL cholesterol.

Reilly et al say their research adds to previous work suggesting apoB should be used as an alternative measure to LDL cholesterol for cardiovascular risk prediction. They add that apoB measurement is standardized, automated, and inexpensive and should therefore not be difficult to carry out.

They conclude in the journal Diabetes: “ApoB levels may be particularly useful in assessing atherosclerotic burden and cardiovascular risk in Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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When you have to manage a lifelong condition like diabetic nerve pain (also called diabetic neuropathy), it will be prudent to think about long-term solutions. All that you need to do under such circumstances is to bring some lifestyle changes in order to protect yourself from the disease.

These following 10 foot care tips can help you to protect yourself from diabetic nerve pain:

1. Check your feet every day

Ensure to check your feet and the regions between your toes daily. Most of the infections and blisters occur between your toes. However, diabetic neuropathy may not allow you to feel them until infection occurs or they become irritated.

2. Wear well fitted shoes

An ill fitted shoe can cause a blister convert into a sore, which in turn may become infected and take a lot of time to heal. So, purchase better-fitting shoes and wear comfortable socks.

3. Wash your feet with warm water

Instead of using hot water, use lukewarm water to wash your feet. However, don’t soak your feet for long as waterlogged sores will take more time to heal. Remember to pat your feet and the regions between your toes dry right away.

4. Don’t walk barefoot

Give your heels and toes enough protection by wearing shoes or slippers. It is advisable to wear your shoes with socks, as plastics, leather and artificial shoe materials can cause irritation of your skin and cause blisters to occur quickly.

5. Consult your doctor

Whenever you feel any unusual signs or sensation in your feet, toes or legs, tell your doctor about the same -irrespective of how trivial it may seem.

6. Keep your skin soft and dry

Due to the high glucose levels, you may suffer from dry and cracked skin. Remember that cracked skin enables bacteria to get under your skin easily, thereby making the healing process of infections delayed. So, you can use some skin lotion daily to keep the skin of your feet soft. However, ensure that your feet stays dry and not damp.

7. Opt for non-impact exercises

Go for exercises that have negligible impact on your feet like cycling, swimming, tai chi and yoga.

8. Go for orthotics

You can consider fitted orthotics to offer the weak muscles of your feet some support, thereby decreasing the diabetic nerve pain. You may even opt for orthopedic shoes or foot braces.

9. Fix hammertoes, corns and bunions

Your shoes will not fit comfortably if you have hammertoes, corns and bunions. So, get them treated at the earliest.

10. Keep your blood sugar under control

The best way to treat diabetic nerve pain is to effectively manage your diabetes. So, keep your glucose levels under control by using proper diet, exercise and meditations.

Use the foot care tips as mentioned above to protect yourself from diabetic nerve pain.