Whenever I inform my patients that they may be suffering from juvenile diabetes, better known as Type 1, the reaction is often the same. “How can I have juvenile diabetes when I am not an adolescent?” This is a very good question and one worth explaining.

Although juvenile diabetes tends to occur in young, lean individuals, usually before the age of 30, older people may also show signs of this chronic condition. What’s worse is that approximately 12 million people in the United States have diabetes and don’t even know it! The reason for this astounding statistic is that the American Diabetes Association does not recommend screening for the general population at this time unless you have a parent or sibling with the disease.

With an estimated 17 million people (about 8 % of the population) in the United States affected with diabetes it is important for everyone to have a better understanding of this insidious disease.

There are many factors that play into the cause of type 1 diabetes including genetics and exposure to certain viruses. Diabetes is considered to be a chronic condition meaning that it lasts a lifetime. Despite ongoing research no known cure has been found to date, but type 1 diabetes is manageable and treatable. People suffering with diabetes are now living longer, healthier lives with the addition of herbs and nutritional supplements available to complement conventional medicine.

All About Blood Sugar

Glucose is a simple sugar found in food and is a necessary nutrient that provides energy for the cells to function properly. Glucose in digested food cannot enter the cells without the help of insulin to help it along. Without it, the cells become starved of glucose energy and the unused sugar is wasted in excreted urine. That’s why a urine test is sometimes used as a means to measure sugar levels in the body and to check for potential signs of diabetes.

A person with type 1 diabetes doesn’t produce enough of the hormone insulin or is unable to use it effectively, which causes high blood sugar (glucose) levels. Over time, this imbalance can lead to heart disease, nerve damage, kidney disease, vision loss, and other complications. The less controlled your blood sugar, the higher the risk of disabling complications over a long period of time.

As a type 1 diabetic, the goal is to keep your blood sugar level as close to normal as possible to delay or prevent complications. This is done by monitoring blood glucose levels and is the only way to make sure that your sugar level remains within the target range.

You should also include a healthy diet of fruits, vegetables, and whole grains. These foods are high in nutrition and low in fat and calories. Fewer sweets and animal products provide more nutrients and less sugar.

Move to Keep Blood Sugars Low

If you are a type 1 diabetic, the secret to lowering blood sugar is more than just a healthy diet. Exercise is right up there with watching what you eat. The advantage of physical activity is that it moves sugar from your blood into your cells so the more you move the lower your blood sugar level.

Walking, biking, and swimming are examples of activities that you might enjoy and can easily be included in your daily schedule. Shoot for at least 30 minutes of aerobic exercise as many days of the week as possible. Add some weight bearing exercises along with stretching to round out your program. Remember not to do too much too soon especially if you have not exercised for awhile. Consult your doctor for advice on the level of physical activity that is best for you.

Type 1 diabetics must also be cautious of their blood sugar dropping too low especially when taking insulin. When blood sugar drops the condition is known as hypoglycemia and is common among diabetics as well as people who are not.

Nature Can Help You Live with Type 1 Diabetes

The majority of people with type 1 diabetes are insulin dependent. But did you know there are natural remedies that have been around for years proven to be effective in lowering blood glucose levels? Here are a few of nature’s miracle workers:

?Gymnema sylvestre - The name of this herb actually means “destroyer of sugar” and was used in ancient times as a treatment for diabetes. “A study published in Ethnopharmacology in 1990 showed a daily dose of 400 milligrams was effective in lowering blood glucose levels in diabetics over the long term.”

?Fenugreek - A popular herb used for high blood sugar and lowering cholesterol.

?Bitter Melon (Momordica charantia) - This plant has a long history of use as a hypoglycemic agent and has been referred to as vegetable insulin. At least three properties of Bitter Melon have been reported to have sugar-regulating properties.

Many famous athletes and professional people suffer with type 1 diabetes. It is possible to live a normal life as long as you follow your treatment plan, get daily exercise, eat a healthy diet, and monitor your blood sugar. Ask your doctor about natural remedies that will help you keep your glucose levels in check and aid you in your quest for good health.

In my previous article I helped you better understand the problems and solutions of diabetes type 1. Unfortunately, many Americans suffer from another type of diabetes that is far more prevalent and this article will help you better comprehend the differences. Here’s a general description on the two types:

Diabetes falls into the category of metabolic diseases characterized by high blood sugar levels. Under normal conditions, blood glucose levels are controlled by insulin, a hormone produced by the pancreas, the organ responsible for sugar control. All types of diabetics have difficulty either producing too much or not enough. Here is the difference between type 1 and type 2 diabetes in a nutshell.

Type 1 diabetes is sometimes called juvenile diabetes and occurs when the pancreas stops producing insulin. Nobody knows exactly why this happens, but some experts believe a virus or an autoimmune response, in which the body attacks its own pancreatic cells, is responsible. People with this type of diabetes must take insulin for life.

Type 2 was once known as adult-onset and those affected are noninsulin-dependent. In the case of type 2 diabetes, the pancreas secretes plenty of insulin, but the body’s cells don’t respond to it.

Age, Gender, and Obesity Linked to Type 2 Diabetes

Did you know that men, aged 35 to 54 are almost twice as likely to have diabetes as women Recent studies indicate that although diabetes occurs in people of all ages and races, some groups have a higher risk for developing the disease. What researchers don’t know is why certain people develop type 2 diabetes and others do not.

What medical reports do tell us are the factors that increase a person’s risk of getting type 2 diabetes. Let’s take a look at the relationship of type 2 diabetes and three very important characteristics that put you in danger of developing the disease.

Weight - The more fatty tissue you have, the more resistant your cells become to insulin.

Inactivity - Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.

Age - The risk of type 2 diabetes increases as you get older, especially after age 45. It may be because as people age they tend to become less active, lose muscle tone and gain unwanted weight.

Its no wonder these common risk factors have sparked concern among members of the medical profession.

More Staggering Statistics

You might agree that it seems more and more people you know are becoming a statistic; one more victim of diabetes 2. I’d like to share a few facts about this fast growing disease that might be of interest to you.

Type 2 diabetes is the most common form and is responsible for 90% - 95% of the 21 million people afflicted with the disease.

People over 40 are at higher risk of the condition, as are people with a large waist or family history of the disease.

Type 2 diabetes is the form linked to poor exercise and diet. Many of the two million people with type 2 are overweight or obese - and an estimated 500,000 more people have type 2 but do not know it.

The number of obese people will increase in the coming decades, putting people at higher risk of heart disease, stroke and certain types of cancer.

Type 2 diabetes can be undetected for a decade or longer and many already have complications by the time it is diagnosed. These complications include heart disease, stroke, kidney failure, blindness and amputation.

The News Is Not All Bad

If you have been diagnosed with type 2 diabetes it might seem frightening at first. But don’t let it get you down. Although type 2 diabetes is serious, it is also manageable. If you are willing to follow a healthy life style you can reduce your risk of developing the disease as well as learn to control it. Consider this:

Losing weight can reduce the risk of type 2 diabetes in high-risk people by 58 percent.

Exercising can cut the risk by 64 percent.

There are also natural remedies for type 2 diabetes that are being explored in addition to standard treatment. Make sure that you inform your doctor about any herbs, supplements, or natural treatments you are taking to safeguard against adverse reactions with other medications.

Diabetes Improves With Natural Minerals

Chromium is a mineral that helps increase the efficiency of insulin, and picolinateis an amino acid that allows the body to use chromium much more readily.

Research shows that chromium picolinate helps lower blood sugar levels in most type 2 diabetics after taking a daily supplement containing the mineral. What’s even better is chromium picolinate has shown to reduce obesity which means it may enable some people with type 2 diabetes to lose enough weight to stop taking drugs entirely.

Magnesium is a mineral that can be found naturally in green leafy vegetables, nuts, seeds, and whole grains. It is needed to help regulate blood sugar levels as well as other bodily functions. Some studies suggest that magnesium supplementation may improve insulin sensitivity and lower fasting glucose levels.

Zinc is important to type 2 diabetics because it helps in the production and storage of insulin. It can be found naturally in oysters, ginger root, lamb, pecans, split peas, egg yolk, rye, beef, liver, lima beans, almonds, walnuts, sardines, and chicken.

Vanadium can be found in soil and many foods and has been found to improve insulin and reduce blood sugar. It actually imitates the action of insulin in the body.

It’s not hard to see why nutritional supplements can be an aid to a diabetic sufferer. However, all diabetics are not created equal. Cases differ in terms of the severity, prescribed medication, diet, and exercise. That’s why I stress the importance of working with a qualified health care professional to find the best treatment and supplement for you.

The anti-diabetes drug rosiglitazone is associated with an increased risk for new-onset heart failure (HF) but no increase in acute coronary events as compared with traditional glucose-lowering drugs, post hoc analyses of the RECORD trial indicate.

The new data lay to rest one safety concern associated with rosiglitazone therapy, but confirm and solidify another, according to investigators speaking at the European Society of Cardiology annual meeting in Barcelona, Spain.

John McMurray (University of Glasgow, UK), an investigator in the RECORD trial, told MedWire News: “My personal belief is that you should not give [glitazones] to anyone with HF or structural heart disease.

“The big question mark ” the really important thing ” is what do you do in other patients, who don’t have a background of heart injury or dysfunction. Are [glitazones] even safe in them “

The first analysis, a study into the effect of rosiglitazone on HF events in the RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycemia in Diabetes) trial, was presented at a Clinical Trial Update session on Sunday by Michel Komajda (Universite Pierre et Marie Curie, Paris, France). The main study results were published in June 2009.

The post hoc analysis was undertaken in view of previous reports linking thiazolidinediones with an increased risk for HF. In particular, a meta-analysis found that thiazolidinedione therapy conferred a 72% increase in relative risk for HF versus control.

However, some diabetologists questioned the significance of the “HF” observed in the trials included in the meta-analysis, suggesting that it was not “real” HF but fluid retention, which is a known and relatively harmless side-effect of rosiglitazone therapy.

RECORD was a large, long-term, randomized, open-label clinical trial involving 4447 patients aged 40 “75 years who had Type 2 diabetes mellitus and were on metformin or sulfonylurea monotherapy. All participants were free of HF at baseline.

Metformin-treated patients were randomly assigned to receive add-on rosiglitazone or sulfonylurea (and continued metformin), while sulfonylurea-treated patients were randomly assigned to receive add-on rosiglitazone or metformin (and continued sulfonylurea).

The average duration of follow-up was 5.5 years. During this time, there were a total of 29 fatal and nonfatal HF events in the metformin/sulfonylurea treatment groups versus 61 in the rosiglitazone groups. Fatal HF events accounted for two and 10 events in the metformin/sulfonylurea and rosiglitazone groups, respectively.

Komajda revealed that study participants taking rosiglitazone had a more than two-fold greater risk for developing HF than patients in the other treatment groups (hazard ratio [HR]=2.10, p=0.001).

Kaplan-Meier curves showed that the increased HF risk associated with rosiglitazone became apparent early in the trial and continued to increase over time.

Komajda noted that the risk for HF was similar in patients with and without prior ischemic heart disease, although the absolute risk was greater in the former group.

In multivariate analysis, significant baseline predictors of HF were rosiglitazone treatment (HR=2.25); age 60 years (HR=3.81); waist circumference 104 cm (HR=3.52); presence of microalbuminuria or proteinuria (HR=3.35); and use of beta blockers (HR=1.86).

“Overall, these findings support the current recommendation that rosiglitazone should not be used in patients with symptomatic HF or with a history of HF,” Komadja concluded.

In comments to MedWire News, McMurray said that the new data were important because they laid to rest any notion that the fluid retention observed in rosiglitazone-treated patients was harmless.

“It is a legitimate concern and shouldn’t be diminished as something unimportant or benign,” he said. “The conclusion is that glitazones do cause HF, it is real HF, in other words, it is the syndrome that we know carries a very poor prognosis,” he said.

McMurray presented a second post hoc analysis of RECORD at Monday’s Clinical Trial Update session. This followed a controversial meta-analysis that found a 43% increased risk for myocardial infarction (MI) versus control.

The prevalence of ischemic heart disease in the RECORD trial was 15 “20%, McMurray reported, although patients with a recent major CV event or planned CV intervention were excluded.

As already revealed in the main study report, the risk for suffering a first fatal or nonfatal MI did not differ significantly between the two study groups (HR=1.14). According to new data presented on Monday, outcomes following nonfatal MI were also comparable between the treatment groups, with similar rates of recurrent MI and unstable angina.

In the overall study population, the rosiglitazone and metformin/sulfonylurea groups had comparable risks for developing the following: acute coronary syndromes (ACS, HR=1.05); ACS or “other” hospitalization attributed to angina pectoris (HR=0.99); and ACS, other angina hospitalization, or coronary revascularization (HR=0.94).

McMurray ended his presentation by showing an analysis of total cardiovascular events, which revealed no difference between the treatment groups with regard to death, hospital admission, or revascularization. There were a total of 221 such events (in 127 patients) in the rosiglitazone groups and 230 events (in 128 patients) in the metformin/sulfonylurea groups.

He concluded: “In the RECORD trial, there was no statistically significant excess of ‘first’ MI, unstable angina, or other coronary outcomes in subjects treated with rosiglitazone plus metformin or a sulfonylurea compared to those treated with the combination of metformin plus a sulfonylurea.”

A third post hoc analysis of RECORD has also been performed, McMurray noted. This focused on the risk for bone fractures and confirms other studies showing that there is an increased risk for fractures in rosiglitazone-treated patients. The analysis will be presented at a future meeting.

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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The long-term risk for ischemic heart disease (IHD), all-cause mortality, and cardiovascular (CV) mortality is increased in patients with Type 1 diabetes if they have poor glycemic control, dyslipidemia, and renal dysfunction, report Danish researchers.

“This is, to our knowledge, the first study of mortality in Type 1 diabetes associating endpoints to baseline data obtained over several years,” say Jakob Grauslund, from Odense University Hospital, and colleagues.

They explain that the study was conducted over an expanded follow-up period of 13 years, in order to overcome the known intraindividual variation of metabolic regulation.

The team obtained urine and blood samples from 389 patients with Type 1 diabetes, and subsequently measured each patient’s baseline level of glycemic regulation, serum lipids, albumin, and creatinine.

Over a follow-up period of 13 years, 30% of the patients died.

After adjusting for age, gender, and diabetes duration, a 1% increase in glycated hemoglobin (HbA1c) was associated with a 1.47-, 1.54-, and 1.64-fold increase in all-cause mortality, CV mortality, and IHD risk, respectively.

When glycemic regulation, determined by HbA1c, was arranged into quartiles, patients in the highest quartile (HbA1c of 9.73-14.0%) had a 3.53-fold increase in risk for all-cause mortality, a 3.65-fold increase in risk for CV mortality, and a 5.60-fold increase in risk for IHD, compared with those in the lowest quartile (HbA1c 5.47% to 8.03%).

A similar trend was observed when lipid measurements were arranged into quartiles, with a 2.29- to 4.95-fold increase in risk for all-cause mortality, a 2.43 to 7.29-fold increase in CV mortality risk, and a 2.19 to 5.05-fold increase in risk for IHD in patients in the highest quartiles for triglycerides, low-density lipoprotein cholesterol, and total cholesterol, respectively, compared with those in the lowest quartiles.

Of note, high-density lipoprotein levels had a significant but inverse correlation with IHD, all-cause mortality, and CV mortality risk.

Patients in the highest quartile for creatinine had a 5.10-, 6.29-, and 4.25-fold increase in risk for all-cause mortality, CV mortality, and IHD, respectively, compared with those in the lowest quartile.

Patients with macroalbuminuria (>299 mg/l) did not have an increased risk for IHD; however, their risks for all-cause and CV mortality increased by 2.40- and 2.57-fold, respectively, compared with those without macroalbuminuria.

No relationship was observed between microalbuminuria (30-299 mg/l) and CV mortality, all-cause mortality, and IHD risk.

Grausland et al conclude: “Additional studies will be needed to examine the possible benefits of tightening glycemic regulation in long-term patients.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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The metabolic syndrome is only linked to an increased risk for severe coronary atherosclerotic lesions in non-diabetic Turkish patients with an indication for coronary angiography, a study suggests.

This association however, occurs only when the World Health Organization’s (WHO) definition of the metabolic syndrome is used, say Sibel Ertek, from Ufuk University in Ankara, and team.

They also add that the influence of diabetes on the atherosclerotic process may explain why their findings do not extend to Turkish patients with diabetes and the metabolic syndrome.

The researchers determined the presence of the metabolic syndrome in 184 Turkish patients with (n=88) and without diabetes (n=96). They used criteria outlined by the WHO, the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III, and the International Diabetes Federation (IDF) to determine the metabolic syndrome status of all patients.

All patients then underwent coronary angiography and a Gensini score, indicating the severity of coronary atherosclerosis, was calculated.

As reported in the journal Acta Diabetologica, patients with diabetes had a significantly higher Gensini score than patients without diabetes, irrespective of metabolic syndrome status.

In addition, patients with the metabolic syndrome as defined by WHO and IDF had significantly higher Gensini scores than those without the metabolic syndrome, irrespective of diabetes status. When the metabolic syndrome was defined by NCEP-ATP III criteria, the same association between Gensini score and the metabolic syndrome occurred, although it was nonsignificant.

However, when the researchers analyzed patients with and without diabetes separately, they found that the metabolic syndrome was only associated with high Gensini scores among nondiabetic patients and only when the metabolic syndrome was defined by WHO criteria.

Of note, no significant relationship was found between Gensini score and patient gender or the individual components of the metabolic syndrome.

Ertek et al conclude: “The detection of metabolic syndrome in Turkish Patients is of strong relevance to early detection of subjects with severe coronary lesions, especially in non-diabetics.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Over a quarter of US diabetics aged 40 years or older have retinopath, with a particularly high prevalence seen in non-Hispanic Black individuals, show study results published in the Journal of the American Medical Association.

“Investigating the prevalence of diabetic retinopathy (DR) is important because it is a key indicator of systemic diabetic microvascular complications, and as such, a sentinel indicator of the impact of diabetes,” write Xinzhi Zhang (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and colleagues.

They carried out a cross-sectional, nationally representative study of the prevalence of DR in 1006 diabetic adults who participated in the National Health and Nutrition Examination Survey 2005-2008 and were aged 40 years or older.

The researchers defined diabetes as a self-reported previous diagnosis or a glycated hemoglobin (HbA1c) level of 6.5% or more, and DR was identified using fundus photographs graded according to the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale.

Predicted population values for the prevalence of DR and vision-threatening DR were 28.5% and 4.4%, respectively.

The overall recorded prevalence of DR was 31.6% in men and 25.7% in women with diabetes. Male gender increased the risk for having DR 2.07 fold. Vision-threatening DR prevalence was not influenced by gender and was 4.2% overall.

Non-Hispanic Black and Mexican-American diabetics had a higher prevalence of DR than non-Hispanic White diabetics, at 38.8% and 34.0% versus 26.4%, respectively. The former two ethnic groups also had a higher prevalence of vision-threatening DR, at 9.3% and 7.3% versus 3.2% in non-Hispanic White diabetics.

Individuals with DR had higher mean HbA1c (7.9% vs 7.0%), longer diabetes duration (15.0 vs 7.3 years), and higher systolic blood pressure (134.2 vs 130.1 mmHg) than those without DR. They were also 3.23 times more likely to be taking insulin than those without DR.

“These estimates provide policy makers updated information for use in planning eye care services and rehabilitation. With the aging of the population and the increasing proportion of the population with diverse racial/ethnic heritage, the number of cases of diabetic retinopathy and vision-threatening diabetic retinopathy will likely increase,” conclude the authors.

“Furthermore, the need for eye care and for culturally appropriate interventions that can reduce disparity and improve access to eye care among diverse populations is also likely to increase,” they add.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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The progression of diabetic retinopathy (DR) may be slower in diabetic patients with high levels of soluble receptors of advanced glycation end products (sRAGE) than in those with low levels of the receptor, a study suggests.

The study also implicates soluble forms of vascular cell adhesion molecules (sVCAM-1) and nitric oxide (NO) in the development of DR, indicating that low sVCAM-1 and NO levels may help delay DR progression.

Basma Khalil (Misr International University, Cairo, Egypt) and colleagues hypothesize that sRAGE can protect blood vessels, such as those in the eye, from damage by advanced glycation end products (AGE), by limiting the binding of AGE to cell membrane RAGE.

They explain that in the body, AGEs bind to RAGE or to sRAGE. When AGEs bind to RAGE, an inflammatory response, which assists the development and progression of DR, is triggered in vessel walls. However, when AGEs bind to sRAGE, this response does not occur.

The team measured the serum levels of sVCAM-1, NO, and sRAGE in 37 patients with diabetes, and 20 healthy participants.

All patients with diabetes were classified as having no retinopathy (n=14), nonproliferative retinopathy (n=14), or proliferative retinopathy (n=9).

The findings, published in the Journal of Diabetes and its Complications, show that sRAGE levels varied with DR severity, with mean sRAGE levels being 1712.7 and 1833.1 pg/ml in healthy controls and diabetics without retinopathy, respectively, versus 1331.13 and 934.87 pg/ml in patients with NPDR and PDR, respectively.

All diabetic patients also had elevated levels of NO and sVCAM-1 compared with the healthy controls, at 96.43 versus 28.78 ng/ml, and 1310.22 versus 616.55 ng/ml, respectively.

The team also notes that the patients with more advanced forms of DR had higher NO and sVCAM-1 levels.

Khalil et al conclude: “sRAGE could be protective by acting as a decoy receptor for plasma AGEs.”

They add: “The therapeutic potential for novel agents that can ameliorate AGE formation and attenuate RAGE signalling in the retina is recommended.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Elderly women who have had five or more live births - grand multiparity - are significantly more likely to develop Type 2 diabetes than those with fewer or no births, report researchers.

They note, however, that the relationship was abolished after correcting for variation in body weight and sociodemographic factors.

Angela Fowler-Brown (Harvard Medical School, Boston, Massachusetts, USA) and colleagues analyzed parity data from 3211 women aged 65 years or above (mean 72.5 years) who were enrolled in the Cardiovascular Health Study.

Diabetes status, based on fasting levels of glucose and insulin and use of medication, was measured at baseline and after approximately 10 years in women without diabetes at baseline (n=2761).

The investigators found that there was a higher prevalence of Type 2 diabetes at baseline in women with grand multiparity, at 25%, compared with those with a lower number or no births, at 12% and 15%, respectively.

Following adjustment for age and ethnic background, women with grand multiparity had a significant 57% increased diabetes prevalence compared with other women. However, further adjustment for demographic, clinical, and body anthropometric factors caused the association to become nonsignificant.

In women without diabetes at baseline, parity was not associated with incident Type 2 diabetes over the follow-up period, although there was a small association between parity and higher fasting insulin levels and insulin resistance.

“Much of the higher prevalence of diabetes associated with past child-bearing seems to be mediated (or confounded) by the heavier body mass index associated with grand multiparity,” write the authors in the journal Diabetes Care.

“This finding presents an opportunity for education and intervention related to weight control among grand multiparous women to reduce diabetes prevalence.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Giving birth to many children may increase Type 2 diabetes risk

Danish researchers have found that diabetes education administered in a group setting does not improve the glycemic control of patients with diabetes more than individual counseling.

“On the contrary, the mean glycated hemoglobin (HbA1c) level decreased significantly more among participants in the individual counseling group,” say Eva Vadstrup (Bispebjerg University Hospital, Copenhagen) and team.

They add that cardiovascular (CV) risk factors such as “weight, waist circumference, and blood pressure (BP) decreased significantly compared with baseline values in both groups.”

The researchers assessed the level of glycemic control and CV risk among 143 adults with diabetes at baseline, and after a 6-month individual counselling (n=70) or group-based rehabilitation (n=73) program.

Both programs were taught by a nurse, dietician and podiatrist, and consisted of education on the pathophysiology of diabetes and blood glucose self-monitoring techniques, in addition to advice on the management of diabetes using medication, diet, and exercise.

In all, 87% of the patients in the group-based rehabilitation and 82% of the patients in the individual counseling group completed the 6-month programs.

As reported in the journal Patient Education and Counseling, both groups had a slight improvement in glycemic control at 6 months. This improvement was greater among the patients who received individual counseling than those in the group-based rehabilitation group, with a mean HbA1c reduction of 0.6% and 0.3%, respectively.

In addition, by the end of the programs both groups experienced a similar degree of improvement in CV risk factors, namely weight, waist circumference and systolic BP, with a mean weight loss of 2.0 kg and 2.1 kg, waist circumference reduction of 1.8 cm and 2.0 cm, and systolic BP reduction of 6 mmHg and 5 mmHg, among the patients in the individual and group programs, respectively.

Interestingly, Vadstrup et al found that despite the similar outcomes, the group-based intervention required twice as many personnel resources as the individual counseling program.

They advise against the broad implementation of such group-based interventions in preference to individual diabetes education at present.

“Further research should address the ways to modify and reorganise program content,” the researchers conclude, advising the consideration of “alternative strategies to achieve larger improvements, particularly in the light of the increasing prevalence of Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, is an effective predictor of prognosis in coronary artery disease (CAD) patients with Type 2 diabetes, report Japanese researchers.

Over 30% of patients with CAD also have Type 2 diabetes, explain Michinari Nakamura (The Cardiovascular Institute, Minato-ku, Tokyo) and colleagues. They add that such patients have double the risk for adverse cardiovascular (CV) events compared with CAD patients without diabetes making it important to try to improve risk stratification for these individuals.

Nakamura and team assessed the efficacy of baPWV for prediction of all-cause death, or a composite endpoint of death, nonfatal myocardial infarction (MI), repeat revascularization, or re-admission for heart failure (HF) in 564 Japanese CAD patients participating in the Shinken Database cohort study.

Of these, 191 had Type 2 diabetes and 373 did not. The mean follow-up period for the study was 25.4 months.

Patients with diabetes and CAD were divided into two groups based on baPWV: high baPWV was defined as a reading at or above 1730 cm/s, and low baPWV as a reading below 1730 cm/s. The patients with CAD alone were used as a comparison group (median baPWV=1671 cm/s).

Over the follow-up period, 2.1% of the diabetic CAD patients with low baPWV compared with 10.4% of those with high baPWV died of any cause. A corresponding 23.2% compared with 38.5% experienced the composite endpoint. Both these between group differences were significant.

Three-year CV event-free survival occurred in 72.8% of diabetic CAD patients with low baPWV, compared with 51.3% of diabetic CAD patients with high baPWV, and 80.8% of the nondiabetic CAD patients.

Multivariate analysis showed that a high versus low baPWV was significantly associated with a poorer clinical outcome (increased risk for either death or composite endpoint; hazard ratio=1.97) in patients with CAD and Type 2 diabetes.

The researchers conclude: “We believe that risk stratification of short term prognosis with baPWV can help target careful follow-up and more intensive medication therapy for patients at higher risk for future cardiovascular events.”

The results of this study are published in the journal Hypertension Research.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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