Combination therapy with fenofibrate and simvastatin does not provide additional protection against cardiovascular disease (CVD) in high-risk patients with Type 2 diabetes compared with simvastatin alone, according to findings from the ACCORD lipid trial.

Presenting the findings at the 59th Annual Scientific Session of the American College of Cardiology, in Atlanta, Georgia, USA, Henry Ginsberg (Columbia University College of Physicians and Surgeons, New York, USA) said that the findings “provide physicians with important new information regarding the treatment of a common lipid abnormality affecting many of their patients with Type 2 diabetes”.

The findings were also simultaneously published online in the New England Journal of Medicine.

For the ACCORD (Action to Control CardiOvascular Risk in Diabetes) lipid trial, 5518 people who had Type 2 diabetes and either pre-existing CVD or at least two additional CV risk factors and who were already taking simvastatin were randomly assigned to additional treatment with fenofibrate 54??”160 mg/day or placebo.

At baseline, the average total cholesterol level was 175 mg/dl (4.5 mmol/l), and the average high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride levels were 101 mg/dl (2.6 mmol/l), 38 mg/dl (0.98 mmol/l), and 162 mg/dl (1.83 mol/l), respectively.

After a mean follow-up of 4.7 years, there was no significant difference between the two groups in the annual rate of the primary outcome (CV death, nonfatal heart attack, or nonfatal stroke) at 2.2% in patients taking fenofibrate and simvastatin and 2.4% in patients taking simvastatin and placebo. Annual rates of death were 1.5% in the fenofibrate group and 1.6% in the placebo group.

The researchers also compared rates of the primary outcome in 10 prespecified subgroups based on baseline characteristics. Of these, there appeared to be a difference between men and women taking combination therapy, “with the data for women suggesting potential harm and the data for men suggesting potential benefit,” Ginsberg reported. But the results did not reach statistical significance for either group.

There was also a trend toward benefit of fibrate treatment in a prespecified subgroup of patients with particularly high triglyceride levels of at least 204 mg/dl (2.30 mmol/l) and low HDL levels of 34 mg/dl (0.88 mmol/l). In these patients, the primary outcome rate was 12.4% in those taking fenofibrate plus simvastatin versus 17.3% in the simvastatin plus placebo arm. This compared with a rate of 10.1% in both study groups for all other participants.

“This dyslipidemia group outcome, which was prespecified, is concordant with several post hoc analyses from prior lipid trials,” Ginsberg noted.

He cited the Helsinki Heart Study (HHS) of gemfibrozil, which had a positive result for the primary outcome in the whole cohort and a greater benefit in a dyslipidemia subgroup, similar to that reported here. Other trials included the Bezafibrate Infarction Prevention (BIP) study and the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, which despite having negative results for the whole cohort showed significant findings for subgroups with severe dyslipidemia.

Ginsberg concluded: “ACCORD lipid does not support use of the combination of fenofibrate and simvastatin compared to simvastatin alone, to reduce CV events in the majority of patients with Type 2 diabetes mellitus who are at high risk for CVD.”

He added: “Subgroup analyses suggesting heterogeneity in response to combination therapy by gender or by the presence of significant dyslipidemia require further investigation.”

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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Diabetes is a very common disease among almost, if not, all countries across the globe. Morbidity and mortality rates are enough evidences of how this disease has affected quite a lot of people even in cases when it is not the main source of death, there were complications with diabetes found among most patients. With such debilitating and serious effects, it is important to be able to make use of diabetes management effectively.

Defined as a medical condition revolving around the body’s reaction to insulin, diabetes actually is of two types. Basically, the pancreas produces insulin, which is the reason why cells can absorb glucose for the purpose of turning it into energy. In the absence of insulin or when there is insufficient amount of it, glucose tends to get accumulated in the blood. This can result to different complications.

People with diabetes tend to experience frequent hunger and feeling of being thirsty. They also urinate more frequently than the usual. Weight loss, eyesight problems and feelings of fatigue and irritation can also be observed. Another very popular signs of diabetes is the slow healing of cuts, bruises and other wounds. Skin, gum, bladder and other infections tend to reoccur.

These symptoms might not occur all at the same time. In fact, there are cases where only one of these is observed. One should be constantly on the lookout for irregularities in the bodily functions in order to avoid going past certain symptoms that might be related with serious diseases such as diabetes.

It is a trusted fact that prevention has always been better than cure no matter what diseases they come in. Statistics show that the onset of type 2 diabetes is during adulthood, but in the recent years, obesity rates grew tremendously, and diabetes grew hand in hand with it. The most effective way to avoid having diabetes is to maintain a healthy obesity-free lifestyle.

For those with diabetes, there is a great need for a complete lifestyle makeover. One of the basic things to do is to incorporate regular exercise into one’s daily activities. The goal with this is to burn as much glucose as possible since insulin, the main one responsible for such, cannot fully live up to its purpose. More so, one should be wary of his own body weight. Obesity is highly associated with the development of diabetes.

Another change that should be taken is regarding one’s diet. Although the no-sugar diet is a myth, it is still very important for a person with diabetes to refrain from consuming much sugar. The idea is to have a healthy and balanced diet. The body still needs sugar, but it takes much insulin to break it down into energy. For a healthier diet, one can incorporate high fiber foods items as well as soya products. As a matter of fact, scientific studies can back up the good effects of such a diet on diabetes patients.

The management of diabetes takes as much effort as other serious diseases. However, all of these are worth it considering the positive results in the end.

Levels of tissue kallikrein, a component of the kallikrein??”kinin system (KKS), are elevated in people with Type 2 diabetes, Australian researchers have shown.

Interestingly, this relationship was unaffected by statin therapy, indicating that the KKS is not involved in the beneficial effects of statins on endothelial function.

David Campbell (St Vincent’s Institute of Medical Research, Fitzroy, Victoria) and co-workers tested the hypothesis that diabetes increases the activity of the KKS, a system with a broad spectrum of actions including inflammation and organ protection.

They obtained blood from 71 patients scheduled for coronary artery bypass (CABG) surgery, 16 of whom had diabetes. CABG patients were chosen because they routinely have arterial cannulae inserted before surgery, which allows rapid blood collection with minimal kallikrein activation.

Writing in the journal Diabetologia, Campbell et al report that circulating levels of tissue kallikrein were 62% higher in diabetic versus nondiabetic patients. Diabetic patients also had increased tissue kallikrein immunoreactivity in atrial myocytes and increased tissue kallikrein messenger RNA levels in atrial tissue.

By contrast, there were no differences in blood levels of angiotensin, bradykinin, and kallidin peptides, or in plasma levels of plasma kallikrein or kallistatin between diabetic and nondiabetic individuals.

Separate analyses showed that treatment with statins, aspirin, calcium antagonists, beta-blockers, or long-acting nitrates had no effect on circulating levels of any of the KKS components. However, statin therapy was associated with decreased plasma aldosterone levels, which the authors suggest may be due to an effect of statins on cholesterol supply for steroid-hormone synthesis.

Campbell et al say that the mechanism underlying the increase in tissue kallikrein in diabetes is uncertain, but it may be caused by hyperinsulinemia.

Noting that tissue kallikrein plays an essential role in protecting the heart from ischemic injury, they conclude: “[T]issue kallikrein may play a greater role in cardioprotection in Type 2 diabetic than in nondiabetic patients and may also contribute to the benefits that Type 2 diabetic patients derive from angiotensin-converting enzyme inhibitor and other therapies inhibiting kinin metabolism.”

They add: “Our findings do not support the idea that the KKS plays a role in the impaired endothelial function of Type 2 diabetes or in mediating the improvement of endothelial function by statin therapy in nondiabetic and diabetic 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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When you received your type 2 diabetes diagnosis, it was certainly easy to think you could take care of your high blood sugar levels with Metformin or any anti-diabetic drug actually. However, with any drug there are always risks. Many people who have undergone different surgical procedures often look back and say… “if they had only known, they would never have had the surgery.” The same applies to people taking various medications.

Metformin is a standard drug given to type 2 diabetics. It is taken orally and medical practitioners consider it to be the drug of choice, particularly for type 2 diabetics that are overweight with normal kidney function.

Metformin causes few side effects but, nevertheless, can be associated with:

1. General malaise, fatigue or a feeling of just being unwell. It is estimated 10 to 25% of women who take Metformin experience this as a side effect.

2. Nausea, diarrhea and/or vomiting: These gastrointestinal symptoms usually occur after you eat meals high in fats or sugar. What this means is you really can’t cheat on your eating plan just because you are taking medications; unfortunately you will pay the price with nausea, vomiting and/or diarrhea.

3. Reduced levels of vitamin B12: Up to 30% of people taking Metformin show a problem with absorption of vitamin B12. Symptoms include:

• memory loss
• an itchy or tingling tongue
• white spots in your skin which usually increase in size over time
• shortness of breath
• eye twitching
• facial pain
• migraine headaches,
• anemia that doesn’t respond to iron,
• depression, irritability and personality changes.

4. Elevated homocysteine: homocysteine is the amino acid associated with coronary artery disease, chronic fatigue, heart attack, fibromyalgia and cervical cancer levels.

5. Hair Loss: In males you may find hair loss at your temples and at the top of your head. Many women have reported this pattern of hair loss also.

6. Reduced levels of Thyroid Stimulating Hormone (TSH) if you already have low thyroid function. The problem here is many of the population already have low thyroid function. Reducing this hormone further causes symptoms such as fatigue, depression, and a definite inability to get out of bed in the morning.

7. Reduced testosterone production which leads to impotency.

So… knowing all these symptoms, do you still really think Metformin is the best way for you to lower your blood sugar levels? A healthy eating plan will give you weight loss, lower blood sugar levels and lessen your risk of diabetic complications… maybe this is something you want to think about. There are also alternative health and natural healing approaches… these help to build your health as well as aid with reversing type 2 diabetes.

The bottom line is: Why not follow a healthy eating plan and lifestyle… this is more effective than Metformin alone. With weight loss you will be able to reduce your dosage of Metformin or eliminate it altogether.

If you have type 2 diabetes, it will come as no surprise to you that lifestyle has a major impact on your diabetes, especially your blood sugar control. The first line of treatment that is usually applied in 90% of people with type 2 who are overweight or obese, is to implement a weight loss plan where there is a change in diet and an increase in physical activity.

These are lifestyle tips to help you achieve blood sugar levels as close to normal as possible:

1. Fiber is the unsung hero of type 2 diabetes. Research shows foods high in fiber, especially soluble fiber, slows the absorption of glucose into your bloodstream … this helps with control of your blood sugar levels. Fiber also helps to satisfy your hunger, maintain a healthy weight and lowers your cholesterol levels.

2. Eat plenty of high-fiber, non starchy fruits including cherries, kiwi fruit, apples, and fruits in the berry family, eg. blueberries, blackberries. They contain lots of vitamins and minerals as well as fiber.

3. People who eat the most vegetables have the lowest long-term risks associated with type 2 diabetes. Non-starchy, high-fiber vegetables are best as they are high in nutrients and contain the least carbohydrates. The fiber in vegetables blunts your body’s response to naturally occurring sugar.

4. Low glycemic index (low-GI) foods … certain foods have an especially low-GI value: beans and other legumes, green leafy vegetables, most fruits, barley (great in soup).

5. Eat healthy oils and fats … virgin olive oil, flaxseed oil, avocados and nuts are known to lower your risk for both blood sugar problems and cardiovascular conditions.

6. The most common cooking oils …corn, safflower, cottonseed, soybean, peanut oil and any type of partially hydrogenated vegetable oil increase your risk of becoming overweight. They all interfere with normal insulin function and alter the regulation of your blood sugars.

7. Kidney, pinto or lima beans, are packed with soluble fiber and will blunt the entry of sugar into your bloodstream. Soluble fiber also helps to lower your LDL (bad) cholesterol.

8. Eating small meals more often, at regularly timed intervals, will give you much better blood sugar control rather than infrequent large meals. Large meals cause more sugar to enter your bloodstream quickly and make it difficult for your pancreas to produce insulin in proportion to the amount you eat at each sitting. Research show type 2 diabetics who eat smaller meals more often, make better food choices eating less sugary foods and less calories.

9. Moderate exercise helps your muscle cells become sensitive to insulin. Insulin is the hormone that transports blood sugar out of your bloodstream and into your cells. Gradually increasing your activity to thirty minute sessions five or six times per week can often lower your blood sugar levels by fifty or more points. Exercise is really protective when used in conjunction with a low-GI eating plan.

High insulin and blood sugar levels can be looked on as the result of taking in more food than the body can really manage … so cutting back really will lessen the burden!

The signs of diabetes type 2, also termed adult onset diabetes, must be identified at their earliest. This is vital as it is a medical condition that can prove to be life threatening. It is an ailment in which blood sugar becomes high thus creating some diabetic symptoms or signs of diabetes.

The root cause behind these signs of diabetes type 2 is either inadequate insulin or an inability to use provided insulin. Sometimes both of these can be the diabetic symptoms in type 2. A carefully calculated data says that more than 17 million people of America are suffering from signs of diabetes.

There are basically three main types of this disease

Type 1 Diabetes: Type 1 diabetes is generally diagnosed in childhood. The body of the sufferer either makes no or little insulin.

Type 2 Diabetes: More than 85% of all diagnosed cases of diabetes accounts for type 2. In this acute condition the pancreas produce enough insulin but the cells of the body become inefficient to use the provided insulin.

Signs of type 2 Diabetes are rapidly becoming more popular as the number of diagnosed diabetics is increasing day by day. The basic reason behind this increased number is the lack of exercise and unhealthy eating habits. This leads to an increase in the number of obese individuals. Obesity is one of the leading causes of this type of diabetes.

Gestational Diabetes: Gestational diabetes is a short-term phase of diabetes suffered by women during pregnancy. This temporary phase is over after the completion of pregnancy.

Signs of Diabetes Type 2

Here are some common diabetic symptoms

• Blurred vision
• Frequent urination
• Excessive hunger
• Excessive thirst
• Slow healing infections and wounds
• Fatigue

It is important to find out the root cause of this disease to treat the signs of diabetes.

Researchers have identified several candidate genes and loci associated with variation in the acute insulin response to glucose (AIRg), including those involved in phosphorylation and ion transport.

Genetic factors play an important role in an individual’s risk for developing Type 2 diabetes. Stephen Rich (University of Virginia, Charlottesville, Virginia, USA) and co-workers attempted to identify genes and regions in the human genome that are associated with the AIRg, a direct measure of beta-cell response and an important predictor of Type 2 diabetes.

The team performed a two-stage genome-wide association scan to analyze single nucleotide polymorphisms (SNPs) in Hispanic-American participants from the Insulin Resistance Atherosclerosis Family Study.

In the first stage, 317K SNPs were assessed in 229 Hispanic-American DNA samples from participants without Type 2 diabetes who had complete data for glucose homeostasis and obesity phenotypes available.

A total of 1536 SNPs with evidence of association were chosen for genotyping in the 1190 Hispanic samples for which glucose homeostasis data were available.

The researchers identified multiple regions of the human genome as likely to harbor genes contributing to variation in AIRg.

No individual SNP achieved genome-wide levels of significance, the authors report in the journal Diabetologia. However, “two regions, 6p21 and 20p11, were notable in having associations at more than one SNP,” they write.

Additional genotyping in these regions highlighted several candidate genes that may contribute to variation in AIRg. These included a gene desert in chromosome 6p21 (containing PXT1, KCTD20, and STK38) and several genes in chromosome 20p11 (ENTPD6, PYGB, GINS1, and RP4-691N24.1).

“The latter series of genes suggests a mechanism of action that could be involved in phosphorylation and ion transport,” note the authors.

The genes and loci identified in this study explain a small component of variation in AIRg. “The genes identified are involved in phosphorylation and ion transport, and provide preliminary evidence that these processes are important in beta cell response,” conclude the authors.

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

Free abstract

If you are trying to live with type 2 diabetes or prediabetes then you know that it changes your whole life.

There are free diabetic diet plans online that can help you lose those pounds fast and control your blood sugar. Did you know that all diet plans are based on the diabetic diet plans?

You can actually lose up to 40 to 50 pounds in just 60 days if you will follow this diabetes diet plan. These plans will cost over $200.00 if you hired a nutritionist to do this for you.

You must know that the medications that you are on will never cure your diabetes, but the diabetic diet plan can actually reverse your diabetes.

This diabetic diet plan online has helped many men and women lose those extra pounds and reverse your diabetes type 2.

You know that this diet is absolutely free and all you do is follow it strictly and you will lose the weight that you have wanted to lose for a long time.

Being overweight is a dangerous to you and it just makes your diabetes worse. Take control of you diabetes today and lose that weight.

Diabetes is a serious disease and if you have diabetes you should seek medical advise. The diabetes diet meal plan is the most effective treatment for type 2 diabetes and maybe your physician has discussed that with you.

All you have to do is answer five quick questions so they can get the right diet for you.

Study results show that patients with Type 2 diabetes who are treated with insulin or a thiazolidinedione (TZ) have fewer highly stenotic coronary artery lesions than those not treated with these drugs regardless of duration of diabetes, glycemic control, or other risk factors.

“Patients with diabetes continue to die of coronary artery disease (CAD) at rates two to four times higher than patients without diabetes, despite advances in treatment of cardiovascular disease,” say Teresa Jones (National Institutes of Health, Bethesda, Maryland, USA) and co-investigators.

They explain that “the role of glycemic control therapies, independent of their glucose-lowering effects, on cardiovascular disease is a recurring question.”

To investigate this further, the team assessed the association of different glycemic control therapies (insulin and TZs) with the extent of CAD found on angiography in 1803 participants of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.

All participants had Type 2 diabetes, documented CAD, no previous revascularizations, and were aged 62.1 years on average.

As reported in the American Journal of Cardiology, the researchers found that individuals who were using insulin at baseline had 23% less highly stenotic lesions and a significantly lower myocardial jeopardy index than those not using insulin. This was despite having a worse overall cardiac risk factor profile, increased inflammatory markers, and a higher prevalence of unstable angina than non-users.

Type 2 diabetics who had been taking a TZ for 6 months or more at baseline had 17% fewer highly stenotic lesions and significantly lower levels of the inflammatory markers C-reactive protein, fibrinogen, and plasminogen activator inhibitor-1 than those not taking TZs.

Of note, participants who were taking insulin and a TZ had 43% fewer highly stenotic lesions than patients taking neither treatment.

As this is significantly less than for individuals taking either treatment alone the researchers suggest that “different mechanisms or factors relating to CAD… might be affected by these two therapeutic classes.”

The authors caution that their results need to be confirmed by further research.

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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Sometimes it seems that popular diabetes research may have forgotten it’s objective, but there are certainly things diabetics can do to treat themselves. In fact, even the ADA agrees with this notion. This idea is suggested in one of their publications called, Diabetes A to Z: What you Need to know About Diabetes; Simply Put. It is now in it’s 5th edition.

When reporting the results of diabetes research, it is quite acceptable to say something like the following statement in a news release or report: “new drug shows promise for treatment.” You have to be careful, however, in saying something like, “ancient practice of using certain natural dietary supplements limits incidence of type 2 diabetes among Mayan descendants”. No claims of treatment or cure can be made regarding any naturally available product used as food or food supplement without approval. This FDA technicality shows the tilt of the play field - it’s not towards the sufferers of this degenerative disease, but towards the drug manufacturing industry.

However, before we examine the pitiful state of metabolic disease research any further, I want to share some interesting bit of information on type 2 diabetes; in particular some new research study on a natural food supplement. I actually “tore” out a piece of the page of the report and posted it on the web.

Let us consider one commendable effort by a research organization as seen in a January 2009 article. We read that that US Olympic swimmer, Gary Hall, Jr. was “tapped as spokesman for new study that explores benefits of exercise on autoimmune diseases.” Mr. Hall, who competed in the Olympics from 1996 through 2004 and won 5 gold, 3 silver, and 2 bronze medals in 3 Olympics was diagnosed with type 1 diabetes in 1999.

Scientists conducting diabetes research to investigate the effect of physical exercise on autoimmune response in type 1 diabetes believe that regular aerobic activity increases insulin sensitivity. But this has been known and practiced for some time now. One exercise physiologist to whom I have listened several times even told of clients who simply exercise and then eat in order to control their blood sugars. I am not sure I would advocate anyone working so hard for every meal, but it shows the effectiveness and importance of physical activity in regulating blood sugar.

Diabetes research has been chasing the money

With all the knowledge and experience gained from various diabetic research studies that prove the effectiveness of proper diet and exercise very little is being done to promote healthy lifestyle intervention especially among the high risk groups. Diet and lifestyle regulation can help in not only controlling, but preventing, the onset of type 2 diabetes. Instead, science continues to chase the “so-called” genetic factors and the development of more drugs to tackle the epidemic. Why?

Well, since it is difficult to “patent” a freely growing plant that can be used in dietary supplementation, then expensive research has to follow the money. However, even the researchers agree that there are things we can do to treat ourselves, and we should. After all, our health is the result of choices we make daily.

Recent double-blind clinical studies have shown very satisfactory results for controlling blood glucose level using common, easily available, traditionally used, and natural dietary supplements. Having tried some of the ingredients individually, it is particularly thrilling to see new combinations and special blends of these traditionally safe products. One question still hangs unanswered, however. Will the established arm of the pharmaceutical and medical industries still keep this information under their clipboard, or will they help spread the news to diabetics?