After there has been an incidence of fasting twice or more, when your blood sugars are not in the diabetic range but are close, it is said you have pre-diabetes (also known as impaired glucose tolerance). It is no wonder that many people do not know if they are in the risk of developing Type 2 diabetes as with pre-diabetes there are not any symptoms. However, be aware that there are changes to the body whether visible or not. Full blown diabetes is easier to detect, as persons with diabetes normally have increased thirst, frequent urination, fatigue, and visual problems. However even without symptoms, pre-diabetes should not be taken lightly as it is important, and can lead to problems with the heart and possible strokes. There are over fifty million people in this country with the disease, and many who are not aware they have it.

The health risks of even slightly increased blood sugar levels should be taken seriously, and it should be handled aggressively It is best to have a glucose test often. Glucose usually provides energy in the cells, but in pre-diabetes it circulates in the blood. Blood sugar readings between 100 and 125 are what are considered pre-diabetes. Full-blown diabetics register at 126 and above. Julie Paff, clinical dietician and diabetes educator said, “Research tells us people with pre-diabetes will likely develop full-blown diabetes within 10 years unless they make changes in their lifestyle.” This consists of healthful food as well as exercise .

Whole grains should be a major food in the diet. Overweight persons should lose 5 to 7 percent of their weight. Lifestyle changes can prevent the risk of future diabetes especially if there is a family history of it. Fifteen minutes of exercise a day can be very beneficial, with walking highly recommended. You can start with fifteen minutes and progress to thirty minutes.

Your doctor may advise going to a dietician for instruction on what to eat. He or she may also prescribe a medicine in order to nip pre-diabetes in the bud. At rate, if the doctor says you have pre-diabetes, don’t ignore it.

http://www.discussingpre-diabetes.info

Overweight diabetic individuals who have not previously received treatment are around half as likely to need antihyperglycemic therapy if they follow a Mediterranean-style diet, rather than a low-fat diet, say researchers.

A Mediterranean-style diet is typically high in monounsaturated fats and its association with increased insulin sensitivity led to it being recommended by the American Diabetes Association to aid weight loss in overweight individuals with diabetes. The Association also recommends low-carbohydrate or low-fat diets; however, few studies have directly compared the benefits of Mediterranean and low-fat diets over the long term.

Dario Giugliano (Seconda Universitá di Napoli, Italy) and colleagues therefore compared the two diets in 215 overweight volunteers with newly diagnosed Type 2 diabetes who had never received antihyperglycemic medication and who had HbA1_c levels of less than 11%.

The patients were randomly assigned to a Mediterranean-style diet, with less than 50% of total daily calories from carbohydrates, or a low-fat diet, with less than 30% of total calories from fat. The Mediterranean-style diet was rich in vegetables, whole grains, and monounsaturated fats from poultry, fish, and olive oil. The low-fat diet was rich in whole grains but low in sweets and high-fat snacks and no more than 10% of calories came from saturated fats.

The principles of the diet were explained in detail to the volunteers during monthly visits to a nutritionist and a dietician in the first year after joining the study and every 2 months thereafter. Study participants were also advised to take regular exercise.

After an average follow-up time of 4 years, 70% of patients following the low-fat diet needed antihyperglycemic treatment, compared with only 44% of those following the Mediterranean-style diet. Importantly, the significance of this difference remained after controlling for differences in exercise levels and differing degrees of weight loss, which was greater overall in those following the Mediterranean-style diet.

“We believe our findings suggest that people with newly diagnosed Type 2 diabetes who use a low-carbohydrate, Mediterranean-style diet can lower their HbA1_c levels and delay the need for antihyperglycemic drug therapy compared with use of a low-fat diet,” conclude Giugliano and team in the Annals of Internal Medicine.

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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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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Few Australian patients with Type 2 diabetes meet Australian National Health Foundation (NHF) guidelines for daily sodium or potassium intake, researchers report.

These guidelines recommend a daily sodium and potassium intake of less than 100 mmol and more than 120 mmol, respectively, for individuals with a high risk for cardiovascular (CV) disease.

However Elif Ekinci (Austin Health, Victoria, Australia) and team found that “only 3% of male patients and 14% of female patients with Type 2 diabetes met the Australian NHF guidelines for sodium consumption.”

The researchers assessed the 24-hour urinary sodium (uNa), potassium (uK), creatinine (uCr), urea (uUrea), and glucose (uGlc) levels of 122 Australians with Type 2 diabetes, over a mean of 5 years, collecting a mean 1.9 samples per patient per year.

At baseline, all patients received dietary advice stressing actions such as avoiding high-energy processed foods and consuming lots of fresh fruit and vegetables.

By the end of the study, the mean patient uNa level was higher than the NHF recommendation, at 170 and 142 mmol/day in men and women, respectively. Mean uK level, however, was lower than the NHF recommendation, at 75 and 62 mmol/day in men and women, respectively.

After adjustment for insensible sodium and potassium losses, a significantly smaller proportion of men met the NHF sodium guidelines than women, at 3% versus 14%. However, significantly fewer women than men met NHF potassium guidelines, at 3% versus 14%.

Of note, body mass index (BMI), uUrea level, urine volume, and uGlu level were all independent predictors of uNa level.

“The strong association of urinary sodium with BMI is likely to reflect excessive consumption of sodium-rich processed food,” the researchers hypothesize in the journal Diabetic Medicine.

They say that hypertensive and normotensive individuals could reduce their systolic blood pressure (SBP) by 5 and 2.5 mmHg, respectively, simply by reducing their salt intake by 3g per day.

This reduction in SBP “would be expected to produce a CV benefit in the general population equating to an approximate 13% reduction in stroke and 10% reduction in ischemic heart disease,” they conclude.

Ekinci et al add, however, that “it remains to be shown whether salt restriction can be maintained outside study conditions and whether it can reduce CV outcomes in 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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A high consumption of green leafy vegetables, such as spinach, kale, and lettuce, significantly reduces the risk for developing Type 2 diabetes, results from a systematic review and meta-analysis suggest.

“The findings add to the growing body of evidence that lifestyle is key for the prevention of Type 2 diabetes,” lead study author Patrice Carter (University of Leicester, UK) told MedWire News.

In total, six studies involving a total of 223,512 participants were included in the analysis. The follow-up period for the studies ranged from 4.6 to 23 years.

Prospective cohort studies that included a measure of intake of fruits, vegetables, or a combination of the two and an assessment of Type 2 diabetes risk were considered suitable for the analysis. Of the six studies identified, four also provided information on the intake of green leafy vegetables.

Pooled estimates showed that eating 1.35 (highest intake) compared with 0.20 (lowest intake) servings of green leafy vegetables per day was associated with a significant 14% reduction in risk for Type 2 diabetes.

Pooled estimates of highest versus lowest intake of fruit, vegetables, or both, did not show a significant reduction in risk for Type 2 diabetes, but there was a nonsignificant trend for improvement.

Carter emphasized that “this should not be ignored and shows more research would be beneficial.”

When asked about possible reasons for the observed risk reduction, Carter commented: “Green leafy vegetables have a number of potential benefits for reducing diabetes risk, they are high in antioxidants and magnesium. They also contain fatty acids which may increase insulin sensitivity of cells.

“Further research is needed to determine why green leafy vegetables are so important.”

The research is published in the British Medical Journal.

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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For patients with Type 2 diabetes who show inadequate glycemic control on metformin alone, add-on therapy with saxagliptin achieves equivalent reductions in glycated hemoglobin (HbA1c) as standard glipizide, results of a non-inferiority trial show.

Furthermore, patients in the saxagliptin group experienced significantly fewer hypoglycemic and other adverse events than the control group.

“Failure to achieve and maintain adequate glycemic control is caused by the progressive nature of Type 2 diabetes mellitus and the limitations of current therapies,” Ingrid Gause-Nilsson (AstraZeneca R&D, Molndal, Sweden) and colleagues comment in the International Journal of Clinical Practice.

Metformin is standard first-line pharmacotherapy for patients with Type 2 diabetes, but it is often insufficient to maintain glycemic goals over time.

Sulphonylureas, including glipizide, are commonly used as add-on therapy; however, their use is associated with limitations including multiple titration steps, the potential for beta-cell failure, weight gain, and increased risk for hypoglycemia.

Dipeptidyl peptidase-4 inhibitors, of which saxagliptin is one, are a relatively new class of oral antidiabetic drugs, and may offer a more favorable alternative to sulphonylureas.

To investigate, the researchers recruited 858 patients on stable metformin doses (?1500 mg/day) who were randomly assigned to receive saxagliptin (5 mg/day) or glipizide up-titrated as needed from 5 to 20 mg/day, for 52 weeks.

Elevation in HbA1c from baseline was not significantly different between the two arms, at 0.74% with saxagliptin and 0.80% with glipizide.

There was, however, a significantly smaller rise in HbA1c from week 24 to 52 with saxagliptin compared with glipizide (0.001% vs 0.004%) - indicating a sustained glycemic effect beyond week 24.

Treatment with saxagliptin was associated with a significantly smaller proportion of patients with hypoglycemic events than treatment with glipizide (3.0% vs 36.3%) and a divergent impact on body weight (mean change from baseline -1.1 kg with saxagliptin vs +1.1 kg with glipizide).

Excluding hypoglycemic events, the proportion of patients experiencing adverse events was similar (60.0% saxagliptin and 56.7% glipizide), although treatment-related adverse events were less common with saxagliptin than with glipizide (9.8% vs 31.2%), which was attributable to the higher frequency of hypoglycemia in glipizide patients.

Gause-Nilsson et al comment: “By using agents that differ in their mechanisms of action and side-effect profiles, combination regimens can better address the numerous pathophysiological abnormalities that characterize Type 2 diabetes while reducing safety and tolerability issues.”

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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Researchers demonstrate that improved cardiorespiratory fitness, achieved though aerobic and resistance exercise training, is associated with significant reductions in glycated hemoglobin (HbA1c) in individuals with Type 2 diabetes.

Writing in the journal Diabetologia, Glen Kenny (University of Ottawa, Ontario, Canada) and colleagues report results from a study of 251 patients with Type 2 diabetes who were randomly assigned to participate in aerobic, resistance, or aerobic and resistance exercise for 6 months.

They found that aerobic and resistance training alone led to significant 0.51% and 0.38% reductions in HbA1c, respectively, over the study period.

Combined exercise training led to greater reductions in HbA1c at 6 months than those achieved by the aerobic and resistance training groups, with respective additional reductions of 0.46% and 0.59%.

To assess fitness, the researchers measured peak oxygen consumption (VO₂ peak), workload, treadmill time, and ventilator threshold measurements from maximal treadmill exercise testing both at study enrollment and at 6 months.

The team found that for the aerobic group the beneficial changes in HbA1c were linked to improvements in VO₂ peak and workload, whereas improvements in strength on the seated rowing machine and in mid-thigh muscle cross-sectional area were associated with improved HbA1c in the resistance group.

For the combined group, improvements in VO₂ peak, workload, and ventilatory threshold were most significantly linked with HbA1c decreases. Of note, in this group increases in muscle cross-sectional area were not significantly linked with improved HbA1c.

“Both aerobic and resistance exercise training alone cause clinically important improvements in physical fitness and glycemic control,” summarize the authors.

“However, the association between changes in physical fitness and glycemic control may be more pronounced with combined exercise training due to improvements in aerobic fitness and in muscular strength,” they suggest.

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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Investigators have found that being a member of an ethnic minority, having low socioeconomic status, being overweight, and having a family history of diabetes are all associated with childhood-onset Type 2 diabetes.

Type 2 diabetes is predominantly a condition affecting middle aged and older people, but in recent years has become significantly more common in younger age groups.

Kenneth Copeland (University of Oklahoma College of Medicine, Oklahoma City, USA) and colleagues report baseline characteristics from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort, which represents the largest and best-characterized sample of American youth (aged 10-17 years) with Type 2 diabetes.

In total, 704 participants (64.9% female) were recruited who had a mean age of 14.0 years and disease duration of 7.8 months.

As Type 2 diabetes is a degenerative condition with a significant long-term health impact, it is important to assess factors that may increase the risk for development at an early age.

Copeland and team found that the mean body mass index Z-score was high, at 2.15 (generally indicative of being above the 95th percentile). Family history of diabetes was common, at 89.4%, and 72.6% were non-Hispanic Black or Hispanic (31.5% and 41.1%, respectively).

In addition, 26.3% had blood pressure in the 90th percentile or higher, 13.0% had microalbuminuria, 79.8% had low high-density lipoprotein cholesterol, and 10.2% had high triglycerides.

Regarding socioeconomic factors, 38.8% were living with both biological parents, 41.5% had a household income below US$25,000 (€17,967), and 26.3% had parents or guardians with low educational attainment (lower than high school degree).

“The baseline characteristics of the TODAY cohort can be interpreted as representative of youth with Type 2 diabetes throughout the US in general,” write the authors in the Journal of Clinical Endocrinology and Metabolism.

Following baseline measurements, the participants were randomly assigned to treatment with metformin, metformin plus rosiglitazone, or metformin plus lifestyle intervention and will be followed up for 2-6 years.

“Final outcome data will yield insights applicable to the treatment of youth with Type 2 diabetes,” add the researchers.

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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Younger age at diagnosis, female gender, and high body mass index (BMI) and glycated hemoglobin (HbA1c) at initial clinic visit predict switching to insulin therapy in patients with Type 2 diabetes, say researchers.

Mohsen Janghorban and Masoud Amini from Isfahan University of Medical Sciences in Iran followed up 6896 non-insulin treated patients with Type 2 diabetes for a mean period of 9.3 years for incidence of progression to insulin therapy. At baseline, the participants were aged 51.2 years and had a mean diabetes duration of 5.8 years.

Over a total of 64,540 patient-years of follow-up, 1599 (23.2%) patients switched from diet and exercise (24.4%) or oral antidiabetes (75.6%) medication to insulin therapy, a rate of 2.5 per 100 patient years.

The researchers found that each additional year of age was associated with a significant 3% reduction in risk for switching to insulin, whereas each additional unit of BMI (kg/m²) at baseline significantly increased the risk for switching by 2%.

Each additional follow-up visit over the study period decreased the risk for switching by a significant 3%, while each 1% increase in HbA1c at baseline was linked with a significant 8% increase in risk for switching.

Finally, female gender increased the risk for switching to insulin by a significant 20%.

Writing in the journal Diabetes Research and Clinical Practice, the team concludes: “The findings of this study illustrate for the first time the switching rates and its predictors to insulin from a non-insulin regimen in patients with Type 2 diabetes in Iran.”

They suggest: “These findings may be taken into account in future treatment decisions.”

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 proposed use of a specific glycated hemoglobin (HbA1c) threshold to identify Type 2 diabetes could miss the majority of patients who are diagnosed using oral glucose tolerance tests, a study suggests.

Among individuals identified with Type 2 diabetes based on two oral glucose tolerance tests during follow up of the Finnish Diabetes Prevention Study, up to 60% would have remained undiagnosed using HbA1c levels of at least 6.5% (48 mmol/mol).

This threshold was recently proposed by an International Expert Committee as a diagnostic tool for diabetes, researchers in the above study note.

A recently published position statement by the American Diabetes Association has also, accordingly, recommended HbA1c as alternative diagnostic criteria for the diagnosis of diabetes.

However, Pia Pajunen (National Institute for Health and Welfare, Helsinki) and colleagues say: “Our results show that changing the diagnostic method for diabetes from glucose measurement to HbA1c is not without major problems.”

The team compared the diagnostic efficacy of annual HbA1c measurements with the oral glucose tolerance test in 172 men and 350 women taking part in the Diabetes Prevention Study, all of whom were overweight and had impaired glucose tolerance at baseline.

HbA1c of at least 6.5% as a diagnostic criterion for Type 2 diabetes had a sensitivity of 35% for women and 47% for men compared with diagnosis based on two consecutive oral glucose tolerance tests.

The corresponding sensitivity of HbA1c of at least 6.0% (42 mmol/mol) was 67% and 68%.

Individuals with HbA1c of at least 6.5% and diabetes based on the oral glucose tolerance test were more likely to be obese and had higher fasting glucose and 2-hour glucose levels than those who had a diabetic oral glucose tolerance test but HbA1c levels lower than this.

There were no differences in the predictive performance of baseline fasting glucose, oral glucose tolerance test and HbA1c.

Reporting in the journal Diabetic Medicine, the authors say: “This study provides evidence that agreement between HbA1c and oral glucose tolerance test-based diagnosis of Type 2 diabetes in persons with impaired glucose tolerance is limited.”

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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