Diabetes Mellitus Type II
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REVIEW our Selected Diabetes Articles in 2007. Stay informed and updated!
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Diabetes
NIH - Diabetes (Medical Encyclopedia) Type 2 diabetes is far more common than type 1 and makes up 90% or more of all cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise. … Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and/or oral medications. … Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels."
NHS - Diabetes: the facts “Symptoms of diabetes The symptoms of both type 1 and type 2 diabetes include: • Increased thirst, and drinking a lot of fluids. • Passing a lot of urine. • Being tired for no reason. • Weight loss. • Genital itching or repeated bouts of thrush. • Slow healing of wounds. • Blurred vision. In type 1 diabetes, symptoms will typically develop over a few weeks and quickly become very obvious. In type 2, symptoms can develop more slowly, over a period of months. Some people with type 2 diabetes have only very mild symptoms, which they believe have other causes. A few people may have no symptoms at all. … Types of diabetes There are two main types of diabetes. • Type 1: in this type, the body can't produce any insulin. This type of diabetes usually occurs before age 40, and accounts for only around 10% of all cases. But it is the most common form of childhood diabetes. • Type 2: this is where the body doesn't make enough insulin, or where the body builds up a resistance to insulin so that it doesn't work effectively. It's the most common form of diabetes (90% of all cases), and is frequently linked with being overweight. One in 10 people in the UK will eventually develop type 2 diabetes.”
Highlighted Articles
Diabetes Seems to Heighten Glaucoma Risk: Regular screenings may help prevent irreversible nerve damage (2008) "A recent study in the journal Ophthalmology found that women with diabetes have about a 70 percent increased risk of developing the most common form of glaucoma -- primary open-angle glaucoma -- compared to women without diabetes."
Researchers report periodontal disease independently predicts new onset diabetes (2008) “These data add a new twist to the association and suggest that periodontal disease may be there before diabetes," said Ryan T. Demmer, PhD, MPH, associate research scientist in the Department of Epidemiology at the Mailman School of Public Health and lead author. "We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop Type 2 diabetes later in life when compared to individuals without periodontal disease." “
Intake of Fruit, Vegetables, and Fruit Juices and Risk of Diabetes in Women (Diabetes Care 2008) “CONCLUSIONS—Consumption of green leafy vegetables and fruit was associated with a lower hazard of diabetes, whereas consumption of fruit juices may be associated with an increased hazard among women.”
Diabetic Neuropathy--A Review (Nat Clin Pract Neurol. 2007) "Diabetic neuropathy is the most common neuropathy in industrialized countries, and it is associated with a wide range of clinical manifestations. The vast majority of patients with clinical diabetic neuropathy have a distal symmetrical form of the disorder that progresses following a fiber-length-dependent pattern, with sensory and autonomic manifestations predominating. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients experience pain, trophic changes in the feet, and autonomic disturbances. Occasionally, patients with diabetes can develop focal and multifocal neuropathies that include cranial nerve involvement and limb and truncal neuropathies."
Adiposity Compared With Physical Inactivity and Risk of Type 2 Diabetes in Women (Diabetes Care 2007) "CONCLUSIONS—Obesity and physical inactivity independently contribute to the development of type 2 diabetes; however, the magnitude of risk contributed by obesity is much greater than that imparted by lack of physical activity."
Walking for exercise--does three times per week influence risk factors in type 2 diabetes? (Diabetes Res Clin Pract. 2006) "Our results suggest that an increase of regular physical activity equivalent to 45 min of walking 3 days/week may suffice to improve systolic and diastolic blood pressure, lipid metabolism and BMI in patients with type 2 diabetes."
Internet SitesCONTINUE YOUR INFOMEDSEARCH RESEARCH with our previous InfoMedLinks. Start with InfoMedLinks 2007.
Notes
The Guidelines section will contain 2008 and some 2007 updated published guidelines. To view Guidelines from previous years, view the Guideline sections or the Article sections or our Monthly Online Newsletter (under the Guidelines section).
Diabetes Mellitus Type 2
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
4 More Deaths Reported Among Byetta Patients “On Aug. 18, the FDA said two deaths had resulted from six recent cases of pancreatitis among Byetta users. The agency said at the time it was working on stronger labeling for the injected drug, which has been used by more than 700,000 people since being approved in June 2005. Last October, the FDA said there had been 30 reports of pancreatitis among Byetta users. In that announcement, the FDA warned that people should stop taking the drug if they developed symptoms of acute pancreatitis, including nausea and abdominal pain. “
Combo of diabetes drugs may increase mortality “Combination treatment for type 2 diabetes using two classes of drugs -- metformin and sulfonylureas -- may increase the risk of hospitalization for cardiovascular disease and mortality, according to a report in the current issue of Diabetes Care. Researchers came to this conclusion after an analysis of pooled data from nine large observational studies. "The paper highlights a real dilemma we have today in diabetes treatment," senior investigator Dr. Vivian A. Fonseca told Reuters Health. "We have drugs that lower glucose but we seem to run into problems over time with improving outcomes -- particularly cardiovascular outcomes." "A big question," he added, "is whether it is due to the disease or the drugs increasing cardiovascular risk."“
FDA - Warning Added to Regranex Label “A boxed warning alerting healthcare professionals to an increased risk of cancer death has been added to the labeling for Regranex (becaplermin), a topical medication used to treat certain diabetic foot and leg ulcers.”
More Evidence of Increased Fractures With Thiazolidinediones
Use of Thiazolidinediones and Fracture Risk (Arch Intern Med. 2008) “Conclusion This analysis provides further evidence of a possible association between long-term use of thiazolidinediones and fractures, particularly of the hip and wrist, in patients with diabetes mellitus.”
Rosiglitazone-Associated Fractures in Type 2 Diabetes (Diabetes Care 2008) “CONCLUSIONS—Further investigation into the risk factors and underlying pathophysiology for the increased fracture rate in women taking rosiglitazone is required to relate them to preclinical data and better understand the clinical implications of and possible interventions for these findings”
Exubera (insulin human rDNA origin) Inhalation Powder “[Posted 04/09/2008] Pfizer informed healthcare professionals and patients of updated safety information in the WARNINGS section of prescribing information for Exubera, a short-acting insulin you breathe in through your mouth using the Exubera inhaler that helps to control high blood sugar in adults with diabetes. There have been 6 newly diagnosed cases of primary lung malignancies in clinical trials among Exubera-treated patients, and 1 newly diagnosed case among comparator treated patients.”
Drugs
The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease (BMJ 2008) “Conclusion This trial does not provide evidence to support the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality in the population with diabetes studied.”
Diabetes aspirin use questioned
More meds, more quickly to treat type 2 diabetes
The benefit of aspirin therapy in type 2 diabetes: What is the evidence? (Int J Cardiol. 2008)
Aggressive approach to diabetes proves harmful “Patients with type 2 diabetes, a high risk of cardiovascular disease, and who use aggressive measures to reduce their blood sugar levels could actually be shortening their lives, according to a large clinical trial. The results contradict the established theory that diabetics benefit from driving down their excessively high blood sugar levels as forcibly as possible.”
Exercise
Effect of 6-month supervised exercise on low-density lipoprotein apolipoprotein B kinetics in patients with type 2 diabetes mellitus. (Metabolism. 2008)
Research shows aerobic exercise combined with resistance training improves glucose control in diabetics “Patients with diabetes who participate in a program combining aerobic and high-force eccentric resistance exercise demonstrate improvements in glucose control, physical performance, and body fat composition, according to a study published in the November 2008 issue of Physical Therapy (PTJ), the scientific journal of the American Physical Therapy Association (APTA). "Although aerobic exercise is what is typically recommended for treating people with diabetes, this study shows that adding a high-force strength training component has significant advantages," says APTA spokesperson Robin L Marcus, PT, PhD, OCS, assistant professor at the University's Department of Physical Therapy and the study's lead researcher. Diabetes affects approximately 24 million adults and children in the United States.1 The onset of type 2 diabetes — a chronic illness marked by decreased insulin sensitivity and overall poor glucose control — is fostered by decreased physical activity. “
Walking extra 45 mins helps diabetes “ “By building physical activity into everyday life, the difficulty of making time to go out just for exercise is avoided. It is an important and simple health message – walking 45 minutes extra a day helps diabetes,” he explained.”
Just Do It: Diabetes and Exercise
Resistance Exercise Training Beneficial in Asian Indian Diabetics “Progressive resistance training improves insulin sensitivity, glycemic control and lipid levels and reduces subcutaneous adipose tissue deposits in Asian Indian patients with type II diabetes, researchers from India report in the July issue of Diabetes Care. "Asian Indians manifest insulin resistance and the metabolic syndrome at a younger age and at a higher magnitude than many other ethnic groups," the investigators explain. “
Physical activity participation may offset some of the negative impact of diabetes on cognitive function. (J Am Med Dir Assoc. 2008) “CONCLUSIONS: Certain types of physical activity, including light and moderate exercise, appear to be beneficial to mental function in individuals with T2 DM. Having diabetes, particularly when less well controlled, is associated with lower cognitive function scores, and physical activity participation may prevent some of the potential decline in cognition.”
Moderate Fitness Reduces Mortality Risk for Men With Type 2 Diabetes “"Even with moderate levels of activity, one could improve their overall survival and reduce their overall mortality, and this would equate to brisk walking maybe 130 minutes per week," Dr. Jacob-Issac explained. "Moderate levels of activity should be recommended for all diabetics."”
Tai Chi 'helps improve diabetes' “Tai Chi exercises can help people with type 2 diabetes control their condition, research suggests. Two separate studies found a 12-week programme of exercise was enough to boost the immune system, and to cut blood sugar levels. “
Aerobic exercise training improves the role of high-density lipoprotein antioxidant and reduces plasma lipid peroxidation in type 2 diabetes mellitus. (Scand J Med Sci Sports. 2008)
Effect of aerobic exercise training on oxidative stress in patients with type 2 diabetes mellitus. (Metabolism. 2008) "In conclusion, aerobic exercise training improved glycemic control and reduced oxidative stress in patients with type 2 diabetes mellitus. Furthermore, improvement in glycemic control was associated with a reduction in oxidative stress."
General Information
Lifestyle, Not Drugs, for Preventing Type 2 Diabetes: "Gladiatorial" Debate Concludes “Lifestyle changes, not drugs, should be the main focus for preventing type 2 diabetes: that was the conclusion of a lively debate here at the European Association for the Study of Diabetes 2008 Meeting. While Dr Paul Zimmet (Baker IDI Heart and Diabetes Institute, Melbourne, Australia) argued nimbly that glucose-lowering drugs could play an important role in preventing progression to diabetes, the audience, in a show of hands, ultimately voted to feed him to the lions following what both speakers, in a nod to their Roman surroundings, called a "gladiatorial debate." In defense of lifestyle interventions, Dr Nick Wareham (Institute of Metabolic Science, Cambridge, UK), pointed to the fundamental, philosophical problem of treating patients who have no overt disease with pharmaceutical agents that have no proven benefits as preventive medications. "As a physician I know that drug therapy is hugely beneficial in certain circumstances. The question is whether it is beneficial for people who don't have a disease to be treated with drugs," Wareham said. "I do not contest the notion that this group is at risk, but I think there is a profound philosophical question we're facing: when we as physicians seek out people who don't come to us to offer them help, we'd better be damn sure that what we're doing is actually going to do so."
“10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes (NEJM 2008)
Age threshold for routine aspirin treatment to prevent cardiovascular disease in patients without diabetes. (Heart. 2008) “CONCLUSIONS: Aspirin should routinely be considered to all men and women without diabetes above the ages of 48 and 57 years respectively for primary CVD prevention. For individuals below these age thresholds or for those above the age of 75 years, decision to initiate aspirin should be based on patient's individual cardiovascular risk profiles. These proposed age thresholds aims to take into account patient's gender, their bleeding risk and the cardio-protective benefits of low-dose aspirin therapy.”
Some patients may not need insulin for long-term control of type 2 diabetes “Some patients with type 2 diabetes can control their disease for years yet avoid insulin injections by using multiple classes of oral diabetic medications, a new study found. The results were presented Sunday, June 15, at The Endocrine Society's 90th Annual Meeting in San Francisco. Findings from the study contradict common beliefs about non-insulin diabetic medications, said principal investigator Arthur Swislocki, MD, of the Veterans Affairs (VA) Northern California Health Care System in Martinez. Oral diabetes medications help control blood glucose, or sugar, levels in people whose bodies still produce some insulin, as is true for many patients with type 2 diabetes. "Generally, both patients and physicians believe that long-term use of oral diabetic medications is not possible because these drugs lose their effectiveness over time as the patient's pancreas fails," Swislocki said. "Our data suggest that some patients can remain in good glucose control for years using non-insulin, oral diabetic agents." “
Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. (N Engl J Med. 2008)
Effects of Intensive Glucose Lowering in Type 2 Diabetes. (N Engl J Med. 2008) “CONCLUSIONS: As compared with standard therapy, the use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events. These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes.”
Management of type 2 diabetes: oral agents, insulin, and injectables. (J Am Diet Assoc. 2008)
Effect of a multifactorial intervention on mortality in type 2 diabetes. (N Engl J Med. 2008)
Guidelines
Consensus Statement Updated on Management of Hyperglycemia in Type 2 Diabetes
Canadian Diabetes Association 2008 Clinical Practice Guidelines
NGC - Standards of medical care in diabetes. V. Diabetes care. (2008)
NGC - Management of type 2 diabetes mellitus. (2007)
American Diabetes Association Updates Guidelines for Medical Nutrition Therapy
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Weight Loss After Diabetes Diagnosis Offers Big Benefits: Study “Studies have shown that weight loss is important to maintain blood-sugar and blood-pressure control, as well as to keep cholesterol levels in check. These parameters, in turn, are critical for avoiding the long-term complications of diabetes, such as heart disease, blindness, kidney damage, amputations and even death.”
Broccoli may undo diabetes damage “"Our study suggests that compounds such as sulforaphane from broccoli may help counter processes linked to the development of vascular disease in diabetes. "In future, it will be important to test if eating a diet rich in brassica vegetables has health benefits for diabetic patients. We expect that it will." Dr Iain Frame, director of research at the charity Diabetes UK, stressed that research carried out on cells in the lab was a long way from the real life situation. “
Cocoa can be 'boost to diabetics' “A cup of enriched cocoa may help improve the working of blood vessels in diabetic patients, research suggests. Doctors prescribed three mugs of specially formulated cocoa a day for a month, and found "severely impaired" arteries regained normal function. The German study, featured in the Journal of the American College of Cardiology, suggests chemicals called "flavanols" may be responsible. “
Grape skin compound fights the complications of diabetes: Resveratrol in grape skins could stop diabetic complications such as heart disease, retinopathy and nephropathy, research finds "The elevated levels of glucose that circulate in the blood of patients with diabetes causes micro- and macrovascular complications by damaging mitochondria, the tiny power plants within cells responsible for generating energy. When they are damaged they can leak electrons and make highly damaging 'free radicals'. Complications that can result when this happen include nephropathy (kidney disease), heart disease and retinopathy (which if left untreated can lead to blindness). Resveratrol stops the damage by helping cells make protective enzymes to prevent the leakage of electrons and the production of toxic 'free radicals'. "
Other
Other Treatments
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Vitamin D improves endothelial function in patients with Type 2 diabetes mellitus and low vitamin D levels (Diabetic Medicine 2008) "Conclusions Vitamin D insufficiency is common in patients with Type 2 diabetes during winter in Scotland. A single large dose of oral vitamin D2 improves endothelial function in patients with Type 2 diabetes and vitamin D insufficiency."
How Antioxidant Therapy May Play A Role In The Treatment Of Type 2 Diabetes
Surgery
Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes (J Clin Endocrinol Metab 2008)
Gastric banding for the treatment of type 2 diabetes mellitus in morbidly obese. (Surg Obes Relat Dis. 2008)
Diabetes Study Favors Surgery to Treat Obese "The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs. In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did - 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery."
Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes (JAMA. 2008) "Conclusions Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed."
Transplantation
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