Diabetes Mellitus Type II
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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."
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Notes
View Treatment Guidelines from previous years. Go to Treatment for each year.
Diabetes Mellitus Type 2
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug Side-Effects and Interactions
Diabetes drug Byetta tied to kidney problems, says FDA
Metformin Linked to B12 Deficiency “Researchers found that 40% of type 2 diabetes patients using metformin had vitamin B12 deficiency or were in the low-normal range for the essential vitamin. And 77% of metformin users with vitamin B12 deficiency also had peripheral neuropathy, a common form of nerve damage associated with type 2 diabetes. … They say it’s not clear whether vitamin B12 deficiency may contribute to or cause peripheral neuropathy. But they recommend screening metformin users for vitamin B12 deficiency and supplementing the vitamin, when necessary, to reduce the risk of nerve damage.”
Can Metformin Induce Anorexia in Certain Elderly Patients?
Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer, Study Suggests “Researchers from the Larry L. Hillblom Islet Research Center at UCLA found that sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. Januvia is marketed by Merck & Co. Inc. Sitagliptin is a member of a new class of drugs that enhance the actions of the gut hormone known as glucagon-like peptide 1 (GLP-1), which has been shown to be effective in lowering blood sugar in people with Type 2 diabetes. “
Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis (CMAJ 2009)
Drugs
Cholesterol drug cuts amputation risk for diabetics “The anti-cholesterol drug fenofibrate appears to reduce risks of amputation for diabetics by as much as 36 percent, a study has found.”
Exercise
Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic syndrome is dependent on exercise modalities and independent of weight loss. (Nutr Metab Cardiovasc Dis. 2009)
Exercise Training for Type 2 Diabetes Mellitus (CIRCULATION 2009)
Higher Cardiorespiratory Fitness Tied to Lower Mortality in Diabetic Men
General Information
A Randomized Study on the Effect of Weight Loss on Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes (Arch Intern Med. 2009) “Conclusions Physicians and their patients can expect that weight loss will result in significant and clinically relevant improvements in OSA among obese patients with type 2 diabetes. “
How Much Evidence Do We Need to Change Practices in Which We Firmly Believe? “In the first major trial (done in the 1960s) of tight glucose control in patients with type 2 diabetes, oral glucose-lowering agents were associated with higher cardiovascular mortality and no differences in microvascular complications compared with placebo.1 Insulin also was not associated with clinical benefit. In three recent large randomized trials (ACCORD,2 ADVANCE,3 and VADT4), tight control in patients with long-standing type 2 diabetes did not lower overall mortality, cardiovascular-related mortality, stroke, amputations, or even clinical (as opposed to surrogate) microvascular endpoints. Differences in specific outcomes in these trials might be related to different treatments or to duration of diabetes in participants. In some studies, fewer intensively treated patients reached composite outcomes (such as "any diabetes complications"), but the bulk of improvement was in nonclinical outcomes (e.g., incident albuminuria). Tight control was associated with severe hypoglycemia and weight gain. In the UKPDS study,5 published a decade ago, nonobese intensively treated participants with newly diagnosed type 2 diabetes were less likely to reach microvascular endpoints (including "need for photocoagulation," but not visual loss) but showed no difference in mortality (cardiovascular, diabetes-related, or all-cause) compared with nonobese control patients. Among obese participants, metformin alone lowered long-term mortality and myocardial infarction rate, but sulfonylureas and insulin did not; tight control did not lessen risk for microvascular complications. Metformin and sulfonylureas in combination were associated with excess diabetes-related deaths and all-cause mortality. Because trials do not support tight control and because of the cost, burden, and harms associated with tight control, we should be emphasizing cardiovascular risk reduction (particularly control of blood pressure and cholesterol levels) and healthy lifestyles for patients with type 2 diabetes.6 “
Glycemic control in type 2 diabetes: time for an evidence-based about-face? (Ann Intern Med. 2009) “Some diabetes guidelines set low glycemic control goals for patients with type 2 diabetes mellitus (such as a hemoglobin A(1c) level as low as 6.5% to 7.0%) to avoid or delay complications. Our review and critique of recent large randomized trials in patients with type 2 diabetes suggest that tight glycemic control burdens patients with complex treatment programs, hypoglycemia, weight gain, and costs and offers uncertain benefits in return. We believe clinicians should prioritize supporting well-being and healthy lifestyles, preventive care, and cardiovascular risk reduction in these patients. Glycemic control efforts should individualize hemoglobin A(1c) targets so that those targets and the actions necessary to achieve them reflect patients' personal and clinical context and their informed values and preferences.”
Health Tip: Understanding Various Types of Insulin “The American Diabetes Association offers this information about insulin's different forms: • "Rapid-acting" insulin, often called Humalog or lispro, begins to work right away after injection and is most effective after about an hour. It's usually taken just before mealtime. • "Regular," or short-acting insulin, may be taken 30 minutes to 45 minutes before meals, but it takes longer to work, and keeps working longer. • "Intermediate-acting" insulin, often called NPH or Lente, is combined with another substance that helps it work more slowly. This type of insulin can last as long as 18 hours. • "Long-acting" insulin, dubbed Ultralente, is commonly taken early in the morning or at bedtime, and can last for up to 20 hours. • "Very long-acting insulin," or glargine, begins working about an hour after it's injected and can remain consistently effective for about 24 hours. “
Tight Glycemic Control May Not Be Best in Type 2 Diabetes
Treating Type 2 Diabetes: How Safe Are Current Therapeutic Agents? (Int J Clin Pract. 2009)
Guidelines
IDF Releases New Guidelines on Diabetes Management
New Guidelines Address Treatment of Hospitalized Patients With High Blood Glucose Levels
NGC - Wisconsin essential diabetes mellitus care guidelines. (2008)
NGC - Management of diabetes mellitus. (2008)
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
The potential of cinnamon to reduce blood glucose levels in patients with type 2 diabetes and insulin resistance. (Diabetes Obes Metab. 2009)
Effects of Walnut Consumption on Endothelial Function in Type 2 Diabetics: A Randomized, Controlled, Cross-Over Trial (Diabetes Care 2009)
Study Shows How Substance In Grapes May Squeeze Out Diabetes
Mediterranean Diet Might Delay Need for Drugs in Diabetes “By following a low-carbohydrate, Mediterranean diet rather than a low-fat diet, newly diagnosed diabetic patients may postpone the need for drugs to control this disease, a study suggests [1]. After four years, with continued nutritional advice, only 44% of newly diagnosed diabetic patients on a Mediterranean diet vs 70% of those on a low-fat diet required drug therapy as well as diet to control their diabetes. Patients on the Mediterranean also showed greater improvement in some cardiovascular risk factors. "Perhaps most important, the findings reinforce the message that benefits of lifestyle interventions should not be overlooked, despite the drug-intensive style of medicine fueled by the current medical literature," the authors write.”
Black Tea May Fight Diabetes “Polysaccharides, a type of carbohydrate that includes starch and cellulose, may benefit people with diabetes because they help retard absorption of glucose. The researchers found that of the three teas, the polysaccharides in black tea had the most glucose-inhibiting properties. The black tea polysaccharides also showed the highest scavenging effect on free radicals, which are involved in the onset of diseases such as cancer and rheumatoid arthritis.”
Two Dietary Oils, Two Sets Of Benefits For Older Women With Diabetes
Slashing Carbs Cuts Medication Use, Improves or Reverses Type 2 Diabetes, Study Says
How a 'Diabetes Diet' Protects Your Health
Other
Other Treatments
Experimental
Future Diabetes Treatment May Use Resveratrol To Target The Brain
Radiotherapy
Supplements-Vitamins-CAM
Vitamin D Supplements May Counteract Diabetes
Carnitine Supplements Reverse Glucose Intolerance In Animals “After just eight weeks of supplementation with carnitine, the obese rats restored their cells' fuel- burning capacity (which was shut down by a lack of natural carnitine) and improved their glucose tolerance, a health outcome that indicates a lower risk of diabetes. These results offer hope for a new therapeutic option for people with glucose intolerance, older people, people with kidney disease, and those with type 2 diabetes (what used to be called adult-onset diabetes). Muoio said that soon her team of researchers will begin a small clinical trial of carnitine supplementation in people who fit the profile of those who might benefit from additional carnitine – older people (60 to 80 years) with glucose intolerance. … Carnitine is a natural compound known for helping fatty acids enter the mitochondria, the powerhouses of cells, where fatty acids are "burned" to give cells energy for their various tasks. Carnitine also helps move excess fuel from cells into the circulating blood, which then redistributes this energy source to needier organs or to the kidneys for removal. These processes occur through the formation of acylcarnitine molecules, energy molecules that can cross membrane barriers that encase all cells.”
A Current Update on the Use of Alpha Lipoic Acid in the Management of Type 2 Diabetes Mellitus. (Endocr Metab Immune Disord Drug Targets. 2009) “There is growing evidence that Alpha Lipoic Acid (ALA) has beneficial effects on the treatment of T2DM and some of its complications. It represents an attractive pharmacological target in the treatment of T2DM by modulating the signal transduction pathways in insulin resistance and antagonizing the oxidative and inflammatory stresses, which are major players in the pathogenesis of this disorder. A potent anti-oxidant and free radical scavenger, ALA also targets cellular signal transduction pathways which increases glucose uptake and utilization, thus providing specific targeted therapy in the treatment of insulin resistance and diabetic neuropathy.”
Surgery
Transplantation
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