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BACKGROUND AND CURRENT STATISTICS ON DIABETES
Diabetes affects nearly 21 million people in our country. Type 2 diabetes is the major form of this disease, and is often associated with obesity and a lack of sufficient activity. Unfortunately, despite public awareness, diabetes continues to soar, as do long term complications, such as risk of blindness, heart disease, kidney failure and even amputations. Loss of sensation, called neuropathy, is another complication, which can increase the risk for falling and fractures. Type 1 diabetes usually results from a virus that destroys the ability of the cells within the pancreas to produce insulin. It is considered an autoimmune disorder, as the body destroys its own pancreatic cells, called islets. Type 1 affects about two million Americans and usually occurs in children or young adults. (Statistics from American Diabetes Association’s Web site, www.diabetes.org).
More often, people become diabetic because of a decrease in the sensitivity of their body’s insulin to glucose, as with Type 2. Glucose is the body’s primary fuel source, and insulin helps convert that glucose into energy. If a person has become resistant to insulin, blood glucose is no longer controlled well by insulin supplied from the pancreas. As it exhausts itself pumping out a large amount of insulin to counter skyrocketing glucose, the pancreas may eventually become like a Type 1 case, destroying the cells that produce insulin.
In a healthy situation, a meal raises blood glucose levels over a two-hour period and insulin returns them to normal levels with a relatively small amount of effort. After longterm exposure to high glucose in the bloodstream, however, storage sites in the liver and muscle tissue become insensitive to insulin. When that happens, insulin stops doing its job to bring glucose out of the blood and into storage sites for later use. It takes more and more insulin to perform the same work once accomplished with a small amount of insulin. A person may be in an insulin resistant, pre-diabetic state for some time prior to developing diabetes. Blood glucose testing helps detect problems and should be done routinely in anyone age 40 and older. Glucose levels are considered impaired when in a range of 100-125 mg/dL when fasting about 8-12 hours. Normal fasting glucose is 65-99 mg/dL, and diabetes is diagnosed by a physician after fasting glucose reads over 126 mg/dL on more than one occasion (from the American Diabetes Association).
Approximately 54 million people are considered to be in a “pre-diabetic” state and are likely to develop diabetes within the next 10 years. Besides glucose levels, other signs may sound pre-diabetes alarms. Dark patches, around the skin of knuckles, behind the neck, or other areas of the skin where folds exist, may indicate a problem. Knowing family health history is important (Cleveland Clinic Health Extra Newsletter) to help determine likelihood of developing the condition. Genetic markers are also now detectable and may be tested in blood samples as early as childhood. Anyone over age 40 with abdominal obesity may also be suspected of future diabetes risk (girth measurement at the smallest part of the waist over 35 inches for women and over 40 inches for men – American College of Sports Medicine).
Medications may prevent diabetes, but, according to experts, lifestyle modification is the much preferred method.
Some diabetes medications, such as those for many other conditions, carry a risk for side effects. Most recently, diabetes medications, called Thiazolidinedinones (THZ’s), have increased likelihood of heart failure and heart attacks. The FDA is requiring a warning on all medication packages, but has not discontinued the medicines. Research on the medication, Actos, suggests decreased risk of heart attack, stroke and overall premature death by 18% in almost 16,000 participants studied. Unlike other THZs, such as Avandia (and others containing the ingredient Rosiglitazone), Actos works with a different ingredient. However, Actos is still associated with a risk of heart failure.
RESEARCH AND LATEST NEWS
The National Institutes of Health conducted a study on 3,500 participants with pre-diabetes over a three-year period. The participants were randomly selected for one of three groups: one that maintained current habits, one that began taking a diabetes medication called Metformin, and one that began eating better and exercising for a recommended five days per week, for at least 30 minutes per day. Of the three, the group that adopted lifestyle changes experienced the least amount of participants who actually went on to develop diabetes. Taking a pill may seem like an ideal solution for many of our health problems, but adequate exercise and a smart diet have also been recognized as effective for diabetes prevention and for good overall health, without any side effects.
Good news for those with Type 2 diabetes who need to lose weight – the prescription drug Pramlinitide (Symlin in US) has shown to contribute to weight loss, as well as glucose control. Almost two-thirds of a group of 204 people with diabetes in a San Diego study reported improvements in appetite control. The drug works by improving satiety, or satisfaction from food, by decreasing the rate of food emptying from the stomach. The findings are significant enough that more investigation is being done in using the drug as a weight-loss prescription. Symlin is used along with insulin in those diabetics who take insulin at mealtime. The USDA recently approved injectable pens (versus syringes) for administering Symlin when the patient is having a meal.
Initial findings from the “STRRIDE 2” study indicated that 251 participants who exercised (aerobic, plus strength conditioning) decreased HbA1c values by almost a whole percentage point. HbA1c is a measure of glucose, which is attached to hemoglobin cells, and shows a measure of how well glucose levels have been managed over a two- to three-month period (the lifespan of hemoglobin cells). It is expressed as a percentage, with 6.5% a goal in those with diabetes. Higher values indicate more risk of long-term complications, such as damage to eyes, nerve cells and overall circulation. This study has a branch of participants at Duke University in Durham, NC and at East Carolina University in Greenville, NC, and will continue collection of data with the same exercise regiments for another three years.
Those interested in learning more about diabetes on the Web have a new option: dLifeTV. dLifeTV is the first and only national, weekly, lifestyle series devoted to living with diabetes, and www.dLife.com is the largest, independent Web site with diabetes information.
NEWS IN GLUCOSE TESTING
Sensors – New technology allows a sensor, which sends wireless readings of glucose to a pager-like device every five minutes, to be placed under the skin of the abdomen, or along the side of the trunk. The sensors can record glucose values over a three- to seven-day period and alert for changes. The sensors are currently available through Medtronics, Inc. and Dexcom, Inc. and may initially cost $1,000 and up, plus the cost of supplies. Insurance companies are debating coverage based on how well the sensors perform for diabetes patients.
Breath analysis for children with Type 1 diabetes – Exhaled methyl nitrate levels are consistent with plasma glucose values, according to a study at the University of California at Irvine. Using the same technique used to measure air pollution, researchers found that exhaled methyl nitrate levels rose and fell when glucose levels were high or low, and also remained steady when glucose values were in a normal range. The technique holds hope, but currently requires costly, large-scale equipment that is not yet feasible for widespread physician or public use. However, with such consistent results from initial tests in children, experts hope testing will become more readily available in the near future. Additionally, the tests may pick up on metabolic conditions that occur with high blood sugar, such as ketones and high blood fat levels, as well as oxidative and inflammatory markers that point towards a risk of long-term diabetes complications.
Omega 3 fatty acids and Type 1 Diabetes – One more reason to ensure you’re getting enough Omega 3 is the recent news that it could help reduce chances of developing Type 1 diabetes in children, according to research at the University of Colorado. Since Type 1 diabetes is an autoimmune disorder where the body attacks its own islet cells, the study researched how Omega-3 fatty acids affected that process. In over 1,700 children studied, over a sixyear period, those with higher intake of Omega-3’s had over 50% less risk of developing the antibodies that show autoimmunity in the pancreas.
Inflammation and Diabetes – Recent research indicated that inflammatory markers, such as C-reactive Protein and interleukin-6, detected in blood samples could be more helpful in earlier detection of diabetes than even impaired fasting glucose. Those who find they have high levels of inflammatory markers need to take action to reduce diabetes and heart disease risk factors; C reactive Protein (CRP) is associated with insulin resistance and increased BMI, even in non-diabetics. Markers of inflammation seem to be predictive of development of diabetes, especially in women.
Additionally, high levels of inflammation could partially explain why diabetics are more likely to go on to develop coronary heart disease, since high CRP is evident in those with heart attacks and other heart problems (according to a Finnish Diabetes Prevention Study conducted in September 2006).
