Diabetics can avoid problems with attention to heart risks

Even if they haven't been diagnosed with heart disease, diabetics with classical heart-risk factors like smoking and elevated “bad” cholesterol are at heightened risk of serious heart-related “events” and death, according to a new study.

Among people with diabetes but not heart disease, researchers linked more than a third of cardiovascular “events”—such as heart attack and stroke—and 7 percent of deaths to inadequate control of heart risk factors.

That means those cardiac events and deaths might have been avoided with better control of the known risk factors, the study team writes in Diabetes Care.

“The take home message from this study is that adults with diabetes can reduce their risk of cardiovascular events, and patients should work together with their provider to set a care plan including goals and strategies to reduce modifiable risk factors,” said lead author Gabriela Vazquez-Benitez, a research investigator at HealthPartners Institute for Education and Research in Minneapolis, Minnesota.

“This can include regular care visits, screening, laboratory, weight, and blood pressure,” she told Reuter’s Health in an email.

The risk factors for cardiovascular problems in diabetes are well known and include high blood pressure, smoking and poor control of blood sugar. If more attention were paid to these risk factors, the rate of cardiovascular problems and death could be substantially reduced, the study team argues.

There are nearly 25 million Americans with diabetes and if current trends continue, more than one in three adults are projected to develop the disease.

Stroke and coronary heart disease are the major causes of complications, deaths and healthcare costs in adults with diabetes, they write.

The authors point out that medical advances have improved the health of people with diabetes, especially when it comes to cardiovascular problems. But for people with diabetes as a group, the burden of cardiovascular problems remains very high.

In their study, Vazquez-Benitez and her team analyzed data on nearly 860,000 adults with diabetes.

They looked at rates of major cardiovascular complications such as heart attacks and heart failure, as well as deaths from all causes, plus four risk factors: blood pressure, levels of LDL cholesterol, smoking and blood sugar levels over the months.

The authors emphasize that overall rates of major cardiovascular complications and deaths were “substantially higher” in people with diabetes who already had heart disease, compared to those without it.

But delaying diabetes complications is possible, Vazquez-Benitez said, not only for cardiovascular events but for problems like nerve damage and kidney disease.

“Although there is a genetic component of diabetes, there are modifiable risk factors that can reduce risk of heart attack, stroke and death,” said Deborah Greenwood, a registered nurse and president of the American Association of Diabetes Educators. Lowering blood sugar, LDL cholesterol and blood pressure, as well as quitting smoking can greatly reduce risk, she said.

All adults over 45 should be screened for diabetes so it can be diagnosed and treated early, said Greenwood, who was not involved in the study. For most people with so-called pre-diabetes, she pointed out, losing 5 to 7 percent of body weight and doing 150 minutes of physical activity per week could avert progression to full-blown diabetes.

She also emphasized the importance of participating in diabetes self-management education and partnering with a credentialed diabetes educator to change behaviors and improve modifiable risk factors. “A diabetes educator will work with you to develop a plan specifically tailored to your individual needs, preferences and lifestyle to ensure success,” Greenwood said. — Reuters

Large breakfast, small dinner tied to better diabetes blood sugar

Big breakfasts and small dinners might be a healthier way to eat for people with type 2 diabetes, according to a small new study.

Diabetics in the study who ate big breakfasts and small dinners had fewer episodes of high blood sugar than those who ate small breakfasts and large dinners, researchers found.

Blood sugar—also known as blood glucose—is controlled by the body’s internal clock, with larger blood sugar peaks after evening meals, Dr. Daniela Jakubowicz told Reuters Health in an email.

People with type 2 diabetes often time their meals in opposition to their internal clock, said Jakubowicz, a researcher at Tel Aviv University’s Wolfson Medical Center in Israel.

“They frequently skip breakfast while eating a high-calorie dinner,” she said, adding that skipping breakfast is linked to obesity and poor blood sugar control.

The new study involved eight men and ten women with type 2 diabetes, ages 30 to 70, who were being treated with either the diabetes drug metformin and dietary advice or diet advice alone.

Type 2 is the most common form of diabetes and is often linked to obesity. In type 2 diabetes, the body's cells are resistant to the hormone insulin, or the body doesn't make enough of it. Insulin gives blood sugar access to the body's cells to be used as fuel.

The participants were randomly assigned to follow a meal plan that consisted of either a 700-calorie breakfast and 200-calorie dinner or a 200-calorie breakfast and a 700-calorie dinner. Both diets included a 600-calorie lunch.

After following the assigned meal plans for six days at home, the participants spent a day at the clinic, where blood tests were taken. They repeated the experiment two weeks later with the other diet plan.

The study team found that post-meal glucose levels were 20 percent lower, and levels of insulin were 20 percent higher, when the participants consumed the large breakfasts and small dinners, according to the results in Diabetologia.

“Our study demonstrated that a large breakfast and reduced dinner is a beneficial alternative for the management of glucose balance during the day and should be considered as a therapeutic strategy in type 2 diabetes,” Jakubowicz said.

Jakubowicz said longer studies are needed to see if the benefits would continue over time.

The new results support the advice to eat like a king at breakfast, a prince at lunch and a pauper at dinner, said Anna Taylor in an email to Reuters Health.

“Select your calories with care, however; what you eat, how you eat, and when you eat all play an important role in your nutrition as well as your health,” said Taylor, a registered dietitian at the Cleveland Clinic in Ohio. She wasn’t involved in the study.

She added that it’s important for people to keep in mind that the study’s participants took few medications and had no major complications.

The results might therefore not apply to other groups with diabetes, Taylor said.

She said that people with diabetes who take insulin should speak to their endocrinologists before experimenting with drastic dietary adjustments. — Reuters

Many with diabetes unaware of vision loss – US researchers

NEW YORK - Less than half of people with diabetes-related eye disease in the US have been told about it, which means they're also missing out on treatment that could save their sight, researchers say.

In US surveys of adults with diabetic macular edema—a condition that can ultimately lead to blindness—just 45 percent of respondents said they had been informed by their doctor that diabetes had affected their eyes. Nearly 30 percent already had vision loss in the affected eye.

It's important to catch the signs of diabetic macular edema (DME) early because it can be treated, Dr. Neil M. Bressler said. He led the study at the Wilmer Eye Institute of Johns Hopkins University School of Medicine and Hospital in Baltimore.

Diabetes commonly causes DME, which is a thickening of the eye's retina. That change can be detected in an eye exam that includes dilation of the pupils. Left untreated, DME is likely to cause progressive vision loss.

Degeneration of the retina in people with diabetes, known as diabetic retinopathy—which is often caused by DME—is the leading cause of blindness in the US, Bressler and his colleagues write in the journal JAMA Opthalmology.

Many U.S. medical authorities recommend annual eye checks for diabetics to monitor early signs of vision problems, but many people with diabetes do not get the proper type or frequency of eye care.

The survey data Bressler's team used included patient questionnaires and physical examinations, so people with vision loss could be identified even if they themselves were unaware of the changes in their sight.

The researchers considered a subset of 800 people from the survey who reported having diabetes, which affects 25.8 million people in the U.S., according to the Centers for Disease Control and Prevention.

Of the 800 self-reported diabetics, the physical exam confirmed that 238 had diabetic retinopathy without DME and 48 had DME.

Some 60 percent of those with DME said they had undergone an eye exam with pupil dilation within the past year. But only 45 percent said their doctor told them about the changes in their eyes.

Physician and patient behavior seem not to have changed in recent years, despite wonderful new achievements in potential treatments for diabetic eye problems, Dr. Lee Jampol told Reuters Health.

A professor of ophthalmology who studies diabetes and vision at Northwestern University in Chicago, Jampol was not involved with the new estimate.

"This study is very important as it shows that many diabetics are not aware of potential or actual real risk to their eyesight from diabetic retinopathy," Jampol said.

Physicians and patients need to be more aware of the vision risks involved in diabetes and insist on yearly visits to the ophthalmologist, he said.

Treatment for DMA "typically involves injections of biologics into the middle cavity of the eye that in most cases cause resolution of the swelling with prevention of vision loss in about 90 to 95 percent of cases, and improvement in vision in about 50 percent of cases when the edema involves the center of the retina and is causing vision impairment," Bressler said.

Patients tend to need about nine injections in the first year with a couple of additional shots over the next two years, and may require laser surgery as well, which can cause the price to vary quite a bit, he said.

"Everyone with diabetes should be referred to an appropriate health care provider who can evaluate the retina for DME or diabetic retinopathy, even in the absence of symptoms, periodically, so that complications which can be treated to prevent vision impairment and blindness can be done," Bressler said. — Reuters

source: gmanetwork.com

'Smart' nanoparticles may replace injections for diabetes treatment

In the near future, diabetics may no longer have to suffer multiple injections of insulin daily. Injections may be reduced to just once per week, and instead if insulin being fired into the bloodstream, nanoparticles may take its place, according to Time.

Scientists at North Carolina State University, the University of North Carolina at Chapel Hill, the Massachusetts Institute of Technology and Children Hospital Boston are behind the research that may change the lives of an estimated 366 million people worldwide suffering from diabetes.

“We’ve created a ‘smart’ system that is injected into the body and responds to changes in blood sugar by releasing insulin, effectively controlling blood-sugar levels,” said biomedical engineering assistant professor Dr. Zhen Gu of North Caroline State University. “We’ve tested the technology in mice, and one injection was able to maintain blood sugar levels in the normal range for up to 10 days.”

Diabetes is a metabolic condition in which the sufferer has increased levels of glucose, or “blood sugar”. Glucose is important because it release energy the body requires to function properly. Insulin is the hormone responsible for bringing this energy to the body’s cellular network. Problems arise when not enough insulin is produced, leading to an unhealthy buildup of blood sugar. Symptoms can include frequent urination as well as increased thirst and hunger.

If left untreated, diabetes can lead to death. Diabetics therefore have to closely observe their blood sugar levels daily, as well as inject themselves with insulin several times a day. This has proven as much of a hassle as it is painful to sufferers of the disease.

The proposed new treatment involves introducing nanopartciles, each containing insulin and special enzymes modified to detect glucose, into the bloodstream. The enzymes will circulate throughout the body, immediately converting the glucose they come into contact with into insulin. The enzymes are “fully biocompatible and dissolve in the body,” according to the researchers.

“This technology effectively creates a ‘closed-loop’ system that mimics the activity of the pancreas in a healthy person, releasing insulin in response to glucose level changes,” said Gu. “This has the potential to improve the health and quality of life of diabetes patients.”

The research was recently published in the science journal ACS Nano. The scientists are keen to commence human testing. — TJD, GMA News

source: gmanetwork.com