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Half (49 per cent) of people with Type 2 diabetes (excluding those treated with insulin) experienced at least one hypo an episode of low blood glucose that can result in symptoms ranging from sweating to a loss of consciousness during a fortnight period, according to a new survey by Diabetes UK.

Sponsored by BristolMyers Squibb (BMS) and AstraZeneca (AZ), the survey questioned 1,954 people with Type 2 diabetes in the UK and provides insight into the prevalence and impact of mild to moderate hypos.

Time off work

Over half (52 per cent) of those surveyed believe mild to moderate hypos affect their quality of life and one in ten reported having to take at least one day off work in the last year as a result of a mild to moderate hypo.

Everyday impact

“Previous research around hypoglycaemia has tended to focus on the impact of severe hypoglycaemia,” said Simon ONeill, Diabetes UKs Director of Care, Information and Advocacy.

“This survey, however, reveals the everyday impact of mild and moderate hypos among people with Type 2 diabetes.

Hypos despite not taking insulin

“Importantly, this survey has also shown us that even people who are not taking insulin are having regular hypos. These people need to be reassessed by their GP to ensure they are taking the appropriate medication.

No structured patient education received

“Almost 90 per cent of people with diabetes in the UK have never received structured diabetes education, which is key to improved selfmanagement and a reduced risk of hypoglycaemia. Its therefore vital that we make this area a priority for improvement. We want to see hypos become the exception rather than the rule.”

Daytoday tasks affected

The survey also revealed that more than one third reported that mild to moderate hypos affect their ability to carry out daytoday tasks, including housework (35 per cent), social activities (37 per cent), sports activities (35 per cent) and sleep (35 per cent). Nearly half of those questioned said they worry about having a mild to moderate hypo (47 per cent) and that their emotional wellbeing is affected (47 per cent).

Hypos and Type 2 diabetes

Type 2 diabetes is treated with a healthy balanced diet and regular physical activity, but medication is often also required. Hypos only occur in people with Type 2 diabetes who have to take certain medications.

Treating a hypo

Treating a hypo is usually simple and requires taking some fastacting carbohydrate, such as a sugary drink or some glucose tablets, and following this up with some longeracting carbohydrate, such as a cereal bar or sandwich.

“Nagging fear”

Tim Page, 53, from Wadhurst, East Sussex, was diagnosed with Type 2 diabetes in November 2003.

He said “I experience hypos fairly regularly, most of which are mild but nonetheless have a huge effect on my life.

“Even the mildest of hypos can leave me feeling weak and disorientated, very tired in fact, exhausted.

Urban Institute Estimating the Cost of Racial and Ethnic Health Disparities In this brief, researchers analyze the cost burden associated with excess rates of diseases such as diabetes, hypertension, stroke and renal disease among Hispanics and African Americans relative to nonHispanic whites. The study predicts that in 2009, “Medicare alone will spend an extra $15.6 billion while private insurers will incur $5.1 billion in additional costs due to elevated rates of chronic illness among African Americans and Hispanics.” The researchers also estimate that “[o]ver the 10year period from 2009 through 2018 … the total cost of these disparities [will be] approximately $337 billion, including $220 billion for Medicare” (Waidmann, 9/22).

Annals of Internal Medicine Ambulatory Care Among Young Adults in the United States Using crosssectional data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, researchers examined ambulatory care utilization among adults, ages 20 to 29 years. Despite young adults being “the most likely age group to be uninsured and have the highest prevalence of substance abuse, motor vehicle accidents, and sexually transmitted diseases,” the researchers conclude, “Young adults use less ambulatory medical care relative to other groups and infrequently receive preventive care directed at the greatest threats to their health” (Fortuna, Robbins and Halterman, 9/15).

Health Affairs Containing Costs And Improving Care For Children In Medicaid And CHIP This study examines the overall distribution of spending for children in Medicaid/CHIP as measured by the Medical Expenditure Panel Survey. The study found “Ten percent of enrollees (twothirds of whom have a chronic condition) account for 72 percent of the spending” whereas “30 percent of enrolled children,” who are disproportionately African American, “receive little or no care” over a twelvemonth period. “These results highlight the importance of cost containment strategies that reduce avoidable hospitalizations among children with chronic problems and policies that increase preventive care, particularly among African American children,” the authors write (Kenney, Ruhter, and Selden, 9/17).

Kaiser Family Foundation Medicaid and Childrens Health Insurance Program Provisions Americas Affordable Health Choices Act & Americas Healthy Future Act This brief examines provisions related to Medicaid and the Childrens Health Insurance Program (CHIP) in the House TriCommittee bill and Senate Finance Committee bill compared to current law (9/22).

Robert Wood Johnson Foundation Cost Savings and CostEffectiveness of Clinical Preventive Care This report evaluates the economic evidence for investing in preventative care as indicated in costeffectiveness literature. The authors conclude “Based on the literature synthesized in this report, there are relatively few clinical preventive interventions for which there is strong evidence of cost savings. Moreover, many preventive interventions that do save money are already in widespread use (e.g., childhood immunizations), thus limiting the potential for additional savings. For these reasons, it is unlikely that substantial cost savings can be achieved by increasing the level of investment in clinical preventive measures. On the other hand, this review has shown that many preventive measures deliver substantial health benefits given their costs” (Cohen and Neumann, Sept. 2009)

Childrens National Medical Center In a policy statement scheduled to appear in the October issue of the journal Pediatrics, a team of pediatric emergency medicine specialists and other health experts point to a IOM report that found only 6 percent of U.S. hospital emergency departments are fully equipped to properly care for children even though children account for more than 20 percent of all emergency room visits. The authors make “recommendations for appropriate equipment, training, medications, and policies for pediatric emergency care,” according to a Childrens National Medical Center description of the policy statement (9/21).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Diabetes UK Care Events team is expanding its programme with a new event for young adults with Type 1 diabetes.

The first Young Adult Support Weekend (13 to 15 November 2009) offers a chance for young people aged 18 to 25 to meet others, join in discussion groups, talk to healthcare professionals and find out more about issues such as going away to university, discrimination at work, travelling, alcohol, driving, sex and relationships.

A chance to meet and share experiences

“The new weekends will be a great opportunity for young people to meet others and share their experiences,” said Susie Reilly, Head of Care Events at Diabetes UK.

Peer support

“Just as with our existing support holidays and weekends, peer support has proven to be invaluable to attendees.

Informal education sessions

“The informal education sessions by specialist healthcare professionals will also provide a safe environment for people to learn more about diabetes, diabetes management and the care they are entitled to.”

Where and when?

The first weekend will be from 13 to 15 November 2009 at the Sachas Hotel, Manchester, and costs £130 per person.

Accommodation, meals, snacks, seminars, professional healthcare support and the comedy club trip and casino themed night are all included in the price. A bursary is available.

Find out more

Diabetes has so many costs to your health, your emotions, and of course, your wallet. The October issue of Diabetes Forecast, the consumer magazine of the American Diabetes Association, features ten ways to save some money and improve your health. With a little knowhow, you can save some big bucks on screenings, supplies, and preventive treatments. Here are a few of the costcutting ideas Diabetes Forecast recommends

Head to a Health Fair or EXPO Hospitals, universities, churches, towns, and community groups often set up health fairs to provide a wide range of screenings and health information. Health expos offer even more by bringing together medical experts and exhibitors for screenings, seminars, workshops, and demonstrations.

Get Screened Staying on top of your health and preventing diseases or their complications before they become major problems makes a significant impact on your budget. Besides regular examinations by your health care team, you often can get screened for different conditions at clinics, pharmacies, and local health departments, among other places.

Attend a Cooking Demonstration Want to make sure youre getting the most out of your meals? Need a little extra inspiration to get back on track? Stop by a cooking demonstration at a farmers market or grocery store.

Flex That “Flexible” Spending If you have a flexible spending account through your benefit program at work, you can use the money you set aside (before tax is withheld) on a variety of nonreimbursable medical costs, from copays to overthecounter medications and supplies.

Try these moneysaving tricks to help manage diabetes and other things that cause your health care costs to creep up. Best of all, many of these proactive moves may keep you healthier, too!

The October issue also brings you information about “Cracking the Case” A federal jury finds diabetes discrimination at the FBI. Veteran lawman Jeff Kapache had heard from FBI field agents that he would be a great addition to the bureau, sowhen he applied and was denied a job, he knew something was up. It wasnt the grueling physical exams, tough aptitude tests, or extensive interviews that kept him from landing the job it was his diabetes. Learn how Kapche fought this discrimination and, after seven years of legal battles, finally won his lawsuit against the FBI.

More in the newest issue of Diabetes Forecast

Diabetes at 100 mph Catching up with race car driver Charlie Kimball about his type 1 diabetes
Antioxidants Sifting through the hype about the value of antioxidants, in foods and in supplements
Topping It Off Need a little help in adding flavor to your dishes? The secret is in the sauce!

Diabetes Forecast has been Americas leading diabetes magazine for more than 60 years, offering the latest news on diabetes research and treatment to provide information, inspiration, and support to people with diabetes.

Source

Diabetes mellitusassociated coronary artery disease (CAD) is assuming epidemic proportions, especially in western countries. Both coronary revascularization and medical management have improved tremendously over the last decade and the respective role in the diabetic population is not well defined. This aspect was investigated in the BARI 2D study*.

The results of the BARI 2D trial demonstrate that diabetic patients with stable CAD need more than just stents or grafts, namely a global care including, in addition to coronary revascularization, aggressive cardiovascular risk factor management and life style changes. In the presence of an excellent compliance, a strategy based on initial medical management followed by coronary revascularization if clinically indicated is a good option for diabetic patients with stable CAD.

A total of 2368 diabetic patients with stable CAD and qualifying for coronary revascularization were randomized to optimal medical therapy or revascularisation either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in addition to optimal medical therapy. Primary end points of the study were the 5.year rate of death and major cardiovascular invents (MACE) defined as a composite of death, myocardial infarction or stroke. Survival and MACEfree survival at followup did not differ between the revascularisation group and the medical therapy group. At 5 years, 42% of the patients randomised to medical management did require coronary revascularisation. Both groups were characterized by an excellent compliance with respect to medical therapy.

*Published on June 11th 2009 in the New England Journal of Medicine.

By Dr. Marco Roffi

Source
Jacquelline Partarrieu

Diabetes mellitusassociated coronary artery disease (CAD) is assuming epidemic proportions, especially in western countries. Both coronary revascularization and medical management have improved tremendously over the last decade and the respective role in the diabetic population is not well defined. This aspect was investigated in the BARI 2D study*.

The results of the BARI 2D trial demonstrate that diabetic patients with stable CAD need more than just stents or grafts, namely a global care including, in addition to coronary revascularization, aggressive cardiovascular risk factor management and life style changes. In the presence of an excellent compliance, a strategy based on initial medical management followed by coronary revascularization if clinically indicated is a good option for diabetic patients with stable CAD.

A total of 2368 diabetic patients with stable CAD and qualifying for coronary revascularization were randomized to optimal medical therapy or revascularisation either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in addition to optimal medical therapy. Primary end points of the study were the 5.year rate of death and major cardiovascular invents (MACE) defined as a composite of death, myocardial infarction or stroke. Survival and MACEfree survival at followup did not differ between the revascularisation group and the medical therapy group. At 5 years, 42% of the patients randomised to medical management did require coronary revascularisation. Both groups were characterized by an excellent compliance with respect to medical therapy.

*Published on June 11th 2009 in the New England Journal of Medicine.

By Dr. Marco Roffi

Source
Jacquelline Partarrieu

Researchers at Huntsman Cancer Institute (HCI) at the University of Utah have uncovered new information on the notion that sugar “feeds” tumors. The findings may also have implications for other diseases such as diabetes. The research is published in the journal Proceedings of the National Academy of Sciences (PNAS).

“Its been known since 1923 that tumor cells use a lot more glucose than normal cells. Our research helps show how this process takes place, and how it might be stopped to control tumor growth,” says Don Ayer, Ph.D., a Huntsman Cancer Institute investigator and professor in the Department of Oncological Sciences at the University of Utah.

During both normal and cancerous cell growth, a cellular process takes place that involves both glucose (sugar) and glutamine (an amino acid). Glucose and glutamine are both essential for cell growth, and it was long assumed they operated independently, but Ayers research shows they are interdependent. He discovered that by restricting glutamine availability, glucose utilization is also stopped. “Essentially, if you dont have glutamine, the cell is short circuited due to a lack of glucose, which halts the growth of the tumor cell” Ayer says.

The research, spearheaded by Mohan Kaadige, Ph.D., a postdoctoral fellow in Ayers lab, focused on MondoA, a protein that is responsible for turning genes on and off. In the presence of glutamine, MondoA blocks the expression of a gene called TXNIP. TXNIP is thought to be a tumor suppressor, but when its blocked by MondoA , it allows cells to take up glucose, which in turn drives tumor growth. Ayers research could lead to new drugs that would target glutamine utilization, or target MondoA or TXNIP.

Ayer says the next step in his research is to develop animal models to test his ideas about how MondoA and TXNIP control cell growth. “If we can understand that, we can break the cycle of glucose utilization which could be beneficial in the treatment of cancer,” Ayer says.

NXT Nutritionals Holdings, Inc. (”NXT Nutritionals”) (OTCBB NXTH), a developer and marketer of proprietary, patentpending healthy natural sweeteners, food and beverage products, comments on a new research study from Harvard published in the Public Library of Science Medicine Journal Vol. 6, April, 2009. The study finds that high blood glucose levels is one of the most common killers of Americans, coming in as the fifth most deadly killer, after tobacco, high blood pressure, overweight/obesity and physical inactivity.

High blood glucose levels are a higher and a greater risk factor for disease and death than are high cholesterol, high levels of dietary salt, low omega3 levels, high levels of trans fatty acids, alcohol use, low levels of fruit and vegetables and low levels of polyunsaturated fatty acids. According to the study, there were between 163,000 and 217,000 high blood glucoserelated mortalities in 2005 that could have been avoided. (Source Public Library of Science Medicine Journal Vol. 6, April, 2009)

NXT Nutritionals SUSTA™ Natural Sweetener is a revolutionary minimal calorie, very low glycemic index natural sweetening system with health benefits, designed not only to avoid a spike in ones blood sugar, but to contribute a potential benefit in helping to modify the glycemic response of an accompanying snack or meal. SUSTA™ is a proprietary blend of insulin fiber, fructose, natural flavors, botanical extracts, vitamins, minerals, and probiotics and is totally free of synthetic or processed chemicals.

Dr. Richard L. Kozlenko, Director of Research and Development for NXT Nutritionals, comments, “SUSTA™ not only avoids provoking the glycemic response of raising blood sugar, but in addition, contributes a meaningful measure of key positive health and nutritional value per serving that goes well beyond the current zero glycemic and zero calorie sweetening concepts.”

Dr. Paul S. Auerbach, Director of NXT Nutritionals, also comments, “Physicians who care for patients with diabetes understand well the toll taken on people by high blood sugar. We are learning more and more that one doesnt need to be diabetic to suffer ill effects from high blood sugar. Anything that we can do to lessen that risk is very important. SUSTA™ has replaced sugar in my diet. The added nutritional benefits make it even better.”

University of Texas Medical Branch at Galveston researchers have found that a single enzyme is apparently critical to most allergenprovoked asthma attacks and that activity of the enzyme, known as aldose reductase, can be significantly reduced by compounds that have already undergone clinical trials as treatments for complications of diabetes.

The discovery, made in experiments conducted with mice and in human cell cultures, opens the way to human tests of a powerful new treatment for asthma, which today afflicts more than 20 million Americans. Such a development would provide a badly needed alternative to current asthma therapy, which primarily depends on hardtocalibrate inhaled doses of corticosteroids and bronchodilators, which have a number of side effects.

“Oral administration of aldose reductase inhibitors works effectively in experimental animals,” said UTMB professor Satish Srivastava, senior author of a paper on the discovery appearing in the Aug. 6 issue of the journal PLoS One. “If these drugs work as well in humans as they do in animals you could administer them either orally or in a single puff from an inhaler and get longlasting results.”

Srivastava and his colleagues (postdoctoral fellows Umesh Yadav and Leopoldo AguileraAguirre, associate professor Kota Venkata Ramana, professor Istvan Boldogh and LSU Health Sciences Center assistant professor Hamid Boulares) focused on aldose reductase inhibition as a possible asthma therapy after establishing an essential role for the enzyme in other diseases also characterized by inflammation. In disorders such as colon cancer, atherosclerosis, sepsis and uveitis, the Srivastava team has found, cells are hit by a sudden overload of reactive oxygen species (varieties of oxygen and oxygen compounds that are especially eager to react with other molecules). The result is a chain of biochemical reactions that leads the cells genetic machinery to crank out a barrage of inflammatory signaling proteins. These summon immune system cells and generate even more reactive oxygen species, producing a vicious cycle of everincreasing inflammation.

Aldose reductase plays an essential part in the activation of the cellular machinery that produces inflammatory proteins in these diseases, the Srivastava group discovered. “We found that if you block aldose reductase, you block the inflammation,” Srivastava said. “Now, asthma, a chronic disease of inflammation is augmented by reactive oxygen species. So we thought, why not find out if aldose reductase inhibition also has an effect on asthma?”

In an initial series of in vitro experiments, the researchers applied ragweed pollen extract (ragweed pollen is notorious for provoking the allergic reactions that lead to allergies and asthmatic airway inflammation) to cultures of human airway epithelial cells the cells that line the network of air passages within the lungs. Some of the cultures had been pretreated with an aldose reductase inhibitor, while others had not.

The untreated cells responded in much the same way airway cells do in an asthma attack, with an increased rate of apoptosis (cell suicide), a jump in the levels of reactive oxygen species, the activation of key “transcription factors” that kickstart the production of inflammatory proteins and the largescale generation of a whole host of molecules associated with inflammation. Cells treated with aldose reductase inhibitors, by contrast, had a much lower rate of apoptosis, reduced levels of reactive oxygen species, far smaller increases in critical transcription factors and substantially lower increases in inflammatory signaling molecules.

In collaboration with Boldogh, Srivastava next investigated whether aldose reductase inhibitors could reduce the asthmalike symptoms of mice exposed to ragweed extract, a wellestablished clinical model mimicking the allergic airway inflammation that commonly leads to asthma in humans. When untreated mice inhaled ragweed extract, their lungs suffered an influx of eosinophils (inflammationinducing white blood cells), a jump in inflammatory signaling molecules, a buildup of mucin (a protein component of mucus) and an increase in airway hyperreactivity (the tendency of air passages to suddenly constrict under stress). Mice fed a dose of aldose reductase inhibitor before inhaling ragweed extract, however, showed dramatically reduced levels of these components of the asthmatic response.

“Our hypothesis performed exactly as expected, with the experiments showing that aldose reductase is an essential enzyme in the transduction pathways that cause the transcription of the cytokines and chemokines known to act in asthma pathogenesis,” Srivastava said. “They attract eosinophils and cause inflammation and mucin production in the airway.”

The next step, Srivastava said, will be clinical trials to determine whether aldose reductase inhibitors can relieve asthma in humans. The researcher expressed optimism about their potential outcome of the trials, as well as gratitude to the UTMB National Institute of Environmental Health Sciences Center and the sole supporter of his asthma work, the American Asthma Foundation, which last year awarded him a threeyear $750,000 research grant.

“Really, a lot of the credit for this belongs to the AAF,” Srivastava said. “Our primary interest is in cancer and the secondary complications of diabetes, but we were attracted to asthma pathogenesis because the AAF invited me to apply for a grant. I think theyre going to be happy with the results.”

Source
Jim Kelly

Diabetes affects nearly 24 million people in the United States. The most widespread form is type 2 diabetes, accounting for about 90 to 95 percent of all diagnosed cases of diabetes, according to the American Diabetes Association (ADA).

The research team at New York Hospital Queens is offering the community a chance to participate in a new type 2 diabetes study. The study, called TINSALT2D (Targeting Inflammation using Salsalate in Type 2 Diabetes), looks at the safety and effectiveness of an investigational medication (similar to aspirin) in the treatment of type 2 diabetes. The study medication has been approved by the U.S. Food and Drug Administration to treat arthritis, but it has not yet been approved for diabetes.

To be eligible for this study, participants must have type 2 diabetes, be between 18 and 75 years old, and be on a stable dose of oral antidiabetic medication and the diabetes is still not well controlled.

The study includes 12 visits to the Lang Research Center over approximately one year. Qualified participants will receive a physical exam and laboratory tests at no cost. Participants will be compensated for their time and effort.

Nationally lauded endocrinologist, Daniel Lorber, M.D., associate director, Eugene and Theresa Lang Research Center for Research and Education at New York Hospital Queens, is the principal investigator of the clinical trial. Last month, Dr. Lorber received the ADAs “Outstanding Physician Clinician Award” for his contributions to the ongoing fight against diabetes.

A clinical trial is a scientific study that evaluates the safety and effectiveness of medical treatments, drugs or devices. These studies are required by the U.S. Food and Drug

Administration for manufacturers to earn approval for new products and new uses for existing products.