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[IP] Re: +AFs-IP+AF0- RE: Complications



Wow Scott+ACE-  Thank you for sharing the article from JDF+ACE-
It was very good+ACEAIQAhACE-
----- Original Message -----
From: +ACI-Scott Strumello+ACI- +ADw-sstrumello+AEA-usa.net+AD4-
To: +ADw-insulin-pumpers-digest+AEA-bzs.org+AD4-
Sent: Thursday, April 04, 2002 10:48 AM
Subject: +AFs-IP+AF0- RE: Complications


+AD4- I read Jacob Chojnacki's post on complications and thought it posed an
+AD4- interesting question.  Its useful to look at what research has revealed on
the
+AD4- subject.  Although some of us question whether spending +ACQ-165 million on a
+AD4- study to +ACI-prove+ACI- that better control reduces complications couldn't have
been
+AD4- better spent on cure or treatment-related research (after all, if we could
+AD4- always maintain good control, it would be similar to not being a diabetic,
so,
+AD4- isn't it common sense that it would reduce complications?), the
much-heralded
+AD4- DCCT proved that good glycemic control dramatically reduced or delayed the
+AD4- incidence of diabetes-related complications.  The results were as follows:
+AD4-
+AD4- 76+ACU- reduced risk of eye disease
+AD4- 50+ACU- reduced risk of kidney disease
+AD4- 60+ACU- reduced risk of nerve disease
+AD4-
+AD4- (If readers have never actually seen the DCCT results, the National
Institute
+AD4- of Diabetes and Digestive and Kidney Diseases (NIDDK), which is part of
the
+AD4- National Institutes of Health, provides a link to the results at the
following
+AD4- address
+AD4-
+AD4- http://www.niddk.nih.gov/health/diabetes/pubs/dcct+AF8-st/sld001.htm
+AD4-
+AD4- The fact remains that while good glycemic control dramatically reduces the
+AD4- risk of complications, having DM still results in a statistically higher
risk
+AD4- of encountering kidney disease, retinopathy, neuropathy, and
cardiovascular
+AD4- disease than the general population, even with good control.  Which is
what
+AD4- makes Jacob's question so interesting.  However, its also true that good
+AD4- glycemic control is the best tool we available to minimize the impact of
DM
+AD4- and related complications, and I believe pumps are an excellent (if less
than
+AD4- perfect) tool to do that.
+AD4-
+AD4- Countdown magazine (published by the Juvenile Diabetes Foundation) had a
very
+AD4- intersing article on research progress last summer, which addressed a lot
of
+AD4- Jason's question.  In the interest of keeping this post less than a mile
long,
+AD4- I've included a relevant excerpt, but the entire article can be viewed at
the
+AD4- following link
+AD4-
+AD4- http://www.jdf.org/publications/jdfcure/respipe.php
+AD4-
+AD4- Happy reading+ACE-
+AD4- Scott Strumello
+AD4-
+AD4- Age 33, Type 1 for the past 26 years (and old enough to remember 4+-),
+AD4- hopefully soon to be pumping
+AD4-
+AD4- ----------------------------------------------------------------
+AD4-
+AD4- The Diabetes Research Pipeline, by Robert S. Dinsmoor.
+AD4- (from Summer 2001 Countdown)
+AD4- What Causes Diabetes-related Complications and How Can We Prevent Them?
+AD4-
+AD4- At least as early as the 1930s, shortly after the discovery of insulin,
+AD4- diabetes researchers debated whether hyperglycemia (high blood sugar
levels)
+AD4- was the driving force behind the development of diabetes-related
+AD4- complications, according to David M. Nathan, M.D., director of the
Diabetes
+AD4- Center at Massachusetts General Hospital in Boston. That debate continued
for
+AD4- nearly five decades.
+AD4-
+AD4- +ACI-If you look back at the literature from the 1960s and 1970s, there was an
+AD4- enormous debate going on, with a whole series of editorials, letters, and
+AD4- special articles in the New England Journal of Medicine. Two distinct
sides
+AD4- were arguing whether glucose control was the issue,+ACI- he recalls. +ACI-It was a
lot
+AD4- of hot air, because we didn+IBk-t have the means to adequately measure or
+AD4- control blood glucose levels at the time, nor did we have methods for
+AD4- objectively measuring the development of, for example, eye disease or
nerve
+AD4- disease. As much as people yelled back and forth, the truth is they just
+AD4- didn+IBk-t know.+ACI-
+AD4-
+AD4- In the ensuing decades, a lot changed. In the early 1980s, the hemoglobin
Alc
+AD4- (HbA1c) test came into widespread use and was shown to be a reliable and
+AD4- useful indication of long-term blood glucose control. Meanwhile, more and
more
+AD4- patients with diabetes began to monitor their own blood glucose levels.
+AD4- Increasing numbers of patients began using insulin pumps and newly
designed
+AD4- multiple-injection regimens to achieve tight control over blood glucose
+AD4- levels. Researchers developed ways to objectively measure and quantify
varying
+AD4- degrees of diabetes-related complications. At the same time, there was a
shift
+AD4- toward evidence-based medicine+IBQ-that is, making treatment decisions based
on
+AD4- the results of scientific studies rather than tradition or educated
guessing.
+AD4-
+AD4- According to Dr. Nathan, all these developments set the stage for the
landmark
+AD4- Diabetes Control and Complications Trial (DCCT). This very rigorously
designed
+AD4- study, the results of which were published in 1993, proved beyond a shadow
of
+AD4- a doubt that tight blood glucose control could dramatically delay the
+AD4- development of diabetic eye disease (retinopathy), diabetic kidney disease
+AD4- (nephropathy), and diabetic nerve disease (neuropathy) in most people with
+AD4- Type 1 diabetes.
+AD4-
+AD4- +ACI-The major remaining question is, Can we make intensive insulin therapy
more
+AD4- user-friendly, more accessible, easier, and less burdensome to the
patient?+ACI-
+AD4- Dr. Nathan says.
+AD4-
+AD4- Simplifying intensive insulin therapy is proving to be no easy task. Even
with
+AD4- new tools and technologies, researchers and manufacturers have made only
+AD4- modest strides in making blood glucose control easier and more precise.
Two
+AD4- fast-acting insulin analogs+IBQ-insulin lispro (Humalog) and insulin aspart
+AD4- (Novolog)+IBQ-as well as a long-acting insulin analog+IBQ-insulin glargine
+AD4- (Lantus)+IBQ-may well prove effective in fine-tuning blood glucose control.
+AD4- Additionally, at least two manufacturers are working on inhaled insulin
+AD4- products to make insulin delivery more comfortable for the patient.
+AD4-
+AD4- Technologies using minimally invasive, continuous glucose monitoring of
+AD4- interstitial fluid (the glucose-containing fluid under the skin) may
+AD4- eventually provide better information for improving blood glucose control.
+AD4- Ultimately, this type of technology may allow for +ACI-closed-loop+ACI- insulin
+AD4- delivery, whereby an insulin pump can continually change its insulin
output
+AD4- based on moment-to-moment changes in blood glucose levels.
+AD4-
+AD4- +ACI-Some of these continuous monitors are in use now and I think they're
going to
+AD4- revolutionize therapy,+ACI- says Dr. Eisenbarth.
+AD4-
+AD4- In the early 1980s, researchers began testing certain drugs called
+AD4- aldose-reductase inhibitors in patients with diabetic neuropathy.
+AD4- Aldose-reductase is an enzyme that acts on glucose to produce sorbitol+ADs-
+AD4- another enzyme called L-iditol dehydrogenase acts on sorbitol to produce
the
+AD4- sugar fructose. When blood glucose levels are high, excessive amounts of
+AD4- sorbitol and fructose are produced+ADs- this excess is believed to contribute
to
+AD4- diabetic complications, especially neuropathy. Aldose-reductase
inhibitors,
+AD4- designed to block this biochemical pathway, have shown promise in
laboratory
+AD4- animals but not in human clinical trials. In the early 1980s, researchers
+AD4- discovered other potential contributing pathways, involving another
enzyme,
+AD4- protein kinase C-beta (or PKC-beta), and toxic substances called advanced
+AD4- glycation endproducts (or AGEs), which are now believed to play a key role
in
+AD4- various diabetic complications.
+AD4-
+AD4- In the late 1990s, scientists began to study superoxide (a reactive form
of
+AD4- oxygen) produced by the mitochondria. Researchers hypothesized that an
+AD4- overproduction of superoxide was somehow connected to diabetes-related
+AD4- complications. The mitochondria is essentially the cell+IBk-s +ACI-powerhouse,+ACI-
+AD4- converting glucose and fat into the energy-yielding molecules needed for
cells
+AD4- to operate. In response to excess glucose that occurs in diabetes,
however,
+AD4- the mitochondria malfunctions and overproduces superoxide, which in turn
gives
+AD4- rise to other reactive species that damage cells. The process sets off a
+AD4- destructive sequence of events inside otherwise healthy cells.
+AD4-
+AD4- In a study recently reported in Nature, Michael Brownlee, M.D., Anita and
Jack
+AD4- Saltz Professor of Diabetes Research at the Albert Einstein College of
+AD4- Medicine in New York, and an international cadre of colleagues were able
to
+AD4- show that the overproduction of superoxide appears to be the +ACI-master
switch+ACI-
+AD4- that initiates all hyperglycemia-induced biochemical pathways previously
+AD4- thought to act independently of each other.
+AD4-
+AD4- +ACI-A naturally occurring enzyme called superoxide dismutase normally rids
the
+AD4- body of superoxide. Using a new technology called combinatorial chemistry,
+AD4- several small companies are testing small-molecule agents called
superoxide
+AD4- dismutase mimetics, which a person could swallow. The agents would act
+AD4- identically to the enzyme inside hyperglycemic cells,+ACI- Dr. Brownlee
explains.
+AD4- +ACI-I think this is going to be a very central part of the treatment of
+AD4- complications in the next 5 or 10 years.+ACI-
+AD4-
+AD4- ---------------------------------------------------------------
+AD4-
+AD4- Date: Wed, 03 Apr 2002 22:23:08 -0600
+AD4- From: Jacob Chojnacki +ADw-Jacob+AEA-westerncom.net+AD4-
+AD4- Subject: +AFs-IP+AF0- Complications
+AD4-
+AD4- Ok, Hi everyone.  I got a question.  I have had diabetes for 14 years and
+AD4- I'm 24 years old.  I have read so many different studies and stories about
+AD4- complications from diabetes.  I want to know IF WE CONTROL OUR BLOOD
SUGARS
+AD4- WILL WE STILL GET COMPLICATIONS?  WILL THEY ONLY BE DELAYED?  IF YES, THEN
+AD4- THIS BRINGS A GREAT DEAL OF DEPRESSION UPON US.
+AD4-
+AD4- ANYONE CARE TO SHED SOME LIGHT OR COMMENTS.
+AD4-
+AD4- i have been pumping for the last year and my A1C's are at 6.3, which i
think
+AD4- is great.  I am starting an exercise program and nutrition.   I just want
some
+AD4- kind of hope that i'm not going to be stuck with failed kidneys no matter
how
+AD4- hard I work at this.....
+AD4-
+AD4-
+AD4- thanks+ACE-
+AD4-
+AD4- jacob Chojnacki
+AD4- dx 14 years.... 1 year pumping MM508
+AD4- Chicago
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