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[IP] FWD: Diabetes In Control Newsletter Issue 35 January 17, 2001

>===== Original Message From "Diabetes In Control Newsletter"
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Diabetes In Control Newsletter - http://www.diabetesincontrol.com


The Newsletter for Professionals in Diabetes Care

January 16, 2001,  Issue 35

NEWS FLASH: HbA1c Levels Can Predict Mortality

Each 1% increase in HbA1c above 5% was associated with a 28% increase in
risk of death (P<.002) independent of age, blood pressure, serum
cholesterol, BMI, and smoking.

See below item 1

Dr. Richard Bernsteins Corner:
                    The Laws of Small Numbers    Or
How To Have Tight Control Without Hypoglycemia

"Big inputs make big mistakes; small inputs make small mistakes."

  Over the next couple of weeks I will give you the tools to understand
and teach the Laws of Small Numbers.  This week I will explain the
importance of small numbers and how to begin to achieve blood sugar
predictability.  We will start with The Law of Carbohydrate Estimation and
in the next article we will discuss The Law of Insulin Dose Absorption,
The Law of Insulin Timing and finally 2 weeks hereafter, Obeying the
Laws of Small Numbers

Go to: www.diabetesincontrol.com/drbernstein/article1.htm


This newsletter is the condensed version.  If you would like to see the
full newsletter got to  www.diabetesincontrol.com/issue35

ITEMS For The Week:

Item #1
HbA1c Levels Predict Mortality Across Population Ranges
Who says a HbA1c between 5-6% is good?  Should we be using the HbA1c as a
predictor of cardiovascular disease and diabetes for the general

Each 1% increase in HbA1c above 5%was associated with a 28% increase in
risk of death (P<.002) independent of age, blood pressure, serum
cholesterol, BMI, and smoking.

In a prospective population study, HbA1c levels "significantly predicted
mortality, with increasing risk throughout the whole range of
concentrations, even below the threshold commonly accepted for diagnosis
of diabetes." Researchers evaluated the relation between HbA1c, diabetes,
and subsequent mortality among 4,662 men (age, 45-79 years) enrolled in
the European Prospective Investigation into Cancer and Nutrition.  For
Study go to: www.diabetesincontrol.com/issue35/item1.htm

Item #2
Improved Glycemic Control Saves Health Care Costs

Diabetes educators are now worth  their weight in gold!

     Sustained improvements in glycemic control among adult patients with
diabetes significantly reduce health care utilization and costs, according
to findings from a historical cohort study.  Researchers found that
because of the additional costs associated with improving diabetes
management,  there is an interest in whether improved glycemic control
leads to reductions in health care costs, and, if so, when such cost
savings occur.

     To address this question, they studied diabetic patients who received
care at a staff-model HMO in western Washington State. Participants
included 4,744 patients aged 318 years who were continuously enrolled in
the HMO between January 1992 and March 1996 and who had HbA1c measured at
least once per year from 1992 through 1994.

     The 732 patients whose HbA1c declined by 31% between 1992 and 1993,
and who sustained the decline through 1994, were classified as improved.
The 4,012 patients whose HbA1c levels decreased by 20.9% or increased were
considered to be unimproved.

    These groups were compared for total health care costs, percentage
hospitalized, and number of primary care and specialty visits in 1992
through 1997. For more info: www.diabetesincontrol.com/issue35/item2.htm

Item #7
Lisinopril and Nisoldipine Have Similar Benefits in Type 1 Diabetics

The calcium channel blocker nisoldipine and the ACE inhibitor lisinopril
appear to have comparable long-term beneficial effects on the progression
of diabetic nephropathy in hypertensive type 1 diabetic patients,
according to a report by Danish researchers.

Dr. Lise Tarnow, from the Steno Diabetes Center, Gentofte, Denmark, and
colleagues randomized 48 type 1 diabetics, who also had hypertension and
diabetic nephropathy, to receive either nisoldipine 20 to 40 mg once a day
or lisinopril 10 to 20 mg once a day. The study, which ran 4 years, was
double-blinded during the first year and single-blinded thereafter.  For
more info: www.diabetesincontrol.com/issue35/item7.htm

Item #8
Post-prandial hyperglycemia and diabetes

Post-prandial hyperglycemia (PPHG) is an independent risk factor for the
development of macrovascular complications. It is now recognized that
normalizing post-prandial blood glucose is more difficult than normalizing
fasting glucose.

 Many factors affect the post-prandial blood glucose excursion. The
glycemic index of the meal depends on the nature of the ingested food and
starch composition. Gastric emptying is influenced by various factors
including gut hormones such as GIP and GLP1, which potentiate insulin
secretion, especially in its acute first phase, now referred to as an
incretin effect. They also modulate glucagon secretion. Post-prandial
hyperglycemia is limited by uptake of glucose by the liver and by
inhibition of endogenous glucose production in this organ. In healthy
controls, hepatic glucose production is halved after a meal, whereas in
glucose-intolerant individuals and type 2 diabetics this inhibition is
impaired (20-30% versus 50%).

The persistence of endogenous glucose production during the post-prandial
phase appears to be the main culprit in the PPHG. This reduced decrease in
endogenous glucose in glucose intolerant and type 2 diabetic patients
depends not only on the first acute phase of insulin secretion, but above
all on the non-suppressed glucagon level during the post-prandial phase.

Glucagon levels fall in healthy control subjects during the post-prandial
phase. Although peripheral glucose uptake by insulin-dependent tissues is
altered in type 2 diabetic patients, it does not appear to be the major
cause of the PPHG as there are patients with insulin resistance but
without post-prandial hyperglycemia.  Diabetes and Metabolism; 2000 26/4
(265-272) H. Gin, Service de Nutrition-Diabetologie, Hopital Haut Leveque,
Avenue de France

Item #12
New Test reveals why some women with Type 1 diabetes need additional
insulin during pregnancy

The test looks for TPO-Abs antibodies, predictors of hypothyroidism.
Hypothyroidism is characterized by a decrease in thyroid hormone
production, and symptoms include a slower metabolic rate, weight gain and

According to an article in October's Diabetes Care, pregnant type 1 women
who test positive for the antibodies before becoming pregnant have a far
greater risk of developing hypothyroidism and suffering from poor glucose
control during their pregnancy. They may also need higher doses of insulin
during the second and third trimesters of their pregnancies

According to the researchers Luisa Fernandez-Soto, MD, Amalia Gonzalez,
MD, et. al.
For more info: www.diabetesincontrol.com/issue35/item12.htm
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