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[IP] From Diabetes in Control newsletter

The following items from this weeks Diabetes in Control newsletter.

When I tried to get to the articles via the URL listed below I got a window 
telling me that the Diabetes in Control URL 'ran out' and needed to be 
renewed as of June 5th.

I don't if this sight is going to continue in the future (I've written to 
the list manager and asked)


Item #7
Diabetics with Chronic Illness can Control Blood Sugar

Having a chronic illness such as high blood pressure or heart disease does 
have to compromise diabetics' attempts to successfully manage their 
researchers report.
Their study of 654 patients with type 2 diabetes found that those who took
medication to manage their diabetes were significantly more likely to avoid
dangerous spikes in blood glucose (sugar), which can contribute to kidney
damage, blindness, heart disease and amputations over the long term.

The findings are good news for the increasing number of Americans who are 
to be diagnosed with diabetes and other chronic diseases in the coming 
according to Dr. Imad M. El-Kebbi and colleagues of Emory University in 
Individuals aged 65 years and older currently make up more than 12% of the 
population. That number is expected to exceed 20% by 2040, the authors note 
the May 28th issue of the Archives of Internal Medicine.  For more 
Item #8.
Slight Progression of Retinopathy Indicates Likely Development of PDR

As little as 1 step of progression in retinopathy during a 4-year period
strongly suggests the development of proliferative diabetic retinopathy 
during the subsequent 6 years, researchers found.

The investigators analyzed data from 1,025 people with diabetes. Color
stereoscopic fundus photographs of 7 standard fields were taken at baseline,
after 4 years and after 10 years. Upon masked grading of the photographs, 
subject was classified as having one of 15 levels of retinopathy.

Patients whose retinopathy progressed 1 levels during the first 4 years 
were 5.8 times as likely to develop PDR during the next 6 years as were 
with no progression (nG4). Patients who progressed 1 steps were 3.8 times as
likely to develop clinically significant macular edema (CSME).
Patients whose retinopathy progressed 2 steps during the first 4 years were
significantly more likely to develop PDR or CSME than were patients who
progressed only 1 step. The correlation continued for each of the first 5 
of change.
"[These findings] show that as few as one or more steps of progression in 
modified...retinopathy severity scale over a four-year period is meaningful 
describing risk of incidence of PDR or CSME over the following six years," 
authors wrote. (Klein R, et al. Arch Ophthalmol 2001;119:547-53.)

Item #10
Avoiding Hypoglycemia Can Restore Hypoglycemia Awareness

In type 1 diabetes, avoidance of hypoglycemia restores hypoglycemia 
awareness by
increasing beta-adrenergic sensitivity; suggest results from a controlled 
"It has been thought that reduced counter regulatory hormone responses to
hypoglycemia are primarily responsible for hypoglycemia unawareness," wrote
investigators. "However, recent studies suggest that impaired 
sensitivity may also be involved."
In this study, the authors examined the effect of strict avoidance of
hypoglycemia during 4 months in 10 men (mean age, 46 years) with type 1 
of long duration (mean, 20 years). To avoid hypoglycemia, target preprandial
blood glucose was increased from 100 to 150 mg/dL while target bedtime blood
glucose was increased from 100 to 180 mg/dL.
To achieve these targets, the researchers reduced the dose of long-acting
insulin (preferably that given at bedtime); the daily short-acting insulin 
was also reduced and adjusted to the carbohydrate content of meals and 
blood glucose levels.

Participants were instructed to measure blood glucose 5 times each day and 
contacted at least biweekly for adjustments of insulin dosage to prevent 
glucose from falling to <70 mg/dL. Beta-adrenergic sensitivity was measured 
isoproterenol testing; hypoglycemia awareness and catecholamine response 
assessed by hypoglycemic clamp (glucose level, 54 mg/dL).

After 4 months, the mean HbA1c value increased from 6.8% to 7.7% (P<.001). 
frequency of hypoglycemia (blood glucose levels .2). The increase in
beta-adrenergic sensitivity correlated with increased autonomic symptom 
(r=0.65; P=.04).

"Our findings reinforce the principle that simple but rational adjustment in
insulin regimens...can reverse hypoglycemia unawareness while only modestly
increasing the [HbA1c] value," the authors concluded. "Conceivably, once
hypoglycemia awareness is restored, the insulin dosage may again be altered 
reestablish better glycemic control with less risk for hypoglycemia." 
A, et al. Ann Intern Med 2001;134:729-36.)

Item #11
Type 1s Use More Services than Type 2 Diabetic Patients

Investigators identified 13,563 people with diabetes from a commercial 
total enrollment of 828,208. Of those patients, 4,349 had type 1 diabetes 
8,810 had type 2 diabetes.

Though diabetes patients only accounted for 1.6 percent of the total 
they incurred 9.4 percent of the costs.
Compared with the total population, overall rates of use of inpatient 
were more than four times higher for all diabetes patients, three times 
for type 2 diabetes patients and more than seven times higher for type 1
diabetes patients.

Diabetes patients used approximately five times the amount of inpatient 
related to acute myocardial infarction than did the total population. 
patients rate of use was 5.6 times higher for services related to coronary
artery bypass and almost 10 times higher for services related to heart 
The corresponding rates for type 1 diabetes patients were 8.3 times higher, 
times higher and 22.1 times higher than the total population, respectively.
A combined measure of the volume and intensity of physician services was 
higher for diabetes patients than for the total population.

Rates associated with visits to endocrinologists were 13.2 times higher for 
diabetes patients and 28 percent higher for type 1 diabetes patients. For
ophthalmologist services, the rates were 6.3 percent higher and 12.9 percent
higher, respectively. For nephrologist services, rates were 9.4 percent 
for the total diabetes population and 27.8 percent higher for the type 1
diabetes population.
"Use, costs and intensity of resources used were substantially higher for
individuals with diabetes and markedly higher for the population with type 1
diabetes," the authors wrote. "Our findings show that people with type 1
diabetes are at substantially higher risk for serious complications than 
with type 2 diabetes."
The study appears in the current Archives of Internal Medicine

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