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[IP] Diabetes In Control Newsletter - http://www.diabetesincontrol.com

Diabetes In Control Newsletter - http://www.diabetesincontrol.com


          The Newsletter for Professionals in diabetes care

          November 28, 2000 Issue 28

Item #3

Scientists Eliminate Juvenile Diabetes

Just rodents so far, but maybe very soon for us

Scientists eliminate juvenile diabetes by using gene therapy to turn
rodent livers into insulin factories that regulate blood sugar at
near-normal levels for months.

Researchers who did not participate in the Korean-Canadian study said
while the results were a good start, it remains unclear whether they can
be applied to human diabetics.

``It's fair to say that this is the most efficient insulin gene therapy
that's been reported thus far. It's a nice first step, but there are a
number of things that need to be worked out,'' said Dr. Robert Sherwin,
president of the American Diabetes Association.

Although insulin activity in the treated rats and mice was only 20 percent
to 40 percent that of normal rodents, it was enough to regulate blood

The study, spearheaded by Hyun Chul Lee of the Yonsei University Medical
School in Seoul, South Korea, and three colleagues, appears in last
Thursday's issue of the journal Nature. For more on this story:

Item #4

To View the stamp: www.diabetesincontrol.com/issue28 and check out item #4

There will be a new postage stamp, designed by the U.S. Postal Service,
that will be available in March, 2001. The commemorative stamp was
unveiled at the Carousel of Hope Ball in Southern California.

With this stamp, the Postal Service continues a tradition of raising
public awareness of health and social issues. Some 16 million people in
the U.S. have diabetes and about one-third of them are unaware that they
have this chronic disease.

The stamp was proposed by the Juvenile Diabetes Foundation International
and is supported by the American Diabetes Association and the National
Institute of Diabetes and Digestive and Kidney Diseases at the National
Institutes of Health. The artwork includes two elements associated with
diabetes testing and research: a microscope and a test tube containing
blood. Courtesy of the U.S. Postal Service

Item #5 A person dies every 3 minutes from diabetes and 81% of the public,
have a Clue - Survey Shows Huge Gap in Public's Knowledge of the Disease

81 percent of Americans wrongly think taking insulin for Type 1 diabetes
delays and prevents the development of complications, which can include
kidney failure, blindness, limb amputation and nerve damage. There is a
large gap between what most of the general public knows about diabetes and
the actual facts about the disease. Even the most basic information eludes
many people while others underestimate the serious nature of diabetes, a
devastating disease that kills one American every three minutes.

These are general findings illustrated in the results of a survey
commissioned this year by the Juvenile Diabetes Research Foundation
International (JDRF). The survey, conducted by Penn, Schoen & Berland
Associates, Inc. of Washington, DC, posed ten key questions about diabetes
and its complications to a nationally representative field of respondents
in the United States, Canada, Australia and the United Kingdom. Its is
being released to coincide with National Diabetes Awareness Month --

According to the JDRF survey, 81 percent of Americans wrongly think taking
insulin for Type 1 diabetes delays and prevents the development of
complications, which can include kidney failure, blindness, limb
amputation and nerve damage. The United States is not alone in this
particular misconception. People in Canada (81 percent), Australia (86
percent) and the United Kingdom (76 percent) think the same.

At least half of the people in each of the four countries are not aware of
the difference between Type 1 and Type 2 diabetes nor can they identify
kidney disease, blindness or amputations as complications of diabetes.
Further, they do not know that diabetes is the single most costly disease
in terms of health care. For more on this story go to

Item #6
Early Insulin Resistance May Trigger Obesity

Investigators have long known that added body fat can slow cellular
responses to insulin, yielding chronic imbalances to insulin, yielding
chronic imbalances in blood glucose levels and ultimately producing type 2
diabetes. However, a recent study indicates that early dysfunction of
pancreatic beta-cells, with reduced insulin secretion and imbalances in
blood glucose levels, may act through appetite and energy centers in the
brain to trigger weight gain.

In some cases, the problem may have a genetic source, noted study
investigator Dr. Daniel Porte of the University of California, San Diego
(UCSD). Such is the case among Pima Indians of the southwestern United

Summarizing the study, reported at the 60th Scientific session of the
American Diabetes Association, UCSD physician Ashok Balasubramanyan points
out that as these persons grow older or acquire other risk factors, they
develop insulin resistance. With increasing resistance, accompanied by
inadequate beta-cell secretion of insulin, intra-abdominal fat accumulates
in a vicious cycle that further aggravates insulin resistance, notes
Balasubramanyan. Early detection of insulin dysfunction, with the
potential for preventing the worsening cycle of resistance and obesity,
can be accomplished with the Metabolic Dysglycemia Profile.

Item #7

Drug Interactions with ACE Inhibitors

The field of interactions of natural medicines with allopathic medicines
and foods is growing at quantum speed because of a number of reasons.
First , more people are taking natural medicines today then ever before in
modern history, partly because of the increased quantity and accessibility
of both natural medicines and information about them. At the same time,
people are currently taking more conventional drugs than in the past.
Moreover, many people use both allopathic and alternative remedies at the
same time. As a result, there is a greater potential than has ever
existed for these two types of medicines  each having the ability to
alter the bodys biochemistry and functioning  to interact with each

Because the field of tracking and recording substance interactions is
continually expending, it is impossible to capture all of the potential
interactions of any kind at any given time. As the information becomes
available, we will share that information with you.

Following are some examples of notable interactions between conventional
and natural medicines. Interactions of foods and medicines are also
discussed. Because many people with diabetes are taking Ace Inhibitors,
we will go over some of the newer information regarding some of their
interactions. For the complete article:

Item #8

Protein under Development Restores Complete Nerve Function in
Pre-Clinical Models of Diabetic Neuropathy

Findings presented last week at the Fifth Annual Diabetic Neuropathy
Satellite Meeting of the Society for Diabetic Neuropathy showed that
treatment with the Sonic Hedgehog protein, under development by Curis,
Inc., restored nerve function to normal in pre-clinical models of diabetic

Data from a study conducted by Dr. David Tomlinson of the University of
Manchester showed complete restoration of both sensory and motor nerve
function in pre-clinical models after that function was impaired. Five
weeks after treatment on these models was begun, nerve conduction velocity
measurements showed that sensory and motor function returned to
pre-diabetic levels.

"The repair and restoration of normal function in nerves that have been
compromised by diabetes, as shown in this study, represents a key
objective of the company's efforts in developmental biology, and we are
moving forward aggressively to move such a therapy into human clinical
testing." For complete article:

Item #11
Post-Meal Glucose Levels Better Predictors of Premature Mortality than
Fasting Glucose or HbA1c

A new study indicates that two-hour blood glucose (2h-BG) levels are
better predictors for all-cause mortality than either fasting plasma
glucose (FPG) or hemoglobin A1c (HbA1c).

The study, which was presented at the 17th International Diabetes
Federation Congress, provides further validation of 2h-BG as an
independent risk factor for death from heart disease.

The data underscore the significance of mealtime glucose "spikes" which
result from the body's inability to produce an early insulin response
after a meal. The acute toxicity of glucose spikes, as measured by 2h-BG
levels, is an independent risk factor for cardiovascular disease and
mortality and a better predictor than FPG, as seen in the published
research from the European DECODE study group. Cardiovascular disease is a
serious complication, causing a large proportion of deaths in people with
type 2 diabetes.

"These also demonstrate that two-hour blood glucose is a better predictor
of mortality than HbA1c. This is true not just for cardiovascular
mortality, but for death from all causes," observed Jaakko Tuomilehto,
M.D., Professor of Public Health at the University of Helsinki and at the
Diabetes and Genetic Epidemiology Unit of the National Public Health
Institute in Helsinki, Finland. "Because of this correlation, it will be
important for the control of mealtime glucose spikes to be a goal in
diabetes management."
For complete article: www.diabetesincontrol.com/issue28/item11.htm

Item #12
Three Distinct Subtypes Of Diabetes Mellitus Type 1 Postulated

An appropriate classification of diabetes type 1 could lead to a greater
understanding of the disorder's pathogenesis and to the development of new
therapeutics, according to a recent Japanese report.

Researchers in Osaka examined pancreatic tissue from patients who had been
recently diagnosed with the disorder, and analyzed clinical

Results of the investigation led the researchers to speculate that there
are three distinct subtypes of diabetes mellitus: 1) type 1, which
includes autoimmune; 2) non-autoimmune fulminant; 2) and non-autoimmune
non-fulminant, (or non-autoimmune chronic).

Autoimmune type 1 diabetes mellitus, which affects about 60 percent of
patients, is characterized by insulitis and over expression of class 1
major histocompatibility complex (MHC) molecules in the islet cells. It
also possesses a high prevalence of diabetes-related autoantibodies and a
progressive loss of beta-cell function after the onset of the disorder.

About 30 percent of patients have non-autoimmune non-fulminant type 1
diabetes mellitus and exhibit neither insulitis nor over expression of
class 1 MHC antigen in the islet cells. In addition, it has a low
prevalence of diabetes-related autoantibodies and, following the onset of
the disorder, there is a relatively slow progression of beta cell loss.

The non-autoimmune fulminant type 1 form of diabetes affects about 10
percent of patients and reveals no insulitis or over expression of class 1
MHC molecules. It is, however, characterized by lymphocytic infiltration
in the exocrine pancreatic tissue, elevated pancreatic enzyme levels and
absence of diabetes-related autoantibodies. The course of the disease is
as remarkably aggressive, according to the authors.

Annals of Medicine 2000 Vol 32 pp 539-543

Item #13
Who should be screened for gestational diabetes in pregnancy?

Since the 1970s, it has been recommended that all pregnant women have
screening for diabetes at the end of the second trimester of pregnancy,
between 24-28 weeks. Screening consists of a plasma glucose sample
obtained one hour after a 50g glucose load, given at any time of the day,
irrespective of the time of the last meal. If the results of the screening
test is a glucose level > 140 mg/dl, gestational diabetes is considered
highly likely and is, therefore, tested for (as a second step) with a full
OGTT, which is given in the fasting state. This approach is justified by
the high morbidity for the neonate associated with missing the diagnosis
of diabetes during pregnancy.1 This two-step screening process is
effective because the first step only requires a single blood sample one
hour after ingesting the glucose solution and, thus, is relatively simple
for all concerned, i.e., patient and physician. The result of this
screening process is a 4% incidence of diabetes in pregnancy, although
this may vary between 1-14%, depending upon the population studied.2 This
incidence rate amounts to about 135,000 women with gestational diabetes
(GDM) each year in the United States.2 However, even with such large
numbers who have GDM, most women test negative on the screen with a 50g
glucose load -- yet all pregnant women are screened.

Given the large number of women who tested negative, a different approach
has now been recommended in order to simplify screening. The American
Diabetes Association (ADA) recommends that screening not be done in those
women who were considered to be at very low risk for developing diabetes
during pregnancy, i.e., those who are youngest and leanest.3The following
procedures are suggested:

Do not screen women who are considered to be at very low risk for
gestational diabetes. Screen women who have the following risk factors:3

Age 25 years or more A previous pregnancy with gestational diabetes Obesity A
member of a high-risk
population (for diabetes), e.g., African-American,
Hispanic, Native American, Asian-American. A first degree relative with
diabetes Thus, any woman of 25
years or older, or, if younger, with one of the risk
factors mentioned above, should have the two-step screening process with
the initial 50g oral glucose load as screening and a full OGTT if
necessary thereafter.3


1. Metzger BE. Summary and recommendations of the Third International
Workshop Conference on Gestational Diabetes Mellitus. Diabetes 1991; 40,
Suppl 2:197-201.

2. Engelgau MM, Herman WH, Smith PJ, German RR, Aubert RE. The
epidemiology of diabetes and pregnancy in the U.S., 1988. Diabetes Care

3. Report of the expert committee on the diagnosis and classification of
diabetes mellitus. Diabetes Care 1997; 20:1176-1201

 The opinions expressed here are mine and no one elses.

 If you like them you have my permission to use them as
 long as my wife gets credit for any good ideas (who I
 probably got them from in the first place)
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