Diabetics

Nobody's perfect. We all have bad habits we just can't seem to shake. Cigarettes have a hold on some people; others can't say no to alcohol, sweets or a life on the couch in front of the television. As much as we may want to make more healthful choices, change is difficult. Even the awareness that our behaviors can harm us often isn't enough to make us mend our ways. Amazingly, people who have already suffered heart trouble, diabetes or other lifestyle-related illnesses —people who intimately know the consequences of their behaviors — often have an especially hard time turning things around.

Randy Jackson is known for providing measured critiques to aspiring singers on Fox's "American Idol," but in his private life, he's had to analyze something entirely different: After a diagnosis of Type 2 diabetes nine years ago, the music industry veteran needed to reevaluate his diet and lifestyle. Jackson went from piling his plates high with fried food and counting riding in a golf cart as exercise to eating veggies with every meal and working out every day. He talked to us about how his diagnosis changed his life and how he hopes to help others.

Is tight glucose control good at reducing cardiovascular risks in diabetics? The data are conflicting, but it is beginning to appear that the answer is yes for some patients but no for others. In diabetes, every 1% rise in blood sugar level increases by about 20 the risk of heart attack and stroke, which are the disease's major killers. So doctors and diabetes experts long assumed that lowering a patient's blood sugar, or glucose, would bring about a parallel reduction in cardiovascular risk.

Too little sleep - or disrupted sleep - seems to increase the risk of diabetes and obesity, scientists found during a recent lab experiment. Orfeu Buxton, a neuroscientist and sleep researcher at Brigham and Women's Hospital in Boston, placed 21 test subjects in isolation for nearly six weeks.  For the three weeks before the experiment began, he and his colleagues instructed the volunteers to spend 10 hours in bed, to make sure they got an optimal level of sleep.   Then the subjects moved into dimly lit, isolated suites in the laboratory, where the research team removed "time cues" and otherwise disrupted the volunteers' sleep, allowing them only about five hours of per 28-hour period, scattered over various times of the day and the night.  Participants were not allowed visitors or Internet access.  One person came in with 20 years' worth of photo-stuffed boxes and came out with well-organized photo albums, Buxton said.  Another wrote a long paper.

Physicians hear a common refrain from patients with Type 2 diabetes: "Not the needle! Not yet. Give me three more months. I'll be good!" So they try with renewed vigor to control their disease without insulin through diet, exercise and oral medications. Inevitably, many patients lapse and their diabetes again slips out of control, doing invisible damage to their kidneys, nervous systems and cardiovascular health. This cycle of fear and denial has little to do with insulin itself, a normal human protein, but rather its method of delivery: a hypodermic needle.

It seemed like a good idea. Diabetics are at an unusually high risk of heart disease, heart attack and stroke, so sharply reducing their blood pressure, cholesterol and blood sugar should be highly beneficial. But a decade of studies of thousands of patients show that is not the case. Two new reports from a major nationwide trial called ACCORD released Sunday show that lowering either blood pressure or cholesterol below current guidelines does not provide additional benefit and, in fact, increases the risk of side effects.

Yet more support for the combination of aerobic and resistance training exercise: A new study released Tuesday in the Journal of the American Medical Assn. finds that combining the two was good for blood sugar levels in people with Type 2 diabetes, more than those who did not exercise or who did just aerobics or resistance training. The study participants were made up of 262 sedentary men and women who had Type 2 diabetes and hemoglobin A1C levels of at least 6.5%. A1C levels are a measure of blood glucose over a two- to three-month period, and 4% to 6% is considered a normal range.

Albert S. Keston, 80, inventor of a test used by diabetics to determine urine sugar levels. His simple, inexpensive glucose-sensitive tape called Tes-Tape led to the discovery of millions of cases of diabetes. He also developed several other diagnostic tools and used the money from his inventions to found the Institute for Medical Research and Studies in New York City. He taught at City College of New York, the New York University School of Medicine and Mt. Sinai School of Medicine.

For the first time in a decade, the "exchange lists" used for the past 36 years by diabetics as an aid to control their specialized diets have been revised. The American Dietetic Assn. announced the new revisions at its annual meeting in Las Vegas last week. Dietitians predict the changes will please not only diabetics but thousands of dieters and other nutrition-conscious people. The exchange system, first established by the American Diabetic Assn. and the American Dietetic Assn.

Maple syrup: It's sweet, it's calorific, and -- this just in -- it contains antioxidants and anti-inflammatories and stuff. Which must mean -- reasoning leap alert! -- that it is a superfood that can help ward off myriad health problems, like cancer and diabetes. In a study just reported at a meeting of the American Chemical Society, researchers analyzed the various compounds in maple syrup. They found 54 antioxidants, including five new ones. (One they've dubbed Quebecol, after the region where much maple syrup is produced.)

Pregnant women might now have one more good reason to watch their diet and exercise: A new study links autism and developmental delays in young children to metabolic conditions, like obesity and diabetes, in their mothers. The findings, published in Monday's edition of the journal Pediatrics, found that women who had diabetes or hypertension or were obese were 1.61 times as likely as healthy women to have children with autism spectrum disorders. They also were 2.35 times as likely to have children with developmental delays.

Metformin is a workhorse drug for people with diabetes. It helps patients control their blood sugar and makes them more sensitive to insulin. But soon, metformin may take on a new role fighting cancer. Results of a preliminary study presented Saturday at the American Assn. for Cancer Research's annual meeting in Chicago suggest metformin slowed the growth of prostate cancer tumors. The study involved 22 men with prostate cancer. All of them were scheduled to have their prostates removed, and some of them took metformin for about seven weeks beforehand.

A pair of landmark studies demonstrated that weight-loss surgery may be the best solution for Type 2 diabetics with poor control over their blood sugar. So, now what? Experts say that diabetes care is likely to undergo a profound shift. But before diabetics get in line for space on the operating table, a lot of questions need to be answered. Not least of those, say clinicians, is who will do those operations, how well and for how much. Bariatric surgery has exploded in recent years, and with that growth have come concerns about quality of care and patient safety.

On Monday, researchers reported in two new clinical trials that several types of weight-loss surgery were more effective at controlling blood-sugar levels in obese people with diabetes than the usual care regimen of diet and drugs. In many cases, as Los Angeles Times reporter Melissa Healy wrote Monday (see related items link), surgical procedures to reduce the size and sometimes the placement of the stomach often allowed subjects to discontinue diabetes medications within weeks.

In findings that promise radical changes in the care of the 20 million U.S. patients with Type 2 diabetes, two new clinical trials have shown that weight-loss surgery brings about dramatically greater improvement of blood sugar control in obese diabetics than standard diabetes care. In both studies, even rigorously supervised regimens of diet, exercise and medications failed to bring blood sugar under good control after a year or more. In contrast, two teams of researchers - one in Italy, the other in the United States - reported that surgical procedures to reduce the size and sometimes the placement of the stomach often allowed subjects to discontinue diabetes medications within weeks.

Diabetes affects more than 25 million Americans. New medications and strategies to treat the disease are greatly needed. But the jury is still out on the experimental medication dapagliflozin. The medication looks to have significant benefits and risks, according to a study published Monday. Dapagliflozin is being developed by Bristol-Myers-Squibb Co. in partnership with AstraZeneca. It represents a new class of diabetes medications called selective renal sodium glucose contransporter inhibitors.

Cholesterol-lowering drugs called statins can reduce the incidence of heart attacks and strokes among diabetics by a quarter to a third, even in patients who do not have high cholesterol levels, according to a major new British study. Giving the drugs to the 17 million Americans with diabetes could prevent as many as 170,000 heart attacks and strokes each year, researchers said. Worldwide, the drugs could prevent more than 1 million such events each year, they added.

UC San Diego researchers have developed an implantable glucose sensor for diabetics that has worked for a year in pigs and that could be a major step forward toward the development of an artificial pancreas. As many as 800,000 people already use external insulin pumps that, through programming, inject a continuous background level of insulin and higher jolts at mealtimes or when a physical blood test indicates. The goal of many researchers has been to develop a continuous glucose monitor that can be implanted and send electronic signals to control how much insulin the pump secretes, thereby mimicking the action of the pancreas.

Here's some good news for a change from the diabetes front: Lower-limb amputations due to diabetes complications dropped 65% from 1996 to 2008. In a study published this week in the journal Diabetes Care, researchers from the Centers for Disease Control and Prevention analyzed data from two national studies that looked at diabetes prevalence and nontraumatic lower-extremity amputations among people age 40 and over. Those types of amputations are typically caused by circulation problems due to diabetes, not by injuries.

They're called “risk factors” for a reason - people with high blood pressure, diabetes, high cholesterol and/or a smoking habit are much more likely to have heart attacks, strokes and other manifestations of cardiovascular disease, including death. A new study coming out in Thursday's edition of the New England Journal of Medicine analyzed health data on more than 250,000 adults to confirm that those who had any of these risk factors were in greater peril than those who didn't.