Research Raises Eyebrows

| Aug 1, 1998

It's impossible to pick out the "best" research, particularly when there is so much interesting scientific work to choose from. My choice of what to include in this report, while necessarily arbitrary, was guided by what seemed most interesting to me. So if you've been involved in a particular research project that I've omitted, please accept my apologies. Here are the new findings that I would like to share.

Estrogen Replacement

Several reports at the conference confirmed what many of us already surmised: estrogen replacement therapy (ERT) is beneficial for women with diabetes. Estrogens have been suspected of lessening the risk of heart disease and have protective effects on the bones. Studies at Kaiser Permanente in California and Tulane University in New Orleans showed an additional positive effect: post-menopausal diabetic women are better able to control their blood sugar if on estrogen.

Even more surprising were the results of another study from the University of Wisconsin, which showed that ERT decreased the likelihood of high-risk women getting type 2 diabetes. ERT is associated with certain risks, including pelvic and breast cancer. Nevertheless, ERT seems more likely than before to offer significant benefits. Women with diabetes should carefully discuss the benefits and risks of the therapy with their doctors.

Blood Glucose Monitoring

There's been a lot of hope recently that we are on the threshold of non-invasive blood glucose monitoring. Chicago brought us a step closer with new performance results of semi-invasive devices. One such device, made by MiniMed, analyzes the amount of sugar in the interstitial fluid of the skin, rather than the blood, and the results seem to match the levels of sugar found in the bloodstream.

MiniMed demonstrated their continuous glucose monitoring system in the conference exhibit hall. The meter has a tiny electric contact that's stuck into the skin, and is connected to a beeper-sized "black box" that keeps track of blood sugar. The meter also has a hypoglycemia warning signal. The meter does not display results; the numbers have to be download to a computer.

A version of the device will soon be distributed to endocrinologist offices for trial use. It will surely be an eye-opener, allowing both patient and the diabetes team to observe bounces of blood sugar that neither was previously aware of.

The Wonders of Vitamin E

Are vitamins likely to help diabetes? A study from Boston found that vitamin E, an antioxidant, normalized blood flow in the retina and improved kidney function in type 1 patients. When given in high dosages (1800 IU daily), vitamin E helped the eyes and kidneys, but it did not influence blood sugar control (as measured by glycohemoglobin levels). Administration of vitamin E appears to be a simple and safe idea for helping people with diabetes; I'll be very interested in seeing more studies to confirm this finding.

Newsy Inhalers

There has been a lot of press recently about inhaled insulin. I personally thought it might be a great idea, but the news reports have tended to ignore two things. First, in the type 1 trials, the subjects received pre-meal inhaled insulin, plus a bedtime Ultralente insulin injection, which implies that some shots are still necessary. Second, the device is not as small as I had expected. It's described to be about the size of a flashlight, but it clearly will not fit into a pocket or purse. But if it works reliably, I suspect that the inhaler's size won't stop people from using it.

Seizing the Teachable Moment

A study from New York City offered proof of what most of us suspected: that hospitals are bad places for people with diabetes. When hospitalized for other reasons (not diabetes), many diabetic patients didn't get any updates on how to monitor glucose or dietary information. "Almost half (46 percent) received no explanation of their diabetes treatment plans," the study claims. Over half of the patients were also not told about danger signals to look for after discharge. Doctors and hospital staff are missing a golden opportunity to teach patients during hospitalization.

Type 2 Epidemic

On a different note, researchers at the ADA meeting announced that a diabetes epidemic could occur in the next century. According to Michael P. Stern, MD, of the University of Texas Health Science Center at San Antonio, "The incidence of type 2 diabetes rose rapidly, by nine percent per year, over the decade ending in 1996." The jump in new cases was particularly dramatic in Mexican Americans. "Even after controlling for such risk factors as obesity, age, gender, ethnicity, and socioeconomic status, the trend for a rapid rise in diabetes incidence remained," said Stern.

Although the increased incidence of diabetes can partially be explained by the aging of baby boomers and expanding waistlines, Stern speculated on at least two other possible reasons for the results: a decline in physical activity and perhaps some poorly defined changes in the American diet. "Our findings suggest that diabetes and obesity are likely to emerge as the preeminent public health problems in the near future, and will likely have a significant impact on the rate of cardiovascular disease mortality, potentially bringing recent reductions to a grinding halt," he said.

Heart Disease Risk Rises

People with diabetes, both men and women, are known to have a risk of developing heart disease earlier in life than the rest of the population. That's why physicians must always look for early signs of the disease, aggressively treat high blood pressure and elevated cholesterol, and encourage their patients to stop smoking, take aspirin, control blood sugar levels and lose weight.

A report at the meeting emphasized the need for such aggressive treatment, showing that individuals with type 1 diabetes who had no noticeable symptoms of heart disease had significant calcium deposits on the walls of their coronary arteries at surprisingly early ages (the build-up was detected using computerized tomography). The deposits were two to four times as common in people with diabetes, many of whom were under age 30. The researchers pointed out that aggressive intervention to control heart disease should begin before the age of 30. Such studies demonstrate that every adult with diabetes has to be treated as a high-risk individual and started on therapy to protect him or her from heart disease.

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Categories: Blood Glucose, Blood Sugar, Diabetes, Heart Care & Heart Disease, Insulin, Losing weight, Low Blood Sugar, Professional Issues, Research, Type 1 Issues, Type 2 Issues, Vitamins

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