Letters to the Editor
The NIH Research Debate Continues
We were very disappointed in the article by Dr. Allen Spiegel in the April issue of Diabetes Interview ("Where We Stand With Research & Prevention at the NIH" p. 23). It was self-congratulatory and so steeped in professional jargon that it was hard for a layperson to digest. Sadly, it also suggested that the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) is focused primarily on identifying the cause of, or preventing, diabetes.
That is not the problem facing our 12-year-old grandson, who has been a type 1 for six years. What our grandson needs is research that will help him live better with diabetes, and aggressive research to find a cure.
Why is there no self-monitoring pump, i.e., an artificial pancreas, to help people in the short term? What is the NIDDK doing to advance development of such equipment? Why is that more difficult or less important, than say, sending probes to Mars? Why is stem-cell research, evidently the most promising avenue to finding a cure, apparently being held hostage to certain religious or political ideology?
Those are the sorts of questions we hoped Dr. Spiegel would address. After reading his article, we fear our grandson is being sacrificed by the NIDDK for the benefit of future generations, or perhaps to provide an intellectual challenge (or jobs) for researchers or even, as others have charged, for the benefit of private industry. We don't know. What we do sense is that, contrary to its assertion, the NIDDK has no "master plan" to help people currently diagnosed with diabetes. We seriously question Dr. Spiegel's understanding of, or sensitivity toward, their day-to-day challenges.
Perhaps unwittingly, Dr. Spiegel has shown us why such a huge outlay of public funds has yielded so little useful help.
We hope Diabetes Interview and its readers will keep the pressure on our government and its agencies to help today's patients.
William and Susan Smith
Ocean Shores, Washington
I read the April article "Where We Stand With Research and Prevention at the NIH" and I understand the frustration of your readers about the slow pace of diabetes research. I was glad to see Dr. Spiegel respond in detail. I know Dr. Spiegel personally and, even though he is not a diabetologist, I believe he is a man of integrity and will be a strong advocate for the diabetes community in his role as director of the NIDDK.
I also wanted to comment on one of the letters about patients being told their complications occurred because they were "non-compliant" with their physicians' recommendations. This is a particularly sore point for me. Having been trained at Joslin in the mid 1970s (pre-DCCT), I have been fighting for intensive-insulin therapy for over 25 years. Many physicians are very cavalier about diabetes and many have simply not kept up with the newer advances. It is unfortunate that almost all type 1 patients are treated by university diabetologists in Europe, but many in the U.S. remain under the care of family physicians, general pediatricians or general internists.
Most of the patients who sought my expertise were self-referred. Many of them told me that they were called "non-compliant" by their primary care physician. Physicians would tell me that certain patients were non-compliant-but it soon became very clear to me that these physicians were clueless about how to treat people with diabetes.
Bob Tanenberg, MD, FACP
Greenville, North Carolina
It will be 200 years before any of the NIDDK's genetic research pays off for type 1 or 2 diabetes. Dr. Allen Spiegel does not realize that we want some shots in the dark toward a cure right now.
In other parts on the world, diabetes researchers are narrowing in on the antibody and immune system problems that cause diabetes. Why does the NIH have to concentrate on genetic solutions? Why not start by testing vaccines to solve the antibody problem? Cancer research shows that antibodies block receptor sites. Antibodies come from decades of faulty immune responses to food and environmental allergies. And, yes, I know antibodies are caused by dysfunctional DNA. Still, we should focus on developing vaccines now and concentrate on gene transfers in the future.
Also, I don't want to see another letter to the editor that says obesity causes type 2 diabetes. It is not true. They are related, but people with type 2 diabetes are not unrepentant gluttons.
The current type 2 diabetes treatments of self-mutilation (four finger pricks a day), starvation and enforced labor are not acceptable to me. I want a cure for this disease. I don't think that people with diabetes are getting a bang for their buck at the NIH. I want this changed. I want to see a solution; nothing else will do.
Many Type 2s are Actually
I am writing to comment on your March article by Joan Williams Hoover ("Fat Chance!" p. 48).
Her article states that about 20 percent of type 2s are not considered to be obese. However, this statement does not address the fact that, all too often, thin type 2s who require insulin are, in fact, type 1s who have been misdiagnosed.
Numerous studies, particularly recent ones that used antibody testing (such as islet-cell antibodies, or ICA, anti-glutamic acid decarboxylase (anti-GAD) antibodies, etc.), indicate that approximately 10 percent of adults newly diagnosed with type 2 diabetes in fact have the auto-immune markers for type 1 and have been misdiagnosed.
In the landmark United Kingdom Prospective Diabetes Study (UKPDS) of type 2 diabetes, 10 percent of the people that supposedly had type 2 and ICA and/or anti-GAD antibodies clearly had type 1. The Endocrine Society estimates that as many as 20 percent of the people diagnosed with type 2 actually have type 1.
The Web site for the Lehigh University Diabetes FAQ section (www2.lehigh.edu) states, "Latent auto-immune diabetes in adults (type 1 diabetes in adults) may constitute as much as 50 percent of non-obese adult-onset diabetes." In actuality, non-obese people constitute 10 percent or less of the type 2 population.
Walnut Creek, California
Editor's note: We asked Joan Hoover to reply.
In her comment regarding my article "Obesity Causes Diabetes? Fat Chance!" Ms. Rorty poses some interesting theses, which I am in no position to refute. However, the point I was making remains unchanged by her numbers. I said, in essence, "It can't be that getting fat causes people to get diabetes, because look how very many fat people there are who DON'T have diabetes! It must be something else. Let's try to find out what it is."
Gaining weight may possibly increase your risk if you are predisposed to get diabetes in the first place. Losing excess weight may help you to control diabetes once you have it, but I've seen no evidence that getting fat, in itself, is the cause of diabetes (and, we might add, "Thank God!").
Joan Williams Hoover
Diabetes Interview Patient Advocate Advisor
Chevy Chase, Maryland
All Tobacco Products Are Bad
In the Questions and Answers section of the April issue of Diabetes Interview (p.43), Dr. James Guggenheimer, DDS, answers Mike Hanson's questions about smokeless tobacco rather incompletely. There are several aspects related to diabetes and smokeless tobacco use that are significant.
To begin with, people with diabetes should avoid nicotine delivered by any mechanism (smoking, chewing or even the use of nicotine-replacement therapies). Nicotine stimulates adrenergic receptor activity, associated with free levels of adrenaline and noradrenaline, which opposes the actions of insulin and elevates glucose levels.
In addition, there are several major studies that followed male and female non-diabetic tobacco users versus non-diabetic non-users. The results were compelling. The subjects using tobacco products were significantly more likely to develop diabetes than non-users.
With respect to smokeless tobacco, it has a significantly higher addiction potential than cigarettes, delivering up to four times the nicotine. Just one can of smokeless tobacco contains the same amount of addictive nicotine as 60 cigarettes (three packs). Smokeless tobacco also contains the known carcinogens n-nitosamine and formaldehyde, as well as the unsavory additives polonium 210, cadmium, cyanide, arsenic, benzene and lead.
The purveyors of these products add silica, grit and other irritants to their products specifically to "cut" the gums and other oral mucosa and cause an increased method of rapid nicotine delivery. This leads to gum irritation that is associated with early indicators of periodontal degeneration and with lesions in the oral soft tissue. These lesions, or leukoplakia, can develop with very little smokeless tobacco use. Smokeless tobacco causes cancer of the mouth and throat and users are four to six times more likely to develop oral cancer than non-users. Oral cancer is the seventh leading form of cancer.
John R. Bancroft
Alternative Tobacco Products, Inc.
Solana Beach, California
If The Shoe Fits
In your column on foot care ("Seeing Red," February 2001, p. 6), Dr. Richard Bernstein recommends wearing Rockford shoes for comfort. I and some other diabetic friends who suffer from neuropathy of the feet have found SAS shoes to be far more comfortable. They have much more width in the toe area. They come in an attractive style and can be purchased in various colors.
New York, New York
Dr. Bernstein's reply: The foot-care recommendations that appear in the February 2001 issue were initially published a number of years ago and are in need of some minor updating. Today, there are many more shoes available with wide, deep toe boxes than there were when the recommendations were written. Styles in footwear have changed dramatically for the better. Unfortunately, I gather from my patients who lived in Europe that the pendulum is again swinging back toward pointed shoes. Suitable shoes are now so widely available that it is no longer necessary to specify a particular brand. This situation may change with the latest swing of the pendulum.
Word of Warning About Taking Pycnogenol
I saw the great news about Pycnogenol in the April issue of Diabetes Interview (p. 37) and how it helps retinopathy. One word of caution: if the person has seasonal allergies or is taking herbals, he or she should be careful about taking it. I, too, have concerns about diabetic retinopathy and tried Pycnogenol. However, I am also allergic to pine trees and, after taking 3 doses of Pycnogenol, I was reaching for my allergy medications. As host of the Women's Health Discussion forum in Pittsburgh (and former host of the PlanetRx.com/Diabetes.com community), I can tell you that we caution our members about the possibility of allergic reactions. My doctor pointed out that I could help my son's cold with zinc lozenges, but told me to stay away from Echinacea. He has seasonal allergies as well, and this herb comes from cornflowers.
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