Thursday, November 20, 2008

Gender makes a difference in diabetic neuropathy

Gender makes a difference in diabetic neuropathy


Neuropathies are characterized by a progressive loss of nerve fibers
that can be assessed noninvasively by several tests of nerve function,
including nerve conduction studies and electromyography, quantitative
sensory testing, and autonomic function tests. A widely accepted
definition of diabetic peripheral neuropathy is "the presence of
symptoms and/or signs of peripheral nerve dysfunction in people with
diabetes after exclusion of other causes."1
Diabetic neuropathy is classified into several syndromes, each with a
distinct pattern of involvement of peripheral nerves. Patients often
have multiple or overlapping syndromes.

Peripheral neuropathies
have been described in patients with primary (types 1 and 2) and
secondary diabetes of diverse causes, suggesting a common etiologic
mechanism based on chronic hyperglycemia. The contribution of
hyperglycemia has received strong support from the Diabetes Control and
Complications Trial (DCCT).2
The dose-dependent effect of hyperglycemia on nerves has been supported
further in recent years by increasing recognition of an association
between impaired glucose tolerance (prediabetes) and peripheral
neuropathy.3 Pathologically, numerous changes have been demonstrated in both myelinated and unmyelinated fibers.

Click above to read full article

Friday, September 26, 2008

New Guidelines Launched by Canadian Diabetes Association

New Guidelines Launched by CTORONTO -- September 18, 2008 -- The
Canadian Diabetes Association has released new clinical practice
guidelines to emphasise the importance of early identification of risk
factors in the prediabetes stage in order to prevent the onset of
diabetes and the aggressive management of those risk factors in order
to prevent the serious complications associated with the disease.

Healthcare professionals are encouraged to
incorporate the guidelines into their daily practice as they offer
strategies to help Canadians with diabetes live longer, healthier lives.

"The Guidelines provide clinicians with
detailed information about how to best manage diabetes, with a large
focus on the prevention and management of the serious complications
associated with diabetes, particularly heart disease," said Gillian
Booth, MD, Department of Medicine, University of Toronto, and Expert
Committee for the 2008 Clinical Practice Guidelines, Toronto, Ontario.

"The reality is more and more Canadians
are being faced with diabetes and its complications, which means that
healthcare professionals and people with diabetes need to work closely
together to identify risk factors for diabetes early, and to manage
other risk factors as quickly as possible after diagnosis to reduce the
risk of serious and deadly complications."

The Expert Panel committee responsible for
the development of the Guidelines includes 99 volunteers representing a
broad variety of healthcare professionals from across the country. A
number of new chapters have also been added to the Guidelines, widening
the scope to address emerging research in diabetes-related care.

Cardiovascular Disease

The Guidelines recommend a multifaceted,
comprehensive approach to diabetes management, which includes healthy
meal planning, physical activity, smoking cessation and tight control
of important targets, such as blood pressure, cholesterol, and blood
glucose levels.

Furthermore, the Guidelines now provide
clinicians with more information on how to best screen people with
diabetes for cardiovascular risk. Research has proven that the risk of
heart disease can be reduced by more than 50% through a combination of
lifestyle approaches and medications that protect against
cardiovascular disease.


The Guidelines define prediabetes as a
fasting plasma glucose (FPG) level of 6.1 to 6.9 mmol/L or presence of
impaired glucose tolerance on a 75-gram oral glucose tolerance test
(OGTT). For those individuals with an FPG level between 5.6 and 6.0
mmol/L and one or more risk factors for diabetes, the Guidelines
recommend performing an OGTT.

Development of type 2 diabetes in patients
with prediabetes can be delayed or prevented with lifestyle changes and
if required, medication.

Select Recommendations

· Early identification and
treatment of risk factors for diabetes-related complications such as
cardiovascular disease, kidney, and eye disease is essential through
proper disease management to avoid serious complications.

· The Guidelines are now
recommending that people with diabetes who are at risk for developing
heart disease be aggressively treated to lower low-density lipoprotein
(LDL) cholesterol to <=2 mmol/L. This lower level, in combination
with strict blood pressure control, is proven to help substantially
reduce heart disease and stroke.

· People with diabetes are
encouraged to perform resistance exercises in addition to moderate to
vigorous aerobic exercises, such as brisk walking.

· Adults with diabetes should
consume no more than 7% of total daily energy from saturated fat and
should limit intake of trans fatty acids to a minimum.
anadian Diabetes Association

Wednesday, March 26, 2008

Anna Levis has been diabetic from the age of four. It has made the legal secretary from Dagenham 'very careful' about her health. But after she developed a blister on her foot things started to go badly wrong.

For diabetics who don't look after themselves, the long-term risks are damage to the eyes, kidneys, nerves, heart and major arteries. One of the biggest dangers is losing a foot or leg to gangrene: diabetics are 15 times more likely to have an amputation because of the way the disease affects the circulation of blood to the extremities.

"For that reason I've always strived to keep my blood glucose, blood pressure and cholesterol levels as near to normal as possible," says Anna. But despite her best efforts, at just 36, she had to have part of her foot amputated due to the complications of her illness.

Last year, her right little toe and part of her foot were removed in emergency surgery after she developed life-threatening gangrene.

For months after the surgery she was unable to stand on her injured foot and she had to have further corrective surgery on the amputation in April.

It has taken hours of physiotherapy to teach her how to balance and walk again. As a result of the strong antibiotics she's been taking, she's also lost three stone in weight, going from a size 12 to a size six. Only now, one year on, is she strong enough to return to work.

The fact that diabetics have poor circulation makes them particularly vulnerable to severe infection and gangrene, as the blood flow that carries infection-fighting white blood cells to the extremities is so poor.

Diabetes can also cause a loss of sensation in the feet, called neuropathy, which can mean that a foot injury is not felt or noticed.

Consequently, a relatively small foot infection can easily develop into dead tissue and blood poisoning.

Yet despite the number of people affected by the disease, care for diabetics is a Cinderella service, according to the charity Diabetes UK.

Its recent research shows that more than a quarter of diabetics at high risk of having an amputation are not offered any kind of specialist appointment. The study also found that two in five diabetics do not receive advice on how to prevent and treat foot infections.

"It is shocking that some people with diabetes are getting sub-standard specialist foot care, or even none at all, if they are at high risk of amputation," said Douglas Smallwood, chief executive at Diabetes UK.

There are almost two million people with diagnosed diabetes in the UK and it is believed there are 750,000 more who do not realise they have the condition, who could also be at risk of gangrene and amputation.

Latest figures from the Information Centre for Health and Social Care show that diabetes diagnosis has risen from 3.6 per cent to 3.7 per cent of the UK population in the past year.

Mr Smallwood describes the figures, released three months ago, as nothing short of an epidemic. "These statistics mean there were 70,000 people newly diagnosed with diabetes in the past year alone."

Anna's diabetes is type 1, which means her body is unable to produce any insulin at all and she has been reliant on injected insulin since she was a child.

But this is the less common type, accounting for just 5 to 15 per cent of cases. On the increase in the UK is the far more common type 2 diabetes, which develops when the body doesn't produce enough insulin, leading to high blood sugar levels. Type 2 is strongly linked with being overweight.

And with four million Britons deemed to be clinically obese, it's little wonder that diabetes figures are rocketing.

"We've got to make sure diabetic people get the right treatment. All too often it's an underfunded and second rate service," says podiatric surgeon Mike O' Neill, spokesman for the Society of Chiropodists and Podiatrists.

Anna's story is sadly all too typical of such cases. It starts in August 2006 with her purchase of a new pair of shoes for work.

"I knew I had to wear sensible shoes because of my diabetes, so I bought myself a simple pair of flat black moccasins. But it's a purchase I'll regret for the rest of my life."

Within days, the shoes were rubbing and Anna developed a blister on the outside edge of both her feet near her little toes. She went straight to her GP, who referred her to a chiropodist.

"Initially, the blisters were treated with a seaweed dressing, which I was told would promote healing," she explains.

"But within two weeks the infection had worsened and I went back to my GP for antibiotics.

"Three days later I was still so worried I went straight to my local A& E department at King George Hospital, Essex. Initially, I was told I needed to have both the wounds on my feet debrided, which means cut open, cleaned out and stitched up, followed by a month off work. I was shocked but not surprised as I was in a lot of pain."

But in an unfortunate series of events, Anna found herself caught up in an episode of what she claims is a marked lack of proper care.

She explains: "I sat in the consulting room while my doctor was passed from one ward to the other and back again, with everyone insisting I was not their problem. By the end he was shouting down the phone in an attempt to get me treated.

"Finally, after a wait of several hours, the surgical team admitted me for assessment. But once I was on the ward, another doctor took one look at my feet and completely contradicted what the A& E doctor had advised.

"He said it was just blisters and told me I did not need the debriding procedure after all. Instead, he said he would keep me in overnight for observation and send me home in the morning with stronger antibiotics."

And so Anna went home as instructed. She returned to her GP for outpatient dressings and treatment to her feet on the following Monday. But she is convinced that her alleged mismanaged stay at the hospital contributed to the disaster that ensued.

"My feet were treated and dressed by the GP practice nurse daily for a fortnight. But soon, it all went horribly wrong. I had the foot dressed on a Thursday morning and was told to come back on Monday.

"On the Saturday, however, I noticed the skin was looking grey. I should have gone to hospital there and then but I soon began to feel absolutely dreadful and too ill to move. I was living on my own and rapidly became delirious. I spent the night alone at home with a raging temperature, unable to think straight.

"Finally, I managed to pull myself together and get to the phone to call my mother."

Once Anna raised the alarm early on the Sunday morning, her family rushed to help and found her to be nearly unconscious.

"What's more, the smell of decay from my foot literally hit them in the face as soon as they opened the door," says Anna.

Anna was admitted to hospital, but by then the side of her right foot was black - gangrene had set in. The flesh was literally rotting and she was at risk of dying from blood poisoning.

"The only solution was an immediate amputation. I knew I had no option but to agree," says Anna.

And so she had her little toe and the side of her foot - the metatarsal area - surgically removed on September 25, 2006.

Today, Anna is angry about what happened and wants to speak out, not only to warn other diabetics but to raise awareness among health professionals about the dangers of foot problems and diabetes.

Although she believes she may have a legal case against King George Hospital, she is not pursuing it. She says she wants to move forward with her life and does not believe in the compensation culture.

"I've lost enough time already," she says, remarkably cheerfully.

"I don't want to spend years chasing a case through the courts. What I need now is to get well and look to the future.

"But I do want to speak out in order to alert others to what happened. This has cost me a year of my life and left me permanently disabled at the age of just 36, all because I didn't get the simple treatment I needed."

For more information on diabetes visit

Wednesday, February 27, 2008

Diabetic mice 'cured' with drugs
US scientists have managed to rid diabetic mice of the effects of the disease using a cocktail of drugs.

The mice, who had type 1 diabetes, started producing their own insulin after taking a mixture of four drugs.

Previously the same team at Harvard University had only been able to stop the destruction of the cells which make insulin, not regenerate them.

But in a study reported in the New Scientist, they say adding another drug to the original cocktail did just that.

They now hope to start trials in humans.

The only way to manage diabetes is through regular injections of insulin and until now, research into a cure has focused on transplanting the pancreatic beta cells which produce the hormone from donors.

However this is complicated - both because of the difficulty in finding a donor and the problems of rejection - so regenerating a person's own cells is seen as far better option.

Extra enzyme

Last year, Dr Terry Strom and his team demonstrated that they could stop the on-going destruction of insulin-producing beta cells in mice using a combination of three drugs, although they were unable to regenerate the cells.

It is exciting that these drugs could stop the immune system from attacking insulin-producing cells, but it is too early to tell whether these cells recovered in the mice or if new cells were produced
Iain Frame
Diabetes UK

However, when they added an extra ingredient - an enzyme called alpha 1 anti-trypsin - a significant rise in the number of beta cells was seen.

It is thought this extra drug may ease the inflammation of pancreas, a key feature of the disease.

"It would appear that by altering the inflammatory state that surrounds this autoimmune disease, you can create an environment that enables expansion of the beta cell mass," said Dr Strom.

He added that it was too early to say whether the beta cells which had stopped making insulin had recovered, or whether new ones were being produced.

Dr Iain Frame, director of research at Diabetes UK said: "This could potentially be very important research in finding a better treatment for diabetes.

"More research is needed as initial studies have only been conducted in mice, but Diabetes UK is pleased that clinical trials are planned and look forward to hearing the results."
Story from BBC NEWS:

Published: 2008/02/27 18:15:55 GMT


Friday, January 25, 2008

Title: Use of Diabetes Medication by Older Adults Linked with Increased Risk of Heart Problems, Death

"Use of Diabetes Medication by Older Adults Linked with Increased Risk of Heart Problems, Death"

CHICAGO, IL -- December 11, 2007 -- Older patients treated with the diabetes medications known as thiazolidinediones (which include rosiglitazone) had a significantly increased risk of heart attack, congestive heart failure and death, compared with the use of other hypoglycemic drugs, according to a study in the December 12 issue of [JAMA. The authors suggest that these results provide further evidence that this class of medication may cause more harm than good.

The thiazolidinediones (TZDs) rosiglitazone and pioglitazone are oral hypoglycemic agents used to treat type 2 diabetes and have been shown to improve glycemic control. "While improved glycemic control has been linked to better clinical outcomes in diabetes and TZDs have been suggested as having potential cardiovascular benefits, recent concerns have arisen regarding adverse cardiac effects of these drugs," the authors write.

Some research has indicated that both rosiglitazone and pioglitazone may increase the risk of congestive heart failure (CHF), and that rosiglitazone may be associated with an increased risk of acute myocardial infarction (AMI; heart attack) and death. "These findings prompted a recent hearing by a U.S. Food and Drug Administration advisory panel regarding the safety of rosiglitazone; however the panel voted against removing rosiglitazone from the market because of insufficient data."

Lorraine L. Lipscombe, M.D., M.Sc., of the Institute for Clinical Evaluative Sciences, Toronto, and colleagues evaluated the risks of CHF, heart attack, and all-cause death associated with the use of TZDs, compared with other oral hypoglycemic agents among patients age 66 years or older with diabetes. This older patient population has often been under-represented in trials of TZDs, even though they have a high prevalence of diabetes, and may be at greater risk of medication-related harms. The researchers analyzed data from health care databases in Ontario that included 159,026 individuals with diabetes who were treated with oral hypoglycemic agents and were followed for a median (midpoint) of 3.8 years, through March 2006. During this time, 7.9 percent of patients had a hospital visit for congestive heart failure (n = 12,491), 7.9 percent had a hospital visit for a heart attack (n = 12,578), and 19 percent died (n = 30,265).

Compared to oral hypoglycemic agent combination therapy users, current users of TZD monotherapy had a 60 percent increased risk of congestive heart failure; had a 40 percent increased risk of heart attack; and had a 29 percent increased risk of death. These increased risks associated with TZD use appeared limited to rosiglitazone.

"Our findings argue against current labeling of TZDs that warns against use only in persons at high risk of CHF, as we did not identify any subgroup of older diabetes patients who may be protected from adverse effects of TZDs," the authors write. "These findings provide evidence from a real-world setting and support data from clinical trials that the harms of TZDs may outweigh their benefits, even in patients without obvious baseline cardiovascular disease."

"Further studies are needed to better quantify the risk-benefit tradeoffs associated with TZD therapy and to explore whether the hazards associated with these agents are specific to rosiglitazone. In the interim, treatment decisions must remain individualized, with clinicians weighing the potential benefits and harms of TZD treatment, especially among high-risk elderly populations."

JAMA. 2007;298(22):2634-2643.

SOURCE: JAMA and Archives Journals

Wednesday, August 08, 2007

Diabetes problems 'vitamin link'
Diabetes problems 'vitamin link'
A simple vitamin deficiency may be the cause of many of the side effects of diabetes, a study suggests.

Researchers found people with the disease expelled thiamine - vitamin B1 - from their bodies at 15 times the normal rate in a study of 94 people.

The Warwick University team said thiamine helped ward off complications such as heart disease and eye problems, the Diabetologia journal said.

Experts said diet supplements could potentially help people with diabetes.

Supplementing diets could be an effective way of minimising the risk of these complications
Professor Paul Thornalley, lead researcher

It is the first time a deficiency of the vitamin, which is found in meat, yeast and grains, has been identified in people with diabetes.

It has been missed in the past because of the way thiamine levels were measured.

Traditionally, the activity of an enzyme called transketolase in red blood cells has been used to indicate thiamine levels.

But the researchers found that increased activity - usually a sign of high thiamine levels - was also associated with the body's response to deficiency.

Instead, the team measured thiamine levels in blood plasma and found concentrations were 76% lower in people with type 1 diabetes and 75% lower in people with type 2.

Thiamine is key to warding off vascular problems such as kidney, retina and nerve damage as well as heart disease and stroke.

It works by helping protect cells against the effect of high glucose levels.

Trials are now being carried out to see if supplementing diet with thiamine could return levels to normal.


Lead researcher Professor Paul Thornalley said: "It is early days, but it could have a huge difference.

"Supplementing diets could be an effective way of minimising the risk of these complications."

Matt Hunt, of Diabetes UK, which helped to fund the study, said more research was needed.

But he added: "The study could potentially have very exciting outcomes.

"Around 80% of people with diabetes die of cardiovascular disease and diabetes is the leading cause of blindness in the UK's working age population.

"Therefore, any research that could help must be looked at seriously."
Story from BBC NEWS:

Published: 2007/08/07 23:05:27 GMT


Tuesday, May 01, 2007

Significant Strides Being Made Against Diabetic Retinopathy
0 Apr 2007

Research increasingly shows promise to both slow and relieve the effects of diabetic retinopathy, the most common complication of diabetes.

In its earliest stages, retinopathy often has no overt symptoms but can progress over time to a phase in which the blood vessels of the eye leak and rupture easily, eventually causing blindness. This frightening complication is caused by high blood glucose levels, and nearly all people with type 1 diabetes show some symptoms of the disorder.

An in-depth article in the spring 2007 edition of Countdown, the quarterly journal of the Juvenile Diabetes Research Foundation, details ongoing human clinical trials in this area, and important findings that have been made to date. In the article, JDRF-funded scientists share valuable insights into the causes of retinopathy, as well as the therapeutics that are being developed as a result of the identification of new biological targets.

One study mentioned within the article was led by Dr. Lloyd Aiello of the Joslin Diabetes Center, who showed that the compound ruboxistaurin slowed the progress of retinopathy by inhibiting an enzyme in the body called protein kinase C beta (PKC beta), which is believed to contribute to the blood vessel damage that leads to the disease. This is the first time a drug has been shown to protect against the complication in a human clinical trial.

According to Dr. Richard Insel, Executive Vice President of Research for JDRF, "Since retinopathy is the most common and serious eye-related complication of those with type 1 and type 2 diabetes - and is the leading cause of adult blindness in Americans - the outstanding research being done in this area will have a significant impact on the millions of people with diabetes."


JDRF was founded in 1970 by the parents of children with type 1 diabetes - a disease that strikes children, adolescents, and adults suddenly, makes them insulin dependent for life, and carries the constant threat of devastating complications. Since inception, JDRF has provided more than $1 billion to diabetes research worldwide. More than 80 percent of JDRF's expenditures directly support research and research-related education. JDRF's mission is constant: to find a cure for diabetes and its complications through the support of research. For more information please visit

Contact: Peter Cleary
Juvenile Diabetes Research Foundation International

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