Monday, December 27, 2004

Depression May Raise Women's Diabetes Risk

Depression May Raise Women's Diabetes Risk
Symptoms of Depression Linked to Insulin Resistance

By Jennifer Warner
Reviewed By Brunilda Nazario, MD
on Wednesday, December 22, 2004
WebMD Medical News

Dec. 22, 2004 -- Feeling blue may raise women's risk of developing type 2 diabetes, according to new research.

The study shows that symptoms of depression in middle-aged women are associated with higher levels of insulin resistance, which is a precursor to diabetes.

Researchers say the findings may help explain why depression is twice as common among people with diabetes compared with the general population. Depression is also associated with poor diabetes management.

Depression and Diabetes Linked

In the study, which appears in the December issue of Diabetes Care, researchers looked at the association between symptoms of depression and diabetes among a group of 2,662 middle-aged women who took part in the Study of Women's Health Across the Nation. All of the women were free of diabetes when the study began.

Three years later, 97 cases of diabetes were diagnosed among the women.

Researchers found that depression predicted a 66% greater risk of diabetes in the women, but this association disappeared after they adjusted for other risk factors associated with the development of diabetes, such as excess fat around the midsection (a heart disease and type 2 diabetes risk factor known as central adiposity).

However, symptoms of depression were linked to greater levels of insulin resistance among the women.

In addition, depressed African-American women were more than 2.5 times more likely to develop diabetes, even after adjusting for other risk factors.

Researchers say the results show that depressive symptoms can increase the risk of diabetes and are related to higher levels of insulin resistance -- another risk factor for diabetes.

They add that depression can alter hormones relating to how the body handles stress. This in turn can affect body fat distribution and how it handles blood sugar metabolism.

They say people should be encouraged to seek treatment for depression and maintain and adopt active lifestyles, healthy diets, and weight loss, if needed, to reduce their risk of diabetes.

SOURCE: Everson-Rose, S. Diabetes Care, December 2004; vol 27: pp 2856-2862.

A Nutty Way to Improve Cholesterol in Diabetes

A Nutty Way to Improve Cholesterol in Diabetes
Eating a Healthy Diet Including Walnuts May Reduce Type 2 Diabetes Risks

By Jennifer Warner
Reviewed By Brunilda Nazario, MD
on Friday, December 03, 2004
WebMD Medical News

Dec. 3, 2004 -- Incorporating a handful of walnuts into a healthy diet may help people with type 2 diabetes improve their cholesterol levels and reduce their risk of heart disease, a new study suggests.

Researchers found including walnuts as part of a balanced, low-fat diet helped people with diabetes increase their "good" HDL cholesterol levels while lowering their "bad" LDL cholesterol levels.

But don't reach for the nut bowl just yet. Experts say merely adding walnuts to an already unhealthy diet won't necessarily undo the damage. Instead, they say it's important to substitute walnuts for other sources of fat in the diet in order to achieve the best results.

Walnuts contain an omega-3 fatty acid called alpha-linolenic acid or ALA, which is similar to the omega-3 fatty acids found in fatty fish, such as salmon. Previous studies have shown that alpha-linolenic acid has a number of heart-healthy effects, including improving cholesterol levels.

Researchers say this is one of the first studies to look at the effects of the fatty acids found in walnuts in people with type 2 diabetes.

Walnuts May Aid in Diabetes Management

In the study, which appears in the December issue of Diabetes Care, researchers looked at the effects of three different diets on cholesterol levels in older adults with type 2 diabetes.

Nearly 60 men and women were divided into three groups that followed three different diet plans: a low-fat diet, a modified-fat diet, or a modified-fat diet that included eight to 10 walnuts per day (30 grams). All of the diets were based on eating a variety of whole foods, such as cereals and breads, fruits and vegetables, lean meat, fish, and low-fat dairy products with no more than 30% of total calories from fat.

After six months of the diet, the results showed that the people who ate the modified-fat diet including walnuts experienced a bigger increase in "good" HDL cholesterol levels than those in the other two diets. People who ate walnuts as part of a balanced diet also experienced an average 10% reduction in "bad" LDL cholesterol levels.

Researchers say the study suggests that incorporating walnuts into a healthy diet may be an easy way for people with type 2 diabetes to get the right kinds of fats and fatty acids into their diet.

"Walnuts are an easy and convenient way of getting polyunsaturated omega-3 fatty acids into the diet. And they're particularly important for people with diabetes because they're a simple snack food, which is an integral component of managing the diet in diabetes," says researcher Linda Tapsell, PhD, of the University of Wollongong in Australia, in a news release.

Although the walnut diet appeared to help improve cholesterol levels in people with type 2 diabetes, no significant differences were found between the groups in terms of body weight or body fat.

Funding for the study was provided by the California Walnut Commission.

Hyperglycemia Slows Mental Functions in People with Diabetes

ALEXANDRIA, VA -- December 22, 2004 -- A temporary rise in blood glucose (sugar) levels in people with both types of diabetes can interfere with their ability to think quickly and solve problems, according to a study in the January issue of Diabetes Care.

Researchers at the University of Virginia Health System (UVHS) found that people who had both type 1 and type 2 diabetes performed poorly on math and verbal tests when they became hyperglycemic, a condition in which blood glucose levels are higher than normal. Symptoms of hyperglycemia include high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst. Roughly 55 percent of the people in the study showed signs of cognitive slowing or increased errors while hyperglycemic, suggesting that the consequences of hyperglycemia vary among individuals. However, among those whose cognitive performance deteriorated when blood sugar levels rose, the negative effects consistently appeared once levels reached or exceeded a threshold of 15 mmol/l or 270 mg/dl.

Because hypoglycemia (when blood glucose levels are too low) can cause dizziness and an inability to focus, many people consume large amounts of carbohydrates to avoid this state prior to school exams and other cognitive- sensitive tasks. But this study suggests that carbohydrate-loading could be counterproductive, the researchers conclude, because hyperglycemia often occurs after overeating.

"The best way to minimize any negative effects on cognitive functioning is to keep blood glucose levels tightly controlled," said lead researcher Dr. Daniel J. Cox, of the Center for Behavioral Medicine Research at UVHS. "People who have diabetes should pay careful attention to the warning signs of hyperglycemia so that they can quickly take action to treat it."

Treatment for hyperglycemia can include increasing insulin or reducing food intake.

SOURCE: American Diabetes Association

Wednesday, December 15, 2004

BioMed Central | Full text | Update on Charcot Neuroarthropathy: "Charcot neuroarthropathy is not uncommon in diabetic patients with peripheral neuropathy. Often, the condition is misdiagnosed for cellulitis or osteomyelitis and treatment is delayed. A high index of suspicion is required in these patients to initiate appropriate treatment early. This article covers the pathogeneses of this condition and briefly describes the recent studies performed to understand the underlying etiopathogenetic factors of this devastating condition. Lastly, it mentions the recently completed multicenter trial using bisphosphonates in diabetic Charcot neuroarthropathy."

Saturday, December 11, 2004

Diabetic Gourmet Magazine - Dedicated to Diabetic Dining and Healthy Living
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You are visiting Sarahealth, the site dedicated to achieving optimal physical and emotional wellness. This page discusses Type 2 diabetes with a focus on self-education and self-management."

Monday, December 06, 2004

The Brownsville Herald � Study on diabetes surpasses anticipated figures
Dec. 6, 2004 — Elida Ortiz blames a poor diet and sedentary lifestyle for her diabetes, but the odds may have been stacked against her.

“You are what you eat,” said Ortiz who was diagnosed with Type II diabetes four years ago.

“I used to eat three of four flour tortillas or six corn tortilla tacos (per meal),” said 59-year-old Ortiz, “I needed to change that.”

Lifestyle choices, such as a high-fat, high-sugar diet and lack of exercise, can trigger diabetes in individuals that carry the disease.

Sunday, December 05, 2004

Vitamin E Helps Some Diabetes Patients - Trustworthy, Physician-Reviewed Information from WebMD: "Nov. 23, 2004 -- Some people with diabetes may benefit from taking vitamin E, according to an international team of scientists.

Vitamin E's possible heart benefits are described in a letter published in the November issue of the journal Diabetes Care. The letter was written by researchers, including Andrew Levy, MD, PhD, of Technion-Israel Institute of Technology in Haifa, Israel."

Friday, December 03, 2004

Title: Testosterone Deficiency Found in One-Third of Diabetic Men
"Testosterone Deficiency Found in One-Third of Diabetic Men"

Study is first to reveal hypogonadism as common complication of diabetes BUFFALO, NY -- November 29, 2004 -- Low testosterone production appears to be a common complication of type 2 diabetes in men, affecting 1 out of 3 diabetic patients, a new study has shown. Moreover, results of the investigation show that this condition, known clinically as hypogonadism, is caused not by a defect in the testes, where testosterone is produced, but by improper functioning of the pituitary gland, which controls production of testosterone, or of the hypothalamus, the region of the brain that controls the pituitary. "This starts a whole new story on the crucial complications of type 2 diabetes," said Paresh Dandona, M.D., senior author on the study and director of the Division of Endocrinology, Diabetes and Metabolism at the University at Buffalo and Kaleida Health, where the study was conducted. Results of the study appear in the November issue of Journal of Clinical Endocrinology and Metabolism. Sandeep Dhindsa, M.D., UB assistant professor of medicine and first author on the study, said the findings are important because hypogonadism has not been recognized as a complication of type 2 diabetes, and the high prevalence of 30 percent was unexpected. "The surprisingly high prevalence of low testosterone levels was associated with lower levels of pituitary hormones called gonadotrophins, suggesting that the primary defect in these patients was either in the pituitary or higher up in the hypothalamus," he said. "Since gonadotrophins drive the testes to produce testosterone, this finding gives us an insight into the pathogenesis of this complication of type 2 diabetes." Earlier studies, including those conducted by this research group, found that diabetic subjects with erectile dysfunction and low testosterone levels often have low levels of pituitary hormones. However, conclusions from prior studies have been fraught with problems with testosterone assays, Dhindsa noted. "A large portion of testosterone in the blood is bound to proteins, but a small portion is unbound and largely determines the amount of testosterone that is available to the tissues," said Dhindsa. "This active portion is called free testosterone. Assays to accurately determine it are delicate, tedious and time-consuming. "This investigation set out to determine, in a prospective fashion, the prevalence of low total testosterone, accurately measure free testosterone in male patients with type 2 diabetes and to attempt to determine the seat of the problem in those with low free testosterone." The study involved 103 consecutive males with type 2 diabetes who were referred to the Diabetes-Endocrinology of Western New York for treatment. None of the men had been diagnosed previously with low testosterone levels. The researchers collected fasting blood samples from the participants and analyzed them for testosterone levels and for hormones associated with testosterone production. They also measured cholesterol and glucose levels, and a blood marker for how well glucose was controlled during previous months, called hemoglobin A1c. Data on height, weight and diabetic complications, including erectile dysfunction, neuropathy, retinopathy and coronary artery disease, were recorded. Results showed that nearly one-third of the men had hypogonadism. Although obesity is associated with hypogonadism and is prevalent among type 2 diabetics, only 10-15 percent of the variation in low free testosterone levels could be attributable to body mass index, Dhindsa said. More than 30 percent of lean patients also were hypogonadal. "Equally important, most of the men who had low testosterone levels also had lower levels of gonadotrophins, as compared to men with normal testosterone levels," he noted. "Furthermore, the gonadotrophin concentration in the blood correlated positively with free testosterone levels, supporting the notion that the cause of the defect is in the pituitary or hypothalamus." The high prevalence of low testosterone in diabetic men is concerning, said Dhindsa, because in addition to lowered libido and erectile dysfunction, the condition is associated with loss of muscle tone, increase in abdominal fat, loss of bone density, and can affect mood and cognition. "Further studies will help us determine why type 2 diabetic patients are more prone to developing hypogonadism," he said. "While obesity may explain part of the high prevalence of hypogonadism, it is likely that other factors associated with type 2 diabetes also contribute significantly. This area is clearly ripe for further investigation." Additional researchers on the study were Sathyavani Prabhakar, M.D., UB clinical assistant instructor of medicine, Manak Sethi, M.D., research assistant, Arindam Bandyopadhyay, M.D., UB clinical assistant professor of medicine, and Ajay Chaudhuri, M.D., UB assistant professor of medicine. SOURCE: University at Buffalo