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 www.diabetes.org.uk

Wednesday, February 27, 2008

BBC NEWS
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:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7267586.stm

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

© BBC MMVIII

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'
BBC NEWS
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.

Diets

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:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/6935482.stm

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

© BBC MMVII

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 http://www.jdrf.org/

Contact: Peter Cleary
Juvenile Diabetes Research Foundation International

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=68974

Monday, February 12, 2007

The test that could reveal your chances of developing diabetes

The test that could reveal your chances of developing diabetes

 

British scientists have made a major breakthrough in the battle against diabetes by identifying the genes which raises the risk of getting the condition.

The findings mean there could soon be a test to identify those who could get Type 2 diabetes - of which there are around one million sufferers in Britain.

Many of them developed it because they are overweight or obese.

However experts believe some people are more susceptible than others due to their genetic make up.

Now for the first time researchers have pinpointed the most important genes that heighten the risk of getting type-2 diabetes.

The UK scientists hope it will lead to a test to spot those most at risk so they can take steps to prevent it developing.

It could also lead to new treatments for the condition, which if not properly controlled can lead to serious problems including loss of sight and organ damage.

Lead researcher Professor Philippe Froguel of Imperial College London said: "If we can tell someone that their genetics mean they are predisposed towards Type 2 diabetes, they will be much more motivated to change things such as their diet to reduce their chances of developing the disorder.

"We can also use what we know about the specific genetic mutations associated with Type 2 diabetes to develop better treatments."

The research, published on-line in Nature, is the first time the genetic make-up of any disease has been mapped in such detail.

The team took 700 people with Type 2 diabetes and a family history of the condition, and compared their genetic mutations with 700 healthy people.

The researchers identified four points on sufferer's genetic maps that were linked to their risk of developing the disorder.

They then confirmed their findings by analysing the genetic make-up of another 5,000 people with Type 2 diabetes and a family history of the disorder, to check for the same mutations.

From this they concluded these four points explain up to 70 per cent of the genetic background of Type 2 diabetes.

They also believe one of the mutations might help explain one of the triggers for the condition and so lead to new treatments.

They found sufferers have a particular mutation in a gene involved in transportation of zinc around the body and insulin secretion.

By fixing this problem, they may therefore be able to overcome insulin deficiencies of some people with Type 2 diabetes.

Prof Froguel of the Division of Medicine at Imperial said: "The two major reasons why people develop Type 2 diabetes are obesity and a family link.

"Our new findings mean that we can create a good genetic test to predict people's risk of developing this type of diabetes."

Professor David Balding, study co-author, added: "The task now is to study the genes identified in our work more intensively, to understand more fully the disease processes involved, devise therapies for those affected and to try to prevent future cases."

Dr Iain Frame, Research Manager at Diabetes UK said: "We have known for some time that family history plays a part in whether or not someone might develop Type 2 diabetes.

Sunday, February 11, 2007

Eye disease in Diabetics tied to risk of dying

Eye disease in diabetics tied to risk of dying

 

Fri Feb 9, 3:04 PM ET

In adults with type 2 diabetes, a common diabetes-related complication of the eye called retinopathy is associated with an increased risk of dying within in a given period of time, a study shows.

Retinopathy arises when diabetes damages the tiny blood vessels of the retina, the light-sensitive tissue at the back of the eye. It can lead to blurred vision and blindness if unchecked.

Dr. Markku Laakso, from the University of Kuopio in Finland, and colleagues compared the outcomes of 425 men and 399 women with type 2 diabetes who were divided into three groups based on results of eye exams: no retinopathy, background (early) retinopathy, or more advanced "proliferative" retinopathy. All of the subjects were free from heart and vascular disease initially. They were followed for 18 years.

In women, proliferative retinopathy was associated with a 2.9-fold increased risk of death from all causes. In women, this type of retinopathy was also associated with a 3-fold increased risk of cardiovascular death and a nearly 5-fold increased risk of coronary heart disease death.

Risks for death were also elevated, albeit to a lesser extent, in women with background retinopathy.

In men, proliferative retinopathy was significantly associated with death, increasing the risks of all-cause, cardiovascular, and coronary heart disease mortality by 3.05-, 3.32-, and 2.54-fold, respectively.

The association between retinopathy and mortality was independent not only of conventional cardiovascular disease risk factors but also of blood sugar control and duration of diabetes, the authors note.

SOURCE: Diabetes Care, February 2007.

Monday, February 05, 2007

Diabetic Foot Net

CLEAR COM

Mission Statement

CLEARcast is a twice-monthly podcast featuring interviews with world-renowned clinican researchers in the field of the foot and ankle. The special emphasis is placed on amputation prevention, wound healing, and the diabetic foot.

CLEARcast

Upcoming Conferences

Sunday, February 04, 2007

COMMONSENSESECUITY

Common Sense Security

This site is designed to give an overview of what we can do to keep our computers safer and more secure while we are on the Internet. I have known the owner (Mark Rider) for a long time and confirm that his site is secure AND gives out some very useful advice. I can  recommend it highly.

Tony

Monday, January 29, 2007

Lifestyle Changes Effective In Protecting Against Type II Diabetes

24 Jan 2007

Changing to a healthier lifestyle appears to be at least as effective as taking prescription drugs in reducing the risk of developing Type 2 diabetes, says a new BMJ study.

Type 2 diabetes is a growing problem - in England around 1.3 million people have diabetes and around 5% of total NHS resources are used for the care of people with diabetes.

Researchers from Leicester reviewed studies which measured the effects of different interventions - lifestyle, diabetes drug and anti-obesity drug - on people with impaired glucose tolerance (1).

They found that lifestyle changes, e.g. switching to a healthier diet and increasing exercise to be at least as effective as taking prescription drugs. On average, lifestyle changes helped to reduce the risk of developing type 2 diabetes by around half. Lifestyle changes were also less likely to have adverse side-effects.

However, the researchers say that both lifestyle changes and prescription drug taking must be sustained in order to prevent the development of Type 2 diabetes.

The authors say that as global rates of Type 2 diabetes are likely to double by 2030, interventions to prevent the condition will have an important role to play in future health policies. The study findings have large implications for public health policy, however, the authors note that if lifestyle changes are to be truly effective more needs to be done to support people to adopt healthier lifestyles.

###

(1) People with impaired glucose tolerance have a high risk of developing type II diabetes

Contact: Emma Dickinson
BMJ-British Medical Journal

Article URL: http://www.medicalnewstoday.com/medicalnews.php?newsid=61209

Positive Opinion For Type 2 Diabetes Treatment, JANUVIA - First In New Class Of Oral Treatments Known As DPP-4 Inhibitors, European Union

JANUVIA (sitagliptin), Merck, Sharp & Dohme's treatment for patients with type 2 diabetes, today received a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Evaluation Agency (EMEA) in Europe. The CHMP opinion recommends that JANUVIA be approved in the European Union for the treatment of type 2 diabetes. Following the conclusion of the CHMP review, the opinion for JANUVIA will be transmitted to the European Commission (EC). If the EC adopts the opinion, JANUVIA will be the first and only prescription medication in a new class of drugs known as dipeptidyl peptidase-4 (DPP-4) inhibitors, which enhance the body's own ability to lower blood sugar (glucose) when it is elevated. The decision will be applicable to the 27 countries that are members of the European Union, including the United Kingdom, Germany, France, Italy and Spain. JANUVIA is currently approved in eleven countries including the United States and Mexico. Marketing authorization from the European Commission is expected in early April after the adoption of the opinion.

The CHMP, comprised of regulators from all European Union countries, gave the positive opinion following a review of comprehensive data supporting the efficacy and safety and tolerability profile of JANUVIA. The submission package consisted of studies involving approximately 4,000 patients with type 2 diabetes treated with JANUVIA.

JANUVIA has been investigated in patients with type 2 diabetes to improve glycaemic control in combination with metformin when diet and exercise, plus metformin, do not provide adequate glycaemic control. JANUVIA has also been studied as add on therapy with PPARγ agonists in patients with type 2 diabetes mellitus in whom use of a PPARγ agonist (e.g. a thiazolidinedione) is appropriate. In addition, JANUVIA has been studied as monotherapy in many patients.

In a clinical study, JANUVIA plus metformin, compared to treatment of a sulfonylurea (SU) plus metformin, showed comparable glucose lowering efficacy. In this study patients taking JANUVIA plus metformin lost weight (-1.5 kg) compared to patients taking glipizide plus metformin who gained weight gain (+1.1 kg). Hypoglycaemia (when blood sugar becomes too low) was more common in patients treated with glipizide plus metformin (32 percent) compared to patients treated with JANUVIA plus metformin (4.9 percent). In the overall phase III clinical programme the incidence of hypoglycaemia in patients taking JANUVIA was similar to patients taking placebo (1.2 percent, JANUVIA vs. 0.9 percent, placebo). In clinical trials of up to 2 years in duration, patients have received treatment with JANUVIA alone or in combination with metformin, a sulfonylurea (with or without metformin) or a PPARγ agent. In these trials, the rate of discontinuation due to adverse experiences considered drug-related was 0.8 percent with JANUVIA and 1.5 percent with other treatments. No adverse reactions considered as drug- related were reported in patients treated with JANUVIA occurring in excess (> 0.2 % and difference > 1 patient) of that in patients treated with control. Reported adverse events included nausea (common), somnolence, upper abdominal pain, diarrhoea and hypoglycaemia (uncommon).* JANUVIA should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings.

About JANUVIA

JANUVIA (sitagliptin) is an oral, once daily, potent and highly selective DPP-4 inhibitor. DPP-4 inhibitors work by enhancing a natural body process that lowers blood sugar, the incretin system. When blood sugar is elevated, incretins work in two ways to help the body regulate high blood sugar levels: they trigger the pancreas to increase the release of insulin and signal the liver to reduce its production of glucose. DPP-4 inhibitors enhance the body's own ability to control blood sugar levels by increasing the active levels of these incretin hormones in the body, helping to decrease blood sugar levels in patients with type 2 diabetes.

Expanding Clinical Trial Program for JANUVIA

MSD's clinical development program for JANUVIA is robust and continues to expand with 43 studies completed or under way, and four more studies set to begin this year. There are about 6,700 patients in the Company's clinical studies with about 4,700 of these patients being treated with JANUVIA. Additionally, about 1,100 patients have been treated with JANUVIA for more than a year.

About Merck

Merck & Co., Inc., which operates in many countries as MSD (Merck Sharp & Dohme), is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service. For more information, visit www.merck.com.

Forwarding-Looking Statement
This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements are based on management's current expectations and involve risks and uncertainties, which may cause results to differ materially from those set forth in the statements. The forward-looking statements may include statements regarding product development, product potential or financial performance. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. Merck undertakes no obligation to publicly update any forward- looking statement, whether as a result of new information, future events, or otherwise. Forward- looking statements in this press release should be evaluated together with the many uncertainties that affect Merck's business, particularly those mentioned in the cautionary statements in Item 1 of Merck's Form 10-K for the year ended Dec. 31, 2005, and in its periodic reports on Form 10-Q and Form 8-K, which the company incorporates by reference.

-- JANUVIA - Patient and Caregiver Web Site
-- JANUVIA - Health Care Professional Web Site

* Frequencies are defined as: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1,000, < 1/100); rare (≥ 1/10,000, < 1/1,000); and very rare (< 1/10,000).

(R) JANUVIA is a registered trademark of Merck & Co., Inc., which operates in many countries as MSD (Merck, Sharp & Dohme).

Monday, January 01, 2007

A Happy New Year to one an` all.
May the year ahead bring all that you desire and more.
If that includes a substantial lottery win my address is available on
request.

Best Wishes
Tony

Saturday, December 30, 2006

PCD Europe

Primary Care Diabetes EUROPE (PCD Europe)

PCD Europe (www.pcdeurope.org) exists to provide a focal point for primary care clinicians and their patients. Its purpose is to promote high standards of care throughout Europe. Emphasis is placed on incorporating evidence based medicine into daily practice as well as promoting diabetes education and research in primary care.

Monday, November 20, 2006

Diabetes News Links

 

Reducing The Risk Of Diabetes

Unlocking The Secrets Of Slowly Digestible Starch

STUDY

Fruit Yogurt Could Play An Important Role In Diabetes Management

 

Yogurt enriched with fruit or made from soy could play an important dietary role for people living with Type 2 diabetes and high blood pressure, suggests new findings by University of Massachusetts Amherst researchers.
Led by Kalidas Shetty, the UMass Amherst scientists screened extracts from a sampling of dairy and soy yogurts for properties that could help keep diabetes and hypertension in check, such as the activity level of enzymes that help moderate blood glucose levels. The researchers found that fruit-enriched yogurts-especially those made with blueberries or made from soy-contain active natural compounds that may curb some aspects of diabetes, the researchers report in an upcoming issue of the Journal of Food Biochemistry.............Continued ONLINE

Sunday, October 08, 2006

WELCOME TO DIABETES HEALTH ONLINE

Welcome to DiabetesHealthOnline

Recommended reading on what you need to know about diabetes.

Wednesday, September 13, 2006

DIEBETES MINE

DiabetesMine 

 

For journalist Amy Tenderich, being diagnosed with diabetes changed her life -- twice. The news itself transformed the way she regarded everyday things like meals and exercise. But when she sought information on how others cope with the disease, how people interpret new research and try new therapies, she became frustrated. So she created her own resource -- www.diabetesmine.com -- and in its short existence, her work has propelled her to the forefront of an online community of diabetics, healthcare experts, and researchers.

Thursday, September 07, 2006

UNDERSTANDING TYPE 2 DIABETES

Barry J. Goldstein, MD, PhD   

The Growing Epidemic of Type 2 Diabetes

Type 2 diabetes mellitus is a progressive metabolic disease that is becoming increasingly common in the United States. The number of Americans with type 2 diabetes more than doubled from 1980 to 2004.[1] According to the American Diabetes Association (ADA), approximately 20.8 million children and adults in the United States — 7% of the population — have diabetes. Although an estimated 14.6 million people have been diagnosed with diabetes, approximately 6.2 million are unaware that they have the disease.[2] The potential causes of this growing epidemic include an aging population, lifestyle changes, limited physical activity, obesity, and high caloric intake. Type 2 diabetes is a costly healthcare burden and a major cause of morbidity and mortality. In terms of medical expenditures and lost productivity, the cost of type 2 diabetes was estimated to be about $132 billion in 2002.[3]

Insulin resistance accounts for more than 90% of all type 2 diabetes cases.[4] The National Health and Nutrition Examination Survey (NHANES) estimated that one third of the US population between the ages of 40 and 74 years is insulin-resistant.[5] Insulin resistance is at the core of the pathogenesis of the metabolic syndrome and leads not only to insulin-stimulated glucose uptake with glucose intolerance or frank diabetes, but also to high triglycerides, low high-density lipoprotein cholesterol (HDL-C), high blood pressure, and increased cardiovascular risk.[6] Elevated blood glucose levels are diagnostic of type 2 diabetes. Clinical studies have demonstrated that diabetes itself is one of the major risk factors for coronary heart disease and micro- and macrovascular complications.[7-9]

Obesity, a growing epidemic in both adults and children, is a metabolic abnormality that is highly associated with the development of type 2 diabetes. The NHANES data indicated that the prevalence of obesity is also on the rise. In 2003 and 2004, 17.1% of US children and adolescents were overweight.[10] These data indicated that the age-adjusted prevalence of overweight and obesity among adults has increased from a level of 23% in NHANES III to a new level of approximately 32%.[11] These high incidences of overweight among children and obesity among adults remain a major public health concern, because they can lead to subsequent type 2 diabetes and cardiovascular disease. A recent study showed that individuals with onset of diabetes in youth (especially at younger than 20 years of age) had a 3-fold higher death rate than nondiabetic participants, compared with a 1.4-fold increased rate in individuals with onset of diabetes occurring at an older age.[12]

Pathophysiology of Type 2 Diabetes: A Dual-Defect Disease

Type 2 diabetes is a dual-defect disease characterized by insulin resistance and impaired beta-cell function. Glucose derived from dietary carbohydrate and hepatic glucose production is tightly regulated by insulin. Type 2 diabetes results from an imbalance between insulin sensitivity and insulin secretion.[13] In the diabetic condition, glucose production fails to be adequately regulated by insulin, leading to hepatic glucose overproduction and diminished glucose uptake by muscle tissue. In addition, accelerated gastric emptying and excessive lipolysis in adipose tissue also contribute to developing type 2 diabetes.[13] Over time, pancreatic beta cells fail to maintain their high rate of insulin secretion, leading to glucose intolerance, insulin resistance, and overt type 2 diabetes.[13] Various clinical syndromes are associated with insulin resistance, including obesity, type 2 diabetes, cardiovascular disease, essential hypertension, polycystic ovary syndrome, nonalcoholic fatty liver disease, certain types of cancer, and sleep apnea.

Treatment Goals and Options for Type 2 Diabetes

Glycemic control remains fundamental to treating diabetes. The UK Prospective Diabetes Study (UKPDS) demonstrated that intensive glycemic control with antidiabetes drugs reduces microvascular complications.[8] The availability of sensitive and inexpensive home glucose monitors has made it possible for patients with type 2 diabetes to monitor long-term glycemic control. Diabetes treatment guidelines recommend vigorously lowering glucose levels to attain near-normal glycemia in order to reduce micro- and macrovascular complications. The most recent recommendations of the ADA suggest that although the glycated hemoglobin (A1C) goal for patients with all forms of diabetes is < 7%, the goal for an individual patient is an A1C as close to normal (< 6%) as possible, because this level can be safely achieved without significant hypoglycemia.[14] The American College of Endocrinology recommends a similar A1C goal of ≤ 6.5%.[15,16]

Patients with type 2 diabetes have various treatment options available to control their glucose levels. In addition to therapeutic lifestyle changes that include diet and exercise, several classes of medications with different mechanisms of action are currently available. Advances in our understanding of the pathophysiology of diabetes, identification of the targets of antidiabetes medications, and pivotal clinical trials have all contributed to the development of antidiabetes treatment strategies — both monotherapy and combination therapy.[17-20]

The goal of pharmacotherapy is to control hyperglycemia and delay the comorbidities that are associated with diabetes. For type 2 diabetes, drugs that increase circulating insulin levels or decrease insulin resistance are used. Important considerations include the additional effects of medications on biomarkers of cardiovascular risk, and safety and tolerability issues. The following drugs effectively control glucose levels by differing mechanisms of action.[21]

Sulfonylureas: Sulfonylureas (glipizide, glyburide, glimepiride) reduce glucose levels by stimulating insulin release from the pancreas. However, they tend to cause hypoglycemia and can become less effective over time.[22]

Meglitinides: Meglitinides (nateglinide, repaglinide) are insulin secretagogues and act by stimulating insulin release from the pancreas. They have a short half-life and restore insulin levels following meals. However, compliance is an issue because they must be taken 3 times a day with main meals.

Biguanide: Biguanide (metformin) primarily acts by inhibiting hepatic glucose production and controlling glucose levels. Although it tends to cause less weight gain, gastrointestinal side effects may be significant. Additionally, this agent may not be effective in the long-term control of this chronic disease state.

Alpha-glucosidase inhibitors: Alpha-glucosidase inhibitors (acarbose, miglitol) delay the postprandial digestion of complex carbohydrates and thus inhibit postprandial hyperglycemia. These agents are associated with severe gastrointestinal side effects and are limited by their relatively weak efficacy in lowering A1C levels.

Thiazolidinediones (TZDs): TZDs (rosiglitazone, pioglitazone) bind and activate peroxisome proliferator-activating receptor-gamma, thereby improving insulin sensitivity and reducing hepatic glucose levels. Additionally, these agents have been shown to improve estimates of beta-cell function and provide sustained glycemic control. Unlike sulfonylureas, TZDs do not cause hypoglycemia or stimulate insulin release. However, TZDs may cause fluid retention and weight gain.

Combinations: A variety of combination therapies are used to treat type 2 diabetes with 2 agents with complementary mechanisms of action. Many of these combinations have demonstrated clinical success by improving glycemic control to recommended goals while offering better tolerability profiles, in many cases due to a reduced dose of 1 or both agents. Sulfonylureas have been used in combination with insulin-sensitizing medications, including metformin and TZDs, and have demonstrated significantly improved glycemic control.[8,23] TZDs, such as rosiglitazone and pioglitazone, in combination with metformin have been shown to improve glycemic control, insulin sensitivity, and beta-cell function.[24,25]

Insulin: Insulin is required for the management of type 1 diabetes and in many patients at the more advanced stages of type 2 diabetes. Insulin is administered in long-acting (basal), short-acting (mealtime), and premix (long- and short-acting) formulations. Relatively peakless long-acting recombinant insulin analogs have been helpful in restoring basal insulin needs (glargine, detemir). New forms of rapid-acting insulin — called insulin analogs (lispro, aspart, glulisine) — have a faster onset and shorter duration of action than regular insulin. They are used to lower mealtime glucose excursions. Inhaled insulin, which only contains rapid-acting human insulin, is also available. This is also used for mealtime glucose control and is taken before a meal.

Incretin mimetics and dipeptidyl peptidase (DPP)-IV inhibitors: Incretins, including glucagon-like peptide (GLP)-1, are hormones secreted in the gut in response to the absorption of glucose and they have multiple glycoregulatory actions. GLP-1 levels are reduced in patients with type 2 diabetes. Exenatide, an agent that mimics the effects of naturally occurring GLP-1, has been proven effective in improving glucose control by restoring the impaired glucose-dependent insulin secretion by the islet beta cells and suppressing islet alpha-cell glucagon secretion, 2 effects that contribute to hyperglycemia in diabetes. Exenatide also slows gastric emptying, leading to a better match between food absorption and insulin secretion, which leads to improved postprandial glucose control. Exenatide administration is associated with moderate weight reduction. Side effects include nausea, especially during the first week or two of use. The drug is administered via injection twice daily, and it is costly. Longer-acting GLP-1 agonists are in development and may provide an improvement over exenatide because they would only need to be injected once daily or weekly.

Another approach to enhance the action of GLP-1 in the body, currently under US Food and Drug Administration (FDA) review, is via the DPP-IV inhibitors. DPP-IV is the enzyme responsible for the degradation of GLP-1 in the bloodstream, and blocking the action of DPP-IV significantly prolongs the blood levels of this incretin. Levels of another incretin, glucose-dependent insulinotropic polypeptide, are also enhanced when DPP-IV is inhibited. Two new oral medications, vildagliptin and sitagliptin, have shown similar glycemic benefits as exenatide via beta-cell-stimulated insulin secretion, islet alpha-cell glucagon suppression, and slowing of gastric emptying. Unfortunately, these agents have not shown a significant effect on weight reduction.

What Does the Future Hold?

Perhaps the most important goal in the management of diabetes is preventing long-term complications. One approach is the primary prevention of diabetes altogether. To that end, a number of prevention studies have shown that oral antidiabetic agents or lifestyle interventions can significantly reduce the progression of impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) to overt diabetes. Other studies have shown reduced primary or secondary cardiovascular events in patients with type 2 diabetes who were using various interventions, including statins, antihypertensives, and TZDs.[26] In patients with established cardiovascular disease, pioglitazone showed some improvement of secondary cardiovascular endpoints in the Prospective Pioglitazone Clinical Trial In Macrovascular Events Study, but outcomes data in patients treated at earlier stages of the development of atherosclerosis are lacking. Due to increasing evidence that the prevention of diabetes and its complications may ultimately be a therapeutic possibility, several large-scale studies are under way that will help establish the best clinical approach to this goal. Clinical outcomes include the impact of intensive glycemic control on progression to diabetes, the benefits of early intervention, reduction of cardiovascular complications, and the improvement of beta-cell function.

The Diabetes Reduction with Ramipril and Rosiglitazone Medication (DREAM) study is designed to determine whether rosiglitazone and/or ramipril can delay or prevent the development of type 2 diabetes in those who have IGT and/or IFG who are at high risk of developing diabetes.[27] The Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) study is assessing the effect of valsartan and short-acting nateglinide in prediabetes patients.[28] The Actos Now for Prevention of Diabetes (ACT NOW) trial is evaluating the effect of pioglitazone in subjects with IGT and metabolic syndrome for improvement in insulin sensitivity, beta-cell function, body composition, and cardiovascular risk factors.[29] The A Diabetes Outcome Progression Trial (ADOPT) is designed to provide data on the differentiating effects of rosiglitazone, glyburide, and metformin on glycemic control, beta-cell function, and macrovascular disease risk.[30] These large-scale clinical trials may have a significant impact when their findings are reported over the next several years.

Conclusions

Type 2 diabetes is a major health problem in the United States. Consequently, the incidence of diabetes complications and cardiovascular diseases is also increasing and has a negative impact on public health and the economy. Therefore, it is important to control the growing epidemic of type 2 diabetes. Younger people are especially at risk for the long-term complications of diabetes when they acquire the disease at an early age. Glycemic control is one of the most important risk factors to contain the progression of type 2 diabetes and its associated microvascular complications, and glucose itself is likely to play a key role in macrovascular disease as well. In addition to therapeutic lifestyle changes, several pharmacologic options are available for the treatment of type 2 diabetes. Antidiabetes drugs effectively control glucose levels. Intensive glycemic control may be shown to help delay the progression of type 2 diabetes as well as to offer additional benefits, such as improved beta-cell function. Ultimately, we anticipate that type 2 diabetes and its complications will be effectively managed with a comprehensive treatment strategy that includes therapeutic lifestyle modifications and pharmacologic therapy aimed at glycemic control as well as reduction in cardiovascular risk.

Saturday, June 03, 2006

Increased Statin Dose Can Benefit Diabetics With Heart Disease

NEW YORK (Reuters Health) May 26 - Treating diabetics who have clinical signs of coronary heart disease with a high dose of atorvastatin (80 mg daily), rather than the normal dose of 10 mg daily, can lower the rate of major cardiovascular events by 25%, according to a report in the June issue of Diabetes Care.
In the main analysis of data from the Treating to New Targets (TNT) study, increasing the atorvastatin dose was shown to provide significant clinical benefits for patients with stable coronary heart disease. The focus of this subanalysis, conducted by Dr. James Shepherd of the University of Glasgow and colleagues, was to determine if this benefit applied to patients with heart disease and diabetes as well.
The study involved 1501 patients with baseline LDL-C levels of less than 130 mg/dL who were randomized to atorvastatin at a dose of 10 or 80 mg per day and followed for a median of 4.9 years. The primary endpoint was the time to a first major cardiovascular event, including death from heart disease, non-fatal MI, resuscitated cardiac arrest or stroke.
The final LDL-C levels reached in the 10- and 80-mg atorvastatin groups were 98.6 and 77.0 mg/dL, respectively.
The primary event rate in the higher dose atorvastatin group was 13.8%, significantly lower than the 17.9% rate noted in the lower dose group (p = 0.026). In addition, the higher dose was also linked to a delay in the occurrence of cerebrovascular events and any cardiovascular event.
Side effects were similar in both groups and no persistent elevations in liver enzymes were noted, the report indicates.
"Pending a definitive trial, these data suggest that the use of high-dose statin to achieve an LDL cholesterol level considerably lower than 100 mg/dL may be appropriate for patients with diabetes and coronary heart disease, irrespective of their initial LDL cholesterol level, age, duration of diabetes, or glycemic control," the authors conclude.
Diabetes Care 2006.

Tuesday, February 28, 2006

Novel Type 2 Diabetes Screening Program Helps Identify at-Risk Youth

Feb. 27, 2006 (Reno, Nevada) A new screening checklist may help identify children at risk for type 2 diabetes, according to a new study presented here at the annual meeting of the American College of Preventive Medicine. The checklist combined elevated body mass index (BMI) with other traditional risk factors, such as race/ethnicity, family history of type 2 diabetes, acanthosis nigrans, and hypertension."Our goal was to identify children ages 10 to 18 with type 2 diabetes, prediabetes, or metabolic syndrome, and to provide an intensive family-based healthy lifestyle program for children diagnosed with diabetes or prediabetes," said Elizabeth Tilson, MD, MPH, medical director of Community Care of Wake/Johnston Counties, North Carolina, a quality improvement program for Medicaid patients. Implementing the program required a collaborative community effort, involving private practitioners, the local health department, medical society, hospital, YMCA, and other agencies. Dr. Tilson and colleagues developed a screening checklist tool based on the American Academy of Pediatrics and American Diabetes Association guidelines with some modifications. Participating physicians were to screen all children aged 10 to 18 years for elevated BMI. Children with a BMI higher than the 85th percentile were assessed for the risk factors of race/ethnicity, family history of type 2 diabetes, acanthosis nigrans, and hypertension (defined as systolic blood pressure higher than the 90th percentile for age and height). If a child had one or more risk factors present in addition to a BMI higher than the 85th percentile, he or she was referred for a fasting blood glucose test and an oral glucose tolerance test. "Any child with a BMI higher than the 95th percentile was referred for a fasting blood glucose and a glucose tolerance test, even if no other risk factors were present because a BMI in this percentile is a strong risk factor for prediabetes or diabetes, Dr. Tilson said.A total of 89 physicians in 37 different practices used the new screening tool between July 2004 and December 2005. They referred a total of 747 children aged 10 to 18 years for laboratory tests during this 18-month period. At the start of the program, physicians referred fewer than 10 at-risk children per month for laboratory testing. By June 2005, however, physicians were referring about 50 children per month. Of the 747 children referred, 606 (81%) received fasting blood glucose and glucose tolerance tests. Considering the logistics of obtaining these tests in children, Dr. Tilson commented, "We were really excited about this. We thought 81% showed that the program was quite effective."Of the children who received laboratory tests, 272 (45%) had abnormal results. A majority of those children met criteria for metabolic syndrome with 3 or more factors present, such as elevated systolic blood pressure, triglycerides, and high-density lipoprotein levels, and impaired fasting blood glucose. Three children were diagnosed with type 2 diabetes (defined as a fasting blood glucose level higher than 126 mg/dL). "Of the kids that had abnormal lab results, keep in mind that the mean age of these children was 12. We are really dealing with a syndrome that used to only be seen in adults," Dr. Tilson stressed during her presentation.Children diagnosed with prediabetes or diabetes underwent a 12-week lifestyle intervention with their families, including educational classes and exercise coordinated with the YMCA and other organizations.Dr. Tilson identified several barriers to screening in private practice. "One barrier is actually parent refusal," she told Medscape. "Some parents don't want to acknowledge that their child is overweight or they aren't interested in any lifestyle interventions." She also cited time pressure on physicians. "The screening tool we have put together is to make [screening] as easy as possible in a busy clinic," Dr. Tilson said.Dr. Tilson added that physicians may not be identifying children at moderate risk for diabetes. "Physicians see so many kids that have BMIs off the chart greater than the 95th percentile so when we see kids with BMIs between the 85th and 95th percentile, we've been desensitized to referring them," she told Medscape.Commenting on Dr. Tilson's presentation, Neal Kohatsu, MD, MPH, president of the American College of Preventive Medicine, told Medscape, "The screening program is a thoughtful integration of medicine and public health. It involved working with other community constituencies to help identify populations at risk, so it was novel in that regard." He added, "I definitely think that this program could apply to many other settings where underserved children and minority populations are targeted. [The study results] would be useful information in developing a community-based diabetes screening program."The study was independently funded. The authors report no pertinent financial disclosures.Preventive Medicine 2006: Session 24 Submitted Abstracts Session. Presented February 24, 2006.Reviewed by Peggy Keen, PhD, FNP