Stem cells treat foot wounds
Filed under: Type 1, Type 2, Childhood, Adult Onset, Research, Care, Complications
Diabetic foot complications are responsible for many lower extremity amputations. But this last drastic step can be prevented up to 85 percent of the time with early diagnosis and proper care.
Now Thai researchers and physicians have shown using a patient's own stem cells can effectively heal chronic foot wounds. Diabetes patients with chronic foot wounds, aged 50-72, were injected with stem cells obtained from their own blood. Most excitedly, the wounds healed nicely within three to four months. The stem cell treatment also makes fiscal sense. According to this article, stem cell treatment for wounds in a patient with diabetes costs about $6,000, one-fifth the cost of conventional treatment for a leg wound.
Studies have shown primary care physicians often fail to examine the feet of patients with diabetes. It's a shame, as this step is the least costly and most effective way to prevent foot wounds and potential amputations. But at the same time, it is nice to know there is a promising, cheaper treatment utilizing patient-donated stem cells.
Diabetic trauma patients face hazards
Filed under: Type 1, Type 2, Research, Care, Complications
You may have heard that diabetics face a greater risk of complications during hospital stays. Well, now there's evidence that diabetics with trauma injuries are particularly at risk. That info comes courtesy of a large Pennsylvania study that looked at records for around 25,000 trauma patients, half with diabetes, the other half without. The study tracked the patients' progress over the course of almost twenty years. Impressive.What did they find? Twenty-three percent of the diabetic trauma patients experienced complications. That compares with only fourteen percent of non-diabetics. The diabetics also spent slightly more time in intensive care and were more likely to need ventilator support. The overall risk of infections was higher too - eleven percent versus six percent.
Good news: despite all this, the data did not suggest people with diabetes are more likely to die after a trauma injury. Nor did it suggest diabetics stay in hospital longer than non-diabetics. The team that conducted the study states that the next step would be to examine whether or not improved blood sugar control in diabetic trauma patients would impact these figures.
Read more about these findings by visiting MedPageToday or, for a brief summary, the Atlanta Journal-Constitution. Or check out the full report, published in Archives of Surgery (July, 2007).
[RESEARCH] Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial
Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus.
Design Prospective randomised controlled trial of self monitoring versus no monitoring (control).
Setting Hospital diabetes clinics.
Participants 184 (111 men) people aged <70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics. Major exclusion criteria were secondary diabetes, insulin treatment, previous self monitoring of blood glucose.
Interventions Participants were randomised to self monitoring or no monitoring (control) groups for one year with follow-up at three monthly intervals. Both groups underwent an identical structured core education programme. The self monitoring group received additional education on monitoring.
Main outcome measures Between group differences in HbA1c, psychological indices, use of oral hypoglycaemic drugs, body mass index (BMI), and reported hypoglycaemia rates.
Results 96 patients (55 men) were randomised to monitoring and 88 (56 men) to control. There were no baseline differences in mean (SD) age (57.7 (11.0) in monitoring group v 60.9 (11.5) in control group) or HbA1c (8.8 (2.1)% v 8.6 (2.3)%, respectively). Those in the monitoring group had a higher baseline BMI (34 (7) v 32 (6.2)). There were no significant differences between groups at any time point (12 months values given) in HbA1c (6.9 (0.8)% v 6.9 (1.2)%, P=0.69; 95% confidence interval for difference –0.25% to 0.38%), BMI (33.1 (6.4) v 31.8 (6.0); adjusted for baseline BMI, P=0.32), use of oral hypoglycaemic drugs, or reported incidence of hypoglycaemia. Monitoring was associated with a 6% higher score on the depression subscale of the well-being questionnaire (P=0.01).
Conclusions In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale.
Trial registration ISRCTN 49814766.
Accidental Diabetes Drug
Filed under: Type 2, Adult Onset, Drugs, Research
Much like a roadblock, but with a fortuitous outcome -- an experimental heart drug didn't achieve the primary goal of a late-stage trial but it did dramatically reduce the risk patients would develop diabetes.
The anti-oxidant, anti-inflammatory drug, the first of its kind, reduced the risk of developing diabetes by 64% and demonstrated a small but statistically significant reduction in blood sugar after 12 months. The study included data from 6,144-patients. The company believes this finding to be a serendipitous outcome, despite the initial shortcomings of the trial objective. They need to confirm it in a large clinical trial. The impressive diabetes results may come as a surprise to investors who have abandoned AtheroGenics or who have been betting the drug will fail.
Heart patients in the study received either 300 milligrams of the drug or a placebo on top of a host of standard-of-care medicines they were already taking, such as aspirin, cholesterol-lowering statins, blood thinners and/or diabetes medicines.
The drug had an undesirable impact on blood fats, raising bad LDL cholesterol by about 12% and lowering good HDL cholesterol by roughly the same amount. There were also some potentially troubling safety signals with a trend toward more heart failure in those taking the drug. In spite of the undesirable affects on blood lipids, the drug has a profound effect on diabetes. Further research will be conducted on the efficacy of this drug in reducing the risk of developing diabetes.
Running over the same old ground: exercise and diabetes
Filed under: Type 2, Lifestyle, Exercise, Daily News
Oh yawn, I thought to myself this morning. Upon turning on National Public Radio, I immediately heard what seems to be yet another report on diabetics and exercise. According to the results of a new study, the majority of people with Type 2 diabetes or at risk for it fail to follow through on their doctors' advice to get moving and get some good old-fashioned exercise to ward off the disease - or at least slow its progress. The study comes courtesy of a team of researchers at the University of Colorado, Denver. It's a sizable study, involving over 22,000 patients. The results are being published in Diabetes Care (February 2007) and basically conclude that fewer than forty percent of those advised to get exercise actually do so. Moreover, those most at risk are in fact the least likely to heed exercise advice. Dr. Elaine Morrato, who led both this study and an earlier one on a similar topic, says "People should exercise more, that story is out. What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise.'" Now, I hate to be a grumpy naysayer, but (to use an exercise-related metaphor) isn't this just a case of running over the same old ground? Is this study really contributing anything new? According to the NPR report, Morrato goes on to say that the results are "very pessimistic," but that she does not know the answer to what is perhaps the real question: how to change peoples' behavior. We already know there is a T2 diabetes epidemic going on. We already know that obesity and inactivity are to blame. Instead of studying the issue over and over, from every conceivable angle, shouldn't researchers be focusing on how to stop this national health train wreck that we're seeing? Am I being unreasonable? You tell me.
Diabetes and Pot
Filed under: Type 1, Type 2, Childhood, Adult Onset, Lifestyle, Drugs, Opinion, Support
A new study found smoked marijuana to be safe and effective at treating peripheral neuropathy, which causes great suffering among diabetics. Diabetic nerve disease, or "peripheral neuropathy," is the most common complication of diabetes, affecting up to 62% of Americans with diabetes.
This type of pain is caused by damage to the nerves and can make patients feel like their feet and hands are on fire, or being stabbed with a knife. This type of pain responds poorly to conventional pain medications -- even addictive, dangerous narcotics. In this randomized, double-blind, placebo-controlled trial, a majority of patients had a greater than 30% reduction in pain after smoking marijuana. For many, that level of relief means having a significantly improved quality of life and for some it actually permits return to careers cut short by debilitating symptoms of neuropathy.
Our government spends a lot of money campaigning the "War on Drugs" to convince us that marijuana is an addictive and dangerous drug. When the US Government assumes the responsibility to make my mind up for me - sometimes I fear the decision is made from a capitalist perspective and not entirely with my best interest in mind. There is nothing fair about taking away someone's ability to decide for himself. Everything about federal medical policy should be reconsidered, based on science, common sense, and simple human decency.
Post-op diabetes risk factors
Filed under: Research
In the January 2007 issue of the the journal Liver Transplantation, the official journal of the American Association for the Study of Liver Disease (AASLD), French scientists published an article suggesting a link between certain risk factors and new-onset diabetes mellitus (NODM) following liver transplantation.
Specifically, a history of impaired fasting glucose, obesity and hepatitis C infection -- when paired with the use of an of immunosppressant -- was shown to be associated with an increased risk of NODM.
The study, conducted by a team of researchers at the Hospital Paul Brousse in Villejuif, France, included 211 patients from 10 transplant centers who had undergone a liver transplant between October of 2003 and June of 2004. The patients' records were reviewed and their fasting blood sugar levels were recorded 3, 6, 12, and 18 months after the surgery. Those patients with NODM had their date of diagnosis noted, in addition to the immunosuppressive treatment and diabetes management they received.
The results demonstrated an incident of NODM of 22.7 percent, with most cases being diagnosed within three months after transplant surgery. Moreover, 12.4 percent of the patients with normal glucose levels before the surgery developed impaired fasting glucose.
[RESEARCH] Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial
Objective To assess the cost effectiveness of self monitoring of blood glucose alone or with additional training in incorporating the results into self care, in addition to standardised usual care for patients with non-insulin treated type 2 diabetes.
Design Incremental cost utility analysis from a healthcare perspective. Data on resource use from the randomised controlled diabetes glycaemic education and monitoring (DiGEM) trial covered 12 months before baseline and 12 months of trial follow-up. Quality of life was measured at baseline and 12 months using the EuroQol EQ-5D questionnaire.
Setting Primary care in the United Kingdom.
Participants 453 patients with non-insulin treated type 2 diabetes.
Interventions Standardised usual care (control) compared with additional self monitoring of blood glucose alone (less intensive self monitoring) or with training in self interpretation of the results (more intensive self monitoring).
Main outcome measures Quality adjusted life years and healthcare costs (sterling in 2005-6 prices).
Results The average costs of intervention were £89 (113; $179) for standardised usual care, £181 for less intensive self monitoring, and £173 for more intensive self monitoring, showing an additional cost per patient of £92 (95% confidence interval £80 to £103) in the less intensive group and £84 (£73 to £96) in the more intensive group. No other significant cost difference was detected between the groups. An initial negative impact of self monitoring on quality of life occurred, averaging –0.027 (95% confidence interval–0.069 to 0.015) for the less intensive self monitoring group and –0.075 (–0.119 to –0.031) for the more intensive group.
Conclusions Self monitoring of blood glucose with or without additional training in incorporating the results into self care was associated with higher costs and lower quality of life in patients with non-insulin treated type 2 diabetes. In light of this, and no clinically significant differences in other outcomes, self monitoring of blood glucose is unlikely to be cost effective in addition to standardised usual care.
Trial registration Current Controlled Trials ISRCTN47464659.
Willingness to manage chronic disease not reflective of reality
Filed under: Type 2, Adult Onset
A Roche Diagnostics survey found eight out of ten adults are willing to self-manage a future chronic condition such as diabetes or cardiovascular disease, but self-management in practice is not always a success story. Unfortunately, poor blood glucose management is reality for two out of five adults with diabetes, and this can lead to serious complications. Roche Diagnostics is leading a campaign for greater awareness of various tools to help patients self-manage chronic disease.
In 2005, only six percent of Diabetes UK patient members took the self-management training available to them. Six measly percent. Diabetes is a responsibility-laden disease. Annually, people with diabetes spend 8,757 hours managing their disease, and a mere three hours with their doctor. I never really thought about managing diabetes in terms of hours -- it can be one lonely disease, even with the love and support of family and friends. Roche Diagnostics does offer several innovative tools to manage the disease, but an insulin delivery system does not give you a hug or hold your hand on the difficult days.
Diabetes Nurse Consultant Debbie Hicks stated it is good news self-management is embraced by the public, but clearly many people with diabetes struggle as they fail to self-manage. Hicks pointed out successful self-management is a combination of correct treatment, reliance on monitoring systems, professional education and support. Don't forget those free hugs.
Surgeon Urges Diabetics to Take GABA
Filed under: Type 1, Type 2, Childhood, Adult Onset, Lifestyle, Products, Support
Dr. Daniel Johnson has been working to prevent lower limb amputation in diabetics and strongly urges all diabetics to start taking a nutritional supplement, GABA (gamma-aminobutyric acid) twice a day. The supplement has clinically proven to prevent and improve diabetic vision loss as well as peripheral neuropathy that can lead to amputation.
Researchers discovered that the cells in the pancreas that make insulin also make GABA. When the body produces less GABA, the GABA C receptors in the retina of the eye and in a part of the pituitary gland are impaired from maintaining cell health. With GABA supplementation, the improvements were seen in the vision of patients with diabetic retinopathy and in restoration of feeling in the feet of those with diabetic neuropathy. Awaiting clinical trials by the FDA to provide reversal of complications from a naturally occurring enzyme is simply unnecessary.
The problem in taking GABA by mouth, Dr. Johnson advised, is limited absorption from the digestive tract. He has found that people who take 375 to 500 mg. of plain GABA twice-a-day with an acid-containing beverage (like grapefruit juice) get the best results. If the diabetic patient cannot drink orange or grapefruit juice because of the sugar content, he recommends that they take the GABA with a dose of ascorbic acid -- Vitamin C.
While he would not give an endorsement, Johnson did say that his colleagues had found that Source Naturals 750 mg. tablet form of GABA (half a tablet twice a day) or Solgar's 500 mg. capsule form, also twice-a-day seemed to work best. Please note that the results from Dr. Johnson's use of GABA in the treatment of peropheral neuropathy and diabetic vision loss were clinically recognized but not FDA verified.