18 June 2008: Welcome to Diabetes bulletin, produced on a weekly basis by the Science Information team at Diabetes UK.
This is a round up of what is going on in the world of diabetes and diabetes-related topics.
Black asian minority ethnic (BAME)
Diabetes prevention in US ethnic minorities: role of the social environment
'Journal of the American Dietetic Society' (June 2008); 108 (6): 942-947. This commentary explores aspects of the American social and cultural environment that may play a part in the higher rates of Type 2 diabetes in people from ethnic minorities.
See also Obesity
Blood glucose
Effects of intensive glucose lowering in Type 2 diabetes: the ACCORD study
'New England Journal of Medicine' (12 June 2008); 358 (24): 2545-2559. This study found that unexpectedly, in the group of people being studied, intensive therapy increased mortality and did not significantly reduce major cardiovascular events. Read the full article.
Glycaemic control in Type 2 diabetes: not for sidelining
'Diabetic Medicine' (June 2008); 25 (6): 639-642. A review article looking at the evidence for glucose control as a corner stone of diabetes management, especially in light of the confusion created by the results of the ACCORD trial.
Intensive blood glucose control and vascular outcomes in patients with Type 2 diabetes: the ADVANCE collaborative group
'New England Journal of Medicine' (12 June 2008); 358 (24): 2560-2572. Intensive treatment that lowered the HbA1c levels in the target group to 6.5 per cent, resulted in a 10 per cent reduction in complications. This may have been due to a 21 percent reduction in nephropathy. Read the full article.
Intensive glycemic control in the ACCORD and ADVANCE trials: editorial
'New England Journal of Medicine' (12 June 2008); 358 (24): 2630-2633. A discussion of the two trials and what the outcomes mean. Concludes that health care professionals may ‘best serve our patients with Type 2 diabetes by implementing programs to help more of them reach the currently recommended goals.’ Read the full article
See also complications.
Care
Association of British Clinical Diabetologists (ABCD) and the Diabetes UK survey of specialist diabetes services in the UK 2006: the consultant physician perspective
'Diabetic Medicine' (June 2008); 25 (6): 643-650. This article concludes that ‘there are continued disparities in specialist service provision. Without effective commissioning and adequate specialist team staffing, integrated diabetes care will remain unattainable in many regions, regardless of reconfigurations and alternative service models.’
Honey in wound care: effects, clinical application and patient benefit
'British Journal of Nursing' (12 June 2008); 17 (11): S30-S36. Looks at the use of honey in the treatment of infected burns and wounds. Including its effects and clinical applications and the current dressings available.
Children and young people
Early-onset puberty in girls slowed by diabetes drug
'Medical News Today' website. In young girls at risk of early puberty and insulin resistance, the diabetes drug metformin delayed the onset of menstruation and decreased the development of insulin resistance, a risk factor for Type 2 diabetes, according to a new study. Read the full item.
Let them eat fish
'Diabetes Health' website. Eating a diet rich in Omega-3 fats may help keep high-risk children from developing Type 1 diabetes, a recent study published in the Journal of the American Medical Association suggests. Read the full item.
Sun and vitamin D levels may play a strong role in risk of Type 1 diabetes in children
'NewsMedical.net' website. Sun exposure and vitamin D levels may play a strong role in risk of Type 1 diabetes in children, according to new findings by researchers. Read the full item.
Complications
Diabetics twice as likely to suffer hearing loss
'Medical News Today' website. Hearing loss is about twice as common in adults with diabetes compared to those who do not have the condition, according to a new study funded by the National Institutes of Health (NIH). Read the full item.
Cardiovascular disease (CVD)
Glycemic targets and cardiovascular disease: editorial
'New England Journal of Medicine' (12 June 2008); 358 (24): 2633-2635. Discusses the implications of the action to control cardiovascular risk in diabetes (ACCORD) and action in diabetes and vascular disease (ADVANCE) trial results for cardiovascular disease in people with diabetes. Arguing that, ‘both studies are important contributions to the field but do not provide a definitive answer to the problem of glycemic control and cardiovascular disease.’ Read the full article.
Nurse coordinated multidisciplinary, family based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster randomised controlled trial
'Lancet' (14 June 2008); 371 (9629): 1999-2012. It is known that established risk factors are not treated enough and established treatments underused when it comes to cardiovascular disease. The study looks at improving this and shows that a ‘multidisciplinary intervention that emphasises established risk factors and treatments improves lifestyle and metabolic risk factors for cardiovascular disease.’ Read the abstract.
See also Women
Foot
A natural history and framework for managing diabetic foot ulcers
'British Journal of Nursing' (12 June 2008); 17 (11): S20-S29. Divides the natural history of diabetic foot ulcers into five stages and covers the full range of the condition. Highlights the importance of patient education, good control of blood glucose levels, lipids and blood pressure and how ‘aggressive management of foot ulceration will reduce the number of ... amputations in diabetic foot patients.’
Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale study a prospective cohort study
'Diabetic Medicine' (June 2008); 25 (6): 700-707. ‘Treatment of many patients is not in line with current guidelines and there are large differences betweeen countries and centres. The data suggests that current guidelines are too general and that healthcare organisational barriers and personal beliefs result in underuse of recommended therapies.’
Costs
Expenditure on diabetes treatments and achievement of glycaemic control: retrospective analysis
'Diabetic Medicine' (June 2008); 25 (6): 738-742. This study looked at whether there is a relationship between the prescribing costs of diabetes treatments and hitting the Quality and Outcome Framework targets for glycaemic control. It found that ‘at primary care organisation level, there is no association between weighted expenditure on diabetes treatments and achievement of glycaemic control targets.’ This suggests that a careful and evidence based approach is needed to the use of newer, more expensive treatments.
Diet
Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study
'BMJ' (14 June 2008); 336 (7657): 1348-1351. A Mediterranean diet which is rich in olive oil, plant based foods (fruits, vegetables and legumes) and fibre, but low in meat was found to be associated with a lower risk of Type 2 diabetes in initially healthy participants. Read the full article.
Big breakfast helped women lose weight
'Medical News Today' website. Researchers from Venezuela and the US found that women who had a big breakfast packed with carbohydrates and protein, and then followed a low carbohydrate, low calorie diet for the rest of the day, were more successful at losing weight and keeping the weight off than women on strict low carbohydrate diets. Read the full item.
Education
Effects of the Diabetes Manual 1:1 structured education in primary care
'Diabetic Medicine' (June 2008); 25 (6): 722-723. The Diabetes Manual resulted in a modest improvement in diabetes related distress and confidence to self care in the participants. However there was no change in glycaemic control. More research is needed to find out what the best form of structured education is and who would benefit from it most.
General interest
Companies’ use of web to recruit patients for studies brings opportunities, risks
'JAMA' (18 June 2008); 299 (23): 2733-2734. Pharmaceutical companies are starting to use websites to find patients for clinical trials. In the past patients have only been recruited through their physicians or advertisements asking them to contact the clinicians carrying out the trial. Recently websites listing clinical trials have become a popular way of recruiting volunteers. Now in a climate of cost cutting the pharmaceutical industry is becoming more aggressive and a whole sector has emerged focusing only on recruiting patients for trials, partly driven by health websites that collect and sell personal and medical information. Critics are concerned that patient privacy or the integrity of clinical research may be at risk. Read the abstract.
Ketosis prone Type 2 diabetes mellitus and human herpesvirus 8 (HHV-8) infection in sub-saharan Africans
'JAMA' (18 June 2008); 299 (23): 2770-2776. This study looked at an unusual form of Type 2 diabetes usually diagnosed when the individual suddenly develops ketosis and occurs commonly in patients who are black and of African origin. Findings indicate that the presence of HHV-8 antibodies was associated with this form of diabetes, so it may be associated with the viral infection. Read the abstract.
Snoring diabetics
'New Scientist' (14 June 2008); 198 (2660): 4. The International Diabetes Federation (IDF) is calling on doctors around the world who are treating people with sleep apnoea to test them for diabetes and vice versa. The link between the two is strong, ‘40 percent of patients with apnoea have diabetes, while about 23 per cent of diabetics have apnoea.’
Guidelines
Screening for Type 2 diabetes mellitus in adults: US preventive services task force recommendation statement
'Annals of Internal Medicine' (3 June 2008); 148 (11): 846-854. The updated recommendation suggests screening in adults with no symptoms and blood pressure above 135/80. Read the full article.
Screening adults for Type 2 diabetes: a review of the evidence for the US preventive services task force
'Annals of Internal Medicine' (3 June 2008); 148 (11): 855-868. There is a lack of evidence to support general population screening for Type 2 diabetes. Read the full article.
Mental health
Examining a bidirectional association between depressive symptoms and diabetes
'JAMA' (18 June 2008); 299 (23): 2751-2759. This study found that there was some association with having depressive symptoms and developing Type 2 diabetes, which could be explained in part by life style factors. It also found that those who were undiagnosed with Type 2 diabetes and had impaired fasting glucose had less depressive symptoms than those who had been diagnosed and were being treated for diabetes. Read the abstract.
NHS
Implementing a national quality assurance system for diabetes care: the Scottish diabetes survey 2001-2006
'Diabetic Medicine' (June 2008); 25 (6): 743-746.
Obesity
Obesity and intermediate clinical outcomes in diabetes: evidence of a differential relationship across ethnic groups
'Diabetic Medicine' (June 2008); 25 (6): 685-691. Found that obesity is more common in younger people than older people with diabetes in ethnic minority groups. The relationship between obesity and blood pressure control in diabetes varies a lot across different ethnic groups. The study highlights the importance of reducing obesity in the young and improving long-term outcomes.
Physical activity
Physical activity is associated with risk factors for chronic disease across adult women’s life cycle
'Journal of the American Dietetic Society' (June 2008); 108 (6): 948-959. The study indicates that ‘younger age and greater physical activity, despite age, are associated with fewer risk factors for chronic disease such as cardiovascular disease, Type 2 diabetes and obesity.’
See also editorial, Association of activity and chronic disease risk factors: utility and limitations of objectively measured physical activity data.
Pregnancy
Maternal vitamin D deficiency, ethnicity and gestational diabetes
'Diabetic Medicine' (June 2008); 25 (6): 678-684. Vitamin deficiency has been linked to impaired glucose metabolism in pregnant women. This study shows that maternal vitamin D levels are inversely related to fasting glucose, but further research is needed to clarify if there is a relationship with ethnicity.
Women
Diabetic women get less intense treatment of heart disease than men
'Medical News Today' website. Women with Type 2 diabetes and heart disease have poorer control of both diseases and receive less intensive medical treatment than do men, a large new study found. Read the full item.
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