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Diabetes in the News
Geriatric Times March/April 2003 Vol. IV Issue 2
Combination Therapy Enhances Glycemic Control
A recent multicenter, retrospective study was conducted in 318 U.S. endocrinology practices to examine the effects of combining pioglitazone (Actos) or rosiglitazone (Avandia) with metformin (Glucophage) in patients with type 2 diabetes. Characteristics of all patients were similar across all study groups (i.e., comorbidities, concomitant medications, pretreatment hemoglobin A1c [HbA1c], lipid levels). Patients received a combination of either pioglitazone and metformin (n=97) or rosiglitazone and metformin (n=96). The pioglitazone-metformin group had significant changes between pretreatment baseline and posttreatment follow-up (p<0.05) in triglyceride (-0.55 mmol/L), high-density lipoprotein (HDL) (+0.08 mmol/L) and low-density lipoprotein (LDL) (+0.13 mmol/L) concentrations; changes for total cholesterol concentration (+0.04 mmol/L) were not significant.
In comparison, the rosiglitazone-metformin group experienced significant changes in total cholesterol (+0.30 mmol/L) and LDL (+0.18 mmol/L) concentrations; changes in triglyceride (+0.25 mmol/L) and HDL (+0.04 mmol/L) levels were not significant.
The results demonstrated that the triglyceride levels of the pioglitazone-metformin group dropped a statistically significant 19.8% from baseline while levels in the rosiglitazone-metformin group increased by 10.8%. The pioglitazone-metformin group also showed a significant improvement in lipid profiles by increasing the mean HDL cholesterol by 7% from baseline. The mean increase in HDL cholesterol in the rosiglitazone-metformin group was not significant.
According to the National Diabetes Information Clearinghouse, approximately 17 million Americans have diabetes, and heart disease is the leading cause of diabetes-related deaths. Adults with diabetes are between two to four times as likely to die from heart disease than are adults without diabetes. The study authors noted, "These favorable changes in both triglyceride and cholesterol concentrations are important when making therapeutic decisions that may minimize the risk of CVD [cardiovascular disease] complications associated with type 2diabetes, insulin resistance and/or the metabolic syndrome"--RG
Education Improves Outcomes for Patients with Diabetes
Providing effective and appropriate education to people with diabetes enables them to self-manage the disease and is central to providing high-quality care. Unfortunately, adherence to self-management activities can be very demanding. People with diabetes may not realize how important these changes are in significantly increasing quality of life and reducing the risk of death.
One study, led by Annaswamy Raji, M.D., looked at the effects of intensive education in patients with HbA1c levels >8.5% (Arch Intern Med 2002;162:1301-1304). A person without diabetes usually has an A1c level <6%. An A1c level >7% indicates an excess of sugar. In fact, new research presented at last year's annual American Diabetes Association meeting suggested that every A1c percentage point above 7% sharply increases the risk of illness.
During the Raji et al. study, the intensive-education group received a structured curriculum by a multidisciplinary team of health care professionals for 3.5 days. The passive-education group received mailed material that provided basic information associated with diabetes management every three months. Both groups had their HbA1c levels checked every three, six and 12 months. A third group received no intervention and had their HbA1c levels measured at baseline and at 12 months. Results showed that both intense and passive education caused an approximate 2% decrease in HbA1c levels, compared with controls.
Management of diabetes is challenging and is predominantly behavioral, involving diet, activity, daily medication and glucose testing. Evidence shows that many people with diabetes do not know how to manage their condition. Intensive or passive education needs to be provided to patients with diabetes and those with high glucose levels--AR
Diet Including Whole Grains Reduces Risk of Diabetes
Growing evidence shows that type 2 diabetes can be delayed or prevented through diet and lifestyle improvements. Now comes a 12-year, prospective study of nearly 43,000 men ages 40 to 75 without histories of diabetes or cardiovascular disease demonstrating a reduced incidence of diabetes among those with diets of whole grain intake.
As part of the Health Professionals Follow-up Study, Teresa Fung, Sc.D., R.D., and colleagues compared the association of whole grain versus refined grain consumption and the development of type 2 diabetes (Am J Clin Nutr 2002;76[3]:535-540).
The researchers used questionnaires every four years to measure dietary intake, including types of grains consumed. At the end of the study, 1,197 men had developed diabetes. After accounting for age; physical activity; cigarette smoking; alcohol consumption; family history of diabetes; and fruit, vegetable and energy intakes, researchers found the relative risk of type 2 diabetes among men with the highest whole grain intake (3.2 servings/day) to be 42% lower than in those with the lowest whole grain intake (1/2 serving/day). Intake of refined grains was not significantly associated with risk of type 2 diabetes.
The authors of the study recommended increased whole grain intake but added, "After further adjustment for magnesium intake, cereal fiber intake, and glycemic load, the association between whole grains and type 2 diabetes was attenuated and the trend no longer significant," leading them to conclude that high consumption of cereals may offset the benefits of whole grain intake--JH
Poor Glucose Tolerance Linked to Old-Age Memory Loss
Results of a new study published in the February Proceedings of the National Academy of Sciences suggested a link between a prediabetic condition and old-age memory loss. People who do not process sugar normally were found to suffer from poor memory that might have resulted from shrinkage of the brain region crucial for recall.
Antonio J. Convit, M.D., and colleagues evaluated 30 adults, ages 53 to 89. None of the participants had diabetes, but some had impaired glucose tolerance.
After participants received glucose intravenously, the researchers measured how quickly the sugar was absorbed by tissue. Then the participants' memories were examined using the Wechsler Paragraphs recall test and other cognitive function tests.
Those with the lowest scores on the cognition tests had the poorest glucose tolerance. Low scores were also associated with a smaller hippocampus. The researchers suggested that the hippocampus' inability to absorb enough glucose might damage it and cause it to atrophy.
Convit, director of the Center for Brain Health at New York University, told the press that the results of the study might provide the final evidence needed to encourage aging baby boomers to eat healthily and exercise regularly. People who do both generally have healthier blood sugar levels.
Fran Kaufman, M.D., president of the American Diabetes Association, told the press that the small study requires confirmation. If the results are confirmed, she said, the same advice for lowering the risk for diabetes--healthy diet and daily exercise--will also apply to helping people protect their brains and maintain their memories--JK
