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Adverse Events. IN: Collaborative Islet Transplant Registry Fifth Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. pp 213-240.

This chapter on adverse events is from the 2008 annual report of the Collaborative Islet Transplant Registry (CITR) on islet/beta cell transplantation. CITR’s mission is to expedite progress and promote safety in islet/beta cell transplantation through the collection, analysis, and communication of comprehensive and current data on all islet/beta cell transplants performed in North America, Europe, and Australia. After a brief textual introduction, most of the information is presented in charts and figures. The chapter includes 20 tables and figures: percentage of recipients with an adverse event (AE) or serious adverse event (SAE) in year 1 after first infusion; total number of AEs and SAEs in year 1 after first infusion; IA, incidence of posttransplant AEs related to infusion procedure; IAK, incidence of posttransplant AEs related to infusion procedure; IA, incidence of posttransplant AEs related to immunosuppression therapy follow-up based on completed scheduled visits; incidence of posttransplant AEs related to immunosuppression therapy follow-up based on completed scheduled visits; percentage of recipients with a SAE in year 1 after first infusion by year of first infusion, all allograft recipients; SAE type by relatedness to islet infusion or immunosuppression; outcome of SAEs by relatedness to islet infusion or immunosuppression; most common SAEs MedDRA preferred term, islet-alone recipients; most common SAEs MedDRA preferred term, islet after kidney recipients; most common SAEs reported within 1 year of any infusion MedDRA preferred term, all allograft recipients; most common SAEs reported more than 1 year after any infusion MedDRA preferred term, all allograft recipients; summary of reported neoplasms; listing of reported hemorrhages and portal vein thromboses, all allograft recipients; number of days hospitalized at infusion (from admission to discharge) by infusion sequence, islet-alone recipients; number of days hospitalized at infusion (from admission to discharge) by infusion sequence, islet after kidney recipients; hospitalization experienced after last infusion by total number of infusions received, islet-alone recipients; and hospitalization experienced after last infusion by total number of infusions received, islet after kidney recipients. 3 figures. 26 tables.

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Childhood Diabetes Explosion. IN: LeRoith, D.; Vinik, A., eds. Controversies in Treating Diabetes: Clinical and Research Aspects. Totowa, NJ: Humana Press. 2008. pp 179-200.

This chapter about the recent explosion in childhood diabetes is from a book that addresses diabetes controversies, specifically in the etiology and management of the disease. The authors of this chapter contend that the rising incidence of type 2 diabetes (T2DM) in children is closely associated with the obesity explosion, which in turn is linked to an increased food supply and decreased physical activity. They call for more research on the complex interaction between genes, the environment, and the immune system that culminates in type 1 diabetes, which is also on the rise. They focus on the emergence of the diabetes explosion, the proposed pathogenic mechanisms, and potential interventions. They conclude by recognizing that this public health problem requires an all-encompassing effort involving greatly increased government, research, community, and individual commitments to prevent these disorders. 4 figures. 2 tables. 111 references.

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Diabetes And Obesity: Part 2. Diabetes Care. 31(1): 176-182. January 2008.

This is the fifth in a series of articles based on presentations given at the American Diabetes Association’s 67th Scientific Sessions in June 2007 in Chicago. This article focuses on presentations on the interrelationship between diabetes and obesity. Topics include obesity prevention and treatment, lifestyle modification for weight loss, prevalence of obesity, the prognosis for long-term survival for people with obesity, multidisciplinary interventions for obesity, minimizing the weight gain often associated with insulin therapy, weight gain in people with type 1 diabetes, analog insulins and weight gain, pramlintide, dyslipidemia, pharmacologic strategies for weight loss in individuals with type 2 diabetes, phentermine, the cannabinoid receptor blocker rimonabant, exenatide, weight loss diet recommendations, comorbidities associated with obesity and insulin resistance, the role of obstructive sleep apnea (OSA), polycystic ovary syndrome (PCOS), risk of cardiovascular disease (CVD), nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), lipotoxic heart disease, pregnancy and weight gain in women with diabetes, increasing incidence of diabetes diagnoses, insulin sensitivity, and the metabolic syndrome. The author provides the names and locations of the presenting researchers for readers who want to follow up and obtain additional information about the research summarized in this article. 13 references.

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Diabetic Foot. Diabetes Care. 31(2): 372-376. February 2008.

This is the sixth in a series of articles based on presentations given at the American Diabetes Association’s 67th Scientific Sessions in June 2007 in Chicago. This article focuses on presentations on the diabetic foot. Topics include diabetes and wound healing, the medical care of diabetic foot wounds, preventing amputation, the role of osteomyelitis, debridement, growth factor treatment, the use of offloading while an infection or ulcer heals, the interrelationship between stress and wound healing, new approaches to wound healing, evaluating for ischemia, moist wound healing, the treatment of chronic foot ulcers, the role of sensory neuropathy and loss of protective sensation in the feet, the stimulation of angiogenesis to promote wound healing, the prevention of foot wounds, the incidence of foot wounds in people with diabetes, rates of recurrence, the risk factors for amputation, the importance of patient education, measuring surface temperature of the foot as a prevention measure, footwear, and the use of larval debridement for ulcers infected with antibiotic-resistant organisms. The author provides the names and locations of the presenting researchers for readers who want to follow up and obtain additional information about the research summarized in this article. 38 references.

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Hypoglycemia And Employment/Licensure. Diabetes Care. 31(Suppl 1): S94. January 2008.

This brief position statement on hypoglycemia and employment or licensure is from the special supplement issue of Diabetes Care journal that contains the latest update of the American Diabetes Association’s (ADA) major position statement, “Standards of Medical Care in Diabetes.” Selected position statements are provided about certain topics not adequately covered in the standards. This position statement reprints the 1984 ADA policy on employment, which states that “any person with diabetes, whether insulin dependent or non-insulin dependent, should be eligible for any employment for which he/she is otherwise qualified.” The position statement notes that discrimination in employment and licensure against people with diabetes still occurs. The effects of diabetes, notably hypoglycemia, are unique to each individual. The position statement considers the incidence and impact of hypoglycemia on daily activities, concluding that people with diabetes should be individually considered for employment based on the requirements of the specific job. Factors to be considered in this decision should include the individual’s medical condition, treatment regimen, and medical history. 1 reference.

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Increasing Monofilament Examinations as a Means of Teaching Quality Improvement. Clinical Diabetes. 26(4): 167-169. Fall 2008.

This article reports on a pilot test of a longitudinal, skills-based curriculum that used the topic of diabetes to teach quality improvement (QI) techniques to the North Carolina Area Health Education Centers. The pilot test was conducted in partnership with the South East Area Health Education Centers (SEAHEC), based in Wilmington, NC, and responsible for providing educational programs for residencies in internal medicine, obstetric and gynecology, and surgery. The authors report on the development of the charter for the curriculum series, the development of the curriculum itself, assessment considerations, interventions, data collection, and the results of the pilot study. The intervention chosen for this proposal was the use of monofilament examination. Nurses would identify each patient with a “diabetes” sticker on the chart and a “date of monofilament exam” sticker on the intake sheet. Various other methods were used to improve the incidence of a monofilament examination being used. After a 2-week period of data collection, monofilament exam completion rates did improve. However, adherence rates to the proposed intervention by the residents were low over time. The authors conclude that the pilot project met some of the stated goals, including reviewing core topics in diabetes care and QI topics. The SEAHEC team was able to assess overall performance and collect real-time data after initiating their intervention. However, implementing any refinements in the health care providers’ intervention proved more difficult. Barriers faced by groups undertaking QI included low group buy-in and a shortage of personnel and time devoted to project work. 1 figure. 1 reference.

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Is Pancreatic Diabetes (Type 3c Diabetes) Underdiagnosed and Misdiagnosed?. Diabetes Care. 31(Suppl 2): S165-S169. February 2008.

This article, from a special supplement of Diabetes Care magazine that reports the proceedings of the 1st World Congress on Controversies in Diabetes, Obesity, and Hypertension (CODHy) held in Berlin in 2006, discusses pancreatic diabetes, known as type 3c diabetes. Exocrine pancreatic insufficiency is frequency associated with both type 1 and type 2 diabetes. The incidence of diabetes caused by exocrine pancreatic disease appears to be underestimated and may make up 8 percent or more of the general diabetes patient population. The authors review the multiple mechanisms by which nonendocrine pancreas disease can cause diabetes. Both regulation of beta-cell mass and physiological incretin secretion are directly dependent on normal exocrine function. The authors comment on the presence of genetic mutations that can induce both exocrine and endocrine failure. The authors conclude by calling for the adaptation of diagnostic and screening strategies to detect exocrine diseases at earlier stages and possibly to stop progression to overt exocrine and endocrine pancreas insufficiency. 1 table. 47 references.

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Liver, Kidney, Lipid, and PRA Effects. IN: Collaborative Islet Transplant Registry Fifth Annual Report. Bethesda, MD: National Diabetes Information Clearinghouse. 2008. pp 193-212.

This chapter on liver, kidney, lipid, and plasma renin activity (PRA) effects is from the 2008 annual report of the Collaborative Islet Transplant Registry (CITR) on islet/beta cell transplantation. CITR’s mission is to expedite progress and promote safety in islet/beta cell transplantation through the collection, analysis, and communication of comprehensive and current data on all islet/beta cell transplants performed in North America, Europe, and Australia. After a brief textual introduction, most of the information is presented in charts and figures. The chapter includes 20 tables and figures: incidence of abnormal liver function tests at any CITR scheduled time after first infusion, all allograft recipients; alanine aminotransferase (ALT; IU/L) before infusion and after last infusion; aspartate aminotransferase (AST; IU/L) before infusion and after last infusion; alkaline phosphatase (IU/L) before infusion and after last infusion; total bilirubin (mg/dl) before infusion and after last infusion; incidence of abnormal lipid tests at any CITR scheduled time after first infusion, all allograft recipients; total cholesterol (mg/dl) before infusion and after last infusion; high-density lipoprotein (HDL; mg/dl) before infusion and after last infusion; low-density lipoprotein (LDL; mg/dl) before infusion and after last infusion; triglycerides (mg/dl) before infusion and after last infusion; incidence of increase in serum creatinine (mg/dl) greater than 0.5 from baseline at any CITR scheduled time after first infusion; serum creatinine (mg/dl) before infusion and after last infusion; calculated creatinine clearance (ml/min/1.73m2) before infusion and after last infusion; estimated glomerular filtration rate (GFR; ml/min/1.73m2) before infusion and after last infusion; class I PRA percentage before infusion and after last infusion; change in class I PRA from before first infusion before subsequent infusion and after last infusion; class I PRA after last infusion, islet-alone recipients with complete graft loss; class I PRA after last infusion, islet-alone recipients without complete graft loss; class I PRA after last infusion nonimmunosuppressed, islet-alone recipients; and class I PRA after last infusion immunosuppressed, islet-alone recipients. 31 figures.

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Natural History of Cardiovascular Disease in Patients With Diabetes: Role of Hyperglycemia. Diabetes Care. 31(Suppl 2): S155-S160. February 2008.

This article, from a special supplement of Diabetes Care magazine that reports the proceedings of the 1st World Congress on Controversies in Diabetes, Obesity, and Hypertension (CODHy) held in Berlin in 2006, considers the natural history of cardiovascular disease (CVD) in patients with diabetes. The authors discuss possible reasons for the increased incidence of cardiovascular (CV) events in individuals with diabetes. They contend that although an increased prevalence of standard CV risk factors has been clearly documented in association with diabetes, diabetes-related abnormalities, particularly hyperglycemia, also play a role. Analysis of data from populations that included individuals with impaired glucose tolerance and impaired fasting glucose suggests that the pathogenic role of hyperglycemia on the blood vessel wall already exists in the early stages of glucose intolerance. Epidemiological data demonstrate that the effect of postprandial or postchallenge hyperglycemia on the risk of CVD is greater than the effect of fasting hyperglycemia. The authors conclude that the most appropriate targets in interventional trials would be postprandial hyperglycemia or A1C levels, which measure blood glucose levels over time. 1 figure. 1 table. 45 references.

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Acute Complications. IN: Beaser, R.S., ed. Joslin’s Diabetes Deskbook: A Guide For Primary Care Providers. 2nd ed. Boston, MA: Joslin Diabetes Center. 2007. pp 403-428.

This chapter on acute diabetes complications is from a book that gives primary care providers a comprehensive overview of diabetes care. The authors categorize the acute complications of diabetes, which can be categorized as relating to either very high glucose levels, called hyperglycemia, or very low glucose levels, called hypoglycemia. The chapter begins with a discussion of diabetic ketoacidosis (DKA), including the usual setting for DKA, pathogenesis, clinical presentation, DKA in patients with alcoholism, diagnostic tests used to confirm the presence of and monitor DKA, patient management issues, complications of therapy, and the importance of patient education. The chapter then discusses hyperosmolar hyperglycemic state (HHS) and lactic acidosis. A final section covers hypoglycemia, including incidence and precipitating factors, hypoglycemic unawareness, treatment concerns, and patient education. The authors caution that acute complications can occur with very little warning and that the best approach is for the patient to be aware of the symptoms and signs of these problems. 6 tables. 3 references.

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Cardiovascular and Metabolic Disease in Menopause: Exploring the Mechanisms. Review of Endocrinology. 1(3): 32-34. July 2007.

This article discusses strategies for the prevention of cardiovascular disease (CVD) and metabolic disease in menopause, including diet, exercise, and soy protein supplementation. The authors note that morbidity and mortality rates from CVD increase after natural and surgical menopause, and the incidence of diabetes dramatically increases after menopause. The authors review the components of metabolic syndrome, including insulin resistance, dyslipidemia, inflammation, vascular function, and adiposity; the role of hormone replacement therapy (HRT); and the use of soy protein. The classic method for counteracting the decrease in energy expenditure with the subsequent increase in abdominal adiposity with aging and menopause is with caloric restriction and exercise; the use of soy protein as a specific dietary supplement shows some promise in preventing the development of risk factors for CVD and metabolic disease in this population. 1 table. 51 references.

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Celiac Disease and Diabetes: Is There a Link?. Today's Dietitian. 9(7): 22-23. July 2007.

This article explores the interplay between celiac disease and type 1 diabetes mellitus, both immune-mediated illnesses that occur in genetically susceptible individuals. Having one of these diseases significantly increases one's risk of developing the other. The author briefly reviews the research in the last few decades that examines the genetic and environmental factors affecting the two disorders. Finding a link between these and other autoimmune diseases may result in improved screening and early detection, and in development of guidelines for prevention and, eventually, a cure. The author reviews some of the hypotheses that have been proposed to explain the worldwide increase in the incidence of type 1 diabetes since 1950. The final section considers celiac disease and the concomitant risk of developing various other autoimmune diseases, including type 1 diabetes, thyroid disease, and lupus erythematosus. 1 figure. References available by request (references@gvpub.com).

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Childhood Diabetes: A Moving Target. Diabetes Wellness News. 13(9): 1, 6. September 2007.

This patient education newsletter article reports on recent information about weight management and childhood obesity, with a focus on childhood type 2 diabetes. The author describes a recent study of a weight management program at Yale University called “Bright Bodies” that found the best results came from a family-based program that uses nutrition education, behavior modification, and supervised exercise. The author focuses on the importance of nurture––behavior and environment––in the prevention and management of health problems. The author summarizes two articles published in the Journal of the American Medical Association (JAMA). The first article reported on a study of the incidence of diabetes in youth in the United States, an incidence that is increasing, although at a lower rate than it is in the rest of the world. The second article was an editorial that addressed the idea that excess fat serves to stimulate and prolong autoimmune insulitis––inflammation of the pancreatic islet cells. The author of this newsletter article describes and comments on these professional articles, offering readers tidbits they can use in their own lives. 3 figures.

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Diabetes, the Metabolic Syndrome, and Ischemic Stroke: Epidemiology and Possible Mechanisms. Diabetes Care. 30(12): 3131-3140. December 2007.

Diabetes is a major risk factor for developing stroke, yet this risk is often not realized or understood by patients with diabetes. This article explores the potential underlying mechanisms that lead to increase incidence of stroke among people with diabetes. The authors consider metabolic syndrome and its components, the impact of diabetes and hyperglycemia on stroke outcomes, and current approaches to reduce and prevent stroke in this high-risk population. The article focuses primarily on type 2 diabetes because that is the type that affects the majority of those diagnosed with diabetes. Specific topics include insulin resistance, hypertension, hyperlipidemia, obesity, microalbuminuria, endothelial dysfunction and nitric oxide, hypercoagulability conferred by diabetes, and carotid intima-media thickness. 166 references.

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Diabetes: Disabling Disease to Double by 2050. Washington, DC: Centers for Disease Control and Prevention. 2007. 4 p.

This fact sheet presents statistics and information about the increasing incidence of diabetes in the United States. The fact sheet briefly reviews the different types of diabetes and the complications caused by the disease and then focuses on how diabetes can be prevented and controlled. Topics covered include the costs of diabetes, the role of the Centers for Disease Control and Prevention (CDC) in supporting state programs and monitoring research studies and epidemiology, the education programs of the National Diabetes Education Program (NDEP), prevention research, and strategies that target specific high-risk populations. The CDC is committed to ensuring that all people, especially those at greater risk for health disparities, will achieve their optimal lifespan with the best possible quality of health at every life stage. The CDC works with partners to provide data for public health decisions, inform the public about diabetes, and ensure good care and education for people with diabetes. A sidebar describes an improved health care delivery system that has been implemented in the state of Washington. Readers are referred to the CDC website at www.cdc.gov/diabetes and its toll-free number at 1–800–232–4636 for more information. 2 figures.

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DPP-4 Inhibitors: Review of Vildagliptin Phase 3 Data. Review of Endocrinology. 1(2): 47-51. June 2007.

This article reports on the Phase 3 research data on the DPP-4 inhibitor called vildagliptin. The authors note that the extensive clinical trial program has provided evidence of the consistent glucose-lowering efficacy of vildagliptin across a wide range of clinical uses. They describe monotherapy trials of vildagliptin in drug naïve patients, as well as combination therapy trials in which vildagliptin was added to existing oral antidiabetes therapy. Vildagliptin has also been added to existing insulin therapy with good results in patients with long-standing disease. Vildagliptin therapy was weight-neutral and well tolerated, with a low incidence of hypoglycemia. The authors conclude that vildagliptin has the potential to be a useful addition to the treatment options for people with type 2 diabetes. 2 figures. 1 table. 17 references.

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Epidemiology of Diabetic Neuropathy. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 7-30.

This chapter on the epidemiology of diabetic neuropathy is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of diabetic neuropathy. The authors stress that peripheral neuropathy is a devastating complication because of the debilitating symptoms it causes and the associated higher risk of other complications, particularly those involving the legs and feet. The authors review the prevalence, incidence, and risk factors for the seven types of diabetic neuropathy: distal symmetric polyneuropathy, autonomic neuropathy, nerve entrapment syndromes, proximal asymmetric mononeuropathy, truncal radiculopathy, cranial mononeuropathy, and chronic inflammatory demyelinating polyradiculopathy. They focus primarily on the first two types noted, reporting on a detailed literature search that they conducted. The predominant risk factor for diabetic neuropathy was found to be duration of disease. Other risk factors for neuropathy included smoking, age, and baseline coronary artery disease (CAD). They conclude that the epidemiology of diabetic neuropathy is not as well understood compared with other complications of diabetes, including retinal, renal, and CAD. 1 figure. 2 tables. 59 references.

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Hypoglycemia and the Autonomic Nervous System. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 379-388.

This chapter on hypoglycemia and the autonomic nervous system is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of diabetic neuropathy. The author notes that intensive diabetes management regimens have increased the incidence of severe hypoglycemic events, with resulting morbidity and even mortality. Hypoglycemia provokes a sequence of counterregulatory metabolic, neural, and clinical responses. For example, insulin secretion decreases whereas glucagon, epinephrine, norepinephrine, pancreatic polypeptide, cortisol, and growth hormone increase. Decreased symptom perception can be due to decreased autonomic nervous system activation, resulting in a cycle of hypoglycemic unawareness and decreased counterregulatory hormone responses to the hypoglycemia. The author concludes that the mechanisms of hypoglycemia-induced autonomic failure are not fully understood. 2 figures. 69 references.

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Influenza Vaccination: An Unmet Need in Patients With Diabetes. Clinical Diabetes. 25(4): 145-149. Fall 2007.

This article reviews the situation of influenza vaccination in people with diabetes. The authors note that people with diabetes are one of the at-risk groups recommended to get regular vaccination. However, the current level of vaccination falls far short of the 2010 national health objectives. The authors review the increasing incidence of diabetes, the impact of influenza in this population, vaccination outcomes in people with diabetes, vaccination recommendations, and strategies to increase the reach of influenza vaccination. Influenza vaccinations should be offered to all individuals with diabetes who are older than 6 months of age. Vaccination each year is required because of waning immunity and changes in the circulating strains of influenza viruses. The authors conclude that this simple, effective, and safe treatment can prevent an uncomfortable and potentially severe viral infection. 1 figure. 2 tables. 52 references.

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Insulin Analogs and Pregnancy. Diabetes Spectrum. 20(2): 94-101. Spring 2007.

Diabetes during pregnancy is a major risk factor for poor fetal, neonatal, and maternal outcomes; however, this risk can be greatly reduced by the early use of medical nutrition therapy (MNT) and insulin treatment. This article explores the use of insulin analogs and pregnancy, focusing on the newer, rapid-acting insulin analogs lispro and aspart. The author stresses that maintaining maternal glycemic as near to normal as possible reduces the risk of congenital anomalies, macrosomia, neonatal hypoglycemia, and large-for-gestational-age infants. Topics include pregestational diabetes; gestational diabetes mellitus (GDM); the use of NPH insulin during pregnancy; current categories for drug use in pregnancy; long-acting insulin analogs, such as glargine and detemir, problems with retinopathy and insulin analogs; concerns about congenital anomalies and insulin analogs; and macrosomia and insulin analogs. The author concludes that, when compared with human regular insulin, the rapid-acting insulin analogs are effective at reducing hyperglycemia during pregnancy, with a safety profile that resulted in a lower incidence of neonatal complications. The long-acting insulin analogs do not yet have sufficient safety evaluation in clinical studies to warrant their use during pregnancy. The article includes a patient treatment algorithm as a guideline for all insulin-requiring pregnant women with type 2 diabetes, GDM, or type 1 diabetes. 1 figure. 7 tables. 67 references.

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Mom? Dad? Meet Diabetes: Expert Advice on Life after Diagnosis. Diabetes Forecast. 60(10): 42-44. September 2007.

This patient education article, from a magazine for people with diabetes, offers advice for parents whose child has been recently diagnosed with diabetes. The author describes the growing incidence of diabetes, including type 2 diabetes, in children. The author reminds readers that diabetes education is an ongoing process and they will have time to learn as they go along. Parents who have been through the process share their tips and experiences in the article; they emphasize the importance of support groups, grieving, and working closely in tandem with health care providers. The author encourages parents to maintain their regular routines and to learn different approaches to achieving the appropriate care for their child. A sidebar lists three online information resources for parents. 2 figures.

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Probe to Bone: What Do the Data Tell Us?. Diabetes Care. 30(6): 1663-1669. June 2007.

This article is the second in a series of four articles about presentations at the World Congress on the insulin resistance syndrome (IRS), reviewing the relationship between insulin resistance and nonalcoholic fatty liver disease (NAFLD) and aspects of insulin resistance in children and adolescents. Topics include diagnostic approaches to NAFLD, the increases in hepatic free cholesterol and lipid peroxidation in NAFLD, the evaluation and management of NAFLD, tests used to diagnose and monitor liver function, management approaches, the avoidance of alcohol and drugs, correction of underlying risk factors, the problem of liver complications arising after bariatric surgery in obese patients, drug therapy for diabetes that may affect NAFLD, cardiovascular disease risk factors, diagnosing insulin resistance in childhood and adolescence, the incidence of metabolic syndrome, the impact of parents with insulin resistance on the incidence of metabolic syndrome in their children, the fetal origins of IRS, long-term complications of IRS, type 2 diabetes in youth, the spectrum of insulin resistance among obese children, nonalcoholic steatohepatitis (NASH) in children and adolescents, and insulin sensitivity changes during puberty. 53 references.

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Runaway Freight Train. Diabetes Wellness News. 13(11): 1, 3. November 2007.

This article, from a wellness newsletter for people with diabetes, responds to recent comments by Ann Albright, Ph.D., president-elect of Health Care and Education of the American Diabetes Association (ADA) who likened the epidemic of diabetes to a “freight train.” The author notes that Dr. Albright’s comments were prompted by several reports that came from the June 2007 ADA meetings, where statistics were reported that described an ongoing 5 percent annual increase in the incidence of diabetes. The author discusses statistics regarding the continuing increase in obesity, noting that the pattern of obesity in the United States is being closely mimicked by the worldwide incidence of overweight and obesity. There is a consideration of the paradox of so many people coping with obesity while 12 percent of the world’s population are still underfed. The author concludes by pondering what measures could possibly stop this “runaway train” of obesity and diabetes and by inviting readers to contribute their ideas. 1 figure.

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Therapies for Diabetes: Pramlintide and Exenatide. American Family Physician. 75(12): 1831-1835. June 15, 2007.

This article reviews the use of pramlintide and exenatide as part of a comprehensive program for diabetes management. Pramlintide (Symlin) and exenatide (Byetta) are injectable drugs that use the alternative hormones amylin and glucagon-like peptide (GLP-1), respectively, and that may make glycemic goals more attainable. Pramlintide, indicated for use in patients with type 1 or type 2 diabetes, is a synthetic analogue of human amylin that acts in conjunction with insulin to delay gastric emptying and inhibit the release of glucagon. Exenatide, a GLP-1 mimetic, has multiple mechanisms for lowering glucose levels, including the enhancement of insulin secretion, and is used in patients with type 2 diabetes. Both agents can reduce fasting plasma glucose levels and body weight. No studies are yet available that examine the effects of these therapies on diabetes complications, cardiovascular disease, or overall mortality. The author discusses dosing information, sites of action, and possible adverse effects for pramlintide and exenatide. The author reminds readers that the use of exenatide is somewhat limited because it is indicated only for those patients also taking metformin, a sulfonylurea, and/or thiazolidinedione. A high incidence of gastrointestinal adverse effects and cost may also limit its use. The author concludes by calling for additional clinical studies on both drugs. 2 tables. 21 references.

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Treatment of Children With Diabetes. IN: Beaser, R.S., ed. Joslin’s Diabetes Deskbook: A Guide For Primary Care Providers. 2nd ed. Boston, MA: Joslin Diabetes Center. 2007. pp 595-622.

This chapter on the treatment of children with diabetes is from a book that gives primary care providers a comprehensive overview of diabetes care. The authors review the epidemiology of diabetes in children, noting there is a wide variation in prevalence according to age and ethnicity. For example, youth from infancy to 9 years old have much lower rates than do youth 10 to 19 years old. Non-Hispanic white youth have the highest prevalence among younger children, whereas among youth 10 to 19 years old, black youth and non-Hispanic white youth have the highest rates. Recent epidemiologic data show rising incidence rates of both type 1 and type 2 diabetes in children. The chapter covers risk factors for type 2 diabetes; the team approach to patient care; the goals of treatment; insulin therapy in youth of all ages, including the use of insulin pumps; management strategies for youth with type 2 diabetes; monitoring diabetes control; nutrition education; a suggested physical activity program; and comorbidities in youth with diabetes, including nephropathy, hypertension, dyslipidemia, retinopathy, associated autoimmune conditions, and adjustment and psychiatric disorders. The authors conclude by encouraging readers to consider the treatment of a child with diabetes as providing the foundation for the treatment of an adult with diabetes. 3 tables.

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World Diabetes Day. Diabetes Forecast. 60(11): 41-44, 46. November 2007.

This article describes the United Nations World Diabetes Day, which is held in November and is a time to recognize the worldwide health epidemic of diabetes. American Diabetes Association author reviews the epidemiology of diabetes in the world, including the viewpoints of several editors and doctors from abroad. Situations vary greatly from country to country, but diabetes is increasing everywhere. Topics include the health care expenditures in different countries, concerns about adequate patient education and general public education about the disease, access to insulin and other medications in developing countries, and the theme and activities of American Diabetes Month. 1 figure.

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Can Your Neighborhood Cause Diabetes?. Diabetes Wellness News. 12(7): 1-2, 8. July 2006.

This article discusses the important contribution that one’s local neighborhood can make to preventing overweight and encouraging exercise. Several studies have shown that a good way to combat diabetes is to live in a town or neighborhood that is designed to make it easy to exercise regularly. These places make it easier to incorporate healthy activity into their everyday lives. This article is the first in a series of five articles designed to help readers choose a healthy community. The author reviews the amount of calories burned with regular daily walking, in the course of doing one’s regular errands. The article uses the five minute benchmark for walkability to common daily destinations. Readers are encouraged to get out into their community and walk, enjoying the more-human perspective from eye-level at a slower pace than in a vehicle. The author concludes by maintaining that suburban sprawl is responsible for the increasing incidence of type 2 diabetes. 3 figures.

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Chronic Complications. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 462-473.

With the rising incidence of diabetes, the diabetes health care community must make the prevention, delay, and reduction of chronic complications a major focus of attention. This chapter on chronic complications is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The chronic complications of diabetes include cardiovascular disease, neuropathy, nephropathy, retinopathy, foot complications, and dental and oral health problems. Combinations of multiple risk factors are responsible for the development of these chronic complications in people with diabetes; some of the risk factors can be modified, but others, such as heredity, cannot. Modifiable risk factors including hyperglycemia, hypertension, dyslipidemia, obesity, physical activity, smoking cessation, and excessive alcohol consumption are the target for diabetes treatment and self-management education. Some complications can be minimized and even avoided when attention is given to the underlying causes, such as inadequate blood glucose control, poorly control or uncontrolled blood pressure, and dyslipidemia. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 49 references.

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Conditions Contributing to the Risk of Diabetes Complications. IN: Silent Trauma: Diabetes, Health Status, and the Refugee: Southeast Asians in the United States. Bethesda, MD: National Diabetes Education Program. 2006. pp. 13-18.

The impact of type 2 diabetes on Southeast Asian (SEA) communities in the United States (a group that includes Cambodians, Hmong, Laotians, and Vietnamese) is driven by cultural, historical, and logistical factors. Though there is great diversity within the SEA subgroup, its members are united by a strong sense of their respective communities and a reverence for local leaders. This chapter on conditions contributing to the risk of diabetes complications is from a monograph written to increase awareness among health care providers, decision makers, and organizations serving Asian Americans of the risk for type 2 diabetes in SEAs. The monograph highlights data collection issues, barriers to care, and special health care needs, and then introduces successful models that can be used to reach and serve Southeast Asian populations. In this chapter, the authors discuss underrecognition of the risk of diabetes complications, high prevalence of tobacco use, and high blood cholesterol as conditions contributing to diabetes complications. The chapter includes a sample body mass index (BMI) chart, and another chart that summarizes the risk of co-morbidities based on BMI. The chapter concludes with a section on the incidence of stroke as a cause of morbidity and mortality for people with diabetes. One spotlight focuses on the cultural differences in perception of mental health (notably depression) and the implications for diabetes care. Relevant references are provided at the end of the monograph. 1 figure. 2 tables.

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Cystic Fibrosis-Related Diabetes. IN: Pediatric Diabetes: Health Care Reference and Client Education Handouts. Chicago, IL: American Dietetic Association. 2006. pp. 32-33.

Cystic fibrosis (CF) is a genetic disorder that affects the water and electrolyte composition of secretions from the sweat glands, airways, liver, and intestinal tract. As the mean survival of people with CF increases, there is also an increase in the diagnosis and incidence of glucose intolerance and cystic fibrosis-related diabetes (CFRD). This chapter on CFRD is from a resource book that provides health-care professionals with practical, age-appropriate diabetes self-management and nutrition education materials for children and adolescents with type 1 and 2 diabetes. In this chapter, the author discusses how CFRD develops, the diagnosis of CFRD, nutrition management in people with CFRD, and counseling suggestions for dietitians working with this population. Readers are advised that, if nutrition management principles for cystic fibrosis and diabetes conflict, more priority should be placed on the requirements for managing cystic fibrosis. Consistent blood glucose monitoring is vital. 5 references.

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Diabetic Retinopathy. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 291-318.

Diabetes mellitus is the leading cause of blindness in people between the ages of 20 and 74 in the United States, and diabetic retinopathy (DR) will eventually affect most people with type 1 diabetes. DR encompasses a wide spectrum of manifestations from mild to profound vision loss, and early screening and appropriate treatment determine prognosis. This chapter on diabetic retinopathy is from a comprehensive textbook on obesity and diabetes. The authors discuss the two types of DR, their prevalence and incidence, pathophysiology (including vascular remodeling and angiogenesis, chronic inflammation, apoptosis, platelets, vascular permeability factor), risk factors, screening and diagnostic considerations, complications of DR and the mechanisms of vision loss, prevention strategies, and treatment (both conventional as well as emerging and experimental treatments). The authors conclude that tight glycemic (blood glucose) control is the mainstay of current medical management. Appropriate surgical therapy with photocoagulation or vitrectomy can delay progression of the disease and preserve vision. 5 figures. 213 references.

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Diagnosed Diabetes Among American Indians and Alaska Natives Aged [Younger Than] 35 Years, United States, 1994-2004. Morbidity and Mortality Weekly Report. 55(44): 1201-1203. November 10, 2006.

The findings in this report indicate that, during 1994–2004, the prevalence of diagnosed diabetes doubled among American Indians or Alaskan Natives younger than 35 years old in the Indian Health Service health care delivery system. During 1994–2004, prevalence of diagnosed diabetes in this population increased from an age-adjusted 8.5 percent per 1,000 to 17.1 percent per 1,000, increasing by an average of 7.7 percent per year. This increase in diagnosed diabetes might be the result of the increased incidence of diabetes, increased screening for diabetes, or a combination of both. The editorial comment appended to the article reviews the limitations of the study and comments on the concerns raised by the study’s findings. If the increase in diagnosed diabetes indeed reflects an increase in the actual total prevalence, rather than just increased screening, that is of particular concern. Earlier onset of diabetes increases the lifetime duration of disease and thus the risk for costly and disabling complications. 2 figures. 1 table. 9 references.

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Dyslipidemia Associated with Diabetes and Insulin Resistance Syndromes. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 193-212.

In addition to having markedly increased risk of coronary heart disease (CHD), patients with type 2 diabetes have much worse outcomes after a major cardiovascular event. An understanding of the pathophysiology and treatment of modifiable metabolic abnormalities that often cluster with type 2 diabetes may help reduce the incidence of and mortality from CHD in this population. This chapter on dyslipidemia associated with diabetes and insulin resistance syndromes is from a comprehensive textbook on obesity and diabetes. The authors focus primarily on the dyslipidemia associated with type 2 diabetes and obesity as part of the insulin-resistant metabolic syndrome. The authors first provide an overview of the major lipoproteins and lipoprotein metabolism, then present the characteristics and mechanisms of dyslipidemia associated with diabetes and obesity. The authors review the lipid goals according to the American Diabetes Association (ADA) and Adult Treatment Panel III (ATP III) criteria and discuss lipid-lowering treatment options. Topics include the benefits of lifestyle modification, the mechanisms of action of the lipid-lowering medications available in the United States, and clinical trial data relevant to the management of patients with diabetes and the metabolic syndrome. The chapter includes a brief discussion of dyslipidemia associated with type 1 diabetes and with insulin-resistant states including human immunodeficiency virus (HIV) and polycystic ovary syndrome (PCOS). 4 figures. 3 tables. 77 references.

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Interventions to Normalize Blood Lipid Levels. Today's Dietitian. 8(4): 20-22. April 2006.

This article familiarizes dietitians which interventions that can be used to normalize blood lipid levels, particularly in their patients with diabetes mellitus. Diabetes carries with it an increased incidence of heart disease and stroke, but people with diabetes can reduce their risk for these cardiovascular diseases (CVD) is they are empowered to practice the skills necessary to control their blood lipid levels. Evidence supports the need for three to four medical nutrition therapy (MNT) visits with the registered dietitian (RD) to achieve optimal outcomes. Recommendations include following a heart healthy diet (as outlined by the National Cholesterol Education Program), incorporating higher dietary intakes of omega-3 fatty acids, ingesting moderate amounts of alcohol, sodium intake less than 2,400 milligrams per day, adequate intakes of dietary potassium, weight loss as needed (through reduced caloric intake and increased levels of physical activity), and moderate caffeine intake. Tables summarize the recommendations regarding essential components of the therapeutic lifestyle change diet. 3 tables.

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Native American Medicine. IN: Soumyanath, A., ed. Traditional Medicines for Modern Times: Antidiabetic Plants. Boca Raton, FL: CRC Press. 2006. pp. 169-178.

This chapter is from a textbook on antidiabetic plants, part of a series called Traditional Herbal Medicines for Modern Times. This volume is the first detailed compilation of information from across the world on plants used traditionally to treat diabetes and the scientific methods by which they can be and have been investigated. In this chapter, the authors present Native American medicine, focusing on the rise in prevalence of type 2 diabetes among Native Americans and the plants used to treat diabetes in North America. The bulk of the chapter consists of a chart of plants, including the plant’s Latin name, common name, part used, cultural affiliation, and reference that comments on the use of the plant. The authors conclude that new approaches are needed to slow the sharp rise in the incidence of diabetes among Native Americans. Several factors have been identified as playing contributing roles in the increase of diabetes, but dietary changes appear to be the most important influence. The reincorporation of traditional plant foods into the diet may help to reduce the incidence of diabetes because they may contain a number of beneficial phytochemicals. 3 tables. 54 references.

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Obese Kids More Likely to Have Diabetes. Nephrology News & Issues. 20(3): 20. March 2006.

This brief article reports on a recent study (February 2006, Diabetes Care) that estimated the prevalence of children with diabetes and that investigated the interrelationship of childhood obesity and diabetes. The study found that more than 229,000 children (approximately 3.2 cases for every 1,000 American children under the age of 18) currently have diabetes; one-third of those children are obese. The study used data from the National Survey of Children's Health (NSCH), a population-based household survey sponsored by the Maternal and Child Health Bureau, the National Center for Health Statistics, and the Centers for Disease Control and Prevention. The study found that among school-aged children, obese children have more than twice the risk of developing diabetes, compared with children of normal weight. Prevalence of diabetes was higher among older children and the disease was more common among non-Hispanic Caucasian children than non-Hispanic African Americans or Hispanic/Latino children. Data used for the study did not distinguish between type 1 and type 2 diabetes. The author concludes that these results point to a need for public health strategies to curb childhood obesity and thus reduce the number of children with diabetes.

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Obesity and Diabetes: The Historical Events Marking the Evolution of the Understanding of the Pathophysiology and Treatment of Two Related Diseases. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 3-14.

This introductory chapter is from a comprehensive textbook on obesity and diabetes. In this chapter, the authors review the historical events marking the evolution of the understanding of the pathophysiology and treatment of these two interrelated diseases. Topics include the origins of obesity and diabetes, the classical ages (500 BC to AD100), the scientific era (AD 1500 to the present), the path toward a treatment, recent discoveries for diagnostic and treatment approaches, and recent advances in genetics. The authors conclude that the incidence of obesity and diabetes is becoming increasingly prevalent at an alarming rate as the world embraces a Westernized lifestyle. Never before has there been a greater need to spread awareness of the risk factors associated with these diseases and to coordinate medical progress with cultural modification. Through the ongoing exploration of the biological mechanisms underlying these illnesses, researchers can hope to offer new treatment and prevention strategies for both obesity and diabetes. 38 references.

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Obesity, Diabetes and Risk of Cancer: A Review of Epidemiologic Studies. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 233-254.

Ample evidence indicates that overweight and obesity are associated with increased incidence of and mortality from most cancers. This chapter on obesity, diabetes, and risk of cancer is from a comprehensive textbook on obesity and diabetes. The authors summarize the mounting epidemiological studies that link overweight, obesity, and diabetes with cancer incidence and mortality. A review in 2002 by International Agency for Research on Cancer (IARC) concluded that there is sufficient evidence of a cancer-preventive effect of avoidance of weight gain for cancers of the endometrium, breast (in postmenopausal women), and colon (especially for men); renal cell carcinoma; and esophageal adenocarcinoma. Since that review, a large cohort study (the Cancer Prevention Study II), along with other studies, has provided evidence that obesity possibly may be a risk factor for other cancers as well, including those of the prostate, ovary, pancreas, and gallbladder; multiple myeloma; leukemia; and non-Hodgkin lymphoma. Overall, the current patterns of overweight and obesity in the United States have been estimated to account for 20 percent of all deaths from cancer in women and 14 percent in men. The authors conclude that, in view of the high proportion of cancer cases that could be prevented if the population maintained a healthy body weight, efforts to promote physical activity and healthful dietary practices are of substantial relevance for maintaining public health. 3 figures. 1 table. 146 references.

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Overview of Diabetes. IN: Katsilambros, N., et al. Diabetes in Clinical Practice: Questions and Answers From Case Studies. Somerset, NJ: John Wiley & Sons. 2006. pp 1-21.

This introductory chapter is from a book that deals with various aspects of diabetes in clinical practice, presented in the form of questions concerning diabetes diagnosis, management, and therapy, all based on real-life case studies. Topics covered in this overview include a definition of diabetes mellitus (DM), the different types of DM, the incidence of DM, epidemiology, genetics, the indications for performing a glucagon test, contraindications for glucagon testing, diagnosing disturbances of glucose metabolism, the oral glucose tolerance test (OGTT), the symptoms of type 2 diabetes, the symptoms of type 1 diabetes, the importance of good glycemic control, and the difficulties in achieving and maintaining high levels of glycemic control. The chapter presents seven case studies, which are individually discussed, and relevant questions are posed and answered. Readers are walked through the diagnostic and patient care management processes for the case studies presented. 6 tables. 11 references.

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Oxidative Stress And Vascular Complications of Diabetes Mellitus. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. pp 361-380.

This chapter about oxidative stress and vascular complications of diabetes is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The authors describe oxidative stress as excessive production of reactive-oxygen species (ROS) or pro-oxidant factors in the presence of diminished antioxidants. Antioxidant factors include vitamins, minerals, and enzymes that interact in a special biochemical chain to scavenge free radicals. The first section considers the pathophysiology of oxidative stress, diabetes, and vascular injury, including hyperglycemia, dyslipidemia, and insulin resistance. The authors describe clinical manifestations of diabetic angiopathy, including the microvascular complications of retinopathy and nephropathy and the macrovascular complications of coronary disease, cerebrovascular problems, and peripheral vascular problems. A final section considers possible treatment strategies for oxidative stress in diabetes. The authors conclude that as the incidence of diabetes reaches pandemic proportions, treatment approaches that target all components of this complex disease, including oxidative stress, will be needed. 2 figures. 155 references.

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Pregnancy with Preexisting Diabetes. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 233-257.

While the survival rates for infants of women with preexisting diabetes have risen, maternal and fetal complications continue to be higher than in the normal pregnant population. This chapter on pregnancy in women with preexisting diabetes is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The higher incidence of maternal and fetal complications are associated with poor glycemic control in preexisting diabetes. Optimal blood glucose levels are associated with lower perinatal mortality rates. Thus, the main strategies to improve outcomes for pregnant women and their babies are preconception counseling (to achieve optimal blood glucose before conception) and euglycemia throughout pregnancy. The woman will have the greatest success in maintaining optimal glycemic control throughout her pregnancy when working with a multidisciplinary team and receiving targeted self-management education. Key components of care include medical tests (of both the mother and fetus), and effective use of self-management skills. The author discusses healthy eating and appropriate weight gain during pregnancy, and stresses that breastfeeding should be recommended for all women without contraindications. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 9 tables. 67 references.

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Tight Control of Type 1 Diabetes: Recommendations for Patients. American Family Physician. 74(6): 971-978. September 2006.

This article reviews the recommendations that physicians should be providing to their patients with type 1 diabetes regarding blood glucose control. The authors stress that tight control of blood glucose levels and risk factors for cardiovascular disease can substantially reduce the incidence of microvascular and macrovascular complications from type 1 diabetes. Physicians play an important role in helping patients make essential lifestyle changes to reduce the risk of these complications. Patients should be counseled to: take control of daily decisions regarding their own health, focus on preventing and controlling risk factors for cardiovascular disease, tightly control blood glucose levels, be aware of potentially inaccurate blood glucose test results, use physiologic insulin replacement regimens, and learn how to manage and prevent hypoglycemia. Physicians are encouraged to take the time to explain each of these approaches with their patients, rather than just hand out a list of suggestions. Readers are referred to the ADA web site for patient education materials (www.diabetes.org). 3 tables. 50 references.

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Understanding Peripheral Neuropathy. Lupus Newslink. 18: 13-17. Summer 2006.

This article, from a newsletter for people with lupus erythematosus, describes peripheral neuropathy. Peripheral neuropathy (PN) is a failure of the nerves that carry information to and from the brain and spinal cord. This results in pain, loss of sensation, and inability to control muscles. The author discusses the causes, incidence and risk factors for PN (including diabetes mellitus), the typical symptoms, movement difficulties, autonomic symptoms (affecting involuntary or semi-voluntary functions such as control of internal organs and blood pressure), diagnostic tests that can be used to confirm the presence of PN, treatment strategies, safety issues, support groups, prognosis, and complications. The author concludes that all people can reduce the risk of neuropathy through a balanced diet, drinking alcohol only in moderation, and maintaining good control of diabetes and other medical problems. 2 figures. 1 table.

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Burden of Mortality Attributable to Diabetes: Realistic Estimates for the Year 2000. Diabetes Care. 28(9): 2130-2135. September 2005.

Routinely reported statistics based on death certificates seriously underestimate mortality from diabetes, primarily because individuals with diabetes most often die of cardiovascular and renal disease and not from a cause uniquely related to diabetes, such as ketoacidosis or hypoglycemia. This article reports on a study undertaken to estimate the global number of excess deaths due to diabetes in the year 2000. The authors used a computerized generic formal disease model (DisMod II), used by the World Health Organization to assess disease burden through modeling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, age-specific and sex-specific estimates of diabetes prevalence, and available published estimates of relative risk of death for people with diabetes compared to people without diabetes. The results showed that the excess global mortality attributable to diabetes in the year 2000 was estimated to be 2.9 million deaths, equivalent to 5.2 percent of all deaths. Excess mortality attributable to diabetes accounted for 2 to 3 percent of deaths in the poorest countries and over 8 percent in the United States, Canada, and the Middle East. In people aged 35 to 64 years, 6 to 27 percent of deaths were attributable to diabetes. The authors conclude that globally, diabetes is likely to be the fifth leading cause of death. 1 figure. 3 tables. 28 references.

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Chronic Disease in American Indian/Alaska Native Elders. IHS Primary Care Provider. 30(5): 120-123. May 2005.

This article describes a Native elder health data file that was derived from an ongoing Native elder needs assessment project at the National Resource Center on Native American Aging (NRCNAA). The Center undertook a collaborative project between the tribes and the NRCNAA to provide data to assist with designing and building long-term care infrastructure in tribal communities. In order to produce reliable data, systematic random sampling was used to select participants from larger tribal populations; reservations or tribes with smaller numbers of elders (n = 200 or less) were encouraged to involve all elders in the survey process. Results showed that Native elders had a greater prevalence of arthritis, asthma, breast cancer, congestive heart failure, diabetes, high blood pressure, prostate cancer, and stroke as compared with the United States general population over age 55. Older Native elders had a significantly greater prevalence of arthritis, cataracts, colon or rectal cancer, congestive heart failure, high blood pressure, prostate cancer, and stroke than elders in the youngest age group (55 to 64 years). In contrast, the prevalence of asthma and diabetes among Native elders significantly decreased with increasing age. The author notes that there may be simply few Native Americans with diabetes who live into their elder years. A targeted diabetes disease management program may help to increase the life expectancy of Native elders with diabetes by helping them better manage their disease and prevent comorbidities. 3 tables.

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Contraceptive Use By Diabetic and Obese Women. Women's Health Issues. 15(4): 167-173. July August 2005.

Women with chronic medical conditions are at increased risk for adverse pregnancy outcomes, yet contraceptive use by these women has not been well described. This article reports on a study undertaken to describe contraceptive use by women with diabetes and by overweight or obese women compared with women without these conditions. The authors used cross-sectional data from the 11 states participating in the Family Planning Module of the Behavioral Risk Factor Surveillance System (2000) to analyze contraceptive use among 7,943 sexually active women of reproductive age (18 to 44 years) who were not trying to conceive. Contraceptive nonuse was reported by 1,500 (18.9 percent) of the total sample, 31 (25.8 percent) of the women with diabetes, 371 (20.0 percent) of the overweight women, and 385 (23.4 percent) of the obese women. After analysis, obesity was significantly associated with contraceptive nonuse, but there were no significant differences in contraceptive nonuse for women with diabetes or overweight women. Older, Black, Hispanic, married, less educated, and women without health insurance were more likely to report contraceptive nonuse. The authors conclude that because women with chronic conditions like obesity are at higher risk of pregnancy-related complications and adverse pregnancy outcomes, proper contraceptive use and unintended pregnancy avoidance must become priorities in the patient care of these women. 3 tables. 25 references.

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Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired Glucose Tolerance. Annals of Internal Medicine. 142(5): 323-332. March 2005.

The Diabetes Prevention Program (DPP) demonstrated that interventions can delay or prevent the development of type 2 diabetes. This article reports on a study undertaken to estimate the lifetime cost-utility of the DPP interventions. The authors use a Markov simulation model to estimate progression of disease, costs, and quality of life. The interventions considered include intensive lifestyle, metformin, and placebo. The results showed that, compared with the placebo intervention, the lifestyle and metformin interventions were estimated to delay the development of type 2 diabetes by 11 years and 3 years, respectively, and to reduce the absolute incidence of diabetes by 20 percent and 8 percent, respectively. The cumulative incidence of complications were reduced and survival was improved by 0.5 years and 0.2 years. Compared with the placebo intervention, the cost per quality adjust life-years (QALY) was approximately $1100 for the lifestyle intervention and $31,300 for the metformin intervention. From a societal perspective, the interventions cost approximately $8,800 and $29,900 per QALY, respectively. From both perspectives, the lifestyle intervention outperformed the metformin intervention. The authors caution that simulation results depend on the accuracy of the underlying assumptions, including participant adherence.

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Cultural Issues in Diabetes Management in Pregnancy. IN: Thomas, A.M.; Gutierrez, Y.M., eds. American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association. 2005. pp. 93-100.

This chapter on cultural issues in gestational diabetes mellitus (GDM) is from a Guide that serves as a resource for health professionals involved in the care of women who develop diabetes during their pregnancy. The Guide helps readers to promote sound nutrition principles in GDM, to achieve optimal outcomes for the woman and her infant. The author of this chapter begins by summarizing the incidence of GDM nationally and globally, then identifies the cultural and ethnic issues that may influence patient care. The author outlines the use of the LEARN (listen, explain, acknowledge, recommend, negotiate) as an effective approach to patient education with people from different cultures. The author concludes that cultural competence is important in the care of the GDM patient. All women with GDM, regardless of their backgrounds, must receive medical nutrition therapy to promote normoglycemia, to avoid excessive or insufficient weight gain, and to meet their nutrient requirements. 23 references.

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Diabetes Management and Exercise in Pregnant Patients with Diabetes. Clinical Diabetes. 23(4): 165-168. Fall 2005.

Pregnancy in patients with diabetes is associated with an increased incidence of congenital anomalies in fetuses and spontaneous abortions in women with poor glycemic control. Therefore, normalizing blood glucose concentrations before and early in pregnancy can reduce these risks to levels of the general population. This article reviews diabetes management and exercise in pregnant women with diabetes. The authors focus on women with type 2 diabetes and those with gestational diabetes, although most of the recommendations are also appropriate for women with type 1 diabetes. Specific topics covered include monitoring blood glucose levels, the use of oral agents (notably sulfonylureas and biguanides), medical nutrition therapy, insulin therapy, exercise, and the role of preconception counseling. The authors conclude that in order to improve outcomes, pregnant women with diabetes should plan their pregnancies, maintain good metabolic control of their diabetes, exercise, and take folate daily. 2 tables. 23 references.

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Effects of Race and Region on Cardiovascular Morbidity Among Elderly Americans with Diabetes. Diabetes Care. 28(11): 2620-2632. November 2005.

Geographic region is known to influence the risk of cardiovascular disease (CVD) in the United States. This article reports on a study undertaken to determine the effects of race and region on cardiovascular morbidity among elderly Americans with diabetes. The retrospective cohort study used the Medicare claims of 126,153 white and 17,962 black patients with diabetes, aged older than 65 years in 1994, and followed them through 1999 for new acute myocardial infarction, ischemic heart disease, stroke, and heart failure. The incidence of any CVD ranged from 23.9 per 100 person-years among southern black men to 29.2 per 100 person-years among non-southern black women. The risk of CVD was lower among southern black men and women than their southern white counterparts. The authors conclude that among elderly Americans with diabetes, the incidence of CVD is unlikely to differ a great deal between whites and blacks. Residence in the South seems to confer a modest benefit for elderly black people with diabetes. 1 figure. 3 tables. 28 references.

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Elevated Liver Function Tests in Type 2 Diabetes. Clinical Diabetes. 23(3): 115-119. Summer 2005.

Individuals with type 2 diabetes have a higher incidence of liver function test (LFT) abnormalities than individuals who do not have diabetes. This article reviews the pathology, incidence, causes, and drug therapy related to type 2 diabetes and elevated LFTs. Mild chronic elevations of transaminases often reflect underlying insulin resistance. Elevation of transaminases within three times the upper limits of normal is not a contraindication for starting oral antidiabetic or lipid-modifying therapy. In contrast, antidiabetic agents have generally been shown to decrease alanine aminotransferase levels as tighter blood glucose levels are achieved. The most common cause of elevated LFTs in type 2 diabetes patients in non-alcoholic fatty liver disease (NAFLD). Hepatitis C virus (HCV), the leading cause of liver disease in the United States, is a known independent predictor of type 2 diabetes. The author notes that, for diabetes patients over the age of 40 years, and certainly in the setting of multiple cardiovascular risk factors or know cardiovascular disease, the potential risk of statin therapy (hepatotoxicity) is far outweighed by the proven benefit from CVD risk reduction. The author concludes by reviewing relevant research studies on the use of oral antidiabetes agents in type 2 diabetes patients with elevated transaminases.

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Erectile Dysfunction. Clinical Diabetes. 23(3): 105-113. Summer 2005.

Erectile dysfunction (ED) affects approximately 30 million men in the United States to some extent. ED may indicate the presence of a serious underlying medical condition, such as cardiovascular disease, diabetes, or depression. ED can compromise multiple aspects of a patient's life, including overall quality of life and interpersonal relationships. This article reviews ED in men with diabetes. The incidence of ED in this patient population increases with advancing age, and it occurs at an earlier stage than age-matched counterparts without diabetes. Clinicians need to be aware of the underlying pathophysiology of ED in diabetes in order to ensure the best possible outcomes in managing this problem. Topics include prevalence and pathophysiology of ED, endothelial dysfunction, the International Index of Erectile Function, the significance of ED in patients with diabetes, ED management strategies, drugs used to treat ED, intracavernosal therapy, intraurethral prostaglandin therapy, vacuum-constriction devices, surgery, beta blockers, and androgen therapy. The authors also remind readers of the importance of screening for cardiovascular disease in patients who present with ED. Follow-up at regular intervals and reassessment of all patients receiving treatment for ED is highly recommended. 1 figure. 5 tables. 31 references.

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Exenatide Versus Insulin Glargine in Patients with Suboptimally Controlled Type 2 Diabetes. A Randomized Trial. Annals of Internal Medicine. 143(8): 559-569. October 2005.

This article reports on a study that compared the effects of exenatide and insulin glargine (both injectable drugs) on blood glucose control in patients with type 2 diabetes mellitus that is suboptimally controlled with metformin and a sulfonylurea (oral hypoglycemic agents). The 26-week multicenter, open-label, randomized, controlled trial utilized 82 outpatient study centers in 13 countries and included 551 patients with type 2 diabetes and inadequate glycemic control. Inadequate glycemic control is defined as hemoglobin A1c (HbA1c, a measure of blood glucose over time) level ranging from 7.0 percent to 10.0 percent, despite combination metformin and sulfonylurea therapy. Baseline mean HbA1c level was 8.2 percent for patients receiving exenatide and 8.3 percent for those receiving insulin glargine. At week 26, both exenatide and insulin glargine reduced hemoglobin A1c levels by 1.11 percent. Exenatide reduced postprandial glucose excursions (changes in blood glucose levels after a meal) more than insulin glargine, while insulin glargine reduced fasting glucose concentrations more than exenatide. Body weight decreased 2.3 kilograms with exenatide and increased 1.8 kilograms with insulin glargine. Rates of symptomatic hypoglycemia were similar, but nocturnal hypoglycemia occurred less frequently with exenatide. Gastrointestinal symptoms were more common in the exenatide group than in the insulin glargine group, including nausea (57.1 percent versus 8.6 percent), vomiting (17.4 percent versus 3.7 percent) and diarrhea (8.5 percent versus 3.0 percent). The authors conclude that exenatide and insulin glargine achieved similar improvements in overall glycemic control in this patient population. Exenatide was associated with weight reduction and had a higher incidence of gastrointestinal adverse effects than insulin glargine. 3 figures. 3 tables. 34 references.

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Hepatitis C Virus Infection and Type-2 Diabetes Mellitus in Renal Diseases and Transplantation. Alimentary Pharmacology and Therapeutics. 21(6): 623-632. March 2005.

This review article addresses the potential link between hepatitis C virus (HCV) infection and the development of type 2 diabetes mellitus in patients with renal disease and transplantation. The authors found that the unadjusted odds ratio for developing post-transplant diabetes mellitus in hepatitis C virus-infected renal transplant recipients ranged between 1.58 and 16.5 across the published studies. The rate of anti-hepatitis C virus antibody in serum was higher among dialysis patients with diabetes mellitus. Patients with type 2 diabetes-related glomerulonephritis had the highest anti-hepatitis C virus prevalence in a large cohort of Japanese patients who underwent renal biopsy. The authors contend that the link between HCV and diabetes mellitus may explain, in part, the detrimental role of HCV on patient and graft survival after liver transplantation or renal transplantation. The authors conclude that preliminary evidence suggests that anti-viral therapies prior to kidney transplantation and new immunosuppressive regimens may lower the occurrence of diabetes mellitus in HCV-infected patients after kidney transplantation.

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High Risk on the Borderline: Type 2 Diabetes Rates Are Twice as High Along the U.S.-Mexico Border. Diabetes Forecast. 58(9): 70-71. September 2005.

This brief article describes the incidence of type 2 diabetes along the United States-Mexico border and the health promotion efforts that are being undertaken in this area. The 'border region' extends 60 miles on either side of the 2,040 mile-long border. Data released in 2004 showed that approximately 1.2 million of the 8 million border region residents have type 2 diabetes. In addition, 14 percent of the border population has pre-diabetes and more than half of the adult population is overweight or obese. The author notes that a combination of factors including ethnicity, diet, and limited access to health care put residents there at higher risk. The article concludes with a brief description of the second phase of the U.S.-Mexico Border Diabetes Prevention and Control Project, which will concentrate on improving health care along the border, teaching diabetes management to patients and their families, and using community organization to educate residents and encourage healthier habits.

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Identifying Children at Risk for Obesity, Type 2 Diabetes, and Cardiovascular Disease. Diabetes Spectrum. 18(4): 213-220. Fall 2005.

Health care providers need to recognize the critical periods for the development of childhood obesity for initiation of interventions to prevent obesity. Treatment options once obesity occurs are limited. This review article provides information to assist health care providers in identifying those children and adolescents more vulnerable to becoming obese and developing associated comorbidities. Greater body weight predisposes children to many of the medical complications of obesity that are also found in adults, including hypertension, dyslipidemia, impaired glucose metabolism, and hyperinsulinemia. Race, genetic predisposition, sedentary lifestyle, duration of overweight, and underlying conditions are major determinants of risk for type 2 diabetes and cardiovascular disease (CVD). The authors note that the appropriate risk stratification for adolescents could guide clinicians in recognizing overweight youth who are at higher risk of developing prediabetes, diabetes, or cardiovascular disease (CVD) and lead to a prompt intervention. Stratification of adolescents based on severity of overweight, estimates of beta cell activity and insulin resistance, and cardiovascular risk profile may be useful for the longitudinal follow-up of overweight youth. The authors conclude by encouraging health care providers of overweight children to pursue efficient screening procedures earlier in the progression of overweight in order to prevent adolescents from developing these diseases. 4 tables. 53 references.

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Impact of ACE Inhibitors or Angiotensin II Type 1 Receptor Blockers on the Development of New-Onset Type 2 Diabetes. Diabetes Care. 28(9): 2261-2266. September 2005.

ACE inhibitors and angiotensin receptor blockers (ARBs) have been used for years to reduce the rate of diabetic nephropathy (kidney disease) progression in patients with type 2 diabetes. This article reports on a meta-analysis that was conducted to determine the impact of ACE inhibitors or ARBs on the development of new-onset type 2 diabetes itself. The reviewers identified 11 trials, including 66,608 patients, for inclusion in the analysis. The use of an ACE inhibitor or an ARB had a positive impact on the development of new-onset type 2 diabetes. The influence of either an ACE inhibitor or an ARB alone on new-onset type 2 diabetes was similar. Regardless of the original indication for use, i.e., hypertension, coronary artery disease, or heart failure, reductions in new-onset type 2 diabetes were maintained. ACE inhibitors and ARBs did not reduce the odds of mortality, cardiovascular, or cerebrovascular events versus control therapy among all of these studies combined or the hypertension trials. ACE inhibitors and ARBs did reduce the odds of these outcomes among the coronary artery disease studies versus control therapy. 3 figures. 1 table. 22 references.

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Incidence of Type 2 Diabetes in the Randomized Multiple Risk Factor Intervention Trial. Annals of Internal Medicine. 142(5): 313-322. March 2005.

Weight loss and increase physical exercise reduce the risk for diabetes in people with impaired glucose tolerance (IGT), however evidence on the effects of these interventions on people without IGT is lacking. This article reports on a study undertaken to examine the influence of a comprehensive intervention program on the risk for developing diabetes in men without IGT and in a post hoc subgroup analysis by baseline cigarette smoking status. The study included 12,866 men aged 35 to 57 years, at risk for cardiovascular disease, who were randomly assigned to either a special intervention or usual care group and followed for 6 to 7 years. This article reports on 11,827 men from this group who were without diabetes or IGT at entry and for whom follow-up glucose measurements were available. Men in the special intervention group were counseled to change diet (reduce saturated fat, cholesterol, and calorie intake), to stop smoking, and to increase physical activity. Blood pressure was treated more intensively in the special intervention group than in the usual care group. Results showed that 11.5 percent of the special intervention group and 10.8 percent of the usual care group developed diabetes over 6 years of follow-up. The authors conclude that weight gain after smoking cessation and the use of antihypertensive drugs may have counterbalanced the beneficial effect of the lifestyle intervention for the special intervention group smokers, while the lifestyle intervention was beneficial among nonsmokers. 1 figure. 5 tables. 52 references.

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National Diabetes Fact Sheet, United States, 2005. Phoenix, AZ: Centers for Disease Control and Prevention. 2005. 10 p.

Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications. This lengthy fact sheet reviews the different types of diabetes, treatment strategies, the problem of prediabetes, the prevalence and incidence of diabetes in the United States (including differences between ethnic groups), the epidemiology of diabetes complications, and the importance of management and prevention approaches to minimize the impact of diabetes complications. The direct and indirect costs of diabetes are also estimated. The fact sheet concludes with a list of the web site addresses of organizations that collaborated in compiling the information for the fact sheet and with a glossary of related terms. 6 figures.

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Pramlintide Use in Type 1 Diabetes Resulting in Less Hypoglycemia. Diabetes Spectrum. 19(1): 50-52. Winter 2005.

This article presents a case report of a 49 year old white male who has had type 1 diabetes for 43 years, and been on an intensive insulin regimen since 1982. The author describes the inclusion of pramlintide to help this patient reduce his incidence of hypoglycemia, which had intensified over the years and even resulted in an automobile accident in 2003. The author presents the case report and then lists the questions that the health care provider must consider. The discussion section offers strategies to improve this patient's care and diabetes control. Pramlintide is an analog of the naturally occurring pancreatic hormone amylin, which works with insulin to suppress glucagon secretion and to regulate gastric emptying. The case report patient had widely fluctuating blood glucose levels, frequent hypoglycemia, persistent postprandial hyperglycemia, and weight gain, despite intensive insulin regimens and skillful diabetes self-management. The author reports on the case patient's management during 18 months on pramlintide (in addition to his regular insulin regimen); since starting pramlintide, the patient's HbA1c has improved, his weight is stable, and he has had less hypoglycemia and less fluctuation in his blood glucose levels. Patient care strategies, including administration and dosing suggestions, are provided. 3 tables. 5 references.

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Prevalence and Incidence of Diabetes in HIV-Infected Minority Patients on Protease Inhibitors. Journal of the National Medical Association. 97(8): 1088-1092 p. August 2005.

This article reports on a study of the prevalence and incidence of diabetes in minority patients infected with HIV on protease inhibitors (PIs). In people infected with HIV the use of protease inhibitors is associated with a constellation of abdominal obesity; buffalo hump; decreased facial and subcutaneous fat; hyperlipidemia and type 2 diabetes mellitus, a so-called HAART-associated dysmetabolic syndrome. The authors reviewed 101 charts of people infected with HIV who visited an inner-city HIV outpatient clinic. Three years later (2002) the same patient charts were reviewed for evidence of new-onset diabetes. Ten percent of the subjects were identified as having diabetes at baseline. The prevalence of diabetes was 12 percent among those who were taking PIs, compared to 0 percent among those who were not taking PIs. The incidence of newly diagnosed diabetes during this 3-year period was 7.2 percent. Diabetes occurred only in the group taking PIs. 2 tables. 21 references.

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Proteases and the Diabetic Foot Syndrome: Mechanisms and Therapeutic Implications. Diabetes Care. 28(2): 461-471. February 2005.

Diabetic foot syndrome represents a major problem in the health care of people with diabetes. This review article summarizes the current status of research on diabetic foot syndrome and describes new implications for the treatment of this syndrome. The authors stress that understanding the cellular and molecular abnormalities that contribute to the diabetic foot syndrome will enable the development of treatments that can reduce the incidence and severity of this major complication. Topics include the biology of normal wound healing, the pathogenesis of wound healing in chronic wounds, cytokines and growth factors in wound healing, the role of MMPs (matrix metalloproteinases) in wound healing, abnormal levels of MMPs in chronic wounds, and clinical studies of growth factors and protease inhibitors, including the implications for local therapy with protease inhibitors. The authors conclude that most diabetes-related foot ulcerations can be prevented by educating and informing patients. However, once a wound develops, approximately 70 percent of neuropathic foot lesions in people with diabetes can achieve healing by structured and stage-related therapy (off loading) and removing the barriers to natural healing. When more advanced therapies are needed to promote healing, the treatments chosen should be based on correcting the molecular defects, including increasing the levels of biologically active growth factors and reducing elevated levels of proteases. 3 figures. 2 tables. 138 references.

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Relationship between C Peptide and Chronic Complications in Type 2 Diabetes Mellitus. Journal of the National Medical Association. 97(8): 1113-1118 p. August 2005.

This article reports on a study undertaken to evaluate the relationship between serum C-peptide and chronic complications in patients with type 2 diabetes mellitus. The study included 318 patients (138 male, 180 female) with type 2 diabetes mellitus. Microvascular (nephropathy, retinopathy, and neuropathy) and macrovascular complications (coronary artery disease and peripheral vascular disease) were determined in all patients. There were 90 patients (28.3 percent) with sensorial neuropathy, 48 patients (15.1 percent) with autonomic neuropathy, 72 patients (22.7 percent) with nephropathy, 84 patients (26.4 percent) with retinopathy, 135 patients (42.5 percent) with hypertension, 270 patients (84.9 percent) with dyslipidemia, 33 patients (10.4 percent) with coronary artery disease, and 18 patients (5.7 percent) with peripheral vascular disease. Serum C-peptide level was higher in patients with dyslipidemia, hypertension, coronary artery disease, peripheral vascular disease, and autonomic neuropathy. There was no relationship between C-peptide and sensorial neuropathy, nephropathy, and retinopathy. The authors conclude that there is a relationship between C-peptide and macrovascular but not microvascular complications in patients with type 2 diabetes mellitus. 3 tables. 41 references.

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Smoking and Incidence of Diabetes Among U.S. Adults: Findings from the Insulin Resistance Atherosclerosis Study. Diabetes Care. 28(10): 2501-2507. October 2005.

This article reports on a study undertaken to determine the association between smoking and incident (new) diabetes among adults in the United States. The authors used the Insulin Resistance Atherosclerosis Study (IRAS) to examine the relationship between smoking status categories (never, former, and current) and incident 5-year type 2 diabetes among 906 participants free of diabetes at baseline. The study also considered the effect of pack-year categories (never, former less than 20 pack-years, former more than 20 pack-years, current less than 20 pack-years, and current more than 20 pack-years) upon diabetes incidence. Results showed that, of current smokers, 96 (25 percent) developed diabetes at 5 years, compared with 60 (14 percent) never smokers. After multivariate adjustment, smokers exhibited increased incidence of diabetes compared with never smokers. Similar results were found among current smokers with greater than 20 pack-years with normal glucose tolerance. The authors conclude that smoking shares a robust association with incident diabetes. 1 figure. 2 tables. 32 references.

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Socioeconomic Status and Diagnosed Diabetes Incidence. Diabetes Research and Clinical Practice. 68(3): 230-236. June 2005.

This article reports on a study undertaken to investigate the association between socioeconomic status (SES) and incidence of diabetes. The authors used three measures of SES and incidence of diagnosed diabetes among women and men in the NHANES I Epidemiologic Followup Study, 1971-1992, who were free of diagnosed diabetes in 1980. Among women, diabetes incidence was inversely associated with income (measured as percent of the poverty level), education, and occupational status, adjusting for age and race. Adjustment for potential mediators, including body size variables, diet, physical activity, and alcohol and tobacco use, substantially reduced the associations with income and education. Among men, a trend toward lower diabetes incidence with higher income and higher education was evident, but there was no inverse association of diabetes incidence with occupational status. The authors conclude that low socioeconomic status, assessed using three different measures, is associated with risk of diabetes. They briefly discuss the implications of their findings. 2 figures. 1 table. 52 references.

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Systematic Review of Drug Therapy to Delay or Prevent Type 2 Diabetes. Diabetes Care. 28(3): 736-744. March 2005.

This article reports on a systematic review undertaken to examine the evidence for the prevention of type 2 diabetes by pharmacological therapies. The authors identified randomized controlled trials and cohort studies examining the effect of oral hypoglycemic agents, antiobesity agents, antihypertensive agents, statins, fibrates, and estrogen on the incidence of type 2 diabetes. Ten studies of oral hypoglycemic agents and 15 studies of nonoral hypoglycemic agents were found. In the largest studies of 2.5 to 4.0 years' duration, metformin, troglitazone, and orlistat have all been shown to decrease diabetes incidence compared with placebo; however, follow-up rates varied from 43 percent to 96 percent. The authors conclude that current evidence for statins, fibrates, antihypertensive agents, and estrogen is inconclusive. In addition, the critical question of whether drugs are preventing, or simply delaying, onset of diabetes remains unresolved. Detailed, lengthy tables summarizes the studies included. 3 tables. 57 references.

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Ten-Year Incidence of Self-Reported Erectile Dysfunction in People with Long-Term Type 1 Diabetes. Journal of Diabetes and Its Complications. 19(1): 35-41. 2005.

This article reports on a study that examined the overall 10-year incidence of erectile dysfunction (ED) and its relationships to other characteristics in men with younger onset diabetes. The population-based cohort study based in southern Wisconsin collected the cumulative incidence of reported ED in men who were 21 years of age or older, were less than 30 years of age at diagnosis of diabetes, had 10 or more years of diabetes, and were taking insulin (n = 264). In these men, 25 percent developed ED. The incidence of ED increased with age (from 10.2 percent in the youngest group to 48.6% in those 40 years of age or older) and with increasing duration of diabetes (from 16 percent in those with 11 to 14 years of diabetes at baseline to 38.2 percent in those with 25 or more years of diabetes). Analyses showed that incidence of ED was associated with age, untreated hypertension, and a history of smoking at baseline. The authors conclude that cessation of cigarette smoking and tighter control of blood pressure might prevent or delay the onset of erectile dysfunction in persons with type 1 diabetes. 2 figures. 3 tables. 42 references.

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Treating Type 2 Diabetes in Children. Diabetes Self-Management. 22(4): 80-83. July-August 2005.

This article explains the comprehensive plan of diabetes care that is involved in treating type 2 diabetes in children. The author first defines type 2 diabetes and discusses the increasing incidence of type 2 diabetes, along with an increasing incidence of obesity in children. The link between being overweight and diabetes is insulin resistance: overweight contributes to insulin resistance. Other topics include the diagnostic tests used to confirm type 2 diabetes; risk factors, in addition to obesity, for type 2 diabetes; treatment options, including diet and exercise, insulin and drugs, blood pressure control, blood lipid control, and regular checkups, including HbA1c tests (a blood test that measures blood glucose levels over time); the importance of taking a family-centered approach to diabetes management and lifestyle changes; and the importance of dealing with the psychosocial aspects of a diabetes diagnosis and ongoing care. The author concludes by encouraging parents to access the many resources available to help their family cope with diabetes.

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Urologic Complications of Diabetes. Diabetes Care. 28(1): 177-185. January 2005.

Diabetes mellitus is associated with an earlier onset and increased severity of urologic diseases, resulting in costly and debilitating urologic complications. Urologic complications, including bladder dysfunction, sexual and erectile dysfunction, as well as symptomatic and asymptomatic urinary tract infections (UTIs), have a profound effect on the quality of life of men and women with diabetes. This review article presents an overview of the current understanding of clinical and basic research on urologic complications of diabetes and recommendations for future directions for research and clinical care. The authors note that research studies that define expected prevalence, incidence, and risk factors, as well as interventions to reduce the risk of developing these complications, are limited. However, intensive glycemic control delays the onset and progression of microvascular complications of diabetes in both type 1 and type 2 diabetes. If microvascular complications also damage the vascular and neurologic innervation of the urethral sphincter, bladder, and corpora cavernosa, then intensive glycemic control may prevent or improve the severity of urologic complications. The authors conclude by reiterating the need for new research initiatives to better understand the disease mechanisms and burden of urologic complications in men and women with diabetes. 118 references.

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Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes. Diabetes Care: 27(2): 596-601. February 2004.

Antipsychotic medications, notably second generation antipsychotics (SGAs) are an important component in the medical management of many psychotic conditions. Although the SGAs have many notable benefits compared with their earlier counterparts, their use has been associated with reports of dramatic weight gain, diabetes, and an atherogenic lipid profile. This article reports on a consensus development conference on SGAs and obesity and diabetes. The consensus statement addresses five issues: the current use of antipsychotic drugs; the prevalence of obesity, prediabetes, and type 2 diabetes in the populations in which the SGAs are used; the relationship between the use of these drugs and the incidence of obesity or diabetes; monitoring patients for the development of significant weight gain, dyslipidemia, and diabetes, and treatment strategies if these conditions develop; and the research needed to better understand the relationship between these drugs and significant weight gain, dyslipidemia, and diabetes. The authors conclude that when prescribing an SGA, a commitment to baseline screening and follow up monitoring is essential in order to mitigate the likelihood of developing CVD, diabetes, or other diabetes complications. 4 tables. 25 references.

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Depressive Symptoms, Insulin Resistance, and Risk of Diabetes in Women at Midlife. Diabetes Care. 27(12): 2856-2862. December 2004.

This article examined the relationship between depressive symptoms and insulin resistance and risk of diabetes in a multi-ethnic community sample of middle-aged women participating in a longitudinal study of women's health and aging. The prospective study included 2,662 women in the ethnic groups of Caucasian, African-American, Hispanic, Japanese-American, and Chinese-American. Depression predicted a 1.66-fold greater risk of diabetes, however, this became nonsignificant after adjustment for central adiposity (body fat). After risk factor adjustment, depression predicted a 2.56-fold greater risk of diabetes in African-Americans only. Depression is associated with higher HOMA-IR (homeostasis model assessment of insulin resistance) and new diabetes in middle-aged women. The authors conclude by reiterating that central adiposity mediated the relationship between depression and diabetes; depressed women had greater adiposity, which in turn accounted for the elevation in diabetes incidence. 2 tables. 37 references.

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Diabetic Neuropathy: Early Clues, Effective Management. Consultant. 44(12): 1549-1556. October 2004.

This article guides physicians in a structured approach to the diagnosis and treatment of diabetic neuropathy (nerve disease associated with diabetes mellitus). The author stresses that the early signs of diabetic neuropathy can be detected during a routine clinical examination and annual surveillance for evidence of neuropathy and intensive diabetes management can reduce the incidence of complications. Physicians should inspect patients' feet for deformities and for sensory loss, which indicate risk of ulceration. Prolonged poor glycemic (blood glucose) control, alcohol abuse, and obesity increase the risk of amputation. Autonomic dysfunction, which can lead to sexual dysfunction and gastropathy (gastrointestinal problems), can be detected by measurement of heart rate and blood pressure. Electromyography and nerve conduction studies can be used to confirm a diagnosis of diabetic neuropathy. Improved metabolic control is the main goal of treatment. Analgesics, neuromodulators, and tricyclic antidepressants are effective for managing pain. 1 figure. 3 tables.

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Diagnosis, Classification, and Epidemiology of Diabetes Mellitus. In: Harmel, A.P. and Mathur, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 1-22.

Diabetes is a group of metabolic diseases that are characterized by hyperglycemia (high levels of blood glucose) resulting from defects in insulin secretion, insulin action, or both. The lack of effective insulin action leads to alterations in carbohydrate, fat, and protein metabolism. The chronic hyperglycemia of diabetes is associated with long term dysfunction and damage of organs, including the kidneys, eyes, nerves, heart, and blood vessels. This chapter on the diagnosis, classification, and epidemiology of diabetes mellitus is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. This chapter defines diabetes, then discusses diabetes as a local and global epidemic, the incidence and prevalence of diabetes among specific communities, current recommended criteria for the diagnosis of diabetes mellitus, alternative approaches to the diagnosis of diabetes, implications and importance of impaired glucose tolerance, the role of screening for diabetes, classification of diabetes, type 1 diabetes, type 2 diabetes, other specific types, and gestational diabetes. 5 tables. 155 references.

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Differences in Diabetes Prevalence, Incidence, and Mortality Among the Elderly of Four Racial-Ethnic Groups: Whites, Blacks, Hispanics, and Asians. Diabetes Care. 27(10): 2317-2324. October 2004.

This article reports on a study undertaken to examine the prevalence and newly diagnosed cases of diabetes among Medicare elderly beneficiaries in the years 1993-2001, as well as mortality rates among individuals with diabetes. Comparisons are made between four racial or ethnic groups (whites, blacks, Hispanics, and Asians), five age-groups, and both sexes. The study was a retrospective analysis of a 5 percent random sample of Medicare fee-for-service beneficiaries older than 65 years in each of the study years. In 1993, the prevalence of diabetes among those older than 67 years of age was 145 cases per 1,000 individuals. By 2001, the prevalence in this population was 197 per 1,000, an increase of 36.0 percent. The 2001 prevalence among Hispanics (334 per 1,000) was significantly higher than among blacks (296 per 1,000), Asians (243 per 1,000), and whites (184 per 1,000). During the 7-year study period, the greatest increase in diabetes prevalence was among Asians. The mortality rate among individuals with diabetes decreased by approximately 5 percent between 1994 and 2001. No decrease in mortality was seen in the same time period among elderly individuals without diabetes. The authors conclude that the dramatic increase in the incidence and prevalence of diabetes likely reflects a combination of true increases, in addition to changes in the diagnostic criteria and increased interest in diagnosing and appropriately treating diabetes in the elderly. Improved treatment may have had an impact on mortality rates among individuals with diabetes, although they could have been influenced by the duration of diabetes before diagnosis, which has likely decreased. 1 figure. 3 tables. 38 references.

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Effect of Oestrogen Plus Progestin on the Incidence of Diabetes in Postmenopausal Women: Results from the Women's Health Initiative Hormone Trial. Diabetologia. 47(7): 1175- 1187. July 2004.

This article reports on a randomized, double-blind trial that compared the effect of daily 0.625 milligrams of conjugated equine estrogen plus 2.5 milligram of medroxyprogesterone actate (progestin) with that of a placebo during 5.6 years of follow up in 15,641 postmenopausal women enrolled in the Women's Health Initiative Hormone Trial. The women were aged 50 to 79 and all had an intact uterus. Diabetes incidence was determined by self-report of treatment with insulin or oral hypoglycemic medications. The results showed a cumulative incidence of treated diabetes of 3.5 percent in the hormone therapy group and 4.2 percent in the placebo group. There was little change in the hazard ratio after adjustment for changes in body mass index (BMI) and waist circumference. During the first year of follow up, changes in fasting glucose and insulin indicated a significant fall in insulin resistance in actively treated women compared to the control subjects. The authors conclude that combined estrogen and progestin therapy reduces the incidence of diabetes, possibly mediated by a decrease in insulin resistance unrelated to body size. 2 figures. 5 tables. 61 references.

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Epidemiological Perspective on Type 2 Diabetes Among Adult Men. Diabetes Spectrum. 17(4): 208-214. 2004.

Diabetes prevalence, costs, and complications are growing at alarming rates in the United States. The prevalence of diabetes is increasing at similar rates for men and women. However, some complications, such as lower-extremity amputation and end-stage renal disease, are more prevalent among men, particularly among ethnic minority groups. This article offers an epidemiological perspective on Type 2 diabetes among adult men. The authors examine the prevalence and incidence of diabetes, including rates among high-risk populations, diabetes complications, and primary and secondary diabetes prevention practices. Diabetes is a significant contributor to erectile dysfunction (impotence). Because men are less likely to engage in the health care system, primary and secondary prevention efforts need to be implemented in culturally appropriate, male-oriented venues. Recent efforts to reach men with health messages include having the message delivered by people men can identify with (e.g., sports figures), or in venues frequented by men. 5 figures. 2 tables. 34 references.

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Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-Based Cohort of Children with Type 1 Diabetes. Diabetes Care. 27(10): 2293-2298. October 2004.

This article reports on a study undertaken to determine the impact of changes to treatment on the incidence of severe hypoglycemia (low blood glucose) and its risk factors in a large population-based cohort of children with Type 1 diabetes (n = 1,335, mean age at entry was 9.5 years). The mean follow-up period was 4.7 years (plus or minus 3.1 years), yielding 6,928 patient-years of data. Patients were reviewed every 3 months for a period between 1992 and 2002; prospected assessment of severe hypoglycemia (an event leading to loss of consciousness or seizure) and associated clinical factors and outcomes was made. A total of 944 severe events were recorded. The incidence of severe hypoglycemia increased significantly by 29 percent per year for the first 5 years but appeared to plateau over the last 5 years. The overall average HbA1c (glycosylated hemoglobin, a measure of blood glucose over time) significantly decreased (by 0.2 percent per year) over the entire follow-up period. An increased risk of severe hypoglycemia was associated with lower HbA1c, younger age, higher insulin dose, male sex, and lower parental socioeconomic status. Of insulin therapies, only pump treatment was associated with reduced rates of severe hypoglycemia. The authors conclude that severe hypoglycemia remains a major problem for children and adolescents with Type 1 diabetes. 2 figures. 3 tables. 25 references.

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Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances. Diabetes Care. 27(10): 2464-2469. October 2004.

Sleep deprivation in healthy men has been experimentally found to result in disturbances in glucose metabolism and in sympathovagal imbalance. This article reports on a study that investigated whether sleep disturbances and elevated resting heart rate are associated with increased risk of developing diabetes. The prospective, population-based study in Malmo, Sweden included a group of 6,599 initially healthy nondiabetic men aged 44.5 years (plus or minus 4.0 years). The incidence of diabetes during a mean follow-up of 14.8 years (plus or minus 2.4 years) was examined in relation to self-reported difficulties in falling asleep and resting heart rate at baseline. Diabetes was assessed at follow-up in all subjects by questionnaire and in a subgroup of 1,551 men by blood glucose measurement. A total of 615 subjects (9.3 percent) reported either difficulties in falling asleep or in regular use of hypnotics (seen as markers of sleep disturbances) and 158 subjects (2.4 percent) reported both of these. Altogether, 281 (4.3 percent) of the men developed diabetes during the follow-up period. Analyses showed that difficulties in falling asleep or regular use of hypnotics, and resting heart rate to be associated with development of diabetes when full adjustments were made for baseline age, biological risk factors, lifestyle, family history of diabetes, and social class. The authors conclude that sleep disturbances and, possibly, elevated resting heart rate, in middle-aged men, are associated with an increased risk of diabetes. 2 tables. 43 references.

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Learn the Risks: You Have the Power to Prevent Kidney Disease. Bethesda, MD: National Kidney Disease Education Program. 2004. 4 p.

People with diabetes, high blood pressure, or a family member with kidney failure are more likely to develop kidney disease. This brochure helps African Americans understand the risk factors for kidney disease, a problem that is more prevalent in this community than in white Americans. The brochure outlines the basic physiology of the healthy kidneys, reminds readers that kidney disease often strikes without warning symptoms, and reviews the impact of hypertension and diabetes on the incidence of kidney disease. Diabetes is the most common cause and hypertension is the second leading cause of kidney failure, thus strategies to control these conditions may prevent kidney disease as well. A tear-away card is included that lists questions for readers to ask their health care providers, as well as tips for talking with members of their health care team. Readers are also referred to the National Kidney and Urologic Diseases Information Clearinghouse (www.kidney.niddk.nih.gov) and the National Kidney Disease Education Program (www.nkdep.nih.gov) for more information. The brochure is illustrated with photographs of African Americans.

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Magnesium-Diabetes Connection. Today's Dietitian. 6(11): 37, 70. November 2004.

This article considers the role of magnesium in glucose metabolism, particularly in people with diabetes mellitus. The author notes that recent research suggests that magnesium keeps blood glucose from rising too high, thus possibly fending off diabetes. The author outlines these studies, many of which include a variety of micronutrients such as magnesium, and which also study other lifestyle factors besides diet. The Iowa Women's Health Study found that over the six years of the study (40,000 participants), higher consumption of total grains, whole grains, total fiber, cereal fiber, and magnesium were associated with a lower incidence of type 2 diabetes. The author reviews the Daily Value (DV) for magnesium (400 milligrams) and notes that most Americans have inadequate magnesium intake. The expert consensus is that an overall healthy diet is the best prevention for diabetes since that ensures adequate intake of magnesium and other nutrients such as folate, other B-vitamins, and fiber. To meet the DV for magnesium, the most bioavailable sources of the mineral are whole grains, avocados, squash, almonds, fruits, and leafy greens. The author concludes by encouraging dietitians to educate their patients and clients on the importance of magnesium-rich foods. 1 table.

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Peripheral Arterial Disease in People with Diabetes. Clinical Diabetes. 22(4): 181-189. 2004.

Peripheral arterial disease (PAD) is a condition characterized by atherosclerotic occlusive disease of the lower extremities. This article presents the consensus statement of the American Diabetes Association for guidelines regarding the care of patients with both diabetes and PAD. The consensus statement addresses four areas: the epidemiology (incidence and prevalence) and impact of PAD in people with diabetes; how the biology of PAD is different in people with diabetes, including inflammation, risk factors for PAD, endothelial cell dysfunction in diabetes, and coagulation; recommended diagnostic methods for evaluating PAD in people with diabetes, including noninvasive evaluation, vascular lab evaluation, treadmill functional testing, and imaging studies; and the appropriate medical treatments for PAD in people with diabetes. Treatment options include treatment of systemic atherosclerosis associated with PAD, smoking cessation, glycemic (blood glucose) control, treatment of hypertension (high blood pressure), treatment of dyslipidemia (dysfunctional levels of blood lipids or fats), antiplatelet therapy, exercise rehabilitation, drug therapies, preventive foot care, treatment of the ischemic (reduced blood flow) foot, debridement, appropriate footwear, dressings, treatment of infection, and indications for revascularization procedures. The consensus statement concludes that PAD is a common cardiovascular complication in patients with diabetes. Diagnosis of PAD is vital to monitor symptoms, prevent disability and limb loss, and to identify patients at high risk of stroke and death. 4 tables. 37 references.

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Physical Activity-Exercise and Type 2 Diabetes. Diabetes Care. 27(10): 2518-2539. October 2004.

Exercise has been a cornerstone of diabetes management, along with diet and medication. This review article examines areas of major advances that have occurred since the last American Diabetes Association technical review of exercise and Type 2 diabetes in 1990. Advances in basic science have increased the understanding of the effects of exercise on glucoregulation. Large clinical trials demonstrating that lifestyle interventions (diet and exercise) reduce incidence of Type 2 diabetes in people with impaired glucose tolerance (IGT). Studies of structured exercise interventions in Type 2 diabetes have shown the effectiveness of exercise in reducing HbA1c (glycosylated hemoglobin, a measure of blood glucose over time), independent of body weight and the association between exercise training intensity and change in HbA1c. Large cohort studies have shown that low aerobic fitness and low physical activity level predict increased risk of overall and cardiovascular disease (CVD) mortality in people with diabetes. Clinical trials have shown the effectiveness and safety of resistance training (such as weight lifting) for improving glycemic control in Type 2 diabetes. 2 figures. 2 tables. 190 references.

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Prevalence and Trends of a Metabolic Syndrome Phenotype Among U.S. Adolescents, 1999-2000. Diabetes Care. 27(10): 2438-2443. October 2004.

This article reports on a study undertaken to determine the prevalence of a metabolic syndrome phenotype among United States adolescents using the most recent national data and to examine trends in metabolic syndrome prevalence. The metabolic syndrome is characterized by an association between obesity, high fasting triglycerides, elevated fasting plasma insulin, impaired glucose tolerance, hypertension, and cardiovascular disease. The authors analyzed data on 991 adolescents (aged 12 to 19 years) who had fasted for at least 6 hours. The metabolic syndrome was determined using the National Cholesterol Education Program (NCEP) definition, modified for age. The results showed that the overall prevalence of a metabolic syndrome phenotype among U.S. adolescents increased from 4.2 percent in NHANES III (1988 to 1992) to 6.4 percent in NHANES 1999-2000. The syndrome was more prevalent in male than female adolescents and was found in 32.1 percent of overweight adolescents, compared with 7.1 percent of adolescents at risk for overweight. The authors contend that, based on population-weighted estimates, more than 2 million U.S. adolescents currently have a metabolic syndrome phenotype. The authors conclude that the prevalence of a metabolic syndrome phenotype has increased significantly over the past decade among U.S. adolescents and is particularly prevalent (more than 30 percent) in overweight adolescents. 2 figures. 37 references.

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