Type 1 Diabetes Incidence Flying In Finland

The incidence of Type 1 diabetes has more than doubled in Finland in the last 25 years. A publication in Lancet suggests this is due to "genetics and lifestyle factors".

Worldwide there has been a steady increase in the incidence of type 1 diabetes, with an average increase per year of 2.5-3.0%. This trend has been most clear in children under the age of four, and it has been highly irregular between different individual countries. Incidence of diabetes between European countries, for example, can vary up to ten-fold. The lowest incidences in the world are found in Venezuela and China, while the highest levels of diabetes are found in Finland and Sardinia. This overall increase in diabetes incidence are attributed to manifestation of the disease at an earlier age, and not an increase in the patients who get the disease in later life.

Differences were also seen between males and females: at the age of one, the cases were evenly distributed 1 boy to 1 girl, at the age of 13 years, this ratio was 1.7 boys to 1 girl. Additionally, the peak incidence for girls was at 10 years of age, while for boys it occurred three years later at the age of 13.

Finland has led the world in Type 1 diabetes incidence since the 1950s.

Read the full story here for more details.

If you wish to read the Lancet article, you can obtain free registration here.

Jay Cutler Update

Read previous information about the Type 1 diabetic quarterback of the Denver Broncos here.

Team doctors are unwilling to name the type of insulin Cutler is taking or his dosages, citing his right to privacy. Cutler himself says it remains a fluid matter, as they are still determining a plan to suit his unique needs.

Can this be another way to say, "We haven't yet finished a deal with one of the insulin companies to serve as a sponsor"? After all, when your yearly salary is only $8.253 million, you've got to be certain to capitalize on every available opportunity. That's the American way!

Read the Diabetes Health update here.

ADVANCE Data To Be Released In June

We'll get the results in June.

The second, and final, part of the ADVANCE (Action in Diabetes and Vascular Disease) trial is complete. This is the largest Type 2 diabetic study ever initiated and will help assess whether intensive control of blood sugar has an impact to lower the risk of macrovascular disease (large blood vessel impact leading to cardiovascular death, heart attacks or strokes) and small vessel impact (leading to kidney and eye damage).

Over 11,000 patients were randomised and more than 20 countries participated in ADVANCE. The final patient visits were made at the end of January 2008, the database is now closed and main analysis complete. The data from the blood glucose lowering arm of ADVANCE will be presented for the first time at the American Diabetes Association Scientific Sessions on 6 June 2008 in San Francisco, USA.

Read the full article, with much more information, here.

Type 1 Diabetes "Cure" In Mice

Researchers at the University of British Columbia (UBC) report a "cure" for Type 1 diabetes in mice. They have genetically engineered "K cells" in the intestine to produce insulin in response to meals. Normally, K cells produce glucagon-dependent insulinotropic polypeptide (also known as gastric-inhibitory peptide) (GIP), a hormone that signals the need for insulin production when food is detected in the intestines. The UBC team has converted K cells into insulin-producing cells.

Normally, insulin is produced by beta cells in the pancreas. However, in people with Type 1 diabetes, the immune system attacks the beta cells, which makes it impossible for them to produce their own insulin.

UBC medical professor, Timothy Kieffer, leads the research team.

“What we find is that when the immune system in those animals attacks the beta cells, it doesn’t kill the insulin-producing K cells in the intestine, and those cells are thereby able to protect the animals from developing Type 1 diabetes,” Kieffer said. “We’re really excited.”

“Hopefully, in the not-too-distant future, we’ll be able to find out if this idea works in humans,” he said.

A very important advantage of this system is that it does not require the use of anti-rejection medications that are necessary in any transplant situation.

Read the full article here.

North Carolina Diabetes Rates More Than Double In The Last Ten Years

The North Carolina Division of Public Health reports shows rates of diabetes have risen from 4.4% to 9.1% from 1996 to 2006. That compares to 7.5% of the national population.

In 2006, more than 16,000 people in North Carolina were hospitalized for diabetes at a cost of $257 million.

"We've had many generations of kids that do better and live longer than their parents," said Dr. Marcus Plescia, chief of the public health division's Chronic Disease and Injury Section. "And we think we're on the cusp of seeing that change."

The Charlotte.com story is here.

Talking Insulin Pumps In Scotland?

I don't think any of our pump-treated patients use an insulin pump they can have a conversation with. Does the following headline suggest this does happen in Scotland?

Scottish Parliament To Debate Insulin Pumps

Yes, we try to get some cheap laughs.

Anyway, there are only 200 pump users in Scotland. That represents less than 1% of the Type 1 diabetic population there and that is half the rate of use throughout the entire UK in Type 1 diabetics. Rates of pump use may be approaching 20% in the United States and Germany.

The full article is here.

Mary Tyler Moore "Struggling" With Diabetes

She's got a number of problems, and complications, after 40 years of Type 1 diabetes. Read about it here.

It does not appear that her diabetes has prevented her from having "a little work done"?

..... And The Streak Continues

It's another pump malfunction on a full moon requiring a temporary pump discontinuation. There's just been one full moon in the last 10 months in which we have not heard about an insulin pump malfunction.

Check out all of our "Full Moon Fun" here. It's almost spooky.

More Than 30 Pancreas-Kidney Transplantations In Wales To Date

Sara Griffiths is a 46 year old Type 1 diabetic female (onset at age 16), but she's no longer diabetic after undergoing pancreatic transplantation seven months ago. She had previously undergone kidney transplantation 13 years ago.

Sara, who is a volunteer worker and lives in Raglan, said: “There are no more injections, no more blood tests and no more worrying about my sugar levels. I can finally say, after more than 30 years, that I am not diabetic – I don’t miss it for an instant.”

She admits her diabetes had not been well controlled in the past and that cost her most of her kidney function.

“The price I paid was kidney failure and going on haemodialysis for three-and- a-half years, which felt like 30. Dialysis does, for the most part, keep people alive, but I found it punishing and those years felt like eternity. Before I had the kidney transplant I was only existing – I had to use a walking stick to get around and I didn’t even have the energy to wash my hair.”

At that time of Ms. Griffiths kidney transplant, pancreatic transplantation was in its infancy. Its success is still complicated by the need to use anti-rejection drugs, but the center in Wales is one of the more successful "small programme" centers in the world.

The full story is here.

Another Side Of A Story?

Zachariah Kramer, a Type 1 diabetic medical student at the Oregon Health and Sciences University, speaks about his experience with the Medtronic-MiniMed Paradigm Real-Time pump with continuous glucose monitoring. The comments equally apply to any of the continuous glucose monitoring (CGM) devices currently available.

His well-written summary can be seen in this month's issue of Diabetes Health by clicking here. By the way, the key to the Medtronic photo, and further description of this system, can be seen here.

We still have a limited experience with any of these devices as they are not yet covered by health insurances. However, some patients have gone ahead and purchased a CGM system. One thing I've heard, from more than one CGM wearer, has really surprised me. One of the potential benefits of CGM technology is the ability to be alerted when blood sugars rise above, or below, a certain level. In addition, the CGM devices have a "rate of change" alarm when blood sugars are falling, or climbing, too quickly. Surprisingly, some CGM wearers get tired of all the alarms and turn them off or change levels so they sound less often.

We don't think we'll see the real potential benefits of the CGM devices until more patients, and their physicians, are permitted to get proper experience with them. Right now, the insurance carriers are the roadblock. I just keep thinking that one hospital admission avoided likely pays for two years of CGM use.

It tends to remind me of that old Fram oil filter commercial -- "You can pay me now ... or pay me later". It always seems to be a bit more expensive later.

Jay Cutler Update

Read a well-written article by a sportswriter with a Type 1 diabetic son. It's one of the rare diabetes-related articles I've seen without a glaring piece of "mis-information".

Jay Cutler, starting quarterback for the Denver Broncos, lost 33 pounds through the 2007 season as blood sugars became more and more uncontrolled. He was officially diagnosed about one month ago. He has regained most of the lost weight and now weighs in at 230 pounds at a height of 6'3".

True to form, when diabetes is involved, he's getting "expert advice" -- this is my favorite paragraph in the article:

"Everyone's got a special drink or something for me to try that's supposedly either gonna 'cure' it or 'help' it," Cutler said, shaking his head. "Or people say, 'Hey, you've been eating bad' or, 'You've been drinking alcohol, and that's what brought it on.' They mean well, but they don't understand."

Read the Yahoo! Sports article here.

Other NFL teams may be in for a big surprise this year if Jay Cutler is "feeling better".

Is It All About The Dendritic Cells In Type 1 Diabetes?

Research at Washington University School of Medicine in St. Louis may have identified, in mice, an early step in the process by which beta cells are are damaged via an attack of the immune system.

Dendritic cells were noted during the process of beta cells destruction.

"Now that we've isolated dendritic cells from the pancreas, we can look at why they get into the pancreas and determine which of the materials that they pick up are most critical to causing this form of diabetes. That may allow us to find ways to inhibit dendritic cell function in order to block the disorder," study senior author Dr. Emil R. Unanue, a professor of pathology, said in a prepared
statement.

Interestingly, another observation in the same laboratory had previously suggested dendritic cells may be beneficial in beta cells. It was noted that beta cells were smaller (a sign they are less healthy) when dendritic cells could not be identified in the pancreas.

"We think these dendritic cells aren't in the pancreas by accident. We believe that, in the normal individual, they help maintain the health of beta cells. But in a person with autoimmune diabetes, they appear to start the problems that destroy beta cells," Unanue said.

The full Washington Post article is here.

Diabetes Medication Costs Rise As Cholesterol Medication Costs Fall

A Medco report suggests it costs more last year for diabetes medications (up 12%), but less to treat dyslipidemia. The likely explanation is the continued increasing use of newer, and more expensive (BYETTA, JANUVIA, etc.), medications for diabetes whereas many of the cholesterol medications (statins) have gone generic.

Diabetes medications accounted for 7% of prescription drug costs, whereas the cholesterol lowering drugs (such as the statins) accounted for 10.8%, but that number is falling from year to year.

Use of the cholesterol drugs actually grew much faster than use of diabetes drugs last year (5.9% versus 2.3%). But two big statins, Merck’s Zocor and Bristol-Myers Squibb’s Pravachol, went generic in 2006, driving prices through the floor. Use of Pfizer’s Lipitor, which is still patented, fell a bit, as some insurers pushed patients on Lipitor to switch to generics.

Medco filled $36 billion worth of prescriptions in the last two years.

The Wall Street Journal article is here.

How About A METFORMIN Chewing Gum?

Check out the Diabetes Health article here. Clinical studies are just getting underway.

Someone Actually Read This Blog!

We have proof! They also left a comment!

We're just kidding .... a little.

SusanT1 left a comment regarding this post about text-messaged reminders to take medications.

No need to wait! Parents and teens can set up their own text reminders right now on www.OnCellRx.com You can use this service for free - for awhile - and test it for yourself. It works like a charm for me! I have to use eye drops twice a day and I'd NEVER remember - if I didn't get my text msgs. It's really cool that my phone is actually helping me stay healthy!

If you read that previous post about text messaged reminders, you might note a bit of sarcasm. I've got a practice limited to patients with diabetes. Only three patients in our practice are treated by "diet alone". Therefore, everyone else is taking at least one prescription medication to control their blood sugars. Maybe I'm the one that's "odd", but I have a hard time accepting the fact that a patient needs some kind of a daily reminder to take a prescription medication.

I'll leave it at that.

Susan, we do thank you for the comment and the information.

See the service Susan is telling us about here. I'll sign up for alerts to remind me to tell patients to stop having full cell phone conversations during their office visits! I can understand answering the phone (it's amusing to hear that occasional embarrassing ring tone), but it would seem to be more appropriate to simply tell the caller you'll call them back when your office visit is completed.

By the way, I hope that lunch someone arranged for next Tuesday turns out to be enjoyable!

C U l8tr?

Using Text Messaging To Improve Medication Compliance

Why not, in these days and times in which fewer and fewer individuals seem to take responsibility for themselves?

4gt yr meds? Getting kids to remember their medicine may be a text message away. Cincinnati doctors are experimenting with texting to tackle a big problem: Tweens and teens too often do a lousy job of controlling chronic
illnesses like asthma, diabetes or kidney disease.

Data relating to how often adolescents and teens do not adhere to medication regimens for chronic diseases is stated to be "alarming" by the NIH's National Institute of Diabetes and Digestive and Kidney Diseases.

Some studies suggest only half of adolescents, on average, properly follow treatment steps, says Dr. Dennis Drotar of Cincinnati Children's Hospital. The more medications required or the more troublesome the side effects — even, for appearance-conscious teens, such things as weight gain from steroid
medications — the worse kids adhere.

Dr. Maria Britto, an asthma specialist at Cincinnati Children's, noticed that even when she's talking to adolescent patients perched on the clinic exam table, they'll keep texting on their cell phones.

"You have to get in their face a little," she says with a laugh.

But it sparked the idea for a study to see if a daily medication reminder via text message would improve kids' asthma control — preventing full-blown attacks,
improving school attendance and decreasing doctor and emergency-room visits. After all, Britto says kids as young as 12 carry the phones into her clinic,
poor and middle class alike.

An NIH-funded study is already tracking this form of intervention for Type 1 diabetics in Cincinnati, Miami and Wilmington, Delaware.

The full Associated Press article is here.

METFORMIN Therapy OK "Down Under" For Gestational Diabetes

METFORMIN has been found to be safe for use for gestational diabetes according to a study out of the University of Adelaide in Australia. Gestational diabetes may be seen in as many as 5% of Australian pregnancies.

The potential for modest, and safe, weight loss with METFORMIN during pregnancy is a potential additional benefit.

The brief Australian Broadcasting Corporation article is here.

METFORMIN therapy during pregnancy is beginning to gain support in the United States, but has not yet been fully accepted.

Team Type 1 Cyclist Speaks With Students And Support Groups

Read about Joe Eldridge of the Team Type 1 Cycling Team by clicking here.

P1736 In The Netherlands

Piramal Life Sciences Ltd. has begun clinical study of a new compound for the treatment of Type 2 diabetes. Testing will begin in the Netherlands.

Piramal earlier submitted the clinical trial application (CTA) for P1736 to the Netherlands regulatory agency, the Central Commission on Medical Research Involving Human Subjects (CCMO) and the Independent Ethics Committee of the Foundation Evaluation of Ethics in Biomedical Research (BEBO).

We'll hear more about this drug at the upcoming annual meeting of the American Diabetes Association next month in San Francisco.

The full press release is here.

Brits Say "No Extra Road Risk" With Diabetes

Diabetes UK is proposing that tighter driving licence restrictions for people with diabetes may not be necessary. The potential threat of hypoglycemia (low blood sugar), leading to confusion or loss of consciousness, in insulin-treated individuals, has previously prompted tighter restrictions for drivers of "larger vehicles and some passenger carrying vehicles".

However, a team at Plymouth's Peninsula Medical School, found the rate of road traffic collisions in patients with insulin treated diabetes was lower - at 957 accidents per 100,000 people - than those who did not have the condition (1,469/100,000).

There was no significant difference in accident rate between the two groups at any specific age.

Individual case risk assessment is still strongly advised.

Diabetes UK recommends that people with diabetes check their blood glucose levels before they get behind the wheel (and regularly during journeys) to avoid having a hypoglycaemic episode.

However, the charity (Diabetes UK) advises that people who have just started taking insulin, have difficulty recognising the early symptoms of hypoglycaemia, have a problem with their eyesight that cannot be corrected by glasses or have numbness or weakness in the limbs from neuropathy (diabetic nerve damage) should not drive.

The full BBC News article is here.

Low Birth Weight May Increase Type 2 Diabetes Risk?

A research team at the University of Pennsylvania has proposed that intrauterine growth retardation (IUGR) may be linked to the development of Type 2 diabetes as an adult. In other words, low birth weight may be an increased risk for Type 2 diabetes as an adult. The initial studies have been performed in rats.

Rat studies have previously shown that a gene, Pdx1, critical for normal development of beta cells, is under-expressed in individuals with IUGR.

The full Science Daily article is here.

If this article is not "scientific enough" for you, read more about Pdx1 here and here.

Diabetes + Arthritis = Less Exercise

Patients with both diabetes and arthritis are more inactive than those patients with either disease alone -- not avery surprising finding. However, the numbers of patients involved does grab some attention as more than half of all Type 2 diabetics in the United States also have arthritis.

About 30 percent of people with both conditions were inactive, compared with 21 percent with diabetes alone and 17 percent with arthritis alone, according to the study by the U.S. Centers for Disease Control and Prevention. Just 11 percent of adults with neither condition were inactive.

About 46 million adults in the U.S. have arthritis and 21 million have diabetes, according to the CDC. Exercise helps control blood sugar, blood pressure and body weight, which are especially important in people with diabetes, the CDC said. Regular activity reduces the risk of heart disease and nerve damage in diabetics and strengthens arthritic joints.

Read the full Bloomberg Science article here.

It Depends Where The Fat Is?

Body fat distribution has an impact on the risk of developing diabetes. Fat accumulating around the hips and buttocks may actually be protective.

"It was a surprising result."

Read the Fox News article here.

Another Step Toward An "Artificial Pancreas"?

Joseph P. Kennedy, and colleagues, at the University of Akron (Ohio), has developed a new device, coated with a permeable polymer membrane, that may be the key to further development of the "bioartificial pancreas". Their work is reported in the May 5th issue of Chemical & Engineering News.

Their new membrane improves the exchange of insulin and glucose between islet cells and blood in the presence of a better oxygen supply. It has shown promise in animal studies and human trials are being considered.

Written by Associate Editor Bethany Halford, the C&EN article points out that researchers have been trying to develop an artificial pancreas for years. Most approaches involve encapsulating healthy islet cells -- the pancreatic cells that detect glucose and release insulin -- and transplanting them into diabetic patients. But enclosing a large collection of cells has been difficult because the materials designed to hold them are not biocompatible, or optimal for use in the body, Halford notes.

See the full Science Daily article here.

THANK YOU!

Surgery "curing" diabetes? As said here, it's likely a "relative term".

FDA Study Indicates Pump Therapy May Be Risky In Teens

It ends up being an article that really discusses issues of "common sense" -- however, as we've noted before, there seems to be a whole lot less of that floating around any more. The FDA has published an article in the May issue of the journal Pediatrics.

Thirteen deaths and more than 1500 injuries were identified in a review of a decade's worth of pump use in teens that ended in 2005. Two of these were suicide attempts when patients attempted to give themselves too much insulin.

"The FDA takes pediatric deaths seriously," said the agency's Dr. Judith Cope, lead author of the analysis. "Parental oversight and involvement are important. Certainly teenagers don't always consider the consequences."

It is estimated that approximately 100,000 teen diabetics use pumps, part of a $1.3 billion annual pump business.

Read the full article here.