JJS Diabetes

Self-Inflicted?

2012-01-26T12:14:00.000-05:00

You can say she brought it on herself -- essentially, she's turning a profit, with her deal promoting VICTOZA, for having diabetes. However, how sad a commentary is it, on today's society, that we can see the following headline:

Paula Deen Caught Eating a Cheeseburger

Check it out here.

Great News

2012-01-24T18:39:00.000-05:00

New government records show foot, and leg, amputations show a "dramatic decline" and it's probably due to "better treatments".

The rate has fallen by more than half since the mid-1990s, according to what is being called the most comprehensive study of the trend.

For older diabetics, amputations dropped from more than 11 to about 4 per 1,000 people, the Centers for Disease Control and Prevention reported Tuesday.

The study appears in this month's issue of Diabetes Care.

Read the full article, with more details, here.

The True Takeaway From The Paula Deen Debacle

2012-01-24T05:43:00.000-05:00

The discussion of whether the Krispy Kreme Burger did it, or if a paid endorsement of a diabetes drug is OK, or whether Paula Deen waited too long to tell the world that she had been diagnosed with type-2 diabetes is an exercise in asking and answering the wrong questions. Instead, let’s talk about how to avoid joining Deen and the nearly 26 million Americans who have type 2 diabetes.

Type 2 diabetes is a disease that can be prevented. Read all about that here.

Who's That In The Super Bowl?

2012-01-23T06:26:00.000-05:00

Well, let's just say it's not a "Dream Team". The header photo gives you a hint.

90 Years Ago Today

2012-01-23T06:19:00.001-05:00

On this date, in 1922, a 14-year-old boy named Leonard Thompson (at the time, a two-year duration Type 1 diabetic) received the first successful injection of insulin. In 1922, the diagnosis of Type 1 diabetes was, essentially, a death sentence as it was treated by a starvation diet.

Twelve days previously, on January 11, Leonard Thompson had taken the first injection of insulin, but had a severe allergic reaction (probably due to an impurity in the solution).

Leonard, at the time, a 65-pound teenager close to death, improved after that second injection and lived on to the age of 27 to die of pneumonia.

The story of insulin is here.

The first mention, today, of the anniversary is seen in the Wales Online article here.

Can We Get In One More Comment?

2012-01-21T06:04:00.001-05:00

From a FoxNews.com article (regarding Paula Deen):

The only surprising thing about celebrity chef Paula Deen's announcement on the "Today Show" this week that has diabetes is that she didn't do it with a fried stick of butter hanging out of her mouth.

Check it out here.

It Does Happen

2012-01-20T06:46:00.000-05:00

At age 35, you can hear a doctor say, "You've had a myocardial infarction, or a heart attack."

Read this Diabetes Health account of a ten-year duration diabetic here.

Not So Subtle?

2012-01-19T14:16:00.001-05:00

The Paula Deen story will likely generate some news for a few more days.

Anthony Bourdain, another "celebrity chef", chimes in, on Twitter, with:
"Thinking of getting into the leg-breaking business, so I can profitably sell crutches later."

Check it out here.

Just So You Know ......

2012-01-19T09:43:00.002-05:00

None of our patients receive anything from drug endorsements.

However, we have first hand knowledge that a good number of them donate to the American Diabetes Association.

Paula Deen Will Donate Some Drug Endorsement Profits To The ADA

Look At It From The Other Side

2012-01-18T11:27:00.002-05:00

There are some very valid points .....

The headline is:

The Evil Marketing Genius Of Paula Deen -- The New Face Of Diabetes

Check it out here.

The "Rumor" Is True

2012-01-17T08:54:00.000-05:00

Paula Deen admits she's kept the diagnosis of diabetes hidden for three years. She gets in a plug for VICTOZA and USA Today even gets in that critical piece of information that she was "wearing a turquoise blouse" at the time of the announcement -- imagine trying to get to sleep tonight without that information!

The full article is here.

2007 Price Tag For Diabetes

2012-01-17T08:37:00.000-05:00

$174 billion

That would build 109 Met-Life Stadiums in East Rutherford, NJ (home of the New York Giants and the other New York team that claims it is going to the Super Bowl every year).

That's what it cost, in 2007, to care for the more than 25 million Americans with diabetes and the almost 80 million that have "pre-diabetes". Keep in mind that much of this total cost is spent on managing the complications of diabetes.

The disease leads to complications with the nervous system, vision, kidney function, the vascular system and blood pressure; it can also lead to heart disease and stroke.

"Renal failure leads to dialysis. With eye problems, you may need laser treatment. Blindness brings many other costs for daily living. If (diabetes) leads to amputation, it limits activity; if you have a physical job you may not be able to do it." And the list goes on. "The cost to the system itself is tremendous when people don't take care of diabetes."

Diet and exercise are the best tools to help avoid diabetes. The endocrinologist contributing to this Missouri-based article recommends reducing calories rather than a specific diet. The American Diabetes Association's recommendation of 150 minutes per week of exercise is noted.

DIABETES "BY THE NUMBERS":
* 25.8 million children and adults in the U.S. have diabetes (8.3% of population)
* There were 1.9 million new cases diagnosed in people 20 and older in 2010
* Adult diabetics have a heart disease death rate 2-4 times higher than non-diabetics
* The risk for stroke is 2 to 4 times higher among people with diabetes
* In 2005-2008, 4.2 million people 40 and older with diabetes had diabetic eye disease
* In 2008, 202,290 people with diabetic kidney disease were on dialysis
* 60-70% of diabetics have some degree of neuropathy (nerve damage)
* More than 60% of non-traumatic lower-limb amputation occur in people with diabetes

Read the complete article here.

Should We Talk About "Rumors"?

2012-01-13T13:02:00.000-05:00

Why not?

Paula Dean To Declare Diabetes ... And Drug Endorsement

BYDUREON Is A "Go" In The UK

2012-01-13T08:26:00.000-05:00

The once-weekly "jab", slow-release formulation of EXENATIDE (BYETTA), known as BYDUREON, has been approved for use in the UK. This weekly "jab" (the UK term for injection) can replace the current twice-daily injection formulation.

It'll cost £18 per week for the single "jab" (that's $27.59 with today's conversion rate) or $1435 per year.

How many of the 2.25 million UK diabetics will be using the drug? Time will tell. Keep in mind that it is estimated there are another 850,000 diabetics in the UK that are not yet diagnosed.

The final FDA decision on this drug is anticipated by late this month. Nausea is experienced by about one quarter of the patients using BYDUREON.

Read the full article here which includes a nice photo of the original source of this protein.

Stay In School

2012-01-11T19:12:00.000-05:00

The journal Health Affairs has published a study suggesting that young persons with diabetes might lose as much as $160,000 in income through a lifetime, based on a 40-year work period, as compared to non-diabetics.

The study linked lower earnings to higher high school dropout rates, potentially due to more health-related absences.

It is noted that high school dropout rates are 6% higher among diabetics and diabetics are less likely to go on to college. The study states, “high school and college graduates earn 1.5 and 2.7 times more than high school dropouts, respectively.”

"Job lock" is mentioned as a contributing factor to lower wages in employees with diabetes. These patients may not be as willing to look for new, and better, jobs for fear of losing health insurance.

The complete article is here.

Has It Really Come Down To This?

2012-01-11T05:50:00.001-05:00

"They" want to tax your "sugar-sweetened beverage" at a rate of one penny per ounce. "They" say it will save $17 billion in medical costs per year and generate an additional $13 billion in revenue.

These figures, published Monday in the journal Health Affairs, are based on some facts and several assumptions.

First, the facts: Americans drank 13.8 billion gallons of soda, punch, sports drinks, sweet tea and other high-calorie, nutrient-free beverages in 2009, according to industry data. That works out to about 70,000 calories per person. The sugar in all this “liquid candy,” as it is often called, is considered to be a major contributing factor to the obesity crisis, which in turn has fueled the rise of Type 2 diabetes and other diseases.

"They" assume the tax would reduce consumption by 15%. "They" assume 40% of the calories saved would be replaced by drinking more milk and juice. "They" come to the conclusion that the tax would eventually reduce daily caloric consumption by NINE calories per day in the American adult (age 25-64) population .... but, that adds up to reduce the obese population by 867,000 over ten years. In turn, this reduces the incidence of new cases of diabetes by 2.6% and other savings.

Of course, "they" can't be sure that a can of Coke, costing an additional 12 cents, will lead to any changes in consumption.

Has it really come to this?

Check out the full article here.

Note, this Los Angeles Times article did not blame ANYTHING on former President George Bush!

Good To Know

2012-01-10T19:58:00.000-05:00

Dietary Supplements: Know Before You Swallow

What Else Can You Do?

2012-01-09T09:34:00.002-05:00

A patient has a total cholesterol of 246 mg/dl and an LDL ("bad cholesterol") of 153 mg/dl (our goal, in the absence of established heart disease, is to keep the LDL under 100 mg/dl in a diabetic).

You start her on a prescription medication to lower the cholesterol and a follow-up LDL is 102 mg/dl (not bad).

Three months later, upon reviewing her medications at check-in, she informs you that she decided to stop the cholesterol medication 6 weeks prior -- "I just don't want to take it" is her response. She denies significant "side effects" (it is a generic, so we do not consider cost to be a major issue). .

You schedule her to come in fasting at her next visit so that the cholesterol profile can be re-checked. You'd like to get an idea whether a "non-statin" therapy can be considered.

She is a "no show" for that appointment.

You reschedule the appointment.

She shows for this appointment, but notes "I forgot" when asked why she did not fast (she had been given written instructions to fast for 10 hours before this visit).

You ask her to come in fasting the next week ... or ... go to the lab or her choice.

She does not comply.

GO GIANTS !!

2012-01-07T07:45:00.002-05:00

Cancer Incidence, And Mortality, Higher In Adults With Diabetes

2012-01-07T07:32:00.000-05:00

According to a study published in this month's issue of Diabetes Care, Type 2 diabetics do have a higher incidence of cancer and an increased mortality rate due to cancer.

Researchers at Johns Hopkins University (Baltimore) determined the age-adjusted cancer risk, per 1000 person-years was 13.25 in diabetic adults versus 10.58 in non-diabetic adults.

After adjusting for potential confounders, the risk of incident cancer was 22 percent higher in people with diabetes than in those without the condition, and the risk of death due to cancer was 36 percent higher.

"Our study suggests that for many common cancers like colon, breast, and prostate, diabetes exerts a stronger adverse influence downstream, after cancer occurs, than upstream, in relation to incident cancer risk. Whether improvements in diabetes management might reduce the risk of mortality in cancer patients with preexisting cancer deserves further attention," the authors write.

A truncated version of the article is here.

mySentry(TM) Remote Glucose Monitor Gets FDA Approval

2012-01-04T09:32:00.001-05:00

Medtronic, Inc. announced, today, that the U.S. Food and Drug Administration (FDA) has approved the launch of a "first-of-its-kind" remote glucose monitor, the mySentry^TM. The device permits a parent, or caregiver, the ability to monitor the data provided by the MiniMed Paradigm REAL-Time Revel(TM) System.
mySentry shows caregivers "real-time" insulin pump and blood glucose data. A number of alarms can be set for low, and high, blood sugars as well as exaggerated rates of change in the blood glucose trend.

"Many of the parents of our patients wake up a couple of times every night to check their child's blood sugar level and even that may not be enough to prevent episodes of severe hypoglycemia," said William Tamborlane, M.D., Chief of Pediatric Endocrinology and Deputy Director of the Yale Center for Clinical Investigation. "Advances in continuous glucose monitoring, including remote monitoring like mySentry, have given parents an added level of protection from dangerous nighttime hypoglycemia occurring in their sleeping child, as well as a means to improve their quality of life."

It is estimated that 75% of serious hypoglycemic (low blood sugar) events, in children, occur during the hours of sleep.

More information is available at www.medtronicdiabetes.com/mysentry .

The full press release is here.

Didn't Know It Was Contagious

2012-01-03T07:49:00.000-05:00

Another example of Electronic Medical Record (EMR) humor:

One of our patients, now a retired carpenter, has recently undergone a pulmonary (lung) evaluation for asthma-like symptoms. The conclusion of the evaluation reads:

"________ has mild obstructive lung disease. I suspect this is secondary to the dust and fume exposure during his wife's work in construction"

We did not know Mrs. ________ had also worked as a carpenter.

Wishing All A Happy And Healthy New Year !!

2011-12-31T12:24:00.003-05:00

... from our staff

Go Giants !!

Eight New Products For 2012

2011-12-28T14:59:00.000-05:00

Check them out here.

MERRY CHRISTMAS !!

2011-12-23T11:19:00.000-05:00

What Would The Holidays Be Without .....

2011-12-23T11:11:00.000-05:00

... one of the standard articles about "keeping off the pounds" through the Holiday Season? Check it out here.

Not OK in UK?

2011-12-21T09:56:00.000-05:00

They will be revamping the application forms for driver's licenses in the UK following complaints noting that rules and regulations, regarding diabetics, are too confusing (is anyone listening here?).

Drivers in the UK experiencing two "severe" hypoglycemic (low blood sugar) incidents per year are finding it difficult to renew their licenses.

I like the reference to "pointless new regulation".

Check out the full article here.

"Symptoms Of Diabetes"

2011-12-20T05:26:00.000-05:00

Check out a new website providing information on various aspects of Type 1 and Type 2 diabetes.

Click here.

U.S. Diabetes Rate Levels Off In 2011

2011-12-17T04:52:00.000-05:00

Eleven percent of Americans reported, in 2011, being informed they had developed diabetes. Amazingly, this represents a decline from that seen in 2009-1010.

The full article is here.

These Pumps Never Need Refilling

2011-12-17T04:44:00.000-05:00

The Boivins, a couple in La Sarre, Quebec, decided to get tattoos of insulin pumps on their abdomens in support of their son, Jacob, a Type 1 diabetic since age 3½. He's now five years of age and pump-treated.

“He adapted pretty quick, but one time he told me that he felt different and he was wondering if he was alone in the world, you know, wearing a pump,” Boivin said.

“Before we had the pump, I think the way he felt is that having shots was just a little part of his day and nobody had to know. But then now, he was wearing a pump, and people could see it and people were asking questions and I think that’s what bothered him a little bit. So he felt really alone.”

Read the full article here.

Students Return

2011-12-15T06:04:00.000-05:00

Second-year medical students from the Robert Wood Johnson School of Medicine will be rotating through our office starting today.

Fun With Electronic Records?

2011-12-08T16:28:00.001-05:00

We wonder if some of the physicians (a podiatrist in this case) look at the notes they generate with their electronic medical record systems. However, it was "electronically signed" by the podiatrist.

The S: stands for the SUBJECTIVE section of a "SOAP" note that is commonly used by practitioners. Check out a review of SOAP notes here.

We use the SOAP format for our notes, but I'm pretty sure we'll never see something equivalent to this. By the way, the patient is an 80+ year female with an A1c of 7.6% (give us time, she's new to us).

By the way, we're also ready for Christmas!

Get Off The Night Shift!

2011-12-07T08:32:00.001-05:00

Did you ever think about what life would be like if you avoided all the things that raise the risk for this or for that?

Do you think you'd ever leave the house (and only if you lived in some remote area)? Would you eat anything but broccoli? Would you drink anything but water from a true spring (not a well that yields "spring water")?

Night Shift Work May Raise Diabetes Risk

There is a very good chance, after seeing this, that one of our 1+ pack per day smokers, that doesn't follow their diabetic diet or get any exercise, will ask us for a "note" to get them off the night shift -- you know, so they can lower their health risk.

Finally

2011-12-05T17:06:00.001-05:00

It's a year and 2 days too late for Ron Santo to enjoy his election into The Major League Baseball Hall of Fame, but it corrects one of the biggest ongoing mistakes the election committees have ever made.

Ron Santo is now in the Hall of Fame (where he has belonged for many years). Check out previous posts below (keeping in mind some of the text colors are changed secondary to the old blog format) and today's announcement :

July 3, 2005

February 27, 2007

December 15, 2009

December 25, 2009

December 12, 2010

Finally, the Hall of Fame welcomes "Mr. Cub".

Can You Spell HYPOCRITE?

2011-12-05T05:19:00.000-05:00

How many think Nick Saban is going to turn down the invitation to play in the BCS National Championship game this year after Alabama didn't even win their division in the Southeastern Conference?

Pretty ironic that he made the statement while coaching LSU, this year's SEC conference winner.

Watching The Destruction

2011-12-03T11:49:00.001-05:00

Type 1 diabetes is all about the autoimmune destruction of the beta cells of the pancreas, thereby, eventually leading to a person's inability to produce enough insulin to maintain normal blood sugar control.

Researchers at the La Jolla Institute for Allergy & Immunology have, for the first time, unveiled movies of cellular destruction in mouse model systems.

"We are presenting the first images at cellular resolution of type 1 diabetes as-it-unfolds," said Matthias von Herrath, M.D. one of the world's top type 1 diabetes researchers and director of the Diabetes Research Center at the La Jolla Institute for Allergy & Immunology. "Being able to view these insulin-producing cells while they interact in the pancreas, rather than in a static state under the microscope, will greatly enhance our ability -- and that of the broader scientific community -- to find interventions for type 1 diabetes."

"This live imaging of the white blood cells that cause diabetes is quite remarkable," said George Eisenbarth, M.D., Ph.D., a prominent type 1 diabetes researcher and executive director of the Barbara Davis Center for Childhood Diabetes in Colorado. "These images provide critical information about the disease process, in particular showing us the reasons why the beta cell destruction (underlying type 1 diabetes) occurs very slowly over time. Such information may enable new approaches to stop the destruction process, with the ultimate goal being prevention."

In the movies, objects resembling ants can be seen furiously scampering about looking for their prey. The "ants" are actually immune system T cells, the body's cellular soldiers. The "prey" is insulin-producing beta cells, which the T cells mistakenly attack and destroy, eventually leading to type 1 diabetes.

Two-photon microscopy makes this process available as researchers can examine living tissue at much greater depths than conventional microscopy.

Interested readers should read the Science Daily article and the videos can be seen at the end of the published paper, in the Journal of Clinical Investigation, here.

Head Scratchers

2011-12-01T17:03:00.004-05:00

A good number of new patients to the practice are asked to see the dietician within a short time of their initial evaluation. Imagine reading the dietician's summary of her encounter with an insulin pump-treated patient that told you they determine their pre-meal insulin bolus dose by "counting carbohydrates":

"Patient doesn't know that fruit is a carbohydrate"
"Patient does not exhibit any skill at counting carbohydrates"

How about the patient that shows you a "sliding scale insulin" regimen they have from their previous physician? "Sliding scale" is generally defined as a set of instructions for administering insulin dosages based on specific blood glucose readings.

However, this patient, because of stroke-induced hand disability is, essentially, "one-handed" and is unable to test her blood sugar.

Anything Left That Doesn't Raise Diabetes Risk?

2011-11-28T05:19:00.000-05:00

Now, it's traffic pollution -- raises diabetes risk by 4%. Is this as significant as having your chance of winning the lottery raised by "four percent"?

Check out the article here.

Happy Thanksgiving

2011-11-23T05:25:00.002-05:00

Diabetes Hospitalization Rate Rises 10.5% In Pennsylvania

2011-11-23T05:22:00.003-05:00

Pennsylvania diabetes-related hospitalization rates are higher than the national average. That's 19.2 admissions per 10,000 residents as compared to a national rate of 17.7 per 10,000 residents for the period 2000-2009. In addition, more than 20% of those admitted were re-admitted for some reason within one year.

Closer to our office, rates were 14.2 and 15.5 per 10,000 residents for Bucks and Montgomery counties, respectively, suggesting the problems are greater in the less-affluent urban centers. The risk of admission is "significantly higher", statewide, in adults with annual incomes less than $25,000.

Among adults with diabetes, 27 percent were taking insulin in 2009, according to the Pennsylvania Health Department’s Behavioral Risk Factor Surveillance Survey. However, Type 1 versus Type 2 diabetes is not distinguished as far as that statement is concerned.

The complete article, with more interesting statistics, is here.

The Holidays With Diabetes

2011-11-23T05:09:00.000-05:00

Check out yet another one of the yearly opinions here.

We Won't Comment Any Further ......

2011-11-18T07:34:00.000-05:00

...... but, it might be said, in the end, he really wasn't a "Winner"?

Illinois Man Arraigned In Rhode Island For Medicare Penis Enlarger Fraud

Very Interesting ........

2011-11-17T09:18:00.003-05:00

........ are the points made in this article (Diabetes Drugs Differ in Effects on Weight in ESRD). ESRD is end-stage renal (kidney) disease.

However, the SITAGLIPTIN (JANUVIA) noted is much, much more expensive than GLIPIZIDE and we have to balance the flak we get from patients and the insurance companies regarding the cost. We'd certainly much prefer to use the drugs in this class (the DPP-4 inhibitors, or DPP-IV for the Roman numeral buffs) as they are safer (they do not promote low blood sugar) and do not cause weight gain. However, in patients with reduced kidney function, we can only use the half-maximum dose of JANUVIA and we must often fill out questionnaires as the insurance companies challenge our decision to use the expensive medications in Medicare patients. There is a new drug in the same class (TRADJENTA) that allows us to use the maximum dose in patients with reduced kidney function, but this newer drug is Tier 3 pretty much across the board at this time.

In fact, we've discovered the "Doughnut Hole Syndrome" (aka "DHS" in our office). We had noted several patients, after taking Tier 2 and Tier 3 drugs for months with no difficulties, suddenly developing "side effects" they blame on these Tier 2 and Tier 3 medications. They ask to stop them. Upon confronting a few of these patients with our suspicion that the "side effects" were more related to the cost of the drugs, they admitted that was the case. There has been more than one of the others that actually requested to "try the medication again". Interestingly, these requests come only in January or February -- yes, you guessed it -- when the "doughnut hole" had been cleared.

For an explanation of the "doughnut hole", click here.

OK To Drink With Diabetes?

2011-11-15T08:16:00.000-05:00

Read a summary of the potential ramifications of drinking alcohol, if you are diabetic, here.

Take the quiz -- believe it or not, yours truly actually got them all right!

Check out another good review of the subject here and more from dLife on the subject here.

522 Million By 2030?

2011-11-14T07:02:00.003-05:00

No, that's not how many times Andy Reid will say, "We have to get better" when talking about his 3-6 "Dream Team" Philadelphia Eagles.

It's the projected number of persons with diabetes and it's not the most encouraging thought on World Diabetes Day 2011.

Check out this article.

Almost 9% In Beijing

2011-11-12T10:04:00.000-05:00

The Health Bureau of Beijing Municipality has revealed that 8.6% of the population between 18-79 years of age is diabetic. In addition, another 5.1% of the population is considered at risk to also develop diabetes.

Check out the brief article here.

Veterans' Day 2011

2011-11-11T07:35:00.003-05:00

We salute all that have served our nation in times of war and peace

Check out the Department of Veterans Affairs website here.

Check out some Veterans Day quotations here.

Rest In Peace, "Smokin' Joe" Frazier

2011-11-09T16:43:00.001-05:00

Check out his previous "Knocking Out Diabetes" article here.

Eli Lilly And Amylin Pharmaceuticals End Collaboration

2011-11-09T05:41:00.000-05:00

Eli Lilly and Co. and Amylin Pharmaceuticals Inc. have announced their multi-year collaboration has ended. As a result, Amylin assumes full responsibility for the continued marketing of BYETTA and the once-weekly formulation of the the same drug (BYDUREON) if it is ever approved in the United States (it has been approved in Europe).

Further details of the agreement can be reviewed in the full article here.

Nice To See Some Realistic Reporting

2011-11-07T10:41:00.000-05:00

First, you wonder how "stem cell research" found its way to becoming a political issue. Next, you get a kick out of listening to some of the politicians discussing stem cell technology -- they wouldn't know a stem cell from the proverbial hole in the ground.

We get a realistic article from the Los Angeles Times ... and, once again, George Bush is not blamed for anything!

Ever since scientists started talking about the medical potential of embryonic stem cells, curing Type 1 diabetes has been one of the dearest dreams. When researchers announced in 1998 that they had derived stem cells from human embryos, their landmark report flagged juvenile-onset diabetes as a disease that might be treated by stem cell transplants. In the run-up to the 2004 vote on California's Proposition 71, diabetes was repeatedly mentioned as a target by scientists campaigning to form a state-backed stem cell agency.

Years later, the promise remains. But success has been elusive.

As reported, it's "simple as a concept". However, there are, most of the time, simple solutions to a lot of problems that never get considered. Did someone mention politicians?

Check out a well written article here.

Presidential Proclamation -- National Diabetes Month, 2011

2011-11-02T05:52:00.002-04:00

Check it out here.

FDA Delays Ruling On Dapagliflozin

2011-10-27T08:46:00.000-04:00

Bristol-Myers Squibb and AstraZeneca must wait at least three more months to hear if the FDA will approve their new drug, dapagliflozin. This drug, representing a new class in the treatment of Type 2 diabetes, helps lower blood sugar levels by causing diabetic patients to eliminate excess sugar in the urine.

The FDA Advisory Panel, this past July, expressed concern about the possibility of increased risk of bladder and breast cancer with this drug, as well as the potential for urinary tract infections.

The full article is here.

Can Insulin Pumps Be Hacked?

2011-10-26T19:46:00.003-04:00

Medtronic has asked software security experts to determine if insulin pumps might be hacked to provide irregular doses of insulin.

Security software maker McAfee, which has a health industry business, exposed the new vulnerability in one model of the Medtronic Paradigm insulin pump on Friday and believes there could be similar risks in others.Medtronic and McAfee declined to say which model is involved or how many such pumps are currently used by patients. It has two models of insulin pumps on the market and supports six older versions, with about 200,000 currently in use by patients.

The full article is here.

The Diabetes Is Coming, The Diabetes Is Coming

2011-10-26T19:41:00.000-04:00

The prevalence of diabetes in Russia has increased by 20% over the past five years and now stands at 2.12%. Diabetes is also being seen in younger individuals -- the average age at diagnosis is now almost 5 years younger than it had been in 2006 -- it now stands at 51.4 years.

Many additional, and interesting facts can be reviewed in the full article here.

The title of the post comes from here for those not at my advanced age.

Difficult Not To Follow These Instructions?

2011-10-25T13:42:00.000-04:00

Sarcasm In Seattle?

2011-10-24T11:29:00.000-04:00

A little graffiti in Seattle -- yes, it's the same place that counts the amount of carbon dioxide being put into the atmosphere (see below) .... instead of the national debt.

Shortage Of APIDRA SoloStar Pens

2011-10-22T06:59:00.000-04:00

Sanofi has announced that a manufacturing problem, in Frankfurt, Germany, has caused a shortage of the rapid-acting insulin APIDRA in the SoloStar Pen. Patients may, at some point, need to switch to vial-and-syringe, to use APIDRA until this situation can be corrected.

The full article is here.

Louisiana Researchers Shedding Some Light On The Subject

2011-10-21T05:58:00.000-04:00

Physicians at the LSU Health Sciences Center are adding to the knowledge base regarding diabetes and we're wondering if this might help explain one of the situations we've been seeing in some of our patients.

"We, in our initial research, found that glucose was just not the complete answer to this. Two people could have the same glucose and yet have very different A1c's, " said Dr. Stuart Chalew, a professor of pediatrics at LSUHSC and director of pediatric endocrinology and diabetes at Children's Hospital.

The LSUHSC doctors have been showing that non-diabetic parents of diabetic children show similar levels of of proteins in the skin that seem to correlate with the aging process.

"When we looked at our kids with diabetes, we looked at their parents too, who don't have diabetes, and the amount of this substance they had under their skin was similar to their parents, who didn't have diabetes, who are like 20 to 30 years older. So if you want an analogy, they speed up their aging process by about 20 to 30 years. Imagine that happening to you," said Dr. Chalew.

They're using the SCOUT DS machine by VeraLight, Inc. to correlate these findings. We first discussed this device more than six years ago. The SCOUT DS device is approved in Canada, but our FDA is still considering its helpfulness.

Read the full local news article about this here and we'll see if we can find a more complete, and formal, update of the LSU work.

Conversation With A World Leader In Diabetes Care

2011-10-20T18:14:00.000-04:00

Jesper Høiland is a senior vice president at Novo Nordisk and is responsible for international operations in 150 countries. Among other points in an interesting article, he notes:

It's strange to think that more people today die from being overweight than from starvation. Obesity is preventable to some extent and needs to be placed on the global agenda; if not, we will eat ourselves to death, which is quite terrifying.

The full article is here.

Better Than Fireworks?

2011-10-14T11:54:00.003-04:00

Everybody's Got Their Own Story

2011-10-14T09:19:00.000-04:00

Here's one of them here.

The American Diabetes Association Launches Free Online Resource For Meal Planning

2011-10-14T09:12:00.001-04:00

The American Diabetes Association has launched "MyFoodAdvisor", a free online resource for meal planning and recipes. You must register here.

Those that do register will receive a monthly e-newsletter to notify them about new content that is available.

The press release is here.

"MyFood Advisor" -- I remember the days when it would simply have been called "Food Advisor". Just like "your weather" on the weather forecasts used to simply be "the weather". It's hard to deny the "ME" generation.

Exercise Is Good -- Everybody Is Doing It

2011-10-14T08:11:00.003-04:00

by Mariano Bazo (Reuters)

In downtown Guadalajara in front of the upcoming Pan American Games

That Can't Be Good

2011-10-12T11:21:00.000-04:00

A just published paper, from the British Medical Journal, suggests that more than 50% of the panel members writing clinical practice guidelines (CPGs) for diabetes care and management of elevated cholesterol have conflicts of interest. Perhaps more disappointing is that 11% of panel members having conflicts of interest denied them.

CPGs help inform health care personnel how to best care for patients with certain medical problems.

Check out the full story here.

Diabetes And Obesity In America -- By The Numbers

2011-10-11T13:07:00.001-04:00

Mississippi is no longer the "most diabetic" state in the country (2010 statistics) and you can see how closely this is tied to obesity rates. It's nice to see this effort seems to be working in Mississippi.

Actor Puts A "FACE" On Diabetes

2011-10-11T05:31:00.000-04:00

African-Americans are twice as likely to develop diabetes as the Caucasian population. Actor Anthony Anderson ("Law & Order"), himself a Type 2 diabetic, joins a new campaign to raise diabetes awareness in the black population.

"I have this great scale at the house. Step on it barefoot, it tells you everything about yourself, metabolical age, how much physical fat you have one you, organs that have fat that can kill you," says Anderson. "I stood on that one day and at 36 it told me that I had the body of a 50 year old."

Diagnosed with diabetes 10 years ago, Anderson is now also working to raise awareness among black Americans through Eli Lilly's "Fearless African-Americans Connected and Empowered (F.A.C.E.) Diabetes" campaign.

Anderson has lost 35 pounds and plans to drop 20 more. Read the full article (and watch a video) here.

TV Time Related To Type 1 Diabetes Control?

2011-10-07T05:35:00.005-04:00

Patients with Type 1 diabetes spending more time in front of a television, or computer, screen appear to have less success controlling blood sugars. The explanation for this observation is not readily apparent -- factors such as family income, exercise or obesity do not explain the difference.

A German-based study suggested hemoglobin A1c levels were almost a point higher in the patients spending more time in from of a screen.
But while snacking could be a culprit, this study cannot really prove that screen time is at all to blame for the poorer blood sugar control, according to Dr. Sanjeev Mehta, a diabetes specialist who was not involved in the research.

One limitation of the study is that it measured kids' screen time and their blood sugar control at one time point. "So we cannot say that increased media consumption leads to poorer (blood sugar) control," said Mehta, of the Joslin Diabetes Center and Harvard Medical School in Boston.

Another issue, he told Reuters Health in an email, is that the study did not collect information on diet. So it's not possible to tell whether snacking, or overall eating habits, might explain the findings on screen time.

The American Academy of Pediatrics recommends, at worst, 2 hours of screen time per day I wonder if you can count how many individuals follow that recommendation on the fingers of a basketball team?

We wonder if this also includes the time they spend texting during their office appointments.

The full article is here.

Head Banger

2011-10-05T13:32:00.003-04:00

She was 76 years of age about 16 months ago
You've been helping take care of her diabetes for almost 7 years
She is at a height of 64 inches and weighs 236 pounds
She had previously refused to use JANUVIA due to cost
At that time, she was on maximum doses of METFORMIN and a sulfonylurea
-- this was in addition to a daily insulin dose

The A1c had risen to 7.5% at that visit 16 months ago
You suggest she try VICTOZA to help with blood sugar control
-- this is suggested as it will also help with weight control
She refuses VICTOZA, primarily due to cost

16 months later, you discover her primary physician started her on VICTOZA
-- this happens without your knowledge
-- you have primarily managed her diabetes (with good results) for 8 years
-- she has seen the same primary physician for that entire time
-- you send that primary physician a summary after every visit
-- you realize your efforts are being ignored

You discover she was started on the maximum dose of VICTOZA. You know very few patients tolerate this.

She develops significant nausea and experiences profuse vomiting -- as would be expected when starting a patient at maximum dose VICTOZA.

Now, she won't consider VICTOZA any longer. You've lost the chance to properly initiate a medication that has the best chance of helping this patient.

Diabetes Crisis In Ireland

2011-10-04T08:02:00.001-04:00

The "national crisis" is that "one in three" Irish persons has a family member with diabetes. It is estimated that 180 thousand people in Ireland are diabetic and that figure is projected to be 233,000 by the year 2020. In addition, another 146, 000 are thought to have "undetected pre-diabetes" and may develop Type 2 diabetes within 5 years.

The full Irish Times article is here.

The dLife Healthy, Low Carb Snack List

2011-10-04T07:34:00.000-04:00

Check out the list here.

Level Of Blood Sugar Control May Not Have Impact On Cognitive Decline

2011-10-02T07:33:00.000-04:00

Type 2 diabetics at 70+ years old are twice as likely to suffer mental impairment as those without diabetes. However, unlike some other potential complications of diabetes, this one does not seem to be impacted by the level of blood sugars control.

The full article is here.

Discovery Of Insulin Switches In Pancreas Could Lead To New Diabetes Drugs

2011-09-27T05:49:00.000-04:00

Salk Institute researchers have discovered how hormonal control helps regulate a series of "molecular switches" in the pancreas that leads to insulin production. This may, someday, be a method of therapy to treat both Type 1 and Type 2 diabetes.

"By understanding how pancreatic cells can be encouraged to produce insulin in the most efficient way possible, we may be able to manipulate those cells to treat or even prevent diabetes," says the study's lead author, Marc Montminy, a professor in the Clayton Foundation Laboratories for Peptide Biology at Salk. Such new agents might increase the functioning of beta islet cells even in people who have not developed diabetes.

"The truth is that as we grow older, these islet cells tend to wear out," Montminy says. "The genetic switches just don't get turned on as efficiently as they did when we were younger, even if we don't develop diabetes. It's like using a garage door opener so many times, the battery wears out. We need a way to continually refresh that battery."

This mechanism may be important in more fully understanding how BYETTA helps treat diabetes in Type 2 diabetics and how insulin production may be further stimulated.

For those that are a bit more scientifically inclined, more details can be seen in the full press release here.

Diabetes-Free Life Expectancy At18 Years Down Since 1980s

2011-09-26T19:05:00.000-04:00

You may expect to live longer nowadays, but must now also expect to develop Type 2 diabetes earlier in life. Those are the facts suggested in an article in the October issue of Diabetes Care.

The diabetes-free life expectancy at 18 years of age in the United States decreased in both men and women between the 1980s and 2000s, with obese individuals experiencing the greatest losses, according to a study published in the October issue of Diabetes Care.

Solveig A. Cunningham, Ph.D., from Emory University in Atlanta, and colleagues investigated the changes in diabetes-free life expectancy for men and women in the United States between 1980 and 1989 and between 2000 and 2004. The contribution of these changes to age-specific diabetes rates, and the changing effects of weight status on diabetes risks were also assessed.

The proportion of 18-year-olds likely to develop diabetes in their lifetime almost doubled for men, and increased by nearly 50 percent for women. A large percentage of this change is related to increasing rates of obesity.

The complete article is here.

Back From Vacation .... And These Are Always Disappointing To See

2011-09-25T08:15:00.000-04:00

Adrienne Carrington (age 56) admits stealing almost $570,000 from the American Diabetes Association through the past ten years -- see the full story here.

"Cover My Insulin Pump"

2011-09-13T10:12:00.000-04:00

Alberta is one of three provinces in Canada that does not yet cover the cost of insulin pump therapy. The cost is approximately $6000 per year.

You can read the "back and forth" logic for each side here.

Latest U.S. Food Trends

2011-09-08T05:57:00.000-04:00

Check them out here and, for some unknown reason, the list does not include Fried Bubblegum!

Stimulation Of Beta Cell Growth

2011-09-08T05:53:00.000-04:00

Finding molecules, or proteins, that may stimulate beta cell growth is one of the most important goals of research regarding insulin-dependent diabetes. Researchers, funded by the Juvenile Diabetes Research Foundation, together with Hoffmann-La Roche (a pharmaceutical company), have identified a protein that regulates beta cell growth and a chemical compound that stimulates the protein.

The details of the research are published in the current issue of Cell Metabolism and are summarized in this Scientific Daily article (for the scientifically-inclined).

"Fat Burning" Underwear?

2011-09-02T07:58:00.005-04:00

They are stated to be "perfect" for "exercise-shy-food-lovers". They are MXP Calorie Shaper Pants. The claim is that they force muscles to work harder during walking or stair climbing because they're made with "non-elasticated" material (a resin is printed on fabric to prevent it from stretching) .
A 140 pound man, walking 90 minutes daily in "fat burning underwear", will burn an extra 210 calories. Each pair of underwear costs £23.52 ($38.11 at today's conversion rate).

The underpants also boast deodorising particles, increasingly popular in salaryman clothing particularly during summer months, to keep the garments fresh.

A "salaryman" is a white collar office worker in Japan.

We're not sure what else can be said .... except .... at least, they're not "Made In China"?

The full article is here.

Study Suggests Increased Risk Of Bowel Cancer In 55-84 Year Old Type 2 Diabetic Men

2011-09-02T07:40:00.000-04:00

An Australian study suggests men, aged 55-84, were 87% more likely to develop a bowel cancer than the general population. Almost 1300 Type 2 diabetics were followed for up to 17 years people and it is concluded that "more research was needed to explain the link".

The full article is here.

Do Electronic Medical Records Improve Diabetes Care?

2011-09-02T07:29:00.002-04:00

This week's New England Journal of Medicine includes a study that suggests diabetes care improves with the use of electronic records (in place of paper files). The improvement is suggested to occur via "boosting communication".

However, there are caveats to the study. The research doesn't prove that electronic records directly improved patient care; other factors could explain the difference. And it can be costly for clinics to convert to electronic records, although many may be able to get financial incentives from the federal government.

Recently, we provided an "interesting" example of electronic medical records here. Yesterday, we received records from a Family Practice office regarding an upcoming new patient to our practice. We believe there is a significant chance that much of the record is incorrect (as a result of the electronic records format), but that must first be confirmed when the new patient is seen next week -- we'll provide an update.

"Boosting communication" has been easy for our office for many years. It's done via our fax machine. We provide a copy of each patient's visit summary letter, and any laboratory testing results, to their primary physician (and selected specialists when appropriate), after each visit. This practice is discussed with the patient at their initial visit and they can opt out at any time. We would estimate we get this type of information, in return, about 10% of the time. It would save a lot of time after a patient tells us they have been started on a new medication, but all they know is that it is a "white pill".

An important point about the study is made by Dr. Randall D. Cebul , a professor of Medicine at Case Western Reserve University in Cleveland:

He acknowledged that the study does not use the prospective approach that's considered the gold standard in medical research. Instead, it looked back at what happened to the patients instead of randomly assigning clinics to use electronic or paper records and then tracking their progress. "It's not a randomized controlled trial," he said, "but that will never happen."

The full article is here.

Telephone Lines Are Out

2011-08-31T08:38:00.002-04:00

If you are trying to contact the office, our three main lines are out of service (thanks to Irene). However, the answering machine line is functional (leave a message).

Otherwise, full office power has been restored.

No Power In The Office

2011-08-30T11:54:00.000-04:00

All appointments for Tuesday, August 30th, will need to be rescheduled. Thank you for your understanding. It was Irene's fault.

Loyalty

2011-08-26T08:31:00.001-04:00

Check out the story here.

In remembrance of those who make the ultimate sacrifice to defend our nation:

It Is The Soldier

Charles M. Province

It is the Soldier, not the minister

Who has given us freedom of religion.

It is the Soldier, not the reporter

Who has given us freedom of the press.

It is the Soldier, not the poet

Who has given us freedom of speech.

It is the Soldier, not the campus organizer

Who has given us freedom to protest.

It is the Soldier, not the lawyer

Who has given us the right to a fair trial.

It is the Soldier, not the politician

Who has given us the right to vote.

It is the Soldier who salutes the flag,

Who serves beneath the flag,

And whose coffin is draped by the flag,

Who allows the protester to burn the flag.

"There Will Be A Diabetes Cure" (Article in Diabetes Health)

2011-08-26T07:00:00.000-04:00

Check it out here.

"Great News" For Type 1 Diabetics

2011-08-22T06:07:00.000-04:00

Researchers now say those with Type 1 diabetes live nearly as long as those without diabetes.

That's right: According to a study from the University of Pittsburgh Graduate School of Public Health, the estimated life expectancy for type 1s diagnosed from 1965 to 1980 is 68.8 years. The average nondiabetic life expectancy is 72.4 years -- a bit more than three years' difference.

But there's more. Type 1s diagnosed from 1950 to 1964 have an average estimated life expectancy of only 53.4 years. That means that treatment advances in recent years have added more than 15 years to the life of an average person with type 1.

Projections are not made for those diagnosed after 1980 ..... keeping in mind the data from the DCCT does not become available until the mid-1990s. It is very likely that lifespans of Type 1 diabetics were further extended by the knowledge gained in that landmark study.

The full Diabetes Health article is here.

Chicago Bears' Jay Cutler Raises Money For Youth Diabetes Awareness

2011-08-22T05:58:00.000-04:00

Cutler catches a lot of flack for several things ..... but not for this -- check it out here.

This Will Be Interesting To Watch

2011-08-21T06:06:00.000-04:00

We'll just post the following excerpt regarding a situation in the United Kingdom and we'll pass on a comment at this time:

Under a new definition of the rules to meet an EU directive, a diabetic who has two hypos in a year – even while in bed – will end up banned from driving.

Diabetes UK is protesting the changes that are due to take effect in October.

The full Daily Mail article is here.

Insulin Pumps On Airline Flights

2011-08-21T05:50:00.004-04:00

An Australian study, published in an upcoming issue of Diabetes Care, has suggested that changing cabin pressure, during airline flights, may cause insulin pumps to deliver less, or more, insulin than the pump is set up to do. However, this potential situation may only impact patients with very small daily insulin requirements.

We have not seen, or heard, of any problem, to date, in any of our patients.

"It's certainly not a frequent and recurring problem that I hear about from patients who fly," said Dr. Robert Cohen, an endocrinologist at the University of Cincinnati College of Medicine, who was not involved in the new study. "The people who are very sensitive to small changes in doses are the ones who are going to be most sensitive to this," he told Reuters Health. "People who are on large doses or are not very sensitive...are far less likely to be affected by this."

Researchers at John Hunter Children's Hospital in Newcastle, Australia, arranged to put ten insulin pumps (by Animas and Medtronic) on a commercial flight. Pumps delivered 1.0 to 1.4 units less insulin during takeoff (when cabin pressure decreases). Less than one unit difference was observed during descent, as cabin pressure increases).

Once again, this is not expected to be a significant problem for the vast majority of pump-treated patients and it is suggested the "solution may be worse than the underlying problem if somebody doesn't really understand how to carry it out."

Speak to your physician about any questions you may have.

The full article is here.

A Reason To Cross The Border?

2011-08-19T08:06:00.007-04:00

Diabetes is "deadlier" for Mexican-Americans than Anglos, and much deadlier for diabetics living in Mexico. This is the report of the San Antonio Heart Study, published this week in the Annals of Epidemiology. The study followed thousands of residents over three decades and includes data from the Mexico City Diabetes Study.

They found that while Anglo diabetics had double the risk of nondiabetics of dying, Mexican-Americans had three times the risk. And diabetics living in Mexico City were four times more likely to die.

By the way, we imagine they should be saying that these individuals are more likely to die from a diabetes-related outcome or by a certain age, etc. The last time we checked, everyone dies. That should lead to a statement that the risk of dying is the same for everyone.

Some reviewing this data suggest the differences are largely related to the environment. Previous studies studies have show that "living in a poor neighborhood" is also a risk factor for diabetes.

The complete article is here.

SANDOZ vs. NOVO-NORDISK

2011-08-19T07:40:00.002-04:00

Sandoz Inc., a unit of the Swiss drug company Novartis, has asked a court in Detroit to determine that its generic version of PRANDIN does not infringe upon that of Novo-Nordisk's product. However, Sandoz, apparently, plans to produce the generic before the Novo-Nordisk patent expires, but the patent has already been challenged (and that ruling is being appealed).

As an outsider that has also watched cases involving patent law in other industries, one wonders why a patent cannot, seemingly, just be a patent. Why go to all the trouble, in the first place, if it doesn't really seem to make a difference?

Check out the full story here.

Don't Watch The Commercials?

2011-08-19T07:36:00.002-04:00

Check out the logic here.

Australian researchers are telling us that, after the age of 25, you lose 22 minutes of life expectancy for every hour of TV you watch. If you consider an average hour of television includes about 22 minutes of commercials, you will, theoretically, improve your situation by not watching them (record everything you watch).

The study, which was published this week in the British Journal of Sports Medicine, followed 11,000 adults over a 6.5-year period and used national mortality statistics and data from the Australian Diabetes, Obesity and Lifestyle Study.

Calculation methods used to estimate the impact of smoking, obesity or other risk factors on life expectancy were used in this study and they controlled for leisure-time physical activity, obesity and being overweight. A lifetime average of 6 hours of TV-watching daily will shorten lifespan by almost 5 years.

Based on this premise, we'd imagine that reading or sitting around shooting the breeze with neighbors are also "dangerous" activities that would decrease your longevity .... but, there's no commercials with those activities!

Are you following the logic?

Check out the complete article here.

BYDUREON Decision By January 2012?

2011-08-12T06:03:00.001-04:00

Amylin Pharmaceuticals, Inc., Eli Lilly and Company and Alkermes, Inc. have responded to the second complete response letter (CRL) requested by the FDA regarding their once-weekly formulation of EXENATIDE. The FDA will treat this as a "Class 2 submission" to suggest a final decision comes down by January 28, 2012.

Get all the details here.

Beginning Of The End For ACTOS?

2011-08-06T08:03:00.003-04:00

It doesn't look as if it will let up. The number of lawsuits is climbing against the maker of ACTOS, the world's best-selling diabetes medication. It appears the last of the three thiazolinedione medications is headed for a fall, just like the two that came before it. REZULIN (troglitazone) was withdrawn from the market in March 2000. AVANDIA (rosiglitazone), can be used only in limited situations.

In June, Takeda Pharmaceuticals Co. Ltd. halted sales of ACTOS, its top drug, in Germany and France after pressure from regulators.

Since then, both the U.S. Food and Drug Administration and the European Medicines Agency have issued warnings about the cancer risk based on new research, but they have allowed sales to continue. Doctors are being told not to prescribe Actos for people who have or have had bladder cancer.

ACTOS, like the two thiazolinediones approved before it, helps improve the body’s sensitivity to insulin, thereby minimizing the most significant defect of Type 2 diabetes (insulin resistance). Since AVANDIA was banned in Europe and significantly restricted in the United States, sales of ACTOS rose from $2.9 billion in 2006 to more than $4.3 billion last year. However, there will be more and more of these as time goes on.

More than 20 firms, from Florida to Washington state, are advertising for clients on the Internet or in newspapers, a standard practice in personal injury law.

Despite what you will read from the "Wall Street experts", we have few, if any, other medications that will adequately replace the mechanism of action of ACTOS in a diabetic patient that is already using METFORMIN. Insulin will likely be the most appropriate substitute to replace the impact of the drug on blood sugar control. In fact, ACTOS use in our office, through the years, has largely been prompted as a "last gasp" option to avoid insulin therapy in Type 2 diabetics.

Read the full Washington Post article here.

DEGLUDEC Continues To Show Promise

2011-08-06T07:10:00.001-04:00

DEGLUDEC is a new "very long acting" insulin that has been developed by Novo-Nordisk. Our office has been participating in some of the clinical trials to date. This week's issue of The Lancet (a British medical journal) includes reports that DEGLUDEC therapy maintains blood sugar control, in Type 2 diabetics, at levels equivalent to that of LANTUS. The difference is DEGLUDEC can be injected three times weekly.

In addition, DEGLUDEC users experience less hypoglycemia (low blood sugar) and the new insulin can be mixed with other insulins, if needed..

Novo-Nordisk is hoping DEGLUDEC reaches the market by 2013.

Check out the full Diabetes Health article here.

Not Generally Recommended?

2011-08-05T08:42:00.001-04:00

No problem with keeping cool in the summer ..... but you wonder whether this method comes to a "shocking" end?

Railroad Therapy

2011-08-02T06:03:00.001-04:00

We haven't tried it yet -- click here to check it out.

We doubt Aetna will cover it.

No Definitive Conclusion (Yet) That Intensive Blood Sugar Control In Type 2 Diabetes Reduces Cardiovascular Risk

2011-07-30T08:42:00.001-04:00

The July 27th online edition of the British Medical Journal (BMJ) includes a paper reporting the results of a meta-analysis of 13 studies that included more than 34,000 subjects. The conclusion is that we do not yet have solid data suggesting intensive treatment of Type 2 diabetes lowers risk of cardiovascular-related deaths (heart attacks, strokes, etc.).

In the new study, Catherine Cornu, a research physician at the Clinical Investigation Centre, Louis Pradel Hospital, in Bron, France, and colleagues reviewed 13 studies that included a total of 34,533 diabetes patients -- 18,315 who underwent intensive glucose-lowering treatment and 16,218 who received standard treatment.

Intensive treatment did not significantly reduce cardiovascular death or all-cause death, but it was associated with a 15 percent reduced risk of nonfatal heart attacks and a 10 percent reduced risk of microalbuminuria, an indicator of kidney problems and heart disease, the researchers found.

But intensive treatment was also linked with a more than twofold increase in the risk of dangerously low blood glucose levels (severe hypoglycemia), the investigators noted in a journal news release.

This is why we have always, and continue to, support the individual assessment of treatment goals in individual patients.

An article about the study is here and the study abstract, from the BMJ, is here.

Maybe Not A Bad Thing?

2011-07-30T08:27:00.000-04:00

The state of Utah is acknowledging difficulty in getting its doctors and hospitals "all on the same page" with their electronic medical records (EMR) systems.

Health information exchanges are in various stages of development in every state, a growing IT infrastructure fueled by billions in federal funding and a belief that data can improve health care and lower costs.

Utah’s cHIE, or Clinical Health Information Exchange, has buy-in from all the state’s major hospital systems. And the state’s doctors are a tech-savvy bunch, which should favor creation of a health exchange. About 60 to 70 percent of them use digital medical records — double the adoption rate of their peers nationally — largely due to e-health investments by the state’s hospital giants, Intermountain Healthcare and University of Utah Health Care.

Our concern is that non-IT-savvy physicians are going to have difficulty when EMRs are mandated on a certain date. We fear they'll be paying much less attention to patients at visits than they do to completing the EMR correctly. Patients may see a lot more of the top of their physicians' heads as they "hunt and peck" on the data entry device during the visit. At some point, it's likely that full reimbursement for services will be linked to proper, and complete, EMR documentation.

We've been "amazed" (we'll use that word) at the quality of some of the EMRs we've received. Just last week, we saw a new patient transferring from an Endocrinology practice that had begun using EMRs. As far as we're concerned, it doesn't matter if this record is readily available anywhere the patient goes. For our purposes in gathering information about the patient, it was not very helpful. Believe it or not, we understand what is written -- you can see how exciting our lives are. However, we imagine this record would be borderline worthless for other physicians seeing the patient. We'll show one portion below, but the patient also confirmed the current medication list was significantly incorrect (as matched against the medications she brought to the first visit with us).

Click on the image below to enlarge:

Read about Utah's situation here.

We Didn't Say It

2011-07-27T05:10:00.000-04:00

"Lives Wasted As FDA Stalls On Diabetes Care"

Click on the link to find out what that is all about. Ms. Sagan's comments can be added to what seems to be the "billions and billions" complaints about the FDA.

FDA Advisory Panel Is "Thumbs Down" On DAPAGLIFLOZIN

2011-07-20T04:52:00.001-04:00

The FDA Advisory Panel, in a 9-6 vote, did not approve DAPAGLIFLOZIN, the joint product of Bristol-Myers Squibb and AstraZeneca. This medication offers a new mechanism regarding blood sugar lowering and weight loss -- it leads to loss of sugar (and the calories that go with it) in the urine.

Reports have hinted, for the past several weeks, that there was some clinical trial evidence of breast cancer, bladder cancer and liver damage concerns.

It is unknown if the FDA will request further data from additional clinical trials.

Dapagliflozin is the first in a new class of diabetes drugs. Normally, the kidney recycles sugar back into the body. But dapagliflozin inhibits a transporter molecule called SGLT-2. The result: Sugar passes out of the body in the urine, lowering blood sugar without affecting insulin levels.

Another result: Patients lose weight. In clinical trials, Type 2 diabetes patients who took dapagliflozin for six months lost 1 to 5 pounds. In a special study to look at weight loss in people with diabetes, 30% of those who took dapagliflozin plus metformin lost 5% of their body weight.

Additional "side effects" were shown to be dehydration, heat intolerance and increased risk of urinary tract infections (secondary to the increase in sugar passing through the urinary tract).

Further details can be seen in the full article -- click here.