Replacing white rice with whole grains, like brown rice and pasta, could help cut the risk of type two diabetes by a third.
In a large Harvard University study, people who ate five or more servings of white rice a week were 17 percent more likely to have diabetes, compared to those who ate less than one serving a month.
Yet eating brown rice at least twice a week reduces the diabetes risk by 11 percent.
Inhaled insulin proved to be as effective at lowering blood sugar levels as standard insulin injection treatment, and with minimal side effects, among patients with uncontrolled type 2 diabetes, according to a new study.
Reporting in this week’s American Diabetes Association meeting and in The Lancet, researchers compared two approaches to managing type 2 diabetes among patients ages 18 to 80 from 10 different countries. The patients were nonsmokers and had poor control of blood sugar despite insulin therapy.
A total of 211 patients received inhaled insulin plus insulin glargine, a long-lasting form of insulin taken by injection, before bedtime to help manage blood sugar. They were compared with a comparison group of 237 patients who did not use the inhaler, but received insulin injections instead.
One year after treatment, the researchers found that:
“Our findings show that inhaled insulin plus insulin glargine, alone or in combination with an oral antidiabetes drug such as metformin, is an effective alternative to conventional insulin therapy (biaspart insulin) in uncontrolled type 2 diabetes,” study researcher Julio Rosenstock, MD, and colleagues write. “Inhaled insulin … could provide improved blood sugar control with lower weight gain and rates of hypoglycaemia in many individuals with type 2 diabetes.”
This research was funded by MannKind Corp., a California-based biopharmaceutical company that manufactures Technosphere, the inhaler device used to deliver the insulin in this study. MannKind is using Technosphere to administer an inhaled insulin drug called Afreszza, which has not yet been approved by the FDA.
There is a great deal of interest among drug companies and patients in finding new ways to better manage diabetes. According to the American Diabetes Association, nearly 8% of the U.S. population has either type 1 or type 2 diabetes. There are 1.6 million new cases of diabetes diagnosed in people aged 20 and older every year.
In an accompanying editorial, British researchers Clifford J. Bailey, MD, from Aston University and Birmingham Children’s Hospital, and Anthony H. Barnett, MD, from the Heart of England NHS Foundation Trust and the University of Birmingham, suggest that more research is needed to flesh out any possible safety issues with using inhaled insulin, particularly concerns over how inhaled insulin affects the alveoli — tiny air sacs in the lungs.
They conclude: “The opportunity for convenient inhaled bolus insulin, to facilitate complex insulin delivery regimens, will be welcomed by some patients. For now, we say: proceed with caution.”
Inhaled insulin was recently introduced to the U.S. market when Exubera, manufactured by the New York-based pharmaceutical corporation Pfizer, was approved by the FDA in 2006. However, Pfizer discontinued Exubera the following year due to poor sales.
Aggressive drug treatment to lower blood sugar, blood pressure and cholesterol in diabetics does little to prevent heart disease and strokes, but it does help prevent diabetic eye disease, nerve and kidney disease, U.S. researchers said on Tuesday.
The five-year, U.S. government-backed study, presented at the American Diabetes Association meeting on Tuesday, was stopped temporarily in February 2008 because there were 20 percent more deaths among diabetics with heart problems who got intensive treatment to lower their blood sugar compared to those who were treated more conservatively.
The patients getting the tougher treatment were transferred into the gentler group and the trial continued.
The latest long-term results show that using more drugs and adding a fibrate drug like Abbott Laboratories’ TriCor to statin cholesterol drugs did little to prevent heart problems.
But it did help prevent diabetic retinopathy, the chief cause of vision loss in working-age Americans, the study of 10,251 older diabetes patients showed.
Because intensively lowering blood sugar in some patients can increase the risk of dying from heart problems or cause episodes of severely low blood sugar, doctors need to treat every patient individually, researchers said.
“These results underscore the importance of patient-centered care that stresses individual treatment choices made in consultation with a physician,” said Dr. Denise Simons-Morton of the National Institutes of Health’s National Heart, Lung and Blood Institute, the study’s main sponsor.
The researchers on the study, called ACCORD, set out to prove what most experts had already assumed — that lowering a diabetic’s blood sugar to near-normal levels would prevent serious heart complications, a chief killer of people with type 2 diabetes.
Doctors used several combinations of drugs to control blood pressure, lower cholesterol and reduce blood sugar to a level well below the current standard of care.
IMPROVED EYE AND KIDNEY FUNCTION
There was no difference in the risk of heart disease among those whose blood sugar was lowered to a hemoglobin A1C level of less than 6 percent, a normal level, compared with standard goals of 7 to 7.9 percent.
But patients in the intensive group did have less protein in the urine, a sign of kidney disease, and they had sharper vision and better nerve function than those who got standard care.
“Less protein in the urine is a very good sign,” said Dr. Faramarz Ismail-Beigi of Case Western Reserve University, whose findings were published in the journal Lancet.
A sub-study of 3,000 patients in the ACCORD trial by Dr. Emily Chew of the NIH, published online in the New England Journal of Medicine, looked specifically at the effect of intensive treatments for blood pressure, cholesterol and blood sugar on diabetic eye disease.
She found that diabetic retinopathy developed more slowly among people who had their blood sugar lowered aggressively and in people who got both a fibrate and a statin, compared to those who got standard treatment.
The trial is the first to show that adding a fibrate to statin treatment can cut the progression of diabetic eye disease, the team said.
If you need a drug for Type 2 diabetes, Consumer Reports has long advised that a time-tested older medication called metformin is your safest and best first bet. Two studies published Monday, both involving a newer drug, Avandia, underscore why.
In the first study, published in the Journal of the American Medical Association, researchers led by David Graham of the Food and Drug Administration analyzed Medicare records of more than 227,000 people who took either Avandia or another diabetes drug, Actos. They found that those using Avandia had an increased risk of stroke, heart failure and death.
In the second study, published in the Archives of Internal Medicine, Steven Nissen of the Cleveland Clinic updated his 2007 meta-analysis (an analysis that includes results of several studies) of Avandia. The new analysis, which included 14 additional studies on top of the 42 that made up the original meta-analysis, confirmed his previous finding that Avandia increases the risk of heart attacks.
An FDA advisory committee is set to discuss the safety of Avandia in mid-July. The drug already carries a warning that it can cause heart failure, but some FDA officials think it also causes heart attacks and should be pulled from the market. According to internal reports released by leaders of the Senate Finance Committee earlier this year, FDA officials speculate that if patients on Avandia were switched to Actos, 500 heart attacks and 300 cases of heart failure could be prevented every month.
The FDA documents were discovered in a two-year investigation into Avandia by the committee; its report charged that the manufacturer, GlaxoSmithKline, knew of the heart risks associated with the drug for years before the danger was made known to the public. Avandia now carries a black-box warning — the FDA’s strongest — that the drug can cause or worsen heart failure.
GlaxoSmithKline issued a statement denying the allegations.
The report also raised grave concerns about the FDA’s handling of a study that is comparing the heart risks of Avandia with Actos or a placebo. In the internal reports, FDA officials called the trial unethical and unsafe for patients, given the known heart risks of Avandia. If you are involved in this study, called the TIDE trial, ask your doctor whether Avandia or Actos is appropriate for you. (Actos also carries a warning that it can cause heart failure.)
For people who need a diabetes drug, Consumer Reports’ free Best Buy Drugs report recommends metformin, either alone or with glipizide or glimepiride, as the first option. It has a well-established safety profile and is available as an inexpensive generic.
Type 2 diabetes drugs improve the body’s processing of sugar. When they work well, a test measuring the long-term presence of blood sugar called HbA1c improves. Studies show that the newest medicines are not any more effective than those that have been around for decades, such as the sulfonylureas and metformin. In fact, three of the newer medicines — acarbose, miglitol and nateglinide — actually decrease HbA1c less than some of the older drugs. Also, all diabetes drugs have the potential to cause adverse effects, both minor and serious. The newer drugs don’t have a safety advantage; in fact, they may be less safe.
Start with metformin, which offers the best combination of effectiveness, safety and affordability. Studies show that people who have trouble controlling their HbA1c level using a single medication do better if they add a second drug. Taking two medicines at once does raise the risk of side effects. But if you run into problems, your doctor may simply recommend that you try lowering the dose of one or both drugs.
Taking into consideration their overall effectiveness, safety, side effects, dosing and cost, Consumer Reports chose the following diabetes medicines as Best Buys. All of them are available as low-cost generics, costing from $10 to $60 a month, sometimes less:
– Metformin, alone or in combination with glipizide or glimepiride.
– Glipizide and glipizide sustained release, alone or in combination with metformin.
– Glimepiride, alone or in combination with metformin.
Copyright 2010. Consumers Union of United States Inc.
Improper nutrition does contribute to the development of diabetes, but proper nutrition can be a powerful treatment for this disease. (1) This disease is so closely related to diet and nutrition; scientists have studied how nutritional supplements can effectively treat diabetes. In researching vitamin supplements, researchers have found that many vitamins and herbs can effectively help lower blood sugar. Some of these supplements are vitamin C, B vitamins, minerals like chromium and vanadyl sulfate, and herbs like Gymnema Sylvestre can all help lower blood sugar. If one combines these supplements together, they can synergistically work together to lower blood sugar. First let’s look at what diabetes is and then we can discuss how these supplements work.
The foods we eat are digested and broken down into simpler forms; most carbohydrates are broken down into sugar also known as glucose. These sugars are absorbed through the intestinal tract into the bloodstream where it is circulated through out the body to feed cells.
Insulin is a hormone released by the pancreas. The pancreas is a long skinny organ that sits behind the stomach adding enzymes into the digested food. Insulin helps deliver nutrients and sugar from the bloodstream into cells where it is needed. The sugar supplies energy to various organs such as the heart and lungs; for example the heart beats and lungs breathe which keep us alive as a result of sugar’s energy supply. (2,3)
There are two classes of diabetes type I and type II. Type I diabetes is sometimes called insulin dependent, juvenile or child onset diabetes. This type usually starts at a very early age and the pancreas stops producing insulin. When the body does not make insulin, the sugar stays in the bloodstream instead of going into the cells where it’s needed. This can be fatal, so a person with type I diabetes needs a shot of insulin every day for his/her body to function properly (to stay alive).
Type II diabetes usually starts in adults and is the most common kind of diabetes in America. Most people who have diabetes have type II, that’s about 90% -95% of all diabetics in America. In this type of diabetes, the pancreas is producing enough insulin but the body doesn’t use the insulin effectively. This is called insulin resistance, cells in the body do not respond to the insulin and so the pancreas produces more and more insulin to over compensate this resistance. When blood sugar starts to raise in the bloodstream in this manner, the medical doctor (MD) will diagnose type II diabetes. Most type II diabetics need a prescription drug to lower the blood sugar because a diet change isn’t enough to control their blood sugar problem. (4)
In both cases, the blood sugar is too high in the bloodstream and will cause several problems. The first problem is cells cannot absorb sugar for energy; they starve and start to die. Secondly an excess amount of sugar in the blood leads to cardiovascular disease, hardening of the arteries, nerve and eye damage, and kidney damage.
Scientists are not exactly sure what causes type I diabetes, but they do know it has something to do with the immune system. A healthy immune system protects us from the common cold and cancer cells (cells in the body that go bad). The immune system can becomes confused and starts attacking good cells, in some cases, the healthy cells in the pancreas that produce insulin, which causes diabetes. (4)
Type II diabetes has been linked to individuals who are overweight. These overweight individuals have high blood pressure and high cholesterol as well which may also lead to this form of diabetes. Being overweight causes the body to become insulin resistant and by dropping some excess weight one could possibly reverse type II diabetes (rare).
If you think you have diabetes, you should look for the following symptoms. Type I diabetics usually have frequent urination because of the high blood sugar; the kidneys are trying to balance the body’s bloodstream. The kidneys are forced to eliminate all the unused nutrients and sugar in the blood over working the kidneys and if left unchecked can lead to kidney damage. If you experience intense thirst, your body is trying to replace the liquids lost from frequent urination. You may experience increased hunger but you will not gain weight when you do eat more. This is because your body’s cells need more nutrients, but since these cells can not absorb the insulin and nutrients the body starves.
With type II diabetes you might not notice any symptoms. Type II diabetes usually happens very gradually and the person doesn’t know about it till diabetic complications occur, then it’s too late. (3,4)
All diabetic complications are caused from high blood sugar. The longer the blood sugar goes unchecked the greater your chances of having complications. High blood sugar causes cardiovascular disease. The blood vessels begin to thicken from excess fat in the bloodstream because high blood sugar elevates the fat circulating in the blood. When the vessels thicken circulation becomes poor and with poor circulation your ability to heal is impaired. Heart attack, heart pain, and stroke are common in diabetics because of poor circulation and blocked arteries form all the fat buildup in the blood vessels.
Nerve damage is another complication of diabetes. Diabetics may notice numbness in their arms and legs because of nerve damage caused from high blood sugar. These nerves can not send signals to the brain relaying pain and touching sensations. Most diabetics will notice numbness in the feet and lower legs before other parts of the body are effected. (3,4)
The next complication is eye damage. A more sever complication because going blind is not pleasant for anyone. The eye has very small delicate vessels in the retina, these vessels help you see when light shines upon them in the eye. When blood vessels are weakened, they can hemorrhage and leak fluid into the eye. This causes swelling and blurs the vision. There is a clear gel in the eye keeping it solid and round, if blood leaks into this gel, your vision can become blurred or completely impaired. As the eye continues to get damaged, the eye will attempt to repair itself by growing new vessels. These new vessels are fragile and can burst. Scar tissue can form and cause the retina to pull away from the eye, worst case causing blindness.
Blood vessels network throughout the entire body. Your kidneys are made up of vessels and can become damaged as well. If the vessels in the kidneys become impaired, waste cannot be eliminated from the body and a form of treatment called dialysis might be required. If blood sugar is not kept under control, damage to the kidneys will continue to the point where a transplant might be needed or daily dialysis is required to remove waste from the bloodstream. The good news is practically all of the complications that occur with diabetes can be prevented when the right care is taken.
With proper diet and nutrition one can successfully prevent diabetic complications. Along with diet and nutrition, vitamins, minerals and herbs can also help lower blood sugar and reduce the complications that may occur. The best kind of supplement is one that combines vitamins and herbs together so that they work together synergistically to effectively lower blood sugar. You might be wondering what vitamins, minerals and herbs are good for blood sugar, your in luck here is a list:
Vitamin C, Vitamin E, Vitamin B-6, Folic Acid, Vitamin B-12, Biotin, Magnesium, Zinc, Selenium, Copper, Manganese, Chromium, Gymnema Sylvestre, Bitter melon, Fenugreek seed extract, Bilberry berry extract, Bioflavonoids, and Vanadyl Sulfate. Make sure most of these ingredients are in the formula you buy. The frequency at which you take these supplements should be listed on the bottle you buy as well. As a rule of thumb they should be taken at least twice a day. Do not stop taking your normal multiple vitamin supplement; diabetic formulas are a complement to what you currently take not a replacement.
Vitamin C (ascorbic Acid) – keeps diabetics blood vessels and kidneys healthy. Vitamin C works with vitamin E to get sugar out of the blood stream and into the cells.
Vitamin E (Natural Tocopherols) – helps prevent nerve damage, helps prevent kidney damage, blindness, and heart attack. Vitamin E works with the B vitamins to help keep the pancreas healthy.
Vitamin B-6 (pyridoxine HCL) – works with folic acid to help prevent nerve damage and heart attack.
Folic Acid – works with B-12 to help prevent stroke and the loss of limbs due to diabetic complications.
Vitamin B-12 (cyanocobalamin) – works with B-6 and folic acid to help relieve neuropathic pain.
Biotin – helps insulin work better and helps keep the pancreas working well to lower blood sugar.
Magnesium (Krebs Cycle Chelate) – helps insulin work more effectively and relieves neuropathic pain.
Zinc (picolinate, chelate) – helps insulin work better and helps shuttle blood sugar into cells.
Selenium (aspartate) – helps prevent nerve damage and protects blood vessels against elevated blood sugar. Selenium mimics insulin helping blood sugar into the cells.
Copper (picolinate) – helps protect the cells that produce insulin in the pancreas. Also, copper helps prevent diabetes-related damage to blood vessels and nerves, and lowers blood sugar levels.
Manganese – helps prevent damage to nerves and blood vessels.
Chromium (picolinate) – works with biotin to help bring down blood sugar and keeps the pancreas working well.
Gymnema Sylvestre leaf extract – helps balance blood sugar and may protect us from gaining weight.
Bitter melon whole fruit extract – helps pathways in the liver work more efficiently; lowers blood sugar levels.
Fenugreek seed extract – helps our kidneys and liver metabolize blood sugar more efficiently.
Bilberry berry extract – helps reduce the severity of diabetic cataracts.
Mixed bioflavonoids – helps protect vitamin C and E from becoming damaged. Helps clear and sharpen vision in diabetics.
Vanadyl sulfate – helps muscle and liver cells use insulin more effectively.
These supplements will not lower your blood sugar too much, but help bring them down to a more normal level. Diabetes is a disease that needs to be monitored daily several times throughout the day. When you start taking a diabetic supplement to help equalize your blood sugar, monitor your sugar levels more often at first so you can get a feel for where you sugar levels come down to before taking more insulin. A normal range of blood sugar for diabetics before a meal is 70 – 150 (1,2,5) and ideally 70 – 120.
The diabetic formula you may take for lowering blood sugar is by no means a license to eat any way you want. You still need to eat healthy and see your health practitioner on a regular basis. Diabetes might make you feel overwhelmed, especially if you have recently been diagnosed with it. With proper exercise, diet, and vitamin supplements you can be well on your way to a lower more manageable blood sugar level, and live a longer healthier life.
References:
1. American Diabetes Association. In the news. Available at: www.ada.yellowbrix.com/pages/ada. Accessed on December 10, 2001.
2. Guven S, Kuenzi J. Diabetes mellitus. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 810-830.
3. Guyton AC, Hall JE. Diabetes mellitus. In: Textbook of Medical Physiology. 10th Ed. Philadelphia, Pa: W.B. Saunders Company;2000: .
4. Grodner M, Anderson SL, DeYoung S. Diabetes mellitus. In: Foundations and Clinical Applications of Nutrition: A Nursing Approach. St. Louis, Mo: Mosby; 2000:540-548.
5. The National Institute of Diabetes and Digestive and Kidney Diseases. Do your level best. Available at: www.niddk.nih.gov/health/diabetes/dylb/chap1.htm#e. Accessed December 31, 2001.
Like every major league ballplayer, Brandon Morrow has his routines.
There’s a time to dress, a time to eat, a time to stretch, a time to throw.
But unlike other players, Morrow, the Blue Jays’ 25-year-old righthander, must also find time to test, to adjust and to monitor.
Morrow performs on baseball’s highest level while at the same time keeping his Type I diabetes in check. It’s a balancing act that few without the chronic disease can appreciate as Morrow has to think about blood sugar levels as much as he does about scouting reports.
Diagnosed in 2003 as a high school senior, Morrow says the key to staying on top of his diabetes is routine, which is a large part of major league life.
“Baseball players are really routine-oriented, and my daily routine helps me stay on top of stuff,” said Morrow, who came to Toronto from Seattle in a December trade and is 5-6 with a 4.50 ERA. “I just figure it in with the rest of my throwing, stretching, that sort of thing. I just try to stay on a schedule, do the same things at the same time every day and make sure I stay on top of all that.”
Morrow began to experience symptoms during his senior season at Rancho Cotate High School in Rohnert Park, Calif., only he had no idea where they would lead him.
“I was losing a lot of weight and drinking a lot of water and my mom thought I put myself on some strange diet or something,” Morrow said. “I was complaining about my symptoms to a friend who actually had just done a research project on diabetes and he told me my symptoms matched up. That’s when we started looking at this seriously. At first there was just this disbelief. You just don’t want to believe it.”
But Morrow wasted little time with self-pity and began meeting his diabetes head on.
“After I was diagnosed I went to the hospital, got some fluids and I was on insulin shots the next day,” said Morrow, who pitched collegiately at Cal-Berkeley. “I just kind of jumped right in. I learned to check my blood sugar several times a day and give myself insulin shots. Now I wear an insulin pump.”
The insulin pump, which is attached to a port on a diabetic’s body, gives a steady drip of insulin to the person based on his or her individual needs. When a diabetic eats, he or she programs the pump to administer a larger dose to cover the amount of carbohydrates in the meal.
“It works like your pancreas does,” Morrow said. “It’s just more consistent (than the old method of taking insulin shots). It takes away the real highs (blood sugars) and the real lows a little bit more.”
But even Morrow’s routines have to be altered on days he pitches.
“I check my blood sugar more on a start day because I have a tendency to get low during warmups,” said Morrow, a first-round pick of the Mariners in 2006. “Sometimes I try to be too perfect in keeping my blood sugar levels right and I give myself a touch too much insulin and I fall a little low and I’ll need a Gatorade before the game starts. Then I have to check again after the first inning and after the second and usually from there I’m all right.”
Morrow does not pitch with his pump during games, unlike former big leaguer Jason Johnson, another diabetic, who got permission from Major League Baseball to wear his on the mound.
It’s a daily challenge Morrow must meet, as if facing big-league hitters isn’t challenging enough. Still Morrow is living his dream - just with a few added wrinkles. And he has advice for any young players with Type I diabetes who hope to pursue a similar career path.
“Right off the bat it’s all about routine,” Morrow said. “You’ve got to keep your sugar levels stable and in a good range. So develop your routine, especially on game days. It doesn’t have to be a worry. Find what works for you so then you don’t have to worry about, ‘Man, am I going to go low during a game?’ Once you have that routine down, you’re fine.”
Read more: http://www.nydailynews.com/sports/baseball/yankees/2010/07/04/2010-07-04_jays_morrow_primes_pump.html#ixzz0tWpoapEA
Cellular changes in fat tissue play a major role in the development of type 2 diabetes, a new study shows.
University of Cincinnati researchers found that these changes in fat cells — not the immune system, as previously thought — are linked to the “hyperinflammation” seen in obesity-related glucose intolerance and type 2 diabetes. The findings, they said, may eventually lead to the development of new drugs to treat type 2 diabetes and may also offer insights into the formation of aggressive cancers.
“This finding is quite novel because current drug development efforts target immune cells (macrophages, T-cells) to eliminate this hyperinflammation,” said Jorge Moscat, the study’s principal investigator and chair of UC’s cancer and cell biology department, in a university news release. “Our research suggests obesity-related glucose intolerance has nothing to do with the immune system. It may be more effective to target (fat cells).”
In laboratory animals, the researchers found that a gene known as protein kinase C (PKC)-zeta plays a dual role in molecular signaling associated with inflammation. Obesity, they said, can switch the gene from acting as an inflammation regulator to an agent promoting inflammation. PKC-zeta does this by causing fat cells to secrete a substance called interleukin-6 (IL6), which streams to the liver in large quantities to cause insulin resistance.
The study appears in the July 7 issue of the journal Cell Metabolism.
Previous research has linked PKC-zeta to the development of malignant tumors. Researchers say it may do so in a manner similar to the way in which it triggers the inflammation associated with diabetes.
“Now we are trying to understand how PKC-zeta regulates IL6 to better determine how we can manipulate the protein to help prevent diabetes and cancer,” Moscat said.
More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more abouttype 2 diabetes.
Tight control of high blood pressure, recommended for those withdiabetes by national guidelines, gives no better results than moderate control, according to a new study.
”The guidelines suggest you want diabetics to have [systolic pressure] under 130,” says researcher Rhonda M. Cooper-DeHoff, PharmD, associate professor of pharmacy and medicine at the University of Florida, Gainesville.
But in her study, those who kept their systolic pressures moderately controlled — at 130 to 139 — did as well as those who controlled it more tightly. Systolic pressure is the upper of the two blood pressure numbers, representing the maximum pressure exerted when the heart contracts.
She compared ranges of blood pressure control on the effect on death, heart attack, and stroke during the follow-up. “There was no difference comparing those with tight control or usual control,” she tells WebMD,” which is contrary to what the guidelines would suggest.”
”The message is: we need to get diabetic patients’ systolic blood pressure to less than 140, particularly when they have heart disease, but working to get it to less than 130 does not appear to add any additional benefit with regard to the risk of death, stroke, or heart attack,” Cooper-DeHoff says.
For this study, Cooper-DeHoff and colleagues looked at a subgroup of 6,400 participants of a large study, called INVEST (International Verapamil SR-Trandolapril Study). It included more than 22,000 participants from 14 countries who were at least 50 years old and had high blood pressure and coronary artery disease.
Study participants enrolled in the study from 1997 to 2000 and were followed through March 2003, with follow-up for U.S. participants extended through August 2008.
For this analysis, the researchers focused only on the 6,400 who also had diabetes at the study start.
INVEST compared two blood pressure lowering approaches, with participants given either a calcium antagonist medication first or a beta-blocker medication, followed by more drugs if needed to lower pressure.
Next, the researchers categorized the 6,400 participants into three groups:
During the follow-up, researchers looked to see which of the groups categorized by the amount of control were more likely to die from any cause or to have a heart attack or a stroke.
Little difference was found between the tight control and moderate control groups. Of the 6,400:
During the extended follow-up period, the risk of death from any cause was actually higher in the tight control group, 22.8%, vs. those in the moderate control group, 21.8%.
Cooper-DeHoff cautions that the results can’t be generalized to those who have diabetes but not coronary artery disease.
Even though the guidelines recommending lower blood pressures in those with diabetes have been in place for nearly 20 years, she writes, ”there is a paucity of evidence supporting this recommendation, particularly for lower systolic blood pressure.”
Cooper-DeHoff reports receiving research funds from Abbott Laboratories, which makes blood-pressure-lowering drugs.
”This is good news all the way around,” says P.K. Shah, MD, a cardiologist and director of the division of cardiology at the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, who reviewed the study findings for WebMD.
The take-home message for those like the participants, he says, is that moderate blood pressure control is a reasonable range to shoot for. “This is saying moderate control of blood pressure is effective.”
Other research finds that those with naturally low blood pressure are at reduced risk for problems such as heart attack and stroke, Shah says. “But drug-induced lowering [of blood pressure] is not the same as natural low blood pressure,” he says, explaining that blood pressure lowering by drugs does not mimic all the good effects of having naturally low pressure.
A five-year study aimed at finding ways to reduce some complications of diabetes tried several approaches but failed to reduce the risk of heart attack and stroke. But the study did identify some effective ways to reduce common vision, kidney, and nerve-related problems.
The government-funded study is called ACCORD, which stands for Action to Control Cardiovascular Risk in Diabetes. The study included high-risk diabetes patients – typically older and obese, with a history of complications.
Some patients got medicine to aggressively reduce cholesterol or blood pressure or their blood sugar levels. They were compared with patients in a control group who got standard treatments.
None of the aggressive treatments significantly reduced the risk of heart attacks, strokes, or other cardiovascular complications.
In the blood pressure group, for example, ACCORD researcher William Cushman said the aggressively-treated group did lower their blood pressure.
“Despite that, our composite cardiovascular outcome of dying from cardiovascular events or having a non-fatal heart attack or a non-fatal stroke, that combined outcome was not significantly reduced.”
One positive outcome from the ACCORD study was evidence supporting ways to improve what doctors call diabetes patients’ microvascular conditions. The disease affects small blood vessels in a way that can damage nerves, kidneys and the eyes. So, Emily Chew of the National Eye Institute noted that aggressive lowering of blood sugar or cholesterol levels helped control the progression of eye disease.
“This is a very important outcome,” Chew told reporters. “[Diabetes] is the leading cause of blindness in Americans, especially in the young, productive, working-age men and women. We have very effective treatments for it, but yet if we can prevent it, it’s so much better than having laser [treatment] or vitrectomy.”
Vitrectomy is a kind of eye surgery.
In another part of the ACCORD study, patients got intensive therapy to lower their blood sugar. After three-and-a-half years, the group getting intensive therapy was switched into the control group, to standard therapy, because they were dying at a higher rate.
Dr. Sue Kirkman of the American Diabetes Association says the study results leave open the possibility that aggressively lowering blood sugar can help younger patients who have suffered relatively few effects from the disease.
“On the other hand, if people have more advanced disease, known cardiovascular disease or suspected cardiovascular disease, known kidney disease, probably a shorter life expectancy, it’s probably not beneficial to that patient and may be harmful to really push intensive glycemic [blood sugar] controls,” said Kirkman
Results of the ACCORD study were announced at a news conference at the American Diabetes Association’s annual science meeting in Orlando, Florida, and were published in The Lancet and The New England Journal of Medicine.
(HealthDay News) — A pair of new studies has uncovered evidence that low levels of vitamin D could lead to poor blood sugar control among diabetics and increase the risk of developing metabolic syndrome among seniors.
Both findings are slated to be presented Saturday at the Endocrine Society’s annual meeting in San Diego.
In one study, researchers at the Johns Hopkins University School of Medicine in Baltimore reviewed the medical charts of 124 type 2 diabetes patients who sought specialty care at an endocrine outpatient facility between 2003 and 2008.
More than 90 percent of the patients, who ranged in age from 36 to 89, had either vitamin D deficiency or insufficiency, the authors found, despite the fact that they all had had routine primary care visits before their specialty visit.
Just about 6 percent of the patients were taking a vitamin D supplement at the time of their visit, the research team noted, and those who had lower vitamin D levels were also more likely to have higher average blood sugar levels.
“This finding supports an active role of vitamin D in the development of type 2 diabetes,” study co-author Dr. Esther Krug, an assistant professor of medicine, said in a news release from the Endocrine Society.
“Since primary care providers diagnose and treat most patients with type 2 diabetes, screening and vitamin D supplementation as part of routine primary care may improve health outcomes of this highly prevalent condition,” Krug added.
A second study involving nearly 1,300 white Dutch men and women over the age of 65 found almost half were vitamin D-deficient, while 37 percent had metabolic syndrome.
Metabolic syndrome is a grouping of health risk factors, including high blood pressure, abdominal obesity, abnormal cholesterol levels and high blood sugar.
“Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases,” study co-author Dr. Marelise Eekhoff, of VU University Medical Center in Amsterdam, said in the same news release.
Regardless of gender, those with insufficient amounts of vitamin D in their blood were more likely to have the syndrome than those with sufficient amounts of vitamin D, Eekhoff and her colleagues found.
“It is important,” added Eekhoff, “to investigate the exact role of vitamin D in diabetes to find new and maybe easy ways to prevent it and cardiovascular disease.”
More information
For more on vitamin D, visit the U.S. National Library of Medicine.
