Diabetes: Vegetarians Better Off Than Non-Vegetarians On All Counts Including Blood Sugar, Blood Pressure, Waist Size, BMI & Blood Fats

People who follow a vegetarian or meat-free diet may be at a lower risk of developing diabetes and heart disease, a new study suggests. The study of lifestyle habits of more than 700 adults showed researchers that 23 out of every 100 vegetarians have at least three metabolic syndrome factors, compared with 39 out of every 100 non-vegetarians and 37 out of every 100 semi-vegetarians.

The researchers measured a suite of factors ‒ blood sugar, blood fats, blood pressure, waist size, and body mass ‒ that when elevated add up to "metabolic syndrome," and found that vegetarians were lower than non-vegetarians on all counts except cholesterol.

Metabolic syndrome is a combination of health disorders that increase the risk of developing coronary artery disease, stroke, and diabetes. The risk factors include conditions like abdominal obesity, blood fat disorders, elevated blood pressure, insulin resistance or glucose intolerance.

Vegetarianism excludes high-calorie foods and animal products laden with saturated fats. It instead concentrates on foods that give necessary minerals and vitamins that help give diabetics a better chance of blood glucose control. These include whole grains, legumes, fruits and vegetables.

The Vegetarian Pyramid

Vegetarian diets are rich in fiber, which has numerous benefits. When a diabetic eats a fiber-rich meal, the desire for further food disappears. Fiber also plays a protective role for pre-diabetics, and can lead to lower daily requirements of insulin amongst type 1 diabetics.

Fiber is well known as being important in the improving blood sugar control, lowering cholesterol levels and providing folate, thereby reducing the risk of complications like heart disease. Considerable research is available as evidence for the role of fiber in diabetes.

Research has shown vegetarian diets promote a healthy weight since they are often lower in calories than non-vegetarian diets. They also improve blood sugar control and insulin response since eating vegetables, fruits, whole grains, legumes and nuts — features of a vegetarian diet — can improve blood sugar control and make your body more responsive to insulin. Most importantly, a vegetarian diet reduces the risk of cardiovascular disease since it is cholesterol-free, low in saturated fat and usually high in soluble fiber.

The new study ‒ published in the journal Diabetes Care ‒ has confirmed that vegetarians are lower than non-vegetarians on all counts including blood sugar, blood pressure, waist size, body mass index (BMI), and blood fats except cholesterol.

The findings show the vegetarians' average BMI of 25.7 was four points lower than that of non-vegetarians, who, on average, had BMIs close to 30. However, semi-vegetarians fell in the middle. A BMI greater than 25 is considered overweight, and greater than 30 is considered obese. Moreover, the findings suggested that while vegetarians, on average, were 3 years older than the meat-eaters, they were in better shape and health status.

"I was expecting there should be a difference….but I didn't expect that it would be that much," lead researcher Nico Rizzo of Loma Linda University was quoted by Reuters as saying, adding he was not sure what's behind the differences and wondered whether it was primarily the meat intake, the plant food intake or a combination of both.

It's possible that diet is not the cause because the research showed only an association between food choices and health factors, not cause-and-effect. High BMI, for instance, one of the traits that make up the metabolic syndrome profile, itself contributes to high blood pressure, and indirectly, blood sugar, and thereby potentially raising a person's risk of heart disease and diabetes.

One of the shortcomings of the study is that the researchers didn't study the reasons behind the differences between vegetarians and non-vegetarians even though the scientists suggest it may be caused by the meat intake, eating the plant food or a combination of both. The researchers also did not follow the subjects over the long term to see whether those who abstained from meat actually had lower rates of diabetes or heart disease.

The data for this research, which was funded by the National Institutes of Health, came from the Adventist Health Study 2, a long term study of Seventh Day Adventists. This Christian religious group has considerably more vegetarians than the general population.

In this study, 35 percent of the subjects did not eat meat, whereas only about five percent of all Americans are vegetarian. One of the differences Rizzo discovered between the groups was age. Vegetarians, on average, were 3 years older than the meat-eaters. "Even though they're older, they're in better shape," Rizzo said. "That's something I found quite interesting."

Mystery Mechanism Protects Some Diabetics From Developing Complications

WHY are some diabetics free of complications? Researchers are now asking the question the other way around. They want to know why some diabetic patients do not develop complications. What is protecting them? It seems some people with diabetes possess yet-unidentified factors that reduce the risk for and even prevent them from developing diabetes-related complications, despite living with the disease for decades. If researchers can identify the mechanisms protecting these individuals ‒ who are clearly different because something protects them from devastating complications ‒ then it might be possible to develop drugs that can do the same thing.

I had reported end January that what current research provides is an admission that the fundamental mechanisms that create the environment for the development of diabetes complications are still very much unknown.

One aspect of the disease though that is very well documented is the damage that the disease wreaks on an individual’s blood vessels. Diabetes does not kill the individual but the complications often do.

Among the top of the list of complications is cardiovascular disease, as diabetics have three times of the risk compared to non-diabetics. The small blood vessels are also damaged. Nearly 70 percent of patients would have suffered from kidney damage leading to end stage renal failure. Many others suffer from eye complications, with nearly two percent of these diabetics going blind eventually.

Still, despite decades of intensive research on diabetes complications, the fundamental mechanisms are not yet fully known. Neither it is possible to prevent or treat the damage of the blood vessels that affects a majority of all diabetics.

“The blood vessels and other organs of the body are sugar coated and become stiff. It is reminiscent of a premature biological aging,” says Peter Nilsson of the Lund University Diabetes Centre in Sweden who isstudying diabetics with no complications in Sweden.

A just-published study conducted by the Joslin Diabetes Center on people who have lived with type 1 diabetes for more than 50 years presents a strong case for the existence of a protective mechanism in some individuals that allows them to live relatively free of the problems typically associated with long-term duration of diabetes. These mechanisms, the study found, may be different for microvascular (such as kidney, nerve and eye disease) than macrovascular complications (such as heart disease).

A press release issued by the American Diabetes Association yesterday quotes lead researcher George King, Chief Scientific Officer of the Joslin Diabetes Center and Professor of Medicine at Harvard Medical School saying: "If we can identify what constitutes this protective mechanism, we have the potential to induce such protections in others living with diabetes…That's huge."

The Joslin researchers looked at 351 U.S. residents known as the "Medalist" cohort and found that a subgroup of people who had lived with type 1 diabetes for more than 50 years remained free from such complications as proliferative diabetic retinopathy (PDR), a serious eye disease that can lead to blindness (42.6 percent of them); nephropathy, or kidney damage (86.9 percent of them); neuropathy, or nerve damage (39.4 percent); and cardiovascular disease (51.5 percent). Of those who did not develop PDR, 96 percent with no retinopathy progression in the first 17 years of their disease never experienced a worsening of symptoms, meaning that they likely possessed some type of protection specific to this complication.

Surprisingly, glycemic control was not a factor in providing this protective mechanism.

"That doesn't mean of course that glycemic control doesn't help to prevent complications. Numerous other studies have shown that it unquestionably does. In this case, it means only that there is a separate, protective mechanism in play that is not related to glycemic control that also helps to protect against diabetes-related problems. We are still working on identifying just what that is," King said.

It's important to note that most of the people in this study developed type 1 diabetes before strict glycemic control was even possible or used as the standard of medical care, the researchers write. The people in this study likely lived for several decades, therefore, without maintaining strict control.

The study also found that those with high plasma carboxyethyl-lysine and pentosidine, or advanced glycation end products (AGEs), were 7.2 times more likely to have some kind of complication than those who had low levels of this combination of AGEs. (AGEs are compounds that develop in the body after long exposure to high glucose levels and have generally been regarded as playing a role in diabetes-related complications.)

However, those with other types of AGE molecules exhibited protective features. Thus, this study suggests that not all AGEs are alike in their actions and raises the exciting possibility that some AGEs may be markers for protection against one or more diabetic complications.

In an accompanying editorial titled The Question Is, My Dear Watson, Why Did the Dog Not Bark?, Dr. Aaron Vinik, Director, Eastern Virginia Medical School Diabetes Research Center, writes that "the accumulation of AGEs may be one of the important factors in metabolic memory," a phenomenon in which an initial period of good glycemic, lipid and blood pressure control results in a prolonged period of health benefits that last beyond the period of control.

However, while it is clear that for some there is a protective mechanism at play, it's unclear whether metabolic memory is playing a role because glycemic control was not considered important until 1993, long after the study began.

What's most interesting, Vinik points out, is that sRAGE (the circulating soluble receptor for AGEs) is deficient in those who have the most severe complications, and is present at high levels in those with the most longevity. "If this is the missing link, it is huge for the possible emergence of a new biomarker and the potential for therapy that might increase circulating sRAGE or sRAGE itself," he said.

Aspirin May Help Diabetics With Kidney Disease Avoid Heart Complications

A new study from a team of Japanese researchers at the Nara Medical University shows that low daily doses of aspirin may help reduce risk of heart disease in patients who have both type 2 diabetes and kidney disease.

Heart disease, as we all know, is the most common cause of death for individuals who have type 2 diabetes because persistently high levels of blood sugar in the veins causes inflammation that leads atherosclerosis, which is a hardening of the arteries that causes the heart to work harder, eventually causing it to wear out.

The research, published in the journal Diabetes Care, concludes that there appears to be a strong relationship between diabetes-induced kidney disease and aspirin therapy. If future studies bear out these results, aspirin could provide a simple solution to a major problem that affects millions of people.

"The current study demonstrated that low-dose aspirin therapy reduced the risk of atherosclerotic events in type 2 diabetic patients," the researchers wrote in their report.

For the study, researchers gave a group of more than 2,500 participants who had type 2 diabetes and kidney disease either an 81 mg daily dose of aspirin, a 100 mg daily dose or no aspirin at all. The researchers then tracked the participants' medical records for nearly five years. During this time they checked for instances of stroke, heart disease and peripheral artery disease.

They found that individuals who were in either of the groups that received aspirin had significantly fewer atherosclerosis-related incidences than those who did not receive aspirin.

"The current study demonstrated that low-dose aspirin therapy reduced the risk of atherosclerotic events in type 2 diabetic patients," the researchers conclude.

All Diabetics Should Take Statins, Say Experts

The European Association for the Study of Diabetes (EASD) has recommended that all people suffering from diabetes should be taking statins, as research showed that the evidence for their effectiveness in reducing cardiovascular risk in diabetics, and even people without diabetes, is incontrovertible.

Professor John Betteridge, of University College London Medical School, pointed out at the EASD annual meeting in September 2010 that all people with diabetes should be taking statins to reduce their chances of having a heart attack or stroke, although he also warned that they should avoid any drug interactions with other medications being taken.

Betteridge has analysed a number of studies into the use of statins, such as the CollaborativeAtoRvastatin Diabetes Study (CARDS), funded by Diabetes UK, the Department of Health and Pfizer, which examined their benefits in people with type 2 diabetes who did not already have evidence ofcardiovascular disease .

In the CARDS study, atorvastatin 10mg/day was shown to reduce major cardiovascular events by 37 per cent and strokes by 48 per cent, reinforcing guidelines issued by the Joint British Society (JBS) regarding targets for low-density lipoprotein cholesterol in this high-risk group.

Betteridge argues that statins are safe if taken appropriately and drug interactions avoided, as they can lead to serious side effects, especially when patients are on a variety of drug treatments. Statins should also not be used by pregnant women at least six weeks before conception.

He realises that statins don’t always get a good press, and that many diabetics will be wary of this advice, but he points out that the evidence shows them to be highly effective in preventing major vascular events in patients with diabetes.

However, the idea of taking statins to offset the effects of junk food has been criticised by diabetes experts. New research had recommended that fast food outlets should give out free statin pills as a way of combating the impact of unhealthy food, as they can reduce the levels of bad cholesterol in the blood, which is why they are normally prescribed to decrease the risk of cardiovascular disease.

There are now worries that using statins could encourage people to lead unhealthier lives, eat more fast food and therefore increase the risk of developing type 2 diabets. Although studies have found that a single, cheap statin pill could offset the increased risk to the heart caused by the fat in a cheeseburger and a small milkshake, there are concerns that it is both irresponsible and dangerous to promote their use as a quick fix to counteract the effects of an unhealthy diet.

Zoe Harrison, Care Advisor at the charity Diabetes UK, said Statins can reduce the risk of cardiovascular disease by lowering the bad cholesterol in our blood which can be raised due to a high-fat diet. However, they don't prevent all the side effects that result from an excessive intake of fatty food.

Statins also have some serious side effects - such as damage to the liver, pancreas and muscles – which is why they should always be prescribed by your doctor who can then closely monitor how you are responding to the medication.

Here's an overview of Diabetes and Statins
Diabetes and statins have a complex relationship and are the focus of intense patient and healthcare debate. Statins are cholesterol-lowering drugs.

Statins are used in diabetes care due to the knowledge that people with diabetes face a greater likelihood of heart attack and stroke.

When used alongside good blood glucose control and other medication, the case for statins argues that they cut cholesterol levels and lower the risk of a cardiovascular event.

Type 2 diabetes in particular is certainly a disease of the circulatory system, and this argument has some weight.

How can I lower my risk of cardiovascular problems without taking statins?
There are many ways to lower your risk of stroke and cholesterol levels. These include stopping smoking and controlling your blood pressure. Diet and exercise can help to lower raised blood pressure, and a healthy lifestyle can cut cholesterol levels. However, some doctors prescribe statins to help reduce cholesterol levels.

What do statins do for people with diabetes?
Statins slow the action of the liver in manufacturing cholesterol, causing blood cholesterol levels to fall.

Do statins work for people with diabetes?
Statins definitely lower cholesterol, and major studies have shown that the risk of heart attack and stroke plummets amongst people with diabetes taking statins. Results indicate that statins can prevent cardiovascular disease by reducing heart attack and stroke risks.

What are the side effects of statins?
Statins are usually well-tolerated by people with diabetes. Side effects can include:

• Headaches

• Affect on liver function

• Stomach problems such as abdominal pain, constipation, flatulence, diarrhoea and vomiting

• Rashes

• Disorder of the muscles (myopathy)

Shouldn’t all people with diabetes therefore take statins?

Statins are the subject of current and ongoing healthcare debate when it comes to diabetes patients. Further research is in progress to make the wider use of statins in diabetes care more clear.

Often, people under 40 may not benefit from taking a statin.

A statin is also just one part of diabetes care and shouldn’t be used instead of good diet, exercise, smoking and excess drinking avoidance.

Source: diabetes.co.uk

Retirement Reduces Fatigue, Depression

Retirement leaves people much less mentally and physically fatigued and to a smaller degree less depressed, reports UPI quoting Swedish researchers.

However, Dr. Hugo Westerlund of Stockholm University in Sweden also finds retirement does not change the risk of chronic illnesses such as respiratory disease, diabetes and heart disease.

Westerlund and colleagues say the study of 11,246 men and 2,858 women in France who were surveyed annually from 1989 to 2007 -- seven years prior to retirement and seven years after retirement. Seventy-two percent retired between the ages of 53 and 57, but all retired by the age of 64.

In the year before retirement, 25 percent suffered from depressive symptoms and 7 percent were diagnosed with one or more of respiratory disease, diabetes, heart disease or stroke.

"If work is tiring for many older workers, the decrease in fatigue could simply reflect removal of the source of the problem ... furthermore, retirement may allow people more time to engage in stimulating and restorative activities, such as physical exercise," Westerlund and colleagues say in a statement.

The research results "indicate that fatigue may be an underlying reason for early exit from the labor market and decreased productivity, and redesign of work, healthcare interventions or both may enable a larger proportion of older people to work in full health."

The findings are published in the British Medical Journal.

Controlling a Fat-Regulating Protein Dramatically Increases Insulin Sensitivity

PPARy is a protein that regulates the body's production of fat cells. However, obesity can modify how PPARy works, leading to decreased insulin sensitivity and the development of metabolic syndrome. (Metabolic syndrome is the cluster of factors, including insulin resistance, overweight, high blood pressure, and abnormal blood sugar levels, that is a precursor to type 2 diabetes.)

But now a joint team of researchers from The Scripps Research Institute in San Diego and the Dana-Farber Cancer Institute at Harvard University in Cambridge has found a way to control the adverse changes in PPARy brought on by obesity.

One of those changes is phosphorylation, when an enzyme called cdk5 kinase adds a phosphate group to PPARy. That addition causes PPARy to alter the expression of several genes, including one that regulates production of adiponectin, a protein essential to insulin sensitivity. 

The challenge for the scientists was to find a way to change PPARy back to its normal state without inducing it to overproduce fat cells. They knew from a previous study that an agonist, a compound that makes cells respond in certain ways, interacted with the region of PPARy known to regulate fat generation. The agonist in that case was a full agonist, meaning that it was able to easily combine with a receptor in that region of PPARy and activate it to do a certain thing-in this case, not generate fat cells.

The researchers wondered if partial agonists-chemical agents that have only partial effects on certain cell receptors-could be used to counteract the insulin-suppressing effects of phosphorylation on PPARy without the side effect of ramping up fat cell production.

They found that while partial agonists did not interact with the PPARy receptor that governs fat cell production, one, called MRL24, worked  extremely well in the exact region of PPARy where phosphorylation takes place. By altering and diminishing that region's receptiveness to  phosphorylation, MRL24 allowed PPARy to increase the production of adiponectin.

Those findings, which open the door to learning how to fully manipulate PPARy, could lead to drugs that reduce the risk of developing type 2 diabetes and cardiovascular problems. If PPARy can be prevented in obese people from losing its ability to direct the production of adiponectin, it could become a significant therapy in treating the effects of extreme overweight.

Thank you Patrick Totty

Surgical Procedure Can Control Type 2 Diabetes, Claims Brazilian Surgeon

A new procedure which requires surgical intervention through Ileal Transposition (or small intestinal switch) can effectively control Type 2 diabetes, a Brazilian surgeon claimed in Hyderabad, India on August 21.

Dr Aureo Ludovico de Paula, was in the city to address the first international conference and live workshop on this procedure along with his Indian counterpart Dr Surendra Ugale.

Ugale who is also the organizing secretary of the workshop said, “the new research has shown that there are some intestinal hormones which have a great effect on the pancreas and insulin secretion especially in response to food intake. Dr Paula has devised a laparoscopic operation which he claims is proving to be a cure for Type 2 diabetes.”

Paula said, “The surgery can control diabetes without insulin, arrest the metabolic syndrome of the body organ deterioration, thus avoiding future diabetic complications.”

The doctor who has performed 700 surgeries with 95% remissions said the operation involves a long segment of ilium (ending portion of small intestine) which is shifted to the upper small intestinal area, where food particles will reach it very soon on eating a meal.

This causes an immediate secretion of good hormone GLP-1 which acts on the B cells of pancreas to secrete insulin and control blood sugar.

The fall out is a biochemical process that facilitates insulin secretion in the presence of undigested food and controls Type 2 diabetes, a metabolic disorder that is marked by the failure to absorb sugar and starch due to lack of the hormone insulin, Paula said.

Type 2 diabetes is the most common form of diabetes. In this disease, either the body does not produce enough insulin or the cells ignore it.

Ugale explained that Type 2 Diabetes affects several organs. The solution therefore is to stimulate these hormones in lower intestine that in turn secrete GLP which in turn stimulates the pancreas to stimulate the insulin and get fresh beta cells.

He said patients who already have diabetes for ten years and using medication, and are suffering from five associated diseases are ideal candidates for this kind of surgical intervention which costs less than US $10,000 (in India).

The surgery not only controls high blood pressure but also improves kidney cholesterol nerves reduces excess weight and also one need not take any medicines. He also can eat normally post surgery, including sweets.

However, doctors insist that first of all in any patient they would advise lifestyle changes, exercise followed by medication, if there is diabetes and if the patient is not doing well only then surgery is advised.

Presently a centre in Mumbai and Hyderabad are performing this surgery. A centre has also come up in Coimbatore.

Over hundred doctors from all over the country and endocrinologists are participating in the two-day seminar

Effectiveness Of Statins Is Called Into Question

As the world's most-prescribed class of medications, statins indisputably qualify for the commercial distinction of "blockbuster." At the zenith of their profitability, these medications raked in $26.2 billion a year for their manufacturers.

But in recent months the drugs' touted medical reputation has come under tough scrutiny.

Statins were initially approved by the US Food and Drug Administration for the prevention of repeat heart attacks and strokes in patients with high cholesterol who had already had a heart attack. And used for that purpose — called "secondary prevention" — the drugs are powerful and effective medications, driving down patients' risk of another heart attack or stroke by lowering their levels of LDL (or "bad") cholesterol.

Then physicians came to believe statins could also reduce the risk of a first heart attack in people who have high LDL cholesterol but are nonetheless healthy. This use of statins — called "primary prevention" — has driven the growth in the market for statins over the last decade.

Today, a majority of people who use statins are doing so for primary prevention of heart attacks and strokes. It is this use of statins that has come under recent attack.

"There's a conspiracy of false hope," says Harvard Medical School's Dr. John Abramson, who has cowritten several critiques of statins' rise, including one published in June in the Archives of Internal Medicine. "The public wants an easy way to prevent heart disease, doctors want to reduce their patients' risk of heart disease and drug companies want to maximize the number of people taking their pills to boost their sales and profits."

Heart patients and their physicians are not the only ones to pin their hopes on statins. The drug companies that brought statins to the market have explored the medications' benefits in prevention or treatment of such conditions as Alzheimer's disease, rheumatoid arthritis, prostate and breast cancer, kidney disease, macular degeneration and diabetic neuropathy. Although clear proof that statins could forestall or treat any of these diseases might bring in millions of new, paying customers, results have largely been mixed, inconclusive or disappointing.

In an ideal world, debate over the clinical virtues or vices of a drug would be long settled by the time the medication saw a meteoric rise in use. But in a healthcare system that relies on commercial incentives to spur drug development, prescription medications are a product like any other.

The FDA assesses drugs' safety and effectiveness for specific use; but its judgments are based on preliminary data, most of it generated by a drug company seeking approval for its product. Once the agency approves a drug for marketing, the company that makes it will move quickly and aggressively to expand the universe of patients taking its product.

Sometimes, by the time the deliberate pace of medical research and debate suggests that a drug is not all it's been cracked up to be, it's already become a bestseller. Statins, say some who study the relationship between medicine and the drug industry, seem to fit that pattern.

Statins appear to drive down the risk of heart attack or stroke by lowering the levels of fatty deposits circulating in the bloodstream. Research suggests that the drugs dampen inflammatory processes that can prompt deposits of plaque to break away from blood vessel walls and cause sudden blockages of arteries leading to the heart or brain.

And yet, the relationship between cholesterol-lowering and heart disease is not perfectly understood, and the precise role of inflammation in heart disease is also uncertain.

Statins certainly decrease rates of heart attack in people who have clear signs of cardiovascular disease, but it's not so clear they work that way in people who are healthy. In spite of that uncertainty, statins' use for primary prevention has skyrocketed.

That's the issue in the latest round of debate, which spilled onto the pages of the Archives of Internal Medicine in late June: whether statins prevent, safely and at a reasonable cost, the development of cardiovascular disease in people who are still healthy but are considered to be at high risk of a heart attack or stroke.

In the first of three studies published in the Archives last month, medical researchers found that, contrary to widely held belief, statins do not drive down death rates among those who take them to prevent a first heart attack.

A second article cast significant doubt on the influential findings of a 2006 study, called JUPITER, that has driven the expansion of statins' use by healthy people with elevated blood levels of C-reactive protein, a measure of inflammation. A third article suggested potential ethical, clinical and financial conflicts of interest at work in the execution of the JUPITER study and concluded the widely hailed trial was "flawed" and raises "troubling questions concerning the role of commercial sponsors."

"Tens of billions of dollars of revenue for the sponsor over the patent life of the drug were at stake in the JUPITER trial, as well as potentially millions of dollars in royalties for the principal investigator," wrote Dr. Lee Green of the University of Michigan Medical School in an editorial accompanying the trio of studies. "Doubtless, both sponsor and investigative team believe they made their design decisions for the right reasons," Green added. "But social psychology research provides abundant evidence that we human beings both respond strongly to self-interest incentives and firmly believe that we do not."

Statins still have ardent admirers, including cardiologist Steven Nissen of the Cleveland Clinic in Ohio. For many patients on a clear collision course with heart disease but not there yet, he said, statins make a difference. And even though recent studies question whether statins reduce heart attack deaths, Nissen added, many patients' lives are clearly improved by pushing a heart attack further into the future.

The stakes of this debate are big and continuing to grow (see related story, " Pinning down the side effects of statins"). As many as three-quarters of patients currently taking statins haven't yet had a stroke or heart attack; they have diabetes or high LDL cholesterol, conditions widely thought to put them at high risk of having one.

Those patients largely joined the ranks of statin consumers after 2001, when the US National Heart, Blood and Lung Institute adopted guidelines on the treatment of patients with high cholesterol.

The guidelines, updated again in 2004, suggested that as many as 36 million Americans should take statins — essentially tripling overnight the potential American market for the drugs. Of the nine experts involved in drafting the cholesterol treatment guidelines, the National Institutes of Health later acknowledged that eight had substantial financial ties to statin makers — links that may have predisposed them to view evidence of statins' benefit in its most positive light.

Said Abramson, the author of "Overdosed America: The Broken Promise of American Medicine": The best way to drive down the risk of developing cardiovascular disease in the first place is to exercise regularly, not smoke, drink in moderation and eat a healthy Mediterranean-style diet. But, he added, "this message gets drowned out by the commercial interests" of pharmaceutical companies who stand to benefit from increased sales.

Courtesy: Melissa Healy/LA Times

Should All Adults With Diabetes Take Statins?

One-third fewer people with type 1 or type 2 diabetes would suffer heart attacks or strokes if they took cholesterol-lowering statin drugs. Cardiovascular disease eventually kills two-thirds of people with diabetes notes Colin Baigent of England's Medical Research Council. High levels of "bad" LDL Cholesterol play a major role.

 

Statin drugs lower LDL cholesterol. In people without diabetes, the drugs cut the risk of heart attack, stroke, and other cardiovascular diseases. But it hasn't been clear whether people with diabetes get as much benefit.

They do, claims Baigent's study. The researchers pooled data from 18,686 people with diabetes enrolled in 14 clinical trials of statins. The result: People with diabetes, whether male or female, get just as much benefit from statins as anyone else. If 1,000 people with diabetes took statins for five years, 42 of them would avoid heart death, heart attack, or coronary revascularization (bypass or stenting).

"We are saying that, after middle age, almost everybody with diabetes is a candidate for statin treatment - and at a large enough dose to give them a substantial reduction in LDL cholesterol," says Baigent. "That is quite important, because the size of the benefit depends on the size of the cholesterol reduction."

The American Heart Association says it's best to have an LDL cholesterol level of less than 100 mg/dL - and calls LDL cholesterol levels of 100 to 129 mg/dL "near optimal/above optimal."

 

Baigent and colleagues calculate that for every 39 mg/dL drop in LDL cholesterol, people with diabetes cut their risk of major heart events by one-fifth. An average dose of statins cuts LDL cholesterol by 57 mg/dL, which would lower this risk by one-third.

But not everyone with diabetes has the same heart risk, argues Bernard M.Y. Cheung, professor of clinical pharmacology and therapeutics at the University of Birmingham, England. "If you are crossing the street, you can choose to wear a helmet because it may save your life in case you are knocked by a car. You are relatively safer, although the absolute risk of this is quite low," argues Cheung. "But if you are riding a motorcycle, the helmet is going to be important because your risk of an accident is much greater."

Some people with diabetes have a lower heart-disease risk than others. For them, Cheung says, taking statins would be like wearing a helmet to cross the street.

"It was once believed that the mere fact of having diabetes gives a person the same risk of heart attack as a person who had a heart attack before," Cheung says. "We are now treating people's diabetes much better than before, and their baseline risk of heart disease is lower than before."

Cheung says everyone with diabetes should discuss cholesterol-lowering therapy with their doctors, but he does not think doctors should always recommend drug therapy.

However, Baigent disagrees. "Even if a person has a 1% per year risk of a major cardiovascular event, there is still a benefit from statins," he says. "So for people whose risk increases over time - and after middle age, that is most everybody with diabetes - there is no point in not treating them with statins."

Thank you Daniel J DeNoon

Diabetes Is Responsible For Many Heart Disease Deaths

Don't take diabetes lightly. More than one in 10 heart disease deaths may be attributable to diabetes. In fact, my friend Shiv Harsh, MD, says most heart specialists like him equate diabetes with onset of heart disease, as it were.

In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.

They reported their findings online in The Lancet and will present them during an oral session at the American Diabetes Association meeting.

“In this decade, about 10% of vascular deaths in populations in developed countries have been attributable to diabetes in adults, corresponding to an estimated 325,000 deaths per year in high-income countries alone,” Sarwar and colleagues wrote.

“This burden will increase if the incidence of diabetes continues to rise, even if rates of vascular disease continue to fall because of decreases in smoking, improvements in treatment, or other reasons,” they added.

There have been uncertainties about the magnitude of associations between heart disease risk and stroke, and diabetes and fasting glucose concentration.

So to quantify those associations for a wide range of circumstances, the researchers conducted a meta-analysis of individual risk factors in patients without vascular disease from studies in the Emerging Risk Factors Collaboration.

They included 698,782 patients in 102 prospective studies. The mean age was 52 and 43% were women, with the majority in Europe, North America, and Australia, and the remainder in Japan or the Caribbean.

A total of 7% of patients reported a history of diabetes at baseline.

Over the study periods, there were 52,765 nonfatal or fatal vascular outcomes.

The researchers found that patients with diabetes had around a twofold increased risk of heart disease, ischemic stroke, and other vascular deaths:

* Coronary heart disease: HR 2.0, 95% CI 1.83 to 2.19
* Ischemic stroke: HR 2.27, 95% CI 1.95 to 2.65
* Hemorrhagic stroke: HR 1.56, 95% CI 1.19 to 2.05
* Unclassified stroke: HR 1.84, 95% CI 1.59 to 2.13
* Other vascular deaths: HR 1.73, 95% CI 1.51 to 1.98

The researchers said that risk was about a third higher for fatal than nonfatal myocardial infarction, “perhaps suggestive of more severe forms of coronary lesions in people with diabetes than those without, differential response of the myocardium to ischemia, or possibly in part, differential coding of deaths from coronary heart disease.”

Risk of heart disease among diabetics was higher in women than in men, in patients ages 40 to 59 than those 70 and up, in nonsmokers than in smokers, and in those with below-average systolic blood pressure.

Risk of stroke was higher in women, the same younger age group, and in those with above average body mass index (BMI).

These findings, the researchers said, warrant further study.

Also, at an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% of vascular deaths, they added.

Yet only moderate associations were found between impaired fasting glucose and risk of heart disease and stroke.

Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L.

But risk of heart disease increased with increasing plasma glucose concentrations:

* 5.60 to 6.09 mmol/L: HR 1.11, 95% CI 1.04 to 1.18
* 6.10 to 6.99 mmol/L: HR 1.17, 95% CI 1.08 to 1.26

The researchers added that risk was “substantially higher” among those with concentrations of 7 mmol/L or higher.

The study was limited in that it may not be generalizable to patients in low- or middle-income countries. But that does not mean that the findings can be dismissed as a problem faced by diabetics in developed countries. In countries like India too evidence is emerging that diabetics face more risk of heart disease than non-diabetics.

In an accompanying commentary, Hertzel C. Gerstein, MD, of McMaster University in Hamilton, Ontario, said it remains unknown whether the spectrum of dysglycemia is causally related to cardiovascular outcomes.

Trials of glucose-lowering therapies have shown a modest reduction in myocardial infarction, but “the size of the effect strongly suggests that glucose is not the only player,” he wrote. Others could include fatty acid and lipoprotein metabolism, visceral fat deposition, hepatic function, and renin-angiotensin, among others.

“Any or all of these factors (and others) might promote cardiovascular disease through various known and unknown mechanisms,” Gerstein wrote. “Large, long-term clinical trials of insulin-replacement therapy, incretins, and other approaches targeting one or more of these abnormalities … are certain to shed more light on the link between dysglycemia and serious outcomes.”

 

Thank you Kristina Fiore/MedPage Today

Killer Drug Gets Safety Certificate From FDA - GSK Claims "Victory"

This week the US Food and Drug Administration voted not to ban GlaxoSmithKline's diabetes drug rosiglitazone (brand name Avandia). Their vote has been reported as a victory for the company. I don't think so: this saga tells an ugly story about our collective medical incompetence.

Rosiglitazone was first marketed in 1999. From the outset it was a magnet for disappointing behaviour. That first year Dr John Buse discussed an increased risk of heart problems at a pair of academic meetings. He was silenced. GSK made direct contact, then moved on to his head of department.

Buse felt pressured to sign various legal documents and after wading through documents for several months, in 2007 the US Senate committee on finance released a report describing the treatment of Dr Buse as "intimidation".

In 2003, the Uppsala drug monitoring group of the World Health Organisation contacted GSK about an unusually large number of reports associating rosiglitazone with heart problems. GSK conducted two internal meta-analyses of their data in 2005 and 2006.

These showed the risk was real, but although both GSK and the FDA had these results, neither made any public statement, and they were not published until 2008.

Why then? In 2004 GSK were caught ‑ famously - hiding data showing side effects of the antidepressant paroxetine in children: a court settlement required them to post all clinical trial results voluntarily on a public website.

Using this data source, cardiologist Prof Steve Nissen and colleagues published a landmark meta-analysis in 2007 showing a 43% increase in the risk of heart attack on rosiglitazone. People with diabetes are already at increased risk of heart problems.

The FDA found a similar risk in their own calculations, but voted in 2007 to keep the drug on the market. This is not insane: diabetes is tricky, 300 million people have it worldwide, a great many die from it, and rosiglitazone is unusually good at controlling blood sugar. Lots of dangerous drugs are kept on the market and then used less frequently, in extreme circumstances.

A consensus algorithm from the American Diabetes Association and the European Association for the Study of Diabetes, meanwhile, unanimously recommended against rosiglitazone. Although annual sales for rosiglitazone fell, they still remained over $1bn (£650m). Concerns continued to mount. So did the bad behaviour. In 2007, Nissen caught GSK out discussing a copy of his unpublished paper, which they had obtained improperly.

Then on 28 June this year Nissen published an updated meta-analysis of 56 trials in over 35,000 patients. Again it found an increased risk of heart problems. GSK's response to all this has been like the responses you get from homeopaths.

There are seven trials since 2007, they said, showing no excess risk: fine, except there are 56 which collectively do show an excess risk. There is this other meta-analysis, they said, which looked at 164 trials: fine, except it's published in a fairly obscure journal, and it looked at trials lasting more than four weeks, when the others set the bar at trials over 24 weeks, because a heart risk takes time to develop.

In any case, this other meta-analysis is not brilliant for GSK's case, since it points out that the company denied access to data from six trials which we know to have taken place. There is no excuse for companies withholding data from academics and doctors. But most revealingare the deep-rooted flaws this story exposes in our rather ad hoc systems for gathering, analysing, and disseminating evidence on risks and benefits of treatments.

This drug has been on the market since 1999, and it has seen billions of dollars of sales every year. There has been plenty of real patient experience of this treatment, but we have failed to capture it for analysis. Most of the trials included in these meta-analyses were not specifically designed to look at heart problems, and so the data on these is unpredictably inaccurate.

In an ideal world, for every patient, wherever possible, we could be gathering anonymised outcome data and comparing this against medication history. In an ideal world, wherever there is genuine uncertainty about which treatment is best, a patient would be randomised to one treatment, and their progress monitored. In an ideal world, these notions would be so embedded in our notion of what healthcare looks like that no patient would be bothered by it.

This isn't fanciful, or difficult, or disproportionately expensive. Instead we have a hotchpotch of incomplete monitoring systems and unforgivable secrecy.

Courtesy: Ben Goldacre/The Guardian

Diabetic Neuropathy: No Clear Answers

Do high glucose levels cause neuropathy? That's an issue that worries most diabetics. And unfortunately there are no clear answers.

Experts think of blood glucose values as a spectrum of numbers with no clear cutoff between nondiabetic and diabetic. In similar manner, there is a gray area of blood glucose that defines pre-diabetes. Many people use blood sugar and blood glucose interchangeably.

The definition of diabetes has changed over time. The numbers you quote might very well be considered diagnostic of diabetes today whereas they were not 20 years ago. In 1997, the American Diabetes Association definition of normal blood glucose decreased from 120 to 110 mg/dL (6.1 mmol/L). In 2002, the American Diabetes Association defined a normal fasting blood glucose as less than 100 mg/dL (5.6 mmol/L).

Today we consider fasting blood sugars of 100 mg/dl to 125mg/dl to be in the realm of glucose intolerance which is sometimes called pre-diabetes. These patients are at increased risk for developing frank diabetes. Several fasting glucose levels over 125 or a single random glucose over 200 mg are considered diagnostic of diabetes.

There are other tests used to make the diagnosis of pre-diabetes or diabetes. Pre-diabetes is defined as a blood sugar of 140 to 199 mg/dL (7.8 to 11.0 mmol/L) two-hour after drinking 75 grams of an oral glucose solution. The diagnosis of diabetes is confirmed with a blood sugar of 200 mg/dL or greater, two hours after ingestion of the glucose solution.

Hemoglobin A1C is a blood test that gives an estimate of blood sugar levels over the previous three months. Persons with a value of 5.7 to 6.4 percent are thought to have pre-diabetes. Those with a value of 6.5 percent or higher are considered diabetic.

About 30 percent of patients with frank diabetes for more than a decade have some neuropathy. It usually presents as numbness, itching or tingling in the legs but can also be pains. It can even present as digestive problems such as difficulty digesting food or diarrhea due to problems with nerves in the bowels.

Most diabetic neuropathy is caused by peripheral artery disease, in which the small blood vessels are obstructed or partially obstructed and cannot carry oxygenated blood to areas of the body. These areas have pain or other difficulties due to the lack of oxygen.

It is very possible for someone with numbers that are considered pre-diabetes to have some of the complications of diabetes This is especially true of big vessel disease such as myocardial infarction (heart attack), stroke and peripheral vascular disease. Retinopathy, neuropathy and kidney disease are rarer in pre-diabetics but can occur, especially in someone who has pre-diabetes and hypertension (high blood pressure).

The condition of pre-diabetes combined with hypertension is often referred to as the "metabolic syndrome." Elevated cholesterol and triglyceride combined with diabetes and hypertension increases risk of neuropathy even further. Of note, there are some nondiabetics with neuropathy and peripheral vascular disease caused by elevated cholesterol and triglycerides only.

It is prudent that you have a relationship with a physician who will measure not just blood sugar, but cholesterols, triglycerides and blood pressure. He or she may decide that lowering your blood sugars through diet or medication or both might be beneficial for your long-term health. Lowering blood sugar can sometimes even better the pain of diabetic neuropathy.

Many pre-diabetics and diabetic patients are also treated for cholesterol and triglyceride problems and get a baby aspirin daily to decrease risk of heart disease. There are also a number of treatments for pain caused by neuropathy.

In addition to having the above tests, people with pre-diabetes and diabetes should get an annual eye examination to rule out early diabetic retinopathy. Diabetic retinopathy is treatable and is the most common cause of blindness.

It is also prudent to examine the feet for wounds that the patient might not appreciate due to loss of sensation as a part of diabetic neuropathy. Assessment of kidney function and some studies of the heart and vascular system may also be called for.

By the way, there are other causes of peripheral neuropathy. Not uncommon are amyloidosis, which is a disease in which excess protein is deposited in nerve tissue, and vasculitic neuropathy, a rheumatologic disease in which the patient has inflammation near the nerve.

Also we must consider alcoholic neuropathy in someone with an extreme drinking history and even lead poisoning as a possible cause. Patients who have been treated with chemotherapy for cancer and some rheumatologic diseases can also get some painful neuropathies.

Thank you Dr Otis Brawley

Diabetes: Rely On Facts, Not Fiction

Several sources of information on the type two diabetes can be found almost everywhere. If you suspect that you have the diabetes type 2 condition or are at risk of acquiring it, type 2 diabetes information can be easily and conveniently found online. However, not every bit of online data may be accurately written. Therefore, it is necessary to set the facts straight about the common misconceptions about type 2 diabetes.

Fact #1: Diabetes has no remedy
Accurate and reliable data on type 2 diabetes should tell you that currently, no known 100% cure on diabetes has been developed in the medical field yet. Albeit a diabetic patient can try and even prevent the diabetes condition from worsening he or she cannot completely treat it.

It is therefore important to be cautious with information on type 2 diabetes that will offer to provide you with a cure.

Fact #2: Type 2 Diabetes is not fully understood
Many medical researchers as well as medical organizations are constantly trying to help us understand more about type 2 diabetes by conducting researches. It is a known fact though that these studies and researches will take time if we are to fully grasp, and consequently, come up with the best possible medical solution for type 2 diabetes as, even its definite causes cannot be fully identified.

Several common possible sources have been identified such as genetic heritage wherein some people are insulin resistant compared to others. This hereditary trait, combined with and unhealthy diet and lifestyle may worsen any existing diabetes condition or increase the risk of having one.

Fact #3: Too much sugar does not necessarily cause diabetes
Consuming too much sweets, by itself, does not really cause diabetes. However, diabetics prohibited from eating too much sweet food because of their body’s inability to process glucose. Facts about type 2 diabetes will tell you that type 2 diabetics’ body do not react to insulin. It is this insulin in our body which tells us to open up and take in glucose for energy production.

Sugar is not the only food item that diabetics are warned by doctor against. Other food items that diabetics should also be careful with is Carbohydrates and it should be the first thing that should be watched out for. Reliable and accurate information on type 2 diabetes should include instructions on how to count the carbohydrates level in your body so you can control your intake. This is because foods rich in carbohydrates produce just as much glucose as sugar and other sweets.

Fact #4: Not all fruits are good
People have the misconception that going on a healthy food diet of vegetables and fruits is all that is we need to address your diabetes condition. What any reliable and accurate information on type 2 diabetes should inform you, however, is that it is not about eating as much fruits and vegetables as you can to replace carbohydrates intake.

A diabetic’s diet as far as fruits are concern should be about moderation and simply making sure that you eat only within your recommended daily allowance of sugars and carbohydrates, and fruits. Fruits may still contain sugar and, as a type 2 diabetic, you should try to do away with those foods that are high in the glycemic index in your information on type 2 diabetes.

Fact #5: Not all diabetics show symptoms
Since not all people manifest signs and symptoms of being diabetic, there are some who discover their condition too late. Factors which are contributory to diabetes such as being overweight, being advanced in age and a family background on the condition should be enough warning for you to undergo regular check ups as well as enough reason for you to have a healthy change in diet and lifestyle.

Fact #6: Complications from diabetes can kill
It is not really diabetes itself that kills in most cases. Diabetics usually die because of the complications. Heart ailments for example are the number one cause of death in people with severe or uncontrolled diabetes. Others however may also suffer from kidney failure.

Thank you Andy Rowde

Diabetes Increases Risk Of Abnormal Heart Rhythm

People with diabetes are at increased risk of a common type of abnormal heart rhythm known as atrial fibrillation, new research shows.

This risk gets worse the longer a person has been taking medications for diabetes, while poor blood sugar control also exacerbates risk, Dr Sascha Dublin of the Group Health Research Institute in Seattle and her colleagues found.

Atrial fibrillation is not in and of itself deadly, Dublin noted, but it does increase a person's risk of stroke and heart failure.

Studies examining the relationship between diabetes and atrial fibrillation have yielded mixed results, and often didn't take obesity into account. This is important, Dublin noted, because obesity increases both diabetes risk and atrial fibrillation risk. "We felt that the literature really was in a state of uncertainty," Dublin said.

In the current study, Dublin and her team looked at data from Group Health, a large health care delivery system, on 1,410 people diagnosed with atrial fibrillation and 2,203 people without the abnormal heart rhythm. Eighteen percent of the people with atrial fibrillation were taking medications for diabetes, compared to 14 percent of the controls. This translated into a 40 percent increased risk of atrial fibrillation for the treated diabetics.

And the more severe a person's diabetes was, the greater their risk of atrial fibrillation.

To gauge diabetes severity, the researchers used two measurements: average hemoglobin A1C levels, a standard indicator of blood sugar control over many years; and the amount of time a person had been on medicines for diabetes.

Atrial fibrillation risk rose as people's blood sugar control worsened, the researchers found. While the risk was only about 6 percent greater for people with A1C levels of 7 or less, indicating good long-term blood sugar control, risk was about 50 percent higher for people with A1C levels between 7 and 9, and nearly doubled for people with levels above 9.

Similarly, risk of the abnormal heart rhythm increased with diabetes duration; for every additional year a person had been taking diabetes medications, their risk of atrial fibrillation increased by 3 percent.

Doctors who treat diabetic patients should be aware of their increased atrial fibrillation risk, Dublin said. She pointed out that the condition can be treated effectively, for example with blood-thinning drugs to reduce stroke risk.

And for patients whose symptoms are interfering with their quality of life, for example making them short of breath with exertion, "we can make them feel a lot better by slowing their heart down with commonly used and safe drugs," she added.

SOURCE: Journal of General Internal Medicine, online April 20, 2010.

Diabetes: Preventing Hypoglycemia

A team of Boston researchers has developed an artificial pancreas that prevented blood sugar from falling perilously low (hypoglycemia) in a trial

 

Boston researchers have made a major step toward the development of an artificial pancreas that overcomes the bugaboo of most previous such attempts -- dangerously low blood sugar caused by injection of too much insulin.

Their experimental device secretes two hormones normally produced by the pancreas -- insulin and its counterbalancing hormone, called glucagon -- and has been shown to control blood sugar levels in about a dozen people for at least 24 hours, they reported Wednesday.

The team is now planning longer trials as they gear up for what they hope will be approval by the Food and Drug Administration in as little as seven years.

"This is a very important proof-of-concept study," said Dr. Irl B. Hirsch, an endocrinologist at the University of Washington School of Medicine, who was not involved in the research. "It was becoming obvious that if we were ever going to get [an artificial pancreas], we would have to use both hormones. . . . The fact that they have been able to do so successfully is very big and very exciting news."

Most people know that Type 1 diabetes, which affects more than a million Americans, is caused by the loss of insulin-secreting beta cells in the pancreas.

Few realize, however, that the disease also affects alpha cells of the pancreas, which secrete glucagon to raise the level of sugar in the blood. Together, the two hormones help the body in the delicate balancing act of maintaining blood sugar levels that are neither too high nor too low.

Researchers have made tremendous advances in controlling blood sugar levels with continuous monitors and insulin pumps, "but one of the challenges is that we have an accelerator but not a brake," which means blood sugar levels can fall too much, said molecular biologist Aaron Kowalski, a vice president of the Juvenile Diabetes Research Foundation, which partially sponsored the new research. The glucagon research, reported in the journal Science Translational Medicine, may provide that brake.

The brake is crucial, Kowalski added, because low blood sugar, or hypoglycemia, can cause seizures and even be fatal. For people who have been on insulin for long periods, the risk of hypoglycemia appears to grow over time, but it is also a problem in young children. "That's what keeps us awake at night," said Hirsch, who has been diabetic for 46 years.

What the Boston team has invented is a computer algorithm that responds to changes in blood sugar and computes how much insulin or glucagon to inject. Biomedical engineer Edward Damiano of Boston University began developing it a decade ago when his then-11-month-old son, David, was diagnosed with diabetes. He put the algorithm in a laptop and paired it with off-the-shelf insulin pumps -- which could also be used to inject glucagon -- and glucose monitors that are implanted under the skin.

After Damiano proved the system would work in diabetic pigs -- which are remarkably similar to humans physiologically -- Dr. Steven Russell of Massachusetts General Hospital suggested that it be tested in humans. Their first trials were conducted with 11 diabetics, who were hospitalized for 27 hours for the tests.

It was "a really rigorous test," Russell said. "We fed them three very-high-carbohydrate meals, which is the most challenging part of automated control."

Six of the patients experienced no hypoglycemia, but five had episodes that required they drink orange juice to recover. Subsequent analysis showed that those patients absorbed and metabolized insulin more slowly than normal. When Damiano adjusted the algorithm to account for this slowed absorption, all passed a repeat of the trial with flying colors -- as did the six who did well the first time around.

The next test, perhaps beginning next month, will involve a larger group who will be on the devices for at least two days in the hospital. They will use a portable form of the system that will allow them to walk around and exercise on a treadmill, which is another challenge for automated systems.

A key problem is developing a stable solution of glucagon that can be used in the pump without decomposing, an effort that is being pursued by several companies.

But because that may produce delays in commercializing a pump that uses both hormones, Damiano and Russell think an insulin-only device will be first to market, in about five years. A device that uses both hormones might follow within a couple of years.

"I am committed to trying to get something along fast enough that it could develop into a commercial product before my kid goes to college," Damiano said.

thomas.maugh @latimes.com

Diabetes: Controlling Blood Sugar Is Not Enough

I'm sure all of you who live with diabetes or know someone who carries the burden of the disease will find their diabetes management has been inadequate.

This is because nearly all diabetics are fixated on keeping their blood sugar under control. As long as glucose levels are within acceptable limits, they feel the disease is under control.

Nothing can be farther from the truth. In fact, you may be deluding yourself that all is good even as your heart, kidneys, eyes etc are just rotting away, as it were.

In fact, my good friend Dr Shiv Harsh MD, a heart specialist, says he considers diabetes to be basically a heart disease.

To get this blog going, I'm paraphrasing a great article from New York Times that I came across a few years ago. It is made a difference to my diabetes management.

Most people discover they have Type 2 diabetes by accident, mostly after a routine urine test. The test reveals your blood sugar level is sky high and glucose is spilling into your urine.

"You've got diabetes," confirms your doctor.

So, from then on, like most others with diabetes, you become fixated on your blood sugar. Your doctor has warned you to control it or the consequences could be dire - you could end up blind or lose a leg. Your kidneys could fail.

You try hard. When dieting does not work, you begin counting carbohydrates, taking pills to lower your blood sugar and pricking your finger several times a day to measure your sugar levels. When they remained high, you agree to add insulin to your already complicated regimen. Blood sugar is always on your mind.

But in focusing entirely on blood sugar, you end up neglecting the most important treatment for saving lives — lowering the cholesterol level. That protects against heart disease, which eventually kills nearly everyone with diabetes.

Like I said in the beginning, Dr Shiv Harsh considers diabetes a heart disease. (I'm putting this in layman's language; Dr Shiv Harsh has a more nuanced approach. I'll get him to write on this blog sometime.)

Moreover, most diabetics also miss a second treatment that protects diabetes patients from heart attacks - controlling blood pressure. Most assume everything is taken care of if you can just lower your blood sugar level.

Blood sugar control is important in diabetes, specialists say. It can help prevent dreaded complications like blindness, amputations and kidney failure.

But controlling blood sugar is not enough.

Yet, largely because of a misunderstanding of the proper treatment, most patients are not doing even close to what they should to protect themselves. What is going on? We can only conclude that people are not aware of their risks and what could be done about them.

In part, the fault for the missed opportunities to prevent complications and deaths lies with the medical system. Most people who have diabetes are treated by GPs (family doctors) who have had just a few hours of instruction on diabetes, while they were in medical school. Then the doctors typically spend just 10 minutes with diabetes patients, far too little for such a complex disease, specialists say.

In part it is the fault of proliferating advertisements for diabetes drugs that emphasize blood sugar control, which is difficult and expensive and has not been proven to save lives.

And in part it is the fault of public health campaigns that give the impression that diabetes is a matter of an out-of-control diet and sedentary lifestyle and the most important way to deal with it is to lose weight.

Most diabetes patients try hard but are unable to control their disease in this way, and most of the time it progresses as years go by, no matter what patients do.

Ninety per cent of diabetes patients have Type 2 diabetes, the form that usually arises in adulthood when the insulin-secreting cells of the pancreas cannot keep up with the body’s demand for the hormone. The other form of diabetes, Type 1, is far less common and usually arises in childhood or adolescence when insulin-secreting pancreas cells die.

And, like many diabetes patients, you end up paying the price for your misconceptions about diabetes.

Most diabetics think the biggest risk from diabetes is blindness or amputations. You never think about heart disease and have no idea how important it is to control cholesterol levels and blood pressure mostly because doctors do not advise you to take a cholesterol-lowering or blood pressure drug. And you do not think you need them.

Indeed, most people with diabetes are unaware of the danger that heart disease poses for them.

A survey by the American Diabetes Association found that only 18 percent of people with diabetes believed that they were at increased risk for cardiovascular disease.

Yet, when you think about it, it’s not the diabetes that kills you, it’s the diabetes causing cardiovascular disease that kills you.

So, if you are one of those who don’t think you are at increased risk, finding out that you are and that you can decrease that risk substantially could literally change your life.

The science is clear on the huge benefits for people with diabetes of lowering cholesterol and controlling blood pressure.

With cholesterol, levels of LDL cholesterol, the form that increases heart disease risk, should be below 100 milligrams per deciliter and, if possible, 70 to 80. Yet, diabetes patients with LDL cholesterol levels of 100 to 139 often are told that their levels — ideal for a healthy person without diabetes — are terrific.

But many practicing doctors just don’t know that an LDL cholesterol number that is normal for someone without diabetes is not normal for someone with diabetes.

Not surprisingly, most diabetics do not know the other measures proven to prevent complications in diabetes.

Sure, high blood sugar is dangerous. It can damage the small blood vessels in the eyes, leading to blindness; the nerves in the feet, leading to amputations; and the kidneys, leading to kidney failure. But no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation.

So while controlling blood sugar can be important, other measures also are needed to prevent blindness, amputations, kidney failure and stroke. But, alas, most diabetics are doing none of them.

The common assumption that Type 2 diabetes is simply a consequence of being fat. And that losing weight will help cure it.

Obesity does increase the risk of developing diabetes, but the disease involves more than being obese. Only 5 percent to 10 percent of obese people have diabetes, and many with diabetes are not obese.

To a large extent, Type 2 diabetes is genetically determined — if one identical twin has it, the other has an 80 per cent chance of having it too. In many cases, weight loss can help, but most who lose weight are not cured of the disease. You can lose 20 kg but still have diabetes.

So if you're diabetic worried only about blood sugar levels, get ready for a new diabetes regimen: a statin to drive your cholesterol level very low, drugs to lower your blood pressure, besides insulin and drugs to reduce his blood sugar levels.

Remember, you’ll never be out of the woods. You’ve got to face that.

And it is not just that many diabetes patients are overweight, as people with Type 1 diabetes, who often are thin, also have a high risk of heart disease. There is something about diabetes itself, researchers say, that leads to high levels of LDL cholesterol and a form of LDL cholesterol particles that is particularly dangerous. Diabetes also leads to increased levels of triglycerides, which are fats in the blood that increase heart disease risk, and in diabetes is linked to high blood pressure.

Being obese or overweight, in contrast, are supposed to be “weak contributors to heart attack risk.”

Type 2 diabetes does not exist in isolation. Underlying diabetes are all these cardiovascular risk factors.

It has taken quite a while for the alarm bells to go off because it is heart disease researchers, not diabetes researchers, who have conducted the seminal studies.

The key to saving lives is to reduce levels of LDL cholesterol to below 100 and also control other risk factors like blood pressure and smoking. The cholesterol reduction alone can reduce the very high risk of heart attacks and death from cardiovascular disease in people with diabetes by 30 per cent to 40 per cent. And clinical trials have found that LDL levels of 70 to 80 are even better for people with diabetes who already have overt heart disease.

Studies of blood sugar control have been more problematic than those of cholesterol lowering.

In Type 2 diabetes, the most ambitious effort was a huge study in Britain. It found that rigorous blood sugar control could lower the risk of complications that involved damage to small blood vessels, a list that includes blindness, nerve damage and kidney damage. But there was no effect on the overall death rate. There was a small decrease in the number of heart attacks but it was not statistically significant, meaning it could have occurred by chance.

Since researchers are still groping in the dark, as it were, cholesterol lowering, for patients with Type 1 and Type 2 diabetes, is the most effective and easiest way by far to reduce the risk of heart disease and the only treatment proven to save lives. But doctors say achieving the recommended cholesterol levels usually means taking a statin.

Some patients resist, wary of intense drug company marketing to patients and afraid of side effects like muscle or liver damage which, although extremely rare, have frightened many away from the drugs.

Yet lowering cholesterol with statins is much simpler than anything else diabetes patients are asked to do. And the drugs are among the best studied and the safest on the market.

My own doctor says if he had to rate the different regimens for a typical middle-age person with Type 2 diabetes, the first priority would be to take a statin and lower the LDL cholesterol level. (I take one statin after dinner.)
Besides, two other measures to protect against heart disease, blood pressure control and taking an aspirin to prevent blood clots, should not be neglected.

Right now, without waiting for lots of exciting things that are almost in the pipeline or in the pipeline, starting tomorrow, if everyone did these things — taking a statin, taking a blood pressure medication, and maybe taking an aspirin — you would reduce the heart attack rate by half.

But even when you do take the right steps to control diabetes, the grueling process can simply wear you down.

In fact, a fistful of prescriptions, including a statin, blood pressure medications and one for the drug that most diabetics dread – insulin – besides regular checks for eye, nerve and kidney damage and watching what you eat and count carbohydrates is enough to drive anyone crazy.

Diabetes specialists say they are well aware of how daunting the program can be. Many go to the doctor once or twice and walk away saying, “I don’t want to do this.”
Meanwhile, no matter what they do, most people with Type 2 diabetes get worse as the years go by. Patients make less and less insulin and their cells become less and less able to use the insulin they do produce.

That is why it is not uncommon to start initially with diet therapy, then after a few years you need to add a drug that improves insulin sensitivity. Then when that drug isn’t enough, the doctor adds a second drug that improves insulin sensitivity by a different mechanism. Then he add a drug that stimulates that pancreas to make more insulin.”

Then patients with Type 2 diabetes may need insulin itself, but when that happens they have to take even more than a person with Type 1 diabetes — two or even three times as much — because their cells no longer respond adequately to the hormone.

Nevertheless, while it is not easy to re-energize burned-out patients, at the very least doctors and patients should know what is important.

We already have the miracle pills - statins and blood pressure medications – that are cheap but what is imperative is patient education and physician training that this stuff is out there and this is what doctors should be focusing on to make a difference in lives.

Note: I am NOT an expert. I am managing diabetes with moderate success and want to share published material appearing elsewhere. DO NOT start any medication without consulting your doctor. Get your lipid profile (12 hours fasting before test) and BP checked before you meet your doctor next.

If you have anything to share with other diabetics, do post your experiences on this blog