Aspirin Use In Patients With Diabetes Requires Careful Consideration

ASPRIN has been proven to be effective in reducing the risk for cardiovascular events; however, patients with diabetes are a unique population that requires special considerations before treatment. While aspirintherapy is recommended, further exploration into dosing strategies, strongerantiplatelet therapy and the clinical interaction between aspirin and patients with diabetes is essential.

“A landmark stage published in 1990 really set the stage as to why diabetics are different and why antiplatelet therapy may be effective in this population,” Jeffrey S. Berger, MD, of the NYU Cardiac and Vascular Institute at the NYU Langone Medical Center in New York, said during a presentation. “Compared with non-diabetics, diabetics had greater platelet activity.” He was speaking at the American College of Cardiology (ACC) 60th Annual Scientific Sessions in New Orleans earlier this week.

Berger noted that one study currently being conducted at NYU suggests that markers of platelet activity correspond well with an increasing prevalence of diabetes. Data from other trials support this association, and these results raised an important question: Can measuring platelet activity prevent a future event? At present, this question remains unanswered but warrants further investigation, he said.

A Closer Look
In addition, physicians must consider dosing when treating with aspirin. Berger explained that aspirin inhibits COX-1 and, thus, reduces amounts of platelet activation and vasal constriction. However, aspirin also reportedly inhibits prostacyclin, which causes the opposite effect on thromboxane. Therefore, Berger emphasized that physicians be careful not to prescribe too much aspirin, even among patients with diabetes.

Many physicians believe that patients with diabetes respond differently to aspirin than those without the disease. Berger pointed out that this is a misconception, however, and cited data from one study indicating no significant differences in aspirin’s interaction in patients with diabetes compared with those without the disease. Most importantly, he said, research showed no significant differences in how aspirin prevents cardiovascular (CV) events between patients with the disease and those without.

Despite aspirin’s efficacy, the medication has been linked with serious adverse events, such as hemorrhagic stroke, with research showing a low number needed to treat and a low number needed to harm.

“Thinking about it this way, for every 1,000 patients treated for 5 years, three ischemic events are avoided, but three major bleeds are caused,” Berger said. “So when you’re thinking about who should get aspirin, you should think about the absolute benefit and the absolute risk.”

Future Studies
Because patients with diabetes are a special population, researchers and physicians should consider whether stronger antiplatelet therapies are required. Berger said future studies must take other medications into account. Statins, fish oil and ACE inhibitors, for example, have antiplatelet activity and this effect may be sufficient for patients with diabetes.

He also noted that dosing strategies may have to be altered, such as administering aspirin twice a day instead of once daily. Additionally, improved tools for monitoring aspirin’s effect on preventing CV events would also be extremely valuable, according to Berger.

“There is no significant clinical interaction between diabetics and non-diabetics regarding the effect of aspirin, how diabetics may need a different strategy of dosing or a stronger antiplatelet therapy, and I think future clinical trials should address these issues,” Berger said.

Commenting, Rhonda Cooper-DeHoff, Associate Professor in the Department of Pharmacotherapy and Translational Research at the Colleges of Pharmacy and Medicine, University of Florida, said: “Dr. Berger raised some very provocative points, particularly about what dose of aspirin should be used. The fact that he showed data that suggest that a lower dose of 81 mg may not be as effective as we think in patients with diabetes is an important take-home message. I don’t think that message is really out there.

“The other very provocative point he raised is that we need better tools to monitor the effect of aspirin like we have to monitor the effect of cholesterol-lowering and blood pressure-lowering drugs. We are really missing that with aspirin. Some of the focus for future trials that he discussed would be incredibly useful to the overall care for the patient with diabetes.”

Reported by Endocrine Today

Diabetes Management: Killer Apps That Are Revolutionizing Diabetes Care

The advantages of the wireless world are finally being brought to use beyond socializing. For us diabetics, they're being used as a means of communicating critical information about our health and the status of the conditions that can be mortally devastating and an expensive burden.

Of course, nothing replaces weight loss and proper diet. But, in the meantime, communications technology can be used as a means to inform, monitor and support patients.

Indeed, health care providers and medical companies are quickly learning how to leverage emerging communication and electronic technologies to make diabetes management more efficient, reducing hospitalizations and ultimately decreasing the cost of the disease to individuals and on society.

What's more, the health care market is seeing a large influx of companies who are putting technology to use in a growing field of healthcare communications and health-record management. At a basic level, this means using technology to manage health records and share information with a patient's physician or other approved health care providers and caregivers ‒ including family members.

But, for treating diabetes patients in particular, the use of technology has been slow. When killer apps for iPhone and iPad are out in the market days after the devices are released, it is quite ironic that given the ever-changing condition of diabetes ‒ by its very nature we could benefit from up-to-the minute capabilities that technology brings ‒ diabetes management technology remained rooted in the last century. But that’s changing.

At long last, technology is coming to the rescue of diabetics, trying to make diabetes management easier. In fact, just in the past few years, there finally has been marvelous progress in diabetes care. This isn't just with insulin pumps and home blood glucose monitoring systems. The technologies available now and those at the cusp of development are really encouraging and exciting.

Wireless Technology Improves Patient Care For Marginalized CommunitiesOf my favorites is an innovative use of wireless technology will help underserved communities improve diabetes care and prevention in Tijuana. Using 3G mobile technologies, the Dulce Wireless Tijuana project helps patients in remote areas both monitor and treat their diabetic condition. The Dulce Wireless Tijuana system, announced by Qualcomm Incorporated in October last year, combines mobile applications, web applications, mobile phones, netbooks, laptops, diabetes educational content and health care worker and patient training. Service delivery is available to diabetes patients and their caregivers wirelessly through Qualcomm’s 3G technology network.
                                              

Dulce Wireless Tijuana patients now will have access to the system and technology, including primary care diabetes services and disease management programs. The project stands as an example of how wireless technology can improve patient care for marginalized communities — not just in Mexico, but throughout the world.

Goodbye Bariatric Surgery!
Then there is a matchbox-sized gadget called DIAMOND (Diabetes Improvement and Metabolic Normalization Device) ‒ a.k.a. TANTALUS™ ‒ developed by German medical device maker MetaCure. The system is implanted under the skin on the abdomen, and stimulates the stomach muscles when the patient is eating. This tricks brain into thinking more food has entered the stomach than the person has actually eaten. To deal with this supposedly large meal, the brain boosts insulin production as well as triggering the release of hormones that suppress appetite.

This means that the patient feels full much sooner than normal. A wireless charger system allows the patient to recharge the device at home by placing the charger over the abdomen for 45 minutes, once a week. The result is an improvement in blood glucose levels, which is often accompanied by weight loss, and reduction of blood pressure, waist circumference and blood lipid level. Goodbye bariatric surgery!

Over 200 patients are using the DIAMOND system to date, many of them for over two years, and many for over four years. Trials at the Medical University of Vienna showed the device reduced blood glucose levels by a quarter over three months and the DIAMOND has been shown to significantly reduce blood glucose levels and blood pressure levels. Goodbye bariatric surgery!

Diabetes Management System Could Be iTunes of Diabetes Care
A UK-based medical device company, Cellnovo develops and manufactures an innovative mobile diabetes management system. Comprised of a mobile connected micropump, mobile touchscreen controller, blood glucose meter and applications, the Cellnovo system provides intuitive operation, wireless Internet connectivity and real-time activity tracking – all industry firsts.

Cellnovo offers extensive experience gained at the world’s premier medical device and wireless companies, including Medtronic, DuPont, Novo Nordisk, Abbott, AT&T Lucent, and other industry leaders. The Cellnovo system’s advanced micropump technology enables people with diabetes to more efficiently manage their life-saving therapies while benefiting from greater personalization and portability. This mobile-connected, disease management approach to diabetes removes the burden of keeping journals and pushes information to healthcare professionals so they always have a real-time view of this information

Treating High Blood Pressure With Radio Waves
 

The Symplicity Catheter Systemdeveloped in Australia is used to perform a procedure termed renal denervation (RDN). In a straightforward endovascular procedure, similar to an angioplasty, the physician inserts the small, flexible Symplicity Catheter into the femoral artery in the upper thigh and threads it into the renal artery. Once in place within the renal artery, the device delivers low-power radio frequency (RF) energy to deactivate the surrounding renal sympathetic nerves. This, in turn, reduces hyper-activation of the sympathetic nervous system, which is often the cause of chronic hypertension. The one-time procedure aims to permanently reduce blood pressure. RDN may also allow patients to reduce or eliminate the need for lifelong antihypertensive medications.

The procedure is highly effective with 84 per cent of patients who underwent renal denervation experiencing a reduction in systolic blood pressure by more than 10 mmHg. The study also found that the therapy was safe, with no serious device or procedure-related events, no cardiovascular complications and no kidney-related complications.

Removing Pain From Diabetes Management
A quick and painless way to measure blood sugar is highly sought-after by diabetes sufferers, who currently have to prick their fingers to draw blood several times a day. Now, researchers in the US may have found a solution – a device that works by simply shining a light on skin.

An MIT team has developed an algorithm to relate blood glucose to interstitial glucose levels. “We’ve incorporated a mass-transfer model into the overall Raman spectroscopic algorithm, which allows us to seamlessly transform between blood and interstitial fluid glucose,” explains Ishan Barman, lead author of the research.Using an early version of the device, the team tested the blood-sugar levels of some human volunteers and found that the accuracy and precision of the test was just as good as conventional finger-prick tests. In addition, the new algorithm allows the test to predict impending episodes of high or low blood sugar (hyperglycemia and hypoglycemia) by extrapolating the rate of change of sugar concentration.

The vision is to create a laptop-sized device that could be kept at home or carried around. Rather than having to pierce the skin to obtain blood samples, the device measures sugar levels by simply placing a scanner against the skin. Because measurement is fast and easy, it is hoped that the device may encourage people with diabetes to check their blood sugar more often, giving them better control over their condition.

This research addresses a real problem and appears to provide an important means for improving the calibration of non-invasive sensors. It may also be helpful in the development of a so-called ‘artificial pancreas’ – where insulin can be dispensed automatically in response to sugar levels.

High-Tech Tattoo For Monitoring Blood Sugar
Another MIT team has given people with diabetes one more reason to join the tattoo craze: a special tattoo under development could help them monitor their blood sugar. The team is developing a glucose “tattoo” that could give people with diabetes a visual track of their blood sugar, and reduce the need for the painful finger pricks required for traditional monitors. The glucose tattoo ink, which would be injected under the skin, would be made from a substance that can reflect infrared light back through the skin to a watch-sized monitor that the person with diabetes wears over the ink.

By having this special ink injected under their skin, and by consistently checking the small monitor worn over it, people with diabetes can get a “real-time” feed on their glucose. They can note and take action when they see their blood sugar climbing or dropping; they don’t have to wait until they can get to a convenient place to conduct a finger prick or, worse, until they start to feel ill. The device also opens up an avenue of thought: if special ink can alert people with diabetes to dropping glucose levels, could an automatic, implanted glucose dispenser or pump be far behind?

Shed a Tear to Test Blood Sugar
On diabetes forum like TuDiabetes, diabetics are forever discussing lancet devices, painful pricks, first drop of blood, and callused fingertips. Now a team of researchers at the Arizona State University in collaboration with the Mayo Clinic is developing a new sensor that could make the lives of diabetes patients much easier. The team has come up with a sensor that would enable patients to take tear fluid from their eye to test their glucose levels. The researchers claim the tear sample would give just as accurate a reading as a blood test does.

Team members assessed how current devices were working – or failing – and how others have attempted to solve monitoring problems. They came up with a device that can be dabbed in the corner of the eye, absorbing a small amount of tear fluid like a wick that can then be used to measure glucose. Because of its potential impact on health care, the technology has drawn interest from BioAccel, an Arizona nonprofit that works to accelerate efforts to bring biomedical technologies to the marketplace.

Improving Compliance
A number of companies have developed continuing blood glucose monitoring and insulin injection products with the goal of improving compliance in diabetic patients. Today's children with diabetes also have the opportunity for better blood glucose control than any generation before.

A research study reported in Pediatric Diabetes showed that, compared to multiple daily insulin shots, children on insulin pump therapy for 12 months significantly and consistently lowered their A1C levels. In fact, insulin pump therapy has been shown to significantly decrease severe hypoglycemia in youth. Recent studies showed that adolescents and young children on insulin pump therapy had over 50 percent fewer episodes.

To encourage compliance in diabetic children, Bayer Diabetes Care recently released its Didget blood glucose monitor, which connects to the Nintendo DS and DS Lite. The meter provides children with an adventure game that rewards consistent testing with points, which can be used to unlock new game levels. The product was approved by the FDA in April.

Bioject Medical Technologies markets a needle-free injection system that is approved for delivering subcutaneous or intramuscular injections.

The system forces liquid medication through a tiny opening held against the skin, creating an ultra-fine high-pressure stream that penetrates the skin. The technology can be used for a variety of applications, including diabetes, malaria and influenza.

Echo Therapeutics has developed a wireless, transdermal glucose monitoring system for patients with diabetes. The Symphony tCGM Systemuses a skin permeation device, called Prelude, to painlessly remove the outermost layer of skin in approximately three to five seconds, allowing the transdermal biosensor to read glucose levels through the remaining layers of skin.

OrSense has developed a noninvasive continuous glucose monitor that utilizes a patented technology called Occlusion Spectroscopy. A ring-like sensor temporarily closes off (occludes) blood flow in the patient’s finger, creating new blood dynamics that generate a unique optical signal. Clinicians can analyze the signal to obtain measurements of glucose levels and other blood parameters.

Online Diabetes Resources
Then there are new computer programs that support the analysis of home blood glucose data. Insulin pens are finally the norm and diabetes sufferers are using not just more convenient and expedient methods of insulin administration ‒ they are now using more accurate methods because of technologies that provide improved measurement and monitoring. The idea of subcutaneous glucose sensors were a dream only a decade ago and now they're an everyday part of diabetes care.

Bethesda-based Telcare, a Bethesda-based company that has developed blood glucose monitoring technology that combines a glucose meter with wireless connectivity to Telcare's "cloud" server. The electronic device keeps an open two-way communication between a patients and caregivers ‒ those that are loved ones and those that are professionals such as the nurses and doctors.

Telcare monitor users can access all of their glucose data, as well as offering additional electronic logbook capabilities such as manual recording, nutrition recording, weight management, exercise regimens, medication amounts, and blood pressure statistics. Most impressive is that Telcare provides a cross-platform social community where people with diabetes and healthcare professionals can interact, share stories, discuss the diabetes technology that they use, and learn from one another.

Many diabetes-related health problems ‒ such as eye, kidney and heart disease ‒ are the result of high levels of blood glucose affecting organs over time. So doctors are encouraged that today's young diabetes patients can achieve consistent, lower blood sugar levels from an early age that can continue for a lifetime. For example, Roche makes the ACCU-CHEK® Spirit insulin pump system.

These pumps are milestones above the traditional method of treating fluctuating glucose levels. These pumps can deliver 480 basal doses of insulin each day. But here's where technology comes in: A Palm device and the ACCU-CHEK Pocket Compass software with a bolus calculator determines a patient's bolus doses and even creates pie charts and other graphs to track a patient's progress. This software application can be loaded onto smartphones.

Another company is PositiveID Corp, a growth-stage micro-cap known for their digital personal health records technology. The company unveiled its new 'iglucose' technology at the Cellular Technology Industry Association (CTIA) annual conference in Orlando, Florida last week. It is a wireless communication device for the automatic transmission of blood glucose readings from market leading, data-capable glucometers to the iglucose database.

PositiveID's iglucose technology is making great strides in the advancement of diabetes management and control by allowing patients to wirelessly track blood glucose levels. It connects to the patient's existing glucometer and, using M2M (machine-to-machine) technology, collects, records and transmits a patient's blood glucose data to the iglucose database.

From there, it can be shared automatically via text message, email or fax with family members and health care professionals in real-time. In doing so, iglucose helps eliminate the burden of keeping journals and empowering individuals with diabetes to be more engaged in the self-management of their condition.

Cure for Diabetic Neuropathy
Neuropathy is typically measured by taking skin biopsies from the foot and running a series of specialized tests that can take up to a week to complete. In many cases, this debilitating condition is not identified until serious, and irreparable, damage has already been done.

But in a profound and important breakthrough, Nathan Efron, an Australian optometrist, has discovered that the nerves affected by neuropathy are an exact match to nerves found in front of the eye, and is testing whether looking at their level of degeneration in these nerves over a period of time would match the nerve degeneration found in arms and legs.

Quick and non-invasive eye tests would deliver results in a matter of minutes. In short, the importance of Efron’s discovery lies in the fact that since the eye is a transparent structure, it is the only place in the body where you can look directly at nerves and their degeneration over time.

There are multiple benefits of being able to measure the onset of neuropathy, one being that there are drugs in development that aim to cure diabetic neuropathy. When these drugs are ready to come onto the market the method would be able to detect nerve degeneration early and then hopefully cure it.

For the tests, patients would receive a drop of anesthetic in the eye. A corneal confocal microscope would then capture a 20 second “movie” of their eye for analysis. Two more eye tests will look at the effect of nerve degeneration on the retina.

Efron hopes his discoveries will lead to early testing for diabetic neuropathy that will motivate sufferers to better manage their disease. Testing could be carried out at the same time as diabetes patients are tested for other eye problems caused by the disease. The test has been used to monitor nerve regeneration in patients who have undergone kidney and pancreas transplants, and it could help track the effects of new treatments.

It’s interesting to ponder how technology – much of which already exist for other uses – can help us maybe not cure diseases like diabetes, but at least treat them in a way that takes the burden off the patient. There's more to come…What ideas do you have?

With inputs from Huffington Post

Controlling Diabetes May Reduce Cancer Risk and Death

There are myriad benefits from avoiding diabetes through exercise, diet and maintaining a healthy body weight. A new NIH-AARP Diet and Health Studyhas confirmed additional benefits in the form of reduced morbidity and mortality from certain cancers.

Diabetes is associated with lower risk of prostate cancer in men but with higher risk of other cancers in both men and women, and the results provide further evidence that abnormal insulin and glucose signaling may contribute to cancer initiation and development. Previous epidemiologic studies have also shown an association between diabetes and an increased risk for cancers including colorectal, liver and pancreas.

Diabetes Associated With Increased Cancer Risk

The 11-year prospective study followed more than 500,000 patients ‒ predominantly white, non-Hispanic men and women aged 50 to 71 years ‒ from 1995 to 1996. The results showed that diabetes was associated with an 8 percent increased risk for cancer among women and a 4 percent decreased risk for men.

Diabetes is Linked to 3 of 5 Leading Causes of Cancer

In previous research, a decreased risk for prostate cancer was associated with diabetes, which researchers believe might be due to the lower testosterone levels associated with diabetes. After excluding prostate cancer from their evaluation, the researchers found that diabetes was associated with a 9 percent increased risk for cancer in men.

As for mortality, diabetes was associated with an 11 percent increased risk in women and a 17 percent increased risk in men. These risks appeared independent from other cancer risk factors, such as obesity and cigarette smoking.

After evaluating by cancer site, the researchers found diabetes was associated with a significant increase in risk for colon, rectal and liver cancers among men and women. In men, diabetes was associated with an increased risk for pancreatic and bladder cancers. In women, it was associated with an increased risk for stomach, anal and endometrial cancers. No association was found between diabetes and lung, skin or other cancers.

Earlier research has also linked obesity, diabetes and metabolism to cancer risk with the findings linking weight gain and diabetes to a variety of cancers affecting both men and women, including breast, prostate and colorectal cancer.

Colorectal Cancer & Type 2 Diabetes Share Common Factors

Women with diabetes are 1.5 times more likely to develop colorectal cancer than those who do not have the metabolic disorder. The findings add to the complex body of evidence linking diet and colorectal cancer and also provide new evidence that furthers our understanding of the role of insulin in cancer promotion.

It has been determined that colorectal cancer and type 2 diabetes share a number of common factors, including obesity, so it is interesting to see the direct line between these two conditions. In general, the idea is that if elevated insulin levels create a biochemical environment conducive to cancer growth, it provides one mechanism by which diet and lifestyle can really influence cancer risk.

Data from a massive screening study called the Breast Cancer Detection Demonstration Project, initiated at 29 centers throughout the United States in the 1970s involving more than 45,000 study participants with no history of colorectal cancer or self-reported diabetes for eight years (from 1987-1989 and from 1995-1998), was used to identify which of them subsequently developed colorectal cancer.

According to the findings, women with diabetes had a greatly increased risk of developing colorectal cancer. These results remained statistically significant even after controlling for all known and suspected confounding variables.

However, it is not exactly clear what aspect of diabetes is the underlying cause for this increased risk but one hypothesis centers on the elevated concentration of insulin typically seen in people with type 2 diabetes. In the early stages of the disease process, people become insulin resistant, meaning they must produce more and more insulin to regulate their blood sugar.

Pre-Diabetics Also at Increased Risk

Even after frank diabetes begins, insulin levels remain chronically elevated for extended periods before the pancreas can no longer supply the level of insulin the body demands. So, if the elevated insulin is the problem, then pre-diabetics, who are also hyper-insulinemic, should also be at increased risk for developing colorectal cancer.

To test that idea, the researchers re-analyzed the data, this time including women who were likely pre-diabetic at the beginning of the follow-up period. The idea was that these women were likely hyper-insulinemic at that stage. Surprisingly, the elevated risk, while still significant, had dropped slightly in comparison with that of known diabetics.

This suggests that either the pre-diabetic women had not had elevated insulin long enough or intensely enough to increase risk as they observed in the diabetic women, or alternatively, something other than or in addition to hyper-insulinemia could explain the significant, increased risk for colorectal cancer observed in people with diabetes.

Low Levels of Vitamin D Don't Put Older Women at Greater Risk for Type 2 Diabetes

But pregnant women with gestational diabetes are likely to have low levels of vitamin D, potentially leading to bone weakness in their babies

A recent report on vitamin D from the Institute of Medicine (IOM), an independent scientific body that advises the U.S. government, said the evidence didn't show that vitamin D has any health benefits beyond building and maintaining strong bones. It also said average Americans already have vitamin D blood levels at or above the amount that's needed for good bone health.

These findings are corroborated a new study ‒ published online by the journal Diabetes Care ‒ which found that low levels of vitamin D don't put older women at greater risk for type 2 diabetes. The findings may further temper the enthusiasm for vitamin D that has built up in recent years.

Many studies have linked Vitamin D deficiency to lower risks of everything from diabetes, to severe asthma, heart disease, certain cancers and depression. But the problem with those studies is that they were observational ‒ which means that researchers simply looked at people's vitamin D intake, or their blood levels of the vitamin, and whether or not they developed a given health condition. Those types of studies cannot prove that vitamin D was the reason for any lower disease risk.

That’s one reason why people should continue to focus on lowering their diabetes risk by looking at their overall lifestyle ‒ eating a balanced diet, getting regular exercise and maintaining a healthy weight. Exercising outside and eating foods rich in vitamin D will also ensure that you're getting enough of the vitamin. The IOM recommends that adults in their 70s and up get 800 IU of vitamin D per day, while everyone else older than 12 months should get 600 IU.

The new study involved women participating in the Women's Health Initiative, a large government project that looked at the health effects of hormone therapy, diet changes, and vitamin D and calcium supplements on women age 50 and older.

Of 5,140 women who were free of type 2 diabetes at the start of the trial, 6 percent developed the disorder over an average of 7 years. But the research team found no clear link between the women's blood levels of vitamin D at the outset and their risk of developing type 2 diabetes later on.

Initially, there was some evidence of an association. But it disappeared when the researchers accounted for factors like body weight, exercise levels and certain diet habits, like fiber intake ‒ which are key in the risk of developing type 2 diabetes.

Very few foods in nature contain vitamin D. The flesh of fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 and its metabolite 25(OH)D3. Some mushrooms provide vitamin D2 in variable amounts. Mushrooms with enhanced levels of vitamin D2 from being exposed to ultraviolet light under controlled conditions are also available.                                                        

Most people meet at least some of their vitamin D needs through exposure to sunlight. And fortified foods, especially dairy products, provide most of the vitamin D in the American diet. People who get those things are a lot different from people who don't and it's those factors that may account for the link between vitamin D and lower diabetes risk researchers thought they had found in older studies. Still, the study, like past ones, was observational ‒ so it doesn't disprove a role for vitamin D in diabetes risk. So-called randomized studies are what's needed to prove whether the vitamin curbs disease risks. In that type of trial, participants are randomly assigned to different treatment groups, which helps ensure the results are accurate and not just an effect of chance.

In the meanwhile, another research paper published in the latest issue of theMedical Journal of Australia recommends that all pregnant women should be tested for vitamin D deficiency and those found to be deficient should be treated. Pregnant women with gestational diabetes are likely to have low levels of vitamin D, potentially leading to bone weakness in their babies, the research discovered.

Studying 147 women who attended a gestational diabetes clinic between February 2007 and February 2008, excluding those with known pre-pregnancy glucose intolerance, the Australian researchers found that more than 40 percent of the women were found to have inadequate vitamin D levels. They found that while low levels were more common in women with darker skin, more than 25% of women in all groups were deficient.

"Vitamin D insufficiency has a well-established impact on bone density, neonatal vitamin D and calcium status, and childhood rickets (soft or weak bones). The 41 per cent prevalence of inadequate 25(OH)D (25-hydroxyvitamin D) levels in women with GDM (gestational diabetes mellitus) in our study is unacceptable and identifies vitamin D insufficiency as an issue of public health significance," the researchers noted while recommending that further research into the potential link between vitamin D status and gestational diabetes be conducted.

In an accompanying editorial in the journal, Professor Peter Ebeling from the University of Melbourne at Western Health suggested scheduling of lower-cost, higher-dose vitamin D supplements be altered so that more women could afford them. "Those pregnant and breastfeeding women that are most at risk of vitamin D deficiency are often the least likely to be able to afford supplements," Professor Ebeling said.

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."

Diabetics May Have Increased Risk of Developing Parkinson's Disease

The two diseases share some underlying mechanisms, a study of 289,000 adults suggests

Symptoms of Parkinson's Disease

A new study ‒ published in the April issue of the journal Diabetes Care ‒ suggests that diabetics may have a slightly increased risk of developing Parkinson's disease. Though the reasons for the link are far from clear, the connection between diabetes and Parkinson's risk could mean that the two diseases share some underlying mechanisms.

One possibility is chronic, low-level inflammation throughout the body, which is suspected of contributing to a number of chronic diseases by damaging cells. Oxidation ‒ the process fought by anti-oxidants ‒ is another.

The study, of nearly 289,000 older U.S. adults, found that those with diabetes at the outset were more likely to be diagnosed with Parkinson's over the next 15 years. Of 21,600 participants with diabetes, 172 (0.8 percent) were eventually diagnosed with Parkinson's. That compared with 1,393 cases (0.5 percent) among the 267,000 men and women who were diabetes-free at the study's start.

When the researchers accounted for other factors ‒ like age, weight and smoking habits ‒ diabetes itself was linked to a 41 percent increase in the risk of future Parkinson's. That, however, does not prove that diabetes is a cause of Parkinson's, and the reasons for the connection remain unknown.

Other large studies, too, have looked at the diabetes-Parkinson's link before, with conflicting results. However, the current study included a larger number of people with Parkinson's. And unlike most past studies, it looked at the duration of people's diabetes.

In general, the researchers found, the higher Parkinson's risk was largely seen among people who'd had diabetes for more than 10 years before the start of the study. That supports the idea that diabetes came first, before Parkinson's, rather than the other way around. But more studies are needed to understand why the connection exists, and what, if anything, can be done about it.

The evidence at this time is very preliminary, the researchers say, and diabetics should simply continue to do the things already recommended for their overall health ‒ eating a well-balanced diet and getting regular exercise. Still, there might be something about diabetes ‒ like a problem regulating insulin ‒ that contributes to Parkinson's. But that remains to be proven.

Middle-Age Diabetics Carry Double the Risk for Developing Geriatric Ailments

Diabetes affects multiple organ systems and has the potential to contribute significantly to the development of a number of issues that we associate with aging. A new study has found that adults between 51 and 70 with diabetes develop age-related ailments like cognitive impairment, incontinence, falls, dizziness, vision impairment and pain at a faster rate than those without diabetes.

For adults aged 51-60 with diabetes, the odds of developing new geriatric conditions were nearly double those of their counterparts who didn't have diabetes. By the time people with and without diabetes reach 80, the overall effects of aging and impact of other diseases start to reduce the disparities between the two groups, the researchers found.

The research was based on nationally representative data from the University of Michigan Health and Retirement Study and the results published in the March issue of the Journal of General Internal Medicine.

"The findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than we previously thought… "If we know to start looking for these conditions earlier, we can manage and treat them more effectively," said lead author Christine Cigolle, M.D., M.P.H., an assistant professor of family medicine and internal medicine at the University of Michigan Medical System and research scientist at the VA Ann Arbor Healthcare System

These findings echo the findings of another study published in the journal Diabetes last year. Margaret Gatz and researchers from Sweden showed that getting diabetes before the age of 65 corresponds to a 125 percent increased risk for Alzheimer's disease.

This risk of Alzheimer's disease or other dementia was significant for mid-life diabetics — as opposed to those who develop diabetes after 65 — even when controlling for family factors. In other studies, genetic factors and childhood poverty have been shown to independently contribute to the risk of both diabetes and dementia.

Indeed, the chances of a diabetic developing Alzheimer's disease may be even greater in real life than in the study, the researchers said. They identified several factors that might have led them to underestimate the risk of dementia and Alzheimer's among those who develop diabetes before the age of 65.

Diabetes usually appears at a younger age than dementia does, the researchers noted. Diabetes is also associated with a higher mortality rate, which may reduce the size of the sample of older adults. In addition, approximately 30 percent of older adults with diabetes had not been diagnosed.

The results of the study implicate adult choices such as exercise, diet and smoking, as well as glycemic control in patients with diabetes, in affecting risk for Alzheimer's disease and diabetes, according to the researchers.

In fact, researchers from Mayo Clinic's Florida campus say that dementia in some diabetics appears to be caused often by vascular disease in the brain, and the dementia that develops in people without diabetes is more likely associated with deposition of the plaque seen in people with Alzheimer's disease.

"This helps in understanding diabetes and dementia. It suggests that the vascular dementia seen in diabetics, which appears to be related to small blood vessel disease and strokes, can potentially be averted if development of diabetes is prevented," says Mayo neurologist Neill Graff-Radford, M.D.

The results agree with a number of autopsy studies conducted on patients with dementia and diabetes, in which vascular abnormalities were found to be related to the dementia but the Alzheimer's pathology of plaque and tangles was not, he says.

The findings also suggest that an experimental blood test to predict development of Alzheimer's disease may be more accurate than some studies of people with dementia have suggested, because those studies included participants with diabetes, says Dr. Graff-Radford. "We now propose that future studies of this test should take into account diabetic status," he says.

The test is based on discoveries made by Mayo neuroscientists, which measure the ratio of two different kinds of amyloid beta proteins in blood. Plaque found in the brains of Alzheimer's disease patients at autopsy started when the toxic form of amyloid beta, known as Aβ42, began to be deposited.

The findings also make sense biologically, Dr. Graff-Radford says. Both the insulin hormone and amyloid beta proteins are degraded by the insulin-degrading enzyme (IDE). He adds that if the blood contains excess insulin, as is the case in diabetics, then IDE preferentially degrades insulin instead of amyloid. "That means there would be higher levels of both Aβ42 and Aβ40 in the blood of diabetics," he says.

Indeed, patients with dementia and diabetes appear to display a different pattern of injuries in their brains than patients with dementia but without diabetes, Joshua A. Sonnen, M.D. of the University of Washington, Seattle, discovered. The association between diabetes mellitus and increased risk for dementia in the elderly is well documented. Several possible mechanisms have been proposed for this association, including the direct effects of high blood glucose and insulin, the build-up of beta-amyloid plaques in the brain and the effects of diabetes-related vascular disease on blood vessels in the brain.