Health ShortsDiabetes
ACE Inhibitors for Diabetics:
Medicare Coverage Is Cost Effective
Although most diabetes patients on Medicare would benefit from treatment with ACE inhibitors, only 40 percent take them, at least in part because of the lack of insurance coverage. With the cost of treatment with generic ACE inhibitors averaging $233 a year, a recent study found that Medicare would save money as well as lives by paying the full cost of ACE inhibitor treatment for diabetic beneficiaries.
Approved as blood pressure medications, ACE inhibitors have been found effective in slowing the progression of kidney disease and lowering the risk of heart attack and stroke in diabetics–even those who do not have high blood pressure.
[SOURCE: “The Cost-Effectiveness of Full Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors for Patients with Diabetes,” Annals of Internal Medicine, July, 2005] African Americans Have High Rates Of Diabetes and Hypertension
African Americans have high rates of both diabetes and hypertension. Compared to non-Hispanic whites the same age, blacks are 1.6 times more likely to develop diabetes. A health screening program in predominantly black rural areas of Alabama found that 18.3 percent of African Americans had diabetes, compared to a prevalence of 10.1 percent among whites. Seventy-five percent of African American diabetics (but only 29 percent of non-diabetics) had pre-existing hypertension. Among whites screened, 54 percent of diabetics and 27 percent of non-diabetics had high blood pressure.
[SOURCE: "Study Indicates Aggressive Treatment Helps African Americans with Diabetes, High Blood Pressure," Black Issues in Higher Education, July 1, 2004; Dennis Pillion, Anna Schmidt, Kent Daum and Mary-Jean Sanspree, "Diabetes and Hypertension Screening in the Rural 'Black Belt' of Alabama," Diabetes, June, 2003] Altered Heart Disease Patterns for Diabetics For most of us, athlete's foot is a minor nuisance; for a person with high levels of blood sugar, even a fungal infection can quickly escalate into major trouble. A study involving about 1,200 subjects in 11 European countries concluded that diabetes patients were 50 percent more likely than non-diabetics to have a fungal foot infection. About 33 percent of diabetes patients had both athlete's foot and a fungal toenail infection.
[SOURCE: "Diabetic Feet: Fungal Infection," Family Practice News, December 15, 1999] Blood Sugar Control Is Improving
Of the 20.8 million Americans with diabetes, more than half are keeping their blood sugar at the level recommended by their doctors, compared to only a third who had their blood sugar under control in 2001.
Tight control of blood sugar is crucial to preventing diabetic complications that affect the heart, large and small blood vessels, nerves, kidneys, eyes and other organs.
[SOURCE: Julie Steenhuysen, “Americans Making Progress Managing Diabetes,” Reuters Health, June 23, 2007] Recent research has indicated that c-reactive protein (CRP)-a marker for inflammation or infection-is an important risk factor for heart disease. Other studies have concluded that inflammation may also play a role in the development of diabetes. In a study of 5,245 middle-aged Scottish males, subjects with the highest CRP levels had a three times greater risk of developing type 2 diabetes over a five-year period than those with the lowest levels. CRP predicted type 2 diabetes as effectively as widely accepted risk factors such as body weight or levels of blood sugar or triglycerides. A study of 27,628 women found that those with the highest CRP levels had a risk of developing diabetes 15.7 times greater than those with the lowest levels.
[SOURCE: Diabetes, May, 2002; JAMA, July 18, 2001] CAD Often Silent in Diabetics
One key symptom of coronary artery disease is angina or chest pain during exertion. Because of nerve problems related to their disease, diabetics may experience less pain sensation and not recognize the onset of a deadly heart attack. Diabetics have a risk of coronary artery disease two to four times that of other Americans, but, without regular screening, it often goes undetected.
[SOURCE: "Researchers Study Treatment Options for Coronary Artery Disease," Diabetes Week, October 14, 2002] Childhood Diabetes Takes Heavy Toll
Type 2 diabetes takes a heavy toll on children and adolescents. Tracking all type 2 diabetes patients diagnosed before age 18 in Manitoba and northwestern Ontario since 1986, Heather Dean, M.D. of the University of Manitoba reported that nine percent have died, 6.3 percent are on dialysis and 38 percent have suffered miscarriages or stillbirths.
[SOURCE: "Alarming Increase in Children with Type 2 Diabetes Is a Wake-Up Call," Diabetes Week, July 8, 2002] Coffee Linked to Lower Diabetes Risk
Women who drank six or more cups of coffee a day–decaf or regular–had a 22 percent lower risk of type 2 diabetes than non-coffee-drinkers, according to a study published in the Archives of Internal Medicine [June 26, 2006]. The researchers were surprised to find that the lowest risk was for women who drank decaf coffee; those drinking regular coffee had only slightly lower risk than those not drinking coffee at all.
The authors pointed out that the study did not prove that decaf coffee prevents diabetes but only that a higher coffee intake and a lower diabetes risk occurred in the same women. [SOURCE: Karen Kassel, MS, RD, MEd, “Coffee Drinkers have a Lower Risk of Type 2 Diabetes,” EBSCO Publishing, June, 2006; M.A. Pereira et al, “Coffee Consumption and Risk of Type 2 Diabetes Mellitus,” Archives of Internal Medicine, June 26, 2006] Diabetes and Obesity: Twin Epidemics
The number of Americans classified as obese increased by 57 percent from 1991 to 1999. During the same period, the number diagnosed with type 2 diabetes rose by 38 percent. Nearly 19 percent of Americans are now obese; nearly 7 percent have type 2 diabetes.
Obesity is a major risk factor for type 2 diabetes.
[SOURCE: Centers for Disease Control and Prevention, cited in The Johns Hopkins White Papers, Diabetes, 2002] Diabetics Benefit from Flu Shot
But Vaccination Rates Are Low
Diabetes increases the risk of getting severe complications from the flu. Getting a flu shot, according to a recent Dutch study, resulted in 56 percent fewer flu-related complications, 54 percent fewer hospitalizations and 50 percent fewer deaths among diabetics, Yet vaccination rates remain low among persons with diabetes.
[SOURCE: “Flu shots and diabetes (in the news),” Health News, February, 2007] Whether you already have diabetes or want to prevent it, it's important to maintain a weight as close to normal as possible. Most doctors, however, warn diabetics against the high-protein, low-carbohydrate diets now in vogue. The jury is still out on the long-term effectiveness and safety of these diets, but there are indications that they could increase the risk of cardiovascular and kidney complications in certain susceptible individuals, including those with diabetes. According to American Diabetes Association guidelines, a diabetic should get no more than 20 percent of calories from protein in order to limit stress on the kidneys.
[SOURCE: "The Dangers of High-Protein, Low-Carbohydrate Diets for People with Diabetes," The Johns Hopkins White Papers, Diabetes, 2002] Diabetic Drivers: Check Blood Sugar
Even a mild episode of hypoglycemia, or low blood sugar, can significantly impair driving ability. A severe hypoglycemic attack can severely alter judgment or cause a driver to lose consciousness.
One recent study found that subjects with a normal awareness of hypoglycemia tended to make safe decisions concerning driving. Nearly 90 percent said they would stop if they experienced symptoms. However, only about 40 percent indicated that they checked blood sugar routinely before driving.
[SOURCE: Alexander D.M. Stork, Timon W. van Haeften and Thiemo F. Veneman, “The decision not to drive during hypoglycemia in patients with type 1 and type 2 diabetes according to hypoglycemia awareness,” Diabetes Care, November, 2007] Diabetics Don't Need Supplements
Diabetes patients generally don't need vitamin or mineral supplements, according to the most recent dietary guidelines of the American Diabetes Association. With the exception of folate for women to prevent birth defects and calcium to head off bone disease in older persons, vitamins and minerals needed by diabetics can best be obtained from food. "There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies," the guidelines state.
[SOURCE: American Diabetes Association, "Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications," Clinical Diabetes, Spring, 2002] Diabetics: Eat More Fish, Nuts
Women with type 2 diabetes who ate fish regularly had a significantly lower risk of heart disease than those who rarely ate fish, according to a study conducted by Frank B. Hu, M.D. of the Harvard School of Public Health. Another study by Dr. Hu found that women eating an ounce of nuts or a tablespoon of peanut butter at least five times a week reduced their risk of diabetes by 30 percent compared with those rarely eating nuts. [SOURCE: "Diabetic Women Gain Significant Health Benefits from Eating Fish," Women's Health Weekly, May 1, 2003; "A Nutty Way To Prevent Diabetes: Eating Nuts and Peanut Butter May Help Protect You Against Type 2 Diabetes," Natural Health, May-June, 2003] Diabetes Epidemic: The Consequences Fueled in part by increased levels of obesity, the prevalence of type 2 diabetes is increasing dramatically. There are now 150 million persons worldwide diagnosed with the disorder, and that number is projected to double over the next 25 years. The consequences: during the period from 1990 to 2000, the rate of heart attack and stroke among non-diabetic patients in New York declined by 14 percent while the rate among type 2 diabetics increased by 54 percent. Recent studies indicate that many cases of diabetes can be prevented through modest reductions in body weight coupled by regular exercise. [SOURCE: Muhammad A. Abdul-Ghani, et al, “What Is the Best Predictor of Future Type 2 Diabetes?” Diabetes Care, June, 2007] Adhesive capsulitis or frozen shoulder, a frequent cause of shoulder pain and stiffness, is more likely to occur and more likely to cause permanent problems in persons with diabetes. About 20 percent of diabetics-compared to only 5 percent of the general public-suffer from frozen shoulder. Doctors aren't sure why diabetics have a greater risk but believe it may be because high blood sugar may lead to abnormal deposits of collagen in cartilage and tendons. Even with therapy, diabetics are more likely than others to suffer permanent loss of mobility-sometimes as much as 50 percent-in the shoulder.
[SOURCE: Terri Kordella, "Frozen Shoulder & Diabetes: Frozen Shoulder Affects 20 Percent of People with Diabetes, Proper Treatment Can Help You Work Through It," Diabetes Forecast, August, 2002] Diabetic Eye Problems Get Early Start
Diabetic eye disease may start earlier than previously believed–even before the onset of type 2 diabetes–according to recent data from the Diabetes Prevention Program study.
Researchers found diabetic retinopathy in eight percent of pre-diabetics, subjects with impaired glucose tolerance but not enough for a diabetes diagnosis. And among subjects who developed diabetes during the course of the study, 12 percent had retinopathy.
These findings reinforced previous views that even newly diagnosed type 2 diabetics should have regular eye examinations.
[SOURCE: Rosemary Janiszewski, “Diabetic Retinopathy Occurs in Pre-Diabetes,” NIH News, June 12, 2005; Emily Chew, M.D., paper presented to American Diabetes Association Annual Scientific Sessions, June, 2005] Diabetic Youth Want To Feel Normal
Several studies have found that children with diabetes are most concerned with being like other children as opposed to being singled out as different. Particularly during the teen years this desire to be normal is likely to lead to poor management of the disease.
Adolescent males may engage in risky behavior such as smoking, drinking and use of recreational drugs. Females are more likely to ignore or neglect their treatment plan.
[SOURCE: Karina Huus and Karin Enskar, “Adolescents’ Experience of Living with Diabetes,” Paediatric Nursing, April, 2007; Janet Silverstein, et al, “Care of Children and Adolescents with Type 1 Diabetes,” Diabetes Care 2005;28(1):186-212] Diabetics Face Greater Heart Risk
Of the one million Americans who are admitted to the hospital because of a minor heart attack or prolonged chest pain, 20 to 30 percent are diabetics-many of whom do not know they have the disease. According to a pooled analysis of four studies involving 24,000 patients, those with diabetes had a mortality rate of 5.5 percent compared to 3.0 percent for those without diabetes.
[SOURCE: Jean McCann, "Cardiologists Hail Stats on Standards, Stents, and Statins," Drug Topics, April 15, 2002] Diabetics: Keep Blood Pressure Low
A diabetic can lower her risk of eye complications and slow the progression of eye disease by keeping her blood pressure as low as possible. Every 10 mmHg decrease in diastolic blood pressure reduces the risk of severe diabetic retinopathy by 24 percent, according to research.
In a United Kingdom study involving 1,248 patients with type 2 diabetes and hypertension, subjects who kept their blood pressure under tight control with medication had 30 percent fewer abnormal blood vessels in the retina compared to those who practiced less tight control.
[SOURCE: “JOURNAL WATCH: BP Control Cuts Diabetic Eye Disease,” Pulse; November 29, 2004; “Reducing the Risk of Diabetic Retinopathy,” The Johns Hopkins White Papers, Diabetes, 2003] Watermelon, papaya, apricots, asparagus, carrots, squash, red bell peppers, spinach and other greens–they’re all foods high in carotenoids and, as such, should help you head off type 2 diabetes. A study published in the American Journal of Epidemiology [May 19, 2006] found that among teens and young adults followed for 15 years, non-smokers with the highest blood levels of carotenoids at the start of the study were the least likely to develop type 2 diabetes.
[SOURCE: Alan Greene, FAAP, M.D., “Organic Watermelon, Papaya, and Diabetes,” WebMD Medical Commentary from DrGreene.com, reviewed on May 31, 2006] ED May Be Marker for Diabetes
Men who develop erectile dysfunction before age 65 are at higher than average risk of diabetes. A study of 1.8 million males published in the Journal of Urology found that such men were 60 percent more likely than other males to have type 2 diabetes. For men developing ED before age 45, the risk was double that of other men. No association was found between diabetes and ED diagnosed after age 65.
Erectile dysfunction is also linked to high blood pressure and an increased risk of heart disease and stroke.
[SOURCE: “Wellness Made Easy,” University of California Berkeley Wellness Letter, August, 2007] Ethnicity and Its Role in Diabetes Risk The Diabetes Prevention Program (DPP), a study of 3,200 significantly overweight subjects with impaired glucose tolerance and a high risk of developing diabetes, found that exercise provided better protection than an oral diabetes medication. Subjects taking part in an exercise program (150 minutes a week) plus weight loss counseling had a 58 percent reduced risk of getting diabetes, compared to a 31 percent reduction for subjects taking metformin along with lifestyle counseling.
[SOURCE: Bruce Agnew, "Improve Your Fitness One Step at a Time: When It Comes To Walking for Health, All the Recent News Is Good News," Diabetes Forecast, September, 2003] Have you begun to notice little specks, lines or blobs floating in front of your vision, especially when you’re looking at a plain surface? Or spots or streaks of light that last only a second or two?
Floaters are shadows caused by little globs in the vitrous gel that fills your eyeball; under normal conditions, they are generally harmless. Flashes are somewhat more serious–an indication that the vitreous fluid may be pulling or rubbing on the retina. If you have diabetes, however, floaters and flashers may be an early sign of a far more serious problem, diabetic retinopathy. Whether you’ve been diagnosed as diabetic or not, floaters and flashes are reason to see an eye doctor.
[SOURCE: Shauna S. Roberts, “When You See Spots or Stars,” Diabetes Forecast, April, 2003] Seven healthy, normal-weight males given high doses of fructose for six days showed increased levels of triglycerides and blood sugar plus impairments in insulin sensitivity, according to a study published in Diabetes [July, 2005]. When the subjects were given fish oil, their triglyceride levels decreased but they showed no change in their sensitivity to insulin.
[SOURCE; David Faeh, et al, “Effect of Fructose Overfeeding and Fish Oil Administration on Hepatic de Novo Lipogenesis and Insulin Sensitivity in Healthy Men,” Diabetes, July, 2005] Diabetes patients are advised to drink in moderation and only with meals or a snack. Particularly for patients using insulin or a medication that increases insulin production, heavy drinking, binge drinking and drinking on an empty stomach can lead to a hypoglycemic attack (low blood sugar) even a day or two later.
[SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases Clearinghouse, “Hypoglycemia,” NIH Publication No. 09-3926, October, 2008] In addition to the 7 percent of Americans diagnosed with diabetes, another 11 percent have a condition known as pre-diabetes, with elevated blood sugar levels but not high enough for a diagnosis. About 7 percent of these persons go on to develop diabetes every year, and these individuals are 50 percent more likely to later have a heart attack or stroke compared to persons with normal blood sugar. With lifestyle changes, however, they can prevent or delay the onset of diabetes and heart disease. An individual with impaired glucose tolerance is typically overweight and at least somewhat insulin-resistant. Treatment involves weight loss, smoking cessation and measures to reduce blood pressure and serum cholesterol.
[SOURCE: The Johns Hopkins White Papers, Diabetes, 2003] High Protein Diets Risky for Diabetics
Diabetic meal plans, like some popular weight loss diets, frequently call for some degree of carbohydrate counting. Controlling spikes in blood sugar requires limited intake of carbohydrates, particularly sugars and starches.
Low carbohydrate programs, such as the Atkins diet, however, often allow high intake of protein–25 to 30 percent of daily calories–which could put a diabetes patient at increased risk of kidney disease.
[SOURCE: Zachary T. Bloomgarden, “Diabetes and Nutrition,” Diabetes Care, October, 2002] Incidence of Diabetes Escalating
Many people with type 2 diabetes don't know they have it. Nevertheless, the number of Americans diagnosed continues to escalate in what some term an epidemic. Incidence of type 2 diabetes has tripled since 1958, and most authorities attribute the increase to changes in lifestyle and more overweight Americans. During the 1990s the percentage of Americans classified as obese rose by 57 percent while the percentage diagnosed with type 2 diabetes increased by 38 percent.
[SOURCE: "On the Rise: Obesity and Type 2 Diabetes," Johns Hopkins White Papers, Diabetes, 2002] Inflammation Precedes Diabetes
Type 1 diabetes is now believed to be a chronic inflammatory disorder involving the immune system. Levels of C-reactive protein (CRP) have previously been found to be elevated in adults with type 2 diabetes and pre-diabetes. And a 2004 study found high levels of CRP in infants and children before they developed type 1 diabetes.
Of 16 children in the study who later developed diabetes, 15 had two or more readings of high CRP. Since these readings were before diagnosis, they could not be explained by high blood sugar.
[SOURCE: H. Peter chase, et al, “Elevated C-Reactive Protein Levels in the Development of Type 1 Diabetes,” Diabetes, 53(10):2569-2573, 2004] Is That Giant Soft Drink A Good Value?
A super-size soft drink might seem like an excellent value compared to an 8- or 10-ounce version of the same drink, but what are the costs in terms of health? The giant soft drink could very well add at least 400 to 500 calories to a child's (or an adult's) daily diet that could result in a 40- or 50-pound weight gain over a year's time. Being obese or overweight accounts for about 300,000 deaths a year in the United States and health care costs of more than $100 billion.
[SOURCE: "Alarming Increase in Children with Type 2 Diabetes Is a Wake-Up Call," Diabetes Week, July 8, 2002; Iris Rosendahl, "Type 2 Diabetes: Why Are Growing Numbers of Young People Developing It?" Medical Laboratory Observer, May, 2001] Like Parent, Like Child
More than half of children diagnosed with type 2 diabetes have a parent or sibling with the same disorder. In many cases, however, the parent's disease is detected as a result of the child's diagnosis. Although it's known that certain individuals and ethnic groups (African Americans, Native Americans, Hispanics, Asian/South Pacific Islanders) have an increased risk, diabetes also runs in families because of shared behavior: unrestrained eating combined with a sedentary lifestyle.
[SOURCE: American Diabetes Association, "Type 2 Diabetes in Children and Adolescents," Diabetes Care, March, 2000] Most Kids Control Blood Sugar Well
When children are prescribed intensive treatment for diabetes, about two thirds are able to achieve good control of blood sugar, according to a recent study. As the authors pointed out, however, “there remains a small core of patients with multiple risk factors who continue to do poorly.”
The study found a correlation between poor blood sugar control and low socioeconomic status–but not race or ethnicity.
[SOURCE: “Most Children with Type 1 Diabetes Can Achieve Good Glycemic Control,” Reuters Health, August 31, 2006; Stuart A. Weinzimer, et al, Journal of Pediatrics, 2006;149:227-232] Neuropathy: Know the Signs
Peripheral neuropathy, a nerve disease that is frequently a complication of diabetes, often develops gradually with symptoms that are barely noticeable. Earliest signs may be numbness or tingling in the toes or balls of the feet. Some describe it as a sensation similar to wearing an invisible sock. More severe symptoms may include: · burning or freezing sensations, · sharp, jabbing or electric pain, · | ArchiveAIDS & HIV |
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