Type 2 Diabetes

South Dakota State University has demonstrated that a culturally based nutrition intervention can promote small, but beneficial, changes in weight among Native Americans.

Researchers at UT Southwestern and 14 other centers worldwide found that injections of the drug used to treat autoimmune disorders slowed beta cell destruction in the pancreas of those newly diagnosed with type 1 diabetes for at least a year.

"The Vine that Ate the South" may one day be known as "The Vine that Fought the Metabolic Syndrome," according to University of Alabama at Birmingham researchers.

A few months ago the FDA issued a formal statement about the issue of sharing insulin pens and cartridges. In short, they gave it a big NO all around.

The last 2 decades have seen enormous strides in the identifi cation and modification of cardiovascular disease (CVD) risk factors. Many large, population-based studies, led by the Framingham Heart Study, have been invaluable in identifying these risk factors.

Former ADA President Gerald Bernstein discusses the history of and recent advances in the delivery of insulin.

I am convinced that we essentially sabotage both our guests and ourselves when we offer only these high calorie and often totally unhealthy options time and time again.

Treatment of type 2 diabetes should achieve and maintain euglycemia, thereby preventing complications from this progressive disease. Current antidiabetic therapies should be a part of a multimodal management program that includes diet, exercise, and blood pressure and lipid control. Oral antidiabetic drugs are still first-line therapy for type 2 diabetes, but intensification of therapy, including starting insulin, should occur every 2 to 3 months as needed to achieve euglycemia. The first insulin added is typically a basal insulin, which is effective in lowering fasting plasma glucose (FPG). A persistently elevated glycated hemoglobin (HgbA1C) level despite near or complete normalization of FPG, however, indicates postprandial hyperglycemia. In these cases, the addition of bolus insulin is required to reduce postprandial glucose (PPG). Several approaches to initiate and titrate insulin can be used based on FPG, PPG, HgbA1C, and patient factors.

Rates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.

The benefits of intensive glycemic control appear to be confined to microvascular disease, with 3 randomized controlled clinical trials failing to demonstrate a macrovascular benefit with intensive glycemic control in patients with type 2 diabetes.

We examined the association between plasma N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) levels and the occurrence of cardiac events, including cardiogenic shock and mortality, among hospitalized diabetic patients with acute myocardial infarction. Nt-pro-BNP level was shown to be a reliable predictor of outcome in this group of patients.

The vital cell stress protein, heat shock protein (Hsp)60, has recently been found in the circulation of healthy subjects over an extremely large concentration range. We performed an analysis of subjects with diabetes to determine whether Hsp60 is associated with biochemical markers of cardiovascular disease. Results showed that high circulating levels of Hsp60 are associated with clinically manifest cardiovascular disease. Hsp60 has cytokine-like actions, which may be responsible for this association.

Circulating biomarkers have been used in cardiovascular medicine as predictors of incident or prevalent disease.

This study evaluated whether exogenous insulin use to control blood glucose in patients with type 2 diabetes was associated with the development of hypertension by analyzing data obtained from a large national sample in Taiwan. Exogenous insulin use was shown to be a significant risk factor for hypertension development.

Insulin resistance has been linked to an increased risk of hypertension, type 2 diabetes mellitus, and cardiovascular disease.

Diabetic cardiomyopathy is a clinical condition characterized by altered myocardial function in the absence of coronary artery disease, hypertension, and valvular or congenital heart disease. Patients with this condition exhibit changes in cardiac structure that may be attributed to the direct effect of diabetes mellitus. The author discusses the mechanisms, risk factors, screening, diagnosis, prevention, and treatment of cardiomyopathy in patients with diabetes.

New findings published in the September issue of The Lancet show that a new formulation of the drug exenatide given once a week is more effective than when given twice a day, as is the current practice.

Stroke is an especially important disease to study in terms of secular trends because it is so common, deadly, and disabling.

Statins are the most commonly used pharmacologic intervention in patients with increased cardiovascular risk. In addition to their beneficial effect on the atherogenic lipid profile, they have been shown to exert several pleiotrophic effects, including the reduction of low-grade inflammation. Thiazolidinediones (TZDs) are a new class of antidiabetic drugs that have been shown to improve insulin sensitivity and to reduce cardiovascular risk in patients with type 2 diabetes. Our study is the first to show a complementary effect of TZD and statin treatment on several cardiovascular risk factors in subjects without diabetes. These findings may have important implications for further discussion on cardiovascular risk reduction, especially for patients with metabolic syndrome.

We evaluated the effectiveness of the current American Diabetes Association guidelines for the detection of coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes and assessed whether a more aggressive diagnostic strategy would permit detection of silent CAD at an earlier stage. The prevalence of myocardial perfusion defects and CAD in asymptomatic diabetic patients was high independent of risk factor profile, and an aggressive diagnostic approach in patients who would normally be excluded from screening permitted identification of CAD at an earlier stage, when coronary anatomy is more likely to respond to treatment.