/publications/issue/2006/2006-09/2006-09-5817

DIABETES WATCH

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Research Indicates Need for Fracture Prevention

Women with diabetes need better prevention efforts against hip fracture, according to the results of a study reported in Diabetes Care (July 2006). The findings are based on data from 109,983 women enrolled in the Nurses' Health Study. During the 22-year study, the women with type 1 or type 2 diabetes were interviewed about their history and treatment of diabetes and other possible risk factors for hip fracture.

During the period of the study, 1398 women fractured a hip. After accounting for age, the risk of fracture was 7 times higher in women with type 1 diabetes and nearly twice as high in women with type 2 diabetes, compared with women without the disease. The researchers further adjusted the data for weight, smoking, physical activity, menopausal status, postmenopausal hormone use, and daily intake of calcium, vitamin D, and protein. The results indicated that the probability of hip fracture was >6 times higher in women with type 1 diabetes and >2 times higher in women with type 2 diabetes.

The investigators pointed out that the mechanisms involved in these negative effects on fracture risk in diabetes are murky. The chance of hip fracture rose with longer duration of type 2 diabetes; having type 2 diabetes for =12 years was linked with a 3 times higher risk, compared with no diabetes. The possibility of hip fracture also increased with insulin treatment. This association may indicate a more severe disease process, the researchers noted, rather than being a direct contributor to hip fracture. They suggested further study to examine the role of insulin in fracture risk.

Study Shows Diabetes and MS Connection

Researchers have found a strong link between diabetes and multiple sclerosis (MS). A study of 6078 patients with type 1 diabetes indicated a 3-fold increased risk of developing MS, compared with patients without the disorder. The researchers also investigated the presence of type 1 diabetes in 14,771 first-degree relatives of 11,862 patients with MS.

The results of the study showed that 11 cases of MS developed in the patients with diabetes, whereas only 3.38 cases would be expected, based on the rates of the general population. As for first-degree relatives of patients with MS, they had a 63% risk of developing type 1 diabetes. After accounting for the possibility of also being related to a patient with type 1 diabetes, the excess risk dropped to 44%, however. (The findings were reported in the Archives of Neurology, July 2006.)

Diabetes Raises Glaucoma Risk

An analysis of >76,000 participants in the Nurses' Health Study found an increased risk of developing glaucoma in women with type 2 diabetes. The study included women at least 40 years of age and with no diagnosis of glaucoma when the study commenced in 1980. Over the 20-year study period, 429 women were diagnosed with glaucoma.

In the study, the researchers considered weight, physical activity, age, and other possible risk factors. Reporting in Ophthalmology (July 2006), the researchers discovered that type 2 diabetes was linked with an 82% greater risk of developing the eye condition.The likelihood was even higher in women who had had diabetes for 5 years or less, compared with patients with long-standing disease.

"While obesity fuels the type 2 diabetes epidemic, it appears that factors unrelated to obesity contribute to the positive association between type 2 diabetes and glaucoma," commented lead author Louis R. Pasquale,MD. "We were surprised to find this."

Leg Length May Correlate with Diabetes

A petite frame and particularly short legs seem to raise the risk of being overweight and developing type 2 diabetes in middle age. A study of 7424 men and women aged 40 to 74 years looked at the relationship between stature-related measurements, total body fat, and 2 prediabetic conditions?insulin resistance and glucose intolerance.

Reporting in Diabetes Care (July 2006), the researchers found that the percentage of body fat was significantly higher in women with shorter height, shorter leg length, and lower leg length-to-height ratio. A similar trend was identified in men, although none of the associations reached statistical significance. In patients without diabetes, lower leg length-to-height ratio also was linked with greater levels of insulin resistance. Furthermore, all 3 of the aforementioned body features were connected with a higher frequency of diabetes.

The researchers concluded, "Insofar as adult stature is an indicator of development and growth during early life," the danger of obesity and diabetes in adulthood "might begin to accrue before puberty." Thus, interventions to enhance childhood nutrition "could present novel means to combat the epidemic of obesity and type 2 diabetes."


ARTHRITIS WATCH 70

New Research Begun in Gene Therapies for OA

By the end of 2006, scientists will start testing the first gene therapies for osteoarthritis (OA) in search of more effective treatments and possibly a cure for the disease. One effort involves injecting a gene into a diseased joint that will continuously pump medicine right where it is needed. Another will use genetically modified cells to prompt the growth of damaged cartilage. Some of these trials will piggyback on gene therapy experiments in rheumatoid arthritis that are showing hints of effectiveness.

In OA, one "goal is to convert the joint into a factory that makes its own medicine," said Christopher Evans, PhD, a professor of orthopedic surgery at Harvard University who is leading some of the new research. The therapy will be tried initially in 9 volunteers who have OA that is severe enough to negatively affect their quality of life.

New treatments for osteoarthritis are desperately needed. None of the current options?such as steroids, lubricants, pain pills, and dietary supplements?alter the course of the disease, and some do little to ease the pain and disability. About 500,000 Americans every year face joint replacement surgery, as the cartilage in their joints erodes from injury and other causes, the Arthritis Foundation said.

Childhood Injury Can Lead to Early Arthritis Development

The results of a study at the University of Michigan showed that almost 70% of children and adolescents who suffer an injury to the anterior cruciate ligament (ACL) in the knee have a greater chance of developing osteoarthritis (OA) earlier than their peers. Researchers said that early intervention may help prevent OA from progressing.

Each year, 1 of every 3000 people experiences an ACL injury. Most of these injuries occur among children and teens, but the group most at risk is young female athletes. When injured, the ACL can completely tear, causing a rupture, or only partially tear, resulting in a sprain. An ACL will not heal by itself, however; it must be surgically reconstructed. After the surgery, the patient must undergo complex rehabilitation, which can take up to a year for complete healing.

The investigators currently are working to identify the earliest signs of degenerative arthritis in the knees of younger patients, to allow for earlier medical intervention in the hopes of staving off the disease. "There's no doubt that the number of ACL injuries [has] increased, especially among children," the researchers said. "What's concerning is that, by the time those kids are in their late teens or early 20s, they'll be living with [OA] as a result of that ACL injury."

New Resource Helps PA Patients Cope

The National Psoriasis Foundation is introducing the Psoriatic Arthritis Total Approach to Health (PATH), a program that provides resources and information for managing the physical and emotional aspects of living with psoriatic arthritis (PA). A survey conducted by the foundation showed that patients with PA experience psychological effects due to the impact of the disease on their appearance and the social stigma associated with PA.

The foundation developed the PATH program in conjunction with Abbott Laboratories. The cornerstone of the program is an on-line resource at the foundation's Web site, www.psoriasis.org/PATH. It provides tips from experts on reducing stress, exercising, eating right, and incorporating other healthy lifestyle tactics to help alleviate the impact of PA.

"I have witnessed firsthand the effects of [PA] and how patients need more than medicine alone to help manage this chronic inflammatory condition," said Lester Miller, MD, rheumatologist and adjunct associate clinical professor of medicine, Division of Immunology and Rheumatology, Stanford University of Medicine.

Gout Can Increase Heart Attack Risk

Researchers at the University of Pittsburgh School of Medicine found that patients with gouty arthritis have an increased risk of having a heart attack. The investigators examined data from 12,866 men who were enrolled for a mean of 6.5 years in the Multiple Risk Factor Intervention Trial (MRFIT). MRFIT is a randomized primary cardiovascular disease prevention trial conducted and supported by the National Heart, Lung, and Blood Institute. During the course of the study, 1108 heart attacks occurred in the group with gout (10.5%), and 990 occurred in the group without gout (8.4%).

The group with gout was significantly more likely to have used diuretics and alcohol. Small yet statistically significant elevations of blood pressure, blood glucose levels, and body mass index were observed in the gout group. Participants in the group with gout were less likely to be current smokers. The study also found a relationship between gout and the risk of heart attack to be present among nonusers of alcohol, diuretics, or aspirin, as well as among those who did not have metabolic syndrome, diabetes mellitus, or obesity.