/publications/issue/2006/2006-12/2006-12-6131

DIABETES WATCH

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Blood Sugar Levels Impact Risk of Blood Clots Low blood sugar levels are important for patients with diabetes prior to having hip-or knee-replacement surgery. Elevated blood sugar levels put patients at risk of developing life-threatening blood clots. A study analyzed the records of 6500 patients who underwent hip-or knee-replacement surgery at Thomas Jefferson University Hospital between 2003 and 2005.

The researchers uncovered 38 patients who had blood-glucose levels above 250 mg/dL during preoperative testing and on the day of the surgery. Of the patients, all but one patient were diabetic, which was defined as a fasting blood glucose level >126 mg/dL.

Lead investigator Boris Mraovic, MD, said, "We found that 10.5% of those with high blood sugar developed a pulmonary embolism, compared [with] only 1.7% of the other patients. This rate is more than 6 times higher than we would expect to see in the general population." He said additional studies are needed to confirm his results. (The findings were recently reported at the annual meeting of the American Society of Anesthesiologists.)

Buyer Beware: Web Site Touts Fake Diabetes "Cures"

The FDA and US Federal Trade Commission (FTC) are warning patients about US and foreign-owned Web sites that tout dietary supplements as a cure, treatment, or prevention of diabetes. Upon finding the sites through an "Internet sweep" for counterfeit sites and products, the agencies sent warning letters to the companies and notified government agencies in Canada and Mexico.

The FDA, which warned 24 individuals and private companies, generally resolves such matters without further action. The agency can, however, impose fines and other penalties as well as confiscate products. The FTC confirmed that about 25% of the firms that were warned about misleading ads?84 US Web sites and 7 Canadian sites targeting Americans?have changed their claims or taken down their sites. Another 21 sites were referred to other foreign governments.

Nonadherence Is a Risky Behavior

A new study found that 21% of patients with diabetes do not adhere to their medications for blood-sugar lowering, blood-pressure lowering, or cholesterol lowering. P. Michael Ho, MD, and colleagues reported that patients who did not comply with their medications had a 58% higher risk of hospitalization and an 81% greater risk of dying, compared with patients who took their medications.

"Incremental increases in medication adherence were associated with improved outcomes," reported the researchers in the Archives of Internal Medicine (September 2006).

Is Aggressive Treatment Too Stressful?

In the first years, a little anxiety is par for the course following a diagnosis of type 2 diabetes. A study, reported in Diabetes Care (October 2006), found that early and rigorous treatment appears to lead to greater anxiety and less ability to cope, however. The study examined 196 patients diagnosed 3 to 33 months previously who were undergoing usual care or intensive treatment. The researchers learned that a majority of patients reported minor distress and reduced levels of perceived seriousness and vulnerability and felt secure coping with the disease. They had a different response from patients diagnosed between 2 and 3 years previously. This group considered their diabetes more threatening. The group who had intensive treatment reported more distress and less self-confidence in the first year.

CVD Is Dangerous for Older Patients with Diabetes

A study of 6000 individuals aged over 65 years found that patients with diabetes are 2 times more prone to die from cardiovascular disease (CVD) when compared with patients without diabetes. The risk was even greater for patients taking insulin. During the 11-year study, >40% of the patients died, and about 50% to 60% of the fatalities were attributed to heart-related issues.

The researchers also found that patients taking insulin were 6 times more likely to die from infectious diseases or kidney failure, compared with patients without diabetes. Furthermore, women treated with insulin had a remarkably high mortality risk. Earlier studies have shown that diabetes ups the risk of death from CVD in young and middle-aged individuals. It was not clear, however, how it affected seniors. "The results of this study suggest that rectifying this situation could prolong the lives of many elderly people with diabetes," reported the investigators recently in the on-line journal Public Library of Science.