Pharmacy Times

DIABETES WATCH

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New Threat Surfaces for Diabetes

As the US diabetes epidemic continues to soar out of control, physicians are finding patients who experience both types of diabetes—a trend known as "double diabetes" or "hybrid diabetes." Recent studies suggest that as many as 30% of newly diagnosed diabetes cases among children involve kids with both type 1 and type 2 diabetes.

"It's mostly people who have a type 1 diabetes who become overweight and show the profile of type 2, with obesity and hypertension," explained Stewart Weiss, MD, assistant clinical professor of medicine at New York University School of Medicine.

Dr. Weiss believes that double diabetes may manifest in patients with type 1 diabetes who are taking insulin but have yet to make other necessary lifestyle changes to handle the disease. "One of the consequences of proper insulin use is weight gain," he said. "Often, patients who have not had a good understanding of how to eat are taking insulin to cover what they normally eat."

Panic Attacks Intensify Diabetes Markers

A study of about 4400 patients with diabetes found that some of them experienced frequent panic attacks. The episodes can lead to poorer control of the disease, more severe heart problems, and a reduced quality of life. In previous research, the investigators had concluded that depression was linked with these same problems.

The researchers' analysis indicated that 193 patients (4.4%) reported panic attacks that impacted their behavior. Of those 193 patients, 54.5% also had depression symptoms. The patients who experienced panic attacks had an average glycosylated hemoglobin of 8.1%, compared with 7.7% for patients without panic episodes. The patients with panic attacks also experienced an average of 4.2 diabetes symptoms, compared with 2.4 symptoms for patients with no panic attacks. (The findings were reported in General Hospital Psychiatry, November 2006.)

Noninvasive Test Detects Vascular Damage

Patients with type 2 diabetes can now have vascular damage detected using the noninvasive skin autofluorescence technique. The technique can measure tissue for the accumulation of advanced glycation end products (AGEs), which amass as a result of elevated blood sugar levels. AGEs have a harmful effect on the walls of small and large blood vessels, leading to diabetes-related micro-and macrovascular disease.

The researchers investigated the connection between skin autofluorescence and micro-and macrovascular problems in 973 patients with type 2 diabetes by illuminating the skin of the patients' forearms with an 8-watt blacklight and measuring the levels of light given off. The findings showed that average skin autofluorescence was 33% higher among the diabetic patients, compared with the control group, the researchers reported in Diabetes Care (December 2006). The findings also indicated that patients with both micro-and macrovascular complications had higher average skin autofluorescence, compared with patients without problems and patients with only microvascular complications.

Obese Diabetics May Fib About Calories

Obese adults with diabetes may not be honest about the quantity of food they consume—a complication that can impede management of the disease, according to a study reported in the December 2006 issue of Diabetes Care. The study involved 21 obese men and women with type 2 diabetes.

The researchers found that the patients reported eating fewer daily calories than objective tests suggested they did. The researchers caught the error by using the doubly labeled water method, a sensitive measure of metabolic rate. All of the participants had a stable weight, which would be sustained when the amount eaten equals the calories burned daily.

The study's findings showed that, on average, the patients reported a caloric intake that was nearly 25% lower than they would need "even for basic functions to live." The obese study participants without the disease, however, reported more accurate eating habits. The researchers tested the reliability of the patients' reports on their diet by having them remember what they had eaten over the previous 3 days; they then calculated each individual's estimated daily caloric intake and compared that with the metabolic rate. The researchers recommended that physicians and dietitians be made aware of this tendency.

Insulin Drug Lowers Body Weight

Data presented to the International Diabetes Federation (December 5, 2006) showed that Novo Nordisk's Levemir (insulin detemir [rDNA origin] injection) reduced body weight and improved blood glucose levels in patients with type 2 diabetes. The findings were based on a subanalysis of 2377 patients from a larger multinational study. The researchers found that patients taking Levemir lost 0.7 kg after 14 weeks, compared with baseline.