/publications/issue/2007/2007-03/2007-03-6328

DIABETES WATCH

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Too Much Iron Increases Heart Risks

Patients with diabetes may want to limit the amount of red meat and other foods high in heme iron. Researchers found that the consumption of these foods appears to increase the risk of heart disease.

The investigators noted that diabetes-related metabolic malformation may exacerbate the adverse side effects of excess iron on the heart. They added, however, that little is known about whether iron consumption also affects heart disease risk. For the study, reported in Diabetes Care (January 2007), 6161 women participating in the Nurses' Health Study who reported a diagnosis of type 2 diabetes were followed. During the follow-up from 1980 to 2000, 550 new cases of heart disease were documented.

The study's findings indicated that a high intake of both heme iron and red meat seems to raise the risk of heart disease, even after factoring in age and body weight. In particular, women who consumed large quantities of heme iron were 50% more likely to develop heart disease, compared with the lowest intake group. The risks were most significant in women who were postmenopausal.

Health Costs Drop for Diabetes/Depression Group

A different model for treating depression in patients with diabetes can save health care costs, according to a study reported in the January 2007 edition of the Archives of General Psychiatry. The researchers assessed the incremental cost and incremental cost-effectiveness of a systematic depression program, compared with standard care, for 329 patients with diabetes and depression. The researchers found that systematic depression treatment considerably lowered the patients' average depression scores after 6 and 12 months.

The findings indicated that, even though outpatient depression treatment costs were about $700 higher in the intervention group during the initial year, a majority of the difference was offset by lower general medical outpatient costs in this group. The second year proved more cost-effective. The approximate $100 in higher outpatient depression treatment costs in the intervention group was more than compensated by lower outpatient costs of $1400. Systematic depression treatment correlated with an increase of 61 depression-free days and an estimated savings of $300.

Alzheimer's Link Absent in Diabetic Seniors

Although seniors with diabetes do not face an increased risk of developing Alzheimer's disease, the disease is associated with cerebral infarction—brain damage that can impair mental capacity. The researchers based their findings on autopsy results from 233 older participants in the Religious Orders Study.

The findings, reported in Neurology (December 2006), showed that a little over a third of participants had one or more cerebral infarctions. The patients with diabetes were about 2.5 times more likely to have brain damage, compared with patients without diabetes. On the contrary, the levels of Alzheimer-type damage were parallel in both patient groups.

Spine Diminishes Early in Diabetic Neuropathy

Researchers found that spinal cord size in adult patients with diabetes shrinks considerably long before they become symptomatic for nerve damage. The study included 84 men with type 1 diabetes, 24 patients without the disease, and 8 participants with inherited neuropathy.

Of the participants, 19 patients with diabetes had no diabetic neuropathy, 23 had silent or subclinical neuropathy, and 39 had clinically detectable neuropathy. Magnetic resonance imaging of the spine indicated that the spinal cord area was 67.5 mm in patients with diabetes and no neuropathy, 62.4 mm in patients with diabetes and subclinical neuropathy, and 57.2 mm in patients with diabetes and evident neuropathy. There was no major difference in the spinal cord area of patients with diabetes without neuropathy and the control group. (The findings were reported in Diabetes Care, December 2006.)

Forum Addresses Need for Worldwide Diabetes Change

Former President Bill Clinton served as keynote speaker at the recent Global Changing Diabetes Leadership Forum in New York City. The event, hosted by Novo Nordisk and supported by the International Diabetes Federation, brought together people from government, international organizations, and patient organizations and health care professionals from >18 countries.

The discussion provided a proactive dialogue on redefining health care with an emphasis on the needs of patients with diabetes. The forum also explored the concepts described in Redefining Health Care: Creating Value-Based Competition on Results by Professors Michael E. Porter and Elizabeth Teisberg. Professor Teisberg, who attended the meeting, shared her views on the importance of focusing on the needs of patients over the full cycle of care—from prevention and diagnosis through recovery to long-term disease management.