DECEMBER 01, 2007

Diabetics Face Silent Heart Disease

The records of 1046 patients with diabetes and the absence of heart disease found that 16.7% had reduced left ventricular ejection fraction (LVEF), which translates to the heart pumping abnormally low amounts of blood with each beat.

Reporting recently in the American Heart Journal, lead investigator Panithaya Chareonthaitawee, MD, said that the presence of reduced LVEF corresponded with a reduced survival rate of 10 years—29% versus 57% in patients with a normal LVEF. Because heart failure can be treated and results improved, he noted that a potential role exists for screening patients who are in the asymptomatic stages of reduced LVEF.

He cautioned that findings are only preliminary and larger studies are needed to confirm the results.

Charcot Foot Growing Among Diabetes Patients

Physicians with the American College of Foot and Ankle Surgeons (ACFAS) want patients with diabetes and their care providers to know about a growing complication of the disease— Charcot foot.

Charcot foot is a sudden softening of the foot's bones caused by severe neuropathy. The condition can cause joint loss, fractures, collapse of the arch, ulcers, amputation, and even death. Because most patients with Charcot cannot feel pain in their lower extremities, they continue walking on the foot, causing more injury.

Although it is a rare complication, the prevalence of the condition appears to be growing as more Americans are diagnosed with diabetes. The ACFAS stresses the importance of educating patients, physicians, and caregivers. For more information, visit the ACFAS Web site at www.FootPhysicians.com.

Insulin Puzzle May Be Solved

Researchers have isolated the PKCepsilon (PKCe) enzyme that is present during diabetes and blocks the availability of insulin, according to a study reported in the October 2007 issue of Cell Metabolism. The findings may explain why insulin production fails in individuals with type 2 diabetes.

Lead investigators said that the findings could significantly add to the development of a medication that would inhibit PKCe and allow the pancreas to produce enough insulin for patients with type 2 diabetes. The researchers noted, however, that the effect of PKCe to restore the pancreatic ability to produce insulin was a surprise. Whereas existing therapies stimulate the body to make more insulin, no existing drug acts as a PKCe inhibitor to restore an individual's normal function. The researchers believe that more research could protect individuals who are at high risk for developing the disease.

Use A1C Levels to Screen for Diabetes

Researchers at Charles R. Drew University (Los Angeles, Calif) found that measuring a patient's glycosylated hemoglobin levels (A1C) could be used to test for diabetes, according to a study reported in Diabetes Care (September 2007).

To determine what A1C levels should lead to more testing for diabetes, the researchers examined data from 4935 participants in the 1999-2004 National Health and Nutrition Examination Survey. The findings indicated that 3280 patients were at normal levels, 1485 patients had prediabetes levels (100 mg/dL to 125 mg/dL), and 170 patients had previously undiagnosed diabetes (126 mg/dL or higher), based on fasting plasma glucose levels.

"This should increase the early diagnosis of diabetes so that appropriate treatment can be instituted to prevent the complications of the disease," said researcher Mayer B. Davidson, MD.

Diabetes Self-care Ignored with Depression

Poor adherence to self-care in patients with type 2 diabetes is associated with depression. For the study, the researchers compared the effects of depression on 879 patients with diabetes from 2 primary care clinics.

The participants were surveyed using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence. Overall, the findings showed that 19.3% of the patients met the HANDS criteria for possible major depression, and 66.5% had some depression symptoms without meeting the criteria for probable major depression.

Of the participants with probable major depression, 59.4% had depression documented in their medical records, and 48.8% had been prescribed an antidepressant drug. The researchers found a significant association between major depression and poor adherence to diet and exercise. These patients faced a 2.3-fold increased risk of missing medication doses in the previous week. (The findings were reported in Diabetes Care, September 2007.)

F A S T   F A C T : The number of individuals with undiagnosed diabetes totals 6.2 million.

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