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Early Intensive Therapy May Benefit Type 2 Diabetes
A study published in the July 2011 issue of the Lancet examined the effect of early intensive therapy on diabetes outcomes.
Called the ADDITION-Europe study, the double-blind intentto-treat analysis randomly assigned 3055 patients from Denmark between the ages of 40 and 69 years without known diabetes to routine care (the control group) or screening followed by intensive treatment of multiple risk factors (the treatment group). A1C, blood pressure, and total cholesterol were targeted for intensive treatment; low-dose aspirin was also administered to everyone in the treatment group. The primary end point was incidence of first cardiovascular event within 5 years of follow-up.
The results showed that after a mean follow-up of 5 years, the incidence of first cardiovascular event did not differ significantly between the groups (7.2% in the intensive therapy group and 8.5% in the control group [hazard ratio 0.83, 95%, confidence interval (CI) 0.65-1.05]). Differences in secondary end points—the change in risk factors such as elevated A1C, blood pressure, and cholesterol—were statistically significant, though probably not clinically significant.
The authors note some limitations in the study. Although the trial was designed appropriately, the results may still be due to chance, because the incidence of cardiovascular events in the control group was lower than expected. This discrepancy might have been overcome if follow-up had been extended past 5 years. Nevertheless, despite only the small improvement in modifiable risk factors in the intensive treatment group, the authors state, “The trial shows that screening for type 2 diabetes and early intensive multifactorial treatment of the detected patients are feasible in general practice.”
Red Meat Found to Increase Risk of Type 2 Diabetes
The results of a large meta-analysis published in the October 2011 issue of the American Journal of Clinical Nutrition demonstrate that consumption of processed red meat is associated with an increased risk of type 2 diabetes.
The study, conducted by researchers from the Harvard School of Public Health, followed a large cohort of men and women for a long period of time: 37,083 men in the Health Professionals Follow-Up Study from 1986 to 2006, 79,570 women in the Nurses’ Health Study I from 1980 to 2008, and 87,504 women in the Nurses’ Health Study II from 1991 to 2005. Diet was assessed using questionnaires.
The researchers found that after adjustment for age, body mass index, and other lifestyle and dietary risk factors, there was a significantly increased consumption of unprocessed and processed red meat (P <0.001) in the 13,759 cases of type 2 diabetes documented during the study period. The hazard ratios for a 1 serving per day increase of unprocessed and processed red meat consumption were 1.12 (95% CI 1.08-1.16) and 1.32 (1.25-1.40), respectively. The researchers went a step further and found that replacing red meat with 1 serving of nuts, low-fat dairy, or whole grains per day would significantly decrease the risk of developing type 2 diabetes.
Many mechanisms are thought to be responsible for the increased risk of type 2 diabetes from red meat consumption. The heme iron contained in red meat can cause oxidative stress and damage to pancreatic beta-cells. Processed meat may be even more damaging due to the increased concentrations of sodium, nitrites, and nitrates, which are also toxic to pancreatic beta-cells. PT
Gaps in Care in Children with Diabetes
A study published in the journal Pediatrics in September 2011 suggests that a significant percentage of children with types 1 and 2 diabetes do not receive routine tests recommended for managing their disease.
The study surveyed 1514 participants with either type 1 or 2 diabetes and examined the likelihood that they received care as recommended by the American Diabetes Association (ADA) guidelines, including eye examinations, A1C measurements, lipid panels, blood pressure readings, and tests for microalbuminuria. The results showed that although 95% of the participants had their blood pressure checked, only 68% underwent A1C testing and 66% had eye examinations. The researchers also noted age and family income were 2 important correlates of overall quality of care. Those 18 years and older were less likely than younger participants to receive the recommended tests, and children whose families earned less than $25,000 a year were 35% less likely to receive the recommended tests than those whose families earned $75,000 or more a year.
The ADA recommends that children and young adults with diabetes have A1C tests at least twice a year, or at least 3 times a year if taking insulin. It also recommends eye examinations once a year in everyone with type 2 diabetes and once a year in patients at least 10 years old who have had type 1 diabetes for at least 5 years. Although a large percentage of children and young adults are receiving blood pressure and lipid tests, the authors write, “Efforts are needed to improve the rate of A1C testing and eye examinations.”