Diabetes Watch

OCTOBER 01, 2008

Pharmacists: Diabetes Info at Your Fingertips

Novo Nordisk's Web resource NovoMedLink.com provides relevant tools and resources tailored to a clinician's specific needs. Membership is free.

The pharmacist's home page includes links to product overviews, education material, device demonstrations, and more. The product information and formulary tool allows pharmacists to look up pharmacology and safety profiles, prescribing information, and formulary status of Novo Nordisk products. The eLearning component has video programs that offer useful information on a variety of topics. The patient education materials offer patients helpful information on living with diabetes with Novo Nordisk's Changing Life with Diabetes booklets, available in English and Spanish.

Pharmacists also can register for monthly eNewsletters with in-depth information on the latest clinical innovations in diabetes care. Slide kits and journal article reprints also can be downloaded about the company's products and the conditions they treat. To join, visit www.novomedlink.com.

Communication May Help Diabetic Teens Manage Disease

Talk therapy may benefit teenagers with type 1 diabetes struggling to manage their condition, suggested a study published in Diabetes Care (August 2008). The study involved 91 teenagers with the disease who were patients at 1 of 4 pediatric diabetes clinics.

The centers were randomly assigned to either assess the teenagers' health-related quality of life, or stay with standard of care only. All of the participants had 3 routine pediatrician visits at 3-month intervals. The intervention group completed a computer-based survey on health-related quality of life prior to each appointment, and the physicians discussed the results during the visit.

The findings showed that the teenagers who had their health-related quality of life assessed by their physician showed improvements in their psychological well-being over 1 year. The researchers found that the participants had fewer behavior problems, improved self-esteem and mental health, and more quality of time with their families.

Dementia Linked with Diabetes Duration, Acuteness

Mayo Clinic researchers found developing diabetes before age 65 and greater severity of the disease may be crucial in the development of mild cognitive impairment among the elderly. Of the 1969 participants between 70 and 80 years old and free of dementia in 2004, 356 had diabetes.

The study results, reported in the August 11, 2008, issue of Archives of Neurology, showed that rates of diabetes were comparable in the 329 patients (20.1%) with mild cognitive impairment and the 1640 patients (17.7%) without dementia. Yet, mild cognitive impairment was associated with developing diabetes before age 65, having diabetes for 10 years or longer, being treated with insulin, and having diabetes complications.

Diabetes Goes Undiagnosed in Obese Patients

Obese patients with diabetes are just as likely to go undiagnosed as their thinner peers with the disease, according to a study reported in Diabetes Care (September 2008). Whereas consensus is lacking on who should be screened for the disease, the researchers reported that early diagnosis is important for obese patients because research indicates they are less prone to be offered preventive care that can help ward off serious disease complications.

To determine the impact of a patient's body mass index (BMI) on the chances of having undiagnosed diabetes, the researchers looked at 5514 participants in the 1999-2004 National Health and Nutrition Examination Survey. Of the participants, 10% had diabetes and 28% had not been diagnosed with the disease. The researchers determined that an individual's BMI made no difference from a statistical standpoint on whether or not they went undiagnosed; 22% of normalweight individuals were undiagnosed, 32% of overweight individuals were undiagnosed, and about 33% of obese individuals were undiagnosed.

The researchers added that more research is warranted to understand whether including overweight and obesity in diabetes screening programs may be beneficial for public health.

F A S T   F A C T: Diabetes is the leading cause of kidney failure.

Continuous Monitoring Best for Blood Sugar Control

Published in the New England Journal of Medicine (October 2008), new research indicates that using continuous glucose monitoring devices to help manage diabetes results in better blood sugar control in adults with insulin-dependent diabetes (type 1). The studied included 322 patients aged 8 to 72, at 10 sites.

Some patients were assigned to a small continuous glucose monitoring device and the control group was assigned standard blood sugar monitoring.

The participants were followed for 26 weeks and their hemoglobin A1C levels were monitored. The results found that improvements in blood sugar control were best in the continuous blood glucose monitoring patients group aged 25 and older. Their A1C levels decreased during the study period by an average of 0.53%, compared with the control group.

The patients in other age groups, however, fared no better than patients using the standard method.

Arsenic in Drinking Water Boosts Diabetes Odds

Increased levels of arsenic in urine may be associated with a greater risk of developing type 2 diabetes, reported researchers in the August 20, 2008, issue of the Journal of the American Medical Association. The findings are the first to link lowlevel exposure to arsenic with type 2 diabetes incidence in the United States.

The findings are based on an analysis of 788 US adults aged 20 or older. The data showed that patients with type 2 diabetes had a 26% higher level of total arsenic in the urine, compared with patients without the disease. The patients with the highest levels of arsenic were nearly 3.6 times more prone to have diabetes, compared with participants with the lowest levels.

The patients with the highest levels of dimethylarsinate (a compound into which inorganic arsenic is metabolized) had 1.5 times the risk of diabetes as those with the lowest levels. The risk was determined after adjusting for organic arsenic compounds primarily from seafood, such as arsenobetaine and arsenosugars.

Common Genes May Link Fetal Growth, Diabetes

A study of Swedish twins found that a common genetic cause underlies both the propensity to develop type 2 diabetes and low birth weight. The study, published in Epidemiology (September 2008), included 18,230 fraternal and identical twins (592 with type 2 diabetes) born between 1926 and 1958.

For the study, the researchers first looked at all twins as independent individuals. As with previous research, the current study found that low birth weight was more prevalent among adults with type 2 diabetes. The researchers took the study a step further and analyzed the twins as pairs when one had diabetes and the other did not. The results showed a continued link between low birth weight and diabetes among fraternal twins. This link, however, was not seen between identical twins who share the same genes.

Researcher Stefan Johansson, MD, explained, "Within a fraternal twin pair, the lighter twin would face an increased risk of diabetes? But with an identical twin pair, the lighter and heavier twin have the same risk of developing diabetes later in life."

Study LDL, Cancer Risk for Diabetes Patients

A study of 6107 patients with type 2 diabetes showed that low or high levels of low-density lipoprotein (LDL) cholesterol are linked with an increased rate of cancer in this patient population. None of the participants were taking cholesterollowering statins.

The researchers found that LDL levels below 2.80 mmol/L were associated with greater risk of cancer of the digestive organs and peritoneum, genital and urinary organs, and lymphatic and blood tissues. LDL levels above 3.80 mmol/L were connected with an increased risk of oral, digestive, bone, skin, and breast cancer. The findings, published in the August 26, 2008, issue of the Canadian Medical Association Journal suggest "the use of these levels as risk markers may help clinicians to assess their patients more fully," said the researchers.

F A S T   F A C T: The rate of amputation for people with diabetes is 10 times higher than for people without diabetes.