DIABETES WATCH

Pharmacy Times, Volume 0, 0

New Threat Surfaces for Diabetes

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

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

Dr. Weiss believes that double diabetes may manifest in patients withtype 1 diabetes who are taking insulin but have yet to make other necessarylifestyle changes to handle the disease. "One of the consequences ofproper insulin use is weight gain," he said. "Often, patients who have nothad a good understanding of how to eat are taking insulin to cover whatthey normally eat."

Panic Attacks Intensify Diabetes Markers

A study of about 4400 patients withdiabetes found that some of themexperienced frequent panic attacks.The episodes can lead to poorer controlof the disease, more severe heartproblems, and a reduced quality of life.In previous research, the investigatorshad concluded that depression waslinked with these same problems.

The researchers' analysis indicatedthat 193 patients (4.4%) reported panicattacks that impacted their behavior.Of those 193 patients, 54.5% also haddepression symptoms. The patientswho experienced panic attacks had anaverage glycosylated hemoglobin of8.1%, compared with 7.7% for patientswithout panic episodes. The patientswith panic attacks also experienced anaverage of 4.2 diabetes symptoms,compared with 2.4 symptoms for patientswith no panic attacks. (The findingswere reported in General HospitalPsychiatry, November 2006.)

Noninvasive Test Detects Vascular Damage

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

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

Obese Diabetics May Fib About Calories

Obese adults with diabetes may not be honestabout the quantity of food they consume—a complication that can impede managementof the disease, according to a study reported inthe December 2006 issue of Diabetes Care. Thestudy involved 21 obese men and women withtype 2 diabetes.

The researchers found that the patientsreported eating fewer daily calories thanobjective tests suggested they did. Theresearchers caught the error by using thedoubly labeled water method, a sensitivemeasure of metabolic rate. All of the participantshad a stable weight, which would besustained when the amount eaten equals thecalories burned daily.

The study's findings showed that, on average,the patients reported a caloric intake thatwas nearly 25% lower than they would need"even for basic functions to live." The obesestudy participants without the disease, however,reported more accurate eating habits. Theresearchers tested the reliability of thepatients' reports on their diet by having themremember what they had eaten over the previous3 days; they then calculated each individual'sestimated daily caloric intake and comparedthat with the metabolic rate. Theresearchers recommended that physicians anddietitians be made aware of this tendency.

Insulin Drug Lowers Body Weight

Data presented to the InternationalDiabetes Federation (December 5,2006) showed that Novo Nordisk'sLevemir (insulin detemir [rDNA origin]injection) reduced body weight andimproved blood glucose levels inpatients with type 2 diabetes. Thefindings were based on a subanalysisof 2377 patients from a larger multinationalstudy. The researchers foundthat patients taking Levemir lost 0.7kg after 14 weeks, compared withbaseline.