DIABETES WATCH

Pharmacy Times, Volume 0, 0

Campaign Emphasizes Reliable A1C Test

A campaign of the National Institute of Diabetes andDigestive and Kidney Diseases is highlighting the importanceof using accurate ways to test hemoglobin A1C inindividuals with diabetes who have sickle cell trait or otherinherited forms of variant hemoglobin.

The 2 booklets, "Sickle Cell Trait and Other Hemoglobinopathiesand Diabetes: Important Information forPhysicians" and "For People of African, Mediterranean, orSoutheast Asian Heritage: Important Information aboutDiabetes Blood Tests," explain the specific needs for testingblood glucose control in these patients. In diabetes patientsof African, Mediterranean, and southeast Asian descent,several circumstances may suggest the presence of ahemoglobin variant:

  • An A1C result does not match with the results of selfblood glucose monitoring
  • An A1C result is different than expected or from a previoustest result after a change in laboratory methods
  • An A1C result is >15%

For more information, visit www.diabetes.niddk.nih.gov.

Weight Loss May Help Diabetic Hearts

In a recent study, researchers identified risk factors forcoronary artery disease (CAD) progression in 222 adults withtype 1 diabetes. They also examined if changes in these factorsinfluenced the progression to CAD. The participants had2 electron beam tomographic screenings 4 years apart.Progression was defined as an increase >2.5 in the squareroot-transformed coronary artery score.

Researchers determined an increase in weight was themost influential modifiable risk factor connected with CADprogression, increasing the risk by 38%. They concluded thatfor patients with type 1 diabetes to slow the progression ofCAD, and for other health reasons, weight control is crucial.The findings were reported in the November 15, 2007, issueof American Journal of Cardiology.

Does Smoking Cause Diabetes?

Individuals who smoke have a 44% increased risk of developingtype 2 diabetes, compared with nonsmokers, reportedresearchers in the Journal of the American Medical Association(December 12, 2007).

The findings are based on an analysis of 25 studies examiningthe association between smoking and diabetes. Therisk was even greater for heavy smokers. The participantswho smoked at least 20 cigarettes a day faced a 61% higherrisk of diabetes, compared with nonsmokers.

The researchers also found that quitting smoking reducedthe risk. Former smokers had a 23% higher risk than nonsmokers,but lower than that of current smokers. Carole Willi, MD,noted that the researchers could not conclude that smokingwas the reason for diabetes in those who developed it.

Eating Disorders Frequent in Diabetic Girls

Girls with type 1 diabetes face a greaterprevalence of disturbed eating behaviorand eating disorders, accordingto the findings of a 5-year study. Atstudy onset, higher rates of disturbedeating behaviors were seen in 126 girlswith type 1 diabetes between the agesof 9 and 13 years, compared with theircounterparts without the disease (8%vs 1%).

At the 5-year follow-up, of the 98 girlswith diabetes who remained in thestudy, 43 reported that they had restrictedtheir eating, 6 reported binge-eatingepisodes, 3 reported self-inducedvomiting, and 25 reportedintense excessive exercise for weightcontrol.

The participants with disturbed eatingbehavior also had a considerablyhigher average body mass index, at26.1%, versus 23.5% in other girls. Thefindings were reported in the November2007 issue of Diabetes Care.

Self-management Course Proves Helpful

A self-management program has been shown to helppatients with type 2 diabetes reduce both their weight andtheir blood pressure and maintain these benefits over time.The Netherlands study included 196 patients with type 2 diabetesbetween 50 and 70 years old. The patients were receivingeither usual or intensive medical diabetes managementas part of the Dutch arm of an ongoing type 2 diabetes treatmentstudy.

A group of patients was randomly assigned to participatein a 3-month self-management course, while others werenot. The course included 2 (1-hour) individual sessions and 4(2-hour) biweekly group sessions with a trained nurse.

Reporting in Diabetes Care (November 2007), researchersfound that 9 months after completing the course these patientshad a net reduction in body mass index (BMI) of 0.39,whereas nonparticipants had a net increase in BMI of 0.38.

F A S T F A C T : Inaccurate hemoglobin A1C readings, whether falsely high or low, may lead to overtreatment or undertreatment of diabetes.