Another reason to stay on top of your health: Diabetes and mental function may be linked. Researchers at the Mayo Clinic found that mild cognitive impairment--a stage between general mental decline due to aging and dementia--is associated with long-term diabetes. Researchers led by Rosebud Roberts, MBChB, MS, examined nearly 2,000 people ages 70 to 89. Just over 300 of them had mild cognitive impairment. Mental decline was not found to be associated with a higher rate of diabetes, but those with cognitive impairment were more likely to have been diagnosed with diabetes before age 65, to have had it for 10 years or more, and to have had complications related to the disease. Roberts and her colleagues hypothesize that chronic high blood glucose, which can lead to blood vessel damagin the brain, may contribute to cognitive impairment. Stay tuned for more news on this subject; another long-term study on the mind-diabetes connection is already underway.
Source: Archives of Neurology, August 2008

More Monitoring, Fewer Problems

A new study has found that continuous blood glucose monitoring improves blood glucose control in people with type 1 diabetes who are 25 or older. (A continuous glucose monitor, or CGM, consists of a disposable sensor placed under the skin, which relays readings every few minutes to a small wearable display.) By the end of the 26-week study, about a third of CGM users aged 25 and up achieved recommended A1Cs of less than 7, compared to just 9 percent of those not using a CGM. The study also found that people 8 to 24 did not see a significant benefit from CGM use, but this may be because those users clocked fewer hours of glucose sensing each week than older users did. The researchers recommend additional study to identify barriers that keep youths from CGMs' potential benefits. Also, they caution against generalizing their results because participants were selected based on already having excellent self-care practices. It is unclear how CGMs might work in a population of adults with less well-controlled diabetes to begin with.
Source: New England Journal of Medicine, Sept. 8, 2008

Diabetes and Male Hormones

A few years ago, researchers at the University of Buffalo found that middle-aged men with type 2 diabetes have low testosterone levels. Now, after analyzing the hormone in men 18 to 35, those same researchers discovered that younger men experience the same deficiency. The study of about 60 men with diabetes found that those with type 2 had half as much testosterone in their blood as those with type 1. More than half of the men with type 2 had lower levels of testosterone than average for the general male population of their age. The type 1 men, meanwhile, had normal levels. The findings are significant since low testosterone can contribute to a decrease in bone mass, underdeveloped skeletal muscle, low libido, and erectile dysfunction. While obesity or insulin resistance mayplay a role here, further research is needed to determine a cause.
Source: Diabetes Care, October 2008

Cellular Alchemy

Circumventing the need for controversial embryonic stem cells, researchers have for the first time demonstrated the ability to convert non-insulin-making adult cells into insulin producers in mice. Scientists were able to reprogram pancreatic exocrine cells by infecting them with viruses that were loaded with three particular genes. These newly introduced genes triggered the cells to start behaving like insulin-producing beta cells. The manufactured insulin-producing cells were able to lower blood glucose in diabetic mice, an observation that suggests this strategy could in the future be useful in the treatment of people with diabetes.
Source: Nature, Aug. 27, 2008

Environmental Awareness

Recent research is pointing to three environmental factors that may increase the risk of developing type 2 diabetes: arsenic, bisphenol A (BPA), and polychlorinated biphenyls (PCBs)

In one study, people with type 2 diabetes had on average a 26 percent higher level of arsenic in their urine than those without diabetes. These findings support the notion that arsenic--found in low but potentially significant levels in drinking water, for example--is related to diabetes.

Urinary levels of BPA, which is widely used in the linings of food and beverage containers, were strongly associated with a risk of heart disease and diabetes, according to data from the National Health and Nutrition Examination Survey 2003-2004. The U.S. Food and Drug Administration has reached the tentative conclusion that BPA is safe. In contrast, however, the Canadian government has placed restrictions on the chemical, the Wal-Mart chain has announced it will no longer sell baby bottles treated with BPA, and the company Nalgene plans to stop using it in its popularwater bottles.

PCBs are organic pollutants that persist in the environment and can be introduced into the body by the consumption of contaminated fish, meat, or dairy products. Taiwanese researchers followed a cohort of women who ate PCB-laden rice-bran oil in the 1970s and showed that those with higher PCB exposure levels had a greater incidence of diabetes over a 24-year period.
Sources: Journal of the American Medical Association, Aug. 20, 2008; Journal of the American Medical Association, Sept. 17, 2008; Diabetes Care, August 2008

Fewer injections, anyone?

A once-weekly form of the injected type 2 diabetes drug exenatide (Byetta) in development now controls blood glucose better than the current twice-daily version, according to a recent study. Exenatide acts similarly to natural hormones called incretins, which can lower blood glucose by triggering the release of insulin at mealtime. A side effect of exenatide is weight loss, which was found to be similar for the twice-daily and once-weekly versions of the drug. The once-weekly injection (which has yet to be introduced to consumers) consists of microspheres, which combine exenatide with a special polymer that degrades slowly and allows gradual drug delivery at a controlled rate. By the end of the trial, 77 percent of the once-weekly group achieved A1Cs of less than 7 percent compared with 61 percent of the twice-daily users. (The ADA recommends a target A1C of less than 7 percent in people with diabetes.) The two groups had similar rates of low blood glucose
Source: The Lancet, Sept. 8, 2008

Don't forget your flu shot!

It may hurt for a moment, but it's important to get your pneumonia and influenza shots, say researchers from Denmark, who found that people with diabetes had a 25 to 75 percent greater risk of pneumonia-related hospitalizations than those without the disease. A higher risk was associated with longer disease duration and poor glycemic control. Earlier studies have shown that people with diabetes are more likely to develop severe flu than are people who don't have diabetes.
Source: Diabetes Care, August 2008