Diabetes News for January 13, 2002

Distress Increases Stroke Risk

Numerous studies have linked psychological well-being to physical health, and have shown that poor emotional health can increase the risk for health problems. A new study shows that psychological distress, including depression, anxiety, sadness, and other negative mood states, increases the risk of having a fatal stroke.

The study was conducted by researchers from the University of Bristol, in conjunction with a larger study of heart disease called the Caerphilly study. Over 2,200 men between the ages of 45 and 59 participated in the psychological study by completing a survey which focused on their emotional well-being. The researchers found that 22% of the men had some type of psychological distress.

The study follow-up lasted 14 years, and there were 130 strokes during this time. Seventeen of the strokes were fatal, and 113 were nonfatal. Results indicated that the men who were distressed were more than three times as likely to have a fatal ischemic stroke, which occurs when a blood clot interferes with blood flow to the brain.

The researchers have published the results of the study in Stroke: Journal of the American Heart Association (volume 33, January 2002). They believe more research is needed to clarify the connection between psychological distress and stroke. In the meantime, they encourage doctors to treat psychological distress as a health risk, and monitor patients for signs of stroke.

Smoking Moms Increase Kids' Diabetes

There are numerous health problems associated with smoking, not all of which are limited to the smoker. A new study shows that women who smoke while pregnant are more likely to give birth to children with a greater risk of developing diabetes later in life.

Data included in the study includes birth records of about 17,000 children born in 1958. This information was obtained by doctors at the Karolinska Institute in Stockholm, Sweden, who used data from the British National Child Development Study. The smoking status of the women during pregnancy was recorded, and was recorded again in 1974. The children's medical records were obtained when they were the ages of 7, 16, and 33.

Examination of the children's health records showed that 15 men and 13 women developed diabetes between the ages of 16 and 33. The children of mothers who smoked more than ten cigarettes per day during pregnancy had a risk of developing diabetes that was 4.5 times greater than the children of women who didn't smoke. The children of women who smoked less than 10 cigarettes per day had a risk of developing diabetes that was 4.13 times greater than children of women who didn't smoke.

The researchers also found that women who smoked during pregnancy had children who were at a 34-38% greater risk of becoming obese than children of nonsmokers. About 10% of the study group were clinically obese by the time they were 33. Women smokers are often motivated by the perception that smoking keeps their weight down. Now it appears that smoking greatly increases the risk of obesity in their offspring.

The study is included in the new issue of the British Medical Journal (volume 324, pages 26-27, January 2002). The researchers believe that women who smoke during a pregnancy may cause an increased risk of diabetes and obesity in their children due to a lack of nutrients needed for proper development. Beta cells may also be damaged by oxidizing agents or toxins introduced by smoke.

Diabetes Care Does Not Harm Learning

Previous research has implied that treating diabetes with insulin can lead to neurological problems and learning difficulties. However, a new study restores hope in diabetes treatment, and finds no link between it and learning problems.

A recent issue of the journal Pediatrics (January 2002) includes a study conducted by researchers at the University of Iowa. In the study, researchers compared the academic performance of 244 children with diabetes with the performance of 319 of their peers and siblings who did not have diabetes. The children were 15 years old on average, and their average grade was the eighth.

The researchers found that the children with diabetes did better than the children without the disease in the area of math, and in overall academic ability. Their average scores on reading exams were almost as high as those of the children without diabetes. Researchers also saw that the children who had the best control over their blood sugar had slightly better academic performance than those who did not have as good control.

Other differences that were demonstrated were in attendence and behavior. Children with diabetes missed more school than their peers, and tended to be moodier, more tired, and less compliant. These mildly negative outcomes would likely be corrected by improved blood sugar management, such as with use of insulin pumps for precise insulin delivery and encouragement of blood sugar testing by teachers, school nurses and school districts.

The results of the study are hopeful for children with diabetes, and indicate that treatment of their disease should not be associated with any delays in their learning ability.

Autoimmune Diseases Linked To Asthma

Children with autoimmune diseases like Type 1 diabetes, celiac disease (the inability to digest gluten, which is found in wheat), and rheumatoid arthritis may be at an increased risk for asthma, according to the results of a new study.

The study was led by doctors at Ruprecht-Karls-Universitat Heidelberg in Germany, who examined the medical records of all children born in Finland in 1987. The researchers examined 60,000 medical records to determine the prevalence of asthma in children with one of the three autoimmune diseases listed above.

Results, which are published in the Journal of Allergy and Clinical Immunology (volume 108, pages 781-783, 2002), indicate that 25% of the children with celiac disease had asthma, as compared to the 3% of children without celiac disease. About 10% of children with rheumatoid arthritis had asthma, and only 3% of children without rheumatoid arthritis did. Children with Type 1 diabetes were also more likely to have asthma than children without diabetes.

The results appear to contradict previously-accepted beliefs about the way immune system cells work. People who have asthma have high levels of immune-system cells called T-helper 2 (Th2) cells, and people with autoimmune diseases have high levels of T-helper 1 (Th1) cells. Previous studies suggested that Th1 and Th2 are cross-regulatory and are therefore not both present in high levels. As a result, researchers expected that children with autoimmune diseases would have a lower risk of asthma, while the opposite appeared to be the case. More research is needed to determine the links between the conditions.

Clearing Arteries Aids Both Sexes

Several treatment options available for people who survive a heart attack help prevent further coronary problems. One if these is percutaneous coronary interventions (PCI). A study conducted in Germany indicates that this is just as effective for women as for men.

Doctors at Technische Universitat in Munich followed over 1,900 people who had had heart attacks and were treated at their center. They found that women and men had similar rates of survival after undergoing an angioplasty, despite the fact that the women tended to be older and more likely to have diabetes or high blood pressure.

Previous research indicates that women are less likely to survive a heart attack than men, although the reason for this is not clear. Possible explanations include the fact that women who have had a heart attack tend to be older than men who have had one. Other reasons could be that women aren't typically prescribed as intense a drug treatment therapy as men. In any case, the new study shows that both men and women have similar survival rates with angioplasty-based treatment.

In the study, which has been published in The Journal of the American Medical Association (volume 287; pages 210-215; January 9, 2002), the participants were followed for six years. Most received percutaneous coronary interventions (PCI) to enable blood to flow to the heart. PCI usually includes angioplasty, in which a balloon-tipped catheter is inserted into a clogged heart artery to flatten blockages against the artery wall. After one year, the death rate was 12.9% among men and 13.8% among women.

The researchers emphasize that their results show that gender should not be a factor in determining whether or not a person should be treated with PCI.

Eating Grains Improves Heart Health

Decisions about diet have an enormous effect on people's health. A new study shows that choosing to eat whole grains and legumes instead of refined rice can significantly improve heart health.

This study was led by doctors from Yonsei University in Seoul, Korea. They included 76 men with heart disease in the study, and divided them into groups who ate a daily meal of whole-grain powder or maintained their usual diet of refined rice. The study lasted for sixteen weeks, at the end of which the researchers measured the participants' blood glucose, insulin, homocysteine (indicative of increased risk for heart disease), and vitamin E levels. In addition, the researchers measured the participants' plasma lipid peroxidation, which can lead to heart disease when it is increased.

At the end of the study, the participants who had eaten the whole grains had decreased their blood glucose levels by 24% and their insulin levels by 14%. They had increased their daily fiber intake by 25% and their vitamin E intake by 41%. Fifty-five of these participants who did not have diabetes decreased their fasting levels of glucose and insulin. The same held true for the 21 participants with diabetes. All participants in this group also improved their ability to process glucose. Plasma lipid peroxidation also decreased by 28%.

The study has been published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology (volume 21, page 2065, December 2001). The authors recommend that people with heart disease eat grains that have been minimally refined, and eat plenty of vegetables and legumes. Since the use of refined grains and the rate of heart disease are both epidemic in the U.S., whole grains may be the way to go.

Diet For Diabetes: Balance

Because the diet of people with diabetes plays such a big part in their health, the American Diabetes Association has again updated their dietary guidelines, with little new content in their diet for the masses.

The guidelines primarily focus on the idea that watching the total amount of carbohydrate consumption is essential in diabetes control, and that the source of the carbohydrates doesn't matter. Foods like cakes, cookies, pasta, and potatoes have a high "glycemic index," which means that they cause a faster rise in blood sugar levels than carbs like whole wheat pasta or brown rice.

Unlike the findings of the study above, the ADA currently believes reasearch studies have not shown any significant difference between the health benefits of low and high glycemic index diets. Heated debate occurs between dieticians about the way in which diet research is conducted.

Many glycemic index studies are conducted in hospital settings where low glycemic foods are institutionally prepared, making interpretation into real life very difficult. Long term diet studies, such as those done of the French, Okinawan and Mediterranean diets, measure so many variable besides diet that interpretation becomes meaningless.

The ADA guidelines also warn people with diabetes against adopting a diet that eliminates a particular category of food, such as carbohydrates or protein. Low protein diets, for instance, may be damaging to kidneys in the long run, and tend to be high in fat, which increases the risk of heart and blood vessel disease. A recent advisory of the American Heart Association suggested that it may also lead to vitamin and mineral deficiencies that could increase risks for cancer and osteoporosis.

The ADA's report has been published in the journal Diabetes Care (volume 25, pages 202-212, January 2002). The ADA recommends that people with diabetes consult a nutritionist if they have concerns about their dietary habits. Our advice is to always eat healthy with an emphasis on whole grains, vegetables, fruits, and low fat meats with lots of variety.