Diabetes News for Jan. 27, 2002

Nutritionists Now Covered By Medicare

For people with diabetes, eating a healthy diet is an essential way of managing the disease and preventing further problems. A new law may make that easier to do.

As of January 1, 2002, nutritionists are covered by Medicare for people with diabetes and kidney disease. This is welcome news for those who do not know how to make healthy dietary decisions, and for those who are seen by busy physicians who don't have time to address healthy day-to-day meal choices with their patients.

In addition, the American Dietetic Association and the American Academy of Family Physicians have sponsored the Nutrition Screening Initiative. This initiative creates a guide for doctors to provide proper nutrition advice for people with diabetes, cancer, chronic obstructive pulmonary disease, congestive heart failure, coronary heart disease, dementia, high blood pressure, and osteoporosis. Visit their website for further nutrition information.

Fructosamine Testing Improves Type 2 Control

People with Type 1 diabetes are intimately familiar with the need for multiple daily testing of blood glucose levels in order to maintain control of their disease. However, new research shows that this kind of testing may be just as important for people with Type 2 diabetes.

Recently, researchers from the San Diego Veterans Affairs Medical Center and the University of California at San Diego conducted a study to determine if weekly fructosamine testing could help people with Type 2 diabetes gain better control of their disease. Glucosamine tests measure blood sugar control over the last two to three weeks. Twenty-five people participated in the study. Fourteen of these were instructed to perform glucose testing up to four times per day. The others were instructed to conduct weekly fructosamine tests in addition to the daily blood sugar tests. They were also instructed to contact the researchers if their fructosamine levels exceeded 350 umol/L, which is equivalent to a HbA1c level of 7.8%.

After three months, the study participants returned to have HbA1c levels measured to see if they had achieved better control. Those who tested only glucose levels had their HbA1c drop by 0.3% which was a non-significant improvement in glycemic control. However, those who also tested fructosamine levels and called when their fructosamine level was high achieved much greater control over their disease. Their HbA1c level dropped by 1.2% down to to 8%. The reduction occurred because they called healthcare professionals when their tests yielded results that concerned them.

The researchers have published the results of this study in the journal Endocrine Practice (volume 7, number 6, pages 454-458, November/December 2001). They note that people with Type 2 diabetes can easily make fructosamine testing part of their health regimen. Participants in the study utilized the Duet Diabetes Control System, which is manufactured by the LXN Corporation. This meter measures glucose and fructosamine levels by using two different test strips. A newer personal meter called the InCharge is now also available.

Can Anger Lead To Stroke?

There are several risk factors for stroke, including high cholesterol level, smoking, high blood pressure, and diabetes. A new study suggests that anger may be added to that list.

The study was conducted by researchers from the Centers for Disease Control and Prevention in Atlanta, Georgia. Approximately 14,000 adults between the ages of 48 and 67 participated in the study. Each participant completed a health survey in regards to the ways they handle anger. The reasearchers also used data from a study of cardiovascular disease to determine how anger related to stroke risk.

The results of the study showed that anger was linked to a slight increase in stroke risk, but that "high-anger" increased the risk of stroke by three times in those aged 60 and below, as well as in those with high HDL levels. The researchers stated that anger did not increase the risk of stroke in older participants and those with low HDL, and that this might be because the risk for stroke was already great enough that anger didn't add more.

This study has been published in Stroke: Journal of the American Heart Association (volume 33, pages 13-20, January 2002). The reasearchers postulate that anger may increase stroke risk by increasing blood pressure, blood-vessel constriction, and blood-clotting substances. All of these can hinder blood flow to the brain, resulting in stroke. Also, boosts of hormones like adrenaline during anger may injure blood vessel walls.

Metabolic Syndrome Linked To Type 2

It has been known for quite some time that Type 2 diabetes is on the rise in the US, and recent research indicates that this may be due to the rise of metabolic syndrome.

Metabolic syndrome is a condition that is linked to an increased risk of diabetes and heart disease. It is marked by abdominal obesity, elevated levels of triglycerides, low levels of HDL ("good") cholesterol, high blood pressure, and high blood sugar levels. Recent research shows that 22% of adults between the ages of 20 and 79 have at least three of these symptoms.

The reseach was conducted by the US Centers for Disease Control and Prevention, and was published in The Journal of the American Medical Association (volume 287; pages 356-359; January 16, 2002). About 9,000 men and women participated in the study, which occurred between 1988 and 1994. Metabolic syndrome was more common in older people than in younger people. There were differences along lines of ethnicity and gender, as well. Mexican Americans were more likely to develop the syndrome than people of other ethnic backgrounds. Also, women were more likely to have the syndrome than were men.

The researchers hope this study will encourage people to make healthy diet and lifestyle changes in order to prevent the onset of metabolic syndrome.

Type 2 Health Problems Inhibit Women's Lives

Women with Type 2 diabetes are at risk for a variety of health problems associated with the disease, including stroke, heart problems, kidney failure, and vision problems. However, a new study shows that they are also at greater risk for complications which inhibit daily life.

Recently, researchers at the US Centers for Disease Control and Prevention in Atlanta, Georgia conducted a study of over 8,000 women aged 65 and older to determine how diabetes affects their lives. The study lasted for twelve years, and focused on the women's ability to conduct daily activities.

Results of the study, which have been published in the journal Diabetes Care (volume 25, pages 61-67, January 2002), indicated that 10% of women with diabetes had some form of functional disability, compared to 5% of women without diabetes. About 4% of women with diabetes said that they could not walk two blocks, while only 2% of women without diabetes reported this. Between 1% and 2% of women with diabetes said they could not prepare meals, while less than 1% of women without diabetes couldn't.

Further results of the study indicate that weight, age, and vision problems increase the risk of having a functional disabilty, and use of estrogen and exercise decreased the risk. The researchers encourage women to make appropriate lifestyle changes like losing weight and managing any diseases such as heart disease to decrease the risks of having functional disabilities.

Thyroid Disease And Diabetes Awareness

Although thyroid disease affects 13 million Americans, about half of these cases go undiagnosed. The American Association of Clinical Endocrinologists has launched a campaign to increase awareness of the disease, and the health problems that are associated with it.

The thyroid is a small gland located below the Adam's apple. It produces hormones that help control almost all body organs, tissues, and cells. Thyroid diseases include hypothyroidism (under-activity of the thyroid gland), hyperthyroidism (over-activity of the gland), and thyroid cancer. Thyroid disease can lead to elevated cholesterol levels, osteoporosis, infertility, depression, and even coma or death if it is not treated. There is also a link between thyroid disease and diabetes, anemia, and depression.

The AACE hopes that people will become more aware of the prevalence of thyroid disease, and will be screened for the disease. This is particularly important for those who have thyroid disease in their family history.