   
Ultrasound Monitors Diabetes Glucose PainlesslyNo more finger-sticking is the dream of many people with diabetes who test their blood sugar, sometimes as often as 8-10 times a day. A realization of this dream may be around the corner. The new device uses low frequency ultrasound to increase the skin's permeability so that glucose can painlessly cross the skin and be measured. A stream of ultrasound is applied to the surface of the skin on the back of the forearm where less hair interferes. After this two minute treatment, glucose crosses the skin and is measured continuously for the next 12-15 hours. The clinical trial of 7 people with Type 1 diabetes is reported in Nature Medicine by Robert Gabbay, M.D., Ph.D., assistant professor of medicine at Penn State's College of Medicine and one of the research team from Massachusetts Institute of Technology in Boston. Blood was drawn from the arm of the participants and tested with strips and a meter to compare with the readings from the ultrasound procedure. The readings were almost identical. A finger stick test will be needed to calibrate the ultrasound device each time it is used. The ultrasound machine that was used was from a research lab. A new hand-held device incorporated in a wristwatch or patch so that blood glucose readings could be continuously displayed is under development for home use. A larger clinical trial is planned for later this year.
Diabetes Cure Through Gene Technology?The islet neogenesis associated protein (INGAP) gene discovered by Eastern Virginia Medical School may prevent or stop certain forms of diabetes and identify those at risk so that intervention can occur. EVMS scientists and GMP Companies, Inc. of Fort Lauderdale, Fla. have signed a license and research funding agreement to develop this approach. Over the next five years, the agreement provides for $6 million in research funding. The agreement also includes a license fee, research milestones, and royalty structure. The INGAP technology using recombinant molecular biological
techniques grows new islet cells that produce insulin from the
body's own stem cells. Aaron Vinik, M.D., Ph.D., professor of
medicine and pathology/anatomy and director of research at the
EVMS Strelitz Diabetes Institutes, believes that this ability to
generate new islet cells from a patient's own pancreatic cells
represents a potential cure for diabetes. Past attempts using
islet cell transplants, engineered beta cells, and the
artificial pancreas, have been unsuccessful because the body has
rejected all of these. The INGAP technology overcomes these
weaknesses by generating new cells recognized by the body as its
own. This technology should help people with Type 1 where no insulin is produced and Type 2 where additional insulin production is needed to overcome the body's insulin resistance.
Diabetes Reversed In MiceMice transplanted with laboratory-grown cells that produce insulin have been cured of Type 1 diabetes. The cells were grown from stem cells, according to researchers at the University of Florida College of Medicine who reported their results in the March issue of Nature Medicine. People have received transplants of islet cells, but the typical problems are the immune system rejects cells from a donor source and the cells are in short supply because they come from cadavers. Using stem cells overcomes these problems because the stem
cells do not cause the immune system rejection and the stem
cells are processed to make abundant quantities of islet cells
in the laboratory. The next step is to try a similar approach in people. The advantages of a semi-invasive process of injecting cells under the skin combined with an unlimited supply of cells that do not trigger rejection makes islet cell transplantation more feasible as a cure for diabetes.
Extreme Thinness Unhealthy For ElderlyWith obesity rising at epidemic proportions, most news these days is about the risk for disease and death that occurs with excess weight. Now a study of older people with high blood pressure suggests that being very thin may also increase the risk of disease and death. Dr. Sylvia Wassertheil-Smoller of the Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, and colleagues from the Systolic Hypertension in the Elderly Program, treated 3,975 elderly participants with an average age of 71 who have systolic hypertension. Over the 5 years of the study, some were treated with an inactive placebo and the rest with antihypertensive therapy. Systolic hypertension occurs when the blood pressure reading has a high first number, 160 or higher, and a normal second or diastolic number. As reported in the Archives of Internal Medicine, the study revealed, not surprisingly, that stroke and death rates were lower in participants who received antihypertensive therapy. Unexpectedly, the results also showed that participants with a low BMI were at more risk of stroke and death than were those at medium weight. Why do participants with lower BMIs have a greater risk of
stroke and death? The answer to this is not clear but it may be
that thinness denotes deficiencies in nutrition.
People Not Lowering Cholesterol EnoughDiet, exercise, weight reduction, and drug therapy. Even though there are 4 methods for affecting cholesterol levels, more than half of people who have high LDL (''bad'') cholesterol do not lower it to the recommended target set by the National Cholesterol Education Program (NCEP), even when they know about these methods. In a study that appears in the Archives of Internal Medicine, risk groups were classified according to incidence of diabetes, high blood pressure, obesity or other medical conditions, and whether cigarette smoking or evidence of coronary heart disease (CHD) existed. About one half of the participants were in the high-risk group with at least two of these risk factors but no CHD. Only a quarter fell into the low-risk group with fewer than two risk factors and no CHD. Target levels for cholesterol are set for each risk group. The usual treatment for high LDL is to prescribe diet and exercise changes to reduce weight, then if that doesn't work, on to drug therapy, particularly statins and then higher doses of drugs if the LDL still doesn't come down. According to the study results, only 38% of the participants had LDL levels in their target range. The best group was the low-risk group with 68% in the range and the next best was the high-risk group with 37% achieving their targets. The worst group contained the participants with CHD with a success rate of only 18%. According to the physicians who saw the participants, more than 90% of people with high LDL were told about the importance of diet, exercise, and weight reduction. This was not successful in many cases so that drug therapy was required, but the group that took cholesterol drugs was only 5% better than those who took no medication. Those who took statins to lower cholesterol levels had higher success rates than other medications. The NCEP guidelines are: People who have arterial disease should start diet therapy for LDL cholesterol levels that are 160 mg/dL or more in patients with fewer than two other CHD risk factors, or 130 mg/dL or more in patients with two or more CHD risk factors. Therapy should be escalated until LDL cholesterol levels are below the thresholds for initiating therapy.
Overweight Children May Need Testing For Type 2 DiabetesType 2 diabetes, a disease that used to occur almost exclusively in adults middle-aged or older, is now showing up in overweight children and teens. Because this trend exists, an eight-member panel, created by the American Diabetes Association, is recommending that overweight children be tested for Type 2 diabetes. Other recommendations from the panel, published in the journal Pediatrics, state that overweight children should be tested for diabetes if they have two of three risk factors known to increase the likelihood of Type 2 diabetes. These are a family history of Type 2 diabetes, belonging to certain ethnic groups (American Indian, African-American, Hispanic American, Asians/South Pacific Islanders), or having signs of insulin resistance, high blood pressure or high blood fat levels. They should be tested from age 10 every other year or at the onset of puberty. Overweight as defined for children by the panel is weighing more than 120% of ideal weight for height. When children are found to have Type 2 diabetes, the panel recommends that they be taught disease management skills, such as how to monitor blood glucose levels, an exercise program and diet skills. If the child is healthy at diagnosis, they should be treated with diet and exercise, which will eventually not be enough. At that time, the child should be put on insulin as approved by the FDA. They may be given oral agents, although this is not approved by the FDA for children. They should also be monitored for eye problems, kidney problems, cholesterol and blood pressure problems. All children should be taught the importance of normal weight, a healthy diet and regular exercise.
Stress Increases Diabetes RiskStressful major life events exposes middle aged people to a greater likelihood of developing Type 2 diabetes. Psychological stress caused by major life events, such as the death of a spouse, a financial crisis or other major event that radically changes life, may increase the risk of developing diabetes in middle age. This is true regardless of family history, exercise or alcohol use. More than 2,000 people between 50 and 74 were surveyed about psychologically stressful life events, such as the death of a spouse, the end of a significant relationship or serious financial problems. People with three or more stressful events in the last five years were 60% more likely to have diabetes as those with fewer stressful life events. In all, 5% of the people surveyed had diabetes. These were the findings reported in Diabetes Care by a team of Dutch researchers led by Dr. Johanna Mooy and colleagues with the Vrije Universiteit in Amsterdam. Interestingly, there was no association between stressful work-related events such as a forced job change, retirement or long-lasting problems at work. What is the connection between psychological stress and diabetes? The study is not conclusive but does support the theory that stress increases the risk of diabetes by increasing levels of the stress hormone cortisol and decreasing levels of sex hormones such as testosterone. Levels of these hormones have been shown to influence the effectiveness of insulin, which regulates blood sugar.
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