Diabetes News
Week of May 28, 2000 |
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Islet Injections Eliminate Insulin Need
For some people with diabetes, blood sugar control with insulin injections
is difficult or impossible to achieve. A
team of doctors in Canada hope to put an end to this chaotic
situation and
their experimental new treatment just may be the way.
At a recent meeting of the Juvenile
Diabetes Association, Dr. James Shapiro of the
University of Alberta in Canada reported his research team's
data. Dr. Shapiro performed a new treatment on several
people between the ages of 29 and 53 who had extremely poor
control of their blood sugars. The treatment involved the
injection of healthy islet cells harvested from donor pancreases
into the recipient's liver. From there, the islet cells are able
to produce adequate insulin supplies control blood
sugars.
Another part of Dr. Shapiro's treatment included a regimen of
drugs to prevent rejection of the transplanted cells. Some anti-rejection drugs are so strong that they kill off
islet cells. To prevent that from happening, Dr.
Shapiro did not include prednisone as part of the treatment.
Instead, he used a combination of three different genetically
engineered drugs: Tacrolimus, Sirolimus, and Daclizumab.
Dr. Shapiro's treatment also differed from earlier transplant
attempts in that he injected many more islet cells into the
study participants than had been common before. He used the
islet cells from two different pancreases in order to increase
the chances for success.
The results of the study are promising. Eight people---half
of the study participants---have been off insulin for over a
year, and none have shown signs of rejection.
For now, the treatment is still very much in the experimental
stage. The recipients required beta cells from two cadaver
donors, and heavy-duty rejection drugs, which may increase risks
for cancer and infection, must be taken. However, the researchers plan to begin another study at
eight hospitals in the U.S. and Canada. They will perform at
least 32 more cell transplants in adults with very poor blood
sugar control in the hopes of replicating the success they had
in the first study.
Is Better Control Cheaper, Too?
Spend some money on intensive diabetes control, improve people's health and save
money by avoiding a greater expense in treating
complications? Recently, researchers in Britain decided to see if more
intensive control of Type 2 diabetes would increase the
cost-effectiveness of managing this disease.
The researchers used information from the ten-year United
Kingdom Prospective Diabetes Study, and published their findings
in a recent issue of the British Medical Journal (320: pgs
1373-1378, 2000). They compared
the costs associated with intensive blood sugar control (having
fasting blood glucose below 110 mg/dL) with the costs associated
with conventional treatment (having fasting blood glucose below
270 mg/dL). The study included 4,000 participants who were newly
diagnosed with Type 2. Those in the intensive blood glucose
control group took either insulin or sulfonylurea drugs.
Researchers found that it costs about $1,075 (US) more per
year over ten
years to maintain intensive control than to have conventional
control. However, the average cost of complications (as measured
by hospital stays) was higher for those in the conventional control
group whose hospital costs were about $1,150 more per year
for those in the intensive control group. The lower cost of
complications in the intensive control group counterbalanced the
slight increase in cost of treatment for this group.
When the authors calculate cost-effectiveness, they arrive at
a cost of about $850 per complication-free year of life
gained. This cost is far below the cost of treating
hypertension and other chronic medical problems.
Physicians Heal Themselves Better
According to a recent survey, health professionals who have
diabetes are receiving much better care for their disease than
the average person who is not in the healthcare field. Doctors
and nurses with the disease also seem to have much better
control over their disease.
The survey was published in a recent edition of the Diabetes
Educator, and it included 800 members of the American
Association of the Diabetes Educators (AADE) and the American
Diabetes Association (ADA) who also have diabetes. According to
the results of the survey, 96% of the respondents practice
intensive treatment, meaning that they take at least 3
injections of insulin per day or use an insulin pump. Over 50%
of the doctors and nurses said that they use an insulin pump.
This compares to less than 25% of the general population
who either use a pump or do multiple daily injections of insulin.
Researchers believe that part of the reason for the
discrepancy between the care levels of healthcare professionals
and the general population is lack of information. Doctors and
nurses have daily access to the latest information, studies,
specialists, and technology developed to treat the disease.
Most
healthcare professionals with diabetes treat their own disease
according to the standards of care recommended by the American
Diabetes Association. Those in the general population, however,
may not even be aware of these standards. Researchers hope that
the study will help improve communication between doctors and
their patients with diabetes.
Dialysis Linked To Heart
Problems
For many people with kidney problems, dialysis is the only
way to maintain good health. However, a new study conducted at
UCLA and published in the New England Journal of
Medicine (342 (20):pgs. 1478-83, 200) indicates that young adults undergoing
dialysis may have a great risk of having dangerous levels of
coronary artery calcification.
Coronary artery calcification is the presence of calcium in
blood vessel walls leading to the heart. It is extremely rare in
healthy individuals over the age of 40, and practically
non-existent in those younger. Calcification is linked to
arteriosclerosis, as well as an increase in the risk of
cardiovascular disease. Among people on dialysis, nearly 50% die
of cardiovascular disease.
In the UCLA study, 39 people between the ages of 7 and 30 who
were using dialysis were compared to a control group of 60 men
and women who had normal renal function. Researchers used
electron beam computed tomography to obtain a computer image of
the coronary artery in order to detect calcification. They found
that 14 of 16 dialysis participants between the ages of 20 and
30 had some calcification. However, no dialysis participants
under the age of 20 had calcification. Of the control group,
only five percent had any signs of calcification.
Those who had calcification also had a doubled daily
intake of calcium through phosphate-binding agents, as well as
higher phosphorus levels and higher calcium-phosphorus ion
products in their bloodstream, as compared to the control group.
Calcium deposits also doubled within 18-24 months in 90% of
those who had some deposits at the beginning of the study.
Extraordinary Vitamin E
In a recent report published by Cornell University's Medical
College entitled "The Science of Eating Right: Vitamins,
Minerals, and Dietary Supplements'', vitamin E is associated with many health benefits.
For people with diabetes, taking vitamin E may help increase
cardiovascular protection. This is especially important, as
diabetes has long been associated with the development of heart
disease. Cornell researchers believe the vitamin also has benefits for people with
asthma, Alzheimer's disease, cancer, immune deficiencies, and
women going through menopause.
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