Diabetes News for July 1, 2001
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Breakthrough Devices Shown At ADA
The annual 2001 ADA meeting last week in Philadelphia was the
launch pad for several new tools that promise to make control easier. The two most exciting designs came in the form of Personal Digital Assistants
(PDAs) from Therasense and Animas. Therasense has created a
Freestyle meter add-on for the Handspring PDA, using the Palm OS. The meter portion is a nice redesign of their existing Freestyle meter, which uses very small quantities of blood
sampled from the arm or hands.
Plugged in, the meter extends about a half inch beyond the top of the Handspring device where the
add-on port is located, and where other devices like a cell phone or keyboard
can also be placed.
Therasense demonstrated only an early software version with a database of just 750 foods. Although they were contemplating a simple meter device, the feedback they received at the ADA, along with a look at the Animas PDA below, has made them reconsider their mission. They are now contemplating adding other helpful information so the user can track exercise, weight, low blood sugar symptoms, insulin to carb ratios, etc., so your input to the company at this time is likely to improve its design and features.
Meanwhile, Animas showed off another Palm-based software program that will accompany their insulin pumps, but could easily be used as a stand alone Palm program. It offers an 8,000 food database, and records exercise, insulin doses, and daily events, but what really makes the Animas software a standout is the incorporation of insulin dose recommendations based on the insulin to carb ratio that was developed by John Walsh, PA, CDE (Insulin Pump Therapy Handbook, 1992), and the correction factor for high blood sugars, developed by Dr. Paul Davidson in 1989.
The food database allows fast analysis of the carb content in a meal. As the precisely determined carb intake is then matched with accurate insulin doses based on the insulin to carb ratio and the user's current blood sugar, control is likely to improve greatly. The Animas pump has an infrared port, so data can be downloaded into the Palm for determining things like residual insulin remaining in the body from recent boluses.
These PDA devices have the potential to revolutionize diabetes clinical care. How often have you wanted to show your doctor what you really do each day in your clinic visits? Perhaps that your lunch readings really do go two different directions when you eat the same breakfast two days in a row. Or your food choices in detail, for better or worse.
The lack of real data exchange between the physician and person with diabetes during clinic visits is one of the most common and frustrating experiences in medicine. (See Improving Today's Meters). Your physician does not generally know what you eat, how long and intense your exercise and activities are, or what percentage of your total daily insulin dose is given to correct high blood sugars. But a Palm device could simplify testing, recording, and dosing; let you easily see the glucose and weight impact of your food; let you record the level, duration and intensity of your activities; and much more. Not everyone would use them, but those who do are likely to find blood sugar management much less of a hassle.
Disetronic is taking a different tack with its insulin pump. It is incorporating an infrared download of pump doses over the internet using software developed by Imetrikus at My Health Channel. Imetrikus has developed an extremely secure web site which will download any blood sugar meter with memory, as well as the Disetronic pump, to solve this part of the information. Imetrikus is also developing a Palm-based program for recording food intake and events for a complete control picture.
Another nice new device is called the InDuo (Latin for endure) by Novo-Nordisk shown above. This combined meter and insulin dosing device will be released within a few weeks in conjunction with the introduction of their new, fast Novolog insulin. Unlike the Palm and internet based devices above, the InDuo combines a nifty injection device together with a meter that is functionally identical to the Lifescan Ultra. The top containing the meter slides off to reveal an insulin cartridge with precise doses that are dialed into the device. A timing device lets you know how long to leave the injector in place before removal from the skin, as well as memory for the timing and doses of previous injections. Now if we can only get it to talk with a Palm-based carb database.
Does Diabetes Mouse Cure Offer Hope?
There have been many studies conducted using animals to try to find cures for diseases, including diabetes. Although results are not always replicated in human studies, recent research involving mice offers hope in the fight against Type 1 diabetes.
The study was led by researchers from Massachusetts General Hospital, and has been published in the Journal of Clinical Investigation (July 2001). The mice in the study were bred to have Type 1 diabetes. They were then treated for 40 days in an attempt to stop their immune systems from attacking the islet cells that control blood sugar levels. This was a two-fold procedure, involving the triggering of the naturally occurring drug TNF-alpha to destroy immune cells that were attacking islet cells, as well as the injection of donor islet cells to re-program the immune system to accept islet cells.
As a result of this process, insulin-producing cells appeared to re-grow, and blood sugar levels returned to normal. About 75% of the mice remained healthy for at least 100 days without further treatment. These results offer hope for the cure of diabetes in humans as well, although clinical trials involving humans are not yet on the horizon.
Heart Disease Starts In Teens With Diabetes
One of the most common complications of Type 1 diabetes is heart disease. This can be partially attributed to the fact that those with diabetes are more susceptible to atherosclerosis. A disturbing new study shows that this can happen at a very young age.
The meeting of the American Diabetes Association in Philadelphia (June 26, 2001) included a presentation of the study by Drs. J.S. Krantz, Francine Kaufman and others from the University of Southern California and Children's Hospital Los Angeles (abstract 637-P). Their study included 57 youth between the ages of 12 and 21 who had Type 1 diabetes. They measured the innermost layer of the artery wall in the participants' necks and also took blood samples. They found those with diabetes had thicker intermedial walls which is closely linked to the risk for heart disease where blood flow and oxygen are obstructed by the accumulation of fatty plaque.
Researchers found that the participants with the most plaque in their arteries were those with higher levels of LDL ("bad") cholesterol (over 130 mg/dl), blood homocysteine levels above 10 umol.L, and lipoprotein a levels above 20 mg/dl. Homocysteine, often found at higher levels in kidney disease, can be lowered easily with B vitamins, while LDL levels can be determined with a cholesterol panel and lowered with statin medications. The researchers emphasize that the results of the study indicate early treatment of diabetes is necessary in order to avoid serious complications.
Gene That Directs Stem Cells Identified
The topic of stem cell research has been politically controversial for quite some time now, but researchers are still trying to determine exactly how the cells work. Scientists working with zebrafish believe that they have identified the gene that directs stem cells to develop into other cells.
The researchers, based at the University of California at San Francisco, have published a report in the journal Genes and Development (volume 15; pages 1493-1505; June 15, 2001). They discovered a gene in zebrafish that directs embryonic stem cells to develop into cells of internal organs and the lining of the lungs and guts. The gene is called casanova (Latin for new house, aka Giacomo Girolamo Casanova born in Venice in 1725), and is the main director of endoderm development, which is one of the three cell layers found in embryos. The endoderm subsequently develops into the digestive system, glands including the liver and the pancreas, and part of the respiratory system.
Researchers also found that the zebrafish that did not have the casanova gene did not develop any gut tissue, or any other tissue that develops out of the endoderm layer. When the scientists introduced excess casanova genes into cells that normally develop into mesoderm, the cells grew into endoderm tissue. The researchers believe that the gene may assist in directing embryonic stem cells to produce needed cells and tissues. More research is needed to determine if the casanova gene works the same way in humans as it does in zebrafish.
Exercise Is Healthy Even Without Weight Loss
For people with Type 2 diabetes, treatment plans often include exercise. Recent research shows that this is beneficial, even if the person does not lose weight in the process.
This study was conducted by researchers at the University of Ottawa, and was among those presented at the annual meeting of the American Diabetes Association in Philadelphia (June 26, 2001). The researchers analyzed 14 different studies that compared the effects of eight weeks of exercise with the effects of no exercise at all. Over 500 adults with Type 2 diabetes participated in the studies. Twelve groups adopted aerobic exercise routines, and two groups did weight training.
Results of the studies indicated that those who did regular
exercise had lower blood glucose levels over several months as
compared with those who did not exercise. These positive results
held true even if the participants did not lose weight.
Researchers hope that this study will encourage more people with
Type 2 to use exercise to help control their disease.
Should Kids Be On A Pump?
At the recent American Diabetes Association annual meeting in Philadelphia, two studies dealt with the topic of children with diabetes, and whether or not they should use an insulin pump to control their disease. The studies had very different results.
The first study was conducted by researchers at the pediatric diabetes program at Yale University in New Haven (abstract 268-OR). The study included 102 children under the age of 12 who were attending a pediatric diabetes program. The children in the study who were in elementary school used the pumps for about 20 months, and children in preschool used the pumps for about 17 months.
The researchers found that the pump was more effective in the stabilization of blood sugar than insulin injections, and there were no significant negative effects. The risk of severe hypoglycemia was 0.2 events per child per year. Infections at the pump site were minor and easily cured. The researchers concluded that the pump can be used by any child who has an interest, and is particularly recommended for children who check their blood sugar four or more times per day, those who have hypoglycemia at night, and those who are picky eaters.
The other study was conducted by researchers at Children's Hospital of Philadelphia (270-OR). This study included 34 children around 14 years old. All participants received multiple daily insulin injections for a year, and insulin pump therapy for a year. In comparing the two treatments, researchers found that the children had many more incidents of diabetic ketoacidosis and higher body mass indexes while on the pump. Ketoacidosis, or acid buildup in the blood, can occur rather quickly if the insulin pump fails. The researchers conducting this study concluded that people of any age who are not able to self-monitor their disease should not use the pump.
Diabetes Gets Poor Coverage On TV
Television is one of the most influential and readily-accessed ways of imparting news, and plays a huge role in American culture. As such, it can be a powerful tool in providing information about health issues. The results of a recent study indicate that television is not used as often as it could be to address the topic of diabetes.
At the annual meeting of the American Diabetes Association in Philadelphia (June 26, 2001), Stephania Miller, PhD, and others from the Vanderbilt University Diabetes Research and Training Center in Nashville, Tennessee presented their study of the television news coverage of chronic diseases in the past ten years (abstract 299-PP). They found that the three major networks presented 68 diabetes-related stories, as compared to the 1,695 cancer-related stories and the 2,151 heart-disease stories.
The researchers conclude from this information that many people are unaware of the risk factors for diabetes, symptoms and methods of treatment. They encourage diabetes organizations to advocate for more diabetes-related stories in the news in order to increase awareness about the disease.
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