Islet Transplants May Treat Type 1
For people with Type 1 diabetes, daily injections of insulin may be an inconvenient, painful, and even ineffective way of controlling blood sugar levels. An experimental therapy involving islet transplantation may be the answer, as most of the people who have undergone the procedure no longer need insulin.
Islet cells are clusters of cells in the pancreas that contain beta cells, which produce insulin. In Type 1, these cells are diminished because the body's own immune system attacks them. By transplanting islet cells back into the body, researchers hope to eliminate the need for insulin to control blood sugar. The most recent issue of the journal Diabetes (volume 51, pages 2148-2157, July 2002) includes a study on this treatment.
Researchers from the University of Alberta in Edmonton in Alberta, Canada have recently released information from follow-up studies on 17 people who have received transplanted islet cells. Of the 15 people who have been followed for at least one year, 9 no longer take insulin. Among those who have been followed for two years, 4 out of 6 no longer take insulin. Although several study participants needed to resume insulin therapy, half of these only take 50% of the insulin they took prior to the transplant.
Although these are promising results, there have been several negative side effects associated with the transplant. These include blood clots, bleeding, higher cholesterol levels, and an increase in creatinine, which can indicate kidney disease. The procedure is only suitable for a small group of people with Type 1, those who are unable to control blood sugar levels through any other means. Scientists hope that further research will lead to safer procedures so that the number of people who are eligible to receive the transplant will expand. The number of people who can receive the transplant is also limited by a shortage of available pancreatic cells.
  
Insulin-Producing Stem Cells
Stem cells, which are cells that have the capacity to develop into any body cell, are seen as a potential cure for diseases such as diabetes because they may be able to replace the cells whose loss leads to the disease. New research shows that stem cells that are treated with a particular hormone may be even more likely to succeed in treating diabetes.
Recently, researchers from Massachusetts General Hospital in Boston took human islet stem cells and exposed them to the hormone glucagon-like peptide-1 (GLP-1). This hormone is released in the intestines as a response to food intake, and helps regulate blood sugar levels. As a result, the islet stem cells began producing insulin.
The study gives the researchers hope that the transplanting of insulin-producing cells from a person's own stem cells will prevent rejection by the immune system. In addition, further exposure to GLP-1 may help maintain the function of these cells and even lead to the production of additional cells.
The researchers, who have published their findings in the journal Endocrinology (volume 143, August 2002), say that much more research needs to be conducted before this experimental procedure could be attempted in humans.
Heart Disease Risk Prior To Type 2
One of the many health problems associated with Type 2 diabetes is an increased risk for cardiovascular disease. However, a new study shows that even those who have "pre-diabetes" and have not yet been diagnosed with Type 2 have a greater risk of heart problems.
This new information comes from follow-up work done by scientists at the Harvard School of Public Health on a long-term study of 117,629 female nurses. When the study began in 1976, only 1,508 of the participants had Type 2 diabetes. Over the next 20 years, 5,894 more women developed the disease. There were also 1,556 heart attacks, 1,405 strokes, 815 deaths from heart disease, and 300 deaths from stroke.
The researchers adjusted for risk factors that lead to both cardiovascular disease and diabetes (such as obesity), and still found that those who were subsequently diagnosed with Type 2 diabetes had a greater risk of having a heart attack or stroke prior to diagnosis. This may be explained by insulin resistance, which often precedes diabetes.
These findings have been published in the journal Diabetes Care (volume 25; pages 1129-1134, 1142-1148; July 2002). The study authors recommend that people who are obese or have a family history of Type 2 diabetes consult their physicians regularly to determine if they are insulin resistant. Also, people with Type 2 diabetes should make changes in their diet, exercise, and blood pressure levels through medication, if needed.
Ethnicity May Influence Heart Failure Effects
Not everyone experiences heart failure in the same manner, and a new study shows that there may be differences along lines of ethnicity.
In the study, conducted by researchers from Emory University in Atlanta, Georgia, 316 whites and 82 African Americans diagnosed with heart failure were followed for six months. All of the participants were at least 50 years old, and all were interviewed regarding their family income level and expenses, access to healthcare, and level of physical functioning before being hospitalized. Death rates and the need for re-hospitalization were similar in the two ethnic groups. However, there were differences in the participants' ability to complete daily activities.
Overall, about 38% of the African Americans in the study experienced functional decline, while only 25% of the whites did. While the researchers are not clear on the reasons behind this, they did find that there were other differences between the two groups that probably play a part. For instance, the African American participants had less education and income, as well as more financial stress, than did the white participants. Also, about 50% of the African American participants had minimal or no health insurance, while only 18% of the whites had this disadvantage. In addition, the African Americans were more likely to have a history of high blood pressure, kidney disease, and diabetes, and to be overweight.
These results have been published in the American Heart Journal (volume 143, pages 1058-1067, July 2002).
New Cardiovascular Guidelines
The American Heart Association (AHA) has recently updated their guidelines for cardiovascular care, calling for much more aggressive prevention of stroke and heart attack.
One of the new recommendations is that doctors should evaluate a person's risk of developing cardiovascular disease within the next 10 years following the person's 40th birthday. This evaluation should be repeated at least every five years after age 40, and should begin even earlier when a person has cardiovascular risk factors.
The guidelines also spell out the actions people can take to decrease their risk of cardiovascular problems. These include refraining from smoking, avoiding secondhand smoke, eating a healthy diet, keeping weight to a healthy level, and exercising for at least 30 minutes on most days. In addition, people should keep their blood pressure below 140/90, and that people with kidney disease, heart failure, or diabetes should keep it even lower. People who do not have more than one risk factor for cardiovascular disease should keep their levels of LDL ("bad") cholesterol under 160 mg/dL, and those with more than one risk factor should keep the levels lower.
The guidelines also call for an increased use of aspirin to prevent heart attack and stroke. People who have a high risk of cardiovascular disease should take 75-160 mg of aspirin per day, even if they have not previously had a heart attack or stroke. In addition, people with an irregular heart rhythm known as atrial fibrillation should take blood thinners to decrease their likelihood of having a stroke.
The guidelines can be viewed in the online version of Circulation: Journal of the American Heart Association (10.1161/01.CIR.0000020190.45892.75).
Can Alcohol Protect Arteries?
There have been numerous studies conducted both to prove and disprove the claim that drinking alcohol has health benefits. The latest of these studies asserts that drinking one or two alcoholic drinks per day may decrease the risk of artery disease in people with Type 2 diabetes.
The study was conducted by researchers at Yamagata University in Japan, and involved 200 adults with Type 2 diabetes. Study participants were questioned about their drinking habits, and then underwent a procedure called aortic pulse wave velocity to determine the stiffness of the heart's main artery. The researchers found that those who drank one or two drinks per day had less aortic stiffness than those who drank heavily and those who didn't drink at all.
The researchers are not sure why moderate drinking may be associated with less artery stiffness. They postulate that it may be because alcohol may thin the blood and increase "good" cholesterol levels. The study authors say that further research is needed to determine if alcohol really can reduce arterial stiffness, as arterial stiffness increases the likelihood of heart attack and stroke. Their study has been published in the journal Diabetes Care (volume 25, pages 1223-1228, July 2002).
The American Diabetes Association currently recommends that men with diabetes don't have more than two drinks per day, and that women don't have more than one drink per day.
Marital Happiness May Help With Diabetes
Type 2 diabetes is a complicated disease that often requires major lifestyle changes in order to maintain good health. According to the results of a new study, people are more likely to adjust well to their disease and have a better quality of life with it if they have happy marriages.
The study was conducted by doctors at the State University of New York Upstate Medical University in Syracuse, and has been published in the journal Diabetes Care (volume 25, pages 1154-1158, July 2002). The researchers interviewed 78 adults with Type 2 diabetes who had been married for an average of 21 years. A follow-up interview was conducted two years later. Overall, the participants' levels of marital adjustment and intimacy predicted their satisfaction with their quality of life with diabetes, as well as their emotional response to their disease.
Participants who said that they had high levels of intimacy in their marriage at the first survey were more likely to say that they had an increased sense of satisfaction with their diabetes care two years later. The researchers believe that this may be because the people who are able to work to maintain a good marriage are also able to work to manage their diabetes. Also, their partners are more likely to be supportive of their efforts to maintain good health. The researchers encourage healthcare workers to take into consideration a person's relationships, and to be aware that if there are relationship problems, the person may have more difficulty in adapting to having diabetes.
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