Diabetes News - November 28th, 1999

Exciting Progress In Non-Invasive Monitoring
Poor Diabetes Control Increases Gum Disease
Type 2's Need To Know About Insulin Resistance  
Inactivity Costs Estimated At Over $24 Billion/Yr
Best Kidney Care: White, Not-For-Profit Center

Exciting Progress Reported In Non-Invasive Monitoring

The research was intended to verify their NIR method, and included over 1,700 readings in 10 people without diabetes, and in 2 people with Type 1 diabetes. Although their system automatically identified and rejected 4.2% of these measurements as outliers, the remaining measurements, done every five minutes, were remarkably accurate. The average blood sugar produced by the NIR device varied by less than 5 mg/dl from lab values, with a correlation coefficient of 98% as shown in the graph. 

The instrument was able to give whole blood glucose values in real time, and the researchers say that further testing, done in higher blood sugar ranges where the NIR signal is stronger, have gone without a problem. Most of the readings using the device were done after calibrating the NIR device with a blood sugar test. However, some testing done without this calibration step appeared to be nearly as accurate.

This research appears as a breath of fresh air in the beleaguered NIR area that was given a foul smell after two private firms involved in developing near infrared monitors were accused of fraud or sued by disgruntled investor in 1996.

There are many hurdles to overcome, however, before we see a product on store shelves. The medical school's lab setup, which includes a Tungsten halogen infrared light source, a finger probe, a BioNIR spectrophotometer, and a portable computer running MATHLAB software, still has to be miniaturized for convenient use. Reliability of the device also needs to be verified in people with different skin colors, callus thickness, various degrees of protein glycosylation, and states of hydration. This type of measurement is also sensitive to the amount of pressure between the device and the finger being tested, but there are a number of ways to solve this problem.

If the device proves to be this accurate in wider testing, it will be the first device that opens the door to true non-invasive testing of blood glucose. It is believed that the same technology could also open the door to non-invasive measurement of many other important organic compounds. Read more about NIR in our Non-Invasive Technology section.

Poor Diabetes Control Increases Gum Disease

A new study finds that poor diabetes control increases a person's risk of gum disease, but high blood sugars may not be the direct cause, according to the Journal of Periodontology. Researchers acknowledge that high blood sugars can lead to infection and slow healing. But other recent research suggests that a stronger link between poor control and poor oral health may be the high levels of fat typically found in the blood when blood sugars are high.

The study, conducted by lead researcher, Dr. Christopher Cutler of Baylor College of Dentistry in Dallas, Texas, shows that people with diabetes often have high levels of fats, such as cholesterol and triglycerides, in their blood. After following 35 people with and without diabetes, who were given dental tests to study their risk for gum disease, researchers found high levels of harmful inflammatory proteins called cytokines, as well as reduced levels of proteins that help fight infections called growth factors in the mouths of people whose diabetes was poorly controlled. In the study, the same people also had higher levels of triglycerides, a mobile form of fat, in their blood.

Dr. Cutler and his associates believe that the higher blood triglycerides levels may be more directly connected to gum disease, because in other studies researcher have found that people without diabetes who eat high-fat diets also have an increased risk of developing gum disease. Regardless, the people who are at risk of gum disease, either because of diabetes or due to an unhealthy diet, will need good dental care at home, along with regular visits to their dentist or dental hygienist to reduce their odds of developing gum disease. Regular checks for gum disease are especially important for anyone who has high triglyceride levels, and this includes most people with Type 2 diabetes.

Type 2's Need To Know About Insulin Resistance

A new nationwide survey says that people with Type 2 diabetes who do not understand or have never heard of insulin resistance are more likely to be in poor control.

The telephone survey released by the American Association of Diabetes Educators was conducted by Yankelovich Partners among more than 1,000 people with Type 2 diabetes over the age of 45. The significant findings of the survey are that nearly two-thirds of the participants either do not understand or have never even heard of insulin resistance, believed to be the major underlying cause of Type 2 diabetes.

What is the impact of this lack of knowledge? These same two-thirds have substantially poorer blood glucose control as evidenced by HbA1c levels above 7%, blood glucose levels above 140, and less likelihood of taking a thiazolidinedione (TZD) than patients who understand insulin resistance. TZD's are a new class of Type 2 diabetes drugs that directly target insulin resistance. The American Diabetes Association (ADA) recommends that patients keep their HbA1C levels close to normal range (4 to 6 percent) and their blood sugar levels close to 126.

According to the survey, 18 percent of people who correctly defined insulin resistance had an HbA1C level of less than 7, a desirable range, compared to 8 percent of those who could not provide a correct definition. Likewise, patients who correctly defined insulin resistance were more likely to report a blood sugar level of less than 140 than those who could not.

In the telephone survey, the participants were asked questions about their diabetes and treatment, their HbA1C and blood glucose levels, and sources of information about their disease. Most people who were interviewed reported that modified diet and exercise (88 percent) and oral medication (84 percent) are part of their current treatment. Many participants (72 percent) want more information about how to manage their condition, but 75 percent do not make an effort to seek support. Many more are aware of their blood sugar level (92 percent) than their HbA1c (25 percent). Only 28 percent of participants have discussed insulin resistance with a healthcare professional. The results suggest more education is greatly needed. 

Click here for more information about insulin resistance, and to learn how to tell What Type of Diabetes you have.

This survey was conducted through an educational grant provided by SmithKline Beecham Pharmaceuticals. For information about Type 2 diabetes or to find out how to contact a diabetes educator in your area, please call 1-800-TEAM-UP-4 (800-832-6874) or go to the AADE Website.

Inactivity Costs U.S. At Least $24 Billion A Year

A novel new study has found that inactivity in the U.S. costs an estimated $24.3 billion a year--and that this cost could be an underestimate.

Researcher Graham A. Colditz of Brigham and Women's Hospital in Boston searched Medline's online database for research that estimated the cost of diseases or conditions related at least in part to lack of exercise. These are high blood pressure, heart disease, stroke, diabetes, hip fractures, and cancers of the breast and colon, as determined by other studies. He then computed what part of the health care cost could be attributed to inactivity. His final figure of almost $24 billion was staggering.

This study, published in a journal published by the American College of Sports Medicine called Medicine and Science in Sports and Exercise, also determined that all of these costs could be avoided if people who are inactive simply participated in 30 minutes of moderate activity on most days of the week. This is the minimum amount of activity recommended by the federal government.

The cost of inactivity could actually be higher because the data was collected in 1995, the year in which the federal Centers for Disease Control and Prevention estimated 28 percent of Americans do no exercise. In this year inactivity caused 22 percent each of coronary heart disease, colon cancer and hip fractures, as well as at least 12 percent of the diabetes cases. The situation may have worsened since inactivity is believed to have increased since 1995, along with the increase in obesity.

Costs could also be higher for another reason. If state-level reports are used instead of federal, the estimated number of people who are inactive, or who participate in some activity but not enough to improve their health, rises to 52% of the U.S. population. If this level of inactivity is used, the estimated cost of inactivity rises to $37.2 billion (3.7 percent of direct health care costs). Also, other medical conditions that the study did not analyze could affect total cost.

Before undertaking this exercise study, Colditz had already examined costs for obesity, and in this exercise project he also updates his figures on obesity. Estimating that 23 percent of Americans are obese, he finds that the cost of obesity is now approximately $70 billion, or 7 percent of 1995 total health care costs.

Best Kidney Care: Whites At Not-For-Profit Centers

Two new studies published in the New England Journal of Medicine reveal disparities in treatment for people with kidney failure. The first research, done at Harvard Medicine School, shows that whites are nearly twice as likely to get a kidney transplant as blacks. The second study, conducted at Johns Hopkins School of Medicine, finds that patients at not-for-profit dialysis centers are more likely to get on a transplant waiting list and less likely to die than dialysis patients going to for-profit centers.

About 240,000 Americans undergo dialysis annually. For most, a transplant can mean a longer, stronger life. In the United States, Medicare generally pays for all kidney transplant costs, averaging $92,000 per person, and also covers 80 percent of dialysis costs, or about $48,000 per person per year. This comes to an annual total of about $12 billion in the U.S.. Medicare rules are that all patients desiring a transplant are to be evaluated and given treatment options equally.

The cause of the racial gap of kidney transplants is difficult to explain, but may be due to prejudice and a breakdown in communication between white doctors and black patients, researchers speculated. After following patients from 1996 through 1998, they found that white patients were about 30 percent more likely to be referred for evaluation for a transplant and were nearly twice as likely to get a transplant or get on a waiting list. When the Harvard researchers asked 1,392 patients whether they wanted kidney transplants, they found that just a few percent more of white patients wanted them than black patients. Other differences between treatment preferences, overall health and socioeconomic factors of patients can explain only about 40 percent of the disparity.

Why are profit-making centers doing a poorer job than not-for-profit centers in getting their patients on a transplant list and keeping them alive? Understaffing in the for-profit centers, which limits patient care and education, may explain the difference, but the study raises the possibility that some profit-making centers may prefer the profit of keeping their dialysis patients on dialysis.

Lead author Dr. Pushkal Garg and his team examined federal data covering about 3,500 patients at dialysis centers in the early 1990s. At that time they found that patients at for-profit centers were 26 percent less likely to get a transplant, or to get a spot on a waiting list within 18 months of starting dialysis. They were also 20 percent more likely to die. For-profits had less staff than other centers, which was one of the ways they seemed to be cutting costs aggressively. Cost cutting has been necessitated because Medicare reimbursements for kidney patients has stayed the same since 1983.

Regardless of the explanation as to the causes of the findings of either study, Medicare has announced that its rules will be strengthened and enforced so that all people with kidney failure will be evaluated equally for transplants and informed of their options. It is not known, in the shifting sands of medical care, whether the discrepancies found in these studies between for-profit and not-for-profit dialysis care, and in referral rates between black and white patients still exist.

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