Diabetes News for Dec. 30, 2001
Critical Ways To Lower High Blood Pressure
High blood pressure greatly increases the risk for heart disease, and people who have diabetes have an even greater risk. Several recent studies have focused on ways to minimize heart risk by lowering blood pressure.
Doctors at the National Heart, Lung and Blood Institute in Bethesda, Maryland have conducted a study showing that people who followed a low-fat diet with a lot of fruits and vegetables, and little salt, were able to significantly reduce their blood pressure. This was true even for people who had normal blood pressure. The researchers published their findings in the Annals of Internal Medicine (volume 135; pages 1019-1028 & 1074-1086; December 18, 2001).
The same issue of the journal includes a study conducted by researchers at the Center for Health Research in Portland, Oregon. The study included 412 people of different ages, ethnicities, genders, and levels of blood pressure. The participants were put on a low-fat diet called Dietary Approaches to Stop Hypertension (DASH). The diet includes fruit, vegetables, low-fat dairy foods, whole grains, poultry, fish, and nuts.
In addition to the dietary changes, the participants were also placed into groups whose sodium intake varied. The groups consumed 3.5 grams, 2.3 grams, or 1.2 grams of sodium per day for a month at a time during the 3-month study. Normal daily sodium intake averages 4.5 grams, with most people consuming less than 6.0 grams. Those who consumed the least amount of sodium, and participated in the DASH diet, had the biggest reductions in blood pressure levels, showing a 7.0/3.8 mm Hg drop in those who were over 45 years of age. The results suggest that people can most easily and successfully reduce their blood pressure levels by making dietary modifications.
Other methods of treating high blood pressure include medication. In the same issue of the Annals of Internal Medicine, researchers from Wake University School of Medicine in Winston-Salem, North Carolina discuss the merits of blood pressure drugs. Although some drugs, such as diuretics, have been shown to be effective ways of treating high blood pressure, others have harmful side effects in the Antihypertensive and Lipid-Lowering Treatment To Prevent Heart Attack Trial or ALLHAT Study.
One such drug is doxazosin, which works as an alpha blocker. This drug appears to be effective in lowering blood pressure, but participants in a study of the drug showed a 25% increased risk of cardiovascular disease. As a result, that portion of the study was stopped. Researchers believe that there is a need for studies comparing blood pressure drugs with diuretics.
A fourth report in the journal highlights the need for people with Type 2 diabetes to have aggressive therapy to reduce high blood pressure. Researchers have repeatedly shown that high blood pressure in people with diabetes accelerates kidney failure and cardiovascular problems, such as heart attack and stroke.
Norman Kaplan, M.D., a nationally recognized hypertension expert, professor of Internal Medicine at Southwestern Medical Center in Dallas, and author of the Annals Review Article recommends that people with diabetes keep their blood pressure levels below 130/80. When considering both the benefits and costs of treating high blood pressure, Dr. Kaplan advises angiotensin converting enzyme inhibitors as the first choice for therapy, with long-acting diuretics (such as chlorthalidone) and calcium channel blockers as the second and third choices.
   
6-Month Extension For Pediatric Drug Studies
Since 1997, there has been a law in effect that guarantees exclusivity rights for an additional six months for pharmaceutical companies that conduct studies on the health implications of their products for children. This has led to many new pediatric studies, which were significantly deficient before. Congress is now in the process of voting to extend this program, as well as change the wording to prevent Glucophage from maintaining a monopoly for several more years.
As it stands, the pediatric exclusivity program allows pharmaceutical companies to market their product, without competition from generics, if they study its effects on children. The six months of exclusivity can earn the company millions of dollars of extra revenue. The Senate has passed a five-year extension of this program, and the House of Representatives passed it by a voice vote. President Bush is expected to sign the bill into law.
Some generic companies claim that the program is being abused, most notably by Bristol-Myers Squibb Co., which manufactures the diabetes drug Glucophage. The company has been trying to gain an additional three years of exclusivity because of its pediatric studies. Current legislation would prevent that, and would allow generic versions of the drug to be marketed. However, these generics would be unable to include pediatric information on their labels for three years.
Additional changes in the legislation would make it easier and faster for study information to be passed on to doctors and parents. Also, pharmaceutical companies would need to pay user fees so that they could get faster approval of pediatric information on their products' labels. The new legislation also extablishes a fund to help conduct pediatric studies involving off-patent drugs that would otherwise be ineligible for exclusivity rights.
Surgeon General's Fight Obesity Message
There has been much publicity of late on the subject of obesity, and its ever-increasing rate among Americans. The Surgeon General, David Satcher, has made an announcement about the steps that need to be taken to fight this problem.
A primary focus of the Surgeon General's statement was the role that schools can play in preventing obesity. He says that more schools need to make daily physical education a requirement for all students. In addition, schools should have more healthy food available for students' meals, and limit the number of soda machines on school campuses.
In addition, the Surgeon General urges fast-food restaurants to offer "reasonable portions," since meal sizes seem to be on the rise in such places. Also, Satcher encourages communities to study the marketing policies of fast-food restaurants, since fast food restaurants seem to be more plentiful in poorer neighborhoods.
The Surgeon General also called for communities to make sure that there are safe and easily-accessible places for people to exercise. He hopes that these changes will make it more likely that people will adopt a healthier lifestyle.
Diabetes Healthcare: Frequent Calls And Visits
Because diabetes affects so many people in America, the Agency for Healthcare Research and Quality (AHRQ) has issued a statement on ways to care for the disease properly.
The AHRQ funded a review of 290 research articles that had been published between the years of 1976 and 1994. They found that members of different ethnic groups are far more likely to develop Type 2 diabetes than white people. In addition, African Americans are more likely to have kidney problems as a result of Type 1 or 2 diabetes than white people.
The AHRQ also funded a study of 121 people with Type 2 diabetes and 30 people with Type 1 diabetes. They found that most of the people had good blood sugar control, which was most likely attributable to frequent visits and calls to healthcare providers.
The AHRQ recommends as a result that people with diabetes should maintain careful control of their disease by taking several steps. FIrst, people with diabetes should visit their doctor/nurse practitioner at least four times per year. Also, people should call their healthcare providers with any questions or concerns about their disease. They should also be screened by a dietitian to make sure they are eating well. People should also practice self-monitoring, so they are aware of whether or not their blood sugar is in control.
Birth Weight May Affect Adult Depression
Several studies have shown a link between low birth weight and risk for health problems such as heart disease, diabetes, stroke, and high blood pressure in adulthood. A new study attempts to establish a similar link between low birth weight and depression.
The study was conducted by researchers at the University of Southampton in the UK, who examined the birth record of 882 male babies born at full-term in the 1920s. They also recorded the babies' weight at one year of age. When the participants in the study turned 68, they were asked to complete a questionnaire and be interviewed by a nurse in regards to symptoms of depresion.
Results have been published in the British Journal of Psychiatry (volume 179, pages 450-455), and indicate that those who weighed less than 6.5 pounds at birth were three to four times more likely to be depressed than those who weighed over 8.5 pounds at birth. Men who had weighed 6.5-7.5 pounds at birth were about three times as likely to be depressed, and those who weighed 7.5-8.5 pounds were 2.8 times as likely to be depressed.
The researchers postulate that the reason for the depression in men who had low birth weight stems from poor nourishment in the womb.
Women Need Better Health Care
According to a report issued by the National Women's Law Center, the United States is not doing enough to address and deal with women's health issues.
The group last year released a similar report on women's health issues, including 30 policy issues and 30 healthcare issues. This year's report asserts that only a few states have attempted to address diseases affecting women, such as heart disease and cervical cancer. In addition, the report says that neither the federal government nor the states have done enough to help women gain access to health insurance and medical services. Also, little has been done to curb the rates of women's diabetes, obesity, smoking, or high blood pressure.
The National Women's Law Center encourages both federal and state governments to take steps to improve women's health.
Pregnant Women: Guidelines For Flying
There are many widely-held beliefs about the activities in which pregnant women can safely engaged. However, a new report to be issued by the American College of Obstetricians and Gynecologists (ACOG) may refute some of these.
Currently, international airlines prohibit women from flying after 35 weeks of pregnancy, but the ACOG is now saying that flying is safe for pregnant women up to 36 weeks. Women with health risks such as poorly-controlled diabetes, placental abnormalities, or likelihood of preterm delivery are advised not to fly while pregnant.
The ACOG report also advises that women with heart problems or high blood presure should be prescribed supplemental oxygen while flying, as changes in cabin pressure can lead to increases in heart rate and blood pressure. Also, pregnant women should avoid gas-producing foods or drinks before flying, as gas expands with increased altitude. Pregnant women should consider wearing support stockings while flying to prevent an accumulation of fluid in their legs, and should move their legs periodically to prevent blood clots.
ACOG also refutes the idea that pregnant women should limit their physical activity, and states that these women should engage in at least 30 minutes of moderate activity per day.
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