Friday, January 13, 2012

Grain Fiber and Magnesium Intake Associated With Lower Risk for Diabetes


Higher dietary intake of fiber from grains, cereals, and magnesium, may each be associated with a lower risk of type 2 diabetes, according to a report and analysis in the May 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Projections indicate that the number of people diagnosed with diabetes worldwide may increase from 171 million in 2000 to 370 million by 2030, according to background information in the article. The associated illness, death, and health care costs emphasize the need for effective prevention, the authors write. Fiber may help reduce the risk of diabetes by increasing the amount of nutrients absorbed by the body and reducing blood sugar spikes after eating, among other mechanisms. Current American Diabetes Association guidelines include goals for total fiber intake, but research suggests that some types of fiber may be more beneficial than others. Findings regarding magnesium and diabetes risk remain unclear.

Dr. Matthias B. Schulze, and colleagues at the German Institute of Human Nutrition, conducted a study of 9,702 men and 15,365 women age 35 to 65 years. Participants completed a food questionnaire when they enrolled in the study between 1994 and 1998, then were followed up through 2005—an average of seven years—to see if they developed diabetes. In addition, the researchers performed a meta-analysis of previously published work related to intake of fiber or magnesium and risk of diabetes.
During the follow-up period, 844 individuals in the study developed type 2 diabetes. Those who consumed more fiber through cereal, bread, and other grain products (cereal fiber), were less likely to develop diabetes than those who ate less fiber. When the participants were split into five groups based on cereal fiber intake, those who ate the most (an average of 29 grams per day) had a 27 percent lower risk of developing diabetes than those in the group that ate the least (an average of 15.1 grams per day). Eating more fiber overall or from fruits and vegetables was not associated with diabetes risk, nor was magnesium intake.

In the meta-analysis, the researchers identified nine studies of fiber and eight studies of magnesium intake. Based on the results of all the studies, in which participants were classified into either four or five groups according to their intake of fiber or magnesium, those who consumed the most cereal fiber had a 33% percent lower risk of developing diabetes than those who took in the least, while those who consumed the most magnesium had a 23percent lower risk than those who consumed the least. There was no association between fruit or vegetable fiber and diabetes risk.

"The evidence from our study and previous studies, summarized by means of meta-analysis, strongly supports that higher cereal fiber and magnesium intake may decrease diabetes risk," the authors conclude. "Whole-grain foods are therefore important in diabetes prevention."

Mayo Clinic Islet Cell Transplants to Improve Diabetes after Partial Pancreas Removal


ROCHESTER, Minn.  Sometimes doctors have to surgically remove a portion, or a person's entire pancreas. Infections and inflammation can shut down the pancreas. The natural result when the pancreas fails is diabetes &mdash often called pancreatogenic diabetes. The Mayo Clinic has been experimenting with pancreatic islets in select patients undergoing partial pancreas removal. Its most recent report on the progress of the procedure has found that the procedure shows promise for reducing the effects of diabetes related to pancreatogenic diabetes.

As you know, the pancreas is a gland organ that secretes hormones to regulate blood sugar levels and produces enzymes that break down digestible foods. Pancreatitis causes painful inflammation in the abdomen that occurs when digestive enzymes attack the pancreas, affecting digestion and the hormones that help control blood sugar levels. Severe inflammation of the pancreas can cause separation of the pancreatic duct between the right and left portions of the gland, a condition known as disconnected pancreatic duct syndrome.

"After attempts to control pain and improve malabsorption problems have been exhausted, total or near-total removal of the pancreas is recommended for patients with severe cases of pancreatitis in which pancreas tissue dies," says Santhi Swaroop Vege, M.D., a gastroenterologist at Mayo Clinic. "Such surgery, however, often results in a type of diabetes known as pancreatogenic diabetes."

Pancreatic islet autotransplantation (a transplant using a person's own tissue) is one treatment option to prevent pancreatogenic diabetes caused by pancreatic surgery. The procedure involves isolation and purification of insulin-producing cells (islets) after the pancreas, or a portion of the pancreas, is surgically removed in patients for whom pancreatic cancer is not a concern. The purified islets are then infused in the patient's portal vein, a large vein that carries blood from the digestive tract to the liver. The islets gradually implant in the liver and begin producing insulin.

Approximately 30 medical centers in North America have islet isolation laboratories. At these centers, pancreatic islet autotransplantation is a recommended procedure for patients undergoing total or near-total pancreatectomy. But according to Dr. Vege, half of patients undergoing distal or extended distal pancreatectomy (removal of 50 percent to 70 percent of the pancreas) will also develop pancreatogenic diabetes.

The Mayo Clinic islet autotransplantation team studied whether pancreatic islet autotransplantation is a feasible treatment option for patients undergoing distal or extended distal pancreatectomy after severe pancreatitis and disconnected pancreatic duct syndrome. The team attempted pancreatic islet autotransplantation on seven patients who were undergoing removal of 50 percent to 70 percent of their pancreas. In four patients, the removed portion of the pancreas contained insufficient insulin-producing islets. The remaining three patients received the procedure. Of those, two did not develop pancreatogenic diabetes and one developed a less-complicated case of pancreatogenic diabetes.

"Our initial experience with pancreatic islet autotransplantation in this patient population shows that the procedure is a feasible treatment option," says Dr. Kudva. "Long-term follow-up, expansion to additional patients and research studies will help us better understand the full utility of this procedure."
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Why does this matter to people with diabetes?

If a diabetic person's pancreas is partially or completely failing, islet cell transplantation may be able to help restore some insulin production. As physicians learn how to have higher success rates with islet transplantation, it may be able to help millions of people. However, if insulin resistance is contributing to a person's diabetes, islet transplantation does not directly address the problem. A person confronting diabetic insulin resistance should work with exercise, diet and medication to help their muscles and fat tissue re-energize its ability to use insulin properly.

Chromium Study Does Not Prove Benefit to Diabetes


A study out of the Netherlands, and published in the journal Diabetes Care, found that chromium yeast was not beneficial to people with type 2 diabetes. The study lasted six months and enrolled about 60 patients. Chromium yeast is also known as Baker's yeast.

Chromium has been the subject of a number of studies in conjunction with diabetes. Most of the studies have found that chromium has little or no effect on improving blood sugar measures. However, there was one recent study that showed some benefit from chromium picolinate. Still, one study is not as compelling as all of the studies that proceeded it with disappointing results. We would like to see continuously good science before we can get incredibly excited about chromium. Please check with your doctor. Her or his opinion should weigh more heavily on your decision than our short update here.

Sources: Diabetes Care, ClinicalTrials.gov

Japanese Diabetes Drug May Take Four Years to Make it to USA


A drug company can decide which countries it wants to introduce its drugs into first. Here in the United States, we assume drug companies will introduce them here first. Usually American drug companies introduce drugs in the United States. But drug companies in Europe often apply for approval there. The same holds true with Japan, Israel, and other counties where there are quite a few drug-producing companies.

Glufast, or mitiglinide calcium hydrate, is a diabetes medication from Japan, that has been in use there since 2004. It improves the body's own ability to produce insulin, and has the tendency to lower post-meal glucose levels in its users. However, it is not on the market in the United States. It is not even yet being considered by the FDA for approval. The company that owns the rights to market Glufast in North America, Elixir Pharmaceuticals, Inc., plans to submit a new drug application with the FDA in 2008. This is the way it goes in the global health care system.

Conflicting Interpretations of Data for Diabetes Medication Rosiglitazone


Because of the uproar in the diabetes community fueled by a New England Journal of Medicine (NEJM) last week, the publication decided to release some preliminary findings in an article about an additional study on rosiglitazone (brand name Avandia). But even these preliminary findings are open to a lot of interpretation, and audiences are drawing different conclusions . One of todays' headlines read Diabetes drugmaker cites "reassuring" study, while another national media outlet captioned with Newest Avandia Study Not Reassuring. Even in the New England Journal of Medicine there were three different editorial pieces, all putting forth different interpretations of this data. Keep in mind that this is only preliminary.

We are amazed at what science has accomplished, and its ability to prolong life and heal. We are beneficiaries of that marvel. However, it is still appropriate to recognize that science has its limitations. For the last few weeks we've been confronting one of them. It is challenging enough to measure one issue, like a drug's ability to lower blood sugar levels. (Avandia does it very well.) It is even harder to measure the next generation of questions such as heart attacks. Taking such measures requires years of outcome data from very large numbers of patients.

My Diabetes Information wants science to measure these issues. We are not going to make excuses for adverse events. However, we do want to state that each and every one of us that uses any type of medication needs to realize that science has not been able to uncover or measure many of the risks that exist when we take advantage of the focused benefit that comes in a pill.

Lessons Learned from Popular Diabetes Strategy - Weight Loss Surgery


CHICAGO — There are millions of people battling diabetes that are not able to control their weight using diet and exercise alone. Their genetics and other factors have programmed them to be obese. If they are insulin dependant, insulin may actually make them more prone to be overweight. Medicare has recently begun covering bariatric (weight loss) surgery although significant death rates have previously been reported in Medicare patients undergoing the procedure. However, the risks of death and other complications after bariatric surgery appear similar between patients younger and older than age 60, and also between Medicare recipients and non-recipients, according to a study in the June issue of Archives of Surgery, one of the JAMA/Archives journals.

"Obesity has become the leading cause of preventable death in the United States," according to background information in the article. "Rates of obesity have continued to climb in the last decade across all age groups. Surgery for morbid obesity is currently the most effective treatment." The success of bariatric surgery has expanded the treatment of morbid (severe) obesity and its conditions for patient populations that had not previously been served. Peter T. Hallowell, M.D., and colleagues of University Hospitals Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, reviewed the cases of 892 patients who had gastric bypass surgery from 1998 to 2006. The patients were divided into four groups:

·         Group one, 46 patients age 60 to 66 years was compared with group two, 846 patients age 18 to 59 years.
·         Group three, 31 Medicare recipients (age 31 to 66), was compared with group four, 861 non-Medicare recipients (age 18 to 64).
The age, sex and body mass index of each patient were documented as well as time spent in the operating room, length of stay, other illnesses and complications — including death. When the research team analyzed the data, they found:

·         When comparing older (group one) and younger (group two) patients, the male-female ratios and the BMIs were similar between both groups.

·         The average length of the hospital stay was a half-day longer for group one than for group two.
·         The older group spent an average of 17 minutes less in the operating room than the younger group.
·         There was no statistically significant difference found between the two groups for any postoperative complication or death.

"No mortality was seen in the older group (group one) at 30 days, 90 days or one year. Three deaths occurred within 30 days in the younger group (group two) with one additional death within one year," the authors note.

When comparing Medicare and non-Medicare patients, group three (Medicare patients) had a greater average BMI of 56 and spent an average of 14 minutes longer in the operating room. Medicare patients also spent an average of a day-and-a-half longer in the hospital. There was no significant difference between the two groups for any complication or death after surgery. No Medicare patients died at 30 days, 90 days or one year. Three non-Medicare patients died within 30 days and one additional patient died within one year.

"Bariatric surgery can be performed in carefully selected Medicare recipients and patients 60 years or older with acceptable morbidity and mortality," the authors conclude. "We believe that these results reflect careful patient selection, intensive preoperative education and expert operative and perioperative management. Our results indicate that bariatric surgery should not be denied solely based on age or Medicare status."

If you are considering weight loss surgery, you should consult with your physician that helps you manage your diabetes. Your doctor will have a pretty good idea how beneficial weight loss surgery could be for you, and he or she will be able to weight the risks against the potential rewards.

Source: American Medical Association, Archives of Surgery. 2007;142:506-512.

Being Literate About Your Health Could Save Your Life


Just the fact that you are reading this means that you are looking for medical information. We often refer to health literacy as simply the ability to speak intelligently with your doctor about your condition. We hope My Diabetes Information is helping you maintain your literacy.

A study reported today from Northwestern University suggests that people who are health literate tend to live longer with health conditions than those who do not understand their illness. It seems logical that a person who understands his or her condition could strategize better. It is also likely that he or she would recognize symptoms of potentially dangerous situations and address them.

So, keep reading and learning, and keep listening to your body. It is likely to pay off by improving your physical health, as well as making you feel better.