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Grain Fiber and Magnesium Intake Associated With Lower Risk for Diabetes

2012-01-13T17:29:00.000-08:00

Higher dietary intake of fiber from grains, cereals, andmagnesium, 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 InternalMedicine, one of the JAMA/Archives journals.

Projections indicate that the number of people diagnosedwith diabetes worldwide may increase from 171 million in 2000 to 370 million by2030, according to background information in the article. The associatedillness, death, and health care costs emphasize the need for effectiveprevention, the authors write. Fiber may help reduce the risk of diabetes byincreasing the amount of nutrients absorbed by the body and reducing bloodsugar spikes after eating, among other mechanisms. Current American DiabetesAssociation guidelines include goals for total fiber intake, but researchsuggests that some types of fiber may be more beneficial than others. Findingsregarding magnesium and diabetes risk remain unclear.

Dr. Matthias B. Schulze, and colleagues at the GermanInstitute of Human Nutrition, conducted a study of 9,702 men and 15,365 womenage 35 to 65 years. Participants completed a food questionnaire when theyenrolled in the study between 1994 and 1998, then were followed up through2005—an average of seven years—to see if they developed diabetes. In addition,the researchers performed a meta-analysis of previously published work relatedto intake of fiber or magnesium and risk of diabetes.

During the follow-up period, 844 individuals in the studydeveloped type 2 diabetes. Those who consumed more fiber through cereal, bread,and other grain products (cereal fiber), were less likely to develop diabetesthan those who ate less fiber. When the participants were split into fivegroups based on cereal fiber intake, those who ate the most (an average of 29grams per day) had a 27 percent lower risk of developing diabetes than those inthe group that ate the least (an average of 15.1 grams per day). Eating morefiber overall or from fruits and vegetables was not associated with diabetesrisk, nor was magnesium intake.

In the meta-analysis, the researchers identified ninestudies of fiber and eight studies of magnesium intake. Based on the results ofall the studies, in which participants were classified into either four or fivegroups according to their intake of fiber or magnesium, those who consumed themost cereal fiber had a 33% percent lower risk of developing diabetes than thosewho took in the least, while those who consumed the most magnesium had a23percent lower risk than those who consumed the least. There was noassociation 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 cerealfiber and magnesium intake may decrease diabetes risk," the authorsconclude. "Whole-grain foods are therefore important in diabetesprevention."

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

2012-01-13T17:28:00.000-08:00

ROCHESTER, Minn. Sometimes doctors have tosurgically remove a portion, or a person's entire pancreas. Infections andinflammation can shut down the pancreas. The natural result when the pancreasfails is diabetes &mdash often called pancreatogenic diabetes. The MayoClinic has been experimenting with pancreatic islets in select patientsundergoing partial pancreas removal. Its most recent report on the progress ofthe procedure has found that the procedure shows promise for reducing theeffects of diabetes related to pancreatogenic diabetes.

As you know, the pancreas is a gland organ that secreteshormones to regulate blood sugar levels and produces enzymes that break downdigestible foods. Pancreatitis causes painful inflammation in the abdomen thatoccurs when digestive enzymes attack the pancreas, affecting digestion and thehormones that help control blood sugar levels. Severe inflammation of thepancreas can cause separation of the pancreatic duct between the right and leftportions of the gland, a condition known as disconnected pancreatic ductsyndrome.

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

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

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

The Mayo Clinic islet autotransplantation team studiedwhether pancreatic islet autotransplantation is a feasible treatment option forpatients undergoing distal or extended distal pancreatectomy after severepancreatitis and disconnected pancreatic duct syndrome. The team attemptedpancreatic islet autotransplantation on seven patients who were undergoingremoval of 50 percent to 70 percent of their pancreas. In four patients, theremoved portion of the pancreas contained insufficient insulin-producingislets. The remaining three patients received the procedure. Of those, two didnot develop pancreatogenic diabetes and one developed a less-complicated caseof pancreatogenic diabetes.

"Our initial experience with pancreatic isletautotransplantation in this patient population shows that the procedure is afeasible treatment option," says Dr. Kudva. "Long-term follow-up,expansion to additional patients and research studies will help us betterunderstand the full utility of this procedure."

Why does this matter to people with diabetes?

If a diabetic person's pancreas is partially or completelyfailing, islet cell transplantation may be able to help restore some insulinproduction. As physicians learn how to have higher success rates with islettransplantation, it may be able to help millions of people. However, if insulinresistance is contributing to a person's diabetes, islet transplantation doesnot directly address the problem. A person confronting diabetic insulinresistance should work with exercise, diet and medication to help their musclesand fat tissue re-energize its ability to use insulin properly.

Chromium Study Does Not Prove Benefit to Diabetes

2012-01-13T17:27:00.001-08:00

A study out of the Netherlands, and published in the journalDiabetes Care, found that chromium yeast was not beneficial to people with type2 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 inconjunction with diabetes. Most of the studies have found that chromium haslittle or no effect on improving blood sugar measures. However, there was onerecent study that showed some benefit from chromium picolinate. Still, onestudy is not as compelling as all of the studies that proceeded it withdisappointing results. We would like to see continuously good science before wecan get incredibly excited about chromium. Please check with your doctor. Heror his opinion should weigh more heavily on your decision than our short updatehere.

Sources: Diabetes Care, ClinicalTrials.gov

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

2012-01-13T17:26:00.001-08:00

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

Glufast, or mitiglinide calcium hydrate, is a diabetesmedication from Japan, that has been in use there since 2004. It improves thebody's own ability to produce insulin, and has the tendency to lower post-mealglucose levels in its users. However, it is not on the market in the UnitedStates. It is not even yet being considered by the FDA for approval. Thecompany that owns the rights to market Glufast in North America, ElixirPharmaceuticals, Inc., plans to submit a new drug application with the FDA in2008. This is the way it goes in the global health care system.

Conflicting Interpretations of Data for Diabetes Medication Rosiglitazone

2012-01-13T17:18:00.001-08:00

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

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

My Diabetes Information wants science to measure theseissues. We are not going to make excuses for adverse events. However, we dowant to state that each and every one of us that uses any type of medicationneeds to realize that science has not been able to uncover or measure many ofthe risks that exist when we take advantage of the focused benefit that comesin a pill.

Lessons Learned from Popular Diabetes Strategy - Weight Loss Surgery

2012-01-13T17:17:00.001-08:00

CHICAGO — There are millions of people battling diabetesthat are not able to control their weight using diet and exercise alone. Theirgenetics and other factors have programmed them to be obese. If they areinsulin dependant, insulin may actually make them more prone to be overweight.Medicare has recently begun covering bariatric (weight loss) surgery althoughsignificant death rates have previously been reported in Medicare patientsundergoing the procedure. However, the risks of death and other complicationsafter bariatric surgery appear similar between patients younger and older thanage 60, and also between Medicare recipients and non-recipients, according to astudy in the June issue of Archives of Surgery, one of the JAMA/Archivesjournals.

"Obesity has become the leading cause of preventabledeath in the United States," according to background information in thearticle. "Rates of obesity have continued to climb in the last decadeacross all age groups. Surgery for morbid obesity is currently the mosteffective treatment." The success of bariatric surgery has expanded thetreatment of morbid (severe) obesity and its conditions for patient populationsthat had not previously been served. Peter T. Hallowell, M.D., and colleaguesof University Hospitals Case Medical Center and Case Western Reserve UniversitySchool of Medicine, Cleveland, reviewed the cases of 892 patients who hadgastric bypass surgery from 1998 to 2006. The patients were divided into fourgroups:

· Group one, 46 patients age 60 to 66 years wascompared with group two, 846 patients age 18 to 59 years.

· Group three, 31 Medicare recipients (age 31 to66), was compared with group four, 861 non-Medicare recipients (age 18 to 64).

The age, sex and body mass index of each patient weredocumented as well as time spent in the operating room, length of stay, otherillnesses and complications — including death. When the research team analyzedthe data, they found:

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

· The average length of the hospital stay was ahalf-day longer for group one than for group two.

· The older group spent an average of 17 minutesless in the operating room than the younger group.

· There was no statistically significantdifference found between the two groups for any postoperative complication ordeath.

"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 theyounger group (group two) with one additional death within one year," theauthors note.

When comparing Medicare and non-Medicare patients, groupthree (Medicare patients) had a greater average BMI of 56 and spent an averageof 14 minutes longer in the operating room. Medicare patients also spent anaverage of a day-and-a-half longer in the hospital. There was no significantdifference 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-Medicarepatients died within 30 days and one additional patient died within one year.

"Bariatric surgery can be performed in carefullyselected Medicare recipients and patients 60 years or older with acceptablemorbidity and mortality," the authors conclude. "We believe thatthese results reflect careful patient selection, intensive preoperativeeducation and expert operative and perioperative management. Our resultsindicate that bariatric surgery should not be denied solely based on age orMedicare status."

If you are considering weight loss surgery, you shouldconsult with your physician that helps you manage your diabetes. Your doctorwill have a pretty good idea how beneficial weight loss surgery could be foryou, and he or she will be able to weight the risks against the potentialrewards.

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

Being Literate About Your Health Could Save Your Life

2012-01-13T17:16:00.003-08:00

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

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

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

Bone Protein Osteocalcin Also Important to Blood Sugar

2012-01-13T17:16:00.001-08:00

When we pass on scientific experiments from animal studieswe are careful because they do not often turn out the same in humans. However,a recent study from Columbia University Medical Center conducted with micerevealed how important the bone compound osteocalcin is to the endocrinesystem.

Osteocalcin signals the pancreas to create more insulin. Italso signals fat cells to release the valuable compound adiponectin.

The Columbia University scientists point out, "Peoplewith type 2 diabetes have been shown to have low osteocalcin levels, suggestingthat altering the activity of this molecule could be an effectivetherapy."

As the research goes forward, it may reveal how we canimprove skeletal health, and maintain a healthy endocrine system.

Genes May Determine Response to Metformin for Diabetes

2012-01-13T17:15:00.001-08:00

Your genes may be signaling how well you respond tometformin. If you have the right geneticmakeup, metformin may lower your A1C score to a healthy level. A change or variation in gene that tells thebody how to create a small structure with cells call an organic cationtransporter 1 (OCT1) contributes to metformin's effectiveness. (A simplified explanation of an organiccation transporter is a chemical that helps certain atoms to enter a cell.)

In a recent clinical trial, people who had genetic variationsthat reduced the function of OCT1 also had less success at lowering bloodglucose with metformin. This study does not suggest that patients consideringmetformin take a genetic test. Perhaps that will occur someday. For now, ifmetformin is not helping you control your blood sugar, the best strategy may beto combine another medication with it, or switch to a different medictionaltogether. Your doctor will be your best resource for making thisdecision.

The Wall Street Journal published an article about genes andmedications back in August, that is more general than diabetes. It highlightsan individual very sensitive to the blood thinner warafin. It reinforces thefact that there is always a risk with medications, and people can have strangeunforseen reactions. Medicine is amazing in most cases, but it is good torealize that problems can occur.