Cyndrome

Archive for May, 2010

Low-intensity physical exercise at least once a week is enough to significantly reduce the risk for Type 2 diabetes in people aged 70 years or older, report researchers.

However, in those aged 50–69 years, only vigorous/moderate-intensity exercise at least once a week lowered the risk for developing Type 2 diabetes.

Panayotes Demakakos (University College London, UK) and colleagues analyzed data from 7466 participants in the English Longitudinal Study of Aging who were aged 50 years or older without known diabetes at baseline.

The participants reported the amount of exercise they regularly participated in and were categorized as physically inactive, or participating in low- or vigorous/moderate-intensity exercise at least once a week. They were followed up for a mean of 45.3 months for incident Type 2 diabetes.

As reported in the journal Diabetologia, the team found that vigorous/moderate-intensity exercise was associated with a significant 36% reduction in risk for Type 2 diabetes compared with no exercise, but low-intensity exercise was not.

However, when the participants were stratified by age, those aged 70 years or older who participated in low-intensity exercise once a week or more had a significant 47% reduction in risk for Type 2 diabetes compared with participants in the same age group who were physically inactive.

Notably, this was not the case in younger participants (50–69 years), in whom physical activity level needed to be of vigorous–moderate intensity to result in a reduced risk for Type 2 diabetes.

“According to these results, physical activity recommendations for adults aged 70 years and over should encourage participation in any physical activity,” conclude the authors.

Limited health literacy significantly increases the risk for hypoglycemia in patients with Type 2 diabetes, report researchers.

“Limited health literacy has been found to be common among patients with Type 2 diabetes and has been shown to be a barrier to adequate self-management of medication regimens, with less comprehension of medication instructions, dosing, timing, and warnings, which could lead to increased risk for hypoglycemia,” say Urmimala Sarkar (University of California, San Francisco, USA) and colleagues.

They therefore investigated the influence of health literacy, determined using a questionnaire asking patients to report non-vision problems with reading, understanding, and filling out forms, on frequency of significant (losing consciousness or needing assistance from others) hypoglycemia in patients with Type 2 diabetes.

In total, 14,357 adults with pharmacologically treated Type 2 diabetes were enrolled in the Diabetes Study of Northern California (DISTANCE). They were asked to report frequency of significant hypoglycemia in the previous 12 months and complete the health literacy questionnaire.

At least one significant hypoglycemic event in the previous 12 months was reported by 11% of the participants. Around 59% of the cohort were taking insulin and this subgroup was at highest risk for significant hypoglycemia.

A high percentage of people were considered to have limited health literacy. More specifically, 53% had problems learning about health, 40% needed help reading health-related materials, and 32% were not confident filling out medical forms by themselves.

Following adjustment for factors such as age, gender, ethnicity, English proficiency, medication type, diabetes duration, and glycated hemoglobin, patients with learning problems were 40% more likely to experience significant hypoglycemia than those without.

Similarly, participants who needed help reading and those who were not confident filling out forms were 30% more likely to experience significant hypoglycemia than their counterparts who did not have these problems.

“Among ambulatory Type 2 diabetes patients receiving care in a well-integrated, managed-care system, we found that hypoglycemia is a significant problem,” write the authors in the Journal of General Internal Medicine.

“Efforts to reduce hypoglycemia and promote patient safety may require self-management support that is appropriate for those with limited health literacy, and to consider more vigilant surveillance, conservative glycemic targets or avoidance of the most hypoglycemia-inducing medications.”

The 57 million Americans currently living with “pre-diabetes” could benefit from a group weight loss program, like Weight Watchers, according to a new study published in this month’s American Journal of Lifestyle Medicine.Researchers found that after a 6-month Weight Watchers group program, overweight or obese adults who attended at least two thirds of the weekly sessions, not only lost weight, but also significantly reduced fasting glucose and insulin levels – important indicators of diabetes risk.

Sixty-one overweight or obese men and women participated in a 6-month Weight Watchers study that included education on a lower calorie diet (a food plan), exercise (an activity plan) and weekly group support sessions. Not surprisingly, the researchers found that participants who attended the most sessions, had the most success, reinforcing the importance of group support in lifestyle change. In fact, those who attended at least twenty of the twenty-four sessions, lost an average of 14 pounds and had the most dramatic change in glucose and insulin levels associated with diabetes risk, compared to those who attended few sessions.

“We know that previous research programs have successfully reduced diabetes risk using intensive lifestyle treatment,” said Kathleen Melanson, PhD, RD, LD study co-author. “But what we didn’t know is that a program that costs appreciably much less than specially-designed diabetes prevention programs would have a profound impact on the same risk factors for type 2 diabetes. These findings could have important public health potential.”

Type 2 diabetes is closely tied to obesity – and both conditions have increased dramatically over the past 20 years. There are now more than 23 million Americans living with type 2 diabetes in this country. Combined with those who have pre-diabetes, a condition that will likely lead to diabetes without any intervention, the toll on our healthcare system is extensive. According to the Centers for Disease Control, the total cost of treatment of diabetes in the United States exceeds $200 billion, making treatment and prevention a priority for healthcare experts. Yet, the gold standard study on diabetes prevention, the Diabetes Prevention Program Trial (DPP), found that individual lifestyle interventions could reduce the risk of developing diabetes by more than fifty percent.

“Individual lifestyle intervention is obviously successful in reducing the risk for diabetes, but it comes at a high cost, and may not be realistic for all Americans,” said Karen Miller-Kovach, RD, chief scientific officer for Weight Watchers International. “We’re encouraged that the Weight Watchers program, already successful for helping millions of Americans lose weight, could also have the potential to reduce disease risk and even help reduce healthcare burden, for as little as about forty dollars per month, per person.”

According to the American Diabetes Association, “structured programs emphasizing lifestyle changes including moderate weight loss (7% body weight) and regular physical activity (150 min/week), with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes.”

Diabetes significantly increases long-term mortality risk for patients following liver transplantation, say researchers.

Patients with diabetes often have worse health-related outcomes than nondiabetic patients for many medical conditions, but whether this is true for patients undergoing liver transplant is uncertain.

Andrew Samuelson (Stanford University, California, USA) and co-authors carried out a retrospective analysis of 370 patients who underwent liver transplantation at Stanford University Medical Center between 1995 and 2006.

In total, 62 patients had diabetes and 308 did not. Diabetics were older on average than nondiabetics, at 54.4 versus 50.1 years. They also had a higher mean body mass index (BMI), at 28.6 versus 27.1 kg/m2, and a lower Model for End-stage Liver Disease (MELD) score, at 17 versus 19.

Writing in the journal Digestive Diseases and Sciences, the team reports that after 4.5 years of follow-up, 81% of the diabetic group compared with 94% of the controls had survived.

After adjustment for age, BMI, presence of hepatitis C, and MELD score, the presence of diabetes increased the risk for death during follow-up a significant 3.11-fold.
“Diabetes mellitus is an independent risk factor for mortality following liver transplantation,” summarize the authors.

“Further investigation of this relationship should focus on the impact of more intensive pre- and post-liver transplantation glucose control, cardiovascular risk factor reduction, and the effects of accelerated atherosclerosis in the setting of immune suppression,” they suggest.

“Progress in addressing cardiovascular issues for diabetics may also extend survival in nondiabetic patients with significant cardiovascular disease.”

What is Mosaicism?

Every cell in the human body comes from one initial cell: the fertilized egg, which is also called the zygote. After fertilization, the zygote then proceeds to divide. As new cells form, the chromosomes duplicate themselves so that the resulting cells have the same number of chromosomes as the original cell. However, mistakes sometimes happen and one cell ends up with a different number of chromosomes. From then on, all cells originating from that cell will have the different chromosomal number, unless another mistake happens. (All like cells originating from a single type of cell is called a cell line; for example, the skin cell line, the blood cell line, the brain cell line, etc.)

When a person has more than one type of chromosomal makeup, that is called mosaicism, like the mosaic style of art in which a picture is made up of different colors of tiles. In Down syndrome, mosaicism means that some cells of the body have trisomy 21, and some have the typical number of chromosomes.

How is Mosaicism Diagnosed?

The usual way in which mosaic Down syndrome is discovered is through genetic testing of the baby’s blood. Typically, 20 to 25 cells are examined. If some of the cells have trisomy 21 and some don’t, then the diagnosis of mosaicism is made. However, this blood test can only determine the level of mosaicism in the blood cell line.While mosaicism can occur in just one cell line (some blood cells have trisomy 21 and the rest don’t), it can also occur across cell lines (skin cells may have trisomy 21 while other cell lines don’t). In the latter case, it may be more difficult to diagnose mosaicism. When mosaicism is suspected but not confirmed through the blood test, other cell types may be tested: skin and bone marrow are most commonly the next cells checked. Because skin cells and brain cells arise from the same type of cell at the beginning of fetal development (ectoderm), many doctors believe that skin cell tests reflect the chromosomal makeup of the brain cells as well.

How Does Mosaicism Happen in Down Syndrome?

There are two different ways mosaicism can occur:

• The initial zygote had three 21st chromosomes, which normally would result in simple trisomy 21, but during the course of cell division one or more cell lines lost one of the 21st chromosomes.
• The initial zygote had two 21st chromosomes, but during the course of cell division one of the 21st chromosomes were duplicated.

It’s possible to determine the origin of mosaicism in individual cases using special DNA markers, but this isn’t done on a regular basis.

What Does Mosaicism Mean for my Child?

At the present time, there is not much research on the similarities and differences between simple trisomy 21 and mosaic trisomy 21. One report published in 1991 on mental development in Down syndrome mosaicism compared 30 children with mosaic Down syndrome with 30 children with typical Down syndrome. IQ testing showed that the mean IQ of the mosaic group was 12 points higher than the mean of the non-mosaic group. However, some children with typical Down syndrome did score higher on the IQ tests than some of the children with mosaic Down syndrome.The Department of Human Genetics at the Medical College of Virginia has had an ongoing study project of children with mosaic DS. In a survey of 45 children with mosaicism, they found that these children did show delayed development compared to their siblings. When 28 of these children with mosaicism were matched up with 28 children with typical Down syndrome for age and gender, the children with mosaicism reached certain motor milestones earlier than children with typical DS, such as crawling and walking alone. However, the speech development was equally delayed in both groups.

A cold or the flu can make it harder to keep your blood sugar in check. It is recommended that people with diabetes get a flu shot every year. Also, you and your healthcare provider should make a “sick-day” plan. When you’re sick:

• Check your blood sugar four times a day. If it’s higher than 300 mg/dL, use a home test to check your urine for ketones.
• Keep taking your diabetes medicines.
• Drink plenty of water or sugar-free drinks to stay hydrated.
• Try to eat as usual. If your stomach can’t handle it, try clear soups or gelatin.
• Check any over-the-counter medicines for sugar.Ask your pharmacist for sugar-free options.

Call your doctor if your blood sugar is lower than 70 mg/dL several times a week, or if it stays higher than 240 mg/dL. Also, call if you’ve been vomiting or had diarrhea for several hours, or if your urine has high ketone levels.

Besides testing your blood sugar, your doctor may want you to get other tests regularly because diabetes can affect many parts of the body over time. Here are some tests he or she may want you to have:

• Microalbuminuria test. At least once a year, your doctor will test for protein in your urine. A positive test may mean that your kidneys have been damaged by diabetes or high blood pressure. Fever and exercise can raise the protein in your urine short-term, so your doctor may want to repeat this test. He or she may prescribe certain high blood pressure medicine(s).
• Cholesterol. Have your cholesterol and triglycerides levels checked at least once a year. You want your LDL cholesterol to be less than 100 mg/dL (lower, if you have had a heart attack and have diabetes). You want your HDL cholesterol to be over 40 mg/dL for men and over 50 mg/dL for women. Triglyceride levels should be less than 150 mg/dL. If you can’t control your cholesterol with diet and exercise, your doctor may prescribe medicine.
• Blood pressure. Your blood pressure should be tested every time you visit your doctor. People with diabetes should try to keep their blood pressure below 130/80 mm Hg. High blood pressure can cause heart disease, eye disease, stroke, and kidney damage. Again, your doctor may prescribe medicine if your blood pressure doesn’t come down with diet and exercise.
• Feet. You should check your feet every day for calluses, bunions, sores, or discolored skin. These can lead to infections or ulcers, and, in people with severe nerve damage, they can lead to amputations. Your doctor should do a complete foot exam at least once a year.
• Eyes and teeth. Get an eye exam at least once a year. Ask a dentist to check your teeth and gums every six months.