Category Archives: Diabetes

Apples Beware!

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Annals of Internal Medicine reports that people who have a normal body mass index (weight to height ratio) but abdominal fat are at high risk for heart related deaths.

Using National Health and Nutrition Examination Survey data, researchers studied more than 15,000 adults with BMIs greater than 18.5. Normal being 18-24.

After a mean follow-up of 14 years, waist-to-hip ratio (WHR), but not BMI, was associated with higher overall mortality risk. Among men with normal BMI, those with central obesity had an 87% higher total mortality risk than men without central obesity. Similarly, women with normal-weight central obesity had a 48% higher mortality risk than women with similar BMI but no central obesity.

The recommended waist circumference for men is less than 102 cm, and for women is less than 88 cm.

 

Timing of blood pressure medications and development of diabetes

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According to two Spanish studies in Diabetologia, elevated nighttime blood pressure may promote development of adult onset diabetes, and taking medication to control blood pressure at bedtime, might actually help reduce that risk.

In the first study, 2700 adults who were not diagnosed with diabetes, periodically underwent 48-hour ambulatory BP monitoring. Over 6 years’ median follow-up, 7% developed diabetes. Risk for diabetes was greater with higher levels of sleep-time systolic BP and with smaller BP declines during sleep. Systolic BP during sleep was the second most significant predictor of diabetes, behind fasting glucose.

In the same study group, patients with high BP, were randomized to take at least one of their BP medications before bed or to take all of their BP medications in the morning. Compared with the morning group, the nighttime group had better ambulatory BP control (particularly during night sleep) and was at significantly reduced risk for developing diabetes (12% vs. 5%). When taken at bedtime, angiotensin-receptor blockers, angiotensin-converting-enzyme inhibitors, and beta-blockers showed greater benefit.

 

Double Whammy — Does smoking increase your risk for diabetes?

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Yes, according to an article published in the Lancet Diabetes & Endocrinology. In this meta- analysis, researchers examined data from nearly 90 studies reporting on smoking behaviors and type 2 diabetes; almost 6 million participants and 300,000 diabetes cases were included. The findings were as follows-

Compared to non smokers-

  • Current smokers had a 37% increased risk for diabetes.
  • Former smokers had a 14% increased risk.
  • Those exposed to secondhand smoke had a 22% increased diabetes risk
  • People who quit smoking had a 54% increased diabetes risk in the first 5 years after quitting, this risk increase declined to 11% by 10 years.

 

A Novel Way To Treat Obesity Without A Pill

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The FDA has approved a new device that treats obesity, and works in the gut, by controlling feelings of hunger. The Maestro Rechargeable System is indicated for adults 18 and older with a BMI of 35 to 45 who have at least one obesity-related condition like high cholesterol, high blood pressure, type 2 diabetes and for whom other weight-loss programs have been ineffective.

The device, needs to be surgically implanted into the abdomen, and works on a nerve that emits electric pulses to the brain and blocks  stomach signals of emptiness and fullness. Unfortunately the Maestro did not meet the clinical trial’s primary endpoint (10% more excess weight loss in the treatment group than in the control group); but an advisory panel concluded that its benefits of sustained weight loss outweighed any potential risks.

The manufacturer will conduct a 5-year postapproval study to look at adverse events and changes in obesity-related conditions, among other things. Serious adverse events included nausea, surgical complications, and vomiting.

What does “being healthy” mean in Women?

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An interesting article about young women and their habits– according to a study done by the Journal of the American College of Cardiology, young women with healthy habits are less likely to develop coronary heart disease or cardiovascular risk factors as they age,

They looked at six criteria in women aged 27-44 years of age

nonsmoker

normal body mass index

physical activity of at least 2.5 hours weekly

television viewing of 7 hours or less weekly

moderate alcohol consumption

and a healthy diet —

These women had almost no heart disease and low rates of type 2 diabetes, hypertension, and high cholesterol after 20 years’ follow-up.

Compared with women who met none of the criteria, those meeting all six had a 92% reduction in risk for coronary heart disease and a 66% reduction in CV risk factors. Of note, only about 5% of study participants met all six criteria.

 

Can regular use of Metformin prevent certain types of cancers?

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In a retrospective analysis, using metformin for >3 years reduced
stomach cancer risk by 43% in patients with type 2 diabetes who did
not use insulin.
However, the risk of stomach cancer risk was doubled in insulin users
versus nonusers, regardless of metformin use.

The oral antidiabetic drug metformin has demonstrated anticancer
activity in other studies as well.

Metformin slows prostate cancer growth in adjuvant setting (AACR,
103rd Annual Meeting2012),
boosts survival in ovarian cancer(Mayo Clinic,2012),
exhibits antineoplastic effect in patients with thyroid cancer
(J.Clin.Endoerinol Metab.2013).

Kim Y-I et al. Long-term metformin use reduces gastric cancer risk in
type 2 diabetics without insulin treatment: A nationwide cohort study.
Aliment Pharmacol Ther 2014 Apr; 39:854. (http://dx.doi.org/10.1111/apt.12660
)PubMed abstract.

Which Blood Pressure Medication Is Best For Diabetic Patients?

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Angiotensin-converting–enzyme (ACE) inhibitors are associated with 
reduced mortality and cardiovascular events in patients with diabetes, 
while angiotensin-receptor blockers (ARBs) have little effect, 
according to a meta-analysis in JAMA Internal Medicine.

Researchers assessed the results of 35 randomized, controlled studies 
comprising some 56,000 patients. Participants had been randomized to 
either the active group (ACE inhibitors or ARBs) or a comparator group 
(placebo, no treatment, or other antihypertensive drugs).

Use of ACE inhibitors was associated with a 13% to 17% risk reduction 
in all-cause mortality, cardiovascular mortality, and major 
cardiovascular events. ARB users did not see a similar benefit. 
However, ARBs were associated with a 30% risk reduction in heart 
failure.

The authors conclude that ACE inhibitors “should be considered as 
first-line therapy to limit the excess mortality and morbidity in this 
population.”

JAMA Internal Medicine article