<![CDATA[Type 2 Diabetes - Health.com]]> en daily 1 <![CDATA[Daily Aspirin Riskier Than Thought, May Change Some Heart-Attack Prevention Guidelines]]>
Drug and Therapeutics Bulletin.

About 50 million Americans take low-dose (325 milligrams per day or less) aspirin to prevent cardiovascular problems. Some do so even though they don’t have heart disease or a history of heart attack or stroke, an approach known as primary prevention.

Currently, the American Diabetes Association (ADA) recommends low-dose aspirin for primary prevention in people with diabetes who are at risk for cardiovascular disease—but this will be changing. (Diabetes can dramatically increase the risk of developing heart disease.)

“Because of some recent studies suggesting that the benefit is not very large, and because aspirin can also have risks (intestinal bleeding or hemorrhagic stroke), the January 2010 recommendations will recommend it mostly for higher-risk people than was the case in the past, when it was recommended for people with more moderate levels of risk and above," says M. Sue Kirkman, MD, the vice president of clinical affairs for the ADA.

The authors of the new analysis say there’s not enough evidence to justify the routine use of low-dose aspirin to prevent cardiovascular disease in apparently healthy people, including those with elevated blood pressure or diabetes.

Dr. Kirkman stresses that people with diabetes who are taking aspirin—and have no history of heart attack—should talk to their doctor and see if he or she recommends continuing the therapy.



“There isn't a strong rationale to take people off it if they're doing fine,” she explains.

Although aspirin thins the blood and helps prevent clots, it is not risk free, according to the U.K. review led by a panel of experts.


Next Page: Who can benefit?
For example, the researchers looked at two large studies of people with diabetes (one with 1,276 participants and the other with 2,539) and found that those who took 81 to 100 milligrams of aspirin daily were just as likely to have a heart attack or stroke in the next four to seven years as those who did not.

Aspirin can cause gastrointestinal bleeding and other problems—some of them serious. People who take aspirin daily are two to four times as likely to have upper gastrointestinal problems, such as an ulcer with complications, than those not taking aspirin (even if the aspirin is buffered or has a protective coating to limit stomach problems). Although aspirin can prevent clots, which cause about 80% of strokes, it may increase the risk of hemorrhagic strokes, which are caused by bleeding in the brain.

“This article synthesizes what many people in the field are beginning to feel: The risks of daily aspirin therapy exceeds the benefits in people who have not had a heart attack,” says Steven E. Nissen, MD, the chairman of cardiovascular medicine at the Cleveland Clinic, in Ohio.

The American Heart Association recommends daily low-dose aspirin for people who have had a heart attack, for those with heart disease–related chest pain known as unstable angina, or those who have had a clot-related stroke (or those who have had ministrokes, episodes that suggest a stroke is imminent). In general, the risk of heart attack has to be 10% within the next decade to warrant daily aspirin use, the group says.

In 2004, a U.S. Food and Drug Administration advisory panel rejected the idea of using aspirin for primary prevention.

“If you have had a heart attack, bypass surgery, or a history of coronary artery disease, the benefits of daily aspirin therapy do outweigh the risks,” Dr. Nissen says. “If you never had a heart attack or heart disease, you need to be at very high risk to benefit from daily low-dose aspirin therapy.”

So who falls into this very high-risk category?

According to Dr. Nissen, “the right person would likely have a cluster of risk factors for heart disease, such as diabetes, smoking, high cholesterol, and high blood pressure,” he says. “Once you have a cluster of risk factors, you start to look like someone who has already had a heart attack.”

The bottom line? “Do not take daily aspirin therapy on your own,” Dr. Nissen advises. “This review article emphasizes the need for a dialogue between a patient and provider about the benefits and risks,” he says. Risks include gastrointestinal bleeding and a small, but potentially devastating, risk of bleeding in the brain.

“You can’t ignore the risk side to the equation,” Dr. Nissen says.]]> Istockphoto <![CDATA[Diabetes Drug Byetta Tied to Kidney Problems, Says FDA]]>
U.S. Food and Drug Administration (FDA) reported this week.

The drug’s label will be updated to warn doctors and patients about this possible side effect.

Byetta (exenatide) is a relatively new drug and was approved to treat type 2 diabetes in 2005. It’s known as an incretin mimetic and is a synthetic version of a compound found in the venom of a Gila monster, a lizard in the southwestern United States.

Doctors wrote almost 7 million Byetta prescriptions between 2005 and 2008. The drug is injected, and patients and doctors tend to like it because it’s easier to inject than insulin and can promote weight loss in some people.

In 2007, Byetta was linked to a higher risk of acute pancreatitis, a potentially life-threatening inflammation of the pancreas. The symptoms are severe abdominal pain that is sometimes accompanied by nausea and vomiting.

In general, side effects of Byetta can include diarrhea, nausea, and vomiting, which may contribute to changes in kidney function, says Richard Hellman, MD, the past president of the American Association of Clinical Endocrinologists, and a clinical professor at the University of Missouri–Kansas City School of Medicine.

“It is thought that the main reason nausea occurs is the effects of Byetta on the stomach,” he says. “If someone starts vomiting, they can lower the volume of fluid in their body. If it gets to dangerously low levels, their kidneys could be damaged and kidney failure could take place.”

The FDA received 78 reports of kidney problems related to Byetta, including kidney failure, between April 2005 and October 2008. Some patients already had kidney disease before they started the drug, but others developed kidney problems after taking Byetta. Overall, 91% of patients were hospitalized, 18 required dialysis, two had kidney transplants, and four died. Eighty percent stopped taking Byetta, and half of those patients had an improvement in kidney function after stopping the drug.

“The 78 cases represent a small percentage of the total number of patients using the drug to control blood sugar (glucose) levels,” according to the FDA.

People with type 2 diabetes should always be aware of the signs of kidney damage, as high blood sugar is a leading cause of kidney disease.

Although kidney problems sometimes cause no symptoms at all, the symptoms can include changes in urine color, swelling that starts in the feet and legs, fatigue, nausea or vomiting, and trouble sleeping. Patients with any of these symptoms should talk to their doctor. If left untreated, kidney damage can worsen and turn into kidney failure, which can have serious effects on the heart, brain, and bones.

“Before any patient takes Byetta, they should ask their physician whether they have decreased function of their kidneys,” Dr. Hellman says, “and whether their kidneys are functioning well enough that taking Byetta would not be hazardous to their health.”]]> (DAILY-DIABETIC.COM) <![CDATA[5 Things You Should Do After a Type 2 Diabetes Diagnosis]]>

Or you could have experienced symptoms such as blurry vision or excessive thirst, or just happened to find out from a routine blood test during a checkup.

However you are diagnosed, it's difficult to make instantaneous lifestyle changes. Most people need to gather their wits, talk to the experts and get up to speed on a confusing array of medical terms.

But there are a few things you need to do right way.
  • Don't let the past haunt you. Type 2 diabetes is partly genetic; many people have childhood memories of grandparents or other relatives with diabetes who died after amputations, blindness, heart attacks, or strokes. A lot has changed in recent years. Previous generations had no way to test their blood sugar at home, little or no medication options, and no knowledge about the benefits of diet and exercise. You have tools to control diabetes they could only dream of.
  • Don't go on a crash anything. Moderation and consistency are crucial in type 2 diabetes. You'll learn how to eat at consistent times, limit your total calories, and space your carbohydrate intake out throughout the day. Even exercise needs to be done on a routine, because it can lower blood sugar too. "People who have wild swings in their diet or wild swings on their activity level—that actually makes it more difficult to manage the diabetes," says William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta.

Next Page: Stay positive
  • Don't beat yourself up about it. It's natural to ask yourself—"What did I do?" The important part is to move past this. You could feel bad or guilty, but the more quickly you move on to "What can I do about this?" the better. "You feel that it's your fault, that you did something wrong," says Nancy Janow, 54, of South Orange, N.J. "Maybe you should have lost those few pounds extra that you're carrying. But would it really have made a difference? Or would it have just delayed it?" With more thought and education, Janow realized that, "No, it's not anything I did. It's just who I am. And I've learned to live with it," she says.
  • Don't panic. Many people are horrified when they hear the word diabetes. It could be the idea of using insulin needles, pricking their finger to test blood sugar, or never eating a piece of cake again. There are a lot of myths floating around about type 2 diabetes (such as you can never eat cake). Look to a diabetes educator or other people with diabetes to help fill in the details on what you can eat, whether insulin hurts, or how hard it is to prick your own finger. Most people find these aren't as bad as they expected.
  • Don't be too rigid about treatment options. You may feel that you never want to take oral medication or insulin. Or you may think you could never control diabetes with diet and exercise. The American Diabetes Association recommends that patients initially treat type 2 diabetes with lifestyle changes (improved diet, more exercise, and weight loss) and the oral medication metformin. What works best will depend on your individual circumstances. Sky-high blood sugar at diagnosis? You may have to take insulin before trying to control blood sugar with diet and exercise. The most important thing is to do whatever it takes to lower your blood sugar to safe levels—with diet, exercise and medication, if necessary—so that you can start lowering your risk of complications right away.

    If you need insulin at first, you may not need it permanently. "Insulin is an important tool for controlling type 2 diabetes. It can be used at diagnosis and then, as glucose levels improve, it can be replaced with pills. Insulin is then always available for use when glucose levels get out of hand and extra help is needed," says Katie Weinger of the Joslin Diabetes Center in Boston.

    Overall, 15% of people with type 2 diabetes don't take any medication (controlling blood sugar with diet and exercise alone), and 57% take oral medications alone, without injected drugs like insulin.

    Sixteen percent of people with type 2 diabetes take insulin only, and 12% use a combination of insulin and oral medication.

]]> It's natural to ask yourself—"What did I do?" The important part is to move past this. (ISTOCKPHOTO/HEALTH) <![CDATA[Treating Mild Pregnancy-Related Diabetes Is Good for Mom, Baby]]>

As many as 14% of pregnant women in the U.S., or about 200,000 women annually, develop gestational diabetes. This pregnancy-related diabetes can cause the fetus to grow too rapidly, and the excess weight can make delivery difficult and lead to complications. What’s more, gestational diabetes increases the risk of fetal death and preeclampsia, a potentially life-threatening rise in blood pressure in the mother.

However, the benefits of treating gestational diabetes are somewhat controversial; although most obstetricians screen and treat pregnant women for blood-sugar abnormalities, the 2008 guidelines of the U.S. Preventive Services Task Force has said there is not enough strong evidence for or against screening and treating gestational diabetes.

“Almost all obstetricians do screen for gestational diabetes, but some of them have not been particularly aggressive about treating milder cases, reserving aggressive treatment for people with higher blood-glucose results,” says lead study author Mark Landon, MD, of Ohio State University Medical Center, in Columbus. “For them, this study serves as notice that aggressive treatment with diet alone is useful for even mild gestational diabetes cases.”

Gestational diabetes can be treated with dietary restrictions, the oral drug metformin, or insulin injections. Dr. Landon says that, unfortunately, some women diagnosed with the condition are not even given a real meal plan to follow; instead they are simply advised to watch their sugar intake.

In the study, published in the New England Journal of Medicine, 958 women diagnosed with mild gestational diabetes between 24 and 31 weeks of pregnancy were divided into two groups; half were treated for diabetes, half were not. Women were considered to have mild gestational diabetes if they had an abnormal result after taking an oral glucose-tolerance test (a test in which women drink a sugary liquid and blood sugar is measured at regular intervals), but their fasting glucose level (a test in which blood sugar is measured after fasting) was below 95 milligrams per deciliter. Many doctors treat gestational diabetes only if it is more severe, generally considered to be 95 milligrams per deciliter or higher.

The new research, a partnership of 14 different institutions, showed that women were half as likely to have larger-than-normal babies if they were treated. For example, 14% of women who weren’t treated had a baby that weighed more than 8 pounds, 13 ounces, compared with only 6% who were treated.


Next Page: The newborns also had fewer cases of shoulder dystocia
The newborns also had fewer cases of shoulder dystocia (1.5% with treatment vs. 4% without treatment), a potential emergency in which the birthing process stalls due to entrapment of the infant’s shoulders—a problem that’s more likely if a newborn is larger-than-normal. Women who were treated had fewer cases of high blood pressure or preeclampsia (8.6% vs. 13.6%) and were less likely to need a Caesarean section (about 27% vs. 33.8%) than women who were not.

David Sacks, MD, a maternal fetal medicine specialist at Kaiser Foundation Hospital, in Bellflower, Calif., says there is a disconnect between public health organizations and what doctors practice in terms of gestational diabetes. Most U.S. obstetricians have assumed that testing and treating the condition is beneficial, and the American Diabetes Association recommends screening for the condition.

“Gestational diabetes has been somewhat of an enigma for the last four decades because the benefits of treating it were not substantiated by strong evidence,” explains Dr. Sacks, who wrote an editorial that was published with the study. “Now we know that it’s a treatable disease and that’s supported by solid science.”

Although treatment regimens are fairly well-established, Dr. Sacks says that exactly when women should be treated for gestational diabetes is still unclear. Whereas the current study used a fasting-glucose-test threshold of less than 95 milligrams per deciliter in women with an abnormal oral glucose tolerance test, another large-scale randomized trial published in 2005 by Australian researchers showed similar benefits using a much higher threshold of 140 milligrams per deciliter. “A uniform definition of gestational diabetes mellitus is necessary to make valid comparisons of the results of intervention trials,” writes Dr. Sacks.

According to Dr. Landon, new criteria for the testing and treatment of gestational diabetes are being considered and may eventually lead to more women being treated for the condition.

Most women in the U.S. are screened for gestational diabetes between 24 to 28 weeks of pregnancy but may be tested even earlier if they are very obese, have a strong family history of the condition, or if they had gestational diabetes or gave birth to a large baby during previous pregnancies. If a one-hour oral glucose test is positive for elevated blood sugar, then women generally undergo a similar three-hour test in order to be diagnosed.

Although gestational diabetes usually goes away after a woman gives birth, women who have the condition are 50% more likely to develop type 2 diabetes within the next 20 years. For that reason, the American Diabetes Association recommends occasional blood-sugar testing, a healthy diet, and regular exercise even after childbirth.]]> Getty Images <![CDATA[Tennis Legend Billie Jean King in Match With Type 2 Diabetes]]>

King is not only managing her own diabetes, but she is also active in the fight to raise awareness about the disease and is the spokesperson for the Face of Change campaign, a traveling photo exhibit that includes personal stories about diabetes.

Nearly 24 million people in the United States have diabetes, and 90% of them have the type 2 form of the disease. Unlike type 1, an autoimmune disease that requires daily insulin injections to survive, people with type 2 can sometimes keep their blood sugar in the safe range by careful eating (mostly by managing carbohydrate intake) and exercise. However, as the disease progresses, many people will need to take pills or insulin injections to keep their blood sugar from creeping into the danger zone.

King is plenty busy. She’s still active in tennis, blogging about current tournaments at World Team Tennis, an organization she helped found. (She recently compared Melanie Oudin’s run at the 2009 U.S. Open, which is being played at the national tennis center that bears King’s name, to Chris Evert’s 1971 U.S. Open Tournament.)

Still, King took time to sit down with Health.com to talk about her experiences with type 2 diabetes.

Q: You’ve been living with type 2 diabetes for nearly two years. How has it changed your life?
A: I’ve been really trying to cut down on [carbohydrates]. I’m trying to pay attention to my intake. Because I love to eat. I just have to deal.

Q: Most people think type 2 diabetes can only strike obese people with a sedentary lifestyle—not world-class athletes. As an athlete, was your diabetes diagnosis a surprise?
A: No. I have type 1 diabetes in my family, even though type 1 is autoimmune and type 2 is more genetic. I’ve known a lot about diabetes all my life. I had a friend in second grade, Fraser Brandt, and that’s how I started to learn about the disease because he had to take injections. That was the early ‘50s. I started asking questions with him.

Anyone can develop diabetes, even an athlete. For example, the Novo Nordisk Donnelly Awards are grants given to four tennis kids with diabetes. It’s fantastic. The awards are named after tennis players Diane Donnelly Stone and Tracey Donnelly Maltby, who both worked at World Team Tennis. Diane got type 1 when she was 6 and Tracey when she was 14. So I wanted to do something for them.

Diabetes is something that’s been in my life and that now I’m dealing with personally.


Next Page: Managing the disease
Q: How are you managing the disease?
A: I exercise a lot. I also find if I get enough sleep that helps me a lot because I don’t eat as much. Obviously, getting exercise and taking my medication and testing my blood.

Q: How often do you test your blood sugar?
A: Fortunately, I only have to test about once or twice a day. My blood sugar is pretty good most of the time—if I’m eating right, exercising, and taking my medication. [King takes metformin, one of the most commonly prescribed pills for diabetes.]

Q: What’s your exercise regime like?
A: I have weights at home and a stationary bike. I’ll do the bike and I’ll go to the gym. I have bad knees, so my days of heavy weight bearing are over. I try to do resistance training for my upper and lower body.

My goal is to get back on the tennis court. I’m getting close. I had an operation last year and had to start over. I couldn’t use my core for 10 weeks. I’m getting to the point where I can finally get back to the tennis court. It absolutely makes me happy when I can hit the ball.

Tennis is so good for diabetes. We’ve had several examples of professional tennis players with diabetes. Billy Talbert lived into his 80s. Ham Richardson lived into his 70s. They lived much longer than the normal lifespan for diabetics, I think, because of the tennis and taking good care of themselves. They never got overweight. And they were very conscientious. In doing so, they were great examples for all of us.

I just loved watching them play. In the old days, they’d change ends and they’d just guzzle down a Coke. Uh, oh, they’re blood sugar was low. It must have been such guesswork in those days compared to what we can do now.

Q: What’s the best advice you’ve gotten about diabetes?
A: I’m 65 now and on Medicare. If you’re that age, you qualify for a free diabetes test. Ask your doctor. I didn’t know that. I think the main thing is getting everyone tested.

Q: Being a world-class athlete, did you find it ironic to get type 2 diabetes, a disease often associated with poor diet and exercise habits?
A: Not really. I have an eating disorder; I was a binge eater. I don’t binge eat anymore, but for about 10 years, I was being very cruel to my poor little pancreas.

Then I also had diabetes in my family.

Q: Now that you have diabetes, are you concerned about other health issues?
A: I’m worried about what it can do if I don’t take care of myself. I know it’s the leading cause of blindness and I know there are other complications.

Q: What’s tougher—living with diabetes or beating Bobby Riggs?
A: [Laughing] That was a long time ago. That was over 35 years ago. I think it’s the daily thing of living with diabetes. It’s been around me my whole life, people with type 1 and type 2. You can live a great life with the disease, but you have to pay attention and do the right things to manage it.

Q: What’s the hardest thing to adjust to living without?
A: Bagels. I’d love to have bagels. But those are treats now. Portion control. Eat less, less often. I do a lot better when I don’t eat something like a bagel every day. That kind of sets up my taste buds to want it.

The main thing is to get my exercise in. And I try to really enjoy my eating time. I try to eat slower. I used to eat really fast and I didn’t know when I was full. So I really try to pay attention now.]]> (LIFE.com) <![CDATA[Symlin Can Help Curb Post-Meal Blood-Sugar Boosts in Diabetics]]>

It is the first in a new class of drug called amylinomimetics.

Symlin is for people who use insulin at mealtimes but still have trouble controlling their blood sugar. It slows down the transit of food through your stomach, which helps curb the post-meal boost in blood sugar.

"It causes some nausea at times, but keeps my blood glucose from spiking really high," says Jan Chait, a 60-year-old freelance writer in Terre Haute, Ind. "It can also make you feel full, so you don't eat as much."

]]> (DIABETESNET.COM) <![CDATA[4 Key Treatment Strategies for Type 2 Diabetes]]>
]]> <![CDATA[How Avandia and Actos Help Control Type 2 Diabetes]]>

This relatively new class of drug helps combat insulin resistance by making your body more sensitive to insulin. The first thiazolidinedione was approved for sale in the U.S. in 1997. It was sold under the brand name Rezulin (troglitazone), but was pulled from the market in March 2000 due to the risk for severe liver problems.

Avandia and Actos were approved by the U.S. Food and Drug Administration in 1999.

In 2007, a study suggested that Avandia was associated with an increased risk of heart attack and heart failure, a condition in which the heart becomes enlarged and pumps inefficiently. Shortly after, another study found that Actos also boosted the risk of heart failure, although it reduced the risk of heart attack, stroke and death overall. Both studies were widely covered in the news.

The U.S. Food and Drug Administration added a "black box" warning to the class of drugs in 2007, noting that they should not be used in people with heart failure. And in 2008, the U.S. Food and Drug Administration and GlaxoSmithKline notified doctors and pharmacists that patients must now receive a medication guide in each Avandia prescription (a step reserved for drugs that "pose a serious and significant public health concern").

"There's a concern about the link between heart disease and the use of thiazolidinediones," says Dace Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. "There's a concern that [the drugs] will cause heart failure and that's always been a known risk but it's a bit more surprising that there's a link to heart attacks. It's not clear how strong that linkage is."

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