Monday, June 28, 2010

Diabetes an independent risk factor for vascular disease

New data suggest that although diabetes doubles the risk of vascular disease, elevated fasting glucose has little effect on the risk of coronary heart disease (CHD) or major ischemic events. The results of a meta-analysis of 1.2 million patients in 120 randomized, controlled trials were presented Saturday morning at a special symposium cosponsored by ADA and The Lancet, which published the study in their June 26 issue.
“We’ve known for decades that diabetes is a risk for vascular disease,” said lead author Nadeem Sarwar, PhD, University of Cambridge, United Kingdom. “But how the risk varies by age, sex, and levels of other risk factors remains unknown.”
Sarwar represented the Emerging Risk Factors Collaboration, which designed and conducted the study. The collaboration represents more than 12 million person-years of risk, he said, with a mean follow-up of 10 years.
Analysis of contributed studies showed that diabetes roughly doubles the risk of cardiovascular events regardless of other factors. Having diabetes increases the risk of coronary death by 2.31 times and increases the risk of a nonfatal myocardial infarction (MI) by 1.82 times.
The presence of diabetes also increases the risk for ischemic stroke by 2.27 times, for hemorrhagic stroke by 1.56 times, and for other vascular deaths by 1.73 times.
Overall, the hazard ratios (HRs) for CHD were higher for women than for men and higher in younger (40-59 years) patients than in those 70 years old and older. The HRs were also higher for fatal events compared with nonfatal MIs.
Why diabetes produces a greater risk in groups that would be expected to be at lower risk is not clear, Sarwar said. Diabetes may be associated with more severe vascular lesions, but further study is needed.
“We did not see a linear relationship between fasting glucose and cardiovascular disease,” Sarwar continued. “The risk is essentially flat for serum glucose between 3.9% and 5.6%, then increases sharply.”
The analysis suggests that diabetes is responsible for about 10% of all vascular deaths, roughly 325,000 people annually in the developed world.
“Diabetes doubles the risk for vascular diseases independent of other factors,” Sarwar concluded. “In people who do not have diabetes, fasting glucose is not a useful predictor of vascular disease.”
~ Drug Topics ~

Sunday, June 27, 2010

Diabetes exposure in utero increases risk of early ESRD

Being exposed to diabetes in utero substantially increases the risk of premature end-stage renal disease (ESRD), found Robert G Nelson, MD (left).
The finding comes from a study of Pima Indians 5 to 44 years old with type 2 diabetes, 102 of whom were the offspring of diabetic mothers and 1,748 without diabetes exposure in utero.
“Pima Indians have the highest rate of type 2 diabetes in the world. We’ve been studying the population since 1965, so we have extensive longitudinal data that allows us to look not only at disease in the parents, but in the offspring, and follow them into adulthood,” said Nelson.
An earlier study by Nelson and colleagues showed that exposure to diabetes in utero caused a dramatic increase in the development of diabetes in youth. About one-third of cases of diabetes in young adulthood are attributable to diabetes exposure in utero, he said.
Genetic susceptibility from the mother can partially explain the early onset of diabetes in the offspring, Nelson said. Intrauterine exposure also is associated with higher birth weight and higher weight in childhood and adolescence compared with persons without such exposure.
In the current study, the participants were followed for a maximum of 40 years, from their onset of diabetes until either death, onset of ESRD, or age 45 years.
Fifty-seven of the participants who were exposed to diabetes in utero developed ESRD before age 45, which was 4 times the rate of ESRD compared with controls who were not exposed to diabetes in utero.
Twenty percent of ESRD that occurs in the population before age 45 is attributable to exposure to diabetes in utero,” said Nelson. Assuming this relationship is causal, “if you delayed the development of diabetes until after the onset of childbearing years, you would reduce the incidence of diabetic ESRD by about 20%,” he said.
If the offspring are exposed to diabetes in utero, diabetes prevention efforts in the form of lifestyle modifications (diet and exercise) are needed to slow or prevent the development of diabetes and its complications, Nelson said.
~ Drug Topics ~

Monday, June 14, 2010

Diabetes-related leg amputations could be prevented and need not be costly: IDF

Published: Apr 12, 2010 17:28

Of more than one million lower extremity amputations performed each year worldwide, 70 percent happen to people with diabetes. In India alone, almost 40,000 legs are amputated every year as a consequence of diabetes.

These figures were mentioned by Prof. Jean Claude Mbanya, president of International Diabetes Federation (IDF), in his message to the mid-term continuing medical education (CME) meeting on "high-risk diabetic foot" organized by the Association of Surgeons of India (ASI), UP Chapter and Indian Podiatry Association (IPA) in Kanpur last Sunday.

Mbanya's message, which was also handed out to the media, said the latest data from the IDF indicates that “diabetes affects 285 million people around the world, and is increasingly on the rise.”

“Of the many serious complications that can affect individuals with diabetes, it is the complications of the foot that take the greatest toll," Mbanya said.

On a positive note, he said, amputations could be prevented and need not be expensive.

"Many of these amputations can be prevented. Better education and improved management of foot care can be performed at relatively low costs and have been shown to reduce the number of lower extremity amputations by 50-85%," he said.

And this can be done through a concerted effort involving members of the global diabetes community to increase awareness in levels of health care services worldwide, Mbanya said.

"It is time to reduce the unnecessary suffering that foot complications can bring. With relatively low investment, it is possible to advance education and prevention that will result in lower rates of amputation, and better quality of life for people with diabetes. The time to act is now!" he said.

Mbanya is a professor of medicine and endocrinology at the University of Yaoundé I in Cameroon. He is also the director of the National Obesity Centre University of Yaounde, Cameroon, and chief of the Endocrinology and Metabolic Diseases Unit of Hospital Central in Yaoundé