New research demonstrates the importance of treating pregnant women with even the mildest forms of gestational diabetes to reduce healthcare risks for both infants and mothers.

Dr. Mark Landon, lead investigator of the multicenter study, and a team of investigators from the Eunice Kennedy Shriver National Institute of Child Health and Human Development conducted a clinical trial to determine if a benefit existed to diet intervention and frequent glucose monitoring in the management of mild gestational diabetes.

The results appear in todays (Oct. 1) issue of The New England Journal of Medicine.

“Treatment is prescribed on a regular basis for most women with gestational diabetes. But we have lacked the evidence until now as to whether treatment of the mildest cases would benefit, or pose risks for, mothers or their newborns,” says Landon, who is also interim chair of obstetrics and gynecology at The Ohio State University Medical Center. “The study confirms that it is worth the time and effort to treat women with even the mildest form of glucose intolerance during pregnancy.”

In most cases of gestational diabetes, a woman receives her diagnosis during pregnancy, and the diabetes does not persist after pregnancy. However, these women have a higher chance of being diagnosed again with adult onset diabetes later in life.

This randomized study included 958 women at 15 medical centers, half receiving treatment for their mild gestational diabetes, and half receiving the usual prenatal care.

Women who received treatment in the study were half as likely to deliver babies with excess body fat and were half as likely to experience shoulder dystocia at birth, occurring when a babys shoulders are caught in the maternal pelvis after delivery of the infants head. The women with treatment also had fewer cesarean deliveries and less preeclampsia, or hypertensive disorders of pregnancy.

The treatment involved a diet plan, together with close monitoring using a portable meter. If a woman in the study received treatment, she performed at least four glucose tests per day, during her fasting and after meals, to be certain that the diet therapy was keeping her blood glucose within the desired target range. Of the women treated, 93 percent were managed with diet intervention alone, whereas only 7 percent required insulin injections to control blood sugar.

If a woman has elevated blood sugar levels during pregnancy, the fetus may also experience high blood sugar levels. As a result, the fetus makes extra insulin, which can lead to excess body fat. Previous studies have suggested that larger babies have an increased frequency of longterm complications such as childhood diabetes and a risk for type II diabetes throughout their lifetime, according to Landon.

“The condition of gestational diabetes may affect up to 14 percent of all U.S. pregnancies,” says Landon. “Recent studies have indicated that the frequency of gestational diabetes is, in fact, increasing in the United States and worldwide. Because of the increasing frequency of gestational diabetes, our study importantly gives hope to affected women that the condition is generally manageable, with dietetic modifications and close monitoring during pregnancy. Considering the potential downstream effects on the infants, treatment at this stage might serve to control the amount of diabetes in the future.”

The study was sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network a part of the National Institutes of Health in addition to the NIHs National Center for Research Resources.

For broadcast quality soundbites and broll of this story, please contact OSU Medical Center Media Relations.

Source Ohio State University Medical Center

The Diabetes UK Media Relations Team was a proud finalist for the Third Sector Excellence Awards in the category of Communications Team.

The other finalists competing for one of the sectors most prestigious awards were the Childrens Society (the winner), Crimestoppers Trust, EveryChild and Macmillan Cancer Support.

Winners were announced at an awards ceremony on 24 September at the Grosvenor House Hotel in London.

Fantastic achievement

“Its fantastic to have made it through to the final stages of such a prestigious award,” said Paul McDonald, Head of Media at Diabetes UK.

Merck & Co., Inc., which operates in many countries as Merck Sharp & Dohme (MSD), has received a positive opinion from the European Medicines Agencys (EMEA) Committee for Medicinal Products for Human Use (CHMP) for JANUVIA® tablets and JANUMET® tablets recommending their use as addon to insulin for the treatment of type 2 diabetes. If adopted by the European Commission, sitagliptin will be the only diabetes treatment in the DPP4 inhibitor class to have an indication for use as addon to insulin in the European Union.

In the United States, JANUVIA is indicated, as an adjunct to diet and exercise, to improve glycemic control in adult patients with type 2 diabetes. JANUMET is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when treatment with both sitagliptin and metformin is appropriate. JANUMET and JANUVIA should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. The labeling for both JANUVIA and JANUMET state that they have not been studied in combination with insulin.

In the United States, a supplemental New Drug Application (sNDA) that is similar to the European proposal concerning the use JANUVIA and JANUMET in combination with insulin has been accepted by the U.S. Food and Drug Administration (FDA) and is currently under review. The use of JANUVIA and JANUMET in combination with insulin is investigational in the U.S.

Sitagliptin is a selective, oncedaily DPP4 inhibitor that enhances a natural body system called the incretin system to help regulate blood sugar by increasing levels of active GLP1 and GIP hormones; it inhibits DPP4 over 24 hours. The fixeddose combination of sitagliptin and metformin targets all three key defects of diabetes insulin deficiency from pancreatic beta cells, hepatic insulin resistance, and overproduction of glucose by the liver. Sitagliptin is the first approved medicine in the DPP4 inhibitor class of oral treatments. It has been approved in more than 80 countries, and to date there have been more than 15 million prescriptions dispensed worldwide.

Selected cautionary information for JANUVIA

JANUVIA is contraindicated in patients with a history of a serious hypersensitivity reaction to sitagliptin, such as anaphylaxis and angioedema. As is typical with other antihyperglycemic agents used in combination with a sulfonylurea, when JANUVIA is used in combination with a sulfonylurea, a class of medications known to cause hypoglycemia, the incidence of hypoglycemia was increased over that of placebo. Therefore, a lower dose of sulfonylurea may be required to reduce the risk of hypoglycemia. Because JANUVIA is renally eliminated, and to achieve plasma concentrations of JANUVIA similar to those in patients with normal renal function, a dosage adjustment is recommended in patients with moderate renal insufficiency and in patients with severe renal insufficiency or with ESRD requiring hemodialysis or peritoneal dialysis. Because there is a need for dosage adjustment based upon renal function, assessment of renal function is recommended prior to initiation of JANUVIA and periodically thereafter. Safety and effectiveness of JANUVIA in pediatric patients have not been established. There are no adequate and wellcontrolled studies in pregnant women. JANUVIA should be used during pregnancy only if clearly needed. It is not known whether sitagliptin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when JANUVIA is administered to a nursing woman.

There have been postmarketing reports of hypersensitivity reactions in patients treated with JANUVIA. These reactions include anaphylaxis, angioedema and exfoliative skin conditions including StevensJohnson syndrome. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Onset of these reactions occurred within the first three months after initiation of treatment with JANUVIA, with some reports occurring after the first dose. If a hypersensitivity reaction is suspected, discontinue JANUVIA, assess for other potential causes for the event and institute alternative treatment for diabetes. There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with JANUVIA or any other antidiabetic drug.

Selected Adverse Reactions for JANUVIA

In controlled clinical studies as both monotherapy and combination therapy with metformin or pioglitazone, the overall incidences of adverse reactions, hypoglycemia, and discontinuation of therapy due to clinical adverse reactions with JANUVIA were similar to placebo. In these clinical studies, the most common adverse reactions reported with JANUVIA (≥5 percent and higher than placebo) were stuffy or runny nose and sore throat, upper respiratory infection and headache. In clinical trials in combination with a sulfonylurea (glimepiride), with or without metformin, JANUVIA demonstrated an overall incidence of adverse reactions higher than that seen with placebo, in part related to a higher incidence of hypoglycemia.

In a prespecified pooled analysis of two monotherapy studies, an addon to metformin study, and an addon to pioglitazone study, the overall incidence of adverse reactions of hypoglycemia in patients treated with JANUVIA 100 mg was similar to placebo (1.2 percent vs. 0.9 percent). Adverse reactions of hypoglycemia were based on all reports of hypoglycemia; a concurrent glucose measurement was not required. In an additional, 24week, placebocontrolled factorial study of initial therapy with sitagliptin in combination with metformin, the incidence of hypoglycemia was 0.6 percent in patients given placebo, 0.6 percent in patients given sitagliptin alone, 0.8 percent in patients given metformin alone and 1.6 percent in patients given sitagliptin in combination with metformin.

Selected cautionary information for JANUMET

The labeling for JANUMET contains a boxed warning for lactic acidosis, a rare, but serious, metabolic complication that can occur due to metformin accumulation during treatment with JANUMET. JANUMET is contraindicated in patients with renal disease, renal dysfunction, or abnormal creatinine clearance; and acute or chronic metabolic acidosis, including diabetic ketoacidosis. JANUMET should be avoided in patients with evidence of hepatic disease. Before initiation of therapy with JANUMET and at least annually thereafter, renal function should be assessed and verified as normal. Patients should be warned against excessive alcohol intake while receiving JANUMET. Patients may require discontinuation of JANUMET and temporary use of insulin during periods of stress and decreased intake of fluids and food such as may occur with fever, trauma, infection or surgery. Patients previously controlled on JANUMET who develop laboratory abnormalities or clinical illness should be evaluated promptly for evidence of ketoacidosis or lactic acidosis. The reported incidence of lactic acidosis in patients receiving metformin hydrochloride is very low (approximately 0.03 cases/1000 patientyears, with approximately 0.015 fatal cases/1000 patientyears). When lactic acidosis occurs, it is fatal in approximately 50 percent of cases.

Metformin and sitagliptin are known to be substantially excreted by the kidney. The risk of metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. Thus, patients with serum creatinine levels above the upper limit of normal for their age should not receive JANUMET. In the elderly, JANUMET should be carefully titrated to establish the minimum dose for adequate glycemic effect, because aging can be associated with reduced renal function. Any dose adjustment should be based on a careful assessment of renal function. Before initiation of therapy with JANUMET and at least annually thereafter, renal function should be assessed and verified as normal.

There have been postmarketing reports of serious hypersensitivity reactions in patients treated with sitagliptin, one of the components of JANUMET. These reactions include anaphylaxis, angioedema, and exfoliative skin conditions including StevensJohnson syndrome. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Onset of these reactions occurred within the first three months after initiation of treatment with sitagliptin, with some reports occurring after the first dose. If a hypersensitivity reaction is suspected, discontinue JANUMET, assess for other potential causes for the event, and institute alternative treatment for diabetes.

As is typical with other antihyperglycemic agents used in combination with a sulfonylurea, when sitagliptin was used in combination with metformin and a sulfonylurea or a sulfonylurea alone, a medication known to cause hypoglycemia, the incidence of hypoglycemia was increased over that of placebo in combination with metformin and a sulfonylurea. Therefore, patients on sitagliptin also receiving an insulin secretagogue (e.g., sulfonylurea, meglitinide) may require a lower dose of the insulin secretagogue to reduce the risk of hypoglycemia.

Clinicians should be mindful that hypoglycemia could occur when caloric intake is deficient, when strenuous exercise is not compensated by caloric supplementation, or during concomitant use with other glucoselowering agents (such as sulfonylureas and insulin) or ethanol. Elderly, debilitated, or malnourished patients and those with adrenal or pituitary insufficiency or alcohol intoxication are particularly susceptible to hypoglycemic effects.

There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with JANUMET or any other oral antidiabetic drug.

Selected Adverse Reactions for JANUMET

The most common adverse reactions reported in >/= 5 percent of patients started simultaneously on sitagliptin and metformin and more commonly than in patients treated with placebo were diarrhea, upper respiratory tract infection, and headache.

About Merck

Merck & Co., Inc. is a global researchdriven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through farreaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a notforprofit service.

ForwardLooking Statement

This press release contains “forwardlooking statements” as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements are based on managements current expectations and involve risks and uncertainties, which may cause results to differ materially from those set forth in the statements. The forwardlooking statements may include statements regarding product development, product potential or financial performance. No forwardlooking statement can be guaranteed and actual results may differ materially from those projected. Merck undertakes no obligation to publicly update any forwardlooking statement, whether as a result of new information, future events, or otherwise. Forwardlooking statements in this press release should be evaluated together with the many uncertainties that affect Mercks business, particularly those mentioned in the risk factors and cautionary statements in Item 1A of Mercks Form 10K for the year ended Dec. 31, 2008, and in any risk factors or cautionary statements contained in the Companys periodic reports on Form 10Q or current reports on Form 8K, which the Company incorporates by reference.

JANUVIA is a registered trademark of Merck & Co., Inc., Whitehouse Station, New Jersey, USA

Scientists expect a new mathematical model of chronic wound healing could replace intuition with clear guidance on how to test treatment strategies in tackling a major publichealth problem.

The Ohio State University researchers are the first to publish a mathematical model of an ischemic wound a chronic wound that heals slowly or is in danger of never healing because it is fed by an inadequate blood supply. Ischemic wounds are a common complication of diabetes, high blood pressure, obesity and other conditions that can be characterized by poor vascular health.

An estimated 6.5 million people in the United States are affected by chronic wounds, and many are at risk of losing limbs or even dying as a result of the most severe of these wounds.

Modeling by mathematicians with expertise in biomedical processes has become increasingly important in the health sciences. The modeling reduces the need for guesswork and timeconsuming animal testing traditionally required as researchers pursue prevention, diagnosis and treatment of complex diseases.

“Before you treat any problem successfully, you have to understand it,” said Chandan Sen, professor and vice chair for research in Ohio States Department of Surgery and a senior author of the study. “Now that we have this model, we can take the next step to find what factors in the equations can be finetuned to the point where the net result is improvement in the ischemic wound outcome.”

The modeling research appears this week in the online early edition of the Proceedings of the National Academy of Sciences.

The mathematical model, to date, simulates both nonischemic wounds those typical of wounds in healthy people with good circulation and ischemic wounds. The current model produced results that generally match preclinical expectations that a normal wound will close in about 13 days, and that 20 days after the development of an ischemic wound, only 25 percent of the wound will be healed.

The model also showed that normal wounds have higher concentrations of proteins and cells expected to be present during the healing process, while ischemic wounds lack oxygen and remain in a prolonged inflammatory phase that interferes with the subsequent cascade of events required to begin wound closure.

Sen, also executive director of the Comprehensive Wound Center at Ohio State, recently published a report about a biological preclinical model of an ischemic wound that his lab designed using the skin on a pigs back. The new mathematical model, a system of partial differential equations, borrowed some data from the animal model, but also includes numerous calculations assigning values to the various cells and chemicals involved in the woundhealing process.

“Wound geometry is complicated because it is threedimensional,” said Avner Friedman, a senior author of the paper and a Distinguished University Professor at Ohio State. “It would be infeasible to perform our computations within the framework of this geometry. However, we used some mathematical ideas to reduce the problem to a simpler geometry without giving up any of the important aspects of the process.”

It is not just the wound that is threedimensional, the researchers noted. The complexity of this process is compounded by the fact that the woundhealing model must take into account both the total space occupied by the wound and the time required for the healing process.

Wound healing under normal conditions occurs in four overlapping stages haemostasis, when platelets make clots to stop bleeding and release chemicals that attract cells to the wound; transient inflammation, when a variety of white blood cells go to work to kill infectious agents and generate growth factors needed for repair; proliferation, when new blood vessels form and when cells produce a bed, called the extracellular matrix, on which the repair occurs; and remodeling, which can take years, as the repaired wound site gains strength.

Sen and colleagues have spent years studying the characteristics of wounds and the intricate details of the healing process. Oxygen is a known essential element to the healing process, and highpressure oxygen chambers are used to treat some wounds. But for ischemic wounds, oxygen alone isnt enough.

Scientists know that reduced blood flow to a wound site means that oxygen, important nutrients and circulating cells are not finding their way to the wound to initiate healing. Researchers hope that manipulating mathematical models of these conditions could offer guidance on how to approach this problem without the time and trialanderror required in biological studies on animals.

“Were not just considering what type of therapy should be used for these wounds. It is the specifics of when and how you apply it those are the details that matter,” Sen said. “Mathematical algorithms provide more pointed data that biologists can use to develop hypotheses.”

Developing the biological model was an important start, Sen and Friedman noted. To create an animal model of an ischemic wound, researchers had to strike a careful balance so they reduced blood flow to the wound site without killing all the surrounding tissue by cutting off too much blood. Sen said the 8millimeterwide cylindrical puncture wounds rest on what the researchers consider an “island” of skin receiving too little blood to effectively deliver healing cells and chemicals to the wound. Details about the animal model are published in the May issue of the journal Physiological Genomics, a publication of the American Physiological Society.

In developing the mathematical model, Friedman worked with first author Chuan Xue, a postdoctoral researcher in Ohio States Mathematical Biosciences Institute, to assign values to variables in the first two stages of wound healing. These included oxygen concentration, concentration of growth factors, density of white blood cells that fight pathogens, density of fibroblasts that perform part of the repair, and density of tips and sprouts of tiny new blood vessels.

The two also modeled the extracellular matrix the bed on which cells work to close the wound in a way that allows for the matrix to change the way it functions over time. This part of the model also allowed for simulation of the exertion of pressure a characteristic of certain types of ulcers that people with diabetes are prone to develop.

Xue noted that the equations were borrowed from the mathematical theory of homogenization by manipulating a single parameter called parameter alpha to draw the distinction between ischemic and nonischemic wounds in the model. This is one example, Friedman noted, of simplifying the model without leaving out important biological details.

This work is supported by the National Science Foundation, the National Institutes of Health and the Center for Clinical and Translational Science at Ohio State.

Source
Chandan Sen

A study exploring the healing of diabetic skin ulcers using topical oxygen/ozone gas mixtures could not proceed to completion and was now abandoned, according to Ozonics International, LLC, a veteranowned biotechnology company engaged in the research and development of ozonebased medical therapies. “This fully scientific study, a worldfirst in its scope, was to be performed in Egypt, recruiting the collaboration of U.S. and Egyptian experts,” said Gerard Sunnen, MD, Ozonics president.

Egypt has a diabetic population estimated at 5 million. The prevalence of diabetes is rising rapidly in the Middle East. 20% of diabetics develop skin lesions such as leg ulcers, and 15% of those will eventually require amputation. In the U.S., out of 24 million diabetics about 80,000 undergo lower limb amputations yearly.

“Pilot research studies have shown that topical oxygen/ozone treatment can dramatically reduce these amputation numbers,” Dr. Sunnen emphasized, adding, “The FDA has already approved topical oxygen for skin healing in diabetes and vascular conditions. This proprietary technology adds a natural elements remarkable antimicrobial properties to accelerate wound resolution. No other antimicrobial can claim such wide range of action against the entire spectrum of woundinvading bacterial and fungal families, nor claim such unwavering defense against bacterial resistance, the bane of all antibiotics.”

Other reported unique features of ozone include its ability to neutralize wound bacterial and fungal toxins well known to inhibit healing and to enhance local circulation via the activation of nitric oxide, in biochemical pathways shared by drugs like sildenafil (Viagra).

The study, named “Safety and efficacy of ozone therapy in the treatment of diabetic skin ulcers A randomized double blind controlled clinical study,” was to be sponsored by the University of Cairo, and endorsed by the National Research Centre, Cairo, the Egyptian National Institute for Diabetes and Endocrinology, and the Egyptian National Cancer Institute.

“The New York State Department of Health (NYSDOH), despite its denials, has long shown adversity to complementary medicine and to ozonebased medical therapies in particular, and research initiatives have suffered. Another U.S. medical ozone company, for example, had to back off from its groundbreaking clinical investigations on hepatitis C and now focuses on ozone disinfection of hospitals. NYSDOHs interference has proven to be a potent deal breaker. Inhibition of medical ozone development, possibly motivated by commercial interests, is done by discouraging potential business partners from collaborating with U.S. based medical ozone companies and by discrediting U.S. researchers and entrepreneurs. Germany, Italy, Japan and Russia are consequently now far ahead of the U.S. in the development of these forwardlooking biotechnologies.”

Dr. Sunnen concluded, “Let us hope that the abandonment of this study will only be temporary and that research avenues will unlock. Diabetics need not suffer the travails of protracted skin ulcer treatments, often experienced as interminable. Amputations devastate the body and often profoundly demoralize patients. Looking into the future, research in oxygen/ozone topical therapies will find applications in all manner of acute and chronic wound care, including diabetic and pressure ulcers, circulatory skin lesions, postsurgical wounds, and complex accident and war wounds.”

A team of French scientists have found the dose of DHA (docosahexaenoic acid) that is “just right” for preventing cardiovascular disease in healthy men. In a research report appearing in the September 2009 print issue of The FASEB Journal, the scientists show that a 200 mg dose of DHA per day is enough to affect biochemical markers that reliably predict cardiovascular problems, such as those related to aging, atherosclerosis, and diabetes. This study is the first to identify how much DHA is necessary to promote optimal heart health.

“This study shows that regularly consuming small amounts of DHA is likely to improve the health status of people, especially in regards to cardiovascular function,” said Michel Lagarde, coauthor of the study.

To determine the optimal dose of DHA, Lagarde and colleagues examined the effects of increasing doses of DHA on 12 healthy male volunteers between ages of 53 and 65. These men consumed doses of DHA at 200, 400, 800, and 1600 mg per day for two weeks for each dose amount, with DHA being the only omega3 fatty acid in their diet. Blood and urine samples were collected before and after each dose and at eight weeks after DHA supplementation stopped. The researchers then examined these samples for biochemical markers indicating the effects of each dose on the volunteers.

“Now that we have a very good idea about how much DHA is just right, the next step is to try it out in an expanded clinical trial that involves many more people,” said Gerald Weissmann, M.D., EditorinChief of The FASEB Journal. “Until then, Ill stick with tasty foods that contain DHA, like fish, rather than getting a quick fattyacid fix at the local vitamin store.”

Source
Cody Mooneyhan

A team of French scientists have found the dose of DHA (docosahexaenoic acid) that is “just right” for preventing cardiovascular disease in healthy men. In a research report appearing in the September 2009 print issue of The FASEB Journal, the scientists show that a 200 mg dose of DHA per day is enough to affect biochemical markers that reliably predict cardiovascular problems, such as those related to aging, atherosclerosis, and diabetes. This study is the first to identify how much DHA is necessary to promote optimal heart health.

“This study shows that regularly consuming small amounts of DHA is likely to improve the health status of people, especially in regards to cardiovascular function,” said Michel Lagarde, coauthor of the study.

To determine the optimal dose of DHA, Lagarde and colleagues examined the effects of increasing doses of DHA on 12 healthy male volunteers between ages of 53 and 65. These men consumed doses of DHA at 200, 400, 800, and 1600 mg per day for two weeks for each dose amount, with DHA being the only omega3 fatty acid in their diet. Blood and urine samples were collected before and after each dose and at eight weeks after DHA supplementation stopped. The researchers then examined these samples for biochemical markers indicating the effects of each dose on the volunteers.

“Now that we have a very good idea about how much DHA is just right, the next step is to try it out in an expanded clinical trial that involves many more people,” said Gerald Weissmann, M.D., EditorinChief of The FASEB Journal. “Until then, Ill stick with tasty foods that contain DHA, like fish, rather than getting a quick fattyacid fix at the local vitamin store.”

Source
Cody Mooneyhan

The Hormone Foundation, the public education affiliate of The Endocrine Society, in collaboration with the National Alliance for Caregiving, released key findings from a firstofitskind survey aimed at better understanding the daily needs and struggles of unpaid caregivers of people with diabetes.

The online survey completed by 1,002 respondents in April 2009 found that the major challenges in caring for those with diabetes include exercise and diet compliance, patient depression and maintaining target sugar levels. Caregivers reported that the physician is their top information source, followed by the Internet. However, while 73 percent of caregivers reported using the Internet to obtain diabetes information, many expressed frustration in evaluating the quality and reliability of online content.

Specific survey findings include More than half of respondents (54 percent) struggle with dietrelated issues like cooking, meal planning and noncompliance;

Nearly half of respondents (49 percent) reported challenges with medical management of diabetes; and

Twelve percent of respondents reported their own stress and emotional health as a significant concern. “Caregivers are involved with a wide range of diabetesrelated responsibilities and as a result, many report some social and personal health sacrifices due to their caregiving,” said Gail Hunt, president and CEO of the National Alliance for Caregiving. “The more information we have to understand the issues and burdens caregivers experience, the better equipped we will be to provide them with meaningful assistance.”

“This survey identified many important needs among caregivers of adults with diabetes, but this is only the first step,” said Alvin M. Matsumoto, MD, chair of The Hormone Foundation Committee that spearheaded the survey initiative.

“To address the needs identified through the survey, the Foundation will be creating Diabetes Caregiver Central®, an easytouse Web site containing the most uptodate information relevant to diabetes caregivers. The new Web site will serve as a comprehensive onestop shop including resources and information about diabetes; diet and exercise; optimizing blood sugar control; managing complications and coexisting illnesses; and handling patient and caregiver stress and mental health,” said Matsumoto.

Diabetes Caregiver Central® is expected to go live in the fall of 2010.

Additional findings from the survey suggest that 92 percent of respondents are often dealing with other conditions in addition to diabetes caregiving; women caregivers are more likely than men to have their mental and physical health affected by their caregiving role; and finally, women caregivers are more likely than men to seek information on diabetes caregiving.

The research for this survey was conducted by Richard Day Research, Inc. and was supported by an educational grant from Eli Lilly and Company.

Source
Arlyn Riskind

Treatment to lower high systolic blood pressure in nondiabetic patients is associated with a reduction in left ventricular hypertrophy (LVH), a thickening of the heart muscle that can lead to heart failure and rhythm problems. Thus, a lowering of systolic blood pressure targets from the currently recommended 140 mm/Hg or less to below 130 mm Hg should be the treatment goal in lowrisk patients with high blood pressure, concludes an Article published in this weeks edition of The Lancet.

Despite a lack of evidence, hypertension guidelines recommend that blood pressure be lowered to less than 140/90 mm Hg. Evidence from previous trials does lend support to a blood pressure target of below 130/80mm Hg in highrisk patients with cardiovascular disease or diabetes. However, the level to which systolic blood pressure should be lowered in patients without high cardiovascular risk has not been evaluated in clinical trials. Indeed, there is currently no evidence to support a lower treatment target in patients with high blood pressure without diabetes.

For the first time, Paolo Verdecchia from the Hospital S. Maria della Misericordia and ANMO Research Centre in Italy and colleagues conducted a randomised trial to examine the cardiovascular effects of a systolic blood pressure target below 130 mm Hg (tight control) compared with a target below 140 mm Hg (usual control) in nondiabetic patients with hypertension.

In total, 1111 nondiabetic patients aged 55 years or older with a systolic blood pressure of 150 mm Hg or higher were recruited from 44 centres in Italy between 2005 and 2007. Patients were randomly assigned to a target systolic blood pressure of less than 140 mm Hg (553) or less than 130 mm Hg (558). Antihypertensive drugs were used to lower bloodpressure and tailored to individual patients needs. Blood pressure was checked every 4 months for 2 years and at the final 2year visit patients were tested for LVH.

Over 2 years, tight (

Compared with patients with moderately controlled glucose levels, diabetic patients who have heart failure and either too high or too low glucose levels may be at increased risk of death, said researchers at Baylor College of Medicine in a report published in the current issue of Journal of the American College of Cardiology.

To determine average glucose levels in the blood over a two to three month period, doctors measure glycosylated hemoglobin (the oxygencarrying protein in the blood that is bound to the sugar glucose). In general, higher levels have been associated with increased risk of heart disease, said Dr. David Aguilar, assistant professor of medicine cardiology at BCM.

“Most doctors try to keep glucose levels of those with diabetes as low as they can to lower the risk of complications such as eye problems, kidney disease or the development of heart disease,” said Aguilar, senior author of the study. “However, we found that in diabetic patients with heart failure, glucose levels slightly higher than what are normally recommended had the lowest risk of death.”

Researchers at BCM and the Michael E. DeBakey Veterans Affairs Medical Center in Houston identified 5,815 veterans with heart failure and diabetes who were receiving treatment at VA medical centers across the nation. They followed the patients for two years, dividing them into five categories based on their glycosylated hemoglobin levels.

Most medical professionals recommend levels at 7 and below as the target for optimal health for diabetic patients. However, the results of the study of diabetic patients with heart failure showed that those with levels 7.1 to 7.8 had the lowest rate of death. Those patients at both ends of the spectrum had the higher death risks.

“This doesnt mean that diabetic patients with heart failure should change their target goal for glucose levels,” Aguilar said. “The results could simply be telling us that the glycosylated hemoglobin levels are a marker for other risks that are contributing to increased risk of death, but not necessarily the cause of the problem.”

Aguilar said the correlation needs to be further investigated to confirm the findings and see what other factors could be contributing to the mortality rate.

The research is supported by a V.A. Health Services Research and Development Service grants and a National Institutes of Health Mentored Career Development Award.

Other researchers who took part in this study include, Drs. Biykem Bozkurt, Kumudha Ramasubbu and Anita Deswal, all from the Winters Center for Heart Failure Research and Section of Cardiology, and the Department of Medicine at BCM. Deswal is also at the Houston Center for Quality of Care and Utilization Studies at the Michael E. DeBakey V. A. Medical Center in Houston.

Source
Graciela Gutierrez