The randomized, double-blind, placebo-controlled, multicenter study, published in Diabetes Care, investigated the effects of ALA on symptoms in diabetic patients with diabetic neuropathy. Researchers at various institutions in Dusseldorf, Germany administered either 600, 1200, or 1800 milligrams of alpha-lipoic acid or a placebo daily to 181 diabetics with neuropathy, for five weeks. All of the participants initially received a placebo for one week. Tests measuring neuropathy symptoms including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet, were obtained from the participants during the study.

The researchers found that all three ALA groups had a significant decrease in neuroopathy symptoms (including stabbing pain and burning pain), as compared to the placebo group. The ALA groups showed improvement in symptoms within one to two weeks of treatment.

"Oral treatment with ALA for 5 weeks improved neuropathic symptoms and deficits in patients with DSP (distal symmetric polyneuropathy)," the study authors conclude. "An oral dose of 600 mg once daily appears to provide the optimum risk-to-benefit ratio."

REFERENCES:
1. Ziegler D et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care 2006 Nov;29(11):2365-70.

The study, published in the British Medical Journal, investigated the effectiveness of drugs or lifestyle changes to prevent or delay type 2 diabetes in people with impaired glucose tolerance. Researchers from the University of Leicester in England reviewed 17 clinical trials including 8,084 adults with impaired glucose tolerance. The studies were analyzed for the effects of diet and exercise, diabetes drugs, and anti-obesity drugs on men and women with impaired glucose tolerance.

The researchers found that participants who adopted lifestyles changes reduced the risk of developing diabetes by 49 percent, compared to those who received advice only. Diet alone was not as effective as exercise alone or exercise combined with diet. Participants who took oral diabetes drugs reduced the risk of developing diabetes by 30 percent and those who took anti-obesity drugs reduced the risk by 56 percent. Furthermore, diet and exercise lifestyle interventions were found to have significantly fewer side effects than those caused by drugs.

"Lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance," the study authors conclude. "Lifestyle interventions seem to be at least as effective as drug treatment."

REFERENCES:
1. Gillies CL et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 2007 Jan 19; [Epub ahead of print]

Researchers and physicians alike are working to find diagnostic criteria to help determine an individual woman's risk for complications during her pregnancy. This key piece of information found early in the pregnancy can hopefully help to prevent the complications or to prepare the family for a less than optimal outcome.

The greatest risks during a pregnancy complicated by IDDM happen to the developing fetus. Brain damage, birth defects, and even death are a possibility of blood sugar control is poor.

Recent findings published in the journal Diabetes Care found that monitoring a woman's Hemoglobin A1c (HbA1c) during the first trimester can help determine risk of complications for the fetus.

A normal HbA1c level is usually from 4-6 percent. IDDM patients can have HbA1c levels above 10, especially if their diabetes is under poor control. HbA1c levels will increase in response to higher than normal average blood sugar values, especially if the elevation persists over time.

Researchers in Denmark looked at HbA1c levels in more than 530 IDDM pregnant women and compared them to the final pregnancy outcomes.

There was not a large difference in the average HbA1c levels among positive and negative outcome groups. But a trend was observed between HbA1c levels and pregnancy outcome that is highly clinicaly relevant.

For every 1 percent increase in HbA1c, a woman's risk for poor or negative pregnancy outcome increases by 5.5 percent. Women with a HbA1c above 10 have a 1 in 5 chance of a positive or good outcome.

There seems to be more to the association, because women with an HbA1c of 6 percent or less still have a 15 percent chance of a poor outcome.

More research into this area is under way, but for any woman with IDDM the message is clear. Keep good control of the diabetes. It may be helpful to have your HbA1c checked prior to becoming pregnant. Many treatment options for IDDM can lower the HbA1c, thereby potentially increasing the chance that a pregnancy may end well.

Diabetics can develop kidney disease, vision loss, peripheral neuropathy, high blood pressure, and liver disease.

A new study released this last October found that diabetics are also at increased risk for developing anemia, or a deficiency of iron and hemoglobin in the blood. The study was published in the American Journal of Kidney Diseases.

More than 500 Type 2 diabetics were enrolled in the study and followed for five years. At the begining of the study only 12 percent were anemic, but after five years that number more than doubled. The changes were very slow, but enough to prompt the authors to make recommendations about screening.

They suggested that all individuals with Type 2 diabetes be screened for anemia and their annual visit, and that treatment be initiated at first signs of declining hemoglobin levels.

As a side, those diabetics with known kidney damage had increased risk for developing anemia, and the anemia was less insiduous than in other participants.

As with any chronic conditions early detection and intervention improves the outcome dramatically.

The study, presented at the June 10-11, 2006 meeting of the American Diabetes Association in Washington, DC, investigated whether antidepressant drugs are associated with the risk of developing type 2 diabetes. Researchers at the Johns Hopkins Medical Institutions in Baltimore, Maryland analyzed the data of 3,187 overweight participants with impaired glucose tolerance (IGT), as part of the Diabetes Prevention Program (DPP), for three years. At the beginning of the study, 5.7% of participants were taking antidepressants and 13.6% had previously taken antidepressants. Seventy-eight percent of those using antidepressants were taking selective serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors, or serotonin modulators. The participants' symptoms of depression were measured on the Beck Depression Inventory.

The researchers found that there was a two- to three-times greater risk of developing type 2 diabetes for participants who took antidepressants. Findings also revealed that participants with symptoms of depression at the beginning of the study, but were not taking antidepressants, did not have an increased risk for type 2 diabetes. These results were found after controlling for demographic factors and weight changes.

The study results don't explain how antidepressant drugs increase the risk for type 2 diabetes, or which antidepressants may be linked with the greatest risk.

REFERENCES:
1. Rubin RR et al. "Depression Symptoms, Antidepressant Medicine Use and Risk of Developing Diabetes in Diabetes Prevention Program Participants." Abstract 869-P, presented at the June 10-11, 2006 meeting of the American Diabetes Association in Washington, DC

The study out of Finland gathered data on more than 500 men and women who had impaired glucose tolerance or IGT. This meant that their body responded abnormally to glucose and is usually a precursor to adult onset diabetes. Half of the group recieved strict dietary guidelines and rigorous exercise while the other half recieved no education and made no changes.

Mean follow up was seven years later.

The researchers found that the group who underwent changes to diet and exercise had a dramatic 15-20 percent drop in diabetes risk. They had improved glucose tolerance. The researchers even concluded that the changes could at least delay the onset of diabetes in those who did not have a reduction in risk.

So what are these simple steps:

First: Lose weight. Dropping extra weight, as much as 20-50 pounds in some cases can alone lower risk substantially.

Second: Cut down on saturated fats. Saturated fats disrupt normal lipid metabolism, increase inflammation in the body, and interfer with normal liver function.

Third: Eat more fiber. A diet high in fiber results in improved blood sugar control as well as lower cholesterol.

Fourth: Exercise at least 30 minutes every day of the week. Exercise should be cardiovascular (get the heart rate up).

Making simple lifestyle changes such as those listed above can not only cut your risk for developing diabetes, but can also reduce your risk of heart disease, stroke, blindness, and kidney disease. All of the latter conditions can develop as a result of long term diabetes.

These changes can also help someone who has already been diagnosed with diabetes and may help to lower medication (and side effects).

The study was started in the 1970's, and enrolled men in their forties who had no previous diagnosis of prostate cancer or metabolic syndrome.

Prostate cancer is the number 3 cause of cancer related deaths in men, with Lung cancer and Colorectal Cancer taking spot number one and two respectively. Metabolic syndrome is a condition characterized by high blood lipids, high blood pressure, high blood insulin, and central obesity.

Over the study period researchers found that men who had 2 or more characteristics of metabolic syndrome as mentioned above were more likely to develop prostate cancer. The increased risk was as much as 50 percent in some cases.

Other factors which increased the risk for prostate cancer in this study were age, BMI, and sedentary work.

The authors feel that this study supports a connection between metabolic syndrome and prostate cancer. The mechanism may be via IGF-1 (insulin like growth factor), which has been shown in previous studies to interact with prostate tissue, and levels are abnormal in metabolic sydrome.

Expect more studies in the future.

Adult onset diabetes develops over a period of time. It starts as a carbohydrate intolerance, and ends with decreased production of insulin by the pancreas, now unable to keep blood sugar in check. Type 2 diabetics can have dangerously high blood sugar levels if untreated.

Researchers at the University of California in San Diego wanted to examine the relationship between coffee consumption and Type 2 diabetes, if any. They gathered data on more than 900 men and women over the age of 50 who had not been previously diagnosed with diabetes. Some of the participants had a condition known as impaired glucose tolerance, which can preceed diabetes.

On two occasions information about coffee consumption, both caffienated and decaf, was obtained. The two sessions were about 8 years apart. Then information about diabetes and blood sugar was collected.

Coffee drinkers, regardless of caffeinated or decaffienated, were more than 60 percent less likely to have developed diabetes (adult onset) over the eight year period. This was even true for those who had impaired glucose tolerance at the beginning of the study.

The study did not categorize the coffee drinkers based on quantity, so a specific amount of cups per day could not be labeled as better or worse. Past studies had found benefit from about 3 cups per day but not more than 6 cups per day. The authors noted that most were moderate drinkers, and not heavy consumers of coffee.

The reason or mechanism behind coffees protective benefits in this study could not be determined. It is possible that the high amounts of antioxidants in coffee could provide some benefit, but more studies will be needed to confirm any possibilities.

Vitamin B12 is a necessary vitamin for many functions in the body including the production of DNA and for proper nervous system functioning. A deficiency in Vitamin B12 can result in conditions such as megoloblastic anemia and peripheral neuropathy.

For the study researchers analyzed Vitamin B12 status in diabetic patients who were either on metformin or not. They found that the use of metformin statistically effected the Vitamin B12 status.

Individuals who had been using a 1000 mg dose of metformin had more than twice the risk of having Vitamin B12 deficiency compared to non-users. Those that had been taking the medication for long term, greater than 3 years also had double the risk compared to non-users regardless of the dose.

The lead authors suggests that all individuals taking metformin to treat Type 2 diabetes be screened for a Vitamin B12 deficiency. For those taking a higher dosage or who have been taking it long term screening is even more important.

Supplemtation with Vitamin B12 should not effect the performance or efficacy of metformin for treating Type 2 diabetes. Though this study does not recommend it, supplementation may become a recommendation for any person on metformin in the future.

The study, published in Phytotherapy Research, measured the effect of silymarin in Type 2 diabetics on conventional medication. Silymarin is the primary active compound in milk thistle.

A total of 51 participants were randomized to receive 200 mg three times a day for four months or placebo. After the study period blood sugars were compared between the two groups.

Those participants in the silymarin group had improved fasting blood sugars compared to the placebo group. Each participant followed similar treatments with the exception of the silymarin.

The researchers were optimistic about the results. They could not determine from this study the mechanism by which silymarin exerts the postive effect on blood sugar, but suggest some role with normal liver function and blood sugar metabolism.

It is important to note that silymarin was not the sole therapy, each person remained on their prescribed medications for blood sugar control. In this particular study the milk thistle compound was an adjunctive treatment.

Milk thistle is safe and relatively non-toxic. It can affect the metabolism of certain drugs by the liver and anyone taking medication should notify their physician before starting milk thistle.

Now a survey reports that U.S. doctors and patients are ignorant about diabetic care and diabetics need more assistance in managing diabetes. The Harris poll, commissioned by the American Association of Clinical Endocrinologists and the American Association of Diabetes Educators, suggests that a team approach including diabetes educators effectively improves diabetes management.

The Harris poll, "Type 2 Diabetes Nationwide Survey Summary", was conducted between April 6 -14, 2006 among 784 type 2 diabetic adults and April 7-12, 2006, among 400 primary care physicians who see at least three type 2 diabetics monthly. The objective of the survey was to determine patient's and physician's understanding of diabetes treatment.

The survey reported the following:

1. 69 percent of patients report feeling knowledgeable about managing their diabetes, but 59 percent believe their condition is not well- controlled.

2. 83 percent of patients report they follow a healthy diet, but only 29 percent of physicians agree this is the case.

3. 55 percent of patients don't know their A1C level (a protein measure indicating blood sugar control).

4. Physicians inconsistently demonstrate understanding of diabetes. 78 percent of physicians report that insulin resistance is the most important contributor to type 2 diabetes. However, beta (insulin-producing) cell dysfunction may be a more important contributing factor than insulin resistance.

5. 76 percent of patients who have seen a diabetes educator report feeling knowledgeable about managing their diabetes, compared to 61 percent of patients who haven't seen a diabetes educator.

REFERENCES:
1. Type 2 Diabetes Nationwide Survey Summary, Harris Interactive, June 1, 2006:
http://www.harrisinteractive.com/news/newsletters/clientnews/2006_AADE.pdf

A study published this month in Diabetes Care investigated which dietary factors affect diabetes risk in African American women. The study gathered information from more than 41,000 women who were participating in the Black Women's Health Study. They specifically wanted to determine if calcium and magnesium, both of which proved preventative in white women, would offer the same benefit to black women.

After an average follow-up of eight years about 5% (1,964) of the women in the study developed diabetes. The researchers found several factors that resulted in decreased risk including lower consumption of red meat, decreased saturated fat intake, and a more active lifestyle. But they also found that intake of calcium and magnesium to be postively coorelated with decreased risk for the condition.

Only magnesium intake, as determined by food choices and supplemenation, was associated with decreased risk after accounting for variables that may have greater effect, i.e. fitness and low saturated fat intake. Women with the greatest intake of magnesium had a 31 percent lower risk of developing diabetes than women with the lowest intake of the mineral.

The study did not separate magnesium intake based on source. The foods most associated with decreased risk were whole grains, which are high in magnesium as well as many other vitamins and minerals which may provide protection. So at this point the authors did not recommend women begin taking a magnesium supplement. But eating a diet with foods high in magnesium such as whole grains and dark leafy green vegetables won't hurt.

The study, published in Diabetes Care, investigated the effects of a low-fat vegan diet and the American Diabetes Association (ADA) diet in patients with type 2 diabetes. Researchers at the George Washington University School of Medicine in Washington, DC, administered two different diets to 99 adults with type 2 diabetes, for 22 weeks. Half of the participants were randomly assigned to a low-fat vegan diet (10% of daily calories from fat, 15% protein, and 75% carbohydrates) with unrestricted daily calories or food intake, and the other half were assigned to the ADA diet (15%-20% of daily calories from protein, 60%-70% carbohydrates and monounsaturated fats, and less than 7% from saturated fats). Overweight subjects in the ADA group also reduced their caloric intake by 500-1,000 calories daily.

The researchers found that both diets lowered LDL (bad) cholesterol and improved diabetes control. However, the vegan diet reduced the need for diabetes medications by 43 percent, as compared with the ADA diet which reduced need by 26 percent. Furthermore, the vegan diet group had greater reductions in cholesterol levels and weight loss than those on the ADA diet.

"Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients," the study authors conclude. "These improvements were greater with a low-fat vegan diet."

REFERENCES:
1. Barnard ND et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006 Aug;29(8):1777-83.

Currently more than 5.62 percent (16.2 million) of Americans have diabetes. The CDC advised that as many as 48.3 million may be diagnosed in 2050. This will represent a 200% increase in caucasians, a 300% increase in African Americans, and a 600% increase in Hispanics.

They also sighted increases in older patients, with the rates in those over 75 increasing five-fold. This may be due to the advancement of medications to treat diabetes and its complications which help prolong life.

The randomized, double-blind, placebo-controlled study, presented at the 2006 annual meeting of the European Congress of Rheumatology, examined whether patients with probable RA would benefit from methotrexate treatment. Researchers from Leiden University Medical Center in the Netherlands administered 15 mg methotrexate or a placebo (no treatment) weekly to 110 patients with undifferentiated arthritis (type of arthritis not yet diagnosed) participating in the PROMPT (Probable rheumatoid arthritis: Methotrexate versus Placebo Treatment) study. Cyclic citrullinated peptide antibody (CCP) tests for RA were obtained from the participants.

The researchers found that the methotrexate group had fewer participants developing RA and more participants reaching remission than the placebo group. Furthermore, the placebo group had a significantly higher progression of erosive disease than the methotrexate group.

"Anti-CCP-positive patients seem to benefit most from treatment with methotrexate, which indicates the existence of a window of opportunity in anti-CCP-positive arthritic patients to influence the disease progression into full-blown RA," the study authors write. "This is the first RCT that demonstrates the existence of such a window of opportunity."

REFERENCES:
1. Van Dongen H et al. Probable Rheumatoid Arthritis Methotrexate Versus Placebo Therapy (PROMPT)-Study: Indications For A Window Of Opportunity In The Treatment of Patients With Undifferentiated Arthritis. Ann Rheum Dis 2006;65(Suppl II):54