Diabetes increases by 26 percent the likelihood that women will develop atrial fibrillation (AF), a potentially dangerous irregular heart rhythm that can lead to stroke, heart failure, and chronic fatigue. These are the findings of a new Kaiser Permanente study, published in the October issue of Diabetes Care, a journal of the American Diabetes Association.

While other studies have found that patients with diabetes are more likely to have AF, this is the first large studyinvolving nearly 35,000 Kaiser Permanente patients over the course of seven yearsto isolate the effect of diabetes and determine that it is an independent risk factor for women.

“The most important finding from our study is that women with diabetes have an increased risk of developing this abnormal heart rhythm,” said the studys lead author, Greg Nichols, PhD, investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. “Men with diabetes are also at higher risk, but the association between the two conditions is not as strong. For men, obesity and high blood pressure are bigger risk factors from diabetes.”

“AF is the most common arrhythmia in the world, and diabetes is one of the most common and costly health conditions. Our study points out that there is a connection between these two growing epidemicsone we should pay closer attention to, especially among women,” says Sumeet Chugh, MD, coauthor and associate director of the CedarsSinai Heart Institute in Los Angeles. “The gender differences need to be looked at more closely because they could have significant implications for how we treat diabetes in men and women.”

Atrial fibrillation occurs when the two upper chambers of the heart beat irregularly and too fast, causing blood to pool and clot. If the clot travels out of the heart and becomes lodged in an artery or in the brain, it can cause a stroke. About 2.2 million Americans are diagnosed with AF; however, many more people have the condition but dont know it. Diabetes affects more than 23 million Americansand, according to the study, nearly 4 percent, or 1 million, have atrial fibrillation.

The study involved 17,372 patients in Kaiser Permanentes diabetes registry in Oregon and Washington and an equal number of nondiabetic patients, matched for age and sex. Researchers used Kaiser Permanente HealthConnect®, the worlds largest civilian electronic health records system, to identify the nondiabetic patients. The two groups were followed for an average of 7.2 years until Dec., 31, 2008 or until they died or left the health plan. At the start of the study, 3.6 percent of the patients with diabetes had AF, vs. only 2.5 percent of the nondiabetic patientsa difference of 44 percent. During the study period, diabetics were more likely than nondiabetics to develop AF. But after controlling for other factors like obesity, high blood pressure and age, the increased risk was only significant among women. Women with diabetes were 26 percent more likely than their nondiabetic counterparts to develop AF.

Authors include Gregory A. Nichols, PhD, Kaiser Permanente Center for Health Research; Kyndaron Reinier, PhD, and Sumeet S. Chugh, MD, CedarsSinai Heart Institute, Los Angeles.

About the Kaiser Permanente Center for Health Research

Kaiser Permanentes Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Ore., Honolulu, Hawaii and Atlanta.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of Americas leading health care providers and notforprofit health plans. Founded in 1945, our mission is to provide highquality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industryleading technology advances and tools for health promotion, disease prevention, stateofthe art care delivery and worldclass chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.

Source Kaiser Permanente

What

In recognition of American Diabetes Month® in November, the American Diabetes Association will be launching a movement to encourage Americans to confront, fight and Stop Diabetes (SM).

Anyone can join the movement by choosing to share their experiences with diabetes, helping to raise awareness about diabetes, becoming active in their community, learning about diabetes, giving of their time and passion, or donating funds to support diabetes research, information, or advocacy efforts.

Who

The American Diabetes Association is leading the fight against the deadly consequences of diabetes and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

When

November 2, 2009

Why

With nearly 24 million children and adults afflicted with the disease in the U.S. and an additional 57 million at risk for type 2 diabetes, diabetes has reached epidemic proportions. If current trends continue, one out of three children will face a future with diabetes.

How

To let your viewers/listeners/readers know about American Diabetes Month and the Stop Diabetes movement. Interviews with an American Diabetes Association spokesperson are available upon request.

Blocking a protein that battles infection may help thwart a common cause of vision loss in chronic diseases such as diabetes, Medical College of Georgia researchers say.

The protein, interleukin6, prompts inflammation a healthy and sometimes lifesaving defense against invaders such as bacteria and viruses. But the proteins action “is bad in diseases like diabetes because the inflammation is chronic,” says Dr. Wenbo Zhang, a senior postdoctoral fellow in the MCG Vascular Biology Center.

The key insult in diabetes is excess glucose, which causes inflammation and unleashes a cascade of complications. Dr. Zhang is dissecting the relationship of interleukin6 and one of the complications, diabetic retinopathy, and recently received a threeyear, $270,000 advanced postdoctoral fellowship from the Juvenile Diabetes Research Foundation International to see if blocking this proinflammatory protein can target a new treatment for the potentially blinding disease.

“Diabetic retinopathy is the leading cause of blindness in workingage adults, so if we can find something to prevent it, slow it down or even cure it, that would be a good thing,” says Dr. Zhang, who working with Dr. Ruth Caldwell, a cell biologist in the MCG Vascular Biology Center and Charlie Norwood Veterans Affairs Medical Center.

Dr. Zhang will determine whether increased levels of interleukin6 in the vitreous, a gellike substance in the center of the eye, will prompt small blood vessels in the retina to leak. Fluid then collects in the retina, causing swelling and blurred vision. Unchecked, this can lead to proliferation of new blood vessels, which further obstruct vision.

“Blocking interleukin6 may stop the small blood vessels from leaking,” Dr. Zhang says. “Interleukin6 receptor neutralizing antibody could be a new therapeutic approach for treating diabetic retinopathy. It is already in clinical trial for the treatment of rheumatoid arthritis and may provide a possible immediate benefit for diabetic retinopathy patients.”

Says Dr. Caldwell, “If you can control the blood glucose levels, you can reduce the risk of diabetic retinopathy. Ideally, you would try to control the levels perfectly, but this is nearly impossible to achieve so other therapies are needed, and this would be one of them.”

Dr. Zhang earned a doctorate in biochemistry and cell biology from the Chinese Academy of Sciences and a bachelors degree in biochemistry from Yunnan University.

Source
Amy Connell

The beneficial effects of aspirin in primary prevention of cardiovascular events i.e. stroke, MI and cardiac death are known and generally accepted. In a recent metaanalysis total cardiovascular event rate was shown to be reduced by 12% and the rate of myocardial infarctions by 18% (Lancet 2009; 373, 184960). This holds specifically true for individuals with a 10year risk for cardiac death above 5% or a total cardiovascular event risk above 15%. Several scientific bodies including the ESC do recommend aspirin for primary prevention in this population, including all diabetics.

Recent trial results seem to contradict this general recommendation. Dr Hisao Ogawa et al. published the results of the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) (i>JAMA 2008; 300, 213441) Trial showing no significant effect of aspirin on a combined endpoint of cardiovascular adverse events including fatal or nonfatal ischemic heart disease, fatal or nonfatal stroke and peripheral artery disease. However, the event rate in this trial was much lower than predicted and therefore the trial was largely underpowered to draw a meaningful conclusion. In addition, secondary endpoints focussing on more severe events like death, MI and stroke exerted a significant effect of aspirin in the entire patient cohort, as did the observation of the primary endpoint in diabetics above the age of 65 years.

The key role of antiplatelet therapy (mainly aspirin) for the secondary prevention of myocardial infarction and strokes is firmly established for highrisk patients with established arterial disease, and the proportional reductions in these cardiovascular events appear to be in the range of 20 to 25%, independent if the patients have diabetes or not. However, many young and middleaged persons with diabetes do not have manifest arterial disease yet although they are at a significant cardiovascular risk. Therefore, the substantial persons with uncertainty about the role of aspirin for the prevention of myocardial infarctions and strokes among apparently vascular healthy diabetes will remain until results of ongoing trials focussing on diabetics will be published in the years to come.

Until these results are available, the clinical strategy should include aspirin for primary prevention in all diabetics above the age of 65 years, or below 65 years if there is at least one additional cardiovascular risk factor present like obesity, hypertension or dyslipoproteinemia. In the case of a known vascular disease proven by the presence of atherosclerotic plaques in the coronary or carotid circulation, or a reduced ABI for the peripheral circulation, all diabetics should be offered a primary prevention with aspirin.

By Professor Harald Darius

Source
Jacquelline Partarrieu

Children and young people now have the opportunity to get involved in Diabetes UKs campaigning, by joining our new My Voice campaign network. Support will be given to help you lobby local decision makers on issues and challenges faced by young people like you who are affected by diabetes.

What to expect if you join

As a member of My Voice you will receive a free bag containing a badge, stickers and lots of useful information about campaigning. You will also receive regular updates, opportunities and ideas on how to get involved.

Fantastic opportunity

“This is a fantastic opportunity for young people with diabetes to get involved and make a real difference, working with us to get the care and respect they are entitled to and deserve,” said Raj Johal, Local Campaigns Officer at Diabetes UK.

“We encourage all young people to join My Voice whether you have diabetes or have a friend with diabetes, why not become a My Voice campaigner.”

The My Voice website is now live at diabetes.org.uk/MyVoice.

Young peoples lobby of parliament

World Diabetes Day 2008

Diabetes UK is committed to campaign for people affected by the condition.

In November 2008, more than 200 young people travelled to Westminster to lobby their MPs about the support they need to manage their diabetes in school.

The rates of serious complications among individuals with type 1 diabetes appear lower than reported historically, especially when patients are treated intensively, according to a report in the July 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“The clinical course of type 1 diabetes mellitus, including its treatment, metabolic outcomes and longterm clinical complications, has changed dramatically in the past 20 years,” the authors write as background information in the article. Treatment innovations, including insulin pumps and analogues, along with the improved treatment of cooccurring illnesses such as high blood pressure and abnormal cholesterol have contributed to changes in the management of type 1 diabetes. In addition, clinical trials such as the Diabetes Control and Complications Trial (DCCT)a study conducted between 1983 and 1993 comparing the thencurrent standard of care with more intensive therapyand its longterm observational followup, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, have shown the benefits of more careful control of blood glucose levels.

The DCCT/EDIC Research Group analyzed the incidence of longterm complications among participants in those studies, including both patients who were originally assigned to intensive therapy and those who received standard therapy until the DCCT clinical trial ended in 1993 and all patients were offered intensive therapy. In addition, they assessed complication rates among participants in the Pittsburgh Epidemiology of Diabetes Complications study, an observational study in which researchers have collected data on patients who were diagnosed with type 1 diabetes between 1950 and 1980.

“After 30 years of diabetes, the cumulative incidences of proliferative retinopathy [an eye disease associated with diabetes], nephropathy [kidney disease] and cardiovascular disease were 50 percent, 25 percent and 14 percent, respectively, in the DCCT conventional treatment group, and 47 percent, 17 percent and 14 percent, respectively, in the Pittsburgh Epidemiology of Diabetes Complications cohort,” the authors write. “The DCCT intensive therapy group had substantially lower cumulative incidences (21 percent, 9 percent and 9 percent) and fewer than 1 percent became blind, required kidney replacement or had an amputation because of diabetes during that time.”

Differing methods of ascertaining and defining complications make exact historical comparisons difficult. However, the rates of retinopathy (30 percent) and nephropathy (12 percent) in DCCT/EDIC participants after 25 years compare favorably to rates in studies of individuals who developed diabetes 10 to 20 years prior (40 percent to 53 percent for retinopathy and approximately 35 percent for nephropathy). Rates of functional impairment, such as vision loss and the need for kidney transplant, are also difficult to compare but were low in the overall DCCT/EDIC cohort, with only three of 1,441 patients becoming legally blind and 18 requiring kidney replacement therapy after an average of 25 years.

“While the results of the DCCT/EDIC conventional therapy and of the Pittsburgh Epidemiology of Diabetes Complications study supply clinicians with a realistic description of clinical outcomes that they can discuss with their patients who have had their type 1 diabetes mellitus in the past 25 years, the intensive treatment group results provide a view of what patients with type 1 diabetes mellitus can expect in the future. Intensive therapy, now the standard of care, should result in more than 50 percent reduction in the rates of complications over time, with implementation early in the course of diabetes providing the most powerful salutary effect.”

Arch Intern Med. 2009;169[14]13071316.

Volunteers are needed for the final phase of a Diabetes UKfunded study investigating whether flavonoids compounds found in chocolate can protect older women with diabetes from heart disease.

The first group of volunteers, recruited last April, have already been eating specially formulated chocolate twice a day for a year. Now researchers at the University of East Anglia need 40 more women to take part in the study.

Eating chocolate every day

Participants will be required to eat a small amount of chocolate everyday for one year and have their risk of heart disease tested on five occasions to see whether changes occur. This will involve giving blood and urine samples, having an ultrasound scan of their arteries and filling in questionnaires about their lifestyle. These tests will take place in Norwich, at either UEA or NNUH, and travel expenses will be reimbursed up to a distance of 60 miles roundtrip.

Heart disease risk higher in women

The risk of death from coronary heart disease associated with Type 2 diabetes is about 50 per cent greater in women than it is in men. Research suggests that although statin therapy can reduce the risk of heart disease, foods like cocoa and soy which contain flavonoids, can offer further protection from the disease.

It is hoped the trial will pave the way for a larger clinical study to examine the subject in more detail.

Diabetes UK warns that people must not consume vast quantities of chocolate. “We certainly dont advise people to start eating a lot of chocolate as its very high in sugar and fat”, said Dr Iain Frame, Director of Research at Diabetes UK. “We would always recommend that people with diabetes eat a diet low in fat, salt and sugar with plenty of fruit and vegetables.

The International Diabetes Federation (IDF) called for urgent assessment and responses from regulatory authorities into a possible link between the use of insulin glargine (an insulin analogue) and increased risk of cancer based on findings published on 26 June, 2009 in Diabetelogia, the journal of the European Association for the Study of Diabetes (EASD).

The online data published in Diabetelogia is based on four studies relating to a possible link between a longacting insulin analogue, insulin glargine and cancer. According to EASD, the findings are based on evidence from studies in Germany, Sweden, Scotland and the United Kingdom. The studies however, are not conclusive.

The International Diabetes Federation understands the concern about the Diabetelogia study findings but urges the diabetes community to wait for the current scientific information to be released and calls for urgent further scientific studies to be undertaken in other countries.

Six of the worlds foremost health agencies, collectively managing an estimated 80% of all public health research funding, today announced formation of a landmark alliance to collaborate in the critical battle against chronic, noncommunicable diseases cardiovascular diseases (mainly heart disease and stroke), several cancers, chronic respiratory conditions, and type 2 diabetes.

The health impact and socioeconomic cost of these largelypreventable diseases is enormous and rising, potentially derailing efforts at poverty reduction.

The Global Alliance for Chronic Diseases (Alliance) is being created to support clear priorities for a coordinated research effort that will address this growing health crisis, now reaching world epidemic proportions. Experts estimate that, unless action is stepped up, 388 million people worldwide will die of one or more such diseases within the next decade.

Work of the Alliance will focus in particular on the needs of low and middle income countries, and on those of low income populations of more developed countries.

The Alliances charter members are

* Australia National Health and Medical Research Council;
* Canadian Institutes of Health Research;
* Chinese Academy of Medical Sciences;
* The U.K. Medical Research Council; and
* The U.S. National Institutes of Health, specifically its National Heart, Lung, and Blood Institute (NHLBI), and the Fogarty International Center.

The Indian Council of Medical Research, New Delhi, will be invited to join the Alliance as a member. Research agencies from other countries and private funders may be invited to join in a second wave.

The World Health Organization (WHO) is joining the Alliance as an observer to facilitate Alliance support for implementation of the World Health Assemblyapproved “Action Plan for the Global Strategy for Prevention and Control of Noncommunicable Diseases”

The following research priorities have been proposed by some founding Alliance members, for discussion at their inaugural scientific meetings in November

* Test ways to prevent cardiovascular diseases and complications of diabetes;
* Identify and promote public health measures for controlling obesity;
* Characterize and quantify the major risk factors for chronic obstructive airways disease (both tobacco and environmental pollution) and the development of control measures; and
* Advance research into the problem of tobacco consumption and its relationship to cancer, cardiovascular disease and other disorders;
* Develop interventions to address the above priorities.

The proposed priorities were identified in a collaborative paper, “Grand Challenges in Chronic NonCommunicable Diseases,” published in the journal Nature (Vol 450|22, Nov. 2007). Based on a global Delphi survey, this widelycited research paper has been acknowledged as a sound, systematic framework for reaching practical policy solutions to the prevention and treatment of humanitys most common chronic diseases.

Setting research priorities for noncommunicable disease prevention will be closely coordinated with WHO.

A future Alliance research priority is likely to be in the area of mental health.

Notes

Quotable quotes

Elizabeth G. Nabel, MD, Director, NHLBI

“One of the most promising outcomes of this collaboration is the opportunity to translate research findings into sustainable solutions. For example, we know about preventing heart attacks and strokes associated with smoking or high blood pressure, but how should we best put these ideas into practice, especially in lowresource settings or on a large scale?

“We look forward to working together to find solutions to diseases that have so stubbornly defied reduction and to learn from innovations in low and middle income countries, such as community interventions and/or rearranging health care delivery in the most cost effective way.”

Ala Alwan, MD, Assistant Director General for Noncommunicable Diseases and Mental Health, World Health Organization

“The World Health Organization hopes that this new initiative will assist with the implementation of the Global Strategy Action Plan. Prevention and implementation research will be critical to reducing the enormous health and socioeconomic burden of noncommunicable diseases (NCD), particularly in low and middleincome countries. It is crucial to have close coordination between this initiative and the work underway in WHO to develop a prioritized research agenda focusing on strengthening prevention interventions and promoting national capacity in NCD prevention research.”

Sir Leszek Borysiewicz, Chief Executive, U.K. Medical Research Council

“It is essential that we work in close partnership with colleagues from developed and developing countries to address the challenges posed by the worldwide increase in noncommunicable diseases. We welcome this opportunity for the UK to establish global links in this vital area of research and look forward to the future expansion of the partnership.”

Alain Beaudet, President of the Canadian Institutes of Health Research

“Canada is proud to collaborate with other countries in the fight against these chronic diseases. I believe that Canada can excel on the world stage by bringing our unique research talents to bear on these global health research problems that affect millions of people worldwide.”

Prof. Warwick Anderson, CEO, Australia National Health and Medical Research Council

“Australia is pleased to be part of this landmark global alliance which is bringing together the worlds leading health and medical research funding agencies to work in an unprecedented partnership to fight chronic, noncommunicable diseases. This alliance will help direct research collaborations across the world aimed at creating and translating research evidence towards the prevention and control of these diseases.”

Sir John Bell, Regius Professor, Oxford University; President, UK Acadamy of Medical Science

“This is the first alliance on chronic diseases that we have seen. It has been due for a long time and I hope that it will grow fast so we can begin to break the rising curve of these diseases globally.”

Stig Pramming, Director, Oxford Health Alliance

“Industry has an important role in helping to solve some of these problems and the Alliance intends to work with the commercial sector as appropriate.”

Abdallah Daar, McLaughlinRotman Centre for Global Health, based at the University of Toronto and the University Health Network

“We anticipate that the initial group of Alliance members will expand rapidly, embracing research funders, including philanthropic foundations, from around the world that have an interest in this agenda.”

Background

In their 2007 paper in Nature, the 19 authors of the “Grand Challenges,” led by Dr. Daar, said chronic noncommunicable diseases

* Cause the greatest share of death and disability worldwide; Account for over 60% of deaths worldwide, fourfifths of those fatalities being citizens of low and middle income countries;

* Cause twice as many deaths as the combined total of HIV/AIDS, tuberculosis, malaria, maternal and perinatal conditions, and nutritional deficiencies.

As well, in the absence of serious action taken now, it is estimated that China, India and the U.K. will lose an estimated $558 billion, $237 billion and $33 billion respectively in foregone national income over the next decade due to heart disease, stroke and diabetes.

Source
Terry Collins

New data presented at the American Diabetes Association (ADA) 69th Annual Scientific Sessions showed that initial treatment with Janumet* (sitagliptin/metformin) provided significantly greater blood sugar improvements in drugnaïve** patients with type 2 diabetes, compared with metformin alone.[i]

“In this study, initial combination therapy with the fixeddose combination sitagliptin and metformin for the treatment of type 2 diabetes helped patients achieve blood sugar goals more effectively than metformin alone,” said Barry J. Goldstein, M.D., Ph.D., Vice President of Clinical Research, Diabetes and Obesity, Merck & Co., Inc.

Maintenance of combination therapy may not be appropriate for all patients. These management options are left to the discretion of the physician.

*Note, initial therapy with Janumet is not currently licensed and the fixeddose combination drug is not currently available in some countries, such as the UK.

Sitagliptin is a highly selective, oncedaily DPP4 inhibitor that enhances a natural body system called the incretin system, to help regulate blood sugar by increasing blood levels of active GLP1 and GIP hormones; it inhibits DPP4 over 24 hours.[ii] The fixed dose combination of sitagliptin and metformin targets all three key defects of diabetes insulin deficiency from pancreatic beta cells, insulin resistance, and overproduction of glucose by the liver.[iii] Sitagliptin is the first approved medicine in the DPP4 inhibitor class of oral treatments. It has been approved in over 80 countries and todate, there have been more than 11.1 million prescriptions dispensed worldwide.[iv]

Initial therapy with a fixed dose sitagliptin and metformin*1

This large, randomised, doubleblind study of initial therapy with a fixed dose combination of sitagliptin and metformin, compared to metformin alone, involved 1,250 drugnaïve patients** with a mean HbA1c*** baseline of 9.8 percent. Patients were randomized to sitagliptin/metformin (50/1,000 mg twice daily) or metformin (1,000 mg twice daily) for 44 weeks. The primary study hypotheses were addressed after 18 weeks. After 18 weeks, patients taking fixed dose combination of sitagliptin and metformin as initial therapy achieved mean HbA1c reductions from baseline of 2.4 percent (n=560), compared with 1.8 percent for patients taking metformin alone (n=566), a significant betweengroup difference of 0.6 percent (p