RedScrubs
The Resource for Medical Professionals

In a study published in the June, 2008 issue of The American Journal of Medicine the cut-off level for determining diabetes was again challenged. After looking at 46, 578 members of Kaiser Permanente it was found that subjects developed diabetes at a rate of 1% per year. Subjects were assigned to 1 of 4 categories of blood sugar levels (<85, 85-89, 90-94, or 95-99 mg/dl). They were followed for 81 months.

The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors (i.e. body mass index, blood pressure, lipids, smoking, cardiovascular disease and hypertension) suggests that diabetes risk increases as fasting plasma glucose increases, even within the currently accepted normal range. For example, for each mg. per deciliter of fasting plasma glucose diabetes risk was increased by 6%. Subjects with glucose levels of 95-99 were 2.33 times more likely to develop diabetes. Subjects in the 90-94 mg/dl group were 49% more likely to progress to diabetes.

A wide range of products claiming to lower blood sugar are marketed to the public. Individuals with diabetes are 1.6 times more likely to use complementary and alternative medicine than those without diabetes according to a recent study published in the April, 2008 supplement to the Journal of the American Dietetic Association (JADA). Reasons for using alternative medicine have been reported to include:
• Troublesome side-effects from conventional drug therapy
• A need for more personal control over one’s care plan
• The increasing cost of prescription drugs
• Dissatisfaction with conventional health care providers
• The ability to spend quality time with alternative practitioners, i.e. doctors do not spend enough time educating and talking to their patients so patients choose to go to those who will spend the time.
Several problematic areas may come up with the use of alternative therapies and pharmacists and Registered Dietitians are uniquely poised to address issues such as potential side-effects, drug interactions, lack of product standardization and the need for evidence-based information on the supplements being used.

Pycnogenol, an extract from the bark of a French maritime pine tree, was found to lower the blood sugar in those individuals who had diabetes and allowed them to lower their antihypertensive medication thus lowering their cardiovascular risk profile. This study, published in the May 2008 journal of Nutrition Research, indicates that Pycnogenol might serve as an important complementary therapy when used with conventional medicine. According to this study, there are approximately 20 million people living in the U.S. that might benefit from this adjunctive therapy.

“Half of the people with diabetes experience high blood pressure and many have problems with cholesterol, and now it has been documented that Pycnogenol mediates a number of beneficial effects on both people with diabetes and healthy individuals” according to Dr. Watson, the lead researcher of the study. This is a landmark study because it is the “first study to suggest that Pycnogenol might also be beneficial in protecting kidney function in diabetics” stated Dr. Watson.

Reveratrol, a compound found in red wine, could lower blood sugars but the side-effects might prevent its benefits. Research presented May 16, 2008 at the pediatric endocrinology unit at the Case Western Reserve in Ohio stated that “ all the studies we have to date have focused primarily on the GLUT 4 glucose transporters on the muscle tissue and adipose tissue”. This study looked at the GLUT 1 transporter cells.

Resveratrol is a naturally occurring chemical found in grapes that has been shown to have cardioprotective, anti-inflammatory, hypoglycemic and antiviral properties. It is considered to be “anti-aging” by the media and is one of the hottest supplements in town.

It is projected that by the year 2025 the majority of patients with diabetes will be aged 65 or older. Diabetes prevalence will increase by more than 200% in persons aged 65-74 and by more than 400% in those 75 and older. In patients with diabetes, the disease itself already accounts for 52% of nursing home admissions and 47% of deaths – percentages that only increase when corrected for related cardiovascular conditions.

Recently I published a news article about the relationship between fructose and the development of gout. Well, now there is more bad press about fructose, the sugary substance commonly found in soft drinks, baked goods and other foods. A recent study in the March 10 issue of the Journal of Hepatology (2008) has shown that fructose consumption parallels the growth in non-alcoholic fatty liver disease (NAFLD). The consumption of fructose is further linked to insulin resistance.

Bitter melon is a fruit used in cooking around the world. It has been used historically as a treatment modality for diabetes and as a stimulant for digestion, dyspepsia, constipation, demulcent and as an inflammation modulator. It has been theorized to contain bioactive compounds effective for treating HIV infection. These compounds have been identified as glycoprotein lectins.

Diabetes is a disease that comes with complications. These complications can include heart disease, stroke, eye damage, chronic kidney disease, foot amputations – complications that can cost a person with type 2 diabetes about $10,000 per year. In a one of a kind report issued last year, we were able to take a look at how many complications occur in an individual with type 2 diabetes.

A study recently published in JAMA express highlighted the comparison between two diabetic treatments on progression of coronary atherosclerosis in patients with type 2 diabetes. Up until this point, no study has shown an antidiabetic regimen to reduce the progression of atherosclerosis.

Commonly used glucose lowering agents include the sulfonyureas (ie. Glimerpiride), which are insulin secretagogues and thiazolidinediones, which are insulin sensitizers.