V.A.C.(R) Therapy Found More Effective In Treating Diabetic Foot Ulcers

The negative pressure wound therapy which is the V.A.C. (R) System was found more effective when compared to the AMWT which is the advanced moist wound therapy used in treating the foot ulcers of diabetic patients. Diabetes Care will publish this in the April 2008 issue but is now available online at http://diabetes.org/diabetescare.

Dr. Peter A. Blume, who is the main researcher of the study and from the American Center for Limb Preservation, said that treating diabetic foot ulcers is a challenge to physicians. Now this study shows that there is more healed diabetic foot ulcers and less amputations when using the V.A.C. therapy when compared to the use of the advanced moist wound therapy.

So far this is the largest study of this kind involving 342 patients. These participants had diabetic foot ulcers that were difficult to heal. The number of therapy days at home was 90%. The patients treated with the V.A.C. therapy showed significantly higher complete ulcer closure than those treated with the advanced moist wound therapy.

In addition those treated through the V.A.C. system healed faster than their counterparts whose time for ulcer closure at 100% was not easy to find out. And more importantly, the number of less amputations for the VAC group was significant. Safety-wise, there was no difference between the two groups.

The chief medical officer of Kinetic Concept Inc. which conducted the study, Dr. Dan Ciaburri, said that these results corroborate the findings of a study on amputated diabetic foot wounds that was published in the November 12, 2005 issue of the Lancet.

Dr. Ciaburri further said that the V.A.C. system with its exceptional foam dressing offers an additional clinical benefit in the treatment of diabetic foot ulcers. In a nutshell, here are the findings of this clinical trial on the advantages of VAC therapy over those on AMWT:

• More complete ulcer closure
• Less time to closure of the wound
• Fewer amputations

Intensive Blood Glucose Control Stopped

This news came after the National Heart, Lung, and Blood Institute stopped the intensive blood sugar control study of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) because of safety concerns. Why did they do this?

You see, the ACCORD is studying the effects of an intensive treatment procedure for reaching an A1c blood glucose of less than 6% versus a standard treatment program with an A1c target of between 7 to 7.9%. But the increased death in the first group (14 per year per 1000) made them switch these to the standard group which has 11 per thousand deaths.

Since there has been proof that controlling blood glucose levels to about 7% considerably reduces diabetes complications, ADA still advises the diabetics to make every effort to reach the glucose reading target of less than 7%. Currently more than 50% of diabetics in the US have less than 7% A1c result.

ADA pointed out that the treatment procedure should fit the individual needs and that for some, intensive treatment to control the glucose level may not be the answer. Those with limited life expectancy, children, serious hypoglycemia and others may require less strict A1c targets.

The ACCORD announced that the intensive treatment to control blood glucose levels may be harmful to adults with risk factors for vascular disease to at least the middle aged and older group. At this point they do not know why although they have ruled out drug treatment and hypoglycemia as the cause.

Clearly there is a need for more study on this but in the meantime the diabetics who have heart problems are advised to consult with their doctors regarding their treatment and to manage their cholesterol and blood pressure to within target levels.

New Treatment for Type 2 Diabetics Approved in Europe

Galvus has been approved by health authorities in Europe as a new way to treat type 2 diabetics. This has come after changes on its administration and affects 27 countries including Norway and Iceland. Thus presentations in Europe are planned.

The approval is for Galvus to be used with the current oral anti-diabetes medications that are most often prescribed such as sulphonylureas or thiazolidinediones and metformin. Doctors can prescribe Galvus as 50mg once a day with sulphonylureas or 50mg two times a day with thiazolidinediones or metformin.

Novartis Pharma AG's chief medical officer, James Shannon, M.D., said that they will now be able to introduce this new option for treating type 2 diabetics. He said that the clinical trials showed Galvus to offer more effectiveness when taken with the current oral anti-diabetes medications.

At the clinical trial program, they studied over 20,000 patients with almost 13,000 administered with Galvus. When combined with the anti-diabetes medications, Galvus reduced the blood glucose level significantly and was tolerated by most patients.

The side effects experienced by the participants who took Galvus were similar to the ones that affected those who took a placebo. Mostly, the side effects were headaches, dizziness, stuffy nose and infection in the upper respiratory tract.

Although Galvus is not for those with liver and severe renal or congestive heart problems and has forward-looking statements in the report, it is still good to have on-going effort on looking for more treatment options as many who are taking the current medication still cannot control their blood glucose level.

Managing the blood glucose level to within target limit is not easy and a lot still have not reached their target level goals despite taking the medications now available. This poses a problem as when this condition is not effectively treated it could lead to a host of complications.

News for Patients with Metabolic Disorders

Treating hypertension in patients with diuretics seems to offer the same or better results than calcium-channel blockers. This was reported in the Archives of Internal Medicine's January 28 issue. The alpha-blockers did not show any advantage over the use of diuretics.

Metabolic disorders are those conditions that are factors that lead to cardiovascular disease. These conditions along with high blood pressure contribute to the patients raising their risk of cardiovascular disease. They call this metabolic syndrome which also contributes to diabetes.

For this study, metabolic syndrome was referred to as hypertension combined with two or more of these issues: 30 body mass index, pre-diabetes or diabetes, low level of HDL (high-density lipoprotein) or good cholesterol and high level of triglyceride.

The recommendation to treat high blood pressure is to use ACE inhibitors, alpha blockers and calcium channel blockers instead of diuretics and beta-blockers because they said the former has better results in the short term on blood cholesterol and glucose levels.

They conducted a study to prove this point called ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack). Cleveland's University Case Medical Center and Case Western Reserve University's Jackson T. Wright Jr, M.D., PhD. and his team assessed the gathered data.

There were 42,418 participants in the study who were assigned to take either diuretic, a calcium-blocker, alpha-blocker or ACE inhibitor and were followed up for 4.9 years on the average except for those who took alpha-blocker which was stopped because of increased cardiovascular disease.

There was no distinct difference among the four treatment groups. They did add that for those with metabolic syndrome, there was higher rate of heart attack for those who took the ACE inhibitor, alpha-blocker and calcium channel blocker. They therefore concluded that their findings did not succeed in supporting the use of these over diuretics.

FDA Approved Continuous Glucose Monitoring System

The physician-use continuous glucose recorder was approved by FDA. Physicians can now send their patients home with the recorder that can reveal patterns and probable problems that at present cannot be identified by the glucose system like the A1c test and the standard glucose systems now in use.

This new system called CGMS iPro Recorder is lighter, smaller and needs less time to use than the previous recorders. Clinically, the physicians can now obtain perceptions into the current condition and the diabetics gain additional freedom from wearing this.

In addition to this, in 50 states, the doctors connected with this Continuous Glucose Monitoring System (CGMS) are reimbursed by Medicare. The physician services for this have an extensive reimbursement from private insurance companies as well.

How does this CGMS work? The patients are asked to wear this for three days which at the end of the period, the doctor can review the results of the readings. He will be able to see the pattern and the glycemic profiles collected by the recorder and so will be able to adapt the best treatment for the patient.

The recorder is fastened to a glucose sensor that is put under the skin. The recorder routinely records glucose readings while the patient works, eats, sleeps and exercises. After three days, the doctor removes the recorder and can read and interpret the reports which will help in customizing the treatment.

The diabetics who get high and low glucose levels and are unaware of hypoglycemia and want to control their condition better will benefit from this recorder. And so will the pregnant women who have this condition or gestational diabetes.

Texas Diabetes and Endocrinology's Thomas Blevins, M.D. said that this recorder will help him better address the fact that diabetes needs customized care for the patients. He will be able to recognize how each patient's daily activities affect the management of the disease.

Is Gastric Surgery a Diabetes Treatment?

A diabetes treatment in gastric surgery? Well, this is what a new study declares. In Georgia, USA, surgeons have given an account from the results they had on 53 gastric band patients. Before the surgery, these patients were taking type 2 diabetes medication.

The British Obesity Surgery Patient Association reported this result. They maintained that 80% of the operated patients no longer had diabetes even after two years of the surgery. As for the other 20%, their condition improved.

Diabetes UK's Care Advisor, Libby Dowling gave this caution. She said there is no diabetes treatment but there are ways to control the condition. For those who want to lose weight, gastric surgery should be considered as a last resort. Why? Because they say it is risky.

There are some concerns about gastric surgery. For example, there is a condition they call dumping syndrome that can take place from eating foods that are high in fat and sugar. This is not a health risk but nausea, vomiting, sweating, weakness, diarrhea and faintness are unpleasant.

Then there must be supplements of calcium, multivitamins, iron and Vitamin B 12 that have to be taken which is not really that bad. Also, the stomach and the parts of the small intestine cannot be easily seen by X-ray if problems occur after surgery like bleeding, malignancy and ulcers.

It is still best to lose weight the natural way. The combination of eating healthy and exercising is the still the best and safest way to lose weight. Anyway, this has been proven to lower the risk for type 2 diabetes and also to improve the condition. Thus, this is the diabetes treatment that is recommended before even prescribing oral medication.

Group Support Improved Diet That May Cut Diabetes Risk

American Indian women received group support that helped them change their diet. The support enabled them to buy more fruits and vegetables thus increasing their consumption of these food groups. This can cut the risk to develop type 2 diabetes among the American Indians.

The subjects of the study were American Indian women who were from 18 to 40 years old living in urban areas. Over 50% of American Indians live in urban areas and they do not have much help to prevent diabetes. This is according to England's University of Bristol's Janice Thompson, PhD., who is the main author of this research.

The American Journal of Preventive Medicine reported that these women attended a monthly session of over two hours long in duration. At these sessions, they learned about diet and exercise approaches from American Indians who were trained to do this type of program.

There were 200 participants at the start of the program with 135 finishing the study in 18 months. Among these, 64 took walks together for 15 minutes and received tips on how to exercise. They also learned how to shop for foods and choose restaurants more wisely.

In addition, this group set their goals as to how much weight to lose and how many exercise minutes to do. They also exchanged recipes that are healthy and discussed in the group some tips to keep them motivated like the American Indian women who grew their own vegetables.

The other group composed of 71 women also ate more greens but they had medical check-ups at six month intervals while participating in the study. This group's weight loss was more immediate than the other group but at the end of the study, both groups showed the same weight loss.

Both groups also reduced their waistlines and lowered their bad cholesterol. They also lowered their time in front of the TV, and had healthier meals with lower calories, fat and sugar. The exercise program continued on. It just goes to show that support of monthly sessions can go a long way in preventing diabetes.

Blood Sugar of Type 2 Diabetics Increased by Caffeine

Type 2 diabetics who drink four or more cups of coffee a day have their blood sugar level go up to 8% which does not happen on days they do not drink coffee. This makes it hard for them to control their blood glucose level and so their diabetes.

This is the finding of a US study conducted by the Duke University psychologist Dr. James Lane. He is from the university's Medical Center in North Carolina. He and his team published their result in the Diabetes Care's February 2008 issue.

Since other studies have revealed that the type 2 diabetics who are regular coffee drinkers seem to raise their insulin and glucose, Lane and his team wanted to investigate how this will affect the way the type 2 diabetics take care of their condition.

The investigators planted a device that detects glucose under skin of the abdomen of ten diabetics. This way they were able to monitor their blood sugar level for 72 hours. This is the first time this has been done in connection with coffee intake.

The subjects were type 2 diabetics and were habitual coffee drinkers of at least two cups each day. They are also engaging in the use of exercise, drugs and diet to manage their condition. They are not using extra insulin to look after their diabetes at this point.

What the investigators did to arrive at their finding was this. They administered caffeine capsules that are about four cups of coffee in one day and a placebo the next day. It was a double blind study in the sense that both the patients and the ones who administered the drugs did not know which were the caffeine or the placebo capsules as they looked identical.

The findings revealed that on days when caffeine capsules were administered, the blood glucose level went up 8% and higher after meals. They did not know why but the study suggests that to manage diabetes, one should just quit drinking coffee.



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