What Drug Lowers Risk for Cardiovascular Disease Among Diabetics with Kidney Disease?

December 13, 2007

The Journal of the American Society of Nephrology reports in the January issue that treating patients with CKD (chronic kidney disease) with pioglitazone may lower the risk for cardiovascular disease. A new study on this confirms this.

University of Cologne's Dr. Christian A. Schneider of Germany said that this drug reduced death and cardiovascular occurrence when they studied more than 5000 type 2 diabetics who were at high risk for cardiovascular disease due to damage to the large blood vessels.

The patients treated with pioglitazone showed a lower risk for cardiovascular occurrence when compared to those assigned to take the placebo. The rate of death and cardiovascular events was reduced by 33.33%. It was noted that the decrease happened among those with lower stage of kidney function.

Dr. Schneider said their findings may not apply to diabetics with lower risk for cardiovascular events. Caution should be exercised when looking at the result of their study until it is further confirmed. This research was supported by Takeda Pharmaceutical Company.

More Evidence of Danger in Diabetes Drug?

A Canadian study published in the JAMA's December 12th issue finds issues that suggest there's more evidence of danger in the glitazone class of drugs including Avandia and Actos. This study was released by ICES, the acronym for the Institute for Clinical Evaluative Sciences.

The finding shows that drugs like Avandia raises the risk for heart attacks and death. The study was undertaken because of concern that older diabetics who take the same type of drugs are at more risk for cardiac problems.

The study looked at the databases of the Ontario Health Care on patients 65 years old and over who were on oral diabetic medication between 2002 and 2006. Dr. Lorraine Lipscombe, the ICES researcher who is the main author of this study said they did it because seniors have the highest statistics for diabetes.

The investigators explored the database on visits to the hospital for heart failure, heart attack and death and looked at their use of specific drugs. Avandia and Actos are linked to these results when they were compared with the other diabetes pills:

. There's 60% relative increase in heart failure, 40% in heart attacks and 30% in death.

. This shows an estimate of three more occurrence of heart failure, four more heart attacks and five more deaths for every 100 high-risk older patients over a four-year period.

. Risk was found mainly among those taking Avandia.

. The smaller number of those taking Actos limited the investigators' ability to report on this group.

Dr. David Alter, co-author of this study said people should not panic over this result. Decisions regarding treatment should still be individualized and that the benefits and potential problems will have to be weighed before making any decisions. This just goes to show that surveillance of drugs should be an on-going process after they have been on the market. They are also not certain whether similar results will show among the younger patients.

Dermal Thermometry Helps Prevent Amputation

There's a thermometer that helps prevent leg and foot amputation. I breathed a sigh of relief when I heard this news because now diabetics can check the temperature of their feet and consequently monitor their condition. No, you don't put the thermometer under your tongue; you put it in the bottom of your feet.

Using this Temp Touch which is in the form of a wand can help prevent ulcers. How? You can tell if something is wrong from the differences in the readings. This is great help because diabetics lose sensation to their feet so it takes a while to find the problem and by this time it's too late to save the foot.

The American Journal of Medicine will publish one of the clinical trials this December. It will prove that monitoring the temperature of the skin will considerably decrease foot ulcers among those who have diabetes and have consequently lost sensation to their feet due to neuropathy.

The lead investigator of the most recent study on the infrared Temp Touch is the director of Scholl College Clear which is acronym for Center for Lower Extremity Ambulatory Research. He is Dr. David Armstrong who started using thermometer 15 years ago on his patients in order to prevent ulcers.

Dr. Armstrong has advised his patient to buy this fancy, expensive thermometer but it will help keep the feet. The diabetics can use this before they start the day and will be warned if the temperature spikes up that an infection is coming. They can then stay off their feet until the ulcer threat has gone down.

Dr. Armstrong explained that before the skin breaks, the wound will heat up first. Therefore, one can detect the infection by comparing the temperature of one foot versus the other or comparing one toe with another toe's temperature.

Foot problems among diabetics cause one-third of admission to the hospital. The result of the most recent clinical tests shows that those who used the Temp Touch were three times less prone to develop ulcers than their counterparts who were taught to inspect their feet.

Xilas Medical, a company based in San Antonio, holds the patent for this weapon to fight foot ulcers and its president, Ruben Zamorano said the cost to treat diabetic foot ulcers is 14,000 per person in the first year. When the patient develops foot ulcer, it may be healed by a physician but then the problem recurs so prevention is the key.

Xilas received a million dollar grant from Texas in 2006 and the company donated foot thermometers, 5000 in all, to Texas Medicaid patients. They are now contacting insurance companies in New York and Tennessee. They face real challenge with insurance companies who pay lip service to prevention but are reluctant to cover the cost.

Hopefully more diabetics will start using this hand-held tool like the Temp Touch which improves in the ease of use and in the cost as well. The $150 cost for this may go down as they become cheaper to make and as more insurance companies reimburse the cost. It is hoped that dermal thermometer will become a standard for treating the diabetic foot.

Tips on Diabetes and Holiday Foods for a Healthy Balance

The holiday season is a special temptation for the diabetics because of the temptations that surround them that might make them forget the healthy eating habits they have worked hard to maintain all year. There are holiday parties where foods rich in calories are served.

Cedars-Sinai Medical Center's Family Diabetes Outpatient Treatment Center director, Philip Barnett, M.D., said that to go through the holiday season successfully, it's important to remember that one can have a holiday but diabetes cannot.

Cedars-Sinai Medical Center is acclaimed nation-wide for its diabetes outpatient program. Its leader, Dr. Barrett said that diabetics should keep away from too much sugary desserts and other rich foods. They should also follow the regular exercise program.

This does not mean the diabetics cannot enjoy the holiday foods; they just have to eat in moderation. The holiday weeks of festivities should not stop them from doing their meal planning and exercise program. Here are the tips from Dr. Barrett:

1. Keep on with the regular exercise regimen. If there's not enough time, walk briskly for ten to fifteen minutes at different times of day. They add up to a respectable amount of exercise but remember to wait 60 to 90 minutes after eating a holiday meal before taking a walk.

2. Before a party, eat a little bit at home because one who is hungry tends to eat more and choose less healthier foods. It is a good idea to take a fruit on the way out to go to a social event.

3. Eat the holiday foods in smaller portion for this will be less prone to disturb the blood glucose level.

4. Go to the vegetables and fruits section at buffets and holiday parties.

5. For beverage, drink water or diet soft drinks. If you must drink alcohol, drink it with food.

6. Don't omit meals and do monitor the blood sugar level.

7. Make sure the meals are healthy and balanced. If you have a treat, replace it with a comparable item in your regular meal.

8. Remember to be positive and think that diabetes does not control you; on the contrary, you control it.

Oral Insulin Reduced Glucose Levels in Pre-Clinical Trials?

Oral Insulin Cobalamini has been shown to considerably reduce sugar levels when tested on animals. This is as per announcement of Access Pharmaceuticals. They used some formulas of Cobalamini that are based on the body's natural absorption of Vitamin B12. They plan to do more pre-clinical tests.

Hopefully, this will be a success especially for people who have to do multiple insulin injection daily. This emerging company already has patents on Vitamin B12 to carry drugs. It will transfer this to the blood for easier absorption. Cobalamini therefore has the potential to deliver insulin orally or improve the delivery system currently in use.

Senior Vice President of Access Pharmaceuticals' Research and Development, Dr. David P. Nowotnik said that the company has data to use this method with different proteins but the result of the pre-clinical trials delighted them as there is indication that desired effect can be attained.

Access Pharmaceuticals plans to collaborate with other companies in the development of this oral delivery device. They have conducted studies with top pharmaceutical companies but are looking for partners to do more research on the availability of oral insulin.

CEO and Access Pharmaceutical Stephen R. Seiler said they're excited by the results of the research they conducted on animals. The potential for an oral delivery system for insulin is indicated. The Cobalamini technology, he said, can be applied to some cancer products as well.

Disabled Diabetics May Collect Social Security Benefits

The main cause of disability in the US is diabetes. Its complications are many among which are blindness, kidney failure, nerve problems and blindness rendering diabetics disabled. Now there is news they are entitled to full disability benefits from Social Security.

One who is unable to work or earn enough income due to these complications and the condition has gone on or may continue for a year may be able to collect full benefits on disability insurance from Social Security. Apply at the Social Security Office.

If the application is turned down, a social security lawyer who is experienced with disability insurance may be of help. These lawyers usually win cases on appeal when the client's application has been rejected. But consult the lawyer as soon as the application is turned down.

For those who are not disabled from diabetes, please continue the regimen of eating healthy, being physically active and taking the medication as prescribed. It looks like only about 50% gets disabled from these complications.

Improvement In Glucose Control And Weight Loss Seen in Monotherapy

The findings of a 24-week long study were released by Amylin Pharmaceuticals, Inc. and Eli Lilly and Company. The research was on the use of Byetta injection two times a day given to 232 type 2 diabetes patients. These patients showed considerable lowering of their A1c test which is a measure of the average blood glucose over three months. About 60% of the participants had a 7% A1c which is the goal for good blood sugar control.

The two companies plan to submit this to the Food and Drug Administration during the first half of 2008. It must be pointed out that over 85% of the participants finished the study. Weight loss among the participants was noted as significant.

Global Medical Director James Malone, MD of Eli Lilly and Company said the American Diabetes Association has guidelines in the treatment of type 2 diabetes. And these are weight loss for obese and overweight patients and the attainment of the target sugar control. If this monotherapy is approved, both the physicians and the patients will have additional treatment option.

During the study, there was no occurrence of severe hypoglycemia while the incidence for nausea was low. It was 3% for those taking 5 mcg and 13% for those on 10 mcg. Byetta by the way was approved by the FDA as incretin mimetic and has been used by more than 700,000 patients as an add-on therapy. Now it is being considered as a stand alone therapy or monotherapy.

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