KYW's Medical Editor Discusses Diabetes

by KYW’s medical editor Dr. Brian McDonough

The numbers are startling. It’s about 24 million. That’s the number of Americans who have diabetes today; however, 6 million of them don't know they have diabetes.

The problem with diabetes is it can cause long term problems, such as kidney failure, heart disease, neurologic issues, and can even cause blindness. Now there are several things you can do to reduce your chances of developing diabetes, but several things you can do even if you have diabetes that can really help you.

First of all, you should set goals for yourself. Try to figure out what you can do realistically and go after it. One of the things I often suggest is to get 30 minutes of exercise each day. But remember, you don’t have to do it all at once, don't buy into the 'no pain, no gain' theory. Start slow and build.

You should make better food choices, meaning you should drink water rather than soda, chose vegetables as a snack instead of cakes and pies. Common sense is the answer.

Vigorous exercise makes big difference in heart health of seniors: study Diabetes

Provided by: Canadian Press
Written by: Shannon Montgomery, THE CANADIAN PRESS
Oct. 25, 2009

CALGARY - New research suggests it's never too late for seniors saddled with Type 2 diabetes and other problems to start turning their health around through vigorous exercise often recommended only for younger people.

While exercise is touted as a key component of health in people under the age of 65, the message often trails for people who are later in life, says Dr. Kenneth Madden, a geriatrician at the University of British Columbia.

Madden decided to see whether aerobic exercise could have the same effect in what he terms "the worst-case scenario" of patients - those with Type 2 diabetes, high blood pressure and high cholesterol.

"There's a lot of talk about prevention, but everyone just kind of gives up when people are over 65 and have all these risk factors. So we decided - can you actually do something at this point?"

He assigned adults between the ages of 65 and 83 to one of two groups. One group continued to do no exercise at all while those in the other one engaged in vigorous exercise on treadmills and stationary bicycles for one hour, three times a week.

The stiffness in their arteries - shown to be a risk factor for heart attacks and strokes - was measured by monitors on pulse points that checked how fast a pulse wave moved through their bodies.

After three months, the exercise group had improved the stiffness of their arteries by about 20 per cent, a large impact in such a short period of time, says Madden.

The shift was especially surprising because many believed it was too late for sedentary seniors to be able to change at all.

"It was just assumed it was kind of irreversible at that point, the damage has been done."

Seniors are often wary about starting aerobic exercise, a fear that is shared by many others working in health care, he says.

"It's a constant struggle to convince people over 65 that it's safe to do an exercise program and a struggle with other health-care providers to convince them that it's not too late and that it's never too late."

It was initially difficult to recruit patients into the study, but once they started they were quickly hooked, Madden says.

While the study did not measure the effect of the exercise beyond the arteries, he's heard anecdotally that some of the seniors involved have cut back on their medication and have felt better overall.

"We had the hardest time getting people out of the study at the end," he laughs. "They didn't want to stop the intervention, but after a while I said, 'I'm not running a gym."'

Lindsay Walker, strength and conditioning director at the Eau Claire YMCA in Calgary, says the gym has several seniors-specific classes.

The important thing is to build up slowly, she says. For example, while she might build up balance for younger clients by getting them to stand on balance balls, she would likely start a senior just balancing on one leg on the floor.

"It's totally never too late to start. Everyone can at least walk, you know? And from there you can build up."

Madden says seniors wanting to start an exercise program should check with their family doctor. He also recommends a session or two with a personal trainer experienced in working with seniors, who can suggest a proper program.

"The amount of money we spend on drugs and cholesterol-lowering agents and all these sorts of things, in the context of that, one single session with a trainer isn't a big-ticket item," he says. "It's $50, compared to hundreds and hundreds and hundreds of dollars a year on medication."

Madden will present his research Sunday at the 2009 Canadian Cardiovascular Congress, which is being held in Edmonton. It was published recently in the journal Diabetes Care.

Skin bacteria different in diabetic mice

In people with diabetes, wrong microbes on skin could make wounds slow to heal

HONOLULU – Too much of the wrong type of skin bacteria may keep diabetics from healing, new research suggests.

People with diabetes have a notoriously hard time healing from skin wounds. New research on diabetic mice suggests that bacteria normally present on healthy skin may play a role in wound healing, says Elizabeth Grice, a researcher at the National Human Genome Research Institute in Bethesda, Md. Grice presented results of a study comparing bacterial diversity on the skin of diabetic and normal mice October 23 during the annual meeting of the American Society of Human Genetics.

The work aims to find out how bacteria and other microorganisms on the skin — known collectively as the skin microbiome — affect health.

Grice and her colleagues had recently completed a survey of bacteria populating the skin of healthy people and found a wealth of diversity from individual to individual and from body part to body part.

At any given time, about 15 percent of diabetes patients will have a slow-healing wound, Grice says. Previous laboratory work to grow bacteria from cultures of diabetic wounds revealed that the wounds contain Staphylococcus, Streptococcus, Pseudomonas, Enterococcus and Corynebacterium. But Grice’s survey of healthy skin also found that those bacteria are a normal part of the healthy skin microbiome.

In order to find out how the microbes in the wounds of diabetic mice differ from those in the wounds of healthy animals, Grice compared bacteria from the skin of diabetic mice with those from the skin of the mice’s healthy siblings. The researchers first shaved the backs of both types of mice and found that the diabetic mice have inflamed, fragile skin. Sequencing DNA from swabs taken from the mice showed that diabetic mice have 40 times more bacteria on their skin than healthy mice, but fewer types of microbes.

The researchers then used a skin punch, like those used by dermatologists to take a skin sample, to make a small wound on the mice’s backs. As the wounds healed, the team collected bacteria and skin samples to find out how the population of bacteria and the mice’s response to the wound changed over time.

Wounds in normal mice healed in about two weeks, but healing took nearly a month for the wounds on diabetic mice. Even after the wounds healed, the skin around the wound site was inflamed in the diabetic mice, but not in the normal mice, the researchers found.

The diabetic mice had higher levels of Staphylococcus and other rod-shaped bacteria, such as Aerococcus and Weissella, in their wounds, the team discovered. The injury sites in normal mice had increased levels of Clostridium and Streptococcus bacteria. These types of bacteria may occupy an important niche in healthy animals. Either the bacteria keep out other types of bacteria just by their presence, or they make compounds that would fight off bacteria that could prevent healing or cause infection, Grice says. “If you leave that niche wide open, it leaves room for something else to come in,” she says.

Grice’s team also found different immune responses to the wounds. Diabetic mice make altered levels of antimicrobial compounds and of immune and inflammatory chemicals compared with their healthy siblings.

Grice doesn’t yet know whether the shifts in microbes lead to impaired wound healing or are a result of slow healing or other differences in the skin of diabetics. She hasn’t yet sampled bacteria in diabetic people.

But the study may lead to improved therapies for treating wounds in people who have diabetes.

Diabetes Drug Promotes Weight Loss

Liraglutide Not Yet Approved in U.S.

By Salynn Boyles
WebMD Health News

Reviewed by Louise Chang, MD

Oct. 22, 2009 -- The injectable diabetes drug liraglutide appears to help obese people who do not have diabetes shed extra pounds, but larger studies are needed to prove its safety and effectiveness for weight loss, researchers say.

Liraglutide has been approved for the treatment of type 2 diabetes in Europe, but it is not yet approved for use in the United States.

In earlier studies, diabetes patients who received once-daily injections of the drug lost weight and showed improvements in blood sugar.

In the newly published study, overweight people without diabetes who received daily injections of liraglutide lost more weight than patients treated with the oral weight loss drug orlistat, sold as Xenical and Alli in the U.S.

Liraglutide belongs to the same class of drugs as the diabetes treatment Byetta, which has also been shown to promote weight loss.

The mechanism by which the drugs affect weight is not completely understood, but they are believed to suppress appetite and delay the movement of food from the stomach to the small intestine. The thinking is that this helps people feel full longer after eating.

Liraglutide and Weight Loss and Diabetes

The 20-week weight loss study included 564 obese people with body mass indexes (BMI) of between 30 and 40, treated at 19 sites throughout Europe.

Participants received either daily injections of one of four doses of liraglutide, injections of an inactive placebo, or the weight loss drug orlistat taken orally three times a day.

All the study participants followed calorie-restricted diets, which contained about 500 fewer calories a day than they needed to maintain their weight. They also increased their physical activity.

By the end of the study, the liraglutide-treated patients had lost significantly more weight than either the placebo-treated patients or those who took the oral weight loss drug.

Orlistat-treated patients lost an average of 9 pounds during the 20-week study, compared to a weight loss of 10.5 pounds in patients on the lowest dose of liraglutide (1.2 milligrams a day).

Patients treated with the highest dose of the liraglutide (3 milligrams daily) lost the most weight, averaging nearly 16 pounds. These patients also had the most nd vomiting, with 3.5% of participants withdrawing from the study as a result of these side effects.

Placebo-treated patients lost the least amount of weight -- about 6 pounds.

The study was paid for by liraglutide manufacturer Novo Nordisk, which has also provided independent financial support to several study authors.

Weight Loss and diabetes & What is Diabetes

Researchers say longer studies will be needed to determine the drug’s long-term risk-benefit profile as a weight loss treatment.

Novo Nordisk Chief Science Officer Mads Krogsgaard Thomsen tells WebMD the company will decide whether to go ahead with larger studies once the FDA decides whether or not to approve liraglutide for use as a diabetes treatment in the U.S.

That decision is expected by the end of the year.

“The study published today in Lancet is encouraging, but it is important to stress that this is only phase II data,” Thomsen says.

Weight loss researcher George A. Bray, MD, tells WebMD that it remains to be seen if people will embrace a weight loss drug that they have to inject, even if it proves to be more effective than approved oral treatments.

Patients who take Byetta inject the drug twice a day; liraglutide is given once a day.

“My guess is that there will be much longer acting versions of both these drugs in the future that will require much less frequent injections,” Bray says. “But it still isn’t clear if people who aren’t used to injections will take shots to lose weight.”

Novo Nordisk is now testing a drug similar to liraglutide that is injected once a week instead of once a day.

Bray would also like to see studies to determine if combining Byetta or liraglutide with approved weight loss drugs leads to bigger weight loss than has been reported with any of the drugs alone.