Friday, 20 July 2007

Top rated diabetes books - what's yours?

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TuDiabetes.com is a site for people touched by diabetes. The creator of the site, Manny Hernandez, got the ball rolling on a topic of interest we all take to heart - diabetes book recommendations.

When you ask diabetics to brainstorm on a terribly intrinsic topic you get some pretty good responses. One suggested read was The Diabetes Improvement Program. This book helped a diabetic overcome depression, when the talented team of healthcare professionals could not. Other honorable mentions include: Psyching Out Diabetes, Dr. Bernstein's' Diabetes Solution, Diabesity, and Diabetes for Dummies.

Somebody actually asked something very interesting - where is the book on the evolution of diabetes treatment? Often a topic of discussion, and yet so rarely documented is the sequential events of diabetes treatment, starting with the discovery of insulin. A lull ensued from about 1930 till the boom of genetically modified human insulin, in the early 80s. Any investigative journalist willing to take a stab at it? I guarantee the book will make my must read. And Eli Lilly might actually pay you not to write it.

P.S. One reader pointed out - a chapter of Brent Hoadley's book, Too Profitable to Cure presented a chronology of the evolution of diabetes treatment.

Asian herb aids in blood sugar control

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I've dabbled with herbal remedies over the years -- astragalus for good health, arnica for muscle soreness, echinacea for immune support, I even sent away for a bag of some wild grown herbal tea leaf when I was trying to get pregnant with our second child. That stuff was disgusting to drink, but I immediately noticed it whisked away some hormonal imbalances I experienced after the birth of our first child. A naturopathy novice, I haven't read any herbal medicine books nor met with a naturopathic doctor. But even my guarded respect for allopathy (Western medicine) cannot prevent herbal medicine from speaking to my soul. Whenever I read good news about an herb, I am downright enthused.

A new study suggests the herb Salacia oblonga may help men and women with type 2 diabetes control their blood sugar. Researchers from Abbott Laboratories reported S. oblonga reduced post-meal blood sugars in 66 men and women with type 2. Participants guzzled high-carbohydrate liquid meal replacements three separate times. One day they had only the meal, and the other two days 240 mg or 480 mg of S. oblonga extract was added. On average, the lower S. oblonga dose decreased peak blood sugar response by 19 percent, and the higher dose by 27 percent. S. oblonga also reduced the typical increase in insulin post-meal.

Researchers suspect the herb blocks the body's absorption of carbohydrates, similar to type 2 meds called alpha-glucosidase inhibitors. They call for more research to study S. oblonga's long-term impact on blood sugar control. S. oblonga grows in the forests of India and Sri Lanka. The roots and stems are used to treat obesity and diabetes in Ayuvedic and traditional Indian medicine.

History underway in type 1 diabetes cure

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Dr. Faustman's lab is currently collecting blood samples from individuals with established Type 1 diabetes. These samples are being used to quantify the number of autoreactive T-cells and develop the adequate dosage for Phase 1 of human trials to cure Type 1 diabetes.

The research has been presented and the NIH confirmed it. By reeducating the confused T-cells and instructing them not to attack healthy islets, an apparent cure of established type 1 diabetes in non-obese diabetic mice is possible. Now, Dr. Faustman is collecting human samples to bestow the same cure for diabetes in humans.

If you wish to be a part of this revolutionary event for curing Type 1 diabetes, please contact the Clinical Coordinator or call Dr. Faustman's lab at (617) 726-4084. Each participant is asked to bring a control person along with them - an unrelated person without Type 1 diabetes or another autoimmune disease. Diabetic or not - you can be a part of history in curing Type 1 diabetes!

Novartis' Galvus gains EU support

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An advisory committee for the European Medicines Agency (EMEA) gave a thumbs up on type 2 diabetes drug Galvus. The EMEA's recommendations are usually endorsed by the European Commission within a few months.

Galvus, marketed by Swiss drugmaker Novartis, is a new oral anti-hyperglycemic agent of the DPP-4 class of drugs. Known as vildagliptin, it inhibits the inactivation of GLP-1 and GIP by DPP-4, allowing insulin secretion in the beta cells and suppression of glucagon from the islets of Langerhans.

In the United States, Galvus is awaiting Food and Drug Administration approval. The agency has delayed approval twice, requesting additional clinical data on vildagliptin, including proof the skin lesions and kidney impairments seen in an earlier animal study have not occurred in humans. The delays have carved a big market lead for Januvia, a similar drug marketed by Merck.

Galvus is one of Novartis' most important drugs under development. No wonder, it could potentially generate $1 billion or more in revenue. If only the same amount of money was spent on supportive diet and exercise programs for those at risk for type 2 diabetes. Photo by rodrigo senna at flickr.

Meager data on benefits of diet and exercise for type 2s

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As I search the daily news buzz on type 2 diabetes, it is drugs, drugs and more drugs. Where is the research buzz on diet and exercise to help treat type 2? I just went camping with a friend who lost 60 pounds and threw away his insulin. My eyes first widened in amazement at this feat, then gleamed in utter respect as I witnessed his celebration of newfound health as we hiked, ate nutritious food and threw frisbees with our kids. While losing weight and exercising is certainly not the magic cure for all type 2s (there are thin type 2s!), the power of diet and exercise is undeniable in improving blood sugar control and lessening drug doses.

Cochrane Library reviewers recently examined a wide body of research on diet and exercise for diabetics. The search yielded 36 articles across 18 different trials, including 1,467 participants with type 2 diabetes. The quality of the data was poor, only a minority of the trials included hard clinical endpoints such as macrovascular/microvascular complications, quality of life or even death. Weight and blood glucose control were central to most of the articles, factors easier to measure. Meta-analyses could not even be performed for various forms of dietary advice (e.g., very low calorie vs. low-calorie or dietary advice plus behavior changes) due to scant data. On a brighter note, seven studies comparing dietary advice vs. dietary advice with exercise suggested participants adding exercise realized a significant decrease in glycated hemoglobin of 0.9%. Researchers call for well-designed studies examining a range of interventions. They noted a promising study called "look AHEAD" is measuring the long-term health effects of weight loss in men and women, ages 45 to 75, who are overweight and have type 2 diabetes. Funded by the National Institutes of Health, "look AHEAD" participants will be assessed up to 11 and a half years.

We need an influx of clinical studies examining the effects of dietary and exercise improvements on the health of people with type 2. We need Big Diet and Exercise to step in, instead of the ubiquitous presence of Big Pharma ... a Big D&E with research and development money to help inform and motivate people to change their lifestyles. Yes, we are a car country. Yes, genetically-modified, processed, carbo-loaded food is the norm for most. Yes, kids don't run around and play like they used to, the computer and rigidly organized sports have usurped free play. Yes, parents are usually working and families have less time around the dinner table. Yes, there are other issues beyond these. Childhood and adult obesity is a multi-pronged problem, and we need research and solutions across many levels. What motivates people to better their health? Is there some saturation point when frustration and sadness over worsening health triggers behavioral change? It is easy to scold, to point a finger and say "just lose 50 pounds." Yet shame is abusive and wrong, let alone ineffective. A healthy diet and regular exercise takes desire, fortitude and a culturally supportive environment.

I see the glass more than half full. Plenty quit smoking, and in many societal segments it is not cool to smoke anymore. There currently is no nicotine patch for bolstering better diets and more exercise, but people can and do adopt healthier habits, and the food industry and societal norms will ultimately reflect the masses.

Moles may be related to aging

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How many moles do you have? I counted 14 before I got bored and gave up, but I have quite a bit, although I always thought they were just dark freckles (As an aside, I noticed I have a collection of moles on my arm that form an M--my first initial--so hooray for this post. Though you're probably not interested so nevermind ... )

Anyway, here's my point: A study shows that people with 100 or more moles age better and have a biological age that's 6 or 7 years younger than counterparts of the same calendar age. And if you're wondering what one's biological age is based on, it's the length of their telomeres, which are the ends to our DNA strands. As we age, telomeres inevitably get shorted, which it's thought is one of the main factors behind the whole aging process.

As such, people with a younger biological age are less prone to age-related diseases and conditions like heart disease. So count your moles and if you have over 100, count your lucky stars too!

Prescribed a blood thinner? Things you should know

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Shortly after giving birth to her first child, my sister-in-law developed a blood clot that traveled to her lung. Because she's only in her mid-30s, she was surprised to find out she'd be taking blood thinners for the rest of her life, due to a previously undiscovered genetic blood clotting disorder.

Though blood thinners are commonly prescribed to those with high risk of heart attack or stroke, they're also prescribed to prevent blood clots and to those who suffer from atrial fibrillation and congestive heart failure. When you first start using blood thinners, there are a few basics you should know, including:
  • Blood thinners may interact with other medications you are taking, so be sure to tell you doctor about all prescription and over-the-counter drugs you use.
  • Alcohol should be avoided while on blood thinners and patients should quit smoking.
  • Regular monitoring of the blood is necessary to make sure your medication is effective.

Genes found that predict heart disease

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Scientists in Europe have just found 6 specific genes that may be a key to heart disease. Data shows that people with variations in one or more of these genes have a much greater risk of suffering a heart attack or heart disease before the age of 66. These genes only seem to predict risk, however, not the definite future. Not everyone identified with a "genetic predisposition" ultimately gets sick, so it's still very much worthwhile to eat a heart healthy diet and get plenty of exercise.

Cancer drugs too expensive? Can you get the government to pick up the tab?

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It's good news if you live in Alberta, like I do, or even if you don't, it's a step in the right direction on a larger scale: The cost of a very pricey colon cancer treatment will be footed by the government at an expense of $7M per year. The place I live in is notorious for putting healthcare on the backburner and making more money for already-wealthy oil executives on the front burner, so I'm pleasantly surprised to hear that at least some patients in this messed-up system get the treatment they deserve at the expense of the government. Sorry -- rant over.

The drug in question is called Oxaliplatin and it's been shown to be an extremely effective tool in fighting colorectal cancer. In the wake of announcements like this, not to mention eye-opening movies like Sicko, I hope North America is heading in the right direction -- and dying or gravely ill patients won't be denied access to the drugs that could save their lives.

Thought for the Day: Go natural while showering

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I'm not sure if you have investigated some of the components inside that name-brand shampoo, conditioner and body wash, or have you. When showering, your pores open up more than usual and wouldn't you know it -- some of that product probably invades your skin, and more than on just the surface.

I'm not so sure I would want to have some of the chemicals, fragrance chemicals and preservatives inside standard brands of shampoo and other shower and bath products flowing down my body, for nothing else than for minimal exposure to certain components external to my body.

But there is a solution -- buy all-natural and organic personal care products. They're more expensive, sure. But, like anything, you get what you pay for. Even with these products, though -- do your research.

Survivor Spotlight: Cancer again!

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I did a post back in August of last year about my friend Larissa's journey through breast cancer. Larissa was just recently diagnosed with cancer again. This time it was skin cancer, basal cell carcinoma.

I asked Larissa if she would talk about her experience and how it felt to be diagnosed with cancer yet again. Larissa blogs at Welcome to the Dallehouse.

How did you find out you had skin cancer?

I had a red patch on my face that didn't go away for several months. I kept an eye on it and noticed it was getting larger so I made an appointment with a dermatologist. The dermatologist thought it looked suspicious and did a shave biopsy. The biopsy came back positive for basal cell carcinoma.

What types treatments were recommended?

MOHS surgery was recommended since the lesion was on my face. It is the least invasive procedure. The surgeon removes the lesion and sends it to the lab while you wait. After about an hour or so, they can tell if they have clean margins. If not, they can tell exactly where the remaining cancer is and just remove another layer. That is sent to the lab and the process is continued until all is clear.

What treatments did you receive?

I underwent the MOHS surgery and I got clean margins in two takes. The entire process lasted about 4 1/2 hours, most of it waiting for the lab results. And even though the lesion was so small (about the size of a pencil eraser), it left me with about a two inch scar. They have to cut about four times the length of the mass in order to be able to stitch it back up in a straight line.

As a breast cancer survivor and skin cancer survivor, how to you feel emotionally about being diagnosed twice? Was the second one easier to handle mentally since you have went through breast cancer?

The doctors told me that off all cancers to get this was the best. No chemo. It has an excellent cure rate and it almost never metastasizes. But still in the back of my head I kept thinking "OK, what is next?" This cancer was easy to find because it was on my face, staring back at me everyday in the mirror. But what about other cancers that could be lurking inside, hiding in organs and bones? I started to really not trust my body. Plus I don't fit the criteria for someone with skin cancer. I don't have fair skin, light hair nor blue eyes. I don't spend lots of time in the sun. And I am relatively young. The nurse told me I was a baby compared to most of their patients. But I've heard that before. I thought I was too young for breast cancer.

Even for all the self doubt, I still wasn't too worried about this particular diagnosis. From everything I read about basal cell and MOHS, I thought it was going to be a breeze. And I was fine for the first couple of hours during surgery. It really wasn't until the nurse asked if I wanted to see the scar in the mirror before they patched me up, that I started to fall apart. All kinds of memories came back. All the time spent in oncologist's offices. All the surgeries. All the scars. First they took my breast. Then they took a piece of my back to create a new breast. And now my face! I just lost it and started crying. I think if this was my first cancer, it wouldn't have been such a big deal. It would have just felt more like a procedure, like having your wisdom teeth removed.

What advice would you give to someone about skin cancer?

Wear sunscreen. Know you body. If you notice anything that looks different, get it checked out. The sooner it is caught, the better your prognosis. If I had ignored this lesion, over the years it would have grown and could have done serious cosmetic damage to my face. It could have even spread to my cheek bone. And that would be much worse than a two inch scar.

Anything else larissa that you would like to add?

It's been two weeks since surgery. And I am feeling better. I am starting to get used to the scar. I suppose it gives me character. Plus I can always make up interesting stories on how I got it. It makes me look tough.

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Tammy Faye on Larry King

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Dressed in red and her signature pound of make-up, Tammy Fay Messner appeared on Larry king Live last night, looking like a mere shell of herself -- so thin that when she took the deep breaths that punctuated her sentences, the bones in her chest were clearly visible. But as the 65-lb woman struggled to talk, one thing is apparent: She is weak in body but not in spirit. She talks of god and heaven with a certainty that I admire. To trust so much, to put your entire life into the hands of god, is something that amazes me.

Here's a brief synopsis of what I learned from the interview:
Messner doesn't want to know how much time she has left on earth because she doesn't want a death sentence--she wants to enjoy each day she has left. She's not afriad of dying. She misses cheeseburgers and looks forward to the day she'll eat a juicy one again. She's already thinking of the people she'll meet in heaven -- particularly Billy and Ruth Graham. She's ready to go to heaven, but wants to stick around to spare her family the pain of losing her. She has no regrets. She wants us to know that she wants us, every one of us, to find peace in our lives.

And she wants to be remembered for her eyelashes.

Love her or hate her, I think she is incredibly brave to face death with such dignity.

Actor Daniel Baldwin says drug rehab is his chemo

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I watched ABC's Primetime: Family Secrets on Tuesday night. Correspondent Cynthia McFadden went behind the scenes with actor and famous Baldwin brother Daniel as he trudged his way through a Malibu drug rehab experience. It wasn't his first help-seeking trip -- at one point in his life, he went to rehab six times in four years.

It's a disease, this whole addiction thing, say experts who believe addicts harbor a genetic predisposition for their bad habits. Baldwin agrees. And he calls this ninth stint in rehab his chemotherapy. He needs it, he says, to beat his disease.

McFadden asked Baldwin if his comparison of addiction to cancer wasn't a bit off target. Isn't choice part of the addiction equation, she inquired. "No," he responded. His disease will be with him for the rest of his life, he explained. It's no different really than if he was battling cancer.

I'm not sure about this. I see the genetic argument. I understand addictive personalities. I know it must be hard to kick addiction. But I don't know if I'd put it in the same category as cancer -- because addicts can elect to get help and it can work. Even though nearly 80 percent of those who complete rehab programs go back to using, it's possible to come out clean. Research shows it takes 90 days for the brain to rid itself of this "disease." Research shows there may never be a true cure for cancer.

So I'm just not sure about Baldwin's "chemotherapy." What about you?
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Folic acid and colorectal cancer link examined

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Since folic acid has been added to grains on a nationwide level in the 1990s, the number of infants born with neural tube defects has declined by 20 to 50 percent. However, at the same time, the rate at which new colorectal cancer cases were diagnosed has increased, according to Joel Mason MD and colleagues at Tufts University. Since folic acid fortification began, there has been an additional four to six cases of colorectal cancer for every 100,000 people.

Mason notes that the analysis suggests that the increase is not due to increased screening or chance.

"The body's response to folic acid appears to be complex," says Mason. "While fortification of the food supply is clearly beneficial for women of child-bearing age and their offspring, it is possible that it may, coincidentally, be linked to the increase in colorectal cancer rates. Our report is intended to create a foundation upon which to further explore that possibility."

Mason urges caution and debate as more and more countries are considering instituting folic acid fortification.

Armstrong takes cancer fight into presidential spotlight

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Lance Armstrong, one of the fiercest proponents of cancer research and the all-time leading winner of the Tour de France biking event, will be hosting presidential candidate forums on cancer next month in Iowa.

Armstrong says that he wants the U.S. presidential candidates to "discuss the #1 killer in this country," and if anyone can stir up deep thoughts on the fight against all types of cancer, it would be Armstrong.

This quote says it all: "I think whoever wants to be commander in chief ought to answer the cancer question." That's quite prophetic, and with five acceptances so far from both the Democratic and Republican side, next month's open forum on cancer should prove interesting. I'll be watching, that's for sure.

England and Ireland to ban Red 2G dye

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Meat eaters in England and Ireland might have to switch to raisin bran or be forced to eat paler sausages soon. The European Union has determined that Red 2G, a common food coloring agent in burgers and sausages, is too carcinogenic for the meats.

When consumed, the Red 2G breaks down to analine in the intestines and is thought to cause cancer. The dye has been banned in many other countries for some time. However, the European Food Safety Authority (EFSA) recently reached the conclusion that even a small amount of the coloring was toxic enough to cause concern, thus the ban of the Red 2g.

Hilary Swank to donate hair to charity

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Hilary Swank is not your average Hollywood celebrity. She is private, talented and driven to do good things. One of her current projects will benefit the charity Pantene Beautiful Lengths Campaign. This charity collects hair from woman and then creates wigs for patients who have lost their hair to cancer therapy.

Swank, who is currently sporting long locks, will have to grow enough hair to produce an 8 inch pony tail. As per the Pantene requirements, she will not be able to use permanent dyes on her hair and cannot have more than 5% gray in her hair. The actress reports that she is looking forward to donating her hair to a good cause and sporting a new look.

Fewer young smokers seek help to quit

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A new study shows that younger smokers trying to quit are less likely than older smokers to use tools such as patches to medications to help them, a new study out of the University of Illinois at Chicago shows.

Dr. Susan J. Curry and her team analyzed data from over 6,500 smokers from the 2005 National Health Interview Survey. Over 30 percent of smokers 25 and older had tried medication compared to only 18 percent of younger smokers. According to Curry, current smoking cessation and prevention program focus either on older people with smoking-related illness or younger people who haven't yet started to smoke.

Curry says that more research is needed to find out how to reach younger smokers regarding the available treatment options for quitting smoking.

Wheat can cause cancer?

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Wheat is my comfort food -- I love bread, pasta, bagels and pretty much anything along those lines. But according to this post on That's Fit, titled Reasons to Avoid Wheat, I've learned a lot about my comfort food that I didn't want to know. Ignorance is bliss.

Here's the thing that caught my eye: According to this study, If you have an intolerance to wheat, it can increase your chances of dying from cancer, particularly non-Hodgkin's Lymphoma. It doesn't say why, but it's good to know nonetheless. The study seems to be confined to those with celiac disease, and celiac disease, as far as I know, is not a condition that often goes undiagnosed because the symptoms can be rather severe and include weight-loss, bowel disorders and diarrhea.

What's your take on wheat?

Thursday, 19 July 2007

Height matters: Americans are getting shorter

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A relative of mine lives in a cozy house in Southern England that dates back to the the 1500s. Take a walk through her living room and you'll realize that it's not just a rumor that people were shorter back when her house was built. My head touched the ceiling in some places and I am average height -- 5'7.

We've gotten taller over the last 500 years or so, and it's mostly down to improved nutrition. But here's the thing -- We're going backwards, getting shorter. Why? Because the nutrition of the average American, which has been getting exponentially better over the years, is now getting worse. With all this technology, our nutrition is getting worse? It's strange but true -- we're learning more than ever but at the same time becoming more (intentionally?) ignorant than ever about one thing that matters more than anything -- our health. Yes in the Netherlands -- where nutrition is generally good and levels of obesity are low -- people continue to get taller. Perhaps we should take lessons from those Dutch. What do you think?

Merv Griffin treated for prostate cancer recurrence

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Merv Griffin, inventor and producer of TV game shows Jeopardy! and Wheel of Fortune, has been hospitalized for a recurrence of prostate cancer. The cancer was discovered during a routine examination several weeks ago.

Now in Cedars-Sinai Medical Center, the 82-year-old Griffin says, "I'd rather play Jeopardy! than live it. I was ready for a vacation; however, this wasn't the destination I had in mind."

Griffin's son, Tony, said his father is getting great care. His medical team wants to monitor his progress in a controlled setting, he said, and that's why he's in the hospital.

According to TV Squad, Griffin has another game show in the works. Let's Play Crosswords will premiere in syndication across the country this fall.

Single-agent chemotherapy for advanced colorectal cancer is gentler and just as effective, says study

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According to two new studies in The Lancet, for patients starting out treatment for advanced colorectal cancer, beginning chemotherapy with one drug is gentler and just as effective. Current clinical practice favors using combo therapy from the start.

In the first study from the University of Leeds, three groups of advanced colorectal cancer patients received three different regimens: the first group received only fluorouracil for as long as it controlled their disease, the second received fluorouracil followed by combo therapy (adding irinotecan or oxaliplatin), the third received combo therapy from the beginning.

Patients in the first group had the shortest survival times, while patients in the second and third groups had similar overall survival times.

In the second study from the University Nijmegen Medical Center in the Netherland, patients were randomly assigned to either sequential treatment with capecitabine, irinotecan and oxaliplatin; or combination treatment of capecitabine plus irinotecan followed by capecitabine plus oxaliplatin. Both groups of patients had similar overall survival rates.



UK diabetes care basic, at best

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British watchdog group The Healthcare Commission just gave diabetes care in the UK a lukewarm review. Its study of the facilities in which British diabetics receive care concludes that care levels overall are basic, at best. Most of the places (73%) surveyed in the study were rated "fair," meaning patients know what medications they are supposed to be on and when they should be taking them. They also know they should be getting annual checkups. Only five percent of facilities were rated "excellent by the Commission.

The system is lacking, however, when it comes to anything beyond those most basic of services. Just like here in the US, most British people with diabetes are not receiving help with diabetes management. Studies suggest that regular consultations with a health "coach" on an individual basis could really improve patient outcomes. One reason they are helpful is because they get patients to come up with a care plan tailored for each person, making it more likely he/she will be able to stick with it.

Diabetes UK head of healthcare policy, Bridget Turner, agrees with the Commission's conclusions: "The NHS [National Health Service] has to focus more on...self-care. For people with diabetes, 95% of diabetes management is self-care."

To read more, click here or visit the Healthcare Commission's own web summary of the report.

Insulin "Bong" produces mixed results

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I apologize for covering a topic that may have very well been covered already a few weeks ago, but the way I see it, if the entries on this page change too quickly for the bloggers to keep up, it must be extra tough for the readers. That all being said, I wanted to point out the mixed results of a recent study on inhaled insulin (or the insulin bong, as I like to call it).

For people with type 2 diabetes, taking extra insulin during mealtimes is a necessary step in helping to regulated blood glucose levels. These doses are taken in addition to baseline insulin that is taken throughout the day and night. What researchers at the ECRI Institute have discovered is that inhaled insulin may improve blood sugar control for people with type 2 just as well as short-acting insulin taken by injection.

After a three-month period, the researchers found the inhaled insulin to produce equally as effective results in patients than insulin shots. The tricky part, however, is that the inhaled insulin seemed to be a bit problematic for users who experienced low blood sugar levels -- hypoglycemia.

Despite the mostly positive results, inhaled insulin still gets mixed reviews from researchers. Not only is its problem dealing with hypo a...well, a problem, but speculation also surrounds the long-term effect of inhaled insulin on the lungs.

Big savings today with IT based diabetes care

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Last month Bev addressed a news article that found high tech diabetes management did not equate to better diabetes care. Doctors felt that electronic care is only as good as the patient willing to participate beyond office visits. However, another service is trying to evolve the preconceived notions with a more developed system - and a bigger bang for the buck. How does $14.5 billion sound?

Information technology enabled diabetes management (ITDM) was found to be beneficial in avoiding diabetic complications - MILLIONS of cases. This is an overzealous finding - considering the word prevent is permanent and should probably be replaced with delayed. Even the DCCT knew that much. However, the study was conducted over a period exclusive to the program, and not the lifespan of diabetics in the study. However patient compliance did grow from less than 50% to approximately 80%. That would evoke a few halleluiahs from doctors. Another reason in support of ITDM is the fact that an electronic diabetes registry offers Medicare and other payers the ability to save quite a bit. Over 10 years, the overall net savings is estimated to be $14.5 billion. Does that figure include COLA - cost of long-term diabetes complications adjustment? The complications that did not occur in 2008 saved Medicare and payers $1.45 billion. Score! What is the inflation adjusted cost of those delayed complications occurring in 2013?

The headcount standing at 20 million diabetics, at a savings of $1.45 billion per year - I asked for clarification on that figure. The savings is speculative because the company is anticipating saving costs on preventing diabetic complications. That's optimistic but not entirely realistic.

Insulin pen patent fight: Novo vs. Sanofi

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Novo Nordisk, one of the Big Three insulin manufacturers (Eli Lilly and Sanofi-Aventis round out the group), has started legal action in the United States to block the launch of rival Sanofi-Aventis' new SoloSTAR injection pen. Novo claims Sanofi's SoloSTAR infringes on the patents of its NovoPen 4. Sanofi is ramping up for a U.S. launch in the next few months -- they contest Novo's claims and will defend their rights in court.

According to a March 2007 post in Scott Strumello's blog, the SoloSTAR is a disposable insulin pen aimed at the vast type 2 market, and Sanofi's Lantus will be the first insulin used in the new pen. SoloSTAR reduces the injection force by 30 percent or more compared to other leading disposable pens, good for people with poor grip or limited hand mobility. Different pen colors will be offered for different insulins, a nice feature to aid in correct insulin identification.

From my internet and blogosphere research, the SoloSTAR was introduced in Europe last April, and it was recently approved by the Food and Drug Administration.

This isn't the first Novo/Sanofi patent scuffle. Novo has alleged Sanofi's OptiClik pen deliberately infringed patent protections on Novo's Flexpen (post image from www.novonordisk.com). The Insulin Dependent Diabetes Trust's April newsletter stated the case should go to court sometime this year.

Deep belly fat not so evil after all?

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Did you hear about renowned Harvard scientist Barbara Kahn's latest published research? I blogged about it recently. Kahn and colleagues state, in a report published in Cell Metabolism (July 2007), that it's possible to use a simple blood test to detect the presence of a specific protein called RBP4. Kahn et al say the presence of RBP4 can be used to measure accumulations of deep belly fat. Underpinning this research is a belief that such accumulations of belly fat increase risk for metabolic syndrome, leading to various maladies including heart disease and diabetes.

However, not everyone accepts this point of view. A Yale research team says that deep belly fat may not be so evil after all. The researchers, who are based at Yale University School of Medicine in Chevy Chase, Maryland, assert that metabolic syndrome is caused not by belly fat but by insulin resistance in skeletal muscle. This resistance, they state, makes it tough for the body to manufacture glycogen, so - in people who are insulin resistant - energy that cannot be stored as glycogen gets diverted into fatty acid production, which then contributes to metabolic syndrome.

The team compared abdominal fat levels in young and healthy individuals, some of whom were insulin sensitive and some of whom were insulin resistant. The result? "There is absolutely no difference in the volume of abdominal fat," states Yale's Gerald I. Shulman, who was lead author of the study. Abdominal fat, says Dr. Shulman, "may come later in the course of the disease [metabolic syndrome], but it's not a primary, underlying factor."

Willingness to manage chronic disease not reflective of reality

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A Roche Diagnostics survey found eight out of ten adults are willing to self-manage a future chronic condition such as diabetes or cardiovascular disease, but self-management in practice is not always a success story. Unfortunately, poor blood glucose management is reality for two out of five adults with diabetes, and this can lead to serious complications. Roche Diagnostics is leading a campaign for greater awareness of various tools to help patients self-manage chronic disease.

In 2005, only six percent of Diabetes UK patient members took the self-management training available to them. Six measly percent. Diabetes is a responsibility-laden disease. Annually, people with diabetes spend 8,757 hours managing their disease, and a mere three hours with their doctor. I never really thought about managing diabetes in terms of hours -- it can be one lonely disease, even with the love and support of family and friends. Roche Diagnostics does offer several innovative tools to manage the disease, but an insulin delivery system does not give you a hug or hold your hand on the difficult days.

Diabetes Nurse Consultant Debbie Hicks stated it is good news self-management is embraced by the public, but clearly many people with diabetes struggle as they fail to self-manage. Hicks pointed out successful self-management is a combination of correct treatment, reliance on monitoring systems, professional education and support. Don't forget those free hugs.

NFL family raises awareness of diabetes complications

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Retired Dallas Cowboys running back Ron Springs is only 50 years old, but since his type 2 diabetes diagnosis in 1990, he has endured multiple amputations and a recent kidney transplant. Ron's son Shawn Springs plays cornerback for the Washington Redskins. He offered to end his career and donate a kidney to his dad, but Ron refused. Since that time, Ron received a donated kidney from former teammate Everson Walls in March 2006. Incredible.

Now Ron and Shawn are national spokespeople for the State of Diabetes Complications in America, an educational campaign to raise awareness about serious health complications resulting from uncontrolled diabetes, such as heart disease, stroke, kidney disease, eye damage and foot problems leading to possible amputation.

A new report shows the state of Texas spent about $1.85 billion on direct medical costs related to diabetes and complications. Diabetes and related complications cost each Texan approximately $8,500 annually, of which nearly $1,400 is paid out-of-pocket for non-reimbursables such as co-pays and deductibles.

But Ron and Shawn want to spread the word the risk of developing these serious complications can be reduced, and they want to share how people with type 2 diabetes can work with their doctor to create a personal diabetes management plan. Next Wednesday, July 25, they will join Dr. Jonathan D. Leffert, Clinical Assistant Professor at The University of Texas Southwestern Medical Center at Dallas, to discuss Ron's story and how it has impacted the Springs family. Celebrities are often hired by advertisers to hawk diabetes supplies. It is nice to see two NFL celebrities raise awareness to prevent the devastating complications of uncontrolled diabetes.

(photo by krisandapril at www.flickr.com)

Foods to help you quit

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Nothing says sexy like a long, brown Pall Mall cigarette hanging out of someone's mouth. Oh wait, my bad, I meant that nothing says "bad breath, bad teeth, and a shortened life expectancy" than that same scenario.

If I seem harsh about smoking, I'm sorry. Coming from a family of smokers - but not being one - I live in constant fear of my loved one's health and spend too much time questioning why they, and millions of people worldwide, would purposely do something so unhealthy. "It's a stress release" - yeah, I've heard that one before. "I only smoke when I drink" - yup, heard that one, too. "It's just too tough to quit" - aahh, a reason that at least has some merit. But, what all the smokers out there might not know is that there are actually certain foods that will help you quit (and no, this isn't the part where I try to get all cute and tell you that one of those foods is Cold Turkey).

Based on a study published in the journal (strangely enough) Nicotine & Tobacco Research, smokers claim that fruits, vegetables, juice, and dairy products combine the worst with the flavor of their cigarette. By contrast, caffeinated beverages and alcohol seem to be flavor enhancers.

At least that explains the whole "I only smoke when I drink" excuse.

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Sisters, and Cheerios, Saving Hearts

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Heart disease is the #1 killer of both men and women in North America, but there's one particular group the it seems to affect more profoundly: African American women. To help bring awareness to this problem, Cheerios and General Mills have established a program called Sisters Saving Hearts, and they've recently awarded 5 African American women $25,000 in grants for their efforts in bringing awareness to important health issues like heart health, heart disease and obesity.

Although large corporations like Cheerios have lots of money to throw around, I think it's amazing when they support the community and bring attention to important health issues. Don't you agree?
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Chew on this

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In the always interesting world of fad diets, turns of phrase like "Lose 10 Pounds in 2 Days!" are tossed about like the salad-only diet you would probably have to follow to really lose that much weight in that short amount of time (only that too wouldn't exactly be healthy weight loss). But, when I came across some information about a new chewing gum (supposedly able to mimic the satiety feeling produced naturally by the pancreatic polypeptide) that researchers at the Imperial College London are developing, I couldn't help but make the mental leap to the infomercials and B-rated celebrity endorsements that will likely come next.

Strangely, the results from the gum seem to be somewhat convincing thus far. After giving the hormone (which is found in the gum) to a portion of overweight test subjects - and giving a placebo to the other portion of subjects - and then offering them a buffet meal, the researchers found that the non-placebo group at 22 percent less food during that meal. What's more, that same group also consumed 25 percent less calories over the next 24 hours.

Does it work? Maybe. Who knows? Who cares, really? Either way, we won't know for at least another 5 to 10 years, as the gum will not be available until then. In the meantime, we at least have fun making suggestions of which B-list celebrity would make the perfect spokesperson.

Is the fat-burning zone a myth?

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Over at That's Fit, Martha recently asked a question that surprised me: Is the fat-burning zone a myth? The idea behind the fat-burning zone is that if you keep your workout at a moderate level, you'll burn more fat. But if you take your workout up a level of high intensity, you'll burn mostly stored carbohydrates. Fitness experts have long tried to those trying to lose weight in the fat burning zone, but, according to Prevention Magazine those who exercise in the high-intensity zone burn more calories, which they say is more important than burning fat.

It's an interesting debate. Read more about it here at About.com.

New treatment: Freeze the heart

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My friends often joke that because I didn't cry at the Notebook, my heart is ice-cold, frozen from all compassion and feeling. But as That's Fit has reported, there's a new treatment out there that will involve freezing the heart -- literally.

A condition called Atrial Flutter may respond to treatment using Nitrous Oxide to freeze the heart for a few seconds. Freezing the heart, in turn, treats the areas around the heart that are responsible for abnormal rhythms. It sounds interesting ... and dangerous. Even if it's only frozen for seconds, the thought of intentionally stopping a heart gives me ... well .... heart flutters. What about you?

The FDA hasn't approved the treatment yet, but their advisers are recommending they do.

A lost bankcard gets a faster response than stroke symptoms?

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Maybe if we all took our health as seriously as we do our money we'd be better off. The recent results of a study, which can only be described as shameful, show that the majority of people would react faster to a stolen bankcard than they would to the symptoms of a stroke. Like heart attacks, it seems many people don't know what the symptoms of a stroke are and don't really want to believe it's happening to them. Of the people surveyed, those taking the longest to seek medical help were people over 65 -- the very people at the highest risk.

Symptoms of a stroke include facial weakness, arm weakness, and speech problems. Strokes can cause immediate and devastating brain damage, with every minute critical to recovery, so if you even suspect a stroke please act immediately.

GSK's Cervarix drug gets support from Europe

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GlaxoSmithKline's Cervarix cervical cancer drug is closer to approval in Europe after an influential medical panel there Wednesday afternoon suggested the drug be approved.

GSK expects EU approval in the coming months, with a European Cervarix launch possibly in 2007 sometime. Cervarix assists in the prevention of pre-cancerous lesions in the cervix caused by the human papillomavirus (HPV), which has been a center of contention as certain states in the U.S. have suggested mandatory vaccinations for teenage girls against the HPV.

Cervical cancer is the second-most common form of cancer in women after breast cancer worldwide. So far, Cervarix has not received approval by the FDA in the U.S.

Fear of skin cancer prompts call to action

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I keep thinking about my ongoing negative relationship with the sun, how it burns me time and time again, how I keep trying to fine-tune my approach to dealing with this deadly force. Today, I have arrived at two new thoughts.

1. There was a time when I wanted a tan. I'd accept a burn even, in hopes it would turn to the slightest shade of brown on my pasty white skin. I would search high and low for the sun. I would drive in its direction, bask in its glory, give hours of my day to this crazy pursuit. Somehow, though, achieving a tan -- or burn -- wasn't easy. Sometimes, I'd see some color appear; sometimes my efforts seemed for nothing. It took work, effort, endless amounts of time and while my ventures in sunbathing did sometimes prove successful, there were many times I was left with, well, pasty white skin.

Fast forward to now. Not only do I seek shelter from the sun, but I use sunscreen, sit under umbrellas, and cover up whenever I can. Still, I get burned. It seems if I look in the direction of the sun, with my sunscreen-coated face, it will get burned. Long ago, my bare face only occasionally absorbed the sun. Why the change? Why when I worked not at all at protecting myself was it so hard to attract a golden glow? Why now do I protect myself in all ways possible and still sizzle? I'm wondering if it has anything to do with the chemotherapy drugs that poisoned my body for so long. A dermatologist once told me about a phenomenon called UV recall. The sun and the drugs can react, long after treatment has concluded, and can cause skin reactions. Maybe this is what's happening to me. Just in case, this gives me all the more reason to avoid all contact with the sun.

2. Back to the dermatologist. I think it's time I see her more often than once per year. With each burn I collect, the more scared I get. For peace of mind, I want someone to look at my skin more often. That way, if cancer pops up, it can be detected early. That's the point of screening, after all -- early detection. And I don't like the thought of waiting one year for my doctor to determine cancer might be tangled up in my skin. I'm confident my every-few-month breast cancer follow-up appointments will turn up anything suspicious with enough time for successful treatment. Approaching my skin in the same manner is perhaps just what I need.

When it comes to cancer, it's all about control for me. So I will control this deadly disease, starting today, by avoiding the sun, at all costs, and by monitoring my skin in the most vigilant way possible.

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Some diabetes drugs tied to increased risk of cancer, says report

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According to a new report out of the University of Vermont, patients with diabetes who take thiazolidinediones, which include Avandia and Actos, have an increased risk of developing cancer. This association was only seen in women and was not statistically significant in men.

Dr. Maria Ramos-Nino and colleagues examined the relationship between thiazolidinediones and cancer prevalence among nearly 9,000 diabetic patients. The team found that the use of any thiazolidinedione was associated with a 59 percent increased risk of cancer. The use of Avandia increased the risk by 89 percent, where the risk associated with Actos was not statistically significant.

The researchers could not explain why these risk numbers were so different for the two drugs, since they are thought to work by the same mechanism.

On the other hand, the use of sulfonylurea by women was associated with a 51 percent decreased risk of cancer.

The authors acknowledge that the study had several limitations and do not recommend changing any clinical decisions involving these drugs at this time.

Wednesday, 18 July 2007

New Zealand Cancer drug shows disapointing results

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Those of us following cancer news wait with baited breath for news of cures and treatments with promising results. So it's always a bit of a disappointment when it's bad news, like this: New Zealand researches and determined that the clinical trails on an Ovarian Cancer Drug called DMXAA have not demonstrated any positive results.

The premise behind the drug was that it could kill cancer by reducing the blood supply to tumors, and it was given to Ovarian Cancer patients, along with Chemotherapy, to see if it would make a difference in recovery. Unfortunately, it didn't, and research on Ovarian cancer will be put on the backburner to make way for Lung Cancer trials at Novartis in New Zealand.

Inspiring interview with June Callwood

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June passed away in April, she was 82. She was one of Canada's most celebrated authors and social advocates. She helped the homeless, dealt with issues of racism and injustice. She did much volunteer work.

In 2004, June was diagnosed with inoperable cancer and refused to undergo treatments.

I came across a last interview with her that I thought was very moving. She talks about her life, her marriage, and the fact that her cancer is terminal.

What an amazing woman.

'Ole dinosaur metformin as good as new

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The first in-depth comparison of type 2 oral medications arriving on the scene over the last decade was published earlier this week in the Annals of Internal Medicine. The review determined older, cheaper diabetes drugs are as safe and effective as new alternatives. Oh boy, Big Pharma's newer drug sales teams won't like this conclusion.

Metformin, also known as Glucophage, was cited as the safest and best option, as it works as well as other oral medications, but does not cause weight gain or hypoglycemia. Bad cholesterol is also lowered on metformin, and the drug only costs about $100 a year. Newer drugs cost as much as $262 a month, stated lead researcher Dr. Shari Bolen, and there was no benefit to the newer drugs unless tolerance to an older one was at issue. They also noted taking two oral meds can improve blood sugar, but the cost and risk of side effects are both higher.

The researchers reviewed more than 200 published studies and some unpublished information from the Food and Drug Administration. Avandia's manufacturer, GlaxoSmithKline, stated this analysis was completed prior to the completion of one Avandia study that showed Avandia improved blood sugar control compared to two rival meds.

But the dinosaur Metformin does have a roar -- it can cause a rare, dangerous side effect called lactic acidosis. Read more in Globe and Mail.

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Grilled meat and cancer: connected?

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I've looked at acrylamides (search this term using Google Scholar) and how the byproducts of grilling meats (and anything else, for that matter) can produce this product that is best not consumed.

Reading deeper recently, it looks like the U.S. Department of Health and Human Services has found that heterocyclic amines (HCAs), which are produced when cooking specifically meat and fish, could be classified as as "human carcinogens."

Great -- so grilling produces carcinogens. But that is not all. It seems that these HCAs are even formed using other means of direct or indirect temperature cooking, like stewing and steaming.It's hard to eat raw food all the time, but from reading this, perhaps it's not a bad idea on a regular basis.

Bark once for yes: training dogs to detect hypos

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Bad headline for the week: "Does Diabetes Have a Canine Cure?" This, from the Lincolnshire Echo in the UK. Well, no. Of course dogs can't cure diabetes! However, they can do more than just roll their lovable brown eyes at you. Specifically, dogs can be trained to detect building hypoglycemic episodes caused by perilously low blood sugar levels. Dogs that have received such training will then try and sound the alert in various ways like pawing and whining, or pouring you a glass of orange juice (joke). Heck, I think there was even one dog that was trained to dial 911 for his owner, and saved the guy from going into a coma, might I add.

This is what this Echo article is really all about. Professors and students at the University of Lincoln have set out to examine the use of dogs to predict hypos. The study is being run in conjunction with Queen's University in Belfast, and has received funding from Diabetes UK. Says research team member Dr. Niro Siriwardena, "We are not yet sure whether dogs detect this [hypos] by smell or because they are much more adept than humans in detecting change. That is something we are looking into."

Stay tuned for details when this study is complete. "Dog people" like myself will be excited to hear what they discover. Wouldn't you like to know what enables dogs to be so super-sensitive? And doesn't it make you wonder: if dogs can detect something like low blood sugar, what else are they noticing about us as we go (obliviously) about our daily lives?

FEMA trailer plaintiff dies of lung cancer

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Desiree Collins, who claimed in a lawsuit that FEMA trailers exposed the residents to formaldehyde, has died of lung cancer at the age of 47. Collins died on July 2. Her lung cancer was diagnosed a week before she died.

Attorney Justin Wood said that he hasn't determined whether the formaldehyde is to blame for the cancer. Specialists will test Collins' tissue samples.

Collins sued Forest River Inc. and other unnamed vendors over 120,000 trailers FEMA supplied to displaced citizens during the hurricanes in 2005. Her husband and children will now carry on as plaintiffs in the case. Formaldehyde is used in a number of materials inside the trailers and can irritate the eyes, nose, throat and skin. As of May, FEMA has received 140 formaldehyde complaints.

According to the National Cancer Institute, formaldehyde has been classified as a human carcinogen by various governmental agencies.