DIABETES WATCH

Blood Sugar Levels Impact Risk of Blood ClotsLow blood sugar levels are importantfor patients with diabetes prior to havinghip-or knee-replacement surgery.Elevated blood sugar levels put patientsat risk of developing life-threateningblood clots. A study analyzed therecords of 6500 patients who underwenthip-or knee-replacement surgeryat Thomas Jefferson University Hospitalbetween 2003 and 2005.

The researchers uncovered 38 patientswho had blood-glucose levels above 250mg/dL during preoperative testing and onthe day of the surgery. Of the patients, allbut one patient were diabetic, which wasdefined as a fasting blood glucose level>126 mg/dL.

Lead investigator Boris Mraovic, MD,said, "We found that 10.5% of thosewith high blood sugar developed apulmonary embolism, compared [with]only 1.7% of the other patients. Thisrate is more than 6 times higher thanwe would expect to see in the generalpopulation." He said additionalstudies are needed to confirm hisresults. (The findings were recentlyreported at the annual meeting of theAmerican Society of Anesthesiologists.)

Buyer Beware: Web Site Touts Fake Diabetes "Cures"

The FDA and US Federal Trade Commission(FTC) are warning patients about US and foreign-owned Web sites that tout dietary supplementsas a cure, treatment, or prevention of diabetes.Upon finding the sites through an"Internet sweep" for counterfeit sites and products,the agencies sent warning letters to thecompanies and notified government agencies inCanada and Mexico.

The FDA, which warned 24 individuals andprivate companies, generally resolves suchmatters without further action. The agencycan, however, impose fines and other penaltiesas well as confiscate products. The FTC confirmedthat about 25% of the firms that werewarned about misleading ads?84 US Websites and 7 Canadian sites targetingAmericans?have changed their claims ortaken down their sites. Another 21 sites werereferred to other foreign governments.

Nonadherence Is a Risky Behavior

A new study found that 21% of patients with diabetes do not adhere totheir medications for blood-sugar lowering, blood-pressure lowering, or cholesterollowering. P. Michael Ho, MD, and colleagues reported that patientswho did not comply with their medications had a 58% higher risk of hospitalizationand an 81% greater risk of dying, compared with patients whotook their medications.

"Incremental increases in medication adherence were associated withimproved outcomes," reported the researchers in the Archives of InternalMedicine (September 2006).

Is Aggressive Treatment Too Stressful?

In the first years, a little anxiety is par for the course following a diagnosisof type 2 diabetes. A study, reported in Diabetes Care (October 2006), foundthat early and rigorous treatment appears to lead to greater anxiety and lessability to cope, however. The study examined 196 patients diagnosed 3 to 33months previously who were undergoing usual care or intensive treatment.The researchers learned that a majority of patients reported minor distressand reduced levels of perceived seriousness and vulnerability and feltsecure coping with the disease. They had a different response from patientsdiagnosed between 2 and 3 years previously. This group considered theirdiabetes more threatening. The group who had intensive treatment reportedmore distress and less self-confidence in the first year.

CVD Is Dangerous for Older Patients with Diabetes

A study of 6000 individuals aged over 65 years found thatpatients with diabetes are 2 times more prone to die from cardiovasculardisease (CVD) when compared with patients withoutdiabetes. The risk was even greater for patients takinginsulin. During the 11-year study, >40% of the patients died,and about 50% to 60% of the fatalities were attributed toheart-related issues.

The researchers also found that patients taking insulin were6 times more likely to die from infectious diseases or kidneyfailure, compared with patients without diabetes.Furthermore, women treated with insulin had a remarkablyhigh mortality risk. Earlier studies have shown that diabetesups the risk of death from CVD in young and middle-aged individuals.It was not clear, however, how it affected seniors. "Theresults of this study suggest that rectifying this situation couldprolong the lives of many elderly people with diabetes," reportedthe investigators recently in the on-line journal PublicLibrary of Science.