DIABETES WATCH

Too Much Iron Increases Heart Risks

Patients with diabetes may want to limit the amount of red meat andother foods high in heme iron. Researchers found that the consumptionof these foods appears to increase the risk of heart disease.

The investigators noted that diabetes-related metabolic malformationmay exacerbate the adverse side effects of excess iron on the heart. Theyadded, however, that little is known about whether iron consumption alsoaffects heart disease risk. For the study, reported in Diabetes Care (January2007), 6161 women participating in the Nurses' Health Study who reporteda diagnosis of type 2 diabetes were followed. During the follow-up from1980 to 2000, 550 new cases of heart disease were documented.

The study's findings indicated that a high intake of both heme iron andred meat seems to raise the risk of heart disease, even after factoring inage and body weight. In particular, women who consumed large quantitiesof heme iron were 50% more likely to develop heart disease, comparedwith the lowest intake group. The risks were most significant inwomen who were postmenopausal.

Health Costs Drop for Diabetes/Depression Group

A different model for treating depression inpatients with diabetes can save health care costs,according to a study reported in the January 2007edition of the Archives of General Psychiatry. Theresearchers assessed the incremental cost andincremental cost-effectiveness of a systematicdepression program, compared with standard care,for 329 patients with diabetes and depression. Theresearchers found that systematic depressiontreatment considerably lowered the patients' averagedepression scores after 6 and 12 months.

The findings indicated that, even though outpatientdepression treatment costs were about $700higher in the intervention group during the initialyear, a majority of the difference was offset bylower general medical outpatient costs in thisgroup. The second year proved more cost-effective.The approximate $100 in higher outpatient depressiontreatment costs in the intervention group wasmore than compensated by lower outpatient costsof $1400. Systematic depression treatment correlatedwith an increase of 61 depression-free daysand an estimated savings of $300.

Alzheimer's Link Absent in Diabetic Seniors

Although seniors with diabetes do not face an increased risk of developingAlzheimer's disease, the disease is associated with cerebral infarction—braindamage that can impair mental capacity. The researchers based their findingson autopsy results from 233 older participants in the Religious Orders Study.

The findings, reported in Neurology (December 2006), showed that a littleover a third of participants had one or more cerebral infarctions. The patientswith diabetes were about 2.5 times more likely to have brain damage, comparedwith patients without diabetes. On the contrary, the levels ofAlzheimer-type damage were parallel in both patient groups.

Spine Diminishes Early in Diabetic Neuropathy

Researchers found that spinal cordsize in adult patients with diabetesshrinks considerably long before theybecome symptomatic for nerve damage.The study included 84 men withtype 1 diabetes, 24 patients withoutthe disease, and 8 participants withinherited neuropathy.

Of the participants, 19 patientswith diabetes had no diabetic neuropathy,23 had silent or subclinicalneuropathy, and 39 had clinically detectableneuropathy. Magnetic resonanceimaging of the spine indicatedthat the spinal cord area was 67.5mm in patients with diabetes and noneuropathy, 62.4 mm in patientswith diabetes and subclinical neuropathy,and 57.2 mm in patientswith diabetes and evident neuropathy.There was no major difference inthe spinal cord area of patients withdiabetes without neuropathy andthe control group. (The findings werereported in Diabetes Care, December2006.)

Forum Addresses Need forWorldwide Diabetes Change

Former President Bill Clinton served as keynotespeaker at the recent Global Changing DiabetesLeadership Forum in New York City. The event,hosted by Novo Nordisk and supported by theInternational Diabetes Federation, brought togetherpeople from government, international organizations,and patient organizations and health careprofessionals from >18 countries.

The discussion provided a proactive dialogue onredefining health care with an emphasis on theneeds of patients with diabetes. The forum alsoexplored the concepts described in RedefiningHealth Care: Creating Value-Based Competition onResults by Professors Michael E. Porter andElizabeth Teisberg. Professor Teisberg, who attendedthe meeting, shared her views on the importance offocusing on the needs of patients over the full cycleof care—from prevention and diagnosis throughrecovery to long-term disease management.