April 9, 2010 · 2:00 AM

Prediabetes Ignored Way Too Often

Only half of Americans with prediabetes take steps to avoid progression to diabetes, according to a recent report in the American Journal of Preventive Medicine.

Prediabetes is defined as:

  1. fasting blood sugar between 100 and 125 mg/dl (5.56–6.94 mmol/l) or
  2. blood sugar level 140–199 mg/dl (7.78–11.06 mmol/l) two hours after drinking 75 grams of glucose

Prediabetes is a strong risk factor for development of full-blown diabetes.  It’s also associated with increased risk for cardiovascular disease such as heart attack and stroke.  One of every four adults with prediabetes develops diabetes over the next 3 to 5 years.  The progression can often be prevented by lifestyle modifications such as dietary changes, moderate-intensity exercise, and modest weight loss.  

Investigators looked at 1,402 adult participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) who had fasting blood sugar tests and oral glucose tolerance tests diagnostic of  prediabetes.  

The researchers estimate that 30% (almost one out of every three) of the adult U.S. population had prediabetes in 2005-2006, but only 7% of them (less than one in 10) were aware they had it.

Only half of the prediabetics in this survey reported attempts at preventative lifestyle changes in the prior year.  Only one of every three prediabetics reported hearing about risk reduction advice from their healthcare provider.

People, we’ve got to do better! 

My fellow physicians, we’ve got to do better!

The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in 2000 will develop diabetes.  The great majority of this will be type 2 diabetes.  You understand now why James Hirsch, author of Cheating Destiny, calls diabetes America’s leading public health crisis.  I agree.

Steve Parker, M.D.

Reference:  Geiss, Linda S., et al.  Diabetes risk reduction behaviors among U.S. adults with prediabetes.  American Journal of Preventive Medicine, 38 (2010): 403-409.

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April 7, 2010 · 2:00 AM

Quote of the Day

Of all the behavioral aspects of diabetes management, none is more important than nutrition.  However, nutritional control is usually not well done by patients and is largely ignored by physicians.

—David K. McCulloch, M.D., Clinical Professor of Medicine, University of Washington

—in “Insulin therapy in type 1 diabetes mellitus,” UpToDate.com, version 17.3, September, 2009

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April 4, 2010 · 2:00 AM

New Page Here: Drugs for Diabetes

This is the best time in history to have diabetes.  Thanks to the advancement of science, supported by the profit motive and a degree of free market economics, we now have 10 classes of drugs to help us conquer the disease. 

I recently finished a series of brief reviews on each drug class.  Click on the Drugs for Diabetes page for links to all the reviews. 

Steve Parker, M.D.

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April 2, 2010 · 2:00 AM

Association of American Physicians and Surgeons Challenges New Healthcare Reform Law

Equal Justice Under Law

AAPS is the first national physician group to sue the federal government over the the Democrat’s new healthcare reform law, according to an article at MedPageToday.  The challenge is based on violations of both the Fifth and Tenth Amendments to the U.S. Constitution, which the polititians had taken an oath to uphold. 

The new law will interfere greatly with the patient-physician relationship, inserting polititians and bureaucrats into the middle.  Patients will suffer. 

Steve Parker, M.D. 

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March 31, 2010 · 3:07 PM

Drug Review: Meglitinides (repaglinide and nateglinide)

Meglitinides—also called glinides—increase the output of insulin by the pancreas beta cells into the bloodstream.  In that respect they are similar to sulfonylurea drugs, so the two classes are sometimes lumped together as insulin secretagogues.  If the pancreas produces no insulin at all—as in most cases of type 1 diabetes—these drugs won’t work. 

Two meglitinides are available in the U.S.: repaglinide is sold as Prandin, and nateglinide is Starlix. 

Meglitinides have about the same effectiveness as sulfonylureas, but are considerably more expensive.  Repaglinide and nateglinide  increase the pancreas’ output of insulin, working faster than sulfonylureas.  They don’t last as long as sulfonylureas, which may help avoid hypoglycemia.  Glinides work mostly to reduce sugar levels after meals.   

We don’t know if these drugs affect death rates. 

Uses

May be used alone or in combination with certain other diabetic drugs.  Since they have the same mechanism of action, sulfonylureas and meglitinides would not normally be used together.  In combination therapy, you want to use drug classes that work by different mechanisms. 

Dosing

Starting dose for repaglinide is 0.5 mg by mouth before each meal.  Maximum dose is 4 mg before each meal.

Nateglinide: 120 mg by mouth immediately before each meal.

Side Effects

Hypoglycemia is the most common and potentially serious adverse effect of the meglitinides, but may be less common than with sulfonylureas.   

Weight gain is common. 

Precautions . . .

Nateglinide:  Use with great caution, if at all, in the setting of severe kidney disease and moderate to severe liver disease.

Repaglinide:  Use cautiously in severe kidney and liver disease.

Steve Parker, M.D.

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March 31, 2010 · 2:00 AM

Ronald McDonald Retiring

Tom Naughton at his Fat Head blog has a hilarious interview with Ronald McDonald.

Steve Parker, M.D.

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March 30, 2010 · 11:59 AM

What’s Passover?

This is the first day of Passover, a major Jewish holiday.  My Lord and Savior, Jesus Christ, was a Jewish carpenter while he was walking the Earth.  I figure he must have observed Hebrew traditions.  In preparation for teaching my children about Passover, I reviewed it at Wikipedia.  Here’s a brief summary:

Passover is the Jewish celebration of the Hebrews’ release from enslavement by Pharaoh in Egypt.  Before release, the Lord brought ten plagues to Egypt.  The tenth plague was the killing of the firstborn – all in the area: humans (including Pharaoh’s firstborn), even cattle.

The Hebrews were instructed to mark their doorposts with the blood of a spring lamb.  The spirit of the Lord would pass over those homes, sparing the firstborn therein.

The Wikipedia article is a quick read full of interesting details on Passover customs.

Steve Parker, M.D.

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March 28, 2010 · 8:48 AM

Quote of the Day

When you sell a man a book, you don’t sell him 12 ounces of paper and ink and glue—you sell him a whole new life.

—Christopher Morley

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March 26, 2010 · 2:00 AM

Vinegar and Weight Loss: Didn’t Work For Me

Mt. Fuji in Japan

Last November I started another self-experiment to see if vinegar consumption would lead to any weight loss in me.  I quit after nine weeks instead of sticking it out for the entire 12-week trial.  I just got tired of it and hadn’t seen any weight loss.  And I ran out of apple cider vinegar. 

Results?  No change in weight.

A Japanese study had shown loss of 2.2-4.4 lb in Japanese overweight study subjects.  Maybe it didn’t work for me because I wasn’t overweight.  Or because I’m not Japanese.  Or because I chose to do the experiment over the Christmas-New Years’ holiday, a notorious over-eating time of year. 

Oh, well.

Nevertheless, the vinegar option would be reasonable for an overweight person to try. 

Steve Parker, M.D. 

PS: I blogged recently about how vinegar diminishes blood sugar elevations after meals that contain complex carbohydrates.  So an overweight type 2 diabetic would be a perfect study subject.

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March 24, 2010 · 2:00 AM

Take Vitamin D With Largest Meal to Increase Blood Levels

The Healthy Librarian at the Happy Healthy Long Life blog wrote about a small scientific study documenting an incredibly easy way to increase blood levels of vitamin D in people taking supplemental vitamin D: 

Take the supplement with the largest meal of the day

Subjects of this research were taking vitamin D supplements—often a very high dose—for medical reasons, yet blood levels remained unacceptably low.  Blood levels of vitamin D (25-hydroxyvitamin D) rose by 50% simply by taking the same dose with the largest daily meal. 

Other people, including young healthy adults, may or may not respond the same way.  Do you know?

As for me, I’ll be sure to take my vitamin D supplement with my largest meal.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary, nutritional supplement, or exercise changes.

 

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