2007 ADA Conference: The Bad News, etc.

Hey, it’s the Virtual Age! Who says I actually have to be physically present at the annual ADA Conference (which kicked off this weekend) to bring you all the hottest news?

(Note that ADA staffers are putting a human face on the event this year with their collaborative SciSessions blog. Once again, I hope to represent the rest of us…)

67thsslogo It’s a very exciting year for gene research and community diabetes care, according to the event press materials. But there’s also a long list of bad-news discoveries. Are you sitting down? Here goes:

* New diabetes risk: Hearing Impairment. The National Health and Nutrition Examination Survey (NHANES) has identified yet another complication of this disease: people with diabetes were 76% to 91% more likely to have problems with hearing than those without diabetes. Researchers hypothesize that this “could be related to either underlying vascular or neuropathic dysfunction.” Either way, a new push will be to get diabetes patients’ hearing checked.

* Soaring rates of diabetic eye disease (but new shots may help). According to the CDC, the incidence of eye disease in PWDs is expected to TRIPLE from 2005 to 2050: from 5.8 million to 17.7 million people with diabetic retinopathy, and 1.3 to 3.7 million with eye damage in that direction. Mama Mia, that’s a lot of eye disease! No wonder our healthcare system is getting more snowed under all the time.

A glimmer of hope here is new eye injections of a substance called pegaptanib sodium, currently FDA-approved for neovascular macular degeneration (age-related eye damage). A very small study of younger patients developing retinopathy shows that shots of this stuff “led to total regression of abnormal blood vessel growth, and some slight improvement in vision.” Currently, patients with potentially blinding diabetic retinopathy have only two options — laser therapy or surgery, both “imperfect treatments.” So the new injections could bring an excellent alternative, researchers say.

* Tall diabetics are screwed (that’s my wording, btw). If you’re Type 1 diabetic, the taller you are, the more likely you are to develop peripheral neuropathy — presumably because your extremities are farther away from the heart, and thus receive less blood flow. “The good news is that intensive glucose control helps to reduce this risk just as it did in the short folks,” the researchers report. Hmm, so Tall People have even more reason to obsess about BG levels?!

* Electronic medical records help Nada. This one was reported around the Net last month as well: according to an observational study with 19 medical groups at 84 clinics around the country, using electronic medical records did not make a difference in diabetes patient care at all. A1c, LDL, and systolic blood pressure in patients was unchanged when their caregivers had access to the latest and greatest high-tech record-keeping. Another hmmm. More study is called for here to figure out what didn’t go right…

* Higher drug costs = higher A1cs. Here’s a no-brainer for you: for every $10 increase in health plan drug co-payments, there was also a 1.5% decrease in “adherence” — meaning patients tended to skip their meds or otherwise get off their care regimen, and A1c levels went up accordingly. Surprise!

What Helps:

* Brush-Up on injection techniques. When you think of all the extremes we go to to improve our BG control, this one makes you smile. A simple study showed that when patients were given a brush-up course on shot techniques, their A1c levels improved. Might be time to ask your CDE to walk you through the proper procedure, yet again.

* See that nutritionist! Finally, a study in Philadelphia looked at visits with health educators and nutritionists as means to reducing risk of diabetes complications. Interestingly, only the nutritionist visits really seemed to make a difference, at least in reducing hospitalization rates and costs. Each nutritionist visit was associated with a $2,157 reduction in hospital charges. Wow.

That’s all for now, Folks. I have a few “moles” on the expo floor whom I hope will report back with some hot product news very soon — beyond all that coming over Google News at the moment. Same bat channel :)

14 Responses

  1. jill.
    jill. June 24, 2007 at 8:46 am | | Reply

    Thanks for the linked summary, Amy! It’s very helpful!

  2. melissa
    melissa June 24, 2007 at 4:01 pm | | Reply

    Hmmm, maybe that explains my trouble hearing lately. The one thing I thought that was not connected to my diabetes. Lately I keep turning the TV up louder and louder, and my job is getting more difficult (transcribing physician dictations using headphones). Guess I’ll be adding a hearing check to my next eye exam.

  3. shawn
    shawn June 25, 2007 at 7:59 am | | Reply

    wow, as a 6′-5″ type 1, i only see bad new here

  4. CB
    CB June 25, 2007 at 9:27 am | | Reply

    Your post on hearing for us PWDs is unsurprising. After all, we already should know from past medical studies’ results that diabetes is positively related to EVERY known human ailment. Oh, well. My suspicion is that once again medical researchers have confused correlation with causality. Perhaps this study did find that there’s a correlation with hearing problems for folks who haveT1 or T2; but this in no way means that having diabetes causes hearing problems. Such fundamental mistakes are all too often present in bio-statistical studies that unfortunately promote much misunderstanding. So my question is: are you going to change your control program based on this “information” about hearing problems? Not me; I’m going to continue to keep my A1c between 6 and 7 whether this results in reducing the risks of 3 sets of complications or 30 sets.

  5. Sarah
    Sarah June 25, 2007 at 3:21 pm | | Reply

    In Type 1′s, hearing loss can be connected to autoimmune thyroid disease or even autoimmune hearing damage. I have Type 1 and Hashimoto’s, so I’m screwed. :) I also am pretty deaf, and was found to have scarring on my ear drums of “unknown origin”. I always blamed Metallica and my headphones…

    Lately, I’ve seen so many people ask about Type 1 diabetes and “hearing loss” that I knew there must be a link.

    All this in addition to factor “x” that has been linked to “diabetic hearing loss”, which most likely is high blood sugar. Perhaps diabetics also have a higher incidence of ear infections?

    Either way, it’s common sense that high blood sugars can damage to the brain, nerves, and blood vessels in every part of the body. New evidence also suggests that LOW blood sugar may cause nerve damage as well.

    Are we going to cure this disease, or just waste more time and money looking for ways to “manage” and study it? When it comes to Type 1 diabetes, studies like this are an insult.

    Oh well, perhaps one day these stupid studies (how is knowing this useful if we can’t do anything more than we are already doing?) will fall on “deaf ears”…hehe

  6. Lauren
    Lauren June 26, 2007 at 2:41 pm | | Reply

    One research topic I’d like to hear more about is C-peptide. According to all the journal articles I’ve read, C-peptide confers some great benefits — it’s protective against circulatory damage and neuropathy. A normal person with functioning beta cells endogenously produces #1 insulin, #2 amylin, and #3 C-peptide. Type 1 diabetics lack all three, yet insulin is the only one regularly replaced. (Symlin is synthetic form of amylin as I’m sure you all know, but it is not widely used. I know there is some controversy surrounding its use as well.)

    As far as I know, there is currently no way to replace C-peptide. If Lilly or Novo Nordisk added C-peptide to their vials of insulin they could probably make another couple billion dollars, so there’s probably an incentive to develop it. I think we type 1′s would be better off for it.

    If anyone else knows about C-peptide research as it pertains to diabetics, I’d love to hear more.

  7. anonlurkermom
    anonlurkermom June 26, 2007 at 4:56 pm | | Reply

    I live in Chicago and it is very weird to see advertisements for pre-filled insulin pens on top of taxi-cabs!

  8. JasonJayhawk
    JasonJayhawk June 26, 2007 at 6:46 pm | | Reply

    Just wanted to add on to what Lauren said about C-peptide. Like amylin (discovered in 1987), it will probably be 20 more years before we see any theraputic use of c-peptide on the shelves.

    Not enough research is being done on it. It’s believed that c-peptide functions in the muscle layer of arteries and according to Diabetes 55:3581-3587, 2006, an article states that c-peptide reverses neuropathy in type 1 diabetes (in rats).

    I would be curious to know if any drug companies have c-peptide in their drug pipeline.

    Finding a way to safely deliver it (or even include it with insulin) would guarantee a large amount of income for the company that comes to market with the first patent.

  9. Lauren
    Lauren June 26, 2007 at 8:47 pm | | Reply

    It is so frustrating to me that new therapies emerge at a snail’s pace! I don’t want to wait 20 years for something that is protective against complications — by then, the time for prevention could have passed. I would gladly enroll in a study piloting the use of C-peptide in type 1′s — however, I have no idea whether this therapy is in development, despite the slew of journal articles claiming C-peptide can reverse early neuropathy and confer other cardioprotective benefits. I wish research could focus on things like this rather than the development of inhaled insulin, for example.

    By the way, Sarah, I want to mention that I agree with what you said above: I don’t want the medical community to give us more depressing study results if we aren’t being offered any better ways to manage our disease. We’re all striving for good A1c’s and doing the best we can with the tools we have. I have no doubt that diabetes affects every single aspect of health — someone will come out with a study claiming diabetics are more likely to get the Ebola virus, or fall off buildings during hypoglycemic episodes, etc. I’d rather that these studies give us more info regarding prevention rather than reminding us we’re doomed.

  10. Kevin
    Kevin June 27, 2007 at 1:29 pm | | Reply

    Great. Now my wife is going to think that I have diabetes due to my apparent loss of hearing when she asks me to take out the trash. But seriously, the event was packed while I was in attendance. The conference center is huge and made it difficult to just pop in and out of various sessions. Not much going on in the Exhibits area.

    My session was pretty well attended and included talks from Satish Garg, Lois Janovic, yours truly, Steve Edelman and Mayer Davidson focused on extender technologies and programs that reach beyond traditional practice-based care. I have blogged a little so far at ChallengeDiabetes.com and will continue to add as I digest the conference.

    I announced some very exciting trial results for our type 2 patients. Type 1 results are forthcoming. Essentially, the combination of consumer-ish technology with diabetes devices, rules engine technology and social networks leads to improved outcomes and practice efficiencies.

    Even Dr. Garg, one of the leading researchers behind clinical evaluation of CGMS understood the value of integrating the real-time sensor into a real-time system like the one we use in our programs.

    My prediction for the next year is a heightened awareness around accuracy at every point in diabetes care. Fine tuning what we have now is going to be necessary before we move to automated dosing, etc… Let’s get the data right then we can take the next big step.

  11. Challenge Diabetes
    Challenge Diabetes June 27, 2007 at 1:29 pm | | Reply

    Diabetech Publishes Type 2 Clinical Trial Results at ADA

    People with type 2 diabetes using our GlucoMON wireless glucose meter for mobile diagnostics, the GlucoDYNAMIX rules engine and connectivity with their social networks enjoyed significant reductions in their A1c levels. This is just another of many r…

  12. Darla Lindenmayer
    Darla Lindenmayer July 2, 2007 at 2:22 pm | | Reply

    Thanks for all you do for the site. My son has Type 1 diabetes and recently just participated in the cord blood transplant trial in FL. He is doing great! He is down from 5 shots a day to only one so the cord blood is kicking diabetes butt. I myself have Type 2 so its good to read everything you put on the site.

  13. Nel
    Nel September 19, 2009 at 1:50 pm | | Reply

    Diabetics screwed by doctors who delay prescribing insulin. At trenchvillecity mayor Itsy Bitsy arrests Jack Punkel for stating insulin is the only effective treatment. Who do you think 500 diabetics died today, and why do you think 5,000 will die in 10 days. That is because the drug companies and doctors are greedy, self-centered profit seekers. You can pick up any book that list drugs and you can see the complications the drugs created, you can see that your unborn baby is taking the drugs too, and we also know insulin is a very effective treatment.

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