The Journal of the American Medical Association (JAMA) has devoted an entire special issue to Diabetes this week. It features the results of four big studies that are enlightening, but are not going to make you happy.
The first comes from Kaiser Permanente, and shows that in elderly people with Type 2 diabetes, severe hypoglycemia is closely linked to dementia. That is, the study showed that patients experiencing just one single severe bout of low blood sugar have a 26% increased risk of dementia; those with two episodes had an 80% increased risk; and people who had had three or more episodes had nearly double the risk. This is supposed to highlight the need for tight BG control in Type 2s, but just depresses the hell out of me, as a Type 1 for whom some severe lows at some point in my life appear inevitable.
A second study is about the state of C-Peptide levels and insulin independence in newly diagnosed Type 1′s who’ve had stem cell transplantation. The good news is that after about 30 months, “C-peptide levels increased significantly and the majority of patients achieved insulin independence with good glycemic control.” The bad news is that out of 23 patients, two developed bilateral nosocomial pneumonia, 3 developed late endocrine dysfunction, and 9 patients developed oligospermia (bad news for the guys.) So we’ve got some serious side effects going here. Ugh.
A third study is on the risk of diabetic patients dying from severe hypoglycemia while hospitalized following a heart attack. (Are we having fun yet?) The study found that the “risk was confined to patients who developed hypoglycemia spontaneously” rather than those whose insulin therapy had somehow been messed up in the hospital. I’m not sure what this means, other than the hospital staff is off the hook for screw-ups? Although it does state that death-by-hypoglycemia was more common in patients not treated with insulin at all (?)
A fourth report, on the DIAD study, is available in full for free online. It looked at the controversial practice of screening Type 2 patients for coronary artery disease (CAD) even if they don’t have any symptoms. CAD is “the major cause of mortality and morbidity,” but does routine pre-screening really make a difference? 561 participants were screened, and 562 not screened — and you might be sad to learn that screening made little difference:
“The strategy of routine screening for CAD in patients with Type 2 diabetes is based on the premise that testing could accurately identify a significant number of individuals at particularly high risk and lead to various interventions that prevent cardiac events. However, the results of the DIAD study would appear to refute this notion.” Blah.
Another highlight of the JAMA diabetes issue is a commentary titled, “Can Diabetes Be Cured?” by Dr. Christopher Saudek, which isn’t fully available online (for non-subscribers), but looks like another dance around the pro’s and con’s of pancreas transplants and “mechanical approaches” to automating diabetes care. And where’s the cure in that?
There’s also a commentary by Drs. Gregg and Albright titled “The Public Health Response to 
Diabetes — Two Steps Forward, One Step Back,” which is equally unavailable online, but no matter: the title says it all.
There are also articles on developing the artificial pancreas, using bariatric surgery for treating diabetes, and islet cell transplantation — all meant to update the wider medical establishment on what’s happening with diabetes research and care. Published continuously since 1883, JAMA is the most widely circulated medical journal in the world. So that’s a good thing.
But as an assertive diabetes “ePatient,” the only thing in the TOC here that made me smile was the headline “The Tyranny of the Measuring Cup,” apparently a personal commentary by a doctor who either has diabetes or attempts to live like he does. Kudos for that. Because understanding what it’s like to live with this thing is one of — if not the — most important thing(s) for physicians serving diabetic patients to grasp. And not the kind of thing you usually read about in medical journals.
 JAMA Diabetes News)
Wow! This truly was depressing news.
Are we dead yet?
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Sheesh. Alright Amy, I hope you’ve got a serious “pick-me-up” lined up for tomorrow!
Yeah really.
But maybe fitting for “Tax Day”?
Guarantees in life: death and taxes.
Ugh.
Ugh, I just have to complain that patients can’t access articles like this. I mean, seriously, it’s about US and OUR medical conditions! I understand the journals cost money to publish, but the cost of them is beyond the means of the average patient, and to be fair, don’t we already spend enough money on just trying to stay alive and healthy? I just wish there was some way that we could get access to that information. While patient empowerment and influence seems to be putting a dent in other realms of health care, this realm feels awfully impenetrable to me.
Lee Ann, try searching pubmed.org. It’s a great resource for finding tons of medical journal articles.
I will certainly read these articles myself, especially the one about hypoglycemia and dementia. There’s another hypothesis, and one that I’ve heard more about, that says hyperglycemia accelerates the formation of plaques in the brain, and insulin/insulin sensitivity is protective against Alzheimer’s type dementia. So unless that study is talking about actual brain damage from prolonged hypoglycemic episodes, I don’t see how low sugars are a one-way ticket to losing your mind.
Somebody on Twitter asked if there wasn’t any good news coming out the JAMA data here. Lots of mainstream media including Forbes ( http://www.forbes.com/feeds/hscout/2009/04/14/hscout626051.html ) is reporting the stem cell study as a success — although I’m surprised they don’t mention all the side ailments patients developed. Still sounds pretty risky to me.
Lee Ann you can get access to journals such as this at most university libraries–maybe bigger public libraries too (although I’ve never checked that out).
In the first study you mentioned, what did they consider a severe hypoglycemic event? If I’m walking around and my meter says “LO” and somebody else is passed out at the same level, are we both experiencing a “severe” event?
I hate diabetes.
Here’s another Stem Cell article, from Manny at TuDiabetes:
http://uk.reuters.com/article/rbssHealthcareNews/idUKN1338055520090414
And I agree Amy, where is mention of the “downfalls/side effects”? All treatments have them, each body is different, reacts differently.
And George, you hit the nail on the head my man.
(captcha: pupils people’s — ha ha. say it ten times fast. hey, we all need a light laugh today, every day!)
Hey, this is stuff that most of us ‘lifers’ already know. Diabetes affects absolutely every part of the body. Type 1 I consider more so because of the added duration (*most* are diagnosed in infancy, childhood, or as teens), the inability to completely replace your pancreas with injected insulin in any form, the severe swings in BG levels, and all of the issues with autoimmunity (autoimmune complications, other comorbid autoimmune diseases, and inflammation from autoimmunity on top of damage from hyper/hypoglycemia. Let’s stop kidding ourselves and atop allowing ourselves to be ‘guinea pigs’ and ‘lab rats’ who eagerly lap up whatever bogus ‘cure progress’ and devastating obvious research that gets thrown at us. Note that the only “positive” research here is useless for anyone who is not in early stage Type 1 (pre-DKA), and it is nothing more than using toxic drugs to simply prolong a honeymoon state.
Ick. We need a cure, and believe me, it’s not going to come from any of the disillusioned diabetes bigwigs out there. They’ve been barking up the wrong tree for so long that even if they grabbed a clue and banded together, it’s too little too late.
Talk to any endo and you’ll realize that they only see you as a mathematical equation (perfect insulin and food in=perfect BGs out=hogwash) that they can write scripts/prescriptions for. You’re fun to study with a curious eye. It’s good for research funding, keeping these scientists/MDs employed. How does diabetes affect x, y, z? What about if the diabetic person stands on their head…hmmm…how does that affect blood flow if BG is >x?
Stupid….and sick…we are lab rats for career researchers. We KNOW diabetes (especially Type 1) is a terrible disease, cure it already. Why waste precious money on these pointless and obvious studies when we can’t derive any tangible outcome from them!?
It’s diabetes Christmas, where we get more unwated gifts from the gift that keeps on giving. Bahumbug!
Just wanted to apologize for my horrible syntax
and also point out that from what I know, the ‘stem cell’ transplant did infact require immune suppression, presumably to ‘reprogram’ the immune system and halt the autoimmunity.
Funny, I was going to put a warning at the top of this post with the term: Bahumbug! Thanks for handling that for me, Frustrated.
The most disturbing thing in a report last night about this research that appeared on CBS news is the doctor they interviewed about what the research means for diabetics is to suggest what is impossible to avoid both hypoglycemia and hyperglycemia. If I who has had type 1 for more than 50 years (diagnosed in 1958) could prevent both extremes I would have to be ble to precisely control glucose metabolism like a normal person. We don’t have the tools that can do that — not even the best in cgm and pumps.
Unless they think they can ever do transplants without using immunosuppressive therapy – like using your own stem cells – I wish they’d stop pouring so much research $ into that. I’d rather take insulin than be on immunosuppressive therapy. From what I’ve read, that’s not any better than diabetes management, and to call it a “cure” seems pretty far-fetched to me – cured of one ailment, but constantly battling to keep dozens of other ailments at bay? No thanks!
Yeah, I agree about the immunosuppression problem. There’s got to be a way to get around that for islet cell transplants to be successful. Come on researchers, we are counting on you.
And as for the above comment about doctors suggesting that the best way to reduce problems related to diabetes is to avoid hypo and hyperglycemia — just unbelievable that doctors think this way, but they do. That’s like saying the best way to avoid death is to not die. Well, duh — but easier said than done.
I have met a handful of physicians who are type 1 diabetics, as well as two type 1 diabetic nurses now. They get it. I will listen to those people because their advice is practical and reality-based and most of all comes with empathy and a sense that we’re all in the same boat. I won’t listen to a world-class endocrinologist who has no real idea what living with type 1 diabetes is about.
Well! This is a wakeup call for me. I don’t have diabetes but a close friend of mine does. I have thought about it, because I am overweight. I know I would hate having the disease, and especially the needle sticks. Hypoglycemia does run in my family, and we can get shaky going without a meal. The study should announce the side effects, too. These sound like a pretty bad set of side effects. Over half of the patients in the study developed some bad side effects. It’s like telling a patient about to go into surgery that he/she has a 45% chance of surviving the surgery. Then ask yourself, would you go for it? Not me, I don’t like the odds. They are against me. I wish you all good luck, love, peace and wisdom.
I don’t think we should be worrying about this. Obama says he will cure diabetes and I believe him. Yes he can! Now if we can just redestribute all the new tax dollars to diabetes care and cure.
Amy … don’t get depressed about this topic (hypglycemia, elderly and dementia). Get angry. Write; write hard, get loud and make a difference.
This theory is plain bologne! I spent a week after reading about this study calming down enough to write my blog intelligently. Were they using their brains when they developed this study?
So .. here’s the link to my take on the issue (http://www.diabetes1.org/blogs/Doris_Blog/2009/4/20). I could have said a lot more but this was even more words than “the Web” prefers.
I feel very passionately about very shoddy elder care … I’ve seen too much (with family members) and had too many arguments in nursing homes and hospital environments with inept, shoulder shrugging staff. t (huge blood sugar swings) doesn’t have to happen. They should stop scaring people and figure out how to do this correctly.
Oh … and I don’t know about you but at 32 years and counting I have not had any “severe” hypoglycemia incidences. I will continue to work hard for the rest of my life to prove them wrong too!
Doris J. Dickson