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:
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"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.