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Diabetic Retinopathy May Predict Congestive Failure

Retinopathy damages the the retina. It's common among diabetics and may indicate a greater risk of developing congestive heart failure. Both retinopathy and congestive heart failure affect small blood vessels.

Diabetics with retinopathies and without cardiovascular disease, risk a higher incidence of congestive heart failure, than diabetics without retinopathies.

The April 22 issue of American College of Cardiology reports 21.6 percent of the participants with retinopathies developed congestive heart failure compared to 8.5 percent for those who did not. This was a nine-year study.

Diabetic retinopathy occurs in about 80 percent of those who have had diabetes 10 or more years, and does not discriminate by type 1 or 2. The walls of the retinal vessels become frail and bleeding occurs, leading to blindness if not cared for.

Congestive heart failure is another manifestation of small vessel disease. It occurs when the pumping of the heart weakens and the blood backs up, providing difficult breathing. One of the cardinal indications of congestive heart failure is fluid collecting in the lower extremities, such that when touched, an indentation is left for several moments. This condition is known as pitting edema. The cause of congestive failure in diabetics has long been associated with small vessel disease.

The study would seem to be a way to foretell the possibility of future events. I think finding predictors is all well and good, if patients and physicians pay attention to them. I wonder though, when these kinds of studies are published, whether people who don’t have retinopathies understand that they are still at high risk.

Routine eye care is vital for diabetics with or without retinal problems. Most ophthalmologists recommend a visit at least yearly. Some individuals see an optometrist, which is fine if you don’t have the eye disease. Once diagnosed, you will want to see a physician who specializes in retinal disorders. There is a difference between the two. Advise your doctor of your retinopathies and get a cardiac evaluation whether or not you have symptoms. Your cardiologist can decide how often you should be seen after that.

Kidney Disease May Predict Heart Problems

The presence of a certain chemical in people with diabetes who have malfunctioning kidneys could signal an increased risk of heart problems. Diabetes-related kidney disease was associated with an increase in cardiac events.

Researchers have identified the concentration of a naturally occurring metabolite that hints at heart problems in diabetic patients with nephropathy, or malfunctioning kidneys.

The research published in the April 2008 issue of Diabetes Care examined a certain chemical produced by the body as a marker that could indicate risk of cardiovascular events. The chemical is called asymmetric dimethylarginine (ADMA), and is produced as the body processes glucose. It makes sense that individuals with diabetes and damaged kidneys would also have a greater risk of damage to the small vessels of the heart, which would be cardiac disease. Diabetes is an illness marked by small vessel damage and organs contain small vessels.

Studies revealed that those with diabetes-related kidney disease sustained 43 percent more fatal or non-fatal cardiac events than those without kidney disease. The concentrations of the ADMA, were higher in the kidney patients because their glomerular rate, which is the fine filtering of the kidney, was not functioning adequately. Higher concentrations had impact on nitric oxide levels, which affect the small vessels. Overall, however, patients with higher ADMA had a 67 percent higher mortality rate than those with lower results.

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Keep this in mind when discussing anything about predictors. Discovering such predictors may or may not cause a lifestyle change. They’re nice to know about, but what are you going to do about it now that you know? You can take steps to change your lifestyle now with or without knowing your risk. Eat and live well from today on and you won’t have to worry about predicting your future.

What Did You Say?

Researchers have determined that diabetes is an independent factor for hearing loss, no matter a person's age, environmental influences, other disease, or trauma. If you've been having trouble hearing, or know someone with diabetes who is struggle with hearing loss, read more.

Are you a diabetic who frequently asks people to repeat what they are saying? Does it seem like everyone is whispering? It may not be them who have the problem. 

A new study indicates that diabetes may be an independent factor in hearing loss. It means you don’t need any other influences such as advanced age, other diseases, trauma, or environmental influences to induce hearing loss.

The research, published in the July 1 issue of the Annals of Internal Medicine, found of 587 patients with hearing problems, 399 were diabetic. Subjects were from diverse cultures, ethnicity, age, and both genders. That equals 68 percent of those with hearing loss.

Hearing loss was determined to be more severe in the diabetics than the non-diabetics, as well. The only group which was equivalent in their loss was the oldest participants, age 60 through 69. We should note hearing deficit was not uniformly symmetrical, meaning one ear was usually more affected than the other. This was established by means of audiometric testing. The hearing test evaluates whether an individual can hear tones at certain levels of loudness and pitch.

Most individuals didn’t realize their hearing was progressively diminishing. I suspect their family members did, however. The authors of this study conclude diabetics should get routine hearing tests. There are many devices available these days which amplify sound and are discreetly hidden in the ear. There are no more stigmas attached to wearing a hearing aid than to wearing corrective lenses for your eyes.

Diabetes Resolution May Be Near

New research has found a protein that may cause pancreatic cells--the cells that produce insulin--to regenerate. Type 1 diabetes destroys these important cells, making people who live with type 1 diabetes insulin dependent.

Researchers presented findings of a specific agent and a protein which appears to cause regeneration of defunct pancreatic cells at the annual conference of the American Diabetes Association.

This is good news for type 1 diabetics. They are the individuals who have an autoimmune reaction which eventually destroys the insulin producing cells of the pancreas. Type 2 diabetics are more subject to environmental and lifestyle influences, although many have a genetic disposition for diabetes.

The research is in its infancy. So far, scientists have only studied the protein in mice as the subjects. Autoimmunity, as in cases of type 1 diabetes, means the body attacks itself and causes destructive inflammation. Scientists used lisofylline (LSF) with islet neogenesis-associated protein (INGAP) to work against inflammation and control immune responses. INGAP is a protein in the pancreas which has been shown to cause new cell growth with functional insulin production.

The pancreas is the organ which produces insulin. Insulin drives glucose into the body’s cells, giving the body energy. Without insulin, glucose circulates in the blood without providing the required nourishment to the muscles or brain. Type 1 diabetes progresses rather rapidly; approximately 90 percent of the beta cells that produce insluin need be destroyed before it becomes clinically evident

Type 2 diabetics produce insulin but not enough to overcome insulin resistance in peripheral tissue. These patients do well on oral agents which stimulate the pancreas into greater production.

From what we can see with this one study, there is a great deal of potential when it gets to human trials. Is it around the corner? No. This was one study out of many which will have to be duplicated before the appropriate human dosing and testing may be derived. It does, however, confirm the long-held hypothesis of inflammation and autoimmunity being the root pathology or cause of the disease. In the future, perhaps patients will only need one dose of the medication a month or week or never! We don’t know how long the results will last, nor if it will work on human physiology. However, it certainly gives us hope.

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Vision Loss More Common Among People with Diabetes

From the Journal of the American Medical Association

Damage to the retina is one of the most common complications of diabetes, and contributes to increased vision loss among people with diabetes. Researchers analyzed rates of vision loss and impairment in groups of people with diabetes as well as people without the disease.

Visual impairment appears to be more common in people with diabetes than in those without the disease, according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Approximately 14.6 million Americans had diagnosed diabetes mellitus in 2005 and another 6.2 million had undiagnosed diabetes, according to background information in the article. It is estimated that the number of individuals with diagnosed diabetes will increase to 48.3 million by 2050. "Diabetic retinopathy [damage to the retina caused by diabetes], one of the most common microvascular complications of diabetes, is considered to be one of the major causes of blindness and low vision," the authors write. Although studies suggest that controlling glucose and blood pressure have reduced the rate of retinal diseases, other ocular conditions suffered by diabetic patients, such as cataract and glaucoma, may increase the risk of visual impairment. Additionally, decreased vision caused by an abnormal shape of the cornea is also common among people with diabetes.

Xinzhi Zhang, M.D., Ph.D., and colleagues at the Centers for Disease Control and Prevention, Atlanta, used data from the National Health and Nutrition Examination Surveys from 1999 to 2004, which included 1,237 adults with diabetes (average age 59) and 11,767 adults without the disease (average age 45) and also measured their visual acuity before and after optical correction. Participants’ vision was tested while they were wearing any glasses or contacts they typically used, and their demographic information was also noted.

An estimated 11 percent of American adults with diabetes had some form of visual impairment (3.8 percent uncorrectable and 7.2 percent correctable), while only 5.9 percent of those without diabetes had some form of visual impairment (1.4 percent uncorrectable and 4.5 percent correctable). "People with diabetes were more likely to have uncorrectable vision impairment than those without diabetes, even after controlling for selected other factors," the authors write. "Our findings also suggest a strong association between visual impairment (correctable and uncorrectable) and older age, member of racial/ethnic minorities, lower income and lack of health insurance, all independent of diabetes status."

"The high prevalence of visual impairment among people with diabetes indicates a need for diverse public health strategies to reduce the burden of both correctable and uncorrectable visual impairment," the authors conclude. "It is important to identify and pursue ways to increase access to eye care for everyone and to correct visual impairment, where possible, to diminish morbidity and mortality due to impaired vision."

 

Drug-Eluting Stents Increase Survival for Diabetes Patients

Drug-eluting stents, or stents that are coated with a drug to prevent narrowing of the vessel, may increase survival rates among people with diabetes who have blocked arteries. The coated stents may also decrease risk of subsequent heart attack and revascularization. Read more.

Drug-eluting stents reduced the risk of revascularization, heart attack, and death in diabetics as compared with bare-metal stents in the largest observational comparison, researchers reported at the American Heart Association’s Scientific Sessions 2008.

The results from The Drug-eluting and Bare Metal Stenting in Patients with Diabetes Mellitus: Results from the Mass-DAC Registry, were presented as a late-breaking clinical trial. The study is simultaneously published in Circulation: Journal of the American Heart Association.

“We actually saw a significant benefit from using drug-eluting stents in this patient population,” said Laura Mauri, M.D., M.Sc., principal investigator of the study and assistant professor of medicine at Brigham and Women’s Hospital and Harvard Medical School in Boston. “First, they significantly reduced the need for repeat procedures which included repeat stenting or bypass surgery. Second, they were associated with lower rates of death and heart attack. So, as a result we can say that these stents appear to be safe in diabetic patients, whose diabetes puts them at higher risk of mortality and heart attack than the general population.”

People with diabetes make up about a third of all patients undergoing percutaneous coronary interventions (PCI) to reopen blocked blood vessels. In PCI with stenting, a balloon-tipped catheter is threaded into the artery to the point of blockage. Then, the balloon is inflated to open the vessel and a mesh metal stent—either bare-metal (BMS) or drug-eluting (DES)—is inserted to keep the channel open. DES are coated with a drug that fights the proliferation of cells that can block the artery (called stenosis).

Researchers identified 5,051 diabetics who underwent PCI at acute-care, non-federal hospitals between April 2003 and September 2004. Diabetic patients at those hospitals were about twice as likely to get DES compared to BMS (66.1 percent vs. 33.9 percent), researchers said.

After three years, people with diabetes who received a drug-eluting stent had a higher survival rate than diabetic patients who received a bare-metal stent. There was a 4.4 percent mortality rate for DES patients compared to 22.2 percent for BMS patients, Mauri said.

After two year, rates of heart attack and revascularization were also lower among patients with diabetes who received drug-eluting stents.

“Diabetic patients represent a large and growing proportion of patients who undergo stenting,” Mauri said. “We know that patients with diabetes have a higher incidence of adverse events following the procedure, including higher rates of restenosis (reblockage), heart attack and death related to heart problems.”

“Previous studies indicated that drug-eluting stents reduce the rate of restenosis, but there has been controversy about their safety because of conflicting evidence from smaller studies.”

Some of those studies found higher mortality associated with DES while others found no safety differences between the two types of stents. This study showed lower mortality and adverse events.