Diabetic Diets: June 2013

Low-carbohydrate diet improved HbA1c, weight loss in diabetes !

June 28, 2013

CHICAGO — Compared with a low-fat, calorie-restricted diet, a low-carbohydrate diet reduced HbA1c and resulted in twice as much weight loss in patients with diabetes, study results presented at the ADA Scientific Sessions suggest.

Participants were randomly assigned a low-fat, calorie-restricted diet in which caloric intake was 500 calories below the estimated need for weight maintenance (n=18) or a low-carbohydrate diet that restricted intake of carbohydrates to 50 gm per day excluding fiber (n=16). Carbohydrates comprised 45% to 50% and fat comprised 25% to 35% of the low-fat, low-calorie diet. Both groups were taught psychological skills to assist in behavior change and maintenance during 13 sessions over 3 months. Patients receiving insulin were excluded from the trial, and 74% were receiving oral medication.

Overall, mean HbA1c decreased –0.02% in the low-fat, low-calorie group and –0.59% in the low-carbohydrate group (P=.04 comparing groups). Thirteen percent of participants in the low-carbohydrate diet group reached an HbA1c of less than 5.7% vs. none in the low-fat, low-calorie group, according to the study abstract. The use of oral diabetes medication was reduced or discontinued by 11% of participants in the low-fat, low-calorie diet group vs. 47% in the low-carbohydrate group. Although calories were not restricted, those on the low-carbohydrate diet lost twice as much weight compared with those on the low-fat, low-calorie diet. Researchers said that blood lipid levels did not worsen in the low-carbohydrate group, despite the high fat content of carbohydrates.

“Our results suggest that a lower carbohydrate diet coupled with skills that promote behavior change may improve glucose control in type 2 diabetes,” researchers wrote.

For more information:

Saslow L. #25-LB. Presented at: ADA Scientific Sessions; June 21-25, 2013; Chicago.

http://www.healio.com/endocrinology/diabetes/news/online/%7BB279D740-D2E3-4494-B4B6-DD47AC500F29%7D/Low-carbohydrate-diet-improved-HbA1c-weight-loss-in-diabetes

Graham

Gezzathorpe and why I feel another Jimmy Moore pod cast coming on.

“As for making a point against lowcarb, I think I have claimed to be lowcarb at least 6 times in various blogs, so it would strange for me to be making a point against my own practice.”

Sorry folks, some of you must be getting sick of the amount of times we have posted about this guy recently, but he gets more ludicrous with every post. Remember he says he is a diabetic (he has proved he is not), he uses no diabetes medication and holds non diabetic blood glucose numbers on 250 carbs a day. Now he says he has said a least six times he is a lowcarber. Gezza makes Sid Bonkers appear sane, believe me that takes some doing.

Don’t get me wrong, as a pair of court jesters they are as good as it gets, but you can see from comments made on the threads they have infested, they are causing great confusion for the newbie’s and inexperienced. Meanwhile the administrator and mods sit back, and their only input has been to lock the Southport Doctor thread, (a proven medical professional) and a thread started by IanD. I feel another Jimmy Moore pod cast coming on. Here is the last one, big changes were made within days of this going out. The two senior mods got their exit visas.

Eddie

Click on screen shot to enlarge

More on Graham’s post last night.

So often in life it’s not what you do, it’s how you do it. The nearer a diabetic can get to non diabetic blood glucose numbers the better the outcome in avoiding serious diabetic complications. This has been proved many times. It is of paramount importance how you achieve those numbers. Using a high carb diet and ramming BG numbers down with drugs is a disaster, as proved in the ACCORD study. So many type two diabetics died, the study ended early. Unfortunately the lowcarb naysayers forget to point out the reason this comment is made so many times.

From Grahams post.

“However, Dr. Lachin did divulge that there is no increased mortality among the intensive-treatment group, a phenomenon that has been seen in some trials involving patients with type 2 diabetes.”

So, a casual look at that statement may make some type two diabetics feel intensive BG control would not help CV outcomes, indeed some have suggested intensive BG control could make matters worse. Nothing could be further from the truth. When I checked out the ACCORD study when it came out, it stated the participants had suffered from long term obesity, they had run very high BG numbers for years and here is the knock-out punch, they were using insulin and up to four type two diabetes medications including Actos and Avandia. Two drugs banned in many countries for killing people ! I remember writing at the time the poor participants had one foot in the grave at the start of the trial.

I know I do not have to tell readers of this blog how to reduce BG and weight safely. And no-one will ever convince me drugs should be the first line of defence for an over-weight person or a type two diabetic.

Eddie

BTW Check out another view of another waste of money and an exercise in futility the Look AHEAD study here.

ADA: 18 Years Later, A1c Matters for DCCT Intensive Control Group !

The results continue to show dramatic reductions in complications....

Almost two decades after the landmark Diabetes Control and Complications Trial (DCCT) ended, we are still seeing dramatic reductions in diabetes complications achieved with intensive glycemic control in the intensive control group.

After 18 years, the overall prevalence of diabetes complications is 50% lower among the type 1 diabetes patients in the DCCT who were randomly assigned to intensive glucose control compared with those who received conventional treatment, despite the fact that HbA1c levels are no longer different between the 2 study groups.

The findings were presented at the American Diabetes Association (ADA) 2013 Scientific Sessions, in a special symposium commemorating the 30th anniversary of the launch of the National Institutes of Health-funded study that proved the benefit of intensive glucose control for patients with type 1 diabetes and established the practice as the standard of care.

DCCT/EDIC biostatistician John M. Lachin, ScD, professor of biostatistics and epidemiology, and statistics at the Biostatistics Center of George Washington University, Rockville, Maryland, stated that, even after so many years, "The message is exactly the same. The HbA1c matters today, tomorrow, and for many, many years to come. It matters."

The new data come from the DCCT's long-term follow-up study, Epidemiology of Diabetes Interventions and Complications (EDIC), which began in 1994, the year after DCCT ended. Glycemic control in the 2 groups became roughly the same soon after patients went back to their communities for care, so EDIC is measuring the ongoing impact of glycemic control in the initial study's 10 years, a phenomenon investigators have dubbed "metabolic memory."

Previously reported endpoints of retinopathy, nephropathy, neuropathy, and cardiovascular disease continue to be reduced among those originally in the intensive-treatment group, albeit to a lesser degree than in previous EDIC analyses in 2000. (N Engl J Med. 2000;342:381-389).

The investigators are also looking at mortality in EDIC, with results under embargo, as they are due to be published soon. However, Dr. Lachin did divulge that there is no increased mortality among the intensive-treatment group, a phenomenon that has been seen in some trials involving patients with type 2 diabetes.

EDIC coordinating center principal investigator, Rose Gubitosi-Klug, MD, assistant professor, pediatrics at Case Western Reserve University School of Medicine, Cleveland, Ohio, said: "In some ways, it's surprising how it's gone on this long. [The original DCCT investigators] expected the effect to wane after 10 or 12 years. But here we are at 18 years, and we still have significant risk reduction. Although it's starting to decrease over time, there's still a significant reduction. It's fantastic."

The original DCCT, which involved 1441 patients with type 1 diabetes, demonstrated that intensive glycemic control -- resulting in a mean HbA1c of about 7% -- reduced the risk for retinopathy, nephropathy, and neuropathy by 76%, 50% and 60%, respectively, compared with the conventional-treatment group, whose HbA1c averaged about 9%.

After DCCT ended, patients who had been in the conventional-treatment group were instructed in intensive glycemic control. Their average HbA1c levels dropped to about 8%. At the same time, control worsened in the original intensive-control group to about 8%. That level has remained relatively unchanged during EDIC.

Lloyd P. Aiello, MD, PhD, head of the Joslin Diabetes Center, Section on Eye Research, Boston, Massachusetts, reported the new EDIC retinopathy findings. The difference in retinopathy rates between the previous intensive- and conventional-treatment groups was 70% at 4 years, 53% at 10 years, and 46% at 18 years. Rates of ocular surgery were also lower at 18 years in the prior intensive group, with differences of 48% in cataract extraction and 44% in vitrectomy or retinal detachment.

"Further EDIC follow-up has demonstrated a consistent beneficial effect on severe eye disease. Even though the risk reduction has decreased with time, the effect is still substantial after 18 years of EDIC follow-up," said Dr. Aiello, who is also associate professor of ophthalmology at Harvard Medical School, Boston, Massachusetts.

Among the most recent neuropathy findings, presented by Catherine L. Martin, MS, APRN, CDE, from the University of Michigan, Ann Arbor, were a 30% reduction in the development of confirmed clinical neuropathy and 31% reduction in confirmed autonomic neuropathy among the intensive-treatment group at year 14 of EDIC, both statistically significant.

Ian H. de Boer, MD, associate professor of medicine and adjunct professor of epidemiology from the University of Washington, Seattle, presented the 18-year update demonstrating continued effects of intensive glycemic control on kidney function.

At 18 years there was a 39% reduction in risk for the development of microalbuminuria among the subjects who did not have it at the start of DCCT. At 8 years, that risk reduction had been 57%.

The comparable numbers for the development of macroalbuminuria were 61% at 18 years, compared with 84% at the 8-year analysis. A parallel reduction in hypertension is a likely mechanism, he said. Previously, his group had shown a 50% risk reduction in the development of impaired glomerular filtration with intensive control.

The cardiovascular data were summarized by Dr. Lachin, who explained that the end of DCCT was too soon to assess CVD outcomes in the still relatively young study population.

However, at 9 years into EDIC, there was a 42% decrease in any cardiovascular event and a 57% reduced risk for nonfatal heart attack, stroke, or death from cardiovascular causes, as previously reported (N Engl J Med. 2005;353:2643-2653). Extending those analyses through 2012, those same risk reductions are 33% and 35%, "both still statistically significant and of course clinically meaningful," he observed. He then added that, previously published EDIC analyses have shown benefits of intensive glycemic control in carotid intimal-medial thickness (Diabetes. 2011;60:607-613) and cardiac function.

In summarizing future directions for DCCT, it was stated that all the currently monitored end points will continue to be followed, with cardiovascular end points expected to become more prevalent in the now middle-aged study population.

Practice Pearl:

The lesson from the DCCT is to start intensive diabetes management as soon and as safely as possible.
American Diabetes Association (ADA) 2013 Scientific Sessions. DCCT/EDIC 30th Anniversary Symposium-Contributions and Progress, presented June 22, 2013.

http://www.diabetesincontrol.com/articles/diabetes-news/14820-ada-18-years-later-a1c-matters-for-dcct-intensive-control-group

Graham

Robin Thicke - Blurred Lines ft. T.I., Pharrell

This must be a first for this blog the current UK chart topper, decided not to post the explicit version sorry guys don't want to upset the ladies. Graham

Saturday night is music night on this blog ! Nile Rodgers popular music super star !

Usually we post up some utube vids of our favourite music, tonight it’s a little different. Last night we watched Nile Rodgers and Chic at Glastonbury, a stunning performance for sure. I had heard of Nile but I did not realise until last night his stunning and massive contribution to popular music. Check out the last number of the set and his monumental musical CV on Wiki, a true legend in his own lifetime. Good times for sure ! Eddie

Link to the last number last night here miss this and you will be missing out. Stunning musicianship and singing. Go full screen, volume to the max, get your headphones on, and blow your brains out. No need for street meds here to have a good time.

Nile CV here.

Does anyone know a good Surgeon?

Help ladies (and gentlemen). Eddie is a sport and music fanatic, yes he does have a life other than diabetes blogs and lowcarb. This weekend it’s the British Grand Prix,Wimbledon, Motor GP, Rugby and the Glastonbury music festival. I have a feeling that on Sunday night he will need a Surgeon to remove the sofa from his butt (sorry ladies bottom). Meanwhile I have had my orders and I am off to the shops for his favourite lowcarb food and wine. What really annoys me is how many times he says “I have to do it ALL round here”.

Yes dear of course you do LOL

All the best Jan

Am I still a diabetic ?

Wonders will never cease, Sid Bonkers finally gets something right !

"low carbing is often claimed to make you more sensitive to carbs which seems a little self defeating to me for obvious reasons."

That was said today by Sid Bonkers on the forum of flog. Sid was having a kick at lowcarb, nothing new there then eh. But for once he was right. Over the years many people get slowly poisoned by highly processed carbohydrates, sugars and starches. The damage takes many years to manifest itself and becomes noticeable when we start to get health problems. Some people become obese, with all the hazards that brings on. Some people become type two diabetics, the list of health problems is long.

Look at it this way. Most of us know someone who drinks too much*, they can start drinking at a midday barbeque and still be drinking late at night, and they never get drunk, they don’t even seem to get tipsy. How can they do this ? It’s because they have become immune to alcohol, their body has been damaged, and they do not get the warning signs others get, who are not heavy drinkers, when they are poisoning themselves. In short they have built up a very high tolerance to alcohol. The same is true with carbs. When we eat starchy carbs/sugar our blood glucose goes up, plasma insulin goes up and knocks the BG down, but over time we build up a very high tolerance to insulin, we need more and more to get the BG lowering fix.

So, the informed and intelligent carboholics and sugar addicted, let’s call them junkie’s, I was one of them for most of my life, have a decision to make, do they dump the carbs and get well, or do they stay on the food that poisoned them, and try to get well with a bunch of drugs. Drugs that in some cases cause more problems than the poison carbs. For me and millions around the world, it’s a no brainer, the carbs get dumped. So back to Sid’s comment. He is right for the first time in a long time, when we dump the foods that brought about our health problems we lose the high tolerance we once had, we become very sensitive to what excessive carbs do to our bodies. Almost all lowcarbers fall off the wagon occasionally for many reasons, sometimes we have a discipline failure day or we are at a business or social occasion like a wedding, and it’s carbs or go hungry, and what do we find, and is reported by many ? We feel awful the next day, lack of energy, head aches, lethargic and bloated. We have poisoned ourselves !

As Sid said "low carbing is often claimed to make you more sensitive to carbs which seems a little self defeating to me for obvious reasons." He was right we have become more sensitive to carbs, more sensitive to, what is for millions around the world, poison. That seems a good thing to me, but as Sid likes to say we are all different, ain’t we just.

Have a good weekend.

Eddie

Forum of flog link here.

* If anyone says you lowcarbers are all drunks I will send the boys round.

Your brain on carbs: Study suggests how sugary, starchy foods may lead to addiction !

High-glycemic carbohydrates, the kind found in highly processed foods like white bread, white rice and refined sugar, trigger activity in the brain's reward centers in a different way than low-glycemic carbs, researchers from Boston Children's Hospital found.

Are sugary, starchy foods like crack to the brain?

A new study published in The American Journal of Clinical Nutrition found that the brain responds differently to some types of carbohydrates than others — and some sugary foods trigger the same reward mechanisms as drug and alcohol addiction.

In the study, researchers observed the brain activity of 12 overweight or obese men between the ages of 18 and 35 in the hours after they consumed milkshake meals. The milkshakes were identical in taste as well as calories, nutrients and carbohydrates, but one set of shakes was made with high-glycemic carbs, such as the kind found in white bread, white rice and processed sweets, that spike blood sugar more quickly. The other set contained low-glycemic carbs such as those found in whole wheat bread and brown rice that cause a more gradual rise in blood sugar.

Predictably, when subjects drank the high-glycemic shakes, their blood sugar levels rose more quickly, and several hours later had dipped lower than when they drank the low-glycemic version. They also reported feeling hungrier.

But researchers also noticed substantially more activity in the parts of the brain that regulate reward and craving, the same areas activated in addicts, four hours after the men drank the high-glycemic shakes.

Lead study author Dr. David Ludwig, director of the obesity research center at Boston Children’s Hospital, said the brain activity may suggest why some people get stuck in a cycle of reaching for — and overeating -- sugary, starchy foods.

“Beyond reward and craving, this part of the brain is also linked to substance abuse and dependence, which raises the question as to whether certain foods might be addictive,” Ludwig said in a statement.

"Limiting high-glycemic index carbohydrates like white bread and potatoes could help obese individuals reduce cravings and control the urge to overeat."

Eating too many high-glycemic foods isn't good for anyone, but the bigger picture of whether a person can become addicted to food — or to specific type of food like high-glycemic carbs — is more complicated, said Dr. Lisa Young, RD, PhD, adjunct professor of nutrition at New York University.

"I wouldn't jump so fast to call it addiction, but it's possible in a certain subset of people," Young told the Daily News. "There are other factors you need to look at, at the same time. When some people eat a cookie they can't stop, but other people can stop. You're dealing with psychological behavior."

How the body and brain process high-glycemic foods also depends on how you consume them, she added.

"The glycemic index is complicated," Young said. "You want to look at, are you eating protein and fat also? A baked potato scores high on the glycemic index, but if you eat it with salmon it's not going to have the same effect."

People may consume greater quantities of highly processed fast foods because many are devoid of the fiber that helps you feel full, Young said.

"You keep eating and keep eating and don't necessarily recognize satiation," she said. "These foods could be addictive — but is it the glycemic content, is it the salt, the fat? Regardless of what it does, it's not helping you because it's stripped of nutrients."

http://www.nydailynews.com/life-style/health/brain-carbs-study-suggests-sugary-foods-lead-addiction-article-1.1384443

Graham

Gezzathorpe between a rock and a hard place !

When Gezza started posting, and then talking about a GT test, I thought this guy is putting himself between a rock and a hard place. If he proved he was not a diabetic, which many suspect, he proves us right. If he proves he is a diabetic, then my comment saying he is one in a million also stands. In five years I have never come across a diabetic on nil diabetes medication who could consume 250 carbs and get the sort of BG numbers Gezza was stating. I have seen nothing that changes my initial opinion.

Gezza started a thread today at the flog detailing his GT test last night, the thread was deleted by the mods within minutes, why ? Part of his post missed by the screen shot, was words to the effect he is the only one that can prove what he claims. I don’t think so. What he has proved is the fact he is not a diabetic, he does not even fit the profile of a person with glucose intolerance. Check out the data in the second screen shot, this confirms my reason for thinking Gezza was not a diabetic, at the start of his posting regarding his BG numbers on a high carb diet and no diabetes meds.

Some may be thinking look at his numbers around the one hour mark, true they are high, but not as unusual as you might think. Back in my early days of living with diabetes, I done a huge amount of testing, both on myself and family and friends, and very often they were into double BG numbers within an hour of a carby meal. The massive difference between them and me, was how quickly they returned to non diabetic BG numbers, usually within two hours, my drop in BG to non diabetic was taking anything up to six hours and in extreme situations 8 hours.

So to conclude Gezza’s BG was 5.0 and at 2 hours 8.7 then within thirty minutes plummeting to 4.7. He then went into a hypo and weetabix and a banana saved him from expiring on the spot. Never to risk a GT test again. That’s a pity because I was hoping we could have BG meters at dawn duel. We could meet up, down the dreaded Lucozade and test every 15 minutes, I bet my profile would have been very different to Gezza’s. While he was staggering around having a hypo I would probably still be seeing double figure BG numbers on my meter. But I am a diabetic.

Click on screen shot to enlarge Gezza's deleted post.

Click on screen shot to see DCUK info on GT tests.

Eddie

New Government health warning announced !

As from the first of July 2013 all Sid Bonkers diabetes.co.uk forum posts must carry a Government black box health warning.

The Sun

BTW Gezza we have your deleted thread and post re. the GT test. We will post it up on this blog later, when time permits.

Eddie and the dreamers, going down the shops.

Type 1 diabetes vaccine hailed as 'significant step'

It may be possible to reverse type 1 diabetes by training a patient's own immune system to stop attacking their body, an early trial suggests.

Their immune system destroys the cells that make insulin, the hormone needed to control blood sugar levels.

A study in 80 patients, published in the journal Science Translational Medicine, showed a vaccine could retrain their immune system.Experts described the results as a "significant step".Normally a vaccine teaches the immune system to attack bacteria or viruses that cause disease, such as the polio virus.

In patients with type 1 diabetes, the immune system destroys beta cells in the pancreas. This means the body is unable to produce enough insulin and regular injections of the hormone are needed throughout life.It is a different disease to type 2 diabetes, which can be caused by an unhealthy diet.The vaccine was targeted to the specific white blood cells which attack beta cells. After patients were given weekly injections for three months, the levels of those white blood cells fell.

Prof Lawrence Steinman said: "We're very excited by these results, which suggest that the immunologist's dream of shutting down just a single subset of dysfunctional immune cells without wrecking the whole immune system may be attainable. "This vaccine is a new concept. It's shutting off a specific immune response."

More on this story here.

Diabetes care shortfall puts patients at risk !

Audit report says number of patients at risk of developing life-threatening diabetic ketoacidosis is 'appalling'

Many patients with diabetes who end up in hospital are suffering life-threatening complications because their care is not good enough, according to an audit published today.

The National Diabetes Inpatient Audit report says it is shocking that 60 patients in hospitals across England and Wales should have developed diabetic ketoacidosis during the one week survey. The condition, which can be fatal, occurs when a diabetic patient is not given enough insulin.

"It is appalling that some people with diabetes are being so poorly looked after in hospitals that they are being put at risk of dying of an entirely preventable, life-threatening condition," said Bridget Turner, director of policy and care improvement at Diabetes UK, which jointly managed the audit with the health and social care information centre. The audit was commissioned by the Healthcare Quality Improvement Partnership.

Turner called on the government to lead change. "Even a single case of diabetic ketoacidosis developing in hospital is unacceptable because it suggests that insulin has been withheld from that person for some time. The fact that this is regularly happening raises serious questions about the ability of hospitals to provide even the most basic level of diabetes care.

"But the small minority of people who become seriously ill through neglect is just the tip of the iceberg. In every aspect of hospital diabetes care that this report shines a light on, the picture that emerges is profoundly disturbing.

Medication errors are being made with alarming regularity, large numbers of people are not getting foot checks that we know can help prevent amputation, while one in 10 people's blood glucose level is dropping dangerously low during their hospital stay.

"Put together, this adds up to a situation where in too many cases hospitals are doing people with diabetes more harm than good. This is a scandal and the really shocking thing is that it's a scandal we have known about for some time but which there has never been any serious focus on bringing to an end."

Most of the patients with diabetes were admitted for some other reason, but the care of their diabetes was not as good as it should be. A third of patients in England (39.8%) suffered from a medication error, although that was an improvement on 2010, when the figure was 44.5%. In Wales, 36.7% suffered from a medication error.

Less than 60% of patients who should have visited by a specialist diabetes team actually saw one. A third of hospitals in England (32.2%) and nearly half in Wales (47.1%) had no specialist diabetes nurse for inpatients.

http://www.guardian.co.uk/society/2013/jun/27/diabetes-treatment-hospitals-patients-risk

Graham

NHS Direct pulls out of two NHS 111 contracts and admits others are ‘unsustainable’

NHS Direct has pulled out of providing NHS 111 in two areas of the country and said the contracts it is currently delivering in other areas have become ‘financially unsustainable’ in a major blow to the rollout of the new urgent care number. The provider was contracted to cover a third of England’s population in 111 different areas with the new service, but papers for its latest board meeting show that it has been forced to cancel NHS 111 contracts in Cornwall and North Essex.

Pulse revealed details from a leaked internal NHS report earlier this month that questioned the future viability of NHS Direct after revealing a catalogue of failures during its rollout of NHS 111. This latest revelation from the chief executive’s report for its July meeting, cast a further blow for the beleaguered provider, which said in the report it is currently delivering only 30% to 40% of its contracted call volumes. Chief executive Nick Chapman said in his report: ‘Agreement has been reached with commissioners for North Essex and for Cornwall, that NHS Direct is not in a position to mobilise the 111 services for those areas.‘These commissioners are expected now to make arrangements with alternative providers to mobilise the 111 service in their area.’ He went to say that in live NHS 111 areas contracted to the provider, staff levels were ‘above those planned to handle the full 100% of contracted call volumes’ and warned: ‘As a result of the lower than contracted call volumes, we expect to receive substantially lower income than originally budgeted.
‘The imbalance of costs and income on NHS Direct’s 111 contracts means that each of the 111 contracts as they currently stand are financially unsustainable.’

More on this story here.

Ian Day the man of calm and peace who never stops fighting for the lowcarb cause.

Ian posted this thread on a diabetes forum yesterday, I have shamelessly nicked it. Check out Ian’s story and how he almost became crippled by his type two diabetes and his road to recovery. Over seventy years of age and now playing tennis against people half his age. Pretty good for an old timer wouldn’t you say. Ian not only posts on forums, he is out on the streets, in halls, promoting lowcarb wherever he can.

Eddie

“At the Hounslow Diabetes/Cardio Support group in Hounslow last night, a Hospital consultant came to talk about heart drugs. He came in time to hear the previous presentation on "Heart Muscle Regeneration" by a mother & daughter team. The daughter had studied the heart regeneration ability of zebra fish as an A-level project. The search is on for the right stem cells. Consultant added that they were expecting results on stem cells in years, rather than decades.

Lots of questions from the floor.

'Mother' also spoke on heart attack risks, including stress and raised heart rate, so I asked about my tennis heart rate: No heart problems or medication. Resting - 60, maximum - 150 after intense rallies, between games - 120. Both seemed happy that that was OK. Presumably my resting normal heart rate & BP are indicative of a healthy heart that can cope with the exercise.

I asked the consultant about diet - NHS high 'good' carb, low fat, versus the low carb, increased fat diet that has reported benefits, but is not officially recommended. He acknowledged the controversy and that low carb may be OK, provided we don't eat lots of fish & chips, and hydrogenated fats - keep to unsaturated fats. He said if we have raised chol, we should not eat increased fats. I didn't tell him about cream on my nut porridge, or my 5+ chol. A previous talk recommended getting below 3 for total chol.

Not a good answer, as fish & chips aren't low carb, and the recommended (LCHF) sat fats are certainly not 'hydrogenated.' I suppose consultants only see cholesterol when it blocks arteries. Are they aware of data on raised chol in heart-healthy people? There has been plenty of discussion on this forum, questioning the danger of raised chol & the benefits of statins. He asked a show of hands for angina patients - about 40 out of 50; Keep your hand up if you've got your GTN spray with you - only 1 I could see; Always keep it with you - you don't know when it will save your life.”

Check out Ian's uplifting story and his road to recovery to good health and fitness here.

Diabetes.co.uk does Sid Bonkers own the forum ?

After years of getting threads locked and promoting a ludicrous 1200 calorie per day diet, the Bonkers one manages to get the Southport Doctor thread locked again. Even Gezzathorpe had agreed to leave the thread alone, and the thread was back on topic, but the Bonkers one had to have one last wheedle, and push his luck again. I am left thinking he must own the forum or maybe has some sort of hold over the people that do, how else can anyone explain why he has lasted so long ? What the objectives are of the forum owners is impossible to fathom, but in my opinion, helping the majority of diabetics to a safe place, is not high up on their priorities.

Sid and others should be able to say what they like within reason and the law, but why do the mods allow him to wreck and engineer thread locking at will ? Are the mods so blind or stupid they cannot see what has gone on for years ? Or is something more sinister afoot ?

Eddie

Click on screen shot to enlarge

Great food ideas from my friend Lynda.

Frittata

This recipe is a great way to use up left over vegetables. You can use roast vegetables, cooked cabbage, broccoli, carrot, peas, beans... anything!! Please note that all measurements here are approximate because it depends on the size of your frypan and the amount of leftovers.

Please Note: You must use a frypan that can be put into the oven (no plastic handle) !! If you don't have a frypan you can put into your oven you could transfer the mixture (after sautéing into a pie dish or individual muffin trays (silicon is best to stop sticking).

1 small onion chopped (or half a large onion)
2 rashers of chopped bacon or ham (optional)
1-2 cups approx of left over vegetables
1 tablespoon butter
4 eggs
1/4 cup of cream (approx)
Salt and pepper
1/4 - 1/2 teaspoon of curry powder (optional)
1/2 cup grated cheddar cheese

Method:
Sauté the onion in the butter, add the bacon and cook a little longer then add the curry powder (if using it). Make sure to use a pan that can go into the oven - no plastic handle!!
Add the vegetables and heat through.

Pour over the eggs previously beaten with half the cheese, cream and seasoning.

Cook through a little on the stove top, top with remaining cheese and then put into a moderate oven until the top is puffed and brown. You can either use fan bake for this for approx 8 minutes or grill. Whatever works for you and your oven.

You can find more of Lynda's lovely recipe ideas here.

All the best

Jan

Diabetes.co.uk outbreak of fours the floor virus suspected !

Members over at the flog have had a hard time recently, just as a dangerous outbreak of dietus ludicrous carbus appears to have been dealt with, a severe case of four’s the floor virus has broken out. Old hands may remember the Kensters obsession re. type two diabetics and hypos. He never accepted that non meds or lowcarbing type two diabetics rarely suffered from hypos. Indeed, most non meds type two diabetics have to work hard to keep BG down not up. Fours the floor was believed to have been eradicated, but returned today with a vengeance, when Kenster clone Gezzathorpe appeared to be going down fast. Looking pale and under great strain Gezza croaked “Many non-diabetics and diabetics get hypos and lower bG than that.” The BG number 3.1.

More fun and games expected, watch this space for up-dates.

The Sun

Peter Attia: What if we're wrong about diabetes?

Published on 25 Jun 2013As a young ER doctor, Peter Attia felt contempt for a patient with diabetes. She was overweight, he thought, and thus responsible for the fact that she needed a foot amputation. But years later, Attia received an unpleasant medical surprise that led him to wonder: is our understanding of diabetes right? Could the precursors to diabetes cause obesity, and not the other way around? A look at how assumptions may be leading us to wage the wrong medical war. Graham

Gezzathorpe diabetic super star or full of it ?

As you can see there are some posts on this blog re. the diabetes.co.uk forum member Gezzathorpe. This guy waded in big time when a GP joined the forum. Sid Bonkers accused the Doctor of being a troll and Gezza had his five bobs worth. Nothing new here, healthcare professionals are actively discouraged from joining and contributing on the forum of flog, just ask Dr. Jay Wortman. This thread really got cooking when Gezzathorpe told us about his wonder diet. To cut a long story short, Gezza is on 250 carbs a day, no meds and holds non diabetic BG numbers. I’m not known for beating around the bush so I will say it load and clear, Gezza’s story is the biggest load of bullshit I have heard in years.

Others have noticed this fantasy island job, but not the old clique of Cugila, the disgraced and fired forum mod. Bare in mind the clique would applaud anyone, whatever they stated, as long as they are not lowcarbing. If a person was not lowcarbing, and reported a diet of depleted uranium and anthrax the clique would be in raptures. Get your sick bag out, from Catherinecherub chief forum fantasist “Well done gezzathorpe, marvellous results” From Sid Bonkers “Great results Gezzathorpe You must be well pleased” from Noblehead the biggest slime ball and wimp in the forums history stated “no Dr is going to be taken seriously if they want to remain anonymous and do not want to publish their finding for all to see” and “Until then I'm afraid I'll sit on the fence with this one” I know what you are thinking, where is Phoenix in all this, what has happened to the slippery one? Well Gezza got a whipping today on the GP thread and started another thread.

Fear not, she turned up on Gezza’s latest thread called “Am I still a diabetic ?” Please bare in mind, once a diabetic, always a diabetic ! There is no cure, hence it is called a chronic disease, full stop. The mighty Gezza talks about doing a GT test and publishing the results, (so far he has edited his post 4 times) the Phoenix states “I shouldn't bother if I were you. If you 'pass 'it, will you consider yourself a non diabetic ?Your method works well for you, don't let others negate what you have done” What method would that be Phoenix ? The laboogie rule method, jeez give me a break.

Anyway, here’s the deal, get your butt over here Gezza and let’s debate the issues, you stated today at 11.50 at diabetes.co.uk “Some recent comments from an external, undisclosed (my choice) source which should give you a good laugh .... sad, insecure, cowardly folk, especially 'Queen Eddie', with nothing better to do” I am waiting Gezza, go for it lad, if you want to try and claim any credibility.

Last word to Carbdodger at 11.58 to Gezza.

“So you run for the hills when challenged after leaving posts that will do the newly diagnosed no good at all. That is so unfair. But hey maybe best you are not here for the health of many.”

Eddie

Check out Graham’s post last night and you would get the impression weight loss was a waste of time in diabetics regarding heart attacks and stroke, pretty depressing read for sure. But and it is a very big but ! all the participants had extremely poor HbA1c numbers. Are you getting the big picture ? Also the intensive control group were on a heavy duty medication regime, including drugs now banned for killing people. Check out what I wrote some months ago when this Look Ahead Trial was abandoned, for being a waste of time and a huge amount of money. The problem with far too many medics, is the fact that HbA1c makes all the difference in the world for a diabetic and staying complication free, the medics have yet to learn that fact.

Eddie

$220 million well spent ! Proves NHS,DUK,ADA dietary information for type two diabetics useless !

The most damning piece of information regarding diet for type two diabetics, I have ever read in four years of studying type two diabetes, was the complete failure of the Look Ahead Trial to improve CVD outcomes for type two diabetics. By using a modest reduction in weight and calorie reduction, the trial participants were on a 55% carb diet, the trial was doomed to fail from day one ! I am wading through a mass of information, but one thing stands out a mile, the pitiful reduction in HbA1c (see chart below). The participants had a top HbA1c of eleven at the start of the trial, higher numbers excluded from taking part. After 11 years of a 13 year trial it was deemed ‘futile’ to continue. No benefits in outcomes regarding CVD among the participants was found. Average HbA1c reduction 0.5% and the boffins expected an improvement in CVD, what planet are these people on !

With the correct diet it would be normal to see massive reductions in HbA1c and vastly improved blood glucose control. Huge reductions in obesity, far better lipid counts and huge reductions in medication used. This has been proved countless times by lowcarbing diabetics, and they didn’t need 11 years and $220 million to find out a way to improve CVD. The good news we see on blogs and forums all over the world, counts for nothing with outfits like the NHS,DUK and the ADA, they call the good news reported ‘anecdotal’ they much prefer to accept the information received from big pharma and junk food companies. The fact that many of these outfits have been fined $billions for lying, bribery and corruption and falsifying drug trial evidence matters not a jot. Why, because the people we should be able to trust have sold out, and put money before peoples health and wellbeing. We need far more people like Bernstein, Wortman, Taubes, Kendrick, Briffa et al. They have the courage to stick their heads above the parapet, and refuse to be lackeys and yes men to stupidity and greed.

Some HbA1c facts

For every percentage point drop in A1C blood test results (from 8.0 percent to 7.0 percent, for example), the risk of diabetic eye, nerve, and kidney disease is reduced by 40 percent. Lowering blood sugar reduces these microvascular complications in both type 1 and type 2 diabetes. Intensive blood sugar control in people with type 1 diabetes (average A1C of 7.4%) reduces the risk of any CVD event by 42 percent and the risk of heart attack, stroke, or death from CVD by 57 percent.

Source: DCCT/EDIC, reported in December 22, 2005, issue of the New England Journal of Medicine.

Hi folks, please spare a thought for the Medics, evidently they are 'perplexed' as to the best way to treat hyperglycaemia in type two diabetics. The truth is they are perplexed how to treat most conditions in type two diabetics. The $200 million plus Look Ahead Trial proved one thing without a shadow of a doubt. A reduced calorie diet with modest exercise done nothing for type two diabetic outcomes regarding CVD. It also proved the diet of death pushed by the NHS, DUK and ADA i.e. 55% carbs does no diabetic any favours. The other question I’m asking myself is what meds were involved ? Actos, Avandia etc. etc. One thing is for sure, type two diabetics on a 55% carb diet must have made med taking a full time job.

Well those good guys at the ADA wanted to ease the burden on these 'perplexed' Medics.

"As a consequence, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for antihyperglycemic therapy in nonpregnant adults with type 2 diabetes"

The Task Force, anyone smelling a rat ?

R.M. Bergenstal: membership of scientific advisory boards and consultation for or clinical research support with Abbott Diabetes Care, Amylin, Bayer, Becton Dickinson, Boehringer Ingelheim, Calibra, DexCom, Eli Lilly, Halozyme, Helmsley Trust, Hygieia, Johnson & Johnson, Medtronic, NIH, Novo Nordisk, Roche, Sanofi, and Takeda (all under contracts with his employer). Inherited stock in Merck (held by family)

J.B. Buse: research and consulting with Amylin Pharmaceuticals, Inc.; AstraZeneca; Biodel Inc.; Boehringer Ingelheim; Bristol-Myers Squibb Company; Diartis Pharmaceuticals, Inc.; Eli Lilly and Company; F. Hoffmann-La Roche Ltd; Halozyme Therapeutics; Johnson & Johnson; Medtronic MiniMed; Merck & Co., Inc.; Novo Nordisk; Pfizer Inc.; Sanofi; and TransPharma Medical Ltd (all under contracts with his employer)

M. Diamant: member of advisory boards of Abbott Diabetes Care, Eli Lilly, Merck Sharp & Dohme (MSD), Novo Nordisk, Poxel Pharma. Consultancy for: Astra-BMS, Sanofi. Speaker engagements: Eli Lilly, MSD, Novo Nordisk. Through Dr. Diamant, the VU University receives research grants from Amylin/Eli Lilly, MSE, Novo Nordisk, Sanofi (all under contracts with the Institutional Research Foundation)

E. Ferrannini: membership on scientific advisory boards or speaking engagements for: Merck Sharp & Dohme, Boehringer Ingelheim, GlaxoSmithKline, BMS/AstraZeneca, Eli Lilly & Co., Novartis, Sanofi. Research grant support from: Eli Lilly & Co. and Boehringer Ingelheim

S.E. Inzucchi: advisor/consultant to: Merck, Takeda, Boehringer Ingelheim. Research funding or supplies to Yale University: Eli Lilly, Takeda. Participation in medical educational projects, for which unrestricted funding from Amylin, Eli Lilly, Boehringer Ingelheim, Merck, Novo Nordisk, and Takeda was received by Yale University

D.R. Matthews: has received advisory board consulting fees or honoraria from Novo Nordisk, GlaxoSmithKline, Novartis, Eli Lilly, Johnson & Johnson, and Servier. He has research support from Johnson & Johnson and Merck Sharp & Dohme. He has lectured for Novo Nordisk, Servier, and Novartis

M. Nauck: has received research grants (to his institution) from AstraZeneca, Boehringer Ingelheim, Eli Lilly & Co., Merck Sharp & Dohme, Novartis Pharma, GlaxoSmithKline, Novo Nordisk, Roche, and Tolerx. He has received consulting and travel fees or honoraria for speaking from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Bristol-Myers Squibb, Diartis, Eli Lilly & Co., F. Hoffmann-La Roche Ltd, Intarcia Therapeutics, Merck Sharp & Dohme, Novo Nordisk, Sanofi-Aventis Pharma, and Versartis

A.L. Peters: has received lecturing fees and/or fees for ad hoc consulting from Amylin, Lilly, Novo Nordisk, Sanofi, Takeda, Boehringer Ingelheim

A. Tsapas: has received travel grant, educational grant, research grant and lecture fees from Merck Serono, Novo Nordisk, and Novartis, respectively.

Eddie

Diabetes: Doctors warn on amputation risk !

Scotland is in the grip of an obesity epidemic. The consequence of this is type-2 diabetes, a weight-related and life-threatening condition.

Almost a quarter of a million people in Scotland have it. Dr Gerald Spence has worked as a GP at Shettleston medical practice in Glasgow for more than 30 years. He says: "We've had an almost 50% increase in diabetics in the past five or six years in the practice."We've gone from about 250 to about 350 in the practice. "Now we are seeing it in younger and younger people. People in their 20s are coming in with symptoms and you think 'oh goodness me, that sounds like diabetes'."

The potential consequences of a diabetes diagnosis are stark - blindness, organ failure, heart disease and amputation. Ten years ago Ricky Callan, from Edinburgh, was a successful actor and comedian, often using his large size as material for his jokes. He was diagnosed with type-2 diabetes and an infected foot led to doctors having to operate. Ricky says that when the doctors told him they might have to amputate below the knee "it was like they were saying it in slow motion". "I could not take it in," he says. "I have lost half a leg. I have got three toes amputated on the other foot and I have had both eyes operated on. "I have recently had kidney failure and it just eats away at you. You feel like you are dying a slow death and that you are being pulled apart like an Action Man. "It is tortuous and painful and feels never ending - and it's my fault, my responsibility." Ricky is 52 and was diagnosed in his 30s.

But doctors are now diagnosing patients as young as 13.

More on this story here.

Eddie

Weight loss does not reduce heart, stroke woes in overweight Type 2 diabetics !

An intensive, lifestyle intervention focused on weight-loss does not reduce cardiovascular events in overweight or obese adults with Type 2 diabetes, according to the first reported results from the more-than-decade-long Look AHEAD trial conducted by University of Alabama at Birmingham (UAB) researchers and colleagues, and presented June 25, 2013 at the 73rd Scientific Sessions of the American Diabetes Association.

Researchers said the rates of cardiovascular death and complications were virtually equal among participants in the intensive, lifestyle-intervention program and participants who only received diabetes support and education.

“Short-term studies have shown that weight-loss in overweight and obese individuals with Type 2 diabetes had numerous benefits, including improvements in glycemic control, cardiovascular disease-risk factors, quality of life and other obesity-related complications,” said the study’s co-author Cora E. Lewis, M.D., professor in the UAB Division of Preventive Medicine and senior scientist in the UAB Comprehensive Diabetes Center. “Until now, however, there were no studies showing whether or not these effects held for the long term.”

Look AHEAD (Action for Health in Diabetes) was a randomized trial that followed overweight and obese individuals with Type 2 diabetes at 16 clinical sites for as many as 13-plus years. It compared the long-term effects of an intensive, lifestyle-intervention program of weight-loss and physical activity with a control program of diabetes support and education.

Between August 2001 and April 2004, a total 5145 participants were enrolled and randomly assigned to lifestyle intervention or support and education. The average age was 58.7 years, and 59 percent were women; half had diabetes for five years, and 14 percent reported a history of cardiovascular disease. On Sept. 14, 2012, Look AHEAD’s primary sponsors instructed study investigators to halt the intervention because enough data had been collected to conclude the difference between the two groups was very small; all data analyses extend to this date. When the intervention was stopped the average participant follow-up was 9.6 years.

In analyzing the data collected, researchers looked for cardiovascular death (including fatal heart attack and stroke), non-fatal heart attack, hospitalized angina and non-fatal stroke. The researchers also examined the effect of the intervention on cardiovascular disease risk factors, diabetes control and complications, general health, quality of life and psychological outcomes.

The intensive lifestyle intervention produced significantly greater changes than the diabetes support and education intervention in weight, waist circumference and fitness. Differences in average weight-loss were greatest at one year, with the intervention group losing 8.6 percent of their body weight versus 0.7 percent of body weight in the control group, but remained statistically significant throughout the trial.

During the first year of follow-up, intensive lifestyle intervention produced greater improvements than diabetes support and education in all measured cardiovascular risk factors except low-density lipoprotein (LDL) cholesterol. The difference in cardiovascular risk factors between intervention groups diminished over time, with hemoglobin A1c and systolic blood pressure showing the most sustained differences. LDL cholesterol levels were lower in the control group than the intervention group. Use of antihypertensive medications, statins and insulin was lower in the intervention group than in the control group, so the intensive group had at least as good, if not better, control of risk factors and diabetes with less medication.

However, the primary outcome of the first occurrence of hospitalized angina, nonfatal heart attack, nonfatal stroke, or death from cardiovascular causes occurred in 821 participants — 403 in the intensive lifestyle intervention group and 418 in the diabetes support and education group. There also were no significant differences between the two trial groups with respect to the pre-specified composite secondary outcomes, including various combinations of heart attack, stroke, and death due to cardiovascular disease.

Lewis said this does not mean overweight or obese Type 2 diabetics should not try to lose weight.

“Strictly speaking, the study was designed to test differences in cardiovascular outcomes, including heart attack and stroke, and none was found. So, if you were only considering that, the answer would be in the long run, there was not an advantage of losing weight,” Lewis said. “However, I would not say that there was absolutely no benefit to the weight-loss and increased physical activity achieved by the intensive intervention group. There were other benefits — better control of diabetes and of risk factors such as cholesterol with less medication and cost; less depression and better quality of life, etc. We also know from several diabetes prevention trials that weight loss through programs very similar to the Look AHEAD intensive lifestyle intervention has a powerful effect on preventing Type 2 diabetes in people with pre-diabetes.”

Lewis added that individuals in the intervention group of Look AHEAD were more likely to experience partial diabetes remission during the first four years of the trial. Other benefits identified during the early years of the trial included improvements in urinary incontinence, sleep apnea, depression, quality of life, physical function and mobility.

“Even though the intensive lifestyle intervention did not reduce the risk of cardiovascular death or complications, there still are positive outcomes we can take from the study,” she said.

The study was sponsored by the National Institutes of Health with additional support from other federal partners and the clinical research centers of several participating institutions. Major contributions were provided by the UAB Diabetes Research and Training Center; FedEx Corp.; Health Management Resources; LifeScan Inc., a Johnson & Johnson Company; Nestle HealthCare Nutrition Inc.; Hoffmann-La Roche Inc.; Abbott Nutrition; and Unilever North America. None of the corporate sponsors had any role in the trial design, data analysis or reporting of results.

http://www.uab.edu/news/latest/item/3565-weight-loss-does-not-reduce-heart-stroke-woes-in-overweight-type-2-diabetics

Graham

New weight-loss drug available !

Nearly a year after receiving approval from the U.S. Food and Drug Administration, a new obesity drug will be available to certain patients by prescription, starting Tuesday. The FDA approved Belviq, an oral medication, in June 2012. The delay in availability was in part because the Drug Enforcement Administration needed to review the drug. People with a body mass index of more than 30 or a BMI of 27 with at least one weight-related condition, such as hypertension or Type 2 diabetes, are eligible for a prescription. Belviq, as the FDA pointed out in its statement announcing approval last year, is intended "as an addition to a reduced-calorie diet and exercise."

Belviq, or lorcaserin hydrochloride, works by activating a serotonin receptor in the brain, which may help a person eat less and feel full after eating smaller amounts of food, according to the FDA. Belviq received approval about the same time as another weight-loss pill, Qsymia, which hit the market in September.

The Golden Gezza Award Unveiled !

One of the diabetes worlds most closely guarded secrets was unveiled today at the monthly board meeting of the Wallycorker foundation and lowcarb diabetic blog trustees. Co-designed by Lord Beantipper and Roger ‘Keto Warrior’ Jenkins and cast in solid 24ct.gold The Golden Gezza was universally accepted as a masterpiece. Both men refused to comment on rumours Beantipper’s member had been used to make the mold.

This prize will only be awarded to diabetics who have made a monumental discovery in the control of diabetes. Only diabetics that consume eye-watering quantities of carbohydrates on zero diabetic medication and hold non diabetic numbers will be considered. The Golden Gezza will be the highest prize awarded by the Lowcarb diabetic blog trustees. The award also carries a $1,000,000 cash prize. At the meeting Lord Beantipper stated “ The first winner of this new award will have to have unbelievable control to be considered worthy of The Golden Gezza” Monty went on to say “at the present time only one type two diabetic in the world appears to have the credentials, but with so much money and glory awaiting the winner others are bound to come forward”

The Sun

ADA: Intensive Tx Yields Long-Term Gain in Type 1 Diabetes !

CHICAGO -- Benefits seen with intensive therapy for type 1 diabetes in a large epidemiological study persist through extended follow-up, according to the latest data from the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) trial.

Over 18 years, patients who had intensive management -- hitting a glycated hemoglobin (HbA1c) target of 7% -- had a 46% lower risk of retinopathy, a 39% reduced risk of microalbuminuria, and a 61% lower risk of macroalbuminuria (P<0.0001 for all), several investigators involved in the trial reported during a special symposium at the American Diabetes Association (ADA) meeting here.

"As we follow this population longer, we've been able to show that early benefits with regard to early complications has extended," study co-chair David Nathan, MD, of Massachusetts General Hospital (MGH) in Boston, told MedPage Today. "We've demonstrated that loss of kidney function is reduced, people develop less severe eye complications, and we see a host of other benefits on long-term severe complications that we didn't see during the initial trial because the patients were too young and had diabetes for a relatively short period of time."

The 10-year DCCT was followed by the ongoing EDIC trial, and has now been running for a total of 30 years.

The DCCT revealed that intensive therapy -- lowering HbA1c to 7% rather than the 9% which was standard practice at the time -- in patients with type 1 diabetes diminished a range of complications about 35% to 75%, establishing intensive therapy as the standard of care.

The trial was extended into EDIC and Judith Fradkin, MD, director of diabetes at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) said during a press briefing that 95% of trial patients who are still alive continue to participate in the trial.

At the meeting, several researchers presented updated data on complications including retinopathy, nephropathy, and musculoskeletal complications.

Lloyd Paul Aiello, MD, PhD, of the Joslin Diabetes Center at Harvard Medical School, reported a 46% reduced risk of retinopathy after 18 years of follow-up in the EDIC study with intensive therapy compared with the standard of care (P<0.0001).

He noted that 86.7% of that risk reduction was explained by between-group differences in HbA1c levels.

Aiello also reported a reduction in severe diabetic retinopathy with intensive management, with a 47% reduced risk of proliferative diabetic retinopathy and a 35% reduced risk of clinically significant macular edema (P<0.0001 for both).

During the 18 years of EDIC follow-up, the researchers also saw a 39% lower risk of focal laser therapy and a 48% lower risk of any ocular surgery (P<0.0001).

"Further EDIC follow-up has demonstrated a consistent beneficial effect on severe eye disease," Aiello said. "Although the risk reduction has decreased with time, the effect is still substantial."

Ian de Boer, MD, of the University of Washington in Seattle, reported nephropathy findings that pointed to a "continued separation of microvascular and macrovascular complications" over 18 years of EDIC data.

Specifically, the researchers saw a 39% reduced risk of microalbuminuria and a 61% reduced risk of macroalbuminuria with intensive therapy through that time (P<0.0001 for both).

Once again, the vast majority of risk reduction -- between 91% and 100% -- was explained differences in HbA1c levels, de Boer said.

Earlier analyses that had been previously reported also showed that intensive therapy delayed the development of hypertension and preserved estimated glomerular filtration rate (eGFR), he added.

"The kidney findings speak volumes about the long-term benefits of intensive therapy," de Boer said during a press briefing. "It's demonstrated that intensive therapy can have a sustained, long-term impact on mini manifestations of this microvascular and macrovascular disease."

The researchers also reported new data on musculoskeletal complications, particularly cheiroarthropathy, which is periarticular skin thickening of the hands and limited joint mobility. It typically results from the accumulation of advanced glycation end-products in collagen, and includes carpal tunnel syndrome, adhesive capsulitis, Dupuytren's contracture, flexor tenosynovitis (or "trigger finger"), and prayer sign (or trouble holding the hands flat when palm-to-palm).

Mary Larkin, RN, of MGH, and colleagues conducted a cross-sectional analysis of EDIC data during years 18 and 19.

They found that a third of of about 1,200 patients (33%) had at least one type of this complication, with the most common being adhesive capsulitis, followed by carpal tunnel and then prayer sign.

Another 20% of patients had at least two complications, and another 10% had at least three, Larkin said. About 3% had four or more complications.

Only 34% were free of these complications, Larkin reported.

Risk factors for these conditions included older age, female gender, longer duration of disease, and higher HbA1c over time. It was also associated with neuropathy and retinopathy, but not with nephropathy, she reported.

"Cheiroarthropathy represents an important constellation of long-term complications worthy of further clinical and research attention," Larkin said. "Surveillance of musculoskeletal disorders should be considered in routine care of patients with type 1 diabetes."

Nathan said these conditions may have been under-recognized in type 1 diabetes in the past.

John Lachin, MD, of George Washington University in Washington, D.C., said longer term EDIC data also show a reduced risk of cardiovascular effects with intensive management, as well as cardiovascular mortality -- a finding that somewhat departs from recent findings in type 2 diabetes.

"This is a little different from type 2 diabetes, where there's been a question as to whether intensive therapy is important or not," Nathan told MedPage Today.

Lachin said the mortality data are in press and therefore embargoed and could not be released at the time of his ADA presentation.

But he noted that, as with other complications, the long-term benefits of intensive therapy on cardiovascular outcomes are largely mediated by HbA1c levels.

The study was supported by the NIDDK.

The researchers reported no conflicts of interest.

Primary source: American Diabetes Association
Source reference:
Nathan DM, et al "DCCT/EDIC 30th anniversary symposium -- contributions and progress" ADA 2013.

http://www.medpagetoday.com/MeetingCoverage/ADA/40047

Graham