Diabetes Archive

More than 18,000 clinical trials are underway right now in the United States, covering nearly every aspect of health and disease. Harvard Heart Letter editor P.J. Skerrett describes his experience as a volunteer in a clinical trial called TINSAL-T2D at the Joslin Diabetes Center in Boston.

Q. I am a 72-year-old with diabetes, and I need to have a hip replaced. Does my diabetes make this surgery too dangerous for my heart?

A. While people with diabetes have a generally higher risk of cardiac problems than those without this condition, the increase in risk for cardiac complications with major surgery is quite low — and there may be no increase at all with good care. People with diabetes have higher rates of atherosclerosis, of course, and if you've already had a heart attack or kidney problems, those risk factors do increase your risk of heart problems with surgery. But after taking those factors into account, diabetes is not clearly linked to short-term complications with surgery.

Exercise is one of the best all-around treatments for diabetes, a condition that often accompanies heart disease. Here's an interesting question: if you have only a limited amount of time each week for exercise, should you spend it all on aerobic exercise (like walking or swimming), strength training (like weight lifting), or a combination of the two?

Do both, say researchers with the Pennington Biomedical Research Center in Baton Rouge. They looked at changes in blood sugar — a key health measure for people with diabetes — during a nine-month exercise trial. All of the volunteers exercised for about 140 minutes a week. Compared with a control group of non-exercisers, those who combined aerobic exercise with strength training had the biggest decrease in hemoglobin A1c, a measure of average blood sugar over the preceding two to three months. Hemoglobin A1c fell significantly less in volunteers who did only aerobic exercise or only strength training (Journal of the American Medical Association, Nov. 24, 2010).

A large new study links drinking sugar-sweetened sodas and juices with higher blood pressure and extra pounds. The results are in line with earlier studies, and with some clinical trials, showing that daily consumption of sugar-sweetened beverages isn’t so good for the body.

It's no secret that overweight and obesity are big problems in the United States. At present, two-thirds of all Americans need to lose weight, and the number of overweight children and adults is growing at an alarming rate.

And it's no secret that obesity is bad for health. Excess body fat raises levels of LDL ("bad") cholesterol and triglycerides while also lowering HDL ("good") cholesterol levels. Obesity impairs the body's responsiveness to insulin, raising blood sugar and insulin levels. But obesity does more than produce bad numbers: it also leads to bad health, increasing the risk of heart attack, stroke, hypertension, diabetes, gallstones, cancer, osteoarthritis, obstructive sleep apnea, fatty liver, and depression. All in all, obesity is a killer; in fact, obesity and lack of exercise are responsible for about 1,000 American deaths each day, and if present trends continue, they will soon overtake smoking as the leading preventable causes of death in the U.S.

Health problems, or treatments for them, sometimes thwart sexual desire and sexual function. There may not be a quick fix for health-related sexual problems, but there are things you can do to enjoy your love life while taking care of the rest of your health.

Diabetes is an ancient disease, but the first effective drug therapy was not available until 1922, when insulin revolutionized the management of the disorder. Insulin is administered by injection, but treatment took another great leap forward in 1956, when the first oral diabetic drug was introduced. Since then, dozens of new medications have been developed, but scientists are still learning how best to use them. And new studies are prompting doctors to re-examine a fundamental therapeutic question: what level of blood sugar is best?

Normal metabolism

To understand diabetes, you should first understand how your body handles glucose, the sugar that fuels your metabolism. After you eat, your digestive tract breaks down carbohydrates into simple sugars that are small enough to be absorbed into your bloodstream. Glucose is far and away the most important of these sugars, and it's an indispensable source of energy for your body's cells. But to provide that energy, it must travel from your blood into your cells.

Q. Because of the recent news about Avandia, my physician has advised me to stop taking it. Is that wise?

A. It's a good idea for all patients with diabetes to keep their blood sugar levels under control, and there's no doubt that Avandia (the generic name is rosiglitazone) is effective in lowering blood sugar. However, in September 2010, the FDA advised people to stop taking the drug unless they couldn't lower their blood sugar with any other treatment. The FDA stated that, while not conclusive, there was considerable evidence that Avandia increased the risk for heart disease and stroke, and of death from these and other cardiovascular conditions. At about the same time, the European Medicines Agency (the European equivalent of the FDA) recommended that all use of the drug be stopped. So your doctor has good cause to be concerned about you taking Avandia.

The increase in obesity and type 2 diabetes among Americans has led to an increase in fatty liver disease. Weight loss and exercise are the mainstays of treatment.

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