Home > Weekly Newsletters > Diabetes

WEDNESDAY, Sept. 10 (HealthDay News) -- Type 2 diabetics who tightly control their blood sugar levels early, even if only for the first 10 years after diagnosis, have reduced risk of heart attack, death and other complications a decade or more later, British researchers report.

The same cannot be said for type 2 diabetics who control their blood pressure for five years after diagnosis, however. The benefits from blood pressure control are only maintained as long as antihypertensive treatment is maintained, the same group of British researchers found.

"It is real encouraging to know that a prolonged period of good [blood sugar] control followed by a prolonged period of mediocre control, can still have good effect on our health," said Dr. Ping H. Wang, professor of medicine and director of the Center for Diabetes Research & Treatment at the University of California, Irvine.

"Humans are not perfect, it is quite often that diabetic patients go through periods of good control and not-so-good control," noted Wang, who was not involved in the studies. "Now, I can go back to my clinic and tell my patients that even though they are not perfect, the good control they have achieved will have long-lasting effect."

Both of the new studies were published in the Sept. 9 online edition of the New England Journal of Medicine. The findings were also expected to be presented Wednesday at the European Association for the Study of Diabetes, in Rome.

The trial, called The United Kingdom Prospective Diabetes Study (UKPDS), "showed continuing benefit of earlier improved glucose control," said lead researcher Rury Holman, a professor of diabetic medicine and director of the Diabetes Trials Unit at the University of Oxford.

For the first study, more than 4,200 patients with type 2 diabetes were randomly assigned to either a restricted diet aimed at improving blood sugar or to intensive blood sugar control with medicines such as insulin or metformin. The patients were followed for an average of about 10 years. Then, for 5 years after the trial ended, patients were asked to check in at clinics annually, but they were no longer mandated to follow any particular blood sugar-lowering treatment.

Holman's team found that, overall, patients who had initially received intensive blood sugar control with metformin during the 10 years of the trial had a 21 percent reduction in microvascular disease, heart attack, and all-cause mortality during the post-trial 5-year period -- when many had adopted less stringent blood sugar control. In fact, these patients reduced their long-term risk of heart attack by 33 percent, the team found. Their overall risk of death was also reduced by 27 percent, compared to patients who had not entered into medicinal blood sugar control during the trial.

"There was no significant change during or after the trial with respect to microvascular disease," Holman added. However, among patients receiving insulin, there was a 24 percent reduction in microvascular disease.

The bottom line: Strict control of blood sugar appears to have healthful effects that last long after such strategies end, the team found.

Would similar results arise for the control of blood pressure? In their second study, Holman's team randomly assigned more than 1,100 type 2 diabetics with high blood pressure to tight or moderate blood pressure control regimens for a four-year period. After that initial phase, the participants were asked to check in with doctors at annual clinics, but no attempt was made by the researchers to maintain each patient's assigned treatment.

The result: Any difference in blood pressure between the two groups (tight or moderate blood pressure control) disappeared two years after the trial ended, and patients lapsed back into less-than-optimum blood pressure control.

"Any diabetes-related endpoint -- such as diabetes-related death or stroke and microvascular disease -- were not maintained following the loss of within-trial blood pressure and antihypertensive therapy differences," Holman said. "No significant changes were seen during or after the trial with respect to [heart attack] or all-cause mortality," he said.

This leads Holman to believe that control of blood sugar, rather than blood pressure, may be the most effective way to help diabetics over the long-term, in terms of reducing diabetes-linked complications.

"The full benefit of blood pressure lowering was achieved during the trial, but for glucose, the benefits persisted and increased with time in the intensively treated group, even though glucose levels no longer differed with respect to the conventional group," Holman said. "This suggests that early glucose-lowering treatment brings greater benefits than starting later in the course of the disease, reducing not only micro but also macrovascular risks."

Wang agreed.

"Both blood sugar and blood pressure are important for diabetic complications, including heart diseases," he stressed. "However, the effect of blood sugar and blood pressure behave differently. Blood sugar [control] has a long-lasting effect, even after 10 years."

More information

For more on diabetes, visit the American Diabetes Association  .

MONDAY, Aug. 25 (HealthDay News) -- Low or high levels of LDL cholesterol are associated with an increased risk of cancer in patients with type 2 diabetes, according to a Chinese study that noted the increasing evidence of an association between type 2 diabetes and cancer risk.

The study included 6,107 diabetes patients. None of the patients were taking cholesterol-lowering statins.

The researchers found that LDL levels below 2.80 mmol/L were associated with an increased risk of cancers of the digestive organs and peritoneum, genital and urinary organs, and lymphatic and blood tissues. LDL levels above 3.80 mmol/L were associated with increased risk of oral, digestive, bone, skin, connective tissue and breast cancers.

The findings suggest "the use of these levels as risk markers may help clinicians to assess their patients more fully and thus to prevent premature deaths in patients who have high risk," wrote the team from the Hong Kong Institute of Diabetes and Obesity, the Li Ka Shing Institute of Health Sciences and The Chinese University of Hong Kong.

The study was published in the Canadian Medical Association Journal.

The researchers recommended a re-analysis of data from clinical trials to confirm or refute their findings.

Confounding factors such as lifestyle, socioeconomic status and indication for use of statins need to be considered when examining the association between LDL levels and cancer risk, Drs. Frank Hu and Eric Ding of the Harvard School of Public Health, wrote in an accompanying commentary.

"Low serum cholesterol is commonly observed in individuals with ill health (e.g., cancer patients) and those with unhealthy lifestyle characteristics such as smoking and heavy drinking," they noted.

More information

The U.S. Centers for Disease Control and Prevention has more about diabetes.

TUESDAY, July 8 (HealthDay News) -- The current childhood obesity epidemic in the United States may lead to large numbers of young adults developing type 2 diabetes in the future, along with serious diabetes-related health complications, warns a University of Michigan researcher.

"The full impact of the childhood obesity epidemic has yet to be seen, because it can take up to 10 years or longer for obese individuals to develop type 2 diabetes. Children who are obese today are more likely to develop type 2 diabetes as young adults," Dr. Joyce Lee, a pediatric endocrinologist at the university's C.S. Mott Children's Hospital, said in a prepared statement.

The longer a person has diabetes, the more likely he or she is to develop serious complications such as kidney failure and blindness, Lee noted. That means that young adults with type 2 diabetes are much more likely to develop such complications during their lifetime than older people with the disease. She added that babies born to young women with type 2 diabetes are at greater risk for obesity and type 2 diabetes.

"Recent studies suggest that there have been dramatic increases in type 2 diabetes among individuals in their 20s and 30s, whereas it used to be that individuals developed type 2 diabetes in their late 50s or 60s. This may be the first indication of a type 2 diabetes epidemic among young adults who were obese during childhood," Lee said.

More needs to be done to fight childhood obesity, she urged in an article in the July issue of the journal Archives of Pediatric & Adolescent Medicine.

"Our society heavily invests in the treatment and management of chronic diseases like type 2 diabetes for adults. But it spends very little for the prevention and treatment of childhood obesity to stave off the onset of type 2 diabetes," Lee said.

"If there isn't a significant investment in obesity prevention and treatment during childhood within schools, communities, and the health care system, recent trends in childhood obesity will likely lead to increases in type 2 diabetes among young adults, resulting in even greater costs to society and the health care system."

Toward that end, the American Academy of Pediatrics (AAP) on Monday issued new cholesterol screening and treatment recommendations for children, including prescribing cholesterol-reducing drugs known as statins for some 8-year-olds.

The group also urged screening for young patients whose family history is unknown or those who have other heart disease risk factors including obesity, high blood pressure or diabetes. Screening, the AAP said, should take place after age 2, but no later than age 10.

More information

The Nemours Foundation has more about overweight and obese children  .