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Glucose Testing of Blood Samples from Alternative Sites- State of Affairs. Diabetes Technology & Therapeutics. 7(4): 609-611. August 2005.

Manufacturers have been looking for blood glucose meters that can use alternate site testing (AST) to reduce the lancing pain associated with self-monitoring of blood glucose (SMG), an important part of diabetes self-care. This commentary considers the current developments in glucose testing of blood samples from alternate sites. Alternate sites include the lower arm, upper arm, thigh, calf, and palm of the hand. The author describes the Food and Drug Administration guidelines for SMBG and AST. For those SMBG monitors and alternate sites where data indicated a lag in glucose levels, manufacturers agreed to include cautionary language that would limit AST to times when glucose concentrations are more stable. During periods of rapid change, the recommendation was to test samples from the fingertip or from the palm of the hand as they reflect the glycemic status more accurately. The commentary author briefly reports on a recent study (Clarke et al, 2005) that compared the Softsense and Optium meters (both from MediSense Products, Whitney, UK). The Softsense meter is used on less sensitive body sites and combines lancing with testing. Women with GDM found the Softsense less painful and easier to use; at the end of the study, 25 chose the Softsense meter over the Optium meter for further testing. The women with pre-existing diabetes found the Optium significantly less messy, less disruptive, and easier to use outside the home (primarily because of the bulkiness of the Softsense meter). The commentary author concludes that measuring glucose in blood samples from sites other than the finger is now quite a prevalent practice that is appealing to many patients. AST is definitely aiding in the introduction of blood glucose testing to newly diagnosed individuals who have many other disease management issues to deal with and who are quite apprehensive about the pain and discomfort associated with glucose testing. 14 references.

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Glycemic Status and Development of Kidney Disease. Diabetes Care. 28(10): 2436-2440. October 2005.

Diabetes mellitus is a major risk factor for the development of kidney disease. This article reports on a study undertaken to determine if pre-diabetes status is also associated with the development of kidney disease. The study included subjects free of chronic kidney disease (CKD) from the Framingham Heart Study offspring cohort (1991-1995) and included follow up for an average of 7 years. Of the 2,398 subjects (53 percent women, mean age 54 years), 63 percent were had normal blood glucose levels, 29 percent had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), 3.4 percent were newly diagnosed with diabetes, and 4.6 percent had known diabetes. The fully adjusted odds of developing CKD were 0.98 for those with IFG or IGT, 1.71 for those with newly diagnosed diabetes, and 1.93 for those with known diabetes, compared with those who were normoglycemic at baseline. Among participants without diabetes, metabolic syndrome was not associated with kidney disease at follow up. The authors conclude that cardiovascular disease risk factors explain much of the relationship between prediabetes and the development of CKD. The data suggest that CKD in the setting of prediabetes might be thought of as an additional complication of macrovascular atherosclerosis. 1 figure. 2 tables. 32 references.

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Help Your Child Manage Diabetes: A Parent's Handbook. South Deerfield, MA: Channing Bete Company. 2005. 31 p.

This booklet is designed to help parents of a child newly diagnosed with diabetes understand the basics of caring for a child with diabetes. The booklet covers a description of diabetes, its causes and symptoms; the role of support and emotional health; a plan for diabetes management; blood glucose monitoring; general health approaches, including nutrition and physical activity; diabetes medications, including insulin and its administration and the role of diabetes pills; hypoglycemia and hyperglycemia; diabetes care in the school setting; foot care; and other safety tips. A summary page reminds parents to test the child?s blood glucose, follow a healthy meal plan, encourage the child to be physically active, make sure the child takes all medications, keep good records, and involve the whole family in eating better and staying healthy. The booklet includes a food and medications care chart, a list of resources, a wallet card for the child to carry, and plenty of blank space for individualizing recommendations and management strategies for the child and his or her family. The brochure is illustrated with black-and-white photographs of children and their families, as well as figures and charts designed to increase understanding of the material presented. 5 figures. 2 tables.

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Managing Diabetes Your Way Workbook: Living with Type 2 Diabetes. Berkeley, CA: Ulysses Press. 2005. 164 p.

This book is designed to help readers newly-diagnosed with Type 2 diabetes understand how to monitor, track, and gain control of their disease. The book includes eleven chapters: an introduction with a brief explanation of diabetes; the role of team participation and team health care; understanding blood glucose results; medications for diabetes; diabetes and weight control; developing a food plan; the role of exercise; psychosocial factors; diabetes and cardiovascular (heart) considerations; working with the health care team to minimize complications; and sharing diabetes with others in one's family, friends, and workplace. The author includes four sections in each chapter, each marked with a graphic for ease of understanding: illumination, the facts one needs to know, without medical jargon; contemplation, understanding what those facts mean to one's health; application, the steps necessary to put a plan into action; and evaluation, or ways to track one's progress. The author emphasizes how factors such as diet and stress can produce unhealthy changes in the blood glucose and why simple steps such as proper exercise can have very positive results. The book includes blank charts and worksheets for readers to individualize their goals and progress. The book concludes with an annotated list of resources for implementing a diabetes plan, information about the references used to compile the book, an appendix of additional worksheets, and an author biography.

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Prevalence and Incidence of Diabetes in HIV-Infected Minority Patients on Protease Inhibitors. Journal of the National Medical Association. 97(8): 1088-1092 p. August 2005.

This article reports on a study of the prevalence and incidence of diabetes in minority patients infected with HIV on protease inhibitors (PIs). In people infected with HIV the use of protease inhibitors is associated with a constellation of abdominal obesity; buffalo hump; decreased facial and subcutaneous fat; hyperlipidemia and type 2 diabetes mellitus, a so-called HAART-associated dysmetabolic syndrome. The authors reviewed 101 charts of people infected with HIV who visited an inner-city HIV outpatient clinic. Three years later (2002) the same patient charts were reviewed for evidence of new-onset diabetes. Ten percent of the subjects were identified as having diabetes at baseline. The prevalence of diabetes was 12 percent among those who were taking PIs, compared to 0 percent among those who were not taking PIs. The incidence of newly diagnosed diabetes during this 3-year period was 7.2 percent. Diabetes occurred only in the group taking PIs. 2 tables. 21 references.

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Taking Control of Your Diabetes. Clearwater, FL: CCS Medical. 2005. 52 p.

This booklet is designed to help readers who are newly diagnosed with type 2 diabetes understand and manage their disease. The booklet is also helpful for readers who havehad diabetes for a while and who may have experienced a change in health that requires a new treatment strategy. The booklet first reviews the types of diabetes and general signs and symptoms of the disease. Then it discusses diabetes care management in detail, covering meal planning, counting carbohydrates, the use of exchange lists, food labels, snack ideas, the importance of portion control, the use of sweeteners, dietetic foods, cholesterol, sodium, alcohol, dietary fiber, eating out at restaurants, weight control, exercise, insulin, oral medications, other medications, testing for control (including self-monitoring of blood glucose, or SMBG), low blood glucose (hypoglycemia), high blood glucose (hyperglycemia), testing for ketones, care during illness (sick-day management), complications, and the psychosocial impact of living with diabetes. Readers are encouraged to share the booklet with friends and family so they, too, can understand diabetes and how it can be managed. The booklet is illustrated with line drawings and tables that clarify the material presented. 14 figures. 7 tables.

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The Adventures of Captain Glucose and Meter Boy.

This instructional two-minute Public Service Announcement (PSA) on DVD features two live action comedic superheroes with no real superpowers. Their mission statement is to ‘Educate, Enlighten, and Entertain people with diabetes of all ages.’ Captain Glucose has Type 2 Diabetes as does the actor who plays him, Bill Kirchenbauer. Meter Boy, his sidekick, has Type 1 Diabetes, as does the actor who plays him, Brad Slaight. The diabetes superheroes are called upon by the "Commissioner of Diabetes" (played by Alan Thicke) to help educate people who are newly diagnosed with diabetes. When someone is first diagnosed with diabetes they are usually confused and overwhelmed with the news. This video can provide people who are newly diagnosed with diabetes with some basic information about what diabetes is and how to deal with it. Topics include the symptoms of diabetes, the importance of exercise in a comprehensive program of diabetes care, and the numbers of people in the United States with diabetes (including those who are undiagnosed). The PSA concludes with the web site for getting more information about this educational program (www.captainglucoseandmeterboy.com).

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Wizdom: A Kit of Wit and Wisdom for Kids with Diabetes (and Their Parents) Alexandria, VA: American Diabetes Association. 2005.

This kit contains two books, juggling balls, and a pen. The book, Wizdom: For Kids Only, is introduced by two teenagers with diabetes, helps kids newly diagnosed with type 1 diabetes understand some of the basics of diabetes management. The first chapter introduces the characters of Amazing Audrey and AJ; Audrey is a diabetes wizard and AJ is newly diagnosed with diabetes and given the task of being a wizard apprentice. The remaining 14 chapters follow these two characters as they cover a definition of diabetes, the juggling act of diabetes care, insulin and how to administer it, food habits and nutrition, carbohydrate counting, food labeling, exercise, blood glucose self-monitoring (SMBG), hypoglycemia (low blood glucose levels), hyperglycemia (high blood glucose levels), the emotional impact of diabetes, coping with depression, talking about diabetes, school and diabetes care, discrimination and patient rights, coping with sick days, the members of the diabetes care team, and resources where readers can find additional information. Throughout the book are definitions of medical terms, colorful illustrations, lift-the-flap diagrams, and quick quizzes on the material covered. The book also includes a spinner that helps readers understand the meaning of different blood glucose levels, a set of four laminated recipe cards, and a page of colorful stickers depicting Audrey and AJ in their magician's clothes. The book is spiral-bound. 10 references. The second book, Wizdom: For Parents Only is introduced by the parent of a child with diabetes and a physician who works with children with diabetes and helps the parents of kids newly diagnosed with type 1 diabetes understand some of the basics of diabetes management. After an introductory chapter that defines diabetes and its symptoms, the book includes 14 chapters that cover the juggling act of diabetes care, insulin and how to administer it, food habits and nutrition, carbohydrate counting, food labeling, exercise, blood glucose self-monitoring (SMBG), hypoglycemia (low blood glucose levels), hyperglycemia (high blood glucose levels), the emotional impact of diabetes, coping with depression, talking about diabetes, parenting and family life, school and diabetes care, discrimination and patient rights, coping with sick days, the members of the diabetes care team, handling special occasions, specific concerns about teens and diabetes, and resources where readers can find additional information. Throughout the spiral bound book are definitions of medical terms and colorful illustrations. 43 references.

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Albuminuria is Evident in the Early Stages of Diabetes Onset: Results from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). American Journal of Kidney Diseases. 44(5): 792-798. November 2004.

Albuminuria (protein in the urine) is a common complication of diabetes and a leading cause of end-stage renal disease. This article reports on a study of the prevalence of and factors associated with albuminuria in an Australian population. The authors also examined the association of albuminuria with glucose tolerance. The Australian Diabetes, Obesity, and Lifestyle Study included 11,247 adults aged 25 years and older from 42 randomly selected areas of Australia. Microalbuminuria is defined as an albumin-creatinine ratio of 22 to 220 milligram per gram in men and 31 to 220 milligrams per gram in women; macroalbuminuria is defined as an albumin-creatinine ratio of 220 milligrams per gram or greater. Overall, 25.3 percent of patients with diabetes mellitus (both known [KDM] and newly diagnosed [NDM], Type 1 and Type 2) had evidence of albuminuria (21.0 percent, microalbuminuria; 4.3 percent, macroalbuminuria). Prevalence increased with increasing glycemia. Patients with diabetes (KDM and NDM) and impaired fasting glucose (IFG) had an increased risk for albuminuria compared with those with normal glucose tolerance, independent of age, sex, and other known risk factors for albuminuria. Analyses identified age, duration of diabetes, systolic blood pressure, current smoking, body mass index, and glycated hemoglobin level (a measure of blood glucose over time) as independent risk factors for albuminuria. The authors conclude that albuminuria is common among patients with established diabetes, is present before the onset of diabetes, and becomes more prevalent with worsening glucose tolerance. 1 figure. 4 tables. 31 references.

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Diabetes Screening in Children: When and How. Consultant. 44(13): 1609-1610. November 2004.

This article considers guidelines for screening in children from families where either Type 1 or Type 2 diabetes are already present. The authors discuss the two types of diabetes separately, contending that there are completely different issues at stake. In children with a strong family history of Type 1 diabetes, primary autoantibody screening is recommended to identify those who are at risk. Readers are reminded, however, that 85 percent of children with newly diagnosed Type 1 diabetes have no family history of the disease. They stress that for children in the general population, the newer strategy of primary genetic (HLA) screening at birth, followed by antibody screening in a research setting for those identified as high risk, makes more sense. The main determinants of Type 2 diabetes risk remain the triad of poor diet, insufficient exercise, and obesity. In children who are obese, who have physical evidence of insulin resistance (such as acanthosis nigricans), or who have a strong family history of Type 2 diabetes, screening for prediabetes and the metabolic syndrome is clearly indicated. The authors conclude that lifestyle changes that encourage weight loss and exercise are the most effective way to avoid the eventual development of diabetes in these children. However, early use of metformin can also help delay the onset of diabetes in children with impaired glucose tolerance. 1 reference.

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