Archive for the ‘Diabetes’ Category

NATURAL HISTORY OF TYPE 1 DIABETES: EFFECT OF INTENSIVE MANAGEMENT – WEIGHT

Tuesday, May 3rd, 2011
In the DCCT, intensively treated patients gained an average of 4.75 kg more than conventionally treated patients (p < 0.0001 ). This finding represented an excessive increase in BMI of 1.5 kg/m2 in men and 1.8 kg/m2 in women. Weight gain was most rapid in the first year of therapy. By year 9 of the study, BMIs had increased >5 kg/m2 in 35% of women and 28% of men, whereas comparable figures in the conventionally treated women and men were approximately 13% and 4%.
Waist-to-hip ratio did not differ between treatment groups. However, intensively treated DCCT subjects who were in the highest quartile of weight gain had increased waist-hip ratios and BMIs, associated with a slightly higher blood pressure and a relatively atherogenic lipid profile. These patients may be predisposed to the insulin resistance syndrome, and their tendency for abdominal obesity may have been exposed by intensive insulin therapy. Long-term follow-up of these patients in EDIC will be of great interest.
Among patients without major weight gain, those on intensive therapy had a greater fat-free mass with no difference in adiposity. Although the benefits of intensive management on microvascular complications in type 1 diabetes are clear, improved understanding of the causes of weight gain and methods to control it are needed.
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RISKS OF TYPE 2 DIABETES

Sunday, March 6th, 2011
The risks of type 2 diabetes are well documented; coronary heart disease, dyslipidaemia, blindness, renal failure, amputation and so on. Failing to diagnose the condition, and thus missing the opportunity to prevent the sequelae, is a costly error and an illustration that obesity must not be ignored; 10% of NHS resources are spent on diabetes and its complications, on behalf of only 3% of the population. WHO fact sheet 138 describes diabetes as the most important consequence of obesity. There are currently estimated to be over 150 million cases worldwide, a number that is likely to double by 2025.
One of the most disturbing aspects of the increasing numbers of people with type 2 diabetes is the fact that adult-onset diabetes is now being seen in children as young as 10. Until recently, type 2 diabetes was unknown in children – it was usually restricted to adults over the age of 40. However, because of the increasing levels of childhood obesity it is now being seen in grossly obese children (weighing 20 stone or more). Although the phenomenon was initially reported in the US, the first cases of childhood-onset type 2 diabetes are being seen in the UK. Children such as these have a whole lifetime in which to develop the complications of diabetes, not to mention the comorbidities of obesity itself. Their shortened life expectancy has made some commentators believe that the current generation will be the first in which parents consistently outlive their children.
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RISKS OF TYPE 2 DIABETESThe risks of type 2 diabetes are well documented; coronary heart disease, dyslipidaemia, blindness, renal failure, amputation and so on. Failing to diagnose the condition, and thus missing the opportunity to prevent the sequelae, is a costly error and an illustration that obesity must not be ignored; 10% of NHS resources are spent on diabetes and its complications, on behalf of only 3% of the population. WHO fact sheet 138 describes diabetes as the most important consequence of obesity. There are currently estimated to be over 150 million cases worldwide, a number that is likely to double by 2025.One of the most disturbing aspects of the increasing numbers of people with type 2 diabetes is the fact that adult-onset diabetes is now being seen in children as young as 10. Until recently, type 2 diabetes was unknown in children – it was usually restricted to adults over the age of 40. However, because of the increasing levels of childhood obesity it is now being seen in grossly obese children (weighing 20 stone or more). Although the phenomenon was initially reported in the US, the first cases of childhood-onset type 2 diabetes are being seen in the UK. Children such as these have a whole lifetime in which to develop the complications of diabetes, not to mention the comorbidities of obesity itself. Their shortened life expectancy has made some commentators believe that the current generation will be the first in which parents consistently outlive their children.*2/312/5*