THE 2002 OFFICIAL PATIENT’S SOURCEBOOK
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J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The 2002 Official Patient’s Sourcebook on Diabetes: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83369-9 1. Diabetes-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of diabetes.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to diabetes. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to diabetes, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Acromegaly
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The Official Patient's Sourcebook on Addison's Disease
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The Official Patient's Sourcebook on Asymptomatic Primary Hyperparathyroidism
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The Official Patient's Sourcebook on Cushing's Syndrome
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The Official Patient's Sourcebook on Cystic Fibrosis
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The Official Patient's Sourcebook on Diabetes Insipidus
·
The Official Patient's Sourcebook on Diabetes Mellitus
·
The Official Patient's Sourcebook on Diabetic Neuropathy
·
The Official Patient's Sourcebook on Gestational Diabetes
·
The Official Patient's Sourcebook on Hyperparathyroidism
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The Official Patient's Sourcebook on Hypoglycemia
·
The Official Patient's Sourcebook on Multiple Endocrine Neoplasia Type 1
·
The Official Patient's Sourcebook on Prolactinoma
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents vii
Table of Contents INTRODUCTION...................................................................................... 1
Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 6
PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON DIABETES: GUIDELINES................... 9
Overview............................................................................................................... 9 What Is Diabetes?............................................................................................... 11 What Are the Types of Diabetes? ....................................................................... 12 What Tests Are Recommended for Diagnosing Diabetes?................................. 14 What Are the Other Forms of Impaired Glucose Metabolism?.......................... 14 Scope and Impact of Diabetes ............................................................................. 15 Who Gets Diabetes?............................................................................................ 15 How Is Diabetes Managed?................................................................................ 16 Current Status of Diabetes Research.................................................................. 18 What Will the Future Bring? ............................................................................. 19 Additional Information....................................................................................... 20 More Guideline Sources ..................................................................................... 22 Vocabulary Builder............................................................................................. 38
CHAPTER 2. SEEKING GUIDANCE ....................................................... 41
Overview............................................................................................................. 41 Associations and Diabetes .................................................................................. 41 Finding More Associations................................................................................. 61 Finding Doctors.................................................................................................. 62 Finding an Endocrinologist................................................................................ 63 Selecting Your Doctor ........................................................................................ 64 Working with Your Doctor ................................................................................ 65 Broader Health-Related Resources ..................................................................... 66
CHAPTER 3. CLINICAL TRIALS AND DIABETES ................................... 67
Overview............................................................................................................. 67 Recent Trials on Diabetes ................................................................................... 70 Benefits and Risks............................................................................................. 106 Keeping Current on Clinical Trials.................................................................. 109 General References............................................................................................ 110 Vocabulary Builder........................................................................................... 111
PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL................................................ 117 CHAPTER 4. STUDIES ON DIABETES .................................................. 119
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Overview........................................................................................................... 119 Federally-Funded Research on Diabetes........................................................... 119 E-Journals: PubMed Central ............................................................................ 135 The National Library of Medicine: PubMed .................................................... 158 Vocabulary Builder........................................................................................... 168
CHAPTER 5. PATENTS ON DIABETES ................................................. 175
Overview........................................................................................................... 175 Patents on Diabetes .......................................................................................... 176 Patent Applications on Diabetes ...................................................................... 192 Keeping Current ............................................................................................... 209 Vocabulary Builder........................................................................................... 209
CHAPTER 6. BOOKS ON DIABETES..................................................... 215
Overview........................................................................................................... 215 Book Summaries: Online Booksellers ............................................................... 215 The National Library of Medicine Book Index ................................................. 219 Chapters on Diabetes ........................................................................................ 223 General Home References ................................................................................. 223
CHAPTER 7. MULTIMEDIA ON DIABETES .......................................... 225
Overview........................................................................................................... 225 Bibliography: Multimedia on Diabetes............................................................. 225
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES ................... 229
Overview........................................................................................................... 229 NIH Guidelines................................................................................................. 229 NIH Databases.................................................................................................. 230 Other Commercial Databases ........................................................................... 233 The Genome Project and Diabetes .................................................................... 234 Specialized References....................................................................................... 239 Vocabulary Builder........................................................................................... 239
CHAPTER 9. DISSERTATIONS ON DIABETES ...................................... 241
Overview........................................................................................................... 241 Dissertations on Diabetes ................................................................................. 241 Keeping Current ............................................................................................... 243
PART III. APPENDICES .................................................. 245 APPENDIX A. RESEARCHING YOUR MEDICATIONS.......................... 247
Overview........................................................................................................... 247 Your Medications: The Basics .......................................................................... 248 Learning More about Your Medications .......................................................... 249 Commercial Databases...................................................................................... 254 Contraindications and Interactions (Hidden Dangers) ................................... 263 A Final Warning .............................................................................................. 264 General References............................................................................................ 265 Vocabulary Builder........................................................................................... 265
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 269
Overview........................................................................................................... 269 What Is CAM? ................................................................................................. 269 What Are the Domains of Alternative Medicine?............................................ 270 Can Alternatives Affect My Treatment? ......................................................... 273 Finding CAM References on Diabetes ............................................................. 274 Additional Web Resources................................................................................ 284 General References............................................................................................ 292
APPENDIX C. RESEARCHING NUTRITION ......................................... 295
Overview........................................................................................................... 295 Food and Nutrition: General Principles........................................................... 296 Finding Studies on Diabetes............................................................................. 300 Federal Resources on Nutrition........................................................................ 301 Additional Web Resources................................................................................ 302 Vocabulary Builder........................................................................................... 324
APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 325
Overview........................................................................................................... 325 Preparation ....................................................................................................... 325 Finding a Local Medical Library ...................................................................... 326 Medical Libraries Open to the Public............................................................... 326
APPENDIX E. YOUR RIGHTS AND INSURANCE ................................. 333
Overview........................................................................................................... 333 Your Rights as a Patient................................................................................... 333 Patient Responsibilities .................................................................................... 337 Choosing an Insurance Plan............................................................................. 338 Medicare and Medicaid .................................................................................... 340 NORD’s Medication Assistance Programs ..................................................... 343 Additional Resources ........................................................................................ 344
APPENDIX F. NIH CONSENSUS STATEMENT ON DIET AND EXERCISE IN NONINSULIN-DEPENDENT DIABETES MELLITUS ......................... 345
Overview........................................................................................................... 345 What Is Non-Insulin Dependent Diabetes Mellitus? ...................................... 346 Significance of Excess Body Fat in Patients with Noninsulin-Dependent Diabetes Mellitus.............................................................................................. 347 Dietary Prescription for Patients with Noninsulin-Dependent Diabetes Mellitus .......................................................................................................................... 349 Calories ............................................................................................................. 350 Fat and Carbohydrate ....................................................................................... 350 Other Carbohydrate Issues ............................................................................... 351 Protein .............................................................................................................. 352 Education.......................................................................................................... 352 Benefits and Risks of Exercise in Patients With Noninsulin-Dependent Diabetes Mellitus? How Should Exercise Be Prescribed? .............................................. 352
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Evidence: Weight Control, Diet, and/or Exercise Can Prevent NoninsulinDependent Diabetes Mellitus ........................................................................... 354 Directions for Future Research......................................................................... 354 Conclusion ........................................................................................................ 356
ONLINE GLOSSARIES.................................................... 357 Online Dictionary Directories.......................................................................... 370
DIABETES GLOSSARY ................................................... 371 General Dictionaries and Glossaries ................................................................ 392
INDEX................................................................................... 394
Introduction
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INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
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Diabetes
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The 2002 Official Patient’s Sourcebook on Diabetes has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to diabetes, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on diabetes. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on diabetes should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
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options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching diabetes (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to diabetes. It also gives you sources of information that can help you find a doctor in your local area specializing in treating diabetes. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with diabetes. Part II moves on to advanced research dedicated to diabetes. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on diabetes. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with diabetes or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with diabetes. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with diabetes.
Scope While this sourcebook covers diabetes, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that diabetes is often considered a synonym or a condition closely related to the following: ·
Bronze Diabetes
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Central Diabetes Insipidus
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Diabetes Insipidus, Neurohypophyseal
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Diabetes
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Diabetes Mellitus
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Diabetic Coma
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Diabetic Glomerulosclerosis
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Diabetic Kidney Disease
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Glucose Intolerance of Pregnancy
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Iddm (insulin-dependent Diabetes Mellitus)
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Insulin Reaction
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Insulin Shock
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Insulin-dependent Diabetes Retinopathy
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Juvenile Diabetes
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Ketoacidosis
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Kimmelstiel-wilson Disease
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Low Blood Sugar
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Nephrogenic Diabetes Insipidus
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Nephrogenic Diabetes Insipidus - Congenital
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Nerve Damage - Diabetic
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Niddm (non-insulin-dependent Dia-betes Mellitus)
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Non-insulin Dependent Diabetes Mellitus Retinopathy
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Nonketotic Hyperglycemic Coma
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Npdr-nonproliferative Diabetic Retinopathy
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Pdr-proliferative (advanced) Diabetic Retinopathy
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Phosphate Diabetes
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Reactive Hypoglycemia
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Type 1 Diabetes Mellitus (insulin-dependent Diabetes Mellitus)
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Type 2 Diabetes Mellitus (non-insulin-dependent Diabetes Mellitus)
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Vasopressin-resistant Diabetes Insipidus
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Vasopressin-sensitive Diabetes Insipidus
In addition to synonyms and related conditions, physicians may refer to diabetes using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your
Introduction
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physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for diabetes:4 ·
250 diabetes mellitus
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250.0 diabetes mellitus (niddm)
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250.0 diabetes mellitus without mention of complication
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250.1 diabetes with ketoacidosis
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250.1 diabetic ketoacidosis
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250.1 insulin-dependent diabetes mellitus without complication (iddm)
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250.2 diabetes with hyperosmolarity
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250.3 diabetes with other coma
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250.4 diabetes with renal manifestations
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250.5 diabetes with ophthalmic manifestations
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250.6 diabetes with neurological manifestations
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250.7 diabetes with peripheral circulatory disorders
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250.8 diabetes with other specified manifestations
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250.8 diabetes with specified manifestation
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250.8 diabetic hypoglycemia
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250.9 diabetes with unspecified complication
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253.5 diabetes insipidus
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275.0 disorders of iron metabolism
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3 type i [insulin dependent type] [iddm] [juvenile type], uncontrolled
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362.01 retinopathy, diabetic, background
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362.02 retinopathy, diabetic, proliferative
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648.0 diabetes mellitus
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648.8 abnormal glucose tolerance
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to
4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
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Diabetes
diabetes. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with diabetes will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with diabetes is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of diabetes, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on diabetes. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of diabetes to you or even given you a pamphlet or brochure describing diabetes. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
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CHAPTER 1. THE ESSENTIALS ON DIABETES: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on diabetes. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on diabetes can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on diabetes. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
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There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with diabetes and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on diabetes.
What Is Diabetes?7 Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy. For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move glucose from blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.
Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/diabetes/pubs/dmover/dmover.htm. 7
12 Diabetes
Prevalence of diabetes in men and women in the U.S. population age 20 years or older, based on the National Health and Nutrition Examination Survey III. Diabetes includes previously diagnosed and undiagnosed diabetes defined by fasting plasma glucose greater than or equal to 126 mg/dL. (age-std=agestandardized)
What Are the Types of Diabetes? The three main types of diabetes are: ·
Type 1 diabetes
·
Type 2 diabetes
·
Gestational diabetes
Type 1 Diabetes Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body’s system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Someone with type 1 diabetes needs to take insulin daily to live.
Guidelines 13
At present, scientists do not know exactly what causes the body’s immune system to attack the beta cells, but they believe that both genetic factors and environmental factors, possibly viruses, are involved. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. Type 1 diabetes develops most often in children and young adults, but the disorder can appear at any age. Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis.
Type 2 Diabetes The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2, and one-third of them have not been diagnosed. This form of diabetes usually develops in adults age 40 and older and is most common in adults over age 55. About 80 percent of people with type 2 diabetes are overweight. Type 2 diabetes is often part of a metabolic syndrome that includes obesity, elevated blood pressure, and high levels of blood lipids. Unfortunately, as more children become overweight, type 2 diabetes is becoming more common in young people. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but, for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes--glucose builds up in the blood and the body cannot make efficient use of its main source of fuel. The symptoms of type 2 diabetes develop gradually. They are not as sudden in onset as in type 1 diabetes. Some people have no symptoms. Symptoms may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores.
14 Diabetes
Gestational Diabetes Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, American Indians, Hispanic Americans, and people with a family history of diabetes. Though it usually disappears after delivery, the mother is at increased risk of getting type 2 diabetes later in life.
What Tests Are Recommended for Diagnosing Diabetes? The fasting plasma glucose test is the preferred test for diagnosing type 1 or type 2 diabetes. However, a diagnosis of diabetes is made for any one of three positive tests, with a second positive test on a different day: ·
A random plasma glucose value (taken any time of day) of 200 mg/dL or more, along with the presence of diabetes symptoms.
·
A plasma glucose value of 126 mg/dL or more, after a person has fasted for 8 hours.
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An oral glucose tolerance test (OGTT) plasma glucose value of 200 mg/dL or more in the blood sample, taken 2 hours after a person has consumed a drink containing 75 grams of glucose dissolved in water. This test, taken in a laboratory or the doctor’s office, measures plasma glucose at timed intervals over a 3-hour period.
Gestational diabetes is diagnosed based on plasma glucose values measured during the OGTT. Glucose levels are normally lower during pregnancy, so the threshold values for diagnosis of diabetes in pregnancy are lower. If a woman has two plasma glucose values meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting plasma glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.
What Are the Other Forms of Impaired Glucose Metabolism? People with impaired glucose metabolism, a state between “normal” and “diabetes,” are at risk for developing diabetes, heart attacks, and strokes. There are two forms of impaired glucose metabolism.
Guidelines 15
Impaired Fasting Glucose A person has impaired fasting glucose (IFG) when fasting plasma glucose is 110 to 125 mg/dL. This level is higher than normal but less than the level indicating a diagnosis of diabetes. Approximately 13.4 million people in the United States, or about 7 percent of the population, have IFG. Impaired Glucose Tolerance Impaired glucose tolerance (IGT) means that blood glucose during the oral glucose tolerance test is higher than normal but not high enough for a diagnosis of diabetes. IGT is diagnosed when the glucose level is 141 to 199 mg/dL 2 hours after a person is given a drink containing 75 grams of glucose.
Scope and Impact of Diabetes Diabetes is widely recognized as one of the leading causes of death and disability in the United States. According to death certificate data, diabetes contributed to the deaths of more than 193,140 people in 1996. Diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes. In 1997, diabetes cost the United States $98 billion. Indirect costs, including disability payments, time lost from work, and premature death, totaled $54 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $44 billion.
Who Gets Diabetes? Diabetes is not contagious. People cannot “catch” it from each other. However, certain factors can increase the risk of developing diabetes. Type 1 diabetes occurs equally among males and females, but is more common in whites than in nonwhites. Data from the World Health
16 Diabetes
Organization’s Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most African, American Indian, and Asian populations. However, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are not known. Type 2 diabetes is more common in older people, especially in people who are overweight, and occurs more often in African Americans, American Indians, Asian and Pacific Islander Americans, and Hispanic Americans. On average, non-Hispanic African Americans are 1.7 times more likely to have diabetes than non-Hispanic whites of the same age. Hispanic Americans are nearly twice as likely to have diabetes as non-Hispanic whites. American Indians have the highest rates of diabetes in the world. Among the Pima Indians living in Arizona, for example, half of all adults have type 2 diabetes. The prevalence of diabetes in the United States is likely to increase for several reasons. First, a large segment of the population is aging. Also, Hispanic Americans and other minority groups make up the fastest-growing segment of the U.S. population. Finally, Americans are increasingly overweight and sedentary. According to recent estimates, the prevalence of diabetes in the United States is predicted to be 8.9 percent of the population by 2025.
How Is Diabetes Managed? Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment. Today, healthy eating, physical activity, and insulin via injection or an insulin pump are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication and insulin to control their blood glucose levels. People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too
Guidelines 17
low or too high. When blood glucose levels drop too low from certain diabetes medicines--a condition known as hypoglycemia--a person can become nervous, shaky, and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint. A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia. People with diabetes should see a doctor who helps them learn to manage their diabetes and monitors their diabetes control. An endocrinologist is one type of doctor who may specialize in diabetes care. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, and dietitians and diabetes educators to help teach the skills of day-to-day diabetes management. The goal of diabetes management is to keep blood glucose levels as close to the normal range as safely possible. A recent major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels as close to normal as safely possible reduces the risk of developing major complications of type 1 diabetes. The 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches-intensive management and standard management--on the development and progression of eye, kidney, and nerve complications of diabetes. Intensive treatment aimed at keeping hemoglobin A-1-c as close to normal (6 percent) as possible. Hemoglobin A-1-c reflects average blood sugar over a 2- to 3month period. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a follow-up study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes persists up to 4 years after the trial ended. The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.
18 Diabetes
Current Status of Diabetes Research NIDDK conducts research in its own laboratories and supports a great deal of basic and clinical research in medical centers and hospitals throughout the United States. It also gathers and analyzes statistics about diabetes. Other Institutes at the National Institutes of Health (NIH) conduct and support research on diabetes-related eye diseases, heart and vascular complications, pregnancy, and dental problems. Other Government agencies that sponsor diabetes programs are the Centers for Disease Control and Prevention, the Indian Health Service, the Health Resources and Services Administration, the Department of Veterans Affairs, and the Department of Defense. Many organizations outside of the Government support diabetes research and education activities. These organizations include the American Diabetes Association, the Juvenile Diabetes Foundation International, and the American Association of Diabetes Educators. In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its complications. Major advances include ·
The development of a quick-acting insulin analog.
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Better ways to monitor blood glucose and for people with diabetes to check their own blood glucose levels.
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Development of external insulin pumps that deliver insulin, replacing daily injections.
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Laser treatment for diabetic eye disease, reducing the risk of blindness.
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Successful transplantation of kidneys and pancreas in people whose own kidneys fail because of diabetes.
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Better ways of managing diabetes in pregnant women, improving chances of successful outcomes.
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New drugs to treat type 2 diabetes and better ways to manage this form of diabetes through weight control.
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Evidence that intensive management of blood glucose reduces and may prevent development of diabetes complications.
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Demonstration that antihypertensive drugs called ACE (angiotensinconverting enzyme) inhibitors prevent or delay kidney failure in people with diabetes.
Guidelines 19
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Promising results with islet transplantation for type 1 diabetes reported by the University of Alberta in Canada. A nationwide clinical trial funded by the NIH and the Juvenile Diabetes Foundation is currently trying to replicate the Canadian advance.
What Will the Future Bring? In the future, it may be possible to administer insulin through inhalers, a pill, or a patch. Devices are also being developed that can monitor blood glucose levels without having to prick a finger to get a blood sample. Researchers continue to search for the cause or causes of diabetes and ways to prevent and cure the disorder. Scientists are looking for genes that may be involved in type 1 or type 2 diabetes. Some genetic markers for type 1 diabetes have been identified, and it is now possible to screen relatives of people with type 1 diabetes to see if they are at risk. The Diabetes Prevention Trial--Type 1, sponsored by NIDDK, identifies relatives at risk for developing type 1 diabetes and treats them with low doses of insulin or with oral insulin-like agents in the hope of preventing type 1 diabetes. Similar research is under way at other medical centers throughout the world. For more information about this trial, call 1-800HALT-DM1 (1-800-425-8361). Transplantation of the pancreas or insulin-producing beta cells offers the best hope of cure for people with type 1 diabetes. Some pancreas transplants have been successful. However, people who have transplants must take powerful drugs to prevent rejection of the transplanted organ. These drugs are costly and may eventually cause other health problems. Scientists are working to develop less harmful drugs and better methods of transplanting beta cells to prevent rejection by the body. Using techniques of bioengineering, researchers are also trying to create artificial beta cells that secrete insulin in response to increased glucose levels in the blood. Recently, researchers at the University of Alberta in Edmonton, Canada, announced promising results with islet transplantation in seven patients with type 1 diabetes. At the time of the report in the New England Journal of Medicine, all seven patients who had received the transplant remained free of insulin injections up to 14 months after the procedure.
20 Diabetes
A clinical trial funded by the NIH and the Juvenile Diabetes Foundation will try to replicate the Edmonton advance. With the insights gained from this trial and other studies, scientists hope to further refine methods of islet harvesting and transplantation and learn more about the immune processes that affect rejection and acceptance of transplanted islets. For type 2 diabetes, the focus is on ways to prevent diabetes. Preventive approaches include identifying people at high risk for the disorder and encouraging them to lose weight, be more physically active, and follow a healthy eating plan. The Diabetes Prevention Program, another NIDDK project, focuses on preventing the disorder in high-risk populations, such as people with impaired fasting glucose, African Americans, Alaska Natives, American Indians, Asian and Pacific Islander Americans, Hispanic Americans, or women who have had gestational diabetes. Several new drugs were recently developed to treat type 2 diabetes. By using the oral diabetes medications now available, many people can control blood glucose levels without insulin injections. Studies are under way to determine how best to use these drugs to manage type 2 diabetes. Scientists also are investigating strategies for weight loss in people with type 2 diabetes.
Additional Information For more information about type 1, type 2, and gestational diabetes, as well as diabetes research, statistics, and education, contact: National Diabetes Information Clearinghouse 1 Information Way Bethesda, MD 20892-3560 Phone: 1-800-860-8747 or (301) 654-3327 Email:
[email protected] Internet: www.niddk.nih.gov/health/diabetes/diabetes.htm The following organizations also distribute materials and support programs for people with diabetes and their families and friends: American Association of Diabetes Educators 100 West Monroe, 4th Floor Chicago, IL 60603 Phone: 1-800-832-6874 or (312) 424-2426 Internet: www.aadenet.org
Guidelines 21
American Diabetes Association ADA National Service Center 1701 North Beauregard Street Alexandria, VA 22311 Phone: 1-800-342-2383 or (703) 549-1500 Internet: www.diabetes.org Juvenile Diabetes Foundation International 120 Wall Street, 19th Floor New York, NY 10005 Phone: 1-800-223-1138 or (212) 785-9500 Internet: www.jdf.org Points to Remember What is diabetes? ·
A disorder of metabolism--the way the body digests food for energy and growth.
What are the main types of diabetes? ·
Type 1 diabetes
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Type 2 diabetes
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Gestational diabetes
What is the impact of diabetes? ·
Affects 16 million people
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Is a leading cause of death and disability
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Costs $98 billion per year
Who gets diabetes? ·
People of any age.
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Most common in older people, overweight and sedentary people, African Americans, Alaska Natives, American Indians, Asian and Pacific Islander Americans, and Hispanic Americans.
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People with a family history of diabetes.
22 Diabetes
More Guideline Sources The guideline above on diabetes is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to diabetes. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with diabetes. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following as being relevant to diabetes: ·
Guides On diabetes Diabetes http://www.nlm.nih.gov/medlineplus/ency/article/001214.htm Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html Diabetes and Pregnancy http://www.nlm.nih.gov/medlineplus/diabetesandpregnancy.html Juvenile Diabetes http://www.nlm.nih.gov/medlineplus/juvenilediabetes.html Diabetes insipidus http://www.nlm.nih.gov/medlineplus/ency/article/000377.htm Diabetes http://www.nlm.nih.gov/medlineplus/tutorials/diabetesloader.html Diabetes insipidus - nephrogenic http://www.nlm.nih.gov/medlineplus/ency/article/000511.htm
Guidelines 23
Diabetes insipidus - central http://www.nlm.nih.gov/medlineplus/ency/article/000460.htm ·
Other Guides Type II diabetes http://www.nlm.nih.gov/medlineplus/ency/article/000313.htm Type I diabetes http://www.nlm.nih.gov/medlineplus/ency/article/000305.htm Gestational diabetes http://www.nlm.nih.gov/medlineplus/ency/article/000896.htm
Within the health topic page dedicated to diabetes, the following was recently recommended to patients: ·
General/Overviews Diabetes http://www.nlm.nih.gov/medlineplus/tutorials/diabetesloader.html Diabetes: A Growing Public Health Concern Source: Food and Drug Administration http://www.fda.gov/fdac/features/2002/102_diab.html JAMA Patient Page: ABCs of Diabetes Source: American Medical Association http://www.amaassn.org/public/journals/patient/archive/jpg051502.htm
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Diagnosis/Symptoms Diabetes Diagnosis Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/diagnosis/diagn osis.htm Diabetes: Assessing Your Risk Source: American Academy of Family Physicians http://familydoctor.org/handouts/347.html Diabetes: How Do I Know If I Have It? Source: American Academy of Family Physicians http://familydoctor.org/handouts/327.html
24 Diabetes
Glucose Tests Source: American Association for Clinical Chemistry http://labtestsonline.org/understanding/analytes/glucose/glance.html Oral Glucose Tolerance Test Source: National Institutes of Health, Clinical Center http://www.cc.nih.gov/ccc/patient_education/procdiag/oralglu.pdf ·
Treatment Diabetes: New Treatments Source: American Academy of Family Physicians http://familydoctor.org/handouts/388.html Insulin Source: Food and Drug Administration http://www.fda.gov/diabetes/insulin.html Treating Insulin Reactions Source: American Diabetes Association http://www.diabetes.org/main/type1/medical/hypoglycemia/insu lin_reaction.jsp
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Alternative Therapy Alternative Therapies for Diabetes Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/summary/altmed/altm ed.htm
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Nutrition Diabetes and Nutrition Source: American Academy of Family Physicians http://familydoctor.org/handouts/349.html Food and Meal Planning Source: Food and Drug Administration http://www.fda.gov/diabetes/food.html Healthy Restaurant Eating: Is It Possible? Source: American Diabetes Association http://www.diabetes.org/main/health/nutrition/restauranteating.jsp How Can I Use the Food Label to Help Me Make Good Choices? Source: American Diabetes Association http://www.diabetes.org/main/health/nutrition/foodlabel.jsp
Guidelines 25
I Have Diabetes: How Much Should I Eat? Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/nutritn/howmuc h/index.htm I Have Diabetes: What Should I Eat? Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/nutritn/what/in dex.htm I Have Diabetes: When Should I Eat? Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/nutritn/when/in dex.htm Low-Calorie Sweeteners Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01029 What I Need to Know about Eating and Diabetes Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/eating/nutri.htm ·
Coping Common Questions about Diabetes: Lifestyle Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DA00018 Diabetes: Helping a Family Member Who Has Diabetes Source: American Academy of Family Physicians http://familydoctor.org/handouts/353.html
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Specific Conditions/Aspects Alcohol, Alcohol Everywhere: But Is It Safe To Drink (for Diabetics)? Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28F1_3%29 Complications of Diabetes Source: Food and Drug Administration http://www.fda.gov/diabetes/related.html Depression and Diabetes Source: National Institute of Mental Health http://www.nimh.nih.gov/publicat/depdiabetes.cfm
26 Diabetes
Diabetes and Vaccines Source: Centers for Disease Control and Prevention http://www.cdc.gov/nip/vacsafe/concerns/Diabetes/default.htm Diabetes in African Americans Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm Diabetes in American Indians and Alaska Natives Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/amindian/amind ian.htm Diabetes in Asian and Pacific Islander Americans Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/asianam/asiana m.htm Diabetes in Hispanic Americans Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/hispan/hispan.ht m Diabetes Insipidus Source: National Kidney and Urologic Diseases Information Clearinghouse http://www.niddk.nih.gov/health/kidney/pubs/insipidus/insipid us.htm Diabetes: Preventing Diabetic Complications Source: American Academy of Family Physicians http://familydoctor.org/handouts/356.html Erectile Dysfunction and Diabetes: Many Possible Solutions Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DA00045 Financial Help for Diabetes Care Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/summary/finhelp/finh elp.htm Gastroparesis and Diabetes Source: National Digestive Diseases Information Clearinghouse http://www.niddk.nih.gov/health/digest/pubs/gastro/gastro.htm Hormone Replacement Therapy and Diabetes Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DA00039
Guidelines 27
Hyperglycemia (High Blood Sugar) Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28C4_6%29 Hyperinsulinemia Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00896 Hypoglycemia in Diabetes Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28C4_5%29 JAMA Patient Page: Safe Driving for People with Diabetes Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=Z ZZRHSKYMAC&sub_cat=268 Keep Your Heart and Blood Vessels Healthy Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/complications/h eart/heart.htm Liver Disease and Diabetes Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00193 Menopause and Diabetes Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DA00038 Skin Care Source: American Diabetes Association http://www.diabetes.org/ada/skin_care.asp Stress: What Stress Does to Diabetes Control Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28F4%29 Traveling With Diabetes Supplies Source: American Diabetes Association http://www.diabetes.org/main/community/advocacy/travel.jsp
28 Diabetes
·
Children Diabetes in Children Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28B4_3%29 MEDLINEplus: Juvenile Diabetes Source: National Library of Medicine http://www.nlm.nih.gov/medlineplus/juvenilediabetes.html Wizdom Youth Zone Source: American Diabetes Association http://www.diabetes.org/wizdom/index.shtml
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From the National Institutes of Health Diabetes Overview Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/dmover/dmover .htm Do Your Level Best: Start Controlling Your Blood Sugar Today http://www.niddk.nih.gov/health/diabetes/dylb/home.htm Your Guide to Diabetes: Type 1 and Type 2 Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/type12/index.htm
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Latest News Alcohol Unlikely to Cut Diabetes Risk Source: 06/24/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_8236.html Diabetes Test After Heart Attack Shows Future Risk Source: 06/21/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_8206.html Heart Health Should Be the Front Line of Diabetes Care Source: 05/07/2002, American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3002623 Many Diabetics Need More Exercise, Healthier Diet Source: 06/27/2002, Reuters Health http://www.nlm.nih.gov/medlineplus/news/fullstory_8278.html
Guidelines 29
More News on Diabetes http://www.nlm.nih.gov/medlineplus/alphanews_d.html#Diabetes Study Examines Cost-effectiveness of Treatment Interventions for Type 2 Diabetes Source: 05/14/2002, Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r020514.htm ·
Law and Policy Discrimination and Diabetes Source: American Diabetes Association http://www.diabetes.org/main/community/advocacy/discrimin_di ab.jsp Expanded Coverage for Diabetes--Medicare and You Source: National Diabetes Education Program http://ndep.nih.gov/materials/pubs/medicare-and-you/expandedcoverage.htm Medicare Program and Nutrition Services Source: American Dietetic Association http://www.eatright.org/gov/medicare.html Rules Published for VA's Diabetes-Agent Orange Benefits Source: Dept. of Veterans Affairs http://www.va.gov/pressrel/aodiab01.htm
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Men Men and Diabetes Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28B4_1%29
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Organizations American Diabetes Association http://www.diabetes.org/main/application/commercewf CDC's Diabetes Public Health Resource Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/diabetes/
30 Diabetes
National Diabetes Education Program http://ndep.nih.gov/ National Diabetes Information Clearinghouse Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/health/diabetes/ndic.htm National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/ ·
Prevention/Screening Am I at Risk for Type 2 Diabetes? Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/risk/risk.htm
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Research Diabetes Control and Complications Trial (DCCT) Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/dcct1/dcct.htm Diabetes Disparities Among Racial and Ethnic Minorities Source: Agency for Healthcare Research and Quality http://www.ahrq.gov/research/diabdisp.htm Diabetes Prevention Program: Questions and Answers Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/patient/dpp/dpp-q&a.htm Diabetes Report Card for the United States, 1988¿1995 Source: American College of Physicians http://www.annals.org/issues/v136n8/fpdf/200204160-00001.pdf Diet and Exercise Dramatically Delay Type 2 Diabetes, Diabetes Medication Metformin Also Effective Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.nih.gov/news/pr/aug2001/niddk-08.htm Fat Cell Hormone Promotes Type 2 Diabetes Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/welcome/releases/1-01.htm
Guidelines 31
Heart Health Should Be the Front Line of Diabetes Care Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3002623 Identifying People at High Risk for Type 2 Diabetes Source: American College of Physicians http://www.annals.org/issues/v136n8/fpdf/200204160-00002.pdf Many Obese Youth Have Condition That Precedes Type 2 Diabetes Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/mar2002/nichd-13.htm Metformin for Patients with Type 2 Diabetes Mellitus Source: American College of Physicians http://www.annals.org/issues/v137n1/fpdf/200207020-00004.pdf Scientists Report New Findings on the Connection Between Diabetes and Heart Disease and Stroke Source: National Institute of Diabetes and Digestive and Kidney Diseases http://www.nih.gov/news/pr/jun2001/niddk-24.htm Study Examines Cost-effectiveness of Treatment Interventions for Type 2 Diabetes Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r020514.htm Undiagnosed Diabetes and Related Eye Disease in MexicanAmericans Source: National Eye Institute http://www.nei.nih.gov/news/pressreleases/062201.htm ·
Statistics Diabetes and Women's Health Across the Life Stages: A Public Health Perspective Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/diabetes/pubs/women/index.htm Diabetes Statistics Source: National Diabetes Information Clearinghouse http://www.niddk.nih.gov/health/diabetes/pubs/dmstats/dmstats .htm
32 Diabetes
Diabetes: Disabling, Deadly, and on the Rise Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/diabetes/pubs/glance.htm FASTATS: Diabetes Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/diabetes.htm Twin Epidemics of Diabetes and Obesity Continue to Threaten the Health of Americans CDC Says Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r010911.htm ·
Teenagers Just For Teens: Diabetes in New Situations Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28C1_3%29
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Women CDC to Introduce Book on Diabetes in Women Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r010509.htm Women and Diabetes Source: American Diabetes Association http://www.diabetes.org/main/application/commercewf?origin=% 2A.jsp&event=link%28B4_2%29
If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at the following: http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
Guidelines 33
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “diabetes” or synonyms. The following was recently posted: ·
ACR Appropriateness Criteria™ for imaging diagnosis of osteomyelitis in patients with diabetes mellitus. Source: American College of Radiology.; 1995 (revised 1999); 8 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1650&sSearch_string=diabetes
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Aspirin therapy in diabetes. Source: American Diabetes Association.; 1997 (revised 2000; republished 2002 Jan); 2 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2359&sSearch_string=diabetes
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Basic guidelines for diabetes care. Source: California Diabetes Control Program/Diabetes Coalition of California.; 2001 January; Various pagings http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2086&sSearch_string=diabetes
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Benefits and risks of controlling blood glucose levels in patients with type 2 diabetes mellitus. Source: American Academy of Family Physicians/American Diabetes Association.; 1999 April; 39 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1603&sSearch_string=diabetes
34 Diabetes
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Care of children with diabetes in the school and day care setting. Source: American Diabetes Association.; 1998 (revised 2000; republished 2002 Jan); 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2370&sSearch_string=diabetes
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Care of the patient with diabetes mellitus. 2nd edition. Source: American Optometric Association.; 1998 (Second Edition); 69 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1212&sSearch_string=diabetes
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Diabetes mellitus and exercise. Source: American College of Sports Medicine/American Diabetes Association.; 1990 February (revised 1999; republished 2002 Jan); 5 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2355&sSearch_string=diabetes
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Effects of menopause and estrogen replacement therapy or hormone replacement therapy in women with diabetes mellitus: consensus opinion of The North American Menopause Society. Source: The North American Menopause Society.; 2000 March; 9 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1792&sSearch_string=diabetes
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Gestational diabetes mellitus. Source: American Diabetes Association.; 1986 (revised 2000; republished 2002 Jan); 3 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2364&sSearch_string=diabetes
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Gestational diabetes practice guidelines. Source: International Diabetes Center.; 2000; 33 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1789&sSearch_string=diabetes
Guidelines 35
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
A Child With Diabetes is in Your Care: Facts You'll Need to Know Summary: Information for people who may be responsible for a child with diabetes. This fact sheet provides basic information about Type 1 (insulin-dependent or juvenile) diabetes. Source: Juvenile Diabetes Research Foundation International http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6259
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African American Diabetes Program Summary: Visit this program's home page to learn more about a voluntary community-based program developed to address the challenge of diabetes in the African American community. Source: American Diabetes Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2450
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Alternative Therapies for Diabetes Summary: Alternative therapies are treatments that are neither widely taught in medical schools nor widely practiced in hospitals. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=2620
36 Diabetes
·
Am I at Risk for Type 2 Diabetes? Summary: Describes what Type 2 diabetes is, its signs and symptoms, risk factors, tests, and what to do to prevent it and control it. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6488
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Ask NOAH About: Diabetes Summary: New York Online Access to Health (NOAH) provides full-text health information for consumers about diabetes in both English and Spanish. Source: NOAH: New York Online Access to Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1424
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Ayurvedic Interventions for Diabetes Mellitus: A Systematic Review (Summary) Summary: The objective of this evidence report was to conduct a search of the published literature on the use of Ayurvedic medicine/therapies for the treatment of health conditions and, on the basis of that Source: Agency for Healthcare Research and Quality http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6475
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Be Smart About Your Heart: Control the ABCs of Diabetes Summary: This brochure from the National Diabetes Education Program focuses not only on glucose control but on the control of blood pressure and cholesterol as well. Source: National Diabetes Education Program, National Institute of Diabetes & Digestive & Kidney Diseases http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6365
Guidelines 37
·
Calendar and Events - National Institute of Diabetes and Digestive and Kidney Diseases Summary: This page offers up-to-date listings of upcoming lectures, seminars and workshops sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=1910
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to diabetes. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
38 Diabetes
·
Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Antihypertensive: An agent that reduces high blood pressure. [EU] Bloom Syndrome: An autosomal recessive disorder characterized by telangiectatic erythema of the face, photosensitivity, dwarfism, and other abnormalities. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Guidelines 39
Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Ketoacidosis: See: Diabetic ketoacidosis. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about
40 Diabetes
which little is known. [NIH] Podiatrist: A doctor who treats and takes care of people's feet. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH]
Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
Seeking Guidance 41
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with diabetes. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with diabetes. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Diabetes As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all 8 Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9
This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm.
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influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Association of Clinical Endocrinologists Address: American Association of Clinical Endocrinologists 1000 Riverside Avenue, Suite 205, Jacksonville, FL 32204 Telephone: (904) 353-7878 Toll-free: (800) 371-3628 Fax: (904) 353-8185 Email: None. Web Site: http://www.aace.com/ Background: The American Association of Clinical Endocrinologists (AACE) is a professional medical organization devoted to the field of clinical endocrinology. The mission of the American Association of Clinical Endocrinologists is to enhance the practice of clinical endocrinology. Some of the Association's goals are to create and maintain a society of qualified adult, pediatric, reproductive, and surgical endocrinologists for the coordination of their efforts in furthering the practice of endocrinology and utilize the highest standards of practice for the care of patients with endocrine diseases and related disorders; study the scientific, economic, social, and political aspects of medicine in order to secure and maintain the highest standard of practice in endocrinology, diabetes and metabolism; and represent the interest of patients and endocrinologists in socioeconomic and related matters with government agencies, the insurance industry, organized medicine, health related organizations, and others. Members of the American Association of Clinical Endocrinologists are physicians with special education, training, and interest in the practice of clinical endocrinology. These physicians devote a significant part of their clinical practice to the evaluation and management of patients with endocrine disease. All members of the American Association of Clinical Endocrinologists are fully licensed physicians and a majority are board certified in Internal Medicine and sub-specialty certified in Adult or Pediatric Endocrinology. Members of the American Association of Clinical Endocrinologists are recognized
Seeking Guidance 43
clinicians and educators, many of them whom are affiliated with medical schools and universities. Members of the American Association of Clinical Endocrinologists contribute on a regular and continuing basis to the scientific literature on endocrine diseases and conduct medical education programs on this subject. ·
American Diabetes Association Address: American Diabetes Association National Service Center, 1660 Duke St., Alexandria, VA 22314 Telephone: (703) 549-1500 Toll-free: (800) 342-2383 Fax: (703) 549-6995 Relevant area(s) of interest: Diabetes, Diabetes Insipidus, Diabetes Mellitus, Hypoglycemia
·
American Medical Association (AMA) Physician Select Address: American Medical Association (AMA) Physician Select Web Site on the Internet, Telephone: (703) 549-1500 Toll-free: (800) 342-2383 Web Site: http://www.ama- assn.org/aps/amahg.htm Background: The American Medical Association (AMA) is a professional association of physicians and medical students dedicated to the health of America. The AMA's web site on the Internet includes an area called 'AMA Physician Select' or 'On-line Doctor Finder' that provides information on most licensed physicians in the United States and its possessions, including more than 650,000 doctors of medicine (MD) and doctors of osteopathy or osteopathic medicine (DO). All physician credential data have been verified for accuracy and authenticated by accrediting agencies, medical schools, residency training programs, licensing and certifying boards, and other data sources. Physician Select is intended for use by the general public to allow them quick access to information on physicians. Online users can search for physicians by physician name, medical specialty, and location. Physician medical specialty categories that may be selected during a Physician Select search include allergy and immunology, anesthesiology, cardiology, dermatology, diabetes, emergency medicine, family practice/general practice, geriatrics, internal medicine, medical genetics, neurological surgery, neurology, obstetrics and gynecology, oncology, ophthalmology, orthopedics, other, otolaryngology, pathology, pediatrics, physical medicine and rehabilitation, plastic surgery, preventive medicine, psychiatry, radiology, surgery, and urology. Specific physician profiles
44 Diabetes
include their location and phone numbers; primary and, if appropriate, secondary practice specialties; medical school and residency training information; major professional activities; and confirmation of board certification. Relevant area(s) of interest: Diabetes ·
American Society of Bariatric Physicians Address: American Society of Bariatric Physicians 5600 South Quebec Street, Suite 109A, Englewood, CO 80111 Telephone: (303) 770-2526 Toll-free: (800) 598- 4668 Fax: (303) 779-4834 Email:
[email protected] Web Site: http://www.asbp.org Background: The American Society of Bariatric Physicians is a national, not-for- profit professional association of physicians who treat people with problems related to overweight and obesity. The Society has a membership of 1,500 throughout the United States and several foreign countries. Established in 1950, the Society has encouraged public awareness of weight related issues and overall health. The Society has helped further the goals of Bariatric Medicine through continuing postgraduate medical education, the exchange of obesity information, and research on the prevention, cause, course, effects, and treatment of obesity. In addition, the Society seeks to advance and improve the standards of practice and quality of professional service in the field of bariatric medicine; improve educational opportunities for the training of bariatricians; increase awareness of bariatric medicine; and maintain a Board of Bariatric Medicine. The American Society of Bariatric Physicians produces educational materials including pamphlets, brochures, booklets, journal article reprints, and a newsletter. Relevant area(s) of interest: Diabetes
·
British Diabetic Association Address: British Diabetic Association 10 Queen Anne Street, London, W1M 0BD, United Kingdom Telephone: 0171 323 1531 Toll-free: (800) 852-3131 Fax: 0171 637 3644 Email:
[email protected] Web Site: http://www.diabetes.org.uk
Seeking Guidance 45
Background: The British Diabetic Association (BDA) is a voluntary organization in the United Kingdom that was founded in 1934. The BDA is dedicated to helping and caring for individuals with diabetes and family members, representing and campaigning for their interests, and funding research. There are different forms of diabetes, including diabetes insipidus and diabetes mellitus. Diabetes insipidus is a condition in which deficient production or secretion of antidiuretic hormone results in excessive thirst (polydipsia) and excessive excretion of urine (polyuria). Diabetes mellitus is characterized by impaired fat, protein, and carbohydrate metabolism due to deficient secretion of insulin. The British Diabetic Association has five regional offices across the United Kingdom and a network of over 450 local groups and branches that are run by people living with diabetes. The Association offers a confidential service known as the 'BDA Careline' that provides information and support on all aspects of diabetes to affected individuals and family members. The BDA Careline handles inquiries concerning such issues as employment, pregnancy, insurance, driving, diet, and many other areas. The Association's Youth and Family Services department provides services and support to children and young people affected by diabetes, parents, teachers, career officers, and others. The department provides Youth Packs and School Packs; distributes a quarterly newsletter; offers a wide range of holiday events in the UK for affected children and adolescents from six to 18 years of age; holds regional days and annual family weekends; and conducts the Youth Diabetes Project to provide a strong voice for affected individuals from 18 to 30 years of age. In addition, the Association's Tadpole Club is for all children with diabetes and their siblings and friends. The British Diabetic Association also typically funds approximately 140 to 160 ongoing research projects to investigate the causes, prevention, and treatment of diabetes; provides educational materials for affected individuals and family members; and maintains a web site on the Internet. Relevant area(s) of interest: Diabetes, Diabetes Insipidus, Diabetes Mellitus ·
Canadian Diabetes Association Address: Canadian Diabetes Association 15 Toronto Street, Suite 800, Toronto, Ontario, M5C 2E3, Canada Telephone: (416) 363-3373 Toll-free: (800) 226-8464 Email:
[email protected] Web Site: http://www.diabetes.ca
46 Diabetes
Background: The Canadian Diabetes Association (CDA) is a voluntary organization that was founded in 1949 to serve the needs of people with diabetes. The organization currently consists of approximately 170 branches across Canada. There are different forms of diabetes, including diabetes mellitus, which is characterized by impaired fat, protein, and carbohydrate metabolism due to deficient secretion of insulin, and diabetes insipidus, a condition in which deficient production or secretion of antidiuretic hormone results in excessive thirst (polydipsia) and excessive excretion of urine (polyuria). The Canadian Diabetes Association is committed to promoting and supporting diabetes research, education, and advocacy. The CDA has several sections, councils, and committees that work to fulfill its mission, goals, and objectives. These include the clinical and scientific section, which consists of over 1,500 physicians and specialists who provide medical leadership and expertise in the field of diabetes; the diabetes educator section, which includes over 1,700 nurses, physicians, pharmacists, dietitians, and social workers who help people overcome the complications of living with diabetes; the national advocacy council, which ensures that people with diabetes are not denied basic benefits, such as health care services, employment, and health insurance coverage; and a national research council that oversees the CDA's research programs and distributes funds in the forms of grants and awards to over 60 researchers across Canada annually. The Canadian Diabetes Association provides additional programs and services including developing and maintaining a clinical database for those involved in diabetes research; advocating, initiating, and coordinating educational programs on behalf of health care professionals involved in diabetes care; and promoting nutrition education and research. The CDA's publications include its peer-reviewed scientific journal entitled the 'Canadian Journal of Diabetes Care'; a magazine for primary-care physicians entitled 'Canadian Diabetes'; and educational materials for affected individuals and family members. The Association also has a web site on the Internet. Relevant area(s) of interest: Diabetes, Diabetes Insipidus ·
Canadian Hemochromatosis Society Address: Canadian Hemochromatosis Society 272-7000 Boulevard, Richmond, British Columbia, V6Y 3Z5, Canada Telephone: (604) 279-7135 Toll-free: (877) 223-4766 Fax: (604) 279-7138 Email:
[email protected] Web Site: http://home.istar.ca/~chcts
Minoru
Seeking Guidance 47
Background: The Canadian Hemochromatosis Society (CHS) is a nonprofit support organization dedicated to providing information and support to individuals and families affected by hereditary hemochromatosis. Hereditary hemochromatosis (HH) is a metabolic disorder characterized by excessive absorption of iron. Without appropriate treatment, excess iron may accumulate in the liver, heart, pancreas, and other organs, resulting in possible multiple organ dysfunction and tissue damage. Established in 1982, the Society is committed to increasing awareness among the Canadian public and the medical community about the importance of early screening for and diagnosis of hemochromatosis. The Society maintains a central registry of all reported cases of hereditary hemochromatosis and provides information regarding appropriate screening and diagnostic testing. CHS also publishes a biannual newsletter that is distributed to doctors and interested individuals all over the world. Its membership questionnaire includes specific questions designed to assist researchers. Other publications include a pamphlet entitled 'Iron Overload? Too Much of a Good Thing Can Kill You...' and a series of fact sheets. The Society maintains a site on the World Wide Web at http://home.istar.ca/~chcts. Relevant area(s) of interest: Bronze Diabetes ·
Carroll Center for the Blind, Inc Address: Carroll Center for the Blind, Inc. 770 Centre Street, Newton, MA 02158 Telephone: (617) 969-6200 Toll-free: (800) 852-3131 Fax: (617) 969-6204 Email:
[email protected] Web Site: http://www.carroll.org Background: Carroll Center for the Blind, Inc. is a nonprofit organization dedicated to providing training as well as information and opportunities for blind and visually impaired persons so they may achieve independence, self-sufficiency, and self-fulfillment. Established in 1936, the Center provides comprehensive rehabilitation services for newly blind adults through mobility training, independent living skills, vocational development, counseling, and adaptive outdoor recreation. The residential program is recognized internationally for helping individuals adjust to vision loss. Other programs include a computer access program for blind individuals; a computer summer workshop for blind children; a school equipment loan program; and an Outdoor Enrichment Program, in which blind people of all ages are able to enjoy outdoor activities such as sailing, canoeing, hiking, and skiing.
48 Diabetes
Educational materials include brochures and pamphlets entitled 'Aids and Appliances Review,' 'Blindness,' and 'Facing the Wind.' Additional services include patient networking, community services for employment, and information on specialized devices such as canes, Braille watches, and talking products. Newsletters and referrals are also available by contacting the organization. Relevant area(s) of interest: Diabetes ·
Diabetes New Zealand Address: Diabetes New Zealand PO Box 54, Oamaru, , New Zealand Telephone: (03) 434-8100 Toll-free: (800) 342-2383 Email:
[email protected] Web Site: http://www.diabetes.org.nz Background: Diabetes New Zealand is a not-for-profit organization dedicated to acting as a national focal point for members and other interested parties in New Zealand who are affected by diabetes mellitus. This disorder is characterized by impaired carbohydrate, fat, and protein metabolism due to deficient production of insulin. Diabetes New Zealand is committed to acting as an advocate for people affected by diabetes, encouraging local support for affected individuals, and raising the level of awareness of diabetes, particularly concerning lifestyle changes that may reduce its frequency. The organization's additional objectives include providing information about diabetes and supporting research concerning the disorder's treatment, prevention, and cure. To help fulfill its mission and objectives, Diabetes New Zealand engages in a variety of activities including conducting annual meetings, lobbying government bodies for increased research funding, working to strengthen links with diabetes societies and programs in other countries, and conducting seminars for health professionals and allied health professionals. The organization also maintains a web site on the Internet and produces a variety of educational materials including leaflets, audiovisuals, and a national magazine entitled 'Breakthrough.'. Relevant area(s) of interest: Diabetes, Diabetes Mellitus
·
Endocrine Society Address: Endocrine Society 4350 East West Highway, Suite 500, Bethesda, MD 20814-4410 Telephone: (301) 941-0200 Toll-free: (800) 467-6663 Fax: (301) 941- 0259
Seeking Guidance 49
Email:
[email protected] Web Site: http://www.endo-society.org Background: The Endocrine Society is a not-for-profit organization dedicated to enhancing the understanding of hormonal communication at the molecular, cellular, and systems levels in order to promote improved prevention, diagnosis, and treatment of endocrine disorders. The human body has 11 major endocrine glands, including the adrenal, thyroid, pancreas, pituitary, and thymus glands. The endocrine glands and tissues secrete hormones, the substances that regulate the body's reproduction, growth, and development; its response to the environment; and the provision of energy and nutrients required for cell function. The Society, which was established in 1916 and currently consists of approximately 9,000 members in over 70 countries, is the world's largest organization dedicated to the research, study, and clinical practice of endocrinology. The scientists, educators, clinicians, practicing physicians, nurses, and students who make up the organization's membership represent all basic, applied, and clinical interests in endocrinology. Endocrinologists conduct research; provide treatment for a wide range of functions and disorders of the human body, including infertility, metabolic disorders, heart disease, glandular cancers, short stature, genetic dysfunction, diabetes, and hormonal imbalances; and develop new drugs and treatments through biogenetic and synthetic techniques. The Endocrine Society is dedicated to fostering a greater understanding of endocrinology among the general public and practioners of complementary medical disciplines; serving as a primary advocate and integrative force for clinicians and investigators; functioning as the major provider of services and information to the endocrine community and the general public; and promoting the interests of all endocrinologists at the national scientific research and health policy levels of government. The Society offers continuing medical education (CME) meetings and courses to keep the scientific and medical communities current concerning the latest research findings and treatments in the field; publishes four medical journals and a variety of additional professional publications; and conducts an annual meeting during which scientific and clinical papers are presented. The Endocrine Society also has a web site on the Internet that offers a series of fact sheets in lay terminology on various endocrine disorders; information on its journals and other professional publications; updates on scientific meetings, public affairs, and awards and grants; membership information; and linkage to endocrine related sites, such as fellow societies/organizations, patient education groups, and additional resources for scientists and physicians. Relevant area(s) of interest: Cushing's Syndrome, Diabetes
50 Diabetes
·
Gerontological Society of America Address: Gerontological Society of America 1030 15th Street NW, Suite 250, Washington, DC 20005-1503 Telephone: (202) 842- 1275 Toll-free: (800) 226-8464 Fax: (202) 842-1150 Email:
[email protected] Web Site: http://www.geron.org Background: The Gerontological Society of America (GSA) is a nonprofit professional organization dedicated to promoting ongoing scientific study of aging, encouraging exchanges among researchers and practitioners, and fostering the use of gerontological research in forming public policy. Established in 1945, the Society currently consists of over 6,000 members including biologists, physicians, nurses, other health care providers, sociologists, psychologists, social workers, policy planners, and program administrators. The Society offers a referral service that identifies experts and Society journal articles on all aspects of aging; provides networking opportunities with other professionals in the field of aging; conducts policy analysis and organizes seminars through its independent, nonprofit National Academy on Aging; and offers annual multidisciplinary conferences for researchers, scientists, and educators. The Society publishes several multidisciplinary scientific journals on gerontology; a monthly member newsletter entitled 'Gerontology News'; the National Academy on Aging's quarterly report entitled 'The Public Policy and Aging Report'; fact sheets; and several special publications on various aspects of aging. The Society also has a web site on the Internet at http://www.geron.org. Relevant area(s) of interest: Diabetes
·
Histiocytosis Association of America Address: Histiocytosis Association of America 302 North Broadway, Pitman, NJ 08071 Telephone: (609) 589-6606 Toll-free: (800) 548-2758 Fax: (609) 589-6614 Email:
[email protected] Web Site: http://www.histio.org Background: The Histiocytosis Association of America is a national notfor-profit organization committed to the promotion of scientific research into the Histiocytoses and the development of improved control and management of these diseases. The ultimate goal is medical research
Seeking Guidance 51
leading to the prevention and cure of Histiocytosis. Established in 1986, the Association seeks to provide solutions to problems that are specific to people who have Histiocytosis and offers support to affected individuals and their families. The Histiocytosis Association of America promotes public education and produces educational materials. These include brochures, a networking directory, and 'white papers' that are used in the evaluation of children with Langerhans Cell Histiocytosis (LCH) and other Histiocytoses. Diseases that are represented by the Association include Histiocytosis X, Langerhans Cell Histiocytosis, Letterer-Siwe Disease, Hand-Schuller-Christian Syndrome, Eosinophilic Granuloma, Pulmonary Granuloma, Hashimoto-Pritzker Syndrome, Langerhans Cell Granulomatosis, Familial Hemophagocytic Lymphohistiocytosis, VirusAssociated Hemophagocytic Lymphohistiocytosis, Xanthogranuloma, and Diabetes Insipidus with Langerhans Cell Histiocytosis. ·
International Diabetes Federation Address: International Diabetes Federation 1 rue Defacqz, Brussels, B1000, Belgium Telephone: 32-2-538-5511 Toll-free: (800) 441-1280 Fax: 32-2-538-51144 Email:
[email protected] Web Site: http://www.idf.org/ Background: The International Diabetes Federation (IDF) is a federation dedicated to working with its member associations to enhance the lives of people affected by diabetes mellitus, a condition characterized by impaired carbohydrate, fat, and protein metabolism due to deficient production or action of insulin. In type I diabetes, also known as insulindependent diabetes mellitus, little or no insulin is produced, resulting in an abrupt onset of such symptoms as abnormal thirst, excessive urination, extreme fatigue, constant hunger, blurred vision, irritability, and additional symptoms and findings. This condition, which usually becomes apparent during childhood or adolescence, requires administration of insulin. Type II diabetes, also known as non-insulindependent diabetes mellitus, is characterized by insufficient production of insulin, causing a gradual onset of fatigue, blurred vision, unusual thirst, frequent urination, and other abnormalities. This condition typically becomes apparent during adulthood and may often be controlled through diet, routine exercise, and oral medications. The International Diabetes Federation was established in 1950 and has evolved into an umbrella organization consisting of 147 national associations in 122 countries. The Federation has established several
52 Diabetes
programs to develop the IDF member associations and regions; supports fellowships and programs for the improvement of diabetes knowledge, research, and science; conducts an international congress for the global diabetes community known as the 'IDF Triennial Congress'; and sponsors an annual World Diabetes Day to raise awareness of the causes, symptoms, treatment, and complications of diabetes. Health care professionals who join the International Diabetes Federation may apply for grants for conducting research, participating in educational courses, or training in another country and have the opportunity to network with other health care professionals. In addition, all members of the Federation may network with other individuals concerned about diabetes; exchange information with others through the 'IDF Newsletter'; receive the 'IDF Bulletin,' which contains current information about diabetes issues, clinical research, and other diabetes-related news; and attend the Triennial Congress at discounted rates. The Federation also provides patient information on diabetes mellitus and has a web site on the Internet. Relevant area(s) of interest: Diabetes Mellitus ·
International Society for Alstrom Syndrome Families Address: International Society for Alstrom Syndrome Families 14 Whitney Farm Road, Mt. Desert, ME 04660 Telephone: (207) 288-6385 Toll-free: (800) 371-3628 Fax: (207) 288-6078 Email:
[email protected] or
[email protected] Web Site: http://www.jax.org/alstrom Background: The International Society for Alstrom Syndrome Families (SASF) is a voluntary not-for-profit organization for individuals with Alstrom syndrome, their families and friends, health care professionals, and all individuals whose lives have been touched by this rare disorder. Alstrom syndrome is a genetic disorder that is slowly progressive, affecting several organ systems. Affected individuals experience progressive degeneration of the nerve-rich membrane lining the eyes (retinitis pigmentosa), resulting in childhood blindness; mild to moderate deafness; glucose intolerance (non-insulin dependent diabetes mellitus) that develops in early adulthood; childhood obesity that often moderates to high-normal weight in adulthood; progressive kidney failure; congestive heart failure that becomes apparent during infancy, adolescence, or adulthood; and/or other symptoms and findings. Alstrom syndrome is inherited as an autosomal recessive trait. The International Society for Alstrom Syndrome Families was established by
Seeking Guidance 53
six affected families in 1995 and currently consists of approximately 100 members. The Society's primary objective is to lend support to families confronting the difficulties posed by Alstrom syndrome and to encourage and promote the idea of families helping other families. The organization is committed to providing information, support, resources, and networking opportunities to affected individuals and family members; promoting and encouraging genetic research with the hope of determining the cause and developing a therapy for Alstrom syndrome and related disorders; and facilitating genetic testing for carrier status for family members. In addition, the International Society for Alstrom Syndrome Families offers an information resource and reference library for families, physicians, and any associated professionals who have an interest in Alstrom syndrome and maintains a web site on the Internet designed to serve as a central repository for such information. The Society is also committed to increasing public awareness of Alstrom syndrome; raising and providing funds for medical assistance and equipment, such as specially adapted computers and other aids for individuals with visual and hearing impairment; and sponsoring regular family gatherings for members. ·
JDF The Diabetes Research Foundation Address: JDF The Diabetes Research Foundation 89 Granton Avenue, Richmond Hill, Ontario, L4B 2N5, Canada Telephone: (905) 889- 4171 Toll-free: (800) 287-2533 Fax: (905) 889-4209 Email:
[email protected] Web Site: http://www.jdfc.ca Background: JDF The Diabetes Research Foundation is an international not-for- profit organization in Canada dedicated to raising funds to support and promote diabetes research. Diabetes is a chronic metabolic disorder that affects the body's ability to properly manufacture or utilize insulin, a hormone necessary for the body to transport food glucose into cells for energy. There are several types of diabetes including InsulinDependent Diabetes Mellitus, IDDM (also known as Juvenile Diabetes); Non-Insulin Dependent (Type II, also known as Adult-Onset Diabetes); and Gestational Diabetes. Established in 1974 and consisting of 14 chapters, JDF supports research advances in therapies to reduce the risk of diabetes- caused blindness, decrease the number of amputations due to diabetes, and control high blood pressure associated with diabetes; disease management practices that help maintain tight control of glucose levels to prevent or delay complications of diabetes; and practices that
54 Diabetes
afford women with diabetes the opportunity for safe pregnancies and healthy children. JDF also supports advancements in methods to detect the earliest signs of diabetes; therapeutic treatments to prevent or delay the disease's onset; experimental techniques for programming cells from outside the pancreas to produce insulin; and research that has contributed to the increased understanding of transplantation immunology, which has helped to make transplantation of pancreatic tissue a reality. JDF publishes a quarterly magazine entitled 'Countdown Canada,' regularly produces 'Research News Updates,' and has a web site on the Internet at http://www.jdfc.ca. Relevant area(s) of interest: Diabetes ·
Juvenile Diabetes Foundation Australia Address: Juvenile Diabetes Foundation Australia Level 1, 48 Atchison Street, St. Leonards, New South Wales, 2065, Australia Telephone: 02 9966 0400 Toll-free: (877) 223-4766 Fax: 02 9966 0172 Email:
[email protected] Web Site: http://www.jdfa.org.au Background: The Juvenile Diabetes Foundation Australia (JDFA) is a notfor- profit organization affiliated with the Juvenile Diabetes Foundation International in the United States. Established in 1982, the Foundation is dedicated to funding basic and applied medical research to help discover a cure for diabetes and prevent its complications. Juvenile diabetes, also known as insulin-dependent diabetes or type I diabetes mellitus, is characterized by impaired carbohydrate, fat, and protein metabolism due to deficient production of insulin. This form of diabetes is an autoimmune disease in which insulin-secreting cells of the pancreas are destroyed due to an abnormal immune response. Associated symptoms, which often become apparent between 10 to 16 years of age, have an abrupt onset and typically include excessive thirst and urination, weight loss, blurred vision, and other findings. The Juvenile Diabetes Foundation Australia is committed to promoting and supporting scientific research; providing educational resources that are specific to the needs of children, young adults, and family members affected by juvenile diabetes; engaging in advocacy and lobbying efforts; and providing networking opportunities that enable those affected by juvenile diabetes to exchange information, resources, and mutual support. The Foundation also provides its members with the latest information on diabetes research and treatment through regular newsletters and its international research magazine, entitled 'Countdown.' In addition, the Foundation has
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a web site on the Internet that provides research updates, the JDFA calendar of events, a directory of JDFA chapters, the organization's research magazine, and understandable information on juvenile diabetes, including sections entitled 'Juvenile Diabetes, The Signs and Key Facts,' 'Insulin - A Guide to Its Usage,' and 'Glossary of Terms.'. Relevant area(s) of interest: Diabetes, Diabetes Mellitus ·
Juvenile Diabetes Foundation International Address: Juvenile Diabetes Foundation International 120 Wall Street, 19th Floor, New York, NY 10005-4001 Telephone: (212) 785-9500 Toll-free: (800) 533-2873 Fax: (212) 785-9595 Email:
[email protected] Web Site: http://www.jdfcure.org Background: Juvenile Diabetes Foundation International is a national voluntary health agency dedicated to supporting and funding research into the cause, treatment, prevention, and cure of diabetes, a chronic metabolic disorder that affects the body's ability to properly manufacture or utilize insulin, a hormone necessary for the body to transport food glucose into cells for energy. Juvenile Diabetes, also known as InsulinDependent Diabetes or Diabetes Mellitus Type I, most commonly becomes apparent in affected individuals between the ages of 10 to 16 years. Founded in 1970, the Foundation also provides information, assistance, and support to affected individuals; promotes public awareness; provides referrals; and offers a variety of educational materials including brochures and fact sheets. Relevant area(s) of interest: Diabetes
·
Mainstream, Inc Address: Mainstream, Inc. 3 Bethesda Metro Center, Suite 830, Bethesda, MD 20814 Telephone: (301) 654-2400 Toll-free: (800) 222-6374 Fax: (301) 654-2403 Email:
[email protected] Background: Mainstream, Inc. is a nonprofit organization dedicated to improving competitive employment opportunities for persons with disabilities. Established in 1975, Mainstream was founded by Harold E. Krents, a graduate of Harvard Law School. His credentials and talents
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were seemingly useless in a business environment that judged him by his disability (blindness). He decided to change this for himself and all persons with disabilities by establishing Mainstream. Mainstream provides specialized services and acts as a bridge that links service providers, employers, and persons with disabilities. To achieve its goals, the organization provides its constituents with training, educational publications, and videos on disability employment issues. Educational materials include a magazine entitled 'Employment In the Mainstream' that reports on the latest trends and developments affecting the employment of Americans with disabilities. A brochure and audio- visual aids are also available. Programs include Project LINK, a model employment service program for persons with disabilities in Dallas, TX and Washington D.C., as well as the Disability Employment Network, a pilot program that provides counseling and referral services to job hunters in the New York City area. Relevant area(s) of interest: Diabetes ·
March of Dimes Birth Defects Foundation Address: March of Dimes Birth Defects Foundation 1275 Mamaroneck Avenue, White Plains, NY 10605 Telephone: (914) 428-7100 Toll-free: (888) 663-4637 Fax: (914) 997-4763 Email:
[email protected] Web Site: http://www.modimes.org Background: The March of Dimes Birth Defects Foundation is a national not-for- profit organization that was established in 1938. The mission of the Foundation is to improve the health of babies by preventing birth defects and infant mortality. Through the Campaign for Healthier Babies, the March of Dimes funds programs of research, community services, education, and advocacy. Educational programs that seek to prevent birth defects are important to the Foundation and to that end it produces a wide variety of printed informational materials and videos. The March of Dimes public health educational materials provide information encouraging health- enhancing behaviors that lead to a healthy pregnancy and a healthy baby. Relevant area(s) of interest: Cystic Fibrosis, Diabetes Insipidus
·
Metabolic Information Network Address: Metabolic Information Network (PHYSICIAN CALLS ONLY) P.O. Box 670847, Dallas, TX 75367-0847
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Telephone: (214) 696-2188 Toll-free: (800) 945-2188 Fax: (214) 696-3258 Email:
[email protected] Background: The Metabolic Information Network (MIN) is a not-forprofit organization dedicated to facilitating research and enhancing care of families affected by inborn errors of metabolism. Established in 1989, the organization publishes a newsletter, a directory, and reports. The Network maintains a Case Register for 10 groups of disorders (representing 86 diagnoses); a physician directory for 200 inborn errors of metabolism; and a listing of worldwide genetic, and a listing of worldwide genetic metabolic patient registries and patient databases. Research investigators and other health care professionals may use the MIN database. Information in the case database for any genetic metabolic disorder includes contact information, relevant diagnoses based on McKusick Codes, 1CD9 codes, and whether tracking/outcome assessment is performed. The progress of these cases is tracked on an annual basis. The MIN case and master databases contain no patient names. Research investigators and other professionals may obtain individual case details only by contacting physicians associated with a particular case recorded in the database. Relevant area(s) of interest: Diabetes Insipidus ·
National Disease Research Interchange Address: National Disease Research Interchange 1880 JFK Boulevard, 6th Floor, Philadelphia, PA 19103 Telephone: (215) 557-7361 Toll-free: (800) 222-6374 Fax: (215) 557-7154 Email:
[email protected] Web Site: http://www.infogen.com/ndri Background: The National Disease Research Interchange (NDRI) is a national not- for-profit agency dedicated to the procurement, preservation, and distribution of high quality human cells, tissues, and organs to researchers studying over 100 diseases. The NDRI was founded in 1980 in response to requests from the biomedical research community for human tissues to corroborate their animal studies. The NDRI, which is funded by the National Center for Research Resources of the National Institutes of Health (NIH), has supplied over 125,000 tissue samples to over 2,200 researchers in the United States, Canada, and some European locations. In addition to NDRI's Human Tissues and Organs for Research (HTOR) program, which focuses on the retrieval and distribution of basic
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tissues and organs (e.g., whole and partial brains and related tissues, cardiovascular tissues, kidneys, livers, respiratory organs, human eyes, human bones and joints), the agency has developed a series of programs relevant to scientific research. These programs include the Human Biological Data Interchange (HBDI), a diabetes research program dedicated to immortalizing cell lines, and extracting DNA from families with diabetes. NDRI maintains a database of more than 7,000 case histories of families with diabetes. The Odyssey I program was established to coordinate the developing uses of tissues and organs for research that hold promising advances for science. These include the utilization of normal pancreatic tissue for the extraction of islet cells for therapeutic studies in treating diabetes as well as analyzing the therapeutic and scientific potential of human bone marrow stem cells. NDRI has also sponsored a number of technical developments including creating a network of leading scientists that help scientific researchers develop the most appropriate protocols for organ retrieval; developing special software for matching tissues to projects; developing and maintaining a database of scientific researchers who use human cells, tissues, and organs in their research; and developing kits to help institutions retrieve organs as easily and efficiently as possible while assuring standardization and quality control for research purposes. Research utilizing NDRI materials has resulted in more than 500 publications in the medical literature. A listing of these publications is available upon request. ·
National Federation of the Blind Address: National Federation of the Blind 1800 Johnson Street, Baltimore, MD 21230 Telephone: (410) 659-9314 Toll-free: (800) 598- 4668 Fax: (410) 685-5653 Email:
[email protected] Web Site: http://www.nfb.org Background: The National Federation of the Blind is a national, voluntary not-for- profit organization dedicated to providing information and support to individuals who are blind, their families, and professionals; ensuring complete integration of affected individuals into society; and acting as a vehicle for collective self-expression of the blind. Established in 1940, the organization, which has over 50,000 members, has more than 600 affiliates throughout the United States. The Federation engages in patient and family advocacy; provides job opportunities in cooperation with the Department of Labor; offers referrals and scholarships; and
Seeking Guidance 59
assists in the development and evaluation of technology for blind individuals. The Federation provides appropriate medical and support referrals; promotes and supports research; and provides a variety of aids and devices for affected individuals. The Federation also offers a wide range of educational and support materials for affected families and professionals. These include a monthly publication entitled 'The Braille Monitor'; quarterly publications, such as 'Future Reflections' for parents and educators and 'Voice of the Diabetic'; brochures; and audio tapes. ·
National Kidney Foundation of Connecticut, Inc Address: National Kidney Foundation of Connecticut, Inc. 920 Farmington Avenue, West Hartford, CT 06107 Telephone: (860) 232-6054 Toll-free: (800) 441-1280 Fax: (860) 236-1367 Email: None Web Site: None Background: The National Kidney Foundation (NKF) of Connecticut is a voluntary, not-for-profit, service organization dedicated to preventing kidney and urinary diseases and improving care and services for affected individuals through research, public and professional education, and patient services. Established in 1964, NKF of CT provides information on kidney disease, stones, kidney failure, dialysis, diabetes, and high blood pressure. It conducts Quality-of-Life conferences for dialysis and transplant patients; holds Pre-Dialysis Orientation for patients and families; educates nurses about their role in the organ donation process; and makes research funds available to renal physicians, nurses, social workers, and dietitians to encourage new investigators. The Foundation also funds a Research Database of kidney and urology patients in Connecticut as a resource for scientific research. In addition, the Foundation creates specialized task forces; holds patient forums and annual medical symposia; and offers patient services, including financial assistance and medical identification jewelry. The Foundation also offers referrals and provides educational and support information through its database, quarterly newsletter, new patient information packets, annual reports, audio-visual materials, and pamphlet series. Relevant area(s) of interest: Diabetes
·
Nephrogenic Diabetes Insipidus Parent Support Group of CHOP Address: Nephrogenic Diabetes Insipidus Parent Support Group of CHOP c/o Mary Evans-Lee, 452 N. Charlotte Street, Pottstown, PA 19464
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Telephone: (610) 326-7955 Toll-free: (800) 598- 4668 Fax: (215) 590-3705 Background: The Nephrogenic Diabetes Insipidus Parent Support Group is a self- help organization dedicated to providing information and support to individuals and families affected by Diabetes Insipidus. Diabetes Insipidus is a rare metabolic disease that is characterized by a deficiency of the hormone vasopressin (anti-diuretic hormone [ADH]), which is produced in the posterior lobe of the pituitary gland. Excessive thirst and urination are the major symptoms of this disorder. The NDI Parent Support Group's mission is to let affected families know that there are others with this condition. Established in 1995 and consisting of 20 members and one chapter, the group publishes two newsletters each year and expects to publish a pamphlet directed toward caregivers and schools. The organization maintains coordinates an active networking program and telephone support system. Relevant area(s) of interest: Diabetes Insipidus, Neurohypophyseal ·
Research Trust for Metabolic Diseases in Children Address: Research Trust for Metabolic Diseases in Children The Quadrangle, Crewe Hall, Weston Road, Crewe, Cheshire, CW1 6UR, United Kingdom Telephone: 1270 250221 Fax: 1270 250244 Web Site: http://www.RTMDC.org.uk Background: The Research Trust for Metabolic Diseases in Children (RTMDC) is an international voluntary health agency located in the United Kingdom. Established in 1981, the Trust is dedicated to furthering medical research into the nature of metabolic diseases in children; encouraging the ongoing investigations of the prenatal diagnosis of these diseases; providing information, counseling, and financial support to caregivers; and providing information to health care professionals. In addition, the organization is dedicated to assisting in the care of affected children in hospitals, homes, or institutions and educating the public about metabolic diseases. The Research Trust for Metabolic Diseases networks parents of affected children for mutual benefit and support. The Trust also provides a regular newsletter, brochures, videos, and other educational materials. Relevant area(s) of interest: Diabetes Insipidus
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Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about diabetes. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “diabetes” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “diabetes”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “diabetes” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with diabetes. You should check back periodically with this database since it is updated every 3 months.
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The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “diabetes” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective. ·
Children with Diabetes http://www.childrenwithdiabetes.com
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About Diabetes http://diabetes.about.com
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Diabetes and Health http://www.diabetesandhealth.com
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with diabetes must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
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·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
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Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
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Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 11 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
Finding an Endocrinologist The American Association of Clinical Endocrinologists (AACE) sponsors a Physician Finder database located at http://www.aace.com/memsearch.php. Physician Finder allows you to search for endocrinologists who are members of the AACE by specialty, city, state, or country. According to the AACE: “Members of AACE are physicians with special education, training and interest in the practice of clinical endocrinology. These physicians devote a While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11
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significant part of their career to the evaluation and management of patients with endocrine disease. All members of AACE are physicians (M.D. or D.O.) and a majority is certified by Boards recognized by the American Board of Medical Specialties. Members of AACE are recognized clinicians, educators and scientists, many of whom are affiliated with medical schools and universities. Members of AACE contribute on a regular and continuing basis to the scientific literature on endocrine diseases and conduct medical education programs on this subject.”12 If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
Selecting Your Doctor13 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about diabetes?
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Really listen to my questions?
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Answer in terms I understood?
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Show respect for me?
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Ask me questions?
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Make me feel comfortable?
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Address the health problem(s) I came with?
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Ask me my preferences about different kinds of treatments for diabetes?
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Spend enough time with me?
Quotation taken from the AACE’s Web site: http://www.aace.com/memsearch.php. section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 12
13 This
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Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor14 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
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It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
·
Bring a “health history” list with you (and keep it up to date).
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Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
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Tell your doctor about any natural or alternative medicines you are taking.
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Bring other medical information, such as x-ray films, test results, and medical records.
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Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
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Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
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Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
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Ask your doctor to draw pictures if you think that this would help you understand.
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Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
14
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·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
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After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:15 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
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Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
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Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
15
Clinical Trials 67
CHAPTER 3. CLINICAL TRIALS AND DIABETES Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning diabetes.
What Is a Clinical Trial?16 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for diabetes is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
16
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What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on diabetes.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for diabetes compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?
Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on diabetes carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on diabetes. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham treatment.” This
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treatment, like a placebo, has no effect on diabetes and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how diabetes develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for diabetes. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history. If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo
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surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Diabetes The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to diabetes.17 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
A Research Study to assess the mechanism by which Glucovance, Metformin, and Glyburide work to control glucose levels in Patients with Type 2 Diabetes Condition(s): Diabetes Mellitus, Non-Insulin-Dependent Study Status: This study is currently recruiting patients. Sponsor(s): Bristol-Myers Squibb Purpose - Excerpt: The purpose of this clinical research study is to support earlier observations that Glucovance controls glucose levels after a mean, and improves overall glucose control better than metformin or glyburide therapy alone in adults with type 2 diabetes. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below
17
These are listed at www.ClinicalTrials.gov.
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·
A Research Study to determine the safety and efficacy of Glucovance Compared to Metformin and Glyburide in Children and Adolescents with Type 2 Diabetes. Condition(s): Diabetes Mellitus, Non-Insulin-Dependent Study Status: This study is currently recruiting patients. Sponsor(s): Bristol-Myers Squibb Purpose - Excerpt: The purpose of this clinical research study is to see if Glucovance, a medication currently approved for use in adults with type 2 diabetes, can control type 2 diabetes safely and effectively in children 10 to 16 years of age. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below
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Achilles Tendon Lengthening in Patients with Diabetes to Prevent Foot Ulcers Condition(s): Diabetes Mellitus; Foot Ulcer; Peripheral Neuropathy Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: People with diabetes often develop severe skin problems (ulcers) on their feet. Sometimes these are treated with surgery and other times by temporarily immobilizing the foot in a cast. This study compares the effect of surgery to lengthen the Achilles tendon and put the foot in a cast, to using a cast alone. The study will also examine how foot strength, joint movement, and overall ability to walk, balance and climb stairs is affected. Phase(s): Phase I Study Type: Interventional Contact(s): Jennifer Henry 1-314-286-1439
[email protected]; Missouri; Barnes-Jewish Hospital, Orthopedic Surgery, St. Louis, Missouri, 63110, United States; Recruiting; Shannon Clouse, Medical Assistant 314-747-2584
[email protected]. Study chairs or principal investigators: Michael J. Mueller, Ph.D., P.T., Principal Investigator; Program in Physical Therapy, Washington University
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Acute Glycemic Effects of a Very Low Fat Diet in Type 2 Diabetes Condition(s): Diabetes Mellitus, Non-Insulin-Dependent
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Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); Duke University; Procter & Gamble Pharmaceuticals; Jenny Craig Purpose - Excerpt: There is some consensus that high fat diets can contribute to the development of obesity and type 2 diabetes in humans and animals. An increase in dietary fat has been shown to produce obesity and diabetes in mice; such diet-induced diabetes can be reversed by reducing the fat in the diet. In humans, there is some evidence that low-fat diets can produce acute improvements in blood sugar control in type 2 diabetes-even in the absence of weight loss. In most human studies, however, dietary fat reduction has been accompanied by a reduction in total calorie intake. It is thus not possible to separate the effects of these 2 metabolic changes. The purpose of this study is to gather preliminary information on the effect of a very-low-fat diet on blood metabolism in persons with type 2 diabetes. The design incorporates controlled feeding procedures, and 30 men and women with type 2 diabetes will be given all foods for 4 weeks--a 2-week diet standardization period (diet composition: 35% fat, 15% protein, 50% carbohydrate), followed by a 2-week experimental diet period. The experimental diet conditions are A) continuation of the moderately-highfat standardization diet, or B) a very-low-fat diet composed of 10% fat, 15% protein, 75% carbohydrate. Outcomes will be measured after the standardization and the experimental periods. The primary outcome variable is fasting plasma glucose; secondary outcomes are fasting insulin, carbohydrate (meal) tolerance, insulin secretion and blood lipids. In addition, we will gather descriptive data on the potential acceptability and utility of a very-low-fat diet constructed using the fat substitute, olestra (sucrose polyester). There are no results yet. Study Type: Interventional Contact(s): Cynthia McCaskill, R.N., Study Coordinator 1-919-684-3019; North Carolina; Duke University Medical Center, Durham, North Carolina, 27710, United States; Recruiting; Cynthia McCaskill, RN 919684-3019; Richard S. Surwit, Ph.D., Principal Investigator. Study chairs or principal investigators: Richard S. Surwit, Ph.D., Principal Investigator ·
Education and Group Support for Diabetic Hispanics Condition(s): Diabetes Mellitus, Non-Insulin-Dependent Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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Purpose - Excerpt: The purpose of this ongoing work in Starr County, located on the Texas-Mexico border, is to conduct clinical studies to determine the effectiveness of diabetes self-management programs designed specifically for Mexican Americans. The programs meet national standards for diabetes self-management education. They are provided in community settings with the primary purpose of improving the health of Mexican Americans with diabetes and their family members, who either have diabetes or are at risk for developing diabetes. The diabetes self-management programs are provided in Spanish and are directed by bilingual Hispanic clinical nurse specialists, dietitians, and community health workers. Key elements of the programs include instruction on nutrition, self-monitoring of blood glucose, exercise, and other diabetes self-management topics, as well as group support to promote behavioral changes. In the original study (1994-1998), 256 Mexican American adults diagnosed with type 2 diabetes and 256 family members or other support persons were enrolled. For one year, the people with diabetes, along with their family members, attended small group sessions held in churches, community health clinics, adult day care centers, and schools. Information on the effectiveness of the program was collected at 3, 6, and 12 months; and annually thereafter. Findings of the original study suggested that the program had a positive impact on diabetes metabolic control. Levels of diabetes knowledge and rates of glucose self-monitoring and attendance suggested that a shorter program - one that incorporated critical elements of the previous successful strategy - might result in similar improvements. Thus, the goal of the new study, funded in June 1999, was to shorten the original program and to compare it to the previous successful program in terms of short- and long-term health outcomes. To identify key components of the previous program, we are exploring differences between subjects who successfully integrated self-care components of the program and who experienced significant improvements in metabolic control and those who were not as successful. The program is being revised and shortened, based on this information. Beginning in April 2000, we will start recruiting participants for the clinical trial of the revised program. Study Type: Interventional Contact(s): Texas; The University of Texas at Austin, Austin, Texas, 78701, United States; Recruiting; Starr County Diabetes Education Study Project Manager 512-471-9909
[email protected]. Study chairs or principal investigators: Sharon A. Brown, Principal Investigator; The University of Texas at Austin
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Evaluation of the Effect on Glucose Control of AC2993 in Patients With Type 2 Diabetes Mellitus Condition(s): Diabetes Mellitus, Type 2 Study Status: This study is currently recruiting patients. Sponsor(s): Amylin Pharmaceuticals Purpose - Excerpt: This is a multicenter, randomized, blinded, placebocontrolled study to assess the effects on glucose control of AC2993 as compared to placebo in patients with type 2 diabetes. Patients will be randomized into one of two AC2993 treatment arms or to placebo treatment and will continue with their required existing diabetes medications (metformin and a sulfonylurea) throughout the study. Phase(s): Phase III Study Type: Interventional Contact(s): There are multiple sites in this clinical trial 1 (866) 823-7632; Pennsylvania; NATIONWIDE - For information on a site near you, please call our call center toll-free at 1 (866) 823-7632, Jamison, Pennsylvania, United States; Recruiting
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Evaluation of the Effect on Glucose Control of AC2993 in Patients With Type 2 Diabetes Mellitus Treated With a Sulfonylurea Condition(s): Diabetes Mellitus, Non-Insulin-Dependent Study Status: This study is currently recruiting patients. Sponsor(s): Amylin Pharmaceuticals Purpose - Excerpt: This is a multicenter, randomized, blinded, placebocontrolled study to assess the effects on glucose control of AC2993 as compared to placebo in patients with type 2 diabetes. Patients will be randomized into one of two AC2993 treatment arms or to placebo treatment and will continue with their required existing diabetes medication (sulfonylurea) throughout the study. Phase(s): Phase III Study Type: Interventional Contact(s): There are multiple sites nationwide in this clinical trial 1 (866) 823-7632; Pennsylvania; NATIONWIDE - For information on a site near you, please call our call center toll-free at 1 (866) 823-7632, Jamison, Pennsylvania, United States; Recruiting
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·
Evaluation of the Effect on Glucose Control of AC2993 in Patients With Type 2 Diabetes Mellitus Treated With Metformin Condition(s): Diabetes Mellitus, Type 2 Study Status: This study is currently recruiting patients. Sponsor(s): Amylin Pharmaceuticals Purpose - Excerpt: This is a multicenter, randomized, blinded, placebocontrolled study to assess the effects on glucose control of AC2993 as compared to placebo in patients with type 2 diabetes. Patients will be randomized into one of two AC2993 treatment arms or to placebo treatment and will continue with their required existing diabetes medication (metformin) throughout the study. Phase(s): Phase III Study Type: Interventional Contact(s): There are multiple sites nationwide in this clinical trial 1 (866) 823-7632; Pennsylvania; NATIONWIDE - For information on a site near you, please call our call center toll-free at 1 (866) 823-7632, Jamison, Pennsylvania, United States; Recruiting
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Genetic Studies of Insulin and Diabetes Condition(s): Diabetes Mellitus; Insulin Resistance Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The study will allow researchers to obtain blood, plasma, DNA, and RNA for genetic studies of insulin. There will be a focus on the causes of insulin resistance and diabetes mellitus. Insulin is a hormone found in the body that controls the level of sugar in the blood. Insulin resistance refers to conditions like diabetes when insulin does not work properly. In this study researchers would like to compare patients with diabetes and other forms of insulin resistance to normal individuals. The study will investigate how insulin attaches to cells. Researchers will take 4 to 6 ounces (100-150 ml) of blood from adult patients and may request up to 12 ounces (one unit) of blood if necessary. Skin samples may be taken for a biopsy if further genetic testing is necessary. In addition some patients may be asked not to eat for up to 72 hours prior to testing. Study Type: Observational Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland,
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20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 ·
Glycemic control and complications in Diabetes Mellitus Type 2 (VADT) Condition(s): Type 2 diabetes mellitus Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program; ADA Purpose - Excerpt: This study is a prospective, 2-arm, randomized controlled trial to determine whether glycemic control, achieved through intensification of treatment, is effective in preventing clinical macrovascular complications in patients with type 2 DM who are no longer responsive to oral agents alone. The study consists of a two-year accrual period and five years of follow-up (7 years total) of 1700 patients across 20 centers. We have powered the study to detect a 25% reduction in the primary event rate. Additional study goals are to determine whether the expenditures, discomfort, and adverse effects associated with intensive intervention are justified in terms of their clinical benefits, considering both macrovascular and microvascular complications. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below
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Ingested Interferon Alpha: Prolongation or Permanence of the "Honeymoon" Phase in Newly Diagnosed Type 1 Diabetes Mellitus Condition(s): Diabetes Mellitus, Type 1 Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: We hypothesize that ingested human recombinant interferon-alpha (hrIFN-a) will prolong the "honeymoon" period and enhance B cell survival in type 1 diabetes in a phase II randomized, placebo-controlled, double-blind clinical trial. We have demonstrated that ingested IFN-a prevents type 1 diabetes in the NOD mouse, prolongs the "honeymoon" period in newly diagnosed type 1 diabetics, and delays murine islet allograft rejection. The natural history of type 1 diabetes is unique for a phase frequently referred as the "honeymoon," a period in which the insulin need becomes minimal and glycemic control improves. The B cell (the insulin producing cell) partially recovers. However, as
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with all honeymoons, they end and the patient becomes completely insulin-deficient. The general consensus of the international diabetes community is to test potential preventive therapies for type 1 diabetes in newly diagnosed patients. Prolongation of the honeymoon as the reversal of the disease is considered a positive result. In this phase II randomized, double-blind, parallel-design clinical trial we will determine whether ingested (oral) human recombinant IFN-a will prolong the "honeymoon" period and increase counterregulatory anti-inflammatory cytokine(s). We will determine the safety and efficacy of 30,000 units ingested hrIFN-a vs placebo in eighty patients with newly diagnosed type 1 diabetes in a phase II trial for one year. Primary outcome measures will be a 30% increase in C-peptide levels released after Sustacal stimulation at 3, 6, 9, and 12 months after entry. Secondary outcome will be decreasing titers of islet cell antibodies (ICA). If successful, a larger and longer phase III trial of prevention of type 1 diabetes in high risk patients will be undertaken. We will also determine if ingested hrIFN-a increases IL-4, IL-10 or IFN-a production in peripheral blood mononuclear cells (PMNC) from patients with recent onset type 1 diabetes. Phase(s): Phase II Study Type: Interventional Contact(s): Staley Brod, M.D. 1-713-500-7046
[email protected]; Texas; Dept. of Neurology, Rm MSB 7.044 Univ. of Texas-Houston Medical School, Houston, Texas, 77030, United States; Recruiting; Staley Brod, M.D. 713-500-7046
[email protected]; Staley Brod, M.D., Principal Investigator ·
Interferon-Alpha for Diabetes Mellitus Type 1 Condition(s): Insulin-Dependent Diabetes Mellitus Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: This study will examine whether interferon alpha can prevent or minimize the risk of complications from diabetes type 1. This type of diabetes results when the body's immune system attacks cells in the pancreas that produce insulin, a hormone that helps regulate blood sugar levels. Many common complications of diabetes, such as blindness, kidney failure, nerve damage and artery disease leading to heart attacks and strokes, are related to high blood sugar. This study will see if interferon alpha, given early in the disease, can stop or slow the immune attack on insulin-producing cells. Animal experiments have shown that interferon alpha taken by mouth may stop the development of diabetes.
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Patients between 3 and 25 years of age with type 1 diabetes mellitus of less than 6 weeks duration may be eligible for this study. Candidates undergo a medical history, physical examination, routine and research blood tests, a urine test and a Boost stimulation test. For the Boost test, patients fast overnight and do not take the next morning's insulin dose. A blood sample is drawn to measure fasting sugar and C-peptide levels. The patient then drinks a food supplement (Boost High Protein) and blood draws are repeated for sugar and C-peptide measurements at 15, 30, 60, 90 and 120 minutes after ingesting the liquid. Participants are randomly assigned to treatment with either interferon alpha or placebo (an inactive, look-alike substance) once a day by mouth for up to 12 months. The active compound consists of either 5,000 or 30,000 units of interferon alpha in a tablespoon of salt water; the placebo consists of salt water alone. Follow-up visits are scheduled at 1, 2, 3, 6, 9 and 12 months for a repeat Boost test, routine and research blood tests, and a physical examination to evaluate possible drug effects. A small blood sample will be drawn for HLA-typing, a genetic test similar to blood typing, to examine the makeup of genes thought to affect diabetes. The results of the genetic studies will be kept confidential. Patients who finish 12 months of treatment before the entire study ends may decide to continue treatment until all study patients completed the protocol. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 ·
Islet Cell Transplantation Alone in Patients with Type I Diabetes Mellitus: steroid-free immunosuppression Condition(s): Diabetes Mellitus, Type 1 Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The goal of islet cell transplantation in patients with Type 1 Diabetes Mellitus is to provide constant normal blood glucose levels. This may eliminate the need for insulin altogether or provide a significant reduction in the amount of insulin necessary to maintain constant normal blood glucose levels. This normalization may prevent or slow progression of diabetic complications. Furthermore, the participant may enjoy a healthier lifestyle and a better quality of life. If you meet the
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initial inclusion criteria for the trial, you must be able to give informed consent personally. Then you will need to participate in an extensive screening process that involves many standard tests and collection of laboratory samples to make sure that the transplant is suitable and safe for you. Phase(s): Phase II Study Type: Interventional Contact(s): Florida; University of Miami Diabetes Research Institute, Miami, Florida, 33136, United States; Recruiting; Patient Recruitment Office 305-243-5321 islet@ med.miami.edu. Study chairs or principal investigators: Rodolfo Alejandro, MD, Study Director; University of Miami Diabetes Research Institute ·
Lactobacillus plantarum as therapy for NK-T cell deficiency Condition(s): Diabetes Mellitus Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: The etiology of immune-mediated diabetes mellitus (IMD) remains unclear. However, previous studies indicate that autoimmunity may be a result of dysfunction of natural killer T cells (NK-T cells). Newly diagnoses patients with IMD have been shown in our laboratory to have significantly lower NK-T cells than normal controls. Other studies have shown that oral administration of lactobacillus can boost NK-T cell activity in children with HIV without side effects. Our objective is to evaluate the effect of lactobacillus administration on NK-T cell activity in patients with IMD Study Type: Interventional Contact(s): New York; Cornell University, New York, New York, 10021, United States; Recruiting; Noel K. Maclaren 212-746-1185
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Look AHEAD: Action for Health in Diabetes Condition(s): Diabetes; Myocardial Infarction; Stroke; Kidney Diseases; Bone Diseases; Dyslipidemia Study Status: This study is currently recruiting patients. Sponsor(s): Office of Research on Women's Health (ORWH) Purpose - Excerpt: The Look AHEAD study is a multicenter, randomized clinical trial to examine the long-term effects of a lifestyle intervention designed to achieve and maintain weight loss. The study will investigate
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the effects of the intervention on heart attacks, stroke and cardiovascularrelated death in individuals with type 2 diabetes who are also overweight or obese. Study Type: Interventional Contact(s): see Web site below ·
Obese Patients with Type 2 Diabetes Condition(s): Obesity; Obesity in Diabetes
Diabetes
Mellitus,
Non-Insulin-Dependent;
Study Status: This study is currently recruiting patients. Sponsor(s): Sanofi-Synthelabo Purpose - Excerpt: To assess the effect on weight loss and weight maintenance over a period of one year when prescribed with a hypocaloric diet in obese patients with Type 2 Diabetes Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below ·
Periodontal Care and Glycemic Control in Diabetes Condition(s): Diabetes Mellitus; Periodontal Disease Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Health Services Research and Development Service; ColgatePeriogard-Dentsply Purpose - Excerpt: Diabetes is a prevalent and costly disease among users of VA care. The Veterans Health Administration's (VHA: National Diabetes Working Group,1997) estimated that 15% of all veterans receiving VA outpatient care have diabetes. Important goals of diabetic care are the prevention and/or delay of complications through glycemic control. However, the most efficient and effective ways to improve glycemic control are not clear. The American Academy of Periodontology (1996) described a strong connection between diabetes and periodontal disease. This project will assess the effectiveness and costs of specific interventions designed to improve glycemic control in poorly controlled diabetics. Specifically, we will: 1. Determine the effectiveness of an aggressive program of periodontal screening and therapy in improving the level of glycemic control in poorly controlled diabetics. 2. Examine whether continued maintenance over a 12-month period provides
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sustained or further improvement in glycemic control. 3. Measure the impact of this care on patient satisfaction with diabetes care, and oralspecific and general health-related quality of life. 4. Identify the costs of providing periodontal screening, aggressive therapy, and continued maintenance. Research Design: We are conducting a randomized clinical trial in 300 poorly controlled non-insulin dependent diabetics receiving medical care in VHA outpatient clinics in the Boston area. Methods: Dentate diabetic patients with HbA1c levels of 9.5% or greater and at least 8 teeth will be invited to participate. Patients who agree to participate will have a repeat HbA1c determination. If their HbA1c remains at or above 9%, they will be randomly assigned to one of two groups. The first is the immediate experimental (EXP) group. Persons in the EXP group will receive an immediate periodontal evaluation and aggressive, initial periodontal therapy at baseline. The second group (USUAL) will receive the periodontal evaluation and treatment 4 months after enrollment. Only the timing of the initial periodontal evaluation and therapy will vary. Participants in both groups will be screened for periodontal disease using the Community Periodontal Index of Treatment Need (CPITN: Ainamo,1982). Persons with CPITN scores of 3 or 4 in at least two areas of the mouth will be enrolled and receive initial periodontal therapy. The primary measure for the effectiveness of periodontal screening and therapy will be the comparison of the change in HbA1c levels at 4 months between the immediate evaluation/treatment group (EXP: after treatment) and the delayed group (USUAL: prior to treatment). Once initial therapy is complete in both EXP and USUAL groups, half from each group will continue in a structured periodontal maintenance program (MAINT) for 8 months and the other half will be referred to their usual source of care (REFER). Thus, we will be able to examine the effects of continued care on glycemic control and functional status. Clinical improvements in diabetes and periodontal condition may have important, measurable effects on selfreported health status and satisfaction with care (Testa and Simonson, 1998). We will examine these effects using brief, standardized measures of satisfaction with diabetes care, functional status, and self-reported oral health. Finally, clinical improvements in glycemic control, functional status and satisfaction with care will be associated with specific costs. We will measure the costs of providing periodontal screening and aggressive initial therapy as well as the structured maintenance program. Costeffectiveness analyses will be conducted at 4 and 12 months. Study Type: Interventional
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Contact(s): Massachusetts; Edith Nourse Rogers Memoral Veterans Hospital, Bedford, Massachusetts, 01730, United States; Recruiting; Judith A. Jones, DDS, MPH 781-687-3161
[email protected] ·
Prospective Controlled Study of Posttransplant Diabetes Condition(s): Diabetes Mellitus; Kidney Failure Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: Research participants will be asked to undergo complete medical history, physical examination and blood tests. The purpose of these tests is to determine whether persons are predisposed to develop diabetes mellitus after kidney transplantation and also to make an early diagnosis if a patient develops diabetes mellitus. Medical information collected as part of the standard transplant evaluation and posttransplant medical care may be incorporated into this study. It is important to realize that research subjects will not be given an experimental drug as part of this study. After kidney transplantation, research subjects will be followed in the posttransplant clinic visits. The study will last up to 6 months. During this time the subjects may be asked to participate in clinical assessment visits (medical history and physical examination), and also during the third or fourth month after transplant will be asked to do a repeat glucose tolerance test. Study Type: Interventional Contact(s): Akinlolu O. Ojo, M.D., Ph.D. 1-734-763-9041; Michigan; 3914 Taubman Center, Ann Arbor, Michigan, 48109-0364, United States; Recruiting; Akinlolu O. Ojo, M.D. 734-763-9041
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Randomized Trial of Health Events Costs in Diabetic Blacks Condition(s): Diabetes Mellitus, Type 2 Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: Diabetes mellitus imposes a major burden on the public health of the United States, leading annually to over 300,000 deaths and over $130 billion in costs. This burden falls disproportionately upon ethnic minority groups, particularly African Americans, who are at excess risk for the development of type 2 diabetes and for a variety of its most serious complications. Suboptimal health care - in terms of access, quality, and adherence -appears to be an important contributing factor.
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Prior work suggests two possible approaches aimed at prevention to enhance risk factor control in outpatients with type 2 diabetes. One approach uses Nurse Case Managers (NCMs) to coordinate care plans with the provider team following protocols/clinical guidelines and algorithms designed to guide treatment including initiating and adjusting drug therapy, enhancing continuity of care, promoting interventions and self-management which include educational and behavioral strategies incorporating feedback and self-regulation. Another approach uses Community Health Workers (CHWs) to enhance culturally sensitive outreach, linkage, and monitoring service; to provide important patient and family education; and to improve access to and continuity of care. Results indicate that this intensive team approach, compared to usual care alone, produces substantial improvements in metabolic control. However, the cost-effectiveness of such interventions is unknown in the ''real-world''. This has led to our current study, a randomized controlled trial within a managed care organization to determine the effects of a NCM/CHW team on metabolic control, on the occurrence of diabetes-related health events, health care utilization, and on direct health care costs. The participants will be African American adults with type 2 diabetes who receive primary care within a managed care organization in inner-city Baltimore. Study Type: Interventional Contact(s): Maryland; The Johns Hopkins Medical Institutions, Baltimore, Maryland, 21205, United States; Recruiting; Marian L. Batts-Turner, MSN, RN, CDE 410-614-4096
[email protected]. Study chairs or principal investigators: Frederick L. Brancati, MD, MHS, Principal Investigator; The Johns Hopkins Medical Institutions ·
Screening for Patients Needing Kidney, Kidney-Pancreas, or Islet-Cell Transplant Condition(s): Diabetes Mellitus; Kidney Failure Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: Kidney transplantation is the preferred treatment for most end-stage kidney disease. This procedure is limited, however, by two major factors: 1) a shortage of donor organs and 2) organ rejection by the recipient. The National Institute of Diabetes and Digestive and Kidney Diseases is screening patients with kidney failure or diabetes who may be eligible for kidney, kidney and pancreas, or islet cell transplantation. Patients in this screening study are not offered treatment.
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When the screening is complete, patients will be offered an opportunity to participate in another institute study, or, if there are no active studies appropriate for the patient, other options will be suggested to the primary or referring physician. Patients found eligible for a study are not obligated to participate. Screening for all patients typically consists of blood tests, urinalysis, electrocardiogram, PPD tuberculosis screen and pregnancy test. Chest and kidney X-rays and other studies may be done on patients determined eligible for a particular study, including transplantation. A summary of all test results will be sent to the referring physician unless the patient requests otherwise. Study Type: Observational Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 ·
Solitary Islet Transplantation for Type 1 Diabetes Mellitus Using Steroid Sparing Immunosuppression Condition(s): Insulin Dependent Diabetes Mellitus Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: This study will test whether a new islet transplant procedure will enable patients with type 1 diabetes mellitus to stop insulin therapy. Islets are cell clusters in the pancreas that contain insulinproducing cells. The new procedure features three important advances, first developed by a group in Edmonton, Canada, over the way islet transplants have traditionally been performed: 1) the islets are transplanted immediately after they are removed from the donor; 2) islets are transplanted from two different donors in order to obtain the number of islets in a normal pancreas; and 3) the anti-rejection drug regimen is designed to reduce the harmful side effects of "conditioning" chemotherapy. (In the standard transplant procedure, patients receive intensive chemotherapy following the transplant. This study will use no radiation and lower-dose chemotherapy.) Patients between the ages of 18 and 65 with the diagnosis of type 1 diabetes mellitus for at least 5 years may be eligible for this study. Candidates will be screened with a medical history and physical examination, blood tests, chest X-ray and tuberculin skin test, electrocardiogram and exercise test for heart function, abdominal ultrasound, psychological evaluation, and an arginine stimulated c-peptide test. The latter test determines if the patient is
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producing any insulin. Eligibility is restricted to patients who make no insulin at all. The study has an active phase lasting 15 months and followup that continues indefinitely. Patients will receive 10,000 "islet equivalents" per kilogram (2.2 pounds) of body weight. This will likely require two separate transplant procedures from two donors. Before the first surgery, patients will be given anti-rejection (immune suppressing) drugs, including FK506 and rapamycin (orally) and daclizumab (intravenously). The islets will be infused through a tube placed in the portal vein (the large vein that feeds the liver). After surgery, patients will receive insulin intravenously for 24 hours. They will then have an abdominal ultrasound and blood tests to determine liver function. If fewer than 10,000 islets were transplanted, patients will continue insulin treatment, with the dosages adjusted to account for the transplanted islets. They will take Daclizumab every 2 weeks, and FK506 and rapamycin daily. Blood tests to follow how much of these drugs are in the blood stream will be performed daily at first and then weekly after blood levels of these drugs stabilize. They will be given antibiotics to prevent infections. The arginine test will be repeated 2 weeks after the transplant and periodically thereafter. Blood will be drawn weekly to check drug levels, and monthly for other tests. The investigators will track daily insulin requirements, and these will be recorded monthly. Patients who require a second transplant to achieve the required amount of islets will return for the procedure when a compatible organ is donated. The second procedure will be done as described above. As before, insulin will be infused for 24 hours following surgery. It will then be stopped, however, and will not be resumed unless blood glucose levels reach above 180 milligrams/deciliter. Patients will continue taking FK506 and rapamycin indefinitely. Daclizumab will be given every 2 weeks for 4 doses following the second transplant, and then stopped. Patients will take an antiviral called gancyclovir for 14 weeks and another antibiotic for 1 year following surgery. For the first year after surgery, patients will have frequent blood tests to monitor drug levels and immune function. They will return to NIH for a complete history and physical examination 2 and 3 years after the final islet transplant and will be contacted yearly by phone to ascertain their general health status and whether they remain insulin independent. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010
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Study of the Effects of Vitamin C on Patients with Type 2 Diabetes Condition(s): Ascorbic Acid Deficiency; Insulin Resistance; Non Insulin Dependent Diabetes Mellitus Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: Diabetes is a disease characterized by decreased sensitivity to the action on insulin to promote sugar (glucose) use and blood vessel relaxation (vasodilation) in muscle. Insulin's ability to cause blood vessel relaxation is controlled, in part, by nitric oxide (NO). Nitric oxide is a substance produced by the cells lining blood vessel walls (endothelium). Increased blood flow to the muscle accounts for increased sugar (glucose) to areas of the body. Therefore, if the cells of blood vessel walls (endothelium) are not functioning properly it may contribute to insulin resistance. Injections of Vitamin C directly into the arteries have been shown to improve blood vessel reaction to nitric oxide in diabetic patients. Researchers believe this may be due to Vitamin C's ability to increase the levels of nitric oxide in blood vessels. The goal of this study is to determine the effects of vitamin C on both insulin sensitivity and endothelium function of patients with type 2 diabetes. An additional goal of the study is to determine the effects of vitamin C on patients with vitamin C deficiency. Patients participating in this study will undergo a series of testes to determine insulin sensitivity and blood vessel reactivity. Patients will be divided into two groups. One group will receive doses of oral vitamin C. The other group will receive doses of a placebo (inactive pill not containing vitamin C). Patients will receive the medications for four weeks and then be tested again for insulin sensitivity and blood vessel reactivity. Researchers believe that doses of vitamin C in diabetics or patients with vitamin C deficiency will improve insulin sensitivity and function of endothelium. Results gathered form this study may provide information about vitamin C levels in diabetics and may lead to the development of new therapies to treat insulin resistance and endothelium dysfunction. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Heart, Lung and Blood Institute (NHLBI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010
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Study of the Pathogenesis and Pathophysiology Neurohypophyseal Diabetes Insipidus
of
Familial
Condition(s): Diabetes Insipidus; Diabetes Insipidus, Neurohypophyseal Study Status: This study is currently recruiting patients. Sponsor(s): National Center Northwestern University
for
Research
Resources
(NCRR);
Purpose - Excerpt: Objectives: I. Determine whether diverse mutations of the vasopressin-neurophysin II (AVP-NPII) gene cause autosomal dominant familial neurohypophyseal diabetes insipidus by directing the production of an abnormal preprohormone. II. Determine whether the AVP-NPII gene-directed preprohormone accumulates and destroys magnocellular neurons because it cannot be folded and processed efficiently. Study Type: Observational Contact(s): Illinois; Northwestern University Medical School, Chicago, Illinois, 60611, United States; Recruiting; Gary L. Robertson 312-503-0058. Study chairs or principal investigators: Gary L. Robertson, Study Chair; Northwestern University ·
The Diabetes Prevention Trial of Type 1 Diabetes (DPT-1) Condition(s): Diabetes Mellitus, Type 1 Study Status: This study is currently recruiting patients. Sponsor(s): Office of Research on Minority Health (ORMH); Office of Research on Women's Health (ORWH) Purpose - Excerpt: The Diabetes Prevention Trial of Type 1 (DPT-1) is a multicenter randomized, controlled clinical trial designed to determine whether it is possible to delay or prevent the clinical onset of type 1 diabetes through daily doses of insulin in individuals determined to be at risk for the disease. The parenteral insulin trial in DPT-1 has been completed, however, the oral insulin trial is still recruiting. Over 350 sites in the United States, Canada, and Puerto Rico are taking part in the study. Screening of patients is ongoing; approximately 100,000 nondiabetic relatives of persons with type 1 diabetes have been screened to detect the presence of islet cell antibodies. Those individuals found to have islet cell antibodies are being staged to determine their risk of diabetes based on genetic, immunologic, and metabolic characteristics. Those individuals found to be at intermediate risk of diabetes are randomized to receive insulin orally or to receive placebo. Patients are being followed for up to six years. Phase(s): Phase III
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Study Type: Interventional Contact(s): see Web site below ·
African-American Diabetes Intervention Project Condition(s): Insulin-Dependent Diabetes Mellitus Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: A controlled trial to assess the potential benefit of a home based worker in improving control in African-American children with insulin dependent diabetes. Study Type: Interventional Contact(s): Ohio; Case Western Reserve University, Cleveland, Ohio, United States
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Deferoxamine for the Treatment of Hemochromatosis Condition(s): Diabetes Mellitus; Heart Disease; Hemochromatosis; Thalassemia Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: When patients receive repeated blood transfusions the level of iron in the patient's blood can rise. When iron is processed in the body a protein known as hemosiderin can begin collecting in the organs. If too much hemosiderin collects in the organs they can begin to malfunction. This condition is called transfusional hemochromatosis. An organ of particular importance in transfusional hemochromatosis is the heart. Patients born with diseases requiring blood transfusions at birth begin to develop heart problems in their teens. These patients typically only live for 17 years. Adults that require transfusions can begin experiencing heart problems after 100-200 units of backed red blood cells. Deferoxamine (Desferal) is a drug that binds to iron and allows it to be excreted from the body. It is the only effective way to remove iron from patients who have been overloaded with iron because of multiple transfusions. Previous studies have lead researchers to believe that deferoxamine, when given as an injection under the skin (subcutaneous), can be delay or prevent heart complications. Researchers plan to continue studying patients receiving deferoxamine as treatment for the prevention of heart complications associated with repeated blood transfusions. In this study researchers will attempt; 1)To determine if deferoxamine,
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given regularly, can indefinitely prevent the heart, liver, and endocrine complications associated with transfusional hemochromatosis 2)To determine whether heart disease caused by transfusional hemochromatosis can be reversed by intensive treatment with deferoxamine. Study Type: Observational Contact(s): Maryland; National Heart, Lung and Blood Institute (NHLBI), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 ·
Diabetes and Cardiovascular Risk In Mexico City (San Antonio Heart Study) Condition(s): Cardiovascular Diseases; Heart Diseases; Diabetes Mellitus, non-insulin dependent Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine factors beyond obesity which contribute to diabetes and cardiovascular risk in Mexicans and Mexican Americans. To test the hypothesis that at any given level of adiposity Mexican Americans will be more insulin resistant than Anglos and that the insulin resistance in Mexican Americans is proportional to the degree of Native American ancestry. The renewal in 1996 supports a second 3.25 year follow-up examination of a cohort of Mexican subjects in order to evaluate type II diabetes and its macrovascular complications. Study Type: Epidemiology Contact(s): see Web site below
·
Diabetes Prevention Program Condition(s): Intolerance
Diabetes
Mellitus,
Non-Insulin-Dependent;
Glucose
Study Status: This study is no longer recruiting patients. Sponsor(s): Office of Research on Women's Health (ORWH) Purpose - Excerpt: The Diabetes Prevention Program is a nationwide clinical study to answer the question: Can Type 2 diabetes (also called noninsulin-dependent or adult-onset diabetes) be prevented or delayed? The study has recruited 3819 volunteers, who are at high risk of developing diabetes, at twenty-five medical centers in the United States. It is sponsored by the National Institute of Diabetes and Digestive and
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Kidney Diseases of the National Institutes of Health, and other Institute and corporate sponsors. Researchers will evaluate the efficacy of a lifestyle intervention and a pharmacological intervention in preventing or delaying Type 2 diabetes in persons with IGT, impaired glucose tolerance. Each person in the study will be followed for 3 to 6 years. Study Type: Interventional Contact(s): Maryland; George Washington University Biostatistics Center, Suite 750, 6110 Executive Blvd, Rockville, Maryland, 20852, United States. Study chairs or principal investigators: Sarah Fowler, PhD, Principal Investigator ·
Epidemiological Study of Cardiovascular Disease in Type I Diabetes Condition(s): Cardiovascular Diseases; Diabetes Mellitus; Heart Diseases; Diabetes mellitus, insulin-dependent Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate the prevalence and incidence rates of cardiovascular disease morbidity and mortality in people with Type 1 diabetes of long duration. Contact(s): see Web site below
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Family-Centered Diabetes Project Condition(s): Diabetes Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The purpose of this project is to determine whether a diabetes lifestyle program will improve the lives of Native American people living with diabetes. We recruited Native American people living in 8 Pueblo communities served by 3 Indian Health Service clinics. Forty percent of people living with diabetes in those communities participated in an interview and had height, weight, blood pressure and hemoglobin A1c measured at the beginning. Then they received a lifestyle program in either groups or one-on-one, or another group which got the intervention after one year (comparison group). The program was developed using input from community members, tribal leaders, and clinic staff, and was taught by community members in or near the participating communities. After each session, participants were asked for feedback about the curriculum. After the program ended, the interview and clinical
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measures were repeated. Feedback to tribal leaders and clinical staff is ongoing. Study Type: Interventional Contact(s): New Mexico; University of New Mexico School of Medicine, Albuquerque, New Mexico, 87131, United States; Marla Pardilla, MPH, MSW 505-272-8465
[email protected]. Study chairs or principal investigators: Janette S. Carter, MD, Principal Investigator; University of New Mexico School of Medicine ·
Finding Diabetes Mellitus Among Veterans Condition(s): Diabetes Mellitus Study Status: This study is no longer recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Cooperative Studies Program Purpose - Excerpt: Population-based screening for diabetes mellitus in non-pregnant adults remains controversial. For a screening strategy to be successful, patients identified by surveillance will have to have better outcomes than if they had been diagnosed at a later, more symptomatic phase of disease. However, little is known about the fate of patients diagnosed with diabetes by screening. Additionally, while about half of the cases of diabetes among the general population at any given time are undiagnosed, the prevalence of undiagnosed diabetes among veterans is unknown. The annual incidence of diabetes among veterans is also unknown. Assessing risk factors prior to blood testing will improve the specificity, with little cost in sensitivity, of screening for diabetes in a medical center setting. The target population which optimizes the potential value of diabetes screening is patients with at least 1 of the above 3 risk factors for diabetes (obesity, hypertension, family history). Hypertension is strongly associated with unrecognized diabetes in veterans. VA and other health care providers considering whether to perform systematic screening for diabetes should use known risk factors to identify an appropriate target population for screening. Study Type: Observational Contact(s): North Carolina; VAMC - DURHAM, NC, Durham, North Carolina, 27705, United States; David E. Edelman, MD 919-286-6936
[email protected] ·
Genetic Influence on Susceptibility to Type 1 Diabetes Mellitus Condition(s): Diabetes Mellitus; Healthy
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Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: Type 1 diabetes mellitus is an autoimmune disease in which the body's immune cells attack the insulin-producing cells of the pancreas. Several environmental and genetic factors may predispose individuals to developing this disease, including changes in a gene called CD152. This study will examine how this gene may influence the development of insulin-dependent diabetes. Patients with Type 1 diabetes mellitus enrolled in clinical trials at the National Institutes of Health and at the University of Florida and healthy normal volunteers may participate in this study. Participants will have up to three blood samples drawn over a period of less than 1 year. The first sample (about 20 milliliters, or 4 teaspoons), will be examined for changes in the structure of the CD152 gene. If the CD152 structure is different from that normally seen in the general population, a second sample (about 90 ml, or 6 tablespoons of blood) will be drawn. This sample will be used to study the function of specialized immune system cells (T cells), including their growth and survival, chemicals they produce when stimulated, and other factors. If these cells function differently from what is generally seen in the population, a third sample (90 ml) will be drawn for more detailed studies. This investigation may help explain what makes certain individuals susceptible to Type 1 diabetes mellitus and may contribute to the development of improved treatments for the disease. Study Type: Observational Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 ·
Identification and therapy efficacy of Type 2 diabetes in Hispanic patients Condition(s): Diabetes Mellitus, Non-Insulin-Dependent Study Status: This study is no longer recruiting patients. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: The two major types of diabetes are type 1 and type 2 diabetes. Although most patients with type 2 diabetes are older than age 40, type 2 diabetes has been reported with increasing frequency among patients under the age of 20. This form of diabetes has been called type 2 diabetes of youth, abbreviated type 2Y. Little is known about the etiology
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of type 2Y; however, clinicians believe that it occurs most commonly in obese children of particular ethnic groups. A positive family history appears to be one major risk factor for developing type 2Y diabetes. The individual contribution of ethnicity, obesity, and genetics to type 2Y have yet to be elucidated. There is no consensus regarding treatment with type 2Y diabetes. Observation of our Hispanic patients in the Houston area reveals a large number with type 2Y. The major purpose of this study is to examine the genetic and environmental risk factors such as family history, ethnicity, and obesity in Hispanic children with type 2Y diabetes. SPECIFIC AIMS: 1) To examine the genetic and environmental risk factors and clinical signs associated with type 1 diabetes and type 2 diabetes of youth. 2) To compare the efficacy of the treatment modalities, insulin and oral agents, in type 2Y patients. METHODS: We will undertake a retrospective case study, to include a review of hypothesized risk factors in all the medical records of pediatric diabetes patients seen at University of Texas. We anticipate that approximately 200 patients with type 1 diabetes and 30 patients with type 2Y diabetes will be identified. A Sustacal challenge test will be done in patients with a suspected diagnosis of type 2Y in order to confirm the clinical diagnosis. Parents will be contacted by phone for a detailed pedigree intake. Type 1 and type 2Y patients will be compared for each of the studied features. A retrospective review of diabetes type 2 therapies used in type 2Y patients will be undertaken through further examination of the medical records in order to compare insulin treatment to oral agents. We will also test a subset of the patients for the gene identified in adult Hispanics with type 2 diabetes. Study Type: Observational Contact(s): Dana Hardin, M.D. 1-731-500-5646 ·
Islet Cell Transplantation Alone and CD34+ Enriched Bone Marrow Cell Infusion in Patients with Diabetes Mellitus: Steroid-Free Regimen Condition(s): Type 1 Diabetes Mellitus Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The goal of islet cell transplantation in Type 1 diabetics is to provide those affected with constant normal blood glucose levels, thereby reducing or eliminating altogether the need for injected insulin. This normalization may prevent or slow progression of diabetic complications, result in a healthier lifestyle, and lead to a better quality of life. Participants who meet the inclusion criteria will undergo an
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extensive screening process which typically includes a series of blood tests, EKG, chest x-rays, and a psychological evaluation, among others. Those who are eligible for and chose to participate in the trial will receive an islet cell transplant and bone marrow infusion from the same donor, together with following immunosuppressive medications: tacrolimus, sirolimus, daclizumab and infliximab. Because the bone marrow infusion may successfully prevent the transplanted islet cells from rejecting, some participants may be able to stop taking the immunosuppressive medications after a year. The islet cell transplant is done under local anesthesia in a special procedure radiology room. Several days after the islet cell transplant, the participant is admitted to the hospital as an outpatient in order to receive bone marrow via a simple intra-venous infusion procedure. All participants will need to be seen at the Diabetes Research Institute after the transplant for follow-up testing and post-islet cell transplant care. Phase(s): Phase II Study Type: Interventional Contact(s): Florida; University of Miami Diabetes Research Institute, Miami, Florida, 33136, United States; Patient Recruitment Office 305-2435321
[email protected]. Study chairs or principal investigators: Rodolfo Alejandro, MD, Principal Investigator; University of Miami Diabetes Research Institute ·
Lifestyle interventions to reduce diabetes risk Condition(s): Glucose Intolerance; Diabetes Mellitus, Type 2 Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: Type 2 diabetes is more frequent in Japanese Americans than in Japan or the U.S. non-Hispanic white population. This appears to be due to the effects of ''westernization'' to bring out metabolic changes that lead to diabetes. This study will look at whether increased physical activity and dietary changes will reduce or prevent the metabolic changes that lead to type 2 diabetes in Japanese Americans who have impaired glucose tolerance, a condition intermediate between normal glucose tolerance and diabetes. Study Type: Interventional Contact(s): Washington; University of Washington, Seattle, Washington, 98195, United States; Wilfred Y. Fujimoto, M.D.
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Mechanisms of Pro-Thrombosis in Diabetes Mellitus -- Ancillary to BARI 2D Condition(s): Cardiovascular Diseases; Heart Diseases; Diabetes Mellitus, non-insulin dependent; Coronary Disease; Thrombosis Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the effect of the method of hyperglycemic management on pro- thrombotic potential in diabetic subjects. Study Type: Clinical Research Contact(s): Schneider, David J. Burling, Vermont, United States . Study chairs or principal investigators: Schneider, David J., Study Chair; University of Vermont & State Agricultural College Burling, Vermont, United States
·
NEW DAY: Nutrition, Exercise, Weight loss, Diabetes And You Condition(s): Diabetes Mellitus, Type 2; Obesity Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: This clinical trial examines whether the addition of individual sessions of a motivational intervention to a state-of-the art behavioral group weight loss intervention for overweight women with Type 2 diabetes improves the weight losses and glycemic control outcomes. Phase(s): Phase II Study Type: Interventional Contact(s): Alabama; University of Alabama at Birmingham, Birmingham, Alabama, 35205, United States; Polly Kratt 205-934-8960
[email protected] ·
Non-Traditional Cardiovascular Risk Factors in Type 2 Diabetes Mellitus - Ancillary to VA Study of Glycemic Control Condition(s): Atherosclerosis; Cardiovascular Diseases; Diabetes Mellitus; Diabetes Mellitus, non-insulin dependent; Heart Diseases Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)
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Purpose - Excerpt: To test whether novel cardiovascular risk factors are related to the presence and development of atherosclerosis and macrovascular events in Type 2 diabetes mellitus and to determine whether intensive glucose lowering therapy will reduce the levels of these cardiovascular risk factors. Study Type: Analysis of Clinical Trials Contact(s): Reaven, Peter D. Phoenix, Arizona, United States . Study chairs or principal investigators: Reaven, Peter D., Study Chair; Carl T. Hayden Veteran Affairs Medical Center Phoenix, Arizona, United States ·
Proactive Diabetes Case Management Condition(s): Diabetes Mellitus Study Status: This study is no longer recruiting patients. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Health Services Research and Development Service Purpose - Excerpt: The consequences of current deficiencies in type 2 diabetes mellitus (T2DM) care are staggering, and conventional approaches to improve care have failed. Treatment guidelines and case management have been advocated as solutions to this problem. However, traditional approaches to guideline implementation have been discouraging and the cost-effectiveness of case management has not been rigorously evaluated. This study addresses two VA HSR&D priority areas: (1) guideline dissemination; and (2) evaluating managed care techniques for use in VA. The study has the following specific aims: (1) to evaluate the impact of a targeted, proactive T2DM case management intervention on: (a) glycemic control, (b) adherence to minimum standards, (c) short-term resource utilization, (d) veteran satisfaction, and (e) short-term patient physiologic and functional outcomes; and (2) using Monte Carlo simulations, estimate the expected impact of changes in key processes of care and intermediate outcomes on end-stage outcomes and long-term costs. The study is a randomized controlled trial. Veterans (n = 246) at two VAMCs who met specific eligibility criteria were recruited to participate in the study and randomly assigned to the intervention or control groups. Study participants are being followed for approximately 18 months. The intervention consists of two nurse practitioners who are actively monitoring and coordinating patient care, guided by approved treatment algorithms. Primary data sources include: (1) a baseline and exit examination; (2) a baseline and exit survey; and (3) the VA medical information system. The primary outcome measure is glycemic control as measured by hemoglobin A1c (HbA1c). Secondary outcomes include serum LDL, veteran satisfaction, functional status, eye and kidney
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screening, foot integrity, blood pressure, resource utilization and costs. The data will be analyzed using the change in the primary and secondary outcome measures over the study period as dependent variables. A subgroup analysis also will be conducted to examine those with poorer glycemic control at baseline (HbA1c > 9.5%) vs. those with better baseline control. A Monte Carlo simulation model will be used to estimate the expected long-term benefits of the intervention. Cost estimates also will be incorporated to evaluate the long term cost-effectiveness of the intervention. Study Type: Interventional Contact(s): see Web site below ·
Subclinical Heart Disease in Insulin-Dependent Diabetes Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Diabetes Mellitus; Diabetes mellitus, insulin-dependent Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate the occurrence and associated risk factors for subclinical heart disease in persons with insulin-dependent diabetes mellitus (IDDM). Contact(s): see Web site below
·
Action to Control Cardiovascular Risk in Diabetes (ACCORD) Condition(s): Atherosclerosis; Cardiovascular Diseases; Hypercholesterolemia; Hypertension; Diabetes Mellitus, non-insulin dependent; Ventricular Fibrillation Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To prevent major cardiovascular events in Type 2 diabetes mellitus patients using intensive glycemic control, intensive lipid and blood pressure control, and insulin resistance-lowering therapy. Phase(s): Phase III Study Type: Prevention Contact(s): see Web site below
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Automated Calls with Nurse Follow-Up to Improve Diabetes Ambulatory Care Condition(s): Diabetes Mellitus Study Status: This study is completed. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Health Services Research and Development Service Purpose - Excerpt: Regular outpatient follow-up is important for all diabetes patients, with some needing frequent attention because their health is unstable, their treatment regimen is complex, or their social supports are inadequate. However, many patients live with access barriers that limit their use of outpatient services, fail to attend outpatient appointments, and experience worse outcomes than trials of aggressive management suggest is possible. Although labor-intensive, telephone care programs are one potential strategy for bringing diabetes management services into patients? homes and improving their glycemic control. Automated telephone disease management (ATDM) systems can augment telephone care by providing frequent monitoring and health education to large patient panels while focusing clinicians? attention on individuals who need it most. Although this technology has shown some promise, it has not been rigorously evaluated, particularly in VA. This study evaluated Automated Telephone Disease Management (ATDM) calls with telephone nurse follow-up as a means of improving the quality of VA diabetes care. Specifically, we will determine whether this service improves patients' glucose control; improves other important outcomes such as their quality of life, satisfaction with care, and health service use; improves health behaviors such as self-monitoring of blood glucose, fat intake, and medication adherence; and has effects that vary across patient subgroups. Patients with diabetes mellitus using hypoglycemic medication were enrolled during outpatient visits to a universityaffiliated VA health care system and randomized to usual care or biweekly ATDM assessment and self-care education calls with follow-up by a nurse educator. The intervention process was evaluated by examining patients? patterns of ATDM use and the reliability and validity of information they provided. Telephone surveys were used to measure intervention effects at 12-months on patients? self-care, symptoms, satisfaction with care, and perceived access barriers. The impact on VA utilization was evaluated using electronic utilization databases, and glycemic control was measured using laboratory tests. A total of 292 patients were randomized and 272 (93%) provided data at 12months. Intervention patients completed ATDM assessments consistently throughout the observation period and the assessments identified groups of intervention patients with varying degrees of health risk at baseline.
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Compared to control patients, intervention patients at 12-months reported more frequent glucose self-monitoring, fewer access problems, and greater satisfaction with care (all p = 0.05). Intervention patients were more likely than controls to have been seen in podiatry clinics (53% versus 31%, p = 0.003) and diabetes specialty clinics (31% versus 17%, p = 0.03) during the study. The intervention did not influence mean endpoint HgA1c levels overall. However, among patients with baseline HgA1c = 8%, mean endpoint values among intervention and control patients were 8.7% and 9.2%, respectively (p = 0.05); intervention effects were even greater among patients with baseline HgA1c = 9%. Moreover, intervention patients at follow-up reported fewer symptoms of poor glycemic control than patients receiving usual care (3.6 versus 4.4, p = 0.03). Phase(s): Phase III Study Type: Interventional Contact(s): California; VA Palo Alto Health Care System, Palo Alto, California, 94304-1207, United States; John D. Piette, PhD 650-493-5000 22849
[email protected] ·
Computer-assisted diabetes self-management interventions Condition(s): Diabetes Mellitus, Type 2 Study Status: This study is completed. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: This project evaluates the effectiveness of different aspects of a program to assist type 2 diabetes patients with dietary changes. It evaluates the effectiveness of Personalized Self-Management Training and Community Resources support, using a randomized design. This study will also evaluate what percent of patients are willing to participate in such a program, and what percent of primary care physicians are willing to recommend it to their patients. Phase(s): Phase IV Study Type: Interventional Contact(s): Colorado; AMC Cancer Research center, Denver, Colorado, 80214, United States; Russell Glasgow, Ph.D. 303-239-3324
[email protected] 100 Diabetes
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Developing and Implementing a Quality Measure for Glycemic Control Condition(s): Diabetes Mellitus Study Status: This study is not yet open for patient recruitment. Sponsor(s): Department of Veterans Affairs; Department of Veterans Affairs Health Services Research and Development Service Purpose - Excerpt: Studies have shown that most patients with diabetes mellitus are under sub-optimal glycemic control. Central to the clinician's task in improving glycemic control is the management of hypoglycemic medications such as insulin and sulfonylureas. Clinical trials have demonstrated that providing more intensive hypoglycemic medication therapy results in improved glycemic control and fewer complications. Yet quality measures for this critical process of care have not been developed and we know little of how clinicians actually manage hypoglycemic medications. Providing clinicians with information on their use of hypoglycemic medications is likely to be important in improving their management of patients with diabetes. We propose to develop a quality measure that describes the intensity of physicians' hypoglycemic medication therapy. We will then provide feedback to VA physicians regarding their practices through the use of local opinion leaders and determine whether this intervention leads to improvements in glycemic control. Specific objectives include: Objective 1: Develop a measure of the process of diabetes care that describes the intensity of hypoglycemic medication therapy provided by physicians. Objective 2: Implement an intervention for VA physicians that combines the use of local opinion leaders with feedback regarding their intensity of hypoglycemic medication therapy. Objective 3: Determine whether this intervention results in improvements in hypoglycemic medication therapy and glycemic control. The study is divided into two phases. During the first phase we will use existing data to model the decision to increase hypoglycemic medications. This will result in a measure of the intensity of hypoglycemic medication therapy. The second phase will be a randomized trial in which clinicians at experimental sites receive feedback on performance through a local opinion leader while usual care is provided at control sites. Outcomes of interest include intensity of therapy and glycosylated hemoglobin levels. This study will use information from existing hospital databases at 16 VA medical centers. We will initially examine the care provided to diabetic patients over 11/2 years. At each medical visit, we will determine whether an increase in medication therapy occurred. We will use recursive partitioning to develop a model that identifies patient characteristics at the visit, such as recent laboratory results and diagnoses, associated with the decision to
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increase therapy. This model assigns a predicted probability of an increase in therapy to each visit. We then use these predictions to define an intensity of hypoglycemic medication therapy for each physician that compares the actual to predicted number of increases over all patientvisits. Primary care physicians at 8 of these VA medical centers will receive an intervention consisting of feedback on performance on their intensity of hypoglycemic medication therapy combined with the presence of a local opinion leader. The local opinion leader will describe the intensity score, explain the known association between intensity and patient outcomes, and instruct on how therapy may be improved. Feedback on performance will be provided twice over 6 months. The change in intensity of treatment scores and glycosylated hemoglobin levels pre- and post-intervention at these sites will be compared to performance of primary care physicians at 8 control sites not receiving the intervention. Study Type: Interventional Contact(s): Massachusetts; Edith Nourse Rogers Memoral Veterans Hospital, Bedford, Massachusetts, 01730, United States; Dan R. Berlowitz, MD, MPH 781-687-2962
[email protected] ·
Diabetes, Lipoproteins and Accelerated Vascular Disease Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Atherosclerosis; Carotid Artery Diseases; Diabetes Mellitus, non-insulin dependent Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To better understand the excess cardiovascular disease associated with diabetes mellitus. Study Type: Epidemiology Contact(s): see Web site below
·
Health Effects of Liposuction in Overweight Women with Elevated Insulin Levels, Impaired Glucose Tolerance and/or Type 2 Diabetes Condition(s): Glucose Intolerance; Hyperinsulinemia; Non Insulin Dependent Diabetes Mellitus; Obesity Study Status: This study is completed. Sponsor(s): National Institute of Child Health and Human Development (NICHD)
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Purpose - Excerpt: This study is for women who have already decided to undergo liposuction at Georgetown University Medical Center in Washington, D.C. To take part in this study, a woman must first meet with the plastic surgeons there, and be accepted by them to have liposuction. This study will investigate whether large volume liposuction improves risk factors for heart disease in overweight women with type 2 (adult onset) diabetes, impaired glucose tolerance, or elevated blood insulin levels. Large volume liposuction is the surgical removal of at least 10 pounds (4.5 kg) of body fat, usually from the abdomen, hips or chest. Risk factors for heart disease include high blood pressure and elevated levels of blood lipids (cholesterol and triglycerides), blood glucose (sugar), and blood insulin. Subjects who participate in all parts of this study will receive a total of $930.00. Overweight women 18 years or older with high blood insulin levels, impaired glucose tolerance, or type 2 diabetes, who are planning to have large volume liposuction performed at Georgetown University Medical Center in Washington, D.C., may be eligible for this study. For a subject to be accepted into this study, she must first meet with the plastic surgeons at Georgetown University Medical Center, and they have to agree to perform large volume liposuction. The decision that someone is suitable for liposuction is not under the control of the NIH or of any NIH investigator. Those enrolled will undergo the following procedures at four separate times - before undergoing liposuction, 4 weeks after surgery, 4 months after surgery and 1 year after surgery: - Body measurements - taken with calipers to measure several skinfold thicknesses (the width of a fat fold) and with a tape measure to measure the circumference of parts of the body. - Urine sample and 6-hour urine collection - to test for pregnancy and to evaluate kidney function. - Glucose tolerance test - measures insulin sensitivity and how the body uses sugar, how well insulin works, and insulin sensitivity. The procedure involves placement of two catheters (thin, flexible tubes) through a needle into a vein in each arm. Sugar water is infused into one catheter and 20 minutes into the test a small amount of insulin is injected. Blood samples are drawn from the other catheter at frequent intervals for a total of 5 hours. - Electrocardiogram (ECG) and echocardiography - measure the heart's electrical activity and function. Abdominal computerized tomography (CT) scan - produces images for measuring body fat in the abdomen. (not done at the 4-week visit). Takes about half an hour to complete. - DXA X-ray - measures body fat, muscle and bone mineral content. Takes about half an hour to complete. - Bod Pod - capsule-like device used to determine the proportion of body weight composed of fat and non-fat tissue. Takes less than 10 minutes Bioelectric impedance analysis device - measures the proportions of body fat based on electrical conduction of a small electric current. Takes 2-3
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minutes. - 24-hour blood pressure monitoring - a device attached to a blood pressure cuff strapped to the arm measures blood pressure every 15 to 30 minutes continuously for 24 hours. - Vascular reactivity tests - a blood pressure cuff is inflated for about 4 minutes before deflating, providing information on the function of the small blood vessels in the skin, as well as an idea of the function level of small blood vessels elsewhere in the body. Takes half an hour. - Blood samples - collected to evaluate kidney and liver function and to measure body lipids, such as cholesterol, minerals, and other substances. Study Type: Observational Contact(s): Maryland; National Institute of Child Health and Human Development (NICHD), 9000 Rockville Pike Bethesda, Maryland, 20892, United States ·
Native Hawaiian Diabetes Intervention Program Condition(s): Diabetes Mellitus, Type 2 Study Status: This study is completed. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The Native Hawaiian Diabetes Intervention Program is a project focused on determining whether a cultural-based, healthy lifestyles program with family support will have a positive effect on lifestyle behaviors and psychosocial and clinical outcomes. A culturally sensitive, lifestyle intervention program was administered via community peer educators to a population of Native Hawaiians with or at risk for diabetes. The effect of this intervention program on selected outcomes is being compared to a ''standard'' program given to a similar population in a second Native Hawaiian community. Study Type: Interventional Contact(s): Hawaii; University of Hawaii, John A. Burns School of Mediicine, Honolulu, Hawaii, 96813, United States; Dr. Marjorie K. Mau 808-586-2910
[email protected]. Study chairs or principal investigators: Marjorie K. Mau, M. D., Principal Investigator; University of Hawaii
·
NNC 90-1170 Mechanism of Action: A double-blind, randomized, single-center, placebo-controlled, crossover study to examine beta-cell responsiveness to graded glucose infusion in subjects with type 2 diabetes Condition(s): Diabetes Mellitus, Non-Insulin-Dependent
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Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR) Purpose - Excerpt: The purpose of this research study is to investigate the mechanism of action of a new investigational medication (drug), NNC 90-1170, which is being developed for the treatment of type 2 diabetes (adult onset type of diabetes. NNC 90-1170 is a modified form of a hormone, Glucagon-Like Peptide 1 (or GLP-1), which is important for controlling insulin levels. Insulin, another hormone, is also important for controlling blood glucose levels, which are higher than normal in people who have type 2 diabetes. This study will measure the effect of NNC 901170, active investigational drug, to cause insulin to be released from the pancreas in response to increasing blood glucose concentrations. These results will be compared to that of a group of healthy volunteers of similar age and body weight who do not have diabetes. Also, various other hormones and substances that are known to control blood sugar will be measured in blood samples that will be drawn. One dose of NNC 90-1170 will be given to subjects with type 2 diabetes only in this study, and the effects of this dose will be compared to a placebo (inactive substance that looks like the active drug). This is a crossover study, which means that subjects will be treated both with NNC 90-1170 and with placebo. The order in which subjects will receive the treatments will be determined by chance (randomly). The study will be conducted as a socalled "double-blind" study, meaning that neither subjects nor study doctors will know the order in which subjects will be given each treatment until the study is over. The study will include approximately 15 healthy volunteers and 15 volunteers with type 2 diabetes, and it will be conducted at 1 clinic (the University of Michigan Health System) in the United States. Phase(s): Phase I Study Type: Interventional Contact(s): Michigan; University of Michigan, Ann Arbor, Michigan, 48109, United States; Marla J. Smith, B.Sc. 734-936-2168 ·
Physical Activity, Hypertension, Diabetes, and Coronary Heart Disease Condition(s): Cardiovascular Diseases; Heart Diseases; Diabetes Mellitus; Coronary Disease; Hypertension; Diabetes Mellitus, non-insulin dependent Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)
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Purpose - Excerpt: To study the influences of physical activity on the incidence of hypertension, non-insulin-dependent diabetes (NIDDM), and coronary heart disease (CHD), taking into account the influences of other life-style elements such as body size, cigarette habit, alcohol consumption habits, and parental history of disease on these same chronic diseases. Study Type: Epidemiology Contact(s): see Web site below ·
Study of Drugs for High Blood Pressure and High Cholesterol in American Indians with Type 2 Diabetes at High Risk of Kidney or Heart Disease Condition(s): Diabetic Nephropathy Study Status: This study is completed. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); Hennepin County Medical Center - Minneapolis Purpose - Excerpt: Objectives: I. Establish a long-term working relationship between clinical investigators and the Minnesota American Indian community. II. Compare the effectiveness of lisinopril (an angiotensin-converting enzyme inhibitor) and nifedipine (a calcium channel blocker) in preventing nephropathy and vascular disease in Minnesota American Indians with non-insulin-dependent diabetes mellitus and microalbuminuria. III. Compare the effectiveness of simvastatin (a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor) with lipid-lowering strategies recommended by the National Cholesterol Education Program in preventing nephropathy and vascular diseases in these patients. Study Type: Interventional Contact(s): see Web site below
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Benefits and Risks18 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for diabetes. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with diabetes. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 18
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How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for diabetes? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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·
Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “diabetes” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
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General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
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Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Arginine: An essential amino acid that is physiologically active in the Lform. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars,
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celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Deferoxamine: Natural product isolated from Streptomyces pilosus. It forms iron complexes and is used as a chelating agent, particularly in the form of its mesylate. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH]
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Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH]
Nephropathy: Disease of the kidneys. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular,
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intraspinal, intrasternal, intravenous, etc. [EU] Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]
Podiatry: The care and treatment of human feet in health and disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH]
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Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Thrombosis: The formation, development, or presence of a thrombus. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on diabetes. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on diabetes. In Part II, as in Part I, our objective is not to interpret the latest advances on diabetes or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with diabetes is suggested.
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CHAPTER 4. STUDIES ON DIABETES Overview Every year, academic studies are published on diabetes or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on diabetes. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on diabetes and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
Federally-Funded Research on Diabetes The U.S. Government supports a variety of research studies relating to diabetes and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.19 CRISP Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control
19
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(Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to diabetes and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore diabetes and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for diabetes: ·
Project Title: Asia-Pacific Diabetes Epidemiology Training Course Principal Investigator & Institution: Dorman, Janice S.; Associate Professor; Epidemiology; University of Pittsburgh at Pittsburgh 4200 5Th Ave Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 1-OCT-2001; Project End 0-SEP2002 Summary: (provided by applicant): To continue to provide young researchers and health professionals with the opportunity to: 1) learn more about the factors responsible for this very serious health problem in all areas of the world, 2) become skilled in the methods of diabetes epidemiology, disease prevention and public health, and 3) develop collaborative networks with established researchers that can be maintained by Internet communications, the WHO Multinational Project for Childhood Diabetes is sponsoring, without financial support, the Second Asia-Pacific Diabetes Epidemiology Training Course in Hong Kong from October 27-November 4, 2001. In addition, the American Diabetes Association Council on Epidemiology and Statistics is an academic sponsor of the course. Approximately 30 English-speaking applicants will be selected, based on their prior experience, interest and opportunities for continued work in diabetes epidemiology. An additional 10 graduates from the three prior Japan-U.S. Diabetes Epidemiology Training Courses in the region will be accepted in an "Advanced Track," where they will present their current research to the faculty for individual feedback. Several graduates of the two previous Training Courses will also present lectures and assist with student
and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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mentoring. At the conclusion of the course, the participants will be knowledgeable about epidemiology and statistics as they apply to diabetes, and have had considerable experience with the Internet. In addition, they will have developed strong links with the very experienced faculty, with whom they will continue to collaborate. As with previous courses, graduates of the Second Asia-Pacific Diabetes Training Course will also be developing comparative epidemiology studies, diabetes prevention programs, etc., in their own countries. Thus, this course will enhance the ethnic diversity of the future generation of diabetes epidemiologists. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Cardiovascular Risks in Adolescents with Diabetes Principal Investigator & Institution: Faulkner, Melissa S.; Maternal-Child Nursing; University of Illinois at Chicago at Chicago Chicago, Il 60612 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-MAY2005 Summary: Cardiovascular disease (CV) is a leading cause of morbidity and mortality in the United States. An increase of two to four times in the risk of heart disease is reported in persons with diabetes, regardless of whether they have type 1 or type 2 diabetes. In spite of the magnitude of this problem, few investigators have explored the effects of diabetes diagnosed during youth on the development of cardiovascular disease. The limited research that is available does suggest that cardiovascular risks, such as lipids and lipoproteins, are elevated for youth with type 1 diabetes compared with nondiabetic counterparts. Additionally, a decrease in heart rate variability has been documented for adolescents with type 1 diabetes, although no data were found regarding adolescents with type 2 diabetes. Greater numbers of adolescents are being diagnosed with type 2 diabetes, particularly in minority populations, secondary to sedentary lifestyle behaviors, obesity, and increased dietary fat consumption. The intent of this proposal is to describe differences in adolescents with type 1 and type 2 diabetes pertaining to cardiovascular risks, personal factors, and behavioral factors. In addition, we will examine relationships among these three sets of variables and determine how sociodemographic components influence each set of variables. A descriptive correlational design with a sample of 100 adolescents with type 1 diabetes and 100 adolescents with type 2 diabetes will be used to investigate cardiovascular risks, as well as predisposing factors such as exercise beliefs, level of physical activity, dietary practices, selfcompetence, and body mass index. Sociodemographic variables such as race, gender, socioeconomic status, family structure and history will be
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included. Determining variations in cardiovascular risks and predisposing factors for youth with type 1 versus type 2 diabetes is essential prior to designing interventions that promote positive health outcomes, ultimately control escalating costs for diabetes care, and minimize adverse effects on health status and well being. This investigation is particularly relevant given the limited research on cardiovascular risks in adolescents with type 2 diabetes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Collaborative Management of Diabetes in Blacks Principal Investigator & Institution: Egede, Leonard E.; Medicine; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 0-JUN2006 Summary: The objective of this application is to develop collaborative management of type 2 diabetes in black Americans. In parallel, the PI's goal is to achieve investigative independence. The central hypothesis is that culturally sensitive collaboration is essential to improving diabetes outcomes in blacks. This hypothesis is based on the Symbolic Interaction Theory. The ISAS paradigm, a modification of this theory, explains Individual behavior as a response to Symbols (meanings) in relation to both an Audience (health care providers) and the Situation (systems and social support). Thus, diabetes self-management in blacks will depend on meanings attached to, and cultural relevance of the provider-patient interaction, and Systems/social support. The rationale for this research is that culturally sensitive collaboration is crucial to changing the poor outcomes of type 2 diabetes in black patients that impact their diabetes outcomes, to identify impediments to improved diabetes outcomes in Blacks that are attributable to health care providers, and to identify external factors that impact on diabetes outcome in Blacks. This research is innovative because it integrates modern, population-based approaches to the management of diabetes with cultural considerations that are relevant to the population of interest. This innovative approach is expected to yield the following outcomes. First, specific cultural impediments to effective treatment of type-2 diabetes in blacks will be identified in both-patients and their health-care providers, which will allow prospective targeting of these factors to improve diabetes outcomes. Second, it is expected that important components of collaborative care for blacks with type-2 diabetes will be identified despite cultural difference between patients and providers. Third, because of this mentored research experience, the principal investigative
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independence, with sufficient data to be competitive for R01 funding. Collectively, these outcomes are important, because they are expected to be competitive for R01 funding. Collectively, these outcomes are important, because they are expected to improve the diabetes outcomes of black Americans with type 2 diabetes and to the cadre of dedicated diabetes health services researchers. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Diabetes Computer Health Performance Assessment Principal Investigator & Institution: Clark, D. J.; Videodiscovery Box 85878 Seattle, Wa 98115 Timing: Fiscal Year 2002; Project Start 1-FEB-2002; Project End 1-JAN2003 Summary: (Scanned from the Applicant's Abstract): Multimedia computer-based technologies are reshaping the practice of diabetes patient education. We propose to develop a computer-based performance assessment to be targeted for children with diabetes (age 10-17) that will provide a comprehensive measure of patient diabetes health knowledge and skills. The assessment will take the form of rich multimedia dramatized simulations in which a series of decisions and observations must be made. The events will be administered using the Computer Performance Based Assessment system developed by Videodiscovery, Inc. The technology uses distributed Linux based server appliances that provide high bandwidth access to streaming video and text within an institution's network. All logical branching, questions, scoring, and student record keeping are stored in the database on the server. Teachers or medical professionals can review student responses and view a summary performance profile for skill and knowledge objectives. In Phase II, the Diabetes Computer Health Performance Assessment will be field tested in a randomized clinical trial and, after final revisions, will be sold directly to diabetes centers, diabetes educators, or persons with diabetes as a online subscription service or stand-alone CD-ROM. PROPOSED COMMERCIAL APPLICATION: The Computerized Diabetes Health Performance Assessment system will be sold directly to diabetes centers, diabetes educators, or persons with diabetes as an intemet subscription or as stand?alone CD?ROMs. The assessment could be used by state and federal agencies to determine the effectiveness of diabetes health education promotion initiatives. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Diabetes Research and Training Center Principal Investigator & Institution: Clark, Charles M.; Professor of Medicine; Medicine; Indiana Univ-Purdue Univ at Indianapolis 355 N Lansing Indianapolis, in 46202 Timing: Fiscal Year 2000; Project Start 1-SEP-1977; Project End 0-NOV2002 Summary: It is now accepted that effective treatment of diabetes reduces the incidence and severity of its complications. Our research and that of others confirm that most patients with diabetes are not receiving adequate care, emphasizing the need for earlier diagnosis and treatment. With this in mind, we have adopted as the theme of this DRTC Shifting the Curve: Preventing Diabetes and Its Complications. The Indiana University DRTC enhances diabetes research through support of Research Enrichment, Pilot Projects, Research Training and Core facilities. The research base consists of 53 primary investigators with annual direct funding of $12,324,577 and 32 Collaborating investigators with an additional $11,889,534. These investigators fall into four groups: Molecular and Cell Biology, Complications, Physiology, and Health Service Research. The Molecular and Cell Biology Group has strengths in metabolism and signal transduction, and is supported primarily by the molecular Biology Core. The Complications Group focuses on molecular mechanisms of vascular disease and other end-organ diabetic complications. It is supported by the Biostatistics, Immunologic services, Molecular Biology and Physiology Cores. The Physiology Group is expanding our knowledge of the pathophysiology of diabetes and insulin resistance. Several newly recruited investigators add expertise in obesity and exercise physiology. The Physiology Core permits this Group to apply a number of advanced techniques to study and characterize individuals with diabetes and insulin resistance. The goal of the Health Services Research (HSR) Group is to improve the delivery of health care to persons with diabetes. The HSR Group has developed cooperative studies with the other three DRTC's which are also Diabetes Prevention Program (DPP) sites to take advantages of the DPP population. Within the HSR Group, the Model Diabetes Unit, the Education Design and Evaluation Core (EDEC) and the Outreach Core propose innovate projects to improve the ability of practitioners to deliver comprehensive diabetes care. These investigators depend on the Biostatistics, Immunologic Services and Physiology Cores. These and numerous institutional resources enhance the DRTC's ability to conduct research, to disseminate its results, and to improve the diagnosis and treatment of persons with diabetes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Genes for Non-Insulin-Dependent Diabetes Mellitus Principal Investigator & Institution: Bell, Graeme I.; Professor; Biochem and Molecular Biology; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2000; Project Start 0-SEP-1993; Project End 1-AUG2004 Summary: Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia resulting from an absolute or relative deficiency of insulin. The chronic hyperglycemia of diabetes is associated with long-term tissue damage, especially of the eyes, kidneys, nerves, heart and blood vessels. Type 2 or non-insulin-dependent diabetes mellitus is the most common form of diabetes, affecting about 15 million people in the United States. Genetic factors play an important role in the development of type 2 diabetes and the overall aim of this application is to identify the genes that are responsible for type 2 diabetes and then to determine how they contribute to the pathogenesis of this disorder. During the present funding period, research carried out under the auspices of this grant has shown that linkage studies using affected sib pairs without parents can be used to localize genes for type 2 diabetes. We have mapped the major type 2 diabetes susceptibility gene in Mexican Americans (gene symbol, NIDDM1), a gene which may account for 30 percent of the familial clustering of type 2 diabetes in this population, to the region of the markers D2S125-D2S140. Our studies also provided evidence for other susceptibility genes of smaller effect than NIDDM1. This is a continuation of collaborative studies between investigators at The University of Chicago, the University of Texas Health Science Center at Houston and Virginia Mason Research Center to identify genes for type 2 diabetes. The aim in the first funding cycle was to map the genes for type 2 diabetes. We have made major progress toward reaching this goal and now propose to make the natural transition from genetic linkage studies to identification and functional characterization of NIDDM1 and other type 2 diabetes genes. Studies being carried out at the University of Chicago will focus on NIDDM1 whereas those at the University of Texas Health Science Center at Houston and Virginia Mason Research Center will involve other regions containing putative type 2 diabetes genes. The identification and characterization of the genes for type 2 diabetes will lead to a better understanding of the molecular basis of this disorder, thereby providing the basis for new approaches for prevention and treatment based on the nature of the underlying molecular defect. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Landmarks in the Progression to Type II Diabetes Principal Investigator & Institution: Dolan, Lawrence M.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 0-AUG2005 Summary: (adapted from the application) Recent clinic-based studies strongly suggest a marked increase in the incidence of type 2 diabetes in adolescents. However, population or community-based studies have not as yet been performed to document the epidemiology of type 2 diabetes in adolescents and the natural history of this disease. This application provides a unique opportunity to address these issues in a large (4,373 student), well-defined (47% female, 53% male), racially integrated (46.7% African-American, 47.7% non-Hispanic white) school district containing a wide range of socio-economic statuses. Since, 1973 a member of the research team has performed community-based studies of lipids and cardiovascular risk factors on students and their families in this district. This 4-year study will use a cohort design to define the epidemiology and risk factors for the development and progression to type 2 diabetes. The specific aims of the study are: 1) to determine the prevalence of insulin resistance, carbohydrate intolerance, and diagnosed and undiagnosed diabetes and risk factors associated with type 2 diabetes in a cohort of adolescents in grades 5 through 12; and 2) to determine each-year the progression to insulin resistance, carbohydrate intolerance and diabetes in a cohort of adolescents over a 4 year interval. To accomplish these goals information concerning personal medical and family history of diabetes, physical examination (body mass index, stage of puberty, acanthosis nigricans, waist circumference) and fasting and 2-hour post glucose load plasma glucose and insulin concentration will be collected, measured and analyzed each year of the study. This application will provide unique, community-based information that will: 1) define the prevalence of insulin resistance, carbohydrate intolerance, and diagnosed and undiagnosed type 2 diabetes in adolescents with an enriched African-American population and 2) identify risk factors and predictors for the development and progression to type 2 diabetes. These data are critical to the development of effective individual and public health intervention strategies to prevent type 2 diabetes and its complications in adolescence. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Pathogenesis of Type 2 Diabetes in Latino Women Principal Investigator & Institution: Buchanan, Thomas A.; Professor; Medicine; University of Southern California University Park Los Angeles, Ca 90007 Timing: Fiscal Year 2000; Project Start 1-JUN-1993; Project End 0-JUN2003 Summary: (Adapted from Investigator's Abstract) The investigators have shown that 50% of Latino women with gestational diabetes mellitus (GDM) develop type 2 diabetes within 5 years after the index pregnancy. The overall goal of their research program is to develop strategies for prevention of diabetes in these high-risk women. Their primary hypothesis is that the subset of Latino women with GDM who are at highest risk for diabetes have a defect that limits pancreatic B-cell compensation for insulin resistance. That hypothesis predicts that (a) poor B-cell function in late pregnancy, when all women are insulin resistant, will identify women at high risk for diabetes after pregnancy, and (b) that insulin resistance following pregnancy will increase the risk of diabetes in women with a B-cell defect. In the initial 5 years of the project, the investigators performed detailed assessments of B-cell function, insulin sensitivity, and body composition in 150 Latino women with GDM during the third trimester of pregnancy. They repeated the tests at 15 months postpartum and will complete testing at 30 months postpartum during the current cycle. Results to date indicate that, in the third trimester, women with GDM have (in addition to hyperglycemia) peripheral and hepatic insulin resistance, elevated basal glucose production, and reduced insulin responses to glucose compared to normal pregnant women. Moreover, poor B-cell function, post-challenge hyperglycemia and elevated basal glucose production were predictive of diabetes within 15 months postpartum. The investigators project that they will have a statistically meaningful sample of women in follow-up until at least 90 months postpartum. Thus, for the next grant cycle, they propose to continue follow-up with detailed metabolic testing at 15month intervals to: (a) identify antepartum characteristics that best predict the development of diabetes or protection therefrom during prolonged follow-up; and (b) identify characteristics outside of pregnancy that predict or attend the progression to diabetes. The former effort will test their prediction about the importance and nature of a Bcell defect early in the pathogenesis of diabetes. The latter effort will test their prediction that chronic insulin resistance will increase the risk of diabetes in women with such a B-cell defect. The investigators point out that the results could provide truly novel information about the pathogenesis of type 2 diabetes in very high risk women, thereby
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allowing identification of potential targets for interventions to delay or prevent diabetes and its long term complications. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Patient-Provider Relationship and Diabetes Self-Care Principal Investigator & Institution: Ciechanowski, Paul S.; Family Medicine; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 5-FEB-2002; Project End 1-JAN2007 Summary: (provided by applicant) Clinicians, researchers and policy planners have recognized that despite the availability of effective medications and self-monitoring methods, normal metabolic control for a great proportion of patients with diabetes remains elusive, in large part because of non-adherence to treatment. Models of care, which focuses on improving patient-provider interactions, have been shown to be effective in improving adherence to therapies in patients with chronic illness. The goal of this 5-year Mentored Patient-Oriented Research Career Development Award is to enable the applicant to obtain the necessary skills and training to become an independent investigator in improving diabetes self-management by focusing on the health care relationship. This career development award will consist of coursework, mentorship, and supervised investigations focusing on: 1) understanding patientprovider relationship influences on diabetes self-care, using attachment theory as a model; 2) assessing cost and utilization and societal implications of poor patient-provider communication in diabetes care; and 3) developing and testing of high quality clinical interventions using relationship-based theoretical models to improve health care utilization, treatment adherence and outcomes in diabetes. Career development activities will be applied to four mentored research studies. In study 1, analyses of existing data sets from primary and tertiary care diabetes patients will test the hypothesis that the quality of the patient-provider relationship is associated with diabetes self-management. In study 2, a large longitudinal epidemiological study of primary care patients with diabetes will assess the impact of patient-provider communication on clinical outcomes and health care costs and utilization. In study 3, indepth qualitative and quantitative assessment of type 2 diabetes patients will be conducted to assess how treatment adherence is influenced by patterns of patient-provider interactions. In Study 4, data from the first three studies will be integrated with career development training to develop and pilot test clinical interventions for improving care of diabetes. Study 4 will test the feasibility of conducting such interventions focusing on the patient-provider relationship in preparation for a clinical
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effectiveness trial (R-01 study). This award will help the applicant bridge the gap between theory-based research on the patient-provider relationship and dissemination of clinical and population-based interventions designed to improve the quality of the patient-provider relationship and self-care in diabetes. This K-23 award will provide crucial support for the applicant's ongoing development as an investigator, clinician, and educator in the area of diabetes care. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Self Care Behaviors Among Hispanics with Type 2 Diabetes Principal Investigator & Institution: Cantero, Patricia J.; Preventive Medicine; University of Southern California University Park Los Angeles, Ca 90007 Timing: Fiscal Year 2000; Project Start 1-AUG-2000; Project End 1-JUL2001 Summary: (adapted from the application): This dissertation study is based on theoretical and culturally sensitive frameworks which utilize demographic, medical, cultural, personal and social-environmental factors to better understand facilitators and barriers to four self-care diabetes behaviors (i.e., taking medication, self-glucose monitoring, and adhering to diet and exercise regimens) between insulin-treated Hispanic men and women with type 2 diabetes. Data on self-care diabetes behaviors will be collected through an interviewer-administered survey, from a group (n = 200) of randomly selected Spanish and Englishspeaking Hispanic men and women from predominantly indigent county clinics in Los Angeles. The findings from the proposed dissertation study will provide rates on self-care diabetes behaviors among Hispanic, particularly among the elderly that are noticeably absent in the literature. In addition, it will provide empirical data on possible facilitators and barriers to self-care diabetes behaviors among Hispanics. These data will help health behavior researchers, health care professionals and diabetes educators to develop and/or improve self-care diabetes management interventions, with the aim of reducing diabetes morbidity and increasing the quality of life of those affected with diabetes. Specific aims of the study are: (1) to collect data on self-care diabetes behaviors among Hispanics, particularly those age 65 and older with type 2 diabetes in Los Angeles County; (2) to assess the consequences of diabetes in older adults for familial support and provider-patient language concordance as they relate to self-care diabetes behaviors; and (3) to determine the role of demographic, medical, cultural, personal, and social-environmental factors on adherence to self-care diabetes behaviors. To test specified age-
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related hypotheses, the sample will be divided into two groups: 65 years and over and those under 65 years. Associations between the independent and dependent variables will be computed using chi-square and Student s t tests. Hierarchical multiple regression analyses will be performed to explain the relationship among the four self-care diabetes behaviors and demographic, medical, cultural, personal and socialenvironmental factors. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Treatment Preferences of Older Patients with Diabetes Principal Investigator & Institution: Chin, Marshall H.; Associate Professor; Medicine; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2000; Project Start 5-AUG-2000; Project End 1-JUL2002 Summary: Diabetes is an excellent chronic disease model for studying provider-patient communication and complex decision-making in older persons, because patient preferences, clinical judgment, and incomplete scientific evidence should be incorporated into the discussion. While approximately 40 percent of the patients with diabetes in the United States are 65 years or older, limited evidence exists to guide their management. In younger populations, tight glycemic control has been demonstrated to prevent microvascular complications such as retinopathy and nephropathy. However, older patients may die of other causes before developing diabetic complications. Given that the treatment of diabetes can adversely affect quality of life through dietary restrictions, the burden of taking medications, hypoglycemia, and the discomfort of insulin injections, treatment should have more benefit than harm. Therefore, it is crucial to understand patient preferences regarding the aggressiveness of treatment. The ultimate goal of this research program is to improve doctor- patient communication about the issues relevant to diabetes care of older persons through provider and patient educational tools that can be used in routine daily clinical practice. The specific aims in this study of 600 patients with diabetes aged 65 years or older are: 1) to assess older patients' preferences regarding the aggressiveness of their diabetes treatment; 2) to identify the factors associated with the aggressiveness of patients' preferences for diabetes care; and 3) to determine the concordance between older patients' preferences and physicians' preferences regarding the aggressiveness of diabetes care, as well as with actual treatment style. Quantitative interviews will measure patient utilities for diabetic complications and intensity of therapy through the time trade-off technique. The interview
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will also use validated scales to measure the patient's view of different domains of the Health Belief Model including: 1) vulnerability to the ill effects of diabetes; 2) severity of diabetes as a disease and illness; 3) benefits of treatment; and 4) barriers to treatment. Physicians will be surveyed about their preference for individual patient's aggressiveness of therapy, and the actual treatment style will be obtained from the medical record. These data sources will supply a comprehensive view of the factors influencing a patient's preferences for aggressiveness of diabetes treatment, and enable the patient's choices to be compared with those of physicians and actual medical practice. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Trialnet: Diabetes Type 1 Prevention Trial Principal Investigator & Institution: Chase, H P.; B Davis Ctr/Childhood Diabetes; University of Colorado Hlth Sciences Ctr 4200 E 9Th Ave Denver, Co 80262 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 1-AUG2008 Summary: (provided by applicant) Long Term Objective: to determine whether early interventional therapies can delay, prevent, or reverse the development of Type 1 diabetes. Specific Aims: intervention trials for subjects with pre-diabetes and new onset diabetes The Diabetes Prevention Trial - Type 1 (DPT-1): to determine whether the early intervention use of insulin in nondiabetic relatives of persons with Type 1 diabetes can delay their development of Type 1 diabetes as a clinical disease. Insulin is used for this purpose since it is a well characterized antigen specifically produced by beta cells. Research design: the parenteral antigen protocol enrolled subjects found to be at high risk (greater than 50 percent) for development of diabetes in the next 5 years. Subjects randomized to the insulin-treated group received insulin intravenously for 4 days each year and two injections of Ultralente each day (before breakfast and before bedtime). The oral antigen protocol enrolls subjects found to be at intermediate risk (25-50 percent) for the development of Type 1 diabetes in the next 5 years. This is a double-blind study and all subjects take 1 capsule daily, with half receiving the antigen and the others receiving a placebo. Levels of antibodies, insulin, Cpeptide, HbA1C and glucose are followed. The main study endpoint is two ?diabetic? oral glucose tolerance tests (OGTT) performed on different days. Immunotherapy Trial in New Onset Type 1 Diabetes: to test the hypothesis that mycophenolate mofetil (MMF alone or with daclizumab (DZB) will prolong the period of C-peptide production in subjects with new onset Type 1 diabetes. A secondary aim is to provide the clinical
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material for the validation of surrogate markers for immunity to islet beta-cells. This study is innovative in that these agents have not been previously evaluated but are rational choices for intervention in an autoimmune disorder. Research design: Levels of autoantibodies and T cell reactivity to islet autoantigens, both of which are surrogate immunological parameters specific for Type 1 diabetes will be followed. Measures of immune modulation will include serologic and T cell reactivity to recall antigens. The metabolic end-points of this study will be fasting and stimulated C-peptide, hemoglobin A1C, and total insulin dose. If this study has a positive outcome, then we would propose a similar study in people at high risk for developing Type 1 diabetes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Type 2 Diabetes and Cardiac Dysfunction Principal Investigator & Institution: Chatham, John C.; Associate Professor; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2000; Project Start 0-AUG-2000; Project End 1-JUL2003 Summary: (adapted from the applicant's description): Diabetes is associated with increased incidence of vascular disease and hypertension; however, there is evidence of a diabetic cardiomyopathy independent of other risk factors for heart disease. Despite the fact that approximately 90% of diabetic patients have Type 2 diabetes, the majority of the experimental studies on the effects of diabetes on the myocardium use acute models of uncontrolled Type 1 diabetes. Therefore, the goal of this project is to determine the consequences of Type 2 diabetes on cardiac metabolism and function. The investigators have shown that contractile dysfunction following diabetes can be attributed, in part, to alterations in energy metabolism. Preliminary studies also demonstrate that metabolic abnormalities are associated with the transition from insulin resistance to Type 2 diabetes and precede the development of overt contractile dysfunction. In light of these results, the hypothesis to be tested is that the development of Type 2 diabetes is associated with impaired energy production as a result of a decrease in both carbohydrate and fatty acid entry into the mitochondria. The investigators propose that these alterations in energy metabolism contribute to the development of impaired contractile function and increased susceptibility to ischemic injury. To test this hypothesis, experiments will be carried out on isolated perfused hearts form Zucker rats (ZF, fa/fa); lean non-diabetic litter mates (fa/?) and obese, non-diabetic Zucker rats (ZF, fa/fa) will be used as controls. The effects of the development of Type 2 diabetes, on
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myocardial substrate utilization, contractile function and the regulation of coronary flow will be investigated. They will determine whether treatment with anti-hyperglycemic agents prevent the myocardial changes associated with the development of Type 2 diabetes in the ZDF rat. 13C-NMR spectroscopic techniques will be used to quantify fluxes through metabolic pathways critical to the regulation of energy metabolism under normal conditions and following ischemia and reperfusion derangement of the myocardium that occur as a result of obesity, insulin resistance as well as Type 2 diabetes. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Type 2 Diabetes in Youth: Beta Cell Preservation Principal Investigator & Institution: Arslanian, Silva A.; Professor; Children's Hosp Pittsburgh/Upmc Hlth Sys of Upmc Health Systems Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 0-SEP-2001; Project End 8-FEB-2009 Summary: (provided by applicant): This application for the treatment of type 2 diabetes mellitus in children (T2DM) is from a strong cadre of investigators from Children?s Hospital of Pittsburgh and the University of Pittsburgh. These investigators bring together a long-standing tradition of expertise in 1) childhood diabetes (Drs. Arslanian and Becker), 2) in investigating insulin resistance and secretion in children (Dr. Arslanian, PI), 3) in behavioral medicine and lifestyle intervention for childhood obesity (Drs. Marcus and Vinditti), 4) in physical activity and lifestyle interventions (Drs. Kriska and Aaron), 5) in epidemiology of chronic disease and large intervention trials of obesity, type 2 diabetes and cardiovascular disease (Drs. Lewis Kuller, Kriska and Marcus), and 6) in recruiting for large intervention trials (Janet Bonk). Based on our collective strength, we believe that we can fully meet the goals for a clinical site for this multicenter trial of type 2 diabetes mellitus in children. The PI, Silva Arslanian, M.D., has been at the forefront of the "emerging epidemic" of type 2 diabetes in children. She has been a consultant to the NIH, CDC, and the American Diabetes Association (ADA). She was one of the eight-member panel of experts who developed the ADA Consensus Position of type 2 Diabetes in Children and Adolescents. Her research in childhood insulin resistance and secretion has made important contributions to the understanding of risk factors for type 2 diabetes mellitus in children. In addition, there is a strong institutional infrastructure to support our application, including 1) the pediatric General Clinical Research Center (Director, Silva Arslanian, M.D.), 2) the Diabetes Center at Children?s Hospital of Pittsburgh, 3) the NIH-funded Obesity Nutrition Research Center (ONRC), (David Kelley,
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M.D., PI), 4) the Graduate School of Public Health, and lastly, 5) the multiple collaborations with different disciplines including national programs for disadvantaged youth. Finally, the K24 Award of the PI in patient-oriented research complements one of the objectives of this RFA which is to train and develop young clinician-scientists. Our proposal will investigate intervention strategies in youth with T2DM with the objective of delaying beta-cell deterioration and preserving beta-cell function. To this aim we propose to use a randomized clinical trial design with 3 arms: conventional care, behavioral lifestyle and risk management intervention, and behavioral lifestyle intervention combined with dualagent insulin sensitizing therapy. Measures of beta-cell function and insulin resistance will be the primary outcome of interest. Urinary albumin excretion and carotid artery intima-media thickness will be the secondary outcomes of interest. We also propose that this RFA incorporate ancillary studies. A comprehensive approach to therapeutic interventions in children with type 2 diabetes mellitus will form the basis for prevention of adult morbidity and mortality starting early in childhood. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: PGS-2 in the Pathogenesis of IDDM Principal Investigator & Institution: Clare-Salzler, Michael J.; Associate Professor; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2001; Project Start 0-SEP-1997; Project End 1-JUL-2006 Summary: Type 1 diabetes, a Th1 mediated autoimmune disease, resulting from poorly defined interactions between susceptibility genes, the environment, and the immune system. A feature of T cell-mediated autoimmune diseases, including type 1 diabetes, is a reduced capacity of antigen presenting cells (APC) to activate T cells. Low levels of activation may predispose to autoimmune because apoptotic death of autoreactive T cells or generation of regulatory T cell responses requires quantitatively highly levels of activation than are needed for T cell survival. We have defined an APC defect, the constitutive expression of the normally inducible cyclooxygenase, prostaglandin synthase 2 (PGS2), which is common to monocytes (MO) of subjects at risk for type 1 diabetes and macrophages (MP) of NOD and NODscid mice. We determined in congenic mice that an NOD gene in a defined region of chromosome 1 controls the PGS2 phenotype, but is not the PGS2 gene. PGS2 expression allows high-level production of inflammatory PG and contributes to defective APC function. Our natural history studies in humans demonstrate healthy controls express low levels of PGS2, whereas high levels are present; 1.) Early in life as infants with high-risk HLA
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genotypes, 2.) In high risk autoantibody positive subjects, and 3.) in 80% of type 1 diabetics. Preliminary studies of patients with other established autoimmune disease demonstrate similar aberrant PGS2 expression and suggest this MO defect may be common to autoimmunity. Furthermore, omega-3 fatty acids which reduce PG metabolism appear to reduce the risk for autoantibodies, suggesting the PGS2 defect is regulatory by dietary environment. PG production appears to play a major role in diabetes pathogenesis as treating NOD mice with drugs that block both PGS activity significantly reduces diabetes incidence. Ongoing prospective studies demonstrated 12/17 (71%) high risk subjects who progressed to diabetes expressed high levels of PGS2. Preliminary, risk analysis suggests MO PGS2 expression increases the chance of developing diabetes by approximately 40%. In order to further define the etiology of PGS2 expression and its role in type 1 diabetes pathogenesis we will address the following specific aims, 1.) determine whether MO PGS2 expression is a risk factor for developing autoantibodies and type 1 diabetes, and establish whether it is similarly expressed in other autoimmune diseases, 2.( Determine the NOD gene(s) encoded on chromosome 1 which contribute to abnormal PGS2 expression and 3.) establish whether PGS2 specific inhibitors and supplementation of dietary omega-3 fatty acids reduce disease in NOD mice. The overall goal is to establish the utility of PGS2 as risk factor for type 1 diabetes and as a potential target for human diabetes prevention trials. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central20 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).21 Access to this growing archive of e-journals is free and unrestricted.22 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “diabetes” (or synonyms) into the search box. This search gives you access to Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 21 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 22 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 20
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full-text articles. The following is a sample of items found for diabetes in the PubMed Central database: ·
[beta] cell apoptosis in T cell-mediated autoimmune diabetes by Michael O. Kurrer, Syamasundar V. Pakala, Holly L. Hanson, and Jonathan D. Katz; 1997 January 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19288
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[beta]-Cell Lipotoxicity in the Pathogenesis of Non-Insulin-Dependent Diabetes Mellitus of Obese Rats: Impairment in Adipocyte-[beta]-Cell Relationships by Y Lee, H Hirose, M Ohneda, JH Johnson, JD McGarry, and RH Unger; 1994 November 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45129
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A cholera toxoid-insulin conjugate as an oral vaccine against spontaneous autoimmune diabetes by Isabelle Bergerot, Corinne Ploix, Jacob Petersen, Valerie Moulin, Carola Rask, Nicole Fabien, Marianne Lindblad, Anne Mayer, Cecil Czerkinsky, Jan Holmgren, and Charles Thivolet; 1997 April 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20771
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A Diabetes-Associated T-Cell Autoantigen Maps to a Telomeric Locus on Mouse Chromosome 6 by A Dallas-Pedretti, M McDuffie, and K Haskins; 1995 February 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42524
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A Membrane Form of Brain L-Glutamate Decarboxylase: Identification, Isolation, and its Relation to Insulin-Dependent Diabetes Mellitus by B Nathan, J Bao, C Hsu, P Aguilar, R Wu, M Yarom, C Kuo, and J Wu; 1994 January 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42923
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A mouse CD8 T cell-mediated acute autoimmune diabetes independent of the perforin and Fas cytotoxic pathways: Possible role of membrane TNF by Pedro Luis Herrera, David M. Harlan, and Pierre Vassalli; 2000 January 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26654
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A Myo-Inositol Pool Utilized for Phosphatidylinositol Synthesis is Depleted in Sciatic Nerve from Rats with Streptozotocin-Induced Diabetes by X Zhu and J Eichberg; 1990 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=55265
Studies 137
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A Predominant Role of Integrin [alpha]4 in the Spontaneous Development of Autoimmune Diabetes in Nonobese Diabetic Mice by X Yang, SA Michie, R Tisch, N Karin, L Steinman, and HO McDevitt; 1994 December 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45487
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A randomised controlled trial of a patient based Diabetes recall and Management system: the DREAM trial: A study protocol [ISRCTN32042030] by Martin Eccles, Gillian Hawthorne, Paula Whitty, Nick Steen, Alessandra Vanoli, Jeremy Grimshaw, and Linda Wood; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=101376
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A Role of Hsp60 in Autoimmune Diabetes: Analysis in a Transgenic Model by OS Birk, DC Douek, D Elias, K Takacs, H Dewchand, SL Gur, MD Walker, RVD Zee, IR Cohen, and DM Altmann; 1996 February 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40025
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A targeted mutation in the IL-4R[alpha] gene protects mice against autoimmune diabetes by Dorel L. Radu, Nancy Noben-Trauth, Jane HuLi, William E. Paul, and Constantin A. Bona; 2000 November 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18827
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A Yeast Artificial Chromosome-Based Map of the Region of Chromosome 20 Containing the Diabetes-Susceptibility Gene, MODY1, and a Myeloid Leukemia Related Gene by M Stoffel, MML Beau, R Espinosa, SF Bohlander, DL Paslier, D Cohen, K Xiang, NJ Cox, SS Fajans, and GI Bell; 1996 April 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39463
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Activation of CD1d-restricted T cells protects NOD mice from developing diabetes by regulating dendritic cell subsets by Yuri N. Naumov, Keith S. Bahjat, Rudolph Gausling, Roshini Abraham, Mark A. Exley, Yasuhiko Koezuka, Steven B. Balk, Jack L. Strominger, Michael Clare-Salzer, and S. Brian Wilson; 2001 November 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61128
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Adeno-associated virus vector-mediated IL-10 gene delivery prevents type 1 diabetes in NOD mice by Kevin Goudy, Sihong Song, Clive Wasserfall, Y. Clare Zhang, Matthias Kapturczak, Andrew Muir, Matthew Powers, Marda Scott-Jorgensen, Martha Campbell-Thompson, James M. Crawford, Tamir M. Ellis, Terence R. Flotte, and Mark A. Atkinson; 2001 November 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61141
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Adoptive Transfer of Autoimmune Diabetes and Thyroiditis to Athymic Rats by U McKeever, JP Mordes, DL Greiner, MC Appel, J Rozing, ES Handler, and AA Rossini; 1990 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54799
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Advanced Protein Glycosylation Induces Transendothelial Human Monocyte Chemotaxis and Secretion of Platelet-Derived Growth Factor: Role in Vascular Disease of Diabetes and Aging by M Kirstein, J Brett, S Radoff, S Ogawa, D Stern, and H Vlassara; 1990 November 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=55090
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Altered Expression of Insulin Receptor Types A and B in the Skeletal Muscle of Non-Insulin-Dependent Diabetes Mellitus Patients by L Mosthaf, B Vogt, HU Haring, and A Ullrich; 1991 June 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51739
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An Abd Transgene Prevents Diabetes in Nonobese Diabetic Mice by Inducing Regulatory T Cells by SM Singer, R Tisch, X Yang, and HO McDevitt; 1993 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=47610
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An Anergic, Islet-Infiltrating T-Cell Clone that Suppresses Murine Diabetes Secretes a Factor That Blocks Interleukin 2/Interleukin 4Dependent Proliferation by C Diaz-Gallo, M Moscovitch-Lopatin, TB Strom, and VR Kelley; 1992 September 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=49979
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Anti-atherogenic effects of fibrates in type 2 diabetes by Philip Barter; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59525
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Apolipoprotein E gene polymorphism is not a strong risk factor for diabetic nephropathy and retinopathy in Type I diabetes: case-control study by Natalia S. Shcherbak; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=37310
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Apoptosis resistance of nonobese diabetic peripheral lymphocytes linked to the Idd5 diabetes susceptibility region by Francesco Colucci, Marie-Louise Bergman, Carlos Penha-Goncalves, Corrado M. Cilio, and Dan Holmberg; 1997 August 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23070
Studies 139
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Association between type 1 diabetes and Haemophilus influenzae type b vaccination: birth cohort study by Marjatta Karvonen, Zygimantas Cepaitis, and Jaakko Tuomilehto; 1999 May 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27850
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Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study by Irene M Stratton, Amanda I Adler, H Andrew W Neil, David R Matthews, Susan E Manley, Carole A Cull, David Hadden, Robert C Turner, and Rury R Holman; 2000 August 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27454
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Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study by Amanda I Adler, Irene M Stratton, H Andrew W Neil, John S Yudkin, David R Matthews, Carole A Cull, Alex D Wright, Robert C Turner, and Rury R Holman; 2000 August 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27455
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Autoantibodies to the GLUT-2 Glucose Transporter of [beta] Cells in Insulin-Dependent Diabetes Mellitus of Recent Onset by LR Inman, CT McAllister, L Chen, S Hughes, CB Newgard, JR Kettman, RH Unger, and JH Johnson; 1993 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45856
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Autoreactive Epitopes Defined by Diabetes-Associated Human Monoclonal Antibodies are Localized in the Middle and C-Terminal Domains of the Smaller Form of Glutamate Decarboxylase by W Richter, Y Shi, and S Baekkeskov; 1993 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46190
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Barriers to appropriate diabetes management among homeless people in Toronto by Stephen W. Hwang and Ann L. Bugeja; 2000 July 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80205
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Birth characteristics of women who develop gestational diabetes: population based study by Grace M Egeland, Rolv Skjaerven, and Lorentz M Irgens; 2000 September 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27469
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Birth weight and childhood onset type 1 diabetes: population based cohort study by Lars C Stene, Per Magnus, Rolv T Lie, Oddmund Sovik, Geir Joner, and The Norwegian Childhood Diabetes Study Group; 2001 April 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=30582
140 Diabetes
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Blood pressure reduction and diabetes insipidus in transgenic rats deficient in brain angiotensinogen by Martina Schinke, Ovidiu Baltatu, Manfred Bohm, Jorg Peters, Wolfgang Rascher, Giampiero Bricca, Andrea Lippoldt, Detlev Ganten, and Michael Bader; 1999 March 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22405
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Breakers of advanced glycation end products restore large artery properties in experimental diabetes by Bruce H. R. Wolffenbuttel, Chantal M. Boulanger, Francy R. L. Crijns, Maya S. P. Huijberts, Pierre Poitevin, Geertje N. M. Swennen, Sara Vasan, John J. Egan, Peter Ulrich, Anthony Cerami, and Bernard I. Levy; 1998 April 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22541
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Checkpoints in the Progression of Autoimmune Disease: Lessons from Diabetes Models by I Andre, A Gonzalez, B Wang, J Katz, C Benoist, and D Mathis; 1996 March 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39783
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Ciliary neurotrophic factor corrects obesity and diabetes associated with leptin deficiency and resistance by Isabelle Gloaguen, Patrizia Costa, Anna Demartis, Domenico Lazzaro, Annalise Di Marco, Rita Graziani, Giacomo Paonessa, Fang Chen, Charles I. Rosenblum, Lex H. T. Van der Ploeg, Riccardo Cortese, Gennaro Ciliberto, and Ralph Laufer; 1997 June 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=21071
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Clinical Update:Angiotensin-II --receptor blockers and nephropathy in patients with type 2 diabetes by Donald Farquhar; 2001 November 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81648&ren dertype=external
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Clinical Update:Lifestyle changes can prevent the development of diabetes mellitus by Kathryn A. Myers; 2001 June 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81220&ren dertype=external
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Cloning, Characterization, and Autoimmune Recognition of Rat Islet Glutamic Acid Decarboxylase in Insulin-Dependent Diabetes Mellitus by BK Michelsen, JS Petersen, E Boel, A Moldrup, T Dyrberg, and OD Madsen; 1991 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52588
Studies 141
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Commentary: Glucokinase, Glucose Sensing, and Diabetes by M Mueckler; 1993 February 1 http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=45753&action =stream&blobtype=file&blobname=[PNASPDFPath]/1993/9003/pdf/pq000784.pdf
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Comparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies by Josie M M Evans, Jixian Wang, and Andrew D Morris; 2002 April 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=102325
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Constitutive arrestin-mediated desensitization of a human vasopressin receptor mutant associated with nephrogenic diabetes insipidus by Larry S. Barak, Robert H. Oakley, Stephane A. Laporte, and Marc G. Caron; 2001 January 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=14550
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Correction of obesity and diabetes in genetically obese mice by leptin gene therapy by Patrick Muzzin, Randy C. Eisensmith, Kenneth C. Copeland, and Savio L. C. Woo; 1996 December 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26217
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Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40 by UK Prospective Diabetes Study Group; 1998 September 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28661
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Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41) by Alastair Gray, Maria Raikou, Alistair McGuire, Paul Fenn, Richard Stevens, Carole Cull, Irene Stratton, Amanda Adler, Rury Holman, and Robert Turner; 2000 May 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27380
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CTLA4 gene polymorphisms are associated with, and linked to, insulin-dependent diabetes mellitus in a Russian population by Dimitry A. Chistiakov, Kirill V. Savost'anov, and Valery V. Nosikov; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31345
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Cytotoxic T-Cell Precursors with Low-Level CD8 in the Diabetes-Prone Biobreeding Rat: Implications for Generation of an Autoimmune TCell Repertoire by D Bellgrau and A Lagarde; 1990 January 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53253
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D-chiro-Inositol Metabolism in Diabetes Mellitus by RE Ostlund, Jr, JB McGill, I Herskowitz, DM Kipnis, JV Santiago, and WR Sherman; 1993 November 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=47698
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Decreased Muscle Glucose Transport/Phosphorylation is an Early Defect in the Pathogenesis of Non-Insulin-Dependent Diabetes Mellitus by DL Rothman, I Magnusson, G Cline, D Gerard, CR Kahn, RG Shulman, and GI Shulman; 1995 February 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42621
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Diabetes care in general practice: meta-analysis of randomised control trials by Simon Griffin; 1998 August 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28634
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Diabetes in Canada's First Nations by William D. Panton; 2001 April 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80962&ren dertype=external
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Diabetes in Canada's First Nations by Bruce N. Leistikow; 2001 April 17 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80963&ren dertype=external
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Diabetes-associated mutations in a [beta]-cell transcription factor destabilize an antiparallel "mini-zipper" in a dimerization interface by Qing-Xin Hua, Ming Zhao, Narendra Narayana, Satoe H. Nakagawa, Wenhua Jia, and Michael A. Weiss; 2000 February 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15743
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Diagnostic criteria for diabetes revisited: making use of combined criteria by Ali Parappil, Suhail A. R. Doi, and Kamal A. S. Al-Shoumer; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=65682
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Drug points:Diabetes inspidus induced by ofloxacin by Anil Bharani and Hrishikesh Kumar; 2001 September 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=48160
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Early expression of antiinsulin autoantibodies of humans and the NOD mouse: Evidence for early determination of subsequent diabetes by Liping Yu, David T. Robles, Norio Abiru, Paramjit Kaur, Marian Rewers, Katalin Kelemen, and George S. Eisenbarth; 2000 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26499
Studies 143
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Early peri-operative hyperglycaemia and renal allograft rejection in patients without diabetes by Merlin C Thomas, John Moran, Timothy H Mathew, Graeme R Russ, and M Mohan Rao; 2000 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29098
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Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study by Jennifer M Jones, Margaret L Lawson, Denis Daneman, Marion P Olmsted, and Gary Rodin; 2000 June 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27398
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Ectopic Expression of the Agouti Gene in Transgenic Mice Causes Obesity, Features of Type II Diabetes, and Yellow Fur by ML Klebig, JE Wilkinson, JG Geisler, and RP Woychik; 1995 May 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41780
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Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39 by UK Prospective Diabetes Study Group; 1998 September 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28660
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Evidence that Down-Regulation of [beta]-Cell Glucose Transporters in Non-Insulin-Dependent Diabetes May be the Cause of Diabetic Hyperglycemia by L Orci, M Ravazzola, D Baetens, L Inman, M Amherdt, RG Peterson, CB Newgard, JH Johnson, and RH Unger; 1990 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=55292
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Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study by Nick A Roper, Rudy W Bilous, William F Kelly, Nigel C Unwin, and Vincent M Connolly; 2001 June 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=32252
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Experimental diabetes in rats causes hippocampal dendritic and synaptic reorganization and increased glucocorticoid reactivity to stress by Ana Maria Magarinos and Bruce S. McEwen; 2000 September 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27147
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Expression of adenoviral E3 transgenes in [beta] cells prevents autoimmune diabetes by Matthias G. von Herrath, Shimon Efrat, Michael B. A. Oldstone, and Marshall S. Horwitz; 1997 September 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23273
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Expression of Yeast Hexokinase in Pancreatic [beta] Cells of Transgenic Mice Reduces Blood Glucose, Enhances Insulin Secretion, and
144 Diabetes
Decreases Diabetes by PN Epstein, AC Boschero, I Atwater, X Cai, and PA Overbeek; 1992 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50693 ·
Failure of a Protective Major Histocompatibility Complex Class II Molecule to Delete Autoreactive T Cells in Autoimmune Diabetes by RM Slattery, JFAP Miller, WR Heath, and B Charlton; 1993 November 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=47867
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Fatty acid-induced [beta] cell apoptosis: A link between obesity and diabetes by Michio Shimabukuro, Yan-Ting Zhou, Moshe Levi, and Roger H. Unger; 1998 March 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=19389
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Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database by Josie M M Evans, Ray W Newton, Danny A Ruta, Thomas M MacDonald, Richard J Stevenson, and Andrew D Morris; 1999 July 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28155
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Gene for Non-Insulin-Dependent Diabetes Mellitus (Maturity-Onset Diabetes of the Young Subtype) is Linked to DNA Polymorphism on Human Chromosome 20q by GI Bell, K Xiang, MV Newman, S Wu, LG Wright, SS Fajans, RS Spielman, and NJ Cox; 1991 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51043
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Gene Therapy for Diabetes Mellitus in Rats by Hepatic Expression of Insulin by TM Kolodka, M Finegold, L Moss, and SLC Woo; 1995 April 11 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42152
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Genes Encoding Tumor Necrosis Factor [alpha] and Granzyme A are Expressed During Development of Autoimmune Diabetes by W Held, HR MacDonald, IL Weissman, MW Hess, and C Mueller; 1990 March 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53662
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Genetic Analysis of Diabetes and Insulitis in an Interspecific Cross of the Nonobese Diabetic Mouse with Mus spretus by B de Gouyon, E Melanitou, MF Richard, M Requarth, IH Hahn, JL Guenet, F Demenais, C Julier, GM Lathrop, C Boitard, and P Avner; 1993 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45983
Studies 145
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Genetic Analysis of Type 1 Diabetes Using Whole Genome Approaches by JA Todd; 1995 September 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41006
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Genetic and Physiological Association of Diabetes Susceptibility with Raised Na+/H+ Exchange Activity by G Morahan, P McClive, D Huang, P Little, and A Baxter; 1994 June 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=44104
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Genetic determination of islet cell autoimmunity in monozygotic twin, dizygotic twin, and non-twin siblings of patients with type 1 diabetes: prospective twin study by Maria J Redondo, Marian Rewers, Liping Yu, Satish Garg, Colleen C Pilcher, Robert B Elliott, and George S Eisenbarth; 1999 March 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27778
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Germ line deletion of the CD1 locus exacerbates diabetes in the NOD mouse by Fu-Dong Shi, Malin Flodstrom, Balaji Balasa, Soon Ha Kim, Kurt Van Gunst, Jack L. Strominger, S. Brian Wilson, and Nora Sarvetnick; 2001 June 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=34429
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Glucokinase Mutations Associated with Non-Insulin-Dependent (Type 2) Diabetes Mellitus have Decreased Enzymatic Activity: Implications for Structure/Function Relationships by M Gidh-Jain, J Takeda, LZ Xu, AJ Lange, N Vionnet, M Stoffel, P Froguel, G Velho, F Sun, D Cohen, P Patel, YD Lo, AT Hattersley, H Luthman, A Wedell, RS Charles, RW Harrison, IT Weber, GI Bell, and SJ Pilkis; 1993 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45994
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Glutamic Acid Decarboxylase Autoantibodies in Preclinical InsulinDependent Diabetes by HJD Aizpurua, YM Wilson, and LC Harrison; 1992 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50229
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Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials by John Pickup, Martin Mattock, and Sally Kerry; 2002 March 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=99054
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Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk) by Kay-Tee Khaw, Nicholas Wareham, Robert Luben,
146 Diabetes
Sheila Bingham, Suzy Oakes, Ailsa Welch, and Nicholas Day; 2001 January 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26599 ·
Health beliefs and folk models of diabetes in British Bangladeshis: a qualitative study by Trisha Greenhalgh, Cecil Helman, and A Mu'min Chowdhury; 1998 March 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28502
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Heterophile antibodies segregate in families and are associated with protection from type 1 diabetes by Jin-Xiong She, Tamir M. Ellis, S. Brian Wilson, Clive H. Wasserfall, Michele Marron, Sharon Reimsneider, Sally C. Kent, David A. Hafler, Donna S. Neuberg, Andy Muir, Jack L. Strominger, and Mark A. Atkinson; 1999 July 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22197
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Human Glucokinase Gene: Isolation, Characterization, and Identification of Two Missense Mutations Linked to Early-Onset NonInsulin-Dependent (type 2) Diabetes Mellitus by M Stoffel, P Froguel, J Takeda, H Zouali, N Vionnet, S Nishi, IT Weber, RW Harrison, SJ Pilkis, S Lesage, M Vaxillaire, G Velho, F Sun, F Iris, P Passa, D Cohen, and GI Bell; 1992 August 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=49778
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Human Monoclonal Islet Cell Antibodies From a Patient with InsulinDependent Diabetes Mellitus Reveal Glutamate Decarboxylase as the Target Antigen by W Richter, J Endl, TH Eiermann, M Brandt, R Kientsch-Engel, C Thivolet, H Jungfer, and WA Scherbaum; 1992 September 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=49941
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Hyperinsulinemia Induces a Reversible Impairment in Insulin Receptor Function Leading to Diabetes in the Sand Rat Model of NonInsulin-Dependent Diabetes Mellitus by H Kanety, S Moshe, E Shafrir, B Lunenfeld, and A Karasik; 1994 March 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43262
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IA-2, a Transmembrane Protein of the Protein Tyrosine Phosphatase Family, is a Major Autoantigen in Insulin-Dependent Diabetes Mellitus by MS Lan, C Wasserfall, NK Maclaren, and AL Notkins; 1996 June 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39028
Studies 147
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Identification and modulation of a naturally processed T cell epitope from the diabetes-associated autoantigen human glutamic acid decarboxylase 65 (hGAD65) by Gerald T. Nepom, John D. Lippolis, Forest M. White, Susan Masewicz, Jarrod A. Marto, Andrew Herman, C. John Luckey, Ben Falk, Jeffrey Shabanowitz, Donald F. Hunt, Victor H. Engelhard, and Barbara S. Nepom; 2001 February 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29331
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Identification of a Limited T-Cell Receptor [beta] Chain Variable Region Repertoire Associated with Diabetes in the BB Rat by DP Gold and D Bellgrau; 1991 November 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52826
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Identification of a Second Transmembrane Protein Tyrosine Phosphatase, IA-2[beta], as an Autoantigen in Insulin-Dependent Diabetes Mellitus: Precursor of the 37-kDa Tryptic Fragment by J Lu, Q Li, H Xie, Z Chen, AE Borovitskaya, NK Maclaren, AL Notkins, and MS Lan; 1996 March 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39791
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Inaugural Article:Interaction of the Ras-related protein associated with diabetes Rad and the putative tumor metastasis suppressor NM23 provides a novel mechanism of GTPase regulation by Jianhua Zhu, YuHua Tseng, Jason D. Kantor, Christopher J. Rhodes, Bruce R. Zetter, Julie S. Moyers, and C. Ronald Kahn; 1999 December 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24747
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Incomplete gastric metaplasia in children with insulin-dependent diabetes mellitus and celiac disease. An ultrastructural study by Marina Bertini, Andrea Sbarbati, Enrico Valletta, Leonardo Pinelli, and Luciano Tato; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=34772
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Induction and Therapy of Autoimmune Diabetes in the Non-Obese Diabetic (NOD/Lt) Mouse by a 65-kDa Heat Shock Protein by D Elias, D Markovits, T Reshef, R van der Zee, and IR Cohen; 1990 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53518
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Induction of resistance to diabetes in non-obese diabetic mice by targeting CD44 with a specific monoclonal antibody by Lola Weiss, Shimon Slavin, Shoshana Reich, Patrizia Cohen, Svetlana Shuster, Robert Stern, Ella Kaganovsky, Elimelech Okon, Ariel M. Rubinstein, and David Naor; 2000 January 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26655
148 Diabetes
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Influence of maternal age at delivery and birth order on risk of type 1 diabetes in childhood: prospective population based family study by Polly J Bingley, Isabelle F Douek, Christine A Rogers, and Edwin A M Gale; 2000 August 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27456
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Inhibition of Insulitis and Prevention of Diabetes in Nonobese Diabetic Mice by Blocking L-Selectin and Very Late Antigen 4 Adhesion Receptors by X Yang, N Karin, R Tisch, L Steinman, and HO McDevitt; 1993 November 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=47803
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Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene is Strongly Associated with Coronary Heart Disease in Non-Insulin- Dependent Diabetes Mellitus by J Ruiz, H Blanche, N Cohen, G Velho, F Cambien, D Cohen, P Passa, and P Froguel; 1994 April 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43641
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Insulin Receptor Isotype Expression Correlates with Risk of NonInsulin- Dependent Diabetes by L Mosthaf, J Eriksson, H Haring, L Groop, E Widen, and A Ullrich; 1993 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46149
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Insulin receptor substrate (IRS) 1 is reduced and IRS-2 is the main docking protein for phosphatidylinositol 3-kinase in adipocytes from subjects with non-insulin-dependent diabetes mellitus by Cristina M. Rondinone, Ling-Mei Wang, Peter Lonnroth, Christian Wesslau, Jacalyn H. Pierce, and Ulf Smith; 1997 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20591
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Insulin selectively increases SREBP-1c mRNA in the livers of rats with streptozotocin-induced diabetes by Iichiro Shimomura, Yuriy Bashmakov, Shinji Ikemoto, Jay D. Horton, Michael S. Brown, and Joseph L. Goldstein; 1999 November 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24120
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Integrin Overexpression Induced by High Glucose and by Human Diabetes: Potential Pathway to Cell Dysfunction in Diabetic Microangiopathy by T Roth, F Podesta, MA Stepp, D Boeri, and M Lorenzi; 1993 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=47625
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Interferon-[gamma] impacts at multiple points during the progression of autoimmune diabetes by Bo Wang, Isabelle Andre , Antonio Gonzalez, Jonathan D. Katz, Michel Aguet, Christophe Benoist, and Diane Mathis; 1997 December 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28395
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Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation by Katherine Gray-Donald, Elizabeth Robinson, Aileen Collier, Kinga David, Lise Renaud, and Shaila Rodrigues; 2000 November 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80308
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Islet expression of the DNA repair enzyme 8-oxoguanosine DNA glycosylase (Ogg1) in human type 2 diabetes by Bjorn Tyrberg, Kamen A. Anachkov, Sergio A. Dib, Jessica Wang-Rodriguez, Kun-Ho Yoon, and Fred Levine; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=111186
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Long-Term Abrogation of Autoimmune Diabetes in Nonobese Diabetic Mice by Immunotherapy with Anti-Lymphocyte Serum by T Maki, T Ichikawa, R Blanco, and J Porter; 1992 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=48882
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Long-term correction of obesity and diabetes in genetically obese mice by a single intramuscular injection of recombinant adeno-associated virus encoding mouse leptin by John E. Murphy, Shangzhen Zhou, Klaus Giese, Lewis T. Williams, Jaime A. Escobedo, and Varavani J. Dwarki; 1997 December 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28408
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Long-Term Reversal of Diabetes by the Injection of Immunoprotected Islets by P Soon-Shiong, E Feldman, R Nelson, R Heintz, Q Yao, Z Yao, T Zheng, N Merideth, G Skjak-Braek, T Espevik, O Smidsrod, and P Sandford; 1993 June 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46819
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Major histocompatibility complex class I-restricted T cells are required for all but the end stages of diabetes development in nonobese diabetic mice and use a prevalent T cell receptor [alpha] chain gene rearrangement by Teresa P. DiLorenzo, Robert T. Graser, Toshiro Ono, Gregory J. Christianson, Harold D. Chapman, Derry C. Roopenian, Stanley G. Nathenson, and David V. Serreze; 1998 October 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=22866
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Maternal and paternal age at delivery, birth order, and risk of childhood onset type 1 diabetes: population based cohort study by Lars
150 Diabetes
C Stene, Per Magnus, Rolv T Lie, Oddmund Sovik, Geir Joner, and the Norwegian Childhood Diabetes Study Group; 2001 August 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=37395 ·
Mechanism of Glucoregulatory Responses to Stress and Their Deficiency in Diabetes by PDG Miles, K Yamatani, HLA Lickley, and M Vranic; 1991 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51004
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Mechanisms of [beta] cell death in diabetes: A minor role for CD95 by Janette Allison and Andreas Strasser; 1998 November 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24908
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Mice Expressing Both B7-1 and Viral Glycoprotein on Pancreatic Beta Cells Along with Glycoprotein-Specific Transgenic T Cells Develop Diabetes Due to a Breakdown of T-Lymphocyte Unresponsiveness by DM Harlan, H Hengartner, ML Huang, Y Kang, R Abe, RW Moreadith, H Pircher, GS Gary, PS Ohashi, GJ Freeman, LM Nadler, CH June, and P Aichele; 1994 April 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43530
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Modification of Low Density Lipoprotein by Advanced Glycation End Products Contributes to the Dyslipidemia of Diabetes and Renal Insufficiency by R Bucala, Z Makita, G Vega, S Grundy, T Koschinsky, A Cerami, and H Vlassara; 1994 September 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=44828
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Molecular basis for a link between complement and the vascular complications of diabetes by Juan Acosta, Judith Hettinga, Rudolf Fluckiger, Nicole Krumrei, Allison Goldfine, Luis Angarita, and Jose Halperin; 2000 May 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=25849
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Multiple differences in gene expression in regulatory V[alpha]24J[alpha]Q T cells from identical twins discordant for type I diabetes by S. Brian Wilson, Sally C. Kent, Heidi F. Horton, Andrew A. Hill, Paul L. Bollyky, David A. Hafler, Jack L. Strominger, and Michael C. Byrne; 2000 June 20 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=16559
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Nephrogenic diabetes insipidus in mice lacking aquaporin-3 water channels by Tonghui Ma, Yuanlin Song, Baoxue Yang, Annemarie Gillespie, Elaine J. Carlson, Charles J. Epstein, and A. S. Verkman; 2000 April 11 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18251
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Nephrogenic Diabetes Insipidus: An X Chromosome-Linked Dominant Inheritance Pattern with a Vasopressin Type 2 Receptor Gene that is Structurally Normal by E Friedman, AE Bale, E Carson, WL Boson, M Nordenskjold, M Ritzen, PC Ferreira, A Jammal, and LD Marco; 1994 August 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=44625
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NMR Studies of Muscle Glycogen Synthesis in Insulin-Resistant Offspring of Parents with Non-Insulin-Dependent Diabetes Mellitus Immediately after Glycogen-Depleting Exercise by TB Price, G Perseghin, A Duleba, W Chen, J Chase, DL Rothman, RG Shulman, and GI Shulman; 1996 May 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39245
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Overexpression of Fibronectin Induced by Diabetes or High Glucose: Phenomenon with a Memory by S Roy, R Sala, E Cagliero, and M Lorenzi; 1990 January 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53272
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Pancreatic Beta-Cell Replication and Amelioration of Surgical Diabetes by Reg Protein by T Watanabe, Y Yonemura, H Yonekura, Y Suzuki, H Miyashita, K Sugiyama, S Miriizumi, M Unno, O Tanaka, H Kondo, AJ Bone, S Takasawa, and H Okamoto; 1994 April 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43625
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Paradoxical Structure and Function in a Mutant Human Insulin Associated with Diabetes Mellitus by QX Hua, SE Shoelson, K Inouye, and MA Weiss; 1993 January 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45707
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Peptide-Induced T-Cell Tolerance to Prevent Autoimmune Diabetes in a Transgenic Mouse Model by P Aichele, D Kyburz, PS Ohashi, B Odermatt, RM Zinkernagel, H Hengartner, and H Pircher; 1994 January 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42965
152 Diabetes
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Poly(ADP-ribose) polymerase gene disruption conferred mice resistant to streptozotocin-induced diabetes by Mitsuko Masutani, Hiroshi Suzuki, Nobuo Kamada, Miho Watanabe, Otoya Ueda, Tadashige Nozaki, Kou-ichi Jishage, Takeshi Watanabe, Tetsuro Sugimoto, Hitoshi Nakagama, Takahiro Ochiya, and Takashi Sugimura; 1999 March 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26778
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Poly(ADP-ribose) polymerase-deficient mice are protected from streptozotocin-induced diabetes by Andrew A. Pieper, Daniel J. Brat, David K. Krug, Crystal C. Watkins, Alok Gupta, Seth Blackshaw, Ajay Verma, Zhao-Qi Wang, and Solomon H. Snyder; 1999 March 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15894
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Polymorphisms in the Mn-SOD and EC-SOD genes and their relationship to diabetic neuropathy in type 1 diabetes mellitus by Dimitry A. Chistyakov, Kirill V. Savost'anov, Elena V. Zotova, and Valery V. Nosikov; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31388
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Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes by Ella M. de Leon, Scott J. Jacober, Jack D. Sobel, and Betsy Foxman; 2002 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=65518
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Prevalent CD8 + T cell response against one peptide /MHC complex in autoimmune diabetes by Brad Anderson, Bjung-Ju Park, Joan Verdaguer, Abdelaziz Amrani, and Pere Santamaria; 1999 August 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17778
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Prevention of Diabetes in Nonobese Diabetic Mice by Tumor Necrosis Factor (TNF): Similarities Between TNF-[alpha] and Interleukin 1 by CO Jacob, S Aiso, SA Michie, HO McDevitt, and H Acha-Orbea; 1990 February 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53391
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Protection of Nonobese Diabetic Mice from Autoimmune Diabetes by Reduction of Islet Mass before Insulitis by A Itoh and T Maki; 1996 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38282
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Protection of Nonobese Diabetic Mice from Diabetes by Intranasal or Subcutaneous Administration of Insulin Peptide B-(9-23) by D Daniel and DR Wegmann; 1996 January 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40166
Studies 153
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QT and QTc dispersion are accurate predictors of cardiac death in newly diagnosed non-insulin dependent diabetes: cohort study by Abdul A O Naas, Neil C Davidson, Chris Thompson, Fraser Cummings, Simon A Ogston, Roland T Jung, Ray W Newton, and Allan D Struthers; 1998 March 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28479
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Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and noninsulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study by Carl Erik Mogensen, Steen Neldam, Ilkka Tikkanen, Shmuel Oren, Reuven Viskoper, Richard W Watts, and Mark E Cooper; 2000 December 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27545
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Randomised controlled trial of long term efficacy of captopril on preservation of kidney function in normotensive patients with insulin dependent diabetes and microalbuminuria by Elisabeth R Mathiesen, Eva Hommel, Henrik P Hansen, Ulla M Smidt, and Hans-Henrik Parving; 1999 July 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28150
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Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk by Ann Louise Kinmonth, Alison Woodcock, Simon Griffin, Nicki Spiegal, and Michael J Campbell; 1998 October 31 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28704
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Randomised controlled trial of structured personal care of type 2 diabetes mellitus by Niels de Fine Olivarius, Henning Beck-Nielsen, Anne Helms Andreasen, Mogens Horder, and Poul A Pedersen; 2001 October 27 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59690
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Rat Obesity Gene Fatty (fa) Maps to Chromosome 5: Evidence for Homology with the Mouse Gene Diabetes (db) by GE Truett, N Bahary, JM Friedman, and RL Leibel; 1991 September 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52392
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Reduction of Exogenous Vasopressin RNA Poly(A) Tail Length Increases its Effectiveness in Transiently Correcting Diabetes Insipidus in the Brattleboro Rat by D Maciejewski-Lenoir, GF Jirikowski, PP Sanna, and FE Bloom; 1993 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45888
154 Diabetes
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Relation between iron stores and non-insulin dependent diabetes in men: case-control study by Jukka T Salonen, Tomi-Pekka Tuomainen, Kristiina Nyyssonen, Hanna-Maaria Lakka, and Kari Punnonen; 1998 September 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28662
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Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23) by R C Turner, H Millns, H A W Neil, I M Stratton, S E Manley, D R Matthews, and R R Holman; 1998 March 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28484
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Role of C282Y mutation in haemochromatosis gene in development of type 2 diabetes in healthy men: prospective cohort study by Jukka T Salonen, Tomi-Pekka Tuomainen, and Kimmo Kontula; 2000 June 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27415
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Screening for diabetes in general practice: cross sectional population study by James M Lawrence, Paul Bennett, Alan Young, and Anthony M Robinson; 2001 September 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=48161
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Seasonality of birth in children with diabetes in Europe: multicentre cohort study by P M Rothwell, S A Gutnikov, P A McKinney, E Schober, C Ionescu-Tirgoviste, and A Neu; 1999 October 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28243
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Shifting of care for diabetes from secondary to primary care, 1990-5: review of general practices by Elizabeth C Goyder, Paul G McNally, Michael Drucquer, Nicola Spiers, and Johannes L Botha; 1998 May 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28554
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Smoking during pregnancy and diabetes mellitus in a British longitudinal birth cohort by Scott M Montgomery and Anders Ekbom; 2002 January 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61655
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Spontaneous Diabetes Mellitus in Transgenic Mice Expressing Human Islet Amyloid Polypeptide by J Janson, WC Soeller, PC Roche, RT Nelson, AJ Torchia, DK Kreutter, and PC Butler; 1996 July 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38975
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Suppression of Diabetes in Nonobese Diabetic Mice by Oral Administration of Porcine Insulin by ZJ Zhang, L Davidson, G Eisenbarth, and HL Weiner; 1991 November 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52906
Studies 155
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TAP1 Alleles in Insulin-Dependent Diabetes Mellitus: A Newly Defined Centromeric Boundary of Disease Susceptibility by DG Jackson and JD Capra; 1993 December 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=47925
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The 37/40-Kilodalton Autoantigen in Insulin-Dependent Diabetes Mellitus is the Putative Tyrosine Phosphatase IA-2 by N Passini, JD Larigan, S Genovese, E Appella, F Sinigaglia, and L Rogge; 1995 September 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40995
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The A3 Allele of the HLA-DQA1 Locus is Associated with Susceptibility to Type 1 Diabetes in Japanese by JA Todd, Y Fukui, T Kitagawa, and T Sasazuki; 1990 February 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53417
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The Diabetes Autoantigen ICA69 and Its Caenorhabditis elegans Homologue, ric-19, Are Conserved Regulators of Neuroendocrine Secretion by Marc Pilon, Xiao-Rong Peng, Andrew M. Spence, Ronald H.A. Plasterk, and Hans-Michael Dosch; 2000 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=14991
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The expression of adipogenic genes is decreased in obesity and diabetes mellitus by Samuel T. Nadler, Jonathan P. Stoehr, Kathryn L. Schueler, Gene Tanimoto, Brian S. Yandell, and Alan D. Attie; 2000 October 10 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17207
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The maturity-onset diabetes of the young (MODY1) transcription factor HNF4[alpha] regulates expression of genes required for glucose transport and metabolism by Markus Stoffel and Stephen A. Duncan; 1997 November 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24288
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The role of MHC class II molecules in susceptibility to type I diabetes: Identification of peptide epitopes and characterization of the T cell repertoire by Cheng-Chi Chao, Huey-Kang Sytwu, Emily Lichuan Chen, Jon Toma, and Hugh O. McDevitt; 1999 August 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17775
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Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 by UK Prospective Diabetes Study Group; 1998 September 12 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28659
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Transgenic Copper/Zinc Superoxide Dismutase Modulates Susceptibility to Type I Diabetes by HM Kubisch, J Wang, R Luche, E Carlson, TM Bray, CJ Epstein, and JP Phillips; 1994 October 11 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=44936
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Transgenic Mice Overexpressing Phosphoenolpyruvate Carboxykinase Develop Non-Insulin-Dependent Diabetes Mellitus by A Valera, A Pujol, M Pelegrin, and F Bosch; 1994 September 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=44765
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Transgenic rescue implicates [beta]2-microglobulin as a diabetes susceptibility gene in nonobese diabetic (NOD) mice by Emma E. Hamilton-Williams, David V. Serreze, Brett Charlton, Ellis A. Johnson, Michele P. Marron, Arno Mullbacher, and Robyn M. Slattery; 2001 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58764
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Troglitazone prevents mitochondrial alterations, [beta] cell destruction, and diabetes in obese prediabetic rats by Moritake Higa, Yan-Ting Zhou, Mariella Ravazzola, Danielle Baetens, Lelio Orci, and Roger H. Unger; 1999 September 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18065
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Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial by Zohar Nachum, Izhar BenShlomo, Ehud Weiner, and Eliezer Shalev; 1999 November 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28269
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Type 2 diabetes mellitus in Canada's First Nations: status of an epidemic in progress by T. Kue Young, Jeff Reading, Brenda Elias, and John D. O'Neil; 2000 September 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80466&ren dertype=external
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Type 2 diabetes: Evidence for linkage on chromosome 20 in 716 Finnish affected sib pairs by Soumitra Ghosh, Richard M. Watanabe, Elizabeth R. Hauser, Timo Valle, Victoria L. Magnuson, Michael R. Erdos, Carl D. Langefeld, James Balow, Jr., Delphine S. Ally, Kimmo Kohtamaki, Peter Chines, Gunther Birznieks, Hong-Shi Kaleta, Anjene Musick, Catherine Te, Joyce Tannenbaum, William Eldridge, Shane Shapiro, Colin Martin, Alyson Witt, Alistair So, Jennie Chang, Ben Shurtleff, Rachel Porter, Kristina Kudelko, Arun Unni, Leonid Segal, Ravi Sharaf, Jillian BlaschakHarvan, Johan Eriksson, Tuula Tenkula, Gabriele Vidgren, Christian Ehnholm, Eva Tuomilehto-Wolf, William Hagopian, Thomas A.
Studies 157
Buchanan, Jaakko Tuomilehto, Richard N. Bergman, Francis S. Collins, and Michael Boehnke; 1999 March 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26760 ·
Undiagnosed diabetes: Does it matter? by T. Kue Young and Cameron A. Mustard; 2001 January 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80628
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Unusual DNA structure of the diabetes susceptibility locus IDDM2 and its effect on transcription by the insulin promoter factor Pur1/MAZ by Amy Lew, William J. Rutter, and Giulia C. Kennedy; 2000 November 7 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=18794
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Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study by Daniele Perucchini, Ursin Fischer, Giatgen A Spinas, Renate Huch, Albert Huch, and Roger Lehmann; 1999 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28232
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Vaccination Against Autoimmune Mouse Diabetes with a T-Cell Epitope of the Human 65-kDa Heat Shock Protein by D Elias, T Reshef, OS Birk, R van der Zee, MD Walker, and IR Cohen; 1991 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51390
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Vasopressin contributes to hyperfiltration, albuminuria, and renal hypertrophy in diabetes mellitus: Study in vasopressin-deficient Brattleboro rats by Pascale Bardoux, Helene Martin, Mina Ahloulay, Francois Schmitt, Nadine Bouby, Marie-Marcelle Trinh-Trang-Tan, and Lise Bankir; 1999 August 31 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17899
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Vitamin D receptor initiation codon polymorphism influences genetic susceptibility to type 1 diabetes mellitus in the Japanese population by Yoshiyuki Ban, Matsuo Taniyama, Tatsuo Yanagawa, Satoru Yamada, Taro Maruyama, Akira Kasuga, and Yoshio Ban; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=34514
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Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data by DECODE Study Group, on behalf of the European Diabetes Epidemiology Study Group; 1998 August 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28629
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Worldwide Differences in the Incidence of Type I Diabetes are Associated with Amino Acid Variation at Position 57 of the HLA-DQ
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[beta] Chain by JS Dorman, RE LaPorte, RA Stone, and M Trucco; 1990 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54748
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.23 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with diabetes, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “diabetes” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “diabetes” (hyperlinks lead to article summaries): ·
Efficacy and safety of high-dose lisinopril in chronic heart failure patients at high cardiovascular risk, including those with diabetes mellitus. Results from the ATLAS trial. Author(s): Ryden L, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Packer M, Poole-Wilson PA. Source: European Heart Journal. 2000 December; 21(23): 1967-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11071803&dopt=Abstract
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Efficacy of Tibetan medicine as an adjunct in the treatment of type 2 diabetes. Author(s): Namdul T, Sood A, Ramakrishnan L, Pandey RM, Moorthy D.
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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Studies 159
Source: Diabetes Care. 2001 January; 24(1): 175-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11194229&dopt=Abstract ·
Epidemiology of diabetes mellitus in Western pacific region: focus on Philippines. Author(s): Lantion-Ang LC. Source: Diabetes Research and Clinical Practice. 2000 October; 50 Suppl 2: S29-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11024581&dopt=Abstract
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Ethnicity and type 2 diabetes: focus on Asian Indians. Author(s): Abate N, Chandalia M. Source: Journal of Diabetes and Its Complications. 2001 November-Dec; 15(6): 320-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11711326&dopt=Abstract
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Ethnobotanical survey of medicinal plants used for the treatment of diabetes, cardiac and renal diseases in the North centre region of Morocco (Fez-Boulemane). Author(s): Jouad H, Haloui M, Rhiouani H, El Hilaly J, Eddouks M. Source: Journal of Ethnopharmacology. 2001 October; 77(2-3): 175-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11535361&dopt=Abstract
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Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy. Author(s): Bott U, Bott S, Hemmann D, Berger M. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 September; 17(9): 635-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11051282&dopt=Abstract
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Evaluation of controlled vocabulary resources for development of a consumer entry vocabulary for diabetes. Author(s): Patrick TB, Monga HK, Sievert ME, Houston Hall J, Longo DR.
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Source: Journal of Medical Internet Research [electronic Resource]. 2001 July-September; 3(3): E24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11720966&dopt=Abstract ·
Evidence of a threshold value of glycated hemoglobin to improve the course of renal function in type 2 diabetes with typical diabetic glomerulopathy. Author(s): Brocco E, Velussi M, Cernigoi AM, Abaterusso C, Bruseghin M, Carraro A, Sambataro M, Piarulli F, Sfriso A, Nosadini R. Source: J Nephrol. 2001 November-Dec; 14(6): 461-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11783602&dopt=Abstract
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Fasting plasma glucose as a screening test for gestational diabetes in a multi-ethnic, high-risk population. Author(s): Agarwal MM, Hughes PF, Punnose J, Ezimokhai M. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 October; 17(10): 720-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11110505&dopt=Abstract
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Fenugreek in diabetes mellitus. Author(s): Puri D. Source: J Assoc Physicians India. 1999 February; 47(2): 255-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10999114&dopt=Abstract
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Field test of a group education program for type 2 diabetes: measures and predictors of success on individual and group levels. Author(s): Sarkadi A, Rosenqvist U. Source: Patient Education and Counseling. 2001 August; 44(2): 129-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11479053&dopt=Abstract
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Formative research to inform intervention development for diabetes prevention in the Republic of the Marshall Islands. Author(s): Cortes LM, Gittelsohn J, Alfred J, Palafox NA.
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Source: Health Education & Behavior : the Official Publication of the Society for Public Health Education. 2001 December; 28(6): 696-715. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11720273&dopt=Abstract ·
From stem cells to beta cells: new strategies in cell therapy of diabetes mellitus. Author(s): Soria B, Skoudy A, Martin F. Source: Diabetologia. 2001 April; 44(4): 407-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11357469&dopt=Abstract
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Gaining freedom: self-responsibility in adolescents with diabetes. Author(s): Christian BJ, D'Auria JP, Fox LC. Source: Pediatric Nursing. 1999 May-June; 25(3): 255-60, 266. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12024340&dopt=Abstract
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Gender and treatment differences in knowledge, health beliefs, and metabolic control in Mexican Americans with type 2 diabetes. Author(s): Brown SA, Harrist RB, Villagomez ET, Segura M, Barton SA, Hanis CL. Source: Diabetes Educ. 2000 May-June; 26(3): 425-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11151290&dopt=Abstract
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Gene and cell therapies for diabetes mellitus: strategies and clinical potential. Author(s): Giannoukakis N, Robbins PD. Source: Biodrugs : Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy. 2002; 16(3): 149-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12102644&dopt=Abstract
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Genes and engineered cells as drugs for type I and type II diabetes mellitus therapy and prevention. Author(s): Giannoukakis N, Pietropaolo M, Trucco M. Source: Curr Opin Investig Drugs. 2002 May; 3(5): 735-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12090547&dopt=Abstract
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Glycosal: the first rapid, point-of-care test for the determination of hemoglobin A1c in patients with diabetes. Author(s): Stevenson T. Source: Diabetes Technology & Therapeutics. 1999 Winter; 1(4): 425-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11474827&dopt=Abstract
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Herbal approaches to diabetes care. Uses demand more scientific study. Author(s): Guthrie DW. Source: Adv Nurse Pract. 2000 August; 8(8): 56, 59. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11761524&dopt=Abstract
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Herbal tea in the treatment of diabetes mellitus. Author(s): Ryan EA, Imes S, Wallace C, Jones S. Source: Clinical and Investigative Medicine. Medecine Clinique Et Experimentale. 2000 October; 23(5): 311-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11055324&dopt=Abstract
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In search of susceptibility genes for type 2 diabetes in West Africa: the design and results of the first phase of the AADM study. Author(s): Rotimi CN, Dunston GM, Berg K, Akinsete O, Amoah A, Owusu S, Acheampong J, Boateng K, Oli J, Okafor G, Onyenekwe B, Osotimehin B, Abbiyesuku F, Johnson T, Fasanmade O, Furbert-Harris P, Kittles R, Vekich M, Adegoke O, Bonney G, Collins F. Source: Annals of Epidemiology. 2001 January; 11(1): 51-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11164120&dopt=Abstract
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Increased DNA oxidative susceptibility without increased plasma LDL oxidizability in Type II diabetes: effects of alpha-tocopherol supplementation. Author(s): Sampson MJ, Astley S, Richardson T, Willis G, Davies IR, Hughes DA, Southon S. Source: Clinical Science (London, England : 1979). 2001 September; 101(3): 235-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11524040&dopt=Abstract
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Influence of a high fibre diet on glycaemic control and quality of life in dogs with diabetes mellitus. Author(s): Graham PA, Maskell E, Rawlings JM, Nash AS, Markwell PJ. Source: The Journal of Small Animal Practice. 2002 February; 43(2): 67-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11873951&dopt=Abstract
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Insulin-secreting pituitary GH3 cells: a potential beta-cell surrogate for diabetes cell therapy. Author(s): Davalli AM, Galbiati F, Bertuzzi F, Polastri L, Pontiroli AE, Perego L, Freschi M, Pozza G, Folli F, Meoni C. Source: Cell Transplantation. 2000 November-Dec; 9(6): 841-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11202570&dopt=Abstract
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Integrative medicine approach to obesity and diabetes. Author(s): Shintani TT. Source: Hawaii Med J. 2001 October; 60(10): 262-3. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11732378&dopt=Abstract
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Iohexol as a marker of glomerular filtration rate in patients with diabetes: comparison of multiple and simplified sampling protocols. Author(s): Pucci L, Bandinelli S, Pilo M, Nannipieri M, Navalesi R, Penno G. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 February; 18(2): 116-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11251674&dopt=Abstract
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Is the defect in pro-hormone processing in Type 2 diabetes mellitus restricted to the beta cell? Author(s): Bano G, Rodin DA, White A, O'Rahilly S, Nussey SS. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 January; 18(1): 17-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11168336&dopt=Abstract
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Konjac-Mannan and American ginsing: emerging alternative therapies for type 2 diabetes mellitus.
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Author(s): Vuksan V, Sievenpiper JL, Xu Z, Wong EY, Jenkins AL, BeljanZdravkovic U, Leiter LA, Josse RG, Stavro MP. Source: J Am Coll Nutr. 2001 October; 20(5 Suppl): 370S-380S; Discussion 381S-383S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11603646&dopt=Abstract ·
Lack of antidiabetic effect of a Eugenia jambolana leaf decoction on rat streptozotocin diabetes. Author(s): Pepato MT, Folgado VB, Kettelhut IC, Brunetti IL. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica . [et Al.]. 2001 Mars; 34(3): 389-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11262591&dopt=Abstract
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Limited joint mobility in selected hand and foot joints in patients with type 1 diabetes mellitus: a methodology comparison. Author(s): Sauseng S, Kastenbauer T, Irsigler K. Source: Diabetes Nutr Metab. 2002 February; 15(1): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11942733&dopt=Abstract
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Long term administration of ascorbic acid does not improve a decreased bone weight and mineral content in rats with neonatally induced streptozotocin diabetes. Author(s): Broulik PD, Stolba P. Source: Endocrine Regulations. 1996 Mars; 30(1): 41-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10979033&dopt=Abstract
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Long-term disease management needs of southern African Americans with diabetes. Author(s): Anderson-Loftin W, Moneyham L. Source: Diabetes Educ. 2000 September-Oct; 26(5): 821-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11140010&dopt=Abstract
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Measuring health beliefs in Spanish-speaking Mexican Americans with type 2 diabetes: adapting an existing instrument. Author(s): Brown SA, Becker HA, Garcia AA, Barton SA, Hanis CL.
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Source: Research in Nursing & Health. 2002 April; 25(2): 145-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11933008&dopt=Abstract ·
Mitochondrial factors in the pathogenesis of diabetes: a hypothesis for treatment. Author(s): Lamson DW, Plaza SM. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2002 April; 7(2): 94-111. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11991790&dopt=Abstract
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Multisite evaluation of a new diabetes self-test for glucose and glycated protein (fructosamine). Author(s): Edelman SV, Callahan P, Deeb LC. Source: Diabetes Technology & Therapeutics. 2000 Summer; 2(2): 233-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11469264&dopt=Abstract
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n-3 polyunsaturated fatty acid supplementation, monocyte adhesion molecule expression and pro-inflammatory mediators in Type 2 diabetes mellitus. Author(s): Sampson MJ, Davies IR, Brown JC, Morgan V, Richardson T, James AJ, Sampson AP, Hughes DA. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 January; 18(1): 51-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11168342&dopt=Abstract
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Natural products used for diabetes. Author(s): Shapiro K, Gong WC. Source: J Am Pharm Assoc (Wash). 2002 Mars-April; 42(2): 217-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11926665&dopt=Abstract
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Neuronal death in the rat hippocampus in experimental diabetes and cerebral ischaemia treated with antioxidants. Author(s): Piotrowski P, Wierzbicka K, Smialek M.
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Source: Folia Neuropathol. 2001; 39(3): 147-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11770125&dopt=Abstract ·
Nutrients and botanicals in the treatment of diabetes in veterinary practice. Author(s): Wynn S. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2001 September; 6 Suppl: S17-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11591170&dopt=Abstract
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On any Saturday--a practical model for diabetes education. Author(s): Carter IR, Nash C, Ridgway A. Source: J Natl Med Assoc. 2002 February; 94(2): 67-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11853048&dopt=Abstract
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Oxidative stress and antioxidant status in type 1 diabetes mellitus. Author(s): Vessby J, Basu S, Mohsen R, Berne C, Vessby B. Source: Journal of Internal Medicine. 2002 January; 251(1): 69-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11851867&dopt=Abstract
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Pancreatic islet regeneration by ephedrine in mice with streptozotocininduced diabetes. Author(s): Xiu LM, Miura AB, Yamamoto K, Kobayashi T, Song QH, Kitamura H, Cyong JC. Source: Am J Chin Med. 2001; 29(3-4): 493-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11789592&dopt=Abstract
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Parents jailed after child dies of diabetes. Author(s): Dyer O. Source: Bmj (Clinical Research Ed.). 1993 November 13; 307(6914): 1232-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11643196&dopt=Abstract
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Potential antioxidant effects of zinc and chromium supplementation in people with type 2 diabetes mellitus.
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Author(s): Anderson RA, Roussel AM, Zouari N, Mahjoub S, Matheau JM, Kerkeni A. Source: J Am Coll Nutr. 2001 June; 20(3): 212-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11444416&dopt=Abstract ·
Prandial glucose regulation with repaglinide: its clinical and lifestyle impact in a large cohort of patients with Type 2 diabetes. Author(s): Landgraf R, Frank M, Bauer C, Dieken ML. Source: International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity. 2000 September; 24 Suppl 3: S38-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11063283&dopt=Abstract
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Preservation of the antioxidant status in chemically-induced diabetes mellitus by melatonin. Author(s): Sailaja Devi MM, Suresh Y, Das. Source: Journal of Pineal Research. 2000 September; 29(2): 108-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10981824&dopt=Abstract
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Prevention of cyclophosphamide-induced accelerated diabetes in the NOD mouse by nicotinamide or a soy protein-based infant formula. Author(s): Reddy S, Karanam M, Robinson E. Source: Int J Exp Diabetes Res. 2001; 1(4): 299-313. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11467420&dopt=Abstract
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Quality of life for patients with diabetes in Korea--I: the meaning of health-related quality of life. Author(s): Choe MA, Padilla GV, Chae YR, Kim S. Source: International Journal of Nursing Studies. 2001 December; 38(6): 673-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11602271&dopt=Abstract
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Relationship between ethnicity and glycemic control, lipid profiles, and blood pressure during the first 9 years of type 2 diabetes: U.K. Prospective Diabetes Study (UKPDS 55). Author(s): Davis TM, Cull CA, Holman RR.
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Source: Diabetes Care. 2001 July; 24(7): 1167-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11423497&dopt=Abstract ·
Remission and regression in the nephropathy of type 1 diabetes when blood pressure is controlled aggressively. Author(s): Hovind P, Rossing P, Tarnow L, Smidt UM, Parving HH. Source: Kidney International. 2001 July; 60(1): 277-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11422762&dopt=Abstract
Vocabulary Builder Aberrant: Wandering or deviating from the usual or normal course. [EU] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Anergic: 1. characterized by abnormal inactivity; inactive. 2. marked by asthenia or lack of energy. 3. pertaining to anergy. [EU] Antidiabetic: An agent that prevents or alleviates diabetes. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antioxidant:
One of many widely used synthetic or natural substances
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added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Arrestin: A 48-Kd protein of the outer segment of the retinal rods and a component of the phototransduction cascade. Arrestin quenches G-protein activation by binding to phosphorylated photolyzed rhodopsin. Arrestin causes experimental autoimmune uveitis when injected into laboratory animals. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]
Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] Bronchospasm: Spasmodic contraction of the smooth muscle of the bronchi, as occurs in asthma. [EU] Caenorhabditis: A genus of small free-living nematodes. Two species, caenorhabditis elegans and C. briggsae are much used in studies of genetics, development, aging, muscle chemistry, and neuroanatomy. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Cardiac: Pertaining to the heart. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
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Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Dimerization: The process by which two molecules of the same chemical composition form a condensation product or polymer. [NIH] Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Fructosamine: An amino sugar formed when glucose non-enzymatically reacts with the N-terminal amino group of proteins. The fructose moiety is dervied from glucose by the "classical" Amadori rearrangement. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Hepatic: Pertaining to the liver. [EU] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part
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due to an increase in size of its constituent cells. [EU] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Intramuscular: Within the substance of a muscle. [EU] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Metaplasia: The change in the type of adult cells in a tissue to a form which is not formal for that tissue. [EU] Metastasis: 1. the transfer of disease from one organ or part to another not directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH]
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Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Normotensive: 1. characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. a person with normal blood pressure. [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of YEASTS. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU]
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Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Renin: An enzyme of the hydrolase class that catalyses cleavage of the leucine-leucine bond in angiotensin to generate angiotensin. 1. The enzyme is synthesized as inactive prorenin in the kidney and released into the blood in the active form in response to various metabolic stimuli. Not to be confused with rennin (chymosin). [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Skeletal: Pertaining to the skeleton. [EU] Substrate: A substance upon which an enzyme acts. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Toxicologic: Pertaining to toxicology. [EU] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]
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CHAPTER 5. PATENTS ON DIABETES Overview You can learn about innovations relating to diabetes by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.24 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with diabetes within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with diabetes. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
24Adapted
from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Diabetes By performing a patent search focusing on diabetes, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on diabetes: ·
Glibenclamide-metformin combination for the treatment of diabetes mellitus of type II Inventor(s): Barelli; Giulio (Pisa, IT), De Regis; Massimo (Pisa, IT) Assignee(s): Abiogen Pharma S.p.A. (Pisa, IT) Patent Number: RE37,330 Date filed: July 5, 2000 Abstract: Non-insulin dependent diabetes mellitus in cases of secondary failure is treated with a combination of glibenclamide and metformin. Excerpt(s): The present invention relates to the use of a combination consisting of glibenclamide and metformin in one specific ratio as medicament for the treatment of diabetes mellitus of type II. ... Noninsulin dependent diabetes of type II (NID) is known to be a frequent metabolic disease and the main cause of hyperglycemia. In recent years, diabetes mellitus of type II has been proved to be a heterogeneous disease, with complex, unclarified metabolic aspects, which disease is characterized by three main metabolic abnormalities contributing to hyperglycemia: the partial or complete decrease in insulin secretion, the resistance of the peripheral tissues to insulin and the increased hepatic production of glucose in fasting conditions. ... Diet and physical exertion are unanimously recognized to be the foundation of the therapy of diabetes of type II: both of them lead to a reduction in insulin-resistance and, in the long run, to an improvement in the pancreas secretive deficit. Web site: http://www.delphion.com/details?pn=US0RE37330__
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·
Treatment of type II diabetes mellitus with amylin agonists Inventor(s): Kolterman; Orville G. (Poway, CA), Thompson; Robert G. (San Diego, CA), Mullane; John F. (Cardiff, CA) Assignee(s): Amylin Pharmaceuticals, Inc. (San Diego, CA) Patent Number: 6,417,164 Date filed: November 6, 2000 Abstract: Methods for treating non-insulin-taking Type II diabetes mellitus which comprise administering a therapeutically effective amount of an amylin agonist. Excerpt(s): The present invention relates,to medicine, and, more particularly, to amylin agonists and methods for the treatment of Type II diabetes mellitus by administering an amylin agonist. ... In normal humans, fasting amylin levels from 1 to 10 pM and post-prandial levels of 5 to 20 pM have been reported (e.g., Hartter et al., Diabetologia 34:5254 (1991); Sanke et al., Diabetologia 34:129-13:2 (1991)); Koda et al., The Lancet 339:1179-1180 (1992)). In obese, insulin-resistant individuals, however, post-food amylin levels can go higher, reaching up to about 50 pM, for example. For comparison, the values for fasting and postprandial insulin are 20 to 50 pM, and 100 to 300 pM respectively in healthy people, with perhaps 3- to 4-fold higher levels in insulin-resistant people. In Type 1 diabetes, where beta-cells are destroyed, amylin levels are at or below the levels of detection and do not rise in response to glucose (Koda et al., The Lancet 339:1179-1180 (1992)). In normal mice and rats, basal amylin levels have been reported from 30 to 100 pM, while values up to 600 pM have been measured in certain insulin-resistant, diabetic strains of rodents (e.g., Huang et al., Hypertension 19:I-101-I-109 (1991)); Gill et al., Life Sciences 48:703-710 (1991). ... The biological actions of amylin relating to fuel metabolism are discussed in Young et al., J. Cell. Biochem. 555:12-18 (1994). While amylin has marked effects on hepatic fuel metabolism in vivo, there is no general agreement as to what amylin actions are seen in isolated hepatocytes or perfused liver. The available data do not support the idea that amylin promotes hepatic glycogenolysis, i.e., it does not act like glucagon (e.g., Stephens, et al., Diabetes 40:395-400 (1991)); Gomez-Foix et al., Biochem J. 276:607-610 (1991)). It has been suggested that amylin may act on the liver to promote conversion of lactate to glycogen and to enhance the amount of glucose able to be liberated by glucagon (see Roden et al., Diabetologia 35:116-120 (1992)). Thus, amylin could act there as an anabolic partner to insulin in liver, in contrast to its catabolic action in muscle. Web site: http://www.delphion.com/details?pn=US06417164__
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·
Neurotoxin therapy for diabetes Inventor(s): Donovan; Stephen (Capistrano Beach, CA) Assignee(s): Allergan Sales, Inc. (Irvine, CA) Patent Number: 6,416,765 Date filed: October 3, 2001 Abstract: The invention encompasses a method for treating hyperinsulinemic type 2 diabetes by local administration of a neurotoxin, such as a botulinum toxin, into the pancreas, thereby reducing insulin secretion from a B cell, and a method for treating hypoinsulinemic type 2 diabetes by local administration of a neurotoxin, such as a botulinum toxin, into a sympathetic ganglion, thereby reducing an inhibitory effect upon insulin secretion. Excerpt(s): The present invention relates to methods for treating diabetes. In particular the present invention relates to methods for treating diabetes by administration of a neurotoxin to a patient. ... Diabetes mellitus is the most common endocrine disorder and is a chronic condition. It is estimated that in 1999 there were 100 million people worldwide with diabetes and the number of diabetics worldwide is expected to reach 300 million within the next ten years, that is by the year 2009. Type 2 Diabetes Prediction and Prevention, edited by Graham A. Hitman, John Wiley & Sons publisher, preface (1999), the entire contents of which publication are incorporated herein by reference. Unfortunately, diabetic retinopathy is a leading cause of blindness and other complications of diabetes include renal disease, foot problems and neuropathic conditions. Of the major forms of diabetes mellitus, type 2 diabetes cases outnumber type 1 diabetes cases by a ratio of about ten to one. ... In type 1 or insulin dependent diabetes mellitus (IDDM) the B cells of the pancreas, and hence the capacity to make insulin, are destroyed by what is probably an autoimmune disease. Insulin replacement is the preferred therapy. Whereas at most about 20% of the cases of diabetes mellitus are type 1 or IDDM, typically about 80% to 90% of the cases of diabetes mellitus are type 2 or non insulin dependent diabetes mellitus (NIDDM). Although NIDDM is more prevalent than IDDM, its pathogenesis is not well understood. It has though been determined that NIDDM is the result of both a beta cell defect and insulin resistance. Thus, patients with type 2 NIDDM have the two physiological defects of hypersecretion of insulin (during at least the early phase of type 2 diabetes) and resistance to insulin in target tissues. There is support for the belief that hyperinsulinemia is the primary defect and it is known that in the early stages of type 2 diabetes, B cell production of insulin increases. Type 2 Diabetes Prediction and Prevention, supra,
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pages 199 and 311. Thus, in the first phase (new onset) of NIDDM, the plasma glucose level is normal despite demonstrable insulin resistance with elevated insulin levels. In the second phase insulin resistance worsens so that postprandial hyperglycemia develops despite elevated insulin. In the third or late phase of type diabetes, insulin resistance does not change but declining insulin secretion causes fasting hyperglycemia and overt diabetes. It is possible that early phase hypersecretion of insulin causes the insulin resistance. Thus, the primary defect can be due to disfunctional islet cells cause insulin hypersecretion which leads to insulin resistance. In support of this theory, one can note that B cell mass is intact in type 2 NIDDM, while most beta cells have been destroyed in type 1 IDDM. Interestingly, the alpha cell population is increased in type 2 NIDDM, resulting in an elevated ratio of alpha to beta cells and excess glucagon production. Harrison's Principles of Internal Medicine 14.sup.th Edition (1998), pages 2064-65. Web site: http://www.delphion.com/details?pn=US06416765__ ·
Use of leptin antagonists for treating insulin resistance in type II diabetes Inventor(s): Ertl; Johann (Bremthal, DE), Preibisch; Gerald (Kelkheim, DE), Muller; Gunter (Sulzbach, DE) Assignee(s): Aventis Pharma Deutschland GmbH (Frankfurt am Main, DE) Patent Number: 6,399,745 Date filed: April 14, 1999 Abstract: The invention relates to pharmaceutical agents containing leptin antagonists for treating Type II diabetes. One leptin antagonist is based on a murine leptin fragment and comprises amino acids 116 to 167 or 116 to 166. Methods of treating Type II diabetes are also disclosed. Excerpt(s): The present invention relates to the use of leptin antagonists for treating insulin resistance in Type II diabetes and to a pharmaceutical for treating such resistance. ... Diabetes is one of the most frequently occurring metabolic diseases in industrialized countries. There are some 110 million diabetics world-wide; while approx. 10 million of these are Type I diabetics, the overwhelming majority (approx. 100 million) are Type II diabetics. The disease is caused by faulty regulation of glucose metabolism. In Type I diabetes, failure of the .beta. cells in the pancreas results in insulin no longer being formed. This lack of insulin leads to an increase in blood glucose and, if not treated by supplying insulin, to ketoacidosis, diabetic coma and death of the patient. In Type II diabetics,
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the causal relationships are different and are characterized by the initial development of insulin resistance, i.e. diminution in the ability of the cells to respond adequately to insulin. Excessive weight and lack of physical activity, in particular, are regarded as being responsible for inducing insulin resistance. The latter condition is not noticed initially since it is offset by an increased secretion of insulin. However, the continuing insulin resistance leads, in a process extending over many years, to failure of the endogenous compensation mechanism and consequent development of Type II diabetes. While diet and physical activity can delay this sequence of events, they are frequently unable to prevent manifestation of the disease. Medicinal intervention is then required in order to control the blood glucose adequately. ... It is of crucial importance for the long-term success of the therapy that the blood glucose be maintained as narrowly as possible within the physiological range. It is the current view that glucose levels which have been elevated for decades, as are found in poorly controlled diabetics (both Type I and Type II diabetics), make an important contribution to late complications in diabetes. These late complications constitute, in particular, blood vessel damage which leads to kidney diseases, loss of sight and cardiovascular diseases. This so-called late damage is an important factor contributing to mortality in diabetics. Web site: http://www.delphion.com/details?pn=US06399745__ ·
Composition containing embryo bud and seed coat from rice and fruit body of Ganoderma lucidum for treating diabetes Inventor(s): Iwasaki; Teruaki (Sapporo, JP) Assignee(s): Kabushiki Kaisha Genmai Koso (JP) Patent Number: 6,395,310 Date filed: October 18, 2001 Abstract: A composition used to treat diabetes is disclosed. The composition is made by first, mixing an isolated embryo bud and isolated seed coat from rice with a fruit body of Ganoderma lucidum to form a mixture. Next, the mixture is fermented with an Aspergillus oryzae strain to produce a resulting fermentate. Then, the resulting fermentate is dried to produce a dried fermentate. Next, the dried fermentate is crushed into a fine powder and lastly, the powder is mixed with vitamin B to form the composition. Excerpt(s): This invention relates to undevitalized enzyme fortified composition showing suppression against onset of diabetes, and more particularly undevitalized enzyme fortified composition having
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suppression like a herb-medicine against onset of diabetes in which mixture of embryo bud and seed coat of rice and fruit body of ganoderma lucidum are mixed to each other, steamed, aspergillus strain colony is mixed with them, cultivated, ripened, starch and protein are decomposed sufficiently into low molecules and concurrently enzyme groups produced by aspergills oryzae strain colony are contained in it as they are, aspergills oryzae strain colony contained in the ripened koji is annihilated, they are dried and changed into fine powder under a state in which each of their capabilities of catalysis is not lost, vitamin B groups are added and fortified to them, both suppression action against onset of diabetes and regenerating action of pancreas-.beta.-cell as well are provided. ... It is estimated that the number of diabetes patients in the world is approximately 60 million and the number of patients accepting administration of insulin as a therapy exceeds 5 million. ... In recent years, obesity of children or diabetes of children has become a social problem and additionally obesity or diabetes of pets such as pet dog and the like has also become a social problem. Web site: http://www.delphion.com/details?pn=US06395310__ ·
Orally active fraction of momordica charantia, active peptides thereof, and their use in the treatment of diabetes Inventor(s): Nag; Bishwajit (Fremont, CA), Medicherla; Satyanarayana (Sunnyvale, CA), Sharma; Somesh D. (Los Altos, CA) Assignee(s): Calyx Therapeutics, Inc. (Hayward, CA) Patent Number: 6,391,854 Date filed: July 31, 2000 Abstract: A water soluble extract of M.charantia named MC6, methods for its preparation and methods for its use in the treatment of hyperglycemic disorders are provided. The active MC6 is characterized by moving as a single band on SDS-PAGE having a molecular weight of less than 10 kDal, and by comprising tree peptides. Also provided is a peptide component of MC6 named MC6.1, as well as analogues and mimetics thereof. The active MC6, MC6.1, MC6.2, and MC6.3 exhibit hypoglycemic activity, even following oral administration. Also provided are methods of using the active agents to treat hyperglycemic disorders, particularly diabetes, where the active agents are preferably orally administered. Excerpt(s): The field of this invention is diabetes. ... Non insulin dependent diabetes mellitus (NIDDM or Type II) is the fourth-leading cause of death in the United States and affects from 5 to 7% of the total
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world population, with an increasing prevalence in western countries. In diabetes, the body either does not produce enough insulin or the insulin which is produced is not effective, resulting in increased blood glucose level, a condition technically known as hyperglycemia. Although diabetes can affect people of any age, the majority of diabetics are over 45 years old. The disease tends to run in families, and the risk factor of acquiring the disease increases in overweight individuals. ... Diabetes is a chronic disease with no cure and is linked with several other disorders. It is the leading cause of blindness in people ages 25-74. Ten percent of all people with diabetes develop kidney disease. Diabetes is the most frequent cause of non-traumatic lower limb amputation. The risk of leg amputation is 30 times greater for people with diabetes. People with diabetes are two to four times more likely to develop heart diseases, and are five times more likely to suffer from stroke. Web site: http://www.delphion.com/details?pn=US06391854__ ·
Materials and methods for detection of insulin dependent diabetes Inventor(s): Maclaren; Noel K. (Gainesville, FL), Notkins; Abner L. (McLean, VA), Lan; Michael S. (Rockville, MD) Assignee(s): The United States of America as represented by the Secretary of the (Washington, DC), University of Florida (Gainesville, FL) Patent Number: 6,391,651 Date filed: August 11, 1995 Abstract: The method and compositions of this invention provide an effective and reliable substitute for the currently employed ICA assay for diabetes. By providing a method for detecting autoantibodies to both GAD.sub.65 and IA-2 auto-antigens, the method provides a chemical assay which has improved reliability. In addition, these antigens may be employed in therapeutic regimens aimed at achieving immune tolerance and therefore amelioration of the clinical condition. Excerpt(s): Diabetes is a term that refers to a collection of diseases resulting in disordered energy metabolism and varying degrees of blood glucose elevations or hyperglycemia. One of the best characterized forms of the disease is that resulting in immunologically mediated destruction of the insulin secreting pancreatic beta cells. This severe form of the disease is termed Insulin Dependent Diabetes (IDD) since it is associated with progressive insulin deficiency and coincident symptoms such as weight loss, glycosuria and polyuria, and increased thirst or polydipsia. Other terms for this form of diabetes are Type 1 Diabetes (cf. Type 2 Diabetes which results from an inherent resistance to insulin action);
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Ketosis Prone Diabetes because there is abnormal generation of ketone bodies as a result of excessive breakdown of body fats due to the severe insulin deficiency, or Juvenile Diabetes, since virtually all diabetes that appears in childhood and adolescence is of this type (see Atkinson and Maclaren, N Engl J Med 1994:331:1428-1436). ... Diabetes is a major public health problem, especially in Western countries. The incidence rates vary greatly worldwide, from as high as 40 per 100,000 persons in Finland to as low as 1-2 per 100,000 among Japanese, with the US in between. The peak incidence is during the pubertal years associated with increasing bodily demands for insulin associated with muscle growth. The prevalence rates in the US population under age 20 years is 0.25% and it approaches 0.4% over a lifetime, albeit an estimated 10-20% of patients with Non Insulin Dependent Diabetes (NIDD) or Type 2 or Maturity Onset Diabetes also have, in reality, slowly progressive IDD. Thus, it is estimated that there should be at least 1 million Americans affected by IDD. ... Diabetes results in progressive damage to the blood vessels of the body, to a degree that depends upon the severity of hyperglycemia and its duration. The incident mortality rate for IDD has been calculated to be 7 fold higher than for age matched non diabetic controls. Whereas the decade long Diabetes Control and Complications Trial (DCCI) concluded in 1994 by the National Institutes of Health in the US showed that meticulous insulin replacement therapy would slow the appearance of damaged arteries, it was not able to prevent this since blood glucose levels were never kept within normal limits. Ocular complications of diabetes are the leading cause of new blindness in persons of 20-74 years of age. The risk of lower extremity amputation is 15 fold higher in those with diabetes, while more than half of the approximately 125,000 persons undergoing lower limb amputation do so as a direct consequence of diabetes. Approximately 40% of persons undergoing renal transplantations have kidney failure because of their diabetes, and the proportion due to diabetes continues to rise each year. Women with diabetes produce newborn infants with a 7% newborn mortality rate, albeit this outcome can be greatly improved with tight glycemic control during the gestation period. Other complications of diabetes include increased heart disease and stroke, loss of nerve cells or neurones innervating the limbs and intestine, impotence and infertility, cataract formation in the lens of the eyes, increased periodontal disease, and predisposition to infectious diseases especially from bacteria and yeast. Of all patients with diabetes, those with IDD have a disproportionate share of these complications because of its severity and usual early age of onset In the US, the direct health care costs attributable to diabetes in 1994 have been estimated to exceed $120 billion. Thus it is important that
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the pathogenesis of IDD be understood and strategies be developed to prevent it as a fully expressed clinical disease. Web site: http://www.delphion.com/details?pn=US06391651__ ·
Remedies for diabetes Inventor(s): Kishino; Michiko (Suita, JP), Nakayama; Chikao (Sanda, JP), Taiji; Mutsuo (Takatsuki, JP), Ichihara; Junji (Takatsuki, JP), Noguchi; Hiroshi (Kawanishi, JP) Assignee(s): Sumitomo Pharmaceuticals Co., Limited (Osaka-fu, JP) Patent Number: 6,391,312 Date filed: July 23, 1999 Abstract: The present invention provides a therapeutic agent for treatment of diabetes and hyperlipemia, especially a therapeutic agent for treatment of type II diabetes mellitus, which comprises as the active ingredient a neurotrophic factor such as BDNF (brain-derived neurotrophic factor), ligands of trkB or trkC receptors, NGF, NT-3, NT4/5, CNTF, GDNF, HGF, etc. Different from conventional oral hypoglycemic agents being mainly used in the treatment of type II diabetes mellitus, the agent of the present invention exhibit blood lipid regulating effects and body fat accumulation regulating effects, in addition to the blood glucose regulating effects. Thus, the agent of the present invention are novel, and can reduce the risk factors in diabetes accompanied by hyperlipemia or obesity, without using any other agent. Excerpt(s): The present invention relates to a therapeutic agent for treating a patient of diabetes or hyperlipemia, more particularly, a therapeutic agent for treating a patient of diabetes or hyperlipemia which comprises a neurotrophic factor as an active ingredient. ... Recently, the number of patients afflicted with degenerative diseases, especially diabetes mellitus, diabetic complications, or hyperlipemia, has been increased, due to an improvement in a living standard, and/or change of the dietary life into the Western style, or increase in lack of exercise. Hyperlipemia is a very important underlining disease, which causes arteriosclerosis, and as a result, further leads to ischemic heart diseases, and occasionally, may lead to the onset of acute pancreatitis. In addition, there is a tendency of increasing numbers of patients afflicted with these diseases in the young generation. ... Diabetes is classified into insulin dependent diabetes mellitus (type I, IDDM) and non insulin dependent diabetes mellitus (type II, NIDDM), and more than 90% of patients of diabetes mellitus are patients afflicted with the latter one. Insulin injections are used for the treatment of IDDM, and an oral antidiabetic
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agent such as sulfonyl urea or a biguanide compound is employed for the treatment of NIDDM, together with exercise therapy or dietary therapy (cf. Today's Therapy 1993, supervised by Shigeaki HINOHARA, Masakazu ABE, published by IGAKU SHOIN, pages 494-498). These drugs are commonly used in order to control the blood glucose level, which is the most important indicator in the treatment of diabetes, but their effects are not sufficient enough, and in fact, continuous hyperglycemia causes various diabetic complications such as diabetic neuropathy, diabetic nephropathy, diabetic retinopathy, diabetic cardiovascular diseases, or delay in healing or ulceration of wound. Besides various risk factors such as an acute hypoglycemia by insulin injection, prolonged hypoglycemia by an insulin secretagogue, sulfonylurea, lactic acidosis by anaerobic inhibitor of glycolysis, biguanide, affect the quality of life of patients afflicted with diabetes. Web site: http://www.delphion.com/details?pn=US06391312__ ·
Diabetes management system and method for controlling blood glucose Inventor(s): Worthington; David R. L. (La Honda, CA), Brown; Stephen J. (Woodside, CA) Assignee(s): Health Hero Network, Inc. (Mountain View, CA) Patent Number: 6,379,301 Date filed: September 30, 1998 Abstract: A diabetes management system for predicting a future blood glucose value of a patient and for recommending a corrective action to the patient when the future blood glucose value lies outside of a target range. The system includes a patient-operated apparatus for measuring blood glucose values and for storing data relating to insulin doses administered to the patient. The apparatus predicts the patient's future blood glucose value based upon the patient's current blood glucose value, the fraction of insulin action remaining from the insulin doses, and the patient's insulin sensitivity. The apparatus also determines the corrective action for the patient when the predicted blood glucose value lies outside of a target range. The system also includes a physician computer in communication with the apparatus for receiving the blood glucose values and insulin dose data and for calculating an adjusted insulin sensitivity for use in subsequent predictions. Excerpt(s): The present invention relates generally to disease management systems, and in particular to a diabetes management system for predicting a future blood glucose value of a patient and for
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recommending a corrective action to the patient when the future blood glucose value lies outside of a target range. ... Insulin dependent diabetes mellitus (IDDM) is caused by the auto-immune destruction of the insulin producing islets of Langerhans in the pancreas. Insulin replacement therapy is the interim treatment for IDDM until such time as islet transplants become feasible. Insulin lowers the concentration of glucose in the blood, while food raises the concentration of glucose in the blood. The challenge of insulin therapy is to administer food and insulin in a manner which maintains blood glucose concentrations in an acceptable range, thereby avoiding hypoglycemia and hyperglycemia. ... The first insulin used by diabetes patients was regular insulin taken from beef or pig pancreases. This insulin lasts for about six hours, so that patients were required to inject it three or four times per day. After World War II, longer acting insulin was developed by binding regular insulin to protamine and zinc. Regular insulin dissociates slowly from protamine and zinc, extending insulin action to twelve hours for intermediate acting insulin and twenty-four hours for ultra-lente insulin. Patients enjoyed reducing injections to one per day, but were required to modify their eating to a snack-all-day regimen to avoid hypoglycemia. The one daily insulin dose was adjusted as needed to reduce the incidence of both hypoglycemia and hyperglycemia. Web site: http://www.delphion.com/details?pn=US06379301__ ·
Metforimin-containing compositions for the treatment of diabetes Inventor(s): Fine; Stuart A. (Northbrook, IL), Kinsella; Kevin J. (La Jolla, CA) Assignee(s): Akesis Pharmaceuticals, Inc. (La Jolla, CA) Patent Number: 6,376,549 Date filed: September 17, 1998 Abstract: Compositions and methods using same for the treatment of diabetes its sequelae and pre-diabetic conditions are provided. Invention compositions include the anti-diabetic agent metformin, and bioavailable sources of one or more of chromium, vanadium and magnesium. Also provided are pharmaceutical agents containing invention compositions and methods for administering such agents. Excerpt(s): This invention relates to pharmaceutical compounds formulated in conjugation with dietary supplements; and to methods of using the resulting compositions for the treatment of a number of conditions. Particularly, this invention relates to metformin-containing pharmaceutical compositions and to methods of using the same for the
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treatment of diabetes and a number of symptoms which precede and/or accompany diabetes. ... Diabetes mellitus is a mammalian condition in which the amount of glucose in the blood plasma is abnormally high. Elevated glucose levels in some instances can lead to higher than normal amounts of a particular hemoglobin, HbA1c. This condition can be lifethreatening and high glucose levels in the blood plasma (hyperglycemia) can lead to a number of chronic diabetes syndromes, for example, atherosclerosis, microangiopathy, kidney disorders or failure, cardiac disease, diabetic retinopathy and other ocular disorders, including blindness. ... Diabetes mellitus is known to affect at least 10 million Americans, and millions more may unknowingly have the disease. There are two forms of the disease. In the form of this disease known as Type II, non-insulin dependent diabetes (NIDDM) or adult-onset (as opposed to juvenile diabetes or Type I), the pancreas often continues to secrete normal amounts of insulin. However, this insulin is ineffective in preventing the symptoms of diabetes which include cardiovascular risk factors such as hyperglycemia, impaired carbohydrate (particularly glucose) metabolism, glycosuria, decreased insulin sensitivity, centralized obesity hypertriglyceridemia, low HDL levels, elevated blood pressure and various cardiovascular effects attending these risk factors. Many of these cardiovascular risk factors are known to precede the onset of diabetes by as much as a decade. These symptoms, if left untreated, often lead to severe complications, including premature atherosclerosis, retinopathy, nephropathy, and neuropathy. Insulin resistance is believed to be a precursor to overt NIDDM and strategies directed toward ameliorating insulin resistance may provide unique benefits to patients with NIDDM. Web site: http://www.delphion.com/details?pn=US06376549__ ·
Methods of treating diabetes Inventor(s): Strassmann; Gideon (Washington, DC), Liang; Li-fang (Elkridge, MD), Topouzis; Stavros (Elkridge, MD) Assignee(s): Matamorphix, Inc. (Baltimore, MD) Patent Number: 6,368,597 Date filed: May 6, 1999 Abstract: Methods for treating diabetes by administering an inhibitor of GDF-8, or a related member of Transforming Growth Factor-beta (TGF.beta.) superfamily of structurally-related growth factors (e.g., GDF-11) are disclosed. Also disclosed are methods for upregulating expression of hexose transporters, such as GLUT4 and GLUT1, in a subject by
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administering an inhibitor of GDF-8. Also disclosed are methods for increasing glucose uptake by cells in a subject, by administering an inhibitor of GDF-8. Excerpt(s): Diabetes mellitus is the most common metabolic disease worldwide. Every day, 1700 new cases of diabetes are diagnosed in the United States, and at least one-third of the 16 million Americans with diabetes are unaware of it. Diabetes is the leading cause of blindness, renal failure, and lower limb amputations in adults and is a major risk factor for cardiovascular disease and stroke. ... Normal glucose homeostasis requires the finely tuned orchestration of insulin secretion by pancreatic beta cells in response to subtle changes in blood glucose levels, delicately balanced with secretion of counter-regulatory hormones such as glucagon. Type 1 diabetes results from autoimmune destruction of pancreatic beta cells causing insulin deficiency. Type 2 or noninsulindependent diabetes mellitus (NIDDM) accounts for >90% of cases and is characterized by a triad of (1) resistance to insulin action on glucose uptake in peripheral tissues, especially skeletal muscle and adipocytes, (2) impaired insulin action to inhibit hepatic glucose production, and (3) dysregulated insulin secretion (DeFronzo, (1997) Diabetes Rev. 5:177269). In most cases, type 2 diabetes is a polygenic disease with complex inheritance patterns (reviewed in Kahn et al., (1996) Annu. Rev. Med. 47:509-531). ... Environmental factors, especially diet, physical activity, and age, interact with genetic predisposition to affect disease prevalence. Susceptibility to both insulin resistance and insulin secretory defects appears to be genetically determined (Kahn, et al). Defects in insulin action precede the overt disease and are seen in nondiabetic relatives of diabetic subjects. In spite of intense investigation, the genes responsible for the common forms of Type 2 diabetes remain unknown. Web site: http://www.delphion.com/details?pn=US06368597__ ·
DNA and peptides of a diabetes-specific endogenous retrovirus Inventor(s): Yoon; Ji-Won (Alberta, CA), Jun; Hee-Sook (Alberta, CA), Park; Hae-Joon (Yongin-si, KR), Ahn; Jong Seong (Yongin-si, KR), Ha; Young-Ju (Seoul, KR), Chung; Soo-Il (Sungnam-si, KR) Assignee(s): Green Cross Vaccine Corporation (Kyonggi-do, KR) Patent Number: 6,365,727 Date filed: July 22, 1998 Abstract: The present invention relates to gene and peptide sequences of a diabetes-specific endogenous retrovirus which is derived from type 1 diabetes patients. In particular, the present invention relates to a whole
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genome of the diabetes-specific variant of endogenous retrovirus (ERV-9) purified from pancreatic tissues of type 1 diabetes (insulin-dependent diabetes mellitus [IDDM]) patients and its genes and peptide and their sequences, which can be used as a diagnosing reagent for type 1 diabetes and as an immunogen.The diabetes-specific retrovirus expressed exclusively in pancreatic beta cells was purified from deceased type 1 diabetes patients. Subsequently, the retroviral gene sequences were determined, and by analyzing the amino acid sequence of the peptide deduced from the gene, 21 domains of the peptide having hydrophilicity and immuno-dominancy were identified.Therefore, the variant gene of the endogenous retrovirus and the peptide deduced from the gene can be effectively used as a diagnosing reagent of autoimmune-antibody for type 1 diabetes and as a vaccine for the variant ERV-9 related diseases. Excerpt(s): The present invention relates to the gene and peptide sequences of a diabetes-specific endogenous retrovirus derived from type 1 diabetes patients. In particular, the present invention relates to the whole genome of the diabetes-specific variant of endogenous retrovirus (ERV-9) purified from pancreatic tissues of type 1 diabetes (insulindependent diabetes mellitus [IDDM]) patients, and viral genes and peptides sequences which can be used to develop a diagnosing reagent for type 1 diabetes and an immunogen. ... Type 1 diabetes, also known as insulin-dependent diabetes mellitus, is an autoimmune diseases resulting from the destruction of pancreatic beta cells by beta cell-specific autoimmune processes. However, the processes which trigger the autoimmunity remain unknown. In the pancreatic beta cells of non-obese diabetic (NOD) mice, a spontaneously diabetic animal model for human type 1 diabetes, the presence of retrovirus particles in pancreatic beta cells, which is known to be associated with insulitis and diabetes, has been reported. The initiation of insulitis in NOD mice is known to occur at 4 to 6 weeks of age. Fujita et al. observed retrovirus particles in NOD mice as young as 2 days old using electron microscopy (Fujita H., et al., Biochemical Research, 5(1): 71-76, 1984). In addition, Serreze et al. found that anti-type C retrovirus antibody shows peak titer shortly after weaning in NOD mice (Serreze D. V., et al., Diabetes, 37: 351-358, 1988). In this study, type C retrovirus particles were found in both intact and lymphocyte-infiltrated islets, and retrovirus particles were also detected in beta cells showing severe nuclear damage within intact islets which showed no evidence of lymphocytic infiltration. In another study, Like and Rossini observed the induction of aberrant retrovirus budding into the rough endoplasmic reticulum of the beta cells, two to three days before insulitis developed in male CD-1 mice treated with multiple doses of streptozotocin (Like A. A. and Rossini A. A., Science, 193: 415-417, 1976). These results suggest that the expression of retrovirus occurs prior
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to lymphocytic infiltration of the islets. Thus, the expression of retrovirus has been assumed to be an initial event in the damage of beta cells, rather than the result of insulitis. ... To date, there has been no report of the exclusive expression of retrovirus particles in the beta cells of recentonset type 1 diabetes patients. Thus, an examination on whether retrovirus particles are expressed in pancreatic tissues of type 1 diabetes patients was required to clarify the etiology of the onset of autoimmune type 1 diabetes. Web site: http://www.delphion.com/details?pn=US06365727__ ·
Fatty analogues for the treatment of diabetes Inventor(s): Berge; Rolf (B.phi.nes, NO) Assignee(s): Thia Medica AS (NO) Patent Number: 6,365,628 Date filed: January 8, 2001 Abstract: The present invention relates to novel fatty acid analogues of the general formula (I): CH.sub.3 --[CH.sub.2 ].sub.m --[x.sub.i -CH.sub.2 ].sub.n --COOR, as defined in the specification, which can be used for the treatment and/or prevention of diabetes. Further, the invention relates to a nutritional composition comprising such fatty acid analogues. Excerpt(s): Diabetes mellitus and its complications are now considered to be the third leading cause of death in Canada and the United States, trailing only cancer and cardiovascular disease. ... Further, we have now synthesized and characterized novel fatty acid analogous which impose an effect on diabetes. ... Diabetes mellitus and its complications are now considered to be the third leading cause of death in Canada and the United States, trailing only cancer and cardiovascular disease. Although the acute and often lethal symptoms of diabetes can be controlled by insulin therapy, the long-term complications reduce life expectancy by as much as one third. Compared with rates of incidence in nondiabetic normal persons, diabetic patients show rates which are increased 25-fold for blindness, 17-fold for kidney disease, 5-fold for gangrene, and 2-fold for heart disease. Web site: http://www.delphion.com/details?pn=US06365628__
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Protection of pancreatic .beta.-cells during islet isolation and assessment of islet viability and candidate diabetes drugs after islet isolation Inventor(s): Konrad; Robert (Hoover, AL), Kudlow; Jeffrey (Birmingham, AL) Assignee(s): NAB Research Foundation (Birmingham, AL) Patent Number: 6,361,995 Date filed: July 26, 2000 Abstract: Standard pancreatic islet isolation results in .beta.-cell toxicity due to nitric oxide and/or streptozotocin-like molecules that are generated during the isolation process. This toxicity can be limited by the addition of compounds that work through the glucosamine pathway in islets and/or by the addition of nitric oxide inhibitors. Unless prevented, this toxicity results in .beta.-cells being unable to properly respond to high glucose, glucosamine, N-acetylglucosamine, or streptozotocin by increasing their relative amount of O-glycosylated protein. Likewise, in order to assess islet viability or the effect of diabetes drugs on .beta.-cell function, islets that have been adequately protected during their isolation can be stimulated with low glucose, high glucose, glucosamine, Nacetylglucosamine, or streptozotocin with or without the drug(s) of interest present. By analyzing the pattern of islet protein O-glycosylation that occurs, one can determine whether the islets are viable and whether or not the candidate drug(s) might be useful in the treatment of diabetes. Excerpt(s): The present invention relates generally to the fields of pancreatic islet isolation and medical therapy for diabetes. More specifically, the present invention relates to improved procedures for isolating pancreatic islets that better protect the islets during the isolation process. In order to screen for new drugs to treat type 2 diabetes, or to prepare islets for transplantation for type 1 diabetes, isolated islets must be protected from toxic molecules that form during the isolation process. ... Early in the course of type 2 diabetes, pancreatic .beta.-cell function is sufficient such that in many patients, oral hypoglycemic agents are adequate to compensate for increased insulin resistance (1). As type 2 diabetes progresses, however, .beta.-cells lose their capacity to produce sufficient amounts of insulin to control the blood glucose level and patients become increasingly hyperglycemic (2). It has been suggested that the hyperglycemia itself may cause damage to .beta.-cells (3-5). The exact mechanism by which a n increased concentration of glucose may affect .beta.-cells, however, is not completely elucidated. ... The prior art is deficient in the lack of effective means of blocking the formation and action of molecules that are toxic to the .beta.-cells of the pancreatic islets
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when the islets are being isolated from the pancreas. The prior art is also deficient in a means by which to determine if pancreatic .beta.-cells are traumatized by toxic molecules such as nitric oxide or streptozotocin-like compounds during the isolation process. Additionally, the prior art is deficient in a means by which to test diabetes drugs to see if they affect glucose toxicity to .beta.-cells by acting through the O-linked protein glycosylation pathway that glucose, analogues of glucosamine, and streptozotocin affect. The present invention fulfills these long-standing needs and desires in the art. Web site: http://www.delphion.com/details?pn=US06361995__
Patent Applications on Diabetes As of December 2000, U.S. patent applications are open to public viewing.25 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to diabetes: ·
Phytanic acid derivative compositions and method of treating and/or preventing diabetes mellitus Inventor(s): Fluehmann, Beat ; (Zuerich, CH), Heim, Manuel ; (Freiburg, DE), Hunziker, Willi ; (Magden, CH), Weber, Peter ; (Malsburg-Marzell, DE) Correspondence: Stephen M. Haracz, Esq.; Bryan Cave, LLP; 245 Park Avenue; New York; NY; 10167-0034; US Patent Application Number: 20020082298 Date filed: July 25, 2001 Abstract: The present invention is a method for the treatment or prevention of preferably non-insulin dependent (NIDDM or so-called Type II) diabetes mellitus, or other conditions associated with impaired glucose tolerance such as obesity, and in particular to the use of phytanic acid derivatives for the said treatment and/or prevention. A method of making a composition for the treatment or prevention of non-insulin dependent diabetes mellitus and related diseases comprising combining phytanic acid or derivatives thereof with a pharmaceutically acceptable additive or adjuvant, and a composition for the treatment or prevention of non-insulin dependent diabetes mellitus comprising phytanic acid or derivatives thereof are also provided.
25
This has been a common practice outside the United States prior to December 2000.
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Excerpt(s): The present invention relates to phytanic acid derivatives and their use for the treatment or the prevention of diabetes mellitus. ... This invention relates to a novel method for the treatment or prevention of preferably non-insulin dependent (NIDDM or so-called Type II) diabetes mellitus, and in particular to the use of phytanic acid derivatives for the treatment or prevention of NIDDM. ... NIDDM is the form of diabetes mellitus that occurs predominantly in adults in whom adequate production of insulin is available for use, yet a defect exists in insulinmediated utilization and metabolism of glucose in peripheral tissues. Overt NIDDM is characterized by three major metabolic abnormalities: elevated serum glucose levels, resistance to insulin-mediated glucose disposal, and overproduction of glucose by the liver. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Benzopyrancarboxylic acid derivatives for the treatment of diabetes and lipid disorders Inventor(s): Sahoo, Soumya P. ; (Old Bridge, NJ), Koyama, Hiroo ; (Hoboken, NJ), Miller, Daniel J. ; (Edison, NJ), Boueres, Julia K. ; (Piscataway, NJ), Desai, Ranjit C. ; (Kendall Park, NJ) Correspondence: Merck and Co Inc; P O Box 2000; Rahway; NJ; 070650907 Patent Application Number: 20020082292 Date filed: September 24, 2001 Abstract: A class of benzopyrancarboxylic acid derivatives comprises compounds that are potent agonists of PPAR alpha and/or gamma, and are therefore useful in the treatment, control or prevention of non-insulin dependent diabetes mellitus (NIDDM), hyperglycemia, dyslipidemia, hyperlipidemia, hypercholesterolemia, hypertriglyceridemia, atherosclerosis, obesity, vascular restenosis, inflammation, and other PPAR alpha and/or gamma mediated diseases, disorders and conditions. Excerpt(s): The instant invention is concerned with benzopyrancarboxylic acids and related heterocyclic compounds and pharmaceutically acceptable salts and prodrugs thereof which are useful as therapeutic compounds, particularly in the treatment and prevention of Type 2 diabetes mellitus, often referred to as non-insulin dependent diabetes (NIDDM), of conditions that are often associated with this disease, and of lipid disorders. ... Diabetes refers to a disease process derived from multiple causative factors and characterized by elevated levels of plasma glucose or hyperglycemia in the fasting state or after administration of glucose during an oral glucose tolerance test. Persistent or uncontrolled
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hyperglycemia is associated with increased and premature morbidity and mortality. Often abnormal glucose homeostasis is associated both directly and indirectly with alterations of the lipid, lipoprotein and apolipoprotein metabolism and other metabolic and hemodynamic disease. Therefore patients with Type 2 diabetes mellitus are at especially increased risk of macrovascular and microvascular complications, including coronary heart disease, stroke, peripheral vascular disease, hypertension, nephropathy, neuropathy, and retinopathy. Therefore, therapeutical control of glucose homeostasis, lipid metabolism and hypertension are critically important in the clinical management and treatment of diabetes mellitus. ... There are two generally recognized forms of diabetes. In type 1 diabetes, or insulin-dependent diabetes mellitus (IDDM), patients produce little or no insulin, the hormone which regulates glucose utilization. In type 2 diabetes, or noninsulin dependent diabetes mellitus (NIDDM), patients often have plasma insulin levels that are the same or even elevated compared to nondiabetic subjects; however, these patients have developed a resistance to the insulin stimulating effect on glucose and lipid metabolism in the main insulinsensitive tissues, which are muscle, liver and adipose tissues, and the plasma insulin levels, while elevated, are insufficient to overcome the pronounced insulin resistance. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Methods for Alleviating Symptoms Associated with Diabetes and Diabetic Neuropathy Comprising Administration of Low Levels of Antibodies Inventor(s): McMichael, John ; (Delanson, NY) Correspondence: Marshall, Gerstein & Borun; 6300 Sears Tower; 233 South Wacker; Chicago; IL; 60606-6357; US Patent Application Number: 20020081300 Date filed: July 30, 2001 Abstract: The invention provides methods and compositions for alleviating the symptoms of diabetes with a pharmaceutical composition including a combination of anti-glutamic acid decarboxylase (anti-GAD) and anti-insulin antibodies. Excerpt(s): Diabetes mellitus is a metabolic disease state that is caused by a deficiency of insulin (Type I diabetes) or by the body's resistance to diabetes (Type II diabetes). The disease is characterized by chronic hyperglycemia, glycosuria, water and electrolyte loss, ketoacidosis, neuropathy, retinopathy, nephropathy, increased susceptibility to
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infection, and coma. Type I diabetes results from the autoimmune destruction of beta cells of the pancreas. Thus, proteins produced by beta cells have been a prime target in the study of diabetes as potential autoantigens that serve as the target for the immune response against the beta cells. One autoantigen found to correspond to the onset of Type I diabetes is glutamic acid decarboxylase (GAD) [Tisch, Roland, et al., Nature, 366:72-75 (1993)]. Another example of a beta cell autoantigen is insulin. ... Much of the research involving the autoimmune response against beta cells or the autoantigens thought to be involved in the autoimmune response has included the administration of autoantigens, immunogenic portions of autoantigens, or molecules that mimic the autoantigens. Tian, Jide, et al.,Nat Med, 2(12): 1348-53 (1996) discusses administration of GAD to alter the diverse immune response that can lead to diabetes. Ramiya, Vijayakumar K., et al., Autoimmunity, 26:139151 (1997) discussed administration of insulin and GAD in nonobese diabetic mouse to achieve anti-diabetic affects. ... While the administration of larger quantities of immunoglobulins is effective in the treatment of many disease states, there remains a desire in the art for methods for the treatment and prevention of diabetes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Treatment for diabetes Inventor(s): Parikh, Indu ; (Chapel Hill, NC), Lane, Anne ; (Westmount, CA), Nardi, Ronald V. ; (Nahwah, NJ), Brand, Stephen J. ; (Lincoln, MA) Correspondence: Rae-Venter Law Group, P.C.; P.O. Box 60039; Palo Alto; CA; 94306; US Patent Application Number: 20020081285 Date filed: December 20, 2001 Abstract: Methods and compositions for treating diabetes mellitus in a patient in need thereof are provided. The methods include administering to a patient a composition providing a gastrin/CCK receptor ligand, e.g., a gastrin, and/or an epidermal growth factor (EGF) receptor ligand, e.g., TGF-.alpha., in an amount sufficient to effect differentiation of pancreatic islet precursor cells to mature insulin-secreting cells. The composition can be administered systemically or expressed in situ by cells transgenically supplemented with one or both of a gastrin/CCK receptor ligand gene, e.g., a preprogastrin peptide precursor gene and an EGF receptor ligand gene, e.g., a TGF-.alpha. gene. The methods also include transplanting into a patient cultured pancreatic islets in which mature insulin-secreting
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beta cells are proliferated by exposure to a gastrin/CCK receptor ligand and an EGF receptor ligand. Excerpt(s): This invention relates to a method for treating diabetes mellitus in an individual in need thereof by administering to the individual a composition comprising a gastrin/CCK receptor ligand and/or an EGF receptor ligand which effectively promotes differentiation of pancreatic islet precursor cells to mature insulin-secreting cells. The method is exemplified by administration of gastrin and transforming growth factor alpha (TGF-.alpha.) either alone or in combination to normal streptozotocin (STZ) induced diabetic and genetically predisposed diabetic Zucker rats. ... Diabetes is one of the most common endocrine diseases across all age groups and populations. In addition to the clinical morbidity and mortality, the economic cost of diabetes is huge, exceeding $90 billion per year in the U.S. alone, and the prevalence of diabetes is expected to increase more than two-fold by the year 2010. ... There are two major forms of diabetes mellitus: insulin-dependent (Type 1) diabetes mellitus (IDDM) which accounts for 5 to 10% of all cases, and non-insulin-dependent (Type 2) diabetes mellitus NDDM) which comprises roughly 90% of cases. Type 2 diabetes is associated with increasing age however there is a trend of increasing numbers of young people diagnosed with NIDDM, so-called maturity onset diabetes of the young (MODY). In both Type 1 and Type 2 cases, there is a loss of insulin secretion, either through destruction of the .beta.-cells in the pancreas or defective secretion or production of insulin. In NIDDM, patients typically begin therapy by following a regimen of an optimal diet, weight reduction and exercise. Drug therapy is initiated when these measures no longer provide adequate metabolic control. Initial drug therapy includes sulfonylureas that stimulate .beta.-cell insulin secretion, but also can include biguanides, .alpha.-glucosidase inhibitors, thiazolidenediones and combination therapy. It is noteworthy however that the progressive nature of the disease mechanisms operating in type 2 diabetes are difficult to control. Over 50% of all drug-treated diabetics demonstrate poor glycemic control within six years, irrespective of the drug administered. Insulin therapy is regarded by many as the last resort in the treatment of Type 2 diabetes, and there is patient resistance to the use of insulin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Compositions and methods for treatment of diabetes Inventor(s): Ziegler, Randy H. ; (Costa Mesa, CA) Correspondence: Crosby Heafey Roach & May; 1901 Avenue Of The Stars, Suite 700; Los Angeles; CA; 90067; US Patent Application Number: 20020068704 Date filed: September 27, 2001 Abstract: Flavonoids, especially luteolin, are shown to be effective against insulin dependent (Type I) and insulin independent (Type II) diabetes mellitus. It is demonstrated that luteolin works in mammals by binding and blocking the K.sub.v1.3 potassium channel of T-cell and Beta cells. Antidiabetic and anti-autoimmune compounds can be selected by measuring their ability to bind to and block the K.sub.v1.3 channel. Excerpt(s): The present application is a Continuation-in-part of PCT/US00/08957 which designates the United States and was filed on Apr. 4, 2000 which in turn was based on and claimed priority from Provisional Application Serial No. 60/127,824, entitled "Compositions, Products, and Methods for Treatment of Diabetes" which was filed on Apr. 4, 1999 and which is incorporated herein by reference. ... The present application concerns the field of natural products and more specifically plant extracts and compounds useful for the treatment of diabetes. ... Diabetes mellitus (honey or sugar diabetes) a potentially devastating, complex disorder of glucose metabolism, which is currently partially controllable by insulin injections and/or drugs, is increasing in worldwide frequency. In the United States over ten million persons are estimated to have diabetes. The financial cost is in the many billions of dollars reflecting treatment expense and loss of productivity while the human cost in impaired function, progression to blindness, limb amputations, kidney failure and heart and vascular disease is immeasurable. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Methods and compositions for treatment of diabetes and related conditions via gene therapy Inventor(s): Caplan, Shari L. ; (Sloatsburg, NY), Boettcher, Brian R. ; (Morristown, NJ), Slosberg, Eric D. ; (New York, NY), Connelly, Sheila ; (Ijamsville, MD), Kaleko, Michael ; (Rockville, MD), Desai, Urvi J. ; (Germantown, MD) Correspondence: Thomas Hoxie; Novartis Corporation; Patent and Trademark Dept; 564 Morris Avenue; Summit; NJ; 079011027 Patent Application Number: 20020065239 Date filed: March 14, 2001 Abstract: Disclosed are methods and compositions for treatment of diabetes, obesity and diabetic-related conditions. The methods include gene therapy based administration of a therapeutically effective amount of vectors encoding the following: glucokinase regulatory protein alone or co-administered with glucokinase or with metabolism modifying proteins; glucokinase co-administered with metabolism modifying proteins; or glucokinase regulatory protein co-administered with glucokinase in combination with metabolism modifying proteins, to a diabetic patient. Wherein the metabolism modifying proteins include UCP2, UCP3, PPAR.alpha., OB-Rb, GLP-1 and GLP-1 analogs (administered via vector or directly as a peptide). Preferred examples of GLP-1 analogs include GLP-1-Gly8, Extendin-4 and the "Black Widow" chimeric GLP-1 analog. Additionally, PPAR.alpha. ligands and DPP-IV inhibitors may be co-administered with the above. Excerpt(s): There are 15.7 million people or 5.9% of the population in the United States who have diabetes. While an estimated 10.3 million have been diagnosed, unfortunately, 5.4 million people are not aware that they have the disease. Each day approximately 2,200 people are diagnosed with diabetes. About 798,000 people will be diagnosed this year. ... Diabetes is the seventh leading cause of death (sixth-leading cause of death by disease) in the United States. Based on death certificate data, diabetes contributed to more than 187,000 deaths in 1995. Diabetes is a chronic disease that has no cure. ... Many people first become aware that they have diabetes when they develop one of its life-threatening complications. Diabetes is the leading cause of new cases of blindness in people ages 20-74. Each year, from 12,000 to 24,000 people lose their sight because of diabetes. Diabetes is the leading cause of end-stage renal disease, accounting for about 40% of new cases. In 1995, approximately 27,900 people initiated treatment for end stage renal disease (kidney failure) because of diabetes. About 60-70 percent of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe
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forms, can lead to lower limb amputations. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 1540 times greater for a person with diabetes. Each year, more than 56,000 amputations are performed among people with diabetes. People with diabetes are 2 to 4 times more likely to have heart disease which is present in 75 percent of diabetes-related deaths (more than 77,000 deaths due to heart disease annually). They are also 2 to 4 times more likely to suffer a stroke. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method for the treatment of diabetes Inventor(s): Sander-Struckmeier, Suntje ; (Hannover, DE), Steinborn, Claus Rudolf ; (Seelze, DE), Rudmann, Martin A. ; (Wathlingen, DE), Schwanitz, Diethard ; (Eime, DE), Henniges, Friederike ; (Braunschweig, DE) Correspondence: Crowell & Moring LLP; Intellectual Property Group; P.O. Box 14300; Washington; DC; 20044-4300; US Patent Application Number: 20020061302 Date filed: September 17, 2001 Abstract: The use of physiologically acceptable enzyme mixtures having lipolytic, proteolytica and amylolytic activity, of microbial or animal origin, preferably digestive enzyme mixtures such as pancreatin or digestive enzyme mixtures containing pancreatin, for the treatment of diabetes. The invention also relates to the production of pharmaceutical compositions suitable for such treatment. A preferred variant of the invention relates to use of this enzyme mixture having lipolytic, proteolytic and amylolytic activity, especially digestive enzyme mixtures such as pancreatin or digestive enzyme mixtures containing pancreatin, for the adjuvant treatment of type I or type II diabetes mellitus. Excerpt(s): The present invention relates to the use of physiologically acceptable enzyme mixtures with lipolytic, proteolytic and amylolytic activity, but especially of mixtures of digestive enzymes such as pancreatin, for the treatment of diabetes and for the manufacture of medicinal products suitable for this treatment. The invention relates especially to the use of these enzyme mixtures with lipolytic, proteolytic and amylolytic activity, but especially of pancreatin or mixtures of digestive enzymes containing pancreatin, for the adjuvant therapy of both type I and type II primary diabetes. ... As used herein the term "diabetes" is understood to mean diabetes mellitus, the so-called "sugar sickness". In addition to other, e. g. secondary forms of diabetes that can
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occur as sequelae of other primary diseases, two main groups of disorders of carbohydrate metabolism are distinguished, i. e. type I diabetes due to insulin deficiency and type II diabetes due to reduced insulin effectiveness, the course of the disease depending on the type concerned, among other factors. Diabetes is furthermore a chronic disease with a variety of pathological manifestations and is accompanied, for example, by disorders of lipid metabolism, circulation and glucose metabolism. The typical symptoms of this disease include elevated blood sugar (hyperglycemia), excretion of sugar in the urine (glycosuria), tendency to infections and pruritus. Diabetes tends to be a progressive disorder and in many cases is also accompanied by various complications. Known complications include, for example, neurologic and vascular diseases. It is therefore necessary to adjust the therapy to meet each patient's individual requirements in every phase of the illness and to select the suitable medicinal product for each individual case. It may also be desirable for this therapy to supplement the selected primary medications with other medicinal products in the form of an adjuvant treatment which can exert a supporting effect on the therapy and beneficially influence the further course of the illness. ... Therefore, it is an object of the invention to provide a new method for the treatment of diabetes mellitus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Composition for treatment of diabetes and treatment of diabetes Inventor(s): Niizato, Tetsutaro ; (Yokohama-shi, JP), Shiotani, Masaharu ; (Yokohama-shi, JP), Shoji, Yoko ; (Yokohama-shi, JP) Correspondence: Larson & Taylor, Plc; 1199 North Fairfax Street; Suite 900; Alexandria; VA; 22314; US Patent Application Number: 20020055491 Date filed: November 26, 2001 Abstract: Fosfomycin or a pharmaceutically acceptable salt thereof has been found to have an action of lowering the serum glucose level and is recognized to be useful as an orally administrable remedy for treating diabetes. It has further been found that the serum glucose level-lowering action of fosfomycin or its salt can be enhanced synergistically and significantly when forfomycin is administered in association with vanadyl sulfate and the like. Therefore, the composition comprising fosfomycin or its salt and vanadyl sulfate or the like is useful as an orally administrable remedy for treating diabetes.
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Excerpt(s): This invention relates to a novel composition for therapeutically treating diabetes, which comprises as an active ingredient fosfomycin, a known antibiotic, or a pharmaceutically acceptable salt thereof. This invention also relates to a novel composition for therapeutically treating diabetes, which comprises fosfomycin or a pharmaceutically acceptable salt thereof and also a vanadyl compound (or a vanadyl salt) containing vanadyl group (VO.sup.2+) as active ingredients. This invention further relates to a novel method for treating diabetes by administration of fosfomycin or a salt thereof. ... Furthermore, this invention includes the use of fosfomycin or a salt thereof or the use of a mixture of fosfomycin or a salt thereof with a vanadyl compound, in the preparation of a remedy of diabetes. ... Diabetes are one of typical diseases incident to old adults, similarly to cancers, brain infarction, cardiac infarction, Alzheimer's disease and the like. There are numerous latent diabetes, too. Diabetes are diseases caused by occurrence of abnormal metabolisms of glucose, protein and lipid due to a deficiency or insufficiency of the actions of insulin. Typical signs of diabetes include an abnormal increase in the serum glucose level over the normal range of the glucose level and an excretion of glucose in the urine. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Treatment of diabetes with thiazolidinedione, insulin secretagogue and alpha glucocidase inhibitor Inventor(s): Buckingham, Robin Edwin ; (Welwyn Garden City, GB), Smith, Stephen Alistair ; (Bramfield, GB) Correspondence: Glaxosmithkline; Corporate Intellectual Property UW2220; P.O. Box 1539; King of Prussia; PA; 19406-0939; US Patent Application Number: 20020052324 Date filed: November 20, 2001 Abstract: A method for the treatment of diabetes mellitus and conditions associated with diabetes mellitus in a mammal, which method comprises administering an effective non-toxic and pharmaceutically acceptable amount of an insulin sensitizer, an insulin secretagogue and an alpha glucosidase inhibitor antihyperglycaemic agent, to a mammal in need thereof; and composition for use in such method. Excerpt(s): This invention relates to a method of treatment, in particular to a method for the treatment of diabetes mellitus, especially non-insulin dependent diabetes (NIDDM) or Type 2 diabetes and conditions associated with diabetes mellitus. ... The sulphonylureas are well known
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examples of insulin secretagogues. The sulphonylureas act as antihyperglycaemic agents and are used in the treatment of Type 2 diabetes. Examples of sulphonylureas include glibenclamide, glipizide, gliclazide, glimepiride, tolazamide and tolbutamide. ... Alpha glucosidase inhibitor antihyperglycaemic agents, such as acarbose, emiglitate and miglitol, are commonly used in the treatment of Type 2 diabetes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Treatment of diabetes with thiazolidinedione and sulphonylurea Inventor(s): Buckingham, Robin Edwin ; (Welwyn Garden City, GB), Smith, Stephen Alistair ; (Bramfield, GB) Correspondence: Glaxosmithkline; Corporate Intellectual Property UW2220; P.O. Box 1539; King of Prussia; PA; 19406-0939; US Patent Application Number: 20020045649 Date filed: October 12, 2001 Abstract: A method for the treatment of diabetes mellitus and conditions associated with diabetes mellitus in a mammal, which method comprises administering an effective non-toxic and pharmaceutically acceptable amount of an insulin sensitiser and a sub-maximal amount of an insulin secretagogue, to a mammal in need thereof; and a pharmaceutical composition for use in such method. Excerpt(s): This invention relates to a method of treatment, in particular to a method for the treatment of diabetes mellitus, especially non-insulin dependent diabetes (NIDDM) (or Type 2 diabetes) and conditions associated with diabetes mellitus. ... The sulphonylureas are well known examples of insulin secretagogues. The sulphonylureas act as hypoglycaemic agents and are used in the treatment of Type 2 diabetes. Examples of sulphonylureas include glibenclamide, glipizide, gliclazide, glimepiride, tolazamide and tolbutamide. ... It is now surprisingly indicated that Compound (I) in combination with a sub maximal amount of an insulin secretagogue provides a particularly beneficial effect on glycaemic control, such combination is therefore particularly useful for the treatment of diabetes mellitus and conditions associated with diabetes. Lowering the dose of the insulin secretagogue in the presence of a full dose of insulin sensitising agent also has the benefit of reducing the likelihood, frequency and/or severity of hypoglycaemic episodes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Isoxazolidine compounds useful in the treatment of diabetes, hyperlipidemia, and atherosclerosis in mammals Inventor(s): Druzgala, Pascal ; (Santa Rosa, CA), Milner, Peter G. ; (Los Altos Hills, CA) Correspondence: Saliwanchik Lloyd & Saliwanchik; A Professional Association; 2421 N.W. 41st street; Suite A-1; Gainesville; FL; 326066669 Patent Application Number: 20020045620 Date filed: September 21, 2001 Abstract: The subject invention provides pharmaceutical compounds useful in the treatment of Type II diabetes. These compounds are advantageous because they are readily metabolized by the metabolic drug detoxification systems. Particularly, isoxazolidine compounds which have been designed to include esters within the structure of the compounds are provided. This invention is also drawn to methods of treating disorders, such as diabetes, comprising the administration of therapeutically effective compositions comprising compounds which have been designed to be metabolized by serum or intracellular hydrolases and esterases. Pharmaceutical compositions of the isoxazolidine compounds are also taught. Excerpt(s): Diabetes is one of the most prevalent chronic disorders worldwide with significant personal and financial costs for patients and their families, as well as for society. Different types of diabetes exist with distinct etiologies and pathogeneses. For example, diabetes mellitus is a disorder of carbohydrate metabolism, characterized by hyperglycemia and glycosuria and resulting from inadequate production or utilization of insulin. ... Noninsulin-dependent diabetes mellitus (NIDDM), often referred to as Type II diabetes, is a form of diabetes which occurs predominantly in adults who produce adequate levels of insulin but who have a defect in insulin-mediated utilization and metabolism of glucose in peripheral tissues. Overt NIDDM is characterized by three major metabolic abnormalities: resistance to insulin-mediated glucose disposal, impairment of nutrient-stimulated insulin secretion, and overproduction of glucose by the liver. It has been shown that for some people with diabetes a genetic predisposition results from a mutation in the gene(s) coding for insulin and/or the insulin receptor and/or insulin-mediated signal transduction factor(s), thereby resulting in ineffective insulin and/or insulin-mediated effects thus impairing the utilization or metabolism of glucose. ... For people with Type II diabetes, insulin secretion is often enhanced, presumably to compensate for insulin resistance. Eventually, however, the .beta.-cells fail to maintain sufficient insulin secretion to compensate for the insulin resistance. Mechanisms
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responsible for the .beta.-cell failure have not been identified, but may be related to the chronic demands placed on the .beta.-cells by peripheral insulin resistance and/or to the effects of hyperglycemia. The .beta.-cell failure could also occur as an independent, inherent defect in "prediabetic" individuals. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method of treating the syndrome of type 2 diabetes in humans Inventor(s): Clemens, Anton H. ; (Madison, WI) Correspondence: Michael Best & Friedrich, LLP; One South Pinckney Street; P O Box 1806; Madison; WI; 53701 Patent Application Number: 20020045572 Date filed: June 11, 2001 Abstract: The invention provides a method of treating a human suffering from the Syndrome of Type 2 Diabetes by administering, by a pharmaceutically effective mode, a drug composition having an opioidergic agent including opiates having .mu.-agonist activity, opiates having .kappa. antagonist activity or a combination thereof and an insulin secretagogue. Excerpt(s): Type 2 Diabetes is a major cause of death in the industrialized world. A wide variety of chemical and physical abnormalities are associated with Type 2 Diabetes, which are a consequence of, and associated with, imbalances in fuel metabolism and impaired hepatic fuel processing. The typical American and Western European diet, i.e. fuel intake, consists of 40-45% carbohydrates, 40% fat and 15-20% protein. Type 2 Diabetes includes elevations in fasting blood glucose, gluconeogenesis and glucose production, in spite of significant increases in fasting insulin and C-peptide concentrations. Hepatic gluconeogenesis is the formation of glucose, particularly by the liver, from noncarbohydrate sources like pyruvate, lactate, odd-chain fatty and amino acids, and glucose production (GP) is the formation of glucose from carbohydrate sources, e.g. glycogen. The underlying insulin resistance (IR) associated with Type 2 Diabetes also contributes to increases in lipogenesis. Typically associated with lipogenesis is dislipidemia, which is characterized by increases in levels of fasting free fatty acid (FFA), fasting triglycerides (TG) and total cholesterol concentrations, increases in levels of fasting LDL-cholesterol, decreases in levels of fasting HDLcholesterol, and an increased LDL/HDL ratio. In addition, lipogenesis leads to increases in body weight and increases in systolic and diastolic blood pressure. ... Type 2 Diabetes represents a syndrome of various, in
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part sequential, disease states. Its pathophysiology slowly progresses through a long period of successive abnormalities: a) Insulin Resistance (IR), which in association with beta-cell dysfuntion mediated excessive hepatic gluconeogenesis (GNG) and Glucose Production (GP), leads to b) Impaired Fasting Glucose (IFG) and, in turn, to c) Impaired Glucose Tolerance (IGT) and eventually to the clinical form of d) Non-Insulin Dependent Diabetes Mellitus (NIDDM). IR is characterized as a state in which a normal amount of insulin produces a subnormal biological response in carbohydrate metabolism. IR tends to remain active throughout the entire pathophysiology of this syndrome. Beta-cell dysfunction is characterized by a gradual disappearance of the so-called first phase insulin secretion. In order to normalize blood glucose levels, affected subjects require above-normal levels of second, or proportional phase insulin release to cope with excessive post-prandial glucose excursions and to compensate for their insulin resistance. ... Compared to Type 1 Diabetes (juvenile diabetes), the Type 2 Diabetes syndrome, particularly its NIDDM form, is characterized by relatively inadequate endogenous insulin concentrations. However, insulin concentrations in Type 2 diabetics may, in fact, be higher than in the normal population. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
N-substituted indoles useful in the treatment of diabetes Inventor(s): Acton, John J. III ; (Cranford, NJ), Black, Regina Marie ; (Cranford, NJ), Jones, Anthony Brian ; (Clavering, GB), Wood, Harold Blair ; (Cranford, NJ) Correspondence: Merck and Co Inc; P O Box 2000; Rahway; NJ; 070650907 Patent Application Number: 20020042441 Date filed: July 25, 2001 Abstract: Certain N-substituted indoles having aryloxyacetic acid substituents are agonists or partial agonists of PPAR gamma, and are useful in the treatment, control or prevention of non-insulin dependent diabetes mellitus (NIDDM), hyperglycemia, dyslipidemi a, hyperlipidemi a, hypercholesterolemia, hypertriglyceridemia, atherosclerosis, obesity, vascular restenosis, inflammation, and other PPAR mediated diseases, disorders and conditions. Excerpt(s): The instant invention is concerned with N-substituted indoles having aryloxyalkanoic acid substituents, and pharmaceutically acceptable salts and prodrugs thereof, which are useful as therapeutic compounds, particularly in the treatment of Type 2 diabetes mellitus, often referred to as non-insulin dependent diabetes (NIDDM), of
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conditions that are often associated with this disease, and of lipid disorders. ... Diabetes refers to a disease process derived from multiple causative factors and characterized by elevated levels of plasma glucose or hyperglycemia in the fasting state or after administration of glucose during an oral glucose tolerance test. Persistent or uncontrolled hyperglycemia is associated with increased and premature morbidity and mortality. Often abnormal glucose homeostasis is associated both directly and indirectly with alterations of the lipid, lipoprotein and apolipoprotein metabolism and other metabolic and hemodynamic disease. Therefore patients with Type 2 diabetes mellitus are at especially increased risk of macrovascular and microvascular complications, including coronary heart disease, stroke, peripheral vascular disease, hypertension, nephropathy, neuropathy, and retinopathy. Therefore, therapeutical control of glucose homeostasis, lipid metabolism and hypertension are critically important in the clinical management and treatment of diabetes mellitus. ... There are two generally recognized forms of diabetes. In type 1 diabetes, or insulin-dependent diabetes mellitus (IDDM), patients produce little or no insulin, the hormone which regulates glucose utilization. In type 2 diabetes, or noninsulin dependent diabetes mellitus (NIDDM), patients often have plasma insulin levels that are the same or even elevated compared to nondiabetic subjects; however, these patients have developed a resistance to the insulin stimulating effect on glucose and lipid metabolism in the main insulinsensitive tissues, which are muscle, liver and adipose tissues, and the plasma insulin levels, while elevated, are insufficient to overcome the pronounced insulin resistance. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Compositions, kits, and methods for identification and modulation of type I diabetes Inventor(s): Byrne, Michael C. ; (Brookline, MA), Hill, Andrew A. ; (Cambridge, MA), Wilson, S. Brian ; (Lexington, MA) Correspondence: Lahive & Cockfield; 28 State Street; Boston; MA; 02109; US Patent Application Number: 20020039736 Date filed: June 5, 2001 Abstract: The invention relates to compositions, kits, and methods for detecting, characterizing, preventing, and treating type I diabetes. A variety of markers are provided, wherein changes in the levels of
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expression of one or more of the markers is correlated with the presence of type I diabetes. Excerpt(s): Diabetes mellitus is a syndrome with interrelated metabolic, vascular, and neuropathic components. The metabolic component, generally characterized by hyperglycemia, comprises alterations in carbohydrate, fat and protein metabolism caused by absent or markedly reduced insulin secretion and/or ineffective insulin action. The vascular component includes abnormalities in the blood vessels leading to cardiovascular, retinal and renal complications. Abnormalities in the peripheral and autonomic nervous systems comprise a third component of the diabetic syndrome. ... There are two types of diabetes mellitus: type I and type II. Type I diabetes is also termed "insulin-dependent" diabetes, due to the fact that subjects afflicted with this disorder cannot synthesize their own insulin, and therefore must periodically inject insulin into their systems. Type II diabetic-afflicted subjects, on the other hand, are able to synthesize insulin, but this insulin is either insufficient for the needs of the subject, or is not effectively used by the subject. Type II diabetes (`non-insulin-dependent` diabetes) is typically controlled by oral medication. ... Like many autoimmune diseases, Type I diabetes mellitus (IDDM) is a disorder with a highly complex etiology, which is thought to involve environmental "triggers" interacting with a polygenic genetic susceptibility. The earliest identification of a genetic locus conferring IDDM susceptibility occurred nearly thirty years ago, when the association of certain alleles of the major histocompatibility locus (MHC) with diabetes was discovered (Eisenbarth (1986) N. Engl. J Med. 214(21): 1360-1368; Wicker et al. (1995) Annu. Rev. Immunol. 13: 179-200; and Todd et al. (1987) Nature 329: 599-604). Subsequent epidemiological studies have conclusively demonstrated that the risk of developing diabetes is strongly correlated with the inheritance of certain MHC Class II alleles. While the MHC locus is the most significant genetic risk factor for diabetes, it accounts for less than 50% of this genetic risk, clearly indicating that non-MHC loci interspersed around the genome also make critical contributions to disease susceptibility and severity (Davies et al. (1994) Nature 371: 130-136). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Anticonvulsant derivatives useful for preventing the development of Type II diabetes mellitus and Syndrome X Inventor(s): Plata-Salaman, Carlos ; (Ambler, PA), Crooke, Jeffrey ; (Dolyestown, PA) Correspondence: Audley A. Ciamporcero Jr.; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20020037861 Date filed: July 6, 2001 Abstract: Anticonvulsant derivatives useful for preventing the development of Type II diabetes mellitus and Syndrome X are disclosed. Excerpt(s): More recently compounds of formula (I) have been found to be effective for maintaining weight loss, as disclosed in WIPO publication WOOO/61140, for the treatment of obesity, as disclosed in U.S. Pat. No. 6,071,537 (WO 9800130), for lowering blood glucose levels, as disclosed in WIPO publication WO 00/61139 and for lowering lipids as disclosed in WIPO publication WO00/61137. Thakur et al in WIPO publication WO99/44581 disclose the use of topiramate for the treatment of diabetes. ... Type II diabetes mellitus (non-insulin-dependent diabetes mellitus or NIDDM) is a metabolic disorder involving dysregulation of glucose metabolism and insulin resistance, and long-term complications involving the eyes, kidneys, nerves, and blood vessels. Type II diabetes mellitus usually develops in adulthood (middle life or later) and is described as the body's inability to make either sufficient insulin (abnormal insulin secretion) or its inability to effectively use insulin (resistance to insulin action in target organs and tissues). More particularly, patients suffering from Type II diabetes mellitus have a relative insulin deficiency. That is, in these patients, plasma insulin levels are normal to high in absolute terms, although they are lower than predicted for the level of plasma glucose that is present. ... Type II diabetes mellitus is characterized by the following clinical signs or symptoms: persistently elevated plasma glucose concentration or hyperglycemia; polyuria; polydipsia and / or polyphagia; chronic microvascular complications such as retinopathy, nephropathy and neuropathy; and macrovascular complications such as hyperlipidemia and hypertension which can lead to blindness, end-stage renal disease, limb amputation and myocardial infarction. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Keeping Current In order to stay informed about patents and patent applications dealing with diabetes, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “diabetes” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on diabetes. You can also use this procedure to view pending patent applications concerning diabetes. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Arteriosclerosis: A group of diseases in which the walls of the arteries get thick and hard. In one type of arteriosclerosis, fat builds up inside the walls and slows the blood flow. These diseases often occur in people who have had diabetes for a long time. [NIH] Aspergillus: A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family Trichocomaceae. [NIH] Assay: Determination of the amount of a particular constituent of a mixture,
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or of the biological or pharmacological potency of a drug. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Diastolic: Of or pertaining to the diastole. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Embryo: In animals, those derivatives of the fertilized ovum that eventually become the offspring, during their period of most rapid development, i.e., after the long axis appears until all major structures are represented. In man, the developing organism is an embryo from about two weeks after fertilization to the end of seventh or eighth week. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Fosfomycin: An antibiotic produced by Streptomyces fradiae. [NIH] Ganglion: 1. a knot, or knotlike mass. 2. a general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3.
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a benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gangrene: Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction. [EU] Gliclazide: An oral sulfonylurea hypoglycemic agent which stimulates insulin secretion. [NIH] Glipizide: An oral hypoglycemic agent which is rapidly absorbed and completely metabolized. [NIH] Gluconeogenesis: The process by which glucose is formed from a noncarbohydrate source. [NIH] Glycolysis: The pathway by which glucose is catabolized into two molecules of pyruvic acid with the generation of ATP. [NIH] Glycosuria: The presence of glucose in the urine; especially the excretion of an abnormally large amount of sugar (glucose) in the urine, i.e., more than 1 gm. in 24 hours. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersecretion: Excessive secretion. [EU] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU]
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Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Lethal: Deadly, fatal. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Medicament: A medicinal substance or agent. [EU] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Neurologic: Pertaining to neurology or to the nervous system. [EU] Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Pancreatin: A mammalian pancreatic extract composed of enzymes with protease, amylase and lipase activities. It is used as a digestant in pancreatic malfunction. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Particle: A tiny mass of material. [EU] Polydipsia: A great thirst that lasts for long periods of time; a sign of diabetes. [NIH] Polyphagia: Great hunger; a sign of diabetes. People with this great hunger often lose weight. [NIH] Polyuria: Having to urinate often; a common sign of diabetes. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prodrugs: A compound that, on administration, must undergo chemical conversion by metabolic processes before becoming the pharmacologically active drug for which it is a prodrug. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Pruritus: Itching skin; may be a symptom of diabetes. [NIH] Reagent: A substance employed to produce a chemical reaction so as to
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detect, measure, produce, etc., other substances. [EU] Tolazamide: A sulphonylurea hypoglycemic agent with actions and uses similar to those of chlorpropamide. [NIH] Ulceration: 1. the formation or development of an ulcer. 2. an ulcer. [EU] Vanadium: Vanadium. A metallic element with the atomic symbol V, atomic number 23, and atomic weight 50.94. It is used in the manufacture of vanadium steel. Prolonged exposure can lead to chronic intoxication caused by absorption usually via the lungs. [NIH]
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CHAPTER 6. BOOKS ON DIABETES Overview This chapter provides bibliographic book references relating to diabetes. You have many options to locate books on diabetes. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on diabetes include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to diabetes (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
All New Cookbook for Diabetics and Their Families by Joan Erskine Denman (Editor), et al (1989); ISBN: 0848707508; http://www.amazon.com/exec/obidos/ASIN/0848707508/icongroupin terna
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Better Homes and Gardens Diabetic Cookbook (1992); ISBN: 0696019884; http://www.amazon.com/exec/obidos/ASIN/0696019884/icongroupin terna
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Borrowing Time: Growing Up With Juvenile Diabetes by Pat Covelli (1979); ISBN: 069001841X; http://www.amazon.com/exec/obidos/ASIN/069001841X/icongroupi nterna
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Childhood Diabetes: The Facts by Oman Craig (1982); ISBN: 0192613308; http://www.amazon.com/exec/obidos/ASIN/0192613308/icongroupin terna
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Clinical Diabetes Mellitus by George P. Kozak (1982); ISBN: 0721655025; http://www.amazon.com/exec/obidos/ASIN/0721655025/icongroupin terna
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Desserts for Diabetics: 125 Recipes for Delicious Traditional Desserts Adapted for Diabetic Diets by R.D. Mabel Cavaiani, et al (1992); ISBN: 0399517340; http://www.amazon.com/exec/obidos/ASIN/0399517340/icongroupin terna
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Diabetes Guide by S. Dagago-Jack, Klaus Johansen (1992); ISBN: 0387544291; http://www.amazon.com/exec/obidos/ASIN/0387544291/icongroupin terna
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Diabetes Mellitus (1991); ISBN: 047183016X; http://www.amazon.com/exec/obidos/ASIN/047183016X/icongroupi nterna
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Diabetes Mellitus and Obesity by Bernard N. Brodoff (Editor) (1983); ISBN: 0683010719; http://www.amazon.com/exec/obidos/ASIN/0683010719/icongroupin terna
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Diabetes: Beating the Odds: The Doctor's Guide to Reducing Your Risk by Elliot J., Md. Rayfield, et al (1992); ISBN: 0201577844; http://www.amazon.com/exec/obidos/ASIN/0201577844/icongroupin terna
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Diabetes: The Facts That Let You Regain Control of Your Life by Charles Kilo, et al (1987); ISBN: 0471858013; http://www.amazon.com/exec/obidos/ASIN/0471858013/icongroupin terna
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Diabetic Candy, Cookie and Dessert Cookbook by Mary Jane Finsand, James D. Healy (1990); ISBN: 0806975865; http://www.amazon.com/exec/obidos/ASIN/0806975865/icongroupin terna
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Diabetic Neuropathy by Peter James Dyck, et al (1987); ISBN: 0721621252; http://www.amazon.com/exec/obidos/ASIN/0721621252/icongroupin terna
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Handbook of Diabetes by Gareth Williams, John C. Pickup (Editor) (1992); ISBN: 0632028882; http://www.amazon.com/exec/obidos/ASIN/0632028882/icongroupin terna
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Hormones: From Molecules to Disease by Etienne-Emile Baulieu, Paul A. Kelly (Editor) (1990); ISBN: 0412027917; http://www.amazon.com/exec/obidos/ASIN/0412027917/icongroupin terna
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Hyperglycemia, Diabetes, and Vascular Disease (Clinical Physiology Series) by Neil Ruderman (Editor), et al (1992); ISBN: 0195067738; http://www.amazon.com/exec/obidos/ASIN/0195067738/icongroupin terna
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Immunology of Clinical and Experimental Diabetes by Sudhir Gupta (1984); ISBN: 0306414023; http://www.amazon.com/exec/obidos/ASIN/0306414023/icongroupin terna
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Lecture Notes on Endocrinology by William Jeffcoate, Ronald F. Lecture Notes on endocrinolog Fletcher (1993); ISBN: 0632033487; http://www.amazon.com/exec/obidos/ASIN/0632033487/icongroupin terna
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Neuropsychological and Behavioral Aspects of Diabetes (Contributions to Psychology and Medicine) by Clarissa S. Holmes (Editor) (1990); ISBN: 0387970754; http://www.amazon.com/exec/obidos/ASIN/0387970754/icongroupin terna
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Recipes for Diabetics by Billie Little, Selvyn B. Bleifer (Photographer) (1990); ISBN: 0399516433; http://www.amazon.com/exec/obidos/ASIN/0399516433/icongroupin terna
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Sarah and Puffle: A Story for Children About Diabetes by Linnea Mulder, Joanne H. Friar (Illustrator) (1992); ISBN: 094535441X;
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http://www.amazon.com/exec/obidos/ASIN/094535441X/icongroupi nterna ·
Sugar Isn't Everything: A Support Book, in Fiction Form, for the Young Diabetic by Willo Davis Roberts (1991); ISBN: 0689712251; http://www.amazon.com/exec/obidos/ASIN/0689712251/icongroupin terna
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Sweet Recovery : A Young Woman's Emotional Ride With Diabetes, Vision Loss, and Food Addiction....to Health and Freedom by Denise J. Bradley (1992); ISBN: 0963052616; http://www.amazon.com/exec/obidos/ASIN/0963052616/icongroupin terna
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The American Diabetes Association and the American Dietetic Association Family Cookbook (1989); ISBN: 0130249106; http://www.amazon.com/exec/obidos/ASIN/0130249106/icongroupin terna
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The American Diabetes Association/the American Dietetic Association Family Cookbook by The American Diabetes Association (1987); ISBN: 0671761331; http://www.amazon.com/exec/obidos/ASIN/0671761331/icongroupin terna
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The American Diabetes Association/the American Dietetic Association Family Cookbook (1987); ISBN: 0130039551; http://www.amazon.com/exec/obidos/ASIN/0130039551/icongroupin terna
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The Diabetic Chocolate Cookbook by Mary Jane Finsand, James D. Healy (1990); ISBN: 0806979003; http://www.amazon.com/exec/obidos/ASIN/0806979003/icongroupin terna
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The Diabetic Pancreas by Bruno W. Volk, Edward R. Arquilla (Editor) (1985); ISBN: 0306417812; http://www.amazon.com/exec/obidos/ASIN/0306417812/icongroupin terna
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The Diabetic's Brand Name Food Exchange Handbook by Clara G. Schneider, et al (1991); ISBN: 0894715968; http://www.amazon.com/exec/obidos/ASIN/0894715968/icongroupin terna
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The Discovery of Insulin by Michael Bliss (1984); ISBN: 0226058980; http://www.amazon.com/exec/obidos/ASIN/0226058980/icongroupin terna
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The Human Side of Diabetes (1991); ISBN: 9991948996; http://www.amazon.com/exec/obidos/ASIN/9991948996/icongroupin terna
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The Hypoglycemia-Diabetes Cope Book: A Guide to Healthy Living by Freda Whalen (1993); ISBN: 0963820109; http://www.amazon.com/exec/obidos/ASIN/0963820109/icongroupin terna
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The Ucsd Healthy Diet for Diabetes: A Comprehensive Nutritional Guide and Cookbook by Susan Algert, et al (1991); ISBN: 0395572258; http://www.amazon.com/exec/obidos/ASIN/0395572258/icongroupin terna
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Why Me? by John. Branfield (1973); ISBN: 0060206624; http://www.amazon.com/exec/obidos/ASIN/0060206624/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “diabetes” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:26 ·
Atlas of diabetes. Author: editor, Jay Skyler; Year: 2002; Philadelphia: Developed by Current Medicine, 2002; ISBN: 1573401897 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1573401897/icongroupin terna
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Ayurvedic interventions for diabetes mellitus: a systematic review. Author: Prepared for Agency for Healthcare Research and Quality by
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
26
220 Diabetes
Southern California Evidence-Based Practice Center/RAND; Mary Hardy ... [et al.]; Year: 2001; Rockville, Md.: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, [2001]; ISBN: 1587630680 ·
Cardiovascular risk in type 2 diabetes mellitus: assessment and control. Author: Nicolae Hancu (ed.); Year: 2003; Berlin; New York: SpringerVerlag, c2003; ISBN: 3540438033 (hardcover: alk. paper) http://www.amazon.com/exec/obidos/ASIN/3540438033/icongroupin terna
·
Diabesity and associated disorders in Australia, 2000: the accelerating epidemic: the Australian diabetes, obesity and lifestyle study (AusDiab) [authors, D. Dunstan ... [et al.]]. Author: Flaws, Bob, 1946-; Year: 2001; Melbourne: International Diabetes Institute, c2001; ISBN: 0957831021
·
Diabetes & cardiovascular disease: a practical primer. Author: MacKinnon, Mary, RGN; Year: 1999; New Orleans, La.: Institute of Professional Education, LSU Health Sciences Center, Louisiana State University School of Medicine, [1999?]; ISBN: 0970478801
·
Diabetes & women's health across the life stages: a public health perspective. Author: Gloria L.A. Beckles and Patricia E. Thompson-Reid, editors; Year: 2001; [Atlanta]: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, [2001]
·
Diabetes care and outcomes: results of the Navajo Area Indian Health Service Diabetes Program care and outcomes audit, 1994 to 2000. Author: English, Patrick; Year: 2002; [Washington, D.C.?]: Navajo Area Indian Health Service, Diabetes Program, [2002?]
·
Diabetes care documentation and coding: a handbook for clinicians. Author: Jerome S. Fischer; Year: 2002; Alexandria, Va.: American Diabetes Association, c2002; ISBN: 1580401295 (pbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1580401295/icongroupin terna
·
Diabetes to wholeness: a natural and spiritual approach to disease prevention & healing! Author: Beth M. Ley; Year: 2002; Detroit Lakes, MN: BL Publications, c2002; ISBN: 1890766232 http://www.amazon.com/exec/obidos/ASIN/1890766232/icongroupin terna
·
Diabetic adolescents and their families: stress, coping, and adaptation. Author: Inge Seiffge-Krenke; Year: 2001; Cambridge; New York: Cambridge University Press, 2001; ISBN: 0521792002 (hardback) http://www.amazon.com/exec/obidos/ASIN/0521792002/icongroupin terna
Books 221
·
Drug treatment of type 2 diabetes. Author: editor, Andrew J. Krentz; Year: 2000; Auckland; Philadelphia: Adis International, c2000; ISBN: 0864710852 http://www.amazon.com/exec/obidos/ASIN/0864710852/icongroupin terna
·
Ellenberg and Rifkin's diabetes mellitus: theory and practice. Author: Immunology of Diabetes Society. Congress (5th: 2001: Madras, India); Year: 2003; New York: McGraw-Hill, Health Professions Division, c2003; ISBN: 0838521789 http://www.amazon.com/exec/obidos/ASIN/0838521789/icongroupin terna
·
Evidence-based diabetes care. Author: editors, Hertzel C. Gerstein, R. Brian Haynes; Year: 2001; Hamilton, Ont.: B.C. Decker, 2001; ISBN: 1550091247 http://www.amazon.com/exec/obidos/ASIN/1550091247/icongroupin terna
·
Immunology of diabetes: autoimmune mechanisms and the prevention and cure of type 1 diabetes. Author: edited by C.B. Sanjeevi; Year: 2002; New York: New York Academy of Sciences, 2002; ISBN: 1573313629 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1573313629/icongroupin terna
·
Implementing group and individual medical nutrition therapy for diabetes. Author: Marion J. Franz, Diane Reader, Arlene Monk; Year: 2002; Alexandria, Va.: American Diabetes Association, c2002; ISBN: 1580401651 (pbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1580401651/icongroupin terna
·
Insulin therapy. Author: edited by Jack L. Leahy, William T. Cefalu; Year: 2002; New York: Marcel Dekker, c2002; ISBN: 0824707117 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824707117/icongroupin terna
·
Life course perspectives on coronary heart disease, stroke, and diabetes: the evidence and implications for policy and research. Author: Franz, Marion J; Year: 2002; Geneva: Ageing and Life Course, Dept. of Noncommunicable Diseases Prevention and Health Promotion, Noncommunicable Diseases and Mental Health Cluster, World Health Organization, 2002
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·
Management of diabetes: a national clinical guideline. Author: Scottish Intercollegiate Guidelines Network; Year: 2001; Edinburgh, Scotland: SIGN, 2001
·
Medical management of diabetes and heart disease. Author: edited by Burton E. Sobel, David J. Schneider; Year: 2002; New York: Marcel Dekker, c2002; ISBN: 0824707451 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824707451/icongroupin terna
·
Mobile lipid clinic: a companion guide. Author: Michael H. Davidson; Year: 2001; Philadelphia: Lippincott Williams & Wilkins, 2001; ISBN: 0781736706 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0781736706/icongroupin terna
·
Nursing management of diabetes mellitus: a guide to the pattern approach. Author: Diane W. Guthrie, Richard A. Guthrie, editors; Year: 2002; New York: Springer, c2002; ISBN: 0826172628 http://www.amazon.com/exec/obidos/ASIN/0826172628/icongroupin terna
·
Philatelic history of diabetes: in search of a cure. Author: Lee J. Sanders; Year: 2001; Alexandria, Va.: American Diabetes Association, c2001; ISBN: 1580401260 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1580401260/icongroupin terna
·
Practical psychology for diabetes clinicians. Author: Barbara J. Anderson, Richard R. Rubin, editors; Year: 2002; Alexandria, Va.: American Diabetes Association, c2002; ISBN: 1580401406 (pbk.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1580401406/icongroupin terna
·
Principles of diabetes mellitus. Author: edited by Leonid Poretsky; Year: 2002; Boston: Kluwer, c2002; ISBN: 1402071140 (hc.: alk. paper) http://www.amazon.com/exec/obidos/ASIN/1402071140/icongroupin terna
·
Providing diabetes care in general practice: a practical guide to integrated care. Author: Mary MacKinnon; Year: 2002; London: Class, 2002; ISBN: 1859590489
·
Treatment of diabetes mellitus with Chinese medicine. Author: by Bob Flaws, Lynn Kuchinski & Robert Casañas; Year: 2001; Boulder, CO: Blue Poppy Press, c2001; ISBN: 1891845217 http://www.amazon.com/exec/obidos/ASIN/1891845217/icongroupin terna
Books 223
·
Type 2 diabetes: managing for better health outcomes. Author: PricewaterhouseCoopers; Diabetes New Zealand, Inc; Year: 2001; [Wellington, N.Z.?: PricewaterhouseCoopers?, 2001]; ISBN: 0473076683
·
Type 2 diabetes. Author: Patrick English, Gareth Williams; Year: 2001; London: Martin Dunitz; Florence, KY: Distributed in the USA by Taylor & Francis, c2001; ISBN: 1841840351 http://www.amazon.com/exec/obidos/ASIN/1841840351/icongroupin terna
·
Vascular complications of diabetes: current issues in pathogenesis and treatment. Author: [edited by] Richard Donnelly and Jost Jonas; Year: 2002; Malden, MA: Blackwell Science, 2002; ISBN: 0632065133 (pbk.) http://www.amazon.com/exec/obidos/ASIN/0632065133/icongroupin terna
Chapters on Diabetes Frequently, diabetes will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with diabetes, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and diabetes using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “diabetes” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books.
General Home References In addition to references for diabetes, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Bible Cure for Diabetes (Health and Fitness) by Don Colbert; Paperback - 96 pages (August 1999), Siloam Press; ISBN: 0884196488; http://www.amazon.com/exec/obidos/ASIN/0884196488/icongroupinterna
224 Diabetes
· The Glucose Revolution Pocket Guide to Diabetes by Kaye Foster-Powell (Editor), et al; Mass Market Paperback - 120 pages (March 12, 2000), Marlowe & Co; ISBN: 1569246750; http://www.amazon.com/exec/obidos/ASIN/1569246750/icongroupinterna · Living with Diabetes: Nicole Johnson, Miss America 1999 by Nicole Johnson; Hardcover - 214 pages, 1st edition (September 15, 2001), Lifeline Press; ISBN: 0895262304; http://www.amazon.com/exec/obidos/ASIN/0895262304/icongroupinterna
Multimedia 225
CHAPTER 7. MULTIMEDIA ON DIABETES Overview Information on diabetes can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on diabetes. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Bibliography: Multimedia on Diabetes The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in diabetes (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on diabetes. For more information, follow the hyperlink indicated: ·
Coding for ICD-9-CM : the complications and manifestations of diabetes mellitus. Source: American Hospital Association; Year: 2000; Format: Videorecording; Chicago, IL: AHA, c2000
226 Diabetes
·
Compendium of diabetes best practices . Year: 9999; Format: Electronic resource; Austin, TX: Texas Medical Foundation, [199-]-
·
Diabetes : managing a 21st century lifestyle disease. Source: Gerald Bernstein; Year: 2000; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c2000
·
Diabetes : practical approaches to primary care. Source: a co-production of Multimedia Communications and Physician Education and Development; Year: 2001; Format: Videorecording; Oakland, CA: Kaiser Foundation Health Plan, c2001
·
Diabetes : staying in balance, an introduction to type I diabetes for kids and their parents. Source: produced in cooperation with the American Association of Diabetes Educators; produced by Milner-Fenwick; Year: 1999; Format: Videorecording; Timonium, MD: Milner-Fenwick, 1999
·
Diabetes mellitus. Source: [presented by] Blanchard & Loeb Publishers, LLC; Year: 2000; Format: Videorecording; Glenmoore, PA: Blanchard & Loeb Publishers, c2000
·
Environmental etiology of type 1 diabetes : viruses and other factors. Source: Marwick, Charles S; Year: 1998; Format: Electronic resource; [Bethesda, Md.: National Institute of Diabetes and Digestive and Kidney Diseases, Division of Diabetes, Endocrinology, and Metabolic Diseases, 1998?]
·
G. Burroughs Mider lecture, 9. Source: 13/78 ; Year: 1978; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1978]
·
Genetic basis of familial clustering of type I diabetes. Source: John Todd; Year: 1996; Format: Sound recording; [Bethesda, Md.: National Institutes of Health, 1996]
·
Gestational diabetes. Source: produced in cooperation with the American Association of Diabetes Educators; produced by MilnerFenwick; Year: 2002; Format: Videorecording; Timonium, MD: MilnerFenwick, [2002]
·
Imaging the pancreatic beta cell : summary of the NIDDK. Source: JDFI Workshop, Washington, D.C., April 19-20, 1999 / [National Institute of Diabetes and Digestive and Kidney Diseases, Juvenile Diabetes Foundation International]; Year: 1999; Format: Electronic resource; [Bethesda, Md.: The Institute, 1999?]
·
Introduction to pattern management. Source: the American Association of Diabetes Educators; Year: 2000; Format: Videorecording; Timonium, MD: Milner-Fenwick, c2000
·
National health priority areas report Diabetes mellitus. Source: Commonwealth Department of Health and Aged Care [and] Australian
Multimedia 227
Institute of Health and Welfare; Year: 1999; Format: Electronic resource; Australia: Dept. of Health and Aged Care, c1999 ·
National High Blood Pressure Education Program Working Group report on hypertension in diabetes . Source: National High Blood Pressure Education Program. Working Group on Hypertension in Diabetes; Year: 1994; Format: Electronic resource; [Bethesda, Md.]: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, [1994]
·
Onychomycosis in diabetes : an often overlooked problem. Source: Gerald Bernstein, Richard K. Scher, Lee J. Sanders; Year: 2001; Format: Videorecording; Secaucus, NJ: Network for Continuing Medical Education, c2001
·
Oral medication for diabetes. Source: produced in cooperation with the American Association of Diabetes Educators; produced by MilnerFenwick; Year: 2000; Format: Videorecording; Timonium, Md.: MilnerFenwick, c2000
·
Oral medication for diabetes. Source: produced in cooperation with the American Association of Diabetes Educators; produced by MilnerFenwick; Year: 1997; Format: Videorecording; Timonium, MD: MilnerFenwick, c1997
·
Preventing long term complications of diabetes. Source: produced in cooperation with the American Association of Diabetes Educators; produced by Milner-Fenwick; Year: 2000; Format: Videorecording; Timonium, MD: Milner-Fenwick, c2000
·
Putting carbohydrate counting into practice. Source: produced in cooperation with the American Association of Diabetes Educators; produced by Milner-Fenwick; Year: 2000; Format: Videorecording; Timonium, MD: Milner-Fenwick, c2000
·
Stripped-down model of autoimmune diabetes. Source: National Institutes of Health; Year: 1998; Format: Videorecording; Bethesda, MD: National Institutes of Health, 1998
·
Studies on the cost of diabetes. Source: Thomas J. Songer, Lorraine Ettaro, and the Economics of Diabetes Project Panel; prepared for Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Pro; Year: 1998; Format: Electronic resource; Atlanta, Ga.: National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, 1998
·
Thiazolidinediones and the management of type 2 diabetes : current perspectives. Source: jointly sponsored by the Dannemiller Memorial Educational Foundation and Gardiner-Caldwell SynerMed; Year: 2000;
228 Diabetes
Format: Electronic Broadcasting, c2000
resource;
[Washington,
D.C.]:
Rockpointe
·
Tracking the causes of diabetes mellitus : from viruses to autoimmunity. Year: 1987; Format: Videorecording; [Bethesda, Md.: National Institutes of Health, 1987]
·
Treating diabetes bicycles [motion picture]. Source: National Institutes of Health, Public Health Service, U.S. Dept. of Health, Education, and Welfare; Year: 1980; Format: Using; [Bethesda, Md.: National Institutes of Health, 1980?]
·
Treatments in endocrinology. International, c2002-
·
What is diabetes? : type 2 diabetes. Source: produced in cooperation with American Association of Diabetes Educators; produced by MilnerFenwick; Year: 2000; Format: Videorecording; Timonium, MD: MilnerFenwick, c2000
Year: 9999; Auckland, N.Z.: Adis
Physician Guidelines and Databases 229
CHAPTER 8. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
230 Diabetes
NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.27 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:28 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
·
HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
·
NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
·
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
·
Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
·
Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 28 See http://www.nlm.nih.gov/databases/databases.html. 27
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·
Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
·
Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
·
Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
·
Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
·
MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
·
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
·
Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat diabetes, the following are particularly noteworthy. The NLM Gateway29 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.30 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).
29 30
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and the public.31 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “diabetes” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 343326 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349372
HSTAT32 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.33 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.34 Simply search by “diabetes” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 32 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 33 The HSTAT URL is http://hstat.nlm.nih.gov/. 34 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention 31
Physician Guidelines and Databases 233
Coffee Break: Tutorials for Biologists35 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.36 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.37 This site has new articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
(SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 35 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 36 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 37 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
234 Diabetes
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Diabetes With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to diabetes. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).38 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “diabetes” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
38
Physician Guidelines and Databases 235
research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for diabetes: ·
Alaninuria with Microcephaly, Dwarfism, Enamel Hypoplasia, and Diabetes Mellitus Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?202900
·
Atherosclerosis, Premature, with Deafness, Nephropathy, Diabetes Mellitus, Photomyoclonus, and Degenerative Neurologic Disease Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?209010
·
Bird-headed Dwarfism with Progressive Ataxia, Insulin-resistant Diabetes, Goiter, and Primary Gonadal Insufficiency Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?210740
·
Diabetes Insipidus, Nephrogenic, Autosomal Dominant Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?125800
·
Diabetes Insipidus, Nephrogenic, Autosomal Recessive Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?222000
·
Diabetes Insipidus, Nephrogenic, with Mental Retardation and Intracerebral Calcification Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?221995
·
Diabetes Insipidus, Nephrogenic, X-linked Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?304800
·
Diabetes Insipidus, Neurohypophyseal Type Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?304900
·
Diabetes Mellitus, Congenital Autoimmune Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?605026
236 Diabetes
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html
Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI).
Physician Guidelines and Databases 237
These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “diabetes” (or synonyms) and click “Go.”
238 Diabetes
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database39 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database40 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “diabetes” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and often Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 40 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 39
Physician Guidelines and Databases 239
listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in diabetes (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Churchill’s Pocketbook of Diabetes by Andrew J. Krentz; Paperback - 316 pages illustrate edition (September 15, 2000), W B Saunders Co; ISBN: 0443061181; http://www.amazon.com/exec/obidos/ASIN/0443061181/icongroupinterna · Diabetes: Emergency and Hospital Management by Simon R. Page, George M. Hall; Paperback (July 1999), B M J Books; ISBN: 0727912291; http://www.amazon.com/exec/obidos/ASIN/0727912291/icongroupinterna · Diabetes Management: Clinical Pathways, Guidelines, and Patient Education by Jo Gulledge (Editor), et al; Paperback - 306 pages, 1st edition (July 15, 1999), Aspen Publishers, Inc.; ISBN: 0834217031; http://www.amazon.com/exec/obidos/ASIN/0834217031/icongroupinterna · The Epidemiology of Diabetes Mellitus: An International Perspective by J.M. Ekoe (Editor), et al; Hardcover - 437 pages, 1st edition (December 15, 2001), John Wiley & Sons; ISBN: 047197448X; http://www.amazon.com/exec/obidos/ASIN/047197448X/icongroupinterna · Preventing Diabetes: Theory, Practice and New Approaches by Dan Mircea Cheta; Hardcover (October 1999), John Wiley & Sons; ISBN: 0471999148; http://www.amazon.com/exec/obidos/ASIN/0471999148/icongroupinterna
Vocabulary Builder Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]
Calcification: The process by which organic tissue becomes hardened by a deposit of calcium salts within its substance. [EU] Goiter: Enlargement of the thyroid gland. [NIH] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU]
Dissertations 241
CHAPTER 9. DISSERTATIONS ON DIABETES Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to diabetes. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Diabetes ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to diabetes. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with diabetes: ·
A Central Role of T/b Cell Collaboration in the Genesis of Autoimmune Diabetes by Noorchashm, Hooman; Phd from University of Pennsylvania, 2001, 145 pages http://wwwlib.umi.com/dissertations/fullcit/3003670
242 Diabetes
·
A Comparison of Intensity of Educational Intervention on Knowledge, Attitude, Weight and Metabolic Control in Obese Individuals with Type Ii Non-insulin Dependent Diabetes Mellitus by D'eramo, Gail Ann, Edd from Columbia University Teachers College, 1987, 157 pages http://wwwlib.umi.com/dissertations/fullcit/8804209
·
A Descriptive Study to Examine the Perioperative Management of the Patient with Diabetes Mellitus Scheduled for Day Surgery or Postoperative Admission Basis by Diubaldo, Karen Leigh; Mn from The University of Manitoba (canada), 2001, 125 pages http://wwwlib.umi.com/dissertations/fullcit/MQ51703
·
A Diabetic Camp: Its Implications for Coping with Juvenile Diabetes Mellitus by Sperlich, Sonja B., Phd from The Catholic University of America, 1982, 196 pages http://wwwlib.umi.com/dissertations/fullcit/8221445
·
A History of Diabetes Mellitus in the United States, 1880-1990 by Presley, James Wright, Phd from The University of Texas at Austin, 1991, 1118 pages http://wwwlib.umi.com/dissertations/fullcit/9200706
·
A Mission-based Program Evaluation and Outcome Study of a Diabetes Summer Camp by Koontz, April Dawn; Phd from University of Kansas, 2001, 158 pages http://wwwlib.umi.com/dissertations/fullcit/3029146
·
A Political Economy of Diabetes, Pregnancy, and Identity in the Gila River Indian Community (arizona) by Smith-morris, Carolyn Markee; Phd from The University of Arizona, 2001, 236 pages http://wwwlib.umi.com/dissertations/fullcit/3031404
·
A Program Evaluation in Adult Education: the Effect of a Diabetes Education Program on Diabetes Control, Knowledge and Attitudes by Ustad, Gilbert Melvin, Edd from University of South Dakota, 1994, 179 pages http://wwwlib.umi.com/dissertations/fullcit/9526692
·
A Quantitative Investigation of Policies and Their Associated Costs for the Clinical Management of Diabetes Mellitus by Armstrong, Charles Paul, Phd from The University of Arizona, 1973, 230 pages http://wwwlib.umi.com/dissertations/fullcit/7328791
·
A Self-control Behavior Techniques Course to Increase Adherence to the Goal for Frequency of Self-monitoring of Blood Glucose (diabetes Mellitus) by Jones, Phyllis Marie, Phd from University of Pittsburgh, 1989, 387 pages http://wwwlib.umi.com/dissertations/fullcit/8921397
Dissertations 243
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to diabetes is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
245
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with diabetes and related conditions.
Researching Your Medications 247
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with diabetes. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for diabetes. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of diabetes. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
248 Diabetes
Your Medications: The Basics41 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of diabetes. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with diabetes take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for diabetes. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
41
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 249
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for diabetes). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for diabetes. One such source is
250 Diabetes
the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.42 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of diabetes. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to diabetes: Acarbose ·
Systemic - U.S. Brands: Precose http://www.nlm.nih.gov/medlineplus/druginfo/acarbosesystemi c203498.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
42
Researching Your Medications 251
Angiotensin-Converting Enzyme (Ace) Inhibitors ·
Systemic - U.S. Brands: Accupril; Aceon; Altace; Capoten; Lotensin; Mavik; Monopril; Prinivil; Univasc; Vasotec 4; Zestril http://www.nlm.nih.gov/medlineplus/druginfo/angiotensinconv ertingenzymeace202044.html
Antidiabetic Agents, Sulfonylurea ·
Systemic - U.S. Brands: Amaryl; DiaBeta; Diabinese; Dymelor; Glucotrol; Glucotrol XL; Glynase PresTab; Micronase; Orinase; Tolinase http://www.nlm.nih.gov/medlineplus/druginfo/antidiabeticagen tssulfonylurea202742.html
http://www.nlm.nih.gov/medlineplus/druginfo/atropinehyoscyaminemet henamine202075.html ·
Systemic - U.S. Brands: Atrosept; Dolsed; Hexalol; Prosed/DS; UAA; Urimed; Urised; Uriseptic; Uritab; Uritin; Uro-Ves http://www.nlm.nih.gov/medlineplus/druginfo/atropinehyoscy aminemethenamine202075.html
Becaplermin ·
Topical - U.S. Brands: Regranex http://www.nlm.nih.gov/medlineplus/druginfo/becaplermintopi cal203460.html
Capsaicin ·
Topical - U.S. Brands: Zostrix; Zostrix-HP http://www.nlm.nih.gov/medlineplus/druginfo/capsaicintopical 202626.html
Carbamazepine ·
Systemic - U.S. Brands: Atretol; Carbatrol; Epitol; Tegretol; Tegretol-XR http://www.nlm.nih.gov/medlineplus/druginfo/carbamazepines ystemic202111.html
Clofibrate ·
Systemic - U.S. Brands: Abitrate; Atromid-S http://www.nlm.nih.gov/medlineplus/druginfo/clofibratesystem ic202150.html
252 Diabetes
Diazoxide ·
Oral - U.S. Brands: Proglycem http://www.nlm.nih.gov/medlineplus/druginfo/diazoxideoral20 2191.html
Diuretics, Thiazide ·
Systemic - U.S. Brands: Aquatensen; Diucardin; Diulo; Diuril; Enduron; Esidrix; Hydro-chlor; Hydro-D; HydroDIURIL; Hydromox; Hygroton; Metahydrin; Microzide; Mykrox; Naqua; Naturetin; Oretic; Renese; Saluron; Thalitone; Trichlorex 10; Zaroxolyn http://www.nlm.nih.gov/medlineplus/druginfo/diureticsthiazid esystemic202208.html
Glyburide and Metformin ·
Systemic - U.S. Brands: Glucovance http://www.nlm.nih.gov/medlineplus/druginfo/glyburideandm etforminsystemic500237.html
Insulin ·
Systemic - U.S. Brands: Humulin 50/50; Humulin 70/30; Humulin 70/30 Pen; Humulin L; Humulin N; Humulin N Pen; Humulin R; Humulin R, Regular U-500 (Concentrated); Humulin U; Lente; Lente Iletin II; Novolin 70/30; Novolin 70/30 PenFill; Novolin 70/30 Prefilled; Novolin L; Novoli http://www.nlm.nih.gov/medlineplus/druginfo/insulinsystemic 203298.html Insulin Aspart ·
Systemic - U.S. Brands: NovoLog http://www.nlm.nih.gov/medlineplus/druginfo/insulinaspartsys temic500253.html
Insulin Glargine ·
Systemic - U.S. Brands: Lantus http://www.nlm.nih.gov/medlineplus/druginfo/insulinglargines ystemic500147.html
Insulin Lispro ·
Systemic - U.S. Brands: Humalog http://www.nlm.nih.gov/medlineplus/druginfo/insulinlisprosys temic203622.html
Researching Your Medications 253
Isoxsuprine ·
Systemic - U.S. Brands: Vasodilan http://www.nlm.nih.gov/medlineplus/druginfo/isoxsuprinesyst emic202310.html
Lypressin ·
Systemic - U.S. Brands: Diapid http://www.nlm.nih.gov/medlineplus/druginfo/lypressinsystem ic202334.html
Metformin ·
Systemic - U.S. Brands: Glucophage http://www.nlm.nih.gov/medlineplus/druginfo/metforminsyste mic202756.html
Methenamine ·
Systemic - U.S. Brands: Hiprex; Mandelamine; Urex http://www.nlm.nih.gov/medlineplus/druginfo/methenaminesy stemic202354.html
Miglitol ·
Systemic - U.S. Brands: Glyset http://www.nlm.nih.gov/medlineplus/druginfo/miglitolsystemic 500231.html
Nateglinide ·
Systemic - U.S. Brands: Starlix http://www.nlm.nih.gov/medlineplus/druginfo/nateglinidesyste mic500277.html
Niacin (Vitamin B 3 ) ·
Systemic - U.S. Brands: Endur-Acin; Nia-Bid; Niac; Niacels; Niacor; Nico-400; Nicobid Tempules; Nicolar; Nicotinex Elixir; SloNiacin http://www.nlm.nih.gov/medlineplus/druginfo/niacinvitaminb3 systemic202405.html
Pioglitazone ·
Systemic - U.S. Brands: Actos http://www.nlm.nih.gov/medlineplus/druginfo/pioglitazonesyst emic500036.html
254 Diabetes
Repaglinide ·
Systemic - U.S. Brands: Prandin http://www.nlm.nih.gov/medlineplus/druginfo/repaglinidesyste mic203463.html
Rosiglitazone ·
Systemic - U.S. Brands: Avandia http://www.nlm.nih.gov/medlineplus/druginfo/rosiglitazonesys temic500022.html
Vasopressin ·
Systemic - U.S. Brands: Pitressin http://www.nlm.nih.gov/medlineplus/druginfo/vasopressinsyst emic202591.html
Zinc Supplements ·
Systemic - U.S. Brands: Orazinc; Verazinc; Zinc 15; Zinc-220; Zinca-Pak; Zincate http://www.nlm.nih.gov/medlineplus/druginfo/zincsupplement ssystemic202622.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with diabetes (including those with contraindications):43 ·
43
Abacavir Sulfate http://www.reutershealth.com/atoz/html/Abacavir_Sulfate.htm
Adapted from A to Z Drug Facts by Facts and Comparisons.
Researching Your Medications 255
·
Acebutolol HCl http://www.reutershealth.com/atoz/html/Acebutolol_HCl.htm
·
Acetohexamide http://www.reutershealth.com/atoz/html/Acetohexamide.htm
·
Albuterol http://www.reutershealth.com/atoz/html/Albuterol.htm
·
Amiloride HCl http://www.reutershealth.com/atoz/html/Amiloride_HCl.htm
·
Amlodipine http://www.reutershealth.com/atoz/html/Amlodipine.htm
·
Amprenavir http://www.reutershealth.com/atoz/html/Amprenavir.htm
·
Atenolol http://www.reutershealth.com/atoz/html/Atenolol.htm
·
Atenolol Chlorthalidone http://www.reutershealth.com/atoz/html/Atenolol_Chlorthalidone.ht m
·
Auranofin http://www.reutershealth.com/atoz/html/Auranofin.htm
·
Basiliximab http://www.reutershealth.com/atoz/html/Basiliximab.htm
·
Benazepril HCl http://www.reutershealth.com/atoz/html/Benazepril_HCl.htm
·
Betamethasone http://www.reutershealth.com/atoz/html/Betamethasone.htm
·
Betaxolol HCl http://www.reutershealth.com/atoz/html/Betaxolol_HCl.htm
·
Bismuth Subsalicylate http://www.reutershealth.com/atoz/html/Bismuth_Subsalicylate.htm
·
Bisoprolol Fumarate http://www.reutershealth.com/atoz/html/Bisoprolol_Fumarate.htm
·
Bitolterol Mesylate http://www.reutershealth.com/atoz/html/Bitolterol_Mesylate.htm
·
Butoconazole Nitrate http://www.reutershealth.com/atoz/html/Butoconazole_Nitrate.htm
256 Diabetes
·
Carbamazepine http://www.reutershealth.com/atoz/html/Carbamazepine.htm
·
Carteolol HCl http://www.reutershealth.com/atoz/html/Carteolol_HCl.htm
·
Cetirizine http://www.reutershealth.com/atoz/html/Cetirizine.htm
·
Chlorpropamide http://www.reutershealth.com/atoz/html/Chlorpropamide.htm
·
Chlorthalidone http://www.reutershealth.com/atoz/html/Chlorthalidone.htm
·
Clofibrate http://www.reutershealth.com/atoz/html/Clofibrate.htm
·
Clomipramine HCl http://www.reutershealth.com/atoz/html/Clomipramine_HCl.htm
·
Clotrimazole http://www.reutershealth.com/atoz/html/Clotrimazole.htm
·
Corticotropin http://www.reutershealth.com/atoz/html/Corticotropin.htm
·
Corticotropin (Adrenocorticotropic hormone; ACTH) http://www.reutershealth.com/atoz/html/Corticotropin_(Adrenocortic otropic_hormone;_ACTH).htm
·
Cortisone http://www.reutershealth.com/atoz/html/Cortisone.htm
·
Cortisone (Cortisone Acetate) http://www.reutershealth.com/atoz/html/Cortisone_(Cortisone_Acetat e).htm
·
Desmopressin Acetate (1-Deamino-8-D-Arginine Vasopressin) http://www.reutershealth.com/atoz/html/Desmopressin_Acetate_(1Deamino-8-D-Arginine_Vasopressin).htm
·
Dexamethasone http://www.reutershealth.com/atoz/html/Dexamethasone.htm
·
Dextromethorphan Hydrobromide http://www.reutershealth.com/atoz/html/Dextromethorphan_Hydrob romide.htm
·
Dinoprostone(PGE2; Prostaglandin E2) http://www.reutershealth.com/atoz/html/Dinoprostone(PGE2;_Prosta glandin_E2).htm
Researching Your Medications 257
·
Disulfiram http://www.reutershealth.com/atoz/html/Disulfiram.htm
·
Dobutamine http://www.reutershealth.com/atoz/html/Dobutamine.htm
·
Enalapril Maleate Hydrochlorothiazide http://www.reutershealth.com/atoz/html/Enalapril_Maleate_Hydroch lorothiazide.htm
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Ephedrine http://www.reutershealth.com/atoz/html/Ephedrine.htm
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Epinephrine http://www.reutershealth.com/atoz/html/Epinephrine.htm
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Esmolol HCl http://www.reutershealth.com/atoz/html/Esmolol_HCl.htm
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Estradiol http://www.reutershealth.com/atoz/html/Estradiol.htm
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Ethacrynic Acid http://www.reutershealth.com/atoz/html/Ethacrynic_Acid.htm
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Ethacrynic Acid (Ethacrynate) http://www.reutershealth.com/atoz/html/Ethacrynic_Acid_(Ethacryna te).htm
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Fenoprofen Calcium http://www.reutershealth.com/atoz/html/Fenoprofen_Calcium.htm
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Fluoxetine HCl http://www.reutershealth.com/atoz/html/Fluoxetine_HCl.htm
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Gemfibrozil http://www.reutershealth.com/atoz/html/Gemfibrozil.htm
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Glimepiride http://www.reutershealth.com/atoz/html/Glimepiride.htm
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Glipizide http://www.reutershealth.com/atoz/html/Glipizide.htm
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Glucagon http://www.reutershealth.com/atoz/html/Glucagon.htm
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Glyburide http://www.reutershealth.com/atoz/html/Glyburide.htm
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Glycerin http://www.reutershealth.com/atoz/html/Glycerin.htm
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Glycerin (Glycerol) http://www.reutershealth.com/atoz/html/Glycerin_(Glycerol).htm
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Gold Sodium Thiomalate http://www.reutershealth.com/atoz/html/Gold_Sodium_Thiomalate.h tm
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Hydrochlorothiazide(HCTZ) http://www.reutershealth.com/atoz/html/Hydrochlorothiazide(HCTZ) .htm
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Hydrocortisone (Cortisol) http://www.reutershealth.com/atoz/html/Hydrocortisone_(Cortisol).htm
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Indapamide http://www.reutershealth.com/atoz/html/Indapamide.htm
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Insulin http://www.reutershealth.com/atoz/html/Insulin.htm
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Insulin Analogs http://www.reutershealth.com/atoz/html/Insulin_Analogs.htm
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Interferon Alfa-n3 http://www.reutershealth.com/atoz/html/Interferon_Alfa-n3.htm
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Ipratropium Bromide Albuterol Sulfate http://www.reutershealth.com/atoz/html/Ipratropium_Bromide_Albu terol_Sulfate.htm
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Isoetharine http://www.reutershealth.com/atoz/html/Isoetharine.htm
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Isoproterenol http://www.reutershealth.com/atoz/html/Isoproterenol.htm
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Labetalol HCL http://www.reutershealth.com/atoz/html/Labetalol_HCL.htm
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Levobunolol http://www.reutershealth.com/atoz/html/Levobunolol.htm
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Levothyroxine Sodium http://www.reutershealth.com/atoz/html/Levothyroxine_Sodium.htm
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Liothyronine Sodium http://www.reutershealth.com/atoz/html/Liothyronine_Sodium.htm
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Lisinopril http://www.reutershealth.com/atoz/html/Lisinopril.htm
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Lithium http://www.reutershealth.com/atoz/html/Lithium.htm
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Lopinavir Ritonavir http://www.reutershealth.com/atoz/html/Lopinavir_Ritonavir.htm
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Medroxyprogesterone Acetate http://www.reutershealth.com/atoz/html/Medroxyprogesterone_Acet ate.htm
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Megestrol Acetate http://www.reutershealth.com/atoz/html/Megestrol_Acetate.htm
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Metaproterenol Sulfate http://www.reutershealth.com/atoz/html/Metaproterenol_Sulfate.htm
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Metformin Hydrochloride http://www.reutershealth.com/atoz/html/Metformin_Hydrochloride.h tm
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Methenamine and Methenamine Salts http://www.reutershealth.com/atoz/html/Methenamine_and_Methena mine_Salts.htm
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Methenamine Hippurate http://www.reutershealth.com/atoz/html/Methenamine_Hippurate.htm
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Methotrexate http://www.reutershealth.com/atoz/html/Methotrexate.htm
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Methylprednisolone http://www.reutershealth.com/atoz/html/Methylprednisolone.htm
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Metolazone http://www.reutershealth.com/atoz/html/Metolazone.htm
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Metoprolol http://www.reutershealth.com/atoz/html/Metoprolol.htm
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Midodrine HCl http://www.reutershealth.com/atoz/html/Midodrine_HCl.htm
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Mometasone Furoate http://www.reutershealth.com/atoz/html/Mometasone_Furoate.htm
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Nadolol http://www.reutershealth.com/atoz/html/Nadolol.htm
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Naratriptan http://www.reutershealth.com/atoz/html/Naratriptan.htm
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Nateglinide http://www.reutershealth.com/atoz/html/Nateglinide.htm
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Nelfinavir Mesylate http://www.reutershealth.com/atoz/html/Nelfinavir_Mesylate.htm
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Niacin http://www.reutershealth.com/atoz/html/Niacin.htm
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Nicotine http://www.reutershealth.com/atoz/html/Nicotine.htm
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Nitrofurantoin http://www.reutershealth.com/atoz/html/Nitrofurantoin.htm
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Nystatin http://www.reutershealth.com/atoz/html/Nystatin.htm
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Octreotide Acetate http://www.reutershealth.com/atoz/html/Octreotide_Acetate.htm
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Oral Contraceptives Combination Products http://www.reutershealth.com/atoz/html/Oral_Contraceptives_Combi nation_Products.htm
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Peginterferon Alfa-2B http://www.reutershealth.com/atoz/html/Peginterferon_Alfa-2B.htm
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Phenazopyridine HCl http://www.reutershealth.com/atoz/html/Phenazopyridine_HCl.htm
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Phenelzine Sulfate http://www.reutershealth.com/atoz/html/Phenelzine_Sulfate.htm
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Phenylephrine HCl http://www.reutershealth.com/atoz/html/Phenylephrine_HCl.htm
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Phenylpropanolamine HCl http://www.reutershealth.com/atoz/html/Phenylpropanolamine_HCl. htm
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Phenylpropanolamine HCl Guaifenesin http://www.reutershealth.com/atoz/html/Phenylpropanolamine_HCl_ Guaifenesin.htm
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Pindolol http://www.reutershealth.com/atoz/html/Pindolol.htm
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Pioglitazone http://www.reutershealth.com/atoz/html/Pioglitazone.htm
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Pirbuterol Acetate http://www.reutershealth.com/atoz/html/Pirbuterol_Acetate.htm
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Prednisolone http://www.reutershealth.com/atoz/html/Prednisolone.htm
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Prednisone http://www.reutershealth.com/atoz/html/Prednisone.htm
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Propranolol HCl http://www.reutershealth.com/atoz/html/Propranolol_HCl.htm
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Pseudoephedrine http://www.reutershealth.com/atoz/html/Pseudoephedrine.htm
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Pyrazinamide http://www.reutershealth.com/atoz/html/Pyrazinamide.htm
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Quinapril HCl http://www.reutershealth.com/atoz/html/Quinapril_HCl.htm
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Ramipril http://www.reutershealth.com/atoz/html/Ramipril.htm
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Repaglinide http://www.reutershealth.com/atoz/html/Repaglinide.htm
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Ritodrine HCl http://www.reutershealth.com/atoz/html/Ritodrine_HCl.htm
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Ritonavir http://www.reutershealth.com/atoz/html/Ritonavir.htm
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Rizatriptan http://www.reutershealth.com/atoz/html/Rizatriptan.htm
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Rosiglitazone Maleate http://www.reutershealth.com/atoz/html/Rosiglitazone_Maleate.htm
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Salicylate Combination http://www.reutershealth.com/atoz/html/Salicylate_Combination.htm
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Scopolamine HBr http://www.reutershealth.com/atoz/html/Scopolamine_HBr.htm
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Sibutramine Hydrochloride http://www.reutershealth.com/atoz/html/Sibutramine_Hydrochloride. htm
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Sildenafil http://www.reutershealth.com/atoz/html/Sildenafil.htm
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Sirolimus http://www.reutershealth.com/atoz/html/Sirolimus.htm
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Sumatriptan Succinate http://www.reutershealth.com/atoz/html/Sumatriptan_Succinate.htm
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Terbutaline Sulfate http://www.reutershealth.com/atoz/html/Terbutaline_Sulfate.htm
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Terconazole http://www.reutershealth.com/atoz/html/Terconazole.htm
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Thalidomide http://www.reutershealth.com/atoz/html/Thalidomide.htm
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Thyroid Desiccated http://www.reutershealth.com/atoz/html/Thyroid_Desiccated.htm
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Tolazamide http://www.reutershealth.com/atoz/html/Tolazamide.htm
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Tolbutamide http://www.reutershealth.com/atoz/html/Tolbutamide.htm
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Trandolapril http://www.reutershealth.com/atoz/html/Trandolapril.htm
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Tranylcypromine Sulfate http://www.reutershealth.com/atoz/html/Tranylcypromine_Sulfate.htm
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Triamterene http://www.reutershealth.com/atoz/html/Triamterene.htm
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Tuberculin Purified Protein Derivative http://www.reutershealth.com/atoz/html/Tuberculin_Purified_Protein _Derivative.htm
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Unoprostone Isopropyl http://www.reutershealth.com/atoz/html/Unoprostone_Isopropyl.htm
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Valsartan http://www.reutershealth.com/atoz/html/Valsartan.htm
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Vasopressin http://www.reutershealth.com/atoz/html/Vasopressin.htm
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Zolmitriptan http://www.reutershealth.com/atoz/html/Zolmitriptan.htm
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Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm. Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with diabetes--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat diabetes or potentially create deleterious side effects in patients with diabetes. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause
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unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with diabetes. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with diabetes. The FDA warns patients to watch out for44: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn’t true.
44
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · 101 Medication Tips for People With Diabetes by Betsy A. Carlisle, et al; Paperback - 128 pages (March 1, 2000), McGraw Hill - NTC; ISBN: 1580400329; http://www.amazon.com/exec/obidos/ASIN/1580400329/icongroupinterna · The Market for Diabetes Drugs, Devices and Disease Management by Kalorama Information; May 1, 2000; ASIN: B00005TV96; http://www.amazon.com/exec/obidos/ASIN/B00005TV96/icongroupinterna · New Drug Treatments for Diabetes by Dana Armstrong, R.D.,C.D.E., Allen Bennett, M.D., F.A.C.P.; King; Mass Market Paperback - 240 pages (October 10, 2001), Consumer Guide Books Publishing; ISBN: 0785353747; http://www.amazon.com/exec/obidos/ASIN/0785353747/icongroupinterna · Pharmacist Disease Management Credentialing: Diabetes by American Pharmaceutical Association; Paperback (October 2000); ISBN: 1582120277; http://www.amazon.com/exec/obidos/ASIN/1582120277/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Acetohexamide: A pill taken to lower the level of glucose (sugar) in the blood. Only some people with noninsulin-dependent diabetes take these pills. [NIH] ACTH: Adrenocorticotropic hormone. [EU] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in ASTHMA. [NIH]
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Auranofin: An oral chrysotherapeutic agent for the treatment of rheumatoid arthritis. Its exact mechanism of action is unknown, but it is believed to act via immunological mechanisms and alteration of lysosomal enzyme activity. Its efficacy is slightly less than that of injected gold salts, but it is better tolerated, and side effects which occur are potentially less serious. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Contraceptive: conception. [EU]
An agent that diminishes the likelihood of or prevents
Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dobutamine: A beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia. It is proposed as a cardiotonic after myocardial infarction or open heart surgery. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethacrynic Acid: A compound that inhibits symport of sodium, potassium, and chloride primarily in the ascending limb of Henle, but also in the proximal and distal tubules. This pharmacological action results in excretion of these ions, increased urinary output, and reduction in extracelluar fluid. This compound has been classified as a loop or high ceiling diuretic. [NIH]
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Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH] Gold Sodium Thiomalate: A variable mixture of the mono- and disodium salts of gold thiomalic acid used mainly for its anti-inflammatory action in the treatment of rheumatoid arthritis. It is most effective in active progressive rheumatoid arthritis and of little or no value in the presence of extensive deformities or in the treatment of other forms of arthritis. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Isoetharine: Adrenergic beta-2 agonist used as bronchodilator for emphysema, bronchitis and asthma. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isoxsuprine: A beta-adrenergic agonist that causes direct relaxation of uterine and vascular smooth muscle. Its vasodilating actions are greater on the arteries supplying skeletal muscle than on those supplying skin. It is used in the treatment of peripheral vascular disease and in premature labor. [NIH]
Levobunolol: A nonselective beta-adrenoceptor antagonist used in the treatment of glaucoma. [NIH] Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Lypressin: 8-Lysyl vasopressin. The porcine antidiuretic hormone most frequently used clinically. A cyclic nonapeptide with lysine in position 8 of the chain; it is used to treat diabetes insipidus and as hemostatic because of its vasoconstrictor action. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It
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also tends to lower blood pressure and increase potassium loss. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]
Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Pyrazinamide: A pyrazine that is used therapeutically as an antitubercular agent. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]
Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Triamterene: A pteridine that is used as a mild diuretic. [NIH]
Researching Alternative Medicine 269
APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to diabetes. Finally, at the conclusion of this chapter, we will provide a list of readings on diabetes from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?45 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?46 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each.
Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are practiced by individual cultures throughout the world, including a number of venerable Asian approaches. 46
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.47
47
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Diabetes Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for diabetes. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to diabetes and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “diabetes” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to diabetes: ·
A diabetes management program for African American women with type 2 diabetes. Author(s): Keyserling TC, Ammerman AS, Samuel-Hodge CD, Ingram AF, Skelly AH, Elasy TA, Johnston LF, Cole AS, Henriquez-Roldan CF.
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Source: Diabetes Educ. 2000 September-Oct; 26(5): 796-805. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11140007&dopt=Abstract ·
A randomized placebo controlled trial of Inolter (herbal product) in the treatment of type 2 diabetes. Author(s): Agrawal RP, Sharma A, Dua AS, Chandershekhar, Kochar DK, Kothari RP. Source: J Assoc Physicians India. 2002 Mars; 50: 391-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11922229&dopt=Abstract
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Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with Type 2 diabetes mellitus: psychometric evaluation and cross-cultural comparison. Author(s): Meadows KA, Abrams C, Sandbaek A. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 August; 17(8): 572-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11073178&dopt=Abstract
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Adaptive changes of antioxidant status in development of experimental diabetes. Author(s): Kucharska J, Gvozdjakova A, Stefek M, Sotnikova R, Sumbalova Z. Source: Bratisl Lek Listy. 2001; 102(11): 515-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11901708&dopt=Abstract
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Alcohol consumption and compliance among inner-city minority patients with type 2 diabetes mellitus. Author(s): Johnson KH, Bazargan M, Bing EG. Source: Archives of Family Medicine. 2000 November-Dec; 9(10): 964-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11115194&dopt=Abstract
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Alternative medicine and diabetes. Author(s): Gill G, Leese G.
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Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2001 November; 18(11): 943. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11703446&dopt=Abstract ·
Alternative therapies for type 2 diabetes. Author(s): Dey L, Attele AS, Yuan CS. Source: Alternative Medicine Review : a Journal of Clinical Therapeutic. 2002 February; 7(1): 45-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11896745&dopt=Abstract
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Alternative therapies: Part I. Depression, diabetes, obesity. Author(s): Morelli V, Zoorob RJ. Source: American Family Physician. 2000 September 1; 62(5): 1051-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10997530&dopt=Abstract
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Amelioration of alloxan induced diabetes mellitus and oxidative stress in rats by oil of Eruca sativa seeds. Author(s): El-Missiry MA, El Gindy AM. Source: Annals of Nutrition & Metabolism. 2000; 44(3): 97-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11053894&dopt=Abstract
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American Diabetes Association 60th Scientific Sessions, 2000: nutrition, lipids, and alternative medicine. Author(s): Bloomgarden ZT. Source: Diabetes Care. 2000 December; 23(12): 1847-51. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11128365&dopt=Abstract
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Antidiabetic effect of Cogent db, a herbal drug in alloxan-induced diabetes mellitus. Author(s): Pari L, Saravanan G. Source: Comparative Biochemistry and Physiology. Toxicology & Pharmacology : Cbp. 2002 January; 131(1): 19-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11796322&dopt=Abstract
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Antihyperglycaemic effect of Diamed, a herbal formulation, in experimental diabetes in rats. Author(s): Pari L, Ramakrishnan R, Venkateswaran S. Source: The Journal of Pharmacy and Pharmacology. 2001 August; 53(8): 1139-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11518024&dopt=Abstract
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Anti-hyperglycemic effect of Eugenia jambolana and Tinospora cordifolia in experimental diabetes and their effects on key metabolic enzymes involved in carbohydrate metabolism. Author(s): Grover JK, Vats V, Rathi SS. Source: Journal of Ethnopharmacology. 2000 December; 73(3): 461-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11091000&dopt=Abstract
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Appropriate timing of glimepiride administration in patients with type 2 diabetes millitus: a study in Mediterranean countries. Author(s): Gomis R, Raptis SA, Ravella R. Source: Endocrine. 2000 August; 13(1): 117-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11051055&dopt=Abstract
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Assessment of group versus individual diabetes education: a randomized study. Author(s): Rickheim PL, Weaver TW, Flader JL, Kendall DM. Source: Diabetes Care. 2002 February; 25(2): 269-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11815494&dopt=Abstract
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Atkins diet helps combat diabetes. Author(s): Rossiter J. Source: Healthc Foodserv Mag. 2000 Winter; 10(1): 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11014776&dopt=Abstract
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Barriers to providing diabetes care in community health centers. Author(s): Chin MH, Cook S, Jin L, Drum ML, Harrison JF, Koppert J, Thiel F, Harrand AG, Schaefer CT, Takashima HT, Chiu SC.
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Source: Diabetes Care. 2001 February; 24(2): 268-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11213877&dopt=Abstract ·
Can vitamin D supplementation in infancy prevent type 1 diabetes? Author(s): Harris S. Source: Nutrition Reviews. 2002 April; 60(4): 118-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12002683&dopt=Abstract
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Cell therapy approaches for the treatment of diabetes. Author(s): Efrat S. Source: Curr Opin Investig Drugs. 2001 May; 2(5): 639-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11569939&dopt=Abstract
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Cell therapy for diabetes using piscine islet tissue. Author(s): Wright JR Jr, Pohajdak B. Source: Cell Transplantation. 2001 Mars-April; 10(2): 125-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11332627&dopt=Abstract
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Chromium supplementation improves insulin resistance in patients with Type 2 diabetes mellitus. Author(s): Morris BW, Kouta S, Robinson R, MacNeil S, Heller S. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2000 September; 17(9): 684-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11051290&dopt=Abstract
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Concepts and treatment for diabetes among traditional and faith healers in the northern province, South Africa. Author(s): Peltzer K, Khoza LB, Lekhuleni ME, Madu SN, Cherian VI, Cherian L. Source: Curationis. 2001 May; 24(2): 42-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11885475&dopt=Abstract
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Counseling programs and the outcome of gestational diabetes in Austrian and Mediterranean Turkish women. Author(s): Hoppichler F, Lechleitner M.
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Source: Patient Education and Counseling. 2001 December 15; 45(4): 2714. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11755772&dopt=Abstract ·
Culturally competent diabetes self-management education for Mexican Americans: the Starr County border health initiative. Author(s): Brown SA, Garcia AA, Kouzekanani K, Hanis CL. Source: Diabetes Care. 2002 February; 25(2): 259-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11815493&dopt=Abstract
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Current progress and perspectives in cell therapy for diabetes mellitus. Author(s): Miyamoto M. Source: Hum Cell. 2001 December; 14(4): 293-300. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11925931&dopt=Abstract
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Cystatin C is not more sensitive than creatinine for detecting early renal impairment in patients with diabetes. Author(s): Oddoze C, Morange S, Portugal H, Berland Y, Dussol B. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2001 August; 38(2): 310-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11479157&dopt=Abstract
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Diabetes and alternative medicine: diabetic patients experiences with Ayur-Ved, "clinical ecology" and "cellular nutritions" methods. Author(s): Vanelli M, Chiari G, Gugliotta M, Capuano C, Giacalone T, Gruppi L, Condo M. Source: Minerva Pediatr. 2002 April; 54(2): 165-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11981532&dopt=Abstract
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Diabetes and behavioral medicine: the second decade. Author(s): Gonder-Redenick LA, Cox DJ, Ritterband LM. Source: J Consult Clin Psychol. 2002 June; 70(3): 611-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12090372&dopt=Abstract
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Diabetes screening. Does it make a difference in the Aboriginal and Torres Strait Islander population? Author(s): Wakerman J, Grundy J. Source: Aust Fam Physician. 2001 December; 30(12): 1141-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11838392&dopt=Abstract
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Dietary patterns and risk factors of diabetes mellitus among urban indigenous women in Fiji. Author(s): Lako JV, Nguyen VC. Source: Asia Pacific Journal of Clinical Nutrition. 2001; 10(3): 188-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11708306&dopt=Abstract
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Dietary trend and diabetes: its association among indigenous Fijians 1952 to 1994. Author(s): Lako JV. Source: Asia Pacific Journal of Clinical Nutrition. 2001; 10(3): 183-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11708305&dopt=Abstract
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Dietary unsaturated fatty acids in type 2 diabetes: higher levels of postprandial lipoprotein on a linoleic acid-rich sunflower oil diet compared with an oleic acid-rich olive oil diet. Author(s): Madigan C, Ryan M, Owens D, Collins P, Tomkin GH. Source: Diabetes Care. 2000 October; 23(10): 1472-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11023139&dopt=Abstract
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Dietary zinc supplementation inhibits NFkappaB activation and protects against chemically induced diabetes in CD1 mice. Author(s): Ho E, Quan N, Tsai YH, Lai W, Bray TM. Source: Experimental Biology and Medicine (Maywood, N.J.). 2001 February; 226(2): 103-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11446433&dopt=Abstract
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Disease management status: a typology of Latino and Euro-American patients with type 2 diabetes. Author(s): Fisher L, Chesla CA, Skaff MA, Gilliss C, Kanter RA, Lutz CP, Bartz RJ.
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Source: Behavioral Medicine (Washington, D.C.). 2000 Summer; 26(2): 5366. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11147290&dopt=Abstract ·
Divergence between LDL oxidative susceptibility and urinary F(2)isoprostanes as measures of oxidative stress in type 2 diabetes. Author(s): Devaraj S, Hirany SV, Burk RF, Jialal I. Source: Clinical Chemistry. 2001 November; 47(11): 1974-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11673365&dopt=Abstract
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Do colonic short-chain fatty acids contribute to the long-term adaptation of blood lipids in subjects with type 2 diabetes consuming a high-fiber diet? Author(s): Wolever TM, Schrade KB, Vogt JA, Tsihlias EB, McBurney MI. Source: The American Journal of Clinical Nutrition. 2002 June; 75(6): 1023-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12036809&dopt=Abstract
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Eating disorders in adolescents with type 1 diabetes. A closer look at a complicated condition. Author(s): Hoffman RP. Source: Postgraduate Medicine. 2001 April; 109(4): 67-9, 73-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11317470&dopt=Abstract
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Economic and clinical impact of alternative disease management strategies for secondary prevention in type 2 diabetes in the Swiss setting. Author(s): Gozzoli V, Palmer AJ, Brandt A, Spinas GA. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2001 June 2; 131(21-22): 303-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11584692&dopt=Abstract
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Effect of a chicken-based diet on renal function and lipid profile in patients with type 2 diabetes: a randomized crossover trial. Author(s): Gross JL, Zelmanovitz T, Moulin CC, De Mello V, Perassolo M, Leitao C, Hoefel A, Paggi A, Azevedo MJ.
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Source: Diabetes Care. 2002 April; 25(4): 645-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11919119&dopt=Abstract ·
Effect of alpha-tocopherol supplementation on the ultrastructural abnormalities of peripheral nerves in experimental diabetes. Author(s): Sharma AK, Ponery AS, Lawrence PA, Ahmed I, Bastaki SM, Dhanasekaran S, Sheen RS, Adeghate E. Source: Journal of the Peripheral Nervous System : Jpns. 2001 Mars; 6(1): 33-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11293806&dopt=Abstract
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Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. Author(s): Gupta A, Gupta R, Lal B. Source: J Assoc Physicians India. 2001 November; 49: 1057-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11868855&dopt=Abstract
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Effect of Vinca rosea extracts in treatment of alloxan diabetes in male albino rats. Author(s): Ghosh S, Suryawanshi SA. Source: Indian J Exp Biol. 2001 August; 39(8): 748-59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12018575&dopt=Abstract
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Effectiveness of changes in the delivery of diabetes care in a rural community. Author(s): O'Grady A, Simmons D, Tupe S, Hewlett G. Source: The Australian Journal of Rural Health. 2001 April; 9(2): 74-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11259960&dopt=Abstract
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Effects of alpha-tocopherol supplementation and continuous subcutaneous insulin infusion on oxidative stress in Korean patients with type 2 diabetes. Author(s): Park S, Choi SB.
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Source: The American Journal of Clinical Nutrition. 2002 April; 75(4): 72833. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11916760&dopt=Abstract ·
Effects of dietary supplementation of alpha-lipoic acid on early glomerular injury in diabetes mellitus. Author(s): Melhem MF, Craven PA, Derubertis FR. Source: Journal of the American Society of Nephrology : Jasn. 2001 January; 12(1): 124-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11134258&dopt=Abstract
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Effects of high-dose glucose-insulin-potassium on myocardial metabolism after coronary surgery in patients with Type II diabetes. Author(s): Szabo Z, Arnqvist H, Hakanson E, Jorfeldt L, Svedjeholm R. Source: Clinical Science (London, England : 1979). 2001 July; 101(1): 37-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11410112&dopt=Abstract
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Effects of known and potential antioxidants on animal models of pathological processes (diabetes, gastric lesions, allergic bronchospasm). Author(s): Stetinova V, Grossmann V. Source: Experimental and Toxicologic Pathology : Official Journal of the Gesellschaft Fur Toxikologische Pathologie. 2000 October; 52(5): 473-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11089899&dopt=Abstract
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Effects of long-term supplementation with moderate pharmacologic doses of vitamin E are saturable and reversible in patients with type 1 diabetes. Author(s): Engelen W, Keenoy BM, Vertommen J, De Leeuw I. Source: The American Journal of Clinical Nutrition. 2000 November; 72(5): 1142-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11063441&dopt=Abstract
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Effects of soybean fibers on blood sugar, lipid levels and hepaticnephritic histomorphology in mice with diabetes mellitus. Author(s): Xu H, Tan SM, Li SQ.
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Source: Biomed Environ Sci. 2001 September; 14(3): 256-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11723727&dopt=Abstract ·
Effects of young barley leaf extract and antioxidative vitamins on LDL oxidation and free radical scavenging activities in type 2 diabetes. Author(s): Yu YM, Chang WC, Chang CT, Hsieh CL, Tsai CE. Source: Diabetes Metab. 2002 April; 28(2): 107-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11976562&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
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The following is a specific Web list relating to diabetes; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Diabetes mellitus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsLookups/Uses/dia betesmellitus.html
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Alternative Therapy Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663, 00.html Apitherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,669, 00.html Aston-patterning Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,101 18,00.html Ayurveda Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Ayurve dacm.html Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672, 00.html Biofeedback Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,675, 00.html Color therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,683, 00.html Detoxification Therapy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Detoxification_Thera py.htm Detoxification therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,101 19,00.html Fasting Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,694, 00.html Grape Cure Alternative names: grape diet Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/g.html Holistic Referrals Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Holistic_Referrals.ht m Homeopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,703, 00.html Homeovitics Alternative names: homoeovitics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705, 00.html Iridology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,709, 00.html Magnet therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,715, 00.html Massage Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Massag ecm.html Native American medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,721, 00.html Naturopathy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Naturo pathycm.html Nutrition Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Nutriti oncm.html Yoga Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Yogac m.html Yoga Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,746, 00.html ·
Chinese Medicine Dangshen Alternative names: Medicinal Changium Root; Mingdangshen; Radix Changii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Digupi Alternative names: Chinese Wolfberry Root-bark; Cortex Lycii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Dihuang Alternative names: Digitalis Leaf; Yangdihuangye; Folium Digitalis
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Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gegen Alternative names: Kudzuvine Root; Radix Puerariae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Gouqizi Alternative names: Barbary Wolfberry Fruit; Fructus Lycii Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Hongqi Alternative names: Manyinflorescenced Sweetvetch Hedysari Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
Root;
Radix
Huangjing Alternative names: Solomonseal Rhizome; Rhizoma Polygonati Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Huanglian Alternative names: Golden Thread; Rhizoma Coptidis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Huangqi Alternative names: Milkvetch; Radix Astragali Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Jiangtang Wan Alternative names: Jiantang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Jiangtang%20Wan &mh=10&sb=---&view_records=View+Records
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Maidong Alternative names: Liriope Root Tuber; Shanmaidong; Radix Liriopes Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Maiwei Dihuang Wan Alternative names: Maiwei Dihuang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Maiwei%20Dihuan g%20Wan&mh=10&sb=---&view_records=View+Records Renshen Alternative names: Ginseng Leaf; Renshenye (Ren Shen Ye); Folium Ginseng Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Sangshen Alternative names: Mulberry Fruit; Fructus Mori Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shanyao Alternative names: Common Yam Rhizome; Rhizoma Dioscoreae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Shanzhuyu Alternative names: Asiatic Cornelian Cherry Fruit; Fructus Corni Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Tianhuafen Alternative names: Snakegourd Root; Radix Trichosanthis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Wubeizi Alternative names: Chinese Gall; Galla Chinensis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
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Wuweizi Alternative names: Chinese Magnoliavine Fruit; Fructus Schisandrae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Yuzhu Alternative names: Fragrant Solomonseal Rhizome; Rhizoma Polygonati Odorati Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/ Zhimu Alternative names: Common Anemarrhena Rhizome; Anemarrhenae Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/
·
Rhizoma
Herbs and Supplements Aloe Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Brewer's Yeast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Bryonia Bryony Alternative names: Bryony; Bryonia sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Caffeine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Caffeine.htm Ephedra Alternative names: Ephedra sinensis, Ma huang
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Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedrach. html Ginseng, Asian Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengAsi anch.html Psyllium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Vaccinium myrtillus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative and Complementary Diabetes Care: How to Combine Natural and Traditional Therapies by Diana W. Guthrie, Richard Guthrie, M.D.; Paperback - 256 pages, 1st edition (March 10, 2000), John Wiley & Sons; ISBN: 0471347841; http://www.amazon.com/exec/obidos/ASIN/0471347841/icongroupinterna
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· Alternative Therapies for Managing Diabetes by David E. Drum; Paperback - 336 pages (September 18, 2001), McGraw-Hill Professional Publishing; ISBN: 0658013807; http://www.amazon.com/exec/obidos/ASIN/0658013807/icongroupinterna · Prevention & Cure Without Medicine: For High Blood Pressure, Diabetes, Flu-Cold, and 20 Other Diseases by Sahid Sulistija Hardja; Hardcover (February 1997), Rutledge Books, Inc.; ISBN: 1887750436; http://www.amazon.com/exec/obidos/ASIN/1887750436/icongroupinterna · Reversing Diabetes: Reduce or Even Eliminate Your Dependence on Insulin or Oral Drugs by Julian M. Whitaker; Paperback - 435 pages, Revised & Updated edition (June 2001), Warner Books; ISBN: 0446676586; http://www.amazon.com/exec/obidos/ASIN/0446676586/icongroupinterna · The Treatment of Diabetes Mellitus With Chinese Medicine by Bob Flaws, et al; Hardcover (March 2002), Blue Poppy Press; ISBN: 1891845217; http://www.amazon.com/exec/obidos/ASIN/1891845217/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with diabetes. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with diabetes may be given different recommendations. Some recommendations may be directly related to diabetes, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of diabetes. We will then show you how to find studies dedicated specifically to nutrition and diabetes.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
·
Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
·
Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
·
Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
·
Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
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Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
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Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
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Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
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Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
·
Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
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·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
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Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
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Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
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Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
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Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:48 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
48
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
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·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?49
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”50 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.51 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 50 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 51 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 49
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the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected] Finding Studies on Diabetes The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.52 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
52
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periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “diabetes” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following is a typical result when searching for recently indexed consumer information on diabetes: ·
Long-term glycemic control has a nonlinear association to the frequency of background retinopathy in adolescents with diabetes. Follow-up of the Berlin Retinopathy Study. Author(s): Children's Hospital, Kaiserin Auguste Victoria Haus, Klinikum Rudolf Virchow, Berlin, Germany. Source: Danne, T Weber, B Hartmann, R Enders, I Burger, W Hovener, G Diabetes-Care. 1994 December; 17(12): 1390-6 0149-5992
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New ways to control and manage diabetes. Source: Anastasio, Patricia. Environ-Nutr-Newsl. New York : Environmental Nutrition, Inc. December 1982. volume 5 (12) page 1-2. 0195-4024
·
On call. I am a 49-year-old man with diabetes. I take Glucophage and I'm careful with my diet. I also walk three miles almost every day. My blood sugar is always below 150, usually in the 130s. My problem is tingling in my fingers and pain in my feet, which often keeps me up at night. Is there anything I can do? Source: Simon, H B Harv-Mens-Health-Watch.
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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·
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to diabetes; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation:
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·
Vitamins Ascorbic Acid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Niacin Alternative names: Vitamin B3 (Niacin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminB3Niacincs.html Niacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html Niacin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Niacin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,892, 00.html Niacinamide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Pantothenic Acid and Pantethine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000218.html Pyridoxine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB6Pyridoxinecs.html
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Thiamin (vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 60,00.html Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_A.htm Vitamin A Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000230.html Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 67,00.html Vitamin B complex Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,962, 00.html Vitamin B1 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B1.htm Vitamin B12 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B12.htm Vitamin B12 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000134.html Vitamin B12 (Cobalamin) Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB12Cobalamincs.html Vitamin B12 (Cobalamin) Alternative names: Cobalamin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminB12Cobalamincs.html Vitamin B3 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B3.htm Vitamin B3 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000188.html Vitamin B3 (Niacin) Alternative names: Niacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/VitaminB3Niacincs.html Vitamin B3 (Niacin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB3Niacincs.html Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B6.htm Vitamin B6 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000225.html
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Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minB6Pyridoxinecs.html Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm Vitamin C Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000098.html Vitamin D Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_D.htm Vitamin E Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_E.htm Vitamin E Alternative names: Alpha-Tocopherol, Beta-Tocopherol, D-AlphaTocopherol, Delta-Tocopherol, Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minEcs.html Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html Vitamin E Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906, 00.html
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Minerals Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minEcs.html Aluminum, Calcium, and Magnesium-Containing Preparations Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Antaci dsAluminumCalciumandMagnesiumContainingPreparationscl.html Angiotensin-Converting Enzyme (ACE) Inhibitors Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/ACE_Inhibitors.htm Beta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minEcs.html Biotin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Biotin.htm Biotin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minHBiotincs.html Biotin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000108.html Biotin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 08,00.html Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Carnitine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Carnitine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000088.html Chromium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Chromium.htm Chromium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/Chromiumcs.html Chromium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Chromium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Chro miumcs.html
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Chromium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Chromium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Chromium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000131.html Chromium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 18,00.html Chromium Picolinate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Chromium Picolinate Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Creatine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html D-Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minEcs.html Delta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minEcs.html Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minEcs.html Iron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Iron.htm Iron Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html L-Carnitine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Carnitine.htm L-Carnitine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html L-Carnitine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Magnesium.htm Magnesium Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/Magnesiumcs.html Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Mag nesiumcs.html Magnesium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000202.html Magnesium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890, 00.html Manganese Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Manganese.htm Manganese Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Man ganesecs.html Manganese Source: Prima Communications, Inc.
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Hyperlink: http://www.personalhealthzone.com/pg000204.html Nicotinamide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Potassium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Potas siumcs.html Potassium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/Inter actions/Potassiumcs.html Potassium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Pravastatin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Pravastatin.htm Quercetin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Quercetin.htm Quercetin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000226.html Retinol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html
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Selenium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Selenium.htm Selenium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Selen iumcs.html Selenium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Selenium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000233.html Simvastatin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Statins Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Vanadium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vanadium.htm Vanadium Alternative names: Vanadate, Vanadyl Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vana diumcs.html
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Vanadium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Vanadium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000245.html Vitamin H (Biotin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vita minHBiotincs.html Zinc Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Zinc.htm Zinc Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Zincc s.html Zinc Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000128.html Zinc Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 71,00.html Zinc/copper Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,938, 00.html
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Food and Diet Atkins Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Atkins_Diet.htm Bananas Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Bread Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Bruising Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Burdock Alternative names: Arctium lappa, Arctium minus, Arctium tomentosum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Burdockch. html Carbo-Loading Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Carbohydrate_Loading_ Diet.htm Cheese Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html
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Cinnamon Alternative names: Cinnamomum zeylanicum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cinnamon.htm Complex carbohydrates Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Complex carbohydrates Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,993, 00.html Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Diabetes.htm Diabetes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Diabetes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Diabetes Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Fasting Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Fasting_Diet.htm
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Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Fish Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Fish Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Fruit Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Garlic Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Garlic Alternative names: Allium sativum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Garlicch.ht ml Garlic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000164.html Grains Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html High-Fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/High_Fiber_Diet.htm High-Fiber Diet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Hypertension Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Hypoglycemia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypoglycemia.htm Hypoglycemia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Hypoglycemia Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Juices Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html
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Legumes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Low-Fat Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Fat_Diet.htm Low-Fat Diet Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Milk Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Natural Sweeteners Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Natural_Sweeten ers.htm Non-Nutritive and Artificial Sweeteners Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Non_Nutritive_A rtificial_Sweeteners.htm Nutritional Yeast Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Brew ersYeastcs.html Nuts Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Obesity Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Omega-3 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ome ga3FattyAcidscs.html Omega-3 fatty acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,992, 00.html Omega-6 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ome ga6FattyAcidscs.html Omega-6 Fatty Acids Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Omega-6 fatty acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,103 7,00.html
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Orange juice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Orange juice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Pain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Pain.htm Polyunsaturated Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Poultry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Rice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Saturated Fats Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Seeds Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Seeds Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Soy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Soy Protein Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Special Diets Index Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Index/Diet.htm Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Sugar Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Sugar Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000285.html Tea Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html The Zone Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Zone_Diet.htm Vegetables Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Vegetarian Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Vegetarian_Diet.htm Walnuts Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html Water Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hypog lycemiacc.html Weight Loss Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html
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Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Weight_Loss.htm Wine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Diabet esMellituscc.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thermoregulation: Heat regulation. [EU]
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APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.53
53
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):54 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
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Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
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California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
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Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
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Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
·
Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
·
Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
·
Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
Finding Medical Libraries 329
·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
·
Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
·
Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
·
Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
·
Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
·
Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
·
Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
·
Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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·
National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
·
Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
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·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
·
Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
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APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with diabetes faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.55 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
55Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding. Choice of Providers and Plans
Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 335
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
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·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
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healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.56
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”57 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 57 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 56
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.58 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.59 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 59 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 58
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3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 341
contact information on how to find more in-depth information about Medicaid.60
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
Your Rights and Insurance 343
phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.61 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
61
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:62 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
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Diet and Exercise in Noninsulin-Dependent Diabetes Mellitus 345
APPENDIX F. NIH CONSENSUS STATEMENT ON DIET AND EXERCISE IN NONINSULIN-DEPENDENT DIABETES MELLITUS Overview NIH Consensus Development Conferences are convened to evaluate available scientific information and resolve safety and efficacy issues related to biomedical technology. The resultant NIH Consensus Statements are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public.63 Each NIH consensus statement is the product of an independent, non-Federal panel of experts and is based on the panel’s assessment of medical knowledge available at the time the statement was written. Therefore, a consensus statement provides a “snapshot in time” of the state of knowledge of the conference topic. The NIH makes the following caveat: “When reading or downloading NIH consensus statements, keep in mind that new knowledge is inevitably accumulating through medical research. Nevertheless, each NIH consensus statement is retained on this website in its original form as a record of the NIH Consensus Development Program.”64 The following concensus statement was posted on the NIH site and not indicated as “out of date” in March 2002. It was originally published, however, in December, 1986.65
63 This paragraph is adapted from the NIH: http://odp.od.nih.gov/consensus/cons/cons.htm. 64 Adapted from the NIH: http://odp.od.nih.gov/consensus/cons/consdate.htm. 65 Diet and Exercise in Noninsulin-Dependent Diabetes Mellitus. NIH Consensus Statement Online 1986 Dec 8-10 [cited 2002 February 19];6(8):1-21. http://consensus.nih.gov/cons/060/060_statement.htm.
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What Is Non-Insulin Dependent Diabetes Mellitus? Diabetes mellitus is a major health problem. It is a leading cause of death. It is the chief reason for new blindness, kidney failure, and limb amputation. Dialysis for kidney failure from diabetes alone costs over $1 billion annually, and this is expected to double over the next few years. Moreover, diabetes is a major emotional burden for many families. Non-insulin-dependent diabetes (NIDDM, also called adult-onset or Type II diabetes) affects about 10 million Americans, mid-age or older, or approximately 90 percent of all diabetic people. The cornerstone of therapy is a style of life centered around diet and supplemented, if needed, by insulin or oral agents. With the very high association of NIDDM with overnutrition and overweight (approximately 80 percent of patients), much dietary effort is directed to caloric reduction, with exercise as an auxiliary means to increase caloric loss and to assist in glucose regulation. The therapeutic aim is normalization of blood glucose and lipid levels with the hope of diminishing cardiovascular risk and preventing complications. There has been much interest in recent years in clarifying the underlying relationships between NIDDM and obesity, heredity, nutrition, physical activity, and other factors. Much has been learned from clinical studies in individuals with and without NIDDM and from parallel studies in experimental animals. However, conflicting claims have emerged for the effectiveness of new dietary strategies and exercise programs. Many of these have been publicized in the professional and lay literature, and this has caused some concern and confusion. In an effort to resolve this problem, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the NIH Office of Medical Applications of Research, in collaboration with Institute National de la Santé et de la Récherche Médicale (INSERM), France, sponsored a Consensus Development Conference on Diet and Exercise in Noninsulin-Dependent Diabetes Mellitus, December 8-10, 1986. The conference brought together researchers, clinicians, other health professionals, and representatives of the public. Following 2 days of presentations and discussion by invited experts and the audience, a consensus panel, drawn from the health care and diabetes-interested communities, weighed the scientific evidence and formulated a draft statement in response to several questions: ·
What is the significance of excess body fat in the patient with noninsulin-dependent diabetes mellitus? How can weight reduction be achieved and maintained?
Diet and Exercise in Noninsulin-Dependent Diabetes Mellitus 347
·
What are the appropriate components of the dietary prescription for patients with non-insulin-dependent diabetes mellitus?
·
What are the benefits and risks of exercise in patients with non-insulindependent diabetes mellitus? How should exercise be prescribed?
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What is the evidence that weight control, diet, and/or exercise can prevent non-insulin-dependent diabetes mellitus?
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What are the directions for future research?
Significance of Excess Body Fat in Patients with NoninsulinDependent Diabetes Mellitus There is strong evidence that NIDDM is genetically determined. Based on considerable epidemiologic data, it is apparent that obesity and aging promote the development of the disease in susceptible individuals. The prevalence of the disease increases steadily from the fourth decade. Individuals who are 20 to 30 percent overweight are clearly at an increased risk for NIDDM, and the risk accelerates with increased body weight. Data suggest that in addition to the degree of obesity, an increasing duration of obesity and the specific distribution of excess body fat are associated with the development of NIDDM. With regard to fat distribution, upper body or android obesity appears to be more strongly associated with diabetes than lower body or gynoid obesity. Individuals with a family history of NIDDM may develop the disease when they have only modest excess of body fat. These people should be assessed routinely for the presence of carbohydrate intolerance and encouraged to maintain desirable body weight. Extensive studies demonstrate that obesity is characterized by insulin resistance. In the obese nondiabetic individual, the principal target tissues for insulin (liver, skeletal muscle, and adipose tissue) do not respond appropriately to those levels of the hormone found in nonobese individuals. The obese nondiabetic person can compensate for this impairment of hormone action by secreting increased amounts of insulin. Weight reduction in these nondiabetic individuals leads to reversal of insulin resistance and the return to a normal pattern of insulin secretion.
How Can Weight Reduction Be Achieved and Maintained? Pancreatic beta-cell dysfunction and insulin resistance are the cardinal pathophysiologic features of NIDDM. Both of these cellular alterations may
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be genetically determined. Although insulin resistance is present in the nonobese patient with NIDDM, associated obesity further aggravates the severity of impaired hormone action. Weight loss in the obese diabetic, as in the nondiabetic, ameliorates insulin resistance, and usually there is accompanying improvement in carbohydrate tolerance. Frequently, hyperglycemia is reduced when a low calorie diet is employed even before there is much weight loss. Furthermore, some studies have also shown modest improvement in beta-cell function when the blood glucose is lowered by diet or other means. Some investigators are concerned that the hyperinsulinemia in NIDDM may contribute to the increased incidence of macrovascular disease. This possibility arises from the observation that the two most common conditions of hyperinsulinemia (obesity and NIDDM) are independently associated with increased cardiovascular risks. There are also data suggesting that the actions of insulin are not uniformly impaired in hyperinsulinemic states. Thus, it is possible that certain insulin-regulated, atherogenic processes may be accelerated in NIDDM with or without obesity. At present, the relationship between hyperinsulinemia and cardiovascular disease is largely speculative, and more definitive answers await additional investigation. The cellular mechanisms of insulin action have been partially elucidated. There is universal agreement that insulin initiates its actions by interacting with specific receptors located on the surface of the target cell. The possibility that there is a receptor deficiency in human obesity and NIDDM has been extensively investigated. Most studies have examined the receptor status in readily available circulating monocytes or erythrocytes. The number of insulin receptors is often decreased in these cells, but the relevance of these findings to the major target tissues (liver, muscle, fat) for insulin action is not known. In fact, results of studies of insulin receptors in fat cells from individuals with NIDDM are conflicting, and studies are just emerging using human muscle and liver. The majority of investigators agree that cellular alterations, other than decreased receptor number, contribute to the insulin resistance of both obesity and NIDDM. Current areas of investigation include (1) functions of the insulin receptor subsequent to hormone binding, (2) the glucose transport process in muscle and adipose tissue, and (3) the status of those factors that may be the intracellular mediators of insulin action. Although the cellular alterations responsible for insulin resistance and beta-cell dysfunction in NIDDM are poorly understood, future studies of the beta cell and insulin action should provide new insights into the pathophysiology of this disease.
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Blood glucose usually returns toward normal as weight loss occurs in the obese diabetic patient. Weight loss also improves hypertension, hypertriglyceridemia, and hypercholesterolemia. Achieving the goal of desirable weight is not easy. Twenty-five years ago, one-quarter of the patients who needed to lose 20 to 40 pounds were successful, and merely 5 percent lost more than 40 pounds. At that time, weight loss programs generally emphasized moderate caloric restriction and dietary counseling. Recently, several more successful strategies for weight loss have been developed. All these approaches continue to rely on reduced calorie ingestion. Although moderate caloric restriction (500 to 1,000 kcal below daily requirements) is preferred, fasts of several days duration and very low calorie diets (to 400-600 kcal intake per day) for several weeks have been successfully employed with careful medical supervision. Other successful programs have utilized support groups, behavioral therapy, and/or exercise in combination with caloric restriction. In recent years, the public has become aware of the health hazards of obesity. Low calorie foods and beverages are readily available, and health clubs exist in many neighborhoods. While all of these benefit those who need or desire to lose weight, weight reduction continues to be difficult. Furthermore, most individuals who lose weight will regain some or all of the lost weight. A greater understanding and resolution of the pathophysiology and behavioral determinants underlying altered eating behavior are needed. While acknowledging the poor prognosis for weight loss maintenance, the panel recommends that most obese patients with NIDDM be maintained on diets moderately restricted in calories. Ideally, this diet should be associated with behavior therapy, group support, and nutritional counseling. An intensive support program of considerable duration may improve the likelihood of maintaining a desirable weight. Increased physical activity and, if appropriate, structured exercise programs are also considered useful adjunctive therapy.
Dietary Prescription for Patients with Noninsulin-Dependent Diabetes Mellitus In individuals with NIDDM, the primary goal for treatment is to reduce blood glucose levels to normal. The diet for all persons with NIDDM should be nutritionally sound, and it should satisfy the recommended dietary allowances (RDA) and follow the Dietary Guidelines for Americans (Home and Garden Bulletin #232, 2nd Edition, Washington, D.C.: USDA and HHS,
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1985). Since most persons with NIDDM have excess body fat, the primary dietary treatment is reduction of weight through caloric restriction. Some people with NIDDM have additional medical problems (e.g., lipoprotein disorders and hypertension) that require additional dietary recommendations.
Calories A weight-reducing diet should be nutritionally complete, using a variety of foods. Moderate caloric restriction of 500-1,000 kcal below daily requirements may be optimal in producing a gradual sustained weight loss. After the desired weight has been achieved, maintenance of that reduced weight may be sustained by adjusting the caloric intake. With low caloric intake, nutrient deficiencies should be avoided. For lean persons with NIDDM, caloric intake should be adequate to maintain body weight.
Fat and Carbohydrate A diet reduced in total and saturated fat and cholesterol has been recommended for all Americans to decrease the risk of coronary heart disease (CHD). Patients with NIDDM are at increased risk for CHD by virtue of their diabetes. In addition, they frequently demonstrate blood lipid abnormalities, including reduced high density lipoprotein-cholesterol (HDLC) and elevated triglyceride concentrations. The initial approach for normalizing serum lipids in the majority of patients with NIDDM is to reduce hyperglycemia because this will frequently increase HDL-C and reduce triglyceride concentrations. High carbohydrate diets (50-60 percent of total calories) may effect these changes in some patients by enhancing insulin sensitivity. When blood glucose is normalized, the panel recommends that patients with NIDDM should further attempt to reduce their risk of CHD by reducing low density lipoprotein-cholesterol. Present recommendations for the general population include a reduction of total fat intake to less than 30 percent of calories, with saturated fat comprising less than 10 percent of total calories. This may be suitable for some but not all NIDDM patients (as discussed below). A reduction in calories from fat usually requires an increase in calories from carbohydrates. High carbohydrate diets may be harmful in some patients by reducing HDL-C and increasing triglycerides. These diets are less effective than weight loss in normalizing blood glucose and may represent a serious lifestyle alteration for many patients. Consequently, the panel suggests that
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patients’ adherence to a regimen of caloric restriction for weight loss is more important than alterations in the macronutrient composition of the diet. Also, both serum lipid and glucose concentrations should be monitored to determine the effectiveness of any dietary changes.
Other Carbohydrate Issues Sucrose (Table Sugar) In the past, individuals with NIDDM have been advised to avoid sucrose. The use of sucrose as a taste additive in mixed meals is acceptable (up to 5 percent of carbohydrate calorie intake) in patients who are lean and do not have carbohydrate-aggravated hyperlipidemia. The advisability of added sucrose intake above 5 percent of carbohydrate calories requires further investigation.
Fiber Dietary fiber is plant material that is resistant to enzymes produced by humans. Most Americans consume 13 to 19 grams of dietary fiber per day. Some studies have suggested that dietary fiber is effective in controlling blood glucose and reducing plasma cholesterol, especially when used in very high carbohydrate diets (greater than 50 percent of calories); however, the results of these studies are inconclusive. Furthermore, high fiber diets may be less palatable, may require substantial changes in traditional eating patterns, may have effects on other nutrients, and may be contraindicated in patients with autonomic neuropathy. Therefore, the panel reaffirms that the primary dietary intervention in NIDDM is weight reduction. However, if individuals desire to increase the fiber content of their diet, foods high in soluble fiber could replace some other carbohydrates. The use of purified fiber supplements is not recommended at this time for diabetes therapy.
Glycemic Index Individual foods containing carbohydrate can have a high, medium, or low impact on postprandial blood glucose. This response can be quantified as “glycemic index.” Several problems have been identified with the
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application of this methodology to the design of general guidelines of a dietary prescription for patients with NIDDM. Many factors contribute to a different glycemic response from the same food. These include processing, cooking, and food storage time. Other considerations include the variable degree of mastication in the elderly with dental problems, the diurnal variation in absorption, and racial and ethnic differences. Some studies have shown diminution of glycemic effects when foods are combined in a mixed meal. For these reasons at this time the panel does not recommend the use of specific glycemic indices in the dietary therapy of patients with NIDDM.
Protein There is no need to change the standard 12 to 20 percent protein content of the diet, providing RDA requirements are met, except in those who have specific problems in which protein intake should be reduced (i.e., in people with NIDDM who have renal disease).
Education Different educational methods will be appropriate for individual patients and for varying ethnic diets. Whatever plan is used, intensive and frequent followup and support are needed until fasting euglycemia is achieved and maintained. Behavior modification and exercise may be combined with diet instruction to enhance weight loss efforts. Changes in diet need to be made gradually. No single educational tool can accommodate the needs of all individuals with NIDDM. When diet therapy alone is unsuccessful or unacceptable because of quality of life issues or failure to reduce hyperglycemia, then alternative euglycemic therapy is indicated.
Benefits and Risks of Exercise in Patients With NoninsulinDependent Diabetes Mellitus? How Should Exercise Be Prescribed? The effect of regular physical exercise alone on metabolic control in NIDDM is quite variable and frequently of small magnitude. Greater improvement in glucose homeostasis can usually be obtained by weight loss. Despite the
Diet and Exercise in Noninsulin-Dependent Diabetes Mellitus 353
relatively small impact of exercise demonstrated to date, regular physical exercise may be a therapeutic component supplementing diet in selected patients. There is epidemiologic and clinical evidence that physical activity may reduce the incidence of coronary heart disease (CHD) in the general population. The risk-benefit ratio of exercise in NIDDM remains to be defined. Because many of the complications of NIDDM are related to atherosclerotic cardiovascular disease, an increase in physical activity for NIDDM patients appears prudent. This recommendation is made despite the absence of conclusive studies and with recognition that improvements in CHD risk factors may not occur in those with NIDDM. Furthermore, the consensus panel seeks to emphasize that the possible benefits of body fat reduction outweigh putative exercise effects. Vigorous exercise appears to blunt the rise in blood glucose that follows carbohydrate ingestion. In addition, exercise training may increase insulin sensitivity, but this change appears to be an acute effect associated with recent exercise and is reversed within 2 to 3 days by physical inactivity. Physical activity may assist in reducing body fat, but exercise without caloric restriction appears ineffective. Patients who exercise regularly may negate its weight-reducing effects by curtailing their usual activities and by increasing caloric intake. Complications of exercise in NIDDM patients include cardiac events (infarction, arrhythmias, and sudden death), bone and soft tissue injuries, and retinal damage in patients--particularly with proliferative retinopathy. The incidence of these complications with exercise has not been defined. NIDDM patients should undergo a thorough medical evaluation prior to increasing physical activity. The components of the evaluation will vary depending on the severity and duration of the diabetes, the presence of complications, the likelihood of asymptomatic CHD, and the intensity of the activity. Because of the possible risks of retinal detachment and vitreous hemorrhage during exercise in patients with retinopathy, exercise that requires straining and breath holding (such as weight lifting) should be discouraged. Special attention should also be given to care of the feet during exercise. In planning and recommending an exercise program for NIDDM patients, health professionals should be aware of several factors. The threshold of energy expenditure required to reduce postprandial hyperglycemia and to
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enhance insulin sensitivity has not been defined. The same holds true for the use of physical activity in lowering the incidence of CHD. The panel believes that NIDDM patients should tailor an increase in their overall physical activity to their physical capacity, preferences, age, and lifestyle. Also, because many of the metabolic effects of exercise are short-lived, it is extremely important that NIDDM patients choose exercises that they are likely to engage in frequently and continue over their lifetimes.
Evidence: Weight Control, Diet, and/or Exercise Can Prevent Noninsulin-Dependent Diabetes Mellitus Approximately 80 percent of persons with NIDDM have excess body fat. Cross-sectional population-based studies show that the prevalence of NIDDM increases with increasing body weight and that the risk of NIDDM is particularly high among obese persons with a family history of this disorder. These relationships suggest that avoidance or elimination of obesity in people whose relatives have NIDDM may delay or prevent the development of NIDDM. Weight reduction is best achieved through the use of hypocaloric diets. In normal weight people, there is no evidence that manipulation of dietary constituents (e.g., reducing refined carbohydrates or increasing complex carbohydrates or increasing dietary fiber) influences the risk of NIDDM. The possibility that exercise may prevent NIDDM is suggested by the observation that prolonged strenuous exercise in individuals with NIDDM may normalize fasting blood glucose and glucose tolerance. However, there are as yet no irrefutable data to demonstrate that weight control, dietary modification, or exercise are effective in preventing or delaying NIDDM. Nevertheless, in the opinion of the panel, it is prudent to maintain or achieve normal body weight in an attempt to minimize the risk of NIDDM in susceptible persons.
Directions for Future Research Many of the issues discussed in this consensus conference need further research in laboratory, clinic, and community-based settings. The following major topics are suggested:
Diet and Exercise in Noninsulin-Dependent Diabetes Mellitus 355
Questions Related to Obesity ·
What is the etiology of the insulin resistance in the obese state?
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What is the etiologic basis of the obesity itself, from genetic, environmental, behavioral, and nutritional aspects?
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What are effective strategies for therapy of the obese state, particularly as it relates to diabetes?
Questions Related to Diabetes and Its Prevention ·
What is the etiology of the beta-cell deficiency in NIDDM?
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What is the pathophysiology of the insulin resistance in the diabetic state without obesity?
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What is the nature of the inherited component in NIDDM?
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What is the relative effectiveness of regular physical activity and/or weight control in the prevention and treatment of NIDDM and its complications?
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What are predictors for the eventual development of NIDDM?
Questions Related to Nutrition ·
What is the relationship of particular diets such as high carbohydrate diets to glucose and lipid metabolism?
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What are the roles of other dietary alterations such as changes in fiber content, various carbohydrates, and other foods on carbohydrate and lipid homeostasis?
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What are the optimal strategies to improve acceptance of therapeutic regimens?
Questions Related to Exercise ·
What are the potential mediators of exercise effects?
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Under what conditions and in which NIDDM patients is exercise likely to be effective in enhancing glucose homeostasis and reducing coronary heart disease?
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Under what conditions is exercise likely to be counterproductive?
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Questions Related to Complications ·
What are the contributions of hyperinsulinemia, obesity, and glucose control to the risk of complications in NIDDM?
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What are the relationships of the carbohydrate and lipoprotein abnormalities and their treatments to the risk of macrovascular disease in NIDDM?
Conclusion Non-insulin-dependent diabetes mellitus (NIDDM or Type II diabetes) is a major health problem. It is highly correlated with obesity and, thereby, with overeating. Normal weight maintenance continues as the cornerstone of therapy with oral agents or insulin added, if needed, to maintain blood glucose normal or near normal. For overweight individuals, reduced-calorie diets should be prescribed and attempts made to alter lifestyle within an acceptable degree for any given patient to encourage weight reduction. These alterations include increased physical activity, perhaps as prescribed exercise regimens, with the recognition that exercise alone is usually ineffective for weight loss unless accompanied by an appropriate diet. Weight loss diminishes hyperglycemia to or toward normal. Exercise itself may have a small but transient direct effect in lowering blood glucose and insulin resistance. Various food combinations, and even different processing or cooking of the same foods, may produce different glucose responses. Incomplete information on these and other factors that affect this phenomenon in individual subjects minimizes the role of the glycemic index in overall diabetes management. Similarly, foods high in soluble fiber may diminish glucose elevation after meals and may be of use in individual patients, but high-fiber foods appear to be less important than adhering to a calorie-restricted diet and achieving weight loss in the obese diabetic person. Approximately four out of five patients with NIDDM are significantly overweight, and the panel’s attention was focused on this group throughout their deliberations. Specific recommendations for diet and activity in the normal-weight NIDDM patient were not addressed except for endorsement of a lifestyle that avoids the development of obesity. Finally, it appears prudent to prevent or reverse obesity, especially in individuals with a family history of diabetes, in the hope that the onset of diabetes may be prevented or postponed.
Online Glossaries 357
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
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Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to diabetes and keep them on file. The NIH, in particular, suggests that patients with diabetes visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Diabetes Diabetes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001214.htm Diabetes - diet Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002440.htm Diabetes insipidus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000377.htm Diabetes insipidus - central Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000460.htm Diabetes insipidus - nephrogenic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000511.htm Diabetes risk factors Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002072.htm Type I diabetes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000305.htm
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Signs & Symptoms for Diabetes Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Blindness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003040.htm
Online Glossaries 359
Coma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Confusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Convulsions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Double vision Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003029.htm Drowsiness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003208.htm Dry mucous membranes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003250.htm Dry skin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003250.htm Excessive thirst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm Excessive urine volume Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm
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Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Frequent urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm High urine output Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm Hunger Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003134.htm Increased appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003134.htm Increased thirst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm Increased urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm Increased urine volume Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm Lack of coordination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003198.htm
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Lethargy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Loss of consciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Loss of hair Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003246.htm Low blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Menstruation, absent Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003149.htm Muscle pains Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Overweight Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Rapid breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm Rapid heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm
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Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Thirst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm Trembling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003192.htm Unconsciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003146.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm ·
Diagnostics and Tests for Diabetes ADH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003702.htm Antidiuretic hormone Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003702.htm
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Blood glucose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Blood glucose level Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003438.htm Blood glucose level Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Blood glucose levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Blood glucose monitoring Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003438.htm Blood sugar levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Blood sugar testing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003438.htm Blood-sugar levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Fasting blood glucose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm GLUCAGON Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003716.htm
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Glucose monitoring Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003438.htm Glucose tolerance test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm Glycohemoglobin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm Glycosylated hemoglobin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm Hemoglobin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003645.htm Hyperglycemia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Hypernatremia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003481.htm Insulin test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003700.htm MRI of the head Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003791.htm Osmolality Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003463.htm
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Pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm Random glucose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003438.htm Serum calcium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003477.htm Serum potassium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003484.htm Serum sodium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003481.htm Triglyceride level Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003493.htm Urinalysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm Urine 24h volume Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003425.htm Urine concentration test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003608.htm Urine ketones Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm
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Urine osmolality Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003609.htm Urine specific gravity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003587.htm Vasopressin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003702.htm ·
Nutrition for Diabetes Carbohydrate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm Carbohydrates Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm Cholesterol Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002472.htm Complex carbohydrates Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002469.htm Fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Fats Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm Fiber Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm
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Protein Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm Proteins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm Vitamins Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002399.htm ·
Background Topics for Diabetes Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Diabetes - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002179.htm Diabetes – support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002179.htm Diabetic education Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003996.htm Diabetic foot care Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003937.htm Distal Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002346.htm
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Electrolyte Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Head injury Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm Hypothalamus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002380.htm Injury to the head Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm Iris Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002386.htm Kidney disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000457.htm Low body temperature Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000038.htm Metabolism Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002257.htm Necrosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002266.htm
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Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Proximal Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002287.htm Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm Renal Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002289.htm Retina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002291.htm Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm Smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm Support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002150.htm Unconsciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000022.htm Weight control Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001943.htm
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Weight management Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001943.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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DIABETES GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetohexamide: A pill taken to lower the level of glucose (sugar) in the blood. Only some people with noninsulin-dependent diabetes take these pills. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] ACTH: Adrenocorticotropic hormone. [EU] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]
Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in ASTHMA. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH]
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Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anergic: 1. characterized by abnormal inactivity; inactive. 2. marked by asthenia or lack of energy. 3. pertaining to anergy. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]
Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized Tlymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Arginine: An essential amino acid that is physiologically active in the L-
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form. [NIH] Arrestin: A 48-Kd protein of the outer segment of the retinal rods and a component of the phototransduction cascade. Arrestin quenches G-protein activation by binding to phosphorylated photolyzed rhodopsin. Arrestin causes experimental autoimmune uveitis when injected into laboratory animals. [NIH] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriosclerosis: A group of diseases in which the walls of the arteries get thick and hard. In one type of arteriosclerosis, fat builds up inside the walls and slows the blood flow. These diseases often occur in people who have had diabetes for a long time. [NIH] Artery: A large blood vessel that carries blood from the heart to other parts of the body. Arteries are thicker and have walls that are stronger and more elastic than the walls of veins. [NIH] Aspergillus: A genus of mitosporic fungi containing about 100 species and eleven different teleomorphs in the family Trichocomaceae. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]
Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]
Auranofin: An oral chrysotherapeutic agent for the treatment of rheumatoid arthritis. Its exact mechanism of action is unknown, but it is believed to act via immunological mechanisms and alteration of lysosomal enzyme activity. Its efficacy is slightly less than that of injected gold salts, but it is better tolerated, and side effects which occur are potentially less serious. [NIH] Autoantigens: Endogenous tissue constituents that have the ability to interact with autoantibodies and cause an immune response. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms:
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round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Bloom Syndrome: An autosomal recessive disorder characterized by telangiectatic erythema of the face, photosensitivity, dwarfism, and other abnormalities. [NIH] Bronchospasm: Spasmodic contraction of the smooth muscle of the bronchi, as occurs in asthma. [EU] Caenorhabditis: A genus of small free-living nematodes. Two species, caenorhabditis elegans and C. briggsae are much used in studies of genetics, development, aging, muscle chemistry, and neuroanatomy. [NIH] Calcification: The process by which organic tissue becomes hardened by a deposit of calcium salts within its substance. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape,
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location) or etiology (cause and time of occurrence). [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Causal: Pertaining to a cause; directed against a cause. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and polleninduced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Confusion: Disturbed orientation in regard to time, place, or person, sometimes accompanied by disordered consciousness. [EU] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU]
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Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Deferoxamine: Natural product isolated from Streptomyces pilosus. It forms iron complexes and is used as a chelating agent, particularly in the form of its mesylate. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU]
Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU]
Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dimerization: The process by which two molecules of the same chemical composition form a condensation product or polymer. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act
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directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Diurnal: Occurring during the day. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dobutamine: A beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia. It is proposed as a cardiotonic after myocardial infarction or open heart surgery. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Embryo: In animals, those derivatives of the fertilized ovum that eventually become the offspring, during their period of most rapid development, i.e., after the long axis appears until all major structures are represented. In man, the developing organism is an embryo from about two weeks after fertilization to the end of seventh or eighth week. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any
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disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Ethacrynic Acid: A compound that inhibits symport of sodium, potassium, and chloride primarily in the ascending limb of Henle, but also in the proximal and distal tubules. This pharmacological action results in excretion of these ions, increased urinary output, and reduction in extracelluar fluid. This compound has been classified as a loop or high ceiling diuretic. [NIH] Ethnopharmacology: The study of the actions and properties of drugs, usually derived from medicinal plants, indigenous to a population or ethnic group. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fosfomycin: An antibiotic produced by Streptomyces fradiae. [NIH] Fructosamine: An amino sugar formed when glucose non-enzymatically
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reacts with the N-terminal amino group of proteins. The fructose moiety is dervied from glucose by the "classical" Amadori rearrangement. [NIH] Ganglion: 1. a knot, or knotlike mass. 2. a general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. a benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gangrene: Death of tissue, usually in considerable mass and generally associated with loss of vascular (nutritive) supply and followed by bacterial invasion and putrefaction. [EU] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gliclazide: An oral sulfonylurea hypoglycemic agent which stimulates insulin secretion. [NIH] Glipizide: An oral hypoglycemic agent which is rapidly absorbed and completely metabolized. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU] Gluconeogenesis: The process by which glucose is formed from a noncarbohydrate source. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]
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Glycolysis: The pathway by which glucose is catabolized into two molecules of pyruvic acid with the generation of ATP. [NIH] Glycosuria: The presence of glucose in the urine; especially the excretion of an abnormally large amount of sugar (glucose) in the urine, i.e., more than 1 gm. in 24 hours. [EU] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Goiter: Enlargement of the thyroid gland. [NIH] Gold Sodium Thiomalate: A variable mixture of the mono- and disodium salts of gold thiomalic acid used mainly for its anti-inflammatory action in the treatment of rheumatoid arthritis. It is most effective in active progressive rheumatoid arthritis and of little or no value in the presence of extensive deformities or in the treatment of other forms of arthritis. [NIH] Haemophilus: A genus of pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gramnegative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Homeostasis: A tendency to stability in the normal body states (internal environment) of the organism. It is achieved by a system of control mechanisms activated by negative feedback; e.g. a high level of carbon dioxide in extracellular fluid triggers increased pulmonary ventilation, which in turn causes a decrease in carbon dioxide concentration. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the
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bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hunger: The desire for food generated by a sensation arising from the lack of food in the stomach. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: Nutrition) the enlargement or overgrowth of an organ or part due to an increase in size of its constituent cells. [EU] Hypoplasia: Incomplete development or underdevelopment of an organ or tissue. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]
Infarction: 1. the formation of an infarct. 2. an infarct. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline
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solution, solution, into a vein. [EU] Ingestion: The act of taking food, medicines, etc., into the body, by mouth. [EU]
Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intestinal: Pertaining to the intestine. [EU] Intoxication: Poisoning, the state of being poisoned. [EU] Intramuscular: Within the substance of a muscle. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoetharine: Adrenergic beta-2 agonist used as bronchodilator for emphysema, bronchitis and asthma. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isoxsuprine: A beta-adrenergic agonist that causes direct relaxation of uterine and vascular smooth muscle. Its vasodilating actions are greater on the arteries supplying skeletal muscle than on those supplying skin. It is used in the treatment of peripheral vascular disease and in premature labor. [NIH]
Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Leptin:
A 16-kD peptide hormone secreted from white adipocytes and
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implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Levobunolol: A nonselective beta-adrenoceptor antagonist used in the treatment of glaucoma. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH]
Lithium: Lithium. An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Lypressin: 8-Lysyl vasopressin. The porcine antidiuretic hormone most frequently used clinically. A cyclic nonapeptide with lysine in position 8 of the chain; it is used to treat diabetes insipidus and as hemostatic because of its vasoconstrictor action. [NIH] Mastication: mouth. [NIH]
The act and process of chewing and grinding food in the
Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that
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induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Metaplasia: The change in the type of adult cells in a tissue to a form which is not formal for that tissue. [EU] Metastasis: 1. the transfer of disease from one organ or part to another not directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Metolazone: A potent, long acting diuretic useful in chronic renal disease. It also tends to lower blood pressure and increase potassium loss. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Myocardium: The muscle tissue of the HEART composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and
Glossary 385
abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Pertaining to neurology or to the nervous system. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]
Normotensive: 1. characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. a person with normal blood pressure. [EU] Nystatin: Macrolide antifungal antibiotic complex produced by Streptomyces noursei, S. aureus, and other Streptomyces species. The biologically active components of the complex are nystatin A1, A2, and A3. [NIH]
Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU]
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Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Outpatients: Persons who receive ambulatory care at an outpatient department or clinic without room and board being provided. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatin: A mammalian pancreatic extract composed of enzymes with protease, amylase and lipase activities. It is used as a digestant in pancreatic malfunction. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Particle: A tiny mass of material. [EU] Perioperative:
Pertaining to the period extending from the time of
Glossary 387
hospitalization for surgery to the time of discharge. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physiologic: Normal; not pathologic; characteristic of or conforming to the normal functioning or state of the body or a tissue or organ; physiological. [EU]
Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Podiatrist: A doctor who treats and takes care of people's feet. [NIH] Podiatry: The care and treatment of human feet in health and disease. [NIH] Polydipsia: A great thirst that lasts for long periods of time; a sign of diabetes. [NIH] Polyphagia: Great hunger; a sign of diabetes. People with this great hunger often lose weight. [NIH] Polyuria: Having to urinate often; a common sign of diabetes. [NIH] Postoperative: Occurring after a surgical operation. [EU] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
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Prodrugs: A compound that, on administration, must undergo chemical conversion by metabolic processes before becoming the pharmacologically active drug for which it is a prodrug. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: Itching skin; may be a symptom of diabetes. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Pyrazinamide: A pyrazine that is used therapeutically as an antitubercular agent. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]
Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Renin: An enzyme of the hydrolase class that catalyses cleavage of the leucine-leucine bond in angiotensin to generate angiotensin. 1. The enzyme is synthesized as inactive prorenin in the kidney and released into the blood in the active form in response to various metabolic stimuli. Not to be confused with rennin (chymosin). [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to
Glossary 389
decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Saline: Salty; of the nature of a salt; containing a salt or salts. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Sedentary: 1. sitting habitually; of inactive habits. 2. pertaining to a sitting posture. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sirolimus: A macrolide compound obtained from Streptomyces hygroscopicus that acts by selectively blocking the transcriptional activation of cytokines thereby inhibiting cytokine production. It is bioactive only when bound to immunophilins. Sirolimus is a potent immunosuppressant and possesses both antifungal and antineoplastic properties. [NIH] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH]
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Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substrate: A substance upon which an enzyme acts. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tacrolimus: A macrolide isolated from the culture broth of a strain of Streptomyces tsukubaensis that has strong immunosuppressive activity in vivo and prevents the activation of T-lymphocytes in response to antigenic or mitogenic stimulation in vitro. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a nonbarbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays
Glossary 391
immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH]
Thermoregulation: Heat regulation. [EU] Thrombosis: The formation, development, or presence of a thrombus. [EU] Tolazamide: A sulphonylurea hypoglycemic agent with actions and uses similar to those of chlorpropamide. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicologic: Pertaining to toxicology. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Transgenes: Genes that are introduced into an organism using GENE transfer techniques. [NIH] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urinalysis:
Examination of urine by chemical, physical, or microscopic
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means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Vanadium: Vanadium. A metallic element with the atomic symbol V, atomic number 23, and atomic weight 50.94. It is used in the manufacture of vanadium steel. Prolonged exposure can lead to chronic intoxication caused by absorption usually via the lungs. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Ventricular: Pertaining to a ventricle. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg,
Glossary 393
M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna ·
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
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Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
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Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
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Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
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Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
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Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
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Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
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Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
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INDEX A Abdomen .................39, 40, 102, 385, 390 Abdominal..............................84, 168, 371 Aberrant.......................................135, 189 Acetylglucosamine...............................191 Adipocytes ...................148, 171, 188, 382 Adjuvant.......................................192, 199 Adolescence ................126, 168, 183, 371 Aggressiveness ...................................130 Agonist .......170, 177, 204, 265, 266, 267, 371, 377, 382 Albuterol ......................................265, 371 Algorithms........................................83, 96 Alleles ..................................................207 Anabolic ...............................................177 Anaerobic ............................170, 185, 380 Analogous............................................190 Anesthesia.............................................94 Antibiotic ....... 40, 85, 201, 210, 268, 378, 385, 390 Antibodies.......77, 87, 111, 131, 146, 170, 194, 372, 378 Anticonvulsant .............................266, 374 Antidiabetic ..................112, 164, 184, 379 Antidiuretic...................................267, 383 Antigen ........131, 134, 170, 171, 378, 384 Antihypertensive ....................18, 267, 381 Antioxidant...........................166, 167, 275 Antiviral ..................................................85 Arginine .................................................84 Arrestin ................................................141 Arrhythmia ...........................................373 Arteries .86, 112, 183, 209, 267, 373, 375, 382 Arteriosclerosis ....184, 209, 211, 373, 381 Artery .............77, 134, 140, 154, 173, 389 Aspergillus ...........................................181 Asymptomatic ......................................353 Atenolol................................................143 Autoantigens................................132, 195 Autoimmunity.........79, 135, 145, 189, 228 Autonomic....................................207, 351 B Bacteria .......40, 113, 168, 183, 296, 372, 382, 390 Biochemical .................168, 170, 372, 380 Biopsy....................................................75 Bronchospasm.....................................283 C Capsules..............................................299 Captopril ......................................143, 153
Cardiac....... 114, 132, 153, 159, 172, 187, 201, 266, 268, 353, 377, 378, 384, 390 Cardiomyopathy.................................. 132 Cataract .............................. 183, 210, 374 Catheter .............................................. 102 Causal................................................. 180 Cerebral .............................. 165, 266, 378 Chemotherapy ...................................... 84 Cholera ............................................... 136 Cholesterol... 36, 102, 112, 113, 114, 204, 267, 296, 298, 350, 351, 379, 383, 390 Coenzyme........................................... 105 Conduction.......................................... 102 Confusion............................................ 346 Coronary .... 105, 133, 154, 194, 206, 221, 283, 350, 353, 355 Cyclophosphamide ............................. 167 Cytotoxic ............................................. 136 D Deferoxamine ....................................... 88 Degenerative .............. 173, 184, 297, 389 Dendritic...................................... 137, 143 Deprivation.......................................... 143 Desensitization ................................... 141 Detoxification ...................................... 203 Diabetes Insipidus ... 5, 87, 140, 141, 150, 267, 383 Diarrhea .............................................. 296 Diastolic .............................. 113, 204, 381 Digestion ................................. 11, 40, 390 Dimerization ........................................ 142 Distal ................................... 266, 378, 388 Diurnal................................................. 352 E Echocardiography............................... 102 Electrolyte ........................... 172, 194, 387 Embryo........................ 180, 181, 210, 377 Endocrinology ............................... 63, 228 Endogenous................ 180, 188, 189, 205 Endothelium .......................................... 86 Enzyme .. 18, 38, 105, 112, 113, 149, 173, 180, 199, 266, 268, 373, 375, 377, 383, 388, 390 Ephedrine............................................ 166 Epidemic ............................. 133, 156, 220 Epidemiological................... 128, 157, 207 Epidermal............................................ 195 Epitopes .............................................. 155 Erythrocytes ................................ 348, 378 Exogenous .................. 169, 170, 374, 378 Extremity ............................................. 183
Index 395
F Fatigue...................................................13 Fats..38, 39, 183, 210, 296, 375, 378, 383 Fibrillation ............................................373 Fosfomycin ..................................200, 201 Fructosamine.......................................165 G Ganglion ..............................................178 Gangrene.............................................190 Genotype .....................................172, 387 Gliclazide .............................................202 Glipizide...............................................202 Glomerular...................................163, 283 Gluconeogenesis.................................204 Glyburide ...............................................70 Glycolysis ............................................185 Glycosuria............182, 187, 194, 200, 203 Glycosylation ...............................191, 192 Gonadal .......................................114, 390 H Hematology ...........................................10 Hemorrhage.........................................353 Hepatic ........127, 176, 177, 188, 204, 283 Hepatocytes.........................................177 Heredity ...............................................346 Histocompatibility.........................149, 207 Homeostasis........188, 194, 206, 352, 355 Hormones ....104, 114, 172, 188, 388, 390 Hypercholesterolemia..........193, 205, 349 Hyperglycaemia...................................143 Hyperlipidemia.............193, 203, 208, 351 Hypersecretion ....................................178 Hypertension ....... 91, 105, 113, 132, 153, 194, 206, 208, 227, 268, 349, 350, 383, 384 Hypertriglyceridemia....187, 193, 205, 349 Hypertrophy .........................................157 I Immunogenic .......................................195 Immunotherapy............................170, 376 Impotence............................................183 Infarction.....141, 173, 201, 208, 266, 353, 377, 389 Infertility .................................40, 183, 392 Infiltration .............................................189 Inflammation ................173, 193, 205, 389 Infusion ..........................94, 103, 145, 282 Ingestion ..............................299, 349, 353 Intestinal ..............................113, 296, 382 Intoxication ..................................213, 392 Intramuscular.......................113, 149, 386 Iris ................................................171, 382 Ischemia ..............................133, 173, 389 K Ketoacidosis 5, 13, 39, 179, 194, 212, 382 Ketosis .........................................212, 382
L Lactobacillus ......................................... 79 Leptin .......................... 140, 141, 149, 179 Lethal .................................................. 190 Lipid ...... 39, 97, 105, 113, 167, 184, 193, 200, 201, 206, 222, 267, 281, 283, 346, 350, 351, 355, 379, 382, 383 Lipoprotein . 113, 194, 206, 280, 350, 356, 383 Lisinopril.............................. 105, 153, 158 Lithium ........................................ 267, 383 Lymphocytic ........................................ 189 M Mastication.......................................... 352 Medicament ........................................ 176 Membrane........................... 136, 266, 375 Metaplasia........................................... 147 Metastasis........................................... 147 Microscopy.......................................... 189 Mobility................................................ 164 Molecular ..... 10, 124, 125, 172, 181, 209, 230, 233, 234, 372, 388 Monocytes................... 134, 268, 348, 391 Myocardium ........................................ 132 N Nausea.................................. 13, 212, 382 Necrosis ...................... 173, 268, 389, 391 Nephropathy ...... 105, 130, 138, 140, 168, 185, 187, 194, 206, 208 Neural ................................................. 297 Neurologic........................................... 200 Neurology.................................... 212, 385 Neurons ................................ 87, 173, 390 Neuropathy ...... 152, 185, 187, 194, 206, 208, 351 Nifedipine ............................ 105, 113, 385 Nitrofurantoin .............................. 268, 385 Normotensive...................................... 153 O Ocular ................................................. 187 Osmolality ................................... 366, 386 Osteomyelitis ........................................ 33 Outpatients............................................ 83 Overdose ............................................ 297 Oxidation............................................. 284 P Pancreas.... 11, 12, 13, 18, 19, 39, 77, 83, 84, 92, 104, 176, 178, 179, 181, 186, 187, 192, 195, 196, 212, 382, 386 Pancreatin........................................... 199 Pancreatitis ......................................... 184 Parenteral ..................................... 87, 131 Pharmacist .................................. 248, 264 Phenotype................... 134, 157, 172, 387 Physiologic............ 96, 172, 209, 371, 388 Placenta ...................................... 266, 378
396 Diabetes
Podiatry .................................................99 Polydipsia ....................................182, 208 Polyphagia...........................................208 Polyuria........................................182, 208 Postprandial.................179, 280, 351, 353 Potassium...197, 266, 268, 283, 298, 365, 377, 378, 384 Precursor .............173, 187, 195, 196, 391 Predisposition ......................183, 188, 203 Prevalence....... 16, 90, 91, 126, 182, 183, 188, 196, 347, 354 Prodrugs ......................................193, 205 Progressive.172, 182, 196, 200, 267, 380, 385 Proportional ...........................89, 205, 386 Pruritus ................................................200 Psychology ..........................................222 Puberty ................................................126 R Radiology...............................................94 Reagent ...............................................189 Receptor .....140, 141, 148, 149, 157, 168, 195, 196, 203, 348, 372 Recombinant .................................76, 149 Regeneration .......................................166 Renin ...................................................153 Reperfusion .........................133, 173, 389 Retinopathy ....5, 130, 138, 178, 185, 187, 194, 206, 208, 301, 353 Riboflavin.............................................296 Ribose .................................................152 S Saline...........................................113, 381 Secretion ......72, 114, 133, 176, 178, 179, 180, 188, 196, 203, 205, 207, 208, 211, 347, 379, 389 Sedentary ................................16, 21, 121 Selenium..............................................298 Serum ...96, 114, 193, 200, 201, 203, 267, 350, 351, 379, 389 Sirolimus................................................94
Skeletal ....................... 188, 267, 347, 382 Skin Care ...................................... 40, 389 Spectrum............................... 10, 266, 375 Steroid................................... 78, 172, 388 Stomach.......... 11, 39, 212, 381, 382, 386 Subclinical............................................. 97 Substrate..................................... 133, 148 Symptomatic ......................... 91, 114, 390 Synaptic .............................................. 143 Systolic........................ 113, 139, 204, 381 T Tacrolimus ............................................ 94 Thermoregulation................................ 296 Tolazamide ......................................... 202 Tolerance ..... 5, 14, 15, 40, 72, 82, 90, 94, 102, 131, 182, 192, 193, 206, 348, 354, 364, 391 Tomography........................................ 102 Topical ........................................ 268, 391 Toxicology..................... 10, 173, 231, 391 Transgenes ......................................... 143 Transplantation .... 18, 19, 20, 78, 82, 83, 93, 191 Tuberculosis.......................................... 84 U Ulcer...................................... 40, 213, 389 Ulceration............................................ 185 Urinalysis .............................. 84, 115, 392 Urinary . 40, 170, 266, 268, 281, 377, 378, 385, 392 Urology.................................................. 10 V Vaccination ......................................... 139 Vaginal ................................................ 152 Vanadium............................ 186, 213, 392 Vascular ...... 18, 105, 124, 132, 150, 193, 194, 197, 200, 205, 206, 207, 211, 267, 379, 382, 387 Viruses .................. 13, 111, 226, 228, 372 Vitreous....................................... 353, 392
