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CABG Appears Superior To PCI For Patients With Type 1 Diabetes, Multivessel Disease

CABG Appears Superior to PCI for Patients With Type 1 Diabetes, Multivessel Disease

CABG Appears Superior to PCI for Patients With Type 1 Diabetes, Multivessel Disease

The observational findings support existing recommendations favoring surgical revascularization in patients with diabetes.
BARCELONA, Spain—Over the long term, patients with type 1 diabetes and multivessel coronary disease fare better with CABG than with PCI, a population-based cohort study suggests.
Those findings, reported by Martin Holzmann, MD, PhD (Karolinska University Hospital, Stockholm, Sweden), at the European Society of Cardiology Congress 2017 here and published simultaneously online in the Journal of the American College of Cardiology, are consistent with both US and European guidelines, which recommend surgical revascularization over PCI in patients with diabetes.
“Our findings indicate that for patients with type 1 diabetes, CABG instead of PCI should be the preferred strategy for multivessel revascularization,” Holzmann said during his presentation.
Even so, he and his colleagues say in the paper that their “findings should be interpreted with some caution because of the observational nature of the study, and maybe more importantly, the large differences in risks in the first year of follow-up, indicating that there were large inherent differences in risk at baseline between the PCI and CABG groups.”
CABG has consistently been shown to improve outcomes over PCI in patients with diabetes—in the BARI and FREEDOM trials and in a subgroup analysis of the SYNTAX trial, for instance. But Holzmann noted that none of those studies has performed subgroup analyses based on the type of diabetes; this could be important when considering the findings because Continue reading

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Genetic findings in 'type 1.5' diabetes may shed light on better diagnosis, treatment

Genetic findings in 'type 1.5' diabetes may shed light on better diagnosis, treatment

Researchers investigating a form of adult-onset diabetes that shares features with the two better-known types of diabetes have discovered genetic influences that may offer clues to more accurate diagnosis and treatment.
Latent autoimmune diabetes in adults (LADA) is informally called "type 1.5 diabetes" because like type 1 diabetes (T1D), LADA is marked by circulating autoantibodies, an indicator that an overactive immune system is damaging the body's insulin-producing beta cells. But LADA also shares clinical features with type 2 diabetes (T2D), which tends to appear in adulthood. Also, as in T2D, LADA patients do not require insulin treatments when first diagnosed.
A study published April 25 in BMC Medicine uses genetic analysis to show that LADA is closer to T1D than to T2D. "Correctly diagnosing subtypes of diabetes is important, because it affects how physicians manage a patient's disease," said co-study leader Struan F.A. Grant, PhD, a genomics researcher at Children's Hospital of Philadelphia (CHOP). "If patients are misdiagnosed with the wrong type of diabetes, they may not receive the most effective medication."
Grant collaborated with European scientists, led by Richard David Leslie of the University of London, U.K.; and Bernhard O. Boehm, of Ulm University Medical Center, Germany and the Lee Kong Chian School of Medicine, a joint medical school of Imperial College London and Nanyang Technological University, Singapore.
Occurring when patients cannot produce their own insulin or are unable to properly process the insulin they do produce, diabetes is usually classi Continue reading

Can synthetic biology finally cure the autoimmune disease?

Can synthetic biology finally cure the autoimmune disease?

Lev Dolgachov/Thinkstock
Type 1 diabetes is a discouraging disease. Despite the availability of synthetic insulin and increasingly sophisticated monitoring technology, it’s still a condition that requires incessant vigilance: Diabetics must constantly track their blood sugar levels and carefully use that information to calibrate drug doses. Even if you manage to do all of that well, bad days remain almost inevitable. Take too much insulin, and you can spiral into a hypoglycemic delirium. Take too little, and your glucose levels will rise, filling the body with dangerous levels of ketones.
Less immediately frustrating—but no less familiar for diabetics—is the state of diabetes research. Possible cures routinely pop up only to fade from view, their benefits never quite surpassing the simple efficacy of an insulin injection. More recently, though, the field of synthetic biology—a hybrid discipline that aims to construct or redesign biological components and systems—has shown the potential to produce a novel set of treatments. The solutions remain speculative, but they do offer cautious reasons for hope.
“Type 1 diabetes, in theory, should be relatively easy to solve. That has been the mantra of researchers for the last 30 years. And I still take insulin every day.”
John Glass, a researcher working on one such new effort, knows how maddening false hope can be, having lived with the disease for decades. “Type 1 diabetes, in theory, should be relatively easy to solve,” he told me over the phone. “That has been the mantra of type 1 diabetes researchers for the Continue reading

Fighting Statin-Induced Diabetes with CoQ10

Fighting Statin-Induced Diabetes with CoQ10

Statins are cholesterol-lowering drugs sold under trade names such as Lipitor® and Crestor®.
They have been shown to benefit people at risk for heart disease caused by elevated LDL-cholesterol and/or C-reactive protein.
For appropriate patients, statin drugs reduce cardiovascular death and disability rates.1-3
But despite these benefits, evidence suggests that statins, especially high doses of potent statins, may increase the risk, especially in older patients, of developing diabetes.3-6
Compelling data reveals that supplementing with CoQ10 can significantly reduce these glucose control issues.
Facts about Statins and Diabetes
Studies show that some statins, such as rosuvastatin (Crestor®), are associated with a 27% increased risk of developing new-onset type II diabetes.7 This is just one of many studies showing this harmful connection.4-6
One meta-analysis that utilized results from 13 statin studies involving more than 91,000 participants demonstrated an across-the-board increased diabetes risk of 9%,8 and found the highest risk in trials involving older subjects. Another meta-analysis showed that those taking higher doses of statins had a 12% higher risk of developing diabetes compared with subjects receiving “moderate” doses.9
These two alarming studies have made it apparent that older patients on more intensive statin regimens are at the greatest risk of developing diabetes from their treatment.3,10 Naturally, this poses a dilemma for anyone who is on, or considering starting, statin therapy. Is lowering the risk of cardiovascular disease worth the risk of deve Continue reading

How Exactly Does Type 2 Diabetes Develop?

How Exactly Does Type 2 Diabetes Develop?

Insulin resistance is the cause of both prediabetes and type 2 diabetes. Ok, so what is the cause of insulin resistance? Insulin resistance is now accepted to be closely associated with the accumulation of fat within our muscle cells. This fat toxicity inside of our muscles is a major factor in the cause of insulin resistance and type 2 diabetes, as it interferes with the action of insulin. I’ve explored how fat makes our muscles insulin resistant (see What Causes Insulin Resistance?), how that fat can come from the fat we eat or the fat we wear (see The Spillover Effect Links Obesity to Diabetes), and how not all fats are the same (see Lipotoxicity: How Saturated Fat Raises Blood Sugar). It’s the type of fat found predominantly in animal fats, relative to plant fats, that appears to be especially deleterious with respect to fat-induced insulin insensitivity. But this insulin resistance in our muscles starts years before diabetes is diagnosed.
In my video, Diabetes as a Disease of Fat Toxicity, you can see that insulin resistance starts over a decade before diabetes is actually diagnosed, as blood sugar levels slowly start creeping up. And then, all of the sudden, the pancreas conks out, and blood sugars skyrocket. What could underlie this relatively rapid failure of insulin secretion?
At first, the pancreas pumps out more and more insulin, trying to overcome the fat-induced insulin resistance in the muscles, and high insulin levels can lead to the accumulation of fat in the liver, called fatty liver disease. Before diagnosis of type 2 diabetes, there is a long silent s Continue reading

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