Thursday, April 20, 2017 5:03 p.m. EDT

By Will Boggs MD

(Reuters Health) - For people with type 2 diabetes, maintaining good blood sugar control in the years after receiving a coronary artery stent is associated with a lower risk of heart attack and stroke, according to a recent study.

Although intensive glucose control had no benefit on the rate of major cardiovascular events in previous studies, our data suggest that strict glucose control after PCI (heart catheterization) can improve long-term clinical outcomes in diabetic patients, Dr. Joo-Yong Hahn from Samsung Medical Center in Seoul told Reuters Health.

Heart disease is the major cause of death among people with type 2 diabetes, Hahns team writes in Circulation: Cardiovascular Interventions. Although intensive blood sugar control is known to reduce damage to tiny blood vessels that are involved in many of the nerve and circulatory effects of diabetes, its not clear if the same is true for major arteries such as the ones that carry blood to the heart.

The researchers studied 980 patients with type 2 diabetes who had undergone percutaneous cardiac intervention (PCI) to clear a blocked coronary artery and place a supportive mesh tube known as a stent. Hahns team followed the patients health for up to seven years.

They looked at long-term blood sugar control using a measurement known as hemoglobin A1c (HbA1c or A1C), and used it to compare the patients risks of death, heart attack, repeat catheterizations and stroke over the study period.

The researchers defined good control as an A1C score below 7.0 and poor control as A1C of 7.0 or higher. Then they matched patients according to other risk factors and ended up with 322 pairs of patients for comparison.

In the overall group of 980 patients, the risk of all bad outcomes was 25 percent lower with good blood glucose control than with poor blood glucose control.

In the matched comparison, some 37 percent of patients with poor control had bad outcomes (heart attack, stroke, and so on) over the next seven years, versus less than 28 percent of patients with good control. Most of the difference in bad outcomes between the groups resulted from a higher rate of repeat stenting in the group with poor blood glucose control.

PCI is not the end of treatment for coronary artery disease, Hahn said by email. Optimal medical treatment, including glycemic control, is a cornerstone therapy after PCI, he said.

The effects of glucose control in type 2 diabetes may differ according to patient characteristics, such as recent cardiovascular events, baseline glycemic control status and duration of diabetes, Hahn added.

The researchers write that more study is needed before they can conclude strict glucose control after stenting will improve long-term clinical outcomes in people with diabetes.

Its important to underscore the message of good glycemic control, said Dr. Azfar G. Zaman from Newcastle University in the UK. He was not involved in the study but has done similar research. In patients with PCI there is evidence to support better outcomes and need for fewer interventions, Zaman said by email.

This is a single center study with limited numbers, but the findings support data from other studies, he noted.

SOURCE: http://bit.ly/2pjU0al Circulation: Cardiovascular Interventions, online April 3, 2017.

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Diabetes control tied to heart stent outcomes - WHTC

by Delaine Mathieu, News 4 San Antonio

Good 4 You: Mental fitness for diabetes

There's a unique new therapy group in San Antonio designed to help people living with diabetes cope with the disease. It's called Mental Fitness for Diabetes. The goal of the program is to help treat mental side-effects that come along with diabetes. "I remember when I was diagnosed with diabetes," said Sarah Villegas. "March 31 for 2016. So, it's been a year."

The 71-year-old registered nurse was completely surprised when she was diagnosed with type two diabetes. "When the doctor came in and showed me my lab results," she explained. "I looked at the paper and I said, are you kidding me?"

Villegas lost seventeen pounds and got her condition under control. When she heard about this new mental fitness group, she was pleasantly surprised. "Never in my 49 years as a registered nurse -- to combine diabetes, a major chronic illness with a major mental health illness, which is chronic, and put them together -- that is an awesome concept," she said.

Valerie Moczgemba, with Alamo Wellness Group, will be running the sessions. "A lot of times, people who have been diagnosed with diabetes experience depression anxiety," she said. "There also may be anger or irritability. She said they'll be focusing on disease management and how mental health symptoms play into disease management.

Villegas says it's high time a treatment like this is made available for people with diabetes. "It cannot be ignored," she said. "We need to address their physical health issues as well as the mental issues. They both go hand-in-hand."

April 30th is the last day to register. If you're interested in signing up, go to alamowellnessgroup.com.

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Good 4 You: Mental fitness for diabetes - WOAI

by Zack Hedrick, Fox San Antonio

Researchers discover technique that could lead to diabetes cure

SAN ANTONIO Doctors in San Antonio have made a breakthrough discovery which could mean a potential cure for people with diabetes.

Tom Mathieu is a fanatical bike rider.

He believes he's pedaled more than 20,000 miles since he began riding in his early thirties.

He started riding because of a condition he was diagnosed with as a teenager.

Doctors told me it'd be a miracle that you see 60," said Mathieu.

Mathieu is a type 1 diabetic and his doctors tell him his body produces zero insulin.

He and his doctors believe his bike riding has helped keep his diabetes in check.

Well I'm 73 and I've had [diabetes] since I was 14," said Mathieu.

Researchers at UT Health San Antonio have discovered a strategy that could mean a cure.

It's a game changer, said Dr. Bruno Doiron. It change drastically the life of a patient that's diabetic."

Using a technique called gene transfer, doctors can alter other cells so they start to secrete insulin but only in response to sugar.

"Im using already what's naturally in your body," said Dr. Doiron.

The University Health System says diabetes is the 4th leading cause of death in Bexar County.

Mathieu calls the potential therapy revolutionary.

He says diabetes is a condition that requires discipline, but says this discovery would give a lot of freedom back to people dealing with diabetes.

People won't be burdened by what diabetes causes and then the cost of those causes, said Mathieu. I think it's miraculous."

Doctors say the therapy has cured diabetes in mice for one year without any side effects, which has never been done.

The goal is to conduct large-animal studies and human clinical trials in the next three to five years.

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Researchers discover technique that could lead to diabetes cure - FOX 29

CARSON CITY Patients and family members of those who suffer from diabetes shared stories of struggle and heartbreak Wednesday and urged support for a bill to rein in the escalating costs of diabetes medication.

Bonnie Sedich knows the pain all too well. Four of her five children were diagnosed with juvenile diabetes. There was no family history. Two children died when in adulthood. Two others live with the disease.

One son, Jeffrey, was diagnosed at age 3. His body was found in a rural California region in 1981, a bottle of insulin by his side. He died at 19.

Another daughter, Elizabeth, was diagnosed when she was 8. She died in November at 51 of complications from the disease. Over the years, the cost of her drugs skyrocketed from about $10 a bottle to more than $300. Toward the end, she was paying more than $2,100 a month if she could afford it, Sedich said.

If you cant afford your diabetes medications then you just suffer and die, Sedich said.

She and others spoke at a press conference to urge support for Senate Bill 265. Sponsored by state Sen. Yvanna Cancela, D-Las Vegas, the bill would establish a list of insulin-related diabetic products to be treated as essential medications. It also would create a refund when insulin costs exceed the medical consumer price index.

The bill would require drug makers to divulge how prices are set, including the cost of medications, as well as amounts spent on marketing and research. It would set registration and reporting requirements on pharmaceutical sales representatives.

Diabetes is a serious disease that affects people for a lifetime, Cancela said. Medical costs are twice as high for people with diabetes.

Deadly and common

Diabetes is the eighth-leading cause of death in Nevada, where 12.4 percent of adults have the disease and 38 percent are pre-diabetic, she said.

Senate Majority Leader Aaron Ford, D-Las Vegas, is one of those who have been determined to be pre-diabetic. He said he received he diagnosis about a year ago.

Diabetes has become one of the largest public health crises in our time, and the medication to treat this disease must be affordable and accessible, he said. In this time of crisis, we have to come together.

Keyonna Lawrence said she was diagnosed as diabetic three years ago. A personal care assistant, she tries to control the disease through diet, and she stretches mediations when she can afford it by taking a half-dose.

My biggest fear is my 11-year-old son is going to wake up, say, Mom? and Moms as cold as ice, Lawrence said.

SB265 was granted an exemption and waiver from deadlines and remains pending in the Senate.

Contact Sandra Chereb at schereb@reviewjournal.com or 775-461-3821. Follow @SandraChereb on Twitter.

Sen. Yvanna Cancela, sponsor of Senate Bill 265, said diabetes care cost Nevadans about $2.4 billiion annually in medical costs.

Over the last 20 years, vials of the most commonn insulin products have gone from $17 to $138; and $21 to $255.

According to the American Diabetes Association, 281,355 people in Nevada, or 12.4 percent of the adult population, have diabetes. Another 787,000, or 38.5 percent of the adult population are pre-diabetic with blood glucose levels higher than normal.

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Family members of diabetes patients plead for law to limit ... - Las Vegas Review-Journal

By Alan Mozes

HealthDay Reporter

WEDNESDAY, April 19, 2017 (HealthDay News) -- People with type 1 diabetes face the risk of developing a disease that can cause blindness, so treatment guidelines have long called for annual eye exams.

But new research suggests this one-size-fits-all advice is costly and ineffective, because people with a low risk may need less-frequent screenings while people at high risk may need to be seen more often.

Diabetic retinopathy can damage the light-sensitive tissue at the back of the eye and trigger full vision loss, the researchers explained. Screening can catch this disease before irreparable damage is done, but not every person with diabetes faces the same risk.

"For example, patients with no or minimal eye changes and good blood sugar levels might not need their next examination for another four years," said study author Dr. David Nathan.

"On the other hand, if the patient already has developing eye disease and their blood sugar control has not been in the recommended range, they might need a repeat examination in as soon as three months," he added.

Nathan is the director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital, in Boston.

Current guidelines suggest getting an annual eye screening within three to five years of a type 1 diabetes diagnosis. People with type 1 diabetes cannot produce any insulin.

To assess that advice, the investigators focused on type 1 diabetics (aged 13 to 39) who had enrolled in a large, national diabetes trial between 1983 and 1989.

The latest analysis involved 24,000 eye exams conducted over 30 years among roughly 1,400 people with type 1 diabetes.

Retinal photographs were taken every six months until 1993, and then -- in a follow-up study -- once every four years until 2012. The study participants' vision, advanced retinopathy status and general diabetes history were tracked for an average of nearly 29 years.

The researchers determined that those participants who had an average blood sugar level of 6 percent, but no signs of retinopathy, could forgo the annual screening in favor of just one exam every four years. Similar people with mild retinopathy should be screened once every three years, the team concluded.

By contrast, those with severe or moderate retinopathy would do well to get screened every three to six months, respectively, the study authors reported.

People with higher blood sugar levels (8 to 10 percent) might also need to be screened more often, the researchers cautioned.

On average, the new recommendations for people with type 1 diabetes would likely cut the need for eye exams in half over a two-decade period. That would translate into an overall savings of $1 billion, while ensuring that those facing the highest risk got more timely treatment, the researchers said.

The findings were published in the April 20 issue of the New England Journal of Medicine.

Nathan described the results as "definitive." However, he said the jury is still out as to "whether the individualized frequency of eye examinations will be implemented by physicians" and followed by people with type 1 diabetes.

"The risk is that physicians may find it easier to schedule an annual eye examination compared with the new individualized schedule, which may be more difficult for physicians and patients to remember," he acknowledged.

"However, most physicians and ophthalmology offices use computer programs -- including reminder programs -- for scheduling, so we think that this potential barrier should not be a substantial obstacle," Nathan added.

Courtney Cochran, senior manager of media relations for the American Diabetes Association (ADA), noted that the ADA issued updated guidelines for retinopathy screenings in February.

The new recommendations now state that people with type 1 diabetes should start annual screenings within five years of their diabetes diagnosis. But those who remain free of retinopathy for a year or two may "consider" the option of less-frequent exams.

However, the ADA also said that if and when "any level" of retinopathy is detected, annual screenings are a must, while those with progressing retinopathy will require even more frequent screenings.

Dr. Jamie Rosenberg, who wrote an editorial that accompanied the study, suggested the new recommendations reflect "a trend toward reducing unnecessary screening for eye diseases."

"The upside to this new screening protocol would be significant money saved for the health care system, in addition to time saved for both patients and doctors," said Rosenberg, who is an associate professor of clinical ophthalmology and visual sciences at the Albert Einstein College of Medicine, in New York City.

Individualized schedules will make tracking patients more difficult, Rosenberg agreed. But, "this new screening protocol has great potential if adherence to the examination schedule could be assured."

WebMD News from HealthDay

SOURCES: David Nathan, M.D., director, Diabetes Center and Clinical Research Center, Massachusetts General Hospital, and professor, medicine, Harvard Medical School, Boston; Jamie Rosenberg, M.D., associate professor, clinical ophthalmology & visual sciences, and associate professor, clinical pediatrics, Albert Einstein College of Medicine, and attending physician, Montefiore Health System, New York City; Courtney Cochran, senior manager, media relations, American Diabetes Association; April 20, 2017, New England Journal of Medicine

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Is Annual Eye Exam a Must for Type 1 Diabetes? - WebMD