More Data Links A1c But Not Fasting Glucose to Cardiac Risk

Page Changed: A1c and High Post-Meal Blood Sugars Predict Heart Attack

Risk Quantified For Non-Diabetic A1cs and Heart Attack Risk

The Atherosclerosis Risk in Communities study tracked 11,092 black or white adults who did not have a history of diabetes or cardiovascular disease. for 15 years. It found no association between fasting blood sugar and risk of heart disease, but A1c was a different story. The The table below summarizes the correlation of baseline A1c with the risk of developing cardiovascular disease.

Multivariate-Adjusted Hazard Ratio

5%:              0.96 (0.74-1.24)
5% to < 5.5%:       1.00 (reference)
5.5% to < 6%:      1.23 (1.07-1.41)
6% to < 6.5%:      1.78 (1.48-2.15)
≥ 6.5%:             1.95 (1.53-2.48)

Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults. Elizabeth Selvin et al.NEJMVolume 362:800-811. March 4, 2010 Number 9.

Keep in mind that because these subjects were probably diagnosed as "non-diabetic" using a fasting glucose test many of those with the higher A1cs probably were diabetic at the study outset based on post-meal values. If you are recently diagnosed with diabetes and have no signs of heart disease, your risk/A1c ratio should be similar if not identical to those shown here.

Vitamin B Supplementation Hastens Kidney Damage Raises Incidence of Stroke

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B Vitamin Supplementation Increases Stroke and Kidney Damage

A study published in JAMA in April 2010 asked whether giving supplemental B vitamins to people with diabetes would improve their kidneys because they were known to have low levels of homocysteine. What the study found was very disturbing: people with diabetes who were given a single daily tablet of B vitamins containing folic acid (2.5 mg/d), vitamin B6 (25 mg/d), and vitamin B12 (1 mg/d) ended up with significantly worse kidney function as measured by GFR and also in a higher incidence of stroke. This suggests B Vitamin supplementation is harmful to people with kidney problems.

Effect of B-Vitamin Therapy on Progression of Diabetic Nephropathy. A Randomized Controlled Trial. Andrew A. House et al. JAMA Vol. 303 No. 16, April 28, 2010.

Potentially Dangerous Drugs for People with Type 2 Diabetes and Kidney Disease

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Other Potentially Dangerous Pharmaceutical Drugs. The following prescription medications are capable of causing problems in people who already have significant kidney damage:

a. ACE inhibitors and ARBs. These drugs protect the kidneys in most people, but if you have a condition called "renal artery stenosis" they may be harmful.There is a test, the Captopril Scan, that can be done to ensure you respond appropriately to these kinds of drugs if there is any question that you might have renal arterial stenosis.

b. Radioacontrast agents used during angiography. According to this review published in Endocrine Today up to 35% of people with diabetes may experience acute renal failure when given these during angiograms. Proper hydration appears to be the appropriate defense. Discuss this issue with your doctor before you find yourself in a hospital having tests done by doctors who don't have your chart. If you are at risk, make sure that information is available at any hospital you might be taken to.

c. Antibiotics. These can occasionally cause kidney failure, too. Again, this is mainly a problem if you have serious kidney damage. If you do ask the doctor who treats your diabetes before you take ANY medication prescribed by another doctor who may not know the details of your case

Endocrine Today: Medications that worsen renal function in diabetes

Blood Levels of Vitamin D Do Not Predict Insulin Secretion or Sensitivity in People with Metabolic Syndrome

Page Changed: Helpful Supplements for Diabetes

A study of 446 European subjects diagnosed with metabolic syndrome found no relationship between blood concentrations of vitamin D and insulin secretion or sensitivity. In this group 20% had vitamin D levels over 30 ng/ml (75 nmol/L). This may suggest that the low vitamin D levels seen in people with diabetes are a result, not a cause of their blood sugar disorder.

Serum Vitamin D Concentration Does Not Predict Insulin Action or Secretion in European Subjects With the Metabolic Syndrome. Hanne L. Gulseth et al. Diabetes Care April 2010 vol. 33 no. 4 923-925. doi: 10.2337/dc09-1692

Metformin Started At Diagnosis Far More Effective Than Metformin Prescribed Later

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A study published of 1,799 Kaiser patients who were able to lower their A1c below 7.5% using Metformin found that when patients were started on Metformin immediately after diagnosis, they were able to stay at an A1c lower than 7% for longer than did patients whose doctors waited a year before starting them on the drug.

Secondary Failure of Metformin Monotherapy in Clinical Practice
Jonathan B. Brown. Diabetes Care Diabetes Care March 2010 vol. 33 no. 3 501-506 doi: 10.2337/dc09-1749

A more detailed discussion of this study can be found here:

Diabetes in Control: Early Treatment Doubles Chance of Success for People with Diabetes

This is important. Many people with diabetes resist taking a drug thinking that it is better to attempt to lower blood sugar with diet or exercise alone. Because the action Metformin is different from the effect of cutting carbs or exercising, this may be a mistake. It may be better to start metformin along with other approaches as soon as you receive a diagnosis of abnormal blood sugar (including a diagnosis of pre-diabetes) rather than waiting.

Another Large Study Links TZDs and Broken Bones

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Added this new study.

Thiazolidinedione Use and the Longitudinal Risk of Fractures in Patients with Type 2 Diabetes Mellitus Zeina A. Habib et al. JClinEndo&Metab Vol. 95, No. 2 592-600 doi:10.1210/jc.2009-1385

In this study, as summarized in the newsletter, Endocrine Today, which gives more information than the abstract, researchers,

... studied 19,070 patients at Henry Ford Hospital in Detroit between January 2000 and May 2007. The study group included 9,620 women and 9,450 men. During the study period, 4,511 patients had at least one prescription filled for a TZD. The investigators used electronically maintained medical claims data to identify nontraumatic bone fractures.

TZD use was associated with an increased risk for fracture in the overall cohort (adjusted HR=1.35; 95% CI, 1.05-1.71) and in women (HR=1.57; 95% CI, 1.16-2.14). Men, regardless of age, were not at an increased risk for fractures (HR=1.05; 95% CI, 0.70-1.58). Women aged 65 years and older appeared to be at the greatest risk for fracture (HR=1.72; 95% CI, 1.17-2.52). They found that the increased risk for fracture in women appeared after approximately one year of TZD use.

More Proof Metformin Is Protective Against Cancer

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Added this text with link to full text of a new study that found evidence that metformin protects people with diabetes against cancer.

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More evidence that metformin is protective against cancer emerged in a second study of 1,353 people with diabetes that lasted almost ten years. It was conducted in the Netherlands as part of the ZODIAC study and published in Februrary 2010. This study found that the cancer risk of people with diabetes taking metformin was identical to that of the population at large which was not the case with those who were not taking metformin. This is significant because people with diabetes have long been known to have a higher risk of cancer.

Metformin Associated With Lower Cancer Mortality in Type 2 Diabetes: ZODIAC-16 Gijs W.D. Landman et al.Diabetes Care Diabetes Care February 2010 vol. 33 no. 2 322-326. doi: 10.2337/dc09-1380