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Friday, January 09, 2009

ADA Accomplishments in 2008

The ADA has just posted this review of their achievements in 2008 on their web-site:

In Diabetes Today 08-JAN-2009
American Diabetes Association Reflects on 2008 Accomplishments in the Fight Against Diabetes and Looks Ahead to Challenges in 2009

I read the whole thing through carefully. Unfortunately, the accomplishments I was looking for weren't in it. I read it twice to be sure.

What they did include as headlines were:

Research Funding
Fighting Discrimination Against People with Diabetes
Health Reform
Creating A Healthy Environment
Those are all necessary and highly laudable achievements. I have nothing but praise for all of those involved in those areas. But that is a very limited list to my mind.

These are the headlines I missed:

"America's average A1c of diagnosed diabetics reduced significantly."or "Mortality rate of diabetics reduced."or "Rates of long-term complications reduced in diabetics."or "Fewer people with metabolic syndrome or pre-diabetes progressing to type 2 diabetes."

I didn't see anything remotely like those. Those, or similar accomplishments, are the headlines that would indicate to me that the ADA is making a real and significant difference to the diabetics of the world, or at least of America.

I searched again, but all I could find was:

"Since 1987, the death rate due to diabetes has increased by 45 percent"

Maybe I'm too simple to understand these things, but isn't that trend heading in the wrong direction? And at a rather high rate?

If beating the medical afflictions of the world was a team sport and the ADA was the most highly funded team in the Diabetes Division, don't you think that by now the fans would be screaming for a review of the team's aims, methods and tactics? Hopefully the recent change in coach will bear fruit.

They note that in "in 2008, the American Diabetes Association provided $42.5 million toward funding research to combat type 1 and type 2 diabetes in people of all ages and races."
How much of that money came from big Pharma ? Most. How much of that money went to discover the optimum SMBG testing and dietary regimen for type 2 diabetes? Any? I doubt it.

On a more optimistic note, back when I wrote Money, Medications and Motives, the ADA FY06 Corporate Recognition Program included several major grains, food and beverage companies. That link no longer works and I could not find the same level of sponsorship from that industry group on the present Become a Corporate Supporter page (although it is still top-heavy with Big Pharma). I hope that is a sign from the new coach of things to come and not just poor search techniques on my part.

In that case I applaud the changes that are occurring and I hope they continue into other areas such as the focus for research funding. Maybe some day I will start to see the headlines I missed today.

Cheers, Alan

Saturday, January 03, 2009

Diabetes and Dental health

A couple of years ago I wrote about the two-way relationship between Diabetes and Periodontal disease in Teeth, Gums, Diabetes and Death .

My main intent at that time was to emphasise that dental hygiene and blood glucose levels seem to be closely related. Poor dental hygiene causes poor blood glucose levels and poor blood glucose levels exacerbate dental problems. The reverse is also true, with improvements in either leading to improvements in the other. For more discussion on that read the earlier article.

One of the cites I provided, Periodontitis and diabetes interrelationships, had an interesting comment: "Thus, there is potential for periodontitis to exacerbate diabetes-induced hyperlipidemia, immune cell alterations, and diminished tissue repair capacity. It may also be possible for chronic periodontitis to induce diabetes." Induce diabetes? I noted that further research should be done there.

Further research has now been done and that possibility is becoming a little more plausible. This paper was published online on April 4, 2008 in Diabetes Care 31:1373-1379, 2008: Periodontal Disease and Incident Type 2 Diabetes

OBJECTIVE—Type 2 diabetes and periodontal disease are known to be associated, but the temporality of this relationship has not been firmly established. We investigated whether baseline periodontal disease independently predicts incident diabetes over two decades of follow-up.

RESEARCH DESIGN AND METHODS—A total of 9,296 nondiabetic male and female National Health and Nutrition Examination Survey (NHANES I) participants aged 25–74 years who completed a baseline dental examination (1971–1976) and had at least one follow-up evaluation (1982–1992) were studied. We defined six categories of baseline periodontal disease using the periodontal index. Of 7,168 dentate participants, 47% had periodontal index = 0 (periodontally healthy); the remaining were classified into periodontal index quintiles. Incident diabetes was defined by 1) death certificate (ICD-9 code 250), 2) self-report of diabetes requiring pharmacological treatment, or 3) health care facility stay with diabetes discharge code. Multivariable logistic regression models assessed incident diabetes odds across increasing levels of periodontal index in comparison with periodontally healthy participants.

RESULTS—The adjusted odds ratios (ORs) for incident diabetes in periodontal index categories 1 and 2 were not elevated, whereas the ORs in periodontal index categories 3 through 5 were 2.26 (95% CI 1.56–3.27), 1.71 (1.0–2.69), and 1.50 (0.99–2.27), respectively. The OR in edentulous participants was 1.30 (1.00–1.70). Dentate participants with advanced tooth loss had an OR of 1.70 (P <>

CONCLUSIONS—Baseline periodontal disease is an independent predictor of incident diabetes in the nationally representative sample of NHANES I."

What that means in layman’s terms was clarified in Endocrine Today online in November when an interview with one of the authors, Ryan T. Demmer, PhD, MPH was published. He said that these findings add a "new twist" to the association, suggesting that periodontal disease may lead to diabetes.

"It has been generally accepted that periodontal disease is a consequence of diabetes despite the fact that this association has not been studied with the same methodological rigor applied to coronary and stroke outcomes," he told Endocrine Today. "We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop type 2 diabetes later in life when compared to individuals without periodontal disease." For more details read that Endocrine Today issue where it is discussed with several other researchers in this field.

I still suspect that type 2 has a genetic cause, but I now believe that periodontal disease can be a trigger for type 2 diabetes in the same way that a poor diet or lifestyle can be. There is also the possibility the genetic tendency to type 2 diabetes may also be the initial cause of the precursor conditions of periodontal disease or obesity.

I already knew that it was important to have very good dental hygiene as a type 2 diabetic. Now it seems that it may be equally important for those of us who have offspring following in our genetic foot-steps to pass that message on loud and clear to them.

Cheers, Alan