Journal of the American Medical Association Devotes Entire Issue to Diabetes Research

Today's issue of the Journal of the American Medical Association focuses entirely on research concerning diabetes, a disease that affects more than 17 million Americans and is expected to affect 30 million by 2050, USA Today reports. The following summarizes several of the studies contained in the issue.

• Differences in long-term diabetes complications result more from varying genetic backgrounds than from access to differing levels of medical care, according to researchers from Kaiser Permanente (Manning, USA Today, 5/15). The study examined 62,432 people with Type I and Type II diabetes who were members of the Kaiser Permanente Medical Care Program in northern California between 1995 and 1998 (Karter et al., JAMA, 5/15). The researchers determined that African-Americans, Asians and Latinos were more likely to experience kidney failure than whites, who were more likely to experience heart attacks. In addition, whites and African-Americans had an equally greater risk than Asians and Latinos of experiencing a stroke or congestive heart failure (Kay, Los Angeles Times, 5/15). Finally, the researchers found that African-Americans, whites and Latinos were 60% more likely than Asians to have a limb amputated because of complications from diabetes (USA Today, 5/15). Researchers concluded that genetic factors and the "contribution of unmeasured environmental factors" might have led to the difference in complication rates (JAMA, 5/15). The study is available online.
  
• In women over age 50, the consumption of one or two alcoholic drinks a day can improve their response to insulin and can reduce the level of triglycerides in their blood, two factors that decrease the risk of developing diabetes, the Wall Street Journal reports. Researchers from the U.S. Department of Agriculture and NIH had 63 postmenopausal women consume zero, one or two alcoholic drinks -- pure ethanol mixed with orange juice -- per day for 24 weeks, rotating the number of drinks the women consumed every eight weeks (Chase, Wall Street Journal, 5/15). The study found that in women who had two alcoholic drinks a day, fasting insulin levels decreased 19%, triglyceride levels decreased 10% and insulin sensitivity increased 7% (Davies et al., JAMA, 5/15). Researchers found that "[s]ubtler improvements" resulted from limiting alcohol intake to one drink a day (Wall Street Journal, 5/15). The study is available online.
  
• A "significant number" of people with diabetes are incorrectly prescribed the drug metformin, which helps the body use insulin and is "among the most common drugs" for treating Type II diabetes, researchers at the University of North Carolina found. According to the package insert for the drug, which is sold by Bristol-Myers Squibb Co. under the brand-name Glucophage, metformin can cause lactic acidosis, a potentially fatal buildup of lactic acid in the blood, in people who have kidney disease or who take drugs for heart failure. Researchers found that 22 of 100 patients who were prescribed Glucophage by a UNC pharmacy had those conditions, although none had developed lactic acidosis. Researchers cautioned that their study might "underestimate the frequency of contraindications" and said that they could not determine whether doctors are intentionally prescribing metformin against the warning label (Tanner, AP/Columbia State, 5/14). The study is available online.
  
• Although policy makers and insurance companies are "beginning to recognize the seriousness" of diabetes, it is a disease that "requires an integrated, global response," Dr. Christopher Saudek, president of the American Diabetes Association writes in an editorial. The current JAMA articles "highlight the need to address issues of chronic disease in general" and "should be of great interest to the clinician and the policy maker alike" (Saudek, JAMA, 5/15). Saudek spoke yesterday during a briefing during which the JAMA research was presented (USA Today, 5/15). An interview from NPR's "All Things Considered" with JAMA Editor Catherine DeAngelis about the diabetes special issue is available online. Note: You must have RealPlayer to listen to the interview.