Diabetes Update


 
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March is Diabetes Awareness Month.  How much do you, as a nurse, know about the latest diabetes research?

Medications
Avandia (rosiglitazone) has recently been named by one study as the most effective drug for delaying diabetes progression. But, it is also expensive and carries significant risks including brittle bones with susceptibility to bone fractures, and heart disease.

Avandia is also one of the medications being used in a recent diabetic study by the National Institutes of Health (NIH) that had to be halted and revised due to the number of death associated within the intensive therapy treatment group.  However, they were unable to link the deaths to any specific medication or treatment and an international study of the same nature has not seen the same results.

Nurses are advised to carefully monitor patients with high blood pressure, high cholesterol, or obesity and a smoking history who also use Avandia.

References:

Kahn, S.E. et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. New England Journal of Medicine, 355:2427–2443, 2006.

Monami, M. et al. Bone fractures and hypoglycaemia treatment in type 2 diabetic patients: a case-control study. Diabetes Care. November 16, 2007

Reinberg, S. Deaths Halt Part of Large Diabetes Trial. HealthDay. Feb 6, 2008.

Steenhuysen, J. International diabetes study contradicts U.S. trial. Reuters. Feb 13, 2008.

Weight
Studies have shown that for many type 2 diabetics, stomach reduction surgeries hold great promise for “curing diabetes.”  Lap band surgery patients see significant diabetes resolution within two years. Gastric bypass may achieve diabetic remission within a few days or months.

“Cure” was defined as achieving normal blood glucose tests without diabetic medication.

Surgery carries its own risks, so nurses should council patient to consider this option in an open-minded comparison with their current medication and control regime for risk factors and side effects.

References:

American Obesity Association, and the National Institute of Diabetes,

Digestive and Kidney Diseases

Exercise
Nurses can now council patients that if they are able, weight training routines in an organized setting offers the greatest benefit for blood glucose control.  Exercise consisting of a warm up, easy cycling and stretching exercises, 45 minutes of intense resistance training, and cool down,  in a gym or health center shows long-term improvements in blood glucose control and insulin sensitivity greater than other forms of exercise, including attempting to follow the same routine outside of an organized setting.

Reference:

Dunstant, D.W. et al. Community center–based resistance training for the maintenance of glycemic control in adults with type 2 diabetes. Diabetes Care 29:2586–2591, 2006.

Foot Care
A new infrared thermometer can measure for areas of increased temperature, from inflammation responses, on the diabetic’s foot and provide a warning for potential skin breakdown days before it happens. This technique was able to reduce the incident of foot ulcers by nearly two-thirds in research participants.

Reference:

Armstrong, D.G. et al. Skin temperature monitoring reduces the risk for diabetic foot ulceration in high-risk patients. American Journal of Medicine 120:1042–1046, 2007.

Bo-tox
Injections of botulinum toxin to the throat muscles have proven effective for treating severe oropharyngeal dysphagia caused by diabetic nerve damage.

Most of the patients treated in the bo-tox trial experienced complete recovery of the swallowing function, the remaining few were found to have a significant improvement in over function, but not complete recovery.

Reference:

Restivo, D.A. et al. Botulinum toxin treatment for oropharyngeal dysphagia associated with diabetic neuropathy. Diabetes Care 29:2650-2653, 2006.

Type 1 Diabetes

Research has confirmed that the higher a child’s blood glucose level the more behavior problems a child will exhibit; this reaction is further amplified the longer the glucose level remains above normal.  The more tightly blood sugar levels are controlled the less likely it becomes that a child will act out.

Reference:

McDonnell, C.M., et al. Hyperglycemia and externalizing behavior in children with type 1 diabetes. Diabetes Care 30:2211-2215, 2007.

 

Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved



 
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Articles in this issue:

Masthead

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    Editor-in Chief:
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