James Hubbard, M.D., M.P.H.

Happy World Kidney Day.

And you should be happy if your kidneys are functioning well.  You can’t live without at least one, you know.  Well, you can with treatment, but it’s such a pain.

Ask the approximately 150,000 Americans who have had to have a transplant, or the roughly 350,000 on dialysis.

And then there are the costs in dollars for treatment of end-stage renal disease (renal failure), over $32 billion per year, with Medicare fronting about $20 billion of that (6.7 percent of its overall expenditures).  The latest estimates are for a 60-percent increase by 2020.  Some of that is those with the disease will be living longer, but here is the take home message:

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by James Hubbard, M.D., M.P.H.

The CDC says we’re having a big problem with type 2 diabetes. It reported a whopping 90-percent increase in new cases from 2005 to 2007, compared to 10 years earlier.

What can we do? Perhaps genetic treatment is the answer!(?)

The current New England Journal of Medicine published two studies on whether we can better predict type 2 diabetes risk by looking at DNA variations on genes. If we could, we might also be able to individualize treatment, they thought. A double whammy.

Alas, they found that it doesn’t help much more than knowing family history and weight.  They hypothesized the reason was scientists haven’t found all the DNA sequences that affect diabetes.

Although I have simplified these complicated studies, that’s the gist.  But I looked at the results a different way.

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by James Hubbard, M.D., M.P.H.

D-blog day was created three years ago on November 9 ”to unite diabetic bloggers and create awareness about diabetes“–and we boy do we need awareness.

Almost everyone is affected by diabetes in some way or other.  You either have it or know someone who does.  In the U.S., 7.8 percent of people have diabetes, according to the CDC (PDF download). As many as 1/4 don’t know they have it.  Twenty-five percent of adults have prediabetes, but only 4 percent know it, says the CDC. Talk about needing awareness.

Have you had your sugar checked lately? Is it possible you have prediabetes?  Better read further to make sure.

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The United Kingdom Prospective Diabetes Study began in 1997. Little did they know that a twist in their plans would result in some surprising findings a few years later.

by James Hubbard, M.D., M.P.H.

Long-term complications of type 2 diabetes can be numerous and severe.  How can you best decrease these?

Treat it hard, fast and early says a new NEJM study, online since September 10, 2008.  Details follow, but the bottom line is, get your sugar under control ASAP after being diagnosed and you will decrease serious complications, even risk of death down the road.   Diet, exercise, oral medicines and insulin, whatever it takes.

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James Hubbard, M.D., M.P.H.

Scientists have now succeeded in manipulating the DNA in mouse cells to make them become different cells altogether, according to a Nature study, published online on August 27, 2008. They called it reprogramming.

There are two types of cells in the pancreas (which is where these came from).

• Exocrine cells produce digestive enzymes.
• Islet beta-cells produce insulin.

They are totally different, never performing the other ones’ function. When the islet beta-cells don’t work correctly, there is no insulin production, hence diabetes. Scientists have transplanted beta cells from another source into a pancreas before. It can work, but the body tries to get rid of (reject) these foreign cells so that’s a big problem. You have to take strong medication to weaken your immune system so your antibodies won’t reject a transplant.

But this is different. Consider the implications.

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by James Hubbard, M.D., M.P.H.

I have read and reread the obesity articles in the August 11/25, 2008, Archives of Internal Medicine attempting to glean a take-home message. They’ve been all over the news because they surprisingly concluded that about a third of overweight and obese people are at low risk for type 2 diabetes and cardiovascular disease. As if that weren’t enough, around a quarter of those at normal weight are at high risk.

So what is it about the fat that’s different? What do we do with this data?

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by James Hubbard, M.D., M.P.H.

The blood pressure in some people goes up just thinking about a medical clinic (white-coat hypertension). It is fine otherwise. Others have elevated blood pressures at certain times of the day. If you have hypertension, prehypertension, or at high risk for getting it, you should consider getting your own cuff. Don’t take my word, look at the AHA recommedations that suggest the same.

If you get a cuff, you want one that is accurate, don’t you? Consumer Reportshelps with unbiased recommendations for blood pressure monitors, along with glucose meters, in their September issue, along with tips such as:

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by James Hubbard, M.D., M.P.H.

With the FDA debating on diabetes drugs and heart disease, what can you do in the meantime to make sure you’re safe? Well, there just happens to be a proven, all-natural, drug-free method–without the extra-risk worries. What is it? You may have guessed.

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by James Hubbard, M.D., M.P.H.

So you’re diabetic. Your cholesterol is high, and you’re overweight; you’re at increased risk for cardiovascular disease. You start on medicine that lowers your sugar … but increases your risk for cardiovascular disease even more. Not good.

This is the dilemma in which patients, physicians and drug companies find themselves. Some studies have suggested that certain diabetes drugs may be worsening heart-disease risk. What to do?

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