In a study encompassing more than 500,000 adolescents at middle schools and high schools in California, researchers report a link between obesity and fast food chains. In a study published in the American Journal of Public Health, researchers report that the closer geographically fast food chains are to schools, the more likely kids attending these schools will be obese. According to government data, 32% of US kids are overweight, while 16% are obese. This is alarming data, not just because this relationship is significant, but also because it appears that fast food chains are intent on clustering around schools. Suffice it to say, that just as we would like our school neighborhoods to be clear of drugs and alcohol, we should also strive for them to be clear of fast food chains.

Aspirin and the Risk of Cardiovascular Events:

A daily small dose of Aspirin (81 mg) has been advocated by most physicians as prevention of heart disease. This is especially true in diabetics, who are more at risk for this complication. A new study, which is the largest primary prevention trial of aspirin in type 2 diabetics, was just reported at the American Heart Association.  The study was conducted in Japan, and looked at 2,539 patients with diabetes who had no history of previous heart disease. The study lasted 4.4 years, and showed that only at ages older than 65 was there a significant reduction of vascular events when patients were prescribed a low-dose aspirin. All of you out there who are younger, may not need to take aspirin, but please consult your physician.
 

Oral Insulins:

Two new oral insulins are currently in clinical trials, and the reports are favorable.  The first is called Capsulin, and is made by Diabetology Ltd, and the second is called IN-105, and is made by Biocon Pharmaceuticals.  Capsulin is an enteric-coated capsule formulation of unmodified human (recombinant) insulin, whereas IN-105 is a conjugated insulin molecule taken orally.  Although not yet approved by FDA, these preparations offer hope to all those needle-phobic patients out there.  Previous trials to deliver insulin orally have all failed due to the stomach acid destructive effects.
 

Candesartan (Atacand) Has Direct Effects On Retinopathy:

In a large study presented at the annual meeting of the European Association for the Study of Diabetes, researchers from Denmark showed the effect of Atacand (an ARB - Angiotensin Receptor Blocker) on development and regression of Retinopathy (eye complications from diabetes) in type 1 and 2 Diabetes.  In type 1 diabetics, results were not statistically significant, in type 2 however, there was a 34% regression in retinopathy. This is important, because it shows that these classes of drugs work beyond their anti-hypertensive effect. In addition to their well know effect of protecting the kidneys, we now can use them for their retinopathy protection as well.
 

Prepregnancy Diabetes and Birth Defects Risk:

Women diagnosed with diabetes prior to pregnancy are 3-4 times more likely to have a child with birth defects compared to women who don't have diabetes prior to pregnancy.  This data comes from a study following more than 15,000 live births and is published by the American Journal of Obstetrics and Gynecology.  The actual prevalence of pregestational diabetes in mothers of infants with birth defects was 2.2%, as opposed to 0.5% in the control group.  The type of birth defects were cardiac, hydrocephalus, cleft lip (with or without cleft palate), anorectal atresia (lack of development of anus/rectum), and limb deficiencies.  Mothers, please consult your doctor about your diabetes-risk.
 

Incidence of Diagnosed Diabetes in the US:

Data from the recent Morbidity and Mortality Weekly Report has shown a rise in new cases of diabetes of greater than 90% among adults during the last 10 years.  During the years 1995-1997 the incidence reported was 4.8 per 1000, whereas during 2005-2007 the incidence rose to 9.1 per 1000.  State-specific, age-adjusted incidence of diabetes ranged from 5 per 1000 in Minnesota to 12.8 per 1000 in Puerto Rico.  As per the greatest number of annual new cases, California, Texas, and Florida took the lead.  Much needs to be done in order to reverse this trend (YL).
 

Gadgets:

• Lancing device: Pelikan Sun electronic lancing device incorporates a 50-lancet disk that automatically uses a new lancet for each blood glucose check.  The device features 30 settings for depth, speed, and "dwell time".  The user never has to see or handle a lancet.
  Info at 877 PELIKA (735-4526), or at www.pelikansun.com.
• Blood Glucose Meters: Clever Chek Auto-Code Voice made by Simple Diagnostics.  This is a meter for people who are blind or have limited vision.  This is a no-coding meter that has a large display and provides spoken instructions and glucose reading in either English or Spanish.  Info at 877 DIABETK (342-2385) or at www.simplediagnostics.com.
• Home HbA1c test: The Appraise Home A1c Kit allows users to check their A1c at home by collecting a small amount of blood from a finger tip sample onto a piece of filter paper which is then sent to Heritage Labs International for evaluation.  More info at (888) 764-2384, or at www.appraisetests.com.
• Syringes: PIC Insumed Syringes are packaged with a clip-on magnifying glass, making seeing and drawing insulin doses easier.  More info at (866) MEDPLAS (633-7527), or at www.medplas.com.
• Sharps disposal container: approved to hold one syring.  (800) 299-5704 or www.medportllc.com.
• Insulin vial protector: a sleeve designed to protect the insulin vial.  www.securiteeblanket.com.
• Diabetes Medicine Guide in Spanish: A new guide, "Pastillas para la diabetes tipo 2: guia para adultos", offers information in Spanish on 10 generic and 13 brand-name oral diabetes medications for patients.  The information can be downloaded at http://effectivehealthcare.ahrq.gov.
  

Cuisine Corner:

Greek Feta Chicken - recipe from Diabetes Forecast Dec 2008.

1. Cook the orzo according to package directions (but without added salt or fat).  While the orzo cooks, sprinkle the chicken breasts with oregano, salt, pepper, and ground red pepper.
2. Heat 2 tsp. of the oil in a large nonstick skillet over medium-high heat.  Add the chicken breasts and cook on both sides for about 4 to 5 minutes until no longer pink.  Remove the chicken from the skillet.
3. Drain orzo and keep warm.
4. Lower the heat to medium and add remaining oil.  Sauté the peppers for 3 minutes.  Add the garlic and sauté for 1 minute more.  Add the lemon juice and cook for 1 minute.  Add back the chicken breasts to the skillet.  Top with feta cheese, cover, and cook 1 minute until cheese slightly melts.  Serve over cooked orzo.

Makes 4 servings.  Serving size: 1 breast, ½ cup orzo, Preparation time: 5 minutes; Cooking time: 15 minutes. 

Nutrition facts: Starch exchanges: 1, Vegetable exchanges: 1,  Lean meat exchanges:3,  Fat exchanges:1,  Amount per serving: Calories 290, Total fat:8 g, Cholesterol:70 mg, Sodium 430 mg, Total Carbohydrates: 24 g, Protein: 29 g.

Reflections:
All of us are exposed to the barrage of different diets that are offered by many professionals.  We all have difficulties in deciding which diet is better for us.  The proponents will list the advantages of their diet, but that still leaves us with a huge selection.  We also hear about the importance of physical activity, and I, for one, will ask you to do at least 200 minutes weekly - aerobic, of course.  But different recommendations are out there, and some focus on building muscle and not on aerobic.  What is one to do?  I suggest a different approach.  Let's focus on the element of time.  We have only 24 hours in a day.  How should one spend one's time?   Let's organize our time and focus on it as our premier commodity.  Let's devote 8 hours to sleep and all activities related to it, and let's allocate 10 hours to work.  That leaves 6 hours for everything else.  I would strongly suggest that you devote one hour daily for physical activity, which would leave us with only 5 hours for everything else.  Into that time slot we have to squeeze family, chores, bills, hobbies, down-time, and of course, meals.  I suggest that we allow only 2 hours a day for meals, which would leave 3 for the rest.  This would limit the time that we actually sit at the table, which is a good thing, and should also promote us to "pay-back" in physical activity-time if we sit at the dinner table too long.  This focusing on time may not work for everyone, but it's worth a try.  Look at your watch when you sit down to eat, and make sure you don't spend more than 2 hours a day at that location.  You may be surprised at the results.