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Diabetes Update: A1c<7

Number 50; December 2, 2002

By David Mendosa

chimp and me My Little Chimp Friend Upcountry Liberia, 1971

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contribution is:

    on December 2, 2002
  • A1c<7
    The folks who sponsor the Diabetes A1c Initiative failed to ask for my support, so I will try to help with what I write about it. The campaign features a team of patient advocates known as A1c Champions who will tour the country and give tips about keeping diabetes under control. If I believe in anything, it is the importance of controlling my diabetes and that regular A1c tests are the best measure that I have to make sure that I am doing that.

    My A1c had crept up to 6.8 last year. That was enough to get me to ask my endocrinologist to prescribe metformin. My most recent test a few months ago came in at 6.2, precisely the point where the U.K. Prospective Diabetes Study says that complications begin.

    Those A1c Champions who are fated to have to campaign without me seek to persuade the world—or at least all Americans with diabetes—that we have to bring down our A1c levels. Nobody knows exactly, but those levels are typically 8.5 to 9. The Diabetes A1c Initiative that they are campaigning for seeks to bring those levels down to 7. Why not to 6.2 or below?

    The answers to that are in my column. You can find it at http://www.diabetes.org/main/community/info_news/web/default.jsp

Updates include:

      on November 20, 2002
  • GLP-1
    One of the most exciting drugs on the horizon for people with type 2 diabetes is AC2993, which in April I wrote about in Diabetes Update Number 36 and my “About the Internet” column for the American Diabetes Association. Amylin Pharmaceuticals now has AC2993 in Phase 3 clinical trials.

    AC2993 is certainly a bland, bureaucratic name for a drug with such an interesting origin and great promise. It is based on Gila monster venom. An extended release form, AC2993 LAR, may offer allow once-a-month injection of AC2993. It is currently in Phase 2 evaluation.

    These drugs are peptides that exhibits several anti-diabetic actions of the mammalian hormone glucagon-like peptide (GLP-1). But unlike GLP-1, which has activity measured in minutes, AC2993 and particularly AC2993 LAR have a prolonged duration of action.

    Several other companies are racing to develop sustained release formulations of GLP-1 analogs. However, Lilly is no longer one of these companies. In September Lilly announced that it was discontinuing its GLP-1 analog program at the time it announced a partnership with Amylin for the development and marketing of AC2993 and AC2993 LAR. Lilly has invested $110 million in Amylin, according to this SEC filing.

    A Novo Nordisk candidate, NN2211, is another once-a-day formulation of a GLP-1 analog. Two studies reported this year in professional publications of the American Diabetes Association, Diabetes Care and Diabetes, had promising results in trials with eight and 11 subjects respectively.

    ConjuChem Inc., a biotechnology company based in Montreal, in July announced the start of a Phase 1 clinical trial for a GLP-1 analog. The company says that they anticipate that the optimal dosing regime will be no more frequent than once per week.

      on December 1, 2002

  • Forthcoming Meter
    Months ago I picked up rumors of a new LifeScan system that combines everything I ever wanted in a blood glucose meter. My requirements are the capability to use it on alternative sites where we have few nerve endings, a small drop of blood, fast results, and event codes such that only the One Touch Profile has had. Now a German site has a picture and description of the meter that makes me think we will have it soon. It’s the One Touch UltraSmart and you can read all about it at http://www.diabetes-kids.de/pics/onetouch_ultrasmart.jpg and http://www.fda.gov/cdrh/pdf2/k021819.pdf. I updated my On-line Diabetes Resources Part 14: Blood Glucose Meters page accordingly.

Research Notes:

      on November 19, 2002
  • More AGEs
    I sense extraordinary resistance to the recommendation that we reduce our intake of advanced glycation end products (AGEs) in order to limit the damage to our blood vessels that they may cause. Helen Vlassara, M.D., a professor at the Mount Sinai School of Medicine in New York, is the lead author of a research report that says we have to radically change the way we cook our foods.

    Some of us are quite interested in Dr. Vlassara’s findings, judging from the number of questions I have received. I passed on the questions to her and her associates. They initially replied by sending me a Microsoft Word file, “Low AGE Meal Plan Instructions.” So that everyone can read it, I used Adobe Acrobat to convert it to a PDF, which I uploaded to my site as http://www.mendosa.com/Low AGE Meal Plan Instructions.pdf.

    Readers wanted to know how cooking in crockpots or in pressure cookers would affect the formation of AGEs. There is also a question about coffee. The “Low AGE Meal Plan Instructions” say, “Limit hot cocoa mixes or chocolate drinks. All others are allowed as desired. Examples are coffee, tea and sodas.”

    But the AP article says, “Vlassara said that coffee, cola and chocolate drinks also are loaded with AGEs.” Should we drink it or not?

    When I asked Dr. Vlassara about these questions, I received this reply from Teresia Goldberg, MS, RD, CDE, the research dietitian who works with her:

    "Regarding AGEs in coffee and colas: These beverages contain higher levels of AGE as compared to milk, water, and juices. Consuming large quantities of these beverages will add to the AGE load, but the major contributors will be protein foods. However, these beverages can be consumed if the major contributors are controlled.

    "We have not tested foods prepared in crockpots or in pressure cookers. However, from the data we do have we know that time is also a factor in AGE generation. The longer cooking time would be expected to increase AGE content. Pressure cooking does reduce cooking time, but pressure also changes protein conformations and may promote more rapid AGE formation."

Book Review:

    on November 20, 2002
    Nutrients for Neuropathy
  • Nutrients for Neuropathy
    The third volume in John Senneff’s "Numb Toes Series," Nutrients for Neuropathy doesn’t quite have the catchy title of its predecessors, Numb Toes and Aching Soles and Numb Toes and Other Woes. Yet the more limited scope of the current book allows John to go into even greater depth.

    These books come from the patient standpoint. John, a retired attorney, suffers from peripheral neuropathy. But don’t be concerned about legalese here. John writes with extraordinary clarity in this 172-page paperback book. This is an easy read on a hard subject. Just published by http://www.medpress.com, Nutrients for Neuropathy lists for $19.95.

    The main divisions of the book are vitamins, minerals, and other supplements. In each of these areas I appreciated John's precision and at the same time found myself wishing that he had gone a bit further. Among vitamins, for example, he recognizes that Vitamin E contains four different tocopherols only in a footnote, and even there says that "Commercially available vitamin E supplements contain primarily alpha-tocopherol." The people at TwinLab and NOW Foods who sell mixed tocopherols might be surprised to hear that.

    Likewise, he has an excellent discussion of the efficacy of magnesium, but ignores the question of what balance it needs to have with calcium intake. For omega-3 fatty acids he recommends more and for omega-6 less, consistent with what most of the experts say.

    But I wonder about his recommendation of 1800 mg of EPA and 900 mg of DHA, the two main omega-3 oils we get from fish. I wish that he had considers some recent studies that may show better results with DHA alone.

    In spite of these, er, peripheral reservations, I provide a positive link to John’s new book on my neuropathy links page, On-line Diabetes Resources Part 15: Diabetic Neuropathy.

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