High Risk people for Diabetes are:

African-American, American-Indian, Asian-American, Pacific Islander, or Hispanic/Latino.


Interior view of heart

What Physicians are Teaching You may be Killing You

Fact: Very little relationship exists between what a patient knows about diabetes and his or her control of its related cardiovascular risk factors and whether or not he or she ultimately succeeds or fails, indicated a study by Duke Clinical Research Institute.

Research found that improved disease knowledge alone does not lead to improved blood sugar control, cholesterol levels, weight management and mortality rates.

And, while education may be part of the puzzle, researchers noted there are likely other pressing health care delivery issues that must be addressed if a diabetic patient hopes to reduce their risks of dying from heart disease -- the main culprit of death among diabetic patients.

The Minute Role of Knowledge

Diabetic patients are twice as likely to suffer from acute coronary syndrome (ACS) than the general population; ACS can eventually lead to chest pain and possibly heart attack.

Considering the facts, researchers measured the progress of 200 diabetic patients who were treated for ACS. At enrollment, each patient took a 14-question standardized test that measured his or her knowledge on diabetes. Patients were then divided into two groups: high- or low-scoring.

Six months later, researchers linked how each of the groups scored with clinical measurements such as glycemic control, cholesterol levels, body mass index (BMI) and death. Data showed:

• The only parallel between the two groups was that diabetes-related knowledge scores rose as the years of education increased.

In terms of mortality, the high-scoring group had a six-month mortality rate of 6.2 percent, compared to 9.7 percent for patients in the low-scoring group.

• Moreover, 15.5 percent of the high-scoring group suffered from at least one heart attack, compared to 19.4 percent in the low-scoring group.

In light of the findings, researchers recognized the need to determine how to best assign scarce health care resources to reduce cardiovascular risk factors faced by diabetics.

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Heart Attack Warning Signs

Some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:
  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.   
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. 
  • Shortness of breath with or without chest discomfort.  
  • Other signs may include breaking out in a cold sweat, nausea or lightheadedness    

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Learn the signs, but remember this: Even if you're not sure it's a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1 or your emergency response number.

Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services (EMS) staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. It is best to call EMS for rapid transport to the emergency room.

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Stroke Warning Signs

If you or someone with you has one or more of these signs, don't delay!

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

Immediately call 9-1-1 or your emergency response number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) can reduce long-term disability for the most common type of stroke. tPA is the only FDA-approved medication for the treatment of stroke within three hours of stroke symptom onset.

TIA, or transient ischemic attack, is a "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage. Recognizing and treating TIAs can reduce your risk of a major stroke. The usual TIA symptoms are the same as those of stroke, only temporary. The short duration of these symptoms and lack of permanent brain injury is the main difference between TIA and stroke.

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Cardiac arrest strikes immediately and without warning. Here are the signs:

  • Sudden loss of responsiveness (no response to tapping on shoulders).
  • No normal breathing (the victim does not take a normal breath when you tilt the head up and check for at least five seconds). 

If these signs of cardiac arrest are present, tell someone to call 9-1-1 or your emergency response number and get an AED (if one is available) and you begin CPR immediately.  

If you are alone with an adult who has these signs of cardiac arrest, call 9-1-1 and get an AED (if one is available) before you begin CPR. 

Use an AED as soon as it arrives.

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Dial 9-1-1 Fast
Heart attack and stroke are life-and-death emergencies — every second counts. If you see or have any of the listed symptoms, immediately call 9-1-1 or your emergency response number. Not all these signs occur in every heart attack or stroke. Sometimes they go away and return. If some occur, get help fast! Today heart attack and stroke victims can benefit from new medications and treatments unavailable to patients in years past. For example, clot-busting drugs can stop some heart attacks and strokes in progress, reducing disability and saving lives. But to be effective, these drugs must be given relatively quickly after heart attack or stroke symptoms first appear. So again, don't delay — get help right away!

Statistics 
Coronary heart disease is the No. 1 cause of death in the United States. Stroke is the No. 3 cause of death in the United States and a leading cause of serious disability. That's why it's so important to reduce your risk factors, know the warning signs, and know how to respond quickly and properly if warning signs occur.

Act in Time
The American Heart Association and the National Heart, Lung, and Blood Institute have launched a new "Act in Time" campaign to increase people's awareness of heart attack and the importance of calling 9-1-1 immediately at the onset of heart attack symptoms. Find the links here.

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TYPE 1 DIABETES – STEM CELLS CLINICAL TRIAL

In VICTORIES & SUCCESS STORIES on September 14, 2009

C-Peptide Levels and Insulin Independence Following Autologous Nonmyeloablative Hematopoietic Stem Cell Transplantation in Newly Diagnosed Type 1 Diabetes Mellitus

Carlos E. B. Couri, MD, PhD; Maria C. B. Oliveira, MD; Ana B. P. L. Stracieri, MD, PhD; Daniela A. Moraes, MD; Fabiano Pieroni, MD, PhD; George M. N. Barros, MD; Maria Isabel A. Madeira, MD; Kelen C. R. Malmegrim, PhD; Maria C. Foss-Freitas, MD, PhD; Belinda P. Simões, MD, PhD; Edson Z. Martinez, PhD; Milton C. Foss, MD, PhD; Richard K. Burt, MD; Júlio C. Voltarelli, MD, PhD

JAMA. 2009;301(15):1573-1579.

Context In 2007, the effects of the autologous nonmyeloablative hematopoietic stem cell transplantation (HSCT) in 15 patients with type 1 diabetes mellitus (DM) were reported. Most patients became insulin free with normal levels of glycated hemoglobin A1c (HbA1c) during a mean 18.8-month follow-up. To investigate if this effect was due to preservation of beta-cell mass, continued monitoring was performed of C-peptide levels after stem cell transplantation in the 15 original and 8 additional patients.

Objective To determine C-peptide levels after autologous nonmyeloablative HSCT in patients with newly diagnosed type 1 DM during a longer follow-up.

Design, Setting, and Participants A prospective phase 1/2 study of 23 patients with type 1 DM (aged 13-31 years) diagnosed in the previous 6 weeks by clinical findings with hyperglycemia and confirmed by measurement of serum levels of anti–glutamic acid decarboxylase antibodies.
Enrollment was November 2003-April 2008, with follow-up until December 2008 at the Bone Marrow Transplantation Unit of the School of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil.
Hematopoietic stem cells were mobilized via the 2007 protocol.

Main Outcome Measures C-peptide levels measured during the mixed-meal tolerance test, before, and at different times following HSCT.
Secondary end points included morbidity and mortality from transplantation, temporal changes in exogenous insulin requirements, and serum levels of HbA1c.

Results During a 7- to 58-month follow-up (mean, 29.8 months; median, 30 months), 20 patients without previous ketoacidosis and not receiving corticosteroids during the preparative regimen became insulin free.
Twelve patients maintained this status for a mean 31 months (range, 14-52 months) and 8 patients relapsed and resumed insulin use at low dose (0.1-0.3 IU/kg).
In the continuous insulin–independent group, HbA1c levels were less than 7.0% and mean (SE) area under the curve (AUC) of C-peptide levels increased significantly from 225.0 (75.2) ng/mL per 2 hours pretransplantation to 785.4 (90.3) ng/mL per 2 hours at 24 months posttransplantation (P < .001) and to 728.1 (144.4) ng/mL per 2 hours at 36 months (P = .001).
In the transient insulin–independent group, mean (SE) AUC of C-peptide levels also increased from 148.9 (75.2) ng/mL per 2 hours pretransplantation to 546.8 (96.9) ng/mL per 2 hours at 36 months (P = .001), which was sustained at 48 months.
In this group, 2 patients regained insulin independence after treatment with sitagliptin, which was associated with increase in C-peptide levels.
Two patients developed bilateral nosocomial pneumonia, 3 patients developed late endocrine dysfunction, and 9 patients developed oligospermia.
There was no mortality.

Conclusion After a mean follow-up of 29.8 months following autologous nonmyeloablative HSCT in patients with newly diagnosed type 1 DM, C-peptide levels increased significantly and the majority of patients achieved insulin independence with good glycemic control.

Trial Registration clinicaltrials.gov Identifier: NCT00315133 Author Affiliations: Departments of Clinical Medicine (Drs Couri, Oliveira, Stracieri, Moraes, Pieroni, Barros, Madeira, Malmegrim, Foss-Freitas, Simões, Foss, and Voltarelli) and Social Medicine (Dr Martinez), School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil; and Division of Immunotherapy, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Burt).


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Our thanks to:
- American Journal of Cardiology June 1, 2005;95(11):1290-1294
- Duke University Medical Center June 2, 2005
- Guest Comment by Dr. Ron Rosedale:


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All material herein is provided for information only and may not be construed as personal medical advice. No action should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being. The FDA has not evaluated these statements. None of the information or products discussed on this site are intended to diagnose, treat, mitigate or cure any disease.


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