MD Conference Express - (Page 38)
n
O T H E R
N E W S
presence of peripheral neuropathies. Intranasal calcitonin may reduce bone turnover, a product of the RANK-L/OPG system, by inhibiting RANK-L. Unlike bisphosphonates, intranasal calcitonin may be used in patients with renal insufficiency [Bern et al. Diabetes Care 2004; Bern et al. Diabetologia 2006]. Preventing a recurrence remains a priority in diabetic foot ulcer management. Cumulative risk for ulceration by foot risk category may be one way of predicting recurrence. The risk groups range from 0 to 3 based on history and the presence of neuropathy or peripheral vascular disease (0=no neuropathy, no PVD; 1=neuropathy+/- deformity; 2=PVD +/- neuropathy; 3=history of pathology). Skin temperatures may provide important predictive data and indicate impending ulcerations. High temperature gradients between feet may predict the onset of neuropathic ulceration, and regular monitoring of bilateral foot temperatures may allow for early intervention and prevention (Figure 1) [Armstrong DG et al. Phys Ther 1997; Armstrong DG et al. Am J Med 2008; Lavery et al. Diabetes Care 2008]. Monitoring physical activity during drug therapy in the diabetic foot may also be a useful tool in predicting disease progression. Figure 1. Are Skin Temperatures Predictive of Ulceration?
HEALTHY Study Group Achieves Modest Improvement in SchoolBased Intervention
The HEALTHY study, a name that was selected by the targeted middle school student population, was initiated after a pilot investigation in 2003 documented a high prevalence of risk factors for diabetes in 8th grade students in the United States [Diabetes Care 2006]. Indeed, of the 1740 subjects who were observed, 49% had a body mass index (BMI) ≥ the 85th percentile (the cutoff for overweightness and obesity); 40.5% had fasting blood glucose (FPG) ≥100 mg/dl; and 36.2% had fasting insulin ≥30 µU/ml, suggesting that middle schools could be logical venues for population-based efforts to prevent or delay the onset of type 2 diabetes mellitus (T2DM). As described by Kathryn Hirst, PhD, George Washington University Biostatistics Center, Rockville, MD, the HEALTHY study enrolled 6th grade students from 42 middle schools and followed them through 8th grade (n=4603). School eligibility required a ≥50% minority student body and/or ≥50% of students who were eligible for free/reduced rate lunch. Schools were randomized 1:1 to either control (observation only) or a comprehensive intervention program that was conducted by teachers and school officials that targeted nutrition, physical activity, and personal behavior [The HEALTHY Study Group. Internatl J Obesity 2009]. At baseline, subjects were assessed for physical measurements and fasting blood was drawn to determine FBG, insulin, HbA1C, and lipids; self-reports of diet, exercise, and quality of life were also collected. The same data were collected at the end of study following two and a half years of HEALTHY intervention delivery. Primary endpoints for the study included measures of adiposity, glucose, and insulin. Gary D. Foster, PhD, Temple University, Philadelphia, PA, reported the primary results of the study [The HEALTHY Study Group. N Engl J Med 2010]. For BMI ≥85th percentile (defined as overweight and obese categories), the changes that were observed for the intervention versus control group were not statistically significant, though significance was seen for BMI z-scores (p=0.04; Table 1). Average waist circumference and FBG were not significantly different; however, significant differences were observed for fasting insulin levels (p=0.04) as well as for reductions in measures
Normal prints
“Hot Spot” on the left foot
Reproduced with permission from D. Armstrong, MD.
Optimal diabetic foot management incorporates innovative strategies, such as a team approach, new technologies, and predictive risk assessment tools. Treating the acute foot wound is a complex endeavor, and preventing recurrence is an important part of successful management.
38
August 2010
www.mdconferencexpress.com
Table of Contents for the Digital Edition of MD Conference Express
MD Conference Express
Contents
Real-Time Continuous Glucose Monitoring and Diabetes Treatment
The Globalization of Diabetes
Treat the Individual, Tend to the Population
Microvascular Outcomes from the ACCORD Trial
Diabetic Retinopathy in the ACCORD Trial
Results from the STAR 3 Study
Findings from HELP PD
Insights from the BARI 2D Trial
Effect of Atorvastatin on Beta Cell Function
Caffeine Supplementation Reduces Exercise Induced Hypoglycemia
Cardiometabolic Risk
Point of Care Devides
Newer Insulins
Diabetes, Glycemia and Cardiovascular Disease: Is it Time to Rethink the Regulatory Approach?
Diabetes and Cancer: ADA Consensus Statement
The Diabetic Foot Wound
HEALTHY Study - Middle School-Based Intervention to Reduce Diabetes Risk
MD Conference Express
https://www.nxtbookmedia.com