Gut Checks Carry More Weight

When big-bellied patients come through the door of George Griffing's medical office in Brentwood, Mo., he pulls out a measuring stick.

Griffing, a professor of internal medicine at Saint Louis University School of Medicine, has those patients lie flat on their backs on an exam table. Then he measures the height of their bulging midsection from table top to tummy top.

"I'd like to use a ruler, but with a lot of patients I have to use a yardstick," he says. "What we're really looking for is how much fat is in the abdomen and the liver. It's simple and accurate and reveals a lot of information."

Medical experts have long suspected that people with excess deep-belly fat are at an increased risk for cardiovascular disease and Type 2 diabetes, and ongoing research bolsters that belief.

Griffing believes that measuring abdominal height is more efficient and accurate at predicting the risks of diabetes and cardiovascular disease than more commonly used methods such as calculating body mass indexes or waist-to-hip ratios, or measuring the circumferences of patients' waists. Those all factor in subcutaneous fat on arms, legs and hips, which is not as bad for you as fat in the gut, Griffing says. Griffing says most studies have found that abdominal heights that measure more than 10 inches in women and more than 12 inches in men triple the chance of cardiovascular disease.

The American Diabetes Association and the American Heart Association endorse using the midsection measuring technique. On its Web site, the American Diabetes Association calls it a simple, cheap and noninvasive tool but added that more research is needed.

New diabetes-related medicines being tested on patients

Four novel approaches to treat type 2 diabetes were discussed at the recent 69th Scientific Sessions of the American Diabetes Association.

All are in stage 3 clinical research trials right now. In other words, real patients are using these new treatments and their progress is being recorded and analyzed.

One treatment of great interest to anyone with diabetes is the possibility of taking insulin by mouth. New approaches have been developed to make this a reality. Until now, any insulin swallowed is damaged by the stomach acids. New discoveries allow the tissues inside the cheek to absorb insulin.

Another new category of anti-diabetic medicines called SGLT-2 inhibitors have been found to reduce blood sugars without the use of insulin. These drugs make the kidneys spill sugar into the urine. This has two potentially beneficial effects. First, it lowers blood sugar levels by helping the body eliminate high sugars faster. Second, the extra calories the sugar represents are lost. This helps the diabetic lose weight. Side effects seem to be minimal. Studies are under way to prove their value and effectiveness.

There is good evidence that the insulin-producing cells of the body are damaged and destroyed by inflammation in type 2 diabetics. That puts it in a similar category with other inflammatory diseases such as rheumatoid arthritis and gout. One new agent being investigated is called interleukin-2 (IL-2) beta receptor antagonist. Studies have shown the receptor plays a significant role in the death of the insulin producing cells. If this killer agent could be blocked, then insulin production would be preserved. Diabetes would be slowed or maybe even stopped.

Another anti-inflammatory agent being studied is Salsalate. Not only might this medication, which is chemically similar to aspirin, be helpful in preventing type 2 diabetes, but it also could protect against the damage to blood vessels so commonly seen in all diabetics. Salsalate is known to slow down overactive inflammatory pathways in type 2 diabetics. There is now good evidence that inflammation of blood vessels is closely associated with insulin resistance and impaired insulin secretion.

None of these medicines will be on shelves anytime soon. It’s important to study new medications for side effects and prove their value. Next, the FDA would need to evaluate these drugs and that process can take time before formal approval. Finally, like any other new medicines, don’t expect them to be inexpensive or covered by your health insurance.

As exciting as any new medicine may seem, the best management for any type of diabetes is carefully balancing food eaten, regular activity, and medications (only if needed). The Diabetes Prevention Program proved more than a decade ago that regular daily exercise combined with improved eating habits aimed at lowering weight by just 7 percent prevents diabetes better than any known medicine.

Extreme Glucose Levels In Diabetic Patients With Heart Failure Linked To Increase Risk Of Deaths

Compared with patients with moderately controlled glucose levels, diabetic patients who have heart failure and either too high or too low glucose levels may be at increased risk of death, said researchers at Baylor College of Medicine in a report published in the current issue of Journal of the American College of Cardiology.

To determine average glucose levels in the blood over a two to three month period, doctors measure glycosylated hemoglobin (the oxygen-carrying protein in the blood that is bound to the sugar glucose). In general, higher levels have been associated with increased risk of heart disease, said Dr. David Aguilar, assistant professor of medicine – cardiology at BCM.

"Most doctors try to keep glucose levels of those with diabetes as low as they can to lower the risk of complications such as eye problems, kidney disease or the development of heart disease," said Aguilar, senior author of the study. "However, we found that in diabetic patients with heart failure, glucose levels slightly higher than what are normally recommended had the lowest risk of death."

Researchers at BCM and the Michael E. DeBakey Veterans Affairs Medical Center in Houston identified 5,815 veterans with heart failure and diabetes who were receiving treatment at VA medical centers across the nation. They followed the patients for two years, dividing them into five categories based on their glycosylated hemoglobin levels.

Most medical professionals recommend levels at 7 and below as the target for optimal health for diabetic patients. However, the results of the study of diabetic patients with heart failure showed that those with levels 7.1 to 7.8 had the lowest rate of death. Those patients at both ends of the spectrum had the higher death risks.

"This doesn't mean that diabetic patients with heart failure should change their target goal for glucose levels," Aguilar said. "The results could simply be telling us that the glycosylated hemoglobin levels are a marker for other risks that are contributing to increased risk of death, but not necessarily the cause of the problem."

Aguilar said the correlation needs to be further investigated to confirm the findings and see what other factors could be contributing to the mortality rate.

The research is supported by a V.A. Health Services Research and Development Service grants and a National Institutes of Health Mentored Career Development Award.

Other researchers who took part in this study include, Drs. Biykem Bozkurt, Kumudha Ramasubbu and Anita Deswal, all from the Winters Center for Heart Failure Research and Section of Cardiology, and the Department of Medicine at BCM. Deswal is also at the Houston Center for Quality of Care and Utilization Studies at the Michael E. DeBakey V. A. Medical Center in Houston.