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Senior Citizen Health & Medicine
Hypertension Guidelines Fail to Improve Blood
Pressure Control in Diabetics
Second
study finds adolescent pupil size predicts later complications; ADA
publishes new clinical practice recommendations
December 27, 2006 – The year ends with bad news for
those involved in the battle against diabetes. Despite the publication
of increasingly aggressive guidelines for lowering blood pressure in
people with diabetes, this condition remains substantially unimproved.
But, some hope in another area of this fight is the discovery that small
pupil size during adolescence may help predict diabetes-related
complications later in life.
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Both studies are being published in the
January issue of Diabetes Care.
The study focusing on small pupil size during
adolescence, says this may help predict diabetes-related complications
as people age, such as retinopathy and microalbuminuria, a marker for
both cardiovascular and kidney disease.
The January issue of Diabetes Care also includes
the American Diabetes Association's (ADA's) new Clinical Practice
Recommendations, which are revised on an annual basis.
Hypertension Guideline Changes Fail to Improve
Control
The blood pressure study, which compared
hypertension control in people with and without diabetes from 1995-2005,
showed that reducing blood pressure goals twice for people with diabetes
during the past decade did little to improve control of this condition.
The findings are consistent with other recent studies which showed that
doctors fail to aggressively treat high blood pressure in people with
diabetes, despite the fact that hypertension is a major symptom of
cardiovascular disease, the leading killer of people with diabetes.
In 1997, and again in 2003, the Joint National
Committee on Prevention, Detection, Evaluation and Treatment of High
Blood Pressure (JNC) lowered blood pressure goals for people with
diabetes. They currently recommend that people with diabetes keep blood
pressure at or below 130/80 mmHg.
The changes, however, "did not lead to
substantially better hypertension control for diabetics compared with
non-diabetic patients," the researchers concluded. "This finding is
somewhat surprising considering the recognition of JNC guidelines as the
gold standard for hypertension treatment, similar recommendations from
other organizations such as American Diabetes Association, American
College of Physicians, and American Academy of Family Physicians, and
public health efforts to promote comprehensive diabetes care."
Previous studies have shown that doctors
intensified treatment of high blood pressure during as few as 12 percent
of office visits when people with diabetes presented with this problem.
High blood pressure can be treated through lifestyle and dietary changes
as well as with numerous medications. Many people with diabetes also
exhibit high blood pressure, an early warning sign for the development
of heart disease.
Identifying effective interventions to deal with
the challenge of lowering blood pressure in people with diabetes should
be a top priority for future research, the authors concluded.
Small Pupil Size Predicts Complications in
Adolescents
In a separate study, researchers identified a
predictive relationship between small pupil size in adolescents with
type 1 diabetes and the presence of microalbuminuria and retinopathy 12
years later. Small pupil size has been used to predict mortality in
adults with diabetes but has not often been used in adolescents.
This study, by researchers in Australia, found that
adolescents with type 1 diabetes whose pupils were reduced in size were
at higher risk for complications from their disease in their 20s. In
particular, they were at greater risk for retinopathy - a progressive
eye disease - and microalbuminuria, or the presence of small amounts of
albumin in the urine, which indicate cardiovascular and kidney problems.
The researchers recommend further research to
determine if improved glycemic control when pupil abnormalities first
appear would improve the condition and lead to fewer complications.
Clinical Practice Recommendations Updated
The ADA's Clinical Practice Recommendations have
been updated to include new information about treatment and prevention
that reflects the latest research. Changes have been made in numerous
areas, including the management of hyperglycemia in type 2 diabetes;
nutrition recommendations; and screening and treatment for children who
have both type 1 diabetes and celiac disease.
Managing hyperglycemia can be a problem for many
people with type 2 diabetes. The revised recommendations now include
information from a Consensus Statement published by the ADA and the
European Association for the Study of Diabetes (EASD), which advises
early intervention with metformin in combination with lifestyle changes
to improve glycemic control. It also advises early initiation of insulin
for those who present with weight loss and more severe symptoms.
In 2006, the ADA published Medical Nutrition
Therapy (MNT) guidelines for people with diabetes, specific to
individual populations, such as those who are obese or pregnant. The
Clinical Practice Recommendations have been updated to reflect these
guidelines and to encourage people with diabetes or pre- diabetes to
seek individualized MNT to help them achieve their treatment goals.
Information about how to treat children who are
diagnosed with both type 1 diabetes and celiac disease was also added to
the Clinical Practice Recommendations this year. Up to 16 percent of
children with type 1 diabetes are also diagnosed with celiac disease, an
immune disorder that affects the digestive system, damages the small
intestine and interferes with the absorption of nutrients from food.
The recommendations call for more aggressive
screening for celiac disease in children with type 1 diabetes who
present symptoms such as weight loss, growth failure, abdominal pain and
chronic fatigue. A gluten-free diet is recommended for those who test
positive for celiac.
Editor's Notes:
Diabetes Care, published by the American Diabetes
Association, is the leading peer-reviewed journal of clinical research
into the nation's fifth leading cause of death by disease. Diabetes also
is a leading cause of heart disease and stroke, as well as the leading
cause of adult blindness, kidney failure, and non-traumatic amputations.
For more information about diabetes, visit the American Diabetes
Association Web site
http://www.diabetes.org or call 1-800-DIABETES (1-800-342-2383).
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