NICE Issues Updated Guidance On The Use Of Insulin Pump Therapy

By admin

NICE has published its final guidance on the use of continuous subcutaneous insulin infusion (CSII or ‘insulin pump’) therapy. This is a review of guidance on the use this technology published in February 2003.

For adults and children 12 years and older with type 1 diabetes, the guidance recommends insulin pump therapy as a treatment option provided that:

-
attempts to reach target haemoglobin A1c (HbA1c) levels with multiple daily injections result in the person having ‘disabling hypoglycaemia’ 1 or

-
HbA1c levels have remained high (8.5% or above) with multiple daily injections (including using long-acting insulin analogues if appropriate) despite the person and/or their carer carefully trying to manage their diabetes.

Insulin pump therapy should only be continued in adults and children 12 years and over if there has been a sustained improvement in the control of their blood glucose levels.

1 Hypoglycaemia means that treatment for diabetes can also cause blood glucose levels to become too low, causing the person to become anxious, dizzy or disoriented, have convulsions or become unconscious. ‘Disabling hypoglycaemia’ is when hypoglycaemic episodes occur frequently or without warning so that the person is constantly anxious about another episode occurring, which has a negative impact on their quality of life.

For children under 12 years with type 1 diabetes, the guidance recommends the use of Insulin pump therapy as a possible treatment if treatment with multiple daily injections is not practical or is not considered appropriate. Children who use insulin pump therapy should have a trial of multiple daily injections when they are between the age of 12 and 18 years.

Insulin pump therapy is not recommended for the treatment of people with type 2 diabetes.

Insulin pumps are small devices worn outside the body, which continuously deliver insulin into the body through a very thin tube or needle inserted under the skin. The insulin can be delivered at a set rate throughout the day, which can be increased when it’s needed, for example, at meal times.

Andrew Dillon, NICE Chief Executive, said: “People with type 1 diabetes need daily injections of insulin to survive. One of the main drawbacks of conventional insulin regimens is the difficulty individuals can have in constantly achieving blood glucose control and balancing the risk of disabling hypoglycaemia, and hyperglycaemia [too high a level of blood glucose] - both of which can be potentially life-threatening. Today’s guidance reaffirms NICE’s original recommendations for the use of insulin pumps published in 2003. It means that people will continue to be able to access this important technology to achieve better blood glucose control, resulting in an improved quality of life and fewer situations where they need help from others.”

The guidance is available on the NICE website at
http://www.nice.org.uk/TA151

About NICE

1.
The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2.
NICE produces guidance in three areas of health:

-
public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

-
health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS

-
clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

National Institute for Health and Clinical Excellence

Inheritance Of Hormonal Disorder Marked By Excessive Insulin In Daughters

By admin

Elevated levels of insulin could be an early sign that girls whose mothers suffer from polycystic ovary syndrome — or PCOS — may also be susceptible to the disease, according to gynecologists who have found evidence of insulin resistance in young children.

The findings could help determine whether daughters of women suffering from PCOS are at a higher risk of developing the disease, compared to girls whose mothers do not have the disease.

Polycystic ovary syndrome is a common hormonal disorder that affects women of reproductive age, and sometimes causes inability to become pregnant. Symptoms include hairiness due to excessive amounts of male hormones, irregular periods, and insulin resistance.

“We found insulin resistance in children who had entered puberty, and whose mothers had PCOS,” said Richard Legro, M.D., professor of obstetrics and gynecology, Penn State College of Medicine and lead author. “We did not find it in the youngest children, which suggests that the disease is triggered by puberty.”

Legro and his colleagues were interested in finding out whether metabolic and reproductive abnormalities associated with the inheritable disease, are more likely to show up in children whose mothers have PCOS, and how parents could find out whether their child was at risk.

The researchers designed a study to compare 38 children — boys and girls aged 4 to 14 — whose mothers had PCOS with 32 children in a control group. They specifically looked for the early onset of androgen — male hormones — production, and production of excess insulin.

“We collected samples of saliva and urine to analyze levels of insulin and sex steroids respectively,” explained Legro. “But we also looked for gonadotropins, hormones that stimulate sex steroids and provide the earliest sign of puberty.”

Results from the test indicate that older girls, but not boys, of PCOS mothers had significantly higher concentrations of salivary insulin. Compared to the control group, the girls also had lower levels of urinary hormones.

According to Legro, the key finding of the study is that insulin levels appear to be elevated in daughters of PCOS mothers, which becomes more pronounced as they pass through puberty. Since the androgen levels were comparatively normal throughout puberty, and insulin resistance was only found in girls who had undergone puberty, Legro argues that insulin is the primary problem, while male hormones are a secondary problem.

“Insulin is the real culprit in terms of stimulating the ovary, more so than gonadotropins, said Legro, whose findings appeared in a recent issue of The Journal of Clinical Endocrinology and Metabolism and was the subject of an editorial in the same issue.

“You could argue children of PCOS mothers build up excessive insulin during puberty, which in turn contributes to reproductive abnormality,” explained Legro.

However, Legro cautions that it may be too early to conclude that excessive insulin is the sole factor that makes daughters of PCOS mothers susceptible to the disease. He is also not fully sure whether hyperandrogenism — excess of male hormones — precedes or follows excessive levels of insulin.

Researchers say future longitudinal studies will focus only on girls and try to pin down whether an abnormal level of insulin is the sole factor that causes reproductive abnormalities.

“That is the tantalizing question,” the Penn State medical researcher said. “The ultimate goal would be to find the earliest sign that makes a child more susceptible to develop PCOS. Right now the earliest sign would be an elevation in insulin levels.”

Legro’s work is funded by the National Institutes of Health.

Other researchers on the paper are Sarah C. Kent, family medicine physician; Allen R. Kunselman, senior research assistant; Laurence M. Demers, M.D., distinguished professor emeritus of medicine and pathology; Carol L. Gnatuk, M.D., professor of obstetrics and gynecology; Peter A. Lee, professor of pediatrics; and William C. Dodson, M.D., professor of obstetrics and gynecology, all at Penn State College of Medicine. Penn State College of Medicine is at http://www.pennstatehershey.org/

The Department of Obstetrics and Gynecology is at http://www.hmc.psu.edu/womens/

Source: Megan Manlove

Penn State

Nerve, Vascular Damage From Diabetes Reduced By Compound That Helps Rice Grow

By admin

Researchers have found that a compound that helps rice seed grow, springs back into action when brown rice is placed in water overnight before cooking, significantly reducing the nerve and vascular damage that often result from diabetes.

“You have to let it grow, germinate a little bit,” says Dr. Robert K. Yu, director of the Institute of Molecular Medicine and Genetics and Institute of Neuroscience at the Medical College of Georgia. “Some of the active ingredients generated as a result of the germination process are beneficial to you.”

Germinated brown rice’s ability to help diabetics lower their blood sugar has been shown but how it works remained unknown. New research, published online in the Journal of Lipid Research, shows the growth factor acylated steryl glucosides or ASG, helps normalize blood sugar and enzymes that are out-of-whack in diabetes.

“The advantage of knowing this key ingredient and its structure is we can now make a ton of it; you don’t have to rely on rice to produce it or eating rice to get this beneficial effect,” says Dr. Yu, the paper’s corresponding author.

Studies were done in animal models of type 1 diabetes with two different blood sugar levels that reflect patients’ varying blood sugars. They were fed diets of white, brown or pre-germinated brown rice. Unlike white rice, less-processed brown rice still has some of the germ or growth structure that, after about 24 hours in water, resumes activity. Scientists watched as the resurrected ASG, a growth factor and lipid, helped normalize metabolism.

“When blood sugar levels increase, the metabolic balance changes,” says Dr. Seigo Usuki, neurobiologist in the MCG School of Medicine and the paper’s first author. “Part of the way we know this growth factor works is by increasing levels of good enzymes that are decreased in diabetes.”

Dr. Usuki is talking about enzymes such as ATPase, which help maintain nerve membranes so they can conduct electricity and communicate. Decrease of ATPase is a hallmark of the nerve damage that accompanies diabetes. Also reduced in diabetes is homocysteine-thiolactonase, or HTase, an enzyme that decreases levels of homocysteine, a known risk factor for vascular disease. The liver produces a low level of homocysteine but that level is elevated in diabetes while the enzyme that controls it decreases. Unchecked, homocysteine makes oxidative stress compounds that injure and kill cells. HTase is one way HDL, the so-called “good cholesterol,” helps protect blood vessels from disease. A regular diet of pre-germinated brown rice diet helps get both back to a healthier level.

Fancl Hatsuga Genmai Co., Ltd., in Yokohama, Japan, which funded the studies and supplied the pre-germinated rice, already is working with Dr. Usuki on a supplement that can provide consumers who prefer not to soak - or eat - rice with the benefits of ASG.

The MCG research team reported in December 2007 in Nutrition & Metabolism that pre-germinated brown rice was better at protecting nerves from diabetes than un-soaked brown or white rice. They showed a then-unidentified lipid helped protect the nerve membrane and increase activity of HTase and the good cholesterol. Germination also is known to increase levels of the neurotransmitter GABA, which is believed to have many beneficial health effects such as lowering blood pressure, improving cognition and lowering blood glucose levels. However the MCG scientists have shown the lipid has a more powerful impact on HTase activity.

The germ layer activated by soaking brown rice contains many vitamins and minerals in addition to the bioactive ingredient that would be beneficial to everyone, Dr. Yu says. The roughage of the rice grain also is helpful.

Source: Toni Baker

Medical College of Georgia

NICE Issues Updated Guidance On The Use Of Insulin Pump Therapy

By admin

NICE has published its final guidance on the use of continuous subcutaneous insulin infusion (CSII or ‘insulin pump’) therapy. This is a review of guidance on the use this technology published in February 2003.

For adults and children 12 years and older with type 1 diabetes, the guidance recommends insulin pump therapy as a treatment option provided that:

-
attempts to reach target haemoglobin A1c (HbA1c) levels with multiple daily injections result in the person having ‘disabling hypoglycaemia’ 1 or

-
HbA1c levels have remained high (8.5% or above) with multiple daily injections (including using long-acting insulin analogues if appropriate) despite the person and/or their carer carefully trying to manage their diabetes.

Insulin pump therapy should only be continued in adults and children 12 years and over if there has been a sustained improvement in the control of their blood glucose levels.

1 Hypoglycaemia means that treatment for diabetes can also cause blood glucose levels to become too low, causing the person to become anxious, dizzy or disoriented, have convulsions or become unconscious. ‘Disabling hypoglycaemia’ is when hypoglycaemic episodes occur frequently or without warning so that the person is constantly anxious about another episode occurring, which has a negative impact on their quality of life.

For children under 12 years with type 1 diabetes, the guidance recommends the use of Insulin pump therapy as a possible treatment if treatment with multiple daily injections is not practical or is not considered appropriate. Children who use insulin pump therapy should have a trial of multiple daily injections when they are between the age of 12 and 18 years.

Insulin pump therapy is not recommended for the treatment of people with type 2 diabetes.

Insulin pumps are small devices worn outside the body, which continuously deliver insulin into the body through a very thin tube or needle inserted under the skin. The insulin can be delivered at a set rate throughout the day, which can be increased when it’s needed, for example, at meal times.

Andrew Dillon, NICE Chief Executive, said: “People with type 1 diabetes need daily injections of insulin to survive. One of the main drawbacks of conventional insulin regimens is the difficulty individuals can have in constantly achieving blood glucose control and balancing the risk of disabling hypoglycaemia, and hyperglycaemia [too high a level of blood glucose] - both of which can be potentially life-threatening. Today’s guidance reaffirms NICE’s original recommendations for the use of insulin pumps published in 2003. It means that people will continue to be able to access this important technology to achieve better blood glucose control, resulting in an improved quality of life and fewer situations where they need help from others.”

The guidance is available on the NICE website at
http://www.nice.org.uk/TA151

About NICE

1.
The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2.
NICE produces guidance in three areas of health:

-
public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector

-
health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS

-
clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

National Institute for Health and Clinical Excellence

Inheritance Of Hormonal Disorder Marked By Excessive Insulin In Daughters

By admin

Elevated levels of insulin could be an early sign that girls whose mothers suffer from polycystic ovary syndrome — or PCOS — may also be susceptible to the disease, according to gynecologists who have found evidence of insulin resistance in young children.

The findings could help determine whether daughters of women suffering from PCOS are at a higher risk of developing the disease, compared to girls whose mothers do not have the disease.

Polycystic ovary syndrome is a common hormonal disorder that affects women of reproductive age, and sometimes causes inability to become pregnant. Symptoms include hairiness due to excessive amounts of male hormones, irregular periods, and insulin resistance.

“We found insulin resistance in children who had entered puberty, and whose mothers had PCOS,” said Richard Legro, M.D., professor of obstetrics and gynecology, Penn State College of Medicine and lead author. “We did not find it in the youngest children, which suggests that the disease is triggered by puberty.”

Legro and his colleagues were interested in finding out whether metabolic and reproductive abnormalities associated with the inheritable disease, are more likely to show up in children whose mothers have PCOS, and how parents could find out whether their child was at risk.

The researchers designed a study to compare 38 children — boys and girls aged 4 to 14 — whose mothers had PCOS with 32 children in a control group. They specifically looked for the early onset of androgen — male hormones — production, and production of excess insulin.

“We collected samples of saliva and urine to analyze levels of insulin and sex steroids respectively,” explained Legro. “But we also looked for gonadotropins, hormones that stimulate sex steroids and provide the earliest sign of puberty.”

Results from the test indicate that older girls, but not boys, of PCOS mothers had significantly higher concentrations of salivary insulin. Compared to the control group, the girls also had lower levels of urinary hormones.

According to Legro, the key finding of the study is that insulin levels appear to be elevated in daughters of PCOS mothers, which becomes more pronounced as they pass through puberty. Since the androgen levels were comparatively normal throughout puberty, and insulin resistance was only found in girls who had undergone puberty, Legro argues that insulin is the primary problem, while male hormones are a secondary problem.

“Insulin is the real culprit in terms of stimulating the ovary, more so than gonadotropins, said Legro, whose findings appeared in a recent issue of The Journal of Clinical Endocrinology and Metabolism and was the subject of an editorial in the same issue.

“You could argue children of PCOS mothers build up excessive insulin during puberty, which in turn contributes to reproductive abnormality,” explained Legro.

However, Legro cautions that it may be too early to conclude that excessive insulin is the sole factor that makes daughters of PCOS mothers susceptible to the disease. He is also not fully sure whether hyperandrogenism — excess of male hormones — precedes or follows excessive levels of insulin.

Researchers say future longitudinal studies will focus only on girls and try to pin down whether an abnormal level of insulin is the sole factor that causes reproductive abnormalities.

“That is the tantalizing question,” the Penn State medical researcher said. “The ultimate goal would be to find the earliest sign that makes a child more susceptible to develop PCOS. Right now the earliest sign would be an elevation in insulin levels.”

Legro’s work is funded by the National Institutes of Health.

Other researchers on the paper are Sarah C. Kent, family medicine physician; Allen R. Kunselman, senior research assistant; Laurence M. Demers, M.D., distinguished professor emeritus of medicine and pathology; Carol L. Gnatuk, M.D., professor of obstetrics and gynecology; Peter A. Lee, professor of pediatrics; and William C. Dodson, M.D., professor of obstetrics and gynecology, all at Penn State College of Medicine. Penn State College of Medicine is at http://www.pennstatehershey.org/

The Department of Obstetrics and Gynecology is at http://www.hmc.psu.edu/womens/

Source: Megan Manlove

Penn State