Diabetes is always on the medical radar screen. As incidence of the disease continues to grow, there is a constant stream of new research on the topic. One thing you can say definitively about diabetes: it never gets dull. The American Diabetes Association meeting in June did not disappoint, revealing both good and bad news.
Fortunately, the good news is abundant. Most importantly, mortality decreased 23 percent overall in diabetes patients and 40 percent in diabetics with cardiovascular disease when comparing 2006 and 1997 results, according to a Centers for Disease Control survey (Diabetes Care June 2012 vol. 35 no. 6 1252-1257). The author of the study warns, however, that diabetics are still at increased risk for severe complications.
Mothers always struggle to get their children to eat breakfast. In this case, Mom may be onto something. In a study of almost 4,000 participants, ages 27 to 35 years old, those who ate breakfast were less likely to develop type 2 diabetes (ADA June 2012, abstract 1364-P). For each breakfast consumed during the week, there was a 5 percent reduction in risk. When the researchers compared those who ate breakfast at least five times a week to those who ate it three or fewer times a week, the risk of developing type 2 diabetes fell 31 percent among the frequent breakfast eaters. Those who ate breakfast more frequently did not gain as much weight, 0.5 kg/m2. BMI played a role in this effect. This is an easy way to help ward off diabetes, as well as get you charged for the day.
Insulin and cancer
There have been concerns that insulin increases the risk of cancer. However, in three very large epidemiologic studies presented at the ADA meeting, there was no significant association between the use of glargine insulin and an increased risk of cancer, when compared to other insulins (ADA June 2012, abstract CT-SY13).
However, there are caveats to these studies. For instance, why they compared glargine to other insulins and not to oral drugs seems to weaken the study’s conclusions. There were also slight, but non-significant, increases in breast cancer, 12 percent, and prostate cancer, 11 percent, in one of the studies. The studies’ durations were not very long when you consider the length of time it takes to develop cancer. They ranged from 1.2 years to 3.1 years with glargine and 1.1 years to 3.5 years with other insulins. Hence, I think it is important to interpret the results with a bit of skepticism, though they do point in the right direction.
Metformin and B12 deficiency
Yet another study presented at the ADA found that those diabetes patients who are taking metformin and have B12 deficiencies have a much higher risk of developing peripheral neuropathies (tingling, numbness and pain in the extremities) that may lead to permanent nerve damage (ADA June 2012, abstract 954-P). Chronic metformin use may be a contributing factor to the B12 deficiency. Before attributing the symptoms to diabetic neuropathy, it is important to test patients’ B12 and methylmalonic acid levels. As age increased, not surprisingly, the likelihood of B12 deficiency also increased. For more information on the appropriate levels of B12, please see my May 1, 2012 article.
Fruit and vegetable effect
Those patients who consumed the most fruits and vegetables saw a 21 percent reduction in risk of diabetes, compared to those who consumed the least, according to the EPIC study (Diabetes Care 2012;35(6):1293-1300). Quantity was important with vegetables, showing a 24 percent lower risk in those who ate the most, but quantity did not play a role in fruits. More important to fruit was the variety, with a 30 percent reduction in those with the most diversity in fruit intake. Combining varied fruits and vegetables resulted in the greatest reduction, 39 percent.
Omega-3 Fatty acids
In a recent randomized controlled trial omega-3 (fish oil) supplements showed disappointing results (NEJM online June 11, 2012). Supplementation with 900 mg of omega-3s did not reduce the incidence of stroke, heart disease or death from cardiovascular disease in pre-diabetes or diabetes patients. This dose may be too low, but still it is unlikely that taking omega-3s will reduce the risk of strokes or heart attacks in diabetes patients. I wrote a two-article series, starting on May 22, 2012, that showed omega-3s were effective in some diseases, but not in others. Therefore, there are more efficient ways to treat diabetes than with fish oil.
Thus, the moral of the story is that lifestyle modifications are an important ingredient in preventing and treating diabetes. If you are taking insulin, you can breathe a sigh of relief that it may not increase your risk of cancer. Make sure to test B12 levels, especially if you are taking metformin, and don’t rely on fish oil to prevent complications from diabetes or pre-diabetes. And as my mom always says, eat your breakfast.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.