National Institutes of Health press release -- Dec. 28, 2004
The National Institutes of Health (NIH), Juvenile Diabetes Research Foundation (JDRF), and Centers for Disease Control and Prevention (CDC) announced today the availability of the largest single collection of biosamples and data for research on the genetic causes of kidney disease in type 1 diabetes.
The Genetics of Kidneys in Diabetes (GoKinD) collection has nearly 10,000 DNA, serum, plasma and urine samples, plus genetic and clinical data, from more than 1,700 adults with type 1 diabetes in the United States and Canada. Of those, 818 have had diabetes at least 10 years and have developed kidney disease, a common complication of diabetes. The other 893 have had diabetes at least 15 years but do not have kidney disease. Also in the collection are data and samples from 1,096 parents (548 sets).
“GoKinD is a tremendous resource. We’re thrilled about the promise it represents,” said Rebekah Rasooly, Ph.D., who oversees the project for NIH and directs genetics and genomics programs at NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “We fund research all the time, but this kind of project reflects a new way of thinking. GoKinD is a gift that will keep on giving, and we are deeply indebted to the individuals and families who made this invaluable resource possible.”
Researchers can apply for DNA, extensive clinical data and some genetic data from GoKinD at www.gokind.org/access; serum, plasma and urine samples will be made available later. Methods of treatment, insulin doses, complications, smoking history and other data have been documented for all GoKinD participants. Also, DNA has been genotyped for genes well-known to predispose to type 1 diabetes. To protect the privacy of patients and families, researchers do not have access to names and other identifying information.
“This study is of exceptional quality and offers a unique opportunity for genetic research,” said Patricia Mueller, Ph.D., chief of CDC’s diabetes and molecular risk assessment laboratory.
Gathering information and samples of the kind, quality and quantity that individual researchers alone would be unable to collect, GoKinD provides a rich means for learning about the genetics of both kidney disease and type 1 diabetes.
“GoKinD will help us tease out genes linked to kidney disease versus those that are primarily important causes of diabetes itself,” said Concepcion R. Nierras, Ph.D., director of research for JDRF.
Both NIH and JDRF will separately consider requests to fund research on GoKinD data and samples. NIH grant applications are at http://grants.nih.gov, and resources for type 1 diabetes research are listed at www.niddk.nih.gov/fund/diabetesspecialfunds/funding.htm. JDRF grant applications are under the research tab at www.jdrf.org.
Once found, genes for susceptibility to kidney disease can be studied to find out what they do, how they do it and how researchers might intervene to prevent the disease or improve treatment. Studies have already linked several genes to susceptibility to type 1 diabetes, but scientists are confident that more genes exist and that other, as yet unknown, genes increase susceptibility to complications such as kidney disease. (Learn more about genetic factors in diabetes at www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=diabetes.chapter.987.)
“These genes alone don’t explain the complete genetic risk for diabetes, and little is known about genes for kidney disease or other complications. Yet, there is clearly a genetic risk for complications, because they run in families and among certain populations,” said Paul L. Kimmel, M.D., F.A.C.P., a nephrologist working part-time with Rasooly and NIDDK on GoKinD. Kimmel also directs the renal disease and hypertension division at George Washington University Medical Center in Washington, D.C.
Diabetes is the leading cause of kidney failure in the United States. In 2002, treatment of kidney failure cost Medicare and private insurers $25 billion for more than 400,000 people, 40 percent of whom had diabetes. Twenty to 40 percent of people with type 1 diabetes will develop kidney failure by the age of 50, but some develop it before the age of 30.
Type 1 diabetes accounts for up to 10 percent of people diagnosed with diabetes in the United States (up to 1 million people). This form of diabetes usually strikes children and young adults, who need several insulin injections a day or an insulin pump to survive. Insulin, though critical for controlling blood glucose, is no cure. Most people with the disease eventually develop one or more complications, including damage to the heart and blood vessels, eyes, nerves, and kidneys.
NIH, JDRF and CDC collaborated on GoKinD. NIH supported the study through a special fund for type 1 diabetes research established by Congress in 1997 and coordinated by NIDDK. In all, the fund will provide $1.14 billion between fiscal years 1998 and 2008, supplementing funds available for type 1 diabetes research through regular NIH appropriations.
Under JDRF, the Joslin Diabetes Center and the George Washington University (GWU) Biostatistics Center (and its associated clinical centers) each recruited about half the patients and their parents. GWU will also distribute GoKinD data. CDC provided genotyping data for the major type 1 diabetes risk factors, HLA DRB1, DQA1, and DQB1 and the -23 insulin gene single nucleotide polymorphism (SNP). In addition, CDC will distribute samples and conduct research on the collection. Biochemical clinical data were provided by the University of Minnesota.
Investigators and centers that recruited participants and provided clinical and genetic data are:
* Stephen A. Brietzke, Univ. of Missouri
* David Brillon, New York Presbyterian Hospital, Cornell Univ.
* George A. Burghen, Univ. of Tennessee
* George W. Burke, Univ. of Miami
* Patricia Cleary, George Washington Univ. Biostatistics Center
* Suzanne Cordovado and Patricia Mueller, CDC
* Debra Counts, Univ. of Maryland Medical System
* James Desemone, Albany Medical Center
* Steven V. Edelman, Univ. of California San Diego
* Carla Greenbaum, Virginia Mason Research Center
* Richard A.Guthrie, Mid-America Diabetes Associates, P.A.
* Irene Hramiak, St. Joseph's Health Care, Univ. of Western Ontario
* Mark Johnson, Univ. of North Carolina at Chapel Hill
* Lois Jovanovic, Sansum Medical Research Center
* John I. Malone, Univ. of South Florida
* Michael Mauer and Mike Steffes, Univ. of Minnesota
* Michael E. May, Vanderbilt Univ. Medical Center
* Larry Melton, Baylor Univ. Medical Center
* Mark E. Molitch, Northwestern Univ.
* Robert E. Ratner, Med-Star Clinical Research Center
* John Rogus, Adam Smiles and James Warram, Joslin Diabetes Center
* William L. Sivitz, Univ. of Iowa
* Maria Szpiech, Medical Univ. of South Carolina
* Neil H. White, Washington Univ. School of Medicine
* Bernard Zinman, Mount Sinai Hospital, Univ. of Toronto
Saturday, January 01, 2005
High Blood Sugar Decreases School Performance
From Diabetes Today, American Diabetes Association -- Dec. 22, 2004
ALEXANDRIA, Va. -- A temporary rise in blood glucose (sugar) levels in people with both types of diabetes can interfere with their ability to think quickly and solve problems, according to a study in the January issue of Diabetes Care.
Researchers at the University of Virginia Health System (UVHS) found that people who had both type 1 and type 2 diabetes performed poorly on math and verbal tests when they became hyperglycemic, a condition in which blood glucose levels are higher than normal. Symptoms of hyperglycemia include high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst. Roughly 55 percent of the people in the study showed signs of cognitive slowing or increased errors while hyperglycemic, suggesting that the consequences of hyperglycemia vary among individuals. However, among those whose cognitive performance deteriorated when blood sugar levels rose, the negative effects consistently appeared once levels reached or exceeded a threshold of 15 mmol/l or 270 mg/dl.
Because hypoglycemia (when blood glucose levels are too low) can cause dizziness and an inability to focus, many people consume large amounts of carbohydrates to avoid this state prior to school exams and other cognitive- sensitive tasks. But this study suggests that carbohydrate-loading could be counterproductive, the researchers conclude, because hyperglycemia often occurs after overeating.
"The best way to minimize any negative effects on cognitive functioning is to keep blood glucose levels tightly controlled," said lead researcher Dr. Daniel J. Cox, of the Center for Behavioral Medicine Research at UVHS. "People who have diabetes should pay careful attention to the warning signs of hyperglycemia so that they can quickly take action to treat it."
Treatment for hyperglycemia can include increasing insulin or reducing food intake.
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).
ALEXANDRIA, Va. -- A temporary rise in blood glucose (sugar) levels in people with both types of diabetes can interfere with their ability to think quickly and solve problems, according to a study in the January issue of Diabetes Care.
Researchers at the University of Virginia Health System (UVHS) found that people who had both type 1 and type 2 diabetes performed poorly on math and verbal tests when they became hyperglycemic, a condition in which blood glucose levels are higher than normal. Symptoms of hyperglycemia include high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst. Roughly 55 percent of the people in the study showed signs of cognitive slowing or increased errors while hyperglycemic, suggesting that the consequences of hyperglycemia vary among individuals. However, among those whose cognitive performance deteriorated when blood sugar levels rose, the negative effects consistently appeared once levels reached or exceeded a threshold of 15 mmol/l or 270 mg/dl.
Because hypoglycemia (when blood glucose levels are too low) can cause dizziness and an inability to focus, many people consume large amounts of carbohydrates to avoid this state prior to school exams and other cognitive- sensitive tasks. But this study suggests that carbohydrate-loading could be counterproductive, the researchers conclude, because hyperglycemia often occurs after overeating.
"The best way to minimize any negative effects on cognitive functioning is to keep blood glucose levels tightly controlled," said lead researcher Dr. Daniel J. Cox, of the Center for Behavioral Medicine Research at UVHS. "People who have diabetes should pay careful attention to the warning signs of hyperglycemia so that they can quickly take action to treat it."
Treatment for hyperglycemia can include increasing insulin or reducing food intake.
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).
Pregnancy Can Go Well for Women with Diabetes
From Reuters Health News -- Fri Dec 31, 2004
NEW YORK (Reuters Health) - Women with type 1 diabetes who monitor their blood glucose daily both before and during pregnancy have better outcomes, Danish researchers report.
In the largest study to date of pregnant women with type 1 diabetes, Dr. Dorte M. Jensen of Odense University Hospital and colleagues found that only one-third of women said they monitored their blood sugar levels every day around the time they conceived.
Daily monitoring and good overall control of blood glucose levels were associated with a lower likelihood of infant mortality and birth defects.
The study is published in the medical journal Diabetes Care.
Specifically, the researchers compared rates of pregnancy complications in the general population with rates for 1,218 consecutive pregnancies in 990 women who had type 1 diabetes.
Among the women with diabetes, compared with the general population, the percentage of babies that died soon after birth was higher (3.1 percent vs. 0.75 percent), as was the rate of stillbirths (2.1 percent vs. 0.45 percent) and birth defects (5.0 percent vs. 2.8 percent).
Among the 93 diabetic women who had serious adverse outcomes - meaning babies that died or had malformations - 22 percent monitored their blood glucose daily at conception, compared to 35 percent of the women who had uncomplicated pregnancies.
Also, blood sugar control before and during pregnancy was not as good among the adverse outcome group, on average, and they were less likely to have received pre-conception guidance than the women without seriously affected babies.
In Denmark, where healthcare is free and women with diabetes are entitled to regular visits with diabetes specialists, the researchers note, the low rates of daily monitoring at conception and pre-conception guidance were "disappointing."
"Our data suggest that glycemic control, self-care and education of the patient still need to be improved significantly and that adequate control using daily glucose monitoring in all patients is a crucial step toward reaching the goals of the St. Vincent declaration," Jensen's team concludes.
That 1989 declaration stated that within five years, rates of complications in diabetic pregnancies should be similar to those seen with non-diabetic pregnancy -- a goal that has not been achieved, the researchers note.
NEW YORK (Reuters Health) - Women with type 1 diabetes who monitor their blood glucose daily both before and during pregnancy have better outcomes, Danish researchers report.
In the largest study to date of pregnant women with type 1 diabetes, Dr. Dorte M. Jensen of Odense University Hospital and colleagues found that only one-third of women said they monitored their blood sugar levels every day around the time they conceived.
Daily monitoring and good overall control of blood glucose levels were associated with a lower likelihood of infant mortality and birth defects.
The study is published in the medical journal Diabetes Care.
Specifically, the researchers compared rates of pregnancy complications in the general population with rates for 1,218 consecutive pregnancies in 990 women who had type 1 diabetes.
Among the women with diabetes, compared with the general population, the percentage of babies that died soon after birth was higher (3.1 percent vs. 0.75 percent), as was the rate of stillbirths (2.1 percent vs. 0.45 percent) and birth defects (5.0 percent vs. 2.8 percent).
Among the 93 diabetic women who had serious adverse outcomes - meaning babies that died or had malformations - 22 percent monitored their blood glucose daily at conception, compared to 35 percent of the women who had uncomplicated pregnancies.
Also, blood sugar control before and during pregnancy was not as good among the adverse outcome group, on average, and they were less likely to have received pre-conception guidance than the women without seriously affected babies.
In Denmark, where healthcare is free and women with diabetes are entitled to regular visits with diabetes specialists, the researchers note, the low rates of daily monitoring at conception and pre-conception guidance were "disappointing."
"Our data suggest that glycemic control, self-care and education of the patient still need to be improved significantly and that adequate control using daily glucose monitoring in all patients is a crucial step toward reaching the goals of the St. Vincent declaration," Jensen's team concludes.
That 1989 declaration stated that within five years, rates of complications in diabetic pregnancies should be similar to those seen with non-diabetic pregnancy -- a goal that has not been achieved, the researchers note.
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