The New York City diabetes database, created to track the growth of (type 2) diabetes amongst the city's residents, has raised the ire of some who claim it violates their right to privacy. A reporter for the Staten Island Advance quotes resident Melissa: "Every time I go to have my blood sugar checked, my test results are being wired to the (city) Health Department. The idea of your privacy being taken away from you goes across all bounds." Melissa also says she doesn't think the city has justification to track patient records for something like diabetes, which is not contagious like, for example, tuberculosis.

My first instinct on reading this: cry me a river, Melissa. Residents should be aware their blood sugar levels are being sent to the health department, and they should be aware of why it is being done. But, really, isn't it a tad paranoid to worry too much about privacy? I mean, why should anyone care about your blood sugar levels out of all the thousands of others out there? If this is a way to gauge how type 2 diabetes is spreading in the NYC area, and if this data can help (as the city claims) determine how best to spend public money on containing the problem, I say go for it.

On the other hand, protecting peoples' privacy should be a factor for consideration, says Dr. Peter Sheehan, of the Mount Sinai School of Medicine and board member of the American Diabetes Association. "We applaud this kind of work," says Dr. Sheehan, but "we're somewhat concerned about the privacy of the individual." This concern is shared by the people entrusted with maintaining the database, says Dr. Diana K. Berger of the Health Department: "We are so careful to protect people's privacy," says Dr. Berger. She adds that only a handful of people have access to the room in which the data is stored, and data is encrypted as it makes its way from laboratories to the city.

All-in-all, it's a slightly unsettling case of weighing priorities: public good versus the right to privacy.

Although the A1c test provides important information about how blood glucose has behaved over the preceding three months, the blood sugar fluctuations after meals have a greater impact on diabetic complications. GlycoMark is a test that monitors mealtime spikes over 2 days to 2 weeks in a single sample.

For diabetics who have good control (A1c less than 7.3%), blood glucose levels immediately following meals account for up to 70% of their total A1c. There is a growing body of evidence suggesting that controlling after-meal glucose levels is critically important in reducing diabetic complications. GlycoMark measures the brief blood glucose elevations (postprandial hyperglycemia) by reading 1,5-anhydroglucitol (1,5-AG). 1,5-AG drops as blood glucose rises above the renal threshold of glucose. The renal threshold of glucose is the blood sugar at which the kidneys start excreting sugar into the urine.1,5-AG decreases rapidly in people with elevated blood sugar.

It is important to note that GlycoMark values decrease when blood sugar increases. An increase in 1,5-AG would indicate improvement, and decrease would indicate worsening of glycemic control. Upon return of better glycemic control, 1,5-AG increases at a constant rate. This consistent recovery rate in 1,5-AG levels provides a rapid indication of the patient's response to treatment. With the GlycoMark, perhaps now we can really evaluate the affects of certain types of foods and how they affect our ability to control our blood sugar after meals. Fore more details, checkout the full brochure online.

While patrolling the PubMed database this weekend, I came across a very interesting study that investigated the effects of new insulins on insulin and C-peptide antibodies, insulin dose, and diabetic control. Please note - this study was published in 1983. After reading -- I invite EVERYONE to let me know if it is possible to get purified pork insulin and whether or not you have been on it-- and if you have seen a difference in your diabetes control. Please?

24 diabetic patients using bovine (beef) insulin and possessing insulin antibodies underwent a study of the immunological and clinical consequences of changes in both purity and species of their insulin. The new insulin regimes tested were one of three: a) purified bovine insulin, b) highly purified porcine insulin, and c) semisythetic human insulin.

The patients underwent 3 consecutive 4-month periods on each insulin regimen. The average insulin antibody levels changed little on purified bovine (beef) insulin; actually increased on semi-synthetic human insulin but fell substantially on highly purified porcine insulin. Okay - so this means, in lay terms that the patient's insulin antibodies (the stuff killing your islets) remained relatively the same on beef insulin but became categorically HIGH on synthetic human insulin. And most importantly - to me-the highly purified porcine insulin actually DROPPED the insulin antibodies. Of course - it would cost big pharmaceutical companies more to manufacture highly purified porcine insulin.

C-peptide antibodies fell significantly and continuously throughout the study. The slower rate of fall in C-peptide antibody levels is likely to be due to the prolonged half-life of circulating exogenous proinsulin in the presence of insulin antibody. Although insulin dose remained constant the incidence of hypoglycaemic episodes did not increase and glycosylated haemoglobin levels rose significantly when patients were on porcine insulin. The deterioration in diabetic control may have been due to greater temporal mismatch between insulin needs and insulin availability with pork or human insulin than with beef insulins, and to reduced insulin antibody levels.

The use of purer insulins which more closely resemble the human form can cause a significant reduction in levels of insulin and C-peptide antibodies. These changes may not necessarily produce better diabetic control. Recent studies have shown that a depletion of C-peptide in the body results in a greater chance of microvascular complications associated with diabetes.

This study was published around the time when all of the synthetic human insulins were sweeping the Nation. I tried calling my local CVS Pharmacy on Saturday morning to see if I could get some purified porcine insulin. No such luck. Go figure. The big guys were successful at convincing the medical community and patients that no other insulin is better. Correction - no other insulin is cheaper to manufacture and that means it is better for them. And the importance of C-peptide was overlooked entirely - or was it? C-peptide prevents the complications associated with injecting insulin - but that sounds like another marketable drug. After all - synthetic human insulin doesn't have C-peptide. REAL HUMAN INSULIN does (the way it comes out of the beta cells, in natural form, it does)!!! And as long as your body is producing insulin antibodies - you NEED their synthetic insulin (conveniently -- the only kind you can buy). Best business model - customer for life!

In 1996 a 41 year old male (a type 1 diabetic for 18 years) was injected with biocapsules containing pig islets to regulate his blood sugar level. The transplanted cells helped reduce the patient's insulin requirement by 34% for over a year, which provided better control. By 2005 the patient's glycated hemoglobin levels (HbA1c) remained lower than the pre-transplant levels.

Ten years later, the patent contacted Living Cell Technologies to inform them that he believed the transplanted pig islets were still alive and well. After tests were conducted, it was concluded that the pig cells were (as he reported) still functioning. This proved that the LCT patented technology for xenotransplantation was effective. It allows the islets to survive at least ten years in a micro-capsule coating and continue to release insulin into the patient's bloodstream without immune suppression. After tests we conducted on the type of insulin present in the patients blood - it was with 100% certainty that it was pig and not human insulin.

LCT has significantly advanced the encapsulation process since the 1996 clinical trial and there is an even greater understanding and control over the longevity and robustness of the encapsulation process, as well as the porcine islet cells. LCT will be trialing the DiabeCell pig islet cell transplant in patients in a phase I/IIa clinical trial, expected to begin in Quarter 2, 2007. In addition, LCT is awaiting approval to conduct an additional trial in New Zealand this year with a different treatment protocol. Subsequent trials in the US or Europe are intended following initial results from these studies.

If overseas trials are coming through with flying colors - why aren't we doing this yet? C'mon USA - where's your competitive spirit? All these pigs up in Spring Point might be put to good use, after all. Oink Oink.

Much like a roadblock, but with a fortuitous outcome -- an experimental heart drug didn't achieve the primary goal of a late-stage trial but it did dramatically reduce the risk patients would develop diabetes.

The anti-oxidant, anti-inflammatory drug, the first of its kind, reduced the risk of developing diabetes by 64% and demonstrated a small but statistically significant reduction in blood sugar after 12 months. The study included data from 6,144-patients. The company believes this finding to be a serendipitous outcome, despite the initial shortcomings of the trial objective. They need to confirm it in a large clinical trial. The impressive diabetes results may come as a surprise to investors who have abandoned AtheroGenics or who have been betting the drug will fail.

Heart patients in the study received either 300 milligrams of the drug or a placebo on top of a host of standard-of-care medicines they were already taking, such as aspirin, cholesterol-lowering statins, blood thinners and/or diabetes medicines.

The drug had an undesirable impact on blood fats, raising bad LDL cholesterol by about 12% and lowering good HDL cholesterol by roughly the same amount. There were also some potentially troubling safety signals with a trend toward more heart failure in those taking the drug. In spite of the undesirable affects on blood lipids, the drug has a profound effect on diabetes. Further research will be conducted on the efficacy of this drug in reducing the risk of developing diabetes.

Until recently, little evidence existed regarding the effects of soy consumption on the metabolic syndrome in humans. Researchers evaluated the effects of soy consumption on metabolic symdrome and found it improved glycemic control and lipid profiles in postmenopausal women.

The study evaluated the plasma lipids, lipoproteins, insulin resistance, and glycemic control in 42 postmenopausal women with the metabolic syndrome. Participants were randomly assigned to consume a control diet (Dietary Approaches to Stop Hypertension, DASH), a soy-protein diet, or a soy-nut diet, each for 8 weeks. Red meat in the DASH period was replaced by soy-protein in the soy-protein period and by soy-nut in the soy-nut period.

The soy-nut regimen decreased the insulin resistance score significantly compared with the soy-protein or control diets. Consumption of soy-nut also reduced fasting blood sugar significantly than did the soy-protein or control diet. The soy-nut regimen decreased LDL cholesterol more than did the soy-protein period and the control diet. Soy-nut consumption significantly reduced serum C-peptide concentrations compared with control diet but consumption of soy-protein did not.

Consumption of the soy-nut leg of the experiment significantly reduced C-peptide concentrations because it was evident that the diabetic women were not creating as much insulin to counter the sugar rise in their blood. C-peptide is ONLY present when your body is producing insulin. So can one logically deduce that naturally occurring insulin causes insulin resistance? Uh oh. Sounds like we've got a pickle of a situation happening here.

I love the Geico commercial with the Caveman-- the one where he's in the therapist's office and his phone rings . He says, "My mother's calling. I'll put it on speaker." According to a recent study published in the medical journal Diabetes Care, researchers have found that family communication and problem-solving skills are important for helping young people with type 1 diabetes to manage the condition. Specially tailored family therapy can help teens with type 1 diabetes keep their blood sugar levels under control.

A family-based behavioral therapy program was specifically tailored to address diabetes-related family issues. The program consisted of 12 sessions offered over six months, and included training in "behavioral contracting" techniques for family members and a 1-week parental simulation of living with type 1 diabetes. For their study, the researchers randomly assigned 104 families of teens with poorly controlled type 1 diabetes to the behavioral family therapy program, standard care, or a multifamily support group that included educational elements. While levels of A1C, a measurement of long-term blood glucose control, fell in all three groups over the first six months, A1C levels climbed again in the standard-care and support-group kids, but remained low for the behavioral family therapy group up to 18 months after the program began.

Researchers concluded that the efficacy of a family-based behavioral therapy approach is more effective in improving diabetes control. There is power in numbers especially when it comes to any family affair. See mom and dad - told you so!

Remember that movie with Billy Crystal and Robert De Niro, Analyze This? Well we all don't have super-risky mobster lifestyles to induce depression like Paul Vitti's, but according to a new study of depressed type 2 diabetics -- depression has a negative impact on blood sugar control.

Researchers treated 93 patients with type 2 diabetes and depression with the antidepressant bupropion (Wellbutrin). They chose the drug because it is capable of reducing depression and weight simultaneously. The hypothesis behind the treatment was mood enhancement and weight reduction would, in fact, improve blood sugar control. (Always a gold star day in my book!) The results were documented in the March issue of Diabetes Care, and showed that antidepressant treatment produced benefits beyond just mood improvement. Patients also lost weight, improved self-management of their diabetes, and improved their A1c levels.

In the 6 months following the conclusion of the study, depression improvement predicted maintenance of improved blood sugar control. This confirms the research hypothesis that depression improvement can produce better blood sugar control, independent of weight loss and overall diabetes management. The importance of weight-independent physiological factors like insulin sensitivity and inflammation improve during depression relief and contribute to better long-term control of diabetes.

The moral of this story? You tell me. I spotlight the research - I like it when you guys give me answers.

Just about every piece of technology has, or at some point will, be unfettered from its wire constraints. Remote controls, a desktop mouse and keyboard, telephones, the internet, and now even glucose meters. With the unveiling of Diabetech's launch of their new GlucoMON2 Wireless Glucose Meter, people with diabetes will now be able to rock wireless.

The Diabetes Control & Complications Trial (DCCT) in the early 90's made one thing very clear: Average blood sugar levels and tight glycemic control are improved through frequent glucose testing and team management with a remote caregiver. The first half of that process can be taken care of fairly easily by the patient themselves. The second part, however, is limited by a few factors, one of which is the lack of connectivity to facilitate this remote teaming strategy. The folks at Diabetech (and, presumably their investors) are hoping to make that connection possible by employing the use of wireless tech.

And evidently, size does matter. GlucoMON2 is approximately 80% smaller than its predecessor, the GlucoMON. The device should be available some time in late 2007, and reportedly is capable or working anywhere in the world where there is support for GSM/GPRS (General Packet Radio Service) networks.

Many of us fear what we do not know, which could be why the diagnosis of diabetes is so harrowing. Fear no more. Amy Tenderich has teamed up with Dr. Richard Jackson, MD of the Joslin Diabetes Center to shed some light on the heaps of material we must digest to control our diabetes. Amy and Dr. Jackson have simply explained it all in Know Your Numbers, Outlive Your Diabetes: 5 Essential Health Factors You Can Master to Enjoy a Long and Healthy Life (Marlowe Diabetes Library).

The book is a priceless addition to any diabetic library. It begins by explaining the five tests that are the cornerstones for monitoring your overall health with diabetes. These tests are: A1c, blood pressure, lipids, microalbumin, and an annual eye exam. You may think you know it all because you've been there, done that. But do you really know - what it tests, why it's done, and what your numbers should look like? After you learn what those tests mean to you and your health - Amy and Dr. Jackson help you develop a plan of action. They build a road, paved with easy to understand (and explained remarkably well) information about nutrition, medicine, organic treatments, support, and specialized shopping sites for diabetes.

I was impressed beyond my expectations. Knowing the award winning caliber of work Amy produces, and the integrity of Dr. Jackson's work with Joslin Diabetes Center and Harvard Medical - I was looking for a good guidebook on diabetes care. No ma'am. This book is AWESOME! I knew it would be good, Amy. You've outdone yourself, once again. I hope this book motivates everyone who reads it to know their numbers and outlive their diabetes. And when it does - remember us little people, ok? Thanks a million, Amy!

The Center for Disease Control announced that they will run a study to examine the cost-effectiveness of treatment interventions for type 2 diabetes. "People with diabetes are at considerable risk for heart disease, strokes and other serious health complications," said David Fleming, M.D. acting CDC director. "This study confirms that aggressive treatment interventions aimed at reducing the risks of cardiovascular disease increase life expectancy and, at the same time, may reduce lifetime health care costs," The footer of the Press Release where I got this story says:

CDC protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

Here comes my spiel, so grab a seat. Remember that huge event back in 1993? I'm talking about the announcement of the DCCT study that proved tighter control reduces the complications of eye, kidney, and nerve diseases caused by type 1 diabetes. And 5 years later the UK reiterated these results for type 2 diabetes. The $2.5 billion question is (yes, diabetic complications cost the United States $2.5 billion in 2005): why are we still relying on an antiquated test that can only be administered every 3 or 6 months to tell us how well we are controlling our diabetes? If more accurate testing and earlier therapeutic intervention result in less diabetic complications - where is the holdup?

To those concerned at the CDC, in an effort to protect people's health and safety by preventing and controlling diseases and injuries why haven't we seen a new test that can monitor our overall diabetes control on a monthly basis, rather than waiting to test every 3 or 6 months? This would, in effect, allow tighter control, which has been proven to reduce the potential of diabetic complications. (Please note: the original issue of the sited press release was May, 2002). Just a thought - you could use that extra $2.5 billion for something else like promoting healthy living through strong partnerships with local, national, and international organizations.

The hemoglobin A1c has been regarded as the undisputed champion for measurement of glycemic control...until now. Those of us running from diabetic complications understand the necessity of this test. Waiting 3 months (or more) gives these glycated red blood cells a lot of time to play havoc with our small blood vessels, over time resulting in a quagmire of diabetic complications. Glycation is the cause of the long-term complications of diabetes. There is a gap between the data provided by daily blood glucose testing and the information on the long-term health of the diabetic patient supplied by the HbA1c test.

Epinex Diagnostics developed the G1A to measure the albumin in the blood, not the hemoglobin. The albumin lifespan is much shorter than the hemoglobin. Albumin regenerates every 2 to 3 weeks, whereas hemoglobin takes 120 days. Albumin is a serum protein in the blood that can be measured more precisely, more frequently, resulting in more effective diabetes management. The G1A test requires a drop of blood, as opposed to the full laboratory tube needed for the A1c test. The G1A test takes 5 minutes, whereas the A1c results could take weeks. In contrast to daily blood glucose and semi-annual A1c testing, the G1A glycated albumin index offers amore accurate predictor of glycation by testing once a month, instead of testing the A1c every 3 or 6 months.

I'm not sure about you, but if someone said they know of a way to manage my diabetes that is more effective, less time consuming, and allows for earlier therapeutic intervention-- sign me up! The G1A has the potential to become the new industry standard for diabetes management. Ask your doctor if he or she has heard of it yet. If they dismiss the idea-- ask them how important accuracy is in diabetes management. There's your answer.

I want to direct your attention to an alphabetically amusing piece of information. Back in 2001, the American Diabetes Association partnered with the U.S. Department of Human Health Services to develop a campaign to raise awareness about treating diabetes comprehensively. This simplified approach explains the importance of controlling three factors to lower your risk of early death due to diabetic complications. Diabetics must manage not only blood glucose, but also blood pressure, and cholesterol. This serious message was packaged in a friendly campaign known as the ABCs of Diabetes.

The A stands for the A1C, or hemoglobin A1C test, which measures average blood glucose (sugar) over the previous 3 months. B is for blood pressure, and C is for cholesterol. This approach was developed because the vast majority of people with diabetes don't know that they are at very high risk of cardiovascular disease and that this risk can be greatly reduced with appropriate treatment. Research shows that 75 percent of people with diabetes die from heart disease and stroke, and they die younger than the general population.

The crying shame of this informative program is that back in 2001 when it began, you could receive your free brochure of the ABCs of Diabetes and a wallet sized card on Uncle Sam's dime. Unfortunately, the card carrying fiesta has ended but the ABCs march on.

Whether you are a regular in your doctor's office, or you make a cameo appearance every leap year, I'd like to express the importance of your relationship with your diabetes management team. Let us begin with an objective question: how did you choose your diabetes management team?

I've been through the gauntlet when it comes to diabetes management teams and their techniques. Some have taken the fear factor approach, some have been the laissez faire (you don't care, we don't care), some have been so concerned I managed to meet every doctor, in every discipline of medicine, in the entire community. Needless to say, it took two decades- but choosing your diabetes management team is a doctor-patient relationship you should take as seriously as a long-term commitment.

My current endocrinologist is THE MAN! He deserves kudos for the approach he's adopted with me. He doesn't ask for a log book. He knows he's not going to get one. He doesn't ask me to brandish a meter. He knows there is one, but I can't be hassled with the sync and send. He'll run my A1C and the other hodgepodge of tests they can squeeze out of a few tubes of blood. What I like most about his approach is that he asks for my approval rating of my diabetes management. As my doctor, he appreciates what I have to offer as much as I appreciate what he has to suggest. Here's my point: diabetes management teams are vitally important. Choose them wisely, treat them well, and talk to them with shameless candor. They know the ins-and-outs of this disease. You know yourself. Remember? You're in good hands. You chose them!