Do not miss this recent NY Times article by Gina Kolata, Looking Past Blood Sugar to Survive With Diabetes. It is a must read for anyone associated with type 2 diabetes, including patients, family caregivers and doctors. I am very encouraged to see a feature on type 2 diabetes in such a well-read newspaper. Many doctors are uninformed on the best ways to treat a person with type 2 diabetes, they spend much more time with type 1 patients. Furthermore, type 1 and type 2 are very different diseases, but since they both end in 'diabetes' there is deep confusion -- see Diane's previous post on this topic. Undoubtedly, we need Big Media to provide greater coverage on the differences and unique treatments for both type 1 and type 2 diabetes.

First off, type 2 diabetes is a form of the disease that usually appears in adulthood where the body does not produce enough insulin or the cells are resistant to insulin. Kolata's article focuses on one man's battle with type 2 diabetes, as well as the importance of other treatments beyond blood sugar control that can markedly prevent heart disease -- the number one threat to a person with type 2. Dave Smith, a pastor from Fairmont, Minnesota, has dealt with type 2 diabetes for nine years. From the start, his doctor advised him to control his blood sugar, so he was a faithful carbohydrate counter, finger pricker, type 2 pill taker. Nothing worked, so he added insulin.

Unfortunately, his fixation on controlling blood sugar ignored the most crucial treatment of all -- lowering cholesterol. According to Kolata's article, heart disease kills nearly everyone with diabetes. The second treatment Smith did not consider was the importance of controlling blood pressure. The third treatment is taking aspirin to control blood clots. Last October, Smith had a major heart attack and nearly died. He had never thought about heart disease, and his doctor never advised him to take a cholesterol-lowering statin or a blood pressure drug. The American Diabetes Association reports only 18 percent of people with diabetes know their increased risk for cardiovascular disease. Grrrr! This lack of awareness among patients and doctors must change for lives to be saved. It took a near-fatal heart attack for Smith to receive the combination of drugs he should have been prescribed at diagnosis: a statin, two drugs to lower blood pressure, aspirin, insulin and two drugs to reduce his blood sugar level.

Fat. Never a good thing, right? At least not in the US, where food is super-abundant. Instead of being rightly grateful for all that food, we blame it for our weight woes. Yes, there's a growing sense that food is the enemy. Food leads to weight gain, which leads to obesity, which leads to heart disease, type 2 diabetes, and on and on. (Read Michael Pollan's The Omnivore's Dilemma for more on what he terms "our national eating disorder.")

But apparently there's a silver lining in all that fat. Says journalist Natalie Angier for The New York Times, "to castigate fat for getting too big and to blame it for high blood pressure or a wheezing heart is like a heavy drinker blaming the liver for turning cirrhotic." That is, if the body couldn't convert energy to fat cells in an efficient manner we'd really be up the proverbial creek. In fact, evolutionary biologists have even speculated that humans' ability to store good-sized quantities of fat has aided the survival of the species and made it possible for our big brains to grow so big and, um, brainy. The fat, you see, helps us through hard times. Food for thought, huh?

The recent attack on diabetes specialist William Petit Jr. and his family is the most horrific thing I've read in the news lately. William Petit is prominent in the world of diabetes research. He is medical director of the Hospital of Central Connecticut in New Britain. The hospital is an affiliate of the Joslin Diabetes Center.

The New York Times has plenty of coverage for those who care to read about it. There's a two-pager on the nature of the crime. This came out yesterday and describes how Petit was beaten and bound by two intruders to his Cheshire, Connecticut, home on July 23. The criminals sexually assaulted the family's two girls, forced Petit's wife Jennifer to withdraw $15,000 in cash from the local bank, then took her back to the house. The money, I guess, was supposed to be some sort of "ransom" money for the family, but to monsters like this, life is cheap; the mom and two girls were killed anyway. Ms. Petit was strangled to death. The house was set on fire and the daughters were left to die, tied to their beds.

Here's the latest: the two men responsible for the attack appeared in court today in New Haven. They were charged with capital felony murder, kidnapping, sexual assault, burglary, robbery, arson, larceny and risk of injury to children. Prosecutors say they will seek the death penalty. The Times reports that about a dozen members of the Petit family were present at the hearing and issued a written statement to reporters. Dr. Petit himself stayed away. My heart really goes out to the doctor and his family.

The votes of yesterday's advisory panel on Glaxo's Avandia demonstrate how dysfunctional this government can be. I was just reading up on the details. There were two key votes. On the question: does Avandia increase risk for heart attack, the vote was 20 to 3 in agreement. Yet, incredibly, the same panel also voted overwhelming - 22 to 1 - to keep Avandia on the market.

Coverage on the subject in today's New York Times described the meeting as "extraordinary" in that US Food and Drug Administration officials were openly in disagreement with each other as to what steps to take. As I mentioned yesterday, one of those officials, Dr. David Graham, said the drug should be withdrawn. However, Dr. Robert Meyer, another FDA high-up-official, disagreed.

Let's recap: Glaxo knew Avandia might cause heart trouble and informed the FDA of this. The FDA did nothing. An article in the New England Journal of Medicine (May 2007) stated the drug increased the risk of heart attack. The FDA twiddled its thumbs. Now this? The drug may stay on the market at the behest of the same FDA officials who voted in agreement that it poses a heart risk. Has the world gone mad? The sooner we get some reform at the FDA, the better off we will all be.

Also worth noting: the Times reports that Dr. Steven Nissen, whose NEJM article sparked the controversy, says he would have voted to remove Avandia from the shelves. Also quoted was Dr. Sidney Wolfe of Public Citizen, a drug safety advocacy group. Observed Dr. Wolfe: "If Avandia were up for approval today based on what we know now, it would be rejected."

Details are emerging from today's advisory committee meeting on Glaxo's Avandia. First up was a presentation by Dr. Robert Ratner of Washington's MedStar Research Institute outlining the unprecedented spread of type 2 diabetes. Ratner emphasized the inadequacy of current drug therapies for diabetes and the strain on the health system caused by the disease. The possible implication: Avandia does more good than harm right now, so let's keep it as an option.

Next, in written preview comments, an official from the US Food and Drug Administration stated his belief that the diabetes drug should be taken off the market. The official, Dr. David Graham, says the heart risks posed by Avandia mean it's just not worth the risk to patients. Especially, he said, not when there are safer alternatives like Actos (by Takeda), which also stabilizes blood sugar levels.

It's a significant step that someone from the FDA publicly made this statement. But will anything come of it? Maybe not. The decision about whether or not Avandia stays on the market is not up to Dr. Graham, who The New York Times reports has a history of coming down harder on drug risks than many colleagues. (Give the guy a medal!) Thing is: there appear to be plenty of other officials within the FDA who don't agree with Graham's interpretation.

For athletes with type 1 diabetes, technological advances have opened up a whole new world. Tell your doctor you want to run a marathon? In past decades, the announcement might have been met with words of caution, even dismay. Exercise wasn't even part of the equation when it came to diabetes management. Being diagnosed with diabetes was a death knell for the careers of budding young athletes. Today, however, docs (well-informed ones, at least) are more likely to say, 'okay, let's come up with a plan.'

Diabetes-related technology is a big reason for this shift in attitudes. An article just out in The New York Times. looks at the extent to which technology has made life easier for type 1 diabetics. Devices like digital meters and automated pumps are not cheap. But they are increasingly efficient, safe, and sleekly high-tech. Above all, they give athletes the tools they need to control blood sugar levels with absolute precision - the kind of precision that was impossible in the days of the urine-glucose test. The down-side, I guess you could say, is the mixed blessing of all that control: "We are essentially the CEOs of our own bodies," observes type 1 diabetic and long-distance cyclist Paul Southerland, "and we don't get a break from them."

Ever noticed that people tend to be around the same weight as spouses and friends? Well, it's not your imagination. A study just out in the New England Journal of Medicine reports that obesity, a major risk factor for type 2 diabetes, acts somewhat like a contagious disease - so when one person puts on weight, others around them follow suit. This, the researchers say, helps explain why Americans have gotten so fat in recent decades.

The study, a summary and discussion of which is featured in The New York Times, involved the analysis of a social network of 12,067 people over a period of thirty-two years (from 1971 to 2003). Researchers tracked not only the health and weight loss/gain of these people, but also who knew whom, who was friends with whom, and who was related to whom. Over time, it became clear that those whose friends became obese were much more likely to grow obese themselves. The likelihood, in fact, tripled in the case of close friends. Interestingly, friendship mattered more as a determining factor than did being related or being neighbors with someone.

It works like this: people tend to share the lifestyle habits of their family and friends. Folks who consider salads delightful and who enjoy frequent jogs around the park generally surround themselves with similarly-minded folks, and it shows in their trim physiques. Likewise, fast-food munchers who enjoy lots of TV tend to hang out with a similar crowd...and their thighs - not to mention waistlines, hearts, blood sugar levels etc. - suffer the consequences. Another factor, says researcher Nicholas Christakis, is the perception of the self in relation to others: "You change your idea of what is an acceptable body type by looking at the people around you."

The archeologist community is abuzz with excitement -- Queen Hatshepsut, Egypt's most powerful female pharoah, has been identified.

An intriguing story, the mummy was found in a humble tomb (labeled Tomb 60) in 1903 in The Valley of the Kings, but overlooked for over a hundred years. Zahi Hawass, secretary general of Egypt's Supreme Council of Antiquities in Cairo, said identification of the well-preserved mummy was made several weeks ago when a CT scan of a box, containing the queen's insignia and an embalmed liver, revealed a tooth. Like the last piece of a jigsaw puzzle, the tooth fit precisely in the jaw socket and broken root of an obese mummy from Tomb 60. The tooth is a key piece of evidence, but DNA analysis also links the female mummy to the matriarch of 18th dynasty royalty, Ahmose Nefertari. Other Egyptologists remain reserved until the DNA analysis and other confirmed evidence are further studied, but Hawass claims he is 100 percent certain.

The New York Times reported the mummy identified as Hatshepsut died in her 50s. She was obese, had bad teeth, probably had diabetes and died of metastatic bone cancer. The search to find the queen was funded by The Discovery Channel. Discovery is airing an exclusive documentary on the find in July. What a scoop!

In a few years when my kids both reach elementary school, I might get the chance to chaperone a field trip to the Chicago Field Museum to meet Queen Hatshepsut. Amazing.

Shrek, Cocoa Krispies, Frosted Flakes. You don't have to be a health nut to find the breakfast cereal and snack treat aisles at your local supermarket a bit disturbing. Sugar, sugar and more sugar: seems that's the main ingredient in most of the cereals pitched at children. And the appalling effect of all that consumption on the nation's children is evident in record (and rising) levels of childhood obesity and Type 2 diabetes. But it seems the food industry is beginning to respond to these concerns.

The New York Times reports that the Kellogg Company plans to quit advertising some of its least nutritious products to children younger than twelve. Those products are the ones packed with so-called "empty-energy" calories derived from sugar and fat, and also containing high levels of sodium. Kellogg also promised to end the use of licensed characters and toys to sell those products. In addition, Kellogg's President and CEO, David Mackay, is quoted as saying that the most sugar-soaked products may be reformulated to make them a tad healthier if it can be done "without negatively impacting the taste of the product."

Kellogg is doing this voluntarily, and expects to complete the changes over the course of the next year and a half. The marketing switch will affect marketing of about half of Kellogg's products. Needless to say, it is what you might call a preemptive move. By making this concession, the company will be able to counter accusations from food industry critics that its execs don't care about the health of our children. Oh, and there's the small matter of a lawsuit which, if it had proceeded, would have brought some horrible bad publicity to Kelloggs. The Center for Science in the Public Interest and the Campaign for a Commercial Free Childhood, along with two Massachusetts parents, says The Times, were threatening to bring a suit against Kellogg and Nickelodeon for their tactics in pitching products to young children. These groups now say they will not pursue their case against Kellogg in light of the changes it has made.

In the wake of the disastrous media coverage now being given to GlaxoSmithKline over its diabetes drug, Avandia, Louise Story of The New York Times has taken a closer look at Glaxo's strategy for selling the drug. It appears that a central pillar of that strategy was pitching the drug extra hard to the African American community. Seems Glaxo was faster and savvier than its competitors to recognize what seems sort of obvious in retrospect: African Americans suffer from Type 2 diabetes at a rate disproportionately high compared with that of the general population, so reaching out to that community could be lucrative for drug manufacturers. Glaxo has been targeting diabetic African Americans in a glossy and carefully crafted ad campaign for some years now.

Della Reese (pictured) was Glaxo's big star for the campaign. Remember Reese? The Touched by an Angel actress and jazz singer was too perfect. Black diabetic? Check! Celebrity status? Check! Grandmotherly yet sassy? Check! Click here to see a sample of the ad literature and images featuring Reese.

The question that industry analysts are now asking is this: will Glaxo's strategy now backfire in the wake of the Avandia scandal? That is, will black diabetics lose trust in the company name over this controversy? Times journalist Story speculates that this could indeed happen; that African Americans have been ill-used before by drug companies and scientists, most famously in the notorious Tuskegee syphilis experiments. Regardless, this is a sector of the market Glaxo can't afford to lose.

GlaxoSmithKline has its hands full right now big-time, defending its conduct over the ever-deepening Avandia scandal. But the big-name pharma company isn't giving up the fight. (No surprise there...) Today Glaxo ran full-page advertisements in a number of prominent US newspapers. The move is described by Britain's Guardian as the launching of a major PR war. The ads are featured in fifteen major newspapers, says the Guardian, including The New York Times, The Washington Post, The Wall Street Journal, and the LA Times. The ad is a direct appeal to patients, taking the form of an open letter from Glaxo's chief medical officer, Dr. Ronald Krall. (Guess he's working some late nights at the moment, huh?)

The ads were timed to appear one day before the congressional hearing on the US Food and Drug Administration's work on Avandia and consumer safety, which is scheduled for tomorrow. Another Glaxo-penned letter defending Avandia was also published in the medical journal the Lancet. Said a company spokesman of today's ads: "We are determined to make sure the science we feel backs us up is heard."

This article also notes that weekly prescriptions for Avandia have fallen by sixteen percent since the recent publication of a damaging article by Dr. Steven Nissen in the New England Journal of Medicine. Nissen asserted that Avandia could increase the risk of heart attack by forty-three percent and the risk of cardiac-related death by sixty-four percent.

By the way, it is worth checking out the Wikipedia entry on Glaxo for a brief rundown of the company's history, including previous wrangles with the media and the law over its products. Note, though, the entry has not yet been updated in the wake of the Avandia scandal.

Here's a question for you to ponder: we know that obesity/overeating is harmful to the body, right? It leads to Type 2 diabetes, among a myriad of other harmful effects. So why do we continue to eat the way we do? Author and academic (at the University of California, Berkeley) Michael Pollan has taken a valiant stab at answering that question. Pollan is the author of the well-received book The Omnivore's Dilemma: A Natural History of Four Meals. I have not read the book (though I'm adding it to my list of books to read in 2007), but I did read Pollan's fab article "Unhappy Meals" in this weekend's New York Times. Our obesity problem, says Pollan, is all tied up with a national hangup about eating and nutrition.

The "elephant in the room," writes Pollan, is the Western way of eating. To be healthier and to avoid diseases like Type 2 diabetes, we should cut consumption of meat and carbs, avoid processed foods, and eat lots more fruits and vegetables. In the case of Type 2 diabetes, the nation needs to stop, in the word's of a scientist quoted by Pollan, "mainlining glucose." And yet...it doesn't happen. Instead, Americans subscribe to fad diets, they invest in expensive exercise equipment and gym memberships. Moreover, says Pollan, Americans are beset by "nutritionism." That is, we try to prevent obesity and diet-related diseases like diabetes by identifying and eliminating the harmful substances in our foods - like salt, fat or carbs - when what we need is to totally modify our diets. He (politely) places a lot of the blame for this on scientists and the media for supplying us with a constant stream of nutrition-related advice that's so confusing and contradictory and seemingly-important that we keep forgetting about that big old "elephant" - the Western diet as a whole. This focus, he says, "has diminished our pleasure in eating it while doing little or nothing to improve our health." It's a conundrum alright.

I've noticed in the last week or so a flurry of articles in the news about the rise of Type 2 diabetes in Asia. Today I see a full-length article has been published by The New York Times about diabetes in India. I recommend you check this out if you're at all interested in how diabetes is affecting people in countries and cultures beyond the United States.

Journalist N.R. Kleinfield tells the story of how the rampant spread of diabetes is taking a toll on an already overburdened healthcare system and causing plenty of suffering and sadness along the way for those afflicted and their families. Example: the wife who sold her treasured gold jewelry to pay for her diabetic husband's medical treatment, and who now has diabetes herself. Example: the diabetic who, unable to afford amputation surgery on his infected leg, laid it across the railway tracks and waited for a passing train to do the job.

The fact that diabetes is "engulfing India," Kleinfield remarks, is all the more striking given that Type 2 diabetes is a disease of those who have plenty to eat in a country more often known for famine, "stick-thin poverty, malaria and AIDS." Yet, says Kleinfield, India now has around 35 million diabetics, and that rate is growing in urban areas faster than in the US. (That's in a population that totals 1.1 billion.)

Lay the blame on industrialization, modernization, and urbanization, say health experts. Add to that a growing passion for fast foods and convenience foods, and a traditional national sweet tooth. "Diabetes," says Dr. A. Ramachandran of Chennai (formerly Madras), "unfortunately is the price you pay for progress."

Living "a cupcake away from a coma" is no picnic, says diabetic Dan Hurley, writing for The New York Times in "The Beep of the Sensor, the Thrill of Control." And that's even when you're doing everything right. Hurley describes the night vacationing in Cape Cod last year when he almost slipped into a low-blood-sugar-induced coma...and death. Revived by his young daughter, "I came to my senses enough to think, 'Not again!'" remembers Hurley. In June he got himself one of the new continuous glucose monitors. How did it feel? "Kind of weird, but kind of cool, in a sci-fi way," he says. Overall Hurley says the gadgets are good but not great. While his monitor's warning system has drastically cut his usual number of lows, he says they're still not as accurate as standard blood-glucose testers. Then there's the expense, which Hurley figures costs him $350 a month. Still, he's sticking with it for the time being. It's worth it for the peace of mind, says Hurley.

What makes this piece by Hurley so compelling is his true-to-life description of how he lives with and manages diabetes. Like so many diabetics, through endless testing and dosing (with insulin), he stays healthy. Yet he is always, always on the edge of danger - hence the cupcake analogy.

I got a ton of comments on the blog I posted August 16 about coffee consumption. For anyone who's interested, I have a couple of thoughts to add.

Point One: my blog was all about a recent New York Times article. This article reported on a recent study indicating that people who consume coffee have a lower risk for Type 2 diabetes and other illnesses. First of all, many readers seem upset that the report contradicts previous information they've heard about coffee. Many of them essentially threw up their hands in frustration, saying "what are we supposed to believe?" or "you can't believe anything you read in the news anymore." Wrong! Friends, the researchers never said that caffeine is good for you. They were not studying caffeine's effects on the body. What they say is this: their research suggests that certain components found in coffee, possibly antioxidants, could work to lower the body's risk of disease. They did not attribute this to caffeine. In fact, they found that participants in the study benefited regardless of whether they drank decaf or the real deal.

Point Two: I don't know about you, but I don't care much for comments that read along the lines of "my dad drank ten cups of coffee and smoked two packs a day but he's ninety and in perfect health." Well, the thing is this: you or your friends/family's (very limited) personal experiences bear little relation to the results of a medical study. Studies like this one on coffee involve a lot of statistical analysis to evaluate risk and benefit. It doesn't matter that you smoked for forty years and don't have lung cancer. The fact is that, statistically speaking, you are in high risk category for such a disease.

Thanks for reading!