UCLA researchers report Nevada County, California residents have the lowest rate of diabetes in the state -- 2.6 percent. That's about one-third the state-wide average (6.8 percent), and slightly less than one-quarter the prevalence of diabetes in Imperial County (11.2 percent).

Take a few guesses why Nevada County's rate of diabetes is so much lower than Imperial County, and well under the national average of 7 percent. Do families eat less processed food around the dinner table? More jogging trails? Better health insurance coverage? Researcher Theresa Hastert states, "There is no one thing, but higher income is associated with better foods and exercise."

Hastert explained Nevada County is mostly white, affluent, educated and insured. Imperial County has a large population of Latinos and migrant farm workers. Nevada County's numbers support general findings that minorities without affordable, continuous health care are more prone to the disease. Who's got time for the dinner table -- Hastert openly speculates eating more junk food may be a consequence of dodging between three jobs just to get by. Also, Nevada County is a beautiful area -- she wonders if environmental factors play a role.

Is diabetes a socio-economic disease? If so, we're in trouble. The gap is widening between our nation's haves and have nots, and large concentrations of poor minorities may explain the disproportionate rates of diabetes from county to county. Read more in The Union.

Diabetic foot complications are responsible for many lower extremity amputations. But this last drastic step can be prevented up to 85 percent of the time with early diagnosis and proper care.

Now Thai researchers and physicians have shown using a patient's own stem cells can effectively heal chronic foot wounds. Diabetes patients with chronic foot wounds, aged 50-72, were injected with stem cells obtained from their own blood. Most excitedly, the wounds healed nicely within three to four months. The stem cell treatment also makes fiscal sense. According to this article, stem cell treatment for wounds in a patient with diabetes costs about $6,000, one-fifth the cost of conventional treatment for a leg wound.

Studies have shown primary care physicians often fail to examine the feet of patients with diabetes. It's a shame, as this step is the least costly and most effective way to prevent foot wounds and potential amputations. But at the same time, it is nice to know there is a promising, cheaper treatment utilizing patient-donated stem cells.

Aaaahh ... fall will soon deliver golden trees, crisp autumn air, piles of fallen leaves begging to be jumped in, and the stick of the flu vaccine.

The National Foundation for Infectious Diseases (NFID) recently issued a report calling for greater influenza vaccination rates among Americans with diabetes. Turns out more than 50 percent of the 21 million people with diabetes do not receive an annual influenza vaccination. This is contrary to the recommendations of the Centers for Disease Control and the American Diabetes Association.

According to Dr. William Schaffner, NFID's vice president, the impaired immune systems of people with diabetes can result in a higher risk of serious complications from influenza, including impaired blood sugar control. Annually, this infectious disease strikes up to 60 million Americans and kills an average of 36,000 people -- more than all other vaccine-preventable diseases combined. Over 10 percent of deaths linked to influenza and pneumonia are due to diabetes. There are studies citing the benefits of the vaccine for people with diabetes, including reduced hospitalization and death by 72 percent for those with diabetes 18 to 64 years of age, and 80 percent less hospital admissions for children and adults with diabetes.

I'm just speculating, but lack of awareness, lack of access to an affordable vaccine or just plain philosophical disagreement with the need for the vaccine (among other factors) may all play a role in the low influenza vaccination rates for people with diabetes. Just an example, my parents both have type 1, and my mom will stand in line for hours to get a shot (she was hospitalized for influenza in her pre-diabetes days), while my dad always refuses -- he's never had influenza. Read more at Infection Control Today.

New research finds tuberculosis (TB) is more difficult to treat if the patient has type 2 diabetes. The study examined 737 Indonesians with tuberculosis screened for type 2. Nearly 15 percent had type 2, and initially, their TB was as severe as the non-diabetics. After two months of treatment, TB sputum tests were positive 18.1 percent for those with type 2 and only 10 percent in non-diabetics. At the six month mark, 22.2 percent of type 2s had positive sputum results compared to 9.5 percent of the non-diabetics.

The story in Reuters does not address why people with TB and type 2 diabetes do not respond as well to TB treatment. Tuberculosis is a serious infectious disease. Over one-third of the world carries the TB bacterium, and one in ten latent infections will progress to active TB disease. Untreated, active TB is a real threat, it kills more than half of its victims. Experts are examining how rising rates of type 2 are impacting TB control and prevention worldwide.

I just finished reading an excellent book about Dr. Paul Farmer's inspirational work treating tuberculosis in impoverished communities worldwide -- Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World -- masterfully written by Tracy Kidder. I wonder what Dr. Farmer has to say about people with type 2 and TB.

How come type 2 diabetes does not affect all obese people? A study recently published in the Journal of Clinical Investigation may explain why. Adiponectin is a hormone that controls insulin sensitivity. Leptin is a hormone which lessens appetite. Too much adiponectin allows mice to store excess calories in fat tissue instead of in more dangerous areas -- the liver, heart or muscle tissue -- where extra fat may lead to inflammation, diabetes and heart disease. Unfortunately adiponectin levels decline as people get fatter. So researchers wondered "what if overeating mice had high levels of adiponectin?"

Researchers genetically engineered mice to produce lots of adiponectin and a lack of leptin. The mice overate and became obese, but their high levels of adiponectin enabled them to dump their fat into fat tissue, which has antidiabetic effects. Dr. Philipp Scherer, senior author, stated the inability to appropriately expand fat mass while overeating may be an underlying cause of insulin resistance, diabetes and cardiovascular disease. Low adiponectin levels don't allow fat cells to accept fat, so the fat builds up in inflammatory locations.

Considering 66 percent of American adults are overweight or obese, Dr. Scherer stated researchers need to find way to deposit extra calories in the least harmful places. He plans to investigate how to maximize good fat areas and shrink bad ones. This solution is disturbing to me -- don't we need to get rid of the fat in the first place? Read more in Health News Digest and check out Diane's recent post on upper body fat's link to insulin resistance.

Scientists from all over the world will meet up in Seattle October 22-23 to attend the Warren G. Magnuson Congress for a Global Diabetes Alliance. The initiative is intended to help fight the rapid rise of type 2 diabetes worldwide. International Diabetes Federation past president Pierre Lefebvre, who will be a speaker at the conference, says the need for such an alliance to fight the T2 global epidemic "could not be more urgent."

More than one hundred diabetes experts hailing from over twenty countries will attend the congress. There's one main goal: the discussion of how to help under-served populations, such as indigenous peoples. However, the more general problems - prevention, treatment and the possibility of a cure - will also be on the table. It is also hoped that the alliance can help change public perception of type 2 diabetes as a disease associated with affluence, when in fact it is spreading faster in poor, developing countries where people frequently lack access to medical care.

Organizers say this is the first global alliance on diabetes. Speaking of organizers: who's behind this anyway? Well, it's being convened by the Pacific Northwest Research Institute (PNRI). Incoming president of the American Diabetes Association, Dr. Paul Robertson, is president and scientific director of the PNRI. Warren G. Magnuson, for whom the conference is named, was a US senator and supporter of the sciences who died from diabetes complications in 1989.

The ADA and PNRI's Dr. Robertson is optimistic the organization can effect change: "The response from top experts from around the world to develop a global, multidisciplinary, collaborative endeavor focused on clinical research on diabetes has been overwhelming."

Way back in my middle school years, students taking Home Economics had to carry around a five pound sack of flour for a week to illustrate mother/fatherhood. Kids drew cute baby faces on their lumpy sacks and proudly carried them around. It was novel for a day or two, then you'd start to see the flour babies left in lockers or simply forgotten at home. Parenthood sounds easy, until you have to rise to the responsibility day in and day out. Same with diabetes.

This past week, Representative Michael Castle (R-DE) and Representative Zack Space (D-OH) signed on for the American Diabetes Association's "Day With Diabetes" -- a demonstration designed to raise awareness of the immense personal impact of the disease. Castle was 'diagnosed' with type 1 and Space with 'type 2.' Both met with a certified diabetes educator and a registered dietician to devise a treatment plan. The Representatives attempted to control their 'diabetes' for a day -- pricking their fingers for blood glucose checks, taking their medications and considering every meal choice. They were also shadowed by people with the real deal -- CJ Jones has had type 1 for 30 years and Berth Garbrandt, has had type 2 diabetes for nine years.

Next month Castle and Space will hold a Congressional briefing to report on their experiences living with diabetes for a day. Space has a good idea, his son has type 1 diabetes. Castle is co-chair of the Congressional Diabetes Caucus. A pretty interesting publicity stunt for diabetes awareness. We need to keep diabetes funding and research on the top of every legislator's mind. Here is the full story.

Our guts don't really have a tongue, but researchers have identified two taste receptors in the human intestines -- T1R3 and G protein gustducin. The receptors operate within taste cells that sense glucose within the intestine. These same receptors are used by our tongues to taste sugary stuff, even artificial sweeteners. Turns out the research team hypothesized the sugar sensors in the tongue might also be the same ones in the gut. They were right. Hey, nice guess!

That Snickers bar you're eating? Your gut tastes it, too. Even the artificially sweetened glass of chilled Crystal Light is tasted by the gut. It is important to understand how the gut is sensing, since these taste cells regulate secretion of insulin and hormones that control appetite.

Researchers say discovering the identity of the gut's sweet tooth receptors may pave the way for new treatments for obesity and diabetes. Lead author, Dr. Robert F. Margolskee, stated the study may explain why today's artificial sweeteners may not help with weight loss. New zero-calorie sweeteners could be developed to better control weight. The findings were published online in the August 20, 2007 "Early Edition" of the proceedings of the National Academy of Sciences. Read the full article in Medical News Today.

The American Association of Clinical Endocrinologists (AACE) has released its new medical guidelines for diabetes. Needless to say, the 66-page guidelines are intended for your doc, not for you. Unless you are having trouble getting to sleep at night...

But they're important for you to know about. Very. The guidelines are the first reference point for physicians determining the best course of care for diabetes patients. Blood sugar, blood pressure, type 1, type 2, pregnancy, metabolism, prevention etc etc. It's all in there.

So what's new? According to AACE president Dr. Richard Hellman, the focus is, for the first time, on patient safety - specifically, reducing the incidence of medical errors involving diabetes patients. "These guidelines are the first that specifically point to how best to protect the patient with diabetes against mistakes and misjudgments by all those who directly or indirectly impact their diabetes care, including themselves," said Dr. Hellman. "Patient safety is not a given."

The guidelines are being published as a supplement to the latest issue of Endocrine Practice (May/June 2007), the journal of the AACE. They can also be accessed online. Click here to view the pdf.

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.

Shhh. Big Pharma scientists hard at work. On what, you ask? Why, on Novo's new "baby" - a drug designed to treat type 2 diabetes. Liraglutide, a hormone analogue, is supposed to improve blood sugar control. It's also supposed to get you that coveted magic bullet (a la Byetta): weight loss. Ooh, baby. Now that's medication!

Novo Nordisk has been working on Liraglutide for a while now. Here's the latest: Novo announced Monday that two Phase III studies were successful in demonstrating the aforementioned blood sugar control and weight reduction. Novo is riding high on the news: its shares rose six percent on the announcement. According to a pharmaceutical industry analyst quoted by Reuters, the shares surged so healthily because the positive news was expected.

The powers-that-be at the drug giant say they hope Liraglutide can be submitted for regulatory approval by mid-2008. They hope it will become another blockbuster, with estimated annual sales topping one billion. Stay tuned.

The title of Kraft Foods' press release this morning was Good Eating, Good Living Radio Show and Website Aim to Clear Up Confusion and Isolation Often Associated with Diabetes. The radio show and Website will provide diet and exercise tips for people with diabetes. Recipes, a meal and fitness planner, product nutrition info, logs/journals, articles, etc ... will be offered. Amy Hendel, a registered physician assistant and Edye Wagner, a registered dietitian and certified diabetes educator, will host the 22 episode radio show beginning August 25 in 30 cities across the country.

Seems like Kraft is spinning a public relations campaign to help pardon the junk food they're hawking to kids and adults. They also are boldly advertising Kraft Foods products in the name of helping people with diabetes. This new program is more about food sales and rationalization against potential future litigation by showing Kraft stands by healthy eating. The press release even included a quote from Amy Hendel, "The good news for the millions with this disease is that by choosing Kraft products they don't have to deprive themselves of their favorite foods or sacrifice flavor."

If Kraft Foods truly wanted to help the millions of people in the United States with diabetes they should stop selling the junk such as Oreos, Fruity Pebbles and Chips Ahoy cookies. Although I do applaud many of their healthier products -- Triscuits, Post Shredded Wheat and Breakstone's Cottage Cheese. Also, in 2005, Kraft did stop advertising some junk food products to kids under age 12. But how about kids over 11? Kraft should also stop being a player in the Big Food lobbying games. The last Bush/Cheney campaign reaped thousands of dollars in donations from a lobbyist for Altria (the company formerly known as Philip Morris), which formerly owned 85 percent of Kraft Foods. (Kraft became a fully independent company March 30, 2007.) Altria also handed the Bush inauguration $250,000 in 2005. It's time for our government to stop taking Big Food's money and start regulating the junk out of Big Food's product lines. But Kraft is smart, if they appear like they're regulating themselves, the government and litigators are less likely to step in. Philip Morris executives know all about tobacco litigation.

This is not to say the radio show or Website will not be decent sources of information for people with diabetes. But as you tune in, keep in mind Kraft's intention may not be that altruistic. Don't miss this informative article on the deceptive tactics of Big Food, Kraft included.

The Chicago-Sun Times just ran a piece about area dentists who are doing their bit for type 2 diabetes prevention. These docs are screening all patients with gum disease for high blood sugar. They hope this will help with early detection, since gum disease is a risk factor for diabetes. (In fact, gum disease is a risk factor for tons of health issues, running the gamut from minor to life-threatening.)

The paper profiles, among others, dentist Dr. Ronald Schefdore. Whenever Schefdore gets patients coming in with gum disease, he automatically gives them blood tests that measure cholesterol and blood sugar levels, as well as inflammation. Schefdore describes a success story involving one patient who, thanks to the tests, got an early diagnosis of pre-diabetic symptoms and now, with the help of his PCP, has his blood sugar back under control.

Schfdore has also trained about five hundred other dentists (wow) how to collect blood samples using the finger-prick method. "If every dentist practiced this way," he comments, "we could improve the health of the world overnight."

This is preventive care in action. People like this are raising the bar for everyone. Cheers!

I have the utmost respect for golfers with disabilities. In a conference match in high school, I played against an opponent missing her right hand and most of her forearm. As a right-handed golfer, her swing arc was primarily guided by her left arm, so she didn't miss a beat when it came to form. Whatever yards she lost on her long game were covered by a pretty mean short game.

I couldn't help but smile wide after hearing this story yesterday about Sheila Drummond, a golfer blinded by diabetes 26 years ago. She may have lost her eyesight to diabetes, but nothing can take this golfing accomplishment away. Last Sunday in a steady rain, 53-year-old Drummond teed off with a driver on the 144-yard, par-3 fourth hole at Mahoning Valley Country Club in Pennsylvania. She smacked it over a water hazard, between the sand traps and onto the green. Her ball hit the flagstick and dropped into the cup. A hole-in-one!

As her drive took off, Drummond's husband Keith, and two other players rounding out the foursome, told her it was a great shot -- then she heard the ball hit the stick. This story will be shared by many golfers gathering round the water cooler this season. Drummond is also on the board of directors of the United States Blind Golfers Association.

The odds of an amateur sinking a hole-in-one are estimated at 1 in 12,750. A few months ago, my mom played in a foursome just behind a friend of hers who teed off on her very first golf hole ever. She hit a hole-in-one. No kidding. What are the odds?

Diabetes rates skyrocketing! is a unified message plastered across the daily news. I've often wondered how improved diagnosis and awareness of diabetes has impacted this incessant news alarm.

Federals scientists analyzed a data set from the National Health and Nutrition Examination Survey to find the total proportion of the population with diagnosed and undiagnosed diabetes. Statisticians found the overall age-adjusted proportion of the population with diabetes has not really changed much from 1988 to 2002, the most recent year of available federal data. Katherine M. Flegal, an epidemiologist at the National Center for Health Statistics, published the results in Diabetes Care last year.

Two subgroups (men and non-Hispanic blacks) did have a small, yet statistically significant increase in the diabetes rate. Dr. James Smith, a senior economist at the Rand Corporation, took an independent look at the male data from the national survey to find out why. He stated the data were distorted by inconsistent surveying of gestational diabetes in women. After removing it from the data, similar rises were seen across both genders.

Dr. Smith does not want to minimize the serious problem of diabetes in this country. But he believes the perception that diabetes is rapidly rising is exaggerated due to confusion over diagnoses versus the actual number of people with the disease. We may need to turn off that rising diabetes news alarm. Read the full story and view a helpful graph on diabetes rates in the NY Times.