Saturday, July 26, 2008

New Guidelines Recommended for Treatment of Prediabetes

For the first time, a panel of experts in diabetes and metabolic disorders has issued a comprehensive regimen of guidelines for diabetes prevention. Prediabetes (elevated fasting glucose levels or impaired glucose tolerance) remains undiagnosed in the majority of our population, and is thought to exceed the number of people who are aware of the condition. The burden on health includes a significant risk of developing Type 2 diabetes and heart disease. The known prevalence of diabetes in the US is currently 56 million.

The American Association of Clinical Endocrinologists (AACE) is expected to issue their final document later this year in Endocrine Practice. In a news release, Yehuda Handlesman MD, FACP, FACE, treasurer of AACE and medical director of the Metabolic Institute of America says, “We understand the difficulties in implementing solutions, but as an association of endocrinologists we are committed to supporting community and national efforts in every way we can."

The new guidelines will include specific lifestyle changes, and medication recommendations when appropriate for those at risk. The goal is to recognize and treat type 2 diabetes early and aggressively.

The panel plans to use a two-fold approach. High risk groups may require medications to lower cholesterol and treat hypertension when lifestyle modification fails. Alan J. Garber, MD, PhD, FACE, professor of medicine, Baylor College of Medicine in Houston, Texas, and chairman of the Consensus Conference says, "Although lifestyle can clearly modify the progression of patients towards overt diabetes, it may not be sufficient. Close monitoring by family physicians is recommended for high risk groups.

Normal blood sugar levels are defined when fasting, at less than 100 mg/dl and glucose tolerance challenges less than 140 mg/dl. When blood glucose levels reach 126 in a fasting state and 200mg/dl after a glucose challenge, a diagnosis of diabetes is made. Those in the middle are poorly defined.

Lifestyle management is desirable because it is safe and can be an effective tool for reducing heart disease risk and the development of diabetes. Exercise, 5 days a week at moderate intensity has been recommended, though a recent study shows that high intensity interval exercise may be even more beneficial. Further recommendations include aspirin for prediabetic patients who are not at risk of bleeding. Guidelines for prediabetic cholesterol and blood pressure management are the same as those with diabetes.

Standards for diabetes prevention include the following dietary recommendations:

Primary prevention of diabetes

•Among individuals at high risk for developing type 2 diabetes, structured programs that emphasize lifestyle changes that include moderate weight loss (7% body weight) and regular physical activity (150 min/week), with dietary strategies including reduced calories and reduced intake of dietary fat, can reduce the risk for developing diabetes and are therefore recommended.
•Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).

Dietary fat intake in diabetes management

•Saturated fat intake should be <7% of total calories.
•Intake of trans fat should be minimized.

Carbohydrate intake in diabetes management

•Monitoring carbohydrate intake, whether by carbohydrate counting, exchanges, or experience-based estimation, remains a key strategy in achieving glycemic control.
•For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone.

Other nutrition recommendations

•Sugar alcohols and nonnutritive sweeteners are safe when consumed within the acceptable daily intake levels established by the Food and Drug Administration (FDA).
•If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (one drink per day or less for adult women and two drinks per day or less for adult men).
•Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety.
•Benefit from chromium supplementation in people with diabetes or obesity has not been conclusively demonstrated and, therefore, cannot be recommended.

The above recommendations can be found at:

The recommendations from the AACE for intensive screening, lifestyle changes,including nutrition and weight loss in addition to testing and monitoring of prediabetes are expected to decrease hospitalizations, provide healthcare savings, and decrease years of disease burden for those who are already at risk.

Source: AACE Consensus Statement of the AACE Task Force on Pre-diabetes. Released July 23, 2008. ◦

Saturday, July 19, 2008

Controlling Surgical Pain with Foot and Hand Massage – Study Review

A study published by Hsiao-Lan Wang, R.N., and Juanita F. Keck, R.N. in Pain Management Nursing, June 2004, (Vol. 5, No. 2, pp. 59-65), showed that twenty minutes of foot and hand massage “significantly reduced both pain intensity and distress resulting from incisional pain on the first postoperative day.” Each of the study participants were recovering from gastrointestinal, gynecological, urological, head, neck or plastic surgery. They all received pain medication one to four hours prior to the massage intervention, and each had asked for something to relieve incisional pain. Before, and immediately after the 20-minute massage, heart rate, respiratory rate and blood pressure were measured, and pain intensity and distress scores were evaluated.

The participants of the referenced study experienced significant reductions in both pain intensity and distress after the 20-minute foot and hand massage. Heart rate and respiratory rates decreased after the same therapist provided petrissage, kneading and friction for five minutes on each hand and each foot, for a total of 20 minutes.

The authors concluded: “Foot and hand massage appears to be an effective, inexpensive, low-risk, flexible, easily applied strategy for postoperative pain management.”

Though the study is not new, it seems alternative therapies are still overlooked, and studies perhaps forgotten, by even the most thoughtful and diligent practitioners of medicine. Healthcare administrators, when considering staff development in hospital and outpatient surgery settings, might take time to explore non-traditional options for patient care. Massage therapists and Nurses can provide much toward patient comfort and healing by providing and/or teaching massage techniques to family members. Improved patient outcomes include post-operative pain control, without excessive use of risky narcotics, shorter patient recovery times and fewer complications following surgery from patient mobilization.

As patient advocates, perhaps physicians, nurses and healthcare administrators should “step out of the box” and take a fresh look at proven alternative treatment options for patients in all types of healthcare settings. In this instance, a simple hand and foot massage sounds like a delightful alternative method for helping patients manage pain.

Resource: Foot and hand massage as an intervention for postoperative pain

Related: Massage Provides Pain Relief Following Surgery

Saturday, July 12, 2008

Computer Program Significantly Improves Memory in Healthy Elders-Study

Declining memory is thought to be a normal part of the aging process. It is also seen in the presence of inflammatory diseases, schizophrenia, neurodegenerative diseases and dementia. According to a new study, a computer based training program, dubbed “BrainStim”, significantly improved working memory in older healthy adults. The study results were presented at the 18th Meeting of the European Neurological Society, in Nice, France.

First author Iris K. Penner, PhD, from the University of Basel, in Switzerland, says the working program is based on a 1974 model published by Baddeley and Hitch that recognizes working memory as a temporary storage unit that we all use on a daily basis. Dr. Penner says, "So if, for example, you go to the supermarket, and you would like to remember what to buy, that is stored for a short period in working memory. If there is a problem with working memory, in the future you may have problems in other cognitive domains. That's why we focus the training on that central function."

The program was developed in three parts, with simplicity in mind. If performance drops, the tasks becomes less difficult; conversely it provides more challenge to the user, based on successful responses. The three parts involve the participants in finding their way on a city map after receiving visual or verbal instructions, finding matching pairs of cards based on a child’s card games, and recalling numbers provided at baseline, while performing an arithmetic task. The programs respectively target spatial orientation, visual object memory and the updating function of the central executive component of working memory, and working memory for recall.

"BrainStim" can be installed on any computer, and is based on Java runtime programming. The authors conclude, "In this concern, BrainStim seems to positively influence brain functionality in healthy elderly subjects and might therefore be a useful tool in prevention."

BrainStim is not yet available commercially, but the authors hope to develop further models, stating that a major German bookseller is interested in the training program.

Source: - 18th Meeting of the European Neurological Society: Abstract P485. Presented Monday, June 9, 2008.

Related: Cognitive Training May Have Long-Term Benefits on Activities of Daily Living in the Elderly

Saturday, July 5, 2008

Drug Free Treatment for Migraines Tested

Safe, drug free, effective treatment for migraine sufferers may be just around the corner. Study investigator Richard B. Lipton, MD, from the Albert Einstein College of Medicine, in the Bronx, New York presented evidence that TMS, or transcranial magnetic stimulation, may help patients that use the device as soon as warning signs of migraine appear (migraine with aura). The device is hand held, weighs less than 3 pounds, is rechargeable and portable.

The current study, presented at the 50th Annual Meeting of the American Headache Society is the second study of its kind. In 2006, the American Headache Society was presented with news that treatment using a large, tabletop TMS device reduced headache pain in the clinic. Because early intervention is necessary, the portable device has been designed for home use.

How it Works

Migraine headaches are thought to be a result of disturbances in the cortex of the brain, known as the cortical spreading depression (CSD) of Leão, or in other terms, a brain signal that is discordant. The hand-held TMS device is thought to disrupt cortical spreading depression. Animal experiments have replicated changes in blood flow that possibly occur with migraine headaches with aura, supporting the hypothesis, but the cause of migraine headaches has been elusive, making treatment difficult. (1) Many people cannot find relief with medications.

The challenge is to compare medication use to the TMS device, which fell short in relieving nausea, light sensitivity (photophobia), and increased sensitivity to sound (phonophobia). However, of the 164 outpatients studied, pain relief was superior when compared to the application of a sham device.

According to estimates, “Eleven million to 25 million Americans suffer from migraine, and headache is one of the top 10 reasons cited for an outpatient medical visit”. New drugs are being researched on a regular basis. Triptans are the most commonly prescribed medications used to treat migraine headaches, but the risk of side effects can be concerning to many patients. Treatment of migraine headaches without side effects that can be dangerous would be welcome news to millions of Americans.

Non-drug approaches to migraine headache treatment may include acupuncture, shiatsu massage, (a form of accupressure), regular exercise, and avoidance of dietary triggers. Some herbs, such as feverfew, and pine bark extract in combination with Vitamin C and Vitamin E have been shown to possibly help.

Source: American Headache Society 50th Annual Scientific Meeting: Abstract LB-OR28. Presented June 27, 2008.

Pathophysiology of the migraine aura
Experimental Portable Device Shows Promise in Treating Migraine with Aura
Transcranial Magnetic Stimulation Effective for Depression in Large Trial

Migraine Information by Ray Sahelian, M.D. Natural treatment for migraine, alternative migraine treatment