ALEXANDRIA, Va., Dec. 27 /PRNewswire-USNewswire/ -- Despite the
publication of increasingly aggressive guidelines for lowering blood
pressure in people with diabetes, this condition remains substantially
unimproved, according to a study being published in the January issue of
A separate study being published in the same issue finds that small
pupil size during adolescence may help predict diabetes-related
complications later in life, such as retinopathy and microalbuminuria, a
marker for both cardiovascular and kidney disease. The January issue of
Diabetes Care also includes the American Diabetes Association's (ADA's) new
Clinical Practice Recommendations, which are revised on an annual basis.
Hypertension Guideline Changes Fail to Improve Control
The blood pressure study, which compared hypertension control in people
with and without diabetes from 1995-2005, showed that reducing blood
pressure goals twice for people with diabetes during the past decade did
little to improve control of this condition. The findings are consistent
with other recent studies which showed that doctors fail to aggressively
treat high blood pressure in people with diabetes, despite the fact that
hypertension is a major symptom of cardiovascular disease, the leading
killer of people with diabetes.
In 1997, and again in 2003, the Joint National Committee on Prevention,
Detection, Evaluation and Treatment of High Blood Pressure (JNC) lowered
blood pressure goals for people with diabetes. They currently recommend
that people with diabetes keep blood pressure at or below 130/80 mmHg.
The changes, however, "did not lead to substantially better
hypertension control for diabetics compared with non-diabetic patients,"
the researchers concluded. "This finding is somewhat surprising considering
the recognition of JNC guidelines as the gold standard for hypertension
treatment, similar recommendations from other organizations such as
American Diabetes Association, American College of Physicians, and American
Academy of Family Physicians, and public health efforts to promote
comprehensive diabetes care."
Previous studies have shown that doctors intensified treatment of high
blood pressure during as few as 12 percent of office visits when people
with diabetes presented with this problem. High blood pressure can be
treated through lifestyle and dietary changes as well as with numerous
medications. Many people with diabetes also exhibit high blood pressure, an
early warning sign for the development of heart disease.
Identifying effective interventions to deal with the challenge of
lowering blood pressure in people with diabetes should be a top priority
for future research, the authors concluded.
Small Pupil Size Predicts Complications in Adolescents
In a separate study, researchers identified a predictive relationship
between small pupil size in adolescents with type 1 diabetes and the
presence of microalbuminuria and retinopathy 12 years later. Small pupil
size has been used to predict mortality in adults with diabetes but has not
often been used in adolescents.
This study, by researchers in Australia, found that adolescents with
type 1 diabetes whose pupils were reduced in size were at higher risk for
complications from their disease in their 20s. In particular, they were at
greater risk for retinopathy - a progressive eye disease - and
microalbuminuria, or the presence of small amounts of albumin in the urine,
which indicate cardiovascular and kidney problems.
The researchers recommend further research to determine if improved
glycemic control when pupil abnormalities first appear would improve the
condition and lead to fewer complications.
Clinical Practice Recommendations Updated
The ADA's Clinical Practice Recommendations have been updated to
include new information about treatment and prevention that reflects the
latest research. Changes have been made in numerous areas, including the
management of hyperglycemia in type 2 diabetes; nutrition recommendations;
and screening and treatment for children who have both type 1 diabetes and
Managing hyperglycemia can be a problem for many people with type 2
diabetes. The revised recommendations now include information from a
Consensus Statement published by the ADA and the European Association for
the Study of Diabetes (EASD), which advises early intervention with
metformin in combination with lifestyle changes to improve glycemic
control. It also advises early initiation of insulin for those who present
with weight loss and more severe symptoms.
In 2006, the ADA published Medical Nutrition Therapy (MNT) guidelines
for people with diabetes, specific to individual populations, such as those
who are obese or pregnant. The Clinical Practice Recommendations have been
updated to reflect these guidelines and to encourage people with diabetes
or pre- diabetes to seek individualized MNT to help them achieve their
Information about how to treat children who are diagnosed with both
type 1 diabetes and celiac disease was also added to the Clinical Practice
Recommendations this year. Up to 16 percent of children with type 1
diabetes are also diagnosed with celiac disease, an immune disorder that
affects the digestive system, damages the small intestine and interferes
with the absorption of nutrients from food. The recommendations call for
more aggressive screening for celiac disease in children with type 1
diabetes who present symptoms such as weight loss, growth failure,
abdominal pain and chronic fatigue. A gluten-free diet is recommended for
those who test positive for celiac.
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).
SOURCE American Diabetes Association