Younger age at diagnosis predicts earlier death in type one diabetes (on standard treatment)

Researchers in Sweden have found that the earlier children are diagnosed with type one diabetes, the less their life expectancy is. Matters are worse for women than men. They think that adults diagnosed in childhood need increased input to deal with cardiovascular risk factors as they get older. Currently age of onset is ignored when it comes to stratifying risk.

Those diagnosed under the age of 10 had 4 times the hazard ratio for all cause mortality, over 7 times the risk of cardiovascular disease, 4 times the risk for non cardiovascular mortality,  over 11 times the risk of cardiovascular disease, 31 times the risk of having a myocardial infarction, over 6 times the risk for stroke, 13 times the risk of heart failure, but almost the same risk as controls for atrial fibrillation.

There is a better outlook for those diagnosed in their late twenties. The risk was almost 3 times the background rate for total mortality and the most prominent risk was again for cardiovascular mortality coming in at 6 times the background rate.

What this means is that if you are a girl diagnosed with type one under the age of ten, you may expect to live almost 18 years fewer than your classmates and if you are a boy, 14 years fewer.

My comment: More effort could also be given to youngsters on diagnosis achieving normal blood sugars by advising parents about the easiest ways to control blood sugars such as the adoption of a low carb diet and advanced insulin techniques. Although these statistics are shocking to see, it doesn’t have to be like this at all. Many diabetics have changed their life expectancy around and reverse some complications by adopting practices that improve glycaemic control and metabolic factors such as we describe on this site.

Rawshani A et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study. Lancet 2018;392:477-86;doi:10.1016/S0140-6736(18)31506-X

 

Public Health Collaboration Conference 2018: Achieving your optimal blood sugar target

Videos of the lectures given at the Public Health Collaboration conference 2018 which was held in May over the royal wedding weekend have now been released on You Tube.

You can see my talk, Achieving your optimal blood sugar target, as well as others, on the link below. There are a wide variety of lifestyle topics discussed. Happy viewing.

 

https://www.youtube.com/results?search_query=public+health+collaboration+conference+2018

Polycystic ovary syndrome has health consequences for the whole family

Parents and siblings of women with polycystic ovarian syndrome are more likely than non relatives to develop insulin resistance. The older relatives are, the more likely they are to develop type two diabetes.

Polycystic ovaries affects 4-19% of women of reproductive age. Type 2 diabetes is significantly higher among both the mothers and fathers of women with polycystic ovaries. Both are over twice as likely to be diabetic compared to matched controls.  Type two diabetes is more prevalent in the sisters and brothers of those with polycystic ovaries but was not statistically significant. Fasting insulin levels and insulin resistance were significantly higher in the mothers, fathers and sisters of women with polycystic ovaries.

My comment: Doctors tend to regard polycystic ovaries as a gynaecological condition, but this research indicates that it is a disease of insulin resistance and increased likelihood of type two diabetes in the whole family and does not just affect women, but men in the family as well. 

Yilmaz B et al. Diabetes mellitus and insulin resistance in mothers, fathers, sisters and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil. Steril.2018 June 27 doi:10.1016/j.fertnsert.2018.04.024.PMID:29960703

Treating hypos post sugar tax

Lucozade just isn’t what it used to be. With the sugar tax affecting the diabetics favourite emergency beverage the Independent Diabetes Trust have compiled a list of substitutes that you may wish to use.

For shear portability and cuteness Emma and I are great fans of Jelly Babies but you may have your own.

 

5-7 Dextrosol

4-5 Glucotabs

60 mls Glucojuice (one bottle)

150-200mls pure fruit juice

3-4 heaped teaspoons of sugar dissolved in water

4-5 Jelly Babies

RCGP: What doctors need to know about types one and two diabetes in young people

The Royal College of General Practitioners have recently released an educational programme for UK doctors which they have very kindly allowed me to link to our website.

I recorded this over a year ago and I think the college held off production until their type two diabetes low carb course was also released for doctors.

This means that the RCGP joins the American Association of Clinical Endocrinologists as supporters of low carbing  for both type one and two diabetes.  Surely the other clinical associations and Royal Colleges will follow in due course?

The screencast includes information on diagnosis, emergency situations, blood sugar and dietary management and contraception.

“I have also separately produced an educational screencast on Diabetes in adults (type 1), children and young people (type 1&2) for the Royal College of General Practitioners in my role as an RCGP Clinical Adviser”

http://elearning.rcgp.org.uk/mod/page/view.php?id=8368

 

What factors are most predictive of a heart attack?

Dr Malcolm Kendrick recently discussed a paper in which computers analysed routine clinical data from UK GP practices to identify the factors that most accurately predicted a cardiovascular event over the next ten years.  All the 378,256  people whose records were analysed were initially free of cardiovascular disease and 48 variables were identified.

The top ten things that were most likely to see you in hospital with a heart attack or stroke, in order,  were:

Chronic Obstructive Pulmonary Disease

Prescribed oral steroids

Older age

Severe mental illness

South Asian ethnicity

Prescribed immunosuppressants

Socio-economic deprivation

Chronic Kidney Disease

 

The least predictive were LDL, Forced expiratory volume ( a measure of asthma) and AST/ALT ( a measure of liver function).  Total cholesterol was 25th.

Can machine learning improve cardiovascular risk prediction using routine clinical data? http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174944

Lancet: Aspirin only works if it is the right dose for your weight

Low dose aspirin 75-100mg daily are only effective in reducing cardiovascular events in those who weigh less than 70kg found researcher Peter Rothwell.  This is the dose range used in the UK and the USA but 80% of all men and 50% of all women weigh more than 70kg.

Higher doses of aspirin are only effective for cardiovascular prevention in those over 70 kg and don’t work in those who weigh less than this. Therefore recommending the higher dose range won’t suit everyone either.

Some people also use aspirin to reduce the chances of other diseases such as colorectal cancer. The effects are thought to be dose related as well.

The take home message is that if you weigh less than 70kg stick to 75-100mg of aspirin a day, but if you weigh 70kg or over you should increase your dosage. For most people in the UK this will mean doubling up on 75mg to 150mg and in the USA where 82.5 mg is standard, upping this to 165mg daily.

Lancet doi:10.1016/S0140-6736(18)31133-4