Jewish World Review May 19, 2002 / 8 Sivan, 5762




Ethnic differences in diabetic complications

By Robert A. Wascher, M.D., F.A.C.S.

http://www.NewsAndOpinion.com | Inadequate access to medical care has been cited as the primary explanation for the poorer outcomes that ethnic minorities with certain diseases often experience. In this week's Journal of the American Medical Association (JAMA), 62,432 diabetic patients enrolled in a large HMO were longitudinally studied for a period of four years. Caucasians made up 64% of the study population, while 14% of patients were Black, 12% were Asian, and 10% were Latino. As all patients, irrespective of their ethnic background, presumably had equal access to care, this study sought to evaluate intrinsic ethnicity-related factors that might affect the incidence of complications due to diabetes.

Interestingly, the Caucasian diabetic patients experienced, on the average, a higher incidence of heart attack and stroke than did any of the minority group patients. However, the risk of developing kidney failure was 1.5 to 2 times as high among the minority group patients when compared to Caucasian patients. The authors, therefore, concluded that access to care may not be the only issue that impacts upon diverse disease outcomes between different ethnic groups. This large study's results point to a probable genetic variation in responses to diabetes among people of different ethnic backgrounds.

The next step towards proving this hypothesis would be to study the activation patterns of large numbers of genes in diabetics. Comparing gene activation patterns between diabetics from different ethnic groups may identify unique genetic characteristics that could explain this study's findings. Other diseases, including cardiovascular disease, stroke, high blood pressure, obesity and cancer should be studied from this perspective as well, as prior research has shown variation in the incidence of -- and mortality from -- these diseases among different ethnic groups.

MODERATE ALCOHOL INTAKE AND BLOOD SUGAR LEVELS

Moderate alcohol intake (1 to 2 drinks per day) has been shown to reduce the risk of coronary artery disease and stroke in a number of research studies. There is also some evidence that moderate drinking might improve the sensitivity of the body's cells to insulin, the hormone that allows cells to take-up glucose from the blood (the loss of insulin sensitivity causes adult onset , or type II, diabetes).

This week's JAMA contains an interesting study that looks at the effects of moderate alcohol intake on the insulin and glucose levels in the blood of postmenopausal women. Although the study included only 63 women, the researchers found that 2 alcoholic drinks per day was associated with significantly improved insulin sensitivity, as well as reduced levels of triglycerides (a form of fat) in the blood. Although excessive drinking has been clearly implicated in a number of diseases, this study provides further evidence that modest-to-moderate drinking may have important health benefits.

MORE GOOD NEWS FOR TEA DRINKERS

I recently reported on the favorable correlation between moderate tea drinking and a reduced risk of death after heart attack. Now a new study in the Archives of Internal Medicine suggests that regular tea drinking may be associated with improved bone mineral density as well. Over 1,000 men and women were queried about their tea drinking habits, and were then tested for bone mineral density using a sophisticated x-ray test called dual-energy x-ray absorptiometry (DEXA scan). A total of 58% of the study participants were habitual tea drinkers, with an average duration of tea consumption of about 10 years.

When compared to nonhabitual tea drinkers, the habitual tea drinkers had significantly increased bone mass in the bones of the lumbar spine (a common site of bone-thinning, or osteoporosis). Sex, age, body mass, and level of physical activity all affected bone mass, but the habitual consumption of tea for 10 or more years proved to be a significant and independent factor favoring increased bone mass. In addition to containing potent antioxidants, it appears that other components of tea might have a bone-strengthening effect that, in theory, might reduce the risk of bone fractures due to osteoporosis.

BLOOD POTASSIUM LEVELS & THE RISK OF CARDIOVASCULAR DISEASE

There have been a couple of previous studies that linked variations in blood potassium levels with an increased risk of heart disease. A new report from the Framingham Heart Study, one of the largest and longest-running cardiovascular health studies in the world, now strongly suggests that there is no relationship between blood potassium levels and the risk of heart disease. As reported in the Archives of Internal Medicine, more than 3,000 volunteers had their blood potassium levels monitored between 1979 and 1983. Contrary to previous reports, there was no apparent increase in cardiovascular disease-related deaths with increasing levels of potassium in the blood.

BRIEFLY…

Post Script: As a follow-up to last week's story on breastfeeding, I wanted to pass along two breastfeeding resources sent to me by concerned readers. In many cases where mothers (and first time mothers in particular) encounter difficulties in breastfeeding their newborns, the advice and assistance of experienced lactation experts can make all the difference in the world between breastfeeding success and failure. The following hyperlinks should be of interest to parents of infants who might be experiencing breastfeeding challenges: http://www.lalecheleague.org/WebUS.html

http://www.breastfeeding.com

ASCO: I will be attending the annual meeting of the American Society of Clinical Oncology this week in Orlando. This is the largest annual cancer meeting in the world, and is the premier forum for the release of cutting-edge research in cancer-related science. I will be presenting my own research in Orlando, and look forward to sharing important new developments with my readers when I return next week.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.

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© 2002, Dr. Robert A. Wascher