Five Ways to Control Type 2 Diabetes

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Q. Glen, What are some of the Complications of Diabetes?


A. in keeping with the latest research on diabetes, which shows that taking early and aggressive steps to achieve tight control of your blood glucose levels -- by eating right and exercising, for instance -- pays off big time.


Type 2 diabetes is a metabolic disorder that affects the body’s ability to effectively use insulin, an important hormone that enables blood sugar to enter the body’s cells and be converted to energy. The result is an elevated level of glucose, or sugar, in the blood, which damages the body.


Type 2 diabetes in America



Early diagnosis and fast action are best. An estimated 20.8 million people, or 7% of the U.S. population, currently have the disease, but of that total, only 14.6 million know it. This is because type 2 diabetes is usually diagnosed years after its onset, giving the disease a head start in causing damage. The result? Serious complications, including heart disease, kidney disease, blindness, erectile dysfunction, infections, and more.


According to Kenneth Snow, MD, acting chief of the adult diabetes section at the Joslin Diabetes Center in Boston, keeping blood glucose levels as close to normal as possible may prevent or slow the progress of these complications. Snow offers five key steps you can take right now to help achieve this goal.


Lose 10 pounds. “More than 80% of people diagnosed with type 2 diabetes are obese, but people find the idea of losing 40 or 50 pounds daunting. Just losing 10 pounds is doable and will have a huge impact on blood glucose levels,” Snow says.


There are two dietary keys to achieving this goal, he says: Making wise choices about what you eat and limiting portion size. “Spend a little time weighing and measuring your food to learn how much you’re eating. Read the labels. People see that a serving size of cereal is 110 calories, so they just pour it into a large bowl and figure they’re eating 110 calories when they are really eating about 350,” he says.


Increase your activity. “I avoid the word ‘exercise.’ Exercise is fantastic, but it’s very difficult for people to do, at least initially, and sustain. But everyone can add activity to their daily lives,” Snow says.



Some ideas: Take the stairs instead of the elevator. If you work on the 10th floor, you can take the elevator to the ninth and walk up a flight, he notes. Walking is extremely beneficial, so Snow tells his patients to buy a pedometer to measure their daily steps. “Set yourself a goal. Try to get to 10,000 steps a day. If you’ve been sedentary, your goal might be 4,000 steps.” Recently, a CDC study found 52% of people with diabetes also have arthritis. While this may make exercise more difficult for some, people with arthritis can do many low-impact activities, such as walking or swimming. Keeping active helps both conditions, Snow notes.


If you smoke, quit. “If you have diabetes and smoke, that’s slow suicide,” says Snow, who adds that smoking accelerates the onset of every single diabetes complication. Ask your doctor for help to break the habit.


Relax. If you’re under stress, your body can react physically; this is known as the “fight or flight” response, and it can adversely affect blood glucose levels. However, Snow says, “it isn’t only the stress itself, it’s how people respond. Usually, people under stress don’t eat right, so stress impacts in that way.” Stress relievers such as meditation, deep breathing, and relaxation exercises can help.


Monitor your blood glucose levels. Snow prefers the word “monitor” to “test” because test has a pass-fail connotation, which sends the wrong message, he says. “You want to check to see what your blood sugar is doing at different times of the day. That way, you’ll know whether the changes you are making are successful.”


These steps can help you achieve tight glucose control, something Anne Tierney knows a lot about. “I don’t use large plates anymore; I eat my food out of little ramekins,” she says. She exercises on a treadmill and an elliptical trainer, and she lifts weights. And what about the chocolate? “I still eat it, but only the sugar-free kind.”


The payoff is that her high blood glucose levels fell so much she’s now classified as “prediabetic.” According to Snow, this doesn’t happen to everyone, but is a possibility when diabetes is caught early and treated vigorously.


Says Tierney, “I was very fortunate to get my blood glucose levels under control. I’m not going back.”


Checkup Checklist:



Of course, good medical care is also key in controlling blood glucose levels. If you have type 2 diabetes, make sure you get regular checkups for potentially serious complications. Doing so will help prevent heart attacks and strokes (the most common causes of death among people with diabetes) as well as kidney disease and blindness. In addition, be sure you get your blood pressure, cholesterol, kidney function, and eyes checked on a regular basis, as all of these can be affected by your type 2 diabetes



Bottom Line! I am a Diabetic.....Do This!!!!Nuff Said


Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !



My mission is to provide you with "Trusted Advice for a Healthier Life."


Yours in good health

Any questions?

Ask Glen!

Diabetes and Dating

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Q. Glen, Does Diabetes Affect Your Love Life?


A.For some folks, diabetes can turn a lovely evening into a "terrible, horrible, no good, very bad...date!" When you are out for a romantic evening, diabetes always tags along as an unwelcome chaperone:

Jerry and Audrey were enjoying a meal at their favorite restaurant. He ordered a diet drink but was sure that the waiter had brought him a regular Coke, which he accidentally consumed without thinking. Jerry didn't know what to expect, but decided to cut the evening short just in case he had to nurse a high blood sugar level back to normal. Needless to say, Audrey was not pleased.

Diabetes can affect the foods you choose, the plans you make, the sweetness of your breath, the sweatiness of your palms, the way you feel after a shared game of tennis and even find its way into private physical moments.

"We were getting a bit romantic when Kevin suddenly became pale and looked dazed. I didn't know what to do at first, but quickly realized that his blood sugar might be low. I offered him some juice, which helped."

Don't let diabetes cramp your dating style. Here are some suggestions to help boost your confidence in the romance department:

Plan your activities in advance
Don't go too long without a meal or snack. This will help you keep unexpected low blood sugar symptoms from appearing. Test your blood sugar level prior to going out; if you're nervous, your blood glucose levels may misbehave. Be prepared for the unexpected, such as a delayed meal, and carry emergency snacks in your purse or pocket. If you plan to inject yourself while at a restaurant, consider bringing an insulin pen; it is discreet and easy to use.

Help keep your sweating to a minimum
Certain foods may increase your sweating level. These include spicy foods, chocolate, cheese, red wine, red sausages and soft drinks. If you anticipate a problem, steer clear of these items.

Keep your breath kissably sweet
Blood sugar levels of 250mg/dl or higher (13.9 mmol/L), are often accompanied by a fruity breath odor. Normalize your blood sugar levels and take care of your dental hygiene. Brush and floss your teeth. Have your teeth cleaned at least twice a year. Avoid mouthwashes that contain alcohol, which can irritate your gums. Dr. Steven V. Edelman, recommends an inexpensive homemade mouthwash made of half hydrogen peroxide and half water. It gets rid of odor-causing bacteria like a charm.

Limit your alcohol
Alcohol can rapidly lower blood sugar levels. To help reduce this effect, consume alcoholic beverages with food and test your glucose level frequently. Remember, everything in moderation. One to two drinks is normally a safe amount, but your personal limit may differ -- some people tolerate more, some less.

For more ways to keep diabetes from giving you terrible, horrible, no good, very bad days, explore the quizzes, advice, personal stories, discussion topics and humor in The Secrets of Living and Loving with Diabetes...Three Experts Answer Questions You've Always Wanted to Ask, by Janis Roszler, RD, CDE, LD/N, William Polonsky, PhD, CDE, and Steven V. Edelman, MD.

Glen's Bottom Line! Stay Informed! Eat Right Exercise and Listen to Your Doctor!

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !



My mission is to provide you with "Trusted Advice for a Healthier Life."


Yours in good health

Any questions?

Ask Glen!

Common Spices May Help Diabetes

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Q. Glen, Can Herbs and Spices Help with my Diabetes?


A. The spice cabinet may prove to be a source of help for diabetes patients.

Some of the most commonly used dried herbs and spices may help block the inflammation believed to drive diabetes and other chronic diseases, laboratory studies conducted by researchers from the University of Georgia suggest.

The researchers tested extracts from 24 common herbs and spices and found that many contained high levels of inflammation-inhibiting antioxidant compounds known as polyphenols.

The early findings suggest that liberal use of cinnamon in your morning oatmeal or Italian seasonings in your spaghetti sauce could have big payoffs for your health, researcher James L. Hargrove, PhD, tells WebMD.

"We might all be better off if we used less salt and pepper, and focused more on herbs and spices," Hargrove says. "I've started putting oregano in my eggs. That's not a big change."

(If you have type 2 diabetes, have you integrated some of these spices into your daily diet? Tell us how on WebMD's Type 2 Diabetes: Support Group board.)

Cinnamon and Diabetes

Hargrove and colleagues found that ground clove had the most inflammation-calming polyphenols of any of the spice and herb extracts they tested.

Cinnamon came in second, but because it is used more in cooking and in larger amounts than ground cloves it has more potential to positively affect health, he says.

So much has been written about the benefits of cinnamon for lowering blood sugar that many diabetes patients now take cinnamon supplements.

But the research on cinnamon's effect on diabetes has been mixed.

Richard Anderson, PhD, was among the first modern researchers to link the antioxidants in cinnamon to increased anti-inflammatory response and blood sugar reductions in diabetes patients.

A scientist with the U.S. Department of Agriculture Beltsville Human Nutrition Research Center, Anderson tells WebMD that he made the connection after finding that instead of raising blood sugar as expected, apple pie lowered blood glucose in their test tube study.

"At first we thought it was the apples, but it soon became clear that it was the cinnamon," he says.

In a 2003 study, Anderson and colleagues reported that as little as half a teaspoon of cinnamon a day significantly reduced blood sugar and improved cholesterol in people with type 2 diabetes who took cinnamon in capsule form after meals.

But combined results from five other studies examining cinnamon supplementation in diabetes patients showed little evidence of a benefit.

"Taking cinnamon supplements for the purposes of either improving glucose control or improving cholesterol levels is not supported by the evidence that is currently available," analysis co-author William L. Baker, PharmD, of Hartford Hospital in Connecticut, tells WebMD.

But Baker adds that the combined studies included just 282 patients treated with either a placebo or various doses of cinnamon.

"These were small studies," he says. "Larger studies may show that supplementation is beneficial, but it seems unlikely."

Glen's Bottom Line! Eat Cinnamon...


Reference: University of Georgia

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !



My mission is to provide you with "Trusted Advice for a Healthier Life."


Yours in good health

Any questions?

Ask Glen!

2 Diabetes Studies Give Mixed Message

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Q. Glen, Does Intense Blood Sugar Control Cuts Eye and Kidney Complications? How About Heart Complications?



A. Intense control of blood glucose levels in type 2 diabetes helps reduce the risk of kidney and eye complications, but not cardiovascular risks such as heart attacks and strokes, researchers said at a news briefing during the annual meeting of the American Diabetes Association in San Francisco.

In one of the two studies highlighted at the briefing, patients who reduced their hemoglobin A1c levels even lower than what is routinely recommended actually had a higher rate of death from cardiovascular problems. But the researchers point out that these were sicker patients than many with type 2 diabetes.

Hemoglobin A1c is a measure representing average blood glucose control for the previous three months. The American Diabetes Association recommends A1c levels of less than 7%. People without diabetes have an A1c of about 5%.

The bottom line for patients hoping to avoid all the diabetes-related complications? Lowering blood glucose levels does help reduce kidney and eye complications from diabetes, but paying attention to blood pressure and cholesterol levels is crucial to reduce the heart attack and stroke-related risks that accompany a diagnosis of type 2 diabetes, researchers from both studies say.

"You can safely reduce glucose A1c to about 6.5% by using the sort of gradual, gentle approach that we used," says Stephen MacMahon, PhD, an investigator of one study, called ADVANCE (Action in Diabetes and Vascular Disease). "It won't improve cardiovascular risks, but it will improve kidney risks."

"If you want to manage cardiovascular risks, focusing on blood pressure and lipids is likely where the money is," says John B. Buse, MD, PhD, president of medicine and science for the American Diabetes Association, who also participated in the briefing.

The studies, along with two editorials and a perspective, are published online in the New EnglandJournal of Medicine.

Both studies looked at the value of lowering blood glucose levels in those with type 2 diabetes more intensely that what is routinely recommended.

Study Details: ADVANCE

In the ADVANCE study, researcher Anushka Patel, MBBS, and colleagues followed more than 11,000 participants, assigning them to a standard group or to an intense control group with a goal of getting their A1c to 6.5%.

The average age of participants was 66, and about a third had already had a stroke or heart attack; the rest were at high risk for cardiovascular problems because of high cholesterol or other risk factors.

After five years, the intense group average A1c was 6.5% and the standard group, 7.3%, Patel says.

"The major effect shown in this is a 21% reduction in risk for kidney disease," Patel tells WebMD. "That was major."

While there was no significant reduction in heart attack, stroke, or death from cardiovascular disease with the intense group, they found "no evidence of increased risk of death [from cardiovascular disease] in the intensely controlled," Patel says.

"This is important because in the ACCORD study, they said those controlled at 6.5% had a significant increased risk of cardiovascular death and they don't know why," Patel says. That arm of the ACCORD study ended in February when the increased risk of death became apparent.

Good Article I am Glad you asked that Question! Glen

All Reference from WebMD!!

John B. Buse, MD, PhD

Stephen MacMahon, PhD

Anushka Patel, MBBS


Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !

My mission is to provide you with "Trusted Advice for a Healthier Life."

Yours in good health

Any questions?

Ask Glen!

Diabetes

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Q. Glen, Do any of these so call Diet's (Weight Watchers, Atkins, Etc ) help with Diabetes?


A. Why Yes! The Mediterranean Diet May Thwart Diabetes, The study Shows Benefits of a Diet That Favors Legumes, Grains, Fruits, Nuts, Vegetables, and Fish May help in the Fight against Diabetes.

Eating a traditional Mediterranean diet may help prevent type 2 diabetes, a Spanish study shows.

The study included 13,380 Spanish university graduates (age range 20 to 90, average age 36) who were followed for about four years. They completed a dietary survey when the study started and follow-up questionnaires every two years after that.

The dietary survey included questions about foods, cooking methods, and olive oil consumption.
Based on the survey, participants were scored on a scale from 0 to 9 to show how closely they followed a Mediterranean diet. High scores meant they consumed a Mediterranean diet, meaning they favored legumes, grains, fruits, nuts, vegetables, fish, and moderate drinking and downplayed meat and dairy products.

A total of 33 people were diagnosed with type 2 diabetes during the follow-up period. Those who followed a Mediterranean diet were less likely to develop type 2 diabetes during the study.

For every two-point increase in the Mediterranean diet score, the odds of being diagnosed with type 2 diabetes dropped by 35%.

The study doesn't prove that the Mediterranean diet prevented type 2 diabetes. But the results held regardless of other factors such as physical activity and family history of diabetes.

The researchers -- who included Miguel A. Martinez-Gonzalez, MD, PhD, MPH, epidemiology professor at Spain's University of Navarra -- report their findings in the advance online edition of BMJ.

Because few participants developed type 2 diabetes -- and because the study only included college graduates in Spain -- the researchers call for further studies to validate their findings.

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !

My mission is to provide you with "Trusted Advice for a Healthier Life."

Yours in good health

Any questions?

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Type 2 Diabetes Mellitus

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Q. Glen, How can I Prevent Type 2 Diabetes?


A.You can help to prevent type 2 diabetes by maintaining your ideal body weight, especially if you have a family history of diabetes. Diet and exercise have been shown to delay the onset of diabetes in people who are in the early stages of insulin resistance, identified by borderline blood sugar levels. The medication metformin (Glucophage) offers some additional protection for people with blood glucose levels that are between 100 and 125 mg/dL, near the diabetes range. People with blood sugar levels in this range sometimes are said to have pre-diabetes.

If you already have type 2 diabetes, you can delay or prevent complications by keeping tight control of your blood sugar. You can lower your risk of heart-related complications by taking an aspirin daily, and by aggressively managing other risk factors for atherosclerosis, such as high blood pressure, high blood levels of cholesterol and triglycerides, cigarette smoking and obesity. Yearly visits with an eye doctor and a foot specialist (podiatrist) are recommended to reduce eye and foot complications.

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !

My mission is to provide you with "Trusted Advice for a Healthier Life."

Yours in good health

Any questions?

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Coming Diabetes Epidemic Is a Disaster We Can Prevent

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Q. Glen, I am getting older, a little over weight and not exercising ! Should I worry about Diabetes?

A. As millions of Americans reach the age of 65 and beyond, you needn't have a degree in medicine to understand the seriously dangerous ramifications of an increasingly unhealthy, older society. In the near future, the number of people who are 85 years old will double -- and eventually triple. Currently half of this "oldest old" population is dependent and utilizes a large fraction of health-care resources. Should this be true for the baby boomers, it will certainly cause a national crisis. To make matters worse, if we continue to become more and more overweight, the increased development of adult-onset diabetes will wreak havoc on the health-care system.

Recently, New York issued the results of its first-ever Health and Nutrition Examination Survey. It found that 12.5 percent of New Yorkers had diabetes. Of these, 3 percent, or 207,000 individuals, were unaware they had the disease.

A total of 23.5 percent of the population had "pre-diabetes," defined by an elevated fasting blood sugar. Without intervention, these subjects will almost certainly develop diabetes in the next few years. The incidence of diabetes is lowest among white New Yorkers (10.6 percent), higher in Hispanics (12.3 percent) and blacks (14.3 percent) and highest in Asian New Yorkers (16 percent). These results are much higher than those of a nationwide Health and Nutrition Examination Survey completed about four years ago that indicated a national incidence of clinically diagnosed diabetes of about 7 percent.

This suggests that New Yorkers have a higher incidence of diabetes than the rest of the nation; I believe the reverse to be true. New Yorkers tend to be more active, walk more and have a lower risk of obesity than residents of most other parts of America. I suspect that if the national study were done now, results in many parts of the nation would be worse than New York's.

We are facing a health crisis of enormous proportions, and we need to act now. The cause is clear -- a higher risk of obesity combined with a sedentary lifestyle leads to diabetes in individuals who are predisposed to developing the illness.

Fortunately, diabetes can be prevented by weight loss and exercise. The journal Diabetes Care recently published a study that examined the relationship between risk of diabetes and exercise and weight. More than 68,000 women participated in the nurse's health study. The risk of diabetes was 16-fold higher in sedentary, obese women. This risk was reduced to 10-fold higher if they exercised. Sedentary thin women had only a two-fold higher risk of developing the disease than thin women who exercise. This led the researchers to conclude that controlling obesity was more important than exercise in preventing diabetes.

Clearly, obesity affecting Americans of all ages is leading to a higher incidence of diabetes. Obesity leads to a condition called insulin resistance, which means a greater amount of insulin must be produced to bring the blood sugar into normal range. If the body is unable to produce sufficient insulin, the blood sugar rises excessively, and diabetes develops. This in turn leads to heart attacks and strokes, blindness, kidney disease, an array of neurological conditions, loss of sexual function and a high risk of foot ulcers that can eventually result in amputation.

While the study found that nutrition and obesity played a stronger role than fitness and exercise in developing diabetes, I still believe it is important for anyone at risk of developing the disease to embark on a rigorous exercise regimen. Muscle is the most metabolically active tissue in the body. Increasing muscle mass increases the ability of the body to clear glucose and reduce insulin resistance. This can be best achieved by exercising vigorously with weights, which will build muscle and reduce fat. If you have already been diagnosed with diabetes or pre-diabetes, your condition may be reversed by combining exercise with an appropriate diet. The best example is former Arkansas Gov. Mike Huckabee, who had very serious diabetes. Having lost 100 pounds, he is now running marathons, no longer has any evidence of diabetes and has guaranteed himself a longer and better life.

A comprehensive approach is the key to reducing your risk of diabetes. Live a healthy lifestyle -- eat right, exercise (with weights), be an educated consumer of health care -- and you can prevent this devastating disease.

Any personal health questions or problems mental or physical or before starting any diet or exercise program. Please consult your physician !

My mission is to provide you with "Trusted Advice for a Healthier Life."


Yours in good health

Any questions?

Ask Glen!

Glycemic Index: What You Need to Know

Have you seen the eye-catching ad for Diabetes Forecast Magazine? The ad pictures a brownie and a baked potato placed side by side and asks which one will raise your blood sugar more. If you haven’t seen this ad, you might be in for a shock.

According to the Glycemic Index (GI), the correct answer is the baked potato. You are probably asking yourself how that could be true. Well, it all started in 1981 when Canadian researcher Dr. David Jenkins conducted research demonstrating that not all carbohydrates are equal in their effect on blood sugar levels. Through Dr. Jenkins’ research, the concept of the Glycemic Index was born.

What is the Glycemic Index (GI)?
The GI is a way of ranking carbohydrate foods based on how much of a rise in blood sugar they produce during the two to three hours after you eat them. Foods with a higher GI number produce a higher rise in blood sugar. As a result, the body must produce more insulin. Lower GI foods produce less of a rise in blood sugar, and, therefore, less insulin needs to be produced.

What are the Benefits of a Low GI Diet?
The benefits of low GI diets appear to be related to lower circulating levels of insulin and may include:

Lower blood sugar levels two to three hours after eating in those with diabetes.

Decreased hunger and increased satiety following lower GI meals.

Increased HDL ("good") cholesterol and decreased triglycerides (blood fats).

The Glycemic Index and Diabetes
Diabetes Care recently published a review on the results of 14 studies testing the glycemic index in people with diabetes. The results showed that those subjects who ate a low GI diet saw a reduction in after-meal blood sugar levels equal to those seen with some types of diabetes medications.

Which Foods Have a High GI, and Which Have a Low GI?
Over 750 different types of carbohydrate foods have been tested and given a GI value. The surprise is that many sweet-tasting foods like grapes, bananas, strawberries and peaches have low GI values. These are the very foods individuals with diabetes may be avoiding for fear that the sweeter-tasting foods will harm blood sugar control

Conversely, many traditional low-sugar foods consumed by people with diabetes like cornflakes, pretzels, Cheerios and baked russet potatoes have a high GI. For the sake of simplicity, it is best to think of a food in terms of whether it has a low, moderate or a high GI.

The table below lists some examples of typical carbohydrate foods and their corresponding Glycemic Index:

Low GI (55 or less)	Moderate GI (56-69)	High GI (70 or more)
Apple (38)	Corn (56)	Bagel (72)
Steamed Brown Rice (50)	New Potato (59)	French Fries (75)
Green Peas (48)	Puffed Wheat (67)	Mashed Potato (70)
Peanuts (23)	Shredded Wheat cereal (67)	Pretzels (83)
Yogurt (plain14) (fruit 36)	Whole grain bread (68)	White Bread (70)

To find a listing of the GI of many carbohydrate foods, click here.

Tips for Using the Glycemic Index:

Consider the total amount of carbohydrates before considering the Glycemic Index.

Select more low GI foods while minimizing the intake of high GI choices.

If you have diabetes, test your blood sugar before and two hours after eating to determine how different foods affect your blood sugar.

Remember that a food with a lower GI is not always a healthy choice, as is the case with the brownie. If you eat too many carbohydrates, even from a lower GI food, you may still have a high blood sugar reading.

Many low GI foods, such as fruits, vegetables and beans, are excellent carbohydrate choices. Using these low GI foods not only improves blood sugar control, but it may also help you reduce the risk of cancer and heart disease.

Regardless of what type of food plan you follow, you can always begin substituting high GI foods with lower ones -- and begin to reap the benefits of a low GI lifestyle

Glen says: Please consult your physician before stating any diet.

Majority of Diabetics Neglect Vitamin D

A troubling European diabetes study indicates that the vast majority of diabetics are neglecting one of the essential nutrients for achieving lasting health. According to research conducted in Italy and published in the journal Diabetes Care, approximately 61% of people with type 2 diabetes suffer from chronic vitamin D deficiency. The findings are particularly troubling given past research showing that low levels of vitamin D can be a risk factor for heart disease. Researchers also estimated that nearly one third of diabetics are at high risk of developing heart disease, partially as a result of inadequate vitamin D intake. The study's authors concluded by urging regular and extensive vitamin D deficiency screening of all type 2 diabetics

Adding New Diabetes Drug may Aid Glycemic Control

NEW YORK (Reuters Health) - The addition of exenatide (Byetta), the first in a new class of drugs called incretin mimetics, to a thiazolidinedione (TZD) in type 2 diabetes patients may improve control of blood sugar (glucose). The addition of exenatide to thiazolidinediones (TZDs), drugs such as rosiglitazone or pioglitazone, that increase cell response to insulin, appears to results in better glucose control, researchers report in the Annals of Internal Medicine. Exenatide exerts its regulatory effects by enhancing glucose-dependent insulin secretion, Dr. Bernard Zinman of Mount Sinai Hospital, Toronto and colleagues note. It also slows gastric emptying and reduces food intake.

The researchers studied 233 patients who were receiving TZDs. They were randomly assigned to abdominal injections of exenatide or placebo twice daily.

At 16 weeks exenatide treatment reduced hemoglobin A1C, a marker of blood glucose, by 0.98 percent. It also reduced serum fasting glucose levels and body weight declined by an average of 3.3 lb.

A total of 35 of the exenatide group discontinued treatment. This was due to adverse events in 19 subjects. In the placebo group, 16 discontinued, but only 2 did so because of adverse events.

In all, 40 percent of exenatide patients experienced nausea. This was true of 15 percent of the placebo group.

"Trial duration was relatively short," the investigators concede. Nevertheless, they also point out that during this period exenatide therapy improved glycemic control, and reduced body weight.

In an accompanying editorial, Dr. Saul Malozowski characterizes the trial as "much too short" as well as "much too small" and says that many questions remain unanswered.

Moreover, Malozowski, of the National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, notes that "small and short studies provide a false sense of safety, because common severe adverse drug reactions may not occur in the condensed timeline and in the limited number of patients."