The Legacy Effect 30 Years Later - Good Control of Diabetes Prevents Heart Disease

A lot of people with diabetes wonder why their doctors and diabetes educators are seemingly obsessed with keeping blood sugars as close to normal as we can.  After all, blood sugars that are only mildly elevated usually don't come with much in the way of symptoms.

The point to keeping sugars as well controlled as possible is to prevent complications of diabetes developing over time - this includes damage to the eyes, heart, kidneys, and nerves in the feet and elsewhere in the body.

And - a new paper published has now shown us that the benefit of good control of diabetes to prevent cardiovascular disease persists for at least thirty years!

The study, which was recently published in the journal Diabetes Care, evaluated patients 30 years after their initial participation in the famed (well, famous in the diabetes world anyway) DCCT trial.  This was a clinical trial that enrolled 1,441 patients with type 1 diabetes, and assigned them to receive either more intense, or less intense, control of their blood sugars for a mean of 6.5 years.

During the 30 years of follow up, they found that the people who were in the tightly controlled group 30 years previously had a 30% reduction in the risk of developing cardiovascular disease, and a 32% reduction in the likelihood of having a heart attack, stroke, or dying from a cardiovascular cause, compared to those who were in the less tightly controlled group.  The tighter blood sugar control during the time of the original 6.5 year study was statistically responsible for all of the difference in cardiovascular disease between the two groups.

This data really impresses upon us the power of what we call the 'legacy effect' - good control of diabetes early on prevents complications later in life.  (Note: there is a similar trial in type 2 diabetics called the UKPDS study, which also showed that the legacy effect exists 10 years later.)

I think it is challenging for anyone to look forward 30 years into the future, and think about the importance of what we are doing now to our future self.  If you think about it, we actually spend a lot of our lives planning for our 30+ year future self.  Take financial planning, for example - most of us structure our home purchases, savings structures, and investments with the goal of planning for the distant future.  As I see it, planning for our health in the future is no different - and for people with type 1 diabetes, we now have very long term data to back this up.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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Natural Remedy Star Fruit Causes Kidney Damage

It is often in my day that people tell me that they are taking natural remedies for any number of medical conditions - for aches and pains, diabetes, obesity, cancer prevention... the list goes on.  The thinking that often underlies the decision to take these remedies is that they are natural, so how could they possibly be harmful?

I worry about my patients taking natural or naturopathic products, because rigorous clinical trials are not done to show benefit, nor (most concerning) to understand potential harms.  So, when I came across two very serious case reports of kidney damage from the seemingly innocent star fruit, I wanted to share it to illustrate the potential dangers of natural remedies.

Star fruit comes from a tree native to India and southeast Asia.  In addition to eating them as a fruit (I've enjoyed them myself on occasion while traveling to these areas), they are also touted as a herbal remedy for various ailments (including diabetes) in these countries.

Recently, two cases of star fruit toxicity were published.  One case was that of a woman with type 2 diabetes who consumed 200 mL of star fruit juice (less than a cup) from six star fruits, which resulted in kidney failure due to an inflammatory reaction in the kidneys (acute interstitial nephritis) caused by the high oxalate content of star fruit.  Thankfully, with medical treatment, her kidneys recovered.

The second case was that of a man with a history of moderate kidney dysfunction, who developed kidney failure after eating four star fruits over four days.  Thankfully, he also recovered after about 2 weeks.

In addition, like the grapefruit, star fruit also inhibits a group of liver enzymes (cytochrome P450 isoforms) which are important for metabolism of medications such as statins (cholesterol medications).  This is why it is advised for patients on statins not to eat grapefruit - star fruit should be included in this counselling as well.

So, take these cases into consideration the next time you think about reaching for a herbal remedy - remember that we simply do not know enough about these remedies to know if they are safe.

As a patient, be sure to tell your doctor about any natural remedies you are taking.

As a health care professional - remember to ask.

Follow me on twitter! @drsuepedersen

www.drsue.ca © 2016

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