BACKGROUND:
It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating.
METHODS:
Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n = 3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors.
RESULTS:
Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89-2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006-.0244), cannabis use (P < .0009), and any drug use (P < .0008).
CONCLUSION:
Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.

According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease, projected to reach second place by 2020. There is also strong evidence that it is an independent risk factor for heart disease, and several studies show that prolonged depression is associated with selective and possibly permanent damage to the hippocampus, a region of the brain critical to memory and learning.
Add the fact that 2 percent to 12 percent of depressed people eventually commit suicide, and the [supposed evolutionary] “advantages” of depression suddenly don’t look so good....
What is natural, the thinking goes, is best. If we are designed to suffer depression in response to life’s ills, there must be a good reason for it, and we should allow it to take its painful and natural course.
But unlike ordinary sadness, the natural course of depression can be devastating and lethal. And while sadness is useful, clinical depression signals a failure to adapt to stress or loss, because it impairs a person’s ability to solve the very dilemmas that triggered it.
Even if depression is “natural” and evolved from an emotional state that might once have given us some advantage, that doesn’t make it any more desirable than other maladies. Nature offers us cancer, infections and heart disease, which we happily avoid and do our best to treat. Depression is no different.

People with diabetes are three to four times as likely to have major depression as people without diabetes, and depression appears to increase the risk of Type 2 diabetes in certain populations. Depression is also known to increase the risk of complications in people with Type 2 diabetes. Now, new research indicates that treating people for both depression and diabetes simultaneously can significantly improve both conditions.
Depression may affect a person’s ability to carry out diabetes self-management tasks, such as taking medicines and monitoring blood glucose. And the stress of managing diabetes can contribute to an increased risk of depression. (There may be other biological factors, such as inflammation, contributing to the association as well)....
[Intervention subjects] and their doctors worked along with integrated care providers to identify and deal with issues that might interfere with [taking] medicines as advised, such as the price of the medicine or a lack of social support. The managers then crafted tailored programs to help these individuals stick to their diabetes medicine and antidepressant regimens....
At the end of the 12 weeks, 60.9% of those receiving the integrated treatment approach had improved their blood glucose levels, compared to only 35.7% of people receiving standard therapy. Moreover, 58.7% of participants in the integrated treatment group showed signs of remission in their depression, compared to only 30.7% of those in the usual treatment group.

• High blood glucose makes your blood “sludgy,” slowing circulation so cells can’t get the oxygen and nutrients they need. Margaret commented, “I can tell if my sugars are high in the morning, because ‘groggy’ doesn’t begin to describe it. ‘Drugged’ is how it feels.”
• Low sugars levels also cause fatigue, because when blood sugar is low, there is not enough fuel for the cells...
• [With vascular inflammation caused by igh blood glucose,] immune cells called monocytes come into the brain, causing fatigue....
• [P]eople with diabetes are more likely than others to have thyroid problems. If your thyroid level is low, you are likely to feel tired, sleepy, and depressed.
• Low testosterone levels, especially in men. Men with diabetes are much more likely to have low testosterone.
• Infections: People with diabetes often have infections they don’t know about. Infections take energy to fight, which can cause fatigue and raise blood sugar levels. A common source is urinary tract or “bladder” infections. They often hurt, but sometimes have no symptoms, except for the fatigue. Silent dental infections and vaginal infections are also common and fatiguing.
• Undiagnosed heart disease : If you get tired after tasks that you used to sail through, it could be time to for a heart check-up....
• Many drugs for diabetes, blood pressure, depression, pain, and other issues can cause fatigue. Read labels, ask your doctor or pharmacist....
• Some people are too wound up or too busy to sleep. Or they’re up to use the bathroom all night, or they have obstructive sleep apnea (OSA), which can wake them up many times an hour....
• [Rotating shifts or working nights] can cause fatigue directly by messing with your body clock or indirectly by disrupting sleep.
• Depression is very common with diabetes. Most depressed people feel fatigued, even if they don’t feel sad. Even at low levels, depression can sap your motivation....
• Doing too much: If you’re ripping and running all day, not taking breaks or even stopping to breathe much, you are courting fatigue....
• Stress: In small doses, psychological or physical stress can give you energy, but if it goes on too long, it will wear you out...
• Too much carbohydrate — especially refined carbs — can make anyone tired, especially with diabetes. Kat wrote, “now that I am eating a higher protein/fat, lower-carbohydrate diet, I have shaken off that really sleepy/extreme fatigue that I used to have every day.”
• According to WebMD, too much caffeine can cause fatigue through a rebound effect. They also say that dehydration, or not drinking enough liquid, is a major cause of fatigue.
• Being out of shape or having weak muscles: Not moving our bodies contributes to fatigue. Of course, it’s hard to exercise when you’re fatigued.

Among hypertensive subjects with [normal glucose regulation] there was an increase in [estimated arterial stiffness] from low normal to high normal values of glucose (p<0.01). [Arterial stiffness] was independently related to all glucose metabolic parameters (p<0.001 for all). In the present study, we demonstrated an association between arterial stiffness and glucose tolerance in hypertensive subjects. Given the prognostic significance of arterial stiffness, aims should be towards closer monitoring and intensive care of hypertensive patients with abnormal glucose metabolism.

Mental Health & Substance Abuse
Comorbidity/Co-occurring Disorders/ Dual Diagnosis

SAMHSA's Office of Applied Studies provides national estimates on mental health problems. As of 2001, state-level estimates on mental health measures are available. Such data includes maps showing the prevalence ranks by States. The latest available national data on serious mental problems are for 2006 and the latest State level data are for 2005. See Mental Health Variables by State, 2005.

Mental health reports:

* All mental health reports from OAS
* Latest national data on mental health problems
* State level mental health data
* Mental health treatment

Special mental health topics:

* Children's mental health
* Co-occurring disorders
* Depression
* Education & mental health
* Employment & mental health
* Homeless
* Mental health in Hurricane Katrina/Rita areas
* Mental health in State treatment planning areas
* Race/ethnicity, education & employment and mental health
* Serious psychological distress
* Suicide
* Unmet mental health treatment need
* Violence
* Youth and mental health issues (highlights)



Mental health data tables:

* OAS data tables on mental health topics
* State treatment planning area mental health data tables
* National Outcome Measures (NOMs) for co-occurring disorders

Public use data files:

* Analyzing mental health data in SAMHSA's OAS data sets

Methodology:

* Methods used for mental health measures in OAS reports

Other resources:

* SAMHSA's Center for Mental Health Services (CMHS)
* Mental health statistics from SAMHSA's CMHS
* SAMHSA's National Clearinghouse on Mental health information (NMHIC)
* SAMHSA's Mental Health Services Locator
* Mental health objectives in Healthy People 2010
* Hurricane Katrina/Rita areas

Reports with mental health data and race/ethnicity

bulletMental health measures for racial and ethnic groups (2005 & 2004)

* Serious Psychological Distress
* Received Mental Health Counseling by Serious Psychological Distress
* Major Depressive Episode (age 12-17)
* Major Depressive Episode (age 18 or older)

bulletMental health measures for all racial and ethnic groups (2004 & 2003)

bulletSerious Mental Illness for Persons Age 18 and Older, 2001 (PDF format: Tables 8.2A - 8.2B)

bulletAll mental health reports

bulletAll reports on racial and ethnic groups



Reports with Race/Ethnicity & Mental Health Data


newThe NSDUH Report: Depression and the Initiation of Alcohol and Other Drug Use among Youths Aged 12 to 17

The DASIS Report: Adolescents with Co-Occurring Psychiatric Disorders: 2003

The NSDUH Report: Suicidal Thoughts among Youths Aged 12 to 17 with Major Depressive Episode

The DASIS Report: Admissions with Co-Occurring Disorders, 1995 and 2001

The NSDUH Report: Reasons for Not Receiving Treatment Among Adults with Serious Mental Illness

The NHSDA Report: Serious Mental Illness Among Adults

The NHSDA Report: Treatment Among Adults with Serious Mental Illness

Demographic and Socioeconomic Characteristics of Adults Receiving Mental Health Treatment in Patterns of Mental Health Service Utilization and Substance Use Among Adults, 2000 and 2001 (HTML)

An elderly woman's sudden depression turns out to be a side effect of her high blood-pressure medication. <br />
A new mother's exhaustion and disinterest in her baby seem like postpartum depression—but actually signal a postpartum thyroid imbalance that medication can correct. <br />
A middle-aged manager has angry outbursts at work and frequently feels "ready to explode." A brain scan reveals temporal-lobe seizures, a type of epilepsy that can be treated with surgery or medication. <br />
More than 100 medical disorders can masquerade as psychological conditions, according to Harvard psychiatrist Barbara Schildkrout, who cited these examples among others in "Unmasking Psychological Symptoms," a book aimed at helping therapists broaden their diagnostic skills. <br />
Studies have suggested that medical conditions may cause mental-health issues in as many as 25% of psychiatric patients and contribute to them in more than 75%.

According to a Harvard psychiatrist, about 25% of psychiatric patients don't have anything wrong emotionally, just physically, and treating their illness can cure their mental problems. So, you're not depressed after all, you just have lupus, Lyme disease, or maybe cancer....<br />
According to Barbara Schildkrout's new book Unmasking Psychological Symptoms, some of the common things that therapists treat their clients for can be caused with medical intervention....<br />
Just like depression might be caused (or worsened) by the conditions above, if you're anxious you may have an overactive thyroid, if you're irritable you might have a brain injury, if you're hallucinating you might have epilepsy or, you know, a drug problem, and if you're psychotic, it's probably just from a venereal disease, not because of something awful that happened to you in your formative years.

[Under 1% of those starting with fasting blood sugar levels between 51 and 82 mg/dl wound up diabetic;] more than 3% did so if they had values between 91 and 99. After controlling for other [risk factors], that corresponded to a two-fold difference in risk of developing the disease.
[With prediabetes, the long-term damage of diabetes—especially to the] heart and circulatory system—may already be starting. If your blood sugar tests over 100 mg/dl fasting more than once, your fasting blood sugar is likely to go over the 125 mg/dl level used to diagnose full diabetes within 3 years.
More importantly, if your blood sugar is at 100 mg/dl fasting, it is very likely that your post-meal blood sugar is heading towards the diabetic range, which is over 200 mg/dl which is why your fasting blood sugar is deteriorating. High post-meal blood sugars kill beta cells. If you can bring down those post-meal highs, you may be able to prevent the beta cell death that is destroying your fasting control!

Non-cardiac comorbidity complicates heart failure care and is prevalent in one form or another for the majority of elderly patients with heart failure. This wide range of comorbidities, which includes respiratory comorbidities, renal dysfunction, anaemia, arthritis, cognitive dysfunction and depression, contributes to the progression of the disease and may alter the response to treatment. Polypharmacy is inevitable in these patients. Cardiologists and other physicians caring for patients with chronic heart failure (CHF) need to be vigilant to comorbid conditions that may complicate the care of these patients. Future trials should focus on optimal strategies for the comprehensive management of the elderly patients with CHF with multiple comorbidities rather than the isolated effects of single drugs in younger patients with few or no comorbidities.

Comorbidity, disability, and polypharmacy [complicate treatment of] heart failure. These factors can change biological response to therapy, reduce patient ability to [self-care, and alter patient desires and expectations....We assesed] demographics, comorbidity, physical function, and medication use in a nationally representative... failure population. <br />
[P]atients with heart failure who were ≥80 years old increased from 13.3% in 1988-1994 to 22.4% in 2003-2008 (P <.01). The proportion of patients with heart failure who had 5 or more comorbid chronic conditions increased from 42.1% to 58.0% (P <.01). The mean number of prescription medications increased from 4.1 to 6.4 prescriptions (P <.01). The prevalence of disability did not increase but was substantial across all years.... <br />
More recent patients have a higher percentage of very old individuals, and the number of comorbidities and medications increased markedly. Functional disability is prevalent, although it has not changed.

[Black heart failure patients are hospitalized more often than white patients. We looked for racial differences] in health literacy and access to outpatient medical care, and to identify factors associated with these differences.... <br />
Black race was strongly associated with worse health literacy and all measures of poor access to care in unadjusted analyses. After adjusting for demographics, noncardiac comorbidity, social support, insurance status, and socioeconomic status (income and education), the strongest associations were seen between race and: health literacy (OR 2.13, 95% CI 1.46 to 3.10), absence of a medical home (OR 1.76, 1.19-2.61), and cost as a deterrent to seeking health care (OR 1.55, 1.07 to 2.23). <br />
[I]mportant racial differences in health literacy and access to care exist among patients with heart failure. These differences persist even after adjustment for a broad range of potential mediators, including educational attainment, income, and insurance status.

Heart failure occurs principally in the geriatric population and often is associated with severe comorbidity. Comorbid conditions that occur in the geriatric population at a prevalence equal to or greater than that of heart failure itself include the brain failure syndromes (i.e., delirium and dementia), depression, falls, postural hypotension, urinary incontinence, undernutrition, frailty, sensory deprivation, polypharmacy, and lack of social support. The effect of major geriatric comorbidities on the management of patients with heart failure is reviewed.

Type 2 diabetes increases the risk of cardiovascular disease (CVD) two- to fourfold compared with the risk in non-diabetic subjects. Although type 2 diabetes is associated with a clustering of risk factors (small, dense low-density lipoprotein [LDL] particles, low high-density lipoprotein [HDL] cholesterol, high triglycerides, elevated blood pressure, obesity, central obesity, hyperinsulinaemia, hyperglycaemia, etc.), the cause for an excess risk of CVD remains unknown. Recent drug treatment trials have indicated that the lowering of total and LDL cholesterol and blood pressure is similarly beneficial in diabetic and non-diabetic subjects. The treatment of hyperglycaemia reduces micro- and macrovascular complications in type 2 diabetic patients. Beta-blocking agents, angiotensin-converting enzyme inhibitors, aspirin, and thrombolytic therapy are also effective in the treatment of CVD amongst diabetic patients.

Psychological distress is linked with impaired glycemic control among diabetics. <br />
OBJECTIVE: [Gauge] changes in glycemic control, weight, blood pressure, and stress-related psychological symptoms in [type 2 diabetics] in a standard Mindfulness Based Stress Reduction (MBSR) program [via a prospective, observational study of adults with DM2 in an a]cademic health center. <br />
INTERVENTIONS: Participation in MBSR program for heterogeneous patient population. Diet and exercise regimens held constant. <br />
MAIN OUTCOME MEASURES: Glycosylated hemoglobin A1c (HA1c), blood pressure, body weight, and Symptom Checklist 90-Revised (anxiety, depression, somatization, and general psychological distress scores).<br />
[11] of 14 patients completed the intervention. At 1 month follow-up, HA1c was reduced by 0.48% (P = .03), and mean arterial pressure was reduced by 6 mmHg (P = .009). Body weight did not change. A decrease in measures of depression, anxiety, and general psychological distress was observed.

[This study assessed] associations between diabetes-related symptom distress, glucose metabolism status, and comorbidities of type 2 diabetes [via] a cross-sectional sample of 281 individuals with normal glucose metabolism (NGM), 181 individuals with impaired glucose metabolism (IGM), and 107 subjects with type 2 diabetes. We used the revised type 2 Diabetes Symptom Checklist (DSC-R) to assess diabetes-related symptom distress. <br />
The total symptom distress score (range 0-100) was relatively low for diabetic subjects (mean +/- SD 8.4 +/- 9.4), although...significantly different from that for subjects with IGM (6.5 +/- 7.1) and NGM (6.1 +/- 7.9)...Ischemic heart disease was associated with elevated DSC-R scores on three subscales, whereas depression showed higher symptom distress levels across all DSC-R domains. <br />
Worsening glucose metabolism [correlates with increasing diabetes-related symptom distress, a relationship] attenuated by ischemic heart disease and particularly by depression.

Diabetes Symptom Checklist-Revised

The total symptom distress score (range 0–100) was relatively low for diabetic subjects (mean ± SD 8.4 ± 9.4), although it was significantly different from that for subjects with IGM (6.5 ± 7.1) and NGM (6.1 ± 7.9) (F = 3.1, 2 d.f., P = 0.046). Ischemic heart disease was associated with elevated DSC-R scores on three subscales, whereas depression showed higher symptom distress levels across all DSC-R domains.<br />
<br />
CONCLUSIONS—Worsening glucose metabolism is associated with increasing diabetes-related symptom distress. This relationship is attenuated by ischemic heart disease and particularly by depression.

Hyperglycemia resulting from diabetes mellitus does not result in a net increase in intracellular glucose in most cells, as insulin is required for glucose uptake. However, chronic dysregulated blood glucose...causes a marked toxicity toward those classes of vascular endothelium which passively assimilate glucose (i.e. in spite of low insulin), notably the pericytes of various microvasculatures. Pericytes express enzymes which convert glucose into osmologically-active metabolites such as sorbitol leading to hypertonic cell lysis. <br />
Over time, pericyte death may result in reduced capillary integrity; subsequently, there is leaking of albumin and other proteins into fluid compartments. The glomeruli of the kidneys are especially sensitive - see diabetic nephropathy - where protein leakage caused by late-stage angiopathy results in diagnostic proteinuria and eventually renal failure. In diabetic retinopathy the end-result is often blindness due to irreversible retinal damage.

Complications and comorbidities of type 2 diabetes account for high costs and reduced life expectancy. There are only incomplete data on the prevalence of those secondary disorders in Germany. <br />
A total of 390,459 data sets of single patients in Bavaria, who were enrolled to disease management program "type 2 diabetes" between 2004 and 2006, were studied. Data obtained from the initial visit documentation were screened retrospectively and analyzed with statistical methods. <br />
About three-fourths of the diabetic population have hypertension. Adiposity and lipometabolic disorder each are found in half of the population. Macro- and microangiopathic disease each occur in about twenty percent. Calculated prevalences of nephropathy, retinopathy and neuropathy are lower than expected. <br />
Complications of type 2 diabetes were frequently observed in the study population. With regard to neuropathy, nephropathy and retinopathy type-2-diabetics should be examined even more thoroughly.

Results
The prevalence of depression was 11% in the total sample with little difference between the groups with and without any vascular co-morbidity (11.2% vs 10.0%). Single vascular co-morbidities were not associated with increased rates of depression. The final model predicting depression included: having multiple vascular co-morbidities compared with none; having less social support; having experienced a recent stressful life event; female sex; and being a smoker.<br />
Conclusions/interpretation
Rates of depression in those with one additional vascular co-morbidity did not differ from patients with diabetes only. Vascular co-morbidities were only associated with higher depression scores in case of multiple co-morbidities.

From a clinical perspective, type 2 diabetes is a cardiovascular disease, an observation that is supported by a range of epidemiologic, postmortem, and cardiovascular imaging studies. Vascular wall dysfunction, and particularly endothelial dysfunction, has been posited as a "common soil" linking dysglycemic and cardiovascular diseases. Vascular wall dysfunction promoted by environmental triggers (e.g., sedentary lifestyle) and metabolic triggers (chronic hyperglycemia, obesity) has been associated with the upregulation of reactive oxygen species and chronic inflammatory and hypercoagulable states, and as such with the pathogenesis of type 2 diabetes, atherosclerosis, and cardiovascular disease.

The guideline shows strong evidence that the seizure drug pregabalin is effective in treating diabetic nerve pain and can improve quality of life. However, pregabalin may not be appropriate for all patients. <br />
The guideline also found that several other treatments are probably effective, including the seizure drugs gabapentin and valproate, antidepressants such as venlafaxine, duloxetine and amitriptyline, and painkillers such as opioids and capsaicin. The researchers also concluded that transcutaneous electric nerve stimulation (TENS), a portable electric device used to stimulate nerves, may be effective in treating diabetic nerve pain.... <br />
More than half of all people with diabetes will develop some form of nervous system damage.

[Apart from confounding factors like age, weight and smoking habits, diabetes itself is linked to a 41% increase in risk of Parkinson's].... <br />
Diabetes arises when the body can no longer properly use the blood-sugar-regulating hormone insulin. Parkinson's is a brain disease in which movement-regulating cells in the brain die off or become disabled, leading to symptoms like tremors, rigidity in the joints, slowed movement and balance problems. <br />
[One possible link is chronic, low-level inflammation throughout the body, thought to contribute to chronic diseases via cell damage.] Oxidation—the process fought by anti-oxidants—is another.... <br />
[A diabetes-Parkinson's link has been studied before, with conflicting results. The new study] included a larger number of people with Parkinson's. And unlike most past studies, it looked at the duration of people's diabetes...[H]igher Parkinson's risk was largely seen among people who'd had diabetes for more than 10 years before the start of the study.

Chronic Periodontitis affects [c. half of all Americans > 55 years and, is 2-to-4 times more likely to occur among diabetics]... <br />
“[Research clearly shows an association between chronic periodontitis and Type 2 diabetes; we hope] treating periodontal infection and inflammation can improve glycemic control"... <br />
Participants [must be ≥ 35 years and have Type 2 diabetes and gum disease. They receive free: dental cleaning by a hygienist and evaluation by a dentist; 6-8 office visits, including] periodontal treatment for 6 months; oral hygiene products and diabetic counselin;, as well as compensation for time and travel. <br />
[Treatment involves scaling and root planing (SRP), which cleans tooth root surfaces in depth to remove pocket plaque,] bacteria and toxins from tooth root. [Research has consistently shown that SRP reduces] bacteria associated with periodontal disease...SRP is usually the first mode of treatment....Some people do not require any further active treatment after SRP.

In theory, a person prone to asthma should not be prone to diabetes.... <br />
[L]ead author Juhn noted that although people with asthma have a more allergy-prone immune profile, it is balanced by [the counter-regulatory Th1 immune profile underlying pro-inflammatory conditions like] coronary artery disease and diabetes. He [originally posited] "an inverse relationship" between asthma and those types of pro-inflammatory conditions. <br />
[Instead, some 138 asthmatics] per 100,000 had diabetes, compared to 104 for people without asthma; the rate for coronary heart disease was close to 189 per 100,000, versus 134 among non-asthmatics. <br />
[Patients from the 1960s through the 1980s] did not have access to many medications available today...Treatment 40 years ago was very "steroid heavy," which could have contributed to weight gain—a known risk factor for diabetes and heart disease..."Sometimes treatment can be part of the problem"...

Acute hepatitis B is nearly twice as prevalent among adults with diabetes as in adults without diabetes‚ according to the Centers for Disease Control and Prevention (CDC).... <br />
The prevalence of diabetes in 2009 was 8.4 percent among more than 12 million individuals at the four sites. The study population reported 326 cases of acute hepatitis B‚ with diabetes information available for 226. Of those patients‚ 15 percent had diabetes and 85 percent did not‚ so the diabetes rate among the hepatitis B cases was nearly double that of the entire study population. However‚ there were other reported risk factors for acute hepatitis B that were less common among those with diabetes‚ such as injection drug use. The estimated annual incidence of acute hepatitis B per 100‚000 adults over age 23 was 1.4 for those with diabetes and 0.7 for those without. The Advisory Committee on Immunization Practices is considering whether to recommend the hepatitis B vaccine for people with diabetes.

Earlier studies have found that diabetes is a risk factor for depression development and recurrence of depression‚ though findings may vary depending on the methods used. <br />
In a new study‚ researchers examined the association of diabetes and the onset of depression by reviewing the literature and conducting a meta–analysis of available longitudinal studies. Investigators looked at 11 studies published up to September 2009‚ including a total of 48‚808 cases of type 2 diabetes without depression at baseline. The pooled relative risk was found to be 1.24 for the random effects model. The researchers concluded that‚ compared to controls without diabetes‚ patients with type 2 diabetes have a 24 percent higher risk of developing depression. The underlying mechanisms to this association‚ however‚ remain unclear and require additional study.<br />
(http://www.springerlink.com/content/0442246817g32021/)

[A new study looks at broader cardiovascular risks associated with the [psoriasis]. Patients with metabolic syndrome have at least 3 risk factors for heart disease and diabetes that include high blood pressure‚ excess belly fat, high fasting blood sugar‚ low levels of HDL cholesterol‚ and high triglyceride levels. Psoriasis‚ an autoimmune disease‚ is thought to be a manifestation of chronic inflammation. "There's evidence on both sides of the fence...There's evidence that obesity drives the development of psoriasis. There's also evidence that inflammation drives some components of insulin resistance." The new research included blood tests performed on about 2‚500 people who participated in the government-sponsored National Health and Nutrition Examination Survey between 2003 and 2006. Among study participants who reported being diagnosed with psoriasis‚ 40 percent had metabolic syndrome‚ compared to 23 percent of those who did not have psoriasis.

Subjects developed diabetes at a rate of less than 1% per year during a mean follow-up of 81.0 months. Each mg/dL of fasting plasma glucose increased diabetes risk by 6% (hazard ratio [HR] 1.06, 95% confidence interval [CI], 1.05-1.07...) after controlling for other risk factors. Compared with those with fasting plasma glucose levels less than 85 mg/dL, subjects with glucose levels of 95 to 99 mg/dL were 2.33 times more likely to develop diabetes (HR 2.33; 95% CI, 1.95-2.79...). Subjects in the 90 to 94 mg/dL group were 49% more likely to progress to diabetes (HR 1.49; 95% CI, 1.23-1.79...). [P <.0001 in all caes] All other risk factors except sex were significantly associated with a diabetes diagnosis.
The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors suggests that diabetes risk increases as fasting plasma glucose levels increase, even within the currently accepted normal range.

Although the overall risk of developing diabetes was low in people with normal FPG levels, the risk increased as FPG increased, after taking other factors into account. For every 1 milligram per deciliter increase in FPG, the risk of developing diabetes increased by 6 percent. Patients with an FPG of 95 to 99 were more than twice as likely to develop diabetes as those with an FPG less than 85, and patients with an FPG of 90 to 94 were 49 percent more likely to develop diabetes than those with an FPG less than 85. Other risk factors for diabetes, such as obesity, high blood pressure, cholesterol problems, and smoking, made development of the disease more likely.

Below 7%, below 6.5% OR NORMAL?
When do we [tell the public the honest truth]? To reduce your risks as if you did not have diabetes, then you need an A1c that represents a healthy individual without diabetes. [A] normal A1c for a healthy person without diabetes should be 4.3 to 4.6%. In the Epic-Norfolk study they showed that an A1c of 5% compared to an individual with an A1c of 6% had an increased risk of cardiovascular death of 28% higher.
In all of the recommendations they say that the A1c should be as low as possible without hypoglycemia. The ADA sticks with 7% or below, AACE stays with 6.5% or below, what does below mean? When we say it should be 7 or below then that is usually where most medical professionals stop being aggressive. We hear 7% we hear 6.5 % we even sometimes hear 6%.
If your child had diabetes, would you be satisfied at 6.5% or would you want it Normal, as if they did not have diabetes? Or would you like to wait 15 years and see what the studies tell us?

* Blood pressure control with cutoff values less than 130/80 mm Hg in patients with diabetes reduces the risk of macrovascular complications and the risk of progression to diabetic nephropathy and proteinuria.<br />
<br />
The multicenter, double-blind, randomized Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) suggested that, for preventing microalbuminuria, a non-dihydropyridine calcium channel blocker alone is not effective, whereas an angiotensin-converting enzyme inhibitor is effective as a single agent. Beta-blockers similarly have not been shown to prevent microalbuminuria.

It is well established that [type 2 diabetes and its risk factors] at this early stage of life significantly increases the likelihood of suffering from heart disease and other chronic conditions. [Now there is] a connection to weak bones. <br />
For the study, investigators examined 140 overweight children between the ages of 7 and 11. They measured the participants' body fat percentage, blood sugar levels and bone density and asked questions about how much physical activity they got on a regular basis. <br />
The researchers found a strong association between risk factors for Type 2 diabetes and poor bone health. A total of 30 percent of the participants showed signs of poor blood sugar regulation. These children had an average of 4 to 5 percent less bone density than participants with healthy blood sugar regulation. <br />
Given the fact that a large percent of an individual's lifetime bone density is developed before reaching puberty, the researchers said that their findings depict a major problem.

"Fatty liver, as diagnosed by ultrasound, strongly predicts the development of type 2 diabetes regardless of insulin concentration"... <br />
[11,091 Koreans] had a medical evaluation including fasting insulin concentration and abdominal ultrasound at baseline and...a follow-up after 5 years. Regardless of baseline insulin concentration, individuals with fatty liver had significantly more metabolic abnormalities including higher glucose and triglyceride concentration and lower high-density lipoprotein [("“good") cholesterol] concentration. Individuals with fatty liver also had a significantly increased risk for type 2 diabetes compare to those without fatty liver. <br />
“Our study shows in a large population of relatively healthy individuals that identifying fatty liver by ultrasound predicts the development of type 2 diabetes in five years,” said Kim. “In addition, our findings reveal a complex relationship between baseline fatty liver and fasting insulin concentration.”

“Insulin has this fundamentally important ability of suppressing lipolysis, [during which triglycerides in fat are broken down and fatty acids are released. Finding] this is mediated in a large part by the brain is surprising...The major lipolysis-inducing pathway in our bodies is the sympathetic nervous system and here the studies showed that brain insulin reduces sympathetic nervous system activity in fat tissue. In patients who are obese or have diabetes, insulin fails to inhibit lipolysis and fatty acid levels [rise]. The low-grade inflammation throughout the body...commonly present in these conditions is believed to be mainly a consequence of these increased fatty acid levels...When brain insulin function is impaired, the release of fatty acids is increased. This induces inflammation, which can further worsen insulin resistance, the core defect in type 2 diabetes. [I]mpaired brain insulin signaling can start a vicious cycle since inflammation can impair brain insulin signaling.”

The study involved 135 people with an average age of 67 from Hisayama, Japan. The participants had several diabetes glucose tests to measure blood sugar levels. They were also monitored for symptoms of Alzheimer's disease over the next 10 to 15 years. During that time, about 16 percent developed Alzheimer's disease. <br />
After the participants died, researchers examined their autopsied brains for the physical signs of Alzheimer's disease, called plaques and tangles. While 16 percent had symptoms of Alzheimer's disease while alive, a total of 65 percent had plaques. <br />
The study found that people who had abnormal results on three tests of blood sugar control had an increased risk of developing plaques. Plaques were found in 72 percent of people with insulin resistance and 62 percent of people with no indication of insulin resistance. However, the study did not find a link between diabetes factors and tangles in the brain.

"In Type 1 diabetes, your pancreas isn't making insulin. In Type 2 diabetes, your tissues are insensitive to insulin because of problems in the insulin receptor. Type 3 is where that insulin receptor problem is localized in the brain....[Some older] individuals start to have less effective insulin signaling, including in the brain"[, making the brain more vulnerable to large sticky plaques of amyloid beta protein,] a hallmark of Alzheimer's...<br />
[Short strands of the protein, known as] ADDLs, attack memory-forming brain cells...[In lab tests, insulin blocked the effects of ADDLs in rat nerve cells, an effect amplified by a drug that] increases insulin sensitivity. <br />
Several studies have found that diabetics have a higher risk of getting Alzheimer's... <br />
[Earlier research reports] diabetics who take insulin plus a range of anti-diabetic medications, including an older pill known as a sulfonylurea], have a lower risk of developing Alzheimer's than diabetics who only take insulin.

The way primary care is organized and reimbursed by insurance companies probably serves as a barrier to achieving optimal blood glucose control....
Before [Maine's] program existed, 80% of people with diabetes had received an HbA1c test within the past year. After a year, 93% of people had received one. The percentage of people with HbA1c values less than 7% rose from 41% to 49%—a 20% increase. The percentage of people with HbA1c values above 8% decreased from 31% to 24%, and the percentage of people with HbA1c values above 9.5% decreased from 13% to 9%. There were similar results in measures of LDL (or “bad”) cholesterol and blood pressure.
“This is not a question of bad doctors or bad patients...It is a question of a care model that is focused on illness instead of prevention, and systems that have been created that don’t accommodate a change in focus. We’re changing the focus, including offering financial incentives for physicians whose patients do better.”

Over half of the nearly 24 million Americans with diabetes also have osteoarthritis. It's the most common kind of arthritis, which occurs when the cartilage that provides a cushion between bones wears away, causing inflammation, stiffness, and pain in joints. One disease affects the other. "Controlling arthritis is critical to diabetes management and vice versa," says John H. Klippel, M.D., the president and CEO of the Arthritis Foundation in Atlanta. Staying active and at a healthy weight are key. Here are seven important facts that can help you manage both conditions to help you stay healthier.

In high-risk adults with type 2 diabetes, researchers have found that two therapies may slow the progression of diabetic retinopathy, an eye disease that is the leading cause of vision loss in working-age Americans.
Intensive blood sugar control reduced the progression of diabetic retinopathy compared with standard blood sugar control, and combination lipid therapy with a fibrate and statin also reduced disease progression compared with statin therapy alone. However, intensive blood pressure control provided no additional benefit to patients compared with standard blood pressure control.
[The discussion of increased mortality in the ACCORD study fails to address what David Spero has pointed out: that "intensive blood sugar control", as defined in the study, refers to intensive drug intervention, not the better patient education and management which can achieve the same ends.—DMM]

[Obstructive sleep apnea] is a syndrome characterized by sleep-disordered breathing, resulting in excessive daytime sleepiness, sleep attacks, psychomotor deficits, and disrupted nighttime sleep. It increases the risk of motor vehicle accidents, and is common among truck drivers. Approximately 2.4 to 3.9 million licensed commercial drivers in the U.S. are expected to have OSA. In addition to being unrecognized or unreported by drivers, OSA often remains undiagnosed by many primary care clinicians despite the fact that OSA increases the risks of hypertension, diabetes mellitus, and heart disease.
Philip Parks, MD, MPH...says, "It is well-known that obesity, a leading risk factor for obstructive sleep apnea, is on the rise in the United States. Truck drivers with sleep apnea have up to a 7-fold increased risk of being involved in a motor vehicle crash."

[Weight loss may be] the single most effective way to reduce [obstructive sleep apnea and other] disorders...[offering benefits of] short- and long-term effectiveness and [a] relatively modest price...[I]n 81 patients with mild OSA, the 40...who [followed a strict calorie-limited diet] combined with lifestyle counseling lost more than 20 pounds on average in a year—and kept it off, resulting in markedly lower symptoms of OSA. The 41 patients in the control arm, who...lost on average less than 6 pounds...were much less likely to see [OSA] improvements...[Sustained weight loss] also improves...co-morbidities such as hypertension, high cholesterol, and diabetes..."[S]ignificant improvements were also found in...insulin resistance, lipids, and cardiorespiratory variables, such as arterial oxygen saturation...The greater the change in body weight or waist circumference, the greater was the improvement"...[M]ild OSA was objectively cured in 88% of the patients who lost more than 33 pounds...

A single subcutaneous dose of MSI-1436 leads to marked reductions in body weight, fasting blood glucose, serum triglycerides and cholesterol in diet-induced obese (DIO) rats[, inducing] changes in daily food intake[,] corresponding decreases in body weight, [and] marked improvements in glucose tolerance and lipid profile. Trodusquemine is the first highly selective inhibitor of [PTP1B], an enzyme central to controlling the function of both the leptin and insulin pathways....Initial clinical studies of trodusquemine in obese and overweight subjects has provided early indicators of weight loss and improved glucose control. These results confirm previous work in animal models which demonstrated significant weight loss without metabolic rebound, which often limits sustained weight loss during caloric restriction. In addition, trodusquemine has shown the ability to reverse co-morbidities associated with obesity such as abnormal glucose metabolism and cholesterol elevation.

More than 90% of [New York's diabetics] have elevated blood pressure, cholesterol or blood sugar--placing them at increased risk of heart attacks, strokes and other complications....Some 500,000 New York City adults have been diagnosed with diabetes; 200,000 more have the condition but don’t know it...1.4 million non-diabetic New Yorkers [may be "pre-diabetic"....A]dults making less than $20,000 a year were almost twice as likely as higher-income adults to have diabetes (15.7% vs. 8.9%). Black New Yorkers were at higher rates than whites (14.5% vs. 10.7%). And Asian New Yorkers had the highest rates of both diabetes (16.1%) and pre-diabetes (32.4%)....[Half of diagnosed diabetics] had elevated blood pressure and nearly two thirds had high cholesterol. Many had not been prescribed medications for either condition, and only 12% were on insulin – compared with 23% nationally...New York City’s medical institutions are failing to meet nationally recognized standards for managing diabetes.

White-coat hypertension[--the tendency for some patients who normally don't have high blood pressure to have a temporary increase while in the doctor's office--]is considered harmless in most people, but it appears to increase the risk of microvascular complications in patients with type 2 diabetes, Brazilian researchers report in Diabetes Care.
Dr. Caroline B. Kramer, lead investigator stated that, "We believe that blood pressure levels are a strong predictor of chronic complications"....[W]hite-coat hypertensives had a higher average systolic blood pressure...during daytime monitoring (126.6 versus 123.2 mm Hg) and during 24-hour ambulatory monitoring (124.7 versus 121.0 mm Hg)...[W]hite-coat hypertension was associated with...protein in the urine, which is a risk factor for nephropathy, and a nearly three-fold increased risk of developing diabetic retinopathy.
"[W]hite-coat hypertension should not be considered a harmless condition and treatment should be considered."

"Chronic inflammation appears to be an important factor underlying...many age-related disorders, and dietary restriction has been shown to reduce the risk for chronic disease and promote longevity in multiple animal models," says [Mark Reynolds, DDS, whose study of rhesus monkeys] showed that males fed a diet of 30% fewer calories...had significantly lower levels of...periodontal pocketing, less immune response to invading bacteria, and higher inflammatory molecules than males fed a normal diet....
Also, for the monkeys not fed the reduced-calorie diet, males showed "significantly greater periodontal breakdown" than females. Consistent with previous studies of humans, the monkeys in the study showed an increasing degree of gum problems as they aged.
Aging and obesity are associated with increased biological signs of overall inflammation and periodontal disease in humans, says Reynolds. [A]bout one-third of adults aged 30 to 90 have periodontitis...

Results: Same sex CR [caloric restriction] and CON [control] monkeys exhibited similar levels of plaque, calculus, and bleeding on probing. Among CON animals, males showed significantly greater periodontal breakdown, as reflected by higher mean clinical attachment level and periodontal probing depth scores, than females. CR males exhibited significantly less periodontal pocketing, lower IgG antibody response, and lower IL-8 and ß-glucuronidase levels compared to CON males, whereas CR females showed a lower IgG antibody response but comparable clinical parameters and inflammatory marker levels relative to CON females. Long-term CR had no demonstrable effect on the periodontal microbiota.
Conclusion: Males demonstrated greater risk for naturally occurring periodontal disease than females. Long-term CR may differentially reduce the production of local inflammatory mediators and risk for inflammatory periodontal disease among males but not females.

A new report suggests that treating gum disease in patients who have diabetes with procedures such as cleanings and periodontal scaling is linked to 10 to 12 percent lower medical costs per month.

George Taylor, University of Michigan associate professor of dentistry, led the research project to investigate whether routine, non-surgical treatment for gum disease is linked to lower medical care costs for people with diabetes.

In periodontal disease, the body reacts to the bacteria causing the gum infection by producing proteins or chemicals called inflammatory mediators. Ulcers and open sores in the gums become passageways for these proteins and for the bacteria themselves to enter the body's blood circulation. These inflammatory mediators, as well as some parts of the bacteria, prevent the body from effectively removing glucose, or sugar, from the blood.

People with diabetes are almost twice as likely to be depressed. [T]he demands of life with diabetes [may] increase a person's risk for depression, especially for those with complications. [B]eing depressed [may increase] a person's risk of developing Type 2 diabetes. Depression and stress can raise blood glucose levels. [Stress] releases hormones that raise blood glucose...and depression aggravates this...[I]f you have "pre-diabetes," depression could push glucose levels high enough...to develop diabetes. Depression and diabetes are a bad combination. When you are depressed, it is hard to do anything, including take good care of yourself...[P]oorer self-care [produces] more complications, including heart attacks and strokes, and more physical limitations....You could be depressed if you feel persistently sad, have lost interest in things you usually enjoy, [have] changes in sleep or eating patterns, [have] trouble concentrating or making decisions, [or feel] bad about yourself.

Many health-care providers are unaware of the association between snoring, sleep apnea, and diabetes, and [miss] treatment opportunities..Everyone with diabetes should be screened routinely for the symptoms of snoring and sleep apnea. When people with diabetes and their sleep partners are asked the following three questions, nearly half will respond positively and can be expected to benefit from a referral to a sleep specialist: Do you snore? (While not everyone who snores has sleep apnea, just about everyone with sleep apnea snores.) Do you wake up tired after a full night’s sleep? Do you have high blood pressure? If you answered yes to any of these questions but your health-care provider has not talked about sleep apnea with you, bring it up at your next appointment. Treating sleep apnea can have remarkable benefits: Not only will you sleep better, but your level of insulin resistance may decrease significantly and you may reduce your risk of cardiovascular disease.

[D]iabetes worldwide will far outstrip even the sharp increase currently projected unless rising trends of obesity are controlled...."[Our projections] take into account only aging and urbanization but not obesity...," stated Gojka Roglic of WHO[, adding that no country shows] any signs of a plateau for obesity...[Diabetics are 3] times more likely to develop active TB...One in every 3 people in the world is infected with TB bacilli...Chances of developing active TB rise when one's immune system is...compromised by a chronic illness. India carries the highest diabetes burden in the world, with 41 million cases in 2007, projected to hit 70 million by 2025. The problem [has quadrupled over 25 years] in rural India...The rate in urban areas is [up by half in 10 years. E]xperts say the propensity for diabetes among Indians may...be due to a switch, linked to rising affluence, to [sedentary lifestyles and to] eating polished rice which has much more sugar than crude, unpolished rice.

30% of patients with Type 2 diabetes have depression[, which new research associates with] higher blood glucose...[A 4-year study of depression and] glycemic control in 11,525 veterans with type 2 diabetes shows that [HbA1c averages] 0.13% higher in [depressives]..."[T]hat the difference persisted over time and that the depressed group had higher mean HbA1c at all 36 time points was surprising," study coauthor Leonard Egede [said, adding] that this difference is...enough to push individuals with diabetes over the optimal threshold for glucose control and increase their risk for poor outcomes. Comorbid depression occurs in approximately 30% of adults with diabetes and is associated with poor metabolic control, [more] complication[s, more] healthcare use and costs...and increased disability and mortality..."[That the association shows] even in a sample with relatively well-controlled diabetes...suggests that in populations with higher baseline HbA1c, the...association may be much higher"

Of nearly 9300 US adults followed for 17 years, those with gum disease were more likely to develop diabetes. Those with moderate gum disease had twice the risk of diabetes as those with healthy gums; substantial tooth loss was linked to a 70% higher risk.