USC Westside Center for Diabetes | December 2001 Newsletter

INSIDE THIS ISSUE


		The Results Are In: Therapies to prevent type 2 diabetes compared.

		Pump Update: Minimed Paradigm release postponed, and Disetronic introduces a new infusion set.

		Sugar: Have your fruitcake and eat it too.

		Kids with Diabetes: Care at school is critical to a healthy life, now and later.

		Changing Rules: FAA issues guidelines for flying with diabetes supplies.

		Prevention: USC physician seeks causes and ways to head off diabetes.

Points of Interest


		Handling stress

		Cholesterol-lowering drugs

		Concern Over Atkins Diet

		Thyroid Hormone Replacement Therapy

		Diabetes... an Aspirin a Day

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	Diabetes...an Aspirin a Day - By Ruchi Mathur, MD Excerpted from MedicineNet.com Apatient came into my office a few months ago with newly diagnosed diabetes. We decided to try to manage her diabetes with diet and exercise. She was very compliant and was trying desperately to change her lifestyle to avoid medication. She started walking regularly and read every label on every item of food she bought. Her enthusiasm was remarkable and very successful. At age 62, she managed to completely change her lifestyle. I saw her in follow-up last week and told her how impressed I was with her progress: She had managed to control her diabetes with diet and exercise and did not need medication to control her blood sugar. Her blood pressure was under control and her cholesterol levels were normal. She was thrilled. As we concluded our visit, I handed her a prescription. She took it with a frown and said: "I thought you said I didn't need any medication. You know how much I despise the thought of taking pills. What's this all about?" I had prescribed coated aspirin. It had nothing to do with her blood sugar controlÑwell, not directly. People with diabetes have a two-to-four-fold increase in risk for dying from heart disease. A major risk contributor: increased production of thromboxane, a substance that causes vessels to constrict and causes platelets—the cells that are responsible for clottingÑto stick together and form clots inside the arteries. Aspirin, though, blocks thromboxane production. Many studies have shown aspirin therapy can benefit patients after a heart attack. And in patients with no previous heart disease, those who started on aspirin experienced 44 percent less risk for heart attacks than others. Among diabetic patients specifically, the heart attack rate was 10.1 percent in the untreated group, compared to a rate of 4.0 percent in the group on aspirin. The American Diabetes Association subsequently released guidelines for aspirin use in diabetes: Aspirin should be used in any diabetic patient who has evidence of heart disease, a prior heart attack, previous bypass procedures, a stroke, angina, claudication or blood vessel disease. Aspirin therapy should be considealt in high-risk men and women with type 1 or type 2 diabetes. This includes diabetic patients who have a family history of heart disease, smoke cigarettes, have high blood pressure, are obese, have protein in the urine, have high cholesterol or are over age 30. Since my patient was over age 30 and had no contraindications, such as aspirin sensitivity, stomach ulcers or bleeding, or liver disease, aspirin therapy could benefit her. I mentioned to her that despite her successful lifestyle changes and controlled blood sugar, certain risks are inherent in diabetes. Although somewhat resistant, she seemed to understand that just like a vitamin a day, aspirin therapy is a preventive measure. In fact, she seemed much more enthusiastic when I told her that aspirin reduced her chance of heart attack by 25 to 30 percent. Aspirin therapy is simple, and a dose of baby aspirin, coated aspirin or regular aspirin work equally well. Blood sugar control is not a criterion for deciding who should take aspirin. Patients with diabetes should discuss aspirin therapy with their primary care physician. If there are no contraindications, the benefits far outweigh the risks.
	Photos By Mark Harmel ©2001/2002 USC. All Rights Reserved

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