Tuesday, November 3, 2009

Mass General experts discuss diabetes

Dr. Cagliero Dr. Jaff Dr. Huang
Enrico Cagliero, MD,
Transplant Center

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   the Transplant Center
Michael Ritt Jaff, DO,
Vascular Center

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   the Vascular Center
Paul L. Huang, MD, PhD,
Heart Center

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   the Heart Center

What are some of the common misconceptions

about diabetes?

Dr. Cagliero: A common misconception is that diabetes inevitability causes eye, kidney and nerve complications. These complications take a long time to develop and are actually very preventable. If people with diabetes control their blood sugar levels from the very beginning, they can significantly reduce the risk of developing complications.

Dr. Huang: Many people think that diabetes is not a serious disease unless someone needs insulin. The reality is diabetes is a serious disease that increases a person’s risk for developing other medical conditions, including heart disease and stroke.

Dr. Cagliero: Another misconception is that insulin causes debilitating side effects and should be a “last resort” treatment. Insulin is actually one of the most effective medications for diabetes and is associated with fewer side effects than many other treatments.

How can people prevent type 2 diabetes, the

most common type of diabetes, and its related


Dr. Huang: Having diabetes increases a person’s risk for developing heart disease and other serious medical conditions. People can significantly lower their risk for developing diabetes and heart disease simply by making healthier food choices and increasing their physical activity.

People who have diabetes should follow their doctor’s advice to control their blood sugar levels, whether it is with oral medications or insulin. Doctors may use a blood test called “hemoglobin A1c (HbA1c)” to show how well patients control their blood sugar or glucose levels over time.

People who have diabetes should also pay attention to other medical conditions that increase their risk for developing heart disease, such as high blood pressure, high cholesterol and obesity, and quit smoking if they smoke.

What should people with diabetes know about


Dr. Huang: High cholesterol increases a diabetic person’s risk of developing heart disease. National guidelines recommend that people who have had a heart attack should lower their LDL cholesterol to 70-100 mg/dl using a statin (an oral medication), if necessary. The same recommendations apply to people with diabetes, whether or not they know they have heart disease. This shows how serious diabetes is as a risk.

All people - whether or not they have diabetes - should ask their doctor how to best manage their cholesterol. There are three ways to do this - make better food choices, increase physical activity and use medications, if necessary. All three ways are important.

What should people with diabetes know about

the risk of stroke?

Dr. Jaff: The risk of stroke and cardiovascular disease is significantly greater for people with diabetes, including younger people. The number one way for people to reduce their risk of stroke is to control high blood pressure, a common condition among diabetics. Some research suggests that controlling blood sugar levels also reduces the risk of stroke. Learn how physicians at the Vascular Center treat stroke

What should people with diabetes know about

the risk of heart disease?

Dr. Huang: Having diabetes increases a person’s risk of developing coronary artery disease, which causes chest pain, heart attacks and heart damage. Heart disease is also the main cause of death for people with diabetes. The better patients control their blood sugar levels, the more they can reduce their risk for heart disease, kidney disease, nerve damage and eye problems. They should manage not only their diabetes but also other conditions, including high blood pressure, high cholesterol and obesity. By doing so, they can make a significant difference in their overall health. Learn about the Heart Center’s Cardiovascular Disease Prevention Center

What is peripheral artery disease, and why

should people with diabetes learn about this


Dr. Jaff: Peripheral artery disease (PAD) refers to the blockage of artery blood flow in the legs (and far less commonly, the arms). PAD can result in difficulty walking due to leg discomfort and also leg and foot sores (ulcers). If PAD is not aggressively treated, people may end up with limb loss. Diabetic patients are at significant risk of developing PAD and limb/foot sores. 

Often people with diabetes cannot feel their feet or legs because of nerve disease, which might make it hard for them to feel or recognize the symptoms of PAD. Therefore, all patients with diabetes should speak with their doctor to assess their risk of developing PAD. Learn how Vascular Center physicians treat PAD

What are a few tips to help people with diabetes

live full, healthy lives?

Dr. Jaff: First and most importantly, people with diabetes should visit their doctors regularly, maintain a healthy diet, monitor blood sugar levels and take medications as prescribed. They should also see a podiatrist regularly, examine their feet daily, wear appropriate fitting shoes and speak with their doctor about being tested for PAD. 

Why do diabetic patients sometimes need a

kidney or pancreas transplant?

Dr. Cagliero: People with diabetes are at risk of developing kidney damage. Although controlling diabetes can help people avoid further medical complications, some people develop kidney disease that eventually leads to kidney failure. Many of these patients are treated with dialysis, but kidney transplantation is the only effective way of restoring normal kidney function. For people with type 1 diabetes, a pancreas transplant at the time of kidney transplant, or after a previous kidney transplant, can cure the disease, restore normal glucose levels and prevent further diabetic complications.

What are islet transplants, and which patients

qualify for this procedure?

Dr. Cagliero: Only 1 percent of pancreas cells are responsible for producing insulin, the hormone that regulates blood glucose levels and is absent in type 1 diabetes. Using an experimental procedure, our physicians can isolate pancreatic islet cells and give them to patients with type 1 diabetes. This procedure has the advantage of not requiring surgery (the islets can be injected in the blood like a transfusion) and can normalize blood glucose levels in most patients. Learn about the Transplant Center’s Pancreas/Islet Transplant Program

What diabetes research is currently being

conducted at Mass General?

Dr. Huang: The Cardiovascular Research Center at Mass General has active research programs that study how diabetes affects blood vessel function, heart attack and stroke. Mass General’s Cardiology Division has a clinical research program, CAMP MGH (Cardiology and Metabolic Patient Cohort), that follows patients over time to evaluate glucose response by using ultrasound studies of their blood vessels.

The Heart Center’s Cardiovascular Disease Prevention Center also has a clinical program called Learn to be Lean, which uses a nutrition education, physical exercise (aerobic and strength training) and yoga/meditation to reduce the risk of heart disease.

Dr. Cagliero: The Transplant Center at Mass General is also conducting several studies on new ways to prevent diabetes and complications in patients who already have diabetes. We evaluate new medications and devices, such as insulin pumps, which help manage the condition. Many of our scientists also investigate how to induce the body to accept transplanted organs without taking anti-rejection medications, obtain and transplant islets more efficiently, and transform other cells to produce insulin, creating an unlimited supply of cells ready for transplants.

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