CDC: Diabetes amputations falling dramatically

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ATLANTA (AP) — Foot and leg amputations were once a fairly common fate for diabetics, but new government research shows a dramatic decline in limbs lost to the disease, probably due to better treatments.

The rate has fallen by more than half since the mid-1990s, according to what is being called the most comprehensive study of the trend.

For older diabetics, amputations dropped from more than 11 to about 4 per 1,000 people, the Centers for Disease Control and Prevention reported Tuesday.

Other diabetes studies have shown declines in lost toes, feet and legs, but not as dramatic.

"What jumped out to me was the scale of the improvement," said Dr. John Buse, a University of North Carolina diabetes expert who was not involved in the new study.

The study was released Tuesday by the medical journal Diabetes Care.

Diabetes is a disease in which sugar builds up in the blood. Roughly 1 in 10 U.S. adults has it, and it is the seventh leading cause of death, the CDC says.

Complications include poor circulation and nerve damage in the lower limbs, resulting in numbness and slow healing of sores and infections. That's most common in elderly patients and those with diabetes for at least 10 years.

While diabetes has been growing more common in the United States — driven by obesity-related Type 2 — researchers have noted recent declines in some of the other most dreaded complications, including blindness and kidney failure.

Buse recalled seeing such problems constantly when he first became director of UNC's Diabetes Care Center in the mid-1990s.

"Pretty much every minute of every day in the waiting room, there would be somebody missing a limb, or with a seeing eye dog or white cane," he said.

But he hasn't seen a patient like that in his waiting room for a few years, he added.

In the CDC study, the researchers checked national hospital discharge records for 1988 through 2008, looking for patients aged 40 and older who had lost a toe, foot or leg to diabetes.

They found that though the number of people with the disease more than tripled over those two decades, foot and leg amputations fell after 1996.

The researchers also looked at people who did not have diabetes, and found the rates of amputation were flat.

It's not clear what happened to start the drop among diabetics, said Nilka Rios Burrows, a CDC epidemiologist who co-authored the study.

But experts note that was a decade in which studies clearly demonstrated the value of close monitoring and stepped-up patient education. It's also when Medicare began paying for blood sugar monitoring and for protective shoes and other medical devices for elderly diabetics.

CDC officials saw increases in the proportion of diabetics who got annual foot exams, and believe the enhanced care is the main reason for the decline in amputations.

But another element may be that larger numbers of diabetics are being diagnosed earlier and with milder disease, Burrows said.

___

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Diabetes Care: http://care.diabetesjournals.org/

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Festival cheer rings diabetes alarm for Indians

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Kashmiri people buy pastries and spices ahead of Eid al-Fitr festival in Srinagar September 20, 2009.

Credit: Reuters/Danish Ismail

By David Lalmalsawma

NEW DELHI | Wed Oct 12, 2011 1:58am EDT

NEW DELHI (Reuters) - It's festival season in India, with the celebrations providing a perfect opportunity for family outings, late-night parties and customary feasting on sweets.

But health experts warn that the festivities, coupled with genetic predisposition and lifestyle changes brought about by the increasing prosperity of the middle class, is contributing to the country being called the world's "diabetes capital," with the highest number of diabetics in any nation.

The string of festivals, starting with Durga Puja and Dussehra and ending with Diwali, take place in accordance with the Hindu calendar and the dates change every year. The first two were on Oct 6 and Diwali falls on Oct 26 this year.

"For the next one month or so, it is all either festivals or outings," says Anoop Misra, chairman at New Delhi's Fortis-C-DOC, Center of Excellence for Diabetes, Metabolic Diseases and Endocrinology.

"During this time, the rate of obesity goes up, sugar control of established diabetics goes down and those who are predisposed to develop diabetes also show diabetes."

Festivals in India are synonymous with eating and gifting sweets, and most food and confectionery shops are decked with an assortment of goodies in colorful wrappings meant for traditional presents.

Two all-time favorites are rasgullas, a soft, spongy ball made from cottage cheese, and the conch-shaped samdesh, made from jaggery. A popular holiday treat is milk-based kaju barfi.

But experts warn the festival fun -- and, not least, the culture of sweet-eating that peaks then -- can help trigger long-term health problems, with diabetes only the start.

The disease is characterized by high levels of sugar in the blood and can lead to more serious complications such as heart disease and stroke, damage to the kidneys or nerves, and blindness.

But the culture of consuming sweets is hard to shake off, especially during festivals.

"Everybody (in India) has a sweet tooth, including me," said Ramachandran, a man in his 50s polishing off a plate of sweets at a New Delhi restaurant.

"(Diabetes) is not because of sweets. It's because people are too lazy (to exercise)," he added.

MIDDLE CLASS DISEASE?

The majority of those with diabetes have Type 2, which is linked to obesity and lack of exercise. India, with 62.4 million cases, has the world's highest number of diabetics.

Misra said numbers are rising at an alarming rate because of a newly rich middle class that increasingly consumes junk food while adopting more sedentary lifestyles.

"Their awareness about healthy eating is very low," he said.

Recent studies have shown the numbers of diabetics is also rising fast in villages, where people are traditionally more active and have not previously been exposed to fast food restaurants and refined snacks.

Nutritionist Uma Gupta attributes it to increasing stress and people adopting city culture, among other causes.

A recent study commissioned by the Indian Council for Medical Research found that in the last one year, the number of diabetics in India increased by 11.6 million, while another 77.2 million are pre-diabetics -- a precursor to Type 2 diabetes where a person's blood sugar levels are higher than normal.

Experts warn that the country's health infrastructure could soon be unable to deal with the burden.

"(Diabetes) is a forerunner of multiple diseases including heart disease and cancer ... I don't think our present health system can counter this pressure," Misra said.

The situation is made worse by a tendency for people to wait until they have a real health problem before doing anything, said Gupta.

"Take measures now, improve your lifestyle. Otherwise, hospitals will not have space for you, doctors will not have time to treat you," she added.

"Treatment should start from your plate itself."

(Editing by Elaine Lies)

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FDA Approves Juvisync, First Combo Pill to Treat Diabetes and High Cholesterol

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The U.S. Food and Drug Administration approved on Friday the first combination pill to treat Type 2 diabetes and high cholesterol.

The new pill called Juvisync, made by Merck, combines the company's most popular diabetes drug, Januvia (sitagliptin), and its cholesterol-lowering statin Zocor (simvastatin). The AP called the pill a "probable blockbuster," predicting that it will appeal to millions of patients with diabetes who are not currently taking a statin.

Many of the estimated 25 million Americans who have Type 2 diabetes also have high cholesterol — in part because both conditions are related to obesity — a dangerous combination that increases patients' risk of heart disease, stroke and kidney disease.

The American Diabetes Association recommends that patients with diabetes who have heart disease or are over age 40 to add a statin to their daily regimen. Patients who follow medication guidelines end up taking multiple pills a day to control blood sugar, cholesterol and blood pressure. But many other patients — up to 4 million diabetes patients over 40 according to Merck scientists, the AP reported — are not taking statins.

Juvisync, which promises to streamline patients' required medications, will sell for the same price as Januvia alone, about $215 per month. Zocor in its generic form costs about $30 a month.

The new pill will be available in six different dosage strengths to accommodate patients with varying disease. The most common side effects of the pill include upper respiratory infection, stuffy or runny nose, headache, sore throat, muscle and stomach pain, nausea and constipation.

Last year, Januvia had sales of $2.4 billion. So far this year, it's brought in $1.5 billion. Merck's Janumet, another combo pill that combines Januvia with the the generic diabetes drug metformin, had sales of $626 million in the first half of 2011.

Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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FDA approves Merck's new diabetes therapy combo

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By Alina Selyukh

Fri Oct 7, 2011 1:23pm EDT

n">(Reuters) - U.S. health regulators approved a new combination therapy for type 2 diabetes from Merck & Co, the first to combine a diabetes drug with cholesterol-lowering medicine in one tablet.

Merck's new drug Juvisync combines the drugmaker's diabetes medicine Januvia, which helps lower high blood sugar levels, with simvastatin, a commonly prescribed statin that helps lower cholesterol alongside diet and exercise.

About 20 million Americans have type 2 diabetes, and many of them also have high cholesterol levels. The conditions can lead to increased risk of heart disease, stroke, kidney disease and blindness, especially if left untreated or poorly treated, the Food and Drug Association said.

For Merck, this is a chance to boost sales of Januvia, generically known as sitagliptin, whose sales rose 30 percent to $779 million in the second quarter.

The American Diabetes Association guidelines recommend statin therapy for anyone who has both diabetes and cardiovascular disease, regardless of cholesterol levels. They also recommend statins for anyone older than 40 with diabetes and with cardiovascular disease risk factors, such as high blood pressure.

Merck's experts have estimated that 6 million to 8 million of the type 2 diabetics who should be on a statin have not been receiving that therapy -- a gap that the company hopes to fill with the single-tablet Juvisync.

"Although clinical guidelines put people with diabetes at the same risk level as those with coronary heart disease, nearly 40 percent of eligible patients do not receive statin treatment," Dr. Barry Goldstein, Merck's vice president for diabetes and endocrinology, said in a statement. "We are proud to bring forward a treatment option that can help address this important health issue."

The FDA on Friday approved the combination in several dosage strengths.

The most common side effects of Juvisync include upper respiratory infection, stuffy or runny nose and sore throat, headache, muscle and stomach pain, constipation and nausea, regulators said.

Merck will now have to conduct a post-marketing clinical trial to compare how Januvia lowers glucose alone compared to its combination with simvastatin, the FDA said.

Merck's shares were up 1.5 percent at $31.88 in afternoon trading on the New York Stock Exchange.

Approved in 2006, Januvia was the first FDA-backed member of a new class of drugs called DPP-4 inhibitors that enhance the body's ability to lower elevated blood sugar. It has previously been coupled with another diabetes drug, metformin, and sold under the brand name Janumet. Merck's second-quarter sales of Janumet reached $321 million.

(Reporting by Alina Selyukh in Washington; additional reporting by Ransdell Pierson in New York and Anna Yukhananov in Washington; editing by John Wallace and Matthew Lewis)

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Diabetes 'dating agency' set up

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7 October 2011 Last updated at 01:22 GMT By Dominic Hughes Health correspondent, BBC News Three regions in England are taking part in a pilot diabetes 'dating agency' scheme A massive recruitment drive is under way to match up thousands of diabetes patients with research projects aimed at finding a cure for the disease.

The scheme is being likened to a kind of "dating agency" that puts researchers and patients in contact.

Researchers say about 30% of cancer patients may be taking part in clinical trials, but for diabetes that figure is less than 1%.

About 2.8 million people in the UK are known to have diabetes.

But the charity Diabetes UK believes another 800,000 people may not know they already have the disease.

Hard to find

Part of the reason researchers have found it hard to find diabetes patients is that most only see their GP.

But three regions in England have been chosen to pilot a scheme which aims to offer 25,000 patients, with any form of diabetes, the chance to take part in clinical trials or other forms of research.

A recruitment drive is taking place in north-east London and the south-west and north-west of England.

Continue reading the main story

I was interested firstly because I thought perhaps it would do some good, perhaps not for me but perhaps for somebody else.

But secondly I also thought that I would get looked at more closely than the chap over the road if I was on this thing.

So there were two sides to it - one that might help somebody else and one that might help me.

Prof Martin Gibson, from the Diabetes Research Network at Salford Royal NHS Foundation Trust, says clinical trials are essential in order to find better treatments for diabetes - or even a cure.

"Pretty much everyone I talk to with diabetes is interested in research but they don't get the opportunity.

"It's not like cancer where people are increasingly offered the chance to take part in research projects.

"Part of the problem is that people with diabetes are very often out in the community, which is not where the researchers are.

"So what we're trying to create is a dating agency so we can bring the two groups together, because both are very interested in trying to find a cure for diabetes."

Diabetes UK estimates that about 10% of the total NHS budget across the UK is spent on illnesses related to the disease.

The charity calculates this works out at about £173m a week - or £1m an hour.

Dr Iain Frame, director of research at Diabetes UK, said: "This is a huge opportunity for people with diabetes to play their part in crucial research that is piecing together the gaps in our knowledge and in our understanding of the condition.

"This exciting campaign will help future generations of people diagnosed with this serious, life-long condition and help us take a step further to a future without diabetes."

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Men 'are more prone to diabetes'

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3 October 2011 Last updated at 10:25 GMT Researchers say they have discovered why men may be more likely than women to develop type 2 diabetes - they are biologically more susceptible.

Men need to gain far less weight than women to develop the condition, study findings suggest.

The Glasgow University team found men developed the disease at a lower Body Mass Index (BMI) than women.

They believe distribution of the body fat is important - men tend to store it in their liver and around the waist.

Women, meanwhile, have greater amounts of 'safe' subcutaneous fat stored on the thighs and hips, for example.

This means women need to accumulate more fat overall than men to develop the harmful fat deposits linked with diabetes, the researchers explain in the journal Diabetologia.

Body fat

Type 2 diabetes is caused by too much sugar in the blood which occurs when the body's ability to regulate sugar levels in several different organs becomes disturbed. The condition is linked to excess fat in some of these organs such as the liver and muscles.

Professor Naveed Sattar, of the Institute of Cardiovascular & Medical Sciences, who led the research, said: "Previous research has indicated that middle-aged men are at a higher risk of developing diabetes than women and one possible explanation is that men have to gain less weight than women to develop the condition.

"In other words, men appear to be at higher risk for diabetes."

For the study, the researchers analysed data from 51,920 men and 43,137 women in Scotland with diabetes, taking into consideration body weight and obesity using the BMI measurement based on height and weight.

The results showed women developed diabetes at a heavier BMI than men - the mean BMI at diabetes diagnosis in men was 31.83 but 33.69 in women.

The researchers say this helps explain why men have higher rates of diabetes in many parts of the world.

Dr Victoria King, Head of Research at Diabetes UK, said: "It is worrying that men develop type 2 diabetes at a higher rate than their female counterparts. Research like this will help us understand reasons why and provide greater insight into what we can do to improve prevention of type 2 diabetes.

"Diabetes UK is calling on both men and women to reduce their chances of developing type 2 diabetes by losing any excess weight, eating a healthy, balanced diet and by taking regular physical activity."

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Diabetes again linked to colon cancer risk

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By Amy Norton

NEW YORK | Wed Sep 28, 2011 3:33pm EDT

NEW YORK (Reuters Health) - A new research review confirms that people with diabetes have a somewhat increased risk of colon cancer -- but the reasons for the connection, and what should be done about it, remain unclear.

Combining the results of 14 international studies, researchers found that overall, people with diabetes were 38 percent more likely to be diagnosed with colon cancer than those who were diabetes-free.

There was also a 20 percent increase in the risk of rectal cancer, though that appeared to be confined to men.

The findings, reported in the American Journal of Gastroenterology, do not prove that diabetes directly contributes to colon cancer in some people.

The results come from observational studies in which people with diabetes were found to have a higher risk of colon cancer than those without diabetes. In most of the studies, the researchers adjusted for at least some factors that might explain the link -- like older age, obesity and smoking -- and the diabetes-cancer connection remained.

However, there could still be other explanations.

"I think we can make the statement that diabetes is consistently associated with colorectal cancer," Dr. Edward Giovannucci of the Harvard School of Public Health, who was not involved the study, told Reuters Health in an email.

"The cause-and-effect aspect is a bit difficult to consider since diabetes is such a complex disease," said Giovannucci, who studies the underlying causes of colon cancer.

He said it seems likely that some aspect of diabetes contributes to colon cancer, but it's not certain what.

One theory is that hormones are involved.

People with diabetes tend to have high levels of the blood-sugar-regulating hormone insulin, as well as related hormones called insulin-like growth factors. Those hormones cause cells to grow and spread, and that may include cancer cells.

Whatever the mechanism, if diabetes does contribute to colon cancer, it's not clear what the implications would be.

People with diabetes are not advised to get colon cancer screening any more often, or at a younger age, than people without diabetes, said Dr. Hiroki Yuhara, who led the new study while based at the University of California, Berkeley.

And it's not clear if that advice will change at any time in the future, Yuhara told Reuters Health in an email.

Experts recommend that most people start colon cancer screening at the age of 50, with any of several tests -- including stool tests that look for hidden blood, or invasive tests like sigmoidoscopy or colonoscopy.

People with certain risk factors for colon cancer -- like inflammatory bowel disease (Crohn's disease or colitis) or a strong family history of the cancer -- are told to start screening earlier. Diabetes is not currently considered one of those risk factors.

And there's evidence that the link between diabetes and colon cancer risk may be weakening.

A study published last year by researchers at the American Cancer Society (ACS) found that among more than 184,000 older Americans followed for 15 years, men with type 2 diabetes were about one-quarter more likely to be diagnosed with colon cancer than diabetes-free men were.

But that increase in risk was modest and, the researchers said, smaller than past studies had suggested.

What's more, there was no similar increase seen among women with type 2 diabetes. (The study was not included in the current analysis, which considered studies published from the 1990s through 2009, from the U.S., Canada, Europe and Japan.)

The ACS researchers speculated that the findings might reflect better diabetes control among Americans -- and women, in particular -- in recent years. A separate government study had shown that U.S. women with diabetes improved their long-term blood sugar control between 1999 and 2004.

In theory, better blood sugar control would mean lower insulin levels, which might affect colon cancer risk.

But that's speculation. For now, Giovannucci recommended that people focus on maintaining a healthy weight and getting regular exercise: Obesity is a risk factor for both diabetes and colon cancer.

According to Yuhara, people with diabetes should be aware of the link to colon cancer risk, and follow their doctors' advice on screening for the cancer.

It's estimated that just over 101,000 Americans will be diagnosed with colon cancer in 2011, while almost 40,000 will be told they have rectal cancer, according to the ACS. The average American has about a 1 in 20 lifetime chance of developing either cancer.

SOURCE: bit.ly/qJa6tK American Journal of Gastroenterology, online September 13, 2011.

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Diabetes again linked to colon cancer risk: study

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n">(Reuters) - People with diabetes have a somewhat increased risk of colon cancer, an international study said -- but the reasons for the connection, and what should be done about it, remain unclear.

Researchers headed by Hiroki Yuhara, at the University of California, Berkeley, combined the results of 14 international studies and found that, overall, people with diabetes were 38 percent more likely to be diagnosed with colon cancer than those who were diabetes-free.

There was also a 20 percent increase in the risk of rectal cancer, though that appeared to be confined to men, according to the findings, published in the American Journal of Gastroenterology.

"These data suggest that diabetes mellitus is an independent risk factor for colon and rectal cancer," Yuhara and his colleagues wrote.

The findings do not prove that diabetes directly contributes to colon cancer in some people.

The results come from observational studies in which people with diabetes were found to have a higher risk of colon cancer than those without diabetes. In most of the studies, the researchers adjusted for at least some factors that might explain the link -- like older age, obesity and smoking -- and the diabetes-cancer connection remained.

"I think we can make the statement that diabetes is consistently associated with colorectal cancer," said Edward Giovannucci of the Harvard School of Public Health, who was not involved in the study.

"The cause-and-effect aspect is a bit difficult to consider since diabetes is such a complex disease," he told Reuters Health in an email.

He said it seems likely that some aspect of diabetes contributes to colon cancer, but it's not certain what.

One theory is that hormones are involved.

People with Diabetes tend to have high levels of the blood-sugar-regulating hormone insulin, as well as related hormones called insulin-like growth factors. Those hormones cause cells to grow and spread, and that may include cancer cells.

If diabetes does contribute to colon cancer, it's not clear what the implications would be.

People with diabetes are not advised to get colon cancer screening any more often, or at a younger age, than people without diabetes, said Yuhara.

It's also not clear if that advice will change at any time in the future. Experts recommend that most people start colon cancer screening at the age of 50.

People with certain risk factors for colon cancer, such as a strong family history of the cancer, are told to start screening earlier. Diabetes is not currently considered one of those risk factors.

And there's evidence the link between diabetes and colon cancer risk may be weakening.

A study published last year by researchers at the American Cancer Society (ACS), and not included in the current analysis, found that among the 184,000 older U.S. residents followed for 15 years, men with type 2 diabetes were about one-quarter more likely to be diagnosed with colon cancer than diabetes-free men were.

But that increase in risk was modest, and smaller than past studies had suggested. In addition, there was no similar increase seen among women with type 2 diabetes.

The ACS researchers speculated that the findings might reflect better diabetes control among U.S. residents -- and women in particular -- in recent years. In theory, better blood control would mean lower insulin levels, which might affect colon cancer risk.

For now, Giovannucci recommended that people focus on maintaining a healthy weight and getting regular exercise.

The analysis included studies published from the 1990s through 2009, from the United States, Canada, Europe and Japan. SOURCE: bit.ly/qJa6tK

(Reporting from New York by Amy Norton at Reuters Health; editing by Elaine Lies)

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Asthma tied to poorer diabetes control in kids

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By Amy Norton

NEW YORK | Mon Sep 26, 2011 2:16pm EDT

NEW YORK (Reuters Health) - Kids with diabetes may have a higher-than-average rate of asthma, and those with both conditions seem to have a tougher time keeping their blood sugar under control, a study out Monday suggests.

Researchers found that among 2,000 3- to 21-year-olds with diabetes, 11 percent had asthma -- higher than the roughly 9 percent rate among children and young adults in the U.S.

The difference was bigger when the researchers looked at the 311 young people with type 2 diabetes, the form associated with obesity and usually diagnosed in adults.

In that group, 16 percent had asthma, compared with 10 percent of those with type 1 diabetes.

Type 1 diabetes is caused by an abnormal immune system reaction that kills off the pancreatic cells that make insulin, a hormone that helps shuttle sugar from the blood and into body cells to be used for energy. People with the disease have to take shots of synthetic insulin (or use an insulin pump) every day to keep their blood sugar levels normalized.

In this study, kids with both type 1 diabetes and asthma were more likely to have poor blood sugar control than their peers who were asthma-free: 15.5 percent, versus 9 percent.

"Poor" blood sugar control meant having a hemoglobin A1C level of more than 9.5 percent. Hemoglobin A1C is a measure of long-term blood sugar control, and experts say it should be kept below 7 percent in adults, while children's can go as high as 8.5 percent depending on their age.

The reasons for the findings, which appear in the journal Pediatrics, are not completely clear.

But the higher rate of asthma among young people with type 2 diabetes suggests a role for obesity, according to lead researcher Mary Helen Black, of the department of research and evaluation at Kaiser Permanente Southern California.

"It's pretty well-established that there's an obesity-asthma connection," Black told Reuters Health in an interview.

As for why young people with type 1 diabetes and asthma had poorer blood sugar control, one possibility is that there is a "real biological connection," Black said.

Some past research, for example, has found that people with poorly controlled diabetes are more likely to show dips in lung function over time than those with well-controlled diabetes. But the reasons for that are unknown.

On the other hand, Black said, it may simply be tougher for kids with type 1 diabetes to control their blood sugar when they have another chronic health problem.

"It can be incredibly challenging to manage both conditions," Black said.

The researchers did find that when kids with both diseases were on asthma medication, their blood sugar control was better.

In particular, poor blood sugar control was seen in less than 5 percent of those taking asthma drugs called leukotriene modifiers (sold under the brand-names Singulair, Accolate and Zyflo).

That compared with about 30 percent of type 1 diabetics who were not on medication for their asthma.

The researchers are not sure if that means there's an effect of the asthma drugs themselves. It may just be that kids with better-controlled asthma are also more likely to have well-controlled diabetes, according to Black.

She said the bottom line for doctors and parents is to be aware that kids with diabetes may have a somewhat higher rate of asthma -- and that those with both may have more trouble with blood sugar control.

If parents notice potential signs of asthma -- like wheezing, coughing or breathing problems that are not related to a cold or other infection -- they should talk to their child's doctor, Black said.

SOURCE: bit.ly/pTAIqi Pediatrics, online September 26, 2011.

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Creepy-crawlies may help heal diabetes wounds

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n">(Reuters) - To jump-start the healing of difficult diabetic wounds, researchers have a suggestion: let maggots do the work.

To allow such wounds to heal, doctors remove infected or dead tissue with scalpels or enzymes, a process they call debridement. But these tools often fail.

"These problem patients with diabetes really need better treatments in order to salvage their limbs," said Lawrence Eron from Kaiser Hospital and the University of Hawaii in Honolulu, who with colleagues presented their findings at a recent scientific meeting in Chicago.

"Maggot debridement treatment is overwhelmingly effective. After just one treatment these wounds start looking better," he told Reuters Health.

The results from Eron's team, which treated 37 diabetics with the maggots, still haven't been vetted by independent researchers.

All of the patients in the study suffered from a type of artery disease that causes poor circulation in the limbs and they all had stubborn wounds, some up to five years old.

The doctors put 50 to 100 maggots, of the species Lucilia sericata, on the wounds and left them there for two days, at which time they applied new ones. They repeated this five times on average.

"We cage the maggots in a mesh-like material. Nylon panty hose might be used. And then we seal them so they don't get out," Eron said.

Maggots secrete substances into wounds that liquefy dead tissue and then ingest the material to further degrade it in their gut. The wounds are cleaned, and other substances contained in the maggot secretions allow the development of granulation tissue, a type of connective tissue that forms during wound healing.

Twenty-one of the patients had successful outcomes, defined as eradication of infection, complete removal of dead tissue, formation of robust connective tissue in the wound and more than three-quarters closure of the wound.

Five wounds were infected with the "superbug" MRSA, but they healed successfully with the maggot therapy. Nine wounds were infected with another bacterium called MSSA, and six of those healed. All 10 cases with infection due to group B streptococci were successfully treated, Eron said.

The treatment failed in some patients. One had excessive inflammation surrounding the wound, two bled too much, and three had problems with infected bones.

Asked how he persuades patients to undergo the treatment, Eron said he carefully explains the procedure and then has them sign a consent form.

"A lot of patients might be somewhat wary of having live insects placed into their wounds so we explain how it works and what possible problems might occur," he said.

"After this, we go on to do further treatment with hydrogels, grafts of cell culture tissue, or negative pressure dressings. But to get to the point there these treatments will work, you really need to clean up the wound, get rid of dead tissue, and get robust granulation tissue into the wound -- and this is where the maggots help."

(Reporting from the United States by Fran Lowry at Reuters Health; editing by Elaine Lies)

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Creepy-crawlies may help heal diabetes wounds

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By Fran Lowry

Fri Sep 23, 2011 5:14pm EDT

n">(Reuters Health) - Researchers from Hawaii have a suggestion for how to jump-start the healing of difficult diabetic wounds: let maggots do the work.

To allow such wounds to heal, doctors remove infected or dead tissue with scalpels or enzymes, a process they call debridement.

But these tools often fail, said Dr. Lawrence Eron from Kaiser Hospital and the University of Hawaii in Honolulu.

"These problem patients with diabetes really need better treatments in order to salvage their limbs," he told Reuters Health.

"Maggot debridement treatment is overwhelmingly effective," he added. "After just one treatment these wounds start looking better."

He and his colleagues presented their findings this week in Chicago at a scientific meeting, and they still haven't been vetted by independent researchers.

Eron's team treated 37 diabetics with maggots. The patients all suffered from a type of artery disease that causes poor circulation in the limbs, and they all had stubborn wounds -- some up to five years old.

The doctors put 50 to 100 maggots (of the species Lucilia sericata) on the wounds and left them there for two days, at which time they applied new ones. They repeated this five times on average.

"We cage the maggots in a mesh-like material. Nylon panty hose might be used. And then we seal them so they don't get out," Eron explained.

Twenty-one patients had successful outcomes, defined as eradication of infection, complete removal of dead tissue, formation of robust connective tissue in the wound and more than three-quarters closure of the wound.

The treatment failed in a handful of patients. One had excessive inflammation surrounding the wound, two bled too much, and three had problems with infected bones.

Five wounds were infected with the antibiotic-mocking "superbug" MRSA, but they healed successfully with the maggot therapy. Nine wounds were infected with another bacterium called MSSA, and six of those healed up. All 10 cases with infection due to group B streptococci were successfully treated, Eron said.

Asked how he persuades patients to undergo the creepy-crawly treatment, Eron said he carefully explains the procedure and then has them sign a consent form.

"A lot of patients might be somewhat wary of having live insects placed into their wounds so we explain how it works and what possible problems might occur," he said.

Maggots secrete substances into the wounds that liquefy dead tissue and then they ingest the material to further degrade it in their gut. The wounds are cleaned, and other substances contained in the maggot secretions allow the development of granulation tissue, a type of connective tissue that forms during wound healing.

"After this, we go on to do further treatment with hydrogels, grafts of cell culture tissue, or negative pressure dressings," said Eron. "But to get to this point where these techniques will work, you really need to clean up the wound, get rid of dead tissue, and get robust granulation tissue into the wound. And this is where the maggots help."

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