The plates measure out healthy portio

Using a simple portion control dinner plate can help people with type 2 diabetes lose weight and decrease reliance on medication, research shows. Canadian researchers put people with type 2 diabetes on a calorie-controlled diet for six months.

They found 17% of those who used a calibrated diet plate lost more than 5% of their body weight, compared with just 4.5% who did not.

The study appears in the journal Archives of Internal Medicine.

DIET PLATE SYSTEM   Provides measured, sectioned or calibrated areas for the various types of food, such as protein, starchy carbohydrates, vegetables, dairy and fat Once the meal is measured, it is moved to one side of the plate and then the remaining space is filled with fresh salad or vegetables

In the majority of cases type 2 diabetes is linked to carrying excess weight – 80% of people are overweight at diagnosis, and doctors recognise that weight loss can greatly improve the condition.

However, many people with diabetes find it hard to stick to a weight loss regime.

The researchers tested the effect of using a calibrated dinner plate and breakfast bowl that helps people to eat healthy sized portions.

On average those who used the diet plates lost 1.75% of their body weight, compared with just 0.05% in the group who had to rely on will power alone.

As a result, they were also much more likely to be able to decrease their reliance on diabetes-controlling medication, including shots of insulin.

As good as drugs

Lead researcher Dr Sue Pederson said the results were comparable to those achieved by taking expensive weight loss drugs.

She said: “The weight loss results are all the more impressive considering that diabetics in general do not respond well to weight loss programmes.”

Dr Ian Campbell, medical director of the charity Weight Concern, said: “Losing weight is never easy and even harder for diabetics.

“To achieve these results over a six month period is excellent and with no more side effects than an occasional decrease in blood glucose, easily corrected by a reduction in medication, is very impressive indeed.”

Tracy Kelly, of the charity Diabetes UK, said eating a healthy balanced diet and taking regular physical activity were the best ways of controlling weight and effectively managing diabetes.

“Cutting down on portion sizes and eating balanced meals will help people control their weight, therefore some people may find this plate useful.

“However, controlling weight can be achieved effectively without spending extra money.

“A healthy balanced diet should be based on carbohydrates and be low in fat, sugar and salt with plenty of fruit and vegetables.”

In the month after a surprising analysis revealed possible heart risks from the blockbuster diabetes drug Avandia, reports of side effects to federal regulators tripled.

AP Photo: Moncef Slaoui,, chairman of Research and Development at GalaxoSmithKline testifies on Capitol Hill in Washington,…

The sudden spike is a sign that doctors probably were unaware of the drug’s possible role in their patients’ heart problems and therefore may not have reported many such cases in the past, several experts said.

It also shows the flaws of the safety tracking system and suggests that a better one might have detected a potential problem before the drug had been on the market for eight years.

Avandia is used to control blood sugar, helping more than 6 million people worldwide manage Type 2 diabetes, the kind that is linked to obesity. These people already are at higher risk for heart attacks, so news that the drug might raise this risk by 43 percent was especially disturbing.

In the 35 days after May 21, when the New England Journal of Medicine published the analysis on the Internet, reports of heart attacks, deaths and hospitalizations leaped. The sharp rise in reports of heart problems appears in data obtained by The Associated Press through a Freedom of Information Act request to the federal Food and Drug Administration.

Only five heart attacks were reported in the 35 days before the study, compared with 90 in the same period afterward. Heart-related hospitalizations went from 11 to 126. The reports involve rosiglitazone, sold as Avandia and Avandamet.

Reporting a drug’s side effects is voluntary, and only a crude indication rather than a scientific measure of how many problems patients are actually having. The FDA relies on this unenforced system once a drug is on the market. Critics say it leads to haphazard oversight in which problems can be missed because doctors don’t connect the dots between a drug and symptoms they see in an individual patient.

With Avandia, the published analysis likely led to more cases being reported, said Vanderbilt University diabetes specialist Dr. Alvin C. Powers.

“Now, patients and their doctors are much more aware of the possible link between Avandia and cardiovascular disease. This is good — this is going to help us going forward to determine whether or not this drug is safe,” he said.

The drug’s manufacturer, British-based GlaxoSmithKline PLC, insists that the drug is safe and effective.

“This is a very well-known phenomenon,” where news reports lead to increased reporting, said company spokeswoman Mary Anne Rhyne. “It’s good that there’s awareness of the reporting system, but drawing conclusions on such data is inappropriate.”

The FDA plans hearings on safety concerns about the drug on July 30. In the meantime, diabetes experts have advised users of the medication to talk to their doctors and not to immediately discontinue it.

The side effects reported range from as minor as a blister to as serious as sudden cardiac death. Most of the reports the AP reviewed seemed to involve serious side effects, and rosiglitazone was listed by the FDA as the “primary suspect” rather than other medicines the patient may have been taking.

There was a total of only 50 adverse event reports in January and 73 in February. From April 16 to May 21, when the study was published, 121 events were reported, including 11 deaths. In the 35 days after the study, 357 events were reported, including 38 deaths.

“You really can’t infer anything about incidence rates from that,” because the spike in reports is likely due to the “publicity effect” of the study, said Dr. David Graham, an FDA drug safety expert.

Dr. David Nathan, chief of diabetes care at Massachusetts General Hospital, agreed, saying it was “not conceivable” that only five people among the 1 million Americans taking Avandia had heart attacks in the month preceding the May 21 study, as the FDA reports suggest.

“It just heightens the concern about the poor reporting we have,” said Nathan, who has received speaker fees from Glaxo and other drug companies. Powers and Graham have no financial ties to any diabetes drug makers.

The issue has roiled the medical community and sparked congressional probes into whether the FDA is properly investigating safety issues. The FDA issued a “safety alert” about the drug only after the May 21 study came out, even though Glaxo had informed the agency of its own analysis of heart risks nearly a year beforehand and possibly as early as 2005.

Avandia’s label warns about possible heart failure and other heart problems when taken with insulin. The drug also raises LDL, or bad cholesterol, and can cause fluid retention and weight gain.

WASHINGTON – Al-Qaida is stepping up its efforts to sneak terror operatives into the United States and has acquired most of the capabilities it needs to strike here, according to a new U.S. intelligence assessment, The Associated Press has learned.

AP Photo: Iraqi soldiers guard a man they have arrested at a checkpoint suspecting him of being…

The draft National Intelligence Estimate is expected to paint an ever-more-worrisome portrait of al-Qaida‘s ability to use its base along the Pakistan-Afghan border to launch and inspire attacks against the United States over the next several years.

Yet, the government’s top analysts concluded that U.S. soil has become a harder target for the extremist network, thanks to worldwide counterterror efforts since the attacks of Sept. 11, 2001.

Among the key findings of the classified estimate, which is still in draft form and must be approved by all 16 U.S. spy agencies:

• The U.S. will face “a persistent and evolving terrorist threat” within its borders over the next three years. The main danger comes from Islamic terrorist groups, especially al-Qaida, and is “driven by the undiminished intent to attack the homeland and a continued effort by terrorist groups to adapt and improve their capabilities.”

• Al-Qaida is probably still pursuing chemical, biological or nuclear weapons and would use them if its operatives developed sufficient capability.

• The terror group has been able to restore three of the four key tools it would need to launch an attack on U.S. soil: a safe haven in Pakistan’s tribal areas, operational lieutenants and senior leaders. It could not immediately be learned what the missing fourth element is.

• The group will bolster its efforts to position operatives inside U.S. borders. In public statements, U.S. officials have expressed concern about the ease with which people can enter the United States through Europe because of a program that allows most Europeans to enter without visas.

The document also discusses increasing concern about individuals already inside the United States who are adopting an extremist brand of Islam.

On a positive note, analysts concluded that increased international efforts over the past five years “have constrained the ability of al-Qaida to attack the U.S. homeland again and have led terrorist groups to perceive the homeland as a harder target to strike than on 9/11.”

Those measures helped disrupt known plots against the United States, the analysts found.

National Intelligence Estimates are the most authoritative written judgments that reflect the consensus long-term thinking of senior intelligence analysts.

Government officials, who spoke on condition of anonymity because the report has not been finalized, described it as an expansive look at potential threats within the United States and said it required the cooperation of a number of national security agencies, including the CIA, FBI, Homeland Security Department and National Counterterrorism Center.

National security officials met at the White House on Thursday about the intelligence estimate and related counterterrorism issues. The tentative plan is to release a declassified version of the report and brief Congress on Tuesday, one government official said.

Ross Feinstein, spokesman for National Intelligence Director Mike McConnell, declined to discuss the document’s specific contents. But he said it would be consistent with statements made by senior government officials at congressional hearings and elsewhere.

The estimate echoes the findings of another analysis prepared by the National Counterterrorism Center earlier this year and disclosed publicly on Wednesday. That report — titled “Al-Qaida better positioned to strike the West” — found the terrorist group is “considerably operationally stronger than a year ago” and has “regrouped to an extent not seen since 2001,” a counterterrorism official familiar with the reports findings told the AP.

On Thursday, news of the counterterrorism center’s threat assessment renewed the political debate about the nature of the al-Qaida threat and whether U.S. actions — in Iraq in particular — have made the U.S. safer from terrorism.

At a news conference Thursday, President Bush acknowledged al-Qaida’s continuing threat to the United States and used the new report as evidence his administration’s policies are on the right course.

“The same folks that are bombing innocent people in Iraq were the ones who attacked us in America on Sept. 11,” he said. “That’s why what happens in Iraq matters to security here at home.”

Yet Senate Intelligence Committee Chairman Jay Rockefeller, D-W.Va., said Iraq has distracted the United States. He said the U.S. should have finished off al-Qaida in 2002 and 2003 along the Afghan-Pakistan border.

Instead, “President Bush chose to invade Iraq, thereby diverting our military and intelligence resources away from the real war on terrorism,” Rockefeller said. “Threats to the United States homeland are not emanating from Iraq. They are coming from al-Qaida leadership.”

Rockefeller, who voted in favor of toppling Saddam Hussein, called for the U.S. to end its involvement in what he called the Iraqi civil war.

In recent weeks, senior national security officials have been increasingly worried about an al-Qaida attack in the United States.

Appearing on a half-dozen morning TV shows Thursday, Homeland Security Secretary Michael Chertoff laid out a list of factors contributing to his “gut feeling” that the nation faces a higher risk of attack this summer: al-Qaida’s increased freedom to train in South Asia, a flurry of public statements from the network’s leadership, a history of summertime attacks, a broader range of attacks in North Africa and Europe and homegrown terrorism increasing in Europe.

“Europe could become a platform for an attack against this country,” Chertoff told CNN, although he and others continue to say they know of no specific, credible information pointing to an attack here.

National security officials are frustrated by an agreement last year between Pakistani President Pervez Musharraf and tribal leaders in western Pakistan, which gave tribes near the Afghan border greater autonomy and has led to increased al-Qaida activity in the region.

Nevertheless, Bush administration officials still view Musharraf as a partner.

Speaking to a congressional hearing, Assistant Secretary of State Richard Boucher said that Pakistan under Musharraf has captured more al-Qaida operatives than any other country and that several major Taliban leaders were captured or killed this year.

“There is a considerable al-Qaida presence at the border, but they are under pressure,” Boucher told a House national security subcommittee.

Rep. Jim Cooper, D-Tenn., was skeptical, saying al-Qaida leader Osama bin Laden and other terrorist leaders apparently feel safe there. “Is this a Motel 6 for terrorists?” he asked.

___

Associated Press writers Matthew Lee, Lara Jakes Jordan and Barry Schweid contributed to this report.