In The News
Efficacy and Safety of Sodium Glucose Co-Transport-2 Inhibitors in Type 2 Diabetes
December 5, 2013. This meta-analysis of randomized trials of sodium glucose co-transport-2 (SGLT-2) inhibitors evaluated these drugs’ impact on A1C levels, weight loss, metabolic markers, and adverse events in type 2 diabetes. Investigators found that SGLT-2 inhibitors were well tolerated and effectively lowered A1C levels by -0.5%, -0.6%, and -0.6% at 12, 24, and 52 weeks, respectively. They were also associated with weight loss, blood pressure reductions, increased HDL cholesterol, and a higher frequency of genital and urinary infections. Click here to read the study abstract.
The Many Faces of Diabetes: A Disease With Increasing Heterogeneity
December 3, 2013. A recent review article in Lancet Endocrinology evaluates evidence that diabetes may be a more heterogeneous disease than its current allocation into types 1 and 2 suggests. The authors discuss the role of genetic susceptibility and environmental and lifestyle factors. They emphasize the need to better characterize patients who can be diagnosed in diabetes subgroups. To read the article abstract, link here.
American Geriatrics Society Releases Newly Updated Diabetes Guidelines
November 26, 2013. The American Geriatrics Society (AGS) has just released its updated guidelines for diabetes treatment, Improving the Care of Older Adults with Diabetes Mellitus: 2013 Update. The 2013 document updates the 2003 version and emphasizes the importance of individualizing and prioritizing treatment, with attention to quality of life and personal and caregiver health care choices. These guidelines can be purchased from AGS; a link with more details and ordering information can be found here.
Metformin Benefit in Cancer Patients With Concurrent Type 2 Diabetes
November 20, 2013. This systematic review and meta-analysis of 20 publications (comprising 13,008 patients) found a relative survival benefit (overall survival and cancer-specific survival) when patients with cancer and type 2 diabetes were treated with metformin, compared to other glucose-lowering medications. This association was also seen in subgroup analyses based on cancer type and country. The authors concluded that metformin is the treatment of choice for patients with both diseases. Click here to download the full article.
Diabetes Management Text Message App Launched
November 21, 2013. An app version of Care4life, a type 2 diabetes management/text messaging program compatible with iPhone and Android, has been released. Patients can use this application to help with important self-care diabetes management activities, including: setting medication and appointment reminders, accessing recipes and nutrition tips, self-reporting and tracking blood glucose readings, and documenting weight and exercise goals. Link to this article for more information about Care4life.
Magnitude of the Dawn Phenomenon and Its Impact on Overall Glucose Exposure in Type 2 Diabetes
October 29, 2013. This study was designed to assess the impact and magnitude of the dawn phenomenon in patients with noninsulin-treated type 2 diabetes. Investigators found that the impact of the dawn phenomenon on overall glycemic control (expressed as A1C level) was approximately 0.4%. This increase was not affected by currently available oral antidiabetes agents. To read the study abstract, link here.
Risk Calculator May Be Flawed in New American College of Cardiology/American Heart Association Cholesterol Guidelines
November 18, 2013. Last week’s release of new cholesterol management guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) has ignited controversy. Some experts have expressed concerns regarding the guidelines’ statin use recommendations and that the guidelines’ online risk calculator may substantially overestimate patient risk. The debate is ongoing. Follow this link to read a summary in The New York Times and this link to read a media report on the ACC/AHA’s response, delivered at a November 18 press briefing.
Canagliflozin Compared With Placebo and Sitagliptin in Patients With Type 2 Diabetes on Background Metformin Monotherapy
September 13, 2013. This randomized, double-blind, trial enrolled 1,284 patients with type 2 diabetes inadequately controlled on metformin alone. Patients were assigned to receive add-on canagliflozin 100 mg or 300 mg, sitagliptin 100 mg, or placebo. Investigators found that canagliflozin significantly improved A1C and blood pressure levels and body weight compared with placebo by week 26 and compared with sitagliptin by week 52. Follow this link to read the study abstract.
Early Combination Therapy for Treatment of Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis
November 9, 2013. This systematic review and meta-analysis was conducted to determine whether early combination therapy with metformin in patients with previously untreated type 2 diabetes mellitus led to improved outcomes compared with metformin alone. Results suggested a potential benefit of initial combination therapy on glycemic outcomes (including attainment of A1C <7%) across a range of baseline A1C levels. Link here to read the study abstract.
Wireless, Synchronizable-to-Smartphone Glucose Monitoring System Now Available
November 1, 2013. Following US Food and Drug Administration approval, iHealth is set to sell its Wireless Smart Gluco-Monitoring System. The device is Bluetooth-enabled and works in conjunction with an app designed for iOS and Android smartphones and tablets. It was designed to provide patients with a streamlined approach to monitoring, tracking, and sharing blood glucose readings. The kit requires only 0.7 mL of blood for a 5-second test and comes with a lancet and 50 test strips. Click here to read an article with more detailed information.
Long-term Safety and Efficacy of Empagliflozin, Sitagliptin, and Metformin: An active-controlled, parallel-group, randomized, 78-week open-label extension study in patients with type 2 diabetes
November 1, 2013. This active-controlled, parallel-group, randomized, 78-week open-label extension study of 2 prior, blinded 12-week studies in patients with type 2 diabetes compared treatment outcomes for patients receiving empagliflozin or sitagliptin (alone or in combination with metformin) or metformin. At week 90, changes from baseline A1C were −0.34 to −0.63% with empagliflozin, −0.56% with metformin, and −0.40% with sitagliptin. Patients experienced weight loss of -2.2 to -4.0 kg with empagliflozin, -1.3 kg with metformin, and -0.4 kg with sitagliptin. Click here to read the study abstract.
Effects of Intensive Glucose Control on Adverse Events, Cardiovascular Disease, and Mortality in Older Versus Younger Adults in the ACCORD Trial
October 29, 2013. In this sub-analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, investigators found that intensive glucose lowering increased CVD risk and total mortality in younger patients (<65 years of age), but had a neutral effect on these outcomes in older patients (≥65 years of age). Both the young and old intensively treated groups achieved similar A1C levels, but older patients had higher absolute rates of hypoglycemia (4.45% in older intensive group vs. 2.45% for younger intensive group). To read the study abstract, link here.
Acarbose and Metformin Achieve Similar A1C Reductions in Comparator Study
October 18, 2013. This 48-week, open-label, randomized study was conducted in China and compared glucose levels among newly diagnosed type 2 diabetes patients with baseline A1C levels of ~7.5%. At trial end, the acarbose group had a mean A1C reduction of 1.11% vs. a 1.12% reduction for patients treated with metformin. To read the study abstract, click here.
Phentermine/Topiramate Reduced Incident Type 2 Diabetes
October 8, 2013. This 108-week, randomized, placebo-controlled, double-blind study evaluated the impact of phentermine/topiramate in overweight/obese patients with prediabetes and/or metabolic syndrome. Patients were randomized to placebo or 1 of 2 dosages of phentermine/topiramate; all patients received lifestyle intervention. Patients with prediabetes and/or metabolic syndrome experienced substantial weight loss (10.9% and 12.1%, based on phentermine/topiramate dosage) as well as reductions in the annualized rate of transition to type 2 diabetes (70.5% and 78.7%, respectively). Link here to read the study abstract.
Using A1C and Fasting Plasma Glucose to Predict Diabetes Incidence Among Older Adults
October 17, 2013. This study, conducted as part of the Health, Aging, and Body Composition study, was designed to determine whether A1C, fasting plasma glucose (FPG), or both measurements best predicted diabetes in older patients (mean age 76.5 years). Over a 7-year follow-up, investigators found that older adults with both impaired fasting glucose and elevated A1C levels had substantially increased odds of developing diabetes and noted that combined FPG/A1C screening may be most helpful in identifying older adults at very high risk for diabetes. Click here to read the study abstract.
Consuming Specific Whole Fruits Is Associated With Lower Risk for Type 2 Diabetes
August 28, 2013. According to data from the Nurses’ Health Study (1984-2008), the increased consumption of specific whole fruits (in particular, blueberries, grapes, and apples) is significantly associated with a lower risk of type 2 diabetes. Increased consumption of fruit juice is associated with a higher risk of type 2 diabetes. To read the study abstract or download the full article, link here.
New AACE Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults
These Clinical Practice Guidelines, cosponsored by The American Association of Clinical Endocrinologists/The American College of Endocrinology and The Obesity Society, propose an evidence-based, standardized context for healthy eating recommendations. They were developed to help endocrinologists and other clinical professionals provide patients with improved nutrition education and management. To download this document, link here (the guidelines are at the top of the list).
ADA Releases Updated Nutrition Guidelines for Patients With Diabetes
October 9, 2013. The American Diabetes Association has released updated Nutrition Therapy Recommendations for the Management of Adults With Diabetes. These guidelines emphasize that no single nutritional plan will work for all patients. Patients’ personal and cultural preferences should be taken into account to design a nutritional plan that addresses their metabolic goals and that can be consistently followed. Recommendations are also provided regarding the intake of fat, carbohydrates, salt, and sugar. Click here to download the full document.
Severe Hypoglycemia and Cognitive Decline in Older People With Type 2 Diabetes
October 8, 2013. Patients with type 2 diabetes mellitus (T2DM) are at increased risk of cognitive decline associated with age. An association exists between cognitive decline and hypoglycemia, but the direction of the relationship is still unknown. This sub-study of the Edinburgh Type 2 Diabetes Study (ET2DS) evaluated 831 adults, aged 60 to 75 years, with T2DM and found that severe hypoglycemia was associated with both poorer initial cognitive ability and accelerated cognitive decline. Click here to read the study abstract.
Diabetes Patients Who Are Sleepy During the Day May Be at Elevated Risk for Hypoglycemia
October 2, 2013. In this study, patients with type 2 diabetes (N=898) were administered the Epworth Sleepiness Scale. Patients who scored highly on this instrument were significantly more likely to have suffered from severe hypoglycemia (with the variables of age, sex, duration of diabetes, A1C, body mass index, and treatment type controlled for in regression analysis). Link here to read the study abstract.
Association of Hypoglycemic Treatment Regimens on CV Outcomes in Overweight/Obese T2DM Patients
October 2, 2013. In this substudy of the Sibutramine Cardiovascular Outcomes Trial (SCOUT), overweight patients with type 2 diabetes mellitus (T2DM) and at high risk of cardiovascular (CV) disease were assigned to lifestyle intervention with or without sibutramine for up to 6 years; results were analyzed based on patients’ specific pharmacotherapeutic regimens. The investigators found that patients receiving metformin monotherapy or managing their diabetes with diet only had a lower risk of CV events than those treated with insulin. Click here to read the study abstract.
US FDA Approves Device That Senses Drop in Blood Glucose
September 26, 2013. The US Food and Drug Administration has approved an artificial pancreas device system (Medronic MiniMed 530G with Enlite sensor technology) that automatically suspends insulin delivery when blood glucose levels drop too low. To learn more about this product, visit this information page at the US Food and Drug Administration or read this media summary.
No Pancreatic Risk Seen in SAVOR and EXAMINE Trials for DPP-4 Inhibitors
September 27, 2013. Research findings presented at the European Association for the Study of Diabetes (EASD) conference indicated no significantly elevated risk of pancreatitis or pancreatic cancer with the dipeptidyl-peptidase-4 (DPP-4) inhibitors saxagliptin or alogliptin compared with placebo. Investigators presented sub-analysis results from the SAVOR-TIMI 53 and EXAMINE trials last week at the EASD (primary cardiovascular data for both of these trials were published last month). You can follow this link to read coverage of these EASD presentations.
Sulfonylureas Taken as First-line Therapy May Increase Risk of Death
September 26, 2013. As reported at the European Association for the Study of Diabetes (EASD) conference, a retrospective analysis of more than 90,000 United Kingdom patients with type 2 diabetes found that individuals treated initially with a sulfonylurea had a 58% higher all-cause mortality risk compared with patients given first-line metformin (95% CI 1.48 to 1.68, P<0.001). To read a media summary of this presentation, click here.
Genetic Testing for MODY May Be Cost-Effective for Certain Patients
September 11, 2013. This study evaluated the cost-effectiveness of a genetic testing policy for Maturity-Onset Diabetes of the Young (MODY) in a hypothetical cohort of type 2 diabetes patients 25 to 40 years of age with a MODY prevalence of 2%. The outcomes suggest that testing for MODY in selected populations might be cost-effective in the United States. Click here to review the study abstract.
Canagliflozin vs. Sitagliptin in Type 2 Diabetes Inadequately Controlled With Metformin and Sulfonylurea
September 2013. Findings from this 52-week randomized controlled trial suggest that, compared with sitagliptin, canagliflozin may provide greater improvements in glycemic control (A1C reductions of 1.03% for canagliflozin and 0.66% for sitagliptin), blood pressure, and weight loss in patients with type 2 diabetes using metformin plus sulfonylurea. However, canagliflozin use was associated with increased genital infections. To read the study abstract, click here.
Impact of Hypoglycemia Unawareness on Family Members
August 29, 2013. Findings from this exploratory, qualitative study found that family members of patients with type 1 diabetes with hypoglycemia unawareness restrict their own daily lives to help the person with diabetes detect and treat low blood glucose levels. Among the findings, family members reported feeling afraid of their relative or partner during hypoglycemic episodes due to personality changes and aggressive behaviors. These results highlight the need for informational and emotional support for family members who care for such patients. Link here for the study abstract.
Systematic Review and Meta-analysis of Cinnamon Supplementation in Type 2 Diabetes
September/October 2013. Existing randomized controlled trials (RCTs) of the effects of cinnamon on glucose lowering have been small and provide inconsistent results. This systematic review and meta-analysis of 10 RCTs in patients with type 2 diabetes found that cinnamon supplementation improved fasting blood glucose and cholesterol but not A1C levels. Follow this link for the study abstract and to access the full document.
Increased Risk of Cognitive Impairment in Diabetes Patients Taking Metformin
September 5, 2013. This subgroup analysis of Australian patients, identified from several studies of aging and memory loss, identified patients with type 2 diabetes mellitus (T2DM) or impaired glucose tolerance to evaluate the association between cognitive impairment and metformin use. Metformin use in T2DM was associated with impaired cognitive performance (adjusted odds ratio 2.23; 95% CI 1.05-4.75), although patients who were taking calcium supplements had better performance. The authors concluded that prospective trials should be conducted to determine whether calcium and vitamin B12 supplementation reduces cognitive impairment in older people with diabetes who are taking metformin. Click here to view the study abstract.
Joint European Guidelines Recommend Diabetes Diagnosis Based on A1C Levels
August 30, 2013. According to new guidelines from the European Society of Cardiology and the European Association for the Study of Diabetes, glycated hemoglobin (A1C) testing should be used to identify diabetes. In cases where patients cannot be diagnosed using A1C levels, then glucose tolerance testing (OGTT) is recommended. These guidelines also recommend new, individualized glucose blood pressure guidelines and discuss the optimal use of vascularization. To download a copy of the guidelines, follow this link.
DPP-4 Inhibitors Appear to Have No Effect on Cardiovascular Events
September 2, 2013. Two trials—EXAMINE and SAVOR-TIMI 53—presented last week at the European Society of Cardiology meeting evaluated the effect of the dipeptidyl peptidase-4 (DPP-4) inhibitors alogliptin and saxagliptin on cardiovascular events. All patients had a history of cardiovascular disease. Patients in the EXAMINE trial were followed for up to 40 months, while those in SAVOR-TIMI 53 were followed for just over two years. In both studies, DPP-4 inhibitor use had no effect (positive or negative) on cardiac events. Both trials were published in the New England Journal of Medicine simultaneously with the conference. Click here to download the EXAMINE study; link here for SAVOR-TIMI 53.
Both Metformin and Exercise Alter Lipid Particles in Patients With Impaired Glucose Tolerance
August 26, 2013. In a subgroup analysis of the Diabetes Prevention Program, researchers found that both metformin and changes to diet and physical activity patterns were associated with significant lipid subfraction distribution. Specifically, patients randomized to metformin or intensive lifestyle intervention saw a beneficial effect on various low-density lipoprotein (LDL) cholesterol particle types, as well as increased levels of high-density lipoprotein (HDL) particles. To read the study abstract, click here.
Ranibizumab Outperforms Laser on Diabetic Macular Edema
August 22, 2013. This randomized, double-masked study evaluated ranibizumab injections plus laser therapy, ranibizumab plus sham laser therapy, and sham injections plus laser therapy in patients with visual impairment due to diabetic macular edema (DME). Investigators found that patients who received ranibizumab (with or without laser) had better outcomes than patients who received laser treatment alone. To read the full study abstract, follow this link.
AACE Consensus Statement: Incretin Risk Lacks Evidence
August 20, 2013. According to a consensus statement from the American Association of Clinical Endocrinologists (AACE), insufficient evidence currently exists to establish a definitive link between incretin therapies and cancer risk. This document also evaluates the possible roles of obesity, hyperinsulinism, glucose, and diabetes and its therapies in the pathogenesis of cancer. To download the full statement, click here; to read the AACE press release regarding incretin agents and pancreatic disease risk, click here.
A Low Glycemic Load/Mediterranean Diet Reduces Diabetes Risk
August 15, 2013. A low glycemic load diet that follows the principles of the traditional Mediterranean diet can lower type 2 diabetes mellitus (T2DM) risk. This study by Rossi and colleagues analyzed data from the Greek cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Participants (n=22,295) were followed for a median of 11.3 years. Researchers found that individuals who adhered to both dietary principles (low glycemic load and Mediterranean diet) experienced a approximately 20% reduced risk for T2DM development. To read the full study, follow this link to the Diabetologia home page (the article can be downloaded from the top of the page).
Following Acute Pancreatitis, Patients Have Elevated Risk for Prediabetes, Diabetes
August 8, 2013. This systematic literature review was conducted to determine the prevalence and time course of prediabetes or diabetes diagnosis in patients following an initial acute pancreatitis (AP) attack. The authors found that 15% of patients were diagnosed with diabetes in the 12 months following their AP episode. At 5 years, this risk increased (relative risk 2.7; 95% CI 1.9 to 3.8). To read the study abstract, follow this link.
Elevated Blood Glucose Levels Tied to Dementia
August 8, 2013. Investigators evaluated blood glucose and A1C levels in 2067 individuals (232 with diabetes, 1835 without; mean patient age at baseline: 76 years) for a median of 6.8 years. No participants had dementia at study baseline. At study end, 524 participants had developed dementia. For patients both with and without existing diabetes, elevated glucose levels were associated with statistically significant elevated risk for dementia. To read the study abstract, click here.
End-stage Renal Disease in Diabetes Multiplies Risk of Cardiovascular Events
August 6, 2013. Based on long-term follow-up of 2 nationally representative cohorts, the presence of coexisting de novo diabetes and end-stage renal disease increases the risk of cardiovascular events by up to 5-fold, compared to patients without either condition. In particular, risk for acute myocardial infarction and stroke are elevated. Click here to read the study abstract.
No Reductions in Myocardial Infarction Seen With Intensive Glucose Control
July 22, 2013. This comparative effectiveness study evaluated the impact of 4 glucose control strategies on myocardial infarction (MI) and nephropathy in 58,000 patients with type 2 diabetes. Over 4 years of follow-up, aggressive glucose-control strategies showed variable short-term effects on microvascular complications, but, consistent with previous trials, no treatment strategy reduced MI rates. To read the full study abstract, click here.
Hypoglycemia Occurs at All A1C Levels
July 20, 2013. This survey study evaluated patients with type 2 diabetes (N=9,094) aged 30 to 77 years to evaluate the association between A1C level and self-reported hypoglycemia incidence. Investigators found that severe hypoglycemia was common across all levels of glycemic control. Risk tended to be higher in patients with either near-normal or very poor glucose levels. Patient age, diabetes duration, and medication type used did not alter this association. To read the full study abstract, link here.
Hypoglycemia Linked to Cardiovascular Disease
July 9, 2013. This meta-analysis of observational studies was designed to quantitate the association between severe hypoglycemia and cardiovascular disease risk in people with type 2 diabetes. Its findings suggest that severe hypoglycemia approximately doubles cardiovascular disease risk. Click here to read the abstract or full article.
European Medicines Agency Finds Lack of Pancreatic Risk With GLP-1s
July 26, 2013. The European Medicines Agency’s Committee for Medicinal Products for Human Use has finalized its review of glucagon-like peptide-1 (GLP-1) agonist therapies. The committee concluded that current data do not confirm concerns regarding an increased risk of adverse pancreatic events with GLP-1 agonists. Link here to read the European Medicines Agency’s press release.
One-year Discontinuation Rates High in Patients With Type 2 Diabetes
July 2013. Data from a large, national retrospective cohort study presented at the American Diabetes Association’s 73rd Annual Scientific Sessions indicate that only 31% of patients with type 2 diabetes prescribed a glucagon-like peptide-1 (GLP-1) agonist continued to use the medication for at least 6 months. Six-month treatment persistence for patients prescribed a dipeptidyl-peptidase-4 (DPP-4) inhibitor was 39%. Regardless of treatment choice, 12-month treatment discontinuation rates ranged from 82% to 89% for patients on GLP-1 agonists, DPP-4 inhibitors, and other antidiabetic agents. You can read a summary of this presentation in Internal Medicine News.
Greater Risk of Insulin Adverse Events Seen in Older Patients
July 2013. Patients with diabetes aged 80 years and older were 2.5 times more likely to visit the emergency department and approximately 5 times more likely to require hospitalization for insulin-related adverse events compared with those aged 45 to 64. These findings were presented at the American Diabetes Association’s 73rd Annual Scientific Sessions and were based on national surveillance data from 2007 to 2011. A summary of this article is available in Internal Medicine News.
Long-term Observational Follow-up of the PROactive Study
July 16, 2013. This study reported long-term observational follow-up data from the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROactive). Over a mean 5.8 years of follow-up, data suggested that the improved macrovascular outcomes observed with pioglitazone subsided without continued treatment. In addition, an imbalance in bladder cancer incidence identified during the double-blind phase of the study did not persist over follow-up. To read the study abstract, link here.
Post-hoc Analysis of BARI 2D Trial Indicates That Rosiglitazone Not Tied to Fatal Cardiac Events
July 15, 2013. A post-hoc analysis of data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial found that patients with type 2 diabetes and coronary artery disease taking rosiglitazone had an equal likelihood of dying over 5 years as patients who didn't take any thiazolidinedione drugs (hazard ratio 0.83, 95% CI 0.58 to 1.18). In addition, the risk of myocardial infarction and heart failure were not significantly different with rosiglitazone, although fracture risk was increased. To view the study abstract, click here.
Young-Onset Type 2 Diabetes More Hazardous and Lethal Than Type 1 Diabetes
July 11, 2013. This matched cohort study (N=824) evaluated long-term outcomes over >20 years in young patients (aged 15-30) with type 1 and type 2 diabetes mellitus (T1DM, T2DM). Multiple negative outcomes were more common in patients with T2DM, including overall mortality, cardiovascular death, macrovascular complications, and nephropathy scores. Click here to read the study abstract.
After Gastric Bypass-Induced Remission, Patients With Diabetes Often Relapse
January 2013. This retrospective cohort study enrolled patients with type 2 diabetes mellitus (T2DM), either uncontrolled or medication-controlled, to identify predictive factors for and long-term rates of T2DM remission following gastric bypass surgery. T2DM relapse was based on glucose levels and diabetes medication use. The investigators found that gastric bypass was associated with T2DM remission in many patients, but approximately one-third of patients experienced relapse within 5 years. Follow this link to read the full study abstract.
Effects of Glucagon-Like Peptide-1 Receptor Agonists on Cardiovascular Risk
July 8, 2013. This meta-analysis evaluated 37 randomized, controlled trials of glucagon-like peptide-1 (GLP-1) agonists with a minimum duration of 6 months. Results indicate that GLP-1 agonists have a beneficial impact on major cardiovascular events and mortality. To read the study abstract, click here.
Blood Pressure-Lowering Effects of GLP-1 Receptor Agonists Exenatide and Liraglutide
July 8, 2013. This meta-analysis of 16 randomized, controlled trials found that, in patients with type 2 diabetes, treatment with glucagon-like peptide-1 agonists (exenatide and liraglutide) reduced systolic and diastolic blood pressure by 1 to 5 mmHg compared with other antihyperglycemic agents including insulin, glimepiride, and placebo. To review the full study abstract, link here.
Hypoglycemia Admissions Outpace Hyperglycemia Admissions in the Elderly
July 1, 2013. According to a retrospective claims analysis evaluating nearly 34 million Medicare patients between 1999 and 2011, and presented at last week’s American Diabetes Association annual meeting, hospital admissions for hypoglycemia now exceed those for hyperglycemia in elderly patients. To read a Medscape summary of this study, click here.
AACE’s Comprehensive Diabetes Management Algorithm 2013 Consensus Statement – Executive Summary
July 1, 2013. The American Association of Clinical Endocrinologists has published the full-text version of its Comprehensive Diabetes Management Algorithm 2013 Consensus Statement. To download the full statement, link here. To download the graphic summary of the Comprehensive Diabetes Algorithm, published last month in Endocrine Practice, click here.
Minimizing the Impact of Hypoglycemia in Type 2 Diabetes
July 1, 2013. This article reviews and discusses the risks and impact of hypoglycemia, providing specific guidance regarding the prevention of hypoglycemia and selection of glucose-lowering agents in individuals with type 2 diabetes. To download the full article (Endocrine Practice, subscription required), click here.
Leading Diabetes Groups Release Recommendations on Incretin Therapy and Pancreatic Disease
June 28, 2013.The American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation have released a statement forclinicians and people with diabetes concerning the use of incretin therapy and pancreatic disease. You can read the full statement here.
DCCT/EDIC 30th Anniversary Symposium at ADA Conference: Intensive Treatment Continues to Yield Long-term Benefits in Type 1 Diabetes
June 23, 2013. The latest data from the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) trial show that the benefits of intensive therapy in patients with type 1 diabetes (T1DM) persist over 18 years of follow-up. Compared with conventional treatment (targeting an A1C level of ~9.0%), patients who received intensive T1DM management (A1C target ~7.0%) have experienced a 61% lower risk of macroalbuminuria, a 46% lower risk of retinopathy, and a 39% reduced risk of microalbuminuria (P<0.0001 for all). MedPage Today provides a summary of this recent American Diabetes Association Conference presentation here.
Initial Triple Combination Therapy Keeps Glucose Levels Lower Longer Than Traditional Step-up Therapy
June 22, 2013. A randomized controlled trial (N=155) of newly diagnosed, drug-naïve patients with type 2 diabetes (T2DM) suggests that starting patients on triple combination therapy (metformin+pioglitazone+exenatide) vs conventional stepwise therapy (metformin, followed by glyburide, followed by insulin glargine) keeps glucose levels lower longer. At 24 months, mean A1C levels for patients on triple therapy was 6.0%, while stepwise progression patients had levels of 6.6% (P<0.001). In addition, time to treatment failure (target A1C 6.5%) was significantly longer with triple therapy; this approach was also associated with less hypoglycemia and with weight loss, rather than weight gain. For more information, see the MedPage Today summary of this recent American Diabetes Association Conference presentation here.
AMA Joins AACE in Defining Obesity as a Disease
June 18, 2013. The American Medical Association (AMA) has officially recognized obesity as a disease. The AMA anticipates that this decision will motivate physicians to pay greater attention to the condition, as well as lead to improved insurance coverage for obesity treatment. The American Association of Clinical Endocrinologists (AACE), a sponsor of this resolution, applauds the AMA for its decision. Click here to read a New York Times article summarizing the AMA’s decision; follow this link to read AACE’s Press Release on the AMA decision.
AACE Responds to the New York Times Op-ed, “Healing the Overwhelmed Physician”
by Dr. Jerry Avorn
June 17, 2013. The American Association of Clinical Endocrinologists (AACE) recently published clinical practice guidelines and a clinical management algorithm for the comprehensive care of people with diabetes. The AACE guidelines were mentioned unfavorably by Dr. Jerry Avorn in a June 11 New York Times op-ed (click here to read the opinion article). AACE has responded with a statement (link here to read).
BMJ Digs Deep Into Incretins and Pancreatic Cancer Debate
June 10, 2013. According to a new, in-depth investigation by BMJ, the link between incretin therapies and pancreatitis and pancreatic cancer has been downplayed by the pharmaceutical industry. To read the article detailing this investigation, click here.
Higher Levels of Vitamin D in Blood Linked With Lower Diabetes Risk
May 2013. Higher blood levels of vitamin D are associated with a lower risk of type 2 diabetes mellitus (T2DM), according to a recent meta-analysis. A total of 21 prospective studies involving 76,220 participants and 4,996 incident T2DM cases were evaluated. Investigators found an inverse and significant association between circulating 25-hydroxy vitamin D levels and risk for T2DM. To read the full abstract, follow this link.
New Blood Test May Make It Easier to Predict Gestational Diabetes Risk Early in Pregnancy
May 29, 2013. Researchers from Tokyo Women’s Medical University have identified a blood biomarker—soluble (pro)renin receptor, or s(P)RR—that can help determine risk of women developing gestational diabetes mellitus (GDM). This prospective cohort study (N=716) was conducted at a referral birth center in Tokyo, Japan. Patients’ s(P)RR concentrations were measured during the first trimester, and results were grouped into 4 quartiles based on observed plasma levels. Of the 44 patients who developed GDM, 32 were in the 2 quartiles with the highest s(P)RR levels. To read the full study abstract, click here.
USPSTF Favors Gestational Diabetes Testing for All Women
May 28, 2013. According to new draft guidelines from the U.S. Preventive Services Task Force (USPSTF), all asymptomatic pregnant women should be screened for gestational diabetes mellitus (GDM) after 24 weeks' gestation. No recommendation was made by the USPSTF for GDM testing before 24 weeks of age, based on insufficient evidence. To review the draft guidelines, follow this link, and to download the systematic review that these draft guidelines are based on, follow this link.
FDA Allows Marketing of First Test Labeled for Diagnosing Diabetes
May 23, 2013. The US Food and Drug Administration (FDA) announced that it is allowing marketing of the COBAS INTEGRA 800 Tina-quant HbA1cDx assay for health care professionals to use to diagnose diabetes. This is the first A1C test that the FDA has allowed to be marketed for this use. Follow this link to read the FDA press release.
TODAY Study Finds That Type 2 Diabetes Progresses More Rapidly in Children
May 23, 2013. Even when young people with type 2 diabetes (T2DM) receive the best available treatment and close monitoring, they experience a more rapid progression of diabetic comorbidities than is typically seen in adults with T2DM. The June 2013 issue of Diabetes Care includes 6 analyses as well as commentary regarding the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. To view this issue’s table of contents, follow this link (scroll about halfway down the page to see the TODAY studies); to review a summary of key TODAY findings, follow this link.
GRADE Trial to Compare 4 Type 2 Diabetes Drugs as Add-on Treatment to Metformin
May 20, 2013. With funding from the National Institute of Diabetes and Digestive and Kidney Diseases, researchers are launching a long-term, large-scale comparative effectiveness trial to help determine which type 2 diabetes (T2DM) drugs are best for glycemic control. The Glycemia Reduction Approaches in Diabetes (GRADE) study is a pragmatic, parallel-group, unblinded clinical trial that will enroll 5,000 patients with recently diagnosed T2DM and A1C levels of 6.8% to 8.5%. The study will focus on 4 main drug classes used as add-on therapy to metformin: dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, insulin, and sulfonylureas. To read the abstract describing this study’s design, follow this link.
AACE Annual Meeting: Quality of Life Greatly Affected by Hypoglycemia
May 7, 2013. Hypoglycemia has a serious impact on health-related quality of life (HRQoL) for insulin-treated patients with diabetes. This post hoc meta-analysis evaluated a series of 26- and 52-week open-label, randomized, treat-to-target clinical trials of insulin degludec and insulin glargine. HRQoL was assessed using the Short Form 36 questionnaire. Investigators found that severe hypoglycemia (defined as an episode requiring third-party assistance) occurred in 11.9% of patients with type 1 diabetes and in 1.7% of patients with type 2 diabetes. The hypoglycemia had a pronounced, negative impact on patients with both diabetes types. To see the study abstract, follow this link and view abstract #1101 on page 221.
AACE Annual Meeting: Hypoglycemia Risk Tied to Fasting Glucose Variance
May 5, 2013. High variability in fasting blood glucose may lead to a greater risk for hypoglycemia in patients with type 1 and 2 diabetes. This post hoc meta-analysis evaluated a series of 26- or 52-week open-label, randomized, treat-to-target clinical trials of insulin degludec and insulin glargine. Patients’ fasting glucose variability was assessed via pre-breakfast plasma glucose levels, and these data were compared for patients with an incidence of confirmed hypoglycemia (plasma glucose <56 mg/dL). Investigators found that, regardless of the insulin formulation used, higher hypoglycemia rates were associated with greater within-patient fasting glucose variations. To see the study abstract, follow this link and view abstract #1104 on page 223.
New Meta-analysis Calls Into Question Whether Glucagon-Like Peptide-1 Agonists Are Properly Targeted
May 10, 2013. Researchers found that patients with type 2 diabetes mellitus (T2DM) may not have impaired glucagon-like peptide-1 (GLP-1) secretion. A meta-analysis of 22 trials revealed that, following an oral glucose tolerance test or mixed meal, patients with T2DM had similar GLP-1 secretion levels as controls. The authors proposed that a deterioration in GLP-1 effect, rather than GLP-1 secretion, may contribute to the incretin deficiency in patients with T2DM. To read the study abstract and/or download the full article, follow this link.
New Electronic Diabetes Management System Cleared by FDA; Allows Data Downloading From 19 Leading Blood Glucose Monitors
May 9, 2013. The U.S. Food and Drug Administration approved the Glooko System, a diabetes management toolkit that includes an iPhone application, MeterSync Cable, and online access for patients and healthcare providers. The Glooko iPhone app allows for easy, detailed tracking of drugs taken and food eaten and includes nutritional data compiled from popular restaurants. The MeterSync Cable can be used to connect an iPhone to any one of 19 different glucometers to transfer glucose readings for charting and review by clinicians. For information about this product, follow this link.
Eighty Percent of US Adults Do Not Achieve Recommended Physical Activity Level
May 3, 2013. According to a Centers for Disease Control and Prevention (CDC) analysis of data from the Behavioral Risk Factor Surveillance System, only 20.6% of US adults reported getting the government guideline-recommended level of aerobic and muscle-strengthening exercise. For more information, follow this link to the CDC Web site.
Qsymia (Phentermine/Topiramate): Data Find No Long-term Heart Risk
May 2, 2013. This post hoc analysis followed patients receiving phentermine/topiramate in 2 clinical study extensions over a total 108 weeks of follow-up. Researchers reported improvements in cardiovascular risk markers (hypertension and dyslipidemia) in all weight loss categories, with greater improvement in patients who lost more weight. To see the full study abstract, follow this link and view abstract #600 on page 98.
Diabetes Targets Are Improving Gradually, but Almost Half of US Adults Still Do Not Meet Recommended Goals
April 25, 2013. US Centers for Disease Control and Prevention investigators analyzed data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System (1999-2010) to evaluate risk-factor control, preventive practices, and risk scores for coronary heart disease. Although there were improvements in risk-factor control (glycemic targets, lipid levels, and blood pressure) and adherence to preventive practices during this period, tobacco use remained high, and almost half of US adults with diabetes did not meet the recommended goals for diabetes care. To read more, follow this link.
Cardiovascular Safety of Sulfonylureas: A Meta-analysis of Randomized Clinical Trials
April 17, 2013. This meta-analysis was performed on 115 randomized controlled, comparator trials of sulfonylurea use over 6 months or longer in patients with type 2 diabetes. Investigators found that the use of sulfonylureas is associated with significantly increased mortality (odds ratio: 1.22, P=0.047) and a higher risk of stroke (OR: 1.28, P=0.026), whereas no elevated risk was observed for myocardial infarction (OR: 0.88, P=0.13). For more information, follow this link.
The Effect of Long-Term Use of U-500 Insulin Via Continuous Subcutaneous Infusion on Glycemic Control Durability and Weight
April 18, 2013. This study retrospectively evaluated the long-term efficacy and safety of U-500 insulin in obese, insulin-resistant patients with type 2 diabetes mellitus. After 3 months of U-500 use, patients’ mean hemoglobin A1C dropped by approximately 1.0%, with improvement sustained over 5+ years of use. Patients experienced no significant changes to body weight, and hypoglycemia incidence was low. To see the study abstract and/or download the article from Endocrine Practice, click here.
Statement on Hypoglycemia and Diabetes
April 15, 2013. This American Diabetes Association and The Endocrine Society workgroup report reconfirms previous definitions of hypoglycemia in diabetes, reviews the implications of hypoglycemia on patient and treatment outcomes, presents strategies to prevent hypoglycemia, and identifies knowledge gaps to be addressed by future research. Also provided are tools for patients to report hypoglycemia at each visit and for clinicians to document counseling. To download the full report, follow this link.
Females With Diabetes Have a Greater Risk of Mortality Than Males
April 5, 2013. This population-based retrospective cohort study evaluated 73,783 adults in Newfoundland and Labrador, Canada. Investigators found that both men and women with diabetes had an increased risk of all-cause mortality, cardiovascular (CV) mortality, and CV hospitalizations compared to individuals without diabetes. These risks were significantly stronger in females than males. In particular, females with diabetes diagnosed later in life had an increased risk of CV mortality (hazard ratio [HR] 6.54) and CV hospitalizations (5.22) compared to females without diabetes, and compared with their male counterparts (HRs of 3.44 and 3.33). To learn more, follow this link.
Canagliflozin vs Sitagliptin in Patients Without Adequate Glycemic Control
April 5, 2013. This 52-week randomized controlled trial compared the efficacy of the sodium-glucose cotransporter 2 (SGLT2) inhibitor canagliflozin with the dipeptidyl peptidase 4 (DPP-4) inhibitor sitagliptin in patients with type 2 diabetes mellitus (T2DM) who were already receiving background treatment with metformin and sulfonylurea. At trial end, canagliflozin 300 mg showed noninferiority vs sitagliptin 100 mg, while a subsequent assessment indicated superiority in reducing A1C (−1.03% and −0.66%, respectively). Patients receiving canagliflozin also experienced greater reductions in fasting plasma glucose, body weight, and systolic blood pressure (P <0.001). Overall adverse event rates were similar for both groups. To learn more, click this link.
US FDA Approves the First-in-Class SGLT2 Inhibitor Canagliflozin
March 29, 2013. The US Food and Drug Administration (FDA) approved canagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, for use in adults with type 2 diabetes. To read the FDA announcement, follow this link.
Fluctuations in A1C Levels Contribute to Nephropathy
March 14, 2013. This study evaluated the association between A1C levels and microvascular complications in patients with type 2 diabetes. Researchers collected A1C values from 8260 patients over a 2-year period and found that elevated A1C levels were associated with both retinopathy and elevated biomarkers for nephropathy (eg, albuminuria and glomerular filtration rate). Substantial A1C variability was associated with an even more elevated nephropathy (but not retinopathy) risk. To view the study abstract, click this link.
AACE, Obesity Society, and American Society for Metabolic & Bariatric Surgery Release Updated Guidelines for Bariatric Surgery Patient Care
March 26, 2013. Updated clinical guidelines outlining the optimal management of bariatric surgery patients’ preoperative and postoperative care have been published by a collaborative group representing AACE, The Obesity Society, and the American Society for Metabolic and Bariatric Surgery. Among the topics addressed in the guidelines are: parameters for selecting appropriate patients for bariatric surgery; best surgical options based on patient profiles; strategies to optimize early postoperative care and long-term patient follow-up; and, ways to recognize and manage postoperative complications. To download the guidelines, follow this link.
LifeScan Issues Worldwide Recall of One Touch Verio IQ Glucose Meters
March 25, 2013. The LifeScan unit of Johnson & Johnson announced that it is voluntarily recalling and replacing its OneTouch Verio IQ blood glucose meters because they malfunction at extremely high blood glucose levels (ie, at levels of 1024 mg/dL and above). For more information, and for instructions for people currently using this blood glucose meter, click here.
Retrospective Study Suggests that GLP-1 Inhibitors May Cut Heart Failure Risk March 10, 2013. Research findings presented at the 2013 American College of Cardiology
March 10, 2013. Research findings presented at the 2013 American College of Cardiology annual meeting indicate that patients treated with glucagon-like peptide-1 (GLP-1) inhibitor drugs may have a decreased risk of heart failure-related hospitalization. This retrospective study used data from 2000-2012 to follow 4,427 patients with diabetes receiving glucose-lowering medications. Patients who received GLP-1 inhibitors had a 41% reduced risk of heart failure-related hospitalization compared with those receiving other medication classes. Patients receiving GLP-1s were also less likely to be hospitalized for any cause or to die from any cause. For more information, follow this link to a National Library of Medicine summary.
The FDA Is Investigating Possible Increased Risk of Pancreatitis and Precancerous Pancreatic Findings Associated With Incretin Mimetic Drugs
March 14, 2013. The U.S. Food and Drug Administration (FDA) issued a Drug Safety Communication to announce that it is evaluating unpublished new findings that suggest an increased risk of pancreatitis and precancerous pancreatic changes in patients with type 2 diabetes treated with incretin mimetic drugs (glucagon-like peptide-1, or GLP-1, agonists, and dipeptidyl-peptidase-4, or DPP-4, inhibitors). For more information, follow this link.
AACE Asks Medical Professionals and Patients With Diabetes to Appeal to Congress to Pass the National Diabetes Clinical Care Commission Act
March 13, 2013. The American Association of Clinical Endocrinologists (AACE) is seeking support for the National Diabetes Clinical Care Commission Act, which would create a public-private commission composed of endocrinologists, other front-line diabetes health care providers, patient advocates, and federal agency representatives involved in diabetes care activities. The commission’s charge would be to identify critical gaps in existing federal diabetes clinical care initiatives, ineffective or redundant activities, and new approaches to stem the tide of the U.S. diabetes epidemic. For more information and/or to find out how to contact your Senator and Congressional Representative, Click Here.
Use of Current 2-Step Approach to Gestational Diabetes Diagnosis Affirmed by National Institutes of Health
March 6, 2013. An independent panel convened by the U.S. National Institutes of Health has concluded that, despite the potential advantages of adopting a new 1-step diagnostic approach for gestational diabetes mellitus (GDM), more evidence is needed to ensure that the benefits outweigh the harms. The panel recommended following the current diagnostic approach until further studies are conducted and noted concern that the adoption of new criteria would increase the prevalence and corresponding costs of GDM without clear demonstration of improvements in key short- and long-term outcomes. For a more detailed summary of the NIH’s decision, follow this link.
Economic Costs of Diabetes in the U.S. Increased Substantially From 2007 to 2012
March 6, 2013. According to the American Diabetes Association, the total cost of diabetes in the United States increased from $174 billion in 2007 to $245 billion in 2012, representing a 41% adjusted increase. Of these expenditures, $176 billion was for direct medical expenses, while $69 billion was attributable to decreased productivity. The largest medical expense was hospital inpatient care, followed by prescription medications, diabetes supplies, office visits, and nursing/residential facility services. To read the full article, follow this link.
Vitamin D Supplementation Linked to Cardiovascular Health in Patients With Diabetes
March 1, 2013. This randomized, placebo-controlled study (N=47) found that daily (1000 mg) intake of vitamin D by patients with diabetes over a 1-year period decreased the central aortic augmentation index, a predictor of cardiovascular events (p<0.0001 vs placebo). Other parameters assessed, such as fasting plasma glucose, A1C level, and lipid profiles, did not change with vitamin D supplementation. These findings may have implications for the recommended daily vitamin D allowance in patients with diabetes. For more information, see this link.
Determinants of Weight Gain in the ACCORD Trial
February 14, 2013. Investigators in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial studied determinants of weight gain over 2 years in 8929 patients with type 2 diabetes assigned to either intensive or standard glycemic control. Patients in the intensive group gained more weight (mean 3.0 kg) than those in the standard group (0.3 kg), and greater weight gain was also associated with high baseline A1C values. The use of thiazolidinedione (TZD) and/or insulin therapy also was associated with weight gain. To learn more, visit this link.
AACE Statement on Risk of Pancreatitis and Hospitalization With GLP-1 Agonists
February 26, 2013. The American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) have issued a statement regarding the recent article published in JAMA Internal Medicine: Glucagonlike Peptide 1-Based Therapies and Risk of Hospitalization for Acute Pancreatitis in Type 2 Diabetes Mellitus. To view the AACE/ADA press release, click here. To view the abstract for the original JAMA article, click here.
A Meta-analysis of the Blood Pressure-Lowering Effects of the GLP-1 Receptor Agonists
February 22, 2013. This meta-analysis evaluated 16 randomized controlled trials and found that treatment with the glucagon-like peptide-1 (GLP-1) receptor agonists exenatide and liraglutide reduced systolic and diastolic blood pressure by 1 to 5 mmHg compared with other drugs such as insulin and glimepiride in patients with type 2 diabetes. For more information, follow this link.
Changes in Cardiovascular Risk Associated With Phentermine/Topiramate (QsymiaTM) in Overweight Patients With Comorbidities
January 29, 2013. This analysis evaluated changes to cardiovascular (CV) risk factors in overweight and obese (body mass index 27-45 kg/m2) patients with dyslipidemia and/or hypertension treated with phentermine/topiramate extended- release for weight loss. Investigators found that the dose-related weight loss induced by this treatment was accompanied by significant improvements in CV risk factors. To learn more about this study, click here.
A 9-Country Evaluation of the Burden of Non-severe Nocturnal Hypoglycemic Events on Diabetes Management and Patients’ Daily Functioning
January 26, 2013. This multi-national survey of 2,108 U.S. and European patients with diabetes found that non-severe nocturnal hypoglycemic events led to meaningful serious consequences for patients, including sleep disturbances, impaired next-day functioning, and decreased well-being. Data were also captured regarding the length of these nocturnal hypoglycemic events and patients’ suspected reasons for why the events might have occurred. For more information, follow this link.
A1C, Blood Pressure, and LDL Cholesterol Goal Achievement Among U.S. Patients With Diabetes
February 15, 2013. The U.S. Centers for Disease Control and Prevention have published updated information, obtained from the 2007-2010 National Health and Nutrition Examination Survey, on the percentage of U.S. patients with type 2 diabetes meeting 3 key management goals. Specifically, 52.5% of patients have A1C levels <7.0%, 51.1% have blood pressure <130/80 mmHg, and 56.2% have LDL cholesterol levels <100 mg/dL; 18.8% of patients met all 3 goals. The authors note that, despite substantial improvement in the past decade, opportunity exists to further increase control. For more information, CLICK HERE.
Consumption of Artificially and Sugar-Sweetened Beverages and Incident Type 2 Diabetes
January 30, 2013. This epidemiologic analysis followed 66,118 women over 14 years to identify type 2 diabetes mellitus (T2DM) risk based on self-reported consumption of sugar-sweetened beverages, artificially sweetened beverages, and 100% fruit juice. Women with the highest rates of artificially sweetened and sugar-sweetened beverages had the highest rates of subsequent T2DM diagnosis (hazard ratios: 2.21 [95% CI, 1.56-3.14] and 1.34 [1.05-1.71], respectively) with no association observed for fruit juice. To learn more about this study, CLICK HERE.
The Role of Bromocriptine-QR in the Management of Type 2 Diabetes: AACE Expert Panel Recommendations
January 21, 2013. An AACE Expert Panel has published a review and analysis of available literature for bromocriptine-QR in the management of type 2 diabetes mellitus (T2DM). Bromocriptine’s favorable cardiovascular risk profile suggests that it may be useful in the treatment of patients with T2DM and a history of CVD, or with significant CVD risk factors. However, insufficient information currently exists regarding the safety and efficacy of adjunctive bromocriptine alongside other common diabetes regimens (eg, thiazolidinediones, insulin). For more information and to download the full report from AACE, CLICK HERE.
Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents
February 2013. The first clinical practice guidelines for the management of newly diagnosed type 2 diabetes in patients 10 to 18 years of age have been published by the American Academy of Pediatrics (AAP) in collaboration with the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics. These AAP guidelines advocate an integrated approach that combines diet, exercise, and pharmacotherapy, alongside recommendations for first-line treatment with metformin or insulin. Frequency of hemoglobin A1C and finger-stick blood glucose monitoring is addressed, as is the importance of establishing referrals and/or partnership strategies between primary care physicians and pediatric subspecialists to ensure optimal patient care. The guidelines can be accessed HERE.
Short-term Intensive Insulin Therapy in Type 2 Diabetes Mellitus
February 2, 2013. Research has indicated that treatment with intensive insulin therapy early in the course of type 2 diabetes (T2DM) may induce glycemic remission. This systematic review reports on the effects of short-term intensive insulin therapy in 839 adults with newly diagnosed T2DM. Additionally, a meta-analysis revealed improvements in homeostasis model assessments (HOMA) of β-cell function and insulin resistance, respectively, following intensive insulin. Approximately 42% of patients maintained drug-free glycemic remission after 2 years. This suggests that short-term intensive insulin therapy may be effective in modifying the natural history of T2DM. For further details, refer to the journal article HERE.
FDA Approves Three New Drugs for Type 2 Diabetes
January 25, 2013. The U.S. Food and Drug Administration (FDA) approved 3 drugs used to treat type 2 diabetes, each with the new active ingredient alogliptin: Nesina (alogliptin) tablets, Kazano (alogliptin and metformin hydrochloride) tablets, and Oseni (alogliptin and pioglitazone) tablets. Alogliptin was initially reviewed by the FDA in April 2012, but additional data and a post-marketing plan were requested at that time. Alogliptin will be the fourth dipeptidyl-peptidase-4 (DPP-4) inhibitor approved in the United States (previously approved drugs are linagliptin, saxagliptin, and sitagliptin). For more information and to view the FDA press release, link HERE.
Reduction of Insulin Resistance and Plasma Glucose Level by Salsalate Treatment in Persons With Prediabetes
December 2012. This double-blind, placebo-controlled clinical trial investigated the efficacy of the anti-inflammatory agent salsalate in improving insulin resistance and glycemic control in 66 patients with prediabetes. After 12 weeks, salsalate patients exhibited significant reductions in fasting plasma glucose and homeostasis model assessment of insulin resistance (HOMA-IR) levels, as well as significant increases in the homeostasis model assessment of β-cell function. No persistent adverse effects were observed. For further details, follow this link.
A Comparative Effectiveness Analysis of Three Continuous Glucose Monitors
December 28, 2012. This head-to-head comparison of 3 continuous glucose monitoring (CGM) devices, the Navigator (Abbott Diabetes Care), the Seven Plus (DexCom), and the Guardian (Medtronic), was conducted in 6 patients with type 1 diabetes. Based on paired measurements of venous plasma glucose with corresponding CGM glucose readings during closed-loop blood glucose control experiments, the Navigator outperformed the other 2 devices in quantitative assessments of accuracy, precision, and reliability. Further details can be found at the following link.