Thursday, 31 October 2013

Earlier onset of complications in youth with type 2 diabetes

Youth with type 2 diabetes exhibit complications sooner than youth with type 1 diabetes. Younger age at diagnosis is potentially protective, and glycemic control is an important modifiable risk factor. The unexpected adverse association between RAAS inhibitor use and outcome is likely a confounder by indication; however, further evaluation in young people is warranted (Diabetes Care)

Prevalence of Prediabetes and Newly Diagnosed Diabetes in Patients with a Transient Ischemic Attack or Stroke

Prediabetes and newly diagnosed diabetes are highly prevalent in patients with a TIA or stroke. The majority of these patients would not have been identified by fasting plasma glucose levels alone. Both 2-hour postload glucose and glycosylated hemoglobin levels identify more patients with a disturbed glucose metabolism (Cerebrovascular Diseases)

Wednesday, 30 October 2013

Unimolecular Dual Incretins Maximize Metabolic Benefits in Rodents, Monkeys, and Humans

This discovery and validation of a balanced and high-potency dual incretin agonist enables a more physiological approach to management of diseases associated with impaired glucose tolerance (Science Translational Medicine)

Neuroanatomical correlates of dysglycemia in young children with type 1 diabetes mellitus

Early onset T1D affects regions of the brain that are associated with typical cognitive development (Diabetes)

Tuesday, 29 October 2013

Transplantation of human islets without immunosuppression

In this paper we present the clinical success of using a bioartificial pancreas for the transplantation of insulin-producing islets without affecting the immune system (PNAS)

Poor Glycemic Control Is Related To Increased Nitric Oxide Activity Within the Renal Circulation of Patients With Type 2 Diabetes

In line with experimental evidence, we could demonstrate in humans that poor glycemic control is related to higher NO activity and hyperperfusion of the kidney. The renal NO system may thus be a novel therapeutic target for improving renal hemodynamics in patients with diabetes (Diabetes Care)

Kidney function and the risk of cardiovascular disease in patients with type 2 diabetes

Even mildly reduced estimated GFR at baseline (under 75 ml/min per 1.73 m2) and during follow-up (under 90 ml/min per 1.73 m2) increased the risk of incident coronary heart disease and stroke among both African-American and Caucasian type 2 diabetes patients (Kidney International)

Monday, 28 October 2013

Project IMPACT: Diabetes Improves Outcomes for Underserved Patients In 25 Communities Disproportionately Affected by Diabetes

Interim clinical results fromProject IMPACT: Diabetes, announced today by the American Pharmacists Association (APhA) Foundation, show statistically significant decreases in A1C or blood sugar levels, LDL cholesterol, systolic blood pressure and Body Mass Index (BMI), which are all recognized standards of diabetes care (American Pharmacists Association)

Data Confirm Pharmacists Play a Key Role on the Healthcare Team

Project IMPACT: Diabetes Improves Outcomes for Underserved Patients In 25 Communities Disproportionately Affected by Diabetes (APhA Foundation)

Diabetes care for the most vulnerable in society – the views of professionals working in care homes and domiciliary care using focus group methodology

The main concerns of health care professionals working in care homes and in the domiciliary sector were: poor communication with all other health care agencies; the need for training, specifically in diabetes and dementia; poor support from the specialist diabetes team (British Journal of Diabetes & Vascular Disease)

Non-invasive risk scores for prediction of type 2 diabetes (EPIC-InterAct): a validation of existing models

Existing diabetes prediction models can be used to identify individuals at high risk of type 2 diabetes in the general population. However, the performance of each model varies with country, age, sex, and adiposity (The Lancet Diabetes & Endocrinology)

GP federation awarded £10m diabetes contract

A group of GP practices has won a £10m contract to provide a full community service for patients with diabetes from April 2014 (Pulse)

Friday, 25 October 2013

Poor glycemic control is a major factor in the overestimation of glomerular filtration rate in diabetic patients

eGFR overestimates Cin as glycemic controls worsen. eGFR corrected by hemoglobin A1c is considered to be clinically useful and feasible (Diabetes Care)

Risks of Diabetic Nephropathy with Variation in Hemoglobin A1c and Fasting Plasma Glucose

Annual FPG and HbA1c variations have a strong association with diabetic nephropathy in patients with type 2 diabetes. Whether intervention for reducing glucose variation should be administered needs to be examined in a future study (American Journal of Medicine)

Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis

There is some evidence to support the recommendation of carbohydrate counting over alternate advice or usual care in adults with type 1 diabetes. Additional studies are needed to support promotion of carbohydrate counting over other methods of matching insulin dose to food intake (The Lancet Diabetes & Endocrinology)

Thursday, 24 October 2013

The Impact of Hyperglycemic Emergencies on the Kidney and Liver

Diabetic ketoacidosis and diabetic ketosis deteriorate liver and kidney function parameters, especially in patients with ketoacidosis. After considering the values of glycemic variables, the diagnosis of a hyperglycemic crisis should be cautious when based on lower prealbumin levels in overt hyperglycemia (Journal of Diabetes Research)

Type 2 diabetes mellitus and hypothyroidism: the possible influence of metformin therapy

Our results support a relatively close association between diabetes and hypothyroidism. Hypothyroidism was more common in the cohort of white subjects than in other ethnic groups. The use of metformin therapy in people with Type 2 diabetes was associated with a significantly lower prevalence of diagnosed hypothyroidism (Diabetic Medicine)

Chief Medical Officer: Prevention pays - our children deserve better

Reducing obesity by just one percentage point among children and young people could lead to savings of £1 billion each year as children would be less likely to end up with long-term health problems needing NHS treatment.

Wednesday, 23 October 2013

Managing overweight and obesity among children and young people: lifestyle weight management services

This guidance aims to provide recommendations on lifestyle weight management services for overweight and obese children and young people (NICE)

Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions

We identify possible opportunities for intervention to improve cognitive outcomes in people with type 2 diabetes, and suggest how treatment can be tailored to individual risk profiles and comorbidities (The Lancet Diabetes & Endocrinology)

Tuesday, 22 October 2013

Dipeptidyl peptidase-4 inhibitors and GLP-1 reduce myocardial infarct size in a glucose-dependent manner

We find that chronic treatment with DPP-4 inhibitors reduced MI size, via the GLP-1 receptor-PKA pathway, in a glucose-dependent manner. Glucose-sensitive cardioprotection of endogenous GLP-1 in diabetic patients may in part explain why intensive control of serum glucose levels has been associated with increased cardiovascular risk (Cardiovascular Diabetology)

Insulin degludec: a new insulin for today?

No abstract (Diabetic Medicine)

Monday, 21 October 2013

TB’s links to diabetes

Symposium draws researchers to strategize against metabolic diseases (Harvard Gazette)

Sunday, 20 October 2013

Indian-made medicines recalled by UK health regulator
One of the medications is gliclazide (Independent)

Anger as diabetic children miss out on insulinpumps

Some health boards in Wales are not following mandatory guidelines by failing to provide insulin pumps to children with type 1 diabetes, BBC Wales has found

Saturday, 19 October 2013

CSII experience among higher specialist trainees: a Young Diabetologists and Endocrinologists Forum survey

We conclude that the provision of CSII training varies considerably in the UK; training opportunities and exposure to pump therapy in practice vary greatly, which reflects a lack of formal detail or consideration of this in the UK curriculum. We propose a basic set of pump training competencies which diabetes registrars should be expected to work towards and fulfil prior to the completion of training (Practical Diabetes)

Obesity experts appalled by EU move to approve health claim for fructose 

Food firms using fructose will be able to boast of health benefits despite fruit sugar being implicated in soaring US obesity levels (Guardian)

Friday, 18 October 2013

Glycosmedia is now sponsoring WEDS with a news feed
Non-invasive detection of microvascular changes in a paediatric and adolescent population with type 1 diabetes

This pilot study has shown that in children and adolescents with established type 1 diabetes, abnormal microvasculature can be detected by nailfold capillaroscopy, laser Doppler flowmetry, retinal vessel analysis and 24-hr ambulatory blood pressure monitoring (BMC Endocrine Disorders)

Thursday, 17 October 2013

The peripartum management of glycaemia in women with Type 1 diabetes

Changes in the pharmacodynamic profile of insulin may contribute to the transient insulin independence sometimes observed postpartum in type 1 diabetes. A dose of 50-60% of the pre-pregnancy insulin requirement resulted in the lowest rate of hypoglycaemia and glucose excursions (Diabetes Care)

Impact of C-Peptide Preservation on Metabolic and Clinical Outcomes in the Diabetes Control and Complications Trial

As C-peptide decreased to non-measureable concentrations, the outcomes changed in a nearly linear manner, with no threshold or breakpoint. While preservation of stimulated C-peptide at =0.2 nmol/L has clinically beneficial outcomes, so also does an increase in the concentration of C-peptide across the range of values (Diabetes)

Wednesday, 16 October 2013

Needle-Free Jet Injection of Rapid-Acting Insulin Improves Early Postprandial Glucose Control in Patients With Diabetes

The considerably more rapid insulin absorption after administration by jet injector translated to a significant if modest decrease in postprandial hyperglycemia in patients with type 1 and type 2 diabetes. The improved early postprandial glucose control may specifically benefit patients who have difficulty in limiting postprandial glucose excursions (Diabetes Care)

Tuesday, 15 October 2013

MannKind Resubmits New Drug Application to U.S. FDA for AFREZZA for the Treatment of Adults with Diabetes

MannKind Corporation announces the resubmission of a new drug application (NDA) to the U.S. Food and Drug Administration (FDA) seeking approval for the marketing and sale of AFREZZA® (insulin human [rDNA origin]) Inhalation Powder with an indication to improve glycemic control in adults with type 1 or type 2 diabetes (MannKind Corporation)

Clinical Inertia in People With Type 2 Diabetes

There are delays in treatment intensification in people with type 2 diabetes despite suboptimal glycemic control. A substantial proportion of people remain in poor glycemic control for several years before intensification with OADs and insulin (Diabetes Care)

General practice-recorded depression and antidepressant use in young people with newly diagnosed Type 1 diabetes

This population-based study shows that people with Type 1 diabetes have higher rates of general practice-recorded depression and antidepressant use. The excess is present within 5 years of diabetes diagnosis, suggesting psychological input for patients is warranted in the early years of their condition (Diabetic Medicine)

Collaborative care for patients with depression and diabetes mellitus

Improving depression care in diabetic patients is very necessary and important. Comparing with usual care, collaborative care was associated with significantly better depressive outcomes and adherence in patients with depression and diabetes (BMC Psychiatry)

Gastric Bypass Leads to Improvement of Diabetic Neuropathy Independent of Glucose Normalization

As expected, BMI and HbA1c levels improved significantly after RYGB. More interestingly, neuropathy scores, such as NSS and NDS, improved significantly early after surgery. Symptomatic neuropathy was completely reversible in 67% of the patients. These findings add further evidence to the fact that RYGB might be a valuable treatment option not only for improving glycemic control but also for reducing diabetes-associated comorbidities, such as DPN (Annals of Surgery)

Monday, 14 October 2013

Social media in diabetes: bane or boon?

If the feedback from patients is that ‘this’ is the forum they would like to use then it's our responsibility to make it work. The days of ‘us’ seeing patients on our own terms are dying a slow death. We need to ensure that we can rise to the challenge and use existing forums to suit patients, especially in a disease process where engagement is the key mantra (Practical Diabetes)

Sunday, 13 October 2013

Delay in diabetic retinopathy screening increases the rate of detection of referable diabetic retinopathy

The rate of detection of referable diabetic retinopathy is elevated in those who were not screened promptly after diagnosis of Type 2 diabetes (Diabetic Medicine)

Chronic kidney disease and diabetes in the National Health Service: a cross-sectional survey of the UK National Diabetes Audit

The high prevalence of chronic kidney disease and poor attainment of treatment targets highlights a large subset of the diabetes population at increased risk of cardiovascular mortality or progressive kidney disease (Diabetic Medicine)

Thyroid autoimmunity in Type 1 diabetes: systematic review and meta-analysis

There is a markedly increased risk of thyroid dysfunction in people with Type 1 diabetes and thyroid autoimmunity. The optimal method or frequency of screening could not be determined from available data. Future studies should examine whether screening improves clinical outcomes in this population (Diabetic Medicine)

Saturday, 12 October 2013

Ethnic Differences in Glycemic Markers in Patients With Type 2 Diabetes

For a given degree of glycemia, HbA1c levels vary among different ethnic groups. Ethnicity needs to be taken into account when using HbA1c to assess glycemic control or to set glycemic targets. Estimated AG is not a reliable marker for mean glycemia and therefore is of limited clinical value (Diabetes Care)

Friday, 11 October 2013

External Validation of the UKPDS Risk Engine in Incident Type 2 Diabetes: a need for new risk type 2 diabetes-specific risk equations

The UKPDS stroke equations showed calibration ranging from poor to moderate; however, the CHD equations showed poor calibration and considerably overestimated CHD risk. There is a need for revised risk equations in type 2 diabetes (Diabetes Care)

Enhancement of Vasoreactivity and Cognition by Intranasal Insulin in Type 2 Diabetes

Intranasal insulin administration appears safe and does not affect systemic glucose control, and may provide acute improvements of cognitive function in patients with type 2 diabetes, potentially through vasoreactivity mechanisms. Intranasal insulin-induced changes in cognitive function may be related to vasodilatation in the anterior brain regions, such as insular cortex that regulates attention-related task performance (Diabetes Care)

Thursday, 10 October 2013

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Updating Diabetic Retinopathy Screening Lists using Automatic Extraction from GP Patient Records

Automatic extraction of data from General Practice identified 709 patients coded as having diabetes not previously known to the Gloucestershire DESP (Journal of Medical Screening)

Hyperglycemia following recovery from hypoglycemia worsens endothelial damage and thrombosis activation in type 1 diabetes and in healthy controls

This study shows that, in type 1 diabetes as well as in controls, the way in which recovery from hypoglycemia takes place could play an important role in favoring the activation of thrombosis and oxidative stress, widely recognized cardiovascular risk factors (Nutrition, Metabolism & Cardiovascular Diseases)

Wednesday, 9 October 2013

PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease)

Accelerated up-titration of RAS antagonists and beta-blockers to maximum tolerated dosages is an effective and safe intervention for the primary prevention of cardiac events for diabetic patients pre-selected using NT-proBNP (American Journal of Cardiology)

Perspectives from Before and After the Pediatric to Adult Care Transition: A Mixed-Methods Study in Type 1 Diabetes

Standardizing transition preparation programs in pediatric care and introducing transition-oriented clinics for late adolescents and young adults prior to adult care may help address patients’ preferences and common transfer-related challenges (Diabetes Care)

Tuesday, 8 October 2013

Leptin regulation of Hsp60 impacts hypothalamic insulin signaling

Type 2 diabetic patients exhibited decreased expression of HSP60 in the brain, indicating that this mechanism is relevant to human disease. These data indicate that leptin plays an important role in mitochondrial function and insulin sensitivity in the hypothalamus by regulating HSP60. Moreover, leptin/insulin crosstalk in the hypothalamus impacts energy homeostasis in obesity and insulin-resistant states (European Journal of Clinical Investigation)

Low-dose interleukin 2 in patients with type 1 diabetes

We have defined a well-tolerated and immunologically effective dose range of IL2 for application to type 1 diabetes therapy and prevention, which could be relevant to other disorders in which a Treg cell increase would be desirable (The Lancet Diabetes & Endocrinology)

Corneal nerve fibre damage precedes diabetic retinopathy in patients with Type 2 diabetes mellitus

Corneal cell pathology occurs in patients with diabetic retinopathy, but corneal nerve fibre damage seems to precede the development of diabetic retinopathy (Diabetic Medicine)

Monday, 7 October 2013

Liraglutide pancreatitis: The ABCD nationwide liraglutide audit

In cases of acute pancreatitis of a patient on liraglutide, if another cause can be found (usually gall stones associated with obesity), the drug is not be necessarily culpable. People with Type 2 diabetes are at greater risk of acute pancreatitis (hazard ratio between 1.5 and 2.8). Thus, the possibility of liraglutide-associated pancreatitis in ‘real-world’ clinical practice represents a very small risk (The British Journal of Diabetes & Vascular Disease)

Human Milk Secretory Immunoglobulin A and Lactoferrin N-Glycans Are Altered in Women with Gestational Diabetes Mellitus

The results suggest that maternal glucose dysregulation during pregnancy has lasting consequences that may influence the innate immune protective functions of breast milk (Journal of Nutrition)

Walking Works

The Ramblers and Macmillan Cancer Support, who run Walking for Health, have launched Walking Works, an extensive overview of the mounting research into the life threatening consequences of inactivity, which concludes that walking is the answer (Walking for Health)

How to improve the way medical research is applied in front-line care

Collaborations for leadership in applied health research aim to encourage staff in the NHS to adopt research-informed practices (Guardian)

Friday, 4 October 2013

New hypoglycemia and pancreatitis subanalyses from the Onglyza® (saxagliptin) SAVOR cardiovascular outcomes trial 

Additional results from the SAVOR cardiovascular outcomes trial found no increased rate of hypoglycemia among patients treated with Onglyza® (saxagliptin) compared to placebo when added to metformin monotherapy and higher rates of hypoglycemia only in the Onglyza group compared to the placebo group among patients taking sulfonylureas, agents known to cause hypoglycemia, at baseline (AstraZeneca)

Thursday, 3 October 2013

Efficacy and safety of lixisenatide once daily vs. placebo in people with Type 2 diabetes insufficiently controlled on metformin

Lixisenatide one- or two-step dose-increase regimens significantly improved glycaemic control and decreased body weight over 24 weeks and during a long-term extension period without increasing hypoglycaemia (Diabetic Medicine)

Soluble factors secreted by T-cells promote ß-cell proliferation

These data suggest that soluble factors secreted from T cells are potential therapeutic candidates to enhance ß-cell proliferation in efforts to prevent and/or delay the onset of type 1 diabetes (Diabetes)

Wednesday, 2 October 2013

Exercise “potentially as effective” as many drugs for common diseases

Analysis ofthe results of 305 randomised controlled trials involving 339,274 individuals and found no statistically detectable differences between exercise and drug interventions for secondary prevention of heart disease and prevention of diabetes (BMJ)

Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: Mechanisms of Diabetes Remission and Role of Gut Hormones

RYGB and SLG have a similar impact on diabetes remission, of which baseline ß-cell glucose sensitivity and a restored GLP-1 response are the chief determinants (Journal of Clinical Endocrinology & Metabolism)

Tuesday, 1 October 2013

Diabetic macular oedema - Fluocinolone acetonide intravitreal implant (rapid review of TA271)

Final appraisal determination document - also evaluation report (NICE)

Medtronic Gains Approval of First Artificial Pancreas Device System with Threshold Suspend Automation

Medtronic's system is the first in the United States that can automatically stop insulin delivery when sensor glucose values reach a preset level and when the patient doesn't respond to the Threshold Suspend alarm ... As a condition of approval, in addition to the post-approval study, Medtronic will engage in direct patient follow up and will make certain manufacturing accommodations (Medtronic)

Researchers discover a biological link between diabetes and heart disease

Researchers have identified for the first time a biological pathway that is activated when blood sugar levels are abnormally high and causes irregular heartbeats, a condition known as cardiac arrhythmia that is linked with heart failure and sudden cardiac death (UC Davis Health System)

Sitagliptin improves albuminuria in patients with type 2 diabetes mellitus

The results suggested that sitagliptin improved albuminuria, in addition to improving glucose. The mechanism of the reduction of albuminuria by sitagliptin could be a direct effect, as well as an increase in active glucagon-like peptide-1, independently affecting blood pressure, bodyweight and glucose metabolism (Journal of Diabetes Investigation)

A psychosocial risk index for poor glycemic control in children and adolescents with type 1 diabetes

This paper presents the first psychosocial risk index for poor glycemic control in children newly diagnosed with type 1 diabetes. It is brief, easily administered, and provides a single score that translates directly into an estimate of risk that can help guide routine diabetes care (Pediatric Diabetes)