Monday, 31 March 2014

Microvesicles and diabetic complications - novel mediators, potential biomarkers and therapeutic targets

MVs contribute to the development of diabetic macrovascular and microvascular complications. In addition, clinical studies have indicated that changes in MV number and composition may reflect the pathophysiological conditions of disease, and therefore, may serve as potential biomarkers for diagnostic and prognostic use (Acta Pharmacologica Sinica)

Nonalbuminuric proteinuria as a biomarker for tubular damage in early development of nephropathy with type 2 diabetic patients

These findings suggest that urinary nonalbumin protein (NAP) reflects tubular damage in the early-stage type 2 diabetic nephropathy. We suggest that urinary NAP could be used as a biomarker for tubular damage in clinical practice (Diabetes/Metabolism Research and Reviews)

Bariatric Surgery versus Intensive Medical Therapy for Diabetes: 3-Year Outcomes

Among obese patients with uncontrolled type 2 diabetes, 3 years of intensive medical therapy plus bariatric surgery resulted in glycemic control in significantly more patients than did medical therapy alone (NEJM)

Sunday, 30 March 2014

Proportion of US Adults Potentially Affected by the 2014 Hypertension Guideline

Compared with the JNC 7 guideline, the 2014 BP guideline from the panel members appointed to the JNC 8 was associated with a reduction in the proportion of US adults recommended for hypertension treatment and a substantial increase in the proportion of adults considered to have achieved goal BP, primarily in older adults (JAMA)

The New Cholesterol and Blood Pressure Guidelines

Perspective on the Path Forward (JAMA)

Friday, 28 March 2014

Incretin Effect and Glucagon Responses to Oral and Intravenous Glucose in Patients with Maturity Onset Diabetes of the Young – Type 2 and Type 3

HNF1A-diabetes, similar to type 2 diabetes, is characterized by an impaired incretin effect and inappropriate glucagon responses, whereas incretin effect and glucagon response to oral glucose remain unaffected in GCK-diabetes, reflecting important pathogenetic differences between the two MODY forms (Diabetes)

Thursday, 27 March 2014

GSK receives European authorisation for once-weekly type 2 diabetes treatment, Eperzan® (albiglutide)

The European Commission has granted marketing authorisation for its once-weekly diabetes treatment, Eperzan® (albiglutide). Eperzan is indicated for the treatment of type 2 diabetes mellitus in adults (GSK)

Wednesday, 26 March 2014

Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease

In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk (JAMA)

Diabetes autoantibodies do not predict progression to diabetes in adults: the Diabetes Prevention Program

These data suggest that ‘diabetes autoimmunity’, as reflected by GAD antibodies and insulinoma-associated-2 autoantibodies, in middle-aged individuals at risk for diabetes is not a clinically relevant risk factor for progression to diabetes (Diabetic Medicine)

Compromised gut microbiota networks in children with anti-islet cell autoimmunity

The findings underscore a role of the microbiome in the pathogenesis of anti-islet cell autoimmunity and type 1 diabetes (Diabetes)

Tuesday, 25 March 2014

One size does not fit all glycemic targets for type 2 diabetes

The present paper briefly reviews the rationale and the clinical trials that support specific glycemic goals towards a ‘tailored’ approach for the management of hyperglycemia in diabetes (Journal of Diabetes Investigation)

Urine and plasma metabolites predict the development of diabetic nephropathy in individuals with Type 2 diabetes mellitus

Type 2 diabetes-specific plasma and urine metabolites were discovered that predict the development of macroalbuminuria beyond established renal risk markers (Diabetic Medicine)

Monday, 24 March 2014

The UK service level audit of insulin pump therapy in adults

The prevalence of continuous subcutaneous insulin infusion use in the UK falls well below the expectation of NICE (15–20%) and that of other European countries (> 15%) and the USA (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users (Diabetic Medicine)

TANDEM: understanding diabetes and tuberculosis

urrently, more than 80% of adults with diabetes live in low-income or middle-income countries, and diabetes generally presents at a younger age in these countries.1 People with diabetes are three times more likely to develop active tuberculosis than are people without diabetes (The Lancet Diabetes & Endocrinology)

Lord Ashcroft: By tackling diabetes, we can boost the nation’s wealth as well as people’s health

Education programmes can be a real lifeline and, by giving people the tools they need to manage their own condition, they can actually save money in the long run

Differences in the HbA1c-lowering efficacy of glucagon-like peptide-1 analogues between Asians and Non-Asians

GLP-1 analogues lower HbA1c more in Asian-dominant studies than in non-Asian-dominant studies. Further studies are warranted to explore the potential mechanisms of the ethnic difference (Diabetes, Obesity and Metabolism)

Friday, 21 March 2014

Longitudinal assessment of neuropathy in type 1 diabetes using novel ophthalmic markers (LANDMark): Study design and baseline characteristics

The LANDMark baseline findings confirm a reduction in corneal sensitivity only in Type 1 patients with neuropathy. However, corneal nerve fibre length is reduced in Type 1 patients without neuropathy with an even greater deficit in Type 1 patients with neuropathy (Diabetes Research and Clinical Practice)

Hemoglobin A1c assay variations and implications for diabetes screening in obese youth

Clinically significant inter-method A1c variability exists that impacts patient classification and treatment recommendations. In the screening of obese youth for diabetes, A1c results should be interpreted with caution (Pediatric Diabetes)

CHMP Recommends Empagliflozin for Approval to Reduce Blood Sugar Levels in Adults with Type 2 Diabetes in Europe

Boehringer Ingelheim Pharmaceuticals and Eli Lilly announce a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency, recommending approval of empagliflozin, an investigational sodium glucose co-transporter 2 (SGLT2) inhibitor, as an adjunct to diet and exercise to improve glycemic control, or blood glucose levels, in adults with type 2 diabetes

Thursday, 20 March 2014

Type 2 diabetes: empagliflozin

Evidence summary (NICE)

Novartis introduces Lucentis® in state of the art pre-filled syringe

Epecifically designed for intraocular injection (Novartis)

Multiple Non-glycemic Genomic Loci Are Newly Associated with Blood Level of Glycated Hemoglobin in East Asians

Variants affecting erythrocyte parameters rather than glucose metabolism may be relevant to the use of HbA1C for diagnosing diabetes in these populations (Diabetes)

Chronic Dipeptidyl Peptidase-4 Inhibition With Sitagliptin Is Associated With Sustained Protection Against Ischemic Left Ventricular Dysfunction

The addition of dipeptidyl peptidase-4 inhibitor therapy with sitagliptin to the treatment regime of patients with type 2 diabetes mellitus and coronary artery disease is associated with a sustained improvement in myocardial performance during dobutamine stress and a reduction in postischemic stunning (Circulation: Cardiovascular Imaging)

Wednesday, 19 March 2014

Heritability of variation in glycaemic response to metformin: a genome-wide complex trait analysis

Glycaemic response to metformin is heritable, thus glycaemic response to metformin is, in part, intrinsic to individual biological variation. Further genetic analysis might enable us to make better predictions for stratified medicine and to unravel new mechanisms of metformin action (The Lancet Diabetes & Endocrinology)

Personalising metformin therapy: a clinician's perspective

Variation in glycaemic response to metformin is likely to be multifactorial, making it difficult to identify the effect of individual genetic variants. Despite the demonstration of a rather high heritability of the glucose-lowering response to metformin by Zhou and colleagues, further genetic studies are needed before a truly stratified approach to metformin treatment in patients with type 2 diabetes can be proposed (The Lancet Diabetes & Endocrinology)

Tuesday, 18 March 2014

Sanofi launches its new generation blood glucose monitor

MyStar Extra® is the first device to support insulin therapy management with estimated HbA1c (Sanofi)

Association between low blood glucose increase during glucose tolerance tests in pregnancy and impaired fetal growth

In a high-risk population, a positive relation between glucose and fetal growth was found. Group Low demonstrated impaired growth. More attention should be paid to pregnant women with an insufficient increase in glucose after a glucose challenge. Future studies should challenge our findings in high- and low-risk populations (Acta Obstetricia et Gynecologica Scandinavica)

Use of Antidiabetic Drugs in the U.S., 2003–2012

The antidiabetic drug market is characterized by steady increases in volume, and newly approved drugs experienced substantial uptake, especially DPP-4 inhibitors. The use of rosiglitazone has been negligible since restrictions were put in place in 2011. Further study is needed to understand why one-third to one-half of other noninsulin antidiabetic drug use was not concomitant with metformin use despite guidelines recommending that metformin be continued when other agents are added to treatment (Diabetes Care)

Insulin Sensitivity and Albuminuria: The RISC Study

In healthy middle-aged adults, reduced insulin sensitivity, assessed by hyperinsulinemic–euglycemic clamp, is continuously associated with a greater risk of increasing albuminuria. This finding suggests that reduced insulin sensitivity is either simply related to or might causally contribute to the initial pathogenesis of albuminuria (Diabetes Care)

The Cytotoxic Role of Intermittent High Glucose on Apoptosis and Cell Viability in Pancreatic Beta Cells

This study suggested that IHG plays a more toxic effect including both apoptosis-inducing and antiproliferative effects on INS-1 cells. Excessive activation of cellular stress and regulation of cyclins might be potential mechanism of impairment in INS-1 cells induced by IHG (Journal of Diabetes Research)

Monday, 17 March 2014

Diabetes, Collagen, and Bone Quality

In this review, we describe the mechanism of low bone quality in diabetes and the usefulness of the measurement of plasma or urinary level of AGEs for estimation of fracture risk (Current Osteoporosis Reports)

Improved real-world glycemic outcomes with liraglutide versus other incretin-based therapies in type 2 diabetes

In clinical practice LIRA was associated with significantly greater reductions in A1C and improved glycemic goal attainment compared with either EXEN or SITA among adult patients with T2D (Diabetes, Obesity and Metabolism)

Low carbohydrate diet to achieve weight loss and improve HbA 1c in type 2 diabetes and pre-diabetes: experience from one general practice

This approach is easy to implement in general practice, and brings rapid weight loss and improvement in HbA1c (Practical Diabetes)

Lack of care planning failing people with diabetes

Almost two thirds of people with diabetes do not have a personal care plan in place despite them being vital for enabling people to manage the condition (Diabetes UK)

Sunday, 16 March 2014

Gestational diabetes: new criteria may triple the prevalence but effect on outcomes is unclear

We need to understand better how to identify high risk pregnancies, incorporating other important factors in addition to glucose concentration (BMJ)

Thursday, 13 March 2014

What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug?

Only a small minority of symptoms reported on statins are genuinely due to the statins: almost all would occur just as frequently on placebo (Preventative Cardiology)

Tuesday, 11 March 2014

Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus

There is no firm evidence for specific blood glucose targets and treatment goals need to be individualised taking into account age, disease progression, macrovascular risk, as well as the patient's lifestyle and disease management capabilities (Cochrane Library)

Individualizing HbA1c targets for patients with diabetes: impact of an automated algorithm within a primary care network

Two automated targeted algorithms would reclassify one quarter to one third of patients from uncontrolled to controlled within a primary care network without differentially affecting vulnerable patient subgroups (Diabetic Medicine)

Percutaneous nephrolithotomy increases the risk of diabetes: A 5-year follow-up study

The present results suggest an association between patients with nephrolithiasis who undergo a percutaneous nephrolithotomy and a subsequent diabetes mellitus diagnosis (International Journal of Urology)

Comparison of gestational diabetes mellitus rates in women with increased and normal white blood cell counts in early pregnancy

Thai or other South-East Asian women with an increased WBC count in early pregnancy had a significantly higher rate of GDM than women having a normal WBC count. Our results demonstrate that WBC count is an independent risk factor for GDM (Journal of Obstetrics and Gynecology Research)

Per capita sugar consumption and prevalence of diabetes mellitus – global and regional associations

These results indicate independent associations between DM prevalence rates and per capita sugar consumption both worldwide and with special regard to the Asian region (BMC Public Health)

Altered glucose metabolism rather than naive type 2 diabetes mellitus (T2DM) is related to vitamin D status in severe obesity

Given the inherent effect of obesity on vitamin D and glucose homeostasis, current data suggest a potential independent role for vitamin D in the regulation of glucose metabolism in a setting of obese patients previously unknown to harbour glucose metabolism abnormalities (Cardiovascular Diabetology)

Saturday, 8 March 2014

Loss-of-function mutations in SLC30A8 protect against type 2 diabetes

The researchers identified 12 rare protein-truncating variants in SLC30A8, which encodes an islet zinc transporter (ZnT8)4 and harbors a common variant (p.Trp325Arg) associated with T2D risk and glucose and proinsulin levels (Nature Genetics)

Friday, 7 March 2014

Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775 385 individuals and 12 539 strokes

The excess risk of stroke associated with diabetes is significantly higher in women than men, independent of sex differences in other major cardiovascular risk factors. These data add to the existing evidence that men and women experience diabetes-related diseases differently and suggest the need for further work to clarify the biological, behavioural, or social mechanisms involved (The Lancet)

Results from the UK cohort of SOLVE: Providing insights into the timing of insulin initiation in people with poorly controlled type 2 diabetes in routine clinical practice

Findings from the UK cohort of SOLVE show that it is possible to improve glycaemic control and reduce HbA1c in patients previously uncontrolled with oral antidiabetic drug therapy, in a primary setting, despite clinical inertia (Primary Care Diabetes)

Wednesday, 5 March 2014

Outcomes of Combined Cardiovascular Risk Factor Management Strategies in Type 2 Diabetes: The ACCORD Randomized Trial

Compared with combined standard treatment, intensive BP or intensive glycemia treatment alone improved major CVD outcomes, without additional benefit from combining the two. In the ACCORD lipid trial, neither intensive lipid nor glycemia treatment produced an overall benefit, but intensive glycemia treatment increased mortality (Diabetes Care)

Optimal strategies for identifying kidney disease in diabetes

Properties of screening tests, progression of renal dysfunction and impact of treatment – systematic review and modelling of progression and cost-effectiveness. Scientific summary (National Institute for Health Research)

U.S. Food and Drug Administration Issues Complete Response Letter for Empagliflozin

Boehringer Ingelheim Pharmaceuticals and Eli Lilly and Company announce the U.S. Food and Drug Administration have issued a complete response letter for the New Drug Application of the investigational sodium glucose co-transporter-2 (SGLT2) inhibitor empagliflozin (Lilly)

NEW Journal Watch feature on Glycosmedia

Comment on recently published papers written by the medical editors of Glycosmedia

Tuesday, 4 March 2014

Insulin pump use in pregnancy is associated with lower HbA1c without increasing the rate of severe hypoglycaemia or diabetic ketoacidosis in women with type 1 diabetes

In this large multicentre study, women using insulin pumps in pregnancy had lower HbA1c without increased risk of severe hypoglycaemia or diabetic ketoacidosis but no improvement in other pregnancy outcomes (Diabetologia)

Genetic Risk Score Associations With Cardiovascular Disease and Mortality in the Diabetes Heart Study

These findings support the utility of two simple genetic risk scores in examining genetic associations for adverse outcomes in European Americans with type 2 diabetes (Diabetes Care)

Does the Prevailing Hypothesis That Small-Fiber Dysfunction Precedes Large-Fiber Dysfunction Apply to Type 1 Diabetic Patients?

Our findings in type 1 diabetes support the prevailing hypothesis that small-fiber dysfunction occurs early in diabetic sensorimotor polyneuropathy. However, further research is required to determine which combination of small-fiber tests is most suitable as a surrogate marker in clinical trials (Diabetes Care)

Monday, 3 March 2014

The Relationship Between Alcohol Consumption and Vascular Complications and Mortality in Individuals With Type 2 Diabetes Mellitus

In patients with type 2 diabetes, moderate alcohol use, particularly wine consumption, is associated with reduced risks of cardiovascular events and all-cause mortality (Diabetes Care)

Motor unit number estimations are smaller in children with type 1 diabetes mellit us. A case-cohort study

Despite the absence of clinical or standard electrophysiological differences from normal control subjects, motor unit number estimation can detect a small significant difference in children with DM, suggesting that motor unit loss begins early and subclinically in the disease (Muscle & Nerve)

Sunday, 2 March 2014

Germany extends drug price freeze to end-2017

German legislators have voted to continue until the end of 2017 the price freeze on reimbursed drugs - which was introduced in August 2010 and originally set to expire at end-2013 (PharmaTimes)

Sitagliptin, a Dipeptidyl Peptidase-4 Inhibitor, Acutely Inhibits Intestinal Lipoprotein Particle Secretion in Healthy Humans

This pleotropic effect of sitagliptin may explain the reduction in postprandial lipemia seen in clinical trials of this agent and may provide metabolic benefits beyond glucose lowering (Diabetes)