Tuesday, 30 September 2014

Acknowledging and allocating responsibility for clinical inertia in the management of Type 2 diabetes in primary care: a qualitative study

In order to understand and address the problem of clinical inertia, provider, patient- and system-level barriers should be considered together rather than as separate issues. Acknowledgement of responsibility should be regarded positively as a motivator for change (Diabetic Medicine)

Serum neuron-specific enolase is elevated as a novel indicator of diabetic retinopathy including macular oedema

Serum neuron-specific enolase is elevated in and indicative of diabetic retinopathy. Neuron-specific enolase may be a potential biomarker of diabetic retinopathy (Diabetic Medicine)

Low-Dose vs Standard-Dose Insulin in Pediatric Diabetic Ketoacidosis

Low dose is noninferior to standard dose with respect to rate of blood glucose decrease and resolution of acidosis (JAMA Pediatrics)

Mortality and Incidence of Renal Replacement Therapy in People With Type 1 Diabetes Mellitus-A Three Decade Long Prospective Observational Study in the Lainz T1DM Cohort

A clear linear relationship between early glycemic control and the later development of end stage renal disease and mortality has been found (Journal of Clinical Endocrinology & Metabolism)

Liraglutide and the Preservation of Pancreatic ß-Cell Function in Early Type 2 Diabetes: The LIBRA Trial

Liraglutide provides robust enhancement of ß-cell function that is sustained over 48 weeks in early T2DM but lost upon cessation of therapy (Diabetes Care)

GLP-1 as a Mediator in the Remission of Type 2 Diabetes After Gastric Bypass and Sleeve Gastrectomy Surgery

The relative importance of the GLP-1 and insulin response versus improvement in insulin action in the liver and skeletal muscles for the glucose tolerance after RYGB and SG depends on when the patients are studied after surgery (Diabetes)

Friday, 26 September 2014

Effects of a patient oriented decision aid for prioritising treatment goals in diabetes: pragmatic randomised controlled trial

We found no evidence that the patient oriented treatment decision aid improves patient empowerment by an important amount (BMJ)

Liraglutide and the Preservation of Pancreatic ß-Cell Function in Early Type 2 Diabetes: The LIBRA Trial

Liraglutide provides robust enhancement of ß-cell function that is sustained over 48 weeks in early T2DM but lost upon cessation of therapy (Diabetes Care)

Thursday, 25 September 2014

Artificial sweeteners induce glucose intolerance by altering the gut microbiota

Our results link non-caloric artificial sweeteners consumption, dysbiosis and metabolic abnormalities, thereby calling for a reassessment of massive NAS usage (Nature)

Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes

The benefits with respect to mortality that had been observed among patients originally assigned to blood-pressure–lowering therapy were attenuated but still evident at the end of follow-up. There was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events (NEJM)

Glucagon-Like Peptide 1 Receptor Agonist or Bolus Insulin With Optimized Basal Insulin in Type 2 Diabetes

Adding exenatide to titrated glargine with metformin resulted in similar glycemic control as adding lispro and was well tolerated. These findings support exenatide as a noninsulin addition for patients failing basal insulin (Diabetes Care)

Wednesday, 24 September 2014

Reduced Testing Frequency for Glycated Hemoglobin, HbA1c, Is Associated With Deteriorating Diabetes Control

These findings provide, in a large, multicenter data set, objective evidence that testing outside guidance on HbA1c monitoring frequency is associated with a significant detrimental effect on diabetes control (Diabetes Care)

Prevalence and Incidence Trends for Diagnosed Diabetes Among Adults Aged 20 to 79 Years, United States, 1980-2012

Analyses of nationally representative data from 1980 to 2012 suggest a doubling of the incidence and prevalence of diabetes during 1990-2008, and a plateauing between 2008 and 2012 (JAMA)

HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight

Evidence from genetic analysis and randomised trials (The Lancet)

Patient Empowerment Programme (PEP) in Primary Care Reduced All-cause Mortality and Cardiovascular Diseases in Patients with Type 2 Diabetes Mellitus

Enrolment in PEP was associated with reduced all-cause mortality and first CVD events among T2DM patients (Diabetes, Obesity and Metabolism)

Relationships between patient activation, disease-specific knowledge and health outcomes among people with diabetes; a survey study

Among people with diabetes, patient activation level was especially related to disease-specific knowledge and less with health-related behavior and outcomes. The PAM might therefore especially be an useful instrument for clinical practice to identify patients most in need for diabetes education (BMC Health Services Research)

Tuesday, 23 September 2014

Effect of Atorvastatin on Pancreatic Beta-Cell Function and Insulin Resistance in Type 2 Diabetes Mellitus Patients: A Randomized Pilot Study

Atorvastatin in the dose used failed to produce significant change in pancreatic beta-cell function and insulin resistance in type 2 diabetes patients as assessed by the HOMA2 index (Canadian Journal of Diabetes)

Living with Sensor-Augmented Pump Therapy in Type 1 Diabetes: Adolescents' and Parents' Search for Harmony

Success with SAPT requires exploration of adolescent and parental expectations for SAPT as well as the degree to which parents have previously fostered their adolescent's involvement in and responsibility for diabetes management (Canadian Journal of Diabetes)

Plasma Triglycerides Predict Incident Albuminuria and Progression of Coronary Artery Calcification in Adults with Type 1 Diabetes: the Coronary Artery Calcification in Type 1 Diabetes Study

In adults with type 1 diabetes, fasting TG independently predicted cardiorenal disease over 6 years and improved reclassification of risk by conventional risk factors (Journal of Clinical Lipidology)

Impact of Islet Autoimmunity on the Progressive ß-Cell Functional Decline in Type 2 Diabetes

These pilot data suggest that the development of islet autoimmunity in T2D is associated with a significantly more rapid ß-cell functional decline (Diabetes Care)

Metformin and low levels of thyroid-stimulating hormone in patients with type 2 diabetes mellitus

In this longitudinal population-based study, metformin use was associated with an increased incidence of low TSH levels in patients with treated hypothyroidism, but not in euthyroid patients (CMAJ)

Friday, 19 September 2014

Effects of telecare intervention for glycemic control in Type 2 Diabetes: A systematic review and meta-analysis of randomized controlled trials

Patients monitored by telecare showed significant improvement in glycemic control in type 2 diabetes than those monitored by routine follow-up (European Society of Endocrinology)

FDA Approves Trulicity™ (dulaglutide), Lilly's Once-Weekly Therapy for Adults with Type 2 Diabetes

Trulicity is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes (Lilly)

Xultophy® (IDegLira) approved in Europe

Xultophy® is for the treatment of type 2 diabetes mellitus in adults. The authorisation covers all 27 European Union member states. Press release (Novo Nordisk)

Thursday, 18 September 2014

Patterns and trends in insulin intensification among patients with type 2 diabetes: A systematic review

Guidelines recommend insulin intensification over time to achieve HbA1c targets ... The paucity of available studies prevented a comprehensive understanding of patterns and trends in insulin intensification. Such information is needed to assess the quality of pharmacologic care for patients with T2DM (Primary Care Diabetes)

Wednesday, 17 September 2014

Insulin pumps (CSII) and cardiovascular diseases and mortality in the Swedish national diabetes register

This large prospective observational study showed risk reductions of around 5% for cardiovascular diseases and mortality with CSII compared to insulin injections in patients with type 1 diabetes followed for 6 years (Presentation Abstract, EASD)

Tuesday, 16 September 2014

Safety and effectiveness of biphasic insulin aspart 30 in people with type 2 diabetes switching from basal-bolus insulin regimens in the A1chieve study

24 weeks after switching from basal-bolus insulin regimens to biphasic insulin aspart 30, glycaemic control and HRQoL were significantly improved, and hypoglycaemia was significantly reduced (Primary Care Diabetes)

Diabetes, antidiabetic medications, and pancreatic cancer risk: an analysis from the International Pancreatic Cancer Case-Control Consortium

This study provides the most definitive quantification to date of an excess risk of pancreatic cancer among diabetics. It also shows that a 30% excess risk persists for more than two decades after diabetes diagnosis, thus supporting a causal role of diabetes in pancreatic cancer. Oral antidiabetics may decrease the risk of pancreatic cancer, whereas insulin showed an inconsistent duration–risk relationship (Annals of Oncology)

Monday, 15 September 2014

Reversal of diabetes with insulin-producing cells derived in vitro from human pluripotent stem cells

Although S7 cells are not fully equivalent to mature beta cells, their capacity for glucose-responsive insulin secretion and rapid reversal of diabetes in vivo makes them a promising alternative to pancreatic progenitor cells or cadaveric islets for the treatment of diabetes (Nature Biotechnology)

Saturday, 13 September 2014

High-Intensity Statin Therapy Alters the Natural History of Diabetic Coronary Atherosclerosis: Insights From SATURN

High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and nondiabetic patients (Diabetes Care)

Effectiveness of chamomile tea on glycemic control and serum lipid profile in patients with type 2 diabetes

Chamomile tea significantly decreased concentration of HbA1C, serum insulin levels, insulin resistance, total cholesterol, triglyceride, and low-density lipoprotein cholesterol compared with control group (Journal of Endocrinological Investigation)

Friday, 12 September 2014

Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis

GLP-1 agonist and basal insulin combination treatment can enable achievement of the ideal trifecta in diabetic treatment: robust glycaemic control with no increased hypoglycaemia or weight gain. This combination is thus a potential therapeutic strategy that could improve the management of patients with type 2 diabetes (The Lancet)

Greater Dose-Ranging Effects on A1C Levels Than on Glucosuria With LX4211, a Dual Inhibitor of Sodium Glucose Transporters SGLT1 and SGLT2, in Type 2 Diabetes on Metformin Monotherapy

Dual inhibition of SGLT1/SGLT2 with LX4211 produced significant dose-ranging improvements in glucose control without dose-increasing glucosuria and was associated with reductions in weight and systolic BP in metformin-treated type 2 diabetes (Diabetes Care)

Saxenda® for the treatment of obesity receives positive 14-1 vote in favour of approval from FDA Advisory Committee 

Saxenda®, the intended brand name for liraglutide 3 mg, is a once-daily human GLP-1 analogue for the treatment of obesity (Novo Nordisk)

Thursday, 11 September 2014

How can pharma meet the need for new diabetes drugs in cash-strapped healthcare markets? 

Experts will be discussing this issue in a Tweetchat, hosted by PMLiVE and M3, the global provider of technology services in healthcare. From noon to 1pm (UK time) you will be able to follow the discussion live on Twitter using the hashtag #M3diabetes and (should you want to) you are invited to join in with your own questions and comments.

Short-term intensive insulin therapy at diagnosis in type 2 diabetes

An expert workshop was convened to assess the available evidence and the potential application of STII therapy should it be advocated for inclusion in clinical practice (Diabetes/Metabolism Research and Reviews)

Targeting intensive versus conventional glycaemic control for type 1 diabetes mellitus

There was no significant effect towards improved all-cause mortality when targeting intensive glycaemic control compared with conventional glycaemic control. However, there may be beneficial effects of targeting intensive glycaemic control on the composite macrovascular outcome and on nephropathy, and detrimental effects on severe hypoglycaemia (BMJ Open)

Wednesday, 10 September 2014

European Commission grants Lilly and Boehringer Ingelheim's insulin glargine product marketing authorisation in Europe

Lilly/Boehringer Ingelheim's insulin glargine product is the first insulin treatment approved through the European Medicines Agency's biosimilar pathway and the fourth diabetes product approved in the EU from the Lilly-Boehringer Ingelheim Alliance

Incretin-Based Drugs and the Risk of Congestive Heart Failure

In our population-based study, incretin-based drug use was not associated with an increased risk of CHF among patients with type 2 diabetes (Diabetes Care)

Ethnicity-specific obesity cut-points in the development of Type 2 diabetes – a prospective study including three ethnic groups in the United Kingdom

In prospective analyses, British South Asians and African-Caribbeans had equivalent diabetes incidence rates at substantially lower obesity levels than the conventional European cut-points (Diabetic Medicine)

Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

Use of statins before diagnosis of incident diabetes was not associated with an increased risk of microvascular disease. Whether statins are protective against some forms of microvascular disease—a possibility raised by these data—will need to be addressed in other studies (The Lancet Diabetes & Endocrinology)

Increase in the pharmacological management of Type 2 diabetes with pay-for-performance in primary care in the UK

We conclude that a greater proportion of people with newly diagnosed diabetes are being initiated on medication within 1 and 2 years of diagnosis as a result of the introduction of financial incentives for tight glycaemic control (Diabetic Medicine)

Tuesday, 9 September 2014

Transcutaneous oxygen pressure (TcPO2): A novel diagnostic tool for peripheral neuropathy in type 2 diabetes patients

This large study of diabetic patients confirms that the sitting-supine position difference in TcPO2 is higher in DPN patients than control subjects, indicating that TcPO2 examination is a promising valuable diagnostic tool for DPN (Diabetes Research and Clinical Practice)

Monday, 8 September 2014

Hemoglobin A1c, comorbid conditions and all-cause mortality in older patients with diabetes: A retrospective 9-year cohort study

In our patient population, HbA1c scores < 6.4% have significantly higher all-cause mortality. CHF is a major determinant of all-cause mortality. Adults with comorbid CHF and high HbA1c scores have lower all-cause mortality (Diabetes Research and Clinical Practice)

Illness beliefs predict self-care behaviours in patients with diabetic foot ulcers: A prospective study

Patients’ beliefs are important determinants of foot-care practices. They may, therefore, also be influential in determining ulcer outcomes. Interventions aimed at modifying illness beliefs may offer a means for promoting self-care and improving ulcer outcomes (Diabetes Research and Clinical Practice)

Estimated insulin sensitivity predicts regression of albuminuria in Type 1 diabetes

Over 6 years, higher baseline estimated insulin sensitivity and change in estimated insulin sensitivity independently predicted regression of albuminuria. Improving insulin sensitivity in people with Type 1 diabetes is a potential therapeutic target to increase rates of regression of albuminuria (Diabetic Medicine)

Friday, 5 September 2014

High risk of failing eradication of Helicobacter pylori in patients with diabetes: A meta-analysis

Current meta-analysis confirmed the higher risk of HP eradication failure in individuals with diabetes compared with those without diabetes, suggesting the necessity of prolonging treatment or developing a new regimen for HP eradication in patients with diabetes (Diabetes Research and Clinical Practice)

Thursday, 4 September 2014

Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes

This analysis of long-term insulin treatment confirms findings from short-term studies and demonstrates that glargine provides sustained, clinically meaningful reductions in risk of hypoglycemia compared with NPH in patients with T2DM (Diabetes and Its Complications)

Lilly's Basal Insulin Peglispro Demonstrated HbA1c Superiority against Lantus® in Phase III Trials in Patients with Type 1 Diabetes

Eli Lilly and Company's basal insulin peglispro (BIL) demonstrated a statistically significant lower HbA1c compared with insulin glargine (Lantus®) at 26 weeks and 52 weeks, respectively, in the IMAGINE-1 and IMAGINE-3 Phase III clinical trials in patients with type 1 diabetes (Lilly)

Sanofi Diabetes is on a mission to support children, parents and carers of children with type 1 diabetes through gaming

The New Mission T1D app, created by Sanofi Diabetes to address the need for greater understanding of T1D amongst children, parents and carers, friends and in the school environment is now available, free of charge, from the Apple UK store (Sanofi)

Wednesday, 3 September 2014

Hypoglycemia After Antimicrobial Drug Prescription for Older Patients Using Sulfonylureas 

Prescription of interacting antimicrobial drugs to patients on sulfonylureas is very common, and is associated with substantial morbidity and increased costs (JAMA)

Androgen-deprivation Therapy and Diabetes Control Among Diabetic Men with Prostate Cancer

ADT is associated with worsening of diabetes control and increases in HbA1c levels despite the use of additional diabetes medications (European Urology)

Tuesday, 2 September 2014

Hemoglobin A1c less than 6.5% on admission increases risk for in-hospital and 1-year mortality in patients with diabetes and chest pain

Patients with diabetes admitted for chest pain with HbA1c less than 6.5% may be at increased risk for in-hospital and 1-year mortality. The mechanism for death may be mediated in part by hypoglycemia (Cardiovascular Endocrinology)

A qualitative synthesis of diabetes self-management strategies for long term medical outcomes and quality of life in the UK

This synthesis has explored how patients give meaning to the experiences of interventions for T2DM and subsequent attempts to balance biomarkers with quality of life in the long term (BMC Health Services Research)