It is the responsibility of diabetes specialists to ensure that people with diabetes are equipped with the knowledge to use self-monitoring more effectively (Diabetologia)
Archives for April 2014
Dosing of First Patient in Phase 2 Clinical Trial of Investigational Soluble Glucagon Formulation for Pumps (Xeris Pharmaceuticals)
Statins impair glucose uptake by cells involved in regulation of glucose homeostasis by inducing cholesterol-dependent conformational changes in GLUTs (BMJ Open, Diabetes Research & Care)
This is the first study to focus on structural changes in the brain associated with DPN. Our findings suggest increased peripheral gray matter volume loss, localized to regions involved with somatosensory perception in subjects with DPN. This may have important implications for the long-term prognosis of DPN (Diabetes Care)
There was a reduction in all-cause mortality for patients treated with metformin combined with DPP-4i versus metformin plus SU, and a similar trend for MACE (Diabetes, Obesity and Metabolism)
Tim Cundy, Evan Ackermann, Edmond A Ryan. BMJ. Doi: 10.1136/bmj.g1567
This analysis with the sub-title “we need to understand better how to identify high risk pregnancies, incorporating other important factors in addition to glucose concentration.” appeared in a BMJ series “Too Much Medicine” and so before you start, you know where it will end. The thrust of the article is that adopting suggested international current recommendations for diagnosing gestational diabetes could double or even more, the numbers of patients affected. This is because it is suggested a diagnosis can be made on a single raised glucose. Surprisingly despite the increased detection rate, there is no evidence that the all important end points are improved. Even worse, attracting a diagnosis of gestational diabetes will draw increased medical interest leading to an increased risk of intervention. Of course gestational diabetes is an important risk factor to pick up as it can be asymptomatic and is associated with possible adverse consequences to both mother and foetus. Over-diagnosis could cause unnecessary patient distress as they now have a “label” complicating their pregnancy. Furthermore coping with this increased demand will suck in resources which could be more successfully deployed elsewhere.
Reviewed by Dr Harry Brown
4th Edition: Edited by Mark Lebwohl, Warren Heymann, John Berth-Jones and Ian Coulson
Published by Elsevier Saunders
Without doubt this is an excellent book and the reader is encouraged to dip in and read around a topic and enhance their knowledge. It is also a super reference book, particularly when wanting more information about dermatological therapeutics-an area that is often neglected.
On 20 February 2014, the Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion, recommending the granting of a marketing authorisation for Vokanamet for the treatment type 2 diabetes mellitus (EMA)
Metformin will not increase the incidence of adverse maternal outcomes and neonatal outcomes (Diabetes Research and Clinical Practice)
The present study found that the impact of diabetes-related amputation was significant for body image disturbance. However, it appears that other psychosocial outcomes are better accounted for by medical co-morbidities common in this group rather than the amputation itself (Diabetic Medicine)
In primary care, lower levels of diabetes distress were reported than in secondary care. The difference in diabetes distress between care settings can be largely, but not fully, explained by specific demographic and clinical characteristics (Diabetic Medicine)
Contrary to conventional wisdom, angina is more prevalent and more severe among patients with DM, both prior to and following AMI (European Journal of Preventive Cardiology)
Reviewed by Jim Young
Dr. Alice Roberts
Published by Dorling Kindersley
Price £20 hardback
In the very first pages of this book we are told that there are 2 metres of DNA (3 billion bases) in every cell in our bodies! That in one square centimetre of skin there are on average 55 centimetres of nerve fibres, 70 centimetres of blood vessels, 15 sebaceous glands, 100 sweat glands, and 200 sensory receptors. How many books can offer such a functional interplay between an exciting text and its reader!
INT131 demonstrated dose-dependent reductions in HbA1c, equivalent to 45 mg pioglitazone, but with less fluid accumulation and weight gain, consistent with its SPPARM design (Diabetes Care)
Statins use is associated with increased HbA1c levels among hypertensive patients and hypertensive patients with diabetes. Clinicians managing hypertensive patients on statins should consider monitoring the HbA1c level and ensure that those with diabetes have their hyperglycaemia kept under control (Diabetology & Metabolic Syndrome)
The goal of this study was to examine how stated preference methods are applied in diabetes care, and to evaluate the value of this information in developing the patient perspective in clinical and policy decisions. (The Patient – Patient-Centered Outcomes Research)
High dp-ucMGP levels were independently associated with below-knee arterial calcification score in patients with type 2 diabetes and normal or slightly altered kidney function. The reversibility of the elevation of dp-ucMGP levels and the latter’s relationship with clinical events merit further investigation (Cardiovascular Diabetology)
Pozilli R, Strollo R, Bonora, E. Journal of Diabetes Investigation. Doi: 10.1111/jdi.12206
Until relatively recently, the mantra for glyceamic control was ‘the lower the better’ when aiming to reduce the chronic complications of diabetes … Derived from the DCCT and UKPDS studies, a clear reduction in microvascular events was noted as HbA1c fell. In UKPDS, a significant fall in cardiovascular events was almost observed. This glucocentric dogma was reinforced following the legacy publications from these studies – the UKPDS legacy now showing a significant reduction in CV events. The glycaemic control issue seemed settled until publication of ACCORD and VADT in the mid 2000s. ACCORD studied older higher risk patients and attempted to achieve near normal glycaemia (HbA1c<6.5%) It showed that patients with the highest HbA1c at baseline had an increased risk of CV events. A similar finding came from VADT where no CV advantage was seen with tighter control. Taken together, evidence is mounting that tight glycaemic control is likely to be beneficial early in the course of diabetes but as time passes the interaction of other CV risk factors, and the impact of hypoglycaemia seem to negate this. Clearly a more personalised approach to glycaemic control is required.
In a large population-based study, the association between diabetes and vascular disease differed according to vascular phenotype (Diabetes Care)
Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies (British Journal of Ophthalmology)