Many women with diabetes are still becoming pregnant with avoidable increased risk as a result of patchy pre-conceptual care, exacerbated by unsatisfactory glucose control during pregnancy. Improving this will require increased awareness of the issue including more collaborative working between public health and primary and secondary care. Hopefully future NPID audits will demonstrate further progress.
Archives for November 2014
Hao G. Wang Z. Guo R. Et al. BMC Cardiovascular Disorders. Doi: 10.1186/1471-2261-14-148
This English language paper originating from China is a meta-analysis of over 20000 type 2 diabetes patients who also had hypertension. Being two common conditions, you would think we know plenty about these disorders. Yet according to this paper, “The effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on cardiovascular (CV) risk in hypertensive patients with type 2 diabetes mellitus (T2 DM) are uncertain.” So they looked at 10 studies which gave them a reasonable pool of patients and the conclusions were reassuring as in the past, previous studies have not provided clarity. Treatment with these therapeutic agents reduced cardiovascular events by 10% and a 17% reduction in cardiovascular mortality. Of course being a meta-analysis, there may be differences between the methodology of each trial, so it may not always be easy to compare like with like. More studies are needed to see if this finding was associated with ACE inhibitors or ARBs. Not only should the superior class be identified but ideally, so should the best drug be highlighted.
Brown adipose tissue is the primary site for thermogenesis and can consume, in addition to free fatty acids, a very high amount of glucose from the blood, which can both acutely and chronically affect glucose homeostasis Journal of Cell Biology)
The DJBL is a safe and effective alternative to invasive bariatric procedures. Six months of DJBL treatment combined with diet leads to superior weight loss and improvement of T2DM when compared with diet alone (Annals of Surgery)
Five-year results suggest focal/grid laser treatment at the initiation of intravitreal ranibizumab is no better than deferring laser treatment for =24 weeks in eyes with DME involving the central macula with vision impairment (Ophthalmology)
Empagliflozin tablets reduced hemoglobin A1C, body weight and several markers of abdominal fat in adults with type 2 diabetes, according to a new retrospective analysis of clinical trial data presented on behalf of Boehringer Ingelheim and Eli Lilly at the 2014 Scientific Sessions of the American Heart Association in Chicago
The investigational IMPROVE-IT study met its primary and all secondary composite efficacy endpoints. In IMPROVE-IT, patients taking the LDL-cholesterol-lowering medicine VYTORIN® (ezetimibe/simvastatin) – which combines simvastatin with the non-statin ZETIA® (ezetimibe) — experienced significantly fewer major cardiovascular events than patients treated with simvastatin alone (Merck)
Treatment with ACE/ARBs results in significant reduction in CV events and mortality in hypertensive patients with T2 DM (BMC Cardiovascular Disorders)
In our cohort of T2DM outpatients, different eGFR equations perform similarly in predicting ACM, whereas SCr did not (Diabetes and Vascular Disease Research)
The protective effect of metformin against free fatty acid induced apoptosis is potentially clinically relevant as metformin is first line treatment for patients with T2D, a patient group which is rapidly increasing and carries a high burden of cardiovascular disease (Cardiovascular Diabetology)
The fourth Access to Medicine Index report provides a finely detailed picture of how the world’s 20 largest research-based pharmaceutical companies address access to medicine. (Access to Medicine Foundation)
Positive perceptions about the use of lay educators support the positive quantitative findings from the main trial. Acceptability is an important consideration in relation to implementation of the model of delivery studied. Concerns raised within the interviews should be considered in the design of training for lay educators (Postgraduate Medical Journal)
National Institute for Health and Care Excellence
NICE (National Institute for Health and Care Excellence) is a highly respected organisation who produces invaluable advice. Sometimes for the busy healthcare professional, it is not always easy to keep up to date with their substantial output. So this very readable news item from NICE is a useful up to date introduction into the topic of obesity. If you want to delve deeper there is a link to the latest guidance which has just been published. With an astonishing 25% of the British population obese and 5% having type 2 diabetes, there is much to do in the management of obesity. According to the article “NICE recommends that all patients with a BMI of 35 or over who have recent-onset type 2 diabetes should be assessed for surgery”. Currently 6 500 have surgery for obesity every year, if the new guidance is completely followed; this could add another 5000 operations annually. The cost of the surgery could be offset by the prevention of complications of diabetes and drug savings.
Peripheral nerve dysfunction is common in asymptomatic patients with LADA or T2DM. Findings of the study suggest that LADA and T2DM differ in the pattern of peripheral nerve involvement over diabetes duration (Diabetes and Its Complications)
we show that adipocyte hypertrophy is linked to increased inflammation in AT in obese children thereby providing evidence that obesity-associated AT dysfunction develops in early childhood and is related to insulin resistance (Diabetes)
Heart failure and peripheral arterial disease are the most common initial manifestations of cardiovascular disease in type 2 diabetes. The differences between relative risks of different cardiovascular diseases in patients with type 2 diabetes have implications for clinical risk assessment and trial design (The Lancet Diabetes & Endocrinology)
Lind M, Svenson AM et al. NEJM. Doi: 10.1056/NEJMoa1408214
It is widely accepted that Type 2 diabetes (T2DM) significantly increases the risk of death particularly from cardiovascular disease, leading to aggressive risk factor modification. In Type 1 diabetes, the situation has always been less clear with patient management guidelines often extrapolated from Type 2 diabetes possibly because of the fewer numbers of studies. Therefore, this paper in the NEJM is welcome as it does shed more light on CV risk in T1DM. Using the Swedish National Diabetes register, compared with controls, patients with T1DM had a higher incidence of death from cardiovascular causes. This varied depending on HbA1c, hazard ratios increasing from 2.92 (HbA1c<6.9) to 10.46 (HbA1c>9.7%). The paper reinforces the need for risk factor reduction in T1DM even and suggests the impact of glycaemic control on cardiovascular mortality.
Diamyd Medical and University of Alabama at Birmingham has entered a Clinical Trial Agreement regarding the study, which will be conducted at Children’s of Alabama in Birmingham, USA. The combination has shown promising results in preclinical studies
These results suggest that increased exposure to fast-food outlets is associated with increased risk of type 2 diabetes and obesity, which has implications for diabetes prevention at a public health level and for those granting planning permission to new fast-food outlets (Public Health Nutrition)
The results demonstrate that individualized medical nutrition therapy is effective in decreasing HbA1c level in patients diagnosed with prediabetes (Journal of the Academy of Nutrition and Dietetics)