There was a close relationship between glycemic variability evaluated by MAGE and DPN in type 2 diabetes with well-controlled HbA1c (Diabetology & Metabolic Syndrome)
Archives for December 2014
These results suggest that there are substantial variations in glycaemic control among people with Type 1 diabetes between the data sources and that there is room for improvement in all populations, especially in young adults (Diabetic Medicine)
Any diabetes story, which attracts the attention of both the BBC News website and the Daily Mail is worthy of investigation. This was how the report of Pagliuca, Millman and Gurtler (all co-first authors) was feted in October, following publication in the journal ‘Cell’.
Vitamin D is involved in the development of DPN in type 2 diabetic patients, and vitamin D deficiency is very likely to be associated with DPN in type 2 diabetic patients. Further studies are needed to validate the association between vitamin D deficiency and DPN (Journal of Diabetes Investigation)
In the present study, we noted a substantial decrease in intrinsic foot muscles and plantar tissue thickness in T2DM subjects as compared to NDM subjects. This reasons out that structural changes in the foot in an antecedent to clinically apparent PN (Journal of Diabetes)
Disordered early phase insulin and glucagon secretions but not incretin secretion are involved in hyperglycemia after ingestion of nutrients in T2DM of even a short duration (Journal of Diabetes and Its Complications)
Saxenda® (liraglutide 3 mg), the first once-daily human glucagon-like peptide-1 (GLP-1) analogue for the treatment of obesity (Novo Nordisk)
Our results suggest that not only proteinuria but also tubulointerstitial lesions should be assessed to predict rapid eGFR decline in patients with type 2 diabetes who have overt proteinuria and biopsy-proven DN (Diabetes/Metabolism Research and Reviews)
Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes (Diabetes Care)
Martin J. Abrahamson: Yes, They Continue to Serve Us Well! (Diabetes Care)
The PD of insulin glargine differs depending on time of administration. With morning administration insulin activity is greater in the first 0–12 h, while with evening administration the activity is greater in the 12–24 h period following dosing (Diabetes Care)
Metformin may have protective effect in patients with type 2 DM for DVT (BMC Cardiovascular Disorders)
Based on the small number of cases observed, the incidences of reported AP and CP were numerically greater with liraglutide than with comparators. Not all cases fulfilled diagnostic criteria, and confounding variables were present in 75% of the AP cases with liraglutide therapy, precluding firm conclusions (Diabetes Care)
Gallagher N. Cardwell C. et al. Diabetic Medicine Doi: 10.1111/dme.12575
This fascinating paper reviewed the impact of Quality and Outcomes Framework (QOF) which the authors called “the most comprehensive pay-for-performance scheme for primary care in the world to date,” on diabetic care. I have seen suggested before, that the way we are paid will almost certainly influence the way we practice medicine and this paper backs up this assertion. This research searched and analysed a General Practice database and followed up 100 000 patients over a 10 year period. The researchers concluded that earlier initiation of pharmacological therapy in type 2 diabetes is directly linked to the QOF initiative, is an interesting observation. This change in behaviour could also be linked to better understanding and education about diabetes, spread through published guidelines. The conclusion begs the question; does this faster introduction of drug therapy result in significantly better clinical outcomes and provide good value for money for the UK taxpayer? This is not an academic question as according to the paper QOF costs more than £1 billion a year.
Eli Lilly and Company and Adocia announce a worldwide licensing collaboration focused on developing an ultra-rapid insulin, known as BioChaperone Lispro, for treatment in people with type 1 and type 2 diabetes
Canagliflozin improved glycaemic control, reduced body weight and systolic BP, and was generally well tolerated in patients aged 55–80 years with T2DM over 104 weeks (Diabetes, Obesity and Metabolism)
The majority of long-duration T1D patients have detectable urine C-peptide levels. While the majority of patients are insulin microsecretors, some maintain clinically relevant endogenous insulin secretion for many years after the diagnosis of diabetes. Understanding this may lead to a better understanding of pathogenesis in T1D and open new possibilities for treatment (Diabetes Care)
At baseline, shorter duration of diabetes and lower fasting glucose can identify patients most likely to benefit from short-term intensive insulin therapy. Most importantly, during therapy, responders had less hypoglycaemia from the third week onwards, despite lower glycaemia, suggesting that 2 weeks of intensive insulin therapy may be needed to improve endogenous islet function (Diabetic Medicine)
Overnight closed loop at home in adults and adolescents with type 1 diabetes is feasible, demonstrating improvements in glucose control and reducing the risk of nocturnal hypoglycaemia (Diabetes, Obesity and Metabolism)
Zoungas S. Chalmers J. et al. New England Journal of Medicine Doi: 10.1056/NEJMoa1407963
Looking at this title, you might think this topic area has been so heavily scrutinised that there is nothing else left to study. But this paper is well worth a read as not only does it look at previous other landmark studies about diabetes and their conclusions but also generates some new data from a previous study. This is quite a detailed paper but in total followed up patients for 10 years, a long enough interval to suggest some reasonable conclusions. In type 2 diabetes, using perindopril and indamide for a few years, positively helped against all cause mortality and cardiovascular disease. Those patients taking this drug combination achieved on average a reduction of just over 5 mm Hg systolic. However the last sentence of this paper might raise a few eyebrows “intensive glucose control for an average of 5 years did not provide any long-term benefits with respect to death or major macrovascular events.” Though this is a surprising conclusion, the paper did point out some limitations of the trial.