Diabetes News

Abbott Diabetes Care – grant renewal
A big thank you to Abbott Diabetes Care for renewing their educational grant for 2012

Feasibility of prolonged continuous glucose monitoring in toddlers with type 1 diabetes
More than 40% of very young children were able to safely use CGM on a near-daily basis after 6 months. CGM demonstrated frequent hyperglycemic excursions, with a large variability in glucose readings. Although improvement in glycemic control was not detected in the group as a whole, parental satisfaction with CGM was high (Pediatric Diabetes)

Spontaneous Normalization of Anti-Tissue Transglutaminase Antibody Levels Is Common in Children with Type 1 Diabetes Mellitus
Physicians treating children with type 1 diabetes and mildly elevated anti-TTG antibody levels might consider 12-month serologic follow-up on a gluten-containing diet rather than immediate duodenal biopsy (Digestive Diseases and Sciences)

Use of Recombinant Human Hyaluronidase to Accelerate Rapid Insulin Analog Absorption: Experience with Subcutaneous Injection and Continuous Infusion
rHuPH20 meaningfully accelerates insulin action profiles with an extent that is comparable to the difference between rapid analog profiles and those of regular insulin. Studies are currently underway to characterize the effect on diabetes management endpoints, including A1C, blood glucose, and hyperglycemia rates, of analog insulins coformulated with rHuPH20 for the management of both type-1 and type-2 diabetes (Endocrine Practice)

Intensive Diabetes Therapy and Glomerular Filtration Rate in Type 1 Diabetes
The long-term risk of an impaired GFR was significantly lower among persons treated early in the course of type 1 diabetes with intensive diabetes therapy than among those treated with conventional diabetes therapy (NEJM)

Pathogenic role of mast cells in the development of diabetic nephropathy: a study of patients at different stages of the disease
Through release of bioactive substances, such as tryptase, chymase, TGF-ß1, renin and TNF-a, into the tubular interstitium by degranulation, mast cells could promote renal inflammation and fibrosis, and thus contribute to diabetic nephropathy (Diabetologia)

Impact of Glycemic Control on Circulating Endothelial Progenitor Cells and Arterial Stiffness in Patients with Type 2 Diabetes Mellitus
In patients with type 2 DM, the level of circulating EPCs and arterial stiffness were closely related to their glycemic control. Furthermore, DM patients with satisfactory glycemic control had higher levels of circulating EPCs and were associated with lower arterial stiffness (Cardiovascular Diabetology)

Association between vitamin D and diabetic neuropathy in a nationally representative sample: results from 2001–2004 NHANES
Vitamin D insufficiency is associated with self-reported peripheral neuropathy symptoms even after adjusting for demographic factors, obesity, co-morbidities, use of medications for neuropathy and diabetes duration and control (Diabetic Medicine)

Improvements in quality of life associated with insulin analogue therapies in people with type 2 diabetes
Compared with baseline scores, beginning insulin with, or switching to, insulin analogue therapies are associated with increased HRQoL (Diabetes Research and Clinical Practice)

A pilot study of the efficacy of miglitol and sitagliptin for type 2diabetes with a continuous glucose monitoring system and incretin-related markers
Completely different response patterns of insulin, glucagon, GLP-1, and GIP were observed among the study subjects with either medication alone or in combination, suggesting that individual hormone-dependent glycemic responses to the alpha-GI and DPP-4 inhibitors are complicated and multifactorial – complete article (Cardiovascular Diabetology)

Transmembrane Emp24 Protein Transport Domain 6 is Selectively Expressed in Pancreatic Islets and Implicated in Insulin Secretion and Diabetes
TMED6 may play a functional role in islet biology, particularly in hormone production or secretion, and its dysregulation may be implicated in the development of diabetes (Pancreas)

Teva Pursues First Type 1 Diabetes Treatment Since Insulin
The therapy, DiaPep277, is made from a human protein that stops the immune system from destroying the pancreatic beta cells that secrete insulin, a hormone needed to convert sugar, starches and other food into energy. The drug also helps control sugar levels in the blood, a late-stage study showed last month (Bloomberg)

National diabetes Audit (NDA) Mortality Analysis 2007-2008
The primary purpose of this mortality analysis is to provide an initial assessment of the feasibility of using the mortality linked NDA data to provide meaningful measures of mortality in people with diabetes (NHS)

Atlas of Variation 2011
Download of Map 6: Percentage of people in the National Diabetes Audit (NDA) with Type 1 diabetes receiving all nine key care processes by PCT here (NHS)

Assessment of the under-reporting of diabetes in hospital admission data: a study from the Scottish Diabetes Research Network Epidemiology Group
Linkage of diabetes register data to hospital admissions data provides a more accurate source for measuring hospital admissions among people diagnosed with diabetes than hospital admissions data (Diabetic Medicine)

The current status of diabetes professional educational standards and competencies in the UK
Position Statement from the Diabetes UK Healthcare Professional Education Competency Framework Task and Finish Group (Diabetic Medicine)

Short- and Long-Term Effects of Real-Time Continuous Glucose Monitoring in Patients With Type 2 Diabetes
Subjects with type 2 diabetes not on prandial insulin who used RT-CGM intermittently for 12 weeks significantly improved glycemic control at 12 weeks and sustained the improvement without RT-CGM during the 40-week follow-up period, compared with those who used only SMBG (Diabetes Care)

Intensive glycemic control has no impact on the risk of heart failure in type 2 diabetic patients
Evidence from a 37,229 patient meta-analysis (American Heart Journal)

Effects of lifestyle intervention in persons at risk for type 2 diabetes
It is possible to achieve important lifestyle changes in persons at risk for type 2 diabetes with modest clinical efforts. Group intervention yields no additional effects (BMC Public Health)

PPAR? as a therapeutic target in diabetic nephropathy and other renal diseases
Peroxisome proliferator-activated receptor gamma (PPAR) agonists are effective in delaying and even preventing the progression of many renal diseases, especially diabetic nephropathy. PPAR? may represent a promising target for the treatment of renal diseases (Current Opinion in Nephrology & Hypertension)

Assessment of Automated Disease Detection in Diabetic Retinopathy Screening Using Two-Field Photography
Automated grading can safely reduce the workload of manual grading using two field, mydriatic photography in a routine screening service (PLoS ONE)

Draft Guidance – Artificial Pancreas Device Systems
Draft Guidance for Industry and Food and Drug Administration Staff – The Content of Investigational Device Exemption (IDE) and Premarket Applications for Artificial Pancreas Device Systems. This guidance document is being distributed for comment purposes only (Food and Drug Administration, USA)

Welsh Endocrinology and Diabetes Society
A new website – the Welsh Endocrinology and Diabetes Society (WEDS) was established as an educational forum for specialist physicians delivering Diabetes and Endocrinology services for the people of Wales (WEDS)

Protein oxidation markers in women with and without gestational diabetes mellitus: A possible relation with paraoxonase activity
There is evidence of a possible association between protein oxidation and decreased PON1 activity in GDM. The increase in protein oxidation parameters in the GDM group leading to decreased PON1 activity might, we think, create a predisposition for clinical complications in GDM group (Diabetes Research and Clinical Practice)

Gestational diabetes and subclinical inflammation: Evaluation of first year postpartum outcomes
Elevated hsCRP levels could be predictors of progression to T2DM later in life in patients with GDM (Diabetes Research and Clinical Practice)

Serum prolidase activity and oxidative status in patients with diabetic neuropathy
The presence of high TOS and OSI levels together with low levels of TAS in diabetic patients with or without neuropathy may support a role of oxidative stress in the pathogenesis of diabetes mellitus (Neurological Sciences)

Tracking Blood Glucose and Predicting Prediabetes in Chinese Children and Adolescents: A Prospective Twin Study
Our longitudinal study of 1,766 subjects represents the largest study to date of gender-specific tracking patterns of both FPG and 2hPG. This report contributes new information to our understanding regarding the dynamic change of plasma glucose from children to adulthood (PLoS ONE)

Differences in metabolic effects of twice daily versus multiple daily insulin injections in children with type 1 diabetes
It was concluded that MDI from diagnosis results in better glycaemic control and a trend towards less weight gain at 12 months than BD. Children who start on BD and then switch to MDI after 12 months do not show the same benefit (Practical Diabetes)

Oral Care Practices and A1C Among Youth With Type 1 and Type 2 Diabetes
Clinicians should beware that children with diabetes tend to have poor oral hygiene practices. Dry mouth may indicate periodontal bone loss in children with diabetes (Journal of Periodontology)

New iInvestigational compound Dapagliflozin
New data show investigational compound dapagliflozin when added to glimepiride maintained reductions in blood sugar levels in adults with type 2 diabetes over 48 weeks of treatment (Bristol-Myers Squibb)

Ranibizumab for the treatment of diabetic macular oedema
Ranibizumab (Lucentis, Novartis) is not recommended for the treatment of visual impairment due to diabetic macular oedema (NICE)

Evaluation of Nonfasting Tests to Screen for Childhood and Adolescent Dysglycemia
HbA1c had poor discrimination, which could lead to missed cases of dysglycemia in children. Random glucose or 1-h GCT may potentially be incorporated into clinical practice as initial screening tests for prediabetes or diabetes and for determining which children should undergo further definitive testing (Diabetes Care)

Risk models and scores for type 2 diabetes: systematic review
Much work has been done to develop diabetes risk models and scores, but most are rarely used because they require tests not routinely available or they were developed without a specific user or clear use in mind Encouragingly, recent research has begun to tackle usability and the impact of diabetes risk scores (BMJ)

Increased Risk of Urinary Tract Calculi Among Patients with Diabetes Mellitus—A Population-based Cohort Study
This cohort study provides epidemiologic support for the causal association between diabetes and UTC, which is independent of UTI. In addition, female patients with UTI accompanied by diabetes tended to be associated with a greater rate of UTC (Urology)

Intracellular pathways of pancreatic ß-cell apoptosis in type 1 diabetes
Bid-deficient islets are protected from recombinant human perforin and granzyme B, as well as from Fas-mediated killing. This makes Bid a target for protection of ß cells from multiple insults relevant to type 1 diabetes (Diabetes/Metabolism Research and Reviews)

Altered Insulin Receptor Signalling and ß-Cell Cycle Dynamics in Type 2 Diabetes Mellitus
These data may have important implications for therapeutic efforts to counter hyperglycemia in patients with type 1 or type 2 diabetes that are focused on the regenerative potential of ß-cells (PLoS ONE)

Increased expression of microRNA miR-326 in type 1 diabetic patients with ongoing islet autoimmunity
miR-326 is expressed at higher levels in T1D subjects with ongoing islet autoimmunity, similar to what has been observed in multiple sclerosis, in which levels of this microRNA were highly correlated with disease severity. Interestingly, an online search of miR-326 predicted targets revealed vitamin D receptor and Erythroblastosis virus E26 oncogene homologue 1, two molecules highly involved in immune regulation (Diabetes/Metabolism Research and Reviews)

Surgical Offloading Surgery of the Diabetic Foot
Video presentation (present PODIATRY)

Aligning actions in the Routemap with the Healthy Weight Outcomes Framework
This paper introduces an outcomes framework to support outcome-focused approaches for healthy weight. The resources are intended to support partners (particularly those developing Single Outcome Agreements) focus on key outcomes, ways of achieving them and ways of measuring them (NHS Health Scotland)

Myocardial perfusion imaging and risk classification for coronary heart disease in diabetic patients
The addition of MPS imaging data to a prediction model based on traditional risk factors and ECG stress test data significantly improved CHD risk classification in patients with diabetes (European Journal of Nuclear Medicine and Molecular Imaging)

ONGLYZA® (saxagliptin) Approved for Use in Europe as Combination Therapy With Insulin (With or Without Metformin) in Adults With Type 2 Diabetes
The approval was based on Phase 3b 24-week data submitted to the European Medicines Agency which showed that ONGLYZA 5 mg added to insulin (with or without metformin) significantly reduced blood sugar levels (glycosylated hemoglobin levels, or HbA1c) in adult patients with type 2 diabetes, compared to treatment with placebo added to insulin – with or without metformin (Bristol-Myers Squibb)

Andromeda announces Phase III Clinical Study with DiaPep277®, a Novel Immunotherapeutic Agent for Type 1 Diabetes, Met Primary Endpoint
The 24-month study was randomized, placebo-controlled, designed to assess the safety and efficacy of DiaPep277®, a novel immunotherapeutic agent for the treatment of newly diagnosed patients with Type 1 Diabetes (AndromedA)

Mother of five wins award for diabetes website
Angela Allison, a Preston mother of five, was winner of the inaugural Quality in Care (QiC) Diabetes People’s Award last week. The awards ceremony was held at Sanofi’s headquarters in Guildford on Wednesday November 16 (Diabetes UK)

Medtronic Receives FDA Approval for Next Generation Professional Continuous Glucose Monitoring
iPro®2 Simplifies Professional CGM for Improved Diabetes Therapy Management (Medtronic)

Short- and Long-Term Effects of Real-Time Continuous Glucose Monitoring in Patients With Type 2 Diabetes
Subjects with type 2 diabetes on prandial insulin who used RT-CGM intermittently for 12 weeks significantly improved glycemic control at 12 weeks and sustained the improvement without RT-CGM during the 40-week follow-up period, compared with those who used only SMBG (Diabetes Care)

Repeat measurements of glycated haemoglobin A1c and N-terminal pro-B-type natriuretic peptide: divergent behaviour in diabetes mellitus
N-terminal pro-B-type natriuretic peptide and HbA1c concentrations significantly diverged over a 1-year period. NT-proBNP was the most potent predictor of outcome at baseline and follow-up, and changes in NT-proBNP concentrations were linked to an altered risk profile, unlike changes in HbA1c levels (European Journal of Clinical Investigation)

Impact of FDA Guidance for Developing Diabetes Drugs on Trial Design: From Policy to Practice
The present review summarizes current attempts to streamline trial design and management to meet the requirements efficiently while adhering to the highest scientific standards (Metapress)

New-onset diabetes and cardiovascular events in essential hypertensives: A 6-year follow-up study
Our findings indicate the high incidence of NOD and its close association with stroke in essential hypertension. Poorer control of hypertension appears to be a common denominator of both NOD and stroke in this setting (International Journal of Cardiology)

Influence of preprandial vs. postprandial insulin glulisine on weight and glycaemic control in T2D
Postprandial glulisine administration provided similar glycaemic control and was non-inferior to preprandial administration on weight gain, without additional risk of severe hypoglycaemia, showing dosing flexibility and the feasibility of such approach when clinically indicated (Diabetes, Obesity and Metabolism)

Haptoglobin Genotype Predicts Development of Coronary Artery Calcification in a Prospective Cohort of Patients with Type 1 Diabetes
Hp genotype may aid prediction of accelerated coronary atherosclerosis in subjects with type 1 diabetes. Hp genotype did not predict CAC progression in individuals without diabetes (Cardiovascular Diabetology)

Renal responses to three types of renin–angiotensin system blockers in patients with diabetes mellitus on a high-salt diet: a need for higher doses in diabetic patients?
The relative resistance of the renal renin response to acute (irbesartan) and chronic (irbesartan and aliskiren) renin–angiotensin system blockade supports the concept of an activated renal renin–angiotensin system in diabetes, particularly at the level of the juxtaglomerular cell, and implies that diabetic patients might require higher doses of renin–angiotensin system blockers to fully suppress the renal renin–angiotensin system (Journal of Hypertension)

Intensive Diabetes Therapy and Glomerular Filtration Rate in Type 1 Diabetes
The long-term risk of an impaired GFR was significantly lower among persons treated early in the course of type 1 diabetes with intensive diabetes therapy than among those treated with conventional diabetes therapy (NEJM)

Preventing type 2 diabetes
Risk identification and interventions for individuals at high risk: draft guidance consultation. Consultation dates: 9 November 2011 – 9 January 2012 (NICE)

Periodontitis and diabetes: a two-way relationship
There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis (Diabetologia)

Molecular changes in diabetic foot ulcers
ESWT showed significant increases in angiogenesis and tissue regeneration over HBOT in diabetic foot ulcers (Diabetes Research and Clinical Practice)

Asthma and allergic symptoms and type 1 diabetes-related autoantibodies in 2.5-yr-old children
We conclude that allergic symptoms are associated with the development of T1D-related autoantibodies during the first years of life (Pediatric Diabetes)

Mast cell stabilization: novel medication for obesity and diabetes
Mechanistic studies suggest that mast cells participate in these metabolic disorders by affecting energy expenditure, protease expression, angiogenesis, apoptosis, and preadipocyte differentiation. These observations open a new era of basic research regarding mast cells, and offer hope to patients suffering from these metabolic disorders (Diabetes/Metabolism Research and Reviews)

Epigenetics and diabetic cardiomyopathy
In this article, we review current literature on the epigenetic mechanisms involved in diabetes and discuss recent evidence of epigenetic changes that may play an important role in pathophysiology of DCM (Diabetes Research and Clinical Practice)

Diabetes mellitus and risk of gastric cancer: a systematic review and meta-analysis of observational studies
These findings of this systematic review indicate that compared with nondiabetic individuals, diabetic women have an 18% increased risk of GC development. However, diabetic men have a similar risk of GC (European Journal of Gastroenterology & Hepatology)

Comparing the effects of insulin glargine and thiazolidinediones on plasma lipids in type 2 diabetes: a patient-level pooled analysis
These findings suggest that favorable effects on plasma lipid profiles should be considered among the attributes of treatment with insulin glargine as they are for TZDs (Diabetes/Metabolism Research and Reviews)

GSK Receives Initial Data From the First Completed Phase Lll Study of Albiglutide in Type 2 Diabetes
Results showed a reduction in HbA1c of 0.78% for patients receiving albiglutide compared to a reduction of 0.99% for liraglutide. While albiglutide did demonstrate a statistically significant reduction in HbA1c from baseline (p<0.001), it did not meet the pre-specified primary endpoint of non-inferiority to liraglutide (95% CI: 0.08 – 0.34%) (GlaxoSmithKline)

Encapsulated pancreatic progenitors derived from human embryonic stem cells as a therapy for insulin-dependent diabetes
Prior to transplanting, cells are encapsulated in alginate to prevent the immune cells of recipient attacking the graft. The alginate capsules have pores with a molecular weight cut-off of 250 kDa. These are too small to allow entry of immune cells, but large enough for passage of nutrients and insulin (Diabetes/Metabolism Research and Reviews)

Needle-free diabetes treatment wins award
The insulin mimetic currently under development is a small molecule that mimics the effects of insulin, and is suitable for sufferers of both Type 1 and Type 2 diabetes. It is hoped replacing painful injections with a pill will help more diabetics comply with their treatment (Curtin University, Australia)

A Light and Portable Novel Device for Diabetic Retinopathy Screening
Given that the EyeScan requires minimal training to use and has excellent diagnostic accuracy in screening for diabetic retinopathy, it could be potentially utilized by the primary eye care providers to widely screen for diabetic retinopathy in the community (Clinical & Experimental Ophthalmology)

Prevalence and significance of lactic acidosis in diabetic ketoacidosis
Lactic acidosis is more common in DKA than traditionally appreciated and is not associated with increased ICU LOS or mortality. The positive correlation of lactate with glucose raises the possibility that lactic acidosis in DKA may be due not only to hypoperfusion but also to altered glucose metabolism (Journal of Critical Care)

Hypoglycemia-associated Mortality Is Not Drug-associated but Linked to Comorbidities
Drug-associated hypoglycemia was not associated with increased mortality risk in patients admitted to the general wards. The association between spontaneous hypoglycemia and mortality was eliminated after adjustment for comorbidities, suggesting that hypoglycemia may be a marker of disease burden rather than a direct cause of death (American Journal of Medicine)

The duration of diabetes affects the response to intensive glucose control in type 2 subjects: the VA Diabetes Trial
In difficult-to-control older subjects with type 2 DM, duration of diabetes altered the response to intensive glucose control. Intensive therapy may reduce CV events in subjects with a duration of 15 years or less and may increase risks in those with longer duration (Journal of Diabetes and Its Complications)

Development of a minimal set of prescribing quality indicators for diabetes management on a general practice level
We showed that a minimal set of prescribing quality indicators for type 2 diabetes mellitus care should not just focus on the management of different clinical risk factors but also reflect different steps of treatment intensification (Pharmacoepidemiology and Drug Safety)

A Primer on Diabetes for the astute Podiatrist
Dr Tamler reviews diabetes as it relates to the podiatrist. Arguing that podiatric physicians are on the front lines of the diabetes epidemic, Dr Tamler discusses when and how to screen for diabetes and what to do with the results obtained therein (presentPODIATRY)

Outcome of pregnancy in type 1 diabetes mellitus (T1DMP): results from combined diabetes–obstetrical clinics in Dublin in three university teaching hospitals (1995–2006)
Pregnancy outcomes in T1DMP remain worse than in the general population despite management of T1DMP in combined obstetric/diabetes clinics in a single centre using similar management protocols (Irish Journal of Medical Science)

Lilly and Amylin Mutually Agree to End Diabetes Alliance and Transition Exenatide Responsibility to Amylin
After nearly a decade-long partnership that achieved a number of important milestones on behalf of people living with diabetes, the companies determined it was in the best interest of all constituents to amicably terminate the collaboration (Lilly)

A big thank you to Lilly for renewing their unrestricted grant for 2012. Jim Young. Editor

Inpatient diabetes – £600 million excess outlay could be reduced with specialist care
The research, titled ‘Inpatient Care for People with Diabetes: The Economic Case for Change (PDF 10.5MB)’, found that the NHS in England spends more than £2.3 billion a year on inpatient care for people with diabetes. That’s 11% of NHS inpatient care expenditure (NHS Diabetes)

Diabetes diagnosis rates driven up by GP practices
Practices in England are closing the gap between detected cases of diabetes and true levels of disease, QOF data suggest (GP)

Which Anthropometric Parameter Is Best Related With Urinary Albumin Excretion and Creatinine Clearance in Type 2 Diabetes
Among the anthropometric parameters, only an increase in WC was found to be independently related to 24-hour 24-hour urinary albumin excretion rate (Journal of Renal Nutrition)

Age-Corrected Beta Cell Mass Following Onset of Type 1 Diabetes Mellitus Correlates with Plasma C-Peptide in Humans
Given the correlation between beta cell mass and plasma C-peptide following onset, plasma C-peptide may provide a surrogate measure of beta cell mass in humans. The clinical relevance of this study is that therapeutic strategies that provide an increase in plasma C-peptide over the predicted value for an individual may actually improve beta cell mass (PLoS ONE)

A Longitudinal Study of GAD65 and ICA512 Autoantibodies During the Progression to Type 1 Diabetes in Diabetes Prevention Trial–Type 1 (DPT-1) Participants
IA-2A titers increase during the years before the diagnosis of T1D, even among those positive for IA-2A. In contrast, GADA titers tend to decline during those years (Diabetes Care)

Sensors for Medicine and Science Raises $54.1 million Series D Financing
Sensors for Medicine and Science, Inc. (SMSI), a privately held medical device company focused on the development and commercialization of the first fully implantable, long-term continuous glucose monitoring (CGM) system for people with diabetes, announced today a $54.1 million Series D equity financing (Sensors for Medicine and Science)

Medtronic Receives IDE Approval to Conduct Aspire In-Home Study of First Insulin Pump with Low Glucose Suspend for US Market
A Critical Step Toward the Development of an Artificial Pancreas, Low Glucose Suspend Aims to Reduce Hypoglycemia (Medtronic)

Alogliptin as a third oral antidiabetic drug in patients with type 2 diabetes and inadequate glycaemic control on metformin and pioglitazone 52-week, randomized, double-blind, active-controlled, parallel-group study
Adding alogliptin to an existing metformin–pioglitazone regimen provided superior glycaemic control and potentially improved ß-cell function versus uptitrating pioglitazone in patients with type 2 diabetes, with no clinically important differences in safety (Diabetes, Obesity and Metabolism)

Therapeutic Modalities in Diabetic Nephropathy: Standard and Emerging Approaches
This review highlights the available standard therapeutic approaches to manage progressive diabetic nephropathy, including markers for early diagnosis of diabetic nephropathy. Furthermore, we will discuss emerging strategies such as PPAR-gamma agonists, Endothelin blockers, vitamin D activation and inflammation modulation. Finally, we will summarize the recommendations of these interventions for the primary care practitioner (Journal of General Internal Medicine)