Diabetes News

Type 1 diabetes: review decision
Review recommendation The guideline should be updated at this time (NICE)

Briefing on the NHS Atlas of Variation in Healthcare: Diabetes
A briefing paper describing forthcoming work on the NHS Atlas of Variation in Healthcare by the National Diabetes Information Service (YHPHO)

Diabetes Footcare Activity Profiles
The Diabetes Footcare Activity Profiles have been developed to provide information on the inpatient care of people with diabetes who are admitted to hospital for a range of footcare conditions – Downloads (YHPHO)

Relationship between vascular stiffness and stress myocardial perfusion imaging in asymptomatic patients with diabetes
Vascular stiffness measured by pulse wave velocity is associated with severe myocardial perfusion imaging defects in asymptomatic patients with diabetes (European Journal of Nuclear Medicine and Molecular Imaging)

Cardiac Geometry and Function in Diabetic or Prediabetic Adolescents and Young Adults
In a population of adolescents and young adults, DM is independently associated with early unfavorable cardiovascular phenotype characterized by increased left ventricular mass, concentric geometry, and early preclinical systolic and diastolic dysfunction; early cardiovascular alterations are also present in participants with prediabetes (Diabetes Care)

Changes in Altitude Cause Unintended Insulin Delivery From Insulin Pumps
Atmospheric pressure reduction causes predictable, unintended insulin delivery in pumps by bubble formation and expansion of existing bubble (Diabetes Care)

Association Between Type 2 Diabetes and Exposure to Persistent Organic Pollutants
This study confirms the association between type 2 diabetes and adult-only exposure to organochlorine pesticides in a general urban population (Diabetes Care)

Opticians ‘should offer blood sugar checks’
While universal screening is not currently recommended, Durham University researchers say there is a case for targeted screening. Their study was published in the British Journal of General Practice (BBC)

Telomere Dysfunction–Related Serological Markers Are Associated With Type 2 Diabetes
Serological N-acetyl-glucosaminidase, telomere length, and the UCP2–886G>A variant are independent risk factors for type 2 diabetes (Diabetes Care)

Rituximab Selectively Suppresses Specific Islet Antibodies
A single course of rituximab differentially suppresses IAAs, clearly blocking IAAs for >1 year in insulin-treated patients (Diabetes)

Linagliptin
Linagliptin is the only DPP-4 inhibitor to be approved at one dosage strength for adults with type 2 diabetes in Europe, without any need for dose adjustments (Lilly)

Hi–tech diabetes aid will send alert text in emergency
A hi-tech diabetes blood glucose monitor is being developed in Wales that will send a text alert to emergency personnel if the patient is in danger of hypoglycaemia attack (Welsh Government)

Prescribing for Diabetes in England 2005/06 to 2010/11
This report is the latest in a series of publications on diabetes by The NHS Information Centre. It covers the period 2005/06 to 2010/11 (NHS Information Centre, UK)

Reduced Serum Vitamin D-Binding Protein Levels Are Associated With Type 1 Diabetes
Serum VDBP levels are decreased in those with type 1 diabetes. These studies suggest that multiple components in the metabolic pathway of vitamin D may be altered in type 1 diabetes and, collectively, have the potential to influence disease pathogenesis (Diabetes)

Early Second-Trimester Serum MiRNA Profiling Predicts Gestational Diabetes Mellitus
Serum miRNAs are differentially expressed between GDM women and controls and could be candidate biomarkers for predicting GDM (PLoS)

Colesevelam HCI Added to Background Metformin Therapy in Patients With Type 2 Diabetes Mellitus
When added to metformin-including therapy, colesevelam HCI reduced HbA1c and significantly reduced LDL-C, TC, non-HDL-C, and apoB in patients with inadequately controlled T2DM (Endocrine Practice)

The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status
Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time

Quality of Medical Care in Diabetic Women Undergoing Fertility Treatment – We should do better
The periconception medical care of diabetic women who undergo fertility treatment is suboptimal and no better than that of diabetic women with spontaneous pregnancies. More intensive and targeted counseling regarding the importance of folic acid and glycemic control is needed to optimize periconception care of these diabetic patients (Diabetes Care)

Involvement of microparticles in diabetic vascular complications
This study demonstrates that MP characteristics are related to the specific type of vascular complications and may serve as a bio-marker for the pro- coagulant state and vascular pathology in patients with T2DM (Thrombosis and Haemostasis)

Glucose-Raising Genetic Variants in MADD and ADCY5 Impair Conversion of Proinsulin to Insulin
By examining parameters of glucose-stimulated proinsulin-to-insulin conversion during an OGTT, we show that the SNP in ADCY5 is implicated in defective proinsulin-to-insulin conversion (PLoS)

Growth Factors and Active Skin Substitutes for the Treatment of Non-Infected Diabetic Foot Ulcers
Add-on therapy with growth factors and active skin substitutes for treating uncomplicated DFU could be an alternative to SWC alone (Experimental and Clinical Endocrinology & Diabetes)

The role of chronic kidney disease as a predictor of outcome after revascularisation of the ulcerated diabetic foot
CKD is a formidable risk factor for poor intermediate outcome after infrainguinal revascularisation in diabetic patients with foot ulcer or gangrene (Diabetologia)

M3 USA Acquires Doctors.net.uk, Largest Physician Network in the United Kingdom
The acquisition follows on the heels of M3’s November 2010 purchase of London-based EMS Research, further strengthening M3’s reach into the European Union in terms of physician access, pharmaceutical product promotion, and market research (M3 USA)

Diabetic retinopathy
The number of people who have been offered screening for diabetic retinopathy as part of a systematic programme that meets national standards – April to June 2011 (DoH)

Exudate-based Diabetic Macular Edema Detection in Fundus Images Using Publicly Available Datasets
In this work, we introduce a new methodology for diagnosis of DME using a novel set of features based on colour, wavelet decomposition and automatic lesion segmentation (Medical Image Analysis)

Random Blood Glucose Measurement at Antenatal Booking to Screen for Overt Diabetes in Pregnancy
RBG at booking may provide a sufficiently sensitive screening tool for the detection of ODIP. We recommend further studies and comparison with fasting glucose and HbA1c (Diabetes Care)

Pathway to diabetes through attenuation of pancreatic beta cell glycosylation and glucose transport
We report a combination of molecular events in human and mouse pancreatic beta cells, induced by elevated levels of free fatty acids or by administration of a high-fat diet with associated obesity, that comprise a pathogenic pathway to diabetes (Nature Medicine)

Oral cholecalciferol decreases albuminuria and urinary TGF-ß1 in patients with type 2 diabetic nephropathy on established renin–angiotensin–aldosterone system inhibition
This is the first study, to our knowledge, showing these beneficial effects of nutritional vitamin D supplementation in diabetic patients with CKD treated with RAAS inhibition (Kidney International)

Promoting Physical Activity in Individuals With Diabetes: Telehealth Approaches
This article provides an overview of telephone, Internet-based, and home-based monitoring interventions that promote physical activity, with a focus on those with diabetes. It also discusses the potential advantages of using telehealth interventions in this context (Diabetes Spectrum)

Effectiveness and safety of a glucose data-filtering system with automatic response software to reduce the physician workload in managing type 2 diabetes
The study showed the efficacy and safety of the software for online communication in diabetes management. The results suggest that it could improve the cost-effectiveness of online communication systems and form the basis of future clinical applications (Journal of Telemedicine & Telecare)

Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control
The combination of behavioral mobile coaching with blood glucose data, lifestyle behaviors, and patient self-management data individually analyzed and presented with evidence-based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year (Diabetes Care)

Teplizumab for treatment of type 1 diabetes (Protégé study): 1-year results from a randomised, placebo-controlled trial
Findings of exploratory analyses suggest that future studies of immunotherapeutic intervention with teplizumab might have increased success in prevention of a decline in ß-cell function (measured by C-peptide) and provision of glycaemic control at reduced doses of insulin if they target patients early after diagnosis of diabetes and children (The Lancet)

Recurrent Diabetic Ketoacidosis in Inner-City Minority Patients
Several behavioral, socioeconomic, psychosocial, and educational factors contribute to poor compliance. The recognition of such factors and the institution of culturally appropriate interventions and education programs might reduce DKA recurrence in minority populations (Diabetes Care)

Increased risk of glucose intolerance and type 2 diabetes with statins
Accumulating evidence suggests that statins worsen glucose tolerance and possibly cause type 2 diabetes (Editorial BMJ)

MHRA Drug Safety Update: Risk of bladder cancer with pioglitazone
The August 2011 issue of Drug Safety Update from the MHRA features an article on the small increased risk of bladder cancer associated with use of pioglitazone, including the recently reported outcome of a European review (National electronic Library for Medicines)

Actos (pioglitazone): Ongoing Safety Review – Potential Increased Risk of Bladder Cancer
The U.S. Food and Drug Administration (FDA) is informing the public that the Agency has approved updated drug labels for the pioglitazone-containing medicines to include safety information that the use of pioglitazone for more than one year may be associated with an increased risk of bladder cancer (FDA)

Panel Pressures FDA to Expedite Development of Artificial Pancreas
The Juvenile Diabetes Research Foundation (JDRF) sent delegates to Congress on June 22, urging legislators to speed up R&D efforts to develop new treatment of the disease and accelerate approval of new treatment technologies and to find a cure for the disease (MD+DI)

Amarantus BioSciences and Generex Biotechnology Collaborate on Cell Therapy for Late Stage Diabetes
In this third research project, the companies will use Amarantus’ proprietary PhenoGuard cell immortalization process to develop beta cell replacement therapies to aid diabetes therapy (Generex)

A large multi-centre European study validates high-sensitivity C-reactive protein (hsCRP) as a clinical biomarker for the diagnosis of diabetes subtypes
In the largest study to date, we have established that hsCRP is a clinically valid biomarker for HNF1A-MODY in European populations. Given the modest costs and wide availability, hsCRP could translate rapidly into clinical practice, considerably improving diagnosis rates in monogenic diabetes (Diabetologia)

Glucose-dependent insulinotropic polypeptide: from pathophysiology to therapeutic opportunities in obesity-associated disorders
Emerging evidence also suggests that the metabolic benefits of bypass surgery are mediated, at least in part, by surgical removal of GIP-secreting K-cells in the upper small intestine (Obesity Reviews)

Hyperinsulinemia Induces Insulin Resistance in Dorsal Root Ganglion Neurons
Our results suggest a new theory for the etiology of diabetic neuropathy, i.e. that, similar to insulin dependent tissues, neurons develop IR and, in turn, cannot respond to the neurotrophic properties of insulin, resulting in neuronal injury and the development of neuropathy (Endocrinology)

Transcriptome Analysis of Human Diabetic Kidney Disease
Our studies have cataloged gene-expression regulation and identified multiple novel genes and pathways that may play a role in the pathogenesis of DKD or could serve as biomarkers (Diabetes)

Bydureon™ FDA action date set for January 28, 2012
The FDA has categorized it as a Class 2 resubmission requiring up to six months for review and assigned a new Prescription Drug User Fee Act (Lilly)

FDA grants Orphan Drug Designation to Kamada’s AAT product for type 1 diabetes
Kamada is currently undergoing a Phase I/II clinical trial with its FDA approved AAT by IV route of administration, for the treatment of type 1 diabetes (News Medical)

Changes to driving regulations for diabetics to be brought forward
Following a ministerial announcement earlier in July 2011, the DVLA intend to bring forward changes to the driving regulations affecting driving and diabetes from October this year. Further information can be found in this letter from the DVLA (NHS Diabetes)

Charities call for NICE to reconsider Lucentis decision
Diabetes UK, along with three other UK charities, have launched an appeal against a NICE (National Institute for Health and Clinical Excellence) decision that could lead to thousands of people with diabetes needlessly losing their sight (Diabetes UK)

Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults
A systematic review (BMJ)

New Horizons in Diabetes
A one-day symposium for experienced diabetologists that centres on advanced clinical science and clinical practice in the treatment of Type 1 and Type 2 diabetes (PriMed)

Effect of metformin on survival outcomes in diabetic patients with triple receptor-negative breast cancer
The findings of the current study suggest that metformin use during adjuvant chemotherapy does not significantly impact survival outcomes in diabetic patients with TNBC (Cancer)

Obesity and symptoms suggestive of gastroparesis in patients with type 2 diabetes and neuropathy
Obesity emerged as a significant independent predictor of cardinal symptoms suggestive of gastroparesis in patients with T2DM and neuropathy. This finding suggests that mechanisms in addition to neuropathy play a role in the generation of symptoms suggestive of gastroparesis in this patient population (Journal of Diabetes and Its Complications)

The facts about fasting During Ramadan
Ramadan 2011 booklet for people with type 2 Diabetes (South Asian Health Foundation)

Victoza, modern insulins drive growth at Novo Nordisk
Novo Nordisk has posted a healthy set of figures for the first half, helped by strong sales of new diabetes drug Victoza, and has slightly raised its outlook for the full year (PharmaTimes)

Different Metabolic Responses of Human Brown Adipose Tissue to Activation by Cold and Insulin
BAT appears to be differently activated by insulin and cold; in response to insulin, BAT displays high glucose uptake without increased perfusion, but when activated by cold, it dissipates energy in a perfusion-dependent manner (Cell Metabolism)

Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes
The overall results of this meta-analysis show limited benefits of intensive glucose lowering treatment on all cause mortality and deaths from cardiovascular causes (BMJ)

Achieved Levels of HbA1c and Likelihood of Hospital Admission in People With Type 1 Diabetes in the Scottish Population
People with type 1 diabetes with highest and lowest mean HbA1c values were associated with increased odds of admission – Achieved Levels of HbA1c and Likelihood of Hospital Admission in People With Type 1 Diabetes in the Scottish Population (Diabetes Care)

Number of HbA1c tests unrelated to quality of diabetes control: An electronic medical record data linkage study
A unique primary care electronic medical record-health administrative database linkage found no clinically meaningful relationship between control (HbA1c value) and number of tests performed, casting doubt on the usefulness in diabetes performance and quality of care assessment (Diabetes Research and Clinical Practice)

Metformin improves the hepatic insulin resistance index independently of anthropometric changes
Metformin improves HIRI independently of anthropometric changes. In persons with elevated HIRI levels, metformin may be considered among the treatment options (Endocrine Practice)

Fasting insulin reflects heterogeneous physiological processes: role of insulin clearance
Fasting insulin is a complex phenotype influenced by several independent processes, each of which might have its own environmental and genetic determinants. One of the most associated traits was insulin clearance, which has implications for studies that have used fasting insulin as a surrogate for insulin resistance (American Physiological Society)

European Medicines Agency recommends new contra-indications and warnings for pioglitazone to reduce small increased risk of bladder cancer
The CHMP also concluded that the small increased risk could be reduced by appropriate patient selection and exclusion, including a requirement for periodic review of the efficacy and safety of the individual patient’s treatment (European Medicines Agency)

FDA Advisory Committee Makes Recommendation on Investigational Compound Dapagliflozin
On the question: “Do the efficacy and safety data provide substantial evidence to support approval of dapagliflozin as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus?” the Advisory Committee voted 6 yes and 9 no (World Pharma News)

Takeda resubmits NDA for new diabetes drug alogliptin
Akeda Pharmaceutical Co has resubmitted two New Drug Applications to regulators in the USA for its investigational type 2 diabetes therapy alogliptin and the fixed-dose combination of the drug and the Japanese drugmaker’s Actos – pioglitazone (PharmaTimes)

Bydureon Reply Submitted to FDA
The reply submission includes results from the recently completed thorough QT (tQT) study, which showed that exenatide, at and above therapeutic levels, did not prolong the corrected QT interval in healthy individuals as defined by the FDA’s published guidance (PharmaLive)

Bardoxolone Methyl and Kidney Function in CKD with Type 2 Diabetes
Bardoxolone methyl was associated with improvement in the estimated GFR in patients with advanced CKD and type 2 diabetes at 24 weeks. The improvement persisted at 52 weeks, suggesting that bardoxolone methyl may have promise for the treatment of CKD (NEJM)

Isis Initiates Phase 1 Study of ISIS-PTP1BRx to Treat Type 2 Diabetes
ISIS-PTP1BRx is designed to increase the body’s sensitivity to the natural hormone insulin, resulting in better glucose control for patients with type 2 diabetes (ISIS Pharmaceuticals)

Ranibizumab is not recommended for the treatment of visual impairment due to diabetic macular oedema
People currently receiving ranibizumab for the treatment of visual impairment due to diabetic macular oedema should have the option to continue treatment until they and their clinicians consider it appropriate to stop (NICE)

Glycaemic control and incidence of heart failure in 20,985 patients with type 1 diabetes: an observational study
The positive association between HbA1c and risk of heart failure in fairly young patients with type 1 diabetes indicates a potential for prevention of heart failure with improved glycaemic control (The Lancet)

Screening for overt diabetes by oral glucose tolerance test
Stratification by fasting blood glucose and patients’ age improve practicability of guidelines in cardiological routine (International Journal of Cardiology)

Association issues position statement on use of A1C in the diagnosis of type 2 diabetes in adults
In a position statement published in the July 2011 issue of the Canadian Journal of Diabetes, the Canadian Diabetes Association recommends an A1C >6.5% as a new diagnostic criteria for type 2 diabetes in adults (Canadian Diabetes Association)

Relationship of glycemia control to lipid and blood pressure lowering and atherosclerosis: the SANDS experience
In diabetic adults with no cardiovascular disease events, A1c was negatively associated with ability to achieve LDL-C, non-HDL-C and SBP goals but was not independently related to treatment-associated changes in CIMT or LVMI over 36 months (Journal of Diabetes and Its Complications)

Oral antiplatelet therapy in diabetes mellitus and the role of prasugrel: an overview
The findings confirm the general hypothesis that more potent oral antiplatelet therapy can partially overcome the prothrombotic milieu and safely improve important clinical outcomes in diabetics (Vascular Health and Risk Management)

Continuous Glucose Monitoring in Gastroparesis
Blood glucose monitoring provides insight to the presence of gastroparesis in diabetic patients: diabetic gastroparetics had prolonged postprandial hyperglycemic profile as compared to non-gastroparetic diabetics (Digestive Diseases and Sciences)

National Diabetes Audit Paediatric Report 2009-2010
19,558 records on children and young people, (0-24 years of age), from 155 paediatric units, were submitted to the 2009–2010 audit (NHS)

NHS Diabetes responds to the National Diabetes Paediatric Audit
Commenting on the audit findings, Anna Morton, Director of NHS Diabetes, said, “The audit shows that there is still much to be done to improve care for children and young people with diabetes, particularly around managing blood glucose levels and preventing potentially fatal diabetic ketoacidosis or DKA (NHS Diabetes)

Temporal Trends in the Prevalence of Diabetic Kidney Disease in the United States
Prevalence of DKD in the United States increased from 1988 to 2008 in proportion to the prevalence of diabetes. Among persons with diabetes, prevalence of DKD was stable despite increased use of glucose-lowering medications and renin-angiotensin-aldosterone system inhibitors (JAMA)

Uncertainties in the measurement of blood glucose in paediatric intensive care: implications for clinical trials of tight glycaemic control
Variation introduced by different devices, sample or source may have led to misclassification of treatment decisions contributing to the conflicting results of TGC studies (Intensive Care Medicine)

Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review
Multiple factors affect the risk of developing diabetic ketoacidosis at the onset of type 1 diabetes in children and young adults, and there is potential time, scope, and opportunity to intervene between symptom onset and development of diabetic ketoacidosis for both parents and clinicians (BMJ)

Comparison of diagnostic criteria to detect undiagnosed diabetes in hyperglycaemic patients with acute coronary syndrome
As APG, HbA1c and FPG had a low sensitivity to detect undiagnosed diabetes, an OGTT appears to be the best test to assess the presence of previously undiagnosed diabetes or impaired glucose metabolism in hyperglycaemic patients with ACS (Heart)

Improved Pharmacokinetic and Pharmacodynamic Profile of Rapid-Acting Insulin Using Needle-Free Jet Injection Technology
Administration of insulin aspart by jet injection enhances insulin absorption and reduces the duration of glucose-lowering action. This profile resembles more closely the pattern of endogenous insulin secretion and may help to achieve better meal insulin coverage and correction of postprandial glucose excursions (Diabetes Care)

The dynamic insulin sensitivity and secretion test – a novel measure of insulin sensitivity
The DISST is a simple, dynamic test that compares favorably with the clamp in assessing SI and allows simultaneous assessment of insulin secretion. The DISST has the potential to provide even more information about the pathophysiology of diabetes than more complicated tests (Metabolism – Clinical and Experimental)

Setting up an Insulin Safety Group: A Practical Approach
Insulin related drug errors are a significant source of adverse incidents in the in-patient hospital setting. Here is a practical guide to setting up an insulin safety group in your hospital (Young Diabetologists)

Lack of confidence among trainee doctors in the management of diabetes
The Trainees Own Perception of Delivery of Care (TOPDOC) Diabetes Study (QJM)

Postprandial hyperlipidemia, endothelial dysfunction and cardiovascular risk: focus on incretins
This review discusses (1) the postprandial state with special emphasis on postprandial lipid metabolism and its role in endothelial dysfunction and cardiovascular risk, (2) the ability of incretins to modulate postprandial hyperlipidemia and (3) the potential of incretin-based therapeutic strategies to improve vascular function and reduce CVD risk (Cardiovascular Diabetology)

Exenatide tQT Study Showed No Prolongation of QT Interval
This randomized double-blind study, designed in accordance with the FDA’s published guidance on clinical evaluation of QT/QTc interval (ICH E14), compared the effects of exenatide at or above therapeutic concentrations to placebo on the QT interval in approximately 75 healthy volunteers (Lilly)