Diabetes News

Impact of Statins on the Coagulation Status of Type 2 Diabetes Patients Evaluated by a Novel Thrombin-Generation Assay
The use of a standardized, easy-to-run, and commercially available APC-dependent thrombin-generation assay detected the presence of a procoagulant status in a large series of patients with long-standing T2D and demonstrated a significant impact of statins in the coagulation status of patients with T2D (Cardiovascular Drugs and Therapy)

Thrombin generation in type 2 diabetes with albuminuria and macrovascular disease
Our results support the hypothesis that TG may be involved in the pathogenesis of MVD in diabetic nephropathy as for the first time, we could show that patients with T2DM in different stages of diabetic nephropathy had disturbances in thrombin generation (European Journal of Clinical Investigation)

Effects of a combination of oral anti-diabetes drugs with basal insulin therapy on ß-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes
In newly diagnosed type 2 diabetes, therapy with oral drugs+insulin has had favourable outcomes on recovery and maintenance of ß-cell function and protracted glycaemic remission compared with treatment with oral drugs alone (Diabetes/Metabolism Research and Reviews)

Management of hyperglycaemia in type 2 diabetes
A patient-centered approach. Position statement of the American Diabetes Association and the European Association for the Study of Diabetes (Diabetologia)

Association between tamoxifen treatment and diabetes
Current tamoxifen therapy is associated with an increased incidence of diabetes in older breast cancer survivors. These findings suggest that tamoxifen treatment may exacerbate an underlying risk of diabetes in susceptible women (Cancer)

Sensorineural hearing loss is a common finding in early onset type 2 diabetes
Patients with early onset T2DM and poor glycemic control have an increased prevalence of subclinical hearing loss and impaired auditory brainstem responses. Hearing impairment may be an under-recognized complication of diabetes (Endocrine Practice)

Protein tyrosine phosphatase 1B inhibitors: A molecular level legitimate approach for the management of diabetes mellitus
The drug discovery research in PTP 1B is a challenging area to work with and many pharmaceutical organizations and academic research laboratories are focusing their research toward the development of potential PTP 1B inhibitors which would prove to be a milestone for the management of diabetes (Medicinal Research Reviews)

Chronic Kidney Disease, Insulin Resistance, and Incident Diabetes in Older Adults
Among older adults, lower eGFR was associated with insulin resistance. However, with lower eGFR, ß cell function was appropriately augmented and risks of impaired glucose tolerance and incident diabetes were not increased (Clinical journal of the American Society of Nephrology)

Changes in Treatment Adherence and Glycemic Control During the Transition to Adolescence in Type 1 Diabetes
The magnitude of the effect of declining treatment adherence (blood glucose monitoring frequency – BGMF) on glycemic control in young adolescents may be even greater than declines observed among older adolescents. BGMF offers a powerful tool for targeted management of glycemic control for type 1 diabetes during the critical transition to adolescence (Diabetes Care)

Altered Excitation-inhibition Balance in the Brain of Patients with Diabetic Neuropathy
This pilot data demonstrates an excitatory/inhibitory neurotransmitter imbalance in the brain of in patients with DN and positive sensory symptoms compared to pain free HC subjects (Academic Radiology)

Do Twin Pregnant Women Require Twice as Much Insulin as Singleton Pregnant Women?
In twin pregnancies, the weekly increase in insulin dose between 14 and 27 weeks was doubled compared with singleton pregnancies (Diabetes Care)

Does Diabetes Care Differ by Type of Chronic Comorbidity?
Our study indicates that diabetes care varies by types of comorbidity. Concordant illnesses result in similar or better care, regardless of visit frequency. Discordant illnesses are associated with diminished care: an effect that decreases as visit frequency increases (Diabetes Care)

Stratifying healthcare costs using the Diabetes Complication Severity Index
The DCSI score is a useful tool for predicting direct healthcare costs. The DCSI can be used to triage high-risk patients for more focused secondary prevention interventions at primary care level, in a bid to lower overall healthcare costs (Diabetes and Its Complications)

Societal correlates of diabetes prevalence: An analysis across 94 countries
Macro-level societal factors are associated with diabetes prevalence. Investigating how these factors affect individual-level diabetes risk may offer further insight into policy-level interventions (Diabetes Research and Clinical Practice)

Initial therapy with the fixed-dose combination of sitagliptin and metformin
Compared with pioglitazone, initial therapy with a FDC of sitagliptin and metformin led to significantly greater improvement in glycaemic control as well as a higher incidence of prespecified gastrointestinal adverse events, a lower incidence of oedema and weight loss vs. weight gain (Diabetes, Obesity and Metabolism)

Trial of Intravitreal Bevacizumab or Laser Therapy (BOLT) in the Management of Diabetic Macular Edema
This study provides evidence supporting longer-term use of intravitreous bevacizumab for persistent center-involving CSME (Archives of Ophthalmology)

First ever mandatory care standards bring hope of improved care for children and young people with diabetes
Set by leading paediatric doctors, nurses and commissioners, working in partnership with NHS Diabetes, the ‘Best Practice Tariff for Paediatric Diabetes’ sets out 13 mandatory care standards1 for paediatric diabetes service teams to meet (NHS Diabetes)

Diabetes Outcomes Versus Expenditure Tool (DOVE)
The Diabetes Outcomes Versus Expenditure (DOVE) tool allows users to compare expenditure on diabetes care with clinical outcomes for a selected PCT, other PCTs with similar populations and all other PCTs. Spending on diabetes care can be compared to a number of outcomes at PCT level (Yorkshire and Humber Public Health Observatory)

Implementing key therapeutic topics: Type 2 diabetes
These bulletins summarise the evidence-base for the therapeutic topics reviewed, and contrast this with the prescribing data available for these topics (MeReC Bulletin

Prevalence of abnormal plasma liver enzymes in older people with Type 2 diabetes
The prevalence of elevated liver enzymes in people with Type 2 diabetes is high, with only modest variation between clinically defined patient groups. Further research is required to determine the prognostic value of raised, routinely measured liver enzymes to inform decisions on appropriate follow-up investigations (Diabetic Medicine)

Alcohol consumption and risk of pre-diabetes and type 2 diabetes development in a Swedish population
High alcohol consumption increases the risk of abnormal glucose regulation in men. In women the associations are more complex: decreased risk with low or medium intake and increased risk with high alcohol intake (Diabetic Medicine)

Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus
Adolescents/young adults with Type 2 diabetes lose approximately 15 years from average RLE and may experience severe, chronic complications of Type 2 diabetes by their 40s. A comprehensive management plan that includes early and aggressive control of cardiovascular risk factors is likely needed to reduce lifetime risk of CHD (Diabetic Medicine)

Evaluation of renal biopsies in type 2 diabetic patients with kidney disease: a clinicopathological study of 216 cases
Our results indicated that the clinical manifestations and pathologic findings in type 2 diabetic patients in different age groups have different features. This study emphasized the usefulness of renal biopsy for determining the pattern of renal damage and thus for the overall management of type 2 diabetic patients (International Urology and Nephrology)

A gene variant near ATM is significantly associated with metformin treatment response in type 2 diabetes: a replication and meta-analysis of five cohorts
This is the first robustly replicated common susceptibility locus found to be associated with metformin treatment response (Diabetologia)

Gestational diabetes and pregnancy outcomes. a systematic review of WHO and IADPSG diagnostic criteria
The WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes (BMC Pregnancy and Childbirth)

Apelin, a promising target for type 2 diabetes treatment?
In this review, we describe the various metabolic functions that are affected by apelin and we present an integrated overview of recent findings that collectively propose apelin as a promising target for the treatment of T2DM (Trends in Endocrinology & Metabolism)

Interaction between glycaemic control and serum insulin-like growth factor 1 on the risk of retinopathy in type 2 diabetes
Our data suggested serum IGF-1 was a contributing factor in severe diabetic retinopathy and this effect may be masked by poor glycaemic control (European Journal of Clinical Investigation)

Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose

From the patients’ perspective, professionals positively present SMBG as a ‘friend’ in order to achieve strict glycemic control. Whereas patients can also perceive SMBG as a ‘foe’ (BMC Public Health)

Variation of Fasting Plasma Glucose: A Predictor of Mortality in Patients with Type 2 Diabetes
Time-dependent variation of FPG was a strong predictor of all-cause, expanded, and nonexpanded cardiovascular disease-related mortality in patients with type 2 diabetes, suggesting that glucose variation may become a measure in clinical practice for the goal in the management of these patients (American Journal of Medicine)

Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
In obese patients with uncontrolled type 2 diabetes, 12 months of medical therapy plus bariatric surgery achieved glycemic control in significantly more patients than medical therapy alone. Further study will be necessary to assess the durability of these results (New England Journal of Medicine)

Remission of Insulin Resistance in Type 2 Diabetic Patients After Gastric Bypass Surgery or Exenatide Therapy
Gastric bypass surgery is better in weight control and in the remission of insulin resistance compared with exenatide therapy (Obesity Surgery)

Early Neurodegeneration in the Retina of Type 2 Diabetic Patients
This study demonstrates thinner inner retinal layers in the macula of type 2 diabetic patients with minimal DR than in controls. These results support the concept that early DR includes a neurodegenerative component (Investigative Ophthalmology & Visual Science)

Effect of Diabetes Mellitus on Severity and Hospital Mortality in Patients With Acute Pancreatitis
Although diabetes may adversely affect the disease process of AP, it seems to protect patients from AP-related mortality (Diabetes Care)

BYETTA® Approved for Use with Basal Insulin in Europe
Amylin Pharmaceuticals and Eli Lilly and Company announced that the European Commission has granted marketing authorization to BYETTA® (exenatide twice-daily) as an adjunctive therapy to basal insulin, with or without metformin and/or Actos® (pioglitazone), for the treatment of type 2 diabetes in adults who have not achieved adequate glycemic control with these agents (Lilly)

Effects of Dapagliflozin, a Sodium-Glucose Cotransporter-2 Inhibitor, on Hemoglobin A1c, Body Weight, and Hypoglycemia Risk in Patients With Type 2 Diabetes Inadequately Controlled on Pioglitazone Monotherapy
In patients with type 2 diabetes inadequately controlled on pioglitazone, the addition of dapagliflozin further reduced HbA1c levels and mitigated the pioglitazone-related weight gain without increasing hypoglycemia risk (Diabetes Care)

Dapagliflozin, metformin XR, or both: initial pharmacotherapy for type 2 diabetes, a randomised controlled trial
In treatment-naïve patients with T2D, dapagliflozin plus metformin was generally well tolerated and effective in reducing HbA1c, FPG and weight. Dapagliflozin-induced glucosuria led to an increase in events suggestive of urinary tract and genital infections (International Journal of Clinical Practice)

Effects of bezafibrate on lipid and glucose metabolism in dyslipidemic patients with diabetes: the J-BENEFIT study
Bezafibrate significantly improved HbA1c in patients with diabetes given individualized treatment. Bezafibrate may offer clinicians an improved modality for the amelioration of disease course and improvement of outcome in these patients (Cardiovascular Diabetology)

QiC Programme Diabetes
Entries are invited from anyone working in the diabetes arena. Whatever the area of patient care, if your initiative or programme relates to diabetes in any way, you should enter it. Each initiative will be reviewed by a panel of high-level diabetes experts, chaired by Anna Morton, director, NHS Diabetes, and Simon O’Neill, director of care, information and advocacy at Diabetes UK (QiC)

Join Us On Our Journey
NHS Diabetes commissioned Leeds Metropolitan University to undertake a 3-year research project. The aims of the research were to develop a model of care that will deliver the aspirations of the policy document ‘Making Every Young Person with Diabetes Matter’ and improve the care provision for children and young people with type 1 diabetes in England (NHS)

Diabetes: the silent pandemic and its impact on Australia
Data from 2010 show that only about half of Australians with diabetes were achieving adequate control of their blood glucose levels. Poor control of blood glucose means a higher risk of developing diabetes complications – Researched and written by Baker IDI Heart and Diabetes Institute

A pilot test of a tailored mobile and web-based diabetes messaging system for adolescents
The results demonstrate the feasibility of the messaging system, user acceptance and a promising effect on glycaemic control. Integrating this type of messaging system with online educational programming could prove to be beneficial (Journal of Telemedicine and Telecare)

Effect of exenatide on the pharmacokinetics of a combination oral contraceptive
The observed reduction in Cmax is likely of limited importance given the unaltered oral contraceptive bioavailability and trough concentrations; however, for oral medications that are dependent on threshold concentrations for efficacy, such as contraceptives and antibiotics, patients should be advised to take those drugs at least 1 hour before exenatide injection (BMC Clinical Pharmacology)

Oral contraception enhances growth hormone responsiveness to hyper- and hypoglycaemia
Given the known boosting effects of growth hormone on hypoglycaemic hormonal counter-regulation, oral contraceptives may thus be a pharmacological candidate contributing to combat hypoglycaemia unawareness in women with diabetes in the future (Diabetic Medicine)

Platelet Isoprostane Overproduction in Diabetic Patients Treated With Aspirin
These findings suggest that in aspirin-treated diabetic patients, oxidative stress–mediated platelet isoprostane overproduction is associated with enhanced platelet recruitment, an effect that mitigates aspirin-mediated TxA2 inhibition (Diabetes)

Long-Term Efficacy of Dapagliflozin in Patients With Type 2 Diabetes Mellitus Receiving High Doses of Insulin
Dapagliflozin improves glycemic control, stabilizes insulin dosing, and reduces weight without increasing major hypoglycemic episodes in patients with inadequately controlled type 2 diabetes mellitus (Annals of Internal Medicine)

Relationship Between Glycosylated Hemoglobin Assessment and Glucose Therapy Intensification in Patients With Diabetes Hospitalized for Acute Myocardial Infarction
Long-term glucose control is poor in most AMI patients with DM, but only a minority of patients undergo GTI at discharge. Inpatient A1C assessment is strongly associated with intensification of glucose-lowering therapy (Diabetes Care)

Effects of some anti-diabetic and cardioprotective agents on proliferation and apoptosis of human coronary artery endothelial cells
Our results suggest that the anti-diabetic and cardioprotective agents mentioned above have direct and beneficial effects on endothelial cell viability, regeneration and apoptosis. This may add yet another valuable property to their therapeutic effect, increasing their clinical utility in type 2 diabetic patients in whom endothelial dysfunction is a prominent feature that adversely affect their survival (Cardiovascular Diabetology)

Impact of insulin pumps on glycaemic control in a pump-naïve paediatric regional population
In a pump-naïve regional paediatric population, insulin-pump therapy for T1DM was safe and effective, and associated with sustained improvements in HbA1c and lower risk of hypoglycaemia (Journal of Paediatrics and Child Health)

A globally applicable screening model for detecting individuals with undiagnosed diabetes
We identified a globally applicable screening model to detect individuals at high risk of undiagnosed diabetes. The model performed well in most geographical regions, is simple and requires no calculations. This global screening model may be particularly helpful in developing countries with no population based data with which to develop own screening models (Diabetes Research and Clinical Practice)

Diabetes Products Proposals
Proposed changes to funded diabetes management products (PHARMAC, New Zealand)

Dipeptidyl peptidase-4 inhibitors for treatment of type 2 diabetes mellitus in the clinical setting: systematic review and meta-analysis
In patients with type 2 diabetes who do not achieve the glycaemic targets with metformin alone, DPP-4 inhibitors can lower HbA1c, in a similar way to sulfonylureas or pioglitazone, with neutral effects on body weight. Increased unit cost, which largely exceeds that of the older drugs, and uncertainty about their long term safety, however, should also be considered (BMJ)

Use of an Automated Decision Support Tool Optimizes Clinicians’ Ability to Interpret and Appropriately Respond to Structured Self-Monitoring of Blood Glucose Data
Use of structured SMBG, combined with the DST, the educational DVD, or both, enhances clinicians’ ability to correctly identify significant glycemic patterns and make appropriate therapeutic decisions to address those patterns (Diabetes Care)

A nursing educational intervention helped by One Touch UltraSmart™ improves monitoring and glycated haemoglobin levels in type I diabetic children
Our research showed that the use of One Touch UltraSmart in the context of an educational intervention raised the awareness of the diabetic children and thus helped them to effectively control their disease and to fully understand the necessity of having good dietary and exercise habits (Journal of Clinical Nursing)

Comparison of HbA1c and oral glucose tolerance test for diagnosis of diabetes in patients with coronary artery disease
There is a large discordance between OGTT and HbA1c in terms of detecting latent DM-2 in patients with CAD. Measurement of HbA1c could result in lower propensity of DM-2 diagnosis (Clinical Research in Cardiology)

Generation of functional insulin-producing cells in the gut by Foxo1 ablation
Here, we show that, unexpectedly, somatic ablation of Foxo1 in Neurog3+ enteroendocrine progenitor cells gives rise to gut insulin-positive (Ins+) cells that express markers of mature ß cells and secrete bioactive insulin as well as C-peptide in response to glucose and sulfonylureas (Nature Genetics)

Recreational drug use in type 1 diabetes: an invisible accomplice to poor glycaemic control?
Drug use was associated with worse glycaemic control and higher risk of diabetic ketoacidosis. Medical awareness of common, currently underreported, drug use in young people with T1D is essential. It offers the possibility of helping such patients improve related suboptimal metabolic control (Internal Medicine Journal)

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 (Diabetologia)

Diabetes-impaired wound healing and altered macrophage activation: A possible pathophysiologic correlation
It was indicated that changed macrophage activation might contribute to impaired healing in diabetes wounds, and that strategies for reverting this abnormal activation could be useful for enhancing the wound healing process (Wound Repair and Regeneration)

National Diabetes Inpatient Audit 2011

Key findings – Hospital Level Analysis for England – Hospital Level Analysis for Wales – Presentation of Results (Health and Social Care Information Centre)

Variation in the recorded incidence of amputation of the lower limb in England
Variation in amputation incidence occurs across England. Because of the similarity in amputation variation between people with and without diabetes the variation may reflect generic differences in local healthcare delivery, although racial factors may also contribute (Diabetologia)

WHO guidance for the use of HbA1c in the diagnosis of diabetes
Abbreviated Report of a WHO Consultation

Pharmacy effect on adherence to antidiabetic medications
The results suggest significant variation in medication adherence attributable to pharmacy factor, independent of other effects. The underlying reason could be varying level of influence from pharmacies’ efforts to inform or influence patients to take medications in prescribed manners (Medical Care)

Type 2 diabetes managed by diet and lifestyle: HbA1c can identify significant post-prandial hyperglycaemia
Even volunteers with reasonably well-controlled, diet-managed type 2 diabetes spent a large proportion (9/24 hours) of the day with glucose concentrations in excess of 8mmol/L, suggesting that implementation of the IDF guidelines presents a challenge in normal clinical practice (Practical Diabetes)

Persistence of Prolonged C-peptide Production in Type 1 Diabetes as Measured With an Ultrasensitive C-peptide Assay
The ultrasensitive assay revealed that C-peptide production persists for decades after disease onset and remains functionally responsive. These findings suggest that patients with advanced disease, whose ß-cell function was thought to have long ceased, may benefit from interventions to preserve ß-cell function or to prevent complications (Diabetes Care)

Spectrum of congenital anomalies in pregnancies with pregestational diabetes
The increased risk of congenital anomalies in pregnancies with pregestational diabetes is related to specific non-chromosomal congenital anomalies and multiple congenital anomalies and not a general increased risk (Birth Defects Research)

Gestational diabetes and cardiovascular risk factors in the offspring: Results from a cross-sectional study
Gestational diabetes mellitus does not appear to have a relevant effect on cardiovascular disease correlates such as blood pressure or cholesterol levels in children, and the potential effect of gestational diabetes mellitus on body composition seems to be widely explainable by maternal BMI (Diabetic Medicine)

Efficacy of endoluminal interventional therapy in diabetic peripheral arterial occlusive disease: a retrospective trial
With a low risk of morbidity and mortality, the percutaneous revascularization accepted by patients does not affect ultimate necessary surgical revascularization and consequently should be considered as the preferred therapy for chronic lower extremity ischemia. The efficacy and prognosis of interventional therapy in diabetic patients is similar that in non-diabetic patients (Cardiovascular Diabetology)

Applicability of a Combination of Hemoglobin A1c and Fasting Plasma Glucose in Population-based Prediabetes Screening
The enhanced prevalence of prediabetes using HbA1c+FPG compared with FPG+2hPG calls for the need to redefine at a more basic and a more practical level how to apply HbA1c in screening for prediabetes. A redefined HbA1c that incorporates FPG, age, race/ethnicity and BMI may put forward a better way to use HbA1c in population-based and clinical settings (Journal of Diabetes)

Arterial Stiffness Is Increased in Patients With Type 1 Diabetes Without Cardiovascular Disease
Arterial stiffness assessed as aPWV is increased in patients with type 1 diabetes without clinical cardiovascular disease, independently of classical cardiovascular risk factors. In men with type 1 diabetes, low-grade inflammation is independently associated with arterial stiffness (Diabetes Care)

Mechanisms for Insulin Resistance: Common Threads and Missing Links
Evidence presented in this Review suggests that ectopic lipid (diacylglycerols and possibly ceramides) may be at the root cause of liver and muscle insulin resistance and that new therapies aimed at decreasing lipid content in these organs will represent the most efficacious therapeutic targets for the treatment of insulin resistance and its associated comorbidities (Cell)

Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes
Evidence from this meta-analysis of individual patient data was not convincing for a clinically meaningful effect of clinical management of non-insulin treated type 2 diabetes by self monitoring of blood glucose levels compared with management without self monitoring, although the difference in HbA1c level between groups was statistically significant (BMJ)

The Accuracy Benefit of Multiple Amperometric Glucose Sensors in People With Type 1 Diabetes
Sensor accuracy is significantly improved with the use of multiple sensors compared with the use of a single sensor. These finding isrelevant to the design of an artificial pancreas device (Diabetes Care)

Oral Disposition Index in Obese Youth from Normal to Prediabetes to Diabetes: Relationship to Clamp Disposition Index
The oDI is a simple surrogate estimate of ß-cell function relative to insulin sensitivity that can be applied to obese adolescents with varying glucose tolerance in large-scale epidemiological studies where the applicability of clamp studies is limited due to feasibility, cost, and labor intensiveness (The Journal of Pediatrics)

The Hyperglycemia and Adverse Pregnancy Outcome Study
Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone (Diabetes Care)

SOD1 suppresses maternal hyperglycemia-increased iNOS expression and consequent nitrosative stress in diabetic embryopathy
We conclude that oxidative stress induces iNOS expression, nitrosative stress, and apoptosis in diabetic embryopathy (American Journal of Obstetrics & Gynecology)

Impact of type 2 diabetes on serial changes in tissue characteristics of coronary plaques: an integrated backscatter intravascular ultrasound analysis
Accelerated plaque progression with an increase in the lipid-rich component of non-culprit plaques was observed in T2DM, despite the use of standard medical treatment. Better glycaemic control ameliorated the worsening of plaque characteristics in T2DM (European Heart Journal – Cardiovascular Imaging)

The management of Type 2 diabetes: A survey of Australian general practitioners
There were significant differences between diabetologists and GPs on the management of diabetes. The survey suggests significant under-dosing by GPs. These findings warrant further investigation (Diabetes Research and Clinical Practice)

Incidence of diabetic retinopathy in people with type 2 diabetes mellitus attending the Diabetic Retinopathy Screening Service for Wales: retrospective analysis
Our analysis supports the extension of the screening interval for people with type 2 diabetes mellitus beyond the currently recommended 12 months, with the possible exception of those with diabetes duration of 10 years or more and on insulin treatment (BMJ)

Emerging Pharmacotherapies for Diabetic Macular Edema
Pharmacotherapies for DME include locally and systemically administered agents. We review several agents that have been studied for the treatment of DME (Experimental Diabetes Research)

Phase III trial tests addition of twice-daily exenatide to insulin glargine in patients with type 2 diabetes
A randomised, double-blind, 30-week, phase III trial (n = 261) found that adding twice-daily exenatide to basal insulin therapy with insulin glargine improved HbA1c levels in patients with sub-optimally controlled type 2 diabetes (NPC Rapid Review)

TAK-875 is the first GPR40 agonist to reach late-stage (Phase 3) clinical development
Phase 2 Data of Takeda’s Investigational GPR40 Agonist, Published in The Lancet, Demonstrated Improved Glycemic Control in Patients with Type 2 Diabetes (Takeda)

Study finds some insulin production in long-term type 1 diabetes
C-peptide production and beta cell functioning detected decades after disease onset (Massachusetts General Hospital)

Acute Response of Peripheral Blood Cell to Autologous Hematopoietic Stem Cell Transplantation in Type 1 Diabetic Patient
Despite the small patient number and prospective study design, we believe our findings provide important insights for understanding AHST effectiveness and possible molecular clues for optimizing AHST management in T1D patients (PLoS ONE)

Integrating an Automated Diabetes Management System Into the Family Management of Children With Type 1 Diabetes
Using the ADMS 1–3 times/week may help children with type 1 diabetes improve glycemic control and gain diabetes self-management skills, as well as improve the BGM effect of parents (Diabetes Care)

CK-elevation, lactacidosis and metabolic myopathy in adult patients with diabetes
Hyper-CK-emia occurs in one fifth and lactacidosis in one quarter of the patients with diabetes. Hyper-CK-emia in these patients is attributable to a primary metabolic myopathy in most of the cases. Hyper-CK-emia in patients with diabetes requires further neurological diagnostic work-up (Endocrine Practice)

Clinical Utility of Creatinine- and Cystatin C-Based Definition of Renal Function for Risk Prediction of Primary Cardiovascular Events in Patients With Diabetes
Only the cystatin C-based CKD definition was an independent risk predictor for cardiovascular events in our diabetic study cohort and indicated a potentially better clinical utility for cardiovascular risk prediction than creatinine-based equations (Diabetes Care)

Enrolment in primary care networks: impact on outcomes and processes of care for patients with diabetes
Compared with patients whose prevalent diabetes is managed outside of primary care networks, patients in primary care networks had a lower rate of diabetes-specific ambulatory care sensitive conditions, were more likely to see an ophthalmologist or optometrist and had better glycemic control (Canadian Medical Journal)

The Risk of a Persistent Glucose Metabolism Impairment After Gestational Diabetes Mellitus Is Increased in Patients With Polycystic Ovary Syndrome
Patients with PCOS are at increased risk for a persistent impaired glucose metabolism after GDM (Diabetes Care)

Hypertensive Disorders in Pregnancy and Subsequent Diabetes Mellitus: A Retrospective Cohort Study
HDP women with obesity and hyperlipidemia are at an extremely high risk of diabetes mellitus. Early identification of women with HDP is needed for prevention, particularly those with other comorbidities (American Journal of Medicine)

Associations of maternal A1C and glucose with pregnancy outcomes
On the basis of associations with adverse outcomes, these findings suggest that A1C measurement is not a useful alternative to an OGTT in pregnant women (Diabetes Care)

Elevated Amylase and Lipase in Patients Using GLP-1 Receptor Agonists or DPP-4 Inhibitors in the Outpatient Setting
Both GLP-1 agonists and DPP-4 inhibitors are associated with increased serum lipase more than serum amylase in many patients with type 2 diabetes possibly suggesting pancreatic inflammation. Whether this may potentially lead to acute pancreatitis or chronic pancreatitis as reported in rat models remains a question. Careful observation of patients taking these medications may be required. (Endocrine Practice)

Exenatide prolonged-release suspension for injection in combination with oral antidiabetic therapy for the treatment of type 2 diabetes
Prolonged-release exenatide in triple therapy regimens (that is, in combination with metformin and a sulphonylurea, or metformin and a thiazolidinedione) is recommended as a treatment option for people with type 2 diabetes as described in ‘Type 2 diabetes: the management of type 2 diabetes‘ (NICE)

CHMP Recommends Approval of BYETTA® for Use With Basal Insulin
The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) has issued a positive opinion in the European Union (EU) for the expanded use of BYETTA® (exenatide twice-daily) as an add-on therapy to basal insulin, with or without metformin and/or Actos® (pioglitazone), for the treatment of type 2 diabetes in adults who have not achieved adequate glycemic control with these agents (Lilly)

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus
A Clinical Practice Guideline From the American College of Physicians (Annals of Internal Medicine)

Angiotensin receptor blockers for prevention of new-onset type 2 diabetes: A meta-analysis of 59,862 patients
There is sufficient evidence that ARBs have beneficial effect in preventing new-onset type 2 diabetes. ARBs should be considered in patients with high risk of developing diabetes (International Journal of Cardiology)

Incidence of insulin-treated diabetes in Australia 2000–2009
During this period, 222,544 people began using insulin to treat their diabetes. Of these, 77% had Type 2 diabetes, 12% had gestational diabetes and 10% had Type 1 diabetes. The remaining 1% had other types of diabetes (Australian Institute of Health and Welfare)

Social adaptability index predicts overall mortality in patients with diabetes
Social adaptability index is associated with mortality in the diabetic population and is useful in identifying individuals who are at risk for inferior outcomes (Journal of Diabetes and Its Complications)

Body composition in children with type 1 diabetes in the first year after diagnosis: relationship to glycaemic control and cardiovascular risk
Insulin deficiency at diagnosis of diabetes causes a catabolic state that is predominantly lipolytic. Body composition normalises within 6 weeks of treatment, though girls remain thinner than boys both at diagnosis and 1 year thereafter, in contrast to published findings. Despite girls being prescribed a larger insulin dose, their HbA1c and cholesterol levels are higher at 1 year suggesting increased insulin resistance and cardiovascular risk (Archives of Diseases in Childhood)

The branching pattern of villous capillaries and structural changes of placental terminal villi in type 1 diabetes mellitus
It is concluded that type 1 maternal diabetes enhances the surface area of the capillary wall by elongation, enlargement of diameter and higher branching of villous capillaries and disrupts the stromal structure of terminal villi (Placenta)

Hyperfiltration in type 1 diabetes: does it exist and does it matter for nephropathy?
In the absence of incipient or overt nephropathy, conventionally determined renal function in patients with type 1 diabetes appears no different from that in the general population. This is hardly surprising, given that these individuals, by all definitions, do not have kidney disease (Diabetologia)

Large-Scale Gene-Centric Meta-Analysis across 39 studies Identifies Type 2 Diabetes Loci
This large-scale meta-analysis involving a dense gene-centric approach has uncovered additional loci and variants that contribute to T2D risk and suggests substantial overlap of T2D association signals across multiple ethnic groups (American Journal of Human Genetics)

Regulation of core clock genes in human islets
The data suggest that perturbations of circadian clock components may contribute to islet pathophysiology in human type 2 diabetes mellitus (Metabolism – Clinical and Experimental)

Gene Expression Differences in Skin Fibroblasts in Identical Twins Discordant for Type 1 Diabetes
This is the first in vitro study demonstrating diabetes-relevant gene expression differences between T1D-discordant identical twins. These SF gene expression differences, persistent despite the HG in vitro conditions, likely reflect “metabolic memory”, and discordant identical twins thus represent an excellent model for studying diabetic epigenetic processes in humans (Diabetes)

Age-related islet autoantibody incidence in offspring of patients with type 1 diabetes
The age period 9 months to 2 years is associated with a high incidence of activation of type 1 diabetes-associated autoimmunity in genetically at-risk children and should be targeted for effective primary prevention strategies (Diabetologia)

Continuous Subcutaneous Insulin Infusion of Insulin Lispro in Children and Adolescents with Type 1 Diabetes
In 26 studies of over 2500 pediatric and adolescent patients with type 1 diabetes, with over 1000 patients specifically receiving lispro CSII, insulin lispro CSII therapy consistently demonstrated similar or improved efficacy and safety versus studied comparators (Endocrine Practice)

Profile of Inflammatory Mediators in Gestational Diabetes Mellitus: Phenotype and Genotype
Women with GDM have significantly lower adiponectin levels in the third trimester, regardless of BMI (American Journal of Reproductive Immunology)

Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes
A population-based cohort study (Diabetologia)

Mitochondrial Fission Triggered by Hyperglycemia Is Mediated by ROCK1 Activation in Podocytes and Endothelial Cells
Several lines of evidence suggest that mitochondrial dysfunction plays a critical role in the pathogenesis of microvascular complications of diabetes, including diabetic nephropathy … These findings provide insights into the unexpected role of ROCK1 in a signaling cascade that regulates mitochondrial dynamics (Cell Metabolism)

Helicobacter pylori Infection Is Associated With an Increased Rate of Diabetes
We demonstrated for the first time that H. pylori infection leads to an increased rate of incident diabetes in a prospective cohort study. Our findings implicate a potential role for antibiotic and gastrointestinal treatment in preventing diabetes (Diabetes Care)

Diabetes Working Group White Paper
Through new research sponsored by the DWG, this white paper examines provider barriers to offering the current standards of diabetes care and offers recommendations to mitigate these barriers (Avalere Health LLC on behalf of the Diabetes Working Group)

Long-term conditions and mental health – The cost of co-morbidities
More than 4 million people in England with a long-term physical health condition also have mental health problems, and many of them experience significantly poorer health outcomes and reduced quality of life as a result – Download (The King’s Fund, UK)

The pathogenesis of early retinal changes of diabetic retinopathy
This review explores the earliest changes to the retina in DR and the factors that predispose or prevent DR, including sleep apnoea, receptor degenerations laser treatment and VEGF polymorphism. The review also presents the evidence that retinal hypoxia, existing in the earliest stages, causes DR (Documenta Ophthalmologica)

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus
A Clinical Practice Guideline From the American College of Physicians (Annals of Internal Medicine)

Diabetes Update for January – Pregnancy
Interesting monthly Diabetes Updates on the Glycosmedia website

Chronic Kidney Disease Resource Pack
This resource pack, developed by NHS Kidney Care, contains a variety of resources designed to help support the management of CKD in the community (NHS Kidney Care)

When Is Hemoglobin A1c Inaccurate In Assessing Glycemic Control?
It is useful to consider the situations in which HbA1c may be spuriously elevated or depressed. These issues are best understood after reviewing how HbA1c is defined and measured–topics fraught with considerable confusion (Clinical Correlations)

Introduction of metformin for gestational diabetes mellitus in clinical practice: has it had an impact?
Women treated with metformin had a significantly lower incidence of macrosomic and large for gestational age neonates as well as a reduced caesarean section rate (European Journal of Obstetrics & Gynecology and Reproductive Biology)

Diabetes indicators in Australia
Standardised measures of the highest priority information that can be used to: establish benchmarks – monitor and compare the diabetes status of population groups over time – and monitor and evaluate the effectiveness of health policy, prevention and management strategies (AIHW)

When Is Diabetes Distress Clinically Meaningful?
In two samples of type 2 diabetic patients we found a consistent pattern of curvilinear relationships between the DDS and HbA1c, diabetes self-efficacy, diet, and physical activity. The shape of these relationships suggests cut points for three patient groups: little or no, moderate, and high distress (Diabetes Care)

Age Before Stage: Insulin Resistance Rises Before the Onset of Puberty
IR starts to rise in mid-childhood, some years before puberty. Its emergence relates more to the age of the child than to pubertal onset. More than 60% of the variation in IR prior to puberty was unexplained. The demography of childhood diabetes is changing, and prepubertal IR may be important (Diabetes Care)

Can sharing experiences in groups reduce the burden of living with diabetes, regardless of glycaemic control?
Support groups are able to reduce diabetes-related and psychological distress 1 year after the intervention for patients with both good and poor glycaemic control displaying high levels of distress (Diabetic Medicine)

Silencing of insulin receptor substrate–1 increases cell death in retinal Müller cells
In these studies, we show for the first time that salmeterol, a beta-2-adrenergic receptor agonist, can reduce retinal Müller cell death through IRS-1 actions. These findings also suggest the importance of IRS-1 in beta-adrenergic receptor signaling in the prevention of cell death in retinal Müller cells (Molecular Vision)

Variations in tissue selectivity amongst insulin secretagogues: a systematic review
Insulin secretagogues display different tissue selectivity characteristics at therapeutic doses. This may translate into different levels of cardiovascular risk (Diabetes, Obesity and Metabolism)

FDA Approves BYDUREON™ – The First and Only Once-Weekly Treatment for Type 2 Diabetes
Provides Glycemic Control in a Once-Weekly Dose (Amylin Pharmaceuticals)

Retinal Vascular Geometry Predicts Incident Renal Dysfunction in Young People With Type 1 Diabetes
Retinal venular geometry independently predicted incident renal dysfunction in young people with type 1 diabetes. These noninvasive retinal measures may help to elucidate early mechanistic pathways for microvascular complications (Diabetes Care)

Increased prevalence of chronic kidney disease in patients with Type 1 diabetes and non-alcoholic fatty liver
Our findings demonstrate that ultrasound-diagnosed non-alcoholic fatty liver is associated with a higher prevalence of chronic kidney disease in patients with Type 1 diabetes, independently of several risk factors, including the components of the metabolic syndrome (Diabetic Medicine)

How much does screening bring forward the diagnosis of type 2 diabetes and reduce complications? Twelve year follow-up of the Ely cohort
Diabetes screening resulted in cases being identified on average 3.3 years earlier, a difference significantly shorter than previous estimates. Earlier diagnosis did not appear to impact on health outcomes. Further evidence is needed to justify the introduction of population-based screening (Diabetologia)

Screening for Gestational Diabetes Mellitus: Are the Criteria Proposed by the International Association of Diabetes and Pregnancy Study Groups Cost-Effective?
The IADPSG recommendation for glucose screening in pregnancy is cost-effective. The model is most sensitive to the likelihood of preventing future diabetes in patients identified with GDM using postdelivery counseling and intervention (Diabetes Care)

Proposed new diagnostic criteria for gestational diabetes – a pause for thought?
New criteria for the diagnosis of gestational diabetes promulgated by the International Association of Diabetes and Pregnancy Study Groups (IADSPG) have been adopted by a number of groups, including the American Diabetes Association. These criteria will increase two- to three-fold the number of women diagnosed with gestational diabetes and have enormous resource implications (Diabetic Medicine)

Integrated Management of Type 2 Diabetes Mellitus and Depression Treatment to Improve Medication Adherence: A Randomized Controlled Trial
A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources (Annals of Family Medicine)

Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women’s Health Initiative
Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population (Archives of Internal Medicine)

FRAX underestimates fracture risk in patients with diabetes
FRAX underestimated observed major osteoporotic and hip fracture risk in diabetics (adjusted for competing mortality) but demonstrated good concordance with observed fractures for nondiabetics. We conclude that diabetes confers an increased risk of fracture that is independent of FRAX derived with BMD. This suggests that diabetes might be considered for inclusion in future iterations of FRAX (Journal of Bone and Mineral Research)

Reversal of type 1 diabetes via islet beta cell regeneration following immune modulation by cord blood-derived multipotent stem cells
Stem Cell Educator therapy is safe, and in individuals with moderate or severe T1D, a single treatment produces lasting improvement in metabolic control. Initial results indicate Stem Cell Educator therapy reverses autoimmunity and promotes regeneration of islet beta cells (BMC Medicine)

Localisation and composition of skeletal muscle diacylglycerol predicts insulin resistance in humans
These data indicate that both cellular localisation and composition of DAG influence the relationship to insulin sensitivity. Our results suggest that only saturated DAG in skeletal muscle membranes are related to insulin resistance in humans (Diabetologia)

Acute and chronic animal models for the evaluation of anti-diabetic agents
The present review highlights the various methods of inducing diabetes in experimental animals in order to test the newer drugs for their anti-diabetic potential – Provisional PDF (Cardiovascular Diabetology)

Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin (Review)
From this review, we conclude that when diabetes duration is over one year, the overall effect of self-monitoring of blood glucose on glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months (Cochrane Collaboration)

Establishing an evidence base for frequency of monitoring glycated haemoglobin levels in patients with Type 2 diabetes: projections of effectiveness from a regression model
In patients with initial HbA1c close to treatment goal, retesting at 6 months would yield more true-positive than false-positive tests. For patients with lower initial HbA1c, retesting at 6 months would yield more false than true-positive tests. In all patients, retesting at 12 months yields more true than false-positive tests. In very few patients would retesting at 3 months be justified (Diabetic Medicine)

Exposure to Gestational Diabetes Mellitus and Low Socioeconomic Status
Maternal GDM and low SES, especially in combination, heighten the risk for childhood ADHD. Long-term prevention efforts should be directed at mothers with GDM to avoid suboptimal neurobehavioral development and mitigate the risk for ADHD among their offspring (Archives of Pediatrics & Adolescent Medicine)

The development and validation of a clinical prediction model to determine the probability of MODY in patients with young-onset diabetes
We have developed clinical prediction models that calculate an individual’s probability of having MODY. This allows an improved and more rational approach to determine who should have molecular genetic testing (Diabetologia)

Novel Urinary Protein Biomarkers Predicting the Development of Microalbuminuria and Renal Function Decline in Type 1 Diabetes
A panel of four novel protein biomarkers predicted early renal damage in type 1 diabetes. These findings require further validation in other populations for prediction of renal complications and treatment monitoring (Diabetes Care)

Surgical and visual outcome following 20-gauge vitrectomy in proliferative diabetic retinopathy over a 10-year period, evidence for change in practice
Outcomes from vitreoretinal surgery for complications of diabetic retinopathy have improved. In addition, the visual outcome after diabetic vitrectomy steadily improved over the 10-year period, which may in part be due to the move to operate on patients with better vision (Eye – Nature Publishing Group)

Statins: risk of hyperglycaemia and diabetes
Statin use may be associated with a level of hyperglycaemia in some patients where formal diabetes care is appropriate. The risk appears to be mainly in patients already at increased risk of developing diabetes (MHRA)

Proton Pump Inhibitor Therapy Associated with Lower Glycosylated Hemoglobin Levels in Type 2 Diabetes
The observed association between PPI therapy and lower HbA1c levels suggests that PPIs may be useful as adjunctive therapy for type 2 diabetes (Journal of the American Board of Family Medicine)

Demonstration of islet-autoreactive CD8 T cells in insulitic lesions from recent onset and long-term type 1 diabetes patients
Our observations provide the first direct proof for islet autoreactivity within human islets and underscore the heterogeneous and chronic disease course (Journal of Experimental Medicine)

‘Killer cells’ and diabetes
Killer T-cells in the human body which help protect us from disease can inadvertently destroy cells that produce insulin, new University research has uncovered (Cardiff University)

NICE gives green light to prolonged-release exenatide for type 2 diabetes in final draft guidance
In final draft guidance NICE, has confirmed its initial draft recommendation of prolonged release exenatide (Bydureon, Eli Lilly) in triple therapy regimens (in combination with metformin and a sulphonylurea, or metformin and a thiazolidinedionei) as a treatment option for people with type 2 diabetes (NICE)

BMS and AZ Receive Complete Response Letter from U.S. Food and Drug Administration for Dapagliflozin
The complete response letter requests additional clinical data to allow a better assessment of the benefit-risk profile for dapagliflozin. This includes clinical trial data from ongoing studies and may require information from new clinical trials (Bristol-Myers Squibb)