[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1.%% M  FDA Approves Insulin Patch-Pen for Use With Insulin Aspart

7/27/10   FDA has granted clearance to market an insulin patch-pen (Finesse)
for up to 3 days' use with rapid-acting insulin aspart (NovoLog). The
bolus-only

flat patch-pen is small (2" × 1" × 0.25") and contains a 200-unit reservoir
from which insulin is delivered through a plastic tube inserted into the
skin.

Worn on the skin like a bandage, the device can be discretely activated
through clothing by squeezing together 2 buttons, providing mealtime, snack
time,

and correction bolus insulin in seconds. "Finesse will be easy for
physicians and DM educators to explain to patients."Like expensive insulin
pumps, Finesse

provides fast, discreet, needle-free dosing. . it accomplishes this with the
simplicity, safety and affordability of syringes or insulin pens."..The
patch-pen

device previously was approved for use with insulin lispro (Humalog.)

 

2.%%MTD  Protein Crucial In Diabetes May Be Central Player In Other Diseases
Too 7/22/10 Studying a protein already known to play an important role in

T2 & cancer, researchers have discovered that it may have an even broader
role particularly in other metabolic disorders and heart disease. The gene
(TCF7L2

) is strongly linked to T2. [it] carries the code for a transcription
factor–a protein that binds to genes and regulates their activity. Exactly
how this

protein acts to affect DM is still unknown. "It may be more feasible to
develop drugs aimed at proteins encoded by specific gene classes regulated
by TCF7L2

rather than aiming at a more ubiquitous transcription factor," lead author
said...

 

3. %%M HbA1c Alone a Weak Predictor of Diabetes & Cardiovascular Risk
(Reuters Health) Jul 26 - Don't rely on hemoglobin (Hb)A1c alone to identify
patients

at risk for DM & heart disease. It's far less precise than glucose tolerance
or fasting plasma glucose tests, 2 new studies show.. "Hemoglobin A1c >6.5%

& 5.7-6.4% cannot be used as the sole criteria for diagnosing DM and
detecting at-risk individuals," the lead author said. "Nevertheless, [it]
can be used

along with categories based on fasting and 2-hr plasma glucose levels as
proposed by the 2010 ADA recommendations." The team analyzed HbA1c, fasting
plasma

glucose (FPG), and 2-hr plasma glucose concentrations  in 855 pts..HbA1c
performed less well than FPG & 2-h PG for assessing insulin sensitivity and
insulin

secretion. the second report, compared HbA1c, 2-h PG, & FPG as predictors of
T2, CV disease, & CV mortality during a 10-yr study of 593 pts. HbA1c of
6.5%

+, 2-h PG in the IGT & diabetic range, was significantly associated with
development of CV disease  but only in women. "Further studies are required
to

compare [these tests] as predictors of T2 and their association with
different CV endpoints, in different populations and age groups,"

 

4.%% ADA  Changes in Short- and Long-Term Cardiovascular Risk of Incident
Diabetes and Incident Myocardial Infarction (MI) 7/27/10  Researchers
recently

assessed the trends of CV outcomes after a patient's first diagnosis of (MI)
or diabetes. [3 million pts].  Results showed that MI patients had a greater

short-term risk of all endpoints compared with the general population, but
the risk rapidly declined in the first year after MI. Patients with DM,
however,

had a constantly elevated risk of all study endpoints compared with the
general population.  The study results emphasize the necessity of early
multi-factorial

intervention in diabetes patients.

 

5.%% ADA Maintenance of Glycemic Control With the Evening Administration of
a Long-Acting Sulphonylurea in Male Patients With T2 7/27/10  Men with T2
who

undertake the Ramadan fast can maintain safe glycemic control by taking 60
mg of gliclazide modified release (MR) in the evenings during the fast,
[and]

can then switch to a morning schedule after the fast. [136 male patients]

 

6.%%  M Shorter (5-mm) Needles Deliver Insulin Reliably 7/30/10  "This study
[259 pts] has demonstrated that 32G [gauge] 5-mm needles can be reliably
inserted

into subcutaneous fat, are relatively pain free, and are associated with
minimal leakage from the injection site," the authors report. They also
recommend

an "angled injection with a pinched skin fold for children, while in adults
the technique should be left to patient preference." sponsored by Novo
Nordisk

A/S. 

 

7.%% CCB list 2 Aug 2010  Daily Insulin Injections Might be a Thing of
ThePast  --researchers from the Nat Institute of Immunology in New Delhi
recently

devised a technique that could lower the frequency of this ritual to once in
several months. A new form of insulin could maintain normal blood sugar
levels

for over 120 days. The Director of the NIIr stated that the insulin
currently available can work for a maximum of 18 hrs, forcing DM patients to
take at

least one injection daily to sustain their sugar levels. With this new
product, they can now restrict their shots to once every 4 months. The new
product,

which has been tested successfully in animals, was based on the principles
of "protein folding," and could release insulin molecules in a controlled
and

sustained manner for over 120 days. ‘ [this] level of human insulin released
in a sustained manner has been found to be effective in not only controlling

the upsurge in the level of blood glucose after meals, but also in
preventing early morning hypo -glycemia, ..’ Asked when it will be cleared
for use by

humans, he said, ".. it is still in its nascent stage.. toxicological
studies in higher animals need to be done." The team has patented the
technology

and transferred it to a US-based company for fine-tuning and clinical
trials, and the product is likely to be in the market in about 6 years.
Source: 

CCB-L mailing list and Sify  India News Portal,2010-08-04 

 

8.%% Nature Medicine 16 2010   Timing is everything .. in the 1970s, some
hospitalized patients with schizophrenia began receiving drug injections
that

lasted for weeks in place of their daily antipsychotic pills..  Newer
versions of such long- acting injectables might radically change the
treatment of

ailments ranging from alcoholism to diabetes  Because of the digestive
cycle, [even] time-release pills can only last about a day in the body. So,
many

companies are focusing on injections. [1 drug] is loaded into microspheres
about the width of a human hair after being dissolved it in a solution
containing

the same biodegradable polymer used in surgical sutures. The microsphere
droplets, when injected, sit just under the skin, and, as the polymer
dissolves

over the course of a couple of weeks, it gradually releases the drug.
Alkermes company  is hoping for approval this year of its long- acting
diabetes

drug, Bydureon - based on a compound that mimics the action of glucagon-like
peptide-1(GLP-1), a molecule that helps control blood glucose. .an  analog

of the human protein was found in the saliva of the Gila monster lizard.
Bydureon is designed to be given once a week. ConjuChem attaches its peptide
to

a  form of albumin, the most common protein found in human blood. As such,
the [drug] circulates though the body, dissociating from the albumin over
time.

Novo Nordisk added a fatty-acid side chain to the liraglutide molecule
causes the drug to link up 7at a time.. “It's like 7 Legos together”- The
difference

is that these 'Legos' come apart.. thereby allowing the drug molecules to
dissociate over time in the circulatory system. Long-acting injectable drugs

usually carry the same side effect risks as their pill-form counterparts,
but they have some unique risks as well.. Doctors usually prescribe a person

the daily form of a drug before switching him or her to the long-acting
version..

 

9.%% M  How Does Victoza® Compare With Byetta®? 8/3/10   What is the best
place for liraglutide (Victoza®) in the treatment of T2, and how does it
compare

with exenatide (Byetta®) In studies both drugs were well tolerated, but
minor hypoglycemia was less frequent with liraglutide. At the end of the
study,

2.5% of patients in the liraglutide group had nausea compared with 8.6% in
the exenatide group. More serious and more severe adverse events were
reported

in the liraglutide [1 case of pancreatitis] than the exenatide group. Both
drugs produce similar weight loss. The 2 agents would be suitable for pts
with

T2, who need 1% A1c reduction to achieve goal, need modest weight loss, and
who have no contraindications to therapy with a GLP-1 agonist. Eexenatide as

a 2-mg weekly dose (long- acting release formulation) may have the ability
to produce A1c and weight reductions similar to those with liraglutide..
However,

until a direct comparison trial is completed, the certainty of this
conclusion is unknown.

 

10.%%  M Black-White Differences in HbA1c 8/4/10   Study Summary

Examining data from 2 very different sources, Ziemer et al; studied 1581
non-Hispanic black & white subjects age 18-87 without DM. They  were
separated

into 3 categories: those with normal glucose tolerance ,(fasting glucose  >
125 mg/dL), or prediabetes (all other glucose values). A1c levels among
black

& white subjects were compared using analysis to account for other factors
known to be associated with A1c levels, -age, sex, body mass index, BP,
fasting

plasma glucose, and 2-hour glucose concentrations. A1c levels were somewhat
higher in blacks than in whites. However,  these differences were greater at

higher glucose concentrations. The adjusted racial differences were greater
among patients with prediabetes and still greater among those with DM. The

team  questions whether A1c values accurately reflect glycemic differences
between blacks and whites. . the more important question is whether an A1c
of,say

, 8.5% confers a different risk for complications for one race compared to
the other, after accounting for other factors. If not, then the intrinsic
difference

in A1c between races is irrelevant..these   results also have important
implications for the use of A1c as a diagnostic tool.

 

11.%% M Wireless Sensor Watches Blood Sugar for Diabetics 7/28/10

(Reuters)  Researchers have developed an implantable sensor that

measures blood sugar continuously and transmits the information without
wires..The device worked in a pig for more than a year and in another for
nearly

10 months with no trouble..It takes the diabetes field a step closer to
development of an artificial pancreas, UCSD and

GlySens Inc.."We hope to begin the first human trial in a few months,"
Medical device makers have been working to develop a so-called artificial
pancreas

to deliver insulin to patients with T1 . This team said their device could
also work for T2.The implant used in the pig study is about 1.5 “ in
diameter

x 5/8 “ thick. It transmits 10 to 12 feet.  There is nothing protruding from
the body. Dr. Gough foresees ways to have the glucose monitor send its
signals

to cell phones.

 

12.%% M Egg or Cholesterol Intake in Older Adults Not Linked to Risk for
T2DM  8/3/10— Among older adults with limited egg intake, there is no
apparent

association between egg consumption or dietary cholesterol and an increased
risk for incident T2. [3898 subjects] annual picture-sorted food
questionnaires

to determine egg intake. Egg consumption was not associated with an
increased risk for T2 in

either sex or overall, based on multivariable-adjusted models.

Dietary cholesterol was not associated with incident T2 in a secondary
analysis .Limitations of this study include small number of participants who
ate

eggs daily or more often.”.egg consumption was not associated with
clinically meaningful differences in fasting glucose or insulin
concentrations or measures

of insulin resistance despite small absolute analytic differences that were
significant."

Am J Clin Nutr. 2010;92

 

13.%%  Nature   Diabetes T2 Collection [free temp access] at     

http://www.nature.com/nrd/collections/type2diabetes/index.html

. . although multiple classes of DM  drugs are available, achieving
long-term control of blood sugar is often a major challenge, in part due to
adverse

effects. .this special collection of articles from Nature Reviews Drug
Discovery [NRDD]  focuses on emerging therapeutic approaches and targets for
T2.

Therapeutic targets to reduce cardiovascular disease in T2;Islet G
protein-coupled receptors as potential targets for treatment of T2;SGLT2
inhibition-

a novel strategy for diabetes treatment;Targeting the CNS [central nervous
system] to treat T2 ..It is now clear that the (CNS) plays an important part

in orchestrating appropriate glucose metabolism,..

 

14. %%  M  Effect of Systemic Medications on Onset and Progression of
Diabetic Retinopathy [DR] 7/27/10  Abstract -DR remains a leading cause of
visual

loss worldwide. Patients with diabetes mellitus commonly have multiple
comorbidities treated with a wide variety of medications. Systemic
medications that

target glycemic control and coexisting conditions may have beneficial or
deleterious effects on the onset or progression of DR .. the use of systemic
therapy

primarily to address ocular complications of DR may be a promising
therapeutic approach. This article reviews current understanding of the
ocular- specific

effects of systemic medications commonly used by patients with DM including
those directed at control of hyperglycemia, dyslipidemia, hypertension,
cardiac

disease, anemia, inflammation and cancer. Current clinical evidence is
strongest for the use of angiotensin-converting enzyme [ACE] inhibitors and
angiotensin-2

receptor blockers in preventing the onset or slowing the progression of
early DR. To a more limited extent, evidence of a benefit of fibrates for
diabetic

macular edema DME exists. Numerous other agents hold considerable promise or
potential risk. Thus, these compounds must undergo further rigorous study

to determine the actual clinical efficacy and adverse effects before
definitive therapeutic care recommendations can be offered. Diabetic Retinal
Disease

primarily manifesting as DR and/or DME is a highly specific retinal vascular
complication of T1& T2. DR is often asymptomatic early on in the disease,

and visual loss is primarily caused by DME, vitreous hemorrhage or traction
retinal detachment.  Specific studies on [includes] biochemical pathways..

oxidative stress, inflammatory markers, and vascular endothelial growth
factor (VEGF), show that  retinal biochemistry and physiology occur long
before

clinically evident disease is observed. DM-induced .. cellular, molecular,
enzymatic, and. anatomic changes may affect the specific response of the
retinal

vasculature to systemic medications. The progression of DR is associated
with an increased risk of visual loss owing to development of the formation
of

neovascular vessels that can lead to vitreous hemorrhage and fibrous
proliferation which can cause traction retinal detachment. DME incidence
increases 

with advancing disease severity and when systemic comorbidities, such as
hypertension, dyslipidemia and renal disease, are present. DME is caused by
..

fluid accumulation in the macula, causing photoreceptor disruption and,
potentially visual loss... In patients with very severe non-proliferative or
early

proliferative DR particularly if the HbA1c  level is high and a large rapid
reduction is anticipated, the initiation of intensive treatment should
generally

be delayed until panretinal scatter photocoagulation, to slow the
development or progression of neovascular vessels in the retina, can be
completed...

In general, proper ophthalmic evaluation and treatment for DR are highly
effective in preventing visual loss, and intensive glycemic control should
not

be discouraged for fear of disease progression, given that the long-term
benefits of tight glycemic control are very  compelling.. an understanding
of

the potential ocular effects of systemic therapy can help inform the
treatment decision process, reducing the risks of worsening diabetic
retinopathy and/or

increasing beneficial effects.

 

15.%% M 8/11/10 — The incidence of dementia and mild cognitive impairment
can be decreased by removing risk factors such as DM and depression. In
addition,

increasing crystallized intelligence (influenced by education and continual
learning as an adult) and the consumption of fruits and vegetables seem to

have a greater impact than modifying genetic risk. However, these factors
are more difficult

to implement as the levels of exposure to which they provide protective
effects are unknown, note the researchers. "Diabetes and perhaps also
depression

..should be the principal targets of future population-based health
prevention programs..it may not be a cause of Alzheimer's disease, but
associated inflammation

and cortisol- related damage may [also] exacerbate underlying pathologies."
the team leader says.[1433 subjects;65 yrs +]

 

16.%% M Early Evidence of Brain Complications With T2DM in Obese Adolescents
8/10/10  — In a small study of obese adolescents, those with T2 performed

worse on several cognitive function tests than their equally obese peers
without DM or preDM. Subtle brain abnormalities on magnetic resonance
imaging

(MRI) were also seen only in the T2 group. The researchers report "We
demonstrate that, in the absence of significant vascular disease, there may
be clear

brain complications among adolescents with T2. There is good evidence to
believe that it is the insulin resistance itself that causes the cognitive
dysfunction,"

[36 subjects ] ..difference in estimated  IQ between the diabetic and
nondiabetic teens (87.8 vs 103.6) “it's not that they are less smart than
the other

kids, it's just that they are not performing as well on the tasks and
therefore their measured IQ is going to be lower."  MRI-based  brain
structural analyses

showed reduced white matter volume and enlarged cerebrospinal fluid space in
the whole brain and the frontal lobe in particular but no obvious reduction

in the volume of gray matter..studies are needed to determine the underlying
pathophysiologic mechanisms of cognitive impairment and brain changes in
obese

adolescents with T2.

 

17.%% M The Juvenile Diabetes Research Foundation (JDRF)at Forty: Updates of
Research in T1DM 7/30/10; Diabetes. 2010;59(7) 40 years ago, a small group

of families founded JDRF dedicated to finding a cure for T1DM and its
complications. JDRF recently conducted an informal poll of scientists and
asked them

to nominate the research highlights of these 40 years. The lessons learned
may be summarized as: 1.  T1 is different from other forms of DM because of

autoimmunity. We need to halt the autoimmune response at every stage of
disease.  2.  The ß-cell is the focus of all forms of DM. In T1 we will need
to

replace lost ß-cells or regrow new ones.

3.  Controlling blood glucose is the key to preventing complications.

4.  There are common pathways that lead to multiple complications.

 

18.%% M Nutritional Intervention in Patients With T2DM Who Are
Hyperglycaemic Despite Optimised Drug Treatment– 8/03/10; BMJ © [93 pts;- 70
yrs;T2 with

glycated haemoglobin (HbA1c) of more than 7%] Conclusions -  Intensive
dietary advice has the potential to appreciably improve glycaemic control
and anthropometric

measures in [these ]patients. Both groups received advice on physical
activity - desirability of achieving at least 30 min physical activity of
moderate

intensity on most, if not all, days of the week.  We translated recommended
total energy intake and nutrient distribution for each participant into
foods,

recipes, and meals on the basis of the initial 3 day weighed diet record,
personal preference, budget, and socio -cultural factors. emphasis was on
appropriate

food quantities, vegetables, fruit, legumes, wholegrain cereals, fish
(preferably oily), nuts, low fat dairy products, and appropriate fats and
oils. Meat,

when consumed, was to be lean. Each participant had 2 individual sessions
with the study dietitian within the first month after randomisation, then
monthly

sessions for 5 months. One group education session within the first two
months and a telephone call between visits, as deemed necessary by the
dietitian.

 

 

19.%% M Salsalate Improves Glycemic Control in Diabetes Patients

8/04/10  Study Summary - Inflammation has been recognized as playing a key
mechanistic role in the morbidity & mortality associated with many diseases

of the kidney and heart. This study describes the effect of treatment with
the anti-inflammatory agent salsalate on patients with DM who demonstrate a

significant degree of

inflammation. [randomized, double-blinded, placebo-controlled; 108 T2 pts;
glycated hemoglobin levels between 7.0% & 9.5% at base].. Direct treatment
of

inflammation rather than treatment of its inciting condition may improve
important intermediate markers. [study] Additional work must now focus on
assessment

of the true safety profile of these medications in these patients, as well
as the potential efficacy of the treatment.. Medscape Nephrology © 2010 

 

20.%% Eye (2010) 24,  Use of pegaptanib for recurrent and non- clearing
vitreous haemorrhage in proliferative DM retinopathy (PDR)

Many with PDR go on to develop vitreous haemorrhage (VH). Those with
recurrent or non-clearing VH require vitrectomy to restore vision.
Pegaptanib [macugen]

is a vascular endothelial growth factor antagonist that disrupts the
proliferative cascade and has been shown to precipitate regression of
retinal neovascularisation.

[growth of abnormal vessels] We assessed the effect of pre-operative
intravitreal (IVT) pegaptanib on the timing, difficulty, and outcome of
vitrectomy

for recurrent VH in PDR. [15 eyes]  Conclusions - IVT pegaptanib can be
considered in DM patients with VH. Approximately one-third may avoid
vitrectomy

altogether. There are clear intra- operative advantages of using IVT
pegaptanib pre-operatively. However, caution should be exercised where there
is pre-existing

retinal detachment.

 

21.%% JH The Challenge of “Brittle” Diabetes 8/12/10  An important goal of
DM treatment is tight glucose control, which means keeping your blood
glucose

level as close to normal as possible. But staying in good control is
difficult, especially for people with [BDM]. What does this old-fashioned
term mean?

BDM is sometimes used to describe the condition of patients who have
frequent swings in blood glucose levels from very high to very low. It's
natural for

blood glucose to rise and fall during the day in response to meals,
exercise, and other influences. However, people with BDM often experience
drops and

peaks in blood glucose so severe that they require medical attention.
Brittle Diabetes is more common in people with T1 but it also can occur in
T2s. Certain

medical conditions may be linked to it such as gastroparesis (a delay in
stomach emptying, which interferes with timing carbohydrate absorption after
meals)

and some endocrine disorders, such as hypothyroidism. Most often, though,
BDM  is a sign that the person is struggling with the inherent challenge of
replacing

the pancreas's finely tuned production of insulin with the cruder method of
injecting this essential hormone. .gaining control is often a matter of
paying

closer attention to the daily requirements of managing blood glucose. . are
you accurately matching your insulin dose to the amount of carbohydrates you

eat at each meal? Often, people find that heeding these kinds of finer
details helps minimize the highs and lows.

 

22.%% Eye (2010) 24  Blood pressure changes after intravitreal bevacizumab
in patients grouped by ocular pathology We evaluated the effects of
intravitreal

injection of bevacizumab (Avastin) on blood pressure (BP) in the context of
ocular vascular pathology. [135pts with DM ret, RVO, CNV, & other retinal
vascular

diseases] Discussion Intravitreal bevacizumab injection is safe in terms of
its effect on BP, regardless of ocular pathology.

 

23.%% Eye (2010) 24, Intravitreal bevacizumab vs  intravitreal triamcinolone
combined with macular laser grid for diffuse diabetic

macular oedema -To evaluate the 12-month clinical outcome of patients with
persistent non-ischaemic diffuse diabetic macular oedema (DME) treated with

intravitreal bevacizumab (IVB)[43 eyes] or with intravitreal injection of
triamcinolone combined with macular laser grid (IVTA-MLG) [96eyes] After 6 &

12 months, the IVB group experienced a statistically significant improvement
in visual acuity when compared with baseline, whereas the IVTA-MLG group did

not not. . An increase in (IOP) was present in 10.4% eyes treated with
IVTA-MLG, and in two cases it was resistant to topical treatment. No
significant

side effects were reported in the IVB group.

 

Abbreviations:Fup-follow up; pt - patients;  DM - diabetes Mellitus; T1DM -
type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema; GDM
gestational

diabetes;PDR - proliferative diabetic retinopathy; IVTA  intravitreal
triamcinolone acetonide; FPG - fasting plasma glucose; BP - blood pressure;
CVD -

cardio-vascular disease; MI -myocardial infarction or heart attack ;HTN -
hypertension or high BP; OCT - optical coherence tomography; VA - visual
acuity 

-ADA - Am Diab Ass & ADA Professional.. Online; JH- Johns Hopkins Alerts ;
M- Medscape Web MD; NIH - Nat Institutes of Health;  MTD- Medical News Today


NREndo;Nature Reviews Endocrinology    Definitions via online Medical
dictionaries.  Disclaimer, I am a BSN RN but not a diabetic or diabetic
educator.

Reports are excerpted unless otherwise noted. This project is done as a
courtesy to the blind/visually impaired and diabetic communities. Dawn
Wilcox BSN

RN Coordinator The Health Library at Vista Center; an affiliate of the
Stanford Hospital Health Library.   contact above e-mail or 

thl at vistacenter.org     

            

    

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