PreDx finger stick comparable to venous blood assay in detecting diabetes risk.

Clinicians may be able to accurately detect a patient’s likelihood of developing type 2 diabetes with the use of a finger stick capillary blood collection test, according to data presented here at the AACE Annual Scientific and Clinical Congress.

“We’ve developed what we call the PreDx score (Tethys Bioscience). It’s a multimarker algorithm-based diagnostic. It combines the results from seven different blood-based biomarkers along with the patient’s age and gender to produce a single score between 1 and 10,” researcher Theodore Tarasow, PhD, senior vice president of research and development at Tethys Biosciences, said during a late-breaking abstract presentation here. “We’ve done clinical studies to show that that score is directly tied to a person’s 5-year risk for developing diabetes.”

Tarasow said the accuracy of the finger stick blood assays yielded promising results that were comparable to venous blood assays. Data presented indicate that the coefficient of variation ranged from 2.4% for HbA1c to 11.3% for adiponectin. Upon calibration, results showed impressive agreement between PreDx values and matched samples. Overall slope was 0.997 (95% CI, 0.916-1.078) and intercept was –0.048 (95% CI, –0.206 to 0.110) by Deming regression, according to data.

Further, data from the Inter99 study indicated no significant differences in area under the curve (AUC), positive predictive value or sensitivity when comparing simulated finger stick scores with venous scores. Both PreDx venous and PreDx finger stick were also superior to fasting glucose by AUC and other measures in predicting development of diabetes.

“What we really need is the ability to find those at the highest risk and apply additional resources to try and prevent or delay that conversion to diabetes,” Tarasow said.

Tarasow said the PreDx is no more expensive than current tests available for its diagnostic purpose.

“From a clinical perspective what this is really going to allow us to do is have greater access to patients where there is not access to onsite phlebotomy,” Tarasow said. – by Samantha Costa

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• Using a litmus paper — a simple technique to do this test — allows greater adoption of this predictive tool for how to aggressively treat diabetes or not. If you have a patient at high risk for diabetes in the prediabetes population, you then may use pharmaceutical agents (i.e., metformin), but if you’re treating a low-risk patient, you probably don’t need to do so. Or, you may put them into a supervised exercise program or some type of diet or bariatric surgery. Your intervention will be much stronger.
• Bruce W. Bode, MD
• o    Atlanta Diabetes Associates
  Endocrine Specialty Group

Source: Endocrine Today

 

 

Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study.

Abstract

Objective To examine if the beneficial effect of statin medication on mortality seen in randomised clinical trials of type 2 diabetes applies equally to observational studies in the general population of older people.

Design A prospective, population-based cohort study.

Setting Reykjavik, Iceland.

Participants 5152 men and women from the Age, Gene/Environment Susceptibility-Reykjavik Study, mean age 77 years, range of 66–96 years.

Main outcome measure Cardiovascular and all-cause mortalities and the RR of dying according to statin use and history of coronary heart disease (CHD) in persons with type 2 diabetes and those without diabetes with a median follow-up time of 5.3 years, until end of 2009.

Results The prevalence of type 2 diabetes was 12.4% of which 35% used statins. Statin use was associated with a 50% (95% CI 8% to 72%) lower cardiovascular mortality and 53% (29% to 68%) lower all-cause mortalities in persons with diabetes. For those without diabetes, statin use was associated with a 16% (−24% to 43%) lower cardiovascular and 30% (11% to 46%) lower all-cause mortalities. Persons with diabetes using statins had a comparable risk of cardiovascular and all-cause mortality to that of the general population without diabetes. The effect was independent of the level of glycaemic control.

Conclusion This observational study lends important support to existing data from randomised clinical trials. These data suggest that in the general population of older people with diabetes, statin medication markedly reduces the excess cardiovascular and all-cause mortality risk, irrespective of the presence or absence of coronary heart disease or glucose-lowering medication.

Source: BMJ

 

Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study.

Abstract

Objective Low socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus.

Design Population-based register study.

Setting Finland, nationwide individual-level data.

Participants All persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database).

Methods Three outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios.

Results The risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively.

Conclusions According to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups.

 

Source: BMJ

 

 

Low Melatonin Levels Linked to Diabetes, Study Finds.

Having low levels of melatonin, a hormone that regulates sleep, may put you at risk for type 2 diabetes, according to a new study.

By Amir Khan, Everyday Health Staff Writer

People with low levels of melatonin, a hormone that helps regulate sleep and circadian rhythm, may be at a higher risk for type 2 diabetes than people with high levels, according to a new study published in the Journal of the American Medical Association.

Researchers from Brigham and Women’s Hospital in Boston looked at 370 women who developed diabetes while taking part in the Nurses’ Health Study, a long-term study on women’s health, alongside 370 healthy controls, and found that study participants with low levels of melatonin were at approximately twice the risk of developing type 2 diabetes when compared to participants with high levels, even after the researchers adjusted for other diabetes risk factors such as smoking, diet, and exercise.

“This is the first time that an independent association has been established between nocturnal melatonin secretion and type 2 diabetes risk,” Ciaran McMullan, MD, study author and researcher in the renal division at Brigham and Women’s Hospital, said in a statement. “Hopefully this study will prompt future research to examine what influences a person’s melatonin secretion and what is melatonin’s role in altering a person’s glucose metabolism and risk of diabetes.”

Previous research done in rats has shown that taking a melatonin supplement protected them against diabetes, the researchers said, but they could not say for sure that it would have the same effect in humans.

Melatonin is produced in the pineal gland, which is located in the center of the brain, and can be measured through a blood, urine or saliva test. The hormone is only produced in the dark, and low levels have been linked to various conditions, including breast cancer, ovarian cancer, andinsomnia.

“Melatonin receptors have been found throughout the body in many tissues including pancreatic islet cells,” the researchers wrote in the study, “reflecting the widespread effects of melatonin on physiological functions such as energy metabolism and the regulation of body weight.”

While the researchers could not say for sure that there was a causal link between low melatonin levels and type 2 diabetes, they said previous research has shown that melatonin can play a role helping to regulate sugar levels in the body. When melatonin levels are low, the researchers continued, your blood sugar levels could be thrown off, raising your risk for diabetes.

In addition, they said that since melatonin helps regulate sleep and circadian rhythm, it’s possible that people with low melatonin levels wake up frequently during the night and sleep fewer hours, which could increase their risk.

“Sleep disruption may also be associated with diabetes,” the researchers wrote in the study. “For example, men who reported sleeping less than five hours per night were twice as likely to develop diabetes as those who reported sleeping seven hours per night.”

Although this is the first study to link melatonin to diabetes risk, some doctors use melatonin to treat patients who are already diagnosed with the condition. Michael Wald, MD, director of nutritional services at Integrated Medicine of Mount Kisco in Mount Kisco, NY, routinely gives his diabetic patients melatonin, and said it helps bring their blood sugar levels back into line.

“Several studies have noted that diabetes often have insomnia and it is this subgroup of diabetes that may benefit the most from melatonin supplementation,” said Dr. Wald. “In diabetics with low melatonin, taking slow-release melatonin seems to improve blood sugar levels. The diabetic blood sugar test, called hemoglobin A1c, is reduced in diabetics who take between 1 to 2 mg of melatonin two hours before bedtime.”

Giving patients melatonin, he added, not only helps their blood sugar levels, but also helps them sleep better, which can reduce the risks of other diseases as well.

“By improving sleep quality, melatonin may reduce the risk of many diseases that are associated with poor sleep quality,” Wald said, “including, but not limited to, cardiovascular disease, sleep apnea, nerve problems, depression and pain.”

Intensive Glycemic Control and End-Stage Renal Disease in Type 2 Diabetes.

One case of ESRD was prevented for every 430 intensively treated patients.

In recent randomized trials, intensive glycemic control did not prevent macrovascular events in patients with longstanding type 2 diabetes. In one of those trials (ADVANCE, with 11,000 patients overall; JW Gen Med Jun 6 2008), intensive control prevented macroalbuminuria, a surrogate endpoint for microvascular disease, from developing in some patients. Now, the researchers present information on the most important renal endpoint — progression to end-stage renal disease (ESRD).

After 5 years, mean glycosylated hemoglobin (HbA_1c) levels were 7.3% and 6.5% in the standard- and intensive-treatment groups, respectively. ESRD occurred in 20 standard-treatment patients and in 7 intensive-treatment patients. The difference is statistically significant, but about 430 patients underwent intensive glycemic control to prevent 1 case of ESRD. Researchers found no significant differences between groups in incidences of “renal death” or doubling of serum creatinine level.

Comment: The authors believe that their results show “intensive glucose lowering using ADVANCE-like regimens may be beneficial for many people with diabetes.” However, the word “many” here is in the eye of the beholder: Editorialists express concern about the large number needed to treat and note that intensive control can confer both benefits and harms. They conclude that “an A_1c target <6.5% for type 2 diabetes should be used cautiously, if at all — perhaps only in well-informed patients who are younger, at lower risk for hypoglycemia, and free of symptomatic cardiovascular disease.”

Source: Journal Watch General Medicine

FDA Approves Novel Diabetes Drug.

The FDA has approved the first oral inhibitor of sodium glucose cotransporter 2 (SGLT2) to treat adults with type 2 diabetes. Canagliflozin (Invokana) lowers blood sugar by blocking the kidneys’ urinary reabsorption of glucose, resulting in increased urinary excretion.

In nine studies comprising over 10,000 patients, the SGLT2 inhibitor improved hemoglobin A1c levels and blood sugar levels. Canagliflozin has been studied as a stand-alone treatment and in combination with metformin, sulfonylurea, pioglitazone, and insulin.

Common side effects include urinary tract infection and vaginal yeast infection. Dizziness or fainting could occur during the first 3 months of treatment due to the tablet’s diuretic effect, which can lead to orthostatic or postural hypotension. The drug should not be used in patients with type 1 diabetes, diabetic ketoacidosis, severe renal impairment, or end stage renal disease.

Source: FDA news

Liraglutide may reduce liver enzyme levels in patients with type 2 diabetes.

Patients with elevated liver enzymes were safely treated with liraglutide, although the treatment’s effect was reduced by its impact on weight and glycemic control, according to recent results.

Researchers performed a meta-analysis of data on 4,442 patients enrolled in six 26-week, phase 3 randomized controlled trials evaluating the impact of liraglutide on liver enzymes in patients with type 2 diabetes. Liraglutide was assigned to 2,734 patients in the cohort, while 524 received placebo and 1,184 received other diabetes treatments.

In all studies, patients initially received 0.6 mg intravenous liraglutide once a day, titrated to 1.2 mg daily after 7 days, with some studies increasing dosage to 1.8 mg after 7 additional days. One study (LEAD-2) randomly assigned patients to receive 0.6 mg, 1.2 mg or 1.8 mg once a day, along with metformin and 4 mg glimepiride or placebo per day. LEAD-2 also included a sub-study assessing the drug’s impact on hepatic steatosis.

Abnormal baseline ALT levels were present in 50.8% of patients. A 1.8 mg dose of liraglutide resulted in a significantly larger ALT reduction than that observed among patients receiving placebo (–8.20 IU/L vs. –5.01 IU/L; P=.003 for difference); no significant differences were observed between placebo and smaller doses of liraglutide. Investigators noted that adjusting for HbA1c (P=.63) and liraglutide’s weight reduction (P=.21) eliminated the statistical significance of the drug’s impact. Rates of adverse events were similar among patients with or without elevated ALT at baseline when treated with 1.2 mg or 1.8 mg liraglutide.

In the LEAD-2 sub-study, the 1.8 mg liraglutide dose trended toward improving steatosis relative to placebo, with a 0.10 improvement to liver-to-spleen attenuation ratio among treated patients compared with 0.0 among those receiving placebo (P=.07). Adjusting for changes to weight (P=.25) and HbA1c (P=.93) reduced this trend.

“[Twenty-six] weeks’ treatment with liraglutide 1.8 mg has an acceptable safety profile and significantly improves liver enzymes vs. placebo in patients with type 2 diabetes and asymptomatic liver injury,” the researchers wrote. “These effects appear to be mediated by the effect of liraglutide on weight loss and glycemic control. Our data support the rationale to prospectively investigate GLP-1 analogues in liver injury associated with type 2 diabetes and the metabolic syndrome.”

• Source: Endocrine Today.

 

Nature’s Goodies for Diabetics.

We understand that as a diabetic, your diet is of utmost importance. And that sometimes those sweet cravings are just way too hard to resist! So we bring you alist of natural goodies that tantalise your taste buds, are easy to find and as a bonus, are great for your health!

Tempting red strawberries or indigo coloured blueberries or just any berries for that matter. Experts advice that these little colourful fruits are rich in antioxidants, vitamins and fibre and are low-carb! So top off your breakfast with some strawberries or just toss them in your mouth. It adds a pop of colour and a dollop of health!

Low in calories and carbohydrate content, this portable fruit can be toted around easily in your bag, making it the perfect snack. Fibrous, with tonnes of vitamins and antioxidants, this diabetes-friendly fruit will add a crunchy and healthy punch to your diet.

Is there nothing this superfood can’t do? Research shows that green, leafy and fresh spinach is extremely low in calories and carbohydrates, which is especially good news if you are a diabetic. In fact, spinach is one of the rare things that a diabetic can eat almost freely!

Kidney beans, black beans or lentils have been shown to have immense health benefits for a diabetic. They are low fat, low calorie and high protein! They make you feel full, slow down your digestion process and prevent blood sugar from spiking.

 

Despite the fact that an orange contains sugar, it also contains other compounds that help control blood glucose, which makes it good for a diabetes patient. The soluble fibre present in an orange thickens as it’s being digested. This in turn slows down the sugar absorption, offering better control of your blood sugar.

Cabbage has a low glycaemic index of 10 which is very diabetes friendly. It is also a rich source of vitamin C and K. However, keep an eye on the fat content if you are including cabbage in your diet.

Brinjal: Non-starchy, low carbohydrate and soluble fibre, could a vegetable be more perfect for diabetes? Load up on this easily available vegetable and enjoy the goodness that it offers!

Okra (Lady’s Finger) is a sure shot hit with kids and diabetics! Like brinjals and oranges, the presence of soluble fibre in okra makes this humble vegetable one of the best things to eat if you are diabetic.

Pears: Rich in potassium and loaded with fibre, a pear is also low in carbohydrates! Add them in your fruit bowl or mix it up with spinach to get an instant fix for your hunger pangs.
Despite the fact that fruits and vegetables are good for you, there’s no denying the fact that some of them contain sugar and carbohydrates, albeit in small amounts. So keep your portions small and do check with your nutritionist before any major diet changes.

 

 

Source: www.mdhil.com

 

Widespread Screening for Type 2 Diabetes Might Not Lower 10-Year Mortality.

In a population-based U.K. study, screening all middle-aged high-risk patients did not help.

Early diagnosis of type 2 diabetes can improve clinical outcomes, and mathematical models have suggested that widespread screening might lower diabetes-related mortality. To test this hypothesis, researchers cluster-randomized 33 general practices in eastern England to offer either a single round of formal screening to all middle-aged patients (age range, 40–69) considered to be at high risk for diabetes according to specified clinical characteristics (28 practices with approximately 16,000 high-risk patients) or to continue diagnosing diabetes in such patients through routine clinical assessment (5 practices with approximately 4000 high-risk patients).

Overall, 73% of invited patients participated in screening, and 3% of patients in both groups received diabetes diagnoses. After a median 9.6 years of follow-up, overall mortality among high-risk patients was similar in the screening and no-screening practices (10.5 and 9.9 deaths per 1000 person-years, respectively). Rates of cardiovascular- and cancer-related mortality also were similar in the two groups.

Comment: The study population was of above-average socioeconomic status; these results might not be generalizable to less-affluent populations in which the prevalence of undiagnosed diabetes might be higher. In addition, multiple rounds of screening and longer follow-up might be necessary to detect mortality differences attributable to screening. Furthermore, important outcomes other than mortality might be modifiable by screening. Regardless, these data suggest that population screening for diabetes might be less effective than expected and should be evaluated carefully before widespread implementation.

Source: Journal Watch General Medicine

 

Screening for Type 2 Diabetes Does Not Reduce Mortality

Screening high-risk patients for type 2 diabetes does not reduce mortality, according to a Lancet study.

Some 30 U.K. general practices were randomized to screening plus intensive diabetes control, screening plus routine diabetes care, or no screening. Over 16,000 patients aged 40 to 69 were eligible for screening, as determined by a risk score based, in part, on BMI and antihypertensive drug use. Three percent were diagnosed with diabetes.

During roughly 10 years’ follow-up, the screening and control groups did not differ in terms of all-cause mortality, diabetes-related mortality, or cardiovascular mortality. Adjustment for intensive versus routine diabetes care did not alter these findings.

Pointing out the low prevalence of undiagnosed diabetes in this cohort, Lancet commentators suggest that screening might be more beneficial in countries where diabetes is more common. They conclude that screening recommendations are “likely to be country-specific and context-specific for the foreseeable future.”

Source: Lancet