Diabetes Health Talk

Type 2 diabetes typically worsens over time as less and less insulin is produced by the pancreas. Usually, treatment for type 2 diabetes starts with lifestyle changes and a diabetes pill, such as metformin. Sulfonyureas and thiazolidinediones are other types of diabetes pills that can be considered, but both can cause weight gain, and sulfonyureas can cause more episodes of hypoglycemia (low blood glucose) than metformin.

Liraglutide is a new injectable diabetes medicine. It is now under development as a possible alternative to available diabetes pills. Researchers are performing studies to find out how liraglutide compares to other diabetes medicines.

Why did the researchers do this particular study?
The researchers wanted to compare the effectiveness and safety of adding liraglutide, glimepiride (a sulfonylurea), or a dummy pill to metformin treatment for people with type 2 diabetes.

Who was studied?
The study included more than 1,000 adults with type 2 diabetes who had been taking either one type of diabetes pill or more than one type of diabetes pill for more than 3 months.

How was the study done?
Participants received liraglutide injections, glimepiride pills, or dummy pills in combination with metformin for 26 weeks. Researchers measured the participants’ A1C and body weight at the start and end of the study and collected information about whether they experienced nausea or hypoglycemia while on the treatments.

What did the researchers find?
Adding liraglutide to metformin provided better diabetes control than metformin alone. The liraglutide-metformin combination controlled blood glucose as well as and caused less weight gain and hypoglycemia than a combination of glimepiride and metformin. Liraglutide caused more nausea than glimepiride, but the nausea declined over time.

What are the implications of the study?
Adding liraglutide to metformin may be a good treatment option for patients whose diabetes is not adequately controlled with metformin alone, especially when weight gain and hypoglycemia are a concern.

Keeping blood pressure down is critical for African Americans with type 2 diabetes as high pressures increase the risk of kidney disease progression, according to a report in The American Journal of Medicine.

“Lower blood pressure targets are clearly recommended in patients with diabetes,” Dr. Mohamed G. Atta from Johns Hopkins University School of Medicine, Baltimore, told Reuters Health. “Even though physicians are aware of the importance of blood pressure control, they are not as aggressive as you would expect.”

Atta and colleagues examined the progression of kidney disease in 186 African American patients with type 2 diabetes participating in Project Sugar, a study of interventions to improve diabetes control. The team specifically looked for demographic and modifiable factors that influence progression.

When the study began, 60 patients had kidneys that leaked small amounts of protein into the urine. During 3 years of follow-up, all of the patients developed more severe leakage problems.

Disease progression was not associated with age, duration of diabetes, underlying heart disease, or the use of cholesterol-lowering drugs, the researchers note. By contrast, progression was associated with the need for blood pressure medications.

“In general, 40 percent of African Americans above the age of 20 have (high blood pressure), highlighting the magnitude of this problem,” Atta said. “The message then is to increase awareness, early recognition of the problem, and aggressive interventions.”

There are programs out there to help people get the medications they need. Pharmaceutical companies have low-income programs to donate needed medications. There are state and federal programs, such as medicare, medicaid and other low-income medication programs that get much needed medications in the hands of those that need them.

New study shows Avandia and Actos doubles a women with Diabetes type-2 risk of bone fractures.

Scientists already knew the two caused bone fractures in certain women, but were unsure of the magnitude.

Sonal Singh of North Carolina’s Wake Forest University School of Medicine.

Singh and colleagues at Wake Forest, working with researchers at Britain’s University of East Anglia, based their findings on a pooled analysis of 10 previous clinical studies lasting at least a year involving 14,000 patients.

They concluded that if TZDs were used by diabetic women aged around 70 for a year, one additional fracture would occur among every 21 women. Among younger women, around age 56, use of the drugs would lead to one extra fracture for every 55 women.

Always be sure to ask your doctor or health care physician of your medications and side effects. Also ask if those side effects need to be addressed, such as additional calcium, in this case. Before starting any new medications or supplements, herbal remedies and minerals, discuss those with your doctor. There may be adverse reactions between then that may increase your sypmptos or have unwanted side effects you hadn’t counted on.

If you need additional calcium, that is easily remedied, by adding more low-fat milk and cheese to your diet, or vitamin D pills or getting just ten minutes more sunshine per day (with your sunscreen and protective covering. ). Exercise is also important to stop bone loss or calcium leaching from your body. Just a ten minute walk a day is all it takes to get started with healty bones.

Is there a youth with diabetes in your life? If they are overwieght, chances are, they have tried using their diabetes type-1 or type-2 to lose weight.

More and more teenagers with diabetes type-1 or type-2 are skipping insulin shots or pills, fasting, using diet aids, vomiting or using laxatives in order to shed a few pounds. While they may be successful in shedding weight, many may not know the danger they are putting their health in.

They may be causing themselves heart, kidney, liver or eye problems or failure. Their heart and other organs must work harder to compensate by not taking care of themselves. Closely monitor their medications, if you must, to ensure they are taking the proper dosages at the proper times.

If they are concerned about weight loss, sit down and calmly discuss proper nutrition, exercise. Try not to turn it to a lecture, because that’s the surest way to lose their attention. What most people respond to is some listening to them and gently showing them proper eating and exercise habits. Will it happen overnight? No. But, it will happen, over time, by showing proper eating habits, fixing fresh foods with herbs and spices.

Find an activitiy that appeals to them: walking is the best activity known to humankind. There are many health benefits, and weight loss is among them. In 2007, I lost 41 pounds by cutting out fried, fatty, high colesterol foods and walking from 30-60 minutes every day. It’s just one pound a week (the FDA’s recommended weightloss).

What is metformin?
Metformin is an oral diabetes medicine that helps control blood sugar levels.

Metformin is for people with type 2 (non-insulin-dependent) diabetes. Metformin is sometimes used in combination with insulin or other medications, but it is not for treating type 1 diabetes.

What should I discuss with my healthcare provider before taking metformin?
Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

You may be more likely to develop lactic acidosis if you have congestive heart failure. Older adults may also have a higher risk of developing lactic acidosis. Talk with your doctor about your individual risk.

Do not use this medication if you are allergic to metformin, if you have kidney disease or kidney failure, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Before taking this medication, tell your doctor if you are allergic to any drugs, or if you have:

liver disease; or
a history of heart disease.
If you have any of these conditions, you may not be able to use metformin, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether metformin passes into breast milk or if it could harm a nursing baby. Do not take metformin without first talking to your doctor if you are breast-feeding a baby.
Metformin should not be given to a child younger than 10 years old. Extended-release metformin (Glucophage XR) should not be given to a child younger than 17 years old.

The National Institutes of Health’s (NIH) National Heart, Lung and Blood Institute has announced the early cancellation of one part of a major diabetes and cardiovascular disease study after discovering that patients undergoing that treatment were more likely to die from heart attacks and strokes.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study included 10,251 adults with Type 2 diabetes who were considered to be at especially high risk of heart attacks and strokes. One of the treatments in the study involved using combinations of FDA-approved diabetes drugs to aggressively lower participants’ blood sugar to levels as close to normal as possible.

“Of these, 257 in the intensive treatment group have died, compared with 203 within the standard treatment group,” the NIH announced. At the time of the experiment’s cancellation, patients had been undergoing treatment for an average of four years.

The NIH said that it does not know what caused the increased risk of death among patients undergoing intensive treatment, but it does not believe that the risk came from any individual drug or combination of drugs. Rather, there appears to be some negative effect on the body from so aggressively lowering blood sugar levels.

“This presents a real dilemma to patients and their physicians,” said Richard Kahn, chief scientific and medical officer for the American Diabetes Association. “How intensive should treatment be? We just don’t know.”

Previously, health experts have believed that the closer to normal a diabetic’s blood sugar can be lowered, the better. The NIH findings have offered a major challenge to that conventional wisdom.

Approximately 21 million people in the United States suffer from Type 2 diabetes, and the numbers increase every year. The elevated blood sugar that is characteristic of the disease is well-established to lead to a host of other health problems, including an elevated risk of cardiovascular disease, heart attack and stroke.

The widespread problem of children failing to take their medication for a range of life-threatening illnesses is to be tackled as part of a new university research project.

The first phase of the study will be to look at methods previously tried to address the problem and to talk to three groups of school-age children — five to seven year olds, 10 to 12-year-olds and 15 to 17-year-olds — and their parents about their experiences of the healthcare system and medication. They will also interview a range of healthcare professionals including GPs, hospital paediatricians, community paediatricians and pharmacists, nurses and GP practice managers and secretaries about the issues they face in communicating their services to young people. Lastly, they will consult with other stakeholder groups including patient groups such as Asthma UK and Epilepsy Action and healthcare-related organisations such as the Royal College of Practice Nurses.

During the second phase they will design a new strategy that can be embedded within the whole range of healthcare services for children — this may include encouraging children and parents to write down their concerns or questions as a driver for their consultation with their GP and giving health practitioners a range of extra resources targeted specifically at supporting younger patients.

Dr Monica Lakhanpaul, Community Paediatrician and Senior Lecturer in Child Health at The University of Leicester, said: “We are fully aware that children may not take medicines sometimes prescribed to them by health professionals.

“Reasons for this vary — children and families may not receive information that facilitates their understanding of why they are taking their medicine and therefore not understand its importance; they may not understand how to take the medicine or the health professionals may not prescribe the type of medication that children could take easily, eg tablets instead of liquids.

“We wish to find out why — and why not — children take their medicine and use this information to develop a tool allowing health professionals to work together with children and parents and carers to improve the medicine they are prescribed. 
 
“A very important element of the study is to gain views from a number of different perspectives i.e from parents/carers, health professionals and children themselves.”
Lecturers at The University of Leicester are key collaborators in the study. Dr Hitesh Pandya is able to provide experience of working with families who are seen in the hospital and Dr Lakhanpaul, a Community Paediatrician, works with children who are managed out of hospital and who, in most cases, will not have a nurse or doctor giving their medication but need to take responsibility within the home or school environment.
 
Dr Lakhanpaul added: “Another advantage at Leicester is that we can provide access to a multi-ethnic community who are often under-represented in research studies. It is important to have perspectives from individuals from different socio-economic and cultural backgrounds. We hope to achieve this by involving families from Leicestershire.”

Drug-coated stents appear to be superior to bare metal stents in both efficacy and safety in patients with diabetes, new research shows.

The safety of drug-coated stents versus conventional bare metal stents has been a matter of controversy for years.

Diabetics have a higher prevalence of ischemic heart disease than the general population, but percutaneous coronary intervention (PCI) has limitations in this group, including a higher rate of restenosis and subsequent heart attack and death.

“There is controversy regarding selecting PCI as a treatment for patients with diabetes,” said Dr. David Williams, with Brown University and Rhode Island Hospital in Providence. “One of the major shortcomings of PCI in this patient subset has been a relatively high need to perform repeat revascularization. Drug-eluting stents may offer a potential advantage in that regard, but there is some concern as to whether they are as safe as bare metal stents.”

Mauri presented three-year follow-up data for a subgroup of about 5,000 diabetic patients undergoing PCI with stenting to reopen blocked vessels.

Two-thirds of the patients were treated with drug-eluting stents, and one-third were treated with bare metal stents.

There was an absolute reduction of around 5 percent in the need for repeat procedures in the target vessel and a small, but significant and surprising, decrease in death and subsequent heart attacks.

“It’s appropriate to conclude that drug-eluting stents are superior to bare metal stents in patients with diabetes in regard to reducing the need for repeat revascularization. It also appears to be safe,” Williams said. “Whether there’s actually a benefit in terms of death and heart attack, I would say this is a provocative finding but not firmly established. This report indicates that probably the selection of bare metal stents over drug-eluting stents will be based on the ability of patients to take dual antiplatelet therapy for a sustained period of time.”

A second study, from French researchers, presented at the meeting detailed a way to give individually tailored doses of Plavix (clopidogrel) to patients who had undergone PCI that still reduced the risk of blood clots.

Older drug better than Avandia for slowing buildup in arteries, study says

The controversial diabetes pill Avandia failed to significantly slow plaque buildup in heart arteries compared with an older drug, though there were some hopeful signs in a new study reported Wednesday.

Avandia, once a blockbuster drug made by British-based GlaxoSmithKline PLC, has been under a cloud since May 2007, when a medical journal report suggested it may raise the risk of heart attacks and heart-related deaths. The American Diabetes Association recently said patients should avoid using it until safety questions are resolved.

The new study tested Avandia against glipizide, sold as Glucotrol by Pfizer Inc. and in generic form, in 672 people in 19 countries. All had Type 2 diabetes, the most common form of the disease and the one linked to obesity. All were at high risk for heart problems and many were very overweight.

Doctors measured the thickness of plaque starting to form in a heart artery of each participant at the start of the study and 18 months later. Those on Avandia had a slight reduction in buildup versus a little increase in those on glipizide, but the difference was so small that the results were a statistical draw.

Avandia did show a significant advantage in a second measure of artery plaque, but this was not the main result being tested.

Dr. Richard Nesto of Lahey Clinic in Burlington, Mass., and Brigham and Women’s Hospital in Boston led the study and reported results Wednesday at an American Heart Association conference.

“This is now the second study that was unable to show a beneficial effect,” said Dr. James Stein, director of preventive cardiology at the University of Wisconsin-Madison, who had no role in the research.

“People really shouldn’t be using this to treat diabetes” because safer and more effective medicines are available, Stein said.

A drug designed to specifically hit a protein linked to the life-extending benefits of a meager diet can essentially trick the body into believing food is scarce even when it isn’t, suggests a new report in the November Cell Metabolism.

The drug called SRT1720, which acts through the protein SIRT1, enhances running endurance in exercised mice and protects the animals against weight gain and insulin resistance even when they eat a high-fat diet, the researchers report. The drug works by shifting the metabolism to a fat-burning mode that normally takes over only when energy levels are low.

The findings bolster the notion that SIRT1 may be a useful target in the fight again metabolic disorders, including obesity and type 2 diabetes. It also helps lay to rest a long-standing controversy in the scientific world over the metabolic benefits of the red wine ingredient known as resveratrol. Resveratrol also acts on SIRT1, but its influence on other metabolic actors had left room to question exactly how it works.

” There has been a lot of controversy in the field about resveratrol action,” said Johan Auwerx of Ecole Polytechnique Fédérale de Lausanne. “We find that the majority of the biology of resveratrol can be ascribed to SIRT1.” While SIRT1 might not explain all of resveratrol’s effects, the new results suggest that the central metabolic protein is responsible for about “80 percent of the picture,” he said.

The researchers had conducted earlier studies to demonstrate many of the benefits of resveratrol. To further explore the underlying pathways responsible in the new study, they ran essentially the same experiments with the more potent and specific SIRT1-activating compound SRT1720 developed by the company Sirtris Pharmaceuticals, Inc.

The researchers found that a low dose of SRT1720 partially protected mice from gaining weight on a high-fat diet after 10 weeks of treatment. At higher doses, the drug completely prevented weight gain in the animals. SRT1720 also improved blood sugar tolerance and insulin sensitivity and endowed the animals with greater athletic ability.

” SIRT1720 made the animals run twice as long,” Auwerx said. That improvement was seen only when the researchers specifically exercised the animals. Their voluntary activity actually declined in the study as they hunkered down to save energy.

They found further evidence that the SIRT1 activator acts as a calorie-restriction mimetic that favors the use of fat stores by promoting the direct modification of multiple SIRT1 targets. It also induces chronic metabolic adaptations that involve the indirect activation of AMPK, an enzyme that regulates skeletal muscle glucose and the metabolism of fatty acids.

Drugs widely used to treat type 2 diabetes may be more likely to keep working if they are used in moderation, researchers at Washington University School of Medicine in St. Louis have found in a study using an animal model.

The drugs, sulfonylureas, help type 2 diabetics make more insulin, improving control of blood sugar levels. But in most patients the effects of sulfonylureas are lost after several years of use, causing insulin secretion to shut down. This typically forces patients to switch to regular insulin injections.

“Why this happens isn’t clear yet, but we’ve found what may be cause for hope,” says senior author Colin G. Nichols, Ph.D., the Carl F. Cori Professor and professor of cell biology and physiology. “We’ve shown in a mouse model that whatever causes this shutdown doesn’t kill the insulin-making beta cells of the pancreas or stop them from making insulin. Instead, it somehow stops them from secreting insulin.”

When they stopped receiving the drug, beta cells began secreting insulin again hours later. Nichols and co-author Maria Sara Remedi, Ph.D., instructor of cell biology and physiology, report the findings in Public Library of Science Medicine.

“I find these experimental observations very exciting,” says Alan Permutt, M.D., professor of medicine and of cell biology and physiology. “But I’m very cautious that patients understand that the relevance of this model to human diabetes and its treatment still needs to be tested.”

If human beta cells also survive and can continue to produce insulin after long-term sulfonylurea exposure, it may be possible to rethink treatment strategies, Nichols suggests.

“Doctors now prescribe new long-acting sulfonylureas to establish a chronic presence of the drug in the bloodstream,” he says. “But it may be beneficial to use the older drugs that go away more quickly, allowing the beta cells time to recover.”

Another potential option would be alternating periods of drug treatment with periods when the patient’s symptoms are managed by insulin injection, Nichols suggests.

A stepped-up care approach is outlined in updated treatment recommendations for type 2 diabetes released Wednesday by the American Diabetes Association and the European Association for the Study of Diabetes.

Lifestyle changes and the drug metformin remain the recommended initial treatment to help people newly diagnosed with type 2 diabetes control levels of blood glucose and A1C, a measure of average glucose levels during the previous two to three months, according to the panel of experts who wrote the updated guidelines.

If this fails to help patients achieve target glucose/A1C levels, there are two treatment choices. One — which is preferred and well-validated — involves the addition of basal insulin or a sulfonylurea to lifestyle changes and metformin. The second choice involves the addition of the drug pioglitazone or a GLP-1 agonist to lifestyle changes and metformin.

If neither of the step 2 choices work, the experts suggested the use of basal insulin, if not already started, and then transition to intensive insulin, if needed.

As in the original guidelines, all of the transitions in therapy usually occur at three-month intervals, with the objective of achieving rapid and continuous maintenance of near-normal glucose and A1C levels.

The updated guidelines were published online in the journals Diabetes Care and Diabetologia.

“Excellent glycemic control is critical to prevent the long-term complications associated with diabetes, which can lead to loss of vision, kidney failure, and amputation,” Dr. David M. Nathan, panel chairman, said in an American Diabetes Association news release.

“After much deliberation, we intentionally chose therapies we highly recommend as safe, effective, and that have much evidence supporting their use. The second tier drugs are valuable if hypoglycemia [low blood sugar] is a major concern, but the use of these drugs is less validated,” he said.

Sirtris, a GSK company focused on discovering and developing small molecule drugs to treat diseases of aging such as Type 2 Diabetes, announced today that it published a new review article on the growing body of sirtuin research and its potential to treat diseases of aging such as Type 2 Diabetes, mitochondrial disorders, inflammation, cancer, and heart disease. Entitled “SIRTUINS – Novel Therapeutic Targets to Treat Age-Associated Diseases,” the review appears in today’s issue of the journal Nature Reviews Drug Discovery.

Sirtuins are a family of enzymes which target genes that control aging. There are a total of seven sirtuin enzymes that exist in mammals. SIRT1 is the founding member of this class of enzymes and is currently the most studied of the group. When activated, SIRT1 appears to mimic some of the positive health effects seen in calorie-restricted animals.

“We are excited to be at the forefront of this research, which continues to intensify as we see positive results from early human clinical studies,” said Christoph Westphal, M.D., Ph.D., Chief Executive Officer of Sirtris, a GSK company. “The body of clinical data supporting the role of SIRT1 activation as a viable mechanism for treating a broad range of diseases of metabolism and aging is growing.”

Peter Elliott, Ph.D., Senior Vice President of Development, said, “At Sirtris, we are targeting the genes which control the aging process with the potential to treat diseases of aging such as diabetes, neurodegeneration, cancer, and inflammation.”

This review highlights the molecular mechanism of action of sirtuins with a view towards diseases where SIRT1 activation shows therapeutic promise. Such diseases of aging include Type 2 Diabetes and mitochondrial disorders, cardiovascular disease, cancer, neurodegeneration and inflammatory diseases. One of the first small molecules discovered to exhibit the positive effects of calorie restriction is resveratrol, a natural ingredient found in red wine. Since then, Sirtris has developed its own proprietary formulation of resveratrol, SRT501. Early clinical studies in patients with Type 2 Diabetes indicate that SRT501 may lower glucose and improve insulin sensitivity. Sirtris also has new chemical entities (NCEs) which are structurally unrelated to and one-thousand times more potent than resveratrol. Sirtris’ first new chemical entity is currently being evaluated for safety and tolerability in a Phase 1a study in humans.

“We are beginning to understand more about activation of other enzymes in the sirtuin family, SIRT2-7, and we’re encouraged by early data that indicates a role for other sirtuins in multiple therapeutic areas,” continued Dr. Westphal.

A new class diabetes drug showed to be safe and effective in a large-scale trial for treatment and management of diabetes.

The drug liraglutide is presented by Novo Nordisk. It belongs to a new generation of diabetes drugs based on glucagon-like peptide-1 (GLP-1) - a natural body hormone aimed at protecting cells from death. The phase 3 one year long trial tested the drug on type 2 diabetes patients.

Liraglutide successfully stimulated insulin production, promoted glucagon (hormone managing blood sugar levels) release from pancreas, reduced appetite. Drug’s diabetes positive effect showed to be long lasting.

Compared to currently available diabetes treatment drugs, liraglutide helps patients lose weight which is extremely important for diabetes treatment. In this trial liraglutide was compared with glimepiride to check drugs’ affect on weight and found that those taking liraglutide lost 4.4 pounds, while those taking glimepiride gained 2.2 pound.

Currently there are a few diabetes treatment drugs undergoing development process based on this innovative technology and one FDA approved drug exenatide (Byetta) marketed by Amylin Pharmaceuticals and Eli Lilly. All the drugs are being designed simultaneously, thus soon diabetes patients will have a wide choice of novel drugs.

This trial also compared liraglutide with exenatide and found that the first is better because it requires only one injection a day, while exenatide requires two injections. However, exenatide is now undergoing improvement process to move to once a week injection. Besides, exenatide injection requires standard hypodermic needle, while liraglutide injection requires ultrafine needle.

However, there is no drug without adverse side effects: liraglutide diabetes drug was reported to have a small risk of pancreatitis with symptoms like nausea, vomiting and belly pain. The risk was not statistically significantly and the symptoms actually affected only a few diabetes patients in the trial.

A single injection is likely to replace the existing 14-shot dosage required weekly by type 2 diabetics, according to a Toronto based researcher.

‘Over two million Canadians have diabetes,’ said Daniel Drucker, clinician-scientist and senior investigator at the Samuel Lunenfeld Research Institute of Mount Sinai Hospital. ‘There is currently no available therapy for type 2 diabetes that patients can receive once a week,’ he said.

The new treatment, Exenatide, once weekly is the first in a new class of long-acting medications that mimic the action of GLP-1 (glucagon-like peptide), a naturally occurring hormone that is produced in the gut after eating.

The report compared outcomes for patients self-injecting Exenatide once weekly against results from the conventional 14 injections a week, as in the currently available version of the drug known as Exenatide (Byetta). The study appeared in the Lancet Monday.

In an international multicentre six-month clinical trial involving 300 eligible patients, 75 percent of them who received the once-weekly Exenatide got their diabetes under control as defined by reaching target glucose levels.

Patients treated with Exenatide once weekly also experienced fewer side effects, had no increased risk of hypoglycemia (decrease in blood sugars) and saw reductions in body weight.

Drucker has studied the gut hormone GLP-1 for over 20 years. Multiple drugs based on GLP-1 action are under active clinical development, and the new once-weekly treatment is expected to undergo Canadian regulatory review as early as 2009.

‘Biomedical research reaches patients and improves lives,’ said Jim Woodgett, director of research at the Samuel Lunenfeld Research Institute. ‘Dr. Drucker is a world-expert in the development of peptide hormone-based therapies for the treatment of human disease and this is an excellent example of moving discovery through to therapeutic application.’