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Category: Type 2 Diabetes

Moderate Drinking May Help Prevent Diabetes

A study published in Diabetologia, conducted by researchers from the National Institute of Public Health of the University of Southern Denmark, suggests that people who drink three to four times a week are less likely to develop type 2 diabetes than those who never drink.

The study, which surveyed over 70,000 people on alcohol intake, found that wine was particularly beneficial—as it likely plays a role in helping manage blood sugar. The study does note, however, that drinking frequency has an independent effect from the amount of alcohol taken: the effects are more beneficial when drinking the alcohol in four portions, rather than all at once.

The researchers concluded that moderate drinking three to four times a week reduced a woman’s risk of diabetes by 32%, while it lowered a man’s risk by 27%, compared with people drinking less than one day a week.

The findings further suggest that not all types of alcohol yielded the same effect: while men who drank 1-6 peers per week lowered their diabetes risk by 21%, there was little to no impact on women’s risk. Conversely, a high intake of spirits among women significantly increased their risk of diabetes—yet there was no effect on men.

The team have used a similar survey to research the effect of alcohol on other conditions, finding that drinking moderately a few times a week was linked to a lower risk of cardiovascular disorders including heart attack and stroke.

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Type 2 Diabetes and Heart Failure: A Deadly Combination

An in-depth session titled “Heart Failure: The Frequent, Forgotten, and Often Fatal Complication of Type 2 Diabetes” was presented last week at the American Association of Clinical Endocrinology’s 26th Annual Scientific and Clinical Congress. The cited evidence and research pointed to a high frequency of heart failure, accompanied by an increased risk of mortality, for patients with diabetes.

The conclusion that heart failure requires increased scrutiny, as a risk factor and complication of type 2 diabetes, has been oft quoted and researched—yet it is still not widely known how common the condition is. While microvascular effects of type 2 diabetes are well known and understood—such as neuropathy and diabetic retinopathy—and macrovascular conditions including stroke and peripheral vascular disease, heart failure almost inevitably raises mortality.

Researchers at the University of Alabama at Birmingham School of Medicine have performed series of clinical trials in an effort to determine whether or not heart failure should be more rigorously treated, in order to alleviate and mitigate the poor outcomes often seen in patients. Conclusions indicate that between 40 and 45 percent of patients with diabetes in the United States suffer from heart failure, vs. 12 percent of non-diabetes.

David S.H. Bell, MD showcased studies that specifically assessed and evaluated the complex effects of diabetes and contributing factors to the three primary causes of the heart failure, while other physicians highlighted relations between glycemic control and heart failure risk—focusing on strong correlations between the high incidence of heart failure and type 2 diabetes. Other researchers pointed to the fact that autonomic system dysfunction, a predictor of cardiovascular risk, often occurs in pre-diabetes—which might offer opportunities for early intervention. Technological advancements of the past decade currently allow for identification of the early stages of autonomic dysfunction, through the utilization of concrete, tangible standardized measurements.

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2017 ADA Standards of Medical Care in Diabetes Emphasize Psychological Health and Personalized Treatment Options

The newly published 2017 Standards of Medical Care in Diabetes by the American Diabetes Association emphasize psychological health, access to care, expanded and personalized treatment options, as well as hypoglycemia tracking in patients with diabetes as critical areas of focus.

In addition to screening, diagnosis, and treatment options, including metabolic surgery, that will provide better outcomes for patients with diabetes and information to improve the prevention/delay of type 2 diabetes, the guidelines also include data from a report that focused on beta-cell dysfunction and describes approaches to clarify specific subtypes of diabetes to facilitate personalized care.

The Standards also specifically include a recommendation to consider the use of empagliflozin in patients with type 2 diabetes and established cardiovascular disease to reduce the risk of cardiovascular death.

References:

ADA: 2017 Standards of Medical Care in Diabetes Released.

2017 Standards of Medical Care in Diabetes.

Boehringer Ingelheim and Lilly welcome new recommendation for Jardiance® (empagliflozin) tablets in updated American Diabetes Association’s 2017 Standards.

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ARB Azilsartan Shows Greater Efficacy in Lowering Blood Pressure Among Patients with Prediabetes and Type 2 Diabetes

ARB Azilsartan Shows Greater Efficacy in Lowering Blood Pressure Among Patients with Prediabetes and Type 2 Diabetes

Results of a recent analysis that compared the efficacy, safety, and metabolic effects of the angiotensin-receptor blocker (ARB) azilsartan medoxomil to valsartan and olmesartan separately in patients with prediabetes and type 2 diabetes found that azilsartan (80 mg) lowered systolic blood pressure to a significantly greater degree than either valsartan or olmesartan. Read more

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“Burst” Exercise Leads to Greater Cardiometabolic Improvements in Patients with Type 2 Diabetes

Researchers studied 76 patients with type 2 diabetes randomly assigned to either 30 minutes of exercise 5 days per week at 65% of their target heart rate, or 10 minutes of exercise 3 times per day, 5 days per week at 85% of their target heart rate. The “burst” exercisers experienced a 2.3-fold greater improvement in HbA1c and a 3-fold reduction in BMI, along with greater improvements in LDL-C, HDL-C, and triglyceride levels and stronger cardiac fitness, which was measured by stress testing.

It isn’t clear why burst exercise resulted in more significant cardiometabolic improvements than longer, low-intensity exercise. Lead study author Avinash Pandey suggested it may be due to higher intensity exercise using energy in a different way. “We are hoping to continue looking at burst exercise and sustained energy in larger and more diverse patient populations. With further study, burst exercise may become a viable alternative to the current standard of care of low-intensity, sustained exercise for diabetes rehabilitation,” he said. Read more

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New “Fingerprint” of Inflammation Identified in Obesity-Associated T2DM

Researchers at Boston University School of Medicine have identified a new “fingerprint” of inflammation that may be able to predict which patients with obesity may also develop type 2 diabetes. Specifically, inflammatory proteins known as Th17 cells, which are associated with autoimmune conditions, were identified as major contributors to inflammation and hyperglycemia. Although research has already shown inflammation promotes obesity-related type 2 diabetes and related complications, anti-inflammatory drugs have had limited success in treatment. Thus, the findings may provide better insight into the relationship between inflammation and obesity-related type 2 diabetes.

Read more on the study published in the journal Obesity  here.

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Lixisenatide Proves Safety in ELIXA While Liraglutide Shows Greater HbA1c Reduction Compared with SGLT-2 Inhibitors

CV outcomes data from the ELIXA trial have been published in the New England Journal of Medicine for the as-yet FDA unapproved GLP-1 agonist lixisenatide, and have shown no increase or decrease in the rate of major cardiovascular events in patients with acute coronary syndrome. Read more here.

Meanwhile, findings from a recent meta-analysis have shown that among people with type 2 diabetes the GLP-1 agonist liraglutide provided greater HbA1c reductions compared with SGLT-2 inhibitors. Comprising the meta-analysis were 17 randomized controlled trials that included patients with type 2 diabetes inadequately controlled with metformin alone or in combination with sulfonylurea, DPP-4 inhibitors, or thiazolidinedione. Liraglutide was also associated with an improved likelihood of achieving glycemic goals compared with SGLT-2 inhibitors. Read more from a press release on the meta-analysis here.

References:
Pfeffer MA et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med. 2015;373:2247-2257.

Lorenzi M et al. Liraglutide vs SGLT-2 inhibitors in people with type 2 diabetes: a network meta-analysis. Presented at 23rd World Diabetes Congress, Vancouver, BC, Canada; 30 November – 4 December 2015. Abstract number 0226-P.

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Lack of Sleep Reduces Insulin Sensitivity, May Increase Risk of Diabetes

Results of a recent study co-authored by CMHC Chair Robert Eckel, MD, showed that a lack of adequate sleep in healthy study participants led to a reduction in insulin sensitivity of approximately 20%, which may increase their risk of developing diabetes over time. Further, eating during the biological night may alter the way the body responds to the food and impairing insulin sensitivity. Although increasing sleep from 5 hours per night to 9 hours per night for 3 days restored oral insulin sensitivity, the same increase in sleep for 5 days was insufficient to restore intravenous insulin sensitivity. “We did a study last year showing weight gain is caused by a lack of sleep and now we find that there could also be a risk of diabetes,” Dr. Eckel said. “While the exact mechanisms are unknown, it’s clear that a lack of sleep causes metabolic stress.”

Read perspective on the study here and the full study here.

Eckel et al. Morning circadian misalignment during short sleep duration impacts insulin sensitivity. Current Biology. http://dx.doi.org/10.1016/j.cub.2015.10.011.

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Are Newest Screening Recommendations for Type 2 Diabetes Falling Short?

In an update to their 2008 recommendations, the US Preventive Services Task Force (USPSTF) is calling for screening of overweight and obese adults between 40 and 70 years of age for abnormal blood glucose levels and type 2 diabetes. The recommendation applies to individuals being seen in primary care settings with no symptoms of type 2 diabetes as a component of cardiovascular risk assessment. Adults who are shown to have elevated glucose levels should be referred for intensive behavioral counseling, emphasizing a healthy diet and regular physical activity. Read more

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Bariatric Surgery Appears to Cure Half of Patients with T2DM for at Least 5 Years

In a study of obese patients with type 2 diabetes, bariatric surgery was found to be more effective than medical treatment in the long-term control of the disease (for at least 5 years). The study consisted of 60 patients randomized to either medical treatment or surgery (Roux-en-Y gastric bypass or biliopancreatic diversion). The primary endpoint was the rate of diabetes remission at 2 years (defined as HbA1c of 6.5% or less and a fasting glucose concentration of 5.6 mmol/L or less) without active pharmacologic treatment for 1 year. Patients were followed up for 5 years. Among 38 patients who underwent surgery, 19 (50%) maintained diabetes remission at 5 years compared with none of the 15 medically treated patients. The study authors advise continued monitoring of glycemic control because of a potential relapse for hyperglycemia.

Read the complete study here in The Lancet. To learn more from one of the study authors, Dr. Francesco Rubino, be sure to attend the 10th Annual CMHC where he will co-present “Long-Term and Metabolic Effects of Bariatric Surgery” on Friday, October 23, from 3:25 – 4:05 pm with Dr. Lee M. Kaplan.

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