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Tag: type 2 diabetes

The Co-Occurrence of Diabetes & Heart Disease

The number of people living with diabetes has tripled since 2000, leading to enormous financial ramifications: the global cost of the disease is $850 billion each year. The latest estimates from the International Diabetes Federation indicate that one in 11 adults worldwide have diabetes; most have type 2 diabetes, which is strongly linked to obesity and lack of exercise. There is a strong link between type 2 diabetes and cardiovascular disease, as people with diabetes are more than twice as likely to develop cardiovascular disease and lower life expectancy.

According to a study presented at the American Heart Association’s Scientific Sessions last week, data indicates that children and young adults with diabetes mellitus have a fivefold increased risk of all-cause mortality, and a sevenfold increased risk of sudden cardiac death, compared with age-matched individuals without diabetes. The findings highlight the critical need for continuous cardiovascular risk monitoring and management in young people with DM.

Less than half of those diagnosed with diabetes are aware that the diseases places them at a much higher risk for cardiovascular disease complications; the lack of awareness prevents addressing risks and improving health–often leading to preventable deaths. Ken Thorpe, Chairman of the Partnership to Fight Chronic Disease, urges education and the power of prevention. “We must do better to diagnose, treat, and prevent chronic conditions like diabetes and cardiovascular diseases, and one of the first and most important actions we can take is to raise awareness among patients, providers, and policymakers of the alarming co-existence of these two debilitating conditions, and what can be done to avoid them in the first place.”

The total number of diabetes worldwide is now 451 million, and is expected to reach 693 million by 2045 if current trends continue.

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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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Biomarkers Could Predict Best Diets

A new study, published in the American Journal of Clinical Nutrition, has indicated two biomarkers that can predict the efficacy of certain diets for weight loss: specifically, for people with prediabetes or diabetes.

Through an analysis of over 1,200 adults, researchers discovered that a person’s fasting blood glucose levels, fasting insulin levels, or both, could pinpoint which diets would most likely lead to weight loss. These biomarkers were particularly effective in determining which diets were best for people with pre-diabetes and diabetes.

Each year, millions of us go on diets in an attempt to lose weight, but not all of us succeed. A new study has uncovered two biomarkers that could predict how effective certain diets will be for weight loss, particularly for people with prediabetes or diabetes.

Statistics from the American Diabetes Association indicate that approximately 29.1 million people in the Untied States have diabetes; estimates show that around 75 million people have pre-diabetes, yet almost 90% remain unaware. Type 2 diabetes is the most common form of the condition: the body is unable to effectively use the hormone insulin, which causes high blood glucose levels. For people with prediabetes, blood glucose levels remain higher than normal—yet not high enough to lead to a diagnosis of diabetes.

The researchers in the study believe that a person’s fasting blood glucose and insulin levels could be utilized to help identify the most effective diet for weight loss, after analyzing the data of three dietary clinical trials: the Diet, Obesity, and Genes trial, the OPUS Supermarket intervention (SHOPUS), and the Nutrient-gene interactions in human obesity (NUGENOB) trial. The subjects were all overweight; the researchers evaluated and assessed their fasting blood glucose levels, and fasting insulin levels, in order to determine whether the levels were associated with weight loss in response to certain diets.

These results symbolize a kind of breakthrough in personalized nutrition: among adults with prediabetes, the team found that a diet rich in whole grains, vegetables, and fruits was the most effective for weight loss. For example, in the SHOPUS trial, adults with prediabetes who followed a diet high in the aforementioned foods lost more weight than those who followed a controlled diet. For people with type 2 diabetes, the researchers found that a diet rich in plant-based, “healthy” fats, and low in carbohydrates, was most effective for weight loss.

The team reported that adding participants’ fasting insulin levels to the analysis further strengthened the identified correlations between diet and weight loss, confirming the hypothesis that fasting blood glucose and fasting insulin levels may be biomarkers for weight loss.

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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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Are We Any Closer to Understanding What’s Driving the Cardiovascular Benefits Seen in EMPA-REG?

Theories abound on what’s driving the cardiovascular benefits seen in EMPA-REG, as an FDA advisory panel votes to support a claim of CV risk reduction on the SGLT-2 inhibitor empagliflozin’s label.

An advisory panel to the US FDA has voted, albeit narrowly, to allow the claim that treatment with the SGLT-2 inhibitor epagliflozin reduces the risk of cardiovascular death in patients with type 2 diabetes. Results of EMPA-REG, which were published last year, showed that the drug reduced cardiovascular death by 38% and reduced the combined risk of cardiac death, non-fatal myocardial infarction, and non-fatal stroke by 14%. The potential mechanisms by which empagliflozin works to reduce this cardiovascular risk are still not known, however, and were the focus of discussion at the recent ADA 2016 Scientific Sessions.

Read more

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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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