DIABETES WATCH

Published Online: Sunday, October 1, 2006

Studies Show Positive Results with Levemir

Novo Nordisk's Levemir (insulin detemir [rDNA origin] injection) has proved successful in treating patients with diabetes. In a clinical trial, reported in Diabetes Care (June 2006), 70% of patients taking Levemir achieved the target glycosylated hemoglobin level of <7%. Data from other clinical studies of the long-acting basal insulin analog found:

•In 12 of 12 controlled clinical trials of >6000 patients with type 1 and type 2 diabetes, Levemir resulted in less weight gain

•The average weight gain of patients taking Levemir was almost 3 times less than that of patients taking neutral protamine Hagedorn (NPH) insulin in a 24-week clinical trial of patients with type 2 diabetes taking oral agents

•A low frequency of minor hypoglycemia was also seen in 4 of 4 studies in adults, as well as a relatively low incidence of major hypoglycemia in 3 of these studies

•In one study, patients taking Levemir were almost half as likely to experience a minor hypoglycemic event, compared with patients taking NPH insulin

High-Risk Groups: Get a Flu Shot

Patients with diabetes should add a flu shot to their to-do list. Researchers have found that the percentage of patients with diabetes who get an annual flu vaccination remains low. A new study looked at the effectiveness of first and repeat flu vaccinations in 9238 adults with diabetes during the 1999-2000 influenza A outbreak in the Netherlands. Of the participants, 44% were aged 18 to 64, and 56% were aged 65 and older.

The results of the study indicated that 131 hospitalizations and 61 deaths were recorded during the study period. These cases were compared with 1561 controls within the group of patients with diabetes who stayed healthy. Of these 192 patients, 141 (73.4%) had received the flu vaccine, compared with 1339 of the 1561 (85.8%) control group participants. Reporting in Diabetes Care (August 2006), the researchers said that the vaccination was linked with a 56% reduction in any complication, a 54% drop in hospitalizations, and a 58% lower mortality rate.

Working Out Wards Off Diabetes Risk

Weight lifting may help to protect teens at risk for type 2 diabetes from getting the disease, suggested a study reported in Medicine & Science in Sports & Exercise, July 2006. Although resistance training has been proven to increase insulin sensitivity in adults, it is not clear how lifting weights impacts insulin response in younger individuals.

The study, which included 22 overweight teenage boys, examined the differences between twice-weekly weight-lifting workouts for 16 weeks and no exercise. At the program's conclusion, the participants who did weight training showed gains in upper and lower body strength. Their insulin sensitivity rose by 45%, compared with a drop of 1% among the inactive group. The researchers noted that the results on insulin sensitivity were consistent even after they factored in the increase in muscle mass caused by exercise. The findings suggested that the workouts enhanced insulin sensitivity by other means. A longer program could also produce additional benefits.

Good News for Neonatal Diabetes Patients

Oral medication may be a possibility for many individuals diagnosed with diabetes in infancy. Furthermore, those who switch to oral medications (sulfonylureas) do not seem to have the complications found with taking insulin, according to 2 studies reported in the New England Journal of Medicine (August 3, 2006). Both studies examined the effect of sulfonylureas on individuals diagnosed with neonatal diabetes that had particular genetic mutations.

The first study included 49 patients in England, France, and Norway with defects in a gene called Kir6.2. The second study involved 34 French patients with mutations in the gene ABCC8, which impacts a sulfonylurea receptor known as SUR1. These mutations affect how potassium travels through the beta cells in the pancreas. When individuals eat, the energy from food is translated into electrical signals, and potassium helps those signals move through the beta cells. Upon receiving the information, beta cells begin to produce insulin to help the body process blood sugar. This is not the norm for individuals who have mutations in the genes that allow potassium to travel through beta cells. Instead, this key communication is interrupted.

The researchers noted that the studies' findings had no bearing on the more common form of insulin-dependent diabetes. In addition, not all of the participants with neonatal diabetes were able to make the switch. In each study, 5 patients did not respond to treatment.There may only be a window of opportunity where this treatment will work.

Diabetics Should Avoid Nighttime Eating

Large quantities of food after dinnertime may increase the risk of severe complications for individuals with diabetes.A study, reported in Diabetes Care (August 2006), showed that, of 714 patients at a diabetes clinic, ~10% claimed they ate >25% of their daily calories after dinner. This behavior caused the patients to be 2 to 3 times more prone to obesity, have poor blood sugar control, or have multiple diabetes complications.

The researchers said that late-night eating can be an indicator of night-eating syndrome, a disorder in which individuals not only take in a large portion of their calories after dinner, but may also snack several times a night—often on fatty, sugary foods. The investigators recommended that patients with diabetes and these eating habits speak with their physicians.

Nerve Problem May Foreshadow Diabetes

A history of carpal tunnel syndrome may predict type 2 diabetes, according to a United Kingdom study. For the study, the researchers looked at the medical records for 644,495 patients in England and Wales. The team identified 2647 patients diagnosed with diabetes between November 2003 and October 2004.A control group of 5294 participants was also selected and matched for age, gender, and location.

The patients' medical records were reviewed for up to 10 years prior to the diabetes diagnosis to determine the first instances of the wrist nerve problem. Reporting in Diabetes Care (August 2006), the researchers found, after taking into account other risk factors, that the prediabetes group was 36% more likely to have had carpal tunnel syndrome in the past, compared with the control group. The team suggested that elevated blood sugar levels "and associated metabolic abnormalities may contribute to causing these important focal peripheral nerve disorders before the diagnosis of diabetes."

Vegan Diet Helps Control Symptoms

Lower blood sugar levels and weight loss were seen in individuals who ate a low-fat, low-sugar vegan diet, compared with individuals on a standard American Diabetes Association (ADA) diet. The study included 99 patients with type 2 diabetes who were randomly assigned to either diet. All the dieters met weekly with advisers.

After 22 weeks on the diet, 43% of the vegan group and 26% of the standard-diet group were either able to cease taking some of their drugs or lowered the doses. Individuals on the vegan diet lost 14 lb on average, compared with 6.8 lb for the standard ADA diet. Furthermore, glycosylated hemoglobin dropped by 1.23 points in the vegan group and 0.38 in the regular diet group.

Childhood Diabetes Poses Greater Risks Later

Children with obesity-related diabetes face serious health consequences by middle age, such as kidney problems and death. The study, which is the first strong proof of the nation's skyrocketing epidemic of type 2 diabetes in children, involved the Pima Indians of Arizona. Researchers from the National Institutes of Health have been tracking this group since 1965.

Of the 1865 participants with type 2 diabetes, 96 were diagnosed as children. The average age of youth-onset diabetes was ~17 years; however, the disease was found in children as young as 31/2. During the 15 years of follow-up, 15% or 16% of those with childhood-onset type 2 diabetes developed end-stage kidney failure or died from diabetic kidney disease by age 55. The finding was compared with 133 (8%) of those diagnosed with diabetes after age 20.

The researchers estimated that the frequency of end-stage kidney failure and death by age 55 was 5 times higher in people who developed type 2 diabetes before age 20, compared with adult-onset diabetes. (The findings were reported in the July 26, 2006, issue of the Journal of the American Medical Association.)

Are Infections Behind Diabetes Clusters?

A study of participants in the United Kingdom aged 10 to 19 found that common infections may set off type 1 diabetes. In particular, the researchers discovered evidence of clustering among young patients with the disease. For the study, the researchers took data from a population-based register in Yorkshire to find support of space-time clustering of individuals with diabetes younger than age 30.

The analysis included 2 groups of patients with type 1 diabetes: 3019 children up to 14 years of age who lived in Yorkshire between 1978 and 2002; and 989 participants aged 15 to 29 who resided in West Yorkshire between 1991 and 2002. Considerable space-time clustering, based on the place and time of diagnosis, was verified for the children aged 10 to 14. The second group also found space-time clustering for participants aged 15 to 19. (The findings were reported in Diabetologia, July 2006.)




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