DIABETES WATCH

Pharmacy Times, Volume 0, 0

Studies Show Positive Results with Levemir

Novo Nordisk's Levemir (insulindetemir [rDNA origin] injection) hasproved successful in treating patientswith diabetes. In a clinical trial, reportedin Diabetes Care (June 2006), 70%of patients taking Levemir achievedthe target glycosylated hemoglobinlevel of <7%. Data from other clinicalstudies of the long-acting basal insulinanalog found:

&#8226;In 12 of 12 controlled clinical trialsof >6000 patients with type 1 andtype 2 diabetes, Levemir resultedin less weight gain

&#8226;The average weight gain ofpatients taking Levemir wasalmost 3 times less than that ofpatients taking neutral protamineHagedorn (NPH) insulin in a 24-week clinical trial of patients withtype 2 diabetes taking oral agents

&#8226;A low frequency of minor hypoglycemiawas also seen in 4 of4 studies in adults, as well as arelatively low incidence ofmajor hypoglycemia in 3 ofthese studies

&#8226;In one study, patients takingLevemir were almost half as likelyto experience a minor hypoglycemicevent, compared withpatients taking NPH insulin

High-Risk Groups: Get a Flu Shot

Patients with diabetes should add a flu shot to their to-dolist. Researchers have found that the percentage of patientswith diabetes who get an annual flu vaccination remainslow. A new study looked at the effectiveness of first andrepeat flu vaccinations in 9238 adults with diabetes duringthe 1999-2000 influenza A outbreak in the Netherlands. Ofthe participants, 44% were aged 18 to 64, and 56% were aged65 and older.

The results of the study indicated that 131 hospitalizationsand 61 deaths were recorded during the study period.These cases were compared with 1561 controls within thegroup of patients with diabetes who stayed healthy. Ofthese 192 patients, 141 (73.4%) had received the flu vaccine,compared with 1339 of the 1561 (85.8%) control groupparticipants. Reporting in Diabetes Care (August 2006), theresearchers 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 teensat risk for type 2 diabetes from getting thedisease, suggested a study reported inMedicine & Science in Sports & Exercise,July 2006. Although resistance traininghas been proven to increase insulin sensitivityin adults, it is not clear how liftingweights impacts insulin response inyounger individuals.

The study, which included 22 overweightteenage boys, examined the differencesbetween twice-weekly weight-liftingworkouts for 16 weeks and no exercise.At the program's conclusion, the participantswho did weight training showedgains in upper and lower body strength.Their insulin sensitivity rose by 45%, comparedwith a drop of 1% among the inactivegroup. The researchers noted that theresults on insulin sensitivity were consistenteven after they factored in theincrease in muscle mass caused by exercise.The findings suggested that theworkouts enhanced insulin sensitivity byother means. A longer program could alsoproduce additional benefits.

Good News for Neonatal Diabetes Patients

Oral medication may be a possibility for many individuals diagnosed with diabetes ininfancy. Furthermore, those who switch to oral medications (sulfonylureas) do not seemto have the complications found with taking insulin, according to 2 studies reported inthe New England Journal of Medicine (August 3, 2006). Both studies examined the effectof sulfonylureas on individuals diagnosed with neonatal diabetes that had particulargenetic 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 mutationsaffect 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 commonform 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 dinnertimemay increase the risk of severe complicationsfor individuals with diabetes.A study,reported in Diabetes Care (August 2006),showed that, of 714 patients at a diabetesclinic, ~10% claimed they ate >25% of theirdaily calories after dinner. This behaviorcaused the patients to be 2 to 3 timesmore prone to obesity, have poor bloodsugar control, or have multiple diabetescomplications.

The researchers said that late-nighteating can be an indicator of night-eatingsyndrome, a disorder in which individualsnot only take in a large portion oftheir calories after dinner, but may alsosnack several times a night—often onfatty, sugary foods. The investigatorsrecommended that patients with diabetesand these eating habits speakwith their physicians.

Nerve Problem MayForeshadow Diabetes

A history of carpal tunnel syndrome maypredict type 2 diabetes, according to a UnitedKingdom study. For the study, the researcherslooked at the medical records for 644,495patients in England and Wales. The team identified2647 patients diagnosed with diabetesbetween November 2003 and October 2004.Acontrol group of 5294 participants was alsoselected and matched for age, gender, andlocation.

The patients' medical records were reviewedfor up to 10 years prior to the diabetesdiagnosis to determine the first instances of thewrist nerve problem. Reporting in Diabetes Care(August 2006), the researchers found, after takinginto account other risk factors, that the prediabetesgroup was 36% more likely to have hadcarpal tunnel syndrome in the past, comparedwith the control group. The team suggested thatelevated blood sugar levels "and associatedmetabolic abnormalities may contribute tocausing these important focal peripheral nervedisorders before the diagnosis of diabetes."

Vegan Diet Helps Control Symptoms

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

After 22 weeks on the diet, 43% of the vegan group and 26% of the standard-dietgroup were either able to cease taking some of their drugs or lowered thedoses. Individuals on the vegan diet lost 14 lb on average, compared with 6.8 lbfor the standard ADA diet. Furthermore, glycosylated hemoglobin dropped by1.23 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 healthconsequences by middle age, such as kidney problems anddeath. The study, which is the first strong proof of the nation'sskyrocketing epidemic of type 2 diabetes in children, involvedthe Pima Indians of Arizona. Researchers from the NationalInstitutes of Health have been tracking this group since 1965.

Of the 1865 participants with type 2 diabetes, 96 werediagnosed as children. The average age of youth-onset diabeteswas ~17 years; however, the disease was found in childrenas young as 31/2. During the 15 years of follow-up, 15% or16% of those with childhood-onset type 2 diabetes developedend-stage kidney failure or died from diabetic kidney diseaseby age 55. The finding was compared with 133 (8%) of thosediagnosed with diabetes after age 20.

The researchers estimated that the frequency of end-stagekidney failure and death by age 55 was 5 times higher in peoplewho developed type 2 diabetes before age 20, comparedwith adult-onset diabetes. (The findings were reported in theJuly 26, 2006, issue of the Journal of the American MedicalAssociation.)

Are Infections Behind Diabetes Clusters?

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

The analysis included 2 groups of patients with type 1 diabetes: 3019 childrenup to 14 years of age who lived in Yorkshire between 1978 and 2002; and 989participants aged 15 to 29 who resided in West Yorkshire between 1991 and2002. 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 foundspace-time clustering for participants aged 15 to 19. (The findings were reportedin Diabetologia, July 2006.)