Author Interviews, Diabetes, PLoS, Primary Care, Telemedicine / 26.07.2016 Interview with: Brian McKinstry MD Professor of primary care e-health and General practitioner MacKenzie Medical Centre EdinburghBrian McKinstry MD Professor of primary care e-health and General practitioner MacKenzie Medical Centre Edinburgh What is the background for this study?  Response: The prevalence of diabetes is rising as the population ages and becomes more obese. Clinical services are increasingly stretched, so much so that it will be difficult for doctors and nurses to continue to look after patients using the same service delivery they have used in the past. Increasingly patients are being asked to self-manage long-term illnesses, but particularly with type 2 diabetes they find this stressful. One solution is to encourage self-management but with monitoring at a distance through telehealth. We performed a randomised controlled trial in family practices in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated haemoglobin (HbA1c) ( a measure of control over the previous three months) >58 mmol/mol. The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice weekly morning and evening glucose for review by family practice clinicians. The control group received usual care, with at least annual review and more frequent reviews for people with poor glycaemic or blood pressure control in the context of incentives in family practice based on a sliding scale of financial rewards for achieving glycaemic and blood pressure control targets. HbA1c assessed at nine months was the primary outcome. Intention-to-treat analyses were performed. (more…)
Author Interviews, Diabetes, Pharmacology / 25.07.2016 Interview with: Stig Ejdrup Andersen MD, PhD Clinical Pharmacology Unit Zealand University Hospital Roskilde Denmark What is the background for this study? Response: For decades, we have used sulphonylurea derivates in the medical treatment of type 2 diabetes. Although several newer drugs have become available, adding an SU is still a recommended and acceptable strategy when metformin monotherapy fails. The SUs are among the cheapest glucose lowering drugs on the marked but the risk of hypoglycaemia make clinicians prefer a newer oral drug such as a DPP-IV inhibitor or a SGLT-2 inhibitor to ansulphonylurea because even mild hypoglycaemia may affect the patients’ quality of life negatively. Several meta-analyses have examined the effectiveness and safety of noninsulin antidiabetic drug, all of which have considered the SUs a homogenous drug class. Pharmacologically, however, the SU agents are quite different. In 2004, a randomized controlled trial by Shernthaner et al. indicated that in comparison with glimepiride, gliclazide MR is equally effective and is associated with fewer hypoglycaemic episodes. Still, head-to-head comparisons of the SU-agents as add-on to metformin are few. In the absence of robust designed comparative trials, we decided to compare the relative risk of hypoglycaemia among the newer SU-agents in a network meta-analysis. (more…)
Author Interviews, Biomarkers, Diabetes, Diabetologia, OBGYNE / 25.07.2016 Interview with: Dr. Sandra Hummel and Dr. Daniela Much Institute of Diabetes Research Helmholtz Center Munich German Research Center for Environmental Health Munich What is the background for this study? What are the main findings? Response: Gestational diabetes mellitus is associated with a seven-fold increased risk of developing type 2 diabetes postpartum. In 2012, we published that type 2 diabetes risk was markedly reduced up to 15 years after delivery in women with gestational diabetes if they breastfed for more than 3 months. However the underlying biological mechanisms are still unclear to date. Aim of this biomarker study was to identify the mechanism underlying the protective effect of prolonged lactation. At our study site in Munich, we enrolled 197 women with previous gestational diabetes participating in a postpartum assessment of glucose tolerance at a median time of 3.6 years after delivery. By using a targeted metabolomics approach (including a broad spectrum of lipids and amino acids), we identified lactation-associated biochemical changes in maternal plasma samples. Most interestingly, these metabolite signatures have been described with decreased risk for type 2 diabetes previously. Our results indicate that lactation-associated alterations persisted up to 11 years post-lactation. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA / 21.07.2016 Interview with: Dr Fiona Bragg Clinical Research Fellow Clinical Trial Service Unit and Epidemiological Studies Unit Nuffield Department of Population Health University of Oxford What is the background for this study? Response: Diabetes is known to be a risk factor for cardiovascular disease. It is less clear, however, whether higher blood glucose levels in individuals without diabetes are also associated with higher risk for cardiovascular diseases. It is important to examine this association because it may help us to understand the mechanisms underlying these diseases as well as appropriate approaches to preventing them. We therefore looked at this association in the China Kadoorie Biobank study of 0.5 million Chinese adults, examining the relationship between blood glucose levels and the subsequent risk for cardiovascular diseases among participants with no history of diabetes at the time of recruitment to the study. (more…)
Author Interviews, Diabetes, JAMA, Pediatrics / 20.07.2016 Interview with: Andy Menke PhD Social & Scientific Systems, Inc. Silver Spring, MD, 20910 What is the background for this study? What are the main findings? Response: Limited information was available on the prevalence of diabetes among adolescents in the US, particularly the percentage that are undiagnosed and unaware of the condition. We found that 0.8% of adolescents 12-19 years of age had diabetes and 18% had prediabetes. Of those with diabetes, 29% overall were unaware of it and this increased to 40% among Hispanic adolescents and 50% among non-Hispanic black adolescents. (more…)
Author Interviews, Diabetes, Lipids, PLoS / 20.07.2016 Interview with: Dr. Fumiaki Imamura Ph.D. MRC Epidemiology Unit University of Cambridge What is the background for this study? What are the main findings? Response: There was insufficient evidence for effects of polyunsaturated fatty acids (PUFA) intake or blood biomarkers on the development of type 2 diabetes. For instance, previous studies using PUFA biomarkers had a maximum of only 673 type 2 diabetes cases. In the EPIC-InterAct Study - a large European collaborative, prospective study where 12,132 diabetes cases were ascertained during its follow-up - we found diverse associations of blood levels of different types of PUFAs with incidence of type 2 diabetes. Despite this diversity, clinically relevant results were observed for major polyunsaturated fatty acids. Higher blood levels of total omega-6 PUFAs and the major omega-6 PUFA (linolenic acid) were associated with a lower risk of developing type 2 diabetes. Likewise, levels of alpha linolenic acid, known as a plant-origin omega-3 PUFA, were associated with lower type 2 diabetes risk. Marine-origin omega-3 PUFAs, including docosahexaenoic acid (DHA), showed inconsistent associations with type 2 diabetes risk. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Pharmacology / 19.07.2016 Interview with: Principal investigator A/Prof Suetonia Palmer PhD University of Otago, New Zealand Senior investigator Prof. Giovanni Strippoli MD, PhD, MPH, MM University of Sydney, Australia and Diaverum, Sweden What is the background for this study? Response: Network meta-analysis is a new technique that allows us to evaluate ALL medical therapies for a specific clinical problem. We wondered whether any of the usual drugs used to treat glucose levels in people with diabetes were safest or most effective. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Nutrition, PLoS, Weight Research / 15.07.2016 Interview with: Dr. Qi Sun Sc.D, M.D., M.M.S. Dr. Geng Zong, Ph.D., a research fellow Assistant Professor in the Department of Nutrition Harvard T.H. Chan School of Public Heath Boston What is the background for this study? What are the main findings? Response: There is growing trend of eating meal prepared out of home in many countries. For example, energy intake from out-of-home meals has increased from less than 10% in mid 60s to over 30% in 2005-2008 among Americans, and average time spent on cooking has decreased by one third. In the meantime, the prevalence of diabetes and obesity of this country keep on growing. In the current study, we followed nearly 100 thousands middle-aged men and women for 26 years. In 1986, we asked people how often their lunch and dinner were prepared at home per week, which will be 14 meals in maximum, and updated this information during follow-up. We found men and women with 11-14 meals prepared at home per week had 14% lower risk of diabetes compared to those had 6 or less meals prepared at home. If we look at lunch and dinner separately, people with 5 or more lunch prepared at home per week had 9% lower risk of diabetes, and those with 5 or more dinner prepared at home had 15% lower risk of diabetes compared to the group who had 2 or less than lunch or dinner at home per week. We further investigated whether people with more meals prepared at home had lower risk of obesity or weight gain in our study. In the first eight years of follow-up, participants with 11-14 meals prepared at home had 14% lower risk of developing obesity compared to people had 0-6 meals prepared at home. For men, these people had 1.2kg less weight gain, and for women they had 0.3 kg less weight gain. Furthermore, we found potential impact of having meals at home and risk of diabetes became weaker. This suggest that weight gain could be one gearwheel that links eating meals prepared at home and diabetes risk. (more…)
Author Interviews, Cancer Research, Diabetes / 13.07.2016 Interview with: Iliana Lega, MD, FRCPC Assistant Professor Department of Medicine and a Clinician Scientist University of Toronto What is the background for this study? What are the main findings? Response: Diabetes and cancer share a variety of risk factors that predispose individuals to both conditions. However the exact mechanism of this relationship is unclear. Our study examined differences in cancer diagnosis at different time points around a diagnosis of diabetes. We found two interesting trends. First, people with diabetes have the highest risk for cancer in the first 3 months following a diagnosis of diabetes. Second, we found that people with diabetes are also more likely to have had cancer even prior to being diagnosed with diabetes. (more…)
Author Interviews, Diabetes, PLoS, Race/Ethnic Diversity / 12.07.2016 Interview with: Matthew James O'Brien MD Northwestern University Feinberg School of Medicine What is the background for this study? Response: In October 2015, the United States Preventive Services Task Force (USPSTF) released new diabetes screening guidelines. This government-supported expert group recommended screening asymptomatic adults who are 40-70 years old and overweight or obese for diabetes. Recent population trends show that racial/ethnic minorities develop diabetes at younger ages and lower weights than whites. Therefore, we sought to determine whether these screening criteria may fail to identify racial/ethnic minorities or other high-risk population subgroups. Our study population was 50,515 patients from federally-funded community health centers, which serve large numbers of minorities and socioeconomically disadvantaged individuals. (more…)
Author Interviews, Diabetes, Diabetologia / 12.07.2016 Interview with: Dr Fraser W Gibb MBChB PhD FRCP Edin Consultant Physician / Honorary Clinical Senior Lecturer Edinburgh Centre for Endocrinology & DiabetesDr Fraser W Gibb MBChB PhD FRCP Edin Consultant Physician / Honorary Clinical Senior Lecturer Edinburgh Centre for Endocrinology & Diabetes What is the background for this study? What are the main findings? Response: We know that diabetic ketoacidosis is associated with a low risk of death in those admitted to hospital but we did not know what the risk of death was in the months and years following discharge from hospital. We have found that recurrent DKA admissions (more than 5 in a lifetime) are associated with a greater than 1 in 5 risk of death in the following three years compared to a 1 in 20 risk for those with only a single DKA. Recurrent DKA is more common in younger, more socially disadvantaged people. (more…)
Author Interviews, Cancer Research, Diabetes, NYU, Sleep Disorders / 09.07.2016 Interview with: Mr. Lloyd Gyamfi and Azizi Seixas, Ph.D. Post-Doc Fellow Department of Population Health Center for Healthful Behavior Change NYU School of Medicine What is the background for this study? What are the main findings? Response: An association exists between unhealthy sleep duration (short:≤6 hrs. or long sleep: ≥ 9hrs.) and cancer. The specific link between cancer and diabetes is unknown. Evidence suggests that cancer and diabetes may share common risk factors such as age, gender, race, being overweight an alcohol use. Based on the data extracted from the National Health Interview Survey (NHIS) dataset (2004-2013) with a sample size of 283,086, it was identified that individuals who had a history of cancer and who reported long sleep duration did not have increased risk of diabetes diagnosis. (more…)
Author Interviews, CDC, Diabetes, Heart Disease, JAMA / 09.07.2016 Interview with: Edward Gregg, PhD Chief of the Epidemiology and Statistics Branch Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention What is the background for this study? What are the main findings? Response: The research was led by the lead author, Karen R. Siegel, PhD, as part of her PhD graduate studies at Emory for her dissertation. Although subsidized foods are intended to ensure adequate availability of storable, staple foods, studies at the population level have linked these subsidies to risk of cardiovascular disease and type 2 diabetes. This study is the first of its kind to examine these relationships at the individual level – specifically, the relationship between diets made up of more subsidized foods, and an individual’s personal risks for developing cardiovascular disease and type 2 diabetes. The study design that was used here does not allow us to say that these subsidized foods specifically cause type 2 diabetes and cardiovascular disease. Rather, people whose diets contain more corn, soybean, wheat, rice, sorghum, dairy, and livestock products are at greater risk for type 2 diabetes and cardiovascular disease. According to this research, people whose diets contained more subsidized foods were on average younger, less physically active and more likely to be smokers. They also had much less income, education and food security - or the ability to get enough safe and healthy food to meet their dietary needs. (more…)
Author Interviews, Diabetes, UT Southwestern / 05.07.2016 Interview with: Dr. Eunhee Choi Research scientist in the Yu laboratory and lead author of the study UT SouthWestern Dr. Hongtao Yu, Professor of Pharmacology at UT Southwestern and Investigator with the Howard Hughes Medical Institute (HHMI). What is the background for this study? What are the main findings? Response: Diabetes is a metabolic disease. High blood sugar is a common symptom of diabetes, and over time it can lead to serious damage to multiple organs. Insulin, a hormone made by the pancreas, regulates blood sugar. Diabetes can occur either when the pancreas does not produce enough insulin (type 1 diabetes) or when the cells in our body cannot efficiently respond to insulin (type 2 diabetes). Diabetes is now a major global epidemic. The World Health Organization (WHO) estimates that more than 400 million people worldwide have diabetes. Insulin binds the insulin receptor (IR) at the cell surface. The insulin-bound IR can send signals inside the cell and instruct the cell to take up sugar from the blood, thus maintaining healthy blood sugar levels. After insulin has done its job, insulin-bound IR is packaged into small vesicles with a protein coat and dragged into the cell, thus terminating the signals. An adequate level of IR on the cell surface is crucial for insulin signaling and blood sugar metabolism. We have found a new mechanism that keeps IR at the cell surface. Without such a mechanism, IR is prematurely dragged inside the cell before it encounters insulin. Our discovery is quite unexpected. A main interest of our lab is to study the molecular control of cell division. During each cell division, the duplicated sister chromosomes are evenly separated into two daughter cells. A cellular surveillance system called the spindle checkpoint ensures the accuracy of sister-chromosome separation. Three checkpoint proteins, p31comet, MAD2 and BUBR1, are critical for accurate chromosome segregation. In the process of studying this checkpoint, we have unexpectedly discovered that mice lacking p31comet in the liver develop diabetes. Liver cells lacking p31comet do not have IR on the cell surface, and thus cannot respond to insulin. We have further shown that MAD2 directly binds to IR, and along with BUBR1, helps to drag IR inside the cell. p31comet prevents BUBR1 from interacting with IR-bound MAD2, thus keeping IR at the cell surface. In cells lacking p31comet, MAD2 and BUBR1 gain the upper hand and remove IR from the cell surface. Thus, the dynamic tug-of-war between p31comet and MAD2-BUBR1 determines the status of IR at the cell surface. (more…)
Author Interviews, Diabetes, Diabetologia, Technology / 05.07.2016 Interview with: Dr Hood Thabit and Co-author: Dr Roman Hovorka University of Cambridge Metabolic Research Laboratories Wellcome Trust-MRC Institute of Metabolic Science Cambridge UK What is the background for this study? What are the main findings? Response: Type 1 diabetes is an insulin-deficient condition, therefore people with type 1 diabetes need to be on life-long insulin therapy to maintain normal blood glucose levels. Currently insulin is delivered either by injections (with an insulin pen) or by infusion (with an insulin pump). In addition, they have to monitor their blood glucose regularly by performing fingerprick measurements several times a day, to avoid over- or under-dosing with insulin. Hypoglycaemia, or low blood glucose, can occur as a result of giving too much insulin; if severe or prolonged can lead to the patient being unconscious and in some cases sudden death. Hyperglycaemia, or high blood glucose, can occur as a result of giving too little insulin, and chronic hyperglycaemia can lead to diabetes related complications such as blindness, kidney failure and heart disease. Maintaining blood glucose within a normal range poses a daily challenge and struggle for many people with type 1 diabetes, who have to juggle with the variability and unpredictability of their glucose levels and insulin requirements due to meals, physical activity and stress. People with type 1 diabetes have on average 3 episodes of severe hypoglycaemia per year which requires third party assistance and sometimes hospitalisation. In the UK, the average HbA1c for people with type 1 diabetes is around 8.5% (69mmol/mol), which puts them at risk of diabetes complications and developing significant disability affecting their lives. There is therefore an unmet need of a novel therapeutic approach to be able to automatically modulate and change the amount of insulin delivered, based on real-time glucose levels. The artificial pancreas, or closed-loop insulin delivery, is an emerging technology which couples real-time sensor glucose levels with insulin delivery under the direction of a control algorithm, and automatically steps-up insulin delivery when glucose levels are going up, and reduces or suspends insulin delivery when glucose levels are going down. The longest home study to date was recently performed by researchers at the University of Cambridge and showed that compared to best available therapy, the artificial pancreas significantly improved long-term glucose control (HbA1c) and reduces the risk of hypoglycaemia. (more…)
Author Interviews, Diabetes, Gender Differences, JCEM, Sleep Disorders / 04.07.2016 Interview with: Dr. Femke Rutters Department of Epidemiology and Biostatistics Vrije Universiteit Medical Centre Amsterdam, The Netherlands; EMGO+ Institute for Care Research What is the background for this study? What are the main findings? Response: In the past 10 years the interest in sleep as a possible cause for obesity/diabetes has risen. But data up until now used mainly self-reported sleep and simple measures of diabetes (related parameters), such as fasting glucose. A study on well-measured insulin sensitivity and beta-cell function was lacking. Such a study could provide more information on the pathophysiology. (more…)
Author Interviews, Brain Cancer - Brain Tumors, Diabetes / 27.06.2016 Interview with: Dr. Judith Schwartzbaum PhD Associate professor of epidemiology Ohio State's Comprehensive Cancer Center What is the background for this study? Response: Meningioma is a slow-growing brain tumor that is associated with obesity. To further understand this risk we examined records of blood sugar levels within approximately 15 years before tumor diagnosis comparing blood sugar levels of people who developed meningioma to those in people who did not. are the main findings? Response: To our surprise we found that risk of this tumor was lower in people with high levels of blood sugar and diabetes. (more…)
Author Interviews, Diabetes, Diabetologia, OBGYNE, Pediatrics / 27.06.2016 Interview with: Lu Qi, MD, PhD, FAHA HCA Regents Distinguished Chair and Professor Director, Tulane University Obesity Research Center Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans, LA 70112 What is the background for this study? What are the main findings? Response: Prenatal malnutrition and other stresses may cause small newborn babies, who are more likely develop type 2 diabetes and other chronic diseases during adulthood. However, whether such relation is causal remains to be determined. Genetic associations provide a new approach to provide evidence for such causality. (more…)
Annals Internal Medicine, Author Interviews, Diabetes, Hepatitis - Liver Disease, Pharmacology / 22.06.2016 Interview with: Kenneth Cusi, M.D., F.A.C.P., F.A.C.E. Professor of Medicine VAMC staff Chief, Division of Endocrinology, Diabetes and Metabolism The University of Florida Gainesville, FL 32610-0226 What is the background for this study? Dr. Cusi: Many patients with prediabetes or Type 2 Diabetes Mellitus (T2DM) are not diagnosed with Nonalcoholic steatohepatitis (NASH), a disease that is the second cause of liver transplantation in the United States. It is also associated with worse cardiovascular disease and harder to control T2DM. We had done in this population a proof-of-concept study published in Nov 2006 in the NEJM. But we lacked a larger, long-term study for definitive proof. This is the largest SINGLE center study, and the longest ever (3 years). NASH is an overlooked problem for perhaps as many as one-third of patients with Type 2 Diabetes Mellitus. There is now a safe and effective treatment option for patients with T2DM and NASH – pioglitazone will become for NASH what metformin is to the treatment of T2DM: a safe, effective, the “backbone therapy" to which other treatments will be added. (more…)
Author Interviews, Diabetes, Exercise - Fitness, University of Pittsburgh / 21.06.2016 Interview with: Dr-Andrea-M-KriskaDr. Andrea M. Kriska PhD MS Professor, Department of Epidemiology Graduate School of Public Health Pittsburgh, PA 15261 What is the background for this study? Dr. Kriska:  The Diabetes Prevention Program (DPP) was a well administered national research study primarily supported by the National Institutes of Health (NIDDK) that demonstrated that lifestyle intervention with weight loss and physical activity goals can prevent type 2 diabetes in diverse, high risk US adults. The importance of physical activity in preventing diabetes development in the DPP until now was thought to be due to its role in achieving weight loss and weight maintenance but activity was not considered a strong key factor alone. The lifestyle group had a significantly greater increase in physical activity and decrease in weight than the other two groups. They also had a 58% decrease in diabetes incidence compared to the control group. The successful decrease in T2D held across all age, sex, baseline BMI and ethnicity/race subgroups. Despite the fact that the lifestyle intervention was then offered to all participants, in the follow-up years, the lifestyle participants still maintained a lower cumulative diabetes incidence that could not be explained by differences in weight loss. (more…)
AHA Journals, Author Interviews, CT Scanning, Diabetes, Heart Disease / 17.06.2016 Interview with: Prof. David A. Halon MB ChB, FACC, FESC Associate Professor of Clinical Medicine Technion, Israel Institute of Technology. Director, Interventional Cardiology Lady Davis Carmel Medical Center Haifa, Israel What is the background for this study? Prof. Halon: Type 2 diabetics are well known to have more cardiovascular events than non-diabetics but even among diabetics this risk is heterogeneous and some remain at very low risk. It remains uncertain if additional diagnostic modalities over and above clinical risk scores may be helpful in defining which diabetics are at high risk for an adverse event. We performed a study using cardiac CT angiography (CCTA) in 630 type 2 diabetics 55-74 years of age with no history of coronary artery disease to examine if CTA findings would have additional prognostic value over traditional risk scores for cardiovascular or microvascular based events over 7.5 years of follow-up. (more…)
Author Interviews, Diabetes, Pharmacology / 15.06.2016 Interview with: Professor Philip Home D.M., D.Phil Professor of Diabetes Medicine Newcastle University What is the background for this study? What are the main findings? Prof. Home: MK1293 is a biosimilar insulin designed with the same amino acid sequence, manufacturing process and formulation as originator insulin glargine (Lantus). This is the clinical proving study in type 1 diabetes, being a 24-week randomized study in 508 participants between MK1293 and Lantus. The primary efficacy endpoint of non-inferiority of HbA1c was met, as was a secondary of equivalence (difference in change from baseline 0.04 (95% CI -0.11, 0.19) %-units), with other measures including hypoglycaemia, insulin antibodies and adverse events also consistent with similarity. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Nutrition, PLoS / 15.06.2016 Interview with: Ambika Satija Departments of Nutrition & Epidemiology Harvard T. H. Chan School of Public Health Boston, MA What is the background for this study? Response: In this study, we followed more than 200,000 male and female health professionals across the U.S. for more than 20 years who had regularly filled out questionnaires on their diet, lifestyle, medical history, and new disease diagnoses as part of three large long-term studies. (more…)
Author Interviews, Diabetes, Kidney Disease, Pharmacology / 13.06.2016 Interview with: Doctor Hiddo Lambers Heerspink Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen the Netherlands What is the background for this study? What are the main findings? Response: SGLT2 inhibitors, including canagliflozin, have beneficial effects on multiple cardiovascular and renal risk parameters. This suggests that SGLT2 inhibitors may confer cardiovascular and renal protection. A recent large clinical trial with the SGLT2 inhibitor empagliflozin demonstrated marked reductions in cardiovascular morbidity and mortality and suggested possible renoprotective effects. Whether SGLT2 inhibition slows the progression of kidney function decline independent of its glucose-lowering effect, however, is unknown. We therefore assessed whether canagliflozin slows the progression of kidney function decline by comparing the effects of canagliflozin versus glimepiride on eGFR and albuminuria. (more…)
Author Interviews, Diabetes, Frailty, JAMA, Mayo Clinic / 07.06.2016 Interview with: Rozalina McCoy, M.D Assistant Professor of Medicine Division of Primary Care Internal Medicine Department of Medicine Mayo Clinic Rochester What is the background for this study? Dr. McCoy: Hypoglycemia is a serious potential complication of diabetes treatment; it worsens quality of life and has been associated with cardiovascular events, dementia, and even death. Most professional societies recommend targeting HbA1C levels less than 6.5% or 7%, with individualized treatment targets based on patient age, other medical conditions, and risk of hypoglycemia with therapy. Treating patients to very low HbA1c levels is not likely to improve their health, especially not in the short-term, but can cause serious harms such as hypoglycemia. The goal of our study was to assess how frequently patients with type 2 diabetes are treated intensively, focusing specifically on patients who are elderly or have serious chronic conditions such as dementia, kidney disease including dialysis need, heart disease, stroke, lung disease, and cancer. Moreover, while prior studies have suggested that intensive treatment may be common, there was no strong evidence that intensive treatment does in fact increase risk of hypoglycemia. Our study was designed specifically to assess this risk. We examined medical claims, pharmacy fill data, and laboratory results of 31,542 adults with stable and controlled type 2 diabetes who were included in the OptumLabs™ Data Warehouse between 2001 and 2013. None of the patients were treated with insulin or had prior episodes of severe hypoglycemia, both known risk factors for future hypoglycemic events. None of the patients had obvious indications for very tight glycemic control, such as pregnancy. “Intensive treatment” was defined as being treated with more glucose-lowering medications than clinical guidelines consider to be necessary given their HbA1C level. Patients whose HbA1C was less than 5.6 percent (diabetes is defined by HbA1C 6.5 percent or higher) were considered intensively treated if they were taking any medications. Patients with HbA1C in the “pre-diabetes” range, 5.7-6.4 percent, were considered to be intensively treated if using two or more medications at the time of the test, or if started on additional medications after the test, because current guidelines consider patients with HbA1C less than 6.5 percent to already be optimally controlled. For patients with HbA1C of 6.5-6.9 percent the sole criteria for intensive treatment was treatment intensification with two or more drugs or insulin. The patients were separated by whether they were considered clinically complex (based on the definition by the American Geriatrics Society)—75 years of age or older; or having end-stage kidney disease, dementia; or with three or more serious chronic conditions. This distinction has been made to help identify patients for whom adding glucose-lowering medications is more likely to lead to treatment-related adverse events, including hypoglycemia, while not providing substantial long-term benefit. (more…)
Author Interviews, Diabetes, Infections, Surgical Research / 04.06.2016 Interview with: Dr. Mary Forhan OT Reg (Alberta), PhD, Assistant Professor ad Dr. Tasuku Terada, post-doctoral research fellow Faculty of Rehabilitation Medicine University of Alberta What is the background for this study? Response: The prevalence of obesity has increased. Notably, a proportion of severe obesity (body mass index: body weight [kg] divided by height squared [m2]: >40kg/m2) has shown the most significant increase. Greater body mass increases the risk of cardiovascular disease and referrals for coronary artery graft surgery (CABG) have increased in patients with severe obesity. Interestingly, while obesity is often considered to increase the risk of complications and associated health care costs, many studies have reported better prognosis in patients with obesity compared to patients with normal weight, a phenomenon referred to as the obesity paradox. Therefore, it was not clear if patients with severe obesity were at higher risk of complications and contributed to greater resource use. A better understanding of the relationship between obesity and post-surgical adverse outcomes was needed to provide quality and efficient care. (more…)
Author Interviews, Diabetes, FASEB / 03.06.2016 Interview with: Dr. Soo Jung Park, Ph.D. Senior Scientist Division of Bioconvergence Korea Basic Science Institute in Seoul, South Korea What is the background for this study? What are the main findings? Response: Diabetes is a leading cause of morbidity and mortality worldwide. The elevated level of blood glucose (hyperglycemia) can induce the cell death of the pancreatic beta cells which are responsible for the production of insulin. Loss of β-cell number and function underlies much of the pathology of diabetes. However, the mechanism is not fully understood, and we found the novel regulator for hyperglycemia induced beta cell death. What should readers take away from your report? Response: TSPAN2 protein levels dramatically increased in response to high glucose. High TSPAN2 levels upregulated phosphorylated-JNK (p-JNK) and induced apoptosis. p-JNK enhanced the phosphorylation of β-catenin (p-β-catenin) and Dickkopf-1 (Dkk1). Dkk1 knockdown by siRNA upregulated nuclear β-catenin, suggesting that it is a JNK/β-catenin-dependent pathway. siRNA-mediated TSPAN2 depletion in RNAKT-15 cells increased nuclear β-catenin. This decreased Bax activation, leading to marked protection against high glucose-induced apoptosis. Bax subfamily proteins induced apoptosis through caspase-3. Thus, TSPAN2 might have induced Bax translocation and caspase-3 activation in pancreatic β cells, thereby promoting the apoptosis of RNAKT 15 cells by regulating the JNK/β-catenin pathway in response to high glucose concentrations. (more…)
Author Interviews, Diabetes, Diabetologia, Heart Disease, Pediatrics / 01.06.2016 Interview with: Dr. Nina Berentzen PhD National Institute for Public Health and the Environment Bilthoven, the Netherlands What is the background for this study? What are the main findings? Dr. Berentzen: Cardiovascular disease and type 2 diabetes often occur together and share risk factors including an unhealthy diet, a lack of physical activity, and being overweight or obese. This study is the first to investigate the occurrence of both diabetes and CVD across two generations of parents and grandparents, and relate it to measurable risk factors in children. We found that one third of the 12-year-olds studied had a strong family history of one or both of cardiovascular disease (myocardial infarction and stroke) and type 2 diabetes. Children had a ‘strong family history’ if they had one affected parent, or at least one grandparent with early disease onset, or 3–4 grandparents with late disease onset. These children had higher levels of total cholesterol, and a higher ratio of total/HDL cholesterol than children with no family history of disease. (more…)
Author Interviews, Diabetes, Endocrinology, Environmental Risks, Lipids / 27.05.2016 Interview with: Maayan Yitshak Sade MPH Chief Scientific Officer Clinical Research Center, Soroka University Medical Center, Israel and   Victor Novack, MD, PhD Soroka University Medical Center and Ben-Gurion University in Beer Sheva, Israel What is the background for this study? Response: Numerous studies found association between exposure the air pollution and increased risk of cardiovascular and respiratory diseases. In recent years links were found between air pollution and diabetes as well. The scientific evidence supports a causal association between air pollution and oxidative stress, possibly involving impaired metabolism of glucose and lipids. In a recent study performed by our group, we observed a significantly increased risk for ischemic stroke among young adults, associated with air pollution exposure. Following these findings, and as a part of the possible theory linking the association air pollution exposure and cardiovascular diseases, we sought to investigate if this association might be mediated through the well-established cardiovascular risk factors such as abnormal lipid and glucose metabolism. (more…)
Artificial Sweeteners, Author Interviews, Diabetes, Weight Research / 26.05.2016 Interview with: Jennifer L. Kuk, PhD Associate Professor York University School of Kinesiology and Health Science Toronto, Ontario What is the background for this study? What are the main findings? Dr. Kuk: Artificial sweeteners are used to help individuals manage their weight, however, individuals who consume aspartame (a type of artificial sweeteners) have worse glucose metabolism than individuals with the same body weight but do not consume aspartame. This observation was only true for adults with obesity. Further, saccharin and natural sugars were not associated with differences in health after considering differences in obesity. (more…)