MedicalResearch.com Interview with:Athena Philis-Tsimikas, M.D.
Corporate Vice President
Scripps Whittier Diabetes Institute, a subsidiary of Scripps Health
MedicalResearch: What are the main findings of the study?Dr. Philis-Tsimikas: Findings from the Dulce Digital study suggest that a text message-based self-management intervention improves glycemic control in high risk Latinos with type 2 diabetes.
Researchers recruited 126 Latinos with type 2 diabetes and HbA1c greater than 7.5% from federally-qualified health centers (FQHCs) that serve disadvantaged populations to investigate the impact of a diabetes self-management intervention delivered via mobile text messaging. Cell phones were provided to patients who did not have them, along with text messaging instructions.
Patients were randomized after completing clinical and self-reported measurements at baseline and these assessments were then repeated at 3 and 6 months. Both Dulce Digital and control groups received usual care. The Dulce Digital group received three types of text messages — educational and motivational; medication reminders; and blood glucose monitoring prompts — two to three messages each day initially, with frequency tapering over 6 months. Project Dulce staff then monitored blood glucose responses, assessed reasons for hyperglycemia or hypoglycemia and encouraged follow up with providers as needed.
Still ongoing, the current analyses included 106 completed participants (mean age= 49.25±9.49 years, 74% female), 52 of which were Dulce Digital participants. Findings showed significantly greater decreases in HbA1c with text messages compared with usual care only (9.4% to 8.4%, vs. 9.5% to 9.3%, P<.05) at 6 month follow-up. No significant group differences, however, have been observed for lipids, weight or blood pressure.
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MedicalResearch.com Interview with:Benjamin D. Horne, PhD, MPH, FAHA, FACC
Director, Cardiovascular and Genetic Epidemiology, Intermountain Heart Institute
Adjunct Assistant Professor, Genetic Epidemiology Division, Department of Medicine,
University of Utah
MedicalResearch: What is the background for this study?Dr. Horne: The Fasting II trial was a single-arm interventional trial of 24-hour water-only fasting among pre-diabetics with metabolic syndrome. The participants were adults with fasting blood glucose >100 mg/dL and at least two other components of the metabolic syndrome, including high triglycerides, low HDL cholesterol (the “good” cholesterol), high blood pressure, or high waist circumference. The participants were asked to fast once per week for 6 weeks, with multiple goals in this pilot study. This is the first interventional trial of fasting in people with pre-diabetes or diabetes.
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MedicalResearch.com Interview with: David J.A. Jenkins
Professor and Canada Research Chair in Nutrition and Metabolism,
Dept. of Medicine and Nutritional Sciences, Faculty of Medicine,
University of Toronto, Toronto, ON, Canada
MedicalResearch: What are the main findings of the study?Prof. Jenkins: The main findings were that inclusion of just over an once (31g) of canola oil in low glycemic index diets of type 2 diabetes study participants, to further reduce the glycemic load (GL), reduced HbAIC more than a high cereal fiber diet, as predicted. However the Canola oil low GL diet also reduced serum TG and LDL-C and thus Framingham risk score for cardiovascular disease. The effect was seen most clearly in those at highest CHD risk and those with features of the metabolic syndrome.
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MedicalResearch.com Interview with L. Keoki Williams, MD, MPH
Center for Health Policy and Health Services Research
Department of Internal Medicine
Henry Ford Health System
Detroit, Michigan 48104
MedicalResearch: What are the main findings of the study?Dr. Williams: Metformin is recommended as first line treatment for type 2 diabetes, and these recommendations are based on the results of clinical trials performed almost exclusively in white individuals. This is the first study to specifically assess whether metformin is effective at reducing blood glucose levels in African American individuals. In our large study of over 19,000 individuals, we showed that metformin was consistently more effective at reducing glycated hemoglobin (HbA1c) levels (a measure of long-term blood glucose control) in African Americans when compared with white individuals.
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MedicalResearch.com Interview with: Peter Stein, M.D.
Vice president, Clinical Research for Diabetes and Dndocrinology
Merck Research Laboratories.
MedicalResearch: What are the main findings of the study?Dr. Stein: This late-breaking observational study assessed the differences in time to initiation of insulin use and the proportion of the population initiating insulin among patients with type 2 diabetes taking the combination of JANUVIA® (sitagliptin) and metformin, and patients taking the combination of a sulfonylurea and metformin. In this study, patients treated with a combination of JANUVIA and metformin initiated insulin therapy at a slower rate during the period of observation than patients treated with a combination of sulfonylurea and metformin.
In this study, the percentages of patients initiating insulin by years one through six were 3.6, 8.4, 12.9, 17.7, 22.4, 26.6 for patients taking JANUVIA; and 4.1, 9.4, 14.6, 21.0, 27.1, 34.1 for patients taking a sulfonylurea. An analysis of the data overall (Kaplan-Meier method) showed that patients taking JANUVIA progressed more slowly to insulin use than patients taking a sulfonylurea (p=0.0034). The Cox proportional hazard regression analysis indicated that by year six, patients in the JANUVIA group were 24 percent less likely to initiate insulin during the period of observation compared to patients taking a sulfonylurea (HR = 0.76; p = 0.0011).
Similar results were observed in the sub-group of patients with a baseline A1C of less than 9 percent (HR = 0.77; p = 0.0128]; however there was no statistically significant difference in time to insulin initiation in the sub-group with a baseline A1C of greater than or equal to 9 percent (HR = 0.75; p = 0.1818).
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MedicalResearch.com Interview with:
Dr. Marcus de Goffau and Dr. Hermie HarmsenDepartment of Medical Microbiology
University Medical Center Groningen
MedicalResearch: What are the main findings of the study?Dr. Marcus de Goffau: In this study we aimed at analysing the gut microbiota composition of children aged 1–5 years with new-onset type 1 diabetes with the microbiota of age-matched healthy controls with a 16S rRNA based method (HITChip). The reason for this selection is that the increase in the incidence of type 1 diabetes worldwide is particularly sharp under the age of 5 years; recent studies indicate that adverse changes in gut microbiota are associated with the development of type 1 diabetes, but little is known about the microbiota in children who have diabetes at an early age. In this study we found that the differences between healthy controls and diabetics change over time, highlighting the importance of a normal gut microbial development. Diabetic children younger than 3 years old often had lower numbers of the Clostridium clusters XIVa and IV, which contain many of the beneficial butyrate producers, than their healthy age-matched controls. The diabetic children older than 3 years have normal numbers of Clostridium clusters XIVa and IV yet not the right species composition; the ones which produce butyrate were underrepresented. The development of the microbiota of diabetic children appears to be one step behind that of healthy controls and/or appears to be going into an aberrant direction. The abundances of other bacteria such as Bacteroides and streptococci were also found to be aberrant in diabetic children.
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MedicalResearch.com Interview with: Tetyana Kendzerska MD, PhD
Postdoctoral Fellow
Institute for Clinical Evaluative Science,
Sunnybrook Health Sciences Center, Toronto, ON
MedicalResearch: What are the main findings of the study?Dr. Kendzerska: Based on a large sample of more than 8,500 participants with suspected sleep apnea, our study shows that among people with obstructive sleep apnea (OSA), and controlling for risk factors for diabetes development, initial OSA severity predicted risk for incident diabetes. Measures of the physiologic consequences of OSA (e.g., low level of oxygen, sleep deprivation) were also risk factors for diabetes in this population.
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MedicalResearch.com Interview with:Christianne L. Roumie, MD MPH
Associate Professor Internal Medicine and Pediatrics
Institute for Medicine and Public Health
Vanderbilt University
Staff Physician VA Tennessee Valley Healthcare System
Nashville TN 37212
MedicalResearch: What are the main findings of the study?Dr. Roumie:This retrospective cohort study compared time to acute myocardial infarction (AMI), stroke, or death among Veterans with diabetes that were initially treated with metformin, and subsequently added either insulin or sulfonylurea. Among 178,341 Veterans on metformin monotherapy, 2,948 and 39,990 added insulin or sulfonylurea, respectively. Patients were about 60 years old, about 35% had history of heart disease or stroke, had been on metformin for an average of 14 months and their hemoglobin A1c was 8.1% at the time of addition of the second medication. Compared to those who added a sulfonylurea, those who added insulin to metformin had a 30% higher risk of the combined outcome of heart attack, stroke, and all-cause mortality. Although new heart attacks and strokes occurred at similar rates in both groups, mortality was higher in patients who added insulin.
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MedicalResearch Interview with:Lars Sjöström, MD, PhD
Professor
Department of Body Composition and Metabolism
Sahlgrenska University Hospital
Göteborg, Sweden
MedicalResearch: What are the main findings of the study?
Prof. Sjöström: In obese diabetic subjects, the 2-year diabetes remission was 72% in bariatric surgery patients but only 16% in obese controls obtaining conventional obesity and diabetes treatment. After 15 years, 30% were in remission in the surgery group and 6.5% in the control group. In addition, the 20-year incidence of diabetes complication was 30 -55% lower in surgery than control patients. (more…)
MedicalResearch.com Interview with: Arch G. Mainous III, PhD
Chair and Florida Blue Endowed Professor
Department of Health Services Research, Management and Policy
Professor of Community Health and Family Medicine
University of Florida
Health Science Center Gainesville, FL 32610
MedicalResearch: What are the main findings of the study?Professor Arch Mainous: This study focused on prediabetes, which is a high risk state for developing diabetes and associated complications. We investigated the national prevalence of prediabetes in England between 2003 and 2011. We found that the prevalence of prediabetes rose substantially in that time period from 11.6% to 35.3%. Further, by 2011 more than half of the population who were 40 years of age and older and were overweight had prediabetes. Minority ethnic groups are particularly affected.
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MedicalResearch.com Interview with: Wouter De Haes
Functional Genomics and Proteomics (Schoofs lab)
Zoological Institute
Leuven Belgium
MedicalResearch: What are the main findings of the study?Answer: We discovered that the lifespan-extending effect of metformin is dependent on the increased production of reactive oxygen species in the roundworm Caenorhabditis elegans. Antioxidants, compounds that remove these reactive oxygen species, abolished the lifespan-extending effect of metformin, adding to the growing body of evidence that anti-oxidants are not as beneficial for health as generally assumed. We also identified the protein, belonging to the group of peroxiredoxins, that seems responsible for translating this increase in reactive oxygen species production into longevity.
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MedicalResearch.com Interview with: John Wilding DM FRCP
Professor of Medicine & Honorary Consultant Physician
Head of Department of Obesity and Endocrinology
Institute of Ageing & Chronic Disease
Clinical Sciences Centre
University Hospital Aintree
Liverpool United Kingdom
MedicalResearch: What are the main findings of the study?Dr. Wilding:This trial studied over 3700 obese people who were trying to lose weight. The main findings were that liraglutide (an injectable medication already approved for diabetes treatment at lower dose of 1.8mg) can help reduce body weight in people with obesity when used at a higher dose than is usually used in diabetes (3mg). Trial participants experienced a weight loss of 8 % from baseline compared to 2.6 % with placebo (diet and exercise alone).
Some risk factors for diabetes and heart disease such as blood sugar, blood pressure and cholesterol also improved with liraglutide treatment to a greater extent than with placebo. The main side effects seen were nausea which in most cases resolved after a few weeks treatment; there were also more cases of gallstones (which could be due to weight loss) and a few more cases of acute pancreatitis in people treated with liraglutide.
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MedicalResearch Interview with:Dr. Valeria PechtnerMedical Advisor,
Lilly DiabetesMedicalResearch: What are the main findings of the study?Dr. Pechtner: Used as monotherapy, once-weekly dulaglutide resulted in significant, sustained glycemic lowering, as measured by HbA1c change from baseline. Both the 1.5 mg and the 0.75 mg dose were superior to metformin at the primary endpoint of 26 weeks. At 52 weeks, dulaglutide 1.5 mg continued to demonstrate superiority to metformin, with dulaglutide 0.75 mg showing non-inferiority. In addition, a majority of patients in all arms achieved the American Diabetes Association’s recommended HbA1c target of less than 7 percent, with more patients achieving this goal in the dulaglutide groups at the 26-week endpoint, and more patients achieving the target in the dulaglutide 1.5 mg group at the 52 week timepoint.
Additionally, dulaglutide 1.5 mg and metformin resulted in similar weight loss. The tolerability and safety profile was comparable for both medications.
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MedicalResearch.com Interview with:Neel M. Butala, AB
Medical student at Yale School of Medicine
New Haven, Connecticut
MedicalResearch.com: What are the main findings of the study?
Answer: We found that patients with diabetes had a disproportionate reduction in in-hospital mortality relative to patients without diabetes over the decade from 2000 to 2010.
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MedicalResearch.com Interview with: Nitesh D. Kuhadiya MD, MPH
Assistant Professor of Medicine
Section of Endocrinology,Diabetes and Metabolism
University of Buffalo, New York
MedicalResearch: What are the main findings of the study?
Dr. Kuhadiya: This is the first randomized clinical trial to show that the addition of liraglutide 1.2 and 1.8mg to insulin significantly reduces HbA1c, mean blood glucose, total insulin doses, body weight, carbohydrate intake, C-Reactive protein (a marker of cardiovascular risk), significantly improves quality of life and reduces systolic blood pressure(top number in a blood pressure reading) in 1.8mg group in patients with type 1 diabetes over a period of 12 weeks.
In 1.2mg, HbA1c fell by 0.78% from 7.84 to 7.06% and in 1.8mg group fell by 0.42% from 7.41 to 6.99% which means that more number of patients will be able to achieve HbA1c levels close to 7% and lower which is recommended by most diabetes organizations. Also the total daily dose of insulin fell by about 10-12 units in both groups. The total daily carbohydrate intake in both the groups fell by an average of 40 grams. There was a 5 kg weight loss in both 1.2 mg and 1.8 mg groups and both these groups on an average lowered their Body Mass Index from 29 to 28 kg/m2 . In 1.8 mg group there was fall in systolic blood pressure by 9 mm from 120 to 111 mm Hg.
The improvements seen are important because 40 to 50 percent of people with Type 1 diabetes have the metabolic syndrome(Cluster of risk factors, including high blood pressure, large waistline, high blood sugar, low HDL ("good") cholesterol and high triglycerides (fats in the blood) which increases the chances of later developing Type 2 diabetes and heart disease.
Our findings have significant implications for the future treatment of patients with Type 1 Diabetes.
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MedicalResearch.com Interview with:Wei Bao MD, PhD
Postdoc fellow, Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health
Rockville, MD 20852
MedicalResearch: What are the main findings of the study?Dr. Wei Bao: This study, to our knowledge, is the first attempt to examine the associations of physical activity and sedentary behaviors with risk of type 2 diabetes mellitus (T2DM) among women with a history of gestational diabetes mellitus (GDM), which is a high-risk population of T2DM. The main findings are:
(1) Physical activity is inversely associated with risk of progression from GDM to T2DM. Each 5-metabolic equivalent hours per week increment of total physical activity, which is equivalent to 100 minutes per week of moderate-intensity physical activity or 50 minutes per week of vigorous physical activity, was related to a 9% lower risk of T2DM; this inverse association remained significant after additional adjustment for body mass index (BMI).
(2) An increase in physical activity is associated with a lower risk of progression from gestational diabetes mellitus to T2DM. Compared with women who maintained their total physical activity levels, women who increased their total physical activity levels by 7.5 MET-h/wk or more (equivalent to 150 minutes per week of moderate-intensity physical activityor 75 minutes per week of vigorous physical activity) had a 47% lower risk of T2DM; the association remained significant after additional adjustment for BMI.
(3) Prolonged time spent watching TV, as a common sedentary behavior, is associated with an increased risk of progression from gestational diabetes mellitus to T2DM. Compared with women who watched TV 0 to 5 hours per week, those watched TV 6 to 10, 11 to 20, and 20 or more hours per week had 28%, 41%, and 77%, respectively, higher risk of T2DM. The association was no longer significant after additional adjustment for BMI.
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MedicalResearch.com Interview with: Malene Nøhr Demant
Department of Cardiology
Copenhagen University Hospital Gentofte
Hellerup, Denmark
MedicalResearch: What are the main findings of the study?Dr. Demant:Our study shows that increasing severity of heart failure is associated with an increased risk of developing diabetes. Increasing loop-diuretic dosage was used as a proxy for heart failure severity. Patients with the most severe heart failure were three times more likely to develop diabetes than those with the least severe. Patients who were also being treated with ACE inhibitors (angiotensin-converting-enzyme inhibitors) had a less pronounced increase in diabetes risk.
Patients who developed diabetes were 16% more likely to die than those who did not develop diabetes.
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MedicalResearch.com Interview with: Sarah P. Psutka, MD
Fellow in Urologic Oncology
Department of Urology, Mayo Clinic
MedicalResearch: What are the main findings of each study? Dr. Psutka: In this study we identified all diabetic patients with localized clear cell renal cell carcinomas who were surgically treated between 1990 and 2008 in our institution and matched them with nondiabetic patients.
Our main findings were that, after controlling for major confounders such as age, sex, type of surgery, renal function, smoking status, performance status, and tumor grade and stage, diabetic patients had inferior overall survival than nondiabetic patients. Furthermore, among patients with clear cell carcinoma, diabetic patients also had shorter cancer-specific survival, suggesting that diabetes is a poor prognostic factor for patients with surgically treated renal cell carcinoma.
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MedicalResearch.com Interview with: Hana Kahleova, MD, PhD
Diabetes Centre, Institute for Clinical and Experimental Medicine
140 21 Prague
Czech Republic
MedicalResearch: What was the aim of your study?Dr. Kahleova: The aim of the study was to compare the effect of six (A6 regimen) vs two meals a day, breakfast and lunch (B2 regimen), on body weight, hepatic fat content (HFC), insulin resistance and beta cell function.
MedicalResearch: What are the main findings of the study?Dr. Kahleova: Comparison of the effect of six vs. two meals (breakfast and lunch) with the same daily caloric restriction (-500 kcal/day) and macronutrient content, each regimen lasting 12 weeks, demonstrated a superior effect of breakfast and lunch on body weight, hepatic fat content, fasting plasma glucose, C-peptide, glucagon and insulin sensitivity.
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MedicalResearch Interview with:Monique Francois
Teaching Fellow & Research Assistant at the University of Otago
School of Physical Education, Sport and Exercise Sciences
University of Otago
Dunedin, New Zealand
MedicalResearch: What are the main findings of the study?
Answer: We found that small 'snacks' of interval exercise before the three main meals lowered postprandial blood glucose and contributed to a lower blood glucose across the day. Whereas 30 minutes of continuous moderate exercise before dinner did not lower postprandial blood glucose nor mean glucose levels the exercise day or the following day, compared to exercise snacking.
Six one minute intervals as walking or a combination of walking and resistance 3x per day (before the three main meals) improved glycaemic control in individuals with insulin resistance.
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MedicalResearch.com Interview with: Viveca Ritsinger MD
Karolinska Institute, Department of Medicine, Cardiology Unit, Karolinska University Hospital, Stockholm
Unit for Research and Development Kronoberg County Council, Växjö, Sweden
MedicalResearch: What are the main findings of the study?Dr. Ritsinger:This is a long-term follow-up of the Swedish DIGAMI 1 study where patients with acute myocardial infarction and diabetes were randomized to either intensified insulin-based glycaemic control or to standard glucose lowering treatment. Patients and controls were followed for mortality for over 20 years and 90% of the patients died during follow up.
Survival improved during a period of about 8 years. Intensified insulin-based glycaemic control increased survival time by an average of 2.3 years.
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MedicalResearch.com Interview with: Dana Dabelea, MD, PhD
Professor and Associate Dean, Faculty Affairs
Colorado School of Public Health
University of Colorado Denver
Aurora, CO 80045
MedicalResearch.com: What are the main findings of the study?Dr. Dabelea: We found that the proportion of US youth living with Type 1 Diabetes has increased by at least 21% over a period of only 8 years. This increase was seen in both boys and girls, most age-groups and race/ethnic groups. While we do not completely understand the reasons for this increase, since the causes of Type 1 Diabetes are still unclear, it is likely that something has changed in our environment- both in the US and elsewhere in the world- causing more youth to develop the disease, maybe at increasingly younger ages.
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MedicalResearch.com Interview with:Dr. Frank B. Hu MD MPH PhD
Professor of Nutrition and Epidemiology
From the Departments of Nutrition and Epidemiology
Harvard School of Public Health, Boston, MA
MedicalResearch.com: What are the main findings of the study?Dr. Hu: We found that people who increased the amount of coffee they drank each day by more than one cup over a four-year period had a 11% lower risk for type 2 diabetes than those who made no changes to their coffee consumption, but those who decreased their coffee consumption by more than a cup per day increased their type 2 diabetes risk by 17%.
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MedicalResearch.com Interview with: Marianna VirtanenPhD
Finnish Institute of Occupational Health
Helsinki, Finland
MedicalResearch: What are the main findings of the study?Dr. Virtanen: We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes. We used a clinical type 2 diabetes risk score to assess future diabetes risk and in addition, participants’ prediabetes status. We found that psychological distress did not predict future type 2 diabetes among participants who were normoglycemic and among those with prediabetes combined with a low diabetes risk score. However, psychological distress doubled the risk of type 2 diabetes among participants with prediabetes and a high diabetes risk score.
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MedicalResearch.com Interview with: Prof. Paul E O'Brien
Centre for Obesity Research and Education
Monash University
Melbourne, Australia
MedicalResearch.com: What are the main findings of the study?Prof. O'Brien: Using a randomised trial format we compared the diabetes status at two years after a program of multidisciplinary diabetes care (MDC) alone or with the addition of a Lap-Band procedure in 50 people who were overweight (BMI 25-30) and with diabetes. 52% of the Lap-Band group had remission of their diabetes as measured by glucose tolerance testing compared to 8% in the multidisciplinary diabetes care group. The Lap-Band procedures were performed as outpatients with a 2-3 hr length of stay. There were no perioperative adverse events. The surgical group had lost a mean of 11.5kg in weight. The incremental cost effectiveness ratio (ICER) for remission of diabetes was AUD $20,700.
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MedicalResearch.com Interview with:Juliana C. N. Chan, MBChB MD FHKAM FRCP
Professor Juliana Chan is Professor of Medicine and Therapeutics, Director, Hong Kong Institute of Diabetes and Obesity and International Diabetes Federation Centre of Education at the Chinese University of Hong Kong, Prince of Wales Hospital and Chief Executive Officer of Asia Diabetes Foundation Hong Kong.
MedicalResearch.com: What are the main findings of the study?Dr. Chan: In this 1-year randomized study, we asked the question whether type 2 diabetic patients receiving team-based integrated care augmented by information technology would further improve in their glycemic control if given additional peer support through the telephone. All patients underwent comprehensive risk assessment guided by the web-based JADE portal which generated personalized risk report with attained treatment targets and decision support. After 1 year, all patients improved significantly in all risk factors including A1c with improved treatment adherence, self efficacy and psychological wellbeing. Although the peer support group did not further improve in A1c, short-stay hospitalization rates were substantially reduced by 50% , especially amongst those with emotional distress. These patients accounted for 20% of the intervention group, in whom peer support further reduced psychological distress and treatment non-adherence.
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MedicalResearch.com Interview with: Prof. Simon R. Heller
Professor of Clinical Diabetes
Department of Human Metabolism
University of Sheffield, Sheffield, U.K.
MedicalResearch.com: What are the main findings of the study?Prof. Heller: We explored the potential to hypoglycaemia to cause cardiac arrhythmias since we have previously shown that a low glucose can alter the electrocardiogram. We had a hypothesis that alterations in heart rhythm or ectopic beats might contribute to cardiac mortality and in part explain the association between intensive diabetic therapy and increased mortality. We therefore undertook continuous glucose monitoring and 12 lead EKG monitoring for a period of 5 days in individuals with Type 2 diabetes at increased CV risk. We found that hypoglycaemia was fairly common and that nocturnal episodes in particular, were generally marked by a pattern whereby glucose levels dropped to low levels for some hours during which patients slept. These periods of hypoglycemia were associated with a high risk of marked slow heart rates (bradycardia) accompanied by ectopic beats. Our data suggest that this was due to overactivity of the vagus nerve. We have therefore identified a mechanism which might contribute to increased mortality in individuals with Type 2 diabetes and high CV risk during intensive insulin therapy.
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MedicalResearch.com Interview with:Dr. Rui Li
Division of Diabetes Translation
Centers for Disease Control and Prevention
Atlanta, GA
MedicalResearch.com: What are the main findings of the study?Answer: The proportion of people with diabetes facing high out-of-pocket (OOP) burden declined between 2001 and 2011. Although insurance and income related disparities have declined, almost one-fourth of all people with diabetes still face a high out-of-pocket burden.
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MedicalResearch.com Interview with: Massimo Porta, MD PhD
Professor of Medicine Head, Unit of Internal Medicine 1
Department of Medical Sciences University of Turin
MedicalResearch.com: What are the main findings of the study?Dr. Porta: Type 2 diabetes has a slow, insidious onset and may remain undiagnosed for several years, during which complications may arise and progress. As a result, many patients already have retinopathy at the time a clinical diagnosis is finally made. Previous attempts at estimating the duration of this period of "hidden" diabetes relied upon extrapolations of a linear correlation between known duration of diabetes and prevalence of retinopathy.
This led to overestimates, because:
a) the best fitting correlation may not be linear,
b) series included insulin treated patients, who might have late-onset type 1 diabetes,
c) patients with any mild retinopathy were included whereas we now know that up to 10% of non diabetic individuals may have minimal retinal signs.
By taking these variables into account, ie including only patients not on insulin and with moderate or more severe retinopathy and applying different mathematical models, we ended up with an estimated duration preceding diagnosis of type 2 diabetes of 4-6 years, against longer than 13 years using "standard" criteria.
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MedicalResearch.com Interview with: Prof Guangwei Li MD
Department of Endocrinology
China-Japan Friendship Hospital
Center of Endocrinology and Cardiovascular Disease, National Center of Cardiology & Fuwai Hospital, Beijing, China
MedicalResearch.com: What are the main findings of the study?Answer: Our study first shows that a six-year period of lifestyle intervention in Chinese people with IGT reduced the incidence of diabetes over a protracted time period and was ultimately associated with a significant reduction in total and cardio-vascular disease mortality. This reduction in mortality appears to be mediated in part by the delay in onset of diabetes resulting from the lifestyle interventions.
(more…)
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MedicalResearch.com Interview with:
Athena Philis-Tsimikas, M.D.
Corporate Vice President
Scripps Whittier Diabetes Institute, a subsidiary of Scripps Health
MedicalResearch: What are the main findings of the study?
Dr. Philis-Tsimikas: Findings from the Dulce Digital study suggest that a text message-based self-management intervention improves glycemic control in high risk Latinos with type 2 diabetes.
Researchers recruited 126 Latinos with type 2 diabetes and HbA1c greater than 7.5% from federally-qualified health centers (FQHCs) that serve disadvantaged populations to investigate the impact of a diabetes self-management intervention delivered via mobile text messaging. Cell phones were provided to patients who did not have them, along with text messaging instructions.
Patients were randomized after completing clinical and self-reported measurements at baseline and these assessments were then repeated at 3 and 6 months. Both Dulce Digital and control groups received usual care. The Dulce Digital group received three types of text messages — educational and motivational; medication reminders; and blood glucose monitoring prompts — two to three messages each day initially, with frequency tapering over 6 months. Project Dulce staff then monitored blood glucose responses, assessed reasons for hyperglycemia or hypoglycemia and encouraged follow up with providers as needed.
Still ongoing, the current analyses included 106 completed participants (mean age= 49.25±9.49 years, 74% female), 52 of which were Dulce Digital participants. Findings showed significantly greater decreases in HbA1c with text messages compared with usual care only (9.4% to 8.4%, vs. 9.5% to 9.3%, P<.05) at 6 month follow-up. No significant group differences, however, have been observed for lipids, weight or blood pressure.
(more…)
