Diabetes Drug May Enhance Melanoma Chemotherapy

MedicalResearch.com Interview with:

Bin Zheng, PhD Assistant Professor Cutaneous Biology Research Center Massachusetts General Hospital Harvard Medical School Charlestown, MA 02129

Dr. Bin Zheng

Bin Zheng, PhD
Assistant Professor
Cutaneous Biology Research Center
Massachusetts General Hospital
Harvard Medical School
Charlestown, MA 02129 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Melanoma is the most deadly form of skin cancer with more than 75,000 newly diagnosed cases in the US each year. Over the years, various genetic driver mutations have been identified that cause melanoma, including mutations in the genes BRAF and NRAS. Recent genetic insights into the development of melanoma showed that also mutations in NF1 can lead to melanoma. While there are targeted therapies available for BRAF-mutant melanoma, thus far no such therapies are available for NF1-mutant melanoma. We identified that using a combination of an ERK inhibitor, SCH772984, and the antidiabetic drug phenformin could provide a novel therapeutic strategy for NF1-mutatnt melanomas.

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A1C May Be Less Accurate Measure of Diabetes in African Americans with Common Sickle Cell Trait

MedicalResearch.com Interview with:
Mary E. Lacy, MPH

Department of Epidemiology
Brown University School of Public Health
Providence, RI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hemoglobin A1c (A1C) is a blood test that is used to screen for and monitor diabetes. It measures average blood sugar control over the past 2-3 months.

A person with sickle cell trait is a carrier for sickle cell disease but often doesn’t have any clinical symptoms. African Americans are more likely than Whites to have diabetes and are more likely to have sickle cell trait. In this article we examined if A1C can be interpreted in the same way in people with and without sickle cell trait.

We found that, despite similar results on other measures of blood sugar control, people with sickle cell trait had lower A1C results than people without sickle cell trait. This means that A1C may underestimate diabetes risk in people with sickle cell trait.
We also found that, when using standard A1C cutoffs to screen for disease prevalence, we identified 40% fewer cases of prediabetes and 48% fewer cases of diabetes in individuals with sickle cell trait than in those without sickle cell trait. To me, this finding really underscores the potential clinical impact that the observed underestimation of A1C in those with sickle cell trait could have.

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Treatment With Liraglutide (Victoza) Reduces Fat Around the Heart

MedicalResearch.com Interview with:

Gianluca Iacobellis MD PhD Professor of Clinical Medicine Division of Endocrinology, Diabetes and Metabolism Department of Medicine University of Miami, FL

Dr. Gianluca Iacobellis

Gianluca Iacobellis MD PhD
Professor of Clinical Medicine
Division of Endocrinology, Diabetes and Metabolism
Department of Medicine
University of Miami, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that epicardial fat, the visceral fat of the heart, is associated with coronary artery disease, diabetes and obesity. My studies have shown that epicardial fat can be easily measured with non invasive imaging procedures. Remarkably, epicardial fat has recently emerged as therapeutic target responding to medications targeting the fat. Liraglutide, a GLP-1 analog has shown to provide modest weight loss and beneficial cardiovascular effects beyond its glucose lowering action. So , we sought to evaluate the effects of liraglutide on epicardial fat.

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SYNTAX Score Predicts Better Results With Bypass Surgery For Type II Diabetes

MedicalResearch.com Interview with:

Fumiaki Ikeno M.D. Program Director (U.S.) Japan Biodesign Stanford Biodesign Medical Director/Research Associate Experimental Interventional Laboratory Division of Cardiology Stanford University

Dr. Fumiaki Ikeno

Fumiaki Ikeno M.D.
Program Director (U.S.) Japan Biodesign
Stanford Biodesign
Medical Director/Research Associate
Experimental Interventional Laboratory
Division of Cardiology
Stanford University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We sought to determine whether the extent of coronary disease in terms of the number of lesions and their complexity in Type 2 Diabetes patients could predict major cardiovascular events, and hypothesized that revascularization would have greater effectiveness relative to medical therapy among patients with more number of lesions and higher complexity in coronary artery disease.

Coronary bypass surgery, catheter-based treatment, and medical therapy all had similar cardiovascular outcomes among patients with less complexity of coronary artery disease who had type 2 diabetes mellitus, stable ischemic heart disease, and no prior coronary revascularization. Among patients with mid or high complexity coronary artery disease, coronary revascularization with bypass surgery significantly reduced the rate of major cardiovascular events during 5 years of follow-up.

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Obesity and Type 2 Diabetes Claims Rise Sharply in Pediatric Population

MedicalResearch.com Interview with:

Robin Gelburd, JD President FAIR Health

Robin Gelburd, JD

Robin Gelburd, JD
President
FAIR Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For more than 20 years, an epidemic of obesity has been contributing to increasing rates of type 2 diabetes in the United States. During at least part of that period, both conditions have been found to be rising in young people as well as adults. Using our FAIR Health database of billions of privately billed healthcare claims, we sought to ascertain recent trends in obesity and obesity-related conditions (including type 2 diabetes) in the national, privately insured, pediatric population, which we defined as spanning the ages from 0 to 22 years. Our study period was the years 2011 to 2015.

We found that claim lines with a diagnosis of obesity increased across the pediatric population during the study period. The largest increase among pediatric patients was 154 percent, in the age group 19 to 22 years. Claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population, increasing 109 percent.

In most pediatric age groups, claim lines with an obesity diagnosis occurred more often in females than in males; by contrast, claim lines with a type 2 diabetes diagnosis were more common for males than females in most pediatric age groups.

Other conditions associated with obesity also increased in claim lines among young people. The conditions included obstructive sleep apnea and hypertension, both of which were more common in claim lines for males than females.

We also compared the percent of claim lines for pediatric type 2 diabetes diagnoses to the percent of claim lines for all pediatric medical claims by state. Using that standard, pediatric type 2 diabetes was most prevalent in Ohio, Pennsylvania, North Dakota, Utah and South Dakota. It was least prevalent in New Hampshire, Vermont, Delaware, Hawaii and Rhode Island.

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Continuous Glucose Monitoring System Improves Blood Sugar Control in Type 1 Diabetes

MedicalResearch.com Interview with:
Dr Marcus Lind

Associate Professor of Diabetology at the University of Gothenburg
Gothenburg, Sweden
Chief Physician of Diabetology, Uddevalla Hospital
Uddevalla, Sweden

MedicalResearch.com: What is the background for this study?

Response: This was a randomized trial over 16 months (cross-over study with 26 weeks of each treatment and a between wash-out period of 17 weeks) of 161 persons with type 1 diabetes. The main purpose was to evaluate whether a “diabetes tool”, denoted continuous glucose monitoring improves the glycaemic control, known to be essential to lower risks for diabetic complications such as injuries on eyes, kidneys, nerves and the cardiovascular system. The study also evaluated whether the glucose could be stabalised, i.e. having less fluctutations (beside the average level per se) and whether well-being, treatment satisfaction and feeling more confident in the daily living to avoid low glucose values which lead influence the cognitive function and can lead to unconciousness. Earlier trials exist of this therapy in connection to insulin pumps. But it has not been tested in randomized trials with persons only using multiple daily insulin injections to administer insulin which is the most common therapy among adults with type 1 diabetes.

Another novelty is that the current CGM-system (DexCom G4) has earlier shown a high accuracy and positive treatment experience among persons with type 1 diabetes, but it has not been tested in long-term randomized trials. Of note this trial was performed among adults with type 1 diabetes.

Continuous glucose monitoring (CGM) is a system where the patient has a sensor subcutaneously that he/she easily can change every week. It estimates the glucose level every minute and shows values on a hand-held small monitor (size of a small cell-phone) and whether the glucose levels are rising or declining. The hypothesis with the study is that if the patient has continuous information of the glucose level and trends it will improve treatment variables. The comparison group was that patients got information of their glucose control via capillary finger sticks which has been the general treatment for a long time period but can only be made at certain occasions since a procedure where blood must be taken from the finger tips.

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Gut Inflammation & Bacterial Changes Linked to Type 1 Diabetes

MedicalResearch.com Interview with:

Prof Lorenzo Piemonti, MD Professor of Endocrinology Deputy Director, Diabetes Research Institute (SR-DRI) Head, Beta Cell Biology Unit Vita-Salute San Raffaele University, San Raffaele Scientific Institute Milano Italy

Prof Lorenzo Piemonti

Prof Lorenzo Piemonti, MD
Professor of Endocrinology
Deputy Director, Diabetes Research Institute (SR-DRI)
Head, Beta Cell Biology Unit
Vita-Salute San Raffaele University,
San Raffaele Scientific Institute
Milano Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The potential role of gut inflammation and microbiome is becoming a hot topic in the field of diabetes. Several very recent publications report the presence of intestinal abnormalities associated with autoimmune diabetes in both experimental rodent models and patients. We have previously published that, compared to healthy subjects, patients with type 1 diabetes or at high risk of developing type 1 diabetes shows increased intestinal permeability.

Among the factors that may modify the intestinal barrier and impact on its immune activation, the gut microbiota is at present the main suspect. Our study is the first in literature that had the opportunity to analyze the inflammatory profile, the microbiome and their correlation on duodenum biopsies of patients with type 1 diabetes, in comparison with patients with celiac disease and healthy controls. Previous papers pointed out a significant difference in the composition of the stool microflora in subjects with autoimmune diabetes.

A major advancement of our work comes from the direct analysis of small intestine, instead of studies on stool samples. In fact, because of their close functional and spatial relationships, as well as a shared blood supply, it is logical to consider the duodenum and the pancreas correlated. We found big differences among the groups: gut mucosa in diabetes shows a peculiar signature of inflammation, a specific microbiome composition and we also discovered a strong association between some analysed inflammatory markers and specific bacteria genera. We think that our data add an important piece to disentangle the complex pathogenesis of type 1 diabetes and more generally of autoimmune diseases.

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Elevated Fasting Glucose and Insulin Resistance Seen Early in Schizophrenia

MedicalResearch.com Interview with:

Dr Toby Pillinger MA(Oxon) BM BCh MRCP Institute of Psychiatry, Psychology and Neuroscience King's College London

Dr. Toby Pillinger

Dr Toby Pillinger MA(Oxon) BM BCh MRCP
Institute of Psychiatry, Psychology and Neuroscience
King’s College London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our meta-analysis has provided strong evidence that compared with healthy controls, individuals with early schizophrenia are at increased risk of developing type 2 diabetes mellitus, even when the effects of antipsychotic drugs, diet and exercise are taken out of the equation.

Schizophrenia is associated with a dramatically reduced life expectancy, with individuals dying up to 30 years earlier than the general population. Approximately 60% of this excess mortality is due to physical health disorders such as heart attack or stroke, for which diabetes is a major risk factor.

People with long-term schizophrenia are 3 times more likely than the general population to have diabetes, something that has previously been blamed on poor diet and exercise habits, as well as the use of antipsychotic medication. However, the link between schizophrenia and diabetes was first made back in the 19th century, long before the use of antipsychotics, and in an era where diets were less likely to cause diabetes. This could suggest that there is a causative link between schizophrenia and diabetes.

Our meta-analysis examined whether diabetes risk is already raised in people at the onset of schizophrenia, before antipsychotics have been prescribed and before a prolonged period of illness that may be associated with poor diet and sedentary behaviour. We pooled data from 16 studies comprising 731 patients and 614 individuals from the general population. We collated blood data examining fasting blood glucose levels, blood glucose levels following the oral glucose tolerance test, fasting insulin levels and degree of insulin resistance.

We demonstrated that compared with healthy controls, individuals with early schizophrenia had raised fasting glucose, raised levels of glucose following the oral glucose tolerance test, raised fasting insulin and elevated insulin resistance. Furthermore, these results remained statistically significant even when we restricted our analyses to studies where individuals with schizophrenia were matched to healthy controls with regards their diet, the amount of exercise they engaged in and their ethnic background.

This suggests that our results were not wholly driven by differences in lifestyle factors or ethnicity between the two groups, and may therefore point towards a direct role for schizophrenia in increasing risk of diabetes.

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Even with Cardiac Risk Factors, Non-CV Deaths More Common In Patients With Impaired Fasting Glucose

MedicalResearch.com Interview with:
Dr. Abhinav Sharma MD
Duke Clinical Research Institute, Duke University, Durham, NC
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
Renato D. Lopes, MD, PhD, MHS
Duke Clinical Research Institute
Durham, NC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Impaired fasting glucose (IFG) has been demonstrated to be a risk factor for cardiovascular death; however, there is growing research suggesting that IFG also increases the risk of non-cardiovascular deaths such as cancer.

The data on the distribution of causes of death among patients with impaired fasting glucose and cardiovascular risk factors have not been described. Our analysis used data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. We identified that while myocardial death is the most common adjudicated cause of death, overall, non-cardiovascular deaths were more common that cardiovascular deaths.

Among non-cardiovascular, cancer deaths were the most common cause of death. Furthermore, the burden of non-cardiovascular deaths increases relative to cardiovascular death over time.

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Enteroviruses Linked To Development of Type 1 Diabetes in Children

MedicalResearch.com Interview with:
Dr. Hanna Honkanen PhD
University of Tampere.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The association between enteroviruses and type 1 diabetes has been suggested for long and analyzed in several studies. However, only few studies have been able to study this association at the time when the disease process starts, which happens several months or years before type 1 diabetes is diagnosed.

Our study made this possible since it was based on a large cohort of children who were followed from birth and samples were collected already before the disease process had started (prospective DIPP-study in Finland). Enterovirus infections were detected by analyzing the presence of viral nucleic acids in longitudinal stool sample series. Infections were found more frequently in case children who developed islet autoantibodies compared to control children. This excess was detected several months before islet autoimmunity appeared. This study is the largest such study carried out so far. The results suggest that enterovirus infections may contribute to the initiation of the disease process that eventually leads to type 1 diabetes.

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Some Type 2 Diabetics May Benefit From Adding Fenofibrate To Statins

MedicalResearch.com Interview with:

Marshall B. Elam PhD MD Professor Pharmacology and Medicine (Cardiovascular Diseases) University of Tennessee Health Sciences Center Memphis

Dr. Marshall B. Elam

Marshall B. Elam PhD MD
Professor Pharmacology and Medicine
(Cardiovascular Diseases)
University of Tennessee Health Sciences Center
Memphis

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This manuscript presents the findings of extended follow up of patients with Type 2 Diabetes who were treated with fenofibrate, a member of a group of triglyceride lowering medications known as fibrates or PPAR alpha agonists, as part of the Action to Control Cardiovascular Risk in T2DM (ACCORD) study.

ACCORD was designed to test the effect of intensive treatment of cardiovascular risk factors including blood glucose, blood pressure and lipids on risk of heart attack, stroke and cardiac death in patients with Type 2 Diabetes.

The lipid arm of ACCORD tested the hypothesis that adding fenofibrate to statin therapy would further reduce risk of these cardiovascular events.

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