Pramlintide injection added to basal insulin at mealtime is similar to titrated rapid-acting insulin in achieving glycemic control but with a lower risk of hypoglycemia and no weight gain in patients with type 2 diabetes, said Matthew Riddle, MD, head, section of diabetes, division of endocrinology/diabetes/clinical nutrition, Oregon Health and Sciences University, Portland.
Coronary artery calcium and abdominal aortic calcium both predicted future cardiovascular events in a Veterans Administration population with type 2 diabetes. The relationship between calcium scores and cardiovascular events was independent of standard cardiovascular risk factors, said Peter Reaven, MD.
Surrogate endpoints in clinical trials (ie, hemoglobin [Hb] A1c) on which drug approvals may be based only explain narrow aspects of complex conditions. For this reason, even when using a drug as labeled, there is always a level of uncertainty over outcomes with the drug, said Saul Malozowski, MD, PhD, MPH.
Clinicians should be wary of health claims made for trace elements such as iron or chromium. While there is no doubt that trace elements are needed for health, there is significant doubt about their utility in preventing or curing diabetes and other diseases, said Eliseo Guallar, MD, DrPH, Johns Hopkins Bloomberg School of Public Health, Baltimore. There are many hypotheses about the beneficial effects of trace elements, but little high-quality data, little reliable population data, few useful biomarkers, relatively crude analytical methods and few mechanistic studies.
Pioglitazone prevented progression to type 2 diabetes in patients with impaired glucose tolerance (IGT), reported Ralph DeFronzo, MD. The effect was marked?81% fewer patients assigned to pioglitazone compared with placebo converted from IGT to type 2 diabetes in a randomized, double-blind, placebo-controlled clinical study.
British women who have poorer glycemic control before and during pregnancy have poorer outcomes and less-healthy babies. That's the take home message from CEMACH, the Confidential Enquiry into Maternal and Child Health, a year-long survey of pregnant women with type 1 and type 2 diabetes across the United Kingdom.
Atherosclerosis and its complications develop in stages. Each of each of these stages is affected by different metabolic abnormalities, said Scott Grundy, MD, PhD, during the annual Edwin Bierman lecture.
Current research suggests that pedal osteolysis, the loss of bone mineral density (BMD) in the foot, may be a useful biomarker for Charcot's arthropathy and other diabetic foot diseases.
An intense glucose-lowering strategy in high-risk patients with type 2 diabetes was associated with an excess of mortality in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, the U.S. counterpart to the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation) study.
Several novel classes of agents designed to treat hyperglycemia are under investigation. These agents were the subjects of a symposium here. One such novel class is the sodium glucose co-transporter (SGLT) type 2 inhibitors, which reduce glucose levels by increasing kidney excretion of glucose. The kidney plays an important role in the handling of glucose, said Robert R. Henry, MD, professor of medicine and chief of VA endocrinology and metabolism at the University of California, San Diego. SGLT-2 is expressed almost exclusively in the kidney. About 90% of glucose reabsorption by the kidney is mediated by SGLT-2 under normal circumstances.
Translating weight loss research into clinical programs is not easy. Too many clinical protocols exist in isolation, according to Donald Williamson, PhD, Pennington Biomedical Research Center, Baton Rouge, LA. The key gap is extending methods that contribute to weight loss into programs that maintain weight loss.
The risk of fracture is probably only slightly increased in persons with type 2 diabetes, said Peter Vestergaard, MD, PhD, DrMedSc, from the Osteoporosis Clinic, Aarhus Amtssygehus, Denmark.
Real-time continuous glucose monitoring (CGM) can significantly improve glycemic control, but it will not help all patients. "Real-time CGM will add significantly to glucose management for some people, but not for all," said Irl Hirsch, MD, University of Washington, Seattle. "Human factors make all the difference between success and failure. Some patients will never figure it out. That?s why real-time control is so challenging.
Good glycemic control is not sufficient to relieve painful diabetic neuropathy, necessitating investigation of other modalities to achieve analgesic efficacy. Dan Ziegler, MD, German Diabetes Clinic, German Diabetes Center, and professor of internal medicine, Leibniz Institute at the Heinrich Heine University, Düsseldorf, provided an overview of pharmacologic treatments that have been explored for painful diabetic neuropathy and the success achieved with each.
Islet cell transplants are effective in both the short- and long-term in freeing patients with diabetes from insulin injections and have proven to be safe, said Bernhard J. Hering, MD. The use of embryonic pig pancreatic precursor tissue as the source of islets appears promising and would expand the number of transplant recipients, which is currently limited by number of potential donors.
Take another look at the popular hypothesis that suggests type 2 diabetes has an acute effect on the secretion of GLP-1 and that lower GLP-1 secretion has an acute effect on insulin. It doesn't work that way, said Michael Nauck, MD, PhD, Diabeteszentrum Bad Lauterberg, Bad Lauterberg, Germany. Decreased GLP-1 secretion is not part of the pathophysiology of type 2 diabetes.
Clinicians and type 2 diabetes patients have a new worry: hepatic steatosis, or nonalcoholic fatty liver disease. Liver disease is a less-obvious problem than kidney disease but may have equally grave consequences.
Researchers at Stanford University are reporting positive results in healing diabetic wounds with a pharmaceutical agent already approved by the FDA, but only in mice so far.
Forget the arguments over fit and fat in the development of diabetes and the resulting complications. Both fitness and fatness can be addressed by the same prescription: physical activity.
Endothelial dysfunction is both a marker for and a cause of diabetic complications. Researchers are teasing out pathways that involve oxidative stress and endothelial dysfunction, said Per-Henrik Groop, MD, PhD, Helsinki University Central Hospital, Helsinki, Finland. The challenge is in finding drugs that show the same activity in vivo that they show in cell studies or animal models.
Intensive blood glucose control in patients with type 2 diabetes resulted in a significant reduction in the risk of microvascular complications compared with standard blood glucose control. This was driven by a reduction in the occurrence of nephropathy, in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) study.
Periodontal disease makes glycemic control more difficult in patients with type 2 diabetes, said George W. Taylor, DrPH, DMD, associate professor of dentistry, School of Dentistry and Public Health at the University of Michigan, Ann Arbor.
The editorial teams in the Modern Medicine Primary Care Content Group, with content from our legacy brands ? Medical Economics, Drug Topics, Geriatrics, Formulary and Contemporary OB/Gyn ? will cover key medical meetings, bringing you breaking news, the latest research findings and reports from the general sessions.
Healthcare reform is a high-profile issue in the presidential election campaign, and drug access has become a central theme in the debate. Both Democratic and Republican candidates have rolled out healthcare reform plans that promise to cover the uninsured while also providing tax breaks and other incentives to help individuals obtain health insurance.
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