Diabetes Research

Our first headline brings news about a possible vaccine against type 1 diabetes caused by common viral infections. The research from Great Britain and published in the journal Diabetologia found a large proportion of infected beta cells in adults with type 2 diabetes. The study at the Royal Infirmary in Glasgow led by Alan Foulis found 60% of youngsters who died form diabetes contained evidence of enteroviral infection of beta cells. A second study at Cambridge University led by John Todd that rare mutations in a gene involved with the body’s response to viruses reduce the risk of juvenile diabetes. The researchers are looking at the process of whittling down the some 100 enteroviruses to find which ones played the main roles with the end goal of developing a vaccine that could protect children against the disease.

Remember giving up smoking at some point in your life? I do. My few months occurred after college when I no longer needed the habit to look the part. So what can we do with tobacco plants to help all of us? Today, genetically modified plants containing a medicine are being studied to stop type 1 diabetes. European researchers have produced tobacco plants containing an potent anti-inflammatory protein called interleukin-10 (IL-10) that could help patients with insulin-dependent type 1 diabetes and other autoimmune diseases. Today antibody medicines and vaccines are produced in cell cultures inside stainless steel fermenters. Mario Pezzotti of the University of Verona believes that tobacco plants are easy to transform genetically and you can “…regenerate an entire plant form a single cell." His work has attracted so much attention that Phillip Morris is supporting a conference on plant-based medicine in Verona in June. Research is still at the “mice" level of intervention, but the researchers are heading toward small doses to prevent diseases in people. We’ll keep our eyes on journals to keep you up to date.

Sanofi-Aventis’s Apidra Solostar injection pen has been approved t treat diabetes as of march 2009. The disposable pen with rapid-acting insulin was approved for adults with type 1 diabetes and for children four years and older with type 1. The device requires lower injection force than competing products, the drug maker says.

More evidence links type 2 diabetes and the risk of Alzheimer’s. For a long time doctors suspected diabetes damaged blood vessels that supply the brain. It now seems even more insidious that the damage may start before someone is diagnosed with full blown diabetes, back when the body is gradually losing its ability to regulate blood sugar. In fact, the lines are blurring between what specialists call “vascular dementia" and scarier Alzheimer’s disease. No matter what it’s called, there’s reason to safeguard your brain by fighting diabetes and heart-related risks. Dr. Ralph Nixon of New York University, vice chairman of the Alzheimer’s Association’s scientific advisory council says don’t panic is you have type 2 diabetes. Genetics still are the prime risk factor for dementia, but the latest research strengthens the link and certainly has scientists asking if diabetes and its related “metabolic syndrome" increase risk solely by spurring brain changes that underlie Alzheimer’s–or if they add an extra layer of injury to an already struggling brain, what Nixon calls “essentially a two-hit situation."

The Lancet 10:1016/50140-6736(09)60552-3 brings us an article titled Coronary Artery Bypass Surgery Compared with Percutaneous Coronary Intervention for Multivessel Disease: a Collaborative Analysis of Individual Patient for Ten Randomized Trials by Mark A. Hlatky, M.D. et al. Coronary artery graft (CABG) and percutaneous coronary intervention (PCI) are alternative for multivessel coronary disease. The researchers undertook a collaborative analysis of data from randomized trails to assess whether the effects of the procedures on mortality are modified by patient characteristics. Ten participating trials provided data on 7812 patients. PCI was done with balloon angioplasty in six trials and with bare-metal stents in four trials. Over a median follow-up of 5-9 years of the 3889 patients assigned to CABG died compared with 628 patients assigned to PCI. In patients with diabetes mortality was substantially lower in the CABG group than the PCI group; however, mortality was similar between the groups without diabetes. Patient age modified the effect of treatment on mortality with hazard ratios of 1-25 in patients younger than 55 years, 0-90 in patients 55-64 years, and 0-82 in patients 65 years and older. Treatment effect was not modified by the number of diseased vessels or other baseline characteristics. The researchers concluded that for patients who were younger than 65 or who did not have diabetes, long-term mortality is similar after CABG and PCI. CABG is suggested for those with diabetes or who are older than 65 years.

It’s time to look at the 2009 clinical practice recommendations. If you need a complete copy you can go to the ADA web site and find the entire text. Here we just want to bring you changes than will impact your self-care goals and care. First, we note that a section on bariatric surgery has been added as well as a section on discharge planning in the “Diabetes care in the hospital" section. Revisions to the “Standards of Medical Care in Diabetes" it is noted that testing children a section of small-for gestational-age birth weight has been added to the list of conditions associated with insulin resistance. It is noted that that one-time counseling is not adequate to prevent or delay type 2 diabetes. Weight loss of 5-10% of body weight to prevent type 2 diabetes is suggested.

• For diabetes care Continuous Glucose Monitors are suggested to lower A1C in selected adults (aged ±25 years) with type 1 diabetes. It may be helpful to those with hypoglycemia unawareness and to prevent frequent events. It is also seen as helpful in adolescents, young adults and children where its success correlates to ongoing use of the device.
• Correlation of A1c with average glucose has been revised to reflect the correlation from the ADAG study (A1c-Derived Average Glucose):

• For a subgroup of patients there is a suggested benefit in microvascular outcomes with A1c less than 7% if hypoglycemia or other adverse effects can be controlled. Conversely, less stringent A1c goals may be appropriate patients with severe hypoglycemia, limited life expectancy, advanced micro-or macrovascular complications, and extensive comorbid conditions and for those with long term diabetes who despite the use of multiple glucose lowering agents including insulin.
• The level of nutrition therapy recommendations has been changed to limit trans fats.

• Bariatric surgery should be considered for adults with BMI=35kg/m² and type 2 diabetes especially if difficult to control.
• Because of lack of evidence surgery is not recommended for those with BMI =35kg/m² outside of research protocol.
• More research is needed for long-term cost-effectiveness and risks of bariatric surgery for those with type 2 diabetes.

Next month we will continue with these new recommendations including Prevention and Management of Diabetes Complications, Diabetes Care for Specific Populations, Diabetes Care in Specific Settings and a round up of other specifics. Please make sure you talk to your physician if you re not receiving this care.

BSP