Hang on to your computer, because here we go! Bristol-Myers Squibb and GlaxoSmithKline are both working on new diabetes drugs using a novel mechanism to help flush excess blood sugar out of the body. The Bristol-Myers Squibb, known as dapagliflozen, will be the first in a new class that seeks to block the reabsorption of glucose to lower elevated blood glucose levels in diabetics. The GlaxoSmithKline Plc is working on a drug using the same concept. The drugs, known as SGLT-2, or sodium glucose uptake transporter 2 inhibitors, work by overriding the kidney’s normal inclination to reabsorb excess glucose from the body rather then excreting it. Bristol’s 47-patient trial found that the drug helped improve fasting glucose levels over 14 days. Patients received one of three different doses alone or with the oral generic medication metformin. Bristol is developing the drug with AstraZeneca and the companies expect to start the final phase of testing before request regulatory approval this year. The GlaxoSmithKline drug called sergliflozin was found to decrease blood glucose concentrations in two studies of 14 diabetic patients. Stay tuned to hear more as we read about it.
The May/June issue of Annals of Family Medicine had an interesting article written by Alberta S. Kong, M.D., MPH et al at the University of New Mexico in Albuquerque. It identifies a skin condition called acanthosis nigrecans that indicates high risk for type 2 diabetes. People with this condition have velvety, brown patches of skin on the back of the neck, the armpit, and elbows, and/or knees. The condition is most common in people who are obese and in those whose bodies overproduce insulin. These are two risk factors for diabetes. The researchers found that children and adults with the condition were twice as likely to have diabetes as were those without the condition. Children and teens aged 7 to 19, with the condition were 8.3 times more likely to have at least two diabetes risk factors as those without the condition. Adults aged 20 to 39 with the skin condition were 4.2 times more likely to have at least two diabetes risk factors as were those with the condition.
The journal Circulation May 15, 2007 addition has an interesting article which links consumption of soft drinks to obesity in middle-aged individuals. The drinking of soft drinks in children and adolescents had already been linked to obesity. The researchers from a Boston hospitals examined participants in the Framingham Heart Study who were4 free of metabolic syndrome at baseline. They found that in middle-aged, soft drink consumption is associated with a higher prevalence and incidence of multiple metabolic risk factors including a higher incidence of developing metabolic syndrome, obesity, increased waist size circumference, impaired fasting glucose, higher blood pressure, hypertriglyceridemia, and low high-density lipoprotein cholesterol. Take note that this study included all type s of soda including sugar free brands. Those of us with diabetes do try to help our children and grandchildren live cardio-protective life-styles.
Lipid-lowering drugs protect against peripheral diabetic neuropathy according to a major epidemiological study conducted over eight years in Australia. This study showed that two classes of lipid-lowering drugs, statins and fibrates significantly lower the risk of developing nerve damage known as peripheral sensory diabetic neuropathy according to a report which was presented at the American Diabetes Association Annual Scientific Session in June. Timothy Davis, M.D., PhD, Professor of Medicine at the University of Western Australia and principal investigator in the study started in a recent interview, “Statins and fibrates reduced the risk of developing peripheral neuropathy by 35% or 48% respectively in those with type 2 diabetes, although these should be considered comparable risk reductions because of the wide confidence intervals.’ A correct estimate falls into a statistical range in this instance means that the two estimates are indistinguishable, statistically speaking.
Dr. Marcia A Testa of Harvard School of Public Health and a colleague reported in June’s Diabetes Care journal that treatment satisfaction and quality of life are more favorable in diabetic patients who use inhaled insulin rather than injected insulin. In the current study, the researchers assessed treatment satisfaction and quality of life in 120 teens and 207 adults with type 1 diabetes who were randomly assigned to use inhaled or injected insulin for 24 weeks. Both insulin regimes provided comparable blood glucose control. The positive results for the inhaled insulin users included quality- of-life, such as symptoms, mental health status, thinking ability, and adherence with treatment. The researchers see this as a good alternative to multiple insulin injections or insulin pump. According to the researchers the pump has been limited by cost of use, required technical expertise, and health care providers trained in its use. They also note patients’ dislike of a multiple injection regime.
Now on to our abstracts. We frequently share with you the need to protect our hearts and cardiovascular system. Reading this abstract may make us all more vigilant. We hope so. The first titled Association of Diabetes Mellitus with Total Life Expectancy and Life Expectancy With and Without Cardiovascular Disease by Oscar H. Franco, M.D., DSc, PhD et al as found in Archives of Internal Medicine, 2007:167:1145-1151. The researchers examined the association of diabetes with life expectancy and the number of years lived with and without CVD. Using data from the Framingham Heart Study, the researchers built life tables to calculate the associations of having diabetes with life expectancy and years lived with and without CVD among populations 50 years and older. For the life table calculations, they used hazard ratios for 3 transitions (healthy to death, healthy top CVD, and CVD to death), stratifying by the presence of diabetes at baseline and adjusting for age and cofounders. The results found indicate that having diabetes significantly increased the risk of developing CVD (hazard ratio, 2.5 for women and 2.4 for men) and of dying when CVD was present (hazard ratio, 2.2 for women and 1.7 for men). Diabetic men and women 50 years and older lived on average 7.5 years less than their nondiabetic equivalents. The differences in life expectancy free of CVD were 7.8 and 8.4 respectively. They concluded that the increase in the risk of CVD and mortality from diabetes represents an important decrease in life expectancy and life expectancy free of CVD. Prevention of diabetes is a fundamental task facing today’s society in the pursuit of healthy aging.
We often speak about depression and diabetes because the association has been known for some time. The problem with depression is that comes with a feeling of hopelessness and helplessness which impedes the ability to care for oneself. The Archives of Internal Medicine, 2007;167:802-807 has an interesting article on the subject titled Longitudinal Association Between Depressive Symptoms and Incident Type 2 Diabetes Mellitus in Older Adults by Mercedes R. Carnethon, PhD et al. Prospective studies indicate that a single self-report of high depressive symptoms is associated with increased risk of type 2 diabetes mellitus. The researchers tested whether a single report of high depressive symptoms, an increase in depressive symptoms, or persistently high depressive symptoms over time were associated with the development of diabetes in adults 65 years and older. Participants from the Cardiovascular Health Study completed the 10-item Center for Epidemiological Studies-Depression Scale (CES-D) annually from 1089 to 1999. A single report of high depressive symptoms (CES-D score = 8), an increase in symptoms during follow-up (=5 from baseline), and persistently high symptoms (2 consecutive scores =8) were each studied in relation to incident diabetes, defines by initiation of diabetes control medications among participants who were free from diabetes as baseline (n=4681). The mean CES-D score at baseline was 4.5. The incidence rate of diabetes was 4.4 per 1000 person-years. Following adjustment for baseline demographic characteristics and measures of physical activity, smoking, alcohol intake, body mass index, and C-reactive protein during follow-up, each measure of depressive symptoms was significantly associated with incident diabetes. The researchers concluded that older adults who reported depressive symptoms were more likely to develop diabetes than their counterparts; this association was not fully explained by risk factors for diabetes.
JAMA , 2007;298:187-193 has an article of interest titled Hydroxychloroquine and the Risk of Diabetes in Patients with Rheumatoid Arthritis by Mary Chester M.Wasko, M.D., M Sc et al. The researchers examined the relationship between hydroxychloroquine, a commonly used medication used to treat rheumatoid arthritis and which has hypoglycemic effects. This is a prospective multicenter study of 4905 adults which rheumatoid arthritis and no diagnosis of diabetes. Main outcome measure were diabetes by self-report of diagnosis or hypoglycemic medication use. During the observation period, incident diabetes was reported by 54 patients who had taken hydroxychloroquine and by 171 patients who had never taken the medication. The hazard ratio fir incident diabetes among patients who had taken hydroxychloroquine was 0.62, the risk of incident diabetes was significantly reduces with increased duration of hydroxychloroquine use; among those taking hydroxychloroquine for more than 4 years, the adjusted relative risk of developing diabetes was 0.23, compared with those who had not taken hydroxychloroquine. They concluded that among patients with rheumatoid arthritis, use of hydroxychloroquine is associated with a reduced risk of diabetes.
BSP
