Diabetes Research

The article titled Incidence trends for childhood type 1 diabetes in Europe during 1889-2003 and predicted new cases 2005-20 by Dr. Christopher C. Patterson, PhD et al. They looked at 20 population-based EURODIAB registers in 17 countries and registered 29,311 new cases of type 1 diabetes diagnosed before age the 15th birthday from 1089-2003. Log linier rates were established for geographical areas in conjunction with published incidence rates and population projections in Europe for 2005, 2010, 2015, and 2020. Ascertainment was better than 90% in most registers. They concluded that type 1 diabetes in children under 5 years will double by 2020 and will go up by 70 percent in those under 15 years old. The trend will be the highest in former Communist countries of Eastern Europe. The authors concluded that this rise cannot be linked only to genes and is based on a combination of genetic risk and life style.

Dr. Nelly Mauras of Nemours Children’s Clinic in Jacksonville, FL. reported on a study she led at the Endocrine Society which that obese children had up to 10 times the normal amount of a compound that reflects inflammation (c-reactive protein) and another that helps blood to clot (fibrinogen)—both known to raise the risk of heart attacks and heart disease in adults. “Our study finding suggests that we need more aggressive interventions for weight control in obese children”, stated Dr. Mauras. None of these children had symptoms of Syndrome X which includes high blood pressure, high cholesterol, and high blood glucose levels. Doctors do not treat obesity in children unless they have these symptoms but the authors conclude that this should be reconsidered.

At the ADA meetings in New Orleans it was announced that an interim look at a long-term study of Onglyza, under development by Bristol-Myers Squibb Co. and AstraZeneca Plc, continued to show lowered glucose levels when used in combination with metformin in people with type 2 diabetes. The companies are awaiting U.S. and European approval for Onglyza or saxagliptin which is a DPP-4 inhibitor.

The nicotine in cigarette smoke may promote insulin resistance and lead to a condition known as prediabetes. The research outlined at the Endocrine Society’s annual meeting by Dr. Theodore Friedman, chief of endocrinology, metabolism, and molecular medicine at Charles R. Drew University of Medicine and Science in Los Angeles, noted that smokers tend to face a higher diabetes risk even though “smoking causes weight loss, which should protect against heart disease.’ In this study the team gave adult mice twice-daily injections of nicotine for 14 days. The mice displayed higher levels of cortisol in the blood. They also ate less and lost weight compared to mice that did not receive the shots but nonetheless developed insulin resistance and prediabetes. “Our results suggest that reducing tissue glucocorticoid levels or decreasing insulin résistance may reduce the heart disease seen in smokers.” “We anticipate that in the future there will be drugs to specifically block the effect of nicotine on glucocorticoids (such as cortisol) and insulin.”

Let’s look at abstracts which examine subjects in depth. Those of us with diabetes have gone through sometimes conflicting suggestions about how to forestall heart disease and complications. The first analysis looked at the ACCORD trial which that the relationship between tight blood sugar control and the risk of heart trouble is still far form certain. The ACCORD trial was shut down when the researchers found a 20 percent increased risk of death among those in the more intensive blood sugar control group. Meanwhile analysis of another trial, the VADT trial, found that intensive blood sugar control that’s begun many years after diagnosis may actually do more harm than good when it comes to cardiovascular problems. “Treatment should be individualized”, Dr. William C. Duckworth co-chair and director of diabetes research at Carl T. Hayden VA Medical Center in Phoenix, said during the teleconference. “Type 2 diabetes is an extremely heterogeneous disease, so if you treat different populations or different groups within the population you’re studying you may get different results’ “We are withholding specific recommendations but there may be potentially glucose-control targets for different groups”, added Dr. Matthew C. Riddle, member of the ACCORD Glycemia Management Group and professor at Oregon Health Science University. “If we can objectively identify which individuals fall into which groups that would be a big step forward.” “The central role of glucose control in preventing microvascular eye, kidney and nerve disease is fairly well-established, said Rick Bergenstahl, executive director of the International Center in Minneapolis and ADA’s president-elect of medicine and science, “Data related to macrovascular effects on the heart are less understood or less conclusive.”

People who achieved a rapid and sustained reduction of A1c from higher levels at the beginning had the lower risk, and the ones who were unable to rapidly to reduce glucose from the beginning had higher risk,” Riddle explained. In other words those who struggled to get their glucose seem to be at higher risk for heart trouble. ‘The closer to normal range the better and that is what we’ve been recommending all along” said Dr Helena W, Robard, past president of both the American Association of Clinical Endocrinologists and the American College of Endocrinology. “We have to aim for good control early on.”

The New England Journal of Medicine (10.1056/NEJMoa080796) has an article titled A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease, by the BARI 2D Study Group. Optimal treatment for Patients with both type 2 diabetes and stable ischemic heart disease has not been established. The researchers assigned 2368 patients with both diabetes and heart disease to undergo either prompt revascularization with intensive medical therapy or intensive medial therapy alone and to undergo either insulin-sensitization or insulin-provision therapy. Primary end points were the rate of death and a composite of death, myocardial infarction, or stroke (major cardiovascular events). Randomization was stratified according to the choice of percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) as the more appropriate intervention. Results at 5 years of survival did not differ significantly between the revascularization group and the medical therapy group of between insulin-sensitization group and the insulin-provision group. The rates of freedom from major cardiovascular events also did not differ significantly among groups: 77.2% in the insulin-sensitization group and 75.4% in the insulin-provision group. In the CABG stratum, the rate of major cardiovascular events was significantly lower in the revascularization group (22.4%) than in the medical-therapy group (30.5%). Adverse events and serious adverse events were generally similar among the groups, although severe hypoglycemia was more frequent in the insulin-prevision group than in the insulin-sensitization group. Overall, there was no significant difference in the rates of death and major cardiovascular events between patients undergoing prompt revascularization and those undergoing medical therapy or between strategies of insulin sensitization and insulin provision.

JAMA 2009;301(21):2234-2242 has another article of interest when we think about the number of children who grow up to have type 2 diabetes titled Timing and Tempo of First-Year Rapid Growth in relation to Cardiovascular and Metabolic Risk Profile in early Adulthood, by Ralph W. J. Le et al. This is an article which is very interesting because as with many of the reasons for type 2 diabetes, we can control many of our risk factors. Here’s one more. The objectives of this research were to examine the association of cardiovascular disease and excessive weight gain in the infancy. Longitudinal data using Programming Factors for Growth and Metabolism (PROGRAM) study of 217 healthy patients ages 18 to 24 years. The main outcome was associated with the periods of the first-year growth and tempo of weight gain and cardiovascular disease and type 2 diabetes. Weight gain in the first 3 months of life were inversely associated with insulin sensitivity and serum high-density lipoprotein cholesterol level and positively associated with waist circumference, acute insulin response, ratio of total cholesterol to high-density lipoprotein cholesterol, and the level of triglycerides in early adulthood. Rapid weight gain during the first 3 months of life resulted in a higher percentage of body fat, more central adiposity, and reduced insulin sensitivity in early adulthood then when weight gain occurred during the entire first year. The researchers concluded that rapid weight gain in the first 3 months of life is associated with several determinates of cardiovascular disease and type 2 diabetes in early adulthood.

BSP