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DIABETES

 

Incretin-based diabetes therapy not associated with increased mortality

28 Jul 2017Registered users

A recent meta-analysis, published in the BMJ, has shown no increase in all cause mortality in patients with type 2 diabetes using incretin-based treatments i.e. GLP-1 agonists and DPP-4 inhibitors.

Insulin pumps vs multiple injections in adults with type 1 diabetes

23 May 2017Registered users

A randomised controlled trial comparing insulin pump use with multiple daily injections suggests that when patients are engaged with intensive self-management, insulin pump therapy may not add significant extra benefits in adults.

How accurate are screening tests for pre-diabetes?

22 Feb 2017Paid-up subscribers

A recent meta-analysis has confirmed that interventions in patients with pre-diabetes reduce the rate of progression to overt diabetes, but found that the screening tests used to identify pre-diabetes are inaccurate. The study was commissioned by policy makers in a London borough who wanted to identify an effective screen and treat policy in an area of high diabetes prevalence. The UK investigators trawled through Medline, PreMedline and Embase for eligible papers evaluating the accuracy of tests for pre-diabetes, and controlled studies of interventions (lifestyle changes or metformin) in pre-diabetes patients identified by screening. A total of 2,874 titles were scanned and 148 eligible papers reviewed. The final analysis included 49 studies of screening tests and 50 intervention trials.

Blood pressure and risk of cardiovascular events in type 2 diabetes

23 Jan 2017Registered users

A large cohort study has found that lower systolic blood pressure (BP) is associated with reduced cardiovascular risk in type 2 diabetes patients with no previous cardiovascular disease (CVD). However, there was evidence of a J-shaped relationship between systolic BP and heart failure, and also all cause mortality.

Is frequent self-monitoring and on-line reporting of blood glucose worthwhile?

23 Jan 2017Registered users

Frequent self-monitoring of blood glucose had a significant effect on HbA1c only when combined with frequent on-line reporting, in a study from Canada.

Diabetes therapy and bladder cancer risk

24 Oct 2016Registered users

A UK population-based cohort study concludes that pioglitazone is associated with an increased risk of bladder cancer in patients with type 2 diabetes.

Diabetes therapy and cardiovascular outcomes

23 Sep 2016Registered users

A large UK study  has shown clinically important differences in the risk of heart failure, cardiovascular disease (CVD), and all cause mortality in patients on different drugs, alone and in combination, for type 2 diabetes. Overall, use of gliptins or glitazones was associated with reduced risks of all three outcomes compared with non-use of these drugs.

Gastric bypass induces remission in type 2 diabetes patients with mild-moderate obesity

01 Aug 2016Paid-up subscribers

The CROSSROADS randomised controlled trial of Roux-en-Y gastric bypass (RYGB) versus intensive lifestyle and medical intervention has demonstrated better rates of type 2 diabetes remission in patients with mild-moderate obesity treated with bariatric surgery in this US study. This study used a well informed population-based sample, and included patients with a BMI < 35 kg/m2. The 60% figure for diabetes remission is in line with findings from a UK national registry of more than 3,000 diabetes patients who were operated on between 2011 and 2013, which showed 65% remission of diabetes.

Hypoglycaemia risk with combination therapy in type 2 diabetes

23 Jun 2016Registered users

A meta-analysis has suggested that the addition of a DPP-4 inhibitor to existing sulphonylurea (SU) therapy is associated with a 50% increased risk of hypoglycaemia in type 2 diabetes patients and one excess case for every 17 patients treated in the first six months. These findings emphasise the importance of following the recommendation to reduce SU dose when commencing a DPP-4 inhibitor.

Breastfeeding may protect against type 2 diabetes following GDM

22 Dec 2015Registered users

A carefully controlled observational study has shown an association between breastfeeding and a reduced risk of progression to type 2 diabetes in women who had had gestational diabetes mellitus (GDM). A total of 1,010 women with GDM enrolled in the SWIFT trial (Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy) were studied.

Insulin pump therapy associated with lower cardiovascular mortality

25 Nov 2015Registered users

Patients with type 1 diabetes using insulin pump therapy had almost half the risk of death from CHD or  cardiovascular disease compared with those receiving multiple daily insulin injections, in a large observational study.

Is high intensity intermittent exercise beneficial in type 2 diabetes?

21 Oct 2015Registered users

Recent research from Newcastle University suggests that high intensity intermittent exercise is associated with improved cardiac structure and reduced liver fat in type 2 diabetes patients.

Lifestyle intervention reduces gestational diabetes in high risk women

24 Sep 2015Paid-up subscribers

A small study from Finland has shown that a relatively simple dietary and exercise intervention during pregnancy can lower the risk of gestational diabetes mellitus (GDM) in high-risk groups.

Low birthweight combined with unhealthy lifestyle boosts diabetes risk

24 Sep 2015Registered users

A recently published study in the BMJ has supported a synergistic effect between low birthweight and poor lifestyle on the risk of developing type 2 diabetes in adults.

Consumption of sugar sweetened drinks linked to type 2 diabetes

05 Aug 2015Registered users

A large meta-analysis has shown that drinking sugar sweetened beverages raises the risk of type 2 diabetes, independent of obesity. The novel aspect of this paper is that the researchers have quantified the size of the problem for public health. The results would suggest that in the UK, between 2010 and 2020, 2-6% of new cases of type 2 diabetes would be attributable to the consumption of sugar sweetened beverages. This figure is higher in the USA, where more sugar sweetened drinks are sold, estimated as 4-13% of new cases in the same period.

Subclinical LVD linked to poor outcomes in type 2 diabetes

22 Jun 2015Paid-up subscribers

Type 2 diabetes patients with asymptomatic left ventricular dysfunction are at greater risk of death and hospitalisation, a prospective cohort study from Australia has shown. A total of 230 asymptomatic patients with type 2 diabetes, followed for up to 10 years, underwent echocardiography to detect LVD.  Asymptomatic LVD was found in nearly half the patients in this study and was independently associated with adverse outcomes. Newer echo techniques can readily detect subclinical LVD.

Serious life events raise risk of type 1 diabetes in children

21 May 2015Paid-up subscribers

A recent prospective study from Sweden has shown that experiencing a serious life event during the first 14 years of life is associated with a three-fold increased risk of developing type 1 diabetes.

Shift work may raise risk of diabetes

23 Apr 2015Paid-up subscribers

A meta-analysis published in the Journal of Occupational and Environmental Medicine has concluded that shift work is associated with an increased risk of diabetes mellitus, especially in men and in those working rotating shifts.

Are glitazones associated with increased cancer risk?

23 Mar 2015Paid-up subscribers

A recent multipopulation pooled cumulative exposure analysis has suggested that the use of pioglitazone is not associated with an increased incidence of bladder cancer. The study used prescription, cancer and mortality data from patients with type 2 diabetes. The raw data were obtained from British Columbia, Finland, Manchester, Rotterdam, Scotland and the UK Clinical Practice Research Datalink. Data were collected on 1.01 million patients over 5.9 million person-years. There were 3,248 cases of incident bladder cancer, 117 in those exposed to pioglitazone, over a median follow-up of 4.0 to 7.4 years.

Sulfonylureas raise risk of CHD in women

23 Feb 2015Paid-up subscribers

The use of sulfonylureas in women with type 2 diabetes is associated with a significant increase in the risk of coronary heart disease (CHD), but not stroke, a large prospective cohort study (The Nurses’ Health Study) has shown.

Enterovirus linked to type 1 diabetes in children

24 Nov 2014Paid-up subscribers

A large retrospective population-based cohort study from Taiwan has added weight to the association between enterovirus infection and onset of type 1 diabetes in childhood.

Interval walking improves glycaemic control in type 2 diabetes

23 Oct 2014Paid-up subscribers

A small Danish study of patients with type 2 diabetes has shown that interval walking training has a beneficial effect on glycaemic control by increasing insulin sensitivity while maintaining insulin secretion. Twenty men and 12 women, with type 2 diabetes of at least two years’ duration, took part in this open, randomised, partial crossover trial.

Which eating patterns are most effective for weight reduction in type 2 diabetes?

23 Sep 2014Paid-up subscribers

Eating two larger meals a day is more effective than consuming the same amount as six smaller meals in patients with type 2 diabetes who are trying to lose weight, the findings of a crossover study suggest. The Prague-based study population comprised 54 patients (29 men) with type 2 diabetes of more than one year’s duration. They had all been treated with oral hypoglycaemic drugs. Participants’ BMI ranged from 27 to 50 kg/m2 and HbA1c 6.0-11.8%, average 7.2%. The mean age was 59.4 years and mean duration of diabetes 8.1 years.

Does yoghurt lower risk of type 2 diabetes?

25 Jul 2014Paid-up subscribers

Findings from a large prospective study suggest that regular consumption of yoghurt may help protect against the development of type 2 diabetes. The EPIC study is a European multicentre trial that has been prospectively investigating the link between diet and cancer. The branch of the trial sited in Norfolk had a nested cohort of patients who were also followed up for incident diabetes. Between 1993 and 1997, the EPIC-Norfolk study recruited a UK-based population cohort of 25,639 men and women aged between 40 and 79 at baseline.

Do changes in coffee intake affect diabetes risk?

22 May 2014Paid-up subscribers

An analysis of data from three large prospective cohort studies in the USA has demonstrated a link between the risk of type 2 diabetes and changes in coffee intake. Increasing coffee consumption over a four-year period was associated with a lowering of risk and vice versa.

Walking can reduce CVD risk in impaired glucose tolerance

22 Apr 2014Paid-up subscribers

Increasing ambulatory activity reduces cardiovascular events in patients with impaired glucose tolerance and raised risk, data from the Navigator trial has shown. The main objective of the original study was to determine whether valsartan or nateglinide prevented cardiovascular events and/or progression of impaired glucose tolerance to overt diabetes. The findings did not show any protective effect from either drug. However, as well as the original research question posed by the trial, the cohort provided a large amount of prospective data for further analysis.  The current paper analysed the relationship between change in daily ambulatory activity and cardiovascular events.

Can tight BP and lipid control affect cognitive decline?

20 Mar 2014Paid-up subscribers

Intensive lowering of blood pressure (BP) and lipids does not appear to reduce cognitive decline in patients with type 2 diabetes, initial results from a randomised prospective study have found. The trial was conducted at multiple centres in North America, and was one of the sub studies of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial. This set out to test the hypothesis that intensive reduction of blood glucose, BP and lipids would improve cardiovascular outcomes in diabetes. The glycaemic study arm with patients treated to tighter HbA1c targets was halted prematurely because of an excess of deaths compared with the control group. No benefits were seen in the other intervention arms, and this finding was consistent with other studies testing the same hypothesis, such as the ADVANCE study.

Do statins increase diabetes risk?

24 Feb 2014Paid-up subscribers

A recent study, from New Zealand, has added further evidence to support a link between taking statins and new onset diabetes. Data from the national primary care electronic database was used to create a prospective cohort study to compare the incidence of new diabetes in groups of patients taking statins and antihypertensive drugs.

Phone advice from practice nurses fails to improve glycaemic control

22 Jan 2014Paid-up subscribers

An Australian study, published in the BMJ, has concluded that telephone coaching of type 2 diabetes patients by practice nurses has no effect on glycaemic control. The authors investigated whether evidence, mostly drawn from studies in the USA, that diabetes nurses using complex algorithms during telephone advice consultations were able to improve glycaemic control and lipid parameters, could be extrapolated to real world general practice. The study was set in 59 general practices in Victoria, Australia. Participating practices were divided into the intervention group (30), who received telephone coaching, and the control group (29), who received standard diabetes care.

Cinnamon may have beneficial effects on blood glucose and lipids

05 Dec 2013Paid-up subscribers

A recent meta-analysis has shown that cinnamon can reduce blood glucose, total and LDL cholesterol, and increase HDL cholesterol in type 2 diabetes. The researchers had published a previous meta-analysis that was unable to show any benefit from cinnamon, but repeated the exercise because there have been several randomised controlled trials performed since the last review. Studies considered eligible for the meta-analysis were randomised controlled trials of patients with type 2 diabetes that evaluated the use of oral cinnamon supplementation in any dose or form, regardless of any additional intervention for diabetes. Trials had to have reported data on at least one of the following endpoints: HbA1c, fasting glucose, total cholesterol, LDL cholesterol, HDL cholesterol or triglycerides.

Can eating fruit prevent type 2 diabetes?

23 Oct 2013Registered users

A large study in the BMJ suggests that eating whole fruit may reduce the risk of diabetes, and that some specific fruits may be more protective than others, but that increased intake of fruit juices may raise the risk of developing the disease.This paper was based on data from three prospective cohort studies of American healthcare professionals. These studies followed the health outcomes of the study groups over many years, gathering detailed data about health and lifestyles. The Nurses’ Health Study (1984–2008) covering 66,105 women, the Nurses’ Health Study II (1991-2009), 85,104 women, and the Health Professionals Follow Up study (1986-2008), 36,173 men, together provided 3,464,641 person-years of follow-up.

Insulin pumps improve long-term glucose control in children

23 Sep 2013Paid-up subscribers

A study on the use of insulin pump therapy in children with type 1 diabetes has demonstrated sustained improvements in long-term glycaemic control, BMI, rates of hypoglycaemia and diabetic ketoacidosis (DKA). The prospective case-control study was based at the Princess Margaret Hospital in Perth, a tertiary centre for children with diabetes serving Western Australia.

Bariatric surgery improves weight loss and diabetic control

24 Jun 2013Paid-up subscribers

Patients with poorly controlled type 2 diabetes who underwent bariatric surgery, in addition to medical treatment, showed a significantly greater improvement in glycaemic control and weight loss than those receiving medical therapy alone. The trial, from the US, was a single site, open label, randomised 12-month study comparing intensive medical therapy with or without the addition of a surgical bariatric intervention (Roux-en-Y gastric bypass or sleeve gastrectomy) in 150 obese patients with poorly controlled type 2 diabetes. A single experienced surgeon performed the bariatric procedures. Mean age of the patients was 49 years, BMI 36 and average HbA1c  9.2%. Two-thirds of the patients were women.

Is early insulin effective in type 2 diabetes?

23 May 2013Paid-up subscribers

A short course of intensive insulin therapy in certain patients with newly diagnosed type 2 diabetes may induce remission, a meta-analysis suggests.

Ranolazine effective for angina in diabetes patients with high CVD risk

25 Apr 2013Registered users

Ranolazine, a sodium channel blocker, significantly improved angina in patients with diabetes and coronary artery disease (CAD), a randomised, double-blind trial has found.

Surgery the best option for patients with diabetes and multivessel coronary disease

21 Mar 2013Paid-up subscribers

Diabetes patients undergoing coronary artery bypass graft (CABG) have a lower risk of mortality than those who receive percutaneous coronary intervention (PCI), the results of recent trials suggest.

Kidney disease raises mortality risk in diabetes

21 Feb 2013Paid-up subscribers

Patients with type 2 diabetes and kidney disease are at high risk of death over the next ten years, according to a study from the US.

Metformin improves cardiovascular outcomes in high-risk patients

28 Jan 2013Paid-up subscribers

Treatment with metformin for three years produced a marked reduction in macrovascular complications and mortality compared with glipizide in patients with type 2 diabetes and coronary artery disease (CAD), a recent trial has shown.

Self-monitoring unnecessary in type 2 diabetes patients not on insulin therapy

20 Jun 2012Registered users

Self-monitoring of blood glucose levels in patients with non-insulin treated type 2 diabetes does not confer any clinical benefit, a recent meta-analysis, published in the BMJ, has concluded. The studies included were randomised controlled trials in patients with non-insulin treated type 2 diabetes comparing an intervention using self-monitoring of blood glucose with clinical management not using self-monitoring. Trials published from 2000 onwards with at least 80 patients were deemed eligible. A total of 2,552 patients were randomised in the six trials included. Dr Peter Savill comments: 'Patients seem to like the reassurance of knowing what their blood glucose is doing whereas clinicians are not convinced that regular testing is necessary to improve wellbeing and outcomes and may feel it is an expense that the NHS cannot afford. Despite a small, albeit significant, reduction in HbA1c level in the self-monitoring group the authors conclude that the evidence from this meta-analysis was not convincing for a clinically meaningful effect on clinical management.This should provide further reassurance for clinicians advising patients that regular monitoring of blood glucose in type 2 diabetes patients who are not taking insulin is unnecessary.'

Which women with GDM are at risk of future diabetes?

24 Jan 2012Paid-up subscribers

Impaired glucose tolerance, low HDL cholesterol and age > 35 were the strongest predictors of developing diabetes in women with gestational diabetes mellitus (GDM), a study from Vienna has found. Commenting on the study, Dr Chris Barclay, GP with an interest in O&G, Suffolk, writes: ' The development of type 2 diabetes appears to be a continuously progressive process which can last for years or even decades. The metabolic stress of pregnancy appears to unmask this tendency temporarily, even though most women will become euglycaemic after delivery. The underlying metabolic disorder for many of these women will however continue to progress. GDM is an independent risk factor for diabetes. The opportunities for timely intervention and prevention here are obvious. Primary care is best placed to offer this help.'

Hours watching TV associated with raised risk of diabetes and heart disease

08 Aug 2011Registered users

A meta-analysis of prospective cohort studies has shown an association between time spent viewing TV and risk of type 2 diabetes, cardiovascular disease, and all cause mortality.

CHD risk greatest in patients with early-onset diabetes

21 Apr 2011Paid-up subscribers

Diabetes is associated with an increased risk of major coronary events and all cause mortality, however, only early-onset disease appears to confer CHD equivalence, a study in Archives of Internal Medicine concludes. The authors used data from the British Regional Heart Study, a prospective study of cardiovascular disease in men from 24 British towns who underwent screening from 1978 to 1980.

Tight BP control fails to improve cardiovascular outcomes in diabetes patients with CAD

21 Sep 2010Registered users

Tight BP control confers no additional benefit with respect to cardiovascular outcomes in patients with diabetes and CAD compared with usual control, a major trial has shown. It may actually worsen outcomes in the long-term. The INVEST study randomly assigned 22,576 patients to two BP lowering regimens starting with verapamil SR or atenolol and adding in an ACEI, thiazide diuretic or both. The main trial results were published in 2003 and showed no difference in cardiac outcomes between the two approaches. This recently published post hoc analysis of the original data categorised 6,400 diabetes patients with established CAD according to the degree of BP control actually achieved. The primary endpoint was a composite of death, MI or stroke. 'The authors conclude that aiming for a systolic BP lower than 130mmHg has no advantages over usual care and indeed could be harmful over the long term in this patient population. Although this was essentially a subgroup analysis the findings are in keeping with other trials such as ACCORD and should prompt us to exercise caution in lowering BP too aggressively in diabetes patients with CAD.'

Does coffee lower risk factors for type 2 diabetes?

14 Apr 2010Registered users

Drinking coffee appears to lower markers for subclinical inflammation and raise HDL cholesterol levels but does not affect glucose metabolism, a small study has found. The study included 47 habitual coffee drinkers who stopped drinking coffee for one month. The following month, they drank four cups of filtered coffee per day, followed by eight cups of filtered coffee daily in the third month. The participants were otherwise in good health, less than 65 years of age but had an increased risk of diabetes based on a diabetes risk score. The results showed that after two months drinking coffee there were significant decreases in markers of subclinical inflammation, including interleukin-18 and adiponectin, but no increases in levels of C-reactive protein. Total cholesterol levels increased by 12% after the second month of drinking coffee, but there was also a 7% increase in HDL-cholesterol levels.

Diabetes trebles risk of dementia in patients with mild cognitive impairment

15 Feb 2010Registered users

Patients with diabetes have a three-fold increased risk of progression from mild cognitive impairment to dementia, a primary care study has shown. The longitudinal cohort study recruited 103 participants aged 65 years or above, from practices in South London, who had mild cognitive impairment. Patients were reassessed four years later. Mild cognitive impairment is a term used to describe people with memory impairment on formal testing who are otherwise functioning well and do not meet clinical criteria for dementia. 'This study provides further evidence that diabetes is associated with faster cognitive decline but at the same time offers the hope that, for this group of patients, we may be able to prevent or slow progression of their condition by more rigorous control of their diabetes. Unfortunately, however, no methodologically sound randomised controlled trials have yet been carried out to investigate this possibility.'

Diabetes a strong predictor of IHD in women

21 May 2008Registered users

IHD affects men at a younger age, and in greater numbers, than women. However, the HUNT 1 study has suggested that diabetes is a more powerful predictor of IHD mortality in women than men.