Individualizing Targets and Tactics for High-Risk Patients With Type 2 Diabetes

Practical lessons from ACCORD and other cardiovascular trials

Diabetes Care: October 2012

Four years ago, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was stopped early as the result of increased mortality associated with intensive glycemic treatment of a population with type 2 diabetes (T2DM) and high cardiovascular (CV) risk (1). Further reports have appeared from ACCORD (2) and other studies of high-risk populations, notably the Action in Diabetes and Vascular Disease: Preterax and Diamacron MR Controlled Evaluation (ADVANCE) (3) and the Veterans Affairs Diabetes Trial (VADT) (4). These studies provide a body of evidence that intensive treatment of hyperglycemia in T2DM does not in all cases lead to an acceptable balance of benefits to risks. Although important questions remain, both the main findings and secondary and epidemiological analyses from these studies suggest possible changes of our therapeutic approach.  Read More

The Effects of Free-Living Interval-Walking Training on Glycemic Control, Body Composition, and Physical Fitness in Type 2 Diabetes Patients

A randomized, controlled trial

Slowly and rapidly digestible starchy foods can elicit a similar glycemic response because of differential tissue glucose uptake in healthy men

American Society for Nutrition: 9/18/12

Previously we observed that the consumption of pasta and bread resulted in a similar glycemic response, despite a slower intestinal influx rate of glucose from the pasta. Underlying mechanisms of this effect were not clear.

Objective: The objective was to investigate the differences in glucose kinetics and hormonal response after consumption of products with slow and rapid in vivo starch digestibility but with a similar glycemic response.

Design: Ten healthy male volunteers participated in a crossover study and consumed ¹³C-enriched wheat bread or pasta while receiving a primed-continuous D-[6,6-²H₂]glucose infusion. The dual-isotope technique enabled calculation of the following glucose kinetics: rate of appearance of exogenous glucose (RaE), endogenous glucose production, and glucose clearance rate (GCR). Read more

A Randomized Trial of Two Weight-Based Doses of Insulin Glargine and Glulisine in Hospitalized Subjects With Type 2 Diabetes and Renal Insufficiency

Impact of a randomized control group on perceived effectiveness of a Disease Management Programme for diabetes type 2

Oxford Journals: 10/11/11

Disease Management Programmes (DMPs) are proposed to enhance the quality of care, to improve health outcomes and to reduce costs. Yet, the evidence regarding the effectiveness of such structured approaches remains uncertain. Randomized controlled trials (RCTs) represent the gold standard of evaluation for complex interventions. However, most of the evidence derives from non-randomized or even uncontrolled trials. We therefore tried to assess the impact of a randomized control group on the interpretation of DMP effectiveness. Methods: We analyzed the data of a RCT on a DMP for diabetes type 2 by creating two scenarios. The first solely includes data of the intervention group (n = 649), representing an ‘uncontrolled pre-test–post-test analysis’. The second comprehends all data (n = 1489) of the ‘randomized controlled analysis’. HbA1c was used as the primary outcome measure for metabolic control in diabetes. Depending on either scenario, we calculated relative and absolute risk reduction regarding clinically relevant endpoints and estimated costs by extrapolating our results according to the UK Prospective Diabetes Study (UKPDS) findings. Read More

Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults

American Medical Association: September 19, 2012

The risk of type 2 diabetes mellitus is heterogeneous among obese individuals. Factors that discriminate prediabetes or diabetes risk within this population have not been well characterized. A dysfunctional adiposity phenotype, characterized by excess visceral fat and insulin resistance, may contribute to diabetes development in those with obesity.

Objective  To investigate associations between adiposity phenotypes and risk for incident prediabetes and diabetes in a multiethnic, population-based cohort of obese adults.

Design, Setting, and Participants  Among 732 obese participants (body mass index ≥30) aged 30 to 65 years without diabetes or cardiovascular disease enrolled between 2000 and 2002 in the Dallas Heart Study, we measured body composition by dual energy x-ray absorptiometry and magnetic resonance imaging (MRI); circulating adipokines and biomarkers of insulin resistance, dyslipidemia, and inflammation; and subclinical atherosclerosis and cardiac structure and function by computed tomography and MRI. Read more

Cognitive Mapping in Persons Newly Diagnosed With Type 2 Diabetes