Personalized Management of Hyperglycemia in Type 2 Diabetes Reflections from a Diabetes Care Editors’ Expert Forum

Diabetes Care June 1, 2013

In June 2012, 13 thought leaders convened in a Diabetes Care Editors’ Expert Forum to discuss the concept of personalized medicine in the wake of a recently published American Diabetes Association/European Association for the Study of Diabetes position statement calling for a patient-centered approach to hyperglycemia management in type 2 diabetes. This article, an outgrowth of that forum, offers a clinical translation of the underlying issues that need to be considered for effectively personalizing diabetes care.  Read more

Screening Tests for Gestational Diabetes: A Systematic Review for the U.S. Preventive Services Task Force

Ann Intern Medicine: May 28, 2013

Background: A 50-g oral glucose challenge test (OGCT) is a widely accepted screening test for gestational diabetes mellitus (GDM), but other options are being considered.

Purpose: To systematically review the test characteristics of various screening methods for GDM across a range of recommended diagnostic glucose thresholds.

Data Sources: 15 electronic databases from 1995 to May 2012, reference lists, Web sites of relevant organizations, and gray literature.

Study Selection: Two reviewers independently identified English-language prospective studies that compared any screening test for GDM with any reference standard.

Data Extraction: One reviewer extracted and a second reviewer verified data from 51 cohort studies. Two reviewers independently assessed methodological quality.  Read more

Benefits and Harms of Treating Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research

Ann Intern Medicine: May 28, 2013

Background: Outcomes of treating gestational diabetes mellitus (GDM) are not well-established.

Purpose: To summarize evidence about the maternal and neonatal benefits and harms of treating GDM.

Data Sources: 15 electronic databases from 1995 to May 2012, gray literature, Web sites of relevant organizations, trial registries, and reference lists.

Study Selection: English-language randomized, controlled trials (n = 5) and cohort studies (n = 6) of women without known preexisting diabetes.

Data Extraction: One reviewer extracted data, and a second reviewer verified them. Two reviewers independently assessed methodological quality and evaluated strength of evidence for primary outcomes by using a Grading of Recommendations Assessment, Development and Evaluation approach.  Read more

Texas’ Struggling Rio Grande Valley Presses for Medicaid Expansion

KHN: May 21, 2013

BROWNSVILLE, Tex. –When the sun rises over the Rio Grande Valley, the cries of theurracas – black birds – perched on the tops of palm trees swell to an unavoidable cacophony.

That is also the strategy, it could be said, that local officials, health care providers and frustrated Valley residents are trying to use to convince Gov. Rick Perry and state Republican lawmakers to set aside their opposition and expand Medicaid, a key provision of the federal health law.

To the struggling counties that stretch along the border with Mexico, where unemployment hovers above 10 percent and the local tax base often cannot fund basic government services, the roll-out of President Barack Obama’s health care overhaul and its promise to open up Medicaid to all low-income adults is akin to eyeing a winning lottery ticket. In Cameron County, for example, where Brownsville is the county seat, it will mean $7 billion added to the local economy over a decade. In neighboring Hidalgo County where some 800,000 people live, the windfall is even more impressive: some $12.6 billion, according to an analysis by Ray Perryman, a Texas economist well-regarded by both political parties.  Read more

Accuracy of Blood Glucose Meters Draws Scrutiny

KHN: May 21, 2013

Blood glucose meters, which millions of diabetics rely upon to regulate their blood sugar, have become less costly and easier and less painful to use.

But they haven’t become more accurate, a top Food and Drug Administration official said Tuesday at a meeting of researchers analyzing studies that show wide variation in the performance of the machines used to measure blood glucose levels.

Katherine Serrano, diabetes branch chief in the FDA division of chemistry and toxicology devices, said the federal government is aware of accuracy problems with meters on the market. But she said the FDA is limited in its response because some manufacturers are in Asia, and the agency must rely on the manufacturers’ own studies related to accuracy.  Read more

Ethnic Differences in the Relationship Between Insulin Sensitivity and Insulin Response

Diabetes Care June 1, 2013

OBJECTIVE Human blood glucose levels have likely evolved toward their current point of stability over hundreds of thousands of years. The robust population stability of this trait is called canalization. It has been represented by a hyperbolic function of two variables: insulin sensitivity and insulin response. Environmental changes due to global migration may have pushed some human subpopulations to different points of stability. We hypothesized that there may be ethnic differences in the optimal states in the relationship between insulin sensitivity and insulin response.  Read more

Diabetes’ Genetic Underpinnings Can Vary Based On Ethnic Background

Red Orbit: May 24, 2013

Ethnic background plays a surprisingly large role in how diabetes develops on a cellular level, according to two new studies led by researchers at the Stanford University School of Medicine.

The researchers reanalyzed disease data to demonstrate that the physiological pathways to diabetes vary between Africa and East Asia and that those differences are reflected in part by genetic differences. The studies will be published online simultaneously May 23 in the journals PLoS Genetics and Diabetes Care.

“We have new insights into the differences in diabetes across the world, just by this new perspective applied to older studies,” said Atul Butte, MD, PhD, senior author of the studies and chief of the Division of Systems Medicine and associate professor of pediatrics and of genetics. “There’s more still to learn about diabetes than we knew.”

The early stages of type-2 diabetes, or adult-onset diabetes, can develop when the pancreas has problems creating sufficient insulin, a hormone critical for regulating blood sugar, or when the body’s cells have trouble responding to insulin, a condition called “insulin resistance.” Both problems will lead to the same result: too much sugar in a person’s blood stream, which is the main criterion for diagnosing diabetes. Diabetics develop both low insulin secretion and insulin resistance as the disease progresses.  Read more