Association Between Intensification of Metformin Treatment With Insulin vs Sulfonylureas and Cardiovascular Events and All-Cause Mortality Among Patients With Diabetes

JAMA: June 11, 2014

Importance  Preferred second-line medication for diabetes treatment after metformin failure remains uncertain.

Objective  To compare time to acute myocardial infarction (AMI), stroke, or death in a cohort of metformin initiators who added insulin or a sulfonylurea.

Design, Setting, and Participants  Retrospective cohort constructed with national Veterans Health Administration, Medicare, and National Death Index databases. The study population comprised veterans initially treated with metformin from 2001 through 2008 who subsequently added either insulin or sulfonylurea. Propensity score matching on characteristics was performed, matching each participant who added insulin to 5 who added a sulfonylurea. Patients were followed through September 2011 for primary analyses or September 2009 for cause-of-death analyses. Read More

Insulin Therapy for Type 2 Diabetes Mellitus

JAMA: June 11, 2014

Importance  The incidence and prevalence of type 2 diabetes mellitus are increasing.

Objective  To review currently available insulin therapy, as well as evidence on the use, application, initiation, and intensification of insulin in the outpatient setting.

Evidence Review  Data sources included PubMed for trials and investigations in type 2 diabetes examining insulin use from January 1998 to April 2014.

Findings  The hemoglobin A1c target for most patients with type 2 diabetes is 7% but needs to be modified when there is increased risk of hypoglycemia, reduced life expectancy, extensive comorbidities, or reduced resources. Insulin therapy may be considered early or late in the disease course; adverse effects include weight gain and hypoglycemia. Basal insulin can be added to oral hypoglycemic agents (generally stopping sulfonylureas) initially, and later, prandial insulin can be added in a stepwise fashion. Insulin treatment must be individualized, and there are a number of challenges to insulin initiation and intensification. Read More

More than 29 million Americans have diabetes; 1 in 4 doesn’t know

CDC: Tuesday, June 10, 2014

Prevention efforts crucial to combat serious health risks

More than 29 million people in the United States have diabetes, up from the previous estimate of 26 million in 2010, according to a report released today by the Centers for Disease Control and Prevention.  One in four people with diabetes doesn’t know he or she has it.

Another 86 million adults – more than one in three U.S. adults – have prediabetes, where their blood sugar levels are higher than normal but not high enough to be classified as type 2 diabetes.  Without weight loss and moderate physical activity, 15 percent to 30 percent of people with prediabetes will develop type 2 diabetes within five years.  Read More

Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary events

Springer: May 2014

Aims/hypothesis

A previous pooled analysis suggested that women with diabetes are at substantially increased risk of fatal CHD compared with affected men. Additional findings from several larger and more contemporary studies have since been published on the sex-specific associations between diabetes and incident CHD. We performed an updated systematic review with meta-analysis to provide the most reliable evidence of any sex difference in the effect of diabetes on subsequent risk of CHD.

Methods

PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between 1 January 1966 and 13 February 2013. Eligible studies had to have reported sex-specific RR estimates for incident CHD associated with diabetes and its associated variability that had been adjusted at least for age. Random-effects meta-analyses with inverse variance weighting were used to obtain sex-specific RRs and the RR ratio (RRR) (women:men) for incident CHD associated with diabetes. Read more

South Texas Receives Funding for Diabetes Prevention

Bionews: May 14, 2014

The Texas A&M Health Science Center Coastal Bend Health Education Center (CBHEC) and the Corpus Christi-Nueces County Public Health District (CCNCPHD) will receive $840,000 in funding for diabetes education and prevention. The funds come from the national health department and are part of recent healthcare initiatives to target the disease. Texas, home to one of the largest state populations in the U.S., is disproportionately affected by diabetes.

“It is a great problem in America. One in 12 persons has diabetes, one in four has pre-diabetes. Here in coastal bend, research tells us that by 2020, one in six persons will have diabetes,” explained Maggie Scheerer, from Texas A&M Health Science Center. Read more

New Diabetes Nutrition Therapy Recommendations: What You Need to Know

Diabetes Spectrum May 2014

The American Diabetes Association (ADA) has long recognized the integral role of nutrition therapy in overall diabetes management and recommends that each person with diabetes receive an individualized eating plan that has been developed in collaboration with his or her health care provider (HCP).1 To ensure that members of the health care team are providing up-to-date, evidence-based clinical practice recommendations, the ADA issues official position statements on scientific or medical issues related to diabetes. Recently, the ADA published a position statement titled “Nutrition Therapy Recommendations for the Management of Adults With Diabetes.”2 These recommendations replace those in previous position statements. This article reviews the development process for the 2013 nutrition recommendations, shares highlights from those guidelines, and discusses priority topics in the publication. Read More

Association of a Low-Frequency Variant in HNF1A With Type 2 Diabetes in a Latino Population

JAMA: June 11, 2014

Importance  Latino populations have one of the highest prevalences of type 2 diabetes worldwide.

Objectives  To investigate the association between rare protein-coding genetic variants and prevalence of type 2 diabetes in a large Latino population and to explore potential molecular and physiological mechanisms for the observed relationships.

Design, Setting, and Participants  Whole-exome sequencing was performed on DNA samples from 3756 Mexican and US Latino individuals (1794 with type 2 diabetes and 1962 without diabetes) recruited from 1993 to 2013. One variant was further tested for allele frequency and association with type 2 diabetes in large multiethnic data sets of 14 276 participants and characterized in experimental assays.

Main Outcome and Measures  Prevalence of type 2 diabetes. Secondary outcomes included age of onset, body mass index, and effect on protein function. Read More