Endocrinology News
'Glycaemic variability': a new therapeutic challenge in diabetes and the critical care setting
Much attention has been paid recently to the possibility that oscillating glucose may superimpose on glycated haemoglobin (HbA1c) in determining the risk for diabetes complications. Furthermore, recent evidence suggests that glucose variability, particularly if accompanied by frequent hypoglycaemic episodes, may adversely alter the prognosis of acutely ill patients. In vitro and animal studies confirm that oscillating glucose is more dangerous than stable constant high glucose, particularly in activating the pathways involved in the pathogenesis of diabetes complications. The production of free radicals, accompanied by an insufficient increase in intracellular antioxidant defences, seems to account for this phenomenon. In humans, studies also confirm that fluctuating glucose levels produce an increase in free radicals as well as endothelial dysfunction, and that these changes are greater than those produced by stable high glucose. Avoiding glucose fluctuations in diabetic patients and in crtically ill patients seems to be an emerging therapeutic challenge.
No pancreatitis risk seen in Byetta, Januvia drugs
Two widely used diabetes medicines, Januvia and Byetta, pose no additional risk for cases of inflamed pancreas compared with other diabetes drugs, according to an analysis of medical claims data released on Sunday. The study also found that diabetics generally are at increased risk of acute pancreatitis, compared with non-diabetics, which the study's author said confirmed previous research, although the risk remains very low.
Increased mortality and morbidity in mild primary hyperparathyroid patients
This study attempted to describe the mortality and disease-specific morbidities in patients with mild primary hyperparathyroidism (PHPT). In total, there were 1683 (69·1% female) patients identified with mild PHPT. Patients were found to have an increased risk of all-cause mortality and cardiovascular mortality. Patients with mild PHPT had a significantly increased risk of developing cardiovascular and cerebrovascular disease, renal dysfunction and fractures.
Hemoglobin A1C Levels Show Limitations
A previous study of participants with prediabetes found that hemoglobin A1c (HbA1c) levels differed between black and white participants with no differences in glucose concentration. This study evaluated whether black–white differences in HbA1c level are present in other populations and across the full spectrum of glycemia. It found that Black persons have higher HbA1c levels than white persons across the full spectrum of glycemia, and the differences increase as glucose intolerance worsens. These findings could limit the use of HbA1c to screen for glucose intolerance, indicate the risk for complications, measure quality of care, and evaluate disparities in health.
Long Term Diabetes Drug (Metformin) Linked To Gradually Worsening Vitamin B-12 Deficiency
Individuals with diabetes type 2 who are treated for long periods with metformin are at risk of developing gradually worsening vitamin B-12 deficiency - in other words, the vitamin deficiency grows with time, according to new research published today in the British Medical Journal (BMJ). Individuals who had been given metformin were found to have a 19% reduction in their vitamin B-12 levels, compared with those in the placebo group, who had virtually no change in their levels during the study.
Moreover, the drop in levels of vitamin B-12 by metformin was not temporary, but continued, and got worse over time.
Improved Glycemic Control with Insulin Glargine Vs Pioglitazone as ADD-ON Therapy to Sulfonylurea or Metformin in Patients with Uncontrolled Type 2 Diabetes
An article in Endocrine Practice compared glycemic control with add-on insulin glargine vs pioglitazone. Overall insulin glargine significantly reduced A1C compared with pioglitazone, yielded significantly greater Fasting Plasma Glucose reductions and resulted in a lower overall incidence of possibly related treatment emergent Adverse Effectss and fewer discontinuations , but a higher rate of confirmed clinically relevant hypoglycemia. Suggesting that adding insulin glargine early in the diabetes treatment paradigm in patients failing sulfonylurea or metformin monotherapy resulted in significant improvements in glycemic control compared with adding pioglitazone.
Low serum 25-hydroxyvitamin D levels are associated with increased all-cause mortality risk in a general population: the Tromsø study
Ecologic and observational studies have suggested an association between serum 25-hydroxyvitamin D (25(OH)D) levels and cardiovascular disease (CVD) risk factors, CVD mortality, and cancer mortality. Based on this, low serum 25(OH)D levels should be associated with higher all-cause mortality in a general population. This hypothesis was tested in the present study. The Tromsø study is a longitudinal population-based multipurpose study initiated in 1974 with focus on lifestyle-related diseases. During a mean 11.7 years of follow-up, 1359 (19.0%) participants died. Overall the study showed that low serum 25(OH)D levels were associated with increased all-cause mortality for non-smokers, but the results did not reach statistical significance for smokers. However, low 25(OH)D levels are known to be associated with impaired general health, and randomized controlled studies are needed to address the question of causality.
Long-Term Use of Bisphosphonates in Osteoporosis
Bisphosphonates have been widely used in the treatment of osteoporosis. Uncommon side effects have emerged in postapproval use. Because they accumulate in bone and provide some residual antifracture reduction when treatment is stopped, we recommend a drug holiday after 5–10 yr of bisphosphonate treatment. The duration of treatment and length of the holiday are based on fracture risk and pharmacokinetics of the bisphosphonate used. Patients at mild risk might stop treatment after 5 yr and remain off as long as bone mineral density is stable and no fractures occur. Higher risk patients should be treated for 10 yr, have a holiday of no more than a year or two, and perhaps be on a nonbisphosphonate treatment during that time.
'Diabetic effect' in dolphins offers new hope for type 2 diabetes cure
Dolphins are the only animals apart from humans to develop a natural form of type 2 diabetes, according to new research. The discovery offers important insights into a disease that is linked to one in 20 deaths. American scientists have discovered that bottlenosed dolphins show a form of insulin resistance very similar to that seen in human diabetes. Unlike patients with the condition, the marine mammals can turn this state on and off when appropriate, so it is not normally harmful.
FDA reports says Avandia can hurt heart: report
Confidential U.S. government reports recommend that GlaxoSmithKline Plc's diabetes drug Avandia be pulled from the market because it can hurt the heart, The New York Times reported on Friday.The newspaper said the findings, which it said it obtained, reported that if all diabetics now taking Avandia were given Takeda's Actos drug instead, about 500 heart attacks and 300 cases of heart failure would be averted each month because Avandia, also known as rosiglitazone, can be harmful to the heart.
Insulin pumps may be better than shots
Pumps that deliver insulin to the body as needed may be more effective than insulin injections for helping people with type 1 diabetes keep their blood sugar under control, according to a new review of 23 studies comparing the two approaches.
New Guidelines Urge A1C Test for Diabetes Diagnosis
In its latest set of clinical guidelines, the American Diabetes Association is promoting a more prominent role for the hemoglobin A1C blood test in the diagnosis of type 2 diabetes and prediabetes. Long used in the management of diabetes, the A1C blood test measures average blood sugar levels for the previous two to three months. The new guidelines call for the diagnosis of type 2 diabetes at A1C levels above 6.5 percent, and prediabetes if the A1C levels are between 5.7 and 6.4 percent.
Subclinical Hypothyroidism and Functional Mobility in Older Adults
Archives of Internal Medicine
Health risks associated with subclinical hypothyroidism in older adults are unclear. Our objective was to compare the functional mobility of people aged 70 to 79 years by thyroid function categorized by thyrotropin (TSH) level as euthyroid (0.4 to <4.5 mIU/L), mild subclinical hypothyroid (4.5 to <7.0 mIU/L), or moderate subclinical hypothyroid (7.0 to 20.0 mIU/L with a normal free thyroxine level) cross-sectionally and over 2 years. Generally, well-functioning 70- to 79-year-old individuals with subclinical hypothyroidism do not demonstrate increased risk of mobility problems, and those with mild elevations in TSH level show a slight functional advantage.
Fast Eating Limits Gut Hormones That Induce Fullness
Eating too fast can lead to overeating because gulping down food limits the release of hormones in the gut that trigger the feeling of being full, Greek researchers have found. For the study, volunteers ate 300 milliliters of ice cream at different rates. Blood levels of glucose, insulin, lipids and gut hormones were measured before and after consumption of the ice cream. Participants who took 30 minutes to finish the ice cream had higher concentrations of the gut hormones peptide YY and glucagon-like peptide and also tended to feel more full than those who took less time to eat the ice cream.
