The American Diabetes Association held its 2010 Annual Scientific Sessions from June 25 to 29 in Orlando. The features below highlight some of the news emerging from the meeting.
» Investigational Drug Effective as Metformin Add-On
» Minor Kidney Damage in Type 1 Diabetes Increases Mortality
» The Impact of Exercise Alone on Diabetes Risk
» Omega-3 Fatty Acids, Women, & Type 1 Diabetes
» Diabetes A Common Cause of Vascular Death
Investigational Drug Effective as Metformin Add-On [back to top]
The Particulars: Dapagliflozin is an investigational selective sodium-glucose cotransporter-2 inhibitor. Dapagliflozin is thought to reduce renal glucose reabsorption so that excess blood glucose is instead excreted into the urine. The mechanism of action is independent of insulin. A phase III trial was conducted in metformin patients who had not achieved adequate glucose control.
Data Breakdown: All patients were randomized to placebo or one of three doses of dapagliflozin (2.5 mg, 5.0 mg, or 10.0 mg), and patients also continued taking metformin. Mean glycosylated hemoglobin decreased significantly for patients on any of the three doses of dapagliflozin when compared with those on placebo. At 24 weeks, more patients in the dapagliflozin groups achieved a therapeutic response, which was defined as A1C levels of less than 7% (33% to 40.6% in dapagliflozin groups vs 25.9% in controls). Decreases in fasting plasma glucose concentration and weight loss were also significantly greater in the dapagliflozin groups when compared with placebo.
Take Home Pearls: Adding dapagliflozin to metformin may improve glycemic control in patients with diabetes who are not responsive to metformin monotherapy. The addition of dapagliflozin to metformin may provide a new therapeutic option for type 2 diabetes
Minor Kidney Damage in Type 1 Diabetes Increases Mortality [back to top]
The Particulars: Early stages of kidney disease in type 1 diabetes may be important because they may increase risk of death. Researchers conducted a long-term prospective analysis of childhood-onset type 1 diabetes in 658 men and women.
Data Breakdown: Investigators tested study participants for microalbuminuria. After 20 years of follow-up, 23% of the participants with microalbuminuria had died, representing a rate that was 6.2 times higher than age- and sex-matched people in the general population. When participants who developed kidney damage after initial protein testing were excluded, mortality rates for those with normal kidneys were no different than in the general population.
Take Home Pearls: People with type 1 diabetes who have early and asymptomatic kidney damage appear to be significantly more likely to die when compared with the general population. When kidneys remain normal over time, people with type 1 diabetes appear to have no greater risk of death than their healthy counterparts.
The Impact of Exercise Alone on Diabetes Risk [back to top]
The Particulars: Little research has examined the effects of regular exercise without diet on total body fat, abdominal fat, and insulin resistance. Investigators designed a randomized study of 26 obese boys, ranging in age from 12 to 18. All subjects had a BMI in the 95th percentile or higher.
Data Breakdown: Participants were randomly assigned to one of three groups for the 3-month study: 1) aerobic exercise for 180 minutes/week, 2) resistance exercise for 180 minutes/week, or 3) no exercise. None of the participants were on calorie-restricted diets. When compared with the no exercise group, exercisers had significant gains in cardiorespiratory fitness after 3 months. Total body fat declined by 9.6% among the aerobic exercisers and by 4.7% among resistance exercisers. Visceral adipose tissue concentrations dropped by 12.6% and 13.3%, respectively, for aerobic exercisers and resistance exercisers.
Take Home Pearls: Obese boys who engaged in regular aerobic or resistance exercise without dietary changes appear to have significant improvements over 3 months in their total body fat, visceral adipose tissue concentrations, and insulin sensitivity than their less active counterparts. A moderate increase in activity (180 minutes per week) may help prevent type 2 diabetes in this high-risk population.
Omega-3 Fatty Acids, Women, & Type 1 Diabetes [back to top]
The Particulars: Omega-3 fatty acids have been shown to promote heart health by preventing buildup of arterial cholesterol. Little is known about the effect of consuming omega-3 in people with type 1 diabetes who are at much greater risk for heart disease. A prospective study analyzed 601 men and women diagnosed with type 1 diabetes to assess the impact of omega-3 consumption.
Data Breakdown:Since 1986, 27.6% of the study participants were diagnosed with cardiovascular disease. Omega-3 intake among participants was generally low in the analysis. The incidence of heart disease was lowest in men who consumed the highest quantities of omega-3 (more than 0.2 grams per day). Women who consumed similar amounts of omega-3, however, did not have lower rates of heart disease.
Take Home Pearls: Consuming higher amounts of omega-3 fatty acids does not appear to lower heart disease risk for women with type 1 diabetes. Although omega-3 is typically associated with decreased risk for cardiovascular disease, this may not be the case for women who have type 1 diabetes.
Diabetes A Common Cause of Vascular Death [back to top]
The Particulars: There have been uncertainties about the magnitude of associations between heart disease risk and stroke, and diabetes and fasting glucose concentration. The burden of vascular deaths in diabetes has not been well characterized. Researchers conducted a meta-analysis of individual risk factors in patients without vascular disease from studies in the Emerging Risk Factors Collaboration.
Data Breakdown: The meta-analysis included 698,782 patients in 102 prospective studies. Patients with diabetes had around a twofold increased risk of heart disease, ischemic stroke, and other vascular deaths. Risk was about one-third higher for fatal than nonfatal myocardial infarction. Risk of heart disease among diabetics was higher in women than in men, in patients aged 40 to 59 than those aged 70 and older, in nonsmokers than in smokers, and in those with below-average systolic blood pressure. Risk of stroke was higher in women, the same younger age group (40 to 59), and in those with above average BMI. Risks were substantially higher among those with glucose concentrations of 7 mmol/L or higher.
Take Home Pearl: In a meta-analysis of more than 100 studies, diabetes appears to be accountable for 11% of vascular deaths.
Readings & Resources (click to view)
For more information on the news emerging from the American Diabetes Association 2010 Annual Scientific Sessions, as well as further data on the studies presented in this feature story, go to http://professional.diabetes.org/Congress_Display.aspx?TYP=9&CID=71390.