New research was presented at the American Diabetes Association’s 72nd Scientific Sessions from June 8-12, 2012 in Philadelphia. The features below highlight just some of the studies that emerged from the conference
Heart & Cancer Risks With Insulin
The Particulars: Previous research suggests that there may be an association between insulin use and an increased risk of myocardial infarction, stroke, and several types of cancer. However, the long-term impacts of insulin on serious cardiovascular outcomes and cancers in patients at high risk for type 2 diabetes have not been examined.
Data Breakdown: A study randomized people at high risk for type 2 diabetes or in the early stages of it to daily insulin glargine injections or no insulin for an average of 6.2 years. No differences in cardiovascular outcomes or the development of any cancer type were observed in the two groups. Patients who received insulin maintained normal glucose levels (90 to 94 mg/dL) throughout the study.
Take Home Pearl: Long-term use of insulin glargine in patients at high risk for type 2 diabetes or in the early stages of the disease does not appear to put them at greater risk of developing cardiovascular conditions or cancer.
Type 1 & 2 Diabetes Prevalence Increasing in the Young
The Particulars: For years, the prevalence of type 1 and type 2 diabetes has been increasing in younger people worldwide. Few data, however, have explored trends in both type 1 and type 2 disease in the United States among younger individuals.
Data Breakdown: An analysis from the CDC and NIH found that the prevalence of type 2 diabetes increased 21%, and the prevalence of type 1 diabetes increased 23% between 2001 and 2009 in young Americans. There were nearly 189,000 Americans under the age of 20 with diabetes, of whom 168,000 had type 1 and more than 19,000 had type 2. Researchers also found measureable signs of peripheral neuropathy among children and adolescents with diabetes. Younger patients with type 2 diabetes were more likely to have protein in the urine than youths with type 1 disease. Youths with type 1 and type 2 diabetes also exhibited early indications of cardiovascular autonomic neuropathy.
Take Home Pearls: During the past decade, the prevalence of both type 1 and type 2 diabetes appears to have grown substantially among young Americans. Greater efforts are needed to ensure that young people with diabetes are getting more exercise, making healthier food choices, and maintaining healthier weights.
A Comprehensive View of Type 1 Diabetes in the U.S.
The Particulars: The care of type 1 diabetes has advanced dramatically in recent years. However, a comprehensive review of data about patients living with and managing type 1 diabetes has not been completed. Clinical outcomes data are also needed.
Data Breakdown: Five analyses were conducted in more than 25,000 people with type 1 diabetes of all ages from 67 clinics throughout the United States. The majority of U.S. adults with type 1 diabetes was overweight or obese and had an A1C averaging from 7.5% to 8.0%. Average A1C levels were 8.3% for those younger than 12 and 8.7% for those aged 13 to 17. Although those aged 50 or older had the lowest average A1C levels of all age groups (7.6%), this patient population had a high percentage of severe hypoglycemia. Among those aged 40 or older, 20% to 30% had diabetes-related complications.
Take Home Pearls: Most people with type 1 diabetes do not appear to be meeting treatment targets for their disease. Most are overweight or obese as adults and experience difficulty reaching target A1C levels as youth.
Old Drug Turns New Tricks for A1C
The Particulars: Salicylate is a well-studied anti-inflammatory agent that has been used since ancient Egyptian and Greek times to treat pain. However, little research has been done on other properties of the drug.
Data Breakdown: A year-long trial compared salicylate to placebo in patients with type 2 diabetes. Investigators found that salicylate reduced A1C levels by 0.24% and fasting blood glucose levels by 11 mg/dl. Among those who were also taking statins, the drug lowered glucose levels even further. Patients who took salicylate had an average weight gain of 2.2 lbs and slightly elevated cholesterol, but triglyceride levels decreased when compared with the placebo group.
Take Home Pearl: Salicylate appears to have glucose-lowering properties and may be a potentially safe treatment for patients with type 2 diabetes.
Managing Type 2 Diabetes in Children
The Particulars: Studies suggest that children with type 2 diabetes should be managed differently than adults with the disease. The efficacy and safety of diabetes medications for young people have not been well established. Data are needed to establish which children are more likely to be able to manage their diabetes.
Data Breakdown: A study of nearly 700 patients aged 10 to 17 with type 2 diabetes followed participants for 48 months. Rates of high blood pressure increased from 12% to nearly 33% during the study period. Rates of elevated urinary albumin rose from 6% to nearly 17%. Approximately 13% of participants showed signs of eye disease. Those with A1C levels in the normal range after 2 to 4 months of taking metformin were more likely to maintain A1C control throughout the study when compared with those who had A1C levels greater than 6.1%.
Take Home Pearls: Comorbidities appear to manifest within a relatively short time in younger patients with type 2 diabetes. Metformin therapy appears to be effective for about half of younger patients with the disease. Future research should focus on the ideal treatment options for younger patients.
