Testing It Up

Pharmaceutical companies are slowly closing in on the treatment of Type 2 Diabetes with the FDA approval of Invokana (canagliflozin), a sugar-controlling tablet manufactured by Janssen.

According to Mary Parks M.D, chief of Division of Metabolism and Endocrinology Products under the Center for Drug Evaluation and Research of the FDA, Invokana is part of a family of drugs that inhibit subtype 2 sodium-glucose transport proteins (SGLT2), which are responsible for re-absorption of glucose in the kidney. The breakthrough drug also enhances the excretion of glucose, and regulates blood sugar levels of people with diabetes.

Clinical trials in Type 2 Diabetes patients showed remarkable improvement in hemoglobin A1c and blood sugar levels. The drug has been tested to be taken as-is or in conjunction with other more notable antidiabetic drugs such as metformin and insulin.

While trials showed success in treating Type 2 Diabetes, Invokana is not advisable for people with Type 1 Diabetes, high ketone levels in urine or blood, or extensive renal disease. Meanwhile, side effects identified after taking Invokana are urinary tract infection, yeast infection in the vagina, and increase in LDL cholesterol. Frequent urination may also be experienced, as well as sudden drop in blood pressure especially when in an upright position. Expect dizzy spells during the first few months of taking the drug.

Several studies are still being done to ensure safety of Invokana as an approved antidiabetic drug. Some of the studies include monitoring for malignancies, effects on cardiovascular health, potential issues on hypersensitivity, pregnancy-related issues, and effect on bone strength. Despite all these, Aaron Cypress M.D. of Joslin Diabetes Center says Invokana looks to be a promising alternative.

For those who are suffering from diabetes, the more common way of controlling the disease entails watching what they eat. A new research, however, indicates that structured exercise programs an also help improve blood sugar levels.

The research, which was published in the May 3rd issue of the Journal of the American Medical Association, involved an analysis of several previously-conducted studies. The researchers indicated that “exercise is a cornerstone of diabetes management, along with dietary and pharmacological interventions… current guidelines recommend that patients with type 2 diabetes should perform at least 150 minutes per week of moderate-intensity aerobic exercise and should perform resistance exercise three times per week.”

The study was conducted by scientists led by Daniel Umpierre, MSc, of the Hospital de Clinica de Porto Alegre in Brazil. The researchers analyzed various studies that looked into the effects of structured exercise programs, which last for at least 12 weeks, on reducing HbA1c. The study looked at data on 8,538 participants for various studies.

Structured exercise, the researchers determined, may be associated with a -0.67% decline in HbA1c levels when compared with participants in comparison groups.

Structured exercise programs that last more than 150 minutes each week could be associated with a 0.89% decline in HbA1c, when compared against those who work out for 150 minutes or less, which was associated with -0.36% reduction.

The researchers wrote: “Structured exercise, consisting of aerobic training, resistance training or a combination of aerobic and resistance exercise training for at least 12 weeks is associated with improved glycemic control in type 2 diabetic patients… Physical activity advice is beneficial only if associated with dietary recommendations.”

A study conducted by researchers led by Roman Hovorka, a principal research associate at the University of Cambridge in the United Kingdom, reported that they had been able to improve blood sugar control, as well as reduce the risk of having low blood sugars overnight, in type 1 diabetes patients. Their study is one of several that are looking into producing an effective artificial pancreas that may be used in the management of type 1 diabetes.

According to a feature on Bloomberg BusinessWeek, an artificial pancreas will utilize existing diabetes management technology, which consists of insulin pumps and continuous glucose monitors, with a computer algorithm that will tell the devices what needs to be done when blood sugar levels rise or fall.

The study observed 24 participants who are suffering from type 1 diabetes. An artificial pancreas prototype was put to the test in two real-life scenarios: one mimicked a night of eating at home, while the other mimicked a night of eating out, incorporating the possibility of drinking alcohol, which may potentially lower blood sugar levels.

The two groups of 12, representing each scenario, were further divided into two groups of six; one group was placed on the artificial pancreas program through the night, while the other group used the standard insulin pump therapy. After several weeks, participants came back for another meal, and swapped overnight regimens.

Hovorka shared: “For the eating-in scenario, overnight closed loop delivery increased the time plasma glucose levels were in target by a median 15 percent… For the eating out scenario, the average time good blood sugar control was increased was 28 percent on average.”

A 9-year-old girl from Reno, Nevada, is set to speak before Congress in June to urge lawmakers to work towards securing funding for diabetes research. Indeed, when it comes to being an advocate for something that you are passionate about, age is really just a number.

A feature on RGJ.com shared her story. Alli Christy was 4 years old when she was diagnosed with Type 1 diabetes. Her mother, Michelle, shared that her daughter had exhibited symptoms that included excessive thirst, urinating, and leg pains. The latter symptom was initially ruled by doctors as a condition unique only to Alli, who was suffering from a rare bone disorder.

Michelle Christy did not just blindly believe in what the doctors had to say, and did her own research; her findings eventually led to the proper diagnosis for her daughter.

Scott and Michelle Christy lost no time in raising their daughter and teaching her how to live with her disease. Michelle shared: “We have taught Alli as we’ve gone along as much as she could understand, and from a young age, she has learned things like how many carbohydrates are in what she eats.”

Now, at 9, Alli can test herself and knows when to ask for nutrition when she needs it; she can also change the device that gives her insulin with assistance.

Alli is one of 3 young people from Nevada, and 150 from across the country, who will speak before Congress. Her trip to Washington, D.C. is sponsored by the Juvenile Diabetes Research Foundation.

A feature on Time.com shared the results of a study that indicated that the drug pioglitazone, being sold as Actos, can be taken by people who are at risk of developing type 2 diabetes, in order to prevent the onset of the disease. Pioglitazone is a drug commonly used for diabetes treatment.

Experts warn, however, that this should not be taken to mean that anyone whose blood sugar levels are high should start taking the medication.

Diabetes starts from impaired insulin sensitivity. For quite some time, doctors have been searching for medications or lifestyle changes that can delay the onset of full-blown diabetes for as long as possible – or prevent its onset altogether.

A study led by Dr. Ralph DeFronzo, at the Texas  Diabetes Institute and University of Texas Health Science Center, determined that pioglitazone can be a useful tool to help patients control their blood sugar levels, and prevent the onset of full-blown diabetes.

Researchers found that among more than 600 patients who had elevated blood sugar levels and at least one other risk factor for diabetes, only 2% of those who took pioglitazone developed diabetes, as opposed to 7.6% in those who only took placebo. The study, which had a 2-year follow-up period, saw a 72% reduction in risk for those who took pioglitazone.

The study authors were quick to warn, however, that the encouraging results of the study should not be considered as a reason to prescribe the drug to anyone with a high risk of developing diabetes.

A study funded by manufacturer Novo Nordisk, and published in The Lancet, indicated that the drug degludec showed potential in reducing the frequency of insulin injections in type 1 diabetes patents.

The study documented the result of phase II trials of the drug, which consisted of the random assignment of receiving the drug metformin orally, in conjunction with any of the following regimens: degludec insulin once a day, degludec three times a week, or Lantus once a day for 16 weeks. Lantus (glargine), manufactured by Sanofi-Aventis, is the most widely used long-acting insulin. Study participants consisted of 245 adults with diabetes, or HbA1c levels between 7% and 11%.

The results of the study indicated that patients who were injected with degludec three times a week exhibited controlled blood sugar level as effective as daily injections of Lantus, and similar reductions in hemoglobin A1c (HbA1c) compared to daily injections of Lantus.

In addition, it was determined that the rates of hypoglycemia were at their lowest in patients who took degludec once a day, despite the fact that the rates were generally lower across all treatment groups.

Professor Bernard Zinman, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, gave the following comment: “Because of its ultra-long action profile, insulin degludec injected three times weekly appears to provide similar glucose control to insulin glargine once daily. This new basal insulin analogue might be a valuable addition to clinical practice…However the safety, efficacy, and optimum use of treatment regimens for insulin degludec will need to be established in larger phase 3 trials.”

Sunday, November 14, is World Diabetes Day. Starting in 2009 until 2013, the observance of World Diabetes Day will carry the same theme: Education and Prevention.

World Diabetes Day was jointly created by the World Health Organization and the International Diabetes Federation to address concerns over the rising threat of diabetes. The United Nations passed Resolution 61/225 in 2007, making World Diabetes Day an official United Nations day.

According to the Centers for Disease Control and Prevention, one in every 10 Americans suffers from diabetes. A feature on The New York Times cited CDC estimates, which projected that if current trends continue, that ratio will become one in every three Americans in the year 2050.

The theme of World Diabetes Day focuses on the importance of understanding diabetes as a way to manage the disease, as well as a means to avoid the disease altogether – or at least delay its onset. The campaign has three key messages: know about the warning signs and risks associated with diabetes; know how to respond to diabetes, and who to turn to; and know how to manage and take control of the disease.

The International Diabetes Federation and the World Health Organization would like to encourage governments to set up, boost, and implement policies towards the prevention and control of diabetes. It is also hoped that the observance of World Diabetes Day will raise awareness regarding, among other things, the warning signs of diabetes, in order to encourage early diagnosis of the disease.

All over the world there are various events that have been organized to mark World Diabetes Day. These include sports events such as charity Run/Walks, workshops, exhibitions, and free diabetes screening.

New York Health Screening

A report published in the journal Science Translational Medicine shared what is considered as a milestone in diabetes treatment.

A feature on Reuters shares information regarding an implantable device that can measure blood sugar continuously, and has the ability to transmit information wirelessly. The wireless sensor was tested in one pig for a year, and in another for ten months; the researchers reported that they did not experience any trouble with the device.

Lead researcher David Gough, professor of bioengineering at the University of California San Diego, shared: “You can run the device for a year or more with it constantly working, and recording glucose quite satisfactorily.” In a telephone interview, Gough shared further that they hope to start human trials in a few months; the device has been tested for 31 years in pigs, according to Gough.

The wireless sensor used in the pig trials measures about 1.5 inches in diameter and is 5/8 inches thick, but Gough said that they intend to make it even smaller in the future. It uses a sensor to detect oxygen in the tissue, where it is implanted to measure glucose. It has the ability to transmit 10 to 12 feet.

The research team said that the device will come in handy for diabetes patients who need to check their blood sugar on a daily basis, particularly patients who are suffering from type 2 diabetes. Eventually, Gough predicts that ways will be developed to enable the device to send its signals to cell phones.

For those who are still unfamiliar with diabetes as a disease – or those who were recently diagnosed with it and are still feeling their way around it – managing diabetes may feel like a gargantuan and time-consuming task. This does not need to be the case, as WebMD provides tips on diabetes management – in ten minutes or less.

One tip is to always keep a pair of slip-on shoes and socks by the door, to ensure that you are not tempted to go outside barefoot. House shoes or slippers should also be kept equally handy; the objective is to prevent the occurrence of injuries, which can have negative complications to a diabetes patient.

Next, take a few minutes after your daily shower to give your body a quick scan. Check for dry, red, or sore spots that can become infected. When going out, always have a baggie with glucose tablets or hard candy to ensure that you have something to pop in your mouth when you are suddenly stricken with hypoglycemia (low blood sugar).

If your doctor advises you to check you blood sugar the moment you wake up and right before you go to bed, then place your glucose monitor where you can easily notice it during these times. The most ideal place will be your nightstand, if you have one.

The American Diabetes Association has a list of ten super foods. Get hold of this list and post it on your fridge or anywhere else where you can see it when it’s time to do the grocery list or when you are in the mood for something to munch.

And of course, don’t forget to hydrate! High glucose levels cause the body to lose fluids, so it is important to drink water and other fluids.