Commentary on:
Libman IM, Miller KM, DiMeglio LA, et al., T1D Exchange Clinic Network Metformin RCT Study Group. Effect of metformin added to insulin on glycemic control among overweight/obese adolescents with type 1 diabetes: a randomized clinical trial. JAMA 2015;314:2241–50.
Context
Weight gain in individuals with type 1 diabetes (T1D) is associated with an increase in other cardiovascular risk factors (eg, hypertension, dyslipidaemia) and increasing insulin resistance, often requiring higher doses of insulin to maintain adequate glycaemic control. The goal of the current study was to explore the use of metformin to improve glycaemic control in overweight and obese adolescents with T1D. To read the full article, log in using your NHS OpenAthens details
The story is based on a study which aimed to see whether taking a 10-minute walk after a main meal resulted in lower blood glucose levels than a single 30-minute walk each day for people with type 2 diabetes.
The study, which involved 41 adults, found that taking shorter, more frequent walks immediately after meals reduced blood glucose by around 12% compared with a single 30-minute walk.
To explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated hemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
Background In our recently published study, including walnuts in the diets of adults with prediabetes led to overall improvement in diet quality. This report adds to those study findings by examining the food groups displaced during walnut inclusion in the diets of those adults with prediabetes.
Conclusions Our data suggest that walnut inclusion in the diets of adults at risk for diabetes led to an increase in intake of other healthful foods. Open Access Article
Remission of pre-diabetes to normal is an important health concern which has had little success in the past. This study objective was to determine the effect on remission of pre-diabetes with a high protein (HP) versus high carbohydrate (HC) diet and effects on metabolic parameters, lean and fat body mass in prediabetic, obese subjects after 6 months of dietary intervention. Open Access Article
Reducing carbohydrate, regardless of high or low GI, decreased GA and fructosamine. This suggests that reducing carbohydrate content, rather than GI, is a better strategy for lowering glycemia in adults at risk for diabetes. Open Access Article
Background: Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy.
The award is in recognition of the team’s efforts in perfecting an innovative Hypoglycaemia simulation training programme. The programme forms part of their work at the Royal Cornwall Hospital and could prove to be a lifesaver.
Objective: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM
Implications for practice and research
Large-scale acceptance of telemonitoring of patient self-administered tests (eg, glucose, blood pressure) will require attention to how additional workload will be integrated into the workflow of the clinic.
Additional research is required to fine tune telemonitoring interventions, including content, intervention dose, intervention length and appropriate targeting to subpopulations with chronic illness. To read the full article, log in using your NHS OpenAthens details
Microvascular complications (retinopathy, nephropathy, and neuropathy) affect hundreds of millions of patients with type 2 diabetes. They usually affect people with longstanding or uncontrolled disease, but they can also be present at diagnosis or in those yet to have a diagnosis made. The presentation and progression of these complications can lead to loss of visual, renal, and neurologic functions, impaired mobility and cognition, poor quality of life, limitations for employment and productivity, and increased costs for the patient and society. If left uncontrolled or untreated, they lead to irreversible damage and even death. This review focuses on the primary and secondary prevention of diabetic microvascular complications in patients with type 2 diabetes, beyond glycemic control. To read the full article, log in using your NHS OpenAthens details
Continuous glucose monitoring can improve glycaemic control in patients with type 1 diabetes who use insulin injections, two studies published in JAMA have found.12
This consists of a sensor under the skin with a transmitter attached that reports glucose levels continuously to the patient on a handheld monitor. Most patients whose continuous glucose monitoring has been compared with self monitored blood glucose have used insulin pumps, whereas the two new studies were carried out in patients with type 1 diabetes who injected insulin. To read the full article, log in using your NHS OpenAthens details
Policies to ‘screen and treat’ people to prevent type 2 diabetes are unlikely to have a substantial effect on the growing diabetes epidemic, say researchers from the University of Oxford. To read the full article, log in using your NHS OpenAthens details
However, it's important to put these findings in context. Diabetes has previously been linked with pancreatic cancer, though it is unclear why. It could be that diabetes increases the risk of pancreatic cancer. What is probably more likely is that rapid onset or progression of diabetes could be a symptom of the cancer itself.
Diabetes is fairly common in the UK, with around 4 million cases, while pancreatic cancer remains very rare. Just because you have diabetes does not mean you will go on to get pancreatic cancer.
P. Royle, L. Bain, und N. Waugh. BMC medical research methodology, 5 (1):
2(Januar 2005)LR: 20061115; PUBM: Electronic; DEP: 20050108; JID: 100968545; 2004/08/11 received; 2005/01/08 accepted; 2005/01/08 aheadofprint; epublish.