I’ll Have the Metformin and Liraglutide Please

After an average of four years of follow-up, the study found that participants taking metformin plus liraglutide or insulin glargine achieved and maintained their target blood levels for the longest time compared to sitagliptin or glimepiride. This translated into approximately six months more time with blood glucose levels in the target range compared with sitagliptin, which was the least effective in maintaining target levels. Treatment effects did not differ based on age, sex, race, or ethnicity.

However, none of the combinations overwhelmingly outperformed the others.

Two popular diabetes drugs outperformed others in large clinical trial — https://www.nih.gov/news-events/news-releases/two-popular-diabetes-drugs-outperformed-others-large-clinical-trial

BUT if you can Stay as Thin as You Can as Long as You Can maybe, just maybe you won’t develop DM2.

Another Sweet Saturday – 09.17.22

Our 1-year RCT indicated that a lifestyle intervention program can be highly successful in older adults with diabetes and chronic comorbidities. In this specific population, lifestyle intervention not only improved glycemic control associated with improved insulin action and secretion but also improved age-relevant outcomes such as body composition, physical function, and quality of life.

Alessandra Celli, Yoann Barnouin, Bryan Jiang, Dean Blevins, Georgia Colleluori, Sanjay Mediwala, Reina Armamento-Villareal, Clifford Qualls, Dennis T. Villareal; Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial. Diabetes Care 1 September 2022; 45 (9): 1943–1952. https://doi.org/10.2337/dc22-0338

From the periods 1988–1994 to 2017 to March 2020, there was an increase in the prevalence of diagnosed diabetes (from 4.6% to 11.7%), but no change in prevalence of persistent undiagnosed diabetes (from 2.23% to 2.53%) or confirmed undiagnosed diabetes (from 1.10% to 1.23%). Consequently, the proportion of all undiagnosed diabetes cases declined from 32.8% to 17.8% (persistent undiagnosed diabetes) and from 19.3% to 9.5% (confirmed undiagnosed diabetes). Undiagnosed diabetes was more prevalent in older and obese adults, racial/ethnic minorities, and those without health care access. Among persons with diabetes, Asian Americans and those without health care access had the highest proportion of undiagnosed cases, with rates ranging from 23% to 61%.

Michael Fang, Dan Wang, Josef Coresh, Elizabeth Selvin; Undiagnosed Diabetes in U.S. Adults: Prevalence and Trends. Diabetes Care 1 September 2022; 45 (9): 1994–2002. https://doi.org/10.2337/dc22-0242

Remember, Stay as Thin as You Can as Long as You Can.

SIDD, SIRD, MOD, AND MARD – DM2 Subgroups

Type 2 diabetes (T2D) was recently reclassified into severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD), which have different risk of complications. We explored whether DNA methylation differs between these subgroups and whether subgroup-unique methylation risk scores (MRSs) predict diabetic complications.

Novel Subgroups of Type 2 Diabetes Display Different Epigenetic Patterns That Associate With Future Diabetic Complications — https://doi.org/10.2337/dc21-2489

More acronyms!

Incidence and Characteristics of Remission of Type 2 Diabetes in England: A Cohort Study Using the National Diabetes Audit

Remission of type 2 diabetes was generally infrequent in routine care settings but may be a reasonable goal for a subset of people who lose a significant amount of weight shortly after diagnosis.

Incidence and Characteristics of Remission of Type 2 Diabetes in England: A Cohort Study Using the National Diabetes Audit – Diabetes Care 2022;45(5):1151–1161
https://doi.org/10.2337/dc21-2136

Just Another Hump Day…Sweet

Scientists have demonstrated that normal brain aging is accelerated by approximately 26% in people with progressive type 2 diabetes compared with individuals without the disease.

eLife. “Type 2 diabetes accelerates brain aging and cognitive decline.” ScienceDaily. http://www.sciencedaily.com/releases/2022/05/220525080527.htm (accessed May 25, 2022)

Makes you wonder if improving your diet will help.

Many adults can achieve remission of type 2 diabetes with a primary intervention consisting of a diet that emphasizes whole, plant-based foods, according to a new publication from the American College of Lifestyle Medicine (ACLM).

Experts Endorse Plant-Based Diet for Type 2 Diabetes Remission — https://www.medscape.com/viewarticle/974591?src=rss#vp_1

But we all know how hard lifestyle changes can be. Maybe best to just listen to some music.

Stay as Thin as You Can as Long as You Can

Based on the evidence from clinical trials weight loss (typically 15 kg or greater) is the main driver and predictor of remission.

Dietary strategies for remission of type 2 diabetes: A narrative review — https://doi.org/10.1111/jhn.12938

A weight loss program can lead to type 2 diabetes remission, even in individuals with a normal body mass index (BMI), via loss of body fat, particularly in the liver and pancreas, shows a UK study.

Type 2 Diabetes Remission Possible For Those With Lower BMI — https://www.medscape.com/viewarticle/971599?src=rss#vp_1

The title of this post is a direct quote from an Endocrinologist who at the time was practicing in Dallas Texas. I asked if he had any advice for me to reduce my risk of developing diabetes.

“Stay as thin as you can as long as you can.”

These words have stuck with me ever since.

Another Sweet Sunday – 12.12.21

RESULTS During 170,148 person-years (PY) (median follow-up 8.5 years), 283 individuals died: 133 with type 1 (103.0/100,000 PY), 55 with type 2 (161.5/100,000 PY), 87 with secondary (1,952/100,000 PY), and 8 with other/unknown diabetes type (312.3/100,000 PY). SMRs (standardized mortality ratios) (95% CI) for the first three groups were 1.5 (1.2–1.8), 2.3 (1.7–3.0), and 28.0 (22.4–34.6), respectively. Diabetes was the underlying cause of death for 42.1%, 9.1%, and 4.6% of deaths, respectively. The SMR was greater for type 2 than for type 1 diabetes (P < 0.001). SMRs were significantly higher for individuals with type 1 diabetes who were <20 years of age, non-Hispanic White and Hispanic, and female and for individuals with type 2 diabetes who were <25 years of age, from all race/ethnic minority groups, and from both sexes.

Demographic Correlates of Short-Term Mortality Among Youth and Young Adults With Youth-Onset Diabetes Diagnosed From 2002 to 2015: The SEARCH for Diabetes in Youth Study — Diabetes Care 2021 Dec; 44(12): 2691-2698. https://doi.org/10.2337/dc21-0728

CONCLUSIONS In the Danish population screened for diabetes with HbA1c, the highest risk of MACE (major adverse cardiovascular event) and all-cause mortality was found in subjects with HbA1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk factors for subjects with prediabetes.

Prediabetes Defined by First Measured HbA1c Predicts Higher Cardiovascular Risk Compared With HbA1c in the Diabetes Range: A Cohort Study of Nationwide Registries — Diabetes Care 2021 Dec; 44(12): 2767-2774. https://doi.org/10.2337/dc21-1062

Thursday 08.12.21 – More Diabetes Research for Your Reading Pleasure

Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes

Our findings show that a substantial proportion of patients had existing complications including CKD, stable angina, and peripheral neuropathy at the time of T2D diagnosis. Results also show that among those newly diagnosed with T2D, the highest incidence rates of complications included peripheral neuropathy, CKD, and CVD (myocardial infarction, unstable angina, and stroke).

Time to incidence of microvascular and macrovascular complications was only a few years; peripheral vascular disease, stable angina, CKD, and peripheral neuropathy developed earlier in the disease course.

BMJ Open Diabetes Research and Care – http://dx.doi.org/10.1136/bmjdrc-2020-001847

Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders

CONCLUSIONS Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of DKA and nearly sixfold increased risk of death compared with their peers without eating disorders.

Diabetes Care 2021 Aug; 44(8): 1783-1787. https://doi.org/10.2337/dc21-0517

Fenofibrate Use Is Associated With Lower Mortality and Fewer Cardiovascular Events in Patients With Diabetes: Results of 10,114 Patients From the Korean National Health Insurance Service Cohort

Diabetes Care 2021 Aug; 44(8): 1868-1876. https://doi.org/10.2337/dc20-1533

I’ve been out of town the past three weekends in a row. Prior to taking these trips I was feeling a bit burned out. I had little desire to continue my research activities. I had even less desire to write or post to my blogs. But as suddenly as my energy levels dipped, the mojo came back.

Hiatus is over. The SupremeCmdr is back.

Just Another Sweet Sunday

RESEARCH DESIGN AND METHODS We linked data from two Danish type 2 diabetes cohorts, the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) and the Danish Centre for Strategic Research in Type 2 Diabetes (DD2), to national health care registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios (IRRs) of CVD and all-cause mortality comparing MNSIq scores ≥4 with scores <4. Analyses were adjusted for a range of established CVD risk factors.

RESULTS In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores <4, MNSIq scores ≥4 were associated with higher incidence rate of CVD, with IRRs of 1.79 (95% CI 1.38–2.31) in ADDITION-Denmark, 1.57 (CI 1.27–1.94) in the DD2, and a combined IRR of 1.65 (CI 1.41–1.95) in a fixed-effect meta-analysis. MNSIq scores ≥4 did not associate with mortality; combined mortality rate ratio was 1.11 (CI 0.83–1.48).

CONCLUSIONS The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes with a high incidence rate of subsequent CVD. MNSIq scores ≥4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.

Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies — Diabetes Care 2021 Jul; 44(7): 1714-1721. https://doi.org/10.2337/dc21-0010

The results for the 500 young adult participants in the Treatment Options for Type 2 Diabetes in Adolescents and Youth 2 (TODAY 2) study were published online July 28 in the New England Journal of Medicine by the TODAY study group.At follow-up — after originally participating in the TODAY trial when they were young teenagers — they had a mean age of 26.4 years.

At this time, more than two thirds had hypertension and half had dyslipidemia.

Overall, 60% had at least one diabetic microvascular complication (retinal disease, neuropathy, or diabetic kidney disease), and more than a quarter had two or more such complications.

‘Shocking’ Early Complications From Teen-Onset Type 2 Diabetes – Medscape – Jul 28, 2021. – https://www.medscape.com/viewarticle/955590?src=rss#vp_1