The American Diabetes Association (ADA) recently wrapped up the 78th Scientific Sessions — its annual conference for presenting new research in the diabetes field — in San Diego. Here is a sampling of studies presented at the meeting:
Metformin and Type 1 Diabetes
The popular oral diabetes drug metformin may provide some protection against atherosclerosis (hardening of the arteries) in people with Type 1 diabetes but does not appear to benefit blood sugar control, according to results from the Reducing with Metformin Vascular Adverse Lesions (REMOVAL) trial. A total of 428 people age 40 and over with Type 1 diabetes and at increased cardiovascular risk were randomly assigned to receive either 1,000 milligrams of metformin twice daily or placebo (inactive treatment) for the course of the three-year trial.
The medicine did not significantly reduce carotid artery intima-media thickness, a marker of atherosclerosis, and although it did significantly reduce HbA1c (a measure of glucose control over the previous 2–3 months), this was only for the first three months of the study. However, metformin did decrease body weight and LDL (“bad”) cholesterol, indicating that it may have benefits for people with Type 1 diabetes.
The trial “changes the way we think about metformin. The guidelines suggest you can add it in obese Type 1 diabetes patients to reduce glucose, but we didn’t see much evidence of glucose reduction beyond three months,” noted lead investigator John R. Petrie, MD, PhD. “Obviously, don’t use it for glucose lowering. But consider using it for reducing weight and LDL cholesterol and possibly atherosclerosis prevention.”
To learn more, see the article “REMOVAL: Mixed Data on CV Benefits of Metformin in Type 1 Diabetes” or the study in the journal The Lancet Diabetes & Endocrinology. And for more information about metformin, see “Diabetes Medicine: Metformin,” by certified diabetes educator Amy Campbell.
Type 2 Diabetes and Blood Sugar Monitoring
Routine blood sugar monitoring did not affect long-term glucose levels in people with Type 2 diabetes not taking insulin in a new study from the University of North Carolina at Chapel Hill. For the study, 450 people with Type 2 diabetes who weren’t taking insulin were randomly assigned to either check their blood sugar once a day with a conventional blood glucose meter, check their blood sugar once a day with a meter that gave them a feedback message, or not to check their blood sugar at all. After a year, the investigators found no differences between the groups in quality of life or how well their blood sugar was managed.
Monitoring blood sugar might be helpful when starting a new medicine or changing doses, the researchers note, and regular monitoring is absolutely necessary in people taking medicines that can cause hypoglycemia (low blood sugar), such as insulin or sulfonylureas.
For those not taking drugs that can cause lows, “the best way to control blood sugar is to take your medication the way your doctor asks you to and to take good care of yourself,” said study author Laura Young, MD, PhD. “The key really is taking your medications.”
To learn more about the research, see the article “Can Folks With Type 2 Diabetes Forgo the Finger Stick?” or the study in the journal JAMA Internal Medicine. And for information about how to get the most from your monitoring, read “Blood Sugar Monitoring: When to Check and Why.”
Nasal Glucagon Spray
A new type of glucagon that is given as a nasal spray showed effectiveness in treating moderate or severe hypoglycemia in people with Type 1 diabetes in a new study. Glucagon is a hormone that raises low blood sugar and is currently administered by injection to treat severe low blood sugar. Over the course of the study period, 69 people had a total of 157 episodes of hypoglycemia — with blood sugar levels ranging from 21.6 mg/dl to 73.9 mg/dl — that were treated with the nasal glucagon spray. For more than 96% of the episodes, the subjects recovered in 30 minutes, with the researchers finding only six episodes in which recovery did not occur within 30 minutes.
Roughly 88% of the subjects experienced effects such as nasal irritation or headache, but no serious drug-related side effects were found. Approximately 83% of caregivers reported being satisfied or very satisfied with the glucagon spray after most episodes of hypoglycemia.
“We know we get lots of prescriptions filled [for injectable glucagon] and people don’t use it because it is hard to use,” noted researcher Elizabeth Seaquist, MD, who is also a consultant for the glucagon spray marketer Eli Lilly. “You have to reconstitute it, and it has a needle, and people get afraid. It’s very exciting as a clinician, as someone who takes care of patients with diabetes and who helps the families to be ready for hypoglycemia, to have another option… I look forward to when it eventually gets to market,” she added in an interview with MedPage Today.
For more information about the study, see the article “Nasal Glucagon Helps Hypoglycemia In Adults With T1D” or the presentation abstract. And to learn more about glucagon, see this definition from contributing editor Robert S. Dinsmoor.
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