Diabetes Mellitus Type II

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Diabetes

NIH - Medical Encyclopedia Diabetes

"Type 2 diabetes is far more common than type 1 and makes up 90% or more of all cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise. … Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and/or oral medications. … Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels."

Highlighted Articles

Diabetic Neuropathy--A Review (Nat Clin Pract Neurol. 2007)

"Diabetic neuropathy is the most common neuropathy in industrialized countries, and it is associated with a wide range of clinical manifestations. The vast majority of patients with clinical diabetic neuropathy have a distal symmetrical form of the disorder that progresses following a fiber-length-dependent pattern, with sensory and autonomic manifestations predominating. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients experience pain, trophic changes in the feet, and autonomic disturbances. Occasionally, patients with diabetes can develop focal and multifocal neuropathies that include cranial nerve involvement and limb and truncal neuropathies."

Adiposity Compared With Physical Inactivity and Risk of Type 2 Diabetes in Women (Diabetes Care 2007)

"CONCLUSIONS—Obesity and physical inactivity independently contribute to the development of type 2 diabetes; however, the magnitude of risk contributed by obesity is much greater than that imparted by lack of physical activity."

Walking for exercise--does three times per week influence risk factors in type 2 diabetes? (Diabetes Res Clin Pract. 2006)

"Our results suggest that an increase of regular physical activity equivalent to 45 min of walking 3 days/week may suffice to improve systolic and diastolic blood pressure, lipid metabolism and BMI in patients with type 2 diabetes."

Health Problems That Diabetes Can Cause

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Diabetes Mellitus Type 2

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Avandia May Raise Osteoporosis Risk

Increased Serious Heart Failure Incidence With Pioglitazone "Pioglitazone use is associated with an increased incidence of serious heart failure, but still provides clinical benefits, with no evidence that it increases subsequent mortality and morbidity, according to a report in the November issue of Diabetes Care."

Experts Urge More Cautious Use of Diabetes Drugs " "New information suggests additional hazards associated with the use of either thiazolidinedione, and rosiglitazone (Avandia) in particular may result in an increased frequency of myocardial infarctions," the revised statement concludes. "We therefore recommend greater caution in using thiazolidinediones, especially in patients at risk of, or with, congestive heart failure." "

Avandia (rosiglitazone maleate) Tablets " … showed Avandia to be associated with an increased risk of myocardial ischemic events such as angina or myocardial infarction. At this time, FDA has concluded that there isn't enough evidence to indicate that the risks of heart attacks or death are different between Avandia and some other oral type 2 diabetes treatments."

FDA: Byetta (exenatide) "[Posted 10/16/2007] FDA has reviewed 30 postmarketing reports of acute pancreatitis in patients taking Byetta (exenatide), a drug used to treat adults with type 2 diabetes. An association between Byetta and acute pancreatitis is suspected in some of these cases."

Systematic Review: Comparative Effectiveness and Safety of Oral Medications for Type 2 Diabetes Mellitus (Annals 2007) "Conclusions: Compared with newer, more expensive agents (thiazolidinediones, -glucosidase inhibitors, and meglitinides), older agents (second-generation sulfonylureas and metformin) have similar or superior effects on glycemic control, lipids, and other intermediate end points. Large, long-term comparative studies are needed to determine the comparative effects of oral diabetes agents on hard clinical end points."

Metformin Use Increases Vitamin B12 Deficiency in Patients With Diabetes "Higher dose and duration of metformin use increased the risk for vitamin B12 deficiency in patients with diabetes."

Expert: Diabetes Drug Should Be Pulled "The widely used diabetes drug Avandia should be pulled from the market because of heart risks, a federal scientist said Monday. Those risks, combined with no unique short-term benefits in helping diabetics control blood-sugar levels, fail to justify keeping Avandia on the market, according to a copy of a slide presentation by Food and Drug Administration scientist Dr. David Graham. … Glaxo, meanwhile, says its own data show no increase in heart risks with Avandia compared with other diabetes drugs, including Actos."

Newest Avandia Study Not Reassuring "The maker of the controversial diabetes pill Avandia on Tuesday published preliminary results of a study that the company claims show the drug does not raise heart risks. However, experts say the results are inconclusive and even seem to suggest more risk from the drug."

FDA Issues Safety Alert on Avandia "The U.S. Food and Drug Administration (FDA) is aware of a potential safety issue related to Avandia (rosiglitazone), a drug approved to treat type 2 diabetes. Safety data from controlled clinical trials have shown that there is a potentially significant increase in the risk of heart attack and heart-related deaths in patients taking Avandia. However, other published and unpublished data from long-term clinical trials of Avandia, including an interim analysis of data from the RECORD trial (a large, ongoing, randomized open label trial) and unpublished reanalyses of data from DREAM (a previously conducted placebo-controlled, randomized trial) provide contradictory evidence about the risks in patients treated with Avandia."

Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes (NEJM 2007) "Conclusions Rosiglitazone was associated with a significant increase in the risk of myocardial infarction and with an increase in the risk of death from cardiovascular causes that had borderline significance. Our study was limited by a lack of access to original source data, which would have enabled time-to-event analysis. Despite these limitations, patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes."

Do not ADOPT rosiglitazone as first-line diabetes treatment.

Fracture risk a class effect of thiazolidinediones in women "Treatment with thiazolidinediones (glitazones) for type 2 diabetes has been found to increase the risk of fractures in women. Pioglitazone has now joined rosiglitazone, as the subject of a US Food and Drug Administration alert for fracture risk."

Avandia (rosiglitazone maleate)

Drugs

Rosiglitazone : A Review of its Use in Type 2 Diabetes Mellitus. (Drugs. 2007)

Treating Type 2 Diabetes – The Oral Diabetes Drugs

Older Diabetes Drug Sometimes the Best Choice "A new U.S. report says an older drug for treating the most common form of diabetes is better in many cases than a new generation of medications. The report doesn't recommend that doctors abandon prescribing the new drugs for type 2 diabetes, because they may be appropriate in some instances. But the report does give a boost to the 12-year-old drug metformin, sold generically under a variety of brand names. "

Statins and Fibrates Reduce the Risk of Diabetic Peripheral Neuropathy, New Study Shows "Therapy with either a statin or fibrate protects against the development of nerve damage in patients with type 2 diabetes mellitus …"

Meglitinide analogues for type 2 diabetes mellitus. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: Meglitinides may offer an alternative oral hypoglycaemic agent of similar potency to metformin, and may be indicated where side effects of metformin are intolerable or where metformin is contraindicated. However, there is no evidence available to indicate what effect meglitinides will have on important long-term outcomes, particularly mortality."

A Randomized Trial of the Effects of Rosiglitazone and Metformin on Inflammation and Subclinical Atherosclerosis in Patients With Type 2 Diabetes (Am Heart J. 2007)

Initial monotherapy with either metformin or sulphonylureas often fails to achieve or maintain current glycaemic goals in patients with Type 2 diabetes in UK primary care (Diabetic Medicine 2007) "Conclusions Many patients fail to achieve glycaemic goals with initial monotherapy and, of those who achieve current goals, few consistently maintain these targets over 3 years. Research is needed to evaluate whether more aggressive treatment or alternative treatments can improve the long-term maintenance of glycaemic control in patients with Type 2 diabetes."

Insulin as initial therapy in type 2 diabetes: effective, safe, and well accepted. (J Investig Med. 2007) "CONCLUSION: Outpatient initiation of insulin therapy at the time of diagnosis of T2DM is an effective, safe, and feasible strategy for rapidly lowering HbA(1c) levels to targets. Insulin was very well accepted by the patients, refuting the misconception of low satisfaction and acceptance of such treatment."

Exercise

The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus. (Eur J Cardiovasc Prev Rehabil. 2007)

Aerobic and Resistance Training Improve Glycemic Control in Type 2 Diabetes

Any kind of exercise helps diabetics: Doctors should prescribe workouts to every patient, researchers say "Weight training works just as well as running on a treadmill or biking to help the most important symptom of type-2 diabetes — long-term control of blood sugar — Canadian researchers said on Monday. Doing both aerobic and resistance training lowered blood sugar levels better than either alone, researchers said — and both appeared to be safe. "

Effects of aerobic exercise on lipids and lipoproteins in adults with type 2 diabetes: A meta-analysis of randomized-controlled trials (Public Health 2007) "Although our overall results suggest that aerobic exercise lowers LDL-C in adults with Type 2 diabetes, additional randomized-controlled trials are needed on this topic."

Exercise key in control of type 2 diabetes: study "People with type 2 diabetes may go a long way in managing their condition if they take up regular exercise, a new research review shows. Researchers found that when they combined the results from 103 studies, there was clear evidence that lifestyle changes helped people with type 2 diabetes gain better control over their blood sugar. But while diet, exercise and medication are all vital to diabetes management, exercise alone was effective in these studies. In fact, the review found, studies that focused only on boosting exercise levels yielded greater benefits than those that tried to change patients' diets, exercise habits and medication adherence all at once. "

Reduction in Weight and Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes (Diabetes Care 2007) "An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. … CONCLUSIONS—At 1 year, ILI resulted in clinically significant weight loss in people with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE."

The role of exercise in patients with type 2 diabetes. (Am Fam Physician. 2007) "This meta-analysis shows that exercise significantly improves glycemic control and reduces visceral adipose tissue and plasma triglycerides, but not cholesterol, in persons with type 2 diabetes, even without weight loss."

General Information

Diabetes Treatment a Burden to Many "Diabetes is now largely manageable, thanks to today's treatments. But while these treatments keep patients healthy, some perceive them to be almost as bad as the disease itself, new research shows. The typical diabetes treatment regimen involves daily pills to control blood sugar, blood pressure, and cholesterol. And patients who require insulin may need multiple shots a day."

Preventing Diabetic Foot Ulcer Recurrence in High-Risk Patients (Diabetes Care 2007) "CONCLUSIONS—Infrared temperature home monitoring, in serving as an "early warning sign," appears to be a simple and useful adjunct in the prevention of diabetic foot ulcerations."

Guidelines

Guidelines Revised for Management of Type 2 Diabetes Mellitus

NGC - GUIDELINE SYNTHESIS - MANAGEMENT/TREATMENT OF OBSTRUCTIVE SLEEP APNEA (OSA) (2007)

NGC - KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. (2007)

NGC - Clinical guideline for adults with diabetes. (2006)

NGC - Clinical guideline for pharmacological management of type 2 diabetes (2007)

NGC - Management of type 2 diabetes mellitus. (2006)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

The effect of an extract of green and black tea on glucose control in adults with type 2 diabetes mellitus: double-blind randomized study. (Metabolism. 2007) "We did not find a hypoglycemic effect of extract of green and black tea in adults with type 2 diabetes mellitus."

Diabetics may do well on Mediterranean diet "Eating a traditional Mediterranean diet -- more vegetables, fruits, and fish, and fewer animal products -- does seem to ward off heart disease, an Australian study shows, and it may be especially beneficial for people with diabetes."

Dietary advice for treatment of type 2 diabetes mellitus in adults. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up, although there is a promising study currently underway."

Nutrition Recommendations and Interventions for Diabetes (Diabetes Care 2007)

Other

Other Treatments

Vinegar at bedtime may benefit type 2 diabetics

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Vitamin E Could Help 40% Of Diabetics Ward Off Heart Attacks "Vitamin E supplements can significantly reduce the risk of heart attacks and related deaths for diabetics who carry a particular version of a gene …"

The effect of an extract of green and black tea on glucose control in adults with type 2 diabetes mellitus: double-blind randomized study (Metabolism) "We did not find a hypoglycemic effect of extract of green and black tea in adults with type 2 diabetes mellitus."

Effects of curcumin on retinal oxidative stress and inflammation in diabetes (Nutrition & Metabolism 2007) "Thus, the beneficial effects of curcumin on the metabolic abnormalities postulated to be important in the development of diabetic retinopathy suggest that curcumin could have potential benefits in inhibiting the development of retinopathy in diabetic patients."

The Role of Vitamin D and Calcium in type 2 diabetes. A systematic Review and Meta-Analysis. (J Clin Endocrinol Metab. 2007) " Conclusions: Vitamin D and calcium insufficiency may negatively influence glycemia while combined supplementation with both nutrients may be beneficial in optimizing glucose metabolism."

Surgery

Transplantation

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