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Issue 5 Alzheimer’s Insights by Curation Health 23 April 2015
Metformin is a great drug, but it’s not always so great to take! What can be done to make it better? The value of retinal screening is made plain to see and we look at the link between statin use and the risk of diabetes. Also, might pears and eggs help stave off diabetes and in the future will parts of us glow different colours depending on our blood sugar levels? Finally, we refuse to think of dementia as “type 3 diabetes”.
Most read stories this week
Type 2 diabetes: Understanding regulation of sugar levels for better treatment
How the data revolution could transform the way people live with diabetes
Leaky Calcium Channels Promote Development of Diabetes
Study Tests Powdered Insulin to Prevent Diabetes
Toward Primary Prevention of Type 1 Diabetes
Making metformin more manageable
New hopes for reducing the common and troublesome gastro-intestinal (GI) side effects of metformin have been raised by two new pieces of research. Metformin is the first-line drug for type 2 diabetes but it is not always pleasant to take. More than one in ten people using it experience diarrhoea, heartburn and nausea and less commonly, bloating, retching, and abdominal gripes and pains. These problems often settle with time and may be reduced by taking metformin with food, using modified release formulations or by starting at a low dose and gradually increasing it. Despite this, many people just stop taking metformin or are not keen to have their dosage increased.

A US study published in Journal of Diabetes Science and Technology looked at a possible role for a novel class of drug called gastrointestinal microbiome modulators. These alter the balance of micro-organisms in the bowels and the study showed that taking metformin along with a gastrointestinal microbiome modulator not only improved the GI tolerability of metformin, but also had an additional benefit in further lowering the fasting blood glucose levels. However, it might be some time yet before a drug like this could be launched.

Meanwhile, new UK research published in Nature Medicine has shown metformin may work in a completely different way to that previously thought. It was believed metformin acted directly on the liver to suppress glucose production. Now it seems that the route is actually via the brain and nervous system: metformin is detected by the intestine which sends nerve signals to the brain and it is the brain itself that then sends nerve signals to the liver to suppress the glucose production. This new knowledge may allow the design of targeted delivery systems or even new drugs to reduce the side effects associated with metformin.

In the meantime, metformin is the “gold standard” first-line therapy which, for some of the people who take it, remains hard to stomach.

Diabetes Treatment
Risk of retinopathy in type 2 diabetes
A diabetic retinopathy that is severe enough to threaten peoples’ sight was found in 2.9% of people with type 2 diabetes in an analysis of a Welsh community-based mobile screening service, published in The British Journal of Ophthalmology. This prevalence was less than that found in those with type 1 diabetes, where it was 11.2%, however, because there are so many more people with type 2 diabetes they actually formed the majority of the population with sight-threatening retinopathy.

People with type 2 diabetes and sight-threatening diabetic retinopathy were more likely to be younger, male and using insulin compared to those without eye changes. The longer a person had the diabetes (type 1 or 2) then the higher the risk of them developing a diabetic retinopathy.

Non-sight-threatening diabetic retinopathy was found in 28.1% of people with type 2 diabetes. This meant overall almost a third of people with type 2 diabetes screened had a diabetic retinopathy and around one in ten of these were sight-threatening. This study re-emphasises the need, as highlighted in Diabetes INSIGHTS Issue Four , for all people with diabetes to have annual eye screening, especially those who use insulin.

Diabetes Complications
Increased risk of type 2 diabetes with statin use
The use of statins, medications commonly used to lower cholesterol levels, may significantly increase the risk of developing type 2 diabetes by even more than previously thought, according to a new Finnish study published in the journal Diabetologia.

Even when taking the other risk factors for type 2 diabetes into account, in men therapy with statins was associated with a 46% increased risk of developing type 2 diabetes compared with men not taking statins . The study was carried out on 8,749 non-diabetic Caucasian men aged 45-73 years, so it is not actually known if this increased risk also equally applies to women or non-Caucasians. The large numbers involved in the study does, however, make the findings more reliable than past research. Older studies had already suggested that using statins raised the risk of type 2 diabetes, but not by nearly as much as this new research suggests.

The study also showed that the increased risk was dependent on the dose of the statin given, at least for two of the most commonly used statins, simvastatin and atorvastatin. These two statins were also found to cause a dose-dependent reduction in both the secretion of insulin and the sensitivity of muscle and fat to insulin. This may explain why statins increase the risk of type 2 diabetes, as these are the two underlying problems found with insulin release and action in type 2 diabetes.

As mentioned, the other risk factors for type 2 diabetes were already taken into account by the study. These included increasing age, raised body mass index (BMI), large waist circumference, low physical activity levels, smoking, high alcohol intake, family history of diabetes and treatment with beta-blockers and diuretic medications. These are the risk factors that should be addressed by anyone with type 2 diabetes or pre-diabetes. Although no one can change their family history or age, the rest can be modified to reverse or treat type 2 diabetes.

Diabetes Research
Good egg or bad egg? Apple or pears?
Every week it seems another food item might help type 2 diabetes! Now it is the turn of the egg and the pear, not a combination often seen on the same plate…

Firstly, the egg: for people with type 2 diabetes, Australia recommends eating a maximum of six per week; in the USA it is four; in the UK there is no suggested maximum (as long as you have a low intake of saturated fatty acids). Researchers from Australia asked groups with type 2 diabetes and pre-diabetes to eat either two eggs a day for six days a week or just two eggs a week. The results published in the American Journal of Clinical Nutrition found the eaters of the extra eggs felt fuller, enjoyed their eggs and, more importantly from a medical point of view, had no significant changes in their blood lipid (fats/cholesterol) profiles compared to the lower egg-intake group. This may mean that eggs could be back on the regular menu in type 2 diabetes…

In the test tube, researchers from North Dakota State University found pulp extracts of certain pears slowed down the metabolism of glucose during digestion according to a study published in Food Research International and analysed here. It is hoped that pears might be used to help manage pre-diabetes or even treat type 2 diabetes, but it is early days yet.

At the moment, it is still “an apple a day that keeps the doctor away”, especially since eating whole fruits - particularly apples, blueberries and grapes - reduces the risk of developing type 2 diabetes, whereas drinking fruit juices increases the risk according to the British Medical Journal!

Diabetes Lifestyle
Shining a light on glucose levels
The search to end the painful ritual of pricking fingers to test glucose levels continues! From Texan newspaper The Battalion comes a report of two local research labs that want to shine a new light on the problem… literally. They jointly propose to develop a device, the size of a grain of rice, which is to be implanted under the skin. Once the skin has healed over, the device will “monitor” glucose levels for up to a year. It does this by chemically interacting with glucose, rather than by using any power source. The users get their glucose readings by shining a fluorescent light (from a light source on a watch or a key ring) onto the overlying skin. The device underneath will then glow in a different colour depending on the glucose levels.

Diabetes Technology
You are not alone… famous people with type 2 diabetes
Image: Phil Guest - Flikr. Licensed under Creative Commons CC BY-SA-2.0

A six time Olympic gold medallist, rower Sir Steve Redgrave CBE was diagnosed with Type 2 diabetes in 1997, three years before the Sydney Olympics. He uses insulin to control his condition. Read his inspiring story here.
And Finally…
Is dementia yet another complication of diabetes to be added to the list? That is the depressing thought prompted by a Danish study in JAMA Psychiatry. It found that people with diabetes had a 20% increased risk for developing dementia. They were also more likely to develop their dementia at a younger age too, something specifically that the researchers found “quite worrisome”. It was also noted that those with depression and diabetes were found to have a 117% increased risk for dementia.

The increasing overlap between diabetes and dementia is such that some experts have even labelled dementia as “type 3 diabetes”. It is unclear how helpful an analogy this is, even if it does get us thinking about links in a new way. What is perfectly clear is that the risk factors for diabetes and dementia are similar.

The better news is that successfully managing type 2 diabetes and its risk factors, as well as any depression, has been shown to reduce the risk of dementia. So the message is that looking after your type 2 diabetes will also help you look after your brain.

Alzheimer’s INSIGHTS from CurationHealth
Readers interested in the links between diabetes and dementia can follow developments here, and track them also from the dementia perspective in another weekly publication from CurationHealth. Click here to see how this story appeared earlier this week in Alzheimer's INSIGHTS.

More Diabetes Feeds on CurationHealth
Diabetes Complications
Diabetes Lifestyle
Diabetes Technology
Diabetes Research
Diabetes Treatment
CurationHealth is a health communications company and not a healthcare company. The information it relays from online and offline publications is provided as is without either endorsement or warranties as to the accuracy or fitness for any specific purpose and should under no circumstances be read as medical or scientific advice, neither as in any sense a prescription or a substitute for the professional advice of a doctor or otherwise trained specialist in matters of health and wellbeing. While information relayed from third parties is conveyed in good faith, no warranties are offered as to the accuracy of information supplied in this way, nor indeed from such agents or follow-on links quoted by third parties from other sources.
Tweets of the week twitter logo
FiercePharma (@FiercePharma)
Merck aims for double payoff with new diabetes education push… $MRK #pharma #marketing by @CarlyHFierce
Shawn Watson (@Shawn_G_Watson)
* Insulin has potential to prevent type 1 diabetes in high risk children say researchers | @bioDiabetes…
Ethan Weiss (@ethanjweiss)
People ask why a Cardiologist like me study diabetes. Here is why...…
Andrew McConaghie (@pharma_phorum)
Sanofi's diabetes drug Lyxumia passes cardiovascular safety trial, opening door to US filing #diabetes @sanofi
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About Diabetes Insights
Diabetes Insights is an online newsletter created for people who live with the challenge of diabetes. The present focus is mainly on Type 2 diabetes. Based upon intelligent search algorithms that scour the Internet for the most read, relevant and useful stories from around the world, it is curated and published each Thursday by a team of health and publishing experts.
Fintan Coyle  
Fintan Coyle Senior Curator
A retired General Practitioner, Fintan has been a writer, columnist and medical editor for both consumer titles and medical journals. His strong personal interest in diabetes began when he developed late onset type 1 diabetes in his thirties. He is committed to highlighting the important issues for you, applying his medical knowledge to breaking stories alongside his real-life insights into what it’s like to live with diabetes.
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