View in browser
Issue 7 Alzheimer’s Insights by Curation Health 7 May 2015
No apologies for prioritising the importance of quitting smoking this week as new research confirms that it is “never too late to quit”. Quitting sugary drinks is also on the lifestyle agenda as research shows it may prevent type 2 diabetes. New genetic research has helped to provide insights into ways to prevent and treat both type 2 diabetes and offers hope for one of its more distressing complications, a diabetic foot ulcer. The underuse of metformin in pre-diabetes raised concerns this week in the USA, but not all experts would agree! Finally, is your insulin pen needle too big for your own good?
Most read stories this week
Invokana shows promise in reducing body weight, HbA1c, BP in type 2 diabetes
Hot Drugs Show Sharp Price Hikes in Shadow Market
Central obesity genetically linked to type 2 diabetes risk
Toujeo approved in the European Union for the treatment of diabetes in adults
Dulaglutide in type 2 diabetes: Hint of added benefit with short-acting insulin
No excuse to not quit smoking
One of the most important ways to reduce complications in type 2 diabetes is to quit smoking, but it may come at the cost of a small increase in HbA1c levels which lasts for up to three years according to a new study in the Lancet Diabetes & Endocrinology. However, (and this is such an important point that I am going to put it in bold) the benefits of quitting smoking far outweigh this temporary and modest increase in HbA1c levels.

The research on 10,692 people with type 2 diabetes patients found those who quit smoking for over a year had an average 0.21% increase in their HbA1c levels (from 7.7% to 7.9%) and this continued for up to three years after they had stopped. As a reminder, for people without concurrent serious illness and low risk of hypos, the target HbA1c level is below or equal to 6.5%. The exact reasons for this HbA1c increase are unclear but it is not due to the quitters putting on weight, which they indeed did by an average of 4.8 kg. Regardless of the underlying mechanism, this increase in HbA1c is small and temporary, and is outweighed by the benefits of quitting.

Quitting smoking is one of the best things you could ever do for yourself. Smoking increases the risk of retinopathy, neuropathy, kidney disease, erectile dysfunction, Alzheimer’s disease and cardiovascular disease (stroke, heart attacks, heart failure, poor circulation) in type 2 diabetes. Given the fact that up to 80 per cent of people with diabetes will die from cardiovascular disease, doing anything to lower the risk is vital.

The recently published largest and most compressive study of the link between smoking and cardiovascular disease in older people highlights this. It was carried out on half a million people in Europe and the US and showed that the risk of stroke and heart attack is significantly reduced within five years of quitting smoking, regardless of the age you are when you quit.

Thus, it is never too late to quit smoking to reduce the risk of complications in type 2 diabetes.

Diabetes Complications
To avoid type 2 diabetes, it’s time to stop drinking sugary drinks
Swapping the daily consumption of one serving of a sugary drink with either water or unsweetened coffee/tea could lower the risk of developing diabetes by between 14% and 25% according to research in Diabetologia. This UK study, which was covered in The Daily Telegraph, shows the importance of lowering free sugar intake from all sources, especially in those with pre-diabetes. It found the risk of developing type 2 diabetes may increase by 18% for each 5% increase of a person's total energy intake provided by sweet drinks.

Drinking “sugar-sweetened beverages” such as fizzy pop drinks, colas, squashes, and sweetened juice drinks is already discouraged in those at risk of type 2 diabetes. This study was the first to show that milkshakes and flavoured milk should also be added to the list.

The role of “artificially sweetened beverages” (i.e “diet” or “low calorie” drinks) was unclear. Those who drank these showed an increased risk of developing type 2 diabetes, but they also tended to be overweight and so preferentially drank such types of drinks to aid their weight loss. On the other hand, previous studies have suggested artificially sweetened beverages may increase the risk of type 2 diabetes. The jury is out on this one for people without diabetes, but for those with diabetes these drinks are a much better alternative to sugary drinks, which should always be avoided.

The simple take-home lifestyle message is to reduce overall daily sugar intake and that replacing sweetened drinks with water or unsweetened tea/coffee will help achieve this and also cut the risk of developing type 2 diabetes in those at high risk. Those with diabetes should not be having sugary drinks.

Diabetes Lifestyle
The role of genes in type 2 diabetes
An important new gene discovery may change the way type 2 diabetes is treated and prevented. Teams from Europe, USA and Asia analysed the genes of 97,000 people, of whom 16,000 had type 2 diabetes. Their findings, published in Nature, showed that a genetic mutation in one particular gene, called the glucagon-like peptide 1 (GLP1R) gene, helped prevent diabetes. Those who had this gene mutation were 14% less likely to suffer from type 2 diabetes, yet it had no effect on their body mass index or their risk of becoming obese.

Researchers hailed this as a “critical finding” which might help in the development of novel therapies to both prevent and treat type 2 diabetes. As with all of these types of discoveries, more research is needed, especially as it is not clear how this mutation actually works to prevent diabetes.

The role of genes in type 2 diabetes continues to be explored. It is acknowledged that the propensity to lay down fat in the abdomen (central obesity) is linked to certain genes. According to a new study in Diabetes Care being genetically predisposed to having central obesity does also increase the risk of type 2 diabetes.

Central obesity is measured by calculating the waist-to-hip size ratio and researchers measured this and then carried out gene analysis on 2,591 adults with type 2 diabetes and on 3,052 without it. They then assigned each a “central obesity genetic score” and found a direct link between this score and an increased risk for type 2 diabetes, regardless of any other lifestyle and risk factors. This suggests a possible causal relationship between central obesity and type 2 diabetes.

Whilst none of us can alter our genes (yet!), it is important to try to reduce weight and waist circumference in type 2 diabetes.

Diabetes Research
Nanotechnology may hold key to treating diabetic foot ulcers
Technology is not all about apps and gadgets: it can be about genes too. A novel gene regulation technology has been added to a standard moisturiser to produce a lotion that may help heal diabetic foot ulcers and even prevent them. Such ulcers are notoriously difficult to heal and can be very painful for sufferers.

An enzyme called GM3 synthase reduces the growth factors that lead to normal wound healing in people with type 2 diabetes. By adding certain “spherical nucleic acids (SNAs)” to a lotion it becomes possible to reduce the negative effect of this enzyme on normal wound healing, just by rubbing it into the skin.

So far a study, published in Proceedings of the National Academy of Sciences and explained by website Futurity, has shown that this all works in mice at least; wounds healed in two thirds of the normal time and blood circulation at the wound site also increased.

It is hoped that an ointment could be developed in the future that not only heals foot ulcers but prevents them too. Its regular use might even be able to prevent diabetic peripheral neuropathy, something which would just be the icing on the sugar-free diabetic cake!

These spherical nucleic acids do seem to represent an exciting possibility for the future. We just have to hope that what is good for mice is also good for humans too…

Diabetes Technology
Metformin underused in US to treat pre-diabetes
A new US analysis, from the Annals of Internal Medicine, has found that only 3.7% of those with pre-diabetes are prescribed metformin, despite the US guidelines which encourage a much higher use. Around a third of all Americans have pre-diabetes, which is when people have raised fasting blood glucose levels (100 -125 mg/dl) but not high enough to be “full-blown” type 2 diabetes (above 125 mg/dl).

The good news is that pre-diabetes is reversible. If lifestyle improvements are undertaken then the likely progression from pre-diabetes to diabetes can be delayed or reversed. Pre-diabetes is not a “wait and see what happens” condition. It is a call for people to change their lifestyle, lose weight, exercise more and eat a healthier diet before they progress to type 2 diabetes. Alongside these lifestyle changes, there is also a role for metformin.

The American Diabetes Association (ADA) guidelines suggest metformin therapy for prevention of type 2 diabetes may be considered in those with “impaired glucose tolerance, impaired fasting glucose, or an HbA1c 5.7–6.4%” and especially for those with “body mass index >35 kg/m2, aged <60 years, and women with prior gestational diabetes mellitus”.

This analysis showed fewer that one in 12 of the latter, highest-risk group were taking metformin; a figure which the authors of the study thought was far too low. However, one complication is that metformin is not actually approved for use in pre-diabetes by the US Food and Drug Administration (FDA), but this is mainly due to a quirk in the approval system, not because it does not work.

In the UK, the National Institute for Clinical Excellence (NICE) guidelines suggest that metformin may be offered to those at high risk of type 2 diabetes for whom a “quality-assured intensive lifestyle-change programme” has proven unsuccessful or is not a viable option.

It is also worth pointing out that there are experts who argue against the label of “pre-diabetes”, and this article gives a brief review of their stance.

Whether the actual label is helpful or not overall, if it promotes a change of lifestyle to a healthier one then it does have at least one benefit…
Diabetes Treatment
You are not alone… famous people with type 2 diabetes: Drew Carey
The US sitcom star and game show host was diagnosed with type 2 diabetes. This motivated him to lose 80 pounds in weight. Read his story in People magazine here.

A word of warning, if you too wish to lose weight, please do not just follow his chosen “no carbs” diet - please consult with your diabetes care team instead.

And Finally…
If you use an insulin pen I have one question for you - how big is your needle? Mine are 8mm but now I am thinking they may be too big thanks to new research published in the Journal of Clinical & Translational Endocrinology. This study suggests that swapping to 4mm pen needles just might improve my blood glucose control. The truth is I can’t even remember why I use the 8mm needles. I was given them at the clinic and I never really thought much about it since…

The idea that using shorter, finer-gauge needles has advantages is not new, but this is the first study to show actual improvement in glucose control and lowered daily consumption of insulin, and all this after only three months of use! These results were achieved by better injection technique and by swapping to 4mm needles from longer, wider-gauge needles. This also led to less painful injections and greater “satisfaction with therapy”.

To me, this seems to be a simple way to improve my life with diabetes, so I might just ask to swap to 4mm needles. The only problem is that I still have three full boxes of 8mm needles to get through before then…

Once I have swapped, I will give you my update!
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
NYTimes Health (@NYTHealth)
Substituting a serving a day of water for a sugar-sweetened soft drink can reduce the incidence of diabetes.
Euro Pharma Review (@PharmaReview)
#Toujeo approved in the EU for the treatment of #diabetes in adults @sanofi RT
Intensive insulin therapy in patients w type 1 diabetes associated w reduced long-term risk of ocular surgery.
Paul Sonnier (@Paul_Sonnier)
1st natural birth for diabetic woman w/artificial pancreas… @OCHWW #DigitalHealth #WearableTech
Berci Meskó, MD, PhD (@Berci)
New paper: Diabetes Social Media: A Tool to Engage Patients.… #hcsm
Follow Diabetes Insights
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.
Explain This!
What is the relationship between type 2 diabetes and high blood pressure?
Click here to find out
Powered by Curation© Corporation
25 Copthall Avenue | London | EC2R 7BP | United Kingdom
Curation Corporation Limited is registered in England no.07864348
Curation Corporation Limited is an Appointed Representative of Makor Securities LLP who are authorised and regulated by the Financial Conduct Authority.