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Issue 10 Alzheimer’s Insights by Curation Health 28 May 2015
Exciting news that Saxenda may delay the onset of type 2 diabetes has made a stir this week: we look at the research. New hopes for a cure for proliferative diabetic retinopathy have also been raised. Diabetic peripheral neuropathy is viewed from both ends: when does it start and, in the end, what can be done about it… is a vegan diet the answer? Finally, we look at smart pill boxes that remind us to take our tablets.
Most read stories this week
SAHF wins BMJ “Diabetes Team Of The Year” award
Talented bacteria detect cancer, diabetes
The marathon of diabetes
Novo Nordisk says 3-year Saxenda treatment reduced diabetes risk
Treatment with Saxenda for three years reduced the risk of developing type 2 diabetes
Obesity drug Saxenda delays onset of type 2 diabetes
©Novo Nordisk
New results have shown that treating obesity using the drug Saxenda (liraglutide) can delay the time it takes for obese people to progress to develop type 2 diabetes. Manufacturer of Saxenda, Novo Nordisk, has just announced the results of the SCALE Obesity and Prediabetes study which was carried out in more than 3,700 overweight or obese people with co-morbidities and prediabetes at the start of the study.

This study showed that treatment with Saxenda, in combination with a low-calorie diet and increased physical activity, led to a delay in the onset of type 2 diabetes and a reduction in the risk of developing the disease. The Saxenda group was compared to a control group who were treated with placebo, also in combination with the same diet and exercise advice. Those people who received Saxenda took 2.6 times longer to develop type 2 diabetes and the overall risk of developing the disease was reduced by approximately 80 per cent.

Weight loss was greater in the Saxenda group, with participants losing an average of 6.1 per cent of their body weight at baseline, compared to 1.8 per cent in the placebo group and over 24 per cent of people lost over 10 per cent of their body weight, compared to only 9.4 per cent in the placebo group.

Saxenda works by mimicking a hormone made in the intestines, called glucagon-like peptide (GLP-1), that tells the brain when you are full. Saxenda has already been mooted as “the most important weight loss medication ever developed” by the Huffington Post. The medicine may be familiar to those people with type 2 diabetes who use it in a lower dose formulation known as Victoza - this is an injectable medicine taken once a day and is delivered with the Victoza Pen.

Diabetes Treatment
Vegan diet of benefit in diabetic peripheral neuropathy
This week we return to the benefits of fibre and vegetables as a new study has shown a positive effect of a vegan diet on diabetic neuropathy. Researchers found that a group of people with diabetes who switched to a total plant-based diet had less pain from their diabetic neuropathy and felt better. Many also lost weight and had improved blood glucose control.

This small study from the journal Nutrition and Diabetes compared two groups of 17, overweight adults, all of whom had diabetic neuropathy. One group was put on a low-fat, high-fibre vegan diet consisting only of fresh vegetables, given a regular vitamin B12 supplement and attended weekly nutrition classes. The other group were only given the regular vitamin supplement. After five months, the vegan diet group had lost, on average, 14 pounds each, they reported that they felt better and had less pain and tests indicated they had improved blood circulation and nerve function.

Many also had noticed improvements in their ability to control their levels of glucose (improved insulin sensitivity), leading to a reduction in the amount of medication necessary.

The study was carried out by researchers at the Physicians Committee for Responsible Medicine (PCRM), a non-profit organisation that focusses on research into reducing the amount of medication required by adopting healthy diets. They suggest that by increasing insulin sensitivity and improving blood glucose levels, this diet regime allowed the body time to fix the nerve damage and so reduce the discomfort from a painful diabetic neuropathy.

However, before you decide to “go vegan” it is worth bearing in mind that the study doesn’t demonstrate exactly what it was about this vegan diet that brought about the improvements. It could just be that this diet offers an effective way to lose weight and it is this that actually leads to the benefits seen.

Diabetes Lifestyle
Newly discovered cause of retinopathy may lead to new treatments
New research from the Johns Hopkins University School of Medicine just published in Proceedings of the National Academy of Science has found a second culprit that may be involved in excessive blood vessel growth that occurs in a proliferative diabetic retinopathy: it is a protein called angiopoietin-like 4.

Proliferative retinopathy is a common complication of diabetes, resulting when high blood sugar levels damage the cells at the back of the eye and cause new blood vessels to grow haphazardly. Scientists have known for some time that there is a protein, known as vascular endothelial growth factor (VEGF), which is produced in response to low oxygen levels in the eye, which stimulates the growth of these new and abnormal blood vessels.

Several recently developed drugs are now available that block the action of VEGF in an effort to slow the progression of retinopathy. But, these drugs – bevacizumab, ranibizumab and aflibercept – have not proved reliable in preventing proliferative retinopathy.

The researchers identified the new angiopoietin-like 4 protein by comparing the effects of fluid taken from healthy people, from people with diabetes and no retinopathy, and from people with diabetic retinopathy of varying severity. They looked first at the levels of VEGF in the fluid and also at the fluids’ ability to stimulate blood vessel growth in lab-grown cells. They found that although the level of VEGF tended to be higher in people with proliferative diabetic retinopathy, there were some examples where the levels were actually lower than in healthy people. This low-VEGF fluid however, was still able to stimulate blood vessel growth. This suggested that, although VEGF clearly plays an important role in blood vessel growth, it was not the only factor.Further work led to the identification of angiopoietin-like 4 and when the action of both of these proteins was blocked, blood vessel growth in lab-grown cells was markedly reduced.

If a drug can be found that safely blocks the angiopoietin-like 4 protein’s action, it could be combined with the anti-VEGF drugs to prevent many cases of proliferative diabetic retinopathy. This would be an important breakthrough.

Diabetes Research
Peripheral neuropathy is also seen in pre-diabetes
Having just looked at how a change of diet might help reduce the pain of diabetic peripheral neuropathy we look now at the other end of the spectrum: new research published in Diabetes Care has shed light on when a diabetic peripheral neuropathy begins to develop and what factors might affect it.

Previous studies have provided contradictory results on the prevalence of peripheral neuropathy in newly diagnosed and pre-diabetic patients. The Prospective Metabolism and Islet Cell Evaluation (PROMISE) study was set up to look at the effect of type 2 diabetes risk factors on metabolism and nerve function. These included family history, obesity, high blood pressure and diabetes during pregnancy. 467 people were studied to see the correlation between development of diabetes and nerve function three years down the line. Peripheral neuropathy was measured by measuring an ability to detect vibration (vibration perception threshold or VPT).

Of the 467 patients who were followed up, 344 had normal glycaemic control, 101 had prediabetes and 22 had new onset diabetes. However, peripheral neuropathy was detected in all groups, as 29 per cent of the normal glycaemic control group had the condition, while the numbers affected in the prediabetes and new onset groups were almost the same, at 49 percent and 50 per cent respectively. When they looked specifically at nerve dysfunction, the average VPT was 6.5 for those with normal glycaemic control, 7.9 for those with prediabetes and 7.6 for those with new onset diabetes.

The researchers concluded that people with prediabetes have a very similar risk of peripheral neuropathy and severity of nerve dysfunction as those with new onset diabetes and that the condition may well be present even without a diagnosis of diabetes. They suggest that medical professionals must be much more vigilant in testing for nerve dysfunction in these types of people and all patients, both young and old, should be better educated about the signs and symptoms of peripheral neuropathy.

Symptoms such as numbness, altered sensation, tingling, pins and needles or burning of the feet could be a sign of developing neuropathy.

Diabetes Complications
Intelligent pill box helps users take their tablets
In type 2 diabetes it really is important to “keep taking the pills” but not all of us have a personal butler to remind us that is time to self-medicate. The role of telehealth programs in encouraging people with type 2 diabetes to take their medicines regularly was highlighted in a study reported in Telemedicine and e-Health. Thirty participants from an “urban poor clinic population” in the US were given an electronic pill box, a Bluetooth-enabled blood glucose monitor and an automatic blood pressure cuff.

When their pills were being taken, the electronic pill boxes uploaded this information via mobile phone networks to online servers and the compliance to therapy could be analysed.

The participants were given daily reminders on which pills to take and when, and users were also given feedback on how they were doing, including regular phone calls from two clinical nurse care coordinators who surveyed the data.

The result was improved adherence to medications which led to a drop in the mean HbA1c from 8.3% to 7.7%. As a reminder, the National Institute of Clinical Excellence (NICE) recommends target HbA1c levels of between 6.5% and 7.5%.

This shows that there is great potential to manage type 2 diabetes in better ways remotely, thanks to such smart connected devices and some human input. The human element is important because even the fanciest technology is no substitute for old-fashioned human compassion and understanding.

Diabetes Technology
You are not alone… famous people with type 2 diabetes
Legendary tennis player Billie Jean King was diagnosed with type 2 diabetes in her early sixties. Read her personal story here.
And Finally… South Asian Health Foundation wins BMJ “Diabetes team of the year” award
South Asian Health Foundation wins BMJ “Diabetes team of the year” award Congratulations this week go to The South Asian Health Foundation (SAHF) which has been named “Diabetes Team of the Year” at the 2015 British Medical Journal Awards. Their community education programme targeted South Asian communities in the UK helping to remove the cultural barriers that may prevent those with type 2 diabetes from self-managing their condition or engaging fully with NHS services.

Compared to white Europeans, South Asians are six times more likely to develop Type 2 diabetes and it also tends to develop at a younger age. This means the complications of type 2 diabetes are then likely to develop at a younger age too. Of the three million South Asians living in the UK, around 388,000 live with type 2 diabetes, so it is important that this community’s health needs are optimally met.

The upcoming season of Ramadan will present a challenge to all those with type 2 diabetes who may wish to fast. The Muslim Council of Britain Diabetes Advisory Group guidelines on this issue are too complex to summarise here, so they are best downloaded. It goes without saying that anyone with type 2 diabetes wishing to fast during Ramadan should discuss this with their diabetes care team.

For a full analysis of the medical effects of fasting in Ramadan with diabetes, this US Diabetes Care article from 2010 is a good summary.
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.
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Divers with diabetes are at risk of sudden loss of consciousness.
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The Future of Diabetes Management: 8 Reasons Why We Face Extraordinary Times! #digitalhealth
I Am Biotech (@IAmBiotech)
New study: Uncontrolled blood sugar may affect cognition and the brain years before #dementia symptoms arise
The King's Fund (@TheKingsFund)
.@Jeremy_Hunt sets out his priorities as new Health Secretary: obesity & diabetes, general practice & NHS culture…
Pascal Meier, MD,BMJ (@pascalmeier74)
Google reveals state of our health: searches for anxiety, dementia and diabetes soar
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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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