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Ryder B.,Diabetes and Endocrine Unit | McKnight J.,Western General Hospital Edinburgh | Blann A.,Sandwell and West Birmingham Hospitals NHS Trust | Dhatariya K.,Norwich University | And 6 more authors.
Practical Diabetes | Year: 2013

• A recent 'joint investigation by the BMJ and Channel 4's Dispatches current affairs programme' has brought widespread attention to the possibility that GLP-1 based therapies may cause pancreatic damage • A plausible mechanism has been proposed by which GLP-1 based therapies might lead to pancreatitis and even pancreatic cancer. The animal data behind this mechanism are inconsistent and the human histological data are preliminary and open to alternative explanations. Nevertheless, a cautious approach would seem reasonable • The single observational study in support of the hypothesis that GLP-1 based therapies cause pancreatitis is open to criticism and is not supported by other such observational studies • Results from studies involving adverse events reporting systems cannot be relied upon because of 'notoriety bias' • In the ABCD nationwide audits of GLP-1 receptor agonists (GLP-1RAs) in real clinical use in the UK, use of these agents was associated with improvements in glycaemic control and weight and reduction in other diabetes therapies, in particular insulin. Alongside this there were very few reports of pancreatitis and 75% of these had an alternative explanation • GLP-1RAs reduce all the major risk factors for cardiovascular (CV) disease. Meta-analyses of existing randomised controlled trials involving DPP4 inhibitors suggest significant reductions in major CV events alongside no increase in pancreatitis or cancer. The eight, long-term, CV safety studies should clarify the issue with regard to risk and benefits of GLP-1 based therapies as they will record not only CV outcomes but also information on pancreatitis, pancreatic cancer and thyroid cancer • The strength of the data in support of GLP-1 based therapies causing pancreatic damage does not justify the alarm that has been caused to patients taking these therapies. By stopping these agents in response to the scare that has been created, harm to patients may occur because of the discontinuation of the agents in whom they were working well • Pharmaceutical companies should make all relevant data available for inspection by independent experts. Copyright © 2013 John Wiley & Sons.


News Article | April 18, 2016
Site: www.rdmag.com

Transplants of insulin-producing pancreas cells are a long hoped-for treatment for diabetes — and a new study shows they can protect the most seriously ill patients from a life-threatening complication of the disease, an important step toward U.S. approval. These transplants are used in some countries but in the U.S. they're available only through research studies. Armed with Monday's findings, researchers hope to license them for use in a small number of people with Type 1 diabetes who are most at risk for drops in blood sugar so severe they can lead to seizures, even death. "Cell-based diabetes therapy is real and works and offers tremendous potential for the right patient," said study lead author Dr. Bernhard Hering of the University of Minnesota, whose team plans to seek a Food and Drug Administration license for the therapy. In Type 1 diabetes, the immune system destroys the pancreatic cells responsible for making insulin, a hormone crucial to converting blood sugar into energy. About 1 million Americans have Type 1 diabetes and depend on regular insulin shots to survive but still can experience complications due to swings in their blood sugar. Diabetics who get kidney transplants sometimes also receive pancreas transplants at the same time, essentially curing their diabetes. But it's an uncommon and grueling operation, so scientists for years have worked on a minimally invasive alternative: Infusing patients with just islet cells, the insulin factories inside the pancreas. The questions: How best to obtain those islet cells from deceased donors, and who benefits most from transplants? When glucose levels drop too low, most people with Type 1 diabetes experience early warning signs — slurred speech, tremors, sweating, heart palpitations — so they know to eat or drink something for a quick sugar boost. But even with optimal care, about 30 percent eventually quit experiencing those symptoms, a condition called hypoglycemia unawareness. They can be in grave danger if their blood sugar plummets when no one else is around to help. Continuous glucose monitors can counteract that problem, but even those don't help everyone. The National Institutes of Health targeted that fraction of highest-risk patients, funding a study that gave 48 people at eight medical centers at least one islet cell transplant. A year later, 88 percent were free of severe hypoglycemia events, had their awareness of blood sugar dips restored, and harbored glucose levels in near-normal ranges. Two years later, 71 percent of participants still were faring that well, concluded the study published by the journal Diabetes Care. The goal wasn't insulin independence, which requires more functioning islet cells than merely restoring blood sugar awareness. But some patients — 52 percent after one year — no longer needed insulin shots and others used lower doses. "It's just an amazing gift," said Lisa Bishop of Eagle River, Wisconsin, who received new islet cells in 2010 and no longer needs insulin shots. Bishop recalls the terror of learning she'd become hypoglycemic unaware, and the difficulty of even holding a job. She hasn't had hypoglycemia since the transplant and says if her blood sugar occasionally dips a bit after exercise, "now my body senses it." Another key: The transplants have long been used experimentally but different hospitals use different methods to cull the islet cells from a donated pancreas and purify them — and it wasn't clear which worked best, explained Dr. Nancy Bridges, chief of the transplant branch at NIH's National Institute for Allergy and Infectious Diseases. The FDA made clear that there had to be a standard method for islet cell transplants if they were ever to be approved — which is necessary for insurance coverage — so the researchers developed that recipe, Bridges said. Side effects include bleeding and infection, and recipients need lifelong immune-suppressing drugs to avoid rejecting their new cells. Even if given the OK for more routine use, donated pancreas cells are in limited supply. Still, "it's a very beautiful study," said Dr. Julia Greenstein of the diabetes advocacy organization JDRF, who wasn't involved in the latest research. "For most people in the U.S., this was not an available choice, and this is the first step in making that an available choice."


Pearson T.L.,Diabetes Care
Journal of Diabetes Science and Technology | Year: 2010

Insulin pen devices have several advantages over the traditional vial-and-syringe method of insulin delivery, including improved patient satisfaction and adherence, greater ease of use, superior accuracy for delivering small doses of insulin, greater social acceptability, and less reported injection pain. In recent years, pens have become increasingly user-friendly, and some models are highly intuitive to use, requiring little or no instruction. Despite this progress, uptake of these devices in the United States has not matched that in many other areas of the world. There is a need for improved awareness of the current characteristics of insulin pen devices among United States health care professionals. Knowledge of the design improvements that have been incorporated into pens, both to address patient needs and as a result of the improved technology behind the device mechanics, is essential to promoting the use of insulin pen devices. This review highlights some of the practical aspects of pen use and discusses the factors to be considered when selecting among different insulin pens. © Diabetes Technology Society.


News Article | August 24, 2016
Site: www.biosciencetechnology.com

Diabetes has become one of the top causes of vision loss around the world, according to an article published on August 23, 2016 in Diabetes Care journal by a global consortium led by researchers at Nova Southeastern University's (NSU) College of Optometry in Fort Lauderdale/Davie, Florida, and the Vision and Eye Care Unit at Anglia Ruskin University in Cambridge, United Kingdom. Blindness and visual impairment due to diabetic retinopathy (DR) increased significantly in the 20-year period researchers analyzed. In 2010, one in every 39 blind people was blind due to DR, which increased 27 percent since 1990. Of those with moderate or severe vision impairment, one in 52 people had vision loss attributed to diabetes, an alarming increase of 64 percent since 1990. Poor control of glucose levels and lack of access to eye health services in many parts of the world are thought to contribute to this increase, according to the researchers. As more people live longer with diabetes, there is a higher risk of developing DR and subsequent vision loss. DR is a condition resulting from chronically high blood sugar from diabetes in which the delicate blood vessels in the lining of the inside of the eye (retina) become damaged and start leaking and distorting vision, according to the National Eye Institute. In DR's most advanced stage, new abnormal blood vessels grow, damaging the retina and leading to permanent scarring and vision impairment or blindness. "Unfortunately diabetic retinopathy usually does not have any symptoms in the early stages," says Janet Leasher, O.D., M.P.H., co-author of the report and a professor at NSU's College of Optometry. "People diagnosed with diabetes should have a dilated eye health exam at least every year and be advised by their eye care practitioner for their personal situation. Patients should work closely with their health care provider to determine the best methods to control their blood sugar levels." During the 20-year period analyzed in this study, the regions of the world with the highest number of people visually impaired by DR were South Asia, Middle East & North Africa, and West Sub-Saharan Africa. The regions with the highest number of people who were rendered blind from DR were East Asia, Tropical Latin America, and South Sub-Saharan Africa. In people older than 50, the greatest increase in the prevalence of blindness caused by DR occurred in South Sub-Saharan Africa, Southern Latin America Central Sub-Saharan Africa. Those regions with the greatest increase in the prevalence of visual impairment caused by DR in this age group lived in Central, South and Tropical Latin America. Results showed a slight decrease in visual impairment caused by DR in South and Southeast Asia, Oceania, and East and West Sub-Saharan Africa. "With the alarming prevalence of vision loss due to diabetes rising more than two-thirds in the last 20 years, the precipitous global epidemic of diabetes must be addressed," said Rupert R.A. Bourne, FRCOphth, M.D., lead investigator of the report, ophthalmologist and professor and associate director of the Vision and Eye Research Unit at Anglia Ruskin University. The authors recommend public policy planning in regions most affected by DR, including: The estimates in this study form part of the broader research of the Global Vision Database, which seeks to estimate and report on the changes over time in the causes and prevalence of vision loss.


News Article | April 19, 2016
Site: www.biosciencetechnology.com

Transplants of insulin-producing pancreas cells are a long hoped-for treatment for diabetes - and a new study shows they can protect the most seriously ill patients from a life-threatening complication of the disease, an important step toward U.S. approval. These transplants are used in some countries but in the U.S. they're available only through research studies. Armed with Monday's findings, researchers hope to license them for use in a small number of people with Type 1 diabetes who are most at risk for drops in blood sugar so severe they can lead to seizures, even death. "Cell-based diabetes therapy is real and works and offers tremendous potential for the right patient," said study lead author Dr. Bernhard Hering of the University of Minnesota, whose team plans to seek a Food and Drug Administration license for the therapy. In Type 1 diabetes, the immune system destroys the pancreatic cells responsible for making insulin, a hormone crucial to converting blood sugar into energy. About 1 million Americans have Type 1 diabetes and depend on regular insulin shots to survive but still can experience complications due to swings in their blood sugar. Diabetics who get kidney transplants sometimes also receive pancreas transplants at the same time, essentially curing their diabetes. But it's an uncommon and grueling operation, so scientists for years have worked on a minimally invasive alternative: Infusing patients with just islet cells, the insulin factories inside the pancreas. The questions: How best to obtain those islet cells from deceased donors, and who benefits most from transplants? When glucose levels drop too low, most people with Type 1 diabetes experience early warning signs - slurred speech, tremors, sweating, heart palpitations - so they know to eat or drink something for a quick sugar boost. But even with optimal care, about 30 percent eventually quit experiencing those symptoms, a condition called hypoglycemia unawareness. They can be in grave danger if their blood sugar plummets when no one else is around to help. Continuous glucose monitors can counteract that problem, but even those don't help everyone. The National Institutes of Health targeted that fraction of highest-risk patients, funding a study that gave 48 people at eight medical centers at least one islet cell transplant. A year later, 88 percent were free of severe hypoglycemia events, had their awareness of blood sugar dips restored, and harbored glucose levels in near-normal ranges. Two years later, 71 percent of participants still were faring that well, concluded the study published by the journal Diabetes Care. The goal wasn't insulin independence, which requires more functioning islet cells than merely restoring blood sugar awareness. But some patients - 52 percent after one year - no longer needed insulin shots and others used lower doses. "It's just an amazing gift," said Lisa Bishop of Eagle River, Wisconsin, who received new islet cells in 2010 and no longer needs insulin shots. Bishop recalls the terror of learning she'd become hypoglycemic unaware, and the difficulty of even holding a job. She hasn't had hypoglycemia since the transplant and says if her blood sugar occasionally dips a bit after exercise, "now my body senses it." Another key: The transplants have long been used experimentally but different hospitals use different methods to cull the islet cells from a donated pancreas and purify them - and it wasn't clear which worked best, explained Dr. Nancy Bridges, chief of the transplant branch at NIH's National Institute for Allergy and Infectious Diseases. The FDA made clear that there had to be a standard method for islet cell transplants if they were ever to be approved - which is necessary for insurance coverage - so the researchers developed that recipe, Bridges said. Side effects include bleeding and infection, and recipients need lifelong immune-suppressing drugs to avoid rejecting their new cells. Even if given the OK for more routine use, donated pancreas cells are in limited supply. Still, "it's a very beautiful study," said Dr. Julia Greenstein of the diabetes advocacy organization JDRF, who wasn't involved in the latest research. "For most people in the U.S., this was not an available choice, and this is the first step in making that an available choice."

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