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A Year of Diabetes Research 2010

Prevention, therapy and complications are the keystones for diabetes research. It would be impossible to cover all of the developments in just one feature. So here is a brief summary of some of the best for 2010.

Number 1: A1c for Diagnosis of Diabetes:

In January, the American Diabetes Association issued its annual update of its Standards of Medical Care in Diabetes.  The most notable change from previous years was the introduction of A1c as a suitable test for diagnosing diabetes. This decision followed the report of an international expert committee that recommended using the A1c test to diagnose diabetes with a threshold of ≥ 6.5%. More studies are likely to follow. Diabetes Care, Jan. 2010

Number 2: Cancer Risk Factors in Diabetes

Landman and colleagues used data from the ZODIAC [Zwolle Outpatient Diabetes project Integrating Available Care] study in The Netherlands to conclude that although patients with type 2 diabetes are at increased risk for cancer, metformin use was associated with lower cancer mortality compared with non-use (hazard ratio 0.43, 95% confidence interval [CI] 0.23-0.80). Diabetes Care, Feb. 2010

Number 3: Long and Short Sleep Duration Increases Risk for Diabetes

The meta-analysis showed that both short and long duration of sleep (5-6 and 8-9 hours, respectively) were associated with greater risk for incident diabetes. Furthermore, difficulty initiating and maintaining sleep also increased diabetes risk. Diabetes Care, Feb. 2010

Number 4: Statin Use and Risk for Diabetes:

Combining data from 13 clinical trials, 174 more cases of incident diabetes occurred in the groups assigned to statin treatment than in the placebo or standard-care groups, representing a 9% increase in the likelihood of development of diabetes during follow-up, or 1 additional case of diabetes per 255 statin-treated patients over 4 years. The risk was stronger in trials with older participants, but baseline body mass index and percent change in LDL-cholesterol did not seem to be important factors. Diabetes Care, March 2010

Number 5: ACCORD: Unexpected Findings For ACCORD

The blood pressure and lipid arms of the ACCORD (Action to Control Cardiovascular Risk in Diabetes). In ACCORD BP, targeting a systolic blood pressure less than 120 mm Hg did not reduce the rate of major cardiovascular events compared with targeting a BP less than 140 mm Hg. The ACCORD Lipid trial, also published in April, tested the combination of fenofibrate and simvastatin compared with simvastatin alone and failed to find a difference in the primary outcome of nonfatal myocardial infarction, nonfatal stroke, or death from CVD. Diabetes Care, April 2010

Number 6: The Post-Hoc Analysis of ACCORD

In an effort to understand the unexpected finding that tight glycemic control increased risk for mortality in the ACCORD trial, a post-hoc epidemiologic analysis of the data was published. Higher average A1c was associated with greater risk for death, as each 1% greater mean A1c was associated with an approximate 20% increase in all-cause mortality. The original ACCORD finding that mortality risk was greater with the intensive strategy than with the standard strategy appeared to hold only when average A1c was > 7%. Diabetes Care, May 2010

Number 7: Dietary Advice Provides Small Gains

Lifestyle Over and Above Drugs in Diabetes (LOADD) study, which investigated whether dietary advice could improve glycemic control and risk factors for cardiovascular disease in people with persistent hyperglycemia (A1c > 7%) despite drug treatment optimized according to current guidelines. After 6 months, A1c in the intervention group declined from a mean of 8.9% to 8.4% but remained unchanged (8.6%) in the control group. Significant favorable differences were also observed in weight, body mass index, and waist circumference. Diabetes Care July, 2010

Number 8: ACCORD Reports Favorable Findings:

 Although intensive treatment of hyperglycemia did not improve the primary outcomes, secondary outcome measures favored intensive therapy. Thus, whereas risks for advanced microvascular composite outcomes that included renal dialysis or transplantation and retinal photocoagulation were not reduced, intensive therapy did delay the onset of albuminuria, some eye complications, and neuropathy.   Diabetes Care, Aug. 2010

Number 9: Diabetes Drugs Pose Risks

The debate over whether rosiglitazone is safe for patients with diabetes was rendered irrelevant in September when the US Food and Drug Administration restricted access to the drug. Rosiglitazone will be available to new patients only if other drugs have failed and the patient has medical reasons for not taking pioglitazone. Current patients will be allowed to continue rosiglitazone only if they acknowledge that they understand the potential risks. Also, the European Medicines Agency banned rosiglitazone from its markets. Diabetes Care, Sept.2010

Number 10: Fracture Risk with Thiazolidinediones

 An observational case-control study using data from the Translating Research into Action for Diabetes (TRIAD) study reported that in women aged 50 years and older, exposure to TZDs increased the odds of fracture by 71% (odds ratio [OR] 1.71, 95% CI 1.13-2.58). The OR of fracture was also dramatically increased among men taking TZDs, but only if they did so in conjunction with loop diuretics (OR 3.46, CI 1.06-11.28). Diabetes Care, Oct. 2010

Number 11: Prevention Falling Short

Diagnosis of individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and subsequent prevention efforts remain inadequate. In a study of 1547 adults, 3.4% reported receiving a previous diagnosis of “impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or pre-diabetes,” but 584 (38%) had IFG and/or IGT. No patient with pre-diabetes reported receiving oral antihyperglycemic medications, and fewer than one third reported receiving counseling for exercise, diet, or both. Diabetes Care Nov. 2010

Number 12: Depression and Diabetes Linked

Several studies showed the apparently bidirectional link between depression and diabetes. Although this link has long been recognized, the real story here was that treatment with antidepressants was implicated as a risk factor in 3 of those studies, confirming an earlier report from the Diabetes Prevention Program. Unlike statins, which were associated with a relatively small increased risk for diabetes (9%), the risk associated with antidepressants was up to 2.5 times greater. Diabetes Care, Dec. 2010

These are just a few of the many studies that diabetes research presented in 2010. We can only imagine what 2011 will bring. 

The staff at Diabetes In Control will continue to bring you the most important information in Diabetes Research and Care for 2011.