Safety of Type 2 Diabetes Medications

December arrives with many parties to attend. If you need ideas for what to make during the holidays, please check out Diabetic-Recipes. There are excellent menus for the holidays available. For example, I have a list of easy recipes to use for a holiday hors d’oeuvres party.

And if you’re looking for the perfect gift for someone with diabetes, check out the list I put together on Diabetic-Lifestyle. You can find a great holiday gift idea there.

Type 1 Diabetes and Renal Disease
The December Diabetes Journal has an interesting article for those of us with type 1 diabetes who work hard to keep renal disease at bay. The article is “Haptoglobin genotype and renal function decline in type 1 diabetes” by Tina Costcou et al.

Haptoglobin (Hp) binds free Hb, inhibiting Hb-induced oxidative damage. As oxidative stress has been associated with microvascular complications, these researchers examined the relationship between the Hp genotype and microalbuminuria, macroalbuminuria, end-stage renal disease (ESRD), and early renal function decline in type 1 diabetes.

Participants were selected from the Epidemiology of Diabetes Complication Study. The researchers chose the participants who had had DNA work-ups done so that they could review the Hp genotype in their DNA.

Participants were studied for the incidence of microalbuminuria, macroalbuminuria, and ESRD. They were also studied for renal function decline.

The researchers found that the Hp genotype isn’t directly associated with albuminuria, but it’s possible that it’s connected to early renal function decline and the progression to ESRD. It could be that having the Hp genotype is a determinant of possible renal problems.

To read the abstract of the study, go here.

Taking Aspirin When You Have Diabetes
We’ve all read the headlines about taking aspirin to prevent cardiovascular disease and those that say that diabetics are not helped by this medication.

December’s Diabetes Care has an article which may help you and your physician make this decision. The article is “Aspirin for primary prevention of cardiovascular events, a systematic review and meta-analysis comparing patients with and without diabetes” by Andrew D. Calvin, MD, MPH et al.

Recently, two randomized controlled trials have challenged current guidelines and recommendations for using aspirin for primary prevention of cardiovascular events in people with diabetes. The researchers in this study conducted a search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopes (all medical databases that store study results). The researchers searched these databases from when they began until November 2008. They were looking for other randomized controlled studies that looked at the benefit of aspirins. Within those studies, the researchers were examining the relative risk ratios for cardiovascular events among patients with and without diabetes.

The researchers found nine randomized controlled studies with moderate to high methodological quality. The relative risk ratios comparing the benefit of aspirin among patients with diabetes compared with patients without diabetes for mortality, myocardial infarction, and ischemic stroke were 1.12, 1.19, and 0.70 respectively. The authors concluded that the relative benefit of aspirin is similar in patients with and without diabetes.

The full abstract can be found here.

Driving with Diabetes
This article in the December Diabetes Care caught my attention because as a type 1 diabetic, it certainly has special interest for me.

“Driving mishaps among individuals with type 1 diabetes, a prospective study” by Daniel J. Cox, PHD et al examined the incidence of hypoglycemic-related neuroglycopenia, which can impact how well you drive.

Retrospective studies have suggested that drivers with type 1 diabetes have more collisions than their non-diabetic spouses.

The researchers completed the initial screening of 452 drivers from three different areas. After that initial step, the drivers reported monthly occurrences of driving “mishaps,” including collisions, citations, losing control, automatic driving, someone else taking over driving, and moderate or severe hypoglycemia while driving.

Over the course of a year, 52% of the drivers reported at least one hypoglycemia-related driving mishap, and 5% reported 6 or more. These mishaps were related to mileage driven, history of severe hypoglycemia, and use of insulin pump therapy.

To make sure this does not happen to me, I always take my blood glucose level before I get into a car. I also retake it at regular intervals, and I have a carbohydrate (such as glucose tablets) within reach at all times.

Read the abstract here.

Type 2 Diabetes Medications: How Safe Are They?
Our last article comes from the December 4 issue of the British Medical Journal. This article reported on a study done at the Imperial College in London and other institutions. It looked at medication records for 91,500 people with type 2 diabetes in the United Kingdom. The records were from 1990 through 2005.

The researchers reported that a class of drugs (sulfonylureas) still taken by millions of people with type 2 diabetes is associated with a higher risk of dying and heat failure than the newer treatment, metformin.

Dr. Steve Nissan, chairman of cardiovascular medicine at Cleveland Clinic commented that “metformin is widely believed to exert a favorable cardiovascular effect, and these findings support this observation.”

The study also found that the diabetes medications Actos and Avanti did not seem to raise the risk of heart attack, but Actos was associated with a lower risk of dying than Avanti. Both of these belong to the class of medications called thiazolidinediones. These facts should be discussed in families with people who have diabetes and with the primary care physician for possible adjustment of medication regime.

Read the full abstract here.

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