New Type 2 Diabetes Treatment

FDA Approves New Type 2 Diabetes Treatment
On January 25, 2010, the FDA approved the glucagon-like peptide-1 (GLP-1) receptor liraglutide (marketed as Victoza) for the treatment of type 2 diabetes. It is given as a once daily injection and is not suggested as an initial treatment. In 5 clinical trials, it was noted that pancreatitis developed more often in patients on Victoza than in patients who were using other diabetes medications.

Other possible side effects of Victoza include headache, nausea, and diarrhea, as well as allergic-like reactions like hives. It is not associated with increased risk of cardiovascular events; however, the maker is to further investigate this area after approval, in addition to evaluating medullary thyroid and other cancer risks.

You can read the FDA press release about this new type 2 diabetes treatment here.

Risk of Developing Type 1 Diabetes
One of the first things people diagnosed with diabetes—type 1 diabetes or type 2 diabetes—may ask is, “What is the genetic risk for my children?”

For type 1 diabetes, it takes genetic risk from both parents to significantly raise the risk to inherit the disease. It’s also been proven that autoantibodies in the blood can be present for years before the disease is diagnosed.

Clearly, this is a complicated disease, but for those of us with type 1 diabetes who have children, the question remains.

The January issue of the journal Diabetes has an article written by Valma Harjutsalo et al titled “Age at onset of type 1 diabetes in parents and recurrence risk in offspring.”

The authors define adult onset type 1 diabetes as meaning onset at 15 to 39 years of age. This study examined records of 9,636 children of diabetics in a 20-year study which ended in 2007.

They found that 413 children were diagnosed with type 1 diabetes, which turned out to be 4% for the children of people with adult onset type 1 diabetes. Risk factors for the children of type 1 diabetic fathers decreased with the age of onset of the disease, while in mothers the risk remained the same regardless of the age of onset.

Daughters of mothers with diabetes had lower risk of developing type 1 if their mothers were diagnosed when they were younger than 10 years old.  The conclusion reached by this study was that there is a strong relationship between age of onset and sex and the risk for their children to develop type 1 diabetes.

Read the abstract of the study here.

Hypoglycemia in Type 2 Diabetes
A few months ago, we reported on a study of driving and hypoglycemia in people with type 1 diabetes. This month, we found an article in the January 10, 2010, issue of Diabetes Research and Clinical Practice that is about hypoglycemia in people with type 2 diabetes.

The article is “Prevalence of impaired awareness of hypoglycemia and frequency of hypoglycemia in insulin-treated type 2 diabetes.”  The study was done by Josefine E. Schopman et al.

For this study, the researchers examined data about 122 type 2 diabetics who had had the disease for 10 to 20 years and had been treated with insulin for 4 to 9 years.  They had a mean age of 67 years. The group had a mean A1c of 8.4%.

Blood glucose levels were taken for 4 weeks to find out the prevalence of hypoglycemia, and a questionnaire was used to assess hypoglycemia awareness.

What the researchers found was that the prevalence of impaired awareness of hypoglycemia in these type 2 diabetics was related to the number of high blood glucose levels measured.

The researchers cautioned that this population needs “to be evaluated at clinical review” to develop interventions to protect this insulin-treated type 2 population.

You can learn more about this study and how it may affect you here.

Who Develops Type 2 Diabetes?
There was an interesting article in the January 2010 Archives of Pediatrics and Adolescent Medicine issue titled “Childhood predictors of adult type 2 diabetes at 9-and 26-year follow-ups.”  It was by John A. Morrison, PhD et al.

Two studies of children—one of 1,067 girls starting at age 10 (National Growth and Health Study) and the other of 822 school children aged 6 to 18 (Princeton Study)—were followed to see how many children developed type 2 diabetes.

Black children in the Princeton Follow-up Study children who scored in the top fifth percentile for systolic blood pressure and body mass index had a high risk for developing type 2 diabetes by the time they were 39 years old. If you add to this abnormal blood glucose levels, HDL, and triglycerides, you can begin to see a picture of risk.

If, however, the BMI, systolic blood pressure, and diastolic blood pressure scores were all lower than the 75th percentile, the risk of developing type 2 diabetes was less than 2%.  If parents did not have type 2 diabetes, the risk factor was 1%.

There are similar results in the National Growth and Health Study.  That study showed that systolic blood pressure in the top 5% and parental diabetes predicted developing type 2 diabetes by age 19. If BMI and blood pressure were lower than the 75th percentile, the risk of developing type 2 diabetes at 19 was .2%. Measurement of insulin in these children was significantly related to development of type 2. It was suggested that office-based measurements can predict whether or not diabetes will develop up to 26 years later.

You can read the full abstract here.

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