Funding for Diabetes Research and Diabetes Treatments
We have heard from the American Diabetes Association that they have testified in front the House Appropriations Subcommittee on Labor, Health and Human Services. They talked about funding for diabetes research, prevention, and treatments. When you have a minute or two, please send your congressman an e-mail telling him/her that as a person with diabetes, you back increased funding for research and prevention. Currently we stand at over 80 million Americans with diabetes or pre-diabetes.
Poor A1c Levels, Oral Diabetes Medications, and Atrial Fibrillation
Our first headline comes from the Journal of General Internal Medicine (the online edition on April 20, 2010). It is titled "Diabetes Mellitus, Glycemic Control, and Risk of Atrial Fibrillation." It was written by Dr. Sascha Dublin et al of the Group Health Research Institute in Seattle.
The researchers found that the longer a person took diabetic medications while they continued to have poor blood glucose control, the greater the risk for atrial fibrillation.
Dr. Dublin and her group noted that past studies did not take into account the fact that obesity raises both the risk for diabetes and atrial fibrillation, so in their study, the researchers examined health data on 1,410 people diagnosed with atrial fibrillation and 2,203 patients with normal heart rhythm from Group Health, a large healthcare system.
They found that 18% of those with atrial fibrillation were taking oral diabetes medications, compared to 14% for the control group. Of interest was the added risk factor for diabetics whose A1c levels indicated lack of control over years of having diabetes.
The risk rose as patients' blood glucose levels worsened. The risk of atrial fibrillation also increased as the years of taking anti-diabetic medication increased. The researchers concluded that physicians who treat type 2 diabetes should be aware of this risk factor and know that atrial fibrillation can be treated effectively with blood-thinning medications to reduce the risk of stroke.
You can read more about this diabetes research here.
Type 2 Diabetes Medications Study: Will They Cause Weight Gain?
When someone is diagnosed with type 2 diabetes, the first line medication most often used is Metformin. Others are then added as needed. The April 14, 2010, Journal of the American Medical Assocation has an article of interest for those who take more than one medication.
The article is titled "Effect of noninsulin antidiabetic drugs added to Metformin therapy on glycemic control, weight control, and hypoglycemia in type 2 diabetes." It is by Olivia J. Phung PharmD et al.
The researchers wanted to look at efficacy of other medications, as well as the risks of weight gain and hypoglycemic events. They did a literature search of randomized controlled studies with at least 3 months duration of added medications when Metformin did not control blood glucose levels. They examined endpoints of change of A1c, body weights, and relative risk of meeting the ADA A1c goal of less than 7% and hypoglycemic risks.
Twenty-seven randomized controlled trials were included. The mean trial length was 32 weeks. The medications included thiazolidinediones, sulfonylureas, and glinides, which were associated with weight gain. Glucagon-like peptide-1 analogs, ?-glucosidase inhibitors, and dipeptidyl peptidase-4- inhibitors were associated with weight loss or no weight change. Sulfonylureas and glinides were associated with higher rated hypoglycemic events than the placebo.
The researchers concluded that all medications added to metformin prescribed at maximum dosages resulted in similar levels of lowered A1c percentages. However, they differed in weight gain risks and risk of hypoglycemic events. This information should be discussed with prescribing physicians depending on individual needs.
You can read the abstract of this study here.