All around the world, hundreds of millions of people face long bouts of major depression. For many people, life conditions are depressing, but for up to 48% of diabetics, the underlying cause of depression may be poorly regulated blood sugar levels.

Depression is thought to be twice as common in diabetics as in the population generally. Different factors can contribute to the development of depression and includes:

• emotions
• environmental factors
• biology

Scientists at the diabetes specialty clinic at the SMS Hospitals in Jaipur, India studied fifty adults who had type 2 diabetes and a control group of thirty adults who were diabetes-free. They excluded anyone who had a previous history of depression or any other psychiatric illness, history of addiction or substance, high blood pressure, or any medical condition except diabetes. (The volunteers in the control had none of these conditions.) Using a standard psychological exam for measuring depression, the researchers then assessed the psychological status of the eighty people in the study.

The researchers found that 46% of the type 2 diabetics in this study suffered depression. Of all the diabetics in the study:

• 12% were were suffering from mild depression
• 16% from moderate depression, and
• 18% from severe depression

There was a trend suggesting higher blood sugars tracked to the most severe depression, but the study group was too small to establish definitive statistics. The average fasting blood sugar level in the type 2 diabetics who did not display depression was 123 mg/dL (6.8 mmol/L). The average fasting blood sugar level among the diabetics who had depression was 151 mg/dL (8.4 mmol/L).

Researchers also tested mental skills in both groups. Diabetics did not do as well as non-diabetics. Diabetics did worse than non-diabetics on every measure of mental ability the researchers tested but especially in tests that involved:

• counting numbers forwards
• counting numbers backwards, and
• recognizing symbols

Diabetics did relatively well in tests that required the use of language, but relatively poorly in tests that required the ability to learn new information quickly. There was no clear-cut relationship between depression and other forms of mental decline.

The researchers admitted that they had not studied enough people to reach definitive, sweeping conclusions. This and other studies, however, suggest that keeping blood sugar levels down goes a long way toward keeping mental faculties sharp.

Although this study showed 46% of those tested suffered some degree of depression, it also showed that lower blood sugar levels gave a lesser degree and chance of depression. Unfortunately depression makes people less motivated to eat healthy foods and to exercise, which means higher blood sugar levels.

Tight control of systolic blood pressure (SBP) to a target of less than 130 mmHg in diabetics with coronary artery disease (CAD) does not significantly reduce the incidence of cardiovascular (CV) events compared with usual control, and is associated with increased all-cause mortality, shows an analysis of INVEST.

In INVEST (International Verapamil SR ??” trandolapril Study), patients with diabetes and CAD were randomly assigned to receive antihypertensive therapy with either a calcium-channel blocker or a beta blocker, plus an ACE inhibitor and/or a thiazide diuretic. In extended follow-up of 6400 patients enrolled in the trial, those who achieved SBPs lower than 130 mmHg had cardiovascular outcomes equivalent to those who achieved SBPs between 130 and 140 mmHg.

But a subanalysis of 5077 patients from the USA showed that the tight BP control strategy was associated with an adjusted hazard ratio (HR) of 1.15 (p=0.036) for all-cause mortality compared with usual control, defined as a SBP lower than 140 mm Hg.

“We wonder whether it’s time to rethink lower BP goals in patients with diabetes and CAD,” said Rhonda Cooper-DeHoff from the University of Florida in Gainesville, Florida, USA, who presented the data during a late-breaking clinical trials session at the 2010 annual scientific sessions of the American College of Cardiology in Atlanta, Georgia, USA.

The findings appear to contravene the position of the American Diabetes Association, which has previously issued a position statement saying that “there is no threshold value for BP [in diabetics], and risk continues to decrease well into the normal range.”

INVEST was designed to determine whether lowering SBP below 130 mmHg could provide additional CV benefits, particularly among diabetic patients with CAD. The international trial enrolled 22,576 patients with CAD and hypertension, and randomly assigned them to receive either verapamil SR plus trandolapril and the thiazide diuretic hydrochlorothiazide [HCTZ], or atenolol plus HCTZ and trandolapril. Trandolapril was recommended for all diabetic patients in the study.

The analysis focused on mortality rates among a US cohort of diabetic patients followed for an extended period, from September 1997 through November 2008. To evaluate the effects of very low SBP, the authors further categorized on-treatment SBP in increments of 5 mmHg.

During the extended follow-up period of 22,700 patient-years, the investigators found that, as predicted, patients whose BP was not controlled on therapy had an approximately 50% higher risk for a composite endpoint of death, nonfatal myocardial infarction (MI) or nonfatal stroke compared with those in the usual-control group. There were no significant differences between the tight- or usual-control groups with regard to either nonfatal MI of nonfatal stroke.

But in a Cox regression analysis of all-cause mortality, both the 110 to less than 115 mmHg and the less than 110 mmHg SBP categories were associated with increased risk for death. Other factors associated with increased mortality risk were age, race, peripheral arterial disease, coronary heart failure, US residency, renal impairment, left-ventricular hypertrophy, and transient ischemia.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Intensive blood pressure (BP) control does not reduce the rate of cardiovascular (CV) events in patients with Type 2 diabetes and high CV risk, reveals research presented at the 59th Annual Scientific Sessions of the American College of Cardiology in Atlanta, Georgia, USA.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure trial found that targeting therapy in such patients to achieve a systolic blood pressure (SBP) below 120 mmHg did not significantly reduce the annual rate of a composite of nonfatal myocardial infarction, nonfatal stroke, or death from CV causes, compared with a standard blood pressure target of below 140 mmHg.

A total of 4733 patients aged an average of 62.2 years with Type 2 diabetes were randomly assigned to intensive BP control (n=2362) or standard BP control (n=2371). The patients had an average baseline SBP of 139 mmHg, ranging from 130 to 180 mmHg, and had stable diabetes for at least 3 months, with a HbA1c of 7.5% to 11.0%. Also, 33.7% of patients had CV disease (CVD), while the remainder had subclinical CVD or at least two risk factors.

Patients in the intensive group were initiated on a two-drug therapy, typically a thiazide-type diuretic plus ACE inhibitor, angiotensin receptor blocker, or beta blocker. Drugs were then added and/or titrated at monthly visits to achieve the target SBP of 120 mmHg. In the standard group, therapy was intensified if SBP was 160 mmHg or above at the first visit or 140 mmHg or above at the second visit.

William Cushman, from the Veterans Affairs Medical Center in Memphis, Tennessee, USA, noted that “the SBP separated very early.”

He reported that BP from a year onward averaged at about 134 mmHg for the standard therapy group and at about 119 mmHg for the intensive therapy group.

This meant that, on average, a delta difference in BP of 14 mmHg was achieved from 1 year to the end of the 4.7-year study, which Cushman said was “certainly far greater” than the 10 mmHg minimum that they had set out to achieve.

Patients in the intensive treatment group took more drugs over the course of the study than did those in the standard treatment group, at an average number of 3.4 versus 2.1. Despite the difference in SBP, the patients receiving intensive BP-lowering therapy had a similar risk for the primary outcome as patients receiving standard therapy, at rates of 1.87% and 2.09%, respectively, and a hazard ratio of 0.88 (p=0.20).

The findings, published simultaneously advance online by the New England Journal of Medicine, did show about a 40% reduction in the risk for stroke in the intensive therapy group compared with the standard therapy group, however. And although this finding is consistent with meta-analyses summarizing the impact of a 10-mmHg reduction in SBP on stroke in observational studies, Cushman pointed out that the overall rate of stroke was very low, at about 0.5% per year.

“Therefore, although intensive management did significantly reduce total stroke and nonfatal stroke, assuming that this finding is real… the number needed to treat to lower the SBP to prevent one stroke over 5 years was 89.”

Cushman cautioned that patients receiving intensive therapy were also at increased risk for complications attributed to antihypertensive treatment compared with those receiving standard therapy, with occurrences seen in 3.3% versus 1.3% of patients. But overall serious adverse events were of a low order.

He concluded: “The results find no conclusive evidence that the intensive BP control strategy reduces the rate of a composite of major CV events, which was all-cause or fatal CV events plus nonfatal myocardial infarction and nonfatal stroke in high-risk adults with Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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Combination therapy with fenofibrate and simvastatin does not provide additional protection against cardiovascular disease (CVD) in high-risk patients with Type 2 diabetes compared with simvastatin alone, according to findings from the ACCORD lipid trial.

Presenting the findings at the 59th Annual Scientific Session of the American College of Cardiology, in Atlanta, Georgia, USA, Henry Ginsberg (Columbia University College of Physicians and Surgeons, New York, USA) said that the findings “provide physicians with important new information regarding the treatment of a common lipid abnormality affecting many of their patients with Type 2 diabetes”.

The findings were also simultaneously published online in the New England Journal of Medicine.

For the ACCORD (Action to Control CardiOvascular Risk in Diabetes) lipid trial, 5518 people who had Type 2 diabetes and either pre-existing CVD or at least two additional CV risk factors and who were already taking simvastatin were randomly assigned to additional treatment with fenofibrate 54??”160 mg/day or placebo.

At baseline, the average total cholesterol level was 175 mg/dl (4.5 mmol/l), and the average high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride levels were 101 mg/dl (2.6 mmol/l), 38 mg/dl (0.98 mmol/l), and 162 mg/dl (1.83 mol/l), respectively.

After a mean follow-up of 4.7 years, there was no significant difference between the two groups in the annual rate of the primary outcome (CV death, nonfatal heart attack, or nonfatal stroke) at 2.2% in patients taking fenofibrate and simvastatin and 2.4% in patients taking simvastatin and placebo. Annual rates of death were 1.5% in the fenofibrate group and 1.6% in the placebo group.

The researchers also compared rates of the primary outcome in 10 prespecified subgroups based on baseline characteristics. Of these, there appeared to be a difference between men and women taking combination therapy, “with the data for women suggesting potential harm and the data for men suggesting potential benefit,” Ginsberg reported. But the results did not reach statistical significance for either group.

There was also a trend toward benefit of fibrate treatment in a prespecified subgroup of patients with particularly high triglyceride levels of at least 204 mg/dl (2.30 mmol/l) and low HDL levels of 34 mg/dl (0.88 mmol/l). In these patients, the primary outcome rate was 12.4% in those taking fenofibrate plus simvastatin versus 17.3% in the simvastatin plus placebo arm. This compared with a rate of 10.1% in both study groups for all other participants.

“This dyslipidemia group outcome, which was prespecified, is concordant with several post hoc analyses from prior lipid trials,” Ginsberg noted.

He cited the Helsinki Heart Study (HHS) of gemfibrozil, which had a positive result for the primary outcome in the whole cohort and a greater benefit in a dyslipidemia subgroup, similar to that reported here. Other trials included the Bezafibrate Infarction Prevention (BIP) study and the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, which despite having negative results for the whole cohort showed significant findings for subgroups with severe dyslipidemia.

Ginsberg concluded: “ACCORD lipid does not support use of the combination of fenofibrate and simvastatin compared to simvastatin alone, to reduce CV events in the majority of patients with Type 2 diabetes mellitus who are at high risk for CVD.”

He added: “Subgroup analyses suggesting heterogeneity in response to combination therapy by gender or by the presence of significant dyslipidemia require further investigation.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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If you have already developed the habit of self-monitoring your blood sugar levels several times a day, this is something to celebrate. Checking your blood sugars regularly is imperative for everyone diagnosed with type 1 diabetes. Those with type 2 diabetes who self-monitor their blood sugars are way ahead of the game compared to those who do not. When you know what your sugar level is, it’s possible to make changes and adjustments in what you are doing for the rest of the day.

Maintaining tight control of your sugar levels… that is keeping them as near as possible to normal… significantly reduces your risk of complications.

The question is when should blood sugar levels be checked?

• these levels should be checked on fasting
• knowing this level gives you an indication of how your day is going to be
• when your fasting level is high… you may be eating less and/or exercising more

Many diabetics want to know when specifically they should take the fasting blood sugar level:

The best time is before your activities of the day get started. This includes before:

• shaving
• cleaning
• showering

The next time of the day to take a glucometer reading is:

• one to two hours after you eat a meal

If you take the reading one hour after you eat:

• this will provide you with valuable information about how well your meal was constructed.

How high did your blood sugar go? Is it normally 150 mg/dL (8.3 mg/dL) and after a pasta meal, your blood sugar shot up to 175 mg/dL (9.72 mmol/L)? If so, it would be wise to analyze the meal and see what nutrients were off kilter… what caused this issue? The protein, fat or carbohydrates?

Usually in a pasta meal, there is not enough protein. People often think that eating pasta noodles with tomato sauce, bread and butter and maybe a small glass of wine is a great meal. However, this type of meal doesn’t have enough protein in it! There may be about 4 or 5 grams but what you need is at least 25 grams. That’s a deficit of about 21 grams. The meal is predominantly carbohydrate, in other words it’s carbohydrate rich and those carbohydrates will, of course, cause a blood sugar spike. This will then create a burst of insulin so that this spike can be lowered. You are then left with a blood sugar level that will go up and down, up and down for the rest of the day.

As well, if you have more glucose in your body than your cells need, insulin takes the extra blood glucose and transports it into fat storage. This step is important because having abnormally high blood sugar levels is called type 2 diabetes and is very damaging to your body. Self-monitoring is one of the best ways to help you overcome your type 2 diabetes.

We all know that stress is a part of life. There are some good points to having stress, as stress can cause us to take action, but an overall high level of stress can cause health problems. But chronic stress can also cause weight gain as well as play havoc with blood sugars if stress is not managed.

If we go back in time to the cave men, we can look at how our bodies respond to stress. If a cave man went out hunting and a bear came after him, he would go into the flight or fight response, either choosing to fight a bear or run. This response would trigger hormone responses, such as increased cortisol to help increase your energy to either fight or run, and a decrease in your serotonin levels because you would not want to fall asleep when you are fighting or running.

Increased cortisol results in your body storing fat (which encourages weight gain) because the cave person would need that stored energy for fighting or running. The decreased serotonin levels result in your body craving carbohydrates because the carbohydrates are easily transferred to energy. The carbohydrates also function to help relax and comfort you since the serotonin level is not optimal. Sustained stress hormone elevation can also lower thyroid function which can affect your metabolism. They also can interfere with growth hormones which affect our muscle mass, resulting in a lower muscle mass which decreases metabolism.

Along with stress, many behaviors can increase cortisol, such as skipping meals, not getting adequate sleep, not eating properly, and consuming high amounts of alcohol, caffeine, sugar, and fat.

If we think about our level of stress compared to a cave man, a cave man’s response to stress was immediate and then when the bear disappeared, the stress level went down. The problem with stress today is the stress level remains elevated all the time, resulting in the constant increased stress hormones in our system. By lowering our stress and working on how we manage stress, we can lower our stress hormones and help promote weight loss and better diabetes control.

Tips to Relieve Stress

1. Determine what you can control and what you can’t control. We sometimes waste a lot of time worrying and trying to solve problems that we cannot control. Learning to stop and look at whether you can really change the situation or whether it is out of your control and you need to let go and change how you are dealing with a situation is important.

2. Take time for you. I frequently hear that it is selfish to take some time for you. I also hear that there is never enough time to do something for you. But if you think about running ragged and never having any downtime or you time, it is taking away from how you are responding to others in your life. By being stressed, anxious, worried, etc, you may be more irritable with those you love, or may not be fully present to enjoy the moments because you are off in your mind worrying about other things. So by taking time for you, you are able to take care of others better. It is like the airplane analogy. Put on your own air mask before putting on your child’s. So make it a priority to schedule some you time. It can be something simple like a quiet cup of coffee in the morning, a hot bath, reading a favorite book, going for a walk, or developing new hobbies.

3. Eat healthy and limit stress increasing foods such as sugar, caffeine, and alcohol. Also eat regular meals and planned snacks. Skipping meals can increase stress. Many people are not breakfast eaters, so try lighter breakfasts such as a granola bar or smoothie. Seek out a Registered Dietitian if you need help in this area.

4. Try some guided imagery, meditation, yoga, or progressive relaxation. Guided imagery is a process where you do deep breathing and imagine yourself somewhere pleasant such as a beach. You imagine using all your senses such as feeling the sand, smelling the salt water, hearing the waves and birds, seeing the grass blades blow and waves crash, etc. Even a five minute “vacation in your head” will help relax you. I had a client who told me “I go fishing in my head.” I love a CD called Ten Minutes to Relax. It is a quick guided imagery that can help lower stress. Progressive relaxation is a process where deep breathing is used, along with tensing and releasing muscles in order to help you see whether muscles are tense without you realizing it. It helps you relax by releasing muscles. Many audios are available that help walk you through this process. When done daily, guided imagery and progressive relaxation help lower overall stress.

5. Take 4×4 breaks each day. This means learning to take four small breaks throughout the day and do four deep belly breaths. This helps you just slow down and relax a few times during the day.

6. Exercise. Yes, that is the dreaded word most people do not like. But exercise is a great stress reliever. It also can increase your energy level and help you focus better. Exercise helps lower those cortisol levels and stimulates serotonin. So build some regular exercise into your routine. Plus you get the benefit of burning calories to help you lose weight.

7. Find a support person. Find someone you can trust and share your thoughts and feelings with. When thinking of a support person, discern who a healthy support person would be. This would be someone who listens and is nonjudgmental, not necessarily have to solve your problem but just being present with you, and someone who does not tell you to “get over it.”

Work on lowering your stress to help change your cortisol and serotonin levels and you will see the benefits in your life. Work on adding in some of these techniques each day, as well as other stress techniques as this is not a complete list of stress reduction. Sometimes people have to actually schedule them on their calendar or post sticky notes for reminders. And don’t be afraid to seek help from a professional if you need more individualized help.

If you have been hoping to lose weight, let’s begin the process. There’s no time to lose… you can’t wait around for the results of clinical trials advising which eating plans will work best. You have received a diagnosis of type 2 diabetes and your blood sugar levels need to be reduced as well as your weight. The truth is this… any eating plan where you are taking in fewer calories or kilojoules than you have been taking in for some time now, will help you lose weight. It won’t matter whether it is low or high in carbohydrates, fats or protein.

And as well as starting to lose weight, you will find your blood sugar levels starting to be lower. All this in a short period of two to three weeks. Isn’t that encouraging?

How do you find a weight loss program that suits your needs, not just for now but an eating style that you will enjoy and want to stick with? And what do you do if you find your chosen eating plan not working for you? You don’t consider yourself a failure, you consider the plan a failure and find another one.

Some of the reasons popular diets work in the beginning are due to:

• many food restrictions
• few food choices
• not enough flexibility
• repetitive boring food

These same reasons are also why these diets fail!

When looking at various diets, keep in mind many of these diets were not put together by people trained in nutrition and maybe their advice is not safe or effective. As you look at different eating plans, remember these points:

• be wary of any diets that promise rapid, easy weight loss… if it sound too good to be true it probably is
• question diets that limit food selections and forbid food groups
• be careful of diets that promote substitution with food products they are selling

A healthy eating plan for a person with or without type 2 diabetes should contain a balance of the three main nutrients in the world of foods:

• carbohydrates
• protein
• fats

Each type plays an important role in keeping your body going every day. A balanced meal plan provides you with food choices from each of these three types of nutrients.

Learning about food can seem complicated, especially if you have never had to follow a special eating plan before. Meeting with a registered dietitian will give you more knowledge about making proper food choices… you will find you are able to eat a wide variety of foods that will help you to lose weight, lower your blood sugar levels and help you control your type 2 diabetes.

Approximately ninety to ninety-five percent of Americans with diabetes have type 2 diabetes, and the key to preventing or reversing this deadly disease is to understand the presenting signs and symptoms.

Diabetes is a disorder of metabolism, whereby the body cannot utilize the glucose it consumes from food. There are two types of diabetes, each having very different causes. Type 1 diabetes is an autoimmune disease caused by destruction of the pancreatic cells that produce and secrete insulin, which most often occurs in children and is not thought to be linked to diet or exercise. Type 2 diabetes is much more common and is directly linked to obesity, poor diet, and lack of exercise. We are more focused on diabetes type 2 here because it is controllable through proper diet and exercise.

Some of the warning signs of diabetes include fatigue, increased hunger, unexplained weight-loss, and frequent urination. These early warning signs should raise a red flag and warrant seeking medical attention.

There are serious complications that can result from this disease, and even though you may not have the early warning signs, it is important to be aware and seek regular check-ups, especially if you are overweight, eat a poor diet, and do not exercise.

Some of the complications of diabetes include:

1. Nerve damage, which causes tingling and numbing of the hands and feet. This may lead to the development of infections and amputation.

2. Eye problems, such as cataracts, glaucoma, and even loss of vision.

3. Skin infections are more common when diabetes is present.

4. High blood pressure, which may cause strokes.

5. Cardiovascular disease, which is the leading cause of death in America

6. Kidney failure, which is also a deadly and very miserable condition.

If you already have diabetes or have risk factors for it’s development, it is important to realize that this disease can be controlled, eliminated, or prevented by taking a few important steps.

Here are some important steps that you should adopt in order to prevent and even control diabetes:

1. Exercise for at least half an hour each day.

2. Lose weight.

3. Avoid trans fats, which are also known as partially hydrogenated vegetable oils.

4. Avoid simple sugars as well as refined white flour.

5. Eat plenty of fiber every day.

6. Do not smoke, and if you already do, please try to quit.

7. Limit alcohol intake.

8. Educate yourself, because education is your best tool in your quest for health and wellness.

For much more information on preventing diabetes and many other life-threatening illnesses, please visit www.ultimatefatloss.org/-Get_Ripped__Book.html. Here you will find information that will help you prevent illness and live a long and healthy life.

Superfoods seems to be one of the new “buzz” words… so what exactly does it mean? According to Wikipedia: “superfood” is a term sometimes used to describe food with high phytonutrient content that may confer health benefits as a result…”. In other words, superfoods are a group of wholesome foods that have health giving properties that really pack a nutritious punch!

So let’s look at how several “superfoods” can help improve the quality of your life as a diabetic:

Colorful Vegetables: Free radicals are the age accelerators of your body… they affect your heart, blood vessels, brain and cell membranes. Unfortunately, this destructive process operates at an increased rate in people with type 1 or type 2 diabetes. Antioxidants block this destruction… the richest source of these antioxidants are found in colorful fruits and vegetables. So, here are a few of the fruits and vegetables your should eat:

• spinach
• collard greens
• broccoli
• tomatoes… the darker the red of the tomato the higher the antioxidant content
• grapes… red grapes are more beneficial than white ones
• raspberries and boysenberries
• strawberries
• green leafy vegetables
• olives

Mix up a bowl of colorful salad vegetables, keep it covered in your refrigerator. Eat a bowl of these at most of your meals.

Grapefruit: Grapefruit is one of the best of all fruits for avoiding sharp rises in your blood sugar level. It also comes to your rescue where heart disease and cholesterol buildup in your arteries is concerned. Dr James Cerda, a professor at the University of Florida found that fiber in grapefruit can definitely lower cholesterol in humans. Grapefruit can interfere with several prescription medications… check with your health care provider if you are on medications.

Garlic: Garlic was first mentioned as a medicine about 6000 years ago and is used extensively in medicines throughout the world today. Garlic may be valuable for helping to reverse both diabetes and its many complications. The debate continues as to the active ingredients but, however it comes: aged, fresh, cooked or in supplement form, it is a healthy addition to your nutrition plan.

Beans: The high amount of soluble fiber in beans is a big help to your blood sugar. If your have insulin resistance or unstable blood sugar levels, beans helps to balance your blood sugar while giving you plenty of slow-burning energy. And the fiber in beans stops your blood sugar from rising too quickly after your meal.

Oats: The benefit of oats on blood sugar levels was first reported way back in 1913… the same soluble fiber that reduces your cholesterol level also benefits people with type 2 diabetes. So if you eat oatmeal, or oat bran rich foods, you will find you have lower and less blood sugar spikes. Soluble fiber slows down the rate at which food leaves your stomach and so delays the absorption of glucose into your bloodstream following your meal.

While there is no cure for type 2 diabetes, these “superfoods” are known to improve blood sugar regulation, insulin activity and slow down the complications of type 2 diabetes.

Add-on treatment with liraglutide improves glycemic control without causing major hypoglycemia or weight gain, a trial in patients with Type 2 diabetes has found.

The study suggests that liraglutide, a new once-daily human analogue of glucagon-like peptide-1 (GLP-1), may be a useful new treatment in patients who are suboptimally controlled on sulfonylurea monotherapy.

Liraglutide mimics the glucoregulatory actions of endogenous GLP-1 by targeting the incretin system, and has been shown to bring about sustained improvements in glycemic control, beta-cell function, and weight, with a low risk for hypoglycemia.

The present study evaluated the safety and efficacy of liraglutide in 264 Japanese patients with a mean body mass index of 24.9 kg/m² and mean glycated hemoglobin (HbA1c) level of 8.4%. They were randomly assigned to take liraglutide 0.6 mg/day, liraglutide 0.9 mg/day, or placebo, each added to sulfonylurea monotherapy, for 24 weeks.

At the end of the study period, HbA1c had fallen by 1.56%, 1.46%, and 0.40% in the liraglutide 0.9 mg/day, 0.6 mg/day, and placebo groups, respectively. The differences between active treatment and placebo were statistically significant.

Furthermore, a significantly greater proportion of patients in the liraglutide treatment groups had achieved target HbA1c levels of less than 7.0% (46.5% with lower-dose and 71.3% with higher-dose liraglutide versus 14.8% with placebo).

Liraglutide treatment was also associated with significant reductions in fasting plasma glucose and postprandial plasma glucose.

Finally, overall safety was comparable among the three groups. There were no major hypoglycemic episodes in any group and body weight was unchanged in both liraglutide groups, whereas mean weight fell by 1.12 kg in the placebo group.

Writing in the journal Diabetes, Obesity, and Metabolism, Kohei Kaku (Kawasaki Medical School, Okayama, Japan) and fellow investigators say that liraglutide provides “superior glycemic control” compared with placebo, offering sustained and significant reductions in HbA1c in a dose-dependent manner.

They conclude: “In Japanese subjects with Type 2 diabetes, once-daily liraglutide administered at 0.9 mg/day is both effective and well-tolerated in combination with sulfonylurea agents, demonstrating significantly greater glycemic control than sulfonylurea monotherapy, without causing adverse weight gain or loss.”

A 28-week follow-up study of the study participants is ongoing and will provide long-term safety and efficacy data.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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