Vildagliptin provides similar glycated hemoglobin (HbA1c) reductions to metformin but with superior gastrointestinal tolerability in drug-naïve elderly patients with Type 2 diabetes, research shows.

Elderly people with diabetes are a challenging population to treat because of an increased risk for renal impairment, a high number of comorbidities and concomitant drug use, and a high prevalence of cardiovascular risk factors.

In the first study with vildagliptin to be conducted exclusively in Type 2 diabetes patients aged at least 65 years, Anja Schweizer (Novartis Pharma AG, Basel, Switzerland) and colleagues compared its efficacy and tolerability with that of metformin.

The 24-week study included 335 patients with an HbA1c of 7??”9% who had not received oral glucose-lowering agents for more than 3 consecutive months at any time in the past and no agents for at least 12 weeks prior to screening.

Patients were randomly assigned to receive vildagliptin 100 mg daily (given as a once-daily dose) or metformin titrated to a maximum of 1500 mg daily (given as 1000 mg in the morning and 500 mg in the evening).

The results, reported in the journal Diabetes, Obesity and Metabolism, show that patients receiving vildagliptin achieved similar HbA1c reductions to those taking metformin, at 0.64% and 0.75%, respectively, from baseline, and establish non-inferiority of vildagliptin to metformin.

As expected, the decrease in HbA1c with either agent was greater in patients with a baseline HbA1c greater than 8%, with mean HbA1c reductions from baseline of 0.93% with vildagliptin) and 1.02% with metformin.

Body weight decreased with both agents, although to a greater degree with metformin (0.45 kg versus 1.25 kg, respectively).

One or more adverse events were reported by 44.3% of patients receiving vildagliptin and 50.3% of patients receiving metformin. A low incidence of hypoglycemia was observed in both treatment groups.

In patients receiving vildagliptin, the most frequent adverse events were nasopharyngitis and dizziness, whereas gastrointestinal events were more frequently reported with metformin.

“We conclude that vildagliptin is effective and well tolerated in drug-naïve elderly patients with Type 2 diabetes in whom it could represent a valuable treatment option,” write the authors.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Treatment of patients with Type 2 diabetes without known large-vessel disease with fenofibrate significantly reduces their risk for amputation events, report researchers from the FIELD study.

However, the risk for major amputation among patients with atherosclerotic disease of the major peripheral arteries was not significantly influenced by fenofibrate treatment.

“Amputations in people with Type 2 diabetes mellitus substantially impair their quality of life and impose high costs on health-care systems,” say Kushwin Rajamani (University of Sydney, New South Wales, Australia) and co-investigators.

The researchers tested the effect of fenofibrate on amputation risk in participants of the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study, which included 9795 patients with Type 2 diabetes aged 50??”75 years.

Of these, 4895 were randomly assigned to take fenofibrate 200 mg/day and 4900 to take placebo for a period of 5 years. During this time, 115 patients had one or more non-traumatic lower-limb amputations as a result of their diabetes.

Major amputations were defined as those above and minor those below the ankle. The researchers further classified individuals who underwent amputation as having minor amputation without previous large-vessel disease - thought to be due to microvascular disease, or minor or major amputations with documented large-vessel disease ??” thought to be due to atherosclerotic disease of the major peripheral arteries.

Writing in The Lancet, the authors report that fenofibrate treatment significantly reduced the risk for first on-study amputation (all types) and minor amputation without previous large-vessel disease by 36% and 47%, respectively, compared with placebo.

However, the reduction in risk for major amputation events with documented large-vessel disease was non-significantly different between the fenofibrate- and placebo-treated groups (7% reduction).

“These findings could lead to a change in standard treatment for the prevention of diabetes-related lower-limb amputations,” conclude Rajamani et al.

Of note, the reduction in amputation risk observed in this study was not associated with any lipid variables, suggesting “the effects of treatment with fenofibrate on the risk of amputation might go beyond the improvements in controlling the lipid profile,” says the team.

“Because development and care of skin ulcers are formidable predictors of future amputations, one has to wonder whether some of the effects of fenofibrate can be attributed to improvement in wound healing,” commented Sergio Fazio and MacRae Linton (Vanderbilt University Medical Center, Nashville, Tennessee, USA) in an accompanying commentary.

“This effect ??” more so than anti-inflammatory, antioxidant, or endothelium-mediated effects ??” would set fibrates apart from the many agents (statins, antihypertensives, aspirin, and vitamin E) that have so far been unable to reduce amputations in people with diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Is diabetes and yeast infection co-related Well, it is a well known fact that diabetes is a state that has many health problems attached with it. One of such possibilities is the occurrence of infections of yeast through diabetes, although many would not like to be very expressive about it. People believe that having it is an embarrassing situation and would not like to discuss about it.

In order to understand the link between the two, it is important to know how the skin infections occur. A lot of bacteria are present in the gastro-intestinal tract. Due to changes in lifestyle and diet, this balance is disturbed. One of such bacteria present is yeast.

How does this infection take place

One of the main causes of yeast overgrowth is chronic infections. This results on account of presence of too much sugar. Not only that it results in diabetes, but also causes Candida infections. If there are repetitive Candida outbreaks, then it would be well advisable to have the levels of glucose checked in your blood. Although diabetes is not the only reason for the incidence of a chronic infection, a high level of sugar consumption surely triggers this condition. Yeast is fed by sugars present in the body, in the same fashion as yeast type foods and carbohydrates.

Yeast infection and diabetes:

An important complication of diabetes is that the blood sugar levels if not kept under control could trigger such a skin infection. This happens because an increased level of glucose in the body does affect many other bodily mechanisms and has a tremendous influence on the body’s immune status.

If you happen to suffer from diabetes, chances are you will find yourself constantly battling with Candida outbreaks. In its advanced form, along with vaginal infections and thrush, you also experience chronic fatigue, pain in the joints and knees, loss of memory, intestinal problems like constipation and diarrhoea and dizziness. In general you experience bad health at all times.

Depending upon the gravity of the disease, the treatment of this infection coupled with diabetes can often be complex. However, a diet that is low in sugar is an absolute must. This will suppress the yeast fungus by letting it starve and ultimately destroys it. Another precaution to be taken is avoiding the consumption of mushrooms, honey and dried fruits that also help a lot in feeding the yeast. If you can remain on diet for a three to six months period, you can gradually re-introduce them into your diet thereafter depending on your situation.

Apart from the above suggestions, you can also try certain holistic treatments in order to get rid of diabetes and yeast infections. You can also consider following a simple Candida Diet that could help prevent any further recurring infections.