Elevated circulating levels of cardiac troponin (cTn)T, measured using a sensitive assay, are common in patients with Type 2 diabetes, researchers report.

They found that almost one in five participants with diabetes had cTnT levels above the 99th percentile of a reference population of healthy individuals.

cTnT levels remained stable over time, were associated with conventional cardiovascular risk factors, and also displayed a graded relationship with hospitalizations during 2 years of follow-up, although the latter result just missed statistical significance.

The researchers say the findings “alert the clinical community that individuals with Type 2 diabetes - even if fairly young and without much apparent comorbidity - have a substantial probability of having a chronically elevated cTnT value with the new high-sensitivity assay.”

cTnT and cTnI are extremely sensitive and specific markers of myocardial necrosis and are crucial components in the diagnosis of myocardial infarction, say Jonas Hallen (Oslo University Hospital, Norway) and colleagues.

They measured cTnT in stored, frozen serum samples from 124 individuals with Type 2 diabetes enrolled in the Asker and Bærum Cardiovascular Diabetes trial at baseline, and at 2-year follow-up in the 96 for whom samples were available.

Overall, 90% of participants had detectable cTnT at baseline, measured using the electrochemiluminescence method, and of these 18% had values above 13.5 ng/l, which was the 99th percentile in 616 apparently healthy volunteers in a control population.

Baseline cTnT levels were associated with the conventional cardiovascular risk factors of age, renal function, and gender, and there was a strong correlation between cTnT levels at the two time points studied.

The risk for hospital stays of at least 24 hours during follow-up increased step-wise with quartiles of baseline cTnT, although this finding was of borderline statistical significance.

Reporting in the journal Cardiovascular Diabetology, the researchers say their observations imply that troponin T release in this patient population reflects underlying and chronic pathophysiologic processes.

“Thus, troponin T may be a useful surrogate marker to define risk among subjects with Type 2 diabetes, and may facilitate early identification of patients with subclinical cardiovascular disease and other high-risk individuals,” they say.

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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Results from a population-based cohort study suggest that individuals who are screened for Type 2 diabetes have lower long-term mortality than those who are not.

Simon Griffin (Institute of Metabolic Science, Cambridge, UK) and colleagues assessed the impact on long-term mortality of inviting 1705 of 4936 patients from a single practice in Ely, Cambridgeshire, UK to Type 2 diabetes screening.

The initial screening took place in 1990-1992 when the participants were aged 40-65 years. They had an oral glucose tolerance test and related cardiovascular risk factors such as lipids and blood pressure were also measured.

A further 1705 individuals from the rest of the cohort were selected for screening in 2000-2003, leaving 1526 who were not screened. All participants were followed-up for mortality until January 2008.

In total, 345 deaths occurred from 1990-1999 and 291 from 2000-2008. Individuals invited to the first round of screening had a nonsignificant 21% reduction in all-cause mortality at study completion in 2008 versus those who did not undergo screening. However, no mortality difference was observed between invited and noninvited participants for the second screened group in 2008.

The researchers note that only 68% and 45% of those invited to the first and second screening sessions, respectively, actually attended. When this was taken into account, participants who attended either diabetes screening session had significantly lower (46-48% decrease) and those who were invited but did not attend had significantly higher (36-73% increase) mortality than those who were not screened.

“While results from this analysis are promising, it remains unclear whether early detection and treatment of diabetes and related cardiovascular disease risk factors is beneficial and produces sufficient improvement in long-term health outcomes to justify the economic costs,” write the authors in the journal Diabetologia.

“In view of the extensive organizational, technical, and financial input that a national Type 2 diabetes screening program would demand, evidence of the cost effectiveness of screening from prospective randomized controlled trials prior to implementation would be desirable.”

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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Adding supervised physical activity sessions to exercise counseling can improve glycated hemoglobin levels and cardiovascular risk factors in patients with Type 2 diabetes and the metabolic syndrome, trial findings suggest.

The Italian Diabetes and Exercise Study (IDES) included 606 sedentary patients with Type 2 diabetes and the metabolic syndrome from 22 outpatient diabetes clinics across Italy.

Participants were randomly assigned to receive twice weekly 75-minute aerobic and resistance training in exercise facilities under the supervision of personal trainers, or no such training.

All participants received structured physical activity counseling by trained physicians every 3 months, along with guideline-based usual medical care.

During the 12-month trial, total self-reported physical activity increased substantially from baseline in both groups.

However, the primary endpoint of glycated hemoglobin level decreased significantly more in participants receiving facility-based training than those receiving control treatment of exercise counseling alone, by 0.30% versus 0.10%, respectively.

The intervention group also had significant improvements in systolic and diastolic blood pressure, high-density and low-density lipoprotein cholesterol levels, waist circumference, body mass index, insulin resistance, inflammation, and coronary heart disease risk scores.

These parameters only improved marginally in patients receiving exercise counseling alone, despite the participants achieving the currently recommended amount of physical activity.

The researchers say: “These results might imply that the amount of physical activity to effectively reduce cardiovascular burden in these high-risk subjects could be higher than the minimum recommended.”

In an editorial accompanying the article in the Archives of Internal Medicine, Ronald Sigal (University of Calgary, Alberta, Canada) and Glen Kenny (University of Ottawa, Ontario) said that the trial is an important addition to the literature on exercise.

They added: “We would argue that this trial, building on the findings of previous studies, supports the addition of supervised, facility-based exercise training to standard therapy for Type 2 diabetes, just as exercise-based cardiac rehabilitation is considered part of the optimal treatment of patients with acute cardiac events.”

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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Results from a randomized trial of the bile acid sequestrant colestilan show that it is effective for improving glycated hemoglobin (HbA1c) and reducing low-density lipoprotein (LDL) cholesterol in Type 2 diabetics.

“Diabetes and frequently complicating hypercholesterolemia are known independent risk factors for onset and progression of cardiovascular and cerebrovascular events,” say Kazuoki Kondo (Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan) and co-workers.

In this study, the team recruited 183 patients with Type 2 diabetes with a fasting plasma glucose of 7.2??”11.1 mmol/l and an HbA1c of 7.0% or more. They were randomly assigned to receive either colestilan 4.5 g/day or placebo for 12 weeks.

Writing in the journal Diabetes, Obesity and Metabolism, the team report that at 12 weeks, colestilan had significantly reduced both HbA1c and fasting plasma glucose by 0.9% and 1.2 mmol/l, respectively, but no significant reductions in fasting insulin were observed.

A significant 22.5% reduction in LDL cholesterol was also achieved by the treatment group versus placebo at 12 weeks.

The most frequently observed adverse events were constipation, nasopharyngitis, and eczema, which occurred in 13.0%, 19.6%, and 5.4% of the colestilan-treated patients, respectively, versus a corresponding 4.4%, 13.2%, and 0.0% of the placebo-treated group. No cases of hypoglycemia or death occurred during the study.

“Colestilan when given alone alleviates markers of hyperglycemia and dyslipidemia in patients with Type 2 diabetes,” summarize the authors.

“This drug might therefore be expected to exert diverse beneficial effects in a wide range of patients with multiple cardiovascular risk factors,” they add.

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

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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

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