Fenofibrate therapy may slow down the progression of albuminuria and glomerular filtration rate (GFR) impairment in patients with Type 2 diabetes, study results indicate.

Previous studies have reported a rise in plasma creatinine associated with fenofibrate use, and this has led to concerns over the safety of the drug.

However, Rudee Ting (University of Sydney, Australia) and colleagues say that their findings show that the early plasma creatinine change associated with fenofibrate therapy does not represent true nephrotoxicity, as cessation of fenofibrate produces rapid reversion to pre-treatment creatinine levels.

In the 5-year study led by Ting, the researchers observed a mean 10.0 ?mol/l increase in the plasma creatinine levels of 9795 diabetic patients during a 6-week run-in phase. However, when approximately half of these patients (n=4900) were switched to placebo after 6 weeks, their plasma creatinine levels returned to baseline levels within 4 months.

The remaining 4895 study patients continued fenofibrate therapy for the duration of the study and their plasma creatinine levels steadily increased, although at a slower rate than that seen during the run-in phase, at 1.62 versus 1.89 ?mol/l per year.

As reported in the journal Diabetologia, the team also observed a slower rate of estimated GFR (eGFR) loss among the patients who continued on fenofibrate compared with those on placebo, at 1.19 versus 2.03 ml/min/1.73 m2.

The plasma creatinine levels of a subgroup of 661 patients (washout group) were measured 8 weeks after treatment termination. A smaller fall from baseline eGFR was noted among the fenofibrate washout patients than among those who had been on placebo, at 1.90 versus 6.90 ml/min/1.73 m2.

This, highlight the researchers, is equivalent to an annual eGFR sparing of approximately 1 ml/min/1.73 m2.

Of note, patients taking fenofibrate also exhibited a mean reduction in urine albumin concentration and albumin/creatinine ratio of 24% and 11%, respectively, compared with those on placebo.

Nonetheless, end-stage renal event rates were similar among both groups.

Ting and colleagues conclude: “The size and consistency of the eGFR and albuminuria benefits support use of fenofibrate in Type 2 diabetes to reduce morbidity.”

They add: “Confirmatory studies are merited.”

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 systematic review and meta-analysis show that pramlintide, a synthetic amylin analog, is modestly effective for reducing glycated hemoglobin (HbA1c) and weight in Type 2 diabetic or obese patients.

Pramlintide is a relatively new antidiabetes drug, approved in 2005 by the US Food and Drug Administration . It has shown some promise for reducing HbA1c and weight, as reported by MedWire News, but there is doubt about whether its benefits outweigh its disadvantages (nausea, need for multiple injections, and cost).

Devada Singh-Franco (Nova Southeastern University, Fort Lauderdale, Florida, USA) and colleagues carried out a systematic review and meta-analysis of eight randomized clinical trials of pramlintide, including four in patients with Type 2 diabetes (n=930) and four in obese nondiabetic patients (n=686).

The studies lasted from 16-52 weeks and involved treatment with intravenous pramlintide 120-360 mcg two to three times per day versus placebo.

The team found that HbA1c was reduced by a mean 0.33% in the Type 2 diabetes patients treated with pramlintide versus placebo. Weight was reduced by an average of 2.27-2.57 kg in both the obese and Type 2 diabetes groups with pramlintide versus placebo.

Hypoglycemia occurred in more placebo than pramlintide group patients, but nausea was 1.8 times more common in pramlintide-treated patients than those given placebo.

“Larger studies (efficacy, tolerability and cost-effectiveness analyses) with newly diagnosed Type 2 diabetes mellitus patients (not on insulins) comparing monotherapy and combination therapy with pramlintide with the other agents are needed,” conclude the authors in the journal Diabetes, Obesity and Metabolism.

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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An elevated microaneurysm score is an important prognostic indicator for progression of diabetic retinopathy and reduced likelihood of regression, suggest study findings.

The researchers say that treatment of microaneurysms using renin-angiotensin system inhibitors may be effective for improving mild retinopathy.

Writing in the journal Diabetic Medicine, Anne Sjølie (Odense University Hospital, Denmark) and team report results from a post-hoc analysis of the DIabetic REtinopathy Candesartan Trials (DIRECT) study.

They included 893 patients with Type 1 (454 placebo; 439 candesartan treated) and 526 patients with Type 2 diabetes (264 placebo; 262 candesartan treated) with microaneurysms and diabetic retinopathy who were assessed for progression.

In addition, 438 patients with Type 1 and 216 with Type 2 diabetes who had significant potential to regress (Early Treatment Diabetic Retinopathy Study [ETDRS] severity scale score level 20 in both eyes) were also assessed for regression of retinopathy.

The researchers found that each additional microaneurysm observed at baseline on retinal photographs increased the risk for progression of retinopathy by 8% and 7% in Type 1 and Type 2 diabetes, respectively.

Chance of regression of retinopathy was reduced by a corresponding 21% and 15% per additional aneurysm scored at baseline.

Use of a renin-angiotensin system inhibitor, in this case candesartan, was observed to reduce the risk for microaneurysm score progression, note the authors.

“Our findings support the use of microaneurysm score as a useful surrogate clinical endpoint for progression and regression of retinopathy in clinical trials and may be more sensitive than the ETDRS in earlier stages,” write Sjølie et al.

“It should be emphasized that this is not applicable to screening for sight-threatening retinopathy in clinical practice,” they add.

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

Free abstract

High blood levels of adipocyte fatty acid binding protein-4 (A-FABP4) are associated with early nephropathy in patients with Type 2 diabetes, study findings suggest.

Turkish researchers measured levels of A-FABP4 and retinol binding protein-4 (RBP4) in 87 patients with Type 2 diabetes. Their aim was to investigate suggestions from animal studies that these proteins - both members of the lipocalin family - are linked with metabolic parameters in diabetes.

Mean levels of A-FABP4 were 13.4 ng/ml in women and 9.9 ng/ml in men, report Fusun Toruner (Gazi University Faculty of Medicine, Ankara) and co-authors in the journal Diabetes Research and Clinical Practice.

A-FABP4 levels were significantly higher in patients with diabetic nephropathy than in those without this complication (17.4 vs 7.4 ng/ml).

Furthermore, circulating levels of A-FABP4 significantly and positively correlated with age (r=0.24), duration of diabetes (r=0.22), body mass index (r=0.42), creatinine (r=0.28), C-reactive protein (r=0.25), and albumin excretion rate (r=0.36); and negatively correlated with glomerular filtration rate (r=-0.43).

A-FABP4 levels showed no correlation with RBP4 levels, and RBP4 levels did not differ according to gender or the presence of diabetic nephropathy. However, RBP4 levels significantly and positively correlated with triglycerides (r=0.35) and creatinine (r=0.27), and negatively correlated with glomerular filtration rate (r=-0.21).

“In this study, we showed that A-FABP4 levels are increased in patients with early diabetic nephropathy,” say Toruner and co-authors , adding that this increase has been found to be associated with renal function, glomerular filtration rate, and subclinical inflammation.

They conclude: “Large-scale and prospective studies are necessary to establish whether these adipokines might be directly involved in the impairment of kidney function in Type 2 diabetes mellitus.”

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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The addition of exenatide to insulin-based therapy is associated with improved glycemic control, less weight gain, and reduced prandial insulin requirements for treatment periods of up to 27 months, researchers report.

Only limited published data exist on the off-label use of exenatide in conjunction with insulin for the treatment of Type 2 diabetes, explain Paris Roach (Indiana University School of Medicine, Indianapolis, USA) and co-workers.

In a retrospective review of data from an outpatient setting collected between June 2005 ??” the date when exenatide became commercially available in the USA ??” and November 2007, the team examined the effects of exenatide on glycemic control, weight, and insulin dose in 188 patients with Type 2 diabetes treated with insulin.

Information on clinical parameters was obtained by retrospective review of medical records for four specified time intervals (0 to 6, 6 to 12, 12 to 18, and 18 to 27 months).

Compared with baseline values obtained before initiation of exenatide, the authors observed mean reductions in glycated hemoglobin (HbA1c) of 0.66% at 0 to 6 months, 0.55% at 6 to 12 months, 0.54% at 12 to 18 months, and 0.54% at 18 to 27 months. However, they note that there was considerable heterogeneity in patient responses.

There was also a significant decline in mean weight with increasing treatment duration with additional exenatide up to 18 months. After this time point an increase in weight was observed, but this remained lower than baseline values.

“The present study is notable in that patients were able to lose weight despite ongoing treatment with insulin,” write the authors.

Prandial insulin dose was significantly reduced compared with baseline, with mean reductions of 33.5% at 0 to 6 months, 25.9% at 6 to 12 months, 29.7% at 12 to 18 months, and 55.7% at 18 to 27 months. Total insulin requirements were also reduced but only for treatment periods of up to 12 months.

Adverse events were generally mild; those most frequently reported were nausea (22.6% of patients), vomiting (19.7%), and hypoglycemia (4.0%).

Based on these results, the authors suggest that insulin therapy does not preclude therapeutic benefit from the addition of incretin mimetics in patients with Type 2 diabetes.

“Prospective controlled trials are needed to further characterize the efficacy and safety of incretin-based therapy in insulin-treated patients with Type 2 diabetes,” they conclude in the journal Clinical Therapeutics.

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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Diabetes has become an epidemic in America. As a result of the way we have become accustomed to living our lives. That’s right this sedimentary life we live as we down those high-fat, sugar-filled foods has boosted the rate of diabetes to a staggering number. This result in the high cost of diabetes, both physically and financially which results in the search for ways to save on test strips. Look at some of the numbers we have to deal with.

The number of American adults with diabetes is expected to double by the year 2050. That means the 18 million who have it now will likely be over 36 million. Over 5 million do not know that they even have diabetes, yet. 20 percent of those over 65 have diabetes. 90 to 95 percent of all diabetes is diagnosed as type 2 diabetes, which is linked to physical inactivity and obesity. It has been estimated that those who were born in the year 2000 one in three will develop diabetes in their lifetime. This dreaded disease takes a tremendous toll on human lives.

Not only does the high cost of diabetes take a toll on the physical but the numbers of financial costs has skyrocketed as well. Just look at what is being done to our pocketbooks with the most expensive disease in our health care system. Over 130 billion dollars per year is spent just in America on diabetes. The average cost per patient with diabetes is $13,000 which is a staggering amount compared to those without the disease who spend an average of only $2,500. Is it any wonder why people are looking to save on test strips which are used only once and disposed of. It does not matter what kind of diabetic test strips you use, Bayer Contour, One Touch, Freestyle test strips, or any other brand the high cost is absurd. We have found some great places to purchase low cost test strips online which has saved us up to 50 percent over pharmacy costs for the exact same strips.

Of course you could also only test yourself two or three times a week instead of per day but that could be disastrous to your health. Always check with your doctor before changing any routine you may have already set up for yourself. Regardless make sure that you do not pay full price for those diabetes supplies especially since you can save a bundle going to sites like TestStripReviews.com to find the right low cost diabetic supplies for your every need.

The treatment for type 2 diabetes is the correct diabetes diet. Food is the primary source of blood sugar, and the correct plan will keep your blood sugar low.

It is a fact that the most effective treatment for diabetes type 2 is the diabetes meal plan. The medications that you given to you by your doctor will not cure your diabetes.

The right meal plan can actually cure/reverse your diabetes.

The diabetic diet menu will include healthy foods such as fruits, vegetables, whole grains and lean meat. Switch from whole milk to low fat milk and low fat yogurt. Add fiber to your food to make you feel full and help reduce your cholesterol.

These diabetic diet menus are geared for success because they have taken into account all of the treatment suggestions from professionals that will make it successful for you to get your blood sugar normal, reduce your cholesterol and lose as much as 30 to 40 pounds. When this happens you can probably stop taking any medications for your type 2 diabetes that were given to you by your doctor.

There are multiple options such as glycemic index which requires a chart of the glycemic index of each food. Another option is the carbohydrate counting, but this will also require a chart.

There is another option, there are corporations who have hired dieticians to develop a free online diabetes diet.

When you strictly adhere to this diet you will bring your blood sugar down, lower your cholesterol and lose up to 30 to 40 pounds.

Do not take risks with your health. Take advantage of this free offer.

Vitamin B₁₂ deficiency is present in 22% of patients with Type 2 diabetes, researchers report.

Vitamin B₁₂ deficiency can lead to nerve symptoms similar to that of diabetic peripheral neuropathy. However, although many patients with diabetes are at risk for vitamin B₁₂ deficiency as a natural consequence of aging and as a result of treatment with metformin, the prevalence of the condition in this population was previously unknown.

In a cross-sectional study, Matthew Pflipsen (Raymond W Bliss Army Health Center, Fort Huachuca, Arizona, USA) and co-workers measured vitamin B₁₂ levels in 203 outpatients with Type 2 diabetes at a large military primary care clinic.

Vitamin B₁₂ deficiency was defined as serum B₁₂ levels of less than 100 pg/ml, or serum B₁₂ levels of 100 to 350 pg/ml with levels of serum methylmalonic acid greater than 243 nmol/l or levels of homocysteine greater than 11.9 nmol/l.

“Elevated methylmalonic acid and homocysteine levels improve the diagnosis of tissue B₁₂ deficiency and may identify patients with deficiency at an early, reversible stage,” explain the authors.

One patient had a B₁₂ level less than 100 pg/ml, and 43 patients with intermediate B₁₂ levels had elevations of either methylmalonic acid or homocysteine, resulting in a total of 44 patients (22%) diagnosed with metabolic B₁₂ deficiency.

Patients using metformin had lower B₁₂ levels, but metformin use was not associated with overt B₁₂ deficiency. The majority of patients were taking metformin and approximately half were on a dose of at least 2 g per day at the time of enrolment.

Just over half the patients in the study were taking a daily multivitamin tablet. In multivariate analysis, multivitamin use seemed to protect patients from B₁₂ deficiency.

Other factors associated with increased risk for B₁₂ deficiency, such as advanced age and use of proton pump inhibitors, were not significantly associated with B₁₂ deficiency.

The authors suggest that physicians should consider the comorbid effects of vitamin B₁₂ deficiency in a population already predisposed to neuropathic complications.

“Further studies need to be undertaken to determine whether screening and subsequent treatment can prevent peripheral neuropathy from developing in patients with Type 2 diabetes before advocating for universal screening,” the researchers conclude in the Journal of the American Board of Family Medicine.

“Multivitamin should also be explored as a method for reducing the incidence of B₁₂ deficiency in the Type 2 diabetic population” 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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There is a relationship between diabetes, high cholesterol and heart disease. Cholesterol is fatty substance that is in every cell in your body. There are two types of cholesterol. The LDL is known as the bad cholesterol. The HDL is the good cholesterol and also helps to remove other bad cholesterol from your body.

Everyone needs to lower their LDL by: staying physically active, stop smoking, keep your body weight in the normal range and eat low cholesterol diet.

It is very beneficial to raise you HDL by: adding olive oil and avocado oil to your diet, increase soluble fiber such as vegetables, legumes, fruits and oats.

As you can see the healthy diet or the diabetes meal plan is the key to treating type 2 diabetes.

In fact, diet is the most effective treatment for type 2 diabetes.

Below are guidelines to reduce your cholesterol: less than 7% of your calories should come from meat, milk and eggs, keep your cholesterol level to less than 200, add 20 to 30 grams of fiber, eat smaller more frequent meals.

Type 2 diabetes has grown at epidemic proportions therefore there are corporations that have released free diabetic meal plans to take the work out of eating right, bringing your blood sugar back to normal, lower your cholesterol and even lose 30 to 40 pounds.

Most people with diabetes have health problems such as high blood pressure and high cholesterol which will increase your risk of heart disease and stroke.

Take care of yourself and use this free online offer to take control and lose those extra pounds.

If you want to stay in the normal range, blood sugar strategies are a must. Control is pretty straightforward as long as you attend to your body, eat right, and exercise.

Here are a couple of tips that will help you stay in the range:

1. Don’t guess about your blood glucose levels. Your body is a wonderful, sensitive instrument, but it can’t beat a glucose meter. People with blood glucose issues often become exquisitely tuned to their bodies. But that’s not enough. If your blood sugar is low and you need to treat yourself, you need to know precisely how low you are. Test!

If you don’t test, you’re on your way to complications. It’s that simple. Fewer than half of patients who guess even come close to their actual glucose level, rarely within even 50 mg/dl. Test regularly if you have diabetes - twice a day if you have type 2 diabetes, before meals and at day’s end if you have type 1.

2. Exercise. Exercise. Exercise. It will burn up glucose in place of insulin. That means you have more give in your diet and your glucose range will vary much less. It helps keep your glucose in check if you’re prediabetic and it can even help balance your food and insulin if you have to inject.

And you don’t have to be a marathoner. Consistency is more important than intensity. Thirty minutes to an hour of moderate exercise a day can reduce your hemoglobin A1c by 1 percent and lower your chance of heart attack, stroke and many cancers. Most people will need to add about 5,000 walking steps a day. That’s not as much as it seems, only about 2 1/4 miles or a brisk 30 minute walk.