Progress Report in Diabetes Research

Diabetes Research

With dozens of journals coming out with new studies each month, there is no doubt that diabetes research is advancing rapidly. One journal, Diabetes Care, published a special issue devoted to diabetes and heart disease. The findings are encouraging and emphasize the importance of managing blood pressure, cholesterol, and weight in addition to blood glucose. Here are the highlights.

Progress Report in Diabetes Research

The Good News

1. Type 2 diabetes can be reversible for up to 2 and one half years (30 months) following very acute weight loss. About 40% of participants who lost weight (starting from an average weight of 220 and dropping to 190, or a 15% weight loss) became non-diabetic and remained non-diabetic for a period of 2 ½ years. The highest likelihood of reversing diabetes was in people with relatively short duration of diabetes, and with higher levels of their own insulin.

2. Tight control of glucose levels in people with Type 1 diabetes for a period of 6.5 years, instituted shortly after development of diabetes, has long term beneficial effects on the risk of cardiovascular disease for as long as 30 years! The DCCT was the first study (first reported in 1993) that showed the benefits of tight glucose control. Now, 30 years later, those people are still showing the benefit despite the fact that they have been in only moderate glucose control for the following 24 years. The difference between the conventional treatment group and the intensive treatment group continues to this day. This is called “Metabolic Memory” –something happened during that initial 6.5 years of intensive treatment that carried over for another 24 years.

3. One of the newer types of medication for diabetes, empagliflozin, can result in a 38% reduction in cardiovascular death, 35% reduction in hospitalization for heart failure, and significant reduction in major cardiovascular events by 14%.

4. Intensive Glucose Control in people with type 2 diabetes reduces the risk of severe renal disease. There is a 66% reduction in development of severe “end-stage” kidney disease over a period of nine years. The best results were seen in people with relatively well preserved kidney function and with good control of blood pressure.

5. When people with diabetes achieve good control of Blood Pressure (BP), cholesterol (specifically “bad” cholesterol or LDL-C) and A1C, they have lower risk of cardiovascular disease, including coronary heart disease.

6. Long term use of insulin glargine (Lantus™) improved metabolic control without any adverse effects with respect to heart disease and stroke. In contrast, use of so-called “Omega-3 fatty acids” did not have any beneficial effect on cardiovascular disease.

7. The DPP-4 Inhibitor class of medications has been studied with regard to possible effects on risk of heart disease or heart failure. There was no increase in risk of heart attacks and other aspects of major cardiovascular events with sitagliptin (Januvia™). However, two other medications with similar mechanism of action showed a modest increase in risk of congestive heart failure in previous studies.

8. Better control of cholesterol resulted in improvement (slower rate of progression) of diabetic retinopathy (disease of the blood vessels in the eye). The best results were seen in people who also had higher levels of “good” cholesterol, namely HDL-C.

The Not-So-Good News

1.  Diabetes and Prediabetes increase the risk of hospitalization. People with diabetes are at increased risk of various medical conditions, and must control risk factors such as glucose levels, blood pressure, cholesterol, smoking, and excess weight.

2. Sleep deprivation worsens loss of mental function during recovery from hypoglycemia.

It’s clear that the positive findings outweigh the negative, indicative of our progress in understanding and treating diabetes. There are still lots of opportunities for discovery and innovation, and we are looking forward to new advances!

556c6fde-7cec-4b2b-bdd7-34650ab56e42

0

Share

0
David Rodbard MD
David Rodbard MD

David Rodbard MD is President of Biomedical Informatics Consultants, based in Washington DC, and is a specialist in diabetes and clinical endocrinology. Prior to consulting, David spent 30 years as a clinician, researcher, and computer scientist for the National Institutes of Health.