Recent Diabetes Clinical Trials

SGLT2 Inhibitors – New drugs for Type 2 Diabetes

There is a new class of medications for type 2 diabetes under investigation in diabetes clinical trials. These drugs are different from other diabetes drugs, in that, they act independently of insulin. Their specific mechanism of action is inhibition of the SGLT2 protein in the kidneys. SGLT2 is responsible for glucose reabsorption in the kidneys. SGLT2 inhibitors block this reabsorption thereby increasing the amount of glucose that is excreted in the urine. An overall reduction in blood-glucose levels is the result.

The SGLT2 inhibitors that are in current diabetes clinical trials are Empagliflozin, Ipragliflozin, Dapagliflozin, and Canagliflozin.

How Can Sleep Affect Your Chances of Developing Metabolic Disorders?

The Lancet Diabetes and Endocrinology recently reported on evidence that reduced sleep can negatively impact energy homeostasis, increasing the risk of metabolic syndrome and disorders related to glucose metabolism. Some of the mechanisms thought to be involved include: reduced insulin sensitivity, alterations in gene expression associated with circadian rhythm & metabolism, and changes in neuroendocrine signalling.

 Diabetes Prevention

Technology now dominates our lives, and it is now finding its role in our health care. A recent clinical trial assessed the effectiveness of text messaging educational and motivational information to participants in diabetes clinical trials. The study successfully demonstrated that those who received these text messages had a reduced rate of progression to type 2 diabetes compared to those who did not receive these messages.

 

Cardiovascular Disease – Links to Diabetes and Gout

CARDIOVASCULAR DISEASE-Links to Diabetes and GoutThe fist-sized heart is a powerful muscle that beats about 100,000 times a day and pumps 7,500 liters of oxygen and nutrient-rich blood to the body through a network of blood vessels. Every cell in the body relies on the heart and blood vessels (i.e. the cardiovascular system) for sustainability.

What is Cardiovascular Disease?

Cardiovascular disease (CVD), also known as heart disease, is the biggest cause of death worldwide. Cardiovascular disease is not a single disease but rather refers to changes or conditions that negatively affect the cardiovascular system.  These include, but are not limited to:

High blood pressure

  • Long-term high blood pressure can cause ‘wear and tear’ to the blood vessels.

Atherosclerosis

  • Atherosclerosis is the hardening and narrowing of blood vessels, often due to the accumulation of cholesterol in the vessels. This reduces blood flow and increases the risk of a ‘clot’ breaking free and blocking blood flow in a blood vessel.

Coronary Artery Disease

  • Coronary artery disease is atherosclerosis of the heart. When blood vessels in the heart narrow and harden, less blood is supplied to this organ. This can result in angina (chest pain), a heart attack and even heart failure.

Heart attack

  • A heart attack occurs when a clot blocks a blood vessel supplying blood to the heart. As a result, the part of the heart that can no longer receive blood and nutrients dies. Heart attacks result in permanent damage to the heart and can result in death.

Stroke

  • A stroke occurs when a clot blocks blood supply to a vessel in the brain. Strokes can result in paralysis, loss of brain or body function, or death.

Heart Failure

  • Heart failure occurs when the muscles of the heart are not strong enough to pump blood or are too stiff to relax to let blood back into the heart.

CVD Risk Factors

Smoking

  • Smoking isn’t just bad for your lungs and your looks. The nicotine in cigarettes contributes to elevated blood pressure which, over time, can lead to the hardening of artery walls.

Poor Dietary Habits

  • The consumption of ‘heart-unhealthy’ foods such as saturated fats and sugary desserts and drinks contributes to elevated cholesterol levels and clogged blood vessels.

Ethnicity

  • Some ethic groups are at a high risk for CVD due to genetic factors. These groups include South Asians (e.g. individuals with Indian, Pakistani, Sri Lankan, and Bangladeshi ancestry), Aboriginals and individuals with African/Caribbean heritage.

Family History

  • A family history of CVD or related conditions such as type 2 diabetes increases the risk for CVD.

Diabetes

  • Individuals with diabetes are 2-6 times more likely to develop CVD than individuals without diabetes. High blood glucose (sugar) levels characteristic in uncontrolled type 1 and type 2 diabetes increases the risk of CVD because glucose can react with and damage blood vessels. Diabetes is also often associated with high cholesterol. It is therefore important to regularly monitor glucose and cholesterol levels and attempt to keep the condition under control.

Gout

  • Gout is a type of arthritis that often afflicts the big toe. Individuals with gout often have elevated levels of uric acid which is a by-product of meat and seafood digestion. Uric acid is pro-inflammatory and contributes to atherosclerosis, coronary artery disease, stroke and heart failure.

Taking Action

Although some risk factors such as ethnicity and family history cannot be altered, there are some measures you can take to lower your CVD risk.

Lace up your sneakers

  • Activities such as walking, gardening, dancing and jogging help keep the heart healthy by training it to work efficiently, lowering blood pressure and reducing stress. Regular exercise also lowers resting heart rate (because the heart doesn’t have to work as hard to pump blood as before) and promotes the growth of blood vessels which improves circulation. A sedentary lifestyle, on the other hand keeps you from reaping the benefits of physical activity.

Diet

  • Aside from cutting down on fatty and sugary foods, the consumption of foods with heart-healthy compounds such as omega 3s and antioxidants can help protect the heart and increase longevity. Omega 3s can be found in fortified eggs and in fish; and fruits and vegetables are rich in antioxidants. HDL, also known as the ‘healthy cholesterol’ is found in sources such as nuts and olive oil. However, it’s important to keep in mind that HDL sources are often high in calories and you should limit consumption to a tablespoon of oil and a few nuts per serving.

Quit Smoking

  • The risk for heart attacks drops and lung function begins to improve anywhere from a few weeks to 3 months of butting out; and after one year the risk for coronary heart disease is half that of a frequent smoker’s.

Keep Diabetes and Gout in check

  • It’s estimated that 3-10% of people with diabetes don’t even know they have it. Given the strong association between diabetes and CVD it is very important to take action to control the condition, and this can’t be done if you don’t think you have a problem.
  • Gout has only recently garnered interest as an important health condition. Currently the recommendations for ‘normal’ uric acid levels vary from country to country and are substantially higher in Canada than the United States and Europe where more research is occurring. As a result, many Canadian physicians and patients may not be aware of the need for their patients to lower uric acid levels. Furthermore, patients with high uric acid levels do not always have symptoms of gout and may not take uric-acid lowering medications appropriately, but rather treat the painful symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs) –which are associated with cardiovascular problems themselves- rather than Colchicine. Therefore patients may not be appropriately lowering their risk for CVD by controlling uric acid levels, and may also be increasing their risk by using some NSAIDs.

Research Efforts

Metformin, which is considered the first line of drug treatment for diabetes is associated with not only improved glucose control, but also a decreased the risk of death among patients with heart failure1,2 and new users of anti-diabetic medications3. New research is aiming to find treatments that will not only help manage glucose, but also protect patients from developing and succumbing to cardiovascular abnormalities in the future.

Similarly, gout research is aiming to target both the condition as well as its associated complications4. New research is examining the ability of medications to both control uric acid levels as well as protect patients from cardiovascular problems and related death.

Sources

1Improved clinical outcomes associated with metformin in patients with diabetes and heart failure. Eurich DT et al. Diabetes Care. (2005)

2 Metformin therapy and prognosis of patients with heart failure and new-onset diabetes mellitus. A propensity-matched study in the community.Romero SP et al. Int J Cardiol. (2011)

3 Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes. Johnson JA et al. Diabetes Care. (2002)

4 Drug treatment of hyperuricemia to prevent cardiovascular outcomes: are we there yet? Gaffo, AL and Saag, KG. Am J Cardiovasc Drugs. (2012)

– See more at: http://www.clinicaltrialsmagazine.com/cardiovascular-disease-links-to-diabetes-and-gout/#sthash.HeCxjVXs.dpuf

The Four Pillars of Diabetes Self-Management

The essence of diabetes self-management encompasses more than just numbers discussed in the physician’s office. It also includes the day-to-day management of this chronic condition and collaboration of various key players: from physicians, nurses, dieticians and family members. Unfortunately, when you finally feel that you have gained control, the inevitable progressive nature of diabetes will challenge you to change with it.

Imagine yourself waking up from a nightmare at 3 a.m. with sweats from an episode of low blood glucose (sugar). Your day progresses with the lack of sleep. Although food provides you with comfort, you need to consider the importance of portion control. You remind yourself you will need to check your blood glucose levels prior to eating and 2 hours after your meals. Not to mention being mindful of the numerous scheduled appointments with the physician, the diabetes team, the endocrinologist, and the nephrologist; and the routine check-ups for your eyes, feet, and dental health.

As a diabetes nurse educator at a community health centre, I often work with clients that require assistance with basic needs in housing and social support. Ultimately, these aspects obscure their ability for self-care.

But what drives their motivation to stay healthy with diabetes, despite these challenges? Here are some ways that can help you build the backbone for diabetes self-management:

 

  1. Explore your feelings and find the key to unlock your motivation from within1-3.What does it mean for you to have diabetes and stay healthy? Take ownership for your health.

 

  1. Set simple and realistic goals so they can be achievable while increasing your confidence and ability for self-care1.
  1. Explore the significance of your personal experiences. Use this wisdom to build strength and create pathways for finding and defining achievement. Through channels of individual or group environment, sharing of experiences is a powerful way to boost your confidence for believing in your capabilities4-5.
  1. Define your support system, whether it is your family, friends, or healthcare team. They walk with you in the flow of care as the course of diabetes management changes with life’s milestones4-5.

Diabetes Education Centres embrace the above pillars of diabetes self-management. Although the complexity of diabetes care increases with the duration of the disease, the way of living healthy with diabetes is no different than living a healthy life without diabetes. As evidenced in my practice, applying the four pillars as guidance in your daily life will help build a strong structure for decision-making and problem solving. This can lead to a successful and sustainable lifestyle without future complications. Aside from all the missing pieces and setbacks – let’s take a moment to appreciate and acknowledge your efforts in living with chronic conditions!

 

Jessica Chan, BScN, RN is a registered nurse and Queen’s University Alumnus. She completed the Diabetes Educators Graduate Certificate Program and is a candidate for the Certified Diabetes Educator (CDE) designation. Jessica provides diabetes education in various settings including acute care hospitals, and the diabetes education centre in Unison Health and Community Services in Toronto. Jessica has also completed an Advanced Clinical/Practical Fellowship from Registered Nurses Association of Ontario (RNAO) on promoting and enhancing interdisciplinary care in diabetes management.

 

Sources

1) Belton A, Simpson N. The how to of patient education. 2nd ed. Canada: Anne Belton & Nancy Simpson; 2010.

2) Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. JCCP, 2007; 75(2); 336-343.

3) Sandén-Eriksson B. Coping with type-2 diabetes: the role of sense of coherence compared with active management. JAN. 2000; 31(6); 1393-1397.

4) Canadian Diabetes Association. Clinical practice guidelines for self-management education. Can J Diab Canada; 2008; S25-S28.

5) Funnell MM, Anderson RM. Empowerment and self-management of diabetes. Clin Diabetes. 2004; 22; 123-127.

 

Channeling the Power of Diet and Exercise for Type 2 Diabetes Prevention

Regular moderate intensity exercise and adherence to the Mediterranean diet may help in type 2 diabetes prevention and control.

Type 2 diabetes is a condition where a hormone called insulin can no longer regulate the movement of blood sugar, or glucose, into cells. As a result, glucose remains in the blood where it damages blood vessels and organs. This increases the risk for secondary complications such as heart disease, blindness, kidney problems, amputations and nerve damage. Individuals with diabetes are also more likely to suffer from depression.

In the famous Diabetes Prevention Program Study individuals at risk for diabetes who engaged in regular exercise and adhered to a low fat, high fiber diet were 34% less likely to develop type 2 diabetes whereas patients taking an anti-diabetic medication lowered their risk by 18%1. Fortunately for individuals who have already developed diabetes, lifestyle changes can aid with the management of this condition.

Channeling the power of diet - balanced dietTHE HEART HEALTHY MEDITERRANEAN DIET

Individuals with type 2 diabetes are 2 times more likely to develop heart disease so it is important to protect this vital organ in addition to managing glucose levels.

The Mediterranean Diet refers to the general pro-heart diet consumed in areas around the Mediterranean Sea. This diet is characterized by:

  • A high consumption of fruits and vegetables
  • A lower consumption of red meats
  • Low fat and yogurt sources of dairy
  • Protein sources from legumes or from lean animal sources such as chicken or fish

 

Carbs don’t have to be the Enemy!

Channeling the Power of Diet - Carbs Are Not Your EnemyCarbohydrates, or carbs, are allowed! Shunning all carbs from your diet may not be the best approach for a diet change because they can be an important source of fiber and help keep you full. The key, however, is to opt for complex carbs rather than simple carbs. Complex carbs come from sources like legumes, vegetables, breads and pastas; and simple carbs are found in sodas, candies and chocolate (think of simple carbs as ‘simple sugar’). It is also helpful to opt for whole wheat breads and pastas because they are higher in fiber, which will help keep you full longer and prevent over-eating and giving in to junk food cravings.

Tip: If you do find yourself daydreaming about Candyland, try fulfilling your cravings with fruit.

 

Not all Fats are Created Equal

Channeling the power of diet - olive oil is healthyFats can be categorized as unsaturated and saturated. Saturated fats usually come from animal sources such as meat, cheese, butter and ice cream, but can also come from non-animal sources like coconut and palm oil. These types of fats are considered ‘unhealthy’ because they are chemically ‘less fluid’ and ‘more stiff’ than unsaturated fats. To put this in perspective, imagine if the cells of your heart were made up of stiff cells versus more fluid and movable cells.

The primary fat source in the MD is from olive oil which is an unsaturated fat. Other sources of unsaturated fat that you can include in your diet include fish, nuts and legumes.

Tip: Use olive oil-based dressings and try replacing butter sticks with non-hydrogenated margarine. Hydrogenation is the process that makes an unsaturated fat a saturated fat. Hydrogenated fats are often found in desserts and pastries.

Wine and Dine

Wine and DineThe MD also often includes red wine (no more than 1 glass/day for women and 2 glasses/day for men). Moderate consumption of red wine is associated with healthy cholesterol levels, and lowered risk of cardiovascular disease. Red wine contains antioxidants which help protect against high blood pressure and clogged arteries.

Tip: Don’t overdo it! A high consumption of alcohol has the opposite effect and can actually increase your health risk.

 

FEEDING YOUR MUSCLES

diabetes preventionRemaining physically active is an important aspect of diabetes care. Although the thought of starting an exercise program may be intimidating for individuals who are relatively inactive, small steps can result in large gains in health.

Start Small but Go Often

To reap the health benefits of exercise for diabetes, it’s not about going hard, but about going often. Muscle contraction stimulates the movement of sugar from the blood into muscle cells without a need for insulin (i.e. this mechanism is insulin-independent).Furthermore, exercise improves the sensitivity of insulin (i.e. your insulin will work better).  This improvement in insulin sensitivity often lasts for 24-48 hours meaning that if you exercise most days of the week, you can improve your blood sugar levels and insulin sensitivity.

All it takes is 20-30 minutes of activities such as brisk walking, swimming, raking leaves or water aerobics on most days of the week. Activities can be done continuously (i.e. one bout of 30 minutes) or throughout the day (e.g. 10 minute-bout, 3 times a day).  But, remember, you need to regularly monitor your blood sugar levels to prevent drastic reductions in blood glucose levels (i.e. less than 5 mmol/L).

Feed your Muscles-Hit the Weights

Since glucose is the main energy source for muscles and muscle contraction can draw in glucose without insulin, the more muscle you have and use, the more glucose you will remove from the blood.

diabetes prevention

The best way to promote muscle growth is through resistance training exercises with free weights (e.g. dumbbells) or weight machines. Start by:

  • Performing 10-15 repetitions of an exercise such as a bicep curl for one set
  •  Progress to 2 sets of 10-15 repetitions after a few weeks
  • Progress to 3 sets of 10-15 repetitions at a heavier weight a few weeks after that

Be sure to incorporate as many muscle groups as possible (e.g. shoulders, biceps, chest, back, legs etc.) and let muscles groups rest for 48 hours before continuing with your resistance training exercises.

Tip: Bring a buddy! If you are new to resistance training, it is important to bring a friend that can both help you stay motivated, but can also help ‘spot’ you and make sure you don’t hurt yourself.

 

Improving Cardio-respiratory Fitness

Cardio-respiratory fitness refers to the ability of your heart and lungs to work to bring oxygen and nutrients to the body. People with better cardio-respiratory fitness are less likely to have heart disease and tend to live longer.

The best way to improve this type of fitness is through aerobic exercises that are continuous, rhythmic and use the same large muscle groups for at least 10 minutes. Aerobic exercises such as walking or swimming also help promote:

  • Weight loss (which helps improve glucose control)
  • Healthy circulation (important in the prevention of diabetes-related amputations)
  • Good mood (aerobic exercises release ‘feel-good’ chemicals in the brain that can help manage depression)
  • Healthy sexual functioning

diabetes preventionTip: Don’t force yourself into something you won’t enjoy. If you really don’t like cycling, but prefer swimming, then swim. Find an activity you can at least put up with and keep at it. Starting to exercise can be challenging but the longer you stick to it, the better it gets.

Note: It is important to continue to monitor blood glucose levels. Speak with a doctor before making drastic changes to your diet or starting an exercise program.

 

Source: 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 November 14; 374(9702): 1677–1686. doi:10.1016/S0140-6736(09)61457-4

 

Promising New Classes of Type 2 Diabetes Medication May Improve Longevity

Type 2 diabetes is a condition in which the body cannot regulate the levels of sugar or glucose in the blood. Normally glucose is regulated by the hormone insulin which helps deliver glucose from the blood and into the cells where it is used for energy. Patients with type 2 diabetes have poor functioning insulin and/or cells that no longer respond to insulin meaning that glucose remains in the blood.

Promising new classes of type 2 diabetesThe regulation of glucose is vital since low blood glucose (hypoglycemia) can cause dizziness, fainting and even induce comas; and high levels of blood glucose (hyperglycemia) can damage blood vessels and organs such as the eyes and kidneys. Type 2 diabetes is also associated with an increased risk of cardiovascular disease and cardiovascular-disease related death. There is currently no cure for diabetes (aside from bariatric surgery which is not feasible for the millions of Canadians with the condition) so treatment focuses on managing the condition rather than eradicating it.

Fortunately, treatment of diabetes has made great progress over the decades with the introduction of oral anti-diabetic medications such as metformin and insulin injections. Various classes of diabetes medications have been assessed for their effectiveness and their ability to improve longevity. Results of these studies suggest that although these drugs are effective in controlling diabetes, they may not improve longevity.

GLP-1 and DPP-4 inhibitors are classes of drugs that have garnered interest in their ability to manage diabetes and potentially protect against cardiovascular disease. GLP-1 is a hormone that promotes the release of insulin from the pancreas and unlike other treatment options, helps promote weight loss by influencing appetite. DPP-4 is an enzyme that breaks down GLP-1 so DPP-4 inhibitors are used as an adjunct treatment to preserve GLP-1 in the body.

Clinical trials have found that the administration of such drugs to patients with previous heart attacks showed improvement in heart function1. As a result, researchers believe that GLP-1 and DDP-4 treatments may prevent death associated with cardiovascular disease by protecting the heart itself.

More research is required and ongoing to determine whether these new classes of drugs can improve not only glucose management but also cardiovascular risk among patients with type 2 diabetes.

Sources:

1  From theory to clinical practice in the use of GLP-1 receptor agonists and DPP-4 inhibitors therapy. Dicembrini I, Pala L, Rotella CM. Exp Diabetes Res. 2011;2011:898913. Epub 2011 Jun 23. http://www.ncbi.nlm.nih.gov/pubmed/21747834

 

Importance of Sleep for Diabetes and Cardiovascular Disease

Our bodies need sleep.  The significance of proper amounts of sleep has already been demonstrated on obesity, hypertension, high blood pressure, and mental health conditions like depression.  There are now reports of the importance of sleep for diabetes in addition to cardiovascular health.

According to a long-term study utilizing thousands of patients by the Monitoring Project on Risk Factors for Chronic Diseases in Netherlands, we can now confidently say that getting 7 or more hours of sleep per night significantly improves cardiovascular health.  Not smoking, regular exercise, a healthy diet, and moderate amounts of alcohol consumption, when practiced together, minimize the risk of Cardiovascular Disease (CVD ) by up to 57 – 67%.  When combined with a proper sleep schedule, this protective effect lowers CVD risk by 65 – 83%.

Another study at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed) has demonstrated that proper sleep patterns benefit men with Type 2 Diabetes by improving their insulin sensitivity.  Approximately 90% of all diabetes sufferers (312 million people worldwide), have Type 2 Diabetes, a condition characterized by the body’s inefficient use of insulin and for which there is still no clear cause.  The immune effects of sufficient sleep may, in part, be attributed to melatonin, a natural hormone produced by the pineal gland in the brain at night.  Individuals who suffer from insomnia or have abnormal sleep patterns have disrupted melatonin levels.  A study at the Kidney Clinical Research Institute at Brigham and Women’s Hospital in Boston showed that patients with less melatonin have a doubled risk of developing Type 2 Diabetes.  These findings reinforce the importance of a good night’s sleep on health, in particular the importance of sleep for diabetes prevention.

Ciaran, J. et al. Melatonin secretion and the incidence of type 2 diabetes. JAMA 309(13): 1388 – 1396, published online 03 April 2013; DOI: 10.1001/jama.2013.2710Hoevenaar-Blom M, Spijkerman AMW, Kromhout D,

Verschuren WMM. Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study. Eur J Prevent Cardiol 2013; DOI: 10.1177/2047487313493057.

Killick, R. et al. The effects of ‘catch-up’ sleep on insulin sensitivity in men with lifestyle-driven, chronic, intermittent sleep restriction. Presented at ENDO 2013, 15-18 June, San Francisco

 

Opening the Door to Type 2 Diabetes Management

With 8 million Canadians currently suffering from type 2 diabetes – a number that is on the rise – there is an urgency to find new ways to prevent, treat and cure the disease. In recent years, science has made strides in catching up with diabetes – partly thanks to the success of clinical trials which have found effective drug therapies for type 2 diabetes management.

type 2 diabetes managementWhat is Type 2 Diabetes?

Diabetes can be understood as an abundance of glucose, or sugar, in the blood.  Normally, sugar consumed in food is absorbed into the bloodstream where it enters the cells with the help of insulin, a hormone that originates in the pancreas.  During periods of low blood sugars (e.g. after exercising or a fast), the liver will release sugar into the bloodstream so that insulin can ‘open the door’ to let it into the cell where it is used as energy.  However, in patients with type 2 diabetes, blood sugars do not enter the cells due to a lack of insulin, or an inability of the cells to respond to insulin.  As a result, the ‘door’ to the cell remains closed, and sugars accumulate in the blood stream where they can damage organs such as the heart, kidneys and eyes.

Symptoms and Risk Factors

Many patients with type 2 diabetes are asymptomatic (without symptoms).  Among those who present with symptoms, common signs of the disease include thirst, frequent urination, hunger, unintended weight loss, fatigue, blurred vision, slow-healing sores, and infections.

The following have been found to be associated with a higher risk for type 2 diabetes:

  • Age > 40 (high risk)
  • Family history (high risk)
  • Aboriginal, Hispanic, Asian and African ethnicity
  • History of heart disease, hypertension, high cholesterol
  • Overweight and obesity

Prevention

The easiest way to prevent diabetes is by maintaining a healthy diet and exercising regularly.  Reducing fat in the diet decreases risk since the less fat a person consumes, the more receptive their cells are to insulin. It is also important to avoid sugar and saturated/trans fats and consume an adequate amount of fruits and vegetables.  Regular and moderate exercise (such as walking for 30 minutes a day) has been shown to improve insulin sensitivity and blood glucose control.

Treatment

Fortunately for individuals who have already been diagnosed with type 2 diabetes, diet and exercise may still improve blood sugar levels.  Diabetes patients are required to regularly monitor blood sugars (via a finger prick device), especially if they are active since exercise can drastically reduce blood sugar levels and put individuals at risk for a diabetic coma.  Depending on how severe the diabetes is, patients may have to monitor their blood sugar a few times a week or as often as three times a day.

Patients with type 2 diabetes are also often placed on a drug therapy since lifestyle modification becomes less effective as the disease progresses.  Oral medications often work by stimulating insulin release from the pancreas or by preventing the liver from releasing sugar.  If oral medications are unable to adequately lower blood sugar levels, patients may be placed on an insulin therapy.

The Role of Clinical Trials

Given the sheer number of Canadians affected by type 2 diabetes, and the importance of drug therapy in the long-term management of this disease, there is a growing demand for clinical research investigating the effectiveness of varied drug therapies.  Patients who participate in diabetes clinical trials receive benefits such as access to new treatments before they are widely available, and the opportunity to undergo informative assessments of overall health and fitness.  Furthermore, patients benefit from the knowledge that their participation is helping to advance the understanding of this disease for the betterment of millions of Canadians.

Fun Facts

The reason frequent urination is a symptom of diabetes is because the body is trying to get rid of excess blood sugar.

Diabetes has been around for a long time and the ancient Indians referred to it as ‘sweet urine disease’. Don’t worry, they didn’t actually taste the urine, they observed that ants were attracted to some people’s urine more than others.

Did You Know?

Blood sugar levels drop during exercise because muscle contraction stimulates the movement of sugar from the blood into muscle cells independent of insulin.  Furthermore, exercise improves the sensitivity of insulin (i.e. your insulin will work better).  This improvement in insulin sensitivity often lasts for 24-48 hours meaning that if you exercise most days of the week, you can improve your blood sugar levels and insulin sensitivity, even if you already have type 2 diabetes! But, remember, you need to regularly monitor your blood sugar levels.

Diabetes and Alzheimer’s: is There a Connection?

The Link between Type 2 Diabetes and Alzheimer’s Disease

The food we eat is broken down in the digestive system into smaller components where it is absorbed into the bloodstream and then transported to cells to be used for energy. Carbohydrates from sources such as bread, vegetables and sweets are broken down into smaller compounds known as glucose. Glucose is transported into cells, including brain cells, with the help of a hormone called insulin. Researchers believe that the loss of glucose regulation typical in type 2 diabetes may increase the risk of Alzheimer’s disease.

What is Type 2 Diabetes?

In type 2 diabetes, insulin cannot work properly and as a result can no longer allow glucose entry into the cells. As a result, glucose remains in the blood at high concentrations, and will react with and damage blood vessels and organs such as the kidneys and eyes over time. High blood glucose levels also contribute to inflammation in the body. It is for this reason type 2 diabetes is a risk factor for heart disease, kidney failure, and blindness. Some signs of diabetes include frequent thirst and urination, unintended weight loss and poor wound healing. Since humans can’t feel high glucose levels they way they can feel back pain or a stomach ache, individuals may overlook these signs and remain undiagnosed for years. Aside from increasing the risk of heart, kidney and vision problems, uncontrolled diabetes may also increase the risk of Alzheimer’s disease.

What is Alzheimer’s disease?

Alzheimer’s disease is a form of dementia characterized by a decline in intellectual functioning. Advanced Alzheimer’s results in an inability to recognize loved ones or to perform activities of daily living such as eating and bathing. Alzheimer’s disease progresses quickly and is ultimately fatal. The exact cause of Alzheimer’s is unknown but may be related to a variety of changes associated with aging. A diagnosis for Alzheimer’s disease requires the elimination of other conditions such as Parkinson’s disease, depression and vitamin deficiency which can contribute to symptoms.  When Alzheimer’s is suspected, tools such as memory and cognitive tests may be used to confirm a diagnosis.

What is the Connection between Type 2 Diabetes and Alzheimer’s Disease?

Type 2 diabetes has long been recognized as a risk factor for Alzheimer’s disease since individuals with Alzheimer’s are more likely to have diabetes than not. New research suggests that high blood glucose levels may contribute to the condition by damaging blood vessels in the brain and promoting inflammation. The brain is a complex organ in which ‘information signals’ travel from one brain cell, or neuron, to another and from one area of the brain to another to help us perceive the world, store memories and form language.  A healthy brain has a high number of neurons that have a high level of connection to other neurons. Neurons rely heavily on glucose for energy (unlike other cells that can survive longer on fat and protein sources of energy) and may starve and die in cases of uncontrolled type 2 diabetes. Additionally, insulin has been recognized as an important growth factor in the brain which promotes neuron growth and connectivity, meaning that an inability to respond to insulin may result in a loss of brain function and an increased risk for Alzheimer’s.

Minimizing the Risk

There are a variety of steps that can be taken to reduce the risk of Diabetes and Alzheimer’s:

  • Exercise your body and mind. This can be as simple as parking further at the grocery store, taking the stairs instead of the elevator, doing crossword puzzles and maintaining an interesting social life.
  • Eat well. A low-fat diet rich in vegetables, lean meat and whole grains can reduce the risk of both type 2 diabetes and Alzheimer’s.
  • See a doctor! A simple blood test can help determine if you have healthy blood glucose levels and if you are at risk of type 2 diabetes.

Even if you have been diagnosed with type 2 diabetes, these measures will help you control the condition.

Press Release: Waterloo Study Seeking Newly Diagnosed Diabetes Patients

A new diabetes study in the Kitchener-Waterloo area is investigating the effectiveness of a combination drug therapy of Metformin and Tradjenta (linagliptin) for people newly diagnosed with type 2 diabetes.

WireService.ca Press Release – May 10, 2012 – Kitchener, Ontario: A phase IV post-marketing research study in the Kitchener-Waterloo area is investigating the effectiveness of a combination drug therapy of Metformin and Tradjenta (linagliptin) for people newly diagnosed with type 2 diabetes. Metformin is often considered the first line of treatment against diabetes, and Tradjenta is a new anti-diabetic therapy that was approved by Health Canada in October of 2011.

To be considered eligible for the study, potential participants must:

Be Male or Female over 18 years of age
Be newly diagnosed with Type 2 Diabetes within the past 12 months
Have never used any anti-diabetic medications

An estimated 1 million Canadians have diabetes and don’t know it.1*

Type 2 diabetes is a disease in which a hormone known as insulin can no longer move sugars, or glucose, from the blood into cells. As a result, cells do not receive this vital energy source and starve.

Some signs of type 2 diabetes include frequent thirst and urination; tingling or numbness in the hands and feet; unintended weight loss; and slow healing cuts or sores. Since humans are unable to sense high blood glucose levels, and signs of type 2 diabetes may take years to develop, an estimated 1 million Canadians go years without a diagnosis. Long term elevated blood glucose levels contribute to a variety of complications such as blindness, kidney disease, amputations, hardening of the blood vessels and heart disease.

Some risk factors for developing diabetes include increasing age; a family history of the disease; being overweight or obese; heart disease or high blood pressure; infrequent doctor visits; and South Asian or African ethnicity. Finding more aggressive diabetes management options is essential and would help reduce the risk of serious complications.

About the Company

The Canadian Centre for Clinical Trials is a Toronto based company with the aim of engaging patients and physicians in clinical research. More information about the Canadian Centre for Clinical Trials can be found at:
http://www.clinicaltrialscanada.com.

For more information about the study please email info@clinicaltrialscanada.com, call 1-855-85-TRIAL (87425) or visit http://diabetes.clinicaltrialscanada.com

Call us to learn more about the study!

Company Contact:
Gazal Vakili
Clinical Research Manager
Gazal.Vakili@clinicaltrialscanada.com
Telephone: (289)-597-0106 ext. 112
Fax: (905)-886-1648

Source:

1 Canadian Diabetes Association: Get Checked Now http://www.getcheckednow.ca/

Would You Undergo Surgery to Manage Diabetes?

A recent peer-reviewed study in the New England Journal of Medicine demonstrates that patients with diabetes who receive medical treatment (i.e. nutritional counseling and drug treatment) plus bariatric surgery (i.e. weight loss surgery) maintained better control of their diabetes and lost more weight than individuals receiving only medical treatment to manage diabetes.

Observational studies have suggested that bariatric surgery may reverse diabetes, yet randomized controlled trials (which are considered the ‘gold standard’ for determining new treatment recommendations) have been scarce.

Although more similar research is required, results of this study suggest that bariatric surgery procedures may be a feasible option for diabetes management, especially given the difficulty in managing diabetes with disease progression.

Bariatric surgery involves a decrease in the size of the stomach or bypassing a portion of the digestive system. These procedures are not without risk and complications. The success of these procedures beyond nine years is not well documented1 and it’s estimated that 52.9% of patients require re-operation as early as 2 years after their initial operation.  Additionally, bariatric surgery is costly and not readily available in Canada2.

What do you think? Would you be willing to undergo surgery to manage diabetes?

Sources

1. Lanthaler M, Aigner F, Kinzl J, et al. Long-term results and complications following adjustable gastric banding. Obes Surg. 2010;20: 1078-1085.

2. Christou NV, Efthimiou E. Bariatric surgery waiting times in Canada. Can J Surg. 2009;52: 229-234.