TUESDAY, Oct. 14, 2014 (HealthDay News) -- In the future, could people with type 2 diabetes manage their medications with a pulse of light? A preliminary new study suggests it may be possible.
In the study, scientists showed that the prototype drug -- for now just called JB253 -- stimulated insulin release from pancreatic cells in the lab when they were exposed to blue light.
"In principle, this type of
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TUESDAY, Oct. 28, 2014 (HealthDay News) -- People newly diagnosed with type 2 diabetes who are initially given the drug metformin are less likely to eventually need other drugs to control their blood sugar, a new study suggests.
The study found that, of those started on metformin, only about one-quarter needed another drug to control their blood sugar. However, people who were started on type 2 diabetes drugs other than metformin often needed a second drug or insulin to control their blood sugar levels, the researchers said.
"This study supports the predominant practice, which is that most people are started on metformin," said lead researcher Dr. Niteesh Choudhry, an associate professor of medicine at Harvard Medical School in Boston. "Metformin might be more effective than others in controlling blood sugar," he noted.
"Metformin, which is one of the oldest drugs we have and which the guidelines recommend as being the first drug to use, is associated with a lower risk of needing to add a second drug or insulin compared to any of three other commonly used classes of drugs," Choudhry said.
The report was published in the Oct. 27 online edition of JAMA Internal Medicine.
A hallmark of type 2 diabetes is insulin resistance, according to the American Diabetes Association (ADA). That means the body doesn't effectively use the hormone insulin. Insulin is produced by the pancreas and helps usher sugar from foods into the body's cells to be used as energy. When people have insulin resistance, too much sugar is left in the blood instead of being used. Over the long-term, high blood sugar levels can lead to serious complications, such as heart and kidney disease, according to the ADA.
There are eight classes of oral type 2 diabetes medications, according to the ADA. Each class works a bit differently. For example, metformin makes the body's cells more sensitive to insulin. It also decreases the amount of sugar naturally produced in the liver, the ADA reports. Sulfonylureas, on the other hand, encourage the pancreas to produce more insulin, according the ADA.
For the current study, Choudhry's team collected data on more than 15,000 people starting treatment for type 2 diabetes from July 2009 through June 2013. The average follow-up time was slightly longer than one year.
Of those patients, almost 60 percent were initially treated with metformin, and about one-quarter began treatment with a sulfonylurea, such as Glucotrol, according to the study. Just 6 percent were started with a thiazolidinedione, such as Actos, and 13 percent with a DPP-4 inhibitor, such as Januvia, the report indicated.
The researchers found that around 40 percent of people taking a sulfonylurea, a thiazolidinedione, or a dipeptidyl peptidase 4 inhibitor (DPP-4 inhibitor) added a second drug to their diabetes treatment regimen during the study. Just 25 percent of those on metformin added an additional oral drug during the study period.
In addition, 5 percent of those started on metformin later added insulin to their treatment, according to the study. About 9 percent of those who started on a sulfonylurea, 6 percent started on a DPP-4 inhibitor and 6 percent started on thiazolidinediones, also took insulin, the investigators found.
Choudhry said that many patients are being started on other drugs, but this study indicates that treatment should start with metformin.
"These findings emphasize the use of metformin as the first-line drug for type 2 diabetes," he said.
Dr. Jodi Segal, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health and co-author of an accompanying journal editorial, said, "It is already well established that metformin is the preferred first-line option for patients who can tolerate it."
But, she added that doctors should pay more attention to their patients' worries about needing to intensify therapy when choosing medications.
"Doctors might want to help their patients understand that intensifying therapy does not mean that the patient has failed," Segal said.
Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, doesn't think that metformin alone is sufficient to treat type 2 diabetes. He believes that treatment needs to aggressively lower blood sugar.
"We don't start treatment with a single drug," Zonszein said. "We use a combination from the get-go."
Zonszein said even this study shows that treatment with a single drug doesn't work. "So why do we wait to intensify treatment rather than treating more aggressively?"
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SUNDAY, Nov. 2, 2014 (HealthDay News) -- Weight-loss surgery significantly lowers an obese person's risk of developing type 2 diabetes, researchers report.
This reduced risk was independent of other factors such as smoking, high blood pressure and high cholesterol, according to the study in the Nov. 3 issue of The Lancet Diabetes & Endocrinology.
"Our results suggest that bariatric surgery may be a highly effective method of preventing the onset of new diabetes in men and women with severe obesity," study author Martin Gulliford, a professor of public health at King's College London, said in a journal news release.
"We need to understand how weight-loss surgery can be used, together with interventions to increase physical activity and promote healthy eating, as part of an overall diabetes prevention strategy," he added.
Being overweight or obese is a major risk factor for diabetes, and up to 3 percent of severely obese people develop diabetes each year, the study authors noted in the news release.
This study included more than 2,100 obese adults without diabetes who underwent weight-loss surgery -- such as gastric bypass or gastric banding -- and the same number of obese adults who did not have weight-loss surgery or other obesity treatments.
The participants were followed for up to seven years (median 2.8 years). The investigators found that those who had weight-loss surgery -- also called "bariatric" surgery -- were 80 percent less likely to develop diabetes than those who did not have the surgery.
In an accompanying commentary, Dr. Jacques Himpens of Saint Pierre University Hospital in Brussels, Belgium, pointed out that while the findings "bring us a step closer to confirming the effect of bariatric surgery on the incidence of
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