Journal Watch

Prepared for IDDT by Jim Young

April 2015

Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus
B. T. Gee et al. Diabetic Medicine. Doi: 10.1111/dme.12744

In this study 390 families with children with Type 1 diabetes were enrolled in a 2-year, randomized clinical trial of a behavioural intervention. The intervention was designed to improve diabetes management practices by targeting the family’s diabetes problem-solving skills. Based on their findings the authors suggest that there needs to be a long-term (over 1 year) focus on the implementation of interventions that target diabetes management in young people. They also posit that behavioural interventions that target problem-solving skills could be considered as practical, non-pharmacological strategies to reduce hypoglycaemia in adolescents with Type 1 diabetes.


Glucose but not insulin or insulin resistance is associated with memory performance in middle-aged non-diabetic women
Anna Backeström et al. Diabetology & Metabolic Syndrome. Doi: 10.1186/s13098-015-0014-7

The aim of this study (127 men and 164 women of average age 50) was to discover if glucose, insulin or insulin resistance was associated with episodic or semantic memory in a non-diabetic and non-demented population. It found that a higher fasting plasma glucose concentration was associated with lower episodic memory in women but not in men. It also found that plasma insulin levels and insulin resistance were not associated with episodic or semantic memory in women or in men.
[Episodic memory is the memory of autobiographical event – who, what, when, where, why knowledge]- [Semantic memory refers to general world knowledge that we have accumulated throughout our lives]


Insulin pump risks and benefits
Lutz Heinemann et al. Diabetes Care. Doi: 10.2337/dc15-0168

The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) joined forces to review the systems in place for evaluating the safety of pumps from a clinical perspective. They found that useful information held by the manufacturing companies is not currently shared in a sufficiently transparent manner. Public availability of adverse event (AE) reports on the US Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database is potentially a rich source of safety information but is insufficiently utilized due to the current configuration of the system; the comparable database in Europe (European Databank on Medical Devices [EUDAMED]) is not publicly accessible. They add that many AEs appear to be attributable to human factors and/or user error, but the extent to which manufacturing companies are required by regulators to consider the interactions of users with the technical features of their products is limited. This leads to the authors noting that once a pump is available on the market, insufficient data are made publicly available on its long-term use in a real-world setting, and that such data could provide vital information to help health care teams to educate and support users and thereby prevent AEs. The statement concludes with a series of recommended specific actions for “meknovigilance” (i.e., a standardized safety approach to technology) that could be implemented to address the shortcomings they highlight.


Treatment intensification with insulin glargine in patients with inadequately controlled type 2 diabetes improves glycaemic control with a high treatment satisfaction and no weight gain
Daniela Riebenfeld et al. Swiss Medical Weekly.  Doi:10.4414/smw.2015.14114

This study evaluated the efficacy of, and treatment satisfaction with, insulin glargine administered with pens in 327 patients with type 2 diabetes mellitus managed by 72 primary care physicians in Switzerland. It found that education on insulin injection and on self-management of diabetes was associated with clinically meaningful improvements in HbA1c and fasting plasma glucose without a mean collective weight gain. The vast majority of both patients and primary care physicians were satisfied with the treatment intensification.


Islet autoantibody status in a multi-ethnic UK clinic cohort of children presenting with diabetes
R Perchard et al. Archives of Disease in Childhood. Doi: 10.1136/archdischild-2014-306542

In this study 316 (68.0% non-white) children presenting with diabetes were tested for islet cell autoantibodies (ICA) and glutamic acid decarboxylase autoantibodies (GAD-65) at diagnosis, and if negative for both they were tested for insulin autoantibodies (IAA). It was found that 25.8% of children assigned a diagnosis of type 1 diabetes still tested negative for all three autoantibodies. 30% of children assigned a diagnosis of type 2 diabetes were autoantibody positive, and these had the highest glycated haemoglobin (HbA1c) levels at 12 months follow-up compared with other groups. It was also discovered that autoantibody positivity was similar between non-white and white, as was mean GAD-65 autoantibody levels, but fewer non-white children had two or more autoantibodies detectable. The authors concluded that Islet autoantibody positivity was associated with a more severe phenotype, as demonstrated by poorer glycaemic control, regardless of assigned diabetes subtype. Positivity did not differ by ethnic group. [Glutamic Acid Decarboxylase Autoantibodies (GAD) is used to help discover whether someone has either type 1 diabetes or Latent Autoimmune Diabetes of Adulthood].


Diabetic retinopathy screening and the use of telemedicine
Zimmer-Galler et al. Current Opinion in Ophthalmology. Doi: 10.1097/ICU.0000000000000142

The authors note that less than half of the total number of patients with diabetes mellitus receive the recommended annual retinal evaluations, and that vision loss due to diabetic retinopathy remains the leading cause of blindness in adults. They posit that poor adherence to screening recommendations stems from a number of challenges which telemedicine technology may address to increase the evaluation rates and ultimately reduce vision loss. Based on recent findings that the benefits of telemedicine diabetic retinopathy are proven for large population-based systems, and that improved screening rates and less vision loss from diabetic retinopathy are being reported after implementation of telemedicine programs, their review provides an update on the recent advances in tele-ophthalmology and how it may expand the current concept of eye care delivery for diabetic eye disease. In summary they state that telemedicine diabetic retinopathy screening programs may have a significant impact on reducing the vision complications and healthcare burden from the growing diabetes epidemic.


Regulation of obesity-related insulin resistance with gut anti-inflammatory agents
Helen Luck et al. Cell Metabolism. Doi: 10.1016/j.cmet.2015.03.001

Although obesity has reached epidemic proportions the authors note that little is known about its influence on the intestinal immune system. They assert that their paper shows that the gut immune system is altered during high-fat diet feeding and is a functional regulator of obesity-related insulin resistance and that this can be exploited therapeutically. Based on their studies in mice they report that the mucosal immune system affects multiple pathways associated with systemic insulin resistance and this may represent a novel therapeutic target for this disease.


Increased carotid intima-media thickness levels in patients with type 1 diabetes mellitus
Yi-Peng Sun et al. Journal of Diabetes and Its Complications. Doi: 10.1016/j.jdiacomp.2015.03.018

This research set out to derive a more precise estimation of carotid intima-media thickness (CIMT) levels in patients with type 1 diabetes mellitus (T1DM). They searched through PubMed and Embase databases to identify all available studies that compared CIMT levels between T1DM groups and control groups. From the 738 articles obtained 47 studies were finally included in the meta-analysis.  It was found that when compared with the control group, the T1DM group had significantly higher CIMT levels. [A meta-analysis refers to methods that focus on contrasting and combining results from different studies]


Personalised care initiatives for diabetes care
Peter Ranscombe.  The Lancet Diabetes & Endocrinology. 10.1016/S2213-8587(15)00083-2

With so many individuals developing type 2 diabetes, the NHS is using personalised care initiatives to help people manage their own condition. This brief article Peter Ranscombe explores how health-care professionals are using new technology to help create personalised care initiatives for people with diabetes. The caveat in the concluding paragraph states that although modern technology seems to have a place in the management of diabetes care, particularly to reduce costs and give patients more control over their treatment, patients will probably always want some human interactions.


Urinary C-peptide/creatinine ratio can distinguish maturity-onset diabetes of the young from type 1 diabetes in children and adolescents
Yılmaz Agladioglu S et al. Hormone Research in Paediatrics. Doi: 10.1159/000375410

The urinary C-peptide/creatinine ratio (UCPCR) and fasting C-peptide level can assess beta-cell function in clinical practice. This study shows that the UCPCR and fasting C-peptide levels in children and adolescents can distinguish patients with MODY from patients with T1DM with high specificity and sensitivity.
[C-peptide is a protein that connects insulin’s A-chain to its B-chain in the proinsulin molecule. Measuring C-peptide can help to determine how much of a patient’s own natural insulin is being produced as C-peptide is secreted in equimolar amounts to insulin] – [Serum creatinine is an important indicator of renal health because it is an easily measured by-product of muscle metabolism. Creatinine levels in blood and urine may be used to calculate the creatinine clearance, which correlates with the glomerular filtration rate]