Eating Disorders in Individuals with Type 1 Diabetes: Case Series and day Hospital Treatment Outcome

Women with type 1 diabetes are at high risk for eating disorders (ED), a combination that can increase medical complications and mortality. As little is known about treatment response in this population, clinical presentation and treatment outcome in an extended case series were assessed. A chart review at the Eating Disorders Day Hospital Program at Toronto General Hospital identified a total of 100 individuals with type 1 diabetes assessed 1990–2012. Of 37 who attended day hospital, most experienced improvement in ED symptoms, but only 18.8% had a good immediate treatment outcome, while 43.8% had an intermediate outcome and 37.5% had a poor outcome (meeting diagnostic criteria at discharge). This is poorer than program outcomes in individuals without diabetes (χ² = 12.2, df = 2; p = 0.002). Factors influencing treatment engagement and outcome must be further studied and used to improve treatment results in this high‐risk group. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Bariatric Surgery and Type 2 Diabetes Mellitus: Surgically Induced Remission

The relationship between obesity and type 2 diabetes mellitus (T2DM) is well known. Morbidly obese patients with T2DM who undergo bariatric surgery have improvement or remission of their diabetes. Different types of bariatric operations offer varying degrees of T2DM remission. These operations are classified as restrictive, malabsorptive, or a combination of both. The gold-standard operation, known as the Roux-en-Y gastric bypass, is a combination operation.Most often, improvement of the diabetes is seen within days of the operation. Various theories to explain this rapid change include calorie restriction and hormonal changes from exclusion of the upper gastrointestinal tract. Weight loss accounts for the sustained improvements in glucose control. The patients who benefit the most are those who are early in their disease course.Having a single treatment for both obesity and T2DM is ideal. As bariatric surgery has become a safe operation when performed by experienced surgeons, it should be considered a treatment for these diseases. The impact it can have on the lives of individual patients and society as a whole is tremendous.     

Electrical Stimulation as Treatment for Obesity and Diabetes

The prevalence of obesity is growing, is driving an increase in the prevalence of diabetes, and is creating a major public health crisis in the United States. Lifestyle and behavior therapy rarely give durable weight loss. There are few medications approved for the treatment of obesity. Those that exist are limited in efficacy and using them in combination does not result in greater weight loss. Surgical treatments for obesity are effective and give durable weight loss, but are accompanied by measurable morbidity and mortality. Several pacing approaches are being tried and are an outgrowth of pacing for gastroparesis. The Transcend® pacemaker blocks vagal efferents and delays gastric emptying, giving a 40% loss of excess body weight, if certain screening procedures are employed. The Tantulus™ pacemaker is still in development but increases antral muscular contractions and delays gastric emptying by stimulation during the absolute refractory period. Weight loss has been 30% of excess body weight, and glycohemoglobin decreased 1.6% in a trial of obese type 2 diabetes. Stimulation to the subdiaphragmatic sympathetics, vagal nerve stimulation with or without unilateral vagotomy, and intestinal pacing are other approaches that are still being evaluated preclinically. Clearly a safe, effective, and durable treatment for obesity is desperately needed. Electrical pacing of the gastrointestinal tract is promising therapeutically, and because pacemakers work through different mechanisms, combining pacemaker treatments may be possible. Rapid progress is being made in the field of electrical stimulation as a treatment for obesity and even greater progress can be expected in the foreseeable future.     

Personalized Medicine for Diabetes: The Prevention of Type 2 Diabetes: An Overview

Type 2 diabetes mellitus is one of the major public health threats in the United States today, reaching epidemic rates. Epidemiological evidence suggests a strong link between obesity and the risk of developing diabetes. Increasing evidence demonstrates that lifestyle interventions can significantly delay or possibly prevent the onset of type 2 diabetes in persons with increased risk. Despite these findings, there remain important barriers to the translation of this research to the public health. These include identifying persons with an increased risk for developing the disease and the lack of easily accessible, cost-effective intervention programs. At least one study, however, has effectively implemented an evidenced-based intervention in community settings, suggesting that it may be possible to develop a model for the national scalability of primary prevention in the United States.     

Personalized Medicine for Diabetes: Genetic Susceptibility to Type 2 Diabetes and Implications for Therapy

Since 2000, we have witnessed an explosion of known genetic determinants of type 2 diabetes risk. These findings have seeded the expectation that our ability to make personalized, predictive, therapeutic clinical decisions is imminent. However, the loci discovered to date explain only a small fraction of overall inheritable risk for this disease. In many cases, the reported associations merely signal regions of the genome that are overrepresented in disease versus health but do not identify the causal variants. Well-powered cohort studies have shown that the set of markers detected thus far does not significantly improve individual risk prediction or stratification over common clinical variables, with the possible exception of younger subjects. On the other hand, risk genotypes may help target subgroups for more intensive surveillance or prevention efforts, although whether such a strategy improves patient outcomes and/or is cost-effective should be examined. Similarly, whether genetic information will help guide therapeutic decisions must be tested in adequately designed and rigorously conducted clinical trials.     

The Business of Intensive Insulin Therapy for Type 2 Diabetes Patients: Where It All Began for Me

Ideally, it would be easy for physicians with Diabetes Control and Complications Trial data in hand to convince type 2 diabetes mellitus (T2DM) patients on insulin to move toward intensive insulin therapy (IIT), but in actuality, patient compliance remains a significant issue. One of the statistics that best illustrates this point is that 89% of T2DM patients on insulin do not inject themselves outside of the home (according to the National Health and Nutrition Examination Survey). The market has responded to poor compliance by developing insulin pens and different insulin formulations to improve compliance. But the fact remains that most T2DM patients on insulin are out of control. I would suggest that, in addition to better education, an opportunity exists for a medical device approach to better facilitate an easy-to-use, discreet approach to moving from conventional to IIT.     

Machine Learning-Based Adherence Detection of Type 2 Diabetes Patients on Once-Daily Basal Insulin Injections

Background:Lack of treatment adherence can lead to life-threatening health complications for people with type 2 diabetes (T2D). Recent improvements and availability in continuous glucose monitoring (CGM) technology have enabled various possibilities to monitor diabetes treatment. Detection of missed once-daily basal insulin injections can be used to provide feedback to patients, thus improving their diabetes management. In this study, we explore how machine learning (ML) based on CGM data can be used for detecting adherence to once-daily basal insulin injections.Methods:In-silico CGM data were generated to simulate a cohort of T2D patients on once-daily insulin injection (Tresiba®). Deep learning methods within ML based on automatic feature extraction including convolutional neural networks were explored and compared with simple feature-engineered ML classification models for adherence detection. It was further investigated whether fused expert-dependent and automatically learned features could improve performance, resulting in a comparison of six different detection models. Adherence was detected throughout each day with an increasing amount of CGM data available.Results:The adherence detection accuracy improved as more CGM data became available on the day of classification. The three classification models based on expert-engineered features obtained mean accuracies of 78.6%, 78.2%, and 78.3%. The classification model based purely on learned features obtained a mean accuracy of 79.7%. The two classification models fusing expert-engineered and learned features obtained mean accuracies of 79.7% and 79.8%. All the mentioned results were obtained 16 hours after time of injection.Conclusion:The results suggest that adherence detection based on CGM data is feasible. Even though our study based on in-silico data indicates only slightly improved performance of more complex models, the question remains whether advanced models would outperform the simple in a real-world setting. Thus, future studies on adherence monitoring using real CGM data are relevant.     

二甲双胍联合瑞格列奈治疗社区2型糖尿病患者的效果分析

目的分析二甲双胍联合瑞格列奈治疗社区2型糖尿病患者的效果。方法按照该院收治的100例患者先后顺序,将其划分为两组。2018年1—6月收治的50例纳入对照组,采取常规护理+二甲双胍干预;2018年7月—2019年1月收治的50例纳入观察组,在对照组的基础上,加入瑞格列奈治疗。对两组患者的血糖控制状况与不良反应发生状况进行统计与比较。结果两组患者干预前的血糖指标比较,差异无统计学意义(P>0.05);在干预后,观察组患者的血糖指标改善状况明显优于对照组,差异有统计学意义(P<0.05)。两组患者的不良反应发生状况比较,差异无统计学意义(P>0.05)。结论二甲双胍联合瑞格列奈治疗社区2型糖尿病患者的临床效果较好,能够对其血糖进行有效控制,降低并发症的发生,且不良反应发生率较低,值得临床推广。     

Personalized Medicine for Diabetes: Genetics Factors Contributing to Type 2 Diabetes across Ethnicities

Type 2 diabetes mellitus (T2DM) is among the many common diseases with a strong genetic component, but until recently, the variants causing this disease remained largely undiscovered. With the ability to interrogate most of the variation in the genome, the number of genetic variants has grown from 2 to 19 genes, many with multiple variants. An additional three genes are associated primarily with fasting glucose rather than T2DM. Despite the plethora of new markers, the individual effect is uniformly small, and the cumulative effect explains little of the genetic risk for T2DM. Furthermore, the success is largely restricted to European populations. Despite success in mapping genes in Asian populations, success in United States minorities, particularly African Americans, has been limited. The genetic findings highlight the role of the β cell in diabetes pathogenesis, but much remains to be discovered before genetic prediction and individualized medicine can become a reality for this disease.     

格列齐特联合阿卡波糖治疗老年2型糖尿病的效果探讨

目的探讨对格列齐特联合阿卡波糖治疗老年2型糖尿病效果。方法抽取该院2013年2月—2014年4月收治的80例老年2型糖尿病患者,随机分组后对比格列齐特联合阿卡波糖治疗（观察组,n=40例）与格列齐特单独治疗（对照组,n=40例）的效果。结果两组各指标均明显降低,观察组2hPBG、HbAlc均明显低于对照组。结论格列齐特联合阿卡波糖治疗老年2型糖尿病疗效显著。     

从2型糖尿病的发病机制谈糖尿病治疗的新策略

目的探讨对2型糖尿病患者的发病机制进行分析和总结,制定新的糖尿病治疗策略。方法对该院2012年—2013年收治的94例2型糖尿病患者的临床资料进行回顾分析,从其发病机制实现对糖尿病治疗新策略的探讨。结果患者胆固醇数值超过6.6 mmol/L,空腹状态的血糖数值超过6.8 mmol/L,尿白蛋白超过20.3 mg,尿酸超过479.98μmol/L。结论全面认识2型糖尿病的发病机制,并采取相应的处理措施,提出新的糖尿病治疗策略,可实现对糖尿病治疗的有效控制和治疗。     

Evaluation of the Dual-Chamber Pen Design for the Injection of Exenatide Once Weekly for the Treatment of Type 2 Diabetes

Background:

Exenatide once weekly, an injectable glucagon-like peptide-1 receptor agonist, has been shown to reduce A1C, fasting glucose, and body weight in patients with type 2 diabetes. Exenatide 2.0 mg is dispersed in poly-(D,L-lactide-co-glycolide) polymer microspheres, which require resuspension in aqueous diluent before subcutaneous injection. A single-use, dual-chamber pen was developed to improve the convenience of exenatide once weekly delivery and tested following Food and Drug Administration (FDA) guidance.

Methods:

Design development goals were established, and validation tests (dose accuracy, torque/force requirements, usability, and ease-of-use) were performed. Dose accuracy was tested under a variety of conditions. After 10 exploratory studies in 329 patients, the final design’s usability and ease-of-use were tested in untrained health care practitioners (HCPs; n = 16) and untrained/trained patients (n = 30/17). Usability testing evaluated completion of multiple setup, dose preparation, and injection steps. Ease-of-use impression was assessed using a scale of 1−7 (1 = very difficult, 7 = very easy).

Results:

The dual-chamber pen successfully met development goals and delivered target volume (650 µL ± 10%) under tested conditions (mean 644.7–649.3 µL), with torque and force requirements below prespecified maximum values. In the final user study, most participants (≥87%) correctly completed pen setup, dose preparation, and injection steps. Mean ease-of-use scores were 5.8, 6.3, and 6.5 out of 7 in untrained HCPs, untrained patients, and trained patients, respectively.

Conclusion:

With self-education or minimal training, participants accurately and precisely suspended, mixed, and delivered exenatide-containing microspheres using the dual-chamber pen with high ease-of-use scores. The dual-chamber pen was FDA-approved in February 2014.     

DialBetics: A Novel Smartphone-based Self-management Support System for Type 2 Diabetes Patients

Numerous diabetes-management systems and programs for improving glycemic control to meet guideline targets have been proposed, using IT technology. But all of them allow only limited—or no—real-time interaction between patients and the system in terms of system response to patient input; few studies have effectively assessed the systems’ usability and feasibility to determine how well patients understand and can adopt the technology involved. DialBetics is composed of 4 modules: (1) data transmission module, (2) evaluation module, (3) communication module, and (4) dietary evaluation module. A 3-month randomized study was designed to assess the safety and usability of a remote health-data monitoring system, and especially its impact on modifying patient lifestyles to improve diabetes self-management and, thus, clinical outcomes. Fifty-four type 2 diabetes patients were randomly divided into 2 groups, 27 in the DialBetics group and 27 in the non-DialBetics control group. HbA1c and fasting blood sugar (FBS) values declined significantly in the DialBetics group: HbA1c decreased an average of 0.4% (from 7.1 ± 1.0% to 6.7 ± 0.7%) compared with an average increase of 0.1% in the non-DialBetics group (from 7.0 ± 0.9% to 7.1 ± 1.1%) (P = .015); The DialBetics group FBS decreased an average of 5.5 mg/dl compared with a non-DialBetics group average increase of 16.9 mg/dl (P = .019). BMI improvement—although not statistically significant because of the small sample size—was greater in the DialBetics group. DialBetics was shown to be a feasible and an effective tool for improving HbA1c by providing patients with real-time support based on their measurements and inputs.     

Hyperinsulinaemia is Associated with Stimulation of Cholesterol Synthesis in Both Type 1 and Type 2 Diabetes

The effect of hyperinsulinaemia and hyperglycaemia on cholesterol synthesis was examined in lymphocytes from diabetic subjects. The first part of the study involved the provocation of hyperinsulinaemia by consumption of a carbohydrate-rich meal, in obese patients with Type 2 diabetes mellitus. Cholesterol synthesis was measured before and 4 h after completing the meal. Results were compared to groups of obese non-diabetic patients and to control subjects. Analysis of the three groups demonstrated that the percentage change in cholesterol synthesis was directly proportional to the percentage rise in serum insulin (r = 0.49, p < 0.05). This physiological study demonstrated that postprandial hyperinsulinaemia promoted cholesterol synthesis; however, we could not estimate the effect of the meal on cholesterologenesis. To study hyperinsulinaemia in isolation, we examined the effects of varying insulin infusion rates for 4 h at either low or high levels of serum glucose using the glucose clamp technique in young Type 1 diabetic patients. Cholesterol synthesis in lymphocytes was again measured before and after the study period. Hyperinsulinaemia stimulated cholesterol synthesis (+28.6%, p < 0.05) but hyperglycaemia alone did not exhibit this effect (-1.7% NS). The combination of hyperinsulinaemia and hyperglycaemia produced the greatest increase in cholesterol synthesis (+ 51.4%, p < 0.05) but this increase was not significantly different from hyperinsulinaemia alone. The percentage increase in serum insulin levels was again proportional to the percentage change in cholesterol synthesis (r = 0.46, p < 0.05).     

Type 2 Diabetes in Children and Youth

Reviews in Endocrine and Metabolic Disorders -     

Tea Consumption and Risk of Type 2 Diabetes: A Meta-Analysis of Cohort Studies

BACKGROUND  Tea consumption has been extensively studied in relation to various diseases, several epidemiologic studies have been performed to investigate the association of tea consumption with type 2 diabetes; however, the results of these studies were not entirely consistent. OBJECTIVE  To conduct a meta-analysis of studies that assessed the association of tea consumption and the risk of type 2 diabetes. RESEARCH DESIGN AND METHODS  We performed a systematic literature search through November 2008 in PUBMED, MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews. The search was limited to English-language studies. Studies were excluded if they were type 1 diabetes, animal studies. Nine cohort studies were identified by two authors, and summary relative risks (RRs) were calculated using a random-effects model. RESULTS  We identified nine cohort studies, including 324,141 participants and 11,400 incident cases of type 2 diabetes with follow-up ranging from 5 to 18 years. The summary adjusted RR did not show that tea consumption was associated with a reduced type 2 diabetes risk (RR, 0.96; 95% confidence interval (CI), 0.92–1.01). Evidence from the results of our stratified analyses revealed that tea consumption ≥4 cups per day (RR, 0.8; 95% CI, 0.7–0.93) might play a role in the prevention of type 2 diabetes. However, no statistically significant association was observed for sex and the follow-up durations stratified between tea consumption and type 2 diabetes. CONCLUSIONS  This meta-analysis indicates that tea consumption ≥4 cups per day may lower the risk of type 2 diabetes.