Kommentar till artikeln på Dagen Diabetes: EASD, CGM Dexcom G5 direkt i smartphone, bättre glukosprecision och data kan nyttjas för att ge sig insulin. 

Artikeln utmålar klassiska blodsockermätare som sämre än de i själva verket är.

CV% värdet (precisionen) för en typisk blodsockermätare på den svenska marknaden ligger idag på ca 2-4 % och inte 10 % som den aktuella artikeln antyder. MARD för kontinuerliga glukosmätare ligger på 8-11%

Sålunda är precisionen för klassiska blodsockermätare ungefär tre gånger bättre än för kontinuerliga mätare.

A.Menarini Diagnostics

Nils Uhlin, Produktchef

 

Kommentar

Tack för debatt-inlägget.

I aktuell text diskuterades MARD för CGM - och budskapet var att CGM med en ny produkt på marknaden, DexCom G5, har fått bättre precision. Den är sedan 2 veckor, under EASD-veckan, godkänd av europeiska myndigheten för att patient ska kunna använda glukosvvärdet för att värdera om behov föreligger att ge sig insulin. Inget extra blodsocker behöver tas i normalfallet - enbart vid tveksamhet kring glkosvärdet ska blodglukos tas med egenglukosmätare. Tidigare har CGM enbart kunna användas för trend-analys av glukosvärdet. 

Insändaren har rätt att de bästa egenglukosmätare fortfarande är bättre än nuvarande CGM.

CV% värdet (precisionen) för en bra blodsockermätare på den svenska marknaden ligger idag på 2-4 %. MARD (Mean Absolute Relative Glucose Difference) ligger på 8-11% för kontinuerliga mätare, CGM. 
-  MARD och CV är olika spridningsmått (precision). MARD är den mätmetod som CGM-tillverkare använder för att presentera sina data på mätnoggrannhet. Ju lägre värden desto bättre. För några år sedan var MARD 15-18% - och nu har de halverats. CGM har i det lägre intervallet, Glukos under 4,5-3,9 mmol/L, dock betydligt sämre precision med dubbla MARD-värden.
Det råder en viss förvirring på diabetesområdet kring dessa statistiska begrepp.
Det finns en önskan att CGM-leverantörerna redovisar precisionen som också CV% såsom tillägg till MARD - just för att underlätta jämförelser i precision mellan CGM och egenglukosmätare.
Inom diabetesvården skulle vi också gärna vilja se framöver samma typ av Equalis-test för CGM-mätare som för klassiska blodsockermätare.
Diabetesprofessionen tillsammans med patientorganisation och tillverkare har ett planerat möte med Equalis kring Analyskvalitet diabetes 15/12 på initiativ av Svensk Föfening för Diabetologi (SFD). Bland annat detta kommer då att diskuteras. 
Precision av egenglukosmätare
Egenglukosmätare har i det lägre intervallet, under 4,5-3,9 mmol/L klart sämre precision (se nedtill). Här behövs en förbättring från tillverkarna för att ge patienter med diabetes en ökad säkerhet och trygghet, för att kunna skilja mellan normalt blodsocker respektive lågt glukosvärde
Internationell standard, ISO Standard 15197;2013, för self-monitor glucose procedure diskuterar vid Glukos under 5,5 mmol/L bias limit på plus minus 0,83 mmol/L med accuracy criteria 95% of results, dvs det är en mycket stor spridning, och vid Glukos 5,5 mmol/L eller högre är det bias limit plus minus 15% med accuracy criteria 95% of results.
De flesta upphandlade egenglukosmätare i Sverige har numera som krav vid upphandlingen att mätaren har en precision på plus minus 10%.
Det vi behöver är egenglukosmätare med bättre precision under 5,5 mmol/L. Vid upphandling är vi beredda att betala mer för dessa mätare. CGM behöver också ha en bättre precision framöver. Vi ska också betala bättre för sådana vid upphandling.
Dewt finns en stor tacksamhet från patientsidan och professionen för att tillverkarna under senare år lyckats att tillhandahålla allt bättre egenglukosmätare och CGM. Presentationen av data har också blivit allt bättre i display och framöver kommer säkerligen smartphone nyttjas allt mer. Det blir då än enklare för brukaren.
Fler landsting kommer 2016 avsätta 2016 en förstärkt budget för moderna diabeteshjälpmedel, exempelvis Östergötland enligt press release idag med beslut om 10 MSEK mer i budget för insulinpumpar och sensorer, för en bättre och bibehållen livskvalitet för patienter med typ 1 diabetes.
DiabetologNytt kommer i nästa nr i febr ha en mer djupgående artikel kring just precisions-begrepp, egenglukosmätare och CGM, och med en förklarande text så att läsaren förstår det hela än mer i detalj för att kritiskt kunna granska mätare och CGM. 
Nyhetsinfo
www red DiabetologNytt

 

People with type 1 diabetes have a substantially increased risk of heart failure, according to a Swedish study published online September 18 in Lancet Diabetes & Endocrinology.

The research also found that poor glycemic control and impaired renal function increase the risk of heart failure in this form of diabetes.

Heart-failure experts have been warning for the past few years that diabetics have an increased risk of heart failure, but most prior work has not distinguished between type 1 and type 2 diabetes.

This new study is the first to look specifically at the likelihood of heart failure in people with type 1 diabetes, compared with the general population, say the authors.

"Our chief finding was that, even if still uncommon, people with type 1 diabetes had four times the risk of heart failure over an average of 8 years, compared with persons without type 1 diabetes from the general population," commented lead author Annika Rosengren, MD, PhD, professor of medicine at Sahlgrenska University, in Göteborg, Sweden.

And "in the presence of poorly controlled diabetes, risk was more than 10 times that of controls, whereas heavy leakage of protein into the urine [macroalbuminuria, which indicates impaired renal function] was associated with more than 15-fold increase in risk," she pointed out.

Diabetes represents an independent risk factor for heart failure. Although rare in youth, the implications of heart failure are "serious" when it does develop, according to Dr Rosengren.

"Because heart failure usually occurs at an advanced age, when type 2 diabetes is by far the predominant type, the role of type 1 diabetes — the type that afflicts children, adolescents, and young adults and that is not related to obesity or lifestyle — has never been investigated," she explained.

Doctors should therefore be aware of this increased risk and carry out appropriate investigations when confronted with symptoms suggestive of heart failure in people with type 1, she added.

In an accompanying editorial, Robert Gilbert, MD, PhD, head of the division of endocrinology at St Michael's Hospital in Toronto, Ontario, agrees, pointing out that people who have diabetes, whether type 1 or type 2, experience "accelerated aging."

"Consistent with heart failure as a disease of elderly people and the premature aging effect of diabetes, the relative risk conferred by type 1 diabetes is magnified in this comparatively young age group [in this study]," he writes, adding that heart failure in type 1 diabetes is "fatal, forgotten, and frequent."

Women With Type 1 at Higher Risk of Heart Failure Than Men

The prospective, case-control study included all individuals with type 1 diabetes logged in the Swedish National Diabetes Registry between January 1998 and December 2011, which includes almost all people with type 1 diabetes in that country.

Researchers identified hospital admissions for heart failure using ICD 10 codes and matched these by age, sex, and county to controls from the Swedish general population.

The analysis included 33,402 type 1 diabetics, with a mean age of 35 years, mean diabetes duration of 20.1 years, and mean baseline HbA1c of 8.2%. Controls numbered 166,228.

Over an average of 8 years, 3% (n = 1062) of type 1 diabetics had hospital admissions for heart failure, compared with 1% (n = 1325) of those in the general population. After adjustment for age, sex, diabetes duration, birth in Sweden, educational level, and baseline comorbidities, those with type 1 diabetes had over a four-times-greater risk of heart failure compared with controls (adjusted hazard ratio [HR], 4.69). Women with type 1 diabetes had higher risk of heart failure than men with type 1 diabetes (adjusted HR, 6.36 and 4.07, respectively, compared with controls).

The risk of heart failure was over 10 times greater in type 1 diabetics with poor glycemic control and up to 18 times greater in those with albuminuria, compared with controls. This risk increased as glycemic control and renal function worsened.

Even type 1 diabetics with well-controlled diabetes and normal renal function had an increased risk of heart failure.

Compared with the general population, the risk was still more than double with well-controlled diabetes (adjusted HR, 2.16) and three times greater with normal renal function (adjusted HR, 3.38).

Doctors Must Be Aware of Heart Failure Risk, Talk to Each Other

"Diabetologists and other health professionals involved in the care of individuals with diabetes type 1 need to be aware of the increased risk [for heart failure] in these patients," Dr Rosengren advised.

"Appropriate investigations, like echocardiography and lab tests, should be carried out if there are symptoms such as breathlessness on exertion or unexplained tiredness.

"Heart failure in the young is frequently misdiagnosed as asthma, with delay of appropriate treatment. The knowledge that persons with type 1 diabetes are particularly vulnerable to heart failure should ensure that this does not happen," she emphasized.

"The combination of these two chronic conditions has dire prognostic implications," she and her colleagues stress.

In his editorial, Dr Gilbert notes that the study raises several questions for practicing clinicians. For example, should patients with lower exercise tolerance be considered out of shape, or could it be a sign of heart failure?

Should such patients have echocardiograms and detailed reports of diastolic and systolic function? And how should clinicians act on this information, especially given no evidence-based treatment for diastolic dysfunction?

"A good first step might be for diabetologists and cardiologists to meet up and discuss the current state of affairs, with a renewed interest in the effect of the various antihyperglycemic drugs at our disposal," he proposes.

"This discussion could be followed by the planning of collaborative research endeavors…as well as investigations into new approaches to prevent the development of overt heart failure among patients at highest risk and in those with subclinical echocardiographic evidence of cardiac dysfunction."The risk of heart failure was over 10 times greater in type 1 diabetics with poor glycemic control and up to 18 times greater in those with albuminuria, compared with controls. This risk increased as glycemic control and renal function worsened.

Even type 1 diabetics with well-controlled diabetes and normal renal function had an increased risk of heart failure.

Compared with the general population, the risk was still more than double with well-controlled diabetes (adjusted HR, 2.16) and three times greater with normal renal function (adjusted HR, 3.38).

Doctors Must Be Aware of Heart Failure Risk, Talk to Each Other

"Diabetologists and other health professionals involved in the care of individuals with diabetes type 1 need to be aware of the increased risk [for heart failure] in these patients," Dr Rosengren advised.

"Appropriate investigations, like echocardiography and lab tests, should be carried out if there are symptoms such as breathlessness on exertion or unexplained tiredness.

"Heart failure in the young is frequently misdiagnosed as asthma, with delay of appropriate treatment. The knowledge that persons with type 1 diabetes are particularly vulnerable to heart failure should ensure that this does not happen," she emphasized.

"The combination of these two chronic conditions has dire prognostic implications," she and her colleagues stress.

In his editorial, Dr Gilbert notes that the study raises several questions for practicing clinicians. For example, should patients with lower exercise tolerance be considered out of shape, or could it be a sign of heart failure?

Should such patients have echocardiograms and detailed reports of diastolic and systolic function? And how should clinicians act on this information, especially given no evidence-based treatment for diastolic dysfunction?

"A good first step might be for diabetologists and cardiologists to meet up and discuss the current state of affairs, with a renewed interest in the effect of the various antihyperglycemic drugs at our disposal," he proposes.

"This discussion could be followed by the planning of collaborative research endeavors…as well as investigations into new approaches to prevent the development of overt heart failure among patients at highest risk and in those with subclinical echocardiographic evidence of cardiac dysfunction."

Lancet Diabetes Endocrinol. Published online September 18, 2015.

http://www.medscape.com

 

Nyhetsinfo

ABSTRACT

 

Summary

Background

Diabetes is an established risk factor for heart failure, but because nearly all heart failure occurs in older individuals, the excess risk and risk factors for heart failure in individuals with type 1 diabetes are not known. We aimed to determine the excess risk of heart failure in individuals with type 1 diabetes overall and by different levels of glycaemic control and albuminuria.

Methods

In this prospective case-control study, we identified all individuals with type 1 diabetes registered in the Swedish National Diabetes Registry between Jan 1, 1998, and Dec 31, 2011, and five controls randomly selected from the general population for each patient, matched according to age, sex, and county, and compared them with respect to subsequent hospital admissions for heart failure, with hazard ratios calculated with Cox regression.

Findings

In a cohort of 33 402 patients (mean age at baseline 35 years [SD 14], 15 058 [45%] women, and mean duration of diabetes 20·1 years [SD 14·5]), over a mean follow-up of 7·9 years, 1062 (3%) patients were admitted to hospital with a diagnosis of heart failure, compared with 1325 (1%) of 166 228 matched controls over 8·3 years, giving a HR 4·69 (95% CI 3·64–6·04), after adjustment for time-updated age, sex, time-updated diabetes duration, birth in Sweden, educational level, and baseline comorbidities. Worse glycaemic control was associated with increased risk of heart failure in a graded fashion, and so was the presence of albuminuria. Risk of heart failure was also increased among those with well controlled diabetes (adjusted HR 2·16 [95% CI 1·55–3·01]) and in those with no albuminuria (3·38 [2·51–4·57]), but not in the subgroup both well-controlled and with normoalbuminuria (1·59 [0·70–3·58]).

Interpretation

Individuals with type 1 diabetes had a four-times increase in the risk of being admitted to hospital with heart failure compared with population-based controls. Poor glycaemic control and impaired renal function substantially increased the risk of heart failure.

 

EDITORIAL

 
www red DiabetologNytt

 

 

Cardiovascular disease and mortality in patients with type 2

diabetes after bariatric surgery in Sweden: a nationwide,

matched, observational cohort study

Bj.rn Eliasson, Vasileios Liakopoulos, Stefan Franz.n, Ingmar N.slund, Ann-Marie Svensson, Johan Ottosson, Soffi a Gudbj.rnsdottir

 

Summary

Background In patients with diabetes and obesity specifi cally, no studies have examined mortality after bariatric

surgery. We did a nationwide study in Sweden to examine risks of cardiovascular disease and mortality in patients

with obesity and diabetes who had undergone bariatric surgery (Roux-en-Y gastric bypass [RYGB]).

 

Methods In this nationwide, matched, observational cohort study, we merged data for patients who had undergone

RYGB registered in the Scandinavian Obesity Surgery Registry with other national databases, and identifi ed matched

controls (on the basis of sex, age, BMI, and calendar time [year]) who had not undergone bariatric surgery from the

National Diabetes Registry. We assessed risks of cardiovascular disease and death using a Cox proportional-hazards

regression model and other methods to examine the treatment eff ect while accounting for residual confounding.

Primary outcomes were total mortality, cardiovascular death, and fatal or non-fatal myocardial infarction.

 

Findings Between Jan 1, 2007, and Dec 31, 2014, we obtained data for 6132 patients who had undergone RYGB and

6132 control patients who had not. Median follow-up was 3.5 years (IQR 2.1–4.7). We noted a 58% relative risk

reduction (hazard ratio [HR] 0.42, 95% CI 0.30–0.57; p<0.0001) in overall mortality in the RYGB group compared

with the controls. The risk of fatal or non-fatal myocardial infarction was 49% lower (HR 0.51, 0.29–0.91; p=0.021)

and that of cardiovascular death was 59% lower (0.41, 0.19–0.90; p=0.026) in the RYGB group than in the control

group. 5 year absolute risks of death were 1.8% (95% CI 1.5–2.2) in the RYGB group and 5.8% (5.0–6.8) in the

control group.

 

Interpretation Our fi ndings provide support for the benefi ts of RYGB surgery for patients with obesity and type 2

diabetes. The causes of these benefi cial eff ects may be the weight reduction per se, changes in physiology and

metabolism, improved care and treatment, improvements in lifestyle and risk factors, or combinations of these

factors.

 

Funding Swedish Association of Local Authorities and Regions and Region V.stra G.taland.

 

Nyhetsinfo

www red DiabetologNytt

 
 
 
Scandinavian Society for the Study of Diabetes (SSSD) har  2-dagars årliga möten i de olika nordiska länderna. Nästa år är mötet förlagt till Island,  Reykjavik,  den 22-24 april. Närmare information finns på www.sssd2016.is. Observera att det ges generösa travel grants  (upp till 6000 kronor) till yngre deltagare (upp tom 40 år) som presenterar  föredrag.
 
Vänliga hälsningar
 
Valdemar Grill
Ordförande SSSD 
 
Nyhetsinfo
www red DiabetologNytt
 

A new classification approach for the preclinical staging of type 1 diabetes has been developed by the Juvenile Diabetes Research Foundation (JDRF) and the American Diabetes Association (ADA).

The model, based on the concept that there is a progressive process leading up to symptomatic type 1 diabetes, "will aid the development of therapies and the design of clinical trials to prevent symptomatic disease and promote precision medicine," according to a joint JDRF/ADA statement published in the October issue of Diabetes Care.

While JDRF and ADA are not advising clinical use of the model for screening at this time, "the staging approach will provide a framework to help inform benefit/risk evaluation in the regulatory, reimbursement, and clinical-care settings," JDRF chief scientific officer Richard A Insel, MD, and colleagues write in the paper.

The three stages are:

Stage 1: Autoimmunity/normoglycemia/presymptomatic type 1 diabetes.Individuals in this stage have two or more type 1 diabetes–associated islet autoantibodies but are still normoglycemic. In one study of children who reached this stage, the risks for developing symptomatic disease were 44% at 5 years and 70% at 10 years, with a lifetime risk of nearly 100%.

Stage 2: Autoimmunity/dysglycemia/presymptomatic type 1 diabetes.These individuals have two or more islet autoantibodies and have lost enough beta cells to become glucose intolerant. The 5-year risk for frank type 1 diabetes at this stage is approximately 75% at 5 years and nearly 100% thereafter.

Stage 3: Symptomatic type 1 diabetes. The individual demonstrates typical clinical symptoms and signs of diabetes, including polyuria, polydipsia, weight loss, fatigue, and diabetic ketoacidosis (DKA).

In natural-history studies, short-term benefits from the use of such staging have included reductions in DKA and hospitalization at symptomatic-disease onset and improved glycemic control with a greater chance of experiencing a "honeymoon" period in which the requirement for exogenous insulin is temporarily blunted.

Dr Insel and colleagues write, "Risk screening and staging as outlined here are not recommended at this time for clinical practice in the absence of cost-effective screening, staging, and effective interventions that delay progression to symptomatic type 1 diabetes."

However, they add, "This classification system, which will be continuously refined with the development of novel stage-specific biomarkers, provides a new taxonomy of type 1 diabetes and a framework for clinical trial design, benefit/risk decisions around interventions, and, ultimately, the practice of precision medicine to prevent symptomatic type 1 diabetes."

The staging approach has been endorsed by The American Association of Clinical Endocrinologists, the Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, and the Leona M and Harry B Helmsley Charitable Trust.

Diabetes Care. 38:1964-1974. Abstract

From www.medscape.com

ABSTRACT

Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association

Abstract

Insights from prospective, longitudinal studies of individuals at risk for developing type 1 diabetes have demonstrated that the disease is a continuum that progresses sequentially at variable but predictable rates through distinct identifiable stages prior to the onset of symptoms. Stage 1 is defined as the presence of β-cell autoimmunity as evidenced by the presence of two or more islet autoantibodies with normoglycemia and is presymptomatic, stage 2 as the presence of β-cell autoimmunity with dysglycemia and is presymptomatic, and stage 3 as onset of symptomatic disease. Adoption of this staging classification provides a standardized taxonomy for type 1 diabetes and will aid the development of therapies and the design of clinical trials to prevent symptomatic disease, promote precision medicine, and provide a framework for an optimized benefit/risk ratio that will impact regulatory approval, reimbursement, and adoption of interventions in the early stages of type 1 diabetes to prevent symptomatic disease.  

The full paper

http://care.diabetesjournals.org/content/38/10/1964.full

www red DiabetologNytt                

EASD och Medscape nyhetsbyrå bjuder på powerpoint-serier från EASD, freeware

Har Du problem att komma in i Medscape, registrera dig där då med eget user och lösen - kostar inget. En bra medicinsk nyhetsbyrå. De hade 3 journalister på EASD Sthlm 14-18/9.

http://www.medscape.org/sites/conference/easd-2015?src=wnl_cme_conf

För att se alla powerpointfiler, eller gå in på enskild pp-ämne

 

Nyhetsinfo

www red DiabetologNytt

 Strategiska forskningsprogrammet i Diabetes vid Karolinska Institutet anordnar ett internationellt endags diabetessymposium den 13 november
 
Bifogat finner du programmet  – det är ett helt öppet möte utan kostnad för deltagande!
 

Program

Symposium on Molecular and Physiological Aspects of Diabetes Mellitus

November 13, 2015

9:00 - 9:10 Welcome Note

Juleen Zierath

9:10 - 9:20 The 4D Type 2 diabetes project: Standardized care process, a platform for

excellent care and research

Eva Toft, Ersta Hospital

9:20 - 9:55 The Kidney in Diabetes

Sally Marshall, Institute of Cellular Medicine, Newcastle University, UK

9:55 - 10:30 The diabetes epidemic: fact and fiction

Sarah Wild, Centre for Population Health Sciences, University of Edinburgh, UK

10:30 - 11:00 COFFEE BREAK

11:00 - 11:35 Genes and Metabolism: What lessons have we learned so far?

Inês Barroso, Wellcome Trust Sanger Institute, Hinxton, UK

11:35-12:10 Insulin resistance in cardiovascular disease development

Markku Laakso, Dept. of Medicine, University of Kuopio, Finland

12:10-13:10 LUNCH

13:10- 13:45 Metabolic dysregulation and insulin action: human phenotypic considerations

William T. Cefalu, Pennington Biomedical Research Center, New Orleans, USA

13:45-14:20 Obesity-related Insulin Resistance: A Systems Approach

Daniel P. Kelly, Sanford Burnham Prebys Medical Discovery Institute at Lake

Nona, Orlando, USA

14:20-14:50 COFFEE BREAK

14:50-15:25 Taking care of the gut microbiota to control diabetes and related metabolic

diseases

Nathalie Delzenne, Metabolism and Nutrition Research Group, Catholic

University of Louvain, Louvain Drug Research Institute (LDRI), Belgium

15:25-16:00 Aging of the autophagic system: Metabolic consequences

Ana Maria Cuervo, Albert Einstein College of Medicine, New York, USA

CLOSING REMARKS

Mer information samt anmälan görs på vår hemsida:
 
 
Vänliga hälsningar
Barbro Svensson
 
P.A. to Professor Juleen R. Zierath
Department of Physiology and Pharmacology
Integrative physiology/Karolinska Institutet
von Eulers väg 4a, IV/SE-171 77 Stockholm
 
 
Nyhetsinfo
www red DiabetologNytt 
 

Symposium on Molecular and

Physiological Aspects of Diabetes

Mellitus

13 November 2015

Karolinska Institutet, Solna 9.00–16.00

Attendance is free of charge and open for everyone,

however registration is mandatory at: ki.se/en/srp-diabetes

Photo: Science Pgoto Library

speakers:

Sally Marshall, Newcastle University, UK

Sarah Wild, University of Edinburgh, UK

Inês Barroso, Wellcome Trust Sanger Institute, UK

Markku Laakso, University of Kuopio, Finland

William T. Cefalu, Pennington Biomedical Research Center, USA

Daniel P. Kelly, Sanford Burnham Prebys Medical Discovery

Institute at Lake Nona, USA

Nathalie Delzenne, Catholic University of Louvain, Belgium

Ana Maria Cuervo, Albert Einstein College of Medicine, USA

KAROLINSKA INSTITUTET

CONFERENCES

2015

Arranged by the Strategic Research Programme in Diabetes

Registration

required latest

1 November

 
EASD

Utmaning när allt fler äldre får diabetes

Hur de allt fler äldre som får typ 2-diabetes ska behandlas och vilka följdsjukdomar som följer handlade ett seminarium på EASD:s andra dag om.

– Runt tio procent av världens befolkning har nu diabetes. Och då inkluderar vi inte ens de som har prediabetes, sade Támas Halmos, som var ordförande för ett seminarium på onsdagensförmiddagen på EASD som handlade om äldre och diabetes.

Även om typ 2-diabetes ökar hos yngre, är det en stor andel av äldre som får sjukdomen. Den brittiska forskaren Melanie Davies menade att dessa äldre diabetespatienter är svåra att behandla. Hon påpekade att mycket få av de kliniska studierna inkluderar äldre patienter och ännu färre är utformade efter äldre patienter med typ 2-diabetes.

Melanie Davies menar att vissa äldre, mer sjukliga diabetespatienter, inte borde behandlas lika aggressivt.

– Vi måste ta hänsyn till komorbiditeter också. Jag anser att vi i vissa fall överbehandlar dessa patienter, särskilt med läkemedel som ökar risken för hypoglykemier. Särskilt tycker jag att sulfonyrea-läkemedel bör omvärderas, sade hon.

Hon tog upp de nya behandlingarna mot typ 2-diabetes, och menade att DPP4-hämmare, SGLT2-hämmare och GLP1-analoger kanske är ett bättre behandlingsalternativ för äldre.

Forskaren Johan Eriksson från Finland påpekade att det verkar finnas fler översiktsartiklar än verkliga studier på diabetespatienter över 75 år. Eftersom dessa patienter ofta kan skilja sig åt bland annat i fråga om andra sjukdomar, så menade han att vården för dessa patienter bör individualiseras mer och att patientens egna önskningar bör vägas in i bedömningen.

Johan Eriksson menade också att de nyare läkemedlen kanske är att föredra framför äldre. Även om de nya läkemedlen är dyrare, så kostar hypoglykemier också pengar, sade han.

Under seminariet togs även förekomsten av demens och neurodegenerativa sjukdomar hos diabetiker upp. 

– Kognitiva sjukdomar borde läggas till på listan över komplikationer från diabetes, avslutade den franska forskaren Lisa Bordier sin föreläsning.

Från www.dagensmedicin.se

Nyhetsinfo

NDR visade på EASD-mötet vid en annan session, att högre HbA1c ger ökad risk för demens - här finns en förbättringsmöjlighet; bättre HbA1c kan minska risken upp till 50%.

www red DiabetologNytt

 

EASD

Monolog om monogen diabetes

På tisdagseftermiddagen höll årets Albert Renold-pristagare Andrew Hattersley, en välbesökt föreläsning om monogen diabetes och insikter i betacellsfunktion.

Andrew Hattersley är professor vid universitetet i Exeter, Storbritannien och fick priset för sin banbrytande forskning om monogen diabetes. Till exempel neonatal diabetes och MODY (maturity onset diabetes of the young), som ofta misstolkas som typ 1- eller typ 2-diabetes och därmed också felbehandlas.

Andrew Hattersley inledde med att tacka för priset.

– Jag har alltid sett mig själv som en kliniker som sysslar lite med genetik. Därför är det en otrolig ära att få ett pris avsett för en riktig vetenskapsman, sa han.

Därefter tog han med åhörarna på en resa genom sin karriär och vägen till bättre kunskap om monogen diabetes.

Se föreläsningen:

http://www.easdvirtualmeeting.org/resources/insights-into-the-beta-cell-from-patients-with-monogenic-diabetes

Ett stort tack till Dagens Medicin som möjliggör denna video-lecture

Nyhetsinfo

www red DiabetologNytt

Study finds taking medication at night cut risk of blood sugar disorder in half

Taking Blood Pressure Drugs at Night May Help Prevent Type 2 Diabetes

WEDNESDAY, Sept. 23, 2015 (HealthDay News) -- In surprising new research, experts report that the timing of taking your blood pressure medicine could have a big impact on whether or not you develop type 2 diabetes.

Specifically, the Spanish researchers found that taking blood pressure medications at bedtime rather than waiting until morning may cut the risk of developing type 2 diabetes by more than half.

People with high blood pressure tend to suffer from a phenomenon called "non-dipping," in which their blood pressure does not substantially decrease during sleep as it does in healthy people, the researchers said in background information.

In an initial study, the investigators found that "non-dippers" tended to have an increased risk of developing type 2 diabetes, compared with people whose blood pressure decreased normally during sleep.

A follow-up clinical trial by the same research group revealed that taking high blood pressure medications right before bed helped lower a person's sleeping blood pressure, and the risk of type 2 diabetes.

For every 14-point decrease in a person's average sleeping systolic blood pressure, they experienced a 30 percent reduction in their risk of developing type 2 diabetes, said lead author Dr. Ramon Hermida. Systolic pressure is the top number in a blood pressure reading.

"The results from our prospective study indicate lowering asleep blood pressure could indeed be a significant method for reducing the risk of developing [type 2] diabetes," said Hermida, who's a professor of medicine at the University of Vigo in Spain.

So, how are these two very different diseases connected? Hormones such as adrenaline and angiotensin play a role in the development of both high blood pressure and type 2 diabetes, explained Dr. Zachary Bloomgarden, a clinical professor of medicine at the Mount Sinai Icahn School of Medicine in New York City.

A number of blood pressure medications specifically target angiotensin, a hormone that causes blood vessels to constrict and blood pressure to rise, Bloomgarden said. Angiotensin also contributes to increased glucose (sugar) release from the liver and decreased insulin sensitivity. These factors can lead to type 2 diabetes, he said.

Drugs that target angiotensin include angiotensin receptor blockers (ARBs), ACE inhibitors and beta blockers. All three classes of medication were associated with a reduced risk of type 2 diabetes when taken at bedtime, the researchers found.

"This could be a very important study, which would influence how we treat high blood pressure in people with diabetes and people at risk for diabetes," Bloomgarden said. "These are some really interesting observations you can fit together into this idea that something's particularly going on at night."

After showing that reduced blood pressure during sleep was associated with lower risk of type 2 diabetes, the researchers decided to see whether taking an entire daily dose of one or more blood pressure medications at bedtime could drive a person's type 2 diabetes risk down even more.

The clinical trial involved more than 2,000 people who had high blood pressure but not diabetes. They were randomly assigned to take all their blood pressure medications either first thing in the morning or right before bed. During an average six-year follow up, 171 of the participants developed type 2 diabetes, the study said.

Study volunteers in the bedtime-treatment group experienced a significant reduction in their sleeping blood pressure, with "non-dipping" occurring in only 32 percent of their group, compared with 52 percent of the patients who took their medication in the morning, according to the study results.

The study found the risk of developing type 2 diabetes was 57 percent lower in the bedtime-treated group than the morning group after researchers adjusted for other complicating factors.

Specifically, the odds of type 2 diabetes dropped 61 percent for people taking angiotensin receptor blockers at bedtime compared to morning. For those on ACE inhibitors at night, the odds went down 69 percent. People on beta blockers reduced their odds of the blood sugar disease by 65 percent when they took their medicine at night, the researchers reported.

"Ingesting hypertension medications at bedtime, instead of upon awakening in the morning, improved asleep blood pressure control and markedly reduced the risk of [type 2] diabetes," Hermida said.

Earlier studies have failed to show any type 2 diabetes prevention benefit from blood pressure medications, but they may have been flawed because people were asked to take the drugs in the morning, Bloomgarden said.

"Typically we give medicines in the morning and not at night," he said. "Maybe the ideal time for blood pressure treatment is at night."

Findings from the new research were published online Sept. 23 in the journal Diabetologia.

More information

For more information on blood pressure medications, visit the American Heart Association.

SOURCES: Ramon Hermida, Ph.D., professor of medicine, University of Vigo, Spain; Zachary Bloomgarden, M.D., clinical professor of medicine, Mount Sinai Icahn School of Medicine, New York City; Sept. 23, 2015, Diabetologia, online

From healthday.com

 

Aims/hypothesis
We investigated whether therapy with the entire daily dose of ≥1 hypertension medications at bedtime exerts greater reduction in the risk of new-onset diabetes than therapy with all medications upon awakening.
Methods
We conducted a prospective, randomised, open-label, blinded endpoint trial of 2,012 hypertensive patients without diabetes, 976 men and 1,036 women, 52.7 ± 13.6 years of age. Patients were randomised, using a computer-generated allocation table, to ingest all their prescribed hypertension medications upon awakening or the entire daily dose of ≥1 of them at bedtime. Investigators blinded to the hypertension treatment scheme of the patients assessed the development of new-onset diabetes.
Results
During a 5.9-year median follow-up, 171 participants developed type 2 diabetes. Patients of the bedtime, compared with the morning-treatment group, showed: (1) significantly lower asleep BP mean, greater sleep-time relative BP decline and attenuated prevalence of non-dipping at the final evaluation (32% vs 52%, p < 0.001); and (2) significantly lower HR of new-onset diabetes after adjustment for the significant influential characteristics of fasting glucose, waist circumference, asleep systolic BP mean, dipping classification and chronic kidney disease (CKD) (unadjusted HR 0.41 [95% CI 0.29, 0.58]; adjusted HR 0.43 [0.31, 0.61]; event-rate 4.8% vs 12.1% with bedtime and morning treatment, respectively; p < 0.001). Greater benefit was observed for bedtime compared with awakening treatment with angiotensin receptor blockers (ARBs) (HR 0.39 [0.22, 0.69]; p < 0.001), ACE inhibitors (0.31 [0.12, 0.79], p = 0.015) and β-blockers (0.35 [0.14, 0.85], p = 0.021).
Conclusions/interpretation
In hypertensive patients without diabetes, ingestion of ≥1 BP-lowering medications at bedtime, mainly those modulating or blocking the effects of angiotensin II, compared with ingestion of all such medications upon awakening, results in improved ambulatory BP (ABP) control (significant further decrease of asleep BP) and reduced risk of new-onset diabetes.
Trial registration: ClinicalTrials.gov NCT00295542
Funding: This independent investigator-promoted research was supported by unrestricted grants from Ministerio de Ciencia e Innovación (SAF2006-6254-FEDER; SAF2009-7028-FEDER); Xunta de Galicia (PGIDIT03-PXIB-32201PR; INCITE07-PXI-322003ES; INCITE08-E1R-322063ES; INCITE09-E2R-322099ES; 09CSA018322PR); and Vicerrectorado de Investigación, University of Vigo.

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