VOLUME 8 NUMBER 4 • NOVEMBER 2011
181
SA JOURNAL OF DIABETES & VASCULAR DISEASE
EASD WATCH
This study demonstrates that obese sub-
jects with and without type 2 diabetes have
significant insulin resistance in the proximal
intestine. Jejunal GU is improved in line
with whole-body and skeletal muscle insu-
lin sensitivity after bariatric surgery and the
recovery of diabetes. The findings suggest
that intestinal insulin resistance is an impor-
tant factor in T2DM.
Source: 1. Svehlikova E,
et al
. Improved glucose metab-
olism early after gastric bypass surgery relies primarily
on enhanced insulin sensitivity. Presentation 182.
2. Makinen J,
et al
. Intestinal insulin resistance asso-
ciated with obesity and type 2 diabetes. Presentation
185.
High risk of depression in type 2
diabetics: motivation for monitor-
ing of emotional well-being in col-
laborative care models
The risk of depression is doubled in individ-
uals with type 2 diabetes, often presenting
as a chronic condition.
The incidence and recurrence/persist-
ence of depression and significant pre-
dictors thereof have been examined in a
cohort of 2 460 primary-care patients with
type 2 diabetes. Female gender, low levels
of education, microvascular disease, other
co-morbid conditions and stressful life
events were all positively associated with
incident depression. Low educational level
was the only significant predictor of recur-
rent/persistent depression.
1
Diabetes has a considerable impact on
health-related quality of life (HRQL). A prog-
nostic link between self-reported HRQL and
unfavourable outcome has not been well
explored in patients with type 2 diabetes
and acute myocardial infarction.
It was found that a low self-reported
HRQL score is of prognostic significance and
can therefore serve as an easily obtained
indicator of patients at high risk for all-cause
and cardiovascular mortality. The predictive
value appeared to be higher in men.
2
Source: 1. Kjellstrom B,
et al
. Health-related quality of
life predicts survival in patients with type 2 diabetes and
myocardial infarction: a report from the DIGAMI2 trial.
Presentation 6.
2. Nefs G,
et al
. The course of depression in primary
care patients with type 2 diabetes: results from the
DiaDDZoB study. Presentation 213.
NUTRITION AND TYPE 2 DIABETES
There is still limited understanding on how
dietary macronutrient composition is linked
with long-term risk of obesity-related
chronic disease.
Diets high in protein have shown prom-
ising results on short-term weight reduction
and glycaemic control. However, high-pro-
tein diets were associated with increased
risk of type 2 diabetes. Replacing protein
with carbohydrates, particularly fibre-rich
breads and cereals, was inversely associ-
ated with type 2 diabetes.
1
The increased consumption of a West-
ern diet high in refined sugar and fat has
led to increased rates of obesity, insulin
resistance and type 2 diabetes mellitus. The
effect of high sugar intake in adolescence
is less well demonstrated.
Lewis and colleagues have studied the
effect of sugar intake in early teenage years
on glucose tolerance and insulin resistance
in early adulthood. Higher dietary sugar
intake in early teenage years independently
affected longer-term glucose metabolism
and was associated with higher fasting
plasma glucose and relative insulin resist-
ance. There was no such association for
high dietary sugar intake in early adult-
hood. These findings indicate a potential
legacy effect of the adolescent diet and a
need to address dietary advice in this age
group
The ability to identify obese subjects
who will lose weight in response to energy
restriction is an important strategy in clini-
cal care of obesity. Kong and colleagues
have concluded that individual responses to
hypocaloric high-protein, fibre-rich dietary
programmes could be predicted by plasma
insulin, IL-6, leukocyte numbers and adi-
pose tissue HAM56 levels prior to diet.
3
Source: 1. Ericson UC,
et al
. High intake of protein and
processed meat is associated with increased incidence
of type 2 diabetes. Presentation 13.
2. Lewis AS,
et al
. A prospective longitudinal observa-
tional study on the effect of dietary sugar intake in ado-
lescence and early adulthood on measures of glucose
metabolism in early adulthood. Presentation 237.
3. Kong L,
et al
. Plasma insulin and inflammatory mark-
ers prior to weight loss can predict dietary responders.
Presentation 16.
CLINICAL TRIALS OF INTENSIVE
GLUCOSE LOWERING
End-stage kidney disease (ESKD):
ADVANCE trial
Blood glucose levels have been linked to
the risk of kidney disease, but the effects of
intensive glucose control on major kidney
outcomes among people with diabetes are
not known. An analysis from the ADVANCE
trial found that an intensive blood glucose-
lowering regimen (HbA
1c
< 6.5%) based on
gliclazide MR reduced the risk of ESKD, but
the effects on other renal outcomes were
less clear.
Source: Zoungas S,
et al
. Intensive glucose lowering and
end-stage kidney disease: new data from the ADVANCE
trial. Presentation 39.
Understanding cardiovascular risk
at HbA
1c
levels below 7%: ACCORD
trial
The ACCORD trial reported significantly
higher mortality in type 2 diabetes patients
treated with intensive glucose lowering
(target HbA
1c
< 6%) versus standard treat-
ment (target HbA
1c
7–7.9%). The ACCORD
findings are contextualised with outcomes
estimated from other data sources, by com-
parison of relative risks of non-fatal MI,
non-fatal stroke, heart failure and all-cause
mortality.
Relative risk of all-cause mortality in
ACCORD was significantly different from pre-
vious data. This difference was not seen in the
other endpoints, was not consistent across
recent studies and was not fully explained by
hypothesising a lower limit of 7% for HbA
1c
benefit. Observed mortality effects in the
ACCORD trial may have been related to fac-
tors other than glucose lowering.
Source: Foos V,
et al
. Comparison of ACCORD trial out-
comes with outcomes estimated from modelled and
meta-analysis studies. Presentation 3.
UKPDS UPDATED RISK MODEL
The United Kingdom Prospective Diabetes
Study (UKPDS) outcomes simulation model
for type 2 diabetes predicts development
and consequences of diabetes complica-
tions, enabling economic evaluation of inter-
ventions. This model has been extended and
enhanced, with additional risk factors.
Micro- or macroalbuminuria was a signif-
icant covariate in eight equations (including
death and renal failure); peripheral vascular
disease was significant in seven equations
(including death and amputation) and
white blood cell count in four equations
(including first stroke and blindness). Nota-
bly, atrial fibrillation was associated with
high risk of first stroke and heart failure.
Source: Hayes AJ,
et al
. An improved model to estimate
lifetime health outcomes of patients with type 2 diabe-
tes using 30-year follow-up data from the United King-
dom prospective diabetes study. Presentation 4.
