Health System

Atherosclerosis and its complications develop in stages. Each of each of these stages is affected by different metabolic abnormalities, said Scott Grundy, MD, PhD, during the annual Edwin Bierman lecture.

Current research suggests that pedal osteolysis, the loss of bone mineral density (BMD) in the foot, may be a useful biomarker for Charcot's arthropathy and other diabetic foot diseases.

An intense glucose-lowering strategy in high-risk patients with type 2 diabetes was associated with an excess of mortality in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, the U.S. counterpart to the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation) study.

Several novel classes of agents designed to treat hyperglycemia are under investigation. These agents were the subjects of a symposium here. One such novel class is the sodium glucose co-transporter (SGLT) type 2 inhibitors, which reduce glucose levels by increasing kidney excretion of glucose. The kidney plays an important role in the handling of glucose, said Robert R. Henry, MD, professor of medicine and chief of VA endocrinology and metabolism at the University of California, San Diego. SGLT-2 is expressed almost exclusively in the kidney. About 90% of glucose reabsorption by the kidney is mediated by SGLT-2 under normal circumstances.

Translating weight loss research into clinical programs is not easy. Too many clinical protocols exist in isolation, according to Donald Williamson, PhD, Pennington Biomedical Research Center, Baton Rouge, LA. The key gap is extending methods that contribute to weight loss into programs that maintain weight loss.

The risk of fracture is probably only slightly increased in persons with type 2 diabetes, said Peter Vestergaard, MD, PhD, DrMedSc, from the Osteoporosis Clinic, Aarhus Amtssygehus, Denmark.

Real-time continuous glucose monitoring (CGM) can significantly improve glycemic control, but it will not help all patients. "Real-time CGM will add significantly to glucose management for some people, but not for all," said Irl Hirsch, MD, University of Washington, Seattle. "Human factors make all the difference between success and failure. Some patients will never figure it out. That?s why real-time control is so challenging.

Good glycemic control is not sufficient to relieve painful diabetic neuropathy, necessitating investigation of other modalities to achieve analgesic efficacy. Dan Ziegler, MD, German Diabetes Clinic, German Diabetes Center, and professor of internal medicine, Leibniz Institute at the Heinrich Heine University, Düsseldorf, provided an overview of pharmacologic treatments that have been explored for painful diabetic neuropathy and the success achieved with each.

Islet cell transplants are effective in both the short- and long-term in freeing patients with diabetes from insulin injections and have proven to be safe, said Bernhard J. Hering, MD. The use of embryonic pig pancreatic precursor tissue as the source of islets appears promising and would expand the number of transplant recipients, which is currently limited by number of potential donors.

Take another look at the popular hypothesis that suggests type 2 diabetes has an acute effect on the secretion of GLP-1 and that lower GLP-1 secretion has an acute effect on insulin. It doesn?t work that way, said Michael Nauck, MD, PhD, Diabeteszentrum Bad Lauterberg, Bad Lauterberg, Germany. Decreased GLP-1 secretion is not part of the pathophysiology of type 2 diabetes.

Researchers at Stanford University are reporting positive results in healing diabetic wounds with a pharmaceutical agent already approved by the FDA?but only in mice so far.

Clinicians and type 2 diabetes patients have a new worry: hepatic steatosis, or nonalcoholic fatty liver disease. Liver disease is a less-obvious problem than kidney disease but may have equally grave consequences.

Endothelial dysfunction is both a marker for and a cause of diabetic complications. Researchers are teasing out pathways that involve oxidative stress and endothelial dysfunction, said Per-Henrik Groop, MD, PhD, Helsinki University Central Hospital, Helsinki, Finland. The challenge is in finding drugs that show the same activity in vivo that they show in cell studies or animal models.

Forget the arguments over fit and fat in the development of diabetes and the resulting complications. Both fitness and fatness can be addressed by the same prescription: physical activity.

Intensive blood glucose control in patients with type 2 diabetes resulted in a significant reduction in the risk of microvascular complications compared with standard blood glucose control. This was driven by a reduction in the occurrence of nephropathy, in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) study.

Periodontal disease makes glycemic control more difficult in patients with type 2 diabetes, said George W. Taylor, DrPH, DMD, associate professor of dentistry, School of Dentistry and Public Health at the University of Michigan, Ann Arbor.

CVS Pharmacy and Century 21 are teaming up with Easter Seals around Chicagoland.

The editorial teams in the Modern Medicine Primary Care Content Group, with content from our legacy brands ? Medical Economics, Drug Topics, Geriatrics, Formulary and Contemporary OB/Gyn ? will cover key medical meetings, bringing you breaking news, the latest research findings and reports from the general sessions.

The feds have issued two guidances related to the use of drugs for the influenza pandemic.

The FDA issues Early Communication of immunosuppressants' possible association with lymphoma.

Member Health's CommunityCareRx plan was the leading Medicare Part D drug plan, while Rite Aid Health Solutions was one of the top pharmacy benefit managers in a survey from Wilson Health Information.

Walgreens has agreed to pay $35 million in generic drug switching allegations lawsuit.

Health Mart, a growing independent pharmacy franchise, takes top spot in pharmacy customer service by WilsonRx.

The agency releases alert to transition patients to new albuterol inhalers by year's end.

Rite Aid is launching a "Fill up & Fuel up" program sweepstakes.

The Kroger Co. and The Little Clinic announced a partnership to roll out walk-in medical clinics throughout the country.

Taking proactive action, APP Pharmaceuticals improves the design of its 1 mL and 2 mL heparin vials to reduce the risk of drug errors.

Two former CVS executives have been acquitted of bribing a Rhode Island state senator for legislative favors.

An updated bulletin from ACOG offers advice on how to treat pregnant patients with mental disorders.

ECRI Institute finds that Curlin Medical's infusion pumps may be be administering too much medication.