Monthly Archives: August 2010

Light May Replace Lancets For Testing Blood Sugar

Checking sugar levels without pricking yourself

A quick and painless way to measure blood sugar is highly sought-after by diabetes sufferers, who currently have to prick their fingers to draw blood several times a day. Now, researchers in the US may have found a solution – a device that works by simply shining a light on skin.

The vision is to create a laptop-sized device that could be kept at home or carried around. Rather than having to pierce the skin to obtain blood samples, the device measures sugar levels by simply placing a scanner against the skin. Because measurement is fast and easy, it is hoped that the device may encourage people with diabetes to check their blood sugar more often, giving them better control over their condition.

At the heart of the device is a Raman spectrometer (named after CV Raman, the Indian Nobel Laureate physicist), which can identify chemical compounds by measuring how near-infrared laser light scatters on contact with molecules. The idea of using Raman spectroscopy to measure sugar levels in blood was first suggested 15 years ago by Michael Feld at the Massachusetts Institute of Technology (MIT). Although Feld sadly passed away in April this year, his team is now starting to realize his vision.

Keeping Up With The Sugar Rush
The problem until now has been that near-infrared light can only penetrate a short distance into the skin. The technique therefore detects glucose in the fluid surrounding skin cells (the interstitial fluid), rather than in the bloodstream. This is a problem because blood glucose levels can change rapidly, such as after eating, while there is a time lag of 5–10 minutes before the sugar changes can be seen in the interstitial fluid.

The MIT team has now resolved the problem by developing an algorithm to relate blood glucose to interstitial glucose levels. “We’ve incorporated a mass-transfer model into the overall Raman spectroscopic algorithm, which allows us to seamlessly transform between blood and interstitial fluid glucose,” explains Ishan Barman, lead author of the research.

Using an early version of the device, the team tested the blood-sugar levels of some human volunteers and found that the accuracy and precision of the test was just as good as conventional finger-prick tests. In addition, the new algorithm allows the test to predict impending episodes of high or low blood sugar (hyperglycemia and hypoglycemia) by extrapolating the rate of change of sugar concentration.

The next challenge is to strip down the Raman system and build a miniaturized device that would be suitable for home use. A prototype has been made and is already scheduled for clinical testing, but reducing the complexity of the system and shrinking down bulky components could take a while.

“We are in a proof-of-concept stage in terms of device development – and we envision a laptop-sized or hand-held unit that could cost as little as $200,” he told “It is difficult to predict due to market variations and FDA regulations, but one could anticipate an optical device for glucose monitoring in the next 5–7 years.”

Randall Jean, an expert in remote sensing at Baylor University in Texas, US, is impressed by the work. “This research addresses a real problem and appears to provide an important means for improving the calibration of non-invasive sensors,” he says. “It may also be helpful in the development of a so-called ‘artificial pancreas’ – where insulin can be dispensed automatically in response to sugar levels.”

Thank you Lewis Brindley/Physics World


Diabetes: What Ails China

China’s struggle with diabetes has reached epidemic proportions. This is the conclusion of a group of researchers from Tulane University, whose findings were recently published in the New England Journal ofMedicine, one of the United States’ most prestigious medical journals.

According to the study, 92.4 million adults in China age 20 or older (almost 10% of the population) have diabetes, and 148.2 million adults have pre-diabetes, a condition that is a key risk factor for developing overt diabetes and/or cardiovascular disease. Of particular significance is the finding that the majority of cases of diabetes are undiagnosed and untreated.

These new figures indicate that China has edged ahead of India to become the country with the largest population of diabetics in the world.

Most cases of diabetes are from so-called type 2 diabetes, a form of the disease that accounts for 90-95% of all diabetes cases among adults. It results from insulin resistance and is sometimes combined with an absolute insulin deficiency.

The diabetes epidemic is not only a serious public health problem — it can also have serious economic repercussions. A study found that estimated medical costs for diabetes and its complications were 18.2% of China’s total health expenditures in 2007. The World Health Organization (WHO) estimates that diabetes, heart disease and stroke will cost China approximately $558 billion between 2006 and 2015.

Until just over a decade ago, diabetes was relatively rare in China. However, in the last decade the problem has become much more severe. Experts believe that China’s rapid economic development — and the increased urbanization, physical inactivity, unhealthy diet and obesity that often accompany increased prosperity — is an important contributing factor in the development of the disease.

Environmental toxins may also contribute to recent increases in the rate of type 2 diabetes. This is the opinion of some experts, who found a positive correlation between the concentration in the urine of bisphenol A, a constituent of some plastics, and the incidence of type 2 diabetes.

Obesity has been found to contribute approximately 55% to an individual’s development of type 2 diabetes. A study on the importance of lifestyle factors showed that those who had high levels of physical activity, a healthy diet, did not smoke and consumed alcohol only in moderation had an 82% lower rate of diabetes. When a normal weight was included, the rate was 89% lower.

The increased rate of childhood obesity between 1960 and 2000 is believed to have led to the increase of type 2 diabetes in children and adolescents. There were more than 60 million obese people in China, and another 200 million who were overweight, according to a 2004 nationwide survey.

In the United States, type 2 diabetes affects approximately 8% of adults. That proportion increases to 18.3% among Americans age 60 and older, according to statistics from the American Diabetes Association. In comparison, the worldwide prevalence of diabetes among all age groups was estimated to be 2.8% in 2000, and will rise to 4.4% in 2030.

Diabetes and its consequences have become a major public health problem not only in China, but in many industrialized countries as well. To avoid further damage to people’s health, it is imperative to develop and institute national strategies for preventing, detecting and treating diabetes in the general population.

Thank you Cesar Chelala/The Globalist

Study To Check If Garlic And Asparagus Can Fight Diabetes

Researchers are investigating whether foods including garlic and asparagus could help weight loss and diabetes. In news that could make ardent vegans and vegetarians feel a little smug, the charity Diabetes UK is examining whether foods rich in fibre could supress people’s appetites and reduce their blood sugar levels.

Fermentable carbohydrates, a kind of fibre, are found in foods such as asparagus, garlic, chicory and Jerusalem artichokes. If the foods are found to have this effect it could revolutionise treatments to tackle obesity and type 2 diabetes. Recent research has suggested that foods high in fermentable carbohydrates are particularly good at stabilising blood sugar levels.

The three-year study by the Nutrition and Research Group at Imperial College London, aims to establish whether these carbohydrates cause the release of gut hormones that could reduce appetite and enhance insulin sensitivity, which could reduce blood sugar levels and help control weight. The carbohydrates will be given to participants in the study as a daily supplement.

Dietitian Nicola Guess, who is leading the study, said: “By investigating how appetite and blood glucose levels are regulated in people at high risk of type 2 diabetes, it is hoped that we can find a way to prevent its onset. Type 2 diabetes accounts for 90% of diabetes cases and, if left untreated, can lead to serious health complications including heart disease, stroke, blindness, kidney failure and amputation, according to Diabetes UK.

Dr Iain Frame, the charity’s director of research, said: “It is unlikely that any single measure used on its own will bring about improved prevention of type 2 diabetes. But it’s hoped that the research being funded at Imperial College will help by aiming to develop an easy and affordable way to help people to reduce their risk of developing type 2 diabetes and managing their blood glucose levels.”

Thank you David Batty/Guardian

Diabetes: eAG (estimated Average Glucose) Explained

I have been getting queries on my earlier post Blood Sugar Management: Estimated Average Glucose. I am reproducing a FAQ from the American Diabetes Association that should help clear the air.

Basically, reporting glucose control as Estimated Average Glucose or eAG will assist health care providers and their patients in being able to better interpret the A1C value in units similar to what patients see regularly through their self-monitoring. So, the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) will be working together to conduct educational efforts to make both patients and providers aware of this new terminology, and help to understand the relationship between A1C and eAG.

This Q&A describes a new term for describing diabetes control, “estimated average glucose”, eAG. eAG correlates directly to A1C, which has been the standard measure of diabetes control for many years.

What is A1C?
The A1C (pronounced A-one-C) test, also known as glycated hemoglobin or HbA1c, measures average blood glucose control for approximately the 3 months. The results can help health care providers – and their patients – know if the diabetes treatment plan is working or if adjustments to treatment are needed.

A1C is measured by a simple blood test performed in a laboratory. The American Diabetes Association recommends that most people with diabetes have their A1C level checked at least twice a year.

The American Diabetes Association recommends that people with diabetes strive for an A1C goal of less than 7%. An A1C for a person without diabetes is approximately 4-6%.

Why is understanding average blood glucose control important in the management of diabetes?
In 1993, when the landmark Diabetes Control and Complications Trial (DCCT) was completed, the importance of A1C as an indicator of risks for the complications of diabetes, such as blindness, kidney disease and nerve damage was firmly established.

The DCCT demonstrated that keeping A1C closer to normal reduces the risk for diabetes-related complications. As A1C increases, so does the risk of complications.

In 1994, the American Diabetes Association began recommending specific A1C treatment goals based on the results of the DCCT. From that time on, the goal for most people with diabetes has been less than 7%.

What is the difference between A1C and the blood glucose measure obtained through daily self-monitoring?
A1C results, which tend to be measured at least 2 times a year as part of a visit with the doctor, measure average blood glucose control over the past 2 to 3 months. Results from the A1C test are reported in percentage points (i.e., A1C of 7%).

When people with diabetes test their blood glucose through daily self-monitoring, those results are reported in different units – mg/dl (i.e., 170 mg/dl). They represent the level of glucose in the blood at that moment in time, but do not give any indication of what the level is at other times of day.

Why is daily self-monitoring of blood glucose so important?
Although the A1C test is an important tool, it can’t replace daily self-monitoring of blood glucose (SMBG). A1C tests don’t measure a person’s day-to-day control. People with diabetes can’t adjust their insulin on the basis of their A1C tests. That’s why blood glucose checks and log results are so important to staying in good control.

The A1C test alone is not enough to measure good blood glucose control. But it is a good resource to use along with your daily blood glucose checks, to work for the best possible control.

What is the A1C-Derived Average Glucose (ADAG) Study and why was it conducted?
The A1C-Derived Average Glucose (ADAG) Study is an international study sponsored by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF). It was conducted in response to the introduction of a new worldwide method of standardization of the A1C assay that would result in values that are 1.5-2 percentage points lower than current standards. It was felt that this change would cause considerable confusion for patients and health care providers.

The objective of the ADAG Study was to define the mathematical relationship between A1C and estimated average glucose (eAG) and determine if A1C could be reliably reported as eAG, which would be in the same units as daily self-monitoring.

How was the ADAG Study conducted?
Five hundred seven people, including 268 patients with type 1 diabetes, 159 with type 2 diabetes, and 80 people without diabetes were recruited from 10 international centers.

A1C was measured using a combination of continuous glucose monitoring and frequent finger stick glucose measurements similar to the way in which people with diabetes check their diabetes control at home by self-monitoring of blood glucose (SMBG).

By comparing the measurement of A1C with the average glucose levels, study investigators were able to derive an equation so that A1C levels can be interpreted accurately as an average glucose level or eAG. (As reported in this blog earlier, the formula is: 28.7xA1C-46.7 = eAG )

What is estimated Average Glucose (eAG) and why is this measure important?
The ADAG Study establishes what has long been assumed but never demonstrated… that A1C does represent average glucose over time. With that relationship demonstrated and defined, health care providers can now report A1C results to patients in the same units that they are using for self-monitoring (i.e., mg/dl) which should benefit clinical care.

Why is the chart in ADA’s Standards of Care showing a correlation between A1C and mean glucose levels slightly different from the correlation published with the ADAG results?
The chart published in the ADA’s Standards of Care is based on a study that analyzed data collected during the DCCT, which included quarterly A1C tests and 7-point glucose measurements in 1,400 type 1 diabetes patients.

The International A1C-Derived Average Glucose (ADAG) Study involved people with type 1 and type 2 diabetes as well as people without diabetes, and took advantage of the development of continuous glucose monitors, as well as patients making traditional glucose checks, to generate a much larger pool of data.

Both studies showed a linear relationship between A1C and average glucose; the ADAG study presents a more refined and accurate formula describing that relationship, and the ADA’s Standards of Care will adopt the new correlation. The formula describing the relationship is: 28.7 times A1C minus 46.7 = eAG.

How will this new terminology, eAG, help health care providers and their patients?
Reporting glucose control as ‘average glucose’ will assist health care providers and their patients in being able to better interpret the A1C value in units similar to what patients see regularly through their self-monitoring.

Part of the logic for choosing the term “eAG” is that the medical community recently adopted another new term, eGFR, for estimated glomerular filtration rate, which was introduced as an easier to understand measure of kidney function than the established method of measuring creatinine levels to assess kidney function. The hope is that the growing acceptance of eGFR will help spur the adoption of the similar eAG.

The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) will be working together to conduct educational efforts to make both patients and providers aware of this new terminology, and help to understand the relationship between A1C and eAG.

Many patients who practice SMBG already see an “average glucose” on their blood glucose meters. Is eAG the same thing?
No, an eAG value is unlikely to match the average glucose level shown on a person’s meter. Because people with diabetes are more likely to test more often when their blood glucose levels are low—first thing in the morning, and before meals—the average of the readings on their meter is likely to be lower than their eAG, which represents an average of their glucose levels 24 hours a day, including post-meal periods of higher blood glucose when people are less likely to test.

One advantage of using eAG as a measure of glucose control is that it will help patients more directly see the difference between their individual meter readings and how they are doing with their glucose management overall.

What are the plans to work with laboratories and manufacturers to incorporate average glucose values in their reports?
The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) will be working with labs to encourage them to incorporate AG values in their reports to physicians.

Source: American Diabetes Association

New Study Finds New Connection Between Yoga and Mood

Researchers from Boston University School of Medicine (BUSM) have found that yoga may be superior to other forms of exercise in its positive effect on mood and anxiety. The findings, which currently appear on-line at Journal of Alternative and Complementary Medicine, is the first to demonstrate an association between yoga postures, increased GABA levels and decreased anxiety.

The researchers set out to contrast the brain gamma-aminobutyric (GABA) levels of yoga subjects with those of participants who spent time walking. Low GABA levels are associated with depression and other widespread anxiety disorders.

The researchers followed two randomized groups of healthy individuals over a 12-week long period. One group practiced yoga three times a week for one hour, while the remaining subjects walked for the same period of time. Using magnetic resonance spectroscopic (MRS) imaging, the participants’ brains were scanned before the study began. At week 12, the researchers compared the GABA levels of both groups before and after their final 60-minute session.

Each subject was also asked to assess his or her psychological state at several points throughout the study, and those who practiced yoga reported a more significant decrease in anxiety and greater improvements in mood than those who walked. “Over time, positive changes in these reports were associated with climbing GABA levels,” said lead author Chris Streeter, MD, an associate professor of psychiatry and neurology at BUSM.

According to Streeter, this promising research warrants further study of the relationship between yoga and mood, and suggests that the practice of yoga be considered as a potential therapy for certain mental disorders.

Controlling a Fat-Regulating Protein Dramatically Increases Insulin Sensitivity

PPARy is a protein that regulates the body’s production of fat cells. However, obesity can modify how PPARy works, leading to decreased insulin sensitivity and the development of metabolic syndrome. (Metabolic syndrome is the cluster of factors, including insulin resistance, overweight, high blood pressure, and abnormal blood sugar levels, that is a precursor to type 2 diabetes.)

But now a joint team of researchers from The Scripps Research Institute in San Diego and the Dana-Farber Cancer Institute at Harvard University in Cambridge has found a way to control the adverse changes in PPARy brought on by obesity.

One of those changes is phosphorylation, when an enzyme called cdk5 kinase adds a phosphate group to PPARy. That addition causes PPARy to alter the expression of several genes, including one that regulates production of adiponectin, a protein essential to insulin sensitivity.

The challenge for the scientists was to find a way to change PPARy back to its normal state without inducing it to overproduce fat cells. They knew from a previous study that an agonist, a compound that makes cells respond in certain ways, interacted with the region of PPARy known to regulate fat generation. The agonist in that case was a full agonist, meaning that it was able to easily combine with a receptor in that region of PPARy and activate it to do a certain thing-in this case, not generate fat cells.

The researchers wondered if partial agonists-chemical agents that have only partial effects on certain cell receptors-could be used to counteract the insulin-suppressing effects of phosphorylation on PPARy without the side effect of ramping up fat cell production.

They found that while partial agonists did not interact with the PPARy receptor that governs fat cell production, one, called MRL24, worked extremely well in the exact region of PPARy where phosphorylation takes place. By altering and diminishing that region’s receptiveness to phosphorylation, MRL24 allowed PPARy to increase the production of adiponectin.

Those findings, which open the door to learning how to fully manipulate PPARy, could lead to drugs that reduce the risk of developing type 2 diabetes and cardiovascular problems. If PPARy can be prevented in obese people from losing its ability to direct the production of adiponectin, it could become a significant therapy in treating the effects of extreme overweight.

Thank you Patrick Totty

Surgical Procedure Can Control Type 2 Diabetes, Claims Brazilian Surgeon

A new procedure which requires surgical intervention through Ileal Transposition (or small intestinal switch) can effectively control Type 2 diabetes, a Brazilian surgeon claimed in Hyderabad, India on August 21.

Dr Aureo Ludovico de Paula, was in the city to address the first international conference and live workshop on this procedure along with his Indian counterpart Dr Surendra Ugale.

Ugale who is also the organizing secretary of the workshop said, “the new research has shown that there are some intestinal hormones which have a great effect on the pancreas and insulin secretion especially in response to food intake. Dr Paula has devised a laparoscopic operation which he claims is proving to be a cure for Type 2 diabetes.”

Paula said, “The surgery can control diabetes without insulin, arrest the metabolic syndrome of the body organ deterioration, thus avoiding future diabetic complications.”

The doctor who has performed 700 surgeries with 95% remissions said the operation involves a long segment of ilium (ending portion of small intestine) which is shifted to the upper small intestinal area, where food particles will reach it very soon on eating a meal.

This causes an immediate secretion of good hormone GLP-1 which acts on the B cells of pancreas to secrete insulin and control blood sugar.

The fall out is a biochemical process that facilitates insulin secretion in the presence of undigested food and controls Type 2 diabetes, a metabolic disorder that is marked by the failure to absorb sugar and starch due to lack of the hormone insulin, Paula said.

Type 2 diabetes is the most common form of diabetes. In this disease, either the body does not produce enough insulin or the cells ignore it.

Ugale explained that Type 2 Diabetes affects several organs. The solution therefore is to stimulate these hormones in lower intestine that in turn secrete GLP which in turn stimulates the pancreas to stimulate the insulin and get fresh beta cells.

He said patients who already have diabetes for ten years and using medication, and are suffering from five associated diseases are ideal candidates for this kind of surgical intervention which costs less than US $10,000 (in India).

The surgery not only controls high blood pressure but also improves kidney cholesterol nerves reduces excess weight and also one need not take any medicines. He also can eat normally post surgery, including sweets.

However, doctors insist that first of all in any patient they would advise lifestyle changes, exercise followed by medication, if there is diabetes and if the patient is not doing well only then surgery is advised.

Presently a centre in Mumbai and Hyderabad are performing this surgery. A centre has also come up in Coimbatore.

Over hundred doctors from all over the country and endocrinologists are participating in the two-day seminar

Diabetes: Look To Older, Longer-Studied Treatments

The safety of most diabetes drugs are time-tested — insulin was discovered in the early 1920s, and two of the other most commonly prescribed, metformin and sulfonylurea, have been around since the 1950s. Indeed, these drugs have five characteristics physicians look for in diabetes medications: few potential complications, safety, tolerability, ease of use and a low cost.

But newer, “high-tech” drugs such as Avandia (Rosiglitazone Maleate) – branded differently outside the US market (e.g. Windia in India) – are different. Avandia landed with a splash on the market 11 years ago and quickly became the top-selling diabetes drug in the world. It’s used by Type 2 diabetics to help improve blood sugar control in a different way than most other diabetes medications. Instead of causing the body to make more insulin, it works to use what is naturally made more efficiently.

But when studies began to link it to an increased risk of heart attacks and strokes, its fortunes quickly reversed. Now an advisory panel to the US Food and Drug Administration has recommended that the drug be slapped with stricter warnings and increased supervision.

That doesn’t mean diabetes patients taking Avandia should necessarily stop. Or that there are no options for those who choose to do so. Far from it. Rather, it offers a lesson in how medications are prescribed for Type 2 diabetes, which accounts for 90% to 95% of the 23.7 million diagnosed diabetes cases in the US alone.

As with high blood pressure and cholesterol, there is no silver-bullet, cure-all medication for either type of diabetes, said Daniel Einhorn, president of the American Assn. of Clinical Endocrinologists. Treatment for Type 1 (in which the body produces no insulin) largely amounts to taking insulin and maintaining a healthy lifestyle. But treatment for Type 2 (in which the body does not produce enough insulin or is resistant to what is produced) often includes a combination of drugs, which can produce varying results among different patients or even in the same person over a number of years.

Neither doctors nor their patients have to wade through the offerings on their own. They have a long history of data on which to draw. Avandia’s rapid rise and fall highlights the importance of knowing what to expect.

Other Treatments

To improve medication management for diabetics, professional associations such as the American College of Endocrinology and the International Diabetes Center have created charts detailing how and when to prescribe the drugs based on myriad factors, including a patient’s weight, fitness level, health conditions, other medications and ability to control blood glucose levels.

“Doctors can take many paths down the road, but the road maps give you advice,” Einhorn said. “They like the ability to choose a plan for patients, but many are kind of glad to have the guidance of general principles.”

The charts provide information on target glucose levels, potential side effects and benefits of the drugs, and suggestions on when to add new medications.

When first diagnosed with Type 2 diabetes, most patients are advised to regulate blood sugar with exercise, diet and stress management. If that fails, the first medication that they receive is usually metformin, said Sanjay Kaul, a cardiologist at the Cedars-Sinai Heart Institute and member of the FDA’s Avandia panel.

Metformin has the five characteristics physicians look for in diabetes medications, Kaul said: few potential complications, safety, tolerability, ease of use and a low cost.

“Metformin is preferred by professional societies as the treatment of first choice for diabetic patients,” he said. “It is relatively safe, without side effects, well tolerated, weight neutral and inexpensive. And evidence shows it may save lives.”

It decreases the amount of sugar (glucose) the body takes from foods and the amount of glucose produced by the liver. About 15% to 20% of diabetes patients cannot tolerate the drug because of gastric side effects or kidney problems, said Richard Bergenstal, president of medicine and science for the American Diabetes Assn. and executive director of the International Diabetes Center.

When first starting diabetes medications, some patients experience side effects such as water retention. These are usually seen within a week or so, and three months is sufficient time to see if a drug is affecting glucose reduction, Bergenstal said.

If a patient can’t tolerate the drug or it doesn’t decrease blood sugar adequately, a second medication is typically added to the regimen. About a dozen categories of drugs are available in the second class of medications, Bergenstal said, but four of them make up about 90% of prescriptions.

One group is sulfonylureas (such as Amaryl, or glimepiride), which help the pancreas release more insulin. A second is DPP-4 inhibitors (such as Onglyza, or saxagliptin). DPP-4 is an enzyme that blocks the secretion of the hormone GLP-1, which stimulates the release of insulin. The third is GLP-1 agonists (such as Byetta, or exenatide), which mimic the actions of GLP-1. And lastly, thiazolidinediones (such as Avandia, or rosiglitazone, and Actos, or pioglitazone), which increase the body’s sensitivity to insulin.

If patients still don’t meet their target glucose levels, a third medication is added to the regimen. This could be another of the drugs not used in the second tier, background insulin (long-acting, which stays in the bloodstream for 24 hours) or a thiazolidinedione. If patients continue to have problems, the fourth, and final, level of treatment is insulin therapy.

Patient-Specific Help

But doctors can, and obviously should at times, move beyond the guidelines. Among the most important factors in doing so are patient preferences and needs.

Treatments should not just be safe but manageable over the long term. That often amounts to a limit of one or two doses a day, Einhorn said. Further, they should be as effective as possible so patients aren’t forced to monitor glucose too frequently.

Many patients don’t want to give themselves shots and look at insulin as “the end of the road,” so doctors may try to avoid insulin when possible, Bergenstal said. Others may need to lose weight, so doctors might choose drugs less likely to cause weight gain.

“Knowing your patient is really critical,” he said. “As much as we put algorithms out … if you match them to patients’ best preferences, you will get the best outcome.”

And monitoring is crucial — both of the patient and of the drugs on, and coming to, the market, as the troubles with Avandia so aptly highlighted.

“Even when a drug gets approved for sure, maybe 5,000 people have taken it, so now we have 1 million who will be using it,” Bergenstal said. “We have to have good surveillance and be willing to change our mind and modify things.”

Even after a drug is approved by the FDA, doctors and medical associations gather data to see how it affects patients before relying on it too heavily, he said. Sometimes the data are inconclusive, as with Avandia — even the FDA panel that waded through numerous studies could not decide if there was enough of a cardio risk to pull it from the market.

This is where physicians help decide the risks and benefits to their patients, Kaul said. When an FDA advisory committee meeting was held in 2007 to look at Avandia studies, physicians had already started curtailing the use of the medication, he said. The market share of thiazolidinediones that year was essentially split 50-50 between GlaxoSmithKline’s Avandia and its competitor, Takeda Chemical’s Actos. Avandia’s market share is about 10% now and “rapidly shrinking,” Kaul said.

“Physicians have already decided what to do with Avandia,” he said. “They use their clinical judgment and are obligated to protect patients from potentially harmful therapies.”

Thank you Tammy Worth/

Blood Sugar Management: Estimated Average Glucose

What Is Estimated Average Glucose?
Diabetes patients may be walking away from their medical appointments armed with new information to help them better improve and manage their diabetes. Like the familiar A1C test, the estimated average glucose, or eAG, is derived from glucose values taken over the course of three months.

The eAG, however, is not reported as a percentage but in the same values seen via daily self-monitoring – mg/dl or mmol/L. The formula for determining average glucose is 28.7xA1C-46.7 = eAG.

The following chart translates A1C percentages into eAG:

If your A1C is this:eAG (Estimated Average Glucose) is this:

% mg/dl mmol/l
10.0% 240 13.4
9.0% 212 11.8
8.0% 183 10.1
7.0% 154 8.6
6.0% 126 7

The new eAG term was introduced to help stem confusion after a new worldwide standardization of A1C analyses was set. The new values are 1.5 to 2 percentages points lower than the current standard. In addition, the new values were reported in millimoles per mole (mmol/L), whereas A1C results were always reported as percentages.

An international study was then conducted to look at the relationship between HbA1c and average glucose. The A1C-Derived Average Glucose Study revealed a close relationship between HbA1C and AG (average glucose). This relationship is the eAG, which applies to patients with both type 1 and type 2 diabetes. This new terminology now focuses on a single set of values for both daily glucose checks and long-term control.

SOURCE: American Diabetes Association. Estimated Average Glucose.

China Faces Diabetes Epidemic After Adopting Western Diet

China suffers from far more cases of diabetes than previously thought, placing its diabetes epidemic on the same scale as that of the United States, according to a study published in the New England Journal of Medicine.

“In the last 10 years, with the country’s economy expanding quickly and people’s standard of living improving, people’s lifestyles have changed,” said co-author Yang Wenying of the China-Japan Friendship Hospital in Beijing. “China’s economic development has gone from a situation of not being able to eat enough, of poverty, to having enough food and warm clothes, and doing much less exercise.”

Lifestyle changes such as increased urbanization and sedentism and “Western” diets high in fat and junk food have caused an increase in heart disease, diabetes, cancer and other “lifestyle diseases” across China. According to the new findings, there are 92 million diabetics in China, more than twice as many as the 43.2 million recently estimated by the International Diabetes Federation (IDF). Another 150 million are believed to be pre-diabetic.

This means that 10 percent of Chinese residents are diabetic, while 16 percent are at risk of developing the disease.

The new figures were calculated from a sample of more than 46,000 people over the age of 19, from 14 different provinces and municipalities across China. They launch China into first place as home to the most diabetics in the world, bumping India down to second place. The IDF estimates that 50.8 million Indians are diabetic.

Yet Anoop Misra of New Delhi-based Fortis Healthcare believes that the numbers in India are vastly underestimated as well.

“I feel that India’s diabetes burden too will be a lot more than estimated,” she said. “At present, while 50 million are known to be diabetic, 100 million are at the stage of pre-diabetes in India.”

In both China and India, most cases of diabetes remain undiagnosed and untreated.

Thank you David Gutierrez

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