Category: Diabetes 101

Researchers located in the United Kingdom say that levels of a hormone called B-type natriuretic peptide could have a role in reducing risk of Type 2 diabetes. The study was published online in the journal “PLoS Medicine.”

According to the research team, B-type natriuretic peptide, also called BNP, provides a variety of functions in the cardiovascular system: it mediates vasodilation, antifibrotic effects, and natriuresis. The researchers wrote that the hormone also has lipolytic activity and cross-sectional studies have indicated that BNP levels, or levels of the inactive fragment of its pro-hormone, N-terminal fragment of pro-BNP (NT-proBNP), are decreased in individuals who are obese or have Type 2 diabetes or insulin resistance.

The researchers conducted a prospective case-cohort study, using data from three case-control studies that involved patients who had been diagnosed with Type 2 diabetes. They used this data to determine if a connection existed between Type 2 diabetes and NT-proBNP in the bloodstream. The research team also genotyped the variant rs198389 within the BNP locus and used those results in a meta-analysis that used data from 11 case-control studies in all.

The multivariable analysis from the case-cohort study suggested that higher levels of NT-proBNP were correlated with decreased risk of Type 2 diabetes. For every increase of one standard deviation in blood levels of NT-proBNP, patients demonstrated a 21 percent reduction in risk of developing type 2 diabetes. The researchers adjusted for confounding factors, including age, sex, body-mass index, use of tobacco, hereditary history of Type 2 diabetes, hypertension, systolic blood pressure, and cholesterol levels (HDL, LDL and triglyceride).

The researchers stated that their estimates regarding the correlation between Type 2 diabetes and rs198389 were accurate.

“The association between rs198389 and type 2 diabetes observed in case-control studies (OR=0.94 per C allele; 95% CI, 0.91-0.97) was similar to that expected (OR=0.96; 95% CI, 0.93-0.98) based on the pooled estimate for the log-NT-proBNP level to type 2 diabetes association derived from a meta-analysis of our study and published data (HR=0.82 per SD; 95% CI, 0.74-0.9) and the difference in NT-proBNP levels (HR=0.22 per SD; 95% CI, 0.15-0.29) per C allele of rs198389,” wrote the team.

Additionally, there appeared to be no association between the rs198389 genotype and factors that may have confounded results, such as age, sex, and BMI. The researchers wrote that the findings demonstrate there may be a causal relationship between BNP and Type 2 diabetes, and the issue warrants further research. If a link is proven, it may open the door for therapeutics involving the manipulation of BNP activity to reduce risk of Type 2 diabetes. However, additional research will be needed before a definite causal link is established.

“The evidence for a potential causal link between the BNP hormone system and type 2 diabetes also promotes BNP as a potentially interesting target of preventive interventions. Influencing BNP activity by pharmaceutical interventions has been proven to be feasible in the context of CV medicine,” they wrote.

BNP is secreted by the ventricles of the heart as a response mechanism to excessive stretching of cardiomyocytes—the cells that make up heart muscle tissue. Secretion of BNP is related to several physiological processes, including the reduction of central venous pressure and systemic vascular resistance. Secretion of BNP also promotes natriuresis, the process by which the kidneys excrete sodium through urine. Natriuresis reduces the sodium content of the blood by expelling it through urine.

The American Diabetes Association recently released a position statement which stated that, in helping young people transition into more responsible roles for managing their own diabetes, parents should gradually transfer the responsibilities associated with the disease to their children.

However, the ADA also noted in its “Diabetes Care for Emerging Adults” position statement that most of the work in preparing young individuals for proper diabetes care in adulthood falls to health care professionals. Doctors should begin preparing young people with diabetes and their families for the transfer to an adult clinician at least a year before the switch occurs.

The ADA’s statement arrived through the ADA Transitions Working Group, a multidisciplinary group involving representatives from the American Association of Clinical Endocrinologists, Endocrine Society, Pediatric Endocrine Society, and the American Academy of Pediatrics. The panel of representatives reviewed issues that occur as a result of the transition from pediatric diabetes care to adult diabetes care, which affect both the patients and their health care professionals. The statement focused on individuals age 18-30 years old—an age group that the statement described as “emerging adults”—and covered both Type 1 and Type 2 diabetes. The statement was authored by Dr. Anne Peters of the University of Southern California in Los Angeles and Dr. Lori Laffel with Joslin Diabetes Center and Harvard University in Boston.

According to the statement, the transition from pediatric to adult care is a tumultuous one for diabetics; it’s described as a “high risk period” and “a perfect storm during which interruption of care is likely for multiple reasons.”

“This is a critical time when patients not only assume responsibility for their diabetes self-care and interactions with the health care system but when they become more independent,” wrote the authors. Individuals may be moving away from their parents’ homes at the time of the transition and the lack of supervision and increased independence puts them at risk for mismanaging their diabetes. The statement noted that tens of thousands of individuals in the United Sates are currently estimated to be moving from pediatric to adult diabetes care every year.

Other factors that may contribute to difficulties in managing diabetes include the loss of health insurance or inadequate coverage. There may also be a lack of professionals who are specifically trained to meet the needs of the age group. According to the statement, additional research and improved training would help health care professionals meet the medical and psychological needs of those transitioning.

The statement identified eight factors relevant to diabetes treatment that this age group faces, including poor glycemic control; higher risk of acute complications; use of alcohol, tobacco, and drugs; and the differences between adult and pediatric diabetes care. The authors noted that these factors, along with other factors that can cause gaps in diabetes treatment, can lead to increased risk of diabetes-related complications in both the short term (hypoglycemia) and long term (retinopathy and nephropathy). Young adults with diabetes also face a higher relative risk of death than those without diabetes.

The authors recommended that health care professionals providing pediatric diabetes care should offer information about medications, diabetes-related comorbidities, and the patient’s self-assessing abilities to the physicians who will be providing adult care for their patients. The preparations for the patient should be individualized and developmentally-appropriate, requiring the patient to take on responsibilities in glucose monitoring and appointment scheduling.

The statement concluded that, throughout the next decade, they expect the growth of “evidence-based strategies that support best practice for the growing numbers of young adults with type 1 and type 2 diabetes who will be making this important transition.”

A recent investigation found that U.S. adults who have been diagnosed with diabetes are about two times more likely to contract hepatitis B infections. The findings prompted a recommendation to the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices that individuals with diabetes should be vaccinated for hepatitis B.

According to Meredith L. Reilly, an epidemiologist with the CDC, inadequately cleaned blood glucose monitors are one of the major causes of hepatitis B infection among diabetics. Reilly presented the findings at a poster at the CDC Advisory Committee meeting.

Dr. Trudy V. Murphy is head of the vaccine unit of the Division of Viral Hepatitis at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention in Atlanta. Dr. Murphy made the suggestion of vaccination to the CDC, stating that “over the past several years, we’ve observed outbreaks of hepatitis B among patients with diabetes in places where they undergo assisted blood glucose monitoring, with more than one person using the monitor.” Out of 28 outbreaks of hepatitis B at long-term care facilities, 24 were traced back to equipment and practices involved in different aspects of blood glucose monitoring.

Dr. Murphy’s recommendations to the CDC Advisory Committee include hepatitis B vaccinations for patients with both Type 1 and Type 2 diabetes. The CDC will place more emphasis on transmission prevention methods such as avoiding needle or lancet sharing and more thorough cleaning of equipment. Dr. Murphy stated that vaccinations will work in concert with other methods as an “additional measure to ensure protection.”

Individuals with diabetes must take extra care to avoid exposure to blood since other blood-borne pathogens can threaten their health. Hepatitis B, in particular, poses a threat to diabetics since it is highly infectious in residual blood and can remain infectious on a surface for seven days. According to Dr. Murphy, a drop of blood small enough to be invisible could still contain enough hepatitis B virus to infect an individual who has diabetes. Additionally, the design of blood glucose monitors makes them difficult to clean thoroughly, and an especially thorough cleaning can damage the equipment.

After conducting investigations into the hepatitis B outbreaks, the CDC reviewed the cases of the disease reported in 2009 and 2010 at sites involved in the CDC’s Emerging Infections Program. The CDC reviewed data from 865 people who had contracted hepatitis B; 95 of those individuals also had diabetes. An analysis showed that individuals age 23-59 with diabetes were 2.1 times more likely to be infected with hepatitis B compared to those without diabetes. The analysis also adjusted for gender, age, ethnicity, and other risk factors for the disease. Individuals age 22 or younger with diabetes were 1.9 times more likely to contract hepatitis B, a statistically significant number, while those 60 or older were 50 percent more likely—which was not statistically significant, according to Ms. Reilly.

The hepatitis B (HBV) virus causes an inflammation of the liver and is spread through contact with body fluids of another individual who has a hepatitis B infection. The disease is commonly spread through needles such as those used for taking blood work or testing blood sugar, which makes it common among individuals with diabetes and health care professionals who perform such tests.

Both Dr. Murphy and Meredith L. Reilly had no disclosures.

New research suggests that drinking less than a couple of glasses of water every day increases an individual’s risk of having elevated blood sugar levels in an unhealthy range.

The study found that adults who drank half a liter of water per day (about two glasses) were more likely to demonstrate blood sugar levels in the pre-diabetes range than those who drank more water. Pre-diabetes is a condition in which blood sugar levels are elevated but not high enough to be characterized as being related to diabetes.

The study does not prove, however, that drinking water directly lowers the risk of developing diabetes. According to Lise Bankir of the French research organization INSERM, the findings demonstrated a correlation between water intake and blood glucose levels but did not show a cause and effect relationship between the two. Bankir did comment that a causal relationship is possible.

“There are good arguments to suggest that there could be a real cause-and-effect relationship in the association we have found,” she said. “But this is not a proof.”

The research team stated that vasopressin, sometimes called diuretic hormone, is the link that may tie reduced water consumption to increased blood sugar levels. The hormone regulates water retention levels, causing the kidneys to retain water when we’re dehydrated. The research suggests that elevated vasopressin levels could also result in elevated blood glucose levels.

According to Bankir, vasopressin receptors can be found in the liver, which produces sugar. The study demonstrated that vasopressin injections in healthy individuals caused blood sugar levels to spike temporarily.

Researchers studied 3,615 French adults, age 30 to 65, who had normal blood sugar levels at baseline—the beginning of the study. Around 19 percent of the study participants stated that they drank less than half a liter a day; the rest of the participants drank a liter or more.

Researchers followed up with the participants for nine years, finding that 565 of the participants developed elevated blood glucose levels while 202 developed Type 2 diabetes. The research team found that the individuals who drank at least a half a liter of water per day were 28 percent less likely to develop elevated blood glucose levels than those who drank less than a half a liter of water every day.

Still, the findings did not demonstrate a definite statistical link between consumption of water and the risk of developing diabetes. Bankir stated that the sample size was “too small to get a significant results” and a larger cohort would be required before a causal relationship could be proven.

Individuals who drink less water are more likely to drink high-sugar drinks such as soda and juice in replacement. Such beverages are often the culprit for high blood glucose levels. However, Bankir’s team adjusted for several factors that could influence results, including the consumption of sugary drinks, exercise levels, and body weight. Even after the adjustments, individuals who drank less water still had higher blood sugar.

One explanation is that individuals who drink more water are more likely to engage in other healthy habits. “Healthier behaviors correlating with higher water drinking could account for the observed association,” said the research team.

Even though the study was unable to prove a direct relationship between drinking more water and lowering one’s blood sugar, Bankir suggested that increasing water intake is always a good idea. “In Western countries, the consumption of sugar is surely too high and contributes to obesity,” she said. “Drinking less of them and more pure water can only be good in my view.”

A new kind of “ultrafast” insulin developed by Halozyme Therapeutics, Inc., has been shown in two clinical trials to work just as well as other insulin replacements in patients with both Type 1 and Type 2 diabetes.

According to Halozyme, the new insulin—called PH20—was as effective as Humalog, an Eli Lilly and Company product, at controlling blood glucose levels. Halozyme stated that PH20 was actually more effective at controlling postprandial glucose levels, or blood sugar levels after a meal. Hypoglycemia rates in PH20 users were similar to those of Humalog users. The two studies were Phase 2, mid-stage clinical trials, each using data from about 110 participants.

One study was conducted on patients with Type 1 diabetes while the other studied participants with Type 2 diabetes. The studies compared effects of PH20 with those of Humalog. PH20 is an insulin analog—a type of insulin that is not produced biologically but synthetically, yet functions the same in the human body as the insulin produced by the beta cells of the pancreas.

PH20 is derived from rHuPH20 (Lispro-PH20 or Aspart-PH20), a recombinant human hyaluronidase enzyme, which “temporarily degrades hyaluronan, a structural protein in the interstitial space,” according to Halozyme. The enzyme allows the delivery of therapeutic medications through subcutaneous injections rather than intravenously. According to Halozyme, subcutaneous injection of pharmaceuticals provides a variety of benefits for patients, including increased convenience and efficiency, extended product life cycle, and decreased costs.

The patients using PH20 insulin demonstrated more than a 50 percent increase in the number of patients who were able to consistently achieve post-mealtime blood glucose targets that are established by the American Association of Clinical Endocrinologists. Patients using PH20 insulin did not demonstrate a significant increase in hypoglycemia or hypoglycemic events; the events that did occur were typically mild and were similar to those experienced by patients using Humalog.

Halozyme stated that it will be pursuing methods of making PH20 available around the world, which means that the company may form a partnership with a larger pharmaceutical manufacturer. Halozyme will present the complete findings of the two studies at a medical conference in 2012. The news boosted Halozyme’s market presence, with shares 49 cents to $8.21 in afternoon trading, a 6.3 percent increase.

Halozyme’s shares also jumped recently by 18.6 percent when the company announced successful clinical trials of a breast cancer drug that Halozyme is developing with Swiss pharmaceutical company Roche. The drug is a variation of Herceptin, which is normally administered with an IV; Halozyme and Roche are working on an injectable version, which was shown in the trial to be just as effective as the IV version. The injectable version will offer more convenience to patients as it can be administered in about five minutes, while the IV version takes about 30 minutes.

According to Halozyme, the company is “dedicated to the development and commercialization of products targeting the area outside the cell known as the extracellular matrix,” a system that provides structural support for tissues and is responsible for directing some important biological activities in humans, such as cell migration, signaling, and survival. The importance of the matrix in biochemical processes allows Halozyme to target the system for treating illnesses. The company was founded in 1998 in San Diego and primarily targets the endocrinology, oncology, dermatology, and drug delivery markets.

A recent study found that phacoemulsification, a process by which the internal lens of the eye is emulsified as a treatment for cataracts, does not affect intraocular pressure (IOP) in individuals who have diabetes. The findings were presented in a poster session at the American Academy of Opthalmology 2011 Annual Meeting, and they contradict previous research on the subject of phacoemulsification’s effects on intraocular pressure.

The poster session detailed the findings of a retrospective chart review which studied the effects of phacoemulsification on patients with diabetes as well as those who had not been diagnosed with the disease. Elevated intraocular pressure in diabetics is a significant issue for doctors since it can precede future loss of vision.

The study was presented by Lisa Park, M.D., and was conducted by a research team at the New York University Langone Medical Center in New York City. Dr. Park’s team analyzed intraocular pressure data from 146 diabetic and non-diabetic patients who underwent cataract phacoemulsification. Measurements of IOP were taken before the procedure, then 1 day, 1 week, and 1 month after the procedure. Patients who did not have diabetes demonstrated significantly lower IOP at the 1 week and 1 month readings after the procedure (1.7mm Hg and 1.8mm Hg, respectively). However, IOP was not significantly different in patients with diabetes at the 1 week or 1 month marks (0.4mm Hg and 0.1mm Hg, respectively). There was a significant difference between diabetics and non-diabetics at the 1 week and 1 month marks (12.7 versus 15.mm Hg at 1 week; 12.6 versus 15.5mm Hg at 1 month).

According to the researchers, the findings demonstrate that diabetics do not benefit from the lowering of intraocular pressure as a result of the phacoemulsification procedure that non-diabetics do.

“Our results show that postoperative IOP is significantly different between diabetic and nondiabetic patients, and that the pressure-lowering effect [seen in previous studies] is not demonstrable in the diabetic population,” they wrote.

According to Dr. Park, the findings may demonstrate that the effects of phacoemulsification on intraocular pressure have simply not received much research.

“Not a lot has been known about postoperative IOP in diabetics. Information has been more anecdotal. A number of factors can be involved in IOP. Our study is different, in that we focused exclusively on IOP and diabetes,” said Dr. Park.

If further research proves demonstrably that cataract surgery does not lower intraocular pressure in diabetics, it could point to difficulties related to vision that extend beyond cataracts. Dr. Park stated that the growing number of individuals with diabetes warrants additional research into methods of reducing intraocular pressure.

“With the population aging and diabetes growing to epidemic proportions, we are going to need to focus more on this segment of the population. Management to reduce IOP after surgery along with management of inflammatory reactions could be done,” she said.

Patients with diabetes are advised to schedule regular visits with an ophthalmologist, as the high blood glucose levels associated with diabetes can cause swelling in the eyes that affect vision. Cataracts, or clouding of the eye, are especially common in individuals with diabetes: they form earlier in life for diabetics and they progress more quickly, causing impaired vision. The lens is unable to focus light and vision is reduced. Common treatments for cataracts include surgery and glasses or contact lens to correct vision.

A new study conducted in Canada suggests that women who have been recently diagnosed with diabetes are more likely to also be diagnosed with breast cancer.

Research has previously linked breast cancer and diabetes. However, this new study also suggests that doctors may be discovering more cases of breast cancer in diabetics partly because they’re checking more, and not just because diabetes increases a woman’s risk of developing breast cancer. The findings of the study were published in the journal “Diabetes Care.”

Jeffrey Johnson of the University of Alberta in Edmonton was one of the researchers involved with the study. “The relationship that we see (between diabetes and cancer), we wondered if it was something about the fact that people with diabetes go to the doctor’s office more often,” said Johnson.

“When a new diagnosis of diabetes is made, people undergo a lot of tests and general health exams,” which often includes breast cancer screenings through mammograms.

Scientists have previously demonstrated in research that individuals who have been diagnosed with diabetes are also at an increased risk of several types of cancer, from colorectal and pancreatic cancer to breast cancer. Some hypothesized that certain risk factors, such as a sedentary lifestyle, poor diet, and smoking could be risk factors for both diabetes and cancer—explaining why the disease seem to accompany each other so often.

The metabolic changes that occur in diabetics, including blood sugar and insulin levels, could also provide a more favorable environment for the growth of tumors, said Johnson.

The study analyzed data from approximately 170,000 women living in British Columba, half of which had been recently diagnosed with Type 2 diabetes; the other half did not have the disease. The researchers tracked study participants for four to five years, and over that time period, about 2,400 of the women were diagnosed with breast cancer.

The chances of getting breast cancer were similar across the diabetes and non-diabetes groups. However, a deeper analysis revealed that age and time of diabetes diagnosis seemed to have an effect on breast cancer rates. Women who were older and post-menopausal with diabetes had a slightly higher chance of being diagnosed with breast cancer than women without diabetes.

Additionally, among women 55 and older, those who had been diagnosed with diabetes within the last three months were about 30 percent more likely to also be diagnosed with breast cancer than women without diabetes. Still, doctors couldn’t determine whether those results were due to random chance.

A few months after the researchers began following the participants—around the time when checkups and appointments would slow down following a diagnosis of diabetes—breast cancer diagnosis rates were the same among women with and without diabetes.

According to Johnson, the results don’t eliminate explanations such as common risk factors for the two diseases or increased chances of cancer due to hormonal changes.

“I think there are so many things going on in the relationship that this is maybe only one part of it,” said Johnson. “We’re really early on in understanding this relationship.”

According to Dr. Christos Mantzoros, an expert on with Harvard Medical School, the findings of the study might mean that the increased diagnoses of breast cancer in women with diabetes was due to the increased frequency of check-ups following diabetes. However, it could also mean that the risk factors common to both diseases could cause them to develop close to each other.

“Women with diabetes need to be more vigilant and their doctors need to be screening them for malignancies associated with diabetes including, but not limited to breast cancer,” said Mantzoros.

The world will soon face a shortage of a quick-acting insulin product developed by Sanofi due to a manufacturing issue at a plant in Frankfurt.

The product in question is the Apidra solostar pen, which is typically used alongside a meal by diabetics. The pen provides fast-acting insulin, which diabetics need so that they don’t experience dangerously high levels of blood glucose after eating a meal.

Sanofi wrote a letter to doctors about the shortage, and the letter was also posted on the Food and Drug Administration’s website. According to Sanofi, the manufacturing plant, located in Frankfurt, Germany, experienced a “technical incident” that affected production of Apidra pens. The incident occurred on July 11; Sanofi says that it is addressing the problem and expects that full production of Apidra pens will resume by the first quarter of 2012.

The letter noted that Apidra pens may become unavailable to U.S. residents later this month. Physicians can switch patients with diabetes to Apidra syringes and vials to replace the usage of the pens and will not have to make any adjustments to dosage.

Sanofi stated in its letter that it will offer free vials to patients with insurance who have co-pays through April. Information helpful to patients can be found on the official website of the Apidra pen, www.apidra.com.

Current users of Apidra pens need not worry, according to Sanofi: the manufacturing problem did not affect the pens that are currently available on the market. Lantus, a long-lasting insulin manufactured by Sanofi, is also not affected by the manufacturing issue.

Apidra is insulin glulisine, which is an insulin analogue—a type of synthetic insulin that does not occur naturally in any organisms but still performs all the functions of natural human insulin. The Apidra solostar pen delivers insulin glulisine through a subcutaneous injection; the insulin takes effect in humans faster than natural insulin does, and dosing is usually given in the 15 minutes before the individual eats a meal. Also known as a “mealtime” insulin, Apidra begins working about five minutes after the injection and continues to lower blood sugar levels for about two to four hours afterwards, as opposed to other types of insulin, which can be effective for up to 24 hours. The most common side effect of Apidra usage is hypoglycemia, or low blood sugar.

Sanofi may face increased competition in the United States due to the shortage of Apidra pens. Other fast-acting insulin products are available which could pick up the slack for the absence of Apidra pens. Patients with Type 1 diabetes require regular injections of insulin, often several per day, to ensure that blood glucose levels remain under control. Some Type 2 diabetics also require insulin injections.

Both variants of diabetes affect approximately 26 million Americans today. The disease is characterized by elevated blood glucose levels, which can cause tissue and nerve damage over time. Blood sugar levels remain elevated since the body either does not produce enough insulin to remove it from the bloodstream or it becomes resistant to the insulin that is produced. Type 1 diabetes occurs because the immune system attacks the beta cells of the pancreas, which are responsible for producing insulin. Type 1 diabetes is often diagnosed in children while Type 2 diabetes is more often diagnosed in adults and often associated with obesity, poor diet, lack of exercise and other unhealthy lifestyle choices.

Of all the factors that affect your health, your neighborhood may be the last thing you’d consider. But a recent study has discovered that the average economic status of a neighborhood’s residents are tied to their risk of obesity and diabetes. The researchers who discovered the association describe it as “modest but potentially important.”

“The effects we see in the study are comparable to what you see from targeted lifestyle interventions or with providing people with medications to prevent the onset of diabetes,” said Jens Ludwig of the University of Chicago, who was lead author on the study. Ludwig commented that the findings of the study demonstrate that an individual’s environment has important implications for his or her health.

Published in the October 20 edition of the New England Journal of Medicine, the findings do not actually show a positive causal relationship between residence and health factors. The study was also limited in that it only measured height, weight, and diabetes status of the participants at the end of the study, not at the beginning.

The study analyzed data from around 4,500 mothers who lived in public housing with high poverty levels, where at least 40 percent of the neighborhood residents lived below the poverty level.

The U.S. government conducted the Moving to Opportunity program from 1994 through 1998; the program gave housing vouchers for neighborhoods with lower than a 10 percent poverty level to 1,788 individuals. Vouchers that were good for any location were given to 1,312 individuals, and all voucher recipients received counseling related to moving. Another 1,398 individuals did not receive any vouchers or counseling.

Over ten years later, the government followed up with the women involved with the study, measuring their height and weight as well as conducting a blood test to determine their blood glucose levels over the three months prior to the follow-up.

For the women classified as obese—those who had a body mass index of 30 or higher—their location of residence made no difference.

Women with more severe obesity—a BMI of 35 or higher—did demonstrate differences according to their place of residence. About 31 percent of the women who received vouchers for low-poverty neighborhoods had a BMI of 35 or higher compared to 36 percent of the women who did not receive vouchers.

Morbid obesity (BMI of 40 or higher) was also more likely in women who did not receive vouchers, at 18 percent, compared to women who did receive vouchers, at 14 percent.

Diabetes was higher in women who did not receive vouchers—20 percent, compared to 16 percent among women who did receive vouchers.

The findings are complicated since only about half of the women who received vouchers for low-poverty areas actually used them. Additionally, most of the women involved in the study moved to less-impoverished neighborhoods regardless of their voucher status.

Despite these limitations, Ludwig believes that the findings demonstrate a real trend. The Department of Housing and Urban Development (HUD) considered 57 additional variables in each of the individuals in the study, finding that individuals in the three groups were very similar at the beginning of the study. It stands to reason, according to Ludwig, that the three groups would be similar in obesity and diabetes status as well.

Ludwig stated that a variety of factors associated with better neighborhoods could be responsible for improved health, including better sidewalks for exercise, better access to supermarkets with healthy food, and less everyday stress.

Amylin Pharamceuticals, Inc. recently won a significant victory as its Type 2 diabetes medication Byetta won expanded approval for use in conjunction with the best-selling insulin throughout the world.

The Food and Drug Administration first approved Byetta, an injectable medication, in 2005. Developed by Amylin Pharmaceuticals and Eli Lilly & Co., Byetta is now cleared for use with insulin glargine, marketed as Lantus by the French pharmaceutical manufacturer Sanofi. Insulin glargine is a long-lasting type of insulin that releases slowly into the bloodstream, similar to insulin release by pancreatic beta cells in individuals without diabetes. One dose of insulin glargine lasts 18 to 26 hours, allowing for a once-daily dose in most diabetics.

Byetta (exenatide) is injected under the skin of the arm, thigh, or abdomen, 60 minutes before either the first or last meal of the day. The drug works by stimulating pancreas cells into ramping up insulin production when blood glucose levels are elevated; it has been approved both as a standalone medication along with diet and exercise and for use in conjunction with other diabetes medications. Byetta has a wide range of benefits for diabetes users. In addition to increasing insulin production, it also suppresses the release of glucagon by the pancreas, which prevents blood glucose levels from rising to dangerous levels; it slows gastric emptying, which slows down the introduction of glucose into the bloodstream after a meal; it reduces the fat content of the liver; and it reduces appetite, promoting weight loss over the long-term, especially in obese individuals, which helps mitigate the risk of complciations associated with Type 2 diabetes.

According to Vincent Mihalik, senior vice president of sales and marketing at Amylin, the FDA’s expanded approval of Byetta will drastically increase its usage, making it “available to millions of insulin-using Type 2 diabetes patients in the United States.”

Of the 26 million people over the age of 20 in the United States with diabetes, about 90 percent are afflicted with Type 2 diabetes, says the American Diabetes Association. Individuals with Type 2 diabetes either lack insulin or their cells don’t respond to insulin, which is normally responsible for lowering blood glucose levels, especially after a meal. The lack of insulin naturally produced by the beta cells of the pancreas means that most Type 2 diabetics need at least one shot of insulin every day.

According to John Buse, director at the Diabetes Care Center and head of the Division of Endocrinology at the University of North Carolina’s School of Medicine, the expanded approval of Byetta will offer new treatment possibilities for patients who are unable to control their diabetes. “This expanded use for Byetta is important for clinical care, in that it provides a new option for the many patients with Type 2 diabetes who are not achieving treatment goals,” said Buse.

Amylin Pharmaceuticals released a statement in May, noting that the company was alleging anti-competitive activity and a breach of a strategic alliance agreement against Eli Lilly & Co. Though Byetta was developed jointly by Amylin and Lilly, Amylin is attempting to prevent Lilly from using the same sales force in promoting Lilly’s other product—linagliptin, marketed as Tradjenta. Lilly is developing linagliptin, as well as a longer-lasting version called Bydureon, in conjunction Boehringer Ingelheim GmbH, a German pharmaceuticals company that is one of the top 20 in the world, with over 42,000 employees globally. The FDA approved Linagliptin for sale in the United States in May.