Category: Diabetes 101

A research team at the John G. Rangos Sr. Research Center at Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine has discovered a molecular pathway responsible for regulating management of insulin in the liver as well as the production of new glucose. The team published their findings in the American Diabetes Association’s journal “Diabetes.”

The liver typically stores excess blood glucose as glycogen and releases that energy during periods of fasting, such as sleeping, to ensure that blood sugar levels remain within the proper range. According to H. Henry Dong, Ph.D., head of the study and associate professor of Pediatrics at the Pitt School of Medicine, in individuals with diabetes the liver continues producing glucose even when the patient is supplemented with insulin treatments.

“Scientists have been trying to find the factors that contribute to this liver overproduction of glucose for decades,” says Dr. Dong. “If we can control that pathway, we should be able to help reduce the abnormally high blood sugar levels seen in patients with diabetes.”

Dr. Dong’s research team has been investigating the Forkhead box family of proteins, also known as FOX. This particular study was focused on the protein FOX06. When mice took too much FOX06, they developed symptoms of metabolic syndrome, a series of complications such as elevated blood glucose, increased insulin levels, and impaired glucose tolerance that typically precedes diabetes. Similarly, mice who produced lower levels of FOX06 displayed very low levels of blood glucose when fasting.

“In a normal animal, a glucose injection causes blood sugar level to rise initially and then it goes back to normal range within two hours,” said Dr. Dong. “In animals that made too much FOX06, blood sugar after a glucose injection doesn’t normalize within two hours. They have lost the ability to regulate the level while the liver keeps making unneeded glucose.” The protein appeared to affect the animals’ ability to respond to elevated blood glucose levels properly by using insulin to shuttle it away from the bloodstream.

The research team also conducted tests on human liver cells that confirmed the effects of FOX06 on glucose production.

“These findings strongly suggest that FOX06 has potential to be developed as a therapeutic target,” said Dr. Dong. “If we can inhibit its activity, we can possibly slow the liver’s production of glucose in patients with diabetes and better control blood sugar levels.”

The study received funding from the National Institutes of Health. Co-authors on the study included lead author Dae Hyun Kim, Ph.D., as well as researchers from the Pedatrics and Pathology departments of the University of Pittsburgh.

The University of Pittsburgh is one of the leading academic centers for biomedical research in the U.S., consistently placing in the top 10 recipients for funding from the National Institutes of Health since 1997. The school system’s progress in research and development is primarily headed by the School of Medicine and its affiliates.

The Forkhead box (FOX) family of proteins is a series of transcription factors that play a role in the expression of certain genes related to cell growth, differentiation, longevity, and proliferation. Also known as the winged helix, the family is named after the forkhead box, a sequence of amino acids that form a motif which binds to genetic material (DNA).

A large United States-backed study recently discovered that lowering blood glucose levels in older individuals with diabetes was helpful in preserving brain volume in the patients but did not help in mitigating the effects of memory loss. The findings were published in the journal “Lancet Neurology.”

The ACCORD study has previously shown that aggressive treatment of diabetics in regulating blood sugar levels to be as close to normal as possible does not produce significant positive benefits. The study was stopped in 2008 when it was discovered that patients who received intensive blood glucose-regulating treatment were at a higher risk of death than were patients who received standard treatment.

Researchers recently shifted focus to study the effects on memory of aggressive diabetes management in 3,000 patients age 55 to 80 who had high blood glucose levels and were at high risk of heart disease.

Individuals over 70 with Type 2 diabetes are twice as likely to develop memory problems as those without the disease. Physicians hypothesized that increased blood sugar levels were the culprit, and reducing blood glucose to a normal level would mitigate the chances of memory loss in older Type 2 diabetics.

“We know that people with type 2 diabetes have a much higher risk of dementia and memory loss than people without diabetes,” said Dr. Jeff Williamson, of the Wake Forest Baptist Medical Center in North Carolina. Williamson also participated in the study on diabetes and memory loss. “What we didn’t know was, if you intensively control blood sugar levels in people who have had a history of trouble controlling them, does the added cost and effort to control blood sugar result in a slowed rate of memory loss?”

The group of 3,000 was split into two groups according to the type of treatment they received. One group received typical treatment for diabetics, intended to lower hemoglobin A1c levels from over 7.5% to between 7% and 7.9%. The other group received a more aggressive treatment which sought to reduce hemoglobin A1c levels to that of non-diabetics, about 6%.

Forty months after the beginning of the study, the patients who received aggressive treatment showed significantly more brain volume; however, they did not demonstrate any improvements in memory.

According to Dr. Williamson, it’s unclear whether the increase in brain volume will provide some benefits to the patients later on in their lives. However, since the intensive treatment is associated with increased risk of death and heart disease, the more aggressive treatment is not recommended.

Dr. Williamson says that instead of focusing on reducing hemoglobin A1c levels drastically, diabetics should focus on diet, exercise, and meeting their typical blood sugar requirements rather than spending extra time and energy to reach the hemoglobin A1c levels of non-diabetics.

He also commented that the results demonstrate that individuals who are at risk for diabetes should take steps to improve their health, since medication will not always provide the answer. “For those folks who are gaining weight and living a sedentary lifestyle, this is a warning that medicine is not going to rescue you,” he said.

The majority of the 366 million people worldwide with diabetes have Type 2 diabetes, sometimes called adult onset diabetes. Caused by poor diet, lack of exercise, and linked to obesity, diabetes requires individuals to manage blood sugar levels and can lead to a variety of complications, from loss of vision to nerve damage and heart disease.

Diabetics looking to network with other patients online have a variety of options, including the availability of a doctor to answer questions, who reviews the material posted on the website, and which companies are allowed advertising space on the website.

A recent study of 15 social networking sites for diabetics discovered that the sites use a variety of approaches in terms of funding and the participation of site administrators and doctors in the discussion. The study was reported in the journal “Archives of Internal Medicine.”

“The most interesting thing is that there is so much variability between sites,” said Dr. William Shrank, with Brigham and Women’s Hospital in Boston. The study was headed by Dr. Shrank. “Patients really need to know what their options are when picking sites where they’re going to participate.”

The sites involved in the study allow diabetes patients to communicate with other patients, such as posting questions and responses and interacting on message boards. The sites ranged in size from 3,000 to more than 300,000 members.

While most of the sites do not have doctors available to answer questions or offer feedback, website administrators usually monitor message boards to ensure that the information presented is accurate.

Of the 15 sites studied in the investigation, twelve run advertisements from companies that manufacture diabetes medications, devices such as insulin pumps, or other products. Most of the sites are funded by those advertisements, whether partially or fully. Some sites, such as www.tudiabetes.org and www.diabetes.org (run by the American Diabetes Association), rely on volunteer donations or support from advocacy and research foundations.

David Edelman, the co-founder of Diabetes Daily (www.diabetesdaily.com), says that members on his site are only required to give minimal identifying information so that they do not feel their privacy is at risk. The site boasts about 65,000 registered members.

Both site members and forum moderators are responsible for ensuring that advertisements such as product pitches are removed from the message boards. Additionally, treatments that have not yet received approval cannot be mentioned by name anywhere on the website. Edelman says that the advertisements that do run on the website are only for “legitimate” products. He also noted that receiving sponsorship from a particular company or organization would not make for an “ideal model.” The site receives funding from a variety of sources, such as drug manufacturers and non-profit organizations.

Advertisements are the only commercial interests that Edelman allows on the site. “We have these rules and our values: you can’t give medical advice, you can’t have financial self-interest, you can’t promote your book. We want to try to get commercial influence out of the community,” said Edelman.

Dr. Shrank noted that backing by pharmaceutical companies “may be great,” but he noted that product promotion has been a concern in the past.

Shrank hopes that the research will show patients and doctors that there is a wide range of social networking options available to diabetics and help them choose sites to participate in by displaying the value of such sites. However, he stressed that the study’s intent was not to recommend any particular site over another. The perfect site for each patient will depend on what he or she wants from the experience, says Shrank. “Some patients may feel comfortable in a setting where there is no health professional oversight. Some patients may really want a health professional to answer questions.”

A study published in the September 26 issue of the journal “Archives of Internal Medicine” has demonstrated that diabetics are healthier when they visit their doctors frequently. The patients involved with the study who saw their primary care physicians once every 1 to 2 weeks had a better chance of achieving their clinical goals than patients who saw their doctors less frequently.

Despite the negative implications of elevated levels of LDL cholesterol, blood pressure, and hemoglobin A1c, most diabetics do not meet their target levels for those factors, which are known to be associated with various complications resulting from diabetes. Hemoglobin A1a (or HbA1c) is a test of a diabetic individual’s blood sugar level over an extended period of time — usually six to eight weeks. Normal hemoglobin A1c levels in non-diabetics are between 4 and 6 percent; for most diabetics, the target is 7%.

While there are no established guidelines for how often diabetics should visit their physicians, it is believed that those who interact more frequently with their doctors are quicker to gain control of hemoglobin levels, blood pressure, and LDL cholesterol.

The retrospective cohort study was headed by Fritha Morrisson MPH, with the Division of Endocrinology at Brigham and Women’s Hospital in Boston, Massachusetts. Morrisson’s research team analyzed data 2000 and 2009 for 26,496 patients who had been diagnosed with diabetes. All of the patients had elevated blood pressure, LDL cholesterol, and/or hemoglobin A1c levels; researchers looked for a correlation between frequency of the patients’ visits to their health care providers with the period of time that it took to attain proper control of the three factors.

The patients were divided into groups according to the frequency of visits to their physicians. Patients who were not taking insulin who visited their doctors every 1 to 2 weeks displayed a median time of 4.4 months to attain hemoglobin A1c levels of less than 7%; patients not taking insulin who saw their physicians once every 3 to 6 months showed a median time of 24.9 months to achieve control of those factors. In patients taking insulin, the difference was 10.1 months for the patients who saw their physicians more frequently compared to 52.8 months for patients who recorded less frequent doctor visits.

A multivariate analysis showed that for every doubling of the time between visits with the physician, median time to reaching the target hemoglobin A1c levels increased: patients not taking insulin displayed a 35% increase while patients taking insulin displayed a 17% increase. Blood pressure and LDL cholesterol also showed similar increases as the length of time between doctor visits grew larger.

According to Allan H. Goroll, M.D., MACP, with the Massachusetts General Hospital and Harvard Medical School, the study did have limitations. The retrospective nature of the study was not optimal; a randomized, prospective study would have provided more accurate results. Since the study is retrospective, according to Dr. Goroll, there is no information available about the nature of the doctor visits or the events that triggered changes in patient behavior.

“Understanding how best to deliver… care and change patient behavior, especially in primary care settings, is going to be as important as knowing what care to prescribe,” says Dr. Goroll.

The study was sponsored with grants from the Diabetes Action Research and Education Foundation, the Agency for Healthcare Research and Quality, and the National Library of Medicine. The study’s authors did not disclose any financial interests.

It may come as a surprise to many that diabetes can affect both humans and animals. Treatment for diabetes in humans is much easier because they’re usually willing to take steps to mitigate the effects of the disease, but it’s impossible to communicate the risks of diabetes to a pet. Any treatment plan for diabetes must be based on accommodating fluctuations in blood sugar; however, such fluctuations can be difficult to detect in pets.

Nadja Affenzeller and her colleagues at the University of Veterinary Medicine in Vienna may have found a solution to the problem. Affenzeller and her team have shown that a commercially-available blood glucose monitoring system can be utilized with dogs at any time, even when they’re outside of a clinic. The information provided by the glucose monitoring can help veterinarians in deciding on the dog’s treatment.

Diabetes, when it goes unmanaged, can lead to a significantly impaired life for both humans and pets. After an individual develops diabetes, care must be taken to maintain insulin levels near those of a non-diabetic. Recent advances in diabetes treatment have led to novel insulin therapies but such medications often require near-constant monitoring of blood glucose levels. Such information can be recorded while the patient is in the clinic but a variety of variables, such as stress, the time of the last meal, and exercise may affect the results. Therefore, it’s must more effective to obtain data on insulin levels while the individual is living his or her normal daily life.

Mennarini Diagnostics has developed a system called GlucoDay for continuous blood sugar monitoring in human diabetics. The system measures a wide range of glucose concentrations, which means that it could also be used in animals. Affenzeller and her team tested the GlucoDay system in ten diabetic dogs, all of which were believed to be receiving appropriate treatment with insulin. The test results were mostly positive, with the system being well-tolerated and working under the test conditions, aside from the loss of one apparatus in a fight and the breakdown of two of the systems before the end of the test.

The researchers were surprised by the results of the test: according to the GlucoDay monitoring, none of the dogs were receiving optimum treatment for diabetes. Using the data, scientists were able to make recommendations for more appropriate treatment, such as increasing dosage of insulin or altering diets.

Affenzeller commented that although the test showed that the dogs were not receiving proper care, the findings are not a sign of poor treatment by the doctors but rather an indication of the difficulty in accurately measuring glucose levels in animals such as dogs. “The information on the dogs’ glucose levels was easy to interpret and enabled us to improve the treatment in every single case,” said Affenzeller. “This doesn’t mean that the vets hadn’t done their work properly but shows how difficult it is to determine appropriate treatment without detailed information of this kind.” The constant monitoring of glucose levels that the GlucoDay system provides could be a catalyst for providing diabetes treatment for dogs that is just as effective as what humans receive.

The research paper, authored by Affenzeller along with Johann G. Thalhammer and Michael Wilmann, is titled “Home-based subcutaneous continuous glucose monitoring in ten diabetic dogs – a case series study” and is published in the journal “The Veterinary Record.”

Scientists in Australia have revealed that they could be on the verge of an exciting development in reversing Type 2 diabetes. The researchers’ discovery involves a specific gene and its disruption of insulin production in the pancreas in response to high-fat diets. The results of the study were published in the journal “Diabetes.”

Over 700,000 Australians have been diagnosed with Type 2 diabetes. There is currently no cure for the disease; caused by a variety of hereditary and environmental factors, including lack of exercise, poor diet, and obesity, Type 2 diabetes most commonly affects older individuals. The disease impairs the ability of the beta cells in the pancreas to produce insulin, which removes sugar from the blood stream and transports it to cells to be used as energy.

In those who follow a healthy diet and exercise regularly, the gene being studied by the Australian researchers — known as ld1 — generally does not activate, and so insulin production is not impaired. However, according to the researchers, a high-fat diet activates the gene and disrupts insulin production in the beta cells of the pancreas. Conducting their research at the Diabetes and Obesity Research Program at the Garvan Institute of Medical Research in Sydney, Australia, the research team based its findings on experiments conducted with mice and cell cultures.

Next on the research team’s agenda is to test whether medications might be developed to prevent the ld1 gene from activating and disrupting insulin production. Dr. Ross Laybutt with the Garvan Institute described how medications that target the gene could be used to reverse Type 2 diabetes. “The drugs could help the beta cells continue to produce insulin and protect them from the effects of a high-fat diet,” said Dr. Laybutt. “So even when you were having this high-fat diet your beta cells would be protected against the normal deterioration that occurs. That’s the potential. You wouldn’t have diabetes anymore because it only occurs when the beta cells fail to secrete enough insulin.”

The research team found that high-fat diets caused the ld1 gene to activate in the lab mice, which triggered the onset of Type 2 diabetes. However, when the mice were fed the same high-fat diets but the researchers blocked their ld1 genes, the mice did not develop diabetes. Additional research showed that pancreatic tissue from patients with diabetes contains increase levels of ld1; the gene is also known to promote the growth of cancerous cells.

Although the genetic relationships that cause diabetes are complex, Dr. Laybutt commented that ld1 seems to be the gene that begins the onset of diabetes by controlling other genes. “This gene is a master regulator of the other genes that make the beta cells work properly… When ld1 switches on it directly affects other genes which confer the ability of the beta cells to secrete insulin. Fat in the diet also switches on the gene as well as high glucose and stress too,” he said.

Dr. Laybutt cautioned that it will likely be years before a medication could be developed based on the findings. “It would be a five to 10 year process. Establishing the clinical benefits of a drug and the safety of drugs takes a lot of time. It would be in that sort of time frame before there would be a marketable drug for Type 2 diabetes to target this gene.”

A study released Monday suggests that children who have been diagnosed with diabetes are at increased risk of developing asthma. In addition, blood glucose regulation seems to be more difficult for children who have both asthma and diabetes. The study was published in the journal “Pediatrics.”

The study’s researchers analyzed data from 2,000 children with diabetes, aged 3 to 21.  Eleven percent of them also had asthma; the rate of asthma among non-diabetic children and young adults is around 9 percent. The reason for the difference in asthma rates was not immediately clear, according to the researchers.

The children with Type 2 diabetes were also shown to be more likely to have asthma than those with Type 1 diabetes. Sixteen percent of the children with Type 2 diabetes had asthma compared to 10 percent of the children with Type 1 diabetes.

Type 1 diabetes occurs more often in children. It results from irregular function of the autoimmune system, which destroys the pancreatic beta cells responsible for producing insulin, the hormone that helps move glucose from the blood and into the body’s cells so that it can be used for energy. Their lack of insulin, known as insulin deficiency, means that Type 1 diabetics have to take injections of insulin or use an insulin pump to deliver the hormone and ensure that their blood sugar levels do not rise too high.

The children and young adults involved with the study who had both Type 1 diabetes and asthma were more likely to demonstrate poor blood sugar control compared to those who did not have asthma: 15.5 percent for children with both diseases compared to 9 percent for children who only had diabetes.

For the purposes of the study, poor blood sugar control was defined as demonstrating a hemoglobin A1C level — a measure of blood glucose control over long periods of time — of over 9.5 percent. The ideal hemoglobin A1C levels for adults are below 7 percent, while children could be healthy with levels of up to 8.5 percent.

According to Mary Helen Black with Kaiser Permanente Southern California, the correlation between diabetes and higher asthma rates points to obesity as a risk factor for the development of asthma. “It’s pretty well-established that there’s an obesity-asthma connection,” said Black. She also believes that there is a “real biological connection” between diabetes and asthma, which may work together to make effective blood sugar control more difficult.

Previous research has shown an increased risk of dips in lung function in people with poorly-controlled diabetes, so the connection has some precedent. However, the mechanisms behind the relationship are unknown.

Black commented, however, that an additional chronic illness may simply make it more difficult for diabetes to control their blood sugar. “It can be incredibly challenging to manage both conditions,” she said.

The research team did find that children and young adults with both diseases who were taking prescription asthma medication displayed better blood sugar control.

Leukotriene modifiers, a type of asthma medication sold as Accolate, Zyflo, and Singular, seemed to be especially helpful in controlling blood sugar: study participants taking those medications showed a less than five percent incidence of poor blood sugar control, compared to 30 percent of Type 1 diabetics who were on asthma medication.

The researchers commented that they aren’t sure whether the asthma medication plays an active role in regulating blood sugar. According to Black, it may just be that kids with better asthma control are more likely to have better diabetes control as well.

Researchers at UCLA demonstrated that the common over-the-counter dietary supplement gamma-Aminobutyric acid (also known as GABA) may aid in inhibiting the development of insulin resistance and glucose tolerance, two conditions that are known to be precursors to the development of both Type 2 diabetes and metabolic syndrome.

In the preclinical study, researchers gave GABA to mice that were obese, had developed insulin resistance, and were in the early stages of Type 2 diabetes. GABA is a naturally-produced compound similar to amino acids that plays an important role in inhibitory processes in the central nervous system of all mammals. When the researchers gave GABA to the mice, they found that the compound worked to suppress the inflammatory immune responses that are associated with the development of Type 2 diabetes.

According to the investigation’s authors, GABA aided in preventing progression of Type 2 diabetes; in addition, it improved insulin sensitivity and glucose tolerance in the mice, even after they had already developed Type 2 diabetes. They also identified regulatory immune cells that play a role in GABA’s inhibition of inflammation.

The research team commented that future studies on the effects of GABA on conditions associated with Type 2 diabetes could provide new medications based on the compound that treat metabolic syndrome and Type 2 diabetes related to obesity.

GABA has become popular in recent years as a dietary supplement promising everything from weight loss to muscle gain to reduced anxiety and depression to better sleep. Since GABA is an inhibitor, it is frequently promoted as a compound that stops excessive brain activity, allowing the individual to relax and eliminate anxiety. “It’s the brakes of your brain. It stops activity,” says Karl Doghramji, M.D., director of the Sleep Disorders Center at Thomas Jefferson University Hospital in Philadelphia.

It is thought that GABA reduces the effects of glutamate, a neurochemical that increases agitation and excitement. By taking GABA, individuals may be able to silence their overactive thoughts and, for example, get a better night’s sleep. Deficiencies in GABA levels are thought to cause a lack of “delta” sleep — the “deep” stage of sleep that begins about 45 minutes after one falls asleep. Lacking this type of sleep could be damaging to an individual’s mental health, according to Dr. Doghramji; those suffering with depression, anxiety, and other disorders often don’t get enough delta sleep.

Research shows that long-term deficiencies in delta sleep can cause more serious problems. One in three people who suffer with recurrent insomnia has some kind of psychiatric disorder, while 25% of those individuals also have anxiety problems.

However, there isn’t sufficient evidence yet to determine whether GABA supplements have an effect on improving sleep patterns and moods. “We just don’t have any data on them. We do not know how much GABA is really in the supplement or the product’s purity. There are no studies backing up the claims made by the supplement manufacturers.”

According to the New York University Langone Medical Center, there is no evidence that GABA supplements are effective in reducing symptoms from anxiety “presumably because the substance itself cannot pass the blood-brain barrier and enter the central nervous system.” Because they do not actually affect brain chemistry, GABA supplements are most likely ineffective in treating mood disorders, though they may still have some utility in treating hypertension.

Having insects liquefy and digest the dead tissue from your wounds might not be the most appealing idea, but a research team in Hawaii has done just that — using maggots to clean infected and dead tissue from wounds in diabetics — with very positive results.

Doctors typically use scalpels or enzymes to remove dead or infected tissue from wounds in diabetic patients, whose natural wound-healing processes are impaired by a reduction in bloodflow to their extremities. Doctors call this process debridement; however, with traditional tools such as scalpels, it is often ineffective.

“These problem patients with diabetes really need better treatments in order to salvage their limbs,” said Dr. Lawrence Eron with Kaiser Hospital and the University of Hawaii in Honolulu. “Maggot debridement treatment is overwhelmingly effective,” he added. “After just one treatment these wounds start looking better.”

Dr. Eron and his colleagues presented the findings of an investigation into the use of maggots for debridement purposes to their peers at a scientific meeting in Chicago. The results of the investigation have not been reviewed by independent, outside experts.

The investigation was conducted on 37 individuals with diabetes who had artery disease that reduced circulation to the extremities and impaired their wound-healing capacities. All of the patients had wounds that had proven difficult to heal, with some of them lasting for up to five years.

Dr. Eron’s team placed 50 to 100 maggots — species Lucilia sericata — on the patients’ wounds. The insects were left on the wounds for two days and then replaced with new ones; the treatment averaged five days across the group of patients.

“We cage the maggots in a mesh-like material. Nylon panty hose might be used. And then we seal them so they don’t get out,” said Dr. Eron.

Of the 37 patients, 21 had successful outcomes, with success being defined as the eradication of infection, total removal of the dead tissue associated with the wound, formation of new connective tissue in the wound and more than 3/4 closure of the wound.

Among the patients in which the treatment failed, three experienced complications with infected bones, two experienced heavy bleeding, and one had excessive inflammation around the wound.

Five of the wounds were infected with MRSA, a “superbug” known to be extremely resistant to antibiotics; those wounds healed successfully with the use of the maggots. A bacterium called MSSA infected nine other wounds; six of those were successfully treated. Among the patients there were 10 cases of wounds infected with group B streptococci; all of those wounds healed successfully, according to Dr. Eron.

As many patients would understandably be apprehensive about having live maggots inserted into their wounds, Dr. Eron noted that it’s important to explain the process and the mechanisms behind its success to patients. “A lot of patients might be somewhat wary of having live insects placed into their wounds so we explain how it works and what possible problems might occur,” he said.

The maggots secrete a digestive substance into the wounds that break down dead tissue. They feed on this tissue, where it is further digested in the gut of the maggot. The process effectively cleans the dead tissue surrounding the wound; the digestive substance that the maggots secrete also encourages development of granulation tissue, a type of connective tissue that forms when wounds heal.

“After this, we go on to do further treatment with hydrogels, grafts of cell culture tissue, or negative pressure dressings,” said Dr. Eron. “But to get to this point where these techniques will work, you really need to clean up the wound, get rid of dead tissue, and get robust granulation tissue into the wound. And this is where the maggots help.”

A recent preliminary study suggests that people taking the prescription drugs Januvia (sitagilptin) or Byetta (exenatide) to treat Type 2 diabetes may be at an increased risk of developing pancreatitis as well as pancreatic cancer.

In addition, the study discovered that Byetta could potentially increase risk of developing thyroid cancer. The researchers commented noted that the results weren’t conclusive and that further investigation would be necessary before a definite link could be identified.

“We have raised concern that there may be a link, but we haven’t confirmed it,” says Dr. Peter Butler, lead researcher on the project and the director of the Larry L. Hillblom Islet Research Center at the University of California in Los Angeles. “We need to do more work to figure out whether this is real or not,” continued Dr. Butler.

Byetta and Januvia are prescribed to Type 2 diabetics to help keep blood glucose levels in a healthy range. The medications encourage the production of a hormone called glucagon-like peptide 1 (GLP-1).

Although Januvia and Byetta, both relatively new injectable drugs that treat Type 2 diabetes, have some benefits over older medications, Dr. Butler warns that every new medication requires thorough research to determine any complications that could arise from its use. “When new drugs come out, the long-term side effects of these drugs are not well understood,” said Dr. Butler.

Dr. Butler’s team used data from the U.S. Food and Drug Administration’s database of adverse events in patients taking Byetta and Januvia between 2004 and 2009. Any time a patient experiences an adverse event, it is reported by the patient’s physician and recorded in the database.

Dr. Butler’s team found that patients who were being treated with Byetta and Januvia displayed six times more reported cases of pancreatitis. Those taking Byetta showed a 2.9-fold increase in pancreatic cancer while those taking Januvia showed a 2.7-fold increase in pancreatic cancer. The researchers also noted that there was an increase in reported cases of thyroid cancer among patients prescribed Byetta.

However, Dr. Butler stated that the data does not necessarily point to an increase in those complications among patients taking the medications but could be a result of an increase in the number of doctors actually reporting those adverse events.

“It is important to avoid alarmism and have people stop medicines that they may be benefitting from when the risk is not yet defined,” said Dr. Butler. “If the drug and you are working well together, I wouldn’t say there is any reason to stop the drug, based on the evidence we have right now,” he said. “But if you have any concern you should talk to your doctor about it.” Butler also noted that losing weight is the greatest deterrent to pancreatic cancer in patients with Type 2 diabetes.

Dr. Mary Ann Banerji, director of the Diabetes Treatment Center at SUNY Health Science Center Brooklyn, New York City, agrees with Dr. Butler, stating that the data “should not be blown out of proportion.”

Dr. Banerji does not prescribe Byetta or Januvia to patients with a family history of thyroid cancer or pancreatitis, but other drugs such as metformin and insulin come with their own risks. “You prescribe them on an individual basis, because, in the end, all of medicine is individual,” said Dr. Banerji. “We should use these drugs judiciously along with metformin.