World Diabetes Congress to Hold 2011 Meeting in Dubai

The World Diabetes Congress of the International Diabetes Federation is holding its annual meeting in Dubai, beginning today and lasting through Thursday.

Alas I wont be attending but hope to share any news I hear on the grapevine. The Diabetes Cafe is the organizing structure allowing delagates and speakers to interact and network with one another. It will include debates, forums, and speaker’s corners.

Today marks the start with a Global Diabetes Forum, but this is an invidtaion only event which looks at political and government factors as they relate to industy and society.

The hours will be 10.00- 17.00 of the main conference Monday through Wednesday, and closing on Thursday at 13.00. Intenet access will be provided free in the exhibition hall, and all sessions will be held in English.

Dubai is the second largest city in the United Arab Emirates. Some CME is provided for medical continuing education including for the sattelite symposia.

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Published in: on December 4, 2011 at 3:53 pm  Leave a Comment  
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New Class of Diabetes Drugs Questioned

The FDA failed to approve the new diabetes drug dapagliflozin, from Bristol-Myers Squibb and AstraZeneca, due to several concerns that may stop the development of a whole class of drugs for Diabetes.

When the FDA rejected dapagliflozin, it also imperilled projects with SGLT2-inhibitors under development at Bristol Meyers and Johnson and Johnson. There was concern raised by the FDA panel about the mechanism of action in the kidney and urinary tract, as well as numerous smaller issues with side effects.

Previously dapagliflozin had been seen as promising because it did not appear to have negative heart/cardiovascular problems. These questions raised by the FDA likely would make research too expensive now to bring most of these drugs to market.

There have been a dearth of new diabetes drugs approved, the most recent dating back to Merck’s 2006 entry Januvia. Of course there is still a great deal of research going on into new drugs and devices, but nothing in the pileline is looming.

Published in: on July 21, 2011 at 8:42 am  Comments (1)  
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Diabetic Retinopathy Now Noted to Occur in the Prediabetic

Several recent pieces of research have noted that the destructive changes in the retina noted in diabetics, known as diabetic retinopathy, have been occurring at lower blood sugar levels (both hemoglobin A1C and daily blood sugar level). Many patients who have never met the formal criteria for diabetes, but have higher than normal blood sugar levels, seem to be developing diabetes.

I have linked to several of these studies. In 2005 the Diabetes Prevention Project (reported at ADA 65th Annual Scientific Sessions) found that 8% of prediabetics, who never developed diabetes, nevertheless showed retinopathy:

 

ADA Scientific Sessions: Retinopathy Found in Pre-Diabetes. Elizabeth Thompson Beckley. DOC News August 1, 2005. Volume 2 Number 8 p. 1

Here is  some more recent research along the same lines:

Relation between fasting glucose and retinopathy for diagnosis of diabetes: three population-based cross-sectional studies Wong TY, et al Lancet 2008; 371: 736-743.

Association of A1C and Fasting Plasma Glucose Levels With Diabetic Retinopathy Prevalence in the U.S. Population: Implications for diabetes diagnostic thresholds Yiling J. Cheng et al. Diabetes Care November 2009 vol. 32 no. 11 2027-2032. doi: 10.2337/dc09-0440

And Colagiuri and colleagues in 2010 metastudy reported in Diabetes Care noted that hemoglobin A1C in the mid- 6’s was associated with signs of retinopathy:

Glycemic Thresholds for Diabetes-Specific Retinopathy: Implications for Diagnostic Criteria for Diabetes:The DETECT-2 Collaboration Writing group. Stephen Colagiuri et al. Diabetes Care Published online before print October 26, 2010, doi: 10.2337/dc10-1206

Overall the messages of these articles suggest that prediabetics are about 1/3 as likely as diabetics to see retinopathy, but somewhere in the 8-11% range of prediabetics showed signs of the damage to the retina.

I also discussed the issue of prediabetes and retinopathy on my diabetes website.

Published in: on December 30, 2010 at 3:41 pm  Comments (1)  
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Eye Problems Diabetics Need to Monitor

Diabetes Mellitus Type 2 – Chronic Eye and Vision Complications

Type 2 diabetes could be hard to accept and acknowledge, and some of the complications can be particularly hard to bare. If the chronic Type 2 diabetic patient does not attend to their own self-care, one of the consequences could actually be blindness.  While total loss of vision only occurs in less than 2% of type 2 diabetics, nearly all of them will have some amount of retinopathy, and by 10 years, over half have developed it. Diabetes is one of the leading causes of preventable deaths nationally in America –  a country with more than its share of obesity.

It also takes a toll through  both emotional and physical stress, once the diabetic process starts to get the upper hand. More often than not, the warning signs of various complications like diabetic retinopathy are ignored, and the diabetic, who may not wish to think about the risks he faces, might be inclined to tune out these symptoms, such as blurry vision, and lack of focus. Sometimes there are no symptoms. Sometimes there is a lack of knowledge about the complications and risks from diabetes. Furthermore, the diabetic can mistakenly believe that insulin and/or other medications are sufficient to address their poor blood glucuse control, their Diabetes Eye Problems, and so may not own their part in the treatment.

The of loss of eye sight in adults diabetics is a serious and all too common problem, and diabetic retinopathy problems is a primary cause of that blindness. Other eye problems, like floaters and macular edema can be devastating. I myself have type 2 diabetes, and blurry vision led me to see my eye doctor. Even though I have some floaters, and atrocious night vision, he gave my retina a “clean bill of health.” At least for another year. As mentioned already, diabetics may not have any symptoms, or they may have the tell tale blurry vision, but an examination of the retina will clarify how much if any damage the retina has sustained.

For most diabetics,  even with a diagnosis of retinal problems, the treatment approach might initially be conservative, with an emphasis on controlling blood sugars, and cholesterol. Blood sugar needs to be kept in check, and big swings avoided; furthermore, hemoglobin a1c should be well below 7.0. But as the disease progresses, if the diabetes continues to worsen, then more intrusive interventions may be needed. Among the options then to address the eye problems would be laser surgery, and if that is not feasible, then other surgical procedures and even freezing the eye are options.

This is the first article in a series on complications in diabetes, to see the next, on diabetic foot problems, follow the link.