Diabetes developments -by Simon O’Neill
This week Simon updates on new research developments.
Traditionally it has been very difficult to get an accurate record of the numbers of deaths related to diabetes. This is because diabetes is rarely included on a death certificate as a cause of death, even though it may well have had a direct impact on health outcomes.
A new study from the US has taken evidence from two recent national surveys, analyzing data from 282,322 individuals who took part in NHIS surveys between 1997 and 2009 and 21,824 individuals who participated in NHANES between 1999 and 2010. They also then looked at mortality in the 5 years following the surveys.
Using this data they found that, on average, 11.7% of deaths occurred in people who had self-reported that they had diabetes and 11.8% occurred in those with an HbA1c levels over 6.5%. This figure was even higher if people were also obese, with 19.4% of deaths attributed to diabetes. This would make diabetes the third leading cause of death in the US. Interestingly only 3.3% of death certificates listed diabetes as the underlying cause of death in the same time period.
Pancreatic Cancer and Type 2 diabetes
A recent study, of about 1 million people, has found that about half of all people newly diagnosed with pancreatic cancer had been diagnosed with Type 2 diabetes the previous year. While obviously concerning, the numbers do have to put in to some sort of perspective, as cases of pancreatic cancer are relatively rare, with about 10,000 cases diagnosed in the UK each year. The highest risk was in people with Type 2 diabetes who experience a rapid deterioration in their diabetes control. This group had a seven-fold increased risk of being diagnosed with the cancer.
The link is not new – but has not been seen in such a large cohort before, adding strength to the call that people with fairly new onset Type 2 diabetes, particularly with suddenly worsening control, should be considered for screening for pancreatic cancer, if no other underlying causes are apparent.
However, the researchers also point out that more needs to be done to develop earlier diagnostic tests for pancreatic cancer, before any symptoms are present. Currently there is no good, non-invasive method for detecting pancreatic cancer if there are no symptoms.
The link between the two conditions is not yet understood. It could be that Type 2 diabetes treatments increase risk, but it could also be that the cancer actually increases the risk of Type 2 diabetes developing before any symptoms of the cancer are apparent.
Is early prevention better than targeted prevention?
A new study from Cambridge has found that public health programs to reduce obesity can significantly lower the risk of Type 2 diabetes. But rather than focusing on those already known to have an increased risk, with an elevated HbA1c, this study looked at the risk in the general population and whether action could be taken to lower their risk as well.
The researchers analyzed data from 33,184 people aged 30 to 60 who were examined twice in 10 years between 1990 and 2013. What the study was interested in was whether a change in body weight over that 10 year period increased the risk of developing Type 2 diabetes.
Results showed that after 10 years, 3.3% of participants developed Type 2 diabetes. 53.9% gained more than 2 pounds over their starting weight and 36.2% maintained their weight. Those who gained more than 2 pounds had a 52% higher risk of Type 2 diabetes than those who maintained their weight.
So rather than waiting for obesity/overweight to increase the risk to Type 2 diabetes, initiatives to encourage people not to put on weight in the first place may be an effective strategy and could prevent more than twice as many cases of Type 2 diabetes than a strategy targeting those already at high risk, with obesity and raised blood glucose.
Severity of Type 2 diabetes in young people
A recent study has shown that young people with Type 2 diabetes (T2D) are much more likely to show signs of complications from the condition than those with Type 1 diabetes (T1D) of similar ages, with the same duration of diabetes. The study included 1,746 young people with T1D and 272 with T2D being managed for their diabetes in the US between 2002 and 2015. Both groups had similar blood glucose levels.
The researchers found that 19.9% of the group with T2D had early signs of possible kidney disease, compared with 5.8% percent of those with T1D. The investigators also found that 9.1% of those with T2D had early signs of retinopathy, against 5.6% of those with T1D. The T2D group were also over four times as likely to have arterial stiffness and twice as likely to have high blood pressure, both risk factors for cardiovascular disease and events like heart attack and stroke.
The big difference between the two groups was obesity, with all those with T2D being overweight or obese. When this was controlled for, the difference in complication rates disappeared.
Although the complications were all at an early stage, this does highlight the increased risk of T2D for younger people and the need to try and prevent T2D in the young.
Earlier studies have also shown that it is difficult to engage young people with T2D with their condition, often because they have no symptoms and are less likely to take their medication, as this can cause unpleasant side effects. T2D in young people and children is still relatively uncommon but is a growing problem, and highlights the importance of educating young people about their condition, together with more effective management solutions.