October 5, 2020
Latest Research On Type 2 Diabetes
By Michael D. Shaw
Over the past few years, this column has covered type 2 diabetes in several articles. The most recent one examined the non-typical case of skinny type 2s. Another discussed the link between lack of sleep and the disease. Yet another one took a hard look at the notion of glycemic control.
During the past months we have focused on the COVID-19 pandemic, but now it is time for an update on significant type 2 diabetes developments.
We start by looking at the two latest landmark studies. You will note that these sorts of studies usually have catchy acronyms.
This study examined type 2 patients at high risk for cardiovascular events, and sought to determine if daily canagliflozin will reduce cardiovascular mortality, nonfatal myocardial infarction or nonfatal strokes when compared to placebo.
The study concluded that canagliflozin had a lower risk of cardiovascular events and reduced the rate of renal decline and heart failure hospitalization compared to those who received placebo but a greater risk of amputation. Relatively modest reductions in HbA1C were reported.
Canagliflozin is sold under the name Invokana®.
This study examined type 2 patients with certain types of diabetic nephropathy, and sought to determine if canagliflozin at a dose of 100mg/day reduces the risk of end-stage kidney disease, doubling of serum creatinine from baseline, and death from renal or cardiovascular disease compared to placebo.
The study concluded that canagliflozin reduces the risk of the composite end-point of end-stage kidney disease, doubling of serum creatinine from baseline, and death from renal or cardiovascular disease when compared to placebo. The study did not directly report mortality due to infection though it did demonstrate an increased incidence of genital mycotic infections, particularly in males.
We continue with some quite recent findings…
Regular use of acid reflux drugs linked to heightened risk of type 2 diabetes. This prospective analysis was published in Gut and summarized the results of three prospective cohort studies involving 204,689 participants. Regular PPI (proton pump inhibitor) users had a 24% higher risk of diabetes than non-users. The risk of diabetes increased with duration of PPI use. Possible mechanisms are given, but messing with the gut biome can have all sorts of negative effects.
Metformin treatment linked to slowed cognitive decline. Readers with type 2 are surely familiar with the widely prescribed first-line diabetes drug metformin. This study examined 1,037 community-dwelling older participants without dementia aged 70–90 years at baseline, and found that those type 2s who were on metformin showed significantly slower global cognition and executive function decline than those not on the drug.
It has been known for some time that type 2s tend to be more subject to dementia, and some authorities, including Diane Kress, have long believed that dementia and Alzheimer’s are strongly related to an insulin imbalance. In fact, there are those who believe that diabetes, coronary heart disease, dementia, vascular issues, and kidney malfunction are all intimately related via insulin problems.
How about this one? Loneliness predicts development of type 2 diabetes. This was a longitudinal observational population study with data on 4,112 diabetes-free participants from the English Longitudinal Study of Ageing. And, yes, there actually is a tool available to assess loneliness.
A total of 264 (6.42%) participants developed type 2 diabetes over the follow-up period. Loneliness was a significant predictor of incident type 2 diabetes independent of age, sex, ethnicity, wealth, smoking status, physical activity, alcohol consumption, BMI, HbA1C, hypertension and cardiovascular disease.
What can we make of all this? Type 2 diabetes is becoming increasingly common, and symptoms and complications beyond the characteristic hyperglycemia range from almost non-existent to extremely serious. It is easy enough to explain the condition away in obese individuals as the body’s adaptation to an overabundance of food intake, but no reasonable etiology for skinny type 2s has ever been proffered. And no one has yet worked out how insulin seems to be related to so many metabolic processes that bear little obvious connection to glucose metabolism.
This is one of the paradoxes of medicine. Technology and longevity keep improving, but our chronic diseases—forever the bane of our species—are always with us.