Medication Safety and the Artificial Pancreas
For Part 1, read here.
The next two themes presented at the course that I would like to discuss are medication safety and the artificial pancreas.
3. Medication Safety. There were several presentations in regard to the different classes of pharmaceutical agents used to treat type 2 diabetes, as well as a discussion of the basal insulins in relationship to the treatment of cancer. Both academic basic science researchers as well as academic pharmacists discussed the different classes. The thiazolidinediones (TZD's) continue to have troubling side effects (more specifically Rosiglitazone (Avandia) in relationship to cardiac issues) as well as Sitagliptin (Januvia) and the DPP4-inhibitors with pancreatitis. The statins (ie: Lipitor), considered a panacea for dyslipidemia, do indeed have side effects: liver and muscle problems that occur more frequently than originally thought. Another big concern is the correlation between the basal insulin, Glargine (Lantus), and cancer in patients with type 2 diabetes. These issues came into focus with the publications of papers in Diabetologia that demonstrated an association via meta-analyses, but did not prove that Glargine caused cancer. An excellent talk by an academician who does research in mice revealed that the link may be due to increased long-term endogenous insulin secretion secondary to insulin resistance seen in people with pre-diabetes and type 2 diabetes. (Endogenous insulin is insulin made by your body, not given by injection). This long-term endogenous insulin secretion, or hyperinsulinemia, has been shown to lead to breast cancer in mice, which may play a role in humans as well. Of course, more research will be required in humans to prove this association. However, it was very reassuring for those healthcare providers that use large amounts of basal insulins, such as Glargine and Determir(Levemirâ) in both type 1 and type 2 diabetes. Probiotics and additives also were discussed in relationship to type 2 diabetes- such as Cinnamon and other products. Several demonstrated positive associations in lowering blood sugars postprandially. However, no probiotic or additive cured either type 1 or type 2 diabetes. For more information, consult the ADA website.
3. The artificial pancreas: Where are we? As a pediatric diabetologist, my interest in this area is enormous. Dr. Aaron Kowalski, a researcher associated with JDRF, discussed the status of the artificial pancreas. Progress is happening; but it is slow. The algorithms for both hyperglycemia and hypoglycemia have been formulated but not put into general practice as yet in the United States. The Medtronic Minimed pump, Veo, is available in Europe but the FDA has yet to approve it for sale in the United States. The Veo shuts off for a certain length of time if the associated continuous glucose sensor notes hypoglycemia. (For more details, see Ann Bartlett's blog). Journal articles have demonstrated improved glycemic control with the use of the continuous glucose monitoring systems in all age groups (when used properly). The key to remember, however, that the sensors do not replace, at present, blood glucose monitoring, as they only measure glucose and document trends in the interstitial fluid. (A cute quote from Dr. Kowalski was "an interstitial frame of mind," as opposed to a "New York state of mind" in reference to measuring blood versus interstitial glucose). JDRF appears to have broadened its approach to type 1 diabetes as well. They are focusing on methods to improve care in people with diabetes now, as well as the cure. I believe this makes an enormous amount of sense.
In summary, the conference served to reinforce the need to prevent the development of T2DM and develop behavioral strategies to do so (not an easy task) and update diabetes healthcare professionals about the medical and behavioral tools to treat diabetes and related conditions.