diabetes: recent news

Depression Can Hamper Glucose Control in People With Diabetes

November 11, 2008 — Depression can cause diabetes patients to suffer from higher glucose levels over time compared to those who are not depressed, finds a study of older veterans with the disease.

“Our study shows that depression is a major and important comorbidity in people with type 2 diabetes,” said study co-author Leonard Egede, M.D., from the Center for Health Disparities Research at the Medical University of South Carolina.

Through a combination of diet, exercise and medication, people with type 2 diabetes work to keep their blood glucose levels within a certain range. Past research has shown that those who are also depressed have a tougher time doing so. About 30 percent of adults with diabetes have depression and the combination is linked to poor glucose control, higher complication rates, decreased quality of life and increased risk of death.

The current study appears in the November/December issue of the journal General Hospital Psychiatry.

Egede and his colleagues analyzed data from 11,525 veterans (98 percent men) with type 2 diabetes who received medical care at a Veterans Administration facility in the Southeast. The participants’ average age was 66 years and 48 percent were white, 27 percent were African-American and 25 percent were of other races.

Researchers evaluated each participant at three-month intervals from 1997 to 2006, with 36 intervals. At each 3-month interval, clinicians checked their HbA1c level, a blood test that measures long-term glucose control. Experts recommend a target level of less than 7 percent.

Six percent of the participants had depression, researchers determined.

They found that over the four-year period, the HbA1c values in the veterans who were depressed averaged 0.13 percent higher than the veterans who were not depressed. Egede said the difference is quite significant — enough to raise people with diabetes above the desirable range for glucose control, putting them at higher risk.

“The fact that the difference persisted over time and that the depressed group had higher mean HbA1c at all 36 time points was surprising,” Egede said.

The researchers also found that the change in HbA1c among the depressed participants did not differ based on race or age.

Evette Joy Ludman, Ph.D., senior research associate at the Group Health Center for Health Studies in Seattle, said that although the link between depression and diabetes complications might seem daunting, it is possible for adults to follow treatment orders for their depression while also managing their diabetes.

“I think it is a reasonable expectation that health care teams can help patients who have both depression and diabetes manage both conditions,” she said. “I don’t think patients see themselves as a collection of different illnesses and if we take a more proactive, integrated approach to caring for them, it is likely they can benefit. Research currently in the field is addressing that exact question.”

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

Richardson LK, et al. Longitudinal effects of depression on glycemic control in veterans with type 2 diabetes. General Hosp Psychiatry, 30(6), 2008.

Artificial Pancreas Could Revolutionize Treatment of Type 1 Diabetes

October 24, 2008 — Researchers at the University of Virginia and sites across the globe are testing a computerized, subcutaneous system that could one day transform the way Type 1 diabetics manage their disease.

UVA investigators have completed the first of several international artificial pancreas clinical trials to test an individually-“prescribed” control algorithm, which regulates blood glucose levels in Type 1 diabetics. UVA is one of seven centers worldwide funded by the Juvenile Diabetes Research Foundation to perform the novel closed-loop computer simulation of the human metabolic system.

Since late June, researchers have successfully tested the new system on five patients at the UVA Health System. An additional three patients have participated in a parallel study at the University of Padova, Italy.

“Our initial results are very encouraging,” says Boris Kovatchev, Ph.D., associate professor of psychiatry and neurobehavioral sciences & systems and information engineering who is leading UVA’s research team. “The system entirely maintained the patients’ blood glucose levels, and the algorithm achieved excellent overnight control without any incidence of hypoglycemia.”

Kovatchev, internationally known for his expertise in applying advanced computational methods to diabetes research, was one of the scientists who developed the system’s novel algorithm, which allows for personalized treatment for each patient. By linking patients’ glucose monitors with their insulin pumps, the “smart” program automatically regulates the amount of insulin a patient needs.

Researchers were granted FDA approval, based solely on in silico computer simulation experiments, to test the artificial pancreas in humans, without any prior in vivo animal trials. Such a rare distinction by the FDA cut research development time from several years to six months.

“This artificial pancreas could one day greatly improve the current methods of self treatment for Type 1 diabetes,” Kovatchev says. “Instead of a patient having to measure his or her blood sugar with a glucose meter several times a day and self-administer insulin injections, this system would continuously regulate the patient’s blood glucose, much like the way a non-diabetic’s pancreas functions.”

Complete results from the initial clinical trials at the UVA Health System, the University of Padova and the University of Montpellier, France are expected by the end of 2008.

The international collaboration is a result of the establishment of the Artificial Pancreas Consortium by the Juvenile Diabetes Research Foundation. Other centers involved in the consortium include Cambridge University, England, the University of Colorado, Sansum Diabetes Research Institute, Stanford University, Boston University, and Yale University.