ENDO Online 2020: The Top Diabetes News From March 30 – Everyday Health

Posted: April 3, 2020 at 8:45 pm

In light of the COVID-19 pandemic, ENDO 2020, the annual meeting of the Endocrine Society, was postponed until June 2020. In lieu of the meeting, which was originally scheduled for March 2831, 2020, in San Francisco, organizers held virtual news conferences March 30 and 31 to share the latest emerging science in endocrinology. All ENDO 2020 studies will be published in a supplemental issue of the Journal of the Endocrine Society.

The worlds first use of a drone to deliver insulin to a patient living in a remote community was performed late last year in Ireland, an accomplishment that has implications for wider use of drones to deliver medications in trying circumstances. Such circumstances might include infectious-disease pandemics like the COVID-19 outbreak.

An international team of researchers spent a year planning the drone test flight from Galway, Ireland, to the Aran Islands, about 12 miles off the west coast of Ireland. The drone was used to drop off insulin and return with the patients blood sample so that a doctor could check the patients glucose levels, says Spyridoula Maraka, MD, an endocrinologist at the University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System in Little Rock.

The project was conceived after healthcare professionals in Ireland noted the difficulties people faced obtaining critically needed medications during a 2017 hurricane and a 2018 blizzard in Ireland, Dr. Maraka says. People with diabetes who require insulin could fall critically ill if they run out of their medication, she says. Drones are already used in remote parts of Africa to deliver blood supplies.

Medicine has a track record of practicing for emergencies before they happen, Maraka said. There are multiple medical delivery drone opportunities.

Irelands Diabetes Drone Mission was launched with a team of experts across different fields, including medical, pharmaceutical, technical, flight operations, telecommunications, and regulatory agencies. The team selected a Wingcopter 178 drone for the first flight and received Irish Aviation Authority approval to conduct the mission.

The team plans to scale up the program to deliver medications to remote areas in the future. It will be important to gain the publics confidence in the program, as well as negotiate with airspace authorities to allow delivery access, Maraka says. That may be challenging in more densely populated areas.

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A common chemical called PFAS detected in the blood of pregnant women is linked to a higher risk of obesity in their granddaughters. PFAS per- and polyfluoroalkyl substances are man-made chemicals used as oil and water repellents and coatings for common products including cookware, carpets, and textiles, according to the Environmental Protection Agency. They are known as endocrine-disrupting forever chemicals because they persist when released into the environment and accumulate over time.

The study, by researchers at the Public Health Institute in Berkeley, California, featured an analysis of data from a project known as the Child Health and Development Studies. Blood samples from pregnant and postpartum women in the 1960s were collected and stored. In the early 2000s, the researchers measured the weight, height, and waist circumference of a subset of the study participants daughters and granddaughters. They determined the risk of total obesity and abdominal obesity in the daughters and granddaughters. The study included 213 sets of grandmothers, mothers, and granddaughters. The California Department of Toxic Substance Control then measured PFASs and other chemicals in the stored blood of the grandmothers.

The study showed that a granddaughters combined risk of abdominal and whole-body obesity increased 53 percent with a doubling of PFAS blood levels in her grandmother, when her grandmother also had lower cholesterol (in the bottom 25 percent). This translated to an estimated 2.3-fold increase in the combined risk of abdominal obesity and whole-body obesity for women whose grandmothers were in the top 25 percent of PFAS exposure compared with the bottom 25 percent of PFAS exposure. Cholesterol is somehow involved in the transport and metabolism of the chemicals, the researchers note.

Pregnancy appears to be based on our study and animal research and other work in progress a critical window of exposure for three generations in humans, says the lead author of the study, Barbara A. Cohn, PhD, the director of Child Health and Development Studies, who is based in Oakland, California.

These findings may help to explain the current U.S. and worldwide increases in obesity in young adults, she says. We dont understand the mechanisms for this association. We do know it has implications for the current epidemic of obesity if this can be confirmed.

Consumers can reduce their exposure to the chemicals by avoiding eating out of take-out and to-go food containers and using glass or stainless steel food storage containers. Another source of exposure is stain- and water-resistant carpet.

But, she says, Personal measures probably are not going to be enough because, like other legacy compounds, they have been so ubiquitous. There is so much everywhere.

RELATED: New Report Finds Toxic Forever Chemicals in Drinking Water in 31 States

People with diabetes who have a stroke have a better chance of preserving cognitive function if they have good blood glucose control after the stroke, according to a study from the Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University in Israel.

The study involved patients who had lacunar strokes, which are a common type of stroke that occurs in a blocked artery deep within the brain. The stroke can cause neurological damage. Researchers looked at 942 adults with diabetes who had a lucunar stroke to assess their A1C management following the stroke. A1C is a measurement doctors use to assess how well a person with diabetes is managing his or her glucose. Its also used to diagnose diabetes, according to the Centers for Disease Control and Prevention. The study showed better glucose management was linked to greater cognitive function and less cognitive decline. The research was observational, meaning that it only links better glucose management with cognitive benefits following stroke. A clinical trial could help prove a causal effect between the two, the authors said.

Still, Understanding potentially modifiable risk factors has large public health implications. One such factor may be A1C control, says the study's lead author, Tali Cukierman-Yaffe, MD, a physician and researcher at the Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University. For example, she says, It may be that individuals with cognitive impairment who have difficulty managing their disease would have worse glucose control.

Current medical recommendations urge healthcare providers to screen older people with diabetes for cognitive impairment, she notes.

Cognitive assessment should be part of the routine checkup of older people with diabetes, she said. The reasons for that are, one, the relationship between cognitive dysfunction and diabetes self-care; and the other is that cognitive function is another complication of diabetes that we should be looking for.

RELATED: Why Some Researchers Are Calling Alzheimers a Type 3 Diabetes

A minimally invasive endoscopic technique that has been approved in Europe can help people with poorly managed type 2 diabetes improve their A1C. The procedure, called Revita duodenal mucosal resurfacing (DMR), has not been approved for use yet in the United States.

During the procedure, doctors insert a balloon catheter through the mouth into the duodenum, which is part of the upper small intestine. They deliver thermal energy to remove or ablate the duodenal lining. After the damaged duodenal lining is removed, a new layer of tissue eventually forms.

Data from a new study of 70 people, dubbed REVITA-2, showed that people who received DMR had improved blood glucose levels and liver insulin sensitivity three months following the procedure compared with patients who underwent a sham procedure.

The novel technique is based on research that shows the duodenal lining is critical to the hormone changes and hormone signaling that lead to insulin resistance. Destroying the lining can interrupt the process underlying diabetes, the study authors say.

A major question about DMR is how long the effects last. Researchers reported evidence that some patients have improved diabetes control for up to two years. But its not known if the procedure will have to be regularly repeated.

This procedure would be for patients who have not been helped by previous treatments, says the study investigator David Hopkins, MBChB, a physician and the director of the Institute of Diabetes, Endocrinology, and Obesity at Kings Health Partners in London. But, he adds, treatment earlier in the course of diabetes could likely produce the most benefit by changing the course of disease.

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In another study on bariatric surgery released from ENDO 2020, researchers at the University of Michigan in Ann Arbor have found that bariatric surgery that takes place prior to the development of diabetes is more effective in facilitating weight loss.

Researchers studied 714 participants who had either gastric bypass or sleeve gastrectomy surgery. All of them had a body mass index (BMI) of more than 40 prior to surgery. Those without diabetes at the time of surgery had a 1.6 times higher chance of losing at least 50 percent of total body weight, regardless of the type of surgery.

The presence of diabetes before surgery is a predictor of future weight loss outcomes, says a study coauthor, Yingying Luo, PhD, of the University of Michigan.

The study suggests that having bariatric surgery before developing diabetes may be an important preventive strategy, says a lead researcher,Elif A. Oral, MD, of the University of Michigan. More research is needed to confirm the study results, the authors said. Yet doctors and patients should consider the timing of bariatric surgery.

We know that bariatric surgery may protect or delay the onset of diabetes, Dr. Luo says. We need a larger sample size. If we can find a true impact on the presence of diabetes, maybe it suggests we should take a step forward to have the surgery.

RELATED: Bariatric Surgery Cuts Heart Risks in People With Obesity and Diabetes

People with diabetes who lose a gland that helps lubricate the eye by producing tears may have elevated blood glucose levels, say the authors of a study from the University of California in San Francisco.

People with diabetes can experience dry eye and eye discomfort. They may have a loss of the meibomian glands in the eyes. The study looked at people with type 2 diabetes diagnosed with dry eye. People with higher A1C levels, a measure of blood glucose levels, were more likely to have the loss of the meibomian glands compared with those with more controlled A1C levels. Even among people who did not have diabetes, those with higher A1C levels had greater loss of meibomian glands.

Doctors should check the eyelids of individuals with diabetes who complain of dry eye, says the coauthor Gloria Wu, MD, an adjunct faculty member at the University of California in San Francisco.

Some people have severe discomfort and pain, she says. This is an easy diagnostic way of looking at diabetes.

RELATED: 5 Ways to Lower Your A1C Levels

People with type 1 diabetes using the Medtronic MiniMedTM 670G insulin pump system are able to maintain blood glucose levels in the targeted range over 71 percent of the time, according to a study that analyzed some 6 million days of real-world data.

The data compares favorably to the results found in clinical trials that led to approval of the device. The MiniMed TM 670G system is the first hybrid closed-loop system approved by the U.S. Food and Drug Administration (FDA) for people with type 1 diabetes.

Sometimes referred to as an artificial pancreas, the device consists of an insulin pump with a tiny infusion catheter worn under the skin and a small continuous glucose monitor that is also placed under the skin. The device measures glucose levels every five minutes and sends the results to the pump to dispense insulin as needed. Individuals upload data from the device to a website so that physicians can monitor their patients.

The real-world study involved more than 51,000 people. Researchers found that individuals were able to maintain blood glucose levels in the targeted range more than 71 percent of the time. When managing diabetes, the goal is to be in the target glucose range of 70180 milligrams per deciliter (mg/dL) more than 70 percent of the time.

Real-world experience does not necessarily live up to the results seen in a clinical trial that recruits highly motivated participants who are under close supervision, says the study's principal investigator, Robert Vigersky, MD, the chief medical officer of Medtronic Diabetes, in Northridge, California. Our results demonstrate that the glycemic control using the MiniMedTM 670G in the real world is excellent and mirrors the results of the small pivotal trials that led to the systems approval.

In February, the FDA announced Medtronic had recalled MiniMed 670G insulin pumps with broken or missing retainer rings following reports that a broken or missing part could lead to incorrect dosing. Insulin pumps with the retainer ring intact do not need to be returned to Medtronic.

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ENDO Online 2020: The Top Diabetes News From March 30 - Everyday Health

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