Exercise Can Help Tame Type 2 Diabetes, Say New Guidelines

New guidelines on exercise for people with diabetes are likely to open some eyes and, for those who follow them, help prevent or manage diabetes, improve overall health and boost quality of life. A panel of nine experts developed the recommendations, published this month in Medicine & Science in Sports & Exercise®, the official journal of the American College of Sports Medicine (ACSM). ACSM and the American Diabetes Association issued the guidelines as a Joint Position Statement.


While research has solidly established the importance of physical activity to health for all individuals, the new guidelines provide specific advice for those whose diabetes may limit vigorous exercise. The recommendations call for at least 150 minutes a week of moderate-to-vigorous aerobic exercise spread out at least three days during the week, with no more than two consecutive days between bouts of aerobic activity. "Most people with type 2 diabetes do not have sufficient aerobic capacity to undertake sustained vigorous activity for that weekly duration, and they may have orthopedic or other health limitations," says Sheri R. Colberg, Ph.D., FACSM, who chaired the writing group. Hence, she explains, the group calls for a regimen of moderate-to-vigorous activity and makes no recommendation for a lesser amount of vigorous activity.


Strength training, too


Aerobic activity alone cannot give full benefit of exercise to diabetic individuals, say the experts. Recent research has shown that resistance exercise (strength training) is as important as and perhaps even more important than aerobic training in diabetes management. The latest studies, says Colberg, have reinforced the additional benefit of combining aerobic and resistance training for people with diabetes.


No excuses: Physicians should prescribe exercise


According to Colberg, "Many physicians appear unwilling or cautious about prescribing exercise to individuals with type 2 diabetes for a variety of reasons, such as excessive body weight or the presence of health-related complications. However, the majority of people with type 2 diabetes can exercise safely, as long as certain precautions are taken. The presence of diabetes complications should not be used as an excuse to avoid participation in physical activity." In keeping with the philosophy of ACSM's Exercise is Medicine® initiative, Colberg urges that physical activity be a conscious part of every person's health plan, as appropriate for age and physical condition.


High stakes, high yield


The benefits far exceed considerations of an individual's health and quality of life, say Colberg and other experts. Predictions that one in three Americans will have diabetes by 2050 (Centers for Disease Control and Prevention) are accompanied by estimates that diabetes and prediabetes in the U.S. will cost almost $500 billion a year by 2020 (UnitedHealth Group, Inc.). According to Colberg, "If current trends go unabated, we are in fact doomed to higher health care costs and drastically reduced quality and length of life due to diabetes-related complications such as heart disease and kidney failure. As individuals, as communities and as part of a nation and world, we have to work collectively to stop diabetes before it stops us."


The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 40,000 international, national and regional members and certified professionals are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.

Diabetes Challenge Website A Winner, UK

The Diabetes UK 'Diabetes Challenge' website - diabeteschallenge.uk - has won the Interactive Media Awards' (IMA) 'Best in Class' award, with a score of 481 out of a possible 500.


The award is the highest honour bestowed by the IMA. According to the IMA it "represents the very best in planning, execution and overall professionalism. In order to win this award level, your website had to pass successfully through a comprehensive judging process, achieving very high marks in each of our judging criteria - an achievement only a fraction of sites in the IMA competition earn each year."


Fantastic recognition


Amanda Neylon, Digital Media Manager at Diabetes UK, said: "It's fantastic to receive recognition for our Challenge website, which we created with web developers Chameleon Net.


"Our aim was to make it as easy and as functional to use as possible."


Challenge yourself in the New Year


"Now we really need as many people as possible to get involved, so why not make your New Year's resolution a Diabetes Challenge?" said Amanda.


About Diabetes Challenge


Diabetes Challenge is a fun and interactive website that enables anybody to challenge themselves or someone else to raise funds for Diabetes UK by taking on a given challenge. Challenges can be anything from losing a turkey in weight, being silent at work for an hour to walking the Great Wall of China.


TV presenter Dominic Littlewood, who has Type 1 diabetes, is taking on a Diabetes Challenge in the summer in western Thailand's Kanchanaburi Province, location of the infamous Death Railway and Bridge over the River Kwai.


"The challenge will take me through the rugged jungles in remote parts of the province close to the border with Burma", he said.


"I'll spend six days trekking, rafting, kayaking and riding elephants through the forests and mountains of the Thung Yai Nareusan Wildlife Sanctuary, all in the name of Diabetes UK!"


Visitors to Diabetes Challenge can access progress updates on all live challenges, including Dominic's. They can see who's challenging who, what they're doing, who's donating and how much has been raised so far.


Users can also share information on their progress and pictures via their social media networking thanks to connections with Twitter and Flickr. Using Facebook Connect, they can post updates direct to Facebook, such as new challenges and donation notifications.


Source
Diabetes UK

New Easy-To-Learn Blood Glucose Meter Focuses On The Essentials Of Testing

LifeScan, Inc., a Johnson & Johnson company, has introduced the OneTouch® UltraMini™ Blood Glucose Monitoring System, designed for people with diabetes who may feel overwhelmed by the demands of managing their disease and are seeking simple, more affordable blood glucose testing.


The new blood glucose monitor offers just the basics of testing in a small, lightweight meter that is simple to use. To help people with diabetes understand that small changes can make big differences in their diabetes management, and that managing their disease does not have to be complicated, the meter also comes complete with Simple Start™ DIABETES+FOOD, a patient-friendly booklet that explains the basics of diabetes, carbohydrate management, portion control and more.


Despite the fact that two-thirds of Type 2 diabetes patients have blood sugar averages that are out of control, many individuals can feel overwhelmed and discouraged by the daily demands of diabetes management, which can lead to them giving up on testing their blood sugar. In fact, each year 25 percent of those who were new to testing the year before abandon blood sugar testing.1 This is of serious concern, as testing and controlling blood sugar is key to managing diabetes - helping patients reduce their risk for long-term complications such as blindness, kidney failure, heart disease and amputation.


While many blood glucose meters appropriately provide an array of features for individuals aiming for more intensive diabetes management, some diabetes patients simply want a meter that will give them a test result as quickly and easily as possible. These patients may feel stressed or overwhelmed by the complexity of diabetes disease management, and though they understand the importance of testing their blood glucose levels regularly, the number of features and options on some other meters can simply add to the burden they already feel. The new OneTouch® UltraMini™ System aims to help diabetes patients overcome some of these barriers.


"When I was first diagnosed with diabetes about 10 years ago, I would have definitely appreciated a meter that's as easy to use as the OneTouch® UltraMini™," stated Jerry Mathers, former star of the popular 1950s and 1960s TV show, Leave it to Beaver. "Some people are not electronics whizzes, and they prefer simple devices that do only one thing. They don't want a cell phone that takes photos, a camera that also shoots video or a blood sugar meter that has more functions than they need. The OneTouch® UltraMini™ System has just two buttons and an easy-to-read screen that tells you what your blood sugar test result is - plain and simple."


With a suggested retail price of $19.99, the OneTouch® UltraMini™ Blood Glucose Monitoring System may be the lowest cost choice for many patients. In addition, OneTouch® Ultra® Test Strips - which are used with the new meter - are covered at the lowest co-pay by more private health plans than any other test strip. Medicare Part B covers these test strips as well. They're also available at a significant discount to many uninsured patients under the Together Rx Access plan (TogetherRxAccess).















"People with diabetes need to test and control their blood sugar to help manage their disease, and the availability of tools that help patients feel less intimidated by testing is key," said Steven Edelman, M.D., clinical professor at University of California, San Diego, and founder of the non-profit organization, Taking Control of Your Diabetes. "A meter like the OneTouch® UltraMini™ System can help patients see that regular blood glucose testing can be uncomplicated and affordable, which will hopefully encourage them to become more proactive in their own diabetes care."


The OneTouch® UltraMini™ meter's requirement of just a speck of blood permits alternate site testing2 (i.e., on the forearm or the palm), as well as conventional fingertip testing.


The OneTouch® UltraMini™ Blood Glucose Monitoring System is now available at pharmacies nationwide. For more information about the new system, visit OneTouchUltraMini.


LifeScan, Inc., a Johnson & Johnson company, and a leading maker of blood glucose monitoring products, is dedicated to creating a world without limits for people with diabetes. For health care professional resources, and information on diabetes care and LifeScan products and services, visit LifeScan.


1 Test strip usage data from a major pharmacy benefits manager, August 2005.


2 Users should read the OneTouch® UltraMini™ Owner's Booklet and talk to their health care professional before beginning to test on the forearm or palm.


The OneTouch® UltraMini™

OneTouchUltraMini

Researcher Offers Hope For Male Diabetes Sufferers - Hereditary Diabetes Insipidus

Scientists at Glasgow have made a significant discovery in the study of a rare form of diabetes which predominantly affects men. Hereditary Diabetes Insipidus is, according to experts, the most common genetic disease known in medicine. It causes serious kidney malfunction and can, if untreated, be fatal. There are an estimated to be around 9000 Heredirary DI patients in the UK.


Although the genetic basis of the disease has been established for a number of years, researchers in the faculty of Biomedical and Life Sciences at Glasgow have now pin-pointed an approach to treatment that may be expected to pave the way for future drug development.


The report has been published in the highly respected international journal, Proceedings of the National Association of Sciences of the USA (PNAS).



Graeme Milligan, Professor of Molecular Pharmacology at the University of Glasgow, and one of the authors on the report, said their findings are of "immense significance" because current strategies used for treatment have limited effect.


He explained: "The gene that is responsible for Hereditary Diabetes Insipidus is found on the X chromosome, which is why it is a predominantly male condition. Genetic defects cause the V2 vasopressin receptor found in the kidney to malfunction.


"In turn this reduces the capacity of the organ to concentrate urine, which is why patients need to go to the toilet frequently and drink large volumes of water, because the receptor is not responding to Vasopressin or Antidiuretic Hormone (ADH) produced to regulate the body's retention of water. The result of these genetic mutations in the receptor protein mean that it fails to mature, fold and function properly."


"These findings are important for sufferers long term, because our studies have employed novel, early stage drugs that can activate the mutated forms of the V2 vasopressin receptor. Further improvements to these drugs will result in their use by patients."


The work was also carried out with Joris Robben who now works at the University of Nijmegen, in Holland, from Glasgow.


Hereditary Diabetes Insipidus is not the only genetic disease in which mutation of a receptor results in its inability to fold and function correctly, so the approach we have taken may be equally applicable to these other conditions.


To view the paper abstract please see here.

Source
Nexxus Scotland

New Clues To Genetics Of Type 2 Diabetes Offered By Major International Collaboration

An international collaboration of scientists from Europe and the US has identified six new genes which play a role in the development of type 2 diabetes, extending the total number of genes implicated in common forms of the disease to sixteen.



The findings provide valuable new insights into the mechanisms responsible for the control of sugar levels in the blood and how malfunctions in this mechanism can result in type 2 diabetes. The research, of which the major UK funders were the Wellcome Trust, Medical Research Council, Diabetes UK and the EU, may lead to new ways of treating and preventing diabetes.



The main feature of type 2 diabetes is a sustained abnormal elevation of blood sugar levels. This results from a failure of the systems (involving the production of insulin from the pancreas) which usually keep those levels within tight limits. Exposure to high levels of glucose over years can result in serious damage to the heart, kidneys and other major organs. There are currently over two million people with diabetes in the UK and as many as 750,000 others who have the condition but are unaware.



Ninety researchers from over 40 centres analysed genetic data gathered from over 70,000 people in search of differences in our genetic code that make some people more susceptible than others to type 2 diabetes. Previous work from these groups and others had identified ten genes contributing to type 2 diabetes risk, to which the new findings, published online in the journal Nature Genetics, add a further six new genes.



"None of the genes we have found was previously on the radar screen of diabetes researchers," says Professor Mark McCarthy from the University of Oxford, one of the authors of the paper. "Each of these genes therefore provides new clues to the processes that go wrong when diabetes develops, and each provides an opportunity for the generation of new approaches for treating or preventing this condition."



The research backs up previous studies suggesting that a key process in the development of type 2 diabetes is the failure to regulate the number of insulin-producing cells in the pancreas.



In addition, the researchers have identified a surprising association between type 2 diabetes and the gene known as JAZF1, which has recently been shown to play a role in a very different condition, prostate cancer.



"Genetic studies of this kind are revealing new and unsuspected connections between diseases," says Dr Eleftheria Zeggini from the University of Oxford, first author on the paper. "This is now the second example of a gene which affects both type 2 diabetes and prostate cancer. We don't yet know what the connections are, but this has important implications for the future design of drugs for these conditions".



Each of the new genes only increases the risk of diabetes by a small amount, though when combined, their effects can be more impressive. However, the scientists caution against any immediate rush to use this information to give individual predictions of disease risk.



"Once we more fully understand the large numbers of genes now implicated in diabetes risk, it might become possible to identify people at particularly high risk before the disease takes root," says Professor David Altshuler of the Broad Institute of Harvard and MIT in Cambridge, USA, who led one of the three groups behind the research. "However, until we have evidence that using such information results in better health outcomes, widespread genetic testing would be premature."



The research was made possible through an unprecedented collaborative effort that brought together many groups active in the field of diabetes research. This international collaboration provided access to large data samples, ensuring that the results are robust.



The findings have been welcomed by Professor Simon Howell, Chair of Diabetes UK, which funded the original collection of samples from people with diabetes within the UK.



"It's remarkable that we still know so little about such a major condition as type 2 diabetes," says Professor Howell. "By revealing new pathways by which the body normally keeps blood glucose levels under control, this research offers new opportunities for more effective ways of treating and preventing this condition."

Eucreas, A Single-tablet Combination Of Galvus And Metformin, Set For Launch In First EU Countries As New Treatment For Type 2 Diabetes

European health authorities have approved Eucreas(R), an oral tablet combining Galvus(R) (vildagliptin) and metformin, as a new treatment for patients with type 2 diabetes. Eucreas is the first single-tablet combination of a member of the new DPP-4 inhibitor class with metformin to be approved in the European Union.


The approval comes after Novartis proposed changes to the EU label recommending that liver monitoring should be conducted at the start of treatment, every three months for the first year, and periodically thereafter. The Eucreas approval closely follows European approval of the updated label for Galvus announced earlier this month.


The decision applies in all 27 countries of the EU as well as in Norway and Iceland, and both medicines will be available in the first European countries within the next few weeks.


Studies show that more than half of patients currently taking medication to manage their type 2 diabetes are still not reaching blood glucose goals1. Combination therapy usually becomes necessary due to progressive worsening of blood sugar control during the natural course of the disease2.


In clinical studies, patients inadequately controlled on metformin, one of the most prescribed oral therapies for type 2 diabetes, were four times more likely to achieve blood sugar control by adding Galvus to their treatment compared to those who added a placebo (or sugar pill)3. Furthermore, Galvus when administered with metformin resulted in additional blood sugar reductions of 1.1% as measured by HbA1c4, the gold standard measure of blood sugar control5.


"The approval of Eucreas marks an important step forward in the management of type 2 diabetes, as it is the first single-tablet combination of a DPP-4 inhibitor with metformin for patients in Europe," said James Shannon, MD, Chief Medical Officer at Novartis Pharma AG. "The complementary actions of Galvus and metformin, which are the medicines combined in Eucreas, help to bring blood sugar levels under control without the side effects commonly associated with many widely-used type 2 diabetes medicines."


In clinical trials, the addition of Galvus to metformin provided robust blood sugar control without weight gain and with fewer cases of hypoglycemia (i.e. dangerously low blood sugar)4, side effects associated with other therapies for type 2 diabetes such as sulfonylureas or thiazolidinediones.


Eucreas has been approved for use in type 2 diabetes patients who are inadequately controlled with metformin alone, or are being treated with Galvus and metformin as separate tablets. Eucreas is recommended for use twice-daily at a dose of either 50 mg vildagliptin/850 mg metformin or 50 mg vildagliptin/1000 mg metformin.


Eucreas combines two agents that work together to target both a dysfunction in the pancreatic islets and insulin resistance, two of the main factors contributing to type 2 diabetes. Galvus works through a novel mechanism of action that targets islet dysfunction and restores the body's natural ability to increase insulin and decrease glucagon - the two main hormones controlling blood sugar levels. Metformin works mainly by decreasing the production of sugar by the liver and increasing insulin sensitivity.















Type 2 diabetes is a progressive disease in which control of blood sugar deteriorates over time. If left untreated or not kept under control, it can lead to heart and kidney disease, blindness, and vascular or neurological problems6.


Disclaimer


The foregoing release contains forward-looking statements that can be identified by terminology such as "likely," "to be," "will," "usually," "can" or similar expressions, or by express or implied discussions regarding the launch of Galvus and Eucreas in Europe, potential future approvals of Galvus and Eucreas in other countries, potential new indications or labelling for Galvus and Eucreas or regarding potential future revenues from Galvus and Eucreas. Such forward-looking statements reflect the current views of Novartis regarding future events, and involve known and unknown risks, uncertainties and other factors that may cause actual results with Galvus and Eucreas to be materially different from any future results, performance or achievements expressed or implied by such statements.

There can be no guarantee that Galvus and Eucreas will be approved for sale, or for any additional indications or labelling in any market. Nor can there be any guarantee that Galvus and Eucreas will be launched in any particular market, or will achieve any particular levels of revenue in the future. In particular, management's expectations regarding Galvus and Eucreas could be affected by, among other things, unexpected regulatory actions or delays or government regulation generally; unexpected clinical trial results, including unexpected new clinical data and unexpected additional analysis of existing clinical data; competition in general; the company's ability to obtain or maintain patent or other proprietary intellectual property protection; production delays or business interruption generally; government, industry and general public pricing pressures, and other risks and factors referred to in Novartis AG's current Form 20-F on file with the U.S. Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those anticipated, believed, estimated or expected. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.



About Novartis


Novartis AG provides healthcare solutions that address the evolving needs of patients and societies. Focused solely on growth areas in healthcare, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, cost-saving generic pharmaceuticals, preventive vaccines and diagnostic tools, and consumer health products. Novartis is the only company with leading positions in these areas. In 2007, the Group's continuing operations (excluding divestments in 2007) achieved net sales of USD 38.1 billion and net income of USD 6.5 billion. Approximately USD 6.4 billion was invested in R&D activities throughout the Group. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 98,200 full-time associates and operate in over 140 countries around the world. For more information, please visit novartis.



References


1. Saydah S, et al. Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes. JAMA 2004: 291(3): 335-342.


2. Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA 281:2005-2012, 1999.


3. Dejager S, et al. Achievement of Glycemic Targets with Vildagliptin. Presented at EASD 17-21 September 2007. (Abstract A-07-899).


4. Bosi E, et al. Effects of Vildagliptin on Glucose Control Over 24 Weeks in Patients With Type 2 Diabetes Inadequately Controlled With Metformin. Diabetes Care. 2007; 30:890-895.


5. American Diabetes Association. Standards of Medical Care in Diabetes - 2006.


6. International Diabetes Federation Diabetes Atlas. Third edition 2006: eatlas.idf/

novartis


View drug information on Glucagon.

Concerns About Anti-Obesity Drug Orlistat

US authorities are investigating concerns that anti-obesity drug Orlistat may cause liver damage.



Orlistat went on sale under the brand name Alli without the need for a prescription in the UK in April.


The US Food and Drug Administration (FDA) has received more than 30 reports linking the drug to serious liver injury.


The pill, which works by blocking the absorption of fat in the body, is considered an option for people with diabetes who have a Body Mass Index (BMI) of 28 or more. It is also available on prescription as Xenical. Clinical trials suggest adding Orlistat to a reduced-calorie, lower-fat diet, can help people lose 50 per cent more weight than dieting alone.


Conducting a new review


The FDA said it was now conducting a review of the safety of the drug, but stressed no definite association with liver damage had been established at this stage. The European Medicines Agency said there was no plan to change the product information at present - but the situation was under review. The manufacturer GlaxoSmithKline said there was no evidence the drug caused liver damage.


Anti-obesity drugs a last resort


Zoe Harrison, Care Advisor at Diabetes UK, said: "If people taking Orlistat are concerned about their health, Diabetes UK would advise them to contact their healthcare team, particularly if they experience possible symptoms of liver injury such as jaundice (yellowing of skin or eyes), loss of appetite or nausea.


"Anti-obesity drugs can help manage weight problems but should only be used as a last resort. In the first instance, Diabetes UK recommends a healthy diet and regular physical activity to manage weight and to reduce the risk of serious conditions linked to obesity such as diabetes and heart disease."

Source
Diabetes UK