US Pharm. 2024;49(11):27-30.
Type 2 Diabetes Rose by Nearly 20% Over a Decade
Type 2 diabetes (T2D) increased by almost 20% between 2012 and 2022, according to a new study from the University of Georgia (UGA). The researchers found an increase in diabetes among all sociodemographic groups. Non-Hispanic black people were particularly hard hit by the disease, however, with just under 16% of black study participants reporting being diagnosed with T2D.
More than one in five individuals aged 65 years or older had the condition. The same age group was more than 10 times as likely to be diagnosed with diabetes than people in the 18-to-24–year age bracket. People aged between 45 and 64 years were over five times as likely to receive the diagnosis.
The study, published in Diabetes, Obesity and Metabolism, also found that individuals with lower incomes had a significantly higher prevalence of diabetes than their higher income counterparts. People with high incomes were 41% less likely to be diagnosed with the disease, and individuals with a college education were 24% less likely to be given a diabetes diagnosis.
“Diabetes is increasing day by day in the U.S., and it will increase even more in the coming years,” said Sulakshan Neupane, lead author of the study and a doctoral student in UGA’s College of Agricultural and Environmental Sciences. “Diabetes costs around $412 billion, including medical costs and indirect costs like loss of productivity. That’s a huge amount, and it’s only going to increase as more people are diagnosed with the disease.”
The researchers used data from the nationally representative Behavioral Risk Factor Surveillance System, an ongoing health survey of more than 400,000 people. They relied on the same dataset for a paper published by the American Journal of Preventive Medicine in April, which emphasized the economic burden of T2D and the increased prevalence of the condition over the same study period as the current paper.
In addition to other risk factors, the researchers found regional differences in diabetes prevalence. The South and Midwest, in particular, experienced large jumps in the number of individuals with T2D, with Arkansas, Kentucky, and Nebraska reporting the highest increases between 2012 and 2022.
Ten states saw increases of 25% or more over the decade-long study period: Arkansas, Kentucky, Nebraska, Texas, Alabama, Minnesota, Illinois, West Virginia, Delaware, and Massachusetts. “In these areas, people are at higher risk of developing diabetes, so policymakers and public health officials need to focus on these regions,” Dr. Neupane said.
Overweight and obese participants were also more likely to report being diagnosed with T2D. About one in five obese individuals reported having the disease in 2022, while one in 10 overweight participants reported having the condition.
Physical activity seemed to guard against diabetes to an extent, with physically active individuals facing a prevalence of under 10% while inactive people experienced a rate at closer to 19%.
“Identifying these risk factors and acting to mitigate them is key,” Dr. Neupane said. “Be more active. Pay more attention to your physical health. Some risk factors like age and race cannot be modified, but you can do something to lower risk of diabetes, like healthy eating, maintaining an active lifestyle, and losing weight.”
Diabetes and Weight-Loss Drug Linked to Lower Opioid Overdose Risk
Since being deemed a public health emergency in 2017, opioids are responsible for 72% of drug overdose deaths in the United States, according to the National Center for Drug Abuse Statistics. New research from the Case Western Reserve University School of Medicine identified a potential new approach to address the opioid overdose epidemic, which has devastated families and communities nationally.
The study, published in the Journal of the American Medical Association Network Open, suggests that semaglutide is linked to lower opioid overdoses in people with opioid-use disorder (OUD) and type 2 diabetes (T2D).
Semaglutide, a glucagon-like peptide receptor (GLP-1R) molecule that decreases hunger and helps regulate blood sugar in T2D, is also the active component in the diabetes and weight-loss drugs Wegovy and Ozempic.
The research team, led by biomedical informatics professor Rong Xu, analyzed 6 years of electronic records of nearly 33,000 patients with OUD who also had T2D. The researchers used a statistical approach that mimics a randomized clinical trial.
They found that patients prescribed semaglutide had a significantly lower risk for opioid overdose compared with those who had taken any of eight other antidiabetic medications, including other types of GLP-1R-targeting medications.
About 107,500 people in the U.S. died from drug overdoses in 2023, mostly from opioids, according to the CDC. Despite effective medications to prevent overdoses from OUD, the CDC estimates only one-quarter of those with OUD receive them and about one-half discontinue treatment within 6 months.
“Not everyone receives or responds to them,” said Dr. Xu, also director of the medical school’s Center for AI in Drug Discovery. “As a result, alternative medications to help people treat opioid use disorder and prevent overdosing are crucial. Therefore, our findings suggest that it is important to continue studying semaglutide as a possible new treatment for combating this terrible epidemic.”
Although the findings potentially support the idea that semaglutide could treat OUD and prevent overdoses, the study’s limitations restrict the researchers from making firm causal conclusions, Dr. Xu said. Semaglutide’s use will need to be further investigated through randomized clinical trials, the researchers added.
New Injectable to Prevent and Treat Hypoglycemia
Patients with diabetes take insulin to lower high blood sugar. If glucose levels plunge too low from taking too much insulin or not eating enough sugar, however, patients can experience hypoglycemia, which can lead to dizziness, cognitive impairment, seizures, or comas.
To prevent and treat this condition, researchers in ACS Central Science reported encapsulating the hormone glucagon. In mouse trials, the nanocapsules activated when blood sugar levels dropped dangerously low and quickly restored glucose levels.
Glucagon, a hormone that signals the liver to release glucose into the bloodstream, is typically given by injection to counteract severe hypoglycemia in patients who have diabetes. While an emergency glucagon injection can correct blood sugar levels in about 30 minutes, formulations can be unstable and insoluble in water. In some cases, the hormone quickly breaks down when mixed for injections and clumps together to form toxic fibrils. Additionally, many hypoglycemic episodes occur at night, when patients with diabetes are not likely to test their blood sugar.
To improve commercial glucagon stability and prevent hypoglycemia, Andrea Hevener and Heather Maynard looked to micelles: nanoscale, soap-like bubbles that can be customized to assemble or disassemble in different environments for drug delivery.
They developed a glucose-responsive micelle that encapsulates and protects glucagon in the bloodstream when sugar levels are normal but dissolves if levels drop dangerously low. To prevent hypoglycemia, the micelles could be injected ahead of time and circulate in the bloodstream until they are needed.
In laboratory experiments, the researchers observed that the micelles disassembled only in liquid environments that mimicked hypoglycemic conditions in both human and mice bodies: less than 60 milligrams of glucose per deciliter. When mice experiencing insulin-induced hypoglycemia received an injection of the specialized micelles, they achieved normal blood sugar levels within 40 minutes.
The team also determined that glucagon-packed micelles stayed intact in mice and did not release the hormone unless blood glucose levels fell below the clinical threshold for severe hypoglycemia.
From additional toxicity and biosafety studies in mice, the researchers noted that empty micelles did not trigger an immune response or induce organ damage.
While more studies are needed, the researchers say that their proof-of-concept is a first step toward a new on-demand and effective method for preventing or mitigating extremely low blood sugar levels.
Replacing Ultra-Processed Foods Reduces T2D Risk
People who eat more ultra-processed foods (UPF) are at increased risk of developing type 2 diabetes (T2D), but this risk can be lowered by consuming less-processed foods, a new study found. The research, published in The Lancet Regional Health–Europe in collaboration with experts at the University of Cambridge (UCL) and Imperial College London, investigated the relationship between the degree of food processing and T2D risk, including which kinds of UPF were highest risk.
The team analyzed UPF intake and health outcomes for 311,892 individuals from eight European countries over 10.9 years on average, during which time 14,236 people developed T2D. They found that every 10% increase in the amount of UPF in a person’s diet was linked to a 17% increase in T2D risk, but this risk can be lowered by consuming less-processed foods instead.
The highest risk UPF groups were savory snacks, animal-based products such as processed meats, ready-made meals, and sugar-sweetened and artificially sweetened beverages, suggesting that particular attention be paid to these foods to help tackle ill health.
The degree of processing in foods is most often assessed using the Nova classification, which divides foods into four groups: unprocessed or minimally processed foods (MPF) such as eggs, milk, and fruit; processed culinary ingredients (PCI) such as salt, butter, and oil; processed foods (PF) such as canned fish, beer, and cheese; and UPF such as ready-to-eat/heat mixed dishes, savory snacks, sweets, and desserts.
The exact causes of the link between UPF and T2D are unconfirmed, although several factors are thought to be at play, including overconsumption and weight gain. In a previous study, backed up by new analysis in this study, increased body fat accounted for around one-half of the association.
Samuel Dicken, first author of the study from UCL Division of Medicine, said, “We know that UPF are associated with a higher risk of certain diseases such T2D. As expected, our findings confirm this link and show that every 10% increase in the diet from UPF increases the risk of developing T2D considerably.
“Most studies to date only consider UPF as a whole, but we also suspect that there may be different risks associated with different types of UPF, and the risks of other processing groups have not been well researched. Our analysis goes a step further than previous studies by looking at all four processing groups in the Nova classification to gauge the impact on T2D risk when we substitute UPF with less processed foods, as well as looking at nine UPF subgroups.
“The good news is that replacing UPF with less processed foods was associated with a reduced type 2 diabetes risk,” said Dr. Dicken.
In the study, researchers from UCL analyzed data from the EPIC study, which investigated the relationship between diet, lifestyle, and environmental factors and the incidence of chronic diseases in more than half a million Europeans over time. Additional analyses on the data were performed to separate UPF into nine subgroups to better understand how level of processing affects T2D risk.
Alongside analyzing how eating UPF affected a person’s risk of developing T2D, the researchers performed substitution modeling on the data to see how, theoretically, replacing one Nova food group with another would affect T2D risk. The results showed that substituting 10% of UPF in the diet with 10% of MPF/PCI reduced T2D risk by 14%.
Substituting 10% of UPF in the diet with 10% of PF reduced diabetes risk by 18%. The authors said that this may be due to the fact that 30% to 50% of PF intake in this study came from beer and wine, which have been associated with a lower risk of T2D in a previous EPIC study. UPF also includes salted nuts, artisanal breads, and preserved fruits and vegetables.
Professor Rachel Batterham, senior author of the study from UCL Division of Medicine, said, “The UPF subgroup analysis in this study has been revealing and confirms that not all foods categorized as UPF are alike in terms of the health risks associated with them.
“Breads and cereals, for example, are a staple of many people’s diets. Based on our results, I think we should treat them differently to savory snacks or sugary drinks in terms of the dietary advice we provide.”
The authors added that due to the observational nature of the study, it can only measure associations rather than causal effects.
Widely Used Gestational Diabetes Test Misses 70% of Cases
When screening pregnant women for gestational diabetes, casual blood glucose testing misses 70% of the cases. The Kobe University study should encourage obstetricians to depend on more reliable tests to help prevent pregnancy complications and the development of type 2 diabetes (T2D) in mothers and children.
When treated for gestational diabetes, most women deliver healthy babies, but if left unmanaged, this can lead to pregnancy complications, babies growing larger than usual, and increased risk of later development of T2D for both the mother and the child. Therefore, the International Association of the Diabetes and Pregnancy Study Groups recommends that all women who have not been diagnosed with diabetes previously undergo a so-called oral glucose tolerance test between Weeks 24 and 28.
This multistep procedure requires women to fast for 8 to 12 hours before a baseline blood sample is taken, then drink a solution containing a standardized amount of glucose. After a specified time, another blood sample is taken to see how well the body metabolizes the sugar. A large percentage of health facilities use a much simpler “casual” blood glucose test for which blood is taken and analyzed for glucose levels only once and at any time without consideration to what or when the woman has eaten, making this both less expensive and quicker. Only if women test positive in that simple screening are they asked to undergo the more rigorous glucose tolerance test.
Kobe University obstetrician Kenji Tanimura and graduate student Masako Tomimoto were concerned that this two-tier approach potentially misses diabetes cases in the first screening. Working in the perinatal center of Kobe University Hospital, they combined the casual blood glucose screening and another standard test for gestational diabetes, the much more sensitive glucose challenge test, into a single protocol for all participating women visiting their center. Drs. Tanimura and Tomimoto and their team asked women who tested positive in the glucose challenge test to also take the actual glucose tolerance test, which allowed them to ascertain how many positive cases would have been missed had they used only the convenient casual blood glucose screening.
Their results, published in the Journal of Diabetes Investigation, showed that out of the 99 women diagnosed with gestational diabetes mellitus, 71.7% had blood sugar levels in their first blood sample that would have resulted in a negative diagnosis. Dr. Tomimoto explained, “Although there have been studies showing that the casual blood glucose test is less sensitive than others, no studies have directly compared the results in the same individuals. Our study confirmed that this screening method, which is widely used in practice, frequently misses the condition it is meant to detect.”
To see how widespread this issue is, the team also conducted a survey among healthcare facilities in Hyogo Prefecture, where Kobe University is based. They found that 43% of the respondents who used blood glucose tests relied only on the casual screening. “In Japan, where about half of all deliveries take place in obstetric clinics rather than in hospitals, the more accurate but complicated and time-consuming tests are not widely used,” said Dr. Tomimoto. This is not a problem unique to Japan, however, as similar surveys showed that in the United Kingdom, 48% of clinics also only rely on the casual blood glucose test for the first screening.
Dr. Tanimura concluded, “We would like to educate healthcare professionals and patients about this danger and encourage them to promote the use of the more accurate glucose tolerance screening method. We hope that our data can contribute to improvements in the management system and to the revision of the guidelines for gestational diabetes mellitus screenings. The goal is to protect more mothers and babies from gestational and childbirth issues caused by this form of diabetes, and in general reduce the risk of developing the disease in the future.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
