Diabetes News

The European Renal Best Practice (ERBP) group published the “Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min) online ahead of print in Nephrology Dialysis Transplantation. “The guideline intends to provide an evidence-based rationale and, thus, to facilitate informed decision-making on the management of adult patients with diabetes mellitus and CKD”, explains Professor Wim Van Biesen, chair of European Renal Best Practice. “A patient with diabetes and CKD has to be treated differently than a non-CKD patient with diabetes. Two things, especially, are important here: The adaptation of medication to renal function and, second, the consideration of the much higher risk for hypoglycemia in patients without chronic kidney disease. Therefore I believe, the guideline is very relevant and will have future impact.” The guidelines cover issues such as dialysis modality choice, vascular access, glycemic control, and transplant options. Kidney donation The guidelines recommend living donation kidney transplantation or simultaneous pancreas kidney transplantation in patients with type 1 diabetes and stage 5 CKD. For type 2 diabetes patients seeking a kidney transplant, the guidelines said "we recommend diabetes per se should not be considered a contraindication to kidney transplantation in patients who otherwise comply with inclusion and exclusion criteria for transplantation." Glycemic control The guidelines do not recommend tighter glycemic control if it can result in sever hypoglycemic episodes. They recommend vigilant attempts to tighten glycemic control with the intention to lower HbA1C when values are >8.5% (69 mmol/mol). and intense intense self-monitoring only to avoid hypoglycemia in patients at high risk for hypoglycemia. Dialysis modality choice The guidelines recommend "giving priority to the patient's general status and preference in selecting renal replacement therapy as there is an absence of evidence of superiority of one modality over another in patients with diabetes and CKD stage 5. In patients opting to start hemodialysis, we suggest preferring high flux over low flux when this is available."   Read the full guidelines.  

Screening to identify type 2 diabetes followed by early treatment could result in substantial health benefits, according to new research published in Diabetes Care that combined large scale clinical observations and computer modeling. 

Blood pressure lowering drugs do not improve life expectancy among adults with diabetes and kidney disease, a new study of the global evidence published in The Lancet reveals.

The U.S. Food and Drug Administration is warning that the type 2 diabetes medicines canagliflozin, dapagliflozin, and empagliflozin may lead to ketoacidosis, a serious condition where the body produces high levels of blood acids called ketones that may require hospitalization. The agency said it is continuing to investigate this safety issue and will determine whether changes are needed in the prescribing information for this class of drugs, called sodium-glucose cotransporter-2 (SGLT2) inhibitors.

A study published in the Journal of Neurophysiology shows that fish oil supplements can restore the condition of nerves damaged from diabetes in mice. Approximately 50% of patients with diabetes suffer from nerve damage, or neuropathy.

Latino adults with diabetes who participated in a church-based education program reported eating less high-fat food and exercising more following a trial intervention program run by researchers from University of Chicago's Department of Medicine.

The incidence of a potentially life-threatening complication of diabetes, diabetic ketoacidosis, in youth in Colorado at the time of diagnosis of type 1 diabetes increased by 55% between 1998 and 2012, suggesting a growing number of youth may experience delays in diagnosis and treatment, according to a study in the April 21 issue of JAMA, a theme issue on child health.&nbsp;

The concerns of high protein diets were addressed recently in an article published in the Journal of Renal Nutrition entitled, "High protein diets and renal health:'1 In this provocative article, several Danish nephrologists discuss the current widespread use of high protein diets (i.e. protein content of more than 25% of energy or more than 2 g/kg body weight per day based on meat and dairy products) to promote weight reduction and better health for individuals in the general population with presumably good kidney function.

In a pilot study that included children at high risk for type 1 diabetes, daily high-dose oral insulin, compared with placebo, resulted in an immune response to insulin without hypoglycemia. According to the researchers, the findings that support the need for a phase 3 trial to determine whether oral insulin can prevent islet autoimmunity and diabetes in high-risk children, according to a study in the April 21 issue of JAMA.

Among a group of more than 320,000 children, intrauterine exposure to gestational diabetes mellitus diagnosed by 26 weeks' gestation was associated with risk of autism spectrum disorders (ASDs), according to a study in the April 14 issue of JAMA. Maternal pre-existing type 2 diabetes was not significantly associated with risk of ASD in offspring.