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Diabetes Headlines
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Catch up on some of the latest headlines in diabetes care, including updates in pediatric management and an artificial pancreas.
Motivational interviewing delivered by primary care physicians and registered dietitians to the parents of overweight children helps the children lose significant amounts of weight. A phase II study is now recruiting patients to test whether the bacillus Calmette-Guérin (BCG) vaccine can reverse advanced type 1 diabetes. Parental factors such as diabetes, hypertension, and high body mass index (BMI) influence the development of these diseases in their children. A simple, intuitive, unified system of delivering insulin to type 1 diabetes patients is now in development that the manufacturer believes requires less time than current alternatives and simultaneously delivers better outcomes.
Motivational Interviewing Plus Dietary Counseling Help Children Lose Weight
• Motivational interviewing and dietary counseling in a primary care physician’s office can help obese children lose weight.
• Motivational interviewing is a client-centered communication style used extensively to modify health behavior and is recommended for counseling pediatric obesity.
• These researchers tested the efficacy of moderate-intensity (4 sessions) motivational interviewing-based counseling and the effect of adding 6 motivational interviewing-based counseling sessions by trained dietitians delivered to parents of 645 overweight youth aged 2 to 8 years.
• Overweight children whose parents received motivational interviewing counseling from their primary care physicians supplemented by counseling by registered dietitians showed a significant reduction in BMI percentile over 2 years as compared with those whose parents received usual care.
• The group that received only the primary care physician counseling showed a slight reduction in BMI.
• The next step is to determine how to train physicians to use motivational interviewing effectively and how best to train registered dietitians and integrate them into primary care settings.
Phase II Trial of BCG Vaccine to Reverse Type 1 Diabetes
• The FDA approved a phase II clinical trial testing the ability of the generic BCG vaccine to reverse advanced type 1 diabetes.
• The 5-year trial will investigate whether repeat BCG vaccination, now approved to treat tuberculosis, can clinically improve type 1 diabetes in adults between 18 and 60 years of age who have small but still detectable levels of insulin secretion from the pancreas.
• Previously, researchers at Massachusetts General Hospital showed the vaccine could temporarily eliminate, in both humans and mice, the abnormal white blood cells responsible for autoimmune type 1 diabetes.
• The phase II study will include 150 adults with long-term type 1 diabetes who will be randomized to receive 2 injections 4 weeks apart of either BCG or placebo and then a single injection annually for the next 4 years.
• The primary outcome measure will be improved HbA1c blood test results.
• The goal is to create a lasting therapeutic response and a regimen that will treat even advanced disease.
Parental Factors Influence Their Children’s Health
• Parents with diabetes and hypertension tend to have children with the same diseases, as well as high BMIs.
• These researchers examined parental factors associated with outcomes of youth in the Treatment Options for type 2 Diabetes in Adolescents and Youth clinical trial.
• The study included 699 youths with type 2 diabetes, who were followed for 2 to 6.5 years.
• For youths with a diabetic parent, more than half failed to maintain glycemic control, compared to a little more than one-third of those who did not have a diabetic parent.
• Parental hypertension was associated with hypertension in the youths.
• Parental obesity (BMI >30 kg/m2) was associated with higher baseline BMI scores in the youths.
• More research is needed to better understand and address parental biological and behavioral factors to improve youth health outcomes.
“Artificial Pancreas” for Type 1 Diabetes in Development
• A prototype automated insulin delivery system, otherwise known as an artificial pancreas, may be brought to market for type 1 diabetes patients by 2018.
• Bigfoot Biomedical intends to provide an accessible, affordable, automated, solution of insulin delivery for type 1 diabetes patients.
• The company recently acquired all assets of Asante Solutions, manufacturer of an insulin pump, and also entered into a development agreement with Dexcom, Inc. to integrate data from the Dexcom Continuous Glucose Monitoring System into the Bigfoot insulin delivery system.
Take-home Messages
• For the first time, a large-scale trial shows statistically significant reductions in BMI among overweight children by using motivational interviewing delivered by primary care physicians and registered dietitians.
• A phase II trial will test BCG vaccine as a treatment for type 1 diabetes.
• Parents who have diabetes, hypertension, and are obese influence the development of these diseases in their children with type 2 diabetes.
• A prototype automated insulin delivery system, or “artificial pancreas,” is in development for type 1 diabetes patients.
