This Inexpensive Type 2 Diabetes Drug May Also Help People With Type 1

TUESDAY, Sept. 6, 2016 (HealthDay News) — An inexpensive medication normally given to people with type 2 diabetes may help preserve heart health in people with the less common form of diabetes—type 1, a small new study finds.

Metformin is the standard first-line treatment for type 2 diabetes to help bring blood sugar levels down. It also appears to help repair damaged blood cells by increasing the number of blood vessel (vascular) stem cells, researchers said.

“We have shown—both in test tube and in patients—the mechanism behind the cardioprotective effects of metformin,” said the study’s senior author, Dr. Jolanta Weaver. She’s a senior lecturer in diabetes medicine at Newcastle University in England.

“This is likely to lead to the development of new drugs for heart disease in diabetes,” she added.

Sanjoy Duttais is assistant vice president of translational development at JDRF, a nonprofit organization that funds type 1 diabetes research. He expressed enthusiasm for the new findings.

“This was an extremely well-designed and conducted study. They have shown which cardiovascular biomarkers go up and down with metformin. But these are markers only. For a drug to be approved or widely accepted, researchers have to demonstrate hard outcomes,” explained Dutta.

JDRF has funded such a study by a different group of researchers that will be done next summer, Dutta said.

That study will look at whether or not people over 40 with type 1 diabetes had less plaque buildup (atherosclerosis) in their blood vessels over three years if they took metformin.

Type 1 diabetes is an autoimmune disease that causes the body’s immune system to destroy the body’s insulin-producing cells. Without sufficient insulin, the body can’t process the carbohydrates from food to provide the body’s cells with fuel.

Heart disease is the leading cause of premature death in people with type 1 diabetes. Even with good blood sugar control, the risk of heart attack or stroke is twice as high for people with type 1 diabetes compared to people without it, the researchers said.

The new study included 23 adults with type 1 diabetes who were treated with metformin for eight weeks. None had overt signs of heart disease. Their average age was 46.

The starting dose was 500 milligrams (mg) a day, which was increased to 2,000 mg a day if tolerated, Weaver said.

These people were compared to 23 healthy age- and sex-matched volunteers without type 1 diabetes. They were also compared to nine people with type 1 diabetes who weren’t given metformin. Their average age was 47.

The people with diabetes were asked to keep their blood sugar control similar to what it was before the metformin. The researchers didn’t want an improvement in blood sugar levels to affect the findings.

The researchers saw a number of markers indicating blood vessel repair go up in patients taking metformin. And on the flip side, cells associated with blood vessel damage were reduced in people taking metformin.

Metformin is an older drug, already approved in the United States for treating type 2 diabetes. Brand names include Glumetza, Glucophage, Riomet and Fortamet. The most common side effects are gastrointestinal problems such as nausea and diarrhea.

Dutta said these side effects tend to go away with time. Or, he said, there are medications that can help lessen the side effects.

Weaver said the researchers plan to follow the health of their patients. But, she added, a larger, randomized trial is needed to better know the heart protective effects of metformin in people with type 1 diabetes.

However, because the drug is already approved, doctors can prescribe it “off-label” to patients with type 1 diabetes, Dutta said.

“I am sure doctors will prescribe it at least in a subset of patients who have a very high risk of cardiovascular disease,” he said.

Weaver said along with the potential heart protective benefits shown in this study, metformin also helped the patients in the study achieve better blood sugar control, and it helped them lessen variations in blood glucose levels.

Findings from the study were published in Cardiovascular Diabetology.

More information

Learn more about heart disease and diabetes from the American Heart Association.

Type 1 Diabetes May Be Triggered By a Common Virus, Study Suggests

A new study suggests that a common virus may increase children’s risk for developing type 1 diabetes, raising the possibility that a vaccine may one day help prevent the lifelong disease. The research is not the first to make a connection between enteroviruses and diabetes, but the authors say it’s the largest and most definitive study to date. 

Enteroviruses are a group of viruses that usually cause mild illnesses, like the common cold. Certain strains of enterovirus—such as the poliovirus, enterovirus-D68, and coxackievirus (also known as hand, foot, and mouth disease)—can cause more serious symptoms.

Previous research has also suggested that children exposed to enteroviruses are more likely to develop , an autoimmune disease that damages insulin-producing cells in the pancreas, than those who have not. To further study this link, researchers at the University of Tampere in Finland tested more than 1,600 stool samples from 129 children who had recently developed diabetes and 282 non-diabetic children for enterovirus RNA—a marker of previous infection. They found a significant difference between the groups: Only 60% of the control group showed signs of prior infection, versus 80% of the newly diabetic group.

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The results, published in the journal Diabetologica, also showed that enterovirus infection typically occurred more than a year before children tested positive for islet autoantibodies, the first sign of type 1 diabetes. Taking this time lag into account, the researchers determined that children with diabetes have roughly three times more enterovirus infections than those without the disease.

The study could not prove a cause-and-effect relationship between enteroviruses and diabetes. But the authors say that large, international studies are in progress to better understand how these viruses—and which strains, specifically—may damage the pancreas. They are hopeful that one day, a vaccine might be developed to protect against those strains associated with diabetes.

“One could assume that such vaccine would give efficient protection against these viruses; in fact, this has already been demonstrated in mouse studies,” lead author Hanna Honkanen, PhD, a researcher in the department of virology, told Health via email. “In [an] optimal situation we could have results from human trials after 10 years.”

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Jessica Dunne, PhD, director of discovery research at JDRF (formerly the Juvenile Diabetes Research Foundation), agrees that the potential for a new enterovirus vaccine is exciting.

“Enteroviruses are not the only trigger for diabetes, so it’s important to note that even if we prevented all enterovirus infections we probably wouldn’t be able to prevent all cases of type 1 diabetes,” says Dunne, who was not involved in the new research. “But even if we could prevent 30% or 50% of cases, I think it would go a long way.”

For now, Honkanen says parents shouldn’t worry about their children being exposed to enteroviruses. “All children will have several enterovirus infections,” she wrote. “Thus, it is clear that additional factors—e.g. genetic factors—are needed for the development of diabetes.” 

It makes sense to safeguard kids against these viruses the same way one would against cold and flu: Encourage them to wash their hands frequently and keep their distance from others who are sick. But besides that, there’s no practical way to avoid infection. “We don’t want to keep our kids in bubbles,” Dunne says.

Overall, she adds, there appear to be multiple pathways to developing type 1 diabetes. “In some way, enterovirus may be a trigger to going down the path to autoimmunity,” she says. “But even for kids who may be at risk for developing type 1 diabetes, there are probably a lot of other things that have to happen to go all the way down that path.”

Mary Tyler Moore Proved Living Well With Type 1 Diabetes Is Possible

Actress and activist Mary Tyler Moore passed away today at the age of 80. No cause of death was immediately available, but Moore spoke publicly for many years about her struggle with , with which she was diagnosed at age 33.

In a statement, Moore’s rep referred to her as “a groundbreaking actress, producer, and passionate advocate for the Juvenile Diabetes Research Foundation.” She had served as International Chairman for the foundation, now known as JDRF, since 1984.

“Mary Tyler Moore’s legacy is that of a woman who tirelessly committed herself to helping the millions with T1D,” said JDRF in a statement. “Over the past 30 years, Moore educated about and increased awareness of T1D around the world and raised millions of dollars for research that will one day lead to a cure. Among her efforts, Moore was actively involved in JDRF Children’s Congress, sitting alongside children diagnosed with T1D to share their stories with elected officials on Capitol Hill and demonstrate the importance of continued T1D research funding.”

According to the National Institutes of Health’s MedlinePlus magazine, Moore’s frequent lobbying visits to Congress over the years helped increase JDRF’s research budget to more than $1 billion.

Moore became active in diabetes advocacy after she was diagnosed with the lifelong disease herself. In 1997, she told the Archive of American Television that her diabetes was discovered when she was in the hospital after suffering a miscarriage.

“While normal blood sugar levels are to be somewhere between 70 and 110, mine was 750,” she said. “They were amazed I was still walking around. And to this day they don’t know which came first, the miscarriage or the diabetes—which caused the other’s onset.”

Moore later told MedlinePlus that she was “incredulous” when she first received her diagnosis. “I was, after all, a very healthy and active adult, and I didn’t ever expect something like that to happen to me,” she said in 2006.

It’s a common misconception that people with diabetes are always overweight or sedentary, says Deena Adimoolam, MD, assistant professor of medicine, endocrinology, diabetes, and bone disease, at the Icahn School of Medicine at Mount Sinai. While lifestyle factors often contribute to the development of type 2 diabetes, they have nothing to do with the onset of type 1.

Symptoms of diabetes can include extreme thirst, frequent urination, drowsiness, sudden vision changes, increased appetite, sudden weight loss, heavy breathing, sweet-smelling breath, and even unconsciousness. Both types affect the body in similar ways, aside from one major difference: “In , the body is producing insulin but cannot use it properly,” says Dr. Adimoolam, who was not Moore’s physician. “In type 1, the body is not making any insulin at all.”

Without insulin, diabetics can develop life-threatening complications, says Dr. Adimoolam. Once a child or adult is diagnosed with type 1 diabetes, they need to take insulin—via injections or an insulin pump—on a daily basis.

“We pay close attention to how much they should be giving themselves, depending on what foods they’re eating, when they’re exercising, and when they’re under stress, for example,” she says. “We teach them to use insulin to balance different factors in their life, so they can live as normal a life as possible.”

Moore told NIH MedlinePlus that paying close attention to her diet and exercise routine helped her get better control over her disease. She also credited research, funded by in part JDRF, for helping to develop laser eye surgery that saved her from diabetic retinopathy—a complication of diabetes that causes blindness.

Still, she admitted that living with diabetes is not always easy. “The millions who suffer from diabetes still confront he specter of devastating complications, despite our best efforts,” she told the magazine. “Insulin is not a cure—it is life support, enabling us to live our lives until a cure is found.”

In addition to retinopathy, diabetics can also develop nephropathy (a condition in which the kidneys don’t function properly) or neuropathy (nerve problems that can cause pain and affect the sense of touch).

Dr. Adimoolam says that it is possible for these conditions to develop even if diabetes is carefully managed. Diabetes also becomes trickier to manage as patients reach old age, she says, since they may be dealing with other medical conditions that can affect blood sugar levels or other aspects of insulin control. 

But, she says, the earlier diabetes is diagnosed—and the more closely it’s monitored—the lower a person’s risks for complications throughout their life.

In 2009, Moore told People that she thought she’d have to “recline on a chaise the rest of my life” after her diabetes diagnosis. She proved herself wrong, however, adding that “there have been challenges, but I’ve triumphed.” And through the years, she showed that it’s possible for someone with diabetes to live a long and healthy life.

“Patients are living longer and doing much better, and we’re not seeing complications nearly as frequently as we were, let’s say, 50 years ago,” says Dr. Adimoolam. “We are lucky to have new technologies and advances in medicine that have improved the lives of people with type 1 diabetes significantly.”