Diabetes meeting features research on prevention, drug effects, complications

CHICAGO—Long-term effects of lifestyle modification and hospitalization rates for complications of diabetes and diabetes treatment were among the research findings presented at the American Diabetes Association's Scientific Sessions last month.

Final results from the Look AHEAD trial, presented at the meeting and published in the New England Journal of Medicine on June 24, showed that an intensive lifestyle intervention for overweight and obese type 2 diabetics reduced weight, hemoglobin A1c and some cardiovascular risk factors but had no impact on the primary outcome of cardiovascular-related death, myocardial infarction, stroke or angina hospitalization.

An analysis of Medicare fee-for-service beneficiaries with type 2 diabetes between 1999 and 2007 revealed that rates of hospital admission for hyperglycemia have declined (from 114 per 100,000 person-years in 1999 to 70 per 100,000 person-years in 2007) while hospitalizations for hypoglycemia have risen (94 per 100,000 person-years in 1999 up to a peak of 130 per 100,000 in 2007 back down to 105 per 100,000 in 2011). The findings should draw attention to the risks of increasing use of antihyperglycemic medications, said the Yale researchers who conducted the study.

Focusing on similar concerns, CDC researchers presented data on rates of emergency department (ED) visits and hospitalizations for insulin-related adverse events. In 2007-2009, insulin was responsible for 5.1% of all adverse drug event-related ED visits, and hypoglycemia occurred in 91.8% of those cases. Patients age 80 and over were significantly more likely to have an ED visit or hospitalization related to insulin (9.6 ED visits per 100 diabetic patients over 80 vs. 4.3 among younger diabetic patients, and 4.1 hospitalizations vs. 1.0 per 100 younger diabetic patients). The most common causes were not eating when expected and taking the wrong insulin or wrong dose.

Finally, an analysis of hospitalizations for diabetic foot infections from 2001-2010 found that the hospitalizations increased at the same pace as diabetes cases overall. The hospitalizations were associated with an average 8.2-day length of stay and $46,107 in hospital charges, as well as serious complications. Mortality occurred in 2.0% of hospitalizations, sepsis occurred in 9.6%, surgical complications occurred in 8.0% and amputation occurred in 10.5%. The statistics raise questions about whether greater efforts need to be made in the outpatient setting to prevent these hospitalizations, said study authors from the University of Arizona.

—By Stacey Butterfield, Associate Editor