Diabetes News Roundup: December 2018

January 3, 2019

Highlights include a link between migraines and T2DM risk in women; fasting-evoked hypoglycemia being overlooked; and how gut microbiome influences the metabolism of diabetes drugs.

Highlights of 3 new studies in type 2 diabetes mellitus (T2DM) include how migraines may reduce the risk of T2DM in women; fasting before a blood draw may send diabetes patients into hypoglycemia; and the gut microbiome may affect some antidiabetes medications.

Migraines in Women Linked to Lower Risk of T2DM

How Does Migraine Mitigate T2DM Risk? Women with active migraine may have a lower risk of T2DM, suggesting a potential role of both hyperglycemia and hyperinsulinism on migraine occurrence. This French prospective, population-based cohort study included 74 247 women, mean age 61 years at baseline, who were without T2DM. A total of 2372 incident T2DM cases occured during follow-up and women with active migraine had a lower risk of T2DM vs women with no migraine history. There was a linear decrease in active migraine prevalence (22%-11%) during 24 years prior to a DM diagnosis, after adjustment for potential T2DM risk factors. A plateau of migraine prevalence of around 11% was observed for 22 years after diagnosis.

Author's Insights. "We observed a lower risk of developing T2DM for women with active migraine and a decrease in active migraine prevalence prior to DM diagnosis. Further targeted research should focus on understanding the mechanisms involved in explaining these findings," Guy Fagherazzi, PhD.

For more information: Fagherazzi G, El Fatouhi D, Fournier A, et al. Associations between migraine and type 2 diabetes in women: Findings from the E3N cohort study. JAMA Neurol. 2018.

Fasting for Lab Tests May Lead to Hypoglycemia

Fasting-evoked Hypoglycemia Overlooked. This study, conducted at 2 endocrinology practices in Michigan, involved 525 DM patients who completed a simple, 2-page survey inquiring about hypoglycemic events while fasting for labs in the preceding 12 months. Complete data was analyzed for 363 patients with a mean age of 60.6 years. A total of 62 patients reported having experienced ≥1 FEEHD event/s in the prior 12 months and 269 patients were at a higher risk of FEEHD (on insulin secretagogues or insulin). Of those 269 patients, 59 reported experiencing FEEHD; 33 recalled having contacted a provider regarding events; and 22 indicated having received some sort of prevention instructions.

Author's Insights. "We encourage patients who receive orders for a lab test to ask their doctor if fasting is really necessary, and if so, how they should handle their DM medications during the fasting period to account for the changes in their blood sugar levels," Saleh Aldasouqi, MD.

For more information: Aldasouqi S, Mora S, Bhalla G, et al. Fasting-evoked en route hypoglycemia in diabetes (FEEHD): An overlooked form of hypoglycemia in clinical practice. Int J Endocrinol. 2018;2018:1528437.

Gut Microbiome Influences Metabolism of Diabetes Drugs

Gut Bacteria Impact OAD Metabolism and Vice Versa. A review of >100 currently published studies in humans and rodents examined how gut bacteria either enhances or inhibits the effectiveness of antidiabetic drugs. Before being absorbed into the bloodstream, many orally administered drugs are processed by intestinal microbial enzymes, and the gut microbiome influences the metabolism of the drugs. The review found that certain drugs work well when given intravenously and go directly into the circulation, but do not work as well when taken orally and pass through the gut. Conversely, metformin works best when given orally, but does not work when given intravenously.

Author's Insights. “Our review showed that the metabolic capacity of a patient’s microbiome could influence the absorption and function of these [antidiabetic] drugs by making them pharmacologically active, inactive, or even toxic. We believe that differences in an individual’s microbiome help explain why drugs will show a 90% or 50% optimum efficacy, but never 100%," Hariom Yadav, PhD.

For more information: Whang A, Nagpal R, Yadav H. Bi-directional drug-microbiome interactions of anti-diabetics. EBioMedicine. 2018;S2352-3964:30550-30554.