Breaking News: Type-2 Diabetes May Be An Autoimmune Disease

Type-2 diabetes is characterized by the gradual development of insulin resistance, which affects the ability of the body to properly metabolize glucose. It's associated with being overweight, but it can also have a genetic component. But despite the fact that millions of people have type-2 diabetes, the root cause of the insulin resistance is not known

Today, Stanford researchers reported that type-2 diabetes islooking more and more like an autoimmune disease, rather than a strictly metabolic disorder.

"The main point of this study is trying to shift the emphasis in thinking of type 2 diabetes as a purely metabolic disease, and instead emphasize the role of the immune system in type 2," says the study’s co-first author Daniel Winer, MD.

Commenting on the findings, Dr. David Kendall, chief scientific and medical officer for the American Diabetes Association, said, “This doesn't change our current approach to type 2 diabetes therapy, but it's important to understand that type 2 has multiple contributors to its onset. For some people, it may be an immune component, and if it is, we should be able to develop some better therapies."

"People with type 2 diabetes are often blamed for bringing the disease on, but it's a combination of genetic and physiological factors exposed to a certain environment. And, this study points out what may be another important biologic factor," he added.

Be that as it may, these findings ‒ published online April 17 in the journal Nature Medicine ‒ will change the way people think about obesity, and will likely impact medicine for years to come as physicians begin to switch their focus to immune-modulating treatments for type-2 diabetes.

Although the causes of type 2 haven't been clear, it's known that the disease runs in families, suggesting a genetic component. Also, while type 2 is strongly linked to increased weight, not everyone who is overweight gets type 2 diabetes. And, that's what got the researchers searching for another factor.

In 2009, Daniel Winer (along with his twin brother Shawn) showed that T- cells of the immune system were involved in people developing insulin resistance. They have now discovered that another immune cell, called a B-cell, also plays an important role.

Winer explained that excess weight has been linked to inflammation, which can cause the immune system to react. As visceral fat (abdominal fat) expands, it eventually runs out of room. At that point, the fat cells may become stressed and inflamed, and eventually the cells die. When that happens, immune system cells known as macrophages come to sweep up the mess.

Other immune system cells, known as T-cells and B-cells, also respond to the stressed or dying cells. But, these cells are the ones that create specific antibodies to remember a threat to the body. For example, these are the cells responsible for creating immunity when you're exposed to a certain flu virus.

In this case, however, instead of creating antibodies against a foreign substance, immune system cells ‒especially the B cells ‒ create antibodies against fat cells. Those antibodies then start attacking the fat cells, making them insulin resistant and hindering their ability to process fatty acids. In addition to type 2 diabetes, this onslaught against the fat cells is associated with fatty liver disease, high cholesterol and high blood pressure, according to the researchers.

The researchers found that mice genetically engineered to lack B cells were protected from developing insulin resistance even when they grew obese on the high-fat diet (60 percent fat). However, injecting these mice with B cells or purified antibodies from obese, insulin-resistant mice significantly impaired their ability to metabolize glucose and caused their fasting insulin levels to increase.

Interestingly, treating the mice with a compound called anti-CD20, which targets mature B cells for destruction, kept the animals from developing insulin resistance. The human version of anti-CD20, called rituximab, is already FDA-approved to treat some blood cancers and autoimmune disorders.

The researchers also tested blood samples from 32 obese humans. Half had insulin resistance. Those who were insulin-resistant had a distinct set of antibodies compared to the antibodies found in those without insulin resistance. This, according to Winer, suggests the possibility of developing a vaccine for type 2 diabetes based on what appear to be protective antibodies in those who are obese but not insulin-resistant.

Pointing out the mice and the human volunteers were all male, Winer said it's not clear if these findings are applicable to women. He also noted that anti-CD20 is not benign ‒ it dampens the immune system and can cause significant side effects, it’s not certain if it would ever be used for type 2 diabetes because other treatments are available.

Sources: Stanford News, HealthDay, Nature Medicine

"Metreleptin Treatment Leads to Long-Term Improvements in Diabetes and Lipid Control in Patients with Lipodystrophy"

RESULTS from a new analysis of an ongoing, long-term research study of the investigational drug metreleptin, an analog of the human hormone leptin, demonstrated robust reductions in HbA1c levels and triglycerides that were sustained for several years of treatment in patients with lipodystrophy.

Lipodystrophy

“Lipodystrophy is a rare, debilitating chronic disease with a large, unmet clinical need. No therapies are indicated specifically for the treatment of the metabolic abnormalities associated with lipodystrophy,” Christian Weyer, MD, senior vice president, research and development, Amylin Pharmaceuticals, said at a late-breaking oral session on April 17 at the 20th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists (AACE) in San Diego.

In the study, which has been ongoing for more than 10 years, researchers at the NIH are examining the effects of metreleptin on several metabolic abnormalities, such as diabetes and hypertriglyceridemia, in patients with rare inherited or acquired forms of lipodystrophy.

[Amylin recently submitted the clinical and nonclinical sections of a rolling Biologics License Application (BLA) for metreleptin to treat diabetes and/or hypertriglyceridemia (high levels of triglycerides in the bloodstream) in patients with rare inherited or acquired forms of lipodystrophy. If approved, metreleptin would be the first therapy indicated specifically for the treatment of diabetes and high triglycerides in patients with lipodystrophy, and the first approved therapeutic use of leptin.]

Weyer presented results of an analysis of 55 patients with lipodystrophy who were assigned to metreleptin. According to the researchers, this is the largest cohort to date. At baseline, 75% of patients had uncontrolled diabetes (HbA1c ≥7%) and 75% had hypertriglyceridemia (≥200 mg/dl).

“When metreleptin was introduced as a subcutaneous injection once or twice a day, both HbA1c and triglycerides fell very rapidly and profoundly in the first 4 months of therapy,” Weyer said. When patients were followed to 3 years, the changes were maintained. In the patients with diabetes, mean HbA1c decreased from 9.4% at baseline to lower than 7% at year 3. In the patients with hypertriglyceridemia, mean triglyceride concentrations decreased from 500 mg/dl to under 200 mg/dl at year 3.

Weyer said adverse events were consistent with known comorbid conditions of lipodystrophy, including pancreatitis, proteinuria and autoimmune/chronic hepatitis, or expected pharmacological effects of metreleptin, such as weight loss or insulin-induced hypoglycemia in the setting of improved insulin sensitivity in patients taking high doses of insulin.

Other studies conducted worldwide have demonstrated metreleptin’s positive effects on insulin sensitivity, high triglycerides, hyperglycemia and liver fat in patients with lipodystrophy who are not responsive to conventional lipid and glucose-lowering agents, the researchers said. Amylin is working with the FDA to get approval of metreleptin. If approved, it would be the first therapy indicated specifically for the treatment of diabetes and hypertriglyceridemia in patients with lipodystrophy.

Commenting on Weyer’s remarks, AACE President Elect Yehuda Handelsman, MD, said:

This whole thing about leptin is fascinating, and I think there is so much more to learn about it. (News about) leptin is everywhere: it is related to bone, it turns out, it is related to smell, taste and hunger. We found out from Dr. Unger (here at the meeting) that it suppresses glucagon terrifically.

Dr. Weyer represents an organization that has a drug called exenatide (Byetta), a glucagon-like peptide 1 that we also think in some way suppresses glucagon. It will be interesting to know if there is any relationship between the leptin suppression and glucagon suppression. We can see now that leptin, in the rarest disease, may be more applicable to a larger group of people that may have partial lipodystrophy, and we don’t as yet know how to recognize it.

Diabetes: “Welchol Added to Existing Diabetes Therapy Achieves Better Glucose Control”

WHEN used in combination with certain antidiabetes medications, colesevelam effectively lowers HbA1c levels in adults with type 2 diabetes, reports Endocrine Today. Colesevelam was approved by the FDA in 2008 for use in combination with metformin (Glucophage), sulfonylureas (Amaryl, DiaBeta, Glucontrol)) and insulin to improve glycemic control in adults with type 2 diabetes.

Harold Bays, MD

Although originally developed as an agent to lower LDL, data from three clinical trials demonstrated that colesevelam (Welchol, Daiichi Sankyo) improved glucose levels in adults with type 2 diabetes, Harold Bays, MD, medical director and president of the Louisville Metabolic and Atherosclerosis Research Center in Kentucky, said during a session of the American Association of Clinical Endocrinologists 20th Annual Meeting in San Diego this week.

Compared with placebo, when added to metformin, insulin and sulfonylureas, colesevelam led to 0.5%, 0.6% and 0.8% reductions in HbA1c levels, respectively, he said. “We did one set of clinical trials with metformin-based therapy, insulin and sulfonylureas…What’s really interesting when we look at the data is that, while these are somewhat different agents, reductions in HbA1c were remarkably similar,” Bays told the audience.

To further evaluate the efficacy of colesevelam, researchers conducted a pooled post-hoc analysis of the three pivotal studies of the drug in patients with type 2 diabetes. In total, the number of patients in the treatment group increased to 355. Results indicated that when added to metformin-based therapy, colesevelam significantly reduced cholesterol levels, improved glycemic parameters and exhibited a good safety profile.

“We found almost exactly what could be anticipated from the original trials,” Bays said. “Data showed reductions in HbA1c, fasting glucose levels, LDL, non-HDL and a nonsignificant increase in HDL and moderate increases in triglycerides.”

Colesevelam was also generally well-tolerated, Bays said. A moderate increase in constipation was the most notable side effect, with 10% to 13% of patients experiencing constipation vs. 2% to 3% in the placebo group. Other common adverse events included nausea, dyspepsia and nasopharyngitis (common cold). In studies involving pediatric populations with heterozygous familial hypercholesterolemia, adverse reactions included nasopharyngitis, headache, fatigue, increases in creatine phosphokinase, rhinitis and vomiting.

Prescribing information for colesevelam recommends against use in patients with a history of bowel obstruction, triglyceride levels greater than 500 mL or with a history of hypertriglyceridemia-induced pancreatitis. Bay emphasized that strict adherence to these indications is important for preventing adverse events and use of clinical judgment.

“We cannot look to these clinical trials for blanket safety information for all patients,” Bays said. “The results are only applicable to those patients who were administered the drug in keeping with the study populations.”

Calorie Labeling and Mandated Food Choices: Can Such Strategies Work?

EARLIER this month Boston's mayor Thomas M. Menino issued an executive order to phase out sugary drinks from all city property earlier this month.

Subsequently, the Boston Public Health Commission has applied the familiar red, yellow and green labels to sugary drinks in its "Stop-Rethink Your Drink-Go On Green" campaign against sugary drinks.

"Red" beverages include non-diet sodas, sweetened ice teas, sports drinks, etc. Diet sodas and diet iced teas, 100 percent fruit juices and low calorie sports drinks qualify as "yellow" beverages, while "green" drinks mean bottled water, low fat milk or unsweetened soy milk.

Boston's not alone in trying to combat obesity through mandated choices. Cities like San Francisco, San Antonio, Seattle, Los Angeles County and New York City have also set standards to limit or prohibit the sale or distribution of unhealthy food ‒ including sugary drinks.

Soda and other sugar-sweetened beverages account for up to 10 percent of total calories consumed in the U.S. diet, and are known to be major contributors to obesity. And a Huff Post report claims there's some proof this type of food policing works.

However, while mandated choice may make an impact on consumption behavior, posting calorie counts to change purchasing behavior may not work, and may actually backfire in some consumers, according to a recent report from researchers at Maastricht University and New Mexico State University and published in the American Journal of Clinical Nutrition.

The report looked at imposing junk-food taxes and posting calorie counts as strategies for combating obesity.

Researchers talked to 178 university students and asked them three times to choose from a list of hypothetical lunch items, of which the high-fat choices had varying prices. Some participants were also provided with calorie information; others were not. In addition, those interviewed were categorized as either restrained or unrestrained eaters. Restrained eaters were those that regularly limited their caloric intake.

Participants were given either $10 or $20 and asked not to exceed those amounts in their lunch purchases during the three times they were asked to do so. The first time, the prices on the menu were based on the prices of the school cafeteria.

The second time, prices for high-calorie products were raised to 125% of the base price, and the third time, prices were raised to 150% of the base price. This study did not include actual calorie consumption – only potential calorie purchases.

While researchers thought they would find an inverse relationship between price and caloric intake, they learned that this association was rather complex and dependant on other factors – i.e. if caloric information was provided and if the consumer was a restrained or unrestrained eater.

When faced with a junk-food tax, unrestrained eaters decreased their caloric intake, regardless of if caloric information was provided or not. On the other hand, pricier foods only dissuaded restrained eaters when caloric intake was not provided.

“Our results suggest that if one wants to help people in general to prevent caloric overconsumption then imposing a high tax on high energy dense food items is much more efficacious than providing calorie-information,” says Dr. Janneke Giesen, Faculty of Psychology and Neuroscience at Maastricht University and a study co-author.

As expected, the food tax did reduce the amount of calories people bought, but this effect was limited to consumers that did not receive calorie information.

Interestingly, the food tax effect existed regardless of the amount of money a participant had to spend, even though those with $20 to spend purchased more calories than those with $10 to spend. Still, the results also suggest that people will not substitute the purchase of expensive high-calorie foods for cheaper low-calorie foods based on price alone. 

In the case of the restrained eater, they may continue to buy a product as long as they can afford it. A restrained eater provided with caloric information will make the necessary adjustments in their caloric intake and adjust the energy content of their lunch, regardless of taxes inflicted.

Dr. Collin R. Payne, Assistant Professor of Marketing at New Mexico State University and a study co-author, says that this study speaks to the problem of a "one-size-fits-all" policy strategy.

That is, in this study, it took a tax of over 25% to change potential calorie purchases significantly, but that tax increase didn't change potential calorie purchasing for those who are most sensitive to calorie consumption and who received calorie information.

In other words, for those who would most benefit from a food tax and calorie information, it didn't help.

Payne continues, “The benefit of caloric posting may be simply that the company posting calories may be seen as more transparent and less likely to trick consumers into purchasing their food. The drawback, as seen in this study, is it is difficult to predict how multiple policy measures interact, sometimes leading to less health food consumption, and sometimes leading to more.”

Giesen says that it’s possible that a large junk food tax could work in combating obesity. It is not clear, though, whether a smaller tax, which is perhaps politically more viable, would help in decreasing obesity rates too – or if it could potentially backfire.

More research is needed to determine the relationship of lower taxes on food purchasing choices. The relationship between caloric information and taxing should be further examined as well, he said.

“As noted by Dr. Loewenstein in the editorial, ‘Confronting reality: Pitfalls of Calorie Posting,’ in the same issue of the American Journal of Clinical Nutrition as our paper, it could be possible that for some people calorie posting may actually increase caloric intake, as in the case of low-income individuals who try to get the most calories for their money,” says Giesen. “Of course this needs to be tested first before we can conclude if this is really the case.”

Payne adds that, for their part, retailers could pair with academic researchers to understand – for their target market – what combination of tools would lead to the best possible health outcome for their shoppers.

Shoppers could then be provided with informational surveys that provide them with what is known about labeling and taxing foods, and would allow them to better accomplish their goals in the supermarket.

“The benefit of a junk-food tax is decreasing less nutritious food consumption and raising public funds to help defer health costs related to obesity and obesity related diseases associated with their over-consumption,” says Payne.

“However, junk-food taxes – at a minimum level – may only stimulate demand, and – at a maximum level – reduce consumption at the expense of the food industry and result in concerns about consumer freedom of choice.”

In this context, it remains to be seen whether Boston’s "Stop-Rethink Your Drink-Go On Green" campaign will actually succeed in arresting the city’s obesity epidemic. After all, Mayor Menino’s mandate covers only city properties and not the entire metropolitan area.

How Fatty Foods Lead to Diabetes

Findings provide further evidence of importance of choosing foods low in unhealthy saturated fats

FINALLY, new research from the University of North Carolina at Chapel Hill School of Medicine adds clarity to the connection between high saturated fat diet and type 2 diabetes.

Several decades ago scientists noticed that people with type 2 diabetes have overly active immune responses, leaving their bodies rife with inflammatory chemicals. In addition, people who acquire the disease are typically obese and are resistant to insulin, the hormone that removes sugar from the blood and stores it as energy.

But for years no one has known exactly how the connection between high levels of body fat (obesity), inflammation and insulin resistance, three factors that are known to increase type 2 diabetes risk.

The Chapel Hill study has found that saturated fatty acids ‒ but not the unsaturated type ‒ can activate immune cells to produce an inflammatory protein, called interleukin-1beta. 

Using mouse cell lines (in vitro) and genetically engineered (defective inflammasome pathway) and wild-type mice (in vivo), the researchers found that intake of the saturated fatty acid palmitate, activates the NLRP3-ASC inflammasome-triggering production of IL-1beta, as well as the additional inflammatory factors caspase-1 and IL-18.

The activation of the inflammasome then impairs insulin signaling in several target tissues, such as muscle and adipose fat, thus reducing glucose tolerance and insulin sensitivity. IL-1beta also affects insulin sensitivity through tumor necrosis factor-α-independent and dependent pathways. When fed with a high-fat diet, mice with a defective inflammasome pathway had better maintenance of glucose homeostasis and higher insulin sensitivity.

The Chapel Hill researchers found that induction of the inflammasome by saturated palmitate is distinguished by its use of the AMP-activated protein kinase and unc-51-like kinase-1 autophagy-signaling pathways, and the presence of mitochondrialreactive oxygen species.

"The cellular path that mediates fatty acid metabolism is also the one that causes interleukin-1beta production. Interleukin-1beta then acts on tissues and organs such as the liver, muscle and fat (adipose) to turn off their response to insulin, making them insulin resistant. As a result, activation of this pathway by fatty acid can lead to insulin resistance and type 2 diabetes symptoms,” explains senior study co-author Jenny Y. Ting, PhD, William Kenan Rand Professor in the Department of Microbiology and Immunology

In layman terms, a diet rich in saturated fat, in addition to causing weight gain, activates certain cells of the immune system, instructing them to produce a protein called interleukin-1beta. This molecule is known to cause inflammation throughout the body.

This molecular complex inside cells, called the inflammasome, plays an important role in immunity by triggering inflammation in response to a wide variety of harmful agents ranging from bacteria to asbestos. This inflammation, in turn, affects the tissue of muscles, the liver and other organs, impairing their ability to react to insulin. This characteristic is one of the hallmarks of type 2 diabetes

Ting and colleagues have found that palmitate, a fatty acid common in a high fat diet, triggers activation of the inflammasome. Palmitate-triggered inflammation is also responsible for interfering with the insulin sensitivity of liver cells ― a major feature of type 2 diabetes.

In addition to explaining a poorly understood set of processes that were known to increase type 2 diabetes risk, the findings also provide further evidence of the importance of choosing foods low in unhealthy saturated fats. The researchers found that unsaturated fats, like omega-3s, did not activate this process.

Individualized Care Plans Important for Treating Diabetes, Says AACE

The American Association of Clinical Endocrinology (AACE) on April 14 released new clinical practice guidelines for developing comprehensive care plans for patients with type 1 and type 2 diabetes mellitus, developed by a panel of 23 of the leading diabetes experts in the U.S.

Debunking one-size-fits-all care plans, the guidelines emphasize the importance of achieving a treatment plan that avoids hypoglycemia, now considered to be a continual and pressing concern for many patients with diabetes. The implications of the new guidelines for practicing physicians, as well as new data on low blood sugar in patients with diabetes, are being discussed at the AACE 20th Annual Meeting and Clinical Congress, now in session in San Diego.

Caring Doctors Improve Patients' A1c, LDL Scores

The new AACE guidelines are also published in supplement 2 of the March/April issue of the association's official medical journal, Endocrine Practice.

The guidelines emphasize a personalized approach to controlling diabetes and achieving blood glucose targets with care plans that take into account patients' risk factors for complications, comorbid conditions, and psychological, social, and economic status. Although the guidelines recommend a blood glucose target of an HbA1c level of 6.5%, if it can be achieved safely, a treatment plan should take into account a patient's risk for the development of severe hypoglycemia.

CGM is the New Standard

The new guidelines also provide information on the appropriate use of new technologies such as insulin pumps and continuous glucose monitoring, as well as managing conditions that may not be immediately obvious to treating physicians, such as sleep and breathing disturbances and depression.

Millions Risk Early Death Because of Poor Diagnosis and Ineffective Treatment

In a statement, Yehuda Handelsman, MD, AACE president-elect and co-chair of the AACE Diabetes Guidelines Writing Committee, said that it was crucial for physicians to address not just hyperglycemia in patients with diabetes but also associated cardiovascular risk factors. "These state-of-the-art guidelines provide the most up-to-date evidence-based answers to real-life (clinical) questions," Dr. Handelsman said.

Tight Cholesterol, BP Control Does Little Good for Diabetics

In the guidelines, AACE recommends comprehensive diabetes lifestyle management education at the time of diagnosis, as well as throughout the course of diabetes. The importance of medical nutrition therapy, physical activity, avoidance of tobacco products, and adequate quantity and quality of sleep should be discussed with patients who have prediabetes, as well as type 1 and type 2 diabetes, according to the new guidelines.

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Hypoglycemia: Many Diabetics Do Not Know Most Common Symptoms Like Dizziness and Shakiness Linked to Low Blood Sugar

NEW survey data released today at the American Association of Clinical Endocrinologists (AACE) 20th Annual Meeting and Clinical Congress reveal that more than half (55%) of people with type 2 diabetes across the country report they have experienced hypoglycemia, or low blood sugar. But, surprisingly, many patients remain uneducated about the risks for hypoglycemia.

The survey also highlighted why hypoglycemia may be more of a health hazard than previously reported, as patients said they often experience low blood sugar during daily activities such as working and driving. Indeed, hypoglycemia has clear risks, as well as being an expensive burden for the healthcare system.

This survey of 2,530 adults diagnosed with type 2 diabetes assessed patients’ personal experience with and knowledge about low blood sugar, and was conducted online in November and December 2010 by Harris Interactive. (See details below)

Hypoglycemia occurs when the level of glucose in the blood is too low for the body’s needs. Symptoms that may be caused by low blood sugar include nervousness or anxiety, shakiness, sweating, tiredness, confusion, hunger, fast heartbeat and dizziness. Low blood sugar usually is caused by eating less or later than usual, changes in physical activity, or a diabetes medicine that is not matched to your needs.

Many diabetics experienced hypoglycemia during typical daily activities such as working (42%), exercising (26%) and driving (19%), according to the survey designed by the American College of Endocrinology (ACE). Recognizing symptoms like nervousness, sweating or shakiness before engaging in common activities is important to help reduce the risk of serious consequences, such as fainting or loss of consciousness.

(These eye-popping results can be extrapolated to other countries as well. I mean, if this is happening in America where the level of diabetes awareness is high thanks to a widespread education program, one can only speculate about the scenario in less developed countries like India and China.) 

Hypoglycemia: Don'y Rely on the Doctor's Prognosis - Tell Him What Needs to be Done to Save Your Life

The fact that patients with diabetes experience hypoglycemia while working and driving is especially problematic, as these activities require focus and concentration, and experiencing hypoglycemia during driving can be life-threatening, said Etie Moghissi, MD, vice president and president-elect of AACE, and an associate clinical professor of medicine at the University of California in Los Angeles, at a press conference.

Although the study clearly showed that at least half (52%) of the patients surveyed were concerned about experiencing a future episode of hypoglycemia, some did not know that the most common symptoms are dizziness (22%) and shakiness (17%), and 39% incorrectly thought that thirst was the primary symptom of hypoglycemia. "Many patients are unable to name the leading causes of hypoglycemia, which is also a great cause for concern," Moghissi confirmed.

Low blood sugar can be caused by skipping meals or irregular mealtimes, sudden increase in or excessive exercise, or certain diabetes medications. In this survey, a number of patients with type 2 diabetes were unable to identify the leading causes, including skipping meals, such as breakfast (27%), and certain diabetes medications (35%). Forty-six percent of patients with type 2 diabetes also remained unaware that excessive exercise may bring on hypoglycemia, particularly when combined with some medications for type 2 diabetes.

These results suggest there is a need for better education and understanding of the common causes, signs and symptoms of low blood sugar. Learning to recognize the symptoms of low blood sugar and quickly treating them is important – symptoms may be mild at first but may worsen quickly if not treated. According to the survey, 6 percent of patients with type 2 diabetes have had to go to the emergency room at some point as a result of low blood sugar.

To help bridge this knowledge gap, ACE recently launched the Blood Sugar Basics program, which aims to help people living with diabetes, their families and loved ones learn about the importance of understanding and managing low and high blood sugar. While the program is focused on type 2 diabetes, the most common type of diabetes, it also may be useful for people with other types of diabetes.

Although hypoglycemia has long been known to be a risk associated with diabetes and its treatment, it often falls under the radar of busy physicians, particularly those in primary care, who may be treating patients for other conditions, Moghissi noted. "The survey shows that it's important to inform patients about the causes, symptoms, and how to address hypoglycemia," Moghissi stressed.

“Low blood sugar can be an alarming experience for people with type 2 diabetes, and failure to recognize and treat symptoms in a timely manner can cause serious complications,” says Moghissi, adding, “Low blood sugar can be avoided, so it’s important for patients to know what can cause blood sugar levels to drop and talk with their doctor about how they can reduce the frequency of future episodes.”

The need for emergency care is just one of the potential consequences resulting from untreated low blood sugar. The survey also indicated that about one in five (21%) patients who have experienced it have needed assistance from others. It is important that patients and their friends, family and caregivers recognize and understand the symptoms of low blood sugar and what to do if it occurs.

Survey Design
This survey was conducted online by Harris Interactive between November 17 and December 14, 2010, among 2,530 adults diagnosed with type 2 diabetes mellitus in the United States. This included 1,308 nationally sampled respondents, as well as oversamples in the following metropolitan statistical areas (MSAs): Cleveland (n=261), Dallas (n=208), Detroit (n=222), Houston (n=211), St. Louis (n=200), San Diego (n=120). Results were weighted as needed for age, sex, race/ethnicity, education, region and household income. Propensity score weighting also was used to adjust for respondents’ propensity to be online. A full methodology is available upon request. The survey was developed by the American College of Endocrinology (ACE) and supported by Merck.

About Blood Sugar Basics
Blood Sugar Basics is an educational program aimed to help people living with diabetes, their families and loved ones learn about the importance of blood sugar control as part of a successful diabetes treatment plan. The program was developed by the American College of Endocrinology (ACE) and supported by Merck.