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New Study Aims to Understand Long-term Effects of Diabetes Medications

Glycemic Reduction Approaches in Diabetes: A Comparativeness Effectiveness Study (GRADE) logo.

The National Institutes of Health (NIH) is looking for volunteers to take part in a study to compare the long-term benefits of four widely used diabetes drugs in combination with metformin, the most common first-line medication for treating type 2 diabetes. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) launched the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) in June 2013. The researchers hope to recruit 5,000 participants at 37 sites.

The goal of this large trial is to understand which combinations of medications are most likely to maintain goal glucose (blood sugar) levels over time, to identify the most effective means of treating type 2 diabetes if metformin alone is not enough. The study will compare drug effects on glucose levels, adverse effects, diabetes complications, and quality of life over an average of nearly 5 years. The researchers hope to be better able to guide physicians as they make treatment decisions for their patients with diabetes.

Large NIH Study to Examine if Vitamin D Prevents Type 2 Diabetes

Researchers have begun the first definitive, large-scale clinical trial to investigate if a vitamin D supplement helps prevent or delay type 2 diabetes in adults who have prediabetes, a condition that puts them at risk for developing type 2.

The multiyear Vitamin D and Type 2 Diabetes (D2d) study leaving site icon will include about 2,500 people at 20 study sites across the United States. Its goal is to learn if vitamin D—specifically D3 (cholecalciferol)—will prevent or delay type 2 diabetes in adults age 30 or older with prediabetes. People with prediabetes have blood glucose levels that are higher than normal but not high enough to be called diabetes.

Researchers are recruiting volunteers to take part in D2d. Half of the participants will receive vitamin D. The other half will receive a placebo—a pill that contains no medication. Participants will have check-ups for the study twice a year, and will receive regular health care through their own health care providers.

“An estimated 79 million Americans have prediabetes, and nearly 26 million more have diabetes,” said NIDDK Director Griffin P. Rodgers, M.D., M.A.C.P. “With D2d, we seek evidence for an affordable and accessible way to help prevent or delay type 2 diabetes.”

New and Updated Publications

Recent Issues

January 2014

NIH Awards Human Microbiome Project Phase II Grants

The bacterium Enterococcus faecalis, which lives in the human gut.

To better understand how and why alteration of the normal microbiome at various body sites promotes diseases, the National Institutes of Health (NIH) will fund three innovative research projects for the next 3 years. These projects constitute the second phase of the Human Microbiome Project (HMP), begun in 2007. The first phase of the HMP focused on the composition and genetic potential of the microbial communities of major regions of the body and how these communities differ in health and for various diseases.

Second-phase research teams will use genomics and other “omics” technologies to measure the biochemical activities of these microbial communities. Researchers hope to determine how microbes influence the physiology of the human host within which they reside.

One joint project will examine the microbes in the gut and nose and determine how alteration in certain microorganisms may trigger the development of diseases such as diabetes. A second joint project will assess the populations and physiological activities of gut microbes in people with Crohn’s disease and ulcerative colitis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) will manage these grants.

A third project will study bacteria that live in the vagina and assess the roles these bacteria play in health and disease in pregnant women as well as in their babies, particularly for preterm birth. The Eunice Kennedy Shriver National Institute of Child Health and Human Development will manage this grant.

Tips for Finding Reliable Health Information Online

Finding accurate, reliable, and current health information online can be difficult and overwhelming. The Internet has a wealth of health information—some information is true and accurate, and some is not.

Here are a few things to keep in mind when visiting a website:

  • Websites should have a way to contact the organization or webmaster. If the site provides no contact information or it is not clear who runs the site, use caution.
  • Beware of claims that offer one cure for a variety of illnesses, like a breakthrough or secret ingredient.
  • Look for latest findings from research, not an individual’s opinion.
  • And, always remember to write down questions to bring to doctor visits.

Several Government resources offer additional tips when searching for online health information:

NIDDK Healthy Moments image

NIDDK Healthy Moments Series
Healthy Moments is an annual series of weekly radio episodes featuring National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Director Griffin P. Rodgers, M.D., M.A.C.P. Each week, Dr. Rodgers provides tips on how to prevent and manage a variety of diseases and conditions.

MedlinePlus image

MedlinePlus Guide to Healthy Web Surfing
This page includes suggestions for evaluating the quality of health information on websites.

National Library of Medicine image

Evaluating Internet Health Information: A Tutorial from the National Library of Medicine
This 16-minute tutorial from the National Library of Medicine (NLM) teaches consumers to evaluate the health information found on the Web.

National Library of Medicine image

FAQ: Reference & Consumer Health Questions
This page from the NLM provides health information and NLM resources based on frequently asked consumer health questions.

National Center for Complementary and Alternative Medicine image

Finding and Evaluating Online Resources on Complementary Health Approaches
This guide from the National Center for Complementary and Alternative Medicine provides help for finding reliable websites, and outlines things to consider in evaluating health information from websites and social media sources.

National Cancer Institute image

Evaluating Online Sources of Health Information
The National Cancer Institute provides a list of questions for consumers to ask when looking for cancer information online. A video from the Federal Trade Commission is included.

National Institute on Aging image

Online Health Information: Can You Trust It?
The National Institute on Aging provides information for older adults on finding reliable sources of health information online.

New and Updated Publications

September 2013

Late September

NIH-funded Study Finding: Lifestyle Intervention Does Not Lower Heart Disease Risk from Type 2 Diabetes

Photo of an older man walking on a treadmill with a doctor in a white coat standing next to the treadmill looking at the contents of a folder.

The Look AHEAD (Action for Health in Diabetes) study found that an intensive diet and exercise program resulting in weight loss does not reduce cardiovascular events such as heart attack and stroke in people with longstanding type 2 diabetes.

The study, supported by the National Institutes of Health (NIH), tested whether a lifestyle intervention resulting in weight loss would reduce rates of heart disease, stroke, and cardiovascular-related deaths in overweight and obese people with type 2 diabetes, a group at increased risk for these events. Researchers compared the intensive lifestyle intervention with a general intervention of diabetes support and education. The study includes 5,145 participants at 16 centers across the United States. The intervention was stopped after up to 11 years of follow-up because participants in both the intervention and control arms had similar rates of cardiovascular disease events.

Participants in the lifestyle intervention were able to lose weight and sustain much of that weight loss throughout the study. They lost over 8 percent of their initial body weight at 1 year and 6 percent at the time the study ended, compared with less than 1 percent and 3.5 percent of those in the diabetes support and education group. Although the lifestyle intervention did not reduce rates of cardiovascular events, it has shown a number of health benefits, including improving sleep apnea, reducing the need for diabetes medications, improving quality of life, and helping to maintain physical mobility.

Researchers will continue to follow long-term outcomes of all Look AHEAD participants.

NIH-funded Study Finding: CABG Has Advantages over PCI in Adults with Diabetes and Multivessel Coronary Heart Disease

Adults with diabetes and multivessel coronary heart disease who underwent coronary artery bypass graft (CABG) surgery had fewer adverse events and better survival rates than those who received percutaneous coronary intervention (PCI) with drug-eluding stents. The 5-year study, funded by the NIH, included 1,900 participants.

"The advantages of CABG over PCI were striking in this trial and could change treatment recommendations for thousands of individuals with diabetes and heart disease," said principal investigator Valentin Fuster, M.D., Ph.D.

New and Updated Publications

Early September

Dr. Thomas E. Starzl Wins 2012 Lasker Award

Image of Dr. Thomas E. Starzl and NIDDK Director Dr. Griffin P. Rodgers

Dr. Thomas E. Starzl, the first person to perform a human liver transplant, received the 2012 Lasker-DeBakey Clinical Medical Research Award—shared with Dr. Roy Calne, University of Cambridge emeritus—on September 21, 2012, for his work in developing liver transplantation. Dr. Starzl is a distinguished service professor of surgery at the University of Pittsburgh School of Medicine and longtime National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grantee. He has also served on the NIDDK Digestive Diseases Advisory Board.

“Dr. Starzl is a pioneer in the world of transplantation, and his work has saved thousands of lives,” said NIDDK Director Griffin P. Rodgers, M.D., M.A.C.P. “This award is a most fitting recognition of his many years of unwavering commitment to teaching, research, and clinical practice.”

2012 Nobel Prize in Chemistry Awarded to Two NIH Grantees

The 2012 Nobel Prize in chemistry was awarded jointly to National Institutes of Health (NIH) grantees Robert J. Lefkowitz, M.D., of the Howard Hughes Medical Institute and Duke University Medical Center, and Brian K. Kobilka, M.D., of the Stanford University School of Medicine, for groundbreaking discoveries on G-protein-coupled receptors. Dr. Lefkowitz has received support from the National Heart, Lung, and Blood Institute (NHLBI) since 1974. Dr. Kobilka has received support from the NHLBI, the National Institute of Neurological Disorders and Stroke, the National Institute of General Medical Sciences, and the National Institute on Drug Abuse since 1990.

"NIH is proud to have supported this work, which began as basic science and ultimately led to dramatic medical advances," said NIH Director Francis S. Collins, M.D., Ph.D.

Many of these advances are relevant to the mission of the NIDDK since hormones that act through these receptors regulate key endocrine and gastrointestinal functions.

August 2013

Late August

NIH-funded Study Finding: Frequency and Severity of Retinopathy in Type 1 Diabetes is Decreasing

A photo of an eye with diabetic macular edema

Two National Institutes of Health (NIH)-funded, population-based studies in the same geographic region looked at the frequency and severity of diabetic eye disease after 20 years of diabetes. A group of 305 subjects from the Wisconsin Diabetes Registry Study (WDRS) received retinal examinations from 2007 to 2011. A group of 583 subjects from the Wisconsin Epidemiological Study of Diabetes Retinopathy (WESDR) received retinal examinations from 1980 to 1996. Researchers found that the frequency and severity of diabetic retinopathy was lower for individuals in the WDRS group compared with those in the WESDR group.

The researchers suggest that more intensive insulin management and diabetes care in recent years appears to have changed the retinopathy prognosis for people with type 1 diabetes. After the Diabetes Control and Complications Trial’s 1993 finding that intensive glucose control was effective in slowing the onset and progression of eye, kidney, and nerve damage, improved health is now evident in people with diabetes as a result of intensive glucose control.

Following people who were enrolled in two population-based studies provided a unique opportunity to compare outcomes of individuals with type 1 diabetes over time. Researchers noted that updated projections should be used when informing newly diagnosed individuals of prognosis and when assessing health care cost.

Study Finding: Prepregnancy Overweight and Obesity Contribute to the Prevalence of LGA Infants

Researchers have found that women with prepregnancy overweight and obesity account for a high proportion of large-for-gestational-age (LGA) infants compared with women of normal weight—even in those who do not develop gestational diabetes mellitus (GDM). Having an LGA infant increases the risk of shoulder injury to the newborn during childbirth. Birth by cesarean section is also more likely to occur with an LGA infant.

The researchers conducted a retrospective study of 9,835 women who delivered at 20 or more weeks’ gestation; had a prenatal 2-hour, 75-g oral glucose tolerance test; and were not treated with diet, exercise, or antidiabetic medications during pregnancy. The women were categorized into six mutually exclusive prepregnancy groups: normal weight with and without GDM, overweight with and without GDM, and obese with and without GDM. Study data suggest that prepregnancy overweight and obesity substantially contribute to the prevalence of LGA infants, as well as other adverse outcomes, in women who never develop GDM. The combination of being overweight or obese and having GDM increased the odds of having an LGA infant even more. Increasing gestational weight gain was associated with a higher prevalence of LGA infants in all groups.

Researchers suggest that interventions that effectively help overweight or obese women lose weight before pregnancy and/or control weight gain during pregnancy, regardless of GDM status, have the potential to reach far more women at risk for having an LGA infant and other adverse outcomes. The Lifestyle Interventions in Expectant Moms study, or LIFE-Moms, conducted by the NIH, is testing several lifestyle interventions to control weight gain in pregnant women who are overweight or obese.


Early August

Panel Supports Maintaining the Current Diagnostic Approach for Gestational Diabetes Mellitus

Photo of a man’s shadow projected onto an electrocardiogram.

An independent panel convened March 4–5 by the National Institutes of Health (NIH) has concluded that despite potential advantages of adopting a new diagnostic approach for gestational diabetes mellitus (GDM), more evidence is needed to ensure that the benefits outweigh the harms. The panel recommended following the current diagnostic approach until further studies are conducted.

“The panel believes that cost-benefit, cost-effectiveness, and cost-utility research is needed to more fully understand the implications of changing diagnostic protocols for GDM,” said Dr. Peter VanDorsten, M.D., conference panel chairperson and Lawrence L. Hester, Jr. Professor, Medical University of South Carolina, Charleston.

NIH-funded Study Finding: After Gestational Diabetes, Women Can Lower Type 2 Diabetes Risk

By sticking to a healthy diet in the years after pregnancy, women who develop diabetes during pregnancy can greatly reduce their risk of developing type 2 diabetes, a study supported by the NIH has found. The risk of developing type 2 diabetes increases greatly in women who have had gestational diabetes compared with women who have not had gestational diabetes.

Women who followed one of three designated diets closely in the years following gestational diabetes reduced their risk of diabetes by about half compared with women who did not follow one of the diets. The study is the first to show that the risk of type 2 diabetes in this population can be reduced solely through dietary intervention.

NIH Launches Study of Long-term Effects of Blood Glucose during Pregnancy

Photo of an albino lab mouse.

Researchers funded by the NIH plan to determine whether elevated blood sugar during pregnancy, a less severe condition than gestational diabetes, influences later levels of body fat in children and development of diabetes in mothers after giving birth. The original study, the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO), looked at 23,316 mother-child pairs and found that a mother’s blood sugar levels, even short of diabetes, were associated with her newborn’s birth weight and body fat.

The HAPO-Follow-up Study (HAPO-FUS) seeks to recruit 7,000 of the original HAPO mother-child pairs for a single visit to one of 10 of the original HAPO clinical centers. Mothers and children (now ages 8 to 12 years) will have their height, weight, blood pressure, body fat, blood sugar, insulin, and blood fats measured.

June 2013

Study Finds Lower Death Rates for People with Diabetes

Photo of a man’s shadow projected onto an electrocardiogram.

Death rates for people with diabetes—especially due to heart disease and stroke—dropped significantly from 1997 to 2006. Although rates of heart disease and stroke are declining for all U.S. adults, researchers at the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) found that the rates are dropping faster for adults with diabetes compared with those without diabetes. Recent CDC studies also found declining rates of kidney failure, lower extremity amputations, and hospitalization for heart disease and stroke among people with diabetes.

Improved medical management of diabetes and heart disease contributed to the decline, as well as prevention efforts such as the National Diabetes Education Program, a joint effort of the CDC and the NIH, and the National Diabetes Prevention Program, a public-private partnership led by the CDC.

NIH Study Shows Big Improvement in Diabetes Control over Past Decades

More people are meeting recommended goals in the three key markers of diabetes control, according to a study conducted and funded by the NIH and the CDC. The measures are A1C—which assesses blood sugar (glucose) over the previous three months—blood pressure and cholesterol.

The report, published online in Diabetes Care, shows that, from 1988 to 2010, the number of people with diabetes able to meet or exceed all three of the measures that demonstrate good diabetes management rose from about 2 percent to about 19 percent. Each measure also showed substantial improvement, with over half of people meeting each individual goal in 2010.

Despite improvement, the results show continued need for better diabetes control. In particular, young people and some minority groups were below average in meeting the goals.

Researchers Induce Beta Cell Gene Expression in Pancreatic Alpha Cells

Photo of an albino lab mouse.

Researchers treating human and mouse cells with compounds that modify cell nuclear material called chromatin have induced the expression of beta cell genes in pancreatic alpha cells.

Diabetes is caused by insufficient numbers of insulin-producing beta cells. Recent studies have noted that alpha cell production of excess glucagon, which elevates blood glucose, is an important feature of diabetes etiology.

The researchers believe that reprogramming alpha cells into beta cells may one day offer a path to cell replacement therapies for type 2 diabetes. Results of the study, funded by the National Institute of Diabetes and Digestive and Kidney Diseases, were published online March 1 in The Journal of Clinical Investigation.

“This would be a win-win situation for diabetics—they would have more insulin-producing beta cells and there would be fewer glucagon-producing alpha cells,” says lead author Klaus H. Kaestner, Ph.D., professor of Genetics and member of the Institute of Diabetes, Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania.

New and Updated Publications

April 2013

Late April

New Diabetes Materials Available for Health Care Instructors, Consumers

Be Active When You Have Diabetes thumbnail image

Be Active When You Have Diabetes, a new booklet and instructor's guide, helps people with diabetes learn about the health benefits of being physically active and ways to increase their activity level. The very easy-to-read booklet, written at a second- to third-grade reading level, contains tools to help consumers create and manage a physical activity plan, record target goals, and track their activities.

Be Active When You Have Diabetes: A Guide for Instructors is the companion instructor's guide developed for use in one-on-one or small group patient education. The flipbook provides color illustrations and simple teaching points on the corresponding instructor pages. The booklet and instructor's guide, from the National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK's) National Diabetes Information Clearinghouse (NDIC), include a list of resources from the NDIC, the National Diabetes Education Program, the NIDDK Weight-control Information Network, and the National Institute on Aging.

NIH Collaborates with India on Diabetes Research Effort

The National Institutes of Health (NIH) is partnering with the Indian Council of Medical Research to collaborate on diabetes research and ways to improve prevention and treatment. The U.S. Department of Health and Human Services signed a joint statement with India's Health and Family Welfare Minister to begin a formal research relationship.

"Both the United States and India have a vested interest in improving our understanding of and treatment for diabetes, and in finding economical ways to do both," said NIDDK Director Griffin P. Rodgers, M.D., M.A.C.P. "Initiating this research relationship will enable both countries to share expertise and engage each other in research to lessen the burden of diabetes—in the U.S., India, and around the world." The NIDDK will lead the U.S. role in the collaboration.

In February 2013, the NIDDK and the Indian Council of Medical Research held a scientific workshop to identify opportunities for collaboration between the two countries in high-priority diabetes research areas of joint interest. A summary of the workshop can be found in the recent NIDDK Director's Update.

NIDDK Seeks Director for the Type 2 Diabetes Prevention Program

The NIDDK is looking for a talented and experienced program officer (medical officer) to serve in the Division of Diabetes, Endocrinology, and Metabolic Diseases (DEM) as director of the Type 2 Diabetes Prevention Program and as a senior scientific advisor to the NIDDK for human subject research in type 2 diabetes. The incumbent would be responsible for the scientific and administrative management of a portfolio that may include multicenter and single-site clinical studies, and for the development of joint research activities with other government organizations.

An appropriate applicant must possess an M.D. or equivalent degree, and expertise in endocrinology, internal medicine, or another specialty relevant to diabetes. Strong candidates should have conducted independent research, and be able to demonstrate the knowledge and insight needed to identify important scientific opportunities in diabetes research and to participate in the design of clinical trials or observational studies. Experience in translational research is also desirable.

The NIDDK Medical Officer vacancy announcement for this position will be posted April 5–16, 2013, at www.jobs.nih.gov/. Search for announcement number NIH-NIDDK-DH-15-855001 in the "Search for NIH Jobs" box.

For questions or information about this and upcoming position openings in DEM for talented medical officers (M.D.) to manage clinical studies and program directors (M.D. or Ph.D.) to help move basic research discoveries toward disease prevention and treatment, please contact DEM Director Dr. Judith Fradkin at fradkinj@mail.nih.gov.

Find other exciting new job opportunities at the NIDDK! Check back often to view vacancies, updated regularly, as positions are advertised for 5–10 days. For more information, go to: www2.niddk.nih.gov/AboutNIDDK/NIDDKJobOpportunities/.

NIDDK, NIH, and DHHS are equal opportunity employers.

New and Updated Publications

Early April

2013 Edition of NIDDK’s Annual Scientific Report Now Available

Cover Image for the 2013 Recent Advances and Emerging Opportunities

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) annual scientific report, NIDDK Recent Advances & Emerging Opportunities, is now available. This report highlights examples of NIDDK-supported research advances published in fiscal year 2012. It also includes stories of discovery, which trace research progress in specific areas over an extended time frame; profiles patients who are living with diseases that are part of NIDDK’s research mission; and highlights scientific presentations made to the NIDDK’s National Advisory Council during the past year.

The report also contains an overview of NIDDK research training programs; information on the HBO documentary series “The Weight of the Nation”—a collaborative public awareness campaign showing how obesity affects the country's health; and a feature on the 2012 Lasker award winner in basic research, long-time NIDDK grantee Dr. Thomas E. Starzl, a pioneer in the field of liver transplantation.

To read the report, go to www.niddk.nih.gov. Or request a hard copy via the message box at http://catalog.niddk.nih.gov/ContactUs.cfm, by calling 1–800–860–8747 between 8:30 a.m. and 5 p.m. EST on Monday through Friday, or by writing to NIDDK Clearinghouses Publications Catalog, 5 Information Way, Bethesda, MD 20892–3568.

New NIH Resources Help Growing Number of Americans with Vision Loss

A large-print booklet and a series of videos to help people adapt to life with low vision are available from the National Eye Institute (NEI), a part of the National Institutes of Health (NIH). The chief causes of vision loss in older people are age-related macular degeneration, diabetic retinopathy, cataract, and glaucoma. The materials were released during Low Vision Awareness Month, February 2013.

The booklet, Living with Low Vision: What you should know, urges people with low vision to seek help from a low vision specialist and provides tips to maximize remaining eyesight, enabling them to safely enjoy a productive and rewarding life. The videos feature patient stories about living with low vision. Another video, targeted to health care professionals, emphasizes the importance of informing patients with vision loss about vision rehabilitation services. The booklet and the videos were developed by the NEI National Eye Health Education Program.

“I encourage anyone with low vision to seek guidance about vision rehabilitation from a low vision specialist,” said NEI Director Paul A. Sieving, M.D., Ph.D. “For many people, vision rehabilitation can improve daily living and overall quality of life.”

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Page last updated March 5, 2014


The National Diabetes Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

National Diabetes Information Clearinghouse
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Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov

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