Outcomes and Phenotype of Screen-Detected Diabetes and New and Emerging Therapies for Type 1 and Type 2 Diabetes Mellitus

Principal aims were to investigate long-term outcomes from T2DM and IGT screening, examine morphological and biochemical phenotypes of screened subjects, comparing White Europeans (WE) with South Asians (SA), and emerging therapies including basal insulin analogues in T1DM and meglitinides in T2DM and their place in management. Following adjustment for age, sex and ethnicity, no significant difference in mortality, microvascular or macrovascular outcomes were detected between known and screened T2DM after ten years. Findings were limited by few events and relatively short follow-up. These data may be useful in power calculations for longer randomised controlled trials. Body fat is higher in SA than WE for given BMI and increases with worsening glucose tolerance. Bioelectrical impedance analysis and skinfold thickness are less sensitive and specific with increasing body fat regardless of ethnicity, and gender. Ethnicity and BMI, but not age, predict total and abdominal fat using DEXA scanning. After adjustment for age, BMI, WHR, gender, smoking and drug history, no differences between SA and WE for adiponectin and resistin were detected. Leptin is predicted by age, gender and smoking in WE but only gender in SA. BMI predicts hsCRP in both groups while age and smoking predicts TNFa in SA. Longitudinal cohort studies are needed to determine impact of interventions on risk markers in different ethnic groups. Insulin glargine results in a small but significant glycaemic improvement without significantly increased hypoglycaemia, weight gain or reduced patient satisfaction when used in a basal bolus regimen with aspart compared with NPH insulin in T1DM. In a six-month randomised study, four different dual oral combinations including nateglinide, pioglitazone, metformin and gliclazide, in early T2DM result in significant glycaemic improvement without increasing hypoglycaemia or patient dissatisfaction with no significant differences between groups. Longer RCT are required to determine how duration of glycaemic improvement with each combination.