Last time I checked -drugs weren't cool, but according to a recent study, within the last 3 years, the number of teens using type 2 diabetes drugs has soared.

Medco, the largest US drug benefits manager, found the number of children taking medicine for type 2 diabetes more than doubled between 2001 and 2005. An analysis of prescription data found a 146% increase over four years in young people aged 10-19 taking type 2 diabetes drugs, and 115 % increase in all children in the survey. Children on diabetes medicines also faced other serious problems. About 17% of the boys and 13% of the girls were on drugs for high blood pressure; 5% of both were taking cholesterol-reducing drugs; and nearly 20% were taking narcotic pain relievers, drugs for respiratory conditions and antidepressants. Medco reviewed over 500,000 children each year. Of those aged 10-19, about 1.47 per 1,000 were taking type 2 diabetes drugs with a clear rising trend.

I'm so glad I'm not a teenager any more. These days it's not about abstaining from drugs. It's about the type of drugs you use. Just because your doctor is the one prescribing it doesn't mean you have to succumb to the peer pressure of drug use. I found an appropriate Chinese proverb for this blog: it is easy to get a thousand prescriptions but hard to get one single remedy. Put that in your pipe and smoke it.

Remember that movie with Billy Crystal and Robert De Niro, Analyze This? Well we all don't have super-risky mobster lifestyles to induce depression like Paul Vitti's, but according to a new study of depressed type 2 diabetics -- depression has a negative impact on blood sugar control.

Researchers treated 93 patients with type 2 diabetes and depression with the antidepressant bupropion (Wellbutrin). They chose the drug because it is capable of reducing depression and weight simultaneously. The hypothesis behind the treatment was mood enhancement and weight reduction would, in fact, improve blood sugar control. (Always a gold star day in my book!) The results were documented in the March issue of Diabetes Care, and showed that antidepressant treatment produced benefits beyond just mood improvement. Patients also lost weight, improved self-management of their diabetes, and improved their A1c levels.

In the 6 months following the conclusion of the study, depression improvement predicted maintenance of improved blood sugar control. This confirms the research hypothesis that depression improvement can produce better blood sugar control, independent of weight loss and overall diabetes management. The importance of weight-independent physiological factors like insulin sensitivity and inflammation improve during depression relief and contribute to better long-term control of diabetes.

The moral of this story? You tell me. I spotlight the research - I like it when you guys give me answers.

Off-label use is the practice of prescribing drugs for a purpose outside the scope of the drug's approved label. The FDA requires numerous clinical trials to prove a drug's safety and efficacy in treating a specific symptom. Once deemed safe and effective, physicians exercise discretion for the use of the drug. It is entirely legal in the United States and in many other countries to use drugs off-label.

More physicians are discovering that many drugs are effective for off-label uses and apply to the needs of their patients. Off-label prescription drugs have become so popular that, today, 1 out of every 4 prescriptions written is off-label. The antiseizure drug gabapentin (Neurontin) is used off-label to treat people with diabetic neuropathy. Another drug used off-label is Lucentis, manufactured by Genentech. It was originally approved for age related macular degeneration, but is now in FDA trials for the treatment of diabetic macular edema. If Lucentis is approved, it would be the first drug to treat this debilitating complication of diabetes.

There are advantages and disadvantages to off-label uses. First (and foremost) is the risk versus reward. You could be the first to experience a breakthrough treatment or you could suffer irreparable consequences from the off-label use. Another consideration is feasibility - often times an off-label treatment may cost you substantially more than the other treatments approved for use. For example, without enrolling in an FDA trial to receive intravitreal injections of Lucentis - it would cost me $2,000 a pop. My peepers are precious, but my pockets aren't that deep! What off-label drug would you consider for use?(With your doctor's blessing, of course).

The results of this study do not surprise me at all. Researchers have found that psychosocial factors like cynical distrust, chronic stress and depression, may be associated with higher levels of inflammatory markers. These inflammatory markers are related to an increased risk for cardiovascular disease, the leading cause of premature death among people with diabetes.

The study included 6,814 men and women between the ages of 45 to 84. Participants were assessed for their levels of depression, chronic stress and cynical distrust. Blood samples obtained at the start of the study were analyzed for markers for inflammation. The researchers found associations between all three psychosocial factors and inflammatory markers.

A high stress lifestyle may increase the chance that an individual engages in social behaviors that increase inflammatory markers. The same high stress lifestyle may contribute to obesity and related metabolic problems. Furthermore, socioeconomic position is likely to be a precursor to psychosocial characteristics. True. But let's not wager our lives on a dollar-denominated scale. Consider the Chinese proverb, those who know when they have enough are rich. Now ask yourself where you stand in the socioeconomic parade. If you put it that way - I'm on easy street! Too bad it's in the wrong neighborhood.

Researchers found that using a systematic approach for the treatment of depression in diabetics will not increase health care spending, and might actually decrease the overall costs.

Researchers evaluated the cost and cost-effectiveness of a systematic depression treatment program versus the usual care for 329 outpatients with diabetes and depression. The intervention involved specialized nurses who provided a 12-month stepped-care depression treatment program using psychotherapy or antidepressant drugs or both. Systematic depression treatment significantly reduced the patients' average depression scores after 6 and 12 months, and these improvements were maintained at 24 months.

Outpatient depression treatment costs were approximately $700 higher in the intervention group during the first year, the results indicate. However the general medical outpatient costs in this group were lower, and offset most of the difference. During the second year, the approximately $100 in higher outpatient depression treatment costs in the intervention group was more than offset by lower outpatient costs of approximately $1400.

The study was designed with the hope of alleviating human suffering caused by diabetes. If reducing the burden of suffering also reduces costs of care, then depression management programs should be routinely integrated into diabetes care. Preempt this mission with the fact that the systematic depression treatment programs were associated with an increase of 61 depression-free days and an estimated cost savings of $300 - that's a monthly stipend of 20% more Happy Days and a half tank of gas. That'll give you something to smile about!

A study reveals the drug duloxetine is useful in treating diabetes-related pain, but it may worsen control of blood sugar levels. Diabetes is the number one cause of damage to the peripheral nerves in the United States. Neuropathy will first appear as burning or stinging in the feet, usually worse at night. The nerves to the feet are affected first because the damage is occurring along the entire length of the axons and the axons to the feet are the longest in the body.

Duloxetine is one of only two drugs approved for the treatment of diabetic peripheral neuropathic pain (DPNP), a common problem in diabetic patients, Cymbalta® or duloxetine is the first drug approved by the FDA for painful diabetic polyneuropathy. The drug was previously approved as an antidepressant. The drug is an SSNRI meaning it is both a selective serotonin reuptake inhibitor and a selective norepinephrine reuptake inhibitor. By blocking the reuptake of serotonin and norepinephrine, these neurotransmitters increase in the spinal cord and brain. It is speculated that both increased serotonin levels and norepinephrine levels produce an inhibitory effect on the ascending sensory tracts.

Data was collected from three clinical trials to investigate changes in weight, sugar levels, and cholesterol levels in patients with DPNP treated with duloxetine. Short-term treatment with duloxetine was associated with a modest increase in fasting sugar levels, but not with significant increases in hemoglobin A1c, a measure of long-term sugar control. With longer treatment, however, there was a significant rise in hemoglobin A1c, indicating impaired sugar control. In addition, there were also small changes in cholesterol levels among duloxetine-treated patients, but a small increase in HDL "good" cholesterol was the only statistically significant change. Weight declined with short-term duloxetine treatment, but increased slightly with long-term treatment.

In future, not filling prescriptions issued for a chronic health condition could earn you a follow up from your insurance company. The Detroit Free Press reports that some Michigan health plans are starting to track whether or not patients on diabetes meds, antidepressants, or on drugs for asthma and heart problems are filling their prescriptions. When they identify patients who are not following through with their doctors' prescribed treatments, they may mail a reminder notice or even notify their doctors. The thinking is that many patients just need a little education on the importance of their prescription meds and the fact that many take a while to start working.

Invasive? Maybe. But the big insurers are concerned to do all they can to get their clients healthy. They realize that preventative care and sticking with prescribed treatment plans are both critical to getting people healthy and, therefore, reducing the necessity for insurance payouts. For example, this particular article cites a study which said that up to twenty percent of hospital and nursing home admissions result simply because patients are not taking their prescriptions or they are taking them incorrectly.

Those delicious late night snackies may be bad for you. Researchers at the University of Washington in Seattle say that diabetics who eat lots of food in the evening are upping their risk of health complications. These experts sat down and interviewed 714 diabetes patients about their eating habits. Ten percent said they ate more than one-quarter of their daily food intake not at dinnertime, but after dinnertime. That means snacking after dinner, and getting up at night (even multiple times in the night) to sneak some late-night food treats - and we're not talking apples and oranges here. No, we're talking about snacks of the fatty and highly processed variety - the kinds of foods that give nutrition experts the night frights.

Seems that this little habit catches up with these patients in their declining health - they were two to three times more likely than the other patients in the study to be obese, to have poor blood sugar control or to have multiple diabetes-related complications, including the "biggies" - heart disease, and kidney and nerve problems. The cause? It seems that these patients are more likely than others to be suffering from depression. It appears that the late night eating is a coping mechanism. Researchers hope that access to therapy and antidepressants could help these people out.

The results of the study have been published in Diabetes Care (August 2006).

In an earlier post, we shared study findings linking diabetes to depression. As a result of this, the Washington University School of Medicine, in St Louis researchers recommended that diabetics would benefit from taking antidepressants in order to control depression.

In another post, we shared study results that University of Alberta researchers were able to establish that Type 2 diabetes patients tended to have a history of depression extending back before they were diagnosed with diabetes.

Most recently, during the American Diabetes Association annual meeting, study results were presented that suggest antidepressants actually appear to increase progression to diabetes in people who are already at risk for the disease. Not exactly in line with the previous two studies, is it. Keeping up with research can be exhausting at times. Stay with me. The ending of this post is priceless.

Johns Hopkins University School of Medicine researchers collected information on 3,000 people who took part in the Diabetes Prevention Program. According to the researchers, those who took antidepressants regularly were two to three times more likely to develop diabetes. No increased risk was reported for those not taking antidepressants. However, the study participants who took the glucose-lowering drug metformin with antidepressants also had not increased risk of developing diabetes.

I am going to end this with a direct quote from study co-leader Richard Rubin, "We don't have a clue what's going on."