THURSDAY, Sept. 25 (HealthDay News) -- New studies published this week in the The Lancet provide further evidence that candesartan, a blood pressure medicine, can cut the risk and severity of retinopathy in people who have diabetes.

"We suggest that clinicians may wish to consider using candesartan [brand name Atacand] in people with type 1 diabetes with hard-to-control blood glucose, who do not currently have retinopathy," said one study's British co-author, Dr. Nish Chaturvedi, of the National Heart and Lung Institute and Imperial College at St Mary's, London. "In type 2 diabetes, in people with established retinopathy who become hypertensive, again the clinician may wish to consider candesartan from the many blood pressure-lowering agents available, as it appears to have this additional beneficial effect on regression of retinopathy."

About 95 percent of diabetics suffer from type 2 diabetes, where cells gradually lose sensitivity to insulin. The illness is often linked to obesity. Around 5 percent of diabetics have the type 1 form, a condition in which the pancreas is unable to produce insulin to regulate blood sugar.

Diabetic retinopathy is a potentially blinding illness linked to changes in retinal blood vessels. It is one of the major complications of both type 1 and type 2 diabetes. Intense control of blood sugar levels is the only proven way to reduce incidence and progression of retinopathy, but this kind of control can be elusive. And even when patients do achieve strict control of blood sugars, retinopathy is not always kept at bay.

Previous studies have indicated that drugs known as renin-angiotensin system blockers, which include candesartan, might prevent or reduce the severity of diabetic retinopathy.

This most current research consists of two trials, with three arms total.

In the DIRECT-Prevent 1 study, more than 1,400 type 1 diabetics with existing retinopathy were randomized to receive either Atacand or a placebo; in the DIRECT-Protect 1 trial, more than 1,900 type-1 diabetics with existing retinopathy were randomized to receive either the drug or a placebo.

Individuals receiving Atacand had an 18 percent lower incidence of retinopathy, considered "borderline" statistically significant, the researchers report.

Further analysis of the DIRECT-Protect 1 trial found that progression of retinopathy was 35 percent lower for patients taking Atacand.

Reanalyzing the data in this way somewhat weakens the findings, noted one expert, Dr. Mina Chung, a retinal specialist at the University of Rochester's Eye Institute. Nevertheless, she added, "this study gives you some evidence that it looks like [Atacand] would be helpful."

The DIRECT-Protect 2 study randomized more than 1,900 type 2 diabetes patients with mild to moderately severe retinopathy to either Atacand or a placebo.

Again, the difference in progression between the groups was statistically nonsignificant. Improvement increased by 34 percent in the Atacand group versus the placebo group.

"Studies have shown that intensive control of blood-sugar levels helps prevent diabetic retinopathy, and now this is another component of the blood pressure effect, but it may also be additional benefits other than just controlling blood pressure," said Dr. Richard W. Allinson, assistant professor of surgery with the Texas A&M Health Science Center College of Medicine and an ophthalmologist at the Scott & White Waco Clinic.

The trials were funded by AstraZeneca and Takeda. AstraZeneca markets Atacand under license from Takeda.

More information

There's more on diabetic retinopathy at the National Eye Institute.

THURSDAY, Sept. 25 (HealthDay News) -- In people with type 2 diabetes, regular aerobic exercise and weightlifting may reduce levels of fat in the liver by as much as 40 percent, according to Johns Hopkins researchers.

High liver fat levels are common in type 2 diabetes patients and contribute to heart disease risk.

The study included 77 diabetic women and men who were divided into two groups. For six months, one group did three 45-minute sessions of moderate aerobic exercise (bicycling, running on a treadmill, or brisk walking) and three 20-minute sessions of weightlifting per week. The other group didn't do any formal aerobic fitness or gym classes.

MRI scans showed that people in the exercise group had lower levels of liver fat by the end of the study (5.6 percent) than those in the non-exercise group (8.5 percent).

The exercise group also had better fitness and less body weight and fat than those in the non-exercise group. Those who did the aerobic/weightlifting program: had 13 percent higher averages for peak oxygen uptake levels during treadmill testing; were 7 percent stronger; had 6 percent lower body fat and body weight; and had 2-inch smaller waistlines (an average of 39 inches vs. 41 inches).

"The benefits in improved fitness and fatness are clear, and physicians should really have all people with type 2 diabetes actively engaged in an exercise program," lead investigator Kerry Stewart, a professor of medicine and director of clinical and research exercise physiology at the Johns Hopkins School of Medicine and its Heart and Vascular Institute, said in a Hopkins news release.

The findings were presented Sept. 18 at the American Association of Cardiovascular and Pulmonary Rehabilitation annual meeting, in Indianapolis.

"People with type 2 diabetes have added reason to be active and to exercise, not just because it is good for health, but also because our study results pinpoint a key benefit to trimming the fatty liver that complicates their illness and which could accelerate heart disease and liver failure," Stewart said.

About 14 million Americans have type 2 diabetes.

More information

The American Diabetes Association has more about type 2 diabetes  .

MONDAY, Sept. 8 (HealthDay News) -- A device worn under the skin that measures blood sugar 24/7 can benefit people with type 1 diabetes, a new study shows.

"Continuous glucose monitoring" consists of a disposable blood sugar sensor placed under the skin, worn for a few days and then replaced. The sensor sends data to a transmitter which, in turn, sends it to a receiver worn like a pager. The receiver displays blood glucose levels on a continuous basis.

The device used in the study "monitors blood glucose about every five minutes," said lead researcher Dr. Roy W. Beck, from the Jaeb Center for Health Research in Tampa, Fla. "We evaluated how much benefit, if any, that could have on control of diabetes in both children and adults with type 1 diabetes," he said.

Type 1 diabetes, often called juvenile diabetes, occurs when the body doesn't produce enough insulin. It affects about 5 percent of all diabetics. Type 2 diabetes, the much more common form, is typically brought on by excess weight or other metabolic imbalances.

Beck has a personal reason for being concerned about type 1 diabetes.

"I have a son who has type 1 diabetes who has used continuous glucose monitoring for two years now every day, except for a few days when it was in for repair, during which time he felt a great loss at not having it. There are many others like him. He was not part of the study," he said

In the study, the researchers found that adults gained substantially better control of their diabetes when using continuous glucose monitoring versus a group using conventional, intermittent blood sugar management.

Improved diabetes control was determined by using what is called the hemoglobin A1c test, which measures how effective blood sugar control is over three months, Beck explained.

"In addition, we were able to get better and tighter control -- closer to normal -- of blood sugar without dangerously low blood sugar levels," Beck said.

The report, funded by the Juvenile Diabetes Research Foundation, was published in the Sept. 8 online edition of the New England Journal of Medicine. It was also expected to be presented Monday at a meeting of the European Association for the Study of Diabetes, in Rome.

For the study, Beck's team randomly assigned 322 adults and children with type I diabetes to one of four brands of continuous blood sugar monitors, or home monitoring with a standard blood glucose meter.

Over 26 weeks, the researchers found that, for patients 25 years of age and older, continuous blood sugar monitoring showed significant improvements in blood sugar control.

For patients 15 to 24 years old, the difference between the groups was not significant, primarily because the younger patients were less likely to use the equipment continuously, the researchers found.

Among patients 25 years of age and older, continuous blood sugar monitoring was used by 83 percent of participants for six days or more per week. For younger patients, only 30 percent of those 15 to 24 used continuous monitoring, as did 50 percent of those aged 8 to 14.

Greater compliance with glucose monitoring among the younger patients comes with parental involvement, Beck said.

"Getting better control of diabetes using continuous glucose monitoring is almost certainly likely to equate with fewer long-term complications," he noted. "This will have substantial long-term benefit on quality of life and reduce health care costs," Beck said.

Based on these findings, he believes that continuous blood sugar monitoring should become a normal practice for type 1 diabetics and that insurance companies should start paying for the device.

Continuous glucose monitoring among people with type 2 diabetes has not yet been tested, Beck said. However, for type 2 diabetics who rely on insulin it may prove beneficial, he added.

Dr. Stuart Weiss, an endocrinologist at New York University Medical Center and a clinical assistant professor at NYU School of Medicine, New York City, believes the technology will eventually be used by all diabetics.

"As someone who has been using continuous glucose monitoring for a long time, I think it's wonderful that studies are coming out to support its use," Weiss said. "It really is a great tool," he said.

For people with type 2 diabetes, continuous glucose monitoring can be helpful, Weiss said. It especially helps patients understand which foods significantly alter their blood sugar, he said.

"If you don't test, you don't know," Weiss said. "The more you test, the more you know."

More information

For more about diabetes, visit the American Diabetes Association  .