Rock for Diabetes

New Way of Early Disease Detection!

2012-02-08T06:43:00.000-08:00

Breathalyzers, not just for seeing if you are intoxicated anymore! A new way of disease detection has been found by researchers at the University of Wisconsin-Madison! http://www.medicalnewstoday.com/releases/241288.php

Disrupted Sleep Patterns Adds to Risk of Obesity, Diabetes

2010-09-02T10:00:00.000-07:00

Disrupted sleep patterns seem to contribute to the risk of obesity and diabetes, according to numerous studies. Scientists have theorized that disrupted circadian rhythms throw off various hormonal processes in the body that contribute to disease.

Researchers at UT Southwestern Medical Center in Dallas have found that mice with defective copies of two genes involved in circadian rhythms develop abnormalities in their pancreatic cells that eventually cause problems with the release of insulin.

This theory is looking stronger all the time, and the mounting evidence bolsters the argument that people should care about their sleep habits and these should be discussed while educating every patient with diabetes.

One gene, the CLOCK gene, operates in many parts of the body to control circadian processes. The other gene, BMAL1, works with the CLOCK protein. In the study, scientists engineered some mice to have defective CLOCK genes in the pancreas and some to lack the BMAL1 gene.

They found that mice with the mutant CLOCK gene were defective in releasing insulin. These mice were prone to obesity and other health problems related to liver and metabolic function. The mice lacking the BMAL1 gene in their pancreas had normal body weight and normal circadian patterns but had abnormal blood sugar levels.

The study shows that disruption of these genes only in the pancreas causes early signs of diabetes.

"These results indicate that disruption of the daily clock may contribute to diabetes by impairing the pancreas' ability to deliver insulin," Dr. Joseph Takahashi, a co-author of the paper, stated in a news release.

journal Nature, July 09, 2010

Implanted Wireless Glucose Sensor Lasts 520 Days

2010-08-25T10:54:00.000-07:00

American bioengineers have demonstrated that an implanted glucose sensor with potential to transform the management of diabetes has passed a crucial test: the device they developed worked continuously for over a year, without showing signs of "tissue encapsulation" seen in trials with other similar devices.

Researchers from the Department of Bioengineering at the University of California San Diego (UCSD), and GlySens Incorporated, showed how an implantable sensor, "capable of long-term monitoring of tissue glucose concentrations by wireless telemetry," ran successfully for a total of 222 and 520 days respectively.

One of the challenges of developing an effective glucose sensor that sits in tissue just below the surface of the skin is how to overcome the problem of "tissue encapsulation" which causes unpredictable fluctuations in the readings.

Dr. David Gough, first author and bioengineering professor at UCSD told the press that the most important aspect of their paper is how they overcame this problem so their sensor remained insensitive to tissue encapsulation for over 500 days.

"That's a big step from a scientific point of view, and it's due to the sensor's unique oxygen detection scheme," said Gough.

He and his team hope that after human trials and FDA approval, their device may help people with diabetes manage their condition more effectively than methods currently in use such as finger-sticking and short-term, needle-like glucose sensors that have to be replaced every three to seven days.

"If all goes well with the human clinical trials, we anticipate that, in several years, this device could be purchased under prescription from a physician," said Gough.

The problem with many current methods, for example the so-called finger-sticking system where the patient pricks his or her finger to get some blood to test in a portable reader (usually done about four times a day), is that they do not monitor the level of glucose continuously, leaving open the risk of dangerous ups and downs of glucose levels, known as "glucose excursions." The more "glucose excursions" a patient has, the higher the risk of developing long term problems of diabetes, affecting the eyes, kidneys, heart, brain, feet and nerves.

The device that Gough and his team developed and tested in the pigs is about 1.5 inches (3.8 cm) in diameter and about 5/8 ins thick (1.6 cm). It is implanted under the skin and continuously monitors tissue glucose and transmits the information without wires to an external receiver.

The device worked effectively, they said, because of its unique way of producing a reliable reading without being affected by the problem of tissue encapsulation.

It does this by taking in glucose and oxygen from surrounding tissue and using the enzyme glucose oxidase to catalyze a reaction where oxygen is consumed in proportion to the amount of glucose present.

Any oxygen left over is measured and compared to the baseline oxygen recorded by a reference sensor, so the difference indicates how much glucose is present.

The authors said that the effect of exercise and changes in local blood flow to the tissues are also in the main subtracted out in this differential oxygen sensing system, where the two sensors sit side by side in the same device.

The sensors used in the animal trials sent the glucose information to a data recorder the size of a cell phone. Gough said the data could be made useful in many ways, for example it could be sent to cell phones or displayed in other ways.

"There are parents with diabetic children who spend their nights worrying that their child in a nearby bedroom may go into nocturnal hypoglycemia," he said, explaining that a continuous glucose sensor could trigger an alert if the level dropped too low in the night.

A long term implanted monitor would keep measuring glucose day and night.

"Others wouldn't even know if someone is using a glucose sensor. Our goal is to get people off the finger-stick cycle," he added. He said if the device passes human trials, it could be implanted in patients in a simple outpatient procedure.

"Function of an Implanted Tissue Glucose Sensor for More than 1 Year in Animals." David A. Gough, Lucas S. Kumosa, Timothy L. Routh, Joe T. Lin, and Joseph Y. Lucisano. Sci Transl Med Vol. 2, Issue 42, p. 42ra53, published online 28 July 2010
DOI: 10.1126/scitranslmed.3001148

Possible Groundbreaking Treatment for Diabetes

2010-08-18T10:58:00.000-07:00

A London company may be on the verge of a groundbreaking treatment for diabetes. A mini pancreas pouch could begin human clinical trials within a year.

In the last few years a procedure kn��;Edmonton Protocol" has been used to treat diabetes by transplanting human islet cells from organ donors into patients. Although the procedure is quite successful it faces two major issues:

The critical lack of organ donors means only a handful of people with diabetes can be treated in any given year. In the United States, there are approximately 6,000 cadaveric organ donors and only a fraction of the available pancreatic tissue is suitable for transplantation. For each patient receiving the transplant there must be at least two donors.
Patients receiving the transplants must stay on anti-rejection drugs for the rest of their lives to keep their immune systems from destroying the transplanted cells. The serious side effects of perpetually compromising a person's immune system means that generally only those people experiencing serious complications receive the transplants. Younger, healthier diabetics who have the most to gain from preventing any more damage by the disease also have the most to lose by living the rest of their lives with suppressed immune systems.
The Cell Pouch System™ has shown long-term efficacy in small animal models, and is currently being tested in the product designed for patients in a large animal model of diabetes supported by a $465,000 in-kind contribution from the National Research Council of Canada. With reduced cost of implantation, increased safety and improved efficacy relative to other cell therapy treatments, this therapy could reduce or eliminate the need for insulin injections in an ever increasing number of patients. The timeline to FDA approval of a medical device is shorter than pharmaceuticals with a higher success rate. Using the device regulatory pathway, Sernova has the potential to have products on the market in a shorter period of time than competing pharmaceutical technologies.

The first clinical indication for the Cell Pouch System™ is anticipated to be for patients with pancreatitis. Patients with severe pancreatitis who have their pancreas removed will become diabetic. These patients could benefit by having their islets removed from the pancreas and placed into the Cell Pouch System™ with the hope of restoring glucose control. Product expansion may then occur through treatment of diabetic patients with the Cell Pouch System™ with immunosuppressant agents or with Sertolin™ cells that provide an immune-protected environment for the islets.

Sertolin is based on the Sertoli cells' natural ability to locally modulate the immune system. Sertoli cells, which are normally found in the testes, synthesize cytokines and growth factors necessary to protect and mature developing spermatozoa. It has been known for more than 60 years that it is possible to transplant cells from different species into the testes without them being rejected. Dr. Helena Selawry discovered that the presence of Sertoli cells is the principal reason for this long-recognized immunologically privileged environment of the testes and that became the basis for the Sertoli patents.

Using the patented Sertoli cells and a medical device inserted under the skin of the patient's abdomen, an immunoprivileged environment is created, in which a second cell type (e.g. insulin producing islets) can be co-transplanted without the need for immunosuppression. Therefore diabetic patients are treated with a minimally invasive day surgery, resulting in a reduced need for insulin or even total insulin independence. The procedure may also prove to have many other cellular co-transplantation or gene therapy applications.

How the Sernova Corporation's pouch works for diabetes treatment:

1.) A "cell pouch" is implanted under the skin in the belly of the patient.
2.) Islets planted in the pouch produce insulin naturally, in response to the blood sugar levels in the patient.
3.) Islets are cells from the pancreas, extracted from a donor, creating a mini pancreas.
4.) The pouch is not visible on the patient.
5.) Animal tests have seen the device work well for six months.
6.) Human clinical trials may begin in about one year.

Sernovacorp.com

Lifestyle Change Wins Over Weight Loss Programs

2010-08-10T10:42:00.000-07:00

Obese adults prefer noncommercial, nonstigmatizing interventions designed to help them improve their lifestyles over programs that just promote weight loss, according to a new study.

Samantha L. Thomas, MD, from Monash University, Notting Hill, Australia, and colleagues write, "Consumer involvement, perceptions and engagement are well recognized as cornerstones for developing effective interventions within communities and in improving the translated outcomes of intervention programs.... Yet, there has been very limited research seeking to understand the perspectives, attitudes and opinions of obese adults about current approaches to obesity."

The aim of this study was to explore the opinions and attitudes of obese individuals toward population and individual interventions for obesity.

The researchers conducted telephone interviews with a community sample of 142 obese adults aged 19 to 75 years who had a body mass index of at least 30 kg/m2. The interviews lasted from 60 to 90 minutes. The participants were asked about their attitudes to 6 interventions:

media-based social marketing campaigns

public health interventions and initiatives

regulation (e.g., banning junk food advertising aimed at children)

obesity surgery

commercial diets (specifically Weight Watchers and Jenny Craig)

specialized fitness programs (e.g., women-only gyms such as Curves and public funding for personal trainers)

The researchers found that about two-thirds of participants thought that regulation was one of the most effective solutions for the obesity epidemic in Australia. Public health interventions and initiatives were favored by 60 participants (42%). One third of the participants thought that media campaigns were effective, especially ones based on positive messages and incentives, rather than scare tactics.

The researchers also report that most participants were somewhat skeptical about the long-term success of obesity surgery, voicing concerns about the commercial marketing of the surgery and also about the associated short- and long-term risks.

Only 26 participants (18%) thought that commercial dieting programs were effective interventions for weight loss, and only a small number thought that diets were effective for weight loss. Weight Watchers was deemed to be better than other commercial programs, with participants calling the program's approach "genuine," "sensible," and "[health-]promoting," according to the study authors.

The authors also found that participants distrusted the commercial marketing techniques of the diet industry and wanted the industry regulated. Some participants also described commercial diets as unsafe -- particularly those that provide pre-prepared meals. They used terms such as "greedy," "a scam," and "a rip-off" to describe the dieting industry. Despite these attitudes, many participants said they would still turn to commercial dieting to lose weight because they had very little other support available to them, the authors stated.

The reserchers noted limitations of their study, including the high education level of the participants and the preponderance of women participants over men.

Dr. Thomas and her colleagues conclude that their study provides a unique assessment of the perspectives, attitudes, and opinions of obese adults toward 6 different interventions currently used in Australia to address obesity. The results highlight the need for interventions that support and empower individuals to improve their lifestyle.

"At the individual level, personalized care planning and long term support systems must be developed to assist obese individuals," they write. "At the population level, anti-stigma campaigns and regulation should both be explored."

BMC Public Health. Published online July 15, 2010.

Daily Insulin Shots May Be a Thing of the Past

2010-08-05T10:51:00.000-07:00

That daily shot of insulin may soon be a thing of the past. Scientists at the National Immunology Institute in New Delhi, India, have developed a new form of insulin which could maintain normal blood sugar levels for over 120 days.

Dr. Avadhesha Surolia, Director of the National Institute of Immunology and Professor of Biophysics, Molecular Biophysics Unit, Indian Institute of Science, stated that the insulin currently available can work for a maximum of 18 hours, forcing diabetes patients to take at least one injection daily to sustain their sugar levels. With this new product, they can now restrict their shots to once every four months.

Dr. Surolia said the new product, which has been tested successfully in animals, was based on the principles of "protein folding," and could release insulin molecules in a controlled and sustained manner for over 120 days.

"The just above basal level of human insulin released in a sustained manner has been found to be effective in not only controlling the upsurge in the level of blood glucose after meals, but also in preventing the dreaded early morning hypoglycemia, which is caused by low glucose levels," he said.

The team has already patented the technology and transferred it to a US-based company for fine-tuning and clinical trials, and the product is likely to be in the market in about six years.

Proceedings of the National Academy of Sciences

Family Meals Keep Kids Trim

2010-07-27T10:37:00.000-07:00

A new study finds that, children who regularly sit down to family meals and get plenty of vegetables in their diet tend to be thinner than their peers without such eating habits.

The published results may not sound surprising. However, few studies have looked at the relationship between children's weight and their diet patterns. And while it is generally believed that sitting down to family dinner is good for kids, there has been little research evidence it keeps them slim.

For the new study, Greek researchers interviewed 1,138 children ages 9 to 13 about their diets and physical activities, and used that information to identify five general diet-and-lifestyle patterns across the group.

One was what they dubbed the "dinner, cooked meals and vegetables" pattern. Children with this pattern had a high intake of vegetables, regularly sat down to family dinner and typically had traditional "cooked" meals (hot or cold) for lunch and dinner, rather than sandwiches, snack foods or "breakfast-like" meals.

Kids who fell into that pattern generally had a lower body mass index (BMI), smaller waistlines and less body fat than their peers who did not fit the diet pattern.

None of the other four diet-and-lifestyle patterns the researchers identified were associated with children's weight or body-fat levels.

Those patterns included an "unstructured eating, fast food/sugary foods and sedentary lifestyle" pattern, and "high fiber," "breakfast," and "exercise, fruits and vegetables" patterns.

According to the researchers, who were led by Dr. Mary Yannakoulia of Harokopio University in Athens, it is not clear why those four categories failed to show a link to children's weight, while the family meal/vegetable pattern did.

But, they write, the habits of sitting down to family dinner and having cooked meals could signify children who are closely sticking to the traditional Mediterranean diet -- one rich in vegetables, olive oil, whole grains and fish.

A key limitation of the study is that it assessed children at one time point. However, Yannakoulia and her colleagues write, the findings suggest that such an eating pattern stands as a "potential preventive approach" to combating childhood obesity. They note that it is also a "non-restrictive" way of eating that most children can live with.

J Pediatr, June 18, 2010

Lifestyle Counseling Reduces Medications and Costs in Diabetes

2010-07-19T08:15:00.000-07:00

Effect of the Look AHEAD Study intervention on medication use and related cost to treat cardiovascular disease risk factors in individuals with Type 2 diabetes....

Look AHEAD (Action for Health and Diabetes) is a multisite clinical trial of 5,145 overweight or obese individuals with Type 2 diabetes, age 45-76 years. Participants were randomly assigned to either intensive lifestyle intervention (ILI), which involved group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity, or to general diabetes support and education (DSE).

The goal is to study the effects on cardiovascular morbidity and mortality. In the current analysis, use of medications prescribed to treat diabetes, hypertension, and hyperlipidemia and the costs of those medications were compared at baseline and 1 year. All participants were required to have a primary care clinician who was responsible for any necessary changes in medications. Costs were conservatively estimated through the use of generic drug costs (when available) and the assumption that patients were using about 50% of the maximum dose. In addition to analyses of all participants, a subanalysis of participants who met optimal care goals for diabetes, blood pressure, and lipid control, was also conducted.

The mean age of the participants was 59 years, and 59% of the participants were women. At baseline, participants in both groups averaged 3.3 prescriptions per month at a mean cost of about $156. After 1 year, medication use for intensive lifestyle intervention was significantly lower than for DSE (3.1 vs. 3.6; P < .001), as were monthly medication costs ($143 vs. $173; P < .001). Thus, medication costs declined by almost 10% in the lifestyle group and increased by 10% in the DSE group. The differences were greatest for diabetes medications: medication costs declined by 17% in the lifestyle group and increased by 11% in the DSE group. Furthermore, the intervention more than doubled the percentage of participants who achieved optimal care goals (from 11% to 24%) and at the same time reduced medication use and cost. A greater proportion in the DSE group also achieved optimal care goals at 1 year (increasing from 10% to 16%), but doing so required an increase in medication use and costs.

The Look AHEAD investigators recently reported beneficial effects of 1 year of intensive lifestyle intervention on weight loss, glycemic control, and cardiovascular risk factors. This, of course, has important implications for long-term morbidity and mortality. In the short term, however, the current study demonstrates that intensive lifestyle intervention can reduce medication use and costs, both of which could be a far stronger motivation for individual patients to undertake lifestyle changes than a small decrease in A1c levels. Furthermore, because lifestyle interventions reduce diabetes incidence among at-risk patients well after the active interventions have ceased, the current findings could be extrapolated to suggest that glycemic control among patients with diagnosed diabetes may also endure beyond active intervention. Even if it doesn't, long-term follow-up of the United Kingdom Prospective Diabetes Study showed a reduction in microvascular complications, myocardial infarction, and all-cause mortality risk even though glycemic control differences between intensive and standard control groups later equalized.

Thus, if possible reductions in medication use and cost can indeed motivate patients to make lifestyle changes, the long-term goals of better health and quality of life can still be achieved. Furthermore, the current results have important implications for the cost-benefit ratio of providing lifestyle interventions; medication cost reductions must be factored in as an offset to the cost of the programs themselves. Perhaps lifestyle interventions can help bend the cost curve.

The study showed that, at 1 year, ILI significantly improved CVD risk factors, while at the same time reduced medication use and cost. Continued intervention and follow-up will determine whether these changes are maintained and reduce cardiovascular risk.

1.) Pi-Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular disease risk factors in individuals with Type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care. 2007;30:1374-1383. Abstract
2.) Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of Type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-1679. Abstract
3.) Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1167-1186.
4.) Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabets Prevention Study: a 20-year follow-up study. Lancet. 2008;371:1783-1789. Abstract
5.) Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in Type 2 diabetes. N Engl J Med. 2008;359:1577-1589. Abstract

Diabetes Care. 2010;33:1153-1158

Pre-existing Conditions Covered by New High-Risk Insurance Pools

2010-07-12T10:28:00.000-07:00

Patients with diabetes and no insurance, beginning July 1, individuals with pre-existing health conditions as diabetes are eligible to enroll in a temporary high-risk insurance pool, courtesy of the health care reform law....

The new Pre-Existing Condition Insurance Plan is a provision of the Patient-Protection and Affordable Care Act (PPACA).

The new plan -- administered by either a state or the Department of Health and Human Services -- will provide health coverage options for individuals who have been uninsured for at least 6 months, have been denied coverage due to a pre-existing condition and are a U.S. citizen or legal resident. The program will be in effect until 2014 when insurers will no longer be able to deny coverage based on pre-existing medical conditions.

As of July 1, HHS will run the Pre-Existing Condition Insurance Plan in 21 states. The remaining 29 states and the District of Columbia will begin enrolling residents in their own insurance pools by the end of the summer, according to a press release from HHS.

From July 1, 2010, through Jan. 1, 2014, the law will provide $5 billion to fund the new plan in each state. Money will be allocated based on the population and costs of each state.

The plan, which is not based on income, will likely be an option for individuals with money to spend on insurance, but who have been denied coverage in the past due to a pre-existing medical condition such as cancer or diabetes. Although some states already have high-risk pools, by law, the new pools cannot charge higher premiums than the standard premiums in an individual's given state.

Modeled after the Children's Health Insurance Program (CHIP), the Pre-Existing Condition Plan allows for flexibility by state as long as basic requirements are met. State programs may vary on cost, benefits and determination of pre-existing conditions. In addition, any unspent funding will be reallocated by the states. Unlike CHIP, however, there is no state matching requirement and the entire cost of the new plan will be covered by the federal government.

For more information on the federal high-risk pools, visit www.healthreform.gov.

Coffee Reduces Risk of Diabetes

2010-07-02T08:26:00.000-07:00

That cup of joe may be doing more than keeping you awake -- it also may be reducing your risk of developing Type 2 diabetes. That's the conclusion of a recent Japanese study involving a strain of mice that are known to become diabetic.

Studies of people have found a correlation between coffee consumption and a reuced risk of diabetes. To find out if there was a direct link between coffee and diabetes, the Japanese researchers let mice drink diluted black coffee instead of water. Those coffee drinkers were compared with a similar group of mice that got plain old H20.

After five weeks, both groups of mice had consumed the same amount of food and weighed essentially the same. However, the coffee-drinking mice had less fat under the skin and in their abdomens. In addition, their insulin did a better job of reducing the concentration of glucose in their blood.

To find out which component of coffee was responsible for these effects, the researchers did another experiment comparing plain water with caffeinated water. Once again, the caffeine-drinking mice wound up with less fat than the control mice despite eating the same amount of food and weighing about the same overall. The caffeine group also had a lower concentration of blood glucose.

The findings "suggest that coffee consumption may help to prevent Type 2 diabetes and metabolic syndrome." Caffeine appears to play an important role, but it can't be the only factor, considering that other studies have linked decaf coffee to a reduced risk of diabetes. The researchers said they are continuing to search for other coffee compounds that are anti-diabetic.

Journal of Agricultural and Food Chemistry, June 2010

Vitamin K Linked to Lower Diabetes Risk

2010-06-25T10:22:00.000-07:00

People who get plenty of vitamin K from food may have a lower risk of developing Type 2 diabetes than those who get less of the vitamin, a new study suggests....

Researchers found that among more than 38,000 Dutch adults they followed for a decade, those who got the most vitamin K in their diets were about 20 percent less likely to be diagnosed with Type 2 diabetes during the study period.

Dr. Joline W.J. Beulens of the University Medical Center Utrecht in the Netherlands writes, the findings appear to be the first to show a relationship between vitamin K and diabetes risk, and do not prove that the vitamin is the reason for the lower risk.

Instead, they add, the results should fuel further research into whether vitamin K does play a role in the development of Type 2 diabetes. The extent to which specific nutrients in the diet might affect diabetes risk remains unclear.

Vitamin K exists in two natural forms: vitamin K1, or phylloquinone, found largely in green leafy vegetables, as well as some vegetable oils, such as canola and soybean oils; and vitamin K2, or menaquinone, which people get mainly through meat, cheese and eggs.

In the current study, both vitamins K1 and K2 were related to a lower diabetes risk, but the relationship was stronger with vitamin K2.

The findings are based on questionnaires from 38,094 men and women who were between the ages of 20 and 70 at the outset. Participants completed a detailed diet survey, from which each person's average vitamin K intake was estimated; they also answered questions on their overall health and lifestyle habits.

Over the next 10 years, 918 study participants were diagnosed with Type 2 diabetes, based on their medical records.

In general, Beulens and her colleagues found, the risk of developing Type 2 diabetes dipped for every 10-microgram (mcg) increase in vitamin K2 intake. Overall, the one-quarter of participants with the highest intake were 20 percent less likely to be diagnosed with diabetes than the one-quarter with the lowest intake.

With vitamin K1, no decreased risk was seen until consumption of the vitamin was relatively high. Similar to the findings with vitamin K2, the one-quarter of men and women who got the most vitamin K1 were 19 percent less likely to develop diabetes than the quarter with the lowest intake.

The researchers accounted for a number of other factors important in diabetes risk, including age, body weight and exercise habits. They also considered other dietary habits, like total calorie intake and consumption of certain other nutrients, like fat, fiber and vitamins C and E. Still, higher vitamin K intake, itself, was linked to a lower diabetes risk.

Exactly why the vitamin might be protective is not known. However, Beulens and her colleagues note, there is evidence that vitamin K reduces systemic inflammation, which may improve the body's use of the blood-sugar-regulating hormone insulin.

In the U.S., the recommended daily intake for vitamin K, in all forms, is 120 mcg for men and 90 mcg for women. In this study, participants with the highest intakes typically consumed between 250 and 360 mcg of total vitamin K each day.

Diabetes Care, online April 27, 2010.

Diabetes Costs More than $218 Billion and Expected to Rise

2010-06-12T10:14:00.000-07:00

Medical costs and reduced work productivity associated with diabetes cost the U.S. over $218 billion in 2007, researchers said.According to Timothy M. Dall of the Lewin Group in Falls Church, Va., the annual average cost per patient was $9,975 for diagnosed diabetes and $2,864 for undiagnosed disease,

"The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life," the researchers wrote online in Health Affairs.

"The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies."

Dall and his colleagues, working with funding from Novo Nordisk, developed the estimates from a proprietary economic model based on medical literature, government statistics, and insurance claims data.

Results from the National Health Interview Survey, corrected with claims data, indicate that about one million Americans had Type 1 diabetes and 16.5 million had Type 2 diabetes in 2007.

The economic model indicated that the per-patient economic burden was $14,856 for Type 1 diabetes and $9,677 for Type 2 disease.

National Health and Nutrition Examination Survey findings indicate that some 57 million individuals had "prediabetes," and another 6.3 million Americans had diabetes but have not been formally diagnosed.

Their average costs were $443 for prediabetes (medical costs only) and $2,864 for undiagnosed diabetes, Dall and colleagues estimated. Compared to those with no diagnosis, people with known diabetes accounted for vastly more use of various services, including outpatient care, emergency visits, and hospitalization.

For example, ambulatory visits for neurological symptoms were nearly eight times as common among Type 1 diabetics as among nondiabetics, and five times as common among those with Type 2 diabetes.

Inpatient days for cardiovascular problems were increased more than six-fold for both types of diabetes, and emergency visits for such problems were about three times as common. Undiagnosed diabetes had smaller but still detectable consequences for medical expenses. Compared with people with no history of diabetes, undiagnosed diabetics had 70% more outpatient visits and more than twice as many hospital inpatient days for cardiovascular complaints.

Overall, the bill for medical services associated with diabetes was $153 billion, according to Dall and colleagues -- about 7% of the total national healthcare expenditure. The researchers put the loss of work productivity at $65 billion, including absenteeism, reduced productivity while at work, disability, and premature death.

Some of the data underlying the estimate came from National Health Interview Survey data on missed workdays and disability rates, reports in the literature, and CDC estimates of diabetes-related mortality.

Dall and colleagues noted that patients and their families bear much of the burden in the form of out-of-pocket expenses and reduced earnings -- not to mention the impaired quality of life and other intangibles. But everyone else shares the costs as well, they argued.

"This diabetes burden represents a hidden 'tax' in the form of higher health insurance premiums and reduced disposable income," Dall and colleagues wrote.

Dall T, et al "Economic burden of diabetes" Health Affairs 2010

One Sleepless Night Can Result in Insulin Resistance

2010-06-02T08:10:00.000-07:00

Researchers found that healthy people who had just one night of short sleep can show signs of insulin resistance, a condition that often precedes Type 2 diabetes. Over the last ten years the average night's sleep in western societies has shortened, coinciding with a rise in cases of insulin resistance and Type 2 diabetes.

These findings suggest this may be more than a coincidence, and that, "a short night of sleep has more profound effects on metabolic regulation than previously appreciated," said Dr. Esther Donga.

Other studies have already shown that several nights of shorter sleep can lead to impaired glucose tolerance, but this is the first to show insulin sensitivity can change after only one night of partial sleep.

For their study, Donga and colleagues from Leiden University Medical Center, The Netherlands, recruited 9 healthy participants, and measured their insulin sensitivity following one night of about 8 hours of normal sleep and again following one night of only 4 hours of partial sleep.

They measured the participants' insulin sensitivity using the "hyperinsulinemic euglycemic clamp method" which infuses glucose and insulin into the bloodstream via catheters and allows you to work out how much glucose is necessary to compensate for an increased insulin level without causing hypoglycemia.

Donga said their results suggest that day to day insulin sensitivity is not fixed in healthy people, but depends on how much sleep they have had the previous night.

"In fact it is tempting to speculate that the negative effects of multiple nights of shortened sleep on glucose tolerance can be reproduced, at least in part, by just one sleepless night," she added.

Prompted by their findings the researchers suggested further investigations should be done to find out whether improving sleep duration could help stabilize glucose levels in patients with diabetes.

"A Single Night of Partial Sleep Deprivation Induces Insulin Resistance in Multiple Metabolic Pathways in Healthy Subjects." Esther Donga, Marieke van Dijk, J. Gert van Dijk, J. Clin. Endocrinol. Metab., Rapid Electronic Publication first published on Apr 6, 2010 as doi:10.1210/jc.2009-2430

Pig Pancreas Works for Type 1's

2010-05-22T10:06:00.000-07:00

Early trial finds technique is safe, improves blood sugar control. Pancreatic cells from pigs that have been encapsulated have been successfully transplanted into humans without triggering an immune system attack on the new cells.

What's more, scientists report, the transplanted pig pancreas cells quickly begin to produce insulin in response to high blood sugar levels in the blood, improving blood sugar control in some, and even freeing two people from insulin injections altogether for at least a short time.

Dr. Paul Tan, CEO of Living Cell Technologies of New Zealand, states that, "This is a very radical and new way of treating diabetes.... Instead of giving people with Type 1 diabetes insulin injections, we deliver it in the cells that produce insulin that were put into capsules."

The cells that produce insulin are called beta cells and they are contained in islet cells found in the pancreas. However, there's a shortage of available human islet cells. For this reason, Tan and his colleagues used islet cells from pigs, which function as human islet cells do.

"These cells are about the size of a pinhead, and we place them into a tiny ball of gel. This keeps them hidden from the immune system cells and protects them from an immune system attack," said Tan, adding that people receiving these transplants won't need immune-suppressing drugs, which is a common barrier to receiving an islet cell transplant.

The encapsulated cells are called Diabecell. Using a minimally invasive laparoscopic procedure, the covered cells are placed into the abdomen. After several weeks, blood vessels will grow to maintain the islet cells, and the cells begin producing insulin.

The company recently released data from its initial safety trial. The study included eight people with difficult-to-control Type 1 diabetes; the volunteers were between the ages of 21 and 68. Half of the group underwent three transplant procedures, two had two transplant surgeries and the final two had just one transplant surgery.

The researchers have been following-up on the transplant recipients for about two years. No serious adverse events have been reported to date. Two people said they had abdominal discomfort after the procedure for up to five days. No one has had any immune system reactions to the transplants.

Two people were able to stop taking insulin injections -- one for four weeks, the other for 32 weeks, according to Tan. Others have reduced their daily need for insulin and after 18 months post-implant, all saw their A1c levels (a measure of long-term blood sugar control) improve.

The next stage of trials has already begun, and Tan said the researchers are already seeing improvements in hypoglycemia unawareness in addition to better blood sugar control. Tan said with the current trial, which is being funded in part by the Juvenile Diabetes Research Foundation (JDRF), the researchers hope to figure out what the optimal transplant dose should be. He hopes they'll move on to Phase 3 clinical trials within the next few years.

What isn't yet clear is how long the encapsulated cells will last, and whether or not people will need repeat transplants, much like booster shots are needed for some immunizations.

"If you can replace the beta cells, you can have a dramatic impact on Type 1 diabetes. The two things that have stopped beta cell transplants from being a win are the use of immunosuppression drugs and the shortage of human islet cells, and Diabecell really addresses both of those issues," explained Julia Greenstein, director of beta cell therapies for the JDRF.

The findings will be presented at the Diabetes Association annual meeting June 2010 in Orlando, FL.

US Fast Food Contains Excessive Levels of Sodium

2010-05-15T13:47:00.000-07:00

Meals from fast-food chains contain excessive amounts of salt, a new study has shown. Over half of all purchases exceeded the 1500-mg daily limit of sodium advised for most Americans, and this rose to 84% of meals when only fried-chicken outlets were considered. Only one in 36 purchases met the FDA "healthy" sodium limit (600 mg) for meals.

Christine M. Johnson (Cardiovascular Disease Prevention and Control Program, New York City Department of Health and Mental Hygiene) and colleagues reported in the Archives of Internal Medicine that, "This study extends analyses of the nutritional content of fast food from calorie to sodium content and shows that fast food is high in sodium as well as calories."

The widespread consumption of fast food "contributes to current high levels of daily sodium intake in the US, higher blood pressure, and the resulting burden of cardiovascular disease," so reducing sodium levels in such foods is "a public-health priority," they urge.

In their study, Johnson et al collected data from noon to 2 pm on weekdays from March to June 2007; adults who bought a meal from one of 167 locations representing 11 fast-food chains across the five boroughs of New York City answered a brief survey and provided their purchase receipt in exchange for a $2 metro card. Nutrition information posted on company websites as of March 1, 2007, was used to determine sodium content.

The final sample size was just over 6,500 meals; each meal contained, on average, 1751 mg of sodium; 20% had more than 2300 mg. Fried-chicken chains were the biggest culprits, with 55% of their meals containing more than 2300 mg.

And excess sodium was not simply the result of large portion size, say Johnson et al; they also calculated sodium density, defined as mg of sodium per 1000 cal. The sandwich and fried-chicken outlets and one pizza chain, Papa John's, were the worst culprits in terms of the sodium density of their foods.

The researchers say the strengths of their study include the use of receipts of meals purchased, rather than reliance on patron self-report, and the large sample of patrons from randomly selected locations. Participants were not asked about salt added at the table, however, potentially underestimating the sodium content per meal.

"Our findings support the need for the fast-food industry to focus on reducing sodium levels across product lines," they conclude. "Government, public-health, and industry involvement to accelerate food reformulation will reduce blood pressure and save lives."

Dr. Henry Black, president of the American Society of Hypertension, commented that, "I am not surprised. I don't think the public really knows how much salt is in these foods." And he agrees that urgent attempts should be made to reduce the sodium content in such foods. "Experience in the UK and other countries has shown that you can reduce the amount of salt in processed foods and restaurant foods without anybody complaining."

Johnson et al note that current US recommendations are for adults to limit sodium intake to less than 2300 mg per day, and several groups -- blacks, middle-aged and older people, and those with hypertension, who together make up 69% of the adult population -- are advised to cap intake at 1500 mg per day. Despite these suggestions, most adults consume an average of 3500 mg of sodium per day, with more than 75% of dietary sodium coming from packaged and restaurant foods.

Black cautions that it will be important as things move forward on this issue in the US to avoid confusion among the public between salt and sodium. "Is the limit 6000 mg of salt a day, is it 2300 mg of sodium? We have to be careful of this, and maybe the people who make recommendations should select one or the other. Perhaps it's better for the public to call it salt?"

Moves are now afoot in the US to emulate the efforts of other countries, which have successfully reduced the amount of salt in processed foods by working together with the food and beverage industries.

Just last week, the Institute of Medicine issued a report advising the FDA that it should set stricter federal standards for the amount of salt that food manufacturers, restaurants, and food-service companies can add to their products, and New York City has been at the forefront of a countrywide campaign -- the National Salt Reduction Initiative -- which aims to cut the salt content in bought foods by 25% over five years. The American Medical Association has also called on industry to reduce the sodium content of processed products by 50%; such a reduction would save "tens of thousands of lives each year" and save almost $20 billion in healthcare costs annually, say Johnson et al.

Mean sodium, mean calories, and mean sodium density of meals at 11 New York City fast-food chains by collection of customer receipts.

Fast-food chain	Mean sodium(mg)	Mean cal	Mean sodium density
Burger King	1685	1008	1727
McDonald's	1477	908	1782
Wendy's	1631	907	1885
Au Bon Pain	1553	608	2842
Subway	1883	768	2627
KFC	2397	958	2504
Popeye's	2497	1050	2418
Domino's	2465	1550	1545
Papa John's	1561	652	2443
Pizza Hut	2272	1017	2233
Taco Bell	1849	909	2093

Johnson CM, Angell SY, Lederer A, et al. Sodium content of lunchtime fast food purchases at major US chains. Arch Intern Med 2010; 170:732-734. PubMed

Also see Article 10 in Issue 519 of DiabetesInControl, IOM Recommends FDA Set New Standards for Salt in Foods.

Moderate Drinking Linked to 44%-65% Lower Diabetes Risk

2010-05-08T13:40:00.000-07:00

Adults who have a drink or two per day may have a lower diabetes risk than teetotalers and the link does not appear to be explained by moderate drinkers' generally healthier lifestyle, a new study finds. A number of studies have found an association between moderate drinking and a relatively lower risk of developing Type 2 diabetes.

However, whether that reflects a benefit of alcohol has been unclear. A central issue is the fact that, compared with both non-drinkers and heavy drinkers, moderate drinkers tend to have a generally healthier lifestyle.

In the new study, researchers found that among more than 35,000 Dutch adults followed for a decade, those who averaged a drink or two per day were 45 percent less likely than teetotalers to develop Type 2 diabetes.

Moreover, the lower risk was seen among men and women whose diabetes risk was already relatively low because of their weight and lifestyle habits -- namely, not smoking, eating a healthy diet and getting regular exercise.

Even among study participants with at least three of those protective factors, moderate drinkers were 44 percent less likely than non-drinkers to develop Type 2 diabetes.

The findings, reported in the American Journal of Clinical Nutrition, do not prove that drinking itself lowers diabetes risk. But they do suggest that the alcohol-diabetes connection is not explained away by other lifestyle factors.

Lead researcher Dr. Michel M. Joosten, Wageningen University in the Netherlands, stated that, "Our results indicate that this is very unlikely, because moderate drinkers with the most healthy lifestyle behaviors ... had a lower chance of developing diabetes compared with subjects with these healthy lifestyle behaviors who did not drink.

The findings are based on 35,625 adults who were between the ages of 20 and 70 and free of diabetes, heart disease and cancer at the outset. Participants had their weight, height and waist and hip circumference measured and completed questionnaires on their health and lifestyle habits.

Over the next 10 years, 796 developed Type 2 diabetes. In general, moderate drinkers -- up to a drink per day for women, and up to two for men -- were less likely to develop the disease than non-drinkers. And that remained true when they examined the effects of other lifestyle-related factors.

For example, when they looked only at normal-weight men and women, moderate drinkers were 65 percent less likely to develop diabetes than teetotalers. Similarly, among regular exercisers, moderate drinkers had a 35 percent lower risk of diabetes.

It was noted that experts do not recommend that non-drinkers take up moderate drinking simply because it is related to lower risks of certain diseases. Alcohol always carries the potential for abuse, and the known risks of problem drinking have to be balanced against the possible health benefits of moderate drinking.

Practice Pearl: Moderate drinking "can be part of a healthy lifestyle to lower your risk of Type 2 diabetes, even if you already comply with multiple other low-risk lifestyle (behaviors)."

American Journal of Clinical Nutrition, online April 21, 2010

Does Eating More Frequent Meals Increase Metabolism?

2010-04-25T13:32:00.000-07:00

You've probably heard that eating smaller meals, several times a day will stimulate your metabolism, and keep it revved to burn more calories throughout your day. But a recent article in the New York Times points out that although some studies have found modest health benefits to eating smaller meals, the research usually involved extremes.

Many weight-loss books and fad diets claim six meals a day is a more realistic approach. But will it really make a difference?

As long as total caloric and nutrient intake stays the same, then metabolism, at the end of the day, should stay the same as well. One study that carefully demonstrated this, published in 2009 in The British Journal of Nutrition, involved groups of overweight men and women who were randomly assigned to very strict low-calorie diets and followed for eight weeks. Each subject consumed the same number of calories per day, but one group took in three meals a day and the other six.

Both groups lost significant and equivalent amounts of weight. There was no difference between them in fat loss, appetite control or measurements of hormones that signal hunger and satiety. Other studies have had similar results.

There is no solid evidence that six small meals a day instead of three will speed metabolism. Exercise, on the other hand, seems to effectively increase metabolism according to studies.

The British Journal of Nutrition November 30, 2009; 1-4.

Health Care Reform: How Does it Affect People with Diabetes?

2010-04-15T13:17:00.000-07:00

The health care reform bill "doesn't fix everything that's wrong with our health care system, but it moves us decisively forward," President Obama said. Insurance companies will be under government regulations, coverage can't be denied based on pre-existing conditions.

According to this New York Times editorial, "The biggest difference for Americans who have employer-based insurance is the security of knowing that, starting in 2014, if they lose their job and have to buy their own policy, they cannot be denied coverage or charged high rates because of pre-existing conditions. Before then, the chronically ill could gain temporary coverage from enhanced high-risk pools and chronically ill children are guaranteed coverage."

There are options for people with diabetes. Now pre-existing conditions can't be denied. Reuters reports that "Uninsured adults with a pre-existing condition will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014." This is in addition to insurers being "barred from excluding children for coverage because of pre-existing conditions."

Newsweek sheds a little more light on this, stating, "Insurers who offer plans on an insurance exchange will be prohibited from rejecting customers with preexisting conditions or charging them higher rates. But the exchanges won't be mandatory until 2014. In the meantime, people with preexisting conditions will be permitted to enter a 'high-risk pool,' which offers caps on premiums and out-of-pocket spending. Still, there's a catch: only people who have been without coverage for six months are eligible. The rule is designed to stop people from arbitrarily switching from their private insurance plans to the cheaper -- but taxpayer subsidized -- pools. But it means that people who lose their jobs can remain uninsured for a full six months."

Now, those people with diabetes hopefully will not have to stay in jobs they dislike.

DNA Testing Determines which Popular Diet Will Work

2010-04-05T11:24:00.000-07:00

New data provided some early evidence that the secret to weight loss might lie in DNA and that the best way to shed excessive pounds is to diet according to genotype....

Researchers are cautious, of course, but the latest study showed that when individuals were assigned to different diets -- including the low-carbohydrate Atkins diet and low-fat Ornish diet -- based on their genotype, they lost significantly more weight than those assigned to a diet unsuited to their genetics.

Dr. Christopher Gardner (Stanford University) writes, "Say you and your wife went on the Atkins diet, and you both think you followed it religiously, but you lost 13 pounds and she lost nothing and is angry because she followed the same diet. Well, she might have a different genotype. She isn't genetically predisposed to do well on a low-carbohydrate Atkins diet."

The new data are derived from a study the group previously conducted in 311 overweight women who were randomized to four popular diets: the very-low-carbohydrate Atkins diet, the low-carbohydrate Zone diet, the very-low-fat Ornish diet, and the low-fat LEARN diet. In that trial, known as the Atkins-Traditional-Ornish-Zone (A TO Z) study, women assigned to the Atkins diet had a modest benefit relative to the other diets, but overall results were disappointing in that the women, on average, lost only about 10 pounds.

"Within every diet group, though, some of the women lost more than 30 pounds and kept it off for over a year," said Gardner. "And some of the women gained more than 10 pounds. Within every diet, the range is at least 40 to 50 pounds. Between the different diets, the weight loss difference was just a few pounds, yet within the group, the difference is much larger. This is actually much more interesting than the difference between groups. How can the responses to the same diet be so different?"

With these data, the researchers were approached by Interleukin Genetics (Waltham, MA), asking them if they could obtain the DNA of the study participants. The company had previously identified three genes -- ABP2, ADRB2, and PPAR-gamma -- that could predict weight loss. These genes were shown to predict weight loss in three different studies, were biologically plausible, and were shown to have gene-diet interaction, said Gardner.

The researchers obtained DNA from 138 women and analyzed the weight loss according to genotype and diet in 133 participants. Among those participants who completed the 12-month study, researchers observed a significant interaction between diet assignment and weight loss after taking genotype pattern into consideration.

Women assigned to a genotype-appropriate diet lost 5.3% of their body weight compared with just 2.3% among those not matched to genotype (p=0.005). Within the Atkins group, for example, those appropriately assigned by genotype lost approximately 12 pounds compared with 2 pounds for those who lacked the low-carbohydrate genotype. In the Ornish group, similar reductions in weight were observed among those appropriately assigned by genotype.

Gardner said the proportion of individuals who were genetically predisposed to the low-fat or low-carbohydrate diets is roughly 50-50, so a significant number of people will fall into each category. He stressed, however, that all individuals assigned to the diet groups were instructed to make healthy, wholesome food choices.

"If they were on low-carbohydrate and high-fat, they weren't told to eat butter and whipped cream but to eat nuts, seeds, and fatty fish," he said. "If they were on the low-fat diet, they weren't told to just eat low-fat Snackwell cookies but to eat veggies, whole grains, and beans. I get worried when people just say low-carbohydrate or low-fat because they don't really understand what that means. This is what really undermines the whole public-health low-fat message."

Dr. Lawrence J. Appel (Johns Hopkins University, Baltimore, MD) said there is interest in the genetic underpinnings of nutrition, however, the environment is key in reducing obesity worldwide. "This is an area of burgeoning interest," said Appel, "but the obesity epidemic occurred pretty quickly, over the past 10 or 20 years, and our genetic pool did not change in the same period. Our obesity epidemic is an environmental problem. Given the environment, genes might influence the response to the environment, but are the genes causal? No. It's likely that the environment has a dominant impact."

Gardner agrees, that the genetic predisposition to do well on certain diets, but not on others, will not put an end to the obesity epidemic, but that the findings could be helpful in fighting the battle of the bulge. The results are retrospective and need to be interpreted cautiously, but his group is planning to conduct a larger prospective study that assigns individuals to the different diets based on genotype.

"The results don't explain the whole nutrition puzzle, but it explains a large enough chunk to be of interest," he said.

Nelson MD, Prabhakar P, Kondragunta V, et al. Genotype patterns predict weight loss success: The right diet does matter. Presented at EPI|PNAM (Cardiovascular Disease Epidemiology and Prevention and Nutrition, Physical Activity, and Metabolism) Conference March 2-5, 2010.

Experimental Artificial Pancreas Succeeds with Type 1 Diabetes Patients

2010-03-22T13:14:00.000-07:00

In the first clinical trial of a system using two hormones, an artificial pancreas delivered insulin and glucagon in a way that closely mimics the body's control of blood sugar and maintained near-normal levels of glucose in a small group of Type 1 diabetes patients without them developing hypoglycemia....

Co-lead researcher Dr. Steven Russell, of the Massachusetts General Hospital (MGH) Diabetes Center, Boston, told the press that, "This is the first study to test an artificial pancreas using both insulin and glucagon in people with Type 1 diabetes.... It showed that, by delivering both hormones in response to frequent blood sugar tests, it is possible to control blood sugar levels without hypoglycemia, even after high-carbohydrate meals."

In the trial, Russell and the other co-lead investigator Dr. Edward Damiano, an associate professor of Biomedical Engineering at Boston University, and colleagues, tested a new type of artificial pancreas developed at Boston University.

The new artificial pancreas system comprises a blood glucose monitor, insulin pump technology and specialized software that controls the delivery of insulin and glucagon (a hormone that raises blood sugar levels).

In healthy people, blood sugar is controlled by a delicate balance between two hormones: insulin, which encourages various parts of the body to take up and use blood sugar, and glucagon, which raises blood sugar levels. Both insulin and glucagon are produced in the pancreas: insulin by beta cells and glucagon by alpha cells. However, in people with Type 1 diabetes, their immune system wipes out the beta cells, so they don't have enough insulin, resulting in too much sugar in the blood.

To control their blood sugar level, Type 1 diabetes patients have insulin treatment, which delays and can even prevent the long term effects of the disease, such as retinal damage, kidney failure and cardiovascular disease.

Insulin treatment for Type 1 diabetes patients is further complicated by the fact that although their glucagon-producing alpha cells are intact, they don't respond to low levels of blood sugar, so if they get too much insulin, they are then at risk of developing a life-threatening drop in blood sugar, or hypoglycemia.

Damiano commented that,"Large doses of glucagon are used as a rescue drug for people with severely low blood sugar."

Because of this elevated risk of hypoglycemia, the researchers at Boston University developed a new type of system that not only accounts for the rate of insulin absorption, but also includes glucagon. "Our system is designed to counteract moderate drops in blood sugar with minute doses of glucagon spread out throughout the day, just as the body does in people without diabetes," explained Damiano.

The researchers tested their prototype system on diabetic pigs in 2007, as a result of which they received Food and Drug Administration (FDA) approval to test on humans. For the trial, Russell, Damiano and colleagues, recruited 11 adults with Type 1 diabetes. The trial was designed primarily to test the software that controls the artificial pancreas. To get the most accurate glucose readings they used a sensor placed directly into a vein instead of taking readings under the skin.

For 27 hours the system controlled the participants' glucose levels, during which time they had three standardized, high-carbohydrate meals and slept at the hospital overnight. For six participants the system kept their glucose close to the target level, while five others had hypoglycemia that was significant enough that they had to drink a dose of orange juice to raise their glucose level.

One of the results that surprised the researchers was the large differences in insulin absorption rates among the patients, the fastest being four times faster than the slowest, which was much slower than expected. They were able to account for this by adjusting the system.

The software controlling the system was initially designed to dispense insulin at an expected absorption rate: this meant participants who absorbed at a slower rate got too much and developed hypoglycemia. When they tested participants' response to a single insulin injection, the researchers verified that some had consistently slow and some had consistently faster insulin absorption rates. They also observed that the rate of absorption varied a lot from experiment to experiment, even on an individual basis, to allow for individually specific dosage calculations.

So, they adjusted the software and globally lowered insulin absorption rate and repeated the experiments with the same participants.

The second time, none of the participants with slower absorption rates became sufficiently hypoglycemic to need intervention, and blood sugar levels were only slightly higher among those who had the faster insulin absorption rate. This showed, said the researchers, that the adjusted software parameters worked for all the participants, and may be adequate for all Type 1 diabetes patients. They concluded that the elimination of hypoglycemic events in the second set of experiments in the same participants, confirmed that they were caused by a mismatch between the parameter settings in the software and the participants' absorption rates.

They pointed out that all previously published studies of artificial pancreas systems have reported hypoglycemic events, but this is the first time that one has confirmed and addressed their cause.

The researchers are now planning to follow up this study with another set of experiments that will run for more than 48 hours, involving both adults and children. This time they will use the revised settings and an FDA-approved continuous glucose monitor.

They also plan to compare this two-hormone system with one that only uses insulin.

Russell said he imagined one day their system will be a wearable device, incorporating a glucose sensor that fits under the skin and communicates wirelessly with a pump about the size of a cell phone. "The pump would administer insulin and probably glucagon, and would contain a microchip that runs the control software," he added.

"It wouldn't be a cure, but it has the potential to be the ultimate evolution of insulin therapy for Type 1 diabetes," said Damiano.

"A Bihormonal Closed-Loop Artificial Pancreas for Type 1 Diabetes." Firas H. El-Khatib, Steven J. Russell, David M. Nathan, Robert G. Sutherlin, and Edward R. Damiano. Sci Transl Med, Vol. 2, Issue 27, p. 27ra27, published online 14 April 2010.

Diabetes Patients' Lives May Be Shorter if They Have Difficulty Trusting and Reaching Out to Others

2010-03-12T11:52:00.000-08:00

Mistrust can exact a high toll. Being overly cautious or dismissive in relating to people, researchers are learning, may shorten the lives of people with diabetes.Diabetes patients who have a lower propensity to reach out to others have a higher mortality rate than those who feel comfortable seeking support. These are the findings of a five-year study reported by Dr. Paul Ciechanowski, associate professor of psychiatry and behavioral sciences at the University of Washington (UW) in Seattle.

This is the first known study, the research team believes, to examine the association between relationship styles and mortality.

The researchers examined 3,535 adult patients with Type 1 and Type 2 diabetes enrolled as Group Health Cooperative patients in the Puget Sound area of Washington state. Because depression has been linked to premature death from diabetes, patients with depression were not included to avoid confounding the study results.

The patients completed a relationship questionnaire, developed in 1994 by Griffin and Bartholomew. Based on the results of this survey, patients were divided into two groups: those with an interactive style and those with an independent style in relating to people.

Individuals with an interactive style find it easy to get close to others and rely on them, and in turn are dependable for others. Those with an independent style tend to be either dismissive or fearful of close relationships. Some people with this style would like emotional closeness, but find it hard to trust or depend on others. Others can be indifferent to close relationships, preferring instead to be free and self-reliant.

"These ways of relating often extend to their relationships with health-care providers," the researchers said.

Regardless of their style, most patients Ciechanowski and his colleagues have studied over several projects perceive health care as rushed, impersonal and fragmented. Those with an independent style also reported feeling threatened by the power health-care providers had. Some were highly attuned to signs of rejection; others were sensitive to being controlled, and at the same time worried that help would not be available for them. Those with an independent style in relationships often felt a wall existed between patients and providers.

Interactive patients tended to understand the pressures health professionals were under, and overlooked minor shortcomings, previous research by Ciechanowski and his team has found. Such patients were more likely to value ongoing relationships with their providers, even when circumstances weren't ideal, and respected their training and knowledge.

During the course of the most recent study, diabetes patients who were mistrustful of people, including health-care providers, had a 33 percent higher mortality rate than those who interacted easily with others and sought comfort and support. The researchers found the significantly higher risk of death among diabetes patients who were less likely to seek support still held after controlling for other potential risk factors for mortality such as age, marital status, other medical conditions, complications of diabetes and body mass index.

The exact mechanisms behind the link between an independent relationship style and a higher mortality rate are not yet known, the researchers said, and further research is needed to delineate the reasons and to develop effective interventions.

"Prior studies have shown that lower support seeking is associated with poorer adherence to treatment," Ciechanowski noted. An independent relationship style, he explained, is often played out in missed appointments, higher glucose readings, lower satisfaction with health-care, and poorer home treatment of diabetes in such areas as foot care, exercise, diet, oral and injectible medication use, blood sugar monitoring, and smoking cessation.

"Many self-management behaviors related to diabetes are optimally carried out in collaboration with others -- family, peers and health-care providers," Ciechanowski noted. Planning and cooking diabetic-friendly meals, exercising, and quitting smoking are best undertaken, he added, with motivational support. Also, as diabetes gets more severe or complications arise, a self-reliant attitude that worked in the past may become a liability.

There are approaches, according to Ciechanowski, that health-care providers can try to improve collaboration with diabetes patients who have an independent relationship style, such as directly and non-judgmentally talking about this style. Also, providers might coach patients and help them set simple goals in seeking support in managing their diabetes. However, the effectiveness of such approaches in reducing the higher death rates among such patients has not yet been tested.

"Our research is based on a developmental theory known as attachment theory where earlier experiences often shape an individual's ability to trust later in life," Ciechanowski explains. "As clinicians, we have to keep in mind that what we say and how we say it can make a big difference in trust between clinician and patient -- which has implications for treatment adherence and health outcomes. Bedside manner matters. Also, as stewards of health care, we have to be mindful about what our fast-paced health-care system says to patients to engender trust or not. Long waits, less face-to-face time with providers, rashly delivered health information, and lack of continuous care can reduce trust -- particularly in those with an independent relationship style."

Psychology / Psychiatry 19 Mar 2010

Preventing Diabetes with Lifestyle Changes Can Persist for at Least 10 Years

2010-03-05T21:47:00.000-08:00

Ten-Year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study shows positive results. The Diabetes Prevention Program (DPP), a randomized clinical trial, demonstrated that intensive lifestyle intervention or metformin prevented or delayed development of Type 2 diabetes in high-risk adults compared with placebo.

The current article is the first report of the Diabetes Prevention Program Outcomes Study (DPPOS), a long-term follow-up of the DPP designed to determine whether the delay in diabetes seen during the DPP can be sustained.

After being informed of the main DPP results, patients in the metformin and placebo groups entered a 1- to 2-week drug washout phase. All participants were offered a group-administered version of the 16-session lifestyle curriculum as a bridge protocol. Once the DPPOS follow-up began, all participants were offered a lifestyle session every 3 months. The DPP lifestyle group participants were also offered 4 group sessions per year. Those in the metformin group continued to receive metformin (850 mg twice daily). As in the DPP, the primary outcome was development of diabetes. Median follow-up from original DPP randomization was 10 years.

In the original DPP, diabetes incidence was reduced by 58% with intensive lifestyle and by 31% with metformin compared with placebo. During DPPOS, diabetes incidence rates were not significantly different between groups. Incidence rates were stable in the lifestyle group, but decreased in the placebo and metformin groups during the DPPOS. During the combined DPP, bridge, and DPPOS periods, the incidence was decreased by 34% in the lifestyle group and by 18% in the metformin group compared with placebo.

The delay in median time to diabetes diagnosis was previously estimated from DPP results to be 11 years for the lifestyle group and 3 years for the metformin group. However, the current study estimated the delay to be about 4 years by lifestyle intervention and 2 years by metformin. Attendance at the quarterly lifestyle session averaged 18% for the original lifestyle group, 15% for the metformin group, and 14% for the placebo group.

The main finding of this study -- that the prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years -- is indeed good news. In fact, the incidence rate in the lifestyle group was remarkably stable, and the lowering of the relative risk reduction (from 58% to 34%) was due to a falling incidence rate in the placebo group rather than a loss of benefit in the lifestyle group. This may have occurred because the placebo group was offered some lifestyle intervention during DPPOS, although attendance was fairly poor. It is also possible, however, that placebo participants who were most prone to diabetes converted quickly (during DPP), leaving those less prone to produce a lower incidence rate.

Studies have suggested such a phenomenon, but the Finnish Diabetes Prevention Study reported a similar diabetes incidence rate among its placebo group during the trial and long-term follow-up phases. It is also important to note that the metformin group experienced a lower incidence rate during the DPPOS than the DPP. This finding suggests that adding modest lifestyle change (even if poorly attended) to metformin may enhance the drug's effect.

Not all the news was good, however. The substantial shortening of the median time to diabetes changes the cost-benefit ratio of the interventions. What remains to be seen is whether lifestyle or metformin intervention reduces the debilitating (and costly) microvascular and macrovascular complications associated with diabetes. Until that is known, regardless of whether the results of the current study were due to early intensive lifestyle intervention (during the DPP) or the addition of lifestyle to all groups (during the DPPOS), there remains little doubt that patients who can make positive lifestyle changes should do so.

Lancet. 2009;374:1677-1686

References
Nichols GA, Hillier TA, Brown JB. Progression from newly acquired impaired fasting glucose to Type 2 diabetes. Diabetes Care. 2007;30:228-233.
Ferrannini E, Nannipieri M, Williams K, et al. Mode of onset of Type 2 diabetes from normal or impaired glucose tolerance. Diabetes. 2004;53:160-165.
Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of Type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-1679.

What You Eat after Exercise Shapes You

2010-02-26T12:42:00.000-08:00

The benefits of exercise can be greatly affected by the food we eat after it, a new study says. Senior study author, Jeffrey F. Horowitz of the University of Michigan, states that, "Differences in what you eat after exercise produce different effects on the body's metabolism."

The study follows up on several previous studies that demonstrate that many benefits of exercise are transient: one exercise session produces benefits to the body that taper off, generally within hours or a few days.

"Many of the improvements in metabolic health associated with exercise stem largely from the most recent session of exercise, rather than from an increase in 'fitness' per se," Horowitz said.

"But exercise doesn't occur in a vacuum, and it is very important to look at both the effects of exercise and what you're eating after exercise," he said.

Specifically, the study found that exercise enhanced insulin sensitivity, particularly when meals eaten after the exercise session contained relatively low carbohydrate content.

Enhanced insulin sensitivity means that it is easier for the body to take up sugar from the blood stream into tissues like muscles, where it can be stored or used as fuel.

Impaired insulin sensitivity (i.e. "insulin resistance") is a hallmark of Type 2 diabetes, as well as being a major risk factor for other chronic diseases, such as heart disease.

But the study also found that one does not have to starve after exercise to reap its benefits.

The study is based on healthy sedentary men, aged between 28 and 30 years.

Journal of Applied Physiology, Feb. 2010

Economic Burden of Diabetes Tops $200B and Going Higher

2010-02-21T12:40:00.000-08:00

Medical costs and reduced work productivity associated with diabetes cost the U.S. $218 billion in 2007, researchers said. According to Timothy M. Dall of the Lewin Group in Falls Church, VA, and colleagues, the annual average cost per patient was $9,975 for diagnosed diabetes and $2,864 for undiagnosed disease.

The researchers write that, "The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life.

"The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies."

Dall and his colleagues, working with funding from Novo Nordisk, developed the estimates from a proprietary economic model based on medical literature, government statistics, and insurance claims data.

Results from the National Health Interview Survey, corrected with claims data, indicate that about one million Americans had Type 1 diabetes and 16.5 million had Type 2 diabetes in 2007.

The economic model indicated that the per-patient economic burden was $14,856 for Type 1 diabetes and $9,677 for Type 2 disease.

National Health and Nutrition Examination Survey findings indicate that some 57 million individuals had "prediabetes," and another 6.3 million Americans had diabetes but have not been formally diagnosed. Their average costs were $443 for prediabetes (medical costs only) and $2,864 for undiagnosed diabetes, Dall and colleagues estimated.

Compared to those with no diagnosis, people with known diabetes accounted for vastly more use of various services, including outpatient care, emergency visits, and hospitalization. For example, ambulatory visits for neurological symptoms were nearly eight times as common among among Type 1 diabetics as among non-diabetics, and five times as common among those with Type 2 diabetes.

Inpatient days for cardiovascular problems were increased more than six-fold for both types of diabetes, and emergency visits for such problems were about three times as common.

Undiagnosed diabetes had smaller but still detectable consequences for medical expenses. Compared with people with no history of diabetes, undiagnosed diabetics had 70% more outpatient visits and more than twice as many hospital inpatient days for cardiovascular complaints.

Overall, the bill for medical services associated with diabetes was $153 billion, according to Dall and colleagues -- about 7% of the total national healthcare expenditure.

The researchers put the loss of work productivity at $65 billion, including absenteeism, reduced productivity while at work, disability, and premature death.

Some of the data underlying the estimate came from National Health Interview Survey data on missed workdays and disability rates, reports in the literature, and CDC estimates of diabetes-related mortality.

Dall and colleagues noted that patients and their families bear much of the burden in the form of out-of-pocket expenses and reduced earnings -- not to mention the impaired quality of life and other intangibles. But everyone else shares the costs as well, they argued.

"This diabetes burden represents a hidden 'tax' in the form of higher health insurance premiums and reduced disposable income," Dall and colleagues wrote.

Dall T, et al "Economic burden of diabetes" Health Affairs 2010

JDRF Artificial Pancreas Project Going Forward

2010-02-16T12:38:00.000-08:00

JDRF forms partnership with Animas to develop first-generation automated system for managing Type 1 diabetes. The Juvenile Diabetes Research Foundation announced an innovative partnership with Animas, a Johnson & Johnson company, to develop an automated system to help people with Type 1 diabetes better control their disease. This would be the first step on the path to what would be among the most revolutionary advancements in treating Type 1 diabetes:

the development of an artificial pancreas, a fully automated system to dispense insulin to patients based on real-time changes in blood sugar levels.

The objectives of the partnership, a major industry initiative within the JDRF Artificial Pancreas Project, are to develop an automated system to manage diabetes, conduct extensive clinical trials for safety and efficacy, and submit the product to the U.S. Food and Drug Administration for approval.

"If successful, the development of this first-generation system would begin the process of automating how people with diabetes manage their blood sugar," said Alan Lewis, PhD, President and Chief Executive Officer of JDRF. "Ultimately, an artificial pancreas will deliver insulin as needed, minute-by-minute, throughout the day to maintain blood sugars within a target range. But even this early system could bring dramatic changes in the quality of life for the 3 million people in the U.S. with Type 1 diabetes, beginning to free kids and adults from testing, calculating and treating themselves throughout the day."

The first-generation system would be partially automated, utilizing an insulin pump connected wirelessly with a continuous glucose monitor (CGM). The CGM continuously reads glucose levels through a sensor with a hair-thin sensor wire inserted just below the skin, typically on the abdomen. The sensor would transmit those readings to the insulin pump, which delivers insulin through a small tube or patch on the body. The pump would house a sophisticated computer program that will address safety concerns during the day and night, by helping prevent hypoglycemia and extreme hyperglycemia. It would slow or stop insulin delivery if it detected blood sugar was going too low and would increase insulin delivery if blood sugar was too high. For example, the system would automatically discontinue insulin delivery to help prevent hypoglycemia, and then automatically resume insulin delivery based on a specific time interval (i.e., 2 hours) and/or glucose concentration. It will also automatically increase insulin delivery to reduce the amount of time spent in the hyperglycemic range and return to a pre-set basal rate once glucose concentrations have returned to acceptable levels.

In this early version of an automated diabetes management system, the patient would still need to manually instruct the pump to deliver insulin at times, (i.e. around meals). But this "hypoglycemia-hyperglycemia minimizer" system would represent a significant step forward in diabetes management, and could provide immediate benefits in terms of blood sugar control, by minimizing dangerous highs and lows.

JDRF

Dietary Fiber Can Help Prevent Body Weight and Waist Circumference Gain

2010-02-12T09:23:00.000-08:00

Dietary fiber may help prevent gain in body weight and waist circumference, according to the results of a prospective cohort study. "Dietary fiber may play a role in obesity prevention," write Huaidong Du, from the National Institute for Public Health and the Environment in Bilthoven, the Netherlands, and colleagues. "Until now, the role that fiber from different sources plays in weight change had rarely been studied."

The goal of this study was to evaluate the relationship of total dietary fiber, cereal fiber, and fruit and vegetable fiber with changes in weight and waist circumference. The study cohort consisted of 89,432 European participants, aged 20 to 78 years, without cancer, cardiovascular disease, and diabetes at baseline. Validated, country-specific, food-frequency questionnaires were used to obtain dietary information. Average duration of follow-up was 6.5 years. In each center studied, multiple linear regression analysis was performed, and estimates were combined with random-effect meta-analyses, after adjustment for follow-up duration; other dietary variables; and baseline anthropometric, demographic, and lifestyle factors.

There was an inverse association of total fiber intake with subsequent change in weight and in waist circumference. For each 10-g/day increase in total fiber intake, the pooled estimate was –39 g/year (95% confidence interval [CI], –71 to –7 g/year) for weight change and –0.08 cm/year (95% CI, –0.11 to –0.05 cm/year) for waist circumference change.

For each 10-g/day increase in fiber intake from cereals, there was a weight change of –77 g/year (95% CI, –127 to –26 g/year) and change in waist circumference of –0.10 cm/year (95% CI, –0.18 to –0.02 cm/year). Fruit and vegetable fiber was not associated with weight change. However, the association of fruit and vegetable fiber intake with change in waist circumference was similar to that seen for intake of total dietary fiber and cereal fiber.

Limitations of this study include difference in methodologies used to collect anthropometric data at follow-up because weight and waist circumference measurements at follow-up were self-reported instead of measured at 4 of 6 study centers. In addition, dietary information was collected only once at baseline, which precluded investigating the concurrent association between changes in fiber intake and changes in weight and waist circumference.

"Our finding may support a beneficial role of higher intake of dietary fiber, especially cereal fiber, in prevention of body-weight and waist circumference gain," the study authors write. "Although the observed effect was rather small in our study when judged on the individual level, the effect of fiber on weight change observed in our study may be of public health relevance."

Am J Clin Nutr. Published online December 16, 2009. Abstract

Risk of Developing Type 2 Diabetes Increased by Smoking Cessation

2010-01-25T11:39:00.000-08:00

Cigarette smoking is a well-known risk factor for Type 2 diabetes, but new research from Johns Hopkins suggests that quitting the habit may actually raise diabetes risk in the short term.The researchers suspect the elevated diabetes risk is related to the extra pounds people typically put on after renouncing cigarettes and caution that no one should use the study's results as an excuse to keep smoking, which is also a risk factor for lung disease, heart disease, strokes and many types of cancer.

Study leader Hsin-Chieh "Jessica" Yeh, Ph.D., an assistant professor of general internal medicine and epidemiology at the Johns Hopkins University School of Medicine, Baltimore, MD, says "The message is: Don't even start to smoke.... If you smoke, give it up. That's the right thing to do. But people have to also watch their weight," she adds.

In the study, researchers found that people who quit smoking have a 70% increased risk of developing Type 2 diabetes in the first six years without cigarettes as compared to people who never smoked. The risks were highest in the first three years after quitting and returned to normal after 10 years. Among those who continued smoking over that period, the risk was lower, but the chance of developing diabetes was still 30% higher compared with those who never smoked.

The study enrolled 10,892 middle-aged adults who did not yet have diabetes from 1987 to 1989. The patients were followed for up to 17 years and data about diabetes status, glucose levels, weight and more were collected at regular intervals.

Type 2 diabetes is a common disease that interferes with the body's ability to properly use sugar, and to regulate and properly use insulin, a substance produced by the pancreas which normally lowers blood sugar during and after eating. In Type 2 diabetes, also known as adult-onset diabetes, the pancreas makes plenty of insulin to help the body when food is eaten, but the body cannot use it normally. The result is excess levels of blood sugar, which over time, can lead to blindness, kidney failure, nerve damage and heart disease. Overweight people and those with a family history of the disease have an increased risk for developing it, as do smokers, though the causal relationship is unclear.

According to the study, those who smoked the most and those who gained the most weight had the highest likelihood for developing diabetes after they quit. On average, over the first three years of the study, quitters gained about 8.4 pounds and saw their waist circumferences grow by approximately 1.25 inches.

Yeh and her colleagues want physicians to keep these findings in mind when they are consulting with patients who are giving up cigarettes, especially the heaviest smokers. They recommend considering countermeasures such as lifestyle counseling, aggressive weight management and the use of nicotine-replacement therapy, which seems to blunt the weight gain related to quitting. Another key step is more frequent blood glucose screening to assure the earliest detection of diabetes.

Annals of Internal Medicine January 5, 2010

Eating Out Too Often Can Increase Risk of Type 2 Diabetes

2010-01-10T09:17:00.000-08:00

Those who ate two meals per week of fried chicken were at 68 percent increased risk of Type 2 diabetes, compared to those who ate none. Type 2 diabetes is a major medical problem in Western Nations. The disease is believed to affect an estimated 20 million Americans, according to the U.S. Government.

Believing that dietary practice has a profound impact on the risk of Type 2 diabetes mellitus, Julie R. Palmer and colleagues at Boston University analyzed data from the prospective Black Women's Health Study to see if there is any correlation between consumption of restaurant meals and incidence of Type 2 diabetes among African American women.

Forty-four thousand participants aged 30 to 69 who were free of diabetes at baseline were surveyed through mailed questionnaires every two years from 1995 for their consumption of restaurant meals of various types.

During the 10-year follow-up, 2,873 incidence cases of Type 2 diabetes were identified.

The researchers found consumption of restaurant meals of hamburgers, fried chicken, fried fish and Chinese food were independently associated with increased risk of Type 2 diabetes.

Compared to those who did not eat any restaurant meals, black women who reported eating hamburgers twice per week were at a 40 percent increased risk of Type 2 diabetes.

Those who ate two meals per week of fried chicken were at 68 percent increased risk of Type 2 diabetes, compared to those who ate none, the study found.

However, when body mass index was included in the analysis, the estimated risk was reduced, which the researcher said suggested that the correlations were mediated through weight gain and obesity.

It is a fact that restaurants use trans fat to prepare many types of meals including fried foods like fried chicken and fried fish. Previous research has already found that trans fat is implicated in the development of diabetes among other things.

There is no safe threshold for intake of trans fat, but the Food and Drug Administration has warned that food consumers should not avoid all foods with trans fat, which could lead to deficiencies of nutrients because most of prepared foods or restaurant-served meals contain trans fat.

In addition to Type 2 diabetes, another disease that has been associated with trans fat is heart disease. Harvard nutritionists and epidemiologists estimated that as many as 100,000 deaths from heart disease each year in the U.S. have something to do with trans fat.

American Journal of Clinical Nutrition. Dec. 15, 2009

More than 90% of People with Gum Disease Are at Risk for Diabetes

2010-01-05T11:34:00.000-08:00

An overwhelming majority of people who have periodontal (gum) disease are also at high risk for diabetes and should be screened for diabetes, a New York University nursing-dental research team has found.

Researchers also determined that half of those at risk had seen a dentist in the previous year, concluded that dentists should consider offering diabetes screenings in their offices, and described practical approaches to conducting diabetes screenings in dental offices.

The study, led by Dr. Shiela Strauss, Associate Professor of Nursing and Co-Director of the Statistics and Data Management Core for NYU's Colleges of Dentistry and Nursing, examined data from 2,923 adult participants in the 2003-2004 National Health and Nutrition Examination Survey who had not been diagnosed with diabetes. The survey, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, was designed to assess the health and nutritional status of adults and children in the United States.

Using guidelines established by the American Diabetes Association, Dr. Strauss determined that 93 percent of subjects who had periodontal disease, compared to 63 percent of those without the disease, were considered to be at high risk for diabetes and should be screened for diabetes. The guidelines recommend diabetes screening for people at least 45 years of age with a body mass index (a comparative measure of weight and height) of 25 or more, as well as for those under 45 years of age with a BMI of 25 or more who also have at least one additional diabetes risk factor. In Dr. Strauss's study, two of those additional risk factors -- high blood pressure and a first-degree relative (a parent or sibling) with diabetes -- were reported in a significantly greater number of subjects with periodontal disease than in subjects without the disease. Dr. Strauss's findings, published today in the online edition of the Journal of Public Health Dentistry, add to a growing body of evidence linking periodontal infections to an increased risk for diabetes.

Dr. Strauss also examined how often those with gum disease and a risk for diabetes visit a dentist, finding that three in five reported a dental visit in the past two years; half in the past year; and a third in the past six months.

"In light of these findings, the dental visit could be a useful opportunity to conduct an initial diabetes screening -- an important first step in identifying those patients who need follow-up testing to diagnose the disease."

"It's been estimated that 5.7 million Americans with diabetes were undiagnosed in 2007," Dr. Strauss added, "with the number expected to increase dramatically in coming years. The issue of undiagnosed diabetes is especially critical because early treatment and secondary prevention efforts may help to prevent or delay the long-term complications of diabetes that are responsible for reduced quality of life and increased levels of mortality among these patients. Thus, there is a critical need to increase opportunities for diabetes screening and early diabetes detection."

Dr. Strauss said that dentists could screen patients for diabetes by evaluating them for risk factors such as being overweight; belonging to a high-risk ethnic group (African-American, Latino, Native American, Asian-American, or Pacific Islander); having high cholesterol; high blood pressure; a first-degree relative with diabetes; or gestational diabetes mellitus; or having given birth to a baby weighing more than nine pounds.

Alternatively, dentists could use a glucometer -- a diagnostic instrument for measuring blood glucose -- to analyze finger-stick blood samples, or use the glucometer to evaluate blood samples taken from pockets of inflammation in the gums.

"The oral blood sample would arguably be more acceptable to dentists because providers and patients anticipate oral intervention in the dental office," Dr. Strauss noted. In an earlier study involving 46 subjects with periodontal disease published in June 2009 by the Journal of Periodontology, an NYU nursing-dental research team led by Dr. Strauss determined that the glucometer can provide reliable glucose-level readings for blood samples drawn from deep pockets of gum inflammation, and that those readings were highly correlated with glucometer readings for finger-stick blood samples.

Journal of Public Health Dentistry on-line Dec, 2009

Novo Nordisk Begins Trial with Oral Insulin

2009-12-21T11:31:00.000-08:00

Novo Nordiskstarted the first human tests on an experimental insulin pill, NN1952, joining companies seeking to develop an alternative to daily injections for diabetes patients who need the hormone to control their disease.

The trial, involving 80 people, will include diabetes patients and healthy volunteers so researchers can determine whether the medication is safe and how it works in the human body, the Bagsvaerd, Denmark-based company said in a statement today. Novo is using Merrion Pharmaceuticals Plc's Gipet technology to enable insulin to permeate the intestinal wall.

The aim of the trial, which is conducted in Germany, is to investigate the safety, tolerance, pharmacokinetics and pharmacodynamics of NN1952 in healthy volunteers and people with Type 1 and Type 2 diabetes.. Results from the trial, which is planned to enroll about 80 people, are expected to be reported in the first half of 2011.

In November 2008, Merrion entered into a development and licensing agreement to develop and commercialize oral formulations of Novo Nordisk's proprietary insulin analogs, using Merrion's proprietary Gastrointestinal Permeation Enhancement Technology. This is the first development milestone achieved by Merrion under this agreement.

Peter Kurtzhals, senior vice president and head of diabetes research at Novo Nordisk, said, "We still have many challenges to overcome, and it is far too early to say whether or when oral insulin will become an alternative to insulin injections.... However, I am encouraged by the progress our R&D teams have made during the past two years, and which has led us to this important milestone."

News release, Novo Nordisk, Dec 2009

Cola Drinks Linked to Higher Risk of Diabetes

2009-12-15T11:26:00.000-08:00

Even though we don't agree with stating the obovious and want to give you information that you may not know. But did you know that high sugar, high calorie drinks and hiogher risk of diabetes are linked? No Kidding? But researchers have found for the first time that drinking more than 5 servings of sugar-sweetened cola a week prior to pregnancy significantly elevates the risk of developing diabetes during pregnancy.

Liwei Chen, MD, PhD, Assistant Professor of Epidemiology at LSU Health Sciences Center New Orleans School of Public Health, is the lead author of the paper, "A Prospective Study of Pre-Gravid Sugar-Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus."

The research team studied a group of 13,475 women from the Nurses' Health Study II. During 10 years of follow-up, 860 incident GDM cases were identified. After adjustment for known risk factors for GDM including age, family history of diabetes, parity, physical activity, smoking status, sugar-sweetened beverage intake, alcohol intake, prepregnancy BMI, and Western dietary pattern, intake of sugar-sweetened cola was positively associated with the risk of GDM. No significant association was found for other sugar-sweetened beverages or diet beverages.

"Compared with women who consumed less than 1 serving per month, those who consumed more than 5 servings per week of sugar-sweetened cola had a 22 percent greater GDM risk," notes Dr. Chen.

Gestational diabetes mellitus (GDM), defined as glucose intolerance beginning during pregnancy, is one of the most common pregnancy complications. Women with GDM are at increased risk for complications and illness during pregnancy and delivery, as well as post-pregnancy Type 2 diabetes. Children of mothers with GDM are at increased risk for obesity, glucose intolerance, and early onset diabetes.

Although the underlying mechanism remains unclear, available evidence suggests that the main defect in the development of GDM is relatively diminished insulin secretion coupled with pregnancy-induced insulin resistance. The researchers discuss a number of explanations of their findings. Consuming a large amount of sugar-sweetened beverages could contribute to a high glycemic load (GL) by providing a large amount of rapidly absorbable sugars. High-GL foods induce a greater plasma glucose response after eating which can result in insulin resistance and impaired beta cell function. (Pancreatic beta cells make insulin.) In addition, higher sugar intake itself may lead to impaired pancreatic cell function.

"We don't know why significant association was only found in sugar-sweetened cola, but not other types of sugar-sweetened beverages -- fruit drinks, other soft drinks, etc...," says Dr. Chen. "One of the explanations could be the tremendous popularity of cola in the US."

Previous studies in children and adults have shown that regular consumption of sugary drinks is associated with excess caloric intake, greater weight gain, and increased risk of obesity. Sugary drinks have also been linked to Type 2 diabetes and other metabolic disorders.

"This is the first study on the impact of sugar-sweetened beverages on GDM risk," notes Dr. Chen. "This finding is important because sugar-sweetened beverages are the leading source of added sugars in the American diet, particularly in the age group most likely to conceive. Cutting down sugary drinks is clearly an important way to reduce this common pregnancy complication."

According to the National Health and Nutrition Examination Survey 1999-2001, from 1977 to 2001, soft drink intake increased from 4.1 percent to 9.8 percent for 19- to 39-year-olds. In percentage terms, soft drink intake was highest among this age group in comparison to other ages.

Diabetes Care Dec. 2009

When You Eat Vs. What You Eat

2009-11-30T11:24:00.000-08:00

Researchers at the Salk Institute for Biological Studies, La Jolla, CA, found that, when you eat may be just as vital to your health as what you eat. Their experiments revealed that the daily waxing and waning of thousands of genes in the liver -- the body's metabolic clearinghouse -- is mostly controlled by food intake and not by the body's circadian clock as conventional wisdom had it.

The study's leader Satchidananda (Satchin) Panda, Ph.D., an assistant professor in the Regulatory Biology Laboratory states that. "If feeding time determines the activity of a large number of genes completely independent of the circadian clock, when you eat and fast each day will have a huge impact on your metabolism."

The Salk researchers' findings could explain why shift workers are unusually prone to metabolic syndrome, diabetes, high cholesterol levels and obesity.

"We believe that it is not shift work per se that wreaks havoc with the body's metabolism but changing shifts and weekends, when workers switch back to a regular day-night cycle," says Panda.

In mammals, the circadian timing system is composed of a central circadian clock in the brain and subsidiary oscillators in most peripheral tissues. The master clock in the brain is set by light and determines the overall diurnal or nocturnal preference of an animal, including sleep-wake cycles and feeding behavior. The clocks in peripheral organs are largely insensitive to changes in the light regime. Instead, their phase and amplitude are affected by many factors including feeding time.

The clocks themselves keep time through the fall and rise of gene activity on a roughly 24-hour schedule that anticipates environmental changes and adapts many of the body's physiological function to the appropriate time of day.

"The liver oscillator in particular helps the organism to adapt to a daily pattern of food availability by temporally tuning the activity of thousands of genes regulating metabolism and physiology," says Panda. "This regulation is very important, since the absence of a robust circadian clock predisposes the organism to various metabolic dysfunctions and diseases."

Despite its importance, it wasn't clear whether the circadian rhythms in hepatic transcription were solely controlled by the liver clock in anticipation of food or responded to actual food intake.

To investigate how much influence rhythmic food intake exerts over the hepatic circadian oscillator, researchers put normal and clock-deficient mice on strictly controlled feeding and fasting schedules while monitoring gene expression across the whole genome.

They found that putting mice on a strict 8-hour feeding/16-hour fasting schedule restored the circadian transcription pattern of most metabolic genes in the liver of mice without a circadian clock. Conversely, during prolonged fasting, only a small subset of genes continued to be transcribed in a circadian pattern even with a functional circadian clock present.

Lead researcher Vollmers stated that, "Food-induced transcription functions like a metabolic sand timer that runs for 24 hours and is continually reset by the feeding schedule while the central circadian clock is driven by self-sustaining rhythms that help us anticipate food, based on our usual eating schedule.... But in the real world we don't eat at the same time every day and it makes perfect sense to increase the activity of metabolic genes when you need them the most."

For example, genes that encode enzymes needed to break down sugars rise immediately after a meal, while the activity of genes encoding enzymes needed to break down fat is highest when we fast. Consequently a clearly defined daily feeding schedule puts the enzymes of metabolism in shift work and optimizes burning of sugar and fat.

The study represents a seminal shift in how we think about circadian cycles. Panda stated that, "The circadian clock is no longer the sole driver of rhythms in gene function, instead the phase and amplitude of rhythmic gene function in the liver is determined by feeding and fasting periods -- the more defined they are, the more robust the oscillations become."

While the importance of robust metabolic rhythms for our health has been demonstrated by shift workers' increased risk of developing metabolic syndrome, the underlying molecular reasons are still unclear. Panda speculates that the oscillations serve one big purpose: to separate incompatible processes, such as the generation of DNA-damaging reactive oxygen species and DNA replication.

To be published in a forthcoming issue of the Proceedings of the National Academy of Sciences

Depression Increases Mortality for Diabetes Patients

2009-11-15T11:11:00.000-08:00

Stress and mood have a tremendous impact on your overall health. Especially strenuous on your heart, stress plays a vital role on the longevity of your life and how many beats your ticker will give you! Eventhough you might not feel "stressed out" when you have diabetes you are added stress to your life even if you don't know it.

Patients with diabetes and coexisting depression face substantially elevated mortality risks beyond cardiovascular deaths.Recent evidence suggests that depression is linked to increased mortality among patients with diabetes. This study examined the association of depression with all-cause and cause-specific mortality in diabetes.
They conducted a prospective cohort study of primary care patients with Type 2 diabetes at Group Health Cooperative in Washington state. They used the Patient Health Questionnaire (PHQ-9) to assess depression at baseline and reviewed medical records supplemented by the Washington state mortality registry to ascertain the causes of death.

The results showed that, among a cohort of 4,184 patients, 581 patients died during the follow-up period. Deaths occurred among 428 (12.9%) patients with no depression, among 88 (17.8%) patients with major depression, and among 65 (18.2%) patients with minor depression. Causes of death were grouped as cardiovascular disease, 42.7%; cancer, 26.9%; and deaths that were not due to cardiovascular disease or cancer, 30.5%. Infections, dementia, renal failure, and chronic obstructive pulmonary disease were the most frequent causes in the latter group. Adjusting for demographic characteristics, baseline major depression (relative to no depression) was significantly associated with all-cause mortality (hazard ratio [HR]=2.26, 95% confidence interval [CI], 1.79-2.85), with cardiovascular mortality (HR = 2.00; 95% CI, 1.37-2.94), and with non-cardiovascular, non-cancer mortality (HR = 3.35; 95% CI, 2.30-4.89). After additional adjustment for baseline clinical characteristics and health habits, major depression was significantly associated only with all-cause mortality (HR = 1.52; 95% CI, 1.19-1.95) and with death not caused by cancer or atherosclerotic cardiovascular disease (HR = 2.15; 95% CI, 1.43-3.24). Minor depression showed similar but non-significant associations.

From the results it was concluded that, patients with diabetes and coexisting depression face substantially elevated mortality risks beyond cardiovascular deaths. This study is the first to examine cause-specific mortality and depression in a diabetes cohort. Emerging epidemiologic results among worldwide populations not limited to patients with diabetes have reported positive links between depression and mortality across a wide spectrum of non-cardiovascular causes, including cancer, human immunodeficiency virus, chronic obstructive pulmonary disease, and rheumatoid arthritis. A large population-based study in Norway confirmed that depression was a risk factor for all major disease-related deaths, not just cardiovascular disease.

Annals of Family Medicine 7:414-421 (2009)

Diabetes on the Rise in the U.S.

2009-11-02T08:05:00.000-08:00

At Rock for Diabetes we want to be on the forefront of information. We have posted and written about the rise of Diabetes in America and in fact this is one of the reasons why we started this organization But here again is another "reminder". Loaded with facts. - Diabetes cases are rising rapidly in the U.S., with the disease afflicting 11.3% of American adults as of the third quarter of 2009, according to a new Gallup survey. That's an increase from 10.4% measured in the first quarter of last year.

That means about 26 million Americans have diabetes. Gallup notes if current trends continue, more than 37 million will be living with the disease by the end of 2015.

Not coincidentally, the survey shows the U.S. obesity rate is up about 1 percentage point in quarter-over-quarter comparisons to 2008.

According to Gallup, Americans who are obese are almost three times as likely as those who aren't to be diagnosed with diabetes.

"The upward trends in obesity rates almost certainly play a substantive role in the increase in diabetes rates over the same time period," the Gallup survey states. "More than one-fifth of obese adults [have diabetes]" -- or 21.2%, compared to 7.4% of non-obese people of comparable ages.

The survey, echoing results of many studies, says one of the best ways to reduce obesity is to exercise. Between January and September 2009, it reports a sharply higher incidence of diabetes among those who didn't exercise at least a half hour on any given day in the previous week.

According to Gallup:

- 8% percent Americans with diabetes exercised at least 30 minutes a day, four to six times per week.
- 9.5% exercised at least half an hour daily in the previous week.
- 15% did not exercise at least 30 minutes in the week before they were surveyed.

"While exercise is seasonal and is expected to climb in the warmer months, even though diabetes is not a seasonal disease, year-over-year comparisons reveal a 2009 decline of 2.7 points in the percentage of American adults who say they are exercising at least 30 minutes three or more times per week, compared with 2008," according to the Gallup organization.

The 10 states with the highest increases in obesity from 2008-2009 have, on average, also seen a related increase of 0.5 percentage points in diabetes incidence, the survey shows. These states are Wyoming, Alaska, Minnesota, Maine, Idaho, Tennessee, Iowa, New Hampshire, North Dakota, and Texas.

The 10 states whose obesity rates have remained unchanged or decreased since 2008 have seen an average reduction in reported diabetes incidence of 0.3 percentage points. These states -- Delaware, Montana, Kansas, Nebraska, South Dakota, Louisiana, Virginia, Missouri, Nevada and Florida -- provide examples for future study to learn more about managing diabetes nationally, according to Gallup.

The report was based on telephone interviews with 623,538 adults, 18 or older, conducted from January to September 2009.

News release, Gallup-Healthways Well-Being Index.

Alcohol Linked to Lower Risk for Diabetes and Less Insulin Secretion

2009-10-15T09:55:00.000-07:00

Moderate daily alcohol intake (1-3 drinks per day) is linked to a reduced risk for incident diabetes and to lower insulin secretion in patients assigned to metformin or lifestyle modification for diabetes prevention, according to the results of a new study.

Jill P. Crandall, MD, (Albert Einstein College of Medicine, New York, which is participating in the Diabetes Prevention Program Research Group) writes, "Moderate alcohol consumption is associated with a decreased risk of Type 2 diabetes in the general population, but little is known about the effects in individuals at high risk of diabetes.... The objectives were to determine associations between alcohol consumption and diabetes risk factors and whether alcohol consumption was a predictor of incident diabetes in individuals enrolled in the Diabetes Prevention Program (DPP)."

The study cohort in the Diabetes Prevention Program consisted of 3,175 participants with impaired glucose tolerance (2-hour glucose: 140- 199mg/dL.[7.8 - 11.1 mmol/L]), elevated fasting glucose (95-126mg/dL. [5.3 - 7.0 mmol/L]), and a body mass index of 24 kg/m2 or greater. Participants were randomly assigned to receive placebo, metformin, or lifestyle modification. With use of a semiquantitative food-frequency questionnaire, alcohol intake was evaluated at baseline and at 1 year. During follow-up (mean duration, 3.2 years), incident diabetes was diagnosed by annual oral-glucose-tolerance testing and semiannual fasting plasma glucose measurement.

Self-reported alcohol consumption tended to be higher in participants who were men, older, white, and less obese, with higher energy intake and a higher high-density lipoprotein cholesterol concentration. At any level of insulin sensitivity, higher consumption of alcohol was associated with lower insulin secretion. In the metformin and lifestyle modification groups, higher alcohol consumption was associated with lower incidence rates of diabetes (P < .01 and P = .02 for trend, respectively). These associations remained significant after adjustment for multiple baseline covariates but were not observed in the placebo group.

"Despite overall low rates of alcohol consumption, there was a reduced risk of incident diabetes in those who reported modest daily alcohol intake and were assigned to metformin or lifestyle modification," the study authors write. "Moderate daily alcohol intake is associated with lower insulin secretion -- an effect that warrants further investigation."

Limitations of this study include baseline differences in diabetes risk factors among the alcohol consumption categories, possible unmeasured confounders, reliance on self-report to assess alcohol consumption, overall low alcohol consumption, and limited generalizability.

"The potential benefits of alcohol use in preventing diabetes may be limited to those who are actively pursuing other therapies to reduce risk," the study authors conclude. "Moderate alcohol intake was associated with decreased insulin secretion, independent of insulin sensitivity. The effect of chronic alcohol consumption on glucose metabolism, especially b cell function, warrants further investigation."

Am J Clin Nutr. Oct. 2009;90:595-601. Abstract

Blueberry Juice Fights Fat and Diabetes

2009-10-08T10:53:00.000-07:00

Juice extracted from North American lowbush blueberries, biotransformed with bacteria from the skin of the fruit, holds great promise as an anti-obesity and anti-diabetic agent, showing a reduction in blood glucose by 35%.

The study, tested the effects of biotransformed juices compared to regular blueberry drinks on mice.

Senior author Pierre S. Haddad, a pharmacology professor at the Université de Montréal's Faculty of Medicine stated that, "Results of this study clearly show that biotransformed blueberry juice has strong anti-obesity and anti-diabetic potential…. Biotransformed blueberry juice may represent a novel therapeutic agent, since it decreases hyperglycemia in diabetic mice and can protect young pre-diabetic mice from developing obesity and diabetes."

The scientists tested the effect of biotransformed blueberry juice on a group of mice prone to obesity, insulin resistance, diabetes and hypertension. Incorporating biotransformed blueberry juice into the water of the mice reduced their food intake and their body weight. "These mice were an excellent model that closely resembles obesity and obesity-linked Type 2 diabetes in humans," says Dr. Haddad, who is also director of the CIHR Team in Aboriginal Anti-Diabetic Medicines at the Université de Montréal.

Biotransformation of the blueberry juice was achieved with a new strain of bacteria isolated from the blueberry flora, specifically called Serratia vaccinii, which increases the fruit's antioxidant effects. "The identification of the active compounds in biotransformed blueberry juice may result in the discovery of promising new antiobesity and antidiabetic molecules," says Dr. Haddad.

As for the impact of blueberry products on diabetes, says Tri Vuong, lead author and recent PhD graduate from the Université de Montréal's Department of Pharmacology: "Consumption of fermented blueberry juice gradually and significantly reduced high blood glucose levels in diabetic mice. After three days, our mice subjects reduced their glycemia levels by 35 percent."

The article "Antiobesity and antidiabetic effects of biotransformed blueberry juice in KKAy mice," published in the International Journal of Obesity,was authored by Tri Vuong, Ali Benhaddou-Andaloussi.

Should Aspirin Be Routine for Type 2’s?

2009-10-05T00:50:00.000-07:00

The widespread recommendation for the routine use of low-dose aspirin in primary prevention of cardiovascular events for all patients with Type 2 diabetes should be revisited, experts said at theEuropean Society of Cardiology 2009 Congress.

Currently, most of the major scientific bodies, including the American Heart Association (AHA), American College of Cardiology (ACC), European Society of Cardiology (ESC), and the European Association for the Study of Diabetes (EASD), uniformly recommend giving aspirin to these patients. The lone exception is the Canadian Diabetes Association, which says that the decision to prescribe aspirin should be left to the discretion of the individual physician. Yet there is inadequate trial evidence for the efficacy and safety of low-dose aspirin in this setting, Dr. Carlo Patrono (Catholic University, Rome, Italy) told meeting attendees.

Patrono commented that, "If a patient has had a prior event, there is no question that he or she should be on aspirin, regardless of whether the patient is or is not diabetic, because we have plenty of evidence there..... But we don't have evidence for the efficacy and safety of low-dose aspirin in diabetics without a prior vascular event or without overt vascular disease. We need direct randomized evidence."

Dr Harald Darius (Vivantes Neukoelln Medical Center, Berlin, Germany), stated that recent trial results appear to contradict the general recommendations by the AHA, ACC, ESC, and EASD. "These societies recommend that every diabetic as soon as the diagnosis is made should receive aspirin as part of the initial therapeutic regimen, but they are probably overestimating the risk of diabetes in otherwise-healthy people."

Indeed, aspirin may be harmful for people with diabetes. "Diabetes is not only a risk factor for the occurrence of a serious vascular event, which is increased by about two-and-a-half fold, it is also a risk factor for major bleeds, which increase by about 50% in association with diabetes. So we should be very careful in seeking adequate evidence for both efficacy and safety of aspirin in this subgroup," Patrono said.

In separate presentations, both Darius and Patrono cited new evidence from the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial, which showed no significant effect of aspirin on reducing cardiovascular events. Another trial -- the Prevention of Progression of Arterial Disease and Diabetes (POPADAD) study -- also failed to find evidence of efficacy from aspirin in 1,300 subjects with diabetes and a low ankle-brachial index.

"The hazard ratio was 0.498 for the primary end point, which was death from coronary heart disease or stroke. My view is that this is a relatively small study, so the negative findings might be due to inadequate statistical power, but it is disappointing that these studies do not provide any direct evidence for efficacy," Patrono said.

There may be specific reasons why aspirin is not as effective in diabetic individuals, Patrono suggested. These include Cox-1 glycation, faster recovery of Cox-1 activity due to accelerated platelet turnover in a fraction of the diabetic population, and enhanced platelet Cox-2 expression that might be associated with accelerated platelet turnover.

Patrono and colleagues are currently studying the second option. "Our hypothesis is that enhanced platelet turnover in at least a fraction of Type 2 diabetic patients may allow sufficient recovery of Cox-1 activity during a 24-hour dosing interval, particularly between 12 and 24 hours, to overcome the antiplatelet effect of low-dose aspirin, thereby limiting its clinical efficacy," he explained.

They tested 100 patients with Type 2 diabetes on chronic low-dose (100-mg/day) aspirin, synchronizing their aspirin administration at 8 pm and then again the following day at 8 am, when they took an additional blood sample every three hours to cover the 12- to 24-hour dosing interval. After obtaining a total of five blood samples, they then studied the time course of recovery of platelet Cox-1 and Cox-2 activity in these individuals and found that some patients demonstrated a very slow recovery, comparable to healthy, nondiabetic individuals; others showed intermediate recovery, and still other subjects demonstrated a substantial recovery of platelet Cox-1 activity.

"These preliminary findings have important practical implications," Patrono said. "They may suggest alternative pharmacologic strategies to apply to particular subgroups of diabetic patients, including different dosing strategies to maximize the effect of low-dose aspirin in these patients. The same might apply to other drugs, such as clopidogrel."

Dr. Marie-Christine Alessi (Université de la Méditeranée Aix-Marseille, Marseille, France), stated that she thought Patrono's data showing that aspirin resistance might be explained by differences in platelet turnover was "very interesting. Aspirin, at least as we use it now, may not be useful." She suggested that it might be possible to isolate a population who may benefit through phenotyping. "And perhaps if we change the dosing strategy, for example by dividing the dose of aspirin so that we are giving it twice daily, we could be more protective."

The uncertainty about the role of aspirin for the prevention of cardiovascular events among patients with diabetes will remain until the results of ongoing trials -- such as A Study of Cardiovascular Events in Diabetes (ASCEND) and Aspirin and Simvastatin Combination for CV Events Prevention Trial in Diabetes (ACCEPT-D) -- are in, but this will take at least five years, Darius said.

Meanwhile, the clinical strategy should include aspirin for primary prevention in all diabetics 65 years and older or below 65 years in the presence of at least one additional cardiovascular risk factor such as obesity, hypertension, or dyslipidemia. Patients known to have vascular disease should continue to be offered primary prevention with aspirin, Darius said.

European Society of Cardiology August 29, 2009 Congress.

Pancreatic Fat Levels Can Help Predict Diabetes

2009-10-01T10:40:00.000-07:00

Researchers have long suspected that overweight people tend to have large fat deposits in their pancreases, but they've been unable to confirm or calculate how much fat resides there because of the organ's location -- that's until now.

Scientists at University of Texas Southwestern Medical Center are the first in the U.S. to use an imaging technique called magnetic resonance spectroscopy (MRS) to measure the amount of pancreatic fat in humans. Though scientists worldwide already use MRS to investigate a number of diseases including breast cancer and epilepsy, the UT Southwestern group has successfully used the noninvasive method to measure pancreatic fat.

Findings from the new study suggest that measuring pancreatic fat content in people could one day serve as an effective clinical tool to identify those at high risk of diabetes and monitor interventions designed to prevent the disease.

"These are very early results, but if they hold true, pancreatic MRS would be a fast and noninvasive test to screen people at risk for diabetes either because they're obese or they have a family history of Type 2 diabetes, or metabolic syndrome," said Dr. Ildiko Lingvay, assistant professor of internal medicine at UT Southwestern and lead author of the study. "It could potentially tell physicians which patients are most likely to develop diabetes in the near future and thus are in need of more aggressive interventions."

MRS is a specialized technique similar to magnetic resonance imaging (MRI). It uses no radiation and is completely noninvasive The test generally takes 20 to 30 minutes. Whereas an MRI can tell clinicians where a tumor is located, MRS can tell those physicians whether the tumor is malignant by providing biochemical information about specific tissues in the body rather than simply detecting the existence of those tissues, Dr. Lingvay said.

For this study, researchers used MRS to measure the amount of pancreatic fat in 79 adult volunteers. The research team obtained duplicate measurements one to two weeks apart from 33 study participants to make sure the results could be replicated over time.

The volunteers were divided into four groups according to their body mass index (BMI) and glucose tolerance. BMI is a weight-to-height ratio commonly used to gauge obesity. A normal BMI is between 18.5 and 25; someone with a BMI of 40 or more is considered morbidly obese. All participants underwent numerous physical measurements including height, weight and blood pressure in addition to extensive clinical evaluations.

Using MRS, the researchers found that the overweight and obese volunteers had significantly more pancreatic fat than did those in the lean group. The volunteers who had similar BMI's but had already developed either pre-diabetes or diabetes had even more pancreatic fat.

MRS has not been approved for routine clinical use, but Dr. Lingvay said this research shows that it could be a very valuable tool for studying the pancreas without a biopsy. "This technology represents a good opportunity for clinicians to pursue research that hasn't been possible because of the lack of advanced tools," she said.

The next step, Dr. Lingvay said, is to determine whether reducing the amount of fat in the pancreas lowers diabetes risk.

Study available online and in a future issue of the Journal of Clinical Endocrinology and Metabolism.

Warped Tour 09

2009-09-30T10:45:00.000-07:00

Another good time had by all on this years 15th installment of the Vans Warped Tour. With headliners like Bad Religion, 3OH!3 and All Time Low just to name a few, it is hard to find a better show!

Needless to say it was a very hectic day. The doors open at 11am with interviews starting right away. We tried to get a many interviews in as possible while trying to take as many pictures as possible too. At the end of the day we had 6 interviews we took over 700 pictures and were done by 8:30pm.

As an new organization and with the given economy we consider this year's date in Chicago a huge success. This year was different because along with our press passes were were granted photo passes as well, which is a big step for Rock for Diabetes to become a crediable organization to the fans, the bands, their management and of course to the people we want to help. Next year we want to go a step father and have a tent located on site for everyone and anyone to stop by and say hi and if you want, get your blood sugar checked.

We want to thank Mr. Lyman for doing it again and putting on another great show and we want to thank all the bands we sat down with for taking the time to answer a few our questions. We should do it again!

We have posted all the best pictures on the web at rockfordiabetes.org, check them out and listen to a few of the interviews that were done as well. And while you are there you can learn a little about diabetes as well

Make Diabetes a National Priority!

2009-07-24T09:51:00.000-07:00

NCDP has recently launched an ePetition looking to gather nation-wide support for the creation of a National Diabetes Coordinator to align federal spending and priorities around diabetes. The position wouldn't be permanent--we're proposing a temporary position that would be phased out when certain milestones are reached.

"Our goal is ambitious: 10,000 signatures by World Diabetes Day on Saturday, November 14. We need people from all 50 states, committed to fighting diabetes in American to show their support. Click the button above to sign the ePetition and learn more today!"

Increase in Type 1 Diabetes Expected

2009-06-21T09:38:00.000-07:00

If current trends continue, cases of Type 1 diabetes among children under 15 will increase by 70 percent by the year 2020, a new study suggests. Those are among the findings by researchers who analyzed diabetes data from 20 centers in 17 European countries. Those centers registered 29,311 cases of Type 1 diabetes between 1989 and 2003.

Around 15,000 new cases of Type 1 diabetes were recorded across the whole of Europe in 2005. Of these, 24% were children up to the age of four, 37% children aged five to nine and 34% children aged 10 to 14.

Researchers found that the overall incidence of the disease was increasing by 3.9% per year. The increase in the 0-4 age group was 5.4%, with a 4.3% rise in the 5-9 age group and a 2.9% increase among 10 to 14-year-olds. A total of 24,400 new cases were forecast for 2020, with a doubling in the number of cases of children aged five and under since 2005, just for Europe.

Numbers of child sufferers older than five were also expected to increase substantially. Scientists say the changes are too fast to be explained by genetic factors alone.

They suggest lifestyle factors may be partly responsible, including a trend towards women having bigger babies and increased numbers of Caesarean section births. Higher increases were seen in eastern Europe, where lifestyle habits were changing more rapidly than in the richer European countries.

The incidence of Type 1 diabetes among very young children will double from 2005 levels in a little over a decade if present trends continue, a new study shows. The prediction is based on Type 1 diabetes trends in Europe, but experts say there is every reason to believe that the U.S. will see a similar dramatic increase in the disease.

They are also convinced that environmental exposures are driving the increase, but it is far from clear what those exposures are.

Once known as juvenile diabetes, Type 1 diabetes is much less common than Type 2 diabetes, except among children and adolescents.

Epidemiologist Christopher C. Patterson, PhD, of Ireland's Queen's University, states that, “The most common age of diagnosis has been the early teen years, but that burden may be shifting toward younger children.”

"We are likely to see more children with severe diabetes complications presenting at earlier ages if we fail to recognize and adequately treat disease in very young patients," he says.

In the latest issue of The Lancet, Patterson and colleagues concluded that rates of Type 1 diabetes among children and young teens are increasing faster than previous predictions suggested.

Patterson and colleagues analyzed data from European registries, which included information on more than 29,000 children with Type 1 diabetes, enrolled between 1989 and 2003.

They found that:

- The overall increase in incidence of Type 1 diabetes was 3.9% per year.

- The increase was greatest among children under 5, who saw increases of 5.4% per year compared to an annual increase of 4.3% among children between the ages of 5 and 9 and 2.9% among children between the ages of 10 and 14.

- If present trends continue, total cases of disease are projected to rise by 70% by 2020 and rates among children under 5 will double.

Since the increases are occurring so quickly, it is likely that environmental influences are driving the trend, Patterson says.
Researchers are examining a wide range of possible environmental triggers, including early-life diet, viral infection, and even C-section delivery. But they still have more questions than answers.

"Being born to an older mom and C-section birth seem to be associated with slight increases in risk, but neither one of these is sufficient to explain the increases we are seeing," he says.

Epidemiologist Dana Dabelea, MD, PhD, from the University of Colorado, stated that one of the key areas of interest is rapid early growth due to improved early-life nutrition.

Dabelea is a co-investigator on the SEARCH for Diabetes in Youth Study, which is following children with Type 1 and Type 2 diabetes in different areas in the U.S. in an effort to better understand diabetes trends in non-adults.

In 2007, Dabelea and colleagues reported higher-than-predicted rates of Type 1 diabetes. The increase was most pronounced among non-Hispanic white children.

In an editorial accompanying the new study, Dabelea called for more research on Type 1 and Type 2 diabetes in children.
"It is imperative that efforts directed at surveillance of diabetes in young people continue and expand, not only to understand its complex etiology, but also because of the increasing public health importance," she writes.

Patterson, C. The Lancet, May 28; online edition. Christopher C. Patterson, PhD, epidemiology research group, Queen's University Belfast. Dana Dabelea, MD, PhD, associate professor, department of epidemiology, Colorado School of Public Health, University of Colorado, Denver. Dabelea D. The Journal of the American Medical Association, June 27, 2007; vol 297: pp 2716-2724.

Higher Levels of a Certain Protein Associated with Lower Risk of Type 2 Diabetes

2009-06-15T09:33:00.000-07:00

Persons with higher levels of adiponectin, a protein that is produced by fat cells and that has anti-inflammatory and insulin-sensitizing properties, have an associated lower risk of Type 2 diabetes, according to an analysis of previous studies.

Some studies have suggested several mechanisms through which adiponectin may decrease the risk of Type 2 diabetes, although the strength and consistency of the relation between plasma adiponectin and risk of Type 2 diabetes has been unclear, according to background information in the article.

Shanshan Li, M.D., M.Sc., of the Harvard School of Public Health, Boston, and colleagues conducted a review and meta-analysis to assess the consistency of the association of adiponectin levels and risk of Type 2 diabetes. The researchers identified thirteen studies with a total of 14,598 participants and 2,623 new cases of Type 2 diabetes that met criteria for inclusion in the meta-analysis.

The authors found that higher adiponectin levels were associated with a lower risk of Type 2 diabetes. This inverse association was consistently observed in whites, East Asians, Asian Indians, African Americans and Native Americans. The results did not differ substantially by method of diabetes ascertainment, study size, follow-up duration, body mass index or proportions of men and women.

"Although these epidemiologic studies cannot establish causality, the consistency of the association across diverse populations, the dose-response relationship, and the supportive findings in mechanistic studies indicate that adiponectin is a promising target for the reduction of risk of Type 2 diabetes," the authors write.

The researchers add that recent studies have shown that adiponectin levels can be increased through pharmaceutical and lifestyle interventions. "In addition, adiponectin levels may be useful for identifying persons likely to benefit most from interventions to treat ‘dysfunctional adipose tissue’ and its metabolic complications. Future studies should also evaluate whether adiponectin is useful for prediction of Type 2 diabetes in addition to established risk factors using statistical techniques appropriate for prognostic analyses."

JAMA. 2009;302[2]:179-188.

Antibiotic Use in Childhood Not Linked to Type 1 Diabetes

2009-06-07T07:00:00.000-07:00

Contrary to what several other studies have shown, the results of a nationwide study of Danish children suggest that antibiotic use does not affect the development of Type 1 diabetes.

The proposed mechanism for the association is that early antibiotic use affects the gut microflora, which in turn influences the gut immune system. Dysfunction in this immune system is thought to be involved in the pathogenesis of Type 1 diabetes.

"Research hinting at a potential association between antibiotic use in childhood and immunologic health is accumulating," study authors Drs. Anders Hviid and Henrik Svanstrom, from Statens Serum Institut, Copenhagen, comment. However, the studies "have all been case-control studies, and most of them have focused on infections and vaccinations and have not analyzed the association in any detail."

The current investigation featured all 606,420 singleton children who were born in Denmark from 1995 to 2003. The researchers classified antibiotic use based on class, number of uses, and age at use.

Any antibiotic use had no significant impact on the risk of Type 1 diabetes, the authors note (rate ratio = 1.16). This held true on all of the subanalyses looking at class, number of courses, and age at use.

The present findings, the authors conclude, suggest no association between antibiotic use and Type 1 diabetes. Nonetheless, there remains a need for "large, analytical studies of the long-term health effects of drug use in susceptible groups, such as children, and especially so for drugs used as prevalently as antibiotics and for common chronic diseases, such as Type 1 diabetes."

Am J Epidemiol. 2009;169:1079-1084.

Fructose Linked to More Metabolic Problems than Glucose

2009-06-03T09:58:00.000-07:00

Fructose appears to pose more problems with insulin resistance, dyslipidemia, and visceral adipose tissue in heavy patients than its companion sugar glucose. Overweight or obese patients who consumed soft drinks sweetened with either glucose or fructose both gained weight.

Peter J. Havel, M.D., of the University of California, Davis, reported that only those who had the fructose drinks saw an increase in visceral adipose tissue, dyslipidemia, hepatic de novo lipogenesis, and insulin resistance.

In the real world, most people consume a combination of the two simple sugars, either as sucrose (table sugar) or high-fructose corn syrup, used in many sweetened beverages and commercial products.

Dr. Havel's group noted that, previous research had established that fructose is associated with a variety of adverse effects in animals, but evidence was lacking in humans.

So they enrolled 32 patients in a double-blinded, parallel arm study. For 10 weeks, the patients consumed 25% of their daily energy from soft drinks sweetened with either fructose or glucose.

Both groups gained comparable amounts of weight, but those who drank fructose-sweetened drinks had an increase in lipid deposition in visceral adipose tissue. Those who drank glucose-sweetened beverages had an increase in subcutaneous adipose tissue.

They also found that fructose consumption increased plasma concentrations of fasting small dense LDL and oxidized LDL, whereas glucose consumption did not.

The researchers said these changes "may be associated with an increased risk of cardiovascular disease."

Hepatic de novo lipogenesis was also increased in those who had fructose drinks, but not those who had glucose drinks. Subsequently, the researchers said, increased lipids from fructose-induced de novo lipogenesis led to insulin resistance as well.

The researchers noted that average consumers drink beverages sweetened with either sucrose (50% glucose, 50% fructose) or high-fructose corn syrup (55% glucose, 45% fructose), rather than either of the pure sugars.

So, it may be that the adverse effects of these sweeteners are "diluted" by their lower fructose content relative to pure fructose, the researchers said.

Also, the average American consumes about 16% of daily energy from added sugars, not the exaggerated 25% in the study.

The researchers said that further studies are needed to determine what levels of dietary added sugars "are associated with adverse changes of lipids and decreased insulin sensitivity in different populations."

Susanna M. Hofmann, M.D., and Matthias H. Tschop, M.D., of the University of Cincinnati said in an accompanying editorial, "The findings make clear that chronic overconsumption of dietary sugars in general is detrimental to our health, and these effects may be synergistic with chronic increases in caloric intake."

"The findings provide major scientific progress by demonstrating marked differences in the metabolic effects of these two major sugars with respect to their ability to promote intra-abdominal lipid deposition and hepatic lipid production, while shifting cholesterol metabolism in an unfavorable manner and diminishing insulin sensitivity in humans."

Stanhope KL, et al "Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans" J Clin Investigation2009; DOI: 10.1172/JCI137385.

New Study Shows How Fructose Promotes Diabetes

2009-06-02T07:56:00.000-07:00

A new study may help explain why diets high in the sugar fructose have been linked to insulin resistance, a precursor to Type 2 diabetes.

Scientists found that a particular gene, known as PGC-1 beta, appears to play a key role in the development of insulin resistance in response to a high-fructose diet. Rats that had the gene's activity blocked were protected from insulin resistance despite feasting on a diet loaded with fructose.

A sweetener known as high-fructose corn syrup has been widely used in sodas and processed foods since the 1980s, and some researchers have blamed this trend at least in part for the concurrent rise in obesity and diabetes.

The authors of the current report, in the journal Cell Metabolism, explain that some studies have shown that fructose is metabolized differently than glucose is, being more readily converted into fat.

Other studies have linked diets heavy in high-fructose corn syrup to elevated risks of high triglycerides (a type of blood fat), fat buildup in the liver, and insulin resistance, note Dr. Gerald Shulman and colleagues at Yale University School of Medicine.
For their study on the genetic underpinnings of fructose-induced insulin resistance, they zeroed in on PGC-1 beta because it activates another gene that governs the production of fat by the liver.

When the researchers blocked the gene's activity in rats fed a high-fructose diet, the animals did not develop insulin resistance and elevated triglycerides.

The implication, according to Shulman's team, is that inhibiting PGC-1 beta could help treat some cases of high triglycerides, fatty liver disease and insulin resistance. Much more research remains to be done, however.

Cell Metabolism, March 4, 2009.

New Online Test Estimates 10-Year Risk for Diabetes

2009-05-29T09:40:00.000-07:00

The QDScore, which includes both social deprivation and ethnicity, is the first risk prediction algorithm to estimate the 10-year risk for diabetes.

The QDScore, which includes both social deprivation and ethnicity, is the first risk prediction algorithm to estimate the 10-year risk for diabetes.

"Although several algorithms for predicting the risk of Type 2 diabetes have been developed, no widely accepted diabetes risk prediction score has been developed and validated for use in routine clinical practice," write Julia Hippisley-Cox, from University Park, Nottingham, United Kingdom, and colleagues. "Previous studies have been limited by size, and some have performed inadequately when tested in ethnically diverse populations. A new diabetes risk prediction tool with appropriate weightings for both social deprivation and ethnicity is needed given the prevalence of Type 2 diabetes, particularly among minority ethnic communities, appreciable numbers of whom remain without a diagnosis for long periods of time."

The goal of this study was to develop and validate the QDScore for estimating the 10-year risk of acquiring diagnosed Type 2 diabetes during a 10-year period, with the use of routinely collected data from an ethnically and socioeconomically diverse population. The derivation cohort, obtained from 355 general practices in England and Wales, consisted of 2,540,753 patients who were observed for 16,436,135 person-years. Age range was 25 to 79 years; 78,081 had an incident diagnosis of Type 2 diabetes. The validation cohort, obtained from 176 separate practices, consisted of 1,232,832 patients (7,643,037 person-years) with 37,535 incident cases of Type 2 diabetes.

Effects of risk factors in the derivation cohort were estimated, and a risk equation in men and women was derived with use of a Cox proportional hazards model. In the final model, predictive variables were self-assigned ethnicity, age, sex, body mass index, smoking status, family history of diabetes, Townsend deprivation score, treated hypertension, cardiovascular disease, and current use of corticosteroids. The primary endpoint of the study was incident diabetes, as recorded in general practice records. The validation cohort was used to determine measures of calibration and discrimination.

Different ethnic groups had 4-fold to 5-fold variation in the risk for Type 2 diabetes. The algorithm explained 51.53% of the variation in women and 48.16% of that in men, when tested in the validation dataset. The model was well calibrated, and the risk score showed good discrimination. D statistic was 2.11 in women and 1.97 in men.

"The QDScore is the first risk prediction algorithm to estimate the 10 year risk of diabetes on the basis of a prospective cohort study and including both social deprivation and ethnicity," the study authors write. "The algorithm does not need laboratory tests and can be used in clinical settings and also by the public through a simple web calculator.”

"This algorithm to predict risk of Type 2 diabetes has the unique advantage of including both ethnicity and social deprivation, can be derived without laboratory measurements, and thus is suitable for use both in clinical settings and for self assessment," the study authors conclude. "The QDScore could be used to identify patients at high risk of diabetes who might benefit from interventions to reduce their risk."

In an accompanying editorial, Peter E.H. Schwarz, from the Technical University Dresden in Dresden, Germany, and colleagues note that the QDScore is a useful computer-based screening tool.

"Incorporation of the QDScore into practice computer programs would not increase doctors' daily workload, but it would be useful because doctors will not always know the complete medical history of their patients and will not identify all people at increased risk of diabetes," the editorialists conclude. "However, accurate and standardized risk stratification is a challenge, and follow-up studies are needed to assess the success of the QDScore."

Practice Pearls
In a previous study, the presence of obesity in a friend, a sibling, or a spouse was associated with an increased risk for incident obesity. However, obesity in a neighbor was not associated with an increase in the risk for incident obesity.
The QDScore consists of demographic and disease factors but not laboratory data. In the current study, it successfully predicted the 10-year risk for incident Type 2 diabetes.

BMJ. Published online March 18, 2009.

Stem Cells Crucial to Diabetes Cure

2009-05-22T08:05:00.000-07:00

A gene called neurogenin3 proved critical to inducing cells in the liver to produce insulin on a continuing basis. They found that these "islet" cells came from a small population of adult stem cells usually found near the portal vein. Only a few are needed usually because. More than five years ago, Dr. Lawrence C.B. Chan and colleagues in his Baylor College of Medicine laboratory cured mice with Type 1 diabetes by using a gene to induce liver cells to make insulin.

Now we know how it works," said Chan, director of the federally designed Diabetes and Endocrinology Research Center at BCM and chief of the division of endocrinology in BCM's department of medicine. "The answer is adult stem cells.”

A gene called neurogenin3 proved critical to inducing cells in the liver to produce insulin on a continuing basis, said Chan and Dr. Vijay Yechoor, assistant professor of medicine-endocrinology and first author of the report. The research team used a disarmed virus called a vector to deliver the gene to the livers of diabetic mice by a procedure commonly known as gene therapy.

"The mice responded within a week," said Yechoor. The levels of sugar in their blood plummeted to normal and stayed that way for the rest of their normal lives.

The quick response generated more questions as did the length of time that the animals stayed healthy.

They found that there was a two-step response. At first, the neurogenin3 gene goes into the mature liver cells and causes them to make small quantities of insulin, enough to drop sugar levels to normal, said Yechoor.

"This is a transient effect," he said. "Liver cells lose the capacity to make insulin after about six weeks."
However, they found that other cells that made larger quantities of insulin showed up later, clustered around the portal veins (blood vessels that carry blood from the intestines and abdominal organs to the liver).

"They look similar to normal pancreatic islet cells (that make insulin normally)," said Yechoor.

They found that these "islet" cells came from a small population of adult stem cells usually found near the portal vein. Only a few are needed because they serve as a safety net in case of liver injury. When that occurs, they quickly activate to form mature liver cells or bile duct cells. However, neurogenin3 changes their fates, directing them down a path to becoming insulin-producing islet cells located in the liver. The mature liver cell cannot make this change because its fate appears to be fixed before exposure to neurogenin3.

The islet cells in the liver look similar to those made by pancreas after an injury, said Yechoor.

"If we didn't use neurogenin3, none of this would happen," he said. "Neurogenin3 is necessary and sufficient to produce these changes."

"The concept is important because we can induce normal adult stem cells to acquire a new cell fate. It might even be applicable to regenerating other organs or tissues using a different gene from other types of adult stem cells," he said.

Finding a way to use the treatment in humans sounds easier than it is, he said. The environment in which cells grow appears to be an important part of the cell fate determination.

However, he and Yechoor plan to continue their work with the eventual goal of providing a workable treatment for people with diabetes.

journal Developmental Cell, March 2009

Just a Touch of Diabetes Increases Risk for Heart Disease

2009-05-19T07:13:00.000-07:00

Adults who have impaired glucose tolerance but who are not considered diabetic are at elevated risk for heart disease and can benefit from. Adults who have impaired glucose tolerance but who are not considered diabetic are at elevated risk for heart disease and can benefit from preventive therapies, according to a new study.

Adults who have impaired glucose tolerance but who are not considered diabetic are at elevated risk for heart disease and can benefit from preventive therapies, according to a new study.

Diabetes becomes increasingly common with age. An estimated 37 million Americans over the age of 65 have diabetes, almost one-quarter of that population. Another 20 to 30 percent of seniors, an estimated 7.5 to 11.1 million, are not clinically diabetic but have impaired glucose tolerance, which is considered a form of "pre-diabetes."

"In most cases, this mild form of high blood glucose causes no symptoms and is often overlooked by both doctors and patients, but studies have shown that it may be associated with increased risk of heart disease," says Dr. Crandall (Albert Einstein College of Medicine of Yeshiva University). "The purpose of this study was to explore the cardiovascular risk profile of older adults with pre-diabetes."

The study looked at 58 older adults with an average age of 71, half with normal glucose tolerance and half with post-challenge hyperglycemia (PCH). PCH is characterized by a temporary spike in blood glucose levels that occurs immediately after a meal. Various measures were taken before and after study participants consumed a standard high carbohydrate meal.
The researchers found that the adults with PCH not only had higher glucose and insulin levels after the meal, but also higher levels of triglycerides (a type of blood fat considered an independent risk factor for cardiovascular disease).

They also had higher levels of a protein that promotes blood clotting, and more inflammation of blood vessels, compared to controls. In addition, a test of blood vessel function after the meal showed impairment only in the PCH group. Studies show that increases in each of these measures raise one's risk for heart disease.

Routine glucose screening of the elderly, using the standard oral glucose tolerance test (OGTT), could be used to identify these high-risk individuals, the researchers note.

The OGTT measures the body's ability to use glucose, the body's main source of energy. The test begins with a measure of one's fasting blood glucose level, providing a baseline for comparing other glucose values. The patient then drinks a sweet liquid containing a specific amount of glucose. Blood samples are collected at several intervals over the next two or three hours.

Despite the results of this study, it has not been established whether treatment aimed at reducing mild hyperglycemia will lower their risk for heart disease. "Consequently, other interventions designed to reduce the risk of cardiovascular disease, including the use of statins and aspirin, should be strongly considered for older adults with PCH," says Dr. Crandall.

The study, "Post-challenge Hyperglycemia in Older Adults is Associated with Increased Cardiovascular Risk Profile," was published in the February 10 online version of the Journal of Clinical Endocrinology & Metabolism.

New Diabetes Research Gives Hope for Type 2s

2009-05-17T09:29:00.000-07:00

Clinical trials overseen by the University of Miami's Diabetes Research Center show dramatic results in treatment of Type 2 diabetes. Stem cells developed into pancreatic cells and...
Human trials under way at the University of Miami and other hospitals in Europe, Asia and Latin America using immature adult stem cells are showing promise for people with Type 2 diabetes.

In a UM clinical trial recently published in the online journal Cell Transplantation, 25 patients achieved better insulin production, lower blood-sugar levels and reduced need for insulin injections.

In the trial, still in its pilot stage, doctors extracted immature adult stem cells from the patients' own bone marrow, purified and concentrated them, and injected them into arteries near the pancreas. They then put the patients into hyperbaric oxygen chambers like those used for divers with decompression sickness -- also called the ''bends'' -- and subjected them to 10 hours of pure oxygen at 2.4 times the atmospheric pressure at ground level.

Researchers believe the high-pressure oxygen pulled extra stem cells from the patients' bone marrow, adding to the stem cells injected near the pancreas. They say the immature stem cells developed into pancreatic cells, regenerating the pancreas' ability to produce natural insulin.

''This could be very important,'' said Dr. Camillo Ricordi, director of the Cell Transplant Center and the Diabetes Research Institute at UM. ``It could be an improved treatment for diabetes, substantially ameliorating Type 2 and preventing the complications of the disease.''

Ricordi cautioned that the optimistic findings come from small pilot studies involving only dozens of patients, and three to four more years of research are needed before practical treatments might start.
''We always have to avoid hype and be careful not to put too much hope in pilot trials,'' Ricordi said. ``But the first results are really promising.''

Two more successful trials over three or four years would be needed before the FDA might approve the treatment. The studies, coordinated by UM's Diabetes Research Institute, will also take place at the Karolinska Institutet in Stockholm, Stem Cell Argentina in Buenos Aires and other institutions.

What You Drink Is More Important than What You Eat

2009-05-15T08:15:00.000-07:00

Researchers examined the relationship between beverage consumption among adults and weight change and found that weight loss was positively associated with a
According to researchers at the Johns Hopkins Bloomberg School of Public Health, when it comes to weight loss, what you drink may be more important than what you eat.

Researchers examined the relationship between beverage consumption among adults and weight change and found that weight loss was positively associated with a reduction in liquid calorie consumption and liquid calorie intake had a stronger impact on weight than solid calorie intake.

Benjamin Caballero MD, PhD, senior author of the study and a professor with the Bloomberg School's Department of International Health stated that, "Both liquid and solid calories were associated with weight change, however, only a reduction in liquid calorie intake was shown to significantly affect weight loss during the 6-month follow upâ€¦. A reduction in liquid calorie intake was associated with a weight loss of 0.25 kg at 6 months and 0.24 kg at 18 months. Among sugar-sweetened beverages, a reduction of 1 serving was associated with a weight loss of 0.5 kg at 6 months and 0.7 kg at 18 months. Of the seven types of beverages examined, sugar-sweetened beverages were the only beverages significantly associated with weight change."

Researchers conducted a prospective study of 810 adults aged 25-79 years old participating in the PREMIER trial, an 18-month randomized, controlled, behavioral intervention. Caballero along with colleagues from the Johns Hopkins School of Medicine; the National Heart, Lung, and Blood institute; and others measured participant's weight and height using a calibrated scale and a wall-mounted stadiometer at both 6 and 18 months. Dietary intake was measured by conducting unannounced 24-hour dietary recall interviews by telephone.

Researchers divided beverages into several categories based on calorie content and nutritional composition: sugar-sweetened beverages (regular soft drinks, fruit drinks, fruit punch, or high-calorie beverages sweetened with sugar), diet drinks (diet soda and other "diet" drinks sweetened with artificial sweeteners), milk (whole milk, 2 percent reduced-fat milk, 1 percent low-fat milk, and skim milk), 100 percent juice (100 percent fruit and vegetable juice), coffee and tea with sugar, coffee and tea without sugar and alcoholic beverages. They found that at 37 percent sugar-sweetened beverages were the leading source of liquid calories.

Consumption of liquid calories from beverages has increased in parallel with the obesity epidemic. Earlier studies by Bloomberg School researchers project that 75 percent of U.S. adults could be overweight or obese by 2015 and have linked the consumption of sugar-sweetened beverages to the obesity epidemic, which affects two-thirds of adults and increases the risk for adverse health conditions such as Type 2 diabetes. Researchers recommend limited liquid calorie intake among adults and to reduce sugar-sweetened beverage consumption as a means to accomplish weight loss or avoid excess weight gain.

"Among beverages, sugar-sweetened beverages was the only beverage type significantly associated with weight change at both the 6- and 18-month follow up periods," said Liwei Chen, MD, PhD, MHS, lead author of the study and a Bloomberg School graduate. "Changes in the consumption of diet drinks and alcoholic beverages were inversely associated with weight loss, but were not statistically significant. Our study supports policy recommendations and public health efforts to reduce intakes of liquid calories, particularly from sugar-sweetened beverages, in the general population."

"Reduction in Consumption of Sugar-Sweetened Beverages is Associated with Weight Loss: The PREMIER Trial" - Liwei Chen, Lawrence J. Appel, Catherine Loria American Journal of Clinical Nutrition, April 2009.

Short Sleepers Increase Risk of Diabetes by 356%

2009-05-13T13:22:00.000-07:00

A recent piece of research has found that persons who get less than 6 hours of sleep each night have a higher risk of developing pre-diabetes

One of the key but often underestimated elements of a healthy lifestyle is a sufficient amount of quality sleep. A recent piece of research has added to the wisdom of this age-old belief, having found that persons who get less than 6 hours of sleep each night have a higher risk of developing pre-diabetes, a condition characterized by impaired fasting glucose preceding an actual diagnosis of diabetes.

The study had been funded by the National Institutes of Health, and the study team had looked at the sleep and blood glucose data of 1,455 persons who were part of the Western New York Health Study. Sleep duration was self-reported, with the subjects categorized into long-sleepers (>8 hours per night), mid-sleepers (6 to 8 hours), and short-sleepers (<6 hours) based on their sleep duration during the work week.

The researchers identified 91 study subjects whose levels of fasting blood glucose had risen from less than 100 milligrams per deciliter (mg/dL) during baseline assessments (1996 to 2001) to between 100 mg/dL and 125 mg/dL when followed up on about 6 years later (2003 to 2004). These persons were compared with 273 persons whose blood glucose levels had remained stable during the period, with the two groups being matched for gender, ethnicity and year of commencing the study.

After factors such as body mass index, age, heart rate, high blood pressure, depression symptoms, glucose and insulin concentrations, as well as diabetes family history were accounted for, the study team discovered that short-sleepers had a significantly heightened risk of having impaired fasting glucose, a staggering 4.56 times, or a 356% increase, than that of mid-sleepers. Long-sleepers, on the other hand, showed no such effect.

Lisa Rafalson, PhD, a research assistant professor at the University at Buffalo in New York and the leader of the study, stated that "This study supports growing evidence of the association of inadequate sleep with adverse health issues. Sleep should be assessed in the clinical setting as part of well-care visits throughout the life cycle.

According to Rafalson, while previous research suggests that some genes may have a small effect on diabetes risk, "There is no known genetic predisposition to sleep disturbances that could explain our study's results." She also said that "It is more likely that pathways involving hormones and the nervous system are involved in the impaired-sleep/fasting glucose association."

"Short-sleepers" may develop blood sugar abnormality that can lead to diabetes http://americanheart.mediaroom.com/...)

What Is a Normal A1c for Type 2 Children?

2009-05-11T07:18:00.000-07:00

According to the ADA and AACE, a normal A1c result is from 4-6%. Yet we know the closer you get to 6% means your average blood glucose is getting higher and increases your risk for pre-diabetes and diabetes.

We should be more aggressive especially with children who are at risk for diabetes; if not they may not live as long as their parents.

So a study was done with 400 healthy, non-diabetic children to measure their A1c result.

The object was to establish the normal distribution for glycohemoglobin (A1c) in sixth and seventh grade children and to assess the practicality of a school-based fingerstick screening program.

Fingerstick capillary whole blood was collected from 400 children aged 11 to 13 years and the percent A1c was determined on-site.

The results showed that, among the boys, the A1c was significantly higher among the minorities (4.88Â±0.37%, meanÂ±S.D.) than among the non-hispanic whites (4.73Â±0.41%, P<0.01), but was similar in the two groups of girls (4.74Â±0.41 and 4.75Â±0.34, respectively, P=0.88).

None of the students had abnormal glucose tolerance by the standards published for adults.

From the results it was concluded that s: A1c in boys was higher among minorities than among the non-hispanic whites, even at this young age of 11â€“13 years. This may be an early sign of predisposition to Type 2 diabetes among the groups known to be at higher risk for Type 2 diabetes. However, this difference was not seen among girls. Reasons for the discrepancy between boys and girls is unexplained. A school-based fingerstick screening program proved to be practical. As the risk of obesity-related diseases, such as Type 2 diabetes mellitus, increases among youth, the classroom may become an important location for screening.

Diabetes Research and Clinical Practice Volume 65, Issue 1, July 2004, Pages 45-49

Nearly Twenty Percent of US 4-Year-Olds Are Obese

2009-05-08T09:15:00.000-07:00

A striking new study says almost one in five American 4-year-olds is obese, and the rate is alarmingly higher among American Indian children, with nearly one-third of them obese. Researchers were surprised to see differences by race at such an early age.

Overall, more than 500,000 4-year-olds are obese, the study suggests. Obesity is more common in Hispanic and black youngsters, too, but the disparity is most startling in American Indians, whose rate is almost double that of whites.

The lead author said the rate is worrisome among children so young, even in a population at higher risk for obesity because of other health problems and economic disadvantages.

"The magnitude of these differences was larger than we expected, and it is surprising to see differences by racial groups present so early in childhood," said Sarah Anderson, an Ohio State University public health researcher. She conducted the research with Temple University's Dr. Robert Whitaker.

Dr. Glenn Flores, a professor of pediatrics and public health at University of Texas Southwestern Medical School in Dallas, said "the cumulative evidence is alarming." Without intervention, the next generation "will be at very high risk" for heart disease, diabetes, high blood pressure, cancers, joint diseases, and other problems connected with obesity, said Flores, who was not involved in the new research.

The study analyzed nationally representative height and weight data on 8,550 preschoolers born in 2001. Children were measured in their homes and were part of a study conducted by the government's National Center on Education Statistics.

Almost 13 percent of Asian children were obese, along with 16 percent of whites, almost 21 percent of blacks, 22 percent of Hispanics, and 31 percent of American Indians.

Children were considered obese if their body-mass index, a height-weight ratio, was in the 95th percentile or higher based on government BMI growth charts. For 4-year-olds, that would be a BMI of about 18.

For example, a girl who is 4 1/2 years old, 40 inches tall, and 42 pounds would have a BMI of about 18, weighing 4 pounds more than the government's upper limit for that age, height, and gender.

The researchers did not examine reasons for the disparities, but others offered several theories.

Flores cited higher rates of diabetes in American Indians and also in Hispanics which scientists believe may be due to genetic differences.

Other factors that can increase obesity risk tend to be more common among minorities, including poverty, less educated parents, and diets high in fat and calories, Flores said.

Archives of Pediatrics & Adolescent Medicine. April 8, 2009

Too Much Protein or Too Many Carbs?

2009-05-07T06:53:00.000-07:00

Why is it that not everybody who is overweight develops diabetes, and not every person with diabetes is overweight? That's where the disease gets complicated
The next time you grab a glass full of protein shake remember this admonition: too much protein, eaten along with fat, may lead to insulin resistance.

In a paper published last week, Duke University researchers describe a new finding that indicates diabetes could be affected by protein - not the usual suspects of sugary carbohydrates. The Duke team found that obese people metabolize protein differently than lean people, particularly when it's part of a high-fat diet.

When people eat too much protein and fat - think double cheeseburger - the metabolic byproducts can't be fully absorbed, and they flood the bloodstream. Among those byproducts is an enzyme that affects insulin sensitivity. As a result, a diet heavy on Big Macs creates a whole new way for the body to become insulin-resistant.

The study was led by Christopher Newgard of Duke Medical Center who reported that rats fed high-fat (HF) diets supplemented with extra so-called branched chain amino acids (BCAA) don't have to eat as much or gain as much weight to develop insulin resistance as do chubbier animals fed a high-fat diet alone.

Moreover, those ill effects of branched chain amino acids, which include 3 of the 20 amino acids that are the building blocks of proteins, occurred only in the context of a high-fat diet.

"We've all made a big deal out of the fact that people in the U.S. eat too much fat and sugar, but we've underestimated the protein component," Newgard said.

And indeed, he said, surveys have shown that most people who overeat don't show any particular prejudice toward one food group or another.

By comparing the metabolic profiles of obese versus lean people in the new study, the researchers found that key among the many differences between the two groups were elevated levels of BCAA in those who were overweight.

They also showed that BCAA tend to climb along with insulin resistance, a condition that is a precursor to diabetes. To further explore that correlation, they turned to studies of rats. Those controlled feeding studies revealed that, despite having reduced food intake and a low rate of weight gain equivalent to animals on standard chow, rats that consume more fat and BCAA were as insulin resistant as rats fed an HF diet. When added to a normal mouse diet, extra BCAA didn't result in insulin resistance.

The insulin resistance in the animals eating extra fat and BCAA was accompanied by changes in molecular players in the insulin signaling pathway, they report.

The ill effects of BCAA in combination with high fat might be explained in part by a buildup of chemicals known as acylcarnitines in the animals' skeletal muscles, the researchers suggest. Consistent with their prior studies, they report that high-fat feeding caused significant accumulation of multiple acylcarnitines in muscle relative to the standard chow or standard chow plus BCAA groups.

"Surprisingly," they report, "the HF/BCAA diet caused accumulation of the same array of muscle acylcarnitines, despite the fact that the HF/BCAA animals weighed less and consumed less food than the HF-fed animals."

HF/BCAA feeding also led to levels of certain acylcarnitines exceeding those in animals in all other feeding groups.

Overall, the results suggest that "in the context of a dietary pattern that includes high-fat consumption, BCAA may make an independent contribution to development of insulin resistance and diabetes," they concluded.

Practice Pearls:

Explain to interested patients that the adverse impact of a high-fat diet on insulin sensitivity is well known

Note that this study suggests that a diet including fat and branched-chain amino acids -- found in dairy product and meats -- may also induce insulin resistance

Cell Metabolism, April 2009

The Economics of Undiagnosed Diabetes

2009-05-04T07:03:00.000-07:00

Approximately 6.3 million adults - or one-fourth of the people in the U.S. with diabetes mellitus - are unaware they have the disease, and this undiagnosed population accounts for an estimated $18 billion in health care costs each year.

Yiduo Zhang, PhD, from the Lewin Group (Falls Church, VA), and colleagues from Ingenix Pharmainformatics (Cary, NC), and Ingenix Research (Basking Ridge, NJ), studied the health care use patterns of a group of people for the 2-year period leading up to a diagnosis of diabetes. They used these findings as the basis for economic estimates they present in the report, "The Economic Costs of Undiagnosed Diabetes."

Diabetes cost the U.S. economy about $174 billion in 2007 in medical expenses and lost productivity, but that figure does not take into account the national economic costs associated with undiagnosed diabetes, which could raise the estimate to more than $192 billion. Yearly health care needs for individuals with undiagnosed diabetes tend to be higher than for persons who do not have diabetes. The health care costs associated with diabetes begin to increase at least 8 years before diagnosis and grow at a faster rate shortly before and after diagnosis.

"Diabetes is one of the most devastating chronic diseases and costs the nation billions of dollars. Building an evidence base as to what works and what doesn't is going to be critical," says Population Health Management Editor-in-Chief David B. Nash, MD, MBA, Dean, and Dr. Raymond C. and Doris N. Grandon Professor of Health Policy, Jefferson School of Population Health, Philadelphia, PA.
Zhang and colleagues studied the healthcare use patterns of nearly 30,000 people for the 2-year period leading up to a diagnosis of diabetes and compared them with medical claims of people never diagnosed with diabetes.
They estimated that undiagnosed diabetes in 2007 cost an additional $2,864 per person, or a total of $18 billion per year.
Complications often present in people with newly diagnosed diabetes include retina damage, nerve pain and heart disease. They said programs aimed at earlier detection and treatment could help reduce these costs.

Population Health Management, May 2009

Drinking Up to Half a Glass of Wine Daily Increases Longevity by 5 Years

2009-05-01T07:37:00.000-07:00

Drinking up to half a glass of wine daily may increase longevity by 5 years in men. Light to moderate alcohol intake also lowers the risk of cardiovascular mortality.
M.T. Streppel, from the National Institute for Public Health and the Environment writes that, “Whether this protective effect can be attributed to a specific type of beverage remains unclear…. Moreover, little is known about the effects of long-term alcohol intake on life expectancy."

The goal of this analysis was to determine the effect of long-term alcohol intake and types of alcoholic beverages consumed on cardiovascular mortality and life expectancy at age 50 years. The study cohort consisted of 1,373 men enrolled in the Zutphen Study who were born between 1900 and 1920 and evaluated repeatedly between 1960 and 2000.

Time-dependent Cox regression models were used to calculate hazard ratios (HRs) for total alcohol intake and for intake of alcohol from wine, beer and spirits. Areas under survival curves were used to assess life expectancy at age 50 years. Light alcohol intake was defined as consumption of not more than 20 g/day.

Compared with no alcohol consumption, long-term light alcohol intake was strongly and inversely associated with risks for cerebrovascular mortality (HR, 0.43; 95% confidence interval [CI], 0.26 – 0.70), total cardiovascular mortality (HR, 0.70; 95% CI, 0.55 – 0.89), and all-cause mortality (HR, 0.75; 95% CI, 0.63 – 0.91).

Long-term wine consumption averaging less than half a glass per day was strongly and inversely associated with coronary heart disease (HR, 0.61; 95% CI, 0.41 – 0.89), total cardiovascular mortality (HR, 0.68; 95% CI, 0.53 – 0.86), and all-cause mortality (HR, 0.73; 95% CI, 0.62 – 0.87), independent of total alcohol intake. Differences in socioeconomic status did not explain these results. Compared with men who did not consume alcohol, men who drank, on average, less than half a glass of wine per day had a life expectancy about 5 years longer.

"Long-term light alcohol intake lowered cardiovascular and all-cause mortality risk and increased life expectancy," the study authors write. "Light wine consumption was associated with 5 years longer life expectancy; however, more studies are needed to verify this result."

"The inverse associations between wine consumption and mortality remained after adjustment for total alcohol intake," the study authors conclude. "Wine consumers had a 5 years longer life expectancy compared with no alcohol consumers; however, more studies are needed to draw conclusions on the strength of the association between wine consumption and mortality."

J Epidemiol Community Health. Published online April 30, 2009.

One-Third of all Type 1 Cases are Misdiagnosed: New Study

2009-04-28T09:57:00.000-07:00

A THIRD of all Type 1 diabetics were initially misdiagnosed as having the more common Type 2 or some other illness, a study shows, and it's a mistake that can be deadly. People with the rarer form of diabetes produce no insulin at all, meaning they need daily injections and not the less intensive treatments for those with diabetes Type 2.

"It's a 24 to 48-hour process where your body can operate with no insulin before you go into a coma and die," says Kate Gilbert, president of The Type 1 Diabetes Network in Australia who also has the condition.

This error has not been looked at in the U.S. as it probably also occurs more often then we think.

"When you have Type 2 diabetes it is different ... you are still producing insulin but maybe it is not quite enough or it is not working so well."

The support group conducted a poll of more than 850 Australians with Type 1 diabetes and it found a third were misdiagnosed when they first started feeling related symptoms including fatigue, weight loss and blurred vision.

One in 10 in the study reported having a blackout before they were correctly diagnosed, while five percent fell into a diabetic coma.

Of those who were misdiagnosed, 65 percent had to go back to their healthcare professional three or more times before this was corrected.

Ms. Gilbert puts this down to two key factors - the rarity of Type 1 compared to Type 2 diabetes and also a "myth" surrounding its onset.

Type 1 diabetes is relatively rare compared to Type 2 diabetes and GPs don't see a lot of it. It's also because Type 1 diabetes used to be called juvenile diabetes ... there is still this myth that it is a childhood disease and if you get diabetes as an adult it must be Type 2."

Type 1 diabetes is an autoimmune disease which switches off insulin production, and while sufferers are born with the genetic fault in half of all cases it is not triggered until adulthood.

Type 2 diabetes is caused by lifestyle issues such as obesity, and in many cases the sufferer still produces enough insulin but they need drugs to help the body process it correctly.

"Don't rule out Type 1 just because a person is an adult," Ms. Gilbert says in a message to GPs.

The study was conducted to mark the five-year anniversary of The Type 1 Diabetes Network's Starter Kit, a support pack for sufferers developed though a Federal grant and now supported by Abbott Diabetes Care.

Weekly Serving of Fish Reduces Heart Risk

2009-04-24T11:52:00.000-07:00

Eating salmon or other fatty fish just once a week helped reduce men's risk of heart failure, adding to growing evidence that omega-3 fatty acids improve cardiac health. That finding of researchers at Beth Israel Deaconess Medical Center, arose from one of the largest studies to investigate the association.

First author Emily Levitan, a research fellow in the Cardiovascular Epidemiology Research Center at the medical center stated that, "Previous research has demonstrated that fatty fish and omega-3 fatty acids help to combat risk factors for a range of heart-related conditions, such as lowering triglycerides [fats in the blood], reducing blood pressure, heart rate and heart rate variability.... Collectively, this may explain the association with the reduced risk of heart failure found in our study."

A life-threatening condition that develops when the heart no longer can pump enough blood to meet the body's needs, heart failure (also known as congestive heart failure) usually results from existing cardiac conditions, including high blood pressure and coronary artery disease.

Symptoms such as fatigue and weakness, difficulty walking, rapid or irregular heartbeat, and persistent cough or wheezing characterize heart failure, the leading cause of hospitalization among patients 65 and older.

The researchers followed 39,367 Swedish men between 45 and 79 from 1998 to 2004. The researchers recorded details of the men's diet and tracked their outcomes through Swedish inpatient hospital registers and cause-of-death registers. During this period, 597 participants who had no previous history of heart disease or diabetes developed heart failure. Thirty-four died.

Analysis of their numbers showed that the men who ate fatty fish (herring, mackerel, salmon, whitefish, and char) once a week were 12 percent less likely to develop heart failure, compared with men who ate no fatty fish.

Levitan noted that, although this association did not reach statistical significance, they also found a statistically significant association with the intake of marine omega-3 fatty acids, which are found in cod liver and other fish oils: the men who consumed approximately 0.36 grams a day were 33 percent less likely to develop heart failure than the men who consumed little or no marine omega-3 fatty acids.

"Our study reinforces the current recommendations for moderate consumption of fatty fish.... Current guidelines from the American Heart Association recommend eating fatty fish twice a week. It will be important, going forward, to replicate these findings in other populations, particularly those including women, as our study looked at men only."

Reported in the online issue of the European Heart Journal, April 22, 2009

New Electronic Skin Patch for Quick and Painless Glucose Test

2009-04-22T08:46:00.000-07:00

A skin patch could one day provide a less-invasive alternative for diabetics who need to take regular samples of their own blood to keep glucose levels in check. When added to an insulin pump, it could become an external artificial pancreas.

Electrical engineers at the Schulich School of Engineering at the University of Calgary have patented a device called the Electronic Mosquito. The patch is approximately the size of a deck of cards and contains four micro-needles that "bite" sequentially at programmed intervals. The needles are electronically controlled to penetrate the skin deep enough to draw blood from a capillary, but not deep enough to hit a nerve. This means patients would experience little or no pain. The patch could be worn anywhere on the body where it could obtain accurate readings of capillary blood.

A sensor in each cell of the e-Mosquito measures sugar levels in the blood. This data can then be sent wirelessly to a remote device such a computer or a monitoring instrument worn on the wrist. The system could even be connected to an alarm to alert patients or doctors when blood sugar levels enter the danger zone.

"This is a dramatic improvement over manual poking, particularly for children and elderly patients," says Martin Mintchev, director of the Low Frequency Instrumentation Lab at the Schulich School of Engineering. "Our approach is radically different and offers a reliable, repeatable solution with the minor inconvenience of wearing something similar to an adhesive bandage."

Mintchev spent three years designing the e-Mosquito along with Karan Kaler, director of the Schulich School's Bio-Micro Electromechanical Systems (MEMS) Laboratory. Their next step is to make the components of the e-Mosquito smaller to fit more needles on the patch. Currently, there are four needles, so the patch would need to be changed at least once a day. Adding more needles would allow patients to wear the patch for longer periods of time or test their blood more frequently, even while they're asleep.

Eventually, Mintchev and Kaler hope to integrate a pump system so insulin injections can also become autonomous based on data from the e-Mosquito, thus converting the device into an external artificial pancreas.

"It's important to find an industry partner for this project," says David Reese, project manager with University Technologies International, the university's technology transfer, commercialization and incubation centre that works with U of C researchers to commercialize their technologies. "Industry has the resources and expertise to speed up the process of product development and bring this technology to market for the benefit of patients."

Source: University of Calgary

Cost Of Diabetes Non-Adherence $11,000 Yearly Per Patient

2009-04-17T08:41:00.000-07:00

There are important variations in the reported costs of diabetes non-adherence which are due to methodological differences among studies. Therefore, decision makers need to identify those sources of variation, and base their decision only on high quality studies.

The objective was to review and analyze carefully all published studies related to costs of diabetic patients who do not adhere to medications and identify sources of differences among studies.

Two hundred nineteen studies were identified with important differences in the estimated costs. For example, if patients do not take the medicine as prescribed for 5 years, this will increase the average total costs from $4,000 to more than $15,000, depending on the study. The differences in those estimations are due to characteristics of patients included, data sources for costs, time of follow-up and methods used for analysis.

Costs of not taking medications as prescribed have an impact on the US economy increasing the costs up to $100 billion per year. In addition, poor adherence to antidiabetic medications might explain why 43% of patients with diabetes mellitus do not reach adequate glycemic control.

This is a true teamwork effort, Dr. Salas said, that has been supported by the ISPOR Special Interest Initiative that provided a forum for information exchange among interested members. This topic is especially important because diabetes is a chronic disease where it is important to maintain adequate drug levels in the body to obtain an effect, which might be translated in reduction of morbi-mortality.

The article appeared in Value in Health, the official journal of the International Society for Pharmacoeconomics and Outcomes Research. ISPOR is a nonprofit, international organization that strives to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly, and efficiently.

Predictive Genetic Testing Helps to Prevent Type 2 Diabetes in Children

2009-04-15T07:00:00.000-07:00

The results of predictive genetic testing can have a big impact on the intention of parents with Type 2 diabetes to try to prevent the disease in their children, despite the independent effect of the child’s weight on disease risk, according to the results of a study of 189 parents.

Dr. Beth A. Tarini and her colleagues reported in a poster at the annual meeting of the Pediatric Academic Societies that, “When faced with a hypothetical positive genetic test result that indicated an increased risk of Type 2 diabetes for their child, 67% of parents were more likely to take preventive measures than when they had no genetic test results.” However, when faced with a hypothetical negative genetic test result indicating a decreased risk, 39% were less likely to take preventive measures.

The researchers surveyed parents with Type 2 diabetes as part of a larger prospective cohort study of diabetic adults. Using a 10-point scale, parents reported their intention to prevent Type 2 diabetes in their youngest child at baseline and after hypothetical vignettes of a positive and a negative Type 2 diabetes genetic test result.

The researchers calculated the change in parents’ scores from their baseline preventive action to after receipt of a hypothetical positive and negative test result. They also evaluated the relationship between the child’s weight status and the parents’ self-reported likelihood of taking preventive action. The average child’s age was 10 years.

According to Dr. Tarini, assistant professor general pediatrics in the Child Health Evaluation and Research unit at the University of Michigan in Ann Arbor, roughly a quarter of parents (28%) were equally likely to act to prevent Type 2 diabetes as at baseline, and only 5% were less likely to act after a positive genetic test result. After a negative genetic test result, half of parents were just as likely to take preventive measures as at baseline, while only 11% were more likely to act,
Nearly half (47%) of parents of overweight children (body mass index of at least 85% for age and gender) were less likely to act to prevent Type 2 diabetes in their children after learning of a hypothetical negative genetic test result. “Negative Type 2 diabetes genetic test results may reduce diabetic parents’ motivation to prevent Type 2 diabetes in their overweight children, despite the independent effect of the children’s weight on Type 2 diabetes risk,” the researchers wrote.

“Given that nearly half of parents of overweight children were less likely to act to prevent Type 2 diabetes after a negative genetic test result, it appears that careful communication with parents about the implications of genetic testing is needed,” they said.

The study was funded by the Clinical Science Scholars Program at the University of Michigan and presented as a poster at the annual meeting of the Pediatric Academic Societies, May 2009.

Warning: Reduce Soft Drink Consumption

2009-04-13T10:31:00.000-07:00

Doctors have issued a warning about excessive cola consumption after noticing an increase in the number of patients suffering from muscle problems, diabetes and obesity. Dr. Moses Elisaf from the Department of Internal Medicine at the University of Ioannina, Greece, stated that, "We are consuming more soft drinks than ever before and a number of health issues have already been identified including tooth problems, bone demineralisation and the development of metabolic syndrome and diabetes.”

"Evidence is increasing to suggest that excessive cola consumption can also lead to hypokalaemia, in which the blood potassium levels fall, causing an adverse effect on vital muscle functions."

A research review carried out by Dr. Elisaf and his colleagues has shown that symptoms can range from mild weakness to profound paralysis. Luckily all the patients studied made a rapid and full recovery after they stopped drinking cola and took oral or intravenous potassium.

The case studies looked at patients whose consumption ranged from two to nine liters of cola a day.

In 2007 the worldwide annual consumption of soft drinks reached 552 billion liters, the equivalent of just under 83 liters per person per year, and this is projected to increase to 95 liters per person per year by 2012. However the figure has already reached an average of 212 liters per person per year in the United States.

It appears that hypokalaemia can be caused by excessive consumption of three of the most common ingredients in cola drinks; glucose, fructose and caffeine.

"The individual role of each of these ingredients in the pathophysiology of cola-induced hypokalaemia has not been determined and may vary in different patients" says Dr. Elisaf.

"However in most of the cases we looked at for our review, caffeine intoxication was thought to play the most important role. This has been borne out by case studies that focus on other products that contain high levels of caffeine but no glucose or fructose.

"Despite this, caffeine free cola products can also cause hypokalaemia because the fructose they contain can cause diarrhea."
The authors argue that in an era when portion sizes are becoming bigger and bigger, the excessive consumption of cola products has real public health implications.

"Although most patients recover when they stop drinking cola and take potassium supplements, cola-induced chronic hypokalaemia can make them more susceptible to potentially fatal complications, such as an irregular heartbeat," says Dr Elisaf.

"In addition, excessive consumption of any kind of cola can lead to a range of health problems including fatigue, loss of productivity and muscular symptoms that vary from mild weakness to profound paralysis.

"We believe that further studies are needed to establish how much is too much when it comes to the daily consumption of cola drinks."

Dr. Packer agrees that the problem needs to be addressed. "Cola drinks need to be added to the physician's checklist of drugs and substances that can cause hypokalaemia," he says.

"And the soft drink industry needs to promote safe and moderate use of its products for all age groups, reduce serving sizes and pay heed to the rising call for healthier drinks."

IJCP, the International Journal of Clinical Practice, June 2009

Type 2 Diabetes Exploding in Asia

2009-04-12T09:28:00.000-07:00

New research suggests diabetes is becoming a global problem, with more than 60% of all cases likely to occur in Asia. What is so unusual is that many affected individuals are not technically overweight or obese. That is, they are "metabolically obese," defined as having a normal body weight, but increased abdominal obesity.

In the West, Type 2 diabetes is often seen as a consequence of diet, age and obesity but researchers say those affected in Asia are relatively young and less likely to be struggling with weight gain.

Citing figures from the International Diabetes Federation, researchers say while people from Japan to Pakistan generally have lower rates of fat, they can have a similar or even higher prevalence of diabetes than in the West.

The problem is that although Asian obesity rates are low, changing diets and sedentary lifestyles, associated with rapid economic development, are taking their toll.

"Type 2 diabetes is an increasing epidemic in Asia, characterized by rapid rates of increase over short periods and onset at a relatively young age and low body mass index," Dr. Chan, lead investigator notes.

To examine the epidemiology, risk factors, and pathophysiology of Type 2 diabetes in Asia, the researchers conducted a search of MEDLINE for relevant studies. Only studies published between January 1980 and March 2009 were included in the review, and studies that looked solely at Type 1 diabetes were excluded.

The review found that the prevalence of Type 2 diabetes has risen from 1% in 1980 to 5.5% in 2001 in China, for example; it rose from 3% in the 1970s to 12% in 2000 among Indian adults, and from 2.3% to 6.8% in rural Bangladesh.

The authors also found evidence that the diabetes epidemic is being fueled, in part, by "diabetes begetting diabetes." They explain that an elevated risk of gestational diabetes coupled with poor nutrition in utero and overnutrition later in life may be a contributing factor in some populations.

Asians, on average, are still far less fat than Westerners, but they are gaining weight around their waists, which is often a precursor for diabetes.

Another alarming aspect of the findings is that young people in Asia seem much more prone to diabetes than young people in the West. A large proportion of victims are between 20 and 59. In the West, the disease tends to strike people between 60 and 79.

With the young age of onset and the long disease duration that follows, the researchers note that the Asian diabetic population is at high risk for cardiorenal complications. At the same time, cancer is increasing as a key cause of morbidity and mortality in this population.

A study published by the Journal of the American Medical Association predicts that cases of diabetes worldwide will grow from 240 million in 2007 to 380 million in 2025. About 60 percent of those cases will be in Asia.

"To curb this epidemic," the authors conclude, "an integrated strategy combining population-wide preventive policies, early detection, and multidisciplinary care programs may reduce the risk of diabetes and associated complications in the general population and in high-risk individuals."

JAMA 2009;301:2129-2140.

Increase in Type 1 Diabetes Expected

2009-04-07T08:25:00.000-07:00

If current trends continue, cases of Type 1 diabetes among children under 15 will increase by 70 percent by the year 2020, a new study suggests. Those are among the findings by researchers who analyzed diabetes data from 20 centers in 17 European countries. Those centers registered 29,311 cases of Type 1 diabetes between 1989 and 2003.

Around 15,000 new cases of Type 1 diabetes were recorded across the whole of Europe in 2005. Of these, 24% were children up to the age of four, 37% children aged five to nine and 34% children aged 10 to 14.

Researchers found that the overall incidence of the disease was increasing by 3.9% per year. The increase in the 0-4 age group was 5.4%, with a 4.3% rise in the 5-9 age group and a 2.9% increase among 10 to 14-year-olds. A total of 24,400 new cases were forecast for 2020, with a doubling in the number of cases of children aged five and under since 2005, just for Europe.

Numbers of child sufferers older than five were also expected to increase substantially. Scientists say the changes are too fast to be explained by genetic factors alone.

They suggest lifestyle factors may be partly responsible, including a trend towards women having bigger babies and increased numbers of Caesarean section births. Higher increases were seen in eastern Europe, where lifestyle habits were changing more rapidly than in the richer European countries.

The incidence of Type 1 diabetes among very young children will double from 2005 levels in a little over a decade if present trends continue, a new study shows. The prediction is based on Type 1 diabetes trends in Europe, but experts say there is every reason to believe that the U.S. will see a similar dramatic increase in the disease.

They are also convinced that environmental exposures are driving the increase, but it is far from clear what those exposures are.

Once known as juvenile diabetes, Type 1 diabetes is much less common than Type 2 diabetes, except among children and adolescents.

Epidemiologist Christopher C. Patterson, PhD, of Ireland's Queen's University, states that, “The most common age of diagnosis has been the early teen years, but that burden may be shifting toward younger children.”

"We are likely to see more children with severe diabetes complications presenting at earlier ages if we fail to recognize and adequately treat disease in very young patients," he says.

In the latest issue of The Lancet, Patterson and colleagues concluded that rates of Type 1 diabetes among children and young teens are increasing faster than previous predictions suggested.

Patterson and colleagues analyzed data from European registries, which included information on more than 29,000 children with Type 1 diabetes, enrolled between 1989 and 2003.

They found that:

The overall increase in incidence of Type 1 diabetes was 3.9% per year.
The increase was greatest among children under 5, who saw increases of 5.4% per year compared to an annual increase of 4.3% among children between the ages of 5 and 9 and 2.9% among children between the ages of 10 and 14.
If present trends continue, total cases of disease are projected to rise by 70% by 2020 and rates among children under 5 will double.
Since the increases are occurring so quickly, it is likely that environmental influences are driving the trend, Patterson says.
Researchers are examining a wide range of possible environmental triggers, including early-life diet, viral infection, and even C-section delivery. But they still have more questions than answers.

"Being born to an older mom and C-section birth seem to be associated with slight increases in risk, but neither one of these is sufficient to explain the increases we are seeing," he says.

Epidemiologist Dana Dabelea, MD, PhD, from the University of Colorado, stated that one of the key areas of interest is rapid early growth due to improved early-life nutrition.

Dabelea is a co-investigator on the SEARCH for Diabetes in Youth Study, which is following children with Type 1 and Type 2 diabetes in different areas in the U.S. in an effort to better understand diabetes trends in non-adults.

In 2007, Dabelea and colleagues reported higher-than-predicted rates of Type 1 diabetes. The increase was most pronounced among non-Hispanic white children.

In an editorial accompanying the new study, Dabelea called for more research on Type 1 and Type 2 diabetes in children.
"It is imperative that efforts directed at surveillance of diabetes in young people continue and expand, not only to understand its complex etiology, but also because of the increasing public health importance," she writes.

Patterson, C. The Lancet, May 28; online edition. Christopher C. Patterson, PhD, epidemiology research group, Queen's University Belfast. Dana Dabelea, MD, PhD, associate professor, department of epidemiology, Colorado School of Public Health, University of Colorado, Denver. Dabelea D. The Journal of the American Medical Association, June 27, 2007; vol 297: pp 2716-2724.

Gabbie's Story . . . A 10 year old big Sister

2009-04-02T18:58:00.000-07:00

Can you imagine... having to get a shot every time you eat, because the food you need to live can also kill you? Can you imagine... sticking a needle in your finger 10 times a day, to test your blood? Can you imagine... waking up in the middle of every night to make sure you don't go into a coma? My 7 year old sister, Bella, can. She has Juvenile diabetes.

Bella was diagnosed in September of 2004. She wasn't yet 3 years old. We thought she had the flu, but it was much, much worse. She would not eat anything. She was so skinny that her ribs were showing. She was sleeping more and more. Then one morning she would not wake up. Little did we know she was nearly in a coma. She was rushed to the hospital, in the middle of Hurricane Charley.

A week later, Bella came home from the hospital. Our family's life had changed, but Bella's life changed much more. She got insulin shots for what she ate. Her blood sugar had to be tested constantly. She was tested in the middle of the night to make sure her blood sugar did not drop too low, otherwise she could go into a coma. Bella learned that a blood sugar above 200 was bad, before she could count to ten. It made me sad to see my little sister cry from all the shots and all the blood tests.

My mom and dad learned as much as they could about juvenile diabetes. Juvenile diabetes is a disease that stops the pancreas from making insulin, so it cannot control blood sugar. Too much sugar in the blood can damage nerves, which can lead to blindness and eventually death. For this reason, people with Juvenile Diabetes must take insulin to stay alive. Research is being done all over the world to find a cure. In early March, President Obama allowed stem cell research to help find cures for diseases like juvenile diabetes. This is the best chance for people with Juvenile Diabetes.

Everyday I wish for a cure for my little sister. Strangely, she does not. She thinks about being a princess, or a singer or dancer. She loves watching SpongeBob. She has lived with diabetes so long that it is a normal part of her life. She can test herself by sticking a needle in her finger. She can figure out how much insulin she needs for the food she eats. She can give herself the insulin she needs to live. To Bella, these are only small interruptions to having fun and being seven years old. To me, she is very brave.

Can you imagine... a seven year old being your hero. I can. It is my little sister Bella.

Leslie's Story

2009-03-28T10:30:00.000-07:00

Okay, so here's my personal story.

In 1980, I became very ill with pneumonia. All the doctors were perplexed when I began losing drastic amounts of weight, throwing temper tantrums, and was urinating and vomiting all the time, even after the pneumonia was 'gone'.

After countless doctors, my mother finally found a wonderful physician by the name of Dr. Robert Creech in Birmingham, AL. He diagnosed me with type one (juvenile diabetes). I was put on shots for a while, but my control only worsened. My mother (who was in nursing school at the time), suggested the 'new' insulin pump. My doctor didn't want to consider that, as I was only 4 years old. Then, my mother asked him, "What would you do if she was YOUR daughter?" This hit home with my Godsend of a physician. He replied, "I'd try her on the pump".

Not only did the insulin pump save my life, it helped better my control. There were no more hospitalizations until I went through puberty, which is extremely difficult on a person with diabetes. I went into the hospital when I transferred to a MiniMed pump (which, in my 28 years of experience, are the BEST INSULIN PUMPS ON THE MARKET TODAY!!!).

My Hemoglobin A1C's were okay, but not perfect. At 19, I became a medical transcriptionist. I worked 2 full-time jobs and went to college full time. I had always been taught by my mother to be independent, because with diabetes I had to learn to take care of myself.

I was a medical transcriptionist up until I was 25 years old. On 9-11-2001, I woke up not only to see the World Trade Centers come tumbling down, I was extremely sick. I didn't know what was wrong. I'd been sick before, in ketosis, but this was different. I couldn't hold anything down. I went to the ER, and they sent me home, with elevated liver enzymes. My father had died 10 months prior due to complications from his insulin dependent adult-onset diabetes. I was having a hard time dealing with the loss. I drank wine nightly to lull myself into sleep. I was also on a 'muscle relaxer' (or so I thought) for scapular thoracic syndrome, as from typing 10 hours a day my shoulder was very weak. The medicine contained acetomenophine (TYLENOL).

I developed tylenol toxic syndrome from prolonged wine consumption (although minimal) along with taking this medication daily for 9 months.

On 9-13-01, I was transferred from Montgomery, AL to Birmingham, Alabama (University of Alabama Medical Center).
I was in triple organ failure (Chest tube, PEG tube, Ventilator, liver and kidney failure). The doctors gave me a very minimal chance of survival. They even called my entire family in to 'tell me goodbye', as my entire body had turned black and blue, and they saw no change in my liver and kidney enzymes. Not to mention, my diabetes complicated everything, as it is an autoimmune disease.

After many prayers, and by the Grace of God... even after having to be on dialysis while I was in a six-week coma, my liver enzymes began to improve, as did my kidneys. They were able to stop the dialysis. Miraculously my liver and kidneys are in full working order today!

When I woke up from my coma, I was very disoriented. The last thing I remembered was our Twin Towers crashing. I became coherent around Halloween of 2001. I still had a tracheotomy and a PEG tube, so I could only "mouth" my words to my family to let them know what I was wanting to say. My muscles had atrophied to the point where I couldn't walk, or write.

After a few more weeks, I was transferred to Spain Rehabilitation (at UAB), where I learned to walk, and went to speech therapy, and dealt with not wearing my insulin pump for the first time in my life, since being diagnosed. They kept me on shots, and my blood sugars were very erratic. I would bottom out and had trouble finding the call button to get the nurse to come check my blood sugar. I was so weak, I would slide down in the bed, and I'd developed severe neuropathy in my feet due to the diabetes and everything else. It felt like I was walking on hot coals and being bitten by fire ants.

When they finally took out my tracheotomy, all I could was cry out in pain. The nurses still had to pull me up to the top of the bed, so that my feet wouldn't touch the bottom of the bed.

I was discharged at the end of November, after Thanksgiving. In the meantime, I had realized my fingertips on my left hand were mummified, from gangrenous necrosis. Because of my triple organ failure, I had to be given drugs to shunt all the blood to my torso, to help my failing organs. I went through severe depression, because I knew they'd have to be amputated, and typing was my livelihood. I also realized that I had absolutely no sight in my left eye. This was due to ammonia in my brain, due to my liver not able to filter out the toxins in my body.

When I was discharged from the hospital, I had to plan a surgery to remove my fingertips. Also I had to deal with having no depth perception and limited vision. I was deathly afraid of falling down, and also freaking out about my fingers.

The doctor at UAB said I should try to 'wait' until my fingertips "fell off" by themselves, as I could save more length. Well, when a piece of my middle fingertip actually did come off, I saw what looked like Styrofoam inside what used to be my fingertip. Needless to say, I had a nervous breakdown... so I scheduled my amputations, ironically with the Doctor I had done transcription for. I trust him. So I let him do the surgery.

The downside of that was, considering I'd been in a coma for six weeks, they couldn't put me to sleep. So....I got an axillary (*under the arm shot to deaden my left arm), and I was awake through the entire surgery. Now, I have PTSD. For years, I couldn't hear a blender, weed eater, or anything that shot me back to laying on my back in that operating room.

But, I am a trooper. I'm a lot better now. I know that I'm here for a reason. My main goal now is to get Medicare and all other insurance companies to cover the continuous glucose monitor. Now that I'm older, it's harder for me to tell when my blood sugars are high or low. It is also harder for me to find any 'rhyme or reason' as to why I get high and low. I follow a very strict diet, but with any stress, my blood sugars go crazy. I check my sugar every few hours. But with MiniMed's groundbreaking continuous glucose monitoring system, it would TELL me when I'm headed up or down.

Let's all get together and get some laws passed! I'm thankful every day for another day I've been given to survive. I went through depression, which I'm sure all diabetics deal with. We have our days of feeling sorry for ourselves, and wondering WHY..... The only thing that has kept me from going completely insane, is knowing that I AM HERE FOR A REASON. I firmly believe that God saved my life, (after technically dying seven times in 2001), to give people hope. If you live with diabetes, daily there are hardships, which people cannot understand (not because they're hard-hearted, but because they haven't walked in our shoes.

Awareness is the key. I've met with my congressman through the JDRF Advocates. I'm also writing to Medicare to get coverage for the CGM. I've got a denial letter, but they said they need more information, such as a letter of medical necessity. I do believe they will cover it for me eventually.

Here's some facts, to pass along, in regards to getting this CGM covered:

In 2007, 20+ million dollars was spent on DIABETES ALONE.
In 2007, 57 million dollars was spend on DIABETES RELATED COMPLICATIONS (such as kidney/liver damage and subsequent transplants, amputations, blindness, not to mention disability benefits). Those are the facts. So why not pay $1350.00 for the CGM and maintenance of $350.00/month, BEFORE they have to pay triple the cost of diabetes on the complications. Check out advocacy on JDRF's website. More insurance companies are already covering the CGMs... they're still working on more.

Let's get this party started!!!! I'm on board. Who else is with me? God Bless you ALL..... I honestly do believe that God doesn't put anything on me that I cannot handle. I'm sick and tired of being sick and tired. And I'm still alive to do something about it!!

Praise God and let's rock on for a cure, or at least coverage of these CGM for all insurance companies. WE just have to make our voices loud and clear! As my granddad used to say "The squeaky wheel gets oiled FIRST!" haha

God bless.

Leslie

Tisherbug's Story

2009-03-26T10:11:00.000-07:00

My diabetic story.......hmmm... dealt with it my whole life. Growing up, my father (who also happens to be a Type 1) had major diffculties-we knew exactly what to do when dad was low.

My brother and I were tested all the time. When I hit my twenties, I thought I was in the clear. Fast forward a few years later. I was eating like a mad woman, drinking an unreal amount of beverages (I would down a 12 pack of diet Dr. Pepper in less than 30 minutes) I had horrible night sweats and the exhaustion....can't put it into words. I'd wake up crying. The point where I was determined to go to the doctor is when I found myself spacing off seversl times throughout the day. I'd sit at stop signs forever.......the final incident is when I attened a meeting at work and didn't realize why I was there, who are these people? What are their names? I called the doc thinking it was something else, but requested a blood test, just in case. Low and behold I had my blood test and turned out I am diabetic. It's only been a little over a year, but I am doing pretty well!

Shawn's Story

2009-03-25T10:08:00.000-07:00

Obla Di Obla Da Life Goes On January 18, 2005, was an ordinary day at my job at the Red Roof Inn in Plano, Texas, a 45- minute drive from my house in Irving. The front desk contacted me and said I had a phone call. Thinking it was my girlfriend Rebecca wanting to know what we were going to do for dinner, it was quite a shock when I picked up the phone and heard the sheer panic in her voice.

Her son Fletcher had fainted at day care and was in the emergency room at Baylor Medical Center. He had been feeling bad, but we chalked it up to a cold or mild flu. I told her not to worry and started the long trek to the hospital. All the way there my mind was full of what ifs and maybes.

Driving as fast as I dared without being unsafe, I made good time, parked, and ran in through the glass doors. Heading straight to the nurse's desk, I asked what room Fletcher Fields was in, and found it post haste. Rebecca, his mother grabbed me and said "They don't know what's wrong with him." Some tests had been taken and we were waiting for the results. I could see the terror in her eyes, the look a mother gets when something is wrong with her child, and I was trying not to look panicked myself.

Fletcher was lying in one of those hospital beds with tubes running out his little body with a scared and pale demeanor. I went over and held his hand and told him" It's going to be alright, the doctors and nurses will take good care of you." So then it became a waiting game, nurses coming and going, wanting various fluids for more tests. We sat there in that cold and sterile room and tried to pretend everything was fine. I remember the flicker of the television in the semi- dark room. He had been there since three o'clock when I arrived at five, but it wasn't till about eight-thirty that we were told of his prognosis.

It wasn't good. They told us he might have diabetes. His blood sugar was way higher than it should be. We were stunned. The doctor said he was to be transferred to Children's Medical Center. We were informed that Care Flight would be transporting Fletcher to Children's Medical Center.

The EMT'S arrived and started getting him ready for his trip. They were very nice and made jokes to ease the tension that was emanating from us all. As they wheeled him out to ambulance, I hugged him and his mother and waved as they took off. All this time, his father who lived in Odessa, was probably breaking many traffic laws to get there as soon as he gotten the news. I took Rebecca's car and drove to Children's.

When I got to the hospital, his mother and father were on either side of the bed, and I joined them. It wasn't long before we got the bad news: he had Type 1 Juvenile Diabetes. Needless to say, we were devastated. As stunning as it was, we had to stay strong for Fletcher. Since none of us knew anything about diabetes, we had to take classes on how to feed him and how to administer the insulin, while Fletcher had to learn how to Prick his fingers to test his blood sugar. I had the honor of giving him his first injection.

He stayed in the hospital for three nights and a day. When we got him home, we were like scientists trying to make his first meal. We were so scared that we were going to make mistakes; we were constantly on the phone with Dr. Odin, who is also a type 1diabetic so he knew where we were coming from. All our lives changed that night. We learned to count carbohydrates; he had to have just the right amount for his meals.

I found out that Type 1 Juvenile Diabetes is caused when the pancreas no longer produces glucose. At first we couldn't believe that he really had it, and Fletcher was in denial also. Oh how he hated taking the insulin shots, and having to prick his fingers. But day by day we started to get used to the routine and so did he. It was only two or three weeks later that he started to inject

Mikki's Story

2009-03-23T10:06:00.000-07:00

My diabetic story... My father was type 1, so I grew up knowing something about it. I was diagnosed at 10 years old, and we tried to control it with diet. I went from being a very chubby child to very skinny, because I was barely eating.

They finally realized that diet was not going to help, and put me on shots. Although my father had diabetes all my life, and our family dealt with the disease, my father was rather distrusting of doctors. I hardly went to doctors or tested my sugar. When I was 18, my father passed away from heart disease caused by the diabetes. I married less than 2 months after his death, and was pregnant a month later. The doctors were amazed at the way I had controlled my diabetes for so long. I had taken 40 L every day since I was about 11. That was the way my dad did it, and taught me. They changed my insulin and the way I managed my sugar- I started testing my sugars and trying to manage it better, but I could not keep it under control enough. My baby was still born at 6 monghts due to ketoacidosis. I almost died as well. So I had lost my father and baby within 8 months of each other due to diabetes. It broke my heart and I tried to change a lot of things after that. I was pregnant again and we were VERY strict on how I managed my sugar levels. We actually kept them a bit too low, and I and the child were in danger from an extreme sugar low. We both made it through- and my daughter was born. She had some complications, but came home healthy! Then, 2 months later I was pregnant again! This time was even a bit more risky, because my body had just went through a pregnancy- which of course is hard on type 1 diabetics. We watched the pregnancy very closely and baby and mom were ok once more. She was born with even more complications than my first daughter though, and the doctors gave her a 50/50 chance of pulling through. For a parent to hear that is heartbreaking, but here we are almost 11 years later with 2 beautiful daughters. Within the last 2 years, I have gone from taking 2-4 shots a day to being on the pump. This is a wonderful medical advancement for me. I am better managed than I ever have been, and test my sugars regularly. Although I could always improve, I have made big steps in taking care of myself. Now we keep close watch on our daughters for signs of the disease. There have been some symptoms in my youngest, which we are keeping a very close eye on. I pray she does not have it, but I know that if she does- we have much more knowledge than they did in the days when I was diagnosed. Of course I will continue to hope for that cure, but for now we live the best we can and try to keep things in control. Although this disease has taken a lot from my family, I have hope for a brighter future for my children and those affected by diabetes. :)

Diabetics Spend $4,100 More Than Non- Diabetics

2009-03-17T07:55:00.000-07:00

People diagnosed with diabetes spend over $4,100 more each year on medical costs than people who don't have diabetes, a gap that increases substantially each year following the initial diagnosis, according to a study.

In the first study to examine medical cost increases for individuals living with diabetes on a year-by-year basis, researchers at RTI International, an independent, nonprofit research institute based in North Carolina, calculated that a 50-year-old newly diagnosed with diabetes spends $4,174 more on medical care per year than a person the same age who doesn't have diabetes. For the person with diabetes, medical costs go up an additional $158 per year every year thereafter, over and above the amount they would increase due to aging-related increases in medical expenses.

Most of the increase can be attributed to the cost of diabetes-related complications, such as heart and kidney disease, the researchers found. Once they controlled for complications, the remaining annual increase in medical costs was $75 per year -- the bulk of which could be attributed to the increasing need for diabetes medications the longer a person lives with the disease.

"The good news is that many of these costs could be contained through proper diabetes management and lifestyle changes," said lead researcher Justin Trogdon, Research Economist. "Numerous studies show that losing weight and increasing physical activity, along with maintaining proper blood glucose levels, can substantially delay or reduce the risk for diabetes-related complications. What our study does is to point out that there is also a cumulative, financial impact to the progression of this disease."

Preventing the onset of diabetes would also help to reduce cumulative costs, since medical expenditures grow along with the duration of the disease, the researchers concluded. "Delaying the development of diabetes will delay the steady rise in medical expenditures that accompanies it," they wrote.

To obtain a copy of the ADA's most recent cost of diabetes study, published January 2008, visit:

http://care.diabetesjournals.org/cgi/content/full/31/3/596.

Diabetes Care, Online November 25th, 2008

Which Bariatric Surgery for Which Type 2 Patient? It Matters!

2009-03-10T13:48:00.000-07:00

The 2 major types of bariatric procedures for obese patients — bypass surgery and restrictive surgery — have different effects on gut hormone secretion, and thus on insulin secretion and sensitivity. These effects should be considered when choosing a surgical approach for severely obese patients with type 2 diabetes and when managing their diabetes postsurgery.

Marion L. Vetter, MD, from the Hospital of the University of Pennsylvania in Philadelphia writes, "Familiarity with these effects can help physicians decide among the different surgical procedures [for patients with type 2 diabetes] and avoid postoperative hypoglycemia."

The review article was based on a literature search of 4 decades' worth of studies on bariatric surgery and diabetes. Most of the studies had serious methodological weaknesses, the authors state. Few were randomized controlled trials, and important data were missing in a number of the studies. A total of 10 studies met minimum criteria for quality and had follow-up rates of at least 80%.

Bariatric surgery was found to reduce the patients' body mass index by 10 to 15 kg/m2 and their weight by 30 to 50 kg in these studies. In 1 study, Roux-en-Y gastric bypass (RYGB) — the procedure considered the current gold standard — was associated with a 25% reduction in total body weight at 10 years, whereas restrictive procedures such as laparoscopic adjustable gastric banding and vertical banded gastroplasty were associated with 16% and 14% weight loss, respectively. Diabetes resolution was reported in 60% to 80% of patients treated surgically.

Bariatric surgery procedures achieve resolution of type 2 diabetes in 49% to 98% of patients. These procedures have different effects on the enteroinsular axis (connection between the gut and pancreatic islet cells), including effects on hormones called incretins (glucagons-like peptide 1 [GLP-1] and glucose-dependent insulinotropic peptide) and nonincretin gut peptides (peptide YY [PYY] and gherelin). Intestinal bypass procedures that expedite nutrient delivery to the distal ileum, such as biliopancreatic diversion and RYGB, increase GLP-1 and PYY levels; in contrast, restrictive procedures do not increase incretin or PYY levels. After surgery, gherelin levels are determined by the remaining amount of gherelin-producing tissue and by whether vagal innervation is intact.

The authors postulate that augmented levels of GLP-1 probably account for the antidiabetic effect of procedures that bypass the small bowel. It is also thought that altered secretion of anorexigenic peptides (ie, GLP-1 and PYY) may mediate a reduction in appetite and sustained weight loss that occurs more often after intestinal bypass procedures.

"Collectively, caloric restriction and alterations in the enteroinsular axis probably affect both insulin secretion and sensitivity. Physicians must anticipate the rapid improvements in insulin action after bariatric surgery and adjust diabetic regimens accordingly to avoid hypoglycemia. In addition to identifying the antidiabetic mechanisms of bariatric surgery, future research should focus on making medical management safer, particularly if the patient takes GLP-1 analogues or DPP-IV inhibitors," the authors write.

Arch Intern Med. Jan. 20, 2009;150:94–103.

Huge Burden of Diabetes Shown in New Survey Results

2009-03-07T22:22:00.000-08:00

In the United States, nearly 13 percent of adults age 20 and older have diabetes but 40 percent of them have not been diagnosed, according to epidemiologists from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC).

The study includes newly available data from an Oral Glucose Tolerance Test (OGTT). Diabetes is especially common in the elderly: nearly one-third of those age 65 and older have the disease. An additional 30 percent of adults have pre-diabetes, a condition marked by elevated blood sugar that is not yet in the diabetic range.

The study compared the results of two national surveys that included a fasting blood glucose (FBG) test and 2-hour glucose reading from an OGTT. The OGTT gives more information about blood glucose abnormalities than the FBG test, which measures blood glucose after an overnight fast. The FBG test is easier and less costly than the OGTT, but the 2-hour test is more sensitive in identifying diabetes and pre-diabetes, especially in older people. Two-hour glucose readings that are high but not yet diabetic indicate a greater risk of cardiovascular disease and of developing diabetes than a high but not yet diabetic fasting glucose level.

"We're facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with pre-diabetes," said lead author Catherine Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the NIH. "For years, diabetes prevalence estimates have been based mainly on data that included a fasting glucose test but not an OGTT. The 2005-2006 National Health and Nutrition Examination Survey, or NHANES, is the first national survey in 15 years to include the OGTT. The addition of the OGTT gives us greater confidence that we're seeing the true burden of diabetes and pre-diabetes in a representative sample of the U.S. population."

In its analysis, the team also found that:

- The rate of diagnosed diabetes increased between the surveys, but the prevalence of undiagnosed diabetes and pre-diabetes remained relatively stable.

- Minority groups continue to bear a disproportionate burden. The prevalence of diabetes, both diagnosed and undiagnosed, in non-Hispanic blacks and Mexican- Americans is about 70 to 80 percent higher than that of non-Hispanic whites.

- Diabetes prevalence was virtually the same in men and women, as was the proportion of undiagnosed cases.

- Pre-diabetes is more common in men than in women (36 percent compared to 23 percent).

- Diabetes is rare in youth ages 12 to 19 years, but about 16 percent have pre-diabetes.

The study is based on 2005-2006 data from the NHANES conducted by the CDC's National Center for Health Statistics. The survey involved 7,267 people, who represented a national sample of persons age 12 years and older. Participants were interviewed in their homes and received a physical exam. A subsample had a blood sugar reading taken after an overnight fast as well as the OGTT, sometimes called a 2-hour glucose challenge. The OGTT measures blood glucose 2 hours after a person drinks a premeasured sugary beverage. The findings were then compared to those of the last NHANES survey that included the OGTT, which was conducted from 1988 to 1994.

People over age 45 should be tested for pre-diabetes or diabetes. Those younger than 45 who are overweight and have another risk factor should ask their health care provider about testing. People are at greater risk of developing pre-diabetes and type 2 diabetes if they:

- are age 45 or older
- have a family history of diabetes
- are overweight
- are inactive (exercise less than three times a week)
- are members of a high-risk ethnic population (e.g., African- American, Hispanic/Latino- American, American Indian, Alaska Native, Asian- American and/or Pacific Islander)
- have high blood pressure: 140/90 mm/Hg or higher
- have an HDL cholesterol less than 35 mg/dL or a triglyceride level 250 mg/dL or higher
- have had diabetes that developed during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds
- have polycystic ovary syndrome, a metabolic disorder that affects the female reproductive system
- have acanthosis nigricans (dark, thickened skin around neck or armpits)
- have a history of disease of the blood vessels to the heart, brain, or legs
have had higher-than-normal blood glucose levels on previous testing.

The researchers report these findings in the February 2009 issue of Diabetes Care, which posted a pre-print version of the article online at http://diabetes.org/diabetescare.

Interviews with The Maine and There For Tomorrow

2009-03-05T11:00:00.000-08:00

It was a very cold day on Sunday March 1 in Poplar Grove, IL at Chubby Rain - House of Tunes but the performaces by the bands were dare we say hot! Seriously we left the show in a light sweat even though it was 10 degrees.

This may had something to do with the fact that we were in a packed house there were at least 200 plus fans in one of the smallest bars we have been in but the show was great.

We just want to thank Pat and Garrett from The Maine and Maika from There for Tommorrow for taking time out and sitting down with us and listening to our cause and also answering a few of our questions.

We have posted Bio's of the bands if you are not familar with them and the interviews are posted on rockfordiabetes.org.

Breakthrough In Understanding Development Of Type 1 Diabetes

2009-03-05T08:20:00.000-08:00

Scientists discovered disturbances in lipid and amino acid metabolism in children who later progressed to type 1 diabetes, also known as juvenile diabetes. The alterations preceded the autoimmune response by months to years. The study may prompt new approaches for prediction and prevention of type 1 diabetes in pre-autoimmune phase of the disease.

Type 1 diabetes is an autoimmune disease in which the immune system attacks the insulin producing pancreatic beta cells. The gradual loss of beta cells results in life-long dependence on exogenous insulin.

At the moment, the earliest identifiable process in the pathogenesis of type 1 diabetes has been the development of autoimmunity to pancreatic beta cells in the measurable form of islet autoantibodies. Although the autoimmunity usually precedes the clinical disease by months to years, its occurrence may already be too late for therapeutic approaches aimed at preventing progression to overt diabetes.

The initiators of the autoimmune response have remained unknown and the mechanisms supporting progression towards beta cell failure have been poorly understood, making discovery of effective prevention a challenge. The results of the SYSDIPP project, which was supported by the Tekes FinnWell Program, bring significant new information for combating the disease.

The SYSDIPP project has made use of metabolomics. Metabolomics systematically studies the chemical fingerprints in cells, tissues and biofluids in a given physiological and environmental context. The metabolic phenotype is sensitive to subtle factors such as age, lifestyle, nutrition and the microbe environment of the intestines. Changes in the concentrations of metabolites may thus reflect both genetic and environmental factors influencing later susceptibility to chronic diseases.

In 1994, an ongoing birth cohort study (DIPP, the Type 1 Diabetes Prediction and Prevention study) was launched in Finland, supported by the Juvenile Diabetes Research Foundation International. Over a period of 14 years, more than 130,000 newborn infants have been screened for genetic risk and over 8000 at-risk children are being regularly followed.

The research team was led by Prof. Matej Orešič from VTT Technical Research Centre of Finland and Prof. Olli Simell from University of Turku took part in the study, which investigated metabolic profiles of DIPP children prospectively from birth.

The research team published the results. The article reports the discovery of metabolic disturbances that precede the autoimmune response in children who later progress to type 1 diabetes. The investigators found that the individuals who developed diabetes had reduced serum levels of succinic acid and phosphatidylcholine at birth, reduced levels of triglycerides and antioxidant ether phospholipids throughout the follow-up and increased levels of proinflammatory lysophosphatidylcholines several months prior to autoimmunity to pancreatic beta cells. The metabolic profile was partially normalized following the autoimmune response, suggesting autoimmunity may be a relatively late physiological response to the early metabolic disturbances. The observed lipid changes were not attributable to HLA-associated genetic risk.

Metabolic profiling at early age may therefore aid in determining the risk of type 1 diabetes. The reported findings imply that metabolic or immunomodulatory interventions during the pre-autoimmune period may be used as a new potential strategy for prevention of type 1 diabetes.

The incidence of type 1 diabetes among children and adolescents has increased markedly in the Western countries during recent decades. The incidence has reached record levels in Finland, where currently 1 child out of 120 develops type 1 diabetes before the age of 15 years. The annual incidence is increasing at accelerated rate, with the number of new cases expected to double in the next 15 years.

Oresic et al. Dysregulation of lipid and amino acid metabolism precedes islet autoimmunity in children who later progress to type 1 diabetes. Journal of Experimental Medicine, Dec. 15, 2008; DOI: 10.1084/jem.20081800

New Diabetes Rate Up 90 Percent In Just 10 Years

2009-03-04T09:50:00.000-08:00

The nation's obesity epidemic is exacting a heavy toll: The rate of new diabetes cases nearly doubled in the United States in the past 10 years, according to the CDC from a report released last Thursday. Diabetes experts said the findings show there is no end in sight to the diabetes epidemic and it will get worse before it gets better.

The data, published in CDC′s Morbidity and Mortality Weekly Report, show that in the past decade, the incidence (new cases) of diagnosed diabetes has increased from 4.8 per 1,000 people during 1995-1997 to 9.1 per 1,000 in 2005-2007 in 33 states.

The highest rates were in the South, according to the first state-by-state review of new diagnoses. The worst was in West Virginia, where about 13 in 1,000 adults were diagnosed with the disease in 2005-07. The lowest was in Minnesota, where the rate was 5 in 1,000.

Nationally, the rate of new cases climbed from about 5 per 1,000 in the mid-1990s to 9 per 1,000 in the middle of this decade. Roughly 90 percent of cases are Type 2 diabetes, the form linked to obesity.

The findings dovetail with trends seen in obesity and lack of exercise — two health measures where Southern states also rank at the bottom. "It isn't surprising the problem is heaviest in the South — no pun intended," agreed Matt Petersen, who oversees data and statistics for the American Diabetes Association.

The study, led by Karen Kirtland of the Centers for Disease Control and Prevention, provides an up-to-date picture of where the disease is exploding. The information should be a big help as the government and health insurance companies decide where to focus prevention campaigns, Petersen said.

Diabetes was the nation's seventh-leading cause of death in 2006, according to the CDC. More than 23 million Americans have diabetes, and the number is rapidly growing. About 1.6 million new cases were diagnosed among adults last year.

The study involved a random-digit-dialed survey of more than 260,000 adults. Participants were asked if they had ever been told by a doctor that they have diabetes, and when the diagnosis was made. The comparisons between 1995-97 and 2005-07 covered only the 33 states for which the CDC had complete data for both time periods. The researchers had data for 40 states for the years 2005-07. West Virginia, South Carolina, Alabama, Georgia, Texas and Tennessee had the highest rates, all at 11 cases per 1,000 or higher. Puerto Rico was about as high as West Virginia. Minnesota, Hawaii and Wyoming had the lowest rates. It is not entirely clear why some states were worse than others. Older people, blacks and Hispanics tend to have higher rates of Type 2 diabetes, and the South has large concentrations of all three groups. However, West Virginia is overwhelmingly white.

The report asked about diagnosed diabetes only. Because an estimated one in four diabetics have not been diagnosed, the findings probably underestimate the problem, said Angela Liese, a diabetes researcher at the University of South Carolina. The underestimates may be particularly bad in the rural South and other areas where patients have trouble getting health care, she noted.

Obesity, the CDC says, is the major risk factor for diabetes. Yet it's not necessary to become thin to avoid this debilitating disease.

A study of people at high risk for diabetes shows you can cut your risk of diabetes by 58% in a three-year period by doing just two things:

- Lose 5% to 10% of your body weight.
- Five days a week, get 30 minutes of moderate physical activity.

To minimize errors, the CDC averaged the study data over two-year periods. The latest data, from 2005-2007, is compared to data from 1995-1997. Complete data are available for 33 states.

By region: South: 10.5 new cases per year, up 133% - West: 8.6 new cases per year, up 51% - Northeast: 8.2 new cases per year, up 78% - Midwest: 7.4 new cases per year, up 76%

The report was released three days after U.S. researchers found that while doctors are using a wider array of newer, more costly drugs to treat diabetes, there is little long-term proof they work better than older, cheaper medications.

State-by-state rates: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5743a2.htm

First Saliva Test For Type 2 Diabetes

2009-03-01T10:34:00.000-08:00

Researchers from India and Oregon have taken a step toward developing the first saliva test to detect and monitor how efficient is the treatment for Type 2 diabetes. Scientists in Oregon and India are reporting an advance toward developing the first saliva test to diagnose and monitor effectiveness of treatment for Type 2 diabetes. Their report was published in the Jan. 2 issue of ACS' Journal of Proteome Research.

The number of cases of that disease (18 million in the United States alone) has doubled during the last 30 years in parallel with the epidemic of obesity. Researchers say their work represents the first comprehensive description of the proteins in the saliva of patients with Type 2 diabetes, also called non-insulin dependent diabetes.

In the study, Paturi V. Rao and colleagues note that early diagnosis and effective treatment is critical for preventing the disease's complications, including loss of vision, nerve damage, and kidney damage. One important barrier is the need for sometimes-painful needle sticks to draw blood for tests. The discomfort can discourage patients from properly monitoring their blood sugar levels, the scientists say.

The researchers analyzed saliva samples from individuals with and without Type 2 diabetes for protein biomarkers of diabetes. They identified 65 proteins that appeared twice as often in the diabetic samples than the non-diabetic samples. These newly identified proteins could lead to new, noninvasive tests for diabetes screening, detection, and monitoring, the researchers say. MTS

American Chemical Society (ACS), Jan. 2009 ACS' Journal of Proteome Research

A1c Test Can Be Used to Diagnose Diabetes

2009-02-28T13:17:00.000-08:00

The American Diabetes Association and other leading diabetes organizations in the U.S. will come out within the next six months with guidelines on the use of the A1C test as a diagnostic tool for patients with type 2 diabetes.

With the diagnosis of diabetes increasing 90 percent over the past ten years, it is important that we have an easy way to diagnosis the disease. Prior to this announcement we had to use the fasting blood glucose, where you had to fast for the test and it still was not 100% accurate. You could have a normal fasting blood sugar and still have diabetes. We also have the Oral Glucose Tolerance Test (OGTT), where you have to drink 75 grams of glucose and then have someone check your blood sugars every 20-30 minutes until your blood sugar peaks. The OGTT was more expensive because it took time in the doctor’s office.

After the ADA announces the guidelines, we will have a test that you will not have to fast for and can be done anytime of the day.

The A1C is an indicator of the average blood glucose level over the past two or three months measured by the concentration of hemoglobin molecules in the red blood cells with glucose attached to the cells. It is also a good predictor of future complications like nerve, eye and kidney damage.

According to a CDC report in October, diagnosed diabetes cases went up by more than 90 percent among U.S. adults over the past 10 years. From 4.8 cases per 1,000 population during 1995-97, the number climbed up to 9.1 per 1,000 people in 2005-07 in 33 states.

In the Epic-Norfolk study they found that those people that had a A1c of 6% compared to those people with a 5%, regardless of whether they had diabetes or not, had a 28% increase in cardiovascular death. So we might also be able to use the A1c test to let patients know if they are at risk for cardiovascular disease even if they do not have diabetes.

The results of the A1c test will also tell people if they have prediabetes or at risk for prediabetes, rather than waiting until their fasting blood sugars goes higher then 126mg/dL.

The A1c test should be done for every person at every physical whenever blood is drawn for other tests such as cholesterol.

American Diabetes Association Online

Daily Consumption of DIET Soda Increases Risk of Type 2 Diabetes By 67%

2009-02-25T12:41:00.000-08:00

Drinking diet soda at least daily is associated with significantly greater risks for select incident components of the metabolic syndrome (MetSyn) and type 2 diabetes, according to the results of an observational study.

Jennifer A. Nettleton, PhD, from the University of Texas Health Sciences Center in Houston, and colleagues tell us that, "Two longitudinal cohort studies have shown positive associations between diet soda consumption and incident MetSyn independent of baseline measures of adiposity…. Replication of previously observed diet soda-MetSyn associations in a distinct cohort would bolster their credibility and provide further insight into the nature of the relationship. Previous studies have not addressed associations between diet soda and individual MetSyn components or risk of type 2 diabetes nor have they fully addressed potential longitudinal mediators of these relationships, i.e., changes in adiposity status."

The goal of this study was to evaluate associations between diet soda consumption and the risk for incident MetSyn, its components, and type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA).

Initial evaluation was performed from 2000 to 2002, at which time baseline food frequency questionnaires measured diet soda consumption. Three follow-up evaluations were performed from 2002 to 2003, 2004 to 2005, and 2005 to 2007. Incident type 2 diabetes was defined as fasting glucose levels of more than 126 mg/dL, self-reported type 2 diabetes, or use of diabetes medication. National Cholesterol Education Program Adult Treatment Panel 3 criteria were used to define MetSyn and its components. After adjustment for demographic, lifestyle, and dietary confounders, hazard ratios (HRs) were estimated for type 2 diabetes, MetSyn, and MetSyn components.

Compared with participants who did not drink diet soda, those who drank diet soda at least daily had a 36% greater relative risk for incident MetSyn and a 67% greater relative risk for incident type 2 diabetes.

Of the individual components of MetSyn, only high waist circumference (men: ≥ 102 cm; women: ≥ 88 cm) and high fasting glucose levels (≥ 100 mg/dL) were prospectively associated with consumption of diet soda. Associations between diet soda intake and type 2 diabetes were independent of baseline measures of adiposity or changes in these measures. In contrast, associations between diet soda and MetSyn were not independent of these factors.

"Although these observational data cannot establish causality, consumption of diet soda at least daily was associated with significantly greater risks of select incident MetSyn components and type 2 diabetes," the study authors write.

Limitations of this study include observational design, precluding determination of causality; possible confounding by other dietary and lifestyle/behavioral factors; and difficulties in estimating intake of diet soda or artificial sweetener.

"These results corroborate findings from the ARIC [Atherosclerosis Risk in Communities] and Framingham studies and show stronger adverse associations exist between diet soda and type 2 diabetes," the study authors conclude. "Diet soda consumption, either independently or in conjunction with other dietary and lifestyle behaviors, may lead to weight gain, impaired glucose control, and eventual diabetes."

Diabetes Care. Published online January 16, 2009

Drinking Two-Plus Cans of Pop Daily Doubles The Risk for Early Kidney Disease by 50%

2009-02-25T12:37:00.000-08:00

Women and not men, who drink two or more cans of regular, not diet soda pop per day are nearly twice as likely to show early signs of kidney disease, a recent study has found.

However, researchers did not find an elevated risk for men, or for people who drink diet soda, said lead researcher David Shoham of Loyola University Health System.

Researchers examined data from a representative sample of 9,358 U.S. adults in the National Health and Nutrition Examination Survey. The NHANES survey included urine samples and a questionnaire about dietary habits.

Women who reported drinking two or more sodas in the previous 24 hours were 1.86 times more likely to have albuminuria, a sensitive marker for early kidney damage. Albuminuria is an excess amount of a protein called albumin in the urine. Since healthy kidneys filter out large molecules such as albumin, an excess amount can be a sign of damage to the kidneys.

About 11 percent of the population has albuminuria. Among those who drink two or more cans of soda per day, 17 percent have this early marker of kidney disease, the study found. It's unclear why drinking soda increased the risk only in women, Shoham said. There may be an unknown underlying cause that is linked to both soda consumption and kidney damage, he said. Shoham is an assistant professor in the Department of Preventive Medicine and Epidemiology.

In recent years, diabetes, obesity and kidney disease have been increasing, along with consumption of high fructose corn syrup, the sweetener used in most sodas.

But what's most important is the amount of sugar, not the type, Shoham said. "I don’t think there is anything demonic about high fructose corn syrup per se," Shoham said. "People are consuming too much sugar. The problem with high fructose corn syrup is that it contributes to over consumption. It's cheap, it has a long shelf life and it allows you to buy a case of soda for less than $10."

Shoham and colleagues concluded that additional studies are needed to determine whether the elevated risk of kidney disease is due to high fructose corn syrup itself, an overall excess intake of sugar, unmeasured lifestyle factors or other causes.

A recent pilot study by other researchers, reported in the journal Environmental Health, found that nine of 20 commercial samples of high fructose corn syrup from three manufacturers contained detectable levels of mercury. "This adds the intriguing possibility that it is not just the sugar itself in high fructose corn syrup that is harmful, because mercury is harmful to kidneys as well," Shoham said.

About 26 million American adults have chronic kidney disease, according to the National Kidney Foundation. Advanced kidney disease causes such symptoms as fatigue, poor appetite, trouble sleeping and concentrating, and swollen feet. Kidney disease can lead to high blood pressure, anemia, nerve damage, weak bones and cardiovascular disease.

The study was published in the Oct. 17 edition of PLoSONE, a peer-reviewed journal of science and medical research published by the Public Library of Science.

Diabetes Doubles Odds of Alzheimer’s

2009-02-24T18:05:00.000-08:00

People diagnosed with diabetes before the age of 65 are more than twice as likely to develop dementia, according to the results of a new study. Diabetes increases the risk of Alzheimer’s and other types of dementia according to a new report.

The study, which focused on the health of 13,693 Swedish twins, found that people who are diagnosed with diabetes before age 65 have more than double the chance of developing Alzheimer’s disease. The link was not as strong for people diagnosed with diabetes late in life.

Weili Xu, PhD of the Karolinska Institutet in Stockholm, Sweden, and colleagues write that their findings offer one more reason for people "to maintain a healthy lifestyle during adulthood in order to reduce the risk of dementia late in life."

Nearly 24 million Americans have diabetes, according to the American Diabetes Association.

Participants in the study were all part of the Swedish Twin Registry and were at least 65 when the study began in 1998. The study lasted until 2001. The study looked at the twins as a group and also made comparisons within twin sets.

Of all the participants, 467 were diagnosed with dementia, including 292 with Alzheimer’s. There were 1,396 participants with diabetes.

By focusing on twins, researchers removed many genetic differences, as well as differences in poverty level, at least during childhood.

“Twins provide naturally matched pairs, in which confounding factors such as genetics and childhood environment may be removed when comparisons are made between twins,” co-author Margaret Gatz, PhD, professor of psychology, gerontology, and preventive medicine at the University of Southern California and foreign adjunct professor of medical epidemiology and biostatistics at the Karolinska Institutet, says in a news release.

The ongoing study also revealed that the younger and older diabetes group showed no difference in impaired performance, suggesting that cognitive decline occurs early in the disease then remains stable, says author Roger Dixon, professor of psychology at the University of Alberta.

Diabetes, Jan 2008

Scientists Create Potential Preventative Therapy for Type 1 Diabetes

2009-02-20T10:25:00.000-08:00

Scientists believe they may have found a preventative therapy for Type 1 diabetes, by making the body's killer immune cells tolerate the insulin-producing cells they would normally attack and destroy, prior to disease onset.

Type 1 diabetes is an autoimmune condition, where the body attacks its own insulin producing cells. It is very serious, with a sudden and dramatic onset, usually in youth. People with Type 1 diabetes must maintain an insulin-monitoring and insulin-injecting regimen for the rest of their lives.

PhD student Eliana Mariño and Dr Shane Grey, from the Garvan Institute of Medical Research in Sydney, have demonstrated how a particular molecule may be used in future as a preventative therapy.

The body's immune cells, or white blood cells, include B cells and T cells. B cells make antibodies and present 'antigens' to T cells, allowing them to recognize, and kill, invaders.

In previously published studies about Type 1 diabetes, Mariño and Grey showed that groups of B cells migrate to the pancreas and pancreatic lymph nodes, presenting specific insulin antigen to T cells. In other words, B cells go to the disease site and tell T cells to kill the cells that produce insulin.

"Taking that work further, our current study looks at different ways of subduing B cells, and how that affects development of the disease," said Grey.

Working with mice that spontaneously develop Type 1 diabetes, Eliana Mariño found that if she blocked BAFF (a hormone that controls survival of B cells) prior to onset, none of the mice developed diabetes.

"This is a remarkable finding, as other B cell depletion methods tested elsewhere have just delayed or reduced disease incidence," said Eliana.

When B cells were depleted, the regulators of the immune system (a subclass of T cells known as T regulatory cells) rose in numbers.

By removing B cells from the picture for a while, it appears you allow T regulatory cells to function as they should, subduing killer T cells and somehow making them tolerant of the insulin producing cells.

The molecule used by Grey and colleagues to inhibit BAFF is known as BCMA, and is already being used in clinical trials for other autoimmune diseases, such as jogren's Syndrome and Lupus.

Diabetes, May 2009

Tattoos Used To Control Diabetes

2009-02-17T22:53:00.000-08:00

Massachusetts-based Draper Laboratories is developing a special tattoo ink that changes color based on glucose levels inside the skin. Nanotechnology researchers associated with the project believe that the injectable ink may one day prove helpful in freeing diabetics from painful blood glucose tests.

Heather Clark, a scientist at Draper, stated that, "It doesn'’t have to be a large, over-the-shoulder kind of tattoo. It would only have to be a few millimeters in size and wouldn'’t have to go as deep as a normal tattoo." She has revealed that her team did not actually set out to create a glucose-detecting ink. "At first I didn'’t even think it was possible," she said.

Clark revealed that she and her colleagues originally created a sodium-sensitive ink to monitor heart health, advancing basic knowledge of electrolytes in the body, or to ensure athletes are properly hydrated.

She said that it was only after talking to a colleague that she decided to give glucose detection a try, starting with the basic three-part system to detect sodium then modifying it to detect glucose.

The nano ink particles are tiny, squishy spheres about 120 nanometers across, inside of which are three parts: the glucose detecting molecule, a colour-changing dye, and another molecule that mimics glucose. Clark says that the particles look like food coloring when dissolved in water.

According to her, the three parts continuously move around inside the hydrophobic orb. Upon approaching the surface the glucose detecting molecule either grabs a molecule of glucose or the mimicking molecule.

If the molecules mostly latch onto glucose, the ink appears yellow. If glucose levels are low, the molecule latches onto the glucose mimic, turning the ink purple. A healthy level of glucose has a "funny orangey," color. The sampling process repeats itself every few milliseconds.

She says that even if there is a significant lag time between blood and skin glucose levels, a small tattoo would let diabetics know if an abnormally high or low reading was either returning to a normal level or getting worse.

She has revealed that the testing of the glucose monitoring nanotech ink in mice could begin by the end of this month but human testing may have to wait for at least two years.

Robert Rubin, a professor at Harvard Medical School, is excited by Clark'’s work at Draper.

"This will give me a great shortcut for understanding what is happening inside the body," said Rubin.

Draper, Inc.

Sixty Percent of U.S. Seniors Have Diabetes or PreDiabetes

2009-02-12T21:00:00.000-08:00

Nearly one-third of U.S. adults age 65 and older have diabetes, while an additional 30 percent have pre-diabetes, researchers said. "We're facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with pre-diabetes," lead author Catherine Cowie of the National Institute of Diabetes and Digestive and Kidney Diseases, a part of the National Institutes of Health said in a statement.

"For years, diabetes prevalence estimates have been based mainly on data that included a fasting glucose test but not an oral glucose tolerance test," Cowie said in a statement. "The addition of the oral glucose tolerance test gives us greater confidence that we're seeing the true burden of diabetes and pre-diabetes in a representative sample of the U.S. population."

The oral glucose tolerance test gives more information about blood glucose abnormalities than the fasting blood glucose test, which measures blood glucose after an overnight fast. The fasting blood glucose test is easier and less costly than the oral glucose tolerance test , but the two-hour test is more sensitive in identifying diabetes and pre-diabetes, especially in older people, Cowie explained.

The 2005-2006 National Health and Nutrition Examination Survey is the first national survey in 15 years to include the oral glucose tolerance test.

The study, published in Diabetes Care, also found 13 percent of adults age 20 and older have diabetes, but 40 percent of them have not been diagnosed.

According to a CDC report in October, diagnosed diabetes cases went up by more than 90 percent among U.S. adults over the past 10 years. From 4.8 cases per 1,000 population during 1995-97, the number climbed up to 9.1 per 1,000 people in 2005-07 in 33 states.

www.NIDDK.nih.gov

Prevent Diabetes by Exercising Just 7 Minutes a Week

2009-02-11T13:09:00.000-08:00

Rigorous workouts lasting as little as three minutes may help prevent diabetes by helping control blood sugar, British researchers said last week. Short bursts of intense exercise every few days over just 2 weeks could dramatically cut the risk of diabetes and heart disease.

The findings published in the journal BioMed Central Endocrine Disorders suggest that people unable to meet government guidelines calling for moderate to vigorous exercise several hours per week can still benefit from exercise.

"This is such a brief amount of exercise you can do it without breaking a sweat," said James Timmons, an exercise biologist at Heriot-Watt University in Edinburgh, who led the study.

"You can make just as big as an effect doing this as you can by doing hours and hours of endurance training each week."

Type 2 diabetes, which affects an estimated 246 million adults worldwide and accounts for 6 percent of all global deaths, is a condition in which the body gradually loses the ability to use insulin properly to convert food to energy.

Very strict diet and vigorous, regular and sustained exercise can reverse type 2 diabetes, but this can be difficult for many people. The condition is closely linked to inactivity.

Timmons and his team showed that just seven minutes of exercise each week helped a group of 16 men in their early twenties control their insulin.

The volunteers, who were relatively out of shape but otherwise healthy, rode an exercise bike four times daily in 30 second spurts two days a week.

After two weeks, the young men had a 23 percent improvement in how effectively their body used insulin to clear glucose, or blood sugar, from the blood stream, Timmons said.

The effect appears to last up to 10 days after the last round of exercise, he added in a telephone interview.

"The simple idea is if you are doing tense muscle contractions during sprints or exercise on a bike you really enhance insulin's ability to clear glucose out of the bloodstream," Timmons said.

"If you go for a jog or a run you oxidise glycogen but you are not depleting the glycogen in your muscles. The only way to get to this glycogen is through very intense contractions of the muscles.”

The findings highlight a way for people who do not have time to work out a few hours each week as recommended to improve their health, he added.

His team did not look for other important benefits to health that come from exercise, such as lowered blood pressure or weight control, but said another study had shown similar benefits to heart function.

But Timmons said getting people to exercise even a little could translate into big savings for health systems that spend hundreds of millions of dollars treating diabetes. "If we can get people in their 20s, 30s and 40s doing these exercises twice a week then it could have a very dramatic effect on the future prevalence of diabetes. What we see is 23% improved insulin function over two weeks.”

BioMed Central Endocrine Disorders Feb., 2009

Obama's big idea: Digital Health Records

2009-02-10T13:38:00.000-08:00

President wants to computerize the nation's health care records in five years. But the plan comes with a hefty price tag, and specialized labor is scarce. President Barack Obama, as part of the effort to revive the economy, has proposed a massive effort to modernize health care by making all health records standardized and electronic.Here's the audacious plan: Computerize all health records within five years. The quality of health care for all Americans gets a big boost, and costs decline.

But, it will not be easy. In fact, many hurdles stand in the way. Only about 8% of the nation's 5,000 hospitals and 17% of its 800,000 physicians currently use the kind of common computerized record-keeping systems that Obama envisions for the whole nation. And some experts say that serious concerns about patient privacy must be addressed first. Finally, the country suffers a dearth of skilled workers necessary to build and implement the necessary technology.

"The hard part of this is that we can't just drop a computer on every doctor's desk," said Dr. David Brailer, former National Coordinator for Health Information Technology, who served as President Bush'shealth information czar from 2004 to 2006. "Getting electronic records up and running is a very technical task."

It also won't come cheap. Independent studies from Harvard, RAND and the Commonwealth Fund have shown that such a plan could cost at least $75 billion to $100 billion over the ten years they think the hospitals would need to implement program.

That's a huge amount of money -- since the total cost of the stimulus plan is estimated to cost about $800 billion, the health care initiative would be one of the priciest parts to the plan.

The biggest cost will be paying and training the labor force needed to create the network. Luis Castillo, senior vice president of Siemens Healthcare, a company that designs health care technology, said the laborers will have the extremely difficult task of designing a a system that "thinks like a physician."

"Doctors cannot spend hours and hours learning a new system," said Castillo. "It needs to be a ubiquitous, 'anytime, anywhere' solution that has easily accessible data in a simple-to-use Web-based application."

Early government estimates showed about 212,000 jobs could be created from this program, but Brailer said there simply aren't that many Americans who are qualified.

Furthermore, ensuring the privacy of patients' records in a nationalized computer network will be tricky. There are obvious concerns about hackers and system failures. And new online health record systems, such as Google Health are not currently subject to the Health Insurance Portability and Accountability Act, the national health privacy law.

"HIPAA was never intended for the digital age, because the laws never anticipated the emergence of Web-based records," said Brailer. "Congress can pass one of numerous policy proposals for change, it's just a question if they have the will to do that."

"This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests," said Obama. "It just won't save billions of dollars and thousands of jobs -- it will save lives by reducing the deadly but preventable medical errors that pervade our health care system," he added.

Massachusetts has developed a plan to fully computerize records at its 14,000 physicians' offices by 2012 and its 63 hospitals by 2014. After a pilot program, the state legislature estimates it will cost about $340 million to build the statewide computer system, with a cost of about $2 million per hospital.

"The whole structure has already been developed," said Stephen Schoenbaum, executive director of The Commonwealth Fund's commission on a high performance health system. "It's feasible to at least make a lot of progress on this in the next five years."

Insulin Diabetes Pill To Begin Testing

2009-02-04T07:22:00.000-08:00

A pill that could mean the end of insulin injections for diabetics is about to be tested in human trials. It will be taken twice a day and releases insulin into the body over several hours.

The pill, developed by Indian government scientists at the Sree Chitra Tirunal Institute for Medical Science and Technology in Kerala, has been successfully tested on animals and is awaiting approval for human trials in India.

The research could lead to an alternative to painful daily injections for millions of people affected by the disease. Previous attempts to develop insulin pills have suffered from the hormone being released into the body too early, such as in the stomach.

The new pill uses nanoparticles which allow the insulin to be delivered into the bloodstream. The nanoparticles break down in response to the pH of blood and release the insulin.

"We have already developed the capsule form of the insulin," said Professor Chandra Sharma, who led the study. "We have already tried it on pigs and rats."

Rat experiments showed the new nanoparticles entered the bloodstream and ended up in organs such as the liver and kidney. Separate experiments with diabetic pigs showed that their blood sugar was controlled after a pill containing the nanoparticles was eaten.

Sharma said there were a number of concerns about the risks nanoparticles might pose to the human body; for example, that they could activate blood platelets and lead to clotting. But Sharma said tests showed that the nanoparticles were generally compatible with human blood.

The research was funded by the Indian government and the technology has been transferred to an Indian-based company, which is expected to begin human trials within months.

A good year!

2009-01-12T10:12:00.000-08:00

Last year Rock for Diabetes started to gain some steam but 2009 might prove to be Rock for Diabetes best year yet! We are gaining tremendous support everyday!

We have have positive responses from several bands that we are going to interview in the next couple of months and help us spread awareness that we will keep you posted on. Keep on eye out for a benefit concert this year as well, several bands want to participate.

You can help us by spreading the message of Rock for Diabetes and spreading the awareness of diabetes. You can join us on myspace, or join our facebook group, follow our blog, share your story's, buy a shirt, or talk to your friends and family about diabetes and how important it is to know about diabetes.

Diabetes is not a joke it is a very real threat. We need your help in spreading the message, that anyone can acquire diabetes.

Pregnancy Diabetes Doubles the Risk of Language Delay in Children

2009-01-06T08:18:00.000-08:00

Your ALL around health is very important through out your life. For women who are pregant, the value of your health doubles. Children born to mothers with pregnancy-related diabetes run twice the risk of language development problems, according to a research team.

Researchers compared the vocabulary and grammar skills of 221 children whose mothers were diagnosed with gestational diabetes to those of 2,612 children from a control group. These tests were conducted at different intervals between ages 18 months and 7 years.

Results showed that children born to mothers with gestational diabetes achieve poorer scores on tests of spoken vocabulary and grammar than children of healthy mothers. The differences between the two groups are probably due to the effects of gestational diabetes on the brain development of babies. The study shows that these effects persist even after the children start school.

This study is the first to isolate the effect of gestational diabetes from other factors including family socioeconomic status, alcohol and tobacco consumption as well as maternal hypertension during pregnancy.

However, the study suggests that the impact of pregnancy-related diabetes on language development is not inevitable, as children of more educated mothers appear less affected. "This protection may be the result of the more stimulating environment in which children of more highly educated mothers develop, but it could also be due to genes that could make some babies less vulnerable," explains Ginette Dionne. "For the moment, we cannot isolate the two factors, but ongoing studies should allow us to answer that question," she continued.

Between 2% and 14% of children are born to mothers who suffer from gestational diabetes. Risk factors for this complication during pregnancy include the mother's age and her body mass index. "As mothers are having their children at a later age and the incidence of obesity in the population is on the rise, the rate of gestational diabetes is clearly increasing," underlined Professor Dionne. "The risk to babies' language development needs to be taken into account," she concludes.

Professor Ginette Dionne of Université Laval's School of Psychology. Journal of Pediatrics. 2008 Oct 31.

ADA’s new Guidelines for Screening, Diagnosing, and Treating Diabetes

2009-01-05T07:45:00.000-08:00

The American Diabetes Association (ADA) has issued new practice guidelines for screening, diagnostic, and therapeutic interventions that are known or believed to improve health outcomes of patients with diabetes.

An executive summary published in the January issue of Diabetes Care provides a detailed description of each of the ADA practice recommendations, a grading system developed by the ADA that uses A, B, C, or E to indicate the level of evidence supporting each recommendation, and suggested targets for most patients with diabetes.

"These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care," the guidelines authors write. "While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed."

Specific topic areas covered include diagnosis of diabetes, testing for prediabetes and diabetes, testing for type 2 diabetes in children, detection and diagnosis of gestational diabetes mellitus, prevention and delay of type 2 diabetes, self-monitoring of blood glucose levels, hemoglobin A1c (A1C) levels, glycemic goals, medical nutrition therapy (MNT), diabetes self-management education (DSME), physical activity, psychosocial assessment and care, hypoglycemia, immunization, hypertension and blood pressure control, and dyslipidemia and lipid management.

Some of the specific recommendations are as follows:

• To diagnose diabetes in children and nonpregnant adults, fasting plasma glucose (FPG) is the preferred test, and use of A1C levels to diagnose diabetes is not currently recommended (E).

• Screening for prediabetes and type 2 diabetes in asymptomatic people should be considered in adults who are overweight or obese (body mass index [BMI] ≥25 kg/m2) with at least 1 more additional risk factor. Otherwise, testing should begin at age 45 years (B), and if results are normal, testing should be repeated at least at 3-year intervals (E).

• Either an FPG test or 2-hour oral glucose tolerance test (OGTT; 75-g glucose load), or both, is appropriate (B) to test for prediabetes or diabetes, and an OGTT may be considered in patients with impaired fasting glucose (IFG) to better define the risk of diabetes (E).

• Individuals found to have prediabetes should be evaluated and treated, if appropriate, for other cardiovascular risk factors (B).

• To prevent or delay onset of diabetes, patients with impaired glucose tolerance (IGT; A) or IFG (E) should be advised to lose 5% to 10% of body weight and to increase physical activity to at least 150 minutes per week of moderate activity such as walking. Follow-up counseling seems to improve the likelihood of success (B). Because of the potential cost savings associated with diabetes prevention, third-party payors should cover counseling (E).

• Metformin therapy should also be considered in patients who are at very high risk for diabetes, based on combined IFG and IGT plus other risk factors, and who are obese and younger than 60 years of age (E).

• Individuals with prediabetes should be monitored every year for the development of diabetes (E).

• Because lowering A1C levels to an average of about 7% has been shown to reduce microvascular and neuropathic complications of diabetes and, possibly, macrovascular disease, the target A1c goal for nonpregnant adults is generally less than 7% (A).

• For selected individual patients, the A1C goal is as close to normal (< 6%) as possible without significant hypoglycemia (B), in light of epidemiologic studies showing a small but incremental benefit to lowering A1C from 7% into the normal range.

• For children, patients with a history of severe hypoglycemia, those with limited life expectancies, individuals with comorbid conditions, and those with long duration of diabetes and minimal or stable microvascular complications, less stringent A1C goals may be appropriate (E).

• Individuals with prediabetes or diabetes should receive individualized MNT as needed to achieve treatment goals, ideally by a registered dietitian who is knowledgeable about diabetes MNT (B). This should be covered by insurance and other payors (E).

• Specific components of MNT should include management of energy balance, overweight, and obesity with diet, physical activity, and behavior modification (B); primary prevention of diabetes among individuals at high risk of developing type 2 diabetes (A); promoting fiber and whole-grain intake meeting US Department of Agriculture recommendations (B); controlling dietary fat intake by limiting saturated fat intake to less than 7% of total calories (A) and minimizing trans fat intake (E); and managing carbohydrate intake.

• Monitoring carbohydrate intake is a key strategy in achieving glycemic control, whether by carbohydrate counting, exchanges, or experience-based estimation (A). For patients with diabetes, glycemic index and glycemic load use may modestly improve glycemic control vs that observed when considering only total carbohydrate (B).

• DSME should be offered to patients with diabetes at the time of diagnosis and as needed thereafter (B), with the goal of changing self-management behavior (E) and addressing psychosocial issues (C). Third-party payors should reimburse for DSME (E).

• People with diabetes should perform at least 150 minutes per week of moderate-intensity aerobic physical activity (50% - 70% of maximum heart rate; [A]), and unless there are contraindications, those with type 2 diabetes should perform resistance training 3 times per week (A).

"People with diabetes should be individually considered for employment based on the requirements of the specific job and the individual's medical condition, treatment regimen, and medical history (E)," the guidelines authors conclude. "Patients and practitioners should have access to all classes of antidiabetic medications, equipment, and supplies without undue controls (E). MNT and DSME should be covered by insurance and other payors (E)."

Practice Pearls

• FPG, not A1C, is the preferred diagnostic test for diabetes in children and nonpregnant adults. Screening for prediabetes and type 2 diabetes in asymptomatic people should be considered in adults with a BMI of 25 kg/m2 or more and at least 1 other risk factor. Otherwise, testing should begin at age 45 years. If results are normal, testing should be repeated at intervals of 3 years or less. FPG or 2-hour OGTT, or both, is appropriate to test for prediabetes or diabetes.

• The target A1C goal for nonpregnant adults is generally less than 7%, or less than 6% without significant hypoglycemia, for selected patients. Less stringent A1C goals may be appropriate in children and in other specific groups of patients. People with prediabetes or diabetes should receive individualized MNT as needed to achieve treatment goals. DSME should be offered to patients with diabetes at diagnosis and as needed thereafter to change self-management behavior and address psychosocial issues. Third-party payors should reimburse for MNT and DSME.

Think Differently

2008-12-17T09:13:00.000-08:00

Being a organization that is promoting people to think about something that could changes their lives forever is very complicated.

In the grand scheme of thing Rock for Diabetes is a very small organization. We do our part and we try our best to do what we believe in and what is right. But like I said it is very hard to make people think about harmful things, it could be like, "Oh, Rock for Diabetes is here, who brought the party poopers".

In general, people don't want to hear bad news and who can blame anybody for that. There is are some general thoughts "out of site, out of mind" or "it won't happen to me". This is very true until "it" is in your face, or "it" does happen to you.

I'll bet that looking back when bad things do happen to some people they wish they could change the clock and go back in time for advice or guidance on how they could have done things differently.

Well here comes some bad news, everyone has the potential to develop Type 2 diabetes in there life, let me repeat "EVERYONE". The facts are already written that 15% of the American population will have diabetes by 2025 this will be contributed by the fact that 45% of the children born after 2005 in the United States will develop diabetes sometime in their life.

Fast forward a mere 16 years, 15% of the population has diabetes, it is in the top three next to heart disease (which goes hand and hand with diabetes) and cancer. Now what? Wanna turn back the clock?

Good News! This hasn't happened yet and there is still time, you can get the advice and the guidance before "it" happens. This is very powerful. Think about it, you have a chance to take a left instead of a right, you can say yes instead of no, you can do right before you do wrong, you can change history before it happens. But the writing is on the wall folks, this will happen if the right steps are not taken.

What steps? First, set an appointment with your doctor and get your blood glucose level checked so you know if you at risk of developing Type 2. Next, why do you think there is such a push for organic foods and fast food restaurants to change the oils in their fryers? Answer weight gain! Do you really need to super size your fast food meals? Is there a big conspiracy to take the taste out of food? It's time to eat a little healthier and think about what you are putting into your body. Finally, it wouldn't hurt anyone to exercise a little more.