New smart contact lens could monitor glucose for diabetics

In the United States, the number of patients diagnosed with diabetes (both Type 1 and Type 2) has doubled over the last decade. Type 2 accounts for 90-95% of all diabetes diagnoses. Over eight percent of the U.S. population is believed to have diabetes, and of those with it, an estimated 27% do not even know it. Monitoring blood glucose levels is critically important and must be done multiple times a day, which can be painful and cumbersome. Google has just announced a prototype device that retrieves information about blood sugar directly from the eyeball, via a contact lens.

Typically, a small blood sample is taken from the fingertip using a combination of a lancet, strips, and a blood glucose meter. For those who have had diabetes for a long time or require more frequent testing, it can be hard to find a spot that will bleed easily. There are embedded blood glucose monitors, but they require a device to be taped to the skin or work on a belt and require outpatient surgery for replacement. Unfortunately, because properly monitoring blood sugar is such a large commitment, many people are not doing it right. Those who choose not to manage their disease properly are at a much greater risk of developing blindness, kidney failure, or having their lower extremities amputated.

Many researchers have been seeking alternative ways to monitor glucose without the use of blood, in order to make it easier for diabetics to stay on top of their sugar levels. Some newer noninvasive glucose tests include checking saliva, urine, or tears. Tears can provide an incredibly accurate measurement, but it is not always easy to get a sample. Google’s solution to using tears is minimally invasive and can provide constant monitoring of glucose levels.

A prototype soft contact lens has been outfitted with a micro-scale computer chip, sensor, and an antenna. Once every second, the sensor monitors the glucose levels in the tears and transmits the information to a wireless device, such as a smart phone. This information could also be sent directly to the person’s doctor. Future prototypes may also include a tiny LED which would immediately alert the wearer that sugar levels are either too low or too high and to take immediate action. The technology within the lens does not impact the field of vision and should not be much different than wearing traditional contact lenses.

Currently, scientists at Google are in talks with the FDA about taking this prototype to the next level. It will be years before the contact will be available for clinical use. Google is reaching out to potential partners in order to make this a feasible option for diabetics. This has the potential to revolutionize how millions of people with diabetes manage their disease and give them the best chance to protect their eyesight, limbs, and life.

- See more at: http://www.iflscience.com/health-and-medicine/new-smart-contact-lens-could-monitor-glucose-diabetics#overlay-context=

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Nanoparticle Suspension and Ultrasound Deliver Insulin Without Regular Injections

 

Insulin injections are no fun for diabetics and they have to be taken as needed by the body, not by the patient’s personal schedule. This means if you have diabetes, you can’t just pre-inject yourself and go worry-free throughout the day. A nanotechnology developed at North Carolina State University and the University of North Carolina at Chapel Hill may end all that thanks to a self-assembling network that can release insulin whenever the patient wants.

The system consists of poly(lactic-co-glycolic) acid (PLGA) nanoparticles filled with insulin and coated with either negatively or positively charged substances. These stick to each other when mixed, so when injected into the body the solution remains together and when you want some insulin released, you simply hold an ultrasound transducer to the injection site and shake up the substance to release the insulin.

From NC State:

The researchers believe the technique works because the ultrasound waves excite microscopic gas bubbles in the tissue, temporarily disrupting Nano-network in the subcutaneous layer of the skin. That disruption pushes the nanoparticles apart, relaxing the electrostatic force being exerted on the insulin in the reservoir. This allows the insulin to begin entering the bloodstream – a process hastened by the effect of the ultrasound waves pushing on the insulin.

“We know this technique works, and we think this is how it works, but we are still trying to determine the precise details,” says Dr. Yun Jing, an assistant professor of mechanical engineering at NC State and co-corresponding author of the paper.

When the ultrasound is removed, the electrostatic force reasserts itself and pulls the nanoparticles in the Nano-network back together. The nanoparticles then diffuse more insulin, refilling the reservoir.

Advanced Healthcare Materials: Ultrasound-Triggered Regulation of Blood Glucose Levels Using Injectable Nano-Network…

original article http://news.ncsu.edu/releases/wms-gu-ultrasound2013/

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ABOUT INSULIN

What is insulin?

Insulin is the internal secretion of the pancreas formed by groups of cells called the islets of Langerhans. It is the hormone needed to enable glucose to enter the cells and provide energy. Insulin is also important in keeping blood glucose levels within the acceptable limits.

Insulin is injected into the body by people with type 1 diabetes in whom the cells that produce insulin have been destroyed. This is the most common form of diabetes in children and young adults, and they depend on insulin for survival. Insulin may also be used by people with type 2 diabetes, where the body needs more insulin than it can produce.

How is insulin prepared?

Since the landmark discovery of insulin by Frederick Banting and Charles Best in 1922, huge steps have been made in research and development regarding its preparation. Early preparations of insulin were purified quite crudely from pancreas tissue extracted from animals - either pigs or cattle. Today, insulin is mostly made biosynthetically by recombinant DNA technology or 'genetic engineering'.

Animal insulin

Until the 1980s, all insulin was extracted from the pancreases of cattle and pigs. The sequence of amino acids (the building blocks that make up the protein) is slightly different in insulin's from the different species. Compared to human insulin, porcine (pork) insulin has one different amino acid and bovine (beef) insulin three different amino acids. These very slight differences do not affect the way in which the insulin works inside the human body. Pork insulin is structurally closer to human insulin than is beef insulin. These days, animal insulin's are made from highly purified pancreas extracts and are marketed as 'natural' insulin's.

Human insulin

Human insulin is not prepared from human pancreas tissue. Rather than being extracted from human pancreases, commercially available human insulin is manufactured through recombinant DNA technology, in which the gene for making human insulin is transferred into simple cells such as bacteria or baker’s yeast. The insulin made by those cells is identical to insulin made by the human pancreas. Unlike animal insulin's, recombinant DNA human insulin's can be made in unlimited supply, since they do not depend on the supply of bovine and porcine pancreases.
Analogue insulin
Analogues are altered molecular versions of a natural substance (in this case insulin). They have been used in many therapies where hormone treatment is needed. The natural hormone is changed slightly, by rearranging the position of amino acids within the molecule (rather like changing the position of beads on a necklace). The insulin molecule is modified so as to give it a more desirable activity profile, thereby making it more convenient to use. These molecularly engineered hormones more closely mimic normal insulin secretion than do traditional insulin's.

Types of Insulin
Manufactured insulin comes in several types that differ in the way in which they act inside the body. Each type differs in three ways:

• Onset: the length of time after injection that the insulin begins to work
• Peak: the length of time after injection that the insulin takes to reach its maximum effectiveness
• Duration: the length of time that the insulin remains effective

The four basic types of insulin and their respective onset, peak and duration are as follows:

• Rapid-acting: begins to work after 15 minutes, peaks in 30 to 90 minutes, and has a duration of three to four hours.
• Short-acting: begins to work in 30 to 60 minutes, peaks in two to three hours, and has a duration of three to six hours.
• Intermediate-acting: begins to work in 90 minutes to six hours, peaks in four to 14 hours, and has a duration of up to 24 hours.
• Long-acting: begins to work in six to 14 hours and remains effective for 24 to 36 hours.

Many people with diabetes use combinations of theses different types of insulin to better control and manage their condition.
Sources: Diabetes Insight (www.diabetes-insight.info); Diabetes UK (www.diabetes.org.uk); Juvenile Diabetes Research Foundation (www.jdrf.org) Insulin use in the world
Insulin is currently underutilized in developing countries as shown in the table.
Source: King H. Insulin: availability, affordability, and harmonization. WHO Drug 1998: 4: 219-223.
Some 65% of people with diabetes live in developing countries and account for only 30% of the world's total insulin usage each year. This is in sharp contrast to the industrialized world that has 35% of the world's diabetic population but account for about 70% of the world's total insulin usage each year.
This difference cannot be entirely due to the low incidence and prevalence of type 1 in the developing countries. Moreover, only a small percentage of people with type 2 diabetes in developing countries may require insulin for survival. The consequences are that in some parts of Africa many people with type 1 diabetes under the age of 15 can expect to live for just one year after diagnosis1.

 

ORIGINAL POST FROM http://www.idf.org/about-insulin-0

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Brain Discovery Could Help Schizophrenics

English: MRI coronal view of the amygdala (Photo credit: Wikipedia)

The discovery of brain impairment in mice may eventually lead to better therapies for people with schizophrenia and major depression.

Studying rodents that have a gene associated with mental illness, Michigan State University neuroscientist Alexander Johnson and colleagues found a link between a specific area of the prefrontal cortex, and learning and behavioral deficits.

While much work needs to be done, the discovery is a major step toward better understanding mental illness. While antipsychotic drugs can treat hallucinations related to schizophrenia, there essentially is no treatment for other symptoms such as lack of motivation or anhedonia, the inability to experience pleasure.

"This study may well suggest that if we start targeting these brain-behavior mechanisms in people with mental illness, it may help to alleviate some of the cognitive and motivational symptoms, which to date remain largely untreated with current drug therapies," said Johnson, MSU assistant professor of psychology.

The study is published in the Proceedings of the National Academy of Sciences.

Schizophrenia, a disabling brain disorder marked by paranoia and hearing voices that aren't there, affects some 2.4 million Americans and runs in families, according to the National Institute of Mental Health.

The researchers conducted a series of experiments with two groups of mice -- those with the gene associated with mental illness and those without the gene (or the control group).

In one experiment, related to cognition, the mice were presented with tasty food when they responded on one side of a conditioning box. After repeated feedings, the food was switched to the other side of the box. The mice with the mental illness gene had a much more difficult time learning to adapt to the new side.

In another experiment, related to motivation, the mice had to respond an increasing number of times each time they wanted food. By the end of the three-hour session, all mice with the mental illness gene stopped responding for food, while half of the control group continued on.

Johnson said the deficiencies may suggest a problem in the prefrontal cortex area known as the orbitofrontal cortex, and that further research should target this area.

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Interspecies Transplant Works in First Step for New Diabetes Therapy

In the first step toward animal-to-human transplants of insulin-producing cells for people with type 1 diabetes, Northwestern Medicine® scientists have successfully transplanted islets, the cells that produce insulin, from one species to another. And the islets survived without immunosuppressive drugs.

Northwestern scientists developed a new method that prevented rejection of the islets, a huge problem in transplants between species, called xenotransplantation.

"This is the first time that an interspecies transplant of islet cells has been achieved for an indefinite period of time without the use of immunosuppressive drugs," said study co-senior author Stephen Miller. "It's a big step forward."

"Our ultimate goal is to be able to transplant pig islets into humans, but we have to take baby steps," said Xunrong Luo, M.D., also co-senior author of the study that will be published online July 12 in the journal Diabetes. "Pig islets produce insulin that controls blood sugar in humans."

Luo is an associate professor of nephrology at Northwestern University Feinberg School of Medicine and medical director of the Human Islet Cell Transplantation Program at Northwestern Memorial Hospital. Miller is the Judy Gugenheim Research Professor of Microbiology-Immunology at Feinberg.

For people with hard-to-control type 1 diabetes, a transplant of insulin-producing islets from a deceased donor is one important way to control their chronic disease, in which their bodies do not produce insulin. However, there is a severe shortage of islet cells from deceased donors. Many patients on waiting lists don't receive the transplant or suffer damage to their heart, nerves, eyes and kidneys while they wait.

Using islets from another species would provide wider access to transplants for humans and solve the problem. But concerns about controlling rejection of transplants from a different species have made that approach seem insurmountable until now.

In the new study, scientists persuaded the immune systems of mice to recognize rat islets as their own and not reject them. Notably, the method did not require the long-term use of drugs to suppress the immune system, which have serious side effects. The islets lived and produced insulin in the mice for at least 300 days, which is as long as scientists followed the mice.

While the barrier from rats to mice is probably lower than from pigs to humans, the study showed interspecies islet transplants are possible and without immunosuppressive drugs, Luo said.

In the study, the rat splenocytes, a type of white blood cell located in the spleen, were removed and treated with a chemical that caused their deaths. Next, the dead splenocytes were injected into the mice. The cells entered the spleen and liver and were mopped up by scavenger cells. The scavengers processed the splenocytes and presented fragments of them on their cell surface, triggering a reaction that told the T cells to accept the subsequently transplanted rat islets and not attack them.

But rejection was still a threat. A unique challenge of an interspecies transplant is controlling the B cells, immune cells that are major producers of antibodies. Initially, when scientists transplanted the rat islets into the mice, the mouse immune system started producing antibodies against the rat cells causing rejection.

To solve the problem, Luo realized she needed to kill off the B-cells at the same time she injected the donor islets into the mice. Thus, she gave the mice B-cell depleting antibodies -- already used in a clinical setting in human transplants. When the B-cells naturally returned after the transplant, they no longer attacked the rat islets.

"With this method, 100 percent of the islets survived indefinitely," Luo said. "Now we're trying to figure out why the B-cells are different when they come back."

The study lead author is Shusen Wang, formerly a postdoctoral student in Luo's lab.

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Undiagnosed Pre-Diabetes Highly Prevalent in Early Alzheimer's Disease Study

English: PET scan of a human brain with Alzheimer's disease (Photo credit: Wikipedia)

When Georgetown University neurologist R. Scott Turner, MD, PhD, began enrolling people with mild to moderate Alzheimer's disease into a nationwide study last year, he expected to find only a handful of participants with undiagnosed glucose intolerance, as all the patients were already under a doctor's care and those with known diabetes were excluded. But Turner says he was "shocked" by how many study participants were found to have pre-diabetes -- a finding that is triggering important questions.

Turner's study examines resveratrol, a compound found in red grapes and red wine, to see if it might change glucose levels in patients with mild to moderate Alzheimer's disease (AD). Turner says resveratrol is thought to act on proteins in the brain in a way that mimics effects of a low-calorie diet.

"We know from animal studies that caloric restriction prevents diseases of aging such as diabetes and Alzheimer's," explains Turner, director of the Georgetown University Medical Center's Memory Disorders Program. "On the flip side of the coin, having diabetes increases one's risk of developing AD. So perhaps by improving glucose tolerance, we will prevent or delay both diabetes and Alzheimer's."

To join the resveratrol study, participants were first given a fasting glucose tolerance test to obtain a baseline level, and then retested two hours after eating. During digestion, the blood sugar level increases, but the pancreas produces insulin to lower it. A high sugar level after two hours reveals glucose intolerance (pre-diabetes) or diabetes if the level is very high.

"The number of people with glucose intolerance (pre-diabetes) was much higher than expected," says Turner. "I was surprised by how many people didn't know they were pre-diabetic, and these are individuals who already get the best medical care."

Five (4 percent) of 128 participants had impaired fasting glucose levels while three others (2 percent) had findings consistent with type 2 diabetes mellitus. Of the 125 subjects who completed the two-hour test, 38 (30 percent) demonstrated glucose intolerance while 16 (13 percent) had results consistent with diabetes. Thus, the overall prevalence of impaired glucose tolerance or diabetes at two hours was 43 percent -- or almost half of the individuals recruited to the study.

Turner asks, "How does glucose intolerance or diabetes lead to AD? Does the inflammation associated with AD trigger glucose intolerance? Or do both events create a vicious cycle of Alzheimer's and glucose intolerance?"

Turner's study isn't designed to answer these questions, but it might provide important clues. Turner says while a glucose tolerance test is not typically ordered by neurologists, "this result suggests that perhaps we should test all our patients with early Alzheimer's. It's a simple, inexpensive study that reveals critical health information."

Turner will discuss his findings at the Alzheimer's Association International Congress in Boston on July 14.

The resveratrol study is sponsored by the Alzheimer's Disease Cooperative Study through a grant from the National Institute on Aging. Turner reports no personal financial interests related to the study.

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Banana Power

This is interesting. After reading this, you’ll never look at a banana in the same way again.
Bananas contain three natural sugars – sucrose, fructose and glucose combined with fiber. A banana gives an instant, sustained and substantial boost of energy.
Research has proven that just two bananas provide enough energy for a strenuous 90-minute workout. No wonder the banana is the number one fruit with the world’s leading athletes.
But energy isn’t the only way a banana can help us keep fit. It can also help overcome or prevent a substantial number of illnesses and conditions, making it a must to add to our daily diet.

DEPRESSION: 

According to a recent survey undertaken by MIND amongst people suffering from depression, many felt much better after eating a banana. This is because bananas contain tryptophan, a type of protein that the body converts into serotonin, known to make you relax, improve your mood and generally make you feel happier.

>PMS:
Forget the pills – eat a banana. The vitamin B6 it contains regulates blood glucose levels, which can affect your mood.

ANEMIA:
High in iron, bananas can stimulate the production of hemoglobin in the blood and so helps in cases of anemia.

BLOOD PRESSURE:
This unique tropical fruit is extremely high in potassium yet low in salt, making it perfect to beat blood pressure So much so, the US Food and Drug Administration has just allowed the banana industry to make official claims for the fruit’s ability to reduce the risk of blood pressure and stroke.

BRAIN POWER:
200 students at a Twickenham school ( England ) were helped through their exams this year by eating bananas at breakfast, break, and lunch in a bid to boost their brain power. Research has shown that the potassium-packed fruit can assist learning by making pupils more alert.

CONSTIPATION:
High in fiber, including bananas in the diet can help restore normal bowel action, helping to overcome the problem without resorting to laxatives.

HANGOVERS:
One of the quickest ways of curing a hangover is to make a banana milkshake, sweetened with honey. The banana calms the stomach and, with the help of the honey, builds up depleted blood sugar levels, while the milk soothes and re-hydrates your system.

HEARTBURN:
Bananas have a natural antacid effect in the body, so if you suffer from heartburn, try eating a banana for soothing relief.

MORNING SICKNESS:
Snacking on bananas between meals helps to keep blood sugar levels up and avoid morning sickness.

MOSQUITO BITES:
Before reaching for the insect bite cream, try rubbing the affected area with the inside of a banana skin. Many people find it amazingly successful at reducing swelling and irritation.

NERVES:
Bananas are high in B vitamins that help calm the nervous system..
Overweight and at work? Studies at the Institute of Psychology in Austria found pressure at work leads to gorging on comfort food like chocolate and chips. Looking at 5,000 hospital patients, researchers found the most obese were more likely to be in high-pressure jobs. The report concluded that, to avoid panic-induced food cravings, we need to control our blood sugar levels by snacking on high carbohydrate foods every two hours to keep levels steady.

ULCERS:
The banana is used as the dietary food against intestinal disorders because of its soft texture and smoothness. It is the only raw fruit that can be eaten without distress in over-chroniclercases. It also neutralizes over-acidity and reduces irritation by coating the lining of the stomach.

TEMPERATURE CONTROL:
Many other cultures see bananas as a ‘cooling’ fruit that can lower both the physical and emotional temperature of expectant mothers. In Thailand , for example, pregnant women eat bananas to ensure their baby is born with a cool temperature.

So, a banana really is a natural remedy for many ills. When you compare it to an apple, it has FOUR TIMES the protein, TWICE the carbohydrate, THREE TIMES the phosphorus, five times the vitamin A and iron, and twice the other vitamins and minerals.. It is also rich in potassium and is one of the best value foods around So maybe its time to change that well-known phrase so that we say, ‘A BANANA a day keeps the doctor away!’

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Three Devastating Statistics of Diabetes Medical Malpractice

Guest Post by Jonathan Portner

It is often forgotten that the preventable consequences of diabetes are just that: preventable. While diabetes itself cannot be cured, the symptoms that are experienced can be managed effectively. The level of care that is given determines whether the patient will be able to carry out his life normally or burdened with crushing ailments. In medical malpractice cases, the standard of care is the ruler that is used to measure the care given to a medical malpractice victim. In cases of diabetes medical malpractice, the standard of care for measuring blood sugar is regular home blood testing.

For over 30 years, the American Diabetes Association has been rallying for better preventative care for diabetes patients. One of the most essential ways in which diabetics can manage their symptoms is through regularly tracking their blood sugar. In 1976, the ADA published this statement, emphasizing the critical need for regular blood monitoring: “[T]he weight of evidence strongly supports the concept that microvascular complications of diabetes are decreased by reduction of blood glucose concentrations. The goal of appropriate therapy should include a serious effort to achieve levels of blood glucose as close to those in the nondiabetic person as feasible.”

Although regular monitoring has been the standard of care since 1986, over a decade later in 1999, the CDC discovered that barely 40% of diabetics are testing their blood regularly. It was found that those patients who respected the toll that poor blood sugar control can take on their bodies were those who were the most adamant in their testing habits.

When blood sugar control is not monitored, the effects can be devastating:

1) As many as 24,000 new cases of adult-onset blindness occur each year as a result of diabetes.

2) Approximately 82,000 new lower-limb amputations occur each year, making diabetes the leading cause of non-traumatic amputation in the United States.

3) 44% of new cases of end-stage kidney disease each year is caused by diabetes.

When a patient declares that he was not informed of the importance of home blood sugar testing, doctors oftentimes claim that the doctor informed the patient of the issue, but the patient refused to heed to the advice. In these cases, experienced diabetes medical malpractice attorneys know that a strong line of questioning usually reveals that the doctor failed to document this alleged conversation, even when everything else of consequence to the patient is recorded. One must remember that it is the physician’s job to ensure that the patient is fully educated, and if the patient is not, it is important for the physician to make a referral to a diabetes education specialist.

 

For more information about medical malpractice, please visit: www.portnerandshure.com

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Mixed Results On Computer-based Support For Diabetes

Cell phones and computer programs give specific advice and support to people with diabetes, but do not do much to improve their health or quality of life, new research suggests.
The outcomes, published in The Cochrane Library, were based on an analysis of 16 previous studies that assessed a different type of interactive intervention. A few of the programs gave access to social networking and peer support groups from home - some were readily available to patients when they visited a clinic.
Despite the fact that mobile phone and computer management programs have small positive effects on blood sugar levels - these effects are short-lived.
Close to 347 million adults around the world live with diabetes and are at an elevated risk for complications like heart attack and stroke.

Some previous research has proven that giving chronically ill patients the skills to control their own disease can help them reduce their risk of complications.
Smart phones and computers give the opportunity to better self-care for diabetes through patient-specific education and support - in turn decreasing costs to health care systems.
The investigators in the current study analyzed data from 16 trials consisting of 3,578 people with type 2 diabetes who used cell phones and computers as part of controlling diabetes interventions ranging between one and twelve months.
Generally, these interventions had positive advantages, but they were limited. In regards to controlling blood sugar, there were small advantages, and even greater advantages for those whose self-care programs were monitored by cell phone.
The authors noted that the advantages decreased after six months. Additionally, there was no proof that these interventions helped improve depression, quality of life or weight in people who have type 2 diabetes.
Lead researcher, Kingshuk Pal of the Research Department of Primary Care and Population Health at UCL in London, said, "Our review shows that although popular, computer-based diabetes self-management interventions currently have limited evidence supporting their use. There are also few studies looking at cost-effectiveness or long-term impact on patient health."
The authors emphasized that some research of computer-based interventions helped to improve education and understanding of diabetes, however, this did not lead to behaviors that can better health, like diet changes and exercise.
Dr. Pal concluded:

"Effective self-management is a complex task that may require changes to many aspects of people's lives. Any intervention to help that process needs to support sustained behaviour change in different areas like eating habits, physical activity or taking medication regularly and provide emotional support. We did not see any convincing evidence for long-term change like this in the interventions we looked at."

Researchers Found Software Program Helpful for Type 2 Diabetes Patiens

Researchers form Maryland University School of medicine reported in Diabetes Care (September 2011 issue) that an interactive computer software program appeared effective in helping patients manage their type 2 diabetes using their cell phones.
Patients who used the application experienced a 1.9% drop in A1c levels over a period of one year.
Charlene C. Quinn, Ph.D., R.N., an assistant professor of epidemiology and public health at the University of Maryland School of Medicine and the principal investigator, said "The 1.9 percent decrease in A1c that we saw in this research is significant. Previous randomized clinical trials have suggested that just a 1 percent decrease in A1c will prevent complications of diabetes, including heart disease, stroke, blindness and kidney failure."

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High-Fat Foods May Be A Factor In Glucose Control

In a study of patients with type 1 diabetes, Joslin researchers found that dietary fat can affect glucose levels and insulin requirements. These findings, which appeared in the April edition of Diabetes Care, have major implications for the management of type 1 diabetes.
Research has shown that dietary fat and free fatty acids (FFAs) impair insulin sensitivity and increase glucose production. Most studies have focused on the role of fat in the development of type 2 diabetes. However, studies of people with type 1 diabetes have shown that higher-fat pizza meals cause hyperglycemia hours after being consumed.

In reviews of continuous glucose monitoring and food log data from adult patients with type 1 diabetes, Joslin clinicians observed that "several hours after eating high-fat meals, glucose levels went up," says study lead author Howard Wolpert, MD, Senior Physician in the Joslin Clinic Section on Adult Diabetes and the Director of the Insulin Pump Program at Joslin. "We wanted to determine the underlying cause of these unexplained fluctuations."
Seven participants (adults with type 1 diabetes with an average age of 55) successfully completed the study. They spent two days at Beth Israel Deaconess Medical Center eating carefully controlled meals and having their glucose and insulin levels monitored.
All breakfasts and lunches featured identical low-fat content. The two dinners had identical carbohydrate and protein content but one was low-fat and the other high-fat. For two 18-hour periods beginning before dinner, participants had their insulin automatically regulated by a closed-loop system and their glucose and plasma insulin levels tested at frequent intervals.
Study results showed that participants required more insulin after eating the high-fat dinner than the low-fat dinner (12.6 units compared to 9 units). In contrast, the two breakfast meals required similar insulin doses. Despite the increased insulin, participants had greater hyperglycemia after the high-fat dinner with insulin levels elevated five to ten hours after the meal. The average increase in insulin was 42 percent with significant individual differences.
"These findings highlight the limitations of basing mealtime insulin dosing for type 1 diabetes solely on carbohydrate intake," says Dr. Wolpert. "We need to consider fat as well as carbohydrates in insulin dosing calculations as well as in nutritional recommendations."
Dr. Wolpert and the research team are about to start a new study funded by the Juvenile Diabetes Research Foundation that aims to define optimal insulin dosages for higher-fat meals. Participants will eat controlled high-fat meals and receive increasingly higher doses of insulin until the optimum dose is determined. "We are looking to identify individual patient characteristics that influence how much additional insulin individuals with type 1 diabetes need to cover high-fat meals," he says. "As we learn more about how dietary fat affects insulin control, we will apply our findings to improve treatment recommendations and outcomes for patients with diabetes."
They are also planning an intervention study to assess whether reducing fat intake would optimize glucose control. In the coming months, Dr. Wolpert also anticipates developing new guidelines for clinicians and patients to enable them to determine whether high-fat foods are a factor in glucose control and make appropriate nutritional changes.

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Disrupting Our Internal Clocks May Lead To A Complete Absence Of 24-Hour Bodily Rhythms And An Immediate Gain In Body Weight

If you're pulling and all-nighter to finish a term paper, a new parent up all night with a fussy baby, or simply can't sleep like you once could, then you may be snoozing on good health. That's because new research published in The FASEB Journal used mice to show that proper sleep patterns are critical for healthy metabolic function, and even mild impairment in our circadian rhythms can lead to serious health consequences, including diabetes and obesity.

"We should acknowledge the unforeseen importance of our 24-hour rhythms for health," said Claudia Coomans, Ph.D., a researcher involved in the work from the Department of Molecular Cell Biology in the Laboratory of Neurophysiology at Leiden University Medical Center in Leiden, Netherlands. "To quote Seneca 'We should live according to nature (secundum naturam vivere).'"
To make this discovery, Coomans and colleagues exposed mice to constant light, which disturbed their normal internal clock function, and observed a gradual degradation of their bodies' internal clocks until it reached a level that normally occurs when aging. Eventually the mice lost their 24-hour rhythm in energy metabolism and insulin sensitivity, indicating that relatively mild impairment of clock function had severe metabolic consequences.
"The good news is that some of us can 'sleep it off' to avoid obesity and diabetes," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "The bad news is that we can all get the metabolic doldrums when our normal day/night cycle is disrupted."

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Direct Association Between Type 2 Diabetes And Obesity Found

Obesity has been historically known as a risk factor for type 2 diabetes, and now a key mechanism has been found in the immune system that plays a part in the development of obesity-linked type 2 diabetes.
The outcome was found in a study led by researchers from King's College London, UK and was published in the journal Cell Metabolism.
The findings are a stepping stone for new treatment methods and prevention of this health issue that has become extremely prevalent worldwide.

Internationally, approximately 371 million people are living with diabetes - 90% of these cases are type 2 diabetes. By the year 2030, there will be an estimated 550 million people with diabetes if this progression continues.
Since 1980, cases of diabetes have increased twofold - with 70 percent of the change happening because of aging populations around the world - while the other 30 percent are due to the rising incidence of risk factors, including obesity.
Previous research has shown the link between obesity and diabetes, but the molecules that cause this link have been a mystery.
The investigators studied mice that were genetically engineered to not have T-bet, a protein that controls the differentiation and function of immune cells. Researchers found that the mice had heightened insulin sensitivity, even though they were obese.
Dr. Howard explained:

"When T-bet was absent this altered the relationship between fat and insulin resistance: the mice had more intra-abdominal fat but were actually more sensitive to the glucose lowering effects of insulin. As fat accumulation in the abdomen is typically associated with worsening insulin resistance and other features of the metabolic syndrome, the findings seen were both unusual and unexpected."

The researchers found that the intra-abdominal fat of these mice had fewer immune cells and was less swollen than that of regular mice. They further discovered that by moving immune cells that had no T-bet to younger, skinnier mice, the insulin sensitivity improved.
Professor Graham Lord added, "It appears that T-bet expression in the adaptive immune system is able to influence metabolic physiology."
Generally, obesity is linked to insulin resistance and diabetes, however, this is not always the case. Many of the most common medications used to treat type 2 diabetes function by improving insulin sensitivity. More trials are needed to pinpoint other molecules in the pathway of action of T-bet, which could start the process for future drug options for the treatment of type 2 diabetes.
Giving specific immune cells as immunotherapy to better insulin resistance could also be a possibility for therapy in the future.
Dr. Howard concluded:

"This is just the start - the idea that the immune system can impact on metabolism is very exciting, but more research needs to be done before we can bring this work from the bench to the bedside for the benefit of patients."

In January of this year, a study published in Nature suggested that a new new gene has been found that plays a role in insulin resistance and obesity - conditions that increase the risk of type 2 diabetes and heart disease.

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Visiting Your Doctor Following ER Care For Chest Pain Reduces Risk Of Heart Attack, Death

Seeing a doctor within a month of an emergency room visit for chest pain significantly reduced the risk of heart attack or death among high risk patients, according to research published the American Heart Association journal Circulation.
Chest pain is the most common reason people go to the emergency room in developed countries and accounts for more than 5 million ER visits each year in the United States.

The study is the first to demonstrate the importance of follow-up care for chest pain patients after leaving the ER, researchers said. High risk patients in this study were those with previously diagnosed heart disease or diabetes.
"Being discharged from the emergency department is reassuring for patients, but it is critical that they follow up with their doctor to reduce their risks of future heart attacks or premature death," said Dennis T. Ko, M.D., M.Sc., senior author and scientist at the Institute for Clinical Evaluative Sciences, Cardiologist at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. "Patients need to advocate for themselves and physicians need to be more diligent about arranging follow-up care."
Researchers analyzed data on 56,767 adults (average age 66, 53 percent men) in Ontario, Canada, who were diagnosed with chest pain in an emergency room between April 2004 and March 2010; had been previously diagnosed with heart disease or diabetes; and didn't require additional hospitalization or die within a month. They tracked data for a median 3.7 years and accounted for differences in key patient characteristics such as age, gender, health status and location.
Among the findings:

• Only 17 percent of high risk chest pain patients seen in the emergency room were evaluated by cardiologists within a month; 58 percent saw a primary care physicians alone, and 25 percent had no physician follow-up within a month.
• Patients who followed up with a cardiologist within 30 days were 21 percent less likely to have a heart attack or die within one year, compared with patients who failed to seek additional care within that time.
• Patients seen by a primary care physician were 7 percent less likely to have a heart attack or die compared to those patients who sought no follow up care.
• Patients treated by cardiologists received more testing, procedures and medication within 100 days of their ER discharge and had the best health outcomes.
• Patients seen by their cardiologist were 15 percent less likely to have a heart attack or die within the first year, compared to patients who received follow up care from their primary care physician.

Patients who didn't seek follow-up care within a month received the lowest rate of care and had the worst health outcomes - demonstrating the need to improve follow-up with high risk chest pain patients after they're discharged from the emergency room, Ko said.
The study notes that there are several reasons patients did not receive additional physician follow-up including: patients believing they didn't need additional care and the lack of a coordinated referral system from the emergency department to physicians who can provide follow-up care.
While there is no cost for seeing a physician at follow-up in the Canadian health care system, the barriers for follow up care could include expense in other countries.
"As physicians, we are often so focused on knowing which drug to prescribe or which test to order that we overlook the fact that many patients fail to get follow-up care to begin with," Ko said. "We need systems of care that better identify these patients who are at increased risk because getting that follow-up can significantly reduce their risks of heart attack or premature death."
Because the study focused on high risk patients, the results may not apply to all who have chest pain. Researchers recommend further study that will also investigate economic factors.

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Adults With Diabetes And Limited Health Literacy Less Likely To Adhere To Prescribed Antidepressants

Adult patients with diabetes who don't understand basic health information are significantly less likely to take newly prescribed antidepressant medication, according to a new Kaiser Permanente study in the Journal of General Internal Medicine.
In this study conducted by the Kaiser Permanente Division of Research and the University of Washington School of Medicine, 72 percent of the 1,366 study participants had limited health literacy, and had significantly poorer adherence to newly prescribed antidepressants, compared to patients with no limitations.
"Research shows that those with health literacy limitations are more likely to have poor control of their chronic medical conditions such as diabetes, congestive heart failure and HIV," said Andrew Karter, PhD, research scientist at Kaiser Permanente and senior author on the study. "However, this is the first study to examine the association between health literacy and antidepressant adherence among patients with diabetes. This type of research gives our health care systems important feedback because, as providers, we often remain unsure whether the critical health information we convey to our patients is fully understood."
The Institute of Medicine defines health literacy as the capacity for patients to "obtain, process, and understand basic health information and services needed to make appropriate health decisions." Because nearly 90 percent of Americans have some difficulty using routine health information, the U.S. surgeon general has identified the improvement of health literacy as a national priority.
Adequate adherence for antidepressants is particularly important for patients with diabetes and other chronic medical conditions. Depression occurs twice as frequently among adults with diabetes compared to adults without diabetes, and has been associated with an increased risk of the serious diabetic complications, dementia and mortality.
In the study, health literacy was based on a self-reported scale in which participants with type 2 diabetes responded to three questions:

• How often do you have problems learning about your medical condition because of difficulty understanding written information?
• How confident are you filling out medical forms by yourself?
• How often do you have someone like a family member, friend, hospital or clinic worker or caregiver, help you read health plan materials?

The study examined medication nonadherence during the 12 months after the initial antidepressant prescription, and researchers found that many patients failed to adhere to their treatment. Although most patients filled the prescription at least once, 43 percent failed to fill the prescription a second time, and nearly two-thirds had discontinued the antidepressant by the end of the 12-month period.
Poor adherence to antidepressant medications has been described previously, but what was not known is that those with health-literacy limitations were significantly less likely to take their antidepressant medications. In fact, diabetes patients with limited health literacy were much less likely to refill their antidepressant medications in a timely fashion than patients with no limitations. These patterns were not explained by other factors known to be associated with medication nonadherence, including age, race/ethnicity, English proficiency and income, which were accounted for in the study.
Depression in adults with diabetes is frequently chronic, suggesting the need for long-term antidepressant therapy. "The high rates of early discontinuation that were observed among adults with diabetes who had any health literacy limitation suggest that few of these individuals received an adequate course of antidepressant therapy. Getting that sufficient treatment is critical in preventing relapse and recurrence of depression," said lead author Amy Bauer, MD, of the University of Washington School of Medicine. "Physicians should be aware of this. For antidepressant treatment to succeed, patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up."
The researchers said the study findings underscore the importance of national efforts to address healthy literacy, simplify health communications regarding treatment options, improve public understanding of the importance of depression treatment, and monitor antidepressant adherence.
Additional authors on the study include Wayne Katon, MD, University of Washington; Dean Schillinger, MD, University of California, San Francisco Division of General Internal Medicine; Melissa Parker, MS, Alyce Adams, PhD, and Howard H. Moffet, MPH, Kaiser Permanente Northern California Division of Research; and Nancy Adler, PhD, University of California, San Francisco Center for Health and Community.

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Household Income Affects Chronic Disease Control In Kids, Despite Free Health Care

Researchers at the University of Montreal have found that the glycated hemoglobin levels of children with type 1 diabetes followed at its affiliated Sainte-Justine Mother and Child University Hospital (CHU Sainte-Justine) is correlated linearly and negatively with household income. Glycated hemoglobin is the binding of sugar to blood molecules - over time, high blood sugar levels lead to high levels of glycated hemoglobin, which means that it can be used to assess

whether a patient properly controls his or her blood glucose level. "Our study highlights a marked disparity between the rich and the poor in an important health outcome for children with type 1 diabetes, despite free access to health care", explained Dr. Johnny Deladoëy, who led the study.
The researchers used statistics collected from 1,766 children who had been diagnosed with type 1 diabetes at CHU Sainte-Justine between 1980 and 2011. They estimated their household income by using the median for their postal code as reported by Statistics Canada and standardized their glycated hemoglobin levels (HbA1c) in order to undertake the study. "We know that there are a variety of socio-economic factors that affect metabolic control in diabetic children, but it is difficult to compare studies as researchers look at these factors in different ways", Deladoëy said. "However, median household income is a good proxy for these factors taken together". In addition, all studies on this subject have come from countries where users must pay to consult a health care professional whereas the present study is the first to look at this in the context of free health care. A study from Ontario, published simultaneously in another journal, reports similar findings.
Because there are so many factors influencing the treatment of this disease, the researchers were not surprised by their results. "These confirm our clinical impression that the most important factor correlated with the treatment of type 1 diabetes is household income", Deladoëy said. Importantly, the researchers found that the difference in glycated hemoglobin levels in kids from the poorest and the richest neighbourhoods corresponds to a doubling of the risk of damage to the eyes (diabetes is a leading cause of blindness in adulthood). "Type 1 diabetes is a chronic disease requiring multiple daily insulin injections and blood tests throughout the individual's life. Our study suggests that there should be greater support to children with type 1 diabetes who live in low income areas; this could include, for instance, increasing the number and length of visits from social workers", Deladoëy explained.

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Diabetes Trials Worldwide Are Not Addressing Key Issues In Affected Populations

Only one in ten are studying prevention while almost two thirds focus on drug therapy
An analysis of diabetes trials worldwide has found they are not addressing key issues relating to the condition with almost two thirds focusing on drug therapy while only one in ten addresses prevention or behavioural therapies. The research is published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), and is by Dr Jennifer Green, Duke University Medical Center, Durham, NC, USA, and colleagues.
There are an estimated 371 million people with diabetes in the world. By 2030, there will be some 550 million with diabetes based on current trends. As such, research addressing the whole spectrum of diabetes care and treatment is essential.

To examine whether current studies adequately address these needs, Green and colleagues analysed diabetes-related trials registered with ClinicalTrials.gov from 2007--2010.
The researchers found 2,484 interventional trials by selecting those with disease condition terms relevant to diabetes. Of these, 75% had a primarily therapeutic purpose while just 10% were preventive. Listed interventions were mostly drugs (63%) while few were behavioural (12%). Most of the studies were also small to medium sized, and were designed to enrol 500 or fewer participants (91%) or 100 or fewer (59%) participants, with mean/median times to completion of 1.8/1.4 years.
A very small proportion of trials targeted persons aged 18 years and under (4%). This may be appropriate given the number of children currently affected by diabetes; however, the estimated 3% annual increase in incidence of type 1 diabetes may warrant greater representation. Furthermore, the increase in type 2 diabetes among adolescents, particularly noticeable in wealthier nations, is of considerable concern, since as Dr Green notes "it is unclear whether findings obtained from trials of adults with diabetes are readily translatable to paediatric/adolescent populations".
And despite the fact that nearly 20% of adults worldwide aged 65 years and over have diabetes, less than 1% of trials specifically targeted this age group, while 31% actually excluded patients over 65 years and almost all excluded those over 75 years.
"Only a tiny proportion of the trials analysed--1.4%--listed primary outcomes including mortality or clinically significant cardiovascular complications," says Dr Green. "Furthermore, distribution of registered trials by country does not reliably correlate with diabetes prevalence."
The International Diabetes Federation list of the 10 locations most affected by diabetes includes six Middle Eastern countries in which diabetes prevalence among adults is approximately 20% (Kuwait, Lebanon, Qatar, Saudi Arabia, Bahrain and the United Arab Emirates). However, this analysis by Green and colleagues, suggests that this region is minimally involved in the registered diabetes-related trials. Comparison of trial activities in countries with the highest diabetes prevalence among adults revealed 1126 trials in the USA. China, India and Mexico participated in 101--250 trials each; however, the Russian Federation (12.6 million persons with diabetes) and Brazil (12.4 million) are involved in fewer than 100 registered trials despite these heavy disease burdens.
Dr Green also says: "Rates of complications including diabetic retinopathy, lower extremity amputation, and end-stage renal disease vary among ethnic groups. To achieve the greatest impact upon clinical care, trials should enrol patients representative of populations disproportionately affected by diabetes and its complications. A better understanding of responses to interventions among diverse individuals and groups may inform individualised treatments of greater effectiveness and tolerability."
She concludes: "The majority of diabetes-related trials include small numbers of participants, exclude those at extremes of age, are of short duration, involve drug therapy rather than preventive or non-drug interventions, and do not focus upon significant cardiovascular outcomes. Recently registered diabetes trials may not sufficiently address important diabetes care issues or involve affected populations...Although many trials will provide valuable information upon completion, our review suggests that the current portfolio does not adequately address disease prevention, management, or therapeutic safety. This information may be meaningful in the allocation of future research activities and resources."

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Diet As Effective As Surgery For Diabetes Patients

Patients with type 2 diabetes who follow the same strict diet required for those who undergo bariatric surgery are just as likely to see a reduction in blood glucose levels.
The finding came from a new study conducted by researchers at UT Southwestern Medical Center and was published in the journal Diabetes Care.
Dr. Ildiko Lingvay, assistant professor of internal medicine and first author of the research, said:

"For years, the question has been whether it is the bariatric surgery or a change in diet that causes the diabetes to improve so

rapidly after surgery. We found that the reduction of patients' caloric intake following bariatric surgery is what leads to the major improvements in diabetes, not the surgery itself."

Ten patients were involved in the report and were followed in a controlled, inpatient setting during two separate times.
At first, the participants were treated only with the standard diet that patients who receive bariatric surgery are required to follow. The experts measured blood glucose levels to determine the impact of the diet.
After many months passed, the subjects received the Roux-en-Y gastric bypass bariatric surgery and followed the same diet. Once again, the scientists observed the patients' blood glucose levels.
During each of these observations, which lasted for 10 days, the volunteers consumed less than 2,000 calories total each day - the customary diet for gastric bypass surgery patients.
Results showed that during the diet-only period, fasting blood glucose levels reduced 21% on average, and after combining the diet with the procedure, levels decreased 12%.
After a standard meal, patients' overall blood glucose levels dropped 15% in the diet-only period and 18% after combining diet with surgery.
This indicates that the very strict diet given to patients after bariatric surgery is accountable for the quick diabetes remission, which usually occurs within days of the operation, the authors said. Previous research found that 67% of bariatric surgery patients were in complete remission for type 2 diabetes after 12 months.
Dr. Lingvay explained:

"Unfortunately, such a restrictive diet is nearly impossible to adhere to long-term in the absence of bariatric surgery. We found that the success of bariatric surgery is mediated through its ability to control food intake, which in turn has a beneficial effect on diabetes."

Type 2 diabetes often develops as an outcome of obesity and occurs because the body cannot meet the increased need of insulin brought upon by obesity and insulin resistance. According to a report from March of this year, people at high risk of developing type 2 diabetes can reduce the risk by sitting less and moving around more frequently.
Over 20 million people in the U.S. are affected by type 2 diabetes, according to the American Diabetes Association.
A recent study found a key mechanism in the immune system that plays a part in the development of obesity-linked type 2 diabetes. The findings, which were published in Cell Metabolism, are a stepping stone for new treatment methods, according to the authors.
If diabetes is left untreated, the disease can lead to other conditions, such as:

• stroke
• heart disease
• nerve damage
• kidney damage

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Late-Life Depression Associated With Prevalent Mild Cognitive Impairment, Increased Risk of Dementia

Depression in a group of Medicare recipients ages 65 years and older appears to be associated with prevalent mild cognitive impairment and an increased risk of dementia, according to a report published Online First by Archives of Neurology, a JAMA Network publication.

Depressive symptoms occur in 3 percent to 63 percent of patients with mild cognitive impairment (MCI) and some studies have shown an increased dementia risk in individuals with a history of depression. The mechanisms behind the association between depression and cognitive decline have not been made clear and different mechanisms have been proposed, according to the study background.

Edo Richard, M.D., Ph.D., of the University of Amsterdam, the Netherlands, and colleagues evaluated the association of late-life depression with MCI and dementia in a group of 2,160 community-dwelling Medicare recipients.

"We found that depression was related to a higher risk of prevalent MCI and dementia, incident dementia, and progression from prevalent MCI to dementia, but not to incident MCI," the authors note.

Baseline depression was associated with prevalent MCI (odds ratio [OR], 1.4) and dementia (OR, 2.2), while baseline depression was associated with an increased risk of incident dementia (hazard ratio [HR], 1.7) but not with incident MCI (HR, 0.9). Patients with MCI and coexisting depression at baseline also had a higher risk of progression to dementia (HR, 2.0), especially vascular dementia (HR, 4.3), but not Alzheimer disease (HR, 1.9), according to the study results.

"Our finding that depression was associated cross sectionally with both MCI and dementia and longitudinally only with dementia suggests that depression develops with the transition from normal cognition to dementia," the authors conclude.

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Young people with diabetes dying due to lack of adequate healthcare

Originally posted on: http://www.diabetes.org.uk/About_us/News_Landing_Page/Young-people-with-diabetes-dying-due-to-lack-of-adequate-healthcare/

Young adults with Type 1 diabetes are much more likely to die than their peers because they are not getting the healthcare they need to manage their condition.

Young women with Type 1 diabetes are nine times more likely to die than their peers – and young men with Type 1 diabetes are four times more likely – and this is likely to be because many of them have not had the care needed to give them the best chance of a long and healthy life.

Blood glucose targets missed

The lack of good-quality healthcare is reflected in the fact that 85 per cent of children with Type 1 diabetes have poor blood glucose control, which puts them at significantly increased risk of devastating health complications later in life.

Just 15 per cent of children with the condition have HbA1c levels (the standard measurement for blood glucose) of under 7.5 per cent, compared to the 34 per cent of children achieving this in comparable countries such as Germany and Austria.

Type 1 essentials for children and young people

This is why we have published the Type 1 essentials for children and young people: a guide that sets out the 10 things that every child with Type 1 diabetes needs.

We are calling on NHS management to make sure the resources are in place so that children with Type 1 diabetes have access to this care, and for healthcare professionals to make sure their patients are getting good-quality care. Parents of children with Type 1 diabetes can use the checklist when discussing care with healthcare professionals, to ensure that their child is receiving the care that he or she should.

Guide to good care

Barbara Young, Chief Executive of Diabetes UK, said, "The fact that so many people with Type 1 diabetes are doing less well than they should is at least partly the consequence of the quality of healthcare for children with the condition.

"Our Type 1 essentials for children and young people sets out the care every child with Type 1 diabetes should be getting – but many children do not get this care.

No reason to lag behind

"There is no good reason why we should be lagging so far behind countries such as Germany in terms of management of the condition, but the stark truth is that the UK fails to deliver good-quality healthcare for children with Type 1 diabetes. Every child needs to get the 10 things that can make a real difference.

"By publishing our guide to what good care looks like, we hope the NHS will ensure that services are commissioned and organised to give every child with Type 1 diabetes the quality of healthcare they deserve. We want parents and healthcare professionals to understand what good care is so they can play their part in making sure it is delivered.

Making sure every child gets 10 out of 10

"Our children with Type 1 diabetes have been let down by poor healthcare for too long. By making sure every child gets 10 out of 10, we can give every child with the condition the best possible chance of a long and healthy life."

"No family should have to struggle to get good care"

Amelia Lily, popstar and children’s ambassador for Diabetes UK, said, "As someone who has Type 1 diabetes myself, I know that no family should have to struggle to get the good care their child deserves. But that’s what thousands of families with children with Type 1 diabetes have to do year in, year out.

"The best possible start in life"

"I’m supporting Diabetes UK’s campaign because I’m passionate about putting an end to poor care so that children and young people with Type 1 diabetes can achieve the best possible start in life.

"Good care for children is so important because it puts you on the road to helping you manage your condition for the rest of your life and helps reduce the risk of developing serious complications, or even dying before your time.

"Living with Type 1 diabetes is hard enough. It’s vital that good healthcare is in place so that can children with the condition can get on with enjoying their childhood."

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Up to Half of Gestational Diabetes Patients Will Develop Type 2 Diabetes, Study Finds

Women who were diagnosed with gestational diabetes during pregnancy face a significantly higher risk of developing Type 2 diabetes in the future, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

The prospective cohort study tracked 843 women who were diagnosed with gestational diabetes between 1996 and 2003 at Cheil General Hospital in Seoul, South Korea. About 12.5 percent of the women developed Type 2 diabetes within two months of delivering their babies. During the next decade, the number of women diagnosed with Type 2 diabetes continued to grow at a rate of 6.8 percent a year.

"The findings indicate as many as half of Asian women who had gestational diabetes will develop Type 2 diabetes within eight years of giving birth," said the study's lead author, Soo Heon Kwak, MD, of Seoul National University Hospital.

The study is among the largest of its kind to study Asian women who had gestational diabetes. Researchers followed 370 participants for more than a year after the birth of their children. Of the remaining women studied, 105 were diagnosed with type 2 diabetes within two months of giving birth and the remainder did not participate in long-term follow-up visits.

Researchers identified two distinct groups of women who were at risk -- those who developed Type 2 diabetes within two months of giving birth and those who took a year or more to progress to a Type 2 diabetes diagnosis. Although obesity was a major risk factor for both groups, researchers found genetic variations that could explain the timing of the disease's onset.

Women who rapidly developed Type 2 diabetes had a significant defect in insulin secretion. Among this population, researchers found a variation in the HHEX (hematopoietically expressed homeobox) gene that is associated with Type 2 diabetes.

Women who were slower to develop Type 2 diabetes were more likely to have a variation in the CDKAL1 gene, which also has been linked to Type 2 diabetes.

More research into genetic and environmental risk factors is needed to develop models that can better predict who will develop Type 2 diabetes, Kwak said. In the meantime, women who had gestational diabetes should undergo regular blood sugar testing.

"It is crucial for women who had gestational diabetes to have their blood sugar levels checked two months after giving birth and annually thereafter," Kwak said. "In addition to the problems undiagnosed Type 2 diabetes poses to the mother, leaving the disease untreated increases the risk of any future children developing congenital disorders."

Other researchers working on the study include: H. Jung, Y. Cho, S. Kim and K. Park of Seoul National University Hospital; S. Choi, S. Lim and H. Jang of Seoul National University Bundang Hospital; and N. Cho of Ajou University School of Medicine.

The article, "Clinical and Genetic Risk Factors for Type 2 Diabetes at Early or Late Post-partum after Gestational Diabetes Mellitus," appears in the April 2013 issue of JCEM.

Related articles

• Up To Half Of Gestational Diabetes Patients Will Go On To Develop Type 2 Diabetes (medicalnewstoday.com)
• Type 2 Diabetes Clinical Trial Now Enrolling at Achieve Clinical Research in Birmingham, Alabama; Accepting M/F Age 18+ with Type 2 Diabetes (prweb.com)
• mHealth program helping Mexican women with gestational diabetes info (voxxi.com)

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