Scottish Government announces insulin pump investment

After many years of campaigning by the charity and patient groups, Diabetes UK Scotland has welcomed a Scottish Government announcement to invest over £1 million in delivering insulin pumps.

All eligible under-18s with Type 1 diabetes will now have access to life-changing insulin pumps under plans announced today by the Scottish Government.

£1 million funding allocated

Funding of at least £1 million has been allocated to NHS Boards to help them deliver pumps to under-18s who need them, as well as tripling the amount of pumps available to all Scots.

Health Secretary Nicola Sturgeon made the announcement alongside five-year-old Daisy Slatter – the youngest person in Scotland to receive a pump. After years of multiple, daily insulin injections Daisy’s life has been dramatically improved by the medical device.

Freedom from multiple jabs

Ms Sturgeon said, "Insulin pumps mean freedom from having multiple insulin jabs a day – giving Scotland’s youngest diabetics a normal childhood.

"By the end of March 2013, this treatment will be made available to the 480 children and teens struggling with Type 1 diabetes who could benefit from it.

"Over the next three years, NHS Boards will also increase the number of insulin pumps available to all Scots to 2,000, tripling the current amount."

"Noticeably happier"

Daisy (pictured left) was diagnosed with Type 1 diabetes in November 2007 when she was just 18 months old. Daisy’s dad, Tim Slatter remembers, "After 11 months of blood sugar highs and lows, and jags coming from all directions we finally embarked on insulin pump therapy on 29 September 2008. It really did help to stabilize Daisy’s blood sugar levels and was noticeable within hours of the pump first being fitted.

"Daisy’s sugar levels were under far better control and she was noticeably happier, although she still pains a little bit when we have to change her infusion set. We were so delighted that she could now eat whatever she wanted, snack whenever and treats weren’t a problem, so long as we knew how many carbs she was consuming."

"Life-changing therapy"

Jane-Claire Judson, Diabetes UK Scotland’s National Director, added, "Today’s announcement is very welcome news and follows years of campaigning by Diabetes UK Scotland and pump users for improved access. The announcement and the Cabinet Secretary's personal leadership on this issue will give people with Type 1 diabetes new hope that they will have improved access to this life-changing therapy."

Continue Reading...

Diabetes Affects Hearing Loss, Especially in Women

Having diabetes may cause women to experience a greater degree of hearing loss as they age, especially if the metabolic disorder is not well controlled with medication, according to a new study from Henry Ford Hospital in Detroit.

Women between the ages of 60 and 75 with well-controlled diabetes had better hearing than women with poorly controlled diabetes, with similar hearing levels to those of non-diabetic women of the same age.

The study also shows significantly worse hearing in all women younger than 60 with diabetes, even if it is well controlled.

Men, however, had worse hearing loss across the board compared to women in the study, regardless of their age or whether or not they had diabetes.

"A certain degree of hearing loss is a normal part of the aging process for all of us, but it is often accelerated in patients with diabetes, especially if blood-glucose levels are not being controlled with medication and diet," says Derek J. Handzo, D.O., with the Department of Otolaryngology-Head & Neck Surgery at Henry Ford.

"Our study really points to importance of patients controlling their diabetes, especially as they age, based on the impact it may have on hearing loss."

The study was presented Jan. 26 in Miami Beach at the annual Triological Society's Combined Sections Meeting.

According to the American Diabetes Association, nearly 26 million people in the U.S. have diabetes, and another 34.5 million have some degree of hearing loss. Signs of hearing loss include difficulty hearing background noises or hearing conversations in large groups, as well as regularly needing to turn up the volume on a radio or TV.

While the association between diabetes and hearing loss has previously been studied, Henry Ford researchers sought to learn more about hearing differences among patients with well-controlled diabetes, poorly controlled diabetes, and those who do not have diabetes.

The Henry Ford research team reviewed records for 990 patients that had audiograms performed between 2000 and 2008 at the hospital. Patients were categorized by gender, age (younger than 60 years old, between 60-75 years old and older than 75 years old), and if they had diabetes. Those with diabetes were divided into two groups: well-controlled or poorly controlled, as determined by the American Diabetes Association guidelines that use HbA1C blood levels.

Dr. Handzo notes that previous studies about diabetes and hearing loss have not focused on blood-glucose levels, nor did they include such a diverse population based on age and gender.

The Henry Ford team looked at patients' pure tone average, a measurement that determines hearing level at certain frequency, and speech recognition at different ages. The team evaluated pure tone average ranges that focus on the frequency at which most people speak and the very high frequencies used in music and alarms.

Women between the ages of 60 and 75 with poorly controlled diabetes had significantly worse hearing than those whose diabetes was well-controlled and the control group. Among the women younger than 60, those with diabetes – regardless of whether or not it was being controlled – had worse hearingthan non-diabetic women.

For the men in the study, there was no significant difference in hearing between those with diabetes that well-controlled or poorly controlled, as well as those who did not have diabetes.

"Younger males in general have worse hearing, enough so to possibly mask any impact diabetes may have on hearing. But our findings really call for future research to determine the possible role gender plays in hearing loss," says Dr. Handzo.

Continue Reading...

Insulin Therapy May Help Repair Atherosclerotic Lesions in Diabetic Patients

New research reveals that insulin applied in therapeutic doses selectively stimulates the formation of new elastic fibers in cultures of human aortic smooth muscle cells. These results advance the understanding of the molecular and cellular mechanisms of diabetic vascular disease. The study is published in the February issue of the American Journal of Pathology.

"Our results particularly endorse the use of insulin therapy for the treatment of atherosclerotic lesions in patients with type I diabetes, in which the induction of new elastic fibers would mechanically stabilize the developing plaques and prevent arterial occlusions," explained lead investigator Aleksander Hinek, MD, PhD, DSc, Professor, Division of Cardiovascular Research, The Hospital for Sick Children and the Department of Laboratory Medicine and Pathobiology, University of Toronto.

Primary insulin deficiency and decreased cellular sensitivity to insulin have been implicated in the pathogenesis of impaired healing processes, atherosclerosis and hypertension, all frequently observed in patients with both type I and type II diabetes.

However, the possibility of a direct contribution of insulin to the cellular and molecular mechanisms that control the production of elastic fibers (elastogenesis) has not been explored. The researchers conducted a series of experiments to determine whether low therapeutic concentrations of insulin would promote the production of elastic fibers in cultures of human aortic smooth muscle cells.

Investigators found that insulin does in fact stimulate the deposition of elastic fibers in cultures of human aortic smooth muscle cells. The data demonstrated, for the first time, that low doses of insulin induce the elastogenic effect solely through the activation of insulin receptor and trigger the downstream activation of the P13K signaling pathway. The ultimate up-regulation of elastic fiber deposition by insulin is executed through two parallel mechanisms: the initiation of elastin gene expression and the enhancement of tropoelastin secretion.

Importantly, the experimental data suggest that insulin-dependent initiation of the elastin gene transcription occurs after dissociation of the FoxO1 transcription factor from the specific domain identified within the elastin gene promoter. The researchers also demonstrated that insulin may facilitate the transportation of tropoelastin into the secretory endosomes, where it can associate with S-GAL/EBP, the "chaperone" protein that enhances secretion.

"We believe that our discovery of the elastogenic action of insulin allows for better understanding of the pathologic mechanisms in which the lack of insulin, in diabetes type I, or insulin resistance, in diabetes type II, contribute to the development of hypertension and the rapid progression of atherosclerosis," concluded Dr. Hinek.

Dr. Hinek further elaborated on the far-reaching effects these data provide: "Importantly, our newest results indicate that the discovered elastogenic effect of low concentrations (0.5-10 nM) of insulin is not restricted to the arterial smooth muscle cells. Thus, insulin also stimulates formation of elastic fibers by human skin fibroblasts and by myofibroblasts isolated from human hearts.

These observations constitute a real novelty in the field of regenerative medicine and endorse 1) local application of small doses of insulin for ameliorating difficult healing of dermal wounds in diabetic patients and 2) systemic administration of insulin in patients after heart infarctions, in hope that insulin-induced elastic fiber deposition may alleviate formation of maladaptive collagenous scars in the myocardium."

The article is "Insulin Induces Production of New Elastin in Cultures of Human Aortic Smooth Muscle Cells," by J. Shi, A. Wang, S. Sen, Y. Wang, J. Kim, T.J. Mitts, and A. Hinek (DOI: 10.1016/j.ajpath.2011.10.022). It will appear in The American Journal of Pathology, Volume 180, Issue 2 (February 2012) published by Elsevier.

Continue Reading...

Insulin Resistance Linked to Brain Health

New research from Uppsala University shows that reduced insulin sensitivity is linked to smaller brain size and deteriorated language skills in seniors. The findings are now published in the scientific journal Diabetes Care.

The main hormonal function of insulin is to support the uptake and use of glucose in muscles and fat tissues. However, in an earlier article recently published in Molecular Neurobiology, Christian Benedict from the Department of Neuroscience at Uppsala University has reported that when insulin reaches the brain, it enhances memory function in humans. As insulin's capacity to stimulate glucose metabolism generally declines with age, it may also be that it affects the rate of cognitive aging in seniors.

In a new study, Christian Benedict, together with colleagues from Uppsala University (Samantha Brooks, Håkan Ahlström, Lars Lind, and Helgi Schiöth), the UK, and the US, have systematically studied 331 men and women at the age of 75 years. The researchers examined whether insulin sensitivity is tied to brain health. The brain structure of each participant was measured using magnetic imaging technology, so-called MRT, and their language skills were tested by asking them to name as many animals as possible in one minute (so-called verbal fluency).

"We found that in elderly whose insulin sensitivity was still high, the brains were larger, and they had more grey matter in regions that are important for language skills, compared with those who had diminished insulin sensitivity. We also observed that higher insulin sensitivity was associated with better scores on the language test. Our findings offer a possible explanation for why methods that improve insulin sensitivity, such as exercise, are promising strategies for counteracting cognitive aging late in life," says Christian Benedict.

The data for the study were taken from the major epidemiological study Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS).

Benedict C et al. Impaired insulin sensitivity as indexed by the HOMA score is associated with deficits in verbal fluency and temporal lobe gray matter volume in elderly. Diabetes Care, in press.

Continue Reading...

Bold new avenue for type 1 diabetes research

Researchers from the University of Pittsburgh have discovered new ways to grow human beta cells in the laboratory. The researchers were able to induce the cells to divide and, notably, to stop the cells from dividing as well.
The cell division was achieved by adding the genes ‘cdk’ and ‘cyclin d’ into the beta cells. The way the genes were introduced into the beta cells was via a virus which was able to penetrate into the cells and deliver the genes.
Beta cells are usually very slow to divide within the body which is one reason why type 1 diabetes is able to develop very quickly. Type 1 diabetes begins when the body’s immune system attacks its own insulin producing beta cells. Within a period of weeks, someone with type 1 diabeteswill have lost sufficient beta cells to require insulin injections to keep blood sugar levels even.
Previously, beta cells have only been available from human or animal donors. This has meant that beta cells have been in short supply even for research purposes. Production of beta cells from the new method described could open doors for more research into beta cells to be possible. The research led by Professor Andrew Stewart was funded by the JDRF.

Continue Reading...

Elevated Glucose Associated With Undetected Heart Damage

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health suggests that hyperglycemia (high blood sugar) injures the heart, even in patients without a history of heart disease or diabetes. Researchers found that elevated levels of glycated hemoglobin (HbA1c), a marker for chronic hyperglycemia and diabetes, were associated with minute levels of the protein troponin T (cTnT), a blood marker for heart damage. The high-sensitivity test they used detected levels of cTnT tenfold lower than those found in patients diagnosed with a heart attack.

The findings, which are published in the latest issue of the Journal of the American College of Cardiology, suggest that hyperglycemia may be related to cardiac damage independent of atherosclerosis.

"Hyperglycemia and diabetes are known to be associated with an increased risk for heart attack and coronary disease and our study sheds some light on what may be happening," said Elizabeth Selvin, PhD, MPH, senior author of the study and associate professor in the Bloomberg School's Department of Epidemiology. "Our results suggest that chronically elevated glucose levels may contribute to heart damage."

For the study, the researchers followed 9,662 participants from the Atherosclerosis Risk in Communities (ARIC) study. None of the participants had coronary heart disease or history of heart failure. Higher levels of HbA1c were associated in a graded fashion with elevated levels of high-sensitivity cTnT. This relationship was present at HbA1c levels even below the threshold used to diagnose diabetes. Using conventional tests, troponin T can be detected in 0.7 percent of the population and is associated with heart attacks and death. With the high-sensitivity cTnT test, low levels of troponin were found in 66 percent of the study population.

"Our study hints at other potential pathways by which diabetes and elevated glucose are associated with heart disease. Mainly, glucose might not only be related to increased atherosclerosis, but potentially elevated glucose levels may directly damage cardiac muscle," said Jonathan Rubin, MD, general internal medicine fellow at the Johns Hopkins School of Medicine. He was lead author of the study while studying at the Johns Hopkins Bloomberg School of Public Health.

Additional authors of "Chronic Hyperglycemia and Subclinical Myocardial Injury" include Kunihiro Matsushita, MD, PhD, and Josef Coresh, MD, PhD, of the Bloomberg School of Public Health; and Christine M. Ballantyne, MD, and Ron Hoogeveen, PhD, of the Baylor College of Medicine.

The research was supported with grants from the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.

Continue Reading...

Enraged by the Henderson Nevada Police

[youtube http://www.youtube.com/watch?v=Xv6Mzcs8Vuw]

Ok so I just got done watching this Youtube clip from 8 News Now in Henderson Nevada of 6 Police Officers beating a man who was in Diabetic Shock. They can be seen kicking and hitting him. All because he didn’t pull over in time. See this is what is wrong with the American Police Force. They automatically resort to violence rather than to talk things out or even get the just of what is going on in the situation. You can clearly see that the guy is not responsive, and makes no threating movements. I understand that being a Cop is a hard job and that they are putting their lives on the line daily, but really is force necessary when it comes to all situations.

What are your thoughts on this?

http://www.8newsnow.com/story/16770611/breaking-news-henderson-officer-in-beating-video-identified

Continue Reading...

Diabetes quadruples birth defects risk, say researchers

The risk of birth defects increases four-fold if the pregnant mother has diabetes, researchers say.

The Newcastle University study, published in the journal Diabetologia, analyzed data from more than 400,000 pregnancies in North East England.

The risk of defects such as congenital heart disease and spinal bifida were increased.

National guidelines already recommend having good control over blood sugar levels before trying to conceive.

Both Type 1 diabetes, which tends to appear in childhood, and Type 2 diabetes, often linked to diet, lead to problems controlling the amount of sugar in the blood.

This is known to cause problems in pregnancy, such as birth defects, miscarriage and the baby being overweight due to too much sugar.

There is concern that rising levels of diabetes, particularly Type 2, could make the issue worse.

Researchers analyzed data from 401,149 pregnancies between 1996 and 2008 - 1,677 women had diabetes.

The risk of birth defects went from 19 in every 1,000 births for women without pre-existing diabetes to 72 in every 1,000 births for women with diabetes.

Their report said that sugar levels in the run-up to conception were the "most important" risk factor which could be controlled.

The lead researcher, Dr Ruth Bell from Newcastle University, told the BBC: "Many of these anomalies happen in the first four to six weeks."

She said the number of pregnancies with poor sugar control were "more than we would like".

"It is a problem when the pregnancy is not intended or when people are not aware they need to talk to their doctors before pregnancy," she said.

Guidelines from the National Institute of Health and Clinical Excellence say women should reduce their levels of glycated haemoglobin (HbA1c - a marker for long-term blood sugar control) to below 6.1% before trying to have a baby.

Dr Bell said: "The good news is that, with expert help before and during pregnancy, most women with diabetes will have a healthy baby.

"The risk of problems can be reduced by taking extra care to have the best possible glucose control before becoming pregnant."

The charity Diabetes UK funded the study. Its director of research, Dr Iain Frame, said: "We need to get the message out to women with diabetes that if they are considering becoming pregnant, then they should tell their diabetes healthcare team, who will make sure they are aware of planning and what next steps they should be taking.

"It also highlights the importance of using contraception if you are a woman with diabetes who is sexually active but not planning to become pregnant."

Source: By James GallagherHealth and science reporter, BBC News

Continue Reading...

Researchers Isolate Protein Linking Exercise to Health Benefits

A team led by researchers at Dana-Farber Cancer Institute has isolated a natural hormone from muscle cells that triggers some of the key health benefits of exercise. They say the protein, which serves as a chemical messenger, is a highly promising candidate for development as a novel treatment for diabetes, obesity and perhaps other disorders, including cancer.

Bruce Spiegelman, PhD, a cell biologist at Dana-Farber, is senior author of the report, posted as an advanced online publication by the journal Nature. The first author is Pontus Bostroöm, MD, PhD, a postdoctoral fellow in the Spiegelman lab.

"It's exciting to find a natural substance connected to exercise that has such clear therapeutic potential," said Bostroöm.

Spiegelman dubbed the hormone "irisin," after Iris, a Greek messenger goddess. He said the discovery is an important first step in understanding the biological mechanisms that translate physical exercise into beneficial changes throughout the body, both in healthy people and in preventing or treating disease.

"There has been a feeling in the field that exercise 'talks to' various tissues in the body," said Spiegelman, a professor of cell biology at Harvard Medical School. "But the question has been, how?"

According to the report, the irisin hormone has direct and "powerful effects" on adipose, or fatty, tissue -- subcutaneous deposits of white fat that store excess calories and which contribute to obesity.

When irisin levels rise through exercise -- or, in this study, when irisin was injected into mice -- the hormone switches on genes that convert white fat into "good" brown fat. This is beneficial because brown fat burns off more excess calories than does exercise alone.

Only a small amount of brown fat is found in adults, but infants have more -- an evolutionary echo of how mammals keep themselves warm while hibernating. In the wake of findings by Spiegelman and others, there has been a surge of interest in the therapeutic possibilities of increasing brown fat in adults.

Along with stimulating brown fat development, irisin was shown to improve glucose tolerance, a key measure of metabolic health, in mice fed a high-fat diet.

The discovery won't allow people will be able to skip the gym and build muscles by taking irisin supplements, Spiegelman cautioned, because the hormone doesn't appear to make muscles stronger. Experiments showed that irisin levels increase as a result of repeated bouts of prolonged exercise, but not during short-term muscle activity.

The Dana-Farber team identified irisin in a search for genes and proteins regulated by a master metabolic regulator, called PGC1-alpha, that is turned on by exercise. Spiegelman's group had discovered PGC1-alpha in previous research.

Bostroöm said the hunt for molecular targets of increased PGC1-alpha activity ultimately pinpointed irisin, which turned out to be located within the outer membrane of muscle cells. This discovery ran counter to other scientists' contentions that such a protein would reside in the cell's nucleus.

To test whether increasing irisin alone could mimic exercise benefits, the scientists injected modest amounts into sedentary mice that were obese and pre-diabetic.

With 10 days of treatment, the mice had better control of blood sugar and insulin levels -- in effect, preventing the onset of diabetes -- and lost a small amount of weight. Although the weight loss was small, Spiegelman said that the hormone may have a greater effect when given for longer periods.

There were no signs of toxicity or side effects, which was predicted since the researchers limited the increase of irisin to levels typically caused by exercise.

In part because it is a natural substance and because the mouse and human forms of the protein are identical, Spiegelman said it should be possible to move an irisin-based drug rapidly into clinical testing -- perhaps within two years.

The irisin discovery has been licensed by Dana-Farber exclusively to Ember Therapeutics for drug development. Ember is a Boston-based startup co-founded by Spiegelman and scientists at the Joslin Diabetes Center and the Scripps Research Institute in Florida.

The scientists said their findings merely scratch the surface of irisin's multiple effects. They are continuing to explore the hormone's possible benefits in metabolic diseases like diabetes, insulin resistance, and obesity, which constitute a growing epidemic around the world, as well as neurodegenerative illnesses like Parkinson's disease.

Spiegelman added that as growing evidence implicates obesity and physical inactivity in cancer development, it's conceivable irisin-based drugs may have value in prevention and treatment of the disease.

Continue Reading...

Hello Cupcake Video Log–Diabetes, Depression, Bipolar and more

[youtube http://www.youtube.com/watch?v=Vx3Ok2P-yxs]

http://youtu.be/Vx3Ok2P-yxs

Continue Reading...

Diabetes and depression

Managing diabetes can seem like an overwhelming task, particularly for the newly diagnosed patient. Many diabetics struggle to cope with the requirements of the disease and the complications that it causes.

As a result, many diabetics suffer from depression.

Depression is the most common psychiatric disorder witnessed in the diabetic population.

I am worried that I might be getting depressed because of my diabetes, what would my symptoms be?

The symptoms of depression are numerous, and will be different in each individual case.

However, the following symptoms can be consistent with depression caused by diabetes.

• Persistent sadness or anxiety, a feeling of hollowness
• An overriding feeling of hopelessness and negativity
• Feeling helpless and powerless to change your situation
• Loss of interest in activities or pleasures
• Lower energy and increased fatigue
• Insomnia, oversleeping, awakening early in the morning
• Concentration problems, memory problems and indecisiveness
• Dwelling on death or suicide
• Restlessness
• Weight change and decreased or increased appetite

Each of these symptoms by themselves does not necessarily mean that depression is present. Also, if the feelings are inconsistent or only occurring rarely, this may be quite normal.

If you have these symptoms consistently, and they begin to interfere with the management of your diabetes, your relationships or your social work it could be sensible to seek an evaluation of depression.

Continue Reading...

Beloved Southern Bell Paula Deen Comes out about being Diabetic.

Many of us have come to know and love Food Networks Paula Deen, but many of us didn’t know that she had a small secret, she is Diabetic.

It was on a routine doctor’s visit for a physical exam, as she does every six months, but that day she left knowing that she was now a Type 2 Diabetic.

Paula said that she waited almost 3 years to tell anyone because she needed to be in a better place in her life and be ‘better armed’ for when people asked her about her condition. Paula Deen has suffered from acute Agoraphobia for years, and has worked hard at coming out of her shell, and did not want a media storm surrounding her announcement.
As for her savory buttery dishes, she makes no plans on changing them, just the amounts she eats taking into consideration her insulin dependency.

Today Paula Deen turns 65, Happy Birthday !!

Continue Reading...

Doctor Not Happy

Well I had to get established with my new Dr. the other day and so she wanted to run a blood panel on me to see what's going on under the hood. We had our initial talk about what I was looking for in a doctor, and what she could help with and what she had to offer.

So I get my blood drawn and the next day I get a phone call “Hello Mr. Peterson, I am calling from Dr. Hongs office and I wanted to go over the results of your blood work. Your blood sugars were really high, but I suppose you already knew that. Your Cholesterol is high, same with your triglycerides and Dr. Hong wants to start you on some medications to help with that, and she also noticed that your Thyroid levels are not where they should be. We would like to have you come back in for some additional blood work.”

Well I will have to say that I am quite interested that my Thyroid is acting up, since I have been screeching at doctors for a while now that my weight problem may be an issue with my thyroid. We shall see what this next round of testing holds.

Continue Reading...

Glucose-Induced Injury In Kidney Cells Reduced By Hydrogen Sulfide: Finding Lays Basis For Studies In Animal Models Of Diabetic Kidney Disease

Hydrogen sulfide, a gas notorious for its rotten-egg smell, may have redeeming qualities after all. It reduces high glucose-induced production of scarring proteins in kidney cells, researchers from The University of Texas Health Science Center San Antonio report in the Journal of Biological Chemistry. The paper is scheduled for print publication in early 2012.
"There is interest in gases being mediators of biological events," said B.S. Kasinath, M.D., professor of medicine and a nephrologist with UT Medicine San Antonio, the clinical practice of the School of Medicine at the UT Health Science Center. "We found that when we added sodium hydrosulfide, a substance that releases hydrogen sulfide, to kidney cells exposed to high glucose, it decreased the manufacture of matrix proteins that scar the kidney." Consistent with this finding, enzymes in the kidney that facilitate production of hydrogen sulfide were reduced in mice with type 1 or type 2 diabetes, Dr. Kasinath and his team reported.
Scarring in the kidney, called renal fibrosis, is a core defect leading to end-stage kidney disease. Nearly half of end-stage kidney disease in the U.S. is related to diabetes, which is a disease marked by poor regulation of blood glucose.
"We have found a way to decrease matrix protein synthesis, which is a problem in diabetes," Dr. Kasinath said. Because the studies are limited to cells, the finding should not be extrapolated to the treatment of human diabetic kidney disease, he emphasized.
The finding paves the way for studies in mice or other animal models. Both the safety and effectiveness of hydrogen sulfide should be established in animal models of kidney disease before human trials can be considered. This precaution is required because hydrogen sulfide, at higher concentrations, is known to be a toxic agent.

Continue Reading...

Scientists Reassess Weight Loss Surgery For Type 2 Diabetes

Weight loss surgery is not a cure for type 2 diabetes, but it can improve blood sugar control, according to a new study published in the British Journal of Surgery. Whereas some previous studies have claimed that up to 80 per cent of diabetes patients have been cured following gastric bypass surgery, researchers at Imperial College London found that only 41 per cent of patients achieve remission using more stringent criteria.
The research was funded by the National Institute for Health Research (NIHR) Biomedical Research Centre awarded to Imperial College Healthcare NHS Trust and Imperial College London.
Obesity is a major risk factor for type 2 diabetes. Worldwide, 80 per cent of people with type 2 diabetes are overweight or obese at the time of diagnosis. Diabetes is normally treated by using insulin injections and drugs to control blood sugar. However, many diabetic patients who had stomach surgery to lose weight found that their diabetes improved, even before they had lost any weight.
Recently the American Diabetes Association pulled together a group of experts to agree on standards by which to assess whether a patient has achieved remission of diabetes. They defined complete remission as returning to normal measures of glucose metabolism without taking diabetes medication at least one year after surgery.
The new study revisited previous data on 209 patients with type 2 diabetes to evaluate the effectiveness of three types of weight loss surgery using the new criteria. They found that the remission rate was 41 per cent for gastric bypass, the most effective type of surgery.
"Using the new criteria, we don't get such eye-catching figures as some that have been quoted in recent years," said Dr Carel le Roux, from the Department of Medicine at Imperial College London, who led the study. "But it's clear that weight loss surgery, particularly gastric bypass, has a significant beneficial effect on glucose control.
"Diabetes is a chronic, multisystem disease. Stomach surgery may not mean that patients can stop taking diabetes medication, but surgery and medication together achieve better results than either treatment on its own."
Gastric bypass involves stapling the stomach to create a small pouch at the top, which is then connected directly to the small intestine, bypassing most of the stomach and the duodenum (the first part of the small intestine). Sleeve gastrectomy, which involves surgically removing a portion of the stomach, and gastric banding, in which a band is placed around part of the stomach, achieved remission rates of 26 per cent and 7 per cent respectively, although these figures are based on smaller numbers of patients

Continue Reading...

Cutting carbs just 2 days a week can spur weight loss

Dieters who can’t stomach the idea of going hungry seven days a week just got good news: You might be able to drop more weight if you cut back on carbs just two days a week.

British researchers found that women who essentially gave up carbs for two days and ate normally the rest of the time dropped about 9 pounds on average, as compared to the 5 pounds lost by women who cut back to around 1,500 calories every day, according to a report presented at the CTRC-AACR San Antonio Breast Cancer Symposium.

“We came up with the idea of an intermittent low-carb diet because it enables people to still have foods that are very satiating,” said the study’s lead author Michelle Harvie, a research dietician at the Genesis Prevention Center at the University Hospital in South Manchester, England. “Also, there’s a lot of evidence from other studies showing that restricting carbohydrates has the same effect as restricting energy.”

Harvie and her colleagues were spurred to find a diet that would be easier for women to follow because research has shown that obesity and the changes it causes in the body increase the risk for breast cancer. “We know from our research in animal models that losing weight has the potential for reducing breast cancer risk,” Harvie said.

The researchers followed 88 women for four months. All the women were at high risk for breast cancer based on their family histories.

One third of the women were put on a Mediterranean-type diet that restricted calories to about 1,500 per day. A second group was told to eat normally most of the time, but two days a week to cut carbs and also calories to about 650 on those two days. The third group was also to cut carbs two days a week, but there was no calorie restriction on those days.

At the end of four weeks women in both of the intermittent dieting groups had lost more weight — about 9 pounds — than the women who ate low calorie meals every day of the week — about 5 pounds.

Women in the intermittent dieting groups also had better improvement than daily dieters in the levels of hormones — insulin and leptin — that have been linked with breast cancer risk, Harvie said.

And, yes, this is something you can try at home, Harvie said. You just need to dramatically cut back carbohydrates two days a week and try to eat sensibly the rest of the time, she added.

What that means, Harvie said, is that you can eat protein and healthy fats on the two low carb days, but skip bread, pasta, root vegetables like potatoes, carrots and parsnips to get to the 50g limit. The diet allows for one piece of fruit on the low carb days. Other foods on the menu include: nuts and green, leafy vegetables, peppers, mushrooms, tomatoes, broccoli, eggplant and cauliflower.

Continue Reading...

Adding dapagliflozin to sulfonylurea improved HbA1c in type 2 diabetes

Results of a phase 3 study presented at the International Diabetes Federation 2011 World Diabetes Congress in Dubai, United Arab Emirates, demonstrate that when added to sulfonylurea therapy, dapagliflozin reduced HbA1c at 24 weeks vs. placebo plus sulfonylurea in patients with type 2 diabetes. The reduction was maintained at 48 weeks, according to a press release.

Patients assigned to dapagliflozin (Bristol-Myers Squibb; AstraZeneca) plus glimepiride also experienced maintained reductions in fasting plasma glucose, postprandial glucose and total body weight.  

Results are from a 24-week extension trial of a 24-week, phase 3, multicenter, randomized, parallel-group, double blind, placebo-controlled study initially presented at the 46th European Association for the Study of Diabetes Annual Meeting in Stockholm, Sweden, in September 2010.

Patients with type 2 diabetes and HbA1c levels between 7% and 10% were randomly assigned to either dapagliflozin 2.5 mg (n=154), 5 mg (n=142) or 10 mg (n=151) per day or placebo (n=145) plus glimepiride 4 mg per day. At 24 weeks, the primary endpoint was mean change in HbA1c; the 24-week extension was conducted to assess the safety, efficacy and tolerability of dapagliflozin plus glimepiride during the 48-week period. The extension was completed by 519 patients.

After 48 weeks, mean improvements in HbA1c were -0.37% for the 2.5-mg arm (95% CI, -0.6 to -0.14); -0.53% for the 5-mg arm (95% CI, -0.75 to -0.3) and -0.7% for the 10-mg arm (95% CI, -0.92 to -0.47) compared with placebo. FPG, 2-hour postprandial glucose and body weight were also improved compared with placebo.

The rate of at least one adverse event was as follows: 58.4% for 2.5 mg, 60.7% for 5 mg and 58.9% for 10 mg vs. 55.5% for placebo.

Compared with placebo, hypoglycemic events were more frequent in the dapagliflozin groups (9.7% for 2.5 mg, 10.3% for 5 mg and 11.3% for 10 mg) compared with placebo (6.8%), although no patients discontinued treatment due to hypoglycemia.

According to a press release, events suggestive of genital infections were more common in patients assigned to dapagliflozin vs. placebo. Those events suggestive of urinary tract infections were similar in both groups.

Continue Reading...

Diabetics May Benefit from n-3 Fatty Acids

Use of a margarine fortified with n-3 fatty acids significantly reduced post-myocardial infarction ventricular arrhythmia-related events among diabetic patients, according to a subset analysis of data from a null study.

Compared with placebo, patients who used the margarine experienced an 84% reduction in ventricular arrhythmia-related events, Daan Kromhout, MPH, PhD, from Wageningen University in Wageningen, the Netherlands, and colleagues found.

The supplementation with n-3 fatty acids also conferred a protective effect against cardiac arrest and sudden death, according to the study published in the December issue of Diabetes Care.

The benefit in the subset of patients with diabetes softens somewhat the disappointment with overall results from the ALPHA-OMEGA trial, which Kromhout reported in 2010 at the European Society of Cardiology meeting.

The study was designed as a secondary prevention trial that tested the hypothesis that n-3 fatty acid supplementation could reduce the risk of second heart attacks in elderly males.

When Kromhout reported the results at the ESC meeting he said that after 40 months, it "had no effect on the rate of major cardiovascular events," despite the fact that there appeared to be an early benefit with the intervention.

ALPHA-OMEGA enrolled 4,837 men, ages 60 to 80, who had survived MI. The secondary analysis was limited to a subset of 1,014 patients considered high risk due to diabetes.

Nearly three-quarters of the patients were diagnosed with diabetes from the combination of elevated blood glucose levels, physician-diagnosed self-report, and drug treatment. About 14% were diagnosed with diabetes on elevated glucose levels only, 9.9% on self-report only, and 3.4% on drug treatment only.

The margarine contained eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA). They randomized patients to four groups: placebo, ALA, EPA-DHA, and EPA-DHA plus ALA.

Baseline characteristics between these four groups did not differ significantly, including factors such as use of antithrombotic drugs, blood pressure medication, lipid-lowering drugs, and antidiabetic drugs.

Researchers recorded a mean intake of margarine of 18.6 g/day and had an 86% compliance rate to the full protocol.

The median follow-up was 40.7 months, equating to 3,195 person-years of follow-up. In that time, 29 patients developed a ventricular arrhythmia-related event, two died suddenly, one had a nonfatal cardiac arrest, 11 had a fatal cardiac arrest, and 15 had a cardioverter defibrillator implanted.

After Kromhout and colleagues adjusted for age, sex, and current smoking, they found that the consumption of n-3 fatty acids significantly reduced ventricular arrhythmia-related events: 0.9% versus 5.6% for placebo, P=0.03 (HR 0.16, 95% CI 0.04 to 0.69).

The fatty acids also helped reduce other cardiovascular events. The hazard ratio for the combined endpoint of cardiac arrest and sudden death was 0.13 (95% CI 0.02 to 1.09) and for placement of a cardioverter defibrillator, it was 0.19 (95% CI 0.02 to 1.55).

The n-3 fatty acid supplementation did not make a significant difference for fatal MI, but in the adjusted model, the combination of all three fatty acids was the closest to reaching significance for this endpoint with a hazard ratio of 0.53.

The analysis was limited by its secondary design, as well as by the small number of ventricular arrhythmia events and deaths from MI, researchers said.

"These mechanistic findings support an important role for n-3 fatty acids in the etiology of diabetes, a major risk factor of fatal MI," they concluded.

Continue Reading...

Protocol Cuts Hypoglycemia During Rehab

A hypoglycemia protocol for insulin-dependent diabetic patients in a rehabilitation hospital resulted in dramatic decreases in the need for rapid response team evaluations and transfers to acute care hospitals, researchers reported here.

During 2010, there were 24 episodes of hypoglycemic adverse events, seven (29%) of which required care by the rapid response team and six (25%) that led to transfer to an acute care hospital, according to Nitika Agarwal, PharmD, and Helen Afolarin, PharmD, of Marianjoy Rehabilitation Hospital in Wheaton, Ill.

During the nine months following implementation of a protocol to be initiated whenever a patient's blood glucose dropped below 70 mg/dL, there were 26 events, four (15%) with a rapid response team code but only one (4%) resulting in acute care facility transfer, the researchers reported in a poster session at the midyear clinical meeting of the American Society of Health-System Pharmacists.

Those outcomes represented a 48% decrease in rapid response team codes and an 84% decrease in acute care hospital transfers, they explained.

When patients with preceding diabetes are admitted to a rehabilitation facility following discharge from an acute care hospital for treatment of conditions such as stroke, surgery, or traumatic brain injury, they are at risk for hypoglycemia.

"What often happens is that when patients come to our facility, their insulin dosage isn't lowered even though they are eating solid food and being more active. As they receive rehabilitation, so they need less insulin," Agarwal explained to MedPage Today. "And in that circumstance, hypoglycemia can happen rapidly."

The researchers reviewed all hypoglycemia-related events, including the need for reversal agents, "code blue" events, rapid responses by teams comprising physicians, nurses, and others, such as respiratory therapists and hospital transfers.

Common reasons for these events included inappropriate managment of both hypo- and hyperglycemia, and delays in the administration of reversal agents because of gaps in knowledge, they found.

The formal management protocol provided directions for what steps must be taken, depending on whether the patient was conscious or not. Also, if the patient's blood glucose had normalized or remained below 70 mg/dL within 15 minutes after administration of juice, food, dextrose, or glucagon. The protocol was detailed on laminated cards and distributed to all clinical staff,

The result of the change in hospital practice was a marked decrease in serious insulin-related adverse events and improved patient safety.

The costs associated with transfer to acute-care hospitals also decreased, according to the researchers.

But despite these improvements, a high number of hypoglycemic events continued to occur.

"This could have several explanations, such as the occurrence of unexpected drug interactions, particularly among patients who are on multiple medications," Agarwal said.

However, the persistence of hypoglycemic events among patients requiring insulin could also relate to an increased awareness among staff of the signs and symptoms of hypoglycemia and more accurate reporting of events, she noted.

"We need to do further research to identify other areas for improvement in avoiding these preventable events," she said.

Continue Reading...

Minute a day 'keeps diabetes away'

Less than one minute of exercise a day could prevent diabetes, researchers have claimed.

Performing short cycle sprints three times a week could be enough to prevent and possibly treat type 2 diabetes, a study suggests.

Scientists at the University of Bath asked volunteers to perform two 20-second cycle sprints on exercise bikes, three times per week.

After six weeks, researchers in the university's department of health saw a 28% improvement in their insulin function.

Type 2 diabetes occurs when blood sugar levels build up to dangerously high levels due to reduced insulin function, often caused by a sedentary lifestyle.

Regular exercise can help keep blood sugar levels low but busy lifestyles and lack of motivation mean 66% of the population are not getting the recommended five 30-minute sessions of moderate exercise a week.

Dr Niels Vollaard, who is leading the study, said: "We already knew that very intense sprint training can improve insulin sensitivity but we wanted to see if the exercise sessions could be made easier and shorter."

In the study the resistance on the exercise bikes could be rapidly increased so volunteers were able to briefly exercise at much higher intensities than they would otherwise be able to achieve. With an undemanding warm-up and cool-down, the total time of each session was only 10 minutes.

Dr Vollaard said: "This is completely new. No one has ever found a programme this easy and short to provide health benefits. At the moment it has only been done in lab conditions but it would be easy to create a bike that does this in a gym setting."

The study, published in the European Journal of Applied Physiology, is now being extended with more volunteers to determine if the exercise sessions can be made even shorter.

Continue Reading...