US Drugmaker Abbot Labs Recalls 359m Blood Sugar Testing Strips

US drug maker Abbott Laboratories on Wednesday announced a recall of up to 359 million diabetes testing strips due to safety hazards.

The recall was initiated because the strips used by diabetics could give false low readings, the company said in a statement.

Abbott uncovered the problem after a routine internal review found that certain lots of the strips took too long to absorb the blood from a patient's finger, which could lead to inaccurate low readings of their blood sugar levels, the statement said.

The affected products should not be used and would be replaced at no cost, said the statement.

Meanwhile, the Food and Drug Administration (FDA) issued a warning that inaccurately low measurements by the strips may lead patients to raise their blood sugar levels unnecessarily or fail to detect dangerously high blood sugar levels.

The recalled strips were made between January and May and sold both to consumers and healthcare facilities, the FDA said.

"FDA and Abbott are reviewing the cause of the manufacturing defect to avoid this problem in the future," said Alberto Gutierrez, head of FDA's Office of In Vitro Diagnostics.

The lots of affected products were only distributed in the U.S. and Puerto Rico, according to Greg Miley, director of public affairs for Abbott Diabetes Care.

The products were marketed under a half-dozen brand names, including Precision Xceed Pro., Precision Xtra, Medisense Optium, Optium, OptiumEZ and ReliOn Ultima, the Abbott statement said.

Fatty Acid Tied to Lower Diabetes and Dyslipidemia Risk

Higher levels of circulating trans-palmitoleate, which may result from consumption of whole-fat dairy products, appear to be associated with lower insulin resistance, dyslipidemia, and incident diabetes, according to a study in the Dec. 21 issue of the Annals of Internal Medicine.

Watching your diet? If so, whole milk, butter, and cheese probably aren't regulars on your shopping list.

Should they be?

Scientists at Harvard School of Public Health have identified a fatty acid in whole dairy foods that is linked to a lower risk of type 2 diabetes. The compound, trans-palmitoleic acid, is a chemical cousin of cis-palmitoleic acid, a diabetes-blocking acid produced naturally in the liver.

In the study of data from 3,736 men and women, those with the highest levels of trans-palmitoleic acid in the blood were found to have a significantly lower risk of developing diabetes, as measured by blood glucose levels and other risk factors.

Lead researcher Dr. Dariush Mozaffarian, associate professor of epidemiology at the school, wonders if trans-palmitoleic acid may make up for the work that used to be performed by the cis-palmitoleic acid.

The study was published in the Dec. 21, 2010 edition of the Annals of Internal Medicine.

"Our working hypothesis, based on several observations," says Mozaffarian, "is that with modern diets being so high in carbohydrates and calories, the body's synthesis of cis-palmitoleic acid might be limited."

In other words, we might be eating so much that we are keeping cis-palmitoleic acid from doing its job.

"Trans-palmitoleic acid may be stepping in as a 'pinch hitter' for at least some of the functions of cis-palmitoleic acid," says Mozaffarian.

"I don't think there's enough evidence to show that we should start drinking whole milk," Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, told Health Day. "We need to understand the mechanism behind this association. Dietary changes in this country tend to be to extremes, but this study should not be used to make changes in the diet; it's just an observation right now."

Mozaffarian says he hopes his work will encourage more research, and that one day trans-palmitoleic acid could be used as a supplement.

So don't buy out the dairy section just yet. 

Courtesy: CBS News

Diabetes: Stress Hormone's Surprise Powers

A hormone that can wreak havoc with the body by setting off harmful effects of stress may have a far more positive use: in a new way to treat diabetes.

The hormone, known as corticotropin-releasing factor, or CRF, has been implicated in anxiety, obesity, addiction and even Alzheimer's disease. The brain and other organs make CRF. It triggers a cascade of chemicals that ultimately produce cortisol and adrenaline and activate the body's "fight or flight" response. Under chronic stress, cortisol breaks down muscle, suppresses the immune system and raises the risk of high blood pressure.

But recently, researchers have showed that CRF increases both insulin secretion and production of the cells that make insulin in the pancreas, known as beta cells. Diabetes, which affects nearly 24 million Americans, involves the body's inability to properly use insulin to convert sugar into usable energy. The findings, which support a hunch that others in the field have had, point to a possible pathway for treatment of diabetes.

"The machinery that allows the cell to respond to the hormone has been found," says Wylie Vale, a professor of molecular neurobiology at the La Jolla, Calif., Salk Institute for Biological Studies, who discovered the structure of CRF in 1981. "We are exploring how this machinery is controlled under conditions such as diabetes and obesity. What we really want to do is understand the system." The research of Dr. Vale and his colleagues was reported in a December paper published in the Proceedings of the National Academy of Sciences.

With Type 1 diabetes, formerly known as juvenile diabetes, the body doesn't produce enough insulin. This happens because the immune system attacks and kills beta cells. These patients are treated with insulin injections.

The most common form of diabetes, associated with obesity, is Type 2. Here, the body doesn't produce enough insulin and the cells from insulin-responsive tissues like muscle are unable to efficiently use the insulin that is produced. The beta cells go into overdrive to try to produce insulin but become overworked and ultimately stop functioning, according to Patricia Kilian, head of the beta-cell-regeneration program at the Juvenile Diabetes Research Foundation, which partially funded the study.

Most Type 2 treatments have focused on drugs to overcome the resistance to insulin in tissues or to promote insulin output by the beta cells. But there's been a recent focus on finding ways to keep beta cells alive in the body and restoring the ability to grow new ones, Dr. Kilian says. That could help prevent or delay long-term complications of diabetes, like kidney failure and nerve damage, she says.

An early clue to CRF's role in insulin production came when Dr. Vale and a group of colleagues identified a group of hormones called urocortins about 10 years ago and later found that one of them stimulated insulin production in the pancreas. Some urocortins bind at the same receptor sites on the surface of cells that CRF does.

Recently, Dr. Vale and Mark Huising, a post-doctoral researcher, along with Nils Billestrup, a colleague at the University of Denmark, decided to see whether CRF itself might have a similar effect on beta cells. Stimulating mouse and later human beta cells with CRF, the researchers found that it not only increased insulin release but also promoted growth of the beta cells.

The next step: to learn whether CRF could stimulate insulin production in mice. This presented new challenges. Exposing the mice to CRF would trigger the production of cortisol, usually part of the stress response, which in turn boosts bloodstream sugar and so sets off the release of insulin. This response would make it difficult to figure out whether CRF or cortisol was responsible for the insulin release.

To avoid that problem, Dr. Huising inactivated the cortisol response in the mice. He then administered CRF to the pancreas of the mice and showed that it was the reason for the increased insulin production. This finding "helps us better understand how blood-sugar control works in healthy individuals and in diseases such as diabetes and obesity," says Dr. Huising.

Researchers don't know yet how to use CRF to stimulate insulin in humans without initiating the chain of stress-related events that CRF usually triggers, as well as associated effects such as increased blood pressure. And, for Type 1 diabetes, CRF would not stop the body's immune system from attacking the beta cells in the first place.

At the same time, researchers are investigating the benefits from blocking CRF. Its suppression reduces anxiety in animals, and several major drug companies are working to turn that into treatments for anxiety and depression. CRF blockers are also being developed for irritable bowel syndrome, since research has shown that stimulation of CRF receptors in the colon leads to diarrhea and pain. Also, CRF receptors in the skin might be targets for treating conditions like psoriasis, and in the bladder for overactive bladder, according to Eric Zorrilla, associate professor at the Scripps Research Institute, who studies CRF, stress and addiction.

Limiting Salt Lowers Blood Pressure and Health Risks in Diabetes

For patients living with diabetes, reducing the amount of salt in their daily diet is key to warding off serious threats to their health, a new review of studies finds.

In the Cochrane review, the authors evaluated 13 studies with 254 adults who had either type 1 or type 2 diabetes. For an average duration of one week, participants were restricted to large reduction in their daily salt intake to see how the change would affect their blood pressure.

“We were surprised to find so few studies of modest, practical salt reduction in diabetes where patients are at high cardiovascular risk and stand much to gain from interventions that reduce blood pressure,” said lead reviewer Rebecca Suckling. “However, despite this, there was a consistent reduction in blood pressure when salt intake was reduced.”

Suckling is part of the Blood Pressure Unit at St. George’s Hospital Medical School, in London.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Patients with diabetes need to be extra cautious to maintain their blood pressure at an acceptable range of less than 130/80 mmHg. However, in the 2003-2004 period, 75 percent of adults with diabetes had blood pressure greater than or equal to 130/80 mmHg or used prescription hypertension medications, according to the American Diabetes Association (ADA).

High salt intake is a major cause for increased blood pressure and, in those with diabetes, elevated blood pressure can lead to more serious health problems, including stroke, heart attack and diabetic kidney disease. The ADA also reports that diabetic kidney disease is the leading cause of chronic kidney disease, accounting for 44 percent of new cases in 2005.

In the Cochrane review, the participants’ average salt intake was restricted by 11.9 grams a day for those with type 1 diabetes and by 7.3 grams a day for those with type 2.

The reviewers wrote that reducing salt intake by 8.5 grams a day could lower patients’ blood pressure by 7/3 mmHg. This was true for patients with both type 1 and type 2 diabetes. The reviewers noted that this reduction in blood pressure is similar to that found from taking blood pressure medication.

Suckling acknowledged that studies in the review only lasted for a week and that the type of salt restriction probably would not be manageable for longer periods.

“The majority of studies were small and only of a short duration with large changes in salt intake,” she said. “These studies are easy to perform and give information on the short-term effects of salt reduction.”

However, Suckling said, the review also found that in studies greater than two weeks, where salt was reduced by a more achievable and sustainable amount of 4.5 grams a day, blood pressure was reduced by 6/4 mmHg.

Diabetes specialist Todd Brown, M.D., of the Division of Endocrinology and Metabolism at Johns Hopkins University, said that practicing low-salt diets of these types is quite challenging for most patients with diabetes even though they know the health risks.

“The effects of salt on blood pressure are well known to health professionals and most patients, but what is less well known is where the salt comes from in our diet,” Brown said.

“The overwhelming majority comes from the processed foods that we eat,” he said. “If we are going to realize the benefits of sodium reduction on blood pressure and other health outcomes, we should focus less on the salt shaker and more on what we buy in the supermarket and at chain restaurants.”

Thank you Health Behavior News Service

Diabetes May Clamp Down On Cholesterol The Brain Needs

The brain contains more cholesterol than any other organ in the body, has to produce its own cholesterol and won’t function normally if it doesn’t churn out enough. Defects in cholesterol metabolism have been linked with Alzheimer’s disease and other neurodegenerative conditions. Now researchers at Joslin Diabetes Center have discovered that diabetes can affect how much cholesterol the brain can make.


Scientists in the laboratory of C. Ronald Kahn, M.D., head of Joslin’s Integrative Physiology and Metabolism research section, found that brain cholesterol synthesis, the only source of cholesterol for the brain, drops in several mouse models of diabetes. Their work was reported online in the journal Cell Metabolism on November 30.


“Since cholesterol is required by neurons to form synapses (connections) with other cells, this decrease in cholesterol could affect how nerves function for appetite regulation, behavior, memory and even pain and motor activity,” says Dr. Kahn, who is also Mary K. Iacocca Professor of Medicine at Harvard Medical School. “Thus, this has broad implications for people with diabetes.” Other investigations have gathered strong evidence that people with diabetes may display varying types of alterations in brain function or ways of responding to stress, he points out.


“It is well known that insulin and diabetes play an important role in regulating cholesterol synthesis in the liver, where most of the cholesterol circulating in blood comes from,” Dr. Kahn adds. “But nobody had ever suspected that insulin and diabetes would play an important role in cholesterol synthesis in the brain.”


In addition to its potential role in Alzheimer’s disease and other forms of neurological dysfunction, the newly discovered mechanism may play a role in diabetic neuropathy, which remains a large challenge for therapy.


People with diabetes are also known to be more prone to depression, memory loss and eating disorders than people without diabetes, and imaging studies have shown that people with diabetes have altered brain function compared to those without.


Additionally, the finding raises a question about potential interactions between anti-cholesterol drugs and diabetes.


In the Joslin study, scientists first examined gene expression in the hypothalamus of a mouse model of insulin-deficient (type 1) diabetes. They found decreased expression for almost all of the genes of cholesterol synthesis, including a gene called SREBP-2, which acts as a master regulator for cholesterol production. Similar findings were present in the cerebral cortex and other regions of the brain in these animals and also found in several other mouse models of diabetes. In the insulin-deficient animals, this phenomenon was associated with decreased cholesterol synthesis. Treatment of the mice with insulin, either by normal injection or injection into the fluid surrounding the brain, reversed the process.


“Our studies showed that these effects occurred in both the neurons and supporting ‘glial’ cells that help provide some nutrients to the neurons,” says Kahn. “Ultimately this affects the amount of cholesterol that can get into the membranes of the neuron, which form the synapses and the synaptic vesicles — the small structures that contain neurotransmitters.”


Additionally, the Joslin work showed a connection between the decrease in brain cholesterol synthesis and appetite. When the scientists took normal mice and temporarily reduced cholesterol creation in the hypothalamus with a technique known as RNA interference, the animals started eating more and gained significant weight. Previous studies by other labs have demonstrated that diabetes may affect brain hormones involved in appetite regulation.

Ryo Suzuki, Ph.D., a postdoctoral researcher in the Kahn lab, is first author on the paper. Other Joslin contributors include Kevin Lee and Enxuan Jing. Other co-authors include Sudha B. Biddinger of Children’s Hospital Boston, Jeffrey G. McDonald of the University of Texas Southwestern Medical Center, and Thomas J. Montine and Suzanne Craft of the University of Washington in Seattle. The work was supported by the National Institutes for Health, the Iacocca Foundation and the Manpei Suzuki Diabetes Foundation.

Diabetes Treatment: How Much Insulin Do You Need?

If you have type 2 diabetes and your doctor thinks it might be a good time to start insulin therapy, there are two important factors to consider: How much insulin do you need to take? When do you need to take it? 

And both are very personal.

"You can't paint everyone with type 2 diabetes with the same brush," says Mark Feinglos, M.D., division chief of endocrinology, metabolism,\ and nutrition at the Duke University School of Medicine, in Durham, N.C. "You need to tailor the regimen to an individual's needs."

A person with type 2 diabetes might start off on half a unit of insulin per kilogram of body weight per day, especially if there is not much known about the nature of his or her diabetes. Still, it is not unusual to need more like one unit, says Dr. Feinglos. (One unit per kilogram would be 68 units per day for someone who weighs 150 pounds, which is about 68 kilograms.)

A lot depends on your specific health situation. People with type 2 diabetes suffer from insulin resistance, a situation in which the body loses its ability to use the hormone properly. Early in the course of the disease, the insulin-producing cells of the pancreas respond to insulin resistance by churning out even more of the hormone. Overtime, though, insulin production declines.

Taking insulin can help you overcome the body's insulin resistance, though many factors can affect your dosage. If your body is still sensitive to insulin but the pancreas is no longer making much insulin, for example, Dr. Feinglos says that you would require less insulin than someone who is really resistant to insulin.

"But the most important issue is not necessarily how much you need to take," he adds. "Rather, it's the timing of what you to take. Timing is everything."

One Shot A Day Or More?

If you wake up with high blood sugar in the morning, it's very likely that you will need at least a once-a-day injection combined with oral drugs, says Dr. Feinglos. Oral medication can lower your insulin resistance, and a long-acting, once-a-day insulin shot (usually taken at bedtime) can mimic the low level of insulin made by the pancreas. (And the shots may not be how you picture them -- painful and complicated. You can use pen-like injectors that have short, thin needles and that allow you to dial the amount of insulin you require, rather than draw it up from a vial using a syringe.)

If your blood sugar tends to spike after meals despite using medication and watching what you eat, you may have to take a dose of rapid-action insulin before every meal.

"There's controversy over how much better you can really do with additional shots," says John Buse, M.D., Ph.D., director of the Diabetes Care Center at the University of North Carolina School of Medicine, in Chapel Hill. "I don't see much improvement in overall glucose control in many patients with the rapid-acting insulin taken at meals. And it does promote weight gain and low blood sugar. Is the burden worth the benefit?"

Either way, a once-a-day long-acting formulation is usually the best way to start, according to Dr. Buse. A standard initial dose might be 10 units. The dosage is then increased until blood sugar levels are lowered into the normal range.

"If a person still has substantial insulin secretion left in their pancreas, one shot a day is probably more than enough to top it off," agrees Robert Rizza, M.D., professor of medicine and executive dean of research at the Mayo Clinic, in Rochester, Minn. "But if you're really running out of insulin and can't store it between meals, then you may need to take both the long and short-acting injections."

Taking Insulin With Meals

If you do end up taking insulin at meals, the doctors agree that it is particularly important to match food intake with insulin, while also accounting for physical activity. (Exercise naturally lowers blood sugar, so if you're working out, you may need to take that into account.)

"Some people recommend matching insulin to carbohydrate counts," says Dr. Buse. "Others suggest eating a set serving of carbohydrates at each meal for a particular dose of insulin."

Even more crucial, according to Dr. Feinglos, is moderating food intake before insulin is ever initiated. "If you're not controlling the calories first, and just start giving insulin," he warns, "then all a patient is going to do is gain weight and get more insulin resistant and end up needing larger doses of insulin."

It Can Be A Vicious Cycle

"The relationship between food and exercise with medicine is so critical in diabetes," he adds. "If you just keep pouring medicine into the problem, it doesn't really solve it."

Nevertheless, a patient may do everything right -- eat well, work out and routinely take his or her medicine -- but still require more insulin over time due to the progressive nature of the disease. Adjustments can come through higher doses, increased frequency of injections, or both.

On a positive note, with improved diet and exercise, some patients are actually able to reduce their intake, even to the point of discontinuing insulin injections altogether.

"There are multiple ways to get to the same point," says Dr. Rizza. "The bottom line is to keep blood sugar normal."

Nestlé India Plans Collaboration To Help Manage Diabetes

Nestlé India has signed a memorandum of understanding with the National Diabetes, Obesity and Cholesterol Foundation (N-DOC) to develop nutrition initiatives aimed at helping to manage diabetes.The collaboration - which focuses on increasing consumers’ awareness and knowledge of their diets - will see Nestlé work with N-DOC to understand the impact of local diets and changing lifestyles on the increasing incidence of the disease in India.

Gary Tickle, Regional Business Head of Nestlé Nutrition, South Asia, said: “The Nestlé Nutrition Institute promotes science for better nutrition and N- DOC conducts culturally specific, basic and applied research in the areas of diabetes, obesity, and cholesterol disorders with the help of physicians and scientists. We see this as the beginning of a strong partnership.”

To kick off the announcement last week, a conference was organised by the Nestlé Nutrition Institute and N-DOC on ‘Nutrition Empowerment for Prevention and Management of Diabetes’ in Delhi. The conference was chaired by Professor Anoop Misra, Chairman of N-DOC, and Director and Head of the Department of Diabetes and Metabolic Diseases at the Fortis Group of Hospitals. Research presented suggested that lifestyle measures, physical exercise and good nutrition can all play a major role in managing, and in some cases even helping to prevent the disease.

Clinical nutrition with scientifically-formulated diets can help to provide balanced nutrition to people with diabetes while also delaying its possible long-term complications.

In many countries, including India, Nestlé HealthCare Nutrition already offers a range of nutritional solutions designed to help diabetic patients more effectively manage their disease and minimise its common side effects. Managing diabetes means keeping blood glucose levels in the target range, controlling blood lipids, managing weight as per guidelines and monitoring blood pressure to reduce the risk of complications.

Products formulated to assist in the dietary management of diabetes include Resource Diabetic, a complete, high-fibre diet with a flexible caloric density for oral supplementation or enteral feeding of patients with hyperglycaemia; Novasource Diabet, a complete balanced nutritional formula; and Boost Glucose Control, formulated with a unique balance of protein, fat and slow-digesting carbohydrates.

Nestlé has been using its expertise in science-based nutrition and food technology to develop products with a ‘health plus’ for everyday consumption ever since the company was established more than 140 years ago.

Retirement Reduces Fatigue, Depression

Retirement leaves people much less mentally and physically fatigued and to a smaller degree less depressed, reports UPI quoting Swedish researchers.

However, Dr. Hugo Westerlund of Stockholm University in Sweden also finds retirement does not change the risk of chronic illnesses such as respiratory disease, diabetes and heart disease.

Westerlund and colleagues say the study of 11,246 men and 2,858 women in France who were surveyed annually from 1989 to 2007 -- seven years prior to retirement and seven years after retirement. Seventy-two percent retired between the ages of 53 and 57, but all retired by the age of 64.

In the year before retirement, 25 percent suffered from depressive symptoms and 7 percent were diagnosed with one or more of respiratory disease, diabetes, heart disease or stroke.

"If work is tiring for many older workers, the decrease in fatigue could simply reflect removal of the source of the problem ... furthermore, retirement may allow people more time to engage in stimulating and restorative activities, such as physical exercise," Westerlund and colleagues say in a statement.

The research results "indicate that fatigue may be an underlying reason for early exit from the labor market and decreased productivity, and redesign of work, healthcare interventions or both may enable a larger proportion of older people to work in full health."

The findings are published in the British Medical Journal.

3G Wireless Technology Delivers Diabetes Health Care In Innovative Project

An innovative use of wireless technology will help underserved communities improve diabetes care and prevention in Tijuana. Using 3G mobile technologies, the Dulce Wireless Tijuana project helps patients in remote areas both monitor and treat their diabetic condition.

In less than four decades, diabetes has become the U.S.-Mexico border’s most prominent public health problem, affecting over 1.2 million inhabitants. A bi-national and multi-sector alliance thus chose to focus on diabetes care with 3G wireless applications and services. The resultant effort is a pilot project.  Participants will determine if this approach might work as a regional model.

The Dulce Wireless Tijuana system, announced by Qualcomm Incorporated earlier this month, combines mobile applications, web applications, mobile phones, netbooks, laptops, diabetes educational content and health care worker and patient training. Service delivery is available to diabetes patients and their caregivers wirelessly through Qualcomm’s 3G technology network.

Dulce Wireless Tijuana patients now will have access to the system and technology, including primary care diabetes services and disease management programs. The project stands as an example of how wireless technology can improve patient care for marginalized communities — not just in Mexico, but throughout the world.

Delivery of health care through wireless technology assists providers and patients in a variety of ways. It allows promotores (health care workers) the real-time ability to locate and receive confidential access to patient information, to manage patient appointments and to review training curriculum. Patients benefit because they can review diabetes information —such as instructional videos— online, participate in interactive surveys that help their providers learn how they are managing their diabetes and receive notifications from an alert system.

“This project is a significant step forward in increasing patient access to proper diabetes care in Tijuana,” said Dr. Paul E. Jacobs, chairman and chief executive officer of Qualcomm.

“The use of mobile technology has the potential to improve health outcomes, bring down costs and provide more people with access to care.”

An equally significant aspect of the project is the cooperation it engendered among a variety of public, private and nonprofit organizations across two nations. The diverse groups collaborated to empower diabetic patients to take control of their health.

The project operates from IMSS Clinic #27, the largest IMSS (Social Security) clinic in Mexico. But the project’s impact could extend far beyond the bounds of the Mexican border. Should it prove successful, this approach to the public health problem of diabetes could “scientifically prove the positive impact of this innovative solution on the public health problem of diabetes in order to provide this alternative as an effective model of care for all of Mexico and the world,” according to Pablo Contreras Rodriguez, IMSS regional delegate for Baja California.

Bringing health care to marginalized areas entails specific challenges, according to Marcela Merino, director general of Fronteras Unidas PRO SALUD, a nonprofit organization serving Tijuana communities.

“One of the greatest issues that these communities face is that —because of distance, public transportation challenges and lack of time— it is extremely difficult to visit doctors and nurses. With this project, patients are now connected to their health care providers, including promotoras, wirelessly via their mobile devices, which will enable them to obtain care they could not receive in the past and help them to live healthier lives.”

The Scripps Whittier Diabetes Institute of San Diego provided background and expertise in training and developing peer educators to deliver a clear and understandable message for diabetes patients. They train peer educators south of the border helping Mexicans implement programs similar to Project Dulce activities in San Diego.

“Diabetes is exceedingly prevalent along the border region so it makes perfect sense for us, if we are going to treat the disease, to treat it in similar ways across both sides of the border,” explained Dr. Athena Philis-Tsimikas, vice president of the SWDI.

The organizations collaborating with Wireless Reach to provide technical assistance, program management, evaluation, in kind and monetary support are:

• the International Community Foundation (ICF) and its sister organization, the Fundación Internacional de la Comunidad

• Iusacell

• the Social Security Institute of Mexico (IMSS)

• the Medical School at the Autonomous University of Baja California (UABC)

• the Scripps Whittier Institute (SWDI)

• Fronteras Unidas PRO SALUD

Thank you Billie Greenwood

Diabetes, Depression Can Be Two-Way Street

Diabetes and depression are conditions that can fuel each other, a new study shows.

The research, conducted at Harvard University, found that study subjects who were depressed had a much higher risk of developing diabetes, and those with diabetes had a significantly higher risk of depression, compared to healthy study participants.

"This study indicates that these two conditions can influence each other and thus become a vicious cycle," said study co-author Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health in Boston. "Thus, primary prevention of diabetes is important for prevention of depression, and vice versa."

In the United States, about 10 percent of the population has diabetes and 6.7 percent of people over the age of 18 experience clinical depression every year, according to the researchers.

Symptoms of clinical depression include anxiety, feelings of hopelessness or guilt, sleeping or eating too much or too little, and loss of interest in life, people and activities.

Diabetes is characterized by high blood sugar and an inability to produce insulin. Symptoms include frequent urination, unusual thirst, blurred vision and numbness in the hands or feet.

About 95 percent of diabetes diagnoses are type 2, and often are precipitated by obesity.

The researchers found that the two can go hand in hand.

The study followed 55,000 female nurses for 10 years, gathering the data through questionnaires. Among the more than 7,400 nurses who became depressed, there was a 17 percent greater risk of developing diabetes. Those who were taking antidepressant medicines were at a 25 percent increased risk.

On the other hand, the more than 2,800 participants who developed diabetes were 29 percent more likely to become depressed, with those taking medications having an even higher risk that increased as treatment became more aggressive.

Tony Z. Tang, adjunct professor in the department of psychology at Northwestern University, said that participants who were taking medications for their conditions fared worse because their illnesses were more severe.

"None of these treatments are cures, unlike antibiotics for infections. So, depressed patients on antidepressants and diabetic patients on insulin still frequently suffer from their main symptoms," said Tang. "These patients fare worse in the long run because they were much worse than the other patients to start with."

Tang cautioned against drawing too many conclusions from the study. He noted that the correlations between diabetes and depression declined markedly when excessive weight and inactivity were controlled for in the study.

"This suggests that much of the observed correlation between depression and diabetes comes from confounding variables," he said. "In layman's terms, being fat and having an unhealthy lifestyle makes people more likely to be depressed, and [also] more likely to have diabetes."

But if research establishes a strong connection between the two illnesses it could advance treatment, Tang added.

"If a substantial causal connection is established between the two disorders, it would be rather novel and it could potentially change how we understand and treat both disorders," Tang said.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said establishing causal relationships is difficult in a study based on questionnaires because self-reports can be inaccurate.

"This is not ideal," he said. "It's difficult to say what is causing what, if one is causing the other. This is very difficult to elucidate."

A large, controlled, randomized study is needed, said Zonszein, who is also a professor of clinical medicine at Albert Einstein College of Medicine, in New York City.

But he praised the research, noting that tracking such as large number of subjects "over a long period of time" strengthened the findings.

Hu, also a professor of medicine at Harvard University, said the study conclusions were valid. When two conditions share the same risk factors (obesity and lack of exercise), "we can still say that the conditions are linked and one is both the cause and consequence of the other condition," he explained.

Depression can affect blood sugar levels and insulin metabolism through increased cortisol, contributing to unhealthy eating habits, weight gain and diabetes, he said.

"On the other hand, management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression," said Hu. The two "are linked not only behaviorally, but biologically."

Thank you Ellin Hollohan/HealthDay

'Poverty A Leading Cause of Type 2 Diabetes'

For years, we have heard that obesity, a lack of physical activity and a family history are the top risk factors for developing Type 2 diabetes.


But new Canadian research says that, in fact, it is living in poverty that can double or even triple the likelihood of developing the disease.


"What we know about Type 2 diabetes is not only are low-income and poor people more likely to get it, but they're also the ones that, once they get it, are much more likely to suffer complications," Prof. Dennis Raphael, one of the researchers, told CTV.ca in a telephone interview.


"And the complications from Type 2 diabetes when they're bad are really bad, whether it's amputations, or blindness, or cardiovascular disease."


Researchers from York University analyzed two sets of data: the Canadian Community Health Survey (CCHS) and the National Population Health Survey (NPHS) for a study published in the journal Health Policy.


The first set of data showed that for men, being in the lowest-income category (earning less than $15,000 per year), doubles the risk of developing Type 2 diabetes compared to being in one of the highest-income brackets (earning more than $80,000 per year). The risk remains the same when other risk factors are taken into account, such as education, body mass index and physical activity levels.


The findings are even more striking for women in the lowest-income category. For them, the risk of developing type 2 diabetes is more than triple the risk of women in the highest-income category. When education, body mass index and physical activity levels are taken into account, the risk is still well more than double.


Results from the NPHS analysis are just as striking. Researchers found that living in poverty in the two years prior to diagnosis increased the risk of developing Type 2 diabetes by 24 per cent, a risk not changed when factoring in weight or physical activity. Living in poverty at any time increased the risk by 26 per cent.


Generally speaking, subjects who lived more often in poverty during the 12-year study period had a 41 per cent greater chance of developing the disease. When obesity and physical activity levels were taken into account, the risk remained very high, at 36 per cent.


The studies are consistent with other findings that link living conditions -- what they call the social determinants of health – with Type 2 diabetes, as well as other ailments.


Raphael, a professor of health policy and management at York, said conventional wisdom about Type 2 diabetes would suggest that once obesity, lack of physical activity and other lifestyle risk factors were taken into account, diabetes incidence rates would even out between lower- and higher-income groups.


While weight, a sedentary lifestyle and other health problems are still key risk factors, the findings suggest that health-care workers who specialize in diabetes should be paying closer attention to the socio-economic conditions that can lead to them.


"When you're in a situation where 15 per cent of kids and their families are living in poverty, and people are worried from day-to-day about their jobs and homelessness, and immigrants are not being provided with what they need to be healthy, and the evidence that suggests these are all things that contribute to the onset of Type 2 diabetes, there has to be more of a balance in how we understand the causes of illness," Raphael said.


But what is it exactly about living in poverty that contributes to type 2 diabetes?


The studies point to living conditions that put low-income adults and children at risk for myriad diseases, not just diabetes. First of all, there is the chronic stress of low-income living that can adversely affect health. The strain of being short on money and living in inadequate housing, or not having any housing at all, can spike levels of cortisol, a hormone released when the body is under stress. While cortisol helps the body deal with stress, constantly elevated levels can cause a wide range of negative side effects, such as highblood sugar levels or high blood pressure.


Residents of lower-income neighbourhoods also often find it difficult to access fresh, healthy foods and programs that promote physical activity, both of which are key to managing stress, controlling weight and, therefore, preventing disease.


Raphael also points to previous research, which suggests adverse circumstances in early childhood, from low birth weight to deprivation as a youngster, raise a child's risk of developing a number of conditions, from respiratory and cardiovascular diseases to diabetes.


Indeed, a report released this week from The Children's Hospital of Philadelphia found that children who have ever lived in poverty have significantly poorer health outcomes than children who have never experienced poverty, ranging from developmental delays and psychological problems to higher rates of asthma and more frequent hospitalizations.


"So we're basically talking about systematic stress over time, lack of control that eventually leads to higher cortisol levels, among other things. Cortisol and other stuff literally messes up the ability of the body to use the insulin that's available. And it's not well understood," Raphael said.


Poor more likely to suffer complications
For another part of their study, the researchers interviewed 60 diabetes patients who reside in low-income Toronto neighbourhoods. What they learned is that the very conditions that contribute to diabetes also make it extremely difficult to manage the disease, meaning low-income patients are suffering from some of the most debilitating side effects.


Raphael and his team found that insufficient income, inadequate or insecure housing and food insecurity were key barriers to managing the disease. According to their interviews, 72 per cent of patients said they lacked the financial resources to follow the kind of diet needed to keep their diabetes in check.


Many said they had to choose between paying rent or feeding their children and managing their disease.


Michelle Westin, a community health worker with the diabetes education program of the Black Creek Community Health Centre, which services a low-income northwest Toronto neighbourhood, says she sees a number of barriers among her clients to successfully managing their diabetes.


Westin cites language as a barrier of particular concern for recent immigrants, who end up having trouble navigating the health-care system, understanding information or directions from their doctors, and communicating their needs.


Other barriers include:

• High costs of medical equipment, such as blood-sugar test strips. If patients don't have private health insurance, they are paying for many of these supplies out-of-pocket.
• Lack of access to healthy foods, and free and safe physical activity programs.
• Stress and isolation, especially for lower-income seniors, which causes blood-sugar levels to spike.

Westin said experts need to advocate for more affordable food, better access to medications and supplies, and more community services to assist lower-income people prevent and treat diabetes.


Raphael said his team's findings show that tackling broader issues of poverty -- lack of employment or under employment, housing, food security and health coverage -- are key to managing diabetes, and other ailments.


"The primary thing is basically for the government, with other sectors of society, to manage the economy in the service of all," he said.


Thank you Andrea Janus/CTV.ca News

The Diabetes and Cancer Link

Researchers have found several connections between diabetes and cancer.

 

Although that may come as frightening news, some of the evidence may come as a surprise: some types of cancer rates are higher while rates of other types are lower in people with diabetes, a common medicine for type 2 may prevent cancer, and a cancer drug may help prevent type 1 diabetes.

 

Research Findings

A recent large-scale study following over 125,000 people with type 2 diabetes lead by Dr. Kari Hemminki of the German Cancer Research Center, found an increased risk for 24 types of cancer. The most significant rates were for pancreatic and liver cell cancers (elevated by factor 6 and more than 4 times the risk respectively compared to the general population). Since pancreatic cancer and diabetes both involve the pancreas, evidence remains unclear on whether diabetes causes or results from the cancer. Risk for cancers of the kidneys, thyroid, esophagus, small intestine, and nervous system were more than twice the rates of those without diabetes.

 

Other studies have found the following:

1.    Meta-analyses from 15 studies and 2.5 million people with diabetes resulted in a 30 percent more likelihood of developing colorectal cancer. Women with type 2 over the age of 55 had double the risk.

 

2.    Women with diabetes had a 20 percent greater risk of developing breast cancer. People with breast cancer treated with chemotherapy and metformin have better outcomes.

 

3.    Metformin use is associated with an anti-cancer effect as those who take it have substantially lower cancer rates (62 percent lower risk of pancreatic cancer and up to 37 percent reduced risk for all cancers). Notably, research has also shown that people with diabetes already diagnosed with cancer may respond better to chemotherapy when treated simultaneously with metformin.

 

4.    Those who take both Actos or Avandia and metformin have a 35 percent reduction in cancer mortality.

 

5.    Further research is needed to better understand the risks and mechanisms that appear to link insulin with tumor growth. This finding may have more to do with insulin resistance rather than a direct effect of insulin itself.

 

6.    Men with type 2 diabetes have a significantly lower rate of prostate cancer (may be related to lower levels of testosterone).

 

7.    The combined effect of smoking, excessive drinking, poor diet, and physical inactivity significantly raises premature death from all causes, including cardiovascular disease and cancer. Cumulative survival, adjusted for subject age at baseline and sex, was 96 percent for those who had none of the poor health behaviors measured, compared with 85 percent for those who had all four poor health behaviors.

 

8.    Rituxamab, a drug that treats lymphoma and rheumatoid arthritis, may soon be used to help stop the destruction of pancreatic beta cells in newly diagnosed cases of type 1 diabetes. A one-time dose of Rituxamab temporarily slows or stops the destruction of the 10 or 20 percent of beta cells that type 1s typically have remaining when they are first diagnosed. Further studies are needed to assess the impact of ongoing treatments.

 

9.    Childhood cancer survivors have double the risk of getting diabetes based on the type of treatment received (anticancer radiation therapy may damage the pancreas). Ongoing endocrine follow-up is important for these children.

 

Dr. Ulf Smith summarized these findings in a sobering statement, "One point has become abundantly clear … cancer must now be numbered amongst the complications of diabetes."

 

What You Can Do

Take this in stride. Keep in mind that self-care behaviors such as healthy eating, being active, and controlling weight either decrease or increase the risk for cancer and diabetes depending how consistent you are with them.

 

Until we have national guidelines on how best to incorporate this research into our standards of practice, advocate for yourself. Ask your provider about getting screened for cancer, get regular mammograms, colonoscopies, prostate exams, and the like.

 

Conclusion

Evidence remains unclear as to why people with diabetes have higher rates of cancer. As research continues to unfold, it is important to stay informed in order to maintain awareness, minimize risk with healthy living, discuss screening tests with your provider, and get help early on if something doesn't feel right in your body. Ongoing efforts to maintain glucose control remain paramount.

 

 

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.