Depression Sufferers Live With Higher Risk of Diabetes

Depression can heighten the risk of developing type 2 diabetes as the mental illness also increases the likelihood of obesity and failing to take enough exercise, a study carried out by the German Diabetes Association (DDG) has shown, reports DPA.   Bouts of depression can also lead to higher levels of the stress hormone cortisol in the blood. Cortisol, also known as hydrocortisone, counteracts insulin and contributes to type 2 diabetes, which is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.   It is recommended that those suffering from depression undergo tests for the disease as they are 11 times more likely to suffer vascular complications than people battling diabetes alone. The risk of damage to arteries, which could lead to a heart attack, is between two and five times as high.   According to the DDG, not only are people with depression at increased risk of developing type 2 diabetes, those with diabetes are also at increased risk of developing depression.   The consequences can be serious as treatment for diabetes requires the active involvement of the patient. "Depression is a major barrier in such instances," explains Bernhard Kulzer, chairman of the DDG's psychology council.   Complications that can result from improperly managed type 2 diabetes include renal failure, blindness and arterial disease, including coronary artery disease. The DDG recommends that diabetics suffering from depression undergo psychological treatment.

Are You Diabetic? It May be Time for Insulin!

If you have type 2 diabetes and have had difficulty achieving blood sugar control, it may be time to find out if insulin is right for you.

Why Consider Insulin

Insulin is proven to lower blood sugar levels when used as part of an overall diabetes treatment plan. In fact, over 5 million people take insulin every day. 

Adding insulin replaces what your body isn't making naturally to help control blood sugar. Insulin is a hormone that is naturally produced in the body that helps convert your blood sugar (or blood glucose) into energy.

When you have diabetes your body doesn't make enough insulin and/or your body doesn't properly use the insulin it does make. As diabetes progresses it can get harder to manage your blood sugar.

Insulin should not necessarily be viewed as a sign of personal failure, or viewed as a last resort.

When diet, exercise, and oral diabetes medications alone don’t bring your blood sugar levels under control, insulin may be an effective tool to help with uncontrolled blood sugar. Do not take insulin if you are allergic to insulin or any of its ingredients. You must test your blood sugar levels when using insulin. 

Choose To Know More About Insulin & Overcome Common Fears

Many people, including you, may be afraid of insulin. However, insulin may help you achieve better blood sugar control. 

It is important to talk to your doctor about the potential benefits and realistic risks associated with insulin use. Hypoglycemia is the most common side effect of insulin therapy, which may be serious. Some fears of insulin may be based on misperceptions. Do any of these concern you?

• It's painful. Today's insulin needles are smaller and thinner than in the past. Generally injections cause little discomfort. You may be surprised by how soon you get used to injections.
• It's a sign of failure. Adding insulin does not necessarily mean that you failed with your current diabetes treatment plan. Over time, your body may have trouble producing what it needs to lower blood sugar.
• It's a "last resort." Insulin should not be seen as a "last resort." With diabetes, your doctor may change your treatment plan over time to find what works best for you. Controlling your blood sugar is what’s most important.
• It's a lifestyle change. Insulin is an effective option that you can add to your diabetes treatment plan to help you reach your daily blood sugar goals and lower your A1C. Most people find that insulin becomes a part of their routine. 
• It's forever. Insulin is not physically addictive or habit-forming. Many patients stay on insulin because they see the effect it has on lowering blood sugar.  

Talk to your doctor sooner, rather than later, if you have uncontrolled blood sugar. Together you can decide if insulin is right for you. Insulin works as part of an overall diabetes treatment plan, which includes diet, exercise and other diabetes medications, to help control blood sugar.

Remember, controlling blood sugar may help reduce the risk of developing diabetes-related complications.

Diabetes: Shortage Of Vascular Surgeons In India Costs 80,000 Limbs Every Year

India has less than 100 vascular surgeons since the establishment of the first department of vascular surgery in 1978. The states of Orissa, Madhya Pradesh, Bihar and Manipur don't have any vascular surgeon.

No government-run hospital in the country's capital New Delhi, including the premiere All India Institute of Medical Sciences, has a department of vascular surgery. Chennai and Bangalore in the southern states of Tamil Nadu and Karnataka respectively, with 20 surgeons each, are slightly better off.

Only last year, the number of seats for post-graduate degree in vascular surgery in the country was raised from four to eight in medical colleges. Including diploma holders, the country produces only 16 vascular surgeons yearly. This, experts feel, should be trebled in two years.

"A large number of people wheeled in for amputations are either trauma victims or long-term diabetics. At least 40% of people with decade-long diabetes develop vascular problems. In a country where more than 40 million people are estimated to have diabetes, the number of people estimated to have vascular problems is large. Add to this road accident victims day and you know why there is a need to produce a greater number of vascular surgeons," says Dr Sekar, who is also the president of the Vascular Society of India. Though there are no clear statistics on amputations, it is estimated that at least one lakh people lose a limb every year. Of these, nearly, 80,000 amputations are avoidable.

Sakthiraj Ekambaram, 29, a chronic smoker, complained of pain every time he walked for more than 20 minutes. "I had to stop for a couple of minutes and walk again. The doctor sent me to the gym," he said. Luckily, Sakthiraj, decided to consult a vascular surgeon for the wound that did not heal for long. "That is when I discovered that the blood supply to my legs was very low. My feet were cold unlike other parts where blood flowed and I did not have good sensation on my feet. I underwent a procedure that saved my legs," he said. But not all patients are as lucky has Sakthiraj, says Dr Sekar.

Pulling out the case sheets of a 40-year-old patient, he continues, "A chronic diabetic, this patient had one of his limbs amputated last year. This year, he had his other leg amputated too. Almost 50% of diabetics who go in for amputation of one limb, lose their second limb in another year. A vascular disease is an indicator of a heart disease because if there are blocks in the leg, there can be blocks in the heart too," says Dr Sekar.

"When people are disabled, the burden is high on the family and the government," says Dr Ravul Jindal, the only qualified vascular surgeon in Chandigarh. "Some patients who can afford the treatment are referred to doctors in other states. The others undergo amputation surgeries. These are done by general surgeons or orthopedic surgeons to prevent infection from spreading to other parts of the body," says Dr Jindal.

The society is now waging an aggressive war with the Union health ministry and at least ten state governments urging them to start new departments in vascular surgery. Vascular surgeons say they consider several options before deciding to remove a limb.

"The blood vessels in the legs and hands are just like arteries and veins in the heart. If there is a block in arteries of the heart, it can reduce supply of blood and cause heart attack, which is death of the heart muscle. When similar things happen on the leg, it leads to death of muscles in the leg. They begin to rot (gangrene). Just like the heart, we have options of using balloons to remove blocks by a procedure called angioplasty, place drug coated thin wires in the vessels to prevent clots or even do a by-pass graft," says Dr Paresh Pai, consultant vascular surgeon at Mumbai's Lilavati Hospital. "But on most occasions, patients are refered to us very late. We want to create awareness among doctors and patients on foot care. For instance, if a wound remains unhealed for long, doctors should first check if there is adequate blood supply and restore it. For this, the patient should come in early," he says.

Representatives from the association would meet Union health minister Ghulam Nabi Azad and health secretary Sujatha Rao to discuss a road map. First, they want the ministry to increase the number of seats for post-graduate degree in vascular surgery. "At present, there are only seven training centers for vascular surgery, training 12 students every year. We want them to double the number of seats in a year and increase it by at least three times by 2012," Dr Sekar said. 

Thank you Pushpa Narayan/Times of India

Diabetes Can Cause A Sugar Coating That Smothers Body's Immune Defences

Research led by the Warwick Medical School at the University of Warwick has found that unhealthy glucose levels in patients with diabetes can cause significantly more problems for the body than just the well-known symptoms of the disease such as kidney damage and circulation problems. The raised glucose can also form what can be described as a sugar coating that can effectively smother and block the mechanisms our bodies use to detect and fight bacterial and fungal infections.

In diabetes, patients suffer a higher risk of chronic bacterial and fungal infections but until now little has been known about the mechanisms involved. Now new research led by Dr Daniel Mitchell at the University of Warwick's Warwick Medical School has found a novel relationship between high glucose and the immune system in humans.

The researchers have found that specialized receptors that recognize molecules associated with bacteria and fungi become "blind" when glucose levels rise above healthy levels. The new research may also help explain why diabetic complications can also include increased risk of viral infections such as influenza, and also inflammatory conditions such as cardiovascular disease.

The researchers looked at the similarities in chemical structure between glucose in blood and body fluids, and two other sugar called mannose and fucose. These sugars are found on the surfaces of bacteria and fungi and act as targets for receptors in our body that have evolved to detect and bind to microbial sugars to then combat the infection.

The research found that high levels of glucose outcompetes the binding of mannose and fucose to the specialized immune receptors, potentially blocking these receptors from detecting infectious bacteria and fungi. Glucose also binds in such a way that it inhibits the chemical processes that would normally then follow to combat infections. If this happens it can inhibit a range of key processes including:

• It can inhibit the function of immune system receptors called C-type lectins such as MBL (Mannose-binding lectin) which are known to bind to a sugar known as mannose that is present in the structure of infectious fungal bacterial cell walls. Unlike glucose, mannose does not exist in mammals as a free sugar in the blood.
• The loss of MBL function may also predispose the body to chronic inflammatory diseases, since MBL is involved in the processing and clearance of apoptotic cells (dying cells).
• A number of C-type lectins tat can be affected by raised glucose levels, including MBL, but also including immune cell surface receptors DC-SIGN and DC-SIGNR, are found in key parts of our circulation and vascular system such as plasma, monocytes, platelets and endothelial cells that line blood vessels. Inhibiting the function of these key molecules in those settings could contribute to diabetic cardiovascular and renal complications.

Warwick Medical School researcher Dr Daniel Mitchell said: "Our findings offer a new perspective on how high glucose can potentially affect immunity and thus exert a negative impact on health. It also helps to emphasize the importance of good diet on preventing or controlling diseases such as diabetes. We will build on these ideas in order to consolidate the disease model and to investigate new routes to treatment and prevention."

Provided by University of Warwick

How Long Does it Take to Lower Your A1C Levels?

Red blood cells and the hemoglobin they contain have an average life span of 120 days during which glucose molecules are exposed to the red blood cells and form glycated hemoglobin. Therefore, in theory, changes in your A1C levels won’t be apparent for at least the 120 days it takes for the affected red blood cells to complete a life cycle.

The amount of time it takes to lower your A1C depends on how big of a change you are trying to achieve. If your A1C is in the double digits, it may take a matter of 2 or 3 months to see a significant change if your diabetes management is consistent and tight. If your A1C is a point or two away from ADA/AACE recommendations, getting to goal may take a little longer.

“Lowering your HbA1c from a [high] number to an 8.0 or 7.5 is much easier than lowering it from a 7.5 to 6.5,” said dLife Expert CDE Claire Blum in response to a question about lowering A1C levels. “Tightening of control that occurs at the lower numbers takes a lot of fine tuning. Our bodies also require some time to adapt to the change of improved [levels].”

There are no special tricks to getting your A1C to a level more acceptable to you and your doctor. Lowering your A1C is doing just what your doctor has always told you was best for good diabetes management.

Insulin Dosage Tracking Device To Make Manual Recording Of Blood Glucose Redundant

Working toward the goal of unifying patients' diabetic treatment information in a single place, the PositiveID Corporation hopes to patent a new device that monitors insulin pens.

The Insulin Tracker would attach to a user's insulin pen and record the times and amounts of injections. That information would then be sent to a database that allows for comprehensive monitoring. Insulin pens come in disposable and cartridge-replaceable flavors; the tracker can be moved easily from one pen to another.

Positive ID has already developed the iGlucose system, which will work with patients' blood glucose meters to collect their test results. The information then goes through SMS text messaging to an online database. The Insulin Tracker data will add a critical component to the data, allowing for a wide-ranging view of a diabetic's treatment regimen.

The company began working on the insulin-tracking device in the second quarter of this year. According to PositiveID chairman and CEO Scott Silverman, the goal is making it easier for diabetics to collect the broad swaths of data necessary for good control.

"Due to the cumbersome nature of manually recording blood glucose levels, insulin dosages and the appropriate dates and times for each, many patients' diabetes logs are incomplete or even nonexistent, which directly impacts patient compliance," Silverman said.

"We believe the addition of the Insulin Tracker functionality to the iGlucose system will enable us to provide a complete solution for insulin-dependent diabetics, helping them automate the time-consuming process of manually tracking insulin data and glucose levels, thereby providing more complete health records."

The company's data collection system works independently of any brand of glucose meter and does not require a computer, internet access or even a cell phone.

The company is keeping its eyes on Medicare requirements, too. According to its website, the iGlucose device "is the first of its kind to address the Medicare requirement for durable medical equipment manufacturers and pharmacies to maintain glucose level logs and records for the millions of high-frequency diabetes patients."

Thank you Clay Wirestone

What Is Prediabetes? Is It A Serious Condition?

Recently, a friend wrote saying she was "mildly diabetic". I wrote back straight away saying: "There's nothing like being 'mildly diabetic'; you're probably prediabetic..."

Anyway, that set me off on a hunt to find a precise definition of "prediabetes". I got the most reasonable answer from Michael Dansinger, MD at WebMD. This is what he has to say: 

Many folks come to the diabetes community upon being diagnosed with "prediabetes". These people are usually concerned about progressing to type 2 diabetes and want to know how to delay or prevent such progression. The diagnosis of prediabetes also typically serves as a "wake-up call" to make healthier lifestyle choices.

Interestingly, the term "prediabetes" was recently discredited by the concensus panel of diabetes experts. The experts encouraged replacing "prediabetes" with the concept of "increased risk of diabetes" which is reflected by a continuum of risk ranging from A1c levels of around 5.8 to 6.5. The experts argued that not everyone in this range progresses to diabetes and it is more accurate to see it as a risk spectrum rather than as a category unto itself.

I personally favor the old system of calling it "prediabetes" rather than "increased diabetes risk". I just like the name better. It used to be called "borderline diabetes", but that name seems so outdated to me. In any case, I urge people to see this as a strong warning that diabetes is probably coming, and lifestyle changes are the main way to slow or stop the progression.

I, too, think "prediabetes" is a much more forceful term than "increased risk of diabetes" - the former rings alarm bells, as it should, while the latter seems like a problem that can be taken care of later after more pressing issues like planning a vacation or buying a new computer are taken care of. Bad idea.

Remember, prediabetes (technically "impaired glucose tolerance") is a health condition with no symptoms. It is almost always present before a person develops the more serious type 2 diabetes. Million of people over age 20 have prediabetes with blood sugar levels that are higher than normal, but are not high enough to be classified as diabetes.

More and more, doctors are recognizing the importance of diagnosing prediabetes as treatment of the condition may prevent more serious health problems. For example, early diagnosis and treatment of prediabetes may prevent type 2 diabetes as well as associated complications such as heart and blood vessel disease and eye and kidney disease. Doctors now know that the health complications associated with type 2 diabetes often occur before the medical diagnosis of diabetes is made.

 

Who's at Risk for Developing Type 2 Diabetes?

Those at risk for type 2 diabetes include:

• People with a family history of type 2 diabetes.
• Women who had gestational diabetes or have had a baby weighing more than 9 pounds.
• Women who have polycystic ovary syndrome (PCOS).
• African Americans, Native Americans, Latinos, and Pacific Islanders, minority groups that are disproportionately affected by diabetes.
• People who are overweight or obese, especially around the abdomen (belly fat).
• People with high cholesterol, high triglycerides, low good 'HDL' cholesterol, and a high bad 'LDL' cholesterol.
• People who are inactive.
• Older people. As people age they are less able to process sugar appropriately and therefore have a greater risk of developing type 2 diabetes.

 

What Are the Symptoms of Prediabetes?

Although most people with prediabetes have no symptoms at all, symptoms of diabetes may include unusual thirst, a frequent need to urinate, blurred vision, or extreme fatigue.

A medical lab test may show some signs that suggest prediabetes may be present.

 

Who Should Be Tested for Prediabetes?

You should be tested for prediabetes if:

• You're over 45 years of age.
• You have any risk factors for diabetes.
• You're overweight with a BMI (body mass index) over 25.
• You belong to a high risk ethnic group.
• You were known to previously have an abnormal glucose tolerance test (see below) or have an impaired fasting glucose level (see below).
• You have a history of gestational diabetes or delivering a baby that weighed more than 9 pounds.
• You have clusters of problems seen in the metabolic syndrome. These problems include high cholesterol and triglycerides, high LDL cholesterol and low HDL cholesterol, central obesity, hypertension, and insulin resistance.
• You have polycystic ovary syndrome.

 

How Is Prediabetes Diagnosed?

To determine if you have prediabetes, your doctor can perform two different blood tests – the fasting plasma glucose (FPG) test and the oral glucose tolerance test (OGTT).

During the FPG blood test your blood sugar level is measured after an 8 hour fast. This laboratory health screening can determine if your body metabolizes glucose correctly. If your blood sugar level is abnormal after the fasting plasma glucose (FPG) test, you could have what's called "impaired fasting glucose," which suggests prediabetes.

 

Understanding the FPG Test Results

Condition	FPG
Normal	Less than 100 mg/dL (milligrams per deciliter)
Prediabetes	100 mg/dL - 125 mg/dL
Diabetes	Greater than 126 mg/dL on two or more tests

The other laboratory health screening test your doctor can perform is the oral glucose tolerance test (OGTT). During this test, your blood sugar is measured after a fast and then again 2 hours after drinking a beverage containing a large amount of glucose. Two hours after the glucose beverage, if your glucose is higher than normal, you have what's called "impaired glucose tolerance," which suggests prediabetes.

 

Understanding the OGTT Test Results

Condition	OGTT
Normal	Less than 140 mg/dL
Prediabetes	140 mg/dL to 199 mg/dL
Diabetes	Greater than 200 mg/dL

 

Why Is It Important to Recognize and Treat Prediabetes?

By identifying the signs of prediabetes before diabetes occurs, you can prevent type 2 diabetes altogether and lower your risk of complications associated with this condition, such as heart disease.

A large 3-year medical study in patients at risk of developing type 2 diabetes found that lifestyle changes with exercise and mild weight loss, and treatment with medications that work to sensitize a person to the actions of insulin, can decrease the chance that a person with prediabetes will get type 2 diabetes by up to 60%. 

Changing a person's lifestyle habits with increased physical activities and mild weight loss was more effective than medications at reducing the risk of developing type 2 diabetes. For some people with prediabetes, intervening early can actually return elevated blood sugar levels to the normal, healthy range.

 

What's the Treatment for Prediabetes?

To successfully treat prediabetes:

• Eat a heart healthy diet and lose weight. A 5% to 10% weight loss can make a huge difference.
• Exercise. Try to exercise 30 minutes a day, 5 days a week. The activity can be split into several short periods: 3 sessions of 10 minutes. Select an activity that you enjoy such as walking. In the study mentioned above, the total amount of exercise per week was 150 minutes.
• Stop smoking.
• Treat high blood pressure and high cholesterol. 

Diabetic Diet: Black Rice - One Of The Greatest 'Superfoods'

Black rice - revered in ancient China but overlooked in the West - could be one of the greatest "superfoods", scientists believe.

The cereal is low in sugar but packed with healthy fibre and plant compounds that combat heart disease and cancer. It was known as "forbidden rice" in ancient China because only nobles were allowed to eat it. Today black rice is mainly used in Asia for food decoration, noodles, sushi and desserts.

"Just a spoonful of black rice bran contains more health-promoting anthocyanin antioxidants than are found in a spoonful of blueberries, but with less sugar, and more fibre and vitamin E antioxidants," said Dr Zhimin Xu the food scientist who led the research.

"If berries are used to boost health, why not black rice and black rice bran? Especially, black rice bran would be a unique and economical material to increase consumption of health-promoting antioxidants."

Bran is the hard outer coating of a cereal grain. When rice is processed, millers remove the outer layers of the grains to produce brown rice or more refined white rice.

Research suggests that plant antioxidants, which mop up harmful molecules, can help protect arteries and prevent the DNA damage that leads to cancer.

Food manufacturers could potentially use black rice bran or bran extracts to make breakfast cereals, beverages, cakes, biscuits and other foods healthier, said Dr Xu, from Louisiana State University in Baton Rouge, US.

The scientists presented their findings on August 26 at the 240th National Meeting of the American Chemical Society in Boston.

Thank you John von Radowitz/The Independent

Another Link Between Diabetes and Alzheimer's Disease Established

Two of the most common and dreaded illnesses may share a connection, with new research suggesting that having insulin resistance or type 2 diabetes raises your risk of developing the brain plaques associated with Alzheimer's disease.

After adjusting for other risk factors, the Japanese study found that people with the highest levels of fasting insulin had nearly six times the odds of having plaque deposits between nerves in the brain, compared to people with the lowest levels of fasting insulin.

Those with the highest scores on a measure of insulin resistance (where cells become less able to use insulin effectively) had about five times the odds of having brain plaques vs. those with the lowest scores on the insulin-resistance test, the study found.

In fact, "the risk of plaque-type Alzheimer's disease pathology increases in a linear relationship with diabetes-related factors," according to one study author, Dr. Kensuke Sasaki, an assistant professor in the department of neuropathology at Kyushu University in Fukuoka, Japan.

Results of the study appear in the August 25 online issue of Neurology.

Both type 2 diabetes and Alzheimer's disease have been rapidly increasing in incidence, so much so that experts worry the illnesses may overwhelm the health-care system in the coming years if nothing is done.

While numerous studies have found a link between cognitive decline and dementia in people with type 2 diabetes, the current study sought to determine the reason for that link.

Using autopsies from 135 Japanese adults, the researchers were able to compare if different indicators of insulin resistance or type 2 diabetes correlated with the development of plaque deposits between the nerves in the brain (neuritic plaques) or neurofibrillary tangles, which are found in dying cells in the brain. Plaques and tangles are thought by many to be the two main causes of the destruction of brain tissue seen in Alzheimer's disease.

All of those autopsied died between 1998 and 2003. In 1988, they had undergone numerous tests as part of an ongoing study on brain and heart health. The tests included an oral 2-hour glucose tolerance test, fasting blood sugar and insulin levels, and a measurement of insulin resistance using a test called homeostasis assessment of insulin resistance (HOMA-IR).

The researchers adjusted the data to control for age, sex, blood pressure, cholesterol, body-mass index, smoking, exercise and cerebrovascular disease.

They found no association between diabetes risk factors and the development of tangles.

However, higher levels of blood sugar two hours after eating, high fasting insulin levels and an elevated HOMA-IR score were associated with an increased risk of developing plaques. Fasting blood sugar levels were not associated with an increased risk of plaques, according to the study.

When the researchers compared varying levels of diabetes risk factors, such as fasting insulin, they found a linear association with the development of plaques. For example, fasting insulin was broken into three groups: low, medium and high.

The low group didn't have an increased risk of plaques, while the medium group had more than twice the risk of brain plaques, and those in the high group had a six times higher risk of plaques than those in the low group.

The researchers also performed a separate analysis to see if the presence of a gene long implicated in Alzheimer's disease (ApoE4) would have an effect on the association between diabetes risk factors and the development of plaques. It did: Those with the ApoE4 gene has the strongest association between high blood sugar levels, insulin resistance and fasting insulin levels and the development of plaques.

"Research has been linking diabetes to dementia, and probably to Alzheimer's, and this study is one more bit of evidence to say that we'd better get a handle on this," said Dr. Richard Bergenstal, president of medicine and science for the American Diabetes Association.

Bergenstal said this study's findings are likely applicable to people with both type 2 and type 1 diabetes, and possibly to those with pre-diabetes, as well.

"This study fits into a body of literature looking at the relationship between diabetes and Alzheimer's disease. This area is being pretty aggressively researched for a number of reasons. Would better control of type 2 diabetes improve the cognitive fate of those with the disease, and is there some way we can intervene in glucose metabolism that might affect Alzheimer's?" said William Thies, chief medical and scientific officer for the Alzheimer's Association.

"If you have diabetes, it's certainly a good idea to keep it under control while we're sorting out the research," Bergenstal said.

"Although we don't know anything that can prevent Alzheimer's disease right now, I do think there are a lot of good reasons for people to try to prevent type 2 diabetes, much of which can potentially be avoided with regular physical activity and weight maintenance," said Thies. "Preventing or controlling diabetes is good for all kinds of reasons, and also because it might contribute to your risk of Alzheimer's disease."

Thank you Serena Gordon/HealthDay

Insulin Users Have 50% Higher Cancer Risk?

Diabetics who take insulin have a higher risk of developing cancer, according to Danish researchers who say they can’t explain the link.

Patients on insulin were 50 percent more likely to get cancer compared with the general population, researchers led by Bendix Carstensen from the Steno Diabetes Center in Gentofte, Denmark, wrote in an abstract of the study posted on the website of the European Association for the Study of Diabetes. The findings will be presented next month in Stockholm at the EASD’s annual conference.

People with diabetes already have a higher risk of cancer, the researchers said, and the tumor development seen in this study may not be caused by insulin itself, according to Carstensen, senior statistician at the center. It may be the result of contributing causes common to cancer, diabetes and insulin use, such as obesity, he wrote in the abstract. The study, conducted on the Danish population, is the largest of diabetes and cancer incidence so far, Carstensen said.

“People who are on insulin have a higher risk of developing cancer,” Carstensen said in a telephone interview today. “But what the reason for that is, it’s not clear from this study nor from any other study.”

In order to follow diabetes patients and see how many of them developed cancer, researchers created links between the Danish National Diabetes Register and the Danish Cancer Register. They compared their findings with data on tumor occurrence among people not suffering from diabetes, according to the abstract. They observed a total of 30,000 cancer cases among diabetics, including tumors of the digestive tract, liver and pancreas.

Sanofi’s Lantus

Diabetes causes blood-sugar levels to be higher than normal. Insulin, a hormone made in the pancreas, helps convert blood sugar into energy. Diabetics either don’t produce enough insulin naturally or their bodies have trouble using it properly. Glucose-lowering therapies such as Sanofi-Aventis SA’s Lantus, the first once-a-day form of insulin, have become standard care for people who can’t control their blood sugar levels with healthy eating or exercise.

This is not the first time that researchers have sought to shed light on the possible link between insulin use and higher cancer risk.

Last year, Ralph DeFronzo, a researcher at the University of Texas Health Science Center, said on a conference call that studies would show Lantus was tied to cancer. Shares in Paris- based Sanofi slumped after that call. The research, published in the journal Diabetologia, delivered mixed results, and the US Food and Drug Administration said it didn’t prove a link.

Tumor Risk

Another study, based on 1,500 patients and published in June in the journal Diabetes Care, also tied insulin glargine, the chemical name for Lantus, to a higher tumor risk.

France’s biggest drugmaker remains confident on the safety of Lantus, Sanofi Chief Medical Officer Jean-Pierre Lehner said in a June 18 interview. The study in Diabetes Care is “unclear” and “lacks precision,” Lehner said during the interview. It can be “methodologically challenged,” Sanofi said at the time.

The Danish study will be presented on Sept. 23 in Stockholm, according to the EASD’s website. 

Thank you Albertina Torsoli/Bloomberg

Light May Replace Lancets For Testing Blood Sugar

Checking sugar levels without pricking yourself

A quick and painless way to measure blood sugar is highly sought-after by diabetes sufferers, who currently have to prick their fingers to draw blood several times a day. Now, researchers in the US may have found a solution – a device that works by simply shining a light on skin.

The vision is to create a laptop-sized device that could be kept at home or carried around. Rather than having to pierce the skin to obtain blood samples, the device measures sugar levels by simply placing a scanner against the skin. Because measurement is fast and easy, it is hoped that the device may encourage people with diabetes to check their blood sugar more often, giving them better control over their condition.

At the heart of the device is a Raman spectrometer (named after CV Raman, the Indian Nobel Laureate physicist), which can identify chemical compounds by measuring how near-infrared laser light scatters on contact with molecules. The idea of using Raman spectroscopy to measure sugar levels in blood was first suggested 15 years ago by Michael Feld at the Massachusetts Institute of Technology (MIT). Although Feld sadly passed away in April this year, his team is now starting to realize his vision.

 

Keeping Up With The Sugar Rush

The problem until now has been that near-infrared light can only penetrate a short distance into the skin. The technique therefore detects glucose in the fluid surrounding skin cells (the interstitial fluid), rather than in the bloodstream. This is a problem because blood glucose levels can change rapidly, such as after eating, while there is a time lag of 5–10 minutes before the sugar changes can be seen in the interstitial fluid.

The MIT team has now resolved the problem by developing an algorithm to relate blood glucose to interstitial glucose levels. "We’ve incorporated a mass-transfer model into the overall Raman spectroscopic algorithm, which allows us to seamlessly transform between blood and interstitial fluid glucose," explains Ishan Barman, lead author of the research.

Using an early version of the device, the team tested the blood-sugar levels of some human volunteers and found that the accuracy and precision of the test was just as good as conventional finger-prick tests. In addition, the new algorithm allows the test to predict impending episodes of high or low blood sugar (hyperglycemia and hypoglycemia) by extrapolating the rate of change of sugar concentration.

 

Downsizing

The next challenge is to strip down the Raman system and build a miniaturized device that would be suitable for home use. A prototype has been made and is already scheduled for clinical testing, but reducing the complexity of the system and shrinking down bulky components could take a while.

"We are in a proof-of-concept stage in terms of device development – and we envision a laptop-sized or hand-held unit that could cost as little as $200," he told physicsworld.com. "It is difficult to predict due to market variations and FDA regulations, but one could anticipate an optical device for glucose monitoring in the next 5–7 years."

Randall Jean, an expert in remote sensing at Baylor University in Texas, US, is impressed by the work. "This research addresses a real problem and appears to provide an important means for improving the calibration of non-invasive sensors," he says. "It may also be helpful in the development of a so-called 'artificial pancreas' – where insulin can be dispensed automatically in response to sugar levels."

Thank you Lewis Brindley/Physics World

Diabetes: What Really Ails China

China’s struggle with diabetes has reached epidemic proportions. This is the conclusion of a group of researchers from Tulane University, whose findings were recently published in the New England Journal ofMedicine, one of the United States’ most prestigious medical journals. 

According to the study, 92.4 million adults in China age 20 or older (almost 10% of the population) have diabetes, and 148.2 million adults have pre-diabetes, a condition that is a key risk factor for developing overt diabetes and/or cardiovascular disease. Of particular significance is the finding that the majority of cases of diabetes are undiagnosed and untreated.

These new figures indicate that China has edged ahead of India to become the country with the largest population of diabetics in the world. 

Most cases of diabetes are from so-called type 2 diabetes, a form of the disease that accounts for 90-95% of all diabetes cases among adults. It results from insulin resistance and is sometimes combined with an absolute insulin deficiency.

The diabetes epidemic is not only a serious public health problem — it can also have serious economic repercussions. A study found that estimated medical costs for diabetes and its complications were 18.2% of China’s total health expenditures in 2007. The World Health Organization (WHO) estimates that diabetes, heart disease and stroke will cost China approximately $558 billion between 2006 and 2015.

Until just over a decade ago, diabetes was relatively rare in China. However, in the last decade the problem has become much more severe. Experts believe that China’s rapid economic development — and the increased urbanization, physical inactivity, unhealthy diet and obesity that often accompany increased prosperity — is an important contributing factor in the development of the disease. 

Environmental toxins may also contribute to recent increases in the rate of type 2 diabetes. This is the opinion of some experts, who found a positive correlation between the concentration in the urine of bisphenol A, a constituent of some plastics, and the incidence of type 2 diabetes.

Obesity has been found to contribute approximately 55% to an individual’s development of type 2 diabetes. A study on the importance of lifestyle factors showed that those who had high levels of physical activity, a healthy diet, did not smoke and consumed alcohol only in moderation had an 82% lower rate of diabetes. When a normal weight was included, the rate was 89% lower.

The increased rate of childhood obesity between 1960 and 2000 is believed to have led to the increase of type 2 diabetes in children and adolescents. There were more than 60 million obese people in China, and another 200 million who were overweight, according to a 2004 nationwide survey.

In the United States, type 2 diabetes affects approximately 8% of adults. That proportion increases to 18.3% among Americans age 60 and older, according to statistics from the American Diabetes Association. In comparison, the worldwide prevalence of diabetes among all age groups was estimated to be 2.8% in 2000, and will rise to 4.4% in 2030.

Diabetes and its consequences have become a major public health problem not only in China, but in many industrialized countries as well. To avoid further damage to people’s health, it is imperative to develop and institute national strategies for preventing, detecting and treating diabetes in the general population.

Thank you Cesar Chelala/The Globalist

Study To Check If Garlic And Asparagus Can Fight Diabetes

Researchers are investigating whether foods including garlic and asparagus could help weight loss and diabetes. In news that could make ardent vegans and vegetarians feel a little smug, the charity Diabetes UK is examining whether foods rich in fibre could supress people's appetites and reduce their blood sugar levels.

Fermentable carbohydrates, a kind of fibre, are found in foods such as asparagus, garlic, chicory and Jerusalem artichokes. If the foods are found to have this effect it could revolutionise treatments to tackle obesity and type 2 diabetes. Recent research has suggested that foods high in fermentable carbohydrates are particularly good at stabilising blood sugar levels.

The three-year study by the Nutrition and Research Group at Imperial College London, aims to establish whether these carbohydrates cause the release of gut hormones that could reduce appetite and enhance insulin sensitivity, which could reduce blood sugar levels and help control weight. The carbohydrates will be given to participants in the study as a daily supplement.

Dietitian Nicola Guess, who is leading the study, said: "By investigating how appetite and blood glucose levels are regulated in people at high risk of type 2 diabetes, it is hoped that we can find a way to prevent its onset. Type 2 diabetes accounts for 90% of diabetes cases and, if left untreated, can lead to serious health complications including heart disease, stroke, blindness, kidney failure and amputation, according to Diabetes UK.

Dr Iain Frame, the charity's director of research, said: "It is unlikely that any single measure used on its own will bring about improved prevention of type 2 diabetes. But it's hoped that the research being funded at Imperial College will help by aiming to develop an easy and affordable way to help people to reduce their risk of developing type 2 diabetes and managing their blood glucose levels."

Thank you David Batty/Guardian

Diabetes: eAG (estimated Average Glucose) Explained

I have been getting queries on my post Blood Sugar Management: Estimated Average Glucose. I am reproducing a FAQ from the American Diabetes Association that should help clear the air. 

Basically, reporting glucose control as Estimated Average Glucose or eAG will assist health care providers and their patients in being able to better interpret the A1C value in units similar to what patients see regularly through their self-monitoring. So, the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) will be working together to conduct educational efforts to make both patients and providers aware of this new terminology, and help to understand the relationship between A1C and eAG.

This Q&A describes a new term for describing diabetes control, “estimated average glucose”, eAG.  eAG correlates directly to A1C, which has been the standard measure of diabetes control for many years.

What is A1C?

The A1C (pronounced A-one-C) test, also known as glycated hemoglobin or HbA1c, measures average blood glucose control for approximately the 3 months.  The results can help health care providers – and their patients – know if the diabetes treatment plan is working or if adjustments to treatment are needed.

A1C is measured by a simple blood test performed in a laboratory.  The American Diabetes Association recommends that most people with diabetes have their A1C level checked at least twice a year.

The American Diabetes Association recommends that people with diabetes strive for an A1C goal of less than 7%.  An A1C for a person without diabetes is approximately 4-6%.  

Why is understanding average blood glucose control important in the management of diabetes?

In 1993, when the landmark Diabetes Control and Complications Trial (DCCT) was completed, the importance of A1C as an indicator of risks for the complications of diabetes, such as blindness, kidney disease and nerve damage was firmly established.

The DCCT demonstrated that keeping A1C closer to normal reduces the risk for diabetes-related complications.  As A1C increases, so does the risk of complications.

In 1994, the American Diabetes Association began recommending specific A1C treatment goals based on the results of the DCCT.  From that time on, the goal for most people with diabetes has been less than 7%.

 

What is the difference between A1C and the blood glucose measure obtained through daily self-monitoring?

A1C results, which tend to be measured at least 2 times a year as part of a visit with the doctor, measure average blood glucose control over the past 2 to 3 months.  Results from the A1C test are reported in percentage points (i.e., A1C of 7%).

When people with diabetes test their blood glucose through daily self-monitoring, those results are reported in different units – mg/dl (i.e., 170 mg/dl).  They represent the level of glucose in the blood at that moment in time, but do not give any indication of what the level is at other times of day.

Why is daily self-monitoring of blood glucose so important?

Although the A1C test is an important tool, it can't replace daily self-monitoring of blood glucose (SMBG).  A1C tests don't measure a person’s day-to-day control. People with diabetes can't adjust their insulin on the basis of their A1C tests. That's why blood glucose checks and log results are so important to staying in good control.

The A1C test alone is not enough to measure good blood glucose control.  But it is a good resource to use along with your daily blood glucose checks, to work for the best possible control.

What is the A1C-Derived Average Glucose (ADAG) Study and why was it conducted?

The A1C-Derived Average Glucose (ADAG) Study is an international study sponsored by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF).  It was conducted in response to the introduction of a new worldwide method of standardization of the A1C assay that would result in values that are 1.5-2 percentage points lower than current standards.  It was felt that this change would cause considerable confusion for patients and health care providers. 

The objective of the ADAG Study was to define the mathematical relationship between A1C and estimated average glucose (eAG) and determine if A1C could be reliably reported as eAG, which would be in the same units as daily self-monitoring.

How was the ADAG Study conducted? 

Five hundred seven people, including 268 patients with type 1 diabetes, 159 with type 2 diabetes, and 80 people without diabetes were recruited from 10 international centers.

A1C was measured using a combination of continuous glucose monitoring and frequent finger stick glucose measurements similar to the way in which people with diabetes check their diabetes control at home by self-monitoring of blood glucose (SMBG).

By comparing the measurement of A1C with the average glucose levels, study investigators were able to derive an equation so that A1C levels can be interpreted accurately as an average glucose level or eAG. (As reported in this blog earlier, the formula is: 28.7xA1C-46.7 = eAG )

What is estimated Average Glucose (eAG) and why is this measure important?

The ADAG Study establishes what has long been assumed but never demonstrated… that A1C does represent average glucose over time.  With that relationship demonstrated and defined, health care providers can now report A1C results to patients in the same units that they are using for self-monitoring (i.e., mg/dl) which should benefit clinical care.

See chart below for a comparison of A1C (%) and average glucose levels (mg/dl)

Comparison of A1C and eAG levels
A1C %	eAG (mg/dl)	eAG (mmol/l)
6%	126	7.0
6.5%	140	7.8
7%	154	8.6
7.5%	169	9.4
8%	183	10.1
8.5%	197	10.9
9%	212	11.8
9.5%	226	12.6
10%	240	13.4

Why is the chart in ADA’s  Standards of Care showing a correlation between A1C and mean glucose levels slightly different from the correlation published with the ADAG results (as above)

The chart published in the ADA’s Standards of Care is based on a study that analyzed data collected during the DCCT, which included quarterly A1C tests and 7-point glucose measurements in 1,400 type 1 diabetes patients.

The International A1C-Derived Average Glucose (ADAG) Study involved people with type 1 and type 2 diabetes as well as people without diabetes, and took advantage of the development of continuous glucose monitors, as well as patients making traditional glucose checks, to generate a much larger pool of data.

Both studies showed a linear relationship between A1C and average glucose; the ADAG study presents a more refined and accurate formula describing that relationship, and the ADA’s Standards of Care will adopt the new correlation. The formula describing the relationship is: 28.7 times A1C minus 46.7 = eAG.

How will this new terminology, eAG, help health care providers and their patients?

Reporting glucose control as ‘average glucose’ will assist health care providers and their patients in being able to better interpret the A1C value in units similar to what patients see regularly through their self-monitoring.

Part of the logic for choosing the term “eAG” is that the medical community recently adopted another new term, eGFR, for estimated glomerular filtration rate, which was introduced as an easier to understand measure of kidney function than the established method of measuring creatinine levels to assess kidney function.  The hope is that the growing acceptance of eGFR will help spur the adoption of the similar eAG.

The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) will be working together to conduct educational efforts to make both patients and providers aware of this new terminology, and help to understand the relationship between A1C and eAG.

Many patients who practice SMBG already see an “average glucose” on their blood glucose meters.  Is eAG the same thing?

No, an eAG value is unlikely to match the average glucose level shown on a person’s meter.  Because people with diabetes are more likely to test more often when their blood glucose levels are low---first thing in the morning, and before meals---the average of the readings on their meter is likely to be lower than their eAG, which represents an average of their glucose levels 24 hours a day, including post-meal periods of higher blood glucose when people are less likely to test.

One advantage of using eAG as a measure of glucose control is that it will help patients more directly see the difference between their individual meter readings and how they are doing with their glucose management overall.

What are the plans to work with laboratories and manufacturers to incorporate average glucose values in their reports?

The American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), and International Diabetes Federation (IDF) will be working with labs to encourage them to incorporate AG values in their reports to physicians.      

Source: American Diabetes Association

New Study Finds New Connection Between Yoga and Mood

Researchers from Boston University School of Medicine (BUSM) have found that yoga may be superior to other forms of exercise in its positive effect on mood and anxiety. The findings, which currently appear on-line at Journal of Alternative and Complementary Medicine, is the first to demonstrate an association between yoga postures, increased GABA levels and decreased anxiety.

The researchers set out to contrast the brain gamma-aminobutyric (GABA) levels of yoga subjects with those of participants who spent time walking. Low GABA levels are associated with depression and other widespread anxiety disorders.

The researchers followed two randomized groups of healthy individuals over a 12-week long period. One group practiced yoga three times a week for one hour, while the remaining subjects walked for the same period of time. Using magnetic resonance spectroscopic (MRS) imaging, the participants' brains were scanned before the study began. At week 12, the researchers compared the GABA levels of both groups before and after their final 60-minute session.

Each subject was also asked to assess his or her psychological state at several points throughout the study, and those who practiced yoga reported a more significant decrease in anxiety and greater improvements in mood than those who walked. "Over time, positive changes in these reports were associated with climbing GABA levels," said lead author Chris Streeter, MD, an associate professor of psychiatry and neurology at BUSM.

According to Streeter, this promising research warrants further study of the relationship between yoga and mood, and suggests that the practice of yoga be considered as a potential therapy for certain mental disorders.

Controlling a Fat-Regulating Protein Dramatically Increases Insulin Sensitivity

PPARy is a protein that regulates the body's production of fat cells. However, obesity can modify how PPARy works, leading to decreased insulin sensitivity and the development of metabolic syndrome. (Metabolic syndrome is the cluster of factors, including insulin resistance, overweight, high blood pressure, and abnormal blood sugar levels, that is a precursor to type 2 diabetes.)

But now a joint team of researchers from The Scripps Research Institute in San Diego and the Dana-Farber Cancer Institute at Harvard University in Cambridge has found a way to control the adverse changes in PPARy brought on by obesity.

One of those changes is phosphorylation, when an enzyme called cdk5 kinase adds a phosphate group to PPARy. That addition causes PPARy to alter the expression of several genes, including one that regulates production of adiponectin, a protein essential to insulin sensitivity. 

The challenge for the scientists was to find a way to change PPARy back to its normal state without inducing it to overproduce fat cells. They knew from a previous study that an agonist, a compound that makes cells respond in certain ways, interacted with the region of PPARy known to regulate fat generation. The agonist in that case was a full agonist, meaning that it was able to easily combine with a receptor in that region of PPARy and activate it to do a certain thing-in this case, not generate fat cells.

The researchers wondered if partial agonists-chemical agents that have only partial effects on certain cell receptors-could be used to counteract the insulin-suppressing effects of phosphorylation on PPARy without the side effect of ramping up fat cell production.

They found that while partial agonists did not interact with the PPARy receptor that governs fat cell production, one, called MRL24, worked  extremely well in the exact region of PPARy where phosphorylation takes place. By altering and diminishing that region's receptiveness to  phosphorylation, MRL24 allowed PPARy to increase the production of adiponectin.

Those findings, which open the door to learning how to fully manipulate PPARy, could lead to drugs that reduce the risk of developing type 2 diabetes and cardiovascular problems. If PPARy can be prevented in obese people from losing its ability to direct the production of adiponectin, it could become a significant therapy in treating the effects of extreme overweight.

Thank you Patrick Totty