Monthly Archives: January 2011

Diabetes May Be Caused By Depression

While it is common knowledge that having a chronic disease increases chances of depression in patients, here is evidence that indicates depression could also be a factor in causing chronic diseases such as diabetes.

A paper published in Diabetes Technology and Therapeutics, 2010, from Chennai showed higher levels of depression among those newly detected with diabetes and those with impaired glucose tolerance, as against those who had normal blood sugar levels.

Authored by S. Poongothai of Madras Diabetes Research Foundation, based in Chennai in south India, as part of a series of articles she worked on for her Ph.D, the paper is significant in that the tests were done in the community and the depression noted before blood sugar tests were done.

Co-author V. Mohan, who heads Dr. Mohan’s Diabetes Specialities Centre, says, “What this article flags off is the idea that depression itself may be a likely cause of diabetes.”

The subjects for the study were recruited from the Chennai Urban Rural Epidemiological Study. Of the total of over 23,000 persons tested, there were 1218 people with newly- detected Diabetes (NDD), 7,657 with impaired fasting glucose (IFG); and 14, 912 with normal fasting glucose (NFG).

While the overall prevalence of depression was 14.3 per cent, an increasing prevalence was seen with increasing grades of glucose tolerance: NFG (13.1 per cent), IFG (15.7 per cent) and NDD (19.7 per cent), being higher among women at all grades.

Depression can increase the risk of diabetes due to increased levels of counter-regulatory hormones, which can lead to obesity, insulin resistance and glucose intolerance, Dr. Poonothai says in the paper. “The lesson in this is that not only should we treat diabetics for depression, but that by treating depression, the person may actually be able to side-step diabetes,” Dr. Mohan explains.

His recommendation is also that everyone with depression must be screened for diabetes as well.


Diabetics Who Suffer No Complications To Be Studied

What the current research provides is an admission that the fundamental mechanisms that create the environment for the development of diabetes complications are still very much unknown.

When one is diagnosed with diabetes, the patient is prepared to prevent and avoid the complications from the disease. There have been so many studies and research on diabetes complications. Now, researchers are looking at the problem from a different perspective since they have found diabetics who do not develop complications.

Now the question is, why don’t these diabetics develop complications? A new research is now being conducted to find out. This is called the PROLONG study and is focused on the nearly fifteen percent of all diabetics that live life complications free. The study is headed by Valeriya Lyssenko and Peter Nilsson from Lund University Diabetes Center.

What the current research provides is an admission that the fundamental mechanisms that create the environment for the development of diabetes complications are still very much unknown.

One aspect of the disease though that is very well documented is the damage that the disease wreaks on an individual’s blood vessels. Diabetes does not kill the individual but the complications often do. Among the top of the list of complications is cardiovascular disease, as diabetics have three times of the risk compared to non-diabetics. Smaller blood vessels are damaged. Nearly seventy percent of patients would have suffered from kidney damage leading to end stage renal failure. Many others suffer from eye complications with nearly two percent of these diabetics going blind eventually.

“The blood vessels and other organs of the body become sugar coated and stiff. It is reminiscent of premature biological ageing”, says Peter Nilsson.

The pilot study is being conducted in Skåne, Sweden and is projected to study diabetes patients for the next thirty years. They would be comparing complication developments in patients in specific timelines and observe those that do not develop complications during the whole duration.

Participants would be answering inquiries about their lifestyle and how the disease affects them. Also part of the study would be genetic testing, blood sampling and history reviews. The researchers believe that thirty years would be the turning point for a diabetic since the absence of complications beforehand would not develop complications during the remainder of their lives.

“If we can identify factors protecting these individuals from devastating complications, then it might be possible to develop drugs that can do the same thing,” said Valeriya Lyssenko, who will lead the study. “Clearly they are different and we want to find out what it is that protects them.”


Root Cause of Blood Vessel Damage in Diabetics Discovered

Researchers at Washington University School of Medicine in St. Louis have identified a key mechanism that appears to contribute to blood vessel damage in people with diabetes.

The researchers said studies in mice show that the damage appears to involve two enzymes, fatty acid synthase (FAS) and nitric oxide synthase (NOS), that interact in the cells that line blood vessel walls.

“We already knew that in diabetes there’s a defect in the endothelial cells that line the blood vessels,” said first author Xiaochao Wei.

“People with diabetes also have depressed levels of fatty acid synthase. But this is the first time we’ve been able to link those observations together.”

Wei studied mice that had been genetically engineered to make FAS in all of their tissues except the endothelial cells that line blood vessels. These so-called FASTie mice experienced problems in the vessels that were similar to those seen in animals with diabetes.

“It turns out that there are strong parallels between the complete absence of FAS and the deficiencies in FAS induced by lack of insulin and by insulin resistance,” Clay F. Semenkovich, the Herbert S. Gasser Professor of Medicine, professor of cell biology and physiology and chief of the Division of Endocrinology, Metabolism and Lipid Research said.

Comparing FASTie mice to normal animals, as well as to mice with diabetes, Wei and Semenkovich determined that mice without FAS, and with low levels of FAS, could not make the substance that anchors nitric oxide synthase to the endothelial cells in blood vessels.

“We’ve known for many years that to have an effect, NOS has to be anchored to the wall of the vessel,” Semenkovich said.

“Xiaochao discovered that fatty acid synthase preferentially makes a lipid that attaches to NOS, allowing it to hook to the cell membrane and to produce normal, healthy blood vessels.”

In the FASTie mice, blood vessels were leaky, and in cases when the vessel was injured, the mice were unable to generate new blood vessel growth.

The actual mechanism involved in binding NOS to the endothelial cells is called palmitoylation. Without FAS, the genetically engineered mice lose NOS palmitoylation and are unable to modify NOS so that it will interact with the endothelial cell membrane. That results in blood vessel problems.

It’s a long way, however, from a mouse to a person, so the researchers next looked at human endothelial cells, and they found that a similar mechanism was at work.

“Our findings strongly suggest that if we can use a drug or another enzyme to promote fatty acid synthase activity, specifically in blood vessels, it might be helpful to patients with diabetes,” Wei said.

The study has been published in the Journal of Biological Chemistry. (ANI)

Diabetes Affects Patients’ Well-Being and Also Impacts Spouses

Older patients with diabetes who are not dealing well with the disease are likely to have symptoms of depression, and spouses of older patients also suffer distress related to diabetes and its management, according to research from Purdue University.

“Responsibilities and anxieties can differ for patients with diabetes and their spouses, but each may experience stress, frustration and sadness at times related to the demands of living with this disease,” said Melissa M. Franks, an assistant professor of child development and family studies. “We know spouses often support their partners, but in our work we want to know what form their involvement takes and how the disease and its management affect both the patient and spouse.”

Franks and her team found that the distress spouses feel is similar to what patients feel, and this could contribute to their own depressive symptoms such as irritability or sadness. These depressive symptoms come from their own anxieties about living with the disease or caring for someone with the disease and not necessarily because the other person is struggling.

Researchers also found that when male patients were concerned about the management of their diabetes, their depressive symptoms were elevated more than those for female patients with similar levels of concerns.

“This gender difference is consistent with prior work showing that male patients who are not managing their disease well tend to experience greater depressive symptoms,” Franks said. “And while we saw this difference between male and female patients, we did not see the same pattern of distress between their respective spouses. This is surprising, because one might assume that the spouse would be as worried, or, according to family roles, that wives might worry more. However, more research, especially long-term observations, is needed.”

The findings, based on statistical models with 185 couples older than 50, appeared in the December issue of the Family Relations journal. The patients and spouses completed individual surveys that measured distress related to diabetes, such as adherence to treatment recommendations, as well as depressive symptoms. The gender effects were measured by comparing the couples’ responses. There were 67 female patients and 118 male patients, and each couple was screened to make sure only one person had diabetes.

“Because spouses’ distress is not always directly linked to feelings of their partner, it tells us that we need to pay more attention to the spouse as well as the patient,” she said. “Understanding the triggers for depressive symptoms can help practitioners and experts better care for patients and spouses as individuals and as a unit.

“We also found that many people reported some depressive symptoms, and some reported levels indicative of risk for clinical depression. It’s important to consider depressive symptoms because they may signal concerns and problems that could be alleviated with treatment.”

Diabetes affects about one in five Americans over the age of 60, and the majority of those people have Type 2 diabetes, which is a disease of the endocrine system. Type 2 diabetes, also referred to as adult-onset diabetes, is caused by insufficient secretion of insulin and resistance to insulin, which is problematic because it lessens the ability of cells to absorb glucose from the bloodstream. The incidence of the disease, which is considered a leading cause of death, is increasing as more people are overweight and sedentary.

The disease is managed daily through diet, exercise and medications. Complications, such as poor blood circulation, vision impairment, heart disease and stroke, are possible if the disease is not managed. In this study, spouses often reported that the disease’s daily management as well as the fear of their loved one’s living with diabetes were common concerns.

Franks co-authored the study with Todd Lucas from Wayne State University, Mary Ann Parris Stephens from Kent State University, Karen S. Rook from the University of California at Irvine and Richard Gonzalez at University of Michigan.

This work was funded by the National Institute on Aging and the Kent State University-Summa Health System Center for the Treatment and Study of Traumatic Stress. Franks’ future studies will look at diet management in the context of distress and depression for patients and their spouses.

Source: Purdue University

Fat Fathers Pass on Diabetes

It stands to reason that chubby mothers give birth to chubby babies. After all, they share food for the nine months before delivery.

But what about chubby fathers passing on the health consequences of their bad eating habits? Evidence that they do comes from an Australian study with rats showing that chubby fathers could be passing on diabetes to their offspring.

Male rats fed a high-fat diet and mated with healthy female rats went on to produce offspring that had trouble with blood-sugar levels even though the offspring were eating low-fat foods.

“I think what’s really exciting about this work is what’s novel about it,” Margaret Morris said of the study she supervised at the University of New South Wales.

“This is the first report of non-genetic, intergenerational transmission of metabolic consequences of a high-fat diet from father to offspring.”

Conventional thinking

Morris looked at fathers because their role has largely been ignored. After all, conventional thinking is that their role stops after they pass on the DNA in their sperm cells. Morris wanted to test this, believing that both mother and father play a role.

“There’s no question that the role of the uterus during the development of the baby is important, but I think it’s important to realise that the father can be having a non-genetic effect as well,” she said.

The findings of the study, published in the US journal Nature, relate to rats but are very likely to hold true for humans as well.

“If it’s true in the human, it really underlines the necessity for both parents to be approaching pregnancy in the best possible physical shape,” Morris said.

The critical aspect of the study – the non-genetic transmission – is something that is not a big surprise to Diabetes Australia chief executive Greg Johnson. That genes play a part in the passing on of diabetes is a certainty but the role of environmental factors are not well understood.

“There are things that people can do to help reduce their risk of developing type-2 diabetes,” Johnson said. “Most of those modifiable things that they can do relate to eating a good healthy balanced diet and maintaining good physical activity and exercise and a healthy body weight.”

But, of course, we knew that; what we did not know – and still do not know for sure – is that a healthy diet and keeping in shape has consequences for a man’s offspring as well as for himself.

WHO Formally Accepts HbA1c Test for Diabetes Diagnosis

The World Health Organisation (WHO) has formally accepted the use of the HbA1c test for the diagnosis of diabetes, rather than the more common method of taking a blood sample and checking it for glucose content.WHO have assessed the HbA1c test as a way of measuring how much glucose is being carried by the red blood cells in the body and shows a person’s levels of blood glucose for the previous two or three months.

The HbA1c test is an easier test for diagnosing, as the use of blood samples meant people sometimes had to fast and then consume a high glucose drink, with blood being taken before and after and the levels of glucose compared.

WHO have stated that the HbA1c test, although more costly, does provide a more practical and easier technique for diagnosing the metabolic condition, but warned that rigorous quality assurance tests must be put in place and measurements standardised.

Ala Alwan, assistant director general of the Non-communicable Diseases and Mental Health Cluster at WHO, commented “Unlike other means of diagnosis, it does not require a patient to fast before a blood sample is taken, nor to consume a glucose drink that many people find unpalatable. HbA1c also has the advantage of reflecting the person’s average blood glucose levels over the preceding two–three months.”

Simon O’Neill, director of care, information and advocacy, at charity Diabetes UK, also said “This recommendation does not mean other tests for diagnosing diabetes will be shelved. Doctors will continue to use their clinical judgement about which test is most appropriate for their patients on an individual basis.”

Link Between Diabetes and Greater Damage From Strokes Revealed

One reason why people with diabetes can suffer more damage during strokes has been discovered by US scientists. The study on rats, published in Nature Medicine, found a protein which increased bleeding when blood sugar levels are high.

Elevated sugar levels have been linked to at least one in ten strokes. There are two main types, 80% are caused by blood clots in the brain (ischemic stroke) and 20% when blood vessels bleed into the brain (hemorrhagic stroke).

More than half of people with hemorrhagic strokes have high levels of sugar in the blood. The hemorrhages also seem to be more severe, forming over a larger area of the brain, causing more damage and increasing the risk of death.

Linking sugar and stroke

Scientists at the Joslin Diabetes Centre injected blood into the brains of rats with and without diabetes. The bleeding was ten times greater in those with diabetes than in healthy rats.

The group then studied the impact of a protein, plasma kallikrein, which had already been linked to sight problems in diabetics. The researchers found that a combination of high blood sugar and plasma kallikrein resulted in increased bleeding. They believe plasma kallikrein slows clotting when there is lots of sugar in the blood, although the exact mechanism remains unclear.

Dr Edward Feener, who led the study, said: “Given the prevalence of strokes and the damage they inflict, these findings are exciting because they suggest the possibility that rapid control of blood sugar levels may provide an opportunity to reduce intracerebral hemorrhage, which is a clinical situation that has very limited treatment options. This work could have broad implications since about half of patients with acute hemorrhagic stroke have hyperglycemia, whether or not that have pre-existing diabetes.”

Dr Sharlin Ahmed, research liaison officer at The Stroke Association, said: “Diabetes is known to increase a person’s risk of stroke, and research has shown that strokes caused by a bleed in the brain are more severe in people with diabetes as a result of poorly controlled blood sugar levels. Controlling glucose levels is vital if you have diabetes. This research not only provides further evidence that glucose control can reduce your risk of stroke, but it also suggests that it could reduce the severity of a stroke caused by a bleed in the brain. However, it is very early days and much more research needs to be carried out before human trials are undertaken.”

Dr Iain Frame, director of research at Diabetes UK, said: “This early research has made an interesting discovery into how high blood glucose levels interact with certain chemicals in the blood, and with the damage caused by stroke. As the authors admit, however, there are limitations in the animal model they used so their results do not reflect what happens to the human brain when it hemorrhages. Much more research is needed to test how we might be able to use this knowledge to limit this stroke damage and that will prove to be the big test as to whether this study will lead to any benefits for people with high glucose levels who have a stroke.”


Diabetes and Marital Conflict

Depression due to the psychological stress that a diagnosis of diabetes brings is quite common. This manifests as a feeling of sadness, confusion and helplessness.

Anger against self and others due to the perceived ‘ill luck’ of developing diabetes and having to follow a particular dietary pattern is also manifested in some individuals with diabetes, while some others are thoroughly embarrassed about having to carry about their medications and blood sugar monitoring equipments and give themselves injections at very odd places.

All of these can definitely lead to stress and conflicts in relationships that individuals with diabetes are involved in. It is indubitable that the social and emotional support accruable from functional marital and other relationships goes a very long way in improving the rate of recovery from illnesses.

Individuals with chronic disorders like diabetes who have very supportive relationships are able to adapt better psychologically to the condition and engage in more healthy behaviours that will lead to an improvement in their clinical condition. The other side of the coin is that in which there is a great deleterious effect on health as a consequence of marital conflict with associated manifestation of unhealthy behavior and poor psychological adaptation by the individual who is ill.

The diagnosis of diabetes as does other chronic illnesses can lead to a dysfunction in family dynamics if not properly handled. Hence, as in all human relationships, thoughtful words and rational communication can help to ameliorate the physical and mental stress associated with the management of diabetes.

Science has clearly proven that hostility between couples does impair health while thoughtfulness between couples has potential health benefits. It has also been proven that stress, whatever the origin, not only raises the blood sugar level, but also impairs health generally. Individuals with poorly controlled diabetes will then do well to ask themselves; is my poor blood sugar control due to disharmony in my marriage or due to work and financial stress?

A study christened IDEATel that compared higher marital stress and diabetes outcomes concluded that higher marital stress leads to poor blood glucose control and higher depression while lower marital cohesion leads to higher blood pressure levels.

How else does marital conflict apart from increasing the level of stress hormones lead to poor blood glucose control? Certain unhelpful behaviours that may hamper blood glucose control have been identified in the spouses of individuals with diabetes. Principal among these is nagging about diet in individuals who are yet to comply with dietary advice. This constant criticism raises the stress level in the person with diabetes with consequent elevation of the blood sugar level. Others include poor communication and poor support.

Helpful behaviours include general relational support, reminders about medication and exercise, hospital visits and dietary support which include food purchase and preparation. Spousal support can thus lead to improved knowledge about diabetes, better blood sugar control and reduced stress level.

Individuals with diabetes should involve their spouses in the day to day management of their diabetes while spouses should not be overly worried to the point of distraction about the health status of their partner as it may be counter-productive. One must however sound a word of caution here that some individuals with diabetes, especially of the male gender sometimes carry their carefree attitude too far so as much as to cause an unnecessary death.

It is known that for many people with diabetes, the strain of living with it does not put any stress on their marital relationships, while it does in some others. For those that are currently having poor control due to marital strain and stress one cannot but ask, do you want your blood sugar to be under control? Then improve your marriage!

When you do fight, be careful with your words, if the words used are strong ones, they not only damage your health but your partner’s too. Family equilibrium should be maintained by avoiding recriminations and attributions of guilt especially in the area of diet.

Thank you Dr Olubiyi Adesina, Consultant Diabetologist/

Asian Americans Show Higher Diabetes Rates

Despite being thinner, Asian Americans are more likely than whites to have type diabetes 2 — and the problem is growing, a new study finds.

Using data from an ongoing government health survey, researchers found that Asian Americans had consistently higher rates of type 2 diabetes than white Americans from 1997 to 2008.

What’s more, diabetes rates rose over time for both racial groups — reaching 8 percent among Asian adults and 6 percent among whites.

That was despite the fact that Asian Americans were less likely to be overweight, one of the prime risk factors for type 2 diabetes.

The findings, reported in the journal Diabetes Care, are in line with past studies showing that Asian background itself is a risk factor for diabetes.

But while researchers know that Asians are at increased diabetes risk, most people are probably unaware of that, said Hsin-Chieh “Jessica” Yeh, an assistant professor at Johns Hopkins University in Baltimore and the senior researcher on the new study.

Genes are partly to blame, Yeh told Reuters Health in an email. But it’s the combination of genetic vulnerability and lifestyle that’s key, she pointed out.

“Asians may be even more susceptible to unhealthy food and related weight gain,” Yeh said.

Specifically, studies have shown that even though Asian adults tend to weigh less than white and black adults, they often have a higher percentage of fat surrounding their abdominal organs. This so-called “visceral” fat is particularly linked to the risk of type 2 diabetes.

Then there is exercise, which is thought to help lower diabetes risk regardless of body weight. Based on health surveys, Asian immigrants to the U.S. are less physically active than native-born non-Asians, Yeh and her colleagues note.

So for Asian Americans — as for all Americans — healthy diet choices, calorie consciousness and regular exercise are key to curbing diabetes risk, Yeh said.

The findings are based on 230,500 U.S. adults who took part in a nationally representative government health survey between 1997 and 2008. Just over 11,000 were Asian American, with the majority being foreign-born.

Over the 12 years of the study, the number of Asian Americans reporting a diabetes diagnosis rose from just over 4 percent to 8 percent. Among white adults, the prevalence rose from just under 4 percent to 6 percent.

That was despite the fact that compared with their white counterparts, Asian Americans had a consistently lower body mass index, or BMI — a measure of weight in relation to height — and lower rates of obesity. In 2006-2008, 25 percent of whites were obese, versus 17 percent of Asians.

When Yeh’s team accounted for factors like age, BMI, income and reported exercise levels, Asian background itself was linked to a 30 percent to 50 percent higher likelihood of having diabetes.

“The main implication of our study is that type 2 diabetes is a growing public health problem for Asian Americans that requires urgent attention,” Yeh’s team writes.

It’s possible that their statistics aren’t precisely correct, the researchers acknowledge. For one thing, they had to assume that participants answered the survey questions correctly. They couldn’t account for how people of mixed race identified themselves. And they didn’t have information on any other diabetes risk factors, such as what participants usually ate, and whether anyone else in their family had diabetes.

Despite these shortcomings of the study, Yeh recommends that along with making healthy lifestyle choices, middle-aged and older Asian Americans should be sure to have routine check-ups with their doctor. Blood sugar tests can detect the abnormally high levels that signal “pre-diabetes.”

In some Asian cultures, Yeh noted, routine doctor visits are not the norm, and that could be one factor in Asian Americans’ higher diabetes rate.

Courtesy: Reuters Health

Thermometer to Save Diabetics Losing Limbs

A new handheld device could greatly reduce the number of ulcers and limb ­amputations in people with diabetes.

The device provides early ­warning of complications which, if left untreated, can lead to the limb becoming so ­damaged it needs to be removed.

Thousands of people undergo an amputation as a result of diabetes. The disease can cause significant ­damage to the nerves and blood vessels — possibly because they are exposed to such high levels of blood sugar.

Nerve damage can lead to loss of feeling in the feet, meaning sufferers might not feel a cut, blister or sore. Left untreated, such injuries can develop into serious ulcers and infections.

Poor circulation exacerbates the problem — reduced blood and oxygen supply to the area makes healing difficult.

Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime.

In some cases, wounds can remain open for months or even years, vastly increasing the risk of life-threatening infection.

If an infection sets in deeply, or affects the bone, antibiotics alone might not be enough. Gangrene can set in and amputation might be the only course of action.

Even if patients don’t end up so drastically affected, they can still suffer from ulcerations, infections and the foot can become deformed.

The new device — a ­battery-­powered thermometer — has been developed by US-based Dibetica Solutions to be used at home by people with ­diabetes and some existing nerve damage.

It uses infrared light to measure changes in foot temperature — a rise in temperature is a sign of inflammation and damage. The readings can help alert a patient that a sore or ulcer is ­developing, before it even breaks the surface of the skin. They can then seek medical attention.

The gadget is designed to be used daily — the patient measures six sites on each foot and ­compares the temperatures.

If this temperature ­difference is more than four degrees Fahrenheit (2C), for two days or more, a problem might be ­brewing and they need to ­contact their doctor.

Previous studies have shown the device cut ulcer rates by a third, compared to ­people who didn’t use the gadget.

Now a larger, ­clinical trial is under way at Oslo University ­Hospital, in Norway, to see whether the device can ­prevent future foot ulcers in patients who have previously ­suffered with this complaint.

Cathy Moulton, clinical adviser at the charity Diabetes UK, says the device could be ­successful as long as patients are vigilant in ­taking their temperature every morning: ‘There is ­evidence ­showing that temperature changes could identify signs of neuropathy (nerve damage).

‘To reduce the risk of ulcers which could lead to ­amputations, ­Diabetes UK ­recommends that people with ­diabetes regularly check their feet looking for discoloration, damage to the skin, swollen areas, and if the foot feels very hot or cold.

‘If there are any changes such as these, they should see their ­doctor as soon as possible.

‘It is also vital that people with diabetes have access to a ­podiatrist and specialist care if any foot ­problems do develop.’

Artificial Skin

A new type of ‘artificial skin’ might help treat severe ulcers in people with diabetes, reducing risk of amputation.

The PriMatrix skin patches are surgically stitched or stapled on to wounds that have proved ­difficult to treat.

Some diabetic ulcers fail to heal because poor circulation in the feet stops the production of new collagen, a crucial structural ­component of skin.

Derived from a component of cow skin — known as fetal bovine dermis — the patch encourages the patient’s skin to grow over the wound by providing a collagen scaffolding that the skin cells can latch on to.

Over five to six months, the patient’s skin grows over the patch, and the collagen is ­eventually replaced with the patient’s own.

The patch is used in ­hospitals in the US and Europe for the management of pressure ulcers, second-degree burns and trauma wounds.


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