Diabetes & Depression Create Adverse Synergy

There’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression

DIABETES and depression are conditions that can fuel each other. 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. So, there’s a clear increase in risk to your health and to your life when you have a combination of diabetes and depression.

While diabetes can be a challenge to control, depression can be difficult to treat and keep in remission. Growing evidence suggests the combination can be especially problematic for patients. And as if this adverse synergy were not bad enough, having these two conditions more than doubles the likelihood that a patient will develop dementia.

What this means is that depression can affect blood sugar levels and insulin metabolism through increased cortisol, contributing to unhealthy eating habits, weight gain and diabetes. On the other hand, management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression. The two are linked not only behaviorally, but biologically, says Dr. Frank B. Hu, a professor of medicine at Harvard Medical School.

However, doctors are unsure whether one condition causes the other or if a single underlying factor is responsible for both ailments. If a substantial causal connection is established between the two disorders, it would be rather novel and could potentially change how doctors understand and treat both disorders.

New research findings from the University of California at San Diego further reinforce the view that since depression and diabetes often co-occur, psychiatrists should be aware that depressed patients may be at risk of the metabolic disorder. The findings of the study were presented at the American Psychiatric Association’s 164th annual meeting in Honolulu last week.

In the San Diego study, reported the Los Angeles Times, researchers who reviewed the medical records of a group of 129 Hispanic diabetics discovered that diabetes was diagnosed first in 54 percent of men with both conditions, while depression was the initial diagnosis of 24 percent of men. Of women with both conditions, 59 percent were first discovered to have diabetes, while 29 percent were first diagnosed with depression.

While doctors are typically aware that someone with diabetes is at higher risk for depression, they may not look for mood disorders as a risk factor for developing diabetes, especially anxiety, the authors noted. Among men with diabetes and anxiety, 54% developed diabetes first and 45% developed anxiety first. Among women, 55% developed diabetes first and 39% developed anxiety first.

Latinos are known to have higher rates of type 2 diabetes than the general US population. Additionally, co-occurring mood disorders are common among these individuals. This made this group of patients an ideal population for studying the relationship between mood disorders and type 2 diabetes.

The San Diego researchers said it is unclear why there is this association between the two conditions, but said that their findings show that there is a strong need to monitor individuals with type 2 diabetes for future mental health issues as the metabolic condition appears to precede mood disorders.

Another 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.

A study carried out by the German Diabetes Association (DDG) has also shown that 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.

The Chennai (India) Urban Rural Epidemiological Study involving around 23,000 participants found that 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. “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,” said co-author Dr. V Mohan.

The American Diabetes Association advises that individuals with type 2 diabetes should consider seeking mental health help if they begin to feel three or more common symptoms of depression, which may include loss of pleasure, loss of appetite, sadness, trouble concentrating and suicidal thoughts.

The bottom line: Since diabetes and depression can influence each other and thus become a vicious cycle, primary prevention of diabetes is important for prevention of depression, and vice versa.

Sources: American Psychiatric Association, American Diabetes Association

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Common Test Could Help Predict Early Death In Diabetes

High levels of calcified ‘plaque’, a strong indicator of coronary heart disease, can be measured by a special ‘gated’ CT scan that costs just over $200

WHILE vascular disease is common in the general population, it is twice as common in people with diabetes. At least 60 percent of diabetes patients – even those on dialysis for kidney failure – ultimately die of a vascular event, such as heart attack or stroke. However, questions about why so many diabetes patients die early have remained unanswered in the medical community’s understanding of the disease.

Diabetes is associated with many other medical problems so identifying a way to determine who is at highest risk and who needs the most intensive medical monitoring and care is especially important. Now new findings reveal that a common test may be useful in predicting early death in individuals with diabetes. The study appears in the May issue of Diabetes Care.

Dr. Donald W. Bowden

“People with diabetes are already at high risk of developing heart disease and experiencing an early death,” said Donald W. Bowden, Ph.D., the director of the Center for Diabetes Research at Wake Forest Baptist Medical Center and lead investigator in a press statement. “With this study, we’ve discovered that we can identify a subset of individuals within this high risk group who are at even higher risk, and the means to do this is already widely available in the form of a computed tomography (CT) scan – a relatively inexpensive and non-invasive test.”

For the Diabetes Heart Study, Bowden and colleagues have been following nearly 1,500 patients with diabetes in North Carolina for about 13 years, gathering data on various aspects of the disease and how it affects individual health. As original study participants began to die, the researchers sought to understand why.

“When we reviewed the data last year, we were shocked by the number of participants who had already died during this study,” Bowden said. “We wanted to find out if there were any predictors of who would succumb versus those who are still living. In a group of people who are already at high risk, we were looking for a way to identify which individuals were at even higher risk for early death, with the goal of finding interventions or ways to focus medical care and attention toward those individuals at highest risk.”

A high coronary artery calcium (CAC) score is known to be a strong indicator of coronary heart disease. The score provides a measure of how much coronary artery disease, or calcified ‘plaque’ is present in the blood vessels of the heart. Plaque plays a major role in heart attacks and other vascular events and can be measured by taking a special ‘gated’ CT scan which, in comparison to typical CT scans, uses very few X-rays, does not require any injections and generally takes less than 10 minutes to perform. (At Wake Forest Baptist, the test costs just over $200 and some insurance companies will cover the exam in appropriate situations, informs the press statement.).

Within the diabetes-affected population, there is a very wide range of calcified plaque buildup in the arteries and the heart, from individuals with none at all, to people whose entire vessels are nearly completely calcified. The researchers separated more than 1,000 study participants into five groups, according to the amount of calcified plaque they had in their blood vessels at the beginning of the study. The health of those participants was then followed for an average of 7.4 years before researchers compared the data from those who died during the study to those who are still living.

“We saw a dramatic risk of dying earlier in the people with highest levels of calcified plaque in their blood vessels,” Bowden said. “When comparing the group with the highest amount of plaque to the group that had the lowest amount of calcified plaque, the risk of dying was more than six times greater in the group with high levels of calcified plaque. The difference in risk that we revealed is striking. It’s in a group of people who are already at risk, but the CAC level really rather dramatically differentiates risk between people within this high risk group. This finding could have novel clinical implications.”

“The striking magnitude of the risk suggests very strongly that other research samples should be evaluated, especially in individuals with diabetes,” he said.

Source: Wake Forest Baptist Medical Center

Diabetes: Tale of 2 Mice Pinpoints Major Factor for Insulin Resistance

Joslin Diabetes Center scientists identify promising candidate for drugs treating type 2 diabetes and fatty liver disease

RESEARCHERS at Joslin Diabetes Center have identified an enzyme called PKC-delta as an important molecular modifier for development of insulin resistance, diabetes and fatty liver in mice. They also have found evidence suggesting a similar role for the enzyme in humans, making PKC-delta a promising new target for drugs for diabetes and related ailments.

It’s well known that insulin resistance typically occurs prior to type 2 diabetes. You can be insulin resistant for years before developing the disease, and often a diagnosis of type 2 diabetes is a person’s first sign that they are in fact insulin resistant.

The road to type 2 diabetes is paved with insulin resistance, a condition often associated with obesity in which the hormone begins to fail at its job helping to convert sugars to energy.

Investigators in the laboratory of C. Ronald Kahn, M.D., began with two existing strains of mice that are on opposite sides of the spectrum for insulin resistance. “The ‘B6’ mouse is very prone to develop both obesity and diabetes, and the ‘129’ mouse is quite protected from both, even if it possesses a genetic defect in insulin signaling,” says Dr. Kahn, Professor of Medicine at Harvard Medical School.

“Comparing the two models, it’s as if there’s an on/off switch for insulin resistance and diabetes between them. We reasoned that if we could find out the differences between B6 and 129 mice, we could identify a factor that could be a major modifier of insulin resistance, and a good drug target for treatment of type 2 diabetes,” he said

Dr C. Ronald Kahn, MD

In previous work, the Kahn lab created a genetic cross between these two mice models, did a genome-wide screening and found an area on mouse chromosome 14 that appeared to be important for insulin sensitivity. In the latest paper, published online in the Journal of Clinical Investigation, they followed up and found that PKC-delta stood out in activity among the genes in that region.

The researchers then showed that levels of the PKC-delta enzyme were about two times as high in the liver and other tissues in the B6 as in the 129 mouse. When both types were put on high-fat diets, levels of the enzyme stayed the same in the 129 mouse but rose to three times higher in the B6 mouse.

Could these differences be enough to make the profound change in insulin sensitivity? The scientists next created three new mice models to check.

In one model, they removed one of the two normal copies of the PKC-delta gene from B6 mice, thus cutting production of the enzyme in half, and the mice became much more insulin sensitive. In a second effort, they removed the gene entirely from the livers of B6 mice, and again the resulting mice were more insulin sensitive. In a third model, they inserted an extra copy of the PKC-delta gene in the liver of 129 mice, which became much more insulin resistant and diabetic.

In short, PKC-delta levels correlated closely with insulin resistance and the abnormalities in glucose tolerance in all three cases of mice. In addition, the insulin resistance correlated with increased fat in the liver, an increasing problem in people with insulin resistance.

Biopsies of human liver tissue, Dr. Kahn says, also showed that levels of the enzyme are heightened in people who are obese or have diabetes. “People with diabetes tend to get fatty liver and that also seems to correlate with the activity of PKC-delta,” he adds.

Overall, “drugs that inhibit the activity of PKC-delta in the liver and other tissues potentially could aid treatments for diabetes and fatty liver disease, which is second only to alcohol as a cause of liver failure,” Dr. Kahn says.

Via Eurekalert

Limiting Cholesterol Levels May Minimize Inflammation and Reduce Type 2 Diabetes Risk

Study will make possible new target therapies that help predict susceptibility to the metabolic condition and perhaps prevent diabetes

BY stimulating the enzyme cholesteryl ester hydrolase (CEH) to remove more cholesterol from cells, it may be possible to limit inflammation, improve insulin sensitivity and reduce an individual’s type 2 diabetes risk, claims a group of researchers from Virginia Commonwealth University School of Medicine. The results of the study have been published online in the Journal of Biological Chemistry.

Cholesterol has long been known to increase inflammation levels, and inflammation is well regarded as a risk factor for type 2 diabetes. Yet the researchers noted that few treatments for type 2 diabetes specifically target high cholesterol levels. It is hoped that the study will make possible new target therapies that help predict susceptibility to the metabolic condition, and perhaps prevent diabetes in the future.

“Although diabetes and heart disease often co-exist, current management of diabetes does not necessarily include cholesterol and/or inflammation control,” said lead researcher Shobha Ghosh, PhD. “These studies provide the first evidence that targeting fat tissue inflammation as well as elimination of cholesterol from the body may be emerging new strategies to prevent diabetes.”

For the study, the team analyzed the effect of turning up the expression of a gene that regulates CEH levels in a group of mice. The results showed that even when fed a high-fat diet, these mice had lower levels of inflammation and were more sensitive to the effects of insulin.

The results held true despite the fact that mice still gained significant weight from being fed the high-fat diet. Ghosh explained CEH appeared to cause low-density lipoprotein cholesterol molecules to exit cells, where they could then be neutralized by high-density lipoprotein cholesterol cells and taken to the liver for processing.

Ghosh said that these findings suggest that taking steps to control cholesterol levels in individuals with other risk factors for type 2 diabetes may be an effective treatment strategy. Additionally, they reveal that stimulating the genes that regulate CEH levels in the body may be one of the surest ways to control cellular cholesterol levels and limit fat’s pro-inflammatory effects.

From Endocrine Today

Related story: Arterial Plaques May Be Reduced By Increasing the Amount of a Key Enzyme in Cells Storing Cholesterol

Can A Low Fat Diet Ward Off Diabetes Without Weight Loss?

HOW your diet affects your health is a big topic in research these days, and this is reflected in the news headlines every week. The problem is that the research findings keep changing the landscape of what’s healthy and what’s not. Eggs were bad, now they’re good. Margarine was good, now it’s bad. Eat low-fat! No, now eat low-carb. For people with no health problems, trying to adhere to the latest dietary advice is simply confusing. For people with chronic conditions such as diabetes, it can be downright dangerous.

So a new research study from the University of Alabama at Birmingham (UAB), which claims that small differences in diet – even without weight loss – can significantly affect risk for diabetes, is bound to raise more questions than it answers.

The unique aspect of this study ‒ published online May 18, 2011, by the American Journal of Clinical Nutrition ‒ is that diabetes risk was reduced independent of weight loss. Received wisdom says overweight individuals can reduce risk of type 2 diabetes by shedding the extra pounds through a combination of diet and exercise.

In the UAB study, 69 healthy, overweight people who did not have diabetes — but were at risk for it — were placed on diets with modest reductions in either fat or carbohydrate for eight weeks. “At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity,” said Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at UAB and lead author of the study. “These improvements indicate a decreased risk for diabetes,” she said in a press statement.

The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.

“People find it hard to lose weight,” said Gower. “What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes.”

Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate.  The lower carb group’s diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.

The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.

“The diets used in this study were actually fairly moderate,” said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. “Individuals at risk for diabetes easily could adopt the lower fat diet we employed.  Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease.”

But then, widely cited research studies also suggest that a low fat, high carb (LFHC) diet causes the following problems:

• Elevates triglycerides, lowers HDL (“good” cholesterol)

• Is ineffective for people with high insulin levels

• Increases insulin levels which spikes blood pressure

• Leads to greater risk for age-related macular degeneration (AMD)

The American Diabetes Association says millions of Americans are unaware they are at high risk with some groups having a higher risk for developing Type 2 diabetes, especially African-Americans, Latinos, Native Americans and the elderly.

It would therefore be premature to jump the gun to think that one can avoid the risk of diabetes without shedding weight by limiting fat intake. Gower rightly says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.

In the meanwhile, the best ways to maintain good health, diabetes or no, is to exercise, limit processed and refined foods, focus on fish, and eat a wide variety (and an abundance) of plant foods.

And shedding weight ‒ even if there’s no risk of developing diabetes ‒ will always remain a good idea.

Source: UAB News

Related Posts:

How Fatty Foods Lead To Diabetes

Is the ADA Shifting its Stance About Carbs?

mHealth: Driving Diabetics to Better Health on The Go

The new technology can warn patients of an impending emergency, or let them upload data through speech-to-text interaction while in their vehicle.

AS consumer demand for being in the know about one’s health while on the go continues to rise, this is an idea whose time has come. In a much-delayed marriage of medical technology, consumer electronics and automotive engineering, Medtronic Inc., a leading manufacturer of glucose monitoring devices, and Ford Motor Co. on Wednesday unveiled a prototype device that uses the automaker’s in-car communications system called Sync to help drivers track their blood glucose activity when they’re behind the wheel.

Medtronic and Ford have teamed up on a prototype device that helps drivers track blood sugar levels while on the go

Working with Medtronic, Ford researchers have developed a prototype system that allows Sync ‒ developed jointly by Ford and Microsoft ‒ to connect via Bluetooth to a Medtronic continuous glucose monitoring (CGM) device and share glucose levels and trends through audio and a center stack display and provide secondary alerts if levels are too low. Ford wants to introduce the diagnostic feature on a new vehicle in the next “one to two years.”

For people with diabetes and their caregivers, constant knowledge and control of glucose levels is critical to avoiding hypoglycemia or low glucose, which can cause confusion, lightheadedness, blurry vision and a host of other symptoms that could be dangerous while driving. Many now depend on a portable CGM device to track their levels.

The high-tech approach makes good use of widely available communications technology to safeguard patients and improve quality of care. Using Bluetooth connectivity, the system links the automaker’s popular in-car infotainment system, called Sync, to a Medtronic CGM. If a driver’s glucose levels are too low, an alert sounds or a signal appears on a dashboard screen.

CGM is the New Standard

The idea has won some preliminary fans in the diabetes community. “I know when I’m driving, if the ‘check engine’ light comes on, I’m going to pay attention,” said Dr. Richard Bergenstal, executive director of Park Nicollet’s International Diabetes Center. “It’s kind of the same principle.”

On the face of it, pairing the Medtronic technology with automotive engineering may seem far-fetched, even unnecessary, but Ford maintains that 78 percent of U.S. consumers are deeply interested in “mobile health solutions.” It cites a recent study by digital messaging powerhouse MobileStorm that confirmed this phenomenon, indicating that medical and healthcare apps was the third fastest-growing category of smartphone applications in early 2010. Indeed, major app stores, such as the Apple App Store, are now housing upward of 17,000 available health apps for download, with nearly 60 percent of those aimed at consumers rather than healthcare professionals, reports mobile research specialist Research2Guidance.

12 Hot Mobile Medical Apps

“Wireless health provides an unprecedented ability for monitoring and promotion of health and wellness for all individuals,” said UCLA Electrical Engineering Professor William Kaiser, who has studied how wireless health technologies can be used to track an individual’s fitness and health status and help identify potential risks and challenges.

“Studies show wireless health empowers people with information and guidance that can directly address the most important health concerns. The new Ford health and wellness connectivity solutions represent a fundamental advancement for these individuals,” Kaiser added, “providing them additional support and functionality during time spent in the vehicle.”

The Ford-Medtronic prototype is still being researched, so it’s unclear when the technology will be marketed, if at all. “Today it’s all about possibilities,” said Medtronic senior vice president James Dallas, adding, “There’s nothing formal yet, but the technology has reached a point where possibilities can become probabilities.”

“Diabetes in particular is a chronic disease where frequent monitoring of blood glucose levels throughout the day is critical… (So) by utilizing information technology and consumer electronic devices, we can help patients actively manage their health via access to real-time data on phones, hand-held devices or even in their cars,” said Dallas.

“Ford Sync is well known in the industry and with consumers as a successful in-car infotainment system, but we want to broaden the paradigm, transforming Sync into a tool that can help improve people’s lives as well as the driving experience,” said Paul Mascarenas, chief technology officer and vice president, Ford Research and Innovation. The Sync system offers three unique ways to bring health and wellness connected services into the car:

• Device connectivity via Bluetooth – Leveraging Bluetooth, medical devices can be connected to the car to share information through Sync, just like a driver connects and accesses his or her cellphone and address book by voice control

• Cloud-based services – Ford created an off-board network of location-based traffic, directions and information providers that drivers can simply access via their cellphone. Known as Sync Services, new services such as medical services can be easily added through this plug-and-play voice-controlled capability

• AppLink – Ford’s latest Sync innovation allows smartphone apps to be accessed by drivers via voice control. The Sync application programming interface (API) allows app developers to enable their apps to communicate through Sync, delivering a smarter way for drivers to manage apps while driving

Medtronic has led the way in continuous glucose monitoring, which records blood sugar levels throughout the day and night. The readings permit patients to make adjustments to insulin levels, often using a Medtronic insulin pump, or by ingesting sugar to coax levels back into normal territory, the basic idea behind the artificial pancreas project. “Ideally, we will get to a place where the sensor and pump communicate and when you get a reading, the pump automatically adjusts,” Medtronic spokesman Brian Henry said.

Some may regard this experimentation as yet another example of a company introducing a technology simply because they could, irrespective of expressed need from the marketplace. Ford disagrees and says that it’s a matter of time before this sort of service moves from the fantastical to the norm.

K. Venkatesh Prasad, a director in Ford’s vehicle design and infotronics division, told New York Times in a telephone interview: “For most people, drive time is private time…The car is the best time to listen to guidance for health and wellness.”

Anand K. Iyer, president of WellDoc, said in a telephone interview that if an app could accurately monitor the condition of diabetics and warn them, as well as health care providers, of a drop in blood sugar or the onset of insulin shock, improved driver safety and reduced insurance costs would result.

Sources: Ford Motor Co., Medtronic Inc., Janet Moore/Star Tribune

Apples Reduce Bad Cholesterol (LDL) By 23%, Increase Good Cholesterol (HDL) By 4%, Finds New Study

APPLES are truly a “miracle fruit” that convey benefits beyond fiber content. Bahram H. Arjmandi of Department of Nutrition, Food and Exercise Sciences at The Florida State University in Tallahassee has found that eating an apple or two a day appears to lower levels of cholesterol and two other markers associated with plaques and inflammation in artery walls.

In his study, postmenopausal women who ate an apple a day gained heart healthy benefits and even lost weight in a study from food science researchers. In six-months, women age 45 to 65, lowered dangerous LDL cholesterol, raised beneficial HDL cholesterol levels and lost a few pounds from consuming dried apples. The study shows apples could be a heart healthy snack for everyone; not just women.

Indeed, the findings are of great interest to diabetics who must maintain tight control of their blood sugar levels every day. Uncontrolled diabetes puts them at greater risk for heart disease.

Arjmandi’s recent research is the first to evaluate the long-term cardioprotective effects of daily consumption of apple in postmenopausal women, says a news release. The results of the study, which were presented at Experimental Biology 2011 on April 12 in Washington, DC, should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.

Arjmandi reported that “incredible changes in the apple-eating women happened by 6 months ‒ they experienced a 23% decrease in LDL cholesterol. The daily apple consumption also led to a lowering of lipid hydroperoxide levels and C-reactive protein in those women.  “I never expected apple consumption to reduce bad cholesterol to this extent while increasing HDL cholesterol or good cholesterol by about 4%,” he said.

Though the study used dried apples for convenience, Arjmandi said fresh are likely to be even better. And it doesn’t matter if they’re green, red, or golden. “Any varieties of apples are good,” he said.

Yet another advantage is that the extra 240 calories per day consumed from the dried apple did not lead to weight gain in the women; in fact, they lost on average 1.5kg (3.3lb). “Reducing body weight is an added benefit to daily apple intake” he said. Part of the reason for the weight loss could be the fruit’s pectin, which is known to have a satiety effect.

This study randomly assigned 160 women ages 45-65 to one of two dietary intervention groups: one received dried apples daily (75g/day for 1 year) and the other group ate dried prunes every day for a year. Blood samples were taken at 3, 6 and 12-months.

Experts said the study’s results were consistent with previous evidence that apples do indeed live up to the famous adage about keeping the doctor away.

“When we look at the whole composite of human studies and animal studies and in vitro lab studies, when you look at the active components in apples and apple juice, there’s definitely benefit,” Dianne A. Hyson, PhD, RD, a nutritionist and researcher at the University of California at Davis was quoted as saying in a WebMD Health News report.

Hyson, who was not involved in the current research, recently completed a review of 80 studies, published since 2005, on the health benefits of apples, and she said that in addition to their cardiovascular benefits, there’s some evidence that apples help regulate blood sugar and control appetite, protect against cancer, and safeguard the lungs.

Another key, Dyson said, is eating the whole fruit, rather than looking for individual components in supplements. “Most of the time, in many studies, the whole is better than the sum of its parts,” she said. As far as how much to eat, just follow the apple-a-day adage, though Arjmandi said two-a-day might be even better. “That’s doable and practical and people like apples,” he said.

The next step in confirming the results of this study is a multi-investigator nationwide study.

Source: Experimental Biology 2011 Onsite Newsroom

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“Breakthrough Medical Food Combined With Low-Glycemic Diet Almost Twice As Effective As One Of The Best Diets Alone For Lowering Diabetes Risk Factors”

Study reminds physicians that the option of prescribing medical food should be considered

The Centers for Disease Control and Prevention (CDC) in the U.S., says chronic illness affects nearly half of all adults and contributes to seven out of 10 deaths. Even more alarming, chronic illness costs Americans more than $1.5 trillion annually in direct medical costs. It is for these reasons researchers and others in the medical profession believe that re-focusing medical practice treatments on the provision of lifestyle therapy will not only significantly improve the health status of most people, but will reduce costs.

The efficacy of lifestyle intervention in reducing the incidence of type 2 diabetes has been established by the Diabetes Prevention Program and other studies. Recently researchers at the University of Florida announced that a program consisting of a breakthrough medical food combined with a low-glycemic, Mediterranean-style diet is almost twice as effective as one of the best diets alone for lowering risk factors for type 2 diabetes and cardiovascular disease.

The results of the multicenter trial have been published in the May/June issue of the Journal of Clinical Lipidology, a publication of the National Lipid Association. The study was sponsored by Metagenics Inc.

As more countries adopt Western dietary habits and sedentary lifestyles, the number of chronic illnesses such as type 2 diabetes, obesity, heart disease, arthritis and autoimmune diseases has increased. Citing the findings of the multicenter research, Metagenics claims its medical food UltraMeal PLUS 360° is 40 percent more likely to resolve metabolic syndrome.

The company’s press release says researchers believe that patients who incorporate the medical food into their diets as well as make necessary lifestyle changes can improve their health faster than by using a Mediterranean diet alone.

Medical foods are foods that are specially formulated and intended for the dietary management of a disease that has distinctive nutritional needs that cannot be met by normal diet alone. They were defined in the Food and Drug Administration’s 1988 Orphan Drug Act Amendments and are subject to the general food and safety labeling requirements of the Federal Food, Drug, and Cosmetic Act. Medical foods are distinct from the broader category of foods for special dietary use and from traditional foods that bear a health claim.

The Mediterranean diet is a pattern marked by daily consumption of fruits, vegetables, whole grain cereals, and low-fat dairy products; weekly consumption of fish, poultry, tree nuts, and legumes; high consumption of monounsaturated fatty acids, primarily from olives and olive oils; and a moderate daily consumption of wine or other alcoholic beverages, normally with meals. Red meat intake and processed foods are kept to a minimum. For these reasons, this diet has been known for long to reduce the risk of metabolic syndrome.

Metabolic syndrome − increasingly common in the United States − occurs if someone has three or more of the following five conditions: blood pressure equal to or higher than 130/85, fasting blood glucose equal to or higher than 100 mg/dl, a waist measuring 35 inches or more in women and 40 inches or more in men, a HDL (“good”) cholesterol under 40 in men and under 50 in women, triglycerides equal to or higher than 150 mg/dl.

The multicenter trial’s requirements were based on standards set forth in the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults – Adult Treatment Panel III (NCEP-ATPIII) criteria. Participants with heart, liver or kidney disease or who were using blood sugar or cholesterol-lowering agents were excluded. Those with type 2 diabetes were not excluded.

The clinical trial, which was conducted at three universities − University of Connecticut at Storrs, University of Florida at Jacksonville, and University of California at Irvine − consisted of 89 women between the ages of 20 and 75. To be eligible for the study, the candidates had to have a LDL-C (low-density–lipoprotein cholesterol) of more than 2.59 mmol/l (100 mg/dl), TG (triglycerides) equal to or greater than 1.70 mmol/l (150 mg/dl), and meet two of the four remaining criteria for metabolic syndrome.

“Chronic illness is draining our healthcare resources and keeping millions of people from enjoying healthy, vibrant lives. Many of these illnesses are the result of long-term lifestyle and behavior choices,” said Robert H. Lerman, MD, PhD, director of medicine and extramural clinical research for Metagenics Inc. “This study is important because it shows how effective UltraMeal PLUS 360°is in resolving metabolic syndrome and cardiovascular risk factors in affected individuals, and identifies a powerful new approach to combating chronic illness.”

“Preventing chronic illness is far more effective from both a cost and treatment perspective than treating the illness once it develops,” said Lerman. “Physicians have evidence-based research that now enables them to actually use lifestyle therapy in their patients to help them avoid chronic illness by treating the cause, not just the symptoms of these conditions.”

“It’s very important for physicians to learn about these new findings. Doctors have not been trained to take a therapeutic lifestyle approach with patients who have metabolic syndrome,” said Mark S. McIntosh, MD, one of the principal researchers who is the Director of Corporate Wellness and Assistant Professor in the Department of Emergency Medicine at the University of Florida – Jacksonville. “Programs like Metagenics’ FirstLine Therapy are needed to provide the tools and support for physicians to change the way they practice and to help patients make real lifestyle changes.”

Both doctors believe that this research underscores the importance of the science of how nutrition impacts genetic expression and its potential to improve health and avoid chronic illness. “Patients who incorporate the medical food along with lifestyle therapy get healthier quickly and safely,” Lerman said.

“Most physicians are accustomed to prescribing drugs for people with lifestyle-related conditions, even though the first line recommended course of treatment is lifestyle therapy,”  said Dr. Wayne S. Dysinger, current president of the American College of Lifestyle Medicine and chair of the Department of Preventive Medicine at Loma Linda University in Loma Linda, California.

“This study reminds physicians that the option of prescribing food, in this case a medical food, should be considered.  It demonstrates the ability of medical foods to reduce risk factors and improve health. The study results are a valuable addition to research on the impact of nutrition on health,” Dysinger added.

In addition to Dr. McIntosh, the other two principal researchers are Maria Luz Fernandez, PhD, Professor in the Department of Nutritional Sciences at the University of Connecticut, Storrs and Wadie I. Najm, MD, Clinical Professor in the Department of Family Medicine at the University of California, Irvine.

Note: This post is for information only. Trade, proprietary, or company names appearing in this article have been used only in the context of the information provided by Metagenics Inc. I do not endorse the products mentioned in the report.

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Blood Sugar Test Costing Only 5 Cents To Detect 133 Million Undiagnosed Diabetics In India

Pharma companies reworking pricing policy to reduce cost of blood sugar testing kits

EVEN as the number of people with type 2 diabetes mellitus is increasing worldwide, many people living with diabetes remain unidentified. Undiagnosed diabetes may also impose substantial public health implications because these patients remain untreated and at risk for complications. Although screening for undiagnosed diabetes within general practice by measuring fasting blood glucose is feasible, it is best targeted at individuals with multiple risk factors for diabetes.

The government of India has therefore taken the lead to make available diabetes screening tests costing just 5 cents (Rs 2) across the country. The Indian Council of Medical Research (ICMR) says the test to determine whether a person is suffering from diabetes could be available in a year-and-a-half. Whether this program will be launched as part of the National Diabetes Census announced last year is not clear.

“Given the fact that India is a known as a diabetes hub, union (federal) health minister Ghulam Nabi Azad is taking keen interest in the project. We have been told that it must be completed as early as possible,” announced ICMR director-general Dr VM Katoch in Mumbai on May 12, adding the news of such an inexpensive test being introduced has already prompted some pharma companies to rework their pricing policy and reduce the cost of their blood sugar testing kits.

Katoch says the project will be a major breakthrough. “At present, the cost of the test is between around Rs 80-100 ($1.5-2). This may not be affordable to the poor. For them, the Rs 2 ($0.05) test will be a godsend,” said Katoch. “We are executing the project with the Council of Scientific & Industrial Research, Indian Institute of Technology at Kharagpur, and a private pharmaceutical company.”

A diabetes awareness campaign in Hyderabad, India

Type 2 diabetes can remain undetected for many years and the diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test. In developing countries, less than half of people with diabetes are diagnosed. Without timely diagnoses and adequate treatment, complications and morbidity from diabetes rise exponentially.

Individuals who are unaware of their disease status are left untreated and are thus more prone to microvascular as well as macrovascular complications. Hence, it is necessary to detect the   large pool of undiagnosed diabetic subjects in India and offer early therapy to these individuals.

In India, studies that have shown an increase in prevalence of diabetes have also reported a very high prevalence of undiagnosed diabetes in the country. According to Dr A Ramachandran, diabetes is a major health care burden in India, especially in the urban areas. Nearly 70% of urban diabetic cases are diagnosed, while in rural areas up to 70% cases remain undetected.  A long asymptomatic stage of diabetes is known to exist causing cellular damage and complications prior to clinical diagnosis. Therefore screening for diabetes is one strategy to prevent this.

Dr Shashank Joshi, vice-president, Research Society for the Study of Diabetes in India, was all praise for the initiative. “Over 60 million Indians suffer from diabetes. The ICMR project will bring hope to the poor who avoid tests because of increasing costs,” said Dr Joshi. He, however, emphasized that the government must ensure that there is no compromise on quality.

If this government-led initiative takes off, it would go a long way in combating the diabetes epidemic not only in India but in all developing countries because there a millions of people who are living with undiagnosed diabetes.

According to the World Diabetes Foundation, undiagnosed diabetes accounted for 85% of those with diabetes in studies from South Africa, 80% in Cameroon, 70% in Ghana and over 80% in Tanzania. The number of deaths attributable to diabetes in 2010 showed a 5.5% increase over the estimates for the year 2007.

80% of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment. Yet, without effective prevention and control programs, the incidence of diabetes is likely to continue rising globally.

An experimental study undertaken in India found that simple instructions such as advising people to walk, and sugar-free coffee/beverage had resulted in 29-30 per cent reduction in diabetes, Dr. Ramachandran said. A new research in Indian population, called the Indian Diabetes Prevention Programme, by him had shown the effectiveness of primary prevention strategies in preventing the onset of diabetes in people with high risk. It was also possible to identify those at high risk.

A national diabetes screening program based on the cheap 5-cent test would detect patients with diabetes and prevent the burden due to its long-term complications. The current figures are an indication that primary prevention is necessary and drastic steps must be taken to diagnose the disease early, provide effective management and also take steps to prevent the onset of disease in high-risk subjects.

Type 2 Diabetics Experience Hyperglycemia Throughout The Day

POSTPRANDIAL (after meals) hyperglycemia is one of the earliest abnormalities of glucose homeostasis associated with type 2 diabetes and is markedly exaggerated in diabetic patients with fasting hyperglycemia. And research conducted with human patients, mice, and pancreas beta cell cultures all point to a single threshold at which elevated blood sugars cause permanent damage to your body: 140 mg/dl (7.8 mmol/l) after meals.

Better control of postprandial blood glucose levels contributes more to improvement in HbA1c levels than fasting glycemic control. And since HbA1c is the gold standard for determining glycemic control among people with both type 1 and type 2 diabetes, all diabetics struggle to control the blood sugar round-the-clock.

However, a new research study from The Netherlands suggests that diabetics face a Sisyphean task ‒ postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients, including even those patients with HbA1c well below 7.0%.

Although postprandial hyperglycemia is recognized as an important target in type 2 diabetes treatment, information on the prevalence of postprandial hyperglycemia throughout the day is limited. The researchers therefore assessed the prevalence of hyperglycemia throughout the day in type 2 diabetes patients and healthy controls under standardized dietary, but otherwise free-living conditions.

The researchers recruited 60 male type 2 diabetes patients (HbA1c 7.5 ± 0.1%) and 24 age- and BMI-matched normal glucose tolerant controls to participate in a comparative study of daily glycemic control. During a 3-day experimental period, blood glucose concentrations throughout the day were assessed by continuous glucose monitoring (CGM).

The researchers discovered that type 2 diabetes patients experienced hyperglycemia (glucose concentrations > 180 mg/dl [10 mmol/l]) 38 ± 4% of the day. Even diabetes patients with an HbA1c level below 7.0% (53 mmol/mol) experienced hyperglycemia for as much as 24 ± 5% throughout the day. Hyperglycemia was negligible in the control group (3 ± 1%).

After evaluating the data, the researchers concluded that hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients, including even those patients with HbA1c well below 7.0%. More importantly, “standard medical care with prescription of oral blood glucose lowering medication does not provide ample protection against postprandial hyperglycemia,” the authors wrote.

The aim of every diabetic is to keep postprandial blood sugar levels in line with the recommendations of the American Association of Clinical Endocrinologists, an organization of specialists who treat diabetes, that blood sugar should not be allowed to rise above 140 mg/dl two hours after a meal. The International Diabetes Federation (IDF) has also adopted the 140 mg/dl post-meal blood sugar target.

Since, as Dutch study shows, a majority of patients with diabetes fail to achieve their glycemic goals, it means elevated postprandial glucose (PPG) concentrations contribute to suboptimal glycemic control.

What is the contribution of PPG to the long-term complications of diabetes? Many studies have demonstrated a positive association between diabetic complications and hyperglycemia. “Complications” is a euphemism for some very ugly outcomes that include blindness, amputation, kidney failure and death. Considering the interrelationships among glycemic measures, this is not surprising.

A team of Italian researchers led by A Gastardelli started examining beta cell response to glucose in people with normal blood sugars discovered that a small amount of beta cell dysfunction began to be detectable in people whose blood sugar rose only slightly over 100 mg/dl on a 2-hour glucose tolerance test. The beta cells are the cells in the pancreas that produce the insulin your body uses to control your blood sugar.

Analyzing their data further, they found that with every small increase in the 2-hour glucose tolerance test result, there was a corresponding increase in how much beta cell failure was detectable. The higher a person’s blood sugar rose within “normal” range, the more beta cells were failing.

In another study, University of Utah neurologists found that patients who were not known to be diabetic, but who registered 140/mg or higher on the 2-hour sample taken during a glucose tolerance test were much more likely to have a diabetic form of neuropathy than those who had lower blood sugars. Even more telling, the researchers found that the length of time a patient had experienced this nerve pain correlated with how high their blood sugar had risen over 140 mg/dl on the 2-hour glucose tolerance test reading.

It is important to note that this study also showed that only the glucose tolerance test results corresponded to the incidence of neuropathy in these patients, not their fasting blood sugar levels or their results on the HbA1c test. This is significant because most American doctors do not offer their patients glucose tolerance tests, only the fasting glucose and HbA1c tests that fail to diagnose these obviously damaging post-meal blood sugars.

Given facts such as these, what does a diabetic do? Jenny Ruhl suggests that if your blood sugar has been very high for a while, you can bring down the levels by proceeding in stages, setting your blood sugar targets progressively lower, a step at a time. But don’t stay at higher than normal levels for any longer than is absolutely necessary. Once your body does adapt, you will probably feel much better and much more energetic than before.

Ruhl recommends patience while your body becomes accustomed to new, healthy, blood sugar levels, cautioning not to respond to feeling as if you were having a hypo by eating carbs to push up your blood sugar as long as your blood sugar tests at 80 mg/dl (4.4 mmol/l) or above. Give your body a chance to adapt and eventually you will feel completely normal when you have a normal blood sugar and may feel surprisingly toxic when your blood sugar reaches the dangerously high levels that you used to feel normal at, she says.

The 140 mg/dl (7.8 mmol/L) blood sugar target is a good start, but many of us find we feel better and get even more normal health if we shoot for truly normal blood sugars and keep our blood sugar under 120 mg/dl (6.7 mmol/L) at all times. If you can do it, go for it. Now that we know that heart attack risk rises significantly at HbA1c in the mid 5% range, getting to true normal is that much more important, Ruhl concludes.

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