Tag Archives: Type 2

New Form Of ‘Ultra-Bad’ Cholesterol That Increases Risk Of Heart Disease Discovered

Fatty material is stickier than LDL, making it more likely to attach to artery walls

SCIENTISTS from the University of Warwick in the UK have discovered a new form of ‘ultra-bad’ cholesterol that increases the risk of heart disease. The fatty material is stickier than the common form of ‘bad’ cholesterol, making it more likely to attach to artery walls.

Funded by the British Heart Foundation (BHF), the researchers found that ‘ultra-bad’ cholesterol, called MGmin-low-density lipoprotein (LDL), which is more common in people with type 2 diabetes and the elderly, appears to be ‘stickier’ than normal LDL. This makes it more likely to attach to the walls of arteries. When LDL attaches to artery walls it helps form the dangerous ‘fatty’ plaques’ that cause coronary heart disease (CHD).

The research – published online on May 26 in the journal Diabetes – shows how the make-up and the shape of a type of LDL cholesterol found in diabetics could make it more harmful than other types of LDL. The findings provide one possible explanation for the increased risk of coronary heart disease in people with diabetes. Understanding exactly how ‘ultra-bad’ LDL damages arteries is crucial, as this knowledge could help develop new anti-cholesterol treatments for patients.

The researchers made the discovery by creating human MGmin-LDL in the laboratory, then studying its characteristics and interactions with other important molecules in the body. They found that MGmin-LDL is created by the addition of sugar groups to ‘normal’ LDL – a process called glycation – making LDL smaller and denser.

By changing its shape, the sugar groups expose new regions on the surface of the LDL. These exposed regions are more likely to stick to artery walls, helping to build fatty plaques. As fatty plaques grow they narrow arteries – reducing blood flow – and they can eventually rupture, triggering a blood clot that causes a heart attack or stroke.

The discovery might also explain why metformin, a widely prescribed type 2 diabetes drug, seems to lead to reduced heart disease risk. Metformin is known to lower blood sugar levels, and this new research shows it may reduce the risk of CHD by blocking the transformation of normal LDL to the more ‘sticky’ MGmin-LDL.

Dr Naila Rabbani

Dr Naila Rabbani, Associate Professor of Experimental Systems Biology at Warwick Medical School, who led the study, said: “We’re excited to see our research leading to a greater understanding of this type of cholesterol, which seems to contribute to heart disease in diabetics and elderly people. Type 2 diabetes is a big issue…particularly common in lower income groups and South Asian communities.  The next challenge is to tackle this more dangerous type of cholesterol with treatments that could help neutralize its harmful effects on patients’ arteries.”

Dr Shannon Amoils, Research Advisor at the BHF, said: “We’ve known for a long time that people with diabetes are at greater risk of heart attack and stroke. There is still more work to be done to untangle why this is the case, but this study is an important step in the right direction.”

Via EurekAlert

U.S. Halts ‘Good Cholesterol’ Study

Meanwhile, U.S. officials abruptly halted a major study Wednesday of a drug that boosts people’s good cholesterol did not go on to prevent heart attacks or strokes.

The disappointing findings involve super-strength niacin (Niaspan), a type of B vitamin that many doctors already prescribe as potential heart protection. The failed study marks the latest setback in the quest to harness good cholesterol to fight the bad kind.

The trial, called AIM-HIGH, looked at whether adding Niaspan — a high-dose, extended-release form of niacin, or vitamin B3 — to certain heart-disease patients’ statin drug regimens would prevent more cardiac events than a statin alone.

“This sends us a bit back to the drawing board,” said Dr Susan Shurin, cardiovascular chief at the National Institutes of Health. The study tested Abbott Laboratories’ Niaspan, an extended-release form of niacin that is a far higher dose than is found in dietary supplements. As expected, the Niaspan users saw their beneficial HDL levels rise and their levels of risky triglycerides drop more than people who took a statin alone.

But the combination treatment did not reduce heart attacks, strokes, or the need for artery-clearing procedures such as angioplasty, the NIH said. It led the NIH to stop the study 18 months ahead of schedule.

Related news: Arterial plaque test may accurately predict risk for cardiovascular complications among type 2 diabetics

Diabetes Can Be Predicted 7 Years Before Pregnancy With Blood Sugar And Body Weight

A woman’s risk of developing diabetes during pregnancy can be identified up to seven years before she becomes pregnant based on routinely assessed measures of blood sugar and body weight, according to a Kaiser Permanente study published in the online issue of the American Journal of Obstetrics and Gynecology.

Researchers at the Kaiser Permanente Division of Research in Oakland, Calif., studied 580 ethnically diverse women who took part in a multiphasic health checkup at Kaiser Permanente Northern California between1984 and 1996. The researchers looked at women who had a subsequent pregnancy and compared those who developed gestational diabetes mellitus (GDM) during pregnancy to women who did not have GDM.

The study found that the risk of GDM increased directly with the number of adverse risk factors commonly associated with diabetes and heart disease (high blood sugar, hypertension and being overweight) present before pregnancy. In addition, the authors found that adverse levels of blood sugar and body weight were associated with a 4.6-fold increased risk of GDM, compared to women with normal levels.

The study is among the first to look at routinely measured cardio-metabolic risk factors before pregnancy in women who later became pregnant and developed GDM. The research provides evidence to support pre-conception care for healthy pregnancies as noted in a 2006 report by the Centers for Disease Control and Prevention. That report suggested that risk factors for adverse outcomes among women and infants can be identified prior to conception and are characterized by the need to start, and sometimes finish, interventions before conception occurs.

Women who develop GDM during pregnancy are more likely to develop Type 2 diabetes after pregnancy, previous research has shown. GDM is defined as glucose intolerance that typically occurs during the second or third trimester and causes complications in as much as 7 percent of pregnancies in the United States. It can lead to early delivery and Cesarean sections, and increases the baby’s risk of developing diabetes, obesity and metabolic disease later in life.

Dr Monique M. Hedderson

“Our study indicates that a woman’s cardio-metabolic risk profile for factors routinely assessed at medical visits such as blood sugar, high blood pressure, cholesterol and body weight can help clinicians identify high-risk women to target for primary prevention or early management of GDM,” said lead author Monique Hedderson, PhD, a research scientist at the Kaiser Permanente Division of Research.

Although the established risk factors for GDM are older maternal age, obesity, non-white race/ethnicity, giving birth previously to a very large baby and a family history of diabetes, these risk factors are absent in up to half of women who develop GDM. This study is significant because it gives a better understanding of pre-pregnancy predictors of GDM that may help identify women at risk and get them into intervention programs before pregnancy to prevent GDM and its associated risks, researchers said.

Related articles on gestational diabetes:

  • A study in the American Journal of Epidemiology found that cardio-metabolic risk factors such as high blood sugar and insulin, and low high density lipoprotein cholesterol that are present before pregnancy, predict whether a woman will develop diabetes during a future pregnancy.
  •  A study in the American Journal of Obstetrics and Gynecology found there is an increased risk of recurring gestational diabetes in pregnant women who developed gestational diabetes during their first and second pregnancies.
  •  A study in Diabetes Care of 10,000 mother-child pairs showed that treating gestational diabetes during pregnancy can break the link between gestational diabetes and childhood obesity. That study showed, for the first time, that by treating women with gestational diabetes, the child’s risk of becoming obese years later is significantly reduced.
  •  A study in Obstetrics & Gynecology of 1,145 pregnant women found that women who gain excessive weight during pregnancy, especially in the first trimester, may increase their risk of developing diabetes later in their pregnancy.

Via EurekAlert

Related Video:

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?

After Cracking Metformin Code, Scientist Makes Breakthrough Discovery That Points The Way To New Class Of Diabetes Drugs

HDAC inhibitors may provide a novel way to cut excessive blood glucose levels at the source

RESEARCHERS have uncovered a novel mechanism that turns up glucose production in the liver when blood sugar levels drop, pointing towards a new class of drugs for the treatment of metabolic disease, the Salk Institute for Biological Studies announced in a press statement on Tuesday.

Dr Reuben J. Shaw

In a uniquely collaborative study, the scientists have found evidence ‒ published in the May 13, 2011 issue of the journal Cell ‒ that a group of enzymes, or proteins, currently under investigation for the treatment of cancer could potentially also work as a treatment for type 2 diabetes. This is significant because it not only portends a new treatment for diabetes, but it also could mean that a new treatment has already gotten through the costly and lengthy early stages of drug development.

The Salk discovery revolves around enzymes called histone deacetylases, or HDACs, which help the liver produce sugars when blood glucose runs low after prolonged periods of fasting, particularly at night. After a meal, insulin “instructs” muscle cells to store this glucose and turns off sugar production in the liver. In patients with type 2 diabetes, however, the body effectively doesn’t “listen” to insulin, and the liver keeps producing sugar.

In liver cells, so called class II HDACs (shown in green) are usually sequestered in the cytoplasm.

“These exciting results show that drugs that inhibit the activity of class II HDACs may be worthwhile to be pursued as potential diabetes drugs,” said lead author Reuben Shaw, an assistant professor in Salk’s Molecular and Cell Biology Laboratory.

Up to this point, all experiments had been performed in cultured cells but the researchers were really interested in whether class II HDACs controlled blood glucose in mouse models of diabetes. Strikingly, suppression of all three HDACs simultaneously restored blood glucose levels to almost normal in four different models of type 2 diabetes.

In response to glucagon, HDACs quickly move into the nucleus, where they help turn on genes needed for the production of glucose in the liver

“The key will be to specifically block HDACs involved in glucose control,” said Shaw, “but the fact gluconeogenesis takes place in the liver makes this task easier as most drugs sooner or later travel to the liver once they hit the bloodstream.”

“Our results predict then that some of those drugs, probably not the same ones that work on cancer but some of the ones that are sitting on the shelf that maybe weren’t effective for cancer but in fact hit these enzymes, that they could be potential therapeutics for diabetes,” said Shaw. “That means that the time from this initial discovery until the time that this can be tested in the clinic is much shorter.”

Dr. Ronald Evans, a professor in Salk’s Gene Expression Laboratory, said that while this discovery is novel, scientists have long noticed a link between cancer and diabetes, particularly because the risks of both diseases are increased in obese patients. This discovery — that suppressing HDACs can treat diabetes as well as cancer — is a way of turning this theory into a potential treatment.

“We know that along with increased weight and obesity there is an increased risk of cancer. We also know that cancer cells undergo a profound metabolic change and so the cancer metabolism has become a very big area (of study),” Evans said.

“So for those of us who study metabolism and study cancer, the link between these two seemingly separate areas, actually at the level of the genome, happen to work with several common pathways,” he continued, “because they’re both dealing with either consuming energy, which is what happens with cancer, or storing energy, which is what happens with obesity.”

Does Periodic Fasting Lower Diabetes Risk?

Currently, metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet), an oral biguanide anti-diabetic drug, is the most widely prescribed agent for treatment of type 2 diabetes. The drug mainly works by lowering glucose production by the liver, and thus lowering fasting blood glucose. Although metformin – approved in the United States in 1994, and in Europe prior to that – has been used for many years, its mechanism of action is not well understood.

Galega officinalis (Goat's Rue)

“Metformin is originally derived from a plant found in Western Europe called ‘French lilac’ or ‘Goat’s Rue’ because goats didn’t like to eat it. They steered clear of the plant because it contains a compound that acts to naturally lower blood glucose in animals that eat it ‒ to prevent them from eating it again,” Shaw explained.

A few years ago, Shaw discovered how metformin helps insulin to control glucose levels:  It binds to a “metabolic master switch” known as AMPK that blocks glucose production in the liver. Trying to identify novel targets of AMPK that might be relevant to diabetes, Maria Mihaylova, a graduate student in the Shaw laboratory, focused her efforts on a family of HDACs known as class II HDACs. They function as negative regulators of gene activity by stabilizing the tightly coiled structure of DNA in chromosomes, making it inaccessible to proteins that transcribe DNA.

Working closely with Ronald M. Evans and his team, Mihaylova found that inhibiting class II HDACs shut down genes encoding enzymes needed to synthesize glucose in liver. “We identified class II HDACs as direct targets of AMPK in a bioinformatics-based screen, but we didn’t know which genes they might regulate in liver since they weren’t even known to be found there,” said Mihaylova.

In collaboration with her colleagues in Marc Montminy’s lab, a professor in the Clayton Foundation Laboratories for Peptide Biology, and like Shaw and Evans a member of the Center for Nutritional Genomics at the Salk Institute, Mihaylova discovered that HDACs themselves associated with the DNA regulatory elements controlling the expression of the glucose synthesizing enzymes, but they only flocked there after she had treated cells with the fasting hormone glucagon.

“In response to the glucagon, chemical modifications on class II HDACs are removed and they can translocate into the nucleus,” she explains. There, they bind to FOXO, a key metabolic regulator, which had been shown previously to be shut down by insulin.

“It came as a big surprise that FOXO is activated by glucagon,” explains Shaw. Further experiments confirmed that the genetic suppression of class II HDACs in liver cells led to an increase in acetylated FOXO, which now can neither bind DNA nor activate the genes encoding glucose-synthesizing enzymes.

A parallel study, led by Montminy and published in the same issue of Cell as Shaw’s paper, shows that in fruit flies, FOXO not only controls the expression of a fat-digesting enzyme but is activated by a glucagon-like hormone in a manner similar to human FOXO.

“The central circuitry of how animals regulate metabolism in response to fasting and feeding is conserved from fly all the way to man emphasizing the importance of class II HDACs in coordinating how different hormones direct the creation and use of glucose,” says Shaw, who is a co-author on Montminy’s paper.

Shaw next plans to test whether these glucose loving HDACs may also play roles in certain forms of cancer as well.

Source: Salk Institute for Biological Studies

D –Blog Week: Many Battles To Be Fought Before The War Against Diabetes Is Won

A Report From the Diabetes Capital of the World 

The second Diabetes Blogging Week (May 9-15) is upon us, giving bloggers who write about diabetes to come together and exchange views. Today we are writing about the different perspectives of diabetes bloggers in different countries and different socio-economic-cultural settings.

If asked, I’d say most of us agree that the diabetes epidemic sweeping many parts of the world must be met head on. Where we differ is our perception of the challenge. Nevertheless, bloggers and diabetes activists like Jenny Ruhl, Manny Hernandez, Scott Strumello, and Amy Tenderich, not to forget countless others, have made tremendous contributions in bringing the fight against diabetes to the forefront in the mainstream media. I’m grateful to all of them for enlightening me about diabetes care. Indeed, they are one of the reasons I began blogging about diabetes.

Unfortunately, however, there’s a tendency amongst writers (unless warranted otherwise) to treat all people with diabetes (PWD) as a general category without appreciating the fact that there is a significant diversity amongst them. To researchers and bloggers alike (including myself), it doesn’t matter that diabetics live on different continents, or belong to different ethnic groups, only the disease is important. Even within the ethnic groups, the divide between rural, semi-urban and urban areas is hardly taken into account to formulate policy, not to speak of wide socio-economic disparities. So even I end up endorsing CGM when a majority of diabetics cannot afford an HbA1c test.

After blogging about diabetes for one year this month, I have come round to the view that while the ultimate goals of all diabetes care programs may be the same, these differences and diversities must be taken into account when drawing up specific plans and guidelines so that the challenge posed by the worldwide diabetes epidemic can be met effectively. This post has inadvertently become lengthy, but I’m using Karen Graffeo’s’s platform in an attempt to educate and inform fellow diabetics about people with diabetes beyond US shores. Of course, I’m laying myself open to well-meaning criticism, but nothing is worse than uncontrolled diabetes.

Take the case of India, a vast and diverse country, which is home to the second largest number of diabetics after China (India may still have more diabetics as millions of cases go unreported). Not only is India a vast and heavily populated country, but the people who live here are ethnically heterogeneous, which is manifested in significantly different religions, communities, castes, cultures, languages (18 major languages and more than 200 dialects!), food habits, lifestyles and genetic endowment. It would be fair to say that India has more diversity than the whole of Europe. It is this diversity that must be taken into account when planning any program for diabetes care in India.

Diabetes in India has long passed the stage of an epidemic and numbers have given the country the dubious distinction of ‘Diabetes Capital’ of the world. To put it simply, it has crossed the stage of a problem associated with individuals to become an astronomically growing large public health problem.

It may surprise many of you, but the type of diabetes which we see here in India is considerably different from that described in the western literature. Although the estimate of Type 1 is around 1% of the total diabetics, the vast majority of Type 2s differ significantly from their western counterparts. Only about one third of these would be considered obese; 10-15% would be underweight and the rest would be of normal weight or just slightly over the acceptable weight range.  The propensity to become a diabetic is higher in Indians as we have a low threshold for the risk factors ‒ Americans develop diabetes when the body mass index (BMI) is 30 and 35; Indians develop it when the BMI is only 25.

What is of considerable interest is not only that the number of diabetics is increasing in leaps and bounds, in India, compared to the US, diabetes appears not only earlier in life (with many Type 2s being diagnosed at the age of 20-30 years), but the chronic long-term complications occur earlier, progressing more rapidly and reaching the hard end points in diabetics who are relatively younger as compared to the picture seen in the past.

To put India’s diabetes epidemic in perspective, the crude prevalence rate of diabetes in the country’s urban areas is about 9% while in rural areas it has increased to around 3% of the total population. If one takes into consideration that India’s population is more than 1 billion, the country is home to around 40 million diabetics. Surveys have also shown that the prevalence of Impaired Glucose Tolerance (IGT) is high. It has been reported that the prevalence of IGT is around 8.7% in urban and 7.9% in rural areas.

Another study has shown that the prevalence rate in urban areas is around 6%, whilst the figure in the rural areas is around 5%. Given the observation that around 35% of those with IGT will develop full blown diabetes within five years, the sheer numbers of those living with diabetes is overwhelming.

Screening has also shown that the unknown to known diabetes ratio is about 1.8:1 in urban areas, whilst it is as high as 3.3:1 in rural areas.

Whilst the high rate of prevalence of complications is disturbing, the picture is rendered all the more gloomy with reports that more than 35-40% of people show the presence of some diabetes related complications at the time of diagnosis.

It is therefore, a major concern to those involved in diabetes care that India has no major initiative available, or even planned, to try and face this problem. Even the central (federal) government’s announcement last year to conduct India’s first diabetes census is yet to take off.

India has a distinct need for a comprehensive diabetes care program that is workable. It needs to continuously be examined and reevaluated so that one is sure that the objectives are being achieved. Without such an objective evaluation, there is always a possibility that such programs will be high on “percept” and abysmal in “practice”.

It is crucial that for any program to succeed, it must be rooted in ground realities present in India. The program should have an infrastructure that makes it AVAILABLE, both in terms of technology and expertise, ACCESSIBLE even to the common man with diabetes, and AFFORDABLE.

Diabetes Clinic in India

The per capita income of an Indian has been estimated to be less than $400. In view of the significant disparity in incomes, more than 75% people earn much less. Economic realities have to be taken into consideration. This includes, both, the finances to make comprehensive and acceptable diabetes care services available to the people, and more importantly, the capacity of the people to afford these services.

It is widely accepted that the health, socio-economic and personal costs of diabetes and its attendant complications in India is unacceptably high, not only to the individual, but also to the nation as a whole when one considers the sheer number of people who are already known to be diabetic. This burden can only increase with the projected increase in the numbers of people with diabetes.

Unfortunately, the Indian government still does not consider diabetes and other non-communicable diseases as a priority area. The feeling is that we still have a long way to go in dealing with communicable diseases, which are again seeing a rise in numbers, immunization, providing clean drinking water and sanitation to the majority of the people, which get most of the funds allocated to the public health sector. As it is, the central (federal) government’s annual budget for health is a mere 1.2% of GDP, meaning a spend of just 25 cents per capita.

According to a recent paper in The Lancet, health services in India’s public sector, which can be accessed free or for a nominal fee, are grossly inadequate. Consequently, most Indians have to access private healthcare that is expensive, unaffordable and even unreliable. Good-quality healthcare in the private sector is also not available, particularly in rural and other remote parts of the country.

Even if the finances necessary for providing the basic modicum of services is made available, can the average person afford it? To paraphrase what 1998 Nobel Prize winner in Economics Amartya Sen said in the context of famines ‒ “the root cause of starvation in famines is not the lack of food, but the capacity of the average person to buy the food” ‒ it can be said that the root cause of a failure of a diabetes program is not only the availability of services, but the capacity of the average person to afford these services.

With the constraints that the government faces, and also the fact that the costs of therapy will increase by leaps and bounds, will optimal diabetes care become beyond the reach of most of our people with diabetes?

In the absence of any diabetes care program available in India, the question is often asked that if India does not have its own homegrown program, why doesn’t it “import” a program from abroad? There are many countries and regions which have good diabetes-related programs and one of these should be used in India.

Given India’s size and complexities, such imported diabetes care programs will rarely succeed. Programs based on the St. Vincent Declaration or the Declaration of the Americas, though excellent in themselves, can only act as beacons and not as the ultimate goals. India has to evolve its own program based on the ground realities. Based on this and the perceived needs and lacunae in diabetes care, India has to draw up a realistic plan to combat the diabetes. Sure, high sounding charters and programs look impressive on paper; but they achieve little, if anything, on the ground.

Therein lies the rub.

————————————————————

Based on the Statement of the ‘Indian Task Force on Diabetes Care in India’, which I endorse.

“Normal” Blood Sugar Levels May Still Mean You Have Prediabetes

FPG between 91 and 99 mg/dl is a strong independent predictor of type 2 diabetes, claims new study

Type 2 diabetes is a lifestyle disease in which the body no longer responds appropriately to the hormone insulin, which helps ferry sugar from the blood into our cells after a meal. When fasting blood sugar levels reach 126 mg/dl or more, doctors will diagnose diabetes

Prediabetes means that your blood sugar level is higher than normal, but it’s not yet increased enough to be classified as type 2 diabetes. Still, without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less. (Scroll to end for Prediabetes FAQs)

Traditionally, blood sugar levels below 100 mg/dl have been considered “safe”, whereas levels between 100 and 126 signal a “higher risk” of diabetes (prediabetes). But according to the new study by Dr. Paolo Brambilla and colleagues at the University Milano Bicocca in Italy, the currently accepted “normal” blood sugar range might be too wide.

“FPG (Fasting Plasma Glucose) between 91 and 99 mg/dl is a strong independent predictor of type 2 diabetes and should be used to identify people to be further investigated and aided with preventive measures,” the researchers say. The conclusion significantly expands the “prediabetes” label.

To back their claim, the researchers report that in the course of their study they discovered people at the high end of what’s considered the “normal” blood sugar range are twice as likely to get the disease as are those in the low end. The findings are in line with an earlier study from Oregon, and the Italian researchers say they can help identify the people who need extra medical attention.

The researchers looked at data for nearly 14,000 men and women who’d had blood drawn several times at their clinic. The patients were between 40 and 69 years old and all of them had normal blood sugar levels at first. Over the next seven to eight years, on average, about two percent of the women and nearly three percent of the men developed diabetes.

Less than one percent of those who started out with fasting blood sugar levels between 51 and 82 mg/dl wound up with the disease, while more than three percent did so if they had values between 91 and 99. After controlling for other factors that might influence the likelihood of getting diabetes, that corresponded to a two-fold difference in risk of developing the disease.

Research has shown that if you have prediabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting. If your blood sugar tests over 100 mg/dl fasting more than once, your fasting blood sugar is likely to go over the 125 mg/dl level used to diagnose full diabetes within 3 years.

More importantly, if your blood sugar is at 100 mg/dl fasting, it is very likely that your post-meal blood sugar is heading towards the diabetic range, which is over 200 mg/dl which is why your fasting blood sugar is deteriorating. High post-meal blood sugars kill beta cells. If you can bring down those post-meal highs, you may be able to prevent the beta cell death that is destroying your fasting control!

While opinion is divided on the question whether doctors should treat these people any different, as the researchers suggest, everyone agrees that people should strive to manage their weight and be physically active irrespective of what their blood sugar level is.

The bald reality is that, according to the American Diabetes Association, in the US alone there are three times as many prediabetics as people with diabetes (79:27 million). And It is estimated that there will be 418 million people worldwide with prediabetes by 2025.

How to Tell if You Have Prediabetes

The American Diabetes Association says while diabetes and prediabetes occur in people of all ages and races, some groups have a higher risk for developing the disease than others and warns that Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. This means they are also at increased risk for developing prediabetes.

There are three different tests your doctor can use to determine whether you have prediabetes:

• The A1C test

• The fasting plasma glucose test (FPG)

• The oral glucose tolerance test (OGTT).

The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have prediabetes or diabetes.

If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT). Both are also known as prediabetes.

The American Diabetes Association Risk Test for Diabetes can help you determine if you are at increased risk for diabetes or prediabetes. A high score may indicate that you have prediabetes or at risk for prediabetes. Take the test and find out for sure.

ADA Prediabetes FAQs

What is prediabetes and how is it different from diabetes?

Prediabetes is the state that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. About 11 percent of people with prediabetes in the Diabetes Prevention Program standard or control group developed type 2 diabetes each year during the average 3 years of follow-up. Other studies show that many people with prediabetes develop type 2 diabetes in 10 years.

What are the symptoms of prediabetes?

The reason why so many people suffer from prediabetes and are completely unaware of it is because it is quite possible for no symptoms to manifest themselves. Both diabetes and prediabetes develop at a gradual rate.

How do I know if I have prediabetes?

Doctors can use either the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT) to detect prediabetes. Both require a person to fast overnight. In the FPG test, a person’s blood glucose is measured first thing in the morning before eating. In the OGTT, a person’s blood glucose is checked after fasting and again 2 hours after drinking a glucose-rich drink.

How do I stop prediabetes developing into Type 2 diabetes?

The good news may be that, if you have become aware of the disease early, your condition can still be cured. The two principle factors for consideration are the changing of diet and the addition of appropriate physical exercise to your lifestyle. By making these changes, it may be possible to return blood sugar levels to normal. Prediabetes is a serious medical condition that can be treated.

The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with prediabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range. But for a comprehensive and individual plan you should see your doctor.

Is prediabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?

Yes. Doctors sometimes refer to this state of elevated blood glucose levels as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG), depending on which test was used to detect it.

Why do we need to give it a new name? Has the condition changed?

The condition has not changed, but what we know about it has. We are giving IGT/IFG a new name for several reasons. prediabetes is a clearer way of explaining what it means to have higher than normal blood glucose levels. It means you are likely to develop diabetes and may already be experiencing the adverse health effects of this serious condition. People with prediabetes are at higher risk of cardiovascular disease. People with prediabetes have a 1.5-fold risk of cardiovascular disease compared to people with normal blood glucose. People with diabetes have a 2- to 4-fold increased risk of cardiovascular disease. We now know that people with prediabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes.

How does the FPG test define diabetes and prediabetes?

Normal fasting blood glucose is below 100 mg/dl. A person with prediabetes has a fasting blood glucose level between 100 and 125 mg/dl. If the blood glucose level rises to 126 mg/dl or above, a person has diabetes.

How does the OGTT define diabetes and prediabetes?

In the OGTT, a person’s blood glucose is measured after a fast and 2 hours after drinking a glucose-rich beverage. Normal blood glucose is below 140 mg/dl 2 hours after the drink. In prediabetes, the 2-hour blood glucose is 140 to 199 mg/dl. If the 2-hour blood glucose rises to 200 mg/dl or above, a person has diabetes.

Which test is better?

According to the expert panel, either test is appropriate to identify prediabetes.

Why do I need to know if I have prediabetes?

If you have prediabetes, you can and should do something about it. Studies have shown that people with prediabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle that include modest weight loss and regular exercise. The expert panel recommends that people with prediabetes reduce their weight by 5-10 percent and participate in some type of modest physical activity for 30 minutes daily. For some people with prediabetes, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.

What is the treatment for prediabetes?

Treatment consists of losing a modest amount of weight (5-10 percent of total body weight) through diet and moderate exercise, such as walking, 30 minutes a day, 5 days a week. Don’t worry if you can’t get to your ideal body weight. A loss of just 10 to 15 pounds can make a huge difference. If you have prediabetes, you are at a 50 percent increased risk for heart disease or stroke, so your doctor may wish to treat or counsel you about cardiovascular risk factors, such as tobacco use, high blood pressure, and high cholesterol.

Who should get tested for prediabetes?

If you are overweight and age 45 or older, you should be checked for prediabetes during your next routine medical office visit. If your weight is normal and you’re over age 45, you should ask your doctor during a routine office visit if testing is appropriate. For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or prediabetes. These include high blood pressure, low HDL cholesterol and high triglycerides, a family history of diabetes, a history of gestational diabetes or giving birth to a baby weighing more than 9 pounds, or belonging to an ethnic or minority group at high risk for diabetes.

How often should I be tested?

If your blood glucose levels are in the normal range, it is reasonable to be checked every 3 years. If you have prediabetes, you should be checked for type 2 diabetes every 1-2 years after your diagnosis.

Could I have prediabetes and not know it?

Absolutely. People with prediabetes don’t often have symptoms. In fact, millions of people have diabetes and don’t know it because symptoms develop so gradually, people often don’t recognize them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, a frequent desire to urinate, blurred vision, or a feeling of being tired most of the time for no apparent reason.

Sources: American Diabetes Association, Diabetes Care, Diabetes UK

Diabetic Diet: Is Determining Glycemic Load Better Than Counting Carbs?

 

 

 

 

 

 

 

To count carbs or discount them ‒ the debate continues. Being type 2 insulin dependent, I’m trying to make sense of the differing conclusions of two studies that have been published recently. It’s hard to say what these studies really show ‒ it can get confusing with all the information out there ‒ especially when pilaf (pilao) is on Sunday’s lunch menu!

Dr. Andrea Laurenzi of San Raffaele Vita-Salute University in Milan suggests that diabetes patients may benefit from counting the number of carbohydrates in their diet. In a small study ‒ published online in the America Diabetes Association journal Diabetes Care ‒ the Milan researchers looked at 61 adults on insulin pump therapy and found that those who learned to count carbs had a small reduction in weight and waist size after 6 months. Additionally, they reported gains in quality of life and an improvement in blood sugar levels.

On the other hand, Jiansong Bao at the University of Sydney in Australia, says the number of carbs alone might not be the best way to go. Writing in the American Journal of Clinical Nutrition, he feels that how many carbs you eat might be less important for your blood sugar than your food’s glycemic load, a measure that also takes into account how quickly you absorb those carbs.

Dr. Sanjeev Mehta, of the Joslin Diabetes Center and Harvard Medical School in Boston says while Laurenzi’s findings do not prove that carb counting is the answer for people with type 1 diabetes, it is widely recommended that people on insulin try to estimate the carbohydrate content of their meals to help calculate their insulin doses. Indeed, a few other studies too have suggested that carbohydrate counting can help people with type 1 diabetes control their blood sugar levels.

There are books and online resources available for people who are interested in learning how to count carbs. However, some people have difficulty learning or sticking with the method, Mehta noted, and benefit from help from a professional, such as a dietitian or certified diabetes educator.

Mayo Clinic nutritionist Katherine Zeratsky, R.D., L.D. explains counting carbohydrates is a method for controlling the amount of carbohydrates you eat at meals and snacks. This is because they have the greatest impact on your blood sugar. Eating consistent amounts of carbohydrates every day helps you control your blood glucose level.

But carbohydrates aren’t the only dietary consideration when you have diabetes. You need to also limit fat and cholesterol and control the number of calories you consume. The best way to do this is to control portion sizes, she says.

“Eating a healthy diet helps you control your diabetes and reduces your risk of diabetes-related conditions, such as heart disease and stroke. So, just because a food contains no carbohydrates doesn’t mean that you can eat it in unlimited amounts,” she cautions.

However, Bao claims the so-called glycemic load of a food, which also takes into account how quickly it makes the blood sugar rise, might work better. Foods with soluble fiber, such as apples and rolled oats, typically have a low glycemic index, one of the contributors to glycemic load. Foods with a low glycemic index cause the blood sugar to rise slowly, and so put little pressure on the pancreas to produce insulin.

The glycemic load is calculated by multiplying the amount of carbs in grams per serving by the food’s glycemic index divided by 100. (The glycemic index for a variety of foods can be found here.)

The Sydney researchers say their findings also suggest that eating foods with high glycemic loads could be linked to chronic disease like type 2 diabetes ‒ which does not require insulin injections ‒ and heart disease by raising blood sugar and insulin levels.

The researchers took finger-prick blood samples from 10 healthy young people who ate a total of 120 different types of food ‒ all with the same calorie content. They also had two groups of volunteers eat meals with various staples from the Western diet, such as cereal, bread, eggs and steak. And the glycemic load repeatedly trumped the carb count in predicting the blood sugar and insulin rise after a meal.

A Reuters report quotes Dr. Edward J. Boyko ‒ a diabetes expert at the University of Washington in Seattle who wasn’t involved in the Sydney study ‒ saying it wasn’t certain the findings would hold up in people who aren’t completely healthy, adding, long-term effects and other nutrients in the food might also be important for disease risk.

“It would just be speculation whether a dietary change like this would help people with type 2 diabetes.” The most important problem, Boyko points out, remains pure and simple overeating. “The excess weight is the main thing we ought to focus on…The simplest message would be, eat less.”

Few Diabetics Aware of Potential Kidney Complications

Too many people who have diabetes don’t know about their increased risk of kidney disease, a British researcher says.

Researchers led by Gurch Randhawa of the University of Bedfordshire in England conducted a multicultural study — including 23 white and 25 South Asian patients with diabetes. The residents of England were between the ages of 34 and 79 years and had all been referred to a kidney specialist.

The study, published in the Journal of Renal Care, said most diabetes patients are completely unaware of how diabetes can affect their kidneys until sent to a specialist. He added “Many of the patients we spoke to were much more aware of how diabetes could affect their eyes and feet than their kidneys. We believe this study highlights a serious need for more information about the risks that diabetics face from kidney disease.”

“The people we spoke to experienced feelings of surprise, fear and regret when they found out their kidney had been affected,” Randhawa said in a statement.

“Some patients saw their kidney referral as a ‘wake-up call’ that they needed to manage their diabetes more seriously, while others were concerned about their lack of knowledge about the disease.”

However, the study finds South Asian patients tend to be a lot younger than their white counterparts. The finding confirms, says Randhawa, that South Asian patients tend to develop diabetic-related kidney problems at an earlier age.

Some Health Factors May Be Linked To Cognitive Problems For People With Type 2 Diabetes

Type 2 diabetes is linked with a number of health problems, but a new study finds that older diabetics who have high blood pressure, gait and balance problems or think their health is poor may be at higher risk for cognitive problems.

Researchers looked at 13 potential variables that could affect cognition, including grip strength, blood pressure, involvement in physical activities, social engagement, gait and balance, and a subjective measure of a person’s health.

The study participants, from British Columbia, included 41 people with Type 2 diabetes age 55 to 81, and a matched group of 458 healthy people that served as a control. They were given cognitive tests that measured memory, verbal fluency, neurocognitive speed, and other abilities.

Three health-related variables were found to be most associated with a higher risk of cognition problems: high systolic blood pressure (the top number that measures the heart’s contractions), walking more slowly and being unstable, and thinking that one’s health is bad.

Blood pressure might be a factor, the study authors said, because of its role in other metabolic issues such as insulin resistance and hyperglycemia, which may be risk factors for cerebrovascular impairment. Walking and balance could figure in since diabetes may influence the areas of the brain that control gait, balance and cognition. And because Type 2 diabetes can affect stress and depression, those factors could influence results on cognitive tests.

Though the study points out that these related health issues may not always produce learning or memory problems, they are important enough risk factors to be noted.

“Awareness of the link between diabetes and cognition could help people realize how important it is to manage this disease; and to motivate them to do so,” said study co-author Roger Dixon of the University of Alberta, in a news release.

The study appears in the September issue of the journal Neuropsychology.

Thank you Jeannine Stein/Los Angeles Times

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