Unilever Gathers Experts for a Diabetes Forum in Singapore

Unilever Research and Development and A Star, the Singapore agency for Science, Technology and Research, organized a symposium to discuss on the causes and prevention of Diabetes and Cardiovascular disease. A total of 250 delegates were expected to attend the meeting along with academic researchers and representatives from public health bodies, NGOs, and private companies.

During the meeting, it was found that developing countries constitute about 80% of Diabetes patients. It also came to light that India and China are the first two countries with the maximum count of diabetic persons. The situation is expected to worsen in the coming two decades. According to Sir Prof. Gluckman from the University of Auckland, “Asians appear to be particularly susceptible to these diseases and are becoming ill at a younger age and a lower body mass index than other ethnic groups.” The experts are still unable to find the reasons for this epidemic.

Jim Crilly (EVP Unilever Research) highlighted that the main purpose of the symposium extended beyond sharing information. He added, “Our aim was to seek opportunities for Unilever to partner and collaborate with the best international and local experts in this field. Unilever as a major manufacturer in the fast moving consumer goods sector seeks to use its brands, R&D and innovations to make Asian consumers lives healthier and happier everyday.”

AstraZeneca and Bristol-Myers Squibb Present Results on dapagliflozin at the 46th annual meeting of the European Association for the Study of Diabetes

AstraZeneca and Bristol-Myers Squibb presented results from the study on dapagliflozin at the 46th annual meeting of the European Association for the Study of Diabetes. As per the results of a late-stage clinical trial, dapagliflozin works as effective as a generic drug already present in the market.

According to the phase-3 trial results, AstraZeneca and Bristol-Myers Squibb’s investigational drug dapagliflozin in combination with a widely available generic metformin was as effective as a combination of combglipizide and metformin, or as compared with metformin alone. Patients who were prescribed dapagliflozin experienced weight loss, while patients prescribed with glipizide experienced weight gain and some patients experienced hypoglycaemia.

Takeda to Continue with ACTOS for Treatment of Type 2 Diabetes

Takeda Pharmaceuticals North America, a part of Takeda, has reiterated its commitment to ACTOS (pioglitazone HCl) and medications having ACTOS for the treatment of type 2 diabetes following suspension announcement of rosiglitazone in the US and Europe by the FDA and the European Medicines Agency (EMA). ACTOS has same use and class as other diabetes drugs but its chemical structure is unqiue having different therapeutic effects. The drug works very well with proper diet and exercise that further improve blood sugar (glucose) control in many adults suffering from the condition.

Clinical studies have been conducted since the last 11 years in over 20,000 patients worldwide, and ACTOS has shown good results without any proof of increased danger of heart attack, stroke or death. Thus, adding the company’s confidence on the consistency and positive results of ACTOS data.

Takeda’s initiatives in the field of diabetes 

• The company in 2005, completed PROactive (PROspective PioglitAzone Clinical Trial In MacroVascular Events) trial, which was undertaken to access significant CV outcomes in type 2 diabetes patients. 
• In 1999, the company introduced ACTOS commercially for treatment of type 2 diabetes.

Research: Blueberries Improve Pre-diabetic Condition

Blueberries have properties that help improve factors related to pre-diabetes and decrease inflammation in obese men and women, as per a research conducted by the Pennington Biomedical Research Center (PBRC).

                                        

Study:

Conducted over a six week period, the study involved 36 obese subjects diagnosed with insulin resistance, but who had no evidence of Type 2 Diabetes. The participants were randomly kept on a blueberry-rich or nutritionally equivalent blueberry-free smoothie for 42 days. The subjects were asked to intake the smoothie twice a day.

Result:

Dr. April Stull, PBRC Researcher, said, "The participants who consumed the blueberry smoothies had improved insulin sensitivity compared to those consuming no blueberries. We now know that compounds in blueberries may help obese, non-diabetic individuals maintain healthy blood glucose levels.”

PBRC is urging additional research to study whether the same effects would be found in people with Type 2 Diabetes.

FDA may Restrict Use of Diabetes Drug Avandia to Patients with Type 2 Diabetes

FDA has declared that the organization will restrict the use of the Diabetes drug Avandia (rosiglitazone) to patients with Type 2 Diabetes who were unable to achieve glucose control on other medications since the drug elevated risk of cardiovascular events, such as heart attack and stroke. The administration further announced that current users of Avandia, who are benefiting from the drug, can continue using the medication if they choose to do so.

Avandia, manufactured by GlaxoSmithKline (GSK), is intended to be used in conjunction with diet and exercise to improve glucose (blood sugar) control in patients with Type 2 Diabetes Mellitus. The drug is in a class of drugs known as thiazolidinediones, or TZDs.

The U.S. Food and Drug Administration ordered GSK to develop a restricted access program for Avandia under a risk evaluation and mitigation strategy (REMS). Under the REMS, Avandia will be available to new patients only if they are unable to achieve glucose control on other medications and are unable to take Actos (pioglitazone), the only other drug in this class.

In addition, the FDA ordered GSK to convene an independent group of scientists to review key aspects of the company's clinical trial known as RECORD, which studied the cardiovascular safety of Avandia compared to standard diabetes drugs.

The agency has also stopped the GSK's clinical trial known as TIDE and rescinded all of the regulatory deadlines for completion of the trial. The TIDE trial compares Avandia to Actos and to standard diabetes drugs.

The FDA may take additional actions after the independent re-analysis of RECORD is completed.

Study: Analog Glulisine Improves Glycemic Control in Hospitalized Type 2 Diabetes Patients

According to the researchers, insulin therapy in hyperglycemic inpatients is difficult due to vacillating meal times in hospitals, irregular food intake, and medical conditions that can lead to hypoglycemia. Hence, they studied the benefit of rapid-acting insulin in this setting in 180 patients with Type 2 Diabetes who were admitted for non-critical medical or surgical care for at least 3 days.

The primary end points of the study were glycemic control, quantified by the mean daily blood glucose concentration and the incidence of hypoglycemia.

After being removed from any prior Diabetes medication, the patients were randomized in two groups to either rapid-acting glulisine (Apidra, Sanofi-Aventis) or regular insulin (Novolin R, Novo Nordisk) before meals, as well as insulin glargine (Lantus, Sanofi-Aventis) at bedtime.

Results: 

• For the first four days, the average blood glucose concentrations were the same, 159 mg/dL, in the both groups. 
• However, after four days, the concentration levels stood at 140 vs. 162 mg/dL (p<0.0007) in the glulisine and normal insulin groups, respectively. 
• After seven days, the levels were 133 vs. 164 mg/dL (p<0.0001) in the glulisine and normal insulin groups, respectively. 

For hypoglycemia, the study stated that "there were 123 hypoglycemic events: 56 in the glulisine group and 67 in the regular insulin group." However, Dr. Meyer and colleagues report, the number of subjects with one or more hypoglycemic episodes (30% vs. 35%, p>0.5) was not significantly different.

The researchers concluded, "The present study provides evidence suggesting that treatment with glulisine can provide superior glycemic control compared (to) regular insulin in hospitalized T2DM patients, especially in those who have a prolonged length of stay."

Study: Risk of Type 2 Diabetes Mellitus increases if breast-feeding period is below 30 days

A study reported in the American Journal of Medicine revealed that breast-feeding for less than 1 month can increase the risk of Type 2 Diabetes. The study’s lead author, Eleanor Bimla Schwarz, MD, MS, from the University of Pittsburgh, Pennsylvania, said, "Diet and exercise are widely known to impact the risk of Type 2 Diabetes, but few people realize that breastfeeding also reduces mothers' risk of developing the disease later in life by decreasing maternal belly fat."

Study:

The study aimed to examine the relationship amongst duration, exclusivity, and consistency of lactation with the risk of Type 2 Diabetes in 2233 female member of a healthcare delivery organization in California, aged between 40 and 78 years. The researchers controlled for age, parity, race, education, hysterectomy, physical activity, tobacco, and alcohol use, family history of diabetes, and body mass index using multivariable logistic regression.

Result: 

• Mothers who never exclusively breast-fed were more likely to have gone on to have Type 2 Diabetes as compared to those who exclusively breast-fed for 1 to 3 months 
• Compared with nulliparous women, those who consistently breast-fed their children for at least 1 month had a similar adjusted risk for Type 2 Diabetes
• Mothers who had never breast-fed an infant had greater risk 

To conclude, the authors added, "Risk of Type 2 Diabetes increases when term pregnancy is followed by <1 month of lactation, independent of physical activity and body mass index in later life. Mothers should be encouraged to exclusively breast-feed all of their infants for at least 1 month."

Study: Diabetes Does Not End Sexual Activity of People in the Middle-age

Diabetes does not end sexual activity of the middle-aged and older adults, though it affects their sexual function, revealed a new study published in the September 2010 issue of Diabetes Care. 

Study

Researchers: Lead author Stacy Tessler Lindau, MD, MAPP, FACOG, associate professor of obstetrics and gynecology and of medicine at the University of Chicago, Illinois, and colleagues

A part of the National Health, Social Life and Aging Project, the survey evaluated 1993 adults aged 57 to 85 years both with and without Diabetes.

Study Design - In-home interviews, medication inventories, and measurements of HbA1c levels

Results

The researchers reiterated the association of Diabetes with sexual dysfunction. Even though Diabetes affects libido, erectile function, and orgasm, older partnered adults with the disease still engage in sexual activity about as often as people without the disease. Almost 70% of partnered men with Diabetes and 62% of partnered women with Diabetes engage in sexual activity an average of 2 or 3 times each month.

Of the participants, 47% of men had Diabetes; about half were aware of the disease. Nearly 40% of the women surveyed were found to have Diabetes. Again, only half of them were aware they had the disease.

Men with diagnosed Diabetes were more likely to report diminished interest in sex (adjusted odds ratio [AOR], 1.72; 95% confidence interval [CI], 1.12 - 2.63) than other men and to report having more problems with Erectile Dysfunction (AOR, 2.52; 95% CI, 1.53 - 4.14). Difficulties in achieving orgasm were more common in participants with Diabetes, and such difficulties were reported in both women and men, regardless of whether they were aware they had Diabetes.

Women with Diabetes were less likely than men with Diabetes (AOR, 0.28; 95% CI, 0.16 - 0.48) and women without Diabetes (AOR, 0.63; 95% CI, 0.45 - 0.87) to be sexually active, and those with Diabetes who had no partners were only about half as likely to be sexually active as women with partners (33% vs 62%, respectively).

Symptoms of Mellitus Diabetes

Signs and symptoms of all types of Diabetes Mellitus are more likely to be similar since the blood sugar is high, either due to less or no production of insulin, or insulin resistance.

Overview of the most significant symptoms:

For Type 1:

During initial stage:

o   Nausea and vomiting

In later stage:

o   Weight loss – Since body starts breaking down the muscle tissue and fat for producing energy.

o   Dehydration – Due to electrolyte disturbance

In advanced stages:

o   Coma

o   Can also result into death

For Type 2:

• Increased fatigue - Due to inefficiency of the cell to metabolize glucose, reserve fat of body is metabolized to gain energy.
• Polydipsia – Excessive thirst
• Polyuria – Increase in urine production; body starts removing the extra sugar in the blood by excreting it through urine.
• Polyphegia – Increased hunger
• Weight fluctuation – Weight can rise due to increased appetite or weight can decrease due to factors like loss of water (Polyuria), Glucosuria, metabolism of body fat and protein.
• Blurry vision – Poor eyesight
• Irritability – a sign of high blood sugar
• Poor wound healing – High blood sugar blocks the growth of White Blood Cell (WBC), which is responsible for body immune system.
• Infections – Whenever there is fluctuation in blood sugar, skin infections like fungal or bacterial or UTI (urinary tract infection) become prominent.  

Symptoms when Diabetes turns into Autoimmune Disorder:

• Due to autoimmune infections, various skin, genito-urinary tract and respiratory problems can arise.
• Defective formation of various blood components like WBC's and platelets result in poor blood composition. This may result in complications like poor wound healing and easy susceptibility to injuries.
• If the disorders are not medicated at the early stage, problems such as blindness, cataract, gangrene, diabetic nephropathy, diabetic neuropathy, diabetic foot, etc. can occur. 

Main Causes of Diabetes Mellitus

The cause of Diabetes totally depends on its type. Type 1 Diabetes is partly inherited and then encouraged by certain infections some evidence pointing at Coxsackie B4 virus. However, even in those who have inherited the susceptibility, Type 1 Diabetes mellitus seems to require an environmental trigger. Type 2 Diabetes mainly results due to lifestyle factors and genetics.

Other Causes:

Genetic defects of β-cell Function

o   Maturity onset diabetes of the young (MODY)

o   Mitochondrial DNA mutations

Genetic defects in insulin processing or insulin action

o   Defects in proinsulin conversion

o   Insulin gene mutations

o   Insulin receptor mutations

Exocrine Pancreatic Defects

o   Chronic pancreatitis

o   Pancreatectomy

o   Pancreatic neoplasia

o   Cystic fibrosis

o   Hemochromatosis

o   Fibrocalculous pancreatopathy

Endocrinopathies

o   Growth hormone excess (acromegaly)

o   Cushing syndrome

o   Hyperthyroidism

o   Pheochromocytoma

o   Glucagonoma

Infections

o   Cytomegalovirus infection

o   Coxsackievirus B

Drugs

o   Glucocorticoids

o   Thyroid hormone

o   β-adrenergic agonists

Risk of Gestational Diabetes Mellitus in women gets reduced with weight-reduction surgery

The risk for Gestational Diabetes Mellitus in a woman gets reduced if she goes through Bariatric (weight-reduction) Surgery before pregnancy and delivery, revealed a study. The authors, led by Anne E. Burke, MD, MPH, from the Johns Hopkins University School of Medicine, in Baltimore, Maryland, reported, "Our findings identify bariatric surgery as a unique strategy to prevent GDM". The data has been reported in the current issue of the Journal of the American College of Surgeons.

Study 

The researchers compared the rates of Gestational Diabetes Mellitus and its related outcomes (cesarean delivery, macrosomia, shoulder dystocia, peripartum infection, postpartum hemorrhage, and fetal demise) in women who delivered infants a mean of 20.9 months after bariatric surgery to similar outcomes in women who delivered their babies a mean of 18.5 months before undergoing the surgery.

Results 

The researchers identified 346 women who delivered before undergoing bariatric surgery (the prebariatric delivery group) and 354 women who gave birth afterward (the postbariatric delivery group). When they did undergo surgery, 75% of the women in the prebariatric group and 87% in the postbariatric group had a bypass procedure. Adjustable banding procedures were more common among women in the prebariatric group (9% vs 3%).

Gestational Diabetes Mellitus occurred in 94 (27%) of the women in the prebariatric group compared with 28 (8%) in the postbariatric group, for an odds ratio of 0.23 (95% confidence interval [CI], 0.15 - 0.36) associated with GDM after bariatric surgery.

According to the researchers, at least 7% of all pregnancies in the US are affected by Gestational Diabetes Mellitus. 

Report: Oral sebacic acid reduces postprandial hyperglycemia in patients with Type 2 Diabetes

A report by Dr. Mingrone from Catholic University of Rome, Italy, and his colleagues revealed that Oral sebacic acid, a naturally occurring medium chain dicarboxylic acid, reduces postprandial hyperglycemia in patients with Type 2 Diabetes. Dr. Mingrone said, “The addition of sebacic acid to a meal greatly reduces plasma glucose levels. Thus, it might be used to help keep glycemia under control, especially in patients with decompensated diabetes."

As a part of the study, the researchers investigated the effect of oral administration of sebacic acid on postprandial glycemia, insulinemia, and glucose rate of appearance (Ra) in 10 obese Type 2 Diabetes and 10 healthy volunteers.

Following results were observed: 

• In Type 2 Diabetes, when 10g sebacic acid was taken with the meal, incremental glucose was reduced by 42%. 
• In Type 2 Diabetes, when 23g sebacic acid was taken with the meal, incremental glucose was reduced by 70%. 
• Incremental glucose in healthy controls was significantly reduced only with the 23g sebacic acid dose. 
• Incremental insulin after meals was reduced by 39% in both diabetes and controls given 10g sebacic acid and by similar amounts in diabetes (64%) and controls (71%) given 23g sebacic acid. 
• Glucose Ra declined among controls and diabetic patients after 23g sebacic acid, whereas glucose clearance (an index of peripheral insulin sensitivity) increased significantly only among controls given 23g sebacic acid. 
• Insulin-dependent glucose uptake from L6 myoblasts in culture increased more in the presence of sebacic acid (38.7%) than in its absence (11.4%), and this increase was associated with a 1.74-fold increase in expression of GLUT4. 

Dr. Mingrone concluded that “Sebacic acid might be used in obesity and in other diseases where the intake of other substrates have to be reduced, such as in chronic renal failure where proteins, but also lipids (due to hyperlipidemia), must be lowered in the diet. In other words, this new substrate class represents a further option and a novel approach for physicians helping to manage their patients' metabolic conditions.”

Study: Children with Type 2 Diabetes have more rapid disease progression than adults

Children with Type 2 Diabetes Mellitus (T2DM) have more rapid disease progression than adults, revealed a study by Dr. Lorraine E. Levitt Katz and colleagues at The Children's Hospital of Philadelphia and the University of Pennsylvania. It has been observed that two years after diagnosis, children and adolescents with Type 2 Diabetes need increasing doses of insulin due to a rapid decline in beta cell function.

Method 

As a part of the study, the researchers observed 59 children (mean age - 14) with Type 2 Diabetes Mellitus for four years. Most of the children were African-American and thirteen of them had Diabetic Ketoacidosis (DKA) at diagnosis. The children received only metformin (up to 1000mg twice daily) for oral medication and insulin therapy was started for hemoglobin (Hb)A1c levels of 8.5% or higher. At baseline, 84% of the children needed insulin, with higher doses required in the group with Diabetic Ketoacidosis. Baseline HbA1c was 13.0% in the Diabetic Ketoacidosis group and 9.8% in the kids without DKA.

Dr. Levitt Katz and her associates found that “within the first 6 months, the HbA1c levels in both groups reached the lowest point and gradually rose after 1 year. Over 4 years, the HbA1c levels had risen with differences in the nonacidotic and Diabetic Ketoacidosis groups.” Gradually, insulin requirements began to rise after two years, and by four years all of the subjects needed higher insulin doses. The highest median dose was in the Diabetic Ketoacidosis group.

Result 

The insulin reserve over time in childhood Type 2 Diabetes Mellitus has been unknown but the researchers suspected there would be “a more rapid decline in glycemic control than has been published for adults and that this decline would be more severe for those presenting with Diabetic Ketoacidosis.” The researchers concluded that “Type 2 Diabetes in youth progresses more rapidly to insulin deficiency than in adults.”

Diabetes Insipidus v/s Diabetes Mellitus

Diabetes Insipidus (Water Diabetes)	Diabetes Mellitus (Sugar Diabetes)
Literally means bland or insipid urine	Literally means honey-sweet urine (back when doctors would sometimes actually taste people's urine to make a diagnosis)
Uncommon	Common
Caused by the lack of the antidiuretic hormone (vasopressin) or the kidney's inability to respond to this hormone	Caused by lack of the hormone insulin
Urination is more frequent and in much greater volumes than the more common sugar diabetes	Urination is less frequent and in much lesser volumes than Diabetes Insipidus
Diagnosed via Water deprivation test/vasopressin test	Diagnosed via Fast blood sugar-24hr. post-prandial test. Glucose tolerance test.

Diabetes Insipidus – Definition and Types

Diabetes Insipidus (DI) is different from Diabetes Mellitus. However, symptoms of both diseases include increased urination and thirst. Diabetes Insipidus is a very rare form of diabetes resulting from a deficiency of vasopressin (the pituitary hormone that regulates the kidneys). This form of diabetes is characterized by the chronic excretion of large amounts of pale dilute urine which results in dehydration and extreme thirst. Disorders of the hypothalamus are one cause of Diabetes Insipidus.

In simple language, Diabetes Insipidus is a condition in which there is an abnormal increase in urine output, fluid intake and often thirst. Sometimes, Diabetes Insipidus is also called as "Water Diabetes” to distinguish it from Diabetes Mellitus, which can also be referred as "Sugar Diabetes”.

Types of Diabetes Insipidus

Basically, there are four main types of Water Diabetes:

Neurogenic DI: This is the most common type of Diabetes Insipidus, which is caused by a lack of vasopressin, a hormone that normally acts upon the kidney to reduce urine output by increasing the concentration of the urine.  This type of Water Diabetes is commonly called “Pituitary Diabetes Insipidus”.

Nephrogenic DI: Caused due to the inability of the kidney to respond normally to antidiuretic hormone (ADH). ADH, which is also known as vasopressin, is a hormone that normally acts upon the kidney to reduce urine output by increasing the concentration of the urine.

Dipsogenic DI: Occurs due to a defect or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output.

Gestational DI: Occurs only during pregnancy. A lack of vasopressin can also develop during pregnancy if the pituitary is slightly damaged and/or the placenta destroys the hormone too rapidly.  This second type of vasopressin deficiency is called Gestational DI.

Pituitary is the master gland of the endocrine system; located at the base of the brain. 

Diabetes Mellitus – Definition and Types

Diabetes Mellitus, often cited as Sugar Diabetes, is a metabolic disorder wherein body produces insufficient insulin or cells fail to respond to the insulin that is produced. Insulin is a hormone which is essential to convert sugar, starches, and other food into energy. Diabetes Mellitus can be also stated as a polygenic disease and is characterized by abnormally high glucose levels (sugar) in the blood.

Types of Diabetes Mellitus

Basically, there are three main types of Diabetes Mellitus:

Type 1 Diabetes: An autoimmune disease which deals with loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. In a simpler language, this type of diabetes happens when body fails to produce insulin. Type 1 Diabetes can be further classified as immune-mediated or idiopathic.

Type 2 Diabetes: Results when cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. Type 2 Diabetes is the most common type.

Gestational Diabetes: Resembles Type 2 Diabetes in several respects and usually defined as “Type 3 Diabetes”. This type happens when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. This type of diabetes occurs in about 2–5% of all pregnancies and may improve or disappear after delivery. Type 3 Diabetes is fully treatable. However, it requires careful medication throughout pregnancy. Around 20-50% of affected women develop Type 2 Diabetes later in life.

Other types of Diabetes Mellitus:

• Congenital Diabetes – Occurs due to genetic defects of insulin secretion
• Cystic fibrosis-related Diabetes
• Steroid Diabetes – Occurs when induced by high doses of glucocorticoids
• Several forms of Monogenic Diabetes