Vegan Diet May Help Fight Diabetes

Around 30% of children born in the year 2000 will develop Diabetes later in life if significant changes in lifestyle do not appear, commented Caroline Trapp, Director of Diabetes Education and care for the Physicians Committee for Responsible Medicine, Washington, D.C., in her article published in Juneau Empire.

Citing a recent study published in Diabetes Care, Caroline said that people who consume more protein from meat and other animal products are at higher risk for Type 2 Diabetes. According to Caroline, researchers analyzed the diets of nearly 40,000 participants and found that for every 5% of calories consumed from protein instead of carbohydrate or fat, the risk of developing Diabetes increased 30%. Increased animal protein intake was also related to increased weight and blood pressure. Vegetable protein was not associated with Diabetes risk.

The Director of Diabetes Education and care for the Physicians Committee for Responsible Medicine further added that meat-heavy diets are contributing to the Diabetes epidemic, but plant-based diets could help fight it. Recent studies find that a low-fat vegan diet is as effective as oral medications at lowering blood sugar. However, Caroline suggested that changes in diet or medication should be made in consultation with a health care professional.

Type 2 Diabetes Mellitus Linked with Colorectal Cancer among Men

Type 2 Diabetes Mellitus is linked with increased risk of incident colorectal cancer (CRC) among men, revealed a study. The risk was higher for those participants with Type 2 Diabetes regardless of whether or not they used insulin. Though the linkage between the two conditions is evident, it is not clear if this association varies by gender or other factors.

Hyperglycemia and hyperinsulinemia, which are especially prominent during the early stages of Type 2 Diabetes, have been proposed as mediators for the association between the two diseases.

However, as far as women are concerned, the study revealed that Type 2 Diabetes and insulin use were not associated with CRC risk among them.

Peter T. Campbell, lead author of this study, said, "While our study supports an association of Type 2 Diabetes with colorectal cancer incidence among men, our results also suggest that insulin use is associated with a slight, but not a substantially increased, risk of colorectal cancer among men with Type 2 Diabetes.”

The author added, "Prevention strategies should emphasize adherence to guidelines intended for the general population such as smoking cessation, weight management, exercise and regular early detection exams.”

Study: Phone Communication with Peer Helps Diabetes Patients

Phone calls with a peer who is going through the same self-management challenges helped Diabetes patients manage their conditions, revealed a new research from the University of Michigan Health System which was based on a peer partnership established by the Veterans Affairs Ann Arbor Health System and the University of Michigan Medical School.

Study

Each peer pair received initial brief training in peer communication skills. They were expected to communicate by telephone at least once a week about their mutual efforts to improve Diabetes control.

Results

The peer partner program produced lower glycated hemoglobin (HbA1c) levels after six months among men with uncontrolled Diabetes. Results also showed that the activity improved blood sugar levels in Diabetes patients better than those who used traditional nurse care management services alone.

Comments from Study Lead Author Michele Heisler

"Our model was testing the hypothesis that a good way to activate patients was to give them some skills and encouragement to both help and be helped. Just as in education they say that the best way to learn something is to try to teach it."

"Our programme hoped to mobilize patients themselves to realize how much they themselves had to offer another person with Diabetes and enjoy the sense of meaning and pleasure that being needed and helping another can provide. That's why I think people did well – they were very motivated when they felt they were helping someone else."

The findings of the study are published in the October 19 issue of the Annals of Internal Medicine.

Higher Type 2 Diabetes Rates in US than UK might be Attributed to Greater Level of Mid-section Fat

According to a study, excess fat around the mid-section is a health risk. The American and British researchers advised that studies of Type 2 Diabetes to concentrate on waist size along with traditional risk factors.

The study revealed that 16% and 14% of American men and women have Diabetes, respectively as compared 11% and 7% of men and women in England, respectively. To know the reason behind the difference, researchers analyzed studies about the health and lifestyles of people in the US and England. However, they found no association between higher Diabetes rates in the United States and conventional risk factors such as age, smoking, socioeconomic status, or BMI.

But, they observed that American men's waists were an average of 3 centimeters (1.5 inches) larger than those of men in England. And American women's waists were an average of 5 centimeters (2 inches) larger than those of women in England.

In addition, women in America were much more likely than women in England to have a higher risk of Diabetes because of their waist size (69% versus 56%), while American men had only a slightly higher waist size-related Diabetes risk than their counterparts in England.

The study co-author James P. Smith concluded, “Americans carry more fat around their middle sections than the English, and that was the single factor that explained most of the higher rates of diabetes seen in the United States, especially among American women. Waist size is the missing new risk factor we should be studying.”

Study: Intensive Lifestyle Intervention More Effective in Type 2 Diabetes than Diabetes Support and Education

Intensive lifestyle intervention (ILI) produces greater improvements in weight, fitness, glycemic control, and cardiovascular (CV) risk factors in patients with Type 2 Diabetes than Diabetes support and education (DSE), revealed the Look AHEAD study. Main objective of the study was to compare the effects of ILI with DSE on lifestyle factors in Type 2 Diabetes patients.

Study

Conducted by Rena Wing from Brown Medical School, Providence, Rhode Island, USA, and her team. Rena said, “The critical question is whether the differences between groups in risk factors will translate into differences in the development of cardiovascular disease. These results will not be available for several additional years. However, effects of the magnitude that we observed for fitness, high-density lipoprotein (HDL) cholesterol and glycated hemoglobin (HbA1c) levels, and blood pressure have been associated with decreased CV events and mortality in previous medication trials and observational studies."

Findings: 

• Over the period of 4 years, the mean percentage of weight loss was greater at 6.15% in ILI group as compared to 0.88% in DSE group
• Treadmill fitness: A significant improvement in ILI group was seen at 12.74% as compared to 1.96% of the DSE group 
• HbA1c: A significant improvement in ILI group was seen at 0.36% as compared to 0.09% of the DSE group
• ILI group witnessed a significant decrease in systolic and diastolic blood pressure than DSE patients, by 5.33 versus 2.97 mmHg and 2.92 versus 2.48 mmHg, respectively
• HDL cholesterol increased and triglycerides decreased to a greater extent in ILI than DSE patients, by 3.67 versus 1.97 mg/dl and 25.56 versus 19.75 mg/dl, respectively
• Low-density lipoprotein cholesterol reductions were greater in DSE than ILI patients, by 12.84 versus 11.27 mg/dl.

Rena concluded, “Longer follow-up will allow us to determine whether the differences between groups in CV disease risk factors can be maintained and whether the ILI has positive effects on CV morbidity and mortality.”

The DSE group is given dietary advice and recommendations to increase physical activity while the ILI group has to attend weekly group sessions and monthly individual sessions with a lifestyle counselor.

Finnish Study: Risk of Developing Type 2 Diabetes Reduces with Moderate Weight Loss

Risk of developing Type 2 Diabetes reduces with moderate weight loss in at-risk individuals, revealed the one-year results of The Finnish National Diabetes Prevention Program (FIN-D2D). The program was conducted to examine effects of weight loss on 2,798 individuals with a high risk of Diabetes.

Study

The study was undertaken by Leena Moilanen from Kuopio University Hospital, Finland, and her colleagues on participants who had a history of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), cardiovascular disease, or gestational Diabetes mellitus.

Findings after a year

• Incidence of Type 2 Diabetes with normal glucose tolerance at baseline

• In men: 2.0%
• In women: 1.2%

• Incidence of Type 2 Diabetes with IFG

•  In men: 13.5%
•  In women: 7.4%

• Incidence of Type 2 Diabetes with IGT

• In men: 16.1%
• In women: 11.3%

• 17.5% of participants lost 5% or more of their body weight, with no significant differences noted between men and women. Simultaneously, these individuals also had a significant 69% reduction in relative risk for Type 2 Diabetes as compared to those who maintained their baseline weight.

It was also noted that participants who lost less weight in the range of 2.5-4.9% had a 28% reduction in relative risk for Type 2 Diabetes compared to those who maintained their weight. On the contrary, participants who gained 2.5% or more of their body weight had a nonsignificant 10% increase in relative risk for Type 2 Diabetes compared with those who maintained their baseline weight.

According to authors in the journal Diabetes Care, “Despite some weaknesses, this is the largest study so far on implementation of screening and prevention of Diabetes among high-risk individuals in the primary health care setting.”

Study: Children and Adolescents with Metabolic Syndrome at Higher Risk of Type 2 Diabetes

Children and adolescents with the metabolic syndrome are at increased risk for developing Type 2 Diabetes and subclinical atherosclerosis in adulthood, according to study by Costan Magnussen (University of Turku, Finland) and team. However, the study also revealed that screening for high body mass index (BMI) alone in this age group is a simpler and equally accurate predictor of later cardiometabolic outcomes compared with the metabolic syndrome as a whole.

Study:

The researchers used data from the Bogalusa Heart Study and Cardiovascular Risk in Young Finns Study to assess whether the metabolic syndrome and its associated components in childhood and adolescence predict Type 2 Diabetes and high carotid intima-media thickness (IMT) in later life. In all 1781 children aged 9-18 years were recruited during 1984-1988. They were then followed up between 2001 and 2007 when aged 24-41 years.

Result:

Children who had the metabolic syndrome had a 2-3 times higher risk for developing Type 2 Diabetes or having increased carotid IMT (at or above 90th percentile for population) than those without the metabolic syndrome. However, they also stated that use of pediatric BMI alone to predict adult Type 2 Diabetes or high carotid IMT was the most significant component of the pediatric metabolic syndrome for predicting adult outcomes.

Comments from the researchers:

"Our findings have direct clinical relevance because they suggest that in the clinical setting, efforts to identify youth with heightened future risk of meaningful outcomes can be minimally achieved with the use of BMI only.”

"However, clinicians who use high BMI to identify youth at increased future risk need to keep in mind that a large proportion of contemporary youth will be classified as at risk and that our analyses are unable to discount that youth metabolic syndrome may be useful in identifying and possibly treating other cardiometabolic disorders."

Study: Type 2 Diabetes Patients May Be Prone to Acute Pancreatitis

Type 2 Diabetes patients are more likely to develop acute pancreatitis compared to Diabetes-free people, reveals a study published in Diabetes Care on September 10. Dr. Antonio Gonzalez-Perez, of Centro Espanol de Investigacion Farmacoepidemiologica, Madrid, Spain, and colleagues, wrote, "The results of this study confirm the excess risk of acute pancreatitis associated with Type 2 Diabetes previously reported in other observational studies."

Study

Data from The Health Improvement Network database in the UK, between 1996 and 2006 were taken to study the risk of acute pancreatitis among patients with Type 2 Diabetes. The researchers performed a population-based case-control analysis in a cohort of 85,525 Type 2 Diabetes patients and 200,000 Diabetes-free subjects from the general population. They followed the patients for an average of 3.8 and 4.0 years, respectively.

Results

·         A total of 419 cases of acute pancreatitis were identified, including 243 in the general population and 176 in the Diabetes cohort.

·         The adjusted incidence rate ratio of acute pancreatitis in Diabetic patients compared to the general population was 1.77, but the magnitude of this association decreased when it was adjusted for multiple demographic and lifestyle factors (adjusted odds ratio 1.37).

·         The use of insulin (adjusted OR 0.35) and long-term use of metformin (adjusted OR 0.50) were associated with a decreased risk of pancreatitis. Past use of sulphonylureas was associated with a significant risk increase (adjusted OR 2.58).

Comments from researchers

"Overall, when we analyzed the risk of pancreatitis among treated and not treated diabetic patients separately, we observed that the greatest risk appeared among those without anti-diabetic pharmacotherapy, who represent a quarter of our diabetic population." 

Study: High Particulate Matter Exposure May Increase Risk for Type 2 Diabetes

According to a research by John Brownstein (Harvard Medical School, Boston, Massachusetts) and colleagues, increased exposure to airborne particulate matter measuring less than 2.5 µm in diameter (PM2.5) may increase risk for Type 2 diabetes.

Study:

Since ambient air pollution adversely affects various aspects of human health, the researchers decided to study the influence of increasing levels of PM2.5 on risk for Type 2 Diabetes. The researchers gathered data from the Centers for Disease Control and Prevention and the US Environmental Protection Agency for 2004 and 2005 to assess levels of PM2.5 exposure and the county level prevalence of Diabetes.

Results:

After studying the data, the researchers realised that the prevalence of Diabetes increased with increasing PM2.5 concentrations. For instance, 1% increase in Diabetes prevalence was linked to a 10 µ/m3 increase in PM2.5 exposure.

               

They further found that despite EPA-based guidelines for PM2.5 exposure, individuals with the highest exposure to PM2.5 had a more than 20% increased prevalence of Diabetes compared with those with the lowest exposure.

The researchers said, "Our results, although associative, demonstrate that additional research is needed to understand the role that PM2.5 plays in the inflammatory pathway or other pollution-mediated mechanisms giving rise to Diabetes. They concluded, "Such research could lead to novel therapeutic approaches to reduce pollution-induced inflammation."

Study: South Asians Living in the US are at Higher Risk of Diabetes than Other Asian Immigrants

South Asians (born in Bangladesh, India, Nepal, and Pakistan) living in the US are at a much higher risk of Type 2 Diabetes compared to the other Asian immigrants, revealed a study led study author, Swapnil Rajpathak, M.D., an assistant professor of epidemiology and population health at the Albert Einstein College of Medicine.

Study:

Data from the New York City Health and Nutrition Examination Survey, conducted in 2004, were studied to evaluate different racial and ethnic groups for risk factors relating to heart disease and metabolic disorders such as diabetes. The researchers studied the fasting glucose levels from 1,324 respondents.

Results:

The findings of the study appear in the latest issue of the journal Ethnicity & Disease. Swapnil Rajpathak said, "In addition to cultural and lifestyle factors, Asians subgroups are also different in terms of their genetic makeup. He added, "Immigrants may experience dramatic changes in their diet and physical activity after moving to this country. Given their higher genetic susceptibility, unfavorable changes in lifestyle factors may increase the risk of diabetes."

The variations found contribute to the inequality in Diabetes risk between whites and Asians overall, as well as between South Asians and Asians from other countries. 

                                                                                                                                                                                   

South Asians were found to have the highest prevalence of Diabetes at 35.4%, compared with 16.1% for all Asians and 10.8% for whites.

Vivian Fonseca, M.D., vice president of the American Diabetes Association and chief of endocrinology at Tulane University Health Sciences Center, said, in general, "Asians get insulin resistance and increased risk of diabetes and heart disease at a much lower level of obesity than Caucasians.”

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.

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."

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.”