Obesity doesn't mean a person is destined to develop diabetes, experiments in mice suggest. Instead, it may all depend on where the fat is stored.
Mice that overate and were very obese still didn't become diabetic, because the activity of two hormones let them store extra calories in fat tissue rather than in their livers or heart muscle.
"What this mouse model shows is what we have appreciated clinically for a while," said lead researcher Philipp Scherer, a professor of internal medicine and director of the Touchstone Center for Diabetes Research at the University of Texas Southwestern Medical Center at Dallas.
"Basically, it shows that for individuals who have the ability to expand their adipose [fat] tissue mass appropriately for the number of calories they take up, those individuals fare much better than someone who has a more reduced capacity to expand their adipose tissue," Scherer said.
If fat isn't stored in the adipose tissue, it ends up in the liver and muscles. That, in turn, causes significant insulin resistance that can lead to diabetes, Scherer explained.
In their experiments, Scherer's team showed that in genetically altered mice, an excess of adiponectin, a hormone linked to sensitivity to insulin, and a deficiency in leptin, a hormone that suppresses appetite, causes the mice to store excess calories in fat tissue instead of in liver, heart or muscle tissues, according to the report in the Aug. 23 online edition of the Journal of Clinical Investigation.
Scherer noted that in people as in mice, where fat is stored is largely determined by genetics. "You have a lot of obese individuals who are not type 2 diabetics, and you have lean individuals that can be type 2 diabetics," he said. Type 2 diabetes is the most common form of the disease, and it is most often tied to overweight or obesity.
All of this means that measuring fat as an indicator of general health might not hold up anymore, Scherer said. "It's really a matter of where we deposit these excess calories," he said. "Fat is a little like real estate, it's all about location, location, location."
Scherer hopes the outcome of his work will be finding ways to manipulate how and where fat is stored in people.
However, none of this should be seen as a free pass to become obese, Scherer said. "Exercise and reduction of food intake are the best ways to stay healthy," he said. "Most people can't prevent some fat from being stored in the liver and muscle," he added.
One expert agreed the finding does mimic what is seen in some people.
"It's too bad, we ain't mice," said Dr. Larry Deeb, president for medicine and science at the American Diabetes Association. "Clinically, there are people who are like those mice. They are significantly overweight, and yet, they don't have the insulin resistance," he said.
There might be therapeutic implications to this finding, if it could lead to a better understanding of why some people can become obese and not develop diabetes, and others don't, Deeb said.
However, there are other health consequences to being overweight besides diabetes, he noted. "Obese people wear out the knees and strain the heart and lungs and other body systems," Deeb said. "In addition, their quality of life suffers."
Monday, September 10, 2007
Heart Attack Boosts Diabetes Risk
After a heart attack, the risk of developing diabetes and so-called pre-diabetes rises steeply, a new study finds.
In fact, recent heart attack patients are up to four-and-a-half times more likely to develop diabetes compared with the general population and more than 15 times more likely to develop high blood sugar, according to the report in the Aug. 25 issue of The Lancet.
"Having a heart attack means that the chances of getting diabetes later are increased," said Dr. Lionel Opie, director of the Hatter Cardiovascular Research Institute at the University of Cape Town, South Africa, and author of an accompanying journal editorial. "We already know that diabetes predisposes one to heart attack, now we add that heart attacks predispose one to diabetes -- one nasty disease leads to another, and it's a two-way process."
In the study, a team led by Dr. Roberto Marchioli, from the Laboratory of Clinical Epidemiology of Cardiovascular Disease, Consorzio Mario Negri Sud, Chieti, Italy, collected data on almost 8,300 Italian patients who had suffered a recent heart attack and were not previously diabetic.
More than three and a half years after the heart attack, a third of the patients had developed diabetes or had impaired insulin resistance (a precursor to diabetes), as measured by an increase in blood sugar.
When they used a lower threshold for measuring blood sugar, 62 percent of the patients were defined as diabetic.
"These findings further tie the knot between heart attacks and high blood glucose -- each is a risk for the other, the patient thus potentially being caught in a fatal vicious circle," Opie said.
Risk markers for diabetes or high blood sugar include age, high blood pressure, and use of heart medicines such as beta-blockers, cholesterol-lowering drugs, and diuretics.
The researchers found being overweight increased the risk of diabetes. Smoking also increased the risk by 60 percent. In addition, an unhealthy diet and heavy drinking increased the risk of developing diabetes after a heart attack.
"Lifestyle factors can be particularly important in preventing disease," Marchioli said. "The reductions in risk associated with a Mediterranean-type diet suggest that diet could help reduce incidence of pre-diabetes and diabetes after a [heart attack]," he added.
Opie agreed that changing diet and exercising can help cut post-heart attack diabetes risk.
"Once you have had a heart attack, watch for new diabetes -- monitor blood sugar and keep exercising a lot," Opie advised. "This 'eats up' the blood sugar. And eat Mediterranean-style, adding olive oil and nuts -- the Mediterranean diet gives some, but not total, protection from new diabetes after a heart attack."
In fact, recent heart attack patients are up to four-and-a-half times more likely to develop diabetes compared with the general population and more than 15 times more likely to develop high blood sugar, according to the report in the Aug. 25 issue of The Lancet.
"Having a heart attack means that the chances of getting diabetes later are increased," said Dr. Lionel Opie, director of the Hatter Cardiovascular Research Institute at the University of Cape Town, South Africa, and author of an accompanying journal editorial. "We already know that diabetes predisposes one to heart attack, now we add that heart attacks predispose one to diabetes -- one nasty disease leads to another, and it's a two-way process."
In the study, a team led by Dr. Roberto Marchioli, from the Laboratory of Clinical Epidemiology of Cardiovascular Disease, Consorzio Mario Negri Sud, Chieti, Italy, collected data on almost 8,300 Italian patients who had suffered a recent heart attack and were not previously diabetic.
More than three and a half years after the heart attack, a third of the patients had developed diabetes or had impaired insulin resistance (a precursor to diabetes), as measured by an increase in blood sugar.
When they used a lower threshold for measuring blood sugar, 62 percent of the patients were defined as diabetic.
"These findings further tie the knot between heart attacks and high blood glucose -- each is a risk for the other, the patient thus potentially being caught in a fatal vicious circle," Opie said.
Risk markers for diabetes or high blood sugar include age, high blood pressure, and use of heart medicines such as beta-blockers, cholesterol-lowering drugs, and diuretics.
The researchers found being overweight increased the risk of diabetes. Smoking also increased the risk by 60 percent. In addition, an unhealthy diet and heavy drinking increased the risk of developing diabetes after a heart attack.
"Lifestyle factors can be particularly important in preventing disease," Marchioli said. "The reductions in risk associated with a Mediterranean-type diet suggest that diet could help reduce incidence of pre-diabetes and diabetes after a [heart attack]," he added.
Opie agreed that changing diet and exercising can help cut post-heart attack diabetes risk.
"Once you have had a heart attack, watch for new diabetes -- monitor blood sugar and keep exercising a lot," Opie advised. "This 'eats up' the blood sugar. And eat Mediterranean-style, adding olive oil and nuts -- the Mediterranean diet gives some, but not total, protection from new diabetes after a heart attack."
Tuesday, April 10, 2007
Blood Sugar Control Boosts Diabetics' Recovery After Surgery
It lowers risks for serious infection, study finds, even though we already knew this was the case.Good blood sugar control before surgery reduces the risk of postoperative infections in people with diabetes, U.S. researchers report.
The study included 490 diabetic patients, average age 71, who had major noncardiac surgery. Their hemoglobin (Hb A1c) levels were measured within 180 days before the surgery. Hb A1c reflects the patient's control of blood glucose levels during the previous two to three months. Good blood sugar control was defined as an Hb A1c level of less than 7 percent, the American Diabetes Association target.
Of the patients in the study, 197 (40 percent) had good blood sugar control, report researchers at Yale University School of Medicine. Patients who did not have good blood sugar control had higher rates of postoperative infections, such as pneumonia, wound infection, urinary tract infection and sepsis (systemic blood infection).
Postoperative infections were also more common among patients who were older, had higher scores on physical status tests, had wounds classified as "non-clean" or had operations that took longer.
The Yale team suggested two reasons why good blood sugar control before surgery might reduce infection risk. One reason: patients with better blood sugar control before surgery are more likely to have lower blood sugar levels after surgery as well, which has been found to reduce the risk of infection.
"The other possibility for decreased postoperative infection with long-term glucose control is the overall improvement in general health and metabolic milieu of the well-controlled diabetic patient," the study authors wrote.
"If the association is confirmed in other studies, strategies to improve glycemic control prior to elective surgery can be employed to decrease infections and improve overall outcomes for diabetic surgical patients," they said.
The study included 490 diabetic patients, average age 71, who had major noncardiac surgery. Their hemoglobin (Hb A1c) levels were measured within 180 days before the surgery. Hb A1c reflects the patient's control of blood glucose levels during the previous two to three months. Good blood sugar control was defined as an Hb A1c level of less than 7 percent, the American Diabetes Association target.
Of the patients in the study, 197 (40 percent) had good blood sugar control, report researchers at Yale University School of Medicine. Patients who did not have good blood sugar control had higher rates of postoperative infections, such as pneumonia, wound infection, urinary tract infection and sepsis (systemic blood infection).
Postoperative infections were also more common among patients who were older, had higher scores on physical status tests, had wounds classified as "non-clean" or had operations that took longer.
The Yale team suggested two reasons why good blood sugar control before surgery might reduce infection risk. One reason: patients with better blood sugar control before surgery are more likely to have lower blood sugar levels after surgery as well, which has been found to reduce the risk of infection.
"The other possibility for decreased postoperative infection with long-term glucose control is the overall improvement in general health and metabolic milieu of the well-controlled diabetic patient," the study authors wrote.
"If the association is confirmed in other studies, strategies to improve glycemic control prior to elective surgery can be employed to decrease infections and improve overall outcomes for diabetic surgical patients," they said.
Blood Sugar Control Boosts Diabetics' Recovery After Surgery
It lowers risks for serious infection, study finds, even though we already knew this was the case.Good blood sugar control before surgery reduces the risk of postoperative infections in people with diabetes, U.S. researchers report.
The study included 490 diabetic patients, average age 71, who had major noncardiac surgery. Their hemoglobin (Hb A1c) levels were measured within 180 days before the surgery. Hb A1c reflects the patient's control of blood glucose levels during the previous two to three months. Good blood sugar control was defined as an Hb A1c level of less than 7 percent, the American Diabetes Association target.
Of the patients in the study, 197 (40 percent) had good blood sugar control, report researchers at Yale University School of Medicine. Patients who did not have good blood sugar control had higher rates of postoperative infections, such as pneumonia, wound infection, urinary tract infection and sepsis (systemic blood infection).
Postoperative infections were also more common among patients who were older, had higher scores on physical status tests, had wounds classified as "non-clean" or had operations that took longer.
The Yale team suggested two reasons why good blood sugar control before surgery might reduce infection risk. One reason: patients with better blood sugar control before surgery are more likely to have lower blood sugar levels after surgery as well, which has been found to reduce the risk of infection.
"The other possibility for decreased postoperative infection with long-term glucose control is the overall improvement in general health and metabolic milieu of the well-controlled diabetic patient," the study authors wrote.
"If the association is confirmed in other studies, strategies to improve glycemic control prior to elective surgery can be employed to decrease infections and improve overall outcomes for diabetic surgical patients," they said.
The study included 490 diabetic patients, average age 71, who had major noncardiac surgery. Their hemoglobin (Hb A1c) levels were measured within 180 days before the surgery. Hb A1c reflects the patient's control of blood glucose levels during the previous two to three months. Good blood sugar control was defined as an Hb A1c level of less than 7 percent, the American Diabetes Association target.
Of the patients in the study, 197 (40 percent) had good blood sugar control, report researchers at Yale University School of Medicine. Patients who did not have good blood sugar control had higher rates of postoperative infections, such as pneumonia, wound infection, urinary tract infection and sepsis (systemic blood infection).
Postoperative infections were also more common among patients who were older, had higher scores on physical status tests, had wounds classified as "non-clean" or had operations that took longer.
The Yale team suggested two reasons why good blood sugar control before surgery might reduce infection risk. One reason: patients with better blood sugar control before surgery are more likely to have lower blood sugar levels after surgery as well, which has been found to reduce the risk of infection.
"The other possibility for decreased postoperative infection with long-term glucose control is the overall improvement in general health and metabolic milieu of the well-controlled diabetic patient," the study authors wrote.
"If the association is confirmed in other studies, strategies to improve glycemic control prior to elective surgery can be employed to decrease infections and improve overall outcomes for diabetic surgical patients," they said.
Gene Protects Against Diabetes, Heart Disease
Why some people no matter what they do will probably never get Type 2 diabetes.People lucky enough to carry a variant in a single gene get added protection against both type 2 diabetes and heart disease, a new study finds.
Individuals with the trait aren't immune from the conditions, researchers say, but a study of nearly 7,900 subjects found that they are as much as 48 percent less likely to suffer from either illness.
"This gives us insight into how heart disease and diabetes may develop," said co-author Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health in Boston.
Scientists don't think diabetes and heart disease are inherited, but genes can play a major role, they say. "We do know there are genes that make people more susceptible to becoming diabetic if they're exposed to the right environmental factors," Rimm said. Specific genes have also been linked to heart disease.
In mice, a gene variation appears to provide protection against type 2 diabetes and clogged arteries. In the new study, Rimm's team examined the medical and genetic records of 7,899 people to see if the variation did the same thing for humans.The study findings appear in this week's issue of the Proceedings of the National Academy of Sciences.
A total of 4.3 percent of the people studied had one copy of the variant gene, Rimm said.
These people appear to have won a kind of genetic lottery, because levels of triglycerides -- a potentially dangerous type of blood fat -- were 12 percent lower in their blood than in the other subjects. Their risk of heart disease was also 34 percent lower, and if they were obese, their risk for type 2 diabetes was 48 percent less than that of obese individuals who did not carry the gene variant.
Rimm suspects that the genetic variation helps control molecular signals that influence how triglycerides circulate in the blood.What next? It's possible that a better understanding of the genetics of diabetes and heart disease could lead to more effective treatments, Rimm said. "If you could emulate what this form of this gene is doing, maybe you could lower someone's risk of heart disease or diabetes by copying the same type of physiological effects," he added.
The research raises another possibility: genetic tests that could alert people if they have a higher likelihood of getting diabetes later in life.
Ideally, "if you know in advance that you're at risk, that would make people think and give them the opportunity to protect themselves," said Dr. Larry C. Deeb, the American Diabetes Association's president-elect of medicine and science. After all, he said, diabetes is largely preventable.
Individuals with the trait aren't immune from the conditions, researchers say, but a study of nearly 7,900 subjects found that they are as much as 48 percent less likely to suffer from either illness.
"This gives us insight into how heart disease and diabetes may develop," said co-author Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health in Boston.
Scientists don't think diabetes and heart disease are inherited, but genes can play a major role, they say. "We do know there are genes that make people more susceptible to becoming diabetic if they're exposed to the right environmental factors," Rimm said. Specific genes have also been linked to heart disease.
In mice, a gene variation appears to provide protection against type 2 diabetes and clogged arteries. In the new study, Rimm's team examined the medical and genetic records of 7,899 people to see if the variation did the same thing for humans.The study findings appear in this week's issue of the Proceedings of the National Academy of Sciences.
A total of 4.3 percent of the people studied had one copy of the variant gene, Rimm said.
These people appear to have won a kind of genetic lottery, because levels of triglycerides -- a potentially dangerous type of blood fat -- were 12 percent lower in their blood than in the other subjects. Their risk of heart disease was also 34 percent lower, and if they were obese, their risk for type 2 diabetes was 48 percent less than that of obese individuals who did not carry the gene variant.
Rimm suspects that the genetic variation helps control molecular signals that influence how triglycerides circulate in the blood.What next? It's possible that a better understanding of the genetics of diabetes and heart disease could lead to more effective treatments, Rimm said. "If you could emulate what this form of this gene is doing, maybe you could lower someone's risk of heart disease or diabetes by copying the same type of physiological effects," he added.
The research raises another possibility: genetic tests that could alert people if they have a higher likelihood of getting diabetes later in life.
Ideally, "if you know in advance that you're at risk, that would make people think and give them the opportunity to protect themselves," said Dr. Larry C. Deeb, the American Diabetes Association's president-elect of medicine and science. After all, he said, diabetes is largely preventable.
Oral-lyn Results for Type 1s
Three-month results of a long-term six-month clinical trial performed in 24 adolescents and 5 young adult patients with type-1 diabetes mellitus (DM) using Oral-lyn, the buccal insulin. This data continuously showed that replacing just 1 one daily subcutaneous injection (s.c.) of regular insulin with Generex Oral-lyn™ during the day, improves parameters of metabolic control in the same manner observed with intensively monitored standard therapy.
At the 3rd month evaluation of this six-month trial, it was demonstrated that a trend similar towards normalization exists when replacing the lunch-time dose of regular insulin with the Generex Oral-lyn™ spray. In fact, not only Daily Glucose Profiles and Fructosamine demonstrated improved values but, of special importance, Glycosylated Hemoglobin (HbA1c), the criterion standard to evaluate metabolic control in Diabetes, showed a significant improvement when compared to standard therapy. The investigators concluded, in their three-month interim analysis, that successful and efficient replacement of injected regular insulin at lunchtime was achieved with Generex Oral-lyn™ altogether with 100% compliance.
These encouraging results prompted the investigators and the partners Generex-Pharmabrand to design studies using larger number of type-1 DM subjects and replacing the three mealtime doses of regular insulin with the Generex-Oral-lyn™ spray on subjects maintained in once daily glargine insulin therapy.
At the 3rd month evaluation of this six-month trial, it was demonstrated that a trend similar towards normalization exists when replacing the lunch-time dose of regular insulin with the Generex Oral-lyn™ spray. In fact, not only Daily Glucose Profiles and Fructosamine demonstrated improved values but, of special importance, Glycosylated Hemoglobin (HbA1c), the criterion standard to evaluate metabolic control in Diabetes, showed a significant improvement when compared to standard therapy. The investigators concluded, in their three-month interim analysis, that successful and efficient replacement of injected regular insulin at lunchtime was achieved with Generex Oral-lyn™ altogether with 100% compliance.
These encouraging results prompted the investigators and the partners Generex-Pharmabrand to design studies using larger number of type-1 DM subjects and replacing the three mealtime doses of regular insulin with the Generex-Oral-lyn™ spray on subjects maintained in once daily glargine insulin therapy.
Diabetes Drug Use by Children Doubled in US Over 3-Year Period
Between 2002 to 2005, the use of agents to prevent or treat type 2 diabetes among US children, 5 to 19 years of age, increased from about 0.3 to 0.6 per 1000, which could have "enormous implications" for long-term healthcare needs and expenses, new research shows.Dr. Emily Cox, Express Scripts senior director of research, and colleagues based their conclusions on an analysis of prescription claims for millions of children enrolled with Express Scripts, a St. Louis-based pharmacy benefit management company. This is the first national study to distinguish between the use of agents for type 1 and type 2 diabetes.
"This study is the first of its kind nationally to reveal the long-suspected national increase in the prevalence of children with or at risk for diabetes," lead author Dr. Cox said in a statement.
The largest increase in the use of type 2 antidiabetic agents -- 106% -- was for children between 10 and 14 years of age. The highest prevalence was among 15- to 19-year-old adolescents in 2005 -- 1.2 per 1000.
During the study period, use of any antidiabetic agent climbed by 41.0%. The use of agents for type 1 diabetes also rose by 30.5%.
"As recently as 2004, standard pediatric textbooks talked about pediatric diabetes in the 'per 100,000 children' level," Dr. Ed Weisbart, chief medical officer at Express Scripts, said in a statement. "Now we're talking about it at the per-1000 children level. We've moved two orders of magnitude within just a few years."
The driving force behind the rise in antidiabetic therapy among children? Although the current study did not investigate the causes, the increasing rate of obesity is widely believed to be the main factor. Findings from the 1999-2002 National Health and Nutrition Examination Survey showed that the percentage of overweight children rose from 11% to 16% in the last decade.
"Type 2 diabetes has long been regarded as 'adult-onset diabetes' due to its representation among middle-aged and older adults, but this study indicates that children with or at risk of type 2 diabetes are becoming far more common," Dr. Weisbart concluded.
"This study is the first of its kind nationally to reveal the long-suspected national increase in the prevalence of children with or at risk for diabetes," lead author Dr. Cox said in a statement.
The largest increase in the use of type 2 antidiabetic agents -- 106% -- was for children between 10 and 14 years of age. The highest prevalence was among 15- to 19-year-old adolescents in 2005 -- 1.2 per 1000.
During the study period, use of any antidiabetic agent climbed by 41.0%. The use of agents for type 1 diabetes also rose by 30.5%.
"As recently as 2004, standard pediatric textbooks talked about pediatric diabetes in the 'per 100,000 children' level," Dr. Ed Weisbart, chief medical officer at Express Scripts, said in a statement. "Now we're talking about it at the per-1000 children level. We've moved two orders of magnitude within just a few years."
The driving force behind the rise in antidiabetic therapy among children? Although the current study did not investigate the causes, the increasing rate of obesity is widely believed to be the main factor. Findings from the 1999-2002 National Health and Nutrition Examination Survey showed that the percentage of overweight children rose from 11% to 16% in the last decade.
"Type 2 diabetes has long been regarded as 'adult-onset diabetes' due to its representation among middle-aged and older adults, but this study indicates that children with or at risk of type 2 diabetes are becoming far more common," Dr. Weisbart concluded.
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