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Seared tuna with butter beans and roasted tomatoes

Preheat the oven to 180ºC / 350ºF / gas mark 4. Mix together the cumin, coriander seeds and chilli flakes, press into both sides of the tuna and set aside for 30 minutes to allow the flavours to develop. Meanwhile, heat the oil in a small pan and fry the onion and garlic for 2-3 minutes. Transfer to an ovenproof dish with the butter beans and tomatoes, place in the oven for 30 minutes until the tomatoes begin to char. Heat a griddle pan until smoking and sear the tuna for about 1 m ...

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Diabetes retinopathy prevalent in Bangladesh
One in four patients with diabetes in Bangladesh could lose their eyesight due to diabetes retinopathy, it has been estimated. Abu Raihan, Regional Director in Asia for ORBIS, a pioneer in global eye health, believes this is a "conservative estimate", with between eight and 10 per cent of the total Bangladesh population currently suffering from diabetes. This equates to about 16 million people, with an explanation widely regarded for this being the prevalence of sweet food in Bengali diets. "In Bangladesh, where people are not aware of it, we can safely say that one in four diabetic patients suffer from retinopathy," Raihan said. "The challenge is we have to find them all to treat". Improving diabetes eye care Raihan stated the best way to prevent eye problems in relation to diabetes is to encourage healthy lifestyles and exceptional diabetes control. A proposal of universal eye care has been made by Raihan, with annual eye check-ups particularly advised for patients with diabetes over 40 years of age. "Those who are at risk of diabetes should have annual check-ups," Raihan said. "Apart from taking care of your eyes, you have to treat diabetes." What is diabetes retinopathy? Diabetes retinopathy occurs before a person ever becomes aware of it. Consistently high blood sugars can lead to leakages when tiny blood vessels of the retina are damaged. If caught early, the condition can be treated, but delayed diagnosis and uncontrolled diabetes could lead to total loss of eyesight. Maintaining excellent control of your diabetes and regularly receiving eye check-ups can prevent diabetes retinopathy from developing. Even small, sustained improvements in blood glucose control can help to reduce the most serious outcomes of retinopathy.
Education programs boost South Asian awareness of diabetes
A report published by the South Asian Health Foundation (SAHF) finds education programs have improved awareness of diabetes in the South Asian community. Prior to this report, 228 South Asian people were questioned and asked to identify levels of diabetes awareness, with 35.7 per cent believing that diabetes only occurred in the elderly. Improving diabetes awareness There were 11 events hosted by the SAHF at GP practises, among other organisations, which featured debates and short films. The SAHF subsequently found a general increase in knowledge of the risks of diabetes and its complications. 10.3 per cent of attendees also demonstrated awareness that people of South Asian origin are more likely to be diagnosed with diabetes. This is because people of South Asian origin are three to six times more likely to develop type 2 diabetes than white Europeans with cultural factors also known to impact the management of diabetes. Professor Wasim Hanif, Consultant Physician in Diabetes and Endocrinology, and Chair Diabetes Working Group, SAHF, concluded: "Our report sets out a number of recommendations that will help transform the lives of people living with diabetes and their close families". Who are the South Asian Health Foundation? The SAHF, founded in 1999, is a charity that aims to raise awareness of ethnic health issues, including type 2 diabetes, and promote a fair health service for the South Asian popularity. Their report aimed to enhance knowledge of diabetes and information specifically relating to South Asian culture, which was achieved through: Commissioning more education - addressing specific needs of the South Asian community Targeting younger people - explaining the risks in diet and lifestyle Targeting gestational diabetes - this affects women during pregnancy Tailoring dietary messaging - looking at the role of sugar in the diet Their events focused on "at risk" populations of the South Asian communities in the United Kingdom and were funded and supported by Novo Nordisk, a global leader in diabetes care.
Risk of heart valve hardening increased by diabetes
New research suggests that high blood sugar levels can slow down the production of heart valves. If the cells that turn raw materials into heart valves are given too much glucose, they can't do their jobs as effectively. The study, published in the Journal of the Royal Society Interface, found that the interstitial cells that create heart valves require a very specific amount of nutrients in order to function properly. The researchers discovered, however, that feeding too much glucose to the cells slowed them down. The correlation between diabetes and the calcification of aortic valves was discovered back in 2006, but this is the first study that can explain why. At fault is the metabolic impact of high blood sugars on the cells that produce heart valves. Peter Kamel, the study's lead author said, "We've seen in a variety of other cell types, like cells in the kidney, the retina and nerves, that high glucose concentrations can directly damage those cells and their activities. That results in patients with diabetes having problems with vision and with their nerves and kidneys as well. "The results that high glucose concentration can also cause pathologic remodelling by the aortic-valve cells could suggest that diabetes is also directly a cause of aortic-valve disease." The researchers suggested that the study only scratches the surface of understanding how the cells interact with excess lipids and sugars.
Genetics research offers new approach to treating type 2 diabetes
Studying the specific proteins that contribute to complex diseases such as diabetes might be a more effective approach to drug development, according to new research. Researchers from The University of Texas Health Science Center at Houston (UTHealth) School of Public Health presented their findings at the American Society of Human Genetics (ASHG) 2014 Annual Meeting in San Diego. The research claims that breaking down the conditions allows scientists to directly address the metabolic functions that have stopped working correctly. "In fact, genes that affect the same process at the protein level can end up influencing multiple traits in tandem," said Dr. Jennifer E. Below, lead author of the study. For example, the researchers discovered that a group of proteins involved with immune system functions also influences heart health. "Findings such as this highlight the importance of capturing the array of effects of genes, rather than treating each analysis as independent. Traits don't exist in silos; they are richly connected and interacting, and we benefit by acknowledging this in our genetic analyses." In other words, rather than considering diseases like type 2 diabetes or obesity as a whole, scientists should analyse the individual proteins that lead to the development of diabetes, and aim to understand how the presence of certain proteins links various diseases. The researchers plan to develop the study by analysing rare genetic variants and patterns of inheritance in families.
Frequent consumption of sugary drinks causes premature cell aging, study suggests
Frequent consumption of sugary soda drinks leads to the premature ageing of cells, according to a new study by scientists from The University of California-San Francisco. The researchers, who published their findings in The American Journal of Public Health, discovered that people who drink large amounts of soda tend to have shorter telomeres (protective DNA on the end of cell chromosomes) in their white blood cells. Previous research has found a relationship between length of telomeres and lifespan. In addition, short telomeres have been linked to tissue damage, insulin resistance, and inflammation, as well as diseases generally thought to be affected by aging, such as diabetes and heart disease. Sugary drinks have long been associated with a rise in obesity in the UK, with doctors demanding they be taxed in an effort to combat the issue. Professor Elissa Epel, lead author of the study, explained that, "Regular consumption of sugar-sweetened sodas might influence disease development...Not only by straining the body's metabolic control of sugars, but also through accelerated cellular aging of tissues." Effectively, the research suggests that, like smoking, sugary drinks increase the risk of developing type 2 diabetes. However, the observed correlation does not necessarily mean causation. The study is also limited by the time frame in which telomere length and soda consumption was compared. Professor Epel seeks to address these limitations in the future. The study will be developed by observing its participants over a longer period of time.
Higher levels of stress linked to type 2 diabetes
Research finds that a link may exist between type 2 diabetes and a weakened ability to recover from stress. Scientists at University College London (UCL) analysed the biological systems of 140 patients with type 2 diabetes, exploring whether they experienced a level of chronic stress higher than average. Cortisol and type 2 diabetes Lead researcher Andrew Steptoe, director of the Institute of Epidemiology and Health Care at UCL, found the patients with type 2 diabetes struggled to bring down their cholesterol, heart rate and blood pressure when responding to stress. The type 2 diabetes participants also had higher levels of cortisol, a stress hormone, in their blood, and IL-6, a protein involved when the immune system responds to stress. There was also a greater level of depressive and hostile symptoms displayed. Steptoe reported: "People with type 2 diabetes experienced more chronic stress exposure in terms of money concerns and neighbourhood problems. "They were more depressed, more pessimistic about the future, and reported a lower sense of control over their lives." Is diabetes caused by stress? The researchers concluded that the results do not reflect that the extra strain on the type 2 diabetes participants is either a consequence or cause of type 2 diabetes. Although a link between type 2 diabetes and stress was found, the UCL team believe the focus should now be on the need to target chronic stress effects with new treatments. This view was backed up by Donna Ryan, RN, CDE, and manager of patient education programs on diabetes, smoking cessation, and asthma at Sacred Heart Hospital in Pensacola, Florida. "The study provides further evidence that patients with diabetes have biological differences to stress, and emphasizes the importance of treatment, referral, and patient education for stress reduction," she said.
Young adults in the US feel uneasy managing their diabetes
Research finds that diabetes is less likely to be reported as a serious health condition among millennials in the United States. Diabetes survey A survey, conducted by Sanofi US, questioned millennials (aged 18-34 years) and non-millennials on their knowledge and awareness of their diabetes. 84 per cent of the older population recognised diabetes as a serious health condition, but this was compared to 74 per cent among millennials. There was also a degree of uncertainty about managing their diabetes, with 43 per cent of millennials saying they felt uneasy about pricking their finger to test their blood glucose levels. Only 28 per cent of older participants felt this way. 54 per cent of millennials, compared to 36 per cent in the older group, thought that taking insulin was the "end of the road", according to Elissa Violino, a registered dietician and certified diabetes educator (CDE) with CDE Help Team of Sanofi US. "With high levels of education and unprecedented access to information, millennials have the means to know more about diabetes than any generation in history," Violino said. "Diabetes is becoming more common, so it is necessary that we provide all people, including millennials, with the information and tools they need". Managing your diabetes Patients with type 1 or type 2 diabetes should not have to feel afraid of their condition, especially when medical research is consistently developing to help find a cure. Regular visits to your GP, consultant or healthcare professional will educate and inform you as to how to best manage your diabetes and advise you on any concerns you may have.
Are you eating too much sodium
A study has found that most patients with diabetes do not know how much salt they should be consuming, with many eating too much. Kristy Gray, a researcher with the University of South Australia School of Pharmacy and Medical Science, co-authored the study and found that salt intake was not a serious concern among participants. Diabetes and salt Gray studied 143 patients with diabetes, with over 80 per cent aware that processed foods, such as pizza, were high in sodium. Sodium is 2.5 x 1g of salt. However, only 30 per cent considered white bread and cheese as foods with high salt levels. Most of the participants, in fact almost half, were more concerned about their sugar consumption. 41 patients were more concerned about saturated fat, with 35 saying their biggest concern in general was their fat intake. Only 10 participants, however, viewed sodium as the highest dietary concern. Subsequently, many were taking in too much sodium in their diet, with type 2 diabetes patients taking in comparatively more salt than women and those with type 1 diabetes. Diabetes guidelines All adults should eat no more than 6g of salt a day, as recommended by the Department of Health. An increased intake of sodium - 2.4g is equivalent to 6g of salt - can lead to complications for those with diabetes, including high blood pressure and risk of a stroke. Vigilantly managing processed food intake can keep blood pressure down in patients with both type 1 diabetes and type 2 diabetes, which should be specifically noted when eating high-fat foods such as pizza.
Enterovirus infections in children increase risk of type 1 diabetes
A new study claims that children diagnosed with enterovirus (EV) are 50 per cent more likely to develop type 1 diabetes. The research, conducted by the China Medical University in Taiwan and published in Diabetologia, also found that the older the child when diagnosed with EV, the greater the risk. Tsai Chung-Li, lead author of the study, said that "Though the cue for genetic predisposition has been elucidated, evidence also points to involvement of enterovirus (EV) infection, including viruses such as poliovirus, Coxsackievirus A, Coxsackievirus B, and echovirus." In other words, the study reveals that there are factors beyond genetic predisposition in the development of type 1 diabetes. Chung-Li also said that the research explains the rapidly increasing levels of type 1 diabetes in regions like Africa, Asia, and South America, where EV is prevalent. There is a relatively low, but quickly rising level of type 1 diabetes in Taiwan, which suggests that "the marked escalation of the said incidence in recent decades can be largely attributed to the highly endemic spread of enterovirus infection in Taiwanese children, given that there has been little gene flow and genetic drift in such a short period." Discovering an effective vaccine against enterovirus, therefore, could reduce the incidence of type 1 diabetes.
Method discovered to prevent type 2 diabetes development
Researchers at McMaster University, in Ontario, Canada, have devised a method which may prevent up to half of future type 2 diabetes cases. They believe a simple method could predict the risk of type 2 diabetes development in adults, with their study analysing data from nearly 5,000 northern Europeans from two independent longitudinal studies. One-hour plasma glucose This involved testing blood glycemia levels one hour after consumption of a 75 gram glucose solution. The information on one-hour plasma glucose (1h-PG) was found by researchers to be sufficient in identifying those at risk of developing type 2 diabetes in the future. 30 per cent of non-diabetic adults, who were middle aged, displayed a high 1h-PG in the study. This was found to be higher than 8.9 mmol/l and they accounted for 75 per cent of all future diabetic cases. Type 2 diabetes prevention "This measurement may help to identify high-risk subjects in the general population for inclusion in type 2 diabetes prevention programs," explained David Meyre, senior author and associate professor in the Department of Clinical Epidemiology and Biostatistics at McMaster's Michael G. DeGroote School of Medicine. Meyre believes this prevention program could improve the lives of millions, if applied on a global scale, as well as preventing "up to half of future type 2 diabetes cases" should mass screening programs be applied. The researchers also found that 1h-PG outperformed current prediction models based on clinical risk factors such as body mass index, sex and age, with Meyre adding: "Another exciting perspective worth investigating is whether 1h-PG predicts future complications of type 2 diabetes." The value of the 1h-PG method to predict type 2 diabetes in multi-ethnic longitudinal studies, still needs to be assessed due to the rate in which the disease varies by ethnicity.
Low testosterone in diabetic men increases risk of atherosclerosis
New research suggests that men with type 2 diabetes and low testosterone have an increased risk of developing atherosclerosis than those with normal testosterone levels. Atherosclerosis is a condition that causes the build-up of plaque in the arteries. It develops when fat and cholesterol build up in the arteries. The study, published in the Endocrine Society's Journal of Clinical Endocrinology and Metabolism (JCEM) found that men with low testosterone and type 2 diabetes were six times more likely to have a thicker carotid artery, when compared to men with type 2 diabetes and normal testosterone. In total, the risk of vascular disease was 54 per cent higher in the low-testosterone men, and ten per cent higher in the men with normal testosterone. Javier Mauricio Farias, MD, of the Hospital Universitario Sanatorio Guemes in Buenos Aires, Argentina, and one of the study's authors said, "Our study indicates a strong association between low testosterone concentration and the severity of atherosclerotic plaques as well as other key atherosclerotic markers in middle-aged men with type 2 diabetes. "The results of our study advance our understanding of the interplay between low testosterone and cardiovascular disease in patients with diabetes." Farias also explained that the findings do not explain if testosterone directly contributes to the development of atherosclerosis, or if it simply suggests heightened risk. According to Farias, "This study is a stepping stone to better understanding the risks of cardiovascular events in men who have both low testosterone and type 2 diabetes."
EU driving regulations may be affecting type 1 treatment, study suggests
EU driving regulations have led to fewer type 1 diabetes patients reporting severe hypoglycemia to their health team, according a new study. According to the regulations, a diabetes patient can lose their license if they report two or more hypoglycemic events within a single year, based on the idea that this poses a risk to other drivers. However, a new study, published in Diabetes Care, claims that drivers simply aren't reporting their hypoglycemic episodes. Lead author Dr. Ulrik Pedersen-Bjergaard explained that, under the old rules, "The clinician could prohibit driving temporarily based on a general medical judgment. Authorities were informed only if the patient did not comply with the clinician's instructions." Clinician's, are now given the responsibility of deciding whether or not their patient can keep their driving license. Dr. Pedersen-Bjergaard believes this could damage the relationship between clinicians and their patients. If a patient is unwilling to tell their doctor about a hypoglycemic event, adequate treatment becomes much more difficult to maintain. The regulations have been in place since 2012, but the findings were published in October 2014. And while this specific study relates to Denmark, Dr. Brian Frier, of the University of Edinburgh, who took part in discussions about how the regulations should be applied in the UK, commented, "This potential issue has not been assessed in the UK as yet, but there is every likelihood that a similar problem exists here." The difference is, type 1 patients in the UK report hypoglycemic episodes directly to a driving authority. Because of this, the doctor-patient relationship, at least, remains unaffected.
Ingestion of arsenic linked to development of type 2 diabetes
A link has been discovered between the intake of arsenic, which is already associated with various types of cancer, to cardiovascular diseases and type 2 diabetes. The study was conducted by the Centre for Research and Advanced Studies, with experts from their Toxicology Department investigating how ingesting arsenic can lead to type 2 diabetes. The researchers focused on analysing a children population in Hidalgo, Mexico, that had drank contaminated water, which led to the consumption of arsenic. It was discovered, thanks to blood samples, that the relationship between cardiovascular diseases and type 2 diabetes with arsenic consumption was identified due to the presence of asymmetric dimethylargine (ADMA). This is an amino acid associated with problems in the arteries. The results suggest that the intake of arsenic for a long time, and from childhood, can lead to a greater likelihood of type 2 diabetes or cardiovascular problems after 30 years. Link to type 2 diabetes The scientists linked the development of type 2 diabetes to arsenic due to its pro-oxidant effects on proteins and lipids within the body. This contamination can lead to trivalent metabolites, which prevents insulin being produced by the presence of glucose. This can then favour the development of type 2 diabetes. The researchers subsequently plan to propose these results as a biomarker to detect diabetes or cardiovascular risks in the future.
USD20 million raised for type 1 diabetes vaccine cure research
Research towards a vaccine to cure type 1 diabetes has received an important boost in funding. Selecta Biosciences Inc. has secured $20 million (US) to fund their research collaboration which has support from type 1 diabetes charity, the JDRF, and Sanofi SA. The funding means that Selecta have now raised more than $78 million for the research project which aims to reprogram the body's immune system. The project aims to produce a true biological cure and has therefore a highly ambitious mission. On the positive side, the project also boasts a huge amount of expertise from the companies and organisations involved. Selecta has been developing antigen-specific immunotherapies based around tolerogenic nanoparticles called Synthetic Vaccine Particles (SVP). Supporting the research is Genzyme, a biotech company based in Cambridge and part of the large pharmaceutical company Sanofi SA. The funding will allow the research collaboration to initiate trials in mice to test the ability of the tolerogenic nanoparticles in reprogramming the immune system to not attack insulin producing beta cells in the pancreas. If the immune system can be successfully modified in this way, it would represent a biological cure for type 1 diabetes. It should be noted that the research is at a very early stage. To date, no attempts to produce a vaccine against type 1 diabetes have been successful in humans but each step of research represents a new understanding of the condition and researchers remain hopeful that one day research will crack the code and deliver the cure that so many people with type 1 diabetes have been waiting for.
New research indicates benefits of polyunsaturated oil
New research suggests that different kinds of fats have different effects on cholesterol levels. The study, published in the Journal of the American Heart Association, was conducted on 39 healthy adults, who had an average age of 27. The participants were required to eat three muffins a day, in addition to their normal diets, with the intention that each participant gains three per cent of their body weight over the seven week time period. Half of the participants were given muffins containing unsaturated sunflower oil. The muffins eaten by the other half were made with saturated palm oil. The muffins all had high sugar and carbohydrate levels. The study found that, although both groups displayed equal weight gain, the participants who had eaten polyunsaturated oils had nine per cent less 'bad' cholesterol when compared to those who had eaten the saturated oils. Both groups also developed higher levels of insulin resistance, which is a common indicator of diabetes risk. There are two forms of cholesterol: Low-density lipoprotein (LDL), known as 'bad' cholesterol, and high-density lipoprotein (HDL), or 'good' cholesterol. HDL removes LDL from the arteries, thus helping to prevent the arteries from becoming clogged. "Dietary fat composition thus seems to be important during weight gain," write the authors, "which is a novel finding that could have clinical implications in the long term." The purpose of the study was to discover how different dietary fats affect cardiometabolic risk, that is, the risk of developing heart disease, type 2 diabetes, or stroke. For people with diabetes, the function of HDL tends to be reduced, meaning that heart disease and strokes are more common. It is important, therefore, for people with diabetes to understand the implications of their fat intake.
New type 2 diabetes drug activated by blue light
Scientists have created a type 2 diabetes drug that can be deactivated by blue light, potentially improving treatment of the condition. Researchers from the Department of Medicine at Imperial College London believe that this could provide a less risky alternative to type 2 diabetes medication. Diabetes drugs, which trigger the production of insulin in the pancreas to control blood sugar levels, often cause side effects. These side effects can affect the heart and brain. The research, published in Nature Communications, found that JB253 - the study's prototype drug, an adaptation of existing drug sulfonylurea - reacted to blue light by increasing insulin production. How does this help? Diabetes patients risk developing hypoglycemia and cardiovascular disease when they use sulfonylureas, but the study claims to address such risks. Dr. David Hodson, lecturer at Imperial College London, said that "in principle, this type of therapy may allow better control over blood sugar levels because it can be switched on for a short time when required after a meal. It should also reduce complications by targeting drug activity to where it's needed in the pancreas." How does it work? Theoretically, the drug is inactive until the patient activates it using blue LED lights attached to their skin. This is, however, only the first step of a long process. While researchers have created a molecule that has the right effect on human pancreatic cells, a lot of work is needed before it can be used to treat patients.
Researchers discover that obesity accelerates ageing of the liver
Researchers at University of California, Los Angeles (UCLA) have discovered that obesity accelerates ageing of the liver. Using an epigenetic clock (an "age predictor" of most human tissues and organs), the study, published in Proceedings of the National Academy of Sciences, suggests that carrying excessive weight can be detrimental to some tissues. It has long been believed that obesity accelerates ageing, but this study is the first to prove it. "This is the first study that evaluated the effect of body weight on the biological ages of a variety of human tissues," said Dr. Steve Hovarth, holder of joint appointments in human genetics at the David Geffen School of Medicine at UCLA and in biostatistics at the UCLA Fielding School of Public Health. "Given the obesity epidemic in the Western world, the results of this study are highly relevant for public health." The study included almost 1,200 human tissues samples, 140 of which came from the liver. It was discovered that, while obesity does not affect the epigenetic age of fat, muscle, or blood tissue, the epigenetic age of the liver is increased by around three years for every ten BMI units. Researchers aim to take the study further by determining whether or not premature ageing of the liver in obese people is preventable. If so, it may help with the development of certain diseases, such as diabetes and liver cancer. The breakdown of the liver can increase insulin resistance, and is therefore a major contributor to the development of type 2 diabetes.
Link discovered between type 2 diabetes and Parkinsons disease
A chemist from Israel believes she is closing in on a groundbreaking discovery to understand links between type 2 diabetes and neurodegenerative diseases such as Parkinsons disease (PD) and Alzheimers disease (AD). Yifat Miller and her PhD student, Yoav Atsmon-Raz, conducted research at Ben-Gurion University of the Negev in Beersheva, revealing the atomic structure of a brain protein fragment called non-amyloid beta component (NAC). Miller's research found that when NAC clumps together it is known to trigger PD. Similarly, an endocrine hormone called amylin also clumps together, which leads it to harm insulin-producing beta cells in the pancreas. This then leads to type 2 diabetes. Amylin is also found in the brain, with studies linking this clumping to AD and the death of neurons. This mechanism, Miller believes, could explain why type 2 diabetics face twice the normal risk of developing AD. Preventing Parkinson's Miller also investigated why people with type 2 diabetes have a higher risk for developing PD as well as AD. Her study lasted three years, which involved using sophisticated computer simulations. The findings were then confirmed through experiments. Miller's findings backed up her hypothesis that amylin can interact with NAC, and she believes that her results could lead to preventative measures to stop this synergy in the brain. "Publishing our results will allow other scientists to use this information to learn more about Parkinson's, its mechanisms and possible drugs to reduce aggregation," Miller said. "Now, one could develop a drug to prevent this interaction so the risk of diabetes will not lead to the risk of Parkinson's".
Diabetic Care Plan offers comprehensive type 2 diabetes care
A survey conducted by London Medical finds that 66 per cent of type 2 diabetes patients believe improvements should be made in the understanding of their condition. 83 per cent of patients also wanted to see increased meetings with healthcare professionals to help them manage their type 2 diabetes, with 33 per cent willing to pay for improved care. The Diabetic Care Plan London Medica analysed these findings and developed the Diabetes Care Plan, a set of unique care packages that provide an alternative to what is being offered by the National Health Service (NHS). The plan is available at London Diabetes - a specialised diabetes centre based within the London Medical clinic - and is revolutionary in being consultant-led, while promoting education, self-care and enhanced communication with their diabetes team. London Medical has a 20-year heritage as an independent healthcare provider, with the company renowned for providing specialist care to diabetes patients. The Diabetes Care Plan offers patients comprehensive care, with the benefits including: Annual consultation with a member of the diabetes team to be used for education, support or treatment changes Free download of glucose meter readings at the clinic three times a year Regular updates, internet teaching modules and news 10 per cent discount on medication purchased from London Medical Pharmacy How can I join the plan? A patient "route map" has been designed by London Diabetes, which outlines options for people to access the Diabetes Care Plan. These include: Primary entry point - for initial assessments and medical tests to assess risks Secondary entry point - for those with an existing diagnosis to gain a second opinion Depending on the results of these initial assessments, patients may then be invited to join the Diabetes Care Plan. David Briggs, General Manager at London Medical, explains: "The Diabetes Care Plan is a totally new concept, offering access to the highest level of care for a minimal cost. "Private healthcare has long been perceived as exclusive and expensive, and this is an exciting opportunity for patients to benefit from an affordable and practical new healthcare service".
Grape seeds and skin extracts help to lower blood glucose levels
Increasing intake of grape seeds and skin extracts may be useful for diabetes management, new research suggests. The study, conducted by researchers from Sheyang Agricultural University, China, found a compound in grape seeds that can control blood glucose levels in patients with diabetes. Called 'procyanidin', and tested on diabetic rats, the compound reduced concentration of blood glucose over a six week period. In addition, the rats also displayed lower levels of serum lipids (cholesterol) and hepatic oxidative stress (liver problems). Furthermore, procyanidin slows the rate of sugar metabolism and counters oral bacteria, thus reducing the development of cavities. It may also reduce the risk of breast cancer development. While there are properties of grape seeds that help to lower blood glucose levels, a single grape contains approximately 1g of carbohydrate. Because of this, diabetic people should moderate their grape consumption, particularly if they are prone to high blood sugar levels. A study at Wayne State University, Michigan, discovered anti-hyperglycemic effects in grape skin extracts (GSE). "It is hopeful that our research may eventually lead to the successful development of a safe, targeted nutritional intervention to support diabetes prevention and treatment," said Kequan Zhou, study author and assistant professor at the Wayne State University. Zhou believes that GSE could be used, in future, as a safe and low cost nutritional treatment for people with diabetes.
High-sensitivity C-reactive protein linked to diabetic nephropathy development
Japanese researchers find that serum high-sensitivity C-reactive protein (hs-CRP), a non-specific marker of inflammation, is associated with the development of nephropathy in type 2 diabetes. However, Yasuaki Hayashino, MD, of Tenri Hospital in Nara, Japan, found that hs-CRP is not directly responsible for the progression of nephropathy, a kidney disease that affects type 2 diabetics. Studying hs-CRP Hayashino and colleagues analysed longitudinal data of 2,518 patients with type 2 diabetes obtained from a national diabetes registry. Their statistics showed a mean age of 66.1 years, body mass index (BMI) of 24.6 kg⁄m2 and HbA1c of 7.5 per cent (57.6 mmol/mol). Depending on their serum hs-CRP levels, patients were divided into four groups. The researchers used Cox proportional hazards, a model to investigate several variables at a time, to assess serum baseline hs-CRP and its correlations with diabetic nephropathy at one year. Findings The researchers found that baseline serum hs-CRP levels were significantly associated with the urinary albumin-to-creatinine ratio, a factor used to detect diabetic nephropathy. However, no significant associations were seen between hs-CRP levels and the risk of progression of nephropathy within type 2 diabetic patients. The researchers concluded that further investigation was required, but that hs-CRP levels could possibly be used in the future to predict developing risks of the kidney complication. The researchers wrote: "More research is needed to examine if there is an effective strategy to reduce the risk of diabetic nephropathy in a group of patients with diabetes and elevated levels of hs-CRP".
No damaging links between high egg diet and type 2 diabetes
Eggs have been found to have no effect on the cholesterol levels of those with type 2 diabetes, a new study has investigated. The study was designed to dispel any negative associations between egg consumption and type 2 diabetes and was conducted by Nicholas Fuller, PhD, from the Boden Institute Clinical Trials Unit, University of Sydney, Australia, Conducting the study Fuller’s study involved exploring the health outcomes of a high-egg diet on two groups of people; those with prediabetes and type 2 diabetes. Weight control was also investigated, with the time-span of the study lasting three months, a period in which cholesterol level changes could become apparent. A total of 140 overweight people were separated into either a low-egg group, who ate less than two eggs a week, or a high-egg group, who ate two eggs per day at breakfast for six days a week. The participants in the low-egg group were told to eat suitable protein to match the levels of the high-egg group, in which cholesterol levels were continually tested. Findings There was no significant difference between the two groups in levels of high-density lipoprotein (HDL) cholesterol. However, those in the high-egg group showed a slight HDL improvement. Fuller also reported that the high-egg group reported less hunger, greater fullness after meals, more satisfaction with their diet and less boredom. "Eggs may also help with greater weight loss and less weight regain than a conventional diet, due to the greater satiety and less hunger reported with a high-egg diet," Fuller said. This study is interesting as the findings suggest that eating two eggs per day for six days a week can safely benefit a healthy diet for those with type 2 diabetes.
Can a new good fat help against type 2 diabetes
A new group of molecules may counter diabetes, according to new research. Scientists at the Salk Institute and Beth Israel Deaconess Medical Centre (BIDMC), claim that this new fat (or lipid), lowers elevated blood sugar levels. The study was conducted on mice with the equivalent of type 2 diabetes. The lipid lowered their elevated blood sugar levels. Researchers also discovered that humans at high risk of diabetes have a lack of the fat. The new lipids, known as fatty acid hydroxy fatty acids, or FAHFA, exist (in low amounts) in a wide variety of fruits and vegetables. "We show that the lipids work through multiple mechanisms. When blood sugar is rising such as after a meal, the lipids rapidly stimulate secretion of a hormone that signals the pancreas to secrete insulin. In addition, these novel lipids also directly stimulate sugar uptake into cells and reduce inflammatory responses in fat tissue and throughout the body," said Barbara Kahn, Vice Chair of the Department of Medicine at BIDMC and a senior author of the work. "The higher levels of these lipids seem to be associated with positive outcomes in mice and humans," says Kahn, who is also a professor at Harvard Medical School. The researchers claim that these "multiple mechanisms" give the lipids huge therapeutic potential. GPR120, the cellular receptor FAHFAs respond to, controls the level of glucose absorbed by fat cells. By giving people more FAHFAs, scientists may be able to use GPR120 to counter the onset of diabetes, or to treat people who already have the disease. The researchers claim that these "multiple mechanisms" give the lipids huge therapeutic potential. GPR120, the cellular receptor FAHFAs respond to, controls the level of glucose absorbed by fat cells. By giving people more FAHFAs, scientists may be able to use GPR120 to counter the onset of diabetes, or to treat people who already have the disease.
Impotence drug treats type 2 diabetes gene mutations, study suggests
Yohimbine, a drug used to counter impotence, may be able to help people with type 2 diabetes. This is according to a study conducted by Swedish researchers, and published in Science Translational Medicine. Type 2 diabetes can be caused, at least in part, by a mutation of the gene alpha (2A)-AR that lowers insulin production, affecting around 40 per cent of people with type 2 diabetes. The research indicates that yohimbine improves insulin production and lowers blood sugar levels in these cases. "If a diabetic patient carries the risk mutation, he or she is more sensitive to stress hormones such as adrenaline," said lead researcher Dr. Anders Rosengren, head of the translational diabetes research group at Lund University Diabetes Centre in Malmo. The increased adrenaline lowers insulin production. Rosengren went on to explain that "It is like driving a car with the brakes constantly on. If you add yohimbine, you release the brake and the car - the insulin producing cells - can go at normal speed. The cells secrete adequate amounts of insulin in response to sugar." Despite this, Dr. Rosengren explained that, while gene mutations can affect the severity of type 2 diabetes, the disease is still triggered by lifestyle. Furthermore, he stressed that lifestyle changes remain the most important factor in the management of type 2 diabetes. Yohimbine also has a number of side effects. Some patients treated with the drug experienced stress, anxiety, and high blood pressure. Researchers are currently trying to decrease the risk of these side effects, while maintaining its benefits.
Harvard University raise hopes of cure for type 1 diabetes
Scientists at Harvard University have discovered a major breakthrough in the pursuit of effective treatment for type 1 diabetes. Experts have created large quantities of insulin-producing beta cells using stem cells. This is the first time Harvard has been able to manufacture the millions of beta cells necessary for transplantation. Human transplantation These beta cells function in almost every way as normal beta cells, with hopes now raised that trials for human transplantation could take place within a matter of years. Trials are currently ongoing to test these stem cell-derived beta cells in animal models, including non-animal primates. After several months, insulin is still being produced by the animals. Doug Melton, Xander University Professor at Harvard University, said: "It was gratifying to know that we can do something that we always thought was possible. We are now just one pre-clinical step away from the finish line". The transplantation of beta cells as a treatment for type 1 diabetes is still experimental, but this advancement, while still in its infancy, will provide optimism to the 400,000 people in Britain with type 1 diabetes that there could be a cure in their lifetimes. Critical acclaim The breakthrough at Harvard is being hailed as equal in significance to the discovery of antibiotics, with scientists in the UK full of admiration for the University’s work. Professor Mark Dunne at Manchester University said: "Overall this is an important advance for the field of diabetes and people with type 1 diabetes". Professor Anthony Hollander, Head of Institute of Integrative Biology at the University of Liverpool, added: "This is very exciting fundamental research that solves a major roadblock in the development of a stem cell treatment for diabetes".
Grapefruit juice investigated as treatment for diabetes
A study conducted at the University of California, Berkeley, has investigated whether grapefruit juice could be used as an effective treatment for diabetes. The researchers fed different groups of mice a combination of liquids. These included grapefruit juice and water that contained metformin, a drug widely used to treat people with type 2 diabetes. Grapefruit juice effects The report showed that the mice fed a high-fat diet and drank grapefruit juice lost 18 per cent more weight than the group of mice that drank sweetened water. This corresponded with a 13-17 per cent drop in blood glucose levels which in turn saw an improvement in insulin sensitivity. The biggest finding was that the mice whose blood sugar was reduced after drinking grapefruit juice displayed glucose-lowering effects that were just as successful as the mice who sipped on metformin. Restrictions None of the mice involved in the study had diabetes, so these findings currently bear little relevance to diabetes in humans. However, the use of grapefruit juice as a treatment to reduce glucose levels is one that had Berkeley scientists excited for future trials. "It was very surprising," said Joseph Napoli PhD, co-author of the study and Professor and Chair of Nutritional Sciences and Toxicology at the University of California, Berkeley. "When someone says a particular food has this magic quality of improving your health all by itself, we mostly take that kind of claim with a grain of salt." The Berkeley researchers are now focused on conducting further trials with humans as the next participants.
Type 2 diabetes starts in the brain, research suggests
A study conducted by the Icahn School of Medicine at Mount Sinai, New York, suggests that the increased presence of certain molecules in the brain can be an early sign of diabetes. The research, published in Cell Metabolism, builds on previous studies. These studies have shown that a significant increase in BCAAs (branched-chain amino acids, more prevalent among patients with type 2 diabetes and obesity) occurs in the years before the appearance of diabetes symptoms. This is because diabetic and obese patients don't break down the molecules as effectively as they should. For years, the reason for this has eluded researchers. However, this study, initially performed on rodents, demonstrates that our brains are supposed to signal to the liver to increase BCAA breakdown through insulin signalling. When BCAA levels are too high, therefore, the problem lies with impaired brain signalling. Dr. Andrew C. Shin, instructor of medicine at the Icahn School, said "What's important is that rodents with impaired insulin signalling exclusively in the brain have elevated plasma BCAA levels and impaired BCAA breakdown in the liver. "Since disrupted brain insulin signalling may cause the early rise of BCAAs seen in persons who eventually develop diabetes, the insulin resistance that leads to diabetes may actually start in the brain. The results suggest that levels of BCAAs may prove to reflect brain insulin sensitivity." This is one of a number of studies to suggest the significance of the brain in the development of diabetes. For example, it was suggested last year that the brain plays a key role in normal glucose regulation.
Eating fried food before pregnancy increases gestational diabetes risk, research suggests
A new study suggests that women who regularly consume fried food increase their risk of gestational diabetes when pregnant. The research, published in Diabetologia, involved a survey of women's dietary habits using a food frequency questionnaire. Beginning in 1991, the data was collected at four-year intervals. Led by Wei Bao, MD, PhD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, researchers discovered that women who ate fried foods seven or more times per week were at the greatest risk of gestational diabetes, while women who ate fried food less than once per week were at the lowest. "The potential detrimental effects of fried food consumption on gestational diabetes risk may result from the modification of foods and frying medium and generation of harmful by-products during the frying process," the researchers wrote. "Frying also results in significantly higher levels of dietary advanced glycation end products, the derivatives of glucose-protein or glucose-lipid interactions … implicated in insulin resistance, pancreatic beta-cell damage and diabetes, partly because they promote oxidative stress and inflammation." The research also revealed that, while gestational diabetes was significantly linked to food consumption away from home, the same did not apply to food fried at home. "Deterioration of oils during frying is more profound when the oils are reused, a practice more common away from home than at home," the researchers wrote. "This may partly explain why we observed a stronger association of gestational diabetes risk with fried foods consumed away from home than fried foods consumed at home."
Development of diabetes drug DiaPep277 halted following falsified results
The development of DiaPep277, a type 1 diabetes drug, has been temporarily halted due to the manipulation of trial data. Hyperion, a United States-based company, had agreed to complete the Phase III trial for the drug upon purchasing Andromeda Biotech from Clal Biotech in June 2014. The milestone payments of the deal meant that Hyperion parted with sums of up to $570 million. Lawsuit In September, Hyperion found that employees of Andromeda were engaged in "serious misconduct" which led to data being falsified in order for the trial to display a favourable result. Citing the allegedly tainted results, Hyperion cancelled its acquisition of Andromeda from Clal Biotech. Subsequently, Clal have sued Hyperion in a US court for $200 million, with both companies agreeing to resolve their dispute after Hyperion halted development. Clal will now appoint an independent party to evaluate any clinical efficiency in a freshly assessed study of DiaPep277 to analyse a potential regulatory path for the drug. What is DiaPep277? The DiaPep277 drug is a peptide designed to protect the internal production of insulin in patients who have recently been diagnosed with type 1 diabetes. It works by stimulation of regulatory responses to prevent the immune destruction of insulin-producing beta cells in the pancreas. These revelations will be disappointing to diabetes patients, with the delay in the drug's production unfortunately due to human error rather than scientific complications. However, it is at least comforting that DiaPep277 will still be studied by another party, inevitably under much more scrutiny, and that the production of a worthwhile drug could still be possible. This story is an updated version of an article Diabetes.co.uk published on Tuesday 09 September 2014.
Molecule delays progression of type 1 diabetes, study claims
New research suggests that a natural molecule may protect against autoimmune diseases, including type 1 diabetes. The study, published in Nature Communications by researchers at Brigham and Women's Hospital (BWH), claims that NAD+ (an oxidised form of co-enzyme nicotinamide adenine dinucleotide) can alter the immune response of cells and repair tissue integrity by activating stem cells. Autoimmunity is a process in which our immune system attacks healthy cells and tissues. This can lead to the development of diseases such as arthritis, multiple sclerosis, and type 1 diabetes. "Our study is the first to show that NAD+ can tune the immune response and restore tissue integrity by activating stem cells," said Abdallah ElKhal, PhD, BWH Division of Transplant Surgery and Transplantation Surgery Research Laboratory, senior study author. "These findings are very novel and may serve for the development of novel therapeutics." The study, performed on mice, used NAD+ to block chronic and acute inflammation. The NAD+ molecules can alter the way that immune cells, called CD4+T cells, differentiate between "good" cells and "bad" cells, thereby making immune cells less likely to attack healthy tissues and organs. "This is a universal molecule that can potentially treat not only autoimmune diseases, but other acute or chronic conditions such as allergy, chronic obstructive pulmonary disease, sepsis and immunodeficiency," said Stefan G. Tullius, MD, PhD, BWH Chief of Transplant Surgery and Director of Transplantation Surgery Research. The study is currently being developed further, as researchers seek to better understand the clinical potential of NAD+.
Type 1 diabetes study shows reduced link between HbA1c and hypoglycemia
A study published in this week’s PLOS magazine finds the link from hypoglycemia to HbA1c (average blood glucose) levels has declined in type 1 diabetes. Beate Karges and colleagues from the RWTH Aachen University in Germany analysed HbA1c levels in 37,539 children and young adults in Germany and Austria, who all had type 1 diabetes, between 1995 and 2012. The link between HbA1c and hypoglycemia and comas was studied using models which used HbA1c as a continuous term, with adjustments made for sex, age, diabetes duration, and insulin treatment regimes. The risk reduction of severe hypoglycemia and comas was strongest in patients with HbA1c levels of 6.0 per cent–6.9 per cent (0.96 and 0.90 reductions each year) and 7.0 per cent – 7.9 per cent (0.96 and 0.89 reductions each year). The authors of the study acknowledged the cause of this reduction is not yet clear, but they believe there was an increase in blood testing during this time, as well the usage of insulin analogs and insulin pumps. In a statement, the authors concluded: "The previously strong association of low HbA1c with severe hypoglycemia and coma in young individuals with type 1 diabetes has substantially decreased in the last decade, allowing achievement of near-normal glycemic control in these patients". This news should provide some reassurance to our forum users who have previously expressed concerns after receiving a low HbA1c result, only to be told by doctors they will subsequently have more hypoglycemic attacks. One user, Miss90, had previously written: "So I had my latest HbA1c today, which was 6.1. I've worked very hard to get this and I'm pleased. However, the consultant said it's 'too good' and the result is one or two hypos a week".
Recommendation that all US adults over 45 be screened for diabetes
As people age, they often become less active. This is considered a leading cause of the development of Type 2 diabetes. That is why a US task force has recommended that every American over the age of 45 should be screened for both Type 2 diabetes and prediabetes. Dr. Michael Pignone, a member of the US Preventative Services Task Force said, "For people with abnormal blood sugar, changes in their lifestyle, such as eating healthier and exercising more often, can help prevent or delay the onset of type 2 diabetes. "The best way to do that is to participate in a program that supports these behaviours. That's why we're recommending that people who are at increased risk be screened." The recommendation develops the task force's comments in 2008, when it suggested that only those at increased risk of heart disease should be screened. The new recommendation was endorsed by endocrinologist Dr. Spyros Mezitis, who explained that the epidemic levels in the United States of obesity, the leading cause of Type 2 diabetes, necessitates such a measure. The last 15 years have seen a dramatic rise in the number of Americans with Type 2 diabetes. The increase corresponds with the nation's obesity epidemic. Research indicates that diagnosing prediabetes significantly reduces a person's chance of developing Type 2 diabetes, as long as they adopt a healthier lifestyle. Although the recommendation focuses on diabetes in the United States, obesity and inactivity is also an issue in the UK. However, for anyone concerned about the risks they face, there are options. The NHS Health Check programme screens for common long-term health problems, including diabetes. Everyone between the ages of 40 and 74 who has not already been diagnosed will be invited for a check and offered advice to help manage the risks they face. Find out more at http://www.healthcheck.nhs.uk/
Lean BMI in Japanese with type 2 diabetes linked to lowest mortality
Japanese researchers have conducted a study that found patients with type 2 diabetes in the leanest body mass index (BMI) category had increased mortality rates. Data was collected on 2,620 adults with type 2 diabetes and separated into two different studies; the Japanese Diabetes Complication Study and the Japanese Elderly Diabetes Intervention Trial. Factors such as age, smoking, physical activity and other variables were considered, with patients divided into BMI categories of 14.4-18.5 kg/m2, 18.5-22.4 kg/m2, 22.5-24.9 kg/m2 and 25-37.5 kg/m2. The researchers found that during a follow-up period of 6.3 years, there were 45 deaths in the 18.5-22.4 kg/m2 category. This was higher than any other BMI category, with a comparative 34 deaths in the heaviest weight category of 25-37.5 kg/m2. Previously research has suggested that obesity plays a role in the low mortality of people with type 2 diabetes. These findings, however, provide interesting results that suggest obesity had no profound influence in the relationship to mortality. In a statement, the research team wrote: "The mechanism underlying higher mortality among lean patients is unclear. A potential explanation is unintentional weight loss due to chronic inflammation. "Furthermore, inflammation may be a manifestation of comorbidities of diabetes such as cardiovascular diseases, cancer and infectious diseases".
Type 1 childhood diabetes caused by prenatal exposure to viruses, study suggests
The exact cause of Type 1 childhood diabetes has for many years been unknown, but a new study by researchers at Tel Aviv University suggests that it is triggered before birth. It argues that the disease, which is increasingly common throughout the world and can have debilitating long-term complications, is developed by the transmission of viruses from the mother to the foetus. The findings were collected in a recent paper by Professor Zvi Laron, and published in Diabetic Medicine. Prof. Laron said, "We knew that type 1 diabetes was associated with other autoimmune diseases like Hashimoto Thyroiditis, celiac disease, and multiple sclerosis, so we investigated the seasonality of birth months for these respective diseases in Israel and other countries. We found that the seasonality of the birth of children who went on to develop these diseases did indeed differ from that of the general public." By testing the differences between pregnant women in different seasons, the study revealed that, during the viral epidemics common in winter, one in ten pregnant women without any family history of the autoimmune disease tested positive for antibodies that cause pancreatic damage. Prof Laron's research found specific antibodies that affect the insulin producing cells of the pancreas. The finding indicates that viral infections, which affected the mother during pregnancy, could lead to damage to either, or both of, the mother and the developing foetus. "If our hypothesis can be verified, then preventive vaccine before conception would be useful in stopping the increasing incidence of type 1 diabetes and other autoimmune diseases. There is no cure for this diabetes, so true intervention would be important not only medically but also psychologically and financially, as the costs of the lifelong treatment of this chronic disease and other autoimmune diseases are great." Funds are currently being raised to develop the research.
Type 2 diabetes clues revealed following identical twin study
A new study from researchers at Lund University in Sweden sheds light on how one identical twin can develop type 2 diabetes while the other remains healthy. The research team of Emma Nilsson and Charlotte Ling studied 14 pairs of identical twins, where one twin had type 2 diabetes and the other did not. They analysed how the biological process of DNA methylation at 480,000 points on the DNA affected the twins' genes. The aim was to see whether epigenetic changes in the DNA lead to fat tissue differences that could explain how type 2 diabetes develops. The results showed that the twins with type 2 diabetes had raised levels of fat in the blood, while their muscles, liver and pancreas absorbed the excess fat. This could lead to the organs developing a resistance to insulin, which could subsequently result in type 2 diabetes developing. A further discovery found that there were differences in the genetic code of the DNA in the twins, in which small parts of the DNA could be duplicated or be absent. Additional or not enough copies of a DNA sequence could therefore lead to changes in gene properties. Nilsson explained: "We found six cases where one of the set of twins had more or fewer of these copies in his or her DNA, and we suspect that this could be another cause of type 2 diabetes".
New drug to treat type 2 diabetes by burning liver fat
A new drug, which has previously been used to treat infections of parasitic worms, could be an effective medication for tackling insulin resistance in people with type 2 diabetes. Researcher Victor Shengkan Jin, from Rutgers Robert Wood Johnson Medical School in New Jersey, wanted to find a treatment which would be able to reduce the amount of fat in major organs such as the liver and muscle. Decreasing fat in the liver has been associated with reduction of insulin resistance, the root cause of type 2 diabetes. Jin knew that the worm infection treatment niclosamide could meet the goal of reducing liver fat. Niclosamide works by a process of mitochondrial uncoupling which increases energy expenditure and has the ultimate effect of burning excess fat in liver cells. Keen to put the niclosamide to the test, Dr Jin's research team used a modified form of the drug, niclosamide ethanolamine salt (NEN), and tested the effects in mice. Mice with genetic and diet induced forms of type 2 diabetes were used in the study. The mice were treated for 8 weeks with NEN and then measurements, including blood glucose levels and insulin levels, were taken. The results showed that after 8 weeks, mice treated with the drug displayed significant signs of reduced insulin resistance through reduced circulating insulin levels as well as reduced blood glucose levels. Dr Jin notes that niclosamide has a known safety profile in mammals and, if found to have tolerable side effects in humans, therefore represents a promising oral treatment that could prevent the need for bariatric surgery procedures, which are currently the only treatments that have shown consistent success in reversing type 2 diabetes. The next step for Dr Jin's research team will be to test the effects of the treatment in humans.
Long acting insulin shown to be better than intermediate insulin in type 1 diabetes
A comparison of long acting and intermediate insulin, involving 39 different clinical studies, has shown long acting analogue insulin to be the stronger option in people with type 1 diabetes. The long acting analogue insulin included in the comparison were Lantus (insulin glargine), which has a duration of around 24 hours and is taken once a day, and Levemir (insulin detemir) which has a duration for 18 to 24 hours and is taken either once or twice a day. The comparative insulin, intermediate insulin is NPH (neutral protamine Hagedorn), which usually has a duration of up to 18 hours and is taken twice daily. Overall, 7,496 people with type 1 diabetes were included in the analysis, which included 39 clinical trials, 26 of which were randomised controlled trials. The researchers analysed effects of the different insulin on HbA1c, weight gain and incidence of severe hypoglycemia. The analysis showed that average improvements in HbA1c with long acting insulin improved HbA1c between 2.9 mmol/mol (0.26%) and 4.3 mmol/mol (0.39%) compared with NPH insulin. In terms of weight gain, long acting insulin led to less average weight gain, of between 4.0 and 5.5kg, compared with intermediate (NPH) insulin. In the trials reviewed, Lantus was the most effective long acting insulin in terms of HbA1c reduction, whereas Levemir (once daily) was the most effective in terms of least weight gained. When numbers of severe hypos were reviewed, users of Levemir (either once or twice daily) had a 35% reduction in incidences of severe hypos compared to users of NPH insulin. The trials showed that whilst long acting insulin analogues are more expensive medications than NPH insulin, the benefit of reductions in HbA1c, weight gain and severe hypoglycemia is likely to outweigh the higher medication costs.
Vitamin D unlikely to be causal factor for type 2 diabetes
Research from the University of Cambridge has cast doubt upon the hypothesis that vitamin D could be a causal factor in the development of type 2 diabetes. Previously, a low level of a marker of vitamin D, known as 25-hydroxyvitamin D, has been associated with increased risks of developing type 2 diabetes. The study investigated whether four different gene variants which control levels of vitamin D in the blood were linked with increased rates of type 2 diabetes. The research, which was a mendelian randomisation study, showed no significant increase in risk associated with the gene variants related to vitamin D and concluded that the results suggest that vitamin D is unlikely to be a cause for the development of insulin resistance and type 2 diabetes. Previous research by Vimaleswaran KS, Berry DJ, Lu C, et al., published in the PLoS One Medicine journal in February 2013, investigated vitamin D's links with obesity and concluded that it was most likely that obesity led to lower levels of circulating vitamin D, rather than the other way round. The study appears in The Lancet Diabetes and Endocrinology journal is accompanied by an editorial piece by Dr. Brian Buijsse, of the German Institute of Human Nutrition, who adds that care needs to be taken in conclusions drawn from mendelian randomisation studies but that: "The results of a meta-analysis of 35 short-term trials, however, do not offer much hope that vitamin D supplementation can be used to prevent type 2 diabetes."
Gout linked with 71 per cent increased risk of type 2 diabetes in women
Gout is linked with a greater risk of type 2 diabetes and the association was found to be stronger in women with gout. The study, carried out by researchers from Harvard Medical School in Boston (US), involved 35,339 people with gout which were compared against 137,056 people without gout. 72% of the study participants were male and the average age of participants, of both genders, was 63 years old. People with gout were found to be more likely to drink higher amounts of alcohol, be more likely to take steroids and diuretics, visit the doctor more often and have additional health conditions. Therefore, hazard ratios, a measure of risk, were adjusted to take into account smoking status, alcohol consumption, doctors' visits, medication use and other health conditions. The results showed that women with gout were 71% more likely to develop type 2 diabetes than participants, with the same BMI, without gout. For men the risk was lower but still significant, with 48% more likely to develop type 2 diabetes than those with the same BMI but without gout. The researchers conclude that the results suggest that gout may be linked with type 2 diabetes independently from other factors such as alcohol consumption and medications.
Implantable mini pump prevents need to inject incretin medication
Researchers have developed an implantable device that delivers incretins, a medication for type 2 diabetes, for up to a year. Currently called ITCA 650, the device has been developed by Boston (US) based Intarcia Therapeutics. The mini-pump really is mini, being the size of a matchstick, yet is able to release up to a year's worth of exenatide medication. Intarcia Therapeutics has developed 6 month and 12 month versions of the mini-pump. The device is implanted into the body subcutaneously (just under the skin) and once the treatment has reached the end of its usable life, is then removed. Exenatide, which is currently available as an injectable medication under the branded names Byetta and Bydureon, is a GLP-1 agonist that helps to reduce HbA1c whilst having additional favourable benefits in facilitating weight loss. Whilst longer lasting forms of incretins are being developed, the most commonly available versions require injections once or twice per day. The device has recently completed four trials at phase 3 stage of the clinical trials process. The ITCA 650 mini-pump was shown to be significantly better than placebo and was able to reduce HbA1c levels by 37 mmol/mol (3.4%) over a 9 month period in patients that started with very high HbA1c levels of between 86 and 108 mmol/mol (10 to 12%). Dr Robert Henry, Professor of Medicine in Residence at The University of California, San Diego, who worked on the studies, expressed his satisfaction with the results of the trial: "I am extremely pleased with these phase 3 results. They delivered everything one could have hoped regarding ITCA 650's ability to provide sustained blood sugar control for many type 2 diabetes patients who are not achieving their goals – and all of this without the need for regular self-injections." Intarcia Therapeutics is keen to continue bringing the mini-pump to the market and have additional phase 3B trials planned to commence in 2015.
Poor standard of diabetes care given to under 40s
Adults under the age of 40 are receiving a low standard of care according to findings from the National Diabetes Audit. People with type 1 diabetes are facing particularly poor care in terms of complications screening with fewer than 3 in 10 of under 40 year olds receiving 8 of the 9 essential healthcare checks. Under 40 year olds with type 2 diabetes are not faring that much better with less than half receiving 8 of the 9 checks. It is a worry that essential screening is not being carried out, meaning that many young people may be blindly heading towards diabetes complications. The situation is not helped by the fact that many people under 40 are struggling to control their blood sugar levels. 22% of people with type 1 diabetes under 40 years old have an HbA1c over 86 mmol/mol (10%). For people under 40 with type 2 diabetes, 16% have an HbA1c over 86 mmol/mol (10%). Diabetes UK's Chief Executive, Barbara Young has responded to the findings, saying: "It is deeply worrying that young adults with diabetes are less likely to get their annual health checks and also less likely to have their condition under control. While it is right that the NHS has focused on older people with multiple conditions over the last few years, we fear that care for younger people and those of working age with diabetes is being left behind." If you are not receiving the complications screening tests you should be or are not being told what the results of these tests are, ask your doctor or consultant to address the issue. You should also be told your HbA1c results and, if they are higher than the recommended levels, you be given advice on how to bring your blood glucose levels under stronger control.
Healthy lifestyle could halve the risk of gestational diabetes
Research from Harvard University, Boston has found that the risk of gestational diabetes could be halved if a healthy lifestyle is followed prior to pregnancy. The study involved an analysis of data from the Nurses' Health Study recorded between 1989 and 2001. The Nurses' Health Study is a collection of data from nurses in the United States that has been running since 1976. The study included 20,136 births from 14,437 nurses that took part in the study. Nurses were aged between 24 and 44 years old at the study of the study period and 70% were aged 40 or above by the end of the study period. Health and lifestyle figures, such as smoking status and weight, were collected twice each year, a food frequency questionnaire was filled in once every four years and questionnaires on physical activity were completed in 1989, 1991 and 1997. The results showed that women that ate a relatively healthy diet, exercised more than 2 and a half hours a week and did not smoke, had a 41% lower risk of developing gestational diabetes. When women met these three healthy lifestyle factors and had a healthy weight going into pregnancy, the reduction in risk of gestational diabetes was by more than a half, 52%. The study showed obesity to be the largest of the risk factors for gestational diabetes, with women that had a BMI of over 33 having a 4 times (400%) higher risk of developing gestational diabetes. The study also showed how few nurses were managing to achieve all four of the low risk factors with only 1 in 6 nurses managing to eat a diet defined as healthy, exercise for 150 minutes or more per week, not smoke and be of a healthy weight. In the study, a healthy diet was defined as one that was rich in cereal grains and polyunsaturated fat and low in red and processed meats, sugary drinks and salt. Arguably, this may not be the healthiest definition of a diet as recent research has shown that diets, with more calories coming from saturated fat (not including processed foods) in place of some of the starchy carbohydrates, tend to be healthier. Gestational diabetes occurs in up to 1 in 20 pregnancies and raises the risk of health complications, notably the risk of having a large baby weighing over 4kg (10 lbs). Research also shows that babies born to mothers with gestational diabetes tend to have a higher risk of becoming obese than those born to mothers without the condition. Furthermore, having gestational diabetes also significantly increases the risk for the mother of developing type 2 diabetes later in life. What we can learn from the research is that if you wish to become pregnant, it is strongly advisable to lead a healthy life well before you plan to become pregnant to prevent gestational diabetes occurring as best as you can. If you currently do not have a healthy diet, do not take sufficient exercise or are currently a smoker, now is the time to turn things around.
Eylea receives European approval for treating Diabetic Macular Edema
A new drug, Eylea, has been approved for the treatment of Diabetic Macular Edema. Diabetic Macular Edema (DME) is a common eye complication of diabetes, affecting around 7% people with diabetes and 29% of people that have been on insulin for more than 20 years. DME is a form of retinopathy which, if left untreated, leads to moderate loss of vision in around a third of patients. Eylea, which is manufactured by Bayer and has the generic medical name aflibercept, is the latest drug to receive European approval for treating Diabetic Macular Edema. Whilst Eylea has been launched in the UK, as well as in Europe, the medication is yet to be approved by NICE. Eylea is in a class of drugs known as Anti-VEGF drug which are injected into the eye and help to prevent new blood vessel growth which poses a risk to vision. Currently, the only Anti-VEGF drug with UK approval to treat Diabetic Macular Edema is Lucentis (ranibizumab). Another drug for treating diabetic macular edema that is also up for approval consideration by NICE is Iluvien (fluocinolone acetonide). The increased competition within this area of treatments is a positive sign for people with diabetes. Currently, whilst Lucentis is available, its availability is limited, largely on account of its cost which is hundreds of pounds per injection.
JDRF WalktoCure Diabetes campaign raises over GBP285K
The type 1 diabetes charity, JDRF UK, has announced that it has raised more £285,000 for its #WalktoCure fundraising campaign. Thousands of UK children and families took part in the #WalktoCure campaign. Walks took place across the country and included a 9 kilometre walk across London's different bridges. The campaign also took part in other countries with, in total, hundreds of thousands of people taking part across the world. The money raised helps the JDRF to fund important type 1 diabetes research into understanding what causes type 1 diabetes, discovering ways in which type 1 diabetes may be cured and supporting the development of new groundbreaking treatments such as the artificial pancreas. The walks provided an opportunity for children with type 1 diabetes to meet each other and a number of children took the opportunity to dress up in outfits which saw the likes of Snow White and Buzz Lightyear walking together. Nikki Johnson was one of the walkers that took part in the Hayling Island walk in Hampshire. Nikki was walking in memory of her granddad Derek who had lived with type 1 diabetes for more than 60 years. Nikki said of the walks: "It's great to be united with other people fighting for the same cause." JDRF's Head of Regional Fundraising, Lydia Warrilow, expressed her gratitude for those who taken part in the walks and supported the fundraising campaign: "Thank you so much to all of our walkers, for supporting JDRF and raising such a remarkable amount of money."
Early initiation of insulin may slow development of type 2 diabetes
The ORIGINALE study is the follow up study to the previous ORIGIN study which investigated the effects of treating patients with type 2 diabetes and those with prediabetes with insulin glargine (Lantus). The ORIGIN study ran for 6 years and the study's primary aim was to assess whether treatment of prediabetes and early type 2 diabetes with Lantus was associated with increased or decreased heart risks compared with standard, non-insulin treatment. The ORIGINALE clinical study continued monitoring of the patients for another 2.5 years. Out of the 10,535 participants that had completed the ORIGIN study, 5,869 enrolled for the ORIGINALE study. The researchers used the study to test whether use of insulin to lower blood glucose levels would slow development of heart disease. The results showed no evidence of either a reduction or increase of heart disease but the ORIGINALE follow up study uncovered a different finding. The researchers found that of the people with prediabetes, those treated with insulin had a lower likelihood of developing type 2 diabetes. In the insulin treated group, 38% of participants with prediabetes developed type 2 diabetes, compared with 42% in the standard care group. When the researchers included possible cases of type 2 diabetes as well, the results showed 41% of new or possible diabetes cases in the insulin treated group and 48% of new and possible diabetes in the standard care group. The results suggest that use of insulin therapy may slow down the development and progression of type 2 diabetes. With most aspects of medication, there is rarely benefit without some form of side effect. In this case, whilst insulin appears to help slow the progression of glucose intolerance, the participants who took insulin experienced more hypos and experienced increased weight gain. The fact that the study provides evidence that insulin therapy may slow the development of type 2 diabetes is seen as encouraging by the researchers, who are keen to investigate further to find more conclusive proof. Currently, a new trial, called the RISE (Restoring Insulin Secretion) study, has just begun which will investigate whether medication (including insulin) or surgical procedures can slow progression of type 2 diabetes.
TALK hypos campaign launched to improve hypo management
TALK hypos is a new campaign which aims to increase awareness of hypos and spur better treatment and prevention of hypos in people with diabetes. Hypoglycemia (low blood glucose levels) can be dangerous for people with diabetes on specific medication, namely insulin, sulphonylureas and glinides (prandial glucose regulators). If hypos are not treated quickly in people on these medications, blood glucose levels can drop to dangerously low levels called a severe hypo, requiring help from someone else and can require hospitalisation. Around 18% of hospital admissions for diabetes complications are as a result of severe hypoglycemia. One of the problems that can lead to severe hypos developing is lack of awareness about the dangers of hypos. This can be a common problem if doctors that prescribe hypo causing medication do not adequately discuss the risks of hypos. Another problem is a condition called hypo unawareness which is when people are unable to recognise the early symptoms of hypos. A consequence of this is that severe hypos can occur without warning. Loss of hypo awareness is likely to occur in people that are spending significant amounts of time in a state of low blood glucose level. Awareness of hypo symptoms can return if low blood glucose levels are avoided for several weeks. The TALK hypos campaign, which is a collaboration between charity Diabetes UK and the pharmaceutical firm Novo Nordisk, encourages more communication between patients and doctors about hypoglycemia so that problems can be addressed and severe hypos can be prevented. The TALK hypos have four areas of action for people with diabetes: THINK: Do you know what a hypo is and whether you get hypos? ASK: Ask your doctor or nurse about hypos as part of your reviews. LEARN: Your doctor and nurse can advise you on spotting, treating and preventing hypos. KEEP TRACK: Note your hypos down so that you can discuss them at your next review or appointment. One of the problems for healthcare professionals is when hypos are not reported, under reporting of hypos is known to be a common problem which can occur for a number of reasons. These reasons include patients not knowing when or whether they are having hypos, patients believing their health team cannot help the problem and, in some cases, deliberate non-disclosure of hypos by patients over fear that their driving licence may be revoked. When hypos are not discussed, this can mean that problems with hypos only get worse which increases the risk that severe hypos will occur. Simon O'Neill, Diabetes UK's Director of Health Intelligence, states: "The first step is to help people with diabetes recognise the symptoms of hypos and better manage their condition by encouraging a regular discussion about them during consultations. We are pleased to be involved in a campaign which aims to do just that."
CQC finds care home failing to care for residents with diabetes
A report by the Care Quality Commission has found significant failings in the level of care provided to residents with diabetes and dementia at Mildenhall Lodge care home. Mildenhall Lodge care home in Suffolk, which is managed by Care UK, describes itself as a "luxury care home" but was found to be failing elderly residents in a variety of ways and only met one out of the five care standards that were reviewed. Amongst the failings noted, were the following concerns: Residents' dietary needs not taken into account, which included residents with diabetes Only one member of staff available to treat 11 residents with dementia Residents left hungry and thirsty Call bells not answered for up to 15 minutes A lack of activities resulting in residents spending most of their time in their rooms Diet is a particularly important aspect of diabetes care and management and therefore failure in this area is a strong concern. Call bells being left unanswered could also result in dangerous situations for any residents on hypo causing medications including sulphonylurea tablets. Care UK's Director of Quality and Governance, Caroline Roberts, responded to the report saying: Caroline Roberts, Care UK's director of quality and governance, said: "We fully take on board the CQC's comments and want to apologise to residents and their families for the care at Mildenhall Lodge falling below the high standard that they deserve." Ms Roberts added that an improvement plan has been drawn up and is being implemented by senior managers.
Overweight people more susceptible to effects of stress
New research shows that people who are overweight are more susceptible to the effects of stress. Scientists have, for a number of years, been aware of associations between stress and the effects of inflammation which include weight gain and type 2 diabetes but there is still much to learn about how stress brings about these changes. A team of researchers from Brandeis University in Massachusetts have uncovered another piece of the jigsaw in showing that people that are overweight are more sensitive the effects of stress. The researchers grouped participants into two groups, those that were overweight and those that were not. Being overweight was defined as having a BMI of 25 or more. Two psychological stress tests were carried out on participants on different days. Levels of the inflammation marker interleukin-6 (IL-6) were collected from blood samples to measure the effects on the body of the stress tests. It was noted that the overweight participants had higher levels of circulating interleukin-6 to begin. After the first stress test, increases in inflammation levels were modest and similar between the healthy and overweight groups. Following the second test, levels of IL-6 in the overweight group jumped to almost double the starting levels, whereas the participants with a healthy BMI experienced only modest changes in IL-6 again. The results appear to show that being overweight increases sensitivity to stress in terms of increased levels of inflammation. The researchers also noted that the effects of excess weight and levels of interleukin-6 displayed a linear association, that is the higher the BMI, the higher levels of IL-6 observed.
More to type 2 diabetes than obesity alone
Statistics show that whilst obesity is the largest risk factor associated with type 2 diabetes, 11.3 percent of people are of a normal weight when diagnosed with the condition. Type 2 diabetes is not such a simple disease and there are a number of ways in which insulin resistance, and therefore type 2 diabetes, can develop. Researchers have found that the link with obesity and type 2 diabetes appears to be dependent on the amount of fat that is stored within muscle tissue and around the organs. The fat that is stored around the organs is given the name visceral fat. Whilst large amounts of visceral fat are usually found in people that are obese, it is possible for a higher amount of visceral fat to be present in people of a healthy weight too. Research has shown that factors, such as genetics and use of certain medications, notably steroids, can affect where fat is stored in the body. In addition, research in identical twins, has shown that stress can also influence the accumulation of intra-abdominal fat. Just as people can accumulate visceral fat without being overweight, the flip side is also true that people can be overweight without having accumulating serious amounts fat around the key digestive and endocrine organs. Research has yet to fully understand what influences the body to store fat around the organs, however, following lifestyle changes, such as eating a good quality food, taking regular physical activity and stopping any excess alcohol consumption are well regarded as effective ways to prevent visceral fat and insulin resistance developing.
Could British diabetes rates plateau by 2020
With the latest data in the US showing that diabetes rates may have hit a plateau between 2008 and 2012, if the UK were to follow a similar trend, we could see diabetes rates levelling off as early as 2015. The latest US diabetes figures come from the United States Centers for Disease Control and Prevention (CDC). Researchers from the CDC used data from the National Health Interview Survey which surveyed 664,969 adults between the ages of 20 to 79 years old. The data showed that whilst rates of diabetes had more than doubled between 1990 and 2008, over the next 4 years, up to 2012, diabetes rates had increased only marginally. The prevalence of diabetes in the US as of 2012 is measured at 8.8%. The slowing in diabetes rates appears to lag behind US obesity rates which levelled off in 2003. Around 1 in 3 US adults are obese and this has been the figure that has remained unchanged since 2003. If US diabetes rates have now reached a peak, this indicates that it has taken between 5 and 9 years from obesity rates levelling off for diabetes rates to do likewise. If we assume that the rates of diabetes have indeed reached their plateau in the United States, this raises the question of whether the UK will see a similar effect in the near future. Whilst diabetes rates have been growing relatively sharply within the UK in recent years, the rates of obesity within the UK have shown signs of slowing down according to data from the Health Survey for England 2012. There had been a dramatic growth in obesity rates between 1993 and 2001, with obesity rates (in people aged 16 years old and greater) increasing from around 15% in 1993 to 22% in 2001. In the 11 years that followed, obesity rates had grown but at a slower rate, with the rate of obese people over 16 years old being measured at 25% in 2012. Indeed, in the period 2010 to 2012, obesity rates actually dipped from 26% to 25% suggesting that obesity rates may have reached a peak in the UK as of 2010. If diabetes rates were to follow a similar trend as observed in the US, with diabetes levelling off with a 5 to 9 year lag behind obesity rates, we might expect to see diabetes rates reaching a plateau as early as over the next 1 to 5 years. Note, as statistics are compiled with a 1 to 2 year lag, we would therefore expect to see a plateau in diabetes rates first reported somewhere between 2016 and 2021. Currently, within the UK, 3.2 million people are estimated to be diagnosed with diabetes, giving a prevalence figure of 6% of the population. Note that this makes a number of assumptions, such as that a similar trend in the US will be reflected in the UK, that obesity rates have indeed levelled since 2010 and also assumes that obesity is the driving force behind the rise in diabetes. Research shows that around 90% of people with type 2 diabetes are obese. With type 2 diabetes representing around 90% of diabetes cases, this means that statistically more than 80% of people with any type of diabetes will be obese. By contrast, diabetes prevalence estimates made by Public Health England have predicted that diabetes rates will not settle before 2020 and will continue to rise over the next 10 years. Public Health England's estimate is that by 2025, 5 million people in the UK will be diagnosed with diabetes, representing around 9% of the population.