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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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25 Jul 2012
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High salt diet doubles heart disease risk in diabetes patients
People with type 2 diabetes who consume lots of salt in their diet may be putting themselves at a significantly higher risk for developing heart disease, according to a new study. The research warns that diets high in sodium can double the risk of heart attack or stroke in people with type 2 diabetes, with the risk rising even higher for those with poor blood glucose control. "The study’s findings provide clear scientific evidence supporting low-sodium diets to reduce the rate of heart disease among people with diabetes," said study author Dr Chika Horikawa, a registered dietician from the University of Niigata Prefecture in Niigata, Japan. "Although many guidelines recommend people with diabetes reduce their salt intake to lower the risk of complications, this study is among the first large longitudinal studies to demonstrate the benefits of a low-sodium diet in this population." For the study, Horikawa and colleagues surveyed 1,588 type 2 diabetic participants aged 40 to 70, who were part of the Japan Diabetes Complication Study, about their dietary habits, particularly their intake of salt. The participants were then followed over a period of 8 years to see who developed heart problems. They results showed that people who ate an average of 5.9g of salt each day - the maximum daily intake recommended for the general population in the UK is 6g - were twice as likely to develop heart disease as those who consumed 2.8g of sodium daily, on average. And for people with poorly managed type 2 diabetes on a high-salt diet, the risk of cardiovascular complications soared nearly 10-fold. "Our findings demonstrate that restricting salt in the diet could help prevent dangerous complications from diabetes," Dr Horikawa added. The study was published July 22 in the Journal of Clinical Endocrinology and Metabolism.
Diabetes drug Actos associated with lower rates of Alzheimers disease
A study of over 100,000 people from German healthcare records show the type 2 diabetes drug, pioglitazone, to be linked with lower rates of Alzheimer's disease. Actos is in a class of drugs called thiazolidinediones, or TZDs for short. These drugs work by increasing the body's sensitivity to insulin. Whilst thiazolidinediones have been shown to improve blood glucose control, researchers have been interested to understand whether this has benefits for the brain, particularly with regard to preventing or delaying forms of dementia such as Alzheimer's disease. The researchers, from the German Centre for Neurodegenerative Diseases reviewed around 146,000 health records of people over 60 years of age that had no previous signs of dementia. Whilst nearly 1 in 10 people (13,841 participants) developed dementia between the years 2004 and 2010, rates of dementia amongst those taking pioglitazone (Actos) were significantly lower. The results back up findings from previous studies that have also indicated reduced risks of dementia. Whilst the findings appear to show benefits for the drug, medical organisations will need to see clear evidence that the drug can prevent Alzheimers before it can be recommended, particularly as the side effects of Actos include a slightly increased risk of bladder cancer. The manufacturers of the drug, Takeda, are currently running a five year clinical trial to see whether pioglitazone can delay the symptoms of Alzheimer's disease.
Sheffield foot clinic reports huge drop in diabetic amputation rates
Rates of diabetes-related amputations in Sheffield have significantly reduced, thanks largely to the introduction of a pioneering foot care programme. In 2007, the number of amputations carried out on diabetes patients in Sheffield were among the highest in the country. But foot clinic staff at the city’s Northern General Hospital revealed that there are now 18 fewer cases of diabetes-related limb loss in the city every year, despite the fact that appointments at the Sheffield clinic have risen by 80%. "We are delighted that, despite a dramatic increase in the number of people developing diabetes and diabetic foot problems in Sheffield in recent years, the changes we have made have led to this astonishing drop in the number of amputations in such a short period," said Dr Rajiv Gandhi, a diabetes consultant at the hospital’s diabetes centre. The major improvement in amputation rates has been attributed to a range of new measures introduced under an innovative diabetes foot care programme by Sheffield Teaching Hospitals NHS Foundation Trust. Dr Gandhi explained: "The treatment pathway for diabetes-related foot problems is a complex one, with many different health professionals involved, including GPs, podiatrists, microbiologists, vascular surgeons and nursing staff. We restructured our foot care pathway to enable rapid access to a specialist team. "Improved training for GPs and other healthcare professionals has meant they can spot problems more quickly and fast-track the patient, so they can see a consultant in 24 to 48 hours, if required. "We’ve also introduced a diabetes foot hotline, run by a consultant diabetologist, which provides advice to any community healthcare professional on diabetes-related foot disease." Further changes to the hospital's foot care service include closer liaison with microbiologists and improved patient education, highlighting specialist services that can be accessed without the need for a GP referral. The new foot care programme has also been well received, with 9 in 10 patients at the Sheffield clinic saying they were satisfied with the services.
Gout treatment to be tested to prevent diabetic kidney disease
A common treatment for gout, the medication allopurinol, is to be tested in patients with type 1 diabetes to see if it can prevent or delay the onset of diabetic kidney disease. Researchers from the University of Minnesota are recruiting 480 patients with type 1 diabetes that are at increased risk of developing kidney disease. The study will last 42 months with participants randomly assigned to take either allopurinol or a placebo pill. Diabetic kidney disease (nephropathy) is one the most common complications of diabetes. To date, the primary methods for preventing kidney disease have been to keep blood glucose and blood pressure levels as close to normal as possible. If the use of allopurinol is shown to be successful, it would present another means, in addition to blood glucose and blood pressure control, to hold back nephropathy. Allopurinol helps to reduce levels of uric acid and preliminary studies have shown it have potential in preventing kidney disease. Another advantage of the drug is that it has been used in humans, for the treatment of gout, for around 50 years and therefore its safety is well known and it is cheap. Whilst the study will review the use of the treatment in type 1 diabetes, it also has potential for preventing kidney disease in type 2 diabetes as well.
Diabetic beauty queen inspires thousands to show off insulin pumps
A diabetic beauty queen in America has become an inspiration for people living with type 1 diabetes after facing her fear of proudly showing off her insulin pump at a beauty pageant. Thousands of people with type 1 diabetes worldwide have been posting pictures of themselves wearing their insulin pump, with the #showmeyourpump, in support of Sierra Sandison who won the Miss Idaho 2014 competition after walking out on stage with a pump hitched to the waist of her bikini. Fans took to the internet to ask her to share the no-famous swimsuit picture online, and the 20 year-old responded by posting it on her Facebook page. After receiving thousands of 'likes' and 'shares', Sierra created her own Twitter campaign - #showmeyourpump - as a way for others to share their support and gain confidence. She said the response has left her overwhelmed, with social media sites being flooded with proud pump-displaying photos from diabetic users. "I would never have dreamt of posting a swimsuit picture on social media, but diabetics from all over the country have been asking to see me and my insulin pump on the Miss Idaho stage," Sierra said. "Honestly, it is terrifying walking out on stage in a swimsuit, let alone attached to a medical device. The Idaho beauty queen admitted that her life was turned "upside down" when she was first diagnosed with type 1 diabetes in February 2012. "For a while, I pretended that I didn’t have diabetes, hoping it would go away. That led to crazy blood sugars, of course, and a very sick, grumpy, and discouraged Sierra." But after discovering that Miss America winner Nicole Johnson was a diabetic who wore - albeit discreetly - an insulin pump, she decided to go one step further by entering the Miss Idaho contest with her pump clearly on display. "My message to everyone, diabetic or not, is that we all have something that doesn't "measure up" to the beauty standards set by the media and that is okay! It does not make you any less beautiful. We also all have obstacles, challenges, and trials," she wrote on her Twitter account. "Don't let your challenge hold you back or slow you down. Use it to, not only empower yourself and grow as an individual, but to serve and influence other people as well."
New islet cell replacement therapy applies for human trials
A new islet cell replacement therapy, with advantages over islet cell transplantation, has had an application to start human trials submitted to the US Food and Drug Administration (FDA). The new technology is called 'beta cell encapsulation therapy' and serves to replace the insulin producing beta cells of the pancreas that are destroyed by type 1 diabetes. The technology is a result of collaboration between ViaCyte, a pharmaceutical company from San Diego in the USA, and the type 1 diabetes charity, the JDRF. The most common treatment in type 1 diabetes is to take insulin injections but this can be complicated to manage and can result in dangerously low blood glucose levels (severe hypoglycemia) if errors are made. A small number of people with type 1diabetes that are at greatly increased risk of severe hypos may apply for islet cell transplantation, a procedure in which pancreatic beta cells (also known as islet cells) are transplanted into the body. Islet cell transplants can be very effective at improving control and reducing hypoglycemia but they require the transplant recipient to take strong immunosuppressive drugs to prevent type 1 diabetes from attacking the newly transplanted cells. These drugs have disadvantages as they render the immune system less able to fight infection. The advantage of the new beta cell encapsulation therapy is that insulin producing beta cells are essentially hidden, by a protective coating, from the rogue immune system of type 1 diabetes. Because the insulin producing cells are protected, there is no need for immunosuppressive medications to be taken. The application that has been sent by ViaCyte and the JDRF is an Investigational New Drug application. If accepted by the FDA, this will allow the new treatment to be tested in patients with type 1 diabetes. Such trials would be phase 1 and phase 2 trials. Three phases of trials need to be successfully passed before the treatment can be considered for authorisation for use in the public. Jeffrey Brewer, President and CEO of the JDRF in the United States responded to the application, saying: "We are excited to continue our collaboration with ViaCyte and believe beta cell encapsulation therapy may one day virtually eliminate the daily management burden for those living with type 1 diabetes."
Researchers recommend carb restriction as primary method of diabetes control
A multinational team of researchers has put forward a comprehensive case for recommending dietary carbohydrate restriction as the default intervention in managing diabetes mellitus. The critical review, which has been published online by the Nutrition Journal, presents 12 points to support the use of a low carbohydrate diet in people with type 2 and type 1 diabetes. In people with type 2 diabetes, the review recommends a low carbohydrate diet as the first intervention. In type 1 diabetes, a low carb diet is advised as the default diet in addition to taking insulin. The 12 points listed by the researchers are backed up by results of clinical studies: High blood sugar is the most important feature of diabetes control. Increase in calorie intake and obesity has been driven by increases in carbohydrate intake. Carbohydrate restriction provides benefits regardless of weight loss. Carb restriction is the most reliable dietary intervention for weight loss. Adherence to low carb diets in type 2 diabetes is as strong as other dietary interventions, and is often significantly stronger. Generally, replacing carbs with protein is beneficial. Increased total fat and saturated fat intake are not associated with increased heart disease risk. Triglycerides are controlled by carbohydrate intake more than by lipids (LDL, HDL). HbA1c is the greatest predictor of microvascular and macrovascular complications in patients with type 2 diabetes. Lowering carb intake is the most effective method for decreasing triglyceride levels and raising levels of ‘good’ HDL cholesterol. Patients with diabetes reduce their dependence on, or doses of, medication when following a low carb diet. Intensive blood glucose reduction though carb restriction has negligible side effects compared with use of medication for the same effect. Within the review, the researchers draw attention to the fact that the studies, aimed to show safety and effectiveness of a low fat diet in improving heart health, have universally failed to show benefit. The review also criticises the use of total and LDL cholesterol as markers of heart health, arguing that other markers have been consistently been shown to be stronger. Other markers include the ratio of total cholesterol over HDL and the ratio of triglycerides over HDL, both of which are easy to measure clinically. The researchers call upon governments and health agencies to hold hearings on the issues presented in the review, adding that vigorous scrutiny should be part of the process.
Hormonal contraception may up risk for gestational diabetes
Women who use hormonal birth control before they get pregnant may be more likely to develop diabetes during pregnancy, according to a new, first-in-kind study. The research, published online July 17 in the Preventing Chronic Disease journal, suggests that hormonal contraceptives raise the risk of gestational diabetes mellitus (GDM), a type of diabetes that occurs or his first recognised in pregnancy and is estimated to affect up to 15% of pregnant women worldwide. To investigate whether a relationship exists between methods of birth control and gestational diabetes risk, Dr Venkata Garikapaty, of the Missouri Department of Health and Senior Services, and colleagues analysed data from over 2,700 women who completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Participants were asked questions about their history of gestational diabetes and their use of birth control, both before becoming pregnant and after giving birth. More than 8 out of 10 (8.3%) of the women reported being diagnosed with GDM in their most recent pregnancy. 18% of the women said they used hormonal contraception, such as birth control pills, contraceptive patches, and cervical rings, making it was the most common form of contraception, closely followed by condoms and other barrier methods at about 17%. The team concluded that women who used hormonal contraceptive methods were 1.4 times more likely to develop gestational diabetes than women who did not use any form of birth control. "Although researchers have not established a causal relationship between hormonal contraception use and [gestational diabetes], results of our study suggest there may be an underlying correlating mechanism," the researchers wrote. However, they added that "more research is needed to verify contraception as a potential risk factor" for gestational diabetes. Limitations of the study included the fact it only focused on one US state and was based on self-reported data. It did not specify if the women had been asked about the exact timing and duration of their contraception use, and whether they were on birth control when they got pregnant.
NICE publishes guidance to widen statins treatment
Despite failing to win the backing by the British Medical Association, NICE has stuck to its decision to widen the number of patients eligible for statin treatment. The decision by NICE (The National Institute for Health and Care Excellence) will see anyone with a 10% risk of heart disease in the next 10 years offered statin treatment. The guidelines will take effect immediately within England but will require signing off in Northern Ireland and Wales. NHS Scotland has proposed no plans to widen statin treatment however. The guideline (clinical guideline 181) will mean the majority of people with diabetes in the UK will be offered statins, if they are not taking them already, and millions of people without diabetes will be offered statins as well. The guidelines note that people prescribed statins should receive annual medication reviews. The decision to widen statin treatment is not without controversy. The General Practitioners Committee (GPC), part of the British Medical Association, has spoken out about its doubts over the new plans, stating: "There is insufficient evidence of significant overall benefit to low-risk individuals to allow GPs to have confidence in the recommendation." Within the medical community opinion is widely polarised over the regularity of side effects associated with statins. The new guidelines from NICE assume that there are very little side effects associated with statins, whilst a number of leading practitioners dispute this assumption. Amongst the leading health professionals that have called the new guidelines into question are Dr Clare Gerada, the former President of the Royal College of General Practitioners (RCGP) and Dr Kailash Chand, Deputy Chairman of the British Medical Association (BMA). Whilst the NICE guidelines assume that side effects of statins are minimal, recently published research shows that adherence to statins increases the risk of type 2 diabetes by as much as a third. The argument in favour of statins is based on the fact that for every 1,000 people taking statins over a three year period, there will be 2 fewer deaths, 4 fewer strokes, and 7 fewer non-fatal heart attacks. Whilst statins will be offered to a much greater number of people, including those with diabetes, adherence is not mandatory and treatment should be agreed between patient and doctor. Prof Sir John Tooke, President of the Academy of Medical Sciences, states: "Whether or not someone takes drugs to diminish their risk is a matter of personal choice, but it must be informed by accurate information on the balance of risk and benefit in their particular case."
Millions of Brits in denial about diabetes
One in three adult Brits are at greater risk of developing type 2 diabetes, but two-thirds of those are not worried about their health. That's according to new analysis by the Simplyhealth Advisory Research Panel, who claim that millions of people across the country are playing a dangerous game of diabetes denial. A third of those polled by the Panel were either heavily overweight or obese and therefore deemed to be more likely to develop type 2 diabetes, backing data published last month in the British Medical Journal, which revealed that 30% of British adults now have prediabetes - often the precursor to full-blown type 2 diabetes. However, most of the 'at risk' respondents claimed not to be concerned about the possibility of becoming diabetic, with 60% saying they don't believe their higher risk is something to worry about it. Commenting on the figures, Dr Ralph Abraham, one of the UK's leading diabetes experts warned: "Britons really are taking a high-risk gamble. "If you have prediabetes, there are no symptoms, and a shocking number of people are sleep-walking towards developing full diabetes and serious health problems." Another diabetes specialist, Dr Gill Jenkins, said: "This level of denial can be deadly. Diabetes damages blood vessels, destroys sight and undermines almost every aspect of your health until one day there is a crisis and it becomes impossible to ignore. "The truth is that diabetes can be controlled and when it is managed many of the associated risks are reduced. But if it's poorly managed or simply not diagnosed, it can have a devastating impact on the quality and length of your life." Yesterday, a team of researchers in the UK and U.S. controversially claimed the term prediabetes is unhelpful, unnecessary and of zero clinical worth. Writing in the British Medical Journal, they stressed that there is no proven benefit of prescribing medications for individuals classed as 'prediabetic' as many of them will not go on to develop diabetes.