Diabetes Health Talk

Balloons

For the test, the subject drinks a solution of glucose labeled with a short-lived radioisotope, carbon-13. A breath analyzer then measures the amount of exhaled carbon dioxide labeled with carbon-13.

“This novel breath test method may assist in recognition of pre-diabetes or early-stage diabetes in at-risk persons without the need for invasive blood sampling, thus making it an attractive option for large-scale testing of at-risk populations, such as children,” the researchers write in the medical journal Diabetes Care.

To test the method, Dr. Melinda Sheffield-Moore, at the University of Texas Medical Branch in Galveston, and her colleagues collected blood and breath samples from 17 subjects every 30 minutes for 10 hours after they consumed a drink containing radiolabeled glucose. The team measured glucose level in the blood samples and the ratio of labeled-to-unlabeled carbon dioxide in the breath samples.

Based on the blood glucose readings, 10 of the subjects were normal while 7 had either pre-diabetes or early-stage diabetes.

“Remarkably,” the investigators report, “the breath analyzer was capable of detecting marked differences in glucose-derived breath carbon dioxide kinetics between (normal and pre-diabetic) individuals within 60 minutes.”

Specifically, the amount of carbon-13 labeled carbon dioxide was much lower in the pre-diabetic group than the non-diabetic subjects between 1 and 3 hours after the glucose load.

Sheffield-Moore and her associates suggest that it would be feasible to use a breath analyzer and storable breath collection bags for large-scale diabetes screening.

Stress

“Much attention has been given to the role of obesity in the development of type 2 diabetes, but stress may be as important in this at-risk population,” study co-author Anastasia Georgiades, of Duke University in Durham, N.C., said in a news release.

The study included 62 healthy, non-diabetic black women who were asked to recall stressful life events. As they did, the researchers measured the women’s levels of blood sugar and epinephrine, the “fight or flight” hormone that’s released in reaction to stress.

Women with high epinephrine levels (25 picograms or more per milliliter of blood) while recalling stressful events and with more belly fat (33 percent or more of total body fat) had significantly higher fasting glucose scores (about 100 milligrams per deciliter) than women with lower epinephrine levels and less belly fat (85 mg/dl). A fasting blood glucose level of 100 mg/dl is considered within the low range of pre-diabetes, and a level of 125 mg/dl is the benchmark for type 2 diabetes.

Women with high epinephrine levels and more belly fat also had bigger increases in blood sugar levels during the stress test.

The findings were to be presented this week at the annual scientific meeting of the American Psychosomatic Society.

“While we don’t fully understand the nature of the association, women with abdominal obesity may be more vulnerable to the impact of stress — causing their body to increase blood sugar production and elevating their risk for diabetes,” Georgiades said.

Accu-chek Meter with skins

Got mine, ordered the Sports Skins. This is a great opportunity for diabetics and those watching their blood sugar.

The gift, the second-largest donation in the university’s history, could be a shot in the arm toward finding a cure for Type 1 diabetes.

Courtesy of Josephine Marcotty. Best Buy founder Richard Schulze and his family foundation will give $40 million to University of Minnesota researchers who are intent on finding a cure for Type 1 diabetes, the university announced Thursday.

The money, the second largest gift in university history, will be paid over five years and provide about half the $20 million the university will spend annually on diabetes research. Officials said they hope it will provide the financial boost needed to defeat the disease.

“We must not settle for anything less than a cure,” said Dr. Bernhard Hering, who will head the project. “We only need to declare it possible.”

Schulze and his daughter, Debra Schulze, 40, who has had Type 1 diabetes for 28 years, said they chose the university’s program over a number of other research organizations, both public and private, after studying programs around the world. They chose the university because it seemed to be closest to finding a cure and was less focused on finding new treatments for symptoms, she said.

As many as 3 million people in the United States live with Type 1 diabetes, in which the immune system attacks islet cells in the pancreas, destroying the body’s ability to produce insulin and regulate blood sugar.

A spoonful of honey brings metabolic stressors down and with it the chances of developing diseases such as diabetes, Alzheimer’s and osteoporosis, says a leading honey researcher.

Ron Fessenden, a retired physician and author from Denver, Colo., says the health benefits of honey are real and can be used to improve the health of the general public. Speaking on Tuesday at the Saskatchewan Beekeepers’ Association convention in Saskatoon, Fessenden said honey lowers blood sugar levels, which reduces metabolic stress.

“Honey actually has a very significant stabilizing affect on blood sugar, that’s counter-intuitive to most individuals who think it’s sort of like saying, ‘Well, I’m going to eat some bacon to help control my cholesterol,’ and that’s not true about honey,” he said.

Honey, which is made of two sugars, facilitates the production of liver glycogen, Fessenden said. Liver glycogen fuels the brain but only has enough stores for about eight hours, he continued. The human body produces cortisol when the brain runs out of glycogen and when cortisol is released, he said, it triggers metabolic stress.

“Obesity, insulin resistance, diabetes, cardiovascular disease, hypertension, polycystic ovarian disease in young women, hyperthyroid conditions, osteoporosis, about 10 per cent of all cancers, Alzheimer’s disease, Parkinson’s disease, neurodegenerative conditions which are impacted by high blood-sugar levels over several decades — all of these things are reduced or eliminated by the elimination of metabolic stress by the reduction of cortisol levels,” he said.

In short, Fessenden says honey keeps the brain happy.

Courtesy U.S. Rep. John Murtha: Diabetes places physical and emotional strains on individuals and their families. Once diagnosed, diabetes becomes a 24/7 responsibility and the entire family becomes involved with managing the disease. If left undiagnosed or untreated, serious health complications can arise.

The medical costs for treating diabetes are staggering. On average, those with diabetes spend $10,000 more per year on medical care than those without diabetes. Last year, diabetes cost the United States $174 billion in excess medical expenditures and lost productivity, a 32 percent increase from 2002. Here in the 12th Congressional District, the medical and indirect costs added up to $366 million last year.

We must reverse this epidemic. November was American Diabetes Month. It is a time to raise awareness, to promote the importance of diet and exercise, and to support proper diabetes management and care.

At the University of Pittsburgh Diabetes Institute, diabetes experts are examining the lifestyle factors and choices of type 2 diabetics. Type 2 diabetes is the most common form of diabetes and occurs when the body does not produce enough insulin or the cells ignore insulin. A poor diet and lack of exercise, which contribute to a growing rate of obesity, are key factors in the rise of type 2 diabetes nationally…. The Pittsburgh Regional Initiative for Diabetes Education (PRIDE), a program created by the Diabetes Institute, is fighting these factors by developing education and outreach tools and placing diabetes educators and dietitians within our rural hospitals and primary care practices…. This allows one-on-one training of medical staff and personalized consultations and care for patients.

The PRIDE program currently reaches patients in seven Pennsylvania counties…. In Fayette, Greene, and Washington Counties, the PRIDE program partners with Uniontown Hospital, Washington Hospital, Highlands Hospital, and the Centerville Clinics to offer patients a comprehensive outpatient educational program. Certified diabetes educators offer one-on-one and group classes on meal and nutrition planning, blood glucose monitoring, behavior modifications, exercise and weight management, and stress management. They also have a free monthly support group that allows patients to interact with specialists and other diabetics.

The widespread problem of children failing to take their medication for a range of life-threatening illnesses is to be tackled as part of a new university research project.

The first phase of the study will be to look at methods previously tried to address the problem and to talk to three groups of school-age children — five to seven year olds, 10 to 12-year-olds and 15 to 17-year-olds — and their parents about their experiences of the healthcare system and medication. They will also interview a range of healthcare professionals including GPs, hospital paediatricians, community paediatricians and pharmacists, nurses and GP practice managers and secretaries about the issues they face in communicating their services to young people. Lastly, they will consult with other stakeholder groups including patient groups such as Asthma UK and Epilepsy Action and healthcare-related organisations such as the Royal College of Practice Nurses.

During the second phase they will design a new strategy that can be embedded within the whole range of healthcare services for children — this may include encouraging children and parents to write down their concerns or questions as a driver for their consultation with their GP and giving health practitioners a range of extra resources targeted specifically at supporting younger patients.

Dr Monica Lakhanpaul, Community Paediatrician and Senior Lecturer in Child Health at The University of Leicester, said: “We are fully aware that children may not take medicines sometimes prescribed to them by health professionals.

“Reasons for this vary — children and families may not receive information that facilitates their understanding of why they are taking their medicine and therefore not understand its importance; they may not understand how to take the medicine or the health professionals may not prescribe the type of medication that children could take easily, eg tablets instead of liquids.

“We wish to find out why — and why not — children take their medicine and use this information to develop a tool allowing health professionals to work together with children and parents and carers to improve the medicine they are prescribed. 
 
“A very important element of the study is to gain views from a number of different perspectives i.e from parents/carers, health professionals and children themselves.”
Lecturers at The University of Leicester are key collaborators in the study. Dr Hitesh Pandya is able to provide experience of working with families who are seen in the hospital and Dr Lakhanpaul, a Community Paediatrician, works with children who are managed out of hospital and who, in most cases, will not have a nurse or doctor giving their medication but need to take responsibility within the home or school environment.
 
Dr Lakhanpaul added: “Another advantage at Leicester is that we can provide access to a multi-ethnic community who are often under-represented in research studies. It is important to have perspectives from individuals from different socio-economic and cultural backgrounds. We hope to achieve this by involving families from Leicestershire.”

Women younger than age 65 with diabetes tend to have worse cardiovascular risk profiles than diabetic men of the same age, leading to higher death rates following a heart attack, research shows.

“The female advantage with fewer cardiovascular events than in men at younger ages is attenuated once a woman has the diagnosis of diabetes,” Dr. Anna Norhammar and associates report.

They sought to identify gender-related differences in prognosis, risk factors, or treatment among 25,555 patients younger than age of 65 treated for heart attack between 1995 and 2002. In this cohort, 23 percent were women and 21 percent of women and 16 percent of men were previously diagnosed with diabetes.

During an average follow-up of 4.4 years, diabetic women had a 34 percent increased risk of dying, compared with diabetic men.

Compared with the male patients, female patients had higher rates of high blood pressure and heart failure and were more likely to smoke.

Fewer women than men had had procedures to open clogged arteries prior to their first heart attack, and women were less likely to be treated with blood pressure drugs called beta-blockers or ACE inhibitors.

Nevertheless, Norhammar, at Karolinska University Hospital in Stockholm, and her team attribute the higher death rate in diabetic women younger than 65, relative to diabetic men of the same age, to risk factors rather than treatment differences.

“The present observation makes further study of the impact of improved risk factor management in this particular group of relatively young, easily identifiable, high-risk patients important,” the researchers conclude, “together with attempts to initiate treatment and cardiac investigations before their first (heart attack) or the onset of heart failure.”

People diagnosed with diabetes spend over $4,100 more each year on medical costs than people who don’t have diabetes, a gap that increases substantially each year following the initial diagnosis, according to a study published online today in the journal Diabetes Care.

In the first study to examine medical cost increases for individuals living with diabetes on a year-by-year basis, researchers at RTI International, an independent, nonprofit research institute based in North Carolina, calculated that a 50-year-old newly diagnosed with diabetes spends $4,174 more on medical care per year than a person the same age who doesn’t have diabetes. For the person with diabetes, medical costs go up an additional $158 per year every year thereafter, over and above the amount they would increase due to aging-related increases in medical expenses.

Most of the increase can be attributed to the cost of diabetes-related complications, such as heart and kidney disease, the researchers found. Once they controlled for complications, the remaining annual increase in medical costs was $75 per year — the bulk of which could be attributed to the increasing need for diabetes medications the longer a person lives with the disease.

“The good news is that many of these costs could be contained through proper diabetes management and lifestyle changes,” said lead researcher Justin Trogdon, Research Economist. “Numerous studies show that losing weight and increasing physical activity, along with maintaining proper blood glucose levels, can substantially delay or reduce the risk for diabetes-related complications. What our study does is to point out that there is also a cumulative, financial impact to the progression of this disease.”

Preventing the onset of diabetes would also help to reduce cumulative costs, since medical expenditures grow along with the duration of the disease, the researchers concluded. “Delaying the development of diabetes will delay the steady rise in medical expenditures that accompanies it,” they wrote.

Black people are 1.8 times as likely to develop diabetes as whites. Diabetics are more likely to experience greater disability from complications such as amputations, blindness, kidney failure and increased risk of heart disease and stroke.

According to the National Diabetes Information Clearinghouse, an estimated 23.6 million people have diabetes. And 5.7 million of those have not been diagnosed.

Blacks, poor often live in one of the most poverty-stricken areas in the country, understands that they face additional challenges with their diagnoses.

Cost Of Diabetes

One such man, Hill. He is black. He is also unemployed during one of the toughest economic times, some say, since the Depression.

Hill, a former salesman, found assistance through a non-profit organization called Care Alliance that provides health and educational services.

Because of his employment status, he is eligible for free health care services.

“They are open and kind,” he says about the Care Alliance staff. “They bend over backward to make sure I have the medication. They suggest new medications and tell me about the side effects.”

Resources To Help Diabetics

Matt Sebastian, an educator with the Diabetes of Association of Greater Cleveland, said informing the communities most affected by diabetes often has it challenges.

People at a greater risk for diabetes include people who over 45, overweight, have family history and those who do not exercise.

Sebastian says while his message includes about symptoms and at-risk factors, he also informs citizens that there are agencies and resources to help.

DAGC provides grocery store tours, free glucose meters and strips, guest speakers, cooking sessions and group meetings of DAGC Divas — women diagnosed with the disease.

“It’s peer pressure in a positive way,” he says about DAGC Divas. “In this group, everyone has diabetes. They can help each other. It’s peer-to-peer motivation.”

Sebastian says that on his grocery store tours, he teaches pre-diabetics, diabetics and at-risk diabetics how to shop.

“Some inner city stores don’t make it easy,” he said. “They have pop three for $3. That’s a lot of liquid for a little money.”

Additionally, he says he encourages people to buy fresh or frozen vegetables instead of canned vegetables and to pay a little more for whole-grain pasta.

About 11 to 18 genes can help predict a person’s likelihood of developing type 2 diabetes, two new studies say. However, those genes don’t add much more to a patient’s diabetes-risk profile than information that’s easily available, such as body mass index, family history, and lifestyle, according to the studies in the New England Journal of Medicine.

The studies included more than 20,000 men and women who were followed for 20 to 30 years to see if they developed diabetes. In both studies, the gene variants’ predictive effect was more powerful for younger people.

However, experts say that genetic testing is probably not very useful in young adults, and probably not in children either. (The studies did not include kids.)

It’s not clear how much genetic testing of children would cost, says Richard Hellman, MD, an endocrinologist in North Kansas City, Mo., who was not involved in the new research. Plus, diabetes is a complex disorder and even testing for a dozen or so genetic variants may not be all that helpful.

“As many as 500 genotypic variants are at play in the development of type 2 diabetes; it’s usually not a single one,” he says. “Lots of factors are playing a role.”

Although more research is needed about type 2 diabetes and children, the disease is still relatively rare in kids, says John Buse, MD, director of the Diabetes Care Center at the University of North Carolina in Chapel Hill. “It would be hard to justify massive screening without a specific trial in that regard.”

For now, the studies seem to have little application in the real world. The findings are “too premature” to help individual people figure out their own risk, according to Dr. Lyssenko.

However, Dr. Hellman still sees it as good news for patients. “It says that there’s much more that we can do to change the course,” he says. “It isn’t just, ‘This is your genotype and this is your destiny.’”

Dr. Lyssenko agrees. “We may not be able to change our genes, but genes only work in concert with the environment, and we can change the environment; we can still improve our future by healthy diet and exercise.”

Findings show some don’t get enough nutrition for proper cell function and metabolism.

A study finds that obese children from poor families often don’t eat enough.

Researchers have long blamed childhood obesity and diabetes, especially in poor neighborhoods, on too much food and too little exercise.

But new findings from a San Antonio study point to another explanation: children living in poverty are obese in part because they don’t eat enough to meet the daily nutritional requirements needed for cell function and metabolism.

A 9-year-old should consume 1,400 to 2,200 calories daily to sustain growth, said Dr. Roberto Trevino, director of the nonprofit Social and Health Research Center. But in the study of 1,400 inner-city children, 44 percent were consuming less than 1,400 calories, and 33 percent were obese.

“They were not overeating,” Trevino said. “This study shows these kids were not eating enough, and when they did eat it was all the wrong things.”

Missing from the children’s diets were four key nutrients: calcium, magnesium, potassium and phosphorus. All play important roles, but magnesium is involved in more than 300 enzymatic reactions in the body that help to spur metabolism and cell function.

When magnesium — found in cooked spinach, black beans, bran cereal and other foods — is missing from the diet, it can predispose an individual to diabetes, Trevino said.

Nearly 7 percent of children in the study screened positive for type II diabetes, typically an adult disease, Trevino said.

Without early intervention, these children could be facing open-heart surgery at age 25 and will be on dialysis by age 35, he said.

In the United States, 12 percent of children are overweight.

Researchers also found that a sedentary lifestyle contributed to the problem. In the study, nearly 90 percent of children scored marginal or unacceptable on physical fitness tests. On average they were watching 3.5 hours of television daily.

Study estimates financial toll from rapidly increasing disease

As diabetes is rapidly becoming one of the world’s most common diseases, its financial cost is mounting, too, to well over $200 billion a year in the U.S. alone.

A new study, released Tuesday exclusively to The Associated Press, puts the total at $218 billion last year — the first comprehensive estimate of the financial toll diabetes takes, according to Danish pharmaceutical company Novo Nordisk A/S, which paid for the study.

That figure includes direct medical care costs, from insulin and pills for controlling patients’ blood sugar to amputations and hospitalizations, plus indirect costs such as lost productivity, disability and early retirement.

The study, conducted by the Lewin Group consultants, estimates costs to society for people known to have Type 1 or Type 2 diabetes at $174.4 billion combined, a total previously reported by Novo Nordisk, the world’s top producer of insulin and the maker of diabetes pills such as NovoNorm and Prandin. That study was done with the American Diabetes Association.

The new study adds estimates for people who haven’t been diagnosed yet ($18 billion), women who develop diabetes temporarily during pregnancy ($636 million) and those on track to develop diabetes, an increasingly common condition called pre-diabetes ($25 billion).

“Diabetes has not seen a decline or even a plateauing, and the death rate from diabetes continues to rise,” said Dana Haza, senior director of the National Changing Diabetes Program, an effort Novo Nordisk began in 2005 to improve diabetes care and prevention in the U.S.

“The numbers just keep going higher and higher, and what we want to say is, ‘It’s time for government and businesses to focus on it,’” said Haza, who believes diabetes will be the country’s biggest health problem in the future, worsened by the obesity epidemic.

Novo Nordisk is to present the data Tuesday at a health care conference for corporate executives and then plans to publish a full report in a professional journal. The calculations are based on numbers from sources including databases on treatment of people with commercial insurance, Medicare and Medicaid, federal public health surveys and other sources.

Older drug better than Avandia for slowing buildup in arteries, study says

The controversial diabetes pill Avandia failed to significantly slow plaque buildup in heart arteries compared with an older drug, though there were some hopeful signs in a new study reported Wednesday.

Avandia, once a blockbuster drug made by British-based GlaxoSmithKline PLC, has been under a cloud since May 2007, when a medical journal report suggested it may raise the risk of heart attacks and heart-related deaths. The American Diabetes Association recently said patients should avoid using it until safety questions are resolved.

The new study tested Avandia against glipizide, sold as Glucotrol by Pfizer Inc. and in generic form, in 672 people in 19 countries. All had Type 2 diabetes, the most common form of the disease and the one linked to obesity. All were at high risk for heart problems and many were very overweight.

Doctors measured the thickness of plaque starting to form in a heart artery of each participant at the start of the study and 18 months later. Those on Avandia had a slight reduction in buildup versus a little increase in those on glipizide, but the difference was so small that the results were a statistical draw.

Avandia did show a significant advantage in a second measure of artery plaque, but this was not the main result being tested.

Dr. Richard Nesto of Lahey Clinic in Burlington, Mass., and Brigham and Women’s Hospital in Boston led the study and reported results Wednesday at an American Heart Association conference.

“This is now the second study that was unable to show a beneficial effect,” said Dr. James Stein, director of preventive cardiology at the University of Wisconsin-Madison, who had no role in the research.

“People really shouldn’t be using this to treat diabetes” because safer and more effective medicines are available, Stein said.

A drug designed to specifically hit a protein linked to the life-extending benefits of a meager diet can essentially trick the body into believing food is scarce even when it isn’t, suggests a new report in the November Cell Metabolism.

The drug called SRT1720, which acts through the protein SIRT1, enhances running endurance in exercised mice and protects the animals against weight gain and insulin resistance even when they eat a high-fat diet, the researchers report. The drug works by shifting the metabolism to a fat-burning mode that normally takes over only when energy levels are low.

The findings bolster the notion that SIRT1 may be a useful target in the fight again metabolic disorders, including obesity and type 2 diabetes. It also helps lay to rest a long-standing controversy in the scientific world over the metabolic benefits of the red wine ingredient known as resveratrol. Resveratrol also acts on SIRT1, but its influence on other metabolic actors had left room to question exactly how it works.

” There has been a lot of controversy in the field about resveratrol action,” said Johan Auwerx of Ecole Polytechnique Fédérale de Lausanne. “We find that the majority of the biology of resveratrol can be ascribed to SIRT1.” While SIRT1 might not explain all of resveratrol’s effects, the new results suggest that the central metabolic protein is responsible for about “80 percent of the picture,” he said.

The researchers had conducted earlier studies to demonstrate many of the benefits of resveratrol. To further explore the underlying pathways responsible in the new study, they ran essentially the same experiments with the more potent and specific SIRT1-activating compound SRT1720 developed by the company Sirtris Pharmaceuticals, Inc.

The researchers found that a low dose of SRT1720 partially protected mice from gaining weight on a high-fat diet after 10 weeks of treatment. At higher doses, the drug completely prevented weight gain in the animals. SRT1720 also improved blood sugar tolerance and insulin sensitivity and endowed the animals with greater athletic ability.

” SIRT1720 made the animals run twice as long,” Auwerx said. That improvement was seen only when the researchers specifically exercised the animals. Their voluntary activity actually declined in the study as they hunkered down to save energy.

They found further evidence that the SIRT1 activator acts as a calorie-restriction mimetic that favors the use of fat stores by promoting the direct modification of multiple SIRT1 targets. It also induces chronic metabolic adaptations that involve the indirect activation of AMPK, an enzyme that regulates skeletal muscle glucose and the metabolism of fatty acids.