Diabetes Health Talk

Scientists at the Diabetes Center at University of California San Francisco say two drugs that are already on the market to treat cancer patients could help people living with Type-1 diabetes.

Results from a new study performed with non-obese diabetic mice show that treating mice with either of the drugs before the on-set of Type-1 diabetes prevented the development of the disease.

“This was a therapy that was working in animals that had already developed the disease. The second surprise for us was that we didn’t have to treat continuously. We could treat for a limited time, a couple of months and then stop the treatment,” explained Dr. Jeffrey Bluestone.

The disease went into permanent remission in 80 percent of the mice.

Bluestone says the challenge now is to set up a trial for humans.

“These drugs in cancer patients have had some side effects,” he warned.

They’re side effects that cancer patients facing a life threatening disease are more likely to endure than diabetics who are generally healthy except for a lack of insulin.

UCSF doctors say if everything goes well with funding they may be able to set up a trial in about a year.

Bluestone warns that these results came from a mouse study, and there are always challenges in going from mouse to man.

The Earth Times: When Yolanda Myers was diagnosed with diabetes at age 17, she was living a lifestyle similar to many Americans – a lifestyle high in calories and low on exercise. As an African-American woman, Myers was at an increased risk for diabetes, high blood pressure and chronic kidney disease. Now, at age 39, she suffers from all three.

Her diabetes and high blood pressure led to kidney failure, and she must now rely on dialysis to perform the functions of her kidneys. Diabetes is the number one contributor to chronic kidney disease, accounting for 44 percent of new cases, according to the American Diabetes Association.

In recognition of the American Diabetes Association’s designation of November as “American Diabetes Month,” Fresenius Medical Care North America, operator of the nation’s leading network of dialysis facilities, encourages people to discuss their health history with family members, especially in regard to diseases like type 2 diabetes and high blood pressure, which can often be prevented or controlled.

While discussing health problems may not seem like exciting dinner conversation, doctors and health researchers stress the importance of prevention and early detection in dealing with these conditions.

“Because families typically gather at the holidays, it’s a good time to have frank discussions about family illnesses, such as diabetes and high blood pressure. If you can show your nieces and nephews, for example, how diabetes has affected your own health, you may be able to influence them to maintain healthier lifestyles,” said Kathryn McDougall, R.N., M.S., C.D.E and Fresenius’ Director of Quality Initiatives.

Fresenius Medical Care offers a free Treatment Options Program to inform at-risk patients and their families about chronic kidney disease and treatments. Sessions are free and open to the public. Call 1-866-4-DIALYSIS (1-866-434-2597) to locate the Fresenius Medical Care facility nearest you.

Though Myers’ mother and aunt would both develop diabetes years later, she didn’t know at a young age how the disease would impact her own life. She couldn’t predict that, by age 38, she would suffer nine mini-strokes, endure eight medical procedures on her eyes, lose a leg to infection and would require dialysis three days a week to stay alive.

But Myers, who lives outside Nashville, Tenn., now has a positive outlook. She is determined to spare her 14-year-old daughter and 12-year-old son from a similar fate by discussing their family’s history of these conditions and by encouraging her children to live a healthy lifestyle.

“I talk to my kids about everything,” Myers said. “I told them that I lost a leg from diabetes. And I tell them to have everything in moderation. I don’t want this to happen to them.”

After you are diagnosed with diabetes, you might find yourself learning quite a bit about your diet. Much of this involves making decisions about how best to eat and drink to achieve good outcomes and avoid problems with your therapy. While some rules are fairly obvious and based on solid science, for others, far less evidence is available. One such example is drinking alcohol.

The prevailing wisdom was that alcohol could impair your judgment, make it difficult to sense the onset of hypoglycemia, and inhibit self-management. While there wasn’t much experimental evidence supporting these assertions, it was the party line of the time.

Today, however, increasing evidence suggests that moderate consumption has many beneficial effects for people with diabetes. In a comprehensive review of several studies on the effect of alcohol use by people with diabetes, the data show that both not drinking at all and drinking heavily (i.e., more than three drinks per day) have more deleterious effects on health status than does moderate consumption. Indeed, moderate alcohol intake (i.e., one to three drinks per day) is associated with decreased incidence of coronary heart disease, a major killer of people with type 2 diabetes; improved lipids; and, potentially, reduction of inflammatory response, which is increasingly linked to the risk of cardiovascular disease events.

Limited research also suggests that alcohol is not associated with adverse outcomes when using sulfonylureas or thiazolidinediones. Moderate consumption was found to have no acute effects on glycemic control in type 2 diabetes. In type 1, it may in fact cause hypoglycemia the following morning, and the usual symptoms of hypoglycemia may be masked and impair the counter-regulatory responses to insulin-induced hypoglycemia.

This suggests that people with type 1 need to consider diet regulation when they drink and make sure they are monitoring their blood glucose.

While moderate consumption of alcohol may have some positive benefits for those who already drink, the science does not support adding alcohol to your diet if you don’t currently do so. But if you have diabetes and you do drink, it’s important to discuss this with your health team. Make them aware that drinking alcohol is part of your lifestyle and that you want to continue to do so in a responsible fashion. A dietitian can show you how to enjoy a glass of wine or beer with your meals without adding excessive calories.

Optimal control of diabetes is not only about attaining good metabolic numbers, but achieving a lifestyle that is comfortable and rewarding while you do so. You can, with a little thought, drink a glass of fine wine with your meal and by doing so benefit your health— and your enjoyment of life.

Clinicians have known for some time that people treated for HIV also become much more susceptible to diabetes and heart disease. A study by scientists at Sydney’s Garvan Institute of Medical Research has now shown some of the reasons why - enabling better patient management and monitoring.

Associate Professor Katherine Samaras, Head of Garvan’s Diabetes and Obesity Clinical Research Group and senior endocrinologist at St Vincent’s Hospital, has demonstrated that inflammation (typically associated with immune function) plays a much greater role than previously suspected. Her findings were published online last week in the journal Obesity.

“People being treated for HIV tend to lose fat on their arms, legs, face and buttocks and gain it around their abdomen,” said Samaras. This redistribution of fat is termed ‘lipodystrophy’ and those patients with the condition have a cardiac and metabolic risk profile worse than being very obese.”

“We think that in some way anti-retroviral drugs influence fat cells, making them push out inflammatory molecules that contribute to creating the heart disease and diabetes we see in patients.”

Professor Samaras collaborated with Professor Andrew Carr from St. Vincent’s Hospital’s Centre for Immunology to measure the body compositions and metabolic responses of patients with HIV-infection.

MRI and DEXA scans measured fat, muscle and bone mass. Blood tests measured cholesterol, glucose and various molecules involved in heart disease and diabetes, such as tumour necrosis factor-alpha, interleukin-6 and adiponectin. Insulin resistance, which refers to the body’s ability to use insulin to take up glucose, was measured by ‘clamp’.

Cumulatively, the tests showed marked changes in body composition and a dramatic increase in tissue-damaging inflammatory molecules.

Samaras and a number of other HIV specialists published a state of the science paper in July’s Circulation, arising out an American Heart Association meeting. The paper summarised the current understanding of how HIV and its treatments caused body composition changes and increased cardio-metabolic risk.

“In the Circulation paper, we discussed the evidence that these drugs increase the risk of heart disease and diabetes and how important it is to understand the mechanisms. My recent study gives some insights into those mechanisms - and how we might avert them.

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.

Centering supper around a fish dish at least twice a week might help people with diabetes lower their risk of kidney disease, a new study suggested.

In the November issue of the American Journal of Kidney Diseases, British researchers analyzed the records of more than

22,000 middle-aged and older English men and women who were part of a large European cancer study. Researchers wanted to examine the effect of eating fish on kidney disease.

The study subjects had answered questionnaires about their diet habits, including how much fish they ate weekly, and had provided urine samples, which were analyzed for a protein called albumin, an indicator of kidney damage.

The researchers reported that of the 517 study subjects who had diabetes (mostly Type 2), those who, on average, ate less than one serving of fish each week were four times as likely to have albumin in their urine as people with diabetes who ate fish twice weekly.

“Protein in the urine is one of the earliest signs of kidney disease, a serious complication of diabetes,” said study co-author Amanda Adler, an epidemiologist with the Medical Research Council Epidemiology Unit at Addenbrooke’s Hospital in Cambridge, England.

Adler speculated that the nutrient content of fish might affect kidney function and improve blood glucose control. But what kind of fish makes the biggest health splash wasn’t determined.

Susan Spratt, assistant professor of medicine in the division of endocrinology at Duke University Medical Center, said it’s too early to recommend diet changes based on the findings, noting that cause and effect are hard to determine in this type of study. “People who eat fish might have other healthier habits,” she said.

To prove fish could be a kidney disease-fighting factor in diabetes, clinical trials would be required where people with diabetes ate fish and others did not, she said.

“But it wouldn’t hurt patients to eat more fish,” said Spratt, who recommends fish oil to lower triglycerides in her diabetes patients.

For dinner, stick with low-fat broiled and baked recipes, she said.

Dietary change enhances blood glucose control, study finds

Eating fish twice a week may help reduce the risk of kidney disease in people with diabetes, according to a British study of more than 22,000 adults, including 517 with diabetes.

The participants’ fish consumption was determined using dietary and lifestyle questionnaires. People with diabetes who ate less than one serving of fish per week were about four times more likely (18 percent) to have protein in their urine than those who ate at least two servings of fish per week (4 percent).

“Protein in the urine is one of the earliest signs of kidney disease,” noted study co-author Dr. Amanda Adler, of the Medical Research Council epidemiology unit at Addenbrooke’s Hospital, Cambridge.

The study was published in the November issue of the American Journal of Kidney Diseases.

Adler and her colleagues suggested the “unique nutrient composition of fish” may benefit kidney function by enhancing blood glucose control and improving plasma lipid profiles.

People who consume fish may have other lifestyle factors that reduce their risk of having protein in the urine (albuminuria), but the study design attempted to account for that possibility, Adler said.

“Diet is a relatively simple lifestyle change to make, and the benefits could be significant,” Dr. Kerry Willis, senior vice president for scientific activities at the U.S. National Kidney Foundation, said in a foundation news release.

In addition to eating fish, other measures that help lower the risk of albuminuria include tight control of glucose, keeping blood pressure under control, quitting smoking, and following a diabetic diet as prescribed by a doctor, according to the kidney foundation.

Children living in poverty have high levels of diabetes risk factors and need early detection and intervention programs, according to researchers at the University of Texas at San Antonio and Texas A&M University, San Antonio.

A study of 1,402 fourth grade students ages 8-10 years old in Texas aimed to determine the prevalence of high blood glucose, obesity, low fitness and energy insufficiency levels among children from poor families. Nearly 75 percent of the participants lived in households with less than $20,400 annual income. The racial/ethnic backgrounds of the students were 80 percent Mexican-American, 10 percent African-American, 5 percent Asian-American and 5 percent non-Hispanic white.

The study found that 44 percent of the students were energy insufficient, 33 percent were obese and 7 percent had high blood glucose levels. Most of these students had marginal to unacceptable fitness levels and ate high energy-dense and low nutrient-dense foods.

The researchers concluded: “Our results elucidate the high levels of diabetes risk among children from poor South Texas families. Unless we invest in early age interventions and quantify the results, diabetes morbidity and health care cost will remain uncontrolled.”-American Dietetic Association

Age-Related Issues

Having a child with diabetes can cause many new stresses and worries. There are age-related issues that you may come across when parenting an infant, toddler, teen, or young adult with diabetes. This section will give you tips, hints, and advice on parenting a child with diabetes.

Diabetes in Infants & Toddlers

There’s not much that’s more frightening than having your infant or toddler diagnosed with diabetes. And a lot of the books and information out there are geared to older kids with diabetes. Download Diabetes in Infants & Toddlers (PDF) to learn more about how to cope with diabetes in younger children.

Preschoolers

Preschoolers with diabetes often have not yet learned to recognize symptoms of low blood glucose, or they aren’t able to tell others when they are feeling “low.” So it’s important to check your preschooler’s blood glucose level often.

Understandably, preschoolers are often frightened by fingersticks and insulin shots. They may try to avoid or delay getting them. It can help to say, “Yes, I know it hurts” and “You’re being very brave.” Stickers and rewards help encourage a child to have a fingerstick or shot. Use positive reinforcements rather than scolding or threats of punishment. You might set up a star chart where your child gets a star for each fingerstick or shot, then stars can be “redeemed” for a trip to the playground, a new book, or another favorite treat. (Try to avoid tying rewards to food, though, as this can build unhealthy relationships with food.)

Young children with diabetes can go through the same fussy eating phases as other children. It’s usually best not to force a fussy child to eat. Have a variety of foods on hand. If your child rejects one food, offer something else, or offer juice or milk instead.

School-Age Children

School-age children want to be like their peers. The child with diabetes may feel “different” because of having to take insulin, check blood glucose regularly, and follow a meal plan. The best way to handle this will depend on the individual child’s personality.

Some children will check their blood glucose or give themselves an insulin injection for show-and-tell. Older children have presented science projects on diabetes and its care. However, a child who is shy or sensitive about having diabetes may not want to bring diabetes to “center stage” and may prefer to keep their diabetes more quiet. It’s usually best to follow the child’s lead on who to tell and how much. It’s usually necessary to tell a certain number of people, such as teachers, coaches, close friends, and family.

But beyond these “must tells,” try to leave the decisions about who to tell and how much to say to your child.

Still more benefits of Green Tea: A powerful antioxidant in green tea may prevent or delay the onset of type-1 diabetes, according to a study.

Researchers were testing EGCG, green tea’s predominant anti-oxidant, on a lab mouse with type-1 diabetes and primary Sjogren’s syndrome, which damages moisture-producing glands, causing dry mouth and eyes.

“Our study focused on Sjogren’s syndrome, so learning that EGCG also can prevent and delay insulin-dependent type 1 diabetes was a big surprise,” said Stephen Hsu, molecular cell biologist at the School of Dentistry, Medical College of Georgia (MCG). The study was published Friday in Life Sciences.

In the mouse, EGCG reduced the severity and delayed onset of salivary gland damage associated with Sjogren’s syndrome, which has no known cure.

“EGCG modulates several important genes, so it suppresses the abnormality at the molecular level in the salivary gland. It also significantly lowered the serum auto-antibodies, reducing the severity of Sjogren’s syndrome-like symptoms,” Hsu said. Auto-antibodies are antibodies the body makes against itself.

Both type-1 diabetes and Sjogren’s syndrome are autoimmune diseases, which cause the body to attack itself. Autoimmune disorders are the third most common group of diseases in US and affect about eight percent of the population, an MCG press release, quoting Hsu, said.

The Miracle of Green Tea

Is any other food or drink reported to have as many health benefits as green tea? The Chinese have known about the medicinal benefits of green tea since ancient times, using it to treat everything from headaches to depression. In her book Green Tea: The Natural Secret for a Healthier Life, Nadine Taylor states that green tea has been used as a medicine in China for at least 4,000 years.

Today, scientific research in both Asia and the west is providing hard evidence for the health benefits long associated with drinking green tea. For example, in 1994 the Journal of the National Cancer Institute published the results of an epidemiological study indicating that drinking green tea reduced the risk of esophageal cancer in Chinese men and women by nearly sixty percent. University of Purdue researchers recently concluded that a compound in green tea inhibits the growth of cancer cells. There is also research indicating that drinking green tea lowers total cholesterol levels, as well as improving the ratio of good (HDL) cholesterol to bad (LDL) cholesterol.

To sum up, here are just a few medical conditions in which drinking green tea is reputed to be helpful:

cancer
rheumatoid arthritis
high cholesterol levels
cariovascular disease
infection
impaired immune function

Health Minister David Cunliffe has approved a clinical trial involving the transplantation of pig cells into humans.

Biotech entrepreneur Living Cell Technologies Ltd (LCT) wants to transfer cells from the pancreas of pigs to produce insulin in type-1 diabetes sufferers in a process known as xenotransplantation. The trial would be conducted at Middlemore Hospital, in South Auckland.

Though the technology could produce significant benefits for individual patients, it is highly controversial given the potential for a pig virus to be transferred that could then became capable of spreading as an infection in people.

But Mr Cunliffe today gave the trial the green light.

He said xenotransplantation had huge potential for diabetes sufferers.

“This is critical new technology that could well make New Zealand a world leader in both the treatment of diabetes and in the use of xenotransplantation.”

The trial would be done under rigorous conditions that met international best practice, he said.

Those conditions included that:

* all patient information and tissue samples involved in the trial would be housed in an archive at Middlemore Hospital;

* the trial would be overseen by an independent data safety management board;

* if LCT ceased trading in New Zealand it must transfer all patient records and tissue samples to the Health Ministry;

* any adverse events must be reported to authorities immediately;

His approval of the trial was also conditional on a favourable peer review by a leading international expert to be nominated by the ministry.

“It remains clear to me that any such trial will always carry a very low residual risk, so the key issue has always been whether this risk is sufficiently small and can be successfully managed,” Mr Cunliffe said.

“I am confident that the stringent conditions I have imposed on this trial represent best practice and meet our international obligations to the World Health Organisation.”

Mr Cunliffe said his decision followed consideration of a report by the National Health Committee and further advice from medicines safety agency Medsafe regarding international regulatory developments.

A molecule called interleukin-6 has opened the way to the creation of new drugs against obesity and diabetes, according to an international study.

Researchers from Vitagenes participated in the project. Vitagenes is a company that is part of the campus programme promoted by the University of Granada (UGR) located at the Technological Park of Health Sciences (PTS).

Jose Luis Mesa of Vitagenes, a co-author, collaborated with Melbourne University and the Baker Heart Research Institute (Australia) scientists.

The main discovery has been the change of the paradigm of a molecule called interleukin-6 in the prevention of obesity and diabetes, according to a Granada University press release. The study has been published in the Journal of Endocrinology.

Until now, scientific evidence suggested that interleukin-6, chronically high in obese persons and diabetics, could be harmful for both these conditions.

However, this study proves exactly the opposite. ‘No study had tried to inject interleukin-6 directly to analyse if this molecule was really harmful or, to the contrary, could help to prevent obesity and diabetes,’ Mesa pointed out.

He explained that ‘our hypothesis was that interleukin-6 was naturally high in diabetic and obese persons precisely to combat such diseases. In order to prove it, we injected human recombinant interleukin-6 daily for two weeks and analysed its behaviour and its effects on the metabolism’.

Mark Febbraio, scientific director at the Baker Heart Research Institute and a member of the Advisory Scientific Committee of Vitagenes, said that ‘we obtained surprising results. The exogenous (through skin) administration of interleukin-6 improved insulin sensitivity and the absorption of glucose, essential for diabetics.’

However, Mesa reported that this is a preliminary study carried out in animal models, and new studies in humans are needed to establish definite conclusions.

Updated guidance published in the current issue of the American Society of Hypertension’s (ASH) Journal of Clinical Hypertension addresses the urgent need for physicians to take a more integrated, individualized approach to treating hypertension (high blood pressure) in patients with diabetes by treating the intricacies of each patient profile, rather than focusing on the disease in isolation. Early initiation of medications that block the renin angiotension system (ACE inhibitors or ARBs) coupled with either thiazide-like diuretics or calcium antagonists are needed to maintain BP <130/80 mmHg. Additionally, more frequent patient follow-up is recommended.

While the fundamentals of treatment and blood pressure goals remain unchanged, the authors emphasize that early detection of risk factors unique to each patient and earlier, more aggressive treatment be implemented. Follow-up visits after each medication adjustment should occur within 2-3 weeks as opposed to 4-8 weeks, and immediate referral to an ASH-certified clinical hypertension specialist should occur if repeated attempts to achieve blood pressure goal fails. Achieving and sustaining blood pressure goal earlier during treatment has been shown
retrospectively in many clinical trials to have an impact on stroke risk. Thus, such an approach is necessary to stop the cardiovascular event rates and stroke death toll from spiraling even further out of control.

Hypertension affects more than 70 million Americans and is the most prevalent risk factor for cardiovascular and kidney disease. More than 75% of adults with diabetes have hypertension or are using antihypertensive medications. If implemented, this new guidance will potentially lead to better control of blood pressure, blood sugar and blood fats, all major risk factors for cardiovascular events if they are not properly managed.

“We know that mortality increases by more than 7-fold when hypertension is present in patients with diabetes,” said George Bakris, MD, president-elect of the American Society of Hypertension, co-author of the Position Paper and professor, University of Chicago School of Medicine. “Because of their increased cardiovascular risk, these patients require an integrated therapeutic intervention that, in addition to blood pressure control, should include glycemic and lipid control and antiplatelet therapy. It is imperative that we attack all risk factors simultaneously and manage the profile of each patient type more vigilantly.”

The guidance from the American Society of Hypertension is offered in a series of recommendations, accompanied by a modified treatment algorithm. Of note, the guidance draws attention to the fact that treatment of blood pressure in people with diabetes must also focus on reducing proteinuria if present. Proteinuria refers to an excessive amount of protein in the urine and may be a sign of impending kidney failure and/or a precursor to stroke and other potentially life-threatening cardiovascular events. The guidance emphasizes the importance of early identification and management of proteinuria as part of its more integrative approach to patient management.

Night-and-day glucose tracking helps type-1 diabetes patients stay healthy and safe, according to a clinical trial of a new class of glucose meter—a pager-sized device that continuously measures sugar levels through a small, fine wire worn under the skin

The meter can be programmed to warn patients if their levels of glucose, the body’s predominant sugar, rise too high or drop too low. It could help them fend off treacherous drops in blood glucose levels and decrease their risk of developing long-term complications, such as blindness and kidney failure.

The study, which tracked 322 type-1 diabetes patients at 10 medical centers, including 40 patients at the medical school and Lucile Packard Children’s Hospital, is the first randomized clinical trial to show that this monitoring enables people with diabetes to take better care of themselves.”This technology allows patients to see exactly what’s going on with their diabetes all the time,” said Bruce Buckingham, MD, professor of pediatric endocrinology at the medical school and leader of the Stanford/Packard portion of the study.

Traditional, finger-prick blood glucose meters give a few snapshots per day of a patient’s diabetes management. In contrast, the new meters produce a 24-hour glucose “movie,” recording glucose trends around meals, during exercise and throughout sleep.

The study, published online Sept. 8 by the New England Journal of Medicine, tracked child, adolescent and adult type-1 diabetes patients for six months. The subjects started with average sugar levels above or at the American Diabetes Association target for diabetes management. At checkups, doctors monitored the patients’ blood levels of glycated hemoglobin, an indicator of long-term glucose control. (Low levels have been associated with a reduced risk of long-term complications.) The study’s control subjects used only finger-prick blood glucose meters, in which a small drop of blood from the finger is applied to the meter to track glucose levels

healthy body stores fat in the form of so-called triglycerides in specialized fatty tissue as an energy reserve.

Under certain conditions the delicate balance of the lipid metabolism gets out of control and fat is accumulated in the liver, leading to the dreaded fatty liver. This increases the risk of many metabolic diseases, such as the metabolic syndrome known as “deadly quartet”. This combination of fatty liver, obesity, diabetes and hypertension is regarded as the primary cause of life-threatening vascular events such as myocardial infarction and stroke.

It was still unknown which conditions cause the body to deposit fat in the liver. However, scientists knew that the body’s own glucocorticoid hormones such as cortisol promote the development of fatty liver. This can be observed, for example, in a condition known as Cushing syndrome. Cortisol levels in affected patients are permanently raised - often caused by malignant tumors. This, in turn, leads to high blood sugar levels and patients frequently develop fatty liver. Long-term cortisone therapies such as those used for treating chronic inflammatory diseases such as asthma also cause the triglyceride level in the liver to rise to dangerous levels. Dr. Stephan Herzig, head of the Junior Research Group “Molecular Metabolic Control” at the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ), and his team have now published the mechanism by which the body’s own glucocorticoid hormones contribute to this disruption of the lipid metabolism.

The researchers in Herzig’s team specifically switched off the cortisol receptor in the livers of mice, thus blocking the hormone’s effect. As a result, the triglyceride level in the livers of the experimental animals dropped considerably. Investigations have revealed that, in the absence of the cortisol receptor, large amounts of the HES1 protein are produced in the livers of these animals. HES1 activates a number of enzymes that break down fat and, thus, counteracts fat accumulation in the liver. If, on other hand, normal mice are treated with cortisol, their HES1 levels in the liver drops, while triglyceride levels rise. Further experiments have shown that the cortisol receptor in this newly found metabolic pathway act directly on a switch of the HES1 gene and, thus, switches it off completely.

“We have discovered a key mechanism here that plays a crucial role in many pathologic metabolic disorders,” explains Stephan Herzig. “It has been obvious for some time that there is an association between the body’s own cortisol or therapeutically administered cortisone and the development of fatty liver. Now we also know what the interconnections look like at a molecular level.”

Diabetics who tightly control their blood sugar _ even if only for the first decade after they are diagnosed _ have lower risks of heart attack, death and other complications 10 or more years later, a large follow-up study has found.

The discovery of this ‘legacy effect’ may put new emphasis on rigorous treatment when people first learn they have Type 2 diabetes, the most common form and the type linked to obesity.

Doctors warn that people should not let their blood sugar spin out of control _ that could have serious health consequences.

‘What you don’t want is for people to think that they had a period of good glucose control and then they allow their blood glucose to go high _ that would be disadvantageous,’ said Dr. Stephen Davis, head of Vanderbilt University’s diabetes and endocrinology division, who had no role in the study.

Results were published online Wednesday by the New England Journal of Medicine and were being presented at the European Association for the Study of Diabetes meeting in Rome.

Diabetes affects more than 18 million Americans. Most have Type 2, which occurs when the body makes too little insulin or cannot use what it does produce. Being overweight raises this risk.

Researchers led by Dr. Rury Holman at the University of Oxford in England originally studied 4,209 newly diagnosed diabetes patients assigned to manage their blood sugar either through standard diet restrictions or medicines. In the drug group, most took sulfonylurea, which prompts the pancreas to release more natural insulin into the bloodstream. Overweight diabetics took metformin, sold in the United States as Glucophage. Treatment lasted on average 10 years.

That study showed intensive blood sugar control lowered the risks of eye disease and kidney damage, but did not find any significant difference in heart attack risk except in the overweight group taking metformin. Those results led to guidelines recommending tight blood sugar control still in wide use today.

The follow-up study was on 3,277 participants who were tracked for an average of 10 more years _ first in clinics, where blood sugar could be measured, and through questionnaires in the later years.