Author Interviews, BMJ, Diabetes / 12.11.2015

MedicalResearch.com Interview with: Prof. Julia Hippisley-Cox PhD Professor of Clinical Epidemiology & General Practice Faculty of Medicine & Health Sciences The University of Nottingham  Medical Research: What is the background for this study? What are the main findings? ProfHippisley-Cox:          Patients with type 1 or type 2 diabetes are at increased risk of blindness and amputation but generally do not have an accurate assessment of the magnitude of their individual risk. There are currently no tools available to calculate risk of other complications such as amputation or blindness. This is important since these are the complications which patients with diabetes fear most and which most impair quality of life. They are also the complications for which patients are most likely to over-estimate their risk and over-estimate the benefits of intensive treatment.          We have developed and externally validated new risk prediction algorithms which calculates absolute risk of developing these complications over a 10 year period in patients with diabetes, taking account of their individual risk factors.
Author Interviews, Diabetes, Kidney Disease / 12.11.2015

[caption id="attachment_19312" align="alignleft" width="160"]Charuhas Thakar, MD Director, Division of Nephrology and Hypertension Professor of Medicine University of Cincinnat Dr. Thakar[/caption] MedicalResearch.com Interview with: Charuhas Thakar, MD Director, Division of Nephrology and Hypertension Professor of Medicine University of Cincinnati Medical Research: What is the background for this study? What are the main findings? "Diabetes is the major contributor to the growing burden of end-stage renal disease,” says Charuhas Thakar, MD, professor and director of the Division of Nephrology and Hypertension at the UC College of Medicine. "Acute kidney injury is a common problem among diabetic patients who require admissions to hospitals. Approximately one-third of patients who develop AKI also have diabetes mellitus.” Dr. Thakar along with a team of researchers have looked at a cohort of about 3,700 patients with Type 2 diabetes longitudinally followed for a five-year period to determine AKI’s impact. AKI is a rapid loss of kidney function, which is common in hospitalized patients. It has many causes that include low blood volume, exposure to substances or interventions harmful to the kidney and obstruction of the urinary tract.
Author Interviews, Diabetes, JAMA, Pediatrics, Probiotics / 10.11.2015

Dr. Ulla Uusitalo PhD University of South Florida, TampaMedicalResearch.com Interview with: Dr. Ulla Uusitalo PhD University of South Florida, Tampa Medical Research: What is the background for this study? What are the main findings? Dr. Uusitalo: The TEDDY Study is an international prospective cohort study with the primary goal to identify environmental causes of Type 1 Diabetes (T1D). It is carried out in six clinical research centers, in four countries: University of Colorado Health Science Center (US), Georgia Regents University (US), Pacific Northwest Diabetes Research Institute (US), Turku University Hospital (Finland), Institute of Diabetes Research (Germany), and Lund University (Sweden), since 2004. One possible environmental factor related to Type 1 Diabetes etiology is diet. Dietary supplements including probiotics as well as various types of infant formulas including probiotic fortified infant formula are studied. The microbial composition of gut has been shown to be associated with the development of  Type 1 Diabetes. Colonization of the infant gut starts already in utero and early microbial exposures have been found to be important in defining the trajectory of colonization. Probiotics have been demonstrated to induce favorable immunomodulation and it has been suggested that probiotic treatment could prevent T1D. Therefore we wanted to study the early exposures of probiotic and risk of islet autoimmunity, a condition often preceding Type 1 Diabetes. This study produced very interesting results. The main finding was that we found 60% decrease in the risk of islet autoimmunity among children with HLA genotype of DR3/4 (high risk), who were exposed to probiotics during the first 27 days of life.
Author Interviews, Depression, Diabetes, Kidney Disease / 10.11.2015

[caption id="attachment_17645" align="alignleft" width="150"]Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Division of Nephrology, Department of Medicine University of Tennessee Health Science Center Memphis, TN, 38163 Dr. Molnar[/caption] MedicalResearch.com Interview with: Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Division of Nephrology, Department of Medicine University of Tennessee Health Science Center Memphis, TN, 38163  Medical Research: What is the background for this study? What are the main findings? Dr. Molnar: We examine the association between presence of depression and all-cause mortality; incident Coronary Heart Disease (CHD) (new onset AMI, CABG or PCI), incident ischemic stroke, slopes of eGFR (OLS, <-5 vs ≥-5 ml/min/1.73m2/yr) in 933,211 diabetic (based on ICD9, medication and HbA1c ≥ 6.5%) US Veterans with eGFR ≥ 60 ml/min/1.73m2 at baseline. We adjusted for independent covariates, collected from VA databases, such as age, gender, race, BMI, marital status, income, service connection, comorbid conditions (ICD9), baseline eGFR, serum albumin. Mean age was 64±11 years, 97% were male and 18% African-American. Depression was present in 340,806 (37%) patients at enrollment. During a median follow-up of 7.3 years, 180,343 patients (19%) developed Chronic Kidney Disease (CKD).AS (adjusted hazard ratio [aHR] and 95% confidence interval [CI]: 1.20 (1.19-1.21)). Similarly, depression was associated with 35% higher risk of incident stroke (aHR and 95% CI: 1.35 (1.32-1.39), 24% higher risk of incident CHD (aHR and 95% CI: 1.24 (1.22-1.27) and 25% higher risk of all cause mortality (aHR and 95% CI: 1.25 (1.24-1.26) during the follow-up.
Author Interviews, Diabetes, Heart Disease, JAMA, Mental Health Research / 10.11.2015

[caption id="attachment_19187" align="alignleft" width="150"]Dr. Christina Mangurian MD Associate Professor of Clinical Psychiatry UCSF School of Medicine and the UCSF Department of Psychiatry's first Director of Diversity Dr. Mangurian[/caption] MedicalResearch.com Interview with: Dr. Christina Mangurian MD Associate Professor of Clinical Psychiatry UCSF School of Medicine and the UCSF Department of Psychiatry's first Director of Diversity Medical Research: What is the background for this study? What are the main findings? Dr. Mangurian: People with severe mental illness (SMI, e.g., schizophrenia and bipolar disorder) die 25 years earlier than the general population, often from cardiovascular disease.  The ADA and APA guidelines recommend annual diabetes screening of this population when taking certain antipsychotic medications.  Despite these guidelines, nearly 70% of this population remain unscreened.  This has huge public health implications and likely costs our public health system a tremendous amount in undiagnosed disease.
Author Interviews, Breast Cancer, Diabetes / 05.11.2015

MedicalResearch.com Interview with: Dr Nicoletta Provinciali, MD Oncologist from the E.O. Ospedali Galliera Genoa, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Provinciali: We know that higher insulin levels have been associated with a worse prognosis in early breast cancer patients. In this study we wanted to evaluate the impact of insulin resistance on metastatic breast cancer patients receiving first line chemotherapy. We found that insulin resistance status together with the endocrine status had an adverse prognostic effect.
Annals Internal Medicine, Author Interviews, Diabetes, Heart Disease / 30.10.2015

[caption id="attachment_18935" align="alignleft" width="157"]Dr. Yung-Tai Chen MD Division of Nephrology Department of Medicine Taipei City Hospital Heping Fuyou Branch Taipei, Taiwan Dr. Yung-Tai Chen[/caption] MedicalResearch.com Interview with: Dr. Yung-Tai Chen MD Division of Nephrology Department of Medicine Taipei City Hospital Heping Fuyou Branch Taipei, Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Chen: Recent studies concluded that dipeptidyl peptidase-4 (DPP-4) inhibitors can provide glycemic control but also raised concerns about the risk of heart failure in patients with Type 2 Diabetes Mellitus (T2DM). However, large-scale studies of the effects of DPP-4 inhibitors versus sulfonylureas (SUs) on cardiovascular outcomes when used as add-ons to metformin therapy remain scarce. Our study showed that compared to SUs, DPP-4 inhibitors were associated with a lower risk of all-cause mortality, stroke and hypoglycemia as an add-on to metformin. Besides, dipeptidyl peptidase-4 inhibitors had comparable risks of hospitalization for heart failure to sulfonylureas as add-ons to metformin.
Author Interviews, Diabetes, Infections, Surgical Research / 29.10.2015

Emily Toth Martin, Ph.D. MPH Assistant Professor, Epidemiology University of Michigan School of Public HealthMedicalResearch.com Interview with: Emily Toth Martin, Ph.D. MPH Assistant Professor, Epidemiology University of Michigan School of Public Health  Medical Research: What is the background for this study? What are the main findings? Response: Surgical site infections are responsible for billions in health care costs in the U.S. We are working to identify groups of people who are particularly impacted by surgical site infections. By looking at the results of 94 studies, we were able to take a 60,000 foot view of the connection between diabetes and surgical site infection. We found that diabetes raises the risk of infection across many types of surgeries.
Author Interviews, Diabetes, NEJM / 28.10.2015

Marcus Lind, M.D., Ph.D Department of Medicine, Uddevalla Hospital Uddevalla, Swede MedicalResearch.com Interview with: Marcus Lind, M.D., Ph.D Department of Medicine, Uddevalla Hospital Uddevalla, Swede Medical Research: What is the background for this study? Dr. Lind:  One of the main goals of the diabetes care is to reduce excess mortality in individuals with type 2 diabetes close to that of the general population. We want patients to have a similar life expectancy as individuals in the general population. Earlier studies have shown that targeting good glucose levels, blood lipid and blood pressure levels are beneficial with respect to decrease cardiovascular disease being the main cause for mortality. We wanted to evaluate the prognosis for individuals with type 2 diabetes today in Sweden. Further, earlier population-based studies have generally assessed mortality rates only on a group level whereas we believe the prognosis differs greatly depending on various factors such as how well risk factor control is obtained in clinical practice. The Swedish Diabetes Registry include more than 90% of all individuals with type 2 diabetes in Sweden and information of e.g. the glycaemic control, measured by a biomarker called A1c exists for most persons. There were 97% who had at least 1 measurement. Also most patients had information of other risk factors, among others renal complications which we believed were of special concern. 
Author Interviews, Diabetes, Gastrointestinal Disease / 21.10.2015

Adil Mardinoglu, PhD Assistant Professor of Systems BiologyScience for Life Laboratory Royal Institute of Technology (KTH) Stockholm, SwedenMedicalResearch.com Interview with: Adil Mardinoglu, PhD Assistant Professor of Systems BiologyScience for Life Laboratory Royal Institute of Technology (KTH) Stockholm, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Mardinoglu: The functional output and diversity of the gut microbiota are important modulators for the development of various human disorders. Obesity, type 2 diabetes (T2D), atherosclerosis, non-alcoholic fatty liver disease (NAFLD) as well as the opposite end of the spectrum, for example, malnutrition have been associated with dysbiosis in the human gut microbiota. In our study, we investigated the interactions between the gut microbiota, host tissues of the gastrointestinal tract and other peripheral tissues as well as diet which are known to be highly relevant for the health of the host. Through integration of high throughput experimental data, we revealed that the microbiota in the small intestine consumes glycine which is one of the three amino acids required for the synthesis of the glutathione. In order to confirm our predictions, we measured the level of the amino acids in the portal vein of the mice. We observed lower level of glycine in liver and colon tissues, and this indicated that the gut microbiota regulates glutathione metabolism not only in the small intestine but also in the liver and the colon tissues.
Author Interviews, Diabetes, Primary Care / 18.10.2015

[caption id="attachment_18523" align="alignleft" width="168"]Jay H. Shubrook DO FACOFP, FAAFP Professor Primary Care Department Director of Clinical Research and Diabetes Services Touro University California College of Osteopathic Medicine Dr. Jay Shubrook[/caption] MedicalResearch.com Interview with: Jay H. Shubrook DO FACOFP, FAAFP Professor Primary Care Department Director of Clinical Research and Diabetes Services Touro University California College of Osteopathic Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Shubrook: Type 2 DM is a progressive disease that is marked by declining beta cell function that results is worsening hyperglycemia. Current guidelines recommend a stepped approach in which people start with lifestyle and then sequentially add medications. The guidelines recommend that treatments be assessed regularly and titrated every 2-3 months. Unfortunately this does not happen. Clinical inertia is coming when treating diabetes where years -- not months- will pass before treatments are titrated. Time is not our friend in type 2 diabetes so we need to find a way to intervene earlier so we can see durable glucose control and hopefully longer terms preservation of beta cell function. The INSPIRE trial (intensive insulin as the primary treatment of type 2 diabetes) tested the effect of a pulse of early basal and bolus insulin therapy on glucose control, side effects (hypoglycemia, weight gain) and beta cell function. This regimen was compared to intensive oral therapy (2009 ADA treatment guidelines0 but medications titrated monthly). In short this randomized controlled multi center clinical trials explored does a 12 week pulse of basal-bolus insulin control glucose better than 15 months of on going and monthly titrated medications. The results showed that 12 weeks of insulin therapy (and then all treatment stopped) had similar A1c reduction and time to and need for rescue therapy compared to intensively treated on going oral medications for 15 months. Rates of hypoglycemia were low and intact those in the insulin arm lost weight while those in the medication arm gained weight.
Author Interviews, Diabetes, JAMA, Surgical Research / 17.10.2015

MedicalResearch.com Interview with: Jan Peter Yska, PharmD Medical Centre Leeuwarden Department of Clinical Pharmacy & Clinical Pharmacology Leeuwarden The Netherlands Medical Research: What is the background for this study? Dr. Yska: Many patients with morbid obesity have known type 2 diabetes mellitus. Bariatric surgery effectively prevents and treats type 2 diabetes. A growing number of studies suggests that surgical treatment for obese patients may be considered an additional treatment option for the management of type 2 diabetes. However, an observational study on the remission of type 2 diabetes, using strict criteria for remisson of diabetes, after different types of bariatric surgery, based on data from general practice has not been carried out yet. Medical Research: What are the main findings? Dr. Yska: Our study included 569 obese patients with type 2 diabetes who had different types of weight-loss surgery and 1,881 similar diabetic patients who didn’t have surgery. This study confirms that bariatric surgery is successful in treating diabetes mellitus type 2. Per 1,000 person years 94.5 diabetes remissions were found in patients who underwent bariatric surgery, compared to 4.9 diabetes remissions in matched controls. A strict definition of remission of diabetes was used, much stricter than in other studies: patients should have stopped all diabetic medications with an HbA1c < 6.0% after at least 6 months of follow-up. Diabetic patients who underwent bariatric surgery had an 18-fold increased chance of diabetes remission, compared to diabetic patients who did not undergo surgery, with the greatest effect size observed for gastric bypass (adj. RR 43.1), followed by sleeve gastrectomy (adj. RR 16.6), and gastric banding (adj. 6.9). The largest decrease in  HbA1c and blood glucose levels was observed in the first two years after bariatric surgery.
Author Interviews, Diabetes, Weight Research / 14.10.2015

[caption id="attachment_18375" align="alignleft" width="180"]Guofang Chen MD Endocrine and Diabetes Center Jiangsu Province Hospital on Integration of Chinese and Western Medicine Nanjing University of Traditional Chinese Medicine Dr. Guofang Chen[/caption] MedicalResearch.com Interview with: Guofang Chen MD Endocrine and Diabetes Center Jiangsu Province Hospital on Integration of Chinese and Western Medicine Nanjing University of Traditional Chinese Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Guofang Chen: With the high prevalence of diabetes in China (about 11.6% in adults from 2013 data), finding a way to improve remission of diabetes, and decrease the risk of developing diabetes, can be considered urgent. Very low calorie diet (VLCD) has been reported as a quick therapeutic tool to improve glucose control in obese type 2 diabetic patients. We investigated the effects of short-term Very low calorie diet in both lean and overweight/obese type 2 diabetic patients in China. We find that short-term VLCD effectively improved insulin sensitivity, beta-cell function, glucose control, and lipid profile in overweight/obese rather than lean patients with type 2 diabetes in China.
Annals Internal Medicine, Author Interviews, Diabetes, Heart Disease, Nutrition / 13.10.2015

Iris Shai MD PhD Professor of Nutrition and Epidemiology of Chronic Diseases Dep. of Public Health Faculty of Health SciencesMedicalResearch.com Interview with: Iris Shai MD PhD Professor of Nutrition and Epidemiology of Chronic Diseases Dep. of Public Health Faculty of Health Sciences Medical Research: What is the background for this study? What are the main findings? Dr. Shai: Despite enormous contribution of observational studies, clinical recommendations for moderate alcohol consumption remain controversial, particularly for people with diabetes, due to lack of long-term, randomized controlled trials, which are needed for evidence-based medicine. People with diabetes are more susceptible to developing cardiovascular diseases than the general population and have lower levels of HDL-c. Also, it is uncertain if red wine confers any advantage over white wine or whether the ethanol is the primary mediator of alcoholic beverages related beneficial associations.  The two-year CArdiovaSCulAr Diabetes and Ethanol (CASCADE) RCT was performed among 224 controlled diabetes patients (aged 45 to 75), who generally abstained from alcohol. Red wine was found to be superior in improving overall metabolic profiles, mainly by modestly improving the lipid profile. As for glycemic control and blood pressure, the effect of both, red or white wine, was dependent on ADH enzyme polymorphism, suggesting personalized approach. Overall, wine of either type did not effect change in liver function tests, adiposity, or adverse events/symptoms. However, sleep quality was significantly improved in both wine groups, compared with the water control group. All comparisons were adjusted for changes in clinical, medical and drug therapy parameters occurring among patients during the years of the study. The trial completed with adherence rate of 87 percent after 2 years.
Author Interviews, Blood Pressure - Hypertension, Diabetes, Diabetologia / 25.09.2015

Ramon C. Hermida Dominguez, Ph.D. Director, Bioengineering & Chronobiology Labs. Campus Universitario Vigo, PontevedraMedicalResearch.com Interview with: Ramon C. Hermida Dominguez, Ph.D. Director, Bioengineering & Chronobiology Labs. Campus Universitario Vigo, Pontevedra Medical Research: What is the background for this study? What are the main findings? Dr. Hermida Dominguez: Independent studies have shown that the asleep blood pressure (BP) mean is abetter predictor of cardiovascular risk than clinic BP or the awake blood pressure mean derived from ambulatory BP monitoring. Moreover, sleep-time hypertension is highly prevalent among patients with type 2 diabetes. In the first manuscript we tested two novel hypotheses: (i) whether sleep-time BP is a prognostic marker for future development of diabetes; and (ii) whether progressive reduction of sleep-time blood pressure actually reduces the risk of developing diabetes. The main findings indicate that sleep-time blood pressure is indeed a highly significant prognostic marker for new-onset diabetes, while clinic blood pressure measurements are not. Most important from the therapeutic point of view, the results from our prospective study also indicate lowering asleep blood pressure could indeed be a significant method for reducing the risk of developing diabetes. On the other hand, multiple clinical trials have shown that bedtime ingestion of hypertension medications of several classes is associated with improved blood pressure measurements control and increased efficacy in lowering asleep BP. In the second manuscript we investigated whether therapy with the entire daily dose of one or more antihypertensive medications at bedtime exerts better reduction in the risk of developing diabetes than ingesting all medications in the morning upon awakening. The results from this randomized clinical trial indicate a significant 57% decrease in the risk of developing diabetes in the bedtime compared to the awakening treatment regimen.
Author Interviews, Diabetes, Outcomes & Safety, Technology / 21.09.2015

Wencui Han PhD Assistant Professor Business Administration University of Illinois at Urbana ChampaignMedicalResearch.com Interview with: Wencui Han PhD Assistant Professor Business Administration University of Illinois at Urbana Champaign Medical Research: What is the background for this study? What are the main findings? Dr. Han: Well-designed disease registries integrate a variety of information, including patient demographics, laboratory results, pharmacy data, and comorbidity data, to serve a variety of functions outside the clinical encounter. However, the adoption of disease registries by healthcare organizations is associated with significant direct and indirect costs. The impacts of using disease registries that meet meaningful use (MU) requirements in improving health outcomes and creating cost savings are understudied. This study examines the impact of using a registry for patient reminders and for improvement of the quality of care, hospital utilization, and cost saving. The results suggest that the use of diabetes registries meeting Meaningful Use core objectives is associated with higher completion or recommended lab tests and a lower hospital utilization rate for patients with type 2 diabetes.
Author Interviews, Diabetes, Lancet, Surgical Research / 17.09.2015

Martin Neovius PhD Department of Medicine, SolnaMedicalResearch.com Interview with: Martin Neovius PhD Department of Medicine, Solna Medical Research: What is the background for this study? What are the main findings? Dr. Neovius: Long-term real world data on economic effects of bariatric surgery versus nonsurgical treatment are scarce. We have previously looked at long-term drug costs, inpatient and outpatient care in the overall bariatric surgery population (Neovius, Narbro et al, JAMA 2012). However, overall findings may mask important subgroup variations. Based on data from the Swedish Obese Subjects (SOS) study, we documented large drug cost savings over 15 years after bariatric surgery versus non-surgically treated controls in patients who had diabetes and prediabetes before intervention. No savings were seen in patients who were euglycemic at baseline. In terms of overall healthcare costs, we saw cost-neutrality versus non-surgically treated patients for the diabetes group, while costs were higher for both patients with normal blood glucose and those with prediabetes (due to the initial high cost of surgery and inpatient care). For the subgroup of patients with diabetes, we also found that patients with recent diabetes onset had more favorable economic outcomes than patients with established diabetes. 
Author Interviews, Cannabis, Diabetes, Diabetologia, Heart Disease / 14.09.2015

Mike Bancks, MPH NHLBI Cardiovascular Disease Epidemiology & Prevention Pre-doctoral Fellow University of Minnesota School of Public HealthMedicalResearch.com Interview with: Mike Bancks, MPH NHLBI Cardiovascular Disease Epidemiology & Prevention Pre-doctoral Fellow University of Minnesota School of Public Health banck005@umn.edu Medical Research: What is the background for this study? What are the main findings? Response: We chose to research this topic because marijuana is the most commonly used illicit drug in the United States and use can be expected to increase as the effort to legalize marijuana for recreational and medicinal use grows. We found that individuals who reported using marijuana in excess of 100 times during young adulthood had 40% greater risk for developing prediabetes by middle adulthood. However, we did not find an association between marijuana use and overt diabetes during this same period in adulthood, suggesting that marijuana use may be a risk factor for the early stage of diabetes.
Author Interviews, Diabetes, Heart Disease, Karolinski Institute, Kidney Disease / 12.09.2015

MedicalResearch.com Interview with: Dr. Daniel Hertzberg M.D., Ph.D. Student Department of Medicine, Solna Karolinska University Hospital Medical Research: What is the background for this study? Dr. Hertzberg: Acute Kidney Injury (AKI) is a common complication in patients undergoing cardiac surgery. It is associated with increased short and long-term mortality, myocardial infarction, heart failure and chronic kidney disease. Diabetes is often considered as a risk factor for AKI. However, when we searched the literature we did not find any studies which specifically studied diabetes as a risk factor for AKI. In addition, in observational studies, it is uncommon that diabetes is subtyped into type 1 or type 2 even though they have different etiologies and thus may have different impact on risk of adverse outcomes. Thus, we designed this study in order to study the association between the two subtypes of diabetes and risk of AKI.
Author Interviews, Diabetes, JAMA / 09.09.2015

Dr. Andy Menke PhD Social & Scientific Systems Inc Silver Spring, MD 20910MedicalResearch.com Interview with: Dr. Andy Menke PhD Social & Scientific Systems Inc Silver Spring, MD 20910 Medical Research: What is the background for this study? What are the main findings? Dr. Menke: Previous studies have shown an increase in diabetes over time. We wanted to use the most recent data available to estimate the prevalence and trends in diabetes in the US population. We found that 14% of US adults had diabetes and the prevalence was higher in blacks, Hispanics, and Asians. About 1 in 3 people with diabetes were unaware that they had the condition and this was even higher in Asians and Hispanics where half were unaware that they had it. Also, among US adults, 1 in 3 people have prediabetes, which means that roughly half of all US adults have either diabetes or prediabetes. Between 1988-1994 and 2011-2012, diabetes prevalence increased by 25% among adults in the US population. The increase over time occurred in every age group, race group, and both genders.
Author Interviews, Diabetes, JAMA, Kidney Disease / 01.09.2015

George L. Bakris MD Professor of Medicine Director, Comprehensive Hypertension Center University of Chicago MedicineMedicalResearch.com Interview with: George L. Bakris MD Professor of Medicine Director, Comprehensive Hypertension Center University of Chicago Medicine Medical Research: What is the background for this study? What are the main findings? Dr. BakrisAldosterone receptor antagonists such as spironolactone are known to reduce mortality from heart failure and reduce albuminuria, a well-known marker of diabetic kidney disease progression. Finerenone is a novel nonsteroidal aldosterone receptor antagonist and is associated with less hyperkalemia (high blood potassium levels) compared to traditional aldosterone receptor blockers like spironolactone. The current study was a dose finding study to ascertain the optimal dose of finerenone for reducing urine albumin (a key risk marker in people with diabetic kidney disease) that is also associated with the smallest rise in serum potassium. The main findings are that in a dose dependent manner finerenone reduced albuminuria and at the highest dose a modest rise in serum potassium. Finerenone was also very well tolerated. 
Author Interviews, Diabetes, JAMA, Weight Research / 19.08.2015

Melanie J Davies MB ChB MD FRCP FRCGP Professor of Diabetes Medicine 
NIHR Senior Investigator Leicester Diabetes Unit
Leicester Diabetes Centre Bloom
University of Leicester MedicalResearch.com Interview Invitation Melanie J Davies MB ChB MD FRCP FRCGP Professor of Diabetes Medicine 
NIHR Senior Investigator Leicester Diabetes Unit
Leicester Diabetes Centre Bloom
 University of Leicester   MedicalResearch: What is the background for this study? What are the main findings?
 Dr. Davies: This study was designed to test the efficacy and safety of Liraglutide using a dose of 3mg for weight loss among patients with type 2 diabetes.  It was a large international study in which we compared once daily subcutaneous Liraglutide at a dose of 3mg to Liraglutide 1.8mg which is the current maximum dose licenced in patients with diabetes and placebo.  In all patients we offered a calorie deficit diet and lifestyle advice to increase physical activity.  Our main findings were that the dose of 3mg of Liraglutide resulted in greater weight loss than both other arms of the study indeed 54% of patients at 56 weeks achieved more than 5% weight loss and a further 25% were able to achieve more than 10% weight loss.  The 3mg of Liraglutide compared to the placebo, there were also significant impacts on HbA1c and other cardiovascular risk factors such as systolic blood pressure and lipids as well as improving patient quality of life particularly physical functioning and patient treatment satisfaction. 
Author Interviews, Diabetes, Diabetes Care, Lifestyle & Health / 14.08.2015

Dr. Kaberi Dasgupta MD, MSc, FRCPC Associate Professor, Department of Medicine Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism Royal Victoria Hospital Quebec, Canada MedicalResearch.com Interview with: Dr. Kaberi Dasgupta MD, MSc, FRCPC Associate Professor, Department of Medicine Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism Royal Victoria Hospital Quebec, Canada   Medical Research: What is the background for this study? What are the main findings? Dr. Dasgupta: We know that health behaviours can contribute to developing gestational diabetes and type 2 diabetes (e.g., eating out frequently, lack of fruits and vegetables, not walking enough, spending most of the day sitting). We also know that genetic factors are important. Sometimes we focus more on the genetic factors than on health behaviours. By showing that spouses share diabetes risk, we highlight the importance that behaviour and environment play as spouses are not generally related biologically. In a previous meta-analysis, we showed that spouses were concordant for diabetes (if one had it, there was a 24% relative risk increase that the other did too.) In the study Gestational Diabetes Mellitus in Mothers as a Diabetes Predictor in Fathers: A Retrospective Cohort Analysis, we took it further and compared men whose partners had gestational diabetes and men whose partners did not. Over a 13 year period of follow-up, the men whose partners had gestational diabetes were 33% more likely to develop diabetes. 
Author Interviews, Case Western, Diabetes, Infections, PLoS / 14.08.2015

Wesley M. Williams, PhD Cell molecular biologist Department of Biological Sciences Case Western Reserve University School of Dental MedicineMedicalResearch.com Interview with: Wesley M. Williams, PhD Cell molecular biologist Department of Biological Sciences Case Western Reserve University School of Dental Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Williams: Individuals with uncontrolled blood sugar levels frequently present with higher than normal rates of infection and protracted wound healing. The beta-defensin family of antimicrobial peptides responds to bacterial, fungal and viral invasion. As part of the innate immune system, these cationic peptides normally expressed by epithelial cells are important early responders that, together with other components of the innate immune response, act to inhibit microbial infection. Our initial observations led us to question whether glucose or a metabolite of glucose could contribute to antimicrobial peptide dysfunction, and thus compromise control of infection. Elevated levels of glucose result in increased production of dicarbonyls, a class of molecule that can selectively react with proteins having an unusually high content of cationic amino acids, such as arginine and lysine. We first investigated the effects of two well-characterized dicarbonyls, methylglyoxal (MGO) and glyoxal (GO) on recombinant beta-defensin 2 (rHBD-2) structure using MALDI TOF and LC/MS/MS mass spectral analysis of the recombinant peptide. We found MGO to be particularly reactive with the rHBD-2 peptide as it readily and irreversibly adducted to two arginine residues and the N-terminal glycine. Next we tested in vitro for the effects of adducted rHBD-2 on antimicrobial and chemotactic functions, both essential to an effective innate and adaptive immune response in vivo. Through radial diffusion testing on gram-negative E. coli and P. aeruginosa, and gram-positive S. aureus, and a chemotaxis assay for CEM-SS cells, we found that both antimicrobial and chemotactic functions of rHBD-2 were significantly compromised by MGO.
Alzheimer's - Dementia, Author Interviews, Diabetes, Diabetologia / 14.08.2015

Laura Ekblad, MD, researcher Turku PET CentreMedicalResearch.com Interview with: Laura Ekblad, MD, researcher Turku PET Centre Medical Research: What is the background for this study? What are the main findings? Dr. Ekblad: The background for our study is that the metabolic syndrome and diabetes have been shown to increase the risk for cognitive decline and dementia. Also, insulin resistance is thought to play a pivotal role in the pathophysiology of Alzheimer´s disease. In addition, intranasal insulin administration is being studied as a promising treatment for Alzheimer´s disease. Previous studies indicate that both gender and APOE epsilon 4 genotype modulate the effects of insulin on cognition. Our main findings are that insulin resistance is associated with poorer verbal fluency, but only in women. Our population-based study consisted of adults from 30-97 years of age and we had nearly 6000 participants. Age did not modulate the association of insulin resistance and cognition, which means that our results apply even to young adults. We also found that insulin resistance associated with poorer verbal fluency only in non-carriers of the APOE epsilon 4 genotype.
Author Interviews, Diabetes, Kidney Disease, Lancet / 12.08.2015

[caption id="attachment_16540" align="alignleft" width="238"]Prof. Der-Cherng Tarng, MD, PhD Division of Nephrology Taipei Veterans General Hospital, and National Yang-Ming University, Taiwan Prof. Der-Cherng Tarng[/caption] MedicalResearch.com Interview with: Prof. Der-Cherng Tarng, MD, PhD Division of Nephrology Taipei Veterans General Hospital, and National Yang-Ming University, Taiwan MedicalResearch: What is the background for this study? What are the main findings? Prof. Tarng: Metformin is generally recommended as a first-line therapy for type 2 diabetes mellitus, but the use of metformin has been limited in patients with impaired kidney function because of the perceived risk of lactic acidosis. More recently, available evidence supports the cautious expansion of metformin use in patients with mild to moderate chronic kidney disease (CKD). However, no studies have yet examined whether metformin can be prescribed more widely to patients with advanced CKD. We conducted a propensity score-matched cohort study using Taiwan’s National Health Insurance Research Database to assess the safety of metformin in patients with type 2 diabetes and serum creatinine levels >6 mg/dL, enrolled between January 1, 2000 and June 30, 2009 and followed-up until December 31, 2009, before Taiwan’s prescribing guidelines for metformin contraindicated its use in patients with CKD. From a consecutive sample of 12350 patients, 1005 (8.1%) were metformin users. Of these, 813 were successfully matched 1:3 to 2439 metformin nonusers. After multivariate adjustment, metformin use remained was an independent risk factor for mortality (hazard ratio 1.35, 95% confidence interval 1.20–1.45; p<0.0001). The increased risk was dose-dependent and was consistent across all subgroup analyses. However, metformin users compared with non-users were associated with a higher but insignificant risk of metabolic acidosis (hazard ratio 1.30, 95% confidence interval 0.88–1.93; p=0.188).
Alzheimer's - Dementia, Author Interviews, Diabetes, JAMA, Nutrition / 31.07.2015

Auriel A. Willette, M.S., Ph.D. Food Science and Human Nutrition Neuroscience Interdepartmental Graduate Program Gerontology Interdepartmental Graduate Program Iowa State University, AmesMedicalResearch.com Interview with: Auriel A. Willette, M.S., Ph.D. Food Science and Human Nutrition Neuroscience Interdepartmental Graduate Program Gerontology Interdepartmental Graduate Program Iowa State University, Ames Medical Research: What is the background for this study? What are the main findings? Response: Obesity is a major health concern around the world. Obesity causes insulin resistance, defined in this case as the inability of insulin to bind to its receptor and mediate glucose metabolism. Other researchers and I have recently found that higher insulin resistance is associated with less glucose metabolism in the brains of patients with Alzheimer's disease. This relationship is found primarily in medial temporal lobe, an area necessary for generating new memories of facts and events. This is important because Alzheimer's disease is characterized by progressive decreases in glucose metabolism over time, and partly drives worse memory performance. Insulin resistance in midlife also increases the risk of developing Alzheimer's disease. We wanted to determine if insulin resistance is linked to similar effects in cognitively normal, late middle-aged participants decades before Alzheimer's disease typically occurs. If so, insulin resistance might be an important biological marker to track from middle-age onwards. Thus, we examined the association between insulin resistance, regional glucose metabolism using FDG-PET, and memory function in 150 middle-aged participants, many of whom had a mother or father with Alzheimer's disease. We found that higher insulin resistance was strongly associated with less glucose metabolism throughout many brain regions, predominantly in areas that are affected by Alzheimer's disease. The strongest statistical effects were found in left medial temporal lobe, which again is important for generating new memories. This relationship, in turn, predicted worse memory performance, both immediately after learning a list of words and a 20-minute delay thereafter. The take-home message is that insulin resistance has an Alzheimer's-like association with glucose metabolism in middle-aged, cognitively normal people at risk for Alzheimer's, an association which is related to worse memory.
Author Interviews, Diabetes, PLoS / 23.07.2015

Dr. Stephanie K. Venn-Watson Doctor of Veterinary Medicine, MS Director, Translational Medicine and Research Program National Marine Mammal FoundationMedicalResearch.com Interview with: Dr. Stephanie K. Venn-Watson Doctor of Veterinary Medicine, MS Director, Translational Medicine and Research Program National Marine Mammal Foundation
    Medical Research: What is the background for this study? What are the main findings? Dr. Venn-Watson: Bottlenose dolphins, just like people, can develop a condition called metabolic syndrome. In humans, metabolic syndrome is also called prediabetes, which affects 1 in every 3 adults in the U.S. Some human studies have suggested that eating a diet high in fish may lower the risk of developing metabolic syndrome. Other similar studies, however, have had inconsistent findings. To better understand how fish diets may be associated with dolphin metabolic health, we compared 55 fatty acids among 49 dolphins and their dietary fish. We were surprised to find that the strongest predictor of lower, healthier insulin levels in dolphins was a saturated fat called, heptadecanoic acid (or C17:0). When we provided a diet higher in C17:0 to six dolphins over six months, their insulin, glucose, and triglycerides normalized. We also saw an immediate decrease in ferritin, a protein which - at high levels - may be a risk factor for metabolic syndrome. In addition to some fish, C17:0 is present in dairy fat, including whole fat milk and butter. C17:0 was not present in nonfat dairy products. We hypothesize that movement towards nonfat dairy foods may be lowering human C17:0 blood levels, which may be contributing to the global rise in metabolic syndrome and type 2 diabetes.
Author Interviews, Brigham & Women's - Harvard, Diabetes, Nutrition, Pediatrics / 22.07.2015

Prof. Lu Qi, Assistant Professor, Department of Nutrition Harvard School of Public Health and Channing Division of Network Medicine Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MAMedicalResearch.com Interview with: Lu Qi, MD, PhD, FAHA Associate Professor of Medicine Harvard Medical School Assistant Professor of Nutrition HarvardSchool of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Lu QiMost previous studies focus on the effects of either lifestyle or prenatal malnutrition on diabetes risk; no study has assess these two types of risk factors in combination.