Alzheimer's - Dementia, Author Interviews, Diabetes, JAMA / 28.04.2015

MedicalResearch.com Interview with: Dimitry S. Davydow, MD, MPH Associate Professor Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle, WA 98195 Dr, Davydow wishes to acknowledge Dr. Wayne Katon, the lead investigator of the study, who passed away on March 1, 2015. Medical Research: What is the background for this study? Dr. Davydow: The medical and public health communities have known for quite a while that diabetes and depression are both potential risk factors for developing dementia later in life. Dr. Wayne Katon previously published two articles detailing the results of two studies of relatively large groups of patients (one with nearly 4,000 patients and the other with 29,000 patients) with diabetes showing that those with diabetes and co-existing depression had a greater risk of developing dementia later in life than those patients with just diabetes. These initial studies were important since patients with diabetes are 3 to 4-times more likely to suffer from depression compared to the general population. However, it remained unclear when comparing to a population without either diabetes or depression, to what extent each independently raised the risk of developing dementia, and then to what extent having both conditions increased an individual’s subsequent risk of dementia. We sought to answer these questions with this study. In addition, with the growing obesity epidemic, which carries with it higher burdens of both diabetes and depression, there is reason to be concerned that the risk of dementia could be higher at even younger ages. To address this issue, we also wanted to see if there was a differential impact of the combination of diabetes and co-existing depression on dementia risk among those younger than 65 compared to individuals 65 or older. We were fortunate to be able to examine health data from all Danish citizens 50 or older over a 6 year period, a population numbering nearly 2.5 million people to be able to answer these questions. Medical Research: What are the main findings? Dr. Davydow: We found that compared to individuals without diabetes or depression, those with diabetes alone had about a 15% greater risk of developing dementia, those with depression alone had about an 83% greater risk of developing dementia, and those with both diabetes and co-existing depression had a 107% greater risk of developing dementia compared to those without either condition. We also found that of all of the cases of dementia diagnosed in Denmark among individuals 50 or older between 2007 through 2013, 6% were potentially due to combination of having both diabetes and depression. This was also true for those 65 or older, where 6% of all diagnosed dementia was potentially attributable to the combination of both diabetes and depression. However, among individuals under age 65, we found that 25% of all cases of dementia may have been directly attributable to the combination of diabetes and co-existing depression. (more…)
Author Interviews, Diabetes, Diabetologia, Pediatrics, Social Issues / 10.04.2015

MedicalResearch.com Interview with: Maria Nygren Division of Pediatrics Linköping University, Sweden MedicalResearch: What is the background for this study? What are the main findings? Response: What factors that cause type 1 diabetes is still unknown, but we know that environmental factors are involved besides the genetics. Since the incidence of type 1 diabetes among children have increased worldwide in recent decades, it is important to find out the reasons behind the disease to hopefully be able to prevent new cases. We have in a prospective study of over 10000 children and their parents in Sweden investigated if psychological stress can be a risk-factor, and found that childhood experience of serious life events (such as death/illness in family, divorce, new adult/child in the family) was associated with increased risk for diagnosis of type 1 diabetes up to 14 years of age. (more…)
Author Interviews, Diabetes, Diabetologia, Lifestyle & Health, University of Pittsburgh / 02.04.2015

MedicalResearch.com Interview with: Bonny Rockette-Wagner, Ph.D. Director of physical activity assessment, University of Pittsburgh Graduate School of Public Health and Andrea Kriska, Ph.D. Professor of epidemiology, University of Pittsburgh Graduate School of Public Health Researchers’ Note: Drs. Kriska and Rockette-Wagner: It should be noted that this study looked at adults at high risk for diabetes. Not everyone in the general population would be at high risk. We would hypothesis that the risk increase from TV watching may be lower in those not at high risk for diabetes, but obviously could not test that in our study population. MedicalResearch: What is the background for this study? Response: In this research effort focused on participants in the Diabetes Prevention Program (DPP) study (published in 2002 and funded by the National Institute of Digestive and Diabetes and Kidney Diseases [NIDDK] section of the US National Institutes of Health [NIH]). That study enrolled 3,234 overweight US adults (1996–1999) of at least 25 years of age with the goal of delaying or preventing type 2 diabetes in high risk individuals with either a metformin drug or lifestyle intervention. The DPP demonstrated that the lifestyle intervention was successful at reducing the incidence of diabetes and achieving its goals of 150 minutes per week of moderate intensity activity (such as brisk walking) and a 7% weight loss (New England Journal of Medicine, 2002). There was no goal to reduce sitting in the Diabetes Prevention Program. Results from other studies suggest that it is unclear if interventions focusing on increasing physical activity also reduce time spent sitting. This current investigation examined whether the Diabetes Prevention Program lifestyle intervention, which was shown to be effective at increasing physical activity, also decreased self-reported sitting time. The effect of sedentary behavior on diabetes development was also examined. MedicalResearch: What are the main findings? Response: For the lifestyle participants, a reduction in reported TV watching alone and the combination of TV watching and work sitting was observed. This reduction was significantly greater than any changes seen in the other two randomized groups, who did not receive the intervention. Because these reductions were accomplished without an explicit program goal to reduce sitting we feel optimistic that with better awareness of sitting behaviors and goal setting to reduce sitting it may be possible to have an even greater impact than what was achieved in this cohort. Additionally, our results showed that for every hour spent watching TV there was a 3.4% increased risk of developing diabetes during the 3 year follow-up period in individuals at high risk for diabetes. This finding means that reductions in sitting can translate into a positive health effect separate from improvements in moderate-vigorous activity. (more…)
Antioxidants, Author Interviews, Diabetes, Nutrition / 01.04.2015

MedicalResearch.com Interview with: Isao Saito, MD, PhD Department of Basic Nursing and Health Science, Ehime University Graduate School of Medicine Toon, Ehime Medical Research: What is the background for this study? What are the main findings? Response: Type 2 diabetes is a major lifestyle-related disease with a rapid increasing prevalence in Japan. One meta-analysis of six cohort studies showed that an increase in daily food intake of 1.15 servings of green leafy vegetables was associated with a 14% reduction in the incidence of type 2 diabetes. Therefore, it is evident to think that green and yellow vegetables have beneficial effects against type 2 diabetes. Nonetheless, the relationship of their nutritive content with insulin resistance is poorly understood. We conducted the Toon Health Study initiated in 2009, which was a prospective cohort study of the Japanese general population. The cohort study was intended to characterize environmental risk factors related to incident diabetes and cardiovascular disease. Participants were recruited from the general population aged 30–79 years who were living in Toon City, Ehime Prefecture, Japan. Of them, we investigated 951 Japanese men and women aged 30–79 years who were not undergoing treatment for diabetes and measured their serum β-carotene and retinol concentrations. A 75-g oral glucose tolerance test was performed and the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and the Matsuda Index were calculated as measures of insulin resistance. Multivariable-adjusted odds ratios of the highest quartile of serum β-carotene compared with the lowest quartile for HOMA-IR >1.6 and Matsuda Index <4.9 were 0.56 (95% confidence interval, 0.34–0.94) and 0.62 (0.37–1.02), respectively. When stratified by sex and overweight status, these associations were observed for women and non-overweight individuals. Serum retinol concentration was not associated with either index. Furthermore, according to the nutritional survey, serum β-carotene concentration was associated with green and yellow vegetable intake (p = 0.01). (more…)
Author Interviews, Diabetes, JAMA, Pediatrics / 01.04.2015

MedicalResearch.com Interview with: Dr. Michele Jonsson Funk, PhD Research Associate Professor, Dept of Epidemiology Director, Methods Core, Center for Women’s Health Research University of North Carolina at Chapel Hill and Dr. Wendy Camelo Castillo, MD, PhD Post-doctoral fellow at the University of Maryland Medical Research: What is the background for this study? Response: Gestational diabetes is a condition that affects between 8-11% of pregnant women worldwide. In the United States, the prevalence of gestational diabetes has more than doubled since the 1990’s. Most women can control their blood glucose levels with changes in diet and exercise, but approximately 10% need to take medication during pregnancy. Over the last decade, the use of glyburide (a pill) to manage gestational diabetes has increased and it is now used more often than insulin (an injectable). Medical Research: What are the main findings? Response: Treatment with glyburide (compared with insulin) was associated with higher risks of admission to the neonatal intensive care unit (NICU) (by 41%), respiratory distress (by 63%), hypoglycemia in the newborn (40% ), birth injury (35% ) and being large for gestational age (43% ).  The risk of NICU admission, large for gestational age and respiratory distress between glyburide and insulin treated women was increased by 3.0%, 1.4% and 1.1% respectively. (more…)
Author Interviews, Diabetes, Stem Cells, Weight Research / 25.03.2015

Timothy J. Kieffer Ph.D. | Professor Laboratory of Molecular & Cellular Medicine Department of Cellular & Physiological Sciences Department of Surgery | Life Sciences Institute The University of British Columbia Vancouver BC Canada MedicalResearch.com Interview with: Timothy J. Kieffer Ph.D. | Professor Laboratory of Molecular & Cellular Medicine Department of Cellular & Physiological Sciences Department of Surgery | Life Sciences Institute The University of British Columbia Vancouver BC Canada Medical Research: What is the background for this study? What are the main findings? Dr. Kieffer: Previously we have examined the therapeutic potential of pancreatic precursor cells derived from human stem cells for insulin replacement in models of type 1 diabetes (PMID: 22740171 & PMID: 23771205). Here we sought to test the efficacy of cell-based insulin replacement in a model of type 2 diabetes, which is by far the most common form of diabetes. Key aspects of type 2 diabetes could be mimicked in immunodeficient mice, namely hyperglycemia and insulin resistance accompanied by excess body weight, by placing the mice on high fat diets. These diabetic mice were transplanted with human stem cell derived pancreatic precursor cells contained within macroencapsulation devices. The diabetic setting did not negatively impact the ability of the transplanted cells to mature into insulin-producing cells. Moreover, the cell transplants were able to significantly improve glucose homeostasis, particularly when combined with low doses of traditional anti-diabetic drugs. Intriguingly, the combined therapy also induced weight loss, such that treated mice were similar in weight to control mice reared on a low fat diet. (more…)
Author Interviews, Compliance, Diabetes, Heart Disease / 17.03.2015

Sameer Bansilal, MD, MS Asst. Prof.- Medicine and Cardiology Clinical Trials & Global Health Studies Icahn School of Medicine at Mount SinaiMedicalResearch.com Interview with: Sameer Bansilal, MD, MS Asst. Prof.- Medicine and Cardiology Clinical Trials & Global Health Studies Icahn School of Medicine at Mount Sinai Medical Research: What is the background for this study? What are the main findings? Dr. Bansilal: Our group has previously published data from FREEDOM, COURAGE and BARI showing that adherence to recommended therapies are low in diabetic (DM) patients. We have spent the last decade developing a potential solution to this- the Fuster-Ferrer polypill. This study was done to better inform the association between levels of medication adherence and long term major adverse cardiovascular events (MACE) in high risk diabetic patients. We analyzed a U.S. health insurers’ claims data for 19,962 high risk diabetic subjects. Using proportion of days covered (PDC) for 1 year after first refill, we stratified patients as fully adherent (FA≥80%), partially adherent (PA ≥40- ≤79%) or non-adherent (NA <40%) and examined the associations with a primary cardiovascualr outcome measure of death, myocardial infarction, stroke and coronary revascularization. We found that only 34% participants were fully adherent to therapy. When compared to being non-adherent at 2 yrs follow up,, being fully adherent was associated with a 28% lower rate of MACE; being partially adherent was associated with a 21% lower rate of MACE. Efforts towards improving adherence in diabetic subjects may lead to substantial reductions in MACE. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Lipids, Statins / 11.03.2015

Joost Besseling PhD-student Academic Medical Center Dept. of Vascular Medicine AmsterdamMedicalResearch.com Interview with: Joost Besseling PhD-student Academic Medical Center Dept. of Vascular Medicine Amsterdam Medical Research: What is the background for this study? What are the main findings? Response: Statins are associated with an increased risk for type 2 diabetes mellitus (DM). The exact mechanism for this adverse event is largely unknown, although the upregulation of the low-density lipoprotein receptor (LDLR) has been suggested to play a role. In familial hypercholesterolemia (FH) the uptake of LDL-cholesterol via the LDLR is decreased due to a genetic defect. We found that the prevalence of type 2 DM is 50% lower in relative terms in patients with familial hypercholesterolemia. Moreover, there was a dose-response relationship: the more severe the genetic defect that causes familial hypercholesterolemia, the lower the prevalence of type 2 DM. (more…)
Author Interviews, Diabetes, Neurological Disorders / 06.03.2015

Dr. John A Kessler MD The Ken and Ruth Davee Professor of Stem Cell Biology Department of Neurology Professor, Department of Pharmacology Northwestern University Feinberg School of MedicineMedicalResearch.com Interview with: Dr. John A Kessler MD The Ken and Ruth Davee Professor of Stem Cell Biology Department of Neurology Professor, Department of Pharmacology Northwestern University Feinberg School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Kessler: Painful diabetic neuropathy afflicts millions of patients. It interferes with sleep and many daily activities of living, and predisposes to depression. There is a loss of sensation in the legs which predisposes to foot/leg ulcers which may lead to amputation. The only currently available treatments, other than controlling glucose levels, are drugs including gabapentin, pregabalin, or antidepressants which have major side effects and which help only some patients. These are medications which must be taken daily or several times daily and are often poorly tolerated by patients. This study examined the effects of a nonviral gene therapy approach for using hepatocyte growth factor (HGF) to treat patients with painful diabetic neuropathy. HGF helps to support the health of neurons and it also helps to grow new blood vessels to support nerve function. Patients received two sets of treatments (injections) and were then followed for 9 months.  The treatment was exceptionally well tolerated -  literally without significant side effects. The patients had highly significant reductions in pain and improvement in the quality of life, and their ability to sense gentle pressure (touch) was improved. The benefits lasted months without additional treatment. (more…)
Author Interviews, Compliance, Diabetes, Pediatrics / 03.03.2015

Dr. Yang Lu Ph.D Los Angeles Biomedical Research Institute Dr. Lu’s research interests include utilization, cost and treatment regimen adherence of chronic conditions, such as obesity and diabetes; behavioral economic interventions, and cost effectiveness studiesMedicalResearch.com Interview with: Dr. Yang Lu Ph.D Los Angeles Biomedical Research Institute Dr. Lu’s research interests include utilization, cost and treatment regimen adherence of chronic conditions, such as obesity and diabetes; behavioral economic interventions, and cost effectiveness studies MedicalResearch: What is the background for this study? Response: Non-adherence is a serious issue in type 1 diabetes management. It leads to poor glycemic control and peaks in adolescence and young adulthood. Peer support is critical for young patients yet few studies examined whether pairing youth with slightly older and more experienced peers with diabetes improves their diabetes self-management and glycemic control. This study had two aims: (1) assess whether adolescents (as prospective mentees) and young adults (as prospective mentors) with diabetes would be interested in peer mentoring as a way to improve adherence, and (2) identify contents and delivery modes for a peer mentoring topic from the perspective of patients and their parents. Fifty-four adolescents and 46 young adults with type 1 diabetes were surveyed. (more…)
Author Interviews, Diabetes, Diabetologia, Nutrition / 28.02.2015

Professor Daniela Jakubowicz MD Diabetes Unit. E. Wolfson Medical Center Sackler Faculty of Medicine, Tel Aviv University and Tel Aviv Medical Center IsraelMedicalResearch.com Interview with: Professor Daniela Jakubowicz MD Diabetes Unit. E. Wolfson Medical Center Sackler Faculty of Medicine, Tel Aviv University and Tel Aviv Medical  Center Israel MedicalResearch: What is the background for this study? What are the main findings? Professor Jakubowicz: Obesity epidemic have lead to alarming rise of type 2 diabetes. It is estimated that more than 382 million worldwide have diabetes, predominately type 2 diabetes. In these persons the cardiovascular disease is the leading complication, carrying 10 to 20-fold increase in the risk compared with persons without diabetes. It has been shown that large glucose peaks after meals along the day, are strongly associated with increased a risk for cardiovascular complications. Therefore the mitigation of glucose excursions after meals becomes a major target in the treatment of type 2 diabetes in order to improve glucose balance and prevent complications. Accordingly, dietary modification focused on reduction post meal glucose peaks is needed. Even though still there is no consensus on which of the dietary strategies (i.e. low-fat diet, Mediterranean and low-carbohydrate, higher fiber, low GI glycemic index meals, etc.) is more suitable in improving post-meal glycemic responses along the day. However in none of these interventions has been considered that modifying the meal timing pattern or daily caloric distribution, may lead to improved post-meal glycemic responses in type 2 diabetic patients. The circadian clock genes existing in the pancreatic β-cells, gut, liver and in skeletal muscle, regulate the diurnal (circadian) oscillation of post-meal glucose responses. In fact, post-meal glycemia displays a clear diurnal variation: it is higher and more prolonged in the evening than in the morning. Meal timing schedule, on the other hand, exerts strong controlling influence on circadian clock regulation, thereby influencing the variation and degree of the post meal glycemic elevations. Indeed meal timing non-aligned with the clock gene circadian rhythms, such as breakfast skipping or high-energy intake at dinner, is associated with obesity, higher HbA1C and poor glycaemic control in type 2 diabetes. To clarify the impact of meal timing and composition on overall post-meal glucose responses, we tested the effect of 2 isocaloric diets with different meal timing one with high energy breakfast (704 kcal), mid-sized lunch (600 kcal) and reduced dinner (200 kcal) and other with similar lunch but reduced breakfast (704 kcal) and high energy dinner(704 kcal). The study clearly demonstrated that in type 2 diabetic patients, a diet consisting on high energy breakfast, and reduced dinner, resulted in significantly reduced glucose response after meals and lower overall plasma glucose levels along the entire day, when compared to a diet with the same caloric content but inverse distribution: breakfast (200 kcal) , lunch (600 kcal) and high energy dinner(704 kcal). Moreover, when we compared the glucose response after high energy meal consumed at breakfast (700 kcal) versus in the dinner (700 kcal), it comes out that the glucose response was significantly higher after dinner than after breakfast. It shows that just by changing the time of the high energy meal we may achieve significant reduction in the glucose response. (more…)
Author Interviews, Diabetes, Karolinski Institute, NEJM, OBGYNE, Weight Research / 27.02.2015

Kari Johansson, Phd Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with: Kari Johansson, PhD Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, Sweden   MedicalResearch: What is the background for this study? What are the main findings? Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers. The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001).  (more…)
Author Interviews, Diabetes, Exercise - Fitness, Pain Research, Weight Research / 20.02.2015

Dan White PT , ScD, Msc University of DelawareMedicalResearch.com Interview with: Dan White PT , ScD, Msc University of Delaware Medical Research: What is the background for this study? What are the main findings? Dr. White: We know that diet and exercise are beneficial to reduce knee pain, however it is not known whether diet and exercise can actually prevent the development of knee pain in people at high risk.  We found that an intensive program of diet and exercise had a small but statistically significant protective effect with preventing the development of knee pain in overweight and obese people with diabetes. (more…)
Author Interviews, Diabetes, Ophthalmology, UCLA / 20.02.2015

Rohit Varma, MD, MPH Professor and Chair, Department of Ophthalmology USC Eye Institute, Keck School of Medicine University of Southern California, Los Angeles, CaliforniaMedicalResearch.com Interview with: Rohit Varma, MD, MPH Professor and Chair, Department of Ophthalmology USC Eye Institute, Keck School of Medicine University of Southern California, Los Angeles, California Medical Research: What is the background for this study? What are the main findings? Dr. Varma: The Centers for Disease Control and Prevention estimates that 4.4% of adults with diabetes aged 40 and older have advanced diabetic retinopathy that may result in severe vision loss. Clinical trials have shown that intravitreal injections of anti-VEGFs, such as ranibizumab, can reduce visual impairment and even in some cases improve visual acuity outcomes in patients with diabetic macular edema. We developed a model, based on data from the RIDE and RISE clinical trials, to estimate the impact of ranibizumab treatment on the number of cases of vision loss and blindness avoided in non-Hispanic white and Hispanic persons with diabetic macular edema in the United States.Results from the model suggest that, compared with no treatment, every-4-week ranibizumab 0.3 mg reduces legal blindness between 58%-88% and reduces vision impairment between 36%-53% over 2 years in this population. (more…)
Author Interviews, Diabetes, Heart Disease, Toxin Research / 20.02.2015

Katherine A James, PhD, MSPH, MSCE Colorado School of Public Health University of Colorado Denver, Aurora, ColoradoMedicalResearch.com Interview with: Katherine A James, PhD, MSPH, MSCE Colorado School of Public Health University of Colorado Denver, Aurora, Colorado Medical Research: What is the background for this study? What are the main findings? Dr. James: Exposure to inorganic arsenic in drinking water has been associated with several chronic diseases including cardiovascular disease and diabetes mellitus in areas with high levels of exposure.  Our study is one of the first to show association with cardiovascular disease and diabetes mellitus in a low-moderately exposed population. Our results show that for every 15 micrograms per liter of inorganic arsenic in drinking water the risk for CHD disease increased 38% and for diabetes it increases 27%. (more…)
Author Interviews, Diabetes, Hospital Readmissions / 16.02.2015

dr-syed-gillaniMedicalResearch.com Interview with: Dr Syed M R Gillani Diabetes Centre, New Cross Hospital, Wolverhampton, UK MedicalResearch: What is the background for this study? Dr. Gillani: NHS is facing the greatest challenge of its history in the form of A&E pressures and bed availabilities. Unplanned admissions are considered one of the key reasons. With an aging population, multiple co-morbidities and increasing pressures on social and primary care, we need to develop a proactive strategy to deal with this situation. It is a high priority agenda for the DOH. Initiatives such as “named GP for over 75” and “directly enhanced services to avoid unplanned admissions” have been rolled out by DOH in the last 2 years. In order to find an innovative way to assist in reduction of unplanned admissions, we decided to conduct an audit on all recurrent unplanned admissions with diabetes in the hospital over 12 months period. Its objective was to determine any unmet patient needs during an index admission to explore potential of changes in the service and to utilize available resources more effectively in an attempt to prevent next hospital admission for that patient. (more…)
Author Interviews, Diabetes, Diabetologia, Race/Ethnic Diversity / 12.02.2015

Dr. Therese Tillin Research Fellow, Cardiometabolic Phenotyping Group Institute of Cardiovascular Science Faculty of Pop Health SciencesMedicalResearch.com Interview with: Dr. Therese Tillin Research Fellow, Cardiometabolic Phenotyping Group Institute of Cardiovascular Science Faculty of Pop Health Sciences Medical Research: What is the background for this study? What are the main findings? Dr. Tillin: The global burden of type 2 diabetes is rising rapidly and people of South Asian origins (from the Indian subcontinent)  remain at much higher risk of developing diabetes than people of European origin.  Why is this?  Although it is  thought that increased levels of obesity around the waist level, diet, physical activity levels and genetic factors contribute, no study to date has been able to tease out fully the underlying causes for the added risk in South Asian people.  However, it is likely that complex metabolic disturbances may play an important role. We have been studying a British cohort of people of European and South Asian origin for nearly 20 years and have used nuclear magnetic resonance spectroscopy to build a profile of amino acids in blood samples that were collected at the start of the study between 1988 and 1991.  We found that higher levels of some amino acids, in particular tyrosine, were already present in non-diabetic South Asian individuals back then.  Some of these amino acids, again especially tyrosine, more strongly predicted later development of type 2 diabetes in the South Asian people than in the Europeans in our study, even after adjustment for other risk factors such as obesity and insulin resistance. A given increase (one standard deviation) in tyrosine increased risk of developing diabetes by just 10% in Europeans, while in South Asians the increase in risk was 47%. (more…)
Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA / 10.02.2015

Prof. KAZEM RAHIMI | DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford Deputy Director, The George Institute for Global Health James Martin Fellow in Healthcare Innovation, Oxford Martin School Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School | University of Oxford Oxford United KingdomMedicalResearch.com Interview with: Prof. Kazem Rahimi  DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford ;Deputy Director, The George Institute for Global Health; James Martin Fellow in Healthcare Innovation, Oxford Martin School; Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Rahimi: Lowering blood pressure (BP) in individuals with diabetes is an area of current controversy. Although it is widely accepted that lowering blood pressure in people with diabetes and elevated blood pressure will reduce the risk of heart and circulatory problems, it is less certain whether diabetics whose blood pressure is not very high should be treated with blood pressure lowering drugs, and how far their blood pressure should be reduced. It is also less well known how blood pressure lowering affects a range of other potential health complications for diabetes patients, such as diabetic eye disease. We found that each 10-mm Hg lower systolic blood pressure led to a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria (the presence of excessive protein in the urine), and retinopathy (loss of vision related to diabetes). Although proportional effects of blood pressure lowering treatment for most outcomes studied were diminished below a systolic BP level of 140 mm Hg, data indicated that further reduction below 140 mm Hg led to a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes. (more…)
Author Interviews, Dermatology, Diabetes / 04.02.2015

MedicalResearch.com Interview with: Mette Gyldenløve MD Gentofte Hospital, University of Copenhagen Denmark MedicalResearch: What is the background for this study? Dr. Gyldenløve: Epidemiological studies have shown that patients with psoriasis have increased risk of type 2 diabetes. The pathophysiology is largely unknown, but it is hypothesised that systemic inflammation causes insulin resistance, which is an early feature of type 2 diabetes. Insulin sensitivity has only been sparsely investigated in patients with psoriasis, and previous studies have used suboptimal methodology. The objective of the present study was to investigate, if patients with psoriasis exhibit impaired insulin sensitivity when assessed by the hyperinsulinaemic euglycaemic clamp technique (gold standard). MedicalResearch: What are the main findings? Dr. Gyldenløve: In this study we found that normal glucose-tolerant patients with moderate-to-severe psoriasis (n=16) had significantly reduced insulin sensitivity compared to age, gender, and body mass index (BMI)-matched, healthy control subjects (n=16). The two groups were similar with regard to age, gender, BMI, body composition, physical activity, fasting plasma glucose, and glycosylated haemoglobin. (more…)
Author Interviews, Diabetes, Sugar / 30.01.2015

MedicalResearch.com Interview with: James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart InstituteJames J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute Medical Research: What is the background for this study? What are the main findings? Dr. DiNicolantonio: We performed a comprehensive literature review comparing the isocaloric exchange of added sugars (sucrose, also known as table sugar, or high fructose corn syrup) versus other types of carbohydrates (such as lactose found in milk, glucose, starch, or dextrose).  Our main findings were that "a calorie isn't a calorie," i.e., that added sugars are more harmful than other carbohydrates even when matched for calories for promoting pre-diabetes and diabetes and the related morbidity and mortality associated with these diseases (more…)
Author Interviews, Diabetes, Nature, University of Michigan / 23.01.2015

MedicalResearch.com Interview with: Martin G. Myers, Jr., M.D., M.P.H. Director, Michigan Diabetes Research & Training Center Associate Professor of Internal Medicine - MEND Division Professor of Molecular & Integrative Physiology Marilyn H. Vincent Professor of Diabetes Research and Department of Pharmacology, University of Cambridge, Cambridge, UK.MedicalResearch.com Interview with: Martin G. Myers, Jr., M.D., M.P.H. Director, Michigan Diabetes Research & Training Center Associate Professor of Internal Medicine - MEND Division Professor of Molecular & Integrative Physiology Marilyn H. Vincent Professor of Diabetes Research and Department of Pharmacology, University of Cambridge, Cambridge Medical Research: What is the background for this study? What are the main findings? Dr. Myers: Diabetic people who take insulin to treat their diabetes are at risk of low blood sugar, which can cause serious consequences (including death).  This risk increases as blood sugar control improves, and so this risk limits the ability to control blood sugar.  The body has a system (the counter-regulatory response) that acts to prevent blood sugar from going too low, but this is often impaired in diabetic patients. We identified a brain circuit that senses and responds to falling blood sugar, and which acts to increase blood sugar.  Furthermore, we showed that the hormone leptin modulates the sensitivity of this circuit, and identified the neurotransmitter (CCK) that acts in this circuit to increase blood sugar.  Thus, we have identified several potential drug targets that could be used to prevent or treat low blood sugar in insulin-treated diabetics.  If we are able to pharmacologically modulate the activity of this brain circuit, it could improve the treatment of these patients. (more…)
Author Interviews, Diabetes, PLoS / 23.01.2015

Dr. Holger Rehmann Department of Molecular Cancer Research UMC Utrecht The NetherlandsMedicalResearch.com Interview with: Dr. Holger Rehmann Department of Molecular Cancer Research UMC Utrecht The Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. Rehmann: We have developed a chemical modified version of the second messenger cAMP, Sp-8-BnT-cAMPS that allows selective activation of Epac2, a protein that augments glucose induced insulin secretion. The second messenger cAMP activates a couple of receptor proteins, which controls such divergent physiological effects as gene transcription, pacemaker activity, olfaction, and cell adhesion. Almost any cell responses in one or the other way to cAMP and thus selective action on only one cAMP receptor would be a requirement for a drug to induce specific effects. The study confirms that it is possible to pharmacologically discriminate between structurally highly related cAMP receptors. And indeed, Sp-8-BnT-cAMPS augments glucose induced insulin secretion in primary human islets. Epac2 is thus a putative target for the development of an antidiabetic drug. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Diabetes Care, Nutrition / 19.01.2015

Jinnie J. Rhee Department of Epidemiology, Harvard School of Public Health, Boston, MAMedicalResearch.com Interview with: Jinnie J. Rhee MSc, ScD Department of Medicine, Stanford University School of Medicine Palo Alto, CA Medical Research: What is the background for this study? What are the main findings? Response: The goal of this study was to see if the dietary determinants of type 2 diabetes observed in predominantly white populations were similar to those in other racial and ethnic groups.  We created a dietary diabetes risk reduction score using eight different dietary factors found to be associated with risk of type 2 diabetes, where a higher score indicates a healthier overall diet (A higher score included low intakes trans fat, sugar-sweetened beverages, and red and processed meats; lower glycemic index; and higher intakes of cereal fiber, nuts, and coffee; and higher polyunsaturated to saturated fat ratio).  We found a protective association of similar magnitude between a healthy overall diet and type 2 diabetes risk in all racial and ethnic groups.  However, in terms of the actual number of preventable cases, a healthier diet conferred even greater benefit for minority women because they were initially at higher risk than white women. This study is significant because diabetes is a rapidly growing epidemic in most parts of the world, but most previous studies of diet and diabetes have been conducted in populations of European origin.  This analysis was very powerful because it combined two large populations with a total of 156,030 women who were followed for up to 28 years with many repeated assessments of diet.  This allowed us to conduct detailed analyses within specific racial and ethnic groups. (more…)
Author Interviews, Diabetes, Geriatrics, JAMA / 12.01.2015

Kasia Joanna Lipska MD, MHS Assistant Professor of Medicine (Endocrinology) Yale School of Medicine New Haven, CT 06520-8020MedicalResearch.com Interview with: Kasia Joanna Lipska MD, MHS Assistant Professor of Medicine (Endocrinology) Yale School of Medicine New Haven, CT 06520-8020 Medical Research: What is the background for this study? What are the main findings? Dr. Lipska: Diabetes is common and affects about 1 in 4 older adults (65 years or more). For younger adults with diabetes, most guidelines suggest lowering blood sugar levels to a hemoglobin A1c below 7%. However, in older patients, especially those with complex medical problems, the benefits of this strategy are unclear. What’s more, this strategy can cause harm. Aiming for a hemoglobin A1c below seven increases the risk for hypoglycemia. And older adults are especially susceptible to this risk. As a result, many guidelines suggest that treatment should be more cautious for these vulnerable elders and that aiming for “tight” blood sugar control may not be worth the risk. Medical Research: What are the main findings? Dr. Lipska: We looked at diabetes treatment of older adults using nationally representative data from 2001 to 2010. We found that 62% of older adults with diabetes had a hemoglobin A1c below 7%. But what’s really striking is that this proportion was similar for patients who were relatively healthy, for those with intermediate health, and for those with poor health. What’s more, the use of insulin or sulfonylureas (drugs that increase the risk for hypoglycemia) was common and similar across these groups. (more…)
Author Interviews, Diabetes, Ophthalmology, Telemedicine / 08.01.2015

MedicalResearch.com Interview with: Shi Lili Department of Medical informatics and Nantong University Library Nantong University, Nantong, China Medical Research: What is the background for this study? What are the main findings? Response: Diabetic retinopathy (DR) is the most frequently occurring complication of diabetes and one of the major causes of acquired blindness in the working-age population around the world. DR can be detected using various methods. Telemedicine based on digital photographs of the fundus is being used with increasing frequency to detect DR, and especially for Diabetic retinopathy screening. The purpose of our study was to assess the diagnostic accuracy of telemedicine in the full range of DR and DME severity compared with the current gold standard. We found that the diagnostic accuracy of telemedicine using digital imaging in DR was overall high. It can be used widely for Diabetic retinopathy screening. (more…)
Author Interviews, Diabetes, Lancet / 07.01.2015

Ahmad Haidar PhD Institut de Recherches Cliniques de Montreal Montreal, QC, CanadaMedicalResearch.com Interview with: Ahmad Haidar PhD Institut de Recherches Cliniques de Montreal Montreal, QC, Canada Medical Research: What is the background for this study? What are the main findings? Response: We published a study in 2013 (Canadian Medical Association Journal 185.4 (2013): 297-305) where we did the first randomized trial comparing dual-hormone artificial pancreas against conventional pump therapy. We showed spectacular reduction in hypoglycemia (8-fold) with the artificial pancreas, but the first question people asked: Out of the improvement you showed, how much is due to simply closing the loop between the glucose sensor and the insulin pump, and how much is due to adding glucagon? In other words: if you just close the loop with insulin alone and use an advanced dosing algorithm, you may get a very high reduction of hypoglycemia that glucagon may not be needed (glucagon is associated with increased cost and device complexity). We were not able to answer this question with our study design. Since then, there have been other studies by other groups either comparing single-hormone artificial pancreas vs conventional pump therapy, or comparing dual-hormone artificial pancreas vs conventional pump therapy, and most of these studies showed improvement of both artificial pancreas systems compared to conventional pump therapy. However, there has been no study comparing the three interventions to allow us to quantify the relative benefits of simply closing the loop between glucose sensor and insulin pump versus adding glucagon to the system. Quantifying the relative benefits of glucagon is important given the increased cost and device complexity of the dual-hormone artificial pancreas. So our study compared the three interventions, and is the first study to do so. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, JAMA / 02.01.2015

Seth A. Berkowitz, MD, MPH Division of General Internal Medicine Massachusetts General Hospital, BostonMedicalResearch.com Interview with: Seth A. Berkowitz, MD, MPH Division of General Internal Medicine Massachusetts General Hospital, Boston Medical Research: What is the background for this study? What are the main findings? Dr. Berkowitz: Prior studies had looked the association between single unmet basic material needs and diabetes control, but hadn't necessarily looked at multiple things people may not be able to afford, which more closely mirrors real-life. Also, prior studies had been done in a 'pre-Affordable Care Act' setting, while, by being in Massachusetts, our study was conducted in a setting of near-universal healthcare coverage that is similar to what the rest of the US is moving towards. We found that difficulties meeting basic material needs, such as difficulties affording food, known as food insecurity, and having financial barriers to taking medications, called cost-related medication underuse, are associated with worse diabetes control and increased use of costly health services in diabetes patients, despite near-universal health insurance coverage (more…)
Author Interviews, Diabetes / 30.12.2014

Aramesh Saremi MD Phoenix VA Health Care System Health Research Scientist Phoenix, AZ 85012-1892MedicalResearch.com Interview with: Aramesh Saremi MD   Phoenix VA Health Care System Health Research Scientist Phoenix, AZ 85012-1892   Medical Research: What is the background for this study? What are the main findings? Dr. Saremi: Our study was a post-hoc analysis of the data that was available from VA cooperative study,  the Veterans Affair Diabetes Trial  (VADT).  The VADT was one of the  recent landmark studies examining the effect of intensive glycemic control on cardiovascular events  in older adults with type 2 diabetes. The main finding in the VADT and other two other landmark studies (ACCORD and ADVANCE ) was that intensive glycemic control does not reduce cardiovascular  disease events in people with type 2 diabetes of moderate to long duration.  However, our subsequent post-hoc analysis suggests that intensive glycemic control was associated with reduced risk of cardiovascular events in Hispanics, but not in non-Hispanic Whites or Blacks. (more…)