Diabetes Drug Reverses Aging Medium That Promotes Melanoma

MedicalResearch.com Interview with:

Reeti Behera, Ph.D. Postdoctoral fellow in the Weeraratna lab The Wistar Institute Philadelphia PA

Dr. Behera

Reeti Behera, Ph.D.
Postdoctoral fellow in the Weeraratna lab
The Wistar Institute
Philadelphia PA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Malignant melanoma is an aggressive disease and is the cause of the majority of skin cancer deaths. In particular, older individuals have a much poorer prognosis for melanoma and are more resistant to targeted therapy than compared to young individuals. A recently published study from our lab has shown that age-related changes in secreted factors in the microenvironment can drive melanoma progression and therapy resistance.

Klotho is a protein whose expression levels decreases with aging. In this study, we have shown that a decrease in klotho levels in the aged microenvironment drives melanoma aggression and therapy resistance by promoting the oncogenic signaling pathway Wnt5A. We also have shown that reconstituting klotho levels in the aged microenvironment by using rosiglitazone, an FDA-approved drug used to treat diabetes, can reduce tumor burden in aged mice. We also show that Klotho expression is decreased in therapy-resistant melanoma tumors. Reconstituting klotho levels in therapy-resistant melanoma cells by treating with rosiglitazone can inhibit Wnt5A levels and MAPK pathway. We also show that rosiglitazone can significantly decrease therapy-resistant tumor burden in the aged mice, but not in the young.

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More Complications In Type 2 Than Type 1 Adolescent Diabetes

MedicalResearch.com Interview with:

Dana Dabelea, MD, PhD Conrad M. Riley Professor of Epidemiology and Pediatrics Director, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center University of Colorado Anschutz Medical Campus Aurora, CO 80045

Dr. Dana Dabelea

Dana Dabelea, MD, PhD
Conrad M. Riley Professor of Epidemiology and Pediatrics
Director, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center
University of Colorado Anschutz Medical Campus
Aurora, CO 80045

MedicalResearch.com: What is the background for this study?

Response: These recent increasing trends in type 1 and 2 diabetes diagnosed in young individuals raise the question of whether the pattern of complications differs by diabetes type at similar ages and diabetes duration. The SEARCH for Diabetes in Youth Stud, looked at five health complications and co-morbidities of diabetes, including: retinopathy, diabetic kidney disease, peripheral, arterial stiffness and high blood pressure. The researchers studied 1,746 adolescents and young adults with type 1 diabetes and 272 with type 2 diabetes diagnosed when < 20 years, with a similar average duration of 7.9 years and at a similar age of 21 years.

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One Fatty Meal Results In Metabolic Disturbances

MedicalResearch.com Interview with:

Prof. Dr. Michael Roden Director, German Diabetes Center (DDZ) Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Chair/Professor, Endocrinology and Metabolic Diseases Heinrich Heine University Düsseldorf Director, Department of Endocrinology and Diabetology University Hospital Düsseldorf Düsseldorf, Germany

Prof. Michael Roden

Prof. Dr. Michael Roden
Director, German Diabetes Center (DDZ)
Leibniz Center for Diabetes Research
at Heinrich Heine University Düsseldorf
Chair/Professor, Endocrinology and Metabolic Diseases
Heinrich Heine University Düsseldorf
Director, Department of Endocrinology and Diabetology
University Hospital Düsseldorf
Düsseldorf, Germany

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prevalence of obesity, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) continue to increase at an alarming rate. Their occurrence has been associated with intake of saturated fats, for example that of palm oil. This study aimed to shed light on how dietary fat initiates metabolic changes which lead to the aforementioned diseases. To this end we provided 14 young healthy volunteers an oral dose of palm oil or placebo randomly, in a crossover manner, with an 8-week washout period between each intervention.

One acute dose of palm oil leads to insulin resistance in the main insulin sensitive tissues of the body: the liver, skeletal muscle and adipose tissue. In the liver, it also results in increased accumulation of triglycerides, increased production of glucose from lipid and amino acid precursors (rather than from glycogen), and increased energy metabolism, as denoted by increased hepatic adenosine triphosphate (ATP) content. Moreover, a similar experiment in mice revealed that one dose of palm oil differentially regulates genes and pathways which are known or suspected regulators of NAFLD, such as lipopolysaccharide (LPS), members of the peroxisome proliferator-activated receptor (PPAR) family and nuclear factor kappa-light-chain-enhancer of activated B-cells.

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Gestational Diabetes Linked To Adverse Pregnancy Outcomes

MedicalResearch.com Interview with:

Dr Sophie Jacqueminet Praticien Hospitalier Service de Diabétologie Pole Cardio Métabolisme Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix

Dr Sophie Jacqueminet

Dr Sophie Jacqueminet
Praticien Hospitalier
Service de Diabétologie
Pole Cardio Métabolisme
Hôpitaux Universitaires
Pitié Salpêtrière – Charles Foix

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The proportion of women who are overweight or obese is increasing in almost all countries worldwide, and this is being accompanied by an increased risk of developing both type 2 diabetes (T2D) (whether pregnant or not) and gestational diabetes (GDM). While other studies have analysed the links between GDM and adverse outcomes in babies, very large studies that draw on an entire national database, study, are rare.
In our research, all 796,346 deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated.

The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with gestational diabetes mellitus. Data linking the mother to the child were available for 705,198 deliveries (88% of the total). The risks of adverse outcomes were two to four times higher for babies of mothers with type 2 diabetes before pregnancy (pregestational diabetes) than for those with GDM. We then adjusted our data, limiting the analysis to deliveries after 28 weeks to ensure all women diagnosed with GDM were included (since diagnosis of GDM in most cases takes place at or after 28 weeks).

Following adjustment, the increased risk of various complications for mothers with gestational diabetes versus mothers without GDM were: preterm birth 30%; Caesarean section 40%; pre-eclampsia/eclampsia 70%; babies born significantly larger than average size (macrosomia) 80%; respiratory distress 10%; birth trauma 30%; and cardiac malformations 30%. While these increased risks combine women with both insulin- and diet-treated GDM, most of the increased risk is found in women with insulin-treated GDM. This is because as stated above, the diabetes is more serious and blood sugar more difficult to control in women who need insulin treatment, resulting in a higher risk of complications than in those women treated with diet only.

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Diabetes Drug May Enhance Melanoma Chemotherapy

MedicalResearch.com Interview with:

Bin Zheng, PhD Assistant Professor Cutaneous Biology Research Center Massachusetts General Hospital Harvard Medical School Charlestown, MA 02129

Dr. Bin Zheng

Bin Zheng, PhD
Assistant Professor
Cutaneous Biology Research Center
Massachusetts General Hospital
Harvard Medical School
Charlestown, MA 02129 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Melanoma is the most deadly form of skin cancer with more than 75,000 newly diagnosed cases in the US each year. Over the years, various genetic driver mutations have been identified that cause melanoma, including mutations in the genes BRAF and NRAS. Recent genetic insights into the development of melanoma showed that also mutations in NF1 can lead to melanoma. While there are targeted therapies available for BRAF-mutant melanoma, thus far no such therapies are available for NF1-mutant melanoma. We identified that using a combination of an ERK inhibitor, SCH772984, and the antidiabetic drug phenformin could provide a novel therapeutic strategy for NF1-mutatnt melanomas.

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A1C May Be Less Accurate Measure of Diabetes in African Americans with Common Sickle Cell Trait

MedicalResearch.com Interview with:
Mary E. Lacy, MPH

Department of Epidemiology
Brown University School of Public Health
Providence, RI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hemoglobin A1c (A1C) is a blood test that is used to screen for and monitor diabetes. It measures average blood sugar control over the past 2-3 months.

A person with sickle cell trait is a carrier for sickle cell disease but often doesn’t have any clinical symptoms. African Americans are more likely than Whites to have diabetes and are more likely to have sickle cell trait. In this article we examined if A1C can be interpreted in the same way in people with and without sickle cell trait.

We found that, despite similar results on other measures of blood sugar control, people with sickle cell trait had lower A1C results than people without sickle cell trait. This means that A1C may underestimate diabetes risk in people with sickle cell trait.
We also found that, when using standard A1C cutoffs to screen for disease prevalence, we identified 40% fewer cases of prediabetes and 48% fewer cases of diabetes in individuals with sickle cell trait than in those without sickle cell trait. To me, this finding really underscores the potential clinical impact that the observed underestimation of A1C in those with sickle cell trait could have.

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Treatment With Liraglutide (Victoza) Reduces Fat Around the Heart

MedicalResearch.com Interview with:

Gianluca Iacobellis MD PhD Professor of Clinical Medicine Division of Endocrinology, Diabetes and Metabolism Department of Medicine University of Miami, FL

Dr. Gianluca Iacobellis

Gianluca Iacobellis MD PhD
Professor of Clinical Medicine
Division of Endocrinology, Diabetes and Metabolism
Department of Medicine
University of Miami, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that epicardial fat, the visceral fat of the heart, is associated with coronary artery disease, diabetes and obesity. My studies have shown that epicardial fat can be easily measured with non invasive imaging procedures. Remarkably, epicardial fat has recently emerged as therapeutic target responding to medications targeting the fat. Liraglutide, a GLP-1 analog has shown to provide modest weight loss and beneficial cardiovascular effects beyond its glucose lowering action. So , we sought to evaluate the effects of liraglutide on epicardial fat.

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SYNTAX Score Predicts Better Results With Bypass Surgery For Type II Diabetes

MedicalResearch.com Interview with:

Fumiaki Ikeno M.D. Program Director (U.S.) Japan Biodesign Stanford Biodesign Medical Director/Research Associate Experimental Interventional Laboratory Division of Cardiology Stanford University

Dr. Fumiaki Ikeno

Fumiaki Ikeno M.D.
Program Director (U.S.) Japan Biodesign
Stanford Biodesign
Medical Director/Research Associate
Experimental Interventional Laboratory
Division of Cardiology
Stanford University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We sought to determine whether the extent of coronary disease in terms of the number of lesions and their complexity in Type 2 Diabetes patients could predict major cardiovascular events, and hypothesized that revascularization would have greater effectiveness relative to medical therapy among patients with more number of lesions and higher complexity in coronary artery disease.

Coronary bypass surgery, catheter-based treatment, and medical therapy all had similar cardiovascular outcomes among patients with less complexity of coronary artery disease who had type 2 diabetes mellitus, stable ischemic heart disease, and no prior coronary revascularization. Among patients with mid or high complexity coronary artery disease, coronary revascularization with bypass surgery significantly reduced the rate of major cardiovascular events during 5 years of follow-up.

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Physical Activity and Abnormal Blood Glucose Among Healthy Weight Adults

MedicalResearch.com Interview with:

Arch G. Mainous III, PhD  HSRMP Department Chair Florida Blue Endowed Professor of Health Administration University of Florida Health

Dr. Arch G. Mainous III

Arch G. Mainous III, PhD
HSRMP Department Chair
Florida Blue Endowed Professor of Health Administration
University of Florida Health

MedicalResearch.com: What is the background for this study?

Response: As our post-industrial society becomes more and more sedentary, there is a concern that a lack of activity is associated with poor health outcomes like diabetes. At the same time, the medical community has a strong focus on determining whether patients are overweight or obese as a way to classify them as  being at higher risk for poor health outcomes. However, individuals at a “healthy weight” in general, are considered to be at low risk. Some recent studies have shown that many individuals at “healthy weight” are not metabolically healthy. How then might we predict who at “healthy weight” would be unhealthy? We hypothesized that individuals at “healthy weight” who had a sedentary lifestyle would be more likely to have prediabetes or undiagnosed diabetes.

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Obesity and Type 2 Diabetes Claims Rise Sharply in Pediatric Population

MedicalResearch.com Interview with:

Robin Gelburd, JD President FAIR Health

Robin Gelburd, JD

Robin Gelburd, JD
President
FAIR Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For more than 20 years, an epidemic of obesity has been contributing to increasing rates of type 2 diabetes in the United States. During at least part of that period, both conditions have been found to be rising in young people as well as adults. Using our FAIR Health database of billions of privately billed healthcare claims, we sought to ascertain recent trends in obesity and obesity-related conditions (including type 2 diabetes) in the national, privately insured, pediatric population, which we defined as spanning the ages from 0 to 22 years. Our study period was the years 2011 to 2015.

We found that claim lines with a diagnosis of obesity increased across the pediatric population during the study period. The largest increase among pediatric patients was 154 percent, in the age group 19 to 22 years. Claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population, increasing 109 percent.

In most pediatric age groups, claim lines with an obesity diagnosis occurred more often in females than in males; by contrast, claim lines with a type 2 diabetes diagnosis were more common for males than females in most pediatric age groups.

Other conditions associated with obesity also increased in claim lines among young people. The conditions included obstructive sleep apnea and hypertension, both of which were more common in claim lines for males than females.

We also compared the percent of claim lines for pediatric type 2 diabetes diagnoses to the percent of claim lines for all pediatric medical claims by state. Using that standard, pediatric type 2 diabetes was most prevalent in Ohio, Pennsylvania, North Dakota, Utah and South Dakota. It was least prevalent in New Hampshire, Vermont, Delaware, Hawaii and Rhode Island.

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Continuous Glucose Monitoring System Improves Blood Sugar Control in Type 1 Diabetes

MedicalResearch.com Interview with:
Dr Marcus Lind

Associate Professor of Diabetology at the University of Gothenburg
Gothenburg, Sweden
Chief Physician of Diabetology, Uddevalla Hospital
Uddevalla, Sweden

MedicalResearch.com: What is the background for this study?

Response: This was a randomized trial over 16 months (cross-over study with 26 weeks of each treatment and a between wash-out period of 17 weeks) of 161 persons with type 1 diabetes. The main purpose was to evaluate whether a “diabetes tool”, denoted continuous glucose monitoring improves the glycaemic control, known to be essential to lower risks for diabetic complications such as injuries on eyes, kidneys, nerves and the cardiovascular system. The study also evaluated whether the glucose could be stabalised, i.e. having less fluctutations (beside the average level per se) and whether well-being, treatment satisfaction and feeling more confident in the daily living to avoid low glucose values which lead influence the cognitive function and can lead to unconciousness. Earlier trials exist of this therapy in connection to insulin pumps. But it has not been tested in randomized trials with persons only using multiple daily insulin injections to administer insulin which is the most common therapy among adults with type 1 diabetes.

Another novelty is that the current CGM-system (DexCom G4) has earlier shown a high accuracy and positive treatment experience among persons with type 1 diabetes, but it has not been tested in long-term randomized trials. Of note this trial was performed among adults with type 1 diabetes.

Continuous glucose monitoring (CGM) is a system where the patient has a sensor subcutaneously that he/she easily can change every week. It estimates the glucose level every minute and shows values on a hand-held small monitor (size of a small cell-phone) and whether the glucose levels are rising or declining. The hypothesis with the study is that if the patient has continuous information of the glucose level and trends it will improve treatment variables. The comparison group was that patients got information of their glucose control via capillary finger sticks which has been the general treatment for a long time period but can only be made at certain occasions since a procedure where blood must be taken from the finger tips.

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Gut Inflammation & Bacterial Changes Linked to Type 1 Diabetes

MedicalResearch.com Interview with:

Prof Lorenzo Piemonti, MD Professor of Endocrinology Deputy Director, Diabetes Research Institute (SR-DRI) Head, Beta Cell Biology Unit Vita-Salute San Raffaele University, San Raffaele Scientific Institute Milano Italy

Prof Lorenzo Piemonti

Prof Lorenzo Piemonti, MD
Professor of Endocrinology
Deputy Director, Diabetes Research Institute (SR-DRI)
Head, Beta Cell Biology Unit
Vita-Salute San Raffaele University,
San Raffaele Scientific Institute
Milano Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The potential role of gut inflammation and microbiome is becoming a hot topic in the field of diabetes. Several very recent publications report the presence of intestinal abnormalities associated with autoimmune diabetes in both experimental rodent models and patients. We have previously published that, compared to healthy subjects, patients with type 1 diabetes or at high risk of developing type 1 diabetes shows increased intestinal permeability.

Among the factors that may modify the intestinal barrier and impact on its immune activation, the gut microbiota is at present the main suspect. Our study is the first in literature that had the opportunity to analyze the inflammatory profile, the microbiome and their correlation on duodenum biopsies of patients with type 1 diabetes, in comparison with patients with celiac disease and healthy controls. Previous papers pointed out a significant difference in the composition of the stool microflora in subjects with autoimmune diabetes.

A major advancement of our work comes from the direct analysis of small intestine, instead of studies on stool samples. In fact, because of their close functional and spatial relationships, as well as a shared blood supply, it is logical to consider the duodenum and the pancreas correlated. We found big differences among the groups: gut mucosa in diabetes shows a peculiar signature of inflammation, a specific microbiome composition and we also discovered a strong association between some analysed inflammatory markers and specific bacteria genera. We think that our data add an important piece to disentangle the complex pathogenesis of type 1 diabetes and more generally of autoimmune diseases.

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Elevated Fasting Glucose and Insulin Resistance Seen Early in Schizophrenia

MedicalResearch.com Interview with:

Dr Toby Pillinger MA(Oxon) BM BCh MRCP Institute of Psychiatry, Psychology and Neuroscience King's College London

Dr. Toby Pillinger

Dr Toby Pillinger MA(Oxon) BM BCh MRCP
Institute of Psychiatry, Psychology and Neuroscience
King’s College London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our meta-analysis has provided strong evidence that compared with healthy controls, individuals with early schizophrenia are at increased risk of developing type 2 diabetes mellitus, even when the effects of antipsychotic drugs, diet and exercise are taken out of the equation.

Schizophrenia is associated with a dramatically reduced life expectancy, with individuals dying up to 30 years earlier than the general population. Approximately 60% of this excess mortality is due to physical health disorders such as heart attack or stroke, for which diabetes is a major risk factor.

People with long-term schizophrenia are 3 times more likely than the general population to have diabetes, something that has previously been blamed on poor diet and exercise habits, as well as the use of antipsychotic medication. However, the link between schizophrenia and diabetes was first made back in the 19th century, long before the use of antipsychotics, and in an era where diets were less likely to cause diabetes. This could suggest that there is a causative link between schizophrenia and diabetes.

Our meta-analysis examined whether diabetes risk is already raised in people at the onset of schizophrenia, before antipsychotics have been prescribed and before a prolonged period of illness that may be associated with poor diet and sedentary behaviour. We pooled data from 16 studies comprising 731 patients and 614 individuals from the general population. We collated blood data examining fasting blood glucose levels, blood glucose levels following the oral glucose tolerance test, fasting insulin levels and degree of insulin resistance.

We demonstrated that compared with healthy controls, individuals with early schizophrenia had raised fasting glucose, raised levels of glucose following the oral glucose tolerance test, raised fasting insulin and elevated insulin resistance. Furthermore, these results remained statistically significant even when we restricted our analyses to studies where individuals with schizophrenia were matched to healthy controls with regards their diet, the amount of exercise they engaged in and their ethnic background.

This suggests that our results were not wholly driven by differences in lifestyle factors or ethnicity between the two groups, and may therefore point towards a direct role for schizophrenia in increasing risk of diabetes.

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Even with Cardiac Risk Factors, Non-CV Deaths More Common In Patients With Impaired Fasting Glucose

MedicalResearch.com Interview with:
Dr. Abhinav Sharma MD
Duke Clinical Research Institute, Duke University, Durham, NC
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
Renato D. Lopes, MD, PhD, MHS
Duke Clinical Research Institute
Durham, NC 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Impaired fasting glucose (IFG) has been demonstrated to be a risk factor for cardiovascular death; however, there is growing research suggesting that IFG also increases the risk of non-cardiovascular deaths such as cancer.

The data on the distribution of causes of death among patients with impaired fasting glucose and cardiovascular risk factors have not been described. Our analysis used data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. We identified that while myocardial death is the most common adjudicated cause of death, overall, non-cardiovascular deaths were more common that cardiovascular deaths.

Among non-cardiovascular, cancer deaths were the most common cause of death. Furthermore, the burden of non-cardiovascular deaths increases relative to cardiovascular death over time.

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Enteroviruses Linked To Development of Type 1 Diabetes in Children

MedicalResearch.com Interview with:
Dr. Hanna Honkanen PhD
University of Tampere.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The association between enteroviruses and type 1 diabetes has been suggested for long and analyzed in several studies. However, only few studies have been able to study this association at the time when the disease process starts, which happens several months or years before type 1 diabetes is diagnosed.

Our study made this possible since it was based on a large cohort of children who were followed from birth and samples were collected already before the disease process had started (prospective DIPP-study in Finland). Enterovirus infections were detected by analyzing the presence of viral nucleic acids in longitudinal stool sample series. Infections were found more frequently in case children who developed islet autoantibodies compared to control children. This excess was detected several months before islet autoimmunity appeared. This study is the largest such study carried out so far. The results suggest that enterovirus infections may contribute to the initiation of the disease process that eventually leads to type 1 diabetes.

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Diabetes Most Expensive Health Care Condition in US

MedicalResearch.com Interview with:

Joseph Dieleman, PhD Institute for Health Metrics and Evaluation | University of Washington Seattle, WA 98121

Dr. Joseph Dieleman

Joseph Dieleman, PhD
Institute for Health Metrics and Evaluation
University of Washington
Seattle, WA 98121

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The objective of this study was to provide a estimate of total health care spending in the United States for an exhaustive list of health conditions, over an extended period of time – from 1996 to 2013. The study primarily focuses on personal health spending, which includes both individual out-of-pocket costs as well as spending by private and government insurance programs on care provided in inpatient and outpatient facilities, emergency departments, nursing care facilities, dentist offices, and also on pharmaceuticals. There were 155 conditions included in the analysis, and spending was also disaggregated by type of care, and age and sex of the patient.

In 2013, we accounted for $2.1 trillion in personal health spending in the U.S. It was discovered that just 20 health conditions made up more than half of all dollars spent on health care in the U.S. in 2013, and spending for each condition varied by age, sex and type of care. Diabetes was the most expensive condition, totaling $101 billion in diagnoses and treatments, growing at an alarmingly rate – a 6.5% increase per year on average.

Ischemic heart disease, the number one killer in the U.S., ranked the second most expensive at $88.1 billion, followed by low back and neck pain at $87.6, treatment of hypertension at $83.9 billion, and injury from falls at $76.3.

Women aged 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 20% was expended on cardiovascular diseases, 10% on Alzheimer’s disease, and 7% on falls. Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a partner at home to provide care.

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Syrosingopine Plus Metformin Have Potential Anti-Cancer Effects

MedicalResearch.com Interview with:
Dr. Don Gary Benjamin
Biozentrum, University of Basel
Basel, Switzerland.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We initiated the study to find a co-drug that would increase the anti-cancer effect of the commonly prescribed anti-diabetic drug metformin. Metformin is a very well tolerated medication, however the dosage required to show anti-cancer activity is higher than that usually prescribed, hence the aim of the study. We found that metformin in combination with a second drug, syrosingopine (an anti-hypertensive), potently kills cancer cells in a variety of pre-clinical models. Quite nicely, both these drugs combine to kill the cells at a concentration where they have no impact on cell growth when applied singly.

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Metformin Associated With Lower Mortality in CKD, CHF and Chronic Liver Disease

MedicalResearch.com Interview with:

Matthew J. Crowley, MD, MHS Assistant Professor of Medicine Member in the Duke Clinical Research Institute Duke University Medical Center

Dr. Matthew Crowley

Matthew J. Crowley, MD, MHS
Assistant Professor of Medicine
Member in the Duke Clinical Research Institute
Duke University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although metformin is widely considered to be the first-line drug for type 2 diabetes, concerns about lactic acidosis have traditionally limited its use in some populations. However, FDA now indicates that metformin may be used safely for patients with mild-moderate chronic kidney disease and other historical contraindications like congestive heart failure. With the lactic acidosis question addressed for these groups, this review asked “what do we know about how metformin affects mortality and other outcomes for patients with historical contraindications and precautions?”

The main take-home message is that metformin appears associated with lower mortality in patients with mild-moderate chronic kidney disease, congestive heart failure, and chronic liver disease.

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Some Type 2 Diabetics May Benefit From Adding Fenofibrate To Statins

MedicalResearch.com Interview with:

Marshall B. Elam PhD MD Professor Pharmacology and Medicine (Cardiovascular Diseases) University of Tennessee Health Sciences Center Memphis

Dr. Marshall B. Elam

Marshall B. Elam PhD MD
Professor Pharmacology and Medicine
(Cardiovascular Diseases)
University of Tennessee Health Sciences Center
Memphis

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This manuscript presents the findings of extended follow up of patients with Type 2 Diabetes who were treated with fenofibrate, a member of a group of triglyceride lowering medications known as fibrates or PPAR alpha agonists, as part of the Action to Control Cardiovascular Risk in T2DM (ACCORD) study.

ACCORD was designed to test the effect of intensive treatment of cardiovascular risk factors including blood glucose, blood pressure and lipids on risk of heart attack, stroke and cardiac death in patients with Type 2 Diabetes.

The lipid arm of ACCORD tested the hypothesis that adding fenofibrate to statin therapy would further reduce risk of these cardiovascular events.

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Light-Intensity Activities Can Improve Glycemic Control in Diabetics

MedicalResearch.com Interview with:

Bernard M Duvivier  Department of Human Biology and Movement Science NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre Maastricht, the Netherlands

Dr. Bernard M Duvivier

Bernard M Duvivier 
Department of Human Biology and Movement Science
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre
Maastricht, the Netherlands

MedicalResearch.com: What is the background for this study?  What are the main findings?

Response: The health benefits of exercise have been well established but sitting is a risk factor for health, independent of exercise.

As many people with type 2 diabetes don’t like to exercise we investigated whether replacing sitting time with light-intensity activities (standing and light walking) is equally effective to exercise when energy expenditure is comparable. Our results suggest that for people with type 2 diabetes, light-intensity activities (light walking and standing) can be an alternative to exercise to improve glucose regulation.

In addition we showed that too much sitting has negative effects on insulin sensitivity which could not be fully compensated by 1 hour of exercise per day.

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Diabetes Drug May Slow Progression of Parkinson’s Disease

MedicalResearch.com Interview with:

Patrik Brundin, M.D., Ph.D. Director, Center for Neurodegenerative Science Van Andel Research Institute

Dr. Patrik Brundin

Patrik Brundin, M.D., Ph.D.
Director, Center for Neurodegenerative Science
Van Andel Research Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The investigational drug at the heart of our study, MSDC-0160, has been in development to treat type 2 diabetes by improving cellular metabolism.

In Parkinson’s, reductions in cellular metabolism slow down vital housekeeping processes that clear out toxic proteins that otherwise accumulate with age. If these proteins aren’t removed, they clump together, leading to the damage and cell death that causes Parkinson’s hallmark symptoms, such as rigidity and tremor. MSDC-0160 helps keep these housekeeping processes working, ultimately protecting the brain.

We demonstrated that MSDC-0160 has strong, reproducible, positive effects across multiple models of Parkinson’s disease—it rescued dopamine-producing cells, improved behavioral deficits in mouse models and reversed inflammation. Overall, we believe it is a strong candidate for repurposing as a potential treatment that actually may slow the disease’s progression, rather than only mitigating symptoms.

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Platypus Venom May Lead To Better Understanding of Diabetes

MedicalResearch.com Interview with:

Platypus

Platypus

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Platypus and Echidnas are the only representative of the unique group of egg-laying mammals. These peculiar animals are human’s most distant relatives amongst living mammals and they have allow unprecedented insights into the evolution of mammals. Many aspect of the biology of these extraordinary mammals are unusual. One of the most remarkable changes is that monotremes lack a functional stomach and lost many genes involved in digestion. This sparked our interest to investigate the Insulin release pathway as a key aspect of blood glucose regulation which is affected in Diabetes.

When we identified and characterised the hormone that is central to the release of insulin after a meal (called GLP-1)we were surprised to see it active in gut where is should be but also in the venom gland of platypus and echidna.

When we investigated the monotreme GLP-1 further we discovered that this hormone is not degraded in human serum. This is exciting as the human GLP-1 is degraded very rapidly (within minutes) and a major treatment approach in type 2 diabetes is to develop long-lasting GLP-1 variants like the one we discovered in platypus and echidna.

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Hypoglycemia Linked To Increased Mortality in Hospitalized Patients

MedicalResearch.com Interview with:
Amit Akirov, MD
Institute of Endocrinology
Rabin Medical Center- Beilinson Hospital
Petach Tikva, Israel

MedicalResearch.com: What is the background for this study?

Response: As hypoglycemia is common among hospitalized patients with and without diabetes mellitus, we aimed to investigate the association between spontaneous and insulin-related hypoglycemia including severe hypoglycemia and all-cause mortality among a large cohort of hospitalized patients.

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Increased Cardiovascular Risk in Rheumatoid Arthritis Comparable to Diabetes

MedicalResearch.com Interview with:
Prof.dr. M.T. Nurmohamed, MD, PhD
and
Rabia Agca MD
Dept. of Rheumatology | VU University Medical Center
Amsterdam Rheumatology & immunology Center
EULAR center of excellence in rheumatology

MedicalResearch.com: What is the background for this study?

Response: About 20 years ago the increased mortality in rheumatoid arthritis (RA) was well known, but not the causes. In daily clinical practice it seemed that RA patients more frequently suffered from myocardial infarctions than general population persons. Therefore, we started this study more than 15 years ago as at that time there were only sparse data with respect to cardiovascular morbidity in rheumatoid arthritis.

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Canadian Limits on Glucose Strips Did Not Impair Diabetes Control

MedicalResearch.com Interview with:

Tara Gomes, MHSc Li Ka Shing Knowledge Institute, St Michael’s Hospital, The Institute for Clinical Evaluative Sciences Leslie Dan Faculty of Pharmacy Department of Health Policy, Management, and Evaluation University of Toronto, Toronto, Ontario, Canada

Tara Gomes

Tara Gomes, MHSc
Li Ka Shing Knowledge Institute, St Michael’s Hospital,
The Institute for Clinical Evaluative Sciences
Leslie Dan Faculty of Pharmacy
Department of Health Policy, Management, and Evaluation
University of Toronto, Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In August 2013, the Ontario government introduced reimbursement limits for blood glucose test strips. Subsequent research has suggested that the provincial government saved $24 million in the first year after implementing this quantity limit policy. This study investigated whether these quantity limits led to any change in diabetes-related patient outcomes.

We found that limiting the number of blood glucose test strips reimbursed by the government to levels recommended by the Canadian Diabetes Association had to no change in diabetes control (measured as rates of emergency department visits for hypoglycemia or hyperglycemia, and mean HbA1c) in the 1.5 years after implementation. Similarly, there was no worsening of patient outcomes in a subgroup of individuals who had been frequent users of test strips prior to the policy being announced.

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Low Carb Meals Reduce Insulin Resistance

MedicalResearch.com Interview with>
Katarina Borer, Ph.D. Professor
Po-Ju Lin,PhD
School of Kinesiology
The University of Michigan
Ann Arbor, MI

MedicalResearch.com: What is the background for this study?

Response: This study was part of the doctoral dissertation of Po-Ju Lin, who is now a post-doctoral fellow at the University of Rochester. With this study, we wanted to answer three questions:

(1) Is daily carbohydrate load responsible for evening glucose intolerance and post-meal insulin resistance. (Evening glucose intolerance represents well-documented higher glucose and insulin responses in the evening than in the morning when the same quantity of glucose is eaten or infused intravenously) To answer this question we offered two daily meals containing about 800 Kcal and either 30% or 60% of carbohydrates.

(2) Will exercise before the meals improve glucose tolerance (glucose clearance from the blood and insulin response) after eating? (Exercise is a well-known means of increasing glucose uptake by the muscle and of increasing muscle sensitivity to insulin action for a number of hours after exercise). To answer this question we had the subjects exercise for two hours walking on a treadmill at 45% of their maximal aerobic effort one hour before each meal.

(3) Is the upper-intestinal hormone GIP involved in any effects associated with variation in dietary carbohydrate? (GIP or glucose-dependent insulinotropic peptide, stimulates insulin secretion in advance of absorbed glucose).

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Tailored Weight Watchers Program Improved Weight Loss and Blood Sugar in Type II Diabetes

MedicalResearch.com Interview with:

Patrick M. O'Neil, Ph.D. Director, Weight Management Center Professor, Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston, SC 29425


Dr. Patrick M. O’Neil

Patrick M. O’Neil, Ph.D.
Director, Weight Management Center
Professor, Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
Charleston, SC 29425

MedicalResearch.com: What is already known about the subject?
• Even modest weight loss (2-5%) from clinical interventions improves glycemic control in type 2 diabetes.
• Commercial weight loss programs, comparatively more affordable and accessible than clinic-based modalities, can produce weight losses in this range, although they typically do not offer diabetes-specific counseling.
• Data are sparse on such programs’ effects on glycemic control for adults with T2DM.

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Electronic Records Can Provide Real World Evidence On Treatments of Type 2 Diabetes

MedicalResearch.com Interview with:

Lee Kallenbach, PhD, MPH Principal Investigator Practice Fusion

Dr. Lee Kallenbach

Lee Kallenbach, PhD, MPH
Principal Investigator
Practice Fusion

MedicalResearch.com: What is the background for this study?

Response: Clinical inertia, or the tendency for patients and providers to continue using the same course of treatment even when clinical markers may suggest that treatment intensification is necessary, is an ongoing factor that can contribute to inadequate diabetes care. This is especially true when the treatment intensification may involve a switch from an oral medication to an injectable medication. It is less challenging for a patient to take a pill than it is to give themselves a shot.

Even with all the new diabetes treatments available, clinical inertia is still common among patients with uncontrolled type 2 diabetes (T2D). To further understand the extent of clinical inertia among patients with T2D, the study assessed treatment intensification patterns and associated demographic and clinical characteristics for patients with uncontrolled T2D who were already taking two or more oral anti-diabetes medications.

The study consisted of a retrospective observational analysis leveraging data from Practice Fusion’s de-identified clinical database, which includes more than 38 million records, representing 6.7 percent of all practices across the United States.1 Using a cohort of 25,365 de-identified records, we studied the care given by providers in independent practices to patients in need of intensifying their antidiabetic therapy for managing T2D. To our knowledge, this is one of the largest real world evidence (RWE) studies of T2D that has leveraged a de-identified clinical database from an electronic health record (EHR) platform.

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Walking After Meals May Lower Blood Sugar

MedicalResearch.com Interview with:

Andrew Reynolds Department of Human NutritionUniversity Otago Dunedin New Zealand

Andrew Reynolds

Andrew Reynolds
Department of Human NutritionUniversity
Otago 
Dunedin New Zealand

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current guidelines for people with type 2 diabetes are to undertake activities such as walking for at least 150 minutes a week, or 30 minutes a day. When to walk in the day is not specified. We thought it reasonable that walking after meals would improve blood sugars more so than a walk where the timing was unspecified.

Our randomised controlled trial considered exactly this, a prescription to walk as per the guideline of 30 minutes a day and a prescription to walk for 10 minutes after each meal. Our participants were free-living, but wore accelerometers to record their movement, and continuous glucose monitoring systems to observe their blood glucose levels. We found that post-meal blood sugar levels dropped 12 per cent on average when the participants followed the walking after meals advice compared to walking at any time of the day. Most of this effect came from the highly significant 22 per cent reduction in blood sugar when walking after evening meals, which were the most carbohydrate heavy, and were followed by the most sedentary time.

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Follicular T Cells May Play a Role in Development of Type I Diabetes

MedicalResearch.com Interview with:

Tuure Kinnunen, MD, PhD Academy Research Fellow School of Medicine, University of Eastern Finland Kuopio, Finland

Dr. Tuure Kinnunen

Tuure Kinnunen, MD, PhD
Academy Research Fellow
School of Medicine, University of Eastern Finland
Kuopio, Finland

MedicalResearch.com: What is the background for this study?

Response: Type 1 diabetes is an autoimmune disease where the immune system destroys the insulin-producing beta cells in the pancreas. It typically manifests in childhood and early adolescence.

Diabetes-associated autoantibodies are highly predictive of type 1 diabetes risk and they can be typically detected in the blood of patients even years before the onset of the disease.

Follicular helper T cells are a recently described type of immune cells that have a central role in activating B cells, which in turn are responsible for producing antibodies. Since the emergence of autoantibodies is a common feature of type 1 diabetes development, it is plausible that follicular T helper cells have a role in the disease process. This notion is also supported by evidence recently generated in the murine models of type 1 diabetes.

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Current Web-Based Risk Tool May Overestimate Risk of Pre-Diabetes

MedicalResearch.com Interview with:

Dr. Saeid Shahraz Assistant Professor of Medicine Tufts Medical Center

Dr. Saeid Shahraz

Dr. Saeid Shahraz
Assistant Professor of Medicine
Tufts Medical Center

MedicalResearch.com: What is the background for this study?
Response: American Diabetes Association (ADA) has set up a lower cut point for diagnosing prediabetes ( those with Impaired Fasting  Glucose   100 mg/dL) compared to the World Health Organization’s cut point, which is 110 mg/dL. This arbitrariness in cut point definition triples the number of cases labeled as prediabetes.

Along with lowering the diagnostic threshold by the ADA, the Centers for Disease Control and Prevention (CDC), the American Medical Association (AMA), and the ADA endorsed and advertised a web-based risk model to define high-risk population for prediabetes. The risk engine asks a few questions ( age, sex, family history of diabetes, history of gestational diabetes and high blood pressure, physical activity and weight) and outputs a score that defines if the person is at risk for prediabetes. We suspected that the risk engine might overestimate the risk.

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Bidirectional Link Between Depression and Risk of Gestational Diabetes

MedicalResearch.com Interview with:

Cuilin Zhang MD, PhD Senior Investigator NICHD, National Institutes of Health

Dr. Cuilin Zhang

Cuilin Zhang MD, PhD
Senior Investigator
NICHD, National Institutes of Health 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pregnant women are at high risk of developing depressive symptoms; at least 10% US women suffering from depression during pregnancy. Gestational diabetes is a common pregnancy complication, affecting 4-7% of pregnancies in the U.S..  Gestational diabetes has  adverse health implications on both women and their children.   Depression and glucose intolerance commonly co-occur among non-pregnant individuals; however, the temporal relationship between gestational diabetes and depression during pregnancy and the postpartum period is less understood.

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Quality Performance Measures Should Include Hypoglycemia Assessments

MedicalResearch.com Interview with:

Victor M. Montori, MD Mayo Clinic

Dr. Victor Montori

Victor M. Montori, MD MSc
Knowledge and Evaluation Research Unit in Endocrinology
Mayo Clinic, Rochester, Minnesota

MedicalResearch.com: What is the background for this study?

Response: Hypoglycemia can acutely disrupt patients’ lives through symptoms ranging from bothersome to life-threatening; worsen quality of life; and hinder medication adherence and glycemic control. Hypoglycemia is now known to increase risk of mortality, cognitive impairment, and cardiovascular events. In order to improve the quality of diabetes care, healthcare organizations use publicly reported performance measures for quality measurement and improvement, and pay-for-performance initiatives. The degree to which existing performance measures are aligned with guidelines, particularly in regard to hypoglycemia avoidance, is uncertain.

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Abuse of Anabolic Steroids May Impair Insulin Resistance For Years After Discontinuation

MedicalResearch.com Interview with:
Jon Rasmussen, MD, PhD fellow
Department of Internal Medicine
Herlev Hospital, Denmark

MedicalResearch.com: What is the background for this study?

Response: Abuse of anabolic androgenic steroids has become highly prevalent among young men involved in recreational strength training. A recent meta-analysis estimated that approximately 18% of young men involved recreational strength training abuse anabolic steroids.

Well-known adverse effects following abuse of anabolic steroids include hypogonadism (For those who have interest, we have recently published a paper concerning this issue, it can be read and downloaded at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161208).

Yet, we have a poor understanding on the adverse effects these compounds might have on the metabolism and insulin sensitivity.

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Rates of Gestational Diabetes Higher in Summer

MedicalResearch.com Interview with:
Anastasia Katsarou PhD
LUND University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The study is using data from the Mamma study which screened pregnant women during 2003-2005. During this period, we gathered results from the oral glucose tolerance tests that the women underwent at the 28th week of pregnancy. We used data on the 2hour blood glucose levels from these tests and the frequency of women who were diagnosed with gestational diabetes and grouped them into months and seasons. We gathered also data on the mean monthly temperatures from the Swedish Meteorological and Hydrological Institute.

We observed that the 2hour glucose levels and the frequency of women diagnosed with gestational diabetes were statistically significantly higher during the summer months.

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New Onset Diabetes, Especially In Lean Patients, Can Be Marker of Pancreatic Cancer

MedicalResearch.com Interview with:
Dr. Pavel Škrha
Charles University, Prague
Czech Republic

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Incidence of pancreatic cancer (PAC) is still increasing. The main problem is in the late diagnosis of the cancer. It was found, that diabetes mellitus was much more frequent in the pancreatic cancer patients than in the general population. DM can be already the first symptom of the disease (secondry T3cDM).

In our study nearly 80 % of all the pancreatic cancer patients had DM/prediabetes and it was of new-onset (less than 2 years before the cancer diagnosis) in 73 % out of them. We have measured the current marker of PAC (CA 19-9) together with serum microRNA-196 and -200 (that we have chosen in the previous pilot study). All the markers were significantly elevated in the pancreatic cancer patients, without any difference between the subgroups according to DM presence/absence. While the sensitivity of CA 19-9 alone (to detect the cancer) was 85 % (specificity 73 %), combining all the three markers improved it to 95 % (specificity 77 %). In the pancreatic cancer group, there were only six patients with T1 or T2 stage (others had an advanced stage of the disease – T3, T4). While CA 19-9 alone identified only 2 patients of them, the combined test identified all the six patients (data not shown in the poster). Continue reading

Socio-Economic Factors Influence Genetic Tendency Toward Obesity

MedicalResearch.com Interview with:

Professor Timothy Frayling PhD Professor of Human Genetics University of Exeter Medical School Exeter, UK

Prof. Timothy Frayling

Professor Timothy Frayling PhD
Professor of Human Genetics
University of Exeter Medical School
Exeter, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that genes and environmental factors influence our Body mass index. We know less about if and how they interact.

We wanted to answer the question of whether or not aspects of the environment and our lifestyles accentuate any genetic predisposition to obesity. The question is important as it may highlight aspects of the environment that cause some people to be particularly susceptible to gaining weight. Previous, separate, studies have suggested that specific aspects of the environment are to blame. These included sugary drinks, fried food and TV watching.

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Can Vitamin D Reduce Insulin Resistance in Muscles of Type 2 Diabetics?

Elisa Benetti, PhD

Elisa Benetti, PhD

MedicalResearch.com Interview with:
Dr. Elisa Benetti PhD
Department of Drug Science and Technology
University of Turin
Turin, Italy

MedicalResearch.com: What is the background for this study?

Response: The idea for this study comes from the debate on the role of vitamin D supplementation in the prevention or progression of type 2 diabetes (T2DM). Epidemiological data point at a strong association between vitamin D deficiency and T2DM prevalence, however a causal relationship is still lacking.

Here we wanted to explore the effect of vitamin D administration on insulin-sensitivity, particularly focusing on skeletal muscle, which is a crucial tissue in the maintenance of glucose homeostasis and which was suggested to be a tissue target of vitamin D.

Using a murine model of insulin-resistance induced by a High Fat-High Sugar Diet (HFHS), we demonstrated that a vitamin D supplementation (7 μg•kg-1, i.p. three times/week) was able to revert the deleterious effects evoked by the diet, including the increase in body weight and in the HOMA-IR (a parameter of insulin resistance) and the glucose tolerance impairment. Consistently, at the muscle level, vitamin D increased the insulin sensitivity by reducing tissue inflammation and fat accumulation (myosteatosis).
These effects are due, at least in part, to the inhibition exerted by vitamin D on carboxymethyl-lysine (CML) production, one of the main Advanced Glucose End-products (AGEs), and on its receptor RAGE.

Collectively, our data indicate the ability of vitamin D to reduce the development of muscle insulin resistance, the primary defect in T2DM patients.
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Standardized Clinical Interview Evaluates Depression in Diabetes Patients

MedicalResearch.com Interview with:

Dr Cathy E. Lloyd Professor of Health Studies School of Health, Wellbeing and Social Care Faculty of Wellbeing, Education and Language Studies The Open University Milton Keynes

Prof. Cathy Lloyd

Dr Cathy E. Lloyd
Professor of Health Studies
School of Health, Wellbeing and Social Care
Faculty of Wellbeing, Education and Language Studies
The Open University
Milton Keynes UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know from earlier epidemiological research that people with diabetes have an increased risk of developing depression and other mental health problems compared to those without diabetes. However the impact of this and what treatment and care should be provided is still unclear, in particular in countries other than the US or the UK.
Our study aims to redress that imbalance, collecting data on diabetes and depression in 16 countries across the globe.

Ours is the first study to measure depressive symptoms but also use a standardised clinical interview to diagnose depression according to ICD criteria.

Overall 10.6% received a diagnosis of Major Depressive Disorder (MDD), however prevalence rates differed widely between countries with 1% diagnosed with MDD in Uganda and nearly 30% in Bangladesh. Twenty-five percent reported subthreshold levels (PHQ-9 score 5 -9) of depression. Those with MDD were significantly more likely to be female and living in an urban rather than rural location (p<0.001). Age and duration of diabetes did not significantly differ between those with and without MDD. Multi-variable analyses demonstrated that while controlling for country, a diagnosis of MDD was significantly associated with female sex, lower education, taking insulin, less exercise, higher levels of diabetes-related distress and a previous diagnosis of MDD. A negligible proportion of those with either MDD or subthreshold levels of depression had a diagnosis or any treatment for their depression recorded in their medical records.

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Progressive Incremental Benefits of Targeting Lower HbA1c on Type 2 Diabetes Complications Rates

MedicalResearch.com Interview with:

Dr. Samiul Mostafa

Dr. Samiul Mostafa

Dr. Samiul Mostafa
Honorary Clinical Lecturer
Diabetes Trials Unit
University of Oxford

MedicalResearch.com: What is the background for this study?
Response: In managing people with Type 2 diabetes mellitus (T2DM), international guidelines recommend individualisation of HbA1c (glucose) targets for long term maintenance; however, few data are available on the potential
benefits that different blood sugar control targets might achieve.

Therefore, there is a need to learn more about the incremental benefits
of progressively lowering blood sugar levels.
In this computer modelling study, we used the UKPDS Outcomes Model
version 2.0 to estimate 10-year event rates for myocardial infarction
(MI, heart attack), stroke, blindness and amputation by entering
baseline risk factor variables (for example, weight, height,
LDL-cholesterol, systolic blood pressure) taken from a for a current
population of 5766 people with T2DM. Complication rates were estimated
with HbA1c levels held constant at 10%, 9%, 8%, 7% and 6% for each
individual whilst maintaining their risk factors at their baseline
values. Standard statistical methods were used to calculate relative
risk reductions of complications at each HbA1c level.

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Severe Periodontitis Associated with Insulin Resistance

MedicalResearch.com Interview with:

In-Seok Song, DDS, PhD Clinical Assistant Professor Oral and Maxillofacial Surgeon Department of Dentistry, Korea University Anam Hospital, Seoul, Republic of Korea

In-Seok-Song

In-Seok Song, DDS, PhD
Clinical Assistant Professor
Oral and Maxillofacial Surgeon
Department of Dentistry, Korea University Anam Hospital,
Seoul, Republic of Korea

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Periodontitis is a well-known cause of various systemic diseases including cardiovascular disease, type 2 diabetes. As for type 2 diabetes, insulin resistance is responsible for the low-grade systemic inflammation, which can deteriorate body function throughout pancreatic β-cell dysfunction and impaired fasting glucose. There are emerging evidences that insulin resistance is a cause of periodontal disease progression among Korean adults as well as other citizens including American, French, Finnish, and the British.

In this study, we hypothesized that insulin resistance aggravates the severity of periodontitis. We investigated the associations between type 2 diabetes, insulin resistance, and severe periodontitis. The associations between severe periodontitis and insulin resistance in non-obese adults with normal body mass index (BMI) or waist circumference (WC) were also evaluated.

We found that non-abdominal obese adults with insulin resistance were more likely to have severe periodontitis compared to metabolically healthy adults with normal waist circumference. Insulin resistance without abdominal obesity can be considered an independent risk factor of severe periodontitis.

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Intensive Diabetes Treatment Extends Life On Average 8 Years, Free of Serious Complications

MedicalResearch.com Interview with:
Oluf Pedersen, MD
Specialist in Internal Medicine and Endocrinology,
The Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen,
Peter Gæde and
Jens Oellgaard

Department of Cardiology and Endocrinology
Slagelse Hospital Copenhagen

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Steno-2 study was the attempt to investigate the effect of an intensified, multifactorial intervention in type 2 diabetes simultaneously targeting risk factors such as hyperglycaemia, hypertension, dyslipidaemia, blood platelet aggregation, and elevated urinary albumin excretion rate as well as life style factors such as smoking, diet and a sedentary lifestyle. On top of that patients were by a dedicated team of care givers offered continued education and motivation.

A total of 160 Danish type 2 diabetes patients with microalbumuria (a biomarker of generalized vascular damage) were originally randomized either to intensified multifactorial treatment at Steno Diabetes Center, Copenhagen or to conventional multifactorial treatment at their general practitioners. The trial ended after 8 years, and patients in both of the original treatment arms were for the following 13 years given intensified multifactorial treatment as the one originally given to the intensified intervention group only.

Three previous milestone reports from the Steno-2 trial published in Lancet and New England Journal of Medicine have provided unprecedented evidence that this targeted and multifaceted approach reduces the risk of diabetic late complications such as kidney, eye or nerve disease as well as cardiovascular disease and total mortality with around fifty percent.

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Comparable Diabetes and Heart Disease Care Provided By Physicians and Advanced Care Providers

MedicalResearch.com Interview with:
Salim S. Virani, MD, PhD and
Julia Akeroyd MPH
Health Services Research and Development
Michael E. DeBakey Veterans Affairs Medical Center
Houston

MedicalResearch.com: What is the background for this study?

Response: Given the increase in the number of Americans seeking primary health care due to the Affordable Care Act, combined with current and anticipated physician shortages in the US, there is a growing need to identify other models of primary care delivery to address chronic diseases.

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Cardioprotective Effect of Metformin in Diabetes Determined

MedicalResearch.com Interview with:

Jolanta U Weaver, FRCP MRCS PhD CTLHE

Dr. Jolanta Weaver

Jolanta U Weaver, FRCP MRCS PhD CTLHE
Senior Lecturer in Diabetes Medicine
Honorary Consultant Diabetologist
Newcastle

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Vascular stem cells, which are associated with an improvement of heart disease, are improved in type 1 diabetes by repurposing metformin, known to reduce heart disease in type 2 diabetes.

We treated patients with type 1 diabetes with metformin for 8 weeks. The metformin dose varied between 500 mg a day to 2000 mg a day, depending on what patients were happy to take. Subjects were requested to keep diabetic control unchanged to study the direct effect of metformin on heart disease. Circulating endothelial progenitor cells (vascular stem cells) count, Hill’s colonies and pro angiogenic cells function (in test tube) improved in comparison to patients, who did not take metformin but remained on standard therapy.

Endothelial cells associated with vascular damage, on the other hand, were reduced following metformin therapy confirming improved vascular health. The glycaemic control remained unchanged (as planned at the onset of the study) to allow us to examine the effect of metformin ALONE on vascular health. Patients did not suffer any serious side effects.

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Metformin Can Stop Weight Gain Seen With Some Autism Spectrum Disorder Medications

MedicalResearch.com Interview with:

Evdokia Anagnostou MD Canada Research Chair (Tier II) in Translational Therapeutics in Autism Senior Clinician Scientist and co-lead of the Autism Research Centre Holland Bloorview Kids Rehabilitation Hospital

Dr. Evdokia Anagnostou

Evdokia Anagnostou MD
Canada Research Chair (Tier II) in Translational Therapeutics in Autism
Senior Clinician Scientist and co-lead of the Autism Research Centre
Holland Bloorview Kids Rehabilitation Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Researchers from Holland Bloorview Kids Rehabilitation Hospital / University of Toronto (Canada), Ohio State University, University of Pittsburgh, Columbia University, and Vanderbilt University, led a double-blind, placebo-controlled randomized clinical trial to examine whether metformin, a common type-2 diabetes drug, may be effective in counteracting weight gain commonly seen with the use of atypical antipsychotic medications, indicated by the FDA for the treatment of irritability in children and youth with autism spectrum disorder (ASD).

Results showed that metformin was effective in helping overweight children and adolescents with autism spectrum disorder (ASD) who take antipsychotic medications lower their body mass index (BMI).

Both FDA-approved antipsychotic medications for treating irritability and agitation symptoms in children and adolescents with ASD can cause a significant increase in weight gain, which in addition to increasing BMI, enhances long-term risk of diabetes. This complicates an already challenging issue as adolescents with autism spectrum disorder are ~ two times more likely to be obese than adolescents without developmental disabilities. Findings of this research are important, especially for families of children with ASD, as managing long-term physical health while also treating irritability/agitation symptoms, can help ensure that their child can participate fully in life (school, etc.).

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Simple Changes in Cooking Methods May Reduce Inflammatory Stress and Decrease Insulin Resistance

MedicalResearch.com Interview with:

Jaime Uribarri, MD Professor, Nephrology Icahn School of Medicine Mt. Sinai Medical Center

Dr. Jaime Uribarri

Jaime Uribarri, MD
Professor, Nephrology
Icahn School of Medicine
Mt. Sinai Medical Center

MedicalResearch.com: What is the background for this study?

Response: We have been doing research in the area of dietary advanced glycation end-products (AGEs) for many years.

AGEs are chemical compounds that form normally in the body in small amounts and also in food when cooking under high heat and dry conditions; a percent of AGEs in food is absorbed and part of it is retained in the body leading to increased smoldering inflammation and oxidative stress that eventually produce most of modern chronic diseases such as diabetes, cardiovascular disease, dementia, etc. We have previously demonstrated that a diet low in AGEs, which essentially means changing the cooking methods to include less application of heat, plenty of water,etc, decreases inflammation of oxidative stress in people with diabetes, chronic kidney disease and in healthy subjects. In the current study we applied the same low dietary AGE intervention to a group of obese patients with the so-called Metabolic syndrome, a risk factor for Diabetes Mellitus.

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Patients With Psoriasis Have Coronary Calcium Scores Comparable to Diabetes

MedicalResearch.com Interview with:
Nehal N. Mehta, .MD., M.S.C.E. F.A.H.A.
Lasker Clinical Research Scholar
Section of Inflammation and Cardiometabolic Diseases
NIH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Psoriasis is associated with accelerated cardiovascular (CV) disease; however, screening for CV risk factors in psoriasis remains low. Coronary artery calcium (CAC) score estimates the total burden of atherosclerosis. Psoriasis has been associated with increase CAC score, but how this compares to patients with diabetes, who are aggressively screened for CV risk factors, is unknown.

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Maternal Gestational Diabetes Increased Risk of Childhood Obesity

MedicalResearch.com Interview with:

Dr. Gang Hu, Associate Professor LSU’s Pennington Biomedical Research Center & Director Chronic Disease Epidemiology Lab

Dr. Gang Hu

Dr. Gang Hu, Associate Professor
LSU’s Pennington Biomedical Research Center & Director
Chronic Disease Epidemiology Lab

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Some studies have found that maternal gestational diabetes mellitus (GDM) places offspring at increased risk of long-term adverse outcomes, including obesity. However, most of studies are from high income countries, with limited data from low to middle income countries. The present study, conducted at urban and suburban sites in 12 countries, found that the increased risk for children of GDM mothers compared with non-gestational diabetes mellitus mothers was 53% for obesity, 73% for central obesity, and 42% for high body fat.

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Closed-Loop Insulin Delivery During Pregnancy Improves Glucose Control

MedicalResearch.com Interview with:
Professor Helen Murphy
and
Dr Zoe Stewart
Institute of Metabolic Science
University of Cambridge

MedicalResearch.com: What is the background for this study?

Response: Controlling blood glucose levels is a daily challenge for people with Type 1 diabetes and is particularly crucial during pregnancy. Previous research shows that women with type 1 diabetes spend only 12 hours per day within the recommended glucose target levels, leading to increased rates of complications including preterm delivery and large for gestational age infants. National surveys show that one in two babies suffer complications related to type 1 diabetes in the mother.

The hormonal changes that occur in pregnancy make it difficult for women to predict the best insulin doses for every meal and overnight. Too much insulin causes low glucose levels harmful for the mother and too little causes problems for the developing baby. The artificial pancreas automates the insulin delivery giving better glucose control than we can achieve with currently available treatments. Previous studies show that the closed-loop system also known as artificial pancreas can be used safely in children and adults and our study aimed to investigate whether or not it was helpful for women with type1 diabetes during pregnancy.

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