Genetic Risk Score Improves Ability To Predict Diabetics at Risk of Coronary Disease

MedicalResearch.com Interview with:

Mario Luca Morieri

Dr. Morieri

Mario Luca Morieri MD
Section on Genetics and Epidemiology, Research Division, Joslin Diabetes Center
Department of Medicine, Harvard Medical School, Boston, MA

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

Response: Coronary artery disease (CAD) is one of the most important complications of diabetes.

Similarly to other complex disorders, CAD is influenced by both environmental and genetic factors. Over the last decade, our understanding of the genetic factors contributing to CAD has dramatically improved and hundreds of new genetic markers associated with increased cardiovascular risk have been identified.

In this study, we showed that combining these genetic markers into a single score (a so called genetic risk score) can improve our ability to the identify those patients with type 2 diabetes who are at higher risk of experiencing a coronary event. 

MedicalResearch.com: What should readers take away from your report? 

Response: One take-away message is that the genetic markers associated with CAD in persons without diabetes have a similar effect in people with diabetes. Another is that prediction of increased risk of CAD in people with diabetes can be improved with the combination of genetic markers with “classic” known markers of CAD such as high cholesterol and high blood pressure. Improving cardiovascular risk prediction will allow physicians to focus their effort on people at higher risk, making the allocation of health-care resources more efficient. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We were able to replicate our findings (from the ACCORD trial) in another study including diabetic patients with similar characteristics (the ORIGIN trial). However, to improve the generalizability of the genetic risk score, its performance should be tested in populations with different clinical characteristics. With the detailed information provided in the paper, other researchers should be able to do this. Also, the genetic score reported in our paper applies to Whites as it was derived from genetic markers discovered in that ethnic group. It would be important to build a similar genetic risk score for people of different ancestry using genetic markers specific to those populations.

MedicalResearch.com: Is there anything else you would like to add? 

Response: We showed in the paper that the identification of an increasing number of genetic markers of CAD risk over the last 8 years has resulted into a progressive improvement in the performance of genetic risk scores for prediction of CAD risk. Thus, if new genetic markers of CAD continue to be identified over the next few years, the usefulness of these genetic scores may continue to increase. 

Citation:

Genetic Tools for Coronary Risk Assessment in Type 2 Diabetes: A Cohort Study From the ACCORD Clinical Trial

Mario Luca Morieri, He Gao, Marie Pigeyre, Hetal S. Shah, Jennifer Sjaarda, Christine Mendonca,Timothy Hastings, Patinut Buranasupkajorn, Alison A. Motsinger-Reif, Daniel M. Rotroff, Ronald J. Sigal,Santica M. Marcovina, Peter Kraft, John B. Buse, Michael J. Wagner, Hertzel C. Gerstein, Josyf C. Mychaleckyj, Guillaume Parè and Alessandro Doria

Diabetes Care 2018 Sep; dc180709.https://doi.org/10.2337/dc18-0709

Sep 29, 2018 @ 6:39 pm 

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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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Type 2 Diabetes: “Stand Up, Sit Less, Move More, More Often” For Better Glucose Control

MedicalResearch.com Interview with:

Paddy Dempsey MPhEd, PhD in Medicine (expected June 2016) Physical Physical Activity and Behavioural Epidemiology Laboratory Baker IDI Heart and Diabetes Institute Melbourne VIC

Paddy Dempsey

Paddy Dempsey
MPhEd, PhD in Medicine (expected June 2016)
Physical Physical Activity and Behavioural Epidemiology Laboratory
Baker IDI Heart and Diabetes Institute
Melbourne VIC

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

Response: In addition to too little physical activity (PA), sedentary behavior – defined as any waking sitting or reclining behavior with low energy expenditure – has emerged as a ubiquitous and significant population-wide influence on cardiometabolic health outcomes, with potentially distinct and modifiable environmental and social determinants. There is now a consistent base of epidemiologic evidence reporting deleterious associations of excessive sedentary behaviors (e.g. TV viewing, car use, and desk work) with mortality and cardiometabolic morbidity, independent of moderate-vigorous PA.

To date, efforts to influence participation in moderate-to-vigorous exercise (i.e. 30 min a day of ‘exercise’ on most days a week for health) at the population level, such as through large-scale campaigns to promote walking, and other initiatives to encourage people to exercise during their leisure time have achieved only modest success. There may, however, be untapped preventive-health and clinical management potential through shifting the high volume of time spent sedentary to light-intensity physical activity interspersed throughout the day. As such, sedentary behavior represents a potentially feasible and therapeutic target, particularly in the promotion of metabolic health.

We posited that people with type 2 diabetes (T2D) were likely to derive the greatest benefits from interrupting their sitting time. However, until now the contributions of prolonged sitting and/or interrupting prolonged sitting with very-brief bouts of light-intensity PA had never been experimentally tested in patients with T2D. Moreover, this study for the first time moved beyond interrupting sitting with standing or ambulatory bouts (although walking bouts were also examined), which may have differing levels of metabolic stimulus (i.e. not physiologically taxing the body enough), practicality, or health efficacy, to examine a potential addition/alternative: simple resistance activities (SRA). A key premise behind these SRA bouts (half-squats, calf raises, gluteal contractions, and knee raises) were that they required no specialized equipment, only small amounts of space, and could be easily performed in a fixed position behind a work desk or at home with minimal disruption to work tasks or leisure pursuits. In addition, they also markedly increase muscle activity, and may also have other longer-term benefits (for example physical function, muscle strength, bone density), however we can only speculate on these aspects at present.

In this study in men and women with type 2 diabetes, plasma glucose, insulin and C-peptide (marker of insulin secretion and pancreatic beta cell function) levels following standardized breakfast and lunch meals were all markedly attenuated when prolonged sitting was regularly interrupted with light walking or resistance activities (3 min every 30 min) over an 8 hour day. Plasma triglyceride levels were also reduced for both types of activity bout; however, the reduction was only significant for the SRAs. Interestingly, the magnitude of glucose reduction for the walking bouts was greater in women for glucose levels.

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HbA1c May Be Useful Screening Test For Pregnant Women With Unrecognized Diabetes

Dr. Janet Rowan Obstetric Physician National Women's Health, Auckland

Dr. Rowan

MedicalResearch.com Interview with:
Dr. Janet Rowan

Obstetric Physician
National Women’s Health,
Auckland

Medical Research: What is the background for this study?

Dr. Rowan: Clinicians are interested in screening during early pregnancy to identify women with previously unrecognised diabetes, as these women have increased risks of adverse pregnancy outcomes. HbA1c is a simple and reproducible measure of glucose elevations, but its usefulness as an early pregnancy screening test is not clear. The aim of this study was to examine whether pregnant women with an HbA1c of 41-49mmol/mol (5.9-6.6%) are a high risk subgroup and whether treating these women from early pregnancy improves outcomes compared with identifying them during routine screening for gestational diabetes (GDM) from 24 weeks’ gestation.

This observational study compared women referred to the diabetes clinic <24 weeks’ who had an early pregnancy HbA1c of 41-49mmol/mol (5.9-6.6%) with women who, at the time of diagnosis of GDM ≥24 weeks’ (typically by 75gOGTT), had an HbA1c of 41-49mmol/mol (5.9-6.6%). Both groups were compared with women diagnosed with GDM who had a lower HbA1c at diagnosis.

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Personalized Diabetes Management Effective For Women But Not Men

MedicalResearch.com Interview with:
Marlene Øhrberg Krag , MD, MIH

Department of Public Health
University of Copenhagen, Denmark

Medical Research: What is the background for this study?

Dr. Krag: In this follow-up study we wanted to assess whether there was any difference in longterm treatment outcome of personally tailored diabetes care when comparing men and women.

The “Diabetes Care in General Practice” trial included people with newly diagnosed type 2 diabetes. Patients were randomized to receive 6 years of either routine care or personally tailored care with regular follow-up, individualized treatment goal setting and continuing education of the participant general practitioners.

Medical Research: What are the main findings?

Dr. Krag: Following up the patients for 13 years after 6 years of intervention a significant reduction in all cause mortality and diabetes related death was seen for women but not men. This difference could not be explained by intermediate outcomes like HgbA1c alone, and is suggested to be based on a complex of biological, social and cultural issues of gender . Women accept disease and implement disease management more easily than men, whereas men may feel challenged by diabetes, demanding daily consideration and lifestyle changes. Furthermore the study provided attention and support, which the women reported they lack and this could provide an incentive to treatment adherence.

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Men More Likely To Develop Diabetes If Spouse Has Gestational Diabetes

Dr. Kaberi Dasgupta MD, MSc, FRCPC Associate Professor, Department of Medicine Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism Royal Victoria Hospital Quebec, Canada

MedicalResearch.com Interview with:
Dr. Kaberi Dasgupta MD, MSc, FRCPC
Associate Professor, Department of Medicine
Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism
Royal Victoria Hospital
Quebec, Canada

 

Medical Research: What is the background for this study? What are the main findings?

Dr. Dasgupta: We know that health behaviours can contribute to developing gestational diabetes and type 2 diabetes (e.g., eating out frequently, lack of fruits and vegetables, not walking enough, spending most of the day sitting). We also know that genetic factors are important. Sometimes we focus more on the genetic factors than on health behaviours. By showing that spouses share diabetes risk, we highlight the importance that behaviour and environment play as spouses are not generally related biologically. In a previous meta-analysis, we showed that spouses were concordant for diabetes (if one had it, there was a 24% relative risk increase that the other did too.)

In the study Gestational Diabetes Mellitus in Mothers as a Diabetes Predictor in Fathers: A Retrospective Cohort Analysis, we took it further and compared men whose partners had gestational diabetes and men whose partners did not. Over a 13 year period of follow-up, the men whose partners had gestational diabetes were 33% more likely to develop diabetes. 

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Dietary Restriction Provides Benefits Beyond Weight Loss

MedicalResearch.com Interview with:
Edward “Ted” Weiss, Ph.D.
Associate Professor
Department of Nutrition and Dietetics
Saint Louis University Saint Louis MO

Medical Research: What is the background for this study? What are the main findings?

Dr. Weiss:  Results from one of our previous study yielded a surprising result that diet-induced weight loss improved insulin sensitivity (major diabetes risk factor) by the same amount as exercise induced weight loss. We thought that the exercise-induced weight loss would have yielded benefits from the weight loss itself but also from a weight loss-independent benefit that has been reported in other studies. One explanation for dietary restriction providing the same benefit of exercise was that it also provides benefits besides those that are attributable to weight loss. Our recently completed/published study was designed to evaluate this possibility and the finding do suggest what we hypothesized… i.e. that dietary restriction provides benefits above and beyond that which are attributable to weight loss.

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Healthy Diet Lowers Diabetes Risk in All Ethnic Groups

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.

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Diabetes: Incretin-Based Drugs Not Linked To Congestive Heart Failure

Kristian Filion, PhD FAHA Assistant Professor of Medicine Division of Clinical Epidemiology Jewish General Hospital/McGill University Montreal, Quebec H3T 1E2 CanadaMedicalResearch.com Interview with:
Kristian Filion, PhD FAHA
Assistant Professor of Medicine
Division of Clinical Epidemiology
Jewish General Hospital/McGill University
Montreal, Quebec H3T 1E2 Canada

Medical Research: What are the main findings of the study?

Dr. Filion: Previous studies have raised concerns that the use of incretin-based drugs, a type of medication used to treat diabetes, may increase the risk of congestive heart failure.  We therefore examined this potential drug safety issue using a large, population-based database, which allowed us to study the safety of these medications in a real world setting.  In doing so, we found that the use of incretin-based drugs was not associated with an increased risk of congestive heart failure among patients with type 2 diabetes.  Similar results were obtained among both classes of incretin-based drugs (glucagon like peptide-1 [GLP-1] analogs and dipeptidyl peptidase-4 [DPP-4] inhibitors), and no duration-response relationship was observed.

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Diabetes: Patients Demonstrate Negative and Positive Coping Mechanisms

Dr. Heather Stuckey D.Ed Department of Medicine Pennsylvania State University College of Medicine, Hershey, PAMedicalResearch.com: Interview with:
Dr. Heather Stuckey D.Ed
Department of Medicine
Pennsylvania State University College of Medicine, Hershey, PA

MedicalResearch: What are the main findings of this study?

Dr. Stuckey: The main findings were that people with diabetes had both negative psychosocial and positive (adaptive) ways of coping with diabetes.
Negative themes included:  1) Anxiety/fear, worry about hypoglycemia and complications of diabetes, depression and negative moods/hopelessness and 2) Discrimination at work and public misunderstanding about diabetes.
Two psychosocial themes demonstrated adaptive ways of coping with diabetes: 1) Having a positive outlook and sense of resilience in the midst of having diabetes and 2) Receiving psychosocial support through caring and compassionate family, friends, healthcare professionals and other people with diabetes.

Most diabetes social sciences research focuses on only the negative aspects of having diabetes.  Although this paper discussed negative aspects, it also focused on the adaptive, or positive, ways in which people with diabetes viewed their disease.  “We found that although these negative experiences with diabetes exist, people also held on to the positive aspects.  Some said diabetes made their lives a little richer because they ate healthier foods, or they were able to connect with their family more to overcome challenges. It gave them a better appreciation of what they have.  The discrimination at work and from society was a finding that was unexpected, but was evident throughout both the quantitative and qualitative data.
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Diabetes in Pregnancy: Lower HbA1c Threshold Improves Detection

MedicalResearch.com Interview With:
Ruth C. E. Hughes
Department of Obstetrics and Gynecology
University of Otago, Christchurch Women’s Hospital
Christchurch, New Zealand

Medical Research: What are the main findings of the study?

Dr. Hughes: The increasing prevalence of undiagnosed type 2 diabetes in women of childbearing age was the main driver behind our study.  In clinical practice, we were finding that women with probable undiagnosed diabetes (and pre-diabetes) had already started developing pregnancy complications at the time they were diagnosed with gestational diabetes diagnosis in the late second trimester. It seemed logical to try to identify them in early pregnancy, with the idea that they might benefit from earlier intervention.  We thus explored the usefulness of first trimester HbA1c measurements to identify women with unrecognised pre-existing diabetes.

In our study, an HbA1c of 5.9% (41mmol/mol) was the optimal screening threshold for diabetes in early pregnancy.  We found that a threshold of 6.5% (48mmol/mol), which is endorsed by the World Health Organization and American Diabetes Association for diagnosing diabetes in pregnancy, would miss almost 50% of women with probable pre-existing diabetes.  Of great relevance, women with an early HbA1c of 5.9%-6.4% (41-46mmol/mol) had poorer pregnancy outcomes than those with an HbA1c <5.9% (<41mmol/mol), with a 2.5-3 fold higher relative risk of major congenital anomaly, preeclampsia, shoulder dystocia, and perinatal death.  These women were also more likely to deliver before 37 weeks gestation.
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Elevated Calcium Linked To Increased Diabetes Risk

Jordi Salas-Salvadó MD PhD Physiopathology of Obesity and Nutrition Institute of Health Carlos III, Madrid, SpainMedicalResearch.com Interview with:
Jordi Salas-Salvadó MD PhD
Physiopathology of Obesity and Nutrition
Institute of Health Carlos III, Madrid, Spain

Medical Research: What are the main findings of the study?

Dr. Salas-Salvadó: The main finding of our study is that an increase in albumin-adjusted serum calcium increases the risk of type 2 diabetes in Mediterranean individuals at high cardiovascular risk. This association remained significant even after taking classic risk factors into account. To the best of our knowledge this is the first study assessing the association between changes in serum calcium levels and the risk of type 2 diabetes development.
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Sulfonylurea For Diabetes Linked To Increased Heart Disease Risk

Dr. Frank B. Hu Department of Nutrition Harvard School of Public Health Boston, MAMedicalResearch.com Interview with:
Dr. Frank B. Hu
Department of Nutrition
Harvard School of Public Health
Boston, MA

Medical Research: What are the main findings of the study?

Dr. Hu: in this study among approximately 5000 patients with type 2 diabetes followed for up to 10 years, longer duration of sulfonylurea therapy was associated with a higher risk of coronary heart disease. The continuous sulfonylurea therapy for 10 years was associated with almost two times greater risk of coronary heart disease compared with nonusers. However, given the observational nature of the study, we cannot make causal inference from these findings.

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Non-White Diabetics Have Higher Incidence of Early Kidney Disease

Satyesh K Sinha, PhD Assistant Professor Charles R Drew University of Medicine and Science Los Angeles, CA-90059MedicalResearch.com Interview with:
Satyesh K Sinha, PhD
Assistant Professor
Charles R Drew University of Medicine and Science
Los Angeles, CA-90059


Medical Research: What are the main findings of the study?

Dr. Sinha: Our main finding is that compared to Whites, African Americans (AAs) and Hispanics, with diabetes, have a higher prevalence of early chronic kidney disease (CKD) which is significantly associated with urinary albumin excretion (UAE) and/or C-reactive protein (CRP).
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Diabetic Lifestyle Interventions Reduced Hospitalizations, Medications and Costs

Mark A. EspelandMedicalResearch.com Interview with:
Mark A. Espeland PhD Professor
Department of Biostatistics
Sticht Center on Aging Center for Diabetes Research
WFU Primate Center Center for Integrative Medicine
Translational Science Institute
Wake Forest School of Medicine, Winston-Salem, NC

Medical Research: What are the main findings of the study?

Dr. Espeland : Over 10 years, overweight and obese adults with type 2 diabetes who were provided a lifestyle intervention targeting sustained weight loss and increased physical activity, lowered their rates of hospitalizations and medication use and reduced the costs of their health care by over $5,000.
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Insulin Sensitivity Predicts Kidney Health in Adolescent Diabetes

MedicalResearch.com Interview with:
Petter Bjornstad, M.D.
Children’s Hospital Colorado
University of Colorado Denver
Aurora, CO 80045

Medical Research: What are the main findings of the study?

Dr. Bjornstad: Type 2 diabetes is the most common cause of end-stage renal disease in the Western world. It is therefore of paramount importance to develop a better understanding of the determinants of diabetic nephropathy risk and progression, to improve outcome in adolescents with type 2 diabetes.

We report high rates of microalbuminuria and renal hyperfiltration in adolescents with type 2 diabetes, which forecast early renal morbidity and mortality. In our observational study, insulin sensitivity measured by hyperinsulinemic-euglycemic clamp studies, rather than adiposity, blood pressure, lipid and glycemic control was associated with markers of renal health (albumin-to-creatinine ratio and estimated glomerular filtration rate).
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High Protein Low Carb Diet For Type 2 Diabetes Management

Grant Brinkworth PhD Associate Professor Senior Research Scientist CSIRO Animal, Food and Health Sciences Adelaide BC, South AustraliaMedicalResearch.com Interview with:
Grant Brinkworth PhD
Associate Professor
Senior Research Scientist
CSIRO Animal, Food and Health Sciences
Adelaide BC, South Australia

Medical Research: What are the main findings of the study?

Dr. Brinkworth: Both a very low carbohydrate, high protein, high unsaturated fat diet and a high carbohydrate, low fat diet achieved similar weight loss, improvements in body composition and health risk markers. However, compared to the high carbohydrate, low fat diet, a very low carbohydrate high protein, high unsaturated fat diet had more favourable effects on blood lipid profile, glycemic control (indicated by greater reductions in glycosylated haemoglobin – primary clinical measure of blood glucose control and the requirements for blood glucose controlling drugs) and for reducing daily blood glucose fluctuations.

The findings from this study suggests that a novel eating pattern that markedly limits carbohydrates, increases protein and unsaturated fat may have more favourable therapeutic potential for optimising the management of type 2 diabetes and reducing cardiovascular disease risk.
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Hypoxia Associated With Improved Insulin Sensitivity

MedicalResearch.com Interview with:
dr_Eric RavussinEric Ravussin, Ph.D., Boyd Professor
Director Nutrition Obesity Research Center
Douglas L. Gordon Chair in Diabetes and Metabolism
Associate Executive Director for Clinical Science
Baton Rouge LA


Medical Research: What is the background of this study?

Dr. Ravussin: It has long been postulated that hypoxia is bad for metabolic health.

Hypoxia of adipose tissue has been thought to cause oxidative stress, resulting in the recruitment of macrophages with resultant secretion of cytokines and inflammation.  However, repeated bouts of hypoxia induced during vigorous exercise results in increased glucose uptake and vascularization of muscle tissue. In addition, living at high altitude is associated with a lower prevalence of impaired fasting glucose and type 2 diabetes compared with living at low altitude.

Therefore, we asked the question, “What is the balance between the beneficial effects of hypoxia in muscle tissue and ‘bad’ effects in adipose tissue”? We devised a study in eight healthy men of different ethnicities, put into a hypoxic environment for 10 consecutive nights for 10 hours. The subjects slept in a hypoxic tent, using nitrogen dilution.

Medical Research: What are the main findings of the study?

Dr. Ravussin: The main findings of this study included:

  • Adipose tissue hypoxia was confirmed;
  • Subjects lost an average of 1.2 kg;
  • This study reports for the first time a reduced fasting glucose level and improved whole-body (skeletal muscle) and hepatic insulin sensitivity after nightly exposure to moderate hypoxia.

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Painful Diabetic Neuropathy Linked To Higher Nocturnal Blood Pressure

MedicalResearch.com Interview with:Vincenza Spallone MD PhD Endocrinology and Neurology Department of Systems Medicine Tor Vergata University, Rome, Italy
Vincenza Spallone MD PhD

Endocrinology and Neurology
Department of Systems Medicine
Tor Vergata University, Rome, Italy

 
Medical Research: What are the main findings of the study?

Dr. Spallone:To investigate a possible relationship between painful diabetic polyneuropathy (PDPN) and the circadian pattern of blood pressure (BP), we performed ambulatory blood pressure monitoring in 113 diabetic patients with PDPN, with painless diabetic polyneuropathy (DPN) and without DPN. In addition, we evaluated neuropathic pain, sleep, risk for obstructive sleep apnoea (OSA), autonomic function, and in a subgroup of patients, depressive symptoms.

The main finding was that patients with painful diabetic polyneuropathy displayed impaired nocturnal fall in BP compared to those without neuropathy, and higher nocturnal systolic blood pressure than the other two groups. Although the day-night change (∆) in blood pressure failed to reach a significant difference between painful diabetic polyneuropathy and DPN groups, nondipping (the loss of nocturnal fall in systolic BP) was more strictly associated with painful diabetic polyneuropathy than DPN and in multivariate analysis, including comorbidities and most potential confounders, neuropathic pain was an independent determinant of ∆ BP and nocturnal systolic blood pressure.

In summary, we showed a novel association of peripheral diabetic neuropathic pain with nondipping and higher systolic nocturnal blood pressure, which was not entirely explained through pain dependent sleep problems or other pain- or diabetes-related comorbidities, like CAN, OSA and depression.
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Diabetes: Even High Risk Patients May Have Modifiable Risk Factors

MedicalResearch.com: Interview with:
Interview with Professor Donald W Bowden and Dr. Amanda J Cox
Center for Diabetes Research,
Center for Genomics and Personalized Medicine Research
Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC

Medical Research: What are the main findings of the study?

Answer: The study examined modifiable cardiovascular disease (CVD) risk factors and risk for mortality in a subset of individuals from the Diabetes Heart Study who were at high risk based for cardiovascular disease based on burden of subclinical CVD assessed by coronary artery calcified plaque scores greater than 1000. Even among this high risk group, known CVD risk factors were still useful in assessing ongoing risk for mortality.  Use of cholesterol-lowering medication was one factor identified to be protective against mortality.

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Canola Oil May Improve Glycemic Control, Reduce Cardiovascular Risk Factors

 David J.A. Jenkins Professor and Canada Research Chair in Nutrition and Metabolism, Dept. of Medicine and Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaMedicalResearch.com Interview with:
David J.A. Jenkins
Professor and Canada Research Chair in Nutrition and Metabolism,
Dept. of Medicine and Nutritional Sciences, Faculty of Medicine,
University of Toronto, Toronto, ON, Canada

 

MedicalResearch: What are the main findings of the study?

Prof. Jenkins: The main findings were that inclusion of just over an once (31g) of canola oil in low glycemic index diets of type 2 diabetes study participants, to further reduce the glycemic load (GL), reduced HbAIC more than a high cereal fiber diet, as predicted. However the Canola oil low GL diet also reduced serum TG and LDL-C and thus Framingham risk score for cardiovascular disease. The effect was seen most clearly in those at highest CHD risk and those with features of the metabolic syndrome.
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Obesity Gene May Facilitate Weight Gain By Shifting Endocrine Balance

Christian Benedict PhD Department of Neuroscience Uppsala University Uppsala, SwedenMedicalResearch.com Interview with:
Christian Benedict PhD
Department of Neuroscience
Uppsala University
Uppsala, Sweden

MedicalResearch: What are the main findings of the study?

Dr. Benedict: By utilizing blood samples collected after an overnight fast, we demonstrated that humans carrying a common risk variant of the fat mass and obesity gene (obesity-associated gene (FTO)) (~16% of the population have two copies of this risk variant) had higher fasting blood concentrations of the hunger hormone ghrelin.  In contrast, fasting serum levels of the satiety enhancing hormone leptin were lower.
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Diabetes: Study Finds Once Weekly Dulaglutide Lowers HbA1c

MedicalResearch Interview with:
Dr. Valeria Pechtner
Medical Advisor,
Lilly Diabetes

MedicalResearch: What are the main findings of the study?

Dr. Pechtner: Used as monotherapy, once-weekly dulaglutide resulted in significant, sustained glycemic lowering, as measured by HbA1c change from baseline. Both the 1.5 mg and the 0.75 mg dose were superior to metformin at the primary endpoint of 26 weeks. At 52 weeks, dulaglutide 1.5 mg continued to demonstrate superiority to metformin, with dulaglutide 0.75 mg showing non-inferiority. In addition, a majority of patients in all arms achieved the American Diabetes Association’s recommended HbA1c target of less than 7 percent, with more patients achieving this goal in the dulaglutide groups at the 26-week endpoint, and more patients achieving the target in the dulaglutide 1.5 mg group at the 52 week timepoint.

Additionally, dulaglutide 1.5 mg and metformin resulted in similar weight loss. The tolerability and safety profile was comparable for both medications.
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Psychological Distress Increases Risk of Diabetes in Pre-Diabetics

Marianna Virtanen Finnish Institute of Occupational Health Helsinki, FinlandMedicalResearch.com Interview with:
Marianna Virtanen PhD
Finnish Institute of Occupational Health
Helsinki, Finland

MedicalResearch: What are the main findings of the study?

Dr. Virtanen: We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes. We used a clinical type 2 diabetes risk score to assess future diabetes risk and in addition, participants’ prediabetes status. We found that psychological distress did not predict future type 2 diabetes among participants who were normoglycemic and among those with prediabetes combined with a low diabetes risk score. However, psychological distress doubled the risk of type 2 diabetes among participants with prediabetes and a high diabetes risk score.

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Diabetes: Patients Still Face High Out of Pocket Expenses

MedicalResearch.com Interview with:
Dr. Rui Li
Division of Diabetes Translation
Centers for Disease Control and Prevention
Atlanta, GA

MedicalResearch.com: What are the main findings of the study?

Answer: The proportion of people with diabetes facing high out-of-pocket (OOP) burden declined between 2001 and 2011. Although insurance and income related disparities have declined, almost one-fourth of all people with diabetes still face a high out-of-pocket burden.

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