Gastric Bypass Surgery Linked to Diabetes Remission

MedicalResearch.com Interview with:
Lene Ring Madsen, MD, Ph.d.
Medicinsk Afdeling  Herning
Hospitalsenheden Vest

Lene Ring Madsen, MD, Ph.d. Medicinsk Afdeling  Herning Hospitalsenheden Vest
MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know from previous studies that there is a significant chance of diabetes remission following Roux-en-Y gastric bypass, but most studies evaluate smaller cohorts of selected patients (e.g. from a single center or only patients covered by a specific type of insurance). By using Danish registries, which hold information on all Danish Citizens independent of social- or economic status and have complete follow-up, we wanted to evaluate the Roux-en-Y gastric bypass surgery (RYGB) in a real-world setting.

The main findings are that more than 70 % of patients with obesity (BMI>35 kg/m2) and type 2 diabetes treated by RYGB had their diabetes go into remission or every 6-month period in the first 5 years after the procedure. Out of those who were in remission within the first year of follow-up 27% had undergone relapse at 5 years.

The most important predictor of a patient not going into remission was if they required insulin to control their disease. Other factors included older age and higher starting HbA1c level. During the more than five years of follow-up, the risk of microvascular complications was 47% lower in the RYGB group than in the control population, with largest decreases in the risk of diabetic retinopathy and diabetic kidney disease. There was a smaller impact on the risk of macrovascular events, which were 24% lower among patients who had received bariatric surgery; however, this difference was not large enough to achieve statistical significance. The 90-day mortality was very low (<0.5%).

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Experimental Bioelectronic Modulation of the Carotid Sinus Improves Glucose Tolerance

MedicalResearch.com Interview with:

Silvia Conde, PhD CEDOC, NOVA Medical School Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisboa

Dr. Conde

Silvia Conde, PhD
CEDOC, NOVA Medical School
Faculdade de Ciências Médicas
Universidade Nova de Lisboa
Lisboa

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

Response: In 2013, Silvia Vilares Conde and her research group described that the carotid body, a paired organ that is located in the bifurcation of the common carotid artery and that is classically defined as an oxygen sensor, regulates peripheral insulin sensitivity and that its dysfunction is involved in the development of metabolic diseases.

This first study (Ribeiro et al. 2013, Diabetes, 62:2905-16) and others afterwards performed by her group in diabetic rats (Sacramento et al. 2017, Diabetologia 60(1):158-168) showed that the bilateral resection of the carotid sinus nerve, and therefore the abolishment of the connection between the carotid body and the brain, restore insulin sensitivity and glucose tolerance. Although efficient this surgical irreversible approach has disadvantages, since the carotid body possesses other physiological functions as the response to the lack of oxygen (hypoxia) or the adaptation to exercise. Silvia Conde’s team also described that the carotid body is over-activated in animal models of type 2 diabetes, suggesting that decreasing the activity of the organ could be a good therapeutic strategy.

In this new work (Sacramento et al. 2018, doi: 10.1007/s00125-017-4533-7), her group in collaboration with Galvani Bioelectronics (former Glaxo Smith Kline Bioelectronics) demonstrated that is possible to electrically modulate the carotid sinus nerve to maintain glucose homeostasis in diabetic animals without significant adverse effects.  Continue reading

Fatty Acids From Fish During Infancy May Lower Risk of Type 1 Diabetes

MedicalResearch.com Interview with:

Sari Niinistö, PhD Senior Researcher, Public Health Solutions, Nutrition Unit National Institute for Health and Welfare Helsinki, Finland

Dr. Niinistö

Sari Niinistö, PhD
Senior Researcher,
Public Health Solutions, Nutrition Unit
National Institute for Health and Welfare
Helsinki, Finland

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

Response: Previous prospective studies have observed protective association between fish-derived fat and type 1 diabetes related autoimmunity in older children. Also some other fatty acids have been associated with the risk for type 1 diabetes associated autoimmunity. We wanted to study very young children, because type 1 diabetes associated autoimmunity often begins early, already in infancy. Therefore, we investigated whether serum fatty acid levels during infancy or the main dietary sources of fatty acids (breast milk and infant formula) were related to the development of autoimmunity responses among children at increased genetic risk of developing type 1 diabetes.

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Diabetes Raises Risk of Death From Cancer in Asians

MedicalResearch.com Interview with:

Yu Chen</strong> Associate Professor, Department of Population Health Associate Professor, Department of Environmental Medicine Associate Professor, Department of Medicine NYU Langone School of Medicine

Dr. Yu Chen

Yu Chen PhD MPH
Associate Professor, Department of Population Health
Associate Professor, Department of Environmental Medicine
Associate Professor, Department of Medicine
NYU Langone School of Medicine

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

Response There is increasing evidence of an association between type 2 diabetes and cancer risk. However, previous studies in Asian only considered one or a few cancer types, included only a small number of patients with diabetes, or didn’t control for other important risk factors such as obesity.
We conducted pooled analyses of 19 prospective population-based cohorts included in the Asia Cohort Consortium (ACC), comprising data from over 771,000 individuals in the Asia.

Diabetes was associated with a 26% increased risk of death from any cancer in Asians.
Significant positive associations with diabetes were observed for the risk of death from cancers of the colorectum, liver, bile duct , gallbladder, pancreas, breast, endometrium, ovary, prostate, kidney, thyroid, as well as lymphoma. Diabetes was not statistically significantly associated with the risk of death from cancers of the bladder, cervix, esophagus, stomach, and lung or with leukemia.

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

Response: Influence of diabetes on the risk of death from overall cancer, digestive cancers and breast cancer is largely similar in Asians and in developed Western countries

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

Response: The findings indicate a potential need for appropriate cancer screening among individuals with diabetes, and a greater emphasis on lifestyle modifications to prevent diabetes and reduce cancer mortality, not only in Western populations, but also in Asians

No disclosures

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

 Chen Y, et al “Association between type 2 diabetes and risk of cancer mortality: a pooled analysis of over 771,000 individuals in the Asia Cohort Consortium” Diabetologia 2017; DOI:10.1007/s00125-017-4229-z.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

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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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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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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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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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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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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Increased Number of People With Diabetes Primarily Due To Type 2 Diabetics Living Longer

MedicalResearch.com Interview with:
Dr. Stephanie Read, PhD
University of Edinburgh, UK

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

Response: The number of people living with type 2 diabetes in Scotland is increasing. We wanted to identify to what extent this trend was due to people living longer with type 2 diabetes or due to increasing numbers of new cases each year.

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Breastfeeding May Correct Metabolic Abnormalities Linked To Diabetes

MedicalResearch.com Interview with:
Dr. Sandra Hummel and Dr. Daniela Much
Institute of Diabetes Research
Helmholtz Center Munich
German Research Center for Environmental Health
Munich

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

Response: Gestational diabetes mellitus is associated with a seven-fold increased risk of developing type 2 diabetes postpartum. In 2012, we published that type 2 diabetes risk was markedly reduced up to 15 years after delivery in women with gestational diabetes if they breastfed for more than 3 months. However the underlying biological mechanisms are still unclear to date.

Aim of this biomarker study was to identify the mechanism underlying the protective effect of prolonged lactation. At our study site in Munich, we enrolled 197 women with previous gestational diabetes participating in a postpartum assessment of glucose tolerance at a median time of 3.6 years after delivery. By using a targeted metabolomics approach (including a broad spectrum of lipids and amino acids), we identified lactation-associated biochemical changes in maternal plasma samples. Most interestingly, these metabolite signatures have been described with decreased risk for type 2 diabetes previously. Our results indicate that lactation-associated alterations persisted up to 11 years post-lactation.

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Recurrent Diabetic Ketoacidosis Signals High Mortality Risk

MedicalResearch.com Interview with:
Dr Fraser W Gibb MBChB PhD FRCP Edin Consultant Physician / Honorary Clinical Senior Lecturer Edinburgh Centre for Endocrinology & DiabetesDr Fraser W Gibb MBChB PhD FRCP Edin
Consultant Physician / Honorary Clinical Senior Lecturer
Edinburgh Centre for Endocrinology & Diabetes

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

Response: We know that diabetic ketoacidosis is associated with a low risk of death in those admitted to hospital but we did not know what the risk of death was in the months and years following discharge from hospital.

We have found that recurrent DKA admissions (more than 5 in a lifetime) are associated with a greater than 1 in 5 risk of death in the following three years compared to a 1 in 20 risk for those with only a single DKA. Recurrent DKA is more common in younger, more socially disadvantaged people.

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Significant Progress Made Toward Artificial Pancreas For Type 1 Diabetes

MedicalResearch.com Interview with:
Dr Hood Thabit and
Co-author: Dr Roman Hovorka
University of Cambridge Metabolic Research Laboratories
Wellcome Trust-MRC Institute of Metabolic Science
Cambridge UK

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

Response: Type 1 diabetes is an insulin-deficient condition, therefore people with type 1 diabetes need to be on life-long insulin therapy to maintain normal blood glucose levels. Currently insulin is delivered either by injections (with an insulin pen) or by infusion (with an insulin pump). In addition, they have to monitor their blood glucose regularly by performing fingerprick measurements several times a day, to avoid over- or under-dosing with insulin. Hypoglycaemia, or low blood glucose, can occur as a result of giving too much insulin; if severe or prolonged can lead to the patient being unconscious and in some cases sudden death. Hyperglycaemia, or high blood glucose, can occur as a result of giving too little insulin, and chronic hyperglycaemia can lead to diabetes related complications such as blindness, kidney failure and heart disease. Maintaining blood glucose within a normal range poses a daily challenge and struggle for many people with type 1 diabetes, who have to juggle with the variability and unpredictability of their glucose levels and insulin requirements due to meals, physical activity and stress.

People with type 1 diabetes have on average 3 episodes of severe hypoglycaemia per year which requires third party assistance and sometimes hospitalisation. In the UK, the average HbA1c for people with type 1 diabetes is around 8.5% (69mmol/mol), which puts them at risk of diabetes complications and developing significant disability affecting their lives. There is therefore an unmet need of a novel therapeutic approach to be able to automatically modulate and change the amount of insulin delivered, based on real-time glucose levels. The artificial pancreas, or closed-loop insulin delivery, is an emerging technology which couples real-time sensor glucose levels with insulin delivery under the direction of a control algorithm, and automatically steps-up insulin delivery when glucose levels are going up, and reduces or suspends insulin delivery when glucose levels are going down. The longest home study to date was recently performed by researchers at the University of Cambridge and showed that compared to best available therapy, the artificial pancreas significantly improved long-term glucose control (HbA1c) and reduces the risk of hypoglycaemia.

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Researchers Find Link Between Low Birth Weight and Adult Type 2 Diabetes

MedicalResearch.com Interview with:

Lu Qi, MD, PhD, FAHA HCA Regents Distinguished Chair and Professor Director, Tulane University Obesity Research Center Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans, LA 70112

Dr. Lu Qi

Lu Qi, MD, PhD, FAHA
HCA Regents Distinguished Chair and Professor
Director, Tulane University Obesity Research Center
Department of Epidemiology
Tulane University
School of Public Health and Tropical Medicine
New Orleans, LA 70112

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

Response: Prenatal malnutrition and other stresses may cause small newborn babies, who are more likely develop type 2 diabetes and other chronic diseases during adulthood. However, whether such relation is causal remains to be determined. Genetic associations provide a new approach to provide evidence for such causality.

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Poor Cardiovascular Health Linked to Increased Diabetes Risk Especially African Americans and Hispanics

MedicalResearch.com Interview with:
Joshua J. Joseph, MD
Christopher D. Saudek M.D. Fellow in Diabetes Research
Division of Endocrinology, Diabetes and Metabolism
Johns Hopkins University School of Medicine

MedicalResearch.com: What does your study explore?

Response: Our study explores two basic questions:

(a) Are multi-ethnic people with higher levels of cardiovascular health less likely to develop diabetes based on the AHA ideal cardiovascular health metric?

(b) Do these associations vary by race/ethnicity (non-Hispanic white, Chinese American, African American, and Hispanic American)?

MedicalResearch.com: Why did you choose this topic to explore?

Response: The literature has shown a strong association between lifestyle factors and elevated risk of diabetes in majority non-Hispanic white studies. One study of American Indians showed that meeting a greater number of ideal cardiovascular health goals was associated with a reduced risk of diabetes. We aimed to assess the association of baseline ideal cardiovascular health with incident diabetes within a multi-ethnic population, due to variation of ideal cardiovascular health by race/ethnicity.

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Pediatric Cardiometabolic Risk Factors Linked to Family History of Heart Disease and Diabetes

MedicalResearch.com Interview with:

Dr. Nina Berentzen PhD National Institute for Public Health and the Environment Bilthoven, the Netherlands

Dr. Nina Berentzen

Dr. Nina Berentzen PhD
National Institute for Public Health and the Environment
Bilthoven, the Netherlands

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

Dr. Berentzen: Cardiovascular disease and type 2 diabetes often occur together and share risk factors including an unhealthy diet, a lack of physical activity, and being overweight or obese. This study is the first to investigate the occurrence of both diabetes and CVD across two generations of parents and grandparents, and relate it to measurable risk factors in children. We found that one third of the 12-year-olds studied had a strong family history of one or both of cardiovascular disease (myocardial infarction and stroke) and type 2 diabetes. Children had a ‘strong family history’ if they had one affected parent, or at least one grandparent with early disease onset, or 3–4 grandparents with late disease onset. These children had higher levels of total cholesterol, and a higher ratio of total/HDL cholesterol than children with no family history of disease.

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Higher Lifetime Cardiac Fitness Linked To Lower Risk of Diabetes

MedicalResearch.com Interview with:

Dr Lisa Chow MD MS University of Minnesota, Minnesota, MI

Dr. Lisa Chow

Dr Lisa Chow MD MS
University of Minnesota, Minnesota, MI 

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

Dr. Chow: A number of previous studies have shown people who maintain or increase their cardiac fitness (CRF) through adulthood have a lower risk of developing diabetes, abnormal metabolic measures, cardiovascular disease and cardiovascular mortality than those whose CRF declines. However, these previous studies are limited for several reasons, including use of a largely male population, measurement of fitness over a limited duration (5–7 years) or measurement of fitness at varying intervals prospectively. In this new research, the authors used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to objectively and rigorously analyse the link between cardiac fitness and development of either prediabetes or diabetes over a 20-year period.

The main finding is that higher cardiac fitness  is associated with lower risk for developing prediabetes and diabetes, even when adjusting for prospective changes in body mass index.

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Life Expectancy Still Shortened For Patients With Type 1 Diabetes

MedicalResearch.com Interview with:

Dr. Dennis James Petrie Melbourne School of Population and Global Health

Dr. Dennis Petrie

Dr. Dennis James Petrie
Melbourne School of Population and Global Health

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

Dr. Petrie: Life expectancy estimates for those with type 1 diabetes allow gaps with the general population to be identified and improvements to be quantified. This research examined mortality for those with type 1 diabetes in Sweden from 2002 till 2011. The aim was to explore whether life expectancy of those with type 1 diabetes has improved in Sweden over the last decade and how any improvement compared with improvements seen in the general population. It found that for men with type 1 diabetes, the remaining life expectancy at age 20 increased significantly by about 2 years (from 47.7 in 2002–06 to 49.7 years in 2007–11) but for women with type 1 diabetes there was no significant change, with a life expectancy at age 20 of 51.7 years in 2002–06 and 51.9 years in 2007–11. There have been recent gains for both men and women from reductions in cardiovascular mortality however these gains were also seen in the general population which meant that the life expectancy gaps have stayed at about 11 years for men and 12 years for women over the last decade in Sweden.

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Type 1 Diabetes Still Associated With At Least A Decade of Reduced Life Expectancy

MedicalResearch.com Interview with:

Associate Professor Dianna Magliano BAppSci(Hon) MPH PhD Head, Diabetes and Population Health Baker IDI Heart and Diabetes Institute Melbourne. VIC

Dr. Dianna Magliano

Associate Professor Dianna Magliano BAppSci(Hon) MPH PhD
Head, Diabetes and Population Health
Baker IDI Heart and Diabetes Institute
Melbourne. VIC

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

Dr. Magliano: This work shows  that Australians with type 1 diabetes had an estimated life loss of 11.6 years for men and 12.5 years for women compared with the general population. We saw no evidence of improvement in this over recent years. For those who are older with type 1, cardiovascular disease contributed substantially to the years of life lost in type 1 diabetes. Death before 60 years and mortality from endocrine and metabolic disease were also important contributors to the years of life lost in type 1 diabetes.

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Women with Type 1 Diabetes Have Elevated Risk of Some Cancers

MedicalResearch.com Interview with:

Bendix Carstensen

Bendix Carstensen

Bendix Carstensen
Department of Clinical Epidemiology Steno Diabetes Center
Gentofte

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

Response: It has long been known that all diabetes patients have elevated risk of cancer (10-15%). Patients on insulin slightly more (20-25%). Type 1 patients is only a small fraction (10%) of all diabetes patients, but they ALL take insulin. If insulin has a role in cancer occurrence it would be expected to be particularly pronounced in type 1 patients, and increasing by duration.

But it is not, the risk of cancer is 15% elevated (if we disregard prostate, breast and other cancers only occurring in one of the sexes), and there is no increase in the excess risk by duration of insulin use. Breast cancer risk is 10% lower and prostate cancer risk some 40% lower. Overall there is very little increased cancer risk – 1% for men 7% for women.

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Sitting Time Raises Risk of Type II Diabetes

MedicalResearch.com Interview with:
Julianne van der Berg  PhD candidate
Social Medicine
Universiteitssingel Maastricht
The Netherlands 

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

Response: The study investigated in data from The Maastricht Study, a large study in the Netherlands, associations of total duration and patterns of sedentary behavior with type 2 diabetes.
We show that participants with type 2 diabetes spent the most time of day sedentary, 26 min more than participants without diabetes.
Each additional hour of sedentary time was associated with a 22% increased risk of type 2 diabetes.
Important is that these results were independent of high-intensity physical activity.

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Sleeping Difficulties Raise Diabetes Risk in Women

MedicalResearch.com Interview with:
Dr. Yanping Li
Research Scientist
Harvard T.H.Chan School of Public Health
Boston, MA 02115

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

Dr. Li: Sleeping difficulty is a common disorder but always lack of attention from both the patients and physicians. Our study finds that women with sleeping difficulty is associated with a higher risk of type 2 diabetes.

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Less Than 50% of Type 1 Diabetic Youth Receive Insulin Pump Therapy

MedicalResearch.com Interview with:
Jennifer Lynn Sherr, MD, PhD
Assistant Professor of Pediatrics (Endocrinology)
Yale School of Medicine

Medical Research: What is the background for this study?

Dr. Sherr: A joint consensus statement released in 2007 by leading pediatric diabetologists recommended pump therapy be considered in children and adolescents with suboptimal diabetes control, wide fluctuations in blood glucose levels regardless of HbA1c, and when insulin regimen compromises lifestyle, indications which would encompass the vast majority of youth living with type 1 diabetes. Yet, variations in the support for and use of pump technology has been reported even in developed Western countries. Therefore, the present study was undertaken to assess the frequency of pump use across three large registries of pediatric type 1 diabetes patients: the German/Austrian Prospective Diabetes Follow-up Registry (DPV), the US T1D Exchange (T1DX), and the English/Welsh National Paediatric Diabetes Audit (NPDA).

Medical Research: What are the main findings?

Dr. Sherr: Our data demonstrate that fewer than 50% of youth in these five countries are using pump therapy. Those on pump therapy had mean lower HbA1c levels as compared to those on injection therapy. Notably, a three-fold greater use of insulin pumps was noted in thetype 1 diabetes and DPV as compared to the NPDA, which may be due to the National Institute for Health Care Excellence (NICE) guidelines limiting pump use in these countries.
Pump use amongst the registries varied widely by age. Additionally, the data demonstrate lower pump use in both ethnic minorities and males.

Medical Research: What should clinicians and patients take away from your report?

Dr. Sherr: As data from three trans-Atlantic registries have identified the beneficial glycemic effect of insulin pump use with mean A1c being 0.5% lower than what is achieved by those on injection therapy, application of this technology for all youth with type 1 diabetes should be a focus of care. Clinicians should investigate their prescribing patterns and be aware that pump use can be applied regardless of patient age, gender, or ethnic background. Patients should advocate for themselves in order assure they are being considered for this treatment modality.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Sherr: Assessment of factors related to determining who is eligible for pump therapy and how we can assure equal access regardless of age, ethnic status or gender will be important. Additionally, exploration of health policy allowing for coverage of such medical devices is warranted to assure our youth are afforded the best care possible. This will become critically important, as the next revolution of diabetes care is a mechanical solution, specifically the artificial pancreas, which relies on insulin pump use for system performance.

Citation:

Diabetologia. 2015 Nov 7. [Epub ahead of print]

Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlantic paediatric registries.

Sherr JL1, Hermann JM2, Campbell F3, Foster NC4, Hofer SE5, Allgrove J6, Maahs DM7, Kapellen TM8, Holman N9, Tamborlane WV1, Holl RW2, Beck RW10,Warner JT11; T1D Exchange Clinic Network, the DPV Initiative, and the National Paediatric Diabetes Audit and the Royal College of Paediatrics and Child Health registries.

 

Jennifer Lynn Sherr, MD, PhD (2015). Less Than 50% of Type 1 Diabetic Youth Receive Insulin Pump Therapy 

Taking Blood Pressure Meds At Night Decreases Diabetes Risk

Ramon C. Hermida Dominguez, Ph.D. Director, Bioengineering & Chronobiology Labs. Campus Universitario Vigo, PontevedraMedicalResearch.com Interview with:
Ramon C. Hermida Dominguez, Ph.D.

Director, Bioengineering & Chronobiology Labs.
Campus Universitario
Vigo, Pontevedra

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

Dr. Hermida Dominguez: Independent studies have shown that the asleep blood pressure (BP) mean is abetter predictor of cardiovascular risk than clinic BP or the awake blood pressure mean derived from ambulatory BP monitoring. Moreover, sleep-time hypertension is highly prevalent among patients with type 2 diabetes. In the first manuscript we tested two novel hypotheses:

(i) whether sleep-time BP is a prognostic marker for future development of diabetes; and (ii) whether progressive reduction of sleep-time blood pressure actually reduces the risk of developing diabetes.

The main findings indicate that sleep-time blood pressure is indeed a highly significant prognostic marker for new-onset diabetes, while clinic blood pressure measurements are not. Most important from the therapeutic point of view, the results from our prospective study also indicate lowering asleep blood pressure could indeed be a significant method for reducing the risk of developing diabetes.

On the other hand, multiple clinical trials have shown that bedtime ingestion of hypertension medications of several classes is associated with improved blood pressure measurements control and increased efficacy in lowering asleep BP. In the second manuscript we investigated whether therapy with the entire daily dose of one or more antihypertensive medications at bedtime exerts better reduction in the risk of developing diabetes than ingesting all medications in the morning upon awakening. The results from this randomized clinical trial indicate a significant 57% decrease in the risk of developing diabetes in the bedtime compared to the awakening treatment regimen.

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