Author Interviews, Diabetes, Lifestyle & Health / 03.02.2016

MedicalResearch.com Interview with: David Drozek, D.O. Assistant Professor of Surgery Ohio University Heritage College of Osteopathic Medicine Athens, Ohio 45701 Medical Research: What is the background for this study? Response: Half of the U.S. population has diabetes or prediabetes.  The rate is even higher in Appalachia.  As a society, we cannot sustain this level of disease.  It exacts a heavy toll on our productivity and our health care costs. Current approaches to diabetes, primarily with medication, are not sufficient.  More attention needs to be placed on the underlying cause of diabetes, and its traveling partners, overweight / obesity, heart disease and many common cancers.  That cause is our lifestyle.  Medical Research: What are the main findings? Response: As has been demonstrated in many other studies of lifestyle modification programs, chronic illnesses, like diabetes, can actually be reversed, and in some cases, even cured, by instituting a plant-based, whole food diet, increased physical activity and stress management techniques.  Our study reinforces that this is possible, even in a rural, poverty stricken region, when people are ready to make healthy changes.  Our study participants, on average, lost weight, and improved their blood sugar, lipid panel and blood pressure, by participating in The Complete Health Improvement Program (CHIP), a lifestyle medicine program. (more…)
Author Interviews, Diabetes, Lancet / 31.01.2016

MedicalResearch.com Interview with: Dr Abbas Dehghan PhD Assistant Professor, Department of Epidemiology Erasmus University Medical Centre Rotterdam, Netherlands MedicalResearch.com: What is the background for this study? Dr. Dehghan: Diabetes is an important health treat given its serious complications including cardiovascular disease, blindness, kidney failure, and lower-extremity amputations. Descriptive studies have so far either reported the prevalence of diabetes which is a snapshot of the percentage of people who have diabetes or the risk that people will develop diabetes in next 5 or 10 years. These estimates are not optimal since they overlook the risk of developing diabetes later in life. We calculated the lifetime risk of type 2 diabetes which is the risk that every person carries to develop type 2 diabetes up to end of his life. Moreover, we provided estimates for prediabetes, a high risk status that people experience before developing diabetes, and need for insulin therapy that might indicates severity of the disease. MedicalResearch.com: What are the main findings?  Dr. Dehghan: Our data suggest that the lifetime risk of developing prediabetes for a normoglycemic individual aged 45 years is one in two, and one in three nondiabetic individuals aged 45 years will develop diabetes. Three-quarters of individuals with prediabetes at age 45 years will eventually progress to diabetes, and half of the patients with diabetes at the same age will start insulin treatment. Stratification by BMI showed that normoglycemic people with healthy weight at age 45 years had a significantly lower prediabetes lifetime risk compared with overweight and obese individuals. Stratification by waist circumference showed similar effects on lifetime risks for diabetes in individuals with prediabetes. Similarly, in individuals with diabetes, the lifetime risk for insulin use among patients with diabetes was higher with increasing BMI and waist circumference. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Diabetologia, Sleep Disorders / 29.01.2016

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. (more…)
Alzheimer's - Dementia, Author Interviews, Diabetes / 27.01.2016

MedicalResearch.com Interview with: Dr. Erin L. Abner PhD Sanders-Brown Center on Aging and Alzheimer's Disease Center College of Public Health, University of Kentucky Lexington, KY  Medical Research: What is the background for this study? What are the main findings? Dr. Abner: Diabetes is an important public health concern, and it has been linked to cognitive impairment and dementia, including dementia due to Alzheimer’s disease, in multiple studies of aging and cognition. Diabetes is considered by many to be a risk factor for Alzheimer’s disease, and there are many good reasons for scientists to have come to this conclusion. But, there are many brain diseases other than Alzheimer’s that cause dementia, and correctly identifying Alzheimer’s in a clinical patient can be deceptively difficult. When we looked at a very large sample of autopsied research volunteers (>2000 persons), we found that brain infarcts were more common among people with diabetes compared to people without, but Alzheimer’s pathology was about the same in both groups. Others have made this observation before, but in much smaller samples. Replicating this finding in a large sample is strong evidence that it is in fact cerebrovascular disease and not Alzheimer’s pathology that should be the primary concern among people with diabetes. In addition, we found that having diabetes was predictive of worsened global cognition at the end of life. (more…)
Author Interviews, Diabetes, JAMA, Mental Health Research, Pediatrics, Pharmacology / 20.01.2016

More on Mental Health on MedicalResearch.com MedicalResearch.com Interview with: Christoph U. Correll, MD Professor of Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine Hempstead, New York, USA Investigator, Center for Psychiatric Neuroscience Feinstein Institute for Medical Research Manhasset, New York, Medical Director, Recognition and Prevention The Zucker Hillside Hospital, Department of Psychiatry  Medical Research: What is the background for this study? Dr. Correll: Antipsychotics have been used increasingly for psychotic, but also for many non-psychotic conditions, including for disorders and conditions for which they have not received regulatory approval. Moreover, antipsychotics have been associated with weight gain and abnormalities in blood fat and blood glucose levels. Although data in youth have been less available than in children and adolescents, youth appear to be more sensitive to the cardiometabolic adverse effects of antipsychotics than adults in whom significant weight gain might have already occurred due to long-term prior antipsychotic treatment. Nevertheless, type 2 diabetes, which is related to weight gain, overweight and obesity, seemed to be more common in adults than youth, likely due to the fact that it takes a long time for the body to develop diabetes. Recently, several individual epidemiologic or database studies with sufficient long-term follow-up durations suggested that the type 2 diabetes risk was higher in youth exposed to antipsychotics than healthy control youth and, possibly, even compared to psychiatrically ill patients treated with non-antipsychotic medications. However, a meta-analytic pooling of all available data has not been available to estimate the absolute and relative risk of type 2 diabetes in youth receiving antipsychotic treatment.  Medical Research: What are the main findings? Dr. Correll: The main findings of the study that meta-analyzed data from 13 studies with 185,105 youth exposed to antipsychotics (average age 14.1 and 59.5 percent male) are that the absolute rates of type 2 diabetes are fortunately still relatively low, i.e. a cumulative type 2 diabetes  risk of 5.7/1,000 patients and an exposure adjusted incidence rate of 3.1/1,000 patient-years. Nevertheless, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.6 times and three times higher compared with 298,803 healthy controls. Furthermore, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.1 times and 1.8 times higher compared with 1,342,121 psychiatric patients not exposed to antipsychotics. Main modifiable risk factors for type 2 diabetes development in antipsychotic-treated youth were treatment with the antipsychotic olanzapine and longer antipsychotic exposure time. (more…)
Author Interviews, BMJ, Diabetes, NIH, OBGYNE / 13.01.2016

MedicalResearch.com Interview with: Cuilin Zhang MD, PhD Senior Investigator, Epidemiology Branch Division of Intramural Population Health Research NICHD/National Institutes of Health Rockville, MD 20852  Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Potatoes are the third most commonly consumed food crop in the world. In the United States, about 35% of women of reproductive age consume potatoes daily, accounting for 8% of daily total energy intake.  Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance with onset or first recognition during pregnancy. GDM is at the center of a vicious circle of 'diabetes begets diabetes' across generations. Potato foods are typically higher in glycemic index and glycemic load, but data are lacking regarding whether potato consumption is associated with the risk of Gestational diabetes mellitus. Medical Research: What is the background for this study? What are the main findings? Dr. Zhang: Women who eat more potatoes before pregnancy may have higher risk of gestational diabetes—the form of diabetes that occurs or first diagnosed during pregnancy—compared to women who consume fewer potatoes. Substituting potatoes with other vegetables, legumes or whole grains may help lower gestational diabetes risk. (more…)
Author Interviews, Mineral Metabolism, Supplements / 12.01.2016

MedicalResearch.com Interview with: Prof. Peter Lay PhD Professor of Inorganic Chemistry School of Chemistry | Faculty of Science Director, Vibrational Spectroscopy Core Facility Research Portfolio The University of Sydney Medical Research: What is the background for this study? What are the main findings? Response: My group has been studying the molecular mechanisms of chromium(VI)-induced cancers and the biochemistry of vanadium over the last three decades. Vanadium drugs have been in clinical trials for their anti-diabetic effects that occur via species with very similar chemistry to chromium(VI).  The more we understood the biochemistry of each, the more we questioned whether the efficacies of anti-diabetic chromium(III) supplements were associated with the generation of carcinogenic chromium(VI) and chromium(V). To test this, we conducted experiments to either provide evidence for our hypothesis or disprove it.  This work commenced some 15 years ago with studies on the changes in the nature of chromium(III) supplements exposed to simulated gastrointestinal juices, as well as in human and animal blood serum over times that mimicked the residence time of the supplements in the human body. We discovered that all supplements were changed to a range of different Cr(III) species in both the GI tract and the blood.1,2  Common species were observed, but the rates at which they formed were dependent on the nature of the chromium(III) supplement.  Both the supplements themselves and the chromium(III) species that formed in blood serum were partially oxidised to Cr(VI) at concentrations of the oxidant, hydrogen peroxide (a type of bleach), found in the blood of people with type II diabetes.1,2 One of the clinical features of patients with type II diabetes is increased levels of oxidants, such as hydrogen peroxide, in their blood and cells. These oxidants are associated with many of the side-effects of type II diabetes that are associated with reduced life expectancy. These transformed chromium(III) species bound to blood proteins were more easily oxidised to chromium(VI) than the administered Cr(III) supplements.  The faster a particular chromium(III) supplement reacted with blood proteins to form these easily oxidised chromium(III)-protein species, the more active was the Cr(III) supplement in its anti-diabetic activity in animal and human studies reported by other groups.1-5  According to many health and regulatory bodies, chromium(III) has minimal or no efficacy in glucose metabolism and no other beneficial effects, such as weight loss or muscle building, in well conducted human and animal trials with non-diabetic subjects. This is consistent with our proposed mechanism of action. It is only under oxidising physiological conditions associated with type II diabetes that chromium(III) can be partially transformed to sufficient concentrations of carcinogenic chromium(VI) to enable significant biological activity.  In a large clinical trial where diabetic patients were treated with high doses of chromium(III) picolinate (one of the least efficacious supplements in animal studies), there was no efficacy in patients with controlled type II diabetes. Only those patients with uncontrolled type II diabetes exhibited improved glucose metabolism.  These patients, who have the highest concentrations of oxidants with the ability to transform chromium(III) to chromium(VI) in blood, are therefore at the greatest risk of developing Cr-induced cancers. Even where efficacy was observed, glucose metabolism was only reduced to the levels in patients with controlled type II diabetes; i.e., no patients exhibited a return to normal glucose metabolism.4,5 Coupled with all of this information our separate studies showed that chromium(VI) and chromium(V), but not chromium(III), are strong inhibitors of protein tyrosine phosphatase (PTP) enzymes.  The relevance of this is that drugs that inhibit PTPs activate circulating insulin in people with type II diabetes.  That is, it causes insulin to bind more strongly to cells involved in glucose metabolism (such as fat cells) to bring about the cascade of biochemical reactions that import glucose into cells and metabolise it.1-5 Thus we were able to link all of the animal, human and in vitro studies to show that physiological conditions under which chromium(III) had the highest probability of being transformed to chromium(VI) were also those in which chromium(III) supplements were most active.1-5 Moreover, we were able to provide a mechanism of activity that required chromium(VI) and chromium(V) to be generated for insulin enhancing activity.1-5  What remained was to establish whether we could observe Cr(VI) and Cr(V) in cells treated with chromium(III) supplements. This has now been established in our most recent study6 that have just been published. Contrary to the press releases of the dietary supplement industry, the published paper was carefully planned to mimic those conditions found in vivo.  The chromium(III) supplement chosen was that which had a chemical structure most closely resembling those generated in blood plasma. Thus we were able to complete the circle in linking our extensive studies on the biochemistry of chromium(III) species generated from chromium(III) supplements in the blood and show that such species were absorbed by the relevant cells and partially oxidised to chromium(VI) and chromium(V). (more…)
Author Interviews, Diabetes, Diabetes Care, OBGYNE / 23.12.2015

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. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Nutrition / 20.12.2015

MedicalResearch.com Interview with: Dr. Qi Sun Sc.D Assistant Professor Department of Nutrition Harvard T.H. Chan School of Public Health Boston, Massachusetts  Medical Research: What is the background for this study? What are the main findings? Dr. Qi Sun: Potato is considered as a vegetable in certain dietary recommendations, such as in the U.S. MyPlate food guide, whereas in the U.K. national food guide, potato is grouped with cereal as sources of carbohydrates. Potato foods are typically higher in glycemic index and glycemic load, but data are rare regarding whether individual and total potato foods are associated with chronic diseases. In this analysis, we focused on diabetes and found that a higher consumption of total potato foods and individual potato foods, especially french fries, was associated with an increased risk of developing type 2 diabetes in three large cohort studies of ~200 thousand U.S. men and women. In addition, we found that increased potato food consumption over time was associated with a subsequent increased risk of developing diabetes. (more…)
Annals Internal Medicine, Author Interviews, Diabetes, Pharmacology / 13.12.2015

MedicalResearch.com Interview with: Francesco Zaccardi, MD Diabetes Research Centre Leicester General Hospital, Leicester, United Kingdom Medical Research: What is the background for this study? Dr. Zaccardi: Nowadays there are different classes of drugs for the treatment of hyperglycaemia in patients with type 2 diabetes and, within the same class, multiple drugs are available.Glucagon-like peptide-1 receptors (GLP-1RAs) are a relatively new class of treatments that improve glucose control and reduce body weight, without an increased risk for hypoglycaemia. To date, however, no direct comparisons between once-weekly GLP-1RAs have been reported. In this view, the aim was to assess the comparative efficacy and safety profile of GLP-1RAs using a network meta-analysis, a methodology that allows the estimation of the comparative effectiveness of multiple treatments in the absence of direct evidence. Medical Research: What are the main findings? Dr. Zaccardi: There are several differences in the efficacy and safety profiles of once-weekly glucagon-like peptide-1 receptor agonists (GLP-1RAs). Some of these drugs evidenced a better glucose control or body weight reduction, while other had an increased risk of side effects, such as nausea. Compared to other once-weekly GLP-1RAs, dulaglutide 1.5mg, once weekly exenatide, and taspoglutide 20mg showed a greater reduction of HbA1c, fasting plasma glucose, and body weight. Marginal or no differences were found for blood pressure and blood lipid levels. While taspoglutide 20mg had the highest risk of nausea, the risk of hypoglycaemia among once-weekly GLP-1RAs was comparable. (more…)
Author Interviews, Diabetes, JAMA, Pediatrics / 10.12.2015

MedicalResearch.com Interview with: Maria C. Magnus PhD Norwegian Institute of Public Health Department of Chronic Diseases Nydalen Norway Medical Research: What is the background for this study? What are the main findings? Dr. Magnus: Type 1 diabetes mellitus is one of the most common chronic diseases with onset in childhood, but environmental risk factors have not been convincingly established. A few previous studies report that childhood weight increase might influence the development of type 1 diabetes. This study combined information from two Scandinavian birth cohorts, including more than 99,000 children. The results showed that a higher weight increase during the first year of life increased the risk of type 1 diabetes. The same was not seen for height increase during the first year of life. (more…)
Author Interviews, BMJ, Cost of Health Care, Diabetes, Mayo Clinic / 09.12.2015

MedicalResearch.com Interview with: Rozalina G. McCoy, M.D. Senior Associate Consultant Division of Primary Care Internal Medicine Assistant Professor of Medicine Mayo Clinic Medical Research: What is the background for this study? What are the main findings? Dr. McCoy: Blood glucose monitoring is an integral component of managing diabetes.  Glycosylated hemoglobin (HbA1c) is a measure of average glycemia over approximately 3 months, and is used in routine clinical practice to monitor and adjust treatment with glucose-lowering medications.  However, monitoring and treatment protocols are not well defined by professional societies and regulatory bodies; while lower thresholds of testing frequencies are often discussed, the upper boundaries are rarely mentioned.  Most agree that for adult patients who are not using insulin, have stable glycemic control within the recommended targets, and have no history of severe hypoglycemia or hyperglycemia, checking once or twice a year should suffice. Yet in practice, there is a much higher prevalence of excess testing.  We believe that such over-testing results in redundancy and waste, adding unnecessary costs and burdens for patients and the health care system. We therefore conducted a large retrospective study among 31,545 adults across the U.S. with stable and controlled type 2 diabetes who had HbA1c less than 7% without use of insulin and without documented severe hypoglycemia or hyperglycemia.  We found that 55% of patients had their HbA1c checked 3-4 times per year, and 6% had it checked 5 times a year or more.  Such excessive testing had additional harms as well – we found that excessive testing was associated with greater risk of treatment intensification despite the fact that all patients in the study already met glycemic targets by having HbA1c under 7%.  Indeed, treatment was intensified by addition of more glucose lowering drugs or insulin in 8.4% of patients (comprising 13%, 9%, and 7% of those tested 5 or more times per year; 3-4 times per year; and 1-2 times per year, respectively). (more…)
Author Interviews, Diabetes, Diabetes Care, Education, Gender Differences / 27.11.2015

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. (more…)
Author Interviews, Diabetes, Macular Degeneration, Ophthalmology / 26.11.2015

MedicalResearch.com Interview with: Karina Birgitta Berg MD Department of Ophthalmology Oslo University Hospital Oslo, Norway  Medical Research: What is the background for this study? What are the main findings? Dr. Berg: Neovascular age-related macular degeneration (nAMD) has been the leading cause of vision loss in the elderly population of Western countries. Inhibition of vascular endothelial growth factor (VEGF) with medications such as bevacizumab and ranibizumab injected into the eye, has dramatically reduced the incidence of social blindness from this disease. Bevacizumab was marketed for intravenous cancer treatment, while ranibizumab was later developed and approved for intraocular treatment of nAMD. Due to similar clinical effects and a strikingly low cost compared to ranibizumab, bevacizumab has remained widely used as an off-label treatment for the treatment of nAMD. In order to preserve vision results over time, most patients need injections repeatedly. Treatment on a monthly basis has shown good vision improvement, while monitoring monthly and treating only when signs of recurrences appear, is less successful. The aim of a treat-and-extend protocol is to gradually increase the treatment intervals, while avoiding potentially harmful recurrences. This treatment modality has become commonly used, entailing fewer patient visits and less burden upon health care systems. The multicenter prospective randomized Lucentis Compared to Avastin Study (LUCAS) was aimed at comparing the efficacy and safety of bevacizumab versus ranibizumab when following a treat-and-extend protocol. The patients received monthly injection treatment until inactive disease was achieved. The treatment interval was then increased by two weeks at a time up to a maximum of 12 weeks. In the event of a recurrence, the treatment interval was reduced by two weeks at a time. The study demonstrated equivalent results in vision improvement with bevacizumab and ranibizumab after two years of treatment. Treatment according to a treat-and-extend protocol was safe with good visual results when extending up to 10 weeks, while recurrences at 12-week intervals had a negative impact on the final results on vision. (more…)
Author Interviews, Diabetes, FASEB, Nutrition, Yale / 24.11.2015

MedicalResearch.com Interview with: David L. Katz, MD, MPH, FACPM, FACP, FACLM Director, Yale University Prevention Research Center Griffin Hospital President, American College of Lifestyle Medicine Founder, True Health Initiative Medical Research: What is the background for this study? What are the main findings? Dr. Katz: the evidence that nuts in general, and walnuts in particular, have health promoting properties is vast and conclusive.  In our own prior research, we have shown that daily ingestion of walnuts ameliorates overall cardiac risk in type 2 diabetics (http://www.ncbi.nlm.nih.gov/pubmed/19880586) and that the same intervention improves cardiac risk and body composition in adults at risk for diabetes (http://www.ncbi.nlm.nih.gov/pubmed/23756586).  Our prior studies, and work by others, suggest that despite their energy density, walnuts may exert a favorable influence on calorie intake and weight, because of their very high satiety factor.  We also know that walnuts are highly nutritious overall, and suspect that those who add walnuts to their diets are apt to 'bump' something less nutritious out, thereby improving the overall quality of their diets as measured objectively. Accordingly, we designed the new study to look at the effects of daily walnut ingestion on diet quality, weight, and cardiac risk measures in a larger cohort of adults at risk for type 2 diabetes (ie, central obesity, indications of insulin resistance) over a longer period of time.  We also wondered whether the addition of some 350 daily calories from walnuts would result in the displacement of a comparable number of calories from other sources, so we compared the effects of the intervention with, and without, counseling to help people 'make room' for the walnut calories. We found again that walnuts improved overall cardiac risk status, as measured by endothelial function- essentially, a direct measure of blood vessel health and blood flow.  We also found that adding walnuts to the diet significantly improved overall diet quality, and did not lead to weight gain.  Walnuts also improved the lipid profile.  When walnut intake was combined with counseling for overall calorie intake, there was a significant decline in waist circumference. (more…)
Author Interviews, Kaiser Permanente, OBGYNE, Pediatrics / 24.11.2015

MedicalResearch.com Interview with: Erica P. Gunderson, PhD, MPH, MS, RD Senior Research Scientist, Division of Research, Cardiovascular and Metabolic Conditions Section Kaiser Permanente Northern California Oakland, CA 94612 Medical Research: What is the background for this study? Dr. Gunderson: Gestational diabetes mellitus (GDM) is a disorder of glucose tolerance affecting 5-9 percent of all U.S. pregnancies (approximately 250,000 annually), with a 7-fold higher risk of progression to type 2 diabetes. Strategies during the postpartum period for prevention of diabetes focus on modification of lifestyle behaviors, including dietary intake and physical activity to promote weight loss. Lactation is a modifiable postpartum behavior that improves glucose and lipid metabolism, and increases insulin sensitivity, with favorable metabolic effects that persist post-weaning. Despite these metabolic benefits, evidence that lactation prevents type 2 diabetes remains inconclusive, particularly among women with gestational diabetes mellitus (GDM). Among women with GDM, evidence that lactation prevents diabetes is based on only two studies with conflicting findings. The Study of Women, Infant Feeding and Type 2 Diabetes after GDM Pregnancy, also known as the SWIFT Study, is the first to measure breastfeeding on a monthly basis during the first year after delivery and the first to enroll a statistically significant number of women with gestational diabetes, and to evaluate social, behavioral and prenatal risk factors that influence development of type 2 diabetes, as well as breastfeeding initiation and success. (more…)
Author Interviews, Diabetes, JAMA, Ophthalmology / 16.11.2015

MedicalResearch.com Interview with: Adam R. Glassman, MS Jaeb Center for Health Research Tampa, FL 33647 Medical Research: What is the background for this study? What are the main findings? Response: Diabetic retinopathy is a complication of diabetes that affects blood vessels in the retina. When diabetic retinopathy worsens to proliferative diabetic retinopathy, blood vessels in the retina can leak fluid or bleed, distorting vision. Diabetic retinopathy is the most common cause of vision loss among people with diabetes and the leading cause of blindness among working-age adults. Scatter laser treatment, also called panretinal photocoagulation, has been standard therapy for the treatment of proliferative diabetic retinopathy since the 1970s. While effective in preserving central vision, laser therapy can reduce side vision and cause swelling in an area of the retina that is important for central vision. This study aimed to find an alternative therapy that avoided these undesirable side effects. Eyes in this study were assigned randomly to treatment with intraocular anti-VEGF injections of Lucentis® or scatter laser treatment. The results of this study demonstrate that eye injections of Lucentis® are as effective for vision outcomes at 2 years as laser therapy. On average, vision among eyes treated with Lucentis® improved by about half a line on an eye chart, with virtually no improvement among eyes treated with laser therapy. Compared with laser-treated eyes, eyes treated with Lucentis injection on average had less side vision loss, less frequent development of swelling in the central retina, and fewer complex retina surgeries for retinal bleeding or retinal detachment. (more…)
Author Interviews, BMJ, Diabetes / 12.11.2015

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

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

Dr. Ulla Uusitalo PhD University of South Florida, TampaMedicalResearch.com Interview with: Dr. Ulla Uusitalo PhD University of South Florida, Tampa Medical Research: What is the background for this study? What are the main findings? Dr. Uusitalo: The TEDDY Study is an international prospective cohort study with the primary goal to identify environmental causes of Type 1 Diabetes (T1D). It is carried out in six clinical research centers, in four countries: University of Colorado Health Science Center (US), Georgia Regents University (US), Pacific Northwest Diabetes Research Institute (US), Turku University Hospital (Finland), Institute of Diabetes Research (Germany), and Lund University (Sweden), since 2004. One possible environmental factor related to Type 1 Diabetes etiology is diet. Dietary supplements including probiotics as well as various types of infant formulas including probiotic fortified infant formula are studied. The microbial composition of gut has been shown to be associated with the development of  Type 1 Diabetes. Colonization of the infant gut starts already in utero and early microbial exposures have been found to be important in defining the trajectory of colonization. Probiotics have been demonstrated to induce favorable immunomodulation and it has been suggested that probiotic treatment could prevent T1D. Therefore we wanted to study the early exposures of probiotic and risk of islet autoimmunity, a condition often preceding Type 1 Diabetes. This study produced very interesting results. The main finding was that we found 60% decrease in the risk of islet autoimmunity among children with HLA genotype of DR3/4 (high risk), who were exposed to probiotics during the first 27 days of life. (more…)
Author Interviews, Breast Cancer, Diabetes / 05.11.2015

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

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

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

Marcus Lind, M.D., Ph.D Department of Medicine, Uddevalla Hospital Uddevalla, Swede MedicalResearch.com Interview with: Marcus Lind, M.D., Ph.D Department of Medicine, Uddevalla Hospital Uddevalla, Swede Medical Research: What is the background for this study? Dr. Lind:  One of the main goals of the diabetes care is to reduce excess mortality in individuals with type 2 diabetes close to that of the general population. We want patients to have a similar life expectancy as individuals in the general population. Earlier studies have shown that targeting good glucose levels, blood lipid and blood pressure levels are beneficial with respect to decrease cardiovascular disease being the main cause for mortality. We wanted to evaluate the prognosis for individuals with type 2 diabetes today in Sweden. Further, earlier population-based studies have generally assessed mortality rates only on a group level whereas we believe the prognosis differs greatly depending on various factors such as how well risk factor control is obtained in clinical practice. The Swedish Diabetes Registry include more than 90% of all individuals with type 2 diabetes in Sweden and information of e.g. the glycaemic control, measured by a biomarker called A1c exists for most persons. There were 97% who had at least 1 measurement. Also most patients had information of other risk factors, among others renal complications which we believed were of special concern.  (more…)
Author Interviews, Diabetes, Primary Care / 18.10.2015

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

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

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

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