Author Interviews, Diabetes, Lifestyle & Health / 03.02.2016
We Don’t Need To Assume Diabetes Is a Relentless Process
MedicalResearch.com Interview with:
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Dr. David Drozek[/caption]
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.
Dr. David Drozek[/caption]
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.
Dr. Christoph Correll[/caption]
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 
Dr. Cuilin Zhang[/caption]
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. 
Prof. Peter Lay[/caption]
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).
Dr. Rowan[/caption]
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 
Dr. Qi Sun[/caption]
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.
Dr. Zaccardi[/caption]
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.
Dr. McCoy[/caption]
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).
Dr. Berg[/caption]
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. 
Dr. David Katz[/caption]
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 (
Dr. Gunderson[/caption]
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 
Dr. Thakar[/caption]
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.
