diabetes Tag
07 Jan Dual-Hormone Artificial Pancreas Reduces Hypoglycemia Risk
MedicalResearch.com Interview with:
Ahmad Haidar PhD
Institut de Recherches Cliniques de Montreal
Montreal, QC, Canada
Medical Research: What is the background for this study? What are the main findings?
Response: We published a study in 2013 (Canadian Medical Association Journal 185.4 (2013): 297-305) where we did the first randomized trial comparing dual-hormone artificial pancreas against conventional pump therapy. We showed spectacular reduction in hypoglycemia (8-fold) with the artificial pancreas, but the first question people asked: Out of the improvement you showed, how much is due to simply closing the loop between the glucose sensor and the insulin pump, and how much is due to adding glucagon? In other words: if you just close the loop with insulin alone and use an advanced dosing algorithm, you may get a very high reduction of hypoglycemia that glucagon may not be needed (glucagon is associated with increased cost and device complexity). We were not able to answer this question with our study design.
Since then, there have been other studies by other groups either comparing single-hormone artificial pancreas vs conventional pump therapy, or comparing dual-hormone artificial pancreas vs conventional pump therapy, and most of these studies showed improvement of both artificial pancreas systems compared to conventional pump therapy. However, there has been no study comparing the three interventions to allow us to quantify the relative benefits of simply closing the loop between glucose sensor and insulin pump versus adding glucagon to the system. Quantifying the relative benefits of glucagon is important given the increased cost and device complexity of the dual-hormone artificial pancreas.
So our study compared the three interventions, and is the first study to do so.
02 Jan Unmet Material Needs May Lead To Poor Diabetes Control
MedicalResearch.com Interview with:
Seth A. Berkowitz, MD, MPH
Division of General Internal Medicine
Massachusetts General Hospital, Boston
Medical Research: What is the background for this study? What are the main findings?
Dr. Berkowitz: Prior studies had looked the association between single unmet basic material needs and diabetes control, but hadn't necessarily looked at multiple things people may not be able to afford, which more closely mirrors real-life. Also, prior studies had been done in a 'pre-Affordable Care Act' setting, while, by being in Massachusetts, our study was conducted in a setting of near-universal healthcare coverage that is similar to what the rest of the US is moving towards. We found that difficulties meeting basic material needs, such as difficulties affording food, known as food insecurity, and having financial barriers to taking medications, called cost-related medication underuse, are associated with worse diabetes control and increased use of costly health services in diabetes patients, despite near-universal health insurance coverage
30 Dec Tight Glycemic Control Not Best For All Patients With Diabetes
MedicalResearch.com Interview with:
Aramesh Saremi MD
Phoenix VA Health Care System
Health Research Scientist
Phoenix, AZ 85012-1892
Medical Research: What is the background for this study? What are the main findings?
Dr. Saremi: Our study was a post-hoc analysis of the data that was available from VA cooperative study, the Veterans Affair Diabetes Trial (VADT). The VADT was one of the recent landmark studies examining the effect of intensive glycemic control on cardiovascular events in older adults with type 2 diabetes.
The main finding in the VADT and other two other landmark studies (ACCORD and ADVANCE ) was that intensive glycemic control does not reduce cardiovascular disease events in people with type 2 diabetes of moderate to long duration. However, our subsequent post-hoc analysis suggests that intensive glycemic control was associated with reduced risk of cardiovascular events in Hispanics, but not in non-Hispanic Whites or Blacks.
20 Dec Blood Type O Linked To Lower Risk of Diabetes
MedicalResearch.com Interview with: Dr Guy Fagherazzi Center for Research in Epidemiology and Population Health INSERM, Villejuif, France, and colleagues. Medical Research: What is the background for this study? What are the main findings? Dr. Fagherazzi: Our work has been based on previous findings regarding the associations between blood type and the risk of stroke or coronary heart disease, where people with the O blood group seamed to have lower risk of developping the disease. The suggested mechanisms could be also be involved with type 2 diabetes. And our results were in agreement with our first hypothesis. We have followed more than 80 000 women from the E3N cohort study, during 18 years and we have found that individuals with the O blood type had lower risk of type 2 diabetes than the others (people with groups A, B and AB).12 Dec Intestinal Bacterial Implicated In Onset of Obesity and Diabetes
MedicalResearch.com Interview with: Prof. Dr. Patrice D. Cani PhD, Research Associate FRS-FNRS Louvain Drug Research Instiute, Metabolism and Nutrition WELBIO, Walloon Excellence in Life sciences and BIOtechnology NeuroMicrobiota lab, European Associated Laboratory (INSERM/UCL) and Dr Amandine Everard Université Catholique de Louvain, Louvain Drug Research Institute, WELBIO (Walloon Excellence in Life sciences and BIOtechnology), Metabolism and Nutrition Research Group, Brussels, Belgium Medical Research: What is the background for this study? What are the main findings? Response: Our intestine harbors more than 100 trillions of bacteria. This huge number of bacteria permanently interacts with our own human cells. Among the systems involved in this crosstalk, the immune system plays a key role in these interactions. We previously showed that specific gut bacteria are able to control energy metabolism, harmful inflammation associated with obesity, body weight gain and type-2 diabetes. However mechanisms involved these effects of gut bacteria on the host during obesity and type-2 diabetes were poorly understood. We identify the essential role of the intestinal immune system in the onset of obesity and type-2 diabetes both induced by a high dose of fat in the diet. This discovery highlights an unexpected mechanism for the control of energy metabolism during obesity and type-2 diabetes. We demonstrate for the first time that the inactivation of a part of the intestine immune system (more specifically the protein MyD88), which is overstimulated by a diet rich in fat, allows to induce weight-loss and to reduce type-2 diabetes associated with obesity. When we tune the immune system by disabling the protein MyD88 specifically in cells covering the intestine, we are able to limit the adipose tissue development induced by the diet rich in fat, to slow down diabetes, to reduce harmful inflammation associated with obesity, to reinforce gut barrier function assumed by our intestine to avoid the inappropriate translocations of bacteria compounds from our intestine in our body. We reveal various mechanisms explaining the partial protection against obesity induced by the inactivation of this protein of the immune system. Among them, we point out that mice that do not have this protein of the immune system (i.e. MyD88) in their intestine are partially protected against obesity because they spend more energy than other obese mice. Moreover, our study shows that this protein of the immune system is able to shape the composition of the gut microbiota residing in our intestine under a high-fat diet. These changes observed in mice deleted for this protein also explain their protection against obesity because when we transfer intestinal bacteria of these mice into other mice that are axenic (without flora), these latest mice are also partially protected against obesity. In conclusions, our studies published in the scientific journal Nature Communications, demonstrated that during consumption of fat food, the intestinal immune system plays an important role in fat storage regulation in the body and is capable to modify the composition of intestinal bacteria (including some which are still unidentified), confirm the implication of intestinal bacteria in the onset of obesity.07 Dec Diabetes and Cardiovascular Disease Share Several Key Driver Genes
MedicalResearch.com Interview with:
Simin Liu, MD, ScD, Professor of Epidemiology
School of Public Health, Professor of Medicine
The Warren Alpert School of Medicine
Director, Molecular Epidemiology and Nutrition
Brown University
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Liu: Cardiovascular Disease (CVD) and type 2 diabetes (T2D) are highly heritable and share many risk factors and show ethnic-specific prevalence. Nevertheless, a comprehensive molecular-level understanding of these observations is lacking. We conducted a comprehensive assessment of whole genome assessment using network-based analysis in >15,000 women and identified eight molecular pathways share in both diseases as well as several “key driver” genes that appear to form the gene networks in which these pathways connect and interact.
07 Dec Few Diabetics Participate in Diabetes Self-management Education and Training
MedicalResearch.com Interview with Dr. Rui Li, PhD Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion CDC Medical Research: What is the background for this study? What are the main findings? Dr. Li: Diabetes is a serious disease associated with severe complications and premature death. Diabetes Self-management Education and Training (DSMT) helps patients improve blood sugar control, which could reduce the risk for diabetes complications, hospitalizations, and health care costs. However, data showed that fewer than 7% of persons with private health insurance received DSMT within 1 year after diagnosis with diabetes. Furthermore, across different population subgroups, DSMT participation rates were less than 15%.28 Nov Diabetes Risk Increased in Poor Neighborhoods
MedicalResearch.com Interview with:
Longjian Liu, MD, PhD, MSc(LSHTM), FAHA
Interim Chair, Department of Environmental and Occupational Health Associate Professor, Department of Epidemiology and Biostatistics, Senior Investigator, Center for Health Equality
Drexel University School of Public Health, and
Adjunct Associate Professor of Medicine, Drexel U. College of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Liu: The prevalence of diabetes is increasing rapidly in the United States and worldwide. In 2010, 25.8 million Americans, or 8.3% of the population had diabetes in the United States. In 2012, these figures were 29.1 million, or 9.3% in the nation. Philadelphia, the largest city in PA, ranks as the 5th largest city in the nation. However, the city also had the highest prevalence of diabetes according to the national surveys in 2009. We face a great challenge to stop the epidemic of diabetes locally and nationally. It is well-known personal risk factors at individual level, including lifestyles, play a role in the prevention and control of diabetes. However very limited studies addressed the importance that physical and socioeconomic environmental factors at community level may also play a pivotal role in the prevention and control of the disease. This study aimed to quantitatively examine (1) the trend of diabetes from 2002 to 2010 in the city of Philadelphia, and (2) the impact of physical and socioeconomic environmental factors at community level (assessed using zip-codes based neighborhoods) on the risk of the prevalence of diabetes.
The main findings support our hypotheses that
- (1) the prevalence of diabetes significantly increased from 2002 to 2012.
- (2) residents who lived in neighborhoods with physical and socioeconomic disadvantage had an increased risk of the prevalence of diabetes.
25 Nov Some Diabetics Do Not Benefit From Exercise
MedicalResearch.com Interview with:
Lauren Marie Sparks, PhD
Faculty Scientist at the Translational Research Institute for Metabolism and Diabetes
Florida Hospital and the Sanford-Burnham Medical Research Institute Orlando, FL
Medical Research: What is the background for this study? What are the main findings?
Dr. Sparks: As a clinical scientist focused on exercise effects on muscle metabolism in diabetes, I have seen first-hand a significant minority of individuals with diabetes not improve their glucose control (HbA1c) after 9 months of supervised exercise. They poured their hearts out on those treadmills 3-4 days a week for 9 months and still ended up no better than when they started. I have also seen similar data from some of my colleagues’ studies. So I really want diabetes research to invest the intellect and dollars into discovering what these roadblocks are—I happen to believe it is in the DNA (genetics) and the way that DNA is “read” or expressed (epigenetics). So it’s a bit of a ‘call to action’ for researchers to start looking into some of their data to find these people and better understand this phenomenon and for hopefully the funding sources to recognize this as a viable area of research.
18 Nov More Fast Food Outlets, More Diabetes?
MedicalResearch.com Interview with:
Dr. Patrice Carter
Diabetes, Nutrition & Lifestyle Research Associate
Diabetes Research Centre (Broadleaf) University of Leicester
Leicester General Hospital Leicester UK
Medical Research: What is the background for this study? What are the main findings?
Dr. Carter: Type 2 diabetes is a growing concern, worldwide prevalence is expected to increase to 552million by 2030. Prevalence is closely linked to increasing obesity rates which are associated to environmental changes that have led to more sedentary lifestyles and poor-quality dietary intake. Consumption of fast food has previously been linked to the obesity epidemic and consumption is associated with low adherence to dietary recommendations.
We analysed data of over 10,000 individuals to investigate the association between screen detected type 2 diabetes and the number of fast food outlets in their neighbourhood.
In summary we found the mean number of fast food outlets in areas with high social deprivation as compared to low social deprivation; mean number of outlets was 3.53 (SD 4.83) and 0.91 (1.89) respectively. The number of fast food outlets was positively associated with screen-detected type 2 diabetes (OR=1.05; 95% CI 1.04, 1.07; p<0.001). In addition, we used these data to calculate that for every additional two outlets we would expect to see one more diabetes case, assuming a 7% prevalence of undiagnosed type 2 diabetes in neighbourhoods with no outlets and approximately 200 residents in a 500m radius, and assuming a causal relationship.
12 Nov Type 2 Diabetes: U-shaped Association of BMI With All-Cause Mortality
Posted at 16:09h
in AHA Journals, Author Interviews, Diabetes, Heart Disease, Metabolic Syndrome, Weight Research
MedicalResearch.com Interview with:
Gang Hu, MD, MPH, PhD, FAHA
Assistant professor & Director
Chronic Disease Epidemiology Lab
Adjunct assistant professor, School of Public Health
LSU Health Sciences Center
Pennington Biomedical Research Center,
Baton Rouge, Louisiana
Medical Research: What is the background for this study? What are the main findings?
Dr. Hu: Many previous studies had small samples, and thus lacked adequate statistical power when the analysis was focused on those who are extremely obese (BMI ≥40 kg/m2). In addition, most epidemiological studies only use a single measurement of BMI at baseline to predict risk of all-cause mortality, which may produce potential bias. The current study indicated a U-shaped association of BMI with all-cause mortality risk among African American and white patients with type 2 diabetes. A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30-34.9 kg/m2.
04 Nov Electronic Registries May Improve Diabetes Detection and Management
MedicalResearch.com Interview with:
Dr. Tim A. Holt PhD MRCP FRCGP
NIHR Academic Clinical Lecturer
University of Oxford
Department of Primary Care Health Sciences
Radcliffe Observatory Quarter
Woodstock Road Oxford
Medical Research: What is the background for this study?
Dr. Holt: Undiagnosed diabetes is a serious and very costly problem. Early diagnosis is important to reduce risk of long term complications. A structured approach to management at the practice level involves electronic diabetes registers, enabling audit of care, automated recall, and screen reminders. Such registers depend on the presence of an electronic code for diabetes in the record.
30 Oct Pregestational Diabetes Mellitus: Preconception Care May Improve Outcomes and Save Billions
MedicalResearch.com: Interview with:
Dr. Cora Peterson PhD
Health Economist at Centers for Disease Control
Medical Research: What is the background for this study? What are the main findings?
Dr. Peterson: Women with pregestational diabetes mellitus (PGDM) have increased risk for adverse birth outcomes. Preconception care for women with pregestational diabetes mellitus reduces the frequency of such outcomes, most likely by improving glycemic control before and during the critical first weeks of pregnancy.
Preconception care for women with pregestational diabetes mellitus includes the following activities:
- medical or dietary blood sugar control, blood sugar monitoring, screening and treatment of complications due to diabetes,
- counseling and education about the risks of diabetes in pregnancy, and
- using effective birth control or contraceptives until appropriate levels of blood sugar are achieved.
20 Oct Enterovirus infection Linked to Increased Risk of Childhood Diabetes
MedicalResearch.com Interview with: Dr Tsai Chung-Li Graduate Institute of Biostatistics, College of Management, China Medical University,Taichung, Taiwan and Dr. Hsiao-Chuan Lin Department of Public Health, College of Public Health, and Department of Pediatrics, China Medical University, Taichung, Taiwan Medical Research: What are the main findings of the study? Response: We conducted a nationwide population-based cohort study that included two groups. Children with enterovirus infection (aged < 18 years) during 2000-2007 were identified and followed up until December 31, 2008 or until first occurrence of type 1 diabetes. The group without enterovirus infection comprised half of all insured children of the same age and without a diagnosis of enterovirus infection. By use of frequency-matching with sex and birth year, children in the group with enterovirus were selected from those eligible. This nationwide retrospective cohort study found:- type 1 diabetes is positively correlated with enterovirus infection in patients younger than 18 years.
- the incidence rate of type 1 diabetes was lower in the non-enterovirus than the enterovirus group (4 vs 6 per 100,000 person-years; incidence rate ratio 1.48 [95% CI 1.19, 1.83]).
- children that have been infected with enterovirus are 48% more likely to have developed type 1 diabetes.
- the risk of developing type 1 diabetes is 2.18 times greater among children aged 10 years and older than among those aged younger than 1 year.
15 Oct Controlling Insulin Release With Photoswitchable Sulfonylurea
MedicalResearch.com: Interview with:
Dr. David Hodson PhD
Faculty of Medicine, Department of Medicine
Imperial College London
Medical Research: What is the background for this research?
Dr. Hodson: Type 2 diabetes represents a huge socioeconomic challenge. As well as causing significant morbidity due to chronically elevated glucose levels, this disease is also a drain on healthcare budgets (~$20billion in the UK per year). While current treatments are effective, they are sometimes associated with side effects, usually due to off-target actions on organs such as the heart and brain. In addition, the ability to regulate blood glucose levels more tightly may decrease complications stemming from type diabetes (e.g. nerve, kidney and retina damage). As a proof-of-principle that the spatiotemporal precision of light can be harnessed to finely guide and control drug activity, we therefore decided to produce a light-activated anti-diabetic.
07 Oct Metformin May Alter Thyroid Hormone in Diabetics
MedicalResearch.com Interview with: Jean-Pascal Fournier, MD, PhD Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada and Laurent Azoulay, PhD Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Department of Oncology, McGill University, Montreal, Quebec, Canada Medical Research: What are the main findings of the study? Response: Patients with type II diabetes and treated hypothyroidism showed a 55% increased risk for low levels of thyroid stimulating hormone (TSH) (below 0.4 mIU/L) when initiating metformin, compared with those initiating sulfonylurea (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.09–2.20). In contrast, this effect of metformin was not observed in euthyroid patients, with an adjusted HR for low TSH of 0.97(95% CI 0.69–1.36).03 Oct Bariatric Surgery Effective For Both Weight Loss and Diabetes Remission
Posted at 02:54h
in Author Interviews, JAMA, Surgical Research, University of Pittsburgh, Weight Research
MedicalResearch.com Interview with:
Anita P. Courcoulas M.D., M.P.H., F.A.C.S
Professor of Surgery
Director, Minimally Invasive Bariatric & General Surgery
University of Pittsburgh Medical Center
Medical Research: What are the main findings of the study?
Dr. Courcoulas: This paper was not a study but a summary of findings from a multidisciplinary workshop (and not a consensus panel) convened in May 2013 by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute. The goal of the workshop was to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research.
03 Oct Vitamin D: No Causal Link With Type 2 Diabetes
MedicalResearch.com Interview with:
Dr Nita Forouhi, MRCP, PhD, FFPHM
Lead Scientist and Programme Leader
MRC Programme Leader and Consultant Public Health Physician
MRC Epidemiology Unit
University of Cambridge School of Clinical Medicine
Cambridge Biomedical Campus Cambridge, UK
Medical Research: What are the main findings of the study?
Dr. Forouhi: This large study found that low blood concentrations of 25-hydroxyvitamin D [25(OH)D], a clinical indicator of vitamin D status, were associated with an increased risk of type 2 diabetes, but this did not appear to be a cause-effect relationship. To investigate these associations, we did two things. We first did a systematic review and meta-analysis across 22 published studies and confirmed that there was a strong inverse relation between vitamin D levels and the risk of future new-onset type 2 diabetes among people who did not initially have diabetes. We then used a genetic approach, called Mendelian randomisation, which allows us to test a cause-effect relationship, and found that genetically lower vitamin D levels were not related to risk of type 2 diabetes. This means that we were able to distinguish between association and causation, and concluded that the vitamin D levels did not have a causal link with type 2 diabetes.
29 Sep Diabetics with Acute Myocardial Infarction Have Higher Mortality
MedicalResearch.com Interview with: Jorge F. Saucedo MD Allstate Foundation, Judson B. Branch Chair of Cardiology Head, Division of Cardiology Co-Director Cardiovascular Institute NorthShore University HealthSystem Clinical Professor of Medicine University of Chicago Pritzker School of Medicine Talla A. Rousan, MD Oklahoma City, OK. First author of study. Medical Research: What are the main findings of the study? Answer: It was found that patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have a higher in-hospital mortality rate compared to patients without DM. Patients with insulin-requiring diabetes mellitus presenting with non-ST-segment elevation myocardial infarction had higher in-hospital mortality rate than patients with non-insulin requiring diabetes mellitus.25 Sep Longer Working Hours Linked To Increased Risk of Diabetes in Lower Socioeconomic Jobs
MedicalResearch.com Interview with:
Prof Mika Kivimäki PhD
Department of Epidemiology and Public Health,
University College London, London, UK
Hjelt Institute, Medical Faculty, University of Helsinki, Helsinki, Finland
Medical Research: What are the main findings of the study?
Prof. Kivimäki: In our study, we pooled published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia. Of them, 4963 individuals developed type 2 diabetes during the mean follow-up of 7.6 years. This is the largest study to date on this topic.
In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group, but was null in the high socioeconomic status group. The association in the low socioeconomic status group did not change after taking into account age, sex, obesity, physical activity, and shift working. So, the association was very robust.
In brief, the main finding of our meta-analysis is that the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.
22 Sep Statins May Have Additional Lipid Profile Benefit in Pre-Diabetes
\MedicalResearch.com Interview with: Prof. Moses Elisaf Professor of Internal Medicine University of Ioannina, Greece Medical Research: What are the main findings of the study? Dr. Elisaf: We evaluated the effects of rosuvastatin in two groups of hyperlipidemic patients: one group had impaired fasting glucose (IFG) while the second group had normal fasting glucose. After study end, both groups had similar changes in their lipidemic profile. However, patients with IFG had a significant greater decrease in the cholesterol concentration of the more atherogenic small dense low-density lipoprotein (sdLDL) particles (-65.7%) compared with controls (-38.5%). Moreover, a greater increase in the mean LDL particle size was observed in the impaired fasting glucose group (+1.5% vs +0.4%). In addition, redistribution from the more atherogenic sdLDL to large buoyant LDL (lbLDL) subfractions was observed in the IFG group.22 Sep Pre-Diabetes Associated With Increased All-Cause and Cardiovascular Mortality
MedicalResearch.com Interview with: Yuli Huang and Yunzhao Hu Department of Cardiology, the First People's Hospital of Shunde, Shunde District, Foshan, PR China. Medical Research: What are the main findings of the study? Response: “Prediabetes” is a general term that refers to an intermediate stage between normoglycaemia and overt type 2 diabetes mellitus (T2DM). It includes 2 groups of individuals, those with impaired glucose tolerance (IGT) and those with impaired fasting glucose (IFG). In 2003, the American Diabetes Association (ADA) redefined the fasting plasma glucose (FPG) concentration range for diagnosing IFG from 110 to 125 mg/dl to 100 to 125 mg/dl in order to better identify individuals at future type 2 diabetes mellitus risk. However, this change has been contentious and was not adopted by the World Health Organization (WHO) Expert Group or other international guidelines. In this meta-analysis, we included data from 26 prospective cohort studies with for 280,185 participants and found that, after controlling for multiple cardiovascular risk factors, the presence of prediabetes at baseline, defined as defined as IFG of 110 to 125 mg/dL(IFG 110), IGT or combined IFG 110 and/or IGT, was associated with increased risk of all-cause and cardiovascular mortality. Specifically, IFG 110 was associated with 12% and 19% increase of all-cause and cardiovascular mortality, IGT was associated with 33% and 23% increase of all-cause and cardiovascular mortality, combination of IFG110 and/or IGT was associated with 21% and 21% increase of all-cause and cardiovascular mortality, respectively. Although IFG 100 was not associated with all-cause or cardiovascular mortality in the overall analysis, the risk was greater in young and middle age males according to subgroup analyses.17 Sep Neuropathy Predisposes Diabetics To Falls on Stairs
Posted at 16:00h
in Diabetes
MedicalResearch.com Interview with:
Steven Brown
School of Healthcare Science
Faculty of Engineering
Manchester Metropolitan University UK
Medical Research: What are the main findings of the study?
Answer: Our main findings were increased extremes of sideways sway in patients with diabetes and severe peripheral neuropathy during stair negotiation. Measured by an increase in the amount of lateral separation between the centre-of-mass and centre-of-pressure. Our results showed a 3cm increase in maximum sway in patients with diabetic peripheral neuropathy during both stair descent and stair ascent.
17 Sep Study Confirms Increased Risk, Earlier Onset of Diabetes in South East Asians
MedicalResearch.com Interview with: Dr. Adam Tabak MD Clinical Research Associate Epidemiology & Public Health Institute of Epidemiology & Health Faculty of Population Health Sciences University College London, UK Medical Research: What are the main findings of the study? Dr. Tabak: Some of the major findings are confirmatory, such as the almost 3 times increased risk and an earlier onset of type 2 diabetes among south Asians, and a decreased insulin sensitivity in this ethnic group. The major novel finding is related to the fact that we could model events before diabetes diagnosis. We found a faster increase in fasting glucose before the diagnosis is south Asians compared to whites and that although insulin secretion increased in both ethnicities until 7 years before diagnosis, this increase was faster among whites.13 Sep Inflammation May Explain Why Glycemic Control Alone May Not Prevent Diabetic Heart Disease
MedicalResearch.com Interview with:
Carlos F. Sánchez-Ferrer, M.D., Ph.D.
Professor of Pharmacology
Universidad Autónoma de Madrid, Spain.
Medical Research: What are the main findings of the study?
Dr. Sánchez-Ferrer: We were studying the possible ways of interaction between high glucose levels, which are found in diabetes mellitus, with vascular damage,
which is the most common and devastating consequence of this disease.
An intriguing fact is that a very strict control of blood sugar in
diabetic patients is not sufficient to avoid the development of such
diabetes-induced cardiovascular diseases. We think our results can
explain why this is happening.
Using cultured smooth muscle cells from the main human artery (aorta)
in the presence of high concentrations of extracellular glucose, we
observed:
1. In the absence of inflammation, excess glucose in the culture fluid
didn’t enter the cells.
2. When extra glucose was forced into the cells, no harm was done in
the absence of inflammation.
3. When the inflammation-stimulating protein interleukin-1 (IL-1) was
introduced, more glucose entered the cells.
4. With IL-1, the glucose entering the cells was metabolized via
chemical pathways that spur escalating inflammation, overwhelming the
cells’ ability to counteract it.
5. In the presence of the anti-inflammatory drug anakinra, which blocks
the activity of IL-1, the deleterious changes didn’t occur.
12 Sep Diabetes: Incretin-Based Drugs Not Linked To Congestive Heart Failure
MedicalResearch.com Interview with:
Kristian Filion, PhD FAHA
Assistant Professor of Medicine
Division of Clinical Epidemiology
Jewish General Hospital/McGill University
Montreal, Quebec H3T 1E2 Canada
Medical Research: What are the main findings of the study?
Dr. Filion: Previous studies have raised concerns that the use of incretin-based drugs, a type of medication used to treat diabetes, may increase the risk of congestive heart failure. We therefore examined this potential drug safety issue using a large, population-based database, which allowed us to study the safety of these medications in a real world setting. In doing so, we found that the use of incretin-based drugs was not associated with an increased risk of congestive heart failure among patients with type 2 diabetes. Similar results were obtained among both classes of incretin-based drugs (glucagon like peptide-1 [GLP-1] analogs and dipeptidyl peptidase-4 [DPP-4] inhibitors), and no duration-response relationship was observed.
12 Sep Diabetes: Vascular Complications Vary By Duration of Disease
MedicalResearch.com Interview with:
Dr. Sophia Zoungas:
Faculty of Medicine, Nursing & Health Sciences
Monash University, Clayton
Medical Research: What are the main findings of the study
Dr. Zoungas: Our study shows that age (or age at diagnosis) and duration of diabetes disease are linked to the risk of death and marcovascular complications (those in larger blood vessels) whereas only diabetes duration is linked to the risk of microvascular complications (in smaller blood vessels such as those in the kidney and eyes)
12 Sep Sleep Apnea Predisposes To Impaired Brain Blood Flow With Physical Activity
MedicalResearch.com Interview with:
Paul M. Macey, Ph.D.
Assistant Professor in Residence
Associate Dean for Information Technology and Innovations,
Chief Innovation Officer UCLA School of Nursing and Brain Research Institute
Medical Research: What are the main findings of the study?
Dr. Macey: People with sleep apnea are less able to control the blood flowing to their brain, in particular when they grip tightly, or have their foot put in cold water. We measured changes in blood flowing through the brain using an MRI scanner while people gripped hard, had their foot placed in cold water, and breathed out hard into a tube with a very small hole in it. These activities all lead to more blood flowing to the brain in healthy people, which probably helps protect the cells from being starved of blood and oxygen. However, people with sleep apnea send less blood that the healthy participants during the gripped and cold foot activities.
A further important finding is that women with sleep apnea are worse off than men. The female patients showed much weaker blood flow than the males, even accounting for normal differences between men and women.
11 Sep VA Effectively Uses Telemedicine To Screen for Diabetic Eye Disease
MedicalResearch.com Interview with:
Mary G. Lynch, MD
Professor of Ophthalmology
Atlanta Veterans Affairs Medical Center Decatur, Georgia.
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
Medical Research: What are the main findings of the study?
Dr. Lynch:
- Since 2006, the VA has been systematically using teleretinal screening of patients with diabetes to screen for retinopathy in the Primary Care Clinics. Under this program, 90% of veterans with diabetes are evaluated on a regular basis. A number of patients who are screened have findings that warrant a face-to-face ophthalmic exam. No information exists on the effect of such a program on medical center resources.
- 1,935 patients underwent teleretinal screening through the Atlanta VA over a 6 month period. We reviewed the charts of the 465 (24%) of the patients who were referred for a face to face exam in the Eye Clinic.
- Data was collected for these patients to determine the reasons for referral, the accuracy of the teleretinal interpretation, the resources needed in the Eye Clinic of the Medical Center to evaluate and care for the referred patients over a two year period and possible barriers to patient care.
- Of the 465 patients referred for an exam, 260 (55.9%) actually came in for an exam. Community notes were available for an additional 66 patients. Information was available for 326 (70.1%) of the referred patients.
- The most common referring diagnoses were nonmacular diabetic retinopathy (43.2% of referrals), nerve related issues (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%) and diabetic macular edema (5.6%).
- 16.9% of the referred patients had 2 or more concurrent problems that put them at high risk for visual loss.
- The percentage agreement between teleretinal screening and the ophthalmic exam was high: 90.4%. Overall sensitivity was 73.6%. The detection of diabetic macular edema had the lowest sensitivity.
- A visually significant condition was detected for the first time through teleretinal screening for 142 of the patients examined (43.6%).
- The resource burden to care for referred patients was substantial.
- 36% of patients required 3 or more visits over the ensuing 2 year period.
- The treatment of diabetic macular edema had the highest resource use involving on average 5 clinic visits, 6 diagnostic procedures and 2 surgical procedures
- The most common non-refractive diagnostic procedures were visual fields and optical coherence tomography.
- The average cost to care for the referred patients (in Medicare dollars) in work RVUs alone was approximately $1,000 per patient. The cost to care for a patient with diabetic macular edema was $2673.36.