Early Respiratory Infection May Double Type 1 Diabetes Risk: Study

Researchers looked at children who had first-degree relatives with the autoimmune disease

By Serena Gordon

HealthDay Reporter

MONDAY, July 1 (HealthDay News) -- What may seem like a harmless cold during the first six months of life may more than double a child's chances of developing antibodies that often lead to type 1 diabetes, new German research suggests.

Infections that occur later don't seem to pose as high as risk. When infants between 6 and 12 months had a respiratory illness, their risk only increased by 32 percent, the study found.

The researchers noted that these findings probably don't apply to all youngsters, because this study was done with children who have a high risk of developing the disease because they have a first-degree relative who has type 1 diabetes.

"In general, the early immune system is still in a phase of development, and may therefore be particularly susceptible for challenges by infectious agents. However, we cannot explain yet why specifically respiratory infections might be relevant in this phase," said study author Andreas Beyerlein, head of the working group on epidemiology at the Institute of Diabetes Research in Munich.

Results of the study were published online July 1 in JAMA Pediatrics.

Infections have long been suspected as potential triggers of type 1 diabetes. Type 1 diabetes is an autoimmune condition that causes the body's immune system to mistakenly attack and destroy insulin-producing beta cells in the pancreas, according to background information in the study. Insulin is a hormone needed to metabolize the carbohydrates in foods so that they can be used as fuel for the body and brain.

Substances called islet autoantibodies appear in the blood before the development of type 1 diabetes, sometimes years before diabetes is evident. These autoantibodies help researchers predict whether or not someone will develop type 1 diabetes.

In the current study, the researchers followed 148 children who were under 3 months old when they started the study. All of the babies had a first-degree relative with type 1 diabetes.

When the children were 3 months old, the parents were asked to complete a detailed questionnaire that included information about their baby's history of infections, fever and medication use. They were asked to detail the types of symptoms their child had. They were also asked about family history of diabetes, and questions about lifestyle factors, such as whether the mother smoked during pregnancy.

Parents were then asked to record information about any illnesses or diseases that occurred until the child was 3 years old. The children also had their blood tested every three months to look for evidence that they had developed islet autoantibodies.

Over the three-year study, there were 1,245 infectious "events." Most -- 669 -- were respiratory infections that affected the upper respiratory tract, including the ear, nose, throat or eye. Infections that affected the digestive system totaled 257, and another 319 cases were classified as "other" infections, such as skin infections.

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Vaccine May Stop Immune Attack in Type 1 Diabetes, Study Suggests

Early trial found it boosts insulin production, appears safe

By Serena Gordon

HealthDay Reporter

WEDNESDAY, June 26 (HealthDay News) -- A new type of vaccine may stop the autoimmune attack that occurs in people with type 1 diabetes, researchers report.

Although an initial trial of the vaccine wasn't able to free anyone from their daily insulin injections, it did boost insulin production, which could help prevent some of type 1 diabetes' most devastating complications.

Instead of increasing the immune system's activity like the polio or influenza vaccine does, the new vaccine turns off a portion of the immune response, acting as a reverse vaccine. The researchers were able to isolate a part of the immune response that only seems to be involved with type 1 diabetes, according to the study. That means the vaccine likely wouldn't have the risks that medications that suppress the immune system do.

"We were able to destroy the rogue cells that are attacking the insulin-producing cells without destroying any other part of the immune system, and that's truly exciting," said senior study author Dr. Lawrence Steinman, a professor of pediatrics and neurology and neurological sciences at Stanford University School of Medicine.

"Once the immune attack is stopped, I believe there's great potential for recovery in the beta cells," Steinman added.

Beta cells in the pancreas produce the hormone insulin. In people with type 1 diabetes, it's believed that the immune system mistakenly destroys the healthy beta cells, leaving the person with no or too little insulin.

Insulin is a crucial hormone because it's involved in the metabolism of the carbohydrates. It allows the glucose (sugar) from those carbohydrates to fuel the cells in the body and brain. Without enough insulin, a person will die. That's why people with type 1 diabetes must take multiple daily injections of insulin, or deliver insulin through a catheter inserted under the skin that's attached to an insulin pump.

The vaccine was designed by changing a piece of immune-system DNA so that it would shut down the immune system's response to signals in the body that have previously triggered the mistaken destruction of beta cells. These signals come from fragments of a protein (peptides) called proinsulin, which is found on the surface of beta cells. Proinsulin is a precursor to insulin.

"We just wanted to throw the off switch for the one cell being attacked," Steinman explained.

The researchers recruited 80 volunteers diagnosed with type 1 diabetes during the past five years. They were randomly placed in one of five groups. Four groups received various doses of the vaccine, and the fifth group received placebo injections. Shots were given weekly for 12 weeks.

No one in the study was able to stop using insulin. "That's a possible goal, but it's too early to start saying cure," Steinman noted.

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Exercise Alone May Help Those With Type 2 Diabetes

Small study found it helped even if no other lifestyle changes were made

By Robert Preidt

HealthDay Reporter

TUESDAY, June 25 (HealthDay News) -- Exercise benefits people with type 2 diabetes even if they don't make any other lifestyle or diet changes, a new study says.

Dutch researchers conducted MRI exams of 12 patients with diabetes before and after they did six months of moderate-intensity exercise. Each week, the participants, who were an average age of 46, exercised between three and a half and six hours a week during two endurance and two resistance training sessions.

The six-month exercise program ended with a 12-day trekking expedition, according to the study published online in the journal Radiology.

There were no changes in the participants' heart function at the end of the exercise program. But they did have significant decreases in the amount of fat in the abdomen, liver and around the heart, all of which have been shown to be associated with increased risk of heart disease.

"In the present study, we observed that the second layer of fat around the heart -- the pericardial fat -- behaved similarly in response to exercise training as intra-abdominal, or visceral fat. The fat content in the liver also decreased substantially after exercise," study senior author Dr. Hildo Lamb, of the Leiden University Medical Center in the Netherlands, said in a journal news release.

He said these exercise-related fat reductions in the liver are particularly important to people with type 2 diabetes, many of whom are overweight or obese.

"The liver plays a central role in regulating total body fat distribution," Lamb said. "Therefore, reduction of liver fat content and visceral fat volume by physical exercise are very important to reverse the adverse effects of lipid accumulation elsewhere, such as the heart and arterial vessel wall."

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New trial muddies the water about diet, exercise, and diabetes

Posted June 25, 2013, 1:50 pm

Long-awaited results from a nearly 10-year trial exploring the effect of changes in diet and exercise among people with diabetes weren’t what most people expected. The Look AHEAD trial found that intensive efforts to lose weight by eating less and exercising more didn’t provide any more protection against heart disease—a common co-traveler with diabetes—than standard diabetes support and education. The spin from some media reports is that weight loss doesn’t reduce heart disease risk among people with type 2 diabetes, but I think that’s the wrong interpretation.

In the Look AHEAD trial, researchers recruited more than 5,000 men and women with type 2 diabetes. All were overweight. Half were assigned to a program aimed at losing weight by exercising and cutting calories. People in this group were asked to eat between 1,200 and 1,800 calories a day and to exercise for at least 175 minutes a week. Their goal was to lose at least 7% of their starting weight, and maintain that weight loss. The other half of the volunteers met three times a year for group counseling sessions that focused on the importance of lifestyle changes like more exercise, a better diet, and greater social support to control their diabetes.

Both groups lost weight and did a pretty good job keeping it off. Those in the intensive-change group lost a little more weight (about 18 pounds) than those in the comparison group (about 14 pounds). After almost 10 years, the rates of heart attacks, strokes, heart-related deaths, and hospitalizations for chest pain were the same in both groups.

There are several ways to explain why the intensive intervention didn’t seem to do any better than standard care, at least for heart disease. Here’s the “obvious” one: Weight loss clearly helps lower blood sugar, but it may not play an important role in heart attack and stroke risk.

I think a closer look at the Look AHEAD participants, and other findings, tell a more important story:

Both groups lost weight at the end of the 9.6 years of the study. The average difference between the two groups was 2.5% of starting weight. It’s possible that weight loss matters for type 2 diabetes and heart disease, but greater weight loss is needed.Fewer people in the intensive intervention group needed medications to lower blood pressure and cholesterol, probably because their diets and exercise did that for them. More people in the usual care group were treated with such medications, which have been shown to decrease the risk of heart attack and stroke.The volunteers generally had their diabetes under control. One measure of diabetes control is a blood test called hemoglobin A1c. The goal for people with type 2 diabetes is a reading under 7.0. Those in the intensive change group had an average of 7.2; those in the comparison group, 7.3. Greater benefits may be in store for lifestyle interventions among people with poorly controlled diabetes.People in the intensive lifestyle intervention group were instructed to eat a standard low-calorie diet that was relatively high in carbohydrates and lower in fat. But such diets aren’t best for cardiovascular health. Urging the intensive change volunteers to adopt a Mediterranean-style diet may have had a greater payoff.

People with diabetes are two to four times more likely to have a heart attack or stroke than those without diabetes. And deaths from heart conditions and stroke are the leading causes of death and disability among people with diabetes.

Lifestyle changes have been emphasized as the mainstay of diabetes treatment, especially for people with type 2 diabetes. Exercising more, losing weight, and adopting a healthier diet are clearly good for lowering blood sugar, which translates to benefits around the body.

The results of the Look AHEAD trial don’t contradict the value of lifestyle changes. People in that group improved their blood sugar with fewer drugs, saving an estimated $600 per year. Those in the intensive change group were 30% less likely to have developed chronic kidney disease, a feared complication of diabetes. They also had less self-reported vision problems (diabetes is a leading cause of vision loss), less depression, and reported feeling better.

The Look AHEAD results reinforce for me that diabetes care needs to be tailored to the individual. It is not a one-size-fits-all recipe. It should go beyond blood sugar control and weight loss, and give equal priority to preventing all of the many complications that follow in the wake of diabetes.

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A Deadly Form of Diabetes That Doctors Sometimes Miss

Common signs of type 1 diabetes often resemble symptoms of other illnesses

By Serena Gordon

HealthDay Reporter

WEDNESDAY, June 19 (HealthDay News) -- Addie Parker was a happy 4-year-old who appeared to have the flu. But within hours she was in a coma.

Tragically, her parents weren't familiar with the signs of type 1 diabetes -- extreme fatigue, thirst and sweet-smelling breath, among others -- in time to save their little girl. Soon after she was diagnosed, Addie's brain hemorrhaged. She died six days later, about a month shy of her fifth birthday.

Experts say a lack of awareness of the signs of type 1 diabetes is all too common. Just this month, a Wisconsin toddler died apparently because of undiagnosed type 1 diabetes.

"Addie had flu symptoms," recalled her mother, Micki Parker, who works in the operating room at a nearby hospital but was unfamiliar with type 1 diabetes.

"By the next morning, she was throwing up every hour," Parker said. Addie didn't have a fever, but later that day, she couldn't get up from the bathroom floor because she was so dizzy.

Eventually, the Parkers learned that Addie's blood sugar level was 543 milligrams per deciliter (mg/dL) -- more than four times higher than normal, according to the American Diabetes Association.

Most people have heard of type 2 diabetes, but type 1 diabetes is far less common. It can strike at any age -- even though it used to be known as juvenile diabetes -- and it always requires treatment with injected insulin or insulin delivered through a pump. People with type 1 diabetes don't produce insulin, a hormone needed to convert the food you eat into fuel for the body. Without insulin, glucose (blood sugar) rises to unhealthy levels.

Untreated, type 1 diabetes causes serious complications and even death. But it's often mistaken for other illnesses -- even by doctors.

"There's an underawareness of type 1 diabetes in the public, and in the healthcare system," said Dr. Richard Insel, chief scientific officer for JDRF (formerly the Juvenile Diabetes Research Foundation). "Missed diagnoses even occur in emergency rooms; people don't always think of it."

Every day, about 80 Americans are diagnosed with type 1 diabetes, and the total number rose 23 percent between 2000 and 2009 in children under 20. Currently, about 3 million Americans -- most of them adults -- are living with type 1 diabetes, according to the JDRF.

One of them is 20-year-old Amanda Di Lella, who was 13 when she knew something was seriously wrong.

"I was losing weight, but I was always hungry. I was always tired. My symptoms weren't extreme at first, but they quickly got worse," she said. "I went from being tired to not being able to get out of bed, from being thirsty to drinking 10 bottles of water in the middle of the night. I had lost 15 pounds, and only weighed 75 pounds when I begged my mother to take me to the doctor."

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Diabetes Self-Care Improves Slowly, U.S. Report Finds

But nearly half of patients aren't meeting goals for blood sugar, blood pressure and cholesterol

By Serena Gordon

HealthDay Reporter

WEDNESDAY, April 24 (HealthDay News) -- More Americans are meeting diabetes care goals, but nearly half still aren't achieving major targets for controlling blood sugar, blood pressure and cholesterol, government health officials say.

Just 14 percent of people with diabetes hit all the recommended health targets during the first decade of the 21st century, according to the new report from the U.S. Centers for Disease Control and Prevention and the U.S. National Institutes of Health.

Researchers found that between 1999 and 2010, the number of people with diabetes who achieved their blood sugar goals improved by about 8 percent. That same time period saw a nearly 12 percent improvement in the number of people meeting their blood pressure goals.

And 21 percent more people lowered their LDL cholesterol (the bad type) to less than 100 milligrams per deciliter during the study time period.

Tobacco use was one area where the numbers didn't move.

"The overarching theme is slow and steady improvement. Just a 1 percent improvement in hemoglobin A1C [a long-term measure of blood sugar levels] in 19 million people with diabetes is tremendous," said report author Dr. Mohammed Ali, an assistant professor of global health and epidemiology at the Rollins School of Public Health at Emory University and a consultant in the CDC's division of diabetes translation in Atlanta.

"There are still huge gaps," Ali said. "We have a good report card, but we have a long way to go in certain aspects, like blood pressure control and tobacco use. One in five people with diabetes still use some form of tobacco."

Almost 19 million U.S. adults have diabetes, according to background information in the study. "Probably 95 percent or higher have type 2 diabetes," said Ali. Type 2 diabetes is considered preventable. Untreated or poorly treated diabetes can lead to serious complications, including vision problems and kidney disease.

According to the report, the primary goals for diabetes care include:

Hemoglobin A1C of 7 percent or lessBlood pressure of less than 130/80 mm HgLDL cholesterol levels below 100 milligrams per deciliterNo tobacco use

The current report, published in the April 25 issue of the New England Journal of Medicine, includes data from more than 100,000 adults who reported a diabetes diagnosis by a health care professional. The data was from two nationally representative studies, but neither study broke its information down by diabetes type.

"We've always been so focused on [blood sugar], but the key for anybody with diabetes is comprehensive control of risk factors. So don't forget your blood pressure. Don't forget your cholesterol. Don't smoke. These are the things, along with [blood sugar], that are really going to improve your quality of life," said Ali.

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Red Meat Linked to Increased Diabetes Risk

Large study finds higher consumption increases risk, but experts are at odds with findings

By Steven Reinberg

HealthDay Reporter

MONDAY, June 17 (HealthDay News) -- People who eat a lot of red meat increase their risk of developing type 2 diabetes, while those who cut down on red meat cut their risk.

Those are the findings of a large new study out of Singapore involving 149,000 U.S. men and women.

The researchers found that increasing the consumption of red meat can increase the risk of developing type 2 diabetes by 48 percent.

"There is no need to have more red meat on your plate; it increases the risk of diabetes," said lead researcher An Pan, an assistant professor at the Saw Swee Hock School of Public Health at the National University of Singapore.

"It is better to reduce your red meat consumption by replacing it with other healthy food choices, like beans, legumes, soy products, nuts, fish, poultry and whole grains," he added.

The report was published in the June 17 online edition of the journal JAMA Internal Medicine.

For the study, Pan's team collected data on three Harvard group studies: the Health Professionals Follow-up Study, the Nurses' Health Study and the Nurses' Health Study II. All the participants answered questions about their diet every four years, resulting in more than 1.9 million person-years of follow-up.

There were more than 7,500 cases of type 2 diabetes, the researches found.

Comparing diet with the cases of diabetes, Pan's group found that people who increased their consumption of red meat by 0.5 servings per day during a four-year period were 48 percent more likely to develop type 2 diabetes, compared with people who ate less red meat.

Moreover, people who cut their red meat consumption were 14 percent less likely to develop type 2 diabetes, they found.

Outside experts, however, argued about the findings.

"Epidemiological studies made by questionnaires are not accurate, and they never prove causation, no matter how big and how good the statistics are," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

The interaction of the many genetic and lifestyle factors that cause obesity and type 2 diabetes is remarkably complex and is still being studied, Zonszein added. "Doing cross-sectional analysis or epidemiological analysis produces questions but not answers," he said.

Blaming red meat for diabetes is misleading, said William Evans, head of the Muscle Metabolism Discovery Performance Unit at GlaxoSmithKline and the author of an accompanying editorial in the journal.

The amount of saturated fat that is also found in many types of meat is the most likely cause for the association of red meat and risk of diabetes, he said.

"Red meat is not the bad food that it is touted to be," Evans said. "There are many cuts of beef that are red and have as much fat as a chicken breast, and the redness in meat provides the most available form of iron from any food that we eat."

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Skipping Breakfast May Raise Diabetes Risk

Overweight women who ate morning meal had lower blood sugar, better insulin response in small study

By Kathleen Doheny

HealthDay Reporter

SUNDAY, June 16 (HealthDay News) -- Eating breakfast every day may help overweight women reduce their risk of diabetes, a small new study suggests.

When women skipped the morning meal, they experienced insulin resistance, a condition in which a person requires more insulin to bring their blood sugar into a normal range, explained lead researcher Dr. Elizabeth Thomas, an instructor of medicine at the University of Colorado.

This insulin resistance was short-term in the study, but when the condition is chronic, it is a risk factor for diabetes, Thomas said. She is due to present her findings this weekend at the Endocrine Society's annual meeting in San Francisco.

"Eating a healthy breakfast is probably beneficial," Thomas said. "It may not only help you control your weight but avoid diabetes."

Diabetes has been diagnosed in more than 18 million Americans, according to the American Diabetes Association. Most have type 2 diabetes, in which the body does not make enough insulin or does not use it effectively.

Excess weight is a risk factor for diabetes.

The new study included only nine women. Their average age was 29, and all were overweight or obese.

Thomas measured their levels of insulin and blood sugar on two different days after the women ate lunch. On one day, they had eaten breakfast; on the other day, they had skipped it.

Glucose levels normally rise after eating a meal, and that in turn triggers insulin production, which helps the cells take in the glucose and convert it to energy.

However, the women's insulin and glucose levels after lunch were much higher on the day they skipped breakfast than on the day they ate it.

On the day they did not eat breakfast, Thomas explained, "they required a higher level of insulin to handle the same meal."

"There was a 28 percent increase in the insulin response and a 12 percent increase in the glucose response after skipping breakfast," she said. That's a mild rise in glucose and a moderate rise in insulin, she noted.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"Their study doesn't prove causation," said Dr. Joel Zonszein, a professor of clinical medicine at the Albert Einstein College of Medicine and director of the Clinical Diabetes Center at Montefiore Medical Center, in New York City.

The study found only a link or association between breakfast skipping and higher insulin levels. More research is needed for confirmation, another expert said.

"This is a small, but very interesting, study," said Dr. Ping Wang, director of the University of California, Irvine, Health Diabetes Center. "The findings will have to be verified with larger studies."

Whether the effect is short-term or long-term is not known, Wang said.

Zonszein recommends against either skipping meals or eating very frequent meals, the so-called nibbling diet. "Studies done in Europe have shown that a large meal in the middle of the day is better than a large meal at dinner," he said.

However, he acknowledged that pattern is more of a habit in Europe than in the United States. Even so, he advises his patients to eat a good breakfast, a good lunch and a lighter dinner.

Other ways to reduce diabetes risk, according to the American Diabetes Association, are to control weight, blood pressure and cholesterol and to be physically active.

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Cities can learn lessons about diabetes from rural areas

Posted June 19, 2013, 11:00 am

City dwellers often think of rural America as a throwback to past “good old days.” But when it comes to obesity and diabetes, people living outside urban areas offer a frightening glimpse of the future.

Last week I had the opportunity to moderate a panel discussion on rural health, sponsored by the Association for Health Care Journalists (AHJC) in Birmingham, Alabama. The discussion highlighted troubling statistics on diabetes, raised some knotty issues, and explored creative solutions.

More than 8% of Americans now have diabetes, a percentage that’s expected to grow along with our waistlines. Diabetes is already the nation’s leading cause of kidney failure, non-traumatic limb amputation, and new cases of blindness. It’s the seventh leading cause of death, and would rank higher if deaths from heart disease accelerated by underlying diabetes were included. What would a much higher diabetes rate look like?

The answer lies just outside nearly every metropolitan area in the diabetes belt that extends across the Southeastern United States. Surrounding Birmingham, Alabama, for example, are several rural counties where about 20% of people have diabetes.

“Diabetes is definitely not distributed evenly across the country,” said Dr. Andrea L. Cherrington, associate professor at the University of Alabama at Birmingham (UAB), pointing to a CDC county-level map of diabetes prevalence. It’s not just rural versus urban, Dr. Cherrington added. Urban areas in the diabetes belt have higher rates of diabetes than urban areas outside of the diabetes belt.

Dr. Cherrington next pointed to a map showing the U.S. counties with the highest levels of obesity. The map looks nearly identical to the diabetes map. The answer to obesity is better nutrition and more exercise. What makes it more difficult to manage weight in rural communities?

The answer to that question will look familiar to anyone who’s been to the less-advantaged parts of any U.S. town or city: barriers to health. These include:

Limited access to health care, especially to specialists such as endocrinologistsMinimal exposure to diabetes educationLimited access to safe sidewalks, exercise facilities, and grocery stores with affordable produce.High rates of poverty.

Such barriers get in the way of exercising, eating a healthy diet, and other healthy lifestyle choices. They also lead to obesity and its many consequences.

“It’s not easy living with diabetes,” Dr. Cherrington said, noting that disease management requires mastering a complex schedule of medications, exercise, self-care, and doctor appointments. “If you overlay this regimen on these barriers to health, it becomes really challenging. If you don’t have resources, it is easy to see how disparity can exist.”

Battling the obesity epidemic has been the life work of panelist Bonnie A. Spear, professor of pediatrics at the University of Alabama, Birmingham, and a nationally recognized expert in child and adolescent obesity.

Spear noted that overweight and obese children and teens tend to become obese adults. Obese children who become obese adults are at extremely high risk of developing diabetes and other chronic conditions.

Too often, Spears argued, we fuss over details such as whether schools should offer chocolate milk rather than whether schools should be allowed to make money from on-campus vending machines, which often sell sugary soft drinks and snacks. Too often, she said, we worry about the cost of providing breakfast and lunch to too many kids when missed breakfast and poor nutrition are linked to lower test scores and difficulty concentrating. And when we worry that U.S. kids are falling behind in academics, physical education classes are the first thing to go—even though fit kids do better at academic subjects than unfit kids. Creating healthy school environments is crucial for preventing obesity and diabetes in the next generation of adults.

When it comes to adults who have diabetes today, one key problem is the lack of primary care physicians. While cities have too few of them, noted Dr. William Curry, associate dean for primary care and rural medicine at the University of Alabama, Birmingham,  the problem often is worse in rural areas, particularly for those who lack transportation.

Part of the answer may be community health workers, Dr. Cherrington suggested. Her work shows that community health workers—lay people trained to provide diabetes education and outreach—can have a major impact on the wellbeing of people with diabetes living in rural areas.

That work has turned her attention to cities, as she now leads Birmingham’s Cities for Life program. Led by the American Academy of Family Physicians, the program borrows from the rural community health worker concept by having doctors refer people with diabetes to “patient navigators” who help them find local resources such as nearby exercise classes or mobile farmers’ markets.

In addition to the clinical component of the program, its community component makes use of a community action team made up of more than 80 organizations drawn from local primary care, health, civic, business, and charitable organizations. A major part of this effort is the mydiabetesconnect.com website, which shows people where to find resources in their own neighborhoods.

Will it work? The program is just a year old, but Dr. Cherrington believes Birmingham eventually will become a model for diabetes control—in both urban and rural areas.

County-by-county maps of diabetes and obesity in the United States prepared by the Centers for Disease Control and Prevention. The darker the color, the higher the rate of obesity or diabetes.

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Blood Test Might Predict Type 1 Diabetes in Children, Study Finds

Evidence of two autoantibodies signaled a 70 percent risk, researchers say

By Serena Gordon

HealthDay Reporter

TUESDAY, June 18 (HealthDay News) -- A diagnosis of type 1 diabetes often seems to come out of the blue. But German researchers say they can predict who will likely develop the chronic disease.

Blood samples taken from children at increased genetic risk of type 1 diabetes reveal significant "preclinical" clues, the researchers found. The strongest predictor is the presence of two diabetes-related autoantibodies, they reported in the June 18 issue of the Journal of the American Medical Association.

"If you have two or more autoantibodies, it's nearly inevitable that you will develop the disease. Most people -- even physicians -- don't appreciate this risk," said Dr. Jay Skyler, deputy director for clinical research at the Diabetes Research Institute and a professor at the University of Miami Miller School of Medicine. Skyler was not involved in the research.

Nearly 70 percent of youngsters with two diabetes-related autoantibodies developed type 1 diabetes over a 10-year period compared to less than 15 percent of kids with just one autoantibody, the researchers found.

Skyler, co-author of an accompanying journal editorial, said this study highlights the need for effective prevention strategies for type 1 diabetes.

Type 1 diabetes is believed to be an autoimmune disease in which the body's immune system mistakenly destroys the insulin-producing beta cells in the pancreas. Insulin is a hormone needed to turn the carbohydrates from food into fuel for the body.

To survive, people with type 1 diabetes must monitor their food intake and replace the lost insulin through injections or an insulin pump.

Type 1 diabetes can occur at any age, and there's currently no known way to prevent or cure it, according to the JDRF (formerly the Juvenile Diabetes Research Association). And unlike its more common counterpart, type 2 diabetes, the development of type 1 diabetes isn't linked to lifestyle choices.

The current study included children from Colorado, Finland and Germany who were followed from birth for as long as 15 years. Children in the Colorado and Finland study groups were included in the study if they had a specific genotype that indicated a genetic predisposition to developing type 1 diabetes. Children in the German study had to have a parent with type 1 diabetes to be included in the study.

More than 13,000 youngsters were recruited in all. During the study follow-up, the researchers found that nearly 1,100 children -- or about 8 percent of the total group -- developed one or more autoantibodies, which are markers for the destruction of the insulin-producing beta cells in the pancreas.

The vast majority of the children, despite their higher risk, remained free of type 1 diabetes and free of signs that the disease might develop.

"Autoantibodies are a marker for the risk of diabetes. [But] they are just markers; they are not causing the disease," said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

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Short Strolls After Meals May Lower Diabetes Risk

Walking 15 minutes three times a day was better for blood sugar levels than one 45-minute walk, small study found

By Kathleen Doheny

HealthDay Reporter

WEDNESDAY, June 12 (HealthDay News) -- Older adults at risk for getting diabetes who took a 15-minute walk after every meal improved their blood sugar levels, a new study shows.

Three short walks after eating worked better to control blood sugar levels than one 45-minute walk in the morning or evening, said lead researcher Loretta DiPietro, chairwoman of the George Washington University School of Public Health and Health Services in Washington, D.C.

"More importantly, the post-meal walking was significantly better than the other two exercise prescriptions at lowering the post-dinner glucose level," DiPietro added.

The after-dinner period is an especially vulnerable time for older people at risk of diabetes, DiPietro said. Insulin production decreases, and they may go to bed with extremely high blood glucose levels, increasing their chances of diabetes.

About 79 million Americans are at risk for type 2 diabetes, in which the body doesn't make enough insulin or doesn't use it effectively. Being overweight and sedentary increases the risk. DiPietro's new research, although tested in only 10 people, suggests that brief walks can lower that risk if they are taken at the right times.

The study did not, however, prove that it was the walks causing the improved blood sugar levels.

"This is among the first studies to really address the timing of the exercise with regard to its benefit for blood sugar control," she said. In the study, the walks began a half hour after finishing each meal.

The research is published June 12 in the journal Diabetes Care.

For the study, DiPietro and her colleagues asked the 10 older adults, who were 70 years old on average, to complete three different exercise routines spaced four weeks apart. At the study's start, the men and women had fasting blood sugar levels of between 105 and 125 milligrams per deciliter. A fasting blood glucose level of 70 to 100 is considered normal, according to the U.S. National Institutes of Health.

The men and women stayed at the research facility and were supervised closely. Their blood sugar levels were monitored the entire 48 hours.

On the first day, the men and women did not exercise. On the second day, they did, and those blood sugar levels were compared to those on the first day.

The men and women were classified as obese, on average, with a body-mass index (BMI) of 30. The men and women walked on a treadmill at a speed of about three miles an hour (a 20-minute mile, which DiPietro described as the lower end of moderate).

The walks after meals reduced the 24-hour glucose levels the most when comparing the sedentary day with the exercise day.

A 45-minute morning walk was next best.

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New Diabetes Drug Expected This Week

April 11, 2013 -- A new oral diabetes drug is expected to arrive on pharmacy shelves in the U.S. this week.

Many people predict that Invokana (canagliflozin), approved by the FDA in March, will be a brisk seller. That's partly because it treats type 2 diabetes in a new way.

It’s also because Invokana not only helped patients improve blood sugar control, but also lose weight and control their high blood pressure, according to maker Janssen Pharmaceutical Companies.

Losing weight can help people control their diabetes.

In one 26-week study, those on Invokana lost about 6 to 8 pounds, while those in the placebo group lost only about a pound. 

But the drug has side effects, including infections of the urinary tract, penis, and vagina. This leads some experts to have less enthusiasm for the new medicine. 

It will also cost a lot more than other diabetes drugs. The wholesale cost for Invokana is $8.77 a pill, according to Katie Mahony, a spokeswoman for Janssen. Retail cost for the 100-milligram starting dose, without co-pays or coverage, is about $10 a pill, or $300 a month.

The popular diabetes drug metformin can cost as little as 25 cents a pill.

"It's another way to control diabetes without injections," says Anthony McCall, MD. He is the James M. Moss Professor of Medicine at the University of Virginia School of Medicine in Charlottesville. He was not involved in the development of the new drug.

A new pill is welcome, McCall says, for some of the estimated 24 million Americans with type 2 diabetes, especially as an alternative to injecting insulin.

"People do have strong feelings about injectable medications," he says. However, he and other experts say they don't expect Invokana to replace other drugs, but rather to offer another option.

In type 2 diabetes, the body doesn’t make enough insulin or doesn't use it properly. As a result, blood sugar (glucose) levels rise, leading to complications such as heart disease, kidney damage, and nerve problems.

Invokana works by blocking glucose from being reabsorbed by the kidneys. That raises the amount of glucose urinated, and lowers the amount of glucose in your blood. 

The new drug is known as a selective sodium glucose co-transporter inhibitor, or SGLT2. Other drug companies are also working on this type of drug.

Other diabetes drugs work in differently. Some lower the amount of glucose made by the liver, while others stimulate the pancreas to release more insulin. And still many others work in different ways.

While Invokana isn't expected to replace other diabetes drugs, ''it's certainly promising," says Aaron Cypess, MD, PhD, of the Joslin Diabetes Center and an assistant professor of medicine at Harvard Medical School. "It's a mechanism we understand and that makes sense."

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FDA Panel Votes to Change Tight Restrictions on Diabetes Drug Avandia

Controversial decision comes after a second look at major data review focused on heart risks

By Dennis Thompson

HealthDay Reporter

THURSDAY, June 6 (HealthDay News) -- An expert advisory panel to the U.S. Food and Drug Administration voted narrowly Thursday to recommend changing tough safety restrictions on the diabetes drug Avandia, which was all but banned nearly two years ago because of reported links to heart problems.

The panel's decision came after a review of data that suggested the medication might not be as harmful as once thought.

However, because of initial concerns over cardiovascular safety, Avandia had been taken off drugstore shelves and its use restricted to patients who first signed a waiver saying they understood the possible risks. The drug was also dispensed only through specially registered pharmacies.

But the new recommendation might change all that. Thirteen members of the 26-person panel voted to alter the safety restrictions, the Associated Press reported, while seven voted to remove the restrictions altogether. Five panelists voted to keep the restrictions in place, while one panelist voted to withdraw Avandia from the marketplace.

The exact nature of any changes to current restrictions are yet to be decided. The FDA is not obligated to follow its advisory panels' decisions, but it usually does.

The panelists spent the past two days reconsidering evidence from an independent review by Duke University researchers of Avandia's original clinical trial, called RECORD. That review did uncover some previously unreported cases of heart complications and deaths, but the Duke team concluded that those cases did not significantly raise the overall risk of heart disease.

"I'm considerably reassured, in light of the reanalysis, that the magnitude of risk we're talking about here is not very great," Dr. Dale Hammerschmidt, of the University of Minnesota, who voted on Thursday to modify the safety limits, told the AP.

The drug's maker, GlaxoSmithKline, which had funded the Duke review, said it was satisfied with the panel's decision.

"We appreciate the committee's thorough examination of the RECORD results and will continue to work with the FDA as it considers the recommendation of the committee," the company's chief medical officer, Dr. James Shannon, said in a statement. "We continue to believe that Avandia is a safe and effective treatment option for type 2 diabetes when used for the appropriate patient and in accordance with labeling."

Not everyone is likely to be so pleased. The FDA's reconsideration of Avandia's safety has prompted stinging criticism from the drug's detractors, who say the agency is trying to save face following a very public embarrassment over the drug.

"This is a drug that has essentially been off the market in almost the entire world for the last three years. It has been banned in most countries, and is available in the United States under such strict requirements that only 3,000 patients now take it," said Dr. Steven Nissen, the Cleveland Clinic cardiologist who first led the charge against Avandia. "It's really about the FDA wanting to clean up its image, not about whether the drug is actually safe or unsafe."

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Even Mild Weight Loss May Lower Diabetes Risk in Obese Teens

Study worked with adolescents and their families to boost activity, healthy eating

By Robert Preidt

HealthDay Reporter

FRIDAY, June 7 (HealthDay News) -- Obese teens don't need to lose large amounts of weight to lower their risk of developing diabetes, according to a new study.

Researchers found that obese teens who reduced their body-mass index (BMI) by 8 percent or more had improvements in insulin sensitivity, a measure of how well the body processes insulin and an important risk factor for developing type 2 diabetes. BMI is a measurement of body fat based on height and weight.

"This threshold effect that occurs at 8 percent suggests that obese adolescents don't need to lose enormous amounts of weight to achieve improvements," study co-author Dr. Lorraine Levitt Katz, a pediatric endocrinologist at the Diabetes Center for Children at the Children's Hospital of Philadelphia, said in a hospital news release.

"The improvements in insulin sensitivity occurred after four months of participating in a lifestyle-modification program," Katz said.

The study included 113 teens, aged 13 to 17, whose average BMI at the start of the study was 37.1. People with a BMI of 35 to 40 are classified as severely obese. None of the teens had type 2 diabetes at the start of the study, but their obesity placed them at high risk to develop the disease in the future.

The teens were put on a weight-loss program that used family-based lifestyle changes. They and their parents were taught about healthy eating habits and encouraged to increase their levels of physical activity. The teens and their parents attended weekly group counseling sessions and the parents were encouraged to support their children's lifestyle changes and to be healthy-lifestyle role models.

The study, published online May 24 in the Journal of Pediatrics, reinforces the importance of lifestyle changes in helping teens lose weight, the researchers said.

They also noted that the 8 percent reduction in BMI needed to improve insulin sensitivity is "achievable" and easy for doctors to track.

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Stem Cell Therapy Cures Type 1 Diabetes in Mice

Whether the new approach would work in humans is unknown, experts say

By Serena Gordon

HealthDay Reporter

WEDNESDAY, June 5 (HealthDay News) -- Using an immune-suppressing medication and adult stem cells from healthy donors, researchers say they were able to cure type 1 diabetes in mice.

"This is a whole new concept," said the study's senior author, Habib Zaghouani, a professor of microbiology and immunology, child health and neurology at the University of Missouri School of Medicine in Columbia, Mo.

In the midst of their laboratory research, something unanticipated occurred. The researchers expected that the adult stem cells would turn into functioning beta cells (cells that produce insulin). Instead, the stem cells turned into endothelial cells that generated the development of new blood vessels to supply existing beta cells with the nourishment they needed to regenerate and thrive.

"I believe that beta cells are important, but for curing this disease, we have to restore the [blood vessels]," Zaghouani said.

It's much too early to know if this novel combination would work in humans. But the findings could stimulate new avenues of research, another expert says.

"This is a theme we've seen a few times recently. Beta cells are plastic and can respond and expand when the environment is right," said Andrew Rakeman, a senior scientist in beta cell regeneration at the Juvenile Diabetes Research Foundation (JDRF). "But, there's some work still to be done. How do we get from this biological mechanism to a more conventional therapy?"

Results of the study were published online May 28 in Diabetes.

The exact cause of type 1 diabetes, a chronic disease sometimes called juvenile diabetes, remains unclear. It's thought to be an autoimmune disease in which the body's immune system mistakenly attacks and damages insulin-producing beta cells (found in islet cells in the pancreas) to the point where they no longer produce insulin, or they produce very little insulin. Insulin is a hormone necessary to convert the carbohydrates from food into fuel for the body and brain.

Zaghouani said he thinks the beta cell's blood vessels may just be collateral damage during the initial autoimmune attack.

To avoid dire health consequences, people with type 1 diabetes must take insulin injections multiple times a day or obtain continuous infusions through an insulin pump. It's estimated that 3 million U.S. children and adults have the disease, which increased by almost one-quarter in Americans under age 20 between 2001 and 2009.

Zaghouani and his colleagues previously tested a drug called Ig-GAD2 that would destroy the immune system cells responsible for destroying the beta cells. The drug worked well to prevent type 1 diabetes, but it didn't work as a therapy when type 1 diabetes was more advanced.

"This made us question whether there were enough beta cells left when the disease is advanced," said Zaghouani. After conducting bone marrow transplants, the researchers came to a surprising conclusion. "The bone marrow cells did go to the pancreas, but they didn't become beta cells; they became endothelial cells," he said. "So, the problem wasn't a lack of beta cells or their precursor, the problem was that the blood vessels that irrigate the islet cells are damaged. That was a very novel and intriguing finding."

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FDA Approves 1st in New Class of Type 2 Diabetes Drugs

Title: FDA Approves 1st in New Class of Type 2 Diabetes Drugs
Category: Health News
Created: 3/29/2013 6:35:00 PM
Last Editorial Review: 4/1/2013 12:00:00 AM

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FDA Approves 1st in New Class of Type 2 Diabetes Drugs

Invokana works by blocking reabsorption of glucose in body

By Robert Preidt

HealthDay Reporter

FRIDAY, March 29 (HealthDay News) -- The first in a new class of type 2 diabetes drugs was approved Friday by the U.S. Food and Drug Administration.

Invokana (canaglifozin) tablets are to be taken, in tandem with a healthy diet and exercise, to improve blood sugar control in adults with type 2 diabetes.

Invokana belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. It works by blocking the reabsorption of glucose (sugar) by the kidney and increasing glucose excretions in urine, the FDA said in a news release.

"We continue to advance innovation with the approval of new drug classes that provide additional treatment options for chronic conditions that impact public health," Dr. Mary Parks, director of the division of metabolism and endocrinology products in the FDA's Center for Drug Evaluation and Research, said in the news release.

About 24 million Americans have type 2 diabetes, and it accounts for more than 90 percent of diabetes cases diagnosed in the United States, the FDA said. If blood sugar levels are not carefully controlled, there is an increased risk for serious complications, including heart disease, blindness, and nerve and kidney damage, the agency added.

The FDA approval is based on the findings of nine clinical trials involving more than 10,000 patients. Patients who took the drug showed improvement in hemoglobin A1c levels (a measure of blood sugar control) and fasting blood sugar levels.

Invokana should not be used by people with type 1 diabetes or people with type 2 diabetes who have increased ketones in their blood or urine (diabetic ketoacidosis), severe kidney disease, kidney failure or who are on dialysis, the FDA said.

The agency told drug maker Janssen Pharmaceuticals that it must conduct five post-approval studies of the drug to determine the risk of problems such as heart disease, cancer, pancreatitis, liver abnormalities and pregnancy complications.

The most common side effects of Invokana are vaginal yeast infections and urinary tract infections. It may also cause dizziness and fainting.

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After a Prediabetes Diagnosis: How to Prevent Diabetes

What to do to stop prediabetes from becoming diabetes.

Getting diagnosed with prediabetes is a serious wake-up call, but it doesn't have to mean you will definitely get diabetes. There is still time to turn things around.

“It’s an opportunity to initiate lifestyle changes or treatments, and potentially retard progression to diabetes or even prevent diabetes,” says Gregg Gerety, MD, chief of endocrinology at St. Peter’s Hospital in Albany, N.Y.

Making these seven changes in your daily habits is a good way to start.

Becoming more active is one of the best things you can do to make diabetes less likely.

If it's been a while since you exercised, start by building more activity into your routine by taking the stairs or doing some stretching during TV commercials, says Patti Geil, MS, RD, author of What Do I Eat Now?

“Physical activity is an essential part of the treatment plan for prediabetes because it lowers blood glucose levels and decreases body fat,” Geil says.

Ideally, you should exercise at least 30 minutes a day, five days a week. Let your doctor know about your exercise plans and ask if you have any limitations.

If you're overweight, you might not have to lose as much as you think to make a difference.

In one study, people who had prediabetes did 30 minutes a day of moderate exercise and lost 5% to 7% of their body weight (just 10-14 pounds in someone who weights 200 pounds) cut their chances of getting diabetes by 58%.

See your doctor every three to six months, Gerety says. 

If you're doing well, you can get positive reinforcement from your doctor. If it's not going so well, your doctor can help you get back on track. 

"Patients like some tangible evidence of success or failure," Gerety says.

Load up on fruits and vegetables, especially the less-starchy kinds such as spinach, broccoli, carrots, and green beans. Add more high-fiber foods into your day. Choose whole-grain foods instead of processed grains -- for example, brown rice instead of white rice.

Also, swap out high-calorie foods. “Drink skim milk rather than whole milk, diet soda rather than regular soda,” Geil says. “Choose lower-fat versions of cheese, yogurt, and salad dressings.”

Instead of snacking on high-fat, high-calorie chips and desserts, choose fresh fruit, or whole wheat crackers with peanut butter or low-fat cheese, Geil says.  

Not getting enough sleep  regularly makes losing weight harder, says Theresa Garnero, author of Your First Year With Diabetes.

A sleep shortfall also makes it harder for your body to use insulin effectively and may make type 2 diabetes more likely.

Set good sleep habits. Go to bed and wake up at the same time every day. Relax before you turn out the lights. Don't watch TV or use your computer or smartphone when you're trying to fall asleep. Avoid caffeine after lunch if you have trouble sleeping.

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Could Statins Raise Diabetes Risk?

Some popular brands associated with high blood sugar levels in study, but odds of problems are low

By Margaret Farley Steele

HealthDay Reporter

THURSDAY, May 23 (HealthDay News) -- Certain statins -- the widely used cholesterol-lowering drugs -- may increase your chances of developing type 2 diabetes, a new study suggests.

The risk was greatest for patients taking atorvastatin (brand name Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor), the study said.

Focusing on almost 500,000 Ontario residents, researchers in Canada found that the overall odds of developing diabetes were low in patients prescribed statins. Still, people taking Lipitor had a 22 percent higher risk of new-onset diabetes, Crestor users had an 18 percent increased risk and people taking Zocor had a 10 percent increased risk, relative to those taking pravastatin (Pravachol), which appears to have a favorable effect on diabetes.

Physicians should weigh the risks and benefits when prescribing these medications, the researchers said in the study, which was published online May 23 in the journal BMJ.

This does not, however, mean that patients should stop taking their statins, the experts said. The study also showed only an association between statin use and higher risk of diabetes; it did not prove a cause-and-effect relationship.

"While this is an important study evaluating the relationship between statins and the risk of diabetes, the study has several flaws that make it difficult to generalize the results," said Dr. Dara Cohen, a professor of medicine in the department of endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mount Sinai in New York City. "There was no data regarding weight, ethnicity and family history -- all important risk factors for the development of diabetes."

Cohen added that there was no information on the patients' cholesterol and blood sugar levels, and that higher-risk patients might automatically be prescribed stronger statins such as Lipitor, Crestor and Zocor.

Finnish doctors wrote in an accompanying editorial that this potential risk should not stop people from taking statins.

"The overall benefit of statins still clearly outweighs the potential risk of incident diabetes," researchers from the University of Turku said. Statins have been proven to reduce heart problems, they said, adding that the medications "play an important role in treatment."

Other statins did perform more favorably than Lipitor, Crestor and Zocor in terms of diabetes, the research found.

"Preferential use of pravastatin and potentially fluvastatin ... may be warranted," the study authors said in a journal news release, adding that Pravachol may even be beneficial to patients at high risk of diabetes. Fluvastatin (Lescol) was associated with a 5 percent decreased risk of diabetes and lovastatin (Mevacor) a 1 percent decreased risk.

In previous research, Crestor was associated with a 27 percent higher risk of diabetes, while Pravachol was linked to a 30 percent lower risk.

For this study, the researchers used patient information from three Canadian databases on 66-year-old men and women who were newly prescribed statins and followed for up to five years. Lipitor accounted for more than half of all new statin prescriptions, followed by Crestor, Zocor, Pravachol, Mevacor and Lescol.

The researchers said between 162 and 407 patients would have to be taking statins of various kinds for one extra patient to develop diabetes.

Results were similar for patients already diagnosed with heart disease and those taking statins to prevent it. Older patients using Lipitor and Zocor were at an increased risk regardless of dose, the researchers found.

People with type 2 diabetes have higher than normal blood sugar levels because their bodies don't make or properly use insulin. The researchers said it is possible that certain statins impair insulin secretion and inhibit insulin release, which could help explain the findings.

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Discovery could someday help people with diabetes make more insulin

Posted May 24, 2013, 3:11 pm

A lot is known about diabetes. But a discovery that could change how this disease is treated shows just how much more there is to learn.

A team of Harvard Medical School researchers has discovered a hormone made by liver and fat cells that signals the body to make more insulin-producing beta cells. A report of their work appears in this month’s issue of the prestigious scientific journal Cell.

For the team’s leader, Dr. Douglas Melton, research on the subject of diabetes is personal as well as professional. In 1993, his six-month-old son was diagnosed with type 1 diabetes. Since then Melton, who is co-director of the Harvard Stem Cell Institute, has turned his considerable research skills to learning how diabetes happens and how it might be cured.

In type 1 diabetes, the body’s immune system attacks the pancreas, a spongy little organ that sits below the stomach. The attack destroys insulin-producing cells in the pancreas, called beta cells. Without enough insulin, muscle cells can’t absorb sugar from the bloodstream. Sugar levels rise in the blood, causing havoc throughout the body. Untreated type 1 diabetes can be deadly. Even with treatment, usually daily injections of insulin, type 1 diabetes often leads to heart disease, vision problems, and nerve problems.

In the more common type 2 diabetes, the muscles resist that action of insulin, causing blood sugar to rise. As the pancreas churns out more and more insulin, the beta cells can eventually become burned out.

Over the years, Melton and his colleagues made a surprising discovery: the pancreas could make new beta cells, even in people with type 1 diabetes. “Old” pancreas cells can divide, forming young ones. Unfortunately, the pancreas isn’t naturally able to make enough new beta cells to make up for those killed by diabetes.

Melton and colleagues reasoned that there might be some chemical signal that prompts beta cells to divide and increase. The Cell paper details their search for and discovery of such a signal in mice. It’s a hormone the team called betatrophin. This hormone, made by liver and fat cells, travels through the blood to the pancreas. There, it prompts existing beta cells to grow and divide, making new beta cells.

In mice with diabetes, turning on the production of betatrophin by liver and fat cells caused an increase in beta cells and a dramatic improvement in blood sugar.

It will, of course, take much more research in mice—and then in humans—to determine if this newly discovered hormone can serve as a treatment for diabetes. So it’s too soon to get excited that the discovery of betatrophin will translate directly into a new treatment for diabetes.

This work is just the latest example of an even larger scientific discovery that has played out over the past two decades. We are learning that the human body has much greater power to naturally repair itself than we once imagined. Scientists all over the world are working to discover ways to stimulate the body’s own natural healing mechanisms, as Dr. Melton and colleagues are doing.

In the United States, this work and other important investigations are threatened by the “sequester,” which is cutting funding for medical research. It would be a shame for an important discovery like Melton’s to languish because of political infighting. Regardless of what you think about federal spending in general, if you share my view that we should not be cutting funding for health research and public health, you could do what I have done. Write your representatives in Congress to restore cuts in medical research.

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