Cyndrome

Archive for August, 2010

Women who don’t breastfeed their babies are more at risk of developing type-2 diabetes, the most common form of the disease, later in life than mothers who did.

“We have seen dramatic increases in the prevalence of type-2 diabetes over the last century,” said Eleanor Bimla Schwarz, assistant professor of medicine, epidemiology, and obstetrics, gynaecology at the University of Pittsburgh.

“Diet and exercise are widely known to impact the risk of type-2 diabetes, but few people realise that breastfeeding also reduces the mothers’ risk of developing the disease later in life by decreasing maternal belly fat,” said Schwarz, according to a Pittsburgh release.

The study included 2,233 women between the ages of 40 and 78. Overall, 56 percent of mothers reported they had breastfed an infant for at least one month, reports the American Journal of Medicine.

Twenty-seven percent of mothers who did not breastfeed developed type-2 diabetes or were almost twice more likely to develop the disease than women who had breastfed or never given birth.

Conversely, mothers who breastfed all of their children were not more likely to develop diabetes than women who never gave birth.

These long-term differences were notable even after considering age, race, physical activity, tobacco and alcohol use.

“Our study provides another good reason to encourage women to breastfeed their infants, at least for the infant’s first month of life,” Schwarz said.

“Clinicians need to consider women’s pregnancy and lactation history when advising women about their risk for developing type 2 diabetes,” she added.

Grapefruit could hold the key to tackling diabetes, a new study has found.

Naringenin, an antioxidant derived from the bitter flavor of grapefruits and other citrus fruits, may cause the liver to break down fat while increasing insulin sensitivity, a process that naturally occurs during long periods of fasting.

Scientists from the Hebrew University of Jerusalem and Massachusetts General Hospital (MGH) report that naringenin activates a family of small proteins, called nuclear receptors, causing the liver to break down fatty acids.

In fact, the compound seems to mimic the actions of other drugs, such as the lipid-lowering Fenofibrate and the anti-diabetic Rosiglitazone, offering the advantages of both.

If the results of this study extend to human patients, this dietary supplement could become a staple in the treatment of hyperlipidemia, type-2 diabetes, and perhaps metabolic syndrome.

“It is a fascinating find. We show the mechanism by which naringenin increases two important pharmaceutical targets, PPARa and PPAR?, while blocking a third, LXRa. The results are similar to those induced by long periods of fasting,” said Yaakov Nahmias, of the Hebrew University of Jerusalem the paper’s senior author.

Scientists are examining whether a diet rich in certain types of fibre can suppress hunger and improve the body’s ability to control blood sugar levels.

Foods such as garlic, chicory, asparagus and artichokes are known as fermentable carbohydrates, which are thought to activate the release of gut hormones that reduce appetite.

They also enhance sensitivity to insulin – the hormone produced by the pancreas that allows glucose to enter the body’s cells – thereby leading to better glucose control, it is believed.

The charity Diabetes UK is now funding research into the health benefits of such foods. If proved to be effective, the findings could revolutionise treatments for obesity and type 2 diabetes.

Nicola Guess, a dietitian at Imperial College, London, who is leading the three-year study, said: “By investigating how appetite and blood glucose levels are regulated in people at high risk of Type 2 diabetes, it is hoped that we can find a way to prevent its onset.

“If successful, this study will be able to determine whether fermentable carbohydrates could provide the public with an effective and affordable health intervention to reduce an individual’s risk of developing diabetes.”

There are 2.35 million people diagnosed with type 2 diabetes in Britain, and a further half a million sufferers who are unaware that they have the condition. If left untreated, it can lead to complications such as kidney failure, heart disease, stroke and amputation.

Research by the University of Leicester, published last week, suggests that eating green leafy vegetables could help cut the risk of type 2 diabetes.

Broccoli, kale, spinach, sprouts and cabbage can reduce the risk by 14 per cent when eaten daily, according to the study published in the British Medical Journal.

The vegetables are rich in antioxidants and magnesium, which has been linked to lower levels of diabetes.

According to CDC investigators, the prevalence of diabetes in the U.S. has risen by about 5 percent annually since 1990 and today about 24 million Americans have the disease. Researchers based at the University of Chicago say if the current trend continues, the number of diabetes cases will nearly double in the next 25 years, climbing from the current 23.7 million to about 44.1 million in 2034. At the same time, the cost of treating people with diabetes is expected to triple, rising from an estimated $113 billion $336 billion. “If we don’t change our diet and exercise habits or find new, more effective and less expensive ways to prevent and treat diabetes, we will find ourselves in a lot of trouble as a population,” said the study’s lead author Dr. Elbert Huang.

Because Type 2 diabetes is considered an obesity-related condition, it makes sense that losing weight can improve, and in some cases eliminate the diabetes altogether. Whether it is diet and/or exercise or weight loss surgery that does the trick, there are ways to lower the incidence of diabetes. And studies show that both lifestyle changes and surgery are effective means of treatment of the condition, and can lower health care costs in the process.

A recent study out of Johns Hopkins University School of Medicine found that nearly 75% of patients who underwent bariatric surgery for weight loss eliminated their diabetes medications within six months and almost 85% of patients remained off diabetes medications two years later.

The study not only found that that the diabetes could be conquered, but that health care costs could be dramatically reduced with weight loss surgery, particularly over the long haul. The average cost of treating each patient before surgery was $6,376 up to two years before surgery, which increased to $10,592 in the year leading up to surgery. In the year following weight loss surgery, the average cost per patient was $6,992, fell to $4,197 in the second year, and fell even further to $1,878 three years after surgery.

A previous 2008 study, funded by Johnsons & Johnson and appearing in the American Journal of Managed Care, showed that the average monthly medical costs for the people who had laparoscopic bariatric surgery were approximately $900 lower than those people who did not, roughly a year after the procedure. Those participants in the study who had the surgery showed a decrease in medical conditions common to obese patients, such as hypertension, diabetes, and sleep apnea.

If you are looking for a weight loss plan that does not include weight loss surgery, visit the HealthNews diet pages and test out our Individual Diet Selection tool, which can help find the right diet for you lifestyle.

Although an estimated 7.8 percent of Americans have been diagnosed with diabetes, patients with this metabolic disease rack up 23 percent of hospital costs nationwide, a new federal analysis finds. Their collective hospital bill in 2008, the most recent year for which data were available: almost $83 billion.

The average hospital stay for someone with diabetes averages roughly a day longer (5.3 days) than in someone free of the disease. And that stay costs about $10,940 — or roughly $2,200 more than the average for people without the disease, according to Taressa Fraze and her colleagues at the Agency for Healthcare Research and Quality. Her group has synopsized its findings in an August statistical brief issued by their agency, a division of the Department of Health and Human Services.

Only about one in 14 hospital stays identified diabetes as the primary cause for a patient’s admission. Many people were instead hospitalized for conditions that could — and probably were — fostered by diabetes, such as impaired circulation or heart disease. Or patients may have landed in the hospital with conditions (such as poor wound healing) that had been exacerbated by their disorder.

Indeed, Fraze’s group observes, circulatory disorders — congestive heart failure, hardening of the arteries, heart attacks, nonspecific chest pain and abnormal pacing of heart beats — constitute five of the top 10 reasons for people with diabetes to be hospitalized.

The new analysis finds that people with diabetes also tend to have an average of 2.6 additional and potentially complicating illnesses — twice the number typically seen in people without the disorder. Chief among these additional conditions is high blood pressure, followed by fluid and electrolyte disorders, chronic pulmonary disease, anemia, kidney failure and obesity.

Rates of hospitalization for diabetics differs by income bracket, with the most well-heeled patients being admitted at a rate of 1,762 per 100,000 — a little more than half the rate typical of the poorest diabetics. Hospitalization rates also vary by region, with the highest prevalence in the South and Northeast, and lowest in the West.

Everyone pays the cost of these hospitalizations through tax dollars (for Medicare, which covered 60 percent of diabetics’ hospitalizations in 2008) and higher premiums for private insurance. So it behooves all of us to help fight the development of this disease within our own households (through exercise, weight management and healthy diets) and to encourage it in older at-risk family and friends.

And if someone we know is diagnosed with the disease, we must remind them to remain vigilant so that they can catch complications early. I have an otherwise robust diabetic family member who ignored a tiny toe infection, last year, and ended up hospitalized on and off for the better part of 6 months with IV-antibiotics and near-daily wound treatment.

His costs were astronomical, although paid almost entirely by insurance and Medicare. So for him, the direct fiscal costs were not an issue. But being laid up for half a year by what initially seemed an inconsequential infection stunned him and frightened his wife and kids.

Because most people with diabetes don’t know it, both the medical community and the public need to reach out and encourage monitoring for hints of the disease. And we must all encourage assiduous monitoring for infections and other co-morbidities among those we know whose bodies no longer remain sensitive to blood sugar levels.

With health care costs spiraling out of control, here is one way we can all work to control them — and keep diabetic friends and family at home and symptomfree.

A team from the University of Leicester, led by Professor Melanie Davies from the Department of Cardiovascular Sciences and Professor Kamlesh Khunti from the Department of Health Sciences, has developed an easy way for people to assess their risk of having diabetes.

Working in partnership with Diabetes UK, the largest diabetes charity in the country, and University Hospitals of Leicester NHS Trust, they have produced the first diabetes risk assessment that can be used in a multi-ethnic population.

The Diabetes Risk Score uses 7 questions to identify how high a risk someone is of getting diabetes. These are age, ethnicity, sex, family history of diabetes, waist size, body mass index and any history or treatment for high blood pressure. Answering these does not tell someone whether they have diabetes, just what their risk of having it is. Their GP needs to be seen to provide a firm diagnosis.

Professor Davies, Honorary Consultant Physician in Diabetes at University Hospitals of Leicester NHS Trust, said: “There are an estimated 2.6m people in England with diabetes with 500,000 of them not diagnosed. The impact of diabetes on individuals and their families can be profound. The costs to the NHS are also significant with diabetes prescriptions alone costing £500m a year. I, and my team, are proud that the Diabetes Risk Score will enable people to quickly and easily find out what their chance of having diabetes is and take action accordingly. The earlier diabetes is diagnosed the earlier effective treatment can start.”

Leicester faces a significant challenge from diabetes with recent evidence indicating that overall 10% of the population has diabetes and this is even higher in the South Asian community. The use of the Diabetes Risk Score will be particularly useful to that community. It also makes this Leicester diabetes research even more relevant to the local community.

The Diabetes Risk Score is already being used in a number of other studies to identify people at high risk of diabetes and encourage them to see their doctor. “

An easy way for people to assess their risk of having diabetes has been developed by a team from the University of Leicester.

Working in partnership with Diabetes UK, the largest diabetes charity in the country, and University Hospitals of Leicester NHS Trust, they have produced the first diabetes risk assessment that can be used in a multi-ethnic population.

The Diabetes Risk Score uses 7 questions to identify how high a risk someone is of getting diabetes.

These are age, ethnicity, sex, family history of diabetes, waist size, body mass index and any history or treatment for high blood pressure.

Answering these does not tell someone whether they have diabetes, just what their risk of having it is. Their GP needs to be seen to provide a firm diagnosis.

Professor Melanie Davies, HonoraryConsultant Physician in Diabetes at University Hospitals of Leicester NHS Trust, said: “There are an estimated 2.6m people in England with diabetes with 500,000 of them not diagnosed. The impact of diabetes on individuals and their families can be profound. The costs to the NHS are also significant with diabetes prescriptions alone costing £500m a year. I, and my team, are proud that the Diabetes Risk Score will enable people to quickly and easily find out what their chance of having diabetes is and take action accordingly. The earlier diabetes is diagnosed the earlier effective treatment can start.”

Xinzhi Zhang MD, PhD, of the CDC, and colleagues conducted a study to determine the most recent prevalence and risk factors of diabetic retinopathy in the older U.S. population. The study included an analysis of data from the National Health and Nutrition Examination Survey 2005-2008 and included 1,006 individuals.

Diabetes was defined as self-reported disease (excluding gestational diabetes) and/or HbA1c level of 6.5% or greater. Photographs were taken of each eye to determine and classify diabetic retinopathy.

From 2005 to 2008, the estimated prevalence of diabetic retinopathy was 28.5% and vision-threatening diabetic retinopathy was 4.4% among people with diabetes aged 40 years and older. When examined by sex, 31.6% of men and 25.7% of women with diabetes had diabetic retinopathy.

Further, 26.4% of whites, 38.8% of blacks and 34% of Mexican Americans with diabetes had diabetic retinopathy. About 3.2% of whites, 9.3% of blacks and 7.3% of Mexican Americans with diabetes had vision-threatening diabetic retinopathy.

Further analysis indicated that independent risk factors for diabetic retinopathy included male sex (38.1% vs. 27.1%), higher HbA1c level, longer diabetes duration, use of insulin (47.4% vs. 26.7%) and higher systolic blood pressure.

According to the researchers’ estimations, diabetes-related blindness costs the United States about $500 billion per year.

“These estimates provide policy makers updated information for use in planning eye care services and rehabilitation. With the aging of the population and the increasing proportion of the population with diverse racial/ethnic heritage, the number of cases of diabetic retinopathy and vision-threatening diabetic retinopathy will likely increase. Furthermore, the need for eye care and for culturally appropriate interventions that can reduce disparity and improve access to eye care among diverse populations is also likely to increase,” the researchers concluded.

Nearly 30 percent of U.S. adults with diabetes over the age of 40 are estimated to have diabetic retinopathy, with about four percent of this population having vision-threatening retinopathy, according to a study to be published on Wednesday in the Journal of the American Medical Association.

Diabetic retinopathy (damage to the retina caused by complications of diabetes mellitus) is the leading cause of new cases of legal blindness among adults 20 to 74 years of age in the United States. Diabetes-related blindness costs the United States approximately 500 million dollars annually, according to background information in the article.

“Investigating the prevalence of diabetic retinopathy is important because it is a key indicator of systemic diabetic microvascular complications, and as such, a sentinel indicator of the impact of diabetes,” the authors write.

Researchers at the U.S. Centers for Disease Control and Prevention conducted a study to determine the most recent prevalence and risk factors of diabetic retinopathy in the U.S. population aged 40 and older. The study included an analysis of data from a nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 and included 1, 006 individuals.

Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A1c (a form of hemoglobin used primarily to identify the average plasma glucose concentration) of 6.5 percent or greater. Photographs were taken of each eye to determine and classify diabetic retinopathy. Prevalence estimates were weighted to represent the civilian, noninstitutionalized U.S. population 40 years of age and older.

The researchers found that from 2005-2008 the estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5 percent and 4.4 percent, respectively, among persons with diabetes aged 40 and older. Approximately 31.6 percent of men and 25.7 percent of women with diabetes had diabetic retinopathy.

Further analysis indicated that independent risk factors for diabetic retinopathy include male sex, higher hemoglobin A1c level, longer diabetes duration, use of insulin, and higher systolic blood pressure.

“These estimates provide policy makers (with) updated information for use in planning eye care services and rehabilitation. With the aging of the population and the increasing proportion of the population with diverse racial/ethnic heritage, the number of cases of diabetic retinopathy and vision- threatening diabetic retinopathy will likely increase,” the authors conclude.

Meet Johnny, a middle-aged employee who has a busy life with no room for complications. He has been taking medications since he was diagnosed with type 2 diabetes few years ago but he is now starting to lose his battle against glycaemic control and for the first time his blood glucose is higher than 7.0 percent.

Diabetes (diabetes mellitus) is a serious, lifelong disease and is a disorder of metabolism — the way our body uses the food we eat for growth and energy. Most of the food we consume is broken down to glucose, the main form of sugar in the blood.

Glucose is our body’s primary energy source. After digestion, glucose passes into the bloodstream where it is used by cells for growth and energy. Insulin, a hormone that is produced by the pancreas, must be present in order for glucose to get into our cells. When we eat, the pancreas produces the right amount of insulin to act as carriers to deliver glucose to our cells.

In people with diabetes, the pancreas produces either little or no insulin, or the cells do not respond appropriately to the insulin being produced.  Glucose builds up in the blood, overflows into the urine and passes out of the body, thus, the body loses its main energy fuel.  The cause of diabetes continues to be investigated, and both genetic and environmental factors such as obesity and sedentary lifestyle appear to play a role.

Diabetes is associated with long-term complications that affect almost every part of the body and may lead to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage.

Patients like Johnny are in need of extra help, and gladly, people at AstraZeneca and Bristol-Myers Squibb have introduced the new DPP-4 inhibitor saxagliptin, a prescription medicine for type 2 diabetes mellitus to improve glycemic control in combination with other prescription such as metformin as an intial combination therapy, paired with diet and exercise.

For people like Johnny, the risk of developing diabetes complications such as kidney failure, heart attack and stroke among others run high.  It is a sad fact that more than half of Filipino patients with type 2 diabetes are unable to achieve optimal blood sugar control with their lifestyle modification such as diet and exercise, thus requiring additional medications.

“Saxagliptin is a welcome addition to the current range of oral anti-diabetes drugs and can help provide that added control some patients may need,” said Dr. Leilani Mercado-Asis, President of Philippine Society of Endocrinology and Metabolism.

In a country such as the Philippines, with its growing population, the ratio of type 2 diabetes is around seven to one, so given that our country has 92 million inhabitants, people with type 2 diabetes can be pegged somewhere between 5.5 to 6.5 million, a very scary number.

According to Dr. Araceli Panelo, executive director of UERMMMC-Institute for Studies on Diabetes Foundation (ISDF), the management of diabetes is now much better compared to the last decades.

“With the increased awareness for disease prevention and the importance of lifestyle change, patients are now better informed and really work towards improving their diabetes condition,” said Dr. Panelo.

For people at risk of developing diabetes complications, the key is to keep blood sugar levels within the normal parameters. Saxagliptin belongs to a novel class of oral anti-diabetec drugs called DPP-4 inhibitors. DPP-4 is an enzyme that inactivates the natural hormones in the body called incretin.

Incretins decrease elevated blood sugar or glucose by increasing the body’s utilization of sugar, mainly through increasing insulin production in the pancreas, and by reducing the liver’s production of glucose.  The US Food and Drug Administration (FDA) approved saxagliptin in July 2009 based on results of clinical studies involving 5,000 patients, more than 4,000 of whom received saxagliptin while the remaining participants received placebos.

This new type 2 diabetes drug has been approved by FDA Philippines in May 2010.  Astra Zeneca is the sole marketing company for saxagliptin in the Philippines.  And for patients like Johnny, extra help is at hand in his fight to reach glycemic goals.