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Could Artificial Sweeteners And Diet Soda Also Lead To Diabetes?

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Artificial sweeteners may have zero calories, but do they offer zero additional risk for developing diabetes? Well, if you attended a presentation at the Experimental Biology 2018 conference in San Diego, you may say, rats, the risk may be far from zero.

To be fair, nothing has zero health risk. Even though eating broccoli in general is quite healthy, you could still bludgeon yourself with broccoli, and eating huge amounts of broccoli could lead to obesity as well as some serious gas and loss of friends. However, the main advertised benefit of artificial sweeteners, such as those in diet soda, is that they don’t contain the calories and the accompanying obesity, diabetes, and other health-related risks of sugar.

The study presented by Brian Hoffmann, George Ronan, and Dhanush Haspula from the Medical College of Wisconsin suggested that things may not be that sweet for artificial sweeteners. They did a combination of in vitro (which essential means inside a test tube or similar equipment) and in vivo (meaning in a live animal) experiments using rats that were specially designed to be more susceptible to developing diabetes. For the in vitro experiments, the research team placed cells from the inside lining of the rats’ small blood vessels into test tubes and exposed these cells to either sugar or a common artificial sweetener. Why the inside lining of blood vessels? Well, one of the effects of diabetes is to cause damage to small blood vessels, which then results in many of the complications of diabetes such as loss of eyesight, kidney function, and blood circulation to various parts of the body.

The in vitro experiments found that both sugars and artificial sweeteners interfered with glycosylation, a key step in which sugars are added to proteins that then affects how the proteins function. Therefore, messing up glycosylation could affect a number of functions that various proteins perform in the cells. The research team did find that sugar and artificial sweeteners seemed to affect the expression of different genes differently, which implies that the way that they affect glycosylation may be different. Nonetheless, the fact that both disrupt this key biochemical process raises concerns.

The second in vivo part of the study involved dividing rats into separate groups and feeding each group high doses of either a sugar (glucose or fructose) or an artificial sweetener (aspartame or acesulfame potassium) for 3 weeks. They then took blood samples from the rats and found that both sugar and artificial sweeteners affected the concentrations of fat, amino acids, and other biochemicals in their blood. In other words, in just 3 weeks, both sugar and artificial sweeteners seemed to be disrupting the way fats and proteins were being processed.

In a press release, Hoffmann said, “Despite the addition of these non-caloric artificial sweeteners to our everyday diets, there has still been a drastic rise in obesity and diabetes. In our studies, both sugar and artificial sweeteners seem to exhibit negative effects linked to obesity and diabetes, albeit through very different mechanisms from each other.”

Of course, this was a presentation at a scientific meeting rather than a peer-reviewed publication in a scientific journal. So we’ll have to wait until a subsequent publication (assuming that it makes it through the scientific peer-review process for a respectable journal) provides more details about the experiments and results before more rigorously evaluating how well the study was done. Also, as I have said before, there are humans who are rats. But rats are not humans. What happens in a rat may stay in a rat. Meaning that humans may handle artificial sweeteners differently. Moreover, the study showed changes that may be related to eventually developing diabetes but did not yet prove that the rats would develop diabetes. Running the experiment for longer periods of time may help offer better proof.

Nevertheless, you may want to be cautious about artificial sweeteners and use moderation if you must consume anything with them. Don’t start drinking diet soda like it’s water when you could instead drink, well, water (meaning why not just drink water and not water from a well, which you shouldn’t drink unless you are sure that it’s clean.) The jury is still out on what the health risks of artificial sweeteners may be. They are designed to trick the body to thinking food or drink has sugar when it really doesn’t. But are such tricks for kids or adults? Do we completely know what tricking the body may ultimately do? As Julia Calderone summarized for Consumer Reports, large population studies have found associations between regular diet soda consumption and increased risk of obesity, type 2 diabetes, stroke, heart attack, and other cardiovascular conditions.

 

More studies, especially clinical trials and laboratory studies are needed. There are still a lot of “buts” associated with artificial sweeteners, meaning “but” with a single “t.” Although, many butts could be on the line if there are indeed health concerns with diet sodas and artificial sweeteners.

For the original article click here: https://www.forbes.com/sites/brucelee/2018/04/23/could-artificial-sweeteners-and-diet-soda-also-lead-to-diabetes/#580ad24a11ca

Personalized Letter Aids Those With Gestational Diabetes

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Women with gestational diabetes who received a customized letter with recommendations upon diagnosis were significantly more likely to meet national guidelines for total gestational weight gain or rate of weekly weight gain than women who did not receive the letter, a new study has found.

Monique M Hedderson, PhD, from the Division of Research, Kaiser Permanente Northern California, Oakland, and colleagues reported their findings April 18 in Diabetes Care.

“The tailored letter was a simple, scalable intervention. This low-intensity approach — which efficiently leveraged clinical data to send personalized advice directly to patients on behalf of the health care system — could have beneficial effects at the population level,” second author Susan D Brown, PhD, also of Kaiser Permanente Northern California, said in a news release.

The study randomly assigned women at the facility level to receive usual care or the intervention, which comprised the tailored letter during pregnancy, and 13 postpartum telephone sessions with a lifestyle coach.

Women Who Received Letter More Likely to Meet IOM Guidelines

The study included 2014 women at 44 medical facilities from the Gestational Diabetes’ Effects on Moms (GEM) cluster-randomized controlled trial: 1047 women at 22 facilities randomly assigned to receive usual obstetric care and 967 women at 22 facilities who received the personalized letter and follow-up (multicomponent intervention).

Women with gestational diabetes in the usual care group received a packet of health educational materials soon after their diagnosis, and a nurse called them once or twice each week to review self-monitored glucose data and provide advice about nutrition and physical activity. The women had telephone access to nurses 7 days/week and dieticians 5 days/week. Recommendations on gestational weight gain were not provided in the health educational materials or during telephone calls, however.

Women in the intervention group received a separate personalized letter, written at below eighth-grade reading level, after the packet of educational materials.

Letters included six tailored messages regarding:

  1. Weight history (the woman’s prepregnancy weight, prepregnancy body mass index (BMI), and current weight at time of gestational diabetes diagnosis);
  2. A recommendation for total gestational weight gain specific to the woman’s prepregnancy BMI;
  3. A corresponding end-of-pregnancy weight goal;
  4. A recommendation for weight management based on the woman’s gestational weight trajectory;
  5. Lifestyle tips to help meet the end-of-pregnancy weight goal; and
  6. Information regarding the impact of gestational weight gain on pregnancy and postpartum health.

Hedderson and colleagues used Institute of Medicine (IOM) recommendations for gestational weight gain, which are based on BMI categorized as underweight (15.9–18.4 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (30.0–59.7 kg/m2) (J Midwifery Womens Health. 2010;55:512-519).

The researchers previously reported the main trial results of GEM, showing that women randomized to the multicomponent intervention (with the letter) had significantly less postpartum weight retention than women randomized to usual care.

In this new analysis, they wanted to drill down into the influence of distinct components of the intervention. And so they first evaluated whether the tailored letter improved gestational weight gain, and then whether gestational weight gain mediated the effect of the multicomponent intervention on the trial’s main outcome, postpartum weight retention.

Women who received the letter were significantly more likely to meet the IOM guidelines for rate of weight gain compared with women in the usual care group (72.6% vs 67.1%; relative risk [RR], 1.08). Results were similar among those who were underweight or of normal weight (RR, 1.07), and those who were overweight or obese (RR, 1.08).

More women (36%) in the intervention group met the gestational weight gain goal compared with those in the usual care (33%) group (RR, 1.08), a difference that was significant among underweight and normal-weight women (RR, 1.28), but not among overweight and obese women (RR, 0.99).

“Most women gain more weight than recommended in pregnancy. Clinicians want counseling tips and actions that can help their patients meet the weight-gain guidelines — especially high-risk patients, such as those with gestational diabetes,” explained Tracy Flanagan, MD, director of women’s health for the Permanente Medical Group of Kaiser Permanente Northern California, in the press release. “Effective communication, with reminders, tips, and coaching, supports patients in achieving that goal.”

Fewer LGA Infants Born to Moms Who Received Personalized Letter

Women in the intervention group were also significantly less likely to give birth to a large-for-gestational-age (LGA) infant compared with usual care (9.7% vs 12.8%; P = .04).

The researchers found no significant differences between the two groups in the proportions of preterm birth (9.8% vs 11.2%; P = .36), cesarean delivery (30.2% vs 33.1%; P = .19), neonatal intensive care unit admissions (13.9% vs 16.5%; P = .07), or small-for-gestational-age infants (8.7% vs 7.8%; P = .83).

And meeting the IOM recommendation for appropriate weekly rate of weight gain from gestational diabetes diagnosis to delivery mediated the intervention’s effect on postpartum weight retention by 24.6%.

“This finding demonstrates the importance of gestational weight gain in impacting postpartum weight retention in this population,” the authors observe.

“Thus, for women with gestational diabetes, pregnancy may offer a unique window of opportunity to intervene to reduce postpartum weight retention when women are motivated to change lifestyle behaviors,” and using the electronic health record enables tailored advice to be provided to large patient populations, they add.

“Our study provides strong evidence that managing weight during pregnancy can have lasting benefits for mom’s weight after the baby is born,” concluded senior author Assiamira Ferrara, MD, PhD, Associate Director of Women’s and Children’s Health, Kaiser Permanente Division of Research.

The authors have reported no relevant financial relationships.

Diabetes Care. Published online April 18, 2018. Abstract

For the original article click here: https://www.medscape.com/viewarticle/895493#vp_2

Type 2 diabetes: Late breakfast could drive obesity

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Going to bed later is linked with obesity in people with type 2 diabetes, and the main factor that drives this relationship is eating breakfast later.

This was the conclusion of a new study now published in the journal Diabetic Medicine.

The research was led by Sirimon Reutrakul, who is an associate professor of endocrinology, diabetes, and metabolism in the College of Medicine at the University of Illinois at Chicago.

Prof. Reutrakul suggests that eating later causes a shift in the biological clock that regulates day-night patterns. Other studies have proposed that this can disrupt energy metabolism.

Type 2 diabetes accounts for the vast majority of diabetes cases.

It develops when the body does not respond properly to insulin, which is a hormone made in the pancreas. It helps cells to take in and use blood sugar for energy.

The pancreas tries to compensate by making more insulin, but eventually, it cannot keep up. This may result in a condition called hyperglycemia, or high blood sugar, which can lead to severe health problems.

Obesity and type 2 diabetes

Obesity is a recognized risk factor for type 2 diabetes and affects most people diagnosed with the disease.

The global obesity epidemic is considered the main reason that rates of diabetes have risen dramatically in the past 20 years.

In the United States, for example — where more than one third of adults are obese — some 12.2 percent of those aged 18 and older are now thought to have diabetes.

In the study paper, Prof. Reutrakul and colleagues refer to research that indicates that a preference for later bedtime and meal times is linked to obesity but note that evidence of this is “lacking in people with type 2 diabetes.”

‘Morningness-eveningness preference’

For the new study, the researchers investigated how the following variables may relate to each other in people with type 2 diabetes:

  • timing of meals
  • patterns of getting up and going to bed early and late, which the authors refer to as “morningness-eveningness preference”
  • body mass index (BMI), which was used as a measure of obesity

In addition, the researchers ran a “mediation analysis” to determine whether morningness-eveningness preference “had a direct effect on BMI,” or whether timing of meals might be driving the effect indirectly.

The participants were 210 working-age Thailand residents with type 2 diabetes who were not working shifts.

The data on morningness-eveningness patterns came from answers that they gave in a standard questionnaire called Composite Scale of Morningness (CSM).

The researchers assessed morningness-eveningness preferences from answers to questions about: preferred waking up and going to bed times, the preferred time of day for taking exercise, and preferred time of day for working, reading, and other mental activities.

The CSM yields a score that ranges from 13 for “extreme evening preference” to 55 for “extreme morning preference.” The researchers decided that scoring under 45 indicated an evening preference and over 45 indicated a morning preference.

New risk factor for obesity in type 2 diabetes

From interviews, further questionnaires, and physical exams, the team also collected data about: meal timing, daily intake of calories, duration and quality of sleep, and weight and height (to calculate BMI).

The results showed that, on average, the participants:

  • slept for 5.5 hours each night
  • consumed 1,103 calories per day
  • had a BMI of 28.4 (which is in the overweight range)

In addition, the scientists found that 113 participants had a preference for mornings (CSM score over 45) and breakfasted between 7:00 and 8:30 a.m., while the remaining 97 showed a preference for evenings (CSM score under 45) and breakfasted between 7:30 and 9:00 a.m.

They also found that those with a preference for mornings ate all their meals earlier — not just their breakfasts, but also their lunches, dinners, and final meals.

Further analysis revealed that a greater evening preference was linked to having a higher BMI. However, calorie intake and timing of lunch and dinner was not linked to a higher BMI.

The mediation analysis showed that a preference for mornings was linked to having an earlier breakfast and a BMI that is 0.37 lower.

As the researchers conclude, “Late breakfast time mediated the relationship between morningness-eveningness preference and BMI.”

For the original article click here: https://www.medicalnewstoday.com/articles/321539.php

Screenings miss half of diabetic, prediabetic patients

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Screenings miss half of diabetic, prediabetic patients

Credit: Northwestern University

Screening patients for diabetes based solely on their age and weight – a recommendation from a leading medical expert group – could miss more than half of high-risk patients, according to a new Northwestern Medicine study of a nationwide sample. These limited screening criteria also missed more racial and ethnic minorities, most notably Asians.

Failing to screen high-risk adults could lead to delayed treatments to prevent type 2 diabetes or manage the condition for those who already have it, possibly contributing to a worsening of the diabetes epidemic. Prediabetes and diabetes affect half of U.S. adults with an estimated cost of $327 billion per year.

The United States Preventive Service Task Force (USPSTF) currently recommends that physicians screen for dysglycemia (prediabetes or type 2 diabetes) when they are 40 to 70 years old and are overweight or obese. By following this recommendation, 53 percent of patients who had prediabetes or type 2 diabetes would not be screened. The study showed that screening patients using an expanded set of risk factors, which the USPSTF suggests but does not formally recommend, would identify most cases of prediabetes and type 2 diabetes.

Only 23 percent of patients with prediabetes or diabetes would be missed if expanded screening criteria were used to make screening decisions, the study found. The expanded criteria include a family history of diabetes, history of or polycystic ovarian syndrome or non-white race or ethnicity.

“This seems like a no-brainer to screen patients who have any of these additional risk factors,” said lead author Dr. Matthew O’Brien, assistant professor of medicine at Northwestern University Feinberg School of Medicine. “By demonstrating how well these expanded criteria work in identifying patients with prediabetes and diabetes, we’re proposing a better path for the USPSTF to strengthen its screening guidelines.”

The study was published today, Friday, April 13, in the Journal of General Internal Medicine. O’Brien will be presenting his findings today at the Society for General Internal Medicine conference in Denver, Colorado. This is the first study to report how these expanded screening criteria would perform in practice among a nationally representative sample of U.S. adults.

The USPSTF has come under scrutiny for other screening recommendations, most notably for breast cancer. But there has been little attention focused on this group’s most recent diabetes screening guideline.

Intensive lifestyle programs and some medications have been proven to prevent or delay type 2 diabetes among adults with prediabetes. A large volume of research over the last three decades has demonstrated that treating type 2 diabetes prevents life-threatening complications such as heart attacks, strokes and kidney failure.

“The earlier patients are diagnosed with these conditions, the sooner they can begin to combat them,” O’Brien said.

African-Americans and Latinos develop type 2 diabetes at younger ages, so waiting until they are 40 years old to screen them is problematic, O’Brien said. In the study, 50 percent of whites with prediabetes or type 2 diabetes were identified using the limited criteria compared to only 48 percent of African-Americans and only 44 percent of Latinos.

Asians are at high risk of developing diabetes even at a healthy weight. By following the limited guidelines and only screening patients who are overweight or obese, approximately 30 percent of Asians with prediabetes or type 2 diabetes would be identified. That would leave 70 percent of Asians with prediabetes or diabetes undiagnosed until their next screening test, which could occur years later.

The study also touches on the financial implications of these guidelines. Under a provision in the Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers. But O’Brien said it is unclear whether insurers will be required to pay for diabetes screening if patients only meet the expanded criteria.

“This could be a particular problem for people of low socioeconomic status who are at high risk of developing and may be unable to pay for a test,” O’Brien said.

The study was conducted collaboratively with the United States Centers for Disease Control and Prevention (CDC), using data collected every year from a nationally representative sample of U.S. adults. It builds on findings from a previous study O’Brien conducted that incorporated electronic health record data from 50,515 adult primary care patients at community health centers in the Midwest and Southwest between 2008 and 2013.

For the original article click here: https://medicalxpress.com/news/2018-04-screenings-diabetic-prediabetic-patients.html

When diabetes is your life, tech – and a little DIY – can help

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A type 1 diabetes diagnosis is a shock to the system. But from online support groups to “bionic pancreases,” there are ways to manage the incurable disease.

One sunny day last July, I was chatting with my cousin Kathryn as we watched her daughter Ruby, now eight, dashing around the garden of my childhood home in Manchester, England, a cute red and white polka-dot bag slung over her shoulder.

It was an idyllic scene, one that stands in stark contrast to just six months earlier, when Ruby, who had exhibited few symptoms other than inordinate hunger and thirst, was rushed to hospital and diagnosed with type 1 diabetes. What followed was a six-day baptism of fire as Ruby was stabilized and forced to deal with her mortal dread of needles, while Kathryn and her husband underwent sleepless nights and a crash course in endocrinology.

“It was like having a new-born baby, but it’s even harder, because you weren’t expecting it,” she told me. Life suddenly became about monitoring, calculating, injecting, and planning around eating, exercise and school — all on no sleep and all totally out of the blue.

That cute bag that Ruby (name changed to protect her privacy) carries with her at all times? It houses a Dexcom glucose monitor and a pack of glucose tablets, which work in conjunction with the sensor attached to her arm and the insulin pump plugged into her stomach. The final item in her bag was an iPhone 5S.

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The content’s of Ruby’s bag.

Kathryn Bond

It’s unusual for such a young child to have a smartphone. But Ruby’s iPhone, which connects via Bluetooth to her Dexcom monitor, allowing Kathryn to read it remotely, illustrates the way technology has transformed the management of diabetes from an entirely manual process — pricking fingers to measure blood sugar, writing down numbers in a notebook, calculating insulin doses and injecting it — to a semi-automatic one. It removes a lot of the guesswork involved with the timing and calculation of insulin doses by providing detailed, almost real-time monitoring of blood sugar levels.

Diabetes is not a small problem. Nearly 10 percent of the US population — just over 30 million people in total — are affected by the disease. Of those, 1.25 million Americans have type 1 diabetes, which puts them at risk of slipping into a fatal coma at any time and for which there’s no cure. Instead, patients must treat and manage the disease, in which the body produces little or no insulin to regulate blood sugar levels, as best they can every day for the rest of their lives.

For all people with type 1 diabetes — often diagnosed in childhood — and for some with type 2, this means injecting themselves with insulin on a regular basis.

It was Ruby’s case that inspired me to look into diabetes and how technology has made treatment less of a pain. Blood sugar levels can now be read almost in real time by devices such as continuous glucose monitors and insulin supplied via a pump continuously fixed to the body.

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A diabetes pump means no injections, but does mean carrying the tech round your waist at all times.

Kathryn Bond

But tech is not a complete panacea.

To start with, the most advanced tech isn’t always available to everyone, and millions around the world don’t have access to even basic gear like blood-glucose testing machines, according to Elizabeth Rowley, founder of charity T1International. It’s led to some people “hacking” their equipment to take advantage of new capabilities.

It also adds new layers of complication to an already complicated disease.

“Technology is great as it gives us lots more information, but it doesn’t take diabetes away and it doesn’t take the management of diabetes away,” said Libby Dowling, who is senior clinical adviser at Diabetes UK and who has 11 years of experience as a children’s diabetes nurse.

Pumps, which negate the need for injections, can also fail as the areas they’re attached to gradually become insulin-resistant, meaning they have to be changed, which takes time. Having reams of data accessible might give an accurate snapshot of what’s going on in the body, but it also increases the number of decisions you need to make. Real-time availability of the data can lead some parents to compulsively check on their child’s blood sugar, in the same way many people do with social media.

“Parents find it really reassuring knowing that they can check in on what their child is up to and what their levels are and all that kind of thing,” said Dowling. “But it can also increase anxiety.”

When Ruby was diagnosed, Kathryn was warned by doctors not to be a perfectionist about monitoring and decision making. “The more tech you have, the more complicated it gets,” she said. “We have chargers coming out of our ears.”

And yet, she tells me: “The good hugely outweighs the bad for us — by a huge margin.”

#WeAreNotWaiting

Even in Australia, where Kathryn’s family is based, the wait for new tech to actually become available is frustrating for well-informed parents who want and can afford the best possible care for their children.

One example Kathryn gave me is the lack of ability to connect an Apple Watch’s cellular capability to the Dexcom G5 glucose monitor (it can only be used with Bluetooth via an iPhone.) Ruby’s older sister, Lucy (name also changed), was diagnosed with type 1 diabetes eight months later, and uses the Dexcom G5, too. Being able to monitor the girls from her wrist is high on Kathryn’s wish list of improvements she’d like to see in diabetes tech.

There are people who are unwilling to wait, and who embrace unorthodox methods. (You can find them on Twitter via the hashtag #WeAreNotWaiting.)

The Nightscout Foundation, an online diabetes community, figured out a workaround for the Pebble Watch. Groups such as Nightscout, Tidepool and OpenAPS are developing open-source fixes for diabetes that give major medical tech companies a run for their money.

Mission: Bionic Pancreas

One major gripe of many tech-enabled diabetes patients is that the two devices they wear at all times — the monitor and the pump — don’t talk to each other. For many years, the community has been waiting for a “closed-loop” system, often referred to as an artificial pancreas, through which the insulin pump could respond automatically and in real time to the monitor’s readings.

For as long as pumps and sensors fail and need changing at the drop of a hat, diabetes will never be a hands-off disease to manage, but an artificial pancreas is basically as close as it gets. The FDA approved the first artificial pancreas — the Medtronic 670G — in October 2017. But thanks to a little DIY spirit, people have had them for years.

Take Dana Lewis, founder of the open-source artificial pancreas system, or OpenAPS. Lewis started hacking her glucose monitor to increase the volume of the alarm so that it would wake her in the night.

From there, Lewis tinkered with her equipment until she created a closed-loop system, which she’s refined over time in terms of both hardware (she uses a Raspberry Pi) and algorithms that enable faster distribution of insulin. It has massively reduced the “cognitive burden” on her everyday life, she told me over email. She no longer has to constantly think about diabetes before, during and after everything she does.

Hacking a glucose monitor is not without risk — inaccurate readings, failed alarms or the wrong dose of insulin distributed by the pump could have fatal consequences — but as with much of the highly inexact science around diabetes management, some people believe it’s worth the tradeoff. Lewis and the OpenAPS community encourage people to embrace the build-your-own-pancreas method rather than waiting for the tech to become available and affordable.

They aren’t alone. JDRF, one of the biggest global diabetes research charities, said in October that it was backing the open-source community by launching an initiative to encourage rival manufacturers like Dexcom and Medtronic to open their protocols and make their devices interoperable.

“This would allow seamless, secure connectivity between devices — much as your cell phone and personal electronics are able to connect wirelessly,” the charity explains in a blog post.

Just like every tech option for diabetes, choosing to use a closed-loop system is a decision heavily dependent on personal preferences. “An automated insulin delivery system is a different way of dealing with diabetes,” Lewis said. “You have to learn to build trust, and learn what to do differently, and how to use the tools to best help you achieve your goals.”

Kathryn told me it’s not something she’d be willing to experiment with for her daughters, but she understands why people do it. “If it were me [with diabetes], I’d be straight on that,” she said.

Although experts like JDRF Research Director Daniel Finan believe the DIY route is safe, those methods won’t have gone through rigorous tests performed by regulators, which means they remain in the Wild West territory of tech for now. Gradually this is changing. Along with Medtronic, US-based startups such as Bigfoot Biomedical and Beta Bionics are attempting to bring officially regulated artificial pancreases to market.

Lewis is encouraged by JDRF’s initiative and can see a day commercial devices will catch up to what the DIY community is doing, but it’s a question of time.

“I think it’s likely going to be the second or third generation of these devices that get to where we DIYers are today, and especially around the needed interoperability and flexibility to really allow an individual to have this technology fit their particular lifestyle,” she said.

Baby steps to better lives

In the meantime, even incremental updates to existing tech have the potential to make massive differences in the lives of people with diabetes. Dexcom last month introduced its latest device, the G6, which is the first continuous glucose monitor that doesn’t require calibration via a fingerstick, a needled device used to take diabetes measurements.

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The update to the girls’ G5 monitors won’t require fingerstick calibration.

Kathryn Bond

That’s a huge deal because you have to prick your finger with the  fingerstick to get the measurements — multiple times a day. Continuous glucose monitors have reduced the use of fingersticks, but until the G6, monitors still required calibration, sometimes up to twice a day.

“When it comes to the treatment of diabetes, the most dreaded thing is the fingerstick,” said Dexcom CEO Kevin Sayers in an interview. “They just flat out hurt.”

Dexcom is the first company to successfully make sensors that don’t need this constant recalibration.

“Think about if you’re the parent of a child,” he said. “You’ve got to wake up in the middle of the night and stick your child’s finger two or three times.” The consequences aren’t just that it is uncomfortable for the child, but leaves both the parent and child exhausted.

All diabetes, all tech trade-offs, all the time

Sleeplessness is something Kathryn and her husband experienced a lot in the early stages of Ruby’s diabetes diagnosis.

Using Dexcom’s monitors with an alarm that goes off if glucose levels go haywire has helped remedy this. It’s one of a list of reasons she favors it over other monitors, even though the girls have a Medtronic pump, which means she has to have two apps on her phone (and on theirs) and two sets of data to analyze.

 

A year into life with diabetes, Kathryn can tell me the pros and cons of practically every monitor out there, as well as their compatibility with pumps and infusion sets (the girls each prefer different ones) or injections. Whatever combination of tech you choose, she said, “it’s always a trade-off.”

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The girls prefer different pumps, which they also like to wear slightly differently.

Kathryn Bond

Finding the right combination of the tech for each of the girls has been a trial-and-error process that will continue to evolve as the girls grow older, face new life challenges and develop different preferences about how much technology they’re willing to be constantly hooked up to.

Through Facebook groups she belongs to, Kathryn has heard about the different ways this can play out from parents of other children with type 1 diabetes who’ve trodden the path before her. A type 1 diagnosis in the family is a shock to the system in many ways, but the help of online communities can prevent it from being quite so isolating. They’re a source of tech support, but also of “huge kindness,” Kathryn told me.

So far, Lucy and Ruby have coped “fantastically well,” but as they grow up, they’ll also have to start to take more responsibility for managing the disease for themselves. It will relieve some of the work Kathryn has to do — she knows parents who’ve given up work following a diagnosis, it’s so labor-intensive. But for the girls the burden of monitoring and controlling the tech as well as physically carrying it everywhere they go will not be a light one to shoulder.

“You are constantly thinking diabetes, because it impacts every single thing you do,” said Kathryn. “It’s the constancy of it, and it never goes away.”

For the original article click here: https://www.cnet.com/news/when-diabetes-is-your-life-tech-and-a-little-diy-can-help/

Weight Loss Over Time May Reduce Risk for Diabetes Onset

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There may be an association between weight changes from young adulthood to midlife over the course of 10 years and the development of incident diabetes, according to a study published in Diabetes Care.

Researchers conducted a retrospective study on data collected from the National Health and Nutrition Examination Survey (NHANES) to determine whether there was a relationship between incident diabetes and weight changes that occurred between young adulthood and midlife.  This study identified 21,554 individuals and placed them in one of four groups:

  • Stable non-obese (n=16,454): body mass index (BMI)age 25 <30 and BMI10 years prior <30
  • Losing (n=227): BMIage 25 ≥30 and BMI10 years prior <30
  • Gaining (n=3719): BMIage 25 <30 and BMI10 years prior ≥30
  • Stable obese (n=1154): BMIage 25 ≥30 and BMI10 years prior ≥30

The purpose of the study was to determine whether individuals were at reduced risk for developing diabetes, over the course of 10 years, if they moved from an obese BMI to non-obese BMI compared with individuals who stayed as stable obese (“risk reduction”). In addition, the study investigated whether individuals considered stable obese were at a higher risk for developing incident diabetes over time compared with individuals considered to be stable non-obese (“residual risk”).

Compared with stable obese individuals, individuals with the lowest risk for developing diabetes during the 10 years observed were individuals who maintained their weight at a stable non-obese BMI state (hazard ratio [HR] 0.22; 95% CI, 0.18-0.28).  Individuals in the “losing” and “gaining” groups were found to have a 0.33 (95% CI, 0.14-0.76) and 0.70 (95% CI, 0.57-0.87) times higher risk for developing incident diabetes, respectively, compared with individuals in the stable obese group.

When the reference group was changed to individuals who maintained a non-obese BMI, there was no significant difference in the risk for developing incident diabetes in individuals who reported going from an obese BMI to a non-obese BMI and individuals who remained at a stable non-obese BMI (HR 1.47; 95% CI, 0.65-3.36).  Not surprisingly, individuals who started at a non-obese BMI and moved to an obese BMI and individuals who started and remained at an obese BMI during the 10 years observed had a 5.77- and 8.07-times higher rate of developing incident diabetes, respectively compared with individuals who remained at a normal BMI (95% CI, 4.63-7.18 and 95% CI, 6.28-10.38, respectively).

Researchers estimated that if 25-year-old individuals were to lose weight and be at a non-obese BMI by midlife, 9.1% of incident diabetes could potentially be averted (95% CI, 5.3-12.8), while 64.2% of all incident diabetes could be theoretically averted if individuals between early adulthood and midlife maintained a weight within the normal range (95% CI, 59.4-68.3).

It was concluded that individuals who remain or become obese between young adulthood and midlife are at a higher risk for developing incident diabetes compared with individuals who maintained a non-obese BMI during the same time period.

Further, the risk reduction hypothesis was tested and  a significant reduction was found in the risk for diabetes onset in individuals who lost weight between young adulthood and midlife compared with individuals who remained obese. Therefore, clinicians should continue to encourage individuals who are obese to lose weight and individuals who are non-obese to maintain a non-obese state, as it this study shows that this reduces the risk for developing incident diabetes later in life.

For the original article click here: https://www.endocrinologyadvisor.com/obesity/remaining-or-becoming-obese-increases-diabetes-onset-risk/article/757534/

Bloodless revolution in diabetes monitoring

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Scientists have created a non-invasive, adhesive patch, which promises the measurement of glucose levels through the skin without a finger-prick blood test

Scientists have created a non-invasive, adhesive patch, which promises the measurement of glucose levels through the skin without a finger-prick blood test, potentially removing the need for millions of diabetics to frequently carry out the painful and unpopular tests.

The patch does not pierce the skin, instead it draws glucose out from fluid between cells across hair follicles, which are individually accessed via an array of miniature sensors using a small electric current. The glucose collects in tiny reservoirs and is measured. Readings can be taken every 10 to 15 minutes over several hours.

Crucially, because of the design of the array of sensors and reservoirs, the patch does not require calibration with a blood sample — meaning that finger prick blood tests are unnecessary.

Having established proof of the concept behind the device in a study published in Nature Nanotechnology, the research team from the University of Bath hopes that it can eventually become a low-cost, wearable sensor that sends regular, clinically relevant glucose measurements to the wearer’s phone or smartwatch wirelessly, alerting them when they may need to take action.

An important advantage of this device over others is that each miniature sensor of the array can operate on a small area over an individual hair follicle – this significantly reduces inter- and intra-skin variability in glucose extraction and increases the accuracy of the measurements taken such that calibration via a blood sample is not required.

The project is a multidisciplinary collaboration between scientists from the Departments of Physics, Pharmacy & Pharmacology, and Chemistry at the University of Bath.

Professor Richard Guy, from the Department of Pharmacy & Pharmacology, said: “A non-invasive – that is, needle-less – method to monitor blood sugar has proven a difficult goal to attain. The closest that has been achieved has required either at least a single-point calibration with a classic ‘finger-stick’, or the implantation of a pre-calibrated sensor via a single needle insertion. The monitor developed at Bath promises a truly calibration-free approach, an essential contribution in the fight to combat the ever-increasing global incidence of diabetes.”

Dr Adelina Ilie, from the Department of Physics, said: “The specific architecture of our array permits calibration-free operation, and it has the further benefit of allowing realisation with a variety of materials in combination. We utilised graphene as one of the components as it brings important advantages: specifically, it is strong, conductive, flexible, and potentially low-cost and environmentally friendly. In addition, our design can be implemented using high-throughput fabrication techniques like screen printing, which we hope will ultimately support a disposable, widely affordable device.”

In this study the team tested the patch on both pig skin, where they showed it could accurately track glucose levels across the range seen in diabetic human patients, and on healthy human volunteers, where again the patch was able to track blood sugar variations throughout the day.

The next steps include further refinement of the design of the patch to optimise the number of sensors in the array, to demonstrate full functionality over a 24-hour wear period, and to undertake a number of key clinical trials.

Diabetes is a serious public health problem which is increasing. The World Health Organization predicts the world-wide incidence of diabetes to rise from 171M in 2000 to 366M in 2030. In the UK, just under six per cent of adults have diabetes and the NHS spends around 10% of its budget on diabetes monitoring and treatments. Up to 50% of adults with diabetes are undiagnosed.

An effective, non-invasive way of monitoring blood glucose could both help diabetics, as well as those at risk of developing diabetes, make the right choices to either manage the disease well or reduce their risk of developing the condition.

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The work was funded by the Engineering and Physical Sciences Research Council (EPSRC), the Medical Research Council (MRC), and the Sir Halley Stewart Trust.

For further information and images, please contact Chris Melvin in the University of Bath Press Office on +44-0-1225-383-941 or c.m.melvin@bath.ac.uk

Notes

Animal research at Bath

The University of Bath has signed the Concordat on Openness on Animal Research. The University is committed to enhancing our communications with the media and public about our research using animals. Find out more: http://www.bath.ac.uk/collections/animal-research/

University of Bath

The University of Bath is one of the UK’s leading universities both in terms of research and our reputation for excellence in teaching, learning and graduate prospects.

The University is rated Gold in the Teaching Excellence Framework (TEF), the Government’s assessment of teaching quality in universities, meaning its teaching is of the highest quality in the UK.

In the Research Excellence Framework (REF) 2014 research assessment 87 per cent of our research was defined as ‘world-leading’ or ‘internationally excellent’. From making aircraft more fuel efficient, to identifying infectious diseases more quickly, or cutting carbon emissions through innovative building solutions, research from Bath is making a difference around the world. Find out more: http://www.bath.ac.uk/research/

Well established as a nurturing environment for enterprising minds, Bath is ranked highly in all national league tables. We are ranked 5th in the UK by The Guardian University Guide 2018 and 6th for graduate employment. According to the Times Higher Education Student Experience Survey 2017, we are in the top 5 universities students would recommend to a friend.

For the original article click here: https://www.eurekalert.org/pub_releases/2018-04/uob-bri040618.php

How estrogen therapy could prevent type 2 diabetes

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New research strengthens the idea that estrogen therapy could help to prevent type 2 diabetes following menopause, after it identified the mechanisms by which the hormone helps to control blood sugar levels.

estrogen written on the page of a book

Researchers reveal how estrogen could help to prevent type 2 diabetes in women who are postmenopausal.

In a study of postmenopausal mice and human cells, researchers found that estrogen targets specific cells in the pancreas and the gut to increase tolerance to glucose.

This is associated with a lower risk of type 2 diabetes.

Study leader Jacques Philippe, who is a diabetes specialist currently working at the University of Geneva’s Faculty of Medicine in Switzerland, and colleagues recently reported their results in the journal JCI Insight.

It is estimated that around 30.3 million people in the United States — or around 9.4 percent of the population — are living with diabetes, which is a condition that causes blood glucose levels to become too high.

Type 2 diabetes — which arises when the body struggles to effectively use insulin, the hormone that regulates blood sugar — accounts for approximately 90–95 percent of all diabetes cases.

Previous research has suggested that after menopause, women may face a greater risk of type 2 diabetes. This has been attributed to hormonal changes, such as a reduction in estrogen levels.

Following on from such studies, scientists have investigated whether or not estrogen replacement therapy could help to prevent type 2 diabetes among postmenopausal women, and many studies have produced positive results.

That being said, the exact mechanisms by which estrogen may protect against type 2 diabetes have been unclear — until now.

Estrogen targets pancreatic and gut cells

For their study, Philippe and colleagues administered estrogen to postmenopausal mice.

While previous studies have primarily focused on how estrogen affects the insulin-producing cells of the pancreas, this latest study also looked at how the hormone impacts cells that produce glucagon, which is a hormone that increases blood glucose.

“Indeed,” says Philippe, “if the pancreas secretes insulin, it also secretes glucagon, a hormone with the opposite effect: insulin captures sugar, while glucagon releases it. Diabetes is therefore due to an imbalance between these two hormones controlling the sugar level in the blood.”

The new study revealed that the alpha cells of the pancreas, or cells that secrete glucagon, are highly sensitive to estrogen; the hormone causes them to release less glucagon, but more of a hormone called GLP1.

And, notably, GLP1 is also released by the intestine after eating; it encourages inulin secretion, blocks glucagon secretion, and increases feelings of fullness.

“Indeed, the gut harbors cells called the L cells that are very similar to pancreatic alpha cells and whose main function is precisely to produce GLP1,” explains first study author Sandra Handgraaf, also of the Faculty of Medicine at the University of Geneva.

“We also observed a strong increase in the production of GLP1 in the gut cells,” she explains, “thus proving the crucial role of the intestine in the control of carbohydrate balance and the influence of estrogens on the entire metabolisms at stake.”

The researchers were able to confirm their results in human cell lines.

Estrogen therapy may be beneficial

Hormone replacement therapy has been associated with a number of health risks for women who are postmenopausal, such as a greater risk of cardiovascular disease.

“[…] if hormonal treatment is taken more than 10 years after menopause, the cardiovascular risk is effectively increased,” notes Philippe.

However, he adds that undergoing estrogen replacement therapy for only a few years shortly after menopause does not appear to raise cardiovascular risk. It could also help to reduce the risk of type 2 diabetes.

In the context of diabetes, an estrogenic treatment allows to avoid, in all cases, the explosion of female diabetes cases. These treatments, well-administered, can really add value for women’s health.”

For the original article click here: https://www.medicalnewstoday.com/articles/321421.php

Diabetes: everything you need to know, including the causes, signs, symptoms and treatments

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What are the risk factors for type 2 diabetes?

You are more at risk of developing type 2 diabetes if: you are over 40, or 25 for south Asian people; have a close relative with type 2 diabetes, such as a parent, brother or sister; are overweight or obese; are of south Asian, Chinese, African Caribbean or black African origin, even if you were born in the UK.

How is diabetes diagnosed?

Diabetes is diagnosed using tests which can detect glucose in urine and blood. “Blood glucose levels change throughout the day,” explains Dr Woodhouse. “After eating, levels rise and then settle down after about an hour. They are at their lowest point before the first meal of the day, which is normally breakfast.”

A simple finger-prick blood test can detect if you have levels of glucose in the blood higher than NICE standards, which is between 4.0 to 6.0 mmol/L when fasting or up to 7.8 mmol/L two hours after eating a meal.

“The most useful way to screen for type 2 diabetes would be to ask your GP for an HbA1c blood test,” says Dr Woodhouse. Glucose in the blood sticks to HbA1C – a type of haemoglobin found in red blood cells.

She adds: “A level of 48mmol/L would indicate type 2 diabetes but anything in the range 42-47mmol/L is a marker for pre-diabetes. This is far more accurate in understanding a person’s long term (last three months) blood sugar control. In addition, it can pick up pre-diabetes.”

Diabetes is diagnosed using tests which can detect glucose in urine and blood Credit: Getty

What is pre-diabetes?

“Pre-diabetes is a state categorised by a slightly elevated level of HbA1c in red blood cells,” says Dr Woodhouse. “It is not quite high enough to call it diabetes, but these people are at risk of developing it if changes are not made.

“If no action is taken, 33 out of 100 people with pre-diabetes (a third) will develop type 2 diabetes within six years. Out of 100 people with pre-diabetes who make ‘healthy lifestyle’ changes, only 13 will develop diabetes.

“The good news is that for many people with pre-diabetes, diabetes can be delayed or prevented by increasing your physical activity, making changes to what you eat and by losing weight. Keeping these changes going over time improves your overall health and reduces your heart disease risk too.

How is diabetes treated?

A variety of drugs are available to help type 2 diabetes. Most people are put on a drug called Metformin (biguanide) at least to begin with:  it helps to stop the liver producing new glucose and it improves the way insulin works, getting glucose into muscle cells more effectively.

But your GP may prescribe other medications in combination with metformin or instead of it.

These include sulphonylureas, which stimulate the pancreas to make more insulin, alpha glucosidase inhibitors, which slow down the intestine’s absorption of starchy foods, in turn slowing down any rise in blood sugar levels after meals, and prandial glucose regulators, which are taken half an hour before you eat and encourage the production of insulin.

Thiazolidinediones reduce insulin resistance and improve sensitivity, allowing insulin to work more effectively. Other drugs mimic the effect of incretin hormones, which can help the body to produce more insulin when needed and reduce the amount of glucose production when it’s not needed.

But lifestyle is also important; overweight patients will be encouraged to lose weight and get fit.

How can you prevent Type 2 diabetes?

Keep your weight in a healthy range. Aim for a BMI between 20-25. Eat a healthy diet, too. This is not simply about avoiding eating sugar. Increasing fibre and limiting refined/processed sugars and fat intake can all help prevent type 2 diabetes.

Dr Woodhouse says it is important to eat regularly. “Have three meals a day. This will help keep your blood glucose levels steady and control your appetite.

“Include a high fibre, complex carbohydrate food at each meal, such as grains or brown rice.

And consume less sugar. Too much sugar and foods containing sugar can cause the blood glucose levels to rise. It is best to replace these with lower sugar and sugar free foods instead.

“Eat less fats as well. High fat diets are linked to heart disease and reducing your fat intake will help you lose weight.”

It is important to keep active and exercising. Adults should be doing 150 minutes of aerobic exercise per week (brisk walking, cycling etc) and strength exercises twice weekly, that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).

“Stop smoking and limit alcohol,” says Dr Woodhouse. “Alcohol is high in energy and may cause weight gain therefore sensible drinking is essential.”

For the original article click here: https://www.telegraph.co.uk/health-fitness/body/diabetes-everything-need-know-including-causes-signs-symptoms/

Taming an Unruly Target in Diabetes

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Focusing on a simple hormone in us all, a Yale researcher has found specific forms of it that poke toxic holes in cells — a discovery that he is leveraging into a treatment for patients with diabetes.

The research, published April 3 in Nature Communications, is also central to the recent awarding of two grants totaling $600,000 from the Connecticut Bioscience Innovation Fund and the Blavatnik Fund for Innovation at Yale.

Andrew Miranker, a professor of molecular biophysics and biochemistry and of chemical & environmental engineering, and his team will use these funds to translate the discoveries into novel therapies for type 2 diabetes. Part of this effort includes the formation of a new biotechnology company, ADM Therapeutics, based in Connecticut. Although the researchers are currently focusing on type 2 diabetes, the approaches they developed also apply to Alzheimer’s and Parkinson’s diseases.

Type 2 diabetes is a degenerative ailment that affects hundreds of millions of people worldwide. Its progression is tied directly to the health of insulin-producing cells in the islets — groups of cells in the pancreas. These cells carefully coordinate the release of insulin in response to changes in blood glucose. Failure of these cells plays a significant role in the cause of the disease as the body loses the ability to regulate blood glucose. Currently available drugs work by stimulating alternative ways for the body to use or eliminate glucose. There are no approved drugs available to address the causes of type 2 diabetes.

Miranker’s lab is focused on a protein partner to insulin. The protein, known as islet amyloid polypeptide (IAPP), is also a hormone made by these same cells. The group has discovered that when IAPP adopts the wrong shape, it pokes holes in the membranes of islets large enough to kill the insulin-secreting cells.

If we ameliorate these very large holes by designing a compound to target a particular IAPP structure, we can prevent toxicity,” said Miranker.

Topological map of a toxic pore formed by hundreds of copies of the hormone IAPP.
Topological map of a toxic pore formed by hundreds of copies of the hormone IAPP.

IAPP works alone in its healthy state, but the toxic version of IAPP is formed from tens to hundreds of copies of the protein. This sprawling structure poses a formidable challenge, note the researchers, and controlling it requires an approach very different from those of traditional drugs. Finding a drug to close a specific toxic hole should be a simple matter of finding the one square peg among round pegs, Miranker said, but mused,  “What if your target is more like a porous pile of spaghetti than a hole?”

Instead of thinking of a protein disease target as a rigid object with a well-defined pocket to aim at, you make the drug extremely well-defined and rigid, and you demand the protein adopt a structure to interact with it,” Miranker said. This amounts to designing a drug that acts like a fork for the spaghetti to wrap around, he said, noting, “you can’t eat spaghetti with a spoon.”

To that end, the Miranker lab has developed a drug lead, ADM-116, that binds to IAPP and can rescue cells that make insulin. The water-soluble ADM-116 crosses the outer cell membrane, finds IAPP, and winds it up. By doing so, ADM-116 prevents IAPP from punching a hole in a sensitive internal cell membrane. Miranker and his team, and ultimately his Connecticut-based company, will translate these discoveries into drugs that improve the long-term health of these cells.

Miranker has been studying how changes in protein shape can result in toxicity for more than 20 years. Only now has this work reached a stage where his team can build off these fundamentals and apply it to human health. Miranker noted that the $500,000 grant from Connecticut Bioscience Innovation Fund, awarded in January, and last year’s $100,000 grant from the Blavatnik Fund for Innovation at Yale were essential to making this leap.

Christopher Unsworth, associate director of business development for the Yale Office of Cooperative Research, said the promise of Miranker’s research is that he takes such a different approach to the problem.

His lab has developed a whole range of techniques to evaluate what is going on with these proteins and then designed a compound that could interfere with that process,” he said. “A lot of times, we see basic research that identifies novel mechanisms that may be related to a disease, but understanding those mechanisms doesn’t necessarily take you to a drug. Andrew’s work, though, is directed pretty much toward chemical matter that could be a potential therapeutic.”

For the original article click here: https://news.yale.edu/2018/04/03/taming-unruly-target-diabetes