Diabetes: Surprising gene discovery could fuel new treatments

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By studying one family with rare blood sugar disorders, scientists have identified a gene mutation that can give rise to both high and low blood sugar. This discovery could lead to new treatments for diabetes.
an illustration of DNA
Researchers have discovered a single gene mutation that may cause both diabetes and insulinomas.

Diabetes is a condition in which the body is unable to produce enough of the hormone insulin, or it cannot use it effectively.

As a result, blood sugar levels become too high.

It is estimated that around 30.3 million people in the United States are living with diabetes. Type 2 diabetes is the most common form, followed by type 1 diabetes.

But there are some rarer forms that account for just 1–4 percent of cases in the U.S. These are known as monogenic diabetes, and they arise from a mutation in a single gene that is passed down from one or both parents.

Such mutations impair the function of beta cells, which are cells in the pancreas that secrete insulin.

One of the commonest forms of monogenic diabetes is maturity onset diabetes of the young, which accounts for approximately 2 percent of all diabetes cases in the U.S. among people under the age of 20.

For this latest study, lead author Prof. Márta Korbonits — of the William Harvey Research Institute at Queen Mary University of London (QMUL) in the United Kingdom — and her colleagues studied a unique family, some members of which had diabetes, while others had insulinomas, or insulin-producing tumors in the pancreas.

Notably, diabetes is characterized by high blood sugar levels, while insulinomas cause blood sugar levels to become too low. How can both of these conflicting conditions run in the same family?

According to Prof. Korbonits and team, a single gene mutation is to blame.

MAFA mutation uncovered

By analyzing the genomes of the family, the researchers were surprised to find a single mutation in the MAFA gene that was present in both the family members with diabetes and those with insulinomas.

The MAFA gene normally regulates the production of insulin in beta cells. A mutation in this gene leads to the production of an abnormal MAFA protein, which seems to be more abundant in beta cells than normal MAFA proteins.

The researchers were able to confirm the presence of the MAFA gene mutation in another family, which also had members with both diabetes and insulinomas.

Overall, the results indicate that a mutation in the MAFA gene may be a cause of both high and low blood sugar levels, but precisely how the mutation causes such conditions remains unclear.

“We believe,” explains first study author Dr. Donato Iacovazzo, also of the William Harvey Research Institute at QMUL, “this gene defect is critical in the development of the disease and we are now performing further studies to determine how this defect can, on the one hand, impair the production of insulin to cause diabetes, and on the other, cause insulinomas.”

These results — now published in the Proceedings of the National Academy of Sciences — represent the first time that a mutation in the MAFA gene has been associated with disease, and the researchers believe that they could pave the way for new treatments for common and rare forms of diabetes.

While the disease we have characterized is very rare, studying rare conditions helps us understand more about the physiology and the mechanisms underlying more common diseases. We hope that in the longer-term this research will lead to us exploring new ways to trigger the regeneration of beta cells to treat more common forms of diabetes.”

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4 Things Every Person With Diabetes Needs To Know About Ketones

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Here’s what ketones are, and why keeping tabs on them could save your life.

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Ketones are fuel that comes from fat.

Ketogenetic (aka keto) diets—which involve eating lots of fat, a good amount of protein, and very few carbs—are all the rage because they force the body to burn stored fat for fuel. But someone who has diabetes has to be careful about switching into this alternate fuel-burning process, called ketosis, because it may mean that you don’t have enough insulin in your system.

If you don’t have enough insulin, you can’t use glucose (sugar) for energy, says Ehsan Ali, MD, a California-based internist affiliated with Cedars-Sinai Medical Center in Los Angeles. Again, that might not sound like a bad thing. Who wouldn’t want to burn off stored fat? The problem is that if fat gets broken down while there’s a lack of insulin (as there is in people with type 1 diabetes and some who have type 2), the liver starts making more and more ketones, and those can start to build up in the bloodstream.

MORE: 6 Weird Things That Might Cause Diabetes

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They can make you sick.

Ketones aren’t always a problem, even for people with diabetes. If you’re trying to lose weight and your blood sugar levels remain in the normal range, the presence of ketones might be OK. Trouble arises when ketone levels get too high, because your blood becomes too acidic. That can lead to so-called diabetic ketoacidosis (DKA), which is a medical emergency. You might feel nauseous, vomit, have trouble breathing, become confused, or pass out. Your breath might also smell fruity; that’s a direct result of the ketones.

The best way to prevent this from happening is to keep a close eye on your blood sugar, and, if you take insulin, to use it exactly as instructed by your doctor. Ketones do not usually develop instantly or after missing one injection of insulin, but rather occur over a period of neglect, says Mildred Bentler, CDE, RDN, a diabetes educator, insulin pump trainer, and registered dietitian.

diabetes ketones

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Be prepared to test at any time.

If you have diabetes, you’ll want to keep some ketone test strips handy, says Bentler. This is especially important if you have type 1, since you’re at greatest risk for DKA, but it’s a good idea to be prepared even if you have type 2. Ketone test strips are sold over-the-counter at pharmacies and on, and they’re easy to use: They change color, which you match to a swatch to determine if ketones are present and how high your levels are. (You can also use a machine called a ketone blood meter; ask your doctor if that’s a better option for you.)

MORE: 4 Steps To Reverse Diabetes Naturally

If your blood sugar is over 250 mg/dL for two tests in a row, it’s time to check your ketones. You should also test when you’re sick, since an illness may cause your sugar levels to unexpectedly spike. Feeling unusually tired or developing fruity-smelling breath should also prompt you to test, says Mona Morstein, ND, a naturopathic physician at Arizona Integrative Medical Solutions and author of Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes. She adds that stomach pain can also be a warning sign of DKA, especially for people with type 2 diabetes who use a sodium-glucose cotransporter-2 inhibitor drug like Jardiance, Invokana, or Farxiga.

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If you test positive, get help right away.

A positive test for ketones isn’t always a life-threatening emergency, but it can be. If your urine test indicates that the amount of ketones is “very large,” or if you take a ketone blood test and it shows that your levels are 3.0 mmol/L or higher, get yourself to the hospital ASAP. (Here are 7 sneaky signs your blood sugar is too high.)

If ketones are present but your levels aren’t quite as high, call your doctor and ask if you should take more insulin. Meanwhile, drink lots of water to help flush the ketones out of your system, and keep testing your sugar and ketones every 3-4 hours until your levels return to normal or your doctor gives you different instructions.

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Diabetes, A Disease of Regret and Guilt

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If you live with diabetes, you probably have a very intimate relationship with regret. Because every meal and every bolus can be an opportunity to make a decision you won’t be happy with later.

I’ve realized that for me, diabetes regret is almost always immediately followed by guilt. I regret a poor food choice I’ve made and then feel guilty about the resulting blood sugar chaos. I regret ignoring my CGM alarms, and then feel guilty when my husband has to finish cooking dinner while I treat a low. I regret not getting a workout in, and then feel guilty when my finger-sticks reveal high numbers.

In my almost 38 years with diabetes, my largest amounts of regret and guilt are around my college years. I regret how little care I put into my diabetes management. I regret that I didn’t check my blood sugar. I regret that I ate and drank whatever I wanted. I regret that I didn’t schedule any appointments with my healthcare team. I regret that the only diabetes thing I did in college was take insulin.

However, the heaviest guilt isn’t around the things I didn’t do. It’s around the consequences that haven’t happen to me. It’s something along the lines of complication’s guilt. I am here, alive and well, even after those years of neglect.

I remember the scare tactics used on me when I was young. The promises that if I didn’t take care of myself, if I let my blood sugar run high, if I snuck those cookies and chocolate bars, the consequences would be severe. I’d go blind, I’d lose limbs, my kidneys would fail, I’d die. Sure, those threats scared me. In fact, I saw all of that happening to my aunt who had diabetes. She was always sick and weak, and although she handled it all with grace, it was clear that she suffered. We lost her to those complications when I was a senior in high school. I witnessed it all first-hand, but I never believed that if I worked hard at managing my diabetes I could avoid this fate. Instead, I believed that this was my future, and nothing I did would change that. So, I didn’t even try.

Yet, here I am about to turn 50 years old in May. The complications that I was sure would hit by the time I turned 25 haven’t knocked on my door yet. No retinopathy, no neuropathy, no kidney failure. So far I’ve only dealt with a bit of frozen shoulder. And of course, I’m thankful for that. But also? I feel incredibly guilty.

I have friends and acquaintances who’ve racked up fewer years with diabetes and have worked much harder than me. And yet they are battling all of the complications I have managed to avoid. As often is the case with diabetes, it just doesn’t make sense. It really isn’t fair. It makes me regret those years that I neglected myself, and it makes me feel so guilty that I’m not paying the consequences.

The thing about guilt and regret is that they really aren’t very productive. I can’t change what happened in the past, I can only change how I live my future. So, while I do remember the things I regret and use them to motivate me to do better, I try not to dwell on them too much. Yes, I’ve made many mistakes in the past, and I’m sure I’ll make plenty more in the future. The best thing I can do is learn from those mistakes and move on.

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Diabetes: Can gene therapy normalize blood glucose levels?

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Researchers may have just found a way to restore normal blood glucose levels in a mouse model of type 1 diabetes, which could prove to be a promising solution for people with type 1 or type 2 diabetes in the future.
pancreas producing insulin

Researchers have developed a gene therapy that restores normal blood glucose levels in diabetes by reprogramming alpha cells in the pancreas into insulin-producing beta cells.

Dr. George Gittes, a professor of surgery and of pediatrics at the University of Pittsburgh School of Medicine in Pennsylvania, and team led the study. Their findings were published in the journal Cell Stem Cell.

Type 1 diabetes, a chronic autoimmune disease, affects around 1.25 million children and adults in the United States.

The immune system that usually destroys germs and foreign substances mistakenly launches an attack on the insulin-producing beta cells that are found in the pancreas, which then results in high blood glucose levels.

Over time, type 1 diabetes can have a significant effect on major organs and cause heart and blood vessel disease, damage to the nerves, kidneys, eyes, and feet, skin and mouth conditions, and complications during pregnancy.

Researchers in the type 1 diabetes field have aimed to develop a treatment that preserves and restores function to beta cells, which would, in turn, replenish insulin, responsible for moving blood glucose into cells for energy.

One barrier to this solution is that the new cells that arise from beta cell replacement therapy would likely also be destroyed by the immune system.

To overcome this hurdle, the team hypothesized that other, similar, cells could be reprogrammed to behave in a similar way to beta cells and produce insulin, but which are different enough not to be recognized and destroyed by the immune system.

Alpha cells reprogrammed into beta cells

The team engineered an adeno-associated viral (AAV) vector that delivered two proteins — Pdx1 and MafA — to the mouse pancreas. Pdx1 and MafA support beta cell proliferation, function, and maturation, and they can ultimately transform alpha cells into insulin-producing beta cells.

Alpha cells were the ideal candidates for reprogramming. They are abundant, similar to beta cells, and located in the pancreas, which would all help with the reprogramming process.

Analysis of the transformed alpha cells showed a nearly complete cellular reprogramming to beta cells.

Dr. Gittes and team demonstrated that in a mouse model of diabetes, blood glucose levels were restored for about 4 months with gene therapy. The researchers also found that Pdx1 and MafA transform human alpha cells into beta cells in vitro.

“The viral gene therapy appears to create these new insulin-producing cells that are relatively resistant to an autoimmune attack,” explains Dr. Gittes. “This resistance appears to be due to the fact that these new cells are slightly different from normal insulin cells, but not so different that they do not function well.”

The future of diabetes gene therapy

AAV vectors are currently being researched in human gene therapy trials and could be delivered to the pancreas through a non-surgical endoscopic procedure, eventually. However, the researchers caution that the protection observed in the mice was not permanent, and 4 months of restored glucose levels in a mouse model “might translate to several years in humans.”

“This study is essentially the first description of a clinically translatable, simple single intervention in autoimmune diabetes that leads to normal blood sugars,” says Dr. Gittes, “and importantly with no immunosuppression.”

A clinical trial in both type 1 and type 2 diabetics in the immediate foreseeable future is quite realistic, given the impressive nature of the reversal of the diabetes, along with the feasibility in patients to do AAV gene therapy.”

Dr. George Gittes

The scientists are testing the gene therapy in non-human primates. If successful, they will begin working with the Food and Drug Administration (FDA) to approve use in humans with diabetes.

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To catch Apple, Fitbit invests in a company that makes a small patch to track blood sugar for diabetics

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  • Fitbit invested $6 million into Sano, a company with a patch for tracking people’s blood sugar. It’s Fitbit’s first start-up investment.

  • Fitbit CEO James Park says it’s in line with the company’s broader strategy of developing health solutions, and not just devices.

  • Apple is developing similar technology, sources have told CNBC.

Fitbit has made its first-ever start-up investment, putting more than $6 million into an enterprise called Sano, which is developing a coin-sized patch that tracks blood sugar levels to help control diabetes.

Building blood-sugar tracking into a future device could dramatically increase the market for Fitbit devices since more than 100 million Americans are now living with diabetes or pre-diabetes, according to the Centers for Disease Control and Prevention. Fitbit has recently suffered declining sales: It sold 3.6 million devices in the quarter ended Sept. 30, down from 5.3 million a year earlier.

Apple is known to have a research team working on a noninvasive glucose reader, as CNBC first reported in April. The New York Times in December reported that the project was authorized by late Apple CEO Steve Jobs while embroiled in a personal battle with diabetes, and current CEO Tim Cook has been seen testing a personal glucose monitor.

The Apple Watch is Fitbit’s most formidable competitor.

‘Looking beyond the device’

Fitbit CEO James Park confirmed the Sano deal this week to CNBC. The investment is part of a larger financing round that Sano expects to close in coming months.

“This fits into our strategy of looking beyond the device and thinking more about (health) solutions,” said Park. “I think the complete solution comes in the form of having some monitoring solution that is coupled with a display, and a wearable that can give you the interventions at the right moment,” he said.

Fitbit already has partnerships with wearable device makers Medtronic and Dexcom that involve integrating blood sugar data with its consumer hardware. Park declined to say whether a future version of Fitbit’s wearable devices will include built-in glucose tracking.

Sano’s approach isn’t noninvasive like Apple’s might be because it involves using tiny needles.

But Sano CEO Ashwin Pushpala said it’s a less painful option than the current alternatives, which include Abbott’s popular FreeStyle Libre, because its device doesn’t penetrate as deeply into the skin. It’s also a cheaper option that needs to be changed more regularly, he said.

Sano’s device won’t be ready to hit the market for about a year and is likely intended for people with either Type 1 or Type 2 diabetes, said Pushpala. It might also be used by those who are pre-diabetic, or simply curious about how food and exercise affect their blood sugar.

Biosensor experts are still debating whether noninvasive approaches for tracking glucose, as Apple is planning, will ever be sufficiently reliable and accurate.

Pharma giants like Johnson & Johnson have unsuccessfully tried to bring this “holy grail” to market.

Alphabet’s Verily is also working on hardware and software diabetics. It is teaming with Dexcom to develop a continuous glucose monitor for people with Type 2 diabetes, and it has a joint venture with Sanofi also targeted to people with the disease. In 2014, its own research team unveiled a prototype for a blood-sugar tracking contact lens.

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Researchers are turning to diabetes treatments to find potential Alzheimer’s breakthroughs

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AP/Alastair Grant

  • Treatments used for diabetes could be key to understanding and treating Alzheimer’s disease and other conditions related to aging. 
  • New research in mice suggests that a drug that goes after diabetes targets could have an impact on the trajectory of Alzheimer’s disease. 
  • Next, the same conclusions will need to be seen in humans. 


The search for new treatments for Alzheimer’s has been unsuccessful for the past 15 years.

After many setbacks, researchers have been trying different approaches to treating the neurodegenerative disease, such as starting treatment earlier and finding new ways to target the brain. Alzheimer’s affects more than 5 million Americans, a number that’s expected to balloon to 16 million by 2050.

One unexpected treatment route is showing some initial promise: Using medication originally designed to treat diabetes.

In a new study based on mice, scientists at Lancaster University found that a drug that goes after three diabetes-related targets “significantly reversed the memory deficit” in mice who got the drug, as measured by their performance in a maze test when compared to mice who didn’t get the drug. The experimental drug targets hormones that are key in regulating the body’s blood-sugar levels: GLP-1, GIP, and glucagon.

In the past, researchers have looked into how one component of the experimental drug — GLP-1 receptor agonists — affects people with Alzheimer’s disease and Parkinson’s disease. GLP-1 drugs are used to better control blood sugar levels in people with type 2 diabetes, and are better known by the brand names: Victoza, Byetta, and Bydureon.

For example, a small study of 38 patients with Alzheimer’s from 2016 looked at the effects of Victoza. The study group that took a placebo had a decrease in glucose metabolism in the brain. But in the group that received that medication, there wasn’t a decrease.

The results are still early, however, and it remains to be seen how the treatment works in humans. While some evidence has suggested a link between diabetes and Alzheimer’s in recent years, there’s still a lot we don’t know about what causes Alzheimer’s, let alone how the two conditions are connected. Still, some doctors are optimistic about the potential to use drugs typically prescribed to treat diabetes for patients with Alzheimer’s.

“With no new treatments in nearly 15 years, we need to find new ways of tackling Alzheimer’s,” Dr. Doug Brown, the director of research and development at the Alzheimer’s Society said in a news release. “It’s imperative that we explore whether drugs developed to treat other conditions can benefit people with Alzheimer’s and other forms of dementia.”

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The 10 Most Popular Diabetes Stories from 2017

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The year is coming to a rapid close, and it’s a great time to reflect on the accomplishments and inspiration of the past year. We’re really proud of the content we’ve created here at ASweetLife, bringing breaking news, recipes, lifestyle pieces, and bits of humor and insight to the diabetes community every week. Which is why we’ve leapt ever-so-casually into the Wayback Machine to take a spin through some of our most popular diabetes stories from this year. Is your favorite on the list?

Actress and Diabetes Advocate Mary Tyler Moore Dies at 80: “For years, the first voice that greeted us on the JDRF phone system was that of Mary Tyler Moore. As it should have been. Ms. Moore was, after all, the heart, soul and lifeblood of the JDRF. It is not an exaggeration to say her willingness to share not just that voice, but that smile, that honesty, and that star-power pushed the diabetes treatment and research landscape to the place it is today.” In 2017, we said goodbye to one of the most prominent, dedicated, and inspiring advocates for people with diabetes – Mary Tyler Moore. Moira McCarthy’s moving piece on Moore’s passing and her lasting influence on the diabetes community is a must-read.

The Never-Relaxed Parent of A Child With Diabetes: “As I held my son and waited for him to “come back”—and yes, through the years I envision that during hypoglycemic episodes he does go someplace else, where his arms and legs are tied to bricks, where he seems to slip away from me—I realized that I’ve gone somewhere, too.” Annie Stoltie writes about what it’s like to parent a young child with type 1 diabetes and how their lives have changed since her son’s diagnosis.

I Know About Needles: Sarah Vedomske, one of A Sweet Life’s newest writers, made her debut with this beautiful essay about the intimacy of needles in her diabetes life. “I know about the orange-capped syringes, how to hold the barrel up to the light, tap the tiny air bubbles to the top, push the plunger, squeeze them out. I know, from being a perfectionist, that sometimes no amount of flicking and tapping and cursing and squinting will release that last miniscule burst of air. I know it is not recommended to reuse these, but I also know that I’ve reused a syringe to the point of all numbers—the measurements—being worn off, to an unmarked barrel, eyeballing my dose.”

Succeeding with Diabetes on a Vegan Diet: We looked at veganism and diabetes again in 2017, interviewing Lee Ann Thill for her perspectives. “But veganism isn’t entirely about diet, for Lee Ann. There’s a bigger picture in play, and one that directly touches her experiences with diabetes. ‘Being vegan has made me more curious about power – who has it, who doesn’t, forces maintaining those dynamics – ways to alter power dynamics, and more critical of how my actions can better reflect my personal values, notably, fairness, empathy, knowledge, and creativity.’”

In Defense of the Unicorn Frappuccino: ASweetLife’s editor-in-chief, Jessica Apple, dives headfirst into the controversy over Starbucks’ unicorn frappuccino, which was unleashed last Spring. “The people of the internet have been making jokes about the Unicorn Frappuccino, calling it diabetes-in-a-cup. And everyone knows that unicorns don’t give you diabetes, so the joke isn’t funny. And what also isn’t funny is that the one responsible for the type 2 diabetes crisis in America is not a horny horse or any single food/beverage corporation, but the U.S. government.”

The Promise of Generic Insulin: “In between working towards a PhD in computer science at U.C. Davis, Di Franco is working to understand enough about producing insulin in a simpler and cheaper way to establish a protocol for enabling almost any business entity to produce insulin. Without the enormous R & D costs that Big Pharma likes to point to when they speak to costs, the Open Insulin Project hopes to open the market to cheaper insulin and happier people with diabetes.” Larissa Zimberoff takes a look at the progress made towards generic insulin.

Solving the Jackie Robinson Diabetes Mystery: “Today, exactly two years before the 100th anniversary of Robinson’s birth, it’s not common knowledge that he lived with diabetes. In fact, his diabetes remains so shrouded in mystery that there isn’t even a clear consensus about which type he had.” Did you know that baseball great and first African American to play in the major leagues, Jackie Robinson, had diabetes? Alex O’Meara takes a look at this mystery.

New Theory About the Cause of Type 1 Diabetes: What’s beta than a new theory to noodle around about the origin of type 1 diabetes? The ASweetLife team checked out this news story in depth. “In order to gain a better understanding of why the immune system attacks the body’s own source of insulin — the pancreatic beta cells in the islets of Langerhans — the team took some clues from cancer molecules that are targeted by the immune system after successful treatment of the cancer with immunotherapy.”

Girl With Diabetes and Insulin Allergy to Receive Pancreas Transplant: What do you do when you have diabetes and you’re allergic to insulin? Columnist Moira McCarthy covered this story for ASweetLife. “A 12-year old South Carolina girl with Type 1 diabetes and what her parents describe as an intense allergy to insulin therapy is set to undergo a rarely performed whole pancreas transplant at the University of Minnesota.”

7 Diabetes Technology Updates for 2018: We can’t close out 2017 without looking into 2018, taking a peek at what’s next in diabetes technology. Christopher Snider closes out our list with his look at what to keep an eye on next year. “When I think about the scope and potential of diabetes technology, it’s more than just a specific product or products that may come to market. So here’s a glimpse at some of the companies and movements that I am going to pay close attention to next year as diabetes technology looks to take another major step forward in 2018.”

But these aren’t all the posts we loved in 2017. Take a look through our recipes, or what’s new in diabetes advocacy, or at some personal stories from PWD like you. And thanks. A big thanks for reading ASweetLife in 2017. We’re excited to bring you more diabetes information and inspiration in 2018!

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Obesity, poverty help explain higher diabetes risk in U.S.

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Even though black adults are more likely to develop diabetes than white adults, the increased risk is largely due to obesity and other risk factors that may be possible to change, a U.S. study suggests.

Researchers followed 4,251 black and white men and women starting when they were 18 to 30 years old; none of them had diabetes to start with. After an average follow-up of more than 24 years, 504 of the participants developed diabetes.

Compared to white women, black women were almost three times more likely to develop diabetes, researchers report in the Journal of the American Medical Association. Black men, meanwhile, had 67 percent higher odds of becoming diabetic than white men.

However, there was no longer a meaningful difference in diabetes risk between black and white people once researchers accounted for a variety of factors that can contribute to this disease including obesity, neighborhood segregation and poverty levels, depression, education and employment.

“Our work suggests that if we can eliminate these differences in traditional risk factors between blacks and whites then we can reduce the race disparities in the development of diabetes,” said lead study author Michael Bancks, a researcher at Northwestern University Feinberg School of Medicine in Chicago.

This isn’t an easy fix, Bancks acknowledged.

“To eliminate the higher rate of diabetes, everybody needs to have access to healthy foods, safe spaces for physical activity and equal economic opportunity to have enough money to afford these things and live in communities that offer this,” Bancks said by email.

“Prior research by our team has shown that black adults live in neighborhoods that have higher rates of poverty, fewer grocery stores and (fewer) safe places for physical activity,” Bancks added. “These neighborhood factors contribute directly to the health behaviors such as physical activity and diet that can lead to obesity and diabetes.”

At the start of the study, participants were about 25 years old on average, and white people were more likely to be married, employed full-time and have at least some college education.

During the study, 189 white people and 315 black people developed diabetes.

This translates into 86 cases of diabetes for every 1,000 white people, compared with 152 cases for every 1,000 black people.

Among all of the risk factors that helped explain this difference, biological factors such as obesity and fasting blood sugar levels played the biggest role, the study found.

The study wasn’t a controlled experiment designed to prove whether or how various risk factors might influence the odds of developing diabetes or explain racial disparities.

Another limitation is that researchers relied on data from blood sugar tests or diabetes medication prescriptions to determine whether people had been diagnosed with the disease, the authors note. Current definitions of the blood sugar levels that indicate diabetes are different than they were during much of the study, and prescription records don’t always offer a complete picture of who has been diagnosed with this disease, the researchers point out.

Even so, the results offer fresh evidence that long-documented racial disparities in diabetes rates in the U.S. might be reduced by focusing on risk factors that are possible to change, said Dr. Daniel Lackland, a researcher at the Medical University of South Carolina in Charleston.

“It is important for black patients and individuals to recognize the disease risk disparities and excess burden for African Americans BUT also know these risks can successfully be reduced by knowing their blood pressure and blood glucose levels; taking medication as prescribed; not smoking; exercise; reducing excess body weight; and consuming a healthy diet,” Lackland, who wasn’t involved in the study, said by email.

“These are interventions individuals could implement regardless of income level,” Lackland added. “For example – having blood pressure measured and knowing numbers; walking in safe areas such as shopping malls; and eating a healthy diet.”

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One Man’s Stand Against Junk Food as Diabetes Climbs Across India

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India is “sitting on a volcano” of diabetes. A father’s effort to ban
junk food sales in and near schools aims to change what children eat.

Rahul Verma’s son was born gravely ill with digestive problems, but over years of visits to the boy’s endocrinologist, Mr. Verma saw the doctor grow increasingly alarmed about a different problem, one threatening healthy children. Junk food, the doctor warned, was especially dangerous to Indians, who are far more prone to diabetes than people from other parts of the world.

One day in the doctor’s waiting room, Mr. Verma noticed a girl who had gotten fat by compulsively eating potato chips. He decided he had to do something.

“On one side you have children like my son, who are born with problems,” said Mr. Verma, “and on the other side you have children who are healthy and everything is fine and you are damaging them giving them unhealthy food.”

Mr. Verma, who had no legal training, sat late into the nights with his wife, Tullika, drafting a petition in their tiny apartment, which was bedecked with fairy lights and pictures of the god Ganesh, who is believed to overcome all obstacles. He filed the public interest lawsuit in the Delhi High Court in 2010, seeking a ban on the sale of junk food and soft drinks in and around schools across India.

Mr. Verma with his son, Uday, who needed many surgeries to survive congenital birth defects. Uday’s struggles inspired Mr. Verma to help children born healthy combat the risks associated with a diet of junk food. Credit Atul Loke for The New York Times

The case has propelled sweeping, court-ordered regulations of the food industry to the doorstep of the Indian government, where they have languished. They have outsize importance in India, population 1.3 billion, because its people are far more likely to develop diabetes — which can lead to heart disease, kidney failure, blindness and amputations — as they gain weight than people from other regions, according to health experts.

Since 1990, the percent of children and adults in India who are overweight or obese has almost tripled to 18.8 percent from 6.4 percent, according to data from the Institute for Health Metrics and Evaluation at the University of Washington.

The International Diabetes Federation projects that the number of Indians with diabetes will soar to 123 million by 2040 as diets rich in carbohydrates and fat spread to less affluent rural areas.

“We are sitting on a volcano,” said Dr. Anoop Misra, chairman of a diabetes hospital at Fortis Healthcare, one of India’s biggest private hospital chains.

In the years since the court ordered the government to develop guidelines to regulate junk food, the case has encountered ferocious opposition from the All India Food Processors Association, which counts Coca-Cola India, PepsiCo India and Nestlé India as members, as well as hundreds of other companies.

Subodh Jindal, the president of the association, said in an interview that junk food was unfairly blamed for diabetes and obesity. It was overeating, not the food itself, that has caused the problem, he said, asking, “Do you eat two pizzas a day or two pizzas a week?”

The government this year took a significant step that public health experts believe will help combat the rise of obesity in the world’s second most populous country. It partially implemented a tax on sugar sweetened beverages, instituting a 40 percent tax on such drinks that are carbonated, though not on juices made with added sugars that many children drink.

But so far, the regulations to ban sales near schools sought by the court in Mr. Verma’s case have led to naught.

“At such a slow pace, we will all be sick and diseased by the time any changes come in,” said Shweta Khandelwal, a nutritionist at the Public Health Foundation of India.

A fast food restaurant in New Delhi. The International Diabetes Federation projects that the number of Indians with diabetes will roughly double to 123 million by 2040. Credit Atul Loke for The New York Times

Jagat Prakash Nadda, India’s minister of health and family welfare, did not respond to repeated requests for comment, but Pawan Agarwal, chief executive of the Food Safety Standards Authority of India, the body in the ministry responsible for such regulations, insisted that the government’s efforts have been sincere.

“This may appear to be typical of India. When you have an issue, you set up so many committees and confuse the whole issue,” he said. But he insisted: “People are concerned. They want to do something about it. Therefore everyone is setting up committees.”

As the case has played out on Twitter and in newspapers, students carrying “Junk Food Rest in Peace” posters have rallied, seeking to make obesity an issue in a country where feeding the hungry has been a national obsession. Some schools have voluntarily stopped serving junk food.

The court battle has unfolded in a grand, wood-paneled courtroom here in the nation’s capital. Mr. Verma, 42, quit his job as a corporate marketing executive after his son’s birth in 2006 and set up a foundation in 2007 to help families like his with sick children. An emotional man, he sometimes wept in frustration with the government’s foot dragging. At one point, doubting his decision to venture into India’s overburdened legal system, the lanky, round-faced Mr. Verma, who wears big square glasses, begged the judge to let him withdraw the petition.

“Nothing is happening. I’ve wasted my time,” he said, tears sliding down his face, as he bemoaned getting sidetracked from his foundation’s mission of helping poor, sick children at the giant public hospital where his son had been treated. “I could have helped hundreds of kids.”

But Chief Justice Dipak Misra refused to let Mr. Verma take back his lawsuit. Instead, spotting a senior advocate, Neeraj Kishan Kaul, at the back of the crowded courtroom, the judge ordered him to act as the pro bono lawyer for Mr. Verma’s case.

As Mr. Kaul, 54, approached the bench, he recalled, he joked to the judge, “You’ve got the wrong guy. I like junk food.”

Mr. Verma filed a public interest lawsuit in 2010 seeking to ban the sale of junk food in and around schools in hopes of protecting children from an unhealthy diet. Credit Atul Loke for The New York Times

An Increased Risk

Researchers around the world began noticing that Indian immigrants were more prone to diabetes in the 1970s.

“But nobody knew why,” said Dr. Viswanathan Mohan, a physician and researcher who owns several dozen diabetes centers in India.

Scientists searched for genes that predisposed Indians to diabetes, but didn’t find them. Instead, a growing body of research suggests that Indians’ body type — one that is smaller but with more abdominal fat — may be responsible.

Being born to a malnourished woman — a common phenomenon in India — may also increase the odds of developing diabetes. Clues to this pattern emerged from other parts of the world. Researchers studied the health of babies born during the Dutch famine in 1944-45. They found that the babies had a higher likelihood of impaired glucose tolerance as adults, which led to higher rates of diabetes.

Dr. Chittaranjan Yajnik, a diabetes specialist, and Barry Popkin, a professor of nutrition at the University of North Carolina, are among the researchers exploring a theory that Indians evolved what Dr. Yajnik has called “a thin-fat” body type over millenniums as a way to survive famines when monsoons failed.

Dr. Yajnik, who is from Pune, a city in western India, noticed during his medical training in Britain in the 1980s that he had higher levels of fat and hormones related to diabetes than European doctors even though he appeared thinner.

That set Dr. Yajnik, now head of diabetes at KEM Hospital Research Center in Pune, on a quest to understand if this was generally true for Indians — and if so, why.

In the 1990s, he began following the pregnancies of hundreds of women in villages outside Pune and tested their offspring as they grew up.

Compared with infants in Britain, Indian newborns were about 1.5 pounds lighter but had more abdominal fat and higher levels of certain hormones in their cord blood, he found, suggesting a predisposition to diabetes.

Dr. Yajnik said he believes Indians’ susceptibility to diabetes may have emerged as their diets changed with rising affluence — and that their bodies, attuned to scarcity, couldn’t handle an overload of food.

Street meals in New Delhi. Scientists have found that Indians are more likely to get diabetes as they gain weight than people from other regions. Credit Atul Loke for The New York Times

As of last year, some 199 million adults in India were overweight or obese according to the Institute for Health Metrics and Evaluation. Since 1990, the percent of India’s adult population with diabetes has surged to 7.7 percent — some 63 million people — from 5.5 percent.”

Although obesity and overweight are far less prevalent in India (24 percent last year) than in Canada (about 60 percent), for example, adults there are just as likely to develop diabetes as in Canada, a New York Times analysis of data from the institute found.

Many of the countries where diabetes is more common relative to obesity are in South Asia, the Times analysis found.

How Diabetes Compares With Obesity Around the World

For every 100 adults who have been overweight or obese since 1990, an average of 21 adults have had diabetes. But in India and other South and Southeast Asian countries, the number of people with diabetes has been much higher relative to the number of people who have been overweight or obese.

Vietnam 87

North Korea


India 51

United States



Bangladesh 71


20 adults with

diabetes for

every 100 who

were overweight

or obese

Fiji 67

In the years since Mr. Verma filed his suit, consumption of junk food has risen sharply across India. Sales of packaged foods have increased 138 percent; fast food 83 percent; and carbonated drinks 58 percent, according to Euromonitor International, the market research firm.

Coca-Cola Company’s chief executive James Quincey, in an interview with Indian media earlier this year, said that he expected the Indian market to eventually become the company’s third largest in sales, up from sixth.

Coca-Cola and PepsiCo have announced plans to invest billions of dollars in the Indian market. They have also said they plan to increase their offerings of drinks with less sugar and more fruit.

Sanjay Khajuria, a Nestlé India spokesman, said the food processors association, which opposed Mr. Verma’s case, had “taken into account inputs received by the association from its members,” and declined further comment on the case. He also noted that the company has joined other companies in India to restrict advertising directed at children under 12 to products with a certain level of nutrients.

A Coca-Cola spokesman referred questions on the lawsuit to the food association. PepsiCo India’s vice president of sales, Harsh K. Rai, also declined to comment on the lawsuit. He said the company has stopped advertising to children 12 and under.

An Unexpected Calling

Becoming a crusader against junk food was far from Mr. Verma’s mind as he and his wife battled to save their son, Uday, who was born with parts of his digestive system missing.

The boy endured nine surgeries, but emerged thriving. His parents decided they wanted to help families facing similar challenges and formed the Uday Foundation. Mr. Verma ran it, while his wife supported the family on her $1,000-a-month salary as an administrator in the government education system.

Uday Verma was born with parts of his digestive tract missing and required nine surgeries to get better, but now he is thriving. Credit Atul Loke for The New York Times

After seeing the obese girl in the doctor’s waiting room, Mr. Verma couldn’t shake his concern about junk food. He also had a worry closer to home: his daughter, Lavanya, sometimes bought burgers at school instead of eating the rice and lentils her mother sent from home.

First the couple approached state officials about banning junk food in New Delhi schools — to no avail.

Then in 2010 he filed the lawsuit, basing his case on the constitutional authority of courts to intervene to protect citizens’ right to life.

In 2011, the presiding judge asked the national government “to take concrete and effective steps to ensure that the sale and supply of junk food in and around schools is banned.”

The food industry hired some of the country’s most politically-connected lawyers to fight the case, including Mukul Rohatgi, the former additional solicitor general; Abhishek Manu Singhvi, who has been a member of Parliament and spokesman for the Congress Party, which has ruled India for most of its post-independence history; and Kapil Sibal, the three-time president of the Supreme Court Bar Association who had served as a senior minister in the Congress-led government.

The hearings dragged on. Finally, in 2014, the working group of an expert committee picked by the food authority recommended that sales of potato chips, sugar sweetened beverages, ready-to-eat noodles and chocolates be banned within 500 yards of schools.

The food association strenuously objected. D. V. Malhan, its executive secretary, said in an interview that there are so many schools that the proposed sales ban would have hurt the industry badly.


Children in the library of the Uday Foundation, which offers tutoring for underprivileged children in the afternoons. Credit Atul Loke for The New York Times

In early 2015, the food authority in the health ministry finally recommended regulations to the court, including some limitations on the sale of junk food around schools. The judge ordered the recommendations carried out within three months. Instead, the food authority appointed yet another committee.

Last year, at a meeting in New Delhi, that committee proposed taxing junk food, prohibiting advertising of it during children’s television shows and requiring consumer labeling of processed food.

Mr. Malhan, of the food association, denounced the report for not soliciting industry input earlier. Shouting, he said the guidelines were unacceptable.

It has been nearly two years since that contentious meeting.

Mr. Agarwal, chief executive of the food authority, insisted his agency is finally ready to start adopting new rules early next year for labeling healthy food with a green light and those high in fat, sugar and salt with a red light.

But he said taxing junk food and banning it around schools were long term goals.

“There is no point in confronting industry on these issues,” he said.

Many More Patients

Jaspreet Singh, left, with his parents Narendra Singh and Jasinder Kaur, watching cricket on television at home in New Delhi. All three suffer from diabetes and are patients of Dr. Anoop Misra’s. Credit Atul Loke for The New York Times

As the government debates junk food policy, doctors here say that over the past 20 years they have seen their offices packed with increasingly younger diabetic patients.

Last month, Sapna Dhingra, 49, called Dr. Rommel Tickoo, a New Delhi internist, complaining of leg pain. He sent her for a blood test and texted her the next day: “Come over. You’ve got diabetes.” She reeled in shock. Her mother is also diabetic, but got the disease in her 60s.

Now diabetes is stalking her husband and daughter, who are what Dr. Yajnik would call “thin-fat.”

Her husband, Hardesh, 54, learned a few months ago that his high blood sugar put him on the borderline of being diabetic. He immediately started taking daily walks, but Delhi’s dangerous air pollution prompted Dr. Tickoo to advise him to stop.

A blood test revealed that the couple’s daughter, Ria, 22, also had elevated blood sugar. She is not overweight, either, although she gained a few pounds recently after a knee injury interrupted her exercise routine.

Dr. Tickoo advised Ria to immediately change her diet but she said it was hard to resist temptation. When she is not studying at the Pearl Academy of Fashion, where she is in her final year, she hangs out in malls crammed with fast food restaurants serving pizza, burgers, fried chicken and oily Indian entrees.

She has switched from milkshakes to smoothies made with fresh fruit, but confesses her motive is not her health. The question for her and her friends: “Are we going to fit in our leggings or not?”

The Future of the Fight

Patients eating khichdi, the traditional Indian dish, distributed three days week by the Uday Foundation outside the New Delhi hospital where Uday Verma was treated. Credit Atul Loke for The New York Times

At lunchtime one recent day, people on crutches and with tubes hanging out of their noses gathered in a crowd outside the hospital where Mr. Verma’s son was treated. A white van pulled up and they jostled to the front of the line for heaping bowls of khichdi, an Indian favorite of rice, lentils and vegetables.

Mr. Verma’s foundation — which now has more than 700,000 Twitter followers — serves these meals three days a week to about 1,000 patients.

At his office, he reveled in his David versus Goliath battle to regulate junk food. He was emphatic that someone needs to continue the fight; he is just not sure that someone is him. He is convinced the unending legal battle gave him high blood pressure.

His former partner on the case, the pro bono lawyer Mr. Kaul, said India needs more than Mr. Verma to make change happen.

Public interest lawsuits have helped citizens press for government action and win significant victories on air pollution, for example.

But that happened after outrage about filthy air had mounted. Mr. Kaul said the government will only move on junk food once public pressure builds.

“You need a movement to fight the inertia of the system,” he said, sipping a can of Coke.

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Government is helping to feed the diabetes crisis in Texas

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Type 2 diabetes is rampant in Texas. Two million residents have the condition, and that figure is expected to shoot up by another million by 2030.

The disease generally afflicts those with unlucky genes who eat poorly. But unhealthy diets are not entirely the fault of Texans. Federal dietary guidelines are based on weak science. These recommendations, which are developed by nutritionists who champion widely accepted but increasingly questionable advice, have a huge impact on how everyone eats. Given the scale of the diabetes epidemic, it’s time to reform the process that produces our nation’s nutritional guidelines.

Diabetes takes a huge and increasing toll here in Texas. From 2000 to 2010, the prevalence of the condition surged 57 percent. It kills 5,000 Texans annually. In 2012, diabetes caused $18 billion in medical expenses and another $5.5 billion in lost productivity.

Obesity is the primary cause of type 2 diabetes. People who are overweight require much more insulin to control their blood sugar but often struggle to produce enough of the hormone.  Since 1990, Texas’s obesity rate has surged from below 10 percent to 34 percent. The epidemic in obesity indicates that our state could soon be overwhelmed by a wave of diabetes in adults.

The federal dietary guidelines were first published in 1980 and are updated by government officials every five years. They were designed to help keep Americans healthy. But they may have inadvertently caused this spike in obesity. That’s not because people disregarded the guidelines, but paradoxically, because they followed them.

The guidelines have long urged people to dodge fats and consume more carbohydrates. This admonition stems from old research that was shaky at best. More rigorous studies since have shown that a high-carb, low-fat diet does nothing to combat obesity or type 2 diabetes. In fact, it worsens diabetes.

Consider one study by researchers at Tulane University who observed two groups of dieters. One group ate a low-carb diet; the other ate a low-fat diet. The low-carb group lost three times as much weight as the low-fat group.

Or look at research about whole milk, which the guidelines recommend avoiding. Surprisingly, study after study has found that consumption of whole milk lowers the risk of being overweight. In a recent review of 25 studies looking at milk-fat consumption, not one showed that whole milk raised the risk of obesity.

Marcia Otto, a University of Texas professor who has conducted extensive research on the issue, notes that avoiding full-fat dairy foods means “losing a huge opportunity for the prevention of disease.” This is especially important for diabetes, as reduction in fat intake is typically associated with an increase in carb intake. But a high-carb diet causes a diabetic’s blood sugar to spike, which requires expensive insulin and contributes to weight gain.

A low-carb diet can reduce (or in some cases of type 2 diabetes, even eliminate) the need for medication. Indeed, a 2015 study in the journal Nutrition found that such diets enable people with type 1 diabetes to dramatically reduce their insulin usage, and some type 2 diabetics can forgo the shots altogether. Another short-term study published in JMIR Diabetes found that a very low-carb, high-fat diet effectively reversed type 2 diabetes.

As an endocrinologist in Texas, I’ve seen this firsthand. Consider just one of my patients. For more than 20 years, she struggled to keep her blood sugar on track. When I started treating her, we decided on a new approach, one that ignored the federal dietary guidelines and instead boosted fat intake and lowered carbohydrate consumption. The results were astounding. In short order, her blood sugar regularly registered in the nondiabetic range, with greatly reduced insulin requirements and near elimination of low blood-sugar events.

Despite all the new research exonerating fats and implicating carbohydrates, leading nutritionists refuse to reconsider entrenched norms of a healthy diet. Consequently, government officials haven’t revised the guidelines. They still recommend eating six servings of grains every day. And they still warn people to consume less than 10 percent of their calories from saturated fats.

In September, the National Academy of Sciences concluded that the entire process for developing the guidelines falls short of “best practices” and needs to be “comprehensively redesigned.”

The government’s guidelines should be based on the latest nutritional science available, not old studies cherry-picked by nutritionists to defend the status quo. Texans can’t afford to be misled any longer about what they should and shouldn’t eat.

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