Diabetes Mellitus: Overview, Causes, Risk Factors, Treatment
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Scientists have created a drug for type 2 diabetes that is switched on by blue light, which they hope will improve treatment of the disease. Diabetes drugs that promote the release of insulin from the pancreas can in some cases cause side effects due to their actions on other organs such as the brain and heart. Some can also stimulate too much insulin release, causing blood sugar levels to drop too low. To help create better drugs, researchers at Imperial College London and LMU Munich adapted an existing type of drug called a sulfonylurea so that it changes shape when exposed to blue light. The drug would be inactive under normal conditions, but a patient could in theory switch it on using blue LEDs stuck to the skin. Only a small amount of light would need to penetrate the skin to change the drug’s shape and turn it on. This change is reversible, so the drug switches off again when the light goes off.
A collaborative research team led by Medical College of Wisconsin (MCW) scientists has identified a new gene associated with fasting glucose and insulin levels in rats, mice and in humans. The findings are published in the September issue of Genetics. Leah Solberg Woods, Ph.D., associate professor of pediatrics at MCW and a researcher in the Children’s Hospital of Wisconsin Research Institute, led the study and is the corresponding author of the paper. The authors of the paper identified a gene called Tpcn2 in which a variant was associated with fasting glucose levels in a rat model. Studies in Tpcn2 knockout mice also demonstrated the difference in fasting glucose levels as well as insulin response between the knockout animals and regular mice. Finally, Dr. Woods’ team identified variants within Tpcn2 associated with fasting insulin in humans. Tpcn2 is a lysosomal calcium channel that likely plays a role in insulin signaling. Glucose tolerance, insulin resistance and beta cell dysfunction are key underlying causes of type 2 diabetes. “Genome-wide association studies in humans have identified 60+ genes linked to type 2 diabetes; however, these genes explain only a small portion of heritability in diabetes studies. As we continue to identify genes and variants of interest, we will evaluate them in multiple models to understand the mechanism of disease,” said Dr. Solberg Woods.
A positive outlook and support from people around them help patients with diabetes cope with psychosocial challenges of the disease, according to an international study that included researchers from Penn State College of Medicine. A better understanding of the emotional, psychological and social challenges people with diabetes face could improve health outcomes. The Second Diabetes Attitudes, Wishes and Needs (DAWN2) study is the largest analysis yet undertaken of personal accounts of people living with diabetes. The original DAWN study in 2001 found that 41 percent of adults with diabetes have poor psychosocial well-being. In the follow-up study, almost half – 46 percent – of people with diabetes had negative emotional, psychological and social experiences related to their illness. Two major negative themes emerged. People with diabetes reported feeling anxiety, fear, worry, depression and hopelessness about their condition, and they experienced discrimination at work and misunderstanding from the public. One in five study participants reported workplace discrimination including losing their job due to their illness. The researchers administered online, telephone and in-person questionnaires to 8,596 people with diabetes living in 17 countries including the United States and Canada. Patients with type 1 diabetes and patients with type 2 diabetes were included. The results appear in the latest edition of Diabetes Care.
The current way of diagnosing type-2 diabetes using blood glucose levels needs to be revised, research by scientists from The University of Manchester and King’s College London suggests. The findings, published in the journal PLOS ONE today (3 September), show the current method of diagnosis – using blood glucose levels – means patients are diagnosed too late so that their blood vessels may already be damaged. Type 2 diabetes, which affects over 90% of all adults with diabetes, often leads to heart damage and blood vessel problems in the brain, eyes and kidneys. It is closely linked to increasing levels of obesity, lack of exercise, unhealthy diets and our aging population. The study focused on young, previously pregnant women followed up in Greater Manchester after being identified as at increased, intermediate and low risk of developing type-2 diabetes. Researchers examined biochemical markers in the blood before glucose became elevated – so before the patients reached the pre-diabetes stage.
In a closed-loop control approach to managing type 1 diabetes, glucose sensors placed under the skin continuously monitor blood sugar levels, triggering the release of insulin from an implantable insulin pump as needed. The aim of this closed-loop insulin delivery system is improved control of blood glucose levels throughout the day and night. But a new study in adults and adolescents found that mean blood glucose levels remained at safe levels 53-82% of the time, according to the results published in Diabetes Technology & Therapeutics (DTT), a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the DTT website until September 25, 2014. Howard Zisser, MD and an international team of researchers representing the Control to Range Study Group measured plasma glucose levels every 15-30 minutes in a group of individuals with type 1 diabetes who participated in the “Control to Range” multinational artificial pancreas study. They monitored the adults and teens over 22 hours, including three meals and periods of day and night. The authors describe the risks of hypo- and hyperglycemia, the variability between participants, and the differences in daytime/nighttime results, and also propose improvements needed in the design and implementation of closed-loop systems in the article “Multicenter Closed-Loop Insulin Delivery Study Points to Challenges for Keeping Blood Glucose in a Safe Range by a Control Algorithm in Adults and Adolescents with Type 1 Diabetes from Various Sites.” “It appears that we are getting closer to an Artificial Pancreas option for patients with type 1 diabetes,” says DTT Editor-in-Chief Satish Garg, MD, Professor of Medicine and Pediatrics at the University of Colorado Denver. “The first version may need to be a hybrid system in which meals and exercise are announced with necessary dose adjustments along with Automatic Threshold Suspend for hypoglycemia.”
Acute pancreatitis involves the pancreas digesting itself resulting in severe abdominal pain, vomiting and systemic inflammation. Every year in the UK around 20,000 patients are diagnosed with the disease resulting in 1000 deaths. There is no immediate cure and treatment is restricted to intravenous fluid and nutritional support. Dr Jason Bruce, from the Faculty of Life Sciences, who led the research, said “The major causes of pancreatitis include bile acid reflux from gall stones and excessive alcohol intake combined with a high fat diet. In fact, the incidence of acute pancreatitis significantly increases during the Christmas period when alcohol and fat consumption is at its highest amongst the general population. When alcohol and fat accumulate inside pancreatic acinar cells – the cells that secrete digestive enzymes into the gut – the resulting small molecules called metabolites deplete cellular energy levels and increase cellular calcium. This causes uncontrolled and catastrophic cell death and the cells burst, releasing their toxic enzymes which digest the pancreas and surrounding tissue.” However, recent research from Dr Bruce’s laboratory published in the Journal of Biological Chemistry, shows that insulin, which is normally released from the beta cells of the pancreas, prevents these toxic effects of alcohol and fatty acid metabolites. Dr Bruce and his team decided to look at insulin because it has been used successfully to treat obese pancreatitis patients by reducing fatty acids in the blood.
Job strain can significantly increase the risk of developing diabetes. This conclusion was based on prospective data from a population-based study conducted by scientists at the Helmholtz Zentrum München. The findings have been published in the scientific journal Psychosomatic Medicine. Workplace stress can have a range of adverse effects on health with an increased risk of cardio-vascular diseases in the first line. However, to date, convincing evidence for a strong association between work stress and incident Type 2 diabetes mellitus is missing. Risk of diabetes about 45 percent higher As the team of scientists headed by Dr. Cornelia Huth and Prof. Karl-Heinz Ladwig has now discovered that individuals who are under a high level of pressure at work and at the same time perceive little control over the activities they perform face an about 45 percent higher risk of developing type 2 diabetes than those who are subjected to less stress at their workplace.
Shift work is linked to a heightened risk of developing type 2 diabetes, with the risk seemingly greatest among men and those working rotating shift patterns, indicates an analysis of the available evidence published online in Occupational & Environmental Medicine. Previous research has suggested links between working shifts and a heightened risk of various health problems, including digestive disorders, certain cancers, and cardiovascular disease. But whether diabetes can be added to the list has not been clear. The authors therefore trawled through scientific research databases, looking for relevant observational studies assessing associations between shift work and diabetes risk. They retrieved 12 international studies out of a potential total of 448, involving more than 226,500 participants, 14,600 of whom had diabetes.
The popular culinary herbs oregano and rosemary are packed with healthful compounds, and now lab tests show they could work in much the same way as prescription anti-diabetic medication, scientists report. In their new study published in ACS’ Journal of Agricultural and Food Chemistry, they found that how the herbs are grown makes a difference, and they also identified which compounds contribute the most to this promising trait. Elvira Gonzalez de Mejia and colleagues point out that in 2012, type-2 diabetes affected more than 8 percent of Americans and cost the country $175 billion. Some people can manage the disease with exercise and changes to their diet, and others take medication. But not everyone can stick to a new lifestyle or afford the prescription drugs necessary to keep their blood-sugar level in check. Recent research has shown that herbs could provide a natural way to help lower glucose in blood. So Gonzalez de Mejia’s team decided to take a closer look. They tested four different herbs, either greenhouse-grown or dried commercial versions, for their ability to interfere with a diabetes-related enzyme, which is also a target of a prescription drug for the disease.
Labelling people with moderately high blood sugar as pre-diabetic is a drastically premature measure with no medical value and huge financial and social costs, say researchers from UCL and the Mayo Clinic, Minnesota. The analysis, published in the BMJ, considered whether a diagnosis of pre-diabetes carried any health benefits such as improved diabetes prevention. The authors showed that treatments to reduce blood sugar only delayed the onset of type 2 diabetes by a few years, and found no evidence of long-term health benefits. Type 2 diabetes is typically diagnosed with a blood test that measures levels of haemoglobin A1c, which indicates average blood sugar level over the last three months. People with an A1c over 6.5% can be diagnosed with diabetes but the latest guidelines from the American Diabetes Association (ADA) define anyone with an A1c between 5.7% and 6.4% as having pre-diabetes. If the ADA guidelines were adopted worldwide, a third of the UK adult population and more than half of adults in China would be diagnosed with pre-diabetes. The latest study questions the logic of putting a label on such huge sections of the population, as it could create significant burdens on healthcare systems without conferring any health benefits. Previous research has shown that type 2 diabetes treatments can do more harm than good for people with A1c levels around 6.5%, let alone people below this level.
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