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Published: Mon, 25 Sep 2017 16:40:18 GMT

Last Build Date: Mon, 25 Sep 2017 16:40:18 GMT

 



Researchers discover mechanism in fat tissue by which insulin resistance develops

Fri, 22 Sep 2017 00:00:00 GMT

A new study shows how specific compounds released from fat tissue play a role in mediating inflammation and the development of insulin resistance. While previous research laid the groundwork for how inflammation in fat tissue can mediate insulin resistance, this new study elucidates the true nature of this inflammatory process as one underlying cause of type 2 diabetes. In a paper, published in the journal Cell, researchers from the University of San Diego School of Medicine explain that obesity leads to the infiltration of fat tissue by immune cells primarily responsible for the inflammatory response known as macrophages. These macrophages are a prominent source of 'proinflammatory' cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), that can block insulin action in fat cells, a characteristic which links inflammation to insulin resistance. Researchers found that, as inflammation sets in, macrophages create and secrete culprit compounds also tied to insulin resistance called adipose tissue–derived exosome-like vesicles (ELVs). ELVs can be thought of as extremely small vesicles or sacs that moves between tissues and engage in a cross-talk between macrophages, metabolic tissues and macronutrient metabolism – the flux and storage of nutrients. After using fluorescent dyes to follow their fate, researchers noticed that ELVs move from fat tissue through the blood to infiltrate muscle and liver tissues, potentially causing all sorts of metabolic derangements along the way. For example, research conducted on mice suggested that injecting animals with ELVs released from the (inflamed) fat tissue of obese mice can lead to decreased glucose uptake or glucose intolerance and reduced insulin signaling which enhances insulin resistance. What happens is that, when ELVs get into other tissues, they can use what's called microRNAs (miRNAs) to regulate gene expression and, therefore, biological processes in different tissues. The study team behind the latest findings on these circulating exosomal miRNAs has found that the process can be reversed, meaning they could restore insulin sensitivity to obese mice by treating them with exosomes from lean mice. Further research will look to sequences ELVs to find out which of the several hundred of miRNAs they contain directly induce insulin resistance and other metabolic dysfunctions increasing the risk for type 2 diabetes.



JDRF launches clinical trial finder for people with type 1 diabetes

Fri, 22 Sep 2017 00:00:00 GMT

Leading type 1 charity JDRF has launched a new type 1 diabetes clinical trial finder to help people find trials relevant to them across the UK. The Type 1 Trial Finder is designed to help increase participation for clinical trials by showing users where trials are taking place. It searches a large database of clinical trials so people can find out more about current research and apply to take part should they wish to. The tool works by asking users to select where they live, how far they’d be willing to travel as well as their age and sex before they are directed to the website of Antidote, the digital health company who created and support the tool. A list of applicable trials will then be listed. The website will also offer you the choice of entering further details, including an email address. Clinical trials are used to test out new treatments and theories for conditions but a lot of the time recruitment numbers are not met so they cannot be carried out to their full potential. Various stages must be met before any research or medication can be deemed safe enough to be used among the general public. Angela Wipperman, senior manager for research communications at JDRF said: "We know that many of our supporters would like to hear about clinical trials relevant to them or their child. We also know that researchers can struggle to recruit the number of participants they need to run a clinical trial." It is hoped the search tool will "help all those affected by type 1 diabetes who would like to access more information through a reliable source," Ms Wipperman added. It is important to always discuss participation in a clinical trial beforehand with your doctor, so they are able to offer advice on the risks and benefits of the trial.



Intensive control leads to greater benefits in type 2 diabetes

Fri, 22 Sep 2017 00:00:00 GMT

Intensive control of blood glucose levels and other health markers benefits people with type 2 diabetes more than standard care, research suggests. Those with near-normal treatment targets across blood sugar, blood pressure and lipids had lower rates of stroke, nephropathy and retinopathy. They also experienced less severe hypoglycemia. However, those with tighter control did not have a significantly lower risk of myocardial infarction (MI), stroke, revascularisation or all-cause death, which researchers attributed to the control group having such good diabetes management to begin with. The Japan Diabetes Optimal Integrated Treatment Study for 3 Major Risk Factors of Cardiovascular Diseases (J-DOIT3) trial was conducted between 2006-2016. A total of 2,540 patients with type 2 diabetes were recruited, all of whom were aged 45-69 years, had an HbA1c greater than 51.9 mmol/mol (6.9%) plus hypertension and/or dyslipidemia. Participants were randomised to receive standard care, which mostly consisted of Japanese guideline-recommended lifestyle counselling, or intensive care, which entailed frequent education sessions from diabetes educators and additional meters to monitor blood pressure and blood glucose levels. During 8.5 years of follow-up, there were 133 primary-outcome events (deaths, MIs, stroke or revascularisation) in the standard care group, and 109 in the intensive therapy group. While the reduction was nonsignificant, adjustment for variables such as smoking showed there was a significantly reduced risk of these outcomes among the intensive therapy group. Ulf Smith, MD, Gothenburg University, Sweden, who chaired the findings at the European Association for the Study of Diabetes (EASD) 2016 Annual Meeting, told Medscape Medical News: "The Japanese DOIT3 trial tells [clinicians] that metabolic control - optimal lipid, blood pressure, and, glycemic control - is important, and the better the targets you can achieve, the less microvascular and macrovascular complications you have." Smith added that the take-home message for healthcare professionals "is that we should aim for near-normal metabolic parameters in our patients when it comes to blood pressure, lipids, and glucose control". The findings have been accepted for publication by The Lancet Diabetes and Endocrinology, and researchers are now conducting a follow-up five-year study.



GPs urged to monitor medication of older people to avoid hypoglycemia

Fri, 22 Sep 2017 00:00:00 GMT

GPs are being urged to pay closer attention to older people who have diabetes as they may not recognise the signs of hypoglycemia, researchers have said. A team from Exeter wanted to look at how diabetes affects older people and whether hypoglycemia - when blood sugar levels drop too low - is being missed. Hypoglycemia should be avoided regardless of age, but in older people it can lead to further health problems if not treated, such as falls, accidents and being admitted to hospital. Now, researchers are urging doctors and healthcare teams to review the medication taken by older people for their diabetes. They also want healthcare teams to take a more proactive approach in asking older patients about hypoglycemia because symptoms can become less prevalent in old age. The trial was led by Dr Suzy Hope, a geriatrician with clinical and academic interests in diabetes in older people at Exeter Medical School, whose research team studied the health records of 335 people aged 65 with type 1 diabetes and type 2 diabetes who were either treated with insulin, metformin, sulphonylurea or no medication at all. Thirty-four per cent of insulin-treated patients documented one or more hypo, compared to five per cent of sulphonylurea-treated patients and two per cent of metformin-only treated patients. Insulin treatment was shown to have the highest risk of hypoglycemia in the older generation, which is why the researchers say clinicians should be "alert to the possibility of unrecognised hypoglycemia in their older insulin-treated patients". The researchers explained: "Nausea, falls and unsteadiness were the most discriminatory symptoms. However in insulin-treated patients at risk of hypoglycemia, these 'hypo clue' symptoms, in particular nausea, falls and unsteadiness, may represent episodes of hypoglycaemia not recognised by the patient. "Thus GPs should consider a review, including of diabetes medication, when patients report or present with these symptoms." The findings have been published in the Primary Care Diabetes journal. Editor's note: People with diabetes of any age can boost their awareness and knowledge of hypo symptoms by signing up to the Hypo Training Program, a 10-week course designed to to improve your knowledge of hypoglycemia and how to prevent hypos.



Further evidence that diet-microbiome interactions influence blood sugar control

Thu, 21 Sep 2017 00:00:00 GMT

A group of researchers at Southern Medical University, in Guangzhou, China, have studied the impact of prebiotic supplementation on the metabolism of healthy adults. Research has shown that differences in gut microbiota composition are associated with the development of insulin resistance and type 2 diabetes. This is the result of intricate and complicated processes that transform the food we ingest into a myriad of metabolites that enter the circulation and fulfill or adversely affect various functional and metabolic processes in the body. Prebiotic supplementation is one strategy that could improve gut microbiota composition by selectively stimulating the growth of certain beneficial bacteria. One of the ways that prebiotics or fermentable dietary fibres can improve the gut microbiota is through raising the number of butyrate-producing bacteria. People with type 2 diabetes as well as obese people tend to have decreased butyrate-producing bacteria and, in many studies, an increased concentration of butyrate is associated with improvements in metabolic health. The goal of this study, published in Scientific Reports, was to test the efficacy of supplementation with two different kinds of prebiotic fibres, called fructo-oligosaccharides (FOS) and galactooligosaccharides (GOS). Researchers looked at whether butyrate-producing bacteria were able to grow on FOS and GOS, and what effects they individually had on glucose metabolism. A total of 35 healthy adults received 16 g of FOS or GOS in a blind cross-over design for 14 days after which time researchers analysed their glucose tolerance test results, fasting glucose response, body composition and fecal samples. After the 14-day intervention, they found that neither FOS or GOS had a significant impact on body weight, body mass index (BMI), body fat, visceral fat or the basal metabolic rate (BMR). Although still within the normal range, fasting blood sugar levels increased slightly after 14 days of GOS supplementation while the FOS intervention led to a somewhat impaired glucose tolerance. In terms of changes in gut microbiota composition, there was a significant increase in the abundance of bifidobacterium, both with FOS and GOS, which can theoretically support a healthy balance of beneficial and less beneficial gut bacteria. However, the diversity of the microbial community did not improve and was actually lower in the GOS group. Furthermore, butyrate-producing bacteria were decreased with FOS and GOS, as partly evidenced by a lower fecal concentration of butyric acid. The results therefore fell short of expectations when it comes to raising butyrate and improving metabolism and show that FOS and GOS have at best a neutral effect on gut microbiota composition. Overall, further long-term studies are needed to evaluate the efficacy of prebiotics and investigate about their effects on blood sugar control.



Natural enzyme shown to reduce type 2 diabetes-related inflammation

Thu, 21 Sep 2017 00:00:00 GMT

A natural enzyme has been found to reduce chronic inflammation which can increase the risk of cardiovascular disease in people with type 2 diabetes. Inflammation is a natural process in the body but it is known to increase too much in people with type 2 diabetes, which can raise the risk of health complications such as cardiovascular disease. Following experiments on mouse models of type 2 diabetes, researchers from the Joslin Diabetes Center, US, say the protective factor called protein kinase C-delta (PKC-delta) can prevent excess inflammation developing. PKC-delta defends against the inflammation process by suppressing the population of cells known as macrophages, which play a significant role in the build-up of inflammation. Dr George King, Joslin's chief scientific officer and corresponding author on the research, said: "The complete surprise to us was that although most forms of PKC make inflammation worse, PKC-delta happens to be the opposite, a natural protective mechanism." The trial also revealed that PKC-delta is triggered by high levels of blood lipids (fats) rather than glucose, indicating the molecule could be used to help prevent inflammation in people with obesity and metabolic syndrome. Previous work carried out by the same research team has shown suppressing the production of PKC-delta could also help heal wounds when applying a cell-therapy approach. Additionally, preventing PKC-delta in the liver could tackle insulin resistance, which can kick-start the development of type 2 diabetes. King added: "We need to target treatment to specific tissues. There are protective factors and risk factors for diabetes complications. We need to have equal focus on stimulating the protective factors as well as limiting the risk factors." This is an early study into PKC-delta in animals and currently there is no data from human trials. King and colleagues believe, though, that it may eventually be possible to reduce inflammation by activating PKC-delta in human white blood cells. The findings have been published in the Circulation Research journal.



Male obesity linked to lower sperm count

Thu, 21 Sep 2017 00:00:00 GMT

Overweight men could be at risk of suffering from a lower sperm count, Indian researchers have said. Being obese was also shown to increase the risk of men having poor quality sperm, which can lower fertility and the chances of conception. Obesity is already linked with a number of chronic illnesses, such as type 2 diabetes, heart disease, high blood pressure and some cancers. People with diabetes are also at an increased risk of sexual dysfunction. In the study 1,285 men were studied, with researchers using computer-aided sperm analysis to assess their sperm. Those with obesity had decreased, poor quality sperm compared to men of normal weight, but the researchers were unable to prove that obesity caused sperm quality to drop. Lead researcher Dr Rama Raju, from the Center for Assisted Reproduction at the Krishna IVF Clinic in Visakhapatnam, India, said: "Parental obesity at conception has deleterious effects on embryo health, implantation, pregnancy and birth rates. "It's known that obese women take longer to conceive. This study proves that obese men are also a cause for delay in conception." While Raju's team does not know why weight gain affects the quality of the sperm, they want to further investigate whether losing weight has a positive impact. They believe that screening men's sperm before IVF might be helpful in a bid to see if natural conception is possible. Age is another significant factor in fertility as the older men and women get, the harder it can be to fall pregnant naturally. For women their fertility declines from their early thirties and in men their sperm count starts reducing after they reach 40. Commenting on the research, fertility expert Dr Avner Hershlag, chief of the Northwell Health Fertility in New York, said: "The message to men is don't continue to abuse your body. Comfort foods and excess alcohol are bound to make you uncomfortable and put you at a higher risk for diabetes, high blood pressure and heart disease, which are all life-shortening, and may also put a damper on your path to fatherhood." The findings of the study have been published in the Andrologia journal.



Gastric bypass surgery benefits continue for 12 years

Thu, 21 Sep 2017 00:00:00 GMT

Gastric bypass surgery has weight loss and other health benefits in patients for up to 12 years, a new US study reveals. The research also revealed that half of patients with type 2 diabetes were free of the condition 12 years after having the surgery. Lower blood pressure and cholesterol were additional benefits. "This study further confirms the long-term durability of gastric bypass surgery," lead author Dr. Ted Adams, Intermountain Healthcare in Salt Lake City, Utah, told Reuters Health. Gastric bypass surgery involves shrinking the stomach so food can bypass part of the small intestine. The procedure can improve blood sugar regulation, and it is a successful technique, albeit an extreme one, to help reverse type 2 diabetes. In the study 1,156 patients with severe obesity were split into three groups, only one of which received Roux-en-Y gastric bypass surgery. The other two were non-surgery groups, separated by their desire to receive surgery. Among the patients who had type 2 diabetes before surgery, remission occurred in 75 per cent at two years, 62 per cent at six years and 51 per cent at 12 years. Three per cent of the surgery group still had type 2 diabetes at 12 years, while this figure was 26 per cent in the control group. In regard to weight loss, 93 per cent of the surgery group maintained at least a 10 per cent weight loss up until year 12; 70 per cent maintained at least a 20 per cent weight loss; and 40 per cent maintained at least a 30 per cent weight loss. Blood markers for heart disease, such as total cholesterol, collective improved among the surgery group, a significant improvement on one of the control groups, but not the other. Dr Jaime Ponce, medical director for bariatric surgery at CHI Memorial Hospital in Chattanooga, Tennessee, said: "What we can learn from this paper is that we have a very effective treatment tool for severe obese patients with associated medical problems." The study was published in the New England Journal of Medicine.



Scientists discuss weight loss goal setting for lowering cardiometabolic risks

Wed, 20 Sep 2017 00:00:00 GMT

In a new study, German researchers debate how much weight loss is needed for obese people to significantly lower their cardiometabolic risks long term. We know from previous research that a weight 'reset' can greatly help to reduce heart disease-related complications and the incidence of type 2 diabetes among obese people. Scientists believe that the body starts to repair itself and reverse metabolic derangements as the weight falls. Experts from the Medical Clinic IV of Tübingen University Hospital and colleagues tried to identify early weight loss thresholds at which these beneficial changes start to appear. Specifically, they've looked at weight setting targets through the lens of the much debated, so-called 'metabolically healthy obesity' phenotype. This theory says that it is possible to have high adiposity and body mass indexes (BMI) while having relatively normal metabolic markers and a low risk of developing conditions such as heart disease or stroke. The new research, published in The Lancet Diabetes and Endocrinolgy journal, questions whether the 5-8 per cent weight loss rate recommended by some medical associations is at all sufficient to lower these risks. The researchers estimate that about 70 per cent of obese people fall into the metabolically abnormal obesity category, which is characteristic of having one or more of the following: dyslipidemia, high blood pressure, hyperglycemia, insulin resistance, fatty liver or abdominal obesity. Based on their data from the Tübingen Lifestyle Intervention Study, they suggest that a weight loss of no more than 10 per cent with an average BMI of 30 may be sufficient to switch from having a high cardiometabolic risk to being reclassified in the metabolically healthy obesity category and only have a moderate risk. In other words, achieving a 10 per cent weight loss could allow these people to get out of the danger zone, so to speak. Furthermore, they found that, at 20 per cent weight loss (when BMI goes down to 25 or less), obese people could reach the cut-off point where the lowest risks are seen. To put this into perspective, according to researchers, people who are obese and metabolically unhealthy have a 150 percent higher risk of adverse health consequences compared to healthy people with a normal weight. They believe this risk drops to only 25 per cent when the initial BMI is reduced by just 10 per cent. However, more research would be needed to confirm this. Overall, this study defines an achievable intermediate goal to reach a healthier weight that could help motivate unsuccessful obese dieters looking to lower their cardiometabolic risks.



Hypoglycemia remains public health concern in US

Wed, 20 Sep 2017 00:00:00 GMT

US health officials have targeted lowering rates of hypoglycemia among people with diabetes, and have classed it as a major public health concern. Nearly 80 per of older people with type 1 diabetes in the US suffer from hypoglycemia, or low blood sugar, at least once a month, and doctors are still assessing how best to lower hypo rates. Hypoglycemia rates were discussed at a recent US Food and Drug Administration (FDA) meeting entitled 'Reducing the Risk of Preventable Adverse Drug Events associated with Hypoglycemia in the Older Population'. It brought together patient advocates, federal officials and diabetologists to discuss the issue and try to tackle it in a bid to improve health outcomes. Hypoglycemia develops when blood sugar levels are too low and affects people who take glucose-lowering medication such as insulin or sulphonylureas. The condition affects more than 50 per cent of those with type 2 diabetes on a monthly basis, it was announced at the event, while people who take both sulphonylureas and insulin were 2.5 times more likely to suffer from hypoglycemia. It was decided during the meeting that hypoglycemia is still not being prevented and treated as well as it should be. Speaking on behalf of the Endocrine Society, Dr Robert Lash, a professor at the University of Michigan School of Medicine, said: "It's amazing that we are still addressing questions of hypoglycemia after so many years of using these two classes of medications. We need to recognise hypoglycemia as an outcome, not as a side effect." Editor's note: Join the Hypo Training Program to improve your knowledge of hypoglycemia and how to prevent it. Six months after completing the program, an average of 63 per cent of users experience fewer severe hypos.