Tag: diabetes

Scientists Discover a New Sense for Sugars

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In a study published in PLOS ONE, scientists report the identification of a new human sensory ability to detect sugars in the mouth with a kind of a molecular ‘calorie detector’. It could help explain why artificially sweetened beverages just don’t have the same appeal as ones containing sugar.

“Our mouth can identify when a sweetener has the potential to deliver calories versus a non-caloric sweetener, which cannot,” said first author Paul Breslin, PhD, a Monell investigator and a professor of Nutritional Sciences at Rutgers University.

The paper describes the first-in-human demonstration of a signaling pathway that uses the sugar glucose, a component of table sugar and high fructose corn syrup, to signal the presence of calories, in addition to the well-studied sweet-taste receptor in taste buds. Glucose is present in many foods, and has been consumed by humans in the form of honey, fruit and other sugar-rich foods.

“Humans love fruit and sugar, as do many other apes, which obtain most of their calories from sugar,” said Prof Breslin.

Recent findings from Monell showed taste bud cells in mice could identify when a sweetener has calories to burn, which prompted the researchers to see whether the ability to sense glucose in the human mouth may also involve this additional pathway. The team wanted to know if the calorie detector is functional, and if it could affect our responses to dietary sugar.

“Now that we know this calorie-detecting taste system is operating in humans, it could help explain the overall preference for sugared beverages over non-caloric sweetener beverages,” said Prof Breslin.

In a series of three human-taste experiments, the team compared oral glucose sensitivity to the ability to sense the artificial sweetener sucralose and to a special form of glucose that cannot be metabolised. “Overall, there are two sweet-sensing pathways in the mouth: one for sweet taste, and another for detecting potential energy-burning sugars,” said coauthor Linda J. Flammer, PhD, a senior research associate at Monell.

The fact that diet fizzy drinks never captured a major share of the beverage market always puzzled Prof Breslin, but he now has a hint: “Diet drinks are not as satisfying as sugared beverages. As a public health initiative, might we get beverages and foods with lower sugar levels to be more rewarding? Now that we know there is this second glucose-sensing system in the mouth, maybe we can tap into it to make healthier beverages that people enjoy drinking.”

Sugar calories are sensed in the gut and blood after swallowing, but this study shows that sugars are identified as different from non-caloric sweeteners in the mouth. “It is remarkable that we evolved a mechanism not only to taste oral sugars as sweet, but also to sense that they have a metabolic or caloric signal,” said Breslin. “This means that the mouth is much smarter than we realised and that it will be difficult to trick it by simply providing non-caloric sweeteners.”

Source: Monell Chemical Senses Center

More ACE2 Makes Pancreatic Cells a COVID Target

Source: CDC

Researchers have revealed insights into how SARS-CoV-2 attacks the insulin-producing cells of the pancreas.

There is mounting evidence of damage to the pancreas and resulting diabetes attributed to COVID, which is of great concern. The virus targets the angiotensin converting enzyme 2 (ACE2) protein on the surface of those cells, and is the subject of a special presentation at this year’s Annual Meeting of the European Association for the Study of Diabetes, given by the University of Siena’s Professor Francesco Dotta. 

“The SARS-CoV-2 virus attacks specific host tissues because of the presence of viral receptors on the surface of the target cells. As such, virus binding to ACE2 protein is the key determinant for its entry, propagation and transmissibility,” explained Prof Dotta.

“Multiple studies have shown that older adults and those with chronic medical conditions like heart and lung disease and/or diabetes are at the highest risk for complications from SARS-CoV-2 infections. Moreover, impaired blood sugar control is associated with increased risk of severe COVID, suggesting a link between COVID infection and diabetes. Several reports indicate a wide, although variable, distribution of the ACE2 protein among different tissues.”

Prof Dotta and colleagues studied the ACE2 expression pattern in pancreatic tissue samples of non-diabetic multiorgan donors to better understand the molecular link between COVID and diabetes.

In the ‘normal’ pancreas, ACE2 is highly expressed in microvasculature and in ductal cells. “Importantly, we found that ACE2 was expressed in human pancreatic islets, where it is preferentially expressed in insulin producing beta-cells. We also demonstrated that ACE2 levels were increased under pro-inflammatory conditions, thus confirming the link between inflammation and ACE2 also in pancreatic islet beta cells.”

In order to isolate the mechanism involved in the upregulation of ACE2 induced by inflammation, ACE2 levels were measured in human pancreatic islets pre-treated with Jak1/2 and TYK2 inhibitors, which block inflammation in beta cells, and then exposed to pro-inflammatory conditions. 

Prof Dotta said: “We showed that these drugs prevent the ACE2 increase induced by inflammation in human pancreatic islets, demonstrating that SARS-CoV-2 receptor ACE2 is regulated through specific molecular pathways and that its increased expression can be prevented.

“We studied the mechanisms of SARS-CoV-2 virus entry into insulin producing beta cells and we discovered that these cells express the SARS-CoV-2 receptor ACE2.” Other authors have independently confirmed such data.

Of note, additional published data confirmed that SARS-CoV-2 can indeed infect pancreatic insulin-producing cells causing their dysfunction or death. Moreover, during inflammation, ACE2 expression increases several times above standard values.

Prof Dotta concluded: “This means that these insulin-producing beta cells could be even more susceptible to viral infection when inflamed. This finding is also important from a clinical standpoint, since keeping inflammatory status under control in patients with COVID may reduce the expression of ACE2 receptor in beta cells with beneficial effects on blood sugar and metabolic control of patients.”

Source: EurekAlert!

Diabetes Drug Could Halve Glaucoma Risk

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GLP-1R agonists, a popular class of diabetes drugs, may also have a protective effect against glaucoma in diabetic patients, according to a new study published in the British Journal of Ophthalmology.

The researchers examined retrospective data of 1961 diabetic patients who were new users of this class of drugs and matched them to 4371 unexposed control subjects. After 150 days on average, 10 patients in the medicated group were newly diagnosed with glaucoma (0.5%) compared to 58 patients (1.3%) in the control group. These results indicate that GLP-1 receptor agonists could halve a diabetic patient’s risk of developing glaucoma.

The findings are supported by a Penn Medicine study from 2020, which found that GLP-1R agonists reduced neuroinflammation and prevented retinal ganglion cell death in mice. This class of drugs has also shown similarly protective effects against Alzheimer’s and Parkinson’s diseases in animal models, and clinical trials are underway to test the medications against neurodegenerative diseases in humans.

Glaucoma is the second leading cause of blindness worldwide, and people with diabetes are twice as likely to develop the condition.

“It was very encouraging to see that a popular diabetes medication could significantly reduce the risk of developing glaucoma, and our study suggests that these medications warrant further study in this patient population,” said Qi N. Cui, MD, PhD, with Brian VanderBeek, MD, MPH, both assistant professors of Ophthalmology at Penn.

Source: EurekAlert!

An Oxygen-delivering Hydrogel for Diabetic Foot Ulcers

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A quarter of people with diabetes develop foot ulcers, which are slow to heal due to hypoxic conditions in the wound from impaired blood vessels and increased inflammation. These wounds can become chronic, leading to poor quality of life and possibly amputation.

Jianjun Guan, professor of mechanical engineering and materials science at the McKelvey School of Engineering at Washington University in St. Louis, has developed a hydrogel that delivers oxygen to a wound and decreases inflammation, helps to remodel tissue and speeds up healing. The results are published in Science Advances

Prof Guan’s new hydrogel uses microspheres to gradually release oxygen to interact with the cells by means of an enzyme coating that converts the microsphere’s contents into oxygen. In this way, the hydrogel delivers oxygen over two weeks, reducing inflammation and promoting healing.
“The oxygen has two roles: one, to improve skin cell survival under the low-oxygen condition of the diabetic wound; and two, oxygen can stimulate the skin cells to produce growth factors necessary for wound repair,” Prof Guan said.

Source: Washington University in St. Louis

Australian Women with Diabetes Incur Significant Expenses

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A new study from at the University of Technology Sydney (UTS) and the University of South Australia has found that women with diabetes incur significant out-of-pocket expenses in managing their health, with costs rising as the disease continues.

Researchers found middle-aged and older women spend almost $500 a year from their own funds, visiting a diverse range of health services to manage their diabetes. Their findings were published in the journal PLOS One.

“Our findings were that most women (88.3 per cent) consulted at least one health care practitioner in the previous 12 months for their diabetes, including medical doctors, allied health practitioners and complementary medicine practitioners, spending on average $492.60 per woman a year,” said Distinguished Professor Jon Adams, deputy head of the School of Public Health at UTS.

He continued: “Our analysis suggests approximately $252 million is spent annually on out-of-pocket expenditure for diabetes management by Australian women aged 50 years and over. The results of this study provide important insights regarding public and private health care use by middle-aged and older Australian women living with diabetes.”

The economic burden these women are placed under warrants further investigation to understand how health care services (and the integration of such services) can better address their biopsychosocial needs, the researchers said.

However, the researchers said the economic burden of self-care of chronic illness by individuals and households is often overlooked in Australia in favor of analyses that center on the macro-economy and the cost to the Australian government.

Diabetes mellitus is a disease of inadequate control of blood levels of glucose. Type 1 and 2 diabetes are the main subtypes, each with different pathophysiology, presentation, and management, but both have a potential for hyperglycaemia. Poor management of diabetes can lead to other chronic health problems such as increased cardiovascular disease risk. 

Source: University of Technology Sydney (UTS)

A Specific Type of Fat Cell Responds to Insulin

Source: Pixabay

While it was known that fat cells can influence insulin sensitivity, researchers have recently discovered that there are three different subtypes of mature fat cells in white adipose tissue and that it is only one of these, called AdipoPLIN, that responds to insulin. The findings, which were published in Cell Metabolism, may have implications for the treatment of metabolic diseases such as Type 2 diabetes. 

“These findings increase our knowledge about the function of fat tissue,” said co-corresponding author Niklas Mejhert, researcher at the Department of Medicine, Huddinge, at Karolinska Institutet. “They show that the overall capacity of fat tissue to respond to insulin is determined by the proportion and function of a specific fat cell subtype. This could have implications for diseases such as obesity, insulin resistance and Type 2 diabetes.”

The researchers identified 18 classes of cells that form clusters in white adipose tissue in humans. Of these, three constituted mature fat cells with distinct phenotypes.

To determine if a specific function was linked to the fat cell subtypes, the researchers measured how these subtypes in four people reacted to short-term increases in insulin levels. They found that insulin activated the gene expression in the AdipoPLIN subtype but did not affect the other two subtypes. The response to insulin stimulation was also proportional to the individual’s whole-body insulin sensitivity.

A challenge to the prevailing view
“Our findings challenge the current view of insulin resistance as a generally reduced response to insulin in the fat cells,” said co-corresponding author Mikael Rydén, professor in the same department. “Instead, our study suggests that insulin resistance, and possibly type 2 diabetes, could be due to changes in a specific subtype of fat cells. This shows that fat tissue is a much more complex tissue than previously thought. Like muscle tissue, people have several types of fat cells with different functions, which opens up for future interventions targeted at different fat cell types.”

The researchers employed spatial transcriptomics, which generates information about tissue organisation via microscopy and gene expression via RNA sequencing.

”This study is unique in that it is the first time we’ve applied spatial transcriptomics to fat tissue, which has a special set of characteristics and composition,” said third corresponding author Patrik Ståhl. “We are very happy that the technology continues to contribute to solving biologically complex questions in an increasing number of research areas.”

Source: Karolinska Institute

Low GI Diet Has Noticeable Benefit against Diabetes

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Following a low glycaemic diet confers small but important benefits in blood glucose levels, cholesterol, weight and other risk factors, according to a study published by The BMJ.

The improvements were over and above existing drug and insulin therapy, suggesting this diet may help complement treatment, said the researchers.

Research has shown that foods with a low glycaemic index (GI), which is a measure of how quickly a food affects blood glucose levels relative to white bread, can help keep blood sugar levels steady and reduce the risk of heart disease in people with diabetes. These include foods such as vegetables, most fruits, pulses and wholegrains.

Due to this, clinical guidelines across the world recommend a low GI or GL (glycaemic load) diet for people with diabetes. However, the last European Association for the Study of Diabetes (EASD) guidelines were released over 15 years ago and since that time a number of trials have been published.
So researchers set out to summarise the effect of low GI/GL dietary patterns on blood sugar control and other known risk factors in diabetes to help inform the update of the EASD guidelines for nutrition treatment.

Their results are based on 27 randomised controlled trials published up to May 2021 investigating the effect of diets with low GI/GL in diabetes for three or more weeks.

The trial recruited a total of 1617 participants with type 1 or 2 diabetes, who were predominantly middle aged, overweight or obese with moderately controlled type 2 diabetes treated with drugs or insulin.

Though the trials varied quality, the researchers could assess the certainty of evidence using the recognised GRADE system.

The results show that low-GI/GL dietary patterns were linked to small but clinically meaningful reductions in blood sugar levels (HbA1c) compared with higher-GI/GL control diets.

Some other risk factors saw changes, such as fasting glucose (blood sugar levels after a period of fasting), LDL cholesterol, body weight, and C-reactive protein (a chemical associated with inflammation), but not blood insulin levels, HDL cholesterol, waist circumference, or blood pressure. The certainty of evidence was high for reduction in blood sugar levels and moderate for most other outcomes.

Limitations that included imprecision in the evidence for the effect of low GI/GL dietary patterns on LDL cholesterol and waist circumference, and the small number of available trial comparisons for blood pressure and inflammatory markers.

However, they say their findings show that low GI/GL dietary patterns “are considered an acceptable and safe dietary strategy that can produce small meaningful reductions in the primary target for glycaemic control in diabetes, HbA1c, fasting glucose, and other established cardiometabolic risk factors.”

“Our synthesis supports existing recommendations for the use of low GI/GL dietary patterns in the management of diabetes,” they concluded.

Source: MedicalXpress

Quality of Life Improvements with Continuous Glucose Monitoring

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A study found that patients with poorly controlled type 2 diabetes benefitted more from continuous blood glucose monitoring than standard blood glucose monitoring using finger pricks.

While continuous glucose monitoring has well-demonstrated benefits for patients with diabetes, the benefits have only been well studied in patients with type 1 diabetes or patients with type 2 treated with  prandial insulin, consisting of multiple daily insulin injections, and not those treated with basal insulin, which is long-lasting and injected only once or twice daily.

Study author Rodica Busui, MD, PhD, at University of Michigan Health, said this of the first studies to assess the impact of continuous glucose monitor in adults with poorly controlled type 2 diabetes with basal insulin.

“Not only does this trial demonstrate the benefits of continuous glucose monitoring for these patients, a technology that hasn’t been covered by many insurers for those with type 2 diabetes, but these benefits were seen across a broad spectrum of socio-economic status and racial backgrounds,” said Dr Busui, adding that about half of the study’s participants were of a racial or ethnic minority.

The randomised clinic trial began enrolling patients in mid-2018 to late-2019, with follow up in mid-2020. The participants received basal insulin, with or without non-insulin medications to help lower blood sugar levels.

“This work wouldn’t have been possible without the partnership between endocrinologists and primary care physicians, as all the patients were recruited and treated by our primary care teams,” said Busui, who is also associate director for clinical research in the Elizabeth Weiser Caswell Diabetes Institute.

The investigators found that continuous glucose monitoring, compared to blood glucose meter monitoring using finger pricks, significantly decreased their haemoglobin A1C over eight months (-1.1% versus -0.16%, respectively).

In addition to testing the efficacy of continuous glucose monitoring paired with basal insulin, Dr Busui and her team sought approach affected patients’ adherence to managing their disease as well as their overall life satisfaction. The 175 study participants exhibited better adherence to managing their diabetes, and their life satisfaction was higher.

“For me, what’s most exciting is that this work demonstrates that using continuous glucose monitoring is effective in substantially improving blood sugars levels and decreasing the risks of hypoglycemia in those that were randomized to use a continuous glucose monitor compared with the usual finger-prick,” said Busui.

“This may open the door for broader coverage of this game-changing technology for all patients with diabetes. More patients can manage their diabetes if they have access to this resource and their primary care physicians are educated on the benefits of their patients utilising it.”

Source: Science Daily

Journal information: Thomas Martens et al, Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin, JAMA (2021). DOI: 10.1001/jama.2021.7444

Is There an Imminent Wave of COVID-caused Diabetes?

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A new study found that about half of hospitalised COVID patients at the start of the pandemic developed new cases of hyperglycemia and had poorer outcomes, prompting concerns about waves of COVID-caused diabetes.

“These people were not diabetic before,” said lead author Paolo Fiorina, MD, PhD, who is affiliated with the Division of Nephrology at Boston Children’s Hospital. “But during admission, about 46 percent of the patients were found to have new hyperglycaemia.” About 35 percent of the newly hyperglycaemic patients were still so six months after infection.

New cases of post-COVID diabetes had been observed since the first waves of the COVID pandemic, though the mechanism behind it was not understood at the time.

The study examined 551 people admitted to the hospital in Italy from March to May 2020, with follow-ups up to six months. All patients were fitted with a glucose sensor at admission.

Compared with patients without signs of glucose abnormalities, the hyperglycaemic patients had worse clinical concerns: longer hospitalisations, worse clinical symptoms, and greater need for oxygen, ventilation and intensive care treatment.

“We wanted to understand the mechanism why these patients did poorly compared to those who did not have hyperglycemia,” said Fiorina, who previously authored a paper showing COVID worsened glucometabolic control in diabetics. The current study was published in Nature Metabolism.
Over the course of time, the researchers detected many abnormalities in glucose metabolic control in the hyperglycaemic patients. They also found that hyperglycaemic patients had abnormal hormonal levels: “We discovered they were severely hyperinsulinaemic; they produced too much insulin,” said Fiorina. They also had abnormal levels of pro-insulin and markers of impaired islet beta cell function.
“Basically, the hormonal profile suggests that the endocrine pancreatic function is abnormal in those patients with COVID and it persists long after recovery,” he said.
Hyperglycaemic patients also had severe abnormalities in levels of inflammatory cytokines, including IL-6.

“We thought that blocking IL-6, and potentially even other cytokines, would be a benefit for beta cell function,” added Fiorina, an idea that proved to work. Patients treated with anti-IL-6 therapy (tocilizumab) had greater improvement in glycaemic control compared.

While glucometabolic abnormalities gradually reduced for some (particularly after COVID infection), other issues persisted: many patients had higher post-prandial glucose levels and abnormal pancreatic hormones after COVID.

“This study is one of the first to show that COVID has a direct effect on the pancreas,” said Fiorina. “It indicates that the pancreas is another target of the virus affecting not only the acute phase during hospitalisation but potentially also the long-term health of these patients.”

The study highlights the importance of evaluating pancreatic function in patients hospitalised for COVID. “This goes beyond fasting glucose testing because we observed glucose metabolic abnormalities during the day which were not always present in a normal fasting test,” said Fiorina.  

Questions remain as to whether patients should be treated just with an anti-diabetic drug like an insulin sensitiser, or should anti-inflammatory drugs like tocilizumab and other drugs be used?

“If you keep targeting and blocking insulin, but you have a strong and chronic inflammation, it may lead to chronic damage,” said Dr Fiorina, who suggested that larger studies to test anti-diabetic and anti-inflammatory treatment are needed. “When you consider how many patients have been hospitalised with COVID and continue to be worldwide, we may see a huge increase in the diabetic population.”

Source: Children’s Hospital Boston

Journal information (1): Laura Montefusco et al, Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection, Nature Metabolism (2021). DOI: 10.1038/s42255-021-00407-6

Journal information (2): Sebastiano Bruno Solerte et al, Sitagliptin Treatment at the Time of Hospitalization Was Associated With Reduced Mortality in Patients With Type 2 Diabetes and COVID-19: A Multicenter, Case-Control, Retrospective, Observational Study, Diabetes Care (2020). DOI: 10.2337/dc20-1521

High Burden of Uncontrolled Disease in KwaZulu-Natal

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A comprehensive health-screening program has found a high burden of poorly controlled or uncontrolled disease KwaZulu-Natal, along with a high incidence of undiagnosed diseases.

The study, published in The Lancet Global Health, found that four out of five women over 30 had a chronic health condition, and that the HIV-negative population and older people had the highest burden of undiagnosed or poorly controlled non-communicable diseases such as diabetes and hypertension. The study was conducted at the Africa Health Research Institute (AHRI).

Study co-leader Emily Wong, MD, at AHRI in Durban, said: “The data will give AHRI researchers and the Department of Health critical indicators for where the most urgent interventions are needed,” Dr Wong said. “The research was done before COVID, but it has highlighted the urgency of diagnosing and treating people with non-communicable diseases — given that people with uncontrolled diabetes and hypertension are at higher risk of getting very ill with COVID.” 

HIV-associated tuberculosis infections are particularly prevalent in Durban. Dr Wong of the University of Alabama works there to understand the impact of HIV infection on tuberculosis pathogenesis, immunity and epidemiology. In sub-Saharan Africa, 15 years of intense public health efforts that increased access to antiretroviral therapy has resulted in decreased AIDS mortality and raised life expectancy. As a result, there is an increasing priority to address other causes of disease, including tuberculosis and non-communicable diseases.

Over 18 months, health workers screened 17 118 people aged 15 years and older via mobile camps within 1 kilometre of each participant’s home in the uMkhanyakude district. They found high and overlapping burdens of HIV, tuberculosis, diabetes and hypertension among men and women.

While the HIV cases were largely well diagnosed and treated, some demographic groups  still had high rates of undiagnosed and untreated HIV, such as men in their 20s and 30s. In contrast, the majority of people with tuberculosis, diabetes or hypertension were either undiagnosed or not well controlled. Of particular concern was the high rates of undiagnosed and asymptomatic tuberculosis discovered, as it remains one of the leading causes of death in South Africa.

“Our findings suggest that the massive efforts of the past 15 years to test and treat for HIV have done very well for that one disease,” Dr Wong said. “But in that process, we may have neglected some of the other important diseases that are highly prevalent.”

The mobile camps screened for diabetes, high blood pressure, nutritional status (obesity and malnutrition), and tobacco and alcohol use, as well as HIV and tuberculosis. The tuberculosis screening component included high-quality digital chest X-rays and sputum tests for people who reported symptoms or had abnormal X-rays. Clinical information was combined with 20 years of population data from AHRI’s health and demographic surveillance research. Using a sophisticated data system combined with artificial intelligence to interpret the chest X-rays, AHRI’s clinical team examined the information in real time, referring people to the public health system as needed.

The study found that: 

  • Half of the participants had at least one active disease, and 12 percent had two or more diseases. Diabetes and hypertension incidences were 8.5 percent and 23 percent, respectively.
  • One-third of the people were living with HIV, but this was mostly well diagnosed and treated. A particularly high burden of HIV, high blood pressure and diabetes was seen in women.
  • For tuberculosis, 1.4 percent of the people had active disease, and 22 percent had lifetime disease. About 80 percent of the undiagnosed tuberculosis was asymptomatic, with higher rates of active tuberculosis seen in men.
  • Several disease patterns varied by geographical location — eg, the highest HIV burden was seen near main roads, while higher rates of tuberculosis and non-communicable diseases were seen in more remote areas.

Source: University of Alabama at Birmingham

Journal information: Wong, E. B., et al. (2021) Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. The Lancet Global Health. doi.org/10.1016/S2214-109X(21)00176-5.