Tag: Type 2 diabetes

Reduce Blood Sugar ASAP After Diabetes Diagnosis, Study Suggests

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Findings from new research published in Diabetes, Obesity and Metablism suggest that people with type 2 diabetes may need to reduce their blood sugar levels sooner after diagnosis than previously thought, to prevent major cardiovascular events such as heart attacks.

The University of Surrey study Surrey suggests that achieving glycaemic control within the first year of diagnosis reduces the incidence of major cardiovascular events. Additionally, the team found that the greater the variation in blood levels 12-months after diagnosis, the more likely a patient was to experience dangerous cardiovascular events.

Dr Martin Whyte, co-author of the study and Reader in Metabolic Medicine at the University of Surrey, said: “The conventional wisdom has been to slowly and steadily treat type 2 diabetes with diet and medicine dose-escalation over years – the period over which it took people to reduce their sugar levels after diagnosis was thought less important for major vascular protection. However, our observational study suggests that getting blood levels under control quickly — within the first 12 months after diagnosis — will significantly help reduce cardiovascular events.”

Type 2 diabetes is a common condition that results in the level of sugar in the blood becoming too high. The condition is linked to obesity or a family history of type 2 diabetes and can increase a person’s risk of getting serious health conditions.

The University of Surrey’s study used Royal College of General Practitioners’ Research and Surveillance Centre database to perform a comprehensive examination of glycaemic control achieved within the first year of diagnosis and subsequent blood sugar level variability with cardiovascular disease incidents.

Source: University of Surrey

Diabetes Almost Doubles COVID Mortality Risk

Diabetes - person measures blood glucose
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Compared to those without diabetes, the COVID mortality risk for people with diabetes is almost double, with almost three times the risk of being critically or severely ill, according to a review of research by researchers from the University of Aberdeen.

Fortunately, the review study, which is published in Endocrinology, Diabetes and Metabolism, also found that good management of the condition can mitigate against the risks.

Specifically, it was found that while diabetes presents a significant risk of severe illness and death with COVID, good glycaemic control in these patients can mitigate this risk.

The researchers reviewed findings from 158 studies, encompassing more than 270 000 participants from around the world to determine COVID’s impact on people with diabetes.

The pooled results showed that people with diabetes were 1.87 times more likely to die with COVID, 1.59 times more likely to be admitted to ICU, 1.44 times more likely to require ventilation, and 2.88 times more likely to be classed as severe or critical, when compared to patients without diabetes.

This is the first time a study has looked at the risks of COVID in patients with diabetes while factoring in the patients’ location and thereby highlighting potential healthcare resources available as well as possible ethnic differences and other societal factors.

Patients in China, Korea and the Middle East were found to be at higher risk of death than those from EU countries or the US. This, they suggested, may be the result of differences in healthcare systems and affordability of healthcare which may explain the finding that maintaining optimal glycaemic control, significantly reduces adverse outcomes in patients with diabetes and COVID.

Stavroula Kastora, who worked on the study explained: “We found that following a COVID infection, the risk of death for patients with diabetes was significantly increased in comparison to patients without diabetes.

“Equally, collective data from studies around the globe suggested that patients with diabetes had a significantly higher risk of requiring an intensive care admission and supplementary oxygen or being admitted in a critical condition in comparison to patients without diabetes.

“However, we found that the studies that reported patient data from the EU or US displayed less extreme differences between the patient groups. Ultimately, we have identified a disparity in COVID outcomes between the eastern and western world. We also show that good glycaemic control may be a protective factor in view of COVID-related deaths.

“In light of the ongoing pandemic, strengthening outpatient diabetes clinics, ensuring consistent follow up of patients with diabetes and optimising their glycaemic control could significantly increase the chances of survival following a COVID infection.”

Source: University of Aberdeen

High Lipid Levels Even More Damaging than Previously Believed

Blood sample being drawn
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High lipid levels in people with type 2 diabetes and obesity are more harmful than previously thought, according to findings from a new study which found that stressed cells can damage nearby cells.

In patients with metabolic diseases, elevated lipid levels in the blood create stress in muscle cells – a reaction to changes outside the cell which damage their structure and function.

The study, published in Nature Communications, shows that these stressed-out cells give off a signal which can be passed on to other cells.

The signals, known as ceramides, may confer a short-term protective benefit, because they are part of a mechanism designed to reduce stress in the cell. But in long term conditions such as metabolic diseases, the signals can actually kill the cells and worsen symptoms and the illness.

High lipid levels have long been known to damage tissues and organs, contributing to the development of cardiovascular and metabolic diseases including type 2 diabetes, a condition which can be caused by obesity.

Professor Lee Roberts, who supervised the research, said: “Although this research is at an early stage, our discovery may form the basis of new therapies or therapeutic approaches to prevent the development of cardiovascular and metabolic diseases such as diabetes in people with elevated blood fats in obesity.”

In the lab, the team replicated the blood lipid levels observed in humans with metabolic disease by exposing skeletal muscle cells to palmitate, a fatty acid. The cells began to transmit the ceramide signal.

When these cells were mixed with others which had not been previously exposed to lipids, the researchers found that they communicated with each other, transporting the signal in packages called extracellular vesicles.

The experiment was reproduced in human volunteers with metabolic diseases and gave comparable results. The findings provide a completely new angle on how cells respond to stress, with important consequences for our understanding of certain metabolic diseases including obesity.

Professor Roberts said: “This research gives us a novel perspective on how stress develops in the cells of individuals with obesity, and provides new pathways to consider when looking to develop new treatments for metabolic diseases.

“With obesity an ever-increasing epidemic, the burden of associated chronic disease such as type 2 diabetes necessitates new treatments. We hope the results of our research here open a new avenue for research to help address this growing concern.”

Source: University of Leeds

A Surprising Benefit of Dapagliflozin in Patients with Heart Failure

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Dapagliflozin, widely used to treat type 2 diabetes, was shown to improve symptoms and physical limitations in patients with heart failure with preserved ejection fraction, according to clinical trial results reported in Nature Medicine.

Heart failure with preserved ejection fraction (HFpEF) occurs when the heart’s lower left chamber is unable to fill with blood properly. The condition accounts for approximately half of all heart failure cases and disproportionally affects older individuals. Patients with HFpEF can experience a host of debilitating symptoms linked to cardiometabolic abnormalities, including physical limitations, impaired cognition and poor quality of life. Life expectancy is also reduced for patients with this diagnosis, with 50% of patients with the diagnosis not expected to survive more than five years.

Finding ways to improve patients’ health and developing or identifying therapeutic interventions that not only reduce hospitalisation but also improve patient survival is key, the researchers said, but at present there are no available treatments that improve patient survival for patients with HFpEF.

Previous studies have shown that sodium glucose cotransporter 2 (SGLT2) inhibitors – which inhibit SGLT2 receptor proteins produced by the kidneys and are used to treat type 2 diabetes – reduces risk of cardiovascular death and heart failure-related hospitalisation in patients with HFpEF.

For this trial, the researchers measured patient-reported symptoms, physical limitations and function in patients with HFpEF who were taking dapagliflozin, an SGLT2 inhibitor drug.

A total of 324 patients with HFpEF, 56.8% women, were randomised to receive either dapagliflozin or placebo for 12 weeks and at the end of the trial were evaluated using the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score, a measure of heart failure-related health status.
“It’s important to note the percentage of women that were enrolled in this study because usually women are under-enrolled in clinical trials,” pointed out study co-author Professor Sadiya Khan.

Compared to the placebo group, an overall improvement in patient-reported symptoms, physical limitations and exercise function was seen in the dapagliflozin group. Adverse events were also similar between both groups, the authors reported.

“It was definitely surprising and very exciting to see such a stark difference between the treatment group and the placebo group, that there was this clear separation that happened even over a short period of time,” Prof Khan said, adding that next steps will be to investigate dapagliflozin’s precise molecular mechanisms that enable its effectiveness.

Source: Northwestern University

Gaps and Gender Differences in Diabetes Management

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A new study from the University of Eastern Finland revealed there are gaps and gender differences in diabetes management. Type 2 diabetes is often accompanied by elevated cholesterol levels, but many patients do not receive appropriate cholesterol-lowering treatment, according to the study, which appears in Scientific Reports.

Type 2 diabetes is a major risk factor of cardiovascular diseases, such as coronary artery disease and heart failure, as well as premature death. To prevent or at least delay complications, regular health care visits and good control of blood glucose, low-density lipoprotein cholesterol (LDL-C) and other risk factors are needed.

The present study shows that LDL-C control and statin prescriptions remain suboptimal in clinical practice – despite guidelines that consistently recommend treating elevated LDL-C with statins at moderate- to high-intensity. The study drew on electronic health records of 8592 type 2 diabetes patients between 2012 and 2017.

Analysing LDL-C values over time, researchers identified four groups with different trajectories. Most patients (86%) had relatively stable LDL-C values at moderate levels and only a few patients showed a significant increase (3%) or decrease (4%) during the follow-up. However, the second-largest group (8%) consisted of patients with alarmingly “high-stable” LDL-C levels at around 3.9 mmol/L.  

The “high-stable” LDL-C group had the lowest proportions of patients on moderate- and high-intensity treatment as well as any statin treatment. The proportion of patients receiving any statin treatment even decreased from 42% to 27% among men, and from 34% to 23% among women between 2012 and 2017.

“We observed significant gender differences in care processes and outcomes,” said Laura Inglin, Early Stage Researcher, University of Eastern Finland. “In all the trajectory groups, women had significantly higher average LDL-C levels and received any statin treatment and high-intensity treatment less frequently than men.”

Significant differences were seen in terms of longitudinal care processes, outcomes, and treatments, pointing out gaps in current diabetes management. Efforts to control LDL-C should be increased – especially in patients with continuously elevated levels – by initiating and intensifying statin treatment earlier and re-initiating the treatment after discontinuation if possible.

Source: University of Eastern Finland

Vascular Damage in Diabetes Arises from Red Blood Cell Changes

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Altered function of the red blood cells leads to vascular damage in type 2 diabetes, and new research shows that this effect is caused by low levels of an important red blood cell molecule. 

Patients with type 2 diabetes have an increased risk of cardiovascular disease, and type 2 diabetes may over time damage blood vessels, raising the risk for heart attack and stroke. However, the disease mechanisms underlying cardiovascular injury in type 2 diabetes are largely unknown and treatments to prevent such injuries are lacking.

Research has shown that red blood cells become dysfunctional in type 2 diabetes and can act as mediators of vascular complications. In this study, published in Diabetes, researchers examined cells from patients with type 2 diabetes and mice to see if molecular changes in the red blood cells could explain these harmful effects in type 2 diabetes.

The researchers found that levels of the small molecule microRNA-210 were markedly reduced in red blood cells from 36 patients with type 2 diabetes compared to healthy controls. Micro-RNAs belong to a group of molecules that serve as regulators of vascular function in diabetes and other conditions. The reduction in microRNA-210 caused alterations in specific vascular protein levels, and impaired blood vessel endothelial cell function. In laboratory experiments, restoration of microRNA-210 levels in red blood cells prevented the development of vascular injury via specific molecular changes.

“The findings demonstrate a previously unrecognised cause of vascular injury in type 2 diabetes,” said Zhichao Zhou, researcher at the Department of Medicine, Solna, Karolinska Institutet. “We hope that the results will pave the way for new therapies that increase red blood cell microRNA-210 levels and thereby prevent vascular injury in patients with type 2 diabetes.”

Source: Karolinska Institutet

1 in 20 People with Diabetes Achieve Remission on Their Own

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In Scotland. about one in 20 people  diagnosed with type 2 diabetes achieve remission from the disease, according to research appearing in PLOS Medicine. This suggests people are achieving remission outside of research trials and without bariatric surgery. Recognition of individuals in remission, following their progress, and understanding better the factors linked to remission could result in improved initiatives to help others.

In 2019 there were an estimated 463 million people with diabetes in the world, 90-95% of whom have type 2 diabetes. Ageing populations, growing obesity and sedentary lifestyles are increasing these numbers. The likelihood of achieving remission after 15% weight loss has been shown to be mainly determined by the duration of diabetes, with responders having better beta‐cell function at baseline.

Some people with type 2 diabetes have achieved remission after bariatric surgery, or after taking part in a research trial of a very low-calorie diet, but it is unknown how many people in the general population are in remission. Mireille Captieux at the University of Edinburgh and colleagues used a Scottish national register of people with type 2 diabetes to estimate the number of people in remission in 2019 and described the characteristics of those in remission and not in remission.

Of 162 316 patients aged > 30 who were eligible for the analysis, 7710 (5%) were in remission in 2019. Individuals in remission tend to have not previously taken glucose lowering medication; have lost weight since their diagnosis; be older; have lower blood sugar levels at diagnosis; or have had bariatric surgery. This finding helps to establish a baseline for future studies, and could also help clinicians identify patients with whom to discuss remission and weight loss.

Captieux added, “We have been able to show, for the first time, that 1 in 20 people in Scotland with type 2 diabetes achieve remission. This is higher than expected and indicates a need for updated guidelines to support clinicians in recognising and supporting these individuals.”

Source: EurekAlert!

Using The 5:2 Diet for Weight Loss in Gestational Diabetes

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In a welcome finding, researchers have found that women who have had gestational diabetes can use the popular 5:2 diet for weight loss to help prevent the onset of type 2 diabetes.   

It can be a challenge to lose weight and keep it off, especially for mothers with a new baby. The study by the University of South Australia suggests that the popular 5:2 or intermittent fasting diet is as effective as a conventional energy-restricting diet, giving women greater choice and flexibility for weight loss.

The 5:2 diet allows five days of normal eating each week while substantially restricting calories over two days a week, as opposed to a typical diet that requires moderate energy restrictions daily.

A fifth of pregnancies are affected by gestational diabetes, which carries a ten-fold risk of developing type 2 diabetes later in life, exacerbated even further by being overweight.

A welcome finding for a growing problem
The study’s lead researcher, Dr Kristy Gray, said women looking to lose weight will welcome the finding: “Gestational diabetes is the fastest growing type of diabetes in Australia, affecting 15% of pregnancies.

“Healthy eating and regular physical activity are recommended to manage gestational diabetes, with continuous energy restriction diets – or diets that cut calories by 25–30% being the most common strategy for weight loss and diabetes prevention.

“The trouble is, however, that new mums often put themselves last – they’re struggling with fatigue and juggling family responsibilities – so when it comes to weight loss, many find it hard to stick to a low-calorie diet.

“The 5:2 diet may provide a less overwhelming option. As it only cuts calories over two days, some women may find it easier to adopt and adhere to, as opposed to a consistently low-calorie diet requiring constant management.

“Our research shows that the 5:2 diet is just as effective at achieving weight loss as a continuous energy-restricted diet in women who have had gestational diabetes, which is great, because it provides women with greater choice and control,” she said, adding that women should seek advice from health professionals before starting the diet.

The research investigated the effects of both the 5:2 diet (five days eating normally and two days eating 500 calories) and a continuous energy-restricted diet (1500 calories per day) on weight loss and diabetes risk markers in women with a previous diagnosis of gestational diabetes. Both diets cut energy intake by about 25% a week.

The study was published in the American Journal of Clinical Nutrition.

Source: University of South Australia

A New, Lasting Diabetes Treatment

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Israeli researchers have come up with a novel approach to the treatment of type 2 diabetes, using an autograft of muscle cells engineered to take in sugar at increased rates.

The disease’s long-term complications include heart disease, strokes, retinal damage leading to blindness, kidney failure, and poor blood flow in the limbs that may result in amputations. Currently a combination of lifestyle changes, medication, and insulin injections are used to treat it, however it is still associated with a 10-year reduction in life expectancy.

Professor Shulamit Levenberg led the study alomg with PhD student Rita Beckerman from the Stem Cell and Tissue Engineering Laboratory in the Technion’s Faculty of Biomedical Engineering. An autograft of muscle cells engineered to take in sugar at increased rates were tested in mice, which displayed normal blood sugar levels for months after a single procedure. The study findings were published in Science Advances.

Muscle cells are among the main targets of insulin, and they are supposed to absorb sugar from the blood. In their study, Prof. Levenberg’s group isolated muscle cells from mice and engineered these cells to present more insulin-activated sugar transporters (GLUT4). These cells were then grown to form an engineered muscle tissue, and finally put back into diabetic mice. The engineered cells not only proceeded to absorb sugar correctly, improving blood sugar levels, but also induced improved absorption in the mice’s other muscle cells through intercellular signalling. After this one treatment, the mice remained cured of diabetes for four months – the entire observation period. Their blood sugar levels remained lower, and they had reduced levels of fatty liver normally seen in type 2 diabetes.

Prof. Levenberg explained how the process worked. “By taking cells from the patient and treating them, we eliminate the risk of rejection.” These cells can easily integrate back into being part of the body and respond to the body’s signaling activity.

An effective treatment, especially as a once-off, could significantly improve both quality of life and life expectancy of those who have diabetes. The same method could also be used to treat various enzyme deficiency disorders.

Source: Technion Israeli Institute of Technology

New Connection Found Between Diabetes and Alzheimer’s

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Researchers have added to the body of evidence linking Type 2 diabetes to Alzheimer’s disease.

In a study published in Communications Biology, researchers show that chronic hyperglycaemia impairs working memory performance and also alters key aspects of working memory networks. Insulin insensitivity has been linked to memory deficits, cognitive decline, and many of the characteristic symptoms that have been displayed in Alzheimer’s disease. At the same time, Type 2 diabetes has remained one of the most adjustable risk factors for the development of Alzheimer’s disease.

“Diabetes is a major risk factor for developing Alzheimer’s disease, but it is not clear why,” said James Hyman, study author and associate professor of psychology at UNLV. “We show that a central feature of diabetes, hyperglycaemia, impairs neural activity in ways that are similar to what is observed in preclinical Alzheimer’s disease models. This is the first evidence showing neural activity changes due to hyperglycemia overlap with what is observed in Alzheimer’s systems.”

“As the number of Alzheimer’s disease diagnoses rapidly rises and the incidence of diabetes and pre-diabetes has accelerated, it’s crucial that we understand what connects these two disorders,” said coauthor Jefferson Kinney, chair and professor in UNLV’s Department of Brain Health.

The researchers found that two parts of the brain crucial for memory, the hippocampus and the anterior cingulate cortex, were over-connected, or hyper-synchronised. When it came time to recall the information and complete a task, these two parts of the brain – which are affected early in Alzheimer’s progression – were over-communicating with each other, resulting in errors.

“We know synchrony is important for different parts of the brain to work together. But, we’re finding more and more these days, that the key with neural synchrony is it has to happen at the right time, and it has to happen with control,” Prof Hyman said. “Sometimes, there’s just too much ‘talking’ between certain areas and we think this leads to memory difficulties, among other things.”

Prof Hyman likens the situation to a CEO who hands over a majority of the company’s business operations to their son, who then decides to upend previous communication structures and become the sole gatekeeper of information.

“The only communication the CEO has is with one person, as opposed to talking with all of the other people in the office,” Prof Hyman explained. “It is possible that in Alzheimer’s patients there’s over-connection in certain areas where there should be flexibility. And in the models in our study, we’re seeing evidence of that in real-time at these crucial moments to do the task.”

This discovery not only provides new insights into brain activity in the hyperglycaemia model, it also provides an important new measure which can be used in future research.

“Our next step is to combine the biochemical markers and electrophysiology data to test specific mechanisms responsible and potential treatments,” said Prof Kinney. “This research will now be able to work towards understanding the risk as well as what may be able to be done to help.”

Source: University of Nevada, Las Vegas