Diabetes News from dLife.com

Researchers Report Periodontal Disease Independently Predicts New Onset Diabetes

2008-08-06T18:46:41Z

August 6, 2008 (EurekAlert) - Periodontal disease may be an independent predictor of incident Type 2 diabetes, according to a study by researchers at Columbia University Mailman School of Public Health. While diabetes has long been believed to be a risk factor for periodontal infections, this is the first study exploring whether the reverse might also be true, that is, if periodontal infections can contribute to the development of diabetes. The full study findings are published in the July 2008 issue of Diabetes Care.

The Mailman School of Public Health researchers studied over 9,000 participants without diabetes from a nationally representative sample of the U.S. population, 817 of whom went on to develop diabetes. They then compared the risk of developing diabetes over the next 20 years between people with varying degrees of periodontal disease and found that individuals with elevated levels of periodontal disease were nearly twice as likely to become diabetic in that 20 year timeframe. These findings remained after extensive multivariable adjustment for potential confounders including, but not limited to, age, smoking, obesity, hypertension, and dietary patterns.

"These data add a new twist to the association and suggest that periodontal disease may be there before diabetes," said Ryan T. Demmer, PhD, MPH, associate research scientist in the Department of Epidemiology at the Mailman School of Public Health and lead author. "We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop Type 2 diabetes later in life when compared to individuals without periodontal disease."

Also of interest, the researchers found that those study participants who had lost all of their teeth were at intermediate risk for incident diabetes. "This could be suggestive that the people who lost all of their teeth had a history of infection at some point, but subsequently lost their teeth and removed the source of infection," noted Dr. Demmer. "This is particularly interesting as it supports previous research originating from The Oral Infections and Vascular Disease Epidemiology Study (INVEST) which has shown that individuals lacking teeth are at intermediate risk for cardiovascular disease" said Moïse Desvarieux, MD, PhD, director of INVEST, associate professor and Inserm Chair of Excellence in the Department of Epidemiology at the Mailman School and senior author of the paper.

The contributory role of periodontal disease in the development of Type 2 diabetes is potentially of public health importance because of the prevalence of treatable periodontal diseases in the population and the pervasiveness of diabetes-associated morbidity and mortality. However, observes Dr. Demmer, more studies are needed both to determine whether gum disease directly contributes to type 2 diabetes and, from there, that treating the dental problem can prevent diabetes. In addition to Dr. Desvarieux, David R. Jacobs Jr., PhD, professor in the Department of Epidemiology and Community Health at the University of Minnesota, also contributed to the research.

Study: Spices May Protect Against Consequences Of High Blood Sugar

2008-08-05T15:29:27Z

August 5, 2008 (EurekAlert) - Herbs and spices are rich in antioxidants, and a new University of Georgia study suggests they are also potent inhibitors of tissue damage and inflammation caused by high levels of blood sugar.

Researchers, whose results appear in the current issue of the Journal of Medicinal Food, tested extracts from 24 common herbs and spices. In addition to finding high levels of antioxidant-rich compounds known as phenols, they revealed a direct correlation between phenol content and the ability of the extracts to block the formation of compounds that contribute to damage caused by diabetes and aging.

"Because herbs and spices have a very low calorie content and are relatively inexpensive, they're a great way to get a lot of antioxidant and anti-inflammatory power into your diet," said study co-author James Hargrove, associate professor of foods and nutrition in the UGA College of Family and Consumer Sciences.

Hargrove explained that when blood sugar levels are high, a process known as protein glycation occurs in which the sugar bonds with proteins to eventually form what are known as advanced glycation end products, also known as AGE compounds. The acronym is fitting because these compounds activate the immune system, resulting in the inflammation and tissue damage associated with aging and diabetes.

The researchers found a strong and direct correlation between the phenol content of common herbs and spices and their ability to inhibit the formation of AGE compounds. Spices such as cloves and cinnamon had phenol levels that were 30 percent and 18 percent of dry weight, respectively, while herbs such as oregano and sage were eight and six percent phenol by dry weight, respectively. For comparison, blueberries – which are widely touted for their antioxidant capabilities – contain roughly five percent phenol by dry weight.

Study co-author Diane Hartle, associate professor in the UGA College of Pharmacy, said various phenols are absorbed differently by the body and have different mechanisms of action, so it's likely that a variety of spices will provide maximum benefit.

"If you set up a good herb and spice cabinet and season your food liberally, you could double or even triple the medicinal value of your meal without increasing the caloric content," she said.

She added that controlling blood sugar and the formation of AGE compounds can also decrease the risk of cardiovascular damage associated with diabetes and aging. She explained that high blood sugar accelerates heart disease partly because AGE compounds form in the blood and in the walls of blood vessels. The AGE compounds aggravate atherosclerosis, which produces cholesterol plaques.

The UGA researchers tested for the ability to block AGE compounds in a test tube, but animal studies conducted on the health benefits of spices lend support to their argument. Cinnamon and cinnamon extracts, for example, have been shown to lower blood sugar in mice. Interestingly, cinnamon lowers blood sugar by acting on several different levels, Hargrove said. It slows the emptying of the stomach to reduce sharp rises in blood sugar following meals and improves the effectiveness, or sensitivity, of insulin. It also enhances antioxidant defenses.

Hargrove said their findings suggest it's likely that the herbs and spices they studied will provide similar benefits in animal tests. He points out that because humans have been consuming herbs and spices for thousands of years, they come without the risk of possible side effects that accompany medications.

"Culinary herbs and spices are all generally recognized as safe and have been time-tested in the diet," he said. "Indeed, some of spices and herbals are now sold as food supplements because of their recognized health benefits."

Study co-author Phillip Greenspan, associate professor in the College of Pharmacy, noted that most people don't get their recommended five to nine servings of fruits and vegetables a day. Rather than seasoning their food with salt – which provides no beneficial phenols and has been linked to high blood pressure – he recommends that people use a variety of herbs and spices to help boost the nutritional quality of their meals.

"When you add herbs and spices to food, you definitely provide yourself with additional benefits besides taste," Greenspan said.

Eating Fish May Prevent Memory Loss and Stroke in Old Age

2008-08-04T21:11:54Z

August 4. 2008 (Newswise) - Eating tuna and other types of fish may help lower the risk of cognitive decline and stroke in healthy older adults, according to a study published in the August 5, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology.

For the study, 3,660 people age 65 and older underwent brain scans to detect silent brain infarcts, or small lesions in the brain that can cause loss of thinking skills, stroke or dementia. Scans were performed again five years later on 2,313 of the participants. The people involved in the study were also given questionnaires about fish in their diets.

The study found that people who ate broiled or baked tuna and other fish high in omega-3 fatty acids (called DHA and EPA) three times or more per week had a nearly 26 percent lower risk of having the silent brain lesions that can cause dementia and stroke compared to people who did not eat fish regularly. Eating just one serving of this type of fish per week led to a 13 percent lower risk. The study also found people who regularly ate these types of fish had fewer changes in the white matter in their brains.

“While eating tuna and other types of fish seems to help protect against memory loss and stroke, these results were not found in people who regularly ate fried fish,” said Jyrki Virtanen, PhD, RD, with the University of Kuopio in Finland. “More research is needed as to why these types of fish may have protective effects, but the omega-3 fatty acids EPA and DHA would seem to have a major role.”

Types of fish that contain high levels of DHA and EPA nutrients include salmon, mackerel, herring, sardines, and anchovies.

“Previous findings have shown that fish and fish oil can help prevent stroke, but this is one of the only studies that looks at fish’s effect on silent brain infarcts in healthy, older people,” said Virtanen. Research shows that silent brain infarcts, which are only detected by brain scans, are found in about 20 percent of otherwise healthy elderly people.

The study was supported by the National Heart, Lung and Blood Institute, the National Institute of Neurological Disorders and Stroke, the Finnish Cultural Foundation, Helsingin Sanomat Centennial Foundation, the Finnish Foundation for Cardiovascular Research, the Yrjö Jahnsson Foundation and the University of Kuopio.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com.

Obesity on the Kids’ Menus at Top Chains

2008-08-04T20:51:06Z

August 4, 2008 (CSPI News Release) - Nearly every single possible combination of the children’s meals at KFC, Taco Bell, Sonic, Jack in the Box, and Chick-fil-A is too high in calories, according to the nonprofit Center for Science in the Public Interest, which today released the results of an investigation into the nutritional quality of kids’ meals at 13 top restaurant chains. Ninety-three percent of 1,474 possible choices at the 13 chains exceed 430 calories—an amount that is one-third of what the Institute of Medicine recommends that children aged four through eight should consume in a day.

Chili’s has 700 possible kids’ meal combinations, but 658, or 94 percent, of those are too high in calories, including one comprised of country-fried chicken crispers, cinnamon apples, and chocolate milk (1,020 calories) and another comprised of cheese pizza, homestyle fries, and lemonade (1,000 calories). Burger King has a “Big Kids” meal with a double cheeseburger, fries, and chocolate milk (910 calories), and Sonic has a “Wacky Pack” with 830 calories worth of grilled cheese, fries, and a slushie.

KFC has a wide variety of side items, but there are few meal combinations that keep a reasonable ceiling on calories, according to the study. One example of a high-cal combo KFC kid’s meal (the chain calls them “Laptop Meals”) has popcorn chicken, baked beans, biscuit, Teddy Grahams, and fruit punch, which has 940 calories. (KFC has since dropped Baked Cheetos from its kids’ meals, and some outlets vary the number of chicken strips or sides.)

Most of the kids’meals (93 percent) at McDonald’s and Wendy’s are too high in calories, as are the possibilities at Burger King (92 percent), Dairy Queen (89 percent), Arby’s (69 percent), and Denny’s (60 percent—though its kids’ meals don’t include drinks). (Since CSPI’s study was completed, Burger King has introduced one new children’s meal with macaroni and cheese, apple “fries,” and 1 percent milk, which has a reasonable 420 calories.)

Subway’s kids’ meals came out on top. Only a third of its Fresh Fit for Kids meals, which include a mini-sub, juice box, and one of several healthful side items (apple slices, raisins, or yogurt), exceed the 430-calorie threshold. Subway is the only chain that doesn’t offer soft drinks with kids’ meals.

“Parents want to feed their children healthy meals but America’s chain restaurants are setting parents up to fail,” said CSPI nutrition policy director Margo G. Wootan. “McDonald’s, Burger King, KFC, and other chains are conditioning kids to expect burgers, fried chicken, pizza, French fries, macaroni and cheese, and soda in various combination at almost every lunch and dinner.”

Besides being almost always too high in calories, 45 percent of the kids’ meals at the 13 chains studied by CSPI are too high in saturated and trans fat, and 86 percent are too high in sodium. That’s alarming, according to CSPI, because a quarter of children between the ages of five and ten show early signs of heart disease, such as high LDL (the “bad” cholesterol) or elevated blood pressure.

“People may not get a heart attack until their 50s or 60s, but arteries begin to clog in childhood,” said Wootan. “Most of these kids’ meals appear to be designed to put America’s children on the fast-track to obesity, disability, heart attack, or diabetes.”

Though the overwhelming majority of chain restaurant kids’ meals are nutritionally poor, calorie counts on menus and menu boards would help parents assemble healthier meals for their children. If Arby’s kids’ meals had calorie counts, parents could see that substituting a fruit cup and a juice box for fries and a soda would cut a popcorn chicken meal from 720 calories to 420. If Denny’s listed calories on menus, parents could see the surprising difference between the calories in Big Dipper French Toastix (770) and Smiley-Alien Hotcakes (without meat, 370).

CSPI has advocated laws or regulations that require chain restaurants to list calories on menus and menu boards. They’ve already begun appearing in New York City. San Francisco, King County (Seattle), WA., Multnomah County (Portland), OR, and Santa Clara County, CA, also have passed menu labeling policies. Similar policies have been introduced in over 20 other states and localities over the last two years. California’s legislature may be on the verge of passing a statewide menu labeling bill, which lobbyists for the chain restaurant industry are fighting tooth and nail. The California Center for Public Health Advocacy, an advocacy group leading the fight for menu labeling legislation in that state, collaborated with CSPI on the study released today.

CSPI only scrutinized the chains that have dedicated children’s menus (19 out of the top 25 chains) and that provide nutrition information on their web sites or elsewhere (13 chains). Applebee’s, T.G.I. Friday’s, Outback Steakhouse, Olive Garden, Red Lobster, and IHOP do not disclose nutrition information for most menu items even upon request.

Lowering Cholesterol Early In Life Could Save Lives

2008-08-04T16:00:37Z

August 4, 2008 (EurekAlert) - With heart disease maintaining top billing as the leading cause of death in the United States, a team of University of California, San Diego School of Medicine physician-researchers is proposing that aggressive intervention to lower cholesterol levels as early as childhood is the best approach available today to reducing the incidence of coronary heart disease.

In a review article published in the August 5, 2008 issue of the American Heart Association journal Circulation, pioneering lipid researcher Daniel Steinberg, M.D., Ph.D., professor emeritus of medicine at UC San Diego, and colleagues Christopher Glass, M.D., Ph.D. and Joseph Witztum, M.D., both UC San Diego professors of medicine, call current approaches to lowering cholesterol to prevent heart disease "too little, too late."

They state that with a large body of evidence proving that low cholesterol levels equate with low rates of heart disease, "...our long-term goal should be to alter our lifestyle accordingly, beginning in infancy or early childhood" and that "…instituting a low-saturated fat, low-cholesterol diet in infancy (7 months) is perfectly safe, without adverse effects…"

According to Steinberg, progress has been made in the treatment of coronary heart disease in adults with cholesterol lowering drugs like statins. However, while studies show a 30% decrease in death and disability from heart disease in patients treated with statins, 70% of patients have cardiac events while on statin therapy. Promising new therapies are under development, but with an alarming rate of coronary heart disease in the U.S. today, action to curtail the epidemic is needed today.

In fact, they propose that lowering low-density lipoproteins (the so-called "bad cholesterol") to less than 50 mg./dl. even in children and young adults is a safe and potentially life-saving standard, through lifestyle (diet and exercise) changes if possible. Drug treatment may also be necessary in those at very high risk.

"Our review of the literature convinces us that more aggressive and earlier intervention will probably prevent considerably more than 30% of coronary heart disease," said Steinberg. "Studies show that fatty streak lesions in the arteries that are a precursor to atherosclerosis and heart disease begin in childhood, and advanced lesions are not uncommon by age 30. Why not nip things in the bud?" Such early signs of heart disease should be taken as seriously as early signs of cancer or diabetes, he said.

Physicians have been slow to measure cholesterol, much less prescribe cholesterol lowering regimens in children and young adults who are otherwise healthy. However, the UC San Diego team notes that studies of Japanese men in the 1950s showed that consuming a low-fat diet from infancy resulted in lifelong low cholesterol levels, and their death rate from heart disease was only 10% of the rate of cardiac-related death in the U.S. Even with risk factors such as cigarette smoking and diabetes, heart disease deaths remained significantly lower in Japanese men with lifetime levels of low cholesterol. This protective effect was lost in Japanese who migrated to the United States and adopted a Western diet leading to higher blood cholesterol levels.

Interventions today typically begin in adults diagnosed with high cholesterol levels or other risk factors or symptoms of coronary artery disease. However, initiating cholesterol-lowering interventions in 50-year-old adults, even if successful, is unlikely to reverse established arterial disease and will therefore have limited impact on the occurrence of adverse events related to coronary heart disease.

Citing the success of lowering cholesterol levels in children diagnosed with familial hypercholesterolemia, the UC San Diego team suggests that programs to lower cholesterol in the population at large from childhood on, with the ideal LDL level set at 50 mg./dl. or less (in those at highest risk), will have a long-term beneficial effect and lower the nationwide rates of coronary artery disease. They do not advocate using drug therapy to reach these levels, especially in children with no other risk factors, but to achieve these low levels through "TLC," or "therapeutic lifestyle changes," such as diet and exercise.

The National Institutes of Health (NIH) has declared "war" against the parallel epidemics of obesity and diabetes. The researchers conclude that "The weapons for those wars—education and behavior modification—are the same as those needed for a 'war' on coronary heart disease."

They propose that "A concerted national effort might dramatically reduce morbidity and mortality due to three major chronic diseases…It would take generations to achieve and it would require an all-out commitment of money and manpower to reeducate and modify the behavior of a nation. Is that impossible? No. We have already shown that even a frankly addictive behavior like cigarette smoking can be overcome (eventually)."

NIDDK Resource Helps Guide Women with Diabetes through Healthy Pregnancies

2008-08-01T21:00:55Z

August 1, 2008 (NIDDK) - Pregnancy is a time of great excitement and anticipation. It also can be a time of anxiety, especially for women with type 1 or type 2 diabetes. Pregnancy in women who have diabetes is automatically considered high-risk. But a new, easy-to-read booklet has information to help women with diabetes experience safe, healthy pregnancies.

For Women with Diabetes: Your Guide to Pregnancy is an illustrated, 44-page booklet that includes information about checking and controlling blood glucose — also called blood sugar levels, maintaining a healthy diet, staying physically active and taking tests and diabetes medications during pregnancy. The importance of planning for pregnancy and getting blood glucose levels under control before pregnancy to decrease the risk of birth defects associated with diabetes is emphasized. Logs for recording daily blood glucose and ketone levels, food intake and physical activity are included.

Produced by the National Diabetes Information Clearinghouse (NDIC), an information dissemination service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health, the new booklet is available at www.diabetes.niddk.nih.gov/dm/pubs/pregnancy. A Spanish-language version of the booklet will be available soon.

To order a free copy of the publication, go to www.catalog.niddk.nih.gov. Copies also can be ordered by calling the Clearinghouse at 1–800–860–8747 or writing to the NDIC at 1 Information Way, Bethesda MD 20892–3560.

The Clearinghouse also has an easy-to-read booklet about gestational diabetes and many other resources about diabetes in English and Spanish. The A-to-Z list of topics and titles at www.diabetes.niddk.nih.gov/dm/a-z.asp lists all of these resources in alphabetical order. All NDIC publications are available free of charge.

The NDIC was created in 1978 to increase knowledge and understanding about diabetes among patients, health care professionals and the general public. To carry out this mission, the NDIC works closely with the NIDDK’s research programs; the National Diabetes Education Program; professional, patient and voluntary associations; and government agencies to identify and respond to informational needs about diabetes and its management.

The NIDDK, a component of the National Institutes of Health (NIH), conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see www.niddk.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

A Mechanism For The Development Of Obesity-Associated Conditions

2008-08-01T20:59:00Z

August 1, 2008 (EurekAlert) - Endocannabinoids are substances produced by several cells in the body that are very similar to compounds found in cannabis plants. They have been implicated in the development of many effects of a high-fat diet, including many risk factors for type 2 diabetes: obesity, insulin resistance, leptin resistance, and dyslipidemia. It is important to determine whether these effects of endocannabinoids occur via activation of the protein CB1 in the brain, liver, or other tissues, as the therapeutic potential of agents that target CB1 is currently limited by the side effects of targeting CB1 in the brain, anxiety and depression. However, new insight into this issue has now been provided by George Kunos and colleagues, at the National Institutes of Health, Rockville, through analysis of mice lacking CB1 only in the liver.

Similar to normal mice, when the mice lacking CB1 only in the liver were fed a high-fat diet they became obese. However, they exhibited less severe insulin resistance, leptin resistance, and dyslipidemia than the normal mice. They also exhibited less severe high fat diet–induced fatty liver, something that increases the risk of developing cirrhosis of the liver. The data indicate that high fat diet–induced obesity is influenced by CB1 found in tissues other than the liver and that liver-specific CB1 is necessary for the development of high fat diet–induced fatty liver and the hormonal and metabolic changes that occur as a result of such a diet, increasing the risk of type 2 diabetes. The authors therefore suggest that targeting liver CB1 might provide an effective way to treat obesity-related medical conditions without the side effects of targeting CB1 in the brain.

Study Shows That People With Sleep Apnea Have A High Risk Of Death

2008-08-01T20:57:06Z

August 1, 2008 (EurekAlert) - A study in the August 1 issue of the journal Sleep shows that people with severe sleep apnea have a much higher mortality risk than people without sleep apnea, and this risk increases when sleep apnea is untreated.

Results show that people who have severe sleep apnea, which involves frequent breathing pauses during sleep, have three times the risk of dying due to any cause compared with people who do not have sleep apnea. This risk is represented by an adjusted hazard ratio of 3.2 after controlling for age, sex and body mass index. When 126 participants who reported regular use of continuous positive airway pressure (CPAP) therapy were removed from the statistical analysis, the hazard ratio for all-cause mortality related to severe sleep apnea rose to 4.3.

"We found that both men and women with sleep apnea in the general population - not patients - mostly undiagnosed and untreated, had poorer survival compared with persons without sleep apnea, given equal BMI, age and sex," said principal investigator and lead author Terry Young, PhD, professor of epidemiology at the University of Wisconsin-Madison.

According to Young, most previous studies of sleep apnea and mortality have involved patients referred for a clinical sleep diagnostic evaluation; the mortality risk for sleep apnea in the general population has not been previously reported.

The study was an 18-year follow-up of 1,522 participants in the ongoing Wisconsin Sleep Cohort Study, which was established in 1988 and involved a random sample of men and women from the community who were between the ages of 30 and 60 when the study began. After spending one night at the University of Wisconsin General Clinical Research Center for assessment by polysomnography, participants were categorized by apnea-hypopnea index (AHI), which is the average number of breathing pauses (apneas) and reductions (hypopneas) per hour of sleep. Sixty-three individuals (about four percent) had severe sleep apnea at baseline with an AHI of 30 or more and a range of 30 to 97 apneas and hypopneas per hour. About 76 percent of the study group (1,157 individuals) had no sleep apnea with an AHI of less than five.

For the follow-up study, state and national death records were reviewed up to March 1, 2008, to identify participants who had died and to note the causes of death listed on the death certificates. Eighty deaths were recorded, including 37 deaths attributed to cancer and 25 deaths attributed to cardiovascular disease and stroke.

About 19 percent of participants with severe sleep apnea died (12 deaths), compared with about four percent of participants with no sleep apnea (46 deaths). Although participants with mild sleep apnea (AHI of five to 14) or moderate sleep apnea (AHI of 15 to 29) had a mortality risk that was 50 percent greater than those with no sleep apnea, the results did not achieve statistical significance.

Hazard ratios for all-cause mortality remained high after further adjustments for other factors such as smoking, alcohol use, sleep duration and total cholesterol. Severe sleep apnea was associated with increased mortality whether or not participants experienced daytime sleepiness.

About 42 percent of deaths in people with severe sleep apnea (5 of 12 deaths) were attributed to cardiovascular disease or stroke, compared with 26 percent of deaths in people with no sleep apnea (12 of 46 deaths). When the 126 participants who reported regular CPAP use were removed from the analysis, the hazard ratio for cardiovascular mortality soared from 2.9 to 5.2 for people with severe sleep apnea. The results suggest that regular CPAP use may protect sleep apnea patients against cardiovascular death.

"I was surprised by how much the risks increased when we excluded people who reported treatment with CPAP," Young said. "Our findings suggest - but cannot prove - that people diagnosed with sleep apnea should be treated, and if CPAP is the prescribed treatment, regular use may prevent premature death."

Statistical adjustments show that high blood pressure, cardiovascular disease, stroke and diabetes may play a role in the association between sleep apnea and mortality, but the specific mechanisms by which sleep apnea contributes to mortality remain unclear.

The study was supported by grants from the National Institutes of Health.

According to the American Academy of Sleep Medicine, obstructive sleep apnea (OSA) involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.

The most common treatment for OSA is CPAP therapy, which provides a steady stream of air through a mask that is worn during sleep. This airflow keeps the airway open to prevent pauses in breathing and restore normal oxygen levels.

Innovative Diabetes Program In Bloomington-Normal, Ill., A Success

2008-08-01T20:54:51Z

August 1, 2008 (EurekAlert) - Diabetes Checks & Balances, a unique program launched locally to help people manage the disease, helped decrease emergency room visits and hospital admissions among participants.

The first program of its kind in Illinois, Diabetes Checks & Balances encourages people with diabetes to contact their physicians and arrange for four tests, including HbA1c (a test indicating the level of blood sugar control), low-density lipoprotein (LDL)-cholesterol, an eye exam, and screening for kidney disease. More than 600 area residents met the criteria for participation, and 29% received all four of the tests – almost twice as many as in 2006, before the program started.

"These results are an impressive start. We will work to continue to drive people with type 2 diabetes to their doctors and other resources that can help them improve how they manage their conditions," said Barb Baurer, Executive Vice President & Chief Operating Officer of COUNTRY Financial.

The American Diabetes Association estimates more than 9,500 – or roughly seven percent – of the McLean County population has diabetes – and more than 120 people in the county die each year from diabetes or diabetes-related complications.

Blue Cross and Blue Shield of Illinois (BCBSIL) collaborated with McLean County employers and health care providers on the Diabetes Checks & Balances program, including COUNTRY Financial, Mitsubishi Motors North America, Inc., State Farm Insurance®, and numerous other local employers to target this population and move them toward care.

"Blue Cross' goal was to join together with local employers and providers and help our members in the area who have diabetes be healthier," said Scott Sarran, MD, BCBSIL's chief medical officer. "Similar to the 'medical home' concept, as part of this program, physicians provided comprehensive coordinated care for their patients that enhanced their health."

As part of the program, BCBSIL identified its local members with diabetes, and sent them information about diabetes and about the program. Through the program, local physicians became actively engaged in improving the care of diabetics. In addition, BCBSIL hosted diabetes screenings in the workplace and elsewhere throughout the area.

Results Highlights

Of those who participated:

Seventy-nine percent had an HbA1c test, an increase of 14 percentage points compared to 2006. The percentage of people with diabetes with controlled blood sugar improved by 13 percentage points.

* Seventy-six percent were screened for low-density lipoprotein (LDL), up 14 percentage points over 2006. The rate of LDL control increased from 52% to 65%.

* Eye exams increased as well, by 18 percentage points compared to the year before.

* An additional 13 percent received medical attention for kidney disease.

"Taking these tests and knowing the results are significant first steps toward better diabetes management. We are encouraged that with early detection, treatment and proper management, people with diabetes may prevent or delay the onset of complications associated with the disease, which range from heart and blood vessel disease, blindness and kidney failure to nerve damage, foot ulcers and urological problems," Mickeisha Armstrong, Manager-Benefits and HRIS, Mitsubishi.

2 Years Old -- A Childhood Obesity Tipping Point?

2008-08-01T20:52:34Z

August 1, 2008 (EurekAlert) - Over the last decade, childhood obesity has grown into an epidemic, reflected in soaring rates of type 2 diabetes and recommendations that pediatricians check toddlers for elevated cholesterol.

What hasn't been as clear is how early to intervene.

A study presented at a pediatric research program on Friday suggested obesity prevention efforts should begin as early as age two, when children reach a "tipping point" in a progression that leads to obesity later in life.

"This study suggests that doctors may want to start reviewing the diet of children during early well-child visits," said John W. Harrington, M.D., a pediatrician at Virginia's Children's Hospital of The King's Daughters (CHKD). "By the time they reach eight years old, they're already far into the overweight category, making treatment more difficult."

The study examined records of 111 overweight children from a suburban pediatric practice. All of the children had their height and weight measured at least five times during pediatric visits. The average age was 12.

Children whose body mass index exceeded that of 85 percent of the general population were classified as overweight. Researchers charted the recorded body mass index of the children from infancy. through They found that the obese children had started gaining weight in infancy at an average rate of .08 excess BMI units per month. On average, they began this progression at three months of age.

Over half the children could be classified as overweight at two years old, 90 percent before reaching their fifth birthday.

Vu Nguyen, a second year student at Eastern Virginia Medical School, CHKD's academic partner, said the results surprised him.

"I didn't think that that obesity would start that early," said Nguyen, who presented the results Friday at a pediatric research scholars program.

Nguyen conducted the study with Harrington and Lawrence Pasquinelli, M.D., a pediatrician with Tidewater Children's Associates in Virginia Beach, Va.

More research is needed to determine the causes of early obesity including "information on family history and the dietary and exercise habits in infancy," said Harrington, an EVMS associate professor. "We may then have to look prospectively to see what interventions work in reversing this trend."

Exercise In A Pill

2008-08-01T00:01:17Z

July 31, 2008 (Press Release) - Trying to reap the health benefits of exercise? Forget treadmills and spin classes, researchers at the Salk Institute for Biological Studies may have found a way around the sweat and pain. They identified two signaling pathways that are activated in response to exercise and converge to dramatically increase endurance.

The team of scientists, led by Howard Hughes Medical Investigator Ronald M. Evans, Ph.D., a professor in the Salk Institute's Gene Expression Laboratory report in the July 31 advance online edition of the journal Cell that simultaneously triggering both pathways with oral drugs turned laboratory mice into long-distance runners and conferred many of exercise's other benefits.

In addition to their allure for endurance athletes, drugs that mimic the effects of exercise have therapeutic potential in treating certain muscle diseases, such as wasting and frailty, as well as obesity and a slew of associated metabolic disorders where exercise is known to be beneficial.

Previous work with genetically engineered mice in the Evans lab had revealed that permanently activating a genetic switch known as PPAR delta turned mice into indefatigable marathon runners. In addition to their super-endurance, the altered mice were resistant to weight gain, even when fed a high-fat diet that caused obesity in ordinary mice. On top of their lean and mean physique, their response to insulin improved, lowering levels of circulating glucose.

"We wanted to know whether a drug specific for PPAR delta would have the same beneficial effects," says Evans. "Genetic engineering in humans, commonly known as gene doping when mentioned in connection with athletic performance, is certainly feasible but very impractical."

An investigational drug, identified only as GW1516 (and not commercially available), fit the bill. When postdoctoral researcher and lead author Vihang A. Narkar, Ph.D., fed the substance to laboratory mice over a period of four weeks, the researchers were in for a surprise.

"We got the expected benefits in lowering fatty acids and blood glucose levels but no effect, absolutely none, on exercise performance," says Narkar. Undeterred, he put mice treated with GW1516 on a regular exercise regimen and every day had them run up to 50 minutes on a treadmill.

Now the exact same drug that had shown no effect in sedentary animals improved endurance by 77 percent over exercise alone and increased the portion of "non-fatiguing" or "slow twitch" muscle fibers by 38 percent. The result, while very dramatic, gave rise to a vexing question: Why is exercise so important?

First and foremost, exercise depletes muscles' energy store, a chemical known as ATP. In times of high demand, ATP releases all its energy and forms AMP. Rising AMP levels alert AMPK, a metabolic master regulator, which acts like a gas gauge that the cell is running on empty and revs up the production of ATP. "That led us to consider whether AMPK activation was the critical trigger that allowed PPAR delta to work," recalls Narkar.

Usually, AMPK can be found in the cytoplasm, the compartment that surrounds the nucleus, but the Salk researchers' experiment revealed that some exercise-activated AMPK molecules slip into the nucleus. There they physically interact with PPAR delta and increase its ability to turn on the genetic network that increases endurance.

"It essentially puts a turbo charge on PPAR delta, which explains why exercise is so important," says Evans.

Then came the ultimate couch potato experiment. The researchers fed untrained mice AICAR, a synthetic AMP analog that directly activates AMPK. After only four weeks and without any prior training, these mice got up and ran 44 percent longer than untreated, untrained mice. "That's as much improvement as we get with regular exercise," says Narkar.

"Exercise in a pill" might sound tempting to couch potatoes and Olympic contenders alike, but the dreams of the latter might be cut short. Evans developed a test that can readily detect GW1516 and its metabolites as well as AICAR in blood and urine and is already working with officials at the World Anti-Doping Association, who are racing to have a test in place in time for this year's Summer Olympics.

The study was supported by the Howard Hughes Medical Institute, the Hillblom Foundation and the National Institute of Health.

Researchers who contributed to the work include postdoctoral researchers Michael Downes, Ph.D., Ruth T. Yu, Ph.D., doctoral candidate Emi Embler, B.S., research associates Michael C. Nelson, B.S., Yuhua Zou, M.S., Ester Banayo, and Henry Juguilon, in the Gene Expression Laboratory, doctoral candidate M. Mihaylova, and assistant professor Reuben Shaw, Ph.D., in the Molecular and Cell Biology Laboratory, assistant professor Yong-Xu Wang, Ph.D., at the University of Massachusetts Medical School, Massachusetts, and professor Heonjoon Kang, Ph.D., at the School of Earth and Environmental Sciences, Seoul National University, South Korea.

The Salk Institute for Biological Studies in La Jolla, California, is an independent nonprofit organization dedicated to fundamental discoveries in the life sciences, the improvement of human health and the training of future generations of researchers. Jonas Salk, M.D., whose polio vaccine all but eradicated the crippling disease poliomyelitis in 1955, opened the Institute in 1965 with a gift of land from the City of San Diego and the financial support of the March of Dimes.

Drinking in Excess Associated with Increased Risk for Metabolic Syndrome

2008-07-31T21:14:45Z

July 31, 2008 (Newswise) - Those who drink in excess of the U.S. Dietary Guidelines (i.e., men who usually drink more than two drinks per day or women who usually drink more than one drink per day) or those who binge drink are at increased risk for the metabolic syndrome, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

The metabolic syndrome consists of a series of risk factors and conditions that are strongly related to cardiovascular disease, the leading cause of death in the United States. These conditions include obesity, high blood pressure, and diabetes.

“These findings are significant because the National Health and Nutrition Examination Survey shows 58 percent of all current drinkers in the United States reported usual alcohol consumption that exceeded the Dietary Guidelines, and 52 percent of all current drinkers reported at least one episode of binge drinking in the past year," said Amy Fan, M.D., Ph.D., of the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), in Atlanta, Ga., and lead author of the study. “Most people who consume alcohol in the United States drink in ways that may increase their risk of the metabolic syndrome and related conditions.”

For this study, Dr. Fan and other researchers evaluated data from 1,529 participants of the 1999-2002 National Health and Nutrition Examination Survey. They restricted their analysis to current drinkers (participants who consumed at least 12 alcoholic drinks in 12 months) aged 20 to 84 years. The survey included both an interview and a physical examination that included a blood test. Measures of alcohol consumption included usual quantity consumed, drinking frequency, and frequency of binge drinking.

“Since more than half of current drinkers in our study drank in excess of the Dietary Guidelines limits and reported binge drinking, prevention efforts should focus on reducing alcohol consumption to safer levels,” said Dr. Fan. “Unfortunately, few physicians screen their patients about alcohol use or are knowledgeable about guidelines that define low-risk or moderate drinking.”

Dr. Fan went on to say that public health messages should emphasize the potential cardiometabolic risk associated with drinking in excess of national guidelines and binge drinking.

Other researchers working on the study include Timothy Naimi, Yan Li, Youlian Liao, Ruth Jiles, and Ali Mokdad of the National Center for Chronic Disease Prevention and Health Promotion, CDC, in Atlanta, Ga., and Marcia Russell of the Pacific Institute for Research and Evaluation in Berkeley, Calif.

The article “Patterns of Alcohol Consumption and the Metabolic Syndrome,” will appear in the October issue of JCEM, a publication of The Endocrine Society.

New Uses For Old-Line Diabetes Monitoring Test: Screening And Diagnosis

2008-07-31T15:20:19Z

July 31, 2008 (EurekAlert) - A blood test currently used as the gold standard for monitoring people already under care for diabetes may have far wider use in identifying millions with undetected diabetes, a team led by a Johns Hopkins physician suggests.

The hemoglobin A1c test (HbA1c), based on a blood sample, is widely used to keep tabs on how well confirmed diabetics keep their blood sugar, or glucose, in check by showing how much glucose red blood cells have been exposed to for the past 120 days, the average lifespan of these cells.

"The test is a measure of long-term glucose control, but doctors don't typically use it to screen for or diagnose the disease, " says Christopher Saudek, M.D., professor of endocrinology and metabolism at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Comprehensive Diabetes Center. "There's reason to believe it could help identify many of the estimated six million people in the U.S. who have diabetes but don't know it," he adds. The current screening and diagnostic tests measure only the amount of sugar present at the moment that blood sample is taken. Consequently, Saudek says, these tests are accurate only if patients fast for at least 10 hours before the test because glucose concentrations can vary greatly depending on a person's recent meals.

Even then, explains Saudek, the tests miss a significant portion of people who have diabetes or are at high risk to develop the disease since glucose also varies depending on a person's diet and exercise regimen for several days leading up to the blood draw.

"If a patient is scheduled for a physical, he or she may 'tune up' by changing their regimen for a few days and throw off their test results, causing doctors to miss the patient's usual pattern of high blood sugar," he says.

In a consensus statement published in the July Journal of Clinical Endocrinology and Metabolism, Saudek and his colleagues conclude that the HbA1c test should be used as a front-line method for identifying patients with diabetes, especially for those at high risk for the disease. Since the test does not require fasting and isn't affected by short-term changes in diet and exercise, the HbA1c test has significant advantages to current testing methods.

The consensus was reached by a group of diabetologists, pathologists and internists seeking to improve detection methods because of the serious consequences of untreated diabetes for patients and public health. They met recently in Chicago with financial support from Metrika Inc., a major manufacturer of diabetes testing equipment. The panel deliberations and manuscript preparation were made independently of the sponsor, according to its members.

After reviewing relevant published studies and available tests, the national panel recommended that individuals who score at least 6 percent on an HbA1c test may have or be at risk for diabetes and should be tracked with additional glucose or HbA1c tests. Those who score between 6.5 percent or above, if confirmed, should be considered to have diabetes.

"This is a first step towards changing medical practice," notes Saudek, and "could greatly enhance how well we're able to identify people with diabetes."

National Birth Defects Prevention Study Finds Pre-pregnancy Diabetes Increases Risk for Multiple Types of Birth Defects

2008-07-30T19:22:57Z

July 30, 2008 (CDC Press Release) - Women who receive a diagnosis of diabetes before they become pregnant are three to four times more likely to have a child with one or even multiple birth defects than a mother who is not diabetic, according to a study by the Centers for Disease Control and Prevention (CDC), released in the American Journal of Obstetrics and Gynecology.

The article from the National Birth Defects Prevention Study (NBDPS), “Diabetes Mellitus and Birth Defects,” shows that pregnant women with pre-gestational diabetes mellitus (pre-pregnancy diagnosis of diabetes, such as type 1 or type 2 diabetes) are more likely than a mother with no diabetes or a mother with gestational diabetes mellitus (pregnancy-induced diabetes) to have a child with various types of individual or multiple birth defects. This includes heart defects, defects of the brain and spine, oral clefts, defects of the kidneys and gastrointestinal tract and limb deficiencies. This study is the first to show the broad range and severity of birth defects associated with type 1 and type 2 diabetes.

“The continued association of diabetes with a number of birth defects highlights the importance of increasing the number of women who receive the best possible preconception care, especially for those women diagnosed with diabetes,” says Adolfo Correa, M.D., M.P.H., Ph.D., lead author and epidemiologist at CDC’s National Center on Birth Defects and Developmental Disabilities. “Early and effective management of diabetes for pregnant women is critical in helping to not only prevent birth defects, but also to reduce the risk for other health complications for them and their children.”

Researchers also found that some of the pregnant women with gestational diabetes were more likely to have a child with birth defects. Because birth defects associated with diabetes are more likely to occur during the first trimester of pregnancy and before a diagnosis of gestational diabetes is made, the observed associations suggest that some of the mothers with it probably had undiagnosed diabetes before they became pregnant. However symptoms went unnoticed until pregnancy.

Further, the associations of gestational diabetes with various birth defects were noted primarily among women who had pre-pregnancy obesity, which is a known risk factor for both diabetes and birth defects. Preconception care also should be considered and promoted for women with pre-pregnancy obesity to prevent birth defects and reduce the risk for health complications.

The NBDPS is a population-based, case-control study that incorporates data from nine birth defect centers in the United States—Arkansas, California, Georgia, Iowa, Massachusetts, New York, North Carolina, Texas and Utah. These centers have been working on the largest study of birth defects causes ever undertaken in the United States. Researchers have gathered information from more than 30,000 participants and are using this information to look at key questions on potential causes of birth defects.

Birth defects affect one in 33 infants and are a leading cause of infant mortality. For some birth defects, some risk factors or causes have been identified; however, for the majority of birth defects the causes remain unknown.

In the United States, the prevalence of gestational diabetes has been increasing in recent years and currently affects about seven percent of all pregnancies, resulting in more than 200,000 cases annually. While it is usually resolved shortly after delivery, women who have had gestational diabetes are at increased risk of developing type 2 diabetes in the future.

For more information about birth defects, please visit http://www.cdc.gov/ncbddd/bd/facts.htm. For more information on diabetes, please visit http://www.cdc.gov/diabetes/, or call toll-free 1-800-CDC-INFO.

Women With Gestational Diabetes At Risk Of Type 2 Diabetes

2008-07-30T15:38:35Z

July 29, 2008 (Science Daily) - Women with gestational diabetes are at greater risk of developing type 2 diabetes, with almost 20% of women developing the condition within 9 years of pregnancy, found a large, population-based study of 659,000 women published in the Canadian Medical Association Journal.

The study, conducted by a group of researchers from the University of Toronto, Mount Sinai Hospital and the Institute for Clinical and Evaluative Sciences, looked at 21,823 women diagnosed with gestational diabetes and examined follow up records up to 9 years. They found the rate of diabetes increased rapidly in the first 9 months after delivery, peaking at 9 years.

"In this large, population-based study, we found that diabetes developed within 9 years after the index pregnancy in 18.9% of women with previous gestational diabetes; this rate was much higher than the rate among women without gestational diabetes (2%)," state Dr. Denice Feig and coauthors.

As well, they note that the rate of gestational diabetes in Ontario, the study province, seems to be increasing and is linked to older mothers. Living in low-income neighbourhoods and in urban areas were also risk factors for gestational diabetes. Higher urban statistics "may reflect the large numbers of South and East Asian and black populations living in urban areas, who have a higher risk of type 2 diabetes," postulate Dr. Feig and colleagues.

"The main strength of our study lies in the fact that it was a large population-based study involving more than 21,000 women with gestational diabetes, with up to 9 years of follow-up," state the researchers. "Unlike other studies, it covered a large, well-defined geographic region with a population of 13 million, which allowed us to make a more robust assessment of the risk of type 2 diabetes after gestational diabetes than has been possible in previous studies."

However, the study could not "assess the effect of ethnicity, obesity and level of fasting glucose during pregnancy, risk factors that are clearly associated with the development of diabetes."

"These women may benefit from both preventative interventions and regular screening," conclude the researchers who point out that physicians and policy makers need to counsel and screen these women accordingly.

In a related commentary, Dr. David Simmons of Cambridge University Hospitals NHS Foundation in the UK comments that many women with gestational diabetes become pregnant again, leading to potential risks for the fetus. "Type 2 diabetes in pregnancy, particularly if previously undiagnosed, is associated with poor outcomes, including an increased incidence of fetal loss, malformation and perinatal death." He argues for more investment in prevention and screening programs for at-risk women to protect women and their future children.