Physicians at The University of Texas Health Science Center at Houston (UTHealth) have begun enrollment for a pilot study on a promising surgical approach for the management of Type 2 diabetes.

The procedure being tested is designed for adults who have Type 2 diabetes and who are overweight or obese but not morbidly obese. Millions of Americans have Type 2 diabetes and most are overweight.

Involving surgery to the small intestine and stomach, the procedure, which is called an ileal transposition with sleeve gastrectomy, is intended to improve or resolve Type 2 diabetes. It will be performed at Memorial Hermann-Texas Medical Center.

Type 2 diabetes is a serious health problem and can lead to blindness, limb amputation and heart disease. It is characterized by an elevated blood sugar level associated with the body’s inability to produce enough insulin and/or to use it properly.

The researchers’ goal is to enhance the ability of a person with Type 2 diabetes to maintain a normal blood sugar level by moving a section of intestine closer to the stomach and reducing the size of the stomach.

Currently, many with Type 2 diabetes must take medication on a daily basis to keep sugar levels in check.

The surgical procedure has been associated with encouraging results in clinical research conducted abroad. If the procedure proves effective, it could allow some people with Type 2 diabetes to cut back or quit their medications.

The objectives of the study include evaluating the safety of the procedure and determining its effectiveness compared to dietary and medical management of Type 2 diabetes.

“No one has compared this surgery directly to medical therapy in a randomized, prospective study like this,” said Brad Snyder, M.D., the principal investigator of the study and an assistant professor of surgery at the UTHealth Medical School.

The UTHealth doctors plan to treat 10 people with Type 2 diabetes surgically and 10 medically. Participants will be followed over a two-year period and their outcomes compared.

“If we can get patients into remission and off their medications, then we could open the door for people who want to pursue careers as firefighters, police officers and commercial pilots who may at times be limited by this disease,” Snyder said.

An estimated 26 million people in the United States have diabetes, reports the Centers for Disease Control and Prevention. In adults, Type 2 diabetes accounts for about 90 -95 percent of all diagnosed cases of diabetes. Also known as adult onset diabetes and non-insulin dependent diabetes mellitus, Type 2 diabetes is associated with older age, physical inactivity and certain ethnic groups.

“This disease takes a terrible toll on both patients and their families,” said Erik Wilson, M.D., a study investigator and an associate professor of surgery at the UTHealth Medical School.

The ileum is the final section of the small intestine and transposition means to change place. Human studies have shown that when you place the ileum closer to the stomach, food from the stomach enters the ileum quickly and hormones that help regulate diabetes are easily stimulated.

In the procedure, surgeons remove a section of the ileum that is about 5 feet in length and reattach it. In addition, they remove about 80 percent of the stomach. It is a “band-aid” procedure that is performed through tiny incisions on the abdomen. As with surgical procedures, there is a risk of complication and the risk is anticipated to be in the 1 to 2 percent range.

The procedure is similar to a treatment for morbid obesity – metabolic and bariatric surgery, which can involve surgery on the stomach and intestines. Research shows that oftentimes Type 2 diabetes improves or resolves in morbidly obese patient following gastric bypass surgery.

“We’re not completely sure why people with morbid obesity and Type 2 diabetes experience this improvement following surgery,” Snyder said. It could be a combination of the different metabolism of food, the improvement of insulin action or the improvement in insulin secretion, he said.

“This research will help us find some answers and could lead to future treatments,” Snyder said.

Metabolic and bariatric surgery is typically limited to people with a body mass index of 40 kg/m² or more, or a BMI of 35 kg/m² or more with an obesity-related condition in accordance with National Institutes of Health (NIH) parameters for bariatric surgery. BMI is a calculation based on height and weight.

This pilot study for the surgical management of Type 2 diabetes is restricted to people with a body mass index (BMI) of 25 to 34 kg/m², which includes people who are overweight or obese. Participants must be between 21 and 55 years of age and being treated for Type 2 diabetes.

The clinical trial team includes Philip Orlander, M.D., a professor of medicine and director of the Division of Endocrinology, Diabetes and Metabolism at the UTHealth Medical School, who medically treats people with Type 2 diabetes. When treating patients, Orlander often begins by recommending they lose weight through conventional means such as restricting their calories and exercising more, as well as taking commonly used medications for diabetes. If that fails and they are eligible for bariatric surgery, Orlander will recommend bariatric surgery as a way to control their Type 2 diabetes.

“The average person with Type 2 diabetes may be on 10 different medications to control their blood sugar, cholesterol and blood pressure,” Orlander said. “When we send people to bariatric surgery, a significant portion may be able to stop all of their diabetes, cholesterol and blood pressure medications.”

Frank Moody, M.D., a professor of surgery at the UTHealth Medical School with a longtime interest in the surgical treatment of digestive system diseases, is assisting the research team and said the study could shed light on hormones involved in the metabolic process. “The team will be looking at the impact of surgery on the processing of sugars by the diabetic subjects with an expectation of fixing the break in their metabolism,” Moody said.

If successful, the next step could involve a large clinical trial, Snyder said. “Our intention is to gather this primary data in a small group to show the safety and likely significance as well.”

Snyder, Wilson and Orlander are collaborating on the study with Kelly Wirfel, M.D., an assistant professor of medicine at the UTHealth Medical School. Snyder and Wilson are members of a UT Specialty Surgery Center called Minimally Invasive Surgeons of Texas (MIST) and are on the medical staff of Memorial Hermann-TMC. Wilson is the director of MIST, chief of Elective General Surgery for the UTHealth Medical School and medical director of Bariatric Surgery for Memorial Hermann-TMC.

The study is titled “A Surgical Approach to the Management of Type 2 Diabetes Mellitus in Patients with a BMI between 25-34 kg/m².” The study was approved by the UTHealth Committee for the Protection of Human Subjects and is anticipated to take about three years to complete.

Source:
University of Texas Health Science Center at Houston
Diabetes From Medical News Today

http://www.medicalnewstoday.com

The study, conducted by the Joslin Diabetes Center on people who have lived with type 1 diabetes for more than 50 years, presents a strong case for the existence of a Some people with diabetes possess yet-unidentified factors that reduce the risk for and even prevent them from developing diabetes-related complications, despite living with the disease for decades, a study published in the April issue of Diabetes Care has found.

The study, conducted by the Joslin Diabetes Center on people who have lived with type 1 diabetes for more than 50 years, presents a strong case for the existence of a protective mechanism in some individuals that allows them to live relatively free of the problems typically associated with long-term duration of diabetes. These mechanisms, the study found, may be different for microvascular (such as kidney, nerve and eye disease) than macrovascular complications (such as heart disease).

“If we can identify what constitutes this protective mechanism, we have the potential to induce such protections in others living with diabetes,” said lead researcher George King, Chief Scientific Officer of the Joslin Diabetes Center and Professor of Medicine at Harvard Medical School. “That’s huge.”

Researchers looked at 351 U.S. residents known as the “Medalist” cohort and found that a subgroup of people who had lived with type 1 diabetes for more than 50 years remained free from such complications as proliferative diabetic retinopathy (PDR), a serious eye disease that can lead to blindness (42.6 percent of them); nephropathy, or kidney damage (86.9 percent of them); neuropathy, or nerve damage (39.4 percent); and cardiovascular disease (51.5 percent). Of those who did not develop PDR, 96 percent with no retinopathy progression in the first 17 years of their disease never experienced a worsening of symptoms, meaning that they likely possessed some type of protection specific to this complication.

Surprisingly, glycemic control was not a factor in providing this protective mechanism.

“That doesn’t mean of course that glycemic control doesn’t help to prevent complications. Numerous other studies have shown that it unquestionably does. In this case, it means only that there is a separate, protective mechanism in play that is not related to glycemic control that also helps to protect against diabetes-related problems. We are still working on identifying just what that is,” King said.

It’s important to note that most of the people in this study developed type 1 diabetes before strict glycemic control was even possible or used as the standard of medical care, the researchers write. The people in this study likely lived for several decades, therefore, without maintaining strict control.

The study also found that those with high plasma carboxyethyl-lysine and pentosidine, or advanced glycation end products (AGEs), were 7.2 times more likely to have some kind of complication than those who had low levels of this combination of AGEs. AGEs are compounds that develop in the body after long exposure to high glucose levels and have generally been regarded as playing a role in diabetes-related complications. However, those with other types of AGE molecules exhibited protective features. Thus, this study suggests that not all AGEs are alike in their actions and raises the exciting possibility that some AGEs may be markers for protection against one or more diabetic complications.

In an accompanying editorial, Dr. Aaron Vinik, Director, Eastern Virginia Medical School Diabetes Research Center, writes that “the accumulation of AGEs may be one of the important factors in metabolic memory,” a phenomenon in which an initial period of good glycemic, lipid and blood pressure control results in a prolonged period of health benefits that last beyond the period of control.

However, while it is clear that for some there is a protective mechanism at play, it’s unclear whether metabolic memory is playing a role because glycemic control was not considered important until 1993, long after the study began.

What’s most interesting, Vinik points out, is that sRAGE (the circulating soluble receptor for AGEs) is deficient in those who have the most severe complications, and is present at high levels in those with the most longevity. “If this is the missing link, it is huge for the possible emergence of a new biomarker and the potential for therapy that might increase circulating sRAGE or sRAGE itself,” he said.

Source:
American Diabetes Association in some individuals that allows them to live relatively free of the problems typically associated with long-term duration of diabetes. These mechanisms, the study found, may be different for microvascular (such as kidney, nerve and eye disease) than macrovascular complications (such as heart disease).

“If we can identify what constitutes this protective mechanism, we have the potential to induce such protections in others living with diabetes,” said lead researcher George King, Chief Scientific Officer of the Joslin Diabetes Center and Professor of Medicine at Harvard Medical School. “That’s huge.”

Researchers looked at 351 U.S. residents known as the “Medalist” cohort and found that a subgroup of people who had lived with type 1 diabetes for more than 50 years remained free from such complications as proliferative diabetic retinopathy (PDR), a serious eye disease that can lead to blindness (42.6 percent of them); nephropathy, or kidney damage (86.9 percent of them); neuropathy, or nerve damage (39.4 percent); and cardiovascular disease (51.5 percent). Of those who did not develop PDR, 96 percent with no retinopathy progression in the first 17 years of their disease never experienced a worsening of symptoms, meaning that they likely possessed some type of protection specific to this complication.

Surprisingly, glycemic control was not a factor in providing this protective mechanism.

“That doesn’t mean of course that glycemic control doesn’t help to prevent complications. Numerous other studies have shown that it unquestionably does. In this case, it means only that there is a separate, protective mechanism in play that is not related to glycemic control that also helps to protect against diabetes-related problems. We are still working on identifying just what that is,” King said.

It’s important to note that most of the people in this study developed type 1 diabetes before strict glycemic control was even possible or used as the standard of medical care, the researchers write. The people in this study likely lived for several decades, therefore, without maintaining strict control.

The study also found that those with high plasma carboxyethyl-lysine and pentosidine, or advanced glycation end products (AGEs), were 7.2 times more likely to have some kind of complication than those who had low levels of this combination of AGEs. AGEs are compounds that develop in the body after long exposure to high glucose levels and have generally been regarded as playing a role in diabetes-related complications. However, those with other types of AGE molecules exhibited protective features. Thus, this study suggests that not all AGEs are alike in their actions and raises the exciting possibility that some AGEs may be markers for protection against one or more diabetic complications.

In an accompanying editorial, Dr. Aaron Vinik, Director, Eastern Virginia Medical School Diabetes Research Center, writes that “the accumulation of AGEs may be one of the important factors in metabolic memory,” a phenomenon in which an initial period of good glycemic, lipid and blood pressure control results in a prolonged period of health benefits that last beyond the period of control.

However, while it is clear that for some there is a protective mechanism at play, it’s unclear whether metabolic memory is playing a role because glycemic control was not considered important until 1993, long after the study began.

What’s most interesting, Vinik points out, is that sRAGE (the circulating soluble receptor for AGEs) is deficient in those who have the most severe complications, and is present at high levels in those with the most longevity. “If this is the missing link, it is huge for the possible emergence of a new biomarker and the potential for therapy that might increase circulating sRAGE or sRAGE itself,” he said.

Source:
American Diabetes Association
Diabetes From Medical News Today

http://www.medicalnewstoday.com

“Before our discovery, the mechanism behind how exactly the insulin-producing beta cells in the islet of Langerhans of the pancreas fail in type 2 diabetes was incompletely understood, making it difficult to design new and better therapies, says Mehboob Hussain, M.D., associate professor of pediatrics, medicine and biological chemistry. “Our research cracks open a decades-long mystery.”

After a meal, the pancreas produces insulin to move glucose from the blood into cells for fuel. People with type 2 diabetes either don’t secrete enough insulin or their cells are resistant to its effects.

In a study designed to figure out more precisely how the pancreas releases insulin, Hussain’s group looked at how other cells in the body release chemicals. One particular protein, Snapin, found in nerve cells, caught their eye because it’s used by nerve cells to release chemicals necessary for cell communication. Snapin also is found in the insulin-secreting pancreatic beta cells.

To test the role of Snapin, researchers engineered a change to the Snapin gene in mice to keep Snapin permanently “on” in the pancreas. Researchers removed the pancreas cells and grew them in a dish for a day, then added glucose to the cells and took samples to measure how much insulin was released.

When the scientists compared that measurement to what was released by pancreas cells in normal mice, they found that normal mice released about 2.8 billionths of a gram of insulin per cell, whereas the cells from “Snapin-on” mice released 7.3 billionths of a gram of insulin per cell – about three times the normal amount.

“We were surprised to find that the Snapin-on mice didn’t have more or bigger pancreas cells, they just made more insulin naturally,” says Hussain. “This means all our insulin-secreting cells have this amazing reserve of insulin that we didn’t really know existed and a switch that controls it.”

To see if permanently turning off Snapin would reduce insulin release and further demonstrate that Snapin controls the process, the researchers first grew normal mouse pancreas cells in a dish, and treated them with a chemical that stopped them from making the Snapin protein. They again bathed the cells in glucose and measured how much insulin was released by the cells. Normal cells released 5.8 billionths of a gram of insulin, whereas cells with no Snapin only released 1.1 billionths of a gram of insulin – about 80 percent less.

“These results convinced us that Snapin is indeed the switch that releases insulin from the pancreas,” says Hussain.

Biology / Biochemistry From Medical News Today

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People with diabetes could be helped by a new type of self-monitoring blood glucose sensor being developed by Arizona State University engineers and clinicians at Mayo Clinic in Arizona.

More than 23 million people in the United States have diabetes. The disease is the fifth leading cause of death in the United States. It contributes to a higher risk for heart disease, blindness, kidney failure, lower extremity amputations and other chronic conditions.

Many people with diabetes suffer due to the difficulty of managing their blood glucose levels. It’s recommended that they monitor their own glucose levels, but current monitoring devices typically require patients to perform the painful task of pricking their finger to draw blood for a test sample – and many patients must do it several times each day.

The new sensor would enable people to draw tear fluid from their eyes to get a glucose-level test sample.

Glucose in tear fluid may give an indication of glucose levels in the blood as accurately as a test using a blood sample, the researchers say.

“The problem with current self-monitoring blood glucose technologies is not so much the sensor. It’s the painful finger prick that makes people reluctant to perform the test. This new technology might encourage patients to check their blood sugars more often, which could lead to better control of their diabetes by a simple touch to the eye,” says bioengineer Jeffrey T. LaBelle.

LaBelle, the designer of the device technology, is a research professor in the School of Biological and Health Systems Engineering, one of ASU’s Ira A. Fulton Schools of Engineering.

He is leading the ASU-Mayo research team along with Mayo Clinic physicians Curtiss B. Cook, an endocrinologist, and Dharmendra (Dave) Patel, chair of Mayo’s Department of Surgical Ophthalmology.

The team reported on their early work on the sensor in the Journal of Diabetes Science and Technology last year and at various regional and national conferences.

Because of its potential impact on health care, the technology has drawn interest from BioAccel, an Arizona nonprofit that works to accelerate efforts to bring biomedical technologies to the marketplace.

“A critical element to commercialization is the validation of technology through proof-of -concept testing,” says Nikki Corday, BioAccel business and development manager. “Positive results will help ensure that the data is available to help the research team clear the technical hurdles to commercialization.”

Researchers must now compile the proper data set to allow for approval of human testing of the device.

“With funding provided by BioAccel, the research team will conduct critical experiments to determine how well the new device correlates with use of the current technology that uses blood sampling,” says Ron King, BioAccel’s chief scientific and business officer.

The results should help efforts to secure downstream funding for further development work from such sources as the National Institutes of Health and the Small Business Incentive Research Program, King says.

BioAccel will also provide assistance using a network of technical and business experts, including the New Venture Group, a business consulting team affiliated with the W. P. Carey School of Business at ASU under the supervision of associate professor Daniel Brooks.

The ASU-Mayo research team began the project with funds from a seed grant from Mayo Clinic. Researchers got assistance in the laboratory from ASU students involved in research at ASU’s Biodesign Institute and the Ira A. Fulton Schools of Engineering Fulton Undergraduate Research Initiative program.

Team members assessed how current devices were working – or failing – and how others have attempted to solve monitoring problems, LaBelle says.

They came up with a device that can be dabbed in the corner of the eye, absorbing a small amount of tear fluid like a wick that can then be used to measure glucose.

The major challenges are performing the test quickly, efficiently, with reproducible results, without letting the test sample evaporate and without stimulating a stress response that causes people to rub their eyes intensely, LaBelle says.

A study commissioned by the American Diabetes Association reported that in 2007 the national economic burden related to diabetes was more than $170 billion – including about $116 billion in additional health care costs and $58 billion in lost productivity from workers debilitated by the disease.

Source:
Mayo Clinic
Diabetes From Medical News Today

http://www.medicalnewstoday.com

In an effort to reduce the risks of diabetes and obesity while improving cardiovascular health, Boston Medical Center (BMC) today announced it has partnered with the YMCA of Greater Boston to form the Exercise and Nutrition to Decrease Diabetes (END Diabetes) Program. The goal of this program is to show that with lifestyle changes and modest weight reduction, the risk of cardiovascular disease can be reduced. Funding for the program has been provided by a grant from AstraZeneca Healthcare Foundation. BMC is one of 14 institutions nationwide to receive this inaugural grant as part of the Foundation’s Connections for Cardiovascular Health program.

While some chronic conditions such as cardiovascular disease have been on the rise for decades in all segments of the United States, many chronic conditions such as diabetes, heart disease, asthma and obesity are more prevalent for low-income, ethnic minorities.

In Boston for example, 10 percent of Black adults have diabetes, compared with five percent of White adults. In 2007, the diabetes hospitalization rate for Blacks was nearly four times higher than the rate for Asians and Whites. In addition, prior studies have shown that people with lower incomes have a harder time accessing affordable healthy nutrition and exercise programs.

END Diabetes will take place at the East Boston, South End, Roxbury and Dorchester Y’s. Each has been identified as being located in and serving communities most in need of cardiovascular health services and health conditions such as diabetes, obesity, reduced access to care and nutrition services that contribute to poor cardiovascular health. The six-month program will offer educational workshops, free YMCA membership, individual coaching and regular exercise sessions for at least 200 adults. As part of this effort, four of BMC’s affiliated Boston HealthNet community health centers are referring patients to the END Diabetes program. They include the South End Community Health Center, the East Boston Neighborhood Health Center, Codman Square Health Center and Roxbury Comprehensive Community Health Center.

“As a direct result of the END Diabetes Program, participants will learn how to make positive, permanent lifestyle changes through proper nutrition, increased physical activity, health education, and participation in fitness and alternative wellness programs,” said Caroline M. Apovian, MD, Director of the Nutrition and Weight Management Center at BMC and principal investigator of the program.”The END Diabetes program will show that with these lifestyle changes and modest weight reduction, a person with pre-diabetic symptoms can prevent or delay the onset of Type 2 diabetes, thus reducing their risk for cardiovascular disease,” she added.

“Cardiovascular disease is taking a terrible toll on our families, our communities and our nation,” said James W. Blasetto, MD, chairman of the AstraZeneca HealthCare Foundation. “Boston Medical Center is developing creative heart-healthy programs tailored to meet the individual needs of the community.”

“Partnering with Boston Medical Center will enable the YMCA to further its mission to support healthy living and help people make lifestyle changes for a better quality of life,” added YMCA CEO Kevin Washington.

The program was initially launched as a result of the success of two prior pilot programs that showed that certain lifestyle changes, such as revised diet and exercise, can be successfully implemented through an individualized program to significantly reduce the incidence of diabetes and cardiovascular disease.

Source:
Gina DiGravio
Boston University Medical Center
Diabetes From Medical News Today

http://www.medicalnewstoday.com

New data released last week from the Centers for Disease Control and Prevention (CDC) paint an urgent picture of the state of diabetes, estimating that nearly 26 million children and adults in the United States are now living with diabetes. With one out of every three Americans at high risk for type 2 diabetes, emphasis must be placed on prevention and lifestyle modifications that can delay or prevent type 2 diabetes, a debilitating disease that can lead to blindness, kidney failure, heart disease and death.

“We’ve seen that diabetes has been on the rise for quite a while, but the new data from the CDC is a real wake-up call. One in four Americans living with diabetes is still undiagnosed, highlighting how essential it is for Americans to know if they are at risk and take action, if needed,” said Robert R. Henry, MD, President, Medicine & Science, American Diabetes Association. “Let’s use these devastating new numbers as inspiration to work harder and stop diabetes in its tracks.”

Early diagnosis of type 2 diabetes is critical to successful treatment and delaying and preventing some of its complications. For many, diagnosis may come seven to ten years after the actual onset of diabetes, often only after patients have already started to show signs of one or more of its complications. Studies have shown that exercising 150 minutes a week and losing 7% of your body weight (about 15 pounds if you weigh 200 pounds), can prevent or delay type 2 diabetes by 57%.

The American Diabetes Association offers tips to help prevent or delay the development of type 2 diabetes and its complications:

• Know Your Risk. There are certain risk factors you can’t change, including being over 45 years of age, a family history of diabetes, or coming from a certain family background (African American, American Indian, Asian American or Pacific Islander, or Hispanic/Latino). Other risk factors you can control include being overweight or inactive, eating an unhealthy diet, smoking, or having higher than normal blood glucose, blood pressure or cholesterol levels.
• Get a Check Up. Don’t wait until you get sick to see your health care provider. Schedule a complete evaluation to learn your numbers, including:
• Blood glucose – There are three different tests that measure blood glucose levels: A1C, Fasting Plasma Glucose (FPG) and Oral Glucose Tolerance Test (OGGT). These tests will determine if prediabetes or diabetes is present.
• Blood pressure level – A healthy blood pressure level is below 120/80. Early high blood pressure is between 120/80 and 140/90. High blood pressure is 140/90 and higher.
• Blood lipid levels – A blood lipid test measures HDL (good) cholesterol, LDL (bad) cholesterol) and triglycerides. To maintain optimal health, it is important to be aware of your lipid levels and to maintain low LDL cholesterol levels.
• Move Those Feet. Experts suggest exercising 30 minutes a day most days of the week. If exercising that long is intimidating at first, try walking 10 minutes most days of the week. Find other ways to be more active, such as taking the stairs and parking farther away.
• Sneak in Healthy Foods. Instead of making a complete lifestyle change, try incorporating one small change into your diet at a time. Choose lower-calorie snacks, eat a salad and a vegetable with dinner, or take home half of your main course when you eat out.

The American Diabetes Association offers free resources for those at risk for type 2 diabetes:

• My Health Advisor – Calculate your risk for type 2 diabetes and heart disease by entering some basic health information. After your risk is calculated, you can quickly and easily see the difference simple lifestyle changes — like losing 10 pounds or quitting smoking — can make in your overall risk.
• CheckUp America – Get in-depth information about the different risk factors associated with type 2 diabetes and what you can do to lower that risk.
• Center for Information and Community Support – By calling 800-DIABETES or chatting with a representative online, you can request free information in English and Spanish, including the new booklet Top 5 Ways to Stop Diabetes and Get Healthy Right Now!

Source:
American Diabetes Association
Diabetes From Medical News Today

http://www.medicalnewstoday.com

These findings in mice show that insulin becomes completely superfluous and its absence does not cause diabetes or any other abnormality when the actions of glucagon are suppressed. Glucagon, a hormone produced by the pancreas, prevents low blood sugar levels in healthy individuals. It causes high blood sugar in people with type 1 diabetes.

“We’ve all been brought up to think insulin is the all-powerful hormone without which life is impossible, but that isn’t the case,” said Dr. Roger Unger, professor of internal medicine and senior author of the study appearing online and in the February issue of Diabetes. “If diabetes is defined as restoration of glucose homeostasis to normal, then this treatment can perhaps be considered very close to a ‘cure.’ ”

Insulin treatment has been the gold standard for type 1 diabetes (insulin-dependent diabetes) in humans since its discovery in 1922. But even optimal regulation of type 1 diabetes with insulin alone cannot restore normal glucose tolerance. These new findings demonstrate that the elimination of glucagon action restores glucose tolerance to normal.

Normally, glucagon is released when the glucose, or sugar, level in the blood is low. In insulin deficiency, however, glucagon levels are inappropriately high and cause the liver to release excessive amounts of glucose into the bloodstream. This action is opposed by insulin, which directs the body’s cells to remove sugar from the bloodstream.

Dr. Unger’s laboratory research previously found that insulin’s benefit resulted from its suppression of glucagon.

In type 1 diabetes, which affects about 1 million people in the U.S., the pancreatic islet cells that produce insulin are destroyed. As a countermeasure to this destruction, type 1 diabetics currently must take insulin multiple times a day to metabolize blood sugar, regulate blood-sugar levels and prevent diabetic coma. They also must adhere to strict dietary restrictions.

In this study, UT Southwestern scientists tested how mice genetically altered to lack working glucagon receptors responded to an oral glucose tolerance test. The test – which can be used to diagnose diabetes, gestational diabetes and prediabetes – measures the body’s ability to metabolize, or clear, glucose from the bloodstream.

The researchers found that the mice with normal insulin production but without functioning glucagon receptors responded normally to the test. The mice also responded normally when their insulin-producing beta cells were destroyed. The mice had no insulin or glucagon action, but they did not develop diabetes.

“These findings suggest that if there is no glucagon, it doesn’t matter if you don’t have insulin,” said Dr. Unger, who is also a physician at the Dallas VA Medical Center. “This does not mean insulin is unimportant. It is essential for normal growth and development from neonatal to adulthood. But in adulthood, at least with respect to glucose metabolism, the role of insulin is to control glucagon.

“And if you don’t have glucagon, then you don’t need insulin.”

Dr. Young Lee, assistant professor of internal medicine at UT Southwestern and lead author of the study, said the next step is to determine the mechanism behind this result.

“Hopefully, these findings will someday help those with type 1 diabetes,” Dr. Lee said. “If we can find a way to block the actions of glucagon in humans, then maybe we can minimize the need for insulin therapy.”

Dr. Unger said anything that reduces the need for injected insulin is a positive.

“Matching the high insulin levels needed to reach glucagon cells with insulin injections is possible only with amounts that are excessive for other tissues,” he said. “Peripherally injected insulin cannot accurately duplicate the normal process by which the body produces and distributes insulin. If these latest findings were to work in humans, injected insulin would no longer be necessary for people with type 1 diabetes.”

Dr. May-Yun Wang, assistant professor of internal medicine at UT Southwestern, and researchers from the Albert Einstein College of Medicine also contributed to the work.

The study was supported in part by the VA North Texas Health Care System, the American Diabetes Association and the National Institutes of Health.

Source:
UT Southwestern Medical Center

Diabetes From Medical News Today

http://www.medicalnewstoday.com/articles/214912.php

“The majority of diabetics will over time develop severe or fatal complications, but 10 – 15 per cent never do. They are the ones we are interested in in the PROLONG study”, explains Valeriya Lyssenko, who along with Peter Nilsson, both from Lund University Diabetes Centre, leads the PROLONG study.

Stiff sugary arteries:

Despite decades of intensive research on diabetes complications, the fundamental mechanisms are not yet fully known. Neither is it possible to prevent or treat the damage to the blood vessels that affects the majority of diabetics.

The risk of dying from cardiovascular disease is two to three times higher for diabetics than for non-diabetics. The small blood vessels are also damaged. After only ten years with diabetes, 70 per cent of patients will have some form of kidney damage that may progress to kidney failure. As many suffer from eye complications some will develop severe visual impairment and two per cent will become blind.

“The blood vessels and other organs of the body become sugar coated and stiff. It is reminiscent of premature biological ageing”, says Peter Nilsson.

Half of the veterans:

Perhaps nature itself can answer the question of why some patients are protected. This is what the PROLONG study will investigate.

Today there are approximately 12 000 people in Sweden who have had diabetes for more than 30 years; of these, 1 600 have had it for over 50 years.

“About half of these diabetic veterans do not have major complications. Two thirds of those who have had diabetes for more than 50 years have escaped complications. Clearly they are different and we want to find out what it is that protects them”, says Valeriya Lyssenko.

Greatest risk passed after 30 years:

The PROLONG study is starting now in Skåne with a pilot study of patients with diabetes duration of more than 30 years. At a later stage patients will be recruited from all hospitals and health care centres in Sweden. They will be compared with diabetics who have already developed severe complications despite having had diabetes for less than 15 years.

The 30-year limit has been chosen because a person who has had diabetes for such a long time without developing complications is unlikely to do so later in life.

Copying nature’s protective mechanisms:

Participants in the PROLONG study will answer questions about their lifestyle and about diseases they, or their closest relatives, may have. Various blood samples, including genetic tests, will be analysed, and close relatives of the participants will also be invited to take part in the study.

“If we can identify factors protecting these veterans from devastating complications, then it might be possible to develop drugs that can do the same thing”, says Valeriya Lyssenko.

“I have dreamt of performing a study like this for a long time”, adds Peter Nilsson.

PROLONG stands for PROtective genes in diabetes and LONGevity

Major diabetic complications include kidney disease (nephropathy), eye damage (retinopathy), heart attacks and stroke.

Sources: Lund University, AlphaGalileo Foundation.

Diabetes From Medical News Today

http://www.medicalnewstoday.com/articles/214485.php

For many Canadians living with diabetes, regular blood glucose monitoring, as recommended by their healthcare professional, is a key part of their daily diabetes management and can help prevent or delay serious complications. However, the majority of people living with diabetes sometimes experience uncertainty between their blood glucose readings and how they feel.1 According to a recent survey, while 82 per cent of Canadians living with diabetes feel that the readings on their meters are accurate, 40 per cent said they sometimes test their blood sugar levels twice in one sitting to make sure the readings are accurate.

Canadians living with diabetes can feel assured in their blood glucose readings with the new OneTouch® UltraMini® Meter with SmartCode25™, which provides an effortless way to keep their meter calibrated for accuracy by eliminating the need for manual coding.

“While blood glucose readings are essential for patients on insulin to provide critical information for accurate dose adjustment, patients on oral medications may still benefit enormously from identifying the impact food, exercise and stress can have on their blood glucose levels,” says Dr. Andrew Farquhar, a family physician in Kelowna, British Columbia and consultant to LifeScan. “The new OneTouch® UltraMini® Meter with SmartCode25™ keeps the meter calibrated for accuracy while removing the need for manual coding so patients can still feel confident in their results.”

The new OneTouch® UltraMini® Meter with SmartCode25(TM) works with the OneTouch® Ultra® Blue Test Strips, the only test strip with DoubleSure® Technology that automatically checks each sample twice to confirm the result. All OneTouch® Ultra® Blue Test Strips are also manufactured to a single calibration code, Code25. Since the new OneTouch® UltraMini® Meter with SmartCode25™ is locked to Code25 at manufacturing, there is no need to manually code the meter. The new OneTouch® UltraMini® with SmartCode25™ is also small and portable, features a large, easy-to-read screen, and provides accurate results in just five seconds. People living with diabetes can find out more about the new OneTouch® UltraMini® Meter with SmartCode25(TM) by talking to their pharmacist or healthcare professional and by visiting here.

The Canadian Diabetes Association (CDA) recommends that people with type 1 diabetes check their blood glucose at least three times a day, and those with type 2 diabetes on an oral medication or insulin check at least once a day as part of a diabetes management plan.2 People living with diabetes should always speak to their healthcare professional about the best diabetes management plan to fit their individual needs.

If left untreated or improperly managed, diabetes can result in a variety of complications, including: heart disease, kidney disease, eye disease and nerve damage.3

References

1. Leger Marketing. Diabetes Study. April 1, 2010.
2. Canadian Diabetes Association. Canadian Diabetes Association 2008 Clinical Practice Guidelines. Available here. Accessed on December 14, 2010.
3. Canadian Diabetes Association. Diabetes Facts. Available here. Accessed on December 14, 2010.

Source:
LifeScan Canada Ltd.

Diabetes From Medical News Today

http://www.medicalnewstoday.com/articles/213974.php

Diabetes Forecast, the consumer magazine of the American Diabetes Association, has published its annual Consumer Guide in its January issue. The number of products on the market can be overwhelming, so Diabetes Forecast seeks to help people with diabetes select the ones that best meet their needs. Highlights from this comprehensive guide to diabetes management products include:

• On the Horizon — Smaller insulin pumps; a tool to turn an iPhone into a glucose meter; a new inhaled insulin; and the most notable cutting-edge technologies coming down the pike.
• Blood Glucose Meters — A complete guide to virtually every meter on the market today, plus everything you need to know about coding, data storage, blood sample sizes, temperature limitations, lancing devices, and more.
• Continuous Glucose Monitors — In-depth, side-by-side comparisons of all four CGMs on the market, plus a list of key functions to consider.
• Insulin Pumps and Infusion Sets — In-depth, side-by-side comparisons of all three pumps currently available, plus what to consider when choosing a pump and infusion set.
• Insulin Pens — An at-a-glance guide to every pen available, with listings of crucial features.
• Online-only listings of diabetes medications and insulins.

There’s more in the January issue. What’s new in healthy living: type 2 diabetes in children, new guidelines for diagnosing gestational diabetes, the latest on calcium and vitamin D, and more. Plus: How to Perfect Your Pasta, a step-by-step illustrated guide to nutritious pasta dishes, with recipes for healthy takes on favorite sauces.

Source:
American Diabetes Association

Diabetes From Medical News Today

http://www.medicalnewstoday.com/articles/212700.php