Archive for the Diabetes News

Does Gastric Banding Help Overweight People With Type 2 Diabetes?

written by Michael O’Leary

While the evidence showing that weight-loss surgery can halt type 2 diabetes in obese people grows, less is known about whether such a drastic intervention might also benefit people who are overweight, but not obese.  (The difference between overweight and obese is a technical one.  Obese refers to people with a body mass index of over 30.  Overweight refers to people with a body mass index between 25 and 29.9.  To calculate your own BMI, visit this link on the NIH website.)

In the first such study designed to make the case for bariatric surgery as treatment for type 2 diabetes in overweight people, Australian researchers compared outcomes in 25 people with a BMI of 25 to 30 treated with gastric band surgery and standard care with 25 similar people treated with standard care alone.

The researchers, led by Emeritus Professor Paul O’Brien and Dr John Wentworth from the Centre for Obesity Research and Education (CORE) at Manash University in Victoria, Australia, followed both groups for two years, and documented blood sugar control during that time. They published their findings in the April 8, 2014 The Lancet Diabetes & Endocrinology.

The gastric surgery consisted of minimally invasive laparoscopic surgery, sometimes called keyhole surgery due to the small incisions needed for the procedure, and placement of an adjustable band around the neck of the stomach to restrict food intake.

After two years, 12 (52 percent) of those in the gastric surgery group had their diabetes in remission, compared to two (8 percent) of those in the standard care group. In addition, the results showed a strong link between the amount of weight loss and the amount of diabetes control. The more weight loss the greater the reduction in diabetes.

One person in the surgery group needed a second surgery due to complications and four others needed adjustments to the gastric band that was too restrictive and made it difficult to eat.

It is a small study, but it is among the first to test such surgery in people who are not obese and normally don’t qualify for such surgery for weight-loss purposes. The researchers concluded that their study shows that weight-loss such as achieved with gastric banding should be given higher priority as a means of treating type 2 diabetes.

Nevertheless, It will require testing in many more people who are only overweight before weight-loss surgery wins FDA approval in the US for treatment of type 2 diabetes.

Talk to the Hand to Control Diabetes

by Michael O’Leary

In a variation on an old joke, family medicine experts at Tufts University are urging doctors to “talk with the hand,” as an easy-to-remember approach to illustrating treatment goals for patients with type 2 diabetes.

In an editorial in the February issue of American Family Physician, Allen Shaughnessy, PharmD and professor of family medicine, says that a simple use of one’s hand is an effective way to communicate with patients about the treatment priorities for type 2 diabetes.

“Glycemic control is stuck in people’s minds as the primary goal of treatment, but evidence has existed since the 1970s that other interventions are of greater benefit,” Shaughnessy said in a press release. “Some degree of glycemic control is necessary to prevent symptoms. It’s just that the return on investment is low when we try to push patients with diabetes to get their blood glucose as close as possible to normal.”

Using his hand, he demonstrates the descending order of priorities for intervention starting with the thumb as the highest priority and ending with the pinky relative to improving length and quality of life for those living with type 2 diabetes. The list includes:

  1. Stop smoking
  2. Control blood pressure
  3. Metformin therapy
  4. Lowering cholesterol
  5. Controlling blood sugar

“Our aim in proposing the ‘lending a hand’ is to communicate the most beneficial interventions patients can make to reduce their symptoms and risk of death from diabetes complications,” said co-author Deborah Erlich, M.D., M.Med.Ed., “But this model requires a shift in thinking away from the outdated idea that glucose reduction is most important, which may be a challenge.”

According to the National Diabetes Information Clearinghouse, diabetes is a major cause of heart disease and stroke and the leading cause of new cases of blindness among adults.

Can Low-Fat Yogurt Help Prevent Diabetes?

by Michael O’Leary

It is always nice when the foods we like turn out to be good for us. That seems to be the case this week for yogurt. We eat a lot of yogurt in this country, according to the Agricultural Marketing Resource Center, Americans consume about 12 pounds of yogurt a year, which is much less than the 63 pounds per year consumed in Sweden, but still a lot of fermented dairy product.

A British study this week showed that consuming low-fat yogurt reduced the risk of developing type 2 diabetes by 28 percent compared to consuming no yogurt. The researchers published their results in Diabetologia (the journal of the European Association for the Study of Diabetes).

Actually the researchers led by Dr. Nita Forouhi of the University of Cambridge found that overall consumption of dairy products did not affect the risk of type 2 diabetes, but when they looked at fermented dairy products, there was an inverse link between consumption and diabetes risk. In other words the more yogurt consumed, the lower the risk of type 2 diabetes among those studied.

“At a time when we have a lot of other evidence that consuming high amounts of certain foods, such as added sugars and sugary drinks, is bad for our health,” Forouhi said in a press release,  “it is very reassuring to have messages about other foods like yogurt and low-fat fermented dairy products, that could be good for our health.”

The study analyzed a subset of 4,127 of the more than 25,000 people living in Norfolk, UK who kept food diaries as part of participating in the large EPIC-Norfolk study. This allowed the researchers to assess the risk of diabetes in relation to the consumption of total dairy product consumption and also consumption of different types of dairy products. They compared the dietary records of 753 people who developed new-onset type 2 diabetes over 11 years of follow-up, with 3,502 randomly selected study participants.

They found that while total milk and cheese intakes were not associated with diabetes risk, those with the highest consumption of low-fat fermented dairy products (such as yogurt, fromage frais (cream cheese) and low-fat cottage cheese were 24 percent less likely to develop type 2 diabetes over the 11 years, compared with non-consumers.

When they separated out yogurt from the other low-fat fermented dairy products, they found that those who consumed more than four 5 ounce cups of low-fat yogurt a week had a 28 per cent reduced risk of developing diabetes. (Food weights were estimated using photographs representing portion sizes.)

The researchers caution that this type of study cannot prove that eating dairy products reduces diabetes risk, but they note that dairy products do contain beneficial nutrients and yogurt contains probiotic bacteria and a special form of vitamin K associated with fermentation.

For the record, the researchers received their funding from the Medical Research Council and the Cancer Research UK, which are similar to the National Institutes of Health and the American Cancer Society, and had no ties to the dairy industry.

Eating More Berries May Cut Type 2 Diabetes Risk

by Michael O’Leary

Consuming lots of berries, vegetables, and of course our favorites, chocolate and wine can protect against type 2 diabetes, a new study shows.

Past studies have shown those foods protect against stroke, heart failure, and cancer. Most of those studies, however looked at the compounds called flavonoids, which form a large family of antioxidant-containing substances.

In a British study appearing online Jan. 20 ahead of Feb. 1, print publication in the Journal of Nutrition, researchers looked at a specific subset of flavonoids, called flavones and anthocyanins. Okay, the chemistry is complicated, but foods high in flavones include herbs and vegetables such as parsley, thyme, and celery. Anthocyanins include berries, red grapes, wine and red or blue-colored fruits and vegetables.

Aedin Cassidy from the University of East Anglia Norwich Medical School led the study of 2,000 healthy women who had completed a food questionnaire designed to estimate total dietary flavonoid intake as well as intakes from six flavonoid subclasses.

Aedin Cassidy With Her Favorite Food

Aedin Cassidy With Her Favorite Food

“This is one of the first large-scale human studies to look at how these powerful bioactive compounds might reduce the risk of diabetes,” Cassidy said in a press release. “Laboratory studies have shown these types of foods might modulate blood glucose regulation – affecting the risk of type 2 diabetes. But until now little has been known about how habitual intakes might affect insulin resistance, blood glucose regulation and inflammation in humans.”

The researchers analyzed blood samples from the women for evidence of both glucose regulation and inflammation. Insulin resistance was assessed using an equation that considered both fasting insulin and blood sugar levels.

“We found that those who consumed plenty of anthocyanins and flavones had lower insulin resistance,” she said. “High insulin resistance is associated with type 2 diabetes, so what we are seeing is that people who eat foods rich in these two compounds – such as berries, herbs, red grapes, wine– are less likely to develop the disease. We also found that those who ate the most anthocyanins were least likely to suffer chronic inflammation – which is associated with many of today’s most pressing health concerns including diabetes, obesity, cardiovascular disease, and cancer.”

The study authors cautioned that the study only showed an association, not cause and effect, nor does it provide any information about how much of these foods need to be consumed to obtain a benefit. Also unclear is how much of a health benefit the compounds really carry.

Cassidy’s team is now seeking men and postmenopausal women to help investigate whether blueberries can improve health linked to heart disease and diabetes. The six-month research study will test if daily consumption of one or two portions of freeze-dried blueberries improves heart health and insulin action in people with metabolic syndrome – a condition characterized by a larger waistline and raised blood sugar, blood fats and blood pressure.

Can Cinnamon Help Prevent Diabetes?

by Michael O’Leary

If you are among the 1 in 4 Americans considered to have prediabetes, you might want to think about increasing your cinnamon consumption. That’s the conclusion of an analysis of several studies of cinnamon and type 2 diabetes in the Journal of Medicinal Food.

Long considered a therapeutic plant, cinnamon is made from the bark of trees grown in China and throughout Southeast Asia. A number of studies have been conducted over the years looking at a variety of potential health benefits of cinnamon.

Paul Davis, a research nutritionist at the University of California Davis compiled the data from eight of these studies, including three new studies and looked at the effect on fasting blood glucose (FBG) in people at risk for type 2 diabetes.

He found that cinnamon intake was associated with a modest reduction in FBG.

“According to our results, it’s a modest effect of about 3 to 5 percent,” Davis told NPR news. This is about the level of reduction found in the older generation of diabetes drugs, he says.

While that isn’t enough to substitute for medications in people with type 2 diabetes, it may be worth considering for the millions of Americans with prediabetes. It isn’t likely to hurt and it could help, plus it tastes good.

There are two cautions for the study. It doesn’t answer the question of what is the optimal amount of cinnamon needed to lower blood sugar in a person with prediabetes, the other is what type of cinnamon is best.

There are many varieties and the most common variety found in your local grocery store is likely to be cassia contains high levels of coumarin, which can cause liver damage when consumed in large quantities in some people who are sensitive to coumarin.

How much is too much? The European Food Safety Authority says that a teaspoon of coumarin a day is the limit. How much coumarin is in a teaspoon of cinnamon is considerably lower than that.

To be safer, the variety Ceylon cinnamon contains very low levels of coumarin but it is more expensive.

Should People With Diabetes Drink Coffee?

by Michael O’Leary

Sometimes it seems as if scientific research is a little like the childhood daisy rhyme, “she loves me, she loves me not,” repeated as petals of the daisy are picked off. So many things are first thought to be good for you, then a new study shows not so much.

That has been the history of research into coffee and health, some studies show health benefits of coffee consumption and just as you pour that second cup, another study shows the opposite. Part of the reason for this, as Harvard nutrition researcher Dr. Rob van Dam explains, is that a simple cup of coffee is anything but simple.

So it is not surprising that people greeted the news about a Chinese study showing coffee consumption might reduce the incidence of type 2 diabetes with a bit of skepticism.

Still, the study published in the Euroean Journal of Nutrition is worth a look. The researchers from the Department of Epidemiology and Health Statistics, Medical College, Qingdao University, analyzed data from 42 studies involving nearly 2 million participants.

Twenty-six of the studies examined the levels of coffee intake. Another 10 studies looked at decaffeinated coffee intake, and six studies looked at caffeine intake.

What they found was that coffee intake was associated with a lower incidence of type 2 diabetes, especially among non-smokers and people who were not overweight (BMI less than 25).

When they did a dose-response analysis, they found that the beneficial effect increased with increased caffeine consumption. They wrote that type 2 diabetes decreased by 12 percent for every two cups of coffee per day, and that incidence of type 2 diabetes declined by 11 percent for every 2 cups of decaf consumed, but declined by 14 percent for every 200 mg/day of caffeine intake.

The amount of caffeine in coffee varies widely, but your average 16 oz. Starbucks contains 150 mg to 300 mg.

While the biological mechanism for caffeine’s beneficial effect on type 2 diabetes is unknown, a Singapore study last year showed that a compound called chlorogenic acid (CGA) may be part of the answer.

You can bet more coffee and type 2 diabetes studies are underway, so you might as well enjoy another cup of coffee until the next study is published.

Is Skipping Breakfast a Good Idea for Type 2 Diabetes?

written by Michael O’Leary

Could you skip breakfast and eat a large midday meal instead to get better control of your blood sugar?

That’s what a group of Swedish researchers wanted to know. They compared consuming a large Mediterranean style lunch with low-fat and low-carb meals among people with type 2 diabetes.

The Mediterranean diet, which the International Diabetes Federation says emphasizes fruit, vegetables, beans, legumes, and nuts, has been credited with lowering heart disease, improving mental function and increasing life span among the obese, according to the Mayo Clinic.

“It is surprising how often one today refers to the usefulness of the so-called Mediterranean diet but forgets that it also traditionally meant the absence of a breakfast,” Professor Fredrik Nystrom principal investigator of the study said in a press release.

The small study of 19 people with type 2 diabetes published Nov. 27, 2013 in PLoS One, showed that after factoring in the number of calories consumed, a single large midday Mediterranean style meal produced a lower post-meal spike in blood sugar than either a low-fat or low-carb diet.

“This suggests that it is favorable to have a large meal instead of several smaller meals when you have diabetes,” says Nystrom. “Our results give reason to reconsider both nutritional composition and meal arrangements for patients with diabetes.”

The researchers at Linköping Universitet compared the three diets using a method, called a crossover study, in which each of the participants tested all three of the diets in random order during the study period.

The low-fat diet derived 55 percent of the total energy from carbohydrates, while the low-carbohydrate diet derived about 50 percent of total energy from fat and 20 percent from carbohydrates.

The Mediterranean diet was composed of only a cup of black coffee for breakfast, and with all the caloric content corresponding to breakfast and lunch during the other two test days accumulated to one large lunch consumed with a glass of red wine. The energy content from carbohydrates was in between the low-fat and the low-carbohydrate meals, and sources of fat were mainly olives and fatty fish.

Participants waited between one day and up to three weeks between switching diets. Blood tests were performed before and after each meal along with other tests for lipids and hormones. The results were published in the open access journal PLoS One (Public Library of Science) journal.

The results showed that even with double the calories consumed, the Mediterranean meal produced a blood sugar level that was on par with the low-fat meal. While the low-carb diet produced the lowest post meal increase in blood sugar it produced higher levels of triglycerides.

The researchers concluded that this suggests that accumulation of caloric intake from breakfast and lunch into a single large Mediterranean style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

“Our results give reason to reconsider both nutritional composition and meal arrangements for patients with diabetes,” Nystrom said.

CONQUERing Type 2 Diabetes: The SEQUEL

If you are overweight and your doctor has told you that you are at risk for type-2 diabetes, you might avoid getting the disease with the help of a new drug, and of course diet and exercise, or at least, you might have a better chance of avoiding the disease than if you do nothing.

Qsymia (KYOO-see-me-a) was the drug used in an extension of the CONQUER trial that had already shown that the drug was better than placebo for weight-reduction. Qsymia is a combination drug that includes phentermine and topiramate, and was developed by VIVUS a biopharmaceutical company in Mountain View, Calif.

In the CONQUER trial of 2,487 people, those who took a low-dose of the drug lost an average of almost 18 pounds in a little more than a year, while those in the higher dose group lost and average of 22 pounds compared to an average weight-loss of almost 2.5 pounds for the placebo group.

To see if the amount of weight reduction might also reduce the number of those patients who go on to actually be diagnosed with type 2 diabetes, the researchers, led by Tim Garvey, MD of the University of Alabama, Birmingham, AL, conducted an second trial using a subgroup of those in the CONQUER trial.

Called the SEQUEL trial, the researchers continued to follow those participants from centers that had shown high enrollment and retained their participants. In other words they only included those who were highly motivated and likely to stick with the study to the end.

That turned out to be 475 people with prediabetes, metabolic syndrome, or both. Metabolic syndrome is a combination of disorders that puts a person at risk of heart disease and diabetes. They followed these folks for another two years and published the results online Oct. 8, 2013, in Diabetes Care.

In addition to maintaining its weight-loss advantage over placebo, Qsymia reduced the risk of being diagnosed with type 2. A total of 6.1 percent of the placebo group went on to be diagnosed with type 2 diabetes, while 1.8 percent of the low-dose and 1.3 percent of the high-dose group were diagnosed with type 2 by the end of the two years. That works out to a 70.5 percent reduction in risk in the low-dose group, and a nearly 79 percent reduction in risk for the high-dose group compared to the placebo group.

The only problem with Qsymia, however, is that motivation factor, not just on the part of patients being willing to stick with the regimen, but on the part of their doctors in prescribing it.

As reported by MedPage Today, the FDA requires the doctor to perform a risk evaluation and mitigation strategy (REMS) before prescribing the drug. That means the doctor must complete an online training module and maintain more paperwork, all of which takes time.

On top of that some doctors may hesitate to prescribe a drug that contains phentermine, one of the ingredients in the infamous FEN-PHEN weight-loss drug linked to heart valve problems years ago. That is despite studies showing that the harmful effects were caused by the FEN (fenfluramine) half of the drug, not the phentermine half.

If you can overcome the obstacles, the researchers are optimistic that Qsymia might be useful for overweight people at risk for type 2 diabetes who want to avoid progressing to diabetes.

Does Metformin Help Decrease Chances of Prostate Cancer?

written by Michael O’Leary

Metformin may be the aspirin of type 2 diabetes. It just seems as if the benefits of metformin therapy seem to grow the more researchers study it.

A case in point is new study published online last week in the Journal of Clinical Oncology.  It showed that men with type 2 diabetes and prostate cancer lived longer and were much less likely to die of prostate cancer when treated with metformin.

This was a retrospective study, meaning they analyzed information already collected for other reasons and stored in a database. In this case the researchers searched the Ontario Diabetes Database to identify all men 66 years or older who had been diagnosed with diabetes between 1997 and 2008. They then cross-referenced those with men diagnosed with prostate cancer after being diagnosed with type 2 diabetes.

The result of those searches produced a study group of 3,837 with a median age of 75 at the time of being diagnosed with prostate cancer. A total of 976 patients had high-grade, aggressive tumors at diagnosis, and 2,167 had high-volume tumors (greater than 30 percent). During the study period 1,343 died, and 291 of those died of prostate cancer.

When they analyzed multiple variables they found that for each six months of taking metformin, there was a 24 percent reduction in prostate cancer deaths as compared to men who did not take metformin. That result remained regardless of they type of prostate cancer treatment the men underwent.

When they looked at all causes of death there was a 24 percent reduction in prostate cancer deaths during the first six months of treatment with metformin, but that effect gradually diminished to a 7 percent reduction in dying from all cancer for those who took metformin for 24 to 30 months.

For the 850 men who took metformin alone for their diabetes, the risk of dying of prostate cancer was 44 percent lower and the risk of dying from all causes was 20 percent lower.

While this is an observational study with many limitations, it adds to the many studies showing metformin directly or indirectly affecting cancer cells ability to grow and reproduce, in other cancers including breast, prostate, lung, and endometrial cancer.

Is Oral Insulin on the Way?

written by Michael O’Leary

Two companies announced clinical trials in the last three weeks aimed at bringing insulin taken by mouth to market.

Generex Biotechnology Corporation announced at the end of January results of a phase III clinical trial showing that its oral insulin spray Oral-lyn™ is as effective as subcutaneously injected regular insulin. The 12-week study conducted by an Indian licensee of Generex involved 209 men and women with type 2 diabetes at 14 clinics in India who did not have well controlled blood sugar levels with oral diabetic drugs.

While the Indian company that conducted the trial released few details of the study results, it advised the drug’s maker, Generex, that it had submitted the study results to Indian drug approval agencies and expected it to be approved this summer. The drug comes in an inhaler, much like asthma drugs, and is delivered in a metered spray through the mouth.

Last week Israeli company Oramed Pharmaceuticals reported that it is ready to launch a phase II clinical trial that it hopes will take it one step closer to putting its oral capsule on the market for people with type 2 diabetes.  The study will be conducted at 12 clinical sites in the U.S. and will enroll close to 150 people.

Scientists have been searching for a way to administer oral insulin for more than 100 years. The difficulty is that stomach acid breaks down the insulin making it unusable by the body, and the intestines block absorption of large molecules such as insulin. Inhaled insulin has been tried, but early versions met with an increased risk of lung cancer.

Generex and Oramed have overcome these limitations by changing the delivery route of the insulin.

Oramed’s capsule overcomes the dual obstacles of stomach acid and molecule size with a special capsule coating that protects the insulin through the esophagus and stomach, and into the intestines. There the capsule breaks down and releases the insulin along with an absorption enhancer that transports the insulin protein across the intestinal membrane. Once across the membrane, the insulin travels through the blood directly to the liver where it is used like natural insulin.

In Generex’s case while it is sprayed into the mouth, it is not inhaled. Instead it is absorbed into the blood stream through the mucous membrane in the mouth.

A number of other companies with a variety of delivery strategies are all racing to get oral insulin tested and approved. Until recently most experts doubted an oral insulin could be achieved. Now, as Oramed CEO Nadav Kidron, said in an interview with Israeli magazine 21c, it is no longer a question of if, but when.

“When they initiated this project almost 30 years ago at Hadassah (University in Israel), trying to get insulin delivered orally looked almost impossible,” says Kidron. “Today it’s just a matter of time till it’s on the market.”