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DATE: December 31, 2004

Hong Kong's best weapon in fighting the city's burgeoning diabetes epidemic could be its traditional Cantonese cuisine, a diabetes expert said this past week.

A healthy diet and regular exercise are the only exhaustive measures for preventing diabetes, which today claims 10 times as many victims in Hong Kong and China as it did 30 years ago, said Jeffrey Bland, a Washington state-based biochemist and nutritionist. However, instead of a stringent diet regime, a regular meal of leafy choi sum, stir-fried chicken, and steamed rice could be enough.

"People need to stop saying we should eat like Americans and view that as a sign of success. Asian eating patterns for years were just right," Bland said. "They lacked all the false sweeteners and fats. China and Hong Kong have thrown away a lot of what was good as they've started eating like Westerners." An emergence of a Western lifestyle in Hong Kong and China is the root cause of the disease's growth here, Bland said. As the region has prospered, more people are choosing quick, unhealthy foods over home-cooked meals.

Fast foods, microwave dinners, and soft-drinks as well as a sedentary lifestyle all impair the cell's ability to process insulin, leading to Type II diabetes _ the particular strain of disease menacing Hong Kong and China. "When China had a biking lifestyle, the exercise mode prevented diabetes. Those who exercise regularly have more than a 50 per cent less chance of getting diabetes," Bland said.

"All the large national data in Asia as well as the United States shows there are fewer meals being prepared from home. We are raising a real generation of youth that don't have any familiarity with cooking." People with Type II diabetes are more likely to have strokes, coronary heart disease, some cancers, and even dementia, said Bland. "Everyone who is in public health is deathly afraid of what this means for this generation of children. As they grow up, they will have a host of other associated diseases," he insisted. "It will put such a burden on health care systems they won't be able to pay for it." Bland's rubric for good diet is one rich in "colored foods", like fruits and vegetables, and other fresh meats and legumes. He recently visited Hong Kong as the guest of honor for an event sponsored by a for-profit group promoting health care products in China and Hong Kong.

DATE: December 24, 2004

A drug that helps people quit smoking also helps them prevent the excess weight gain that often plagues ex-smokers, according to research released at the North American Association for the Study of Obesity (NAASO) Annual Scientific Meeting.

Rimonabant, developed for the treatment of cardiovascular risk factors, nearly doubles a person's chances of successful smoking abstinence while avoiding post-cessation weight gain, according to results of the first of 3 phase 3 trials. At the end of the 10-week treatment phase of this randomized, double-blind, placebo-controlled trial, almost 28% of subjects who took 20 mg per day of the drug by mouth had stopped smoking for at least 1 month compared to 16% of those who took placebo. Those who stopped smoking on rimonabant gained only about 1 pound compared to the approximate 6-pound weight gain seen in the placebo-treated subjects who stopped smoking.

The greatest amount of weight loss on rimonabant was seen in those who weighed the most at baseline. Normal-weight subjects did not lose weight but were able to maintain their baseline weights on rimonabant. Subjects in the study smoked 10 or more cigarettes per day, with a mean age of 42 years. Results were the same for both men and women.

Both smoking and obesity are considered major risk factors for heart disease, which is the leading killer of people with diabetes.

"Gaining weight is a serious obstacle for many people who would like to quit smoking," said lead researcher Lowell C. Dale, MD, associate professor of medicine, Mayo Clinic College of Medicine, associate director, Mayo Clinic Nicotine Dependence Center. "A lot of people give up and go back to smoking as soon as they start to put on those extra pounds. This is the first drug that allows them to focus on quitting without being distracted by worries of trading one health problem for another."

These are the initial results of the first of three large clinical trials studying the use of rimonabant for smoking cessation. Long-term outcomes of this trial and the results of the other 2 trials are still pending. All of these results will be presented to the U.S. Food and Drug Administration as part of the extensive approval process necessary before any drug goes to market. Estimates are that the drug could be available by early 2006.

The study was presented as part of a joint effort by NAASO and the American Diabetes Association (ADA) to increase awareness of the rising problem of obesity and its related health problems in the United States. NAASO and ADA recognize obesity as a significant threat to public health and are cooperating to provide further opportunities for sharing obesity information, increasing obesity awareness and facilitating more research and better clinical care in their joint effort to fight this disease.

The North American Association for the Study of Obesity is a scientific society dedicated to the study of obesity and committed to encouraging research on the causes, treatment and prevention of obesity as well as to keeping the scientific community and public informed of new advances in the field.

The American Diabetes Association is the nation's leading voluntary health organization supporting diabetes research, information, and advocacy.

DATE: December 17, 2004

A promising vaccine against the worst form of diabetes will be tested on humans in Britain next year.

But experts cautioned that it might take a decade to put a dent in the diabetes epidemic in the U.S. and abroad. More than 18 million Americans have diabetes and nearly 1.3 million have Type 1, the most severe type, according to the American Diabetes Association. About 200,000 of them are kids, the ADA said.

Several dozen Type 1 sufferers already are signed up to take part in the trial starting in August. "If the principle works, we will then want to conduct a further 18-month full clinical trial," said Colin Dayan, a consultant senior lecturer at the University of Bristol.

The experimental vaccine, which has taken 10 years to develop, involves injecting a protein that stops the body from destroying the cells that produce insulin. Earlier trials with mice were successful.

Diabetes UK, a leading charity for diabetics, is supporting the trials being run by Bristol U and Kings College.

"A hundred years ago, Type 1 was a death sentence," said Georgina Slack, head of research at Diabetes UK. "Now we're seeing new approaches in research which are improving the chances of providing a cure. The prospect of finding a way of stopping the body from attacking itself is the holy grail of diabetes research."

Type 1 diabetes sufferers need daily injections of synthetic insulin because the pancreas stops producing its own version of the chemical. The more common Type 2 diabetes, which tends to affect the old and overweight, increasingly is seen in kids due to the rise in childhood obesity.

DATE: December 10, 2004

David Lewis knew he had diabetes. He just didn't do much about it. The disease was pretty easy to ignore, says Lewis, 33, of Maysville Ohio - at least until his blood sugar went out of control and he had to be hospitalized. He lost about 50 pounds in a few weeks. "It's bad stuff," he says. Lewis is one of nearly 3 million African-Americans - or about 11.4 percent of African-Americans 20 and older - with diabetes. The American Diabetes Association says about a third of people with the disease don't know they have it. African-Americans, Hispanics and other minorities are more likely to develop diabetes and its complications - cardiovascular disease, kidney failure, blindness and amputations - than whites. Around the nation, health experts are working to change those numbers through education, treatment and prevention efforts. Many factors put non-whites at greater risk for diabetes, says Dr. Barbara Ramlo-Halsted, a diabetes specialist and director of the University of Cincinnati's Diabetes Center at Jewish Hospital Professional Building in Avondale. "There's a significant genetic component, but environmental factors also play a huge role," Ramlo-Halsted says. Research shows that African-Americans, Hispanics, American Indians and Pacific Islanders are more likely to develop Type 2 diabetes - the kind linked to obesity - when exposed to a typical high-fat Western diet, she says. Trimming fats and sugars from the daily diet and increasing physical activity can go a long way toward preventing or controlling diabetes, Ramlo-Halsted says. For people with strong family ties, making the necessary lifestyle changes can be difficult - it's hard to explain why traditional family favorites are no longer being offered at Sunday dinner, she says. "I had one patient who was the matriarch of her family. Hers was the house where everybody went after church for dinner. And of course, she cooked all these comfort foods for her family. When she tried changing the recipes to make them healthier, they all left! They started going to another house where they did the cooking the right way," Ramlo-Halsted says. Staff at the Diabetes Center are developing outreach programs for churches, families and other groups in minority communities on the risks and consequences of diabetes, she says. The Crossroads Health Center in Over-the-Rhine Ohio, which serves mostly African-American and Hispanic clients, has been designated by the U.S. Bureau of Public Health as one of five community clinics nationally for a new diabetes collaborative. JoAnn Reilly, Crossroads' development director, says the project focuses on providing case management for patients who are diagnosed as diabetic. Staff also will work with community councils, church groups and businesses to raise awareness of diabetes, Reilly says. "The hope is there will be a reduction in the onset of diabetes and any of its complications," she says. The American Diabetes Association also targets information to African-American and Hispanic communities. Lewis, a patient at UC's Diabetes Center, takes care of himself now: He takes two medicines to control his blood sugar. He watches what he eats to limit sugars and carbohydrates and exercises. He checks his blood sugar four times a day. When he's tempted to backslide, he remembers one uncle who had to have a leg amputated because of diabetes and another who lost a few toes to the disease. "It's a lot of work, but it's worth it," he says.

Diabetes By The Numbers: African-Americans are 1.6 times more likely to have diabetes than non-Hispanic whites, and Hispanics are 1.5 times more likely to suffer type 2 diabetes than non-Hispanic whites. African-Americans are twice as likely to suffer from diabetes-related blindness among people with diabetes, and more than a third of Mexican Americans with diabetes have diabetic retinopathy, or abnormalities of small blood vessels in the eyes leading to blindness or vision loss. Source: American Diabetes Association <>Diabetes Study Recruiting Patients

The ACCORD study, funded by the National Institutes of Health, is looking at whether tightly controlling blood sugar levels among adults with diabetes reduces their risk of heart attack and stroke. Patients enrolled in the study will receive medication and follow-up at no charge. The study is enrolling people with Type 2 diabetes AND either high blood pressure or high cholesterol who are older than 40 and have had either a heart attack, stroke or blood vessel blockage or are between the age of 55 and 79. To learn more, call (513) 487-6062 or visit www.accordtrial.org

The Warning Signs of Diabetes:

• Fatigue
• Frequent urination
• Rapid and unexplained weight loss
• Nausea and vomiting
• Irritability and mood swings
• Extreme hunger
• Drowsiness
• Blurred vision
• Frequent or recurring skin, urinary tract and gum infections
• Slow healing of cuts or bruises
• Itching in the skin or genitals
• Tingling or numbness in the feet, legs or fingers

Source: Defeat Diabetes Foundation (http://www.defeatdiabetes.org)

DATE: November 26, 2004

People with diabetes who experience the pain associated with nerve damage (diabetic peripheral neuropathy) have a new treatment option--the first FDA-approved drug for managing the burning, tingling, and numbing sensations in the feet, legs, or hands that mark this condition.

The drug, Cymbalta (duloxetine), was recently approved for treating the condition, the most common complication of diabetes.

In clinical trials, people treated with Cymbalta reported less pain compared to those given an inactive substance (placebo). Fifty-eight percent of people treated with Cymbalta reported at least a 30 percent sustained reduction of pain. In comparison, 34 percent of people treated with a placebo reported sustained pain reduction. The most commonly reported side effects were nausea, dry mouth, constipation, and diarrhea. In some cases, patients experienced dizziness and hot flashes.

Cymbalta is manufactured by Eli Lilly and Company of Indianapolis.

DATE: November 19, 2004

November is American Diabetes Awareness Month. According to the Centers for Disease Control and Prevention, diabetes is the sixth deadliest disease in the United States, claiming the lives of more than 200,000 people each year. Approximately 90-95 percent of people living with diabetes have type 2, also known as adult onset, diabetes.

"The long term effects of diabetes can be devastating and potentially life-threatening," says Fouad R. Kandeel, M.D., Ph.D., director of the City of Hope Leslie & Susan Gonda (Goldschmied) Diabetes & Genetic Research Center in Los Angeles. "Damage to the eyes, nerves, kidneys and cardiovascular system are just some of the many problems that can result from the disease."

Although early detection and an awareness of the risk factors associated with type 2 diabetes can significantly increase the chances of successfully preventing or managing the disease, a third of the estimated 18.2 million Americans with diabetes remain undiagnosed. Those at highest risk for diabetes include:

• People over the age of 45;
• Those with a family history of diabetes;
• People who are overweight or do not exercise regularly;
• Women who develop gestational diabetes during pregnancy;
• People of African American, Latino, Native American or Asian decent; and
• Children who are overweight and in middle to late puberty.

For more information about diabetes research and treatment at the City of Hope Gonda Center, call 1-800-826-HOPE, or visit: www.cityofhope.org

DATE: November 12, 2004

After two years on a drug that affects the pleasure center of the brain, obese patients had reason to feel good: Their bellies shrank, their cholesterol improved and their insulin levels moved toward normal, according to research presented Tuesday in New Orleans.

In the trial, more than 3,000 patients lost an average of 19 pounds, including an important reduction of 3.1 inches on their waistlines, compared with a 5-pound weight loss in the placebo group. Central fat is the kind that is most associated with heart disease risk.

Results of the latest trial of the drug rimonabant, which works on certain receptors in brain cells, were presented at the American Heart Association's Scientific Sessions. A Milwaukee hospital will be conducting a new clinical trial of the drug beginning next month.

"It could be an exciting new player in obesity," said Robert Eckel, a physician and professor of physiology at the University of Colorado Health Sciences Center who was not associated with the study.

In addition to taking the drug or a placebo, patients in the clinical trial were instructed to cut food intake by 600 calories a day.

Along with the weight loss, their HDL cholesterol (the good kind) went up 24.5 percent, compared with a 13.8 percent increase in the placebo group, and triglycerides, an unhealthy type of fat in the blood, went down 9.9 percent, compared with 1.6 percent in the placebo group.

The patients also experienced a significant improvement in their ability to use insulin, which is important in preventing type 2 diabetes.

"This seems to be an encouraging drug for weight loss, in particular central fat," said lead author F. Xavier Pi-Sunyer, chief of the division of endocrinology at St. Luke's-Roosevelt Hospital at Columbia University.

The study, which is the third and largest trial of the drug, was sponsored by the drug's maker, Sanofi-Aventis. The company calls the drug Acomplia.

The drug appears to have a low level of side effects with no significant EKG or heart rate changes. It did have slightly higher rates of depression, anxiety and irritability than the placebo, Pi-Sunyer said.

About 13 percent of patients stopped taking the drug because of side effects, compared with about 7 percent in the placebo group.

Doctors not associated with the trial said they were encouraged that a new diet drug soon should be available in the battle against obesity, but they raised several concerns.

"What worries me is this may be an excuse to not go out and do what you are supposed to be doing in terms of lifestyle," said George Bakris, vice chairman of the department of preventive medicine at Rush University Medical Center in Chicago.

He also said he was concerned about the potential for the drug to cause depression.

"When you start interfering with that part of the brain, things can happen," Bakris said.

Others said that while the drug should be helpful, it is not the answer to the obesity epidemic.

"It is such a huge problem," said Robert Bonow, a professor of cardiology at the Northwestern University Feinberg School of Medicine. "Whether a single drug can be a cure-all is not clear."

Rimonabant is the first in a new class of drugs that target certain receptors on the surface of brain cells that are part of the endocannabinoid system, which helps regulate food intake and energy expenditure. In particular, the drug blocks the cannabinoid type 1 receptor, which is the same receptor that is active when people smoke marijuana and get hungry. The receptors also are found on the surface of fat cells.

People who overeat are believed to have an overactive cannabinoid system. The same system is active in cocaine use and smoking. Preliminary research suggests that rimonabant may help people quit smoking as well.

"It's that weird spot in the brain that makes you want to do bad things," said Dana Kappel, senior research coordinator and registered nurse with Cardiovascular Associates at St. Luke's Medical Center in Milwaukee.

The hospital plans to enroll about 10 people in a new study of the drug in December, she said. Researchers will be looking for people who are overweight, diabetic or who are smokers, and who have blockages in their coronary arteries. Once that is established, patients will be put on the drug for 18 months, and a repeat catheterization will be done to gauge whether the blockages have diminished.

Sanofi-Aventis plans to seek Food and Drug Administration approval for rimonabant in the second quarter of 2005, said Douglas Greene, a physician and vice president of corporate and medical affairs.

Greene acknowledged that other drug companies are developing their own compounds that work on the same brain receptors, but Sanofi-Aventis is the first to do clinical trials.

He said he did not know how much Acomplia would cost, but because obesity is now considered a health condition, insurance should pay for it.

"I think there is a strong rationale for this to be covered," Greene said. "It is like a statin (a cholesterol-lowering drug like Lipitor)."

(This news article is from the Milwaukee Journal Sentinel http://www.jsonline.com.)

DATE: November 05, 2004

Getting children with diabetes to prick themselves four times a day to check their blood sugar levels can be a challenge.

But doctors have found that if they turn the chore into a game involving a personal digital assistant, young patients will do the checks more consistently.

Researchers looked at ways to improve monitoring among a group of children, 8 to 18 years old, with Type 1 diabetes.

To prevent the disease from taking a potentially serious toll on their bodies, children with diabetes need to make sure they have the right amount of insulin in their bodies by checking their blood throughout the day.

Many people with diabetes don't do this as well as they should. But children, and especially teenagers, can be the most troublesome, said the senior author of the study, Dr. Lori M. Laffel, director of the pediatric and adolescent section at the Joslin Diabetes Center in Boston and an associate professor at Harvard Medical School.

Dr. Laffel said teenage diabetics often approached their illness as they would any danger -- with little regard. ''Your future is the moment,'' she said, describing the attitude.

So the researchers divided 40 young patients into two groups and gave them all hand-held computers for keeping track of their blood sugar levels, their insulin use and their carbohydrate consumption. They were asked to monitor themselves four times a day.

For half of the children, however, the P.D.A.'s also contained game software tied to the monitoring and designed by one of the study authors, Dr. Vikram S. Kumar, when he was a medical student.

The children earned points when they played the game and more points if they accurately predicted their fourth blood sugar score of the day.

The study found that those children with the game software checked their sugar significantly more often over four weeks compared with those who did not have the game. At the end of that time, they also showed more knowledge about diabetes.

DATE: October 29, 2004

Researchers at Wake Forest University have discovered a gene that could cause up to 20 percent of Type II diabetes.

The discovery of the gene PTPN1 could lead to earlier treatment and new therapies, which already are being tested.

"If we could identify those who are at highest risk, then medical care and preventive care could be focused on those people, and we could either delay or prevent onset," said Donald W. Bowden, a biochemistry and internal medicine professor at Wake Forest and an author of the study, published in the November issue of the journal Diabetes.

Type II diabetes affects 8.2 million Americans, and is the most prevalent form of a metabolic disorder involving insulin. The recently discovered gene plays a role in the regulation of sensitivity to insulin. Scientists have long known that the disease often runs in families, and other genetic links have been found that involve the metabolism of fats and sugars, as well as insulin production.

The Wake Forest work focuses on the body's ability to absorb insulin. Many diabetics produce plenty of insulin, but something keeps cells from recognizing it. As a result, sugar builds up in the bloodstream, leading to nerve damage, blindness, organ failures and sometimes death.

The Wake Forest researchers report that the blunting action stems from the PTPN1 gene, which makes a protein that blocks insulin absorption.

In perhaps one-fourth of diabetics, the gene stimulates too much production of the protein.

Pharmaceutical companies already are looking at this mechanism to develop therapies, Bowden said.

One plan is to devise a drug that diminishes the gene's tendency to overproduce the blocking protein. Some drugs are in clinical trials, Bowden said, but he declined to elaborate.

Other practical applications of the finding include genetic screenings. By developing a genetic test, doctors could scan patients for the form of the gene that produces the blocking agent, and get an early warning before diabetes develops.

"This is an important area, because you like to be able to say to someone, `Well, here's your risk of developing Type II diabetes, given that you're at risk,'" said Dr. Mark Feinglos, professor of medicine and chief of the endocrinology division at Duke University Medical Center.

The Wake Forest findings resulted from two studies involving 1,800 people. The first study focused on white adults, mainly in North Carolina, and compared the genes of people who had diabetes against people who didn't.

A second study examined Hispanic adults in Colorado and Texas, to see how they metabolize glucose and measure insulin levels.

The gene's role in insulin absorption was similar in both groups, Bowden said.

The gene plays less of a role in the development of diabetes in black adults, he said. Blacks have a higher rate of diabetes than whites, with 11.4 percent diagnosed with the disease, compared to 8.4 percent of whites, according to the American Diabetes Association.

"It's complicated, because different populations have different impacts from genes," Bowden said. "We don't know how many other genes there might be, and a lot of researchers are trying to find that out. But this is an important step, an important part in the pathways of diabetes."

DATE: October 22, 2004

The American Academy of Ophthalmology wants Americans to know that only 50 to 60 percent of those with diabetes get the recommended yearly eye examinations.

Diabetes is now an epidemic in the United States and the leading cause of new cases of blindness. However, vision loss can be prevented if the disease is diagnosed and treated in time.

Approximately 29 million people in America have diabetes but some are at greater risk than others. About 13 percent of all African Americans have diabetes -- More than 10 percent of all Latino Americans have diabetes -- 15 percent of Native Americans and Alaska Natives receiving care from Indian Health Services have diabetes -- And 20 percent of the U.S. population ages 65 and older have diabetes.

"Unfortunately, one-third of the people affected by diabetes are unaware they have the disease," said Academy spokesperson Jose S. Pulido, M.D., professor of ophthalmology at the Mayo Clinic in Rochester, Minn., "And are at greater risk for vision loss and other complications. The first step in preventing complications is finding out if you have the disease. It's important for all healthy adults over the age of 45 to have a blood sugar test at least once every three years."

Each year, between 12,000 and 24,000 people lose their sight due to diabetic retinopathy, a degenerative disease of the retina caused by diabetes. Studies show effective treatments for diabetic retinopathy can reduce severe vision loss by up to 94 percent. Other ways to reduce the risk of eye disease: -- Keep your blood glucose level as close to normal as possible through diet, exercise and, if needed, medication -- Keep your blood pressure under control -- Keep your cholesterol levels low -- Don't smoke -- Make sure your hemoglobin A1c levels (a measure of good blood sugar control) are measured at least every four months and are less than 7.1.

The Academy is the world's largest association of eye physicians and surgeons -- Eye M.D.s -- with more than 27,000 members. To find more information about eye health care, visit the Academy's partner Web site, the Medem Network, at www.medem.com To find an Eye M.D. in your area, visit the Academy's Web site at www.aao.org.

DATE: October 15, 2004

Source: Liverpool Daily Post & Echo Ltd

Todays issue of the Liverpool Daily Post states that carrying a lot of fat around the stomach can quadruple the risk of diabetes and heart disease.

Medical scientists in the UK believe waist measurement, rather than overall weight, is more accurate at predicting future health problems such as Type 2 diabetes, which is linked to rising levels of obesity. Fat around the stomach -- a beer gut or apple shape -- can be more deadly than weight carried on the thighs, the so called pear shape.

Anthony Barnett, professor of medicine at Birmingham University, said people should throw away their bathroom scales and reach for the tape measure to understand the risks.

Researchers are realising that fat cells around the stomach are different from fat cells elsewhere in the body and the unwanted chemicals they pump out can damage the insulin system, raising the risk of diabetes and heart disease.

Prof Barnett, speaking at the National Obesity Forum conference in London, said: "Waist measurements can predict the risks of Type 2 diabetes and heart disease more accurately than weight. Men with waists of more than 40 inches and women with waists of more than 35 inches are at an incredibly high risk of Type 2 diabetes and heart disease."

DATE: October 08, 2004

A group of Japanese researchers has discovered that a substance found in the brains of many animals plays a key role in suppressing the appetite.

Their studies confirmed that mice lacking this substance overeat and quickly become obese. The discovery could pave the way for new treatments for obesity and bulimia, according to the team led by Prof. Masayasu Kojima of Kurume University's Institute of Life Science.

The appetite suppressant is a type of neuropeptide called neuromedin U. The substance is believed to play a role in the gastrointestinal and central nervous systems controlling food intake, muscle movement and energy consumption.

During their research, genetically engineered mice lacking neuromedin U ate about 33% more than usual, with their weight soaring to 1.5 times that of average mice. Their body-fat ratio ballooned to 52%, compared with 20% for a normal mouse, creating a condition called "fatty liver." They also developed such diseases as hyperlipemia, hyperglycemia and diabetes.

When the obese mice were given neuromedin U, however, their conditions improved.

It is already known that a protein hormone called leptin serves as an appetite suppressant, but practical treatments based on the substance have not been developed.

Neuromedin U's function is totally unrelated to leptin, the research team said. While leptin is released from fat cells, neuromedin U is a peptide that works in the brain.

The study was sponsored by the Japanese government-affiliated National Agriculture and Bio-oriented Research Organization.

DATE: October 01, 2004

Researchers from 12 medical centers in the United States and Canada, who have performed islet transplants in 86 patients with type 1 diabetes, published their results in the first annual report of the Collaborative Islet Transplant Registry (CITR).

The report (www.citregistry.org) analyzes many factors that can affect the outcome of this experimental procedure for people with severe or complicated type 1 diabetes.

The report provides data on recipient and donor characteristics, pancreas procurement and islet processing, immunosuppressive medications, function of the donated islets, patients' lab results and adverse events.

"We now have much-needed information on the short-term results of islet transplantation," said Dr. Thomas Eggerman of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the part of the National Institutes of Health (NIH) that funds the project.

"Our goal is to collect data on both short- and long-term outcomes for all patients who receive islet transplants so we can better define the overall risks and benefits of this exciting but still experimental procedure."

In islet transplantation as performed by these centers, insulin-producing cells derived from donor pancreata were infused into patients with difficult-to-control type 1 diabetes though the portal vein of the liver. When successful, the transplanted islets took up residence in the liver's small blood vessels and began producing insulin.

The 86 recipients, who had type 1 diabetes for an average of 30 years, received a total of 158 infusions of islets extracted from 173 donor pancreata. Twenty-eight patients received one islet infusion, 44 received two, and 14 received three. At 6 months after the last infusion, 61% of recipients no longer had to inject insulin. At 1 year after the last transfusion, 58% were still insulin independent. Some insulin-independent patients, although not receiving insulin, did have higher-than-normal blood glucose levels. Researchers will continue to monitor patients to see how long they remain insulin independent.

Recipients, 66% of whom were women, were an average age of 42 years (range 24-64 years) and average weight of 143 lbs. (range 103-213 lbs.). Before the procedure, nearly half the recipients were using an insulin pump. Most had recently experienced at least one episode of hypoglycemia, or dangerously low blood glucose, requiring another person's help. Their average level of hemoglobin A1c (HbA1c), which reflects blood glucose control over the previous 3 months, was 7.7%, compared to a normal HbA1c of 6%.

HbA1c levels generally improved with each infusion, as did levels of fasting blood glucose and C-peptide, which reflect insulin production. One infusion, though rarely providing enough islets to free a person from the need to inject insulin, alleviated episodes of severely low blood glucose. After the first infusion of islets, only two recipients had a low blood sugar problem requiring the help of another person. None of those who received a single infusion reported a problem with hypoglycemia a year after the procedure.

"Data collection on islet transplantation has been difficult, because most of the 750 islet transplants performed worldwide since 1974 have been done as part of small, single-center pilot trials," said Dr. Bernhard Hering of the University of Minnesota, who chairs CITR's scientific advisory committee. "This report is an important collaborative effort to combine data from 12 centers on the risks and successes of islet transplantation and to make the information widely available to patients and investigators."

From 1990-1999, only 8% of islet transplants resulted in insulin independence for more than 1 year. In 2000, however, a group of researchers led by Dr. James Shapiro at the University of Alberta in Edmonton, Canada, reported much greater success in patients transplanted with islets from two to four donor pancreata and treated with an immunosuppressive regimen that left out glucocorticoids, now thought to be toxic to islets. In the next few years, other researchers replicated the "Edmonton protocol" pioneered by the Canadian team, and many centers are now using this approach to islet transplantation.

The centers reported 45 serious adverse events but no deaths in the recipients. The 27% of events that were classified as life-threatening included those linked to the transplant procedure itself (e.g., infection, bleeding into the chest or abdomen, low hemoglobin, high liver enzymes) and to medications that suppress the immune system (e.g., anemia, nerve damage, meningitis and low numbers of white blood cells). Most recipients received the same drug regimen used in the Edmonton protocol: daclizumab at induction to prevent the immune system from rejecting the donor islets and sirolimus combined with tacrolimus to maintain immunosuppression.

The CITR's mission is to expedite progress and promote safety in islet transplantation by collecting analyzing, and communicating data on islet transplantation. NIDDK established the registry in 2001 through a contract awarded to EMMES Corporation in Rockville, Maryland.

In the CITR's first report, 12 islet transplant centers detail the experiences of 86 patients who received at least one islet transplant from 1999-2003. Omitted from the report are outcomes for 74 other recipients at these centers and data on about 40 people who received islet transplants in other centers during this time. "We're continuing to receive additional data from the inaugural 12 centers and from new centers joining and contributing data, so future reports will be even more comprehensive," noted Eggerman.

"The CITR will prove invaluable, not only to investigators, but to all parties with an interest in moving the field forward," added Dr. Brian Flanagan, Scientific Program Manager at the Juvenile Diabetes Research Foundation International (JDRF). Recently, five islet transplant centers in Europe, with JDRF funding, began contributing data to the CITR."

DATE: September 24, 2004

University of Toronto researchers have identified individual cells in the adult mouse pancreas capable of generating insulin-producing beta cells.

Their research offers hope for the millions of diabetics worldwide who take insulin injections to compensate for defective pancreatic islets. Healthy islets, made up largely of beta cells, release insulin to help regulate the body's blood sugar levels.

"People have been intensely searching for pancreatic stem cells for awhile now, and so our discovery of precursor cells within the adult pancreas that are capable of making new pancreatic cells is very exciting," said Simon Smukler, a PhD candidate in U of T's department of medical genetics and microbiology, who was one of the lead researchers. He conducted the study along with U of T MD/PhD candidate Raewyn Seaberg and their supervisor, Professor Derek van der Kooy.

The scientists are now hoping to extend their research to prove that these precursor cells are truly stem cells. True stem cells must exhibit two properties: the ability to renew themselves over the entire life of the organism and some ability for the parent cell to generate varied cell types - for example islet cells and exocrine cells. Pancreatic stem cells could provide a plentiful supply of beta cells for transplant treatments.

A finding Smukler considers equally exciting is their discovery that these pancreatic cells generated both beta cells and neurons, cells associated with the workings of the brain and the nervous system.

"The existing dogma regarding how development occurs states that fairly early in development, there is a distinction made between a group of cells destined to make the brain and another group destined to make the pancreas," he said. "The idea that a single cell within the pancreas could make both beta cells and neurons is intriguing."

Copyright ©2004 Diabetes Week

DATE: September 17, 2004

A carefully controlled animal study provides clear evidence that a low-glycemic-index (low-GI) diet - one whose carbohydrates are low in sugar or release sugar slowly - can lead to weight loss, reduced body fat and reduction in risk factors for diabetes and cardiovascular disease.

"The study findings should give impetus to large-scale trials of low-GI diets in humans," said senior author David Ludwig, MD, PhD, director of the Optimal Weight for Life (OWL) obesity program at Children's Hospital Boston. His group's findings appear in the Lancet.

Many studies, including small studies in humans, have suggested that low-GI diets are beneficial, but due to study design, the observed benefits could have come from other aspects of the subjects' diets, such as fiber or overall caloric intake. For this reason, no major health agency or professional association references glycemic index in their dietary guidelines, Ludwig said.

In the current study, rats were fed tightly controlled diets with identical nutrients, except for the type of starch. Both diets were 69% carbohydrates, but 11 rats were randomly assigned to a high-GI starch and 10 to a low-GI starch. Food portions were controlled to maintain the same average body weight in the two groups.

At follow-up, the high-GI group had 71% more body fat and 8% less lean body mass than the low-GI group, despite very similar body weights. The fat in the high-GI group was concentrated in the trunk area, conferring "the apple shape as opposed to the pear shape," Ludwig said. (Having an apple shape is a known risk factor for cardiovascular disease in humans.)

The high-GI group also had significantly greater increases in blood glucose and insulin levels on an oral glucose tolerance test, and far more abnormalities in the pancreatic islet cells that make insulin, all changes that occur in diabetes. Finally, the high-GI group had blood triglyceride levels nearly three times that of the low-GI group, a risk factor for cardiovascular disease.

In a further experiment, rats were randomly assigned to one of the two diets, and, at week 7, were crossed over to the alternate diet for another 3 weeks. Rats that switched from a low to high-GI diet showed greater increases in blood glucose and insulin than rats that were switched from high to low GI. Finally, 24 mice were randomly assigned to the low- or high-GI diet. At week 9, the high-GI group had 93% more body fat than mice on the low-GI diet.

"What the study shows is that glycemic index is an independent factor that can have dramatic effects on the major chronic diseases plaguing developed nations - obesity, diabetes, and heart disease," said Ludwig. "This is the first study with hard endpoints that can definitively identify glycemic index as the active dietary factor."

Unlike the popular Atkins diet, which seeks to minimize carbohydrate intake, the low-GI diet makes distinctions among carbs. It avoids high glycemic-index foods, such as white bread, refined breakfast cereals, and concentrated sugars, which are rapidly digested and raise blood glucose and insulin to high levels. Instead, it emphasizes carbohydrates that release sugar more slowly, including whole grains, most fruits, vegetables, nuts and legumes.

"The Atkins diet tries to get rid of all carbohydrates, which we think is excessively restrictive," said Ludwig. "You don't have to go to this extreme if you pay attention to the glycemic index and choose low-GI carbs."

Copyright ©2004 Diabetes Week

DATE: September 10, 2004

We've all heard about the low carb diet and the no carb diet - now it's time for the 'good' carb diet.

A new regime is being hailed by doctors as a healthier alternative to the controversial but highly-popular Atkins Diet.

Called the 'GI' (low glycaemic index) diet, it is designed to distinguish between 'good' and 'bad' carbohydrates. It rates foods from 0 to 100 - based on their effect on blood sugar levels.

It concentrates on the so-called 'good' carbohydrates which keep a person feeling full for longer, reducing the urge to snack.

Dieters can stick to a fairly conventional balance of protein and carbohydrates, rather than skewing the diet towards high-protein foods such as meat, eggs and cheese.

The Atkins Plan has millions of adherents in The U.S.A. and in Britain, along with celebrities such as Jennifer Aniston and Renee Zellweger.

But although many have lost weight on the diet, scientists have voiced fears over potential links to diabetes, bowel cancer and breast cancer.

In a study published in The Lancet last month, two sets of rats were fed on nearly identical diets, composed of 69 per cent carbohydrates.

For one group, this was made up of 'good' carbohydrates with a low glycaemic index, the other 'bad', high-GI carbohydrates.

After 18 weeks, the high-GI group had 71 per cent more body fat than the low-GI group, which much of the fat concentrated around the middle of the rats' bodies.

Fat around the middle of the body in humans produces the 'apple' shape which is a known risk factor for heart disease. Levels of blood fats were nearly three times higher in the high GI group - another heart disease trigger in humans. Tests also showed changes in the high GI group associated with an increased risk of diabetes.

In a second study, using mice rather than rats, the results were even more marked, with the high-GI group carrying 93 per cent more body fat than the low GI group.

Dr David Ludwig, of the Children's Hospital, Boston, who led the research, said: 'The Atkins diet tries to get rid of all carbohydrates, which is excessively restrictive. You don't have to go to this extreme if you pay attention to the glycaemic index and choose low-GI carbs.' High GI carbohydrates - such as white bread, refined breakfast cereals and concentrated sugars - are rapidly digested, causing a surge of blood glucose and insulin.

Low GI carbohydrates - such as wholegrains, fruit, vegetables, noodles lentils - and many nuts - release their sugar more slowly.

Previous studies have suggested a low-GI diet is beneficial but it has not been clear whether other factors, such as fibre, contribute.

Dr Ludwig said: 'This is the first study that can definitively identify glycaemic index as the active dietary factor. It can have dramatic effects on the major chronic diseases plaguing developed nations - obesity, diabetes and heart disease.' Dr Sarah Brewer, medical adviser to Atkins, said: 'People will lose weight more easily and more quickly following a low-carb diet.

'The conventional mix of carbs and protein is not correct for many people, which is why we have such an obesity problem now.' Dieters will soon have another weapon in their battle against the bulge - a 'fat-busting' steam oven from the Sharp Corporation of Japan.

Sharp Corporation

The oven uses bursts of ' superheated' steam to melt away fat and reduce salt and oil in food.

The Manufacturer says it removes up to eight times more fat from meat than conventional cooking and also claim it helps prevent the loss of vitamin C in vegetables.

DATE: September 03, 2004

By the time overt symptoms of type 1 diabetes appear in an individual, destruction of the insulin-producing beta cells of the pancreas has already progressed significantly. However, findings by researchers at Joslin Diabetes Center and Massachusetts General Hospital, published in the Aug. 24 issue of Proceedings of the National Academy of Sciences, show that a powerful new imaging technology gives scientists a glimpse into the earliest stages of the inflammatory process leading to type 1 diabetes in laboratory animals. The new findings one day may be useful for predicting whether and when diabetes will develop in humans.

Type 1 diabetes is an autoimmune disease in which the body's immune system mistakenly launches an attack on the insulin-producing beta cells of the pancreatic islets. This process may eventually destroy the beta cells, preventing them from producing sufficient insulin, so that high blood-glucose levels--and full-blown diabetes--develop. Early in this process, white blood cells called T-cells invade the islets (an inflammatory condition known as "insulitis"). A very early marker of this inflammation is increased permeability (leaking) of the tiny blood vessels surrounding and within the islets.

Until recently, the only way to track type 1 diabetes in its earliest stages was to measure blood levels of autoantibodies (the immune system's "guided missiles") directed against pancreatic islet proteins. Yet, these tests are only an indirect indication of the disease process, and don't allow researchers to directly follow the progression of disease.

This gap may someday be filled by a new technology that exploits magnetic resonance imaging, commonly known as MRI, to monitor miniscule magnetic nanoparticles leaking from the blood vessels of the pancreas, according to Maria Denis, Ph.D., Christophe Benoist, M.D., Ph.D., and Diane Mathis, Ph.D., of Joslin Diabetes Center, and Umar Mahmood, M.D., Ph.D., and Ralph Weissleder, M.D., Ph.D., of Massachusetts General Hospital, both in Boston. Dr. Denis, a former Joslin research fellow, now works at the BSRC Alexander Fleming Institute of Immunology in Greece. The Joslin and MGH researchers demonstrated the effectiveness of using this new imaging technology to detect the earliest stages of type 1 diabetes in a mouse model.

How the technology works

The new imaging technology uses tiny probes called long-circulating magnetofluorescent nanoparticles (CMFN). These particles contain magnetic nanocrystals of iron oxide, which are very easily detected by MRI. After being injected intravenously, CMFN travels throughout the body, including through the tiny blood vessels of the pancreas. If these vessels have started to become permeable as a result of islet inflammation, more CMFN tends to leak out and collect in the surrounding tissue, as can be seen on the MRI. This technique allows researchers to observe this early inflammatory process over time. "Thus, we have the means to non-invasively monitor the initiation and progression of insulitis in mouse models of type 1 diabetes in vivo and in real time," Dr. Mathis comments.

The researchers say that this new imaging process may prove an invaluable aid in helping researchers and clinicians to spot early insulitis and to monitor how it changes, during the development of disease and after experimental or therapeutic interventions aimed at stopping its progression. Further, they point out that the technique already has been used safely and effectively by the MGH group in human clinical trials to detect the spread of prostate cancer to the lymph nodes. "Given the known safety of magnetic nanoparticles in humans, the technology might someday be used in individuals who are genetically at risk for diabetes to detect this autoimmune process in its earliest stages," Dr. Benoist suggests.

Drs. Mathis and Benoist hold the William T. Young Chair in Diabetes Research at Joslin and co-head the Section on Immunology and Immunogenetics. Both are Professors of Medicine at Harvard Medical School. Dr. Weissleder is Professor of Radiology at Harvard Medical School and the Director of the Center for Molecular Imaging Research at MGH. This research was funded by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.

For more information on Joslin, visit www.joslin.org

DATE: August 27, 2004

Medical researchers at the University of Toronto have discovered potential stem cells in the pancreas, a finding that could lead to new treatments for diabetes.The study, published yesterday in the online edition of Nature Biotechnology, identified individual cells in the adult mouse pancreas capable of making insulin-producing "beta cells."

These beta cells make up the tissues in the organ that release insulin and help regulate the body's blood sugar levels.

It's important news for the millions of people worldwide who have Type 1 diabetes, which usually starts in childhood or adolescence, and who take insulin injections to regulate their body's blood sugar levels. The insulin shots compensate for defective pancreatic portions of tissue, or islets.

"People have been intensely searching for pancreatic stem cells for a while now, and so our discovery of precursor cells within the adult pancreas that are capable of making new pancreatic cells is very exciting," said Simon Smukler, a Ph.D. candidate in U of T's medical genetics and microbiology department. He conducted the study with Ph.D. candidate Raewyn Seaberg and their supervisor, Professor Derek van der Kooy.

More than two million Canadians have some form of diabetes, according to the national Juvenile Diabetes Research Foundation. Insulin-dependent diabetics run the risk of developing debilitating complications like nerve damage, stroke, heart attack, kidney failure, amputation and even death.

"It is a tremendously encouraging step forward for everyone affected by juvenile diabetes," said Robert Hindle, chair of the foundation. "It is worth noting that, once again, a major step forward in diabetes research has occurred in Canada," he said, referring to home-grown advances in the field starting with the discovery of insulin in the 1920s by U of T's Frederick Banting and Charles Best.

If further study proves that Smukler's group did indeed identify stem cells, the discovery could help scientists develop better treatments for diabetics and change the way they think about cell development.

Smukler said the cells identified by the study have exhibited one of the two major properties of stem cells they generate varied cell types. In this case, the cells generated insulin-producing beta cells and - to the researchers' surprise - neurons, those cells which help the brain and nervous system function.

The existing "dogma" about cell development says there is a distinct group of cells destined to make the brain and another to make the pancreas, Smukler said.

This discovery could change all that, he added, because it shows a single cell in the pancreas can make both beta cells and nerve cells.

"It was unexpected and intriguing, and kind of neat," he said.

Smukler said he's not sure why that happens, but it's possible that there could be cells in the body that make both types of cells.

True stem cells also renew themselves, which Smukler said has yet to be proven in these "precursor" cells, although he's hoping to expand the research.

Clinical studies based on the study are a long way off, but he said the finding could affect the way diabetes is treated - particularly Type 1, where the body doesn't have enough beta cells to produce insulin.

Finding donor tissue for pancreatic cell transplants in Type 1 cases is complicated, he said. But the study could point to alternative - and plentiful - sources of insulin-producing cells.

The study was funded by the Stem Cell Network (a group of university and hospital researchers in Canada) and the Canadian Institute for Health Research.

DATE: August 20, 2004

A study of more than 2,000 children of women with gestational diabetes (the diabetes that some women get during pregnancy) has revealed that obesity in mothers is one of the most decisive factors contributing to the appearance of congenital malformations in their children - even more so than the seriousness of the diabetes.

The research, published in the journal Diabetologia, has been carried out by a research team from the Universitat Autonoma de Barcelona and l'Hospital de Sant Pau in Barcelona, Spain.

It has been known since the 1960s that children of women with diabetes before pregnancy have a higher possibility of having congenital malformations, which are primarily related with the mother's degree of hyperglycemia (high blood sugar) during the period in which the embryo's organs are forming. In the children of women with gestational diabetes, which is first detected during pregnancy, the risk of malformations does not increase so much, but it still exists. In this case, during the period when the embryo's organs are forming the glucose levels are usually fairly unaltered.

The research team, headed by Rosa Corcoy, came to an unexpected conclusion after analyzing the relationship between the mother's glucose levels and congenital malformations in the children of mothers with gestational diabetes: Surprisingly, the body mass index, which indicates obesity, is more important for predicting malformations than other variables that indicate the seriousness of the maternal diabetes mellitus.

In a study of 2,060 children, the researchers decided to include body mass index as a variable for the statistical analysis now that it has been demonstrated that obesity plays a part in congenital malformations in embryos, especially those related to the heart and the central nervous system.

According to the study's results, the mother's degree of obesity is the main predicting factor for cardiac malformations and minor malformations and is the only factor able to predict renal and urinary tract malformations. The seriousness of the mother's gestational diabetes, however, was the only factor that could predict skeletal malformations.

Previous studies have not identified the degree of obesity as contributing to the risk of cardiac malformations in the children of woman with gestational diabetes, possibly because this variable was not included in the statistical analysis.

The authors of the study suggest two possible explanations for obesity's important role in congenital malformations: first, obesity is an indicator of energy availability and of all the nutrients that provide energy; excess of these nutrients, not only of glucose, is linked with the appearance of malformations. Second, both the excess and deficiency of insulin can provoke malformations in the embryo, and in the case of obesity, the fact that there is a resistance to the effects of the insulin results in higher concentrations.

Copyright 2004 Diabetes Week

DATE: August 13, 2004

VANCOUVER, Dieters can rejoice as of today. Scientists, dedicated to finding an easier way to lose weight, have discovered a natural and healthy fibre called PolyGlycopleX (PGX(tm)) that will help everyone attain and maintain their ideal weight in a healthy and safe way.

PGX is the result of years of intensive clinical and laboratory research at the University of Toronto and tested at the Canadian Center for Functional Medicine in Coquitlam, B.C. The new proprietary product is a healthy, water-soluble fibre complex developed through a unique process and can be taken every day to greatly reduce appetite, eliminate hypoglycemic cravings and promote efficient fat burning by diminishing insulin resistance, lowering insulin levels and normalizing appetite regulating hormones.

When added to liquid, PGX absorbs 600 times its weight in water and when used in a diet product, such as a meal replacement drink, it continues to thicken and expand as it absorbs water. As long as the dieter takes adequate amounts of liquid with the new product, it will expand in the stomach and intestine and keep appetite under control for several hours by providing a sense of fullness. The thickness and expansion achieved by PGX(tm) is greater than any other fibre or fibre blend ever studied.

Dr. Michael Lyon, medical doctor and scientist, has collaborated with the University of Toronto in various human studies on PGX. Over the past year, he has also supervised a clinical weight loss program using PGX at the Canadian Center for Functional Medicine where he acts as the Medical and Research Director.

"Besides its stomach and intestine filling properties, we found PGX to markedly improve blood sugar regulation and the reaction of insulin. Most people who are overweight have a condition known as insulin resistance. We now know that insulin resistance and its accompanying elevated insulin levels contribute to many serious health problems such as diabetes, heart disease and cancer, and it may be the reason why these people feel hungry all the time and find it hard to lose weight even when they cut calories. With PGX, excessive food cravings are dramatically diminished and dieters' bodies become much more efficient at losing weight without having to starve their bodies of healthy carbohydrate containing foods," says Dr. Lyon.

Results of a study conducted with the University of Toronto were presented in June at the Annual Meeting of the American Diabetes Association in Tampa, Florida. Several other PGX clinical trials have demonstrated its safety and effectiveness and important research will be carried out in collaboration with the University of Toronto over the next few months to help clarify the biochemical and hormonal reasons for this fibre's very unique appetite-reducing properties.

Products containing PGX can be found at all natural health product retailer operations throughout North America.

The Canadian Center for Functional Medicine (www.functionalmedicine.ca) located in Coquitlam, B.C., is a patient-centered healthcare facility dedicated to the research and education of preventative medicine, nutritional medicine and conventional medicine.

DATE: August 06, 2004

Theraputic cloning of human embryos must start now because new stem-cell treatments for conditions such as diabetes and Parkinson's disease are still many years away, according to a leading expert on the technology.

Dr Stephen Minger, the director of the Stem Cell Laboratory at King's College London, called for the UK to develop a comprehensive programme to clone human embryos from which stem cells can be harvested for new therapies.

He told the BioScience 2004 conference: "It is vital that we do not delay learning how to perform cell nuclear replacement in human cells, the technique required for therapeutic cloning, because new stem-cell treatments for diabetes and Parkinson's are still many years away. It is going to take us just as long to figure out how to do this safely and reproducibly."

Cell nuclear replacement (CNR) involves removing the nucleus of a human donor egg, replacing it with the genetic material from the nucleus of an easily obtainable cell, such as skin, heart or nerve from the patient, and stimulating this cell to then divide.

Once a group of cells has been formed, stem cells can be extracted a few days later.

So far a South Korean research team is the only group in the world to have successfully cloned a human embryo, but scientists do not yet know whether this can be replicated and whether the stem cells derived from such an embryo could possibly function therapeutically.

Dr Minger is adamant that cloning human embryos for therapeutic purposes is not "the slippery slope" to creating designer babies.

He said: "There is a total ban in the UK and most of the rest of the world on reproductive cloning. Reproductive cloning must not be confused with therapeutic cloning."

At present, people with Type 1 diabetes have to inject themselves with insulin every day. A goal of therapeutic cloning is to generate an embryonic stem cell line that is genetically identical to the person for whom the new insulin cells would be created.

Success would reduce the risk of rejection and the need for toxic immunosuppressants, which leave the body open to attack from other viruses and diseases.

However, even if the technique of CNR is perfected, the result is still just a line of human embryonic stem cells.

Dr Minger said: "Cloning embryos in itself does not provide a therapy, so now is the time to start to work out how to differentiate these cells into specific types. Then we have to carry out safety tests before attempting to treat people for spinal injury, or diseases like Parkinson's, stroke or diabetes."

DATE: July 30, 2004

They are the building blocks of flab, the wages of cheesecake, the bloated little sacks of grease that make more of us -- more than we can fit into our pants.

Scorned and despised, they are sucked out surgically by the billions from bulging backsides, bellies and thighs.

But they are not without admirers.

"Fat cells are beautiful cells to look at," said Dr. Philipp E. Scherer, associate professor of cell biology and medicine at Albert Einstein College of Medicine in New York. "I've been working with them for 10 years and I still enjoy looking at them."

On a recent afternoon at his lab, Scherer slipped a Petri dish of fat cells under a microscope and showed how strikingly they caught the light and reflected it. Magnified, they became a field of glittering rings.

Scientists used to think body fat was pretty much inert, just an oily storage compartment. But in the past decade research has shown that fat cells are chemical factories and that body fat is potent stuff: a highly active tissue that secretes hormones and other substances with profound and sometimes harmful effects on metabolism, weight and overall health.

In recent years, biologists have begun calling fat an "endocrine organ," comparing it to glands such as the thyroid and pituitary, which also release hormones straight into the bloodstream.

But those glands cannot grow nearly as much as fat, which has a seemingly infinite capacity to make more of itself. Too much body fat can act like a poison, spewing out substances that contribute to diabetes, heart disease, high blood pressure, stroke and other illnesses, including some cancers.

Researchers trying to decipher the biology of fat cells hope to find new ways to help people get rid of excess fat or, at least, prevent obesity from destroying their health. In an increasingly obese world, their efforts have taken on added importance.

Internationally, over a billion people are overweight. Obesity and two illnesses linked to it, heart disease and high blood pressure, are on the World Health Organization's list of the top 10 global health risks. And the incidence of Type 2 diabetes, almost always caused by obesity, has also been climbing around the world.

A lean adult has about 40 billion fat cells, an obese one at least two to three times that. And obese people have much larger fat cells than lean ones.

Even worse, the body can always make more, and compared with other cells they are extremely long-lived.

If a person keeps overeating, fat cells grow and grow, looking as if they are about to pop. When they reach the limit, they don't divide; they send out a signal to nearby immature cells to start dividing to produce more fat cells.

Some kinds of obesity are worse than others, and body shape matters.

People shaped like apples, carrying excess weight in the abdomen, are more likely to have diabetes and heart disease than are those built like pears, who deposit fat in their hips, thighs and backsides.

Women tend to be pears, but also redistribute fat and thicken in the middle after menopause. Ethnic groups vary. For instance, Asians are more likely to put weight in the abdomen and suffer health problems from lesser degrees of obesity.

Why should a big belly be more dangerous than a big backside? Many researchers think the culprit is visceral fat, deposits inside the abdomen, as opposed to subcutaneous fat, under the skin.

An apple-shaped person is sure to have visceral fat, as well as subcutaneous fat in the abdominal area.

Anybody with a belly has visceral fat, and the more you have, the worse off you are.

It is not clear why visceral fat is riskier; it may be more active metabolically and spew out more toxic substances. Also, its secretions go straight to the liver and may interfere with its functions, which include helping to regulate blood glucose and cholesterol.

In a study published this summer in the New England Journal of Medicine, doctors found that liposuction, which removes only subcutaneous fat, had no effect whatsoever on health, even when surgeons sucked out 20 pounds of subcutaneous abdominal fat.

But a person who loses that much weight through dieting and exercise will almost certainly see significant changes in blood pressure, cholesterol and insulin resistance.

Liposuction also fails to shrink the many more fat cells left behind.

The more metabolically harmful fat cells in obese people have 50 to 75 per cent more mass than fat cells in lean people, said lead author of the study Dr. Samuel Klein of the School of Medicine at Washington University in St. Louis.

The best way to get rid of visceral fat and shrink fat cells all at once is diet and exercise. Just a loss of 7 per cent of total body weight helps.

Something about burning more calories than you eat creates a state of negative energy balance that quickly melts away visceral fat and slims down bloated fat cells.

Unfortunately, diet and exercise have high failure rates. Since many people cannot lose visceral fat on their own, researchers have been experimenting with surgical removal.

Not all visceral fat can be removed safely because of where it is situated.

But a portion called the omentum can be taken out relatively easily, said Dr. Edward Mun, a surgeon at Beth Israel Deaconess Medical Center in Boston.

The omentum is a pad of fat weighing two to four pounds that hangs like a curtain in the abdomen. "We estimate that it's more than one-third of the visceral fat," Mun said.

He's doing a pilot study, performing the surgery on six obese, diabetic patients to see if it can reverse their diabetes.

For patients 100 pounds or more overweight, he frequently performs gastric bypass surgery, which shrinks the stomach and rearranges the small intestine to help patients lose large amounts of weight.

"It's the best thing we have," said Mun. "But I do not want the operation still to be around 100 years from now. To treat obesity, we have to understand how it arises. I really want to understand obesity."

DATE: July 23, 2004

Richard A. Anderson, PhD, a U.S. Department of Agriculture nutrition research scientist presented clinical findings about the role of chromium supplementation in maintaining metabolic health and improving insulin resistance at the American Diabetes Association 64th Scientific Session symposia "Complementary and Alternative Therapies for Diabetes."

Anderson provided evidence showing that chromium supplementation may lead to improvements in glucose and insulin metabolism in people with glucose intolerance, depression, and gestational and type 2 diabetes.

In association with the improvements in insulin function, supplemental chromium also improves blood lipids and decreases the risk factors associated with cardiovascular diseases.

Anderson's data showed that stresses on the body, including high sugar diets, strenuous exercise, pregnancy, lactation, infection, physical trauma and glucocorticoid treatment increase chromium losses.

"Research has found that chromium nutrition leads to improved insulin function and alleviation of the signs and symptoms associated with type 2 diabetes," said Anderson. "The research on chromium's role in insulin function is critical to addressing the current worldwide diabetes epidemic."

Chromium is an essential mineral that is needed for healthy insulin function and the metabolism of carbohydrates, fats and protein. Double-blind clinical studies have shown that daily supplementation with 200-1,000 micrograms per day of chromium, as chromium picolinate, can increase insulin function and improve blood sugar metabolism.

Additional clinical data have suggested that chromium picolinate supplementation may help with end-points related to insulin resistance and type 2 diabetes.

Chromax chromium picolinate, which is the most studied form of nutritional chromium, was used in the studies. Nutrition 21, Inc. is a bioscience firm that develops chromium-based nutritional products, which are supported by clinical research.

The company markets Chromax, the leading brand of chromium, and holds 35 patents for nutrition products, and 22 patents for chromium compounds and their uses.

This article was prepared by Diabetes Week

DATE: July 16, 2004

"My God", I thought, "why are we doing this to bears?"

For the human population the statistics of diabetes are staggering and they will eventually destroy our health care system. Every 45 seconds a new diabetic is diagnosed in North America. But it's only those who have to take insulin day after day who know the magnitude of this disease. Now a unique device is available that won't cure diabetes, but it will make life easier and safer for patients. Unfortunately, it won't help bears.

A recent report in the Journal of Zoology states that black bears are becoming obese. Like humans they've developed slothful habits.

Jon Beckman, a bear expert, says urban bears are one-third less active and 30 per cent heavier than forest bears. Urban bears, rather than roaming the forest, are now dining at dumpsters at fast-food restaurants. And since garbage is available year-round many have given up hibernation. I've no experience treating bears, but I doubt they're immune to diabetes.

What's happened to humans is a tragedy of epic proportions. Fifty years ago 10 per cent of diabetes was due to obesity. Now 90 per cent is due to excess pounds. And what is largely a preventable disease has reached epidemic proportions. The real shocker is what's happening to children. An article published in the Archives for Disease in Children shows that they're getting obese at an unheard of rate. And girls are setting the pace.

The irony is that clothing manufacturers know what is occurring while consumers bury their heads in the sand. During the past 20 years children's tummies have increased by at least four centimeters with most of the expansion in the last five years.

But no one likes the idea of being labeled fat. So manufacturers have acted accordingly. Children's clothes are now available up to size 20. The clothes are baggier and often have elastic waists. And what used to be a size 8 is now a size 7. All this is an attempt to fool children and parents and sets the stage for untold misery.

I wish a prediction I made 25 years ago was wrong. I wrote then that obesity, not cancer or heart disease, was the number one killer. That obesity often triggered these diseases, diabetes, coronary attack and some cancers.

Being a diabetic means a life-long tedious struggle to maintain a normal level of blood sugar. This requires regular injections of insulin. But you have to be sure you're giving the right amount at the right time. All this is easier said than done.

In one survey 53 per cent of diabetes patients said they took an injection late, 64 per cent were unsure if they had taken the insulin dose and between 79 and 90 per cent didn't leave the needles in long enough. Studies indicate these patients are more likely to develop atherosclerosis.

To guard against this possibility, and for patients who have to inject insulin two or more times a day, one company Novo Nordisk has developed a unique device called 'InDuo'. This device remembers the amount of the last dose and the time since the last injection. It also accurately measures blood glucose in five seconds and then delivers insulin. Patients can also do the test on the arm where an injection may be less painful.

Type 2 diabetes is another matter. It's a preventable disease if we could convince people it's due to the stress of too many pounds. That you can only whip a tired horse or insulin producing pancreas so long before they both drop. But it would take Draconian measures, or a famine, to cure this epidemic of obesity and diabetes and I don't see either happening.

But if humans can't stop eating and see the folly of their ways let's at least be kind to bears. Bear-proof garbage containers would send them back to the forest hunting for healthy berries and deer. And save them from diabetes and the many other ills that affect obese humans.

Taken From Dr. Gifford-Jones' column in the Guelph Mercury, July 2004

DATE: July 09, 2004

Why do some people seem to develop type 1 diabetes rapidly while in others it may take years to develop? A new study by Joslin Diabetes Center researchers reveals one of the key biochemical pathways that determines whether type 1 diabetes will remain in its early stages or progress to full-blown disease, possibly explaining why some people develop type 1 diabetes more rapidly than others. The study was published earlier this month in The Journal of Experimental Medicine by a team from Joslin's Immunology and Immunogenetics research section.

For many years scientists have known that type 1 diabetes is an autoimmune disease in which the body's immune system mistakenly launches an attack on the insulin-producing beta cells of the pancreas. At an early stage in this process, white blood cells called T-cells invade the islets of Langerhans of the pancreas, where the beta cells reside (a condition known as "insulitis"). Yet, in both mice and humans, insulitis does not always progress to full-blown type 1 diabetes. For years, researchers have been trying to determine why insulitis sometimes leads to diabetes (so-called "destructive" insulitis) and sometimes does not ("respectful" insulitis). They know that certain T-cells called T effector cells promote destructive insulitis, and other T-cells called regulatory T-cells favor respectful insulitis. Yet, no one knows exactly what causes the balance of power to shift between these two types of cells to cause diabetes.

To study this question, Anne E. Herman, Ph.D., Diane Mathis, Ph.D., and Christophe Benoist, M.D., Ph.D., of the Section on Immunology and Immunogenetics at Joslin Diabetes Center in Boston studied insulitis lesions in a certain strain of genetically engineered mice called BCD2.5 mice. These mice develop insulitis, but a very respectful form, such that diabetes does not follow until months later, or, in some, never. The researchers discovered that both effector and regulatory T-cells co-existed and thrived in these insulitis lesions, and they wondered what kept these lesions respectful.

They looked specifically at a molecule called inducible co-stimulator (or ICOS), which was expressed at an unusually high level on regulatory T cells. Using monoclonal antibodies (man-made versions of natural antibodies, which target individual proteins like guided missiles), the researchers blocked the action of ICOS to see what would happen. Blocking ICOS disrupted the balance between T effector and T regulatory cells, and provoked insulitis to immediately convert to diabetes. The researchers concluded that ICOS plays an important role in keeping insulitis lesions from becoming destructive.

"Understanding the molecular and cellular basis of the immune regulation in the lesion might some day lead to the development of therapies that favor regulatory T-cells and respectful insulitis, preventing the development of full-blown diabetes even after insulitis has developed," Herman explains.

Mathis and Benoist hold the William T. Young Chair in Diabetes at Joslin and co-head the Section on Immunology and Immunogenetics. Both are Professors of Medicine at Harvard Medical School. The research was funded by the National Institutes of Health and the Juvenile Diabetes Research Foundation. Gordon J. Freeman, Ph.D., of the Dana Farber Cancer Institute collaborated on the study.

In type 1 diabetes, which affects an estimated 800,000 Americans, the insulin-producing beta cells of the pancreas have been destroyed. People with type 1 diabetes must take insulin to survive, and are at greater risk for heart attack and stroke, as well as diabetes-related diseases of the eyes, kidneys, and nerves. Currently, type 1 diabetes cannot be cured, but by keeping their blood glucose levels as close to normal as possible, many people with diabetes can prevent or slow down the long-term complications of the disease.

Joslin Diabetes Center, dedicated to conquering diabetes in all its forms, is the global leader in diabetes research, care and education. Joslin Research is a team of over 300 people at the forefront of discovery aimed at preventing and curing diabetes. Joslin Clinic, affiliated with Beth Israel Deaconess Medical Center in Boston, the nationwide network of Joslin Affiliated Programs, and the hundreds of Joslin educational programs offered each year to clinicians, researchers and patients, enable Joslin to develop, implement and share innovations that immeasurably improve the lives of people with diabetes. As a nonprofit, Joslin benefits from the generosity of donors in advancing its mission. For more information on Joslin, call 1-800-JOSLIN-1 or visit www.joslin.org.

DATE: July 02, 2004

A study of very obese children suggests that half may have a worrisome cluster of health conditions that increase their risk of developing diabetes and heart disease at an early age.

Researchers at Yale University School of Medicine said their findings suggest that this combination of health ills, a condition called metabolic syndrome, is more common among children and adolescents than previously thought and increases with the level of obesity.

"Obesity is not just a cosmetic issue. It's a big problem because you open the door for serious, chronic complications," said Dr. Sonia Caprio, who runs the pediatric obesity clinic at Yale.

Caprio said metabolic syndrome increases these youngsters' risk of early development of type 2 diabetes and heart disease - problems usually associated with middle age.

Within 2 years, 8 of 34 children with metabolic syndrome developed type 2 diabetes, according to the study in the June 3, 2004, issue of the New England Journal of Medicine.

"This is a yellow flag and a warning for public health officials and education systems to focus on reducing childhood obesity," said Dr. Sethu Reddy, an endocrinologist at the Cleveland Clinic.

The conditions generally used to define metabolic syndrome are obesity, high blood pressure, high blood sugar, high triglycerides and low HDL, the good form of cholesterol. Anyone with three of the five conditions is considered to have metabolic syndrome, and about a quarter of adults have it.

The researchers tested 439 children and adolescents - 244 who were moderately obese and 195 severely obese. Also tested were 51 of their siblings who were overweight or lean.

Metabolic syndrome was found in 50% of the severely obese and 39% of the moderately obese but not in any of their siblings. After obesity, high blood pressure was the most common condition.

An earlier study, based on a 1988-94 national health survey, found that 29% of obese adolescents had metabolic syndrome. Since then, the number of overweight children has increased from 11% to 15% of those 6-18 years old.

Seventy-seven of the Yale participants were checked again about 2 years later. Twenty-four of 34 still had metabolic syndrome, and 8 had developed type 2 diabetes. The syndrome developed in 16 of the 43 children who did not initially have it.

"I've been in the field for 20 years. What I'm seeing now, I've never seen before," said Caprio, adding that it is not uncommon for a teen to weigh 200 or 300 pounds.

Losing weight through diet and increased activity should help reverse or reduce the conditions and ward off complications, she said.

DATE: June 25, 2004

Liposuctioning your waistline can make you look just fabulous, but it won't necessarily make you healthier.

In a study, obese women who dropped up to 10.35 kilograms (23 pounds) of belly fat by way of liposuction did not appear to lower their risk of diabetes or heart disease, both of which are fat-related.

It is a frustrating and surprising finding to researchers who believed that surgically removing fat would help restore a healthier body chemistry.

"It's not how much fat you remove, but how you remove the fat that is really what is more important," said lead study author Dr. Samuel Klein, at Washington University in St. Louis. "We have to go back to the same old traditional recommendation of lose weight and be more physically active."

Liposuction is the United States' most popular form of cosmetic surgery. About 400,000 fat-sucking liposuction procedures are done every year in this country.

The latest study, published in Thursday's New England Journal of Medicine, involved 15 obese women who underwent cosmetic liposuction.

The women's blood chemistry and pressure, which reflect the risk of diabetes and heart disease, were checked before surgery and about three months after. While the women were slimmer afterward, their medical profiles were almost identical.

Body fat has been increasingly tied to diabetes, heart disease, cancer and other diseases in recent years. It turns out that fat doesn't just make the heart pump harder; fat cells churn out a brew of metabolic products that can harm health.

The notion that surgically removing fat should help restore a healthier chemistry to the body still cannot be completely discarded. For one thing, this study involved a small number of people, and all of them women.

Also, Barbara Corkey, a Boston Medical Center biochemist who is president of the North American Association for the Study of Obesity, said the liposuction may have left too much body fat behind or siphoned away the wrong kind of fat.

The surgery removed only belly fat, leaving untouched a deeper layer of what is known as visceral fat. The deeper fat may prove to be more dangerous. It feeds metabolic products more directly into the pancreas, which manufactures the hormone insulin. It is insulin production or metabolism that goes haywire in diabetics.

Visceral fat is harder, but not impossible, to trim by surgery.

Ultimately, doctors may find that fat cells need to shrink in size, and not just number, to restore a healthier chemical balance. Dieting does make fat cells smaller.

It may also be that the body needs to run an energy deficit, through dieting and exercise, to switch on healthier fat chemistry.

The liposuction research suggests that "even if one could suddenly remove the fat tissue per se, you really haven't changed the underlying process," said Dr. David Kelley, who runs the Obesity and Nutrition Research Center at the University of Pittsburgh Medical Center.

DATE: June 18, 2004

Unlike the global erectile dysfunction drug market leader, Pfizer's Viagra (sildenafil), Bayer/GlaxoSmithKline's Levitra (vardenafil) appears to be of benefit to diabetic men, according to the results of studies presented at the American Diabetes Association in Orlando, Florida, this past week.

Men being treated for diabetes are three times more likely to have ED than those in the general population. In addition, more than 50% of diabetic men develop ED within 10 years of being diagnosed with diabetes, and the condition tends to be difficult to treat in diabetic men, notes a Bayer/GSK press statement.

Study results showed that men with diabetes and ED who were previously unsuccessful with Viagra were able to obtain an erection sufficient for successful intercourse on 33% of attempts with Levitra compared with 13% with placebo. In addition, 58% of diabetic men in the study experienced improved erections with Levitra compared with placebo. The results of the study, referred to as the PROVEN (Patient RespOnse with VardENafil in Sildenafil Non-Responders) trial, evaluated Levitra in men with ED who were historically unresponsive to Viagra.

The PROVEN trial assessed the improvement of erectile function in a subset of 138 men with diabetes and ED and a history of unresponsiveness to Viagra. Patients were classified as having diabetes based on medical history, laboratory values (HbA1c>8%), and medication data. The study was a prospective, multicenter, double-blind, flexible-dose trial studying men with ED who had a documented history of non-response to Viagra.

DATE: June 11, 2004

Diabetics taking a daily dose of a cholesterol-lowering drug can cut the risk of a heart attack by a third and that of a stroke by nearly half, a study said yesterday.

The study involved 2,838 patients from Britain and Ireland with Type 2 diabetes, which does not require insulin injections, who had slightly raised cholesterol levels.

Diabetics have an increased risk of heart disease and strokes, with a heart attack being between two and five times more likely than in the general population.

The study, announced at the American Diabetes Association meeting in Orlando, Florida, found that, by giving diabetics the statin drug Lipitor daily, the risk of a heart attack was reduced by 37 per cent and the risk of a stroke by 48 per cent.

Prof John Betteridge, of University College London, one of the two main investigators, said: "For all patients with Type 2 diabetes, consideration should now be given to whether they warrant statin therapy."

About one million Britons suffer from Type 2 diabetes while in the USA the exceeds fifteen million.

DATE: June 04, 2004

People with diabetes might soon be able to throw away their insulin syringes. An inhaled form of insulin provides good long-term control of blood sugar levels, a new study shows, and patients much prefer the treatment to injected insulin.

Previous short-term (12-week) studies demonstrated the efficacy and patient acceptance of inhaled insulin among people with type 1 or type 2 diabetes, Dr. Robert A. Gerber from Pfizer Global Research and Development in Groton, Connecticut, and colleagues explain in the medical journal Diabetes Care. They then followed 121 participants in the original studies who participated in a 1-year extension study.

Improvements in hemoglobin A1c levels -- a measure of long-term control of blood sugar levels -- were similar in subjects who continued taking inhaled insulin, those who switched from injected to inhaled insulin, patients who continued on injected insulin, and people who switched from inhaled to subcutaneous insulin, the authors report.

Episodes of excessively low blood sugar levels were also similar regardless of insulin treatment, the report indicates.

There had been questions about the effect of inhaled insulin on the lungs, but average changes in pulmonary function were the same with inhaled or injected insulin.

During the 1-year extension, participants taking inhaled insulin reported significantly greater improvements in overall satisfaction, ease of use, and social comfort than did patients on injected insulin, the researchers note.

"Results from the current investigation are the first to suggest that the rapid improvement in patient satisfaction with inhaled insulin is sustained," the authors conclude, "and long-term improvements in glycemic control and patient satisfaction are maintained up to the 1-year follow-up."

DATE: May 28, 2004

A new study shows that insulin-producing cells in the pancreas can regenerate themselves, suggesting future treatments for diabetes that could eliminate the need to inject the hormone.

In type 1, or juvenile, diabetes, the body's immune system attacks and destroys a type of specialized cell that makes insulin. The hormone is vital in maintaining the right blood sugar levels.

Regenerating and maintaining these cells in the pancreas could help people with type 1 diabetes make their own insulin. The research does not address the vast majority of diabetes cases, type 2, which are linked to obesity.

Researchers have been seeking ways to produce more of these specialized insulin-producing cells, called beta cells. The new study, done in laboratory mice, suggests there is no need to look beyond the cells themselves. Details are in the May issue of the journal Nature.

Previous studies have suggested that embryonic stem cells or adult stem cells also could be sources for the insulin-producing cells.

The new research found no evidence that adult stem cells, which some groups have hoped would offer an alternative to human embryos, are involved in the regeneration of the insulin-producing cells.

"That's now been eliminated in my mind and gives us two cell types to concentrate on," said study co-author Douglas Melton, a Howard Hughes Medical Institute researcher at Harvard University.

Other experts disagreed, saying differently designed experiments could reveal that adult stem cells do play a role.

"We need to keep all the options open, absolutely," said Vijay Ramiya, who researches pancreatic beta cells at the University of Florida.

It also remains unclear whether beta cells could replicate themselves in sufficient numbers to be useful.

And coaxing embryonic stem cells into forming new insulin-producers appears difficult too, since the cells tend to form tumorous growths, said David Prentice of Indiana State University and a founder of Do No Harm, a group opposed to the use of embryonic stem cells.

Worldwide, there are about 171 million diabetics but only about 10% of those have type 1 diabetes. The vast majority have type 2 diabetes, which is linked to obesity. In the United States, about 900,000 to 1.8 million people have type 1 diabetes, the American Diabetes Association says.

DATE: May 21, 2004

Diabetes may significantly increase the risk of developing Alzheimer's, a study of 824 nuns, priests, and Catholic brothers, found bolstering evidence linking the two diseases.

Participants studied were 55 and older when the research began and were followed on average about six years.

Alzheimer's developed in 151 participants, including 31 who had diabetes.

The researchers calculated that diabetics faced a 65 per cent higher risk of developing the mind-robbing disease.

The link remained strong, even when researchers factored in the prevalence of strokes - a common complication of diabetes - which are also believed to raise the risk of Alzheimer's.

Previous research has linked diabetes with memory problems and diabetes is known to damage blood vessels that supply the brain.

"This is one of the first long-term studies to follow people who start out with no evidence of Alzheimer's disease and track how having diabetes affects their risk of developing it," said William Thies, an Alzheimer's Association vice-president. "It's a powerful argument for doing everything you can to control your blood sugar."

Type 2 diabetes, most common in older people, often can be controlled and even cured through exercise and diet.

Dr. George King, of Boston's Joslin Diabetes Center, called the research "quite important in light of the fact that diabetes is exploding," with some 18 million Americans affected, a number expected to double by 2050.

If the link is real, King said there could be a corresponding surge in Alzheimer's cases.

The study - led by Drs. Zoe Arvanitakis and David Bennett and colleagues at Rush University Medical Center in Chicago - appeared tuesday in the Archives of Neurology journal.

One recent mouse study involving Joslin researchers suggests insulin abnormalities in diabetes might affect a protein called tau, which in Alzheimer's forms tangles in brain cells.

DATE: May 14, 2004

A surprising 41 million Americans have pre- diabetes, high enough blood sugar to dramatically increase their risk of getting the disease, say new government figures that double previous estimates.

The number leaped because doctors have changed the criteria for diagnosing pre-diabetes after research showed that they were missing too many at-risk patients.

"These latest numbers show how urgent the problem really is," said Health and Human Services Secretary Tommy Thompson, who announced this new data at a federal health meeting in Baltimore.

The good news is that modest diet and exercise can delay, if not prevent, the onset of diabetes in many pre-diabetics.

But "most of these people have no idea" they're at risk, said Dr. Francine Kaufman, past president of the American Diabetes Association.

Some 18 million Americans have full-blown diabetes, a leading cause of blindness, kidney failure, amputations and heart disease that claims 180,000 U.S. lives a year.

Some people are born with it, but the vast majority have Type 2 diabetes, an illness that develops, often in middle age, when their bodies lose the ability to turn blood sugar into energy.

DATE: May 07, 2004

More than 28 million Americans over age 40 have eye ailments that put them at risk for vision loss and blindness, researchers say, warning that the numbers will surge as the population ages.

Cataracts are the leading cause of blindness worldwide and the No. 1 cause of poor vision in the United States, affecting an estimated 20.5 million American adults. That number is expected to climb to 30.1 million in the next 20 years, researchers say.

Other major causes of blindness and vision loss are macular degeneration, glaucoma and diabetic retinopathy. All are strongly linked with aging.

The figures published Monday in April's Archives of Ophthalmology present the most accurate estimates to date on the prevalence of major causes of blindness and visual impairment in the United States, according to Dr. Frederick Ferris III of the National Eye Institute, which helped fund the research.

The data are crucial for showing where research dollars need to be spent to avoid a "tidal wave of chronic ocular disease over the next few decades," Ferris and Johns Hopkins University researcher James Tielsch wrote in an accompanying editorial.

Currently, 1 million Americans over 40 are blind. They are among 3.3 million who suffer from some vision loss, a number projected to reach 5.5 million by 2020.

The numbers are of concern not just because of their magnitude, but also "because of the substantial increases in health care costs they spell," said Dr. Nathan Congdon, a coordinator of the research and an associate professor of ophthalmology at Johns Hopkins.

More than $3 billion yearly is spent on cataract treatment alone, which usually involves surgery, Congdon said. Cataracts are cloudy areas that develop on the eye's lens and can result from injuries or age-related chemical changes.

Macular degeneration involves damage to the macula, the center of the retina at the back of the eye. About 1.8 million adults are affected, the researchers said. In some cases, light-sensitive cells in the macula break down, gradually impairing vision. In others, leaky new blood vessels form behind the retina and cause vision loss.

Treatments include lasers or laser-activated drugs, and recent studies have shown that high doses of antioxidant vitamins can help slow or even prevent vision loss in macular degeneration.

Glaucoma affects about 2.2 million U.S. adults. It usually involves a buildup of fluid that normally bathes the eye, causing pressure that damages the optic nerve. Treatment includes eye drops and surgery.

Diabetic retinopathy, which involves eye damage resulting from blood vessels weakened by diabetes, affects about 4 million American adults. Laser therapy, surgery and better control of diabetes are among the treatments.

DATE: April 30, 2004

Researchers have determined there is no link between childhood vaccines and the development of diabetes, the latest study to find no such connection.

Using birth and medical registries, Danish researchers checked vaccination records and cases of Type 1 diabetes for the more than 739,000 children born between 1990 and 2000 in Denmark.

They found no more cases of Type 1 diabetes among vaccinated children compared with unvaccinated children. There also was no increase seen in children with a sibling with diabetes, who are at higher risk of developing the disorder, the researchers reported in the April 1, 2004, edition of New England Journal of Medicine.

Type 1 diabetes is increasing in developed countries, where childhood immunization is widespread. That is one of the main reasons some have proposed a link.

"This study will, one hopes, be the last one that is necessary to disprove an association between immunizations and diabetes," Lynne L. Levitsky, MD, of Harvard Medical School said in a commentary in the journal.

Type 1 diabetes, also known as juvenile diabetes or insulin-dependent diabetes, mostly afflicts young children. Because their pancreas produces little or no insulin, they need to take insulin daily. There is no known cause, but genetic and environmental factors may play a role.

The Danish children were vaccinated against eight diseases on a schedule similar to that in the United States, said Mads Melbye, MD, one of the researchers at the Statens Serum Institut in Copenhagen. He said Denmark's vaccination records are particularly good because doctors aren't paid for giving the shots until they report them to a registry.

"This really reemphasizes that vaccines are generally very safe and they are extremely important," Melbye said.

U.S. recommendations now call for children to be protected against 11 diseases.

DATE: April 23, 2004

Dick Clark disclosed publicly for the first time that he has type 2 diabetes. Mr. Clark, known as "America's oldest teenager," was first diagnosed with type 2 diabetes in 1994 but kept the news private until now. In support of this announcement, Mr. Clark is joining the American Association of Diabetes Educators (AADE) to launch Diabetes: Know the Heart Part, a national public education campaign to alert Americans to the fact that diabetes and heart disease are closely related. The diabetes and heart disease education campaign is supported by Merck & Co., Inc.

"I've previously shared with folks my personal experience with managing my risk factors for heart disease and now I want people to know that having type 2 diabetes also puts them at an increased risk for a heart attack and stroke," Mr. Clark said.

"The Diabetes: Know the Heart Part campaign message is clear: if you have diabetes, know you are at an increased risk for heart attack and talk to your healthcare provider about managing your risk factors for heart disease."

An estimated 18.2 million Americans have diabetes, yet more than two-thirds of people with diabetes surveyed by the American Diabetes Association (ADA) were unaware they faced an increased risk of heart attack and stroke. Compared to adults without diabetes and heart disease, adults with diabetes are at an increased risk of heart attack or stroke - even if their cholesterol is normal. Moreover, adults with diabetes also have the same risk of having a heart attack as adults without diabetes who have already had a heart attack.

"Most adults with diabetes were unaware of their risk for heart disease according to the ADA survey, but research shows it's the leading cause of death among adults with diabetes," said Virginia Zamudio, RN, MSN, CDE, president of the American Association of Diabetes Educators. "Adults with diabetes need to know that along with working with their healthcare provider to help manage their blood sugar level, it is also important to work with their healthcare provider to help manage their risk for heart disease."

Ms. Zamudio also called attention to the latest guidelines from the ADA, which recommend that for adults with diabetes, LDL cholesterol (the "bad" cholesterol) should be less than 100 mg/dl. High blood pressure is also common in adults with diabetes, which substantially increases the risk of stroke and other cardiovascular complications. For adults with diabetes, ADA guidelines recommend a blood pressure goal of less than 130/80 mmHg.

As for Mr. Clark, despite having diabetes, he shows no signs of slowing down either personally or professionally. He continues to produce top awards shows such as the "Golden Globes" and the "American Music Awards" and is the executive producer of the popular family drama, "American Dreams."

"I've made some important changes in my life, and my doctor has me eating healthy, and I exercise regularly, both of which help manage my risk for heart disease," Mr. Clark said. "I encourage others with diabetes to work with their healthcare professional to help manage their risk for heart disease."

Mr. Clark, 74 years old but long known as "America's oldest teenager," will tour major U.S. cities in partnership with community Diabetes Educators over the next several months for Diabetes: Know the Heart Part. As he crisscrosses the country, he will share his personal experiences in dealing with diabetes and the risk for heart disease. Leading by example, he will encourage Americans who have diabetes to talk with their healthcare provider about how they can help manage their risk for heart disease.

Consumers can order a free copy of Diabetes: Know the Heart Part brochure, which includes strategies for helping to manage diabetes and the risk of heart disease by calling toll-free 1-800-224-4089 or logging onto www.knowtheheartpart.com.