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DATE: July 23, 2010

Labels on the popular insulin pen used by people with diabetes warn against visually-impaired people using pens to measure out and administer their insulin dosage. A Case Western Reserve University (CWRU) pilot study from the Frances Payne Bolton School of Nursing overturns that thinking, finding that visually impaired people actually did slightly better than their seeing peers, although the difference was not statistically significant.

Ann S. Williams, the lead investigator of the study, "A Comparison of Dosing Accuracy: Visually Impaired and Sighted People Using Insulin Pens," speculates, based on observations of individuals in the study, that the reason behind the poor performance of certain individuals in the sighted group is that some glossed over important instructions about how to use the pen. In contrast, individuals with sight problems listened, step by step, to complete audio instructions before using the pen in the study. Sixty people participated in the study. This is one of the first research projects on insulin dosage to include participants who are visually impaired.

According to the Centers for Disease Control and Prevention, 23.6 million people in the United States—7.8% of the population—have diabetes. Among the 17.6 million with diagnosed diabetes, 3.6 million, or about 20 percent have visual impairment. The results were published in the Journal of Diabetes Science and Technology. Besides the inherent importance of these results to visually impaired persons with diabetes, this study also demonstrates the importance of including people with disabilities in research. CWRU has established the FIND Lab, a National Institutes of Nursing Research/National Institute of Health-funded center to promote Full Inclusion of Persons with Disabilities (FIND) in Research. It is part of the nursing school's SMART Center, funded by the NIH to find ways to promote better self-management of an individual's healthcare.

Although insulin pens are manufactured by a number of companies and have been on the market since the 1980s, Williams found no research literature available that supported the disclaimer that blind people cannot accurately use the insulin pens when they receive complete instructions in a format they can use. In 2008, the National Federation for the Blind passed a resolution calling for removal of the disclaimer against the use by blind people. "This resolution emphasized the real–world importance of rigorous investigation of the accuracy of insulin dosage by visually impaired people using non-visual techniques," Williams reported. As a diabetes educator, Williams knew visually impaired people were successfully using the pen with accuracy but needed the scientific research to support her observations. During the 2009 National Federation for the Blind meeting in Detroit, Williams recruited 30 individuals who have vision problems that prevent them from reading printed instructions. They were given complete recorded instructions. She also enrolled 30 individuals from Cleveland, Ohio, who could see and read the pen's directions. Each participant first read instructions or listened to an audiotape about how to use the insulin pen. The instructions were essentially the same as those included on printed sheets in the insulin pen packaging, modified slightly to include tactile methods for using the pens. Then each participant measured out 10 doses of insulin and injected them into a rubber ball. The ball was weighed immediately before and after the insulin injections for dosage accuracy.

Generally there was little difference between the two groups in the accuracy of 600 dosages of insulin—although Williams reports the visually impaired group did slightly better. For people with sight problems, measuring and administering insulin presents challenges, since most tools and techniques were designed assuming that people have good vision. "People with visual impairment can manage their own insulin accurately when they have access to nonvisual tools and techniques and complete instructions in a format they can use," Williams said. "This study raises questions about the validity of the disclaimer that pharmaceutical companies put on the labels," Williams said. She added that if studies are designed correctly, people with disabilities can participate in research projects that impact their health.

DATE: July 16, 2010

Adding a continuous blood sugar level sensor to an insulin pump helps patients with type 1 diabetes achieve better blood sugar control compared to the common standard of care, multiple daily insulin injections, concludes a study published online in the New England Journal of Medicine.

The paper is entitled, Effectiveness of Sensor-Augmented Insulin-Pump therapy in Type 1 Diabetes. "Combining the best technologies for insulin delivery and blood sugar monitoring really pays off for diabetes control," says Dr. Bruce Perkins, one of the co-authors of the study, endocrinologist at Toronto General Hospital and Assistant Professor at the University of Toronto. "Being aware of continuous blood sugar trends and having the tools to do something about them can help committed patients of all ages self-manage their diabetes very well." Research conducted at 30 centers across North America, including Toronto General Hospital, found a significant decrease in average blood sugar levels (or A1c levels, which measure the average blood sugar levels over the past two or three months) from a baseline of 8.3% to 7.5% in the group using sensors and insulin pumps, compared to 8.3% to 8.1% in the multiple daily injection group, at one year. The decrease in A1c levels in both adults and children occurred without an increase in the rate of severe hypoglycemia, or low blood sugar, a common problem among patients who are trying to achieve better control of their blood sugar. Symptoms include shakiness, rapid heartbeat, confusion and even unconsciousness.

Moreover, the proportion of participants who reached the A1c target of 7% or less was greater in the pump-therapy group than in the injection-therapy group. Adults with diabetes try and maintain A1c levels of seven percent or below in order to reduce the risk of complications from diabetes, such as kidney failure, heart disease and blindness.

The 485 study participants with inadequately controlled type 1 diabetes ranged in ages from seven to 70, and were treated for at least one year, in a randomized, controlled trial.

In the study, patients in the sensor-augmented pump therapy arm used an integrated system which incorporates an insulin pump, continuous glucose monitor and self-management software. A glucose (sugar) sensor reveals fluctuations in glucose levels in real-time, and transmits electric signals wirelessly to the insulin pump, which is about the size and shape of a small cell phone. The pump displays the blood sugar levels, allowing patients to react to either high or low levels before they become dangerous.

The study was sponsored by Medtronic, Inc.; and supported by Novo Nordisk; Lifescan; Bayer Healthcare; and Becton Dickinson.

DATE: July 09, 2010

City of Hope researchers have found that bone marrow transplantation with islet cell transplantation shows promise as a treatment for late-stage Type 1 diabetes. Islet cells come from the pancreas. The cells from this combination of treatments could enable diabetics to once again make their own insulin. Results from laboratory research, led by Dr. Defu Zeng, an associate professor in the departments of Diabetes Research and Hematology & Hematopoietic Cell Transplantation at City of Hope in Duarte, were published online this month in the journal "Diabetes." In Type 1 diabetes, patients' immune cells mistakenly attack insulin-producing cells in the pancreas, decimating the cells and leaving patients without enough insulin to function.

More than 23.6 million people in the United States have been diagnosed with diabetes, and an estimated 5 to 10 percent of these individuals have Type 1 diabetes, according to the American Diabetes Association. One investigational therapy for severe Type 1 diabetes is islet cell transplantation, a procedure in which physicians transplant donated islet cells into the patient's liver, where they can engraft, take root and produce insulin. Yet, there are several challenges to long-term islet transplantation success. Patients' immune cells may again attack the transplanted cells, and immunosuppressive medications sometimes keep the new cells from properly functioning. The liver also can be an inhospitable site for these transplanted cells. "Islet cell transplants usually only provide two to three years of insulin independence for most recipients," said co-lead author Dr. Miao Wang, a postdoctoral fellow in Zeng's lab. "We wanted to find a way to extend that insulin independence."

DATE: July 02, 2010

New research presented at the American Diabetes Association's 70th Scientific Sessions in Orlando, Florida on June 27, 2010 suggests that a medical food developed by Metagenics, Inc. called UltraMeal® PLUS 360° enhances the cardiovascular disease (CVD) risk-lowering benefits of a Mediterranean-style low-glycemic-load diet.

A team of researchers from the University of Florida College of Medicine in Jacksonville, FL compared the effects of two dietary interventions on CVD risk factors in 47 women with metabolic syndrome. In the 12-week, two-arm, randomized, parallel group study, participants received a Mediterranean-style, low-glycemic-load diet alone or in conjunction with UltraMeal PLUS 360°.

Both groups experienced improvements in the following markers of CVD risk:

• Improvements in total cholesterol, LDL-C, apolipoprotein B (apoB) and non-high density lipoprotein cholesterol (non-HDL-C) compared to baseline
• Reduction in total LDL particle number

The key ingredients in UltraMeal PLUS 360° are soy protein (shown to have cholesterol-lowering effects and which may be more beneficial than animal protein in reducing the risk of heart disease); plant sterols (shown to promote healthy cholesterol levels); and hops rho iso-alpha acids and acacia proanthocyanidins (which function as selective kinase response modulators).

DATE: June 25, 2010

German, Swedish and U.S. researchers said they found a lower rate of prostate cancer among people with diabetes. Study leader Kari Hemminki at Helmholtz Association of German Research Centres in Heidelberg said the researchers could only speculate about the causes. "Possibly, a lower level of male sex hormones in diabetics may be among the factors that are responsible for this," Hemminki said in a statement.

Hemminki and colleagues studied the cancer incidence in 125,126 Swedish citizens hospitalized due to type 2 diabetes complications as well as those of the general population in Sweden. They also found higher risks of several cancers in those with type 2 diabetes -- very significantly for pancreatic cancer and liver cell cancers. Diabetics also had double the risks of cancers of the kidneys, thyroid, esophagus, small intestine and nervous system.

The study, published in The Oncologist, also looked at whether the risk was higher in hospitalized diabetic patients because their tumors were found earlier due to routine diagnostics. The researchers separately analyzed how many cancers occurred in study participants after one and five years, respectively, following their hospital stays. This revealed a slightly lower risk elevation, but, the researchers concluded, the trend was the same.

DATE: June 18, 2010

A research team at Indiana University School of Medicine has identified two new potential protein targets for preventing diabetes.

According to the multi-institutional research team led by Raghu Mirmira, M.D., Ph.D., associate professor of pediatrics at the Indiana University School of Medicine, the two human proteins that evolutionary processes have conserved from ancient single-celled organisms appear to provide new targets of opportunity for scientists hoping to thwart the development of diabetes.

In experiments using diabetes-prone mice, blocking the actions of the proteins significantly reduced the development of diabetes in the mice.

The findings appear in the June 2010 issue of the Journal of Clinical Investigation.

Diabetes can occur when the body is unable to produce enough insulin, or when it loses its ability to respond properly to the production of insulin, a hormone the body uses to convert food into energy. No matter the cause, research suggests that inflammatory processes contribute to the development of diabetes.

One of the proteins targeted in the research, eIF5A, is believed to be involved with inflammation processes, but its activities had not been studied in the pancreas islet cells that produce insulin. The research team looked at eIF5A because its corresponding gene sits near other inflammation-related genes in both the mouse and human genomes, said Dr. Mirmira, director of the Pediatric Diabetes Research Group at the Herman B Wells Center for Pediatric Research, on the campus of Indiana University-Purdue University, Indianapolis.

"Because it sat in a hotbed of inflammatory genes, and because many of these inflammatory genes are known to be important in the progression of diabetes, we thought eIF5A might also have role in the progression of diabetes," Dr. Mirmira said.

But eIF5A doesn't act on its own. Instead, another protein, an enzyme called DHS, is necessary to activate eIF5A - in fact it appears that the sole role of DHS is to activate eIF5A.

"So our underlying premise was that if eIF5A is crucial in inflammation, and DHS is crucial in activating eIF5A, then inhibiting DHS should block eIF5A," Dr. Mirmira said.

The researchers used two different approaches to block the activity of eIF5A. In one, they constructed a special genetic molecule called a small interfering RNA - siRNA - designed to disrupt the production of eIF5A in the islet cells within a living mouse. The second approach used a compound, GC7, that inhibits the production of DHS. Both approaches gave similar results-that the development of diabetes can be blocked in a mouse-but the DHS approach seems to offer a more promising route to possible treatments. (ANI)

DATE: June 11, 2010

Military service members with symptoms of post-traumatic stress disorder (PTSD) are more likely to develop diabetes than their counterparts without PTSD symptoms, results of a new study hint.

While previous research has suggested that depression increases the risk of diabetes, the new study of more than 44,000 active duty service members suggests another stronger association.

"In our analyses, depression really was not significantly related to the increased risk of diabetes but PTSD was," lead author Dr. Edward J. Boyko of the Department of Veterans Affairs Puget Sound Health Care System in Seattle, Washington told Reuters Health.

PTSD is an anxiety disorder that can develop after exposure to a frightening event or ordeal in which grave physical harm occurred or was threatened. Events that may cause PTSD include violent personal assaults, naturally or human-caused disasters, accidents or military combat.

People with PTSD can have a number of symptoms including persistent frightening thoughts and memories of the trauma or they may feel emotionally numb, especially with friends and loved ones. Sleep problems, detachment and an exaggerated startle response are other common symptoms.

It's possible that the stress response associated with PTSD could contribute to widespread inflammation in the body and lower sensitivity to the blood-sugar-regulating hormone insulin, which could lead to diabetes, researchers say.

Boyko and colleagues examined the health status of 44,754 service members who did not have diabetes when they were initially enrolled in the Department of Defense's large ongoing Millennium Cohort Study. Three years later, 376 study participants -- or about 3 per 1000 -- reported they had been newly diagnosed with diabetes.

Those who developed type 2 diabetes (the kind closely linked to obesity) were much older than those who did not. They were also more apt to be overweight or obese, African American or Asian, male, to have PTSD symptoms and to be no longer with the military.

When the researchers factored out age, gender, body weight, race, and other variables that might increase the risk of diabetes (as well as military service characteristics and other mental health conditions), only PTSD symptoms remained significantly associated with an increased risk of diabetes. The risk of diabetes was more than twofold higher in the presence of PTSD symptoms.

In the journal Diabetes Care, Boyko and colleagues emphasize that their study has several limitations. For instance, the presence of diabetes or PTSD or any of the other conditions studied were self-reported by the participants and not medically confirmed. In addition, there may be a bias in favor of detecting diabetes in people being treated for PTSD, the researchers say.

The findings don't explain why there may be a link between PTSD and diabetes. It's possible, for instance, that drugs prescribed for PTSD, or some other factor not studied, could raise the risk of diabetes.

It's estimated that more than 23 million, or nearly 11 percent, of US adults aged 20 and older have type 2 diabetes. And a recent study found that more than one-third of US veterans seen at VA hospitals after serving in Iraq or Afghanistan were found to have PTSD or another mental health disorder.

Before doctors are encouraged to screen for diabetes in people who suffer from PTSD, the findings need to be confirmed, Boyko told Reuters Health.

"The American Diabetes Association has recommendations about when someone should be screened for diabetes, and right now we don't need to add PTSD to that," he said.

DATE: June 04, 2010

People who get plenty of vitamin K from food may have a lower risk of developing type 2 diabetes than those who get less of the vitamin, a new study suggests.

Researchers found that among more than 38,000 Dutch adults they followed for a decade, those who got the most vitamin K in their diets were about 20 percent less likely to be diagnosed with type 2 diabetes during the study period.

The findings appear to be the first to show a relationship between vitamin K and diabetes risk, and do not prove that the vitamin is the reason for the lower risk, write the researchers, led by Dr. Joline W.J. Beulens of the University Medical Center Utrecht in the Netherlands.

Instead, they add, the results should fuel further research into whether vitamin K does play a role in the development of type 2 diabetes.

It's estimated that more than 23 million, or nearly 11 percent, of U.S. adults have type 2 diabetes. The most important risk factors for type 2 diabetes include older age, obesity, family history of diabetes and race -- with black, Hispanic and Native Americans at higher risk than whites in the U.S. The extent to which specific nutrients in the diet might affect diabetes risk remains unclear.

Vitamin K exists in two natural forms: vitamin K1, or phylloquinone, found largely in green leafy vegetables, as well as some vegetable oils, such as canola and soybean oils; and vitamin K2, or menaquinone, which people get mainly through meat, cheese and eggs.

In the current study, both vitamins K1 and K2 were related to a lower diabetes risk, but the relationship was stronger with vitamin K2.

The findings, reported in the journal Diabetes Care, are based on questionnaires from 38,094 men and women who were between the ages of 20 and 70 at the outset. Participants completed a detailed diet survey, from which each person's average vitamin K intake was estimated; they also answered questions on their overall health and lifestyle habits.

Over the next 10 years, 918 study participants were diagnosed with type 2 diabetes, based on their medical records.

In general, Beulens and her colleagues found, the risk of developing type 2 diabetes dipped for every 10-microgram (mcg) increase in vitamin K2 intake. Overall, the one-quarter of participants with the highest intake were 20 percent less likely to be diagnosed with diabetes than the one-quarter with the lowest intake.

With vitamin K1, no decreased risk was seen until consumption of the vitamin was relatively high. Similar to the findings with vitamin K2, the one-quarter of men and women who got the most vitamin K1 were 19 percent less likely to develop diabetes than the quarter with the lowest intake.

The researchers accounted for a number of other factors important in diabetes risk, including age, body weight and exercise habits. They also considered other dietary habits, like total calorie intake and consumption of certain other nutrients, like fat, fiber and vitamins C and E.

Still, higher vitamin K intake, itself, was linked to a lower diabetes risk.

Exactly why the vitamin might be protective is not known. However, Beulens and her colleagues note, there is evidence that vitamin K reduces systemic inflammation, which may improve the body's use of the blood-sugar-regulating hormone insulin.

More research, they say, is needed both to confirm these findings and to study the potential underlying reasons.

In the U.S., the recommended daily intake for vitamin K, in all forms, is 120 mcg for men and 90 mcg for women. In this study, participants with the highest intakes typically consumed between 250 and 360 mcg of total vitamin K each day.

DATE: May 28, 2010

Type 1 diabetes is an autoimmune disease, in which the patient’s immune system attacks the beta-cells in the pancreas which normally produce insulin. Without insulin, blood sugar levels rise and damage many parts of the body. Therefore, the patient with type 1 diabetes is dependent on insulin, either by injection or by pump, for life.Type 1 diabetes often leads to complications like kidney failure, blindness and heart disease, despite insulin treatment.

In a new approach to type 1 diabetes, the US biotechnology company XOMA has been developing an antibody that blocks interleukin-1-beta, a molecule involved in the destruction of beta-cells by an inflammatory process. There is recent evidence that the destruction of beta-cells continues during the course of type 1 diabetes. If this could be stopped, through this antibody’s action, then maybe the beta-cells could regenerate normal function. A Phase II clinical trial of the antibody has just been launched, backed by the Juvenile Diabetes Research Foundation International, the largest patient advocacy organization for type 1 diabetes in the world. The trial will involve 24 patients with type 1 diabetes, who will receive either the XOMA antibody or a placebo and will have the impact on beta-cell functioning and insulin production monitored over six months. This is the first ever clinical trial to set out to show the impact of reducing inflammation on the course of type 1 diabetes.

DATE: May 21, 2010

Researchers have identified the gene changes in whose activity due to stress cause anxiety disorders and depression, as well as metabolic disorders like obesity, type 2 diabetes and arteriosclerosis. These diseases, linked to stress, are reaching epidemic proportions. Alon Chen of the Weizmann Institute's Neurobiology Department and his research team have now discovered that changes in the activity of a single gene in the brain not only cause mice to exhibit anxious behaviour but also lead to metabolic changes that cause the mice to develop symptoms associated with type 2 diabetes.

All of the body's systems are involved in the stress response, which evolved to deal with threats and danger. Behavioural changes tied to stress include heightened anxiety and concentration, while other changes in the body include heat generation, changes in the metabolism of various substances and even changes in food preferences. What ties all of these things together? The Weizmann team suspected that a protein known as Urocortin-3 (Ucn3) was involved. This protein is produced in certain brain cells, especially in times of stress, and it is known to play a role in regulating the body's stress response. The researchers developed a new, finely-tuned method for influencing the activity of a single gene in one area in the brain, using it to increase the amounts of Ucn3 produced in just that location.

They found that heightened levels of the protein produced two different effects: The mice's anxiety-related behaviour increased, and their bodies underwent metabolic changes as well. With excess Ucn3, their bodies burned more sugar and fewer fatty acids, and their metabolic rate sped up. These mice began to show signs of the first stages of type 2 diabetes. A drop in muscle sensitivity to insulin delayed sugar uptake by the cells, resulting in raised sugar levels in the blood. Their pancreas then produced extra insulin to make up for the perceived 'deficit'. 'We showed that the actions of single gene in just one part of the brain can have profound effects on the metabolism of the whole body,' says Chen. This mechanism points the way toward the treatment or prevention of a number of stress-related diseases, a Weizmann Institute release says. The findings were published online in the Proceedings of the National Academy of Sciences (PNAS).

DATE: May 14, 2010

A year after President Barack Obama eased restrictions on research into embryonic stem cells and pledged billions in new stimulus money for it, researchers are almost giddy with enthusiasm about progress in the field. They're confident stem cells will treat — maybe someday cure — heart disease, diabetes, spinal cord injury and other disorders.

But the excitement is not generated by stem cells harvested from human embryos. Instead, researchers are coming to believe they can get results almost as good from adult stem cells taken from the patient's own bone marrow or belly fat, and even full-fledged adult cells from muscle tissue or skin. "Adult stem cells have more flexibility than we thought," says Dr. Joshua Hare, director of the Interdisciplinary Stem Cell Institute at the University of Miami Medical School. "The embryonic stem cell might not be the most valuable property in actual therapy. When you're treating a heart attack, you might do better with an adult stem cell." Already at the UM Medical School, adult stem cells have been injected around a patient's heart to help heal a heart attack, and adult cells are being applied around injured spinal cords in hopes of restoring movement. Another new development exciting researchers is the "induced pluripotent adult stem cell." Scientists at Harvard and in Japan took cells from the skin on a patient's arm and genetically reprogrammed them to be almost as flexible as embryonic stem cells — without destroying an embryo. They hope to use them someday to build up entire human organs, cell by cell.

DATE: May 07, 2010

As the U.S. population keeps aging and gaining weight, diabetes is becoming increasingly common. Some research has associated diabetes with the most common kind of chronically irregular heartbeat, called Atrial Fibrillation, which can raise the risk for stroke and death. But results of past studies of diabetes and atrial fibrillation have conflicted. Now in the Journal of General Internal Medicine Dr. Sascha Dublin of Group Health Research Institute has linked diabetes to a 40 percent greater risk of developing atrial fibrillation; and she found this risk rises higher the longer people have diabetes and the less controlled their blood sugar is.

For three years, Dr. Dublin and her colleagues tracked more than 1,400 Group Health patients who had newly recognized atrial fibrillation. They compared these "cases" with more than 2,200 "controls." The controls were matched to the cases by age, sex, year, and whether they were treated for high blood pressure; but unlike the cases, they had no atrial fibrillation. Dr. Dublin's study was the first to examine the relationship between atrial fibrillation and the duration of patients' diabetes and their blood sugar levels. Unlike most prior studies, this one also adjusted for patients' weight, which is important because both diabetes and atrial fibrillation are more common in heavier people. Here is what she found:

• Patients with diabetes were 40 percent more likely to be diagnosed with atrial fibrillation than were people without diabetes.
• The risk of atrial fibrillation rose by 3 percent for each additional year that patients had diabetes.
• For patients with high blood sugar (glycosylated hemoglobin, also known as HBA1c more than 9 percent), the risk of atrial fibrillation was twice that for people without diabetes.
• But patients with well-controlled diabetes (HBA1c 7 percent or less) were about equally likely to have atrial fibrillation as people without diabetes.

About one in 100 people-and nearly nine in 100 people over age 80-have atrial fibrillation, according to Dr. Heckbert, a professor of epidemiology and scientific investigator in the Cardiovascular Health Research Unit at the University of Washington (UW) and an affiliate investigator at Group Health Research Institute. In many cases, atrial fibrillation has no symptoms, and it is not necessarily life threatening. But it can cause palpitations, fainting, fatigue, or congestive heart failure. Atrial fibrillation can also make blood pool-and sometimes clot-in the atria. When parts of clots break off and leave the atria, they can lead to embolic strokes, as happens in more than 70,000 Americans a year.

DATE: April 30, 2010

A Study has found that bingeing on junk food is as addictive as smoking or taking drugs and can cause compulsive eating and obesity. American researchers found burgers, chips and sausages programmed a human brain into craving even more sugar, salt and fat laden food. Scientists at the Scripps Research Institute in Florida found laboratory rats became addicted on a bad diet just like people who became dependent on cocaine and heroin. While the findings cannot be directly transferred to human obesity, it found that overconsumption of high-calorie food triggered addiction-like responses in the brain. But the study, published online in Nature Neuroscience, suggests for the first time that our brains may react in the same way to junk food as it does to drugs.

Dr Paul Kenny, a neuroscientist who led the research, said the study, which took nearly three years to complete, confirmed the "addictive" properties of junk food. "Obesity may be a form of compulsive eating,” he said. “Other treatments in development for other forms of compulsion, for example drug addiction, may be very useful for the treatment of obesity. "The new study explains what happens in the brain of these animals when they have easy access to high-calorie, high-fat food.” He added: "It presents the most thorough and compelling evidence that drug addiction and obesity are based on the same underlying neurobiological mechanisms.”

In the study, the research team divided the animals into three groups. One got normal amounts of healthy food to eat, another was given restricted amounts of junk food and the third had unlimited amounts of cheesecake, fatty meat products, cheap sponge cakes and chocolate snacks. There were no adverse effects on the first two groups. But the rats which ate as much junk food as they wanted quickly became very fat and started bingeing. When researchers electronically stimulated the part of the brain that feels pleasure, they found the rats on unlimited junk food needed even more stimulation to register the same level of pleasure as the animals on healthier diets. "They always went for the worst types of food and as a result, they took in twice the calories as the control rats,” said Dr Kenny. "When we removed the junk food and tried to put them on a nutritious diet – what we called the 'salad bar option' – they simply refused to eat. "The change in their diet preference was so great that they basically starved themselves for two weeks after they were cut off from junk food." Dr Kenny said the research supported what obese patients have been saying for years that, like addiction to other substances, junk food bingeing is extremely difficult to stop. In the rats, the development of obesity coincided with a progressively deteriorating chemical balance in the circuitry of the brain responsible for reward. As these pleasure centres become less and less responsive the animals quickly develop compulsive overeating habits, consuming larger quantities of high-calorie, high-fat foods until they become obese. The very same changes occur in the brains of rats that over consume cocaine or heroin, and are thought to play an important role in the development of compulsive drug use. The scientists fed the rats a diet modeled after the type that contributes to human obesity easy to obtain high-calorie, high-fat foods. Soon after the experiments began, the animals began to bloat. Latest figures show that one in four people in Britain are obese with married people twice as likely to become obese than their single counterparts. Eight in 10 men and almost 7 in 10 women will be overweight or obese by 2020. Cases of devastating health conditions like heart disease, diabetes and stroke will increase with the nation’s waistlines, the recent Government-commissioned Foresight report warned.

DATE: April 23, 2010

People with diabetes do much better, in terms of survival, if they can turn to others for support in times of need, new research suggests. The study found that those who are more independent and feel they don't need help from others have a 33 percent increased risk of dying over a five-year period. "These are self-reliant, pull-yourself-up-by-your-bootstraps, self-starters and go-getters. But, in the health-care setting with a chronic illness, what is normally an advantage can become a liability over time," said Dr. Paul Ciechanowski, an associate professor in the department of psychiatry and behavioral sciences at the University of Washington School of Medicine. "Day-in, day-out, when you have the mortgage to pay, the kids to get to soccer, work deadlines, medications to take and refill, exercise that needs to be done, healthy food that needs to be cooked, and doctors' appointments, it all starts to break down if you're trying to do it all on your own," he said. "And, the health-care system is one size fits all, so people like this fall through the cracks. They may get labeled as difficult patients, when the truth may be that they're overwhelmed but have a hard time reaching out and trusting. People who are comfortable collaborating well are the ones who do best in our health-care system," noted Ciechanowski.

Previous research has found that people who have chronic illnesses, including diabetes, who lack a good support system are more likely to die, according to background information in the study. Ciechanowski and his colleagues wanted to expand on past research and see what effect personality type had on the risk of mortality in the presence of chronic illness. To do this, they recruited 3,535 non-depressed adults with either type 1 or type 2 diabetes. All of the study volunteers were part of a health maintenance organization in Washington state. The researchers found that 53.8 percent of the study participants had an interactive relationship style, meaning that they had a greater propensity to reach out to others, according to the study. The remainder -- 46.2 percent -- had an independent relationship style. These people have difficulty reaching out to others and may have a hard time trusting other people, the study found. The death rate for those in the interactive group was 29 per 1,000 individuals, compared to 39 per 1,000 in the independent group. That means independent people have a 33 percent increased risk of death, according to the study.

Results of the study were published in the March issue of Diabetes Care. "Much of this study is quite intuitive," said Dr. Vasudevan Raghavan, director of the cardiometabolic and lipid clinic, and the medical weight management service at Scott & White Healthcare in Temple, Texas. "Having a support system provides additional incentive to do the right thing. For example, if you have a mother who visits or calls frequently, she may remind you to get to your doctor's appointment and refill your medication, which prompts you to do it." Raghavan said one finding that was particularly telling was that even though people with an interactive style had a higher body mass index (BMI), they still had a lower risk of death. Normally, a higher BMI in people with diabetes would tend to be associated with a higher risk of death. (BMI is a measurement that takes into account a person's height and weight.) Unfortunately, Raghavan said, "you can't provide a social prescription. You can't mandate that people reach out to or live with others." Both Ciechanowski and Raghavan said these findings should prompt doctors to try to consider a person's relationship style in treatment. "We need to develop different approaches for people who aren't able to collaborate. Often, they'd love extra help, but are afraid to reach out," said Ciechanowski. Possible options are e-mails, telephone calls or appointments with other health-care professionals, he said.

DATE: April 16, 2010

With diabetes affecting more people under the age of 50 than ever before, researchers at Ohio State found that newer, more expensive medications result in a lower risk of hospitalization and lower overall healthcare costs. A new study concluded that patients with type 2 diabetes who took thiazolidinediones are more likely to take their medications as prescribed and are hospitalized less often. TZDs can cost as much as 10 times that of generic versions of medications currently on the market. "Use of medicine as prescribed by physicians can actually curb healthcare costs," said Rajesh Balkrishnan, lead author of the study and a Merrell Dow professor of pharmacy at OSU. "Medicine accounts for only 15 percent of total health care costs, yet (insurance companies) are quick to cut access to medicine."

Those who are uninsured, underinsured and those who are on Medicaid have lesser access to new medications, which cost more because there is no generic version available. Newer drugs often have fewer side effects, control symptoms faster and are more popularly prescribed to patients, Balkrishnan said. The result is fewer hospital visits. Many patients wait until acute symptoms force them to the emergency room where costs can add up quickly, he said. "People diagnosed with diabetes account for enormous economic burden on the health care system," said Rahul Shenolikar, a graduate research associate and co-author of the study. "We feel that these are avoidable and that appropriate interventions can reduce costs and save some money for the diabetics, and these resources can be used in other healthcare areas. With this feeling in mind, we conducted this study."

Participants who took TZDs saved between $920 and $1,760 annually versus those taking the older medications. The total costs included all medications, physician charges, hospital and emergency room visits. The results also showed a 10 percent reduction in the likelihood of hospitalization for those taking TZDs. People diagnosed with type 2 diabetes are insulin resistant. Blood sugar levels remain high because the body cannot use the insulin that it makes. Older medications, such as metformins, lower blood sugar levels in the body while the newer TZDs work with the body to make cells more receptive to insulin. Generic metformin may cost patients as little as $10 per month compared to as much as $100 per month for a brand name TZD. Diabetics are at increased risk for heart disease, cardiovascular disease, blindness and amputation due to infection. Lifestyle factors, such as diets high in fat and sugar, lack of exercise and obesity along with a genetic predisposition, have led to increases in diabetes diagnosis. Another factor affecting the rate of increase in diabetes is "lower patient awareness and less of a preventative health mentality," Balkrishnan said. "(Diabetes) runs in my family. I think about it, but not every day," said Moni Woods, a post-graduate student in English. "But, I try not to eat a lot of sugar, white starch or sodas." Alcohol also has an effect on a person with diabetes. Moderate amounts of alcohol should not cause much concern, but excessive drinking can interfere with the body's ability to release sugar into the bloodstream when necessary, Balkrishnan said. Drinking can also hinder one's ability to recognize the signs that his blood-sugar level is elevated or has dropped to the point of having a hypoglycemic episode. Slurred speech, blurred vision, feelings of dizziness and confusion characterize both hypoglycemia and intoxication. To reduce the risk of developing diabetes Balkrishnan suggests losing weight, eating right and getting moderate exercise.

DATE: April 09, 2010

Among individuals with prediabetes and undiagnosed diabetes, millions may have chronic kidney disease and not know it, new research has found. In the study, researchers looked at a nationally representative sample of about 8,200 people included in the National Health and Nutrition Examination Survey and found that 42 percent of those with undiagnosed diabetes had chronic kidney disease, similar to the 40 percent rate in people with diagnosed diabetes. Only a small percentage of people with undiagnosed diabetes and chronic kidney disease knew that they had kidney disease, said study author Laura C. Plantinga, of the University of California, San Francisco. She and her colleagues also found that nearly 18 percent of people with prediabetes had chronic kidney disease, according to the report scheduled to be published in an upcoming issue of the Clinical Journal of the American Society of Nephrology.

The rate of chronic kidney disease among people without diabetes or prediabetes was about 11 percent, they noted. "Based on these results, there may be a substantial number of individuals in the United States -- up to 13 million -- who have undiagnosed diabetes or prediabetes and who already have signs of kidney damage and/or reduced kidney function," Plantinga said in a news release. "Persons at risk for diabetes and their health-care providers should be aware that earlier screening for both diabetes and kidney disease may be warranted," Plantinga added. "Earlier screening would allow for appropriate, timely medical care to prevent further progression and poor outcomes."

DATE: April 02, 2010

Diabetes is spiraling in Asia but with in a different way. Over 285 million people are affected by diabetes and these numbers are predicated to rise to 438 million by the year 2030. A majority of 50 to 60 percent of these patients will be from the Asian Continent.

These facts were presented last week at the two-day DASG (Diabetes in Asia Study Group) International Conference in Qatar which is calling for Asian-oriented research and studies on diabetes. “DASG was established to promote awareness of diabetes, to encourage research in the field of diabetes and related disorders, to promote exchanges of opinions and to foster advocacy for the benefit of the Asian people which can lead to better strategies for diagnosis, care and prevention of diabetes,” said Dr Abdullah Al Hamaq, Executive Director, Qatar Diabetes Association. “The conference is held at a critical time when there is a rapid rise in the incidence of diabetes in Asia. We will share together the latest scientific data on diabetes from the Asian Continent as well as other parts of the world.” Seven out of the top ten countries in terms of highest diabetes prevalence are in Asia. However, different form the Western population, most of the patients in the region are young. The age differential is so stark that diabetes most often affects people in the West at the age of 60 to 79 years, compared to the age range of 20 to 59 years in Asia. The majority of the diabetes cases in the continent have nothing to do with obesity, which is closely linked in the western population. “In most of the countries, a vast majority are poor and have lower rates of body fat. Hence following the western studies in case of medication, treatment and diagnosis is not what a doctor in the region should do. Doctors should not be following the western guidelines, instead they should make sure their patients get a safe, accessible and affordable treatment,” said Dr Shaukat M Sadikot, Vice President of International Diabetes Federation and President of Diabetes India.

Though Asian obesity rates are low, changing diets and sedentary lifestyles, associated with rapid economic development, is taking their toll, according to experts. The prevalence of diabetes in migrant of urbanized Asians including Indian, Arabs, Chinese, African and Hispanics is between 14 to 50 percent. with millions of people developing diabetes each year, experts have been stressing on primary prevention methods that look at avoiding the development of the disease. The focus at the conference was to be secondary prevention activities that are aimed at early disease detection, thereby increasing opportunities for interventions to prevent progression of the disease and emergence of symptoms. The conference included scientific contributions from different parts of the world, covering the latest information, treatment and developments in the field of Diabetes management.

DATE: March 26, 2010

If there were a pill that could add two decades to your life, would you swallow it? Not if you're like most people scientist Matt Kaeberlein asks — they see it as an invitation to purgatory. "Why would I want to be old for an extra 20 years?" they say. But when the University of Washington longevity researcher dangles the prospect that those extra years would be spent spry and hale, not enfeebled and ill, they listen up. The secret of slowing down human aging would be one of the greatest discoveries in medical history, says S. Jay Olshansky, a biodemographer at the University of Illinois at Chicago. While aging itself is not a disease, postponing it, he says, would simultaneously postpone the risk of our biggest scourges — cancer, heart disease, stroke, diabetes, Alzheimer's. What follows are three hot areas under investigation: cutting calories, developing drugs to mimic a lower-than-normal calorie diet, and deciphering the genetics of the oldest of the old.

Fewer calories

Hundreds of studies since the 1930s have shown that a below-normal intake of calories slows aging and greatly extends healthy life spans in organisms as simple as yeasts and as complex as rats. The journal Science recently reported that rhesus monkeys (our evolutionary cousins) whose daily calories were reduced 30 percent for 20 years had one-third the risk of developing age-related illnesses such as diabetes, cancer, heart disease and brain deterioration compared with normally fed monkeys. That suggests "quite convincingly" that their aging is being slowed, says Richard Weindruch, a professor of medicine at the University of Wisconsin, whose group is leading the ongoing study.

Mimetic drugs

A few years ago, the happy prospect of a pill that would make the body behave as if it was being deprived of calories burst into the headlines when researchers reported that a compound found in the skin of red grapes called resveratrol, when fed to fat mice on a high-calorie diet, seemed to counteract the ill effects of their gluttony without their having to lift a paw. The mice stayed fat but, compared with normally fed mice, they had better bones, heart function and physical performance, fewer cataracts and extra protection from diabetes. They also lived about 25 percent longer than overstuffed mice usually do. Resveratrol already was being sold as a supplement, and within weeks of the 2006 report in Nature, it was flying off the shelves even though there was no proof of the slightest benefit in people, says Rafael de Cabo, an investigator at the National Institute on Aging in Bethesda, Md., who was one of those conducting the research. "Everyone went bananas," he notes. A corresponding surge occurred in sales of red wine, although the beneficial mouse doses were tantamount to 1,000 or so glasses a day. When that sank in, the public frenzy ebbed. Resveratrol's lasting legacy may turn out to be a better understanding of a family of enzymes called sirtuins. Both resveratrol and calorie restriction seem to act at least in part by activating these enzymes, which "regulate the body's defenses against aging and disease," says David Sinclair, a professor of pathology at Harvard Medical School who collaborated with de Cabo on the mouse study.

Clues from the very old

Living to 100 didn't get the warm reception Thomas Perls had expected when his book came out in 1999 ("Living to 100: Lessons in Maximizing Your Potential at Any Age"). He thinks the public assumed that anyone that old "must be in terrible shape." But Perls, who directs the New England Centenarian Study, has found that the vast majority of the centenarians in his sample are doing surprisingly well. Most are free of disabilities until the end of their lives — even those contending with significant age-related ailments, like heart disease. And the 1 out of 7 million people who reach the "supercentenarian" age of 110 and beyond (there are 85 in his study) seem to dodge not only the effects of age-related conditions but the illnesses themselves. Or if they do become ill at the end of their lengthy lives, they quickly die rather than languishing in declining health.

What's the secret of the oldest old? "Our hypothesis is that centenarians get to be 100 because they have some protection against age-related disease and maybe against aging," says Nir Barzilai, director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York.

DATE: March 19, 2010

A new University of Illinois study touts the benefits of soluble fiber—found in oats, apples, and nuts, for starters—saying that it reduces the inflammation associated with obesity-related diseases and strengthens the immune system. "Soluble fiber changes the personality of immune cells—they go from being pro-inflammatory, angry cells to anti-inflammatory, healing cells that help us recover faster from infection," said Gregory Freund, a professor in the U of I's College of Medicine and a faculty member in the College of Agriculture, Consumer and Environmental Sciences' Division of Nutritional Sciences. This happens because soluble fiber causes increased production of an anti-inflammatory protein called interleukin-4, he said. The study will appear in the May 2010 issue of Brain, Behavior, and Immunity

In the experiment, laboratory mice consumed low-fat diets that were identical except that they contained either soluble or insoluble fiber. After six weeks on the diet, the animals had distinctly different responses when the scientists induced illness by introducing a substance (lipopolysaccharide) that causes the body to mimic a bacterial infection. "Two hours after lipopolysaccharide injection, the mice fed soluble fiber were only half as sick as the other group, and they recovered 50 percent sooner. And the differences between the groups continued to be pronounced all the way out to 24 hours," said Christina Sherry, who also worked on the study. "In only six weeks, these animals had profound, positive changes in their immune systems," she said. Now Freund has a new question: Could soluble fiber offset some of the negative effects of a high-fat diet, essentially immunizing obese persons against the harmful effects of fat? Scientists have long known that obesity is linked to inflammatory conditions, such as diabetes and heart disease. Yet, in a recent study, the U of I scientists demonstrated that fat tissue produces hormones that appear to compensate for this inflammation. "There are significant anti-inflammatory components in fat tissue and, if they were strategically unleashed, they could potentially protect obese people from further inflammatory insults, such as a heart attack or stroke. In obese animals, you can see the body compensating in an effort to protect itself," he said. Not all fat is bad, the researcher noted. The Mediterranean diet, which receives high marks for its health benefits, includes such foods as olive oil; salmon, tuna, sardines, and trout, which contain important omega-3 and -6 fatty acids; and plant sources of fat, such as flaxseed. "Now we'd like to find a way to keep some of the anti-inflammatory, positive effects that develop over time with a high-fat diet while reducing that diet's negative effects, such as high blood glucose and high triglycerides. It's possible that supplementing a high-fat diet with soluble fiber could do that, even delaying the onset of diabetes," he said. This study is one of the first to provide two valuable lessons, said Sherry. The first, already noted, is that soluble fiber has direct anti-inflammatory effects and builds up the immune system. The second is that the amount of soluble fiber necessary to achieve these health benefits is a reasonable, not a pharmacological, amount. The recommended daily dietary recommendation is 28 to 35 grams of total fiber, but most of the FDA's health claims are for insoluble fiber, and that's where things get a bit complicated, she said. "Not all fiber is created equal, although you wouldn't know that by reading nutrition labels," said Sherry. "Most manufacturers don't tell you how much of each type of fiber a food contains, and we think it's important that this information be included on a product's packaging." Good sources of soluble fiber are oat bran, barley, nuts, seeds, lentils, citrus fruits, apples, strawberries, and carrots. "We used a citrus-based pectin in our study," Sherry said. Insoluble fiber, found in whole wheat and whole-grain products, wheat bran, and green, leafy vegetables, is also valuable for providing bulk and helping food move through the digestive system, but it doesn't provide the boost to the immune system that soluble fiber provides.

DATE: March 12, 2010

Three years after going on a diet, obese men and women on low-carbohydrate "Atkins"-type plans had gained back nearly all their weight, while those on low-fat diets continued to lose, new research finds. Neither group ended up model-thin, however: Three years out, the low-carb dieters were a mere five pounds thinner and the low-fat group about 10 pounds slimmer than when they began. The study is published in the March 2 issue of the Annals of Internal Medicine.

In 2003, around the time the low-carb Atkins diet was all the rage, researchers from the University of Pennsylvania published research that found that obese men and women lost a lot more weight -- initially -- when on a low-carb versus a low-fat diet. At the six-month mark, obese dieters on the low-carb plan had lost about 13 pounds, compared to about 4.5 pounds on a low-fat diet. But what about keeping the weight off long-term? The new study suggests that as time goes on, low-carbohydrate regimens fall short. The study participants were all severely obese, with a mean body mass index of 43 (30 and above is considered obese) and a mean weight of 288 pounds. About 39 percent had diabetes and 43 percent had metabolic syndrome, a constellation of symptoms that can be a precursor to coronary artery disease and diabetes.

Participants were told to follow either a low-fat diet, in which they cut about 500 calories a day and ate no more than 30 percent of their calories from fat; or a diet that closely matched the low-carb Atkins diet. Low-carb dieters were not told to cut calories, but were instead told to limit their carb intake to no more than 30 grams a day, roughly the equivalent of two slices of bread. Participants met once a month with a nutritionist for a year. After that, they were on their own to continue the diet or go back to eating as they once did. After three years, neither group showed a statistically significant difference in their ability to keep the weight off. The good news for those in the low-fat group, however, was that they continued to show slow and steady weight loss, while the low-carb dieters were trending back up. "It's really hard for people to sustain a low-carb diet. They can stick with it for six months, but then you see a gradual return to baseline," said lead study author Dr. Marion Vetter, medical director of the Center for Weight and Eating Disorders at the University of Pennsylvania. "Low-fat diets may be a little easier for people to stick with."

The researchers also found no changes in blood levels of hemoglobin A1c, a measure of blood sugar control, between the two groups at 36 months. For the millions of Americans struggling to lose weight, the study highlights the difficulty of sustaining weight loss over the long term no matter what method you choose, Vetter said. Over time, both groups showed a gradual return to their pre-diet caloric intake and eating habits. Yet there are dieters who are successful in the long term, said Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center at Dallas. What they tend to have in common is that they cut calories by making small but sustainable changes to their diet and thereby lose weight more slowly. In the study, those who lost the most at the outset were more likely to gain the weight back, she noted. "The study further confirms rapid weight loss leads to rapid regains," Sandon said. "When you attempt to achieve weight loss by doing it in a slower manner, you're more likely to keep it off." In low-fat diets, no food groups are banned, but dieters are encouraged to make certain changes, such as switching from mayo to mustard or from whole to skim milk. Low-carb diets, on the other hand, require more wholesale changes in the way people typically eat and enjoy food. Realistically, how long can a person put up with asking for their hamburger without the bun? "People for years have been trying to figure out if it's the carbs or is it the fat, when really it's the calories," Sandon said. "It doesn't matter where the calories are coming from -- carbs, protein or fat -- it's the calorie balance. We're trying to get people away from the idea that it's a single food group or a single nutrient that's causing the weight gain."

DATE: March 05, 2010

A heart patient's own skin cells soon could be used to repair damaged cardiac tissue thanks to pioneering stem cell research of the University of Houston's newest biomedical scientist, Robert Schwartz. His new technique for reprogramming human skin cells puts him at the forefront of a revolution in medicine that could one day lead to treatments for Alzheimer's, diabetes, muscular dystrophy and many other diseases.

Schwartz brings his ground-breaking research to UH as the Cullen Distinguished Professor of Biology and Biochemistry and head of UH's new Center for Gene Regulation and Molecular Therapeutics. "Professor Schwartz's work will save lives, and his decision to pursue this pioneering research at UH is a big leap forward on our way to Tier-One status," said John Bear, dean of the UH College of Natural Sciences and Mathematics. "Together with the many other outstanding scientists we've assembled here, Schwartz will help make this university a major player in medical research." Schwartz devised a method for turning ordinary human skin cells into heart cells. The cells developed are similar to embryonic stem cells and ultimately can be made into early-stage heart cells derived from a patient's own skin. These then could be implanted and grown into fully developed beating heart cells, reversing the damage caused by previous heart attacks. These new cells would replace the damaged cardiac tissue that weakens the heart's ability to pump, develops into scar tissue and causes arrhythmias. Early clinical trials using these reprogrammed cells on actual heart patients could begin within one or two years.

Although Schwartz is not the first scientist to turn adult cells into such stem cells, his improved method could pave the way for breakthroughs in other diseases. Schwartz's method requires fewer steps and yields more stem cells. Armed with an effective way to make induced stem cells from a patient's own skin, scientists can then begin the work of growing all kinds of human cells. For example, new brain cells could treat Alzheimer's patients or those with severe brain trauma, or a diabetic could get new insulin-producing cells in the pancreas. Generating new kidney, lung or liver tissue is also possible, with scientists even being able to one day grow an entirely new heart or other organ from these reprogrammed cells. Additionally, Schwartz and his team are working on turning induced stem cells into skeletal muscle cells to treat muscular dystrophy. "We're trying to advance science in ways folks never even dreamed about," Schwartz said. "The idea of having your own bag of stem cells that you can carry through life and use for tissue regeneration is at the very cutting edge of science."

DATE: February 26, 2010

Tea is one of the oldest beverages known to man. It is said to have originated in China and has been cultivated for more than 2,000 years. Next to water, tea is the most widely consumed beverage in the world and its consumption is increasing. It is estimated that 3.5 million tons of tea leaves are produced each year throughout the world. Extensive research has been undertaken on the beneficial effects of tea consumption, including potential benefits on stroke, coronary heart disease, certain cancers, and weight management. Although some of these effects are far from being conclusive and lack support from human clinical trials, accumulated evidence is certainly promising. The beneficial effects of tea have been attributed to the presence of high amounts of flavonoids, a group of polyphenols, many of which are potent antioxidants. The Lipton Institute of Tea has been investigating the scientific basis for traditional beliefs about the health benefits of tea, through its own internal research as well as collaboration with universities around the world. The institute has organized a series of tea science symposiums to provide experts an opportunity to share findings from new studies and discuss their clinical relevance, identify future research opportunities, and foster valuable networks and collaborative partnerships.

Stroke (predominantly ischaemic stroke) has an enormous human and economic impact. There is therefore considerable interest in interventions which can reduce the risk of stroke. Animal studies have previously shown that tea and tea components can reduce stroke-related brain damage. There is now considerable evidence for tea protecting against ischaemic stroke in humans. In her keynote address, Prof Lenore Arab (University of California, Los Angeles, US) presented exciting new data on the cardiovascular benefits of tea, in particular, a new meta-analysis showing that the consumption of black and green tea was associated with a reduced risk of ischaemic stroke worldwide. The meta-analysis involved nine studies from five countries with almost 195,000 patients who experienced 4,378 strokes. The study found that consuming three cups of green or black tea per day reduced the relative risk of stroke by 21%, regardless of the geographic region. Prof Arab recognized that further research is required to look into the mechanisms by which tea exerts its protective effect on stroke. Possible mechanisms include an effect on blood clotting, inflammation, endothelial function or perhaps a protective effect on leukoaraiosis (changes in cerebral white matter). The potential bioactive components in tea include catechins and flavonols, theaflavins and thearubigins. These compounds, collectively known as tea flavonoids, are absorbed into the bloodstream where they may exert vascular effects. Recent research has focused on the interaction between tea flavonoids and the innermost lining of the blood vessels, the endothelium. Improved endothelial function may help to explain the reduced risk of cardiovascular disease and stroke observed among tea drinkers.

Recent research has also focused on the vasodilatory effects of tea flavonoids via a non-invasive technique known as flow mediated dilation (FMD). FMD is gaining acceptance as a predictor of cardiovascular disease risk, with higher FMD values being associated with less risk of future cardiovascular or cerebral events in both symptomatic and asymptomatic subjects. Several human studies have investigated the effect of green and black tea consumption on endothelial function/FMD, and the majority of these studies have shown a beneficial effect of tea on FMD. To further investigate the effect of tea consumption on FMD, Dr Sheila Wiseman (Unilever R&D, Netherlands) conducted a meta-analysis via a literature search of available data. In all but one of the eight studies included in the analysis, green or black tea consumption resulted in significant improvements in FMD (a 2 .6% increase with three cups of tea per day), which may contribute to the reduced risk of cardiovascular events and stroke observed among tea drinkers. The effect of tea on FMD was robust, with effects noted in both healthy and non-healthy subjects, young and old subjects, and in males and females. Further research is required to determine which of the bioactive components of tea has the greatest effect on FMD. Drinking more than three cups of tea per day is known to be associated with a reduction in the risk of cardiovascular disease. Prof Zhen-Yu Chen (Chinese University of Hong Kong) described potential mechanisms behind the observed cardiovascular benefits of tea catechins and theaflavins. According to Prof Chen, the cardiovascular protective effects of green and black tea are thought to involve three mechanisms, including an antioxidant or anti-atherosclerotic effect, a cholesterol-lowering effect, and a vasoprotective effect that improves the functioning of the arterial endothelium through nitric oxide pathways.

Previous studies have shown that tea can improve aspects of attention measured with behavioral tests. Dr Eveline De-Bruin (Unilever R&D, Netherlands) described a new study showing that the anine and caffeine in black tea can improve focus and concentration. The study involved 24 young adult males who underwent functional magnetic resonance imaging (fMRI) to measure changes in neural activity during a task that required attention. Subjects were scanned after consuming either a test drink (300mg of caffeine and 135mg theanine in a tea base, equivalent to eight cups of tea) or a control drink (tea base but only 20mg caffeine and 6mg theanine, equivalent to half a cup of tea). Response times following consumption of the test drink were significantly faster in all three components of the test of attention than after the control drink. The test drink also appeared to lead to more efficient functioning of attention networks within the brain. Further research is warranted to see if the effects on attention occur at doses comparable to regular consumption of tea. Previous research has shown that tea flavonoids have positive effects on cardiovascular disease, stroke, cancer, and the metabolic syndrome (including diabetes and obesity). Caffeine in tea has been shown to improve cognitive performance, attention, psychological well-being, and motivation/alertness. Theanine itself does not appear to improve cognitive performance, but it does result in relaxation and potentiation of the behavioral effects of caffeine.

To determine whether there were positive associations between intakes of tea and tea components and cognitive performance and psychological well-being, Dr Janet Bryan (University of South Australia) examined findings in an existing Australian database of a large cross-sectional survey. The survey involved 1,183 middle-aged South Australians who completed self-reported assessments of their tea consumption, health, cognitive function, memory, and psychological well-being. The study found that 63% of participants drank both tea and coffee (only 4% drank neither beverage), with women drinking more tea than men. For men, tea flavonoids (except flavonones) were positively associated with self-reported vitality and physical and mental health. For women, tea and tea components were generally negatively associated with psychological outcomes, whereas nutrients not found in tea (e.g. anthocyanidins and folate) were positively associated with psychological outcomes. There were very few significant associations with cognitive performance measures. Future studies should attempt to identify potential mechanisms by which tea flavonoids exert an effect on cognitive performance. Positive mood is known to be associated with a number of short-and long-term benefits, including increased creativity and problem solving, broadening of attention, better physical health, and increased longevity. Defining and measuring mood is open to interpretation, but generally, mood can be considered as a low intensity and enduring affective state with no obvious antecedent cause that influences a range of behaviors and which lasts longer than emotions (which are generally short-lived with obvious causes). Mood is known to fluctuate throughout the day and is often affected by situational factors (e.g. work stress). Individuals employ a variety of strategies to self-manage their mood throughout the day.

Previous studies have shown that ingesting certain foods (including chocolate and tea, generally black tea with no milk or sugar) can influence positive mood through a variety of mechanisms, including hedonic effects which are quite separate from the nutritional effects of foods or drinks. To determine whether consumption of tea can influence positive mood in non-Western countries, Dr Georgie Russell (Unilever, Netherlands) conducted an exploratory study in Shanghai, China. The study investigated the effect of tea with milk and sugar (“milk tea”) in 30 young healthy subjects from Shanghai, China, using assessment tools specifically modified for an Asian population. The consumption of milk tea led to an improvement in mood and a reduction in self-reported negative mood. Milk tea appeared to be consumed in an attempt to self-manage periods of low mood (e.g. before starting work or after a stressful commute). Future studies should continue to assess cultural differences in the measurement of mood and seek to better understand the effects of tea on mood.

DATE: February 19, 2010

People who carry a few extra pounds after age 70 tend to live longer than people who don’t, new research finds. Overweight older adults who took part in the Australian study had a clear survival advantage over those who were normal weight, underweight, or obese. The findings suggest that the widely accepted body mass index (BMI) weight guidelines may not be particularly useful after age 70, lead researcher Leon Flicker, PhD, of the University of Western Australia told WebMD. He says elderly people who don’t have health conditions like diabetes or osteoarthritis, which are caused or exacerbated by carrying extra pounds, may be better off being overweight. “Unless they have these conditions, there is not much reason to tell people in their 70s and beyond to lose weight if they are not obese,” he says.

The study is not the first to suggest that carrying some, but not too much, extra weight may increase longevity. Last summer, researchers in Canada reported the same findings after analyzing data from more than 11,000 adults followed for more than a decade. In that study, people who met the criteria for being overweight were 17% less likely to die compared to people of normal weight. In the newly reported research, overweight study participants in their 70s followed for up to 10 years had a 13% lower risk of death than participants classified as normal weight.

BMI is calculated by dividing a person’s weight (in kilograms) by the square of their height (in meters). A body mass index of 18.5-24.9 is considered normal, a BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or more is considered obese.

Based on BMI scores, a 5-foot, 7-inch adult would be considered:

• Underweight at less than 118 pounds (BMI <18.5)
• Normal weight at 118 to 159 pounds (BMI = 18.5-24.9)
• Overweight at 160 to 191 pounds (BMI = 25-29.9)
• Obese at 192 pounds or more (BMI = 30+)

Obese and normal-weight study participants had a similar risk of death over the 10 years of follow-up. Underweight study participants had the highest risk of death, even after the researchers adjusted for the wasting effects of disease. Women who were sedentary were twice as likely to die as women who got regular exercise, regardless of BMI. The effect was seen in men, but to a lesser degree. A sedentary lifestyle was associated with a 28% increase in death among men. The study appears in the February issue of the Journal of the American Geriatrics Society. “There is a lot we can’t really explain in our findings, and the fact that a sedentary lifestyle seemed to be more risky for women than men is one of them,” Flicker says. Flicker believes the BMI thresholds for overweight and obese are too restrictive for older people, and he says it may be time for the World Health Organization to change the guidelines to reflect the findings from his and other studies. Geriatric medicine specialist Thomas Yoshikawa, MD, of UCLA’s David Geffen School of Medicine, agrees. “From a hard science point of view it may be a bit premature, but my own personal belief is this is something we should carefully consider.” Yoshikawa says as many as two dozen observational studies suggest that carrying a few extra pounds is beneficial for people in their 80s and older. Although extra pounds clearly add to the risk for chronic diseases like heart disease and diabetes earlier in life, they may actually give older people extra reserves to recover from stresses like surgery or pneumonia, he says. “I would rather have an elderly patient who is in relatively good health and is close to normal weight gain five or 10 pounds than lose five or 10 pounds,” he says.

DATE: February 12, 2010

Depression raises risks of advanced and severe complications from diabetes, according to a prospective study of Group Health primary-care patients in western Washington. These complications include kidney failure or blindness, the result of small vessel damage, as well as major vessel problems leading to heart attack or stroke. The findings were published this week in Diabetes Care, a scientific journal of the American Diabetes Association. The study was conducted by scientists from the Group Health Research Institute, Seattle; the University of Washington (UW) School of Medicine and School of Public Health, and the Veterans Affairs Puget Sound Health Care System. The lead author is Dr. Elizabeth Lin of the Group Health Research Institute.

Among their research volunteers with type 2 diabetes followed over 5 years, major depression was associated with a 36 percent higher risk of developing advanced micro-vascular complications, such as end-stage kidney disease or blindness, and a 25 percent higher risk of developing advanced macrovascular complications, such as stroke or myocardial infarction (heart attack from a blood clot), compared with diabetes patients without depression. The clinically significant risks remained even after the researchers adjusted for diabetes severity and self-care activities. Between 2000 and 2002, the Pathways Epidemiological Follow-up Study enrolled 4,632 primary-care Group Health Cooperative patients with diabetes. These patients were tracked through 2005-2007. The final sample size was 3,723. The researchers reviewed medical records, diagnostic and procedural codes, lists of prescribed medications, and death certificates to determine what happened to each patient over nearly five years. The researchers used proportional hazard models to calculate the association between depression and the risk of advanced complications. Even among patients with diabetes who had no prior indication of microvascular or macrovascular problems, depression increased the chances that these problems would develop.

As in earlier reports, the diabetes patients with major depression tended to be slightly younger, heavier, have more co-existing medical conditions, and were more likely to be treated with insulin than were diabetes patients without depression. They also had higher levels of a substance in the blood formed when the sugar glucose attaches to hemoglobin, an oxygen-carrying protein. The major depression group had a higher proportion of women and smokers. However, after controlling for these differences between depressed and non-depressed patients with diabetes, the increased risk of complications associated with depression remained. Several previous studies suggest the negative relationship between depression and diabetes cuts both ways. People with depression are prone to diabetes, and vice versa. Impairment from diabetes, such as blindness or kidney failure requiring long-term dialysis, interferes with a person's daily life and can be overwhelming. The person may become depressed or an existing depression may worsen. As the incidence of type 2 diabetes soars, the clinical and public health significance of these findings increases, the authors noted. Further research is needed, the authors added, to clarify the underlying biological mechanism for the association between depression and complications of diabetes, and to test interventions which might be effective in lowering the risk of complications among patients who have both diabetes and depression. Grants from the National Institutes of Health supported the research.

DATE: February 05, 2010

The findings are reported in an article published in The Lancet, written by Dr Craig Currie. The study found that patients with type 2 diabetes given insulin-based treatments had a 50% increased mortality risk compared to those given combination oral therapy. The specific goal for control of blood sugar is to return glycated haemoglobin - the glucose level in blood over a prolonged period of time - to a normal range. Good blood sugar (glycaemic) control is known to reduce risk of long-term small blood vessel complications in both type 1 and type 2 diabetes.

Explaining the need for the research, Dr Currie said: “Reports of potentially raised mortality rates associated with intensive blood sugar control have triggered discussion about recommendations for treatment of type 2 diabetes, specifically relating to the optimum target for glycated haemoglobin. Researchers have suggested that hypoglycemia contributes to a heightened risk of mortality in patients with diabetes. Because intensive blood sugar control increases risk of hypoglycemia with some drugs more than with others, assessment of risks associated with the different blood glucose-lowering regimens is important.” The research assessed the association between all-cause mortality and glycated haemoglobin in patients with type 2 diabetes in a primary care setting and aimed to establish whether any evident association was independent of the diabetes treatment regimen. Two cohorts of patients aged 50 years and older with type 2 diabetes were generated from the UK General Practice Research Database from November 1986 to November 2008. The researchers identified 27,965 patients whose treatment had been intensified from oral monotherapy to combination therapy with oral blood-glucose lowering agents (metformin plus sulphonylurea), and 20,005 who had changed to treatments that included insulin. Those with diabetes secondary to other causes were excluded. All-cause mortality was the primary outcome. Age, sex, smoking status, cholesterol, cardiovascular risk, and general morbidity were identified as important confounding factors, and the data were subsequently adjusted for these factors.

Commenting on the findings Dr Currie said: “While the data suggest that insulin could increase the risk of death in type 2 diabetes, differences in the baseline characteristics of the insulin treated patients, such as being older, other medical conditions, longer duration of diabetes, could be behind part of all of this increased risk. “Whether intensification of glucose control with insulin therapy alone further heightens risk of death in patients with diabetes needs further investigation and assessment of the overall risk balance. “Low and high mean glycated haemoglobin values were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to include a minimum value.”

DATE: January 29, 2010

In previous research, consumption of coffee, both caffeinated and decaffeinated, and tea has been linked with a lower risk of type 2 diabetes. Now, according to a meta-analysis published in the December 2009 issue of Archives of Internal Medicine, a high intake of coffee is associated with a reduced risk of diabetes.

Investigators from the University of Sydney in Australia and their colleagues searched for relevant studies regarding the association between coffee, decaffeinated coffee, or tea and diabetes between 1966 and July 2009. They identified 18 studies reporting on the association between coffee consumption and diabetes, which included information on nearly 458,000 participants. They also found 6 studies on the link between decaffeinated coffee and diabetes and 7 studies on the association between tea and diabetes. The investigators found that increased coffee consumption was linked to decreased diabetes risk, with every additional cup of coffee contributing to a 7 percent reduction in the excess risk of diabetes. Similar significant inverse associations were observed with decaffeinated coffee and tea and risk of diabetes. While this meta-analysis suggests a protective effect of coffee, decaffeinated coffee, and tea against the risk of diabetes, these findings need to be validated in randomized clinical trials.

DATE: January 22, 2010

Over the next decade the health benefits achieved because fewer Americans are smoking will be more than overshadowed by the negative health effects of the unchecked rise in obesity, new research suggests. As a population, Americans are smoking less but weigh more than they have in many years. According to the CDC, about 34% of U.S. adults, or 72 million people, are obese today, compared to about 15% in 1980. But half as many adults smoke. About 1 in 5 American adults smoke today, compared to 2 in 5 in the 1970s. Although these competing trends have been obvious, the net impact on health has been less so. In an effort to forecast the effect of the rise in obesity and decline in smoking on health at the population level over the next decade, researchers from Harvard University and the University of Michigan examined data from national health surveys conducted from the early 1970s through 2006. Their study appears in a December issue of the New England Journal of Medicine. In every scenario tested, the researchers found that the negative health impact of not addressing the obesity epidemic outweighed the benefits derived from the decline in smoking.

If all adults in the United States stopped smoking and achieved a normal weight by 2020, the life expectancy of an 18-year-old would increase by nearly four years, according to the forecast. “The hypothetical scenario in which everyone is a nonsmoker of normal weight by 2020, though, perhaps not achievable, illustrates the dramatic toll these behavioral risk factors can take when combined,” lead researcher Susan T. Stewart, PhD, and colleagues wrote. If past trends continue, nearly half of adults in the U.S. will meet the World Health Organization criteria for obesity by 2020, the forecast projects. Better management of chronic conditions closely linked to obesity, including heart disease and diabetes, would also change the forecast, the researchers noted. They conclude that efforts to improve health in the United States at the population level must focus on reducing obesity, further reducing smoking rates, and improving the management of diseases caused by both. “Inadequate progress in these areas could result in an erosion of the pattern of steady gains in health observed in the United States since the early 20th century,” they wrote.

DATE: January 15, 2010

Researchers found that bugs were able to become resistant to disinfectants which were meant to kill them. Not only can they beat the disinfectants, the bugs can become immune from one of the commonly prescribed antibiotics, ciprofloxacin, without even being exposed to the drug. A team of researchers from the National University of Ireland in Galway found that bacteria exposed to small amounts of disinfectant adapted and were able to pump out antimicrobial agents which stopped both disinfectants and antibiotics from working. In practice in hospitals, this could mean a small amount of disinfectant remaining on the floor after it was mopped could help spread serious disease.

Dr Gerard Fleming, who led the study, said: "In principle this means that residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria. "What is more worrying is that bacteria seem to be able to adapt to resist antibiotics without even being exposed to them." Dr Fleming said there needed to be further studies into how disinfectants were used in hospital and how antibiotics were prescribed. "We need to investigate the effects of using more than one type of disinfectant on promoting antibiotic-resistant strains," he said. "This will increase the effectiveness of both our first and second lines of defence against hospital-acquired infections." The study showed that when very small non-lethal amounts of disinfectant were added to the bacteria in culture, the adapted bacteria were more likely to survive antibiotics and the disinfectant compared with the non-adapted bacteria. The adapted bacteria also had a mutation in their DNA that specifically allowed them to resist ciprofloxacin-type antibiotics. The researchers looked at P. aeruginosa - an opportunistic bacterium that causes a wide range of infections in people with weak immune systems and those with diseases such as cystic fibrosis and diabetes. The bug is an important cause of hospital-acquired infections, which kill thousands each year. Disinfectants are used to kill bacteria on surfaces to prevent their spread. But if the bacteria manage to survive the disinfectants and go on to infect patients, antibiotics are used to treat them. Bacteria such as P. aeruginosa that can resist both these control points may be a serious threat to hospital patients. Dr Gerard Flemings paper The effect of sub-inhibitory concentrations of benzalkonium chloride on the competitiveness of Pseudomonas aeruginosa grown in continuous culture will be published in the January issue of the Society for General Microbiologys journal Microbiology.

DATE: January 08, 2010

Researchers led by specialists at the Johns Hopkins Wilmer Eye Institute have found that injecting a corticosteroid, triamcinolone, directly into the eye may slow the progression of proliferative diabetic retinopathy, a complication of diabetes that frequently leads to blindness. Authors of the study caution, however, that because use of steroids in the eye may increase the risk of glaucoma and cataract, laser photocoagulation remains the treatment of choice until further development of drugs that may reproduce the good effects of steroids, without the damage.

"Steroid treatment worked, but because of safety issues, cannot be recommended routinely at this time," says Neil M. Bressler, the James P. Gills Professor of Ophthalmology and chief of the Retina Division of the Johns Hopkins Wilmer Eye Institute, chair of the government-sponsored Diabetic Retinopathy Clinical Research Network. "It is a condition that can be treated safely and effectively with lasers." The study, published in the December issue of the Archives of Ophthalmology, described and compared one of two treatments on 840 eyes from 693 men and women between July 2004 and May 2006. The subjects, about evenly divided between men and women with an average age of 63, had diabetic retinopathy with macular edema, a swelling of the central portion of the retina that's caused by leakage of fluid. Proliferative diabetic retinopathy is marked by the growth of new and unwanted blood vessels on the optic nerve in the back of the eye (which communicates information from the retina to the brain) or another area of the retina, the light-sensitive part of the eye. Despite advances in treating both diabetes and its complications, about 700,000 Americans have proliferative diabetic retinopathy and 63,000 new cases develop each year.

In the study, each patient's eyes were randomly assigned to receive either a laser treatment (photocoagulation) for diabetic macular edema or an injection (1 or 4 milligrams) of triamcinolone acetonide directly into the eye as often as every four months. According to Bressler, lead author of the study, there was some evidence that steroids could improve vision outcomes from diabetic macular edema (DME), swelling of the center of the retina, the part of the retina used for reading or driving. Study results showed that steroids were not superior to laser treatments for DME. "The primary objective of the study was to determine if steroids were superior to laser for DME, and if so, to balance that superiority with steroids' side effects. A secondary objective was to determine if the steroids affected the progression of diabetic retinopathy," adds Bressler. "Steroid treatments did reduce the risk of progression of diabetic retinopathy, but, not DME, which can also cause vision loss from proliferative diabetic retinopathy, bleeding in the middle cavity of the eye or scarring of the retina, which can detach the retina from the back wall of the eye."

The steroid injections were not superior to laser with respect to increasing the chance of improved vision and decreasing the chance of vision loss, the primary objective of a study reported in 2008. "However, there was evidence that steroids can affect the pathways that lead to the development of new blood vessels on the surface of the retina in diabetes, a secondary objective of the study" says Bressler. "Controlling blood glucose levels can help prevent the development of retinopathy and laser treatments can reduce the risk of vision loss, but the identification of other treatments remains important." Bressler and colleagues, in the Diabetic Retinopathy Clinical Research (DRCR) Network, discovered that after two years, retinopathy had progressed in 31 percent of 330 eyes treated with laser treatment, 29 percent of 256 eyes treated with 1-milligram doses of triamcinolone acetonide, and 21 percent of 254 eyes treated with 4-milligram doses. The differences appeared to be sustained at three years, even though most eyes in the triamcinolone groups did not receive injections every four months during the second year and less than half received any injections in the third year because there no longer was macular edema, or less commonly, because side effects from the injections precluded applying additional steroids when following the study's treatment protocol.

Bressler says the study suggests that corticosteroids interfere with the creation of new blood vessels by reducing the production of compounds that spur their growth and cautions that steroids are also associated with other eye diseases. "Researchers now need to find ways of using the steroid effect on these blood vessels for treatment, but, not at the expense of causing glaucoma and the side effects of cataract formation or worsening of cataracts which could lead to the need for a patient to undergo cataract surgery." Other investigators who authored the study for the Diabetic Retinopathy Clinical Research Network include Allison R. Edwards, M.S., Roy W. Beck, M.D., Ph.D., Christina J. Flaxel, M.D., Adam R. Glassman, M.S., Michael S. Ip, M.D., Craig Kollman, Ph.D., Baruch D. Kuppermann, M.D., and Thomas W. Stone, M.D. The study was supported through a cooperative agreement from the National Eye Institute and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, part of the Department of Health and Human Services. Allergan Inc. provided the preservative-free triamcinolone acetonide and topical antibiotics as requested by the DRCR Network and unrestricted funds to the DRCR Network. Following the Network's Industry Collaboration Guidelines to maintain academic integrity, the DRCR Network had complete control over the design of the protocol, ownership of the data and all editorial content of presentation and publications related to the protocol.