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Diabetes: A Year in Review
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From observations about butter and questions about acne to findings about flu shots and platypus venom, dozens of fascinating studies came out in 2016 regarding the disease.
As holiday meals digest and political squabbles (hopefully) fade to memory, the time has come to look back on the good that has come from the past year in medical research.
Diabetes is the focus of the day. An ever-growing public health concern, diabetes produces a constant stream of research on causation, interaction, and treatment. From observations about butter and questions about acne to findings about flu shots and platypus venom, dozens of fascinating studies came out in 2016 regarding the disease. Read on for a rundown of some of the best stories in the field from the past 12 months, and as always, keep abreast of all things new and noteworthy in the diabetes condition center.
Asian Americans are More Likely to be Have It, Less Likely to Know It
Despite a heightened risk of diabetes, Asian Americans are least likely to be screened for the disease, according to a new study from the University of Chicago.
"Asian Americans are not necessarily averse to screening tests," said lead author Elizabeth Tung, MD, citing the study’s findings that even those who had completed breast and colon cancer screenings were less likely to be checked for diabetes. But "even after accounting for education, access to healthcare and other key factors,” she says, “Asian Americans had 34 percent lower odds of being screened compared to non-Hispanic whites."
Due to their higher propensity for diabetes, for 2015 the American Diabetes Association actually lowered thresholds in their recommendations for diabetes screening for Asian Americans.
The Disease has Close Links with Depression
A study of Swedish and Danish twins concluded that the long-observed association between type 2 diabetes mellitus (T2DM) and depression has a significant genetic component.
Previous studies have reported that T2DM patients are about 15% more likely than others to develop depression and that people with depression are wildly more likely than others — up to 60% more likely — to develop T2DM, wrote the authors of the new study, who went on to note that very few of those earlier studies tried to evaluate how much of the connection between the diseases is genetic and how much is environmental. The heritability estimates for clinical diagnoses of T2DM and depression were 66% (95% confidence interval [CI], 58% to 73%) and 45% (95% CI, 32% to 56%) in men and 71% (95% CI, 65% to 77%) and 38% (95% CI, 30% to 47%) in women.
This was just one of a number of studies that explored the link between the two conditions in the past year. Another from the past spring implicated St. John’s Wort in the complicated, often mutually causal relationship.
Flu Shots can Mitigate Heart, Pulmonary Risks in Those with Diabetes
According to Eszter Vamos, MD, public health researcher at Imperial College London, “Research shows that in addition to severe chest infections, flu may also lead to heart attacks and strokes”.
Vamos and his team examined seven years (2003/2004- 2009/2010) of data among approximately 124,503 people in Britain with type 2 diabetes, to analyze how flu vaccines may influence the probability of hospitalization and death for diabetics. They found that vaccination was linked to 30% lower hospital admission rates for stroke, 22% lower rates for heart failure, and 15% lower rates for pneumonia or influenza.
Mobile Apps May Be Useful for Rural Patients Who Have It
People in cities have traditionally had access to a broader range of services than those who live in the country. For those with type 2 diabetes (T2D) who reside in rural communities, their distance from large medical centers and research universities may limit their access to new ideas and programs. The result may be poorer disease management and less physical activity than is reasonable or necessary.
Welcome: mobile apps. Researchers have expanded efforts to determine if mobile apps can kick-start self-management activities. They're investigating ways to educate diabetics, provide problem solving help, and assist patients with self-management. A new study in Telemedicine Journal and e-Health identifies perceived barriers, benefits, and facilitators related to free mobile app use among rural adults with T2D.
Acne Could be an Indicator of It (in Men)
Postadolescent men with acne have insulin resistance more frequently than those without acne according to the results of a study published in the Journal of the American Medical Association Dermatology.
“There was no statistical difference in age, height, and weight between cases and controls,” according to the published study. Researchers took the BMI, waist circumference, and blood pressure of the participants to determine whether or not metabolic syndrome was present. Among the participants with acne, the mean weight was higher in the very severe group than in the mild group, as was the BMI; however, the mean height, waist circumference, and blood pressure was not significantly different across the four groups. The conclusion that the researchers reached is that young men with acne, regardless of severity, tend to have a higher level of insulin resistance.
"Mild Cold Exposure" May Be Good for Prevention or Treatment of It
“Although the exact underlying mechanisms are still not fully understood in humans, exercise and mild cold exposure provide strong intervention strategies for the prevention and treatment of type 2 diabetes mellitus,” according to study author Patrick Schrauwen of Maastricht University in the Netherlands.
Cold exposure, the study said, can “substantially” increase energy metabolism, resulting in metabolic health effects. That’s because the body heat loss, among other things, triggers “glucose oxidation and turnover and thereby improves glucose tolerance and peripheral glucose intake.” The cold provokes physiological reactions to create energy to restore body heat. Their review showed that extreme cold had the most impact because environmental temperature has a major effect on energy expenditure by the whole body and cells. They also found mild cold exposure was more feasible and still could make a difference.
Extremely Low-Calorie Diets May Help Reverse the Disease
A trial found that 8 weeks of a very low calorie diet can reverse all signs of type 2 diabetes in many patients for at least 6 months after.
Investigators recruited 30 patients and measured their glucose control, insulin sensitivity, insulin secretion, hepatic fat content and pancreas fat content. The patients then discontinued all medications and began a 700-calorie-per-day diet that consisted of 3 diet milkshakes and 200 g of non-starchy vegetables. After a gradual return to an isocaloric diet, the investigators took new measurements and provided each individual with a structured program for weight maintenance.
The Platypus Might Be Hiding a Better Treatment for It
In addition to being entirely unique to Australia and New Guinea, and among the only order of mammals that lay eggs (called monotremes), platypuses have another particular characteristic: they secrete venom. And in this most unlikely of substances, there may be a potential treatment for diabetes. Contained in that venom is a form of the glucagon-like peptide-1 (GLP-1) hormone, which is also secreted in the guts of mammals, humans included.
GLP-1 stimulates the release of insulin in order to lower blood glucose, and as such is used commonly in the treatment of type 2 diabetes. Several well-known drugs like dulaglutide and liraglutide are GLP-1 agonists. The problem with GLP-1, however, is how quickly it degrades in the gut due to cleavage by dipeptidyl peptidase-4 (DPP-4), fueling the need for potentially longer-lasting versions of the hormone for extended insulin management. The GLP-1 contained in platypus venom may provide a lead on that.
Evidence for a Link Between It and Alzheimer's Continues to Grow
A paper by researchers from the University of Aberdeen, published in the journal Diabetologia, outlined that the drugs currently used to control glucose levels in diabetes can also mitigate the symptoms and progression of Alzheimer’s. The reason for this is that, for the first time, dementia-related complications within the brain were found to trigger changes in glucose handling — and eventually diabetes.
Bettina Platt, PhD, collaborated with her Alzheimer’s research team and Mirela Delibegovic’s diabetes research team to investigate why the two diseases were so commonly found together older patients. Both research leaders noticed that increased levels of a gene associated with toxic protein production in the brain not only caused Alzheimer’s-like symptoms, but also led to the development of diabetic complications.
Butter Might Not be Bad for It After All
Butter may not be so bad for diabetics and others, according to an international meta-analysis. It made the same finding for other dairy fats in relation to the development of diabetes or risk of cardiovascular death in diabetic patients.
“This systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality, CVD, and diabetes. These findings do not support a need for major emphasis in dietary guidelines on either increasing or decreasing butter consumption, in comparison to other better established dietary priorities; while also highlighting the need for additional investigation of health and metabolic effects of butter and dairy fat,” wrote Laura Pimpin and her co-authors. Pimpin is a PhD candidate at the University of Cambridge.
Current American Diabetes Association guidelines, however, still recommend margarine instead.
