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Two tests for diagnosing diabetes in overweight children recommended


Scientists at Children's Mercy Hospital and Clinics in the United States have argued that the usual blood test for diagnosing type 2 diabetes in overweight children is insufficient and recommend that it is backed up by an oral glucose tolerance test .
The research, recently presented at the Pediatric Academic Societies Annual Meeting, assessed the data on 629 overweight and adolescent patients who had received both tests, finding that the recommended haemoglobin A1C test was not properly diagnosing type 2 diabetes in over two thirds of overweight children being tested .
It was shown that 40 per cent of patients with type 2 diabetes and 67 per cent of high-risk patients diagnosed using the oral glucose tolerance test would have exhibited a normal glycaemic status if just the haemoglobin A1C test were used for diagnosis .
The team stated that carrying out both tests could lower the risk of delayed diagnosis in overweight children. Using a haemoglobin A1C test for screening for diabetes is the easier test, as it does not need the patient to fast for a long while before the test.
Ghufran Babar, lead researcher and a pediatric endocrinologist at the hospital, commented "Our research indicates that special consideration may need to be given to overweight children being tested for diabetes. Simply following the guidelines may not be enough to ensure these children get proper care."

Diabetes charity publishes statement on low carb diets

The leading charity Diabetes UK has published a statement on low carbohydrate diets for people suffering from type 2 diabetes, as these remain a popular way to attempt weight loss and because the organisation had not previously issued recommendations on this important subject.
People who have type 2 diabetes can be recommended to lose weight but find it hard to manage this on a traditional high carbohydrate, low fat diet, and dietary guidance in the past has primarily looked at the kind of carbohydrates consumed, as well as levels of starch in the diet .
The new statement for those with type 2 diabetes who would like to lose weight focuses on lowering overall energy intake while making sure that all the essential nutrients are still taken in. Although evidence suggests that a low carb diets can reduce weight and bring improvements in blood glucose management, the charity has also recommended that a range of approaches to a low carb diet should be considered, to find the most suitable one for each person, and that such a diet may not be the best choice for all type 2 diabetics.
Diabetes UK also said that people looking to reduce their weight should talk to a dietician so that they know any possible side effects from a particular diet, and that levels of blood sugar are properly monitored so that medications can be altered if necessary.

Linagliptin blood sugar tablets for diabetes approved in the US

The Food and Drug Administration (FDA) in the United States has approved linagliptin (to be sold as Tradjenta) tablets that are taken to control blood sugar in adults suffering from type 2 diabetes in combination with exercise and diet .
Tests on the drug, manufactured by Eli Lilly and Boehringer Ingelheim Pharmaceuticals, showed that linagliptin was able to lower levels of haemoglobin A1C by up to 0.7 per cent as compared with a placebo. The haemoglobin A1C test measures the ability of diabetes patients to manage their blood sugar levels over the previous two or three months.
Linagliptin, which is a DPP-4 (dipeptidyl peptidase-4) inhibitor, can be taken with or without food, and on its own or together with metformin, pioglitazone or sulfonylurea, but is not advised for those who have type 1 diabetes of diabetic ketoacidosis, and it has not been trialled in combination with insulin .
John Gerich, professor of medicine, University of Rochester School of Medicine, commented "Many people with type 2 diabetes are not able to control their blood sugar with diet and exercise alone and may also require one or more medications."
He added "The FDA approval of Tradjenta is exciting because there is only one dose to remember for all patients, regardless of kidney or liver impairment. With Tradjenta, physicians will have another option for managing type 2 diabetes, a potentially devastating condition."

Poor sleep raises diabetic insulin levels, according to study

Research into the link between diabetes and sleep patterns has revealed that people who suffer from the metabolic condition and who don’t sleep well have higher insulin resistance, and also find it more difficult to manage their diabetes.
The study, published in Diabetes Care, assessed the sleep of 40 people with type 2 diabetes over six nights, checking if they were suffering any problems with their sleep, such as insomnia, sleep apnea or snoring . They also provided blood samples so the researchers could analyse insulin and glucose levels .
It was found that the diabetics who were also poor sleepers had 23 per cent higher levels of blood glucose in the morning, as well as 48 per cent higher levels of blood insulin. For insulin resistance, these figures meant that poor sleepers with diabetes had 82 per cent higher insulin resistance than normal sleepers with diabetes.
Kristen Knutson, lead author on the study, commented "People who have a hard time controlling their blood glucose levels have a greater risk of complications. They have a reduced quality of life . And, they have a reduced life expectancy ."
Eve Van Cauter, co-author of the study, also said "This suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti-diabetes drugs ."
Diabetics are generally known to have worse sleep patterns than non-diabetics, and poor sleep has even been blamed as a potential risk factor for developing the disease.

Insomnia linked to high insulin resistance in diabetics

Higher blood glucose and insulin levels seen in poor sleepers
In the largest study of it kind to establish a link between sleep and diabetes, researchers found that people with diabetes who sleep poorly have higher insulin resistance, and a harder time controlling the disease.

The findings, published in the June issue of Diabetes Care, suggest that poor sleep may contribute to worse outcomes in people with diabetes.

"Poor sleep quality in people with diabetes was associated with worse control of their blood glucose levels," said Kristen Knutson, PhD, assistant professor of medicine and lead author of the study. "People who have a hard time controlling their blood glucose levels have a greater risk of complications. They have a reduced quality of life. And, they have a reduced life expectancy."

People with diabetes generally have poorer sleep than the general population, and poor sleep has been proposed as a risk factor for developing the disease. Sleep disorders, such as obstructive sleep apnea, are more prevalent in people with type 2 diabetes, Knutson said.

For the study, researchers monitored the sleep of 40 people with diabetes for six nights. The subjects also reported if they generally suffered from symptoms of sleep disturbances like insomnia, snoring or sleep apnea. At clinical examinations, they gave blood samples to allow researchers to measure insulin and glucose levels.

The subjects wore activity monitors on their wrists at night, which measure their wrist movements throughout the night. Poor sleep, or insomnia, was determined by both poor sleep quality based on the activity monitors and the subject telling the researchers that they often had a hard time falling asleep or woke up during the night.

Among the diabetics, poor sleepers had 23% higher blood glucose levels in the morning, and 48% higher blood insulin levels. Using these numbers to estimate a person's insulin resistance, the researchers found that poor sleepers with diabetes had 82% higher insulin resistance than normal sleepers with diabetes.

Knutson said the next step for researchers is to see if treating poor sleep can improve long-term outcomes and quality of life for diabetics. "For someone who already has diabetes, adding a sleep treatment intervention, whether it's treating sleep apnea or treating insomnia, may be an additional help for them to control their disease," Knutson said.

In fact, restoring a healthy amount of sleep may be as powerful an intervention as the drugs currently used to treat type 2 diabetes. "This suggests that improving sleep quality in diabetics would have a similar beneficial effect as the most commonly used anti-diabetes drugs," said Eve Van Cauter, PhD, professor of medicine and co-author of the study.

Further investigation into which leads to the other – the chronic poor sleep or chronic insulin resistance – could improve the quality of life for people with type 2 diabetes. "Anything that we can do to help people improve their ability to control their glucose will help their lives in the long run," Knutson said.

The data was collected as part of the CARDIA study, an ongoing longitudinal study of the heart health. It has tracked thousands of people for over 20 years.

Liverpool baristas cycle to Cardiff for Diabetes UK

BARISTAS from Liverpool went on a bike ride to Cardiff to raise money for charity.

The Bold Street Coffee team left the shop on Friday and cycled across the Welsh hills, before arriving at their destination yesterday lunchtime in support of Diabetes UK.

Taking the most difficult route they could find, they cycled 267 miles on the 2½-day trek, climbing more than 14,500 ft.

Bold Street Coffee chief Sam Tawil, who has Type 1 diabetes, said: "We rode from the shop in Liverpool to Cardiff and we took the most difficult route we could find. 270 miles, 14,500ft of climbing in two and a half days. All this just to have to avoid watching the Royal Wedding.

"Seriously, though, I have Type 1 Diabetes and would like to raise some money for Diabetes UK.Š

"I find it hard to control at the best of times, so I would like to learn how to do this better and help others."

To donate, visit:Šwww. diabeteschallenge.org.uk/ challenge/samtawil-rawride acrosswales



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Mobile phones should be used to manage diabetes in poorer countries

Research has found that mobile phones could be used in poorer countries to help people suffering from diabetes to better manage their condition. The study, by the Veterans Affairs Ann Arbor Healthcare System and University of Michigan in the United States, recommended that phone technology should become a key part of how low-income patients around the world control their diabetes and other chronic diseases .
The research, which was published in the American Journal of Preventive Medicine, involved diabetes patients in a semi-rural part of Honduras who received weekly, automated, interactive mobile phone calls. They chose this part of the developing world as most people have access to mobile phones there, as well as cheap internet -based phone calls.
The findings showed that the scheme was successful in helping the patients improve the management of their diabetes and overall general health. The researchers found a clinically important improvement in levels of haemoglobin A1C, which is used as a measure of blood sugar control.
John D. Piette, lead author on the six-week study, stated "Telehealth programs have been shown to be very helpful in a variety of contexts, but one of the main limitations for delivering these services in the developing world has been a lack of infrastructure."
He added "We wanted to demonstrate that it was possible to deliver a high-tech program from U-M to very vulnerable patients with diabetes in Honduras who only have local cell phone service."

Even small improvements in diet can help fight against diabetes

With being overweight or obese already known to increase your chances of getting type 2 diabetes, and weight reduction helping to lower the risk, a new study by scientists in the United States has found that making a small number of changes to your diet can help achieve this. Researchers also showed that the risk was lowered independent of weight loss .
The study, published in the American Journal of Clinical Nutrition, monitored the health of 69 overweight people at risk of developing type 2 diabetes who were given just the right amount of food needed to maintain body weight, with any minor changes in weight being taken into account. The participants receiving a diet that involving small reductions in levels of carbohydrates and fat over an eight-week period.
At the end of the study period, those people who were on the lower fat diet exhibited significantly greater insulin secretion and improved glucose tolerance, as well as tending to have higher insulin sensitivity, all indicating a reduced risk for diabetes .
The findings also indicate that people wanting to minimise risk for diabetes in the long term could consider keeping their daily consumption of fat down to about 27 per cent of their diet.
Barbara Gower, lead researcher on the study, commented "People find it hard to lose weight. What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes."

Pharma giant GlaxoSmithKline (GSK) has announced they have returned to profit after a raft of cost-cutting measures were imposed by the company. The news comes after they had to pay a GBP1.6 billion charge to settle litigation concerning the diabetes drug Avandia.
The drug manufacturer returned to profit in the second quarter of this year due to a major cost-cutting exercise, with a GBP1.1bn profit for the three months up to the end of last month, as compared to the GBP304m loss they experienced in 2010.
The litigation charge for the Avandia treatment was due to it being banned in Europe because of a potential link with heart disease.
The rise in profits came even though the company saw a four per cent decrease in sales to GBP6.7 billion as administration costs were nearly halved. The sales for the company, excluding that of Avandia, as well as that of the herpes drug Valtrex, which was affected by increased competition, and their pandemic flu product range, did rise by a total of 5 per cent over the quarter.
GSK have also stated they will manage to cut a further GBP300 million in costs over the rest of the year, as they plan to announce a series of new clinical trial results for drugs in the final stages of testing.