City doctors find high stress levels linked to diabetes

Could high stress levels, identified as a risk factor for cardiovascular diseases and hypertension, also be associated with metabolic disorders like diabetes? A Delhi based study funded by the Indian Council of Medical Research (ICMR), and carried out by Delhi government’s Guru Teg Bahadur (GTB) Hospital and its associated University College of Medical Sciences (UCMS), has found “significant” clinical evidence to link high stress levels to diabetes, in patients newly diagnosed with Type 2 diabetes, according to doctors.

The study which is currently under publication, found that individuals who had low glucose tolerance levels diagnosed through glucose tolerance tests (GTT) indicating diabetes, had correspondingly high stress levels and low coping levels for stress, on the basis of questionnaires developed to validate stress. Other scientific indicators were used to identify levels of stress in diabetics.

Dr S V Madhu, head of the department of endocrinology and secretary of the Research Society for Study of Diabetes in India, who was the principal investigator, said, “Stress hormone levels, measured as the human body’s hormonal response to stress was also found to be higher in people diagnosed with diabetes. Hormones associated with stress like cortisol and catecholamines were found to be altered or disturbed in people who had low GTT levels.” He added that established chemical changes in the brain, which are associated with stress were also found to be activated in patients with diabetes. “Certain pathways in the brain, like oxidative stress pathways were found to be disturbed in patients with diabetes, indicating stress,” Dr Madhu explained.

The study identified 1,000 people who were put through diagnostics including glucose tolerance and insulin sensitivity tests, and identified 500 as newly detected with diabetes. There stress levels were compared with another 500 who were found to have normal glucose tolerance levels. “To the best of our knowledge, this is the first time that we have been able to establish direct evidence demonstrating that stress plays a clinically significant role in the expression of human diabetes, in India. Again as far as we know, this is the first time that different stress scales have been used to characterise chronic psychological stress to evaluate its role in development of Type 2 diabetes,” Dr Madhu explained.

… contd.




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What you need to know about diabetes

There are two types of diabetes – type 1 and type 2 – but the one that is usually in the news because of its association with rising obesity rates in America is type 2 diabetes.

Type 1 diabetes: Previously called juvenile diabetes, type 1 is usually diagnosed in children and young adults. In this type, the body does not produce insulin, a hormone needed to convert sugar, starches and other foods into energy. Insulin, by shot or pump, must be started right away. Exercise and nutrition are also important in managing type 1 diabetes. It is caused by one’s immune system attacking and destroying insulin-producing cells in the pancreas. It is thought to be caused genetic and environmental factors.

Type 2 diabetes: This type, which may be prevented through lifestyle changes in diet, weight loss and exercise, accounts for 90 percent to 95 percent of all diabetes cases in the U.S. It occurs when an indivdual’s body doesn’t make enough insulin or use it well. This results in “insulin resistance.” 

Diabetes can be diagnosed using three blood tests – fasting blood sugar test, hemoglobin A1C test and a glucose challenge test.

“Patients are often asymptomatic, but the risks associated with prediabetes and diabetes, like heart attack and stroke, are happening before the diagnosis,” said Dr. Scott Setzer, a family doctor in Lemoyne.

People with prediabetes have blood sugar levels that are higher than normal – between 100 and 125 mg/dl – but not high enough to be called diabetes, the label given when fasting blood glucose is 126 mg/dl or higher. Sometimes, early treatment of prediabetes can return blood glucose levels to normal and prevent escalation to diabetes.

When they do present, symptoms include frequent thirst, extreme hunger, frequent urination as in every two hours, weight loss, blurred vision and fatigue, said Dr. Renu Joshi, medical director of endocrinology at PinnacleHealth System in Harrisburg.

Treatment can include lifestyle change in diet, exercise and weight loss, medications and insulin.

In the past several months, a new medication for type 2 diabetes called Invokana (generically called canagliflozin) was introduced that works by making blood sugar come out in the urine, Joshi said. It holds promise, but it can cause thirst, frequent urination and yeast infections. Patients must have completely normal kidney function to be able to take it, she said.

Get tested

The American Diabetes Association has set these guidelines for diabetes screening:

  • Anyone with a body mass index higher than 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, or having a close relative with diabetes.
  • Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter. 

Tom Hanks reveals he has Type 2 diabetes

Dr Holly Phillips, medical contributor for America’s CBS TV network, said: “In
dramatic weight gain and dramatic weight loss, the equilibrium of the body
is just completely off. So that might predispose him to developing Type 2
diabetes later.”

“He’ll have to watch what he eats very closely, he’ll need to exercise
regularly, but there’s no reason he can’t live a perfectly normal life,”

Hanks revealed his diagnosis after Letterman commented on how “trim”
he was looking.

The actor added: “It’s controllable. Something’s going to kill us all,
Dave. My doctor said ‘If you can weigh as much as you weighed in high school
you will essentially be completely healthy and will not have Type 2
diabetes. I said ‘Well, I’m gonna have Type 2 diabetes because there is no
way I can weigh as much as I did in high school.'”

Asked what he weighed in high school the actor joked that he had been “96
pounds then,” adding: “I was a very skinny boy.”

It is estimated that at least 366 million people worldwide suffer from
diabetes, with the vast majority having Type 2, a condition in which the
body does not produce enough insulin to maintain normal blood sugar levels,
or the insulin produced does not work properly.

The condition has been linked to obesity, poor diet and sedentary lifestyles
and can lead to serious complications including kidney damage, blindness,
nerve damage, heart disease and limb loss. Experts believe most cases could
be prevented by a healthy lifestyle.

Other high profile figures who suffer from Type 2 diabetes include the actress
Halle Berry, who was diagnosed at the age of 19 after collapsing into a
diabetic coma on the set of a TV show.

Hanks is being tipped for a possible third Oscar for his latest film Captain
Phillips. He plays Richard Phillips, captain of the Maersk Alabama which was
captured by Somali pirates in 2009.

Hunt for perfect mix of diet and exercise to beat diabetes

The largest study of its kind is to be carried out to find the right lifestyle to prevent Type 2 diabetes, which is threatening to become a medical “disaster” in Britain.

Experts aim to work out not only the best way to eat, drink and exercise but even how to sleep.

It could lead to people at risk of developing the condition being given a detailed diet and exercise regime, much like a prescription, to help protect themselves.

Professor Anne Raben, the project’s chief coordinator at the University of Copenhagen, said: “We would like to find out if our current dietary and exercise recommendations are optimal or whether another lifestyle and regimen is more effective.

“It could save billions in health care costs for society if we are able to find a formula for how to best prevent Type 2 diabetes.”

The three-year study will start at the end of the year and involve 2,300 adult volunteers and 200 children aged from 12 to 18.

Eight countries will be involved including the UK, where the trial will be run by the University of Nottingham and Swansea University.

Professor Raben said: “We already know that a diet which follows current dietary guidelines can prevent diabetes. What’s unique about this project is that we are testing two diets against one another to find out if there might be a more effective alternative.

“We will include two types of exercise to determine if there is one that is more suitable. Finally we will also study the importance of stress and sleeping patterns.”

How diabetes is at risk of being the 'new norm'

Diabetes rates in England reveal a postcode lottery – with some areas hit twice as hard as others and sufferers numbering one in 10.

In Brent, north London, for example, 10.5 per cent have diabetes.

This is almost double the rate in the City of London, which has the lowest rate of 5.5 per cent despite being just eight miles from Brent.

Other areas in a list of the top 10 hotspots are Newham, east London, with 9.9 per cent, Wolverhampton in the West Midlands with 9.6 per cent, and Leicester in the East Midlands with 9.3 per cent.

Experts last night warned the figures are a cause for grave concern.

Barbara Young, chief executive of Diabetes UK, which publishes the findings today, said: “It is truly alarming that there is now somewhere in England where more than one in 10 of the people have diabetes.

“It shows that we are heading at a frightening speed towards a future where diabetes becomes the norm.”

Diabetes is the main cause of blindness among working-age people in Britain, as well as lower limb amputation, kidney failure and stroke. Around 3.8 million people in Britain suffer with Type 1 or Type 2 diabetes, ­including an estimated 850,000 who have yet to be diagnosed.

Up to seven million people are at high risk of developing Type 2 diabetes and, if current trends continue, about five million will have it by 2025.

Diabetes drug: Ban lifted after talks with experts

After the health ministry consulted the Drug Testing Advisory Board and experts in diabetes, the ban on Pioglitazone drug was lifted.

The ministry concluded that, if used appropriately in the right type of patients, the drug is effective and safe for treatment of Type 2 diabetes.

Welcoming the lifting of the ban, Dr KP Singh of Fortis Hospital said Pioglitazone was safe and the decision to ban the drug was taken in haste by the central government.

Dr Singh said, “There are over 6 crore diabetes patients in India. Over 30 lakh of these take Pioglitazone due tot its favourable action.”

He added that about 95 per cent of patients suffer from Type 2 diabetes, in which the patient becomes insulin resistant.

Pioglitazone is the most commonly used drug for treatment of this disorder.

“Pioglitazone remains among the most effective and economical Type 2 diabetic drugs in the market and patients should consult their doctors for queries. In general, doctors prescribe the drug only after knowing the patient’s history and eligibility of the drug for the particular patient,” Dr Singh added.

The drug improves blood sugar levels in people with Type 2 diabetes by increasing the patient’s reactivity to insulin, which makes it an important prescription choice for doctors.

It is an economical alternative to insulin and is also cost-effective.

Talking about the precautions while taking the drug, Dr Singh said, “The drug should not be used as a first choice. Doctors should check the status after three to six months. The drug should not be prescribed to those suffering from cardiac or renal failure. It should not be given to those who have active or a history of urinary bladder cancer or Haematuria (blood in urine).”

When asked if any incidence of cancer had been reported in north India because of Pioglitazone he said not a single case had been reported. The drug is commonly available in market as Pioglit, Pionorm and Pioglar.


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Diabetes now afflicts those in their 20s

BANGALORE: Type 2 diabetes, believed to afflict the 40-plus age group, is growing younger. Patients are now increasingly in the 20-29 age group.

Of the 12,782 persons who underwent diabetes screening in the past year for a study conducted by a diagnostic lab, 2,713 (21%) suffering from high sugar levels were aged 20-29 years. It’s a clear indicator that Type 2 diabetes — attributed to genetic causes and lifestyle — is affecting the youth.

A recent case which made doctors sit up was a 17-year-old CET aspirant, who was first diagnosed as a case of Type 1 diabetes. The diagnosis was later changed to Type 2 diabetes. Type 1 diabetes is seen in children and adolescents where the body’s malfunctioning affects insulin production. “Because he was so young, he was first treated by a general physician for Type 1 diabetes. More tests proved his was a case of Type 2 diabetes. The causes were increased stress levels due to exam pressure, improper dietary habits, obesity and other lifestyle changes,” said Dr Praveen Ramachandra, adult and paediatric endocrinologist from Columbia Asia hospital.

The study revealed that lifestyle issues are making youngsters more prone to diabetes.

“We were surprised to see many youngsters having high sugar levels, with borderline diabetes. In the initial stages, there may not be any symptoms. When screened, we figured out the need for exercise and healthy dietary habits for such persons, many of who are men. The age group of 20-29 years was so far a grey area, and there was no preventive medication so far. There is need for further research in this area,” said Dr HN Ravi Kumar, managing director of RV Metropolis.

The survey drew material from diabetes screening camps conducted across Bangalore from April 2012 to June 2013. “Such patients need proper counselling,” Dr Ravi added.

Two employees of the Karnataka Rural Infrastructure Development were found to be suffering from Maturity Onset Diabetes of Young (MODY). “The employees, aged 28 and 29, were suffering from MODY caused due to genetic abnormality, and are on treatment now,” said Dr Ravi.

The study was conducted by RV Metropolis Diagnostic and Healthcare Centre.

‘Am I diabetic?’

When youngsters are told they are diabetic, they receive the news with disbelief. This young techie was no exception.

“I started losing weight drastically. I’d feel tired all the time, and this affected my work. When I visited the doctor and gave several tests, I was told my blood had high sugar levels. I’m suffering from Type 2 diabetes,” said a 28-year-old software architect.

“The first line of treatment is diet and regular exercise. I’m on that,” he said.

Scary stats

12,782 persons underwent diabetes screening

13.61% (1,739) persons had very high sugar levels (160-500 mg%).

5.92% were women

7.63% were men

3% were in 0-9 age group (juvenile diabetes)

5% were 10-19 years old

21% (2,713) with symptoms of diabetes are in 20-29 age group

(Source: RV Metropolis study)

DNA flaw boosts cancer risk from diabetes—study



In this Friday, March 2, 2012, file photo, DNA samples are processed at the New York State Police Forensic Investigation Center in Albany, New York. A DNA flaw may explain why people with Type 2 diabetes are more prone to blood cancers than the rest of the population, a study said Sunday, July 14, 2013. AP PHOTO/MIKE GROLL

PARIS—A DNA flaw may explain why people with Type 2 diabetes are more prone to blood cancers than the rest of the population, a study said Sunday.

Doctors have long known that Type 2 diabetes is associated with leukemia and lymphoma, but the reasons for this have been unclear.

Researchers in France and Britain, looking at blood samples from nearly 7,500 people, including 2,200 patients with Type 2 diabetes, suggest the answer lies in cellular mutations called clonal mosaic events (CMEs).

These are defects that result in some cells having extra copies—or, alternatively, missing copies—of large stretches of genetic code.

Reporting in the journal Nature Genetics, the researchers said that in the general population, CMEs are usually very rare in young people but become more common with aging.

Among people aged over 70, around two percent have these mutations, which gives them a tenfold higher risk of developing blood cancer, previous research has found.

Ban on diabetes drug leaves patients crippled

After the government imposed a ban on widely used anti-diabetes drug pioglitazone, city patients and diabetologists are in the dock.
The drug, which is quite popular with Type 2 diabetes patients, is consumed by about 10% of city’s population, claimed city diabetologist Dr Abhay Mutha at a press conference on Friday.

Chief diabetologist at Ruby hall Clinic, Mutha said, “The ban of pioglitazone came as a rude shock to us. It is one of the most prescribed medicines to our patients suffering from Type 2 diabetes. The medicine, being cheap and highly effective with minimum side effects is also used widely in western countries.”
Mutha said that the reasoning for the ban wasn’t clear and that government officials should consult the medical practitioners and reconsider the decision.

Diabetologist Dr Shrirang Godbole said that with the ban, the only available option that doctors have for the patients is to prescribe alternative medication or initiate the use of insulin. “I have been receiving frantic calls from my patients regarding the same,” he said.

There are other drugs available in the market with varying pioglitazone combination, but they are less effective, said Mutha.

Type 2 Diabetes More Common Among Low-Income Families




Diabetes Finger Blood Test


CREDIT: Jim Delillo | Dreamstime


Being born into a low-income family may mean worse health later in life. Research has shown that those with low incomes are more likely to develop Type 2 diabetes than their richer peers, but the reason for this link has remained unclear.

Now, a new study finds that inflammation may be the key behind this connection, and that genetics plays a role.

“We’ve shown … there might be a link going from socioeconomic status to inflammation, through gene regulation, and that finally leads to increased risk of diabetes,” said lead author Silvia Stringhini, of the University Hospital of Lausanne in Switzerland.

Type 2 diabetes, which tends to develop in adults rather than children, occurs when body cells stop responding to insulin and become unable to use sugar in the blood.

The condition has been linked to excess weight and physical inactivity, but studies have shown that people who experienced socioeconomic adversity during their childhood tended to have a higher risk of developing this disease later in life, even when they didn’t suffer from obesity and an unhealthy diet. Stringhini and her team wanted to determine why  childhood poverty would have such a far-reaching effect.

The researchers used data from the Whitehall II study, which tracked clinical and social information from more than 10,000 people in London between 1991 and 2009. Every six years, all participants took an oral glucose test, and the researchers tracked which people developed Type 2 diabetes. They also took blood samples to measure key inflammatory proteins in the blood. To gather socioeconomic data, the researchers asked participants their job title, how much education they had and their father’s occupation. [How Inflammation Affects Your Health]

Participants who had overall low socioeconomic scores were almost twice as likely to develop Type 2 diabetes over the course of the study than those whose scores were high. Furthermore, people whose life trajectories either started or ended in a lower class had an increased risk of developing diabetes as adults.

While this finding may not be immediately surprising, Stringhini pointed out that typical diabetes risk factors, such as being overweight, physically inactive and eating poorly “explain about half of the socioeconomic status differences in the Type 2 diabetes,” she said.

The other half was tied to inflammation, regardless of a person’s weight or physical activity. People who had more disadvantaged lives overall had chronically higher levels of inflammatory proteins in their blood.

While obesity, lack of exercise, smoking and poor diet certainly contribute to chronic inflammation, the study points out that these lifestyle factors aren’t the only culprits.

“The stress related to financial adversity — that of living in poor, unsafe and polluted neighborhoods, experiencing more stressful life events, or experiencing abuse and violence — [may contribute to] an exacerbated inflammatory responses in adult life,” Stringhini said.

This discovery may point to new approaches to tackling the growing problem of Type 2 diabetes. “While this does not mean that we should stop trying to improve lifestyle behaviors in the most disadvantaged sections of society, we might try to recommend medications targeting directly inflammation,” Stringhini said.

Other experts are not so sure. “Type 2 diabetes is a very complex disease,” said Dr. Joel Zonszein, professor of clinical medicine at Albert Einstein University in New York.

“There is no question that it is an inflammation-based disease,” Zonszein said. But, he cautioned that the analysis of the data in the new study was not definitive enough to conclude that inflammation was a cause of Type 2 diabetes. “There is an interrelationship, but I don’t believe it’s a cause-and-effect relationship.”

More research is needed to determine the role of inflammation in Type 2 diabetes, he said.

The study is published today (July 2) in the journal PLoS Medicine.

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