Shared doctor visits may help diabetes self-care


New York |
Thu Oct 10, 2013 3:14pm EDT

New York (Reuters Health) – Diabetes patients who agreed to attend group medical appointments at a Veterans Administration hospital showed health improvements similar to what most diabetes drugs would achieve, according to U.S. researchers.

Getting type 2 diabetes patients to take care of themselves and manage their disease daily is a challenge for healthcare providers, but shared doctor visits could be a useful tool, the study team says.

One way that hasn’t worked that well is to “lecture them,” according to senior study author Dr. Jeffrey Kravetz of the VA Connecticut Health Care System.

“People learn from each other and it is easier to learn from people who are in the same boat,” Kravetz said, adding that it is often more meaningful for people with diabetes to hear from a peer who understands the condition.

Type 2 diabetes can cause serious complications if it is not controlled by a combination of medication, diet and exercise. Healthcare providers agree the best way to approach this chronic condition is to educate patients to take care of themselves, but it’s tough to get people to be better self-managers.

Kravetz, together with pharmacist Alexander B. Guirguis and a team that included a nurse who specializes in diabetes, a registered dietitian and a health psychologist, tried a different approach: shared medical appointments, in which groups of three to 10 patients met in a 90-minute session every six to 12 weeks for a year.

About one quarter of the 8,000 veterans who are seen in the Firm A clinic of the West Haven VA have diabetes, Kravetz and his team write in the American Journal of Medicine.

Around 300 of those patients have exceedingly high levels of a blood protein known as A1C that indicates how well blood sugar has been controlled over the preceding several months. A1C levels greater than 9 percent are considered problematic.

For the study, selected patients with A1C around 9 percent or more were invited to join a shared medical appointment for diabetes management. Before their first visit, the patients agreed to sharing their medical results with the group, and were sent “report cards” with their blood test results.

The 90-minute appointments combined education and consultations with the medical team with peer support and education. The emphasis, according to team leader Guirguis, was to try to make the sessions more “patient interactive as opposed to provider led.”

The team would review patients’ blood test results openly and encourage patients to talk about their challenges and successes. The sessions usually ended with a question and answer session and brief talk by the dietician.

Of the sixty patients who signed up, 40 attended at least two group visits, 19 attended three or more visits and 15 attended four shared medical appointments over the year. And by the study’s end, some patients saw their A1C levels drop by as much as 1 percent, a change Kravetz says is about what would be expected from medication.

For instance, patients with A1C averaging 10.75 percent at the beginning of the study who attended two group appointments dropped to an average A1C level of 9.51 percent. Patients with lower starting levels of A1C – around 9.5 percent – dropped to an average of around 8.5 percent after attending three meetings.

In contrast, a comparison group of patients who were invited to participate but did not follow through had A1C levels that were unchanged or rose about a quarter of a percent over the year.

While these results mean the patients are still within the type 2 diabetes range (an A1C of 6.5 percent and above is considered type 2 diabetes), Kravetz considers them “pretty comparable to some major therapies.” He noted that at most a diabetes drug reduces the A1C by up to 1 percent and these patients are doing better than medication alone.

The team found that patients often shared similar experiences and could talk about how they overcame some of their obstacles to better self care: “We are trying to get people to talk about their barriers rather than lecture to them,” he told Reuters Health.

The majority of the behavior changes were diet and medication related. Guirguis recalls one patient who strongly identified with another patient’s story about setting up his insulin next to the coffee maker.

Another benefit of this kind of peer support is that patients who are leery of going onto insulin can observe peers who “are living perfectly normal lives” while on the medication regime, he said.

Helen Altman Klein, professor emeritus at Wright State University in Ohio, who has conducted extensive studies of diabetes self management education programs, considers this study “small scale in terms of medical research, but filling a very important niche in the field of diabetes education particularly when it comes to trying to help deliver services inexpensively.

“VAs have limited resources and need to serve a lot of people,” she said. “Sometimes with a VA, it’s no small thing for some people to sign up and even make an appointment.”

The Connecticut VA is planning to continue the group appointment program, including expanding into a multisite study. The team is also experimenting with peer-to-peer telephone support, and enrolling patients for the next study, according to Guirguis.

SOURCE: bit.ly/1czY0Xg American Journal of Medicine, online September 26, 2013.

Tom Hanks is diagnosed with type 2 diabetes after suffering with symptoms for …

Hanks added that he is in better shape now and is thinner than he’s ever been in an attempt to control the symptoms of the disease.

“Well it’s controllable and through diet. My doctor said, ‘If you can weigh what you weighed in high school, you’ll essentially be completely healthy and not have type 2 diabetes.'”

However, Hanks’ diagnosis has not slowed him down, and the father-of-four is currently promoting his latest film Captain Phillips.

Hanks was spotted arriving at his London hotel today carrying his granddaughter, ahead of the film’s screening at the London Film Festival tomorrow.

Antidepressants may raise diabetes risk

People taking antidepressants are at a higher risk of type 2 diabetes, a new study has warned.

A number of studies have been carried out to establish whether antidepressants are linked with diabetes but results have varied depending on the methods used, type of medication and the number of participants.

In a systematic review, researchers at the University of Southampton found that people taking antidepressants are at a higher risk of type 2 diabetes.

However, the study cautioned that it is not certain whether the medication is responsible for the condition.

Researchers assessed 22 studies and three previous systematic reviews that looked into the effects of antidepressants on diabetes risk. Overall, people taking antidepressants were more likely to have diabetes.

However, the researchers warned that different types of antidepressants may carry different risks and long-term prospective randomised control trials are needed to look at the effects of individual tablets.

The team said that there are “several plausible” reasons why antidepressants are associated with an increased risk of diabetes.

For example, several antidepressants are associated with significant weight gain which increases the risk of type 2 diabetes.

However, they also said that several studies which explored this association still observed an increased risk of diabetes after adjustment for changes in body weight, implying other factors could be involved.

“Our research shows that when you take away all the classic risk factors of type 2 diabetes; weight gain, lifestyle etc, there is something about antidepressants that appears to be an independent risk factor,” said Dr Katharine Barnard, Health Psychologist from the University of Southampton.

“While depression is an important clinical problem and antidepressants are effective treatments for this debilitating condition, clinicians need to be aware of the potential risk of diabetes, particularly when using antidepressants in higher doses or for longer duration,” said Richard Holt, Professor in Diabetes and Endocrinology at the University.

Antidepressants linked to higher risk of type 2 diabetes

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Main Category: Diabetes
Also Included In: Depression;  Mental Health;  Psychology / Psychiatry
Article Date: 25 Sep 2013 – 8:00 PDT

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A new systematic review of published studies suggests when prescribing antidepressant medication, clinicians
should be extra aware that they are linked to raised risk for type 2 diabetes, although the study does not suggest the
drugs are the direct cause.

Reporting their findings in the latest issue of Diabetes Care, researchers from the University of
Southampton say use of antidepressants has risen sharply over recent years, and there are concerns they may have an
adverse effect on glucose metabolism.

They note 46.7 million prescriptions for antidepressants were issued in 2011 in the UK.

Antidepressant use has also soared in the US, where a
2011 study found they are now the third most widely prescribed group of drugs.

Several studies have shown that antidepressant use is linked to diabetes, but the results have been varied,
depending on the methods and numbers involved and also on the types of drugs themselves.

For instance, one study that found a link between antidepressants and risk for type 2 diabetes discovered
the risk almost doubled in patients using two types of drugs at the same time: tricyclic antidepressants (TCAs) and
selective serotonin reuptake inhibitors (SSRIs).

Antidepressant users more likely to have type 2 diabetes

Injection
Researchers found a link between people who take antidepressants and type 2 diabetes, although it does not mean there is a direct causal effect.

For their systematic review, Southampton health psychologist Dr. Katharine Barnard and colleagues assessed 22 studies
and three previous reviews that looked at the link between antidepressant use and risk for type 2 diabetes.

They found that overall, people on antidepressants were more likely to have type 2 diabetes.

Within that, however, the picture is somewhat “confused, with some antidepressants linked to worsening glucose control, particularly with
higher doses and longer duration, others linked with improved control, and yet more with mixed results.”

They note that although study quality was variable, the more recent, larger studies suggest a modest
effect.

The researchers also propose that different types of antidepressants may be linked to different amounts of risk and
call for long-term randomized, controlled trials to examine the effects of individual drugs.

Several ‘plausible’ explanations

While their review was not designed to investigate causes, the team says there could be several plausible
explanations for the link. For instance, some antidepressants cause patients to put on weight, which in itself increases risk for type 2
diabetes.

But they also point out that some of the studies they reviewed found the raised risk for type 2 diabetes persisted
when they took out the effect of weight gain, suggesting other factors could be involved.

Dr. Barnard says:

“Our research shows that when you take away all the classic risk factors of type 2 diabetes; weight gain, lifestyle
etc, there is something about antidepressants that appears to be an independent risk factor.”

She says that in light of rising prescriptions, “this potential increased risk is worrying,” and:

“Heightened alertness to the possibility of diabetes in people taking antidepressants is necessary until further
research is conducted.”

Co-author Richard Holt, professor in Diabetes and Endocrinology at Southampton, adds:

“While depression is an important clinical problem and antidepressants are effective treatments for this
debilitating condition, clinicians need to be aware of the potential risk of diabetes, particularly when using
antidepressants in higher doses or for longer duration.”

He says doctors prescribing antidepressants should be aware of this raised risk for diabetes and ensure they monitor
patients for the condition, as well as take steps to reduce the risk by encouraging changes to lifestyle.

Written by Catharine Paddock PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

  • Additional
  • References
  • Citations

Antidepressant Medication as a Risk Factor for Type 2 Diabetes and Impaired Glucose Regulation; Katharine Barnard,

Robert C. Peveler, and Richard I.G. Holt; Diabetes Care October 2013 vol. 36 no. 10 3337-3345;

DOI:10.2337/dc13-0560;
Abstract.

Additional source: University of Southampton news release via EurekAlert 24 September 2013.

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Visitor Opinions (latest shown first)

Could be a case of correlation not equaling causation

posted by Justin on 25 Sep 2013 at 11:57 am

Diabetes patients have a higher risk of suffering from depression (both type 1 and type 2). The lifestyles of some patients with type 2 diabetes are often linked to depression (overweight, types of foods eaten, etc).

The extra weight gain as a side effect of the drugs is quite relevant though. I’m not saying that these drugs don’t contribute to type 2 diabetes risk, but there are many other factors in play here.

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Control for antidepressant effect on mood

posted by Otis on 25 Sep 2013 at 11:26 am

I’m curious if there is a difference in diabetes risk among those taking antidepressants with their depression alleviated and those taking antidepressants without their depression alleviated.

I apologize as I don’t have the citation (I think the paper is still in review) and I am stating this based upon personal conversation with the researchers, but antidepressant’s improvement on the rate of myocardial infarction was found to be none on a recent large review. When the researchers looked at the data for antidepressant effectiveness, they found that antidepressant use that alleviated depression did indeed reduce the rate of myocardial infarction.

Antidepressants are widely used, but they are not universally effective. The need for care providers and patients to know the risks and benefits of the drugs is obviously important. I think it is just as important to know what the risks and benefits are when the drugs do and don’t work.

For example, I am planning a pregnancy with a mood disorder. I know my drugs work, and I don’t want to change my treatment if the alternatives have the same or worse outcomes when effective as I am gambling with the possibility that the alternatives won’t work for me. Unfortunately, there is any data to compare the outcomes of my drugs with alternatives during pregnancy based upon whether they successfully manage the mood.

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Happy pills are linked to a higher risk of diabetes: Antidepressants can cause …

  • Researchers say the risk is for all antidepressants, not just some types
  • The pills could put hundreds of thousands at risk of type 2 diabetes
  • The increased risk could be because people on antidepressants are more likely to be overweight and this is a risk factor for diabetes
  • Scientists think the pills may also be an independent risk factor

By
Sophie Borland Health Reporter

14:00 EST, 24 September 2013


|

19:10 EST, 24 September 2013

Antidepressants taken by hundreds of thousands of people may increase the chances of developing diabetes, researchers warn

Antidepressants taken by hundreds of thousands of people may increase the chances of developing diabetes, researchers warn

Antidepressants taken by hundreds of thousands of people may increase the chances of developing diabetes, researchers warn.

A major study involving more than a million patients has shown that those taking all antidepressant pills are at far higher risk from the condition.

Academics from Southampton University think this may be because antidepressants cause weight gain which in turn leads to type 2 diabetes.

But despite the strong link, they cannot be sure that the pills are definitely causing the condition.

Patients on antidepressants are more likely to be overweight so have a higher risk of developing diabetes in the first place than healthy individuals.

The numbers of Britons taking antidepressants has soared in the last decade and more than 50 million prescriptions were handed out by GPs last year compared to just 20 million in 1999.

But experts say doctors are handing out the pills too freely without considering the possible long-term side effects.

In one of the largest studies of its kind, academics from Southampton University looked at 25 research papers that involved just over a million patients.

The study, published in the journal Diabetes Care, found many patients were developing type 2 diabetes – the commonest form – after they had been prescribed antidepressants, which suggests the pills cause the illness.

Antidepressants can cause weight gain
and obesity which in turn worsens the body’s ability to regulate blood
sugar -which triggers diabetes.

Lead researcher Dr Katharine Barnard, a
health psychologist from the University of Southampton said:
‘Antidepressants are used widely in the UK, with a significant increase
in their use recently.

A major study involving more than a million patients has shown that those taking all antidepressant pills are at far higher risk from the condition

A major study involving more than a million patients has shown that those taking all antidepressant pills are at far higher risk from diabetes

‘Our research shows that when you take away all the classic risk factors of type 2 diabetes; weight gain, lifestyle etc, there is something about antidepressants that appears to be an independent risk factor.

‘This potential increased risk is worrying. Heightened alertness to the possibility of diabetes in people taking antidepressants is necessary until further research is conducted.’

Richard Holt, Professor in Diabetes
and Endocrinology at the University of Southampton, said: ‘While
depression is an important clinical problem and antidepressants are
effective treatments for this debilitating condition, clinicians need to
be aware of the potential risk of diabetes, particularly when using
antidepressants in higher doses or for longer duration.

‘When
prescribing antidepressants, doctors should be aware of this risk and
take steps to monitor for diabetes and reduce that risk of diabetes
through lifestyle modification.’

The numbers of Britons taking antidepressants has soared in the last decade and more than 50 million prescriptions were handed out by GPs last year compared to just 20 million in 1999

The numbers of Britons taking antidepressants has soared in the last decade and more than 50 million prescriptions were handed out by GPs last year compared to just 20 million in 1999

Around 3 million people in Britain have now been diagnosed with diabetes, nearly twice as many compared to 1996 when there were just 1.4 million sufferers.

The rise has been blamed on increasing levels of obesity and nine in ten patients have type 2 diabetes which is triggered by being overweight.

Experts calculate that by 2020, there will be 4 million people in the UK with the condition.


Comments (54)

Share what you think

The comments below have not been moderated.

Nicky,

Cheadle Hulme, United Kingdom,

9 minutes ago

I love these comments particularly as I have yet to see a GP who isn’t a loon anyway:)

dean,

Wise County Texas,

22 minutes ago

Sophie Borland, you haven’t a clue. Antidepressants do not make people happy.

It is true however that far too many people are prescribed these who may not truly need them. In the USA, doctors are pressured to give these out, and then sued if someone offs themselves while taking them.

polyxenes,

Fort Worth, United States,

1 hour ago

I’d like to see “happy pill” replaced with the accurate description “antidepressant”. As a long-term sufferer of severe depression, these medications have literally saved my life.

Yes, I have gained some weight – I am far from overweight – and diabetes runs in my family, but I consider the risks involved as opposed to quality of life.

In addition to antidepressants, I am in therapy and look forward to mental health in the future. With any medication, doctors are quick to write a prescription / apply a band-aid. Any drug can be misprescribed.

ang,

London,

2 hours ago

I wish the DM would stop calling them happy pills. for some people they just help to live a normal life not ‘happy’

swindongal,

Swindon, United Kingdom,

56 minutes ago

So true, I need them just to function and live a normal life. Without them I sleep most of the time and have no control of my moods. I’m either crying or angry.

charlatans77,

wilmslow,

3 hours ago

Someone who has reached a situation in life where they are prescribed antidepressants are going to be less likely to excerise as lack of energy and motivation are symptons of depression as is comfort eating. Also a side effect of antidepressants can be drowsiness which is also going to make the patient less active. A patient with a broken leg is probably also going to gain weight but not because of the painkillers. Simple scaremongering.

l–_–l,

Sunny Florida, United States,

3 hours ago

I took Prozac at age 27 and in less than 2 years my weight jumped from 135 to 164. The gain was so depressing! My weight went back down after discontinuing it. In the almost 18 years since then, I’ve taken 2 other antidepressants with no weight gain. At age 45, I feel fortunate to have low blood pressure, cholesterol and blood sugar.

Anne,

Glasgow,

4 hours ago

Everything and anything can cause weight gain or loss but it’s how we manage this which is important.

is the pope catholic,

rome, Vatican,

4 hours ago

so if your taking them be mindful of this and excersise and eat healthy etc,but then again,next week they will say prozac cures diabetes

JoeEsty,

Denver,

4 hours ago

And they don’t work anyway.

Nicky,

Cheadle Hulme, United Kingdom,

11 minutes ago

It depends – they do sometimes and if they don’t you need to have a chat with someone:)

Miss,

UK, United Kingdom,

5 hours ago

Developing diabetes in later life is a small price to pay for a depression treatment that actually works.

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Ignorance of diabetes is 'a disaster in waiting': 70% of Brits don't know …

By
Daily Mail Reporter

20:12 EST, 22 September 2013


|

20:15 EST, 22 September 2013

Widespread ignorance: Most Britons don't know that diabetes can have seriously damaging effects on health (file picture)

Widespread ignorance: Most Britons don’t know that diabetes can have seriously damaging effects on health (file picture)

Widespread ignorance about the damaging effects of diabetes is exposed in a poll out today.

Some 70 per cent of Britons said they did not know that the most serious form of the disease can lead to amputations and blindness.

Only 16 per cent knew that heart attacks are linked to type 2 diabetes and just 7 per cent realised it could trigger strokes, according to the survey.

The lack of awareness comes despite the fact that those with the illness are 36 per cent more likely to die in any given year than those without it of the same age.

Diabetes UK commissioned the survey as part of a £2million campaign funded in partnership with Tesco to raise awareness of the risk factors.

The charity’s chief executive Barbara Young said the aim is to ‘lay to rest the myth’ that type 2 diabetes is a mild condition.

‘This is a misconception that is wrecking lives and is the reason that as a country we are sleepwalking towards a public health disaster of an almost unimaginable scale,’ she said.

Losing weight, eating more fruit and vegetables and becoming more active are thought to cut the risks of diabetes.

But only half of those who took part in the poll knew being overweight was a risk factor.

Only 13 per cent realised that having a family member with diabetes raises the danger and one in 100 mentioned being South Asian or black as a risk factor.

Without urgent action, campaigners fear cases of type 2 diabetes will rise by one million to five million by 2025.

Whole fruits protect against diabetes, but juice is risk factor, say researchers

Eating blueberries, grapes, apples and pears cuts the risk of type 2 diabetes but drinking fruit juice can increase it, a large study has found.

Researchers including a team from Harvard School of Public Health in the US examined whether certain fruits impact on type 2 diabetes, which affects more than 3 million Britons.

People who ate three standard servings a week of blueberries had a 26% lower chance of developing the disease, they found. Those eating grapes and raisins had a 12% reduced risk and apples and pears cut the chances by 7%. Prunes also had a protective effect, giving an 11% drop in the risk of developing type 2 diabetes.

Other fruits such as bananas, plums, peaches and apricots had a negligible impact but drinking fruit juice increased the risk by 8%, according to the study.

People who replaced all fruit juice with eating whole fruits could expect a 7% drop in their risk of developing type 2 diabetes.

For individual fruits, replacing three servings a week of fruit juice with blueberries cut the risk by 33% while replacing juice with grapes and raisins cut the risk by 19%. The risk was also 14% lower if juice was replaced with apples and pears, 13% lower if replaced with bananas and 12% lower if replaced with grapefruit.

The research, published in the British Medical Journal, includes data on 187,382 people taken from three separate studies, of whom 12,198 developed type 2 diabetes.

Food questionnaires were used every four years to assess diet and asked how often, on average, people consumed each food in a standard portion size.

The relatively high glycaemic load of fruit juice along with “reduced levels of beneficial nutrients through juicing processes” may explain why juice increases the risk of type 2 diabetes, the authors suggest. “Fluids pass through the stomach to the intestine more rapidly than solids even if nutritional content is similar. For example, fruit juices lead to more rapid and larger changes in serum levels of glucose and insulin than whole fruits,” they said.

More research was needed, they added, but concluded: “Greater consumption of specific whole fruits, particularly blueberries, grapes and apples, is significantly associated with a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.”

About 2.7 million people in the UK are diagnosed with type 2 diabetes and a further 850,000 are thought to have it but not know. Another 7 million people are estimated to be at high risk of developing the disease, which is linked to obesity and inactive lifestyle.

Complications of type 2 diabetes include limb amputation, blindness, kidney failure, heart disease and stroke.

Dr Matthew Hobbs, head of research for Diabetes UK, said: “The best way to reduce your risk of developing type 2 diabetes is to eat a balanced, healthy diet that includes a variety of fruits and vegetables and to be as physically active as possible.

“This research provides further evidence that eating plenty of whole fruit is a key part of the balanced diet that will help you to achieve a healthy weight and so minimise your risk of developing type 2 diabetes.

“However, the associations between type 2 diabetes and specific types or fruit or fruit drinks must be treated with much more caution. Some of the findings are based on a number of assumptions and models which may have distorted the results significantly.

“For example, the researchers used surveys to ask participants how often they ate certain foods. This type of survey can often be unreliable as people are more likely to remember certain types of food.”

Obesity and type 2 diabetes link identified | Futurity

KING’S COLLEGE LONDON (UK) — Researchers are hopeful that obesity can be “uncoupled” from insulin resistance after finding that the immune system and a key protein link the two disorders.

There are an estimated 371 million people with diabetes in the world and around 90 percent of these cases are type 2 diabetes. By 2030, there will be some 550 million with the condition based on current trends.

Cases of diabetes have more than doubled since 1980, with 70 percent of the trend due to aging populations worldwide and the other 30 percent estimated to be due to increasing prevalence of risk factors including obesity.

New research published in Cell Metabolism identifies a key mechanism in the immune system involved in the development of obesity-linked type 2 diabetes. The findings open up new possibilities for treatment and prevention of this condition, which is becoming increasingly prevalent worldwide.

The association between obesity and diabetes has long been recognized but the molecules responsible for this association are unclear.

Lead author Jane Howard and her colleagues from King’s College London studied mice genetically engineered to lack T-bet, a protein that regulates the differentiation and function of immune cells. They found that the mice had improved insulin sensitivity despite being obese.

“When T-bet was absent this altered the relationship between fat and insulin resistance; the mice had more intra-abdominal fat but were actually more sensitive to the glucose lowering effects of insulin,” says Howard. “As fat accumulation in the abdomen is typically associated with worsening insulin resistance and other features of the metabolic syndrome, the findings seen were both unusual and unexpected.”

  • Yale_freeradiacals_1
  • sadwoman_green_525

It turned out that the intra-abdominal fat of these mice contained fewer immune cells and was less inflamed than that of normal mice. The researchers then went on to discover that by transferring immune cells lacking T-bet to young, lean mice they were able to improve insulin sensitivity. “It appears that T-bet expression in the adaptive immune system is able to influence metabolic physiology,” adds Professor Graham Lord.

Although human obesity is often associated with insulin resistance and diabetes, this is not always the case.

“Our data suggests that obesity can be uncoupled from insulin resistance, through the absence of T-bet,” says Howard. Several of the main drugs currently used to treat type 2 diabetes work by improving insulin sensitivity.

Further studies are needed to identify other molecules in the pathway of action of T-bet which could pave the way for future drug development in the treatment of type 2 diabetes. The administration of specific immune cells as immunotherapy to improve insulin resistance may also one day become a therapeutic possibility.

“This is just the start,” says Howard. “The idea that the immune system can impact on metabolism is very exciting, but more research needs to be done before we can bring this work from the bench to the bedside for the benefit of patients.”

The UK Medical Research Council funded the study.

Source: King’s College London

Gut Taste Mechanism Defective in Type 2 Diabetes Patients

Gut Taste Mechanism Defective in Type 2 Diabetes People

A new study uncovered that the sweet tasting gut mechanism is abnormal in type 2 diabetes patients.

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This is the first time that the researchers from the University of Adelaide have described the abnormal control of the ‘sweet taste receptors’ in the human intestine. This triggers problems with glucose use. This finding could be helpful in nutritious issues faced by diabetes patients.

The study was led by Dr. Richard Young, Senior Postdoctoral Researcher in the University of Adelaide’s Nerve-Gut Research Laboratory. It says taste buds alone do not determine sweetness,  the gut plays a much larger role.

“When we talk about ‘sweet taste’, most people think of tasting sweet food on our tongue, but scientists have discovered that sweet taste receptors are present in a number of sites in the human body. We’re now just beginning to understand the importance of the sweet taste receptors in the human intestine and what this means for sufferers of type 2 diabetes,” Dr Young said in a news release.

Type 2 diabetes makes up for 90-95 percent of the diabetes cases and is generally linked to older age. Nearly 25.8 million people suffer from diabetes in the U.S. and 7 million people have undiagnosed diabetes. It is said that by 2050 1 in 3 adults will suffer from diabetes. In 2007, diabetes was the seventh leading cause of death in the U.S.

To proceed with the finding, the researchers compared healthy adults with type 2 diabetes patients. On glucose exposure, they noticed that in healthy adults, the control of sweet taste receptors in the intestine enabled their bodies to regulate the glucose intake in 30 minutes after exposure whereas abnormalities in diabetic adults led to rapid absorption of glucose.

On detecting the glucose in the intestine, the sweet taste receptors trigger a response that regulates the manner in which glucose is taken by the intestine. The researchers noticed that compared to healthy adults, the diabetes victims absorbed more glucose rapidly and in large quantities.

The study highlights that diabetes is not a disorder that is limited to pancreas and insulin, the gut too plays an effective role. They state the need for further studies to clearly understand the mechanism taking place in the gut.

“So far, we’ve seen what happens in people 30 minutes after glucose is delivered to the intestine, but we also need to study what happens over the entire period of digestion. There are also questions about whether or not the body responds differently to artificial sweeteners compared with natural glucose,” he concludes.

The finding was documented in the journal Diabetes.

Endocannabinoids trigger inflammation that leads to diabetes

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For Immediate Release: Monday, August 19, 2013


NIH scientists identify possible treatment target for type 2 diabetes


Researchers at the National Institutes of Health have clarified in rodent and test tube experiments the role that inflammation plays in type 2 diabetes, and revealed a possible molecular target for treating the disease.
The researchers say some natural messenger chemicals in the body are involved in an inflammatory chain that can kill cells in the pancreas, which produces insulin.

A report of the finding appears online in Nature Medicine.

“This study is a significant milestone in an ongoing exploration of the endocannabinoid system’s role in the metabolic complications of obesity,” says Kenneth R. Warren, Ph.D., acting director of NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA), which led the study.

Endocannabinoids are natural messengers in the body that help regulate many biological functions. They are chemically similar to the active compound in marijuana. Recent studies have tied endocannabinoids to the metabolic problems that lead to diabetes.  Researchers also have recognized that inflammation appears to play an important role in the pathology of diabetes. 

“The identities of the molecular and cellular actors in the inflammatory processes that underlie type 2 diabetes have remained elusive,” explains senior author and NIAAA scientific director George Kunos, M.D., Ph.D.  “Our study connects endocannabinoids to an inflammatory cascade leading to the loss of beta cells in the pancreas, which is a hallmark of type 2 diabetes.”

Working with a strain of genetically obese rats that serve as a model for human type 2 diabetes, Dr. Kunos and his colleagues used a combination of pharmacological and genetic tools to show that endocannabinoids trigger receptors on macrophages in the pancreas.  Macrophages are immune system cells, present in all tissues that rid the body of cellular debris and pathogens.

“Like various other peripheral tissues, such as the liver, skeletal muscles, pancreas, and fatty tissue, macrophages have receptors for endocannabinoids,” explains Dr. Kunos.

The researchers demonstrated that endocannabinoid activation of macrophages in the pancreas leads to activation of a protein complex within macrophages called the Nlrp3 inflammasome.  The inflammasome, in turn, releases molecules that cause the death of pancreatic beta cells and the progression of type 2 diabetes in the rats.

“When we treated the rats with compounds that deplete macrophages or block all peripheral cannabinoid receptors, inflammasome activation and type 2 diabetes progression was slowed,” noted Dr. Kunos.

In test tube experiments, the researchers showed that macrophages from humans and mice produced the same inflammasome response when they were incubated with endocannabinoids.  However, mouse macrophages that were genetically altered to lack cannabinoid receptors or inflammasomes generated no such response.

Most notably, the researchers showed that by selectively blocking the expression of cannabinoid receptors on macrophages, they could protect and restore beta cell function in the genetically obese rats, which delayed the development and reduced the severity of their diabetes.

The authors conclude that the findings point to a key role in type 2 diabetes for endocannabinoid-induced inflammasome activation in macrophages, and identify cannabinoid receptors on macrophages as a new therapeutic target.

“To understand type 2 diabetes, a public health threat that affects young and old alike, we need to consider all the factors at play,” said Monica Skarulis, M.D., staff clinician at National Institute of Diabetes and Digestive and Kidney Diseases and co-author. “We hope that what we’ve learned from this research will help us develop new strategies to prevent and treat the condition.”

In addition to Dr. Kunos’ team of NIAAA scientists and Dr. Skarulis, co-authors on the study included researchers from the University of Colorado Medical Campus, Aurora, and the University of Massachusetts Medical School, Worcester.

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems. NIAAA also disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at http://www.niaaa.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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Reference

Activation of the Nlrp3 inflammasome in infiltrating macrophages by endocannabinoids mediates beta cell loss in type 2 diabetes. Jourdan, T, et al. Nature Medicine. 2013 August 18. [Epub ahead of print]

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