October 6, 2009 (Newswise) - Fat and muscle mass, as potentially determined by a person's ethnic background, may contribute to diabetes risk, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).Obesity, a worldwide health concern, is associated with increased insulin resistance, type 2 diabetes and cardiovascular disease. The prevalence of obesity is increasing in all populations across the globe, yet past research has found that body fat distribution varies widely among different ethnic groups. Researchers in this study investigated which ethnic groups were most likely to be at increased risk for diabetes due to higher total body fat and lower muscle mass.

"We know certain ethnic backgrounds show significant differences in amounts of body fat and lean mass," said Scott Lear, PhD, of Simon Fraser University in Vancouver, Canada and lead author of the study. "What we didn't know, until now, is if these differences are related to insulin levels and insulin resistance, and therefore lead to an increased risk for diabetes. Our findings indicate they are."

In this study, researchers measured insulin levels and compared the amount of total body fat to lean mass in 828 men and women of Aboriginal, Chinese, European and South Asian origin to determine how differences in fat mass and lean mass may be related to insulin levels and insulin resistance in each group. Of the four ethnic groups studied, South Asians were found to have both higher fat mass, lower muscle mass and greater insulin levels, placing them at increased risk for insulin resistance and diabetes.

"An individual's ethnic background may determine the amount of body fat and lean mass they have, and therefore may also be associated with diabetes risk," said Lear. "In populations at increased risk for diabetes, interventions that reduce fat mass and increase muscle mass, such as caloric restriction and regular exercise should be investigated."

Other researchers working on the study include Simi Kohli of Simon Fraser University in British Columbia, Canada; Gregory Bondy of the University of British Columbia in Canada; Andre Tchernof of Laval University Medical Research Centre in Laval, Canada; and Allan Sniderman of McGill Health Science Centre in Montreal, Canada.

The article, "Ethnic variation in fat and lean body mass and the association with insulin resistance," will appear in the December 2009 issue of JCEM.

October 5, 2009 (EurekAlert) - Scientists have long struggled to understand the body's biological clock. Its tick-tock wakes us up, reminds us to eat and tells us when to go to bed. But what sets that circadian rhythm?New research now shows that daily fluctuations in powerful hormones called glucocorticoids directly synchronize the biological clock as an integral part of our mechanism for regulating blood sugar.

"The most surprising part of our findings is that our internal biologic rhythms are embedded directly into another pathway, one that is essential to regulate metabolism," said senior study author Brian Feldman, MD, PhD, assistant professor of pediatric endocrinology at the Stanford University School of Medicine. Feldman also practices at Lucile Packard Children's Hospital.

The new findings give the first in vivo evidence of a direct link between glucocorticoid hormones and genes that regulate our biological clock. The research may eventually help doctors reduce disabling side effects of glucocorticoid drugs such as prednisone, Feldman said. The work could also help diabetics control their blood sugar levels and may shed light on why night-shift workers are at risk for obesity and diabetes.

The study will be published online Oct. 5 in Proceedings of the National Academy of Sciences. Feldman worked previously at the University of California-San Francisco, where much of the research was conducted.

Feldman's team began their experiments by applying a synthetic glucocorticoid to dishes of mouse and human stem cells to see which genes responded. To the team's surprise, three genes known to control the biological clock changed their activity in a direct response to the hormone.

Next, the researchers tested how the hormone's effect on the biological clock is linked with its other functions. The scientists gave the synthetic glucocorticoid to genetically engineered mice lacking a specific gene involved in regulating biologic rhythms. As the team expected, genetically normal control mice responded to the glucocorticoid with blood glucose changes associated with increased diabetes risk. In contrast, the genetically engineered mice were protected from harmful side effects on blood sugar levels. The result shows that blood sugar regulation and the biological clock are closely entwined.

The close link between daily cycles of glucocorticoids, the body's daily rhythms and blood sugar fluctuations should prompt doctors to examine how they use glucocorticoid drugs, Feldman said. For instance, prednisone is a powerful immune-suppressing glucocorticoid used to treat everything from severe asthma to cancer. Unfortunately, its side effects include poor regulation of blood sugar, weight gain and diabetes.

"Some very simple modifications in how we use glucocorticoids may change whether these drugs cause diabetes," Feldman said. Giving prednisone in a daily pattern that matches the body's natural glucocorticoid cycle -- with a daily peak in the early morning -- might help solve the problem, he said. And because prednisone is already approved for human use, clinical trials of this idea would be fast and simple.

Feldman's findings might also be applied to aid people who already have diabetes, possibly making it easier for them to artificially control their blood sugar with medications. And the work provides the beginnings of a concrete explanation for the down side of night-shift work.

"We know that disturbed sleep patterns predispose people to metabolic syndrome," or a combination of obesity and elevated diabetes risk, Feldman said. "But our molecular understanding has been poor. Now we're fleshing out the beginnings of those molecular details."

September 29, 2009 (MannKind Corp.) - AFRESA® (insulin human [rDNA origin]) Inhalation Powder is a well-tolerated, ultra rapid acting insulin able to more closely replicate normal glucose suppression than currently available insulins, according to data presented at the 45th Annual Meeting of the European Association for the Study of Diabetes. Results from the open-label, single-dose, three-way crossover study showed thatendogenous glucose production (EGP) was suppressed earlier following AFRESA administration compared with subcutaneous insulin lispro and inhaled Exubera in adult patients with type 2 diabetes. The inability to effectively suppress endogenous glucose production significantly increases the risk of fasting hyperglycemia in individuals with type 2 diabetes."Many people do not appreciate that most of the excess postprandial glucose increase in individuals with diabetes is due to inadequate suppression of endogenous glucose production by the liver," said Jay S. Skyler, M.D., MACP, Professor, Division of Endocrinology, Diabetes, & Metabolism, Associate Director, Diabetes Research Institute, University of Miami Miller School of Medicine. "This study demonstrates that more rapid insulin availability better suppresses EGP."

AFRESA is a novel, ultra rapid acting mealtime insulin therapy with an action profile that mimics meal-related early insulin release. Based on anextensive phase 2/3 clinical program, a New Drug Application (NDA) is currently under review by the U.S. Food and Drug Administration (FDA) requesting approval to market AFRESA Inhalation Powder and the AFRESA Inhaler for use in adult patients with type 1 and type 2 diabetes mellitus for the treatment of hyperglycemia. AFRESA is conveniently administered by oral inhalation.

Study Design and Key Findings
Findings were based on endogenous glucose production (EGP) suppression in 18 insulin-treated subjects with type 2 diabetes mellitus and normal pulmonary function administered 45 U AFRESA administered by inhalation, 12 IU subcutaneous insulin lispro or 4 mg inhaled Exubera. The main study end-point was time to EGP suppression.

EGP suppression occurred earliest with AFRESA, followed by insulin lispro and Exubera (40, 75 and 130 minutes post-dose of the median EGP-time profiles, respectively). Significant differences between insulin lispro and Exubera were observed up to 40 minutes compared with AFRESA (p<0.002) and up to 2 hours for the Exubera-AFRESA comparison (p<0.05). Median total areas over the EGP curve were comparable across groups (1,938, 1,842 and 2,294 µmol/min). Median postprandial blood glucose areas under the curves were 53,343, 50,608 and 54,598 mg/dl·min for AFRESA, insulin lispro and Exubera, respectively.

September 29, 2009 (EurekAlert) - Diabetes patients should always control their own blood sugar values if this leads to improvements in their treatment. This is the view advocated by Michael Nauck of the Bad Lauterberg Diabetes Center and his coauthors in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2009; 106[37]: 587-94), who discuss sensible approaches to blood glucose self-monitoring.On the basis of their analysis, the authors make differentiated proposals for the cost-efficient self-monitoring of blood glucose in a manner appropriate to the patient's individual needs.

About 40% of patients with type 2 diabetes are treated with oral antidiabetic agents or dietetically. It is controversial whether regular glucose self-measurement can improve the patient's metabolic status.

In combination therapy with oral antidiabetic agents and the daily injection of low acting insulin, the drug dose must be consistently adapted. For these patients, it is recommended to measure fasting blood sugar twice weekly.

Conventional insulin therapy is suitable for about 10% of patients with type 2 diabetes. This uses a mixture of rapid and long acting insulin and provides metabolic control for up to 16 hours. Deviations in blood sugar do not have to be controlled. There have been a variety of different recommendations for the self-monitoring of blood sugar values in these patients.

Intensified insulin therapy is the standard treatment for patients with type 1 diabetes. Its objective is that the metabolic status should be near normal, and it requires frequent blood glucose measurements.

The authors recommend that an individual therapy regimen should be developed and implemented for each patient.

August 5, 2009 (EurekAlert) - A gut hormone first described in 1928 plays an unanticipated and important role in the remote control of blood sugar production in the liver, according to a report in the August 6th Cell Metabolism, a Cell Press publication. What's more, the researchers show that rats fed a high-fat diet for a few days become resistant to the glucose-lowering hormone known as cholecystokinin (CCK)."We show for the first time that CCK from the gut activates receptors to regulate glucose levels," said Tony Lam of the University of Toronto. "It does so via a gut-brain-liver neuronal axis."

Researchers already knew that CCK levels rise in the upper intestine in response to nutrients such as lipids to lower food intake, Lam explained. Now, his team shows that the CCK hormone binds local receptors on nerves of the small intestine, sending a powerful signal to the brain. The brain in turn tells the liver to stop producing glucose.

Lam said his group described the gut-brain-liver circuitry in a paper published last year. The new study shows that it is CCK that acts as the trigger.

A primary increase of CCK-8, the biologically active form of CCK, in the upper intestine lowers glucose production independently of any change to circulating insulin levels, they found. CCK-8's effects depend on activation of CCK-A receptors and the signals they send to the brain and on to the liver, where glucose production slows. Those effects of the hormone begin to fail early in the onset of high-fat diet-induced insulin resistance, they report.

The findings suggest that CCK resistance, like insulin resistance, might be a key contributor to the high blood sugar that often comes with a high-fat diet. It also suggests that drugs targeting the CCK receptors in the gut may hold promise for therapy. That's key, Lam said, because such gut-targeted drugs might be expected to have fewer side effects than currently available diabetes drugs that work directly on the liver.

"This raises the possibility that we might be able to tap into the circuitry [to lower blood sugar]," Lam said. "At least now we know where to start."

Drug combinations that could increase sensitivity to both insulin and CCK might better combat diabetes than either could alone, he added. While the magnitude of CCK's influence over glucose levels relative to the effects of insulin aren't yet known, Lam said it's now clear both are important and neither works properly in the case of diabetes or obesity.

The researchers further suggest that CCK's role in the gut might somehow explain why people often show improvements in their blood sugar levels following gastric bypass surgeries, even before they lose any weight.

"Since we described that duodenal CCK normally triggers a gut-brain-liver axis to lower glucose production but fails to do so in high-fat fed rodents, we propose that duodenal bypass surgeries improve glucose tolerance in diabetes and obesity partly because the surgery bypasses an acquired defect involving duodenal CCK resistance in response to high-fat feeding," they wrote. Further studies are needed to explore that notion.

August 4, 2009 (EurekAlert) - A recent study by doctors at the University of Washington explained that patients who are significantly underweight or very severely obese prior to liver transplantation are at increased risk of death following transplantation surgery. These findings, from the largest known observation of liver transplantation at the extremes of BMI, are published in the August issue of Liver Transplantation, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases.The research team led by André A. S. Dick, M.D., Department of Surgery, Division of Transplantation, University of Washington investigated the impact of pre-transplantation Body Mass Index (BMI) on post-liver transplantation patient survival. The doctors hypothesized that individuals at the extremes of BMI were at increased risk of death following liver transplantation. In this study, patients with BMI < 18.5 kg/m2 were in the underweight group, with 1,827 transplanted, while those with BMI ≥ 40 kg/m2 were designated very severely obese, with 1,447 transplanted. Patients with BMI between 18.5 - 40 kg/m2 were assigned to a control group (68,172 patients) because they had similar survival rates.

When compared with the control group, the underweight patients had a higher retransplantation rate due to graft failure and were more likely to die from hemorrhagic complications or cerebrovascular accidents. Previous studies in Japan and Korea have shown a relationship between low BMI (< 18.5kg/m2) and increased risk of fatal strokes in the study populations. The authors of this study stated, "These patients should either be screened in the evaluation phase or be given special vigilance in the posttransplantation period to prevent strokes."

After transplantation, the very severely obese patients experienced higher rates of death due to infectious complications and cancer. The authors propose that one mechanism for this apparent immune deficiency is the presence of diabetes in patients with BMI > 40 kg/m2. Previous studies show that diabetic patients are at increased risk of infectious complications after surgical procedures, and supplemental immunosuppressive medication may further exacerbate this process. "An appropriate weight-based immunosuppressive regimen, careful management of severely obese patients' co-morbidities (diabetes, hypertension) and aggressive facilitation of weight reduction can optimize the health of these patients and potentially improve patient outcomes," suggest the researchers.

For patients who are severely obese, past protocol was to resolve their co-morbidities and help them achieve weight loss prior to transplantation. "A better approach might be to transplant these patients sooner by not requiring weight loss or working with the United Network for Organ Sharing (UNOS) for a policy change to assign additional Model for End-Stage Liver Disease (MELD) points for severe obesity, as is done for patients with hepatocellular carcinoma," concluded the authors. "Aggressive management of the patients' co-morbid factors and posttransplantation weight loss is a must." The researchers also recommend a posttransplantation immunosuppressive regimen favoring less immunosuppressive medications without steroids and low dose tacrolimus based on the ideal body weight.

In patients who are underweight the authors recommend "close follow-up with a nutritionist. If the patients are unable to meet their caloric intake prior to transplantation, they should then be admitted to the hospital for aggressive nutritional supplementation such as tube feedings. This aggressive regimen is continued after transplantation." The doctors also suggest a more aggressive immunosuppressive regimen with higher doses of tacrolimus and mycophenolate mofetil.

June 6, 2009 (ADA) - The long-awaited results of the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes (BARI 2D) study, a multicenter trial led by the University of Pittsburgh Graduate School of Public Health, were reported at a symposium here today at the American Diabetes Association's 69th Scientific Sessions."In combining the two revascularization approaches, we found that prompt revascularization did not hold any advantage over intensive medical therapy alone with regard to total mortality," said Trevor Orchard, MD, Professor of Epidemiology, University of Pittsburgh Graduate School of Public Health and Director of the Lipid Management Center of BARI 2D. And yet, he added, "Prompt coronary artery bypass surgery, compared to intensive medical therapy alone, had significantly better outcomes when cardiovascular events were considered in addition to death." A large part of this benefit consisted of a reduction in non-fatal heart attacks, never before shown with bypass surgery.

Nearly 24 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, stroke, blindness, kidney disease and amputation. It is a leading cause of death by disease in the United States. Type 2 diabetes involves insulin resistance - the body's inability to properly use its own insulin - and occurs mainly in adults who are overweight and age 40 and older. More than 65 percent of people with diabetes die from heart disease or stroke. With diabetes, heart attacks occur earlier in life and often result in death.

The landmark study evaluated both a cardiovascular treatment approach as well as a diabetes control approach in 2,368 persons with type 2 diabetes and stable coronary artery disease (CAD) to reduce deaths or deaths and cardiovascular events (heart attacks and stroke) combined. The first component compared intensive medical treatment with prompt coronary revascularization by either bypass surgery or angioplasty (which opens blocked arteries by inserting metal stents or balloons through the arteries, without recourse to surgery) to intensive medical treatment alone. The two coronary revascularization procedures were not compared to each other; rather, each treatment group was independently compared to its own control group receiving intensive medical therapy alone. The second component compared whether controlling diabetes with drugs to make insulin work better (insulin sensitization) had an advantage for heart health or survival compared to using a strategy emphasizing drugs increasing insulin itself (insulin provision).

The entry point to BARI 2D was referral for an angiogram due to evidence of ischemia, such as angina or a positive exercise stress test. After an angiogram, a cardiologist reviewed the results and clinical picture and determined the patient's suitability for inclusion in BARI 2D. If the cardiologist recommended either angioplasty or bypass surgery, yet considered intensive medical therapy a suitable option, the patient was deemed a candidate for BARI 2D. If the patient chose to enter the trial, he or she was randomly assigned to the revascularization approach recommended by the cardiologist or to intensive medical therapy.

Overall, researchers found that after an average follow up of five years, there were no differences in mortality rates nor in cardiovascular events between either type of early coronary revascularization compared to medical therapy alone. However, among the subgroup of participants who were pre-identified as candidates for coronary bypass surgery, the group who received prompt surgery had significantly fewer heart attacks or strokes compared to those who initially received intensive medical therapy alone.

Another major question asked was whether the glycemic strategy used would affect outcomes. To address this, the same 2,368 patients were simultaneously randomized to one of two different strategies for glucose control: (1) insulin-providing medications including insulin itself and/or drugs that stimulate the body to produce its own insulin versus (2) insulin-sensitizing drugs that work to lower the body's resistance to its own insulin. These two drug strategies attack two different problems in type 2 diabetes.

Insulin-providing and insulin-sensitizing drugs generally yielded similar results with regard to mortality and cardiovascular events. In contrast to results of some prior studies, no increase in heart attacks was observed in patients receiving rosiglitazone, one of the two major medications used in the insulin-sensitizing treatment arm of BARI 2D. The investigators also noted that the benefit of early bypass surgery was largely seen in patients who were also treated primarily with insulin-sensitizing drugs. "Although this type of interaction was not a major study question and thus should be viewed as preliminary, it strengthens the notion that reducing insulin resistance is a good way to treat type 2 diabetes," said Orchard.

"BARI 2D results further inform the clinical management of type 2 diabetes in patients with stable coronary artery disease and ischemia, and strengthen the choice of early coronary artery bypass surgery over medical therapy alone in those who are appropriate candidates for bypass surgery," said Saul M. Genuth, MD, Professor of Medicine, Case Western Reserve University and Director of the Diabetes Management Center of BARI 2D. "Some of the observations also support the concurrent use of glycemic management aimed at reducing insulin resistance."

"Until now, we have not known whether any revascularization approach is beneficial above and beyond intensive medical therapy for this type of patient, even if you apply absolutely everything that you can do with such medical therapy," said Genuth. "We have been spending a lot of money and placing patients at some risk with these procedures without knowing whether or not we are actually saving lives compared to medical therapy." Now, five-year follow-up data are available to help answer these questions.

June 6, 2009 (UC Santa Barbara College of Engineering) - UC Santa Barbara and Sansum Diabetes Research Institute scientists have demonstrated for the first time that an automated artificial pancreas system (APS) can safely and effectively maintain desired blood glucose levels in patients with type 1 diabetes. The clinical study results will be presented Monday in a late-breaking poster session at the American Diabetes Association's 69th Scientific Sessions in New Orleans.
The UCSB and Sansum researchers, working with the Schneider Children's Medical Center of Israel, tested an automated insulin delivery system comprising the OmniPod® System and the DexCom STS7® continuous glucose monitor, linked and controlled through UCSB's artificial pancreas software. The software's insulin delivery algorithm, optimized for each patient, includes a unique safety feature, based on clinical parameters, which prevents insulin-induced low blood glucose levels (hypoglycemia).

Without any outside intervention, the system restored normal blood glucose levels following both induced high levels (hyperglycemia) and unanticipated meals, while avoiding hypoglycemia. This was achieved through the automatic delivery of insulin to correct for the induced high blood glucose levels, and an insulin infusion rate moderated to ensure a smooth return to normal levels and avoid low blood glucose levels.

"This study demonstrates for the first time a completely automated insulin delivery system that frees the patients from controlling their pumps manually, eliminating the question of compliance in treatment," said principal investigator Frank Doyle, Professor of Chemical Engineering at UCSB.

Doyle continued, "We pulled together a talented team of engineers and medical doctors who created the critical element of the artificial pancreas-a unique algorithm that is robust and straightforward to implement. It's become the gold standard." The UCSB APS software platform is also being used by a number of other teams working on the artificial pancreas project, but no other team has advanced yet to wholly-automated clinical trials.

Closed loop trials were performed in four patients for a mean duration of 5 hours (range of 2-7 hours) and included a meal of 30 grams of carbohydrates. The mean Low Blood Glucose Index was 0.02 (range 0-0.06), the mean High Blood Glucose Index was 9 (range 4.2-15), and the median Daily Risk Range was 'low' (range 'low' to 'moderate').

The poster was presented in New Orleans by Matthew Percival of Doyle's research group. Other researchers in the study included Eyal Dassau, senior investigator, and Benyamin Grossman, both of Doyle's group; and Sansum's Dr. Lois Jovanovi?, CEO and Chief Scientific Officer, and Dr. Howard Zisser, Director of Clinical Research.

The research is part of the artificial pancreas project, which is funded by the Juvenile Diabetes Research Foundation and is being conducted by an international group of diabetes research centers. The project's first goal is to integrate an insulin pump and continuous blood glucose monitor to closely replicate a healthy pancreas for patients with type 1 diabetes-patients whose pancreases no longer produce insulin, which is used by the body to control blood glucose levels. An artificial pancreas will allow for tighter and automated control of blood glucose levels, which would significantly help to avoid the long-term complications of the disease.

U C Santa Barbara is a leading research institution. The two groups at UCSB involved in this study are the Department of Chemical Engineering, in 2007 ranked ninth in the United States and second in the University of California by U.S. News and World Report, and the Biomolecular Science and Engineering Program, which offers a unique interdisciplinary approach to graduate training and research spanning Biochemistry, Molecular Biology, Bioengineering and Biomolecular Materials.

Sansum Diabetes Research Institute is a non-profit research center devoted to the prevention, treatment, and cure of diabetes through research and education. It is best known for its work on methods to detect and chart the progress of diabetes and its expertise in new diabetes technology.

The OmniPod Insulin Management System-the OmniPod insulin pump and its Personal Diabetes Manager, which normally allows the patient to control it-is manufactured and sold by Insulet Corporation (Nasdaq: PODD). The DexCom STS7 continuous glucose monitor is a product of DexCom, Inc. (Nasdaq: DXCM)

May 14, 2009 (EurekAlert) - The beta-carotene in so-called "Golden Rice" converts to vitamin A in humans, according to researchers at Baylor College of Medicine (www.bcm.edu) and Tufts University in an article that appears in the current issue of the American Journal of Clinical Nutrition.Golden Rice was developed in the early 1990s with a grant from the Rockefeller Foundation with the goal of creating rice that had beta-carotene -- a vitamin A precursor - in the rice grain. In its current form, Golden Rice contains 35 micrograms of beta-carotene per gram.

"We found that four units of beta-carotene from Golden Rice convert to one unit of vitamin A in humans," said Dr. Michael Grusak (http://www.bcm.edu/cnrc/faculty/?PMID=9536), associate professor of pediatrics at the USDA/ARS Children's Nutrition Research Center (http://www.bcm.edu/cnrc/?PMID=0) at BCM and Texas Children's Hospital.

They determined this by feeding five healthy adults a specific amount of specially-labeled Golden Rice and measured the amount of retinol, a form of vitamin A, in the blood.

Vitamin A deficiency is prevalent in many parts of the world where poorer community members rely on rice as their major food source. People who lack adequate amounts of this vitamin can have vision problems or even blindness as a result.

"By incorporating vitamin A into the major crop that is consumed, we would be able to make it accessible to the majority of people in the area," said Grusak.

Additional research is necessary before Golden Rice is made commercially available. The next steps of the research include incorporating this technology into the rice grains found in various regions and continuing testing the conversion rates in humans.

May 11, 2009 (EurekAlert) - The International Diabetes Federation (IDF) today announced that its President, Professor Martin Silink has called on governments worldwide to recognize the severe impact of diabetes and other non-communicable diseases and take immediate action to ameliorate the threat.
Speaking today at the ECOSOC Annual Ministerial Review Regional Ministerial Meeting on NonCommunicable Diseases in Doha, Qatar on May 10-11, Professor Silink urged governments, the United Nations (UN) and the World Health Organization (WHO) to recognize the impact of non-communicable diseases including diabetes on global health, and to include them in the United Nations Millennium Development Goals (MDGs) and development aid programs.

President Silink stated that non-communicable diseases such as diabetes, cardiovascular diseases, cancers, and chronic respiratory diseases account for 60% of all deaths worldwide, with the majority of these deaths occurring in low-and middle-income countries . Non-communicable diseases are a major and growing economic burden to individuals and their families and impose a heavy toll on healthcare systems and society. Despite the growing disease burden of non-communicable diseases, they have not been included in the MDGs.

"The global epidemic of diabetes and other non-communicable diseases is hitting the poorest hardest. Four in five deaths from NCDs now occur in low and middle-income countries. The low-cost solutions to prevent many of these deaths are yet to be implemented. Without decisive action, the NCD burden threatens to undermine the benefits of improving standards of living, education and economic growth in many countries," said Silink.

"The global diabetes community," Silink added "is waiting for UN Member States to follow through on the promise of the UN Resolution on diabetes."

In 2006 the United Nations passed UN Resolution 61/225: World Diabetes Day, which recognized that "diabetes is a chronic, debilitating and costly disease associated with severe complications, which poses severe risks for families, Member States and the entire world and serious challenges to the achievement of internationally agreed development goals, including the Millennium Development Goals."

Diabetes in the Gulf

The invitation to the International Diabetes Federation's President recognizes the growing concern about diabetes worldwide and particularly the staggering impact the disease is having in the Gulf Region, where the picture is especially alarming. Of the top 10 countries with the highest prevalence of diabetes, five are in the Gulf. In 2007, the diabetes prevalence rate in Qatar was 15.2%, 15.2% in Bahrain, 19.5% in the United Arab Emirates, 15.7% in Saudi Arabia, 14.4% in Kuwait and 13.1% in Oman. By 2025, these rates will rise respectively to 16.9%, 17%, 21.9%, 18.4%, 16.4% and 14.7%.

Recognizing the impact of diabetes in the Region, IDF will hold its 21st World Diabetes Congress in Dubai, United Arab Emirates in 2011. The IDF Congress is organized every two years through seven world regions and is one the world's largest health conferences. The Federation has committed to Dubai because progressive urbanization, increased life expectancy and economic development associated with a shift to unhealthy lifestyle have resulted in a huge explosion in type 2 diabetes in the Middle East and North Africa over the last 30 years.

IDF's Commitment to Addressing Non-Communicable Diseases

The Federation is working to raise awareness of the growing diabetes burden and catalyse political action to reverse the epidemic. The Federation is also working closely with other NGOs concerned with NCDs.

The International Diabetes Federation will co-host a meeting on May 19 in parallel to the World Health Assembly to highlight the impact of NCDs on development. IDF is hosting this meeting with the World Heart Federation and the International Union Against Cancer to ensure that the NCD message is heard.

According to the WHO, the global burden of non-communicable diseases continues to grow; tackling it constitutes one of the major challenges for development in the 21st century .

"It is time to act," said Professor Silink. "It is time for the world to provide essential medicines for non-communicable diseases like diabetes in the same way as it has addressed the need to provide essential medicines and vaccines for communicable diseases like HIV/AIDS, tuberculosis and malaria."