October 7, 2009 (Newswise) - An international team of scientists, led by Monash University researchers, has found that anti-oxidants commonly touted for their health-promoting benefits, could contribute to the early onset of Type 2 diabetes.The team, led by Professor Tony Tiganis from the Monash Department of Biochemistry and Molecular Biology, has found that molecules known as Reactive Oxygen Species (ROS) may play a protective role in the early stages of Type 2 diabetes by enhancing insulin action. Anti-oxidants prevent the beneficial effects of ROS.

The team showed that when ROS levels were elevated in muscles of genetically-modified mice they could prevent the onset of insulin resistance and diabetes that is induced by a high-fat diet.

However when these animals received anti-oxidants, which 'mop up' ROS, the improved insulin response was lost and the mice became more 'diabetic'.

The findings, published today in the prestigious journal Cell Metabolism, challenge the widely-held view that ROS are always harmful and that anti-oxidants are always beneficial.

"ROS molecules, such as hydrogen peroxide, are important for normal cell function. We have shown that ROS present in muscle enhance insulin action and help lower blood sugar levels," Professor Tiganis said.

"However, our studies do not negate the role of ROS in late-stage disease. There's a 'yin and yang' relationship that takes place, wherein ROS are beneficial in the early stages of Type 2 diabetes and shift to being harmful at later stages of the disease. We are now trying to find out when ROS make the switch from being 'good' to 'bad'.

"Although we need to undertake further studies in humans, our results indicate that the widespread use of anti-oxidants by the general public as a preventative measure is something that should be discouraged, particularly if you are otherwise healthy," Professor Tiganis said.

"Eat healthy and exercise as this is a natural source of ROS that promotes insulin action."

Diabetes is Australia's fastest growing disease, with an estimated 275 people developing the disorder each day. Type 2 diabetes, which is linked to genetic and lifestyle factors including obesity, low physical activity and poor diet, costs our health care system an estimated $3 billion dollars annually.

Professor Tiganis led a team of 12 Monash researchers, scientists from the Baker IDI Heart and Diabetes Institute, University of Melbourne, and Cold Spring Harbor Laboratory in the US.

October 6, 2009 (Newswise) - Although most people with bulimia and binge eating disorders wait many years before seeking help, a new review shows that psychological treatment can make a large difference - and that cognitive behavioral therapy (CBT) is the most effective talk therapy for these disorders.People with bulimia experience cycles of disordered eating behavior in which they overeat and then purge, often by self-induced vomiting or taking laxatives. Binge eating disorder includes bouts of overeating, but without purging, and researchers have linked it to obesity.

Eating disorders are most common in women, with bulimia affecting about 1 percent of women and binge eating disorder affecting 2 percent to 5 percent. Although bulimia rates appear stable, binge eating disorder increasingly is becoming common.

The review included 48 studies with 3,054 participants and strengthened earlier findings in favor of cognitive behavioral therapy. It found that 37 percent of people completely stopped binge eating when given CBT focused on binging - while 3 percent of those assigned to a waiting list control group quit.

Other therapies were less successful than CBT, helping 22 percent of participants achieve abstinence
from binging by the end of treatment. One approach called interpersonal therapy did achieve comparable results - but took months longer to do so.

Lead author Phillipa Hay, M.D., is foundation chair of mental health at the University of West Sydney in Australia. "Cognitive behavioral therapy is really the treatment of choice," she said. "It has far and away the best evidence. It hadn't really been so definitively found in previous reviews."

The review appears in the latest issue of The Cochrane Library, which is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Cynthia Bulik, Ph.D., is director of the University of North Carolina Eating Disorders Program at Chapel Hill. Bulik, who had no connection with the review, said the key findings are that "bulimia nervosa is treatable; that some treatment is better than no treatment; that CBT is associated with the best outcome for bulimia nervosa."

The original intent of CBT was to treat depression. A modified type of CBT in the studies focuses specifically on binge eating disorder symptoms. Nonetheless, participants also experienced significant improvements in mood.

"Many people have problems with depression secondary to binge eating disorders," Hay said. "They often feel anxious and guilty because of their binging so if the eating disorder improves, the depression improves as well. We did look at the effects of CBT [for binge eating] on depression and it does help depression significantly just in itself."

Weight, however, did not change with treatment. "None of these psychotherapies really affect people's weight, which is good thing for people with bulimia who are normal weight but for those who are overweight or obese, they will need weight-loss therapies as well," Hay said.

Cognitive behavioral treatment of bulimia or binge eating disorder typically involves 15 to 20 outpatient sessions with a therapist over a five-month period. CBT works by helping patients change the way they think about their behavior.

"CBT rests on the premise that unhealthy thoughts lie at both the roots of bulimia nervosa and in the maintenance of unhealthy eating behaviors," Bulik said. "The goals of CBT are first to have the patient become his or her own detective and - via self-monitoring - start to understand their patterns of binge eating and purging and recognize and anticipate the cues (triggers) for their unhealthy behaviors." Once these patterns and the thoughts that drive them are identified, they can be challenged and addressed.

Hay gave the example of someone who, after binging, skips lunch and breakfast the following day. That can easily produce another binge because the craving caused by intense hunger is harder to resist. The therapist would help the patient see that eating healthy meals after a binge would break the cycle, even though fasting might initially seem like a better solution.

The review also compared CBT done in conjunction with a therapist to self-help using books that teach its techniques and tactics. While guided CBT was more effective, there was not much research on self-help and Hay says the approach is "promising" and that it should receive further study. There has been more research on bulimia than binge-eating disorder-so more data would help clarify the best approaches to the latter.

Other studies have found that antidepressants can help fight bulimia and binge eating. While this review did not compare medication to psychotherapy, Hay says clinicians should try CBT first because more people stick with it. "The dropout rate is quite significantly higher with drugs," she says.

"Some treatment is better than none," Bulik said. "If you can't find a therapist [who practices CBT for binge eating], don't throw in the towel- find another kind of therapist, pick up a self-help book, do something because the outcome will be better than doing nothing at all."

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."

October 5, 2009 (SHM) - The Society of Hospital Medicine (SHM) is announcing the launch of its new Glycemic Control Mentored Implementation (GCMI) project. Now in place in 30 hospitals across the country, the new program will improve early detection and treatment of hyperglycemia in hospitalized patients.Diabetes is the fifth leading cause of death in the United States and the fourth most common co-morbid condition complicating all hospital discharges. Hyperglycemia, or high blood sugar, in hospitalized patients complicates a variety of illnesses and is an independent risk factor for adverse outcomes.

GCMI, supported by funding from sanofi-aventis, US, LLC, utilizes mentors, glycemic control and quality improvement experts, to provide direct support to hospitalist-led healthcare teams. Each team enrolled in the two-year project receives a dedicated mentor, as well as web-based and print resources on glycemic control.

This project will address the use of both subcutaneous and intravenous administration of insulin, the two most common methods for managing glycemic levels in the hospital. Specific topics include:

• Access to subcutaneous insulin on the general medical/surgical floor
• Intravenous insulin infusion in the intensive care unit
• Transitioning patients from intravenous to subcutaneous insulin
• Transitioning patients home on insulin therapy

"Glycemic control is an important quality and patient safety issue that should be addressed in every hospital," said Jane Kelly-Cummings, RN, CPHQ, Senior Director of Quality Improvement for SHM. "GCMI addresses the pertinent clinical and system issues which will assist hospitals to improve the care of diabetic patients to decrease the incidences of hyper and hypoglycemia, whereby reducing the number of complications associated with this condition."

The following sites have been selected to participate in the new project:

• Abbott Northwestern Hospital- Minneapolis, MN
• Alexian Brothers Medical Center- Elk Grove Village, IL
• Baptist Hospital Saint Thomas Health Systems- Brentwood, TN
• Champlain Valley Physicians Hospital Medical Center- Plattsburgh, NY
• Cooper University Hospital- Camden, NJ
• Duke Raleigh Hospital- Raleigh, NC
• Emory University Hospital- Snellville, GA
• Exeter Hospital- Exeter, NH
• Healthcare Authority for Medical West- Bessemer, AL
• John C. Lincoln Hospital North Mountain- Phoenix, AZ
• Kaiser Sunnyside Medical Center- Clackamas, OR
• Kentfield Rehabilitation and Specialty Hospital- Kentfield, CA
• Kootenai Medical Center- Coeur d'Alene, ID
• Lakeland Regional Medical Center- Lakeland, FL
• Luther Hospital- Eau Claire, WI
• Memorial Medical Center- Springfield, IL
• Mercy Iowa City- Iowa City, IA
• Morton Plant Hospital- Clearwater, FL
• Multicare Health System Tacoma General Hospital- Tacoma, WA
• Oneida Healthcare Center- Oneida, NY
• Penrose-St. Francis Medical Center- Main Campus- Colorado Springs, CO
• Portland Veterans Affairs Medical Center- Portland, OR
• Poudre Valley Health System- Fort Collins, CO
• Providence Portland Medical Center- Portland, OR
• Sacramento Sutter Medical Center- Sacramento, CA
• St. Mary's Hospital- San Francisco, CA
• St. John's Mercy Medical Center- St. Louis, MO
• The George Washington University Medical Center- Washington, DC
• Thomas Jefferson University Hospital- Philadelphia, PA
• University of Virginia Medical Center- Charlottesville, VA

October 2, 2009 (Newswise) - Few people talk openly about having diabetes, so most of us have little understanding of what it feels like to live with diabetes every single day and how it can impact one's every waking moment. That's about to change. In recognition of World Diabetes Day on November 14th, the Making Sense of Diabetes video contest is challenging people living with diabetes to visually reveal its impact on their lives through one of the five senses: sight, hearing, taste, touch or smell. The contest is sponsored by the Diabetes Hands Foundation, a pioneering advocacy organization in social media, and made possible through support provided by Boehringer Ingelheim Pharmaceuticals, Inc."Diabetes affects people's lives in profound and unexpected ways," said Manny Hernandez, founder of the Diabetes Hands Foundation, who has been living with diabetes since 2002. "We smell insulin, savor glucose tablets, feel the poke of devices, react to our doctor's words and see the life ahead of us.

Diabetes is complex and we hope this video contest will help people express and share their diabetes experiences with the diabetes community as a whole as well as with people close to them."

To enter the Making Sense of Diabetes contest, anyone with diabetes over the age of 18 is asked to record and submit to http://www.MakingSenseOfDiabetes.org a video (up to three minutes run time) that demonstrates life with diabetes through one of the five senses. The online video submission should express creativity and originality, be truthful, and convey emotion in a compelling, evocative and personal way.

The contest begins on September 28 and lasts through November 1. Each week will focus on one of the five senses. Three weekly finalists will be chosen based on number of unique views, average rating received, quantity and quality of comments received, creativity and originality and the compelling nature of the video in connection to the sense it is about.

Restrictions and limitations apply. Go to http://www.MakingSenseOfDiabetes.org for the official rules and regulations, prize information, online voting of weekly winners and contest submission guidelines.

October 2, 2009 (Newswise) - South Dallas residents are 30 percent more likely to be admitted to a hospital due to diabetes or a diabetes-related condition than other city residents. In fact by 2010, 13 percent of those living in South Dallas will be diabetic.Baylor Health Care System is reaching out to the traditionally underserved neighborhood, transforming a local recreation center into the area's first and only diabetes health and wellness institute. Baylor will invest $15 million in the project with the mission of saving lives through improved diabetes care, education and research. The new institute is expected to open in Spring 2010.

The focus of the Diabetes Health and Wellness Institute at Juanita J. Craft Recreation Center (Institute) will not only be on treatment, but prevention as well.

The Institute will provide:

• Full-time, on-site physician and nurse practitioner*
• Visiting medical specialists*
• Referral coordinator for specialty and ancillary care
• Diabetes management educator
• Affordable diabetes medications
• Nutrition and healthy cooking classes
• Exercise programs including running and walking clinics and weight training

MORE ABOUT DIABETES IN TEXAS:

• According to the Texas Diabetes Council, the prevalence of diabetes in Texans (18 and older) rose to 10.3 percent in 2007
• More than 1.8 million adults in Texas are diabetic, 460,000 are believed to be undiagnosed
• Diabetes is slightly more common in women than men (10.8 percent vs. 9.9 percent)
• Diabetes rates are higher among African Americans (12.9 percent), Hispanics (12.3 percent) and other minorities (11.8 percent) than Whites (8.5 percent)
• The prevalence of diabetes increases with age (2.7 percent for people under 30, 32.2 percent for people 65 and older)
• Diabetes rates decrease as education levels increase (15.8 percent among those without a high school diploma, 6.9 percent among those who attended college)
• One of every five health care dollars is spent caring for someone with diagnosed diabetes

September 29, 2009 (EurekAlert) - Researchers studying a large sample of adolescent American boys have found an association between metabolic syndrome, which is a complication of obesity, and elevated liver enzymes that mark potentially serious liver disease.The link between metabolic syndrome and the suspected liver disease did not appear in adolescent girls, said study leader Rose C. Graham, M.D., a pediatric gastroenterologist at The Children's Hospital of Philadelphia. There were ethnic differences among the boys as well, she added, between Hispanic and non-Hispanic males.

The study appears in the October 2009 print edition of the Journal of Pediatric Gastroenterology and Nutrition.

Metabolic syndrome is of concern as a risk factor for cardiovascular disease and type 2 diabetes, and is estimated to occur in 22 percent of U.S. adults and 4 percent of U.S. adolescents. It is defined by insulin resistance, increased waist circumference, high blood pressure, and abnormal measures of high density lipoprotein ("good cholesterol") and triglycerides in the blood. The criteria are similar for pediatric metabolic syndrome, although there is some dispute over details of the definition.

In adults, researchers have shown an association between metabolic syndrome and a group of diseases called nonalcoholic fatty liver disease (NAFLD), which at its most severe, may progress to irreversible liver damage. The purpose of the current study was to investigate to what extent metabolic syndrome in adolescents was associated with elevated levels of the liver enzyme alanine aminotransferase (ALT), a marker of NAFLD.

Graham and colleagues analyzed a nationally representative sample of 1,323 U.S. adolescents, aged 12 to 19, from the National Health and Nutrition Examination Survey. They found a strong association between metabolic syndrome and elevated ALT levels in adolescent males, but not in adolescent females.

While looking more carefully at this association in boys, they found that among Hispanic males, this association largely coincided with being obese, as measured by body mass index. The researchers expected to find this correlation, because for all ethnicities, obesity was already known to be a risk factor for both metabolic syndrome and NAFLD. However, they also found that among non-Hispanic adolescent boys, metabolic syndrome and high ALT levels were associated with each other, independent of obesity. "Something else seems to be going on, in addition to the effects of obesity," said Graham. "Some unknown factors may be at work here."

The finding may have implications for treatment, she added. Currently, the only known treatment for NAFLD is weight loss. "If some adolescents with metabolic syndrome may be susceptible to this liver disease regardless of whether or not they are obese, there may be other treatments yet to be discovered."

NAFLD is increasingly being recognized among overweight teenagers. "Our findings suggest that NAFLD in adolescents merits closer attention, and its treatment may require more than just weight loss," said Graham.

September 29, 2009 (EurekAlert) - The more weight women gain from the age of 18 until middle age, the less likely they are to enjoy a long and healthy life, according to new research published on bmj.com today.Compared with lean women, the results show that being obese in middle age reduces those odds by 79%, underscoring the importance of maintaining a healthy weight from early adulthood, say the authors.

Despite the evidence that overweight and obesity can significantly increase the risk of early death, little is known about how adiposity affects overall health and wellbeing among those who survive to older ages.

To address this issue, researchers in the United States investigated the theory that being overweight in mid life is associated with a reduced probability of maintaining optimal health among those who survive to older ages.

Their findings are based on comprehensive two yearly monitoring of more than 17,000 middle-aged women in the United States as part of the Nurses Health Study.

Healthy survival referred to participants who survived to age 70 years or older, were free of major chronic diseases, and had good cognitive, physical and mental health. Usual survival referred to participants who survived to age 70 years or older but did not meet these criteria.

After adjusting for several factors, increased body mass index at the start of the study was significantly associated with reduced odds of healthy survival. Every one unit increase of body mass index was associated with a 12% reduction in the odds of healthy survival.

Similarly, in comparison to women of stable weight, weight gain since the age of 18 was significantly associated with reduced odds of healthy survival. For every one kilogram increase of weight gain since age 18 years, the odds of healthy survival decreased by 5%.

The worst odds of healthy survival were found among women who were overweight at 18 and gained 10kg or more by middle age.

But even among women who were lean at 18, relative to those who kept a stable weight, women who gained more than 10kg by middle age were 59% less likely to achieve healthy survival.

These data provide evidence that adiposity in mid life is strongly related to a reduced probability of healthy survival among women who live to older ages, and stress the importance of maintaining a healthy weight from early adulthood, say the authors.

"Given that more and more Americans are surviving to older ages and, at the same time, gaining weight, our results may be particularly important with respect to clinical or public health policies and deserve further investigation and confirmation in additional studies," they conclude.

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.

September 28, 2009 (EurekAlert) - Richard Feinman, PhD, professor of biochemistry and of family medicine at SUNY Downstate Medical Center in Brooklyn, New York, will speak at the annual conference of the European Association for the Study of Diabetes (EASD) on October 2, 2009. EASD is holding its annual conference September 28 - October 2 in Vienna, Austria.Dr. Feinman will be one of four speakers covering the topic, Controversies in Dietary Strategies in the Treatment of Diabetes.

According to Dr. Feinman, it has been scientifically documented that carbohydrate consumption raises blood glucose and there is no disagreement that diabetes is a disease of carbohydrate intolerance. "There really is no controversy about the science," Dr. Feinman explains. "It's as simple as this: An increase in dietary carbohydrate will raise HbA1c, which in turn will raise the risk of microvascular complications, and this is science we all agree on."

"That being said," he adds, "the controversy may indeed be whether or not we are getting good advice from our healthcare professionals, but that is out of my area - I will be at the conference in Vienna to explain the science."

Dr. Feinman's presentation will take place at the Messe Wien in van Swieten Hall on October 2, 2009.