Let today be the beginning of the end of your diabetes. Today being the World Diabetes Day, there is no better a day to take a new step for the awareness of the lifestyle disease, Diabetes. Every year, World Diabetes Day is co-ordinated by the International Diabetes Federation (IDF) with a particular theme; between 2009 and 2013 the theme has been ‘education and prevention’.
The Experiment Begins
Testing on Humans
The Nobel Prize
The Legacy of Insulin
People who have even slightly raised blood sugar levels may suffer memory loss, a study shows.
Researchers performed tests on 141 healthy people with an average age of 63.
But the study published in journal Neurology found those with with lower blood sugar levels achieved better scores in memory tests.
In a test to recall 15 words 30 minutes after hearing them, higher blood sugar levels were linked with poorer memory.
Lead researcher Dr Agnes Floel, of the Charite University Medicine in Berlin, Germany, said: “These results suggest that even for people within the normal range of blood sugar, lowering their blood sugar levels could be a promising strategy for preventing memory problems and cognitive decline as they age.
“Strategies such as lowering calorie intake and increasing physical activity should be tested.”
Dr Clare Walton, of the Alzheimer’s Society, said: “We already know that Type 2 diabetes is a risk factor for developing Alzheimer’s disease but this new study suggests that higher blood sugar levels may also be linked to poor memory in people without diabetes.
“The research suggests that regulating blood sugar levels might be a way to improve people’s memory, even if they don’t have diabetes.”
Dr Simon Ridley, of Alzheimer’s Research UK, added: “While we do not know whether the people in this study would have gone on to develop dementia, the findings serve as a warning that we should be conscious of the impact that subtle changes in our health could have on our brain.
“Current evidence suggests the best way to keep the brain healthy is to eat a balanced diet, take regular exercise, maintain a healthy weight, not smoke and keep blood pressure and cholesterol levels in check.”
An easier way for diabetics to control their insulin intake
The U.S. Food and Drug Administration has approved its first “artificial pancreas” to automatically control the insulin levels of diabetics.
The hormone insulin controls blood sugar levels and is normally produced in the body by the pancreas. But in Type 1 diabetics (and sometimes Type 2), the pancreas just doesn’t make insulin, meaning diabetics’ bodies can’t regulate blood sugar levels. This system, designed by Minneapolis-based medical tech company Medtronic, is a wearable little gadget that stops insulin delivery automatically when glucose levels get too low, hopefully keeping the wearer from going into a diabetic coma.
Unlike traditional insulin pumps, which require the wearer to still monitor blood sugar levels and manually program the pump to deliver insulin, this one monitors blood sugar for you, and delivers the appropriate amount accordingly. With a traditional pump, the device can keep delivering insulin even when the your blood sugar is too low, lowering levels even further and sometimes causing loss of consciousness. This is especially dangerous during sleep, when you can’t exactly gauge your own blood sugar. Medtronic’s MiniMed 530G system can detect up to 93 percent of hypoglycemia (low blood sugar) episodes, and will sound an alarm to wake you up if your blood sugar gets too low. If you don’t respond, the system will shut off insulin delivery for two hours, hopefully staving off dangerously low blood sugar levels.
One caveat: Medtronic got a warning letter from the FDA only a few weeks ago related to manufacturing processes of their Paradigm Insulin Infusion Pumps (which are used in this system) at their facility in Northridge, Calif. The pumps had been recalled in June because they were malfunctioning and delivering either too much or not enough insulin, and the FDA found the company was not doing enough to verify that the failure wouldn’t happen again. The company said in the press release accompanying the product approval that it had ”already addressed many of the observations noted in the warning letter and is committed to resolving the remaining observations as quickly as possible.”
But there was no proof that one necessarily caused the other.
Or the drugs themselves may interfere with blood sugar control.
These findings fall short of being strong evidence that taking anti-depressants directly increases risk of type 2 diabetes”
Dr Matthew Hobbs of Diabetes UK
Their analysis of 22 studies involving thousands of patients on anti-depressants could not single out any class of drug or type of person as high risk.
Prof Richard Holt and colleagues say more research is needed to investigate what factors lie behind the findings.
And they say doctors should keep a closer check for early warning signs of diabetes in patients who have been prescribed these drugs.
With 46 million anti-depressant prescriptions a year in the UK, this potential increased risk is worrying, they say.
Prof Holt said: “Some of this may be coincidence but there’s a signal that people who are being treated with anti-depressants then have an increased risk of going on to develop diabetes.
“We need to think about screening and look at means to reduce that risk.”
Diabetes is easy to diagnose with a blood test, and Prof Holt says this ought to be part of a doctor’s consultation.
“Diabetes is potentially preventable by changing your diet and being more physically active.
“Physical activity is also good for your mental health so there’s a double reason to be thinking about lifestyle changes.”
Around three million people in the UK are thought to have diabetes, with most cases being type 2.
Dr Matthew Hobbs of Diabetes UK, said: “These findings fall short of being strong evidence that taking anti-depressants directly increases risk of type 2 diabetes. In this review, even the studies that did suggest a link showed only a small effect and just because two things tend to occur together, it doesn’t necessarily mean that one is causing the other.
“But what is clear is that some anti-depressants lead to weight gain and that putting on weight increases risk of type 2 diabetes. Anyone who is currently taking, or considering taking, anti-depressants and is concerned about this should discuss their concerns with their GP.”
A new scoring system could help predict which patients with diabetes will achieve remission after bariatric surgery, according to a study in the Lancet Diabetes & Endocrinology.
Researchers developed and validated the DiaRem algorithm using three cohorts of patients with type 2 diabetes who underwent Roux-en-Y gastric bypass. The model relies on four preoperative variables: insulin use, age, HbA1c concentration, and use of sulfonylureas or other insulin-sensitizing agents.
Fourteen months after surgery, 87% of patients with the lowest DiaRem scores (i.e., those who were young, had low HbA1c concentrations, and were not using insulin, sulfonylureas, or other insulin-sensitizing agents besides metformin) had achieved diabetes remission, while only 5% of those with the highest scores achieved remission.
Commentators write that this research could “challenge present guidelines for provision of weight-loss surgery [for diabetes], which mostly depends on BMI.”
Source: Lancet Diabetes & Endocrinology
Objective To determine whether individual fruits are differentially associated with risk of type 2 diabetes.
Design Prospective longitudinal cohort study.
Setting Health professionals in the United States.
Participants 66 105 women from the Nurses’ Health Study (1984-2008), 85 104 women from the Nurses’ Health Study II (1991-2009), and 36 173 men from the Health Professionals Follow-up Study (1986-2008) who were free of major chronic diseases at baseline in these studies.
Main outcome measure Incident cases of type 2 diabetes, identified through self report and confirmed by supplementary questionnaires.
Results During 3 464 641 person years of follow-up, 12 198 participants developed type 2 diabetes. After adjustment for personal, lifestyle, and dietary risk factors of diabetes, the pooled hazard ratio of type 2 diabetes for every three servings/week of total whole fruit consumption was 0.98 (95% confidence interval 0.96 to 0.99). With mutual adjustment of individual fruits, the pooled hazard ratios of type 2 diabetes for every three servings/week were 0.74 (0.66 to 0.83) for blueberries, 0.88 (0.83 to 0.93) for grapes and raisins, 0.89 (0.79 to 1.01) for prunes, 0.93 (0.90 to 0.96) for apples and pears, 0.95 (0.91 to 0.98) for bananas, 0.95 (0.91 to 0.99) for grapefruit, 0.97 (0.92 to 1.02) for peaches, plums, and apricots, 0.99 (0.95 to 1.03) for oranges, 1.03 (0.96 to 1.10) for strawberries, and 1.10 (1.02 to 1.18) for cantaloupe. The pooled hazard ratio for the same increment in fruit juice consumption was 1.08 (1.05 to 1.11). The associations with risk of type 2 diabetes differed significantly among individual fruits (P<0.001 in all cohorts).
Conclusion Our findings suggest the presence of heterogeneity in the associations between individual fruit consumption and risk of type 2 diabetes. 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.
In three prospective cohorts of US men and women, we found that the associations with risk of type 2 diabetes differed significantly among individual fruits: greater consumption of blueberries, grapes, apples, bananas, and grapefruit were significantly associated with a reduced risk of type 2 diabetes. Most of these associations were quite consistent among three cohorts. Additionally, differences in the glycemic index/glycemic load values of fruits did not account for the association of specific fruits with risk of type 2 diabetes. Moreover, greater fruit juice consumption was associated with an increased risk, and substitution of whole fruits for fruit juice was associated with a lower risk, except for strawberries and cantaloupe.
Results in relation to other studies
In eight previous prospective studies, the association between total fruit consumption and risk of type 2 diabetes was examined,2 3 4 5 6 7 8 9 and the results were mixed. Similar to previous analyses in the Nurses’ Health Study3 and the Finnish Mobile Clinic Health Examination Survey study,2 the current findings supported an inverse association between total fruit consumption and risk of type 2 diabetes, but not in other studies.4 5 6 7 8 9 In contrast to total fruit consumption, evidence on consumption of individual fruits or fruit groups with risk of type 2 diabetes is limited and incomplete. In four prospective studies, consumption of citrus fruit was not associated with a lower risk of type 2 diabetes.5 6 7 8 Apple consumption was inversely associated with risk in the Women’s Health Study29 and in the Finnish study,30 but not in the Iowa Women’s Health Study.31 In addition, greater consumption of berries was associated with a lower risk in the Finnish study,2 but not in the Iowa Women’s Health Study.31 In our previous analyses that focused on anthocyanin rich fruits, intakes of blueberries, strawberries, and apples were associated with a lower risk of type 2 diabetes.32 Consistently, in a clinical trial, increased consumption of berries improved glycemic control among people with diabetes.33 Our current investigation extended the evidence in this regard and found novel, inverse associations for grapes, bananas, and grapefruit.
The different associations of individual fruits with diabetes risk may be due to the heterogeneous composition of these foods. Firstly, blueberries, apples, and red or black grapes contain high levels of anthocyanins.12 In mice with diabetes, bilberry extract rich in anthocyanins can activate adenosine monophosphate-activated protein kinase, enhance glucose uptake and utilization in white adipose tissue and skeletal muscle, and reduce glucose production in the liver.34 Our previous analyses also showed that levels of anthocyanin intake were inversely associated with risk of type 2 diabetes.32 In the current study, further adjustment for anthocyanins did not substantially change the associations for individual fruits, suggesting that the inverse associations of individual fruits are likely due to other constituents of these foods. Both red and white grapes contain high levels of resveratrol in skin.35 In mice, a high fat diet with 0.04% resveratrol increased insulin sensitivity at 24 months compared with the same diet without resveratrol.36 However, randomized controlled trials examining the effects of supplementation of resveratrol on glucose metabolism have generated inconsistent results.37 38 39 Prunes, peaches, plums, apricots, and apples contain chlorogenic acid,40 41 42 43 which may potentially mediate the beneficial effects of coffee consumption on diabetes risk.44 In rats, chlorogenic acid reduces glucose dependent insulinotropic peptide secretion by slowing glucose absorption in the intestine.45Moreover, chlorogenic acid increases muscle glucose uptake in mice with diabetes.46Finally, grapefruits contain high amounts of naringin.12 In rats, naringin inhibits dipeptidyl peptidase 4 similarly to sitagliptin, a dipeptidyl peptidase 4 inhibitor used for the treatment of diabetes.47 Inhibition of dipeptidyl peptidase 4 increases glucagon-like peptide 1, which subsequently leads to improved glucose tolerance.48 In contrast to these specific fruits mentioned above, cantaloupe was associated with an increased risk of type 2 diabetes in the current analysis. Melons have lower levels of phytochemicals than the aforementioned fruits.12 None the less, little evidence exists regarding the effects of melons on glucose metabolism. Although other fruits may also be beneficial for glucose metabolism, significant associations between other specific fruits and risk of type 2 diabetes were not found in the current and previous investigations.5 6 7 8
The glycemic index/glycemic load values of fruits did not seem to be the factor that determined their association with type 2 diabetes in the current study, although in a clinical trial, increased consumption of low glycemic index fruits improved glycemic control among people with diabetes.33 In recent meta-analyses, a higher dietary glycemic index/glycemic load was associated with a greater risk of type 2 diabetes.4950 In the Nurses’ Health Study and Health Professionals Follow-up Study, the associations between dietary glycemic index and risk of type 2 diabetes were positive, although the associations for dietary glycemic load were not significant.51 52 53 None the less, the contribution of total fruit consumption to dietary glycemic load was rather small (about 10%) in these populations. Of individual fruits, the top three contributors to dietary glycemic load were bananas (3-4%), apples (2%), and grapes (1%). In contrast, the relatively high glycemic load values of fruit juices13 along with reduced levels of beneficial nutrients through juicing processes11 12 (for example, the glycemic load values per serving are 6.2 for raw oranges and 13.4 for orange juice, and fibre levels per serving are 3.1 g and 0.5 g, respectively) may explain the positive associations between fruit juice consumption and risk of type 2 diabetes. Moreover, the difference in the viscosity of foods is also an important factor affecting postprandial blood glucose dynamics. Fluids pass through the stomach to the intestine more rapidly than solids even if nutritional content is similar.54 For example, fruit juices lead to more rapid and larger changes in serum levels of glucose and insulin than whole fruits.55 56 Although these mechanisms may potentially explain the diverse associations for individual fruits, further research is apparently needed to confirm our findings on specific fruits in relation to type 2 diabetes and to further elucidate underlying mechanisms.
Strengths and limitations of this study
The present study has several limitations. Firstly, measurement errors were inevitable in the estimates of fruit consumption, especially for individual fruits with lower consumption levels.17 18 Adjustment for energy intake and use of cumulatively averaged intake levels can reduce the magnitude of measurement errors to some extent.26 Generally, random errors in exposure assessments attenuate true associations toward the null. Secondly, the possibility of false positive findings may exist because we examined the associations of multiple fruits in the current investigation without adjusting for multiple comparisons based on a priori hypotheses. Meanwhile, most associations were consistent across three cohorts, and the associations for blueberries, grapes, and apples remained statistically significant even after applying the Bonferroni correction, a conservative method correcting for multiple comparisons. Thirdly, in our food frequency questionnaires, intakes of some individual fruits (apples and pears; peaches, plums, and apricots) were combined because these fruits have similar nutrient profiles. Therefore we could not determine whether the associations for these combined fruits can be ascribed to a specific individual fruit. Fourthly, we cannot exclude the possibility of recall bias in the assessments of diet based on the food frequency questionnaires. However, the prospective study design and exclusion of participants with chronic diseases at baseline should minimize such bias. Fifthly, although in the multivariable analysis we considered a multitude of lifestyle and dietary factors, including other individual fruits, residual or unmeasured confounding may still exist. Finally, our study populations primarily consist of health professionals with European ancestry. Thus our findings may not be generalized to other populations.
Our findings suggest that there is significant heterogeneity in the associations between individual fruits and risk of type 2 diabetes. Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, was significantly associated with a lower risk of type 2 diabetes, whereas greater fruit juice consumption was associated with a higher risk. The differences in the associations between individual fruits were not accounted for by variation in the glycemic index/glycemic load values of individual fruits. Overall, these results support recommendations on increasing consumption of a variety of whole fruits, especially blueberries, grapes, and apples, as a measure for diabetes prevention.
What is already known on this topic
- Total fruit consumption is not consistently associated with a lower risk of type 2 diabetes
- The possible heterogeneity among individual fruits regarding the associations with risk of type 2 diabetes has not been examined
- The associations with risk of type 2 diabetes are different among individual fruits
- Greater consumption of specific whole fruits, particularly blueberries, grapes, and apples, is significantly associated with a lower risk of type 2 diabetes, whereas increased consumption of fruit juices has the opposite association
- In addition, the associations of individual fruits are not determined by their glycemic index or glycemic load values
What this study adds
The increased risk was low but doctors should consider it when prescribing the class of antibiotics, known as fluoroquinolones, to people with diabetes, the researchers said. This class of antibiotics, which includes drugs such as Cipro(ciprofloxacin), Levaquin (levofloxacin) and Avelox(moxifloxacin), is commonly used to treat conditions such as urinary tract infections and community-acquired pneumonia.
One expert said the study should serve as a wake-up call for doctors.
“Given a number of alternatives, physicians may consider prescribing alternate antibiotics … in the place of fluoroquinolones (particularly moxifloxacin) to patients with diabetes,” said Dr. Christopher Ochner, assistant professor of pediatrics and adolescent medicine at the Icahn School of Medicine at Mount Sinai, in New York City. “In general, this study demonstrates that closer attention needs to be paid to particular drug-condition interactions.”
The study included about 78,000 people with diabetes in Taiwan. The researchers looked at the patients’ use of three classes of antibiotics: fluoroquinolones; second-generation cephalosporins (cefuroxime, cefaclor, or cefprozil); or macrolides (clarithromycin or azithromycin).
The investigators also looked for any emergency-room visits or hospitalizations for severe blood sugar swings among the patients in the 30 days after they started taking the antibiotics.
The results showed that patients who took fluoroquinolones were more likely to have severe blood sugar swings than those who took antibiotics in the other classes. The level of risk varied according to the specific fluoroquinolone, according to the study, which was published in the journal Clinical Infectious Diseases.
The incidence of hyperglycemia (high blood sugar) per 1,000 people was 6.9 for people taking moxifloxacin, 3.9 for levofloxacin and 4.0 for ciprofloxacin. The incidence of hypoglycemia (low blood sugar) was 10 per 1,000 for moxifloxacin, 9.3 for levofloxacin and 7.9 for ciprofloxacin.
The incidence of hyperglycemia per 1,000 people was 1.6 for those taking the macrolide class of antibiotics and 2.1 for those on cephalosporins. The incidence of hypoglycemia per 1,000 people was 3.7 for macrolides and 3.2 for cephalosporins.
“Our results identified moxifloxacin as the drug associated with the highest risk of hypoglycemia, followed by levofloxacin and ciprofloxacin,” wrote Dr. Mei-Shu Lai, at National Taiwan University, and colleagues.
They said doctors should consider other antibiotics if they have concerns that patients might experience severe blood sugar swings.
“The study … does not prove a causal connection between particular fluoroquinolones and blood sugar dysregulation,” Ochner said. But he believes that it provides evidence that people with diabetes may be at special risk from moxifloxacin in particular.
“If moxifloxacin is to be prescribed to diabetic patients, there should be some additional expected benefit that justifies the increase in incurred risk,” Ochner said.
But another expert said there could be other explanations for why people on fluoroquinolones had more blood sugar fluctuations.
“It is hard to draw conclusions that fluoroquinolones themselves are the culprit, as all of these patients had infections, and infection can lead to hypo- or hyperglycemia in persons with diabetes,” said Dr. Alyson Myers, an endocrinologist at North Shore University Hospital in Manhasset, N.Y.
“In addition, those in the fluoroquinolone group were more likely to have chronic kidney disease or steroid use – the former can increase rates of hypoglycemia and the latter can increase rates of hyperglycemia,” Myers said. “Another confounding factor would be the type of diabetes treatments that patients were receiving, as sulfonylureas and insulin are both associated with greater risks of hypoglycemia than other diabetes medications.”