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European Medicines Agency Update On Safety Of Insulin Glargine

30^th June 2009

The European Medicines Agency (EMEA) is looking into four recently published registry studies investigating a possible relationship between insulin analogues, in particular insulin glargine, and the risk of cancer. The studies were published on the Diabetologia website on 26 June 2009.

 Insulin glargine is a long-acting insulin analogue, authorised in the European Union (EU) as Lantus and Optisulin, for the treatment of adults, adolescents and children aged six years or above with diabetes, when treatment with insulin is required.

 The results of the four studies were found to be inconsistent. In two studies (Scottish Diabetes Research Network Epidemiology Group and Jonasson et al) an association between breast cancer was found in a group of patients taking insulin glargine as monotherapy, but not in another group of patients using insulin glargine together with other types of insulin. For other cancers, no association was found. In these two studies dose-dependency was not evaluated. The third study (Hemkens et al) reported a dose-dependent association between use of insulin glargine and malignancies. However, no information is available on the types of cancer found in this study. In the fourth study (Currie et al), no association between cancer (either breast, colorectal, pancreatic or prostate cancer) and the use of insulin glargine, or any other insulin, was found.

 On the basis of the currently available data, a relationship between insulin glargine and cancer cannot be confirmed nor excluded. However, the concerns raised by the four studies require further in-depth evaluation.

 The Agency's Committee for Medicinal Products for Human Use (CHMP) will perform a detailed assessment of the studies' results and any other relevant information. This review will also address issues, such as dose-response effects, the implications of the relatively short duration of the studies and influence of other factors on the risk of breast cancer and other cancers (e.g. age, body mass index (BMI), menopausal status, parity, socioeconomic status).

 The Marketing Authorisation Holder for Lantus and Optisulin, Sanofi-Aventis, has been asked to comment on this potential safety concern.

 Patients being treated with insulin glargine are advised to continue their treatment as normal. At this time there is no recommendation that patients should change their current treatment. In case of any concerns, patients should consult their doctor.

 Further information will be provided once the CHMP has concluded its review.

Notes

 1. The articles are available online here.

 2. Insulin analogues, such as insulin glargine, are substances that are similar to human insulin, but with some modifications that change properties such as the way the insulin is absorbed after injection or its duration of action.

 3. Lantus and Optisulin have been authorised in the European Union since June 2000. They are marketed in all 27 EU Member States.

 4. More information on Lantus and Optisulin is available in the European Public Assessment Report EPAR. For Lantus, please see here; For Optisulin, please see here.

Source

European Medicines Agency

Glucose Challenge Test Is Accurate And Economical For Diabetes And Prediabetes Screening

29^th June 2009

A test commonly used to help identify women with diabetes during pregnancy may be an accurate, convenient and inexpensive way to screen the general population for unrecognized diabetes and prediabetes, according to Emory University researchers.

 A test commonly used to help identify women with diabetes during pregnancy may be an accurate, convenient and inexpensive way to screen the general population for unrecognized diabetes and prediabetes, according to Emory University researchers.

 The results of the study, "Glucose challenge test screening for prediabetes and undiagnosed diabetes" will be published online and in print in the journal Diabetologia.

 "Widespread use of the glucose challenge test (GCT) to screen Americans for prediabetes and diabetes could provide a major opportunity to improve the health of more than 40 million people," said lead study author Lawrence S. Phillips, MD, Emory University School of Medicine Professor of Medicine, Division of Endocrinology.

 The study screened 1,573 volunteer participants who had never been diagnosed with diabetes. At a first visit, at different times of the day and without restriction of meals, participants were given a 50-gram glucose drink. Glucose was measured both before the drink (random glucose) and an hour after the drink (GCT glucose).

 At a follow-up visit held in the morning after an overnight fast, participants had measurement of hemoglobin A1c (a standard test used to monitor diabetes), and a 75-gram oral glucose tolerance test (OGTT). The OGTT is the "gold standard" for diagnosing diabetes and prediabetes.

 After screening, researchers found that 4.6 percent of the participants had previously unrecognized diabetes, and 18.7 percent had prediabetes.

 The GCT was the most accurate screening test for these problems, significantly better than the random glucose or A1c tests. Since the good performance of the GCT was unaffected by the time of day, or times after meals, the GCT could be performed during a routine office visit. If a patient's GCT glucose level is low, he/she wouldn't need to be screened again for another two or three years, but if the GCT glucose level is high, patients would need a confirmatory oral glucose tolerance test.

 This approach is similar to screening women for diabetes during pregnancy. GCT screening is almost universal for women in their sixth month of pregnancy.

 The GCT provided consistent results for a diverse group of patients - old and young, normal weight and overweight, men and women, with and without a family history of diabetes, etc. The GCT also appeared to be less expensive than other screening strategies.

 Early diagnosis is a benefit both for people who have diabetes or prediabetes, and for their health care teams. Regular glucose challenge test screening (GCT first, then a follow-up OGTT if the GCT glucose is high) would be a way to assure early diagnosis, according to Phillips and team.

 "Glucose challenge test screening could help improve disease management by permitting early initiation of therapy aimed at preventing or delaying the development of diabetes and its complications," says Phillips.

 Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life.

 According to the American Diabetes Association, 23.6 million U.S. children and adults, or 7.8 percent of the population, have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, 5.7 million people are unaware that they have the disease.

 Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

Aerobically Unfit Young Adults On Road To Diabetes In Middle Age 25^th June 2009

 Most healthy 25 year olds don't stay up at night worrying whether they are going to develop diabetes in middle age. The disease is not on their radar, and middle age is a lifetime away.

 As it turns out, many should be concerned. Researchers at Northwestern University Feinberg School of Medicine have found that young adults (18 to 30 years old) with low aerobic fitness levels --as measured by a treadmill test -- are two to three times more likely to develop diabetes in 20 years than those who are fit.

 The study also shows that young women and young African Americans are less aerobically fit than men and white adults in the same age group, placing a larger number of these population subgroups at risk for diabetes.

 "These young adults are setting the stage for chronic disease in middle age by not being physically active and fit," said Mercedes Carnethon, lead author and assistant professor of preventive medicine at Northwestern's Feinberg School. "People who have low fitness in their late teens and 20's tend to stay the same later in life or even get worse. Not many climb out of that category."

 The study will be published in the July issue of Diabetes Care.

 In the study, the most important predictor of who will develop diabetes is the participants' Body Mass Index (BMI), a measure of the body's fat content.

 "The overwhelming importance of a high BMI to the development of diabetes was somewhat unexpected and leads us to think that activity levels need to be adequate not only to raise aerobic fitness, but also to maintain a healthy body weight," Carnethon said. "If two people have a similar level of fitness, the person with the higher BMI is more likely to develop diabetes."

 Carnethon stressed that unfit young adults can avoid a future with diabetes by exercising and losing weight. "Improving your fitness through physical activity is one way you can modify your body fat," she said. "Research shows that combining regular physical activity with a carefully balanced diet can help most people maintain a healthy body weight and lower the likelihood of developing diabetes."

 This is the longest observational study to focus on the relationship between aerobic fitness and the development of diabetes. Most previous research has focused on the self-reported health behavior of physical activity, but people don't always accurately report their activity level. Fitness, easily measured by a standard treadmill test, provides a more accurate measure than a self-report.

 In addition, this study is the first to look at the development of diabetes over a 20- year period. Because diabetes develops over a long period of time, the number of people affected in the population rises with age. Previous studies that followed adults for a shorter period of time may have stopped short before diabetes was diagnosed.

 Data from the study came from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which began in January 1984 and ended in December 2001. The fitness study included 3,989 participants at baseline and 2,231 at the 20-year testing. The black and white men and women were 18 to 30 at the time of enrollment. Fasting blood sugar levels (the blood marker used to define diabetes) were measured at the beginning of the study and multiple times over 20 years.

 The study was funded by the National Heart, Lung and Blood Institute.

 Source:

Marla Paul

Northwestern University

'Patchy' diabetes services worry – 23^rd June 2009

Only 2% of diabetics are attending classes set up to help manage their condition, according to research for the BBC's Eye on Wales programme.

 A national framework was set up in 2003 to ensure those diabetics were offered education to manage their condition.

 The assembly government said structured education was "patchy" and added it needed to give it greater priority.

 Diabetes UK Cymru said to do nothing was a false economy and could lead to a "catastrophe" within the population.

 Statistics obtained by the organisation show around 42 people with diabetes in Wales will have a heart attack every week and five people will have a limb amputation.

 The cost to the nation is 10% of the overall NHS budget - £500m or £55,000 an hour.

 Around 5% of the population have diabetes but that figure is expected to double in the next 10 years.

 Experts agree that better screening services, education and awareness is the best way to tackle the issue.

 In Carmarthenshire, a six-week course has been set up to offer patients advice on how to manage their condition and how to prevent other diabetes-related diseases developing.

 Richard Thomas, who was diagnosed with type two diabetes, attended such a class.

 "The course has made such a difference... they motivate you so much. I'm going to live with diabetes - it hasn't beaten me and it won't," he said.

 But research has shown only 2% of patients have attended such courses and questions over the consistency of services have been raised.

'Catastrophe'

Liberal Democrat health spokesman Peter Black said: "Parts of Wales, you can go and you can be diagnosed early, you can get the treatment you need.

 "In other parts of Wales that doesn't happen, and clearly that is a discrepancy which the government needs to address as part of rolling out this strategy."

 Dai Williams of Diabetes UK Cymru added: "To not do anything is a false economy.

 "It's going to lead to a catastrophe within the population.

 "A small amount of money spent on structured education, we would save ourselves a fortune in Wales and spend the money where it's really needed."

 In response, a Welsh Assembly Government spokesperson said it recognised the value of providing structured education to help patients manage their condition but said it was not appropriate in all cases.

 He added that despite not all attending courses, education was provided to those with diabetes.

 "We recognise that structured education is still patchy across Wales and that we need to improve this by giving it a greater priority," he said.

 He added that monitoring the NHS progress with implementing the Diabetes National Framework was being stepped up with local health boards being asked to put delivery plans in place.

 He added: "In performance-managing the NHS on progress with their plans, officials will challenge the need to give a higher priority to structured education."

Shocking New Figures Of Diabetes Complications Released

UK  17th June 2009

New figures from the NHS Information Centre reveal a sobering tally of over 300 heart attacks, 300 strokes, 65 foot or toe amputations and 38 leg amputations among people with diabetes each week.

 Due to the way hospital data is recorded, these figures may well be lower than actual numbers as occurrences in the same person are only counted once.

 "Diabetes is the biggest health challenge currently facing the UK and cardiovascular disease is the most common diabetes complication," said Douglas Smallwood, Chief Executive of Diabetes UK.

 "While we can't say for certain whether diabetes is the sole contributing factor behind these new figures, we do know from a wealth of previous research that there is a very strong link.

 "It's important to remember, however, that people with diabetes can minimise the chances of developing these devastating complications by maintaining good blood glucose, blood pressure and cholesterol control, taking regular physical activity, eating a healthy balanced diet, and taking any prescribed medications."

New Diabetes Device Waves Good-Bye To Paper Log Books

Roche Diagnostics announces launch of new Accu-Chek Smart Pix diabetes management system for consumers. Traditionally, Accu-Chek Smart Pix has been an information management tool used by healthcare specialists in clinics, but now people with diabetes can benefit from this advanced technology for home use. With this brand new device, manual log books become a thing of the past, and patients remain fully in control of their diabetes at all times.

The Accu-Chek Smart Pix reads results from the blood glucose meter or insulin pump, then displays them in easy-to-understand charts on the computer[i]. For the 2.5 million people diagnosed with diabetes[ii], tight glucose management is still the best way to manage fluctuations in blood sugar levels which can lead to complications like blindness and amputation[iii]. The speed and simplicity with which Smart Pix works allows patients to create reports, easily spot out-of-range readings and track patterns they may not have otherwise spotted. This can lead to better management of their condition and ultimately more freedom in their lifestyle. The results can be shared with healthcare professionals to enhance patient care.

"Empowering a person with diabetes to manage their condition closely can make a huge difference to that person's life," commented Dr Iain Cranston, Clinical Director from Queen Alexandra Hospital, Portsmouth. "Smart Pix enables patients to take control at home, as they can track their blood sugar levels and spot any trends through easy-to-read colourful graphics, thus avoiding the use of paper records. The patient is then able to see how alterations to their diet or lifestyle affect their condition and reap the long-term benefits of those intelligent choices. As a healthcare professional, I warmly welcome this device which provides actionable information, making consultations with patients more effective."

The Accu-Chek Smart Pix is available at £14.99[iv] by calling the Accu-Chek Care Line on 0800 701 000 (UK) or 1 800 709 600 (Republic of Ireland). The technology behind Smart Pix is constantly developing and complimentary software updates are available to download. Accu-Chek Smart Pix is compatible with all Accu-Chek blood glucose meters, including the slick new Accu-Chek Aviva Nano[v]. Visit http://www.accu-chek.co.uk/smartpix for more information.

Diabetes Amputees Converge On London's O2 Arena To Campaign For Better Foot Services – 16^th June 2009

Diabetes UK is today bringing together 100 people, including 20 diabetes amputees, at the 'Body Worlds and Mirror of Time' exhibition at London's O2 Arena for a photo call to highlight the fact that diabetes causes 100 amputations a week in the UK.

 We are calling on hospitals and primary care organisations to adopt the recommendations set out in a new Diabetes UK/NHS Diabetes report, 'Putting feet first'.

 The report calls for primary care organisations to work with hospitals and community services to ensure people with diabetes have their feet examined at least once a year, to be told if their feet are 'at risk', and what to do to reduce the risk of infection.

 The report also calls for people with diabetes admitted to hospital for any reason to have their feet examined, and protected, and if they develop any foot problems to have it assessed by a doctor, nurse or podiatrist within 24 hours.

Diabetes is the leading cause of lower-limb amputation in the world and around 5,000 people with diabetes undergo leg, foot or toe amputations each year in the UK, equivalent to 100 a week.

 One in three people with diabetes do not realise that having the condition puts them more at risk of having an amputation. Up to 20 per cent (£600m) of the £3bn the NHS spends on diabetes each year goes on treating foot problems in people with diabetes, and at least £252m of this is spent on amputation.

 People with both Type 1 and Type 2 diabetes are at risk of damage to the nerves (neuropathy) and blood supply (ischaemia) to their feet. Both neuropathy and ischaemia can lead to foot ulcers and slow-healing wounds which, if they become infected, can result in amputation. However, researchers estimate that between 49 per cent and 85 per cent of all diabetic amputations can be prevented.

 It's important to remember that by keeping blood glucose, blood cholesterol and blood pressure under control people with diabetes can help to prevent complications associated with the feet.

"Foot injuries or ulcers in people with diabetes need to be assessed as soon as possible by an expert team," said Bridget Turner, Head of Healthcare Policy at Diabetes UK.

 "The longer they are left untreated, the greater the risk of deterioration and loss of the limb, which has devastating effects on a person's mobility and mood, reducing independence and causing disfigurement."

Foot or leg amputation is performed by a surgeon in a hospital under general or regional anesthesia. Recovery is an extensive process of outpatient and usually inpatient care. Treatment involves wound care, stump care, physical therapy, prosthetic training and counseling.

Along with blindness and chronic kidney failure, amputation is one of the most devastating consequences of poorly controlled diabetes. Most of these amputations originate as a sore on the foot and could have been prevented.

Sir Steve Redgrave on diabetes  - 15^th June 2009

"I'm just an ordinary guy who went quite quick in a boat, really."

 Astonishing words for a five-time Olympic gold-medal winner.

 Sir Steve Redgrave is also surprisingly modest about the struggle with diabetes that almost cost him his fifth gold.

 "I don't really want to jump on the bandwagon and say, 'Oh look at me, I'm a diabetic, what a terrible condition this is,'" he says.

 "I will drip feed information out there, and people that want to know, I'm happy to tell."

 But he says it's a delicate balancing act. Some have taken away the wrong message from the fact he managed to win his fifth Olympic medal as a diabetic, thinking it can't be that bad a condition.

 "It's a very very serious condition but dealt with properly, and looked after well, there's no reason why you can't carry on your normal lifestyle," he explains.

 When we meet at his home close to the Thames he is in surprisingly good cheer given his latest "sporting injury".

 Returning from a golf tournament, he slipped down a grassy bank on the way back to the car, and now faces several weeks with his leg in plaster.

 "Most athletes tend to eat pretty good diets, look after themselves reasonably well, try not to do stupid things of getting themselves in situations where illness or injury could happen," he says, laughing at the irony of his words.

 "You tend to be thinking, 'Oh I've got a little bit of a sniffle, I wonder if I'm coming down with a cold'. You're always a bit of a hypochondriac in some ways, thinking something is going to happen to you, illness wise."

 On a day-to-day basis, he makes sure he eats healthily but after years of eating huge amounts of food during training, he has had to cut his intake by half.

 "Being a former rower, for 25 years we're on a diet of six to seven thousand calories a day - that's a huge amount of food. You've done that for 25 years, you stop doing it, and you can't give up the food, so you tend to over-eat slightly.

 "So I've probably halved my diet, from what I was when I was an athlete, but still struggle with my weight a little bit, and the older you become, the harder it is from that point of view, and obviously with the diabetes as well, that becomes harder as well because you should be eating on a regular basis."

 Sir Steve Redgrave was diagnosed with diabetes at the age of 35, in the run-up to the Sydney games, where he hoped to compete for a fifth gold. He says it took him over a year to adjust to the condition, and even now it is a constant juggling act.

 "Every waking moment you're aware that you're diabetic," he says. "But you develop a new sense - what you're going to eat, how much insulin you've got to take with that food that you're taking, what sort of a stressful day you're going to be living because that affects the blood sugar levels as well...so you've got to look at a lot of different things."

 He has chosen to control his blood sugar by taking insulin through a small pump. His main strategy is to take control of diabetes, and not let it interfere too much with his life.

 "I'm very flexible with the whole of my condition - I decided from a very early age that diabetes had to live with me, not me live with it, and that's the way I've really focussed it. So my lifestyle hasn't changed a great deal, I have to come up with regimes to make it work for me."

Diabetes warning signs detected – 9^th June 2009

Body chemistry changes that lead to type 2 diabetes begin several years before symptoms become apparent, research has shown.

 The researchers pinpointed specific changes in blood glucose levels and sensitivity to the hormone insulin.

 They hope this could eventually be used to help identify people at high risk of the disease earlier, meaning action can be taken to delay its progression.

 The Lancet study was led by University College London.

 It was presented to a meeting of the American Association of Diabetes.

The researchers followed 6,538 UK civil servants over almost 10 years, during which 505 cases of type 2 diabetes were diagnosed.

 They examined how the volunteers' blood glucose levels and the capacity of their tissues to respond to insulin - known as insulin sensitivity - changed over time.

 They also looked at how the insulin-producing beta-cells of the pancreas functioned over time.

Rapid acceleration

The researchers showed that in volunteers who did not develop diabetes changes in body chemistry occurred at a steady, even pace over time.

 However, patients who developed diabetes showed a rapid acceleration in both fasting and post-meal blood glucose levels starting three years before they were diagnosed with the condition.

 Insulin sensitivity decreased steeply during the five years prior to diagnosis among the diabetic group.

 And their beta-cell function increased between years four and three prior to diagnosis, as their body tried to compensate for the raised glucose levels, but then decreased in the three years up to diagnosis.

 The researchers said their work could help efforts to develop more accurate models to predict an individual's risk of developing type 2 diabetes.

 They said most prevention studies focused on people in the earliest stages of disease, but by that stage changes to body chemistry were already well advanced.

 Lead researcher Dr Adam Tabak said: "Our model may help detect people at high risk to develop diabetes, so we can better target these people to prevent the development of the disease.

 "We believe that an earlier intervention - before the conventional prediabetes stage - could delay diabetes development substantially."

More work needed

However, in an editorial in the same journal, diabetes experts Dr David Matthews and Dr Jonathan Levy, from the University of Oxford, warn that much more work is needed.

 They wrote: "Does this mean that we find those who are about to get diabetes - perhaps even three or four years ahead? We fear not.

 "The sensitivity and specificity of the forward predictions would be poor.

 "Now the hunt has to be intensified for the pathology that causes the decompensation that precipitates diabetes."

 Pav Kalsi, of the charity Diabetes UK, said: "Although these markers provide a good indication of future type 2 diabetes the lack of sensitivity and specificity means we cannot know for certain, so we'd welcome further research into this promising area of study."

 Judy O'Sullivan, of the British Heart Foundation, said: "This study provides better data than we have had before to show that those who are going to get diabetes have signs they are at risk for several years before the disease becomes clinically obvious.

 "This reinforces the view that more careful and frequent earlier routine screening could lead to a significant gain in preventing or delaying the onset of the disease."

Stop diabetes bullying – 08^th June 2009

Louise Bodeker was diagnosed with Type 1 diabetes at the age of 14.

For the first six months she injected her insulin openly, but a crass remark by a fellow pupil on a school trip changed all that.

"I had to inject halfway up a mountain doing adventurous things and I had to inject in front of everyone," said Louise, who is from Oxfordshire.

"One of the lads made a massive thing of it saying: 'Why do you have to do that in front of everybody? It's gross.'"

Louise's confidence was knocked and it was a long time before she felt happy injecting in public again.

Worried by the experience of Louise, 18, and teenagers like her, the charity Diabetes UK has launched a short viral video called Setting the Record Straight, which is aimed at teaching children and young people the truth about Type 1 Diabetes.

A viral is a video that spreads quickly via the internet and has been used successfully by a number of companies for advertising their products - from eyebrow-wiggling children to advertise chocolate bars, to impromptu dances in stations to promote mobile phones.

Amanda Neylon, Diabetes UK digital media manager, said it hoped its video, which shows a group of teenagers teasing a young girl about her condition, will have a good saturation among young people.

This is the second time Diabetes UK has used viral videos, although this is the first time one is aimed at those without the condition as well as those with diabetes.

"We had a good response last time and a lot of comments from people wanting us to make clear about the distinctions between Type 1 and 2.

"The anti-bullying viral video is a different way of letting young people know more about Type 1 diabetes and helping them understand that other young people with the condition should not be singled out or victimised," she said.

"We know that young people are especially receptive to new technologies and we are always keen to use the internet and social networking sites to communicate with them."

The film is available on YouTube, social networking sites such as Facebook, MySpace and Bebo, and the Diabetes UK website.

It can also be directly embedded into websites or blogs.

Libby Dowling, a care adviser with Diabetes UK, said that when it had asked young people for their feedback about living with the condition, many had been hurt by misconceptions about Type 1.

"What we really need to do is to raise the awareness around children with Type 1 diabetes," she said.

"It is still quite a misunderstood condition. There are still a lot of myths and misconceptions and downright discrimination.

"In the media there is an awful lot about children being overweight and the link to that and developing Type 2.

"That is an important message to get across.

"But we have to remember that the vast majority of children with diabetes have Type 1, and that is nothing at all to do with being overweight or lifestyle factors.

"It is something that could not be prevented and it is important that we do not ignore the needs of this big group of young people.

She added: "Nowadays young people are texting and e-mailing. The traditional leafleting that I grew up with are just not appropriate."

She said that young people with diabetes have been dubbed "druggies" or taunted about their lifestyle.

Seventeen-year-old Katie, from Merseyside, said her teacher made her inject in the school toilets to avoid offending others and she was warned her needles might be considered a weapon.

"That knocked my confidence," said Katie.

"It is a type of bullying. Other students were saying they did not want me to do my insulin around them as it made them feel sick.

"I want to say if you don't like looking at it don't look.

"People said things like 'do you have the one where you have too much sugar or too little?'

"They ask questions like: 'Were you fat? Or have you eaten too many jammy dodgers?' and I get comments and funny looks when I inject.

"I go out for a meal and I have to do my insulin at the table. They liken it to drug abuse and the looks I get are quite disturbing."

Type 1 Diabetes Cases In Children Under Five To Double By 2020 – 2^nd June 2009

Cases of type 1 diabetes in children under five years across Europe will double by 2020 (from 2005 levels) if present trends continue. Numbers in children older than five will also increase substantially. The findings are discussed in an Article published Online First and in an upcoming edition of The Lancet, written by Dr Chris Patterson, Queen's University, Belfast, UK, and Prof Gyula Soltész, Pécs University, Pécs, Hungary, and colleagues.

Type 1 diabetes is caused by insulin deficiency (and thus must be treated with insulin injections), whereas type 2 diabetes is caused by reduced insulin sensitivity along with some insulin deficiency. In the general population, type 1 diabetes cases represent only 10% of total diabetes cases. However among children the numbers of cases of type 1 diabetes is higher than type 2 in most countries. To predict the future burden of type 1 diabetes, the authors analysed diabetes data from 20 centres in 17 European countries, which had registered 29311 cases of type 1 diabetes during the period 1989-2003.

The researchers found that the overall increase in incidence of type 1 diabetes was 3.9% per year; while the annual increase in the 0-4 years age group was 5.4%, with a 4.3% rise in the 5-9 years age group, and a 2.9% rise in 10-14-year-olds. There were estimated to have been approximately 15,000 new cases in Europe in 2005, divided among the 0-4 years, 5-9 years, and 10-14 in the ratio 24%, 37% and 34% respectively. A total of 24,400 new cases is predicted in 2020, with a doubling in the number of cases in children aged under 5 years and a more even distribution across age groups than at present (29%, 37%, and 34% respectively). If present trends continue, the total number of cases (new and existing) in European children under 15 years is predicted to rise from 94,000 in 2005 to 160,000 in 2020-a 70% increase.

The changes over time are so rapid, say the authors, that they clearly cannot be because of genetic factors alone. They discuss modern lifestyle habits as possible contributory factors, such as increased weight and height development and increased caesarean section births. The higher increases are seen in Eastern Europe, where lifestyle habits are also changing more rapidly than in the richer European countries.

The authors conclude: "The predicted rise in childhood type 1 diabetes in Europe during the next 20 years, and the raised proportion of cases diagnosed at younger ages than were before, could result in more cases presenting with ketoacidosis and needing hospital admission. More patients with severe diabetes complications presenting at younger ages than before are also likely, and appropriate care from diagnosis, and maintenance of good metabolic control are crucial for delay or prevention of these adverse complications. In the absence of any effective means to prevent type 1 diabetes, European countries need to ensure appropriate planning of services and that resources are in place to provide high-quality care for the increased numbers of children who will be diagnosed with diabetes in future years."

In an accompanying Comment, Dr Dana Dabelea, Colorado School of Public Health, University of Colorado, Denver, CO, USA, says the findings from this and other studies suggest 'that the incidence of type 1 diabetes is increasing even faster than before, pointing towards harmful changes in the environment in which contemporary children live'. She also discusses the findings specific to children under 5, and the concerns that younger age of onset of type 1 diabetes is usually associated with more acute symptoms. The consequences of longer exposure to altered metabolism due to diabetes and the increasing economic costs of the disease are also looked at.

She concludes: "It is imperative that efforts directed at surveillance of diabetes in young people continue and expand, not only to understand its complex aetiology, but also because of its increasing public health importance."

Asia facing 'diabetes explosion' – 28^th May 2009

New research suggests diabetes is becoming a global problem, with more than 60% of all cases likely to occur in Asia.

A study in the Journal of the American Medicine Association shows those hit in Asia are younger and less likely to be overweight than those in the West.

The study says numbers worldwide could grow by a third by 2025, with low and middle income countries worst hit.

The disease is expensive to treat and could hit Asian economies hard.

The study said trends of diabetes in Asia are influenced by everything from genetic and cultural differences, to smoking and rates of urbanisation.

Click here to enlarge map

Weighty surprise

While in the West, type-2 diabetes is often seen as a consequence of diet, age and obesity, researchers say those affected in Asia are relatively young and less likely to be struggling with weight gain.

Citing figures from the International Diabetes Federation, researchers say while people from Japan to Pakistan generally have lower rates of fat, they can have a similar or even higher prevalence of diabetes than in the West.

The problem is that although Asian obesity rates are low, changing diets and sedentary lifestyles, associated with rapid economic development, are taking their toll.

That transition, which took about 200 years in Europe, has taken just half a century in Asia, experts noted.

The age differential was also stark. Diabetes most often affects people in the West at the age of 60 to 79 years, compared to the age range of 20 to 59 years in Asia.

The study suggested that this appears to be the result of both low birth weights and over-nutrition in later life, partly because Asian women are two- to three-times as likely to have gestational diabetes as their white counterparts. 

India will see its numbers grow from 40 million to nearly 70 million; China 39 million to 59 million; and Bangladesh 3.8 million to 7.4 million; the numbers for Indonesia, the Philippines, Malaysia, Vietnam and others will also rise dramatically.

The findings were based on analysis of hundreds of articles, data and studies published between January 1980 and March 2009.

International Action Needed To Combat Epidemic Of Noncommunicable Diseases - 27th May 2009

The International Diabetes Federation (IDF), International Union Against Cancer (UICC) and World Heart Federation (WHF) have issued a joint statement that calls on the international community to address urgently the epidemic of non-communicable diseases (NCDs), responsible for 35 million deaths a year. The statement demands a substantial increase in funding for NCDs and greater availability of essential medicines, among other urgent responses, in a way to accelerate achievement of the health Millennium Development Goals.

Public health experts are concerned about the impact of the global economic crisis and warn that the emerging epidemic of NCDs is threatening to overwhelm healthcare systems worldwide unless action is taken. Cardiovascular disease, diabetes, cancer and chronic respiratory diseases cause 60% of all deaths worldwide.

NCDs impact on the world

 IDF, WHF and UICC are united by their concern with the consequences of physical inactivity, tobacco use and poor diet, three avoidable risk factors that contribute significantly to the NCDs responsible for 60% of global mortality.

Diabetes is a leading cause of blindness, kidney failure, heart attack, stroke and amputation. The number of people living with diabetes has increased considerably over the past 30 years. In 1985, an estimated 30 million people worldwide had diabetes. A little over a decade later, the figure had risen to over 150 million. Today, according to IDF figures, it exceeds 250 million. A further 300 million are at high risk of developing diabetes. Unless action is taken to implement effective prevention and control programmes, IDF predicts that the total number of people with diabetes will reach 380 million by 2025.

Cardiovascular disease (CVD) is the leading cause of death worldwide. An estimated 17.2 million people die from CVD each year, and that toll could increase to almost 20 million by 2015. The incidence of deaths attributable to CVD continues to rise sharply, accounting for 30% of all deaths globally.  Cardiovascular disease affects the heart or blood vessels and includes heart disease, stroke and high blood pressure.

Cancer is the second leading cause of death worldwide. More than 11 million new cases are diagnosed each year, and about 8 million people die from cancer - over 70% of them in low- and middle-income countries. On current trends, 15.5 million people will be diagnosed with cancer in 2030, and about 12 million people will die from the disease. Yet, we have more knowledge than ever before on how to bring cancer under control. About one-third (30-40%) of all cancers can be prevented, a further third can be cured (given early diagnosis and treatment), and effective palliative care can be provided to patients.

In its 2009-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, the World Health Organization identifies international partnerships as paramount in the global struggle against NCDS. WHO calls for concerted action on a global scale and identifies a key role for non-governmental organizations. IDF, WHF and UICC have taken up this call. Combined, the three organizations represent the interests of 730 member organizations in over 170 countries. They have joined forces to create a powerful voice for change and urge the international community to take action in the face of the NCD epidemic.

Professor David Hill, President of the International Union against Cancer states: "Now, more than ever, we need to join efforts to give cancer and the other NCDs the priority they deserve. The advantages that stand to be gained from the strength of strategic international partnerships, such as the one between our three organizations, will contribute towards a more effective global response to NCDs."

Call for Action

The joint statement issued today in Geneva was timed to coincide with the meeting of the World Health Assembly. The organizations highlighted their support for the WHO Action Plan and call for the international community to:

   1. Ensure the availability of essential medicines for people living with NCDs in low- and middle- income countries

   2. Immediately and substantially increase financing for NCDs

   3. Integrate NCD prevention into national health systems and the global development agenda

   4. Create a Special Envoy of the UN Secretary-General for NCDs

   5. Support a UN General Assembly Special Session on NCDs

WHO has shown that simple, cost-effective solutions exist to take on the burgeoning epidemic of NCDs. If the international community acts now, hundreds of millions of lives could be saved and the quality of life improved for millions more. Such action would bring the international community closer to achieving the UN Millennium Development Goals. Failure to act will have a detrimental effect on healthcare systems and economies worldwide. Governments who invest in prevention now will be spared the overwhelming costs of chronic care later.

Professor Martin Silink, President of the International Diabetes Federation explains: "the world has not previously had to cope with an epidemic of NCDs. Health systems will need to adapt fast to mobilize new and existing resources to tackle the epidemic through prevention and education. The majority of people with non-communicable diseases like diabetes, cardiovascular disease and cancer are responsible for most of their own care most of the time. Health systems will need to support the role of people with NCDs and see them as part of the solution."

Reducing Heart Attack Risk In Diabetes – 26^th May 2009

People with diabetes who maintain intensive, low blood sugar levels are significantly less likely to suffer heart attacks and coronary heart disease, new research published in The Lancet has shown.

By undertaking a meta-analysis which pooled information from five large trials, researchers at the University of Cambridge were for the first time able to provide reliable evidence linking intensive blood sugar level (or glucose) control with fewer heart attacks.

The research, funded by the British Heart Foundation, pointed to a 17 % reduction in heart attacks and a 15 % reduction in coronary heart disease. However, the study found a more modest trend towards reduction in strokes with intensive control of glucose levels compared to standard care. Importantly, in contrast to smaller studies which had suggested possible harm from better blood sugar control, there were no adverse effects on deaths from any cause.

It is well documented that diabetics are at increased risk of heart disease. Even though patients can reduce their risk by maintaining healthy blood pressure levels and cholesterol reduction, the risk remains high.

Dr Kausik Ray of the University of Cambridge, lead author of the study, said: "Previous studies have been inconclusive, leaving diabetics and their doctors unsure as to whether maintaining lower blood sugar levels actually benefitted the patients. Although additional research needs to be conducted, our findings provide insight into the importance of improving glucose levels which should include lifestyle changes as well as medication."

The five trials involved more than 33,000 individuals, including 1497 heart attack cases, 2,318 cases of coronary heart disease, and 1227 strokes. In order to assess the possible risk of various heart conditions, Dr Ray and his team analyzed the data collected on the glucose levels in blood, specifically a long-term marker of glucose control called HbA1c. In healthy individuals, HbA1c levels average between 4-5%. However, diabetics often have levels above 6.5%.

In the present study, those taking a standard treatment maintained a HbA1c level of 7.5%. Individuals who underwent intensive treatment to lower their blood sugar level were 0.9% lower than those who underwent standard treatment (average 6.6%), thereby dramatically reducing their risk of disease in large blood vessels.

Professor Peter Weissberg, Medical Director at the British Heart Foundation said: "It is well established that carefully controlling blood sugar in people with diabetes can help prevent disease in small blood vessels that leads to kidney failure and blindness. This collective analysis of several large clinical trials suggests that careful blood sugar control also protects against heart attacks and strokes, the major causes of death in people with diabetes.

"These findings emphasise the importance of detecting and treating diabetes as early as possible, thus preventing the chances of developing heart and circulatory disease."

Dr Ray concluded: "The present findings reinforce the need for diabetic patients to achieve and maintain better control of blood sugars long-term, as a means to reduce risk of heart disease."

The paper 'Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials' will be published in the 23 May 2009 edition of The Lancet.

What Is The Difference Between Diabetes 1 And

Diabetes 2? - 19^th May 2009

 Before we look at the difference between diabetes 1 and diabetes 2, let's firstly look at diabetes in general: Diabetes, termed diabetes mellitus, is a metabolism disorder. Metabolism refers to how the body uses and digests food for growth and energy. Most of the food we consume is broken down into glucose. Glucose is a type of sugar in the blood - it is the main source of food for our bodies (our cells). When food is digested it eventually enters our bloodstream in the form of glucose. Cells utilize the glucose for growth and energy. However, without the help of insulin, the glucose cannot enter our cells. Insulin, a hormone, is produced in the pancreas. After consuming food the pancreas automatically releases an appropriate quantity of insulin to transport the blood glucose into the cells, thus lowering blood sugar levels.

 If you have diabetes, the amount of blood glucose is too high - a condition called hyperglycemia. This happens for one of two main reasons:

    * The body is producing no insulin - this is Diabetes Type 1

    * The cells do not respond correctly to the insulin - this is Diabetes Type 2

 Consequently, excessive amounts of glucose accumulate in the blood. This blood glucose overload is eventually passed out of the body in urine. Even though the blood has plenty of insulin, the cells of a person with diabetes are not getting their crucial energy and growth requirements.

What is type 1 diabetes?

In Type 1 Diabetes, the person's own body has destroyed the insulin-producing beta cells in the pancreas. When your own body destroys good stuff in your body it has what is called an autoimmune disease. Diabetes Type 1 is known as an autoimmune disease.

 Quite simply - a person with Diabetes Type 1 does not produce insulin. In the majority of cases this type of diabetes appears before the patient is 40 years old. That is why this type of diabetes is also known as Juvenile Diabetes or Childhood Diabetes. Diabetes Type 1 onset can appear after the age of 40, but it is extremely rare. About 15 per cent of all diabetes patients have Type 1.

 People with Type 1 have to take insulin regularly in order to stay alive.

 Diabetes Type 1 is not preventable, it is in no way the result of a person's lifestyle. Whether a person is fat, thin, fit or unfit, makes no difference to his or her risk of developing Type 1. In the case of Diabetes Type 2, much of its onset is the result of bodyweight, fitness and lifestyle. The vast majority of people who develop Type 1 are not overweight, and are otherwise healthy during onset. You cannot reverse or prevent Type 1 by doing lots of exercise or eating carefully. Quite simply, the Diabetes Type 1 patient has lost his/her beta cells. The beta cells are in the pancreas; they produce insulin.

What is type 2 diabetes?

Person with Diabetes Type 2 has one of two problems, and sometimes both:

      1. Not enough insulin is being produced.

      2. The insulin is not working properly - this is known as insulin resistance.

 The vast majority of patients who develop Type 2 did so because they were overweight and unfit, and had been overweight and unfit for some time. This type of diabetes tends to appear later on in life. However, there have been more and more cases of people in their 20s developing Type 2, but it is still relatively uncommon.

 Approximately 85% of all diabetes patients have Type 2.

 Insulin resistance

The body produces insulin, but its insulin sensitivity is undermined and does not work as it should do - glucose in not entering the body's cells properly. Consequently, blood sugar levels rise, and the cells are not getting their required nutrients for energy and growth.

 The problem is with the cells - they are not responding to insulin like they used to. Experts are not sure what exactly is happening when cells stop responding well to insulin. Below is a simple explanation of why insulin resistance happens:

     * Cells build up insulin resistance anyway

      Each time your cells are exposed to insulin they build up a bit of resistance.

     * Lots of food triggers more insulin production

      If a person is eating a lot he will be producing more insulin than somebody who doesn't.

     * Too much insulin is toxic for the cells

      If the exposure to insulin is high the cell will try to protect itself from intoxication - it will down-regulate its receptor activity and the number of receptors so that it does not have to be subjected to all that stimuli all the time.

     * Frequent high insulin speeds up the process

      If the cell's exposure to high insulin is frequent the insulin resistance will grow faster.

     * The pancreas puts out more insulin

      If the insulin is not doing its job properly the pancreas will put out more of it - a vicious circle.

 The insulin resistance will reach a point in which the amount of insulin produced by the pancreas is not enough to make up for the cells lower response. At this point the person will have to take additional insulin.

 Lack of physical activity, being overweight, and some genetic factors make it much more likely that the cells build up insulin resistance more quickly. It is important to remember that insulin resitance is not the insulin not responding properly, it is the cells not responding properly to insulin.

 Unfortunately, insulin resistance can lock a patient into a another vicious circle, because insulin resistance itself promotes weight gain. So, if people are insulin resistant because they are overweight, the excess pounds are harder to get rid of because of it.

 According to Medilexicon's medical dictionary, insulin resistance is a "diminished effectiveness of insulin in lowering plasma glucose levels, arbitrarily defined as a daily requirement of at least 200 units of insulin to prevent hyperglycemia or ketosis; usually due to binding of insulin or insulin receptor sites by antibodies; associated with obesity, ketoacidosis, and infection."

 Written by Christian Nordqvist

New Evidence Of How High Glucose Damages Blood Vessels Could Lead To New Treatments – 12^th May 2009

New evidence of how the elevated glucose levels that occur in diabetes damage blood vessels may lead to novel strategies for blocking the destruction, Medical College of Georgia researchers say. They found a decreased ability of blood vessels to relax resulted from increased activity of a natural mechanism for altering protein form and function, says Dr. Rita C.Tostes, physiologist in the MCG School of Medicine.

 The researchers suspect increased modification of proteins by a glucose-derived molecule is a player in vascular problems associated with hypertension, stroke and obesity as well.

 One aftermath of high glucose levels is low levels of the powerful vasodilator nitric oxide in blood vessels, a shortfall that increases the risk of high blood pressure and eventual narrowing of the vessels, researchers reported at the American Society of Hypertension 24th Annual Scientific Program in San Francisco during a joint session with the Council for High Blood Pressure.

 "We know diabetes is a major risk factor for cardiovascular disease and we think this is one of the reasons," Dr. Tostes says.

 Diabetes increases the risk of cardiovascular disease such as heart disease and stroke, even when glucose, or blood sugar, levels are under control. In fact, about 75 percent of people with diabetes die from some form of heart or blood vessel disease, according to the American Heart Association.

 Most of the glucose in the body goes directly into cells where it's modified to produce the energy source ATP. However about 5 percent of all glucose is converted to another sugar moiety, O-GlcNAc, one of the sugar types that can modify proteins.

 Inside the blood vessel walls of healthy mice, MCG researchers found increased activity by O-GlcNAc competes with another mechanism for modifying proteins called phosphorylation. In blood vessels, phorphorylation modifies the enzyme that produces nitric oxide, called nitric oxide synthase, so that it makes more of the blood vessel dilator. But add more O-GlcNAc to the mix and it seems to beat phosphorylation to the punch so there is the opposite result. The longer O-GlcNAc levels were high, the worse the resulting problem, says Victor Lima, a graduate student at the University of Sao Paulo working with Dr. Tostes.

 An animal model of hypertension seemed to confirm the finding that the more O-GlcNAc, the more blood vessels contract because these animals had higher O-GlcNAc levels. "Now we are trying to see why this is happening and what comes first. Is increased blood pressure leading to changed O-GlcNAc or are augmented levels of O-GlcNAc contributing to the change we see in the vasculature of hypertensives?" Dr. Tostes says. "If we know how this changes vascular function, we can understand some of the dysfunction that we see in diabetes."

 To make sure they were targeting the O-GlcNAc sugar and not dealing with other effects of glucose on blood vessels, the researchers blocked the enzyme OGA, an enzyme that normally removes O-GlcNAc from proteins so they can revert to their normal state.

 If the findings continue to hold true, drugs similar to those they use in the lab to inhibit OGA or OGT, the enzyme that adds O-GlcNAc to the protein, could one day help reduce the significant cardiovascular risk associated with diabetes, Mr. Lima says. "I think it looks very promising," Dr. Tostes adds.

 Future studies will include blocking the pathway for adding O-GlcNAc in hypertensive animals to study the impact on blood pressure and vascular function.

Broccoli may undo diabetes damage – 6^th May 2009

Eating broccoli could reverse the damage caused by diabetes to heart blood vessels, research suggests.

A University of Warwick team believe the key is a compound found in the vegetable, called sulforaphane. 

It encourages production of enzymes which protect the blood vessels, and a reduction in high levels of molecules which cause significant cell damage. 

Brassica vegetables such as broccoli have previously been linked to a lower risk of heart attacks and strokes. 

People with diabetes are up to five times more likely to develop cardiovascular diseases such as heart attacks and strokes; both are linked to damaged blood vessels. 

The Warwick team, whose work is reported in the journal Diabetes, tested the effects of sulforaphane on blood vessel cells damaged by high glucose levels (hyperglycaemia), which are associated with diabetes. 

They recorded a 73% reduction of molecules in the body called Reactive Oxygen Species (ROS). 

Hyperglycaemia can cause levels of ROS to increase three-fold and such high levels can damage human cells. 

The researchers also found that sulforaphane activated a protein in the body called nrf2, which protects cells and tissues from damage by activating protective antioxidant and detoxifying enzymes.

Countering vascular disease

Lead researcher Professor Paul Thornalley said: "Our study suggests that compounds such as sulforaphane from broccoli may help counter processes linked to the development of vascular disease in diabetes. 

"In future, it will be important to test if eating a diet rich in brassica vegetables has health benefits for diabetic patients. We expect that it will." 

Dr Iain Frame, director of research at the charity Diabetes UK, stressed that research carried out on cells in the lab was a long way from the real life situation. 

However, he said: "It is encouraging to see that Professor Thornalley and his team have identified a potentially important substance that may protect and repair blood vessels from the damaging effects of diabetes. 

"It also may help add some scientific weight to the argument that eating broccoli is good for you."

Warning About Failing Insulin Infusion Pump, UK – 5^th May 2009

A medical device alert has been issued by the Medicines and Healthcare products Regulatory Agency (MHRA) relating to the Accu-Chek Spirit insulin pump.

People using the Accu-Chek Spirit insulin pump, up to serial number 10006093, may experience a failure of the device 'up' and/or 'down' buttons. These buttons are necessary to adjust the dosage of bolus insulin and to program basal rate profiles.

If this occurs, it may result in reduced functionality of the insulin pump. If both buttons cease to operate, the pump would not be capable of delivering a bolus nor be re-programmable. Users will then have to revert to a replacement pump or to an insulin pen device to deliver their bolus. The pump will continue to deliver the programmed basal insulin.

The MRHA states that there is no medical risk as pump users will become aware of the failing button function as the usual visual or acoustic confirmation of the insulin pump for the successful bolus entry fails to occur.

What to do if you are affected

Roche Diagnostics, who produce the device, are asking Accu-Chek Spirit users and healthcare professionals to:

- raise the awareness for the potential malfunction in the respective product series and

- report any occurring button malfunction to Roche customer service centers. In case an Accu-Chek Spirit insulin pump is affected by the above mentioned malfunction, Roche will immediately provide a replacement pump.

If you have concerns or for more information please contact Accu-Chek Insulin Pump Freephone Careline numbers:

- UK: 0800 731 2291

- ROI: 18 00 882351.

Detecting Diabetes Without A Needle: The Spit Factor – 30^th April 2009

Research promoting a painless new method for detecting diabetes, utilizing saliva, will be revealed Friday, May 15, at the American Association of Clinical Endocrinologists (AACE) 18th Annual Meeting & Clinical Congress in Houston, Texas.

While searching for biomarkers that may indicate diabetes, doctors examined the saliva of 40 different patients. Through salivary analysis, they managed to devise a new "non-invasive" method for detecting diabetes that foregoes the uncomfortable prick of a needle -- patients need only to spit into a cup. The spit test could be performed for little cost in a doctor's office or at a patient's home.

"Our goal was to characterize proteins in human saliva that may indicate prediabetes and type-2," said Srinivasa R. Nagalla, MD a member of the research team. "Analysis of these proteins allowed us to develop a new method for screening, detecting and monitoring the diabetic state."

Also at the 2009 AACE 18th Annual Meeting & Clinical Congress, diabetes experts will analyze the NICE-SUGAR study's impact on inpatient glycemic control. Other topics of interest include a look at the wide ranging impact of vitamin D in the human body, and clinical recommendations for the treatment of prediabetes -- America's largest healthcare epidemic.

About AACE

AACE is a professional medical organization with more than 6,200 members in the United States and 92 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE initiatives inform the public about endocrine disorders. AACE also conducts continuing education programs for clinical endocrinologists, physicians whose advanced, specialized training enables them to be experts in the care of endocrine disease, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity.

About the AACE Annual Meeting

The 18th Annual Meeting & Clinical Congress will be held in Houston, Texas on May 13-17 at the George R. Brown Convention Center, Hilton Americas Houston. The AACE Annual Meeting & Clinical Congress is structured to provide relevant clinical information for the practicing endocrinologist. The programs will focus on information that allows endocrinologists to achieve the best solutions for the diagnosis and management of endocrine diseases. Pertinent scientific, clinical practice and patient management will be disseminated via general sessions, workshops, meet-the-experts and satellite symposia.

Lifestyle Factors Related To Risk Of Diabetes Among Older Adults – 29^th April 09

Even for older adults, lifestyle factors such as physical activity, dietary habits, tobacco and alcohol use and the amount of body fat are associated with risk of new-onset diabetes, according to a study published in the April 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"Given medical challenges, health care costs, long-term complications and growing incidence and prevalence of type 2 diabetes mellitus, preventing the onset of clinical diabetes is of paramount importance," the authors write. While previous studies have found lifestyle factors such as level of physical activity, diet, smoking habits, alcohol use and body fat levels as risk factors linked to onset of diabetes in younger populations, the combined impact of these factors on risk of diabetes in older adults is largely unknown.

Dariush Mozaffarian, M.D., Dr.P.H., of Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues with the Cardiovascular Health Study examined the relationships of lifestyle risk factors with incidence of diabetes during a 10-year period (1989 to 1998) among 4,883 men and women age 65 years or older. At the beginning of the study, the average participant age was 73 years, 58.6 percent were women and 11.4 percent were nonwhite; 95 percent of nonwhite participants were black. Approximately half of the participants had never smoked.

Low-risk lifestyle groups were defined by physical activity level (leisure time activity and walking pace) above the median (midpoint); dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake and lower average glycemic index); amount of smoking, if any; alcohol use (predominantly light or moderate); body mass index less than 25; and waist circumference of 34.6 inches or less for women or 36 inches or less for men.

After adjustment for age, sex, race, educational level, annual income and other lifestyle factors simultaneously, each lifestyle risk factor was independently associated with incidence of diabetes. Overall, each additional lifestyle factor an individual had in the lower-risk group was associated with a 35 percent lower risk of diabetes.

Individuals in the low-risk category for only physical activity level and dietary habits (nearly one in four adults) had a 46 percent lower incidence of diabetes. Combining low-risk groups for physical activity level, dietary habits, smoking habits and alcohol use (6 percent of participants), an 82 percent lower risk of diabetes was present, and four in five new cases of diabetes appeared to be attributable to not having these low-risk lifestyle factors. Adding either not being overweight or not having large waist circumference was associated with an 89 percent lower risk of diabetes.

"These findings provide an estimate of the public health burden of combined nonoptimal lifestyle risk factors for incidence of diabetes in older adults, the fastest growing segment of the U.S. population," the authors write. "Our findings suggest that, even later in life, the great majority of cases of diabetes are related to lifestyle factors."

Too Much Sugar Is Bad, But Which Sugar Is Worse: Fructose Or Glucose? – 27^th April 2009

In 2005, the average American consumed 64kg of added sugar, a sizeable proportion of which came through drinking soft drinks. Now, in a 10-week study, Peter Havel and colleagues, at the University of California at Davis, Davis, have provided evidence that human consumption of fructose-sweetened but not glucose-sweetened beverages can adversely affect both sensitivity to the hormone insulin and how the body handles fats, creating medical conditions that increase susceptibility to heart attack and stroke.

In the study, overweight and obese individuals consumed glucose- or fructose-sweetened beverages that provided 25% of their energy requirements for 10 weeks. During this period, individuals in both groups put on about the same amount of weight, but only those consuming fructose-sweetened beverages exhibited an increase in intraabdominal fat. Further, only these individuals became less sensitive to the hormone insulin (which controls glucose levels in the blood) and showed signs of dyslipidemia (increased levels of fat-soluble molecules known as lipids in the blood). As discussed in an accompanying commentary by Susanna Hofmann and Matthias Tschöp, although these are signs of the metabolic syndrome, which increases an individual's risk of heart attack, the long-term affects of fructose over-consumption on susceptibility to heart attack remain unknown.

Fructose (also levulose or laevulose) is a simple reducing sugar (monosaccharide) found in many foods and is one of the three important dietary monosaccharides along with glucose and galactose. Honey, tree fruits, berries, melons, and some root vegetables, such as beets, sweet potatoes, parsnips, and onions, contain fructose, usually in combination with glucose in the form of sucrose. Fructose is also derived from the digestion of granulated table sugar (sucrose), a disaccharide consisting of glucose and fructose.

Crystalline fructose and high-fructose corn syrup are often mistakenly confused as the same product. The former is produced from a fructose-enriched corn syrup which results in a finished product of at least 98% fructose. The latter is usually supplied as a mixture of nearly equal amounts of fructose and glucose.

Glucose (Glc), a monosaccharide (or simple sugar) also known as grape sugar, blood sugar, or corn sugar, is a very important carbohydrate in biology. The living cell uses it as a source of energy and metabolic intermediate. Glucose is one of the main products of photosynthesis and starts cellular respiration in both prokaryotes (bacteria and archaea) and eukaryotes (animals, plants, fungi, and protists).

The name "glucose" comes from the Greek word glukus (γλυκύς), meaning "sweet", and the suffix "-ose," which denotes a sugar.

Two stereoisomers of the aldohexose sugars are known as glucose, only one of which (D-glucose) is biologically active. This form (D-glucose) is often referred to as dextrose monohydrate, or, especially in the food industry, simply dextrose (from dextrorotatory glucose[1]). This article deals with the D-form of glucose. The mirror-image of the molecule, L-glucose, cannot be metabolized by cells in the biochemical process known as glycolysis.

Low Blood Sugar Raises Risk Of Dementia In Elderly Patients With Type 2 Diabetes – 21th April 2009

A new study suggests that episodes of hypoglycemia (low blood sugar) raise the risk of dementia in elderly patients with type 2 diabetes, with those who have at least 3 diagnosed episodes having nearly double the risk of those who have had no diagnosed episodes. The researchers suggest that tight glycemic control may be inadvisable for older patients with type 2 diabetes if their treatment causes hypoglycemia.

 The study was the work of researchers from the Division of Research, Section of Etiology and Prevention, Kaiser Permanente, Oakland, California, and the Departments of Psychiatry, Neurology and Epidemiology at the University of California, San Francisco and is published in the 15 April online issue of the Journal of the American Medical Association, JAMA.

 The authors wrote that although acute hypoglycemia has been linked with cognitive impairment in children with type 1 diabetes, scientists have not yet established whether it might be a risk factor for dementia in older people who have type 2 diabetes.

 For the longitudinal cohort study, which lasted from 1980 to 2007, they followed 16,667 patients of mean age 65 years who had type 2 diabetes. The patients were members of a healthcare delivery system in California, and the researchers were primarily interested in investigating hypoglycemic episodes that required hospitalization.

 Using hospital records from 1980 to 2002, the researchers collected and reviewed data on hypoglycemic events and pulled out those that related to elderly patients with no prior diagnosis of dementia, mild cognitive impairment or general memory complaints, as of the start of 2003 and followed them, looking for any diagnoses of dementia, until early 2007.

 The researchers assessed dementia risk using statistical models and adjusted for potential confounders such as age, sex, race/ethnicity, BMI, how long they had been diabetic, and other disease-related factors.

 The results showed that:

     * 1,465 patients (8.8 per cent of the cohort) had at least one episode of diagnosed hypoglycemia.

     * 1,822 patients (11 per cent of the cohort) were diagnosed with dementia during follow up.

     * Of the patients who had at least one episode of hypoglycemia, 250 (17 per cent) of them were also diagnosed with dementia.

     * Compared with patients with no hypoglycemia, those who did have it had a higher risk of dementia that went up in tandem with the number of diagnosed episodes, whereby three or more episodes of hypoglycemia was linked to nearly double the risk of dementia..

     * The hazard ratio (HR) for 1 episode was 1.26 (95 per cent confidence interval [CI] ranged from 1.10 to 1.49); for 2 episodes it was 1.80 (95% CI 1.37-2.36); and for 3 or more it was 1.94 (95% CI 1.42-2.64).

     * Compared with patients with no history of hypoglycemia, those with such a history had a risk of dementia that went up by 2.39 per cent per year (95% CI, 1.72-3.01%).

     * The figures didn't change when the researchers added the following information to the model: how often the patients used the medical services, how long they had been members of the health plan, or how long it had been since their initial diabetes diagnosis.

     * The results were similar when they looked only at emergency department admissions for hypoglycemia (as opposed to hospitalization records).

The researchers concluded that:

"Among older patients with type 2 diabetes, a history of severe hypoglycemic episodes was associated with a greater risk of dementia. Whether minor hypoglycemic episodes increase risk of dementia is unknown."

 Principal investigator Dr Rachel A Whitmer, a research scientist with Kaiser Permanente told the press that:

 "We know that the brain becomes more vulnerable with age, and we need a better understanding of how glycemic control can affect brain health over the long term." 

"This study adds to the evidence base that perhaps we should rethink the notion of very tight glycemic control for our elderly patients with diabetes mellitus."

 In the study, Whitmer and colleagues wondered if cognitive impairment from early dementia could somehow be increasing the chance of having a hypoglycemic episode, but they found that even having one or more hypoglycemic episodes in midlife (mean age 52) still presented a 32 per cent higher risk of dementia later.

 Co-author Dr Joe Selby, who is the director of the Kaiser Permanente Division of Research, explained:

 "Our findings suggest that pursuit of 'tight' glycemic control (ie to hemoglobin A1c levels less than 7 percent) may be inadvisable in older patients with type 2 diabetes if required treatment is causing hypoglycemia."

Low Birth Weight Linked To Heart Disease And Diabetes – 20^th April 2009

Lower weight at birth may increase inflammatory processes - leading causes of chronic diseases such as heart disease and diabetes - in adulthood. The study, to be published in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM), was carried out by researchers at The University of Manchester, Imperial College London and University of Oulu in Finland.

 Both the fetal and infancy periods are sensitive, critical stages of growth and development and studies have previously suggested babies with lower weight at birth are at a higher risk for developing chronic diseases. But there has been little understanding to explain why - until now. This study suggests an association between lower weight at birth and inflammation in adulthood may provide that explanation.

 Inflammation is a normal physiologic response of the body, and serves as a host defence, which provides protective response to infection or tissue injury. If the source of infection or injury is not repressed, low-grade inflammation can persist and may promote the development of heart disease or diabetes.

 Earlier studies have found that babies born small for gestational age have weak immune systems, but at six years old have more white blood cells than babies born at a normal weight. White blood cells are cells of the immune system that defend the body against both infectious disease and foreign materials. These findings suggest that age might amplify the association between early growth and inflammatory processes.

 In this study, researchers followed 5,619 children born in 1966 and followed them until they reached adulthood. As compared to children with 'normal' weight in the first year of life, researchers observed that babies born relatively smaller and gained the least weight during infancy had a higher number of white blood cells, an indicator of inflammation, in adulthood.

 "Our findings suggest that the link between poorer growth early in life and these adult chronic diseases may involve inflammation as a common underlying factor," said Dr Dexter Canoy, in Manchester's School of Community-based Medicine and lead researcher of the study.

 "Ensuring appropriate growth during this narrow 'window' in early development may confer lifelong benefits to health."

 The article, 'Weight at birth and infancy in relation to adult leukocyte count: a population-based study of 5,619 men and women followed from the fetal period to adulthood', will appear in the June 2009 issue of JCEM.

 Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 14,000 scientists, physicians, educators, nurses and students in more than 100 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Chevy Chase, Maryland. To learn more about the Society, and the field of endocrinology, visit our web site at http://www.endo-society.org

People With Diabetes Cutting Back On Care During Recession

16th April 2009

Diabetics are increasingly risking life and limb by cutting back on - or even going without - doctor visits, insulin, medicines and blood-sugar testing as they lose income and health insurance in the recession.

Doctors have seen a drop in regular appointments with diabetic patients, if they come back at all, according to an Associated Press analysis.

Patients more often seek tax-subsidized or charity care. They also end up in emergency rooms more often.

Sales of top-selling drugs and other products used to treat and monitor the disease have dropped since the economic crisis accelerated last fall, The AP found. There are even signs that some patients are choosing less expensive insulin injections over pricier pills to save money.

"We're seeing some signs that consumers and patients are becoming more frugal," Johnson & Johnson Chief Executive Bill Weldon told analysts in January.

People with other health problems also are cutting back on care amid the recession, but diabetics who don't closely monitor and control the chronic disease risk particularly dire complications: amputations, vision loss, stroke - even death.

Better Diabetes Self Care Might Not Mean Lower Blood Sugar 

7th April 2009

People with diabetes who feel they have better control over life events are more likely to take good care of themselves and to believe they have the condition under control, but these factors do not translate to improved blood sugar levels, according to a new study of 1,034 adults.

Participants' responses to survey items on their risk tolerance, concern about their future and beliefs about their longevity had no correlation to clinical measures of their hemoglobin A1c levels, which reflect average blood glucose (or blood sugar) during the previous two to three months.

The study, which appears online in the journal Health Services Research, also found no differences by race or Hispanic ethnicity in how people took charge of their self-care.

People are not always adherent in managing their diabetes care, which affects overall health and the risk of diabetic complications, said lead study author Frank Sloan, Ph.D.

"What we are able to do here is bring some new measures to bear," said Sloan, a professor of health policy and management at the Center for Health Policy at Duke University.

Some people believe that whatever they do, they have no control over their diabetes; others are very tolerant of the risks of diabetes; and, some have a philosophy that they will live for today and not care about the future, Sloan said. "One result that comes through is that people who have self-control over life in general are more likely to adhere," he said.

"This area of study is valuable as we attempt to better understand the relationship between how people from all ethnic and cultural backgrounds perceive their destinies with diabetes," said Sue McLaughlin, a registered dietitian and president of health care and education with the American Diabetes Association.

"This study illustrates the insidious nature of hyperglycemia: it is a silent and deadly killer," added Miller, who had no affiliation with the study. Many people with diabetes assume they are in good health because they do not feel bad, she said.

Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust.

What Is The Pancreas? What Does The Pancreas Do? – 02nd April 2009

The pancreas is a gland organ that is located in the abdomen. It is part of the digestive system and produces important enzymes and hormones that help break down foods. The pancreas has an endocrine function because it releases juices directly into the bloodstream, and it has an exocrine function because it releases juices into ducts.

Enzymes, or digestive juices, produced by the pancreas are secreted into the small intestine to further break down food after it has left the stomach. The gland also produces the hormone insulin and secretes it into the bloodstream in order to regulate the body's glucose or sugar level.

What does the pancreas look like?

The pancreas is a 6- to 10-inch (18 to 25 cm) long organ located behind the stomach in the back of the abdomen. It is spongy and shaped somewhat like a fish that is extended horizontally across the abdomen. The head of the pancreas is the largest part and lays on the right side of the abdomen where the stomach is attached to the first part of the small intestine (the duodenum). It is here where the stomach empties partially digested food into the small intestine and this chyme mixes with the secretions from the pancreas.

The tail or body of the pancreas - its narrowest part - extends to the left side of the abdomen next to the spleen. There is a duct that runs the length of the pancreas, and it is joined by several small branches from the glandular tissue. The end of this duct is connected to a similar duct that comes from the liver, which delivers bile to the duodenum.

There are two main types of tissue found in the pancreas: exocrine tissue and endocrine tissue. Most of the pancreas - about 95% - is exocrine tissue that produces pancreatic enzymes to aid digestion. A healthy pancreas makes about 2.2 pints (1 liter) of these enzymes every day.

The remainder of the pancreas is composed of hundreds of thousands of endocrine cells known as islets of Langerhans. These grape-like cell clusters produce important hormones that regulate pancreatic secretions and control blood sugar.

What does the pancreas do?

A healthy pancreas is able to produce the right chemicals at the right times in the right quantities in order to properly digest the food we eat. After food enters the duodenum, the exocrine tissues secrete a clear, watery, alkaline juice that contains several enzymes that break down food into small molecules that can be absorbed by the intestines. These enzymes include:

    * Trypsin and chymotrypsin to digest proteins.

    * Amylase to break down carbohydrates.

    * Lipase, to break down fats into fatty acids and cholesterol.

The endocrine portion of the pancreas, or islets of Langerhans, is composed of several cells that secrete hormones directly into the bloodstream. Insulin is a hormone secreted by pancreatic beta cells in response to a rise in blood sugar. The hormone also moves glucose from the blood into muscles and other tissues so they can use it for energy. In addition, insulin helps the liver absorb glucose, storing it as glycogen in case the body needs energy during stress or exercise.

Glucagon is a hormone secreted by pancreatic alpha cells when there is a decrease in blood sugar. Its primary job is to cause glycogen to be broken down into glucose in the liver. This glucose then enters the bloodstream in order to restore the level to normal.

What problems are associated with the pancreas?

Pancreatitis

For most people, the pancreas operates as it should with little mention or fanfare. However, it is an organ and capable of malfunction. For example, a pancreas that fails to produce enough digestive enzymes can lead to weight loss and diarrhea because of poorly absorbed food. The islets of Langerhans are responsible for regulating blood glucose. If these cells do not produce enough insulin, there is an increase in diabetes risk as blood glucose levels rise.

Pancreatitis is a disease characterized by acute or chronic inflammation of the pancreas. Inflammation can occur if the main duct from the pancreas is blocked by a gallstone or tumor. This blockage results in pancreatic juices accumulating in the organ, which may damage the pancreas or lead to the pancreas actually digesting itself. Pancreatitis is also known to be a complication associated with mumps, alcohol use, steroids, trauma, and drugs.

Although acute pancreatitis is rare, it does require immediate medical attention. Symptoms include intense stomach pain, abdominal tenderness and swelling, nausea and vomiting, fever, and muscle aches. Pancreatitis is usually first treated with painkillers. Patients will stop ingesting solid food, instead obtaining fluid and nourishment by intravenous means. Sometime - especially when pancreatitis causes secondary infections - surgery is required.

When acute pancreatitis repeats itself to cause permanent damage to the organ, the condition is called chronic pancreatitis. Alcohol abuse is the most common cause of chronic pancreatitis, mostly affecting middle-aged men. The condition has symptoms such as persistent pain in the upper abdomen and back, weight loss, diarrhea, diabetes, and mild jaundice.

Pancreatic Cancer

It is also possible for cancer to develop in the pancreas. Often, it is difficult for physicians to spot the exact cause of pancreatic cancer, but it is often linked to smoking or heavy drinking. Other risk factors include diabetes, chronic pancreatitis, liver problems, and stomach infections. Pancreatic cancer is also more common in men than women and among African-Americans than among whites.

Symptoms of pancreatic cancer may not appear until the cancer is in advanced stages - often too late for successful treatment. The condition often presents:

    * Pain in the upper abdomen from the tumor pushing against nerves

    * Jaundice - a painless yellowing of the skin and eyes and darkening of the urine, created when the cancer interferes with the bile duct and the liver.

    * Loss of appetite, nausea, and vomiting

    * Significant weight loss and weakness

    * Acholic stool (pale or grey stool) and steatorrhea (excess fat in stool)

Treating pancreatic cancer is difficult, and the prognosis tends to be poor. Patients usually receive surgery, chemotherapy, radiation, or a combination of treatments. Often, the treatment is palliative, focusing on reducing pain. Medical News Today contains a special section all about Pancreatic Cancer. You can view the pancreatic cancer information here.

How can I maintain a healthy pancreas?

Maintaining a sensible, balanced diet and avoiding smoking and excessive drinking will help keep the pancreas healthy and functioning.

Barriers To Diabetes Care Include Restaurants And High-risk Lifestyles, Says International Review – 01st April 2009

Eating out, lack of social support and high-risk lifestyles are just some of the barriers that stop patients with type 2 diabetes from controlling their condition, according to a research review that covered 8,900 patients and 4,550 healthcare providers from 28 countries.

The study, published in the March issue of the Journal of Nursing and Healthcare of Chronic Illness, shows that psychosocial, socioeconomic, physical, environmental and cultural factors can provide major barriers to effective care. Researchers from Hong Kong and Northern Ireland studied research carried out between 1986 and 2007 to try and identify how treatment regimes could be improved. Their findings have enabled them to come up with a three-point plan for nurses involved in diabetes care.

"Diabetes is a chronic condition and patients need to modify their lifestyle on a longterm basis to cope with it" says Sandra Pun from the School of Nursing at The Hong Kong Polytechnic University. "According to the World Health Organization, up to 380 million people worldwide will suffer from diabetes by 2025 so it is important to identify and tackle any barriers that prevent people from making those changes."

Major barriers identified by the review included:

- Financial. Even if healthcare was free or funded by insurance, patients still had to spend more money on healthy food, home glucose monitoring kits and transport to and from healthcare appointments.

- Social support. Patients who received support from family, friends and diabetes clinics appeared to handle self-care better than those who did not - Patient provider gaps. Care was more effective when patients and healthcare providers worked together to devise treatment plans that patients could stick to.

- Meals out. Eating out in restaurants was a frequently mentioned problem and being offered inappropriate food when visiting others was also an issue.

- Favourite foods. Healthcare professionals did not always appreciate that patients disliked being denied their favourite foods and would cope better if they were incorporated in eating plans.

- Exercise. Attitudes toward exercise, physical limitations and discomfort prevented people from taking regular exercise. These need to be taken into account when devising exercise programmes.

- High-risk lifestyles. Behavioural and psychiatric disorders and cultural and language barriers, among both patients and family members, can impede effective treatment.

- Medication. Some patients forgot to take their medication and others ran out. Others were also reluctant to carry out regular glucose tests.

- Psychological well-being. Psychological problems are common among people with diabetes, but providers don't always have the resources to manage this aspect of their patient's care.

- Understanding. Patients often lack knowledge about their condition and don't always understand the relevance of diet and care plans.

- Frustration. Being unable to maintain good glucose control can cause helplessness and frustration, as can the progression of the disease

"Our review found that there are various barriers to achieving optimal self-care in type 2 diabetes" concludes co-author Professor Vivien Coates, from the Institute of Nursing Research at the University of Ulster, UK. "Some stem from limitations within the healthcare team, some from ineffective communication between providers and patients and some from the patient's lack of empowerment, motivation and involvement in their treatment.

"Better healthcare delivery systems and reforms that improve affordability, accessibility and efficiency of care are also essential to help both providers and patients to meet desirable standards of diabetes care."

As a result of the study, the researchers are advising that nurses to adopt a threepoint plan to overcome patients' barriers to self-care:

1. Nurses should provide patients with enough information about their condition and its treatment to enable them to make informed decisions about their care. 2. Patients need to be motivated to take action to ensure that they manage their diabetes and prevent complications. 3. Nurses need to approach diabetes care in a holistic way that takes account of a wide range of physical, psychosocial, cultural, financial and environmental factors. "Nurse need to address a number of key questions like what is important to the patient in terms of lifestyle changes and status quo and what patients would expect from the healthcare team" says Professor Coates. "Understanding the barriers that prevent effective self-care from the perspective of both the patients and the healthcare provider is a vital part of this process."

People Who Sleep Less Than Six Hours Nightly Risk Developing Diabetes – 17th March 2009

To the many problems associated with lack of sleep -- moodiness, memory problems, difficulty concentrating -- add the risk of developing diabetes.

A study from the University at Buffalo shows that people who sleep less than six hours a night during the work-week are 4.5 times more likely to have elevated levels of blood sugar than those who slumber 6-8 hours.

The findings are being presented yesterday at the American Heart Association's 49th annual Conference on Cardiovascular Disease Epidemiology and Prevention.

"Impaired fasting glucose -- a reading higher than 100 -- is known as pre-diabetes, which is a precursor to type 2 diabetes," said Lisa Rafalson, Ph.D., a National Research Service Award (NRSA) Fellow in the UB Department of Family Medicine and first author on the study.

"In fact, about 25 percent of people who have impaired fasting glucose will at some point develop type 2 diabetes, which is associated with many complications, including heart disease and premature death." Rafalson also is a research assistant professor is UB's Department of Social and Preventive Medicine.

Rafalson's findings were based on data from an average six-year follow-up of participants who initially took part in the Western New York Health Study, conducted from 1996-2001. The 91 persons with normal fasting glucose levels at baseline who developed pre-diabetes by their follow-up exam were matched to persons from the study who had maintained normal glucose levels who served as controls.

Participants were placed into three groups based on the average daily amount of sleep they reported receiving from Sunday through Thursday: short-sleepers -- those who reported less than 6 hours of sleep nightly; long-sleepers, who reported sleeping more than eight hours nightly; and a reference group who slept 6-8 hours a night.

Results showed that "short-sleepers" had a significantly increased risk of progressing from normal glucose levels to pre-diabetes, compared to those who slept 6-8 hours nightly. Sleeping an average of more than 8 hours a night had no significant effect on glucose levels, results showed.

"This study supports growing evidence of the association of inadequate sleep with adverse health issues," said Rafalson. She suggested that during annual "well" visits, physicians should discuss sleep habits with their patients, along with diet and exercise and other lifestyle issues that are important to long-term health.

"Genetic susceptibility is always a possible explanation for this finding," Rafalson noted, "but it is more likely that pathways involving hormones and the nervous system are involved in the impaired-sleep/fasting glucose association.

"We hope our findings will generate more research into this complex relationship between sleep and illness," she said.

Additional authors on the study are Richard P. Donahue, Ph.D., M.P.H.; Michael LaMonte, Ph.D., M.P.H.; Joan Dorn, Ph.D.; Maurizio Trevisan, M.D., M.S.; Saverio Stranges, M.D., Ph.D.; and Jacek Dmochowski, Ph.D. All authors are current or former members of the Department of Social and Preventive Medicine, UB School of Public Health and Health Professions.

Trevisan now heads the University of Nevada Health Sciences System; Stranges is affiliated with the Clinical Sciences Research Institute, Warwick Medical School, Coventry, UK, and Dmochowski is affiliated with the University of North Carolina, Charlotte.

Halle Berry, Sharon Stone and Sir Steve Redgrave: Young, slim - and diabetic – 16th March 2009

What do two of the world's sexiest actresses, a five-times Olympic gold medal-winner and my neighbours' teenage son have in common? Halle Berry, Sharon Stone, Sir Steve Redgrave and young Will all have diabetes, yet none of them conforms to the stereotypical image of the overweight, ageing diabetic said to be responsible for a near doubling in the prevalence of the condition in the UK over the past decade. Indeed, they are living proof that you don't have to be fat and middle-aged to have diabetes.

There are more than 2.5 million people in the UK with diabetes and probably another half a million who have the condition but don't know it. While most are middle-aged and overweight, a significant minority is not - there are more than 300,000 sufferers under 45, many slim and outwardly healthy - a minority unlikely to be screened for the condition or to even consider that they are at risk.

No one is immune to diabetes. It can strike any shape at any age. And the longer it goes undiagnosed the higher the chances of irreparable internal damage to organs such as the eyes, heart, kidneys, genitals and brain. About half of people with diabetes already show signs of these types of long-term complications by the time the condition is diagnosed, and if the warning signs are not picked up quickly in the more aggressive forms of the disease, just a few days' delay can prove fatal.

People with diabetes can be broadly divided into two main groups: those with type 1, who tend to run into trouble in childhood or early adult life and require insulin injections to control their sugar levels; and type 2 patients, who tend to be older, are much more likely to be overweight, and can often control their condition through a combination of diet, lifestyle changes and medication.

The net result is the same whichever type of diabetes you have - insulin levels are deranged and blood sugar levels are raised, a toxic combination that prematurely ages the delicate lining of arteries throughout the body.

It is this accelerated furring up that leads to problems in the retina, the coronary arteries supplying the muscular heart wall and the circulation to the kidneys, brain, penis and legs. Conditions that may develop later as a result include blindness, difficulty getting a proper erection, a fivefold increase in the risk of an early heart attack and a threefold increase in the risk of stroke, kidney failure,ulcers, gangrene and even amputation of the feet and legs. And that is assuming that you survive the onset of the disease which, in cases of missed type 1 diabetes, can be very rapid, resulting in soaring blood sugar levels, extreme dehydration (high sugar levels result in huge overproduction of urine), coma and death.

My first experience of the speed with which a type 1 patient can go downhill was when I was working in intensive care a few years after qualifying. A young mother in her twenties, who had delivered by Caesarean section, developed an infection on the postnatal ward and her blood sugar spiralled out of control. She deteriorated rapidly and died within 24 hours of being transferred to intensive care. Her case was extremely unusual but it serves as a poignant reminder that diabetes should never be underestimated. The sight of her husband leaving the hospital with their newborn baby will remain with me for ever.

The diagnosis of diabetes is often obvious in hindsight, and it is easy enough retrospectively to elicit a handful of the classic telltale signs and symptoms (see below). The problem is that unless the nurse, doctor, patient or parent considers diabetes, it is all too easy to attribute them to more innocent conditions. The dry, vomiting, drowsy teenager is thought to have gastroenteritis, while the 60-year- old man who lacks energy, is constantly running to the loo and can no longer read his paper properly is just getting on a bit, has some prostate trouble and needs new glasses. But if diabetes is caught early and treated correctly, most of the complications can be ameliorated, allowing those affected to lead near-normal lives. This situation has been boosted by recent advances in disease management, ranging from much-improved diabetic care in general practice through to the latest generation of insulin pumps that mimic the body's natural mechanisms, so leading to much tighter blood sugar control.

There has also been a sea change in the management of risk factors such as high blood pressure and raised cholesterol levels, which accelerate the damage done by diabetes. That is why today's diabetic patient is likely to be on at least four types of medication - something to lower blood sugar, a statin for cholesterol, blood-pressure pills and low-dose aspirin to thin the blood.

The outlook for someone with diabetes has never been better but there is still a lot that people can do to help themselves. The first step is to familiarise yourself with the warning signs and always to consider the diagnosis, particularly if you are at higher than normal risk of developing the condition. High-risk groups include: people with a strong family history of diabetes; people of black or Asian descent; women with polycystic ovarian syndrome and those who have had blood sugar problems during previous pregnancies; overweight men and women, particularly if their waist exceeds 31in for a woman and 37in for a man; anyone over the age of 40, particularly if they have high blood pressure or have had a stroke and heart attack in the past.

A diabetes test takes a couple of minutes and the results are available immediately. If you have any of the symptoms listed below book an appointment with your doctor or practice nurse so that you can be tested. If you are in a risk group it is sensible to consider a finger-prick test every few years or so.

More information at diabetes.org.uk or call 0845 1202960

 drmark@thetimes.co.uk

THE STATS

 9% of total hospital costs in the UK are accredited to diabetes

194m people worldwide are affected by diabetes

10% of deaths in the UK are linked to diabetes

Source: Diabetes UK

DIABETES: MAKE THE DIAGNOSIS

The telltale signs and symptoms vary from person to person, and tend to develop much more quickly in type 1 diabetes. Look out for the following:

Urinating more often than normal (day and night)

A dry mouth and an unusual thirst

An increased appetite

Unexplained fatigue and weakness

Blurred vision

Recurrent minor infections such as thrush, boils and athlete's foot

Drowsiness, confusion and vomiting if sugar levels become very high (as often happens if the diagnosis is missed in type 1)

The simplest way to confirm the diagnosis is to do a finger-prick test. The hard part is considering the diagnosis in the first place. A fasting blood sugar level of 7 or more (usually after an overnight fast) or a random non-fasting level over 11 indicate that you have diabetes

New Study Of Human Pancreases Links Virus To Cause Of Type 1 Diabetes - May Lead To A Vaccine - 10th March 2009

A team of researchers from the Peninsula Medical School in the South West of England, the University of Brighton and the Department of Pathology at Glasgow Royal Infirmary, has found that a common family of viruses (enteroviruses) may play an important role in triggering the development of diabetes, particularly in children. These viruses usually cause symptoms similar to the common cold, or vomiting and diarrhoea. However, the team has now provided clear evidence that they are also found frequently in the pancreas of people who develop diabetes.

The research, which was carried out at Peninsula Medical School and funded by Juvenile Diabetes Research Foundation (JDRF), is published today, 6th March 2009, in the leading European diabetes journal, Diabetologia. It involved the detailed study of a unique collection of pancreases from 72 young people who died less than a year after the diagnosis of type 1 diabetes.

Type 1 diabetes usually starts in young people and results from the destruction of the insulin-producing beta cells in the pancreas. Patients who develop type 1 diabetes have to take multiple daily injections of insulin for the rest of their lives, and the condition affects around 300,000 people in the UK , including 20,000 children under the age of 15. There are a further estimated 440,000 cases of type 1 diabetes in children worldwide, with more than a fifth living in Europe.

It is accepted that children who develop type 1 diabetes inherit a genetic susceptibility to the disease, but studies of identical twins have shown that when one twin has the disease, the other twin will only have approximately a 40 per cent chance of developing diabetes - suggesting that factors additional to inheritance are also involved.

It has long been speculated that viruses might play a role in causing type 1 diabetes by infecting the beta cells of the pancreas. This new research, which has made use of unique source material collected in Glasgow, is the first to provide evidence supporting this theory in such a large number of pancreases from young people recently diagnosed with the disease. It has revealed that more than 60 per cent of the organs contained evidence of enteroviral infection of the beta cells. By contrast, infected beta cells were hardly ever seen in tissue samples from 50 children without the condition.

The new research suggests that enteroviral infection of the beta cells in children with a genetic disposition to type 1 diabetes may initiate a process whereby the body's immune system identifies beta cells as 'foreign' and rejects them, as it would a transplanted organ.

An extension of the study to adults with type 2 diabetes showed that a large proportion (40 per cent) of these patients also had enteroviral infection in their beta cells. This compared with only 13 percent of non-diabetic adults of the same age group. Unlike type 1 diabetes, type 2 diabetes usually starts in adults and is associated with obesity. The beta cells are not destroyed in this disease but their ability to make insulin is compromised. The way that enteroviruses might contribute to the development of type 2 diabetes has not been established but it is known from laboratory studies that an enteroviral infection of beta cells reduces their ability to release insulin. It is possible that in people who are obese (where there is a greatly increased demand for insulin secretion) a reduction of beta cell function, secondary to enteroviral infection, may be sufficient to trigger type 2 diabetes - although more research is required to confirm this.

Overall, the findings of this new study suggest that vaccination in childhood to prevent enteroviral infections of beta cells might be an attractive means to reduce the incidence of both common forms of diabetes. However, there are up to 100 different strains of enterovirus and more research will be needed to identify which particular enteroviruses are associated with the development of diabetes, and whether vaccines could be developed to prevent their spread.

Professor Noel Morgan from the Peninsula Medical School commented: "We are genuinely excited by the findings of our study. This is the first time that scientists have been able to provide such extensive evidence for the relationship between enteroviral infection of the beta cells and the development of type 1 diabetes. This is due in large part to the unique availability of such a large number of pancreases from young people who had died of type 1 diabetes soon after becoming ill. Not only did this give us access to extremely important research material, but it also underlines the importance of continued organ donation to the development of medical research in the UK. "

He added: "The next stages of research - to identify which enteroviruses are involved, how the beta-cells are changed by infection and the ultimate goal to develop an effective vaccine - will lead to findings which we hope will drastically reduce the number of people around the world who develop type 1 diabetes, and potentially type 2 diabetes as well."

Professor Adrian Bone from the University of Brighton said: "It is a real privilege to be part of this work which sheds light on how targeted beta-cell destruction may be triggered in individuals at risk of developing diabetes. Whilst experimental studies from many laboratories, including my own, have been able to document the "natural history" of the disease processes culminating in overt diabetes, the role of viral infections in initiating these events is still unproven and controversial.

"Indeed," he added, "viruses have been shown to be capable of both inducing and preventing the development ofdiabetes. The true importance of our present study lies in the translation of these earlier experimental findings into meaningful observations in children and young people with diabetes."

Pathologist, Dr Alan Foulis of the Royal Infirmary in Glasgow, observed: "It is 25 years since I started assembling this collection of pancreases from patients with recent onset type 1 diabetes, with the express purpose of looking for the presence of enterovirus. It is only very recently that techniques of sufficient sensitivity to detect the virus in such specimens have been developed. The success of this study is largely down to the excellent scientific collaboration we have enjoyed".

Karen Addington, Chief Executive of JDRF, said: "Type 1 diabetes is a life- threatening condition that requires a life-time of painful finger prick blood testing and insulin injections. Incidences are increasing by four per cent each year and there is currently no way to prevent it. We are proud to have funded this crucial piece of research, which helps shed light on the causes of this serious condition. JDRF passionately believes that research such as this brings us a step closer to improving treatment and eventually curing this condition."

Parents Unaware Of Children's Future Health – 9th March 2009

Parents do not know that their children may risk serious health problems in later life due to a sedentary lifestyle and an unhealthy diet, warn leading health charities British Heart Foundation, Cancer Research UK and Diabetes UK.

Links between inactivity and health problems

Of the parents surveyed, the results showed that:

- 83 per cent did not know that a lack of physical activity during childhood could lead to a higher risk of cancer later on in life

- half (50 per cent) were unaware of the link between physical inactivity and Type 2 diabetes

- one in five parents (18 per cent) did not know that it could increase the risk of heart disease.

Shockingly, one in eight parents (12 per cent) did not know that physical inactivity was linked to any of these health problems.

Consequences of an unhealthy diet

The survey also revealed a worrying lack of awareness among parents about the importance of a healthy diet:

- 59 per cent of parents were unaware of the link between an unhealthy diet and cancer.

- A quarter (23 per cent) were unaware of the link between an unhealthy diet and Type 2 diabetes.

- One in six parents (17 per cent) did not know that it could lead to heart disease.

- One in ten parents (10 per cent) did not know that it could lead to any of these health problems.

Obesity in childhood a risk factor for later problems

Results also show that two-thirds of parents (66 per cent) did not know that being overweight in childhood could be a risk factor for cancer in later life. For Type 2 diabetes and heart disease the figures were 13 per cent and 8 per cent respectively.

Lack of awareness is frightening

"This lack of awareness among parents is frightening," said Douglas Smallwood, Chief Executive of Diabetes UK. "Even if children look healthy or are not overweight now, parents need to be aware that if their children are not active or eating a healthy diet, they may grow up to be overweight or obese. And that would put them at a greater risk of developing certain cancers, Type 2 diabetes and heart disease in adulthood.

Government's role to play

"However, if the Government is to deliver on its public health promises it has a major role to play in committing to legislation on restricting junk food advertising and supporting the traffic light system of food labelling, which will go a long way in helping people make informed choices."

Virus 'triggers child diabetes' - 6th March 2009

A common virus may be the trigger for the development of many cases of diabetes, particularly in children, UK researchers have reported.

Signs of enteroviruses were found in pancreatic tissue from 60% of children with type 1 diabetes, but in hardly any children without the disease.

They also found that 40% of adults with type 2 diabetes had signs of the infection in insulin-producing cells.

The study published in Diabetologia raises the possibility of a vaccine.

Although genetics is known to play a fairly substantial role in a person's risk of developing diabetes, environmental factors must also be involved and the idea of a viral cause of diabetes has been considered for decades.

The latest study was made possible by a pathologist in Glasgow who for 25 years collected tissue samples from children across the UK who had died less than 12 months after being diagnosed with type 1 diabetes.

Dr Alan Foulis believed that enteroviruses - a common family of viruses which cause symptoms such as vomiting and diarrhoea - would be present but until recently the technology was not sensitive enough to detect them.

Along with colleagues from the south west-based Peninsula Medical School and the University of Brighton, he has now been able to look for evidence of the enteroviruses in tissue samples routinely taken during autopsy in 72 children and compare that with samples from 50 children without the condition.

In those with diabetes who had signs of the virus, it was specifically found in the insulin-producing beta cells.

Immune trigger

The researchers suggest that, in children with a genetic predisposition to type 1 diabetes - an autoimmune disease in which beta cells in the pancreas are destroyed - enterovirus infection can trigger the immune reaction that kicks off the disease process. With type 2

diabetes - the type often linked to obesity in adults - the researchers speculate that the infection affects the ability of the cells to make insulin, which in combination with the greater demand for insulin in obese people, is enough to set off the disease. At the same time, a separate study, published in Science, by researchers at Cambridge University, found four rare mutations in a gene which reduce the risk of developing type 1 diabetes. It also backs the viral theory because the gene in question is involved in the immune response to infection with enteroviruses. There are 100 different strains of enterovirus, so although the results open the way for the development of a vaccine, researchers still have to pin down which types are involved.

The study's author, Professor Noel Morgan from the Peninsula Medical School, said the results showed the underlying infection with enteroviruses was not a "rare event".

"The next stages of research - to identify which enteroviruses are involved, how the beta-cells are changed by infection and the ultimate goal to develop an effective vaccine - will lead to findings which we hope will drastically reduce the number of people around the world who develop type 1 diabetes, and potentially type 2 diabetes as well," he added.

Dr Iain Frame, director of research at Diabetes UK, said the study was "a big step forward" in understanding the potential triggers for the disease.

"We've known for some time that type 1 diabetes cannot be explained by genetics alone and that other, environmental triggers may also play a part.

"The next steps to identify the viruses and find out what they are doing to the infected beta cells will be hugely exciting and will take us a step closer to preventing Type 1 diabetes."

Karen Addington, chief executive of the Juvenile Diabetes Research Foundation, who funded the research, said the findings were important as the incidence of type 1 diabetes is increasing every year and there is currently no way to prevent it.

"Type 1 diabetes is a life- threatening condition that requires a life-time of painful finger prick blood testing and insulin injections," she pointed.

Are Chocolate And Coffee Good For You? Diabetes Forecast Looks At The Pros And Cons Of Controversial Foods – 05th March 2009

Coffee, chocolate, wine -- you've probably heard claims that these foods are actually good for you. But are they? The March issue of Diabetes Forecast looks at five controversial foods and examines what science says about the pros and cons of each -- and how to get the best out of all of them.

Take coffee, for example. Research suggests that coffee may help you avoid a variety of things including liver cancer, Alzheimer's disease, Parkinson's disease, type 2 diabetes, depression and gallstones. The downside, however, is that caffeine has been connected to high blood pressure , high cholesterol, and elevated post-meal blood glucose levels. An expert from the Department of Nutrition at the Harvard School of Public Health offers perspective to understand what forms of coffee are best and how to determine the effect caffeine has on your blood glucose.

Then there's chocolate: Forget milk and white, but dark chocolate, with its antioxidants, has been shown to improve brain function, reduce blood pressure and risk of heart attack, and lower cholesterol. Sounds like a superfood, doesn't it? Not quite -- read the advice experts share with Diabetes Forecast about getting the most out of the beneficial antioxidants in this high calorie sweet. Also, learn how to pick the best chocolate when it's time to indulge.

Red wine, potatoes, and eggs round out the list. Some of these have been shown to improve the immune system, fight tooth decay, reduce risk of dementia, and even improve insulin sensitivity. But that doesn't mean you should feel free to overdo it: Diabetes Forecast includes tips on how to get the best health benefits from the controversial foods you enjoy.

Also in this issue of Diabetes Forecast:

Hunger: it's a natural reaction to the body's need for food -- or is it? Diabetes Forecast looks at the evolution of hunger, the hormones associated with it, and cutting-edge research that may translate into the next generation of weight-loss drugs. From food addictions to diet therapies, this comprehensive overview provides information about why your belly grumbles and how your brain responds.

The March issue also brings you information on:

-- Insulin pumps: how they work, how they help, and what you should know if you're considering using one.

-- The pancreas: what this little organ does, and how it goes wrong in people with diabetes.

-- Great greens: terrific new recipes, just in time for St. Patrick's Day.

How Omega-3 Fatty Acids Protect Against Liver Damage And Insulin Resistance – 05th March 2009

According to a recent study published online in The FASEB Journal (http://www.fasebj.org), diets rich in omega-3 fatty acids protect the liver from damage caused by obesity and the insulin resistance it provokes. This research should give doctors and nutritionists valuable information when recommending and formulating weight-loss diets and help explain why some obese patients are more likely to suffer some complications associated with obesity. Omega-3 fatty acids can be found in canola oil and fish.

"Our study shows for the first time that lipids called protectins and resolvins derived from omega-3 fatty acids can actually reduce the instance of liver complications, such as hepatic steatosis and insulin resistance, in obese people," stated Joan Claria, a professor from the University of Barcelona and one of the researchers involved in the work.

The scientists found that two types of lipids in omega-3 fatty acids - protectins and resolvins - were the cause of the protective effect. To reach this conclusion, they studied four groups of mice with an altered gene making them obese and diabetic. One group was given an omega-3-enriched diet and the second group was given a control diet. The third group was given docosahexaenoic acid, and the fourth received only the lipid resolvin. After five weeks, blood serum and liver samples from the test mice were examined. The mice given the omega-3-rich diet exhibited less hepatic inflammation and improved insulin tolerance. This was due to the formation of protectins and resolvins from omega-3 fatty acids.

"Doctors are always looking for simple and easy ways to counter the harmful effects of obesity, and the great thing about this study is that the information can be used at dinner tonight," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "It's not unlikely that eating lots more fish or a simple switch to canola oil will make a difference."

 Obese Children Should Have Gastric Bands To Manage Diabetes Says UK Expert – 03th March 2009

A UK expert is recommending, on the basis of a study, that obese children from the age of 15 onwards who have weight-related diabetes should have gastric bands fitted to make their stomachs much smaller so they lose weight. This should be a last resort because there are serious health risks, and should only be considered when all other methods, such as diet and exercise, have failed.

Weight loss is a recognized way of controlling diabetes, but recent research shows children find it difficult to stick to a strict diet and exercise programme.

The Daily Telegraph reported today, Monday 2 March, that Professor Julian Shield of Bristol University and Bristol Royal Hospital for Children, who did a weight loss study of 73 teenagers with type 2 diabetes and found they had increased rather than reduced their weight over 12 months, told the press on Sunday that:

"We have reached the point where it is necessary because of the significant threat of mortality and the morbidity of this disease. There needs to be a formal scientific trial of this method in adolescents."

He said the children they see with type 2 diabetes find it very hard to lose weight by other means and they have all the health problems they see in adults with diabetes.

"They are suffering high blood sugars, they are hypertensive and they have high blood fats. Their health is seriously at risk," said Shield.

A gastric band is an inflatable silicone ring that a surgeon fits around the top of the stomach. The idea is that with a smaller stomach the person can't eat as much. It costs the NHS about 2,500 pounds per procedure. The fatality rate is less than one per cent but up to 10 per cent of patients can have serious complications.

According to a report in the Daily Mail, Shield said that diabetic adults can lose 60 to 70 per cent of their excess weight with gastric banding, which he recommended in preference to gastric bypass surgery because it has fewer potential complications. He said research from the US suggested gastric banding was effective in 90 per cent of cases of adolescents aged 18 and 19.

In the UK doctors have tended to use diet and exercise to help obese diabetic children lose weight, but Shield said this was "tinkering around the edges" and gastric banding was a potential cure for these patients.

Cases of type 2 diabetes have been rising steeply in Britain in line with obesity, although typically a disease of middle age, it is now happening in all age groups. 17 per cent of British children are now obese, about 900,000 in total, said Shield, and about 1,400 of them have type 2 diabetes, at a rate of 100 new cases a year.

A representative of the National Obesity Forum told the Daily Mail that he supported Shield's suggestion.

GP Dr David Haslam told the paper that:

"The epidemic of obesity has reached a desperate place when we are talking about a 15-year-old having surgery but that is the situation we are in, because having type 2 diabetes will knock at least 20 years off their lives."

Gastric banding has been available through the NHS for children under 18 since 2006, but it is only used in very rare cases.

The UK is seeing an explosion of diabetes linked to growing obesity rates, experts are warning – 24th February 2009

From 1997 to 2003 there was a 74% rise in new cases of diabetes.

And by 2005, more than 4% of the population was classed as having diabetes - nearly double the rate of 10 years earlier.

The bulk of cases are type 2 diabetes -which is linked to being overweight or obese - the Journal of Epidemiology and Community Health reports.

"This research is a sad indictment of the current state of the UK's health". Douglas Smallwood, chief executive of Diabetes UK

The findings suggest that rates of diabetes are increasing at a faster rate in the UK than they are in the US, where prevalence of the disease is already one of the highest in the world.

Of more than 42,642 people who were newly diagnosed with the disease between 1996 and 2005, just over 1,250 had the inherited "insulin-dependent" type 1 diabetes, and more than 41,000 had later-onset type 2 disease, which is linked to lifestyle.

While the numbers of new cases of type 1 diabetes remained fairly constant over the decade, the numbers of new cases of type 2 diabetes did not.

These shot up from 2.60 to 4.31 cases per 1,000 patient years, equivalent to an increase of 69% over the decade.

The researchers from Spain and Sweden who analysed the data from almost five million medical records say the trends are not due to increased screening or the UK's ageing population, but from rising obesity rates.

'Time bomb'               

Over the course of the study, the proportion of patients newly diagnosed with type 2 diabetes who were obese increased by a fifth.

The researchers said: "Our results suggest that, although the incidence of diabetes remains lower in the UK than in the USA or Canada, it appears to be increasing at a faster pace."

Rates of obesity and diabetes will continue to rise unless we do something urgently

Tam Fry of the National Obesity Forum

Tam Fry of the National Obesity Forum said projections suggested the worst was yet to come: "Rates of obesity and diabetes will continue to rise unless we do something urgently."

Douglas Smallwood, chief executive of Diabetes UK, said: "This research is a sad indictment of the current state of the UK's health. Sadly, the statistics are not surprising as we know that the soaring rates of type 2 diabetes, are strongly linked to the country's expanding waistline.

"Research shows that losing weight can reduce the risk of developing type 2 diabetes by 58%. It is imperative that we raise awareness of the importance of eating a healthy, balanced diet and doing at least 30 minutes of physical activity a day if we want to make any headway in defusing the diabetes time bomb."

Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, said: "Early detection and treatment are crucial. We must do whatever we can to find the half-million people who don't know they've got it."

There are currently over 2.5 million people with diabetes in the UK and there are more than half a million people with diabetes who have the condition and don't know it.

Type 2 diabetes usually appears in people over the age of 40, however, recently, more children are being diagnosed with the condition, some as young as seven.

The NHS is spending £1m an hour - 10% of its yearly budget - treating diabetes and its complications, according to Diabetes UK.

A Department of Health spokesperson said the rise in recorded diabetes cases was partly due to improvements in diagnosis, along with rising rates of obesity and an ageing population.

As a result, more people were getting the support, advice and treatment required to prevent or delay complications.

"We are committed to working with the NHS to help prevent people from developing diabetes," the spokesperson added.

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