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Liver disease neglected in diabetes

The liver is the neglected organ in diabetes, researchers warn, after finding adults with the condition are at a significantly higher risk of long-term serious liver disease than the general population.

The 13-year study of more than 400,000 adults with newly diagnosed diabetes found they were 77 per cent more likely to develop cirrhosis, liver failure or require a liver transplant than controls.

“Existing guidelines do not advocate screening for liver-related complications among persons with diabetes, making the liver a potentially neglected target organ,” researchers wrote.

Diabetic hepatopathy was less common than diabetic retinopathy or diabetes-related end-stage renal disease, they noted. But when the liver failed, there was no equivalent form of management, such as haemodialysis or retinal photocoagulation, which, the authors argued, strengthened the case for screening.

Annual screening could be performed by measuring enzymes such as alanine aminotransferase, they suggested.
Further research was also needed into the effects of weight loss and glycaemic and lipid control on liver disease, they wrote.

“Adults with newly diagnosed diabetes appeared to be at higher risk of advanced liver disease, also known as diabetic hepatopathy. Whether this reflects non-alcoholic fatty liver disease or direct glycaemic injury of the liver remains to be determined,” the researchers concluded.

Mothers with diabetes that breast-feed could lower obesity in babies

A new study has revealed that babies who are breast-fed for at least the first six months of their lives have a better chance of avoiding being overweight later in childhood . Scientists, from the Colorado School of Public Health, found that children whose mothers were diabetic during pregnancy were at heightened risk of childhood obesity, a risk that was reduced by breast-feeding.

For babies that were exposed to diabetes in utero, those breast-fed for the first six months or longer were no more likely to put on extra weight when they were between 6 and 13 years of age, than those children whose mothers were not suffering from diabetes during pregnancy.

The study, published in journal Diabetes Care, also showed that the benefits of breast-feeding were not exhibited in babies who were breast-fed for less than six months.

Dana Dabelea, lead researcher on the study, commented "Our data suggest that breast-feeding promotion may be an effective strategy for reducing the increased risk of childhood obesity in offspring of mothers with diabetes during pregnancy."

She added "Since childhood obesity and in utero exposure to maternal diabetes have both been associated with later development of type 2 diabetes, it follows that breast-feeding these children may also help reduce their future risk for developing type 2 [diabetes]. However, further research would be needed to confirm that added protection.

Fatty liver 'independent risk factor' for diabetes

Fatty liver is an independent risk factor for diabetes, new research has found.

Scientists from Stanford University said that as fatty liver is often accompanied by common diabetes risk factors such as obesity and insulin resistance, it is difficult to determine whether it increases the chance of a patient having diabetes.

However, the study found that even in subjects with similar insulin concentrations, those with fatty liver were twice as likely to develop the condition.

Researcher Sun Kim said: "Our study shows that fatty liver, as diagnosed by ultrasound, strongly predicts the development of type 2 diabetes regardless of insulin concentration."

Meanwhile, researchers from the University of New South Wales in Australia found that the common cold could be a risk factor for diabetes. It was revealed that children with type 1 diabetes were ten times more likely to have had enterovirus infection than those without the condition.

Lack of sugar molecule raises chance of diabetes onset

Scientists in the US have made a breakthrough in identifying an evolutionary gene mutation that has resulted in an inability to produce a sugar molecule that leads to some people being more vulnerable to developing diabetes. The lack of the sugar molecule could be a factor in the onset of type 2 diabetes, especially if the patient is also overweight.

The research, carried out at the University of California, San Diego School of Medicine and Rady Children's Hospital-San Diego, is the first proper evidence to link the sugar production to insulin and glucose metabolism problems associated with diabetes.

Jane J. Kim, corresponding author on the study, commented "Given the global epidemic of obesity and diabetes, we think that these findings suggest that evolutionary changes may have influenced our metabolism and perhaps increased our risk of the disease."

It is known that type 2 diabetes is results from both genetic and environmental factors, including a fatty diet and lack of exercise, which lead to progressively dysfunctional pancreatic beta cells, high levels of blood sugar because of insulin resistance and more problems regarding health.

The researcher argue that the results of the study, published in the FASEB Journal, help refine our knowledge of why people who are obese appear to be particularly vulnerable to type 2 diabetes.

Blood cells taken from umbilical cord could help wound healing in diabetics

A study by scientists in South Korea has shown that transplanting endothelial progenitor cells (EPCs) from human umbilical cord blood can significantly accelerate the ability of wounds to close in laboratory mice with diabetes . As diabetes can often be associated with impaired wound healing, this investigation could prove timely.

The research, published in the journal Cell Transplantation, examined the therapeutic potential of transplanted EPCs for healing difficult wounds, and transplanted EPCs into a group of mice modelled with diabetes-associated wounds, finding that the EPCs helped wound healing and increased neovascularization for this group.

It was also revealed that growth factors and cytokines were produced in large quantities where the wounds occur, and helped to contribute to the healing process.

Wonhee Suh, corresponding author of the study, commented "EPCs are involved in revascularization of injured tissue and tissue repair. Wounds associated with diabetes that resist healing are also associated with decreased peripheral blood flow and often resist current therapies."

She added "Normal wounds, without underlying pathological defects heal readily, but the healing deficiency of diabetic wounds can be attributed to a number of factors, including decreased production of growth factors and reduced revascularization."

Advice issued on Diabetes Blurry Vision

Those who have developed Diabetes Blurry Vision have been given some useful advice on the condition.

Ourmidland.com said that those who suffer from this will completely lose their eyesight if they do not take action.

The news source said: "Diabetes Blurry Vision is a serious warning that something must be done fast."

Contact lens wearers were told that this disorder is caused by high blood sugar, which eyes are particularly vulnerable to.

However, the news source said that, although the condition cannot be reversed by medication, a special diet may be able to solve the problem. The Spirit Happy Diet claims to help people reverse type 2 diabetes by normalising blood sugar levels.

In addition, contact lens wearers can look after their eye health by making regular visits to an optician, Phil Moss, commercial vehicle manager at the insurance company Swinton, recently said.

He spoke out after a poll by the company discovered that a number of people who operate commercial vehicles have failed to have eye tests and could have defective eyesight that has yet to be spotted.

Aspirin May Lower Type 2 Diabetes Atherosclerosis Risk

Low-dose aspirin therapy may lower the risk of atherosclerotic events in patients with type 2 diabetes with mild renal dysfunction, according to a study published in the February issue of Diabetes Care.

Yoshihiko Saito, M.D., Ph.D., from Nara Medical University in Japan, and colleagues investigated the efficacy of low-dose aspirin for preventing atherosclerotic events in patients with type 2 diabetes and concomitant renal dysfunction. The 2,523 patients enrolled were randomly assigned to two groups, receiving either 81 or 100 mg per day of aspirin, or a nonaspirin group. Stroke, fatal and nonfatal atherosclerotic ischemic heart disease, and peripheral arterial disease were the primary end points in patients followed up for an average of 4.37 years.

The investigators identified a significant interaction between mild renal dysfunction (baseline estimated glomerular filtration rate [eGFR], 60 to 89 mL/min/1.73 m²) and aspirin. In 1,373 patients with eGFR, the primary end point incidence was significantly lower in the aspirin group than in the nonaspirin group (hazard ratio [HR], 0.57). The incidence of primary end points was not affected by aspirin therapy in patients with an eGFR less than 60 mL/min/1.73 m² (HR, 1.3) or in patients with an eGFR greater than or equal to 90 mL/min/1.73 m² (HR, 0.94).

"The current study demonstrated that low-dose aspirin therapy reduced the risk of atherosclerotic events in type 2 diabetic patients with eGFR 60 to 89 mL/min/1.73 m². The results suggest that eGFR may be useful for risk stratification in the primary prevention strategy with aspirin," the authors write.

Several authors reported financial relationships with the pharmaceutical and medical device industries.

Junk food generation faces diabetes timebomb as growing numbers of children develop disease previously only seen in adults

Junk  food is causing rising numbers of children to develop type 2 diabetes, a disease once seen only in adults.

Despite millions of pounds being poured into taxpayer-funded health drives, the majority of youngsters are still not eating a balanced diet. Up to a fifth of ten-year-olds are clinically obese and at risk of heart attacks, cancer and other life-threatening illnesses.

Diabetes time bomb: Poor diets and a lack of fruit and vegetables are causing the rise in the condition. Many children consume just half the recommended amount of fruit and vegetables, with one in five not eating any fruit at all. An independent study into children’s diets, by nutritionist Dr Carrie Ruxton, points to an increase in cases of type 2 diabetes. The disease is linked to obesity which usually occurs only in those over 40.

Around 2.8 million people in Britains suffer from the disease and rates have increased by 75 per cent since 2007. Published in the Nutrition and Food Science journal, the research analysed more than 60 studies into children’s nutrition. It warns that millions of youngsters are at risk of heart disease and cancer. It also says they are at risk of osteoporosis, anaemia and problems with their brain power because they eat the wrong foods. Most do not eat nearly enough fibre, vitamin D or other important minerals such as zinc and calcium. Instead they get as much as a third of their calories from junk food rather than the recommended allowance of less than 10 per cent.

Scientists say many teenage girls are at particular risk as they go on fad diets which rule out meat and dairy, which are sources of iron, protein and calcium. As a result they are more likely to suffer from anaemia and osteoporosis. Dr Ruxton said: ‘Many teenagers miss breakfast, then have crisps on the way to school, chips and curry sauce for lunch and then a pizza in the evenings. ‘A high proportion of calories is coming from junk food.

Artificial pancreas could help diabetic pregnant women

An artificial pancreas has been developed to help pregnant women with diabetes, and which could offer a lifeline to the mother and bring improvements in the health of their babies, making pregnancy safer.

The research, by the Medical Research Laboratories in Cambridge, is aimed at controlling levels of blood sugar in pregnant diabetic women, as people with type 1 diabetes have trouble regulating their levels due to hormonal changes during pregnancy and their pancreas stopping the production of insulin.

During pregnancy the safe range for levels of blood sugar becomes much narrower, and around half of all babies born to mothers with type 1 diabetes are overweight or obese at birth due to the problem of too much sugar in the blood.

The researchers fitted artificial pancreases, which allow the body to maintain sugar at normal levels, to 10 women with the disease, with a sensor monitoring sugar levels, and telling a computer when and how much insulin is needed.

Helen Murphy, from Cambridge University, commented "For women with type 1 diabetes, self-management is particularly challenging during pregnancy due to physiological and hormonal changes."

She added "These high blood glucose levels increase the risk of congenital malformation, stillbirth, neonatal death, preterm delivery, macrosomia [oversized babies] and neonatal admission. So to discover an artificial pancreas can help maintain near-normal glucose levels in these women is very promising."

The mouth-body connection

Opening your mouth is a little like opening up the bonnet of your car. An expert taking a quick look can get a good idea of what's working, what's not, and what should be tuned up regularly to keep your body's systems up and running at their best.

Your teeth and gums, it seems, may speak volumes about your well-being. For a start, there are conditions that affect oral health. Researchers continue to look at the association between cavities, gum disease, and heart disease, although a cause-and-effect relationship has not yet been established. There are some diseases that are associated with an increased risk of infections. Diabetes increases the risks of gingival and periodontal inflammation and infections. Also, loose teeth could be a sign of osteoporosis.

When there's an underlying condition, your dentist may be able to draw an important connection between your oral health and your overall health. So sit back, relax and open wide. Here's what you need to know about the mouth-body connection.

Oral health & diabetes

Bleeding gums, dry mouth, fungal infections, cavities -- these oral signs might alert your dentist to a serious health issue: diabetes. And these symptoms also might suggest other serious conditions.

Diabetes and your mouth have blood sugar in common. If blood sugar levels are out of control in your body, they're out of control in your mouth. With sugar to feed on, bacteria find a happy home in which to grow and thrive. The bacteria then attack the protective enamel layer on your teeth and over time, as the enamel breaks down, cavities develop -- one of the dental signs of diabetes.

Someone with diabetes has more mouth woes to worry about. Uncontrolled diabetes reduces the body's first line of defence against infection -- white blood cells -- which can then put oral health at risk. With bacteria teeming around the gums from high blood sugar levels, periodontal or gum disease is an easy next step.

Unfortunately, because diabetes lowers your resistance to infection, managing periodontal disease isn't easy. If you have diabetes and periodontal disease, you have to get your blood sugar levels under control for the sake of your mouth as well as your body.

Your dentist should be one of your best friends if you are among the 2.8 million Britons living with diabetes. Frequent professional cleaning is important in helping to prevent or control periodontal disease, and home care means flossing and brushing after every meal.

Beer a day keeps the doctor away

Moderate drinking of ale and lager can cut the risk of diabetes and high blood pressure and even help people lose weight, doctors say.

The Spanish researchers suggest combining beer with exercise and a healthy Mediterranean diet high in fish, fruit and vegetables and olive oil.

Beer contains folic acid, vitamins, iron and calcium and has the same health benefits already attributed to moderate wine drinking, researchers found. They blamed fatty foods like chips, a lack of exercise and binge drinking for beer bellies.

Dr Ramon Estruch, the lead researcher, said: “Moderate beer consumption is associated with nutritional and health benefits. It does not necessarily mean weight gain since it has no fat and calorie content is low.”

The joint study was carried out by Barcelona University, the Hospital Clinic in Barcelona and the Carlos III Institute of Health in Madrid.

Dr Estruch and Dr Rosa Lamuela tested 1,249 men and women over 57 years old. They found that those who regularly drank moderate amounts of beer were less likely to suffer from diabetes and high blood pressure and had a lower body fat content. Those with a Mediterranean diet who drank up to a pint of beer a day “not only did not put on weight, but in some cases even lost weight.”

Beer provides a 'protective' effect on the cardiovascular system and has a relatively low alcohol content compared to other drinks, they concluded.

Reversing diabetes

When Jonathan Legg's father died of a heart attack in his 40s, he knew he had to watch his health. 

Although he had gained some weight after college, he was still active.  But two years ago, in his late 30s, Legg was diagnosed with Type 2 diabetes. 

"It was a big wake up call, that what I was doing and that my current weight was not ok,” he said. 

Legg's doctor wanted to put him on medication.  But he said he'd rather try to turn his diabetes around, with diet and exercise. 

"I wanted to be able to know the changes I was making were making a difference and it wasn't the drug." 

So he went back to running, dropped 40 pounds, cut out the beer and started eating a low-carb diet. 

"He cut out significant amounts of sugar in his diet, really changed how he ate,” said his doctor, Dr. Lucy McBride. 

Since his diagnosis, Jonathan has turned his life around.  His sugar levels are normal and technically he is no longer a diabetic.  His doctor says he's an exception. 

"He’s got to keep up those lifestyle habits for things to stay in the right direction. It's something he will need to manage his whole life." 

A lifestyle, Legg says he's willing to live with in order to avoid the complications of diabetes. 

Take more steps to reduce your risk of diabetes

A new study states that you can decrease your risk of developing diabetes by increasing the number of steps you take every day.

Researchers at Murdoch Children's Research Institute in Australia discovered that people who took more steps per day in 2005 than they did five years prior had a lower body mass index, a lower waist-to-hip ratio, and better insulin sensitivity (a measure of Type 2 diabetes risk) than they did at the start of the study, according to researchers.

Sedentary people who increased their daily steps to 10,000 over the five year span also saw improvement in their insulin sensitivity by three times compared to those who took only 3,000 steps for five days a week. The study examined the walking habits of almost 600 adults for five years, with each person wearing a pedometer.

Past research has shown that walking more can decrease the risk of becoming overweight and developing insulin resistance. But the study is the first to suggest that increasing the actual number of steps you take can make a difference in your diabetes risk, researchers said.

How many steps should you take? According to a 2008 study on walking and maintaining a healthy weight, men ages 18 to 50 should take 12,000 steps a day. For men 50 and up, you'll need 11,000 steps a day. Women ages 18 to 40 need to take 12,000 steps a day, whereas women ages 40 to 50 should take 11,000 steps a day. Women in their 50s should take 10,000 steps a day, and women 60 and older should take 8,000 steps a day.

A rough estimate of how far you need to walk: depending on your stride, the average person takes about 1,000 steps for every .8 kilometer (or about a half mile). To walk 11,000 steps is roughly equivalent to 8.8 kilometers (5.5 miles), so you'll need to cover a lot of ground, according to the study.

Type 2, the most common form of diabetes, has spread fast from rich countries to fast-developing economies as fatty, sugary diets and sedentary lifestyles take hold. More than 220 million people worldwide are afflicted with the disease, which kills more than one million people every year, according to the World Health Organization (WHO). As obesity rates increase, the number of deaths could double between 2005 and 2020, the WHO has said.

Ask the Doctor. What should I eat if I have diabetes?

I am type 2 diabetic trying to create a daily diet, and snacks, food program that I can use to prevent getting the terrible sick feeling that comes when my sugar goes too low. I would like to store these foods and snacks in my home so that I can reach them when necessary. Please name the foods, and snacks, as well as the proper times to consume them. Also when is the time to take Metformin even if your readings are regular and you feel OK? Thank you for your answer to these questions.

 Doctor’s Answer
To prevent hypoglycemia and to minimize the complications associated with diabetes including heart disease, kidney disease, eye problems and infection, it is important to keep blood sugar levels as steady as possible throughout the day. To accomplish this, I recommend trying to combine some type of lean protein (skinless chicken, fish, turkey, lean ground beef, beans, egg whites, low-fat cottage cheese or yogurt) or healthy fat (olive oil, canola oil, nuts, seeds, avocado) with a healthy carbohydrate with each meal or snack.

Make sure to choose healthy, low-sugar, antioxidant-rich carbohydrates like whole grains (brown rice, whole-wheat pasta, whole-grain bread, cereal, crackers, quinoa, barley), whole fruit (not juice or dried fruit) and vegetables. These types of carbohydrates are generally low-glycemic, which means they increase blood sugar less rapidly than highly processed, refined, sugar-filled carbohydrates. Naturally high-fiber foods are always a good choice as they slow the emptying of food from your stomach, which helps improve blood sugar control. By preventing spikes in blood sugar, you can also prevent the crashes that follow.

It is also important to try to eat regularly throughout the day. Try not to let more than four hours go by without having either a meal or snack, to prevent blood sugar from getting too low. And do your best to eat within 30 minutes or so of waking up.

Since you talk about storing foods in your home, I'm going to give you some of the best canned and frozen choices, although fresh is always a great choice if you have the option. Here are some staples to keep on hand:

1. Nuts: Nuts (both peanuts, which are actually legumes, and nuts like almonds, walnuts, pistachios, etc.) contain healthy fats, fiber and heart-healthy plant-based protein. They make great snacks alone or with a piece of fruit or can be thrown on a salad or into yogurt for added crunch and nutrition.

2. Beans: These are also excellent sources of fiber and plant-based protein. Drain and rinse canned beans to decrease salt content. Beans work great in soups and chili, on salads or as a healthy side dish. I'm a big fan of bean-based soups like minestrone, vegetable or lentil as a healthy lunch or pre-dinner appetizer.

3. Frozen vegetables: I always have lots of frozen vegetables on hand for healthy side dishes. Try seasoning with a little olive oil (healthy fat) and spices instead of salt for extra flavor.

4. Canned tuna and chicken (water-packed and low-sodium when available): These provide a quick and healthy lunch or dinner option. Mix with mustard or a little olive oil-based spread and serve on whole-grain bread or in a whole-wheat pita pocket (both of which you could freeze to have extra on hand)

5. Frozen fruit: I'm a big fan of frozen berries, which are loaded with antioxidants (important to decrease the complications of diabetes) and fiber. I use them to make smoothies for breakfast (with plain non-fat yogurt or protein powder and one or two tablespoons of ground flax seed for healthy fat), and sometimes I defrost them and top with a little light whipped topping or low-fat vanilla yogurt for a healthy and tasty dessert.

Regarding your Metformin, you should talk to your doctor regarding the best time to take it, as it depends on the type of pill you are taking. In general, however, Metformin should not cause low blood sugar episodes and should be taken with meals.

Thermometer to save diabetics losing limbs

A new handheld device could greatly reduce the number of ulcers and limb ­amputations in people with diabetes. The device provides early ­warning of complications which, if left untreated, can lead to the limb becoming so ­damaged it needs to be removed.

Around 100 Britons a week undergo an amputation as a result of diabetes. The disease can cause significant ­damage to the nerves and blood vessels — possibly because they are exposed to such high levels of blood sugar. Nerve damage can lead to loss of feeling in the feet, meaning sufferers might not feel a cut, blister or sore. Left untreated, such injuries can develop into serious ulcers and infections. Poor circulation exacerbates the problem — reduced blood and oxygen supply to the area makes healing difficult.

 Four out of ten people with diabetes are thought to have lost some feeling in their feet, and nearly half will suffer a foot wound or ulceration in their lifetime. In some cases, wounds can remain open for months or even years, vastly increasing the risk of life-threatening infection. If an infection sets in deeply, or affects the bone, antibiotics alone might not be enough. Gangrene can set in and amputation might be the only course of action. Even if patients don’t end up so drastically affected, they can still suffer from ulcerations, infections and the foot can become deformed.

Diabetes affects 2.8 million people in the UK, with more than one ­million thought to be undiagnosed. It is caused by too much sugar — glucose — in the blood. There are two variants of the condition, type one and type two. Type one can be present from birth and is caused by the destruction of insulin-producing cells. However, around 90 per cent of those who suffer with diabetes have type two, which is triggered by ­obesity. In this case, the body is unable to ­produce enough insulin. The ­condition can be controlled by ­following a healthy lifestyle.

The new device — a ­battery-­powered thermometer — has been developed by U.S.-based Dibetica Solutions to be used at home by people with ­diabetes and some existing nerve damage. It uses infrared light to measure changes in foot temperature — a rise in temperature is a sign of inflammation and damage. The readings can help alert a patient that a sore or ulcer is ­developing, before it even breaks the surface of the skin. They can then seek medical attention. The gadget is designed to be used daily — the patient measures six sites on each foot and ­compares the temperatures. If this temperature ­difference is more than four degrees Fahrenheit (2C), for two days or more, a problem might be ­brewing and they need to ­contact their doctor. Previous studies have shown the device cut ulcer rates by a third, compared to ­people who didn’t use the gadget. Now a larger, ­clinical trial is under way at Oslo University ­Hospital, in Norway, to see whether the device can ­prevent future foot ulcers in patients who have previously ­suffered with this complaint.

Cathy Moulton, clinical adviser at the charity Diabetes UK, says the device could be ­successful as long as patients are vigilant in ­taking their temperature every morning: ‘There is ­evidence ­showing that temperature changes could identify signs of neuropathy (nerve damage). ‘To reduce the risk of ulcers which could lead to ­amputations, ­Diabetes UK ­recommends that people with ­diabetes regularly check their feet looking for discolouration, damage to the skin, swollen areas, and if the foot feels very hot or cold. ‘If there are any changes such as these, they should see their ­doctor as soon as possible.

‘It is also vital that people with diabetes have access to a ­podiatrist and specialist care if any foot ­problems do develop.’

A new type of ‘artificial skin’ might help treat severe ulcers in people with diabetes, reducing risk of amputation. The PriMatrix skin patches are surgically stitched or stapled on to wounds that have proved ­difficult to treat. Some diabetic ulcers fail to heal because poor circulation in the feet stops the production of new collagen, a crucial structural ­component of skin. Derived from a component of cow skin — known as fetal bovine dermis — the patch encourages the patient’s skin to grow over the wound by providing a collagen scaffolding that the skin cells can latch on to. Over five to six months, the patient’s skin grows over the patch, and the collagen is ­eventually replaced with the patient’s own. The patch is also used in ­hospitals in the U.S. and Europe for the management of pressure ulcers, second-degree burns and trauma wounds.

More evidence shows drinking coffee cut type 2 diabetes risk

The effect of the timing of drinking coffee

Sartorelli D.S. and colleagues from University of São Paulo in Ribeirão Preto, Brazil reported in the American Journal of Clinical Nutrition that drinking more than one cup of coffee a day reduced the risk of diabetes by 27 percent in women, compared with those who did not drink.

The researchers followed 69,532 French women aged 41 to 72 years and found the inverse association was only found among those who drank coffee at lunchtime. Those drinking one cup of coffee a day at lunchtime cut their risk of diabetes by 33 percent, compared with those who did not drink.

The inverse association was observed both for regular and decaffeinated coffee and both black coffee and filtered coffee, but not for sweetened coffee.

Total caffeine was inversely associated with reduced risk of diabetes, but consumption of tea, which also contains caffeine, and chicory was not correlated with diabetes risk.

The researchers suggested that the timing of drinking coffee may play a role in the development of type 2 diabetes.

Drinking four cups of coffee boosts production of SHBG

Researchers at University of California at Los Angeles found evidence that suggests caffeinated coffee reduces the risk of type 2 diabetes by increasing the serum level of a protein called sex hormone-binding globin or SHBG.

SHBG regulates the biological activity of the body's sex hormone, testosterone and estrogen and it's been known for long that it may play a role in the development of type 2 diabetes mellitus.

Dr. Simin Liu and colleagues reported in the journal Diabetes that women who drank four cups of coffee each day had higher amounts of SHBG than non-drinkers and were 56 percent less likely to be diagnosed with type 2 diabetes mellitus, compared with non-drinkers.

Further research showed coffee consumption also benefits the protective copy of the SHBG gene, on which two mutations are known to influence the production of SHBG, one increasing the output of the protein and the other suppressing the production.

Additionally, Liu et al. found decaffeinated coffee did not render any protection against type 2 diabetes mellitus.

The researchers reported their findings in the journal Diabetes.

Why are men getting so tubby?

The average British man has piled on A STONE in a decade. Yes greed and laziness are to blame but there are other, more worrying forces at play....

British men are getting fatter than ever, faster than ever. Last week, Oxford University ­scientists reported that the average man is more than a stone heavier — 17lb — than 20 years ago.

It would be easy to blame this dramatic increase on over-eating and lack of exercise, and leave it that. But the Oxford study showed that the explanation isn’t this simple. Indeed, scientific research is revealing that a cocktail of unexpected factors is helping to drive the male obesity epidemic. These include genetics, pollution, stress, vanity, insomnia —and flabby friends. There’s no doubt that British men are eating more. Over their 14-year study period, the Oxford researchers found that around 10.4lb of the extra weight men are carrying was due to extra calories. But that did not explain the full 17 lb rise. And lack of exercise could only partly account for the difference, says the study leader, Dr Peter Scarborough.By contrast, the extra 12lb the average woman gained over the same time is entirely explained by them eating more, according to the study, which was published in the British Journal of Nutrition. This tallies with official statistics that show that nearly half of British men are overweight, compared with just a third of women, while a quarter of men are officially obese (compared with only 7 per cent in 1987).

The result is an epidemic of obesity-related diseases in men: cases of ­diabetes have risen by almost a third since 2003, while in women they rose by less than a quarter. Overweight men also have much higher rates of cancer, stroke and heart disease.

But if overeating and under-exercising are not solely to blame for men’s obesity and disease, what else might be making them fatter? Research in this field is in its infancy compared with studies of women, but it indicates men have a unique ­propensity to put on weight. In November, for example, U.S. ­scientists reported they’d found a gene that causes weight gain in men, but not women. The gene — Arrdc3 — is found in human fat and muscle, but seems to cause only men to become fat as they get older, says lead researcher Dr Parth Patwari of Brigham and Women’s Hospital in Massachusetts. When he removed the gene from male mice, they no longer suffered from age-related weight gain; in fact, they showed a ‘striking ­resistance’ to it. But when the gene was removed from female mice, it made no significant difference.

 Other scientific discoveries suggest men may be particularly vulnerable to environmental factors linked to ­obesity. One threat may come from chemicals called phthalates, which are used as plastic softeners in ­numerous household products. These can cause men to put on weight and lower their sensitivity to insulin (a precondition for diabetes), according to a U.S. study published in the journal Environmental Health Perspectives.

Phthalates seem to impair the way men’s testicles work. Low ­testosterone in adult men is associated with increased obesity, says lead researcher Richard Stahlhut, a ­professor of preventive medicine at Rochester University.

 Another environmental fattener may come from air pollution. Danish ­investigators who studied more than 3,000 people have found that men who have blood group O (the most ­common group) are at particular risk of becoming obese when exposed to long-term industrial air pollution at work, compared with other men and women. How could pollution have this effect? It seems pollution sets off chronic inflammation in the body, according to the report in the International Journal of Obesity. In turn, this reduces the effectiveness of a vital appetite-controlling hormone called leptin. Mice without leptin go on ­eating until they are twice the size of ordinary mice.

But one of the biggest causes of ­spiralling male obesity may be the modern work environment, where so many men spend long hours at desks. It’s not simply lack of exercise that is to blame. Sitting itself has special risks, according to Professor Peter Katzmarzyk, a public health expert at the Pennington Biomedical Research Centre in Louisiana.

 When we sit down, we are not ­tensing our muscles, and this affects men’s fat-burning rates. Animal studies have shown that muscles produce a fat-processing protein only when flexed. Professor Katzmarzyk says while there are huge health benefits from exercise, the benefits of not sitting down are different and unique. ‘We are finding that the effects of sitting are an additional risk factor for ­obesity,’ he says. He adds that his work also shows that men who cut down on the amount they walk for two weeks become worse at ­metabolising sugars and fats.

 Climbing the office ladder can make things worse still for men. Researchers in the U.S. have ­found that male bosses are 20 per cent more likely than average men to be overweight. In women, the risk rises only by 7 per cent, according to the Michigan State University research.

One theory is that it’s down to the effect that lack of sleep — a common result of high-pressure jobs — has on men’s metabolisms. Japanese researchers have found that when men have less than five hours’ sleep a night, it triggers a ­hormone in the blood that stimulates appetite. Again, this effect has not been seen as strongly in women. ‘Lack of sleep increases a sense of hunger, as well as an appetite for high-calorie food,’ report scientists at Nihon University. The result is cravings for sugars and fat. Tam Fry, a spokesman for ­Britain’s National Obesity Forum, agrees that high stress, time-starved lifestyles are pushing men to pile on the pounds.

 ‘There is a general move away from the healthy lifestyles of ­yesteryear into lifestyles that are much higher pressure,’ he says. ‘At work, we have seen the ­disappearance of the lunch hour and the increasing habit of buying ­sandwiches high in fat and sugar, and eating them at the desk. 

‘This eating habit is part of the rise of grazing, which is a major ­contributor to obesity.

‘When you eat while not actually being conscious of what you’re eating, you take on lots of calories without even noticing. If you spend a full day of increasing work hours and stress, you want to go home, sit down in front of the TV, have a drink and eat snacks.’ The problem  is that even without stress, men instinctively head for higher-calorie foods.  A study of more than 14,000 adults by the American Society for Microbiology shows that men are more likely to eat meat and ­poultry, while women are more likely to eat fruit and vegetables. Perhaps one of the most unusual findings about men and weight gain is that their vanity makes them prefer being ­overweight — out of fear of ­appearing puny. Many men simply don’t see themselves as fat when they look in the mirror. They believe they look ‘well-built’, when they are dangerously flabby, says Dr Kerri McPherson, a chartered health psychologist at Glasgow ­Caledonian University, who bases her ­findings on an in-depth survey of 150 men. ‘We know how upset women are if they feel fat, but the men who took part in this study would rather be overweight than too thin. What these men considered to be their ideal waist ­measurement is actually ­medically overweight.

 ‘The ideal for a man is a body that is very muscly. Ideally, they wanted to achieve that bulked-up body image through muscle, but very few achieved that, so they would rather be bulked up by fat and cover it with clothes.’ Men are also prone to another psychological effect: weight ­contagion. Fat men make their male friends fat, according to a study of more than 15,000 people over three generations. If a man has a male friend who becomes fat, his risk of becoming overweight is doubled. Having an overweight wife does not have anywhere near as strong an effect.

‘One of the reasons for this is that when it comes to body image, we compare ourselves primarily to people of the same sex,’ says ­Nicholas Christakis, one of the researchers and co-author of the book Connected: The Amazing Power Of Social ­Networks And How They Shape Our Lives.

‘Men who have large friends get a distorted idea of what constitutes “healthy”,’ says Christakis. ‘It is not that obese or non-obese ­people simply find other similar people to hang out with. Rather, there is a direct causal relationship.’ There is also peer pressure, as any man learns if he tries to eat muesli while male friends are tucking into a full English ­breakfast. His friends will only refrain from teasing him if he is fresh from ­coronary bypass surgery.

 The result of all these factors is our unprecedented rise in male obesity — and a growing national epidemic of related illnesses among men. The National Obesity Forum’s Tam Fry says the ­problem is ­proving ‘incredibly difficult to tackle’. It is a particularly sad fact that we have a ‘lost generation’ of young men who were not educated in food and health. ‘We failed to give nutrition and cookery lessons to boys who went to school in the Nineties. As a result, they rely on buying junk food instead,’ he says. ‘We need to start working on the future generations — the ones now at school.

‘And for the sake of all men, the Government should be ensuring that food sold to us meets the Food Standards Agency’s recommended levels for fat and sugar.’ Meanwhile, Dr McPherson says healthy eating messages must be altered so they suit men’s psyches. ‘Many men are still woefully ­ignorant about the link between diet and disease,’ she says. Her surveys reveal — amazingly — that men often still do not make the link between their eating ­habits and their health. ‘That is often because the stuff men hear about healthy eating is dressed up in terms of dieting for thinness and prettiness. That is a turn-off for men. ‘If you pushed the links between healthy eating and ­exercise, and improved muscularity, that could prove far more persuasive.

how not to let diabetes spoil your christmas

Christmas should be one of the happiest times of the year; a chance for families to come together and spend quality time with each other. One thing is quite likely: there will be a lot of food involved, and some of it will be higher in calories and higher in fat than what one would eat on an everyday basis. As a diabetic, there is no reason why you cannot enjoy Christmas fully. Planning sensibly and knowing how to manage Christmas are probably the only precautions you need to take.

A healthy diet for diabetics is the same as a healthy diet for other people, you do not need to have a separate plate at Christmas dinner, you just need to be aware. Traditional foods are a huge part of an English Christmas. Piles of mince pies, an enormous Christmas pudding soaked in brandy butter, a Christmas cake to top it off… All of these foods may be eaten- it is a case of not having too much. Don’t gorge yourself as many people do at Christmas- spread the traditional foods out for the entire Christmas period. Also, don’t be tempted by special ‘diabetic’ foods. Although these may be low in sugar- they may not actually help diabetics.

Letting friends and family know how you want to be served could be helpful as well. Fried food can be easily avoided by roasting or grilling. Avoid adding butter to vegetables, and keep an eye on how many rich sauces you eat – perhaps ask for them to be served separately. Keeping your food routine constant is a good idea, avoid eating too much at one meal and too little at the next.

Trying to stay active and healthy at Christmas can seem like the last things on your mind. A walk or run in the drizzle might seem too much, but after heavy eating it’ll do you the world of good. And everyone eats too much, so don’t worry if you do. Just keep and eye on your blood sugar levels. However, keeping healthy snacks in-house and visible so you can reach for them instead of a mince pie could be a good idea. Make sure if you are travelling to parties that you have the necessary foods with you. Being flexible with your injection and eating routine may be necessary, but make sure you check with your health care specialist beforehand.

Booze is very much a part of some peoples family Christmases. From the brandy for Santa Claus, through to a glass of mulled wine, the temptation to drink a lot certainly exists for many people. Keep an eye on alcohol levels and what they do to your blood sugar, and remember that sugary soft drinks and some alcohol free drinks should also be kept in moderation. Either wear or carry some form of Diabetes identification, and make certain you inform the people you are with if they don’t already know. That way, there is no chance of a diabetic reaction being confused with being drunk.

Plan well, and have a great christmas.

Cut salt to ward off diabetes

A new review of studies has found that reducing the amount of salt in diabetics' daily diet is key to warding off serious threats to their health.

In the Cochrane review, the authors evaluated 13 studies with 254 adults who had either type 1 or type 2 diabetes.

For an average duration of one week, participants were restricted to large reduction in their daily salt intake to see how the change would affect their blood pressure.

"We were surprised to find so few studies of modest, practical salt reduction in diabetes where patients are at high cardiovascular risk and stand much to gain from interventions that reduce blood pressure," said lead reviewer Rebecca Suckling.

"However, despite this, there was a consistent reduction in blood pressure when salt intake was reduced."

High salt intake is a major cause for increased blood pressure and, in those with diabetes, elevated blood pressure can lead to more serious health problems, including stroke, heart attack and diabetic kidney disease.

In the Cochrane review, the participants' average salt intake was restricted by 11.9 grams a day for those with type 1 diabetes and by 7.3 grams a day for those with type 2.

The reviewers wrote that reducing salt intake by 8.5 grams a day could lower patients' blood pressure by 7/3 mmHg. This was true for patients with both type 1 and type 2 diabetes.

The reviewers noted that this reduction in blood pressure is similar to that found from taking blood pressure medication.

Suckling acknowledged that studies in the review only lasted for a week and that the type of salt restriction probably would not be manageable for longer periods.

However, Suckling said, the review also found that in studies greater than two weeks, where salt was reduced by a more achievable and sustainable amount of 4.5 grams a day, blood pressure was reduced by 6/4 mmHg.

The review appeared in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care.


 

EXPERTS SHED LIGHT ON DIABETES RISK FOR SOUTH ASIANS

University of Glasgow academics have discovered one of the reasons why people of South Asian origin are more at risk of developing type 2 diabetes.

The new finding, published in the journal PLoS ONE, is one which researchers hope will pave way for more studies into this area of type 2 diabetes.

According to lead author Dr Jason Gill, of the Universitys Institute of Cardiovascular and Medical Sciences, South Asian muscles have a lower capacity to burn fat than Europeans which means they are more insulin resistant and so at greater risk of developing diabetes.

Dr Gill explained: We already know that people of South Asian origin living in the UK have much more diabetes than people of White European origin, and develop the disease at a younger age. This is partly due to the fact that South Asians carry more fat, particularly in the tummy area, than Europeans. However, this greater level of body fat does not fully explain the increased insulin resistance and diabetes risk observed in this group.

Our results suggest that the ability of South Asians muscles to use fat as a fuel is lower than in Europeans. This reduced ability to burn fat is linked to increased insulin resistance. In other words, if a South Asian man and a European man were walking alongside each other at the same speed, the South Asian mans muscles would be burning less fat and this may contribute to a greater risk of developing diabetes.

The good news is that regular exercise improves the ability of muscles to burn fat, so taking regular physical activity may be particularly important for South Asians to reduce their insulin resistance and minimise their diabetes risk.

The findings can found in full in Fat Oxidation, Fitness and Skeletal Muscle Expression of Oxidative/Lipid Metabolism Genes in South Asians: Implications for Insulin Resistance?

The work was jointly funded by Diabetes UK and the Translational Medicine Research Collaboration.

Dr Victoria King, Head of Research at Diabetes UK, added: We have known for some time that South Asian people have up to a six-fold increased risk of developing Type 2 diabetes. Although we think this could be due to increased body fat and this fat being more likely to be stored around the abdomen, these factors can only explain part of the increased risk we see.

"This very insightful and novel research suggests that the skeletal muscle of South Asian people is less able to use fatty acids and burns less fat during exercise and that these factors contribute significantly to the insulin resistance we see in South Asian people. This new insight could provide the basis for future studies looking at lifestyle or drug interventions to enhance the uptake and burning of fat in muscles, reducing the risk of Type 2 diabetes in this high risk group."

KEY TO OPTIMAL DIABETES MANAGEMENT

WARD OFF DIABETES WITH A DAILY ORANGE JUICE

A glass of orange juice a day may reduce the risk of diabetes.

In a new trial overweight women are being given the juice to reduce their risk of insulin resistance, which is often called pre-diabetes.

This is where the body becomes less ­responsive to the hormone insulin, which ­controls the amount of sugar in the blood.

Left untreated this can lead to full-blown type 2 diabetes and the health risks ­associated with it, such as heart disease.

However, antioxidants in orange juice are thought to have positive effects on blood ­vessels leading to improvements in insulin sensitivity.

The 14-week trial, where patients will have either 250ml of orange juice or a placebo orange-flavoured drink, will test this theory.

‘People are encouraged to lose weight to reduce their risk of diabetes, but dietary modifications may help maximise benefits of this weight loss,’ say Nottingham University researchers.

World Diabetes Day - 14 November

 According to latest data diabetes now affects 285 million people worldwide costs the world economy at least GB£226 billion in 2010, or 11.6% of total world healthcare expenditure. A further 344 million are at risk of developing diabetes (pre-diabetes). If nothing is done to reverse the epidemic it is predicted that by 2030, 435 million people will live with the disease as at a cost projected to exceed GB£295 billion. The World Diabetes Day campaign, faced with these alarming numbers, aims to establish access to diabetes education as a right for all people with diabetes, to promote greater awareness of the risk factors and warning signs of diabetes, and encourage best-practice sharing in diabetes prevention.

- Every 10 seconds a person dies from diabetes-related causes.

- Every 10 seconds two people develop diabetes.

- Every 30 seconds a limb is lost to diabetes

- Each year a 7 million people develop diabetes

- Each year 4 million deaths are attributable to diabetes

- Diabetes is the fourth leading cause of global death by disease.

World Diabetes Day - 14 November

 When: World Diabetes Day is celebrated on 14 November, a date chosen to mark the birthday of Sir Frederick Banting, who is credited with the discovery of insulin. An official United Nation's Day, World Diabetes Day is represented by the blue circle logo that is the global symbol of diabetes.

 Who: World Diabetes Day is a campaign in 163 countries and territories. Created by IDF and the World Health Organization in 1991, World Diabetes Day became an official United Nations Day in 2007 thanks to a UN resolution that calls on all member states to organize events to mark the day. The World Diabetes Day campaign is supported by 14 official partners: Abbott Diabetes Care, AstraZeneca, Boston Scientific, Bristol-Myers Squibb, LifeScan, Eli Lilly, Medtronic, Merck Sharp & Dohme (MSD), Novartis, Novo Nordisk, Pfizer, Roche, Sanofi Aventis and Takeda.

Theme For 2009 - 2013: Diabetes Education and Prevention.

Sugary drinks linked to diabetes risk

Routine drinking of soda and other sugar-sweetened beverages is linked to a greater risk of metabolic syndrome and type 2 diabetes, researchers say.

Lead author Vasanti Malik of the Harvard School of Public Health and colleagues say the study provides empirical evidence that intake of sugary beverages should be limited to reduce risk of diabetes and metabolic syndrome.

Malik and senior author Frank Hu conducted a meta-analysis pooling 11 studies that included more than 300,000 participants and 15,043 cases of type 2 diabetes.

The findings, published in the journal Diabetes Care, showed drinking one to two sugary drinks per day increased the risk of type 2 diabetes by 26 percent and the risk of metabolic syndrome by 20 percent, compared with those who consumed less than one sugary drink per month.

Drinking one 12-ounce serving of a sugary beverage per day increased the risk of type 2 diabetes by about 15 percent, the study says.

"The association that we observed between soda consumption and risk of diabetes is likely a cause-and-effect relationship because other studies have documented that sugary beverages cause weight gain, and weight gain is closely linked to the development of type 2 diabetes," Hu says.

MPs take diabetes test to launch the Silver Star Health Challenge

72 Members of Parliament with Deputy Prime Minister Nick Clegg, Opposition Leader Ed Miliband and Community and Local Government Secretary of State Eric Pickles attended the launch of the Silver Star Health Challenge on diabetes at the Houses of Parliament on Wednesday 27^th October 2010 as part of Diwali at Westminster. MPs took the quick and easy Type 2 diabetes test to help raise awareness of the need for public testing for the disease and to mark the launch of Ethnic Minority Diabetes day.

As part of the Challenge, MPs were issued with a Silver Star Pedometer that will measure the amount of steps taken over 50 Parliamentary Days. The public can keep track of their MPs position on the Silver Star website and the winner of the 50 day challenge will be announced in February 2011.

Launched in January 2007, Silver Star is a registered charity campaigning to provide diabetes awareness. The Charity runs Mobile Diabetes Units (MDU) that carry out important diabetes testing and promote culturally sensitive healthcare, with particular regard to the high prevalence of diabetes in the major towns and cities of Britain. The Units travel to local community centres, schools, work places and other organisations. The Mobile Diabetes Assessment Units have testing equipment, beds, washing facilities and an entrance for disabled people.

The NHS spends £1 million an hour on diabetes related illnesses and it is estimated that more than 1 million people in the UK may have diabetes without knowing it and another 2.8 million people have already been diagnosed with Type 2 diabetes.

Chairman of the Trustees for Silver Star, Dr Modhwadia said ‘The diabetes test is so quick and easy. It takes two minutes and can save lives. I am delighted that so many MPs have decided to take the test and undertake the Challenge as it raises awareness of this largely unseen health condition to people all over the country”.

Meal Planning Made Simple

From portion control and counting carbs to following the glycemic index, here are five tips to help you adapt to new eating habits

Doctor’s orders: You need to completely change the way you think about food. Eat healthful foods. Watch the carbs. Stick to a meal plan. OK, sure — but what does all that really mean?

Too often, people newly diagnosed with diabetes are told that they need to develop better eating habits without being given specific information on how to do it on a day-to-day — or meal-to-meal — basis.

Eating well with diabetes is going to take some work on your part, and perhaps even a new attitude. You have to be willing to learn about nutrition, carbohydrates and meal planning, and be committed to making your diabetes a priority. The following are five strategies to help you with your new lifestyle.

Strategy 1: Visualize your plate
The most basic meal-planning tool is the “plate method.” It’s pretty simple: Fill half of your plate with nonstarchy vegetables like broccoli, peppers and snow peas; fill a quarter of your plate with lean protein, such as fish or chicken breast; and cover the final quarter of your plate with carbs, including grains or starchy veggies (such as corn or potatoes). On the side, you can also have a serving of low-fat dairy (like skim milk or low-fat yogurt) or soymilk and a serving of fruit, such as an apple or a half cup of berries. You can add a small amount of fat to the meal but avoid butter and other saturated fats.

Strategy 2: Count carbs
Many people who take insulin use another tool: carbohydrate counting. Foods like crackers, oatmeal, apples and bread all contain carbohydrates, one of your body’s main energy sources. Your dietitian, diabetes educator or doctor will help you determine how many carbohydrates you should get per meal — say, 40 to 60 grams — for optimal blood glucose control.

Though carb counting focuses on the amount of carbohydrates in each meal or snack, you still need to pay attention to overall nutrition. If you can have 40 grams of carbohydrates, it’s a question of whether you want two servings of fruit and one serving of rice or two servings of rice and one serving of fruit. Pick healthier carbs over junk food; an apple and a half cup of ice cream both have 15 grams of carbohydrates, but the apple is a smarter choice. If carb counting seems daunting at first, understand that it’s a process you’ll continually get better at.

Strategy 3: Watch those portion sizes
Portion control is key. Restaurants can pack two or three servings onto one jumbo plate. The recommended serving of meat is 3 ounces, or the size of a deck of cards. A serving of pasta or rice should be the size of a clenched fist. A baked potato should be about the size of your computer mouse.

A cup of veggies is the size of a baseball, a two-tablespoon serving of peanut butter is equivalent to a ping-pong ball, and an ounce of cheese is the size of four dice. It’s a bit of a learning process, but you’ll get to a point where you know how big a serving size is.

Strategy 4: Consider nutrition
Whichever meal-planning tools you use, keep in mind the basic nutritional recommendations that everyone should follow. Aim to get a balance of carbohydrates, protein and fat at each meal, and pay attention to the source of these nutrients. Getting 50% of calories from carbohydrates, 20% from protein and 30% from fat is a good rule of thumb.

When it comes to protein, lean meat always trumps fattier cuts because it has less saturated fat, which can raise your cholesterol and put you at risk for heart disease and stroke. When you’re considering carbs, whole grains and fruits are better than refined grains, fruit juice or fruit in syrup. Low-fat dairy is a better source of protein than the full-fat variety, so stick with skim or 1% milk and cheese, and low-fat or nonfat yogurt.

And monounsaturated fats, like those found in olive oil, canola oil and avocados, are better for your heart than the saturated fats found in butter, red meat and full-fat cheese.

Strategy 5: Keep learning
If you haven’t decided on your ideal approach to eating, here are a couple of options:

The exchange system helps people balance their diet by controlling the number of carbohydrates as well as calories in a meal. Foods are grouped into categories with similar nutrient content — such as starches, carbohydrates, nonstarchy veggies, fruits, fats and meat. Within each group, you can exchange one item for another because all foods in that category have roughly equal carbs, fat, protein and calories.

Another tool is the glycemic index (GI), which measures how quickly carbohydrates raise blood glucose. Foods with a high GI raise glucose levels faster than those with a low GI do. Two foods may contain the same number of carbs but have different glycemic indexes. For example, a potato with 15 grams of carbs might raise your blood glucose quicker than an apple with 15 grams of carbs.

Whatever approach you choose, remember that a meal plan isn’t about dieting — it’s a lifestyle change. Enlist the help of a dietitian to better understand which foods are the most nutritious.

This low-sugar fruit cuts your risk of diabetes and high blood pressure

Two new studies add to the growing body of research about the many health benefits of consuming blueberries. Researchers from Pennington Biomedical Research Center (PBRC) have found that blueberries help to prevent obesity-related insulin resistance, which leads to type 2 diabetes, while researchers from Oklahoma State University (OSU) have found similar success in using blueberries to prevent hypertension.

Published in the October issue of The Journal of Nutrition, the PBRC study found that obese participants who consumed blueberry-rich smoothies twice a day for 42 days experienced an increase in insulin sensitivity compared to participants who consumed an equally nutritious, but blueberry-free, smoothie twice a day for the same time period.

None of the participants had diabetes at the time of the study, but the blueberry compounds appeared to actually regulate the obesity-related insulin factors that are implicated in causing pre-diabetes and diabetes.

"We now know that compounds in blueberries may help obese, non-diabetic individuals maintain healthy blood glucose levels," explained Dr. April Stull, a researcher at PBRC.

In the OSU study, which was also published in The Journal of Nutrition, researchers observed that patients with pre-hypertension -- that is, elevated blood pressure levels that are not quite at full hypertension levels -- responded well to drinking a beverage once a day for eight weeks that contained two cups of blended blueberries.

According to Arpita Basu, professor of nutritional sciences at OSU and author of the study, the blueberry group saw an average drop of seven-to-eight points in systolic blood pressure by the end of the evaluation period.

"Many patients rely too heavily on medication to help control blood glucose," explained Basu. "A diet that includes blueberries is a component of a healthier lifestyle that also includes diet and exercise."

Stem cell cure for diabetic blindness

AstraZeneca and UCL researchers look to use stem cells to repair eyesight in rising number of diabetic retinopathy patients.

AstraZeneca and University College London (UCL) will announce a research partnership tomorrow to develop medicines that use stem cells to repair damaged eyesight in people with diabetes.

Under the three-year deal funded by the drugmaker, researchers from AstraZeneca will team up with scientists at the UCL Institute of Ophthalmology to work on new medicines that use the regenerative capacity of stem cells. They hope to come up with a compound in three to five years, which could then undergo clinical development and possibly be on the market in 10 years' time.

Dr Marcus Fruttiger of the UCL Institute of Ophthalmology, who is leading the project, said: "These tools could be used either to manufacture transplantable material or to directly stimulate new cell growth in the eye to help restore or improve the vision of those with diabetic retinopathy [DR]."

DR is now the most common cause of vision impairment or blindness among western people of working age. The majority of patients with type-1 diabetes, which occurs when the body produces no insulin and often develops during the teenage years, will suffer eyesight problems and about 20%-30% will become blind. Moreover, at least 50% of patients with type-2 diabetes – the far more common type of diabetes, which occurs when the body produces too little insulin or when cells in the body do not react properly to insulin – will also develop retinopathy over time.

With the rapid spread of type-2 diabetes, which is linked to obesity, the need for a retinopathy treatment will grow as more than 438 million people are expected to suffer from diabetes by 2030. A study published this year by Oxford University predicted that eight out of 10 men and almost seven in 10 women will be overweight or obese by 2020. It forecast a 98% rise in obesity-related diabetes by 2050.

Alan Lamont, director of sciences and technology alliances at AstraZeneca. said: "We're getting very keen on the whole area of regenerative medicines and they will be part of our research development over the next few years." He said the collaboration aimed to come up with a treatment that could be administered to the back of the eye to repair damage locally.

AstraZeneca's US rival Pfizer also has a partnership with Professor Pete Coffey of the UCL Institute of Ophthalmology, for another eye condition, macular degeneration. Coffey said: "It's great that 'Big Pharma' is considering regenerative medicines as a serious possibility." He added: "This is British science being developed into a commercial entity with the pharmaceutical industry. It's a good example why the government shouldn't cut funding for biomedical research."

While this is the first time that AstraZeneca has worked on medicine for retinopathy, diabetes has been an area of focus. The company has a new diabetes treatment on the market called Onglyza, which was developed with Bristol-Myers Squibb, and the companies are developing a second diabetes drug that could be submitted to regulators for approval later this year.

Short sleepers at risk of diabetes

A new research has suggested that people who sleep less than six hours a night may be three times more likely to develop a condition which leads to diabetes and heart disease.

A study by a team of researchers from Warwick Medical School and the State University of New York at Buffalo has found short sleep duration is associated with an elevated risk of a pre-diabetic state, known as incident-impaired fasting glycaemia (IFG).

IFG means that your body isn’t able to regulate glucose as efficiently as it should. People with IFG have a greater risk of developing type 2 diabetes and are at an increased risk of heart disease and stroke.

The researchers looked at six years of data from 1,455 participants in the Western New York Health Study.

All participants were aged between 35 and 79 years old and all completed a clinical examination that included measures of resting blood pressure, height and weight. They also completed questionnaires about their general health and wellbeing and sleeping patterns.

The study has been published in the Annals of Epidemiology journal.

Fish oil works against diabetes

Researchers at the University of California, San Diego School of Medicine have discovered why eating fish may be a great idea to ward off chronic inflammation and insulin resistance.

Jerrold Olefsky and colleagues identified a key receptor on macrophages abundantly found in obese body fat. Obesity and diabetes are closely correlated. The scientists say omega-3 fatty acids activate this macrophage receptor, resulting in broad anti-inflammatory effects and improved systemic insulin sensitivity.

Obese fat tissue contains lots of these macrophages producing lots of cytokines, which cause inflammation and rising insulin resistance.

Olefsky and colleagues eventually narrowed their focus to a G-protein receptor called GPR120, which is found only on pro-inflammatory macrophages in mature fat cells. When the receptor is exposed to omega-3 fatty acids, it is activated and generates a strong anti-inflammatory effect.

"The omega-3 fatty acids switch on the receptor, killing the inflammatory response," said Olefsky

"Our work shows how fish oils safely do this, and suggests a possible way to treating the serious problems of inflammation in obesity and in conditions like diabetes, cancer and cardiovascular disease through simple dietary supplementation," he added.

However, it's not clear how much fish oil constitutes a safe, effective dose. If too high, it could up the risk of to increased risk of bleeding and stroke in some people.

 

Eating more leafy greens may stem diabetes risk

Conducted by researchers from the University of Leicester and the University Hospitals

of Leicester NHS Trust, the study found that eating 1½ additional servings of spinach and other leafy veggies a day can cut down the risk of developing the diseases by almost 14 percent.

Conducted by researchers from the University of Leicester and the University Hospitals

of Leicester NHS Trust, the study found that eating 1½ additional servings of spinach and other leafy veggies a day can cut down the risk of developing the diseases by almost 14 percent.

Veggies like Spinach, arugula, broccoli, and kale contain high levels of antioxidants, vitamin C, and magnesium, which can help prevent several chronic ailments like cancer, cardiovascular diseases, and diabetes.

Details of the study
The study, funded by cardiovascular research department at the University of Leicester, looked at six different studies, which included 220,000 people.

While some studies had used questionnaires or interviews to gather information on people's usual diet, others had asked people what they'd eaten in the last 24 hours.

On analysis, the researchers found only a slightly lower risk of developing diabetes in participants who consumed high amounts of vegetables and fruits.

The drop was not significant enough and could have been just by chance.

However, on analyzing four other studies which specifically looked at the number of servings eaten by the participants, the researchers found that the ones who ate the maximum number of servings a day were at a 14 percent lower risk of diabetes as compared to those who ate the least.

Nevertheless, the study had some limitations. For example, the review looked at only six studies, and just four of these reported on intake of green leafy vegetables which is insufficient to prove the link between green veggies and diabetes.

Moreover, other diabetes influencing factors in the participants, such as their age, their body mass index (BMI), and their family history of type 2 diabetes, were ignored by the researchers.

The report was published in the British Medical Journal (BMJ), which is owned by the British Medical Association.

Word of advice
Consuming at least 5 servings of fresh fruits and vegetables each day is essential for a healthy immunity system.

Options of green veggies include spinach, kale, lettuce, artichokes, brussel sprouts, and cauliflower.

The probability of developing type 2 diabetes is often closely tied to a person's lifestyle, particularly what they eat and how much they exercise.

Therefore, people with symptoms of diabetes (pre-diabetes) can substantially reduce their risk of the disease by exercising more, eating less fat, and eating more fruit, vegetables, and whole grains, advise researchers.

Study to check if garlic and asparagus can fight diabetes

Researchers are investigating whether foods including garlic and asparagus could help weight loss and diabetes. In news that could make ardent vegans and vegetarians feel a little smug, the charity Diabetes UK is examining whether foods rich in fibre could supress people's appetites and reduce their blood sugar levels.

Fermentable carbohydrates, a kind of fibre, are found in foods such as asparagus, garlic, chicory and Jerusalem artichokes. If the foods are found to have this effect it could revolutionise treatments to tackle obesity and type 2 diabetes. Recent research has suggested that foods high in fermentable carbohydrates are particularly good at stabilising blood sugar levels.

The three-year study by the Nutrition and Research Group at Imperial College London, aims to establish whether these carbohydrates cause the release of gut hormones that could reduce appetite and enhance insulin sensitivity, which could reduce blood sugar levels and help control weight. The carbohydrates will be given to participants in the study as a daily supplement.

Dietitian Nicola Guess, who is leading the study, said: "By investigating how appetite and blood glucose levels are regulated in people at high risk of type 2 diabetes, it is hoped that we can find a way to prevent its onset. Type 2 diabetes accounts for 90% of diabetes cases and, if left untreated, can lead to serious health complications including heart disease, stroke, blindness, kidney failure and amputation, according to Diabetes UK.

Dr Iain Frame, the charity's director of research, said: "It is unlikely that any single measure used on its own will bring about improved prevention of type 2 diabetes. But it's hoped that the research being funded at Imperial College will help by aiming to develop an easy and affordable way to help people to reduce their risk of developing type 2 diabetes and managing their blood glucose levels."

Specialist diabetes care 'vital'

Getting treatment from a foot specialist, or podiatric physician, can significantly reduce the chances of amputation in diabetes sufferers, a study has revealed.

The research found that care by a podiatric physician was associated with a near-15% lower risk of amputation and 17% lower risk of being admitted to hospital.

The study, which defined treatment by a podiatric physician as at least one visit to a specialist before diagnosis of a foot ulcer, examined records for almost 29,000 patients with diabetes between the ages of 18 to 64.

It compared health and risk factors for those who had seen podiatrists to those who had not.

Dr Wrobel said: "More than half of all amputations are related to diabetes. Podiatrists are detecting conditions that can lead to amputation. That's just what we do."

Lead researcher Teresa Gibson, PhD, director of Health Outcomes research at Thomson Reuters said: "We statistically matched patients with diabetes and foot ulcers who had visited a podiatrist with like patients who had not.

"Patients who had seen a podiatrist in the year prior to the onset of a foot ulcer had significantly lower rates of any amputation and hospitalisation than those who had not."

MIT diabetes device monitors glucose with light

 Imagine simply shining a light on your skin to determine how much sugar is in your blood. Researchers at MIT are developing a glucose-monitoring device for diabetes patients that may help do away with finger pricks.

By scanning a user's arm or finger with near-infrared light, the device frees users from the necessity of drawing blood, a daily routine for most type 1 diabetes patients.

The laptop-size machine is the result of 15 years of research at the MIT Spectroscopy Lab. It employs Raman spectroscopy, which can determine chemical compounds based on their molecular vibration.

In a technique described in an Analytical Chemistry paper, the researchers fire near-infrared light into the skin. It only penetrates about half a millimeter, reaching the interstitial fluid surrounding skin cells, but not the blood itself.

While glucose is represented in the interstitial fluid, there's a delay of up to 10 minutes between the time it spikes in the bloodstream (after someone consumes sugary food, for example) and the time it surges in the fluid.

The researchers developed an algorithm that lets them predict blood glucose based on measurements of interstitial fluid glucose, as well as a calibration method that takes into account the rate at which glucose hits the fluid.

The team has done a small study on human volunteers, and plans another study this fall. The effort is one of many using techniques such as spectroscopy and ultrasound to check glucose without breaking the skin. Earlier this year, in fact, MIT engineers also announced work on designing carbon nanotubes that can be injected beneath the skin to reveal continuous blood glucose levels in real time--kind of like a high-tech tattoo.

Shocking study: India to spend $32bn on diabetes care in '10

A study on the financial burden of diabetes on the common man in the country has found that 60% of diabetics — irrespective of their socio-economic status — pay for the expenditure incurred for treatment and management of the disease from their personal savings.

The study, "The Socio-economics of diabetes from a Developing Country: A Population based Cost of Illness Study", conducted by the MV Hospital for Diabetes and Diabetes Research Centre in Chennai, says the next common method of payment was by selling, mortgaging immovable assets or taking loans with interest rates as high as 39%.

The situation is especially grim for those patients whose monthly income is Rs 10,000 or less. Around 60% of them borrow, mortgage or sell their property just to keep their blood sugar level under control. While among the rest, around 27% have simply no option but to finance their treatment while dipping into their savings.

Those with a monthly income between Rs 10,000 and Rs 30,000, 72% pay from their savings, and 11.7% take loans to pay for their treatment.

Published in the "Diabetes Research and Clinical Practice" — the official journal of the Internal Diabetes Federation (IDF) — the study reveals that 81% of the higher income group pay their medical bills from their personal savings. Though health insurance coverage was observed only among the high income group, the figure stands at a paltry 2%.

With a sample size of 4,677 — of which 1,050 had diabetes — the study makes an in-depth finding into the financial burden. On an average, a diabetic in India spends Rs 25,931 annually on diagnosis and treatment of the ailment, and its attendant complications. It includes costs for routine lab investigations, physicians, ambulances, inpatient or outpatient care, medication and transport.

The patient also spends nearly Rs 5,000 as indirect cost annually in the form of lost mandays while making rounds to hospitals for treatment. Extrapolating the figures, the study claims that the nation will spend a whopping $31.9 billion this year on diabetes care.

"Keeping the diabetes explosion in the future in mind, this heavy economic burden highlights the urgent need for the decision makers to allocate resources for planning and implementing strategies in prevention and management of diabetes and its complications," the finding points out. According to the latest edition of IDF Atlas, an estimated 50.8 million will be affected by diabetes in 2010 in India alone.


 

Diabetes prevention could improve the lives of millions

09^th August 2010

Tackling depression and diabetes, as well as increasing intake of fruit and vegetables, could hold the key to reducing the number of dementia cases, according to a study.

The research, published in the BMJ, selected a group of 1,400 elderly people, testing them for signs of dementia after two, four and seven years.

British and French researchers also recorded weight, height, monthly income, alcohol consumption, education level, tobacco use, mobility and dietary habits, as well as giving participants a reading test as a measure of intelligence.

They estimated that eliminating diabetes and depression, as well as increasing fruit and vegetable consumption, could lead to an overall 21% drop in new cases of dementia.

If the main known genetic risk factor for the disease was also tackled, 7% more cases could be prevented.

Professor Clive Ballard, director of research at the Alzheimer’s Society, said: “Effective prevention of diabetes, depression and heart disease could potentially improve the lives of millions of people affected by this cruel condition and reduce the billions spent on dementia care each year.”

Know when to check for diabetes

05^th August 2010

Many people wonder: When should I have a blood sugar test done to screen for diabetes? And how often? How significant is having a relative with diabetes? What if a person is overweight?

Diabetes is one of the most common chronic illnesses in adults. It can be present for many years without causing symptoms. Unfortunately, poor control of the blood sugar in these years before it is discovered can lead to irreversible damage to the kidneys, eyes, heart and blood vessels. Because of this, screening for diabetes is an excellent idea.

The incidence of diabetes increases with age and becomes quite common in older age groups. It is also increasing in younger age groups, even teenagers.

In young adults with no symptoms, a test every couple years may be appropriate. As a person grows older, it is wise to check the blood sugar at least once a year, especially if a person is overweight or if there is a family history of diabetes.

If you have any symptoms of diabetes, such as increased thirst, frequent urination, weight loss, blurred vision, fatigue or a dry mouth, the blood sugar should be checked promptly. If it is normal, it should be repeated in a few days or weeks; the blood sugar is constantly changing and may have been drawn at a time it was in the normal range. Likewise, a single abnormal test does not prove that you have diabetes, and it too must be evaluated further.

The best time to check the blood sugar is in the morning after fasting 12 hours. There is also a blood test that can detect if the blood sugar has been too high over the last few months.

Future of mHealth: texts to keep diabetes in check

04^th August 2010

 On July 30, Nationwide Children's Hospital in Ohio, USA outlined an ongoing pilot study that uses texting to keep diabetic youth on track with their meds, an example of mHealth or mobile health.

"This form of communication allows for real-time health management which is extremely valuable for patients that suffer from a chronic illness like diabetes," explained Jennifer Dyer, MD, MPH, an endocrinologist and principal investigator in the Research Institute at Nationwide Children's Hospital.

Dyer noted, "If adolescent diabetes patients do not adhere to their treatment and medication plan, it can result in difficulty concentrating in school or functioning throughout the day."

"One in three teens sends more than 100 text messages a day, or 3000 texts a month," according to a 2009 survey by the Pew Research Center's Internet & American Life Project published in April 2010.

Dyer found that her "weekly, customized text messages to remind adolescent diabetes patients about their personal treatment activities" increased "overall treatment adherence and improved blood glucose levels."

The texts included "personalized questions and reminders" addressing "glucose testing, meal boluses [insulin treatments] and frequency of high and low glucoses" plus Dyer also sent "friendly, supportive messages" to patients resulting in an increase in teens taking their meds. 

"Excellent control and treatment can have a long term positive effect on a patient with diabetes," said Dyer. "The rate of medication non-adherence among adolescent recipients is approximately four times higher than that among adult recipients."

The study thus far has shown a jump in compliance and Dyer is working on an iPhone application that will allow endocrinologists worldwide to send automated "personalized" texts to numerous patients at a specific time.

Numerous Adult Stem Cell Studies For Heart, Diabetes, MS

03^rd August 2010

 Dr. Thomas Einhorn, Chairman of Orthopedic Surgery at Boston University Medical Centre, whose patient had a broken ankle that would not heal, despite multiple surgeries, took help from the man’s own body. Using a needle, he drew bone marrow from the man’s pelvic bone, and condensing it he then injected the four teaspoons of rich red liquid into his patient’s ankle.

Four months later, the man’s broken ankle had healed, which Einhorn credits to adult stem cells in the marrow injection, which he tried because of published research from France.

While, his experience is not a rigorous study, however, it is an example of the many innovative adult stem cells therapies doctors are studying. Typically, adult stem cells are taken from bone marrow and blood, without destroying embryos.

Over a decade ago, an emotional debate over the use of embryonic stem cells began, however, it is adult stem cells that are being tested today, revealing a wide range of potential treatments.

Researchers are studying adult stem cells in people suffering from multiple sclerosis, heart attacks and diabetes. Early research indicates leg amputation can be avoided in some patients, including restoring vision to patients’ eyes damaged by chemicals.

Apart from this, one of the great success stories of stem cell biology is that adult stem cell transplants have become a standard lifesaving therapy for people with leukaemia, lymphoma and other blood diseases, and are also used to grow skin grafts.

The same promise was long held out for embryonic stem cells, first isolated and grown in a lab dish in 1998. However, controversy over their use saw former President George W. Bush restricting federal funding for stem cell studies in 2001.

Former first lady Nancy Reagan, actors Michael J. Fox and the late Christopher Reeve have supported the therapy opponents object to, because harvesting the cells involves the destruction of human embryos.

Someday, embryonic cells could be used for growing replacement tissue for diseases, such as, Parkinson’s or diabetes, but that is in the future.

As a treatment for heart attacks, studies show stem cell injections help the heart pump blood better, though research has not yet determined whether the injections reduce the risk of death, more heart attacks or future hospitalizations.

Researchers are also studying critical limb ischemia, another heart related condition wherein a blockage in the artery restricts blood flow to the leg, causing pain and perhaps amputation. The aim of injecting stem cells into the leg is to encourage new blood vessels to grow. The limb ischemia research is moving fast and the results have been very encouraging, indeed.

In multiple sclerosis, the body’s own immune system attacks the brain and spinal cord tissues, causing numbness in the limbs, paralysis or vision loss. However, in a small trial last year, Dr. Richard Burt of Northwestern removed stem cells from a patient’s blood and destroyed their immune systems. He then re-injected the patient with his own cells to build a new immune system. To his great surprise, most of the patients actually improved.

Dr. Jeffrey Cohen of the Cleveland Clinic is also trying, albeit a different and less researched approach, wherein a different kind of stem cell is taken from patients’ marrow, which he hopes will not only slow nervous system damage, but also promote repair. This research may eventually lead to clues for treating other conditions like Parkinson’s or spinal cord injury.

However, while this rebooting strategy has allowed patients of Type 1 diabetes to go for four years without insulin, experts call this approach too risky. Stem cell transplant therapy is also being studied for treating cancer, such as, melanoma and kidney cancer.

Researchers Develop Wireless Glucose Monitor for Diabetics

02^nd August 2010 

Bioengineers have developed an implantable wireless monitor for diabetics that can measure glucose levels continuously for up to a year before needing replacement.  The device, if approved by federal regulators, would give diabetics a more reliable and less painful alternative to current glucose monitoring devices.

The glucose monitoring system is designed to be implanted just under the skin, where it automatically measures glucose or blood sugar levels and transmits the data to an external receiver.  The device, a small disc about 38 millimeters across and 16 millimeters thick, could be substituted for painful finger-stick devices and implanted needle-like sensors that monitor glucose levels continuously, but need to be replaced every three to seven days.

Diabetics have difficulty maintaining healthy blood glucose levels because they cannot produce enough of the sugar-processing hormone insulin -- a condition called Type 1 or juvenile diabetes -- or because the insulin they do produce is unable to properly convert dietary glucose into energy - a condition known as Type 2 or adult-onset diabetes.

Large studies have shown that strict blood sugar control, through continual glucose measurements and adjustment when blood sugar levels get too high or too low, reduces the risk of diabetic complications, including kidney, eye and heart disease.

Bioengineer David Gough of the University of California, San Diego is lead author of the study describing the new monitoring system and its successful performance in animal tests.  

Gough says the sensor would allow diabetics to keep a much closer eye on their blood sugar levels than conventional methods. "So they could adjust the insulin or exercise, diet or other therapy and better manage their diabetes.  So this device would be implanted subcutaneously for long periods of time, say a year or more," he said.

The monitor is made up of two oxygen sensors. One contains an enzyme catalyst called glucose oxydase that triggers a chemical reaction in proportion to the amount of oxygen consumed by sugar in the interstitial fluid beneath the skin.

The second sensor reads the amount of oxygen from the first sensor and compares it to a reference level, producing a blood glucose reading.

Gough says the dual sensors could be implanted during a simple outpatient procedure, at the waist or lower abdomen, or just below the collar bone, where heart pacemakers are often located.

The bioengineer says the readings would be sent wirelessly to a receiver outside the body. "You could have the receiver attached to your belt or it might ultimately be a cell phone or something like that," he said.

The wireless glucose monitor would guard against one of the most dangerous aspects of diabetes - hypoglycemia, a condition in which blood sugar levels fall very low.  It is especially dangerous, Gough says, if the condition develops while a patient is asleep. "Those people are under an immediate concern because they can lose cognitive ability and have an accident or something.  So this device would warn when glucose was too low as well.  And both of those things - both the short term problems of diabetes and long term problems of diabetes - could, in principal, be ameliorated," he said.

Gough says the glucose sensors could be used to send a cell phone wake-up call to parents of diabetic children if their child's glucose level dropped dangerously low during the night.

Researchers say their goal is to create a closed-loop system in which the wireless monitor continuously measures blood glucose and an external insulin pump automatically adjusts the amount of insulin being administered.

Gough says researchers hope to begin human clinical trials of the glucose monitor within the next few months and to gain federal regulatory approval soon after that.

An article describing the wireless blood sugar monitor is published in the journal Science Translational Medicine.

Diabetes costs out of control  

30^th July 2010

The NHS is spending too much on diabetes drugs say researchers, who found the medicines account for 7% of the UK prescribing budget.

A big rise in the number of people with type 2 diabetes in recent years does not fully explain the spiralling costs, say Cardiff University researchers.

With rates of the condition expected to rise further, the NHS needs to get the budget under control, they conclude.

But GPs said they had to look out for the best interests of their patients.

In 2008 the NHS spent £700m on drugs to control blood sugar, figures show.

The researchers calculated that between 2000 and 2008 the number of prescriptions for glucose-lowering drugs had risen by 50%.

But costs, even taking into account the price of inflation, rose by 104%, they said.

Writing in the journal Diabetic Medicine, they said figures for England specifically show an increase from £290m to £591m over the study period.

Researchers pointed to marked increases in use of the most expensive therapies.

Newer drugs, like rosiglitazone, as well as increasing use of insulin - the hormone that controls blood sugar levels in the body - have contributed to the increased costs, they said.

Lifestyle

Dr Chris Currie said the findings suggested that national guidelines are not being followed.

The National Institute for Health and Clinical Excellence recommends lifestyle changes as a first-step in controlling type 2 diabetes, before drug treatment is started.

GPs should then start people on the basic treatments before looking at other options if they do not work.

The researchers said in recent years the new expensive treatments had been aggressively marketed by drugs companies.

However, the figures also showed a dramatic rise in use of metformin - a cheap generic drug recommended as first line treatment - which the researchers said was reassuring.

It is thought that 2.6m people in the UK have diabetes - 90% of those type 2 diabetes - and a further one million have the condition but have not yet been diagnosed.

"The drugs bill is extremely high," said Dr Currie.

"Somebody has got to take a lead in managing the way we treat people with diabetes and making sure doctors adhere to the recommendations.

"This is going to continue to rise and part of the issue is people don't realise how big the problem is."

But Dr Niti Pall, a GP in Birmingham and spokesperson for Diabetes UK said she did not agree with the authors' conclusions.

She said the job of GPs was to get blood sugar levels as low as possible by whatever means possible to prevent complications in their patients.

"They have not looked at the health economics, we are saving the NHS money in the long run.

"We need to do whatever it takes to get blood sugar down and some of the cheaper drugs don't do the job."

Are you a diabetes timebomb?

27^th July 2010

If you’re slightly overweight, you could be one of a million Britons with undiagnosed diabetes.

The consultant was an expert in his field, with the air of a man who knew what he was doing.

So when Robert Carew-Hunt was told his grossly swollen legs were a sign of lymphedema - a build up of fluid caused by damage to the lymph system, he accepted the diagnosis and was discharged from hospital with a packet of support stockings to reduce the swelling.

Unfortunately, the specialist was wrong. The swelling was, in fact, a sign of undiagnosed diabetes. and although Robert went on to display other, classic symptoms - such as an ulcer on his big toe that wouldn't heal - a succession of clinicians missed the signs, so that by the time his diabetes was finally diagnosed eight months later, Robert had suffered serious tissue damage.

He has since had two toes amputated on his right foot and has charcot foot in his left - an excruciatingly painful degenerative bone condition caused by high blood-sugar levels damaging blood supply and tissues. It ultimately leads to chronic deformity.

'It has been a long road to be able to walk at all since losing my toes, and I'm still in a lot of pain,' he says.

'I'm not a vengeful person by nature. But I'm frustrated and angry that I was seen by so many medics and yet for months not one suspected diabetes.'

His condition meant that Robert, then in his early 50s, had to take early retirement from his job in the civil service. 

This is by no means an isolated case - indeed misdiagnosis and misunderstanding about the signs and risk factors for diabetes mean more people than ever are undergoing amputation.

And the fear is that the numbers are only going to rise, with an estimated one million Britons living with undiagnosed type 2 diabetes, according to a new report just published by the charity Diabetes UK.

This is twice as many as previously thought, and is largely due to obesity and unhealthy lifestyles.

Type 2 diabetes is caused by the body's inability to produce enough of the hormone insulin - or the insulin that is produced is not working properly (known as 'insulin resistance').

This is because abdominal fat is thought to release a protein which prevents insulin from mopping up excess sugar in the blood.

No warning: Gail Wellings had to have a leg amputated

Unlike type 1 diabetes, type 2 can go undetected for up to a decade or longer as symptoms can be gradual - in around half of cases diagnosed, patients are already showing signs of the complications of the condition, such as nerve pain and sight problems, without having any obvious symptoms of the condition itself (such as excess thirst or passing more urine than normal).

Every week in the UK around 100 diabetes patients have a limb amputated because of complications. The problem is that untreated or poorly managed diabetes damages the nerves in the feet - a side-effect known as diabetic neuropathy.

This reduces sensation, so patients are unaware if they cut or damage their foot. and because diabetes also affects blood flow to the extremities (high sugar levels damage small blood vessels), it's harder for sores and wounds to heal. Left untreated, within just weeks even a minor foot injury such as a blister can quickly become a serious infection - leading to tissue death (gangrene).

As well as amputation, diabetics are at higher risk of heart disease, stroke, kidney failure, and blindness.

Given the risks, why are so many people going undiagnosed? Part of the problem is that medics sometimes simply overlook the obvious, says Dr Brian Karet, a GP specialising in.

'It's a statistical fact that overweight people seem to come to the doctor for one reason or another - coughs, colds, infections - far more frequently. Being overweight can lead to diabetes and doctors should seize on the opportunity to offer these patients a blood glucose test.

'As well as asking these patients about the classic symptoms, they need to question them about subtle signs such as recurrent thrush, poor concentration and lack of libido.

'Doctors and nurses need to be tuned into these symptoms and question patients - but some are not: there simply isn't enough awareness.'

As a result, patients are left to develop unnecessary but life-altering complications.

It seems likely that Robert Carew-Hunt, who lives in Wimbledon, first developed type 2 diabetes three years before his legs started swelling when he began to often feel faint and thirsty. At 6ft 5in and weighing 18 stone he wasn't excessively overweight, though he had a sweet tooth.

'Being a typical man I didn't bother going to the doctor - and diabetes certainly didn't cross my mind.' he says. 'I never ate breakfast and I remember nearly fainting one morning on the way to work - though I felt better after eating something. I was downing endless fizzy drinks but they never seemed to quench my thirst.'

Thirst is a classic symptom of the condition as the excess sugar in the blood leaks into the urine and the kidneys have to work harder, causing dehydration.

'I became aware of a loss of sensation in my feet - just a sort of numbness, but nothing drastic. I thought it was one of those things, possibly from having a sedentary job.' About two years later he was admitted to hospital when his legs suddenly swelled considerably - 'which was uncomfortable and a little alarming', he recalls. 'I was taken first to the fracture clinic and then my X-ray was passed to the specialist who diagnosed lymphoedema.' The correct diagnosis was made a year later after Robert developed the ulcer on his right big toe which wouldn't heal and became increasingly infected.

He saw a succession of nurses at his local health centre as they dressed the wound. But it wasn't until three months later that one, concerned by how long the ulcer was taking to heal, tested his blood glucose levels.

In healthy people the reading is around four to eight; Robert's was 27 - dangerously high.

'I was staggered since I knew nothing about diabetes,' says Robert. 'I immediately saw my GP, who put me on a regimen of healthy eating - no sugar and limited carbohydrate.'

He was also referred to the local hospital diabetes clinic. When the doctors saw his toe, they told Robert the damage was so extensive, it would have to be amputated.

'All I could think of was, would I be able to walk again,' he says. 'although they reassured me I would, they then said my diabetes had started to damage other tissues, and a few months later I lost another toe on the same foot.'

Diabetes UK estimates that up to 85 per cent of all diabetic amputations could be prevented by keeping blood glucose levels under control.

But it's not simply that medics are not spotting the signs. Sometimes there are no signs, as Gail Wellings discovered, when she fell on a kerb, cutting the big toe on her right foot.

Although she wasn't in pain, the toe became increasingly red and the cut failed to heel.

After three weeks, she decided to see her doctor. 'I'll never forget the expression on his face,' says Gail. 'He took one look at my toe and said: "Oh no, Gail, you are going to lose your foot." I couldn't believe it.'

Gail, a secretary from High Wycombe, Bucks, was sent to A&E where, after a day of blood tests and X-rays, she was a told that even though it was just her toe that had been injured, she had no circulation in her lower leg and before long those tissues would become gangrenous, too.

There was no real choice but for her to have a below- knee amputation.

'It was a nightmare,' she says. 'One moment it was my foot. Now it was my lower leg. I was absolutely stunned because everything happened so quickly.

'I kept thinking, my life is over, I won't be able to play tennis, to run, to get around. But what amazed me was that when I came round from the operation I was told the cause was Type 2 diabetes.'

What so perplexed her was that she'd had no other symptoms. 'But now, with the benefit of hindsight I can see why I might have been a candidate for the condition,' she says. 'I was 56 at the time [the risks increase with age] and 2st overweight. Doctors guessed I'd been diabetic for around four or five years, which is why the damage was so great. It was the most horrible, horrible time of my life.'

Gail was discharged from hospital-after eight days and now has a prosthetic lower leg. She spent a year on insulin injections until her blood sugar was stable enough to be controlled through diet and medication.

Her shocking story highlights the need for doctors and patients to know the risk factors as well as the symptoms, says Dr Brian Karet. These include being overweight or having a large waist measurement (more than 31.5in for women and 37in for men). Being over 40 is another risk factor.

Meanwhile, Diabetes UK wants better access to diabetes specialist care. As Cathy Moulton of the charity explains: ' Specialist nurses play a vital role in diabetes care and management and unfortunately, this kind of care is patchy in the UK.

'NHS providers must prioritise the delivery of effective and efficient integrated care, where competent primary and specialist teams can work together to support people with diabetes to self-manage their condition.

'Diabetes is one of the biggest health challenges facing the UK today and it is getting bigger.'

And Gail says: 'I wouldn't want anyone to go through what I've been through. Early action and awareness are critical.'

Robert Carew- Hunt adds: 'Doctors need to consider not only the obvious, but also the subtle side-effects.

'I suppose that I lost "only" two toes, though I have terrible pain from the bone deformity in my other leg. I had diabetes for over two years before it was diagnosed and I've no idea what those lost years could yet do in terms of other potential complications.

'It's just not necessary for anyone else to go through this.'

HOW TO SPOT THE WARNING SIGNS

RISK FACTORS

If you have two or more of the following, see your GP for a simple blood test.

• A waist measurement of 31.5in (80cm) or more for women; 37in (94cm) or more for men. 
• Being overweight. 
• Having a close family member, ie parent or sibling, with Type 2 diabetes.
• Being black or of South Asian origin.

CLASSIC WARNING SIGNS

• Passing urine more often than usual, especially at night. 
• Increased thirst. 
• Extreme tiredness. 
• Unexplained weight loss. 
• Genital itching or regular episodes of thrush. 
• Slow healing of cuts and wounds. 
• Blurred vision.

For many, the first signs of diabetes are symptoms caused by complications. So also watch out for the following:

• Impotence and erectile dysfunction. 
• High blood pressure. 
• Poor circulation to the legs and feet. 
• Gum disease.

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