There are a lot of claims made about cures for diabetes. Some are just scams, some offer real hope. Find out which is which at another of my sites, Diabetes Cure. I obviously have no time for the scams, but you need to know about them, and the good stuff and the latest research can either get ignored or missed.
Get the latest at www.diabetescurereview.com.
Yes folks, I’ve now launched the membership site, with information, a community forum and structured learning programmes for people with diabetes and their families.
Check it out right now at www.diabetesdietdoctor.com.
A new report, The Link Between Local Food Environments and Obesity and Diabetes, just published by the California Center for Public Health Advocacy (CCPHA), has summarised and confirmed the results of the 2005 California Health Interview Survey (CHIS).
It shows a clear link between High Retail Food Environment Index (RFEI) scores and the amount of both obesity and Type 2 diabetes in a neighbourhood.
The RFEI is made by dividing the total number of fast-food restaurants and convenience stores by the total number of grocery stores and local produce vendors in the area, so reflects the proportion of people eating diets with less fruit and vegetables.
The average Californian has easy access to four times as many fast-food restaurants and convenience stores as grocery stores and produce vendors.
Obesity rates are 20 percent higher for Californians with RFEIs of five and above compared to those with RFEIs below three.
Diabetes rates are 23 percent higher for Californians with RFEIs of five and above compared to those with RFEIs below three.
Nearly half of Californians have three times as many fast food outlets as fresh food outlets near them.
Pretty shocking eh?
Although some people have contested results like this in the past, it seems fairly clear to me that high carbohydrate, high trans-fats diets are a sure-fire recipe for putting on weight. and developing diabetes.
DESIGNED FOR DISEASE: The Link Between Local Food Environments and Obesity and Diabetes. The California Center for Public Health Advocacy, PolicyLink and The UCLA Center for Health Policy. 2008.
One of the conclusions reached from The Efficacy of Self-MONitoring in newly diagnosed Type 2 diabetes (ESMON) study recently published online by the British Medical Journal (BMJ) was that the group allocated to more intensive self monitoring scored significantly higher for depression than the control group. This has also been found in other studies of self monitoring.
Well, maybe so, but in this study, just as in all the others, the approach to self monitoring was such that no real improvements in control were achieved. It’s no good getting people to do the tests without putting the appropriate amount of effort into making sure that they know what to do with the results. In this study, the triallists did give some thought to this, but still certainly not enough.
Because of this, there was no overall improvement in control as assessed by the HbA1C levels. My guess is that the patients were just disappointed in their lack of improvement. And I don’t blame them.
Self monitoring, putting the patients in real control of their condition, has the potential to transform their lives by giving them confidence and hope, and offering real benefits in terms of preventing or even reversing the progress of their condition. Some people figure out how to do it on their own. An awful lot more could do it if properly trained.
BMJ, doi: 10.1136/bmj.39534.571644.BE (published 17 April 2008)
I have written before about the many factors that may contribute towards the development of diabetes, and here is some more evidence to support the idea that there may be many more types of diabetes than two.
A large study co-ordinated by the Broad Institute at MIT in collaboration with the WTCCC/UKT2D and the FUSION consortia have found 6 new single-nucleotide changes that are associated with Type 2 diabetes. These, along with the 8 genetic risk factors previously found by these groups adds to the number of genetic contributors to diabetes.
The collaboration between groups is vital to finding new gene changes, since much larger population samples can be studied to a level at which changes can be found. Below these numbers, significant changes can easily be missed. The differences identified in studies of this type are important guides, which can be used for animal studies to find out whether they might be clinically important in humans, and so offer hopes for completely or partially curative gene therapy.
Zeggini E, et al. Meta-analysis of genome-wide association data and large-scale replication identifies additional susceptibility loci for type 2 diabetes. Nature Genetics. doi:10.1038/ng.120.
In an international study of 839 obese patients with Type 2 diabetes, rimonabant produced significant wieght loss, a reduction in waist size and an increase in HDL (”good”) cholesterol levels, but did not lead to any significant change in percentage atheroma volume. There was a small effect on total atheroma volume, but this was not clinically significant. The drug was associated with a high level of psychiatric side effects, as it has done in previous trials, and it has now been withdrawn in the US for this reason.
Weight loss in diabetes remains problematic, but the answer still seems to lie in cutting energy intake, particularly of carbohydrates, and taking more exercise.
Nissen et al. JAMA. 2008;299(13):1547-1560. Published online April 1, 2008 (doi:10.1001/jama.299.13.1547).
A Study published recently in the Journal of the American Medical Association in patients with type 2 diabetes and coronary artery disease, treatment with Actos (pioglitazone) resulted in a significantly lower rate of progression of coronary atherosclerosis compared with glimepiride. The changes were small, however, and the variability of the results wide.
The results have been challenged by other researchers, and although this is interesting, it does not seem to me that this is likely to represent any sort of breakthrough. The studies are continuing though, and may help us understand the mechanisms of heart disease in diabetes rather better.
Nissen et al. JAMA. 2008;299(13):1561-1573. Published online March 31, 2008 (doi:10.1001/jama.299.13.1561).
Following the recent stopping of the Intensive control arm of the ACCORD study of patients with Type 2 diabetes because of an excess of deaths in this group, the investigators in the Australian ADVANCE study ran a preliminary analysis of their data, and found no increase in deaths in their Intensive control patients. This will come as a relief to any of you who were worried that tight control might actually be bad for you. There are some differences between the studies - the ADVANCE patients did not already have the same degree of cardiovascular risk factors as those in ACCORD, and the US patients were even more intensively treated with insulin.
So the message as far as I’m concerned still is - go for good control.
TW
I just came across a very interesting report in the Journal of the American Medical Association (JAMA) from January this year. This was a controlled trial of surgery (gastric banding) comared with conventional weight loss treatments in obese people with Type 2 diabetes.
The conventionally treated group lost less than 2% of their weight on average, although there was some improvement in their diabetes in those who lost more than 10%. The surgical group lost an average of more than 20% of their weight over the 2 year study period, and a stunning 73% of them had complete remission of their diabetes, with no serious complications of the surgery.
Strong evidence indeed that weight loss is the key to improving control in Type 2 diabetes, although it is disappointing that the results in the diet alone group were so poor and that they lost so little weight. The diet, however, was the usual “balanced” diet still usually recommended by dieticians for wieght loss, and I wonder what would have happenned if a low carbohydrate approach had been used. We can’t use gastric banding on everybody!
The reference is Dixon et al. JAMA Jan 23, 2008. Vol 299 No3. 316-323.
You will no doubt be seeing in the newspapers in the next few days that one part of the huge ACCORD trial in patients with Type 2 diabetes has been stopped because of an increased death rate in the group of people assigned to intensive blood glucose control. This is a great shock and no doubt will be taken by some people to indicate that good control of blood glucose may be a bad thing.
No single drug or set of drugs could be identified as being responsible for this, but it all the people in this group were receiving multiple treatments for the diabetes and many of them were using insulin as well as tablets. They did seem to have better blood glucose control in that the haemoglobin A1c levels were significantly lower than in the standard treatment group, but despite this more of them died during thestudy period than in the standard treatment group.
As ever, these results need to be viewed with some care. The group of people included in the study not only had had diabetes for an average of 10 years and were relatively old, but they also had poor control and known heart disease or at least two other risk factors. Although their death rate appeared to be higher in the intensive control group, the rate of non-fatal heart attacks was actually lower and there was no consistent cause of the excess of deaths.
Previous studies have suggested that lifestyle measures leading to better blood glucose control can slow the progress of the condition and reverse some of the complications so this result really does come as a surprise.
The first thing to say is that the results may be a statistical anomaly, which are not that uncommon in large trials of this type (remember the HRT trials?). The second is that it is not the lower blood glucose levels that are likely to be causing the deaths, but rather the treatments. Modern views of diabetes care (not yet promoted by either the American Diabetes Association or Diabetes UK) might say that most of the treatments, and particularly insulin in Type 2 diabetes may well cause more problems than they cure.
You will find a good discussion at: http://www.healthcentral.com/diabetes/c/5068/20145/study-whats/1/
If you want to look at the detail and see what the ACCORD study is all about you can find it at http ://www.nhlbi.nih.gov/health/prof/heart/other/accord/index.htm.
In the meanwhile DON’T CHANGE YOUR TREATMENT! Good glucose control matters.
Tony Woolfson